Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-345 - Ambulance Service Provider Access Payment Program (ASPAPP)

Current through Vol. 41, No. 20, July 1, 2024
(a)
Purpose.
The Ambulance Service Provider Access Payment Program
				  (ASPAPP) is an ambulance service provider (ASP) assessment fee that is eligible
				  for federal matching funds when used to reimburse SoonerCare services in
				  accordance with Section
				  3242.1 through
				  3242.6 of Title 63 of the Oklahoma
				  Statutes (O.S.).
(b)
Definitions.
The following words and terms, when used in this
				  Section shall have the following meaning, unless the context clearly indicates
				  otherwise:
(1)
"Air ambulance"
means ambulance services provided by fixed or rotor wing ambulance
				  services.
(2)
"Alliance"
means the Oklahoma Ambulance Alliance or its successor
				  association.
(3)
"Ambulance"
means a motor vehicle that is primarily used or
				  designated as available to provide transportation and basic life support or
				  advanced life support.
(4)
"Ambulance service"
or
"ambulance service provider
				  (ASP)"
means any private firm or governmental agency licensed by the
				  Oklahoma State Department of Health (OSDH) to provide levels of medical care
				  based on certification rules or standards promulgated by the Oklahoma state
				  Commissioner of Health.
(5)
"Emergency"
or
"emergent"
means a serious situation
				  or occurrence that happens unexpectedly and demands immediate action, such as a
				  medical condition manifesting itself by acute symptoms of sufficient severity
				  including severe pain such that the absence of immediate medical attention
				  could reasonably be expected, by a reasonable and prudent layperson, to result
				  in placing the patient's health in serious jeopardy, serious impairment to
				  bodily function or serious dysfunction of any bodily organ or part.
(6)
"Emergency transport"
means
				  the movement of an acutely ill or injured patient from the scene to a health
				  care facility or the movement of an acutely ill or injured patient from one
				  health care facility to another health care facility.
(7)
"Medicaid"
means the medical
				  assistance program established in Title XIX of the Social Security Act and
				  administered in Oklahoma by the Oklahoma Health Care Authority
				  (OHCA).
(8)
"Net operating
				  revenue"
means the gross revenues earned for providing emergency
				  transports in Oklahoma excluding revenues earned for providing air ambulance
				  services, non-emergency transports, and amounts refunded to or recouped,
				  offset, or otherwise deducted by a patient or payer for ground medical
				  transportation.
(9)
"Non-emergency transport"
means the movement of any patient in an
				  ambulance other than an emergency transport as defined in Part 33,
				  317:30-5-335.1.
(10)
"Upper payment limit"
means
				  the lesser of the customary charges of the ASP or the prevailing charges in the
				  locality of the ASP for comparable services under comparable circumstances,
				  calculated according to methodology in an approved state plan amendment for the
				  state Medicaid program.
(11)
"Upper payment limit gap"
means the difference between the upper
				  payment limit of the ASP and the Medicaid payments not financed using the ASP
				  assessments made to all ASPs, provided that the upper payment limit gap shall
				  not include air ambulance services.