reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › Section 182-546-0250 - Ambulance transportation- Noncovered services

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency does not cover
				ambulance services when the transportation is:
(a) Not medically necessary based on the
				client's condition at the time of service (see exception at WAC
				182-546-1000
				);
(b) Refused by the client (see
				exception for ITA clients in WAC 182-546-4100 through 182-546-4300 );
(c) For a client who is deceased at the time
				the ambulance arrives at the scene;
(d) For a client who dies after the ambulance
				arrives at the scene but prior to transport and the ambulance crew provided
				minimal to no medical interventions/supplies at the scene (see WAC
				182-546-0500(2)
				);
(e) Requested for the
				convenience of the client or the client's family;
(f) More expensive than bringing the
				necessary medical service(s) to the client's location in nonemergency
				situations;
(g) To transfer a
				client from a medical facility to the client's residence (except when the
				residence is a nursing facility);
(h) Requested solely because a client has no
				other means of transportation;
(i)
				Provided by other than licensed ambulance providers (e.g., wheelchair vans,
				cabulance, stretcher cars); or
(j)
				Not to the nearest appropriate medical facility.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › Section 182-546-0300 - Ambulance transportation- General requirements for ambulance providers

Current through Register Vol. 24-14, July 15, 2024
(1) Ambulances must
				be licensed, operated, and equipped according to applicable federal, state, and
				local statutes, ordinances and regulations. An air ambulance provider must have
				a current Federal Aviation Administration (FAA) air carrier operating
				certificate, or have a contractual relationship with an operator with a valid
				medical certificate.
(2) Ambulances
				must be staffed and operated by appropriately trained and certified personnel
				in accordance with chapter 18.73 RCW.
(3) Providers of ambulance services must:
(a) Meet the requirements of chapter 182-502
				WAC and this chapter; and
(b)
				Document the medical necessity for transportation and related services billed
				to the medicaid agency. This documentation must be kept in the provider's file
				and include adequate descriptions of the severity and complexity of the
				client's condition at the time of the transportation and services,
				interventions, and supplies provided to the client prior to loading and in
				transit. The documentation must be made available for the agency to review upon
				request to ensure the agency's medical necessity criteria are
				met.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › Section 182-546-0400 - Ambulance transportation- General limitations on payment for ambulance services

Current through Register Vol. 24-14, July 15, 2024
(1) In accordance
				with WAC
				182-502-0100(8),
				the agency pays providers the lesser of the provider's usual and customary
				charges or the maximum allowable rate established by the agency. The agency's
				fee schedule payment for ambulance services includes a base rate or lift-off
				fee plus mileage.
(2) The agency
				does not pay providers for mileage incurred traveling to the point of pickup or
				any other distances traveled when the client is not on board the ambulance. The
				agency pays for loaded mileage only as follows:
(a) The agency pays ground ambulance
				providers for the actual mileage incurred for covered trips by paying from the
				client's point of pickup to the point of destination.
(b) The agency pays air ambulance providers
				for the statute miles incurred for covered trips by paying from the client's
				point of pickup to the point of destination.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › Section 182-546-0425 - Ambulance transportation-During inpatient hospital stays

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				agency does not pay separately for ambulance transportation when a client
				remains as an inpatient client at the admitting hospital and the transportation
				to or from another facility is for diagnostic or treatment services (e.g., MRI
				scanning, kidney dialysis). Transportation of an inpatient client for such
				services is the responsibility of the admitting hospital, regardless of the
				payment method the agency uses to pay the hospital.
(2)
Hospital-to-hospital
				transfers.
Except as provided in subsections (3) and (5) of this
				section, the agency does not pay for hospital-to-hospital transfers of a client
				when ambulance transportation is requested solely to:
(a) Accommodate a physician's or other health
				care provider's preference for facilities;
(b) Move the client closer to family or home
				(i.e., for personal or family convenience); or
(c) Meet insurance requirements or
				hospital/insurance agreements.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › Section 182-546-0450 - Ambulance transportation-Ground ambulance-Payment

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency pays for two levels
				of service for ground ambulance transportation: Basic life support (BLS) and
				advanced life support (ALS):
(a) A BLS
				ambulance trip is one in which the client receives basic, noninvasive medical
				services at the scene , point-of-pickup, or in transit to a hospital or other
				appropriate treatment facility.
(b)
				An ALS ambulance trip is one in which the client requires more complex
				life-saving services at the scene , point-of-pickup, or in transit to a
				hospital or other appropriate treatment facility. To qualify for payment at the
				ALS level, certified paramedics or other ALS-qualified personnel must provide
				the advanced medical services on board a properly equipped vehicle as defined
				by chapter 18.73 RCW. Examples of complex medical services or ALS procedures
				include, but are not limited to, the following:
(i) Administration of medication by
				intravenous push/bolus or by continuous infusion;
(ii) Airway intubation;
(iii) Cardiac pacing;
(iv) Chemical restraint;
(v) Chest decompression;
(vi) Creation of surgical airway;
(vii) Initiation of intravenous
				therapy;
(viii) Manual
				defibrillation/cardioversion;
(ix)
				Placement of central venous line; and
(x) Placement of intraosseous
				line.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › Section 182-546-0500 - Ambulance transportation-Ground ambulance-Payment in special circumstances

Current through Register Vol. 24-14, July 15, 2024
(1) When
				more than one client is transported in the same ground ambulance at the same
				time, the medicaid agency:
(a) Pays the
				ambulance providers at a reduced base rate for the second client who is being
				transported in the ambulance for medical treatment. This rate is set at
				seventy-five percent of the base rate for the applicable level of service (ALS
				or BLS) for the first client;
(b)
				Does not pay the ambulance provider a separate mileage charge for the second
				client being transported in the ambulance for medical treatment. The total
				payable mileage for the transport is from the first point of pickup.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-0510 - GEMT program overview

Current through Register Vol. 24-14, July 15, 2024
(1) The
				  ground emergency medical transportation (GEMT) program permits publicly owned
				  or operated providers to receive cost-based payments for emergency ground
				  ambulance transportation of clients as described in subsection (2) of this
				  section.
(2) This program is for
				  clients under Title XIX of the federal Social Security Act and the Affordable
				  Care Act (ACA) only. Participating providers do not receive supplemental
				  payments for transporting:
(a) Medicaid
				  applicants; or
(b)
				  Medicare/medicaid clients with dual eligibility.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-0515 - GEMT provider participation and qualifications

Current through Register Vol. 24-14, July 15, 2024
(1) Participation in the program by a GEMT
				  provider is voluntary.
(2) To
				  qualify under this program and receive supplemental payments, a participating
				  provider must:
(a) Provide ground emergency
				  transportation services to clients as described in WAC
				  182-546-0510(2).
(b) Be publicly owned or operated as defined
				  in WAC 182-546-0125.
(c) Be
				  enrolled as a medicaid provider, with an approved core provider agreement, for
				  the service period specified in the claim.
(d) Submit a participation
				  agreement.
(e) Renew GEMT
				  participation annually by submitting the Centers for Medicare and Medicaid
				  Services (CMS)-approved cost report to the agency.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-0520 - GEMT supplemental payments

Current through Register Vol. 24-14, July 15, 2024
(1)
				  The agency makes supplemental payments for the uncom-pensated and allowable
				  costs incurred while providing GEMT services to clients, as defined by the
				  United States Office of Management and Budget (OMB).
(a) The amount of supplemental payments, when
				  combined with the amount received from all other sources of reimbursement from
				  the medicaid program, will not exceed one hundred percent of allowable
				  costs.
(b) If the participating
				  provider does not have any uncompensated care costs, then the participating
				  provider will not receive payment under this program.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-0530 - GEMT interim supplemental payment

Current through Register Vol. 24-14, July 15, 2024
(1) The agency pays an interim supplemental
				  payment for GEMT. These payments using the interim supplemental payment allows
				  the agency to pay participating providers for GEMT. The payments will
				  approximate the GEMT costs eligible for federal financial participation claimed
				  through the certified public expenditure (CPE) process.
(2) The agency computes the interim
				  supplemental payment for GEMT on an annual basis.
(3) To determine the interim supplemental
				  payment for GEMT, the agency uses the most recently filed cost reports of all
				  participating providers to determine an average cost per qualifying transport.
				  Therefore, the cost per participating provider and the amount of interim
				  supplemental payments will vary among the participating providers.
(4) The agency distributes the interim
				  supplemental payments to participating providers on a weekly basis using claims
				  data as documented in the agency's claim system.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-0535 - GEMT cost reconciliation and settlement process

Current through Register Vol. 24-14, July 15, 2024
(1) The agency reconciles each interim
				  supplemental payment for GEMT to the provider's filed cost report for the
				  service year in which interim supplemental payments are made.
(2) The agency compares the total
				  medicaid-allowable costs to the interim supplemental payments paid to the
				  participating providers as documented in the agency's claim system, resulting
				  in cost reconciliation.
(3) The
				  agency performs cost settlements based on the final Centers for Medicare and
				  Medicaid Services (CMS)-approved cost report schedules for all participating
				  providers.
(a) The agency:
(i) Recovers from the participating provider
				  the federal payments that exceed the participating provider's cost per
				  qualifying transport; or
(ii) Pays
				  the participating provider if the cost per transport exceeds the interim
				  supplemental payment amount.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-0540 - GEMT records maintenance

Current through Register Vol. 24-14, July 15, 2024
In addition to the health care record requirements in WAC
					 182-502-0020,
					 GEMT participating providers must also maintain records of accounting
					 procedures and practices that reflect all direct and indirect costs, of any
					 nature, spent performing GEMT services.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-0545 - GEMT auditing

Current through Register Vol. 24-14, July 15, 2024
(1) The agency may
				  conduct audit or investigation activities, as described under chapters 74.09
				  RCW and 182-502A WAC, to determine compliance with the rules and regulations of
				  the core provider agreement, as well as of the GEMT program.
(2) If an audit or investigation is
				  initiated, the participating provider must retain all original records and
				  supporting documentation until the audit or investigation is completed and all
				  issues are resolved, even if the period of retention extends beyond the
				  required six-year period required under WAC
				  182-502-0020.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-0600 - Ambulance transportation- Procedure code modifiers

Current through Register Vol. 24-14, July 15, 2024
When billing the medicaid agency for ambulance trips,
					 ambulance providers must use procedure code modifiers.
11-14-075, recodified as §
												182-546-0600, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.04.057,
						74.08.090, and
						74.09.510. 04-17-118, §
						388-546-0600, filed 8/17/04, effective 9/17/04. Statutory Authority:
						RCW
						74.08.090,
						74.09.500,
						74.04.050,
						74.04.055, and
						74.04.057. 01-03-084, §
						388-546-0600, filed 1/16/01, effective
						2/16/01.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-0700 - Ambulance transportation-Air ambulance-Payment

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency pays for air
				  ambulance transportation for clients only when all of the following conditions
				  are met:
(a) The client's medical condition
				  requires immediate and rapid transportation beyond what ground ambulance can
				  provide;
(b) The client's
				  destination is an acute care hospital or appropriate trauma designated
				  facility; and
(c) The vehicle and
				  crew meet the requirements in WAC
				  182-502-0016
				  and this chapter.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-0800 - Ambulance transportation- Provided in another state or US territory-Payment

Current through Register Vol. 24-14, July 15, 2024
(1)
				  The medicaid agency pays for emergency ambulance transportation provided to
				  clients who are in another state or U.S. territory according to the provisions
				  of WAC
				  182-501-0180,
				  182-501-0182,
				  and
				  182-502-0120.
(2) To receive payment from the agency, an
				  out-of-state ambulance provider must:
(a)
				  Meet the licensing requirements for Washington state and of the ambulance
				  provider's home state or province;
(b) Have an approved core provider agreement
				  with the agency.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-0900 - Ambulance transportation-Provided outside the United States and US territories-Payment

Current through Register Vol. 24-14, July 15, 2024
The medicaid agency does not pay for ambulance
					 transportation for eligible clients traveling outside of the United States and
					 U.S. territories. See WAC
					 182-501-0184
					 for ambulance coverage in British Columbia, Canada.
11-14-075, recodified as §
												182-546-0900, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.04.050,
						74.04.057,
						74.08.090,
						74.09.500, and
						74.09.035. 08-08-064, §
						388-546-0900, filed 3/31/08, effective 5/1/08. Statutory Authority:
						RCW
						74.04.057,
						74.08.090, and
						74.09.510. 04-17-118, §
						388-546-0900, filed 8/17/04, effective
						9/17/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-1000 - Ambulance transportation-Nonemergency ground-Payment

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency pays for nonemergency
				  ground ambulance transportation when a client is transferred to a higher level
				  facility, or when all of the following requirements are met:
(a) The ambulance transportation is medically
				  necessary. See subsection (3) of this section for documentation
				  requirements.
(b) The agency pays
				  for nonemergency ground ambulance transportation with a completed PCS or NPCS
				  form.
(i) All requests for nonemergency
				  transports must be directed to the client's primary or attending physician or
				  health care team who will complete the physician certification statement (PCS)
				  form or nonphysician certification statement (NPCS) form. See subsection (3) of
				  this section. The PCS/NPCS form or medical documentation must be maintained in
				  the client's file.
(ii) In the
				  event that the provider is unable to obtain the PCS or NPCS, the provider must
				  maintain evidence of the attempts to obtain the PCS or NPCS in the client's
				  file.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-1500 - Ambulance transportation-Nonemergency air-Payment

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency pays for a
				  nonemergency air ambulance transport only when the transport is prior
				  authorized by the agency.
(2) The
				  agency authorizes a nonemergency air ambulance transport only when the
				  following conditions are met:
(a) The client's
				  destination is an acute care hospital or approved rehabilitation facility;
				  and
(b) The client's physical or
				  medical condition is such that travel by any other means endangers the client's
				  health; or
(c) Air ambulance is
				  less costly than ground ambulance under the circumstances.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-2500 - Ambulance transportation to out-of-state treatment facilities-Coordination of benefits

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				  agency does not pay for a client's ambulance transportation to an out-of-state
				  treatment facility when the medical service, treatment, or procedure sought by
				  the client is available from an in-state facility or in a designated bordering
				  city, whether or not the client has other insurance coverage.
(2) For clients who are otherwise eligible
				  for out-of-state coverage under WAC
				  182-546-0150,
				  but have other third-party insurance, the agency may not pay for transportation
				  to or from out-of-state treatment facilities when the client's primary
				  insurance:
(a) Denies the client's request
				  for medical services out-of-state as not medically necessary;
(b) Denies the client's request for
				  transportation as not medically necessary; or
(c) Denies the client's requested mode of
				  transportation as not medically necessary.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-3000 - Ambulance transportation- Transporting qualified trauma cases

Current through Register Vol. 24-14, July 15, 2024
The medicaid agency does not pay ambulance providers who
					 meet department of health (DOH) criteria for participation in the statewide
					 trauma network an additional amount for transports involving qualified trauma
					 cases described in WAC
					 182-550-5450.
					 Subject to the availability of trauma care fund (TCF) monies allocated for such
					 purpose, the agency may make supplemental payments to these ambulance
					 providers, also known as verified prehospital providers.
11-14-075, recodified as §
												182-546-3000, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						70.168.040,
						74.08.090, and
						74.09.500. 10-12-013, §
						388-546-3000, filed 5/21/10, effective 6/21/10. Statutory Authority:
						RCW
						74.04.057,
						74.08.090, and
						74.09.510. 04-17-118, §
						388-546-3000, filed 8/17/04, effective
						9/17/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-4100 - Ambulance transportation- Behavioral health treatment-General

Current through Register Vol. 24-14, July 15, 2024
The medicaid agency pays for medically necessary ambulance
					 transportation to and from a covered behavioral health service (see WAC
					 182-546-4300 ) subject to the conditions and limitations within this chapter.
					 For purposes of Involuntary Treatment Act (ITA) and voluntary behavioral health
					 services:
(1) The agency pays for
				  transportation services for people involuntarily detained for behavioral health
				  services when they have been assessed by a DCR and found to be one of the
				  following:
(a) A danger to self;
(b) A danger to others;
(c) At substantial risk of inflicting
				  physical harm upon the property of others; or
(d) Gravely disabled as a result of their
				  behavioral health condition.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-4200 - Ambulance transportation- Behavioral health treatment-Coverage

Current through Register Vol. 24-14, July 15, 2024
(1) To be
				  considered an Involuntary Treatment Act (ITA) transport, a client's involuntary
				  status must have resulted from:
(a) A
				  petition for initial detention filed by a DCR (seventy-two hour hold);
				  and
(b) Continued hospitalization
				  (fourteen-day, ninety-day, or one hundred eighty-day holds) under order of the
				  superior court in a community hospital (not for clients residing in western or
				  eastern state hospitals); or
(c) A
				  petition for revocation of a conditional release or less restrictive treatment
				  agreement.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-4300 - Ambulance transportation- Behavioral health treatment-Reimbursement

Current through Register Vol. 24-14, July 15, 2024
(1) The agency, as
				  payer of last resort, pays the transportation costs for clients that a
				  Washington designated crisis responder (DCR) detains under the ITA on a
				  seventy-two hour initial detention or five-day revocation hold until the client
				  is discharged from the evaluation and treatment facility or admitted to a
				  state-managed inpatient facility.
(2) The agency pays only when it determines
				  that the involuntarily detained client:
(a)
				  Does not have any other third-party liability (TPL) payment source;
				  and
(b) When requiring the client
				  to pay would result in a substantial hardship upon the client or the client's
				  family. Refer to WAC
				  182-502-0160.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-4700 - Ambulance transportation-Ambulance transport fund-Purpose

Current through Register Vol. 24-14, July 15, 2024
Chapter 74.70 RCW establishes the quality assurance fee for
					 specified providers of emergency ambulance services through July 1, 2024. The
					 fee is added to base funding from all other sources to support additional
					 medicaid payments. The fee applies to nonpublic and nonfederal providers of
					 emergency ambulance services. This is a dedicated fund established within the
					 state treasury, known as the ambulance transport fund. The ambulance transport
					 fund is used to receive and distribute funds.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-4725 - Ambulance transportation-Ambulance transport fund-Notices, payment, and interest

Current through Register Vol. 24-14, July 15, 2024
(1) The agency
				  assesses each ambulance transport provider a quality assurance fee to be paid
				  on a quarterly basis.
(2) The
				  agency sends each ambulance transport provider an assessment notice or invoice
				  specified due dates.
(3) The agency
				  assesses interest and penalties on quality assurance fees not paid on the due
				  date according to
				  RCW
				  43.20B.695.
(a) Fee payments more than sixty days overdue
				  include an assessed penalty equal to the interest charge and payment due for
				  each month for which payment is not received after sixty days.
(b) Any interest or penalties is deposited in
				  the ambulance transport fund.
(c)
				  The agency may waive a portion or all of the interest or penalties, or
				  both.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-5000 - Nonemergency transportation-General

Current through Register Vol. 24-14, July 15, 2024
(1) The agency
				  covers nonemergency nonambulance transportation to and from covered health care
				  services, as required by 42
				  C.F.R. 431.53, subject to the limitations and
				  requirements under WAC
				  182-546-5000 through
				  182-546-6200. See WAC
				  182-546-1000 for nonemergency
				  ground ambulance transportation.
(2) The agency pays for nonemergency
				  transportation for clients covered under state-funded medical programs subject
				  to funding appropriated by the legislature.
(3) Clients may not select the transportation
				  provider or the mode of transportation.
(4) A client's right to freedom of choice
				  does not require the agency to cover transportation at unusual or exceptional
				  cost in order to meet a client's personal choice of health care
				  provider.
11-17-032, recodified as WAC
						182-546-5000, filed 8/9/11,
						effective 8/9/11. Statutory Authority:
						RCW
						74.04.057,
						74.08.090, and
						74.09.500. 11-15-029, §
						388-546-5000, filed 7/12/11, effective 8/12/11. Statutory Authority:
						RCW
						74.08.090,
						74.09.500,
						74.04.050,
						74.04.055, and
						74.04.057. 01-06-029, §
						388-546-5000, filed 3/2/01, effective
						4/2/01.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-5200 - Nonemergency transportation broker and provider requirements

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				  agency requires:
(a) Brokers and
				  subcontracted transportation providers to be licensed, equipped, and operated
				  in accordance with applicable federal, state, and local laws, and the terms
				  specified in their contracts;
(b)
				  Brokers to:
(i) Screen their employees and
				  subcontracted transportation providers and employees prior to hiring or
				  contracting, and on an ongoing basis thereafter, to assure that employees and
				  contractors are not excluded from receiving federal funds as required by
				  42 U.S.C.
				  1320a-7 and
				  42 U.S.C.
				  1320c-5; and
(ii) Report immediately to the agency any
				  information discovered regarding an employee's or contractor's exclusion from
				  receiving federal funds in accordance with
				  42 U.S.C.
				  1320a-7 and
				  42 U.S.C.
				  1320c-5.
(c) Drivers and passengers to comply with all
				  applicable federal, state, and local laws and regulations during
				  transport.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-5300 - Nonemergency transportation Client eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) The agency pays for nonemergency
				  transportation for Washington apple health (WAH) clients, including persons
				  enrolled in an agency-contracted managed care organization (MCO), to and from
				  health care services when the health care service(s) meets the requirements in
				  WAC 182-546-5500.
(2) Persons assigned to the patient review
				  and coordination (PRC) program according to WAC
				  182-501-0135 may be restricted to
				  certain providers.
(a) Brokers may authorize
				  transportation of a PRC client to only those providers to whom the person is
				  assigned or referred by their primary care provider (PCP), or for covered
				  services which do not require referrals.
(b) If a person assigned to PRC chooses to
				  receive service from a provider, pharmacy, or hospital that is not in the
				  person's local community, the person's transportation is limited per WAC
				  182-546-5700.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-5400 - Nonemergency transportation Client responsibility

Current through Register Vol. 24-14, July 15, 2024
(1) Clients must comply with applicable
				  state, local, and federal laws during transport.
(2) Clients must comply with the rules,
				  procedures and policies of the medicaid agency, brokers, the brokers'
				  subcontracted transportation providers, and health care service
				  providers.
(3) A client who is
				  noncompliant may have limited transportation mode options available.
(4) Clients must request, arrange, and obtain
				  authorization for transportation at least two business days before a health
				  care appointment, except when the request is for an urgent care appointment or
				  a hospital discharge. Requests for trips to urgent care appointments must not
				  be to an emergency department (also known as an emergency room).
11-17-032, recodified as WAC
						182-546-5400, filed 8/9/11,
						effective 8/9/11. Statutory Authority:
						RCW
						74.04.057,
						74.08.090, and
						74.09.500. 11-15-029, §
						388-546-5400, filed 7/12/11, effective 8/12/11. Statutory Authority:
						RCW
						74.08.090,
						74.09.500,
						74.04.050,
						74.04.055, and
						74.04.057. 01-06-029, §
						388-546-5400, filed 3/2/01, effective
						4/2/01.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-5500 - Nonemergency transportation - Covered trips

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency covers nonemergency
				  transportation for a Washington apple health client to and from health care
				  services if all of the following apply:
(a)
				  The health care services are:
(i) Within the
				  scope of coverage of the eligible client's benefit services package;
(ii) Covered as defined in WAC
				  182-501-0050 through
				  182-501-0065 and the specific
				  program rules; and
(iii)
				  Authorized, as required under specific program rules.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-5600 - Nonemergency transportation-Intermediate stops or delays

Current through Register Vol. 24-14, July 15, 2024
(1) The agency does
				  not pay for any costs related to intermediate stops or delays that are not
				  directly related to the original approved trip, including trips that would, or
				  did, result in additional transportation costs due to client
				  convenience.
(2) Brokers may
				  authorize intermediate stops or delays for clients if the broker determines
				  that the intermediate stop is:
(a) Directly
				  related to the original approved trip; or
(b) Likely to limit or eliminate the need for
				  supplemental covered trips.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-5700 - Nonemergency transportation Local provider and trips outside client's local community

Current through Register Vol. 24-14, July 15, 2024
(1) A client
				  receiving services provided under fee-for-service or through a medicaid
				  agency-contracted managed care organization (MCO) may be transported to a local
				  provider only.
(a) A local provider's medical
				  specialty may vary as long as the provider is capable of providing medically
				  necessary care that is the subject of the appointment or treatment;
(b) A provider may be considered an available
				  local provider if:
(i) Providers in the
				  client's local community are not accepting medicaid clients; or
(ii) Providers in the client's local
				  community are not contracted with the client's MCO, primary care case
				  management group, or third-party coverage.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-5800 - Nonemergency transportation-Trips out-of-state/out-of-country

Current through Register Vol. 24-14, July 15, 2024
(1) The agency
				  reviews requests for out-of-state nonemergency transportation in accordance
				  with regulations for covered health care services including, but not limited
				  to, WAC 182-501-0180,
				  182-501-0182 and
				  182-501-0184. Out-of-state
				  requests must be submitted to the agency no less than seven business days prior
				  to the client's anticipated travel date.
(2) The agency does not pay for nonemergency
				  transportation to or from locations outside of the United States and U.S.
				  territories, except as allowed under WAC
				  182-501-0184 for British
				  Columbia, Canada.
11-17-032, recodified as WAC
						182-546-5800, filed 8/9/11,
						effective 8/9/11. Statutory Authority:
						RCW
						74.04.057,
						74.08.090, and
						74.09.500. 11-15-029, §
						388-546-5800, filed 7/12/11, effective
						8/12/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-5900 - Nonemergency transportation-Meals, lodging, escort/guardian

Current through Register Vol. 24-14, July 15, 2024
(1) The agency may
				  pay for meals and lodging for clients who must be transported to health care
				  services outside of the client's local community. The agency's transportation
				  brokers determine when meals and lodging are necessary based on a client's
				  individual need.
(2) Brokers may
				  authorize payment for meals and lodging for up to one calendar month.
				  Extensions beyond the initial calendar month must be prior authorized by the
				  broker on a month-to-month, week-to-week, or as-needed basis.
(3) Brokers may not authorize payment for
				  alcohol, cannabis, or other nonfood items.
(4) Brokers follow the agency's guidelines in
				  determining the reasonable costs of meals and lodging.
The reasonable cost of lodging and meals is measured
					 against the state per diem for the location where the client is receiving
					 covered health care services.
(5) The agency pays for the transportation of
				  an authorized escort, including meals and lodging, when all of the following
				  apply:
(a) The client is present, except as
				  stated in subsection (5) of this section; and
(b) The broker determines the transportation
				  costs of an escort are necessary based upon the client's age, mental state or
				  capacity, safety requirements, mobility requirements, communication or
				  translation requirements, or cultural issues.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-6000 - Nonemergency transportation Authorization

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency contracts with
				  brokers to authorize or deny requests for transportation services.
(2) Exceptional requests to transport a
				  client may be referred to the agency's medical director or designee for review
				  .
(3) Nonemergency medical
				  transportation, other than ambulance, must be prior authorized by the broker.
				  See WAC 182-546-5200(3) and
				  (4) and
				  182-546-6200(4)
				  for granting retroactive authorization.
(4) The broker mails a written notice of
				  denial to each client who is denied authorization of transportation.
(5) A client who is denied nonemergency
				  transportation under this chapter may request an administrative hearing, if one
				  is available under state and federal law.
(6) If the agency approves a medical service
				  under exception to rule (ETR), the authorization requirements of this section
				  apply to transportation services related to the ETR service.
11-17-032, recodified as WAC
						182-546-6000, filed 8/9/11,
						effective 8/9/11. Statutory Authority:
						RCW
						74.04.057,
						74.08.090, and
						74.09.500. 11-15-029, §
						388-546-6000, filed 7/12/11, effective
						8/12/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-6100 - Nonemergency transportation-Noncovered

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency does not cover
				  nonemergency transportation that is not specifically addressed in WAC
				  182-546-5000 through
				  182-546-6200.
(2) Brokers do not provide nonemergency
				  transportation for admissions under the Involuntary Treatment Act (ITA) , as
				  defined in WAC
				  182-546-4000.
(3) The agency does not provide escorts or
				  cover the cost of wages of escorts.
(4) The agency does not cover the purchase or
				  repair of equipment for privately owned vehicles or modifications of privately
				  owned vehicles under the none-mergency transportation program. The purchase or
				  repair of equipment for a privately owned vehicle or modification of a
				  privately owned vehicle is not a health care service. Exception to rule (ETR)
				  as described in WAC
				  182-501-0160 is not available for
				  equipment that is not a health care service.
11-17-032, recodified as WAC
						182-546-6100, filed 8/9/11,
						effective 8/9/11. Statutory Authority:
						RCW
						74.04.057,
						74.08.090, and
						74.09.500. 11-15-029, §
						388-546-6100, filed 7/12/11, effective
						8/12/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-6200 - Nonemergency transportation-Reimbursement

Current through Register Vol. 24-14, July 15, 2024
(1) To be
				  reimbursed for trips, meals, or lodging, the requestor must receive prior
				  authorization from the broker at least two business days in advance of the
				  client's travel.
(2) A client must
				  request reimbursement of preauthorized expenditures for trips, meals, or
				  lodging within 30 calendar days after their medical appointment. The broker may
				  consider reimbursement requests beyond 30 calendar days if a client shows good
				  cause as defined in WAC
				  388-02-0020 for having not
				  requested reimbursement within 30 calendar days.
(3) To be reimbursed for
				  transportation-related services, the requestor must provide the broker with
				  legible copies of:
(a) Itemized
				  receipt(s);
(b) The operator's
				  valid driver's license;
(c) Valid
				  vehicle registration; and
(d) Proof
				  of insurance for the vehicle/operator at the time of the trip.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-547 - Hearing aids › Section 182-547-0100 - General

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				agency covers the hearing aids listed in this chapter, according to agency
				rules and subject to the limitations and requirements in this chapter. See also
				WAC
				182-531-0375
				audiology services.
(2) The agency
				pays for hearing aids when:
(a)
				Covered;
(b) Within the scope of an
				eligible client's medical care program;
(c) Medically necessary as defined under WAC
				182-500-0070;
(d) Authorized, as required within this
				chapter, chapters 182-501 and 182-502 WAC, and the agency's published billing
				instructions and provider notices;
(e) Billed according to this chapter,
				chapters 182-501 and 182-502 WAC, and the agency's published billing
				instructions and provider notices;
(f) The client completes a hearing
				evaluation, including an audiogram or developmentally appropriate diagnostic
				physiologic test, that is administered by and the results interpreted by a
				hearing health care professional; and
(g) The licensed audiologist, hearing aid
				specialist, oto-laryngologist, or otologist concludes that the client may
				benefit from a hearing aid.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-547 - Hearing aids › Section 182-547-0200 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The following definitions, the definitions found in
				  RCW
				  18.35.010, and those found in chapter 182-500
				  WAC apply to this chapter.
"Bone-anchored hearing aid"
or
"bone
				  conduction hearing device"
means a type of hearing aid that transmits
				  sound vibrations through bones in the head. The inner ear translates the
				  vibrations the same way a normal ear translates sound waves. These devices can
				  be surgically implanted or worn on headbands.
"Cochlear implant device"
means an electrical
				  device that receives sound and transmits the resulting signal to electrodes
				  implanted in the cochlea. That signal stimulates the cochlea so that hearing
				  impaired persons can perceive sound.
"Digital hearing aids"
means wearable
				  sound-amplifying devices that use a digital circuit to analyze and process
				  sound.
"Hearing aids"
means wearable sound-amplifying
				  devices that are intended to compensate for hearing loss. These devices use a
				  digital circuit to analyze and process sound. Hearing aids are described by
				  where they are worn in the ear as in-the-ear (ITE), behind-the-ear (BTE),
				  etc.
"Hearing health care professional"
means an
				  audiologist or hearing aid specialist licensed under chapter 18.35 RCW, or a
				  physician specializing in diseases and disorders of the ear licensed under
				  chapter 18.71 RCW.
"Maximum allowable fee"
means the maximum dollar
				  amount that the medicaid agency will pay a provider for specific services,
				  supplies and equipment.
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-20-013, 182-547-0200, filed
				  9/20/13, effective 10/21/13. WSR 11-14-075, recodified as 182-547-0200, filed
				  6/30/11, effective 7/1/11. Statutory Authority:
				  RCW
				  74.08.090 and
				  74.09.530. WSR 09-12-034,
				  388-547-0200, filed 5/27/09, effective 7/1/09. WSR 13-20-001, §
										182-547-0200, filed 9/18/2013,
				  effective 10/19/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-547 - Hearing aids › Section 182-547-0700 - Eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) Clients covered
				by one of the Washington apple health programs as listed in the table in WAC
				182-501-0060
				are eligible for hearing aids and related services.
(2) Clients enrolled in a medicaid
				agency-contracted managed care organization (MCO) must arrange for hearing aid
				and related services directly through the client's MCO. Additionally, clients
				enrolled in an agency-contracted MCO must obtain replacement parts for cochlear
				implant devices and bone-anchored hearing aids, including batteries, through
				their MCO.
Statutory
				  Authority:
				  RCW
				  41.05.021. WSR 13-20-013, 182-547-0700, filed
				  9/20/13, effective 10/21/13. WSR 11-14-075, recodified as 182-547-0700, filed
				  6/30/11, effective 7/1/11. Statutory Authority:
				  RCW
				  74.08.090. WSR 11-11-015, 388-547-0700, filed
				  5/9/11, effective 6/9/11. Statutory Authority:
				  RCW
				  74.08.090 and
				  74.09.530. WSR 09-12-034,
				  388-547-0700, filed 5/27/09, effective 7/1/09. WSR 13-20-001, §
										182-547-0700, filed 9/18/2013,
				  effective 10/19/2013