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(a) The department will pay for medically necessary emergency transportation to the nearest facility that provides emergency care. The department will not pay for emergency transportation to return the recipient to a residence or other location. A claim submitted to the department for payment of costs for emergency transportation service, including ground ambulance, medevac, and air ambulance service, must be accompanied by written justification of the medical emergency acceptable to the department. A ground ambulance's documentation of a recipient's medical status and medical services provided may serve as adequate written justification to support a claim for emergency transportation services by a ground ambulance service.
(b) The department will pay for an American Indian or Alaska Native recipient to be transported, at the request of the recipient or a family member, to the nearest tribal health facility for treatment of an emergency condition even though the facility is not the nearest facility that provides emergency care.
(c) The department will not pay for emergency air ambulance or medevac services unless the provider submits to the department medical justification for the service within two working days following the date that the recipient was transported.
(d) If the department determines that the use of an emergency ground ambulance was not medically justified, a claim for allowable costs will be paid at the non-emergency ground ambulance rate. If the department determines that the recipient's medical condition did not warrant any form of ambulance transportation, the claim will be denied.
History: Eff. 8/18/79, Register 71; readopt 8/7/96, Register 139; am 6/24/2004, Register 170
Authority: AS 47.05.010
Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.505 in its entirety, without change, under AS 47.05 and AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.
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Last modified 7/05/2006