WAC 388-546-0250   Ambulance services the department does not cover.  (1) The department 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 388-546-1000);

     (b) Refused by the client (see exception for ITA clients in WAC 388-546-4000(2));

     (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 388-546-0500(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.

     (2) If transport does not occur, the department does not cover the ambulance service, except as provided in WAC 388-546-0500(2).

     (3) The department evaluates requests for services that are listed as noncovered in this chapter under the provisions of WAC 388-501-0160.

     (4) For ambulance services that are otherwise covered under this chapter but are subject to one or more limitations or other restrictions, the department evaluates, on a case-by-case basis, requests to exceed the specified limits or restrictions. The department approves such requests when medically necessary, according to the provisions of WAC 388-501-0165 and 388-501-0169.

     (5) An ambulance provider may bill a client for noncovered services as described in this section, if the requirements of WAC 388-502-0160 are met.



[Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. 06-24-036, § 388-546-0250, filed 11/30/06, effective 1/1/07. Statutory Authority: RCW 74.04.057, 74.08.090, and 74.09.510. 04-17-118, § 388-546-0250, 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, § 388-546-0250, filed 1/16/01, effective 2/16/01.]