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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
(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
(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
(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
(5) An ambulance provider may bill a client for noncovered services as described in this section, if the requirements of WAC 388-502-0160
[WSR 11-14-075, recodified as § 182-546-0250, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050
, and 74.09.700
. WSR 06-24-036, § 388-546-0250, filed 11/30/06, effective 1/1/07. Statutory Authority: RCW 74.04.057
, and 74.09.510
. WSR 04-17-118, § 388-546-0250, filed 8/17/04, effective 9/17/04. Statutory Authority: RCW 74.08.090
, and 74.04.057
. WSR 01-03-084, § 388-546-0250, filed 1/16/01, effective 2/16/01.]