OAR 410-136-3180
Reimbursement for Ground and Air Ambulance Transports
(1)
The following applies to how the Authority shall reimburse providers of NEMT ground and air ambulance services that brokerages arrange for eligible clients. This applies to clients receiving services through the fee-for-service delivery system, a PHP or a CCO.(2)
Brokerages shall submit documentation to the Authority stating the brokerage authorized the transportation. The documentation also shall inform the Authority to reimburse at the Authority’s base rate or another amount the brokerage specifies. Ambulance providers shall bill the Authority for payment of authorized rides.(3)
If brokerage does not specify another amount, the Authority’s reimbursement shall include:(a)
The base rate established in the Authority’s fee schedule posted on the OHP Web page at www.oregon.gov/OHA/HSD/OHP/Pages/Fee-Schedule.aspx. The base rate for NEMT ground and air ambulances includes:(A)
Any procedures or services provided, all medications, non-reusable supplies or oxygen and all direct or indirect costs. “Indirect costs” include general operating costs, personnel costs, neonatal intensive care teams employed by the ambulance subcontractor, use of reusable equipment and any other miscellaneous medical items or special handling that may be required in the course of transport;(B)
The first ten miles for ground ambulance transports; and(C)
Mileage for air ambulance transports.(b)
A modified base rate for each additional client, according to OAR 410-136-3220 (Brokerage Reimbursements to Subcontractors), Brokerage Reimbursements to Subcontractors, if applicable;(c)
Payment for an extra attendant, if applicable; and(d)
Compensation for service or care provided at the scene when the client did not require transport, if applicable.(4)
Reimbursement outlined in section (3) also applies to the Authority’s reimbursements to providers of emergency ground or air ambulance services for clients who receive services through the fee-for-service delivery system.(5)
A PHP is responsible for reimbursement to providers of emergency ground or air ambulance for clients who are PHP members.(6)
A CCO is responsible for reimbursement to providers of emergency ground or air ambulance for clients who are CCO enrollees.
Source:
Rule 410-136-3180 — Reimbursement for Ground and Air Ambulance Transports, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-136-3180.