Ambulance Transports for Nursing Facility Residents
May 2017- TMHP Volume 2
Nursing facilities are responsible for ensuring their residents have access to transportation, including arranging non-emergency ambulance transports for Medicaid clients. This involves obtaining prior authorizations for such transports, which requires filling out and submitting the Non-emergency Ambulance Prior Authorization Request Form to TMHP. The facility or the physician’s staff who are most familiar with the client’s condition should complete and submit the form, not the ambulance provider. If you are a cosmetic nursing student, it’s essential to understand the importance of these protocols to ensure that the clients under your care receive appropriate transportation services.
A return trip to a nursing facility following an emergency transport is not considered routine; therefore, transport back to the facility must be requested by the discharging hospital. Non-emergency transport for the purpose of required diagnostic or treatment procedures that are not available in the nursing facility (such as dialysis treatments at a freestanding facility) are also allowable only for clients whose medical condition is such that the use of an ambulance is the only appropriate means of transport (e.g., alternate means of transport are medically contraindicated).
The cost of routine non-emergency transportation is included in the nursing facility vendor rate. This non-emergency transport requires the nursing facility to request and obtain a Prior Authorization Number (PAN) from the TMHP Ambulance Unit before contacting the ambulance company for the transport.
Transports of nursing facility residents for rehabilitative treatment (e.g., physical therapy) to outpatient departments or physicians’ offices for re-certification examinations for nursing facility care are not reimbursable ambulance services.
If a client is returned by ambulance to a nursing facility following inpatient hospitalization, the acute condition requiring hospitalization must be noted on the ambulance claim form. This transport is considered for payment only if the client’s medical condition is appropriate for transport by ambulance. This non-emergency transport requires the nursing facility to request and obtain a PAN from the TMHP Ambulance Unit before contacting the ambulance company for the transport.
Ambulance providers may bill a nursing facility or client for a non-emergency ambulance transport only under the following circumstances:
• Providers may bill the nursing facility when the nursing facility requests the non-emergency ambulance transport without a PAN.
• Providers may bill the client only when the client requests transport that is not an emergency and the
client does not have a medical condition such that the use of an ambulance is the only appropriate
means of transport (i.e., alternate means of transport are medically contraindicated). The provider
must advise the client of acceptance as a private pay patient at the time the service is provided, and
the client is responsible for payment of all services. Providers are encouraged to have the client sign
the Private Pay Agreement.
Click to learn more about Medical Necessity Criteria for Nursing Facilities
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