1. (1) To be eligible for participation in the Alabama Medicaid Ambulance Program and to receive payment for service, each provider of ambulance service in Alabama in compliance with Rule No. 560-X-18-.02(2) must enter into a written agreement with Alabama Medicaid Agency.
2. (2) Ambulance Service Agreement (contract) available from the Alabama Medicaid Agency, must be completed in two (2) copies.
3. (3) Contract must be approved by Alabama Medicaid Agency with an effective date for payment of Medicaid covered ambulance services. The effective date of the contract will be the first day of the month the Agency signs the contract.
4. (4) The Ambulance Service Agreement (contract) may be terminated for failure of the parties to fulfill one or more of the contract provisions. Medicaid reserves the right to immediately terminate a contract in the event of fraud or a criminal conviction.
5. (5) Each party may terminate the agreement on thirty (30) days written notice.
6. (6) The permanent record copy which fully discloses the extent and cost of services, equipment, or supplies furnished eligible recipients must be maintained by the provider and available for audit by State and Federal auditors for a period of three (3) years.
7. (7) Providers of transportation are responsible for verifying the recipient's current Medicaid eligibility.
8. (8) All required blanks and spaces on the claim form must be completed before submitting it to the Medicaid fiscal agent for payment.

Statutory Authority: State Plan; 42 C.F.R. §§401 et seq.; Title XIX, Social Security Act.

History: Rule effective October 1, 1982. Effective date of amendment January 1, 1987. Emergency rule effective June 28, 1991. Amended: effective October 12, 1991. Effective date of amendment January 13, 1993, October 14, 1993. Amended: Filed July 7, 1994; effective August 12, 1994.