Non-covered ambulance services shall include:

1. (a) Transportation for a recipient whose condition permits transport in any type of vehicle other than an ambulance, such as a private vehicle or a wheelchair van, without endangering the recipient’s health;

2. (b) Transportation in an ambulance, except for the following which are covered services pursuant to He-W 572.04:

   1. (1) Scheduled and routine ambulance transportation, as defined in He-W 572.01(k);
   2. (2) For an emergency medical condition, as defined in He-W 572.01(g); or
   3. (3) Transportation of a recipient from one hospital to another inpatient facility such as a hospital or inpatient psychiatric facility, wherein the recipient is coming from the emergency department of the originating hospital or has been discharged from the originating hospital;
3. (c) Transportation by ambulance only for the recipient’s or the recipient’s family’s convenience;
4. (d) Transportation from one acute care hospital to another acute care hospital for necessary treatment or diagnostic testing while the recipient maintains inpatient status with the originating hospital; and
5. (e) Waiting time that exceeds 2 hours.

Source. (See Revision Note at chapter heading He-W 500); ss by #6641, eff 11-27-97; EXPIRED: 11-27-05 New. #8502, INTERIM, eff 12-2-05, EXPIRES: 5-31-06; ss by #8638, eff 5-30-06; ss by #10294, eff 12-1-13; ss by #13840, INTERIM, eff 12-29-23; ss by #14007, eff 6-25-24