1. (1) The medicaid agency pays for emergency ambulance transportation provided to clients who are in another state or U.S. territory according to the provisions of WAC 182-501-0180, 182-501-0182, and 182-502-0120.

2. (2) To receive payment from the agency, an out-of-state ambulance provider must:

   1. (a) Meet the licensing requirements for Washington state and of the ambulance provider's home state or province;
   2. (b) Have an approved core provider agreement with the agency.

3. (3) The agency pays for emergency ambulance transportation provided out-of-state for eligible clients when the transport is:

   1. (a) Within the scope of the client's medical care program;
   2. (b) Medically necessary as defined in WAC 182-500-0070; and
   3. (c) To the closest, most appropriate treatment facility.

4. (4) The agency does not pay for an ambulance transport provided in another state for a client when:

   1. (a) The client's medical eligibility program covers health care services within Washington state or designated bordering cities only. See WAC 182-546-0150 and 182-546-0200(5);
   2. (b) The transport was nonemergency and was not prior authorized by the agency.

5. (5) The agency pays for emergency ambulance transportation at the lower of:

   1. (a) The provider's billed amount; or
   2. (b) The rate established by the agency.
6. (6) The agency does not pay for nonemergency (ground or air ambulance) transportation outside the state of Washington (i.e., both origin and destination points are outside the state's borders).
7. (7) An ambulance provider who transports a client to a facility outside the state (excluding designated bordering cities) or brings a client into the state from a location outside the state (excluding designated border cities) must obtain prior authorization from the agency for a nonemergency transport in order to be paid. See WAC 182-546-4000 for transports under the ITA.

[Statutory Authority: RCW 41.05.021, 41.05.160, 2015 c 157, 2017 c 273, and 2016 1st sp.s. c 29. WSR 20-17-010, § 182-546-0800, filed 8/6/20, effective 9/6/20. WSR 11-14-075, recodified as § 182-546-0800, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 74.09.035. WSR 08-08-064, § 388-546-0800, filed 3/31/08, effective 5/1/08. Statutory Authority: RCW 74.04.057, 74.08.090, and 74.09.510. WSR 04-17-118, § 388-546-0800, filed 8/17/04, effective 9/17/04. Statutory Authority: RCW 74.08.090, 74.09.500, 74.04.050, 74.04.055, and 74.04.057. WSR 01-03-084, § 388-546-0800, filed 1/16/01, effective 2/16/01.]