Section 182-546-2500 - Ambulance transportation to out-of-state treatment facilities-Coordination of benefits(1) The medicaid agency does not pay for a client's ambulance transportation to an out-of-state treatment facility when the medical service, treatment, or procedure sought by the client is available from an in-state facility or in a designated bordering city, whether or not the client has other insurance coverage.(2) For clients who are otherwise eligible for out-of-state coverage under WAC 182-546-0150, but have other third-party insurance, the agency may not pay for transportation to or from out-of-state treatment facilities when the client's primary insurance: (a) Denies the client's request for medical services out-of-state as not medically necessary;(b) Denies the client's request for transportation as not medically necessary; or(c) Denies the client's requested mode of transportation as not medically necessary.(3) For clients who are otherwise eligible for out-of-state coverage under WAC 182-546-0150, but have other third-party insurance, the agency does not consider requests for transportation to or from out-of-state treatment facilities unless the client has requested coverage of the benefit from their primary insurer and been denied.(4) If the agency authorizes transportation to or from an out-of-state treatment facility for a client with other third-party insurance, the agency's liability is limited to the cost of the least costly means of transportation that does not jeopardize the client's health, as determined by the agency in consultation with the client's referring physician.(5) For clients eligible for out-of-state coverage but have other third-party insurance, the agency considers requests for transportation to or from out-of-state treatment facilities under the provisions of WAC 182-501-0165.Wash. Admin. Code § 182-546-2500
Amended by WSR 20-17-010, Filed 8/6/2020, effective 9/6/202011-14-075, recodified as §182-546-2500, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.057, 74.08.090, and 74.09.510. 04-17-118, § 388-546-2500, filed 8/17/04, effective 9/17/04.