OAR 410-125-0120: Transportation To and From Medical Services

(1) Transportation to and from medical services, including hospital services, is a covered service. However, all non-emergency transports require prior authorization in order for the transportation provider to be paid. (2) Interfacility transfers are defined as bed optimization and balancing resource management strategies for the purpose of patient movement across a health network system. The transfer of patients between hospitals, form hospitals to specialized care facilities, or bed to bed lateral transfers within the same health provider network system. (a) Interfacility transfers are not a covered service by the Agency unless they meet medically necessary criteria. (b) Interfacility transfers are considered medically necessary when one or more of the following criteria are met: (A) The patient requires medically necessary diagnostic or therapeutic services that are not available at the originating facility; or (B) The patient requires a higher-level of care which is not available at the originating facility; or (C) The patient has received care at a prior facility for a condition that is not normally managed at the originating facility and the return to the prior facility is needed to diagnose, manage, or treat a complication or other acute issue. (3) The transportation must be the least expensive obtainable under existing conditions and appropriate to the client's needs. (4) Contact the Division-contracted regional Transportation Brokerage (Brokerage) for prior authorization for the transport or instruct the transportation provider to contact the Brokerage. Brokerage map and contact information is available at https://www.oregon.gov/oha/HSD/OHP/Tools/Transportation%20Brokerage%20Map.pdf (5) Hospitals must follow the after hours procedures for the Brokerages and contact the appropriate after hours providers for non-emergent transportation for hospital discharges. (6) No prior authorization is required when the client's condition requires emergency transport. (7) When a hospital sends a patient to another facility or provider during the course of an inpatient stay and the client is returned to the admitting hospital within 24 hours, the hospital must arrange for and pay for the transportation. See billing instructions contained in the Hospital Supplemental Information on the Division website for additional information.