OAR 410-136-3180: Reimbursement for Ground and Air Ambulance Transports

(1) The following applies to how the Oregon Health Authority (Authority) shall reimburse providers of NEMT ground and air ambulance services that brokerages arrange for eligible clients. This applies to clients receiving services through the fee-for-service (FFS) delivery system or a Coordinated Care Organization (CCO). (2) FFS brokerages shall submit documentation to the Authority stating the brokerage authorized the transportation. The documentation also shall inform the Authority to reimburse at the Authority’s base rate or another amount the brokerage specifies. Ambulance providers shall bill the Authority for payment of authorized rides. (3) If brokerage does not specify another amount, the Authority’s reimbursement shall include: (a) The base rate established in the Authority’s fee schedule posted on the OHP Web page at www.oregon.gov/OHA/HSD/OHP/Pages/Fee-Schedule.aspx. (A) The base rate for NEMT ground ambulances includes: (i) Any procedures or services provided, all medications, non-reusable supplies or oxygen and all direct or indirect costs. “Indirect costs” include general operating costs, personnel costs, neonatal intensive care teams employed by the ambulance subcontractor, use of reusable equipment and any other miscellaneous medical items or special handling that may be required in the course of transport; (ii) The first ten miles for ground ambulance transports. (B) The base rate for NEMT air ambulances includes: (i) Any procedures or services provided, all medications, non-reusable supplies or oxygen and all direct or indirect costs. “Indirect costs” include general operating costs, personnel costs, neonatal intensive care teams employed by the ambulance subcontractor, use of reusable equipment and any other miscellaneous medical items or special handling that may be required in the course of transport; (ii) different rates shall apply for urban and rural using the statewide average adjustments for the geographic regions of Oregon at a percent of Medicare. This methodology includes the mileage rate reimbursed separately instead of included into the base rate. The urban and rural rates are defined by Zip Code-Point of Pick Up. (b) A modified base rate for each additional client, according to OAR 410-136-3220, Brokerage Reimbursements to Subcontractors, if applicable; (c) Payment for an extra attendant, if applicable; and (d) Compensation for service or care provided at the scene when the client did not require transport, if applicable. (4) Reimbursement outlined in section (3) of this rule also applies to the Authority’s reimbursements to providers of emergency ground or air ambulance services for clients who receive services through the fee-for-service delivery system. (5) A CCO is responsible for reimbursement to providers of emergency ground or air ambulance for clients who are CCO enrollees.