R 418.101010 Reimbursement for air and ground ambulance services.

Rule 1010. (1) Reimbursement for air and ground ambulance services, when not provided by a hospital owned air or ground ambulance provider billing with the same tax identification number as the hospital, shall be determined by using the reimbursement rate published by CMS. The formula for determining the maximum allowable paid (MAP) for ambulance services is determined by multiplying the (Medicare rate) X (1.40). The MAP shall be published in the health care services fee schedule and shall utilize the practice expense (PE) of the geographical information (GPCI), which shall be a melded average using 60% of the figures published for the city of Detroit added to 40% of the figures published for the rest of this state. (2) The MAP for procedure codes A0425, A0430, A0431, A0435, and A0436 shall list 2 values for each procedure code, an urban and a rural MAP. Reimbursement is based on the zip code at the ambulance point of pick up and based on documented loaded patient mileage only. Urban or rural designations for each zip code shall be based on CMS and indicated on the agency website at www.michigan.gov. (3) The MAP for procedure codes A0426-A0429 and A0432-A0434 shall list 3 values for each procedure code, an urban, a rural, and a super-rural MAP. Reimbursement is based on the zip code at the ambulance point of pick up and based on documented loaded patient mileage only. Urban, rural, and super-rural designations for each zip code shall be based on CMS definitions and indicated on the agency website at www.michigan.gov. (4) Mileage shall be reimbursed per documented loaded patient miles and is expressed in statute mile. (a) For trips totaling up to 100 covered miles, the mileage shall be rounded up to the nearest tenth of a mile. (b) For trips totaling 100 covered miles or greater, mileage shall be rounded up to the nearest whole number mile without use of a decimal. (5) If the patient was pronounced dead by a legally authorized professional after the air or ground ambulance was dispatched but before the ambulance arrived at the scene, reimbursement shall be made for a fixed wing, rotary wing, or basic life support ground ambulance base rate, as applicable. Neither mileage nor a rural adjustment shall be paid. The base rate shall be indicated on the agency website at www.michigan.gov. (6) The MAP for procedure codes A0425-A0436 includes all items, services, and supplies associated with such transport, which shall not be unbundled and billed separately. (7) A hospital owned air or ground ambulance provider billing with the same tax identification number as the hospital shall be reimbursed based on the hospital’s cost-to-charge ratio, which shall be indicated on the agency website at https://www.michigan.gov/leo/0,5863,7- 336-94422_95508_26922---,00.html.