Medicare Standards Require Nursing Home Patients To Be Transported Safely

iStock_000010050829XSmall2Emergency medical and transportation services are a necessary component of a comprehensive medical care program. Ambulance services can be provided by: volunteer, municipal, private, independent and institutional providers. All providers must meet requirements set by State and local laws in order to ensure adequate services and safe transport.

According the U.S. Census Bureau, the population of people 65 and older is expected to double between 2000 and 2030. In the year 2020, there will be 10,000 people each day turning 65. As the population of people age 65 and older increases, there will be more people who require emergency medical and non-emergency transport services. Because many seniors have disabilities or limited mobility that make them particularly susceptable to injury during transport, it is important that companies strictly adhere the applicable standards of care.

Many seniors rely on medical transportation provided by nursing homes and private ambulance companies to get to vital services such as:

  • Physical therapy
  • Dialysis
  • Surgery
  • Doctors appointments

Some state legislatures, such as Illinois, have attempted to address the need for medical transportation in rural areas by passing legislation to increase the resources available for emergency and non-emergency transportation. The Illinois General Assembly (ILGA) passed the Regional Ambulance Services Law (55 ILCS 110) to improve the delivery of health care services in rural areas. This law allows regional ambulance systems the right to use private ambulance services to expand the regional ambulance services.

Private ambulances provide emergency medical and transport services. They transport patients from one hospital to another, to a nursing home, to another special-care center, from hospital to home, and they also answer emergency calls. In addition, some hospitals and nursing homes operate their own ambulances. Many private ambulances will deliver people to the hospital of their choice, unlike city ambulances which usually have to take people to a designated hospital, typically the nearest.

The only transportation service that Medicare (under Medicare Part B) pays for is ambulance services in severe medical situations such as life-threatening emergencies or when dealing with bedridden patients. However, Medicaid may pay for transportation services to get you to a medical appointment if you are eligible. In Chicago, the Chicago Department of Senior Service’s Transportation Program assists older adults who need medical transportation to receive life-sustaining treatments.

According to the Medicare Benefit Policy Manual, ambulances must be designed and equipped to respond to medical emergencies and transport patients in non-emergency situations. These ambulances must contain: a stretcher, linens, emergency medical supplies, oxygen equipment, other lifesaving emergency medical equipment and be equipped with: emergency warning lights, sirens, and telecommunications equipment.

Basic Life Support (BLS) ambulances must be staffed by at least two people, at least one of whom is certified as an emergency medical technician (EMT). Advance Life Support (ALS) vehicles must also be staffed by at least two people, one of whom is certified as an EMT-Intermediate or EMT-Paramedic. The ambulance must submit a statement and documentary evidence that the vehicle and crew meet all Medicare, State, and local requirements.

In order for Medicare to cover ambulance transport, the ambulance services must be “medically necessary and reasonable.” Ambulance transport is medically necessary when no other method of transportation could be used without endangering the health of the patient. This includes transport for patients who are bed-confined, which means that the patient is unable to get out of bed without assistance, unable to ambulate, and unable to sit in a chair or wheelchair. In addition, the medical transport must be to obtain or return from a Medicare covered service.

Furthermore, Medicare only covers ambulance transports to the nearest appropriate facility, as well as return transport. This means that you cannot always be transported to your personal physician or hospital of choice, if it is not the closest reasonable facility. Medicare covers transport to the following destinations: hospital, critical access hospital (CAH), skilled nursing facility (SNF), beneficiary’s home, and dialysis facility.

The Medicare Fee Schedule (FS) applies to app ambulance services including volunteer, municipal, private, independent and institutional providers. The FS equals a base rate for the level of service plus payment for mileage and applicable adjustment factors.

Oftentimes, ambulance transport of nursing home residents qualifies under Medicare coverage because the transport is medically necessary or the resident is confined to a bed. Medicare does not have a pre-authorization process for ambulance services to determine whether Medicare coverage may apply. Therefore, nursing home facilities must be familiar with Medicare requirements to ensure that a resident does not incur additional costs.

Regardless of the circumstances in which you utilize medical transport services, you have a right to be transported safely.  If you believe that your injury is related to negligence during medical transport, we will use the applicable laws in your area to work for you.  Put our experience representing people who have suffered an injury during medical transport to work for you today.  Free consultations with experienced lawyers.  (800) 926-7565

For laws related to Illinois nursing homes, look here.


Illinois General Assembly: Regional Ambulance Services Law

New York Times: Private Ambulances, When to Use Them

Medicare Benefit Policy Manual: Ch. 10 Ambulance Services

Contact Information
Segment Pixel