10-22-12 Council Agenda & Packet

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AUTHENTICATED U.S.GOVERNMENT INFORMATION GPO Centers for Medicare&Medicaid Services, HHS §414.605 (A) The test is ordered by the pa- Subpart H—Fee Schedule for tient's physician at least 14 days fol- Ambulance Services lowing the date of the patient's dis- charge from the hospital; SOURCE: 67 FR 9132, Feb. 27, 2002, unless (B) The specimen was collected while otherwise noted. the patient was undergoing a hospital surgical procedure; §414.601 Purpose. (C) It would be medically inappro- This subpart implements section priate to have collected the sample 1834(1) of the Act by establishing a fee other than during the hospital proce- schedule for the payment of ambulance dure for which the patient was admit- services. Section 1834(1) of the Act re- ted; quires that, except for services fur- (D) The results of the test do not nished by certain critical access hos- guide treatment provided during the pitals (see §413.70(b)(5) of this chapter), hospital stay;and payment for all ambulance services, (E) The test was reasonable and otherwise previously payable on a rea- medically necessary for the treatment sonable charge basis or retrospective of an illness. reasonable cost basis, be made under a (ii)More than 30 calendar days before fee schedule. testing, the specimen is considered to §414.605 Definitions. have been archived and the date of As used in this subpart, the following service of the test must be the date the definitions apply to both land and specimen was obtained from storage. water (hereafter collectively referred (3)In the case of a chemotherapy sen- to as "ground") ambulance services sitivity test performed on live tissue, and to air ambulance services unless the date of service of the test must be otherwise specified: the date the test was performed only Advanced life support (ALS) assessment if— is an assessment performed by an ALS (i)The decision regarding the specific crew as part of an emergency response chemotherapeutic agents to test is that was necessary because the pa- made at least 14 days after discharge; tient's reported condition at the time (ii) The specimen was collected while of dispatch was such that only an ALS the patient was undergoing a hospital crew was qualified to perform the as surgical procedure; sessment. An ALS assessment does not (iii) It would be medically inappro- necessarily result in a determination y ppro- that the patient requires an ALS level priate to have collected the sample of service. other than during the hospital proce- Advanced life support (ALS) interven- dure for which the patient was admit- tion means a procedure that is, in ac- ted; cordance with State and local laws, re- (iv) The results of the test do not quired to be furnished by ALS per- guide treatment provided during the sonnet hospital stay;and, Advanced life support, level 1 (ALS1) (v)The test was reasonable and medi- means transportation by ground ambu- cally necessary for the treatment of an lance vehicle, medically necessary sup- illness. plies and services and either an ALS (4) For purposes of this section, assessment by ALS personnel or the "chemotherapy sensitivity test"means provision of at least one ALS interven- a test identified by the Secretary as a tion. test that requires a fresh tissue sample means Advanced life support, level 2 round to test the sensitivity of tumor cells to mebus either transportation by ground various chemotherapeutic agents. The ambulance vehicle, medically nec- various identifies such tests through adman supplies and least services, and the administration of at least three medi- program instructions. cations by intravenous push/bolus or [71 FR 69786, Dec. 1, 2006, as amended at 72 by continuous infusion, excluding crys- FR 66402,Nov.27,2007] talloid, hypotonic, isotonic, and hypertonic solutions(Dextrose, Normal 63