11-26-12 Council Agenda & Packet

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§414.605 42 CFR Ch. IV(10-1-10 Edition) Saline, Ringer's Lactate): or transpor- ambulance entity begins as quickly as tation, medically necessary supplies possible to take the steps necessary to and services, and the provision of at respond to the call. least one of the following ALS proce- Fixed wing air ambulance (FW) means duress transportation by a fixed wing aircraft (1) Manual defibrillation/ that is certified as a fixed wing air am- cardioversion. bulance and such services and supplies (2)Endotracheal intubation. as may be medically necessary. (3)Central venous line. Geographic adjustment factor (GAF) (4)Cardiac pacing, means,the practice expense (PE) por- (5)Chest decompression. tion of the geographic practice cost (6)Surgical airway. index (GPCI) from the physician fee (7)Intraosseous line. schedule as applied to a percentage of Advanced life support (ALS) personnel the base rate. For ground ambulance means an individual trained to the services, the PE portion of the GPCI is level of the emergency medical techni- applied to 70 percent of the base rate cian-intermediate (EMT-Intermediate) for each level of service. For air ambu- or paramedic. The EMT-Intermediate lance services, the PE portion of the is defined as an individual who is quali- GPCI is applied to 50 percent of the ap- fied, in accordance with State and plicable base rate. local laws, as an EMT-Basic and who is Loaded mileage means the number of also qualified in accordance with State miles the Medicare beneficiary is and local laws to perform essential ad- transported in the ambulance vehicle. vanced techniques and to administer a Paramedic ALS intercept (P1) means limited number of medications. The EMT-Paramedic services furnished by EMT-Paramedic is defined as pos- an entity that does not furnish the sessing the qualifications of the EMT- ground ambulance transport, provided Intermediate and also, in accordance the services meet the requirements with State and local laws, as having specified in§410.40(c)of this chapter. enhanced skills that include being able Point of pick-up means the location of to administer additional interventions the beneficiary at the time he or she is and medications. placed on board the ambulance. Basic life support (BLS) means trans- Relative value units (RVUs) means a portation by ground ambulance vehicle value assigned to a ground ambulance and medically necessary supplies and service. services, plus the provision of BLS am- Rotary wing air ambulance (RW) bulance services. The ambulance must means transportation by a helicopter be staffed by an individual who is that is certified as an ambulance and qualified in accordance with State and such services and supplies as may be local Iaws as an emergency medical medically necessary. technician-basic (EMT-Basic). These Rural adjustment factor (RAF) means laws may vary from State to State. an adjustment applied to the base pay- For example, only in some States is an ment rate when the point of pick-up is EMT-Basic permitted to operate lim- located in a rural area. ited equipment on board the vehicle, Rural area means an area located out- assist more qualified personnel in per- side an urban area, or a rural census forming assessments and interventions, tract within a Metropolitan Statistical and establish a peripheral intravenous Area as determined under the most re- (IV)line. cent version of the Goldsmith modi- Conversion factor (CF) is the dollar fication as determined by the Office of amount established by CMS that is Rural Health Policy of the Health Re- multiplied by relative value units to sources and Services Administration. produce ground ambulance service base Specialty care transport (SCT) means rates. interfacility transportation of a criti- Emergency response means responding cally injured or ill beneficiary by a immediately at the BLS or ALS1 level ground ambulance vehicle, including of service to a 911 call or the equivalent medically necessary supplies and serv- in areas without a 911 call system. An ices, at a level of service beyond the immediate response is one in which the scope of the EMT-Paramedic. SCT is 64