Ill. Admin. Code tit. 89, § 140.492 - Payment for Medical Transportation
Notwithstanding the provisions set forth in subsections (a) through (h), beginning July 1, 2002, the reimbursement rates paid for medical transportation services shall be the lesser of the provider's usual and customary charge to the general public or 94 percent of the fiscal year 2002 rate otherwise determined by the Department under this Section. Notwithstanding Section 140.405, beginning with date of service July 1, 2013 and thereafter, the Department's established maximum rate for ambulance services shall be equivalent to 100% of the rate in effect on June 30, 2012, as reflected on the Department's Fee Schedule, except when a rate that is higher than the rate in effect on June 30, 2012 is specified in subsection (h). Payment for medical transportation services shall be made in accordance with the methodologies outlined in this Section. Base rate reimbursement is determined by the county in which the vehicle is, or the vehicles are, based. In no case shall rates exceed the Medicare allowable, where applicable, or the rates charged to the general public.
a) For dates of service prior to July 1,
2006, medi-car providers shall be paid a base rate, which includes the first
ten miles (20 miles round trip), a mileage rate and a fixed amount for an
employee or non-employee attendant. Loaded miles, i.e., those miles for which
the provider is actually transporting an individual, after ten miles (20 miles
round trip) shall be reimbursed.
b)
For dates of service prior to July 1, 2006, service car providers shall be paid
a base rate, which includes the first ten miles (20 miles round trip), a
mileage rate and a fixed amount for a non-employee attendant. Loaded miles,
i.e., those miles for which the provider is actually transporting an
individual, after ten miles (20 miles round trip) shall be
reimbursed.
c) For dates of service
on or after July 1, 2006, medi-car providers and service car providers shall be
paid at a base rate, a mileage rate and a fixed amount for an attendant.
Payment for an attendant is subject to the requirements in Section
140.490(e)(5).
Mileage reimbursement is made for loaded miles, i.e., those miles for which the
provider is actually transporting an individual. Mileage for multiple
passengers is reimbursed pursuant to Section
140.490(d).
d) Private auto providers shall be paid for
loaded miles at a mileage rate.
e)
Payment for transportation services provided by common carrier, such as
commercial airplanes, buses and trains, shall be at the usual community
rate.
f) Taxicabs in an area
regulated by a municipality or township shall be reimbursed at the community
rate and a fixed amount for an attendant. Payment for an attendant is subject
to the requirements in Section
140.490(e).
g) Taxicabs in non-regulated areas shall be
reimbursed at a rate as determined by the Department and a fixed amount for an
attendant. Payment for an attendant is subject to the requirements in Section
140.490(e). The
Department rate shall be reviewed on an annual basis each July.
h) The Department shall pay for medically
necessary ambulance services provided in accordance with Section
140.490 at a base, mileage rate
(loaded miles) and a rate for oxygen, as appropriate. Payment shall also be
made for Advanced Life Support (ALS) at an all inclusive rate, which includes
the base rate, supplies, and all other services, excluding mileage. However,
for ALS services provided on or after July 1, 1993, separate reimbursement
shall be made for oxygen when used and appropriately billed. Loaded miles for
ALS trips shall be reimbursed at the per mile rate. Payment shall also be made
for Specialty Care Transport (SCT). Rates shall be reviewed beginning November
1, 1986, and each November thereafter, according to the methodology set forth
in subsections (h)(1) through (5). Revised rates pursuant to this methodology
shall be effective with services provided on or after July 1 of the succeeding
year.
1) Payment shall be made at a basic
rate for Basic Life Support (BLS) services that is provider specific. The basic
rate shall be the lesser of the provider's usual and customary charge to the
general public, as reflected on the provider's claim form, or 80 percent of the
50th percentile of the Medicare prevailing charge
for Basic Life Support for the designated Medicare Locality, except that any
basic rate previously approved by the Department that exceeds these parameters
shall remain in force. The rate of annual increase shall not exceed five
percent. Beginning with dates of service July 1, 2018 and thereafter, the
Department's established maximum rate for BLS services shall be equivalent to
112% of the rate in effect on June 30, 2018, as reflected on the Department's
Fee Schedule.
2) Payment for loaded
miles shall be at a rate per mile. If a natural disaster, weather or other
conditions necessitate the use of a route other than the most direct route,
reimbursement will be based on the actual distance traveled. The rate per mile
shall be 50 percent of the 50th percentile of the
Medicare prevailing mileage charge for Medicare Locality 16. The annual rate of
increase shall not exceed five percent. Beginning with dates of service July 1,
2018 and thereafter, regardless of the county in which the vehicle is based,
loaded miles shall be paid at the lesser of the provider's usual and customary
charge to the general public, as reflected on the provider's claim, or the
Department's established rate of $5.60 per mile, as reflected on the
Department's Fee Schedule.
3)
Payment for oxygen shall be made at a flat rate statewide. The rate shall be 50
percent of the 50th percentile of the Medicare
prevailing charge for Medicare Locality 16. The annual rate of increase shall
not exceed five percent.
4) Payment
for Advanced Life Support (ALS) services shall be at the lesser of the
provider's usual charge, or a maximum allowable rate statewide. The maximum
rate shall be 80 percent of the difference between the Medicare
50th percentile prevailing charge for Basic Life
Support services and Advanced Life Support services for Medicare Locality 16.
The annual rate of increase shall not exceed five percent. Beginning with dates
of service July 1, 2018 and thereafter, the Department's established maximum
rate for ALS services shall be equivalent to 112% of the rate in effect on June
30, 2018, as reflected on the Department's Fee Schedule.
5) Beginning with dates of service July 1,
2018 and thereafter, payment for SCT shall be made at the lesser of the
provider's usual and customary charge to the general public, as reflected on
the provider's claim, or the Department's established rate, which is equivalent
to 112% of the ALS rate in effect on June 30, 2018, as reflected on the
Department's Fee Schedule.
i) Payment for medical transportation
services provided by individuals, including those currently receiving public
assistance, legally responsible relatives or household members, will be made at
a loaded mileage rate.
j) The
Department may adjust reimbursement for medical transportation services in a
county when such adjustment is necessary to ensure the availability of
transportation to medical services.
Notes
Amended at 37 Ill. Reg. 20339, effective December 9, 2013
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
Notwithstanding the provisions set forth in subsections (a) through (h), beginning July 1, 2002, the reimbursement rates paid for medical transportation services shall be the lesser of the provider's usual and customary charge to the general public or 94 percent of the fiscal year 2002 rate otherwise determined by the Department under this Section. Notwithstanding Section 140.405, beginning with date of service July 1, 2013 and thereafter, the Department's established maximum rate for ambulance services shall be equivalent to 100% of the rate in effect on June 30, 2012, as reflected on the Department's Fee Schedule, except when a rate that is higher than the rate in effect on June 30, 2012 is specified in subsection (h). Payment for medical transportation services shall be made in accordance with the methodologies outlined in this Section. Base rate reimbursement is determined by the county in which the vehicle is, or the vehicles are, based. In no case shall rates exceed the Medicare allowable, where applicable, or the rates charged to the general public.
a) For dates of service prior to July 1, 2006, medicar providers shall be paid a base rate, which includes the first ten miles (20 miles round trip), a mileage rate and a fixed amount for an employee or non-employee attendant. Loaded miles, i.e., those miles for which the provider is actually transporting an individual, after ten miles (20 miles round trip) shall be reimbursed.
b) For dates of service prior to July 1, 2006, service car providers shall be paid a base rate, which includes the first ten miles (20 miles round trip), a mileage rate and a fixed amount for a non-employee attendant. Loaded miles, i.e., those miles for which the provider is actually transporting an individual, after ten miles (20 miles round trip) shall be reimbursed.
c) For dates of service on or after July 1, 2006, medicar providers and service car providers shall be paid at a base rate, a mileage rate and a fixed amount for an attendant. Payment for an attendant is subject to the requirements in Section 140.490(e)(5). Mileage reimbursement is made for loaded miles, i.e., those miles for which the provider is actually transporting an individual. Mileage for multiple passengers is reimbursed pursuant to Section 140.490(d).
d) Private auto providers shall be paid for loaded miles at a mileage rate.
e) Payment for transportation services provided by common carrier, such as commercial airplanes, buses and trains, shall be at the usual community rate.
f) Taxicabs in an area regulated by a municipality or township shall be reimbursed at the community rate and a fixed amount for an attendant. Payment for an attendant is subject to the requirements in Section 140.490(e).
g) Taxicabs in non-regulated areas shall be reimbursed at a rate as determined by the Department and a fixed amount for an attendant. Payment for an attendant is subject to the requirements in Section 140.490(e). The Department rate shall be reviewed on an annual basis each July.
h) The Department shall pay for medically necessary ambulance services provided in accordance with Section 140.490 at a base, mileage rate (loaded miles) and a rate for oxygen, as appropriate. Payment shall also be made for Advanced Life Support (ALS) at an all inclusive rate, which includes the base rate, supplies, and all other services, excluding mileage. However, for ALS services provided on or after July 1, 1993, separate reimbursement shall be made for oxygen when used and appropriately billed. Loaded miles for ALS trips shall be reimbursed at the per mile rate. Payment shall also be made for Specialty Care Transport (SCT). Rates shall be reviewed beginning November 1, 1986, and each November thereafter, according to the methodology set forth in subsections (h)(1) through (5). Revised rates pursuant to this methodology shall be effective with services provided on or after July 1 of the succeeding year.
1) Payment shall be made at a basic rate for Basic Life Support (BLS) services that is provider specific. The basic rate shall be the lesser of the provider's usual and customary charge to the general public, as reflected on the provider's claim form, or 80 percent of the 50th percentile of the Medicare prevailing charge for Basic Life Support for the designated Medicare Locality, except that any basic rate previously approved by the Department that exceeds these parameters shall remain in force. The rate of annual increase shall not exceed five percent. Beginning with dates of service July 1, 2018 and thereafter, the Department's established maximum rate for BLS services shall be equivalent to 112% of the rate in effect on June 30, 2018, as reflected on the Department's Fee Schedule.
2) Payment for loaded miles shall be at a rate per mile. If a natural disaster, weather or other conditions necessitate the use of a route other than the most direct route, reimbursement will be based on the actual distance traveled. The rate per mile shall be 50 percent of the 50th percentile of the Medicare prevailing mileage charge for Medicare Locality 16. The annual rate of increase shall not exceed five percent. Beginning with dates of service July 1, 2018 and thereafter, regardless of the county in which the vehicle is based, loaded miles shall be paid at the lesser of the provider's usual and customary charge to the general public, as reflected on the provider's claim, or the Department's established rate of $5.60 per mile, as reflected on the Department's Fee Schedule.
3) Payment for oxygen shall be made at a flat rate statewide. The rate shall be 50 percent of the 50th percentile of the Medicare prevailing charge for Medicare Locality 16. The annual rate of increase shall not exceed five percent.
4) Payment for Advanced Life Support (ALS) services shall be at the lesser of the provider's usual charge, or a maximum allowable rate statewide. The maximum rate shall be 80 percent of the difference between the Medicare 50th percentile prevailing charge for Basic Life Support services and Advanced Life Support services for Medicare Locality 16. The annual rate of increase shall not exceed five percent. Beginning with dates of service July 1, 2018 and thereafter, the Department's established maximum rate for ALS services shall be equivalent to 112% of the rate in effect on June 30, 2018, as reflected on the Department's Fee Schedule.
5) Beginning with dates of service July 1, 2018 and thereafter, payment for SCT shall be made at the lesser of the provider's usual and customary charge to the general public, as reflected on the provider's claim, or the Department's established rate, which is equivalent to 112% of the ALS rate in effect on June 30, 2018, as reflected on the Department's Fee Schedule.
i) Payment for medical transportation services provided by individuals, including those currently receiving public assistance, legally responsible relatives or household members, will be made at a loaded mileage rate.
j) The Department may adjust reimbursement for medical transportation services in a county when such adjustment is necessary to ensure the availability of transportation to medical services.
Notes
Amended at 37 Ill. Reg. 20339, effective December 9, 2013