Submission of Rural Air Ambulance Protocols
CMS Change Request CR-3571, Medical Review of Rural Air Ambulance Services, states that air ambulance providers be notified that "the reasonable and necessary requirement for rural air transport shall be deemed to be met when such services are requested by a physician or other qualified medical personnel who reasonably determine or certify that the individual's condition is such that the time to transport by land poses a threat to the individual's survival or endangers their health; or the service is provided pursuant to an established State or regional emergency medical services agency protocol that has been approved by the Secretary."
Air ambulance providers that anticipate rural air ambulance transports pursuant to such a protocol must submit the written protocol to the contractor (WPS Medicare) for review and approval in advance to providing the services. Copies of the protocols can be sent to WPS Medicare by one of the following methods:
US Mail:
Sue Brewer
Provider Outreach and Education
P.O. Box 7758
Madison, WI 53707-7758
608-301-2765
Please indicate "Ambulance Protocol" on the lower left corner of the envelope.
E-mail:
MedicareAdmin@wpsic.com
Place "Ambulance Protocol" in the subject line.
Fax Number:
608-301-2625
Place "Ambulance Protocol" on the Cover Sheet.
ATTN: Sue Brewer
Please include a complete provider address and contact person information with your submission.
The contractor will review each protocol and send a decision to the provider within 30 days of receipt of the protocol. The review decision will be sent to the ambulance supplier by US Mail, e-mail or FAX.
For additional information regarding CR 3571, please reference:
http://www.cms.hhs.gov/Transmittals/downloads/R102PI.pdf (pdf - 9 pages; 49KB)
