BestCare News & Updates

DRAFT policy language for an ALS definition:

Added: June 20, 2011

Texas Ambulance Association

Please see the new proposed ALS definition by HHSC. The Texas Ambulance Association is currently working on a position letter to oppose this definition. Please note the new definition does not allow providers to bill if only an ALS assessment is performed.

DRAFT policy language for an ALS definition: Our Ambulance is currently being reviewed as part of our routine policy maintenance schedule. There is an issue related to how Texas Medicaid defines advanced life support services (ALS) for ambulance companies. In 2009 we implemented new rates for ALS services. In 2010 questions were raised about Texas Medicaid’s definition for ALS services compared to Medicare’s definition. At the 2011 Annual Meeting of the Texas Ambulance Association I spoke about our ongoing policy discussions related to the definitions for ALS services contained in the Texas Health and Safety Code and the ALS definition stated in Texas ’ Medicaid medical policy.

Currently our medical policy definition for ALS services includes an assessment which makes our definition nearly identical to Medicare’s definition. Texas Health and Safety Code (HSC) definition for ALS services, however, is more restrictive than Medicare’s. The HSC definition is in Section 773 and simply states: “Advanced life support” means emergency prehospital care that uses invasive medical acts.”

Where the HSC’s definition is more strict than Medicare, our Medicaid policy must comply with the HSC. We are developing policy changes that incorporate the HSC language for ALS services that do not include an assessment. Draft language is below.
DRAFT policy language for an ALS definition
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Advanced Life Support, Level 1 (ALS 1) is emergency prehospital care that uses invasive medical acts
and at least one ALS intervention. An ALS intervention includes
at least one of the following interventions:
• Administration of IV fluids (except blood or blood products).
• Peripheral venous puncture.
• Blood drawing.
• Administration of approved medications by one of the following methods: intravenous,
subcutaneous, sublingual, nebulizer inhalation, intramuscular (limited to deltoid and
thigh sites only).
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