Common use of Emergency Transportation Services Clause in Contracts

Emergency Transportation Services. 7.5.7.1 The Contractor shall arrange for the provision of Emergency Transportation Services, including maritime and ground transportation, in emergency situations. 7.5.7.2 Emergency Transportation Services shall be available twenty-four (24) hours a day, seven (7) days per week, in each municipality in each of the Contractor’s Service Regions, and throughout Puerto Rico. 7.5.7.3 Emergency Transportation Services do not require Prior Authorization. 7.5.7.4 The Contractor shall ensure that adequate Emergency Transportation is available to transport Enrollees with Emergency Medical Conditions, or whose conditions require Emergency Transportation because of their geographical location. 7.5.7.5 [Intentionally left blank]. 7.5.7.6 Aerial Emergency Transportation Services are not included in this Contract. ASES will provide aerial Emergency Transportation Services directly (without any role of the Contractor); provided, that the Contractor agrees to cooperate with any Provider subcontracted by ASES to render such services in the Service Regions. 7.5.7.7 The Contractor shall pay Claims for Emergency Transportation and shall adhere to Puerto Rico laws and regulations concerning Emergency Transportation, including fees. Fees paid by the Contractor for type 3 ambulances shall be $100 for the initial use, plus $1.50 for each mile traveled. The Contractor shall negotiate fees for the remaining categories. 7.5.7.8 The Contractor may not retroactively deny a Claim for Emergency Transportation Services because the Enrollee’s condition, which at the time of service appeared to be an Emergency Medical Condition under the prudent layperson standard, was ultimately determined to be non-emergency. 7.5.7.9 In any case in which an Enrollee is transported by ambulance to a facility that is not a Network Provider, and, after being stabilized, is transported by ambulance to a facility that is a Network Provider, all Emergency Transportation Claims, provided that they are justified by the definition of Emergency Services in this Contract prudent layperson standards, shall be paid by the Contractor. 7.5.7.10 The Contractor shall be responsible for timely payment for Claims for Emergency Transportation Services in the United States for Enrollees who are Medicaid or CHIP Eligible Persons, if the emergency transportation is associated with an Emergency Service in the United States covered under Section 7.5.9.3.1.2 of this Contract. If, in an extenuating circumstance, a Medicaid or CHIP Eligible Enrollee incurs out-of-pocket expenses for Emergency Transportation Services provided in the United States, the Contractor shall reimburse the Enrollee for such expenses within 30 days of receipt of such expenses, and the reimbursement shall be considered a Covered Service. 7.5.7.11 Emergency Transportation Services will be subject to periodic reviews by applicable governmental agencies to ensure quality of services.

Emergency Transportation Services. 7.5.7.1 The Contractor shall arrange for the provision of Emergency Transportation Services, including maritime and ground transportation, in emergency situations. 7.5.7.2 Emergency Transportation Services shall be available twenty-four (24) hours a day, seven (7) days per week, in each municipality in each of the Contractor’s Service Regions, and throughout Puerto Rico. 7.5.7.3 Emergency Transportation Services do not require Prior Authorization. 7.5.7.4 The Contractor shall ensure that adequate Emergency Transportation is available to transport Enrollees with Emergency Medical Conditions, or whose conditions require Emergency Transportation because of their geographical location. 7.5.7.5 [Intentionally left blank]. 7.5.7.6 Aerial Emergency Transportation Services are not included in part of the Covered Services under this Contract. ASES will provide aerial provide, at full risk, Aerial Emergency Transportation Services directly (without any role of through contract with the Contractor); provided, that the Contractor agrees to cooperate with any Provider subcontracted by ASES to render such services in the Service Regions“Cuerpo de Emergencias Médicas de Puerto Rico”. 7.5.7.7 The Contractor shall pay Claims for Emergency Transportation and shall adhere to Puerto Rico laws and regulations concerning Emergency Transportation, including fees. Fees paid by the Contractor for type 3 ambulances shall be $100 for the initial use, plus $1.50 for each mile traveled. The Contractor shall negotiate fees for the remaining categoriesEmergency Transportation Services subjecto to ASES’s approval. 7.5.7.8 The Contractor may not retroactively deny a Claim for Emergency Transportation Services because the Enrollee’s condition, which at the time of service appeared to be an Emergency Medical Condition under the prudent layperson standard, was ultimately determined to be non-emergency. 7.5.7.9 In any case in which an Enrollee is transported by ambulance to a facility that is not a Network Provider, and, after being stabilized, is transported by ambulance to a facility that is a Network Provider, all Emergency Transportation Claims, provided that they are justified by the definition of Emergency Services in this Contract prudent layperson standards, shall be paid by the Contractor. 7.5.7.10 The Contractor shall be responsible for timely payment for Claims for Emergency Transportation Services in the United States for Enrollees who are Medicaid or CHIP Eligible Persons, if the emergency transportation is associated with an Emergency Service in the United States covered under Section 7.5.9.3.1.2 of this Contract. If, in an extenuating circumstance, a Medicaid or CHIP Eligible Enrollee incurs out-of-pocket expenses for Emergency Transportation Services provided in the United States, the Contractor shall reimburse the Enrollee for such expenses within 30 days of receipt of such expenses, and the reimbursement shall be considered a Covered Service. 7.5.7.11 Emergency Transportation Services will be subject to periodic reviews by applicable governmental agencies to ensure quality of services.