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8.3.1 Emergency Ambulance Transport Services
An emergency ambulance transport service is a benefit when the client has an emergency medical condition. An emergency medical condition is defined, according to 1 TAC §354.1111, as a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances, or symptoms of substance abuse) such that a prudent layperson with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in one of the following:
| a) |
Placing the client's health (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy. |
| b) |
Serious impairment to bodily functions. |
| c) |
Serious dysfunction of any bodily organ or part. |
Facility-to-facility transfers are appropriate as emergencies when the client has an emergency medical condition that the first facility is unable to treat.
The transport must be to an appropriate facility. An appropriate facility is the nearest medical facility that is equipped to provide medical care for the illness or injury of the client involved. An appropriate facility includes the institution, equipment, personnel, and capability to provide the services necessary to support the required medical care.
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