Sec. 10.21.15.06. Payment Rates

The Department shall pay:

A. Hospitals, at rates approved by the Health Services Cost Review Commission;

B. Physicians, the lesser of the:

(1) Amount billed; or

(2) The Statewide average of prevailing charges for an examination by a physician consultant based on Medicare's 75th percentile as determined according to 42 CFR § 405.504; and

C. Transportation providers, if transportation is by:

(1) Ambulance, the lesser of the:

(a) Amount billed; or

(b) The Statewide average of prevailing charges for an ambulance based on Medicare's 75th percentile; or

(2) A law enforcement officer in an emergency vehicle:

(a) The cost per mile based on the county's established rates for emergency vehicles; and

(b) The cost of the law enforcement officer's hourly wage for the number of hours, not to exceed 4 hours, required to transport the emergency evaluee.