CMS Announces Nationwide Expansion of Ambulance Prior Authorization Model

On September 22, 2020, the Centers for Medicare & Medicaid Services (CMS) announced a nationwide expansion of the Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT). This model is estimated to save Medicare about $650 million over four years. This model will be the third to be deployed nationwide under the CMS Innovation Center’s authority to expand successful models.

The RSNAT Prior Authorization Model tests whether prior authorization saves Medicare money while maintaining or improving the quality of care for repetitive, scheduled non-emergency ambulance transportation. These services are covered under Medicare Part B for Medicare beneficiaries who need to ride in ambulances to certain medical appointments, most often for dialysis treatment.

The recently released Second Interim Report found that that the model reduced RSNAT service use by 63% and RSNAT expenditures by 72% among beneficiaries with end-stage renal disease and/or severe pressure ulcers during the first four years of the model. This decrease in RSNAT service expenditures, in turn, caused a total decrease of Medicare fee-for-service expenditures of 2% (about $650 million over four years). The report did not find evidence that the model adversely affected the quality of care.

Since 2014 the model has been currently running in New Jersey, Pennsylvania, and South Carolina; and since 2016 in North Carolina, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia. It will continue without interruption in the current states beyond December 1, 2020, when the model was originally scheduled to end. CMS will release more information on the national expansion and implementation dates for additional states as it becomes available.

More information is available in the fact sheet here and here.

 


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459/smadhani@mcdermottplus.com or Mara McDermott at 202-204-1462/mmcdermott@mcdermottplus.com.