Prior Authorization Pilot Program – Status Update
CMS released preliminary data on the impact of the prior authorization demonstration program on Medicare payments for ambulance services. This data is limited to the three states (NJ, PA, and SC) that were included in the demonstration program’s first year.
CMS noted that it has observed a dramatic decrease in expenditures for repetitive non-emergency ambulance transports since the program’s implementation. CMS released the following data for the first 10 months of the program (i.e. December 2014 – September 2015), comparing that data to the first 11 months of 2014:
- Payments for repetitive non-emergency ambulance transportation in these states averaged $5.4 million per month, down from nearly $18.9 million per month prior to the program’s implementation. This is a reduction of more than 70%.
- In the states that were not part of the demonstration program, payments have decreased very slightly for the 10 months in 2014 and are very similar to the payments in the 11 months prior to the program beginning in SC, NJ and PA.
- 18,367 prior authorization requests were received and finalized by Medicare’s contractors. Of these, 6,430 (35.0%) were approved.
CMS is closely monitoring these results to evaluate its effectiveness. Here is the full status update.