CMS “Pauses” Prior Authorization Model for Scheduled, Repetitive Non-Emergency Ambulance Transportation

CMS released published a guidance document summarizing some of the steps that it has taken to relieve the administrative burden on health care providers and suppliers during the current public health emergency.  As part of that document, CMS indicated that it will be “pausing” the Prior Authorization Model for scheduled, repetitive non-emergency ambulance transports.  Under this program, ambulance suppliers are required to seek and obtain prior authorization for the transportation of repetitive patients beyond the third round-trip in a 30-day period.  Absent prior authorization, claims will be stopped for pre-payment review.  The Prior Authorization Model is currently in place in Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, West Virginia, and the District of Columbia. CMS indicated that this pause went into effect as of March 29, 2020, and will continue for as long as the current public health emergency continues.  During this pause, claims for repetitive, scheduled, non-emergency transports will not be stopped for pre-payment review if the prior authorization has not been requested and obtained prior to the fourth round-trip.  However, CMS indicated that claims submitted and paid during the pause without prior authorization will be subject to postpayment review. CMS further indicated that during this...

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40 Under 40: Alan Brook (New Hanover Regional Medical Center – Wilmington, NC)

40 Under 40 nominees were selected based on their contributions to the American Ambulance Association, their employer, state ambulance association, other professional associations, and/or the EMS profession. ____ Alan Brook Lieutenant / Field Training Officer New Hanover Regional Medical Center Wilmington, NC ____ LinkedIn | Twitter Nominated by: Benjamin Calhoun (New Hanover Regional Medical Center – Wilmington, NC) ____ Biography: Alan Brook has been a Paramedic in the Southeastern North Carolina region for 13 years. Alan currently serves as a Field Training Officer for New Hanover Regional Medical Center’s EMS division, which has recently ranked as the best EMS services in the nation by EMS World. When Alan isn’t providing patient care, he can frequently be found at the local community college, where he serves as a part time instructor for the paramedic program. In his free time, Alan enjoys an active lifestyle and often competes in half marathons, scuba diving, and Olympic weight lifting. ____ Reason for Nomination: Alan developed a passion for “taking care of his own” after a coworker committed suicide. In 2014, Alan focused on the well-being of his peers, and went to training for Critical Incident Stress Management. Alan has since taken part in (and (more…)

40 Under 40: Joshua Holloman (Johnston County Emergency Services – Clayton, NC)

40 Under 40 nominees were selected based on their contributions to the American Ambulance Association, their employer, state ambulance association, other professional associations, and/or the EMS profession. ____ Joshua Holloman Deputy Director Johnston County Emergency Services Clayton, NC ____ LinkedIn | Twitter Nominated by: Emily Johnson (Johnston County Emergency Services – Smithfield, NC) ____ Biography: Joshua B. Holloman, MHS, NRP, CEMSO, is the Deputy Director of Johnston County Emergency Services in North Carolina. Josh is a certified paramedic, firefighter, and Emergency Medical Dispatch instructor. Josh is an advocate for increasing education, professionalism, and leadership within emergency services. Josh obtained an associate of applied science degree in EMS from Wake Technical Community College in Raleigh, N.C. and attended Western Carolina University, obtaining a Bachelor of Science and a Master of Health Sciences degree. Holloman has served Johnston County in positions including Cadet, EMT, Paramedic, Training Officer, and Division Chief, prior to becoming Deputy Director for the Emergency Services Department. ____ Reason for Nomination: Josh Holloman is a constant professional who deserves to be recognized as an inaugural recipient of the Mobile Healthcare 40 under 40. Josh has played a significant role in the development of the local EMS system in Johnston (more…)

CMS Announces Comment Period for National Expansion of Prior Authorization Process

On October 29, 2019, the Centers for Medicare and Medicaid Services (CMS) posted a notice in the Federal Register announcing an opportunity for the public to provide comments on the proposed national expansion of the prior authorization process for repetitive, scheduled non-emergent ground ambulance transportation.  CMS refers to this process as its “RSNAT Prior Authorization Model.”  The CMS Notice can be viewed in its entirety at: https://www.govinfo.gov/content/pkg/FR-2019-10-29/pdf/2019-23584.pdf. Under the Paperwork Reduction Act of 1995, federal agencies are required to publish a notice in the Federal Register concerning each proposed collection of information, and to allow 60 days for the public to comment on the proposed action.  Interested parties are encouraged to provide comments regarding the agency’s burden estimates and other aspects of the proposed collection of information, including the necessity and utility of the proposed information for the proper performance of the agency’s functions, and ways in which the collection of such information can be enhanced. In this instance, CMS is indicating that it is pursuing approval to potentially expand the existing RSNAT Prior Authorization Model nationwide.  Currently, the RSNAT Prior Authorization Model is in place in 8 states (DE, MD, NJ, NC, PA, SC, VA, and WV) and the...

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2019 AMBY Award Winners Announced

The American Ambulance Association is proud to announce the recipients of the 2019 AMBY Awards. The AMBYs highlight excellence in EMS and the ingenuity and entrepreneurial spirit that epitomize  mobile healthcare. The mission of the awards is to showcase creativity and innovation in the ambulance industry by fostering a culture of collaboration, cooperation, and a passion for excellence in patient care. This year’s awards will be presented at the Annual Conference & Trade Show Awards Reception on November 5 in Nashville. Please join us in congratulating our 2019 winners! Clinical Outcome Program Medic Ambulance Service Inc. CPR Initiative Community Impact Program Advanced Medical Transport CPR Race to the Top American Medical Response (Manchester/Nashua, NH) Safe Station Project Sunstar Paramedics Health & Safety Fair Employee Programs American Medical Response (Buffalo, NY) Recruitment/Training Program Northstar EMS, Inc Medical Director Engagement Through Technology Public Relations Campaign Acadian Ambulance Service Hometown Hero Initiative Mecklenburg EMS Agency Bystander CPR Initiative With Pulsepoint Once again, join us in celebrating the 2019 winners! Learn more about the AMBYs.

CMS Announces Extension of Prior Authorization Program

On September 16, 2019, CMS published a notice in the Federal Register that it would be extending the prior authorization demonstration project for another year. The extension is limited to those states where prior authorization was in effect for calendar year 2019. The affected states are Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia and West Virginia, as well as the District of Columbia. The extension will run through December 1, 2020.  In its notice, CMS indicated that the prior authorization demonstration project is being extended “while we continue to work towards nationwide expansion.”  This strongly suggests that CMS believes the program has met the statutory requirements for nationwide expansion under the Medicare Access and CHIP Reauthorization Act of 2015.  However, CMS indicated that it would use the additional year to continue to test whether prior authorization helps reduce expenditures, while maintaining or improving the quality of care offered to Medicare beneficiaries. CMS has also updated its CMS Ambulance Prior Authorization webpage to reflect the expansion of prior authorization in the existing states through December 1, 2020....

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CMS Announces Extension of Prior Authorization Program

On November 30, 2018, CMS issued a notice on its website that it would be extending the prior authorization demonstration project for another year. The extension is limited to those states where prior authorization was in effect for calendar year 2018. The affected states are Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia and West Virginia, as well as the District of Columbia. The extension will run through December 1, 2019.  CMS indicated that the extension will provide it with an additional year to evaluate the prior authorization program, and to determine whether the program meets the statutory requirements for nationwide expansion under the Medicare Access and CHIP Reauthorization Act of 2015. CMS has also updated its Ambulance Prior Authorization FAQs and its Physician/Practitioner Letter to reflect the expansion of the program. The updated FAQ and Physician Letter can be downloaded from the CMS Ambulance Prior Authorization webpage by clicking here....

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Talking Medicare: CMS Implements Further Dialysis Cuts

Talking Medicare: CMS Implements Further Cuts in Reimbursement for Dialysis Services; Medicare Payment Data Shows Continued Reduction in Overall Spending on Dialysis Transports, but Net Increase in Dialysis Payments in Prior Authorization States On October 1, 2018, CMS implemented an additional thirteen (13%) cut in reimbursement for non-emergency BLS transports to and from dialysis. This cut in reimbursement was mandated by Section 53108 of the Bipartisan Budget Act of 2018. This on top of a ten (10%) cut in reimbursement for dialysis transports that went into effect on October 1, 2013. As a result, BLS non-emergency ambulance transports to and from dialysis that occur on or after October 1, 2018 will be reimbursed at 77% of the applicable Medicare allowable. The payment reduction is partially the result of the reduction in the amounts paid for dialysis services. However, it is also reflective of an overall decline in the number of approved dialysis transports. For this, we can look primarily to the impact of a four-year demonstration project that requires prior authorization of dialysis transports in 8 states and the District of Columbia. As a reminder, the original prior authorization states were selected based on higher-than-average utilization rates and high rates of...

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2018 AMBY Award Winners Announced

The American Ambulance Association is proud to announce the recipients of the 2018 AMBY Awards. The AMBYs highlight excellence in EMS and the ingenuity and entrepreneurial spirit that epitomize AAA members. The mission of the awards is to showcase creativity and innovation in the ambulance industry by fostering a culture of collaboration, cooperation and a passion for excellence in patient care. This year’s awards will be presented at the Annual Conference & Trade Show Awards Reception on September 7, 2018. Please join us in congratulating our 2018 winners! Clinical Outcome Program Medic Ambulance Service, Inc. | Vallejo, CA Community Impact Program NorthStar EMS, Inc. | Tuscaloosa, AL Employee Programs Hall Ambulance Service, Inc. | Bakersfield, CA Innovation in EMS Priority Ambulance | Knoxville, TN Mercy Ambulance Service, Inc. | Savannah, GA Public Relations Campaign MEDIC EMS Agency | Charlotte, NC Hall Ambulance Service, Inc. | Bakersfield, CA Quality Improvement Program Sunstar Paramedics | Largo, FL Patient and Employee Safety Program Priority Ambulance | Knoxville, TN Once again, join us in celebrating the 2018 winners! Learn more about the AMBYs.  

Update on Medicare Reimbursement Issues

The AAA would like to take this opportunity to update members on a number of issues related to Medicare reimbursement: CMS and its contractors have begun adjusting claims for ground ambulance services to reflect the restoration of the temporary add-ons. Section 50203(a) of the Bipartisan Budget Act of 2018 retroactively reinstated the temporary add-ons for ground ambulance services. These add-ons increase the applicable Medicare allowables by 2% in urban areas, 3% in rural areas, and 22.6% in “super rural” areas (over and above the corresponding rural rate), retroactive to January 1, 2018. On a March 7, 2018 Open Door Forum, CMS indicated that it had updated the Medicare Ambulance fee schedule to reflect these higher rates, and that it has provided a Change Request to each of its Medicare Administrative Contractors (MACs). The AAA has confirmed that all MACs have successfully implemented the new rates, and that all are paying current claims at the correct rate. The AAA has further confirmed that MACs have started to adjust 2018 claims paid at the original (lower) rates. Unfortunately, neither CMS nor its MACs have committed to a firm timetable for the completion of all required adjustments; however, a number of MACs have...

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First Interim Evaluation Report on Medicare Prior Authorization

Talking Medicare: First Interim Evaluation Report on Medicare Prior Authorization (An 80-page report confirming what you already likely suspected) On February 28, 2018, the Centers for Medicare and Medicaid Services (CMS) posted an interim report on its prior authorization demonstration project for repetitive, scheduled, non-emergent ambulance transportation. The report, titled First Interim Evaluation Report of the Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT), was conducted by Mathematica Policy Research, a nonpartisan think tank. Mathematica studied the impact of the prior authorization model on Medicare payments, ambulance utilization, and patient quality of care. Background CMS implemented the prior authorization demonstration project in December 2014 in three states: New Jersey, Pennsylvania, and South Carolina (referred to in the report as “Year 1 States”). These states were selected based on higher-than-average utilization rates and high rates of improper payment for these services. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) subsequently expanded the demonstration project to five additional states (Delaware, Maryland, North Carolina, Virginia, and West Virginia) and the District of Columbia on January 1, 2016 (referred to in the report as “Year 2 States”). The goal of the demonstration project was to study the impact of...

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CMS Extends Prior Authorization for 2018

CMS Announces Extension of Prior Authorization for Repetitive Non-Emergency Ground Ambulance Transports On December 4, 2017, CMS posted a notice on its website indicating that it would be extending the prior authorization demonstration project for another year. The extension is limited to those areas where prior authorization was in effect for calendar year 2017. The affected states are Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia, as well as the District of Columbia. The extension will run through December 1, 2018. In its notice, CMS indicated that claims with dates of service between December 2 and December 4, 2017 would not be subject to prior authorization or prepayment review, but that ambulance providers could elect to submit a request for prior authorization for these transports. All repetitive non-emergency transports on or after December 5, 2017 would require prior authorization.

Navigating a Post-Prior Authorization World

Talking Medicare: Navigating a Post-Prior Authorization World Novitas Solutions, Inc. recently announced that it will no longer issue prior authorizations for scheduled, repetitive non-emergency transports, effective December 1, 2017. This announcement was based on Novitas’ expectation that the demonstration project will expire at the end of this calendar year. For ambulance suppliers in the states that currently operate under prior authorization, the focus invariably turns to what that means for their repetitive patient populations? First a little background. In May 2014, CMS announced the implementation of a three-year prior authorization demonstration project for repetitive scheduled non-emergency ambulance transports. This demonstration project was initially limited to the states of New Jersey, Pennsylvania, and South Carolina. These states were selected based on higher-than-average utilization rates and high rates of improper payment for these services. In particular, the Medicare Payment Advisory Commission (MedPAC) had singled out these states as having higher-than-average utilization of dialysis transports in a June 2013 report to Congress. As initially conceived, the prior authorization demonstration project first went into effect on December 15, 2014. Congress subsequently elected to expand this demonstration project to additional states as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Specifically,...

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POTUS Signs DEA Standing Orders Bill into Law

On Friday, President Trump signed H.R. 304, the Protecting Patient Access to Emergency Medications Act of 2017, into law. H.R. 304 also known as the DEA Standing Orders Bill is an issue that the AAA has been working on closely for over a year. This new law will “improve the Drug Enforcement Administration (DEA) registration process for emergency medical services (EMS) agencies, and clarify that EMS professionals are permitted to administer controlled substances pursuant to standing or verbal orders when certain conditions are met.” On the passage of H.R. 304, AAA President Mark Postma stated: “the enactment of H.R. 304 ensures that paramedics, EMTs and other emergency medical professionals may continue to administer vital and often life-saving medications to patients. The AAA applauds Congressmen Hudson and Butterfield and Senators Cassidy and Bennet for their successful efforts on this critical issue.” Special thanks to Rep. Hudson (R-NC-08) for authoring the Bill, and to Rep. Butterfield (D-NC-01), Sen. Bill Cassidy (R-LA) and Sen. Michael Bennet (D-CO) for sponsoring this legislation. Additional thanks to Chairman Greg Walden (R-OR-2) for his continued support. H.R. 304 will help to ensure that ambulance service providers are able to continue providing life saving services throughout the country. The AAA would (more…)

2017 AMBY Winner: MEDIC EMS Agency

MEDIC EMS Agency Named 2017 AMBY Award Winner Contact: Jessica Marvin Telephone: 703-610-9018 Email: jmarvin@ambulance.org Washington, DC– McLean, VA — The American Ambulance Association (AAA) has named MEDIC EMS Agency (North Carolina) a recipient of two 2017 AMBY Awards. Each year, the AMBYs highlight excellence in EMS and the ingenuity and entrepreneurial spirit that epitomize AAA members. MEDIC EMS Agency is being recognized with AMBY Awards in the Employee Programs and Quality Improvement Programs categories. MEDIC EMS achieved the Employee Programs honor through the creation of the Night of Honor event, which recognized more than 400 employees, friends, family members and survivors. In the Quality Improvement Programs category, MEDIC EMS demonstrated excellence through an employee-led program to revamp its ambulance design. Representatives from MEDIC EMS Agency will receive their AMBY at the AAA Awards Reception during the 2017 Annual Conference & Tradeshow in Las Vegas. The mission of the AMBY Awards is to showcase creativity and innovation in the ambulance industry by fostering a culture of collaboration, cooperation and a passion for excellence in patient care. For additional information about the AMBY Awards or how to submit a nomination for next year, visit https://ambulance.org/amby-awards/. XXX About the American Ambulance Association (more…)

Talking Medicare: Prior Authorization Spending Update

Prior Authorization Data Shows Continued Reduction in Overall Spending on Dialysis Transports; Pendulum Swings Back Slightly in New Jersey and Pennsylvania In May 2014, CMS announced the implementation of a three-year prior authorization demonstration project for repetitive scheduled non-emergency ambulance transports. This demonstration project was initially limited to the states of New Jersey, Pennsylvania, and South Carolina. These states were selected based on higher-than-average utilization rates and high rates of improper payment for these services. In particular, the Medicare Payment Advisory Commission (MedPAC) had singled out these states as having higher-than-average utilization of dialysis transports in a June 2013 report to Congress. Medicare payment data from calendar year 2015 showed the effect of the demonstration project. Total spending on dialysis transports was $559 million that year, down 22% from the year before.  That correlates to a cost savings to the federal government of $158 million. Telling, $137 million (86%) of those savings came from the three states that participated in the demonstration project. We now have Medicare payment data for 2016. This blog will focus on the second year of the prior authorization demonstration project. This includes tracking the effects of prior authorization on the five additional states (DE, MD,...

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CAAS-GVS Ambulance Remount Forum on June 7

CAAS GVS Remount Forum June 7, 2017 NEW LOCATION: Harris Conference Center Charlotte, NC Register Now► The Commission on Accreditation of Ambulance Services, Ground Vehicle Standard Division (CAAS-GVS) will be holding an open forum for organizations involved in the remounting of ambulances. The intent of this meeting is to identify and establish a dialogue with FSAMs and third party Remounters of ambulances in an effort to collect information that may be used in an identified project to create standards for the ambulance remount industry. Any organization with interest in this topic is invited to attend, including ambulance builders, remounters, regulators, customers and component/material vendors. This is an information gathering session only. Input from this meeting will be for the use of the GVS Committee once a remount standard project has been defined and scheduled. No decisions will be made or standards created at this meeting. The meeting will be held on June 7, 2017, from 12:00 pm-5:00 pm EDT, at the Harris Conference Center in Charlotte, NC. Pre-registration for the meeting will be required. Additional information and a registration link can be found on the www.groundvehiclestandard.org website.

Congressman Richard Hudson Receives AAA Legislative Honor

Congressman Richard Hudson Receives 2017 AAA Legislative Recognition Award For Immediate Release Contact: Amanda Riordan ariordan@ambulance.org 703-610-0264 Washington, DC – The American Ambulance Association (AAA) will honor Congressman Richard Hudson of North Carolina with a Legislative Recognition Award in appreciation of his advocacy for emergency medical services. Congressman Hudson will be presented this award in June in Washington, DC by AAA’s North Carolina Stars of Life—EMS personnel selected for their excellence and dedication. This year’s Stars from the Tar Heel State are Ryan Lowe and Tiffany Johnson, both of Mecklenburg EMS Agency in Charlotte. Congressman Hudson was selected for the Legislative Recognition Award for championing the Protecting Patient Access to Emergency Medications Act to ensure that Paramedics and EMTs can continue to administer life-saving drugs to patients. AAA President Mark Postma notes, “Congressman Hudson has been a trusted advocate for health care and emergency medical services, both in North Carolina and across our country.” Congressman Richard Hudson is serving his third term in the United States Congress representing North Carolina’s 8th Congressional District. Rep. Hudson is a member of the House Energy & Commerce Committee. Prior to being elected to Congress himself, Rep. Hudson served as Chief of Staff to (more…)

Senator Richard Burr Receives AAA Legislative Honor

Senator Richard Burr to Receive 2017 AAA Legislative Recognition Award For Immediate Release Contact: Amanda Riordan ariordan@ambulance.org 703-610-0264 Washington, DC– The American Ambulance Association (AAA) will honor Senator Richard Burr of North Carolina with a Legislative Recognition Award in appreciation of his advocacy for emergency medical services. Senator Burr will be presented this award in June in Washington, DC by AAA’s North Carolina Stars of Life—EMS personnel selected for their excellence and dedication. This year’s Stars from the Tar Heel State are Ryan Lowe and Tiffany Johnson, both of Mecklenburg EMS Agency in Charlotte. Senator Burr was selected for the Legislative Recognition Award in thanks for his support of the Medicare ambulance temporary add-on increases and super rural bonus payment, as well as for being a long-standing champion of EMS providers in North Carolina. AAA President Mark Postma notes, “Senator Burr is a trusted advocate for health care and emergency medical services, both in North Carolina and across our country. The AAA is proud to present him with Legislative Recognition Award.” First elected to the U.S. House of Representatives in 1994, Burr served five terms in the House and is currently serving North Carolina in his third term in the (more…)