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…)