Summary: CMS Ambulance Open Door Forum
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3/16 | CMS Ambulance Open Door Forum
The next CMS Ambulance Open Door Forum scheduled for:
Thursday, March 16, 2023
2:00pm-3:00pm PM Eastern Time (ET);
This call will be Conference Call Only.
To participate by phone:
Dial: 1-888-455-1397 & Reference Conference Passcode: 4325849
Conference Leaders: Jill Darling, Maria Durham
**This Agenda is Subject to Change**
I. Opening Remarks
Chair- Maria Durham, Director, Division of Data Analysis and Market Based Pricing
Moderator – Jill Darling (Office of Communications)
II. Announcements & Updates
• Medicare Ground Ambulance Data Collection System
(GADCS): Top 5 Tips for Selected Organizations in Year 1, 2, 3, and 4
Slide presentation will be available on CMS’ Ambulances
Services Center website: https://www.cms.gov/medicare/ambulance-fee-schedule-zipcode-files/ambulance-events
Please see the following information regarding COVID-19
PHE Updated Guidance for Ambulance Organizations:
Public Health Emergency (PHE) 1135 Waivers: Updated
Guidance for Providers
III. Open Q&A
**DATE IS SUBJECT TO CHANGE**
Next Ambulance Open Door Forum: TBA
ODF email: AMBULANCEODF@cms.hhs.gov
———————————————————————
This Open Door Forum is open to everyone, but if you are a member of the Press,
you may listen in but please refrain from asking questions during the Q & A portion of
the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank
you.
Open Door Participation Instructions:
This call will be Conference Call Only.
To participate by phone:
Dial: 1-888-455-1397 & Reference Conference Passcode: 4325849
Persons participating by phone do not need to RSVP. TTY Communications Relay
Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-
800-855-2880. A Relay Communications Assistant will help.
Instant Replay: 1-800-814-6745; Conference Passcode: No Passcode needed
Instant Replay is an audio recording of this call that can be accessed by dialing 1-
800-814-6745 and entering the Conference Passcode beginning 1 hours after the call
has ended. The recording is available until March 18, 2023, 11:59PM ET.
For ODF schedule updates and E-Mailing List registration, visit our website at
http://www.cms.gov/OpenDoorForums/.
Were you unable to attend the recent Ambulance ODF call? We encourage you to
visit our CMS Podcasts and Transcript webpage where you can listen and view the
most recent Ambulance ODF call. The audio and transcript will be posted to:
https://www.cms.gov/Outreach-andEducation/Outreach/OpenDoorForums/PodcastAndTranscripts.html.
CMS provides free auxiliary aids and services including information in accessible
formats. Click here for more information. This will point partners to our CMS.gov
version of the “Accessibility & Nondiscrimination notice” page. Thank you.
CMS Ambulance Open Door Forum Summary
On August 18, 2022, the Centers for Medicare and Medicaid Services (CMS) held its most recent Ambulance Open Door Forum (ODF). As is typically the case, CMS started the ODF with a series of announcements, before opening the call to questions from the ambulance industry.
The first announcement related to proposed changes to the regulations governing the medical necessity requirements for non-emergency, scheduled, repetitive ground ambulance services. Specifically, CMS is proposing to modify the so-called “special rule” for repetitive, scheduled non-emergency services (set forth in the regulations at 42 C.F.R. §410.40(e)(2)(ii)). CMS indicated that these proposed changes would provide necessary and ensure the consistent application of the documentation requirements by its contractors. The proposed change would add language indicating that both the Physician Certification Statement and “additional documentation from the beneficiary’s medical record” could be used to support medical necessity for the ambulance transport. The new language would further indicate that these documents must provide detailed explanations that are consistent with the beneficiary’s current medical condition. On the ODF, CMS encouraged the industry to submit comments on these proposed changes. However, CMS indicated that, because these changes were the subject of ongoing rulemaking, it would not be able to answer any questions on the ODF.
The second announcement related to the proposed changes to the Medicare Ground Ambulance Data Collection System (GADCS) included in the July 2022 Proposed Rule. CMS and its contractor, the Rand Corporation, went through a detailed PowerPoint presentation that summarized these proposed changes. That PowerPoint presentation can be accessed by clicking here.
As part of its discussion of the GADCS, CMS also announced the implementation of an automated process for requesting hardship exemptions and informal review of determinations that an ambulance provider is subject to a financial penalty for failing to properly submit its cost data.
The final announcement related to ambulance services furnished by Rural Emergency Hospitals (REHS). In the FY 2023 Outpatient Hospital Proposed Rule, CMS is proposing to codify in its regulations the statutory requirement that ambulance services furnished by entities that are owned and operated by REHS will be paid under the Medicare Ambulance Fee Schedule. CMS is also proposing to revise the origin and destination requirements to include REHS as both a covered origin and covered destination for ambulance services.
The ODF concluded with a brief Q&A period. All of the questions posed to CMS related to the GADCS. One of the questions placed to CMS was whether it would permit ambulance suppliers to prospectively seek a hardship exemption, i.e., to permit an ambulance supplier to ask now that it be relieved of the financial penalties for failing to report its cost data. The person posing the question specifically referenced ambulance suppliers impacted by the severe flooding in the State of Kentucky. CMS confirmed that an ambulance supplier had to be notified that it was subject to a financial penalty before it was eligible to seek a hardship exemption.
CMS Ambulance Open Door Forum scheduled for Thursday, August 18
 |
| The next CMS Ambulance Open Door Forum scheduled for:
Date: Thursday, August 18, 2022 Start Time: 2:00pm-3:00pm PM Eastern Time (ET); Please dial-in at least 15 minutes before call start time. Conference Leaders: Jill Darling, Maria Durham **This Agenda is Subject to Change**
Chair- Maria Durham, Director, Division of Data Analysis and Market Based Pricing Moderator – Jill Darling (Office of Communications)
Slide presentation is available at: https://www.cms.gov/Center/ 2. CY 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule: https://www.federalregister. Proposals Regarding Rural Emergency Hospitals Ambulance Services III. Open Q&A **DATE IS SUBJECT TO CHANGE** Next Ambulance Open Door Forum: TBA ODF email: AMBULANCEODF@cms.hhs.gov —————————— This Open Door Forum is open to everyone, but if you are a member of the Press, you may listen in but please refrain from asking questions during the Q & A portion of the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank you. Open Door Participation Instructions: This call will be Conference Call Only. To participate by phone: Dial: 1-888-455-1397 & Reference Conference Passcode: 5109694 Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help. Instant Replay: 1- 866-469-7806; Conference Passcode: No Passcode needed Instant Replay is an audio recording of this call that can be accessed by dialing 1-866-469-7806 and entering the Conference Passcode beginning 1 hours after the call has ended. The recording is available until August 20, 2022, 11:59PM ET. For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/ Were you unable to attend the recent Ambulance ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. The audio and transcript will be posted to: https://www.cms.gov/Outreach- CMS provides free auxiliary aids and services including information in accessible formats. Click here for more information. This will point partners to our CMS.gov version of the “Accessibility & Nondiscrimination notice” page. Thank you. |
TODAY | CCIIO Open Door Forum No Surprises Act
Centers for Medicare & Medicaid Services Center for Consumer Information and Insurance Oversight
Special Open Door Forum: Provider Requirements under the No Surprises Act
Wednesday December 8, 2021 | 2:00-3:00 pm Eastern Time
Conference Call Only
Participant Dial-In Number: 1-888-455-1397
Conference ID #: 8604468
The Center for Consumer Information and Insurance Oversight (CCIIO) and the CMS Office of Communication will host an orientation to provider requirements under the No Surprises Act.
Starting January 1, 2022, consumers will have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network
On July 1, 2021, the “Requirements Related to Surprise Billing; Part I,” interim final rule was issued to restrict surprise billing for patients in job-based and individual health plans who get emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
On September 30, 2021, a second interim final rule was issued and is open for public comment. The “Requirements Related to Surprise Billing; Part II” rule provides additional protections against surprise medical bills, including:
- Establishing an independent dispute resolution process to determine out-of-network payment amounts between providers (including air ambulance providers) or facilities and health plans.
- Requiring good-faith estimates of medical items or services for uninsured (or self-paying) individuals.
- Establishing a patient-provider dispute resolution process for uninsured (or self-paying) individuals to determine payment amounts due to a provider or facility under certain circumstances.
- Providing a way to appeal certain health plan decisions.
Together, these lay the groundwork to provide consumers with protection against surprise billing, starting in 2022. Learn more about how these rules help consumers.
Here is the link to our No Surprises page that has the slides: https://www.cms.gov/
We look forward to your participation.
Special Open Door Participation Instructions:
Participant Dial-In Number: 1-888-455-1397
Conference ID #: 8604468
Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
A transcript and audio recording of this Special ODF will be posted to the Podcast and Transcripts website at https://www.cms.gov/
For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/
Thank you for your interest in CMS Open Door Forums.
CMS | Ambulance Open Door Forum Dec 9
The next CMS Ambulance Open Door Forum scheduled for:
Date: Thursday, December 9, 2021
Start Time: 2:00pm-3:00pm PM Eastern Time (ET);
Please dial-in at least 15 minutes before call start time.
To participate by phone:
Dial: 1-888-455-1397 & Reference Conference Passcode: 8604468
Conference Leaders: Jill Darling, Maria Durham
**This Agenda is Subject to Change**
- Opening Remarks
Chair- Maria Durham, Director, Division of Data Analysis and Market Based Pricing
Moderator – Jill Darling (Office of Communications)
Announcements & Updates
- Emergency Triage, Treat, and Transport (ET3) Model Update
- ET3 Model Website: https://innovation.cms.gov/
innovation-models/et3 - ET3Model@cms.hhs.gov for inquiries
- ET3 Model Listserv for Model updates: https://public.govdelivery.
com/accounts/USCMS/subscriber/ new?topic_id=USCMS_12521
- ET3 Model Website: https://innovation.cms.gov/
- Upcoming Implementation Dates of the Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model
- Ground Ambulance & Patient Billing Advisory Committee Member Nomination Period
- Submission Instructions are contained in this Federal Register Notice: https://www.federalregister.
gov/documents/2021/11/23/2021- 25560/ground-ambulance-and- patient-billing-advisory- committee
- Submission Instructions are contained in this Federal Register Notice: https://www.federalregister.
- CY 2022 Ambulance Inflation Factor (AIF) Change Request 12488, Transmittal 11044
- Medicare Ground Ambulance Data Collection System CY 2022 Physician Fee Schedule Final Rule
- Slide presentation will be available at: https://www.cms.gov/Center/
Provider-Type/Ambulances- Services-Center, under Spotlights, Upcoming Events.
- Slide presentation will be available at: https://www.cms.gov/Center/
III. Open Q&A
**DATE IS SUBJECT TO CHANGE**
Next Ambulance Open Door Forum: TBA
ODF email: AMBULANCEODF@cms.hhs.gov
——————————
This Open Door Forum is open to everyone, but if you are a member of the Press, you may listen in but please refrain from asking questions during the Q & A portion of the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank you.
Open Door Participation Instructions:
This call will be Conference Call Only.
To participate by phone:
Dial: 1-888-455-1397 & Reference Conference Passcode: 8604468
Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
Instant Replay: 1-800-856-2271; Conference Passcode: No Passcode needed
Instant Replay is an audio recording of this call that can be accessed by dialing 1-800-856-2271 and entering the Conference Passcode beginning 1 hours after the call has ended. The recording is available until December 11, 2021, 11:59PM ET.
For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/
Were you unable to attend the recent Ambulance ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. Please allow up to three weeks to get both the audio and transcript posted to: https://www.cms.gov/Outreach-
CMS provides free auxiliary aids and services including information in accessible formats. Click here for more information. This will point partners to our CMS.gov version of the “Accessibility & Nondiscrimination notice” page. Thank you.
CCIIO Open Door Forum No Surprises Act
From CMS on December 3, 2021
Centers for Medicare & Medicaid Services Center for Consumer Information and Insurance Oversight
Special Open Door Forum: Provider Requirements under the No Surprises Act
Wednesday December 8, 2021 | 2:00-3:00 pm Eastern Time
Conference Call Only
Participant Dial-In Number: 1-888-455-1397
Conference ID #: 8604468
The Center for Consumer Information and Insurance Oversight (CCIIO) and the CMS Office of Communication will host an orientation to provider requirements under the No Surprises Act.
Starting January 1, 2022, consumers will have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network
On July 1, 2021, the “Requirements Related to Surprise Billing; Part I,” interim final rule was issued to restrict surprise billing for patients in job-based and individual health plans who get emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
On September 30, 2021, a second interim final rule was issued and is open for public comment. The “Requirements Related to Surprise Billing; Part II” rule provides additional protections against surprise medical bills, including:
- Establishing an independent dispute resolution process to determine out-of-network payment amounts between providers (including air ambulance providers) or facilities and health plans.
- Requiring good-faith estimates of medical items or services for uninsured (or self-paying) individuals.
- Establishing a patient-provider dispute resolution process for uninsured (or self-paying) individuals to determine payment amounts due to a provider or facility under certain circumstances.
- Providing a way to appeal certain health plan decisions.
Together, these lay the groundwork to provide consumers with protection against surprise billing, starting in 2022. Learn more about how these rules help consumers.
Here is the link to our No Surprises page that has the slides: https://www.cms.gov/
We look forward to your participation.
Special Open Door Participation Instructions:
Participant Dial-In Number: 1-888-455-1397
Conference ID #: 8604468
Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
A transcript and audio recording of this Special ODF will be posted to the Podcast and Transcripts website at https://www.cms.gov/
For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/
Thank you for your interest in CMS Open Door Forums.
CMS | Open Door Forum on Prior Authorization for RSNAT
From CMS on October 5, 2021
Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation
Special Open Door Forum: Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model National Expansion
Thursday, October 28, 2021
2:00-3:30 pm Eastern Time
Conference Call Only
Participant Dial-In Number: 1-888-455-1397 | Conference ID #: 8604468
CMS will host a Special Open Door Forum (SODF) to allow ambulance suppliers, other Medicare providers, and additional interested parties to learn about the upcoming national expansion of the Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model in Medicare fee for service. CMS is implementing the national model in multiple phases beginning with Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas on December 1, 2021. The RSNAT Prior Authorization Model is currently operating in New Jersey, Pennsylvania, and South Carolina since 2014 and in North Carolina, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia since 2016. This Special ODF will include information on national expansion, the prior authorization process, and a Q&A period.
You can find more information on the model and slides for the ODF presentation by going to:
Questions on the model can be sent to: AmbulancePA@cms.hhs.gov
We look forward to your participation.
Special Open Door Participation Instructions:
Participant Dial-In Number: 1-888-455-1397
Conference ID #: 8604468
Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
A transcript and audio recording of this Special ODF will be posted to the Special Open Door Forum website at https://www.cms.gov/Outreach-
For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at https://www.cms.gov/Outreach-
Thank you for your interest in CMS Open Door Forums.
CMS Open Door Forum | Medicare Ground Ambulance Data Collection System
August 12, 2021 Ambulance Open Door Forum
August 12, 2021 | 14:00–15:30 ET
Slide presentation on the Overview of the Medicare Ground Ambulance Data Collection System (PDF) is now available.
The next CMS Ambulance Open Door Forum scheduled for:
Date: Thursday, August 12, 2021
Start Time: 2:00pm-3:30pm PM Eastern Time (ET);
Please dial-in at least 15 minutes before call start time.
Conference Leaders: Jill Darling, Maria Durham
Agenda
**This Agenda is Subject to Change**
I. Opening Remarks
Chair- Maria Durham, Director, Division of Data Analysis and Market-based Pricing
Moderator – Jill Darling (Office of Communications)
II. Announcements & Updates
- Emergency Triage, Treat, and Transport (ET3) Model Update
- ET3 Model Website: https://innovation.cms.gov/innovation-models/et3
- ET3Model@cms.hhs.gov for inquiries
- ET3 Model Listserv for Model updates: https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_12521
- ET3 Model Website: https://innovation.cms.gov/innovation-models/et3
Overview of the Medicare Ground Ambulance Data Collection
System
A copy of the presentation will be available on the
Ambulances Services Center website under
Spotlights: https://www.cms.gov/Center/ProviderType/Ambulances-Services-Center
III. Open Q&A
**DATE IS SUBJECT TO CHANGE**
Next Ambulance Open Door Forum: TBA
ODF email: AMBULANCEODF@cms.hhs.gov
———————————————————————
This Open Door Forum is open to everyone, but if you are a member of the Press, you may listen in but please refrain from asking questions during the Q & A portion of the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank you.
Open Door Participation Instructions
This call will be Conference Call Only.
To participate by phone:
August 12, 2021 | 14:00–15:30 ET | Dial: 1-888-455-1397 & Reference Conference Passcode: 8604468
Persons participating by phone do not need to RSVP. TTY Communications Relay
Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
Instant Replay
1-866-470-7051; Conference Passcode: No Passcode needed
Instant Replay is an audio recording of this call that can be accessed by dialing 1-
866-470-7051 and entering the Conference Passcode beginning 1 hours after the
call has ended. The recording is available until August 14, 2021, 11:59PM ET.
For ODF schedule updates and E-Mailing List registration, visit our website at
http://www.cms.gov/OpenDoorForums/.
Were you unable to attend the recent Ambulance ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. Please allow up to three weeks to get both the
audio and transcript posted to: https://www.cms.gov/Outreach-andEducation/Outreach/OpenDoorForums/PodcastAndTranscripts.html.
CMS Ambulance Open Door Forum Feb 25
From CMS on February 18, 2021
February 25 Open Door Forum
Thursday, February 25, 2021 | 14:00 ET
Dial: 1-888-455-1397 & Reference Conference Passcode: 8604468
The next CMS Ambulance Open Door Forum is scheduled for:
Date: Thursday, February 25, 2021
Start Time: 2:00pm-3:00pm PM Eastern Time (ET);
Please dial-in at least 15 minutes before call start time.
Conference Leaders: Jill Darling, Susanne Seagrave
Agenda
**This Agenda is Subject to Change**
- Opening Remarks
Acting Chair- Susanne Seagrave, Acting Director, Division of Data Analysis and Market-Based Pricing (Center for Medicare)
Moderator – Jill Darling (Office of Communications)
- Announcements & Updates
- Emergency Triage, Treat, and Transport (ET3) Model Update
- ET3 Model Website: https://innovation.cms.gov/
innovation-models/et3 - ET3Model@cms.hhs.gov for inquiries
- ET3 Model Listserv for Model updates: https://public.govdelivery.
com/accounts/USCMS/subscriber/ new?topic_id=USCMS_12521
- ET3 Model Website: https://innovation.cms.gov/
- COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing
- Ambulance Services FAQs begins on page 47 of this document: https://www.cms.gov/files/
document/03092020-covid-19- faqs-508.pdf.
- Ambulance Services FAQs begins on page 47 of this document: https://www.cms.gov/files/
- Medicare Ground Ambulance Data Collection System Delay for Year 1 and Year 2 Selected Organizations
- Information can be found at: https://www.cms.gov/Center/
Provider-Type/Ambulances- Services-Center
- Information can be found at: https://www.cms.gov/Center/
- Emergency Triage, Treat, and Transport (ET3) Model Update
III. Open Q&A
**DATE IS SUBJECT TO CHANGE**
Next Ambulance Open Door Forum: TBA
ODF email: AMBULANCEODF@cms.hhs.gov
——————————
This Open Door Forum is open to everyone, but if you are a member of the Press, you may listen in but please refrain from asking questions during the Q & A portion of the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank you.
Open Door Participation Instructions:
This call will be Conference Call Only.
To participate by phone:
Dial: 1-888-455-1397 & Reference Conference Passcode: 8604468
Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
Instant Replay: 1-866-372-3811; Conference Passcode: No Passcode needed
Instant Replay is an audio recording of this call that can be accessed by dialing 1-866-372-3811 and entering the Conference Passcode beginning 1 hours after the call has ended. The recording is available until February 27, 2021, 11:59PM ET.
For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/
Were you unable to attend the recent Ambulance ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. Please allow up to three weeks to get both the audio and transcript posted to: https://www.cms.gov/Outreach-
CMS provides free auxiliary aids and services including information in accessible formats. Click here for more information. This will point partners to our CMS.gov version of the “Accessibility & Nondiscrimination notice” page. Thank you.
10/22 CMS Ambulance ODF Updated Agenda
Open Door Forum Dial-In
October 22, 2020 at 1:00–2:30pm ET
Dial: 1-888-455-1397
Conference Passcode: 9375124
The next CMS Ambulance Open Door Forum scheduled for:
Date: Thursday October 22, 2020
Start Time: 1:00pm-2:30pm PM Eastern Time (ET);
Please dial-in at least 15 minutes before call start time.
Conference Leaders: Jill Darling, Susanne Seagrave
**This Agenda is Subject to Change**
1. Opening Remarks
- Acting Chair- Susanne Seagrave, Acting Director, Division of Data Analysis and Market-Based Pricing (Center for Medicare)
- Moderator – Jill Darling (Office of Communications)
2. Announcements & Updates
- Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model Update
- ET3 Overview and Update
– ET3Model@cms.hhs.gov for inquiries
– ET3 Model Listserv for Model updates: https://public.govdelivery.
- CY 2021 Ambulance Inflation Factor (AIF) https://www.cms.gov/files/
document/r10396CP.pdf. - COVID-19 Public Health Emergency (PHE) Waiver and Flexibility Information
– COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee For Service (FFS) Billing document is available at: https://www.cms.gov/files/
-CMS is using its statutory authority under section 1135(b)(5) of the Act to modify the data collection and reporting period for ground ambulance organizations that were selected to report in year 1 of the Medicare Ground Ambulance Data Collection System. This modification has been issued on page 30 in the following document: https://www.cms.gov/files/
3. Open Q&A
**DATE IS SUBJECT TO CHANGE**
Next Ambulance Open Door Forum: TBA
ODF email: AMBULANCEODF@cms.hhs.gov
——————————
This Open Door Forum is open to everyone, but if you are a member of the Press, you may listen in but please refrain from asking questions during the Q & A portion of the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank you.
Open Door Participation Instructions:
This call will be Conference Call Only.
To participate by phone:
Dial: 1-888-455-1397 & Reference Conference Passcode: 9375124
Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
Instant Replay: 1-866-448-2572; Conference Passcode: No Passcode needed
Instant Replay is an audio recording of this call that can be accessed by dialing 1-866-448-2572 and entering the Conference Passcode beginning 1 hours after the call has ended. The recording is available until October 24, 11:59PM ET.
For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/
Were you unable to attend the recent Ambulance ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. Please allow up to three weeks to get both the audio and transcript posted to: https://www.cms.gov/Outreach-
CMS provides free auxiliary aids and services including information in accessible formats. Click here for more information. This will point partners to our CMS.gov version of the “Accessibility & Nondiscrimination notice” page. Thank you.
CMS Ambulance Open Door Forum Oct 22
From CMS on October 16
Open Door Participation Instructions:
October 22, 1:00–2:30 on ET
This call will be Conference Call Only.
To participate by phone:
Dial: 1-888-455-1397 & Reference Conference Passcode: 9375124
Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
Instant Replay: 1-866-448-2572; Conference Passcode: No Passcode needed
Instant Replay is an audio recording of this call that can be accessed by dialing 1-866-448-2572 and entering the Conference Passcode beginning 1 hours after the call has ended. The recording is available until October 24, 11:59PM ET.
The next CMS Ambulance Open Door Forum is scheduled for:
Date: Thursday October 22, 2020
Start Time: 1:00pm-2:30pm PM Eastern Time (ET);
Please dial-in at least 15 minutes before call start time.
Conference Leaders: Jill Darling, Susanne Seagrave
**This Agenda is Subject to Change**
1. Opening Remarks
- Acting Chair- Susanne Seagrave, Acting Director, Division of Data Analysis and Market-Based Pricing (Center for Medicare)
- Moderator – Jill Darling (Office of Communications)
2. Announcements & Updates
- Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model Update – https://www.cms.gov/newsroom/
press-releases/cms-expand- successful-ambulance-program- integrity-payment-model- nationwide
-
- ET3 Overview and Update
- ET3Model@cms.hhs.gov for inquiries
- ET3 Model Listserv for Model updates: https://public.govdelivery.
com/accounts/USCMS/subscriber/ new?topic_id=USCMS_12521
- COVID-19 Public Health Emergency (PHE) Waiver and Flexibility Information
- COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee For Service (FFS) Billing document is available at: https://www.cms.gov/files/
document/03092020-covid-19- faqs-508.pdf. Ambulance services FAQs begins on page 41.
- COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee For Service (FFS) Billing document is available at: https://www.cms.gov/files/
- CMS is using its statutory authority under section 1135(b)(5) of the Act to modify the data collection and reporting period for ground ambulance organizations that were selected to report in year 1 of the Medicare Ground Ambulance Data Collection System. This modification has been issued on page 30 in the following document: https://www.cms.gov/files/
document/summary-covid-19- emergency-declaration-waivers. pdf.
3. Open Q&A
**DATE IS SUBJECT TO CHANGE**
Next Ambulance Open Door Forum: TBA
ODF email: AMBULANCEODF@cms.hhs.gov
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This Open Door Forum is open to everyone, but if you are a member of the Press, you may listen in but please refrain from asking questions during the Q & A portion of the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank you.
For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/
Were you unable to attend the recent Ambulance ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. Please allow up to three weeks to get both the audio and transcript posted to: https://www.cms.gov/Outreach-
CMS provides free auxiliary aids and services including information in accessible formats. Click here for more information. This will point partners to our CMS.gov version of the “Accessibility & Nondiscrimination notice” page. Thank you.
6/25 | CMS Open Door Forum | Documentation Requirement Lookup Service
From the Centers for Medicare and Medicaid Services
Special Open Door Forum: Medicare Documentation Requirement Lookup Service
Thursday, June 25, 2020 | 2:00-3:00 pm Eastern Time
Conference Call Only
The Centers for Medicare & Medicaid Services, Center for Program Integrity will host a series of Special Open Door Forum (SODF) calls to educate the public about a new initiative underway to develop a Medicare Fee for Service (FFS) Documentation Requirement Lookup Service prototype. Also, to allow physicians, suppliers, IT and Electronic Health Record (EHR) Developers and Vendors, and/or all other interested parties to provide feedback to CMS and inform how interested parties can get involved or track the progress of this initiative.
CMS is collaborating with ongoing industry efforts to streamline workflow access to coverage requirements, starting with developing a prototype Medicare FFS Documentation Requirement Lookup Service and is participating in two workgroups to promote development of standards that will support the Lookup Service. One workgroup is a private sector initiative hosted by Health Level Seven (HL7), the Da Vinci project. The second workgroup is The Office of the National Coordinator for Health Information Technology (ONC) Fast Healthcare Interoperability Resource (FHIR) at Scale Taskforce (FAST).
By working with HL7, ONC, other payers, providers, and EHR vendors, CMS is helping define the requirements and architect the standards-based solutions. In parallel, CMS is preparing to support pilots testing the information exchanges for Medicare FFS programs and possibly coordinate pilots with volunteer participants to verify and test the new FHIR based solutions.
The goals of the Documentation Requirement Lookup Service prototype are to reduce provider burden, reduce improper payments and appeals, and improve “provider to payer” information exchange. The prototype will be made accessible to pilot participants and will allow providers to be able to discover the following at the time of service and within their EHR or practice management system:
- 1. If Medicare FFS requires prior authorization for a given item or service; and
- 2. Documentation requirements for:
- 3. Home Oxygen Therapy
- 4. Continuous Positive Airway Pressure (CPAP) Devices
- 5. Home Blood Glucose Monitors and Supplies
- 6. Non-Emergency Ambulance Transportation (NEAT)
- 7. Respiratory Assist Devices (RAD)
For more information and to access the slide presentation for the SODF, please visit our website: go.cms.gov/MedicareRequirementsLookup.
We look forward to your participation.
Special Open Door Participation Instructions
Participant Dial-In Number: 1-(888)-455-1397
Participant Passcode: 2900212
Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/OpenDoorForums/.
CMS Open Door Forum & Member Q&A – November 7th
| The Centers for Medicare and Medicaid Services has scheduled its next Ambulance Open Door Forum for Thursday, November 7 from 2:00-3:30 PM Eastern. If you plan to attend, please dial in at least 15 minutes before the call.
November 7 | 2:00 PM ET
Participant Dial-In Number: 1-888-455-1397 Conference ID #: 4676500 Questions?Have more questions? The AAA is here to help! Following the ODF the AAA will be publishing a follow up blog post going over any updates and important announcements. AAA Follow Up Q&ANovember 7 | 4:00 PM ET
1-800-250-2600 Pin: 82802314# Speakers: AAA Senior Vice President of Government Affairs, Tristan North; AAA Healthcare Lobbyist, Kathy Lester, Esq.
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CMS Open Door Forum & Member Q&A – August 28
| The Centers for Medicare and Medicaid Services has scheduled its next Ambulance Open Door Forum for Wednesday, August 28 at 2:00 PM Eastern. If you plan to attend, please dial in at least 15 minutes before the call.
August 28 | 2:00 PM ET
Participant Dial-In Number: 1-888-455-1397 Conference ID #: 6609831 Questions?Have more questions? The AAA is here to help! Following the ODF the AAA will be publishing a follow up blog post going over any updates and important announcements. AAA Follow Up Q&AAugust 28 | 3:00 PM ET
1-800-250-2600 Pin: 82802314# Speakers: AAA Senior Vice President of Government Affairs, Tristan North; AAA Healthcare Lobbyist, Kathy Lester, Esq.; AAA Medicare Regulatory Committee Chair, Krista Cuthbert; and AAA Payment Reform Committee Chair, Asbel Montes.
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Summary of March 28, 2019 Ambulance ODF
The Centers for Medicare and Medicaid Services (CMS) held its latest Open Door Forum on Wednesday, March 28, 2019. As with past Open Door Forums, CMS started the call with the following announcements:
- Ambulance Cost Data Collection – CMS reminded the industry that the Bipartisan Budget Act of 2018, enacted on February 9, 2018, requires CMS to create a new cost data collection system by December 31, 2019.
- Emergency Triage, Treat, and Transport Model – A representative from the Innovation Center within CMS provided an overview of the “Emergency Triage, Treat, and Transport Model” or “ET3.” This is a 5-year pilot program intended to provide ambulance providers with greater flexibility to handle low-acuity 911 calls, by providing Medicare payment for: (a) ambulance transportation to alternative treatment destinations and (b) treatment at the scene. The CMS representative indicated that CMS is in possession of data that suggests that 16% of emergency ambulance transports to a hospital emergency department could have been resolved by transporting the patient to an alternative treatment site, e.g., an urgent care center. CMS estimates that had all of these patients elected to receive care in the lower-acuity setting, it would have saved the Medicare Program approximately $560 million each year. With respect to the operation of the model itself, CMS essentially repeated the information that had been previously provided on its webinars. You can view the AAA Member Advisory on the ET3 Model by clicking here.
- Ambulance Inflation Factor – CMS reiterated that the 2019 Ambulance Inflation Factor is 2.3%.
Following the announcements, CMS moved into a Question & Answer period. The majority of the questions related to the ET3 pilot program. As is typical, many questions were not answered on the call; instead, CMS asked the individual to submit their question in writing. However, the following questions were answered on the call:
- Payment Rates under ET3 – CMS was asked whether the BLS base rate payment would be the BLS emergency base rate. It was not clear that the CMS representative fully understood the question, although she indicated that it would.
- Eligibility for Government Agencies – CMS was asked whether governmental agencies that operate 911 centers would submit applications to participate as part of the RFA process in the Summer of 2019. CMS responded that governmental agencies that operate 911 centers would not submit RFAs, but would rather wait for the Notice of Funding Opportunity (NOFO), which will be issued after the ambulance providers and suppliers are selected for participation (expected to be the late Fall/Winter of 2019). CMS further confirmed that if the governmental agency also operated its own ambulance service that it would be eligible to apply for both aspects of the ET3 Model.
- Limit on Ambulance Providers – CMS was asked whether it would cap the number of ambulance providers and suppliers selected to participate in the program. CMS responded that, at the present time, it has no intent to cap the number of participating ambulance providers and suppliers at any specific number.
- Return Transports from Alternative Treatment Destinations – CMS was asked whether the model would provide for ambulance payment for the return transport after a patient was transported to an alternative treatment site. CMS indicated that the model does not provide for payment for the return transport.
- Definition of “Telehealth” – CMS confirmed that the model will use the same definition of “telehealth” used in other areas of the Medicare Program. CMS further confirmed that telehealth encounters require both audio and video connections.
- Approval of Alternative Treatment Sites – CMS confirmed that state and local regulatory agencies would have final approval over acceptable alternative treatment sites.
- Qualified Health Care Practitioner – CMS confirmed that a “qualified health care practitioner” would be an individually enrolled Medicare practitioner, which includes physicians and nurse practitioners. In some instances, it can also include physician’s assistants. CMS confirmed that the definition would not include registered nurses or advance scope paramedics.
- NOFO Funding – CMS indicated that, at the present time, it is not prepared to release additional details on the nature or size of the funding opportunities available to governmental agencies and their designees that operate or have authority over 911 centers.
- Medicare Advantage and Other Payers – CMS confirmed that the ET3 Model applies only to Medicare beneficiaries enrolled in FFS Medicare. It does not apply to Medicare Advantage enrollees, Medicaid recipients, etc.
Questions? Email Brian at bwerfel@aol.com
UPDATED: CMS Open Door Forum – Thursday, March 28
| The Centers for Medicare and Medicaid Services has scheduled its next Ambulance Open Door Forum for Thursday, March 28 at 2:00 PM Eastern. If you plan to attend, please dial in at least 15 minutes before the call.
March 28 | 2:00 PM ET
Participant Dial-In Number: 1-800-837-1935 Conference ID #: 6695896 Questions?Have more questions? The AAA is here to help! Following the ODF the AAA will be publishing a follow up blog post going over any updates and important announcements. |
CMS Non-Emergency Ambulance Transport Open Door Forum 7/26
CMS Issues Data Elements and Templates for Non-Emergency Ambulance Transports (NEAT): Open Door Forum for
Thursday, July 26, 2018 Just Announced
As part of its Patients Over Paperwork Project, the Centers for Medicare & Medicaid Services (CMS) Provider Compliance Group (PCG) has been hosting quarterly listening sessions and reviewing the Request for Information submissions. The American Ambulance Association has been actively engaged in these efforts, highlighting the recommendations we submitted to CMS and the House Ways & Means Committee last year. These recommendations included suggestions as to how CMS could streamline regulatory requirements to eliminate duplicative requirements and reduce regulatory burdens. In addition to these efforts, CMS has been working to standardize documentation data elements and establish templates that providers and suppliers can use to help make the current documentation processes less burdensome as well.
On July 24, CMS released draft documentation-related clinical data elements and clinical templates that could be used for the Physician Certification Statement, Progress Notes, and Prior Authorization requests. View the Documents. These documents are not intended to change current law.
CMS also announced yesterday that it will discuss the templates on a Special Open Door Forum which is scheduled for July 26 at 2-3 pm ET. The call-in information is:
- Participant Dial-In Number: 1-(888)-989-4575
- Conference ID: 3068545
We have shared our concern about the short notice about the call and CMS has indicated it will continue to take comments on the documents after the call as well. The AAA is in the process of reviewing these documents closely and will develop a written comment letter to provide to CMS after the call on Thursday. We welcome input from all our members as part of this process.
While these new documents may be helpful for many services, the AAA also remains committed to move its recommendations which would result in some changes in the PCS and other ambulance provider and supplier requirements.
Summary of March 2018 Ambulance Open Door Forum
CMS held its latest Open Door Forum on Wednesday, March 7, 2018. As with past Open Door Forums, CMS started the call with the following series of announcements:
Medicare Fee Schedule – CMS indicated that the Bipartisan Budget Act of 2018, enacted on February 9, 2018, contained several provisions that impacted the payment of ambulance claims under the Medicare Ambulance Fee Schedule:
- Temporary Add-Ons for Ground Ambulance – CMS indicated that Section 50203(a) of the bill extended the temporary add-ons for ground ambulance services for an additional five years, retroactive back to January 1, 2018. As extended, these add-ons will expire on December 31, 2022. These add-ons increase Medicare’s allowable for ground ambulance base rates and mileage by 2% in urban areas, 3% in rural areas, and by 22.6% (over the applicable rural rate) for services provided in so-called “super rural” areas.
- Cost Reporting – CMS indicated that Section 50203(b) of the bill would require ground ambulance providers and suppliers to submit cost data to CMS. CMS noted that the new law requires CMS to develop, no later than December 31, 2019, a data collection system to collect cost, revenue, utilization, and certain other information related to ground ambulance services. The law provides that cost data will be collected using a survey methodology, with a representative sample of ambulance providers and suppliers being asked to submit cost data in any given year. Finally, CMS noted that, starting on January 1, 2022, providers or suppliers that fail to submit the requested cost data would be subject to a 10% reduction in their Medicare payments, unless otherwise exempted on the basis of significant hardship.
- Additional Reduction in Medicare Payment for Dialysis Transports – Section 53108 of the bill provides that the Medicare allowable for non-emergency, basic life support transports to and from dialysis will be subject to a further 13% reduction. This reduction would go into effect for dialysis transports with dates of service on or after October 1, 2018. This would be on top of the existing 10% reduction in Medicare’s payment for dialysis transports, for a total reduction of 23%.
Temporary Enrollment Moratorium – CMS indicated that the temporary moratorium on the enrollment of new ground non-emergency ambulance providers in Texas was lifted on September 1, 2017. CMS further indicated that the enrollment moratorium was extended for the states of New Jersey and Pennsylvania for an additional six months on January 29, 2018. CMS will need to make a determination on or before July 29, 2018 on whether to lift the moratorium or extent it for an additional six months in that state.
Following the announcements, CMS moved into a brief Question & Answer period. Most of the questions were not answered on the call; instead, CMS took the contact information of the person asking the question, and indicated that they would respond directly to them at a later date. However, the following questions were answered:
- CMS indicated that a Change Request had been sent to all Medicare Administrative Contractors (MACs) informing them of the new, adjusted fee schedule amounts. CMS further indicated that this Change Request, which it indicated was confidential, provided further instructions to the MACs on when and how to adjust claims initially paid at the original 2018 rates.
- CMS confirmed that the adjusted rates are retroactive to January 1, 2018. Accordingly, CMS indicated that claims paid at the original 2018 rates will be adjusted by the MACs at some future date.
- CMS indicated that it recently released its First Interim Evaluation Report on the Medicare Prior Authorization Model for repetitive, non-emergency ground ambulance transports. CMS further indicated that it was still reviewing this report, and that no decision has yet been made on the extension of this model within the existing 9 states and the District of Columbia and/or the expansion of the model to additional states.
Have questions? Please write to the Werfels at bwerfel@aol.com.
March CMS Ambulance Open Door Forum & Follow Up Q&A
The next CMS Ambulance Open Door Forum is scheduled for Wednesday, March 7 at 2:00 PM Eastern. Please dial in at least 15 minutes before the call. View Agenda.
CMS Ambulance Open Door Forum
March 7 | 2:00 PM ET
1-800-837-1935
Conference ID: 31612304
Questions?
Have questions after the CMS Open Door Forum? The AAA is here to help! Following the Open Door Forum, the AAA will host a Q&A conference call open to all members.
AAA Follow Up Q&A
March 7 | 3:00 PM ET
1-800-250-2600
Pin: 73556603#
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