Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model Approved for Nationwide Expansion

Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model Approved for Nationwide Expansion

Today, the Centers for Medicare & Medicaid Services (CMS) announced that it will expand the Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model nationwide, as the model has met all expansion criteria under section 1834(l)16 of the Social Security Act (the Act) (as added by section 515(b) of the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114-10) (MACRA). The RSNAT Prior Authorization Model begin under the authority of section 1115A of the Act in New Jersey, Pennsylvania, and South Carolina in December 2014 and in 2016, North Carolina, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia were added in accordance with section 515(a) of  MACRA. CMS also released today the model’s Second Interim Evaluation Report https://innovation.cms.gov/data-and-reports/2020/rsnat-secondintevalrpt. The report found that the model was successful in reducing RSNAT services and total Medicare spending while maintaining overall quality of and access to care levels. The Chief Actuary of CMS certified https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/CMMI-Model-Certifications in March 2018 that nationwide expansion of the model would reduce net program spending under the Medicare program. Based on the Chief Actuary certification and Interim Evaluation Reports, the Secretary of Health and Human Services determined that the model met the criteria to expand nationwide. The model will be expanded under the authority of section 1834(l)(16) of the Act, as added by section 515(b) of MACRA. With this announcement, the model will continue without interruption in the current states of Delaware, the District of Columbia, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia. CMS will release more information on the national expansion and implementation dates for additional states as it becomes available. The national model will follow the same design as the current model (as tested by the CMS Center for Medicare and Medicaid Innovation under section 1115A of the Act). CMS is continuing to monitor the COVID-19 public health emergency and will take that into account when determining the timeframe for expansion into additional states. More information can be found in today’s Press Release: https://www.cms.gov/newsroom/press-releases/cms-expand-successful-ambulance-program-integrity-payment-model-nationwide