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CMS NEWS
FOR IMMEDIATE RELEASE Contact: CMS Media Relations CMS to
Expand Successful Ambulance Program Integrity Payment Model Nationwide Today, the Centers for Medicare & Medicaid Services (CMS)
announced that it will expand the Medicare Prior Authorization Model for
Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) nationwide.
The model has saved Medicare about $650 million over four years while
preserving quality of care and access to essential services. As part of CMS’s comprehensive approach to protect taxpayer
dollars and target the most significant program integrity risks facing our
health care programs, CMS is working to prevent, rather than chase, fraud,
waste, and abuse through smart, proactive measures. Ambulance services have
long been associated with inappropriate overuse and high improper payments,
meaning many payments don’t meet program requirements – intentional or
otherwise –and contribute to inappropriate spending of Americans’ tax
dollars. The CMS Comprehensive Error Rate Testing program, which measures
improper payments in the Medicare FFS program, has consistently found
ambulance services, and specifically, non-emergent ambulance transports, to
be in the top 20 Part B services with improper payments. The estimated
improper payment rate for non-emergent ambulance transports in 2017 and 2018
was 22.6 and 18.6 percent, respectively. The RSNAT Prior Authorization Model tests whether prior authorization—or
advanced approval of a service before the service is furnished and before a
claim is submitted for payment—helps save Medicare money while maintaining or
improving the quality of care for repetitive, scheduled non-emergency
ambulance transportation. These services are covered under Medicare Part B
for Medicare beneficiaries who need to ride in ambulances to certain medical
appointments, most often for dialysis treatment. With the expansion of this
model, CMS is focusing on results and ensuring that the right payments are
made at the right time for the right beneficiary for covered, appropriate and
reasonable services. “CMS program integrity functions allow us to hold the entire
healthcare system accountable, protect beneficiaries from harm and safeguard
taxpayer dollars.” said CMS Administrator Seema Verma. “When deployed
appropriately, prior authorization can help ensure Medicare requirements are
met before a service is provided and the claim is paid, without creating any
new documentation requirements for providers. The RSNAT model has proven a
resounding success, and beneficiaries across the country deserve to benefit
from it.” Based on the model’s First Interim Evaluation Report in 2018,
the Chief Actuary of CMS certified that nationwide expansion of the
RSNAT Prior Authorization Model would reduce net Medicare spending. The
Second Interim Evaluation Report, which is being released today, supports
previous findings. It found that the model reduced RSNAT service use by 63%
and RSNAT expenditures by 72% among beneficiaries with end stage renal
disease and/or severe pressure ulcers during the first four years of the model.
This decrease in RSNAT service expenditures, in turn, caused a total decrease
of Medicare fee-for-service (FFS) expenditures of 2% (about $650 million over
four years). The report did not find evidence that the model adversely
affected quality of care. The RSNAT Prior Authorization Model began in New Jersey,
Pennsylvania, and South Carolina in 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 the Medicare Access and CHIP
Reauthorization Act of 2015 (Pub. L. 114-10) (MACRA). The model is expanding
nationwide under the authority of section 1834(l) (16) of the Social Security
Act, as added by section 515(b) of MACRA. The model’s program integrity, patient safety and cost-savings
elements will continue without interruption in the current states beyond
December 1, 2020, when the model was originally scheduled to end in these
states. 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. 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. Read the OACT certification memo: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/CMMI-Model-Certifications Read the Phase 1 and Phase 2 evaluation reports: https://innovation.cms.gov/data-and-reports/2020/rsnat-secondintevalrpt ### Get
CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS
Administrator @SeemaCMS and @CMSgov. |
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