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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
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