BREAKING: CMS Announces Nationwide Prior Authorization Plan

BREAKING NEWS
National Expansion of Prior Authorization for Repetitive Patient Transports Begins December 1st

We knew it was coming!  CMS just announced in today’s Federal Register the implementation schedule to expand the Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transports (RSNAT) to all remaining states and territories.  This will be a hot topic for our abc360 Conference set for October 19 and 20 in Hershey, PA where we will provide more details and recommended strategies to minimize the impact this expansion will have on your ambulance service and to help you prepare for this rather quick implementation schedule.

The expansion will be “phased in” and will begin as early as December 1, 2021.  The implementation schedule parallels the MAC jurisdictions, with additional jurisdictions administered by the MACs that have already implemented the pilot program being in the early phases of the national expansion.

The schedule published in the Federal Register today states the program will be implemented “not earlier than” the following dates for the respective states and territories:

December 1, 2021:
Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas (Jurisdiction H, Novitas)

February 1, 2022:   Alabama, Georgia, Tennessee (Jurisdiction J, Palmetto) and  American Samoa, California, Guam, Hawaii, Nevada, Northern Mariana Islands (Jurisdiction E, Noridian)

April 1, 2022:  Florida, Puerto Rico, U.S. Virgin Islands (Jurisdiction N, First Coast); Illinois, Minnesota, Wisconsin (Jurisdiction 6, NGS) and Iowa, Kansas, Missouri, Nebraska (Jurisdiction 5, WPS)

June 1, 2022:  Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont (Jurisdiction K, NGS) and Indiana, Michigan (Jurisdiction 8, WPS)

August 1, 2022:  Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming (Jurisdiction F, Noridian) and Kentucky, Ohio (Jurisdiction 15, CGS)

According to CMS, it will continue to test in the remaining states and territories whether prior authorization helps reduce expenditures, while maintaining or improving quality of care, by using the prior authorization process described in the November 23, 2020 Federal Register (85 FR 74725) to reduce utilization of services that do not comply with Medicare policy.

Submitting a prior authorization request for repetitive, scheduled non-emergent ambulance transports is voluntary. However, ambulance suppliers are encouraged to submit to the Medicare Administrative Contractor (MAC) a request for prior authorization along with all relevant documentation to support Medicare coverage of the transports. If prior authorization has not been requested by the fourth “round trip” in a 30-day period, the subsequent claims will be stopped for prepayment review.  (See 85 FR 74725).

CMS says it will expand outreach and education efforts on this model to affected ambulance suppliers in all states and territories.

This is another reason to REGISTER TODAY for our abc360 Conference in Hershey!