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CMS expands prior authorization model for non-emergent ambulance transport


On September 22, 2020, CMS announced it will expand the Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) nationwide. The RSNAT Prior Authorization Model assesses whether prior authorization saves Medicare money while maintaining or improving the quality of care for repetitive, scheduled non-emergency ambulance transportation.

The RSNAT Prior Authorization Model was initiated in New Jersey, Pennsylvania, and South Carolina in 2014 and expanded to North Carolina, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia in 2016. The Model’s first report in 2018 indicated that nationwide expansion of the RSNAT Prior Authorization Model would reduce net Medicare spending. The Model’s second report, issued on September 22, 2020, 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, resulting in a decrease of approximately $650 million in costs for Medicare. The RSNAT Prior Authorization Model’s second report did not find evidence of any adverse impact on quality of care.

The RSNAT Prior Authorization Model’s program integrity, patient safety and cost-savings elements will continue without interruption in the current states. CMS states that it will release more information on the national expansion and implementation dates for additional states as it becomes available.

CMS’s press release regarding the expansion is available here. The RSNAT Prior Authorization Model second Report is available here.

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