Medicare Ambulance NEMT Prior Authorization | Simon&Co., LLC

Introduction of The Access to Critical Non-Emergency Transportation Services Act

Simon&Co. — Thu, 22 Sep 2022 21:35:53 +0000

On September 15^th, 2022, Representative Earl L. “Buddy” Carter (R-GA) introduced The Access to Critical Non-Emergency Transportation Services Act, H.R.8841. The bill will expand access to non-emergency medical transportation (NEMT) for low income, dual eligible Medicare and Medicaid beneficiaries. These vulnerable patients will now be transitioned to Medicaid NEMT services when they lose access to Medicare ambulance NEMT as a result of new Medicare prior authorization requirements. This bill amends the CMMI Repetitive, Scheduled, Non-Emergent Ambulance Transport (RSNAT) model to ensure that dually enrolled, Medicaid and Medicare beneficiaries, have access to appropriate modes of transportation through the Medicaid program. Representative Carter introduced the bill with support of cosponsors Representatives Tony Cárdenas (D-CA) and Sanford D. Bishop, Jr. (D-GA). The bill has been referred to the Energy and Commerce Committee.

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Letter to CMS from 61 Health Care and Stakeholder Organizations Regarding Proposed Changes to Ambulance Services

Simon&Co. — Thu, 15 Sep 2022 16:35:50 +0000

On September 6th, sixty-one beneficiary advocacy and non-emergency medical transportation (NEMT) stakeholder groups submitted a letter to the Centers for Medicare and Medicaid Services Administrator Brooks-LaSure, commenting on the proposed changes to the Medical Necessity and Documentation Requirements for Nonemergency, Scheduled, Repetitive Ambulance Services. They collectively urged CMS to ensure access to Medicaid NEMT for full and partial dual eligible beneficiaries in the Calendar Year 2023 Physician Fee Schedule proposed rule.

Comments-on-Ambulance-in-CY23-PFS-proposed-rule_Download

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Strong Report Language re RSNAT Model Added to L,HHS Bill

Simon&Co. — Mon, 11 Jul 2022 19:14:25 +0000

On June 30, the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies added strong report language to the FY23 L,HHS bill, requested by Reps. Sanford Bishop (D-GA) and Buddy Carter (R-GA), urging CMS to delay further implementation of the Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) model. The RSNAT model denies ambulance transportation to Medicare dialysis and diabetes wound care patients without appropriate, alternative transportation.

Similar language was included in the FY22 omnibus appropriations bill in March 2022, but CMS has not changed its policies. The report language was strengthened to “strongly urge” CMS to delay the model as well as to require the development of a plan within 90 days to provide alternative transportation to low-income, full and partial dual eligibles.

Below is the final report language adopted by the committee:

Report Language:

Transportation for Dialysis.—The Committee continues to strongly urge CMS to delay further implementation of the Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport model until it ensures appropriate alternative transportation to dialysis services and diabetes-related wound care for low-income beneficiaries who have no other means of transportation. The Committee further requests a plan within 90 days of the date of enactment of this Act to provide alternative transportation to the low-income Medicare-Medicaid full and partial dual eligibles who have no alternative transportation to dialysis and diabetes wound care services.

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