Medicare Program; National Expansion Implementation for All Remaining States and Territories of the Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transports, 48149-48151 [2021-18543]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 86, Number 164 (Friday, August 27, 2021)]
[Notices]
[Pages 48149-48151]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-18543]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-6063-N7]


Medicare Program; National Expansion Implementation for All 
Remaining States and Territories of the Prior Authorization Model for 
Repetitive, Scheduled Non-Emergent Ambulance Transports

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

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SUMMARY: This notice announces the implementation dates for all 
remaining states and territories for the national expansion of the 
Prior Authorization Model for Repetitive, Scheduled Non-Emergent 
Ambulance Transports.

DATES: This expansion of the Prior Authorization Model for Repetitive, 
Scheduled Non-Emergent Ambulance Transports will begin on December 1, 
2021 for independent ambulance suppliers garaged in Arkansas, Colorado, 
Louisiana, Mississippi, New Mexico, Oklahoma, and Texas; and no earlier 
than: February 1, 2022 for independent ambulance suppliers garaged in 
Alabama, American Samoa, California, Georgia, Guam, Hawaii, Nevada, 
Northern Mariana Islands and Tennessee; April 1, 2022 for independent 
ambulance suppliers garaged in Florida, Illinois, Iowa, Kansas, 
Minnesota, Missouri, Nebraska, Puerto Rico, Wisconsin, and U.S. Virgin 
Islands; June 1, 2022 for independent ambulance suppliers garaged in 
Connecticut, Indiana, Maine, Massachusetts, Michigan, New Hampshire, 
New York, Rhode Island, and Vermont; and August 1, 2022 for independent 
ambulance suppliers garaged in Alaska, Arizona, Idaho, Kentucky, 
Montana, North Dakota, Ohio, Oregon, South Dakota, Utah, Washington, 
and Wyoming.

FOR FURTHER INFORMATION CONTACT: Angela Gaston, (410) 786-7409.
    Questions regarding the national expansion of the Prior 
Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance 
Transports should be sent to [email protected].

SUPPLEMENTARY INFORMATION:

I. Background

    In the November 23, 2020 Federal Register (85 FR 74725), we 
published a notice titled ``Medicare Program; National Expansion of the 
Prior Authorization Model for Repetitive, Scheduled Non-Emergent 
Ambulance Transport,'' which announced the national expansion of the 
Prior Authorization Model for Repetitive, Scheduled Non-Emergent 
Ambulance Transports under section 1834(l)(16) of the Act, as added by 
section 515(b) of the Medicare Access and CHIP Reauthorization Act of 
2015 (MACRA) (Pub. L. 114-10). The states that participated in the 
model under section 1115A of the Social Security Act (the Act), which 
included Delaware, the District of Columbia, Maryland, New Jersey, 
North Carolina, Pennsylvania, South Carolina, Virginia, and West 
Virginia, previously transitioned to the national model on December 2, 
2020. Due to the COVID-19 Public Health Emergency, we delayed the 
implementation of the expansion to any additional states.

[[Page 48150]]

II. Provisions of the Notice

    This notice announces the implementation dates for all remaining 
states and territories for the national expansion of the Prior 
Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance 
Transports under section 1834(l)(16) of the Act, as added by section 
515(b) of MACRA (Pub. L. 114-10). This expansion of the model will 
begin on December 1, 2021 for independent ambulance suppliers garaged 
in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, 
and Texas; and no earlier than--
     February 1, 2022 for independent ambulance suppliers 
garaged in Alabama, American Samoa, California, Georgia, Guam, Hawaii, 
Nevada, Northern Mariana Islands and Tennessee;
     April 1, 2022 for independent ambulance suppliers garaged 
in Florida, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, 
Puerto Rico, Wisconsin, and U.S. Virgin Islands;
     June 1, 2022 for independent ambulance suppliers garaged 
in Connecticut, Indiana, Maine, Massachusetts, Michigan, New Hampshire, 
New York, Rhode Island, and Vermont; and
     August 1, 2022 for independent ambulance suppliers garaged 
in Alaska, Arizona, Idaho, Kentucky, Montana, North Dakota, Ohio, 
Oregon, South Dakota, Utah, Washington, and Wyoming.
    We 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. Prior authorization helps ensure that all 
relevant clinical or medical documentation requirements are met before 
services are furnished to beneficiaries and before claims are submitted 
for payment. It further helps to ensure that payment complies with 
Medicare documentation, coverage, payment, and coding rules. Prior 
authorization also allows ambulance suppliers to address coverage 
issues prior to furnishing services.
    The model establishes a process for requesting prior authorization 
for repetitive, scheduled non-emergent ambulance transports. The use of 
prior authorization does not create new clinical documentation 
requirements. Instead, it requires the same information that is already 
required to support Medicare payment, just earlier in the process.
    Submitting a prior authorization request for repetitive, scheduled 
non-emergent ambulance transports is voluntary. However, an ambulance 
supplier or beneficiary is 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. Please see the November 23, 2020 Federal 
Register (85 FR 74725) for additional details on the prior 
authorization model and process.
    We will expand outreach and education efforts on this model to 
affected ambulance suppliers in all states and territories, through 
such methods as an operational guide, frequently asked questions (FAQs) 
on our website, a physician letter explaining the ambulance suppliers' 
need for the proper documentation, open door forums, and educational 
events and materials issued by the MACs. We will work to limit any 
adverse impact on beneficiaries and to educate affected beneficiaries 
about the model process. Beneficiaries will continue to have all 
applicable administrative appeal rights for denied claims associated 
with a non-affirmed prior authorization decision.
    Additional information is available on the CMS website at https://go.cms.gov/PAAmbulance.

III. Collection of Information Requirements

    As required by chapter 35 of title 44, United States Code (the 
Paperwork Reduction Act of 1995), the information collection burden 
associated with this national model (Form CMS-10708--Ambulance Prior 
Authorization) is currently approved under OMB control number 0938-1380 
which expires on August 31, 2023.

IV. Regulatory Impact Statement

    We have examined the impact of this rule as required by Executive 
Order 12866 on Regulatory Planning and Review (September 30, 1993), 
Executive Order 13563 on Improving Regulation and Regulatory Review 
(January 18, 2011), the Regulatory Flexibility Act (RFA) (September 19, 
1980, Pub. L. 96-354), section 1102(b) of the Act, section 202 of the 
Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. L. 104-4), 
Executive Order 13132 on Federalism (August 4, 1999), and the 
Congressional Review Act (5 U.S.C. 804(2)).
    Executive Orders 12866 and 13563 direct agencies to assess all 
costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
Regulatory Impact Analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more in any 1 year). 
This rule does not reach the economic threshold and thus is not 
considered a major rule.
    The RFA requires agencies to analyze options for regulatory relief 
of small entities. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and small governmental 
jurisdictions. Most hospitals and most other providers and suppliers 
are small entities, either by nonprofit status or by having revenues of 
less than $8.0 million to $41.5 million in any 1 year. Individuals and 
states are not included in the definition of a small entity. We are not 
preparing an analysis for the RFA because we have determined, and the 
Secretary certifies, that this notice will not have a significant 
economic impact on a substantial number of small entities.
    In addition, section 1102(b) of the Act requires us to prepare an 
RIA if a rule may have a significant impact on the operations of a 
substantial number of small rural hospitals. This analysis must conform 
to the provisions of section 604 of the RFA. For purposes of section 
1102(b) of the Act, we define a small rural hospital as a hospital that 
is located outside of a Metropolitan Statistical Area for Medicare 
payment regulations and has fewer than 100 beds. We are not preparing 
an analysis for section 1102(b) of the Act because we have determined, 
and the Secretary certifies, that this notice will not have a 
significant impact on the operations of a substantial number of small 
rural hospitals.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule whose mandates require spending in any 1 year of $100 
million in 1995 dollars, updated annually for inflation. In 2021, that 
threshold is approximately $158 million. This rule will have no 
consequential effect on state, local, or tribal governments or on the 
private sector.
    Executive Order 13132 establishes certain requirements that an 
agency

[[Page 48151]]

must meet when it promulgates a proposed rule (and subsequent final 
rule) that imposes substantial direct requirement costs on state and 
local governments, preempts state law, or otherwise has Federalism 
implications. Since this regulation does not impose any costs on state 
or local governments, the requirements of Executive Order 13132 are not 
applicable.
    In accordance with the provisions of Executive Order 12866, this 
notice was not reviewed by the Office of Management and Budget.
    The Administrator of the Centers for Medicare & Medicaid Services 
(CMS), Chiquita Brooks-LaSure, having reviewed and approved this 
document, authorizes Lynette Wilson, who is the Federal Register 
Liaison, to electronically sign this document for purposes of 
publication in the Federal Register.

    Dated: August 24, 2021.
Lynette Wilson,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2021-18543 Filed 8-26-21; 8:45 am]
BILLING CODE 4120-01-P