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CMS Will Pay for Transports to Alternate Destinations

Tuesday, March 31, 2020   (0 Comments)
Posted by: Angela Madden
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The Centers for Medicare and Medicaid Services (CMS) just announced that it will pay for transports to alternative destinations and pause the repetitive, scheduled non-emergency prior authorization program for the ambulance industry during the COVID-19 Public Health Emergency. 

 

CMS just issued an Interim Final Rule establishing that, during the COVID-19 Public Health Emergency, CMS  will expand the list of Medicare covered destinations to include all destinations that are equipped to treat the condition of the patient consistent with Emergency Medical Services (EMS) protocols established by state and/or local laws where the services will be furnished.  Approved alternative destinations may include, but are not limited to:

  • Any location that is an alternative site determined to be part of a Hospital, Critical access hospital (CAH) or skilled nursing facility (SNF);
  • Community mental health centers;
  • Federal qualified health clinic (FQHCs);
  • Rural health clinics (RHCs);
  • Physicians’ offices;
  • Urgent care facilities;
  • Ambulatory surgery centers (ASCs);
  • Any location furnishing dialysis services outside of an ESRD facility when an ESRD facility is not available; and
  • The beneficiary’s home

 
This destination expansion applies to emergency and non-emergency ground ambulance transports of beneficiaries from any point of origin during the Public Health Emergency for COVID-19. Please note, this list of covered alternative destinations during the pandemic applies to all ambulance services in the U.S. and is completely separate and apart from the ET3 pilot program scheduled to begin later this Spring. So, these alternative destinations apply to everyone during this COVID-19 pandemic. CMS has not issued additional guidance on destination modifiers, and the Rule does not waive medically necessary requirements for transports to these alternative destinations. 




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