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CMS implements waiver for treatment in place reimbursement during pandemic

The waiver is retroactive to March 1, 2020 and allows for reimbursement when patients aren’t transported due to community-wide COVID-19 protocols

By Laura French

BALTIMORE — The Centers for Medicare and Medicaid Services (CMS) has announced the implementation of a waiver that will allow ambulance services to be reimbursed for treatment in place when a patient is not transported due to COVID-19 restrictions.

CMS published a fact sheet Wednesday outlining the circumstances under which ground ambulance services can be reimbursed for treatment in place and how agencies can submit claims for reimbursement under the waiver, which applies retroactively March 1, 2020 and will continue until the COVID-10 public health emergency declaration is lifted.

Ground ambulance services can be reimbursed when a patient is treated in place if the treatment was furnished in response to a 911 call, or equivalent emergency call in areas without a 911 system, and if the patient would have been transported to a destination permitted under Medicare regulations but was not transported as a result of community-wide EMS protocols implemented due to the COVID-19 emergency.

CMS stated that treatment in place will not be reimbursed if a transport did not occur solely based on the patient’s decision, including when a patient refuses transport “against medical advice,” if the transport would not have been medically necessary under Medicare regulations, and if documentation cannot be provided that a community-wide COVID-19 protocol preventing transport was in place at the time of the call.

The deadline to submit claims for services rendered between March 1, 2020 and May 5, 2021 is May 5, 2022, and claims for services rendered after May 5, 2021 must be submitted within one calendar year after the date of service.

The American Rescue Plan Act of 2021, which was signed by President Joe Biden on March 11, 2021, gave CMS the authority to implement the waiver during the COVID-19 public health emergency. The provision was sponsored by Sen. Catherine Cortez Masto and Rep. Cynthia Axne and approved in the final version of the Act.*F

Read the full CMS fact sheet below:

EMS1’s EMS trends state-of-the-industry survey provides targets for reducing stress, staffing challenges and leadership shortfalls
Under the “Direct Pay Bill,” health insurance plans will be required to reimburse ambulance providers for transporting out-of-network patients
Adopting programs to improve service delivery and agency culture
A closer look at the causes and effects of pressure, strain and anxiety on the EMS workforce