Medicare Program; National Expansion of the Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transports

Cited as:85 FR 74725
Court:Centers For Medicare And Medicaid Services
Publication Date:23 Nov 2020
Record Number:2020-25728
74725
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CMS–855S is approved under OMB
control number 0938–1056.
IV. Regulatory Impact Statement
A. Background
We have examined the impact of this
notice 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 Social
Security 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), the Congressional
Review Act (5 U.S.C. 804(2)), and
Executive Order 13771 on Reducing
Regulation and Controlling Regulatory
Costs (January 30, 2017).
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). As
explained in this section of the notice,
we estimate that the total cost of the
increase in the application fee will not
exceed $100 million. Therefore, this
notice does not reach the $100 million
economic threshold and is not
considered a major notice.
B. Costs
The costs associated with this notice
involve the increase in the application
fee amount that certain providers and
suppliers must pay in CY 2021. The CY
2021 cost estimates are as follows:
1. Medicare
Based on CMS data, we estimate that
in CY 2021 approximately—
10,214 newly enrolling institutional
providers will be subject to and pay an
application fee; and
42,117 revalidating institutional
providers will be subject to and pay an
application fee.
Using a figure of 52,331 (10,214 newly
enrolling + 42,117 revalidating)
institutional providers, we estimate an
increase in the cost of the Medicare
application fee requirement in CY 2021
of $209,324 (or 52,331 × $4 (or $599
minus $595)) from our CY 2020
projections.
2. Medicaid and CHIP
Based on CMS and state statistics, we
estimate that approximately 30,000
(9,000 newly enrolling + 21,000
revalidating) Medicaid and CHIP
institutional providers will be subject to
an application fee in CY 2021. Using
this figure, we project an increase in the
cost of the Medicaid and CHIP
application fee requirement in CY 2021
of $120,000 (or 30,000 × $4 (or $599
minus $595)) from our CY 2020
projections.
3. Total
Based on the foregoing, we estimate
the total increase in the cost of the
application fee requirement for
Medicare, Medicaid, and CHIP
providers and suppliers in CY 2021 to
be $329,324 ($209,324 + $120,000) from
our CY 2020 projections.
The RFA requires agencies to analyze
options for regulatory relief of small
businesses. 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 $7.5 million to $38.5
million in any 1 year. Individuals and
states are not included in the definition
of a small entity. As we stated in the
RIA for the February 2, 2011 final rule
with comment period (76 FR 5952), we
do not believe that the application fee
will have a significant impact on small
entities.
In addition, section 1102(b) of the Act
requires us to prepare a regulatory
impact analysis 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 would 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 (UMRA)
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 2020, that
threshold was approximately $156
million. The Agency has determined
that there will be minimal impact from
the costs of this notice, as the threshold
is not met under the UMRA.
Executive Order 13132 establishes
certain requirements that an agency
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 notice does not impose
substantial direct costs on state or local
governments, the requirements of
Executive Order 13132 are not
applicable.
Executive Order 13771, titled
‘‘Reducing Regulation and Controlling
Regulatory Costs,’’ was issued on
January 30, 2017 (82 FR 9339, February
3, 2017). It has been determined that
this notice is a transfer notice that does
not impose more than de minimis costs
and thus is not a regulatory action for
the purposes of E.O. 13771.
In accordance with the provisions of
Executive Order 12866, this notice was
reviewed by the Office of Management
and Budget.
The Administrator of the Centers for
Medicare & Medicaid Services (CMS),
Seema Verma, 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: November 17, 2020.
Lynette Wilson,
Federal Register Liaison, Department of
Health and Human Services.
[FR Doc. 2020–25715 Filed 11–20–20; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare and Medicaid
Services
[CMS–6063–N6]
Medicare Program; National Expansion
of the Prior Authorization Model for
Repetitive, Scheduled Non-Emergent
Ambulance Transports
AGENCY
: Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION
: Notice.
SUMMARY
: This notice announces the
national expansion of the Prior
Authorization Model for Repetitive,
Scheduled Non-Emergent Ambulance
Transports to all states, but we are
delaying the implementation of the
expansion to all additional states due to
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1
Government Accountability Office ‘‘Ambulance
Providers: Cost and Medicare Margins Varied
Widely; Transports of Beneficiaries Have
Increased’’ (GAO–13–6) (October 2012).
2
Office of Inspector General ‘‘Medicare Payment
for Ambulance Transport’’ (January 2006).
3
Medicare Payment Advisory Commission, June
2013, pages 167–193.
4
https://innovation.cms.gov/data-and-reports/
2020/rsnat-secondintevalrpt.
5
https://innovation.cms.gov/files/reports/rsnat-
firstintevalrpt.pdf.
the COVID–19 Public Health
Emergency. The model will continue to
operate in the states currently
participating in the model under section
1115A of the Social Security Act (the
Act), which includes Delaware, the
District of Columbia, Maryland, New
Jersey, North Carolina, Pennsylvania,
South Carolina, Virginia, and West
Virginia. CMS will continue to monitor
the Public Health Emergency and will
provide public notice before
implementing the model in additional
states.
DATES
: This national expansion begins
on December 2, 2020 in Delaware, the
District of Columbia, Maryland, New
Jersey, North Carolina, Pennsylvania,
South Carolina, Virginia, and West
Virginia.
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 AmbulancePA@cms.hhs.gov.
SUPPLEMENTARY INFORMATION
:
I. Background
A. Overview
Section 1115A of the Act authorizes
the Secretary to test innovative payment
and service delivery models expected to
reduce program expenditures, while
preserving or enhancing the quality of
care furnished to Medicare, Medicaid,
and Children’s Health Insurance
Program beneficiaries. In the November
14, 2014 Federal Register (79 FR
68271), we published a notice entitled
‘‘Medicare Program; Prior Authorization
of Repetitive, Scheduled Nonemergent
Ambulance Transports,’’ which
announced the implementation of a 3-
year Medicare prior authorization model
under the authority of section 1115A of
the Act that established a process for
requesting prior authorization for
repetitive, scheduled non-emergent
ambulance transport rendered by
ambulance suppliers garaged in three
states (New Jersey, Pennsylvania, and
South Carolina). These states were
selected as the initial states for the
model because of their high utilization
and improper payment rates for these
services. The model began on December
1, 2014, and was originally scheduled to
end in all three states on December 1,
2017.
We chose to test this model on
repetitive, scheduled non-emergent
ambulance transports because these
services have been historically
vulnerable to improper payments.
According to a study published by the
Government Accountability Office in
October 2012, entitled ‘‘Ambulance
Providers: Costs and Medicare Margins
Varied Widely; Transports of
Beneficiaries Have Increased,’’
1
the
number of basic life support (BLS) non-
emergent transports for Medicare Fee-
For-Service beneficiaries increased by
59 percent from 2004 to 2010. A similar
finding published by the Department of
Health and Human Services’ Office of
Inspector General (OIG) in a 2006 study,
entitled ‘‘Medicare Payments for
Ambulance Transports,’’
2
indicated a
20 percent nationwide improper
payment rate for non-emergent
ambulance transport. Likewise, in June
2013, the Medicare Payment Advisory
Commission published a report
3
that
included an analysis of non-emergent
ambulance transports to dialysis
facilities and found that, during the 5-
year period between 2007 and 2011, the
volume of transports to and from a
dialysis facility increased 20 percent,
more than twice the rate of all other
ambulance transports combined.
In the October 23, 2015 Federal
Register (80 FR 64418), we published a
notice titled ‘‘Medicare Program;
Expansion of Prior Authorization for
Repetitive, Scheduled Non-Emergent
Ambulance Transports,’’ which
announced the inclusion of six
additional states (Delaware, the District
of Columbia, Maryland, North Carolina,
West Virginia, and Virginia) in the Prior
Authorization Model for Repetitive,
Scheduled Non-Emergent Ambulance
Transports in accordance with section
515(a) of the Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA)
(Pub. L. 114–10). These six states began
participation on January 1, 2016, and
the model was originally scheduled to
end in all nine model states on
December 1, 2017.
We extended the model for 3
additional years through December 1,
2020, as announced in the December 12,
2017 Federal Register (82 FR 58400),
the December 4, 2018 Federal Register
(83 FR 62577), and the September 16,
2019 Federal Register (84 FR 48620).
B. Expansion Criteria
Section 515(b) of MACRA (Pub. L.
114–10) added paragraph (16) to section
1834(l) of the Act, which requires that,
beginning January 1, 2017, the Secretary
expand the Prior Authorization Model
for Repetitive, Scheduled Non-Emergent
Ambulance Transports nationally to all
states if an expansion to all states meets
certain statutory requirements for
expansion of models tested under
section 1115A of the Act. These
requirements are described in
paragraphs (1) through (3) of section
1115A(c) of the Act, and include the
following:
The Secretary determines that such
expansion is expected to—
++ Reduce spending under
applicable title without reducing the
quality of care; or
++ Improve the quality of patient care
without increasing spending.
The Chief Actuary of CMS certifies
that such expansion would reduce (or
would not result in any increase in) net
program spending under applicable
titles.
The Secretary determines that such
expansion would not deny or limit the
coverage or provision of benefits under
the applicable title for applicable
individuals.
To date, we have released two interim
evaluation reports conducted by CMS
contractor, Mathematica Policy
Research. Most recently, the Second
Interim Evaluation Report
4
found that
the model was successful in reducing
repetitive, scheduled non-emergent
ambulance transport spending and total
Medicare spending while maintaining
overall quality of and access to care.
These findings were similar to the First
Interim Evaluation Report.
5
In
comparison to groups of similar states,
the model has reduced both repetitive,
scheduled non-emergent ambulance
transport use and expenditures, by 63
percent and 72 percent, respectively, in
the model states, resulting in a
reduction of approximately $550
million in expenditures over 4 years for
the population examined: Beneficiaries
with end-stage renal disease, severe
pressure ulcers, or both. The evaluation
reports found that the prior
authorization model overall had no
impact on quality measures or adverse
events.
On March 28, 2018, the Chief Actuary
of CMS certified that expansion of the
model would reduce program spending
under the Medicare program, thereby
satisfying the requirements of section
1115A(c)(2) of the Act, stating that even
under the most conservative
assumptions, the projected savings from
expansion would significantly outweigh
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6
https://www.cms.gov/files/document/
certification-medicare-prior-authorization-model-
repetitive-scheduled-non-emergent-ambulance.pdf.
7
42 CFR 410.40(d)(1).
8
Program Memorandum Intermediaries/Carriers,
Transmittal AB–03–106.
9
Per 42 CFR 410.40(e)(2), the physician’s order
must be dated no earlier than 60 days before the
date the service is furnished.
the cost of administering the prior
authorization policy.
6
On May 29, 2019, the Secretary of the
Department of Health and Human
Services (the Secretary) determined that
the model met the statutory criteria for
expansion under sections 1115A(c)(1)
and (c)(3) of the Act. CMS is therefore
required under section 1834(l)(16) of the
Act, as added by section 515(b) of
MACRA (Pub. L. 114–10), to expand the
model nationwide.
C. Medicare Ambulance Benefit
Medicare may cover ambulance
services, including ground (land and
water) and air ambulance (fixed-wing
and rotary-wing) transport services, only
if the ambulance transport service is
furnished to a beneficiary whose
medical condition is such that other
means of transportation are
contraindicated, to the nearest
appropriate facility. The beneficiary’s
condition must require both the
ambulance transportation itself and the
level of service provided in order for the
billed service to be considered
medically necessary.
Non-emergent transportation by
ambulance is appropriate if either the—
(1) beneficiary is bed-confined and it is
documented that the beneficiary’s
condition is such that other methods of
transportation are contraindicated; or (2)
beneficiary’s medical condition,
regardless of bed confinement, is such
that transportation by ambulance is
medically required. Thus, bed
confinement is not the sole criterion in
determining the medical necessity of
non-emergent ambulance transportation;
rather, it is one factor that is considered
in medical necessity determinations.
7
A repetitive ambulance service is
defined as medically necessary
ambulance transportation that is
furnished in 3 or more round trips
during a 10-day period, or at least 1
round trip per week for at least 3
weeks.
8
Repetitive ambulance services
are often needed by beneficiaries
receiving dialysis or cancer treatment.
Medicare may cover repetitive,
scheduled non-emergent transportation
by ambulance if the—(1) medical
necessity requirements described
previously are met; and (2) ambulance
provider/supplier, before furnishing the
service to the beneficiary, obtains a
written order from the beneficiary’s
attending physician certifying that the
medical necessity requirements are met
(see 42 CFR 410.40(e)(1) and (2)).
9
In addition to the medical necessity
requirements, the service must meet all
other Medicare coverage and payment
requirements, including requirements
relating to the origin and destination of
the transportation, vehicle and staff, and
billing and reporting. Additional
information about Medicare coverage of
ambulance services can be found in 42
CFR 410.40, 410.41, and in the Medicare
Benefit Policy Manual (Pub. 100–02),
Chapter 10, at http://www.cms.gov/
Regulations-and-Guidance/Guidance/
Manuals/downloads/bp102c10.pdf.
II. Provisions of the Notice
This notice announces the national
expansion of the Prior Authorization
Model for Repetitive, Scheduled Non-
Emergent Ambulance Transports to all
states under section 1834(l)(16) of the
Act, as added by section 515(b) of
MACRA (Pub. L. 114–10). Due to the
COVID–19 Public Health Emergency, we
are delaying the implementation of the
expansion to all additional states. The
Prior Authorization Model for
Repetitive, Scheduled Non-Emergent
Ambulance Transports currently
operating under section 1115A of the
Act will transition to the national model
on December 2, 2020. This transition
will include independent ambulance
suppliers garaged in Delaware, the
District of Columbia, Maryland, New
Jersey, North Carolina, Pennsylvania,
South Carolina, Virginia, and West
Virginia. CMS will continue to monitor
the Public Health Emergency and will
provide public notice before
implementing the model in additional
states.
We will continue to test whether prior
authorization helps reduce
expenditures, while maintaining or
improving quality of care, using the
prior authorization process described in
this notice 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.
The national expansion of the model
will follow a similar design as the Prior
Authorization Model for Repetitive,
Scheduled Non-Emergent Ambulance
Transports that operated under section
1115A of the Act. 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. Prior authorization also allows
ambulance suppliers to address
coverage issues prior to furnishing
services. Hospital-based ambulance
providers that are owned or operated by
a hospital or both, critical access
hospital, skilled nursing facility,
comprehensive outpatient rehabilitation
facility, home health agency, or hospice
program have not been included in the
current model, and are not included in
the national model and should not
request prior authorization.
For the national expansion of the
model, the prior authorization process
will apply in all states and the District
of Columbia to the following Healthcare
Common Procedure Coding System
(HCPCS) codes for Medicare payment:
A0426 Ambulance service,
advanced life support, non-emergency
transport, Level 1 (ALS1).
A0428 Ambulance service, BLS,
non-emergency transport.
While prior authorization is not
needed for the mileage code, A0425, a
prior authorization decision for an
A0426 or A0428 code will automatically
include the associated mileage code.
Submitting a prior authorization
request 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 a
repetitive, scheduled non-emergent
ambulance transport. 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.
In order for a prior authorization
request to be provisionally affirmed, the
request for prior authorization must
meet all applicable rules and policies,
including any local coverage
determination (LCD) requirements for
ambulance transport claims. A
provisional affirmation is a preliminary
finding that a future claim submitted to
Medicare for the service likely meets
Medicare’s coverage, coding, and
payment requirements. After receipt of
all relevant documentation, the MAC
will make every effort to conduct a
review and postmark the notification of
their decision on the prior authorization
request within 10 business days.
Notification will be provided to the
ambulance supplier and to the
beneficiary. If a prior authorization
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request is non-affirmed, the request can
be resubmitted with additional
documentation. Unlimited
resubmissions are allowed.
An ambulance supplier or beneficiary
may request an expedited review when
the standard timeframe for making a
prior authorization decision could
jeopardize the life or health of the
beneficiary. If the MAC agrees that the
standard review timeframe would put
the beneficiary at risk, the MAC will
make reasonable efforts to communicate
a decision within 2 business days of
receipt of all applicable Medicare-
required documentation. As this model
is for non-emergent services only, we
expect requests for expedited reviews to
be extremely rare.
A provisional affirmative prior
authorization decision may affirm a
specified number of trips within a
specific amount of time. The prior
authorization decision, justified by the
beneficiary’s condition, may affirm up
to 40 round trips (which equates to 80
one-way trips) per prior authorization
request in a 60-day period.
Alternatively, a provisional affirmative
decision may affirm less than 40 round
trips in a 60-day period, or may affirm
a request that seeks to provide a
specified number of transports (40
round trips or less) in less than a 60-day
period. A provisional affirmative
decision can be for all or part of the
requested number of trips. Transports
exceeding 40 round trips (or 80 one-way
trips) in a 60-day period require an
additional prior authorization request.
The MAC may consider an extended
affirmation period for beneficiaries with
a chronic condition that is deemed not
likely to improve over time. The prior
authorization decision, justified by the
beneficiary’s chronic condition, may
affirm up to 120 round trips (which
equates to 240 one-way trips) per prior
authorization request in a 180-day
period. The medical records must
clearly indicate that the condition is
chronic, and the MAC must have
established through two previous prior
authorization requests that the
beneficiary’s medical condition has not
changed or has deteriorated from
previous requests before allowing an
extended affirmation period.
The following describes examples of
various prior authorization scenarios:
Scenario 1: When an ambulance
supplier or beneficiary submits a prior
authorization request to the MAC with
appropriate documentation and all
relevant Medicare coverage and
documentation requirements are met for
the ambulance transport, the MAC will
send a provisional affirmative prior
authorization decision to the ambulance
supplier and the beneficiary. When the
subsequent claim is submitted to the
MAC by the ambulance supplier, it is
linked to the prior authorization
decision via the claims processing
system, and the claim will be paid so
long as all Medicare coding, billing, and
coverage requirements are met. A claim
could be denied for technical reasons,
however, such as a duplicate claim or a
date of service after a deceased
beneficiary’s date of death. CMS
contractors may conduct targeted
prepayment and post payment reviews
to ensure that claims are accompanied
by documentation not required or
available during the prior authorization
process. In addition, it is possible that
the Comprehensive Error Rate Testing
(CERT) contractor may select a claim
linked to an affirmed prior authorization
decision for review as the CERT
contractor must review a random
sample of claims for purposes of
estimating the Medicare improper
payment rate.
Scenario 2: When an ambulance
supplier or beneficiary submits a prior
authorization request, but all relevant
Medicare coverage requirements are not
met, the MAC will send a non-
affirmative prior authorization decision
to the ambulance supplier and to the
beneficiary advising them that Medicare
will not pay for the service. The
supplier or beneficiary may then
resubmit the request with additional
documentation showing that Medicare
requirements have been met.
Alternatively, an ambulance supplier
could furnish the service and submit a
claim with a non-affirmative prior
authorization tracking number, at which
point the MAC would deny the claim.
The ambulance supplier and the
beneficiary would then have the
Medicare denial for secondary
insurance purposes, and would have the
opportunity to submit an appeal of the
claim denial if they believe Medicare
coverage was denied inappropriately.
Scenario 3: When an ambulance
supplier or beneficiary submits a prior
authorization request with incomplete
documentation, a detailed decision
letter will be sent to the ambulance
supplier and to the beneficiary, with an
explanation of what information is
missing. The ambulance supplier or
beneficiary can rectify the error(s) and
resubmit the prior authorization request
with appropriate documentation.
Scenario 4: If an ambulance
supplier renders a service to a
beneficiary and does not request prior
authorization by the fourth round trip in
a 30-day period, and the claim is
submitted to the MAC for payment, then
the claim will be stopped for
prepayment review and documentation
will be requested.
++ If the claim is determined to be for
services that were not medically
necessary or for which there was
insufficient documentation, the claim
will be denied, and all current policies
and procedures regarding liability for
payment will apply. The ambulance
supplier or the beneficiary, or both, can
appeal the claim denial if they believe
the denial was inappropriate.
++ If the claim is determined to be
payable, it will be paid.
Only one prior authorization request
per beneficiary per designated time
period can be provisionally affirmed. If
the initial ambulance supplier cannot
complete the total number of prior
authorized transports (for example, the
initial ambulance company closes or no
longer services that area), the initial
request is cancelled. In this situation, a
subsequent prior authorization request
may be submitted for the same
beneficiary and must include the
required documentation in the
submission. If multiple ambulance
suppliers are providing transports to the
beneficiary during the same or
overlapping time period, the prior
authorization decision will only cover
the ambulance supplier indicated in the
provisionally affirmed prior
authorization request. Any ambulance
supplier submitting claims for
repetitive, scheduled non-emergent
ambulance transports for which no prior
authorization request is submitted by
the fourth round trip in a 30-day period
will be subject to 100 percent
prepayment medical review of those
claims.
We will expand outreach and
education efforts to all states and the
District of Columbia on this prior
authorization model to ambulance
suppliers, as well as beneficiaries,
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, and educational events
and materials issued by the MACs.
We will work to limit any adverse
impact on beneficiaries and to educate
beneficiaries about the model process. If
an ambulance supplier submits a claim
associated with a non-affirmed prior
authorization decision, it will be denied
and beneficiaries will continue to have
all applicable administrative appeal
rights.
Additional information is available on
the CMS website at http://go.cms.gov/
PAAmbulance.
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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 is currently approved
under OMB control number 0938–1380
which expires on August 31, 2023.
IV. Regulatory Impact Statement
This document announces an
expansion of the 3-year Medicare Prior
Authorization Model for Repetitive
Scheduled Non-emergent Ambulance
Transport. Therefore, there are no
regulatory impact implications
associated with this notice.
The Administrator of the Centers for
Medicare & Medicaid Services (CMS),
Seema Verma, 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.
Authority: Section 1834(l)(16) of the Social
Security Act (the Act), as added by section
515(b) of MACRA (Pub. L. 114–10).
Dated: November 17, 2020.
Lynette Wilson,
Federal Register Liaison, Centers for Medicare
& Medicaid Services.
[FR Doc. 2020–25728 Filed 11–20–20; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–3406–N]
Medicare Program; Town Hall Meeting
on Merit-Based Incentive Payment
System (MIPS) Value Pathway (MVP)
Implementation
AGENCY
: Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION
: Notice of meeting.
SUMMARY
: This notice announces a
virtual Town Hall meeting for CMS to
share updates on the Merit-based
Incentive Payment System (MIPS) Value
Pathway (MVP) policy considerations
and for stakeholders to provide feedback
on those MVP considerations for future
implementation. Clinicians,
professional organizations, third party
vendors, stakeholders, and other
interested parties are invited to this
meeting to present their individual
views on MVP design and
implementation. The opinions and
alternatives provided during this
meeting will assist us as we evaluate our
policies on essential components of the
MVP framework, including, but not
limited to, expanding reporting options
to allow clinicians to form subgroups
and report MVPs, MVP scoring policies,
as well as other areas of MVP
refinement. The meeting is open to the
public, but registration is required, and
attendance is limited. We encourage
early registration to secure a spot.
DATES
:
Meeting Date: The Town Hall meeting
announced in this notice will be held on
Thursday, January 7, 2021, from 9 a.m.
to 4 p.m., eastern standard time (e.s.t.).
Deadline for Posting MVP Topics: In
December 2020, we will post
information concerning the MVP topics
to be discussed for the Town Hall on
our website at https://qpp.cms.gov/
about/resource-library.
Deadline to Indicate Desire to Provide
Verbal Feedback During Town Hall
Meeting: Registered participants may
have the opportunity to provide verbal
comments on the Town Hall agenda
topics for a maximum of 5 minutes or
less per agenda session. Registered
participants who would like to provide
verbal feedback during the Town Hall
are required to send an email to
CMSMVPFeedback@ketchum.com no
later than 11:59 p.m., e.s.t., Thursday,
December 31, 2020, for the opportunity
to secure a spot to provide verbal
feedback during the meeting. The time
available for registrants to provide
verbal comments will depend on the
number of registrants who are interested
in offering verbal comments and we
cannot guarantee that everyone who
wishes to provide verbal feedback will
have the opportunity to do so. We
encourage interested parties to register
early and send an email to the address
noted above to indicate their interest in
providing verbal comments for the
agenda session(s) of their choice.
In addition, we encourage interested
parties to submit written comments on
the agenda topics to be discussed in this
Town Hall meeting and on future
implementation of MVPs as described in
the ‘‘Deadline for Submission of Written
Comments on the MVP Topics and
Future Implementation’’ section below
by 11:59 p.m., e.s.t., Thursday, January
14, 2021.
Deadline for Submission of Written
Comments on the MVP Topics and
Future Implementation: All interested
parties may submit written comments
via email to CMSMVPFeedback@
ketchum.com by 11:59 p.m., e.s.t.,
Thursday, January 14, 2021. Any
interested party may send written
comments about the policies CMS is
considering for future rulemaking
described below in this notice, in the
MVP Town Hall materials posted at
https://qpp.cms.gov/about/resource-
library, and in the Town Hall meeting.
In addition, we encourage registered
participants to consider providing
verbal comments during the Town Hall
meeting as described in the ‘‘Deadline to
Indicate Desire to Provide Verbal
Feedback During Town Hall Meeting’’
section above by 11:59 p.m., e.s.t.,
Thursday, December 31, 2020.
ADDRESSES
: Registration website: The
Town Hall meeting will be hosted
virtually via webinar. Registration is
limited to 1,000 participants.
Participants must register at https://
attendee.gotowebinar.com/register/
2414831410075391244. An open toll-
free phone line will also be made
available for participants to call into the
Town Hall meeting. Information on the
option to participate via webinar will be
provided through an upcoming listserv
notice and posted on the Quality
Payment Program (QPP) website at
https://qpp.cms.gov/about/resource-
library. You can sign up to receive QPP
listservs at https://
public.govdelivery.com/accounts/
USCMS/subscriber/qualify?commit
=&topic_id=USCMS_12196. Continue to
check the website for updates. You may
send general inquiries about this
meeting via email to
CMSMVPFeedback@ketchum.com.
SUPPLEMENTARY INFORMATION
:
I. Background on MVP Implementation
In the CY 2020 Physician Fee
Schedule (PFS) proposed rule (84 FR
40732 through 40745), we requested
comments in a request for information
(RFI) on issues related to the
implementation of MVPs. As discussed
in the CY 2020 PFS proposed rule (84
FR 40732), we had intended to apply
the MVP framework in the 2021 MIPS
performance period. However, due to
the public health emergency (PHE) for
COVID–19 and to allow clinicians to
focus on responding to the PHE, we
announced that the initial
implementation of MVPs would be
delayed until at least the 2022 MIPS
performance year and also limited our
2021 MIPS performance period MVP
proposals to those necessary for the
collaborative development of MVPs.
After review and consideration of RFI
comments, we proposed updates to the
MVP guiding principles and the MVP
development criteria and process in the
CY 2021 PFS proposed rule (85 FR
50279 through 50284).
We are holding this Town Hall
meeting to engage interested parties on
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