The Centers for Medicare and Medicaid Services (CMS) will begin expanding a prior authorization model
for non-emergency ambulance transportation for dialysis patients into six states: Maryland, Delaware, the District of Columbia, North Carolina, Virginia and West Virginia. The program expansion will begin on January 1, 2016 and requires ambulance providers in those states to obtain documentation from physicians prior to beginning service. CMS plans to reach out to ambulance providers and Medicare beneficiaries about the program through educational materials.
This model was originally implemented in New Jersey, Pennsylvania and South Carolina. It came in response to fraud cases found in those states, in which ambulance companies were filing false claims while transporting patients who did not fall under Medicare’s transportation coverage guidelines. Read more about the original implementation of the model here