CMS: EMS Can Now Be Reimbursed for Alternative Destination Transports

The Centers for Medicare and Medicaid Services (CMS) has announced sweeping changes to its reimbursement rules that will finally allow EMS to be reimbursed for transporting patients to alternative destinations, not just hospitals.

Relaxing long-standing regulations surrounding the billing for allowable destinations, CMS called these initiatives "temporary expansion sites," or “CMS Hospital Without Walls,” as they were made in response to the current COVID-19 pandemic.

According to the press release, the change in rules will be in place during the COVID-19 public health emergency (PHE) and will allow EMS to be reimbursed for transporting patients to “any destination that is able to provide treatment to the patient in a manner consistent with state and local emergency medical services (EMS) protocols in use where the services are being furnished. These destinations may include, but are not limited to: any location that is an alternative site determined to be part of a hospital, CAH or SNF, community mental health centers, federally qualified health centers (FQHCs), physician’s offices, urgent care facilities, ambulatory surgery centers (ASCs), any other location furnishing dialysis services outside of the ESRD facility, and the beneficiary’s home.”

Noteworthy in the interim final rule language is that there is no COVID-19-related clinical impression limitation for the alternative destinations. 

Matt Zavadsky, NAEMT president and chief strategic integration officer at MedStar Mobile Healthcare in Fort Worth, Tex., says he will work this week with his association partners to clarify some of the rule’s language with CMS.

“The big question is that in some language, CMS states the patient’s home is an appropriate alternative site,” says Zavadsky.  “We’ll need specific clarification if the protocol-based decision to not transport is now a covered ‘destination’ in the rule.” 

As president of the NAEMT, Zavadsky has been working with CMS for over a year on implementation of ET3 and other alternative payment models. Zavadsky says he is proud to see the results of the combined work of the NAEMT, American Ambulance Association (AAA), International Association of Fire Chiefs (IAFC), and other large national associations that have together worked diligently on this goal.

CMS Administrator Seema Verma said in the press release, “Every day, heroic nurses, doctors, and other healthcare workers are dedicating long hours to their patients. This means sacrificing time with their families and risking their very lives to care for coronavirus patients. Frontline healthcare providers need to be able to focus on patient care in the most flexible and innovative ways possible. This unprecedented temporary relaxation in regulation will help the healthcare system deal with patient surges by giving it tools and support to create nontraditional care sites and staff them quickly.” 

For more, read the full text of these changes, titled “Ambulances: CMS Flexibilities to Fight COVID-19,” here.  Find the full text of the press release here.

Hilary Gates, MAEd, NRP, is the senior editorial and program director for EMS World.