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MLN Product (Revised): MLN6805343 - Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model

This revised Product comprises Subregulatory Guidance for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model, and its content is based on publically available content within at 42 Code of Federal Regulations (CFR) 410.40(e), https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Prior-Authorization-Initiatives/Downloads/AmbulancePriorAuth_OperationalGuide_123115.pdf, and https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Prior-Authorization-Initiatives/Prior-Authorization-of-Repetitive-Scheduled-Non-Emergent-Ambulance-Transport- CMS policy or operation subject matter experts also reviewed/cleared this product. This product educates independent ambulance suppliers on how to request RSNAT prior authorization. Repetitive ambulance service is ambulance transportation provided in 3 or more round trips or at least 1 round trip per week for 3 weeks. The RSNAT Prior Authorization Model reduces the use of services that don’t comply with Medicare policy while maintaining or improving quality of and access to care.
Revisions to this Product include following content updates:
• Added language on how we process claims when you choose to bypass prior authorization (page 5).
The previous version of this product is available to the public and currently posted on the CMS website at https://www.cms.gov/files/document/mln6805343-national-expansion-repetitive-scheduled-non-emergent-ambulance-transport-rsnat-prior.pdf.

Download the Guidance Document

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: November 13, 2023

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.