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Waiver Authorizes EMS Reimbursement for TIP Without Transport

Posted: May 20, 2021

The Centers for Medicare and Medicaid Services (CMS) released a waiver on Medicare treatment-in-place (TIP) for ground ambulance services.

The waiver provides reimbursement to ambulance services PDF for 911 responses made to patients who were not transported to local emergency departments due to community-wide protocol designed to preserve health system capacity during the COVID‑19 pandemic. It is effective retroactively to March 1, 2020 and remains in effect for the duration of the COVID‑19 Public Health Emergency (PHE). The authority for the waiver was given to CMS as part of the American Rescue Plan Act of 2021.

Reimbursement eligibility

To be eligible for these reimbursement costs from CMS, the waiver requires that:

  • The ground ambulance service was provided in response to a 911 call (or the equivalent in areas without a 911 call system).
  • The patient would have been transported to a destination permitted under Medicare regulations, but the transport didn’t occur due to community-wide emergency medical services (EMS) COVID‑19 protocols.

The value of TIP within the American Rescue Plan Act was scored by the Congressional Budget Office with a value of $10 million.

Significance of the waiver

The CMS waiver is important to EMS agencies for several reasons:

  • The President of the American Ambulance Association (AAA), in a briefing last month for the 2021 EMS On the Hill Day video, highlighted that the majority of patients served by EMS are on Medicare and add-ons to the Medicare payments are therefore critical to EMS agencies.
  • The waiver, even if only temporary during the PHE, acknowledges that a patient was provided treatment without transport. This emphasizes EMS agencies' role as more than just an ambulance transport function.
  • Treatment-in-place is part of CMS's new payment model, Emergency Triage, Treat and Transport, or ET3. This model has potential cost savings for both EMS and CMS, as well as the potential for improved services for patients.

The passing of legislation making the CMS waiver possible was the product of collaborative work between CMS and the National Association of Emergency Medical Technicians, AAA, the International Association of Fire Chiefs and the International Association of Fire Fighters.

This article is based on content in the
May 20, 2021 InfoGram.

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