During the COVID-19 public health emergency, the Trump and Biden administrations have created numerous waivers of payment policies to help ensure people with Medicare retain their access to care despite the pandemic. One of the more recent additions is the Waiver for Ground Ambulance Services: Treatment in Place that allows ground ambulance services to be compensated for treating Medicare beneficiaries when they are forbidden from transporting them to a facility like a hospital. The waiver is retroactive to March 2020.
Many states and localities have had rules in place during the pandemic that forbid ambulance services from transporting some 911 callers, often to reduce their risk of infection or keep from overwhelming health system capacity. But Medicare generally only pays for ambulance services if the caller is transported to a facility. This left those ambulance service providers in a bind. They could either transport the callers anyway, in violation of the rule or law, or treat the caller without transporting them—and without being paid.
The American Rescue Plan Act of 2021 gave the Biden administration the authority to create the Treatment in Place waiver for the duration of the public health emergency. The waiver only applies when the ambulance service was furnished in response to a 911 call or its equivalent and when the patient would have been transported to a facility if not for local rules or laws. While the waiver is narrow, it may reduce out-of-pocket costs for beneficiaries in these circumstances.
Importantly, the Treatment in Place waiver and other flexibilities that have been established in order to improve safe access to care during the pandemic are set to expire once the public health emergency is over. This includes various telehealth options as well as eased home health and nursing facility eligibility.
We urge a thoughtful consideration of the COVID-19 flexibilities to determine what changes should be retained once the public health emergency is over. The pandemic forced beneficiaries, providers, and health plans to change the way they get or provide care, and many of these changes were long overdue. Others are merely stopgap measures that should be reversed as soon as possible.
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