PRIOR AUTHORIZATION AND RSNAT SERVICES

A study of the impact on prior authorization for repetitive scheduled non-emergent ambulance transport (RSNAT services) found a Medicare model reduced both useage and Medicare expenditures.
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Percent-point drop in utilization per beneficiary per quarter
RSNAT-PA model resulted in a percentage-point decline from baseline useage.

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Reduction in expenditures per beneficiary per quarter
Expenditures dropped 74% for the Year 1 cohort and 64% for states in the Year 2 cohort.

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Notes

States in the Year 1 cohort: New Jersey, Pennsylvania and South Carolina. Year 2 cohort added Delaware, Maryland, North Carolina, Virginia, West Virginia and the District of Columbia.

Source: Mathematica analysis of impact of RSNAT-PA model on beneficiaries with end-stage renal disease (ESRD) and/or severe pressure ulcers, those found to be more likely to use RSNAT services (more than 85% of claims)

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