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Prior Approval for Non-Emergency Ambulance Use: Medicare Pilot Launched
The 3-year pilot is expected to reel-in significant cost savings for Medicare, which has seen a lot of fraudulent charges with services and equipment.
Seniors living in three states will need prior approval from Medicare before they can get an ambulance to take them to cancer or dialysis treatments.
The change, which begins today, is part of a 3-year pilot to combat extraordinarily high rates of fraudulent billing by ambulance companies in Pennsylvania, New Jersey, and South Carolina.
The good news is that Medicare beneficiaries in those states will now know beforehand whether the program will cover their non-emergency transportation to treatments. The bad news, say advocates, is that many fragile people will be left with no way to get to appointments that might mean the difference between life and death.
"Often people have to go long distances, they feel lousy when treatment is over, and in some cases, it's to the point of being dangerous in providing their own transportation," said Jon Burkhardt, a consultant who has studied transportation for dialysis patients.
Link to the complete article on Medpage Today: http://bit.ly/1HVhJyB
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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How Access to SMA Treatment Varies Globally and by Insurance Type
March 18th 2025Posters presented at the 2025 Muscular Dystrophy Association (MDA) Clinical & Scientific Conference show that therapeutic advances in treating spinal muscular atrophy (SMA) are not uniformly making it into the hands of patients who could benefit.
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The Impact of Cost Sharing on High-Value Care
March 14th 2025Michael Chernew, PhD, professor of health care policy and director of the Healthcare Markets and Regulation Lab, Harvard Medical School, shares how cost-sharing policies shape access to critical health care services and influence value-based insurance design.
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