11-26-12 Council Agenda & Packet

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§414.610 42 CFR Ch.IV(10-1-10 Edition) by the number of miles that the bene- patient is transported simultaneously ficiary was transported. When applica- is based on the total number of pa- ble, the appropriate RAF is also ap- tients (both Medicare and non-Medi- plied to the air mileage rate. care) on board. If two patients are (3) Loaded mileage. Payment is based transported simultaneously, then the on loaded miles. Payment for air mile- payment allowance for the beneficiary age is based on loaded miles flown as (or for each of them if both patients expressed in statute miles. There are are beneficiaries)is equal to 75 percent three mileage payment rates:a rate for of the service payment allowance ap- FW services, a rate for RN services, plicable for the level of care furnished and a rate for all levels of ground to the beneficiary, plus 50 percent of transportation. the applicable mileage payment allow- (4)Geographic adjustment factor(GAF). ance. If three or more patients are For ground ambulance services, the PE transported simultaneously, the pay- portion of the GPCI from the physician ment allowance for the beneficiary (or fee schedule is applied to 70 percent of each of them)is equal to 60 percent of the base rate for ground ambulance the service payment allowance applica- services. For air ambulance services, ble for the level of care furnished to the PE portion of the physician fee the beneficiary, plus the applicable schedule GPCI is applied to 50 percent mileage payment allowance divided by of the base rate for air ambulance serv- the number of patients on board. ices. (5) Rural adjustment factor (RAF). (i) (7) Payment rate for mileage greater For ground ambulance services where i than 50 m les. For services furnished the point of pickup is in a rural area, December the period July 1,loaded through the mileage rate is increased by 50 per- December 31,greater each loaded at is, cent for each of the first 17 miles and, miles mile and greater)than for 50 (that is, for services furnished before January 1, miles r and gnating)in ambulance 2004, by 25 percent for miles 18 through transports originating in eithed urban 50. The standard mileage rate applies areas rate in rural areas percent paid than to every mile over 50 miles and, for on a rate that is 25 percent higher than services furnished after December 31, otherwise is applicable under this sec- 2003, to every mile over 17 miles. For Lion. air ambulance services where the point (d) Payment. Payment. in accordance of pickup is in a rural area, the total with this subpart, represents payment payment is increased by 50 percent; in full (subject to applicable Medicare that is, the rural adjustment factor ap- Part B deductible and coinsurance re- plies to the sum of the base rate and quirements as described in subpart G of the mileage rate. part 409 of this chapter or in subpart I (ii) For services furnished during the of part 410 of this chapter)for all serv- period July 1, 2004 through December ices, supplies, and other costs for an ambulance service furnished to a Medi- 31, 2009, the payment amount for the ground ambulance base rate is in- care beneficiary. No direct payment creased by 22.6 percent where the point will be made under this subpart if bill- of pickup is in a rural area determined ing for the ambulance service is re- to be in the lowest 25 percent of rural quired to be consolidated with billing population arrayed by population den- for another benefit for which payment sity. The amount of this increase is may be made under this chapter. based on CMS's estimate of the ratio of (e) Point of pick-up. The zip code of the average cost per trip for the rural the point of pick-up must be reported areas in the lowest quartile of popu- on each claim for ambulance services lation compared to the average cost so that the correct GAF and RAF may per trip for the rural areas in the high- be applied,as appropriate. est quartile of population. In making (f) Updates. The CF, the air ambu- this estimate, CMS may use data pro- lance base rates, and the mileage rates vided by the GAO. are updated annually by an inflation (6) Multiple patients. The allowable factor established by law.The inflation amount per beneficiary for a single am- • factor is based on the consumer price bulance transport when more than one index for all urban consumers (CPI-U) 66