Under the American Rescue Plan Act of 2021, signed into law by President Biden, Congress permitted ground ambulance suppliers and providers to be reimbursed for Treatment in Place (TIP) without transport under limited circumstances. The Centers for Medicare and Medicaid Services (CMS) has released guidance on this provision.

Ground ambulance suppliers and providers, including fire departments providing these services, may receive reimbursement for TIP during the COVID-19 pandemic emergency by meeting specific criteria:

  • The ground ambulance service was furnished in response to a 9-1-1 call (or the equivalent in areas without a 9-1-1 call system)
  • The patient was transported to a destination permitted under Medicare regulations, but the transport didn’t occur because of community-wide emergency medical service (EMS) protocols due to the COVID-19 pandemic emergency

CMS will now reimburse the costs associated with Basic Life Support (BLS) or Advanced Life Support (ALS), Level 1, non-transports and treatment in place occurring on or after March 1, 2020. Under eligibility rules for reimbursement, the non-transport EMS care provided in the field must be directed by a local or statewide protocol restricting patient transport to hospitals or other approved transport destinations. CMS will not reimburse for non-transports in cases of a patient’s decision to refuse EMS transportation.

The Health and Human Services (HHS) Secretary-issued waiver is retroactive to March 1, 2020, and the benefit is available through the end of the public health emergency.

Affiliate leaders are encouraged to work with their agency’s EMS billing officials to recover all available reimbursements. Leaders are encouraged to share the CMS-issued guidance with agency officials. The complete guidance is available on the official CMS website.

The IAFF sought to include this waiver authority in the American Rescue Plan Act of 2021 to address the heavy financial toll the pandemic has placed on fire and EMS department budgets. The loss of reimbursements from CMS caused by non-transport responses occurring due to measures rapidly set in place by state and local jurisdictions has been detrimental to the day-to-day fire department budgets and IAFF members. This American Rescue Plan Act provision will allow fire and EMS departments to recoup needed funds to lessen the financial strains experienced over the past year.