Emergency Medical Services (EMS) Protocols

6.4.2 – Emergency Medical Services (EMS) Protocols (Rev. 308, Issued: 10-30-09, Effective: 11-30-09, Implementation: 11-30-09) Per Section 415 of the Medicare Modernization act of 2003, the reasonable and necessary requirement for rural air transport may be “deemed” to be met when the service is provided pursuant to an established State or regional emergency medical services (EMS) agency protocol. CMS defines “established” to mean those protocols, which have been reviewed and approved by State EMS agencies or have been developed according to State EMS umbrella guidelines. Additionally, the protocol must be recognized or approved by the Secretary. The information on the FI, carrier, or MAC Web site must inform rural air ambulance providers that if they anticipate transport based upon the contents of such a protocol (either State or regional) they must submit that protocol in advance to the fiscal intermediaries, carriers, or MACs for review and approval. Include instructions on the Web site for submitting the protocol. The contractor will review the protocol to ensure that the contents are consistent with statutory requirements at 1862(a)(1)(A), which direct that all services paid for by Medicare must be reasonable and necessary for the diagnosis or treatment of an illness or injury. The contractor shall make a determination regarding the protocol and/or subsequent revisions and notify the rural air ambulance provider of their determination within 30 days of receipt of the protocol. Approval of a protocol does not exempt the provider from requirements in the Act at 1861(s)(7) and regulatory requirements at 42 CFR 424.106 which outlines the criteria for determining whether the hospital was the most accessible. Regardless of protocol instructions regarding transport locations Medicare payment can be made only to the closet facility capable of providing the care needed by the beneficiary.