selected to implement the model’s treatment in place intervention may still bill for initiating
and facilitating treatment in place, and its qualified health care partners may still bill for
furnishing treatment in place, under the ET3 Model. An ET3 Model participant is not
prohibited from exercising the flexibility made available by the waiver under section 9832 of
the American Rescue Plan Act of 2021, regardless of whether it elected to implement the
ET3 model treatment in place intervention.
New: 5/5/21
26. Question: What is the impact of this waiver on coverage by Medicare Advantage Plans?
Answer: Medicare Advantage (MA) plans must provide coverage of, by furnishing, arranging
for, or making payment for, all benefits that are covered under Part A and Part B in the FFS
Medicare program, pursuant to section 1852(a) of the Act and 42 CFR §§ 422.100 and
422.101. Under the section 1135 waiver(s), authorized by the Secretary pursuant to section
9832 of the American Rescue Plan Act of 2021, of the requirement under sections
1861(s)(7) and 1834(l) of the Social Security Act that an ambulance service include the
transport of an individual, the Medicare FFS program will pay for certain ambulance services
where the individual was not transported under specific conditions. In order to fulfill its
obligations under section 1852(a)(1) of the Act and §§ 422.100 and 422.101, an MA plan
may not deny coverage based on the requirement that an ambulance service include the
transport of the enrollee in situations where that requirement has been waived by CMS, as
described in FAQs X through Y. We note that MA plans may continue to make appropriate
medical necessity determinations using their own medical necessity criteria that are no
more restrictive than original Medicare’s national and, as applicable, local coverage policies.
New: 5/5/21
K. Ambulance Services- Vehicle and Staffing Requirements for
Ambulance Providers and Suppliers
1. Question: Would a ground ambulance vehicle operating without a renewed license
nevertheless satisfy the Medicare requirements at 42 CFR §410.41 if, during the PHE for the
COVID-19 pandemic, a state or locality issues a law or regulation, or a legally adequate
waiver, that permits ground ambulance vehicles to operate without a renewed license?
Answer: Yes, depending on state or local law. 42 CFR §410.41 specifies Medicare’s
requirements for ambulance vehicles, and §410.41(a)(1) states that a vehicle used as an
ambulance must be specially designed to respond to medical emergencies or provide acute
medical care to transport the sick and injured and comply with all State and local laws
governing an emergency transportation vehicle. Key to this is that §410.41(a) requires
compliance with state and local laws. During the PHE for the COVID-19 pandemic, should a
state or locality enact or promulgate a law, regulation, or legally adequate waiver
permitting an ambulance vehicle to operate without a renewed license, such an ambulance
would be in compliance with Medicare’s requirements at §410.41(a). We also note that the
staffing requirements at §410.41(b) must be met in order for the ambulance transport to
Updated: 4/20/2023 pg. 60