Under its agreements with HCPs, the Organization would provide the following administrative services: arranging for the physical vaccination sites, data systems, online and web-based scheduling, site development and training, and reporting to state agencies. In addition, in the context of ground ambulance services performed prior to the issuance of the Waiver, ambulance providers and suppliers would have had no expectation that the Medicare program would reimburse for services that did not involve an actual transport, and there was no expectation on the part of the beneficiaries receiving services that they would have incurred cost-sharing obligations. By wearing a mask, rolling down car windows, and sitting in the back of the car, you can help to reduce your risk of COVID-19 infection. Non-Emergency Medical Transportation (NEMT), transportation to medical appointments, pharmacies, lab visits, and other types of routine care for the transportation-disadvantaged, aims to reduce this barrier. You provided the ambulance service on or after March 1, 2020 Medicare won't pay for claims when: You didn't transport the patient based solely on the patient's decision, including when a patient refused transport "against medical advice" The ambulance service would not have been medically necessary Our longstanding guidance makes clear that "[w]henever a laboratory offers or gives to a source of referrals anything of value not paid for at fair market value, the inference may be made that the thing of value is offered to induce the referral of business." Essentially it's just guidance for first responders to follow, said Kurt Hahn, the deputy EMS coordinator for Orange County Department of Emergency Services To make any efforts on scene for about 20 minutes, and then to make a decision as far as if transportation to hospital, be prudent, or if termination of resuscitation would be the ultimate decision on scene.. The only way I could describe the feeling would be a steamroller starting at the bottom of my lungs. We recognize that FQHCs deliver care to some of the nation's most vulnerable individuals and families, including Federal health care program beneficiaries. In your submission, please provide sufficient facts that allow for an understanding of the key parties and terms of the arrangement at issue. A Look at the Research, Protect yourself when using transportation, Airflows inside passenger cars and implications for airborne disease transmission. Why does the "OIG Policy Statement Regarding Application of Certain Administrative Enforcement Authorities Due to Declaration of Coronavirus Disease 2019 (COVID-19) Outbreak in the United States as a National Emergency" not incorporate sections II(B)(12)-(18) of the blanket waivers of the physician self-referral law as issued by the Secretary? o The car windows should be open for the entire trip. Drawing upon decades of experience, RAND provides research services, systematic analysis, and innovative thinking to a global clientele that includes government agencies, foundations, and private-sector firms. We further understand that some patients with cancer, including Federal health care program beneficiaries, must travel longer distances from their homes to receive chemotherapy or radiation treatment because of practice closures or consolidation of practice sites resulting from the COVID-19 public health emergency. Although drivers can bring a transportation-vulnerable individual to a pharmacy anywhere across the country, they don't have scaled capabilities to pick up the prescription and deliver it to the individual's home. It is our understanding that many FQHCLAs and other providers face financial strain in light of the COVID-19 public health emergency due to shifting demands for health care items and services and, consequently, decreased revenue. The FAQ is a favorable response related to ambulance providers and suppliers waiving or discounting beneficiary cost-sharing obligations resulting from ground ambulance services paid for under the CMS waiver waiving certain statutory requirements relating to Medicare payment for ground ambulance services. Washington, D.C. 20201 Normally the family member or friend will ride in the front cab passenger seat of the ambulance. The FQHC intends to advertise the availability of free testing. "It's like . 1001.952(bb), we understand that the transportation the oncology group practice would like to provide may not always meet every requirement of this safe harbor; for example, the travel distance between a patient's home and the alternate practice location may exceed the mileage limitations associated with that safe harbor. The TNC must be able to work within the state statutes on NEMT, and within the state dictated operating model, such as working with health plans, transportation brokers, and/or state agencies to coordinate service. Under certain circumstances, such as the Federal Communications Commission distributing grants to certain providers to fund Telecommunications Technologies, the remuneration (i.e., the grant funds) from the "donor" (i.e., the Federal Government) to the provider would not implicate the Federal fraud and abuse laws. In light of these EMS protocols, on May 5, 2021, pursuant to section 1135(b)(9) of the Social Security Act, the Secretary of Health and Human Services waived certain statutory requirements relating to Medicare payments for ground ambulance services furnished in response to a 911 call (or the equivalent in areas without a 911 call system) in cases in which an individual would have been transported to a destination permitted under Medicare regulations but such transport did not occur as a result of communitywide EMS protocols established due to the public health emergency (the Waiver). They looked at the differences in air flow when specific windows were open versus when all of the windows were open versus being closed. Non-Emergency Medical Transportation (NEMT), transportation to medical appointments, pharmacies, lab visits, and other types of routine care for the transportation-disadvantaged, aims to reduce this barrier. The Office of Inspector General (OIG) recognizes that, in the current public health emergency resulting from the outbreak of the COVID-19, the health care industry must focus on delivering needed patient care.1 As part of OIG's mission to promote economy, efficiency, and effectiveness in HHS programs, we are committed to protecting patients by ensuring that health care providers have the regulatory flexibility necessary to adequately respond to COVID-19 concerns. The school nurse checked Brasfield's pulse, found it too fast to count and called 911 for an ambulance. They are also investigating the differences in airflow of air conditioning and heating units, and how it affects the airborne transmission of the coronavirus. The AAA, PWW and other ambulance industry partners have also requested that CMS relax the ambulance medical necessity rules during the public health emergency. Accordingly, under the unique circumstances of the COVID-19 public health emergency, and in the context of the Waiver cited above, OIG believes it would represent a sufficiently low risk of fraud and abuse for ground ambulance providers and suppliers to waive or discount beneficiary cost sharing obligations for claims billed in accordance with the Waiver. The ride-alongs are scheduled outside of class time . In the unique circumstances resulting from the COVID-19 outbreak, we believe that these scenarios likely would present a low risk of fraud and abuse under the Federal anti-kickback statute and the Beneficiary Inducements CMP provided the services being offered are (i) necessary to meet patient care needs as a result of staffing shortages directly connected to the COVID-19 outbreak; (ii) provided for free or at a reduced cost only when necessary as a result of the COVID-19 outbreak; (iii) limited to the period subject to the COVID-19 Declaration; and (iv) not contingent on referrals for any items or services that may be reimbursable in whole or in part by a Federal health care program, either during or after the COVID-19 Declaration period. Nevertheless, we believe that the provision of space at no charge by an FQHC in a rural area for a pharmacy to administer COVID-19 vaccinations would pose a low risk of fraud and abuse under the Federal anti-kickback statute because of the unique circumstances of the COVID-19 public health emergency and could address challenges in vaccine access for individuals in rural areas. On the fence about calling an Uber to get to an appointment? For example, the oncology group practice may desire to provide transportation assistance for patient safety reasons to prevent the risk of COVID-19 exposure to patients while using public transportation. Given the numerous potential variations on the facts related to donors, this response focuses only on the financial relationship between the FQHC and the Federal health care program beneficiary receiving grant funding. For the purpose of these FAQs, the original declaration and any renewals are collectively referred to as the "COVID-19 Declaration.". To complete an EMT basic course at the California Institute of Emergency Medical Training (CIEMT), you must perform ambulance ride-alongs. Your submission of a question does not obligate OIG to take action, including responding to the question, making the question public, or issuing public feedback. In contrast, if the pharmacy were to bill Federal health care programs foror otherwise were to receive Federal or State funding (e.g., through the Coronavirus Aid, Relief, and Economic Security Act) to cover the costs associated withthe items and activities for which the clinical laboratory would reimburse the pharmacy, such remuneration could constitute a problematic double payment and could evidence unlawful intent under the Federal anti-kickback statute. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. Mathai says that currently, this study does not apply to other modes of public transportation. According to the FQHC, other than the free use of space, no remuneration would be exchanged between the parties. Because the facts presented here differ from those in the 1994 Alert and the 2014 Alert, we believe that the proposed arrangement between the clinical laboratory and retail pharmacy, in the context of the COVID-19 public health emergency, would be sufficiently low risk under the following circumstances: (i) the retail pharmacy incurs costs in operating the testing collection sites; (ii) the payment is fair market value for the items and services furnished by the retail pharmacy in running the sites; and (iii) the retail pharmacy is not submitting claims to Federal health care programsor directly or indirectly receiving other Federal or State fundingthat reimburse it, in whole or in part, for the items and services furnished by the retail pharmacy in running the sites for which the laboratory reimburses the pharmacy. If you are experiencing any severe symptoms call triple zero (000) for an ambulance and tell the ambulance staff that you have COVID-19. U.S. Department of Health & Human Services Just like it's illegal to hold onto children and infants in your personal vehicle while it's traveling, the same holds suit in the back of an ambulance. In addition, we recognize that this scenario also involves potential direct or indirect financial relationships between the non-governmental donor entity providing funding, the FQHC, and Federal health care program beneficiaries, and there are different potential fraud and abuse risks with respect to those relationships. We stated that if the services for which the laboratory compensated the physician were paid for by a third party through other means, any payment by the laboratory to the physician for the physician's services could constitute double payment that evidenced unlawful intent under the Federal anti-kickback statute. Study: Temperature and Humidity May Indicate COVID-19 Transmission Risk, Evusheld No Longer Authorized to Prevent COVID. Permitting a passenger to unlawfully ride in the bed of a pickup truck carries a $100 fine for either the driver or passenger. We recognize that this scenario involves potential direct or indirect financial relationships between donors, providers, and patients and that there are different fraud and abuse risks with respect to each relationship. Transportation Network Companies (TNCs) like Lyft and Uber have been providing NEMT, since 2016 and 2018 respectively, through a ride-share model. The Organization also explained that the COVID-19 vaccines administered at the sites would be approved by the U.S. Food and Drug Administration (FDA) or subject to an FDA-issued Emergency Use Authorization. We also acknowledge that OIG's longstanding guidance makes clear that, depending on the facts and circumstances, providing free or discounted goods or services to an actual or potential referral source may violate the Federal anti-kickback statute. A complex chain of financial pressures affected state ambulance providers during the COVID-19 public health crisis. When she came home, a letter arrived: The air ambulance company said she owed $52,112 for the trip. We recognize that many physicians who prescribe extended courses of treatment such as chemotherapy, dialysis, radiation therapy, cardio/pulmonary rehabilitation treatment, or behavioral health services to beneficiaries may desire to provide transportation assistance to mitigate the effects of office closures caused by the COVID-19 outbreak or increased risk of exposure to COVID-19 for patients who use public transportation to access care. Soon after the May 2018 incident, Brasfield, now 39, got a $1,206 bill for the 4-mile. "Ambulance officers across the country have been directed to only transport family members with patients in exceptional circumstances. Can a hospital provide access to its existing HIPAA-compliant, web-based telehealth platform for free to independent physicians on its medical staff to furnish medically necessary telehealth services during the time period subject to the COVID-19 Declaration. Similarly, drivers cannot be used to transport patients with suspected or confirmed COVID-19, based on CDC guidance. The Department may not cite, use, or rely on any guidance that is not posted During the current pandemic, movement has slowed as people shelter in place. FAQsApplication of OIG's Administrative Enforcement Authorities to Arrangements Directly Connected to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency--Ambulance Cost-Sharing FAQ. A new study finds that rolling your windows down is more effective than car ventilation for improving air circulation and reducing airborne transmission of the coronavirus. An OIG advisory opinion is a legal opinion issued by OIG to one or more requesting parties about the application of the OIG's fraud and abuse authorities to the party's existing or proposed business arrangement. Ambulance Victoria is a critical link in Victoria's healthcare system. Within airplanes, theres a lot of areas for air to circulate, so theres not as much risk of repeat exposure to the same virus. Ambulances are being told not to transport trauma patients - victims of heart attacks, gunshot wounds, car crashes - to the hospital if they can't be resuscitated in the field. Given the numerous potential variations on the facts related to donors, this response focuses only on the financial relationship between the provider and patient. Check the latest closings and delays for schools, business, and churches around the Hudson Valley. Transportation problems are often cited as a barrier to receiving care and medical compliance. About 40-50% of the spread is from asymptomatic people, he says. The following limitations apply to these FAQs: While an ambulance provider or supplier waiving or discounting beneficiary cost-sharing obligations resulting from ground ambulance services paid for by the Medicare program under a waiver established pursuant to section 1135(b)(9) of the Social Security Act would implicate the Federal anti-kickback statute and Beneficiary Inducements CMP, OIG believes that such discounts or waivers would represent a sufficiently low risk of fraud and abuse under those statutes, provided the ground ambulance services are billed in accordance with the waiver described further below. This response addresses only the provision of free COVID-19 testing by the FQHC to Federal health care program beneficiaries. 0 Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. In your submission, please provide sufficient facts to allow for an understanding of the key parties and terms of the arrangement at issue.3 OIG will update the FAQ site as we respond to additional frequently asked questions. Some states were unable to allow TNCs to provide NEMT because of historical barriers, driver requirements, or other obstacles. In mid-March, Georgia braced for a surge in COVID-19 patients. If you have to ride in a car with someone who has not been in your household during the . Can an oncology group practice provide free in-kind local transportation to and from an established patient's home to an alternate practice location to receive medically necessary oncology care during the time period subject to the COVID-19 Declaration? Still, people have to obtain non-emergency but necessary medical care, including kidney dialysis, chemotherapy, and prenatal care visits. However, there are exceptions to this rule such as when the patient is unconscious, a minor, intoxicated or mentally incompetent. OIG's longstanding guidance makes clear that, depending on the facts and circumstances, the provision of free goods or services to an actual or potential referral source of Federal health care program business may implicate the Federal anti-kickback statute. In the limited context of the COVID-19 outbreak and in light of certain flexibilities in coverage for various telehealth and other virtual services payable by Federal health care programs, we believe the provision of a cell phone, service or data plan, or both (individually or collectively, "Telecommunications Technologies") by a mental health or substance use disorder provider to a patient likely presents a sufficiently low risk of fraud and abuse so long as the arrangement includes the following safeguards: (i) the provider determines in good faith that the patient is in financial need in advance of providing the Telecommunications Technologies; (ii) the provider determines in good faith that the patient requires Telecommunications Technologies to access medically necessary services related to his or her mental health or substance use disorder treatment; (iii) all services furnished using the Telecommunications Technologies are medically necessary, which lowers the risk of overutilization or inappropriate utilization; (iv) the provider uses the third party's funding solely for Telecommunications Technologies; (v) the provider does not market the Telecommunications Technologies (e.g., offer or provide free phones to generate business); (vi) the provider offers the Telecommunications Technologies only to "established patients" as that term is defined under 42 C.F.R. Parties must separately assess any fraud and abuse risks that may arise with respect to any direct or indirect financial relationships between the donor and the FQHC or Federal health care program beneficiary. Issued by: Office of Inspector General (OIG). They can also deliver goods from open stores, such as pharmacy items, including sanitizing materials, non-prescription drugs, and personal care products. If you must share a car with people from outside of your household at this point in the pandemic, a new study highlights several methods to make it as safe as possible. Under the unique and exigent circumstances resulting from the COVID-19 outbreak, we believe that modest, in-kind transportation assistance (e.g., a voucher or reimbursement for taxi or ridesharing services or a driver or ridesharing service paid for by the practice)-that does not otherwise satisfy the conditions set forth in the existing safe harbor for local transportation-provided for free to established patients of an oncology practice would present a low risk of fraud and abuse under the Federal anti-kickback statute and the Beneficiary Inducements CMP and could improve beneficiaries' access to oncology care in certain circumstances. It is incumbent on the parties to determine a fair market value payment for the actual and necessary items and services furnished by the retail pharmacy; we express no opinion regarding the fair market value for such items and services. However, Varghese Mathai, PhD, assistant professor at the University of Massachusetts Amherst and lead author of a December study published in Science Advances, says this might not be ideal for reducing transmission. We believe that transportation assistance provided by these categories of providers in accordance with the conditions set forth above also would likely present a low risk of fraud and abuse. With high scalability and an existing service model available, rideshare could address transportation needs. In the unique circumstances resulting from the COVID-19 outbreak, we believe that these facts likely would present a low risk of fraud and abuse under the Federal anti-kickback statute and the Beneficiary Inducements CMP provided the free blood draw services being offered by an HHAthrough its staff membersto Federal health care program beneficiaries who are not patients of the HHA and reside in an assisted living facility are: (1) within the scope of practice of the HHA's staff; (2) limited to the period subject to the COVID-19 Declaration; and (3) not contingent upon referrals for any items or services that may be reimbursable in whole or in part by a Federal health care program, either during or after the COVID-19 Declaration period. It's a risk based decision, said Hahn. Specifically, based on the facts included in the question submitted to us, the distribution of grant funds would be administered through one of the FQHC's social services programs, and the FQHC would: (1) screen for financial need (demonstrated by an individual's enrollment in Medicaid or by an uninsured individual's attestation of annual income); (2) screen for COVID-19-related financial need to confirm that an individual has lost more than 50 percent of his or her income due to the COVID-19 public health emergency; (3) document each individual's satisfying of the two-pronged financial need criteria; (4) explain to a recipient, and require a signed acknowledgment from each recipient, that eligibility for the cash assistance is not tied to becoming a patient of the FQHC, or for individuals who are the FQHC's patients continuing to receive care from the FQHC; (5) limit any cash-equivalent gift card to $100 to $200 (depending on family size); (6) track to ensure a patient receives gift card assistance only once; and (7) refrain from advertising the program. A visitor to the southern Utah park reported to a . For the purpose of these Frequently Asked Questions (FAQs), the original declaration and any renewals are collectively referred to as the "COVID-19 Declaration.". Theres a risk of the coronavirus on surfaces, but a majority of transmissions are not from it.. Thank you. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis. %%EOF This perspective was supported through an ongoing project on NEMT sponsored by Lyft. More widespread availability of rideshare for NEMT may save lives, reserve emergency resources for those who need them, and provide safe pathways to primary care for the chronically ill. Instead, open windows that are farthest from you. The FQHC would not bill the COVID-19 testing to any Federal health care program, other third-party payors, or the patient. As with many underlying conditions, COVID-19 appears to pose an extra risk for people with kidney failure and patients undergoing dialysis, said Dr. Alan Kliger, a nephrologist at Yale. In response to the COVID-19 public health emergency, various State, local, or municipal authorities (including hospitals, but only where a hospital has the requisite legal authority) have established communitywide emergency medical service (EMS) protocols that require or allow, with patient consent, ambulance providers and suppliers to treat certain patients, including Medicare beneficiaries, "in place" who otherwise, but for the COVID-19 public health emergency, would have been transported to a Medicare covered destination (such as a hospital). Sections II(B)(12)-(17) of the blanket waivers of the physician self-referral law protect "referrals," as defined under section 1877(g) of the Act, rather than "remuneration," and reflect differences in the statutory proscriptions of the physician self-referral law when compared to the Federal anti-kickback statute. 49 views, 2 likes, 1 loves, 3 comments, 1 shares, Facebook Watch Videos from Hope Center Covenant Church: Sunday Celebration, April 09, 2023 Join us.
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