Rideshares cannot offer everything, but there are things that could be done to support rideshare in doing the one thing their drivers do very well: move people and things to where they need to be. The provision of valuable technology and services to Federal health care program beneficiaries for free or at a reduced cost likely implicates the Federal anti-kickback statute and Beneficiary Inducements CMP; in normal circumstances, offering or giving Federal health care program beneficiaries such items or services would be suspect under both laws. We recognize that sufficient access to personal protective equipment is crucial to protect patients and frontline health care workers during the coronavirus disease 2019 (COVID-19) public health emergency. Under the unique circumstances resulting from the COVID-19 outbreak, we believe that the provision of free or discounted lodging by an oncology practice to financially needy Federal health care program beneficiaries otherwise eligible for lodging at a nonprofit lodging facility presents a low risk of fraud and abuse if certain conditions are met. They are also investigating the differences in airflow of air conditioning and heating units, and how it affects the airborne transmission of the coronavirus. According to the facts presented in the question submitted, an oncology practice wishes to offer free or discounted lodging to certain financially needy patients who would have qualified for free or discounted lodging at a nonprofit lodging facility that is now closed as a result of the COVID-19 public health emergency. Nevertheless, OIG believes that a hospital's suspension of rental charges and accrual of interest for a FQHCLA presents a sufficiently low risk of fraud and abuse so long as the following conditions are met: (i) the arrangement suspending rental charges and accrual of interest is set out in a written document or documents, signed by the parties, that describes all material terms of the arrangement (which could be in the form of amendments to the underlying lease and line-of-credit agreements); (ii) the suspension of rent and accrual of interest is not conditioned on the volume or value of Federal health care program business generated between the hospital and the FQHCLA; (iii) the arrangement does not require the FQHCLA (or its affiliated health care professionals) to refer patients to a particular individual or entity or restrict the FQHCLA (or its affiliated health care professionals) from referring patients to any individual or entity; (iv) the suspension of rent and accrual of interest is only offered to the FQHCLA when necessary as a result of the COVID-19 outbreak; and (v) the suspension of rent and accrual of interest is effective only during the period subject to the COVID-19 Declaration. endstream endobj 150 0 obj <. Drivers receive no formal medical training. As the number of positive COVID-19 cases continues to grow in the Hudson Valley, a new directive for EMS workers is put in place to help prevent the spread of the disease. 4 /16. An OIG advisory opinion is legally binding on HHS and the requesting party or parties. In addition, independent physicians who use the hospital's telehealth platform for free (i) receive no remuneration for use of the platform from the hospital (other than free access to the platform); (ii) must be responsible for appropriately maintaining any required records for patients who receive services using the platform; and (iii) independently bill and receive reimbursement from payors for professional services furnished via the platform. Providing free laboratory testing to Federal health care program beneficiaries implicates the Federal anti-kickback statute because the clinical laboratory would be providing something of value for free to beneficiaries who could self-refer to the laboratory for items and services reimbursable by a Federal health care program. 1001.952(bb), for free or at reduced cost to obtain medically necessary items or services furnished by the eligible entity; (ii) provided only when necessary as a result of the COVID-19 outbreak and during the period subject to the COVID-19 Declaration; and (iii) not air, luxury, or ambulance-level transportation. The Pardee RAND Graduate School (PardeeRAND.edu) is home to the only Ph.D. and M.Phil. 2023, Charter Communications, all rights reserved. Free COVID-19 diagnostic testing would be provided on a first-come-first-served basis and would not be tied to receiving any other items or services from the FQHC. 0 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. on the guidance repository, except to establish historical facts. OIG, Special Fraud Alert: Arrangements for the Provision of Clinical Laboratory Services (Oct. 1994), available at https://oig.hhs.gov/compliance/alerts/index.asp (the "1994 Alert"). You can ride in a car with anyone who has been in quarantine with you as long as you're both feeling well. In addition, this allows the fire department paramedics and company personnel to tend to the patient . This response addresses only the distribution of gift cards from the FQHC to Federal health care program beneficiaries. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically During normal times, over 3.6 million Americans miss or delay medical care due to transportation barriers. The school nurse checked Brasfield's pulse, found it too fast to count and called 911 for an ambulance. Is It Really Time to Take Off Your Mask on Public Transit? endstream endobj startxref By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. We recognize that this scenario also involves potential direct or indirect financial relationships between the private foundation, the FQHC, and the Federal health care program beneficiary receiving the grant funding, and that there are different fraud and abuse risks with respect to each relationship. Please have your government issued ID with you when you report for your ride-along. Currently, the CDC recommends opening car windows or setting the air ventilation/air conditioner system to non-recirculation mode. A Federally Qualified Health Center (FQHC) received from a private foundation a $15,000 COVID-19 relief grant designated for emergency cash assistance for financially needy individuals. Before sharing sensitive information, make sure youre on a federal government site. Traditional NEMT options have narrowed or disappeared as public transportation and paratransit stop or operate at reduced schedules, and family and neighbors become less willing to provide transit (lest the infection spread, as occurred in New Rochelle, New York, where an ill individual infected the neighbor providing transportation to the hospital). 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. Can a non-provider philanthropic entity contract to provide certain administrative services to a health care provider relating to the operation of COVID-19 vaccination sites and be compensated on a per-vaccine basis? Riding in a car with someone outside of your home carries a risk of COVID-19 infection for yourself and others. The .gov means its official. TNCs can do more than just provide NEMT during the current crisis. The information in this article is current as of the date listed, which means newer information may be available when you read this. Similarly, depending on the facts and circumstances, providing free goods or services to Federal health care program beneficiaries may implicate the Beneficiary Inducements CMP. And if you have a confirmed case of COVID-19 . The most surprising finding was that if one occupant could potentially infect the other, opening the window next to you might not necessarily be the best option, Mathai says. Similarly, we received a question about a SNF or other long-term-care provider filling patient-care needs as a result of staffing shortages with, for example, community dentists or podiatrists who otherwise are not practicing at full capacity during the current public health emergency and are willing to offer their services for free or at a reduced rate to the SNF's patients on a temporary basis. If you have to ride in a car with someone who has not been in your household during the . A visitor to the southern Utah park reported to a . Laura Fraade-Blanar is an associate policy researcher at the nonprofit, nonpartisan RAND Corporation. Sitting in the back of the car and opening the window farthest away from you may also improve air circulation and reduce exposure to aerosol droplets. 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. While the group practice may be able to structure such transportation arrangements to comply with the existing safe harbor for local transportation, 42 C.F.R. With government cooperation, the range of services rideshare drivers could provide and the number of drivers available are limited only by what is safe for the driver and logistically feasible. According to the facts presented, an oncology group practice has temporarily closed a particular office due to actual or potential patient and staff exposure to COVID-19. We believe an oncology practice's provision of free or discounted lodging to certain financially needy Federal health care program beneficiaries presents a low risk of fraud and abuse under the Federal anti-kickback statute and the Beneficiary Inducements CMP if the following conditions are met: (1) the patient resides at least 50 miles from the treatment site; (2) the patient is an established patient of the oncology practice who has already scheduled chemotherapy or radiation treatment prior to the offer of free or discounted lodging; (3) the patient's physician determines that free or discounted lodging would facilitate access to care while the patient is receiving chemotherapy or radiation treatment; (4) the oncology practice reasonably believes that the patient would have qualified for free or discounted housing during treatment at a nonprofit lodging facility that is closed as a result of the COVID-19 public health emergency; (5) the remuneration is in-kind, such as a direct payment to a hotel or motel for the appropriate number of nights; (6) the hotel or motel is located in close proximity to the treatment site; (7) the practice does not advertise the availability of free or discounted housing or otherwise use the availability of this remuneration for patient recruitment; and (8) the lodging is provided during the COVID-19 public health emergency. 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. Helping Coastal Communities Plan for Climate Change, Measuring Wellbeing to Help Communities Thrive, Assessing and Articulating the Wider Benefits of Research, >Non-Emergency Medical Transportation in the Time of COVID-19, confirmed or suspected COVID-19 and are seeking help or are experiencing a medical emergency, medically vulnerable or transportation-disadvantaged recipients, In Pittsburgh: Feeding the Needy, and Protecting Workers on the Front Lines of the Pandemic, Protecting Household Employers and Workers During the COVID-19 Pandemic, What Autonomous Vehicles Could Mean for American Workers. The mask is there to protect others from other respiratory droplets or anything that is coming out. It's possible to spread the virus. Pursuant to the Waiver, ground ambulance services under such circumstances will be paid at the usual base rate based on the level of service that was provided-Basic Life Support (BLS) emergency or Advanced Life Support, level 1 (ALS1) emergency-that would have been paid if the patient had in fact been transported to the nearest appropriate facility able to treat the patient's condition and other means of transportation were contraindicated, without payment for mileage. Here's when to call an ambulance Published: September 2, 2021 11.35pm EDT shortness of breath loss of appetite dizziness confusion or irritability persistent. According to the facts presented, a clinical laboratory would provide free COVID-19 antibody testing to patients, including Federal health care program beneficiaries, who contemporaneously undergo other medically necessary blood tests performed by the laboratory. For parties analyzing referrals by physicians for designated health services to entities under sections II(B)(12)-(17) of the blanket waivers under the Federal anti-kickback statute, we advise parties to consider whether such referrals would result in remuneration that implicates the Federal anti-kickback statute. However, we believe that there are scenarios in which health care providers could work together to fill critical gaps caused by the COVID-19 outbreak to provide necessary care to vulnerable beneficiaries receiving care in a SNF or other long-term-care facility. Many people who need an ambulance ride to the hospital will find themselves faced with an out-of-network bill for that service. In addition, for the transportation assistance to present a low risk of fraud and abuse, the eligible entity must not: (i) determine an established patient's eligibility for transportation assistance in a manner related to the past or anticipated volume or value of Federal health care program business; (ii) publicly market or advertise the in-kind transportation or allow marketing of health care items and services during the course of the transportation or at any time by drivers who provide the transportation; or (iii) pay drivers or others arranging for the transportation on a per-beneficiary-transported basis. Study Identifies Safest Ways to Share a Car During COVID-19. The FQHC intends to advertise the availability of free testing. It is unlikely that such a provider or supplier would have the requisite intent to induce or reward patient referrals, or generate Federal health care program business, by furnishing such goods or services. In addition, no party may bill or otherwise shift the costs of free blood draws to Federal health care programs. %PDF-1.5 % Mathai explains car air ventilation flows from the back to the front window. With high scalability and an existing service model available, rideshare could address transportation needs. For more information about the advisory opinion process, including information regarding how to submit an advisory opinion and how long it takes for OIG to process an advisory opinion request, please see https://oig.hhs.gov/faqs/advisory-opinions-faq.asp. Some hospitals may be in a position to provide certain relief to FQHCLAs by, for example, suspending rent or forgoing the accrual of interest on loans or lines of credit, which could allow FQHCLAs to continue to serve medical needs in underserved communities during the public health emergency. 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. However, we believe that there are scenarios in which an HHA and an assisted living facility could work together to fill critical gaps caused by the COVID-19 outbreak to provide necessary health care services to vulnerable beneficiaries residing in an assisted living facility. hbbd``b` $f F7 V$R@+ $b^X u "Hf L* ;)'3&~0 F The FQHC would not bill the COVID-19 testing to any Federal health care program, other third-party payors, or the patient. We also acknowledge that it may be possible for parties to structure a program to meet the Promotes Access to Care exception to the Beneficiary Inducements CMP (see, e.g., OIG Advisory Opinion 19-02), but we are unable to make this determination without all the relevant facts, and we further note that there is no parallel safe harbor for protection under the Federal anti-kickback statute. 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. 8. In addition to the facts presented, we also believe that many urban beneficiaries who normally use public transportation (e.g., bus or subway) to access oncology care may temporarily need modest transportation assistance during the COVID-19 Declaration. o The person being transported should sit in the backseat of the vehicle. They can deliver (and as of April 15th are delivering) food to individuals in medical quarantine or who are unable to safely shop for themselves, supplementing existing grocery delivery services who are currently overwhelmed. 3OIG plans to review all submissions, develop responses as appropriate to FAQs, and make such responses publicly available on its website by updating this site. Finally, making rideshare-based NEMT a workable option requires a firm understanding of what rideshare drivers and TNCs can and cannot do. OIG's longstanding guidance makes clear that, depending on the facts and circumstances, the provision of free space to an actual or potential referral source likely implicates the Federal anti-kickback statute and would not satisfy the requirements of the space rental safe harbor, 42 C.F.R. What are the implications, under OIG's administrative sanction authorities, of an ambulance provider or supplier waiving or discounting beneficiary cost-sharing obligations (required by the Medicare program) 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? The proposed arrangement also implicates the Beneficiary Inducements CMP because the free COVID-19 antibody testing could reasonably influence a Medicare or State health care program beneficiary to selector to cause his or her physician to selectthe clinical laboratory for other medically necessary blood testing that is reimbursable by Medicare or a State health care program, in order to qualify for the free COVID-19 antibody testing. Compensation methodologies that involve "per patient," "per click," "per order," and similar methodologies in payment arrangements with parties in a position, directly or indirectly, to refer or recommend an item or service payable by a Federal health care program implicate and may violate the Federal anti-kickback statute. While the protocol was recently implemented in Orange County the state made the revision to these treatment procedures in August 2019. 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. Issued by: Office of Inspector General (OIG). To sign up for updates or to access your subscriber preferences, please enter your contact information below. A federal government website managed by the We encourage parties to review the recent guidance published by the Office for Civil Rights regarding the use of audio or video communication technology to furnish telehealth services during the COVID-19 public health emergency: "Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency. However, providers may find more information about the CARES Act Provider Relief Fund and reach the attestation portal here: https://www.hhs.gov/provider-relief/index.html. 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 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. It's a risk based decision, said Hahn. For this reason, Banerjee warns that a passenger not taking proper precautions can potentially lead to community spread, which is dangerous because of the difficulty to contact trace. Currently, at least 10 states include rideshare as a NEMT provider. In your submission, please provide sufficient facts that allow for an understanding of the key parties and terms of the arrangement at issue. The Organization and each HCP would enter into a signed, written agreement setting forth the duties of each party and the methodology for determining the compensation the HCP pays to the Organization. Federal government websites often end in .gov or .mil. 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. 185 0 obj <>stream Orange County paramedics are on the frontlines for the coronavirus outbreak and with positive cases rising to more than 6,000 . Officials say one way a person who dials 911 for a loved one or someone in distress can protect themselves from the virus is by taking a shirt or towel and covering the patient's mouth and nose while you initiate compression only CPR. Some states were unable to allow TNCs to provide NEMT because of historical barriers, driver requirements, or other obstacles. 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. Finally, the Organization's provision of administrative services to HCPs would not operate in conjunction with any other arrangement or agreement between and among the Organization, the HCPs, any Federal health care program beneficiary who receives vaccinations from one of the sites, or any other person or entity in a position to refer or arrange for the referral of items or services reimbursable by a Federal health care program. Riding in a car with someone outside of your home carries a risk of COVID-19 infection for yourself and others. 2020. p.eabe0166. The OIG's advisory opinion process remains available to interested parties. 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. For the purpose of these FAQs, the original declaration and any renewals are collectively referred to as the "COVID-19 Declaration.". Lyft and Uber have issued guidance to their drivers around safe operations, including disinfecting the in-vehicle environment and not driving when ill. This makes respiratory droplets dangerous. RAND is nonprofit, nonpartisan, and committed to the public interest. An FQHC has received funding from a non-governmental donor to be used to provide free COVID-19 diagnostic testing to vulnerable populations that may have difficulty accessing testing due to low income, lack of transportation, or other barriers. A lot of the spread is from places where we dont necessarily know where the transmission took place, he says. I know there are people who conduct themselves in a general asshat, selfish manner around COVID. This perspective was supported through an ongoing project on NEMT sponsored by Lyft. Andrea Richardson @ASRichardson3, Tamara Dubowitz @TamaraDubowitz, Shanthi Nataraj, Krishna B. Kumar @kbkumar_. However, we believe that the provision of free items and services related to COVID-19 vaccine storage, distribution, redistribution, and administration would pose a low risk of fraud and abuse under the Federal anti-kickback statute. EMT Ambulance Ride-Alongs. Advanced life support is used for life-threatening emergencies, while basic life support is used for non-emergency injuries such as broken . Although we are making every attempt to provide an accurate response to questions posed in the context of the exigent circumstances unique to the COVID-19 public health emergency, due to the limited scope of facts presented to uswhich are not certifiedany favorable answer will not result in prospective immunity or protection from OIG administrative sanctions or prospective immunity or protection under Federal criminal law. ", 1The Secretary of the Department of Health and Human Services (HHS) determined, through a January 31, 2020, determination, pursuant to section 319 of the Public Health Service Act, that a public health emergency exists and has existed since January 27, 2020. This could help Uber, Lyft, and taxis in knowing which windows to open for the safety of the passenger, Mathai says. In light of the unique circumstances of the current public health emergency, the Secretary has offered regulatory flexibilities to health care entities similar to those requested here via Blanket Waivers of Section 1877(g) of the Social Security Act (the Act), issued March 30, 2020 (the Blanket Waivers). 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" does not incorporate sections II(B)(12)-(18) of the blanket waivers of the physician self-referral law as issued by the Secretary. This could include an expanded service into remote, rural areas. 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. Facilitating blood draws for medically necessary clinical laboratory testing in a patient's residence may improve access to care and promote patient safety during the current pandemic by avoiding exposure to a separate testing site. The hospital would receive no payment from any (i) independent physician to whom it grants free access to the platform, or (ii) payor for services furnished through its telehealth platform by the independent physicians. When you are in a confined environment, there is a risk of airborne infection, especially in ride-sharing trips that take just 15 to 20 minutes," Mathai tells Verywell. But when youre in an enclosed space like a car, theres not much opportunity to social distance, Sri Banerjee, PhD, an epidemiologist at Walden University who previously studied infectious diseases at the Centers for Disease Control and Prevention (CDC), tells Verywell. OIG expresses no opinion regarding the liability of any party under the Federal False Claims Act, Federal criminal law, or other legal authorities for any improper billing, claims submission, cost reporting, or related conduct. Do Car Companies Know Where Their Critical Minerals Come From? 1001.952(bb); and (vii) the provision of the Telecommunications Technologies is limited to the time period subject to the COVID-19 Declaration, requiring the return of the cell phone, cessation of payment for the patient's service or data plan, or both, after the time period subject to the COVID-19 Declaration. Passengers are permitted to ride in the back of a pickup or flatbed truck only if the truck bed includes a federally-approved restraint system. Verywell Health's content is for informational and educational purposes only. Section II(B)(18) of the blanket waivers protects a compensation arrangement that is neither set forth in writing nor signed by the parties but otherwise fully complies with an applicable physician self-referral law exception. On the fence about calling an Uber to get to an appointment? It's often up to her to tell patients' families that they can't ride in the ambulance and can't come to the hospital, and to stand there as they slowly realize that her arrival could mean a. Tim Gruber for The New York Times When Congress passed a law. Understanding how to reduce COVID-19 transmission in the air is important in preventing future infections. The Department may not cite, use, or rely on any guidance that is not posted Lyft is delivering meals to students who normally received subsidized school meals, and to senior citizens. In the case of the COVID-19 public health emergency, the Secretary has issued subsequent 90-day renewals of the original January 31, 2020, public health emergency determination. Both are working to distribute cleaning supplies to drivers. 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. Normally the family member or friend will ride in the front cab passenger seat of the ambulance.
