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. An official website of the United States government. Patients and physicians would be able to access COVID-19 antibody testing results through the laboratory's patient portal, and the results from the antibody testing program also would be reported to the Centers for Disease Control and Prevention and State public health agencies to further support COVID-19 surveillance and response efforts. To complete an EMT basic course at the California Institute of Emergency Medical Training (CIEMT), you must perform ambulance ride-alongs. 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. 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. Making ridesharing a workable option in the current crisis requires local and state government cooperation, TNC capacity, clarity around the rideshare driver's role, and protection for the driver. However, given the unique circumstances of the COVID-19 public health emergency, we believe that the provision of free or reduced-cost masks would pose a low risk of fraud and abuse under the Federal anti-kickback statute provided that (1) the decision to furnish masks for free or at a reduced cost is directly connected to addressing the impact of the COVID-19 outbreak (e.g., the nursing home needs masks due to COVID-19 supply chain disruptions); (2) the masks are furnished only during the time period subject to the COVID-19 Declaration; (3) the provision of free or reduced-cost masks is not marketed by the physician group; and (4) the provision of the masks is not made contingent on the nursing home's referrals to the physician group of any specified item or service, or any specified volume or value of past or anticipated referrals of items or services that may be reimbursable, in whole or in part, by a Federal health care program. Many people who need an ambulance ride to the hospital will find themselves faced with an out-of-network bill for that service. We recognize, however, that beneficiary obligations that arise as a result of billing by ambulance providers or suppliers under the Waiver could result in the perception of "surprise billing," particularly with respect to retroactive billing for services that were provided prior to the issuance of the Waiver. While the study focused on passenger cars, it opens doors to other areas of study. This response addresses only the provision of free COVID-19 testing by the FQHC to Federal health care program beneficiaries. First, TNCs must be able to provide NEMT within the state. Check the latest closings and delays for schools, business, and churches around the Hudson Valley. Issued by: Office of Inspector General (OIG). Drivers receive no formal medical training. Mathai explains car air ventilation flows from the back to the front window. The HCPs would oversee administration of the COVID-19 vaccine and provide certain clinical staffing to administer the vaccine at the sites. We recognize that the donation of face masks under these circumstances presents a lower risk of fraud and abuse because it operates to protect the health and safety of the donor physician group and its treating clinicians who furnish services to the nursing home's residents during the public health emergency and who may work closely with the nursing home's staff. Upon arrival for your ride-along shift, you will be required to sign a liability waiver and agree to a routine wants and warrants check by the on-duty watch commander. 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. 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. Medical necessity for COVID-19 patients. The Waiver is effective retroactively to Medicare claims for services rendered on or after March 1, 2020. 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. That configuration allows fresh air to flow in through the back left window and out through the front right window and helps create a barrier between the driver and the passenger. 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). Laura Fraade-Blanar is an associate policy researcher at the nonprofit, nonpartisan RAND Corporation. OIG has become aware that some ambulance providers and suppliers may wish to waive or discount beneficiary cost-sharing obligations in the context of services provided and billed to Medicare under the flexibilities provided by the Waiver. 2020. p.eabe0166. She spent six weeks at the new hospital and survived. She holds a Masters in Psychology concentrating on Behavioral Neuroscience. They are also investigating the differences in airflow of air conditioning and heating units, and how it affects the airborne transmission of the coronavirus. Babies and children younger than 2 years old Anyone who has trouble breathing or is unconscious Anyone who is incapacitated or otherwise unable to remove the mask without help Masks are meant to protect other people in case the wearer is unknowingly infected but does not have symptoms. 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. 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. However, under the facts presented to us, the COVID-19 relief grant was specifically designated for emergency cash assistance to individuals and, in the limited context of the COVID-19 public health emergency and with the combination of safeguards presented below, distributing the grant funds to individuals including Federal health care program beneficiaries in the form of cash-equivalent gift cards would be sufficiently low risk. Because no information was provided with respect to the donor, and given the numerous potential variations on the facts depending on the nature of donors, this response focuses only on the financial relationship between the FQHC and the Federal health care program beneficiary receiving free COVID-19 testing services from the FQHC. California Consumer Limit the Use of My Sensitive Personal Information, California Consumer Do Not Sell or Share My Personal Information. doi:10.1126/sciadv.abe0166. 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. In the circumstances described in the 2014 Alert, the Medicare program reimbursed physicians for processing and packaging specimens for transport to a clinical laboratory through a bundled payment reported under a particular Current Procedural Terminology code. We recognize the need during the COVID-19 outbreak for many health care providers and suppliers to furnish services through various modalities in lieu of in-person visits. RAND is nonprofit, nonpartisan, and committed to the public interest. Can a home health agency's (HHA) staff members furnish free blood draws-provided that such blood draws are within the scope of the staff's licenses-to assisted living facility residents who are Federal health care program beneficiaries and are not patients of the HHA? Door-to-door service involving light assistance from the driver is being explored under other new pilots. When Can I Use Public Transportation Again After Being Fully Vaccinated? In other words, the compensation to the Organization could vary based on the number of vaccine doses the HCP administers. Riding in a car with someone outside of your home carries a risk of COVID-19 infection for yourself and others. Can mental health and substance use disorder providers accept donations from public entities (i.e., local, State, or Federal government entities), private charitable foundations, or health plans to fund cell phones, service or data plans, or both for patients who are financially needy or who do not own their own cell phone for the purpose of furnishing medically necessary services while in-person care is disrupted during the COVID-19 outbreak? Cars dont have the same air filtration system as airplanes, which may be slightly safer because of their HVAC ventilation. Thank you. 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. U.S. Department of Health & Human Services They also recently started delivering groceries, medical supplies, and necessary goods to medically vulnerable or transportation-disadvantaged recipients on behalf of nonprofits, government agencies, and health care organizations. Therefore, OIG is accepting inquiries from the health care community regarding the application of OIG's administrative enforcement authorities, including the Federal anti-kickback statute and civil monetary penalty (CMP) provision prohibiting inducements to beneficiaries (Beneficiary Inducements CMP).2 If you have a question regarding how OIG would view an arrangement that is directly connected to the public health emergency and implicates these authorities, please submit your question to OIGComplianceSuggestions@oig.hhs.gov. With ride-sharing, theres a lot of unknowns, so you always need to take your precautions: wearing a mask that covers your nose and mouth, keeping a hand sanitizer with you, maintaining distance, and opening the window.. Verywell Health's content is for informational and educational purposes only. 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. 1001.952(b). 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. Washington, D.C. 20201 hb```@( 0icI/j:sPq[ Duttp]@X, Uq*s f :n3c`3?3NnB94+ 2H3Q @ % The mask is there to protect others from other respiratory droplets or anything that is coming out. Under some state and regional COVID-19 vaccine plans, providers and suppliers such as hospitals, pharmacies, and health systems play a critical role in the storage, distribution, redistribution, and administration of COVID-19 vaccines. To sign up for updates or to access your subscriber preferences, please enter your contact information below. We believe the proposed arrangement offers the possibility of substantial public health benefits through the identification of additional potential convalescent plasma donors and valuable public health information and data and would pose a sufficiently low risk of fraud and abuse, provided the proposed arrangement includes the following safeguards: (1) the physicians ordering the laboratory tests, including the free COVID-19 antibody tests, would not receive any payments or anything else of value from the clinical laboratory in connection with the free antibody testing program; (2) the patients receiving the laboratory tests would not receive any payments or anything of value, other than the free COVID-19 antibody test, from the clinical laboratory in connection with the free antibody testing program; (3) the tests would be offered only to patients receiving other medically necessary blood tests as part of a medically necessary exam or treatment; (4) no payor, including the patient, a commercial insurance company, or a Federal health care program, would be billed for or pay any costs in connection with the COVID-19 antibody tests; and (5) the antibody tests are cleared or approved by the U.S. Food and Drug Administration (FDA) or are subject to an FDA-issued Emergency Use Authorization. According to the facts presented in the question we received, during the timeframe subject to the COVID-19 Declaration, the hospital would provide free access to a web-based telehealth platform to independent physicians on its medical staff. 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. Providing free testing to individuals who are not Federal health care program beneficiaries would be unlikely to implicate the Federal anti-kickback statute or Beneficiary Inducements CMP. 5Note that "[a public health emergency] declaration lasts until the Secretary declares that the [public health emergency] no longer exists or upon the expiration of the 90-day period beginning on the date the Secretary declared a [public health emergency] exists, whichever occurs first. Third, drivers must be protected during the current pandemic. The Organization stated that it has the experience and expertise to provide reliable administrative services for vaccination sites. 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. For the most recent updates on COVID-19, visit our coronavirus news page. Changes are already occurring in isolated circumstances. 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. Science Advances. 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. During the current pandemic, movement has slowed as people shelter in place. Ticket Fines for Riding in the Bed of a Truck in California. The Secretary has issued subsequent 90-day renewals of that original determination. OIG has longstanding and continuing concerns regarding the provision of cash or cash equivalents to Federal health care program beneficiaries. Narrator: Simultaneously, the paramedics are checking the patient's overall condition, looking at their airway, breathing, and circulation. Andrea Richardson @ASRichardson3, Tamara Dubowitz @TamaraDubowitz, Shanthi Nataraj, Krishna B. Kumar @kbkumar_. So even if someone isnt showing symptoms, they can still spread the virus. It's possible to spread the virus. Such physicians could access the platform from various settings outside of the hospital's campus. Within airplanes, theres a lot of areas for air to circulate, so theres not as much risk of repeat exposure to the same virus. Final. For parties analyzing an arrangement neither set forth in writing nor signed by the parties but that otherwise fully complies with an applicable physician self-referral law exception, we advise parties to consider whether any remuneration stemming from the arrangement implicates the Federal anti-kickback statute. Theres a risk of the coronavirus on surfaces, but a majority of transmissions are not from it.. OIG, Special Fraud Alert: Laboratory Payments to Referring Physicians (June 2014), available at https://oig.hhs.gov/compliance/alerts/index.asp (the "2014 Alert"). 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. 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. Please have your government issued ID with you when you report for your ride-along. This cost can vary depending on where you live, how close the hospital is, and whether you need advanced life support or basic life support. The school nurse checked Brasfield's pulse, found it too fast to count and called 911 for an ambulance. A lot of the spread is from places where we dont necessarily know where the transmission took place, he says. Finally, making rideshare-based NEMT a workable option requires a firm understanding of what rideshare drivers and TNCs can and cannot do. Orange County paramedics are on the frontlines for the coronavirus outbreak and with positive cases rising to more than 6,000 the Hudson Valley Regional EMS Council has adopted the states Cardiac Arrest Standard of Care during the COVID-19 Pandemic. Instead, open windows that are farthest from you. Is It Really Time to Take Off Your Mask on Public Transit? 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. For the purpose of these Frequently Asked Questions (FAQs), the original declaration and any renewals are collectively referred to as the "COVID-19 Declaration.". The information in this article is current as of the date listed, which means newer information may be available when you read this. 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. The Department may not cite, use, or rely on any guidance that is not posted In-kind transportation services offered by an oncology group practice to Federal health care program beneficiaries for free constitutes remuneration that may violate the Federal anti-kickback statute if the requisite intent to induce referrals is present. Transportation Network Companies (TNCs) like Lyft and Uber have been providing NEMT, since 2016 and 2018 respectively, through a ride-share model. While having all the windows down was more beneficial than turning on the ventilation, opening specific car windows also made a difference. Routine waivers of cost-sharing obligations implicate the Federal anti-kickback statute and the civil monetary penalty provision prohibiting inducements to beneficiaries and may result in overutilization or inappropriate utilization of items and services reimbursable by Federal health care programs. 149 0 obj <> endobj James received a Master of Library Science degree from Dominican University. 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. 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. 200 Independence Avenue, S.W. Tim Gruber for The New York Times When Congress passed a law. The FQHC would not bill the COVID-19 testing to any Federal health care program, other third-party payors, or the patient. The protocol is intended to protect EMS workers and to limit the number of people that could potentially be exposed by a possibly infected person. According to reports, Diana's ambulance ride to the hospital should have been five to 10 minutes but took 40 minutes because, applying standard French emergency procedures, they drove extremely. HCPs also would bill third-party payors, including Federal health care programs, for vaccine administration services. Some drivers have erected a do-it-yourself, see-through barrier between the rear and front seats. Get hyperlocal forecasts, radar and weather alerts. Mathai says that while his study looks at how to improve air flow in a car if you must, it is by no means a recommendation to ride in a car with another passengers from outside your household. 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. A visitor to the southern Utah park reported to a . Some studies show that the novel coronavirus can live in the air for up to three hours, so leaving your car's windows open between rides for . If a patient received a positive test result, the patient would be directed to the provider of his or her choice and would not be directed to the FQHC or any other specific provider. We note that the same factors would not be present for providers, suppliers, or other individuals and entities that distribute, redistribute, or administer adulterated, counterfeit, or fraudulent COVID-19 vaccines, or that otherwise attempt to induce or generate Federal health care program business by providing free items and services in connection with COVID-19 vaccines or other medical countermeasures not approved or authorized by the FDA. 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. The latter conduct would be suspect under the Federal anti-kickback statute, and both types of conduct may implicate other criminal and civil statutes. 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. 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. 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. Where do I sign my attestation? 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. Under the Ambulance Fee Schedule, Medicare Part B pays 80 percent of the approved amount, and the beneficiary is responsible for 20 percent of the approved amount as well as the applicable Part B deductible, if it has not yet been met. In your submission, please provide sufficient facts that allow for an understanding of the key parties and terms of the arrangement at issue.
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