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.. OIG expresses no opinion with respect to the application of any other Federal, State, or local statute, rule, regulation, ordinance, or other law that may be applicable to the question answered, including, without limitation, the physician self-referral law, section 1877 of the Act (or that provision's application to the Medicaid program at section 1903(s) of the Act). 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. On the fence about calling an Uber to get to an appointment? 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. 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. 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. The Pardee RAND Graduate School (PardeeRAND.edu) is home to the only Ph.D. and M.Phil. This remuneration also could reasonably influence a patient to select the group practice to receive federally reimbursable items and services. 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. 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 beneficiaries. Thank you, {{form.email}}, for signing up. 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. The mask is there to protect others from other respiratory droplets or anything that is coming out. The Department may not cite, use, or rely on any guidance that is not posted The Organization would contract with various health care providers (HCPs), including physicians, physician group practices, and health systems, to provide these administrative services. Permitting a passenger to unlawfully ride in the bed of a pickup truck carries a $100 fine for either the driver or passenger. 149 0 obj <> endobj Can a hospital assist a Federally Qualified Health Center Look-Alike (FQHCLA) by suspending rental charges and forgoing the accrual of interest on a line of credit during the period subject to the COVID-19 Declaration to ensure the FQHCLA is able to continue to serve the medical needs of the community during the pandemic? By Jocelyn Solis-Moreira Generally, the service has yielded positive results; studies found patients using rideshare-based NEMT had fewer missed primary care appointments, a lower average wait time, a higher rate of on-time pickup compared to those using other types of NEMT, and lower costs. 200 Independence Avenue, S.W. We welcome your comments as they assist us to improve our services. 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. FQHCLAs deliver comprehensive primary care services to some of the country's most vulnerable individuals and families in areas where economic, geographic, or cultural barriers may limit access to affordable health care services. 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. Other NEMT options, such as family or friends driving, ambulances or handivans picking up individuals, become difficult in a pandemic as resources become scarce and people isolate themselves by necessity. Can a physician group that contracts with a nursing home to provide care to its residents furnish protective face masks-at no or reduced cost-to the nursing home if it is experiencing supply shortages due to the COVID-19 outbreak? 4.7K views, 42 likes, 7 loves, 9 comments, 12 shares, Facebook Watch Videos from Allysa maharani: Charleston White Curs3s O.G Percy Sister #CharlestonWhite #OGPercy They looked at the differences in air flow when specific windows were open versus when all of the windows were open versus being closed. Laura Fraade-Blanar is an associate policy researcher at the nonprofit, nonpartisan RAND Corporation. Crack the windows to air out your car between rides. COVID can worsen quickly at home. RAND is nonprofit, nonpartisan, and committed to the public interest. 442 U.S.C. 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. 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. 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. Under the facts described herein, the provision of free COVID-19 diagnostic testing to Federal health care program beneficiaries presents a sufficiently low risk of fraud and abuse under the Federal anti-kickback statute and Beneficiary Inducements CMP because, as described, the program includes the following safeguards: (1) free COVID-19 testing is offered to all patients who request it, regardless of the patient's insurance coverage or lack thereof; (2) beneficiaries who received positive test results would not be referred to the FQHC or to any other specific provider; (3) the FQHC would not offer special discounts or any other free or discounted items or services to beneficiaries who received free COVID-19 testing; (4) no payor, including the beneficiary, a commercial insurance company, or a Federal health care program, would be billed for or pay any costs in connection with the COVID-19 testing services; and (5) the COVID-19 tests are cleared or approved by the Food and Drug Administration (FDA), are subject to an FDA-issued Emergency Use Authorization, or are covered by the Medicare program. In light of such guidance, a physician group's provision of free or reduced-cost masks to nursing homes where they provide care to Federal health care program beneficiaries could raise concerns under the anti-kickback statute. 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. People are sick, losing jobs, postponing important life events, projects, losing chunks of their retirement, and living in a constant state of fear. Under the state protocol, if EMTs are unable to restart the heart or revive an adult cardiac patient using CPR, defibrillators, medication and other techniques at the scene then they are not to transport them to the hospital. Some drivers have erected a do-it-yourself, see-through barrier between the rear and front seats. A Canadian woman had to be resuscitated by rescue teams after losing her pulse while clinging on to a log in Zion National Park's Virgin River. 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 may violate the Federal anti-kickback statute; similarly, depending on the facts and circumstances, the provision of free goods or services to Federal health care program beneficiaries may implicate the Beneficiary Inducements CMP. 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. The FQHC would not bill the COVID-19 testing to any Federal health care program, other third-party payors, or the patient. Therefore, a retroactive waiver of cost-sharing obligations by ground ambulance providers and suppliers for instances in which no ambulance transport was provided but for which the Medicare program retroactively reimburses for these specified services is unlikely to induce the use of those or any other services in the future. 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. 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? The .gov means its official. Moreover, a 2014 Special Fraud Alert described certain problematic "specimen processing arrangements" in which clinical laboratories provided remuneration to physicians to collect, process, and package patients' specimens, and we noted there that "when a laboratory pays a physician more than fair market value for the physician's services or for services . Can an oncology practice offer free or discounted lodging to its financially needy patients who are Federal health care program beneficiaries if, prior to the COVID-19 public health emergency, such patients would have had access to free or discounted housing at a nonprofit lodging facility while receiving chemotherapy or radiation treatment? 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? Although drivers for TNCs could be asked to deliver goods to and between medical facilities, they cannot move medical samples or soiled supplies between medical facilities. on the guidance repository, except to establish historical facts. . Patients who. 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. 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. 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. Medical necessity for COVID-19 patients. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically 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. 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. 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. 4 /16. See U.S. Department of Health and Human Services, Public Health Emergency Declaration Q&As, available at https://www.phe.gov/Preparedness/legal/Pages/phe-qa.aspx#faq7. Learn More. During the closure, the group practice desires to provide established patients with modest transportation assistance (e.g., a voucher or reimbursement for taxi or ridesharing services or a driver or ridesharing service paid for by the practice) to assist them in obtaining oncology care at one of the group practice's alternate locations. 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. The Waiver is effective retroactively to Medicare claims for services rendered on or after March 1, 2020. They can also deliver goods from open stores, such as pharmacy items, including sanitizing materials, non-prescription drugs, and personal care products. 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. With high scalability and an existing service model available, rideshare could address transportation needs. Accordingly, the arrangement implicates the Beneficiary Inducements CMP. Theres a risk of the coronavirus on surfaces, but a majority of transmissions are not from it.. Lyft and Uber have issued guidance to their drivers around safe operations, including disinfecting the in-vehicle environment and not driving when ill. hbbd``b` $f F7 V$R@+ $b^X u "Hf L* ;)'3&~0 F 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. Is It Really Time to Take Off Your Mask on Public Transit? The informal feedback furnished on this site does not bind or obligate HHS, the U.S. Department of Justice, or any other agency. 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. The Organization stated that it has the experience and expertise to provide reliable administrative services for vaccination sites. 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. Read our, CDC Recognizes COVID-19 Can Be Airborne: Here's What That Means, Air Flow May Have Caused COVID-19 Spread In a Restaurant, Study Shows, Privacy Concerns Continue To Prevent Contact Tracing App Use. We wanted to understand how the air flows in the car and how to improve this.". About half of emergency ground ambulance rides result in an out-of-network charge for people with private health insurance, potentially leaving patients at risk of getting a surprise bill, a. Uber has pledged free rides and free meals for health care providers internationally. o The person being transported should sit in the backseat of the vehicle. Still, people have to obtain non-emergency but necessary medical care, including kidney dialysis, chemotherapy, and prenatal care visits. Both offer financial assistance to drivers self-quarantining with a doctor's note. 1395nn; 42 U.S.C. 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. Rental charges paid by a physician (or an immediate family member of a physician) to an entity that are below fair market value for the physician's (or immediate family member's) lease of office space from the entity. 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. Verywell Health's content is for informational and educational purposes only. Christopher Whaley is a policy researcher at RAND and a professor at the Pardee RAND Graduate School. We also understand that some of these lodging facilities have closed as a result of the COVID-19 public health emergency. Instead, open windows that are farthest from you. About 40-50% of the spread is from asymptomatic people, he says. 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. This is to limit the spread of Covid-19 and to keep patient . 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. 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? We recognize that effective and expeditious vaccine administration is crucial to the COVID-19 pandemic response and that individuals in rural areas may face heightened challenges in accessing vaccines. We understand that Federal health care program beneficiaries with cancer, who are receiving chemotherapy or radiation treatment, sometimes qualify for free or discounted housing at a nonprofit lodging facility near treatment sites while receiving treatment. And if you have a confirmed case of COVID-19 . Every day you know EMS workers make life and death decisions, and it's in consultation with the hospital physicians emergency room physicians that will make this decision out in the field," said Hahn, "They're gonna make every effort that's reasonable based on you know what the case is all the decisions are based, you know, based on sound clinical judgment.. This question is outside the jurisdiction of OIG's authorities. 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. It's a risk based decision, said Hahn. 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. 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"). Tweet. This may allow for cross-ventilation in the cabin.. Officers, paramedics and an air ambulance attended, but the woman - believed to be in her 30s - was pronounced dead at the scene. Since we did not look at this or the risk of getting infected, we are not in a position to make health recommendations., Because the risk of respiratory droplets spreading between passengers remains, Banerjee advises people to continue wearing masks in cars. 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. NEMT, covered by Medicaid and certain Medicare Advantage plans, is associated with greater use of preventive and primary health care, lower use of emergency services and inpatient services, and timely medical care among certain health conditions. Currently, at least 10 states include rideshare as a NEMT provider. 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. Check the latest closings and delays for schools, business, and churches around the Hudson Valley. This could help Uber, Lyft, and taxis in knowing which windows to open for the safety of the passenger, Mathai says. 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. endstream endobj startxref 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. 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. We also acknowledge that some vulnerable patient populations may not own or have access to the necessary technology or data services to facilitate these services.
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