Legislation Changes Pave the Way for Healthcare Transportation Impact (Part 1)

Alex Lekacz

The legislative landscape is ever-changing, and we know how important it is to make sure Roundtrip provides the most effective, compliant service. Periodically, we will be sharing about recent legislative changes that affect patient transportation.

Part 1: Local Transportation as a Safe Harbor Under the Anti-Kickback Statute

In December 2016, The Department of Health and Human Services Office of Inspector General (OIG) revised safe harbors under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements to include protection for free or discounted local transportation services that meet specified criteria.

Under this safe harbor, “free or discounted ‘local’ transportation may be made available by an ‘eligible entity’ to ‘established patients’ (and, if needed, a person to assist the patient) to obtain medically necessary items or services.”

These regulation changes are vital to opening up access to more patients through transportation, as long as providers follow the regulations carefully.

To fall under this safe harbor providers must know three key definitions:

  • Eligible entity is defined as “any individual or entity, except individuals or entities (or family members or others acting on their behalf) that primarily supply health care items (including, but not limited to, durable medical equipment (DME) suppliers or pharmaceutical companies).”
  • An established patient has made an initial appointment with the provider, “regardless of whether the patient has received services from that eligible entity in the past.”
  • Local transportation is defined as 25-mile distance for patients in an urban area and 50 miles for patients in a rural area.

Additionally, all transportation programs should account for the guidelines set forth by the OIG:

  • The availability of the transportation should be set forth in a policy that is applied uniformly and consistently and not determined in a manner related to the volume or value of the federal health care program business.
  • The transportation cannot be not air, luxury, or ambulance-level
  • Transportation assistance cannot be publicly advertised or marketed to “patients or others who are potential referral sources, no marketing of health care items or services could occur during the course of the transportation, and drivers or others involved in arranging the transportation cannot be paid on a per-beneficiary transported basis.”
  • The eligible entity that makes the transportation available bears the costs of the transportation and does not shift the burden of these costs onto any federal health care program, other payers, or individuals, unless voluntarily agreed upon, without ties to referrals.

The OIG also outlines specific guidelines for Shuttle Services. Vehicles that run on a set route and schedule are considered shuttle services and are not required to be limited to established patients or healthcare locations, as the individual door-to-door transportation outlined above. However, these shuttle services must comply with the following:

  • Shuttles cannot be not air, luxury, or ambulance-level transportation.
  • The shuttle service may only be provided within the eligible entity’s local area, meaning that there may be no more than 25 miles (urban) or 50 miles (rural) from any stop on the route to a stop where health care items or services are provided.
  • Marketing prohibitions (as outlined above) apply to shuttle services, except that the schedule and stops can be posted.
  • Cost shifting (as outlined above) also apply to shuttles.

You can read up on all the requirements in greater detail in this awesome blog post or the original OIG Final Rule. As your organization creates your transportation program, we encourage you to take all questions and concerns around Safe Harbor and Anti-Kickback Statutes to your legal counsel.