By: Elizabeth Hogue, Attorney
The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) posted Advisory Opinion No. 10-03 on March 6, 2019, which permits hospitals to provide free, in-home follow up care to discharged patients. The hospital that requested the Advisory Opinion developed a program to provide free, in-home follow-up care to patients with congestive heart failure and chronic obstructive pulmonary disease who are at higher risk for admission or readmission to a hospital.
In order to be eligible for the program, patients must meet the following requirements:
Eligible patients receive two visits in their homes from community paramedics each week for approximately thirty days following enrollment. The paramedics are employed by the hospital. The hospital will not bill any federal health care program for costs associated with the program.
During home visits, paramedics provide the following services:
The OIG analyzed this program and concluded that the free services are illegal remuneration or kickbacks under the federal anti-kickback statute. The OIG also concluded that there is no exception or "safe harbor" that permits hospitals to provide these services even though they are impermissible.
Nonetheless, the OIG said that it would not take enforcement action against the hospital for the following reasons:
The Advisory Opinion raises a number of significant questions for home care providers. Perhaps most importantly, the Advisory Opinion seems to completely ignore questions about state licensure and scope of practice. Does the use of community paramedics to provide services in patients' homes amount to the provision of home care services without a license in those states in which licensure is required? This hurdle may, of course, be overcome if hospitals contract with home health agencies to provide these services instead of hiring paramedics.
Another key question is whether patients in the program are eligible to receive home health or hospice services, but do not receive them because they enroll in this program. What if patients are already receiving home health, hospice and/or private duty services in their homes? The eligibility requirements don't exclude patients who already receive these types of services. Will community paramedics provided by hospitals and home care staff be required to coordinate the care they provide to patients? If so, how will it be accomplished?
The Advisory Opinion seems to be another example of new interest in providing services in patients' homes without understanding the home care industry. It's great to be more valued, but a lack of knowledge remains!
©2019 Elizabeth E. Hogue, Esq. All rights reserved.
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For more information about Emergency Triage, Treat, and Transport (ET3) Model, see FutureFocus February 20, 2019: Chronic Care and ED Visits New Solutions Being Tested