Tag Archives: patient

Travel Assistance, Patient Financial Responsibility, and Good Intentions

Last week was the annual Moments of Change conference at The Breakers Hotel in Palm Beach. A beautiful venue for a long-running gathering of providers, clinicians, and industry representatives.

The question which I heard most repeatedly asked on the exhibit floor or in breakout sessions pertained to how to assist patients (I don’t call them “clients”) and their families with the exorbitant out of pocket costs of obtaining quality treatment, such as the cost of travel. In many providers’ minds, financial barriers like this should not prevent a patient from obtaining what is essentially life-saving treatment in a community known for its robust treatment community.

As a result of these financial hardships, providers have tried to find a way to facilitate travel from the patient’s location to their programs. This concept of “travel assistance” is quite controversial in the addiction treatment space because, no matter the intention of the provider, if that offer of “travel assistance” was the reason (inducement) for the patient to choose “x” treatment center, then it is very likely that law enforcement will view such assistance as a violation of the Patient Brokering Act.

In our 10 years working specifically with treatment providers, we have been repeatedly presented with this scenario and asked what is lawful. On our end, we have spent countless hours grappling with the need to develop policies and procedures to clarify, identify, and address compliance concerns regarding financial assistance for patients who have a bona fide financial hardship. Our conclusion to date has remained the same: while the law does not explicitly state that payment of airfare is a de facto inducement or violative of the plain language of the laws against patient brokering, and while we have heard and understand the reasoning provided and the procedure used by providers has been limited to very narrow and strict circumstances, the risk to the provider of arrest is simply too great. In other words, you will have to explain it to the jury, while in the meantime, your business reputation has been soiled in the press. If a provider is not going to 100% scholarship a patient, then any other extension of good-faith credit to a patient may be viewed as illegal by regulators and law enforcement.

Fair? Maybe not. Reality? Absolutely yes.

Stated otherwise, even if at no time was it ever a provider’s intention to sway (induce) the decision-making process of any patient to receive treatment services using travel assistance, and even if such travel arrangements were facilitated solely to provide those specific patients identified as having a bona fide financial hardship with reasonable access to critical addiction treatment services, in today’s environment, law enforcement is going to assume a criminal intent is at play based upon the dozens and dozens of arrests (and reviews of business records) that have been made.  It’s simply the “zero tolerance policy” world that we live in today, based upon the atrocities we have seen by the few who care less about patients and only care about profit.

In summary, while extending credit to a patient or their family who has been legitimately verified as not having the ability to pay may not violate the plain language of Florida’s Patient Brokering Act or the federal Eliminating Kickbacks in Recovery Act, the practice remains highly suspect based upon frequent past abuses uncovered by law enforcement. Therefore, a program that engages in such practices continues to expose itself to great liability of criminal penalties, fines, and damage to reputation.

We understand that many providers have as their overwhelmingly singular goal to provide access to those seeking help, recognizing that some are facing dire financial circumstances and may not at that time have the additional financial resources to travel to their chosen treatment provider. Notwithstanding these good intentions, extending credit to patients to facilitate travel costs, even with legitimate and good faith efforts to determine bona fide financial hardship and robust efforts to collect, is considered suspect and potentially violative of the law.  Accordingly, we continue to be unable to support any practice of providing travel assistance to patients in need.  Sad, but true.

We will continue to advocate for any best practice that connects patients with addiction health care providers, recognizing that the overarching policies behind the state and federal health care laws are often in conflict with present-day realities. Even the Centers for Medicare and Medicaid Services (CMS) has recognized this reality and has been vigorously exploring ways to revamp and rewrite these laws to meet 21st century health care delivery. See https://www.fiercehealthcare.com/payer/cms-impending-overhaul-stark-law-can-only-go-so-far-experts-say

But until then, the conservative course must be the one to follow, if addiction medicine is going to ever receive the due recognition it deserves as an integral part of our national health care model.


Prompt Pay Laws

Many have been calling in recent days regarding insurance carriers refusing to pay for claims for treatment, essentially saying “sue us for your money.” Aside from potentially discriminatory undertones, this is patently illegal.

The State of Florida has what are known as “Prompt Pay” laws which require an insurance carrier to do just that. While I won¹t get into the details here, I thought I would share this article with you to illustrate that ³you are not alone² when it comes to this headache.

Read more about them with Law360’s article:
Hospitals Can Sue Under Prompt Pay Law: NY Appeals Court

Letter from DCF RE: Patient Brokering

Many of you have called me regarding letters you may have received from DCF regarding Patient Brokering. Please be aware that the letter has been sent to all providers and not to anyone specifically accused of any wrongdoing.

That said, you should remain vigilant that you are closely monitoring any activity by your staff that could be construed to violate s. 817.505, Fla. Stat., the Patient Brokering Act. I have attached a copy for your records.

For purposes of the Act, the repeat question I receive is regarding how to effectively and legally use marketing companies to obtain referrals for new patients. The provision in the statute which addresses that point can be found within subsection (i) which allows for:

Payments by a health care provider or health care facility to a health, mental health, or substance abuse information service that provides information upon request and without charge to consumers about providers of health care goods or services to enable consumers to select appropriate providers or facilities, provided that such information service:

1. Does not attempt through its standard questions for solicitation of consumer criteria or through any other means to steer or lead a consumer to select or consider selection of a particular health care provider or health care facility;

2. Does not provide or represent itself as providing diagnostic or counseling services or assessments of illness or injury and does not make any promises of cure or guarantees of treatment;

3. Does not provide or arrange for transportation of a consumer to or from the location of a health care provider or health care facility; and

4. Charges and collects fees from a health care provider or health care facility participating in its services that are set in advance, are consistent with the fair market value for those information services, and are not based on the potential value of a patient or patients to a health care provider or health care facility or of the goods or services provided by the health care provider or health care facility.

Should you have any questions or concerns about your compliance with this provision, please don’t hesitate to give us a call.

CMS publishes final rule on direct patient access to test results

By The Pathology Blawg
The Centers for Medicare and Medicaid Services (CMS) yesterday published its final amendments to HIPAA and CLIA that will allow patients to have direct access to test results.

I talked about this back in October 2013 when HHS announced the patient access to test results final rule would be released soon.

In the broadest terms, the new rules change CLIA’s definition of “authorized person”. Until this rule, an “authorized person” was “the individual authorized under state law to order or receive test results, or both.” In many states, that meant only the physician, or other test-ordering health care provider, and not the patient.

Read the full article here