EMS Law COVID-19 Corona Update Webpage

     

EMS Law COVID-19
Corona Update

Click Here for COVID-19 EMS Resources

NOTE: INFORMATION ON THIS PAGE IS CURRENT AS OF THE DATE POSTED OR REVISED.  PLEASE CONSULT THE  DATE LISTED BECAUSE INFORMATION MAY HAVE CHANGED SINCE THAT DATE.    

We’re Providing Answers to Your Questions During this Crisis

We are receiving many questions on the legal issues related to COVID-19 and PWW will be providing regular updates as these questions come in and we develop a response.   

Please note that our answers to these questions are for general information purposes only and should not be relied on as legal advice or a definitive statement of the law. We are not a government authority.  

Contact Us with Your Specific Issues and Questions

PWW remains in full operational mode.  Please contact any of our professional staff via email or by phone at any time. You may also contact us by sending your question to: info@pwwemslaw.com.  



COVID-19 EMS Legal Questions and Answers (Questions Hyperlinked)


Medicare

1. Our ambulance service is due to revalidate with Medicare. Will my due date be extended?
Date added: 3/24/2020

2. Have Medicare’s patient signature rules been relaxed during the COVID-19 crisis?
Revised Date: 4/13/20

3. Does transport of an individual with isolation precautions due to confirmed (or suspected) COVID-19 meet the Medicare medical necessity requirement?
Date added: 3/30/2020

 

4. Will ambulances services be reimbursed for non-transport services provided to patients?
Date added: 3/30/2020

 

5. Do the new telemedicine options require special documentation practices for EMS?
Date added: 3/30/2020

 

6. What is the Accelerated and Advance Medicare payment program for COVID-19 and how does an agency qualify? If an agency receives accelerated and advance payment, how long will the agency have to repay the amount received?
Date added: 3/31/2020

 

7. What types of audit activities constitute "active medical review or program integrity investigation" that would preclude participation in the accelerated and advance program?
Date added: 3/31/2020

 

8. Will CMS reimburse ambulance services for transports to alternative destinations during the COVID-19 pandemic?
Revised Date: 4/9/20

9. Is CMS pausing the Scheduled, Non-Emergency Ambulance Transport Prior Authorization Model during the COVID-19 pandemic?
Revised Date: 04/7/20

10. Can ambulance services be reimbursed by Medicare for telehealth services?  Can we bill practitioners for telehealth services that we help them provide to our patients?
Date added: 4/1/2020

 

11. Will CMS pay for treat-no-transport if medical command directs a patient with COVID-19 to stay home and self-quarantine?
Date added: 3/31/2020

 

12. What telehealth waivers are currently in place for the COVID-19 Public Health Emergency?
Date added: 4/1/2020

13. When should I use the “CR” modifier on an ambulance claim?
Revised Date: 05/7/20

14. We were asked to conduct in-home follow-up medical checks on patients who tested positive for COVID-19 but did not require hospital care. Can we charge for these wellness checks?
Date added: 4/9/2020 

15. What are relief payments under the CARES Act? How much money will my agency receive? What are the conditions associated with the payments? (See CARES Act FAQ # 1 below)
Date added: 4/10/2020

16I’ve heard about the CARES Act stimulus money payment, but our organization has not received anything. How can we find out more information about our payment amount and when it might be coming to us? (See CARES Act FAQ # 2 below)
Date added: 4/15/2020

17. As a condition of the CARES Act stimulus payment, we understand we are not allowed to “balance bill” the patient. How are we supposed to know what we can and cannot bill? (See CARES Act FAQ # 3 below)
Date added: 4/15/2020

18. We believe that lost revenue and other costs/expenses will be much less than our stimulus payment and we fear the quarterly reports will show this disparity and subject us to scrutiny. We are thinking about not accepting the money, but what are the advantages of keeping the stimulus payment? (See CARES Act FAQ # 4 below)
Date added: 4/18/2020 

19. We have been told that insurance companies are waiving cost-sharing and deductible amounts for patients. Does this only apply to COVID-19 related conditions?
Date added: 4/18/2020

20. One of our nursing homes is planning ahead in case there is a need for transferring residents out of the SNF to create a COVID-19 facility and a non-COVID-19 facility. If we transport a patient from one SNF to another would this be billable to Medicare?
Date added: 4/18/2020 

21. Has CMS waived the requirement to obtain Physician Certification Statements (“PCS”) or Non-Physician Certification Statements (also known as Medical Necessity Certification Statement for Non-Emergency Ambulance Services) for nonemergency transports?
Revised Date: 4/29/20

22. Providers are refusing to sign our PCS forms due to risk of COVID exposure with paper. What are our options? 
Date added: 4/29/20

23. When should I use the “CS” modifier on an ambulance claim?
Date added: 05/12/20 

24. When transporting a patient in Novitas or FCSO jurisdictions, do I still need to use the secondary Z Codes, or do the COVID-19 specific codes replace the need for such codes?
Date added: 05/12/20 

25. Do Medicare Advantage plans follow CMS guidelines on Physician offices being a covered destination?
Date added: 05/15/20 

26. Regarding a Physician’s office as a covered destination, does the treatment have to be COVID-19 related?
Date added: 05/15/20 

CARES Act

1. What are relief payments under the CARES Act? How much money will my agency receive? What are the conditions associated with the payments? 
Date added: 4/10/2020

2. I’ve heard about the CARES Act stimulus money payment, but our organization has not received anything. How can we find out more information about our payment amount and when it might be coming to us? 
Date added: 4/15/2020

3. As a condition of the CARES Act stimulus payment, we understand we are not allowed to “balance bill” the patient. How are we supposed to know what we can and cannot bill? 
Date added: 4/15/2020

4. We believe that lost revenue and other costs/expenses will be much less than our stimulus payment and we fear the quarterly reports will show this disparity and subject us to scrutiny. We are thinking about not accepting the money, but what are the advantages of keeping the stimulus payment?
Date added: 4/18/2020 

5. Does the Payroll Protection Program under the new CARES Act include municipal or governmental EMS or ambulance services? Who exactly is eligible?
Date added: 4/9/2020 

6. Is there a CFDA number associated with these funds?
Date added: 4/29/2020 

7. Regarding the CARES Act Round 2 funding, can a municipality or local government apply for this since they do not have a tax return? They do have a Comprehensive Annual Financial Report (CAFR). Are they able to submit the CAFR in lieu of the tax return or 990 form?
Date added: 4/29/2020 

8. What is the difference between the Terms and Conditions from HHS Stimulus Round 1 and those for Round 2? 
Date added: 4/29/2020 

9. For this new CARES Act stimulus, is it required to run 2018 reports by calendar year? We have provided Fiscal Year reports to most of the larger clients we work with which would equate to July 1st thru June 30th. Can they use these reports instead of rerunning by calendar year?
Date added: 4/29/2020 

10. If for some reason we apply for the second round of funding, if we do not use the funds are we able to return them? As of now, I think our first check will cover us, but I do not want to miss out either. I also need a way out if we do not need those extra funds.
Date added: 4/29/2020 

11. Based on the estimated calculation (i.e. $62,000 for each $1 million of Medicare revenue) of money we should have received in Round 1, it looks like we received more than what we were supposed to receive. Do we need to return excess money?
Date added: 5/1/2020 

12. Based on the estimated calculation (i.e. $62,000 for each $1 million of Medicare revenue) of money we should have received in Round 1, it looks like we received more than what we were supposed to receive. Do we need to return excess money?
Date added: 5/1/2020 

13. In the Round 2 application, we had to provide revenue loss for March and April 2020. The HHS calculation does not appear to factor that into the equation. What gives?
Date added: 5/1/2020

14. I thought I understood that we could file ambulance claims for uninsured patients that were suspected COVID-19 but reading the terms and conditions page it says only the positive COVID-19 claims are covered. Which is correct? 
Date added: 05/12/20  

HIPAA

1. Can facilities and other healthcare providers share the COVID-19 status of patients with EMS and other first responders?
Date added: 3/27/2020


2. How can staff members work remotely and still be secure under HIPAA when dealing with health information?
Date added: 3/27/2020


3. How can we share COVID-19 information about patients within our agency?
Date added: 3/27/2020


4. How can we share COVID-19 information about patients with other first responders and health care providers?
Date added: 3/27/2020


5. What about dispatch communications?  What can we share, and can we flag addresses with suspected COVID-19?
Date added: 3/27/2020


6. What if we think someone is in danger because they may have been exposed?  Can we share COVID-19 information about a patient with that person?
Date added: 3/27/2020


7.  Who can – and should -  we report COVID-19 information to?  Can we report to our health department or EMS regional council?
Date added: 3/27/2020

 

8. What are your recommendations if we have billers that need to work from home that specifically need to handle physical paperwork (run logs, PCS's, face sheets)? Can we deliver paperwork to them at their homes or have them pick up/drop off paperwork? How do we stay HIPAA compliant with physical paperwork at biller's homes?
Date added: 3/30/2020

 

9. What information regarding COVID-19 calls can be shared with county executive and other county officials?
Date added: 3/31/2020

 

10. Does an employer have the right to be notified if one of their employees test positive for COVID-19?
Date added: 3/31/2020

11. Can our EMS agency notify other first responders – such as fire and PD about the COVID-19 status of a patient AFTER a transport if we know that status?  
Date added: 3/31/2020

Workplace Staffing, Safety & Screening

1. Are hospitals required to let EMS personnel know if they had come into contact or possibly been exposed by a patient that was later diagnosed with COVID-19?
Date added: 3/30/2020

 

2. Does an EMS provider exposed to COVID-19 have to self-quarantine? 
Date added: 3/30/2020

 

3. Can an EMS agency require employees to shave? 
Date added: 3/30/2020

 

4. Can an EMS agency refuse to respond to a call because the patient is suspected of having COVID-19?
Date added: 3/30/2020

 

5. Are ambulance services considered essential businesses? Are billing services?
Date added: 3/30/2020

 

6. Is it acceptable for a first response agency to delay arriving on scene until dispatch has completed EMD to determine if the patient has COVID-19 like symptoms?
Date added: 3/30/2020

 

7. We take temperatures of employees per guidelines, if a provider has a fever, we won't allow them to work. Can we make them use sick time or do we put them on administrative time not charged to their leave?
Date added: 3/30/2020

 

8. Our EMS personnel are requesting to wear their body armor, as well as lawful firearms, while serving through this National Emergency. Should we relax our protocols to make these reasonable accommodations?
Date added? 3/30/2020

 

9. In North Carolina, our County Emergency Management has mandated that first responder agencies stage on all calls waiting for EMS to arrive on scene. Some first responder agencies would arrive 20 to 30 minutes before the ambulance. Could this present a legal issue?
Date added: 3/30/2020

 

10. OSHA requires fit testing on each type of mask that may be used by an EMS provider, has this requirement been waived?
Date added: 3/30/2020

 

11. Let's say we face staffing shortages due to quarantined employees and must perform transports with fewer licensed personnel. For example, let's say we have a non-licensed first responder as the driver and our state typically law requires 2 licensed personnel on every ambulance. Can we still bill Medicare in that situation?
Revised Date: 04/7/20

12. What proof or evidence must EMS personnel have (especially EMTs and Medics) to prove they are "essential" personnel or otherwise employed by a "life-sustaining business" when local or state government has issued a "stay in place or stay at home order"? 
Date added: 3/31/2020

13. Does the Ryan White Act apply to COVID-19?
Date added: 3/30/2020

 

14. Can an employee refuse to work due to concerns over COVID-19?
Date added: 3/30/2020

 

15. Can an assisted living facility, or other health care facility, require EMS providers to fill out a questionnaire before allowing entry to their facility?
Date added: 3/30/2020

 

16. What defines an exposure to COVID-19, and can an employee continue work after being exposed?
Date added: 3/31/2020

Workers' Compensation

1. Are volunteer EMS personnel covered under state workers' compensation laws?
Date added: 3/30/2020

 

2. What is a full-time employer's workers' compensation obligation in the event an employee contract COVID-19, but works part-time as an EMS provider elsewhere? 
Date added: 3/30/2020

 

3. Can an employee receive workers' compensation benefits in addition to Emergency Paid Sick Leave benefits if they test positive for COVID-19?
Date added: 3/30/2020

 

4. If an employee refuses to use Personal Protective Equipment ("PPE"), and contracts COVID-19, would it be covered by workers' compensation?
Date added: 3/30/2020

Employee Leave

1. Does the Emergency Paid Family and Medical Leave Act or emergency paid sick leave cover an employee afraid to work for fear of bringing the disease home?
Date added: 3/30/2020

 

2. Would an employee be eligible for FMLA over "anxiety" related to contracting COVID-19?
Date added: 3/30/2020

 

3. Can an employer elect to exclude employees from paid sick leave under the Families First Coronavirus Response Act ("FFCRA")?
Date added: 3/30/2020

 

4. Are local governments included in the Families First Coronavirus Response act ("FFCRA")?
Date added: 3/31/2020

 

5. Are organizations with less than 50 employees subjected to the emergency paid sick or family leave requirements of the Families First Coronavirus Response Act ("FFCRA")?
Date added: 3/31/2020

6. Which EMS employees are considered “emergency responders” and potentially subject to being excluded from the group of employees eligible for Emergency Paid Family and Medical Leave and Emergency Paid Sick Leave under the Families First Coronavirus Response Act?
Date added: 4/1/2020

7. An employee’s spouse was told by their employer that they may have been exposed by a co-worker to COVID-19. The spouse and our employee have had close personal contact since the spouse was told they might have been exposed to COVID-19. Should we have our employee self-quarantine? If we do have them self-quarantine, do we can we pay them using their sick and vacation pay? 
Date added: 4/8/2020 

8. We have an employee that is in isolation due to her full-time job and being exposed to COVID-19. Do we have to pay her for her missed shift here? 
Date added: 5/15/2020 

Patient Care

1. Can an EMS provider refuse to transport a patient if that patient is suspected of having COVID-19 and refuses to wear a mask?
Date added: 3/30/2020

EMS Operations

1. Can hospital emergency departments go on diversion or refuse to accept patients?
Date added: 3/31/2020

Employee Wage & Benefits 

1. Has the full-time employee hour requirement of the Affordable Care Act ("ACA") been waived?
Date added: 3/30/2020

 

2. If an employer is requiring employees to work from home, is the employer obligated to provide any additional equipment to the employees? Can an employer make employees use their personal cell phone to conduct official business?
Date added: 3/30/2020

 

3. Are EMS providers entitled to hazard pay?
Date added: 3/30/2020

 

4. Is there a limit to the number of hours or days a first responder, in any capacity, can be required to work during the COVID-19 Public Health Emergency?
Date added: 3/31/2020

 

5. Must employers pay employees if employees are required to stay after the end of their scheduled shift to clean equipment, shower, or complete PCRs and other paperwork?
Date added: 3/31/2020

6. Does the Payroll Protection Program under the new CARES Act include municipal or governmental EMS or ambulance services? Who exactly is eligible? (See CARES Act FAQ # 5 above)
Date added: 4/9/2020 

Webinar Q&As

1. COVID Coding: What Ambulance Revenue Cycle Professionals Need to Know Webinar 4/20/2020 Q&A
Date added: 4/23/20
 


COVID-19 EMS Resources

PDF iconPWW Secure Remote Working SAMPLE Policy
PDF iconPWW Statement on Sharing COVID-19 Information and HIPAA
PDF iconOCR Guidance on COVID-19 Patient Information With First Responders
PDF iconFull Q&A from WEBINAR: Navigating the COVID-19 Issues Affecting the EMS Workplace
PDF iconMedicare Telehealth FAQs
PDF iconOCR BULLETIN: HIPAA Privacy and Novel Coronavirus
PDF iconOCR Notification of Enforcement Discretion for Telehealth
PDF iconCMS Coverage and Payment Related to COVID-19 Medicare – Including Emergency Ambulance
PDF iconCMS COVID-19 Emergency Declaration Health Care Providers Fact Sheet - Including Enrollment Waivers
PDF iconDOL: Families First Coronavirus Response Act: Questions and Answers
PDF iconCMS FACT SHEET ACCELERATED and ADVANCE PAYMENT for COVID -19 EMERGENCY
PDF iconCDC COVID-19 Guidance for Emergency Medical Services
PDF iconCDC COVID-19 Official ICD10 Coding Guidance COVID 19 - Updated 3.18.20

ON-DEMAND WEBINAR: Navigating the COVID-19 Issues Affecting the EMS Workplace

EMS1 Article:  Finally! Feds tell hospitals they may share information about COVID-19 patients with first responders

EMS1 PWW Article: Temporary CMS Changes Provide Needed Flexibility

PDF icon CDC ICD-10-CM Official Coding and Reporting Guidelines April 1, - September 30, 2020
JEMS EMS Lawline Article:  Make Time for Family

EMS World Article: Will Telehealth Redefine Whether Ambulance Services Are Reasonable?

PDF iconPWW Signature Guidance for EMS Billing Personnel
PDF iconPWW Signature Guidance for EMS Practitioners
EMS1 Article: A hidden gem in the CARES Act that benefits ambulance services
FilePWW Model Ambulance Signature Form COVID-19 Version 2.2-CV (Word)
PDF iconPWW Model Ambulance Signature Form COVID-19 Version 2.2-CV (PDF)
CARES Act Relief Fund Terms and Conditions
EMS1 Article: You’ve seen the CARES Act stimulus payment, but did you see the strings?
PDF icon PCS Form Compliance During the COVID-19 Public Health Emergency

EMS World Article: It’s Time for the CARES Act Round 2 Stimulus Payments—Could You Be Left Out?

PDF iconCMS Ambulance Specific FAQs as of 05/01/2020
HRSA COVID-19 Uninsured Program FAQ
JEMS EMS Lawline Article: The Hidden Pandemic

IMPORTANT: By clicking any of these links and/or downloading any of these documents, you agree to the Terms of Use spelled out below. 

COVID-19 RESOURCES: Any individual or entity who downloads or uses these documents or any modified version of any of these documents in any way is referred to as the "User." Some of the documents are sample forms and policies only, designed by Page, Wolfberg & Wirth, LLC (PWW).  PWW created documents are not legal advice, and no attorney-client relationship is formed by their use. User bears all responsibility for compliance with all applicable laws and regulations, and the User agrees that neither PWW nor the individual designers of PWW created documents are responsible for their use, non-use or modification by any User.  PWW created documents are licensed only for use by individual ambulance services, and may not be sold or distributed by any other individual or entity. Any other use or distribution of PWW created documents requires our express written permission. Please also note that we cannot be responsible to distribute new or updated documents to users. In addition, we do not guarantee that any of these documents will be updated to reflect new laws, regulations or other applicable authority. PWW created documents are Copyrighted by PWW and any use, reproduction or distribution that is not in accordance with these Terms of Use is strictly prohibited unless permitted in writing by PWW. PWW makes no copyright claim to any official government works.