On Tuesday, the NYS Department of Health (DOH) issued guidance to non-emergency medical transportation (NEMT) providers and their front-line workers on how to best operate during the COVID-19 crisis.
As part of the guidance, the DOH first addresses the driver safety. NEMT workers are strongly advised to practice social distancing by maintaining a separation of at least six feet from other individuals; to wash hands as frequently as possible, to avoid touching their mouth, nose, and eyes; and to place the vehicle ventilation fans on high to maximize the intake of outside air and to minimize the recirculation of inside air. In vehicles that are so equipped, the driver and passenger compartments should be isolated and dividers closed. Additional precautions that should be taken during transport are listed here.
According to the guidance, NEMT providers may allow employees exposed or possibly exposed to COVID-19 to work under certain conditions. Some of these conditions include:
- The employee is asymptomatic.
- The employee undergoes temperature monitoring and symptom checks at the beginning of each work shift and at least every 12 hours after.
- If they become symptomatic, the employee immediately stops working and isolates at home.
Moreover, testing for front-line workers may be authorized by a health care provider when, among other things, an individual has come within close contact of another individual known to be positive, an individual who is symptomatic and has not tested positive for any other infection, or an individual who is quarantined and has shown symptoms of COVID-19.
Significantly, the DOH has also advised that, to ensure Medicaid consumers are transported to medical appointments during the crisis, transportation managers shall prohibit “multi-loading vehicles,” including group rides. Multi-loading is only approved in situations where no single loading alternative exists and must be specifically approved by a manager. Exceptions to no group rides can be made for minors, individuals with special needs, and those requiring personal assistance.
Another exception exists for two or more people residing in the same household who are attending the same medical treatment service. This directive creates what is essentially individualized ambulette service for Medicaid patients, while using Medicaid dollars that were budgeted based upon the economics of group transportation. This unfunded mandate is putting additional financial stress on the industry that already lacks sufficient funds and resources to supply required PPE. Requests for financial relief to support this directive have been made but not yet answered even as providers buckle under the twin strain of increased demands for transporting COVID-19 patients and driver attrition due to illness and high-risk conditions.
In addition to COVID-19 social distancing and self-care protocols, the DOH advises transportation providers who transport individuals who have tested positive to isolate the passenger if the vehicle is so equipped. After transporting the patient, the provider should leave the doors of vehicle open or the windows down to allow time for sufficient air exchanges to remove potentially infectious particles, and, when cleaning the vehicle, employees are directed to wear a disposable gown and gloves. Additionally, any visibly soiled surface must first be cleaned then decontaminated using an Environmental Protection Agency-registered hospital disinfectant.
As the pandemic continues, it is best practice for transportation providers to keep their staff informed about COVID-19, including its signs and symptoms, so employees can best identify if there is a possibility of exposure. Occupational Safety and Health Administration guidelines must also be consulted and followed. Transportation providers are also well advised to keep apprised of any new guidance issued by the DOH during this unprecedented time.
If you have any questions regarding the content of this alert, please contact Linda Clark, Health Care Controversies Team leader, at lclark@barclaydamon.com; Margaret Surowka, counsel, at msurowka@barclaydamon.com; Mary Connolly, associate, at mconnolly@barclaydamon.com or another member of the firm’s Health Care Controversies Team.
We also have a specific team of Barclay Damon attorneys who are actively working on assessing regulatory, legislative, and other governmental updates related to COVID-19 and who are prepared to assist clients. You can reach our COVID-19 Response Team at COVID-19ResponseTeam@barclaydamon.com.