OIG Advisory Opinion 08-23: County Can Pay Residents' Cost-Sharing Amounts for EMS Transport

On December 19, 2008, the OIG issued Advisory Opinion 08-23. This opinion was requested by a county which provides EMS transportation through its Fire Department. The county seeks to pay cost sharing amounts for its residents through the use of tax revenue. In other words, it would accept any insurance or Medicare payments as payment in full for EMS transportation to hospitals.
In issuing this favorable opinion, the OIG first noted the overarching concern of waiver of co-payments. Then the OIG noted that Section 50.3.1 of Chapter 16 of the CMS Benefit Policy Manual does allow a government facility to limit residents' charges to insurance or Medicare payments. The OIG thus noted that the arrangement would be permissible to the extent that it was only applicable to bona fide residents.
The OIG went on to note that the exception in the Medicare Benefit Policy Manual does not apply to private ambulance providers who transport a county's patients. In other words, a county cannot require a private ambulance provider to waive out of pocket cost sharing as a condition for getting its business.
However, the OIG further noted that the county could reimburse the private company for the cost-sharing amounts, including lump sum or periodic payments, if the payments are reasonably calculated to cover the unexpected uncollected cost-sharing amounts.
To read the full opinion, please click here.