COVID-19 Guidance for Medicaid Providers

Response to Frequently Asked Questions (FAQs) from Non– Emergency Medical Transportation (NEMT) Providers

• Guidance is also available in Portable Document Format (PDF)

Current, as of April 7, 2020

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The New York State Department of Health (NYSDOH) is providing this FAQ guidance to non – emergency medical transportation (NEMT) providers pertaining to the current novel coronavirus (COVID–19) public health emergency.

Background

The health and safety of the State´s health care providers, and our ability to provide and support patient care, remain our top priorities. Community–wide transmission of COVID–19, and the number of both Persons Under Investigation (PUIs) and confirmed cases, is increasing in NYS. The situation with COVID–19 infections identified in the US continues to evolve rapidly. It is important for all agencies and providers to keep apprised of current guidance by regularly checking NYSDOH´s Novel Coronavirus website.

It is important to keep staff updated as the situation changes, and inform them about the disease, its signs and symptoms, and necessary infection control measures necessary to protect themselves and the people they serve. It is therefore vital that providers maintain up –to– date contact with NYSDOH. Providers should also consider providing an internal contact telephone number for their staff and clients to call with concerns, reports, or questions.

NEMT FAQs:

1. Has NYSDOH issued guidance regarding safety of front–line workers (e.g. NEMT transportation drivers)?
   
   Yes, the following is from safety guidance provided:
   • To the degree practicable, all NEMT workers should practice social distancing protocol, maintaining a separation of at least six (6) feet from other persons.
   • All workers should wash their hands, as often as possible, for 20 seconds using soap and water, or an alcohol–based sanitizer consisting of at least 60% alcohol, if soap and water is not readily available.
   • All workers should avoid touching their mouth, nose, or eyes.
   • If the vehicle is so equipped, the driver and passenger compartments should be isolated. Close any dividers between the driver and passenger compartments.
   • The vehicle ventilation fan(s) should be placed on high, in non–recirculating mode, to maximize the intake of outside air, and to minimize the recirculation of inside air.
   • Other than for minors, special needs patients, or others requiring personal assistance, no family members or other passengers should be permitted in the vehicle.
2. How is testing handled for front–line workers?
   
   Testing for COVID–19 may be authorized by a health care provider when:
   • An individual has come within close contact (e.g. same classroom, office, or gathering) of another person known to be positive; or
   • An individual has traveled to a country that the CDC has issued a Level 2 or Level 3 Travel Health Notice, and shows symptoms of illness; or
   • An individual is quarantined (mandatory or precautionary) and has shown symptoms of COVID–19 illness; or
   • An individual is symptomatic (e.g. fever, cough, troubled breathing) and has not tested positive for any other infection; or
   • Other cases where the facts and circumstances warrant, as determined by the treating clinician, in consultation with state or local department of health officials.
   For additional information on testing, visit here.
3. Has NYSDOH issued guidance for transportation drivers who test positive for COVID– 19?
   
   Yes, the NYS Bureau of Emergency Medical Services & Trauma Systems (BEMS) issued the following guidance on March 20, 2020:
   • NEMT providers may allow employees exposed to, or possibly exposed to, COVID–19 to work under the following conditions:
     • They are asymptomatic (i.e. have no fever, sore throat, cough, or other symptoms associated with COVID–19);
     • They undergo temperature monitoring and symptom checks at the beginning of each work shift, and at least every 12 hours thereafter;
     • They wear a facemask while working, donned before entering the workplace, until 14 days after the date of the last high–risk exposure;
     • If they become symptomatic, they immediately stop work and isolate at home; AND
     • If they develop symptoms consistent with COVID–19, they be treated as if they have COVID–19 infection, regardless of the availability of test results.
   For additional information, visit here.
4. Has NYSDOH issued guidance on the how many individuals can be transported in a vehicle?
   
   Yes, to ensure that Medicaid consumers are transported to medical appointments during the state disaster emergency, transportation managers shall:
   • Prohibit multi–loading vehicles, including group rides. Multi–loading shall only be approved in situations where no single loading alternative exists, and must be specifically approved by the manager/broker.
   • Exceptions must be made for minors, persons with special needs, and those requiring personal assistance.
   • Exceptions may be made for two or more persons, residing in the same household, who are attending the same medical treatment service.
   For additional information, visit here
5. Has NYSDOH issued guidance on how transportation providers should transport individuals who have tested positive for COVID–19?
   
   Yes, the following standards should be adhered to:
   • The patient´s usual mode of transportation should be used to the extent possible.
   • NEMT providers should be trained in infection control practices and utilize appropriate personal protective equipment (PPE). See OSHA Standards 1910.1030 and 1910.134 for additional information
     • https://www.osha.gov/laws–regs/regulations/standardnumber/1910/1910.1030
     • https://www.osha.gov/laws–regs/regulations/standardnumber/1910/1910.134
   • To the degree practicable, all NEMT workers should practice social distancing protocol, maintaining a separation of at least six (6) feet from other persons.
   • All workers should wash their hands, as often as possible, for 20 seconds using soap and water, or an alcohol–based sanitizer consisting of at least 60% alcohol, if soap and water is not readily available.
   • All workers should avoid touching their mouth, nose, or eyes.
   • If the vehicle is so equipped, the driver and passenger compartments should be isolated. Close any dividers between the driver and passenger compartments.
   • The vehicle ventilation fan(s) should be placed on high, in non–recirculating mode, to maximize the intake of outside air, and to minimize the recirculation of inside air.
   • Other than for minors, special needs patients, or others requiring personal assistance, no other passengers should be permitted in the vehicle.
   • After transporting the patient, leave the doors of the vehicle open or the windows down, to allow time for sufficient air exchanges to remove potentially infectious particles. Consideration must be given to ensuring vehicle and equipment security , if staff is not able to stay with the vehicle.
   • When cleaning the vehicle, employees should wear a disposable gown and gloves. A face shield or facemask and goggles should also be worn if splashes or sprays during cleaning are anticipated.
   • Any visibly soiled surface must first be cleaned, then decontaminated, using an Environmental Protection Agency (EPA)–registered hospital disinfectant according to directions on the label.
   For additional information, visit here.
6. Are there requirements for New York City hospitals to bring patients outside to meet at a hospital entrance because drivers cannot go into hospitals, or onto the floors of a hospital, to get patients?
   
   There is no requirement that hospitals in New York City, nor any other hospitals statewide, bring patients outside to meet NEMT providers. Individual hospitals may choose to adopt specific measures to reduce exposure risks. NEMT providers should check with the hospitals that they serve for the most current information.
7. What guidance has been given to New York City medical facilities (e.g. dialysis, nursing homes) regarding transporting patients who are symptomatic or have tested positive for COVID–19? Should they be transported by an ambulance?
   
   Ambulance transportation should only be used for those patients who are experiencing an acute medical emergency, and those who would otherwise require transportation by ambulan ce for specific medical reasons. All other patients should be transported through NEMT following directed protocols.
8. Has NYSDOH issued guidance to dialysis facilities to restrict family members and health aides from traveling with the patient during the state of emergency?
   
   Yes, other than for minors, special needs patients, or others requiring personal assistance, no family members or other passengers should be permitted in the vehicle. Under no circumstance should any accompanying person who is exhibiting signs and symptoms of COVID–19 ride in the vehicle.
   
   General questions or comments about this advisory can be sent to emsinfo@health.ny.gov.