As Ebola has become a worldwide threat, the U.S. Government has provided guidance to prepare numerous agencies and entities that may become involved or affected by Ebola. On November 7, 2013, the Office of Personnel Management (OPM) issued guidance to Federal Employee Health Benefit Program (FEHBP) carriers on their responsibilities for handling members who have been exposed to or infected with the Ebola virus. FEHB Program Carrier Letter No. 2014-26 is available at http://www.opm.gov/healthcare-insurance/healthcare/carriers.
OPM instructs carriers that special consideration may need to be provided to ensure proper support to any exposed or infected members. OPM identifies three specific areas for carriers to review and assess: use and requirements of various therapies, reimbursement for work-related exposures, and medical evacuation/patient transport.
First, carriers are reminded of prior OPM guidance regarding: determining coverage for experimental drugs when an emergency use is granted by the FDA; and not imposing additional conditions on the coverage of routine patient costs for items and services furnished due to participation in an approved clinical trial. Additionally, on a case-by-case basis, carriers should be ready to reduce certain restrictions, such as referrals or pre-authorizations, in order to provide benefits for care at specialized centers, transportation reimbursements, or early refills of prescription medications for any displaced individuals.
Second, as federal employees are working in affected parts of the world, in the event that a work related exposure occurs, carriers are asked to provide immediate payment for exposed or infected members and to seek reimbursement from the Office of Workers’ Compensation Programs.
Finally, to accommodate the need for Ebola patients to be transported to specialized facilities throughout the country, OPM advises carriers to examine their air ambulance company contracts to determine whether resources are available to transport infectious patients.
In the event an FEHBP carrier has an exposed or infected member with Ebola and arranges care, carriers must notify their OPM contract specialists. OPM will develop and post Frequently Asked Questions to the carrier website related to these Ebola issues as circumstances arise.
Epstein Becker & Green, P.C. will be hosting a complimentary webinar addressing the professional and business challenges encountered by health care providers dealing with Ebola and other infectious diseases on November 17, 2014. Additional information about the webinar is available here.