![Stark Law And Anti Kickback Proposed Rules Announced Web](/Areas/CMS/assets/img/blank.gif)
10月9日, 2019, CMS 和 HHS released proposed rules that aim to update the Stark law 和 Anti-Kickback Statute. These physician self-referral regulations have not been updated since 2007, 和 many onlookers across the industry have been calling for revisions to reflect an array of market realities. These updates are part of CMS 和 HHS’s Regulatory Sprint to Coordinated Care. The proposed rule 和 safe harbor changes are offered for public comment through the end of 2019, 和 the final rule is scheduled to be published in the middle of 2020. As part of this announcement, 美国卫生和公众bet8娱乐部表示 以下几点:
The proposed rules provide greater certainty for healthcare providers participating in value-based arrangements 和 providing coordinated care for patients. The proposals would ease the compliance burden for healthcare providers across the industry, while maintaining strong safeguards to protect patients 和 programs from fraud 和 abuse.
The proposed changes offer a wealth of advantages for organizations that have embraced alternative payment models 和 value-based care. In conjunction with HHS, CMS 和 OIG issued the proposed rules.
Taking a Closer Look at Stark Law
The proposed rules under the Stark law are intended to create permanent exceptions for value-based arrangements. The changes stem from industry stakeholder feedback noting that the current law disincentivizes physicians. The fear of violating the Stark law hinders providers from entering into innovative arrangements that can improve quality outcomes, produce health system efficiencies, 更低的成本. The new rules 和 exceptions would apply to arrangements regardless of whether the care model is provided to Medicare or non-Medicare patients.
Furthermore, CMS is soliciting comments regarding price transparency in the context of the Stark law. CMS believes that if patients underst和 the cost of care, then the Stark law can serve as an additional safeguard at the point of referral. Some of the key changes resulting from the proposed rule include 以下几点:
- Greater flexibility for arrangements that involve the value-based enterprise
- Revised definitions of “fair market value” 和 “general market value” to support value-based arrangements
- Clarification of the commercially reasonable st和ard, including two proposed definitions for comment
- Changes to the definitions of key terms implicated in arrangements between providers 和 health systems, including “designated health service,”“bet8网站备用,和“报酬”。
- Remuneration exchanged between or among participants (i.e., risk-based contracting)
- Sharing of tools 和 supports furnished to patients
- Donations for cybersecurity technology 和 services
- Proposed modifications to electronic health record items 和 updates to provisions regarding interoperability
- Additional flexibility with respect to outcome-based payments 和 expansion of local transportation limits for discharged patients
Assessing Changes to the Anti-Kickback Statute
同时, the OIG released proposed changes to the Anti-Kickback Statute, which is a different but related set of laws. The statute sets out safe harbors for financial relationships between providers 和 health systems. The proposed rules revise 和 add safe harbors to encourage innovative arrangements designed to support the value-based efforts envisioned by CMS. Several safe harbors are being proposed, including language related to 以下几点:
- Remuneration exchanged between or among participants (i.e., risk-based contracting)
- Sharing of tools 和 supports furnished to patients
- Donations for cybersecurity technology 和 services
- Proposed modifications to electronic health record items 和 updates to provisions regarding interoperability
- Additional flexibility with respect to outcome-based payments 和 expansion of local transportation limits for discharged patients
Implications for the Future
The rules will have an array of intended 和 unintended consequences for physician arrangements across the industry. The clarifications in the final rules will likely provide (1) greater flexibility for organizations to enter into physician arrangements that offer patients improved value 和 (2) the opportunity to update existing arrangements. The innovative compensation structures will shift organizations’ focus from individual performance to coordination of care. 心电图 will continue to follow the updates as the rules are finalized 和 will provide the industry with guidance on the implications 和 recommended tactics for adjusting to the new market l和scape.
Published October 30, 2019