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CMS Seeks Input on Potential Stark Law Revisions

Analysis  |  By John Commins  
   June 21, 2018

The feds are looking for guidance from stakeholders as they consider revisions to the 30-year-old Stark Law, which many believe to be outdated, inefficient, and a hindrance in the shift to value-based care.

The Centers for Medicare & Medicaid Services is considering revisions to the Stark Law banning physician self-referrals, and they're asking for input from stakeholders.  

"In its current form, the physician self-referral law may prohibit some relationships that are designed to enhance care coordination, improve quality, and reduce waste," CMS Administrator Seem Verma said Wednesday in a blog post.

Building a value-based, patient-centered healthcare system will require that doctors and other providers work together with patients, Verma said, suggesting that the 30-year-old Stark Law is not in sync with the goals of coordinated care.

"Many of the recent statutory and regulatory changes to payment models are intended to help incentivize value-based care and drive the Medicare system to greater value and quality," she said.  "Medicare's regulations must support this close collaboration. The Stark Law and regulations, in its current form, may hinder these types of arrangements."

To that end, CMS issued a request for information on Wednesday.

The RFI notes that CMS is "particularly interested in your thoughts on issues that include, but are not limited to, the structure of arrangements between parties that participate in alternative payment models or other novel financial arrangements, the need for revisions or additions to exceptions to the physician self-referral law, and terminology related to alternative payment models and the physician self-referral law."

Specifically, CMS is asking for suggestions about:

  • Existing or potential arrangements that involve federal payers and referring physicians that participate in alternative payment models or other novel financial arrangements, whether or not such models and financial arrangements are sponsored by CMS.
  • Exceptions to Stark that would protect financial arrangements between federal payers and referring physicians who participate in the same alternative payment model.
  • Exceptions to Stark that would protect financial arrangements that involve integrating and coordinating care outside of an alternative payment model.
  • Addressing the application of Stark to financial arrangements among providers in alternative payment models and other novel financial arrangements.

Stark Law revision has been a priority of CMS.

“We’re going to put together sort of an inter-agency group to start looking at this,” Verma said during an American Hospital Association webinar in January.

Stakeholders Want Change

For years, stakeholders have called for revisions to the Stark Law and other anti-kickback statutes.

AHA President and CEO Rick Pollock said at the January webinar that Stark has made it difficult for hospitals to take advantage of the value-based payment opportunities in which CMS has been investing.

"They both present significant barriers to the implementation of some of these new, innovative models that reward coordination and reward value," he said.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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