October 29, 2019

Health and Human Services Proposes Stark Law and Anti-Kickback Statute Reforms

On October 9, the Department of Health and Human Services (HHS) announced proposed changes to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the “Stark Law”) and the Federal Anti-Kickback Statute. The proposed rules seek to provide greater certainty for healthcare providers participating in value-based arrangements and 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 and programs from fraud and abuse. The proposed rules are part of HHS’s “Regulatory Sprint to Coordinated Care,” which seeks to promote value-based care by examining federal regulations that impede efforts among providers to better coordinate care for patients. The Stark Law’s new value-based exceptions, […]
September 30, 2019

Congress Seeks Higher Payments for Non-Opioid Alternatives

The US Senate, in proposed legislation, advocated for greater reimbursement for device-based opioid alternatives. Language buried in the Senate’s fiscal 2020 Labor-HHS appropriations report, released Wednesday, directs CMS to boost Medicare reimbursement for device-based opioid alternatives. The appropriations legislation, which has been mired in a dispute between Republicans and Democrats over abortion policy and related funding for construction of the border wall, does not appear to have immediate support for passage. House Appropriations Committee Chairwoman Nita Lowey, D-N.Y., introduced a continuing resolution Wednesday, which Senate Appropriations Committee Vice Chairman Leahy, D-Vt., threw support behind, but the prospect of the proposal remains uncertain. In the Proposed Rule for the Hospital Outpatient Prospective Payment System, CMS’ indicated they did not intend to […]
September 30, 2019

GAO Indicates Medicare quality measures need improvement

Center for Medicaid and Medicare Services quality measures might not measure or capture the actual care patients receive, according to a new Government Accountability Office (GAO) report. The GAO studied how the agency decides what quality measures to develop and use. It also evaluated how CMS monitors its funding for quality measurement activities. The GAO report stated that CMS doesn’t have processes to ensure that the indicators actually measure what the agency says it cares about in its strategic objectives. The GAO also found that the CMS carries over large sums of unused funds each year for activities related to quality measurement and that the CMS fails to keep track of all its quality-measurement funding. The report recommends that CMS should create standard […]
September 30, 2019

CMS Receives Input on Prior Authorization Regulations

CMS Administrator Seema Verma has tasked her Patients Over Paperwork team with exploring what CMS can do to improve Prior Authorization (PA) burdens as part of the eighth topic addressed under the initiative. In addition, stakeholders like ISASS and other medical specialty societies have submitted input in writing on the issue. ISASS has been a signatory to an AMA taskforce report on Prior Authorization impacts and continues to work closely with the AMA and other medical specialties. These stakeholders submitted a letter to Administrator Verma on September 19. ISASS and other signatories are concerned that the CMS initiatives are too heavily focused on automation and technology and are not addressing other areas of importance as outlined in the Prior Authorization […]