November 2019

Through two separate notices of proposed rule-making (NPRMs), the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG), seek to remove regulatory barriers and promote value-based innovation and care. In publishing NPRMs related to implementation of the Federal Physician Self-Referral or “Stark Law” and the Federal Anti-Kickback Statute (AKS), the agencies also convey the Administration’s intent to move the health care payment and incentive systems away from fee-for-service to those focused on quality, cost control and financial risk.

Discussed below are certain key requirements, potential implications and open questions related to the Stark, AKS and related proposals designed to facilitate “value-based” health care payment and delivery. Comments on both proposals are due by December 31, 2019. Given the breadth of the proposed rule changes and their likely impact on the nation’s evolving health care system, stakeholders will be well served to weigh-in on the proposals, which are likely to impact their business operations in a fundamental way.

View the full update here.