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CMS issues final rule on Stark Law

by John R. Fischer, Senior Reporter | November 24, 2020
CMS has issued a final rule on the Stark law that enforces value-based care to a greater degree, reduces regulatory burdens and protects patients from costly, unnecessary services
CMS has issued a final rule on the Medicare physician self-referral law (Stark Law) and anti-kickback rules that better integrate value-based care, and lessens regulatory burdens on physicians.

The rule is the first significant update to the law since it was enacted in 1989 and supports the CMS Patient over Paperwork initiative by decreasing unnecessary tasks for providers while preventing physicians from using financial self-interest to prescribe unnecessary, low quality and expensive care to patients.

“Through the Patients over Paperwork initiative, the final rule opens additional avenues for physicians and other healthcare providers to coordinate the care of the patients they serve — allowing providers across different healthcare settings to work together to ensure patients receive the highest quality of care,” said CMS in a statement.

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The final rule creates permanent exceptions to the Stark Law that enable value-based care to be performed at lower costs, with healthcare providers, suppliers and physicians having greater flexibility to coordinate with one another on patient care. This reduces their potential liability and administrative tasks in exchange for taking on more risk.

The exceptions apply to care for people with Medicare and other patients. They include requirements that must be met to ensure compliance with the Stark Law. For example, compensation provided to a physician by another healthcare provider must generally be at fair market value. They also provide clarity and guidance on technical compliance mandates to reduce administrative challenges that increase costs, as well as protection for non-abusive beneficial arrangements between physicians and other healthcare providers.

The exceptions offer additional flexibility for certain arrangements, such as the sharing of cybersecurity technology between providers and practice, regardless of whether the receiving party is part of a fee-for-service or value-based payment system. The idea is to allow small practices to be able to share data with a hospital and reduce the need for patients to coordinate care with each individual provider they see.

The rule is expected to go into effect on January 19, 2021.

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