Time For Change: Potential Modification To Federal Healthcare Laws May Allow For Better Care Coordination Between Providers

medical-doctor-1314902-mAs technology improves the ability for providers to communicate, existing healthcare laws will continue to be put to the test. Now, a new call for care coordination is driving quality improvement initiatives for physicians and hospitals. In 2018, U.S. Department of Health and Human Services (HHS) launched its initiative “Regulatory Sprint to Coordinated Care,” to facilitate value-based healthcare and promote effective communication strategies between physicians. The Regulatory Sprint seeks to increase a patient’s ability to understand their treatment plan, promote coordination between providers, establish incentives for providers to coordinate efficient care, and encourage information-sharing between providers and facilities.

Healthcare Fraud and Abuse Lawyers

The initiative highlights the importance of removing the barriers created by four federal healthcare laws: the Physician Self-Referral Law; the Federal Anti-Kickback Statute; the Health Insurance Portability and Accountability Act (HIPAA); and substance-disorder treatment rules stemming from 42 CFR Part 2. Previously, critics have claimed that the monetary penalty provisions within the statutes prevent providers from being able to adequately coordinate care. In response, HHS has proposed Stark Law and Anti-Kickback reforms.

According to the press release from October 9th, “the proposed rules 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.” HHS has opened commenting on each of the proposed changes to the federal healthcare statutes. Both the Office of Inspector General (OIG) as well as the Centers for Medicare and Medicaid Services (CMS) have proposed changes.

OIG Proposal

Among the suggested reform, the OIG has sought to amend 42 CFR 10001.952 in establishing new safe harbors. Changes to payment models and financial risk are among the list of new conditions. Furthermore, OIG has also proposed 42 CFR 1001.952(jj), which is a safe harbor protecting donations of cybersecurity technology. Additionally, a change to section 1001.952(bb), discussing changes to local transportation remuneration has been proposed.

Under the OIG changes, 42 CFR 1003.110, would also be amended to create a new statutory exception of monetary inducements for “telehealth technologies” for certain in-home dialysis patients.

CMS Proposal

“Patients over paperwork,” is the leading concept governing CMS changes to healthcare regulations. The proposal focuses on modifying the existing definitions of “value based,” and cultivating care-coordination plans that would qualify as a “value based arrangement.” Value based arrangements would be protected from physician referral laws and increase patient care coordination. Currently CMS is seeking comments as to whether or not laboratories should be included in the value based arrangement commodity, as these arrangements may pose threats for fraud and abuse of federal health programs.

In Summary

The following examples of coordinated patient care would be allowed under the proposals:

  • Facilities could allow physicians to monitor patients’ outcomes on a three-way technology system that works in real-time outside of a healthcare facility. All three parties (physician, patient, and hospital facility) would have continued access to a patient’s prognosis.
  • Hospitals would be allowed to donate free cybersecurity software to physicians that refer patients to that specific hospital.
  • Smart pillboxes could be utilized by patients without charge to the patient.
  • Hospitals and physicians could work together to better coordinate post-discharge care plans.
  • A specialty physician practice could share data analytics with primary care providers.

If passed, the proposals could prove to be a crucial step in improving the currently fragmented healthcare system. Over the next few months, additional comments will be assessed by OIG and CMS as parties bring forward their concerns of the proposals. Now, HHS is responsible for finding the delicate balance between patient care coordination by utilizing value-based systems and preventing fraud and abuse.

In our Georgia and South Carolina based law firm, we work with healthcare companies, medical practices and individual healthcare providers to offer advice and counsel concerning compliance and regulatory matters.  If you have questions about this post, contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may learn more about our law firm by visiting www.hamillittle.com.


** Disclaimer: Thoughts shared here do not constitute legal advice. Please consult with an attorney to discuss your legal issue.

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