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Stark and Payment Reform in 2018?

The Centers for Medicare and Medicaid Services (“CMS”) Administrator Seema Verma on January 18, 2018, identified as agency priorities the modernization of the Stark Statute to reflect the move from a fee-for-service to a value and outcomes based payment under Medicare and the review of barriers created by the Stark Statute.  According to Verma the Stark Statute was identified by providers as one of the most burdensome regulations in a CMS request for information issued last year.

Payment reform and CMS’ commitment to a value and outcomes based payment has also been identified by Verma as among the issues the agency will review in the year ahead.

Currently pending in Congress are a number of bills that address modernizing the Stark Statute to reflect value and outcome based payments including the Medicare Care Coordination Improvement Act of 2017.  If enacted, the Medicare Care Coordination Improvement Act would give HHS authority to grant waivers to the Stark Statute for accountable care organizations participating in the Medicare Shared Savings Program, grant exceptions to the Stark Statute to promote care coordination, and establish a new Stark exception for alternative payment models.

We will be following the pending legislation and the new CMS review initiatives described by CMS Administrator Verma to see if reforms will be enacted in 2018.

If you have any questions about this post or any related matters, please contact me at sjarvaweiss@nmmlaw.com.