AMGA Offers Recommendations to CMS and OIG on Value-Based Arrangement
Exceptions and Safe Harbors
Chief Communications Officer
703.838.0033 ext. 393
December 31, 2019
Alexandria, VA – AMGA today recommended
that providers have access to a regulatory framework that supports their ability
to assume risk-based contracts. In comments filed today on proposals from the
Department of Health and Human Services (HHS) Office of the Inspector General
(OIG) and the Centers for Medicare & Medicaid Services (CMS), AMGA recommended
safe harbors under the Anti-Kickback Statute and exceptions from the Physician
Self-Referral Law (Stark Law) address the complex regulatory and legal structure
that hinders adoption of value-based care. AMGA urged OIG and CMS to create a
consistent framework as providers take on increasing amounts of risk and not
treat safe harbors and exceptions as incentives to move into value-based models.
In addition, AMGA advised that OIG’s safe harbors should not offer different
protections for different levels of risk, as this requires providers to revise
their practice patterns as they assume additional financial risk.
“It’s encouraging that HHS recognizes the barriers that the Anti-Kickback and
Stark laws can have for providers who want move into a value-based model,” said
AMGA President and CEO Jerry Penso, M.D., M.B.A. “By aligning their proposals
and ensuring they are not structured on the amount of risk at stake, but based
on a predictable framework, these rules will foster innovation in care
coordination and management.”
AMGA recommended that the OIG finalize its proposal to create a safe harbor
in connection with CMS-sponsored models. This will alleviate the need for
providers to seek distinct fraud-and-abuse waivers.
Regarding the CMS rule, AMGA supports the proposed exceptions that would
apply to value-based arrangements. AMGA recommended that CMS not finalize a
proposed change to its definition of group practices, as doing so would be
disruptive to multispecialty medical groups and organized delivery systems.
The letters are available on the AMGA website.