Self Referral/Anti-Kickback Waivers for ACOs Issued
November 3, 2011 – In conjunction with the release of the ACO Final Rule, CMS, the Office of Inspector General (OIG) and the Department of Health & Human Services (HHS), issued an “interim final rule with comment” that establishes waivers to the physician self-referral law, the federal anti-kickback statute, and certain civil monetary penalties law in order to encourage providers to participate in the Medicare Shared Savings Program (SSP) or in the Advance Payment Initiative. CMS states the waivers incorporate conditions that, in combination with additional safeguards in the SSP final rule, are intended to protect Medicare beneficiaries and the Medicare program from fraud and abuse while furthering the quality, economy, and efficiency goals for the SSP.
There will be five waivers issued to cover ACO organizations:
- ACO pre-participation waiver that applies to start-up accountable care arrangements
- ACO participation waiver during the term of theACOparticipation or time thereafter
- Shared savings distributions waiver for payments earned under the program
- Compliance with physician self-referral law waiver
- Patient incentive waiver for medically related incentives to encourage preventive care and treatment compliance
An ACO need only fit in one waiver to be protected, even if the entity meets the criteria of more than one waiver. The waivers apply uniformly to each ACO, ACO participant, and ACO provider/supplier and are intended to be self-implementing. Apart from meeting applicable waiver conditions, no special action (such as the submission of a special application for a waiver) is required by parties in order to be covered by the waiver.
CMS will oversee the physician self-referral law. The OIG will be responsible for enforcing the civil monetary penalties, while the OIG, with the Department of Justice, will be responsible for the federal anti-Kickback statute.
Comments on the interim rule are due by 5:00 pm on January 3, 2012. You may access this interim rule by clicking below and scrolling to Related Notices and Guidance under the date, October 20, 2011. Click on “Medicare Shared Savings Program Final Waiver.”
Tags: Healthcare Reform
