News | Medicare Compliance RAC OIG

July 16-20: Congress to Examine Stark Law Modifications; Verma Pledges Changes

News | Medicare Compliance RAC OIG

July 16-20: Congress to Examine Stark Law Modifications; Verma Pledges Changes

July 12—As Congress gears up to examine statutory changes to the Stark Law next week, the Trump administration is planning to implement changes on an administrative basis.

CMS changes will address easing Stark Law reporting requirements and reducing the barriers the law poses to coordinated care under value-based payment models, according to the CMS administrator.


July 12—As Congress gears up to examine statutory changes to the Stark Law next week, the Trump administration is planning to implement changes on an administrative basis.

Seema Verma, administrator for the Centers for Medicare & Medicaid Services (CMS), told reporters July 12 that she plans Stark Law changes by the end of this year.

“We intend to address Stark Law and some of the issues it’s been creating,” Verma said.

Key issues that CMS will address include “the burden it puts on the industry to make sure they are compliant” and the law’s barrier to coordinated care under value-based payment models, Verma said at a media briefing.

The anticipated CMS changes to Stark comes as Congress is set to examine legislative changes to the law. The House Ways and Means Committee’s Health Subcommittee plans a July 17 hearingtitled “Modernizing Stark Law to Ensure the Successful Transition from Volume to Value in the Medicare Program.”

Verma said she decided to act on Stark changes based on feedback CMS received from healthcare stakeholders. The feedback came from a 2017 request for information on changes that were needed to “burdensome regulations.”

“And Stark Law was one of the major ones we heard time and time again that was a major barrier,” Verma said. “And so we’ve been studying what we can do.”

Providers have long urged steps to reduce the impact of the Stark Law—which seeks in part to prevent clinicians from profiting through self-referrals—on care coordination.

“Stark was created in a whole different environment from where we’re trying to operate now,” said Richard Deem, senior vice president for the American Medical Association. “Right now, we’re talking about more collaboration. It’s just obvious that we’re going to have to rethink some of those things because we want people to collaborate and coordinate the care and the handoffs.”

Deem note at the media briefing that Stark restrictions go beyond areas of physician ownership of referral sites to affect areas like information technology.

The American Hospital Association (AHA) has not yet released its detailed recommendations for Stark Law changes, but those proposals will include the addition of more “safe harbors for innovative payment arrangements so that providers can coordinate and share the savings that they achieve from an innovative payment model with each other,” said Joanna Hiatt Kim, vice president of payment policy for AHA.

“Right now, in many cases that is either not allowed under Stark or a provider has to seek their own special safe harbor, which is an extraordinarily burdensome process,” Kim told reporters. “Having a standard one would streamline and simplify.”

Changes to the Stark Law also drew support from an insurance company advocate.

“We certainly support better care coordination” Mark Hamelburg, senior vice president of federal programs for America’s Health Insurance Programs, said at the briefing. “To the extent that changes to the Stark Law implementation can facilitate that, then we would support that.”

Monday, July 16

Start of Agency for Healthcare Research and Quality’s free patient safety training course. Learn more and register.

Deadline to enroll clinical teams in a 12-month virtual High-Value Care Collaborative sponsored by the American Hospital Association. Learn more.

Tuesday, July 17

Webinar by HFMA titled “Moving Toward a Denial-Free Future: Improving Patient Satisfaction and Growth with an Optimized Front-end Revenue Cycle.” Learn more and register.

Hearing by the House Energy and Commerce Committee’s Oversight and Investigations Subcommittee titled “Examining State Efforts to Improve Transparency of Health Care Costs for Consumers.” Learn more.

Hearing by the Senate Health, Education, Labor and Pensions Committee titled “Reducing Health Care Costs: Eliminating Excess Health Care Spending and Improving Quality and Value for Patients.” Learn more.

Hearing by the House Ways and Means Committee’s Oversight Subcommittee titled “Hearing on Combating Fraud in Medicare: A Strategy for Success.” Learn more.

CMS Outreach and Education webinar for participants in the Hospital Inpatient Quality Reporting (IQR) Program titled “SEP-1 Early Management Bundle, Severe Sepsis/Septic Shock: Providence Tarzana Medical Center’s Sepsis Journey and v5.4 Frequently Asked Questions.” Learn more and register.

Web conference by the Advisory Board titled “2018 Health Care State of the Union.” Learn more.

Webinar by America’s Health Insurance Programs (AHIP) titled “Harnessing the Power of the Patient.” Learn more.

Wednesday, July 18

Hearing by the Senate Special Committee on Aging titled “Supporting Economic Stability and Self-Sufficiency as Americans with Disabilities and their Families Age.” Learn more.

Webcast by the Brookings Institution titled “Cultivating a vibrant U.S. market for biosimilars: A conversation with FDA’s Scott Gottlieb.” Learn more.

Webinar by the by the American Health Lawyers Association titled “Wellness and Prevention Programs: Emerging Trends.” Learn more.

Thursday, July 19

Webinar by HFMA titled “How Analytics is Transforming Healthcare Financial Management.” Learn more.

Webinar by AHIP titled “Remote Monitoring, Big Data Transform Senior Care.” Learn more.

Webinar by the National Academies of Sciences, Engineering and Medicine titled “Integrating Health Care and Social Services for People with Serious Illness: A Workshop.” Learn more.

Friday, July 20

Webinar by the Brookings Institution titled “Can MIPS be salvaged?” Learn more.

About the Author

Rich Daly

is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

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