As the health care landscape continues to evolve, so do industry regulations. The latest development? New regulations were released last week by the Department of Health and Human Services (DHHS), bringing new exceptions and clarification to current anti-kickback and provider inducement ("stearage") rules. Here’s what you need to know:
The AKS prohibits the exchange of payments, products or services for the purposes of soliciting federal health care program business. The new anti-kickback rule modifies some existing safe harbors and adds additional safe harbors, providing new protections or codifying certain existing protections. Ultimately, the rule adopts all the safe harbors previously proposed, making select modifications as suggested by commenters.
Civil Monetary Penalty Law
Like the AKS, the CMP Law is meant to protect against fraud and abuse in our health system. It states that anyone who provides remuneration to a Medicare or Medicaid beneficiary—which they know (or should know) is likely to influence the beneficiary’s choice of provider, practitioner, or supplier of payable items or services—may be subject to monetary penalties. However, in an effort to encourage activities that incent beneficiaries to seek out care and promote wellness, the new final rule exempts certain practices, including rewards and incentives programs.
What this means for your plan
At the end of the day, these new regulations will have no impact on your plan’s member engagement strategy, especially as it pertains to rewards and incentives programs. The new regulations primarily impact providers and, in fact, generally loosen the rules. The rules for Medicare and Medicaid plans remain unchanged.
Looking for further guidance or a look at the bigger regulations picture? Turn to chapter 4, “Benefits and Beneficiary Protections,” of the Medicare Managed Care Manual. And, as always, stay tuned to our blog for all the latest news on changing industry regulations.
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