3 Upcoming CMS Deadlines & Changes

CMS recognizes that practices have been impacted by the COVID-19 pandemic. Therefore, for the 2020 performance year, CMS will be using their Extreme and Uncontrollable Circumstances policy to allow clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more Merit-based Incentive Payment System (MIPS) performance categories due to the current COVID-19 pandemic PHE. Apply for a hardship exception by December 31. Apply now or learn more.

The Centers for Medicare & Medicaid Services (CMS) finalized changes to outdated federal regulations that have burdened health care providers with added administrative costs and impeded the health care system’s move toward value-based payment. The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity.

With this final rule, CMS has updated regulations interpreting the Stark Law to allow for changes that will help modernize the healthcare system.  The rule finalizes many of the proposed policies from the notice of proposed rulemaking issued in October 2019, including:

• Finalizing new, permanent exceptions for value-based arrangements that will permit physicians and other health care providers to design and enter into value-based arrangements without fear that legitimate activities to coordinate and improve the quality of care for patients and lower costs would violate the physician self-referral law.  This supports CMS’ broader push to advance coordinated care and innovative payment models across Medicare, Medicaid, and private plans.
• Finalizing additional guidance on key requirements of the exceptions to the physician self-referral law to make it easier for physicians and other health care providers to make sure they comply with the law.
• Finalizing protection for non-abusive, beneficial arrangements that apply regardless of whether the parties operate in a fee-for-service or value-based payment system – such as donations of cybersecurity technology that safeguard the integrity of the health care ecosystem.
• Reducing administrative burdens that drive up costs by taking money previously spent on administrative compliance and redirecting it to patient care.

Unless otherwise specified in the rule, all of the provisions in this rule will go into effect 60 days from the rule’s display date in the Federal Register. Learn more.