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Health Law Scan

Legal Insights and Perspectives for the Healthcare Industry

We hope you were able to join us for last month's Fast Break on the Regulatory Sprint to Coordinated Care, which has been a longstanding initiative of the Centers for Medicare and Medicaid Services, US Department of Health and Human Services (HHS), and Office of the Inspector General to navigate a path to value-based payment models, culminating in the December 2020 final rules. If not, you missed a conversational session featuring Katie McDermott, Al Shay, and Jake Harper diving a bit deeper into this topic.

As Al noted, analysis of value-based arrangements really begins with understanding the terminology. Not everything that someone perceives to be a value-based arrangement is going to be viewed as a value-based arrangement that will be accepted under either the Stark Law or the Anti-Kickback Statute, so it’s critical to understand the key terms.

Following analysis of those terms, Katie and Al discussed the value-based exceptions, which are categorized into three tiers based on the financial risk a provider is willing to take on, and highlighted the requirements imposed specific to each category. Looking to the future, our panelists then discussed what the value-based rules anticipate and walked through an example of how a hospital could begin to dip their toe into value-based arrangements. Closing out the presentation, Katie covered the modernization of fraud and abuse laws, with a focus on social determinants of health being proposed, but not yet widely adopted.

For all of these details at length, as well as additional information on other relevant important rule changes, please watch the presentation or view the slides on our event page.

Be sure to join us for this month’s program on March 31, 2021 at 3:00 pm ET as Scott McBride and Jake Harper are joined by Krista Barnes, deputy chief compliance officer at MD Anderson, to analyze the significant victory in the US Court of Appeals for the Fifth Circuit for The University of Texas MD Anderson Cancer Center regarding a Health Insurance Portability and Accountability Act data breach enforcement action brought by the HHS Office for Civil Rights.

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