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HHS & Wisconsin Providers Discuss Removal of Regulatory Barriers to Coordinated, Value-Based Care

Roundtable event in Madison focuses on needed reforms to Stark Law and Anti-Kickback Statute rules

June 25, 2019

On June 20, WHA and several WHA health system members attended a roundtable meeting in Madison with William Brady, Associate Deputy Secretary of the U.S. Department of Health and Human Services (HHS). The purpose was to discuss how HHS’s regulations related to health care anti-fraud statutes should be modernized to remove hospital and health system barriers to forming innovative payment arrangements that reward physicians for improving quality.

At the event, representatives from Advocate Aurora Health, Ascension Wisconsin, Children’s Hospital of Wisconsin, Epic Systems, Marshfield Clinic Health System, and WHA discussed HHS’ “Regulatory Sprint to Coordinated Care” initiative, which is intended to accelerate the transition from fee-for-service to a coordinated care, value-based system. As part of this initiative, in 2018, HHS sought stakeholder feedback on how the regulations involved in implementing two health care anti-fraud statutes, Stark Law and the Anti-Kickback Statute, could be modified to remove regulatory barriers that impede the transition to coordinated, valuebased health care delivery. Based on this feedback, HHS is developing two proposed rules to modernize these regulations and intends to release those rules later in the summer.

During the roundtable, the health care stakeholders expressed concern that HHS’ current rules surrounding the Stark Law and Anti-Kickback Statute prevent innovation and impede new value-based arrangements. Brady agreed and talked about how the Stark Law regulations in particular “have turned into paralyzing vagueness” for health care providers. He told attendees that HHS “look[s] forward to letting the industry be more creative in how they do things.”

Last year, WHA responded to HHS’ request for stakeholder feedback on the Stark Law regulations, commenting that HHS should focus its reforms on clarifying confusing definitions, providing clearer exceptions, prioritizing intentional rather than technical violations, and harmonizing the Stark Law with the Anti-Kickback Statute.

In April, Wisconsin’s Congressional delegation wrote a letter to HHS expressing support for HHS’ “Regulatory Sprint to Coordinated Care” initiative. “[W]e have heard from Wisconsin health care leaders that certain requirements and regulations have become increasing barriers to pursuing greater coordination and value for patients, and can result in significant provider burden and administrative costs,” the delegation wrote in its letter. “[W]e support your efforts . . . to examine these and other regulations created in a fee-for-service era and to understand how to modernize this regulatory framework for tomorrow’s health care system while maintaining important beneficiary protections.”

For more information, contact WHA Assistant General Counsel Andrew Brenton at 608-274-1820.

This story originally appeared in the June 25, 2019 edition of WHA Newsletter