News and Publications

Sweeping new Medicare regs support value-based arrangements, local transportation access

November 23, 2020

On November 20, the Centers for Medicare and Medicaid Services (CMS) and HHS Office of the Inspector General (OIG) finalized new regulations to modernize the physician self-referral law and anti-kickback statute, including an ASTRO-backed plan to expand the distance that health care providers can provide local transportation support to rural patients. The rules respond to concerns from the health care community about the need for the physician self-referral and anti-kickback laws to accommodate the transition from fee-for-service to value-based care. CMS created new self-referral exceptions for value-based payment arrangements, while OIG created or modified safe harbors under the anti-kickback statute.

In a December 24 , 2019, letter drawing on the efforts of ASTRO’s Rural Task Force, ASTRO supported OIG’s plan allow providers to offer local transportation services to patients up to 75 miles, beyond the existing 50-mile limit. While ASTRO urged OIG not to place a mileage limit on local transportation given the long distances some radiation oncology patients travel for treatment, OIG decided to set the limit at 75 miles, although there will be no limit involving patients discharged from inpatient facilities.

According to CMS, the final rule:

  • Creates new, permanent exceptions for value-based arrangements to 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.
  • Provides 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.
  • Provides 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.
  • Reduces administrative burdens that drive up costs by taking money previously spent on administrative compliance and redirecting it to patient care.