The Centers for Medicare & Medicaid Services (CMS) is launching BPCI Advanced – the successor program to the Bundled Payments for Care Improvement Initiative. Providers that like the current BPCI program, or simply missed the opportunity to join BPCI when it launched in 2013, should consider applying for BPCI Advanced before the March 12, 2018 application deadline.
CMS created the concept of bundled payments as a way to link payments across all health care providers during a single episode of care, with the aim of improving care and removing waste from the health care delivery system. BPCI Advanced builds on the work of CMS’s Center for Medicare and Medicaid Innovation (CMMI) and the foundation of the first BPCI initiative, which started in April 2013 and will end on September 30, 2018. The BPCI Advanced performance period will begin on October 1, 2018 and run through December 31, 2023.
Authored by:
Kristin M. Bohl, 410.862.1145, kbohl@bakerdonelson.com
Christopher P. Dean, 410.862.1176, cdean@bakerdonelson.com
Catherine A. Martin, 410.862.1120, cmartin@bakerdonelson.com
Ashley L. Thomas, 202.508.3429, athomas@bakerdonelson.com
As CMS’s approach to Alternative Payment Models continues to evolve, most recently with the release of BPCI Advanced, post-acute care providers may be left scratching their heads as they try to determine where they fit. An evaluation of Year 3 of the BPCI program, released in October 2017, identified shortened skilled nursing facility (SNF) stays as a primary driver of savings under both BPCI Model 2 and Model 3. Shorter SNF stays, and more efficient use of other types of post-acute care, will likely continue to drive savings for BPCI Advanced participants. Despite the role post-acute care (PAC) providers play in reducing costs, the updated iteration of the BPCI program reduces opportunities for them to benefit from the reductions in costs that they help to generate. Nonetheless, under BPCI Advanced, cooperating with participating physicians and hospitals to coordinate care for beneficiaries during BPCI episodes will remain important for SNFs and other PAC providers.
Authored by: Meredith N. Larson, 410.862.1123, mlarson@bakerdonelson.com
The OIG created an opening for nursing facility discounts to private payors when it approved a startup company’s proposal to create a network of nursing facilities willing to offer discounts on the daily rates charged to private long term care insurers and their policy holders in OIG Advisory Opinion 17-08. Because the nursing facilities involved also provide items and services that are reimbursed under federal health care programs, the OIG analyzed the arrangement under the beneficiary inducement prohibitions of the civil monetary penalty statute (beneficiary inducement CMP) and the Anti-Kickback Statute (AKS). The OIG ultimately concluded that neither AKS sanctions nor a CMP would be imposed due to the sufficiently low risk of fraud, abuse or beneficiary inducement under the facts at hand.
Authored by: Kathleen R. Salsbury, 202.508.3411, ksalsbury@bakerdonelson.com
Reviewed by: William T. Mathias, 410.862.1067, bmathias@bakerdonelson.com
A non-profit acute care hospital may share cost savings for certain spinal surgeries with neurosurgeons in a multi-specialty physician group following approval by the U.S. Department of Health & Human Services, Office of Inspector General (OIG). In Advisory Opinion 17-09, the OIG determined that the parties had incorporated sufficient safeguards in the gainsharing arrangement to avoid sanctions under both the civil monetary penalty prohibiting a hospital’s payment to a physician to induce the reduction or limitation of medically necessary services to Medicare or Medicaid beneficiaries (the Gainsharing CMP) and the Anti-Kickback Statute (AKS).
The advisory opinion is notable for two firsts. It is the first advisory opinion to address gainsharing since the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which modified the Gainsharing CMP to prohibit only inducements made to reduce or limit medically necessary services under Medicare or Medicaid. Furthermore, it is the first gainsharing advisory opinion involving a large multi-specialty physician group.
Authored by:
Ashley L. Thomas, 202.508.3429, athomas@bakerdonelson.com
William T. Mathias, 410.862.1067, bmathias@bakerdonelson.com
The OIG added six new items to its Work Plan with the January 2018 update. Consistent with prior Work Plan missives, the OIG continues to focus its efforts on reducing prescription opioid misuse. Additionally, similar to the December 2017 Work Plan update, the Medicare Advantage industry may be interested to know the OIG is examining elements impacting risk-adjusted payments to Medicare Advantage organizations. Those involved in the orthotic device industry should be aware that the OIG is scrutinizing reimbursement for certain off-the-shelf orthotic devices. Furthermore, the OIG is analyzing claims data to determine the prevalence of potential abuse to Medicare beneficiaries. Lastly, the OIG will examine states that receive block grants related to the Child Care Development Fund to ensure program integrity. Read on for brief descriptions of the six new items.
Authored by: Daniel A. Stephenson, 615.726.5678, dstephenson@bakerdonelson.com
Reviewed by: William T. Mathias, 410.862.1067, bmathias@bakerdonelson.com
Jackie Henson and Bill Robinson explain what non-profits need to know about the new tax law in this interview with HealthLeaders.
“This provision, this 21% excise tax, once you start getting into it, is not going to be an easy provision to comply with,” says Jacqueline Henson, an attorney and specialist in tax-exempt organizations with the Washington, D.C. office of the Baker Donelson law firm. “It will make life difficult not necessarily for the largest of the largest organizations, but for the mid-sized. I don’t think non-profits know what’s going to hit them yet.”
Co-Chairs, Health Care Regulatory Group
Jonell B. Beeler
Jackson
601.351.2427
jbeeler@bakerdonelson.com
Catherine A. Martin
Baltimore
410.862.1120
cmartin@bakerdonelson.com
www.bakeroberhealthlaw.com
