AMGA Offers Recommendations to CMS and OIG on Value-Based Arrangement Exceptions and Safe Harbors


Sharon Grace
Chief Communications Officer
703.838.0033 ext. 393

December 31, 2019

Alexandria, VA – AMGA today recommended that providers have access to a regulatory framework that supports their ability to assume risk-based contracts. In comments filed today on proposals from the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS), AMGA recommended safe harbors under the Anti-Kickback Statute and exceptions from the Physician Self-Referral Law (Stark Law) address the complex regulatory and legal structure that hinders adoption of value-based care. AMGA urged OIG and CMS to create a consistent framework as providers take on increasing amounts of risk and not treat safe harbors and exceptions as incentives to move into value-based models. In addition, AMGA advised that OIG’s safe harbors should not offer different protections for different levels of risk, as this requires providers to revise their practice patterns as they assume additional financial risk.

“It’s encouraging that HHS recognizes the barriers that the Anti-Kickback and Stark laws can have for providers who want move into a value-based model,” said AMGA President and CEO Jerry Penso, M.D., M.B.A.  “By aligning their proposals and ensuring they are not structured on the amount of risk at stake, but based on a predictable framework, these rules will foster innovation in care coordination and management.”

AMGA recommended that the OIG finalize its proposal to create a safe harbor in connection with CMS-sponsored models. This will alleviate the need for providers to seek distinct fraud-and-abuse waivers.

Regarding the CMS rule, AMGA supports the proposed exceptions that would apply to value-based arrangements. AMGA recommended that CMS not finalize a proposed change to its definition of group practices, as doing so would be disruptive to multispecialty medical groups and organized delivery systems.

The letters are available on the AMGA website.