CHA News Article

OIG Issues Final Rule on ACO Waivers Under Medicare Shared Savings Program

The Department of Health and Human Services Office of Inspector General and the Centers for Medicare & Medicaid Services have issued the attached final rule revising waivers in connection with the shared savings program for accountable care organizations due to statutory changes included in the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA revised the gainsharing civil monetary penalty (CMP) so that it prohibits hospitals from knowingly making payments, directly or indirectly, to induce physicians to reduce or limit “medically necessary” services provided to Medicare or state health care program beneficiaries under the physician’s direct care. In light of the statutory change, payments by hospitals to induce physicians to reduce or limit medically unnecessary services no longer implicate the gainsharing CMP. Therefore, a waiver of the gainsharing CMP is no longer necessary to carry out the shared savings program.

The final rule also clarifies waivers originally finalized in the 2011 OIG interim final rule with comment period. The waivers include certain provisions of the physician self-referral law, the federal anti-kickback statute, and the beneficiary inducements CMP. The waiver authority is limited to requirements necessary to carry out the purposes of the shared savings program, and does not extend to any other laws or regulations.