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 AHCA/NCAL Supports OIG Safe Harbors to Allow More Coordinated Care

In comments to the Department of Health and Human Services Office of Inspector General (OIG), the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said it backs OIG efforts to identify new antikickback statute “safe harbors” to better enable care coordination arrangements, and in turn allow the participation of more long term and post-acute care (LT/PAC) providers. 

The antikickback statute, excluding safe harbors, makes it a criminal offense to exchange remuneration (compensation) to induce or reward referrals of items or services reimbursable by a federal health care program such as Medicare.

Safe harbors refer to regulations that make clear certain conduct will not a violate a given rule. AHCA/NCAL comments are in reference to OIG-0803-N, Medicare and State Health Care Programs: Fraud and Abuse; Request for Information Regarding the Antikickback Statute and Beneficiary Inducements

The association said the new safe harbors are necessary to “more fully realize initiatives” by the Centers for Medicare & Medicaid Services to identify and eliminate unnecessary regulatory barriers to coordinated care. 

Skilled nursing facilities (SNFs) are highly invested in efforts to improve care coordination and adapt to shifts in the Medicare payment focusing on value over volume, AHCA/NCAL said. “Partnering with other service providers in the post-acute and long term care spectrum is a critical element to successful care coordination. Partnering can take many forms, including joint ventures, financial or clinical integration, or informal networks,” the group said.

SNFs have been especially active in exploring viable relationships with ancillary service providers since the Balanced Budget Act of 1997 introduced the Medicare prospective payment system and consolidated billing.

“Demands to control cost pressures and improve post-acute care coordination have continued for SNFs, accelerating over the past 10 years,” the comments said. “In response to these pressures, SNFs have identified new opportunities to find efficiencies and improve quality delivering ancillary services such as therapy, laboratory services, and transportation.” 

AHCA/NCAL said the overall trend in the health care system for providers to coordinate care across the care continuum is true as well for LT/PAC. “SNF joint ventures for ancillary services are an ideal avenue to efficiently deliver services and improve care coordination in post-acute care,” the comments said.

For example, AHCA/NCAL said numerous SNF-focused companies are exploring vertical integration opportunities to expand into population health, physician services, home health services, personal care services, institutional pharmacy services, and outpatient rehabilitation services.

“Almost all of these services are currently provided by highly fragmented providers. In many instances, the SNF providers do not have the requisite expertise to build a new platform to provide the services on their own, and they are seeking to collaborate with existing providers in these areas,” AHCA/NCAL said.

The group added that in order to position themselves to be desired providers along the spectrum of post-acute care services, SNFs are eager to create a vertically integrated network of services that includes many, if not all, of the services identified above.

“To the extent that SNF providers can collaborate with existing providers for the services within a safe harbor under the federal antikickback statute, we believe that this will lead to better coordinated care for residents, better quality outcomes, and an enhanced ability to negotiate collaboration agreements with acute care providers and third-party and governmental payers,” according to the comments.

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