Federal officials should ease barriers that keep skilled nursing facilities, hospitals and other stakeholders from working together, the skilled nursing industry’s largest trade group said.
A senior policy official with the American Health Care Association recently submitted comments to the Office of the Inspector General, encouraging federal officials to lighten anti-kickback regulations. Currently, the rules prohibit payment for recommending products or services to patients who are covered by Medicare or Medicaid.
New “safe harbors” from these rules would help providers work more closely with one another.
“As a sector, SNFs are highly invested in efforts to improve care coordination and adapt to shifts in the Medicare payment focusing on value over volume,” wrote Lillian Hummel, senior director of policy and program integrity for the AHCA and National Center for Assisted Living. “Partnering with other service providers in the post-acute and long-term care spectrum is a critical element to successful care coordination.”
Amid recent pressure to control costs and improve coordination, SNFs have identified opportunities to deliver ancillary services such as therapy, lab work and transportation, she said. Many providers are exploring opportunities to vertically integrate with physicians, home health, personal care and institutional pharmacies, lacking expertise on those practices in their own facilities.
“To the extent that SNF providers can collaborate with existing providers for the services within a safe harbor under the federal Anti-Kickback 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,” Hummel wrote.
She specifically spells out language for a new safe harbor for ancillary service joint ventures, along with proposing a new navigator/care coordinator safe harbor for promoting value-based care.Hummel’s comments came in response to an August request for comments from the OIG on how existing regulations “may act as barriers to coordinated care or value-based care.”
