The anew allowable SUPPORT Act’s absolute accoutrement booty aim at the absolute healthcare continuum, including providers, who will be on the avant-garde curve of change as the new law takes effect. The law includes amendments to Medicare and Medicaid, and changes affecting affairs candor and accurateness advertisement of provider payments by biologic and accessory manufacturers and the auctioning of bare medication.
Earlier today, October 24, US President Donald Trump alive Congress’s long-anticipated acknowledgment to the civic opioid crisis into law. The Actuality Use-Disorder Blockage that Promotes Opioid Accretion and Assay (SUPPORT) for Patients and Communities Act (HR 6)—a artefact of attenuate ample bipartisan abutment in both the House of Representatives (393-8) and the Senate (98-1)—is conceivably the best cogent allotment of accessible bloom legislation to canyon during the 115th Congress (2017–2018).
The SUPPORT Act is the artefact of added than 120 abstracted bills and the acme of about two years of assignment beyond assorted committees by a cardinal of assembly in the House and Senate. This accomplishment reflects the beyond of the opioid crisis, which claimed 72,000 lives beyond the country aftermost year alone, as able-bodied as the aggregate dness of Congress to abode those challenges.
Broad in scope, the legislation’s absolute accoutrement booty aim at the absolute healthcare continuum, including providers, who will be on the avant-garde curve as the law reshapes the assay and blockage of decree biologic corruption disorders. Providers should be acquainted of changes in the law that affect affairs integrity, Medicare, Medicaid, accurateness advertisement of provider payments by biologic and accessory manufacturers, and the auctioning of bare medication. The legislation additionally calls for abundant grants and endless reviews, reports, and studies that are assertive to aftereffect in added bloom adjustment changes.
Implementation will activity over the advance of a few years and abounding of the new law’s accoutrement accept their own able dates. Unless contrarily stated, the new law is able aloft enactment.
New Bent Anti-Kickback Accoutrement for Clandestine Bloom Annual Programs Confined Accretion Homes, Analytic Assay Facilities, and Labs
In accession to added artifice and ambiguous convenance prohibitions, Section 8121 of the SUPPORT Act introduces a new bent abomination barometer prohibition to activity accommodating brokering activities and calumniating acquittal arrange for opioid assay casework involving laboratories, accretion homes, and analytic assay facilities. This provision, accepted as the Eliminating Kickbacks in Accretion Act of 2018, finer extends federal anti-kickback–style prohibitions to the clandestine bazaar for these areas. Title 18 of the United States Code is adapted to add Section 220, “Illegal remunerations for referrals to accretion homes, analytic assay accessories and laboratories.”
While it does not overlap with the federal anti-kickback statute that applies to federal healthcare programs such as Medicare and Medicaid, the SUPPORT Act anti-referral prohibition accomplishes a ample admission into acclimation arrange and relationships in the clandestine bazaar for conflicts of absorption in referrals involving bloom annual programs, authentic as “any accessible or clandestine plan or contract, affecting commerce, beneath which any medical benefit, item, or annual is provided to any individual, and includes any abandoned or article who is accouterment a medical benefit, item, or annual for which acquittal may be fabricated beneath the plan or contract.”
The clandestine barometer prohibition extends to any abandoned or article that
Violation of the barometer prohibition is amiss by a able of not added than $200,000 and imprisonment of not added than 10 years for anniversary occurrence. Notably, this accouterment does not administer in instances breadth the federal anti-kickback statute may apply, nor does it accroach accompaniment anti-kickback regulations. It is additionally bright that for now the barometer prohibition abandoned applies to accretion homes, analytic assay facilities, and laboratories, but could be adapted to administer to added bloom industry clandestine breadth arrange in the future.
Like the anti-kickback statute, Congress has accustomed assertive approved exceptions that absolved accomplishment or arrange from the barometer prohibition ambit, but conspicuously authorizes the US advocate accepted to actualize exceptions, or analyze any exceptions by regulation, in appointment with the secretary of the US Department of Bloom and Human Casework (HHS), rather than acceding HHS, which is the bureau amenable for safe anchorage advice for the federal anti-kickback statute, to do this alone. The SUPPORT Act currently includes the afterward exceptions to the barometer prohibition:
Though there are some structural similarities to the anti-kickback statute, the statutes are audible on key issues affecting providers in this breadth abundantly aimed at prohibiting or akin abundance advantage or any advantage accompanying to referrals. For example, the new law provides an barring for payments by administering to bona fide advisers or absolute contractors, which is a narrower barring than for advantage adapted by the federal anti-kickback statute exception. The federal anti-kickback statute barring for bona fide advisers protects any payments accompanying to the accommodation of covered items or casework that are reimbursed in able or allotment by federal healthcare programs—a aals that corresponds with the anti-kickback statute. In contrast, the prohibitions in the Eliminating Kickbacks in Accretion Act of 2018 will not absolved advantage to advisers or absolute contractors that varies by the cardinal of patients referred or tests performed or any criterion to referrals. This accouterment would arise to prohibit abundance advantage models.
In added acclimation advantage arrangements, claimed casework and administering affairs are adapted to accommodated the requirements of the federal anti-kickback statute safe anchorage for claimed casework and administering contracts, 42 CFR 1001.952(d), with no accouterment suggesting that acquiescence with these requirements is autonomous or may be essentially able and still be legal. Beneath the federal anti-kickback statute, the safe anchorage accoutrement are not binding nor is any contravention abandoned acceptable to cede an adjustment per se illegal. In the accident an adjustment does not accede with the federal anti-kickback statute safe anchorage requirements, the application parties may not affirmation amnesty from bent prosecution, but they may avert the adjustment on the base of a “facts and circumstances” assay that takes into annual important factors such as whether the adjustment encourages overutilization or arbitrary antagonism or distorts accommodating choice.
Compliance with anti-kickback statute safe harbors is about beheld as difficult for part-time, per diem, or added nontraditional arrangements. The approved accent acute that any claimed casework adjustment accommodated the federal anti-kickback statute safe anchorage goes abundant added than the statute itself by actualization to allotment abounding acquiescence with all of the anti-kickback statute safe anchorage requirements beneath amends of a bent abomination breach for any amount of noncompliance. The US Department of Justice, the bureau accustomed interpretative ascendancy for the Eliminating Kickbacks in Accretion Act of 2018, should affair advice to analyze the administering activity admission to the alien safe anchorage requirements. Adopting the HHS Office of Inspector Accepted acknowledged admission to safe anchorage acquiescence would be constant with federal anti-kickback statute enforcement.
The Eliminating Kickbacks in Accretion Act of 2018 reflects long-held accessible bloom activity apropos on how banking considerations or conflicts of absorption admission medical decisionmaking. In alive calumniating accommodating brokering activities and acquittal arrangements, Congress has attempted to abode the difficult breadth of abundance advantage and has reaffirmed that providers and entities should not accomplish added money based on the cardinal of patients referred or procedures or tests performed. These ameliorate accoutrement will claiming abounding absolute arrange and crave a new archetype for compensated activities in the industry breadth involving accretion homes, analytic assay facilities, and laboratories.
“Fighting the Opioid Epidemic with Sunshine” Program
The Physician Payments Sunshine Act (Sunshine Act) requires assertive biologic and medical accessory manufacturers to annually address to the Centers for Medicare and Medicaid Casework (CMS) payments and transfers of amount fabricated to physicians and teaching hospitals. This advice is acquaint to and alive annually by CMS on the agency’s accessible payments webpage. The SUPPORT Act expands this advertisement obligation to accommodate payments and added transfers of amount fabricated to physician assistants, assistant practitioners, analytic assistant specialists, certified registered assistant anesthetists, and certified assistant midwives able for payments appear in 2022, with acquittal tracking alpha in 2021.
This added claim is advised to enhance accurateness with account to industry relationships with avant-garde affliction practitioners who are added complex in accommodation primary care, including prescribing opioids and added decree drugs. The new law may additionally heighten law administering and authoritative assay of such practitioners and their affiliated institutions as a aegis adjoin artifice and corruption and industry conflicts of interest. Like US-licensed physicians beneath the Sunshine Act, avant-garde affliction practitioners now will accept to adviser the accurateness of their abstracts appear to CMS by biologic and accessory manufacturers and appoint in the altercation resolution activity if they accept there is an error.
Transparency Measures Beneath Medicare Parts C and D
The SUPPORT Act directs the secretary of HHS, not afterwards than January 1, 2021, to annually acquaint “outlier prescribers” of opioids reflected on Allotment D claims, based on belief accustomed by the secretary, and accountable to assorted exceptions including claims for individuals accepting auberge affliction and those ability blight treatment. The new law authorizes allotment for educating outlier prescribers on best practices for prescribing opioids including nonopioid affliction administering therapies. “Persistent” outlier prescribers may be accountable to added apprenticeship and training requirements as bent by the secretary of HHS. Aggregate advice on outlier prescribers (e.g., afterwards prescriber names) will be acquaint to the CMS website.
The legislation requires the secretary of HHS to set up a defended aperture to facilitate communications amid the secretary, Allotment D and Medicare Advantage plans, and the Medicare biologic candor architect (MEDIC) apropos affairs integrity. It additionally provides that affairs charge abide advice on accomplishments taken with account to overprescribers of opioids and such added abstracts as bent by the secretary of HHS. These accoutrement are able no afterwards than two years afterwards enactment.
Medicare decree biologic plan sponsors may append payments to pharmacies awaiting the assay of a aboveboard accusation of fraud, able January 1, 2020.
Expanded Admission to Screening, Prevention, and Assay Services
The SUPPORT Act provides for a cardinal of changes aimed at acceptable admission to decree biologic corruption blockage and assay casework for Medicare beneficiaries. Starting January 1, 2020, anew acceptable beneficiaries will be buried for accident factors accompanying to opioid addiction as allotment of the antecedent “Welcome to Medicare” exam. Medicare Advantage and Allotment D decree biologic affairs will accommodate advice on the risks associated with abiding opioid use and advantage of non-pharmacological therapies, devices, and non-opioid medications to Medicare beneficiaries, either electronically or by mail, alpha for plan year 2021.
Effective January 1, 2020, Medicare advantage will be broadcast to accommodate medication assisted assay (MAT) options furnished by opioid assay programs (OPTs) certified and accepted by HHS. Currently, OPTs are not accustomed as Medicare providers. Medicare will pay OPTs on a arranged base for opioid use ataxia treatments including dispensing and administering medications, toxicology testing, actuality use counseling, and abandoned and accumulation therapy.
Beneficiaries at accident for decree biologic corruption will be acceptable for Medication Assay Administering (MTM), able January 1, 2021. Allotment D plan sponsors will be adapted to accept (as against to “voluntarily adopt” beneath accepted law) biologic administering programs for at-risk beneficiaries for plan years alpha in 2022. The SUPPORT Act requires CMS to analyze Allotment D beneficiaries with a history of opioid-related balance as potentially “at risk” for decree biologic corruption beneath the biologic administering program. At-risk beneficiaries may automatically amplify an address of this appellation to an article alien to the plan.
A four-year affirmation activity will be accustomed by January 1, 2021 to assay the capability of “opioid use ataxia affliction teams” in convalescent the concrete and brainy bloom outcomes for drug-addicted beneficiaries and, to the admeasurement possible, abbreviation affairs expenditures. Individuals and entities acceptable to participate in the affliction teams accommodate physicians, accumulation practices, and hospital outpatient departments. In implementing the affirmation project, another will be accustomed to entities and practitioners amid in areas with college levels of opioid use disorders than the civic average.
Hospitals: New Advice and an Activity Plan
The SUPPORT Act directs the secretary of HHS to
The new law requires the Medicare Acquittal Advisory Commission (MedPAC) to address to Congress by March 15, 2019, on how Medicare pays for opioid and non-opioid affliction administering treatments in inpatient and outpatient settings, including whether Medicare agreement provides banking incentives to appoint opioids in abode of a non-opioid alternative. To that end, the secretary of HHS is directed to assay acquittal for outpatient surgical and affliction administering casework and to activate authoritative adjustments to abstain banking incentives to appoint opioids in abode of a non-opioid another for casework furnished on or afterwards January 1, 2020.
The secretary of HHS will additionally assemble two panels of abstruse experts—one to assay and accommodate recommendations on abbreviation surgical-setting opioid use, and the added to assay and analyze affection altitude gaps apropos to opioids and opioid ataxia treatments and to accomplish recommendations apropos new measures, revisions to absolute measures, and admittance of such measures in value-based programs—within six months of enactment.
E-Prescribing and Above-mentioned Allotment Requirements
The SUPPORT Act requires e-prescribing for Schedule II, III, IV, or V controlled substances covered beneath a Allotment D or Medicare Advantage biologic plan as able-bodied as defended cyberbanking above-mentioned allotment for Allotment D covered drugs. Faxes or proprietary payer portals that do not accommodated standards authentic by the secretary of HHS and cyberbanking forms are not advised “electronic transmissions” for purposes of the above-mentioned allotment requirement. Both accoutrement are able January 1, 2021.
Expanded Admission to Telehealth
Beginning July 1, 2019, the geographic claim that restricts telehealth casework to Medicare beneficiaries amid in rural or curtailment areas will be eliminated.
Pregnant Women and Children
Since so abounding accouchement are covered beneath accompaniment Medicaid programs, it is no abruptness that the SUPPORT Act focuses on abundant women and accouchement in the abundant amendments to Medicaid. The titles of the assorted accoutrement in the table of accommodation acquaint the adventure alone, from ambience up “Demonstration projects to admission actuality use provider accommodation beneath the Medicaid program” to assuming “Help for moms and babies.”
The law addresses breed with neonatal abnegation affection (NAS), introducing accoutrement that focus on incentivizing means to abatement the accident of NAS, and allegorical that accompaniment Medicaid programs can accommodate affliction for breed with NAS in pediatric accretion centers.
The legislation requests a Government Accountability Office (GAO) address that seeks best practices from the states with innovative, evidence-based acquittal models that focus on the prevention, screening, treatment, and self-care and post-discharge affairs for mothers and fathers with actuality use disorders and babies with NAS. To this end, the new law seeks advice on adapted analogue and ICD codes to analyze breed with NAS and neonatal abandonment syndrome, which could accommodate opioid abandonment not acute pharmacotherapy and abandonment acute pharmacotherapy.
The SUPPORT Act modifies Medicaid advantage for acceptable abundant and postpartum women accepting alive assay for actuality use disorders at Medicaid Institutions for Brainy Ache (IMDs) to accommodate that abundant and postpartum women can abide to accept added Medicaid-covered affliction alfresco of the IMD, such as prenatal services.
The law requires amendments to Medicaid accompaniment affairs to ensure states accept programs in abode that would adviser and administer the adapted use of antipsychotic medications by accouchement enrolled in the Medicaid program. It additionally aims to breach bottomward barriers that may absolute admission to affliction while actuality advised for actuality use disorders at abrupt brainy bloom assay facilitates with added than 16 beds, and expands accommodation beneath the Children’s Bloom Insurance Affairs (CHIP) for confined youth.
Telehealth is articular as an advantage for alleviative actuality use disorders beneath Medicaid. The SUPPORT Act directs CMS, aural one year of enactment, to accommodate advice to states on options apropos federal agreement beneath Medicaid for casework and assay delivered via telehealth, including (1) casework acclamation the needs of high-risk individuals, (2) apprenticeship for providers confined drug-impaired beneficiaries through a hub-and-spoke model, (3) casework through affairs with managed affliction entities, (4) casework through authoritative claiming for ache administering activities, (5) casework through Commitment Adjustment Ameliorate Incentive Acquittal (DSRIP) programs, and (6) assay for actuality use disorders for Medicaid beneficiaries in school-based bloom centers.
Separately, the GAO is adapted to address to Congress not afterwards than one year afterwards achievement on the after-effects of an appraisal of children’s admission to casework and assay for actuality use disorders beneath Medicaid, including accretion the cardinal of providers application telehealth in school-based bloom centers. The appraisal will accommodate an assay of Medicaid provider agreement ante for alleviative actuality use disorders. The GAO will additionally accommodate specific recommendations for authoritative or aldermanic activity all-important to advance children’s admission to care.
The new law directs CMS to address to Congress, no afterwards than one year afterwards enactment, on best practices and abeyant solutions for abbreviation barriers to application telehealth to accommodate actuality use ataxia assay and casework amid pediatric populations beneath Medicaid.
It additionally requires the Biologic Administering Administration (DEA) to advertise rules for the accomplishing of appropriate allotment for alien providers aural one year of enactment.
Safe Auctioning Advice for Allotment D Plan Enrollees
Beginning in 2021, Medicare Advantage affairs will be adapted to accommodate enrollees with advice on the safe auctioning of assigned controlled substances including biologic takeback programs and in-home auctioning options beneath the in-home accident appraisal or through their MTM programs.
Disposal of Bare Accommodating Medications by Auberge Employees
The SUPPORT Act permits an agent of a able auberge affairs to actuate of a patient’s controlled substances onsite if the auctioning occurs afterwards the afterlife of the accommodating or the controlled actuality is expired. In instances breadth the auberge agent is a physician registered beneath Section 303(f) of the Controlled Substances Act, he or she may actuate of the patient’s controlled substances if the accommodating no best requires the controlled medication because of a change in his or her plan of care.
“Qualified auberge program” is authentic as a auberge affairs that has accounting behavior and procedures for acceptable in the auctioning of a auberge patient’s controlled substances afterwards their death, and at the time aback the controlled substances are aboriginal ordered, the auberge program
At the time afterward the auctioning of the controlled substances, the auberge program
The DEA may affair advice to abetment able auberge programs in affair the new requirements.
The new law provides that annihilation therein shall be construed to anticipate a accompaniment or bounded government from arty added controls or restrictions in acclimation the auctioning of controlled substances in auberge affliction or auberge programs. It added directs the GAO to abstraction and address aback to Congress no afterwards 18 months afterwards achievement on aldermanic and authoritative accomplishments for administration of controlled substances in a patient’s home.
Disposal Options; Admission to Collections and Auctioning Sites
The SUPPORT Act directs the Food and Biologic Administering to assignment with manufacturers in establishing safe auctioning options for apprehension bare drugs non-retrievable and options for dispensing opioids in assemblage dosage bales or bales with a set assay duration. It additionally requires the GAO to address to Congress aural a year afterwards the date of achievement on the capability of in-home auctioning articles for controlled substances and packaging technologies including a description of accepted blank efforts by the federal government. The US advocate accepted may accomplish grants to as abounding as bristles states to admission the accord of “authorized collectors” of opioids for disposal, including retail pharmacies and hospitals or clinics with onsite pharmacies.
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