On November 2, 2011, the U.S. Department of Health and Human Services issued an interim final rule which identified legal waivers allowed for Accountable Care Organizations (ACOs)[1]. HHS specifically identified “patient incentive” among the five types of waivers.
In lay terms, this means that ACOs and ACO providers may provide service or items to patients for free or below-fair market value if four conditions are met:
- The ACO has entered into a participation agreement and remains [active]
- There is a reasonable connection between the items or services and the medical care of the beneficiary
- The items or services are in-kind (not money)
- The items or services are preventive care items or services or advance one or more of the following clinical goals:
- Adherence to treatment regime
- Adherence to drug regime
- Adherence to a follow-up care plan
- Management of a chronic disease or condition
This patient incentive waiver enables ACO providers and participants to offer non-monetary incentives to patients if the incentive is used to encourage treatment adherence. A few examples of in-kind services meeting this definition include (1) pharmacy delivery services, (2) patient transportation services to office visits and therapies, and (3) the provision of medication event monitoring systems (i.e., electronic medication caps) to patients.
HHS’s intent is that this waiver will help ACOs foster patient engagement and improve quality and lower costs for Medicare by removing any perceived obstacles presented by the Beneficiary Inducements Civil Monetary Penalty and the Federal anti-kickback statute. These laws prohibit hospitals, physicians and other medical providers from “drumming up business” by advertising that they will waive Medicare patient co-pays or otherwise provide services below fair market value to induce patient referrals.
………………………………………………………….. [1] http://www.gpo.gov/fdsys/pkg/FR-2011-11-02/pdf/2011-27461.pdf