04-14-2021 Council Packet - Laserfiche WebLink

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14 amounts, which are adjusted to reflect local differences in wages, to reimburse four categories of covered hospice care: routine home care; continuous home care; inpatient respite care; and general inpatient care. Additionally, a service intensity add-on payment is made for services furnished during the last seven days of a patient’s life. There can be no assurance that the prospective payment amounts for hospice services provided by the Project will be sufficient to cover the actual costs of providing such services. “Fraud and Abuse” Laws and Regulations Minnesota Prohibition on Self-Referral. Under Section 144.6521 of Minnesota Statutes, health care providers with financial or economic interests in, or employment or contractual arrangements that limit referral options with, certain types of health care facilities are prohibited from making referrals to such facilities without disclosing their relevant interests and posting a notice of such interest in a public area of the provider’s facility. In addition, Section 62J.23, Subdivision 5 of the Minnesota Statutes directs the Commissioner of MDH to access provider records for the purpose of auditing the referral patterns of providers that qualify for exceptions under the federal Stark Law. The Commissioner is required to report to MDH any audit results that reveal a pattern of referrals by a provider for the furnishing of health services to an entity with which the provider has a direct or indirect financial relationship. The Corporation does not believe that it is involved in activities that pose an audit risk under Section 144.6521 or Section 62J.23, Subdivision 5 of the Minnesota Statutes. However, there can be no assurance that such audit will not occur in the future. Federal Prohibition on Self-Referral. The federal physician self-referral law at 42 U.S.C. 1395 (known as the “Stark Law”) prohibits a physician who has a financial relationship, or whose immediate family member has a financial relationship, with an entity that provides certain designated health services (including home health services) from referring Medicare patients to that entity for the provision of such designated health services, with limited exceptions. The Stark Law also prohibits an entity that receives a prohibited referral from filing a claim or billing for the services arising out of that prohibited referral. Unlike the Anti-Kickback Law (defined below), the Stark Law is not an intent based statute. No wrongful intent is required for violation of the Stark Law. When a financial relationship exists between an entity and a physician, the arrangement must meet the necessary elements of a Stark Law exception in order for a referral to be made for designated health services to that entity and for that entity to bill for those designated health services generated by the referral. Sanctions under the Stark law include denial and refund of payments, civil monetary penalties and exclusions from the Medicare and Medicaid programs. Also, because the Stark law is a Medicare payment rule, claims prohibited by the Stark law may also be the predicate for liability under the False Claims Act. Substantial revisions to the Stark Law regulations went into effect as of January 19, 2021. These revisions include a number of new and revised exceptions related to value-based arrangements, certain limited remuneration to physicians and electronic health record items and services donations. The revisions also provide guidance regarding the application of the Stark Law and its exceptions, by making changes to existing exceptions, definitions and key Stark Law terms. It is not yet known the extent to which the new rule may impact physician arrangements related to the Project’s operations. If a Stark Law violation were found to have occurred, any sanctions imposed could have a material adverse effect upon the future operations and financial condition of the Corporation. Minnesota Provider Conflict of Interest Law. Minnesota’s Provider Conflict of Interest Law, which is outlined in Section 62J.23, Subdivision 1 of the Minnesota Statutes, provides that the Commissioner of MDH must adopt rules restricting financial relationships or payment arrangements involving health care providers under which a person benefits financially by referring a patient to another person, recommending another person, or furnishing or recommending an item or service, and that the rules must be no less restrictive than the federal Medicare anti-kickback statute and regulations promulgated thereunder. However, to date, the only rules adopted by the Commissioner of MDH under the Provider Conflict of Interest Law are rules related to the workers’ compensation program. Nevertheless, the Provider Conflict of Interest Law further states that, until rules are adopted by the Commissioner of the Department, the restrictions in the federal Medicare anti-kickback statute and regulations apply to all persons in the State of Minnesota, regardless of whether the person participates in any state health care program. As a result, the Provider Conflict of Interest Law currently has the effect of making federal anti-kickback rules applicable even if a