The Stark Law’s prohibitions make little sense in a purely managed care world and some sense in a purely fee-for-service world. But what about when these worlds collide (or at least coincide)? In the 2020 rulemaking, CMS took its most substantial stab to date at addressing this messy middle by creating three new exceptions for “value-based” arrangements. In this webinar, we (i) unpack the key terms underlying all three exceptions; (ii) highlight commonalities and distinctions among the exceptions; and (iii) identify open questions and issues that may present challenges for parties seeking to rely on one or more of these exceptions.

Presentation materials

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White paper

In December 2020, the Centers for Medicare & Medicaid Services (CMS) finalized its long-awaited changes to the agency’s regulations governing the federal physician self-referral law, commonly known as the Stark Law (Final Rule). Many of the changes had been proposed by the agency in an October 2019 proposed rulemaking (Proposed Rule). The Final Rule represents the most significant Stark Law rulemaking in more than a decade. The Health Care Group at Dentons US presented a series of seven webinars, each with a companion white paper, addressing the principal components of the Final Rule. This is the seventh, and last, of these white papers, addressing three new exceptions created by CMS for certain so-called “value-based” compensation arrangements between physicians and entities that furnish designated health services (DHS Entities):

• The exception for arrangements with value-based full financial risk (Full Financial Risk Exception).
• The exception for value-based arrangements with meaningful downside financial risk to the physician (Meaningful Downside Financial Risk Exception).
• The exception for value-based arrangements more generally (Value-Based Arrangement Exception).

We will refer to these, collectively, as the Value-Based Exceptions.

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