On Friday, February 9, 2018, The Bipartisan Budget Act of 2018 (BBA) became law. While its impact on the health law landscape is varied, a few changes will be discussed here.

The BBA introduced some changes to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), in particular with regard to the Merit-based Incentive Payment System, or MIPS. MIPS, which scores clinicians on several performance categories, is the default track under MACRA. The BBA ushered in some changes to the scores and their weights used in MIPS, and also gave CMS discretion to implement MIPS performance threshold more slowly than under the previous version of the law, which may decrease the number of providers who receive payment reductions under MACRA until 2022.

The BBA also codified certain changes to the Physician Self-Referral Law (the Stark law) that had already been discussed by CMS: a clarification on how to satisfy the Stark law's writing requirement and a clarification regarding holdover arrangements for personal services arrangements and leases, namely, that a holdover period may be indefinite provided the holdover is on the same terms and conditions as the original agreement. See Section 50404 of the BBA. Staying abreast of the changes and clarifications to the Stark law, a law with regard to which technical compliance is particularly vital, is valuable. 

Additionally, the BBA increased the penalties for certain Anti-Kickback Statute (AKS) and Civil Monetary Penalty Law (CMP) violations. The various civil penalties increased from $10,000 to $20,000, $15,000 to 2 $30,000, and $50,000 to $100,000. However, due to the embedded inflationary adjustments in these penalties, the actual increase is less severe than it first appears; i.e., the $10,000 fine had crept up to around $15,000 since it had first been set. The BBA also increased the criminal penalties available under the AKS.