Social Determinants of Health Targeted by Legal and Payer Changes

Social determinates of health (SODH) are increasingly being recognized as driving patient health outcomes. Shifts in reimbursement decision-making and changes to the Anti-Kickback Statute and the Stark Law have reflected this, with many payers, providers, and legislators prioritizing addressing SODH to tackle health inequity. A new Reuters article by Brandi Higgins and Darren Skyles covers these changes and their impacts on the healthcare landscape.

According to the authors, “These decisions involve changes to the Stark Law, which prohibits physicians from referring certain Medicare-payable services to an entity with which the physician has a financial relationship unless an exception is met, and the Anti-Kickback Statute, which prohibits payment for referrals of federal health care program business, as well as CMS’ development of a new strategy for the next decade, and payments for social and community-based services for patients. The hope is that these decisions advance health equity for historically underserved patient populations and reduce costs.”

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(Source: Reuters, April 11^th, 2022)