OIG Says Proposed MCO Incentive Program Protected By AKS Safe Harbor

In its favorable Advisory Opinion 18-11, the OIG explains how a managed care organization's proposed incentive program to pay network providers to increase the amount of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services provided to Medicaid beneficiaries would not violate the Anti-Kickback Statute (AKS). What is interesting about this Advisory Opinion is that the OIG finds that the health plan's proposed arrangement would be protected by the managed care safe harbor for eligible managed care organizations (ECMOs), and there are not many opinions addressing this safe harbor.

Here is a brief run-down of the relevant facts:

• The requestor of the advisory opinion (MCO) is a managed care organization that has entered into a full-risk, capitated contract with the state to provide benefits to Medicaid beneficiaries, including EPSDT services. This contract requires MCO to accept the capitated payment as payment in full for all items and services