Federal Policies

Office of Inspector General

CM is subject to federal regulations, especially when delivered in the context of federally funded programs. The following list includes links to relevant federal laws that may apply to Contingency Management.

Please note that CM programs with federal approval via a Medicaid 1115 waiver or an Office of Inspector General opinion may be subject to a different set of rules. Consult your compliance team and/or your CM funder to understand how the following federal rules and regulations impact your CM program.

U.S. Department of Health and Human Services Office of Inspector General (OIG) Fraud & Abuse Laws

Code of Federal Regulations/Title 42/Chapter V/Subchapter B/Part 1001/Subpart C (Permissive Exclusions), often referred to as "Safe Harbors"
- Use Ctrl+F on your keyboard to search for section "hh" entitled "Arrangements for patient engagement and support to improve quality, health outcomes, and efficiency".
- While the Office of Inspector General may issue further guidance specific to CM in the future, this is the most relevant section. See the next link for the “final rule” that discusses how CM fits into this existing Safe Harbor.

Medicare and State Health Care Programs: Fraud and Abuse; Revisions to Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements Final Rule. 12.02.2020
- This document, issued by the Health and Human Services Department of the United States federal government is a summary of the “final rule” regarding the proposed revisions to the Anti-Kickback and related regulations. Use Ctrl+F on your keyboard to search “contingency management” to see where it is discussed.

One of the most current federal documents summarizing the federal government’s support of CM was published in 2023 by the Office of the Assistant Secretary for Planning and Evaluation (ASPE)

Navigating Federal Regulations

The above federal resources are lengthy and may contain unfamiliar legal language. The following resources help interpret how these regulations pertain to CM.

Here is a summary of select “guardrails” to minimize risk of violating federal regulations and provide guidance for protecting CM programs from waste, fraud, and abuse:

Download Here

Additionally, the following articles discuss tangible ways to protect your CM program:

Policy Considerations with American Indian and Alaska Native Community

Federally recognized Tribes are sovereign nations with a government-to-government relationship with the US government. The trust responsibility began in 1787 and is based on Article I, Section 8 of the Constitution. The government-to-government relationship has continued through numerous treaties and laws. Therefore, US government programs and federal funding are legal mandates obligated to federally recognized Tribes. Tribal membership is therefore more akin to nationality than race/ethnicity status, with each Tribal Nation setting their own policies and laws around citizenship.

Each federally recognized Tribe has their own governance. Many Tribal programs are operated under Tribal laws and guidelines. However, the federal government does require implementation of CM to be in accordance with the US Health and Human Services Office of the Inspector General (OIG). The biggest barrier to CM implementation has been funding, including the legal barriers to using rewards or incentives in health care.