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Physician-Owned Hospitals

Section 6001 of the Affordable Care Act of 2010 amended section 1877 of the Social Security Act to impose additional requirements for physician-owned hospitals to qualify for the whole hospital and rural provider exceptions. A physician-owned hospital is now generally prohibited from expanding facility capacity. However, a physician-owned hospital that qualifies as an applicable hospital or high Medicaid facility may request an exception to the prohibition from the Secretary.

For further information about the process and its requirements, see the links below. After reviewing the material below, if you have additional questions, please send an email to POHInquiries@cms.hhs.gov. Requests for exceptions should not be sent to this address, but may be emailed to the address below.

Hospitals requesting an exception in accordance with the statutory requirements may submit an exception request either electronically to POH-ExceptionRequests@cms.hhs.gov or by mailing an original and one copy of its request to:

Centers for Medicare and Medicaid Services
7500 Security Boulevard
Mailstop C4-25-02, ATTN: Physician-Owned Hospital Exceptions
Baltimore, MD 21244-1850

If a hospital submits its request electronically, the hospital must also submit an original hard copy of the required certification.

Expansion Exception Requests Received

  • Lake Pointe Medical Center (Rowlett, TX) submitted an exception request. The corresponding decision notice has been published in the Federal Register and may be found at: http://www.gpo.gov/fdsys/pkg/FR-2014-10-31/pdf/2014-25940.pdf.
  • Doctors Hospital at Renaissance (Edinburg, Texas) – In Process
  • Harsha Behavioral Center, Inc. (Terre Haute, Indiana) - in Progress

Important Updates:

POH Initial Annual Ownership/Investment Report: Release of CMS-855POH;
No Action Required Until Further Notice

CMS has released the CMS-855POH, a new form approved by the Office of Management and Budget (OMB) to replace Attachment 1 of the CMS-855A (Attachment 1).  POHs previously used Attachment 1 to submit the Initial Annual Ownership/Investment Report required under the physician self-referral law. At this time, POHs should not submit a completed CMS-855POH (or a completed Attachment 1) for purposes of the physician self-referral law reporting requirements until CMS issues further instruction on the Physician Self-Referral website.  As stated in our March 12, 2015 announcement in MLN Connects Provider eNews, CMS has extended the deadline for the POH Initial Annual Ownership/Investment Report due to concerns about the accuracy of the data collected in the report, and POHs should continue to stay tuned to the Physician Self-Referral website (as well as the normal CMS communication channels for notifications related to this issue) for information regarding the revised deadline, specific instructions for submitting the report, and the timeframe during which the report can be submitted.

As a reminder, hospitals that did not file the required information by the earlier deadline of March 3, 2014 may have refrained from filing claims after that date to avoid violating the physician self-referral law’s claim submission prohibition. Because of the deadline extension, submission of those claims may be permissible. Please refer to 42 CFR §424.44 for timely filing guidelines regarding such claims.