Final Rule: Modernizing and Clarifying the Physician Self-Referral Regulations
On November 20, 2020, CMS issued a final rule to modernize and clarify the regulations that interpret the Medicare physician self-referral law.
To view the press release, please visit: https://www.cms.gov/newsroom/press-releases/cms-announces-historic-changes-physician-self-referral-regulations
To view the fact sheet, please visit: https://www.cms.gov/newsroom/fact-sheets/modernizing-and-clarifying-physician-self-referral-regulations-final-rule-cms-1720-f
Code List for Certain Designated Health Services (DHS)
The compensation limits for the nonmonetary compensation and medical staff incidental benefits exceptions have been updated for calendar year 2021 and are now available on the CPI-U Updates page.
CMS Issues Blanket Waivers of Sanctions under the Physician Self-Referral Law
On March 30, 2020, CMS issued blanket waivers of sanctions under the physician self-referral law for COVID-19 Purposes. These blanket waivers provide vital flexibility for physicians and providers in the fight against COVID-19. The waivers are effective March 1, 2020 and may be used without notifying CMS. View the Blanket Waivers of Section 1877(g) (PDF).
NEW: On April 21, 2020, CMS issued explanatory guidance related to the scope and application of the blanket waivers to certain financial relationships. View the Explanatory Guidance (PDF).
Individual waivers of sanctions under section 1877(g) of the Act may be granted upon request. Please send your request via email to 1877CallCenter@cms.hhs.gov and include the words “Request for 1877(g) Waiver” in the subject line. All requests should include the following minimum information:
- Name and address of requesting entity
- Name, phone number and email address of person designated to represent the entity;
- CMS Certification Number (CCN) or Taxpayer Identification Number (TIN) of the requesting entity; and
- Nature of request.
Unless and until a waiver of sanctions under the physician self-referral law (that is, a waiver of section 1877(g) of the Social Security Act (the Act)) is granted to the requesting party(ies), such party(ies) must comply with section 1877 of the Act and the regulations at 42 C.F.R. § 411.350 et seq.
Proposed Rule: Modernizing and Clarifying the Physician Self-Referral Regulations
On October 9, 2019, CMS issued a proposed rule to modernize and clarify the regulations that interpret the Medicare physician self-referral law. Comments will be accepted through December 31, 2019.
To view the press release, please visit: https://www.hhs.gov/about/news/2019/10/09/hhs-proposes-stark-law-anti-kickback-statute-reforms.html
To view the fact sheet, please visit: /newsroom/fact-sheets/modernizing-and-clarifying-physician-self-referral-regulations-proposed-rule
To view an unofficial redline of proposed revisions to the physician self-referral regulation text, click here (PDF).
Request for Information
On June 20, 2018, CMS issued a request for information seeking public input on reducing the regulatory burdens of the Physician Self-referral Law. Comments will be accepted through August 24, 2018.
To view the press release, please visit: /newsroom/press-releases/cms-seeks-public-input-reducing-regulatory-burdens-stark-law
To view a blog by CMS Administrator Seema Verma, please visit: https://blog.cms.gov/2018/06/20/working-together-for-value/
New FAQ Related to “Stand in the Shoes” and the SRDP Physician Information Form
A new FAQ describes the circumstances under which a disclosing party may submit a single Physician Information Form (with supporting documentation) to describe a compensation arrangement between a DHS entity and a physician organization that affects multiple physicians who stand in the shoes of that physician organization. Please see the CMS Voluntary Self-Referral Disclosure Protocol (PDF) FAQs on the Frequently Asked Questions page for details.
New FAQ Related to the DHS Code List and the ICD-9-CM to ICD-10-CM Conversion
A new FAQ provides clarification related to ICD-10-CM coding for those CPT/HCPCS codes on the DHS Code Lists for CYs 2015, 2016 and 2017 that are listed as eligible for the exception at 42 C.F.R. § 411.355(h) only when billed with certain ICD-9-CM codes. Please see the Physician Self-Referral Law FAQs (PDF) on the Frequently Asked Questions page for details.