1989 -- Section 6204 of the Omnibus Budget Reconciliation Act of 1989 (OBRA 1989) – Pub. L. 101-239, December 19, 1989 – added section 1877 to the Social Security Act prohibiting physician referrals for clinical laboratory services.
1990 – Section 4207(e) of OBRA 1990 – Pub. L. 101-508, November 5, 1990 – amended section 1877 of the Act to clarify definitions and reporting requirements relating to physician ownership and referral.
1993 – Section 13562 of OBRA 1993 – Pub. L. 103-66, August 10, 1993 - expanded the prohibition to ten designated health services (DHS) in addition to clinical laboratory services.
1993 -- Section 13624 of OBRA 1993 applied certain aspects of the self-referral prohibition to the Medicaid program by amending section 1903(s) of the Act.
1994 – Section 152 of the Social Security Act Amendments (SSAA 1994) – Pub. L. 103-432, October 31, 1994 – amended the list of DHS, changed reporting requirements and modified some effective dates.
1997 – Section 4314 of the Balanced Budget Act of 1997 (BBA 1997) – Pub. L. 105-33, August 5, 1997 - added a provision permitting the Secretary to issue written advisory opinions concerning whether a referral relating to DHS (other than clinical laboratory services) is prohibited under section 1877.
2003 -- Section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) - Pub. L. 108-173, December 8, 2003 - authorized an exception to the physician self-referral prohibition for certain arrangements in which the physician receives necessary non-monetary remuneration that is used solely to receive and transmit electronic prescription drug information.
2003 – Section 507 of the MMA amended section 1877 of the Act by establishing an 18‑month moratorium on physician referrals to certain specialty hospitals in which the referring physician has an ownership or investment interest. Under the moratorium, specialty hospitals cannot fill or submit claims to anyone for DHS furnished as a result of a referral that is prohibited under the moratorium. The moratorium was in effect from December 8, 2003 through June 7, 2005.
2006 – Section 5006(c) of the Deficit Reduction Act of 2005 (DRA) – Pub. L. 109-171, February 8, 2006 - extended the suspension of enrollment for specialty hospitals until the Secretary submitted his final report to Congress on physician investment in specialty hospitals on August 8, 2006.
2008 – Section 143 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) – Pub. L. 110-275, July 15, 2008 – amended section 1877(h)(6) of the Act to establish, effective July 1, 2009, a separate definition for “outpatient speech language pathology services,” which were formally included as DHS under the category of “physical therapy services.
2010 - Section 6409 of the Patient Protection and Affordable Care Act (ACA) was signed into law by the President on March 23, 2010. Section 6409(a) of the ACA required the Secretary of the Department of Health and Human Services, in cooperation with the Inspector General of the Department of Health and Human Services, to establish a Medicare self-referral disclosure protocol ("SRDP") that sets forth a process to enable providers of services and suppliers to self-disclose actual or potential violations of the physician self-referral statute. Self-Referral Disclosure Protocol - Centers for Medicare & Medicaid Services