CMS needs another year to work on anticipated changes to the physician self-referral rule
The Centers for Medicare and Medicaid Services is pushing back the timeline on anticipated modifications to the physician self-referral rule until August 2021, the agency revealed Wednesday.
CMS first issued its proposed changes to the Stark Law—established to prevent docs from referring patients to entities in which they have a financial interest—back in October. Those revisions were meant to “modernize” the law for the first time since its creation in 1989, carving out exceptions for providers in some value-based payment models.
The agency was originally slated to release the final rule this month, however, officials have postponed the process until August 2021.
“We are still working through the complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date,” CMS and Health and Human Services said in an announcement shared this week.
The American College of Radiology was one such commenter, sharing its concerns back in December. The college did not have comment on the announcement late Wednesday. But in a letter to CMS Administrator Seema Verma dated Dec. 26, the ACR chief said the college “has strongly supported the Stark Law since its inception, especially in traditional Medicare fee-for-service systems.”
William Thorwarth Jr., MD, at the time urged CMS to tie any exemptions to the self-referral law to individual doc-patient encounters, “not across all services that a physician may render.” Most alternative payment models still operate under a fee-for-service model, and until that reality changes, ACR cautioned CMS “to maintain needed guardrails around self-referral.”
“Most of the ACR’s legislative advocacy has focused on advocating for a reasonable balance between authorizing legitimate in-office care that benefits patients and pursuing abusive referral arrangements that exploit the loopholes, specifically the in-office ancillary services exception,” Thorwarth added later. “Although CMS did not invite comment on the IOASE in its proposed rule, ACR advocates that CMS modernize the Stark Law, including IOASE prohibitions, only within APMs that actively manage for appropriate utilization of diagnostic imaging services and are not paid on a volume based, fee-for-service model.”
You can check out the full 333-page rule from October here, and a much shorter fact sheet here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.