Medicare Compliance & Reimbursement

Physicians' business relationships with other health care providers could be in for a shakeup this summer. The Centers for Medicare & Medicaid Services plans to release two key regulations on the Stark physician self-referral law in coming months, according to the Department of Health and Human Services Semiannual Regulatory Agenda. Published in the May 27 Federal Register, the agenda says the much anticipated final version of "Phase II" of the mammoth Stark physician self-referral rule is scheduled for a June release. The rule will establish specific rules on all aspects of the Stark II legislation except paragraphs (a), (b) and (h), which were addressed in the Phase I reg in early 2001. Also on the slate: CMS says that in July it plans to issue a proposal that could hit specialty hospitals hard. The agency says it plans to change self-referral rules to keep physician investors in certain specialty hospitals from using the "whole hospital" exception to the self-referral ban. Physician-owned specialty hospitals have been under fire lately, with Rep. Fortney "Pete" Stark (D-CA) proposing legislation that could affect their business dealings and the General Accounting Office outlining findings that some say cast a shadow on the industry (see MCDA, April 2 and May 19, 2003). In addition to new rules relating to the Health Insurance Portability and Accountability Act (see below), regulations on the slate include:
clarification of controversial patient anti-dumping rules (due any day now);
an anti-kickback safe harbor for federally qualified health centers (expected in October);
a final version of the shared risk exception to the safe harbor provisions and of the Medicare SELECT copay waiver safe harbor (both slated for October); and
clarifications of the OIG's authority to oust providers from Medicare (planned for August).