CMS looking to make changes to Stark Law requirements

CMS looking to make changes to Stark Law requirements June 29, 2018

In 1989, a law was enacted to prohibit physicians from profiting financially when they make referrals. The law, which became known as the Stark Law, essentially “prohibits physicians from referring patients to receive ‘designated health services’ payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.” The Stark Law is closely aligned with the Anti-Kickback Statute (AKS), both of which aim to prevent physicians from profiting when making patient referrals.

The Centers for Medicare & Medicaid Services (CMS) is now considering making changes to the Stark Law and is seeking input from physicians as it moves forward with its plans. CMS explains that the law specifically: (1) prohibits a physician from making referrals for certain designated health services (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship (ownership or compensation), unless an exception applies; and (2) prohibits the entity from filing claims with Medicare (or billing another individual, entity, or third party payer) for those referred services.

CMS has issued a Request for Information (RFI) seeking comments and addressing the background of the potential changes to the Stark Law. The RFI states that “The Department of Health and Human Services (HHS) is working to transform the healthcare system into one that pays for value” and has “launched a Regulatory Sprint to Coordinated Care, led by the Deputy Secretary.” The Regulatory Sprint is “focused on identifying regulatory requirements or prohibitions that may act as barriers to coordinated care.”

The RFI lists twenty questions that CMS would like answered by those physicians responding and providing input. Many of the questions relate to the need to coordinate care, alternative payment models, accountable care organizations (ACOs), and the role of transparency. Comments and responses must be submitted no later than 5pm, 60 days after the date of publication in the Federal Register, which was June 25, 2018.