This is the first attempt to modernize and significantly clarify the regulations around the self-referral law since it was enacted in 1989.
The Centers for Medicare & Medicaid Services (CMS) have issued the final rule to modernize and clarify the regulations related to the Medicare Medical Self-Referral Act, or Stark Law.
According to a press release, the final rule creates permanent exceptions to the law for value-based care modalities. It allows doctors to design and enter into value-based deals without fear that their legitimate activities are against the law. These exceptions will apply regardless of whether these provisions relate to the care of a Medicare patient or otherwise.
The final rule also provides additional guidance on several requirements that must be met to ensure compliance with Stark Law, such as how medical compensation from another provider typically needs to be at fair market value. The rule dictates how to determine whether the compensation meets the requirements, the release said.
It also provides clarity and guidance on a number of other technical compliance requirements that are intended to reduce administrative burdens that can increase costs, according to the release.
You can find the complete text of the final standard here.
Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA), says the organization appreciates the move, but the U.S. Department of Health and Human Services (HHS) should have gone further.
“In particular, we support the new exception to Stark Law, which will provide some group practices with greater protection when initiating care coordination arrangements,” says Gilberg. “While the HHS has made an effort to make improvements to key terms that affect physician compensation arrangements, the final rule could have gone further to reduce the overall complexity and regulatory intrusion into group practice operations.
“Despite countless regulations, each of which has identified legitimate problems with Stark Law regulations and attempted to resolve them, the regulatory framework has grown in complexity to the point that it is beyond comprehension for the average physician or practice administrator.” .