AACU News & Notes

CMS Proposes to Recalibrate the Scope and Application of Stark Regulations

posted: October 30, 2019

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) proposed noteworthy changes to regulations that interpret the Stark Law, a statute governing Medicare patient referrals and integrated care that hasn’t been significantly updated since it was enacted in 1989. The proposal promotes patient-centered payer reforms and is well-aligned with the AACU’s campaign to modernize the law restricting coordinated care.

In an official fact sheet describing the proposed rules, CMS admits that the Stark Law, in its current form, may actually inhibit cost savings. “The Stark Law has not evolved to keep pace with the transition to value-based care. In its current form, the Stark Law may prohibit some arrangements that are designed to enhance care coordination, improve quality, and reduce waste.”

Stark Law Proposal

  • Decouple the Stark Law from the Anti-Kickback Statute and other federal/state laws
  • Revise definition of “designated health services”
  • Revise definition of “physician”
  • Clarify definition of “referral”
  • Revise exception in the definition of “remuneration”
  • Clarify availability of “isolated transactions” exception
  • Modify guidance on “period of disallowance”

Therefore, CMS proposes new, permanent exceptions to the Stark Law for value-based arrangements that would apply “regardless of whether the arrangement relates to care furnished to people with Medicare or other patients.” In addition, the proposal calls for exceptions that would allow hospitals to donate certain cybersecurity technology to referring physicians, regardless of whether the parties operate in a fee-for-service or value-based payment system. CMS also wants the public to comment on “the role of price transparency in the context of the Stark Law and whether to require cost-of-care information at the point of a referral for an item or service.”

Additionally, as part of the Regulatory Sprint to Coordinated Care, the Department of Health and Human Services Office of Inspector General proposed several changes to the Anti-Kickback Statute that improve “coordination of care among physicians and other healthcare providers in both the Federal and commercial sectors.”

The AACU will comment on this proposal before the Dec. 31 deadline. Please contact our team with your own comments so we can better represent urologists’ interests.

Providers react to HHS proposal to revise Stark Law (FierceHealthcare, Oct 9, 2019)
HS will change how it enforces the Physician Self-Referral Law, or the Stark Law, and will allow exceptions for health care providers in agreements meant to reduce costs and improve patient health, according to Trump administration officials. The American Hospital Association supported the changes and CEO Rick Pollack said that out-of-date regulations have “created unnecessary roadblocks to the kind of collaboration and coordination that enables caregivers to meet all of their patients’ healthcare needs, whether in the hospital, the doctor’s office or their own homes.”
Bricker and Eckler (Oct 23); Katten Muchin Rosenman (Oct 17); RevCycle Intelligence (10/9)

Fact Sheet: Modernizing and Clarifying the Physician Self-Referral Regulations (CMS, Oct 9, 2019)

Proposed Regulation: Modernizing and Clarifying the Physician Self-Referral Regulations (CMS, Oct 17, 2019)

Advocacy Priorities
  • Prostate Cancer Screening and Awareness

    Eliminating Misdiagnosis and Reducing Wasteful Medicare SpendingEvery 20 minutes an American man dies from prostate cancer. The American Cancer Society estimates that 161,360 men were told they have prostate cancer in 2017. Early detection is critical because research shows the five-year survival...

  • IPAB Repeal

    IPAB permanently repealed in a major victory for the AACU and urology communityThe AACU is pleased to report that the Bipartisan Budget Act of 2018 (H.R. 1892) included provisions to repeal the Independent Physicians Advisory Board (IPAB), a 15-member panel of unelected officials that had the...

  • Graduate Medical Education and Physician Workforce Shortage

    Ensuring a Well-Trained Physician Workforce Increase Federally Funded Physician Training ProgramsRequestUrologists urge Congress to acknowledge the importance of specialty medicine and address urological workforce shortages that jeopardize patient access to care. We urge lawmakers to support...

  • The Impact of Pharmacy Benefit Managers on Access to Affordable Treatment

    Pharmacy benefit managers (PBMs) have a significant impact on prescription drug costs and the ability of patients to obtain the medications they need in a timely and affordable manner, and yet very little is known about their role. The AACU is dedicated to working with policymakers at both the...

  • Improve Preventive Task Force Recommendations, Preserve Access to Prostate Cancer Screening

    The United States Preventive Services Task Force (USPSTF) plays a critical role in preventive care because its recommendations dictate what preventive services many health plans must provide without cost sharing. Currently, however, the USPSTF has little accountability. Task Force members are...

  • Medical Liability Reform: Protect Physician Volunteers During National Disasters

    Protection for Physician Disaster VolunteersClinical urologists urge support for the Good Samaritan Health Professionals Act of 2017, introduced in the House by Rep. Marsha Blackburn (R-TN-7) and in the Senate by Sen. Bill Cassidy, MD (R-LA). This crucial legislation seeks to shield medical...

  • Modernize Law Restricting Coordinated Care (“Stark Law”)

    When Congress enacted the Medicare Access and CHIP Reauthorization Act, it replaced a fundamentally flawed reimbursement framework with a program promoting value-based care delivery. Value-based care, as measured by the new Merit-Based Incentive Payment System (MIPS) and alternative payment...

  • Patients Over Paperwork: Reducing the Burden of Medicare Red Tape

    Urologists across the country treat a high volume of Medicare patients and therefore deal with the program’s numerous requirements and complex payment structures on a near daily basis. The AACU is dedicated to working with legislators and policymakers to identify ways to simplify and...

State Advocacy
  • Fair Contracting and Medical Practice Freedom

    Where We Stand Ensure openness and fairness in health care provider contacts. Prevent third-party payors from changing the terms of their provider contract without notice to the provider and without the consent of the provider. Ensure that physician licensure is based upon a physician's...

  • Medical Liability Reform — Expert Witness Qualifications

    Strengthen expert witness standards Ensure that expert witness is from the same specialty as the defendant physician Prevent frivolous lawsuits Improve the practice environment for physicians in your stateWhenever a physician’s conduct is being called into question, it is only fair...

  • Prostate Cancer Awareness & Assessment

    Where We Stand Continue the progress that has been made in the reduction of prostate cancer morbidity and mortality with the appropriate use of prostate cancer testing. Ensure that third-party payors provide for the reimbursement of prostate cancer testing when the patient and his physician...

  • Uniform Prior Authorization for Prescriptions and Health Services

    Where We Stand Prior authorizations cost the health system $728 million in 2012. Prior authorization requests must use a single form, no more than two pages in length. Forms must available for both access and submission electronically. Requests are deemed approved if no response is...

  • Work Force — Scope of Practice

    Where We Stand Allow the maximum patient-to-physician ratio to increase based on the number of physician assistants in a practice. Expand the ability of nurse practitioners and physician assistants to supervise medical assistants when doctors aren’t on the premises.Proactive Physician...

Home Search Profile Privacy Policy Sign InJoin AACU Contact Facebook Twitter UROPAC Action Center