New Legislation Seeks to Narrow Stark Law Exceptions for Certain Complex Non-Ancillary Services

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Legislation was introduced in the U.S. House of Representatives which – if enacted – would narrow the “Stark” law’s exceptions and have a direct impact on the services provided by physicians who self-refer for the performance of certain designated health services. The 2019 bill is similar to previous proposals.

If enacted, the bill would strengthen the Stark law by excluding specified complex “non-ancillary services” from the Stark law’s in-office ancillary services (IOAS) and physicians’ services exceptions, increasing penalties for violations, and adding compliance review provisions. With certain exceptions, the legislation would define non-ancillary services as: advanced diagnostic imaging studies; anatomic pathology services; radiation therapy services and supplies; physical therapy services; and any other service the Secretary determines “is not usually provided and completed as part of the office visit to a physician’s office in which the service is determined to be necessary.” The definition of specified non-ancillary service would not include: (1) services furnished in an urban area to an individual who resides in a rural area on the same day as the patient’s initial office visit; (2) services furnished as part of a Medicare shared savings program or accountable care organization; (3) services provided under a CMS Innovation Center model; or (4) services provided by an integrated multi-specialty group practice (as defined in the legislation).

The proposed legislation would provide for increased penalties for Stark law violations involving these specified non-ancillary services with some provisions and exceptions.

The legislation will be reviewed and would also require approval by the Senate before enactment.

Read the Draft Legislation here: HR 2143, the Promoting Integrity in Medicare Act of 2019