• Introducing Stark Phase V
  • January 19, 2016 | Author: Grace D. Mack
  • Law Firm: Wilentz, Goldman & Spitzer P.A. - Woodbridge Office
  • On November 16, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published the most significant changes to the physician self-referral law (“Stark Law”) regulations since 2008. Currently being referred to as “Stark Phase V,” these changes constitute the fifth substantive rulemaking under the Stark Law. This rulemaking, which was part of the Medicare Physician Fee Schedule, contains a number of important changes. Several amendments are aimed at easing the burden of existing compensation exceptions related to the signature and writing requirements; the length of term requirement; holdover arrangements, and the definitions of the terms remuneration, stand-in-the-shoes and locum tenens.

    Phase V clarifies a number of issues that routinely arise within the context of documenting compliance with the Stark Law, including:
    • allowing an arrangement that qualifies for a Stark Law exception to continue indefinitely after the arrangement's expiration date;
    • granting all parties involved 90 days to seek a Stark Law exemption to obtain missing signatures on an agreement;
    • clarifying that leasing arrangements involving office space, equipment and/or personal services must last at least one year to qualify for a Stark Law exception;
    • clarifying that parties to an arrangement seeking a Stark Law exception do not need to have a formal written contract;
    • allowing for the sharing of office space, assuming: the arrangement is in writing and is between a hospital and a physician; and
    • clarifying the policy that “incident to” Medicare Part B, services must be billed by the supervising physician or practitioner.
    In addition, CMS introduced two new Stark Law exceptions: (1) for timeshare arrangements for the use of office space, equipment, personnel, items, supplies and other services, and (2) for assistance to compensate non-physician practitioners under certain circumstances. The timeshare exception indicates a departure from CMS’ historical reluctance to address the sharing of space. However, the timeshare exception applies only to limited arrangements predominantly for the provision of E&M services.