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2008 MPFS finalized without most of the Stark 2.5 proposals

November 2, 2007

CMS announced late yesterday that it is finalizing the 2008 Medicare physician fee schedule — including the SGR-mandated negative 10% adjustment, since the SCHIP bill upending the SGR (sustainable growth rate) was DOA.  However, it is deferring virtually all of its proposed revisions to the physician self-referral rules that were slipped into the 2008 Medicare physician fee schedule — the so-called Stark 2.5 rules — to be published at a later date. 

The Stark 2.5 proposals garnered over 1,000 comment letters.  CMS staff feels "confident" that it has sufficient information to finalize the Stark 2.5 proposal without need for additional notice and comment.  The final Stark 2.5 rule will address the following proposals:

  • Burden of proof;
  • Obstetrical malpractice insurance subsidies;
  • Unit-of-service (per-click) payments in lease arrangements;
  • The period of disallowance for noncompliant financial relationships;
  • Ownership or investment interests in retirement plans;
  • “Set in advance” and percentage-based compensation arrangements;
  • “Stand in the shoes” provisions;
  • Alternative criteria for satisfying certain exceptions; and
  • Services furnished “under arrangements.”

Changes to the in-office ancillary services exception will, however, be the subject of separate rulemaking, including a new notice and comment period, since the initial draft solicited input and did not propose specific changes.

The only Stark 2.5 proposal being finalized in the 2008 MPFS final rule put on display yesterday (to be published in the Federal Register November 27) is the tightening up of the anti-markup rule (discussion begins on p. 485 of the display copy of the rule linked to above).

— David Harlow

Filed Under: CMS, Health care policy, Health Law, Medicare, Physicians, Stark

you might also like:

  1. David Harlow quoted in Physician Compensation Report article on Stark regulations; final Stark Phase III rules to be published this week

  2. CMS to delay effectiveness of some Stark III rules

  3. 2007 Medicare physician fee schedule finalized

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  1. HealthBlawg says:
    November 15, 2007 at 12:01 pm

    Stark III partial effective date delay published today — and it’s very narrow

    CMS today published a rule delaying the effective date of the Stark III stand in the shoes rule, as it applies to AMCs and 501(c)(3) integrated health systems, for one year (i.e., until December 4, 2008). The one-year delay in

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