The Patient Protection and Affordable Care Act (“PPACA”) contains new disclosure requirements for physicians who refer patients to imaging services provided in their offices under the in-office ancillary exception to the Stark law. Physicians are now required to both inform patients in writing that patients may obtain the service from a supplier other than the referring physician or someone in the physician’s group practice, and provide patients with a list of alternate suppliers.
On June 30, 2010 the Centers for Medicare & Medicaid Services (“CMS”) proposed new regulations implementing PPACA’s new disclosure requirements and, effective January 1, 2011, CMS has finalized these proposed rules, with certain modifications. Physicians offering imaging services to patients under the in-office ancillary exception to the Stark law must be mindful of the following:
· The disclosure obligation applies only to “advanced imaging” services (MRI, CT, and PET).
· The written notice must indicate to patients that the services may be obtained from a person other than the referring physician or his or her group practice.
· The disclosure notice may not tell patients that they must receive imaging from a supplier on the list (if not receiving the service from the referring physician).
· There is no exception to the disclosure requirement for services furnished on an emergency basis.
· The final rule reduced the number of alternate suppliers included with the written notice to five (the proposed rule required 10 alternate suppliers, but this was deemed to be too burdensome).
· Although the list of five alternate suppliers should not include hospitals, critical access hospitals, and other entities that are providers as defined by Medicare, a provider may be included on the list: (i) if the provider is listed in addition to the five alternate suppliers, or (ii) where there are not five other suppliers in the area, providers may be included on the list to give patients options.
· The physician must maintain documentation of the disclosure, but the physician is not required to obtain patient signatures on the disclosure notification, as had originally been proposed.
· The list of other suppliers must include each supplier’s name, address, and phone number. (CMS did not finalize a proposed requirement that required the list to also include distance information regarding the physician’s office location.)
CMS has indicated that it will not be issuing a standard disclosure, so physicians will be required to draft their own disclosure statement. Your Houston Harbaugh attorneys are available to assist you in this process.