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HHS/CMS

RIN: 0938-AG80

Publication ID: Spring 1999

Title: Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships--Expanded to Designated Health Services (HCFA-1809-F)
Abstract: This rule provides that a physician who has (or whose immediate family member has) a financial relationship with a health care entity may not make referrals to that entity for certain services (designated health services) under the Medicare program except under specified circumstances. In the Medicaid context, this rule would deny payment to a State for expenditures for designated health services furnished on the basis of a physician referral that, all things being equal, would result in denial of payment under Medicare. The provisions of the rule are based on sections 13562 and 13624 of OBRA '93 and section 152 of SSAA '94.
Agency: Department of Health and Human Services(HHS)	Priority: Other Significant
RIN Status: Previously published in the Unified Agenda	Agenda Stage of Rulemaking: Long-Term Actions
Major: Undetermined	Unfunded Mandates: No
CFR Citation: 42 CFR 411.1 42 CFR 411.350 to 411.361 42 CFR 424.22 42 CFR 435.1002 42 CFR 435.1012 42 CFR 455.100 to 455.109
Legal Authority: 42 USC 1302 42 USC 1395hh 42 USC 1395nn

Timetable:

Action	Date	FR Cite
NPRM	01/09/1998	63 FR 1659
NPRM Comment Period End	05/11/1998

Additional Information: BPD-1809-P
Regulatory Flexibility Analysis Required: Yes	Government Levels Affected: State
Small Entities Affected: Businesses
Included in the Regulatory Plan: No
Agency Contact: Joanne Sinsheimer Technical Advisor Department of Health and Human Services Centers for Medicare & Medicaid Services Center for Medicare Management, Chronic Care Policy Group, C4-25-02, 7500 Security Boulevard, Baltimore, MD 21244 Phone:410 786-4620