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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 
EO 13771 Designation: uncollected 
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