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HHS/CMS | RIN: 0938-AG80 | Publication ID: Fall 2000 |
Title: Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships-Expanded to Designated Health Services (HCFA-1809-FC) | |
Abstract: This final rule with 90-day comment period (Phase I of this rulemaking) incorporates into regulations the provisions in paragraphs (a), (b), and (h) of section 1877 of the Social Security Act (the Act). Under section 1877, if a physician or a member of a physician's immediate family has a financial relationship with a health care entity, the physician may not make referrals to that entity for the furnishing of designated health services (DHS) under the Medicare program, unless an exception applies. In addition, section 1877 of the Act provides that an entity may not present or cause to be presented a Medicare claim or bill to any individual, third party payer, or other entity for DHS furnished under a prohibited referral, nor may we make payment for a designated health service furnished under a prohibited referral. | |
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 455.103 42 CFR 455.108 42 CFR 455.109 | |
Legal Authority: 42 USC 1302 42 USC 1395hh 42 USC 1395nn |
Legal Deadline:
None |
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Timetable:
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Regulatory Flexibility Analysis Required: Yes | Government Levels Affected: State |
Small Entities Affected: Businesses | Federalism: Undetermined |
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 |