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This rule proposes to address any undue regulatory impact and burden of the physician self-referral law.

Statement of Need:

This rule is necessary to facilitate the successful transition from volume-based to value-based payment for health care services and promote care coordination among health care providers and suppliers who furnish care to Medicare beneficiaries and other patients. This rule is also necessary to bring needed clarity and flexibility for parties subject to the physician self-referral law’s prohibitions on referrals and Medicare claims submission.

Summary of the Legal Basis:

This rule interprets section 1877 of the Social Security Act.

Alternatives:

We will continue to explore alternatives as we develop the rule.

Anticipated Costs and Benefits:

We believe that this rule could have a positive impact on health outcomes of beneficiaries and other American patients because providers, suppliers and physicians will be able to better coordinate patient care without running afoul of the physician self-referral law’s referral and Medicare claims submission prohibitions. We also believe the proposed regulatory reforms may make compliance with the physician self-referral law more straightforward.

Risks: