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HHS/CMS RIN: 0938-AT64 Publication ID: Fall 2019 
Title: Modernizing and Clarifying the Physician Self-Referral Regulations (CMS-1720-P) 

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

Agency: Department of Health and Human Services(HHS)  Priority: Other Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Proposed Rule Stage 
Major: No  Unfunded Mandates: No 
EO 13771 Designation: Not subject to, not significant 
CFR Citation: 42 CFR 411   
Legal Authority: 42 U.S.C. 1395nn   
Legal Deadline:  None

Statement of Need:

This rule is necessary to facilitate the successful transition from volume-based to value-based payment for healthcare services and promote care coordination among healthcare 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.


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 of the proposals in this rule are still under development and will be included in the published rule for comment.

Action Date FR Cite
RFI Notice With Comment Period  06/25/2018  83 FR 29524   
RFI Comment Period End  08/28/2018 
NPRM  10/17/2019  84 FR 55766   
NPRM Comment Period End  12/31/2019 
Regulatory Flexibility Analysis Required: Undetermined  Government Levels Affected: None 
Federalism: No 
Included in the Regulatory Plan: Yes 
RIN Data Printed in the FR: No 
Agency Contact:
Lisa O. Wilson
Senior Technical Advisor
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicare, MS: C4-25-02, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-8852