In its recently published 2016 Physician Fee Schedule Rule (the
"Rule"), the Centers for Medicare & Medicaid Services
(CMS) finalized two new exceptions from the federal physician
self-referral regulations ("Stark Law") on (1) employment
assistance for certain non-physician practitioners and (2)
timeshare arrangements.
The Rule establishes a new exception at 42 C.F.R. 411.357(x) to
permit payment by hospitals, Federally Qualified Health Centers,
and Rural Health Clinics to physicians for the purpose of
compensating non-physician practitioners (physician assistants,
nurse practitioners, clinical nurse specialists and certified nurse
midwives) under certain circumstances. The exception will apply
only when the non-physician practitioner is a bona fide employee of
the physician or practice receiving the support and when the
purpose of the employment is to provide primary care services. The
exception caps the amount of support at 50% of the non-physician
practitioner's actual compensation, signing bonus and benefits
for a period not to exceed two years.
The Rule also creates a new exception at 42 C.F.R. 411.357(y) to
permit the common practice of timeshare arrangements between
hospitals or physicians for the use of office space, equipment,
personnel, items, supplies, and other services that must be used
predominantly to furnish evaluation and management services. It is
important to note that the exception specifically excludes imaging
equipment, radiation therapy equipment, and clinical or
pathology laboratory equipment, and does not protect timeshare
arrangements offered by other types of healthcare
organizations.
As with other Stark Law exceptions, the newly created exceptions
require that the arrangements be in writing and not be conditioned
on referrals to a hospital, remuneration from a hospital, or other
business generated between the parties, and must be based on fair
market value.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.