Stark III: The Bumpy Road Continues

Teleconference Overview

The Centers for Medicare and Medicaid Services (CMS) has published the much-anticipated Phase III final rule on the Stark self-referral law, with an effective date of December 4, 2007. Please join us on Tuesday, September 18 to discuss the new regulations, with a focus on the following questions:

• What is the practical effect of the curtailment of the indirect compensation arrangement exception that requires physician owners of medical groups and physician organizations to “stand in the shoes” of the intermediate entity and thus satisfy a direct Stark exemption?
• What does the new concept of a “physician organization” mean, and how does it apply in the real world? What is the difference between a “group practice” and a “physician organization,” and when does that matter?
• How does the Stark III final rule relate to the changes that will occur if the Medicare physician fee schedule proposed rule (so-called Stark 2.5) takes effect without amendment on or about October 1?
  • What is the availability of per-click payment structures in view of the potentially conflicting provisions of Stark 2.5 and Stark III?
  • How do the Stark III “stand in the shoes” and the similar Stark 2.5 provisions apply to customary relationships between DHS providers and physician groups, including routine subsidies by hospitals of affiliated physician groups and faculty practice plans?
• What options may a DHS entity consider when it discovers inadvertent, de minimis, or “technical” Stark violations for minimizing or, indeed, altogether avoiding the panoply of Stark penalties?
• What are the preconditions to use of the new extension of the six-month hold-over to personal services arrangements?
• What is the significance of the elimination of safe-harbor protection for certain hourly compensation methodologies in personal services arrangements?