May 2019 ~

The Promoting Integrity in Medicare Act (PIMA) or HR 2143, has been introduced to Congress that seeks to update Medicare policies by preventing self-referrals related to advanced imaging services, radiation therapy, anatomic pathology and physical therapy.

The new legislation has been designed to have a direct impact on the services provided by physicians who self-refer for the performance of certain designated health services. If passed, PIMA would provide for increased penalties for Stark law violations involving the specified non-ancillary services.

The proposal seeks to exclude specified complex “non-ancillary services” from the Stark law’s in-office ancillary services (IOAS) and physicians’ services exceptions, increasing penalties for violations, and adding compliance review provisions.

PIMA would define the four non-ancillary services as: advanced imaging, anatomic pathology, radiation therapy, and physical therapy.

The definition of specified non-ancillary service would not include: (1) services furnished in an urban area to an individual who resides in a rural area on the same day as the patient’s initial office visit; (2) services furnished as part of a Medicare shared savings program or accountable care organization; (3) services provided under a CMS Innovation Center model; or (4) services provided by an integrated multi-specialty group practice (as defined in the legislation).

Additionally, the proposed legislation would restrict the exclusion contained in the current definition of the term “entity” in the Stark rules from applying to the technical component or the professional component of a specified non-ancillary service.

According to a statement from the bill’s co-sponsor, Representatives Jackie Speier, the Stark Law, as it stands, “bars physicians from referring Medicare patients for certain health care services in which they have a financial interest but includes an “in-office ancillary services exception.” PIMA restores the original intent of the self-referral law by prohibiting self-referral for four complex services which are not typically performed at the time of the patient’s initial office visit”.

Source(s): Congress.gov; Radiology Business; Health Industry Washington Watch;