CMS Proposes to Amend or Delete §411.353(g) Special Rule for Certain Arrangements Involving Temporary Noncompliance with Signature Requirements

July 2018- Section 1877 of the Social Security Act, widely known as the physician self-referral law, prohibits a physician from making service referrals payable by Medicare to entities that they may have a financial relationship with. Section 50404 of the Bipartisan Budget Act (“BBA”) of 2018 added provisions to section 1877(h)(1) of the Social Security Act. The added section does not limit an applicable signature requirement to specific exceptions and entities are not restricted to the rule of only once every 3 years with the same referring physician. Moreover, the addition “does not include a reference to the occurrence of referrals or the payment of compensation during the 90 day-period when the signature requirement is not met.”

To be in accordance with the added provision to the Social Security Act, CMS proposed to delete §411.353(g), which is the special rule for certain arrangements involving temporary noncompliance with signature requirements, and instead codify in proposed §411.353(e). Alternatively, CMS has proposed to amend existing §411.353(g) by: “(1) revising the reference at §411.353(g)(1) to specific exceptions and signature requirements; (2) deleting the reference at §411.353(g)(2) to the occurrence of referrals or the payment of compensation during 90-day period when the signature requirement is not met; and (3) deleting the limitation at §411.353(g)(2).”

Public comments on the proposed rules are due by September 10,2018.

Click here to access the CMS press release.

Click here to access CMS’s Proposed Rules PDF (Pages concerning physician self-referral found on 488-492.)

For more information on this topic, please contact Adrienne Dresevic, Esq. at (248) 996-8510 or by email at

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