CMS Issues RFI Seeking Input Concerning Changes to Stark Law

The Centers for Medicare and Medicaid Services (“CMS”) recently published a Request for Information “on how to address any undue regulatory impact and burden of the physician self-referral law,” commonly referred to as the Stark law.

According to CMS, the RFI is part and parcel of the Department of Health and Human Services’ (“HHS”) “Regulatory Sprint to Coordinated Care.”  CMS explains that HHS wants to “transform the healthcare system into one that pays for value;” coordination of care is a key aspect of that, and CMS (and HHS) wants to remove government obstacles that impede coordinated care.

The RFI states that CMS is “particularly interested in… thoughts on issues that include, but are not limited to: [1] the structure of arrangements between parties that participate in alternative payment models or other novel financial arrangements; [2] the need for revisions or additions to exceptions to [Stark]; and [3] terminology related to alternative payment models and [Stark].”

The RFI goes on to list 20 areas on which CMS is requesting input.  Some areas pertain more specifically to “alternative payment models and/or other novel financial arrangements.” Other specific areas where input is sought include Stark’s exception for risk-sharing arrangements, and the statute’s definitions of the terms “commercial reasonableness” and “fair market value.”

Yet, other areas where input is welcomed are written more broadly, e.g.:

“15.     Please identify any provisions, definitions, and/or exceptions in the regulations…for which additional clarification would be useful.”


“18.     Please share your thoughts on the compliance costs for regulated entities.”


“20.     Please share your thoughts regarding whether CMS should measure the effectiveness of [Stark] in preventing unnecessary utilization and other forms of program abuse relative to the cost burden on the regulated entity.”

The complete RFI may be found at the following address:

With a list of 20 issues on which one might voice his or her (or its) opinions, it might be said that there is something in the RFI for everybody – or at least many. In any case, public comments are due by August 24, 2018.


Stephen Alvstad

Beautyman Alvstad, LLP

1201 Bethlehem Pike

Flourtown, PA 19031

Tel.:  (c) (215) 640-9968

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