Delores L. Galias, RN, RHIT

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MEDICARE NEWS

FOR IMMEDIATE RELEASE
CMS Press Office
March 19, 2004

CMS ISSUES GUIDANCE FOR EXCEPTIONS TO SPECIALTY HOSPITAL MORATORIUM

The Centers for Medicare & Medicaid Services today announced details of
its plan to implement a moratorium on physician investment in and
referrals to certain specialty hospitals.  Under the moratorium, a
physician may not refer a patient to a specialty hospital in which he
has an ownership or investment interest, and the hospital may not bill
Medicare or any other entity for services provided as a result of a
prohibited referral.

The moratorium was enacted by Congress as part of the Medicare
Prescription Drug, Improvement and Modernization Act of 2003 (MMA).  It
became effective when the law was signed on December 8, 2003, and it
will expire June 8, 2005.

The MMA moratorium expressly applies to hospitals that are primarily or
exclusively engaged in the care and treatment of patients with cardiac
or orthopedic conditions, patients receiving surgical procedures, and
patients receiving any other specialized type of services that CMS may
designate.  In addition, the law specifies that the following types of
hospitals are not subject to the moratorium:  psychiatric hospitals,
rehabilitation hospitals, children's hospitals, long-term care
hospitals, and those cancer hospitals that are not paid under the
inpatient hospital prospective payment system.  CMS has decided not to
expand the moratorium to other types of specialty hospital services at
this time.

The MMA also excludes from the moratorium (or grandfathers), hospitals
that were in operation before or under development as of November 18,
2003.  In determining whether a hospital was under development as of
that date, the law instructs CMS to consider whether architectural plans
were completed, funding was received, zoning requirements were met, and
necessary approvals from appropriate State agencies were received.  CMS
can also consider additional evidence that would indicate whether a
specialty hospital was under development.

Parties wishing to obtain a determination as to whether their specific
hospital was under development may request an advisory opinion under
existing procedures established by CMS for advisory opinions on the
application of the physician self-referral law.  Specialty hospitals
that had Medicare provider agreements in effect as of November 18, 2003
are considered to have been in operation as of that date and do not need
to request a CMS determination.


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