Alternative payment models. Integrated delivery systems. Provider and payer consolidation. Each of these trends reflect the evolution of our nation’s varied health care delivery and financing systems toward the common goal of better care at lower cost. Laws and regulations in most states, however, have failed to keep up with these practical developments, and some policymakers would further inhibit patient-centered care with proposals to impose new referral restrictions.
Also from the AACU: Congressional retirements promise to make waves
Although physician self-referral is regulated at the federal level through the Stark law, its application is limited to public payers such as Medicaid and Medicare. At least 35 states have their own laws or regulations restricting referral arrangements. The American Medical Association's Advocacy Resource Center identifies three "significant differences" between the Stark law and state statutes:
- State laws may apply to more payers.
- State laws may apply to more providers.
- State laws may encompass a broader range of services.
In recent years, lawmakers in several states considered legislation to conform their laws and exceptions to those outlined in the Stark law. Gov. Andrew Cuomo of New York vetoed legislation in 2012 that would have brought the state's statutes in line with federal law by limiting their application to public payers and adding a few designated health services to the list of exceptions. According to Mintz Levin, a law firm specializing in health care transactions, in vetoing the bill the governor took "the position that a more restrictive statute... outweighs the functional benefits of consistency with its federal counterpart."
Fast forward to January 2018, when Colorado State Sen. Irene Aguilar introduced legislation to extend the state's "mini-Stark law" to services reimbursed by private payers (SB18-115). Faced with opposition from the AACU, Rocky Mountain Urological Society, and Colorado Medical Society, a Senate committee indefinitely postponed consideration of this bill on Feb. 14. Pennsylvania State Rep. Anthony DeLuca, meanwhile, has repeatedly introduced a bill to extend the current prohibition for "self-referrals" that exists for the Commonwealth's workers compensation system to all medical services. His version for the current legislative session has remained stagnant since being referred to the House Health Committee in early 2017 (HB347).