On March 30, 2020, CMS issued blanket waivers of several Stark Law requirements related to COVID-19 physician arrangements. The Stark waivers can be relied upon retroactively to March 1, 2020, until the expiration or termination of the declared public health emergency.
The Stark waivers can be relied upon for financial arrangements that relate ONLY to a “COVID-19 Purpose.” CMS identified the following COVID-19 Purposes:
Scope of the Stark Waivers Related to Fair Market Value Compliance
The Stark waivers exempt providers from sanctions for noncompliance with the Stark Law related to the following types of arrangements, absent the government’s determination of fraud or abuse:
Physician Services – Payment from an entity to a physician that is above or below FMV for services personally performed by the physician to the entity;
Space/Equipment Rentals – Rental charges for equipment or office space that is below FMV;
Payments to Physicians – Payments from an entity to a physician that are below FMV for items or services purchased by the entity from the physician;
Payments from Physicians – Payments from a physician to an entity that are below FMV for the use of the entity’s premises or for items or services purchased by the physician;
Medical Staff – Remuneration that exceeds the current medical staff incidental benefits amount ($36 per occurrence) or annual nonmonetary compensation ($423) limit;
Loans – Loan payments: (1) with an interest rate below FMV; or (2) on terms that are unavailable from a lender that is not in a position to generate business for the physician;
Physician-Owned Hospitals – Referrals by a physician owner of a hospital that temporarily expands its facility capacity above its amount allotted under the physician-owned hospital exception. In addition, referrals by a physician owner of a hospital that converted from a physician-owned ambulatory surgical center to a hospital on or after March 1, 2020, provided that the hospital meets certain requirements;
Group Practices – Referrals by a physician in a group practice for medically necessary designated health services furnished by the group practice: (1) in a location that does not qualify as a “same building” or “centralized building”; or (2) to a patient in his or her private home, an assisted living facility or independent living facility where the referring physician’s principal medical practice does not consist of treating patients in their private home;
Home Health – Referrals to a non-rural home health agency when the physician has an ownership in the home health agency;
Rural Areas – Referrals by a physician to an entity with which the physician’s immediate family member has a financial relationship if the patient who is referred resides in a rural area; and
Other – Referrals by a physician to an entity with whom the physician has a compensation arrangement that satisfies the substance of an applicable exception but is not in writing or signed as required by the exception (unless the arrangement is already covered by another waiver).
The information provided herein is of a general nature and cannot be substituted for an actual fair market valuation opinion, in which specialized knowledge is applied to a particular circumstance. Therefore, nothing in this paper should be construed to offer or render a valuation or legal advice and neither Chris David or HealthValue Group can take any responsibility for an attempt to use or adopt the information or disinformation presented herein.