Rep. McDermott Asks CMS to Submit Plan To Resolve Backlog of Stark Submissions

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By Steve Teske  

 

Rep. Jim McDermott (D-Wash.), ranking member on the House Ways and Means Health Subcommittee, has asked the Centers for Medicare & Medicaid Services to submit a written plan for revising its self-referral disclosure protocol, used by various health care providers to self-disclose actual or potential violations of the physician self-referral law.

As the lead author of the provision in the Affordable Care Act establishing the protocol, McDermott, in an Aug. 13 letter to CMS Administrator Marilyn Tavenner, said the agency was taking several months to settle disclosures that have been submitted under the law, often called the Stark law.


   

“It is important that providers and suppliers have some level of certainty that a submission made through the protocol will be acted upon in a timely manner."  

 

 

--Rep. Jim McDermott

The letter calls on CMS to more promptly resolve disclosures made through the protocol. It also asks the agency to submit a detailed plan by Oct. 15 to address the backlog and to ensure that the protocol will function better in the future.

McDermott said CMS has received nearly 300 submissions under the protocol since it was published in September 2010 but has settled fewer than 30.

CMS received 18 submissions under the Stark self-referral disclosure protocol in the first three months of 2013 and expects roughly 100 submissions for the entire year, an agency official said March 21 (57 HCDR, 3/25/13).

Level of Certainty Needed

“It is important that providers and suppliers have some level of certainty that a submission made through the protocol will be acted upon in a timely manner," McDermott said in the letter. “It simply is not sustainable to continue as CMS is currently operating if there is a one year backlog in resolving submissions.”

“Clearly, CMS is overwhelmed by the number of disclosures it has received through the protocol,” McDermott said. “Accordingly, the process that CMS is using to resolve disclosures must be modified.”

McDermott recommended five ways CMS could modify the protocol to relieve the backlog. He said the agency could issue guidance on time parameters, so providers would have more certainty when submitting disclosures. He also said the agency could change its internal deliberative process used to determine the amounts due.

McDermott also recommended CMS consider making public certain limited information related to CMS's internal deliberations over the submissions to help providers better track their submissions, and consider transferring more serious cases to the Department of Health and Human Services Office of Inspector General.

The lawmaker also said CMS could spur providers to submit more thorough disclosure applications initially, thus cutting down the amount of staff time needed to get more information, by moving providers with repeated difficulties submitting complete applications to the “back of the line.”