Health Law Daily Wrap Up, STARK SELF-REFERRAL LAW—NOTICES: Physician-owned hospital granted exception, facility can expand, (Mar 11, 2021)
What exception did a physician-owned Louisiana hospital fall under for CMS to give expansion approval?
CMS has announced its decision to approve the request of a Louisiana physician-owned hospital for an exception to the prohibition on facility expansion. The hospital, Solutions Medical Consulting, LLC d/b/a Serenity Springs Hospital, submitted the data and certifications required for CMS to approve the exception based on the hospital’s qualifications as a "high Medicaid facility" (Notice, 86 FR 13901, March 11, 2021).
Exception. A physician-owned hospital that seeks an exception to the prohibition on expansion of facility capacity must qualify as an “applicable hospital” or "high Medicaid facility" under 42 C.F.R. 411.362(c)(2) and (3) and be granted an exception by the Secretary of HHS. Individuals and entities in the community where the provider is requesting the exception must have an opportunity to provide input on the provider’s request for the exception. In December 2020, CMS solicited comments from entities in the community but received no comments in the 30-day comment period.
Serenity Springs Hospital. CMS found that the hospital met the requirements as a "high Medicaid facility" to qualify for the exception because the hospital:
is not the sole hospital in the county where the hospital is located;
had an annual percent of total inpatient admissions under Medicaid that is estimated to be greater than the percent for any other hospital located in the county in which the hospital is located; and
certified that it does not discriminate against beneficiaries of federal health care programs and does not permit physicians practicing at the hospital to discriminate against such beneficiaries
With the approval by CMS, Solutions Medical Consulting, LLC d/b/a Serenity Springs Hospital will add 18 total operating rooms, procedure rooms, and beds. The expansion may occur exclusively in facilities in the hospital’s main campus. CMS also determined that the planned expansion will be less than 200 percent of the hospital’s baseline number of operating rooms, procedure rooms, and beds and, as a result, is within the regulatory limitations currently in place.
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