TITLE 42--PUBLIC HEALTH
CHAPTER IV--CENTERS FOR MEDICARE
& MEDICAID SERVICES,
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
PART 411_EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT
--Table of Contents
Subpart J_Financial Relationships Between Physicians and Entities
Furnishing Designated Health Services
Sec. 411.356 Exceptions to the referral prohibition related to ownership
or investment interests.
For purposes of Sec. 411.353, the following ownership or
investment interests do not constitute a financial relationship:
(a) Publicly-traded securities. Ownership of investment securities
(including shares or bonds, debentures, notes, or other debt
instruments) that at the time the DHS referral was made could be
purchased on the open market and that meet the requirements of
paragraphs (a)(1) and (a)(2) of this section.
(1) They are either--
(i) Listed for trading on the New York Stock Exchange, the American
Stock Exchange, or any regional exchange in which quotations are
published on a daily basis, or foreign securities listed on a
recognized foreign, national, or regional exchange in which quotations
are published on a daily basis; or
(ii) Traded under an automated interdealer quotation system
operated by the National Association of Securities Dealers.
(2) They are in a corporation that had stockholder equity exceeding
$75 million at the end of the corporation's most recent fiscal year or
on average during the previous 3 fiscal years. ``Stockholder equity''
is the difference in value between a corporation's total assets and
total liabilities.
(b) Mutual funds. Ownership of shares in a regulated investment
company as defined in section 851(a) of the Internal Revenue Code of
1986, if the company had, at the end of its most recent fiscal year, or
on average during the previous 3 fiscal years, total assets exceeding
$75 million.
(c) Specific providers. Ownership or investment interest in the
following entities, for purposes of the services specified:
(1) A rural provider, in the case of DHS furnished in a rural area
(as defined at Sec. 411.351 of this subpart) by the provider. A
``rural provider'' is an entity that furnishes substantially all (not
less than 75 percent) of the DHS that it furnishes to residents of a
rural area and, for the 18-month period beginning on December 8, 2003
(or such other period as Congress may specify), is not a specialty
hospital.
(2) A hospital that is located in Puerto Rico, in the case of DHS
furnished by such a hospital.
(3) A hospital that is located outside of Puerto Rico, in the case
of DHS furnished by such a hospital, if--
(i) The referring physician is authorized to perform services at
the hospital;
(ii) Effective for the 18-month period beginning on December 8,
2003 (or such other period as Congress may specify), the hospital is
not a specialty hospital; and
(iii) The ownership or investment interest is in the entire
hospital and not merely in a distinct part or department of the
hospital.