DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for ...

CMS-1503-FC 885
are finalizing our proposal that the suppliers be located within a 25-mile radius of the
physician's location at the time of the referral.
We solicited comments related to whether there are procedures or circumstances
in which it may be difficult or impractical to provide the written disclosure prior to the
provision of advanced imaging services. We are finalizing this rule without creating such
an exception.
We also solicited comments regarding an alternative notice that includes a
"reasonable" list of other suppliers with general requirements for the disclosure to
patients, while providing that if the physician meets the more specific requirements set
forth in the proposed rule he or she will be deemed to have a "reasonable" disclosure.
We are not finalizing this in the final rule as we did not receive comments in support of
this alternative.
Comment: A number of commenters asked that the list of alternate suppliers
include hospitals. Two commenters stated CMS has taken an overly literal interpretation
of "suppliers" and has incorrectly excluded hospitals from the list of alternate sites. The
commenters also noted that in many areas, especially rural, the community hospital is the
largest or only remaining independent provider of imaging services. Another pair of
commenters stated that providing a partial list of options is inconsistent with
transparency, inconsistent with collaborative alignment between providers and suppliers,
and that including both providers and suppliers would be more consistent with
"informing a patient's decision-making regarding his or her own care."
Several commenters urged CMS to allow, and even to require, that physicians
include hospitals and CAHs in the written list of alternate suppliers who provide imaging