Section 6003 of the Patient Protection and Affordable Care Act of 2010 (the "Health Care Reform Law") amends the "In-Office Ancillary Services" exception to the Stark Law's ownership interest and compensation arrangement prohibitions. This exception, generally, allows a physician to refer patients to an entity with which the physician (or the physician's immediate family member) has a prohibited ownership interest or compensation arrangement, if the services provided to the patient are furnished personally by the referring physician, a physician who is a member of the same group practice as the referring physician, or an individual who is supervised by the referring physician or another physician in the group practice.

The Health Care Reform Law's amendment to the In-Office Ancillary Services exception is retroactively effective as of January 1, 2010. This amendment requires physicians who refer patients for MRI, CT, and PET services (or other radiology services that the Secretary determines appropriate) to inform the patient, in writing, at the time of the referral, that the patient can obtain the MRI, CT, or PET services from a supplier other than the referring physician or the physician's practice. The referring physician must also provide the patient with a list of suppliers who furnish the services in the geographic area in which the patient resides.

However, questions need to be answered regarding how many suppliers should be identified in the disclosure, how those suppliers should be selected, and what supplier information needs to be included. Due to the immediate effective date, however, physicians who refer patients for MRI, CT, or PET services should begin preparing a list of suppliers in the area in which the majority of their patients reside. Until further guidance is published, we recommend, at a minimum, that this list include the name, address, and phone number of at least three to five reputable suppliers (unless less than three reputable suppliers provide services in the area).