Affordable Care Act and Implications for Certification of Physician-owned Hospitals

The Affordable Care Act prohibits the referral of Medicare beneficiaries by physician owners or investors to new PoHs or to existing PoHs that have expanded their facility capacity beyond their baseline (as described below). An exceptions process allows some PoHs, which meet specific criteria, to expand after the baseline date.The statutory prohibition applies to physician owner referral and hospital billing activity. It does not prohibit licensure by the States or Medicare certification by the Centers for Medicare & Medicaid Services (CMS) of new or expanded PoHs.