IB 
Union Calendar No. 354 
115TH CONGRESS 
1ST SESSION H. R. 3726 
[Report No. 115–479, Part I] 
To amend title XVIII of the Social Security Act to create alternative sanctions 
for technical noncompliance with the Stark rule under Medicare, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 11, 2017 
Mr. MARCHANT (for himself, Mr. KIND, and Mr. MEEHAN) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
DECEMBER 21, 2017 
Additional sponsor: Mr. CURBELO of Florida 
DECEMBER 21, 2017 
Reported from the Committee on Ways and Means with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
DECEMBER 21, 2017 
The Committee on Energy and Commerce discharged; committed to the Com-
mittee of the Whole House on the State of the Union and ordered to be 
printed 
[For text of introduced bill, see copy of bill as introduced on September 11, 2017] 
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A BILL 
To amend title XVIII of the Social Security Act to create 
alternative sanctions for technical noncompliance with 
the Stark rule under Medicare, and for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Stark Administrative 
Simplification Act of 2017’’. 
SEC. 2. ALTERNATIVE SANCTIONS FOR TECHNICAL NON-
COMPLIANCE 
WITH 
STARK 
RULE 
UNDER 
MEDICARE. 
Section 1877 of the Social Security Act (42 U.S.C. 
1395nn) is amended by adding at the end the following new 
subsection: 
‘‘(j) SELF-DISCLOSURE PROTOCOLS.— 
‘‘(1) IN GENERAL.—Beginning one year after the 
date of the enactment of this subsection— 
‘‘(A) an entity or individual may volun-
tarily disclose a compensation arrangement with 
actual or potential inadvertent technical non-
compliance with subsection (a)(1) (as defined in 
paragraph (3)(H)) pursuant to either the self-re-
ferral disclosure protocol (defined in paragraph 
(2)) or the alternative protocol for technical non-
compliance under paragraph (3); 
‘‘(B) disclosures voluntarily withdrawn 
from the alternative protocol for technical non-
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compliance may be submitted to the self-referral 
disclosure protocol; and 
‘‘(C) an entity that, prior to the establish-
ment of the alternative protocol for technical 
noncompliance, disclosed to the self-referral dis-
closure protocol a compensation arrangement 
that was in inadvertent technical noncompliance 
with subsection (a)(1), may elect, not later than 
one year after such alternative protocol is estab-
lished, to withdraw such disclosure from the self- 
referral disclosure protocol and instead submit 
the disclosure to such alternative protocol. 
‘‘(2) SELF-REFERRAL DISCLOSURE PROTOCOL.— 
The term ‘self-referral disclosure protocol’ or ‘SRDP’ 
means the protocol specified in section 6409 of Public 
Law 111–148. 
‘‘(3) ALTERNATIVE PROTOCOL FOR INADVERTANT 
TECHNICAL NONCOMPLIANCE.— 
‘‘(A) IN GENERAL.—The Secretary shall es-
tablish, not later than one year after the date of 
the enactment of this subsection, an alternative 
protocol for technical noncompliance (in this 
subsection referred to as the ‘APTN’) to enable 
entities to disclose arrangements that were pre-
viously in inadvertent technical noncompliance 
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‘‘(I) the compensation arrange-
ment that was in technical noncompli-
ance with subsection (a)(1); 
‘‘(II) how and when the technical 
noncompliance with subsection (a)(1) 
was ended or the arrangement was oth-
erwise terminated; and 
‘‘(III) how the remuneration paid 
under the compensation arrangement 
being disclosed was— 
‘‘(aa) consistent with the fair 
market value of the items and 
services that were provided under 
the compensation arrangement; 
and 
‘‘(bb) not determined in a 
manner that directly or indirectly 
takes into account the volume or 
value of referrals or other business 
generated between the parties; 
‘‘(iii) include a form settlement agree-
ment provided by the Secretary signed by 
the entity; and 
‘‘(iv) include a certification from the 
entity that, to the best of the entity’s knowl-
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edge, the information provided is truthful 
information and is based on a good faith ef-
fort to bring the matter to the Secretary’s 
attention. 
‘‘(C) ACCEPTANCE OR REJECTION OF DIS-
CLOSURE
BY
THE
SECRETARY.—The following 
rules shall apply to the acceptance or rejection of 
a disclosure under the APTN: 
‘‘(i) The Secretary shall accept or re-
ject a complete, accurate, and timely disclo-
sure. 
‘‘(ii) Upon receipt of a disclosure, the 
Secretary shall notify the disclosing party 
of such receipt. 
‘‘(iii) The Secretary may request addi-
tional information from the disclosing 
party. 
‘‘(iv) Upon acceptance by the Sec-
retary, the Secretary shall notify the dis-
closing party in writing of such acceptance. 
‘‘(v) The disclosure shall be rejected 
if— 
‘‘(I) the disclosing party fails to 
furnish the additional information re-
quested by the Secretary in such form 
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and manner as the Secretary may 
specify; or 
‘‘(II) in the Secretary’s sole deter-
mination, the noncompliance disclosed 
did not meet the disclosure require-
ments specified in subparagraph (B). 
‘‘(vi) The disclosure shall be accepted 
if— 
‘‘(I) the Secretary has issued a 
written notice to the disclosing party 
that the disclosure is determined to sat-
isfy the requirements for disclosures 
under this section; or 
‘‘(II) the disclosure is complete, 
accurate, and timely and satisfies each 
of the requirements for disclosures 
under this section, 180 calendar days 
have passed since notification of re-
ceipt by the Secretary of the disclosure, 
and the Secretary has not rejected the 
disclosure during that period. 
‘‘(vii) In determining whether to ac-
cept a disclosure, the Secretary may reason-
ably rely on the information and certifi-
cations included in the disclosure. 
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‘‘(D) RULE FOR WITHDRAWAL OF DISCLO-
SURE.—Prior to acceptance or rejection of a dis-
closure by the Secretary, an entity may volun-
tarily withdraw such disclosure from the APTN. 
‘‘(E) CIVIL MONETARY PENALTIES PURSU-
ANT TO THE ALTERNATIVE PROTOCOL FOR TECH-
NICAL NONCOMPLIANCE.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), for each arrangement disclosed under 
this subsection and accepted under subpara-
graph (C), the Secretary shall impose a sin-
gle civil monetary penalty of— 
‘‘(I) $5,000, in the case in which 
disclosure of the inadvertant technical 
noncompliance with subsection (a)(1) 
was submitted to the Secretary not 
later than the date that is one year 
after the initial date of inadvertent 
technical noncompliance with sub-
section (a)(1); or 
‘‘(II) $10,000, in the case in 
which the disclosure of the inadvertant 
technically noncompliance with sub-
section (a)(1) was submitted to the 
Secretary— 
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‘‘(aa) after the date that is 
more than one year after the ini-
tial date of the entity’s inad-
vertent technical noncompliance 
with subsection (a)(1); and 
‘‘(bb) not after the date that 
is 3 years (or, in the case of a dis-
closure submitted after the 5th 
year for which this subsection ap-
plies, the date that is 2 years) 
from the initial date of the enti-
ty’s inadvertent technical non-
compliance with subsection (a)(1). 
‘‘(ii) SPECIAL
RULE
FOR
ENTITIES 
THAT
DISCLOSED
TO
THE
APTN
AFTER 
WITHDRAWING
A
DISCLOSURE
FROM
THE 
SRDP.—In the case of an entity that elects 
under paragraph (1)(C) to withdraw a dis-
closure from the self-referral disclosure pro-
tocol (as defined in paragraph (2)) and in-
stead submit the disclosure to the APTN 
under this subsection, in determining the 
applicable civil monetary penalty under 
clause (i), the date of disclosure to the self- 
referral disclosure protocol shall be sub-
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stituted for the date of disclosure to the 
APTN. 
‘‘(F) RELATION TO ADVISORY OPINIONS.— 
The APTN shall be separate from the advisory 
opinion process set forth in regulations imple-
menting subsection (g) of this section. 
‘‘(G) PUBLICATION ON INTERNET WEBSITE 
OF APTN INFORMATION.—Not later than one year 
after the date of the enactment of this subsection, 
the Secretary shall post information on the pub-
lic Internet website of the Centers for Medicare 
& Medicaid Services to inform relevant stake-
holders of how to disclose and make payment of 
a civil monetary penalty for inadvertent tech-
nical noncompliance with subsection (a)(1). 
‘‘(H) DEFINITIONS.—In this subsection: 
‘‘(i) TECHNICAL
NONCOMPLIANCE.— 
The term ‘technical noncompliance with 
subsection (a)(1)’ means, with respect to a 
compensation arrangement, that— 
‘‘(I) the arrangement is not signed 
by one or more parties to the arrange-
ment; 
‘‘(II) following the expiration of 
the arrangement, the arrangement was 
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a holdover arrangement for a period 
longer than permitted in regulations 
issued by the Secretary; or 
‘‘(III) the contemporaneous writ-
ten 
documentation 
evidencing 
the 
terms of the arrangement identifies the 
parties to the arrangement and the 
items, services, space, or equipment, as 
applicable, but is not sufficient to sat-
isfy the writing requirement of an ap-
plicable exception. 
‘‘(ii) INADVERTENT.—The term ‘inad-
vertent’ means, with respect to a compensa-
tion arrangement that is in technical non-
compliance with subsection (a)(1), that an 
entity that is a party to the compensation 
arrangement did not know or should not 
have known of the noncompliance. 
‘‘(I) ADMINISTRATION.—Chapter 35 of title 
44, United States Code, shall not apply to this 
subsection. 
‘‘(J) 
IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may 
implement the provisions of this paragraph by 
program instruction or otherwise.’’. 
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Union Calendar No. 354 
115TH CONGRESS 
1ST SESSION 
H. R. 3726 
[Report No. 115–479, Part I] 
A BILL 
To amend title XVIII of the Social Security Act to 
create alternative sanctions for technical non-
compliance with the Stark rule under Medicare, 
and for other purposes. 
DECEMBER 21, 2017 
Reported from the Committee on Ways and Means with 
an amendment 
DECEMBER 21, 2017 
The Committee on Energy and Commerce discharged; 
committed to the Committee of the Whole House on 
the State of the Union and ordered to be printed 
VerDate Sep 11 2014 
23:19 Dec 21, 2017
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