Crosswalk

Crosswalk for PRA Renewal of CMS-10328
30-Day Notice PRA Package
Updates to the CMS Voluntary Self-Referral Disclosure Protocol
OMB No. 0938-1106
Section/Page
Number
CMS-10328 –
Voluntary
Disclosure
Protocol,
page 3

CMS-10328 –
Voluntary
Disclosure
Protocol

Subsection
Instructions,
section
IV.A.2.b

SRDP
Disclosure
Form, section
III

Current Language/Current Format
Note that the physician services
exception at § 411.355(a) and the inoffice ancillary services exception at §
411.355(b) are available only to a
physician practice that qualifies as a
group practice under § 411.352.

For all remaining forms of
noncompliance, determine the type(s)
of noncompliance being disclosed (i.e.,
compensation arrangement failing to
satisfy an applicable exception at §
411.357, ownership or investment
interest failing to satisfy an applicable
exception at § 411.356, or the provision
of services failing to satisfy an applicable
exception at § 411.355), and report the
pervasiveness of the noncompliance
relative to the disclosing party’s similar
financial relationships (in the case of
compensation arrangements or
ownership or investment interests) or
similar services furnished (in the case of
designated health services that failed to
meet an applicable exception at §
411.355). When reporting more than

Updated Language/Updated Format
Note that, if a physician practice consists
of two or more physicians and does not
qualify as a group practice under
§ 411.352, the practice may not rely on
the exception for physician services
exception at § 411.355(a) and or the
exception for in-office ancillary services
exception at § 411.355(b) are available
only to a physician practice that qualifies
as a group practice under § 411.352.
For all remaining forms of
noncompliance, determine the type(s) of
noncompliance being disclosed (i.e.,
compensation arrangement failing to
satisfy an applicable exception at §
411.357, ownership or investment
interest failing to satisfy an applicable
exception at § 411.356, or the provision
of services failing to satisfy an applicable
exception at § 411.355), and report the
pervasiveness of the noncompliance
relative to the disclosing party’s similar
financial relationships (in the case of
compensation arrangements or
ownership or investment interests) or
similar services furnished (in the case of
designated health services that failed to
meet an applicable exception at §
411.355). When reporting more than one

Last updated:August 26, 2022

Reason for
Change
Clarification of
the applicability
of the
exceptions at
§ 411.355(a)
and
§ 411.355(b) to
physician
practices.

Level of
Burden/Impact
None

State explicitly
that disclosing
parties can
provide an
estimate of the
pervasiveness of
noncompliance.

None

Page 1 of 4

Group
Practice
Information
Form
Instructions,
page 1

N/A

one type of noncompliance, the
pervasiveness of the noncompliance
may be reported by type of
noncompliance or in the aggregate. For
disclosures of noncompliant
compensation arrangements, do not
include arrangements involving
nonmonetary compensation or medical
staff incidental benefits in the
determination of the pervasiveness of
the noncompliance, unless the disclosed
noncompliance resulted from a failure
to comply with § 411.357(k) or §
411.357(m).

type of noncompliance, the
pervasiveness of the noncompliance may
be reported by type of noncompliance or
in the aggregate. For disclosures of
noncompliant compensation
arrangements, do not include
arrangements involving nonmonetary
compensation or medical staff incidental
benefits in the determination of the
pervasiveness of the noncompliance,
unless the disclosed noncompliance
resulted from a failure to comply with §
411.357(k) or § 411.357(m). The
disclosing party may provide a
reasonable estimate of the pervasiveness
of noncompliance. If relying on
estimates, please indicate that estimates
were used and explain how the estimates
were calculated.

The Group Practice Information Form
should be completed only by physician
practices (referred to herein as
practices) that are reporting
noncompliance with the physician selfreferral law arising from the failure to
qualify as a group practice under §
411.352. That is, if a practice sought to
qualify as a group practice under §
411.352 in order to use the physician
services exception at § 411.355(a) or the
in-office ancillary services exception at
§ 411.355(b), but these exceptions were
unavailable to the practice because it
failed to meet one or more
requirements in
§ 411.352, the noncompliance should be

The Group Practice Information Form
should be completed only by physician
practices consisting of at least two
physicians (referred to herein as
practices) that are reporting
noncompliance with the physician selfreferral law arising from the failure to
qualify as a group practice under §
411.352. That is, if a practice sought to
qualify as a group practice under §
411.352 in order to use the physician
services exception at § 411.355(a) or the
in-office ancillary services exception at
§ 411.355(b), but these exceptions were
unavailable to the practice because it
failed to meet one or more requirements
in

Last updated:August 26, 2022

Clarification that
the Group
Practice
Information
Form cannot be
used by
physicians in
solo practice.

None

Page 2 of 4

reported using this form.

§ 411.352, the noncompliance should be
reported using this form.

Last updated:August 26, 2022

Group
Practice
Information
Form
Instructions,
page 1

N/A

N/A – New paragraph is being added to
existing instructions.

The Group Practice Form should not be
used to report noncompliance arising
solely from the failure of an entity to
satisfy all the requirements of an
applicable exception in § 411.355,
including the exception for physician
services at § 411.355(a) and the
exception for in-office ancillary services
at § 411.355(b). For example, a physician
practice that qualified as a group practice
under § 411.352 but failed to satisfy all
the requirements of the in-office ancillary
services exception at § 411.355(b) should
continue to use the SRDP Disclosure
Form and separate Physician Information
Forms for each physician in the practice
who made prohibited referrals. Likewise,
the Group Practice Information Form
should not be used by the medical
practice of a physician in solo practice to
report the failure to satisfy all the
requirements of the in-office ancillary
services exception at § 411.355(b).

Clarification that
the Group
Practice
Information
Form should not
be used to
report the
failure to satisfy
an exception in
§411.355.

None

Group Practice
Information
Form, page 2

Section I.A.

§ 411.352(g) Volume or value of
referrals & § 411.352(i) Special rule for
profit shares and productivity bonuses
• Please describe the specific
circumstances of the practice’s
failure to satisfy the requirements
at § 411.352(g), taking into
account the application of the
special rule at § 411.352(i).

§ 411.352(g) Volume or value of
referrals & § 411.352(i) Special rule rules
for profit shares and productivity
bonuses
• Please describe the specific
circumstances of the practice’s
failure to satisfy the requirements
at § 411.352(g), taking into account
the application of the special rule
rules at § 411.352(i).

Correction of
the citation to
§411.352(i).

None

Clarification that
a party may
satisfy the
requirement at
§411.352(g) by
meeting the
Page 3 of 4

Group Practice
Information
Form, pages 1
though 3.

Section I.A

For example: Certain members of the
practice received productivity bonuses
that took into account referrals for
designated health services that were
neither personally performed by the
physicians nor incident to the physician’s
personally performed services.

For example: Certain members of the
practice received productivity bonuses
that took into account referrals for
designated health services that were
neither personally performed by the
physicians nor incident to the physician’s
personally performed services and the
productivity bonuses did not meet the
conditions of the special rules at §
411.352(i).

N/A

The prompt at I.A continues onto several
pages. Instructions have been added at
the bottom of pages 1 and 2 to alert
readers that the prompt continues on the
next page. At the end of the prompt on
page 3, an instruction has been added
noting that the text box for providing a
response can be found on page 4.

Last updated:August 26, 2022
conditions of
the special rules
at §411.352(i).

Instructions to
assist parties
filling out the
form.

None

Page 4 of 4