As described in our July 5, 2007, memorandum the Centers for Medicare and Medicaid Services (“CMS”) recently proposed a number of significant and controversial revisions to the Medicare program rules in its 2008 Medicare Physician Fee Schedule (“MPFS”) Proposed Rule, including revising the independent diagnostic testing facility (“IDTF”) performance standards, expanding the scope of the anti-markup rule for diagnostic tests and narrowing the exceptions available under the physician self-referral regulations.  On November 1, 2007, CMS released an advanced copy of the final rule for 2008 MPFS which, in addition to a projected 10.1 percent payment decrease, finalizes the proposed revisions to the IDTF performance standards and the anti-markup rules.  Notably, CMS declined at this time to adopt as final any of the controversial changes it proposed to the physician self-referral regulations.  The changes become effective for services rendered on or after January 1, 2008.