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Outpatient supervision bill introduced in House

July 26, 2013

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Reps. Kristi Noem, R-SD, and Collin Peterson, D-MN, July 23 introduced H.R. 2801, a House companion to S.1143, the “Protecting Access to Rural Therapy Services Act” – or PARTS Act – introduced in the Senate last month by Sen. Jerry Moran, R-KS.

The AHA-supported legislation would allow general supervision by a physician or non-physician practitioner (NPP) for many outpatient therapy services – a policy change that many small rural hospitals say is critical to ensuring that rural residents continue to receive a range of outpatient services in their own communities.

Under the proposed outpatient prospective payment system (PPS) rule, critical access hospitals (CAH) and small rural hospitals next year would be required to follow the Centers for Medicare & Medicaid Services’ (CMS) direct supervision policy. The policy requires a supervising physician or non-physician practitioner (NPP) to be immediately available whenever a Medicare patient receives outpatient therapeutic services. General supervision allows the service to be performed under the overall direction and control of a physician or NPP without them being present.

CMS had placed direct supervision on hold for CAHs and small rural hospitals with no more than 100 beds since 2009. That’s when CMS first mandated the policy as part of that year’s outpatient PPS rule. The agency characterized the change as a “restatement and clarification” of existing outpatient payment policy that had been in place since 2001 – a move that placed hospitals at increased risk for unwarranted enforcement actions.

In a July 23 letter to Noem, the AHA disputed CMS’ assertion that the direct supervision requirement simply
restates and clarifies outpatient policy. “It is, in fact, a significant change that has left hospitals and CAHs vulnerable.”

The AHA said the PARTS Act “acknowledges this and seeks relief for hospitals who were appropriately providing patient care.” For more on the AHA’s letter, click on:
http://tinyurl.com/kao2t2p.  

H.R. 2801 would require CMS to allow a default setting of general supervision, rather than direct supervision, for outpatient therapy services and create an advisory panel to establish an exceptions process for risky and complex outpatient services. The legislation also would create a special rule for CAHs that recognizes their unique size and Medicare conditions of participation; and would hold hospitals and CAHs harmless from civil or criminal action for failing to meet the “direct supervision” requirements applied to services provided since 2001.