Health Information Management

House bill extends moratorium for CAH therapeutic supervision enforcement

APCs Insider, September 12, 2014

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By Steven Andrews, Editor
Acts of Congress superseding CMS authority can throw a hospital's plans into disarray—as we saw with the recent ICD-10 delay—but they can also be beneficial.
This week, the House of Representatives passed H.R. 4067. The bill extends the enforcement moratorium on outpatient therapeutic services requiring direct supervision for critical access hospitals (CAHs) and small rural hospitals through 2014. The Senate passed a similar bill in February.
The push to move these services from direct to general supervision has been an ongoing issue for CAHs. In the 2009 OPPS final rule, CMS mandated the policy to require direct supervision of outpatient therapeutic services. In subsequent rules, CMS delayed enforcement of this policy through 2013, but did not extend the moratorium for 2014. This meant as of January 1, 2014, CMS and its contractors could enforce the policy. However, with the passage of similar, retroactive bills in the Senate and House, the moratorium would be back in place for all of 2014 once President Obama signs the bill.
While the 2015 OPPS proposed rule did not include mention of another extended moratorium, identical bills in the House (H.R. 2801) and Senate (S. 1143), both named the Protecting Access to Rural Therapy Services (PARTS) Act, were introduced in 2013. The PARTS Act:
Amends title XVIII (Medicare) of the Social Security Act to state that except with respect to high-risk or complex medical services requiring direct levels of supervision, if the Secretary of Health and Human Services (HHS) requires supervision by a physician or non-physician practitioner for Medicare payment for therapeutic hospital outpatient services, that requirement is met if such services are furnished under the physician's or non-physician practitioner's general supervision.
Directs the Secretary of HHS to establish a process for designating therapeutic hospital outpatient services for which direct supervision may be required for the entire service or direct supervision during the initiation of the service followed by general supervision for the remainder of the service.
Declares without force or effect in law regarding Medicare requirements for direct supervision by physicians for therapeutic hospital outpatient services a specified restatement and clarification under the final rulemaking changes to the Medicare hospital outpatient prospective payment system and calendar year 2009 payment rates, which was published in the Federal Register on November 18, 2008.
Passage of the PARTS Act, which has relatively broad, bipartisan support, would therefore remove the need for repeated extensions of the moratorium by permanently changing these services for certain hospitals from direct to general supervision. Despite the bipartisan support and the American Hospital Association actively lobbying for the PARTS Act, it has languished in committees for more than a year.
However, the Hospital Outpatient Payment Panel continues to listen to provider concerns on supervision level changes for individual therapeutic services on a semi-annual basis, before voting on whether to recommend the changes to CMS.

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