U.S. Senators Jon Tester (D-Mont.) and John Thune (R-S.D.) – members of the Senate Rural Health Caucus along with Sen. Moran – introduced the PARTS Act last Congress (S. 1143).
“Rural hospitals need reasonable flexibility to appropriately staff their facilities so they can provide a full range of services to their communities,” Sen. Moran said. “Many hospitals find the Centers for Medicare and Medicaid Services’ direct supervision requirements impossible to meet, which jeopardizes access to this important care. The PARTS Act would preserve patient safety and oversight while easing unreasonable supervision requirements for therapy care. This bill is crafted to make certain federal regulations reflect the realities of rural health care and address this issue on a permanent basis.”
“Outpatient therapeutic services” include services such as pulmonary rehabilitation, certain behavior health assessments and counseling, demonstration/evaluating the use of an inhaler or nebulizer, and certain casting/splinting procedures.
While CMS subsequently revised its standard to also permit direct supervision by certain qualified non-physician practitioners (NPPs), the agency still requires the physical presence of the supervising professional by mandating the supervisor be “immediately available” at all times these services are provided to beneficiaries.
While the need for this “direct supervision” is recognized for certain high risk, complex outpatient services, CMS’ policy often applies to even low risk services, such as some medication injections and minor wound debridement.
For many years, these procedures have been safely administered in hospital outpatient departments under “general supervision,” a standard that permits services to be furnished under the general oversight and control of a supervising practitioner without requiring his or her physical presence.
In fact, in December 2014 President Obama signed into law H.R. 4067 – legislation unanimously passed by Congress – that suspended enforcement of this CMS regulation on Critical Access Hospitals (CAHs) and other small rural hospitals in 2014.
“CMS’ physician supervision policy poses a threat to the delivery of health care in rural Kansas hospitals,” Hutchinson Regional Medical Center President and CEO Kevin Miller said. “We need a permanent solution that recognizes how we operate hospitals in rural America. The PARTS Act fixes this problem by providing rural hospitals with the flexibilities necessary to continue providing the much needed therapy services to patients in their own communities.”
“In rural Kansas, the ability to provide accessible, timely care is critical. The PARTS Act creates a reasonable approach to the physician supervision requirements,” Anderson County Hospital CEO Denny Hachenberg said. “Without this legislation, our hospital would face difficulties in meeting the challenging requirements, thus causing many of our patients to delay care or seek the services outside of our local community.”
The PARTS Act would:
- Require CMS to allow a default setting of general supervision, rather than direct supervision, for outpatient therapeutic services;
- Create an advisory panel to establish an exceptions process for risky and complex outpatient services;
- Create a special rule for CAHs that recognizes their unique size and Medicare conditions of participation; and
- Hold hospitals and CAHs harmless from civil or criminal action for failing to meet CMS' current direct supervision policy for the period 2001 through 2016.
