U.S. Senator John Thune (R-S.D.), along with U.S. Senators Jon Tester (D-Mont.), and Jerry Moran (R-Kan.)– members of the Senate Rural Health Caucus – today introduced S. 1143, the Protecting Access to Rural Therapy Services (PARTS) Act, to make sure that rural and other patients have access to a full range of outpatient therapeutic services in their own communities. “Outpatient therapeutic services” include services such as drug infusions, blood transfusions, and cardiac and pulmonary rehabilitation services.
These health care services have always been administered by licensed, skilled medical professionals in hospitals under the overall direction of a physician. However, in its attempt to clarify existing regulations in 2009, the Centers for Medicare & Medicaid Services (CMS) retroactively interpreted existing policy in place since 2001 to require that a supervising physician be physically present in the department at all times when Medicare beneficiaries receive outpatient therapy services, the majority of which are low risk.
“Requiring supervising physicians to be present for some outpatient therapy services places an unnecessary strain on the already overextended staff of rural health care facilities,” said Thune. “Further, this CMS requirement can place extraordinary demands on physicians, who are already difficult to recruit to rural areas of the country. I have brought this issue up repeatedly to CMS in Senate Finance Committee hearings and in my personal meetings with CMS Director Marilyn Tavenner without resolution. I look forward to working with my colleagues in the Senate to move our common-sense legislation forward, ensuring we provide rural health care facilities in states like South Dakota with the flexibility needed to continue to deliver quality outpatient therapy services without being subjected to budget-busting workforce regulations.”
“When folks in rural areas get ill, the last thing they need is the added burden of having to travel long distances to get the care they need,” Sen. Tester said. “This bill allows folks in rural communities to receive care at local Critical Access Hospitals and maintains the high-quality health care rural Americans expect and deserve.”
“CMS’ policy does not take into account the realities of rural health care. Many Kansas hospitals, and other rural hospitals across the country, find these supervision requirements impossible to meet – jeopardizing continued access to these important health care services,” Sen. Moran said. “Small and rural hospitals, where medical workforce shortages are most severe, need reasonable flexibility to appropriately staff their facilities so they can continue to provide a full range of services to their communities. The PARTS Act is a commonsense solution that would preserve patient safety and ease unreasonable regulations on hospitals.”
In response to concerns raised hospitals and lawmakers, including Senators Thune, Moran, and Tester, CMS delayed enforcement of its direct supervision policy through 2013 for Critical Access Hospitals (CAHs) and other small, rural hospitals. However, the regulations are scheduled to go into effect in 2014.
The PARTS Act would:
- Allow general supervision by a physician or non-physician providers for many outpatient therapy services;
- Require CMS to allow a default setting of general supervision, rather than direct supervision, for outpatient therapy services;
- Create an advisory panel to establish an exemption 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 regarding CMS’ current direct supervision policy for the period 2001 through 2014.