U.S. Sens. Jerry Moran (R-Kan.), Jon Tester (D-Mont.), and John Thune (R-S.D.) – members of the Senate Rural Health Caucus – today introduced S. 257, the Protecting Access to Rural Therapy Services (PARTS) Act. The legislation would ensure rural and other patients have access to a full range of outpatient therapeutic services in hospitals in their own communities. The senators introduced the PARTS Act last Congress (S. 1143).
“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 Sen. Thune. “Further, this CMS requirement can place extraordinary demands on physicians, and it is these kinds of regulations that keep physician recruitment to rural areas challenging. 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.”
“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.”
“Rural families face unique health care hardships and they deserve access to quality care without being forced to travel long distances,” Sen. Tester said. “This bill removes burdens for rural patients, provides Critical Access Hospitals certainty, and upholds the standard of health care that rural Americans expect.”
“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. Hospital outpatient therapeutic services have always been administered by licensed, skilled professionals under the overall direction of a physician. However, in 2009 the Centers for Medicare and Medicaid Services (CMS) abruptly shifted policy to require that outpatient therapeutic services must be furnished under the “direct supervision” of a physician who is required to be physically present in the department at all times that Medicare beneficiaries receives these services. 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.
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.