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AHA Pushes PARTS Bill for Rural Hospitals

 |  By John Commins  
   August 06, 2014

Looks like when lawmakers return next month, Congress will retroactively approve another stopgap measure related to oversight of outpatient therapy services at critical access and small rural hospitals.

Things have gotten so dysfunctional in the U.S. Capitol that Congress can't even act on a bill to delay something.

Since 2012 Congress has suspended a Centers for Medicare & Medicaid Services rule that requires direct physician oversight of outpatient therapy services at critical access and small rural hospitals.

The oversight rule was suspended because it proved particularly burdensome in areas where physicians tend to be in short supply. The practical effect was that relatively routine outpatient services such as drawing blood were restricted or even eliminated because physicians weren't readily available to provide immediate supervision.

That delay of the oversight rule actually expired on Jan. 1, 2014, but Congress has signaled that it will continue to delay the rule while lawmakers work on a more permanent fix. (Sound familiar?)

Now, more than halfway through 2014, it looks like Congress will retroactively approve another stopgap measure for 2014 when lawmakers return next month following a long summer vacation.

The Senate approved the delay by unanimous consent this spring, and a House version is set for a floor vote after easily clearing committee in July. Also, there does not appear to be any fiscal note tied to the legislation.

So, about the time 2015 rolls around, hospitals will be covered for 2014.

It's not completely a moot point. Even retroactively, the delay means that rural providers will get some measure of protection when recovery audit contractors are resurrected.

"For instance, if the Medicare program or the Inspector General wanted to go back and go after the hospitals potentially for noncompliance with direct supervision requirement, this enforcement delay would not allow that to happen. So, it does protect hospitals," says Lisa Kidder, vice president of legislative affairs at the American Hospital Association.

Kidder says the rules around physician oversight are ambiguous.

"What does 'immediately available' mean? This can always be second-guessed," Kidder says. "Different Medicare contractors in different states may interpret the requirements a little differently, so hospitals are never 100% sure that what they have put into place would mean that they are in compliance according to their contractors."

Some of its PARTS
AHA is pushing to get the stopgap delay into 2015 as they urge Congress to adopt a permanent fix laid out in the Protecting Access to Rural Therapy Services (PARTS) Act.

PARTS would:

  • Adopt a default standard of "general supervision" for outpatient therapeutic services and supplement with a reasonable exceptions process with provider input to identify those specific procedures that require direct supervision.
  • Ensure that for critical access hospitals the definition of "direct supervision" is consistent with their conditions of participation that allow a physician or non-physician practitioners to arrive within 30 minutes of being called.
  • Prohibit enforcement of CMS's retroactive reinterpretation that the "direct supervision" requirements applied to services furnished since Jan. 1, 2001.

Roslyne Schulman, director of policy at AHA, says PARTS has not been scored by the Congressional Budget Office, so it's not clear if the bill will carry a fiscal note, which would otherwise prove problematic. The biggest reason for kicking the can with the "Doc Fix" bill is the cost.

"We have talked internally on that and we don't think there would be a large score attached to it," Schulman says. "There really aren't any costs associated with it. It sets up a panel. It has some prohibitions on the OIG. But there really aren't a lot of things that cost money to the Medicare system."

Patient Safety Considerations
Another hurdle for PARTS includes provisions for patient safety. Schulman says that's been taken into consideration.

"PARTS adopts a default standard of general supervision, which means the services are furnished under the overall direction and control of a physician, but their presence is not needed while the services are being furnished," she says.

"The bill would adopt a default standard of general supervision for outpatient therapeutic services but they would be supplemented with an exceptions process, in which CMS could identify specific services that due to safety concerns would require direct supervision."

PARTS has a lot going for it. It appears to be a practical and effective provision to allow rural providers to operate at greater efficiency within the limits of their staffing. At the same time, it keeps in place critical standards for patient safety and provider accountability.

The bill won't get taken up before the new 114th Congress is called into session next January, so it's difficult to predict how it will be received. That shouldn't stop rural providers who support PARTS from contacting their Congressional delegation today. There's already been enough delay.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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