U.S. Senator Jerry Moran (R-Kan.), member of the Senate Rural Health Caucus, recently introduced S. 778, the Protecting Access to Rural Therapy Services (PARTS) Act, to ensure rural populations 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 traditionally been administered by licensed, skilled medical professionals in hospitals under the overall direction of a physician. However, in an attempt to clarify existing regulations, the Centers for Medicare & Medicaid Services (CMS) retroactively interpreted the policy in 2009 to require that a physician not only provide supervision, but physically be present at all times when therapy services are being provided -- the majority of which are low risk.
"CMS' policy does not take into account the realities of rural health care. Many Kansas hospitals, and other rural hospitals across the country, will 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 while easing unreasonable regulations on hospitals."
"CMS' supervision policy threatens the survival of Kansas hospitals," said Dennis George, Chief Executive Officer of Coffey County Hospital in Burlington, Kansas. "We need a permanent solution that recognizes how we operate hospitals in rural America. The PARTS Act would fix this problem by providing rural hospitals with the flexibility we need to continue providing much needed therapy services to patients in their own communities."
In response to concerns raised by Sen. Moran, other lawmakers from rural states, and hospitals, CMS delayed enforcement of direct supervision regulations in 2010 and 2011. However, the regulations are scheduled to go into effect next year.
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 Critical Access Hospitals (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 2011.