H.R. 5613, To provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2016

H.R. 5613

To provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2016

Committee
Ways and Means

Date
September 20, 2016 (114th Congress, 2nd Session)

Staff Contact
Communications

Floor Situation

On­­­­ Tuesday, September 20, 2016, the House will consider H.R. 5613, To provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2016, under suspension of the rules. H.R. 5613 was introduced on July 1, 2016, by Rep. Lynn Jenkins (R-KS) and was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means. The Committee on Ways and Means ordered the bill reported, as amended, by voice vote on July 7, 2016.

Bill Summary

H.R. 5613 requires the department of Health and Human Services to continue to instruct Medicare contractors not to enforce requirements for direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2016.

Background

In November 2009, the Centers for Medicare & Medicaid Services (CMS) confirmed its regulation that requires direct physician supervision. Direct supervision, as defined by 42 Code of Federal Regulations (CFR) 410.32, stipulates that either a physician or non-physician practitioner must be immediately available to provide assistance and guidance during the performance of an outpatient medical procedure. CMS specifically defines which medical services and supplies this direct supervision requirement applies as those non-diagnostic therapeutic services, including: clinical services, emergency room services, and observation services.[1]

CMS originally proposed to apply the direct physician supervision requirement beginning on January 1, 2014, ensuring that critical access hospitals (CAHs) were compliant. However, Congress acted separately in both 2014 and 2015 to actively override any enforcement of the direct supervision requirement. Congress has and continues to apply an exemption for this requirement because of ongoing concerns that such strict regulatory requirements may threaten or limit access to care for beneficiaries living in rural or remote areas.

“In rural hospitals across America, such a requirement is simply not feasible,” according to the bill’s sponsor.[2] Therefore, this legislation would continue temporary relief from enforcing the direct physician supervision mandate for 2016.

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[1] See House Report 114-696, at 2.
[2] See Morning Consult’s Press Release, July 7, 2016.

Cost

Because H.R. 5613 would not change how CMS currently enforces the direct supervision requirement, the Congressional Budget Office (CBO) estimates that enacting the bill would have no significant effect on the federal budget and would not affect direct spending or revenues. Therefore, pay-as-you-go procedures do not apply.

Additional Information

For questions or further information please contact John Wilson with the House Republican Policy Committee by email or at 6-1811.