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From Health Law Daily, September 11, 2014

House gives green light to moratorium on hospital supervision rule

By Melissa Skinner, JD

In a voice vote on the evening of September 10, 2014, the U.S. House of Representatives passed a bill that will extend a moratorium of a CMS action that required critical access hospitals (CAHs) and small rural hospitals to institute physician supervision of certain outpatient therapeutic services throughout 2014. Congresswoman Lynn Jenkins, the creator of the bill, stated after the passage that “the bill corrects a decision that puts a strain on providers and gives more certainty to folks in rural communities so they can receive the quality of healthcare they deserve.” She added that she was “hopeful” that the bill would also pass the Senate and be signed into law soon.

Supervision requirement. In January of 2014, CMS lifted the moratorium on the supervision rule which required physician supervision of certain outpatient services provided by CAHs and small rural hospitals. According to Congresswoman Jenkins’ remarks, the CMS decision meant that “physicians are now required to directly supervise outpatient services, such as drawing blood and activity therapy.” In turn, the Congresswoman argued, a strain would be put on providers in the affected facilities including the 83 CAHs in her home state of Kansas. Jenkins called these hospitals “the lifeblood of our rural communities,” and stated that “one of the many challenges these communities face is access to health care.”

Passed bill. The bill would reverse CMS’s determination to lift the moratorium on the supervision requirement and extend CMS’ former enforcement instruction on supervision requirements through 2014. In turn, the supervision requirements for these affected CAH and small rural hospitals, which Jenkins claimed provided “no quality improvements for the patients they serve,” will not be in place.

Support for bill. Prior to the passage of the bill through the House, Jenkins noted that the bill had “broad bipartisan support in Congress, and the support of key stakeholders.” Indeed, several health care associations and facilities submitted letters in support of the bill. For instance, in a letter of support authored by the American Hospital Association, it was urged that the extension of the moratorium was a “needed delay,” as it noted that while it recognized the need for supervision of certain high risk or complex services, “the CMS service generally applies to even the lowest risk services.” Moreover, the Kansas Hospital Association asserted that the lifting of the moratorium by CMS may have limited “the hospital’s ability to provide their outpatients with basic therapeutic services.”

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