Reps. Kristi Noem (R-SD), Kevin Cramer (R-ND), and Ryan Zinke (R-MT) today introduced legislation to better preserve health care services in rural communities.  The Protecting Access to Rural Therapy Services (PARTS) Act would ensure patients in rural America have access to a full range of outpatient therapeutic services in their own community’s hospital.

“Expecting a Critical Access Hospital in rural South Dakota to adhere to the same bureaucratic requirements as a large facility in Chicago or New York is unreasonable and limits the kind of care smaller hospitals can provide,” said Noem. “Rural hospitals need more flexibility to provide a full range of services to their communities. The PARTS Act offers a real solution to the flexibility problem, while preserving the quality of care patients deserve to receive.”

“One size fits all federal regulations for Critical Access Hospitals do not work in rural America,” said Cramer.  “We do not have enough doctors to provide on-the-spot, direct supervision of medical care.  This care is routinely done by other qualified health care professionals.  The PARTS Act empowers rural health care professionals to provide high quality health care through regulatory reforms adapted to suit the challenges of working in rural America.”

“If ObamaCare has taught us anything, it’s that a one-size-fits-all model does not work, especially in health care,” said Zinke. “Access to high-quality care is critical for everyone; but in rural America, the challenges patients face accessing care are different than they are in the inner city. I’m proud to introduce the PARTS Act because it will lead to Montanans receiving better care and it helps rural health care facilities provide a wide range of services to patients in a safe and professional manner.”

Services like pulmonary rehabilitation, certain behavior health assessments and counseling, demonstrating/evaluating the use of an inhaler or nebulizer, and certain casting/splinting procedures are considered “outpatient therapeutic services.”  These kind of services have always been administered by licensed, skilled professionals under the overall direction of a physician. 

In 2009, CMS began requiring that outpatient therapeutic services must be done under the “direct supervision” of a physician, meaning the physician must be physically present in the department at all times when a Medicare beneficiary receives an outpatient therapeutic service.  CMS loosened the regulations slightly in years since by allowing the “direct supervision” to be done by a non-physician practitioner, such as a nurse practitioner, clinical nurse specialist or physician assistant.  Nonetheless, CMS still requires these individuals to be “immediately available” at all times when services are being administered.

While the need for this “direct supervision” is recognized for certain high-risk or complex outpatient services, CMS’ policy often applies to low-risk services as well, such as medical injections. The PARTS Act, which was also introduced by Sens. Moran, Tester and Thune in the Senate, would:

  • Require the Center for Medicare and Medicaid Services (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.

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