Bill blocks therapeutic services direct supervision policy for remainder of 2015

The Senate voted to extend, through the remainder of 2015, a prohibition preventing CMS from enforcing the direct supervision policy for outpatient therapeutic services in rural areas. The extension via legislation S. 1461 is intended to provide additional time for the body to advance the Protecting Access to Rural Therapy Services (PARTS) Act (S. 257). The PARTS Act clarifies that general supervision of most outpatient therapeutic services by a physician or non-physician practitioner is sufficient for payment of therapeutic hospital outpatient services.


S. 1461 will extend the temporary relief to allow the senators additional time to advance their PARTS Act, in response to concerns raised by hospitals and lawmakers (see Rural hospitals flounder under heavy regulatory restrictions, ask for help, Health Law Daily, July 30, 2015). The 2009 OPPS Proposed rule (73 FR 68502) restated CMS’ policy of requiring the direct supervision of outpatient therapeutic services performed at hospitals. However, on March 15, 2010, CMS instructed its Medicare contractors not to evaluate or enforce the supervision requirements for therapeutic services provided to critical access hospital (CAH) outpatients until it could revisit the issue.

CMS later extended the instruction to include small rural hospitals with 100 or fewer beds that are located in a rural area or paid under the OPPS with a rural wage index, and expanded the exception through 2012. On November 1, 2012, CMS released a statement extending the provision through 2013. Congress suspended enforcement of the regulation through 2014 (see Bill extending exception for rural hospitals awaits Obama’s signature, Health Law Daily, November 24, 2014). The regulation was scheduled to go into effect in 2015.

S. 1461 will now be sent to the House of Representatives for consideration.