Protecting Access to Rural Therapy Services (PARTS) Act - Amends title XVIII (Medicare) of the Social Security Act to state that, except with respect to high-risk or complex medical services requiring direct levels of supervision, if the Secretary of Health and Human Services (HHS) requires supervision by a physician or non-physician practitioner for Medicare payment for therapeutic hospital outpatient services, that requirement is met if such services are furnished under the physician's or non-physician practitioner's general supervision.
Directs the Secretary of HHS to establish a process for designating therapeutic hospital outpatient services for which direct supervision may be required for the entire service or direct supervision during the initiation of the service followed by general supervision for the remainder of the service.
Declares without force or effect in law regarding Medicare requirements for direct supervision by physicians for therapeutic hospital outpatient services a specified restatement and clarification under the final rulemaking changes to the Medicare hospital outpatient prospective payment system and calendar year 2009 payment rates, which was published in the Federal Register on November 18, 2008.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 1143 Introduced in Senate (IS)]
113th CONGRESS
1st Session
S. 1143
To amend title XVIII of the Social Security Act with respect to
physician supervision of therapeutic hospital outpatient services.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 12, 2013
Mr. Moran (for himself, Mr. Thune, and Mr. Tester) introduced the
following bill; which was read twice and referred to the Committee on
Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act with respect to
physician supervision of therapeutic hospital outpatient services.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Protecting Access to Rural Therapy
Services (PARTS) Act''.
SEC. 2. REQUIREMENTS FOR PHYSICIAN SUPERVISION OF THERAPEUTIC HOSPITAL
OUTPATIENT SERVICES.
(a) Therapeutic Hospital Outpatient Services.--
(1) Supervision requirements.--Section 1833 of the Social
Security Act (42 U.S.C. 1395l) is amended by adding at the end
the following new subsection:
``(z) Physician Supervision Requirements for Therapeutic Hospital
Outpatient Services.--
``(1) General supervision for therapeutic services.--Except
as may be provided under paragraph (2), insofar as the
Secretary requires the supervision by a physician or a non-
physician practitioner for payment for therapeutic hospital
outpatient services (as defined in paragraph (5)(A)) furnished
under this part, such requirement shall be met if such services
are furnished under the general supervision (as defined in
paragraph (5)(B)) of the physician or non-physician
practitioner, as the case may be.
``(2) Exceptions process for high-risk or complex medical
services requiring a direct level of supervision.--
``(A) In general.--Subject to the succeeding
provisions of this paragraph, the Secretary shall
establish a process for the designation of therapeutic
hospital outpatient services furnished under this part
that, by reason of complexity or high risk, require--
``(i) direct supervision (as defined in
paragraph (5)(C)) for the entire service; or
``(ii) direct supervision during the
initiation of the service followed by general
supervision for the remainder of the service.
``(B) Consultation with clinical experts.--
``(i) In general.--Under the process
established under subparagraph (A), before the
designation of any therapeutic hospital
outpatient service for which direct supervision
may be required under this part, the Secretary
shall consult with a panel of outside experts
described in clause (ii) to advise the
Secretary with respect to each such
designation.
``(ii) Advisory panel on supervision of
therapeutic hospital outpatient services.--For
purposes of clause (i), a panel of outside
experts described in this clause is a panel
appointed by the Secretary, based on
nominations submitted by hospital, rural
health, and medical organizations representing
physicians, non-physician practitioners, and
hospital administrators, as the case may be,
that meets the following requirements:
``(I) Composition.--The panel shall
be composed of at least 15 physicians
and non-physician practitioners who
furnish therapeutic hospital outpatient
services for which payment is made
under this part and who collectively
represent the medical specialties that
furnish such services, and of 4
hospital administrators of hospitals
located in rural areas (as defined in
section 1886(d)(2)(D)) or critical
access hospitals.
``(II) Practical experience
required for physicians and non-
physician practitioners.--During the
12-month period preceding appointment
to the panel by the Secretary, each
physician or non-physician practitioner
described in subclause (I) shall have
furnished therapeutic hospital
outpatient services for which payment
was made under this part.
``(III) Minimum rural
representation requirement for
physicians and non-physician
practitioners.--Not less than 50
percent of the membership of the panel
that is comprised of physicians and
non-physician practitioners shall be
physicians or non-physician
practitioners described in subclause
(I) who practice in rural areas (as
defined in section 1886(d)(2)(D)) or
who furnish such services in critical
access hospitals.
``(iii) Application of faca.--The Federal
Advisory Committee Act (5 U.S.C. 2 App.), other
than section 14 of such Act, shall apply to the
panel of outside experts appointed by the
Secretary under clause (ii).
``(C) Special rule for outpatient critical access
hospital services.--Insofar as a therapeutic outpatient
hospital service that is an outpatient critical access
hospital service is designated as requiring direct
supervision under the process established under
subparagraph (A), the Secretary shall deem the critical
access hospital furnishing that service as having met
the requirement for direct supervision for that service
if, when furnishing such service, the critical access
hospital meets the standard for personnel required as a
condition of participation under section 485.618(d) of
title 42, Code of Federal Regulations (as in effect on
the date of the enactment of this subsection).
``(D) Consideration of compliance burdens.--Under
the process established under subparagraph (A), the
Secretary shall take into account the impact on
hospitals and critical access hospitals in complying
with requirements for direct supervision in the
furnishing of therapeutic hospital outpatient services,
including hospital resources, availability of hospital-
privileged physicians, specialty physicians, and non-
physician practitioners, and administrative burdens.
``(E) Requirement for notice and comment
rulemaking.--Under the process established under
subparagraph (A), the Secretary shall only designate
therapeutic hospital outpatient services requiring
direct supervision under this part through proposed and
final rulemaking that provides for public notice and
opportunity for comment.
``(F) Rule of construction.--Nothing in this
subsection shall be construed as authorizing the
Secretary to apply or require any level of supervision
other than general or direct supervision with respect
to the furnishing of therapeutic hospital outpatient
services.
``(3) Initial list of designated services.--The Secretary
shall include in the proposed and final regulation for payment
for hospital outpatient services for 2015 under this part a
list of initial therapeutic hospital outpatient services, if
any, designated under the process established under paragraph
(2)(A) as requiring direct supervision under this part.
``(4) Direct supervision by non-physician practitioners for
certain hospital outpatient services permitted.--
``(A) In general.--Subject to the succeeding
provisions of this subsection, a non-physician
practitioner may directly supervise the furnishing of--
``(i) therapeutic hospital outpatient
services under this part, including cardiac
rehabilitation services (under section
1861(eee)(1)), intensive cardiac rehabilitation
services (under section 1861(eee)(4)), and
pulmonary rehabilitation services (under
section 1861(fff)(1)); and
``(ii) those hospital outpatient diagnostic
services (described in section 1861(s)(2)(C))
that require direct supervision under the fee
schedule established under section 1848.
``(B) Requirements.--Subparagraph (A) shall apply
insofar as the non-physician practitioner involved
meets the following requirements:
``(i) Scope of practice.--The non-physician
practitioner is acting within the scope of
practice under State law applicable to the
practitioner.
``(ii) Additional requirements.--The non-
physician practitioner meets such requirements
as the Secretary may specify.
``(5) Definitions.--In this subsection:
``(A) Therapeutic hospital outpatient services.--
The term `therapeutic hospital outpatient services'
means hospital services described in section
1861(s)(2)(B) furnished by a hospital or critical
access hospital and includes--
``(i) cardiac rehabilitation services and
intensive cardiac rehabilitation services (as
defined in paragraphs (1) and (4),
respectively, of section 1861(eee)); and
``(ii) pulmonary rehabilitation services
(as defined in section 1861(fff)(1)).
``(B) General supervision.--
``(i) Overall direction and control of
physician.--Subject to clause (ii), with
respect to the furnishing of therapeutic
hospital outpatient services for which payment
may be made under this part, the term `general
supervision' means such services that are
furnished under the overall direction and
control of a physician or non-physician
practitioner, as the case may be.
``(ii) Presence not required.--For purposes
of clause (i), the presence of a physician or
non-physician practitioner is not required
during the performance of the procedure
involved.
``(C) Direct supervision.--
``(i) Provision of assistance and
direction.--Subject to clause (ii), with
respect to the furnishing of therapeutic
hospital outpatient services for which payment
may be made under this part, the term `direct
supervision' means that a physician or non-
physician practitioner, as the case may be, is
immediately available (including by telephone
or other means) to furnish assistance and
direction throughout the furnishing of such
services. Such term includes, with respect to
the furnishing of a therapeutic hospital
outpatient service for which payment may be
made under this part, direct supervision during
the initiation of the service followed by
general supervision for the remainder of the
service (as described in paragraph (2)(A)(ii)).
``(ii) Presence in room not required.--For
purposes of clause (i), a physician or non-
physician practitioner, as the case may be, is
not required to be present in the room during
the performance of the procedure involved or
within any other physical boundary as long as
the physician or non-physician practitioner, as
the case may be, is immediately available.
``(D) Non-physician practitioner defined.--The term
`non-physician practitioner' means an individual who--
``(i) is a physician assistant, a nurse
practitioner, a clinical nurse specialist, a
clinical social worker, a clinical
psychologist, a certified nurse midwife, or a
certified registered nurse anesthetist, and
includes such other practitioners as the
Secretary may specify; and
``(ii) with respect to the furnishing of
therapeutic outpatient hospital services, meets
the requirements of paragraph (4)(B).''.
(2) Conforming amendment.--Section 1861(eee)(2)(B) of the
Social Security Act (42 U.S.C. 1395x(eee)(2)(B)) is amended by
inserting ``, and a non-physician practitioner (as defined in
section 1833(z)(5)(D)) may supervise the furnishing of such
items and services in the hospital'' after ``in the case of
items and services furnished under such a program in a
hospital, such availability shall be presumed''.
(b) Prohibition on Retroactive Enforcement of Revised
Interpretation.--
(1) Repeal of regulatory clarification.--The restatement
and clarification under the final rulemaking changes to the
Medicare hospital outpatient prospective payment system and
calendar year 2009 payment rates (published in the Federal
Register on November 18, 2008, 73 Fed. Reg. 68702 through
68704) with respect to requirements for direct supervision by
physicians for therapeutic hospital outpatient services (as
defined in paragraph (3)) for purposes of payment for such
services under the Medicare program shall have no force or
effect in law.
(2) Hold harmless.--A hospital or critical access hospital
that furnishes therapeutic hospital outpatient services during
the period beginning on January 1, 2001, and ending on the
later of December 31, 2014, or the date on which the final
regulation promulgated by the Secretary of Health and Human
Services to carry out this Act takes effect, for which a claim
for payment is made under part B of title XVIII of the Social
Security Act shall not be subject to any civil or criminal
action or penalty under Federal law for failure to meet
supervision requirements under the regulation described in
paragraph (1), under program manuals, or otherwise.
(3) Therapeutic hospital outpatient services defined.--In
this subsection, the term ``therapeutic hospital outpatient
services'' means medical and other health services furnished by
a hospital or critical access hospital that are--
(A) hospital services described in subsection
(s)(2)(B) of section 1861 of the Social Security Act
(42 U.S.C. 1395x);
(B) cardiac rehabilitation services or intensive
cardiac rehabilitation services (as defined in
paragraphs (1) and (4), respectively, of subsection
(eee) of such section); or
(C) pulmonary rehabilitation services (as defined
in subsection (fff)(1) of such section).
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line