Axne Puts Forth Bipartisan Legislation to Relieve Rural Hospitals

On Tuesday, Cindy Axne (D-IA) put forth legislation to relieve rural hospitals of supervision restraints that limit the ability of Critical Access Hospitals (CAHs) to provide quality care. Working with Adrian Smith (R-NE), Axne introduced the bipartisan bill to postpone enforcement of oversight rules requiring Medicare hospitals to implement supervision provisions for outpatient therapeutic services.

“We need to address staffing shortages in rural areas, but in the meantime, we need to make sure that regulations aren’t overly burdensome for rural hospitals,” Axne said in a statement.

Arbitrary Supervision

The legislation delays implementation of “direct supervision” – or the requirement that a physician or non-physician practitioner be physically present – for outpatient therapeutic services at rural hospitals until 2021.

“I’ve heard from dozens of rural health care providers across Iowa’s Third District who consistently tell me that staffing shortages continue to be a top concern,” said Axne. “Insufficient staff available for direct supervision can limit the type of care Iowans living in our rural communities can receive.”

Rural hospitals have had difficulties recruiting physicians to practice in rural areas, and the direct supervision requirement can be a limitation on the type of care available to rural Iowans.

“Burdensome regulations like arbitrary physician supervision requirements do not account for the unique challenges faced by rural providers and place a great strain on them. Rural Americans deserve ready access to quality care, and I am pleased this legislation will extend longstanding relief which is necessary to ensuring rural providers can meet the needs of their patients,” said Rep. Smith of Nebraska.

Decade of Delays

This legislation would delay enforcement of this rule until 2021, giving CAHs and rural hospitals more time to comply as Congress works to improve staffing shortages at rural hospitals.

In 2009, the Centers for Medicare and Medicaid Services (CMS) payment rule-making process required Medicare hospitals implement “direct supervision” for outpatient therapeutic services, which means a physician or non-physician practitioner must be physically present, or within an immediate distance.

Rural hospitals and CAHs expressed concerns to CMS regarding insufficient staff available to comply with direct supervision requirements, especially for specialty services.

In response to these concerns, CMS delayed the requirements until 2013. Congress also extended this delayed enforcement from 2013-2016.

CMS has continued non-enforcement in 2018 and 2019. This legislation would again delay the direct supervision enforcement statutorily until 2021.


by Josh Cook
Posted 6/30/19

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