CHA News Article

Federal Commission Reports on Critical Access Hospital Direct Supervision

As required by the 21st Century Cures Act, the Medicare Payment Advisory Commission (MedPAC) has released a report on physician supervision requirements for outpatient therapeutic services in critical access hospitals and small rural hospitals. Specifically, MedPAC was required to report to Congress on the effects of recent extensions of non-enforcement of the direct supervision requirements on Medicare beneficiaries’ access to and quality of care, as well as its economic impact on the affected hospitals.

Due to a lack of data on whether or how hospitals meet direct supervision requirements, MedPAC based its analysis on interviews with staff from the Centers for Medicare & Medicaid Services (CMS), hospital association representatives and leadership from critical access hospitals in various states. MedPAC states that it did not hear from hospitals that the supervision requirements cause a significant economic burden, and that — while they offered what they believe to be the appropriate supervision — hospitals are unclear whether their supervision policies satisfied CMS requirements.

In its findings, MedPAC reiterates its principle that expectations of quality of care in rural and urban areas should be equal for the nonemergency services rural providers choose to deliver. The commission recommends that CMS use clinical judgment to determine the most appropriate supervision level of therapeutic services, and that its clinical decisions should apply to both urban and rural hospitals. In addition, MedPAC urges the agency to establish physician supervision requirements that are specific and clear, but also allow hospitals flexibility in how they meet those requirements. The full report is available on MedPAC’s website.