Nov 05 2010
CMS has released its CY 2011 OPPS Final Rule. The Final Rule contains the following significant developments to CMS’s supervision policy for hospital outpatient therapeutic and diagnostic services:
- Non-enforcement policy for critical access hospitals extended for another year. CMS provided notice in early 2010 that it would not enforce the supervision requirements for outpatient therapeutic services provided by critical access hospitals (“CAHs”) in 2010. In contrast to its original intentions, CMS has extended its non-enforcement policy for CAHs through CY 2011.
- Non-enforcement for small rural hospitals in CY 2011. In addition to extending the non-enforcement policy for CAHs, CMS has decided not to enforce the direct supervision requirement for outpatient therapeutic services provided by small rural hospitals that have 100 or fewer beds. CMS will consider a hospital to be rural if it is geographically located in a rural area or paid through the OPPS with a wage index for a rural area. CMS stated that this definition of “small rural hospitals” is the same definition recognized for Transitional Outpatient Payments.
- Removal of physical boundary limitations. For both hospital outpatient therapeutic services and outpatient diagnostic services, direct supervision will no longer include physical boundary limitations for most settings effective January 1, 2011. Direct supervision will only require the supervisor to be “immediately available.” The exception is for diagnostic services provided under arrangements in non-hospital locations, for which direct supervision will still require the supervisor’s physical presence in the office suite at the non-hospital location.
- Non-Surgical extended duration therapeutic services. CMS has established a category of “nonsurgical extended duration therapeutic services” for which direct supervision is required during the initial stage of the service/procedure, followed by general supervision. This category includes 16 services, including observation services. CMS declined, however, to include blood transfusion or chemotherapy in this category. Chemotherapy and blood transfusion services must still be provided under direct supervision during the duration of the treatment.
- Independent review process for alternative supervision levels. CMS plans to establish an independent review process and committee to consider requests for alternative supervision levels (e.g. general supervision or personal supervision) for outpatient therapeutic services. Effective for CY 2012, the committee would assess whether specific services should require general, direct or personal supervision. All outpatient therapeutic services currently require direct supervision. Time will tell what this process could mean for ongoing supervision requirements.
This Final Rule is good news for providers, especially CAHs and small rural hospitals. The new flexibility regarding physical boundaries also especially helps providers in meeting this Medicare requirement. What has not changed, however, are physician/non-physician practitioner qualification requirements, which continue to raise questions.
You may access a display copy of the full 2011 OPPS Final Rule here.