Two WHA Recommendations Included in Federal Red Tape Relief Legislation

Legislation Would ease restrictions under CAH 96-hour rule; direct supervision

December 18, 2018

Two recommendations the Wisconsin Hospital Association presented to the U.S. House Ways and Means Committee in 2017 were included in a package introduced last week as part of the committee’s Medicare Red Tape Relief Project.

The Critical Access Hospital Relief Act, introduced by Rep. Adrian Smith (R-NE), would repeal the 96-hour physician-certification requirement for inpatient critical access hospital services under Medicare. Hospitals have traditionally understood the 96-hour rule to mean critical access hospitals (CAHs) must have an average length of stay of 96 hours across all inpatient Medicare stays, consistent with federal conditions of participation in the Medicare program. However, sub-regulatory guidance issued from the Centers for Medicare and Medicaid Services (CMS) in 2014 said that as a condition of payment, CAHs must certify that a patient must reasonably be expected to be discharged within 96 hours of admission in order for a Medicare payment to be appropriate.

The Rural Hospital Regulatory Relief Act of 2017, introduced by Rep. Lynn Jenkins (R-KS), would repeal the physician direct supervision requirement for certain outpatient therapeutic services. This issue came to a head in 2009 when CMS introduced a new direct supervision policy that required a physician to be “immediately available” to initiate certain outpatient therapeutic services in order to receive Medicare reimbursement. Previously, only general physician supervision was required in these circumstances and Congress and CMS have previously put moratoriums on enforcement of this policy since there is no clinical rationale for it. This legislation would permanently repeal the requirement for CAHs and other small rural hospitals.

With the current congressional session soon coming to an end and a new session beginning in 2019, it is unclear where these proposals will go in the near future, but WHA will continue advocating for these and other efforts to improve rural health care delivery. For additional information, contact WHA’s director of Federal and State Relations, Jon Hoelter.

This story originally appeared in the December 18, 2018 edition of WHA Newsletter