CMS Final Rule Release

Since March 2010, CMS has instructed all Medicare contractors not to enforce supervision requirements for outpatient therapeutic services provided in critical access hospitals (CAHs). In CY 2011, this policy was expanded to small rural hospitals having 100 beds or fewer.

CMS is not extending this non-enforcement policy for CY 2014, and it will expire on December 31, 2013. This means that CAHs and small rural hospitals will have to comply with the same supervision requirements as other outpatient hospitals.

In the Final Rule, CMS stated that it would allow the non-enforcement of the supervision requirement for therapeutic services for CAHs and small rural hospitals to expire on December 31, 2013. Therefore, beginning January 1, 2014, CAHs and small rural hospitals will be required to abide by the supervision requirements for therapeutic services.

The Final Rule amends the Medicare conditions of payment for therapeutic outpatient hospital or CAH services and supplies furnished “incident to” a physician’s or non-physician practitioner’s service to require individuals furnishing such services be qualified to furnish those services under the scope of practice laws of the state in which the services are provided. Previously, CMS generally deferred to hospitals to ensure that practitioners were following state scope of practice and other rules related to delivery of health care services.

This change makes clear that Medicare contractors could deny or recoup payment for outpatient therapeutic services performed “incident to” a physician’s or non-physician practitioner’s service if such services are not furnished in accordance with state law. CMS did state that this does not impose any new requirements on providers since they are already required to comply with state law.

For More information on the Final Rule click here.