Hospital leaders July 28 urged the House Ways and Means Health Subcommittee to eliminate unnecessary regulatory burdens and support federal policies critical to maintaining access to care in rural communities.

At the hearing, critical access hospital (CAH) leaders from Kansas and Nebraska urged Congress to support legislation to prevent the Centers for Medicare & Medicaid Services from enforcing a Medicare condition of payment for CAHs that requires a physician to certify that a beneficiary may reasonably be expected to be discharged or transferred to another hospital within 96 hours.

They also urged Congress to provide relief from Medicare rules that require a physician or certain non-physician practitioners (NPP) to provide direct supervision over numerous routine outpatient therapeutic services.

Under the direct supervision requirement, relatively simple outpatient procedures like applying a cast or splint to a finger, or administering pulmonary rehabilitation exercises or nebulizer treatments must be furnished under the “direct supervision” of a physician or NPP. That means they must be immediately available to provide assistance and direction during the procedure.  

“CAHs simply do not have the manpower and resources to abide by these arbitrary regulations,” testified Shannon Sorensen, CEO of Brown County Hospital in Ainsworth, Neb. Carrie Saia, CEO of Holton (Kan.) Community Hospital, said “burdensome federal regulations make it difficult to budget, plan and adequately prepare for the future.”

CAHs are often situated in rural areas with high rates of poverty and Medicare and Medicaid use. Hospitals designated as CAHs and with no more than 25 beds are reimbursed under Medicare based on their actual costs to provide care, rather than through a prospective payment system.

Rural TestimonySorensen and Saia told the subcommittee that such regulations as the CAH 96-hour physician- certification and the direct supervision requirements jeopardize patients’ access to care in rural America. They urged Congress to pass the Critical Access Hospital Relief Act, H.R. 169/S. 258, and the Protecting Access to Rural Therapy Services Act, or PARTS Act, H.R. 1611/S. 257, which would provide regulatory relief to small rural hospitals.

The Critical Access Hospital Relief Act would remove the 96-hour physician certification requirement as a Medicare condition of participation. The PARTS Act would adopt a default standard of general supervision for outpatient therapeutic services, which does not require the direct presence of a physician. The bill also would set up a process for making exceptions for complex or risky services.

“This subcommittee and Congress has the power to ensure that Americans living in rural areas who depend on the hospital in their communities will have access to the appropriate care they need by removing the heavy hand of government,” Sorensen said.

As a stopgap measure, the CAH leaders urged lawmakers to pass pending legislation, H.R. 2878/S. 1261, that would continue a stay on the Medicare direct supervision requirement for small rural hospitals for the rest of the year.

In a statement submitted to the subcommittee, the AHA echoed the hospital leaders’ concerns and also urged support for legislation to improve the Recovery Audit Contractor program and extend several important programs for rural hospitals. The association also urged Congress to expand access to Medicare telehealth services.