March 2014
WHY S.382
AACVPR Talking Points
It is this simple:
1. Congress passes Public Law 110-275 (MIPPA) in July, 2008 that mandates Medicare coverage of cardiac and pulmonary rehabilitation services.
2. CMS publishes regulations for cardiac & pulmonary rehabilitation coverage based on this Congressional mandate, effective 1-1-2010.
3. CY 2010: 42 CFR 410.27: CMS allows direct physician supervision to be extended to nonphysician practitioners (in accordance with State license and scope of practice), except for cardiac and pulmonary rehabilitation, which continue to require direct physician supervision be provided by an MD or DO due solely to the statutory language in P.L. 110-275.
4. April 12, 2011: U.S. Senate Finance Committee members send letter to then CMS Administrator, Dr. Donald Berwick, stating that the intent of 110-275, Section 144 was not to limit access to CR/PR programs by requiring MD supervision above and beyond the requirements set in 42 CFR 410.27, particularly if this were to disproportionately cause hardship to rural and critical access hospitals where physicians are not always on site and NPPs are allowed to staff emergency departments of these facilities. CMS was asked to reverse their interpretation of the statute.
5. May 26, 2011: Dr. Berwick responds in a letter to Senator Crapo stating that after legal review, the statute does not allow NPPs to provide the required supervision for these programs and the statutory language would need revision for CMS to make this change.
6. February 1, 2012: Senate bill S.2057 is co-introduced by Senators Schumer and Crapo to provide a “technical correction” to amend 110-275, section 144 to allow NPPs to provide physician supervision by nonphysician practitioners who meet the supervisory requirements, as allowed by other hospital outpatient services that fall under direct physician supervision regulation.
7. December, 2012: 112th Congress adjourns without inclusion of S.2057 in a larger bill.
8. S.382 (identical to previous bill) is introduced in 113th Congress by Senators Schumer and Crapo.
9. Senator Schumer’s office is sending bill to CBO for scoring with expectation that is will show no cost for this non-billable or reimbursable requirement of the Medicare regulation.
10. Hope is that with enough support, particularly from SFC, S.382 would be inserted in a vehicle moving this year.
11. This is 100% a bipartisan bill.
12. Passage of this bill will allow hospitals greater flexibility in meeting the Medicare direct physician supervision requirement. This flexibility was some of the rationale in CMS’ decision to allow NPPs to serve this role in other hospital outpatient areas under this regulation. Many cardiac and pulmonary rehabilitation programs are currently paying physicians (in some cases tens of thousands of dollars yearly) to serve this role, separate from medical director financial contracts. Use of NPPs to meet the supervision requirement (to be physically immediately available) could save significant expense for programs that are low-revenue to break-even services.
13. Resistance to sponsor this bill in previous years was primarily the lack of CBO score. Therefore, your ask to Congressional members/staff you meet with is, “If/when a CBO score of zero is obtained in the near future, is there any other reason you WOULD NOT support this bill? If not, I will contact you when the bill is CBO-scored and ask for your signature on S.382.”