House Panel Approves Rural Hospital Relief Bill

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By Michael D. Williamson

July 7 — Rural hospitals would see eased Medicare regulatory burdens under a bill (H.R. 5613) approved by a House panel July 7.

The Ways and Means Committee unanimously approved the Continuing Access to Hospitals Act, as amended. The legislation would delay Medicare’s so-called physician direct supervision requirement for outpatient therapeutic services in critical access hospitals and small rural hospitals through the end of 2016.

Critical access hospitals must have 25 or fewer acute care inpatient beds and must generally be located more than 35 miles away from other hospitals, and provide round-the-clock emergency care services. The physician direct supervision requirement, if enforced, could reduce margins at rural hospitals, many of which already face financial problems.

The Nebraska-based Center for Rural Affairs, an advocacy organization, said that since 2010, rural hospitals have closed at a rate of one per month.

Specifics of Requirement

The Centers for Medicare & Medicaid Services tried implementing the physician direct supervision requirement at critical access and other small rural hospitals in 2014, the bill's sponsor, Rep. Lynn Jenkins (R-Kan.), said at the markup.

That requirement meant that routine outpatient procedures, such as undergoing active therapy, would have to be directly supervised by a physician, Jenkins said. She added that the requirement strained rural hospitals' ability to serve patients.

Jenkins introduced bills that prevented the CMS from enforcing the physician direct supervision requirements in prior years.

Ways and Means ranking member Sander Levin (D-Mich.) praised the measure. He said Jenkins's bill would help make sure that Americans living in rural areas have access to the health-care services they need, right in their own communities.

In May, Jenkins introduced another measure, the Rural Hospital Regulatory Relief Act (H.R. 5164), which would permanently delay the CMS's ability to enforce the physician direct supervision requirement for outpatient therapeutic services at critical access hospitals. The legislation was referred to Ways and Means and the Energy and Commerce Committee.

Timing of Full House Vote

House leadership hasn't mentioned a time frame for a full House vote on the bill approved in the committee July 7, Michael Byerly, a spokesman for Jenkins, told Bloomberg BNA.

With the House headed into recess after next week, “I would assume the congresswoman will reach out to leadership and see what they are thinking when we return in September,” Byerly said July 7.

Sen. John Thune (R-S.D.) introduced companion legislation (S. 3129) to H.R. 5613, according to Byerly.

Thune introduced S. 3129 on July 6, and the bill was referred to the Senate Finance Committee. The American Hospital Association applauded the bill in a July 6 letter to Thune.

To contact the reporter on this story: Michael D. Williamson in Washington at

To contact the editor responsible for this story: Brian Broderick at

For More Information

Details about the markup, including links to full text of H.R. 5613 and an amendment to it, are at

Full text of H.R. 5164 is at

Details about S. 3129 are at

The AHA's letter is at

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