H. Rept. 113-582 - EXTENSION OF MEDICARE ENFORCEMENT INSTRUCTION ON SUPERVISION REQUIREMENTS FOR OUTPATIENT THERAPEUTIC SERVICES IN CRITICAL ACCESS AND SMALL RURAL HOSPITALS THROUGH 2014113th Congress (2013-2014)
Committee Report
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113th Congress Rept. 113-582
HOUSE OF REPRESENTATIVES
2d Session Part 1
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EXTENSION OF MEDICARE ENFORCEMENT INSTRUCTION ON SUPERVISION
REQUIREMENTS FOR OUTPATIENT THERAPEUTIC SERVICES IN CRITICAL ACCESS AND
SMALL RURAL HOSPITALS THROUGH 2014
_______
September 9, 2014.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Upton, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 4067]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 4067) to provide for the extension of the
enforcement instruction on supervision requirements for
outpatient therapeutic services in critical access and small
rural hospitals through 2014, having considered the same,
report favorably thereon without amendment and recommend that
the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 1
Background and Need for Legislation.............................. 2
Committee Consideration.......................................... 2
Committee Votes.................................................. 2
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 4
Committee Cost Estimate.......................................... 4
Congressional Budget Office Estimate............................. 4
Federal Mandates Statement....................................... 5
Duplication of Federal Programs.................................. 5
Disclosure of Directed Rule Makings.............................. 5
Advisory Committee Statement..................................... 5
Applicability to Legislative Branch.............................. 5
Section-by-Section Analysis of the Legislation................... 6
PURPOSE AND SUMMARY
H.R. 4067 provides for the reinstatement of the calendar
year 2013 Medicare enforcement instruction on physician
supervision requirements for outpatient therapeutic services in
critical access and small rural hospitals through the end of
calendar year 2014.
BACKGROUND AND NEED FOR LEGISLATION
The Medicare program is a health care program for seniors
and those with disabilities, and serves an important function
in providing access to health care services for those in need
of care. Authorized by Congress in 1965, it continues to serve
patients in both rural and urban areas of the country.
Beginning in calendar year 2009, the Centers for Medicare
and Medicaid Services (CMS) created new requirements on medical
providers to provide direct supervision of certain outpatient
therapy services, but created a moratorium for critical access
hospitals and small rural hospitals for a period of four years.
The moratorium ended on January 1, 2014.
During calendar year 2014, the Committee had become aware
of confusion among rural providers related to which services
and instances would fall under the new requirements. In
addition, the continued work of the Advisory Panel on Hospital
Outpatient Payment related to identifying the appropriate level
of supervision for such services appeared to add to provider
confusion. While the Medicare program currently does not
enforce Federal requirements related to direct supervision for
certain outpatient therapeutic services, providers advocate
that extant confusion could lead to access issues for patients
in need of care.
COMMITTEE CONSIDERATION
On July 30, 2014, the full Committee on Energy and Commerce
met in open markup session and ordered H.R. 4067 reported to
the House, without amendment, by a record vote of 31 yeas and
11 nays.
COMMITTEE VOTES
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto. A
motion by Mr. Upton to order H.R. 4067 reported to the House,
without amendment, was agreed to by a record vote of 31 ayes
and 11 nays. The following reflects the record votes taken
during the Committee consideration:
COMMITTEE OVERSIGHT FINDINGS
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee has not held hearings
on this legislation.
STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
The goal of H.R. 4067 is to provide the provider community
an opportunity to verify the specific instances and services
for which the supervision requirements for hospital outpatient
therapeutic services will be enforced by Medicare contractors.
NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
4067 would result in no new or increased budget authority,
entitlement authority, or tax expenditures or revenues.
EARMARK, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS
In compliance with clause 9(e), 9(f), and 9(g) of rule XXI,
the Committee finds that H.R. 4067 contains no earmarks,
limited tax benefits, or limited tariff benefits.
COMMITTEE COST ESTIMATE
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974.
CONGRESSIONAL BUDGET OFFICE ESTIMATE
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
provided by the Congressional Budget Office pursuant to section
402 of the Congressional Budget Act of 1974.
U.S. Congress,
Congressional Budget Office,
Washington, DC, August 12, 2014.
Hon. Fred Upton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 4067, a bill to
provide for the extension of the enforcement instruction on
supervision requirements for outpatient therapeutic services in
critical access and small rural hospitals through 2014.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Lori Housman.
Sincerely,
Robert A. Sunshine
(For Douglas W. Elmendorf).
Enclosure.
H.R. 4067--A bill to provide for the extension of the enforcement
instruction on supervision requirements for outpatient
therapeutic services in critical access and small rural
hospitals through 2014
H.R. 4067 would require the Secretary of Health and Human
Services to continue to apply through calendar year 2014 an
exception to requirements that certain outpatient therapeutic
services furnished in critical access and small rural hospitals
need to be provided under the direct supervision of physicians
in the hospital. The Centers for Medicare and Medicaid Services
(CMS) currently do not enforce federal requirements related to
direct supervision for those services, and CBO anticipates that
CMS would not initiate enforcement of such requirements in the
near future under current law. Rather, those services are
subject to supervision requirements established under state
laws.
Therefore, CBO estimates that enacting H.R. 4067 would have
no significant effect on the federal budget. Because enacting
H.R. 4067 would not affect direct spending or revenues, pay-as-
you-go procedures do not apply.
The bill would not impose intergovernmental or private-
sector mandates as defined in the Unfunded Mandates Reform Act
and would impose no costs on state, local, or tribal
governments.
The CBO staff contact for this estimate is Lori Housman.
The estimate was approved by Holly Harvey, Deputy Assistant
Director for Budget Analysis.
FEDERAL MANDATES STATEMENT
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
DUPLICATION OF FEDERAL PROGRAMS
No provision of H.R. 4067 establishes or reauthorizes a
program of the Federal Government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
DISCLOSURE OF DIRECTED RULE MAKINGS
The Committee estimates that enacting H.R. 4067
specifically directs to be completed zero rule makings within
the meaning of 5 U.S.C. 551.
ADVISORY COMMITTEE STATEMENT
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
APPLICABILITY TO LEGISLATIVE BRANCH
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
Section 1. Extension of enforcement instruction on supervision
requirements for Outpatient Therapeutic Services in Critical
Access and Small Rural Hospitals through 2014
Section 1 establishes that the Secretary of Health and
Human Services shall apply through December 31, 2014 the
enforcement instructions related to Hospital Outpatient
Services provided by Critical Access and Small Rural Hospitals
previously in effect until December 31, 2013.