Day On The Hill 2018; Passing the HR.1155/S.1361 Bill
Great news for cardiac and pulmonary rehabilitation programs! The United States Senate and House of Representatives passed the HR.1155/S.1361 bill which allows non-physician practitioners (NPP) to supervise cardiac rehab, intensive cardiac rehab and pulmonary rehab. This bill passed as part of the ACCESS Act – Advancing Chronic Care, Extenders, and Social Services, and Medicare Extender package which will go into effect January 1, 2024.
This bill does not remove the role of the Medical Director in the rehab setting. The MD will continue to oversee cardiac and pulmonary rehabs and retains responsibility for program safety and efficacy. The NPPs, which include physician assistants, nurse practitioners, and clinical nurse specialists, will simply fulfill the CMS requirement of “direct supervision”. NPPs will not be able to order cardiac or pulmonary rehab nor will they be able to sign ITPs. These documents will still require signature from an MD or DO.
Although getting the HR.1155/S.1361 is a huge step, we still have a lot of work to do to make cardiopulmonary rehab accessible to everyone! LSI’s Ash Walker and Jennifer Broome joined our DOTH Scholarship recipient, Michael Sanchez, in DC this year to encourage Congressional leaders to revisit Section 603 of the Balanced Budget Act of 2015. Also known as the Site Neutrality rule, Section 603 states that any outpatient hospital service that relocates more than 250 yards from the main hospital campus must charge according to the Physician Fee Schedule (PFS) which is almost half of the Hospital Outpatient Prospective Payment System (OPPS) for cardiac and pulmonary rehab services. Programs that were off-site prior to November 2015 are “grandfathered” into the OPPS; however, any existing, off-site program that expands or remodels their existing space is subject to Section 603 rules. Because of this Site Neutrality rule, many hospitals are unable and unwilling to relocate or expand existing programs, limiting patient access to cardiopulmonary rehab.
So, what’s the best solution? AACVPR has proposed that any outpatient service billing < $1 Million annually be excluded from the Site Neutrality rule. This exclusion would allow all outpatient services to benefit from a higher reimbursement rate using the OPPS.
Attendees at 2018’s DOTH were met with a positive response to this proposed change but as we know, with most things, this will take time. Stay tuned to learn more about the progress being made and feel free to contact us to find out what you can do to help.
