This is the last installment in our three-part series covering physician-focused proposals in recent Centers for Medicare & Medicaid Services (CMS) proposed regulations. In this edition, we will discuss two proposals in the Calendar Year (CY) 2021 Hospital Outpatient Prospective Payment System (OPPS) proposed rule. These proposals are relevant for physicians practicing in outpatient hospital settings who receive Medicare payments. We encourage members who practice in hospitals to review our OPPS proposed rule overview to better understand the CY 2021 OPPS proposals and how they may impact care delivery.  

CMS Proposes Discrete Changes to OPPS Supervision Requirements

Through its CY 2021 Hospital Outpatient Prospective Payment System (OPPS) proposed rule, CMS proposes to implement several changes to:

  • Supervision levels for certain outpatient therapeutic services in hospitals, including critical access hospitals (CAHs)
  • Permitting direct supervision through audio/video technology for certain services

Changes to Supervision Levels

On March 31, CMS implemented temporary changes to reduce the minimum default level of supervision for non-surgical extended duration therapeutic services (NSEDTS) during the COVID-19 public health emergency. NSEDTS are CMS-designated therapeutic services that can last a significant period of time and have a substantial monitoring component, typically performed by auxiliary personnel, with a low risk of requiring the physician’s or other nonphysician practitioner’s immediate availability after the initiation of the service. Examples of NSEDTS include IV infusion services and hospital observation.

CMS proposes to permanently establish general supervision as the minimum required supervision for all NSEDTS furnished on or after January 1, 2021. Further, certain non-physician practitioners would be able to provide the required supervision of these services if they can personally furnish the services in accordance with state law and all other applicable requirements.

Direct Supervision Through Audio/Video Technology

CMS also implemented changes that temporarily allow direct supervision of cardiac rehabilitation, intensive cardiac rehabilitation and pulmonary rehabilitation services to be achieved through audio/video real-time communication technology (to reduce exposure to COVID-19). In this rule, CMS proposes to make this change permanent beginning on January 1, 2021. If finalized, “virtual presence” needed to satisfy direct supervision would be achieved by the real-time presence of the supervising practitioner via interactive audio/video technology throughout the service.

ACOFP continues to review these and other proposals in the OPPS proposed rule. As appropriate, ACOFP will submit comments.

We encourage impacted physicians to submit comments by October 5, 2020. 

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