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.

Mr. Speaker, I thank the gentleman for yielding.

Mr. Speaker, I rise today in support of 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.

I was proud to introduce this legislation in February, and I am pleased that Chairman Upton and the Energy and Commerce Committee reported it favorably and brought it to the House floor today.

The 83 critical access hospitals in Kansas are the lifeblood of our rural communities, and one of the many challenges these communities face is access to health care. The presence of a facility such as a critical access hospital in a community could be the deciding factor in whether or not the next generation of children decide to raise their family in their hometown, or perhaps whether or not a business decides to locate there.

The Centers for Medicare and Medicaid Services made a decision on January 1 of this year that will make it more difficult for these rural hospitals to serve their communities. CMS informed these hospitals that physicians are now required to directly supervise outpatient services, such as drawing blood and activity therapy. This is a change in policy that will put a strain on providers while providing no quality improvements for the patients they serve.

This bill will correct that problem by reinstating the moratorium on enforcement of these unnecessary regulations. It has broad bipartisan support in Congress and the support of key stakeholders.

Mr. Speaker, I insert in the Record letters of support for H.R. 4067 from the American Hospital Association, the National Rural Health Association, the Kansas Hospital Association, and Anderson County Hospital, which is a critical access hospital in Garnett, Kansas, one of 1,300 nationwide.

American Hospital Association,

Washington, DC, May 19, 2014.

Hon. Lynn Jenkins,

U.S. House of Representatives,

Washington, DC.

Dear Representative Jenkins: On behalf of our nearly 5,000

member hospitals, health systems and other health care

organizations, and our 43,000 individual members, the

American Hospital Association is pleased to support 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.

Approximately 46 million Americans live in rural areas and

depend on these hospitals as an important, and often the

only, source of care. Critical access and small rural

hospitals face unique challenges because of their remote

geographic location, scarce workforce, physician shortages

and constrained financial resources with limited access to

capital.

Your bill attempts to address one of these unique

challenges--the issue of direct supervision for outpatient

therapeutic services. In the 2009 outpatient prospective

payment system (PPS) final rule, the Centers for Medicare &

Medicaid Services (CMS) mandated a new policy for ``direct

supervision'' of outpatient therapeutic services that

hospitals and physicians recognized as a burdensome and

unnecessary policy change. CMS's policy required that a

supervising physician be physically present in the department

at all times when Medicare beneficiaries receive outpatient

therapeutic services. Hospital outpatient therapeutic

services have always been provided by licensed, skilled

professionals under the overall direction of a physician and

with the assurance of rapid assistance from a team of

caregivers, including a physician, should an unforeseen event

occur. While hospitals recognize the need for direct

supervision for certain outpatient services that pose high

risk or are very complex, CMS's policy generally applies to

even the lowest risk services. Your bill would provide a

needed delay in enforcement of the direct supervision policy

through 2014 for critical access and small rural hospitals

with fewer than 100 beds.

Again, we are pleased to support this bill and applaud your

commitment to America's rural hospitals and health care

providers.

Sincerely,

Rick Pollack,

Executive Vice President.

Mr. Speaker, I was born and raised in a small town in Kansas, and I feel strongly that folks in rural communities deserve access to quality health care.

I urge my colleagues to support this legislation, and I am hopeful that the Senate will soon act on it so that it may become law.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, H.R. 4067 would suspend current enforcement of Medicare rules relating to physician supervision of staff in rural and critical access hospitals for certain outpatient therapeutic services. Enforcement of these rules was delayed from 2009 through 2013, but began again in January of this

year. My understanding is that there has not been any issue with enforcement to date and that the Medicare program has not taken any action against a facility for failure to meet physician supervision standards since January. But as this bill did not follow regular order through the committee process, we have not had an opportunity to hear from interested parties about the issue and bring to light what the implications might be of an additional delay. Frankly, the likely result of such a bill would be confusion for hospitals.

Medicare's physician supervision requirement places a premium on patient safety, and I understand that rural facilities sometimes face difficulty in securing staffing. However, it seems reasonable to me that outpatient clinics that provide services to Medicare beneficiaries should meet some basic standards for having supervisory physicians available if an emergency arises--for example, when patients are receiving potentially lethal doses of chemotherapy medication.

Meanwhile, there are countless public health issues that the committee could productively devote its time to, such as looking into the recent outbreak of Ebola, the effects of e-cigarettes, or perhaps the decline of routine vaccinations that has led to an explosion of preventable illnesses like measles. Rather, the bill before us seems to be only responsive to the fears of certain health care providers that someone could file a complaint that a facility was allowing staff to practice medicine on Medicare patients without any supervision. But isn't that the kind of thing that we might be concerned about--and want a whistleblower to report? Yet, that is just what this bill would prevent.

It remains unclear to me why an additional delay of this Medicare policy is needed. Simply saying that the Senate passed this bill by unanimous consent in February is not sufficient justification--and makes even less sense now that the calendar year is nearly over.

So, Mr. Speaker, we should be finding time to address the real and pressing public issues facing our Nation rather than those that merely cause an inconvenience or anxiety for certain health care providers.

I reserve the balance of my time at this time, Mr. Speaker.

Mr. Speaker, I have no other speakers at this time, and so I yield back the balance of my time.

Mr. Speaker, I move to suspend the rules and pass 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.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and insert extraneous materials in the Record on the bill.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise today in support of H.R. 4067, which provides for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2014. This was a bill introduced by Congresswoman Jenkins of Kansas.

Mr. Speaker, this is a commonsense solution to a problem that has the potential to limit or delay access to health care for America's seniors in rural communities.

The bill would delay until the end of the year enforcement of supervision requirements for outpatient therapeutic services in critical access hospitals. This delay would give the Centers for Medicaid and Medicare Services and provider groups time to identify which services will eventually fall under the requirement.

I ask my colleagues to support this important piece of legislation and reserve the balance of my time.

Mr. Speaker, at this time, I would like to yield 3 minutes to the gentlewoman from Kansas, Congresswoman Jenkins, the author of the bill.

Mr. Speaker, I urge my colleagues to support the bill, and yield back the balance of my time.

Mr. Speaker, H.R. 4067, reinstates a four month delay in the enforcement of the current Medicare rules relating to physician supervision of staff who administer certain therapeutic services in rural and critical access hospitals.

The Medicare physician supervision requirement protects patients by ensuring that Medicare beneficiaries have access to someone capable of dealing with unforeseen emergencies. While I understand that rural healthcare providers often have difficulty acquiring adequate staffing, we should not place greater value on their convenience than on the safety of Medicare beneficiaries.

Reinstating a delay of these requirements until the end of the year only potentially confuses healthcare providers and lowers the bar on patient safety that Medicare has put in place.

Mr. President, I ask unanimous consent that the Senate proceed to the consideration of H.R. 4067.

Mr. President, I ask unanimous consent that the bill be read a third time, passed, and the motion to reconsider be considered made and laid upon the table.