On May 22, CMS announced the newly designated services that may be conducted under general supervision in accordance with the current Medicare regulations and policies. In the 2012 OPPS Final Rule, [76 Fed. Reg 74360]. CMS established a sub-regulatory process to adopt alternate levels of supervision, such as general or personal, for individual HCPCS codes. Hospitals can make requests twice a year to the Hospital Outpatient Payment Panel and upon further review, this panel makes recommendations to CMS for the alternative level of supervision. CMS posts these recommendations for comment on their website and then announces their final decision whereby the changes become effective on either July 1 or January 1.
As a regulatory specialist, one of our responsibilities is to stay cognizant of the endless stream of CMS announcements, but I have to admit that not only did this one slip by me, but any information related to this topic is also very difficult to find on the CMS website. [Well, more difficult than usual!] Because of this, we have included many of the links and citations in this article to help our readers find the information more easily.
Remember that CMS first established the category of “nonsurgical extended duration therapeutic services (a.k.a. extended duration services)” in the 2011 OPPS Final Rule [75 Fed. Reg. 72013 Table 48A]. This initial list of 16 HCPCS codes, which included observation services per hour and injections and infusions, had to be provided under direct supervision during the initiation of the service followed by general supervision for the remainder of the service. CMS defined the initiation of the service as the beginning portion of the service until the supervising physician or NPP determines the patient is stable and the remainder of the service can be delivered safely under general supervision.
In February, the panel met and made recommendations to CMS regarding the supervision levels for 28 HCPCS codes and on April 18, 2012, CMS posted the preliminary decisions for public comment on the OPPS website. In summary, most commenters supported the panel’s recommendations regarding the list of HCPCS codes that will move from direct to general supervision on July 1:
- Specific mental health services from the range 90804-90828 which excludes codes for medical evaluation and management; 90846-90857; G0177; G0410 and G0411
- Bladder catheter insertion 51701
- Vaccine administration 90471-90474
- Smoking cessation counseling 99406-99407
However, at this time, CMS rejected the panel’s recommendation to move HCPCS code 94640 for an inhalation treatment to general supervision because it is not performed over an extended period of time and hospital patients receiving this service may require the supervising practitioner’s presence depending on their condition.
Of note for 2012, critical access hospitals (CAHs) were represented on the panel to help identify and provide perspective on the unique supervision scenarios that occur due to their distinct staffing patterns allowed by the Medicare Conditions of Participation. Even though CAH representation is now present on the Panel, CMS stated for CY2012 it would not enforce supervision requirements for CAHs and small rural hospitals with 100 beds or less paid under PPS. Unfortunately in this announcement, CMS did not restate this 2012 caveat which may cause some confusion for those hospitals that are currently excluded from this regulation.
The next panel meeting is scheduled for August 27-29 and the deadline for submitting recommendations for consideration is July 27. Hospitals that are interested in providing comments must follow the very specific guidelines listed on the CMS website.