2018

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Medicare Provisions in Budget Package – Non-MD Supervision of Cardiac and Pulmonary Rehab Programs

The bill also included several provisions that impact the Medicare program, including a provision that will clarify Medicare law to allow physician assistants, nurse practitioners, and clinical nurse specialists to satisfy the medical supervisions requirements for oversight of cardiac, intensive cardiac, and pulmonary rehabilitation programs.  Previously, CMS had interpreted the Medicare statute to mean that only MDs or DOs could satisfy the medical supervisions requirements for cardiac and pulmonary rehabilitation programs.  While the MD/DO supervision requirement was easily met by most hospitals, the supervision requirement was often a barrier for rural hospitals and critical access hospitals that often are primarily staffed with non-MD providers. 

While this is welcome news for many rural and critical access hospitals, there is a catch.  This provision, along with all the other Medicare provisions on the bill will increase Medicare expenditures.  To reduce the budget impact of these provisions, and to lower the overall cost of the budget bill, Congress delayed the effective date of these provisions to Jan. 1, 2024.  This will now place CMS in an awkward position of knowing that Congress wants to allow non-MD supervision of these programs, but the strict letter of law prevents CMS from allowing non-MD supervision until 2024.  It will be interesting to see how CMS enforces the decidedly “mixed message” that Congress has given. 

Other important Medicare provisions in the bill include: 

  • Permanent Repeal of the Medicare Payment Therapy Cap.  The provision is effective Jan. 1, 2018.
  • Trades “Mis-valued Codes” Savings for Reduction in 2019 Medicare Conversion Update from 0.5 to 0.25.  For the past several years CMS has used the “mis-valued code” provision to force significant cuts in Medicare payments for CPT codes CMS identified as “overvalued.”  These cuts have resulted in billions of lost payment for the physician community.  Congress has removed CMS’s “misvalued code” authority in exchange for reducing the Medicare conversion factor by 0.25 percent.  This trade will be a net “win” for the physician community.
  • MACRA Changes – the budget bill also includes a number of improvements to the quality reporting program under MACRA that should reduce physician financial exposure and extend the transition period for implementation of the reporting and payment system. 
Last Reviewed: February 9, 2018