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SECTION 1. REQUIREMENTS FOR PHYSICIAN SUPERVISION OF THERAPEUTIC
HOSPITAL OUTPATIENT SERVICES.

(a) Therapeutic Hospital Outpatient Services.--
(1) Supervision requirements.--Section 1833 of the Social
Security Act (42 U.S.C. 1395l) is amended by adding at the end
the following new subsection:
''(z) Physician Supervision Requirements for Therapeutic Hospital
Outpatient Services.--
''(1) General supervision for therapeutic services.--Except
as may be provided under paragraph (2), insofar as the
Secretary requires the supervision by a physician or a non-
physician practitioner for payment for therapeutic hospital
outpatient services (as defined in paragraph (5)(A)) furnished
under this part, such requirement shall be met if such services
are furnished under the general supervision (as defined in
paragraph (5)(B)) of the physician or non-physician
practitioner, as the case may be.
''(2) Exceptions process for high-risk or complex medical
services requiring higher levels of supervision.--
''(A) In general.--Subject to the succeeding
provisions of this paragraph, the Secretary shall
establish a process for the designation of therapeutic
hospital outpatient services furnished under this part
that, by reason of complexity or high risk, require
direct supervision (as defined in paragraph (5)(A)).
''(B) Consultation with clinical experts.--
''(i) In general.--Under the process
established under subparagraph (A), before the
designation of any therapeutic hospital
outpatient service for which direct supervision
may be required under this part, the Secretary
shall consult with a panel of outside experts
described in clause (ii) to advise the
Secretary with respect to each such
designation.
''(ii) Advisory panel on supervision of
therapeutic hospital outpatient services
comprised of physicians and non-physician
practitioners serving rural and other areas.--
For purposes of clause (i), a panel of outside
experts described in this clause is a panel
appointed by the Secretary, based on
nominations submitted by hospital, rural
health, and medical organizations representing
physicians or non-physician practitioners, as
the case may be, that meets the following
requirements:
''(I) Composition.--The panel shall
be composed of at least 15 physicians
and non-physician practitioners who
furnish therapeutic hospital outpatient
services for which payment is made
under this part and who collectively
represent the medical specialties that
furnish such services.
''(II) Practical experience.--
During the 12-month period preceding
appointment to the panel by the
Secretary, each physician or non-
physician practitioner described in
subclause (I) shall have furnished
therapeutic hospital outpatient
services for which payment was made
under this part.
''(III) Minimum rural
representation requirement.--Not less
than 50 percent of the membership of
the panel shall be physicians or non-
physician practitioners described in
subclause (I) who practice in rural
areas (as defined in section
1886(d)(2)(D)) or who furnish such
services in critical access hospitals.
''(C) Special rule for outpatient critical access
hospital services.--Insofar as a therapeutic outpatient
hospital service that is an outpatient critical access
hospital service is designated as requiring direct
supervision under the process established under
subparagraph (A), the Secretary shall deem the critical
access hospital furnishing that service as having met
the requirement for direct supervision for that service
if, when furnishing such service, the critical access
hospital meets the standard for personnel required as a
condition of participation under section 485.618(d) of
title 42, Code of Federal Regulations (as in effect on
January 1, 2010).
''(D) Consideration of compliance burdens.--Under
the process established under subparagraph (A), the
Secretary shall take into account the impact on
hospitals and critical access hospitals in complying
with requirements for direct supervision in the
furnishing of therapeutic hospital outpatient services,
including hospital resources, availability of hospital-
privileged physicians, specialty physicians, and non-
physician practitioners, and administrative burdens.
''(E) Requirement for notice and comment
rulemaking.--Under the process established under
subparagraph (A), the Secretary shall only designate
therapeutic hospital outpatient services requiring
direct supervision under this part through proposed and
final rulemaking that provides for public notice and
opportunity for comment.
''(3) Initial list of designated services.--The Secretary
shall include in the proposed and final regulation for payment
for hospital outpatient services for 2012 under this part a
list of initial therapeutic hospital outpatient services, if
any, designated under the process established under paragraph
(2)(A) as requiring direct supervision under such part.
''(4) Direct supervision by non-physician practitioners for
certain hospital outpatient services permitted.--
''(A) In general.--Subject to the succeeding
provisions of this subsection, a non-physician
practitioner may directly supervise the furnishing of--
''(i) therapeutic hospital outpatient
services under this part, including cardiac
rehabilitation services (under section
1861(eee)(1)), intensive cardiac rehabilitation
services (under section 1861(eee)(4)), and
pulmonary rehabilitation services (under
section 1861(fff)(1)); and
''(ii) those hospital outpatient diagnostic
services (described in section 1861(s)(2)(C))
that require direct supervision under the fee
schedule established under section 1848.
''(B) Requirements.--Subparagraph (A) shall apply
insofar as the non-physician practitioner involved
meets the following requirements:
''(i) Scope of practice.--The non-physician
practitioner is acting within the scope of
practice under State law applicable to the
practitioner.
''(ii) Additional requirements.--The non-
physician practitioner meets such requirements
as the Secretary may specify.
''(5) Definitions.--In this subsection:
''(A) Therapeutic hospital outpatient services.--
The term 'therapeutic hospital outpatient services'
means hospital services described in section
1861(s)(2)(B) furnished by a hospital or critical
access hospital and includes--
''(i) cardiac rehabilitation services and
intensive cardiac rehabilitation services (as
defined in paragraphs (1) and (4),
respectively, of section 1861(eee)); and
''(ii) pulmonary rehabilitation services
(as defined in section 1861(fff)(1)).
''(B) General supervision.--
''(i) Overall direction and control of
physician.--Subject to clause (ii), with
respect to the furnishing of therapeutic
hospital outpatient services for which payment
may be made under this part, the term 'general
supervision' means such services are furnished
under the overall direction and control of a
physician or non-physician practitioner, as the
case may be.
''(ii) Presence not required.--For purposes
of clause (i), the presence of a physician or
non-physician practitioner is not required
during the performance of the procedure
involved.
''(C) Direct supervision.--
''(i) Provision of assistance and
direction.--Subject to clause (ii), with
respect to the furnishing of therapeutic
hospital outpatient services for which payment
may be made under this part, the term 'direct
supervision' means that a physician or non-
physician practitioner, as the case may be, is
able to furnish assistance and direction
throughout the furnishing of such services and,
in accordance with the policies, procedures,
guidelines or bylaws of the hospital--
''(I) with respect to such services
furnished in the hospital, or in an on-
campus department of such hospital, is
present and on the same campus and
immediately available (including by
telephone or other means) to furnish
such assistance and direction; or
''(II) with respect to such
services furnished in an off-campus
provider-based department of such
hospital, is present in or in close
proximity to such department and is
immediately available (including by
telephone or other means) to furnish
such assistance and direction.
''(ii) Presence in room not required.--For
purposes of clause (i), a physician or non-
physician practitioner, as the case may be, is
not required to be present in the room during
the performance of the procedure involved.
''(D) Non-physician practitioner defined.--The term
'non-physician practitioner' means an individual who--
''(i) is a physician assistant, a nurse
practitioner, a clinical nurse specialist, a
clinical social worker, a clinical
psychologist, a certified nurse midwife, or a
certified registered nurse anesthetist, and
includes such other practitioners as the
Secretary may specify; and
''(ii) with respect to the furnishing of
therapeutic outpatient hospital services, meets
the requirements of paragraph (4)(B).''.
(2) Conforming amendment.--Section 1861(eee)(2)(B) of the
Social Security Act (42 U.S.C. 1395x(eee)(2)(B)) is amended by
inserting '', and a non-physician practitioner (as defined in
section 1833(z)(5)(D)) may supervise the furnishing of such
items and services in the hospital'' after ''in the case of
items and services furnished under such a program in a
hospital, such availability shall be presumed''.
(b) Prohibition on Retroactive Enforcement of Revised
Interpretation.--
(1) Repeal of regulatory clarification.--The restatement
and clarification under the final rule making changes to the
Medicare hospital outpatient prospective payment system and
calendar year 2009 payment rates (published in the Federal
Register on November 18, 2008, 73 Fed. Reg. 68702 through
68704) with respect to requirements for direct supervision by
physicians for therapeutic hospital outpatient services (as
defined in paragraph (3)) for purposes of payment for such
services under the Medicare program shall have no force or
effect in law.
(2) Hold harmless.--A hospital or critical access hospital
that furnishes therapeutic hospital outpatient services during
the period beginning on January 1, 2001, and ending on December
31, 2011, for which a claim for payment is made under part B of
title XVIII of the Social Security Act shall not be subject to
any civil or criminal action or penalty under Federal law for
failure to meet supervision requirements under the regulation
described in paragraph (1), under program manuals, or
otherwise.
(3) Therapeutic hospital outpatient services defined.--In
this subsection, the term ''therapeutic hospital outpatient
services'' means medical and other health services furnished by
a hospital or critical access hospital that are--
(A) hospital services described in subsection
(s)(2)(B) of section 1861 of the Social Security Act
(42 U.S.C. 1395x);
(B) cardiac rehabilitation services or intensive
cardiac rehabilitation services (as defined in
paragraphs (1) and (4), respectively, of subsection
(eee) of such section); or
(C) pulmonary rehabilitation services (as defined
in subsection (fff)(1) of such section).
Output:
Amends title XVIII (Medicare) of the Social Security Act to state that, except with respect to high-risk or complex medical services requiring direct levels of supervision, if the Secretary of Health and Human Services (HHS) requires supervision by a physician or non-physician practitioner for Medicare payment for therapeutic hospital outpatient services, that requirement is met if such services are furnished under the physician's or non-physician practitioner's general supervision.

Directs the Secretary of HHS to establish a process for designating therapeutic hospital outpatient services for which direct supervision may be required.

Declares without force or effect in law regarding Medicare requirements for direct supervision by physicians for therapeutic hospital outpatient services a specified restatement and clarification under the final rule making changes to the Medicare hospital outpatient prospective payment system and calendar year 2009 payment rates, which was published in the Federal Register on November 18, 2008.