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CMS Proposes to Change Physician Requirements for RHC's and FQHC's

Since the passage of the Patient Protection and Affordable Care Act of 2010 (“PPACA”), many providers, suppliers and physicians that were enrolled in Medicare and Medicaid were mandated to create compliance programs for their healthcare facilities. Since that time, small and rural providers have been scrambling to adopt and implement programs that can adequately withstand regulatory and law enforcement scrutiny. Larger providers, such as multi-state hospitals, were already equipped with a compliance program. It is the small and rural providers, limited by staff and financial resources, which have had their hands full complying with the new regulatory requirements.

On Thursday, February 7, 2013, the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services (“CMS”) released a proposed rule that will actually reduce regulatory requirements for many healthcare facilities. The proposed rule lists several major provisions, but one in particular has the potential to ease the burden of Rural Health Clinics (“RHC’s”), and federally qualified health centers (“FQHC’s”).

This is a welcome change to these entities. Health and Human Services Secretary Kathleen Sebelius said CMS has identified a number of areas within Medicare and Medicaid where efficiencies could be increased by eliminating some regulations that were no longer necessary. "We are committed to cutting the red tape for health care facilities, including rural providers," said Sebelius in the release.

Under current federal regulations, except in extraordinary circumstances, a physician is required to be present in an RHC and FQHC for sufficient periods of time, meaning at a minimum at least once in every 2-week period, to provide medical direction, medical care services, consultation and supervision of other clinical staff. The proposed rule by CMS would lift this requirement. According to the proposed rule, "Some providers in extremely remote areas or areas that have geographic barriers have indicated that they find it difficult to comply with the precise biweekly schedule requirement.” The rule also explained that specifying a time frame in which a physician must visit the facility does not ensure better health care.

Instead, the rule notes, implementation of new technology, such as telemedicine services, should allow physicians "the flexibility to utilize a variety of ways and time frames to provide medical direction, consultation, supervision and medical care services, including being on-site at the facility."

RHC’s and FQHC’s, some of whom may still be working to implement a satisfactory compliance program, should take note of this proposal and its’ potential to ease their future compliance requirements. The deadline for submitting comments to the Proposed Rule is 5 P.M. on April 8, 2013.  Commenters should refer to file code CMS-3267-P and should submit comments in accordance with the instructions described in the Proposed Rule.

Gina M. Riddell, MPA, is a Paralegal of McBrayer, McGinnis, Leslie & Kirkland, PLLC. Ms. Riddell concentrates her practice in healthcare law and is located in the firm’s Lexington office. She can be reached at griddell@mmlk.com  or at (859) 231-8780.

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