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 Policy changes affecting respiratory care are afoot in the Centers for Medicare & Medicaid Services and on Capitol Hill that could offer new opportunities for respiratory therapists.
In late August, CMS addressed the delivery of services in inpatient rehabilitation facility settings. CMS ruled that respiratory therapy can be a covered service if the patient's need is medically necessary, well documented by the rehabilitation physician in the medical record, and is ordered by a rehabilitation physician.
This may be the first step in the approval process of respiratory care as a "recognized therapy" by CMS in this setting. Currently, the only recognized therapies are physical therapy, occupational therapy, speech-language pathology, and prosthetics/orthotics therapy.
CMS also clarified questions about whether or not the delivery of services by respiratory therapists based on orders written by nurse practitioners or physician assistants in a hospital setting could be reimbursed. The Joint Commission's policy PC.02.01.03.04 states: "For hospitals that use Joint Commission accreditation for deemed status purposes: respiratory services are provided only on, and in accordance with, the orders of a doctor of medicine or osteopathy."
CMS has confirmed that physicians could delegate the writing of orders or other duties to NPs/PAs, as long as it is in accordance with both state law and hospital policy. However, the physician would need to co-sign the order for services within whatever time frame the applicable state law or hospital policy established. In most instances, this is 24 hours.
These changes are slated to take effect Jan. 1, 2010, along with updated payment rates.
On the congressional front
Legislation has been proposed to Congress to alter the scope of practice for RTs. If successful, this legislation would significantly increase the number of positions and demand for respiratory care services.
The Medicare Respiratory Care Initiative includes two bills - House Bill 1077 and Senate Bill 343 - which would amend the current policy and include respiratory therapists and the services they provide under Medicare Part B.
Medicare Part B provides medical services delivered in outpatient settings and reimburses for these services if they are delivered by a physician, physician assistant, nurse practitioner, clinical nurse specialist, or physical therapist. The proposed legislation would include qualified RTs providing services under general supervision of a physician.
That phrase general supervision is important. Current law requires that respiratory therapy services be provided under the "direct supervision" of a physician. Changing this requirement to "general" supervision means RTs would be able to provide services with the physician being available for consultation by phone.
Among the services that would be included are office-based spirometry and smoking cessation programs, home visits for ventilator and oxygen use, disease management programs, and the opportunity to contract services with a physician or group of physicians. If Medicare Part B recognizes RTs, insurance companies will likely follow suit, and the demand for therapists will increase significantly.
"Qualified" RTs are defined as providers who are credentialed and legally authorized to perform respiratory services in the state in which the service is furnished and hold an RRT credential and a bachelor's degree. These three requirements are similar to the credentialing requirements of other allied health practitioners recognized under Medicare Part B, specifically nurse practitioners, physician assistants and clinical nurse specialists.
HB 1077 introduced earlier this year by Rep. Mike Ross (D-Ark.) has 23 co-sponsors. SB 343 bill, introduced by Sen. Blanche Lincoln (D-Ark.) has eight co-sponsors.
Margaret Clark is a Georgia practitioner.
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