Proposed rule on partial hospitalization services in CMHCs perpetuates physician supervision requirements

Key provisions reflect longstanding federal statute

by Communications Staff

June 23, 2011—The federal government has just published a proposed rule (PDF, 287KB) governing the delivery of partial hospitalization services by community mental health centers (CMHCs) in the Medicare program.  The rule was published June 17 in the Federal Register.

Psychologists who are already aware of the regulatory proposal have expressed concern about “conditions of participation” stipulating that physicians must lead the treatment team responsible for service delivery in CMHCs and complete, or counter-sign with a psychologist, psychiatric evaluations conducted as part of a comprehensive patient assessment. Yet these conditions reflect longstanding federal statute and regulatory requirements.       

The Centers for Medicare and Medicaid Services (CMS) issued the rule so the agency could more fully regulate CMHC-based partial hospitalization services provided to Medicare beneficiaries. Noting that CMS has received complaints about the quality of such services, the proposed rule contains new provisions including patients’ rights and the use of seclusion and restraint.

“Partial hospitalization services have been promoted in the Medicare program as an outpatient alternative to more expensive inpatient mental health care,” explains Doug Walter, JD, Counsel for Legislative & Regulatory Affairs in the APA Practice Organization’s Government Relations Office. Medicare has recognized since 1990 that CMHCs may provide these services.      

Current law mandates physician supervision of partial hospitalization service delivery. Regulations governing coverage of these services in CMHCs stipulate that Medicare Part B will cover partial hospitalization services if ‘prescribed by a physician and furnished under the general supervision of a physician.’ [42 CFR Section 410.110]

The new regulation expands upon CMHC requirements, but physician supervision of services is already codified in statute. “Only Congress can change this [physician supervision] requirement,” says Walter. “The new regulation just reiterates conditions imposed by Congress.”

“This [proposed rule] is yet another good example of why our push to get psychologists included in the Medicare definition of ‘physician’ is vital,” says APA Executive Director for Professional Practice Katherine C. Nordal, PhD. “Removing unnecessary physician supervision requirements for mental health services provided by licensed psychologists will remove barriers to quality care for Medicare beneficiaries.” 

Key allies of professional psychology in the Senate and House have introduced legislation (S.483 and H.R. 831) to include psychologists in the Medicare “physician” definition. Visit the APA Practice Organization’s Legislative Action Center to urge your Senators and Representative to support these bills.

“We’ve long argued that psychologists should be able to provide partial hospitalization services independently” says Walter. “Gaining the Medicare physician definition bill would prompt reconsideration of federal statutes that continue to place inappropriate restrictions on Medicare service delivery by psychologists.”

The APA Practice Organization will keep members informed about relevant developments related to the newly proposed rule on partial hospitalization services in CMHCs, including submission of written comments by the mid-August deadline. 


For additional information, contact the Government Relations Office by email or by calling (202) 336-5889.