,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #cgfi  ,,in ,,the ,,house ,,of  
,,representatives  ,december #ab1       
#bjac,mr4 ,smith of ,nebraska 7for      
himself and ,ms4 ,jenkins7 introduced   
the following bill2 which was referred  
to the ,committee on ,energy and        
,commerce1 and in addition to the       
,committee on ,ways and ,means1 for a   
period to be subsequently determined by 
the ,speaker1 in each case for          
consideration of such provisions as fall
 within the jurisdiction of the         
committee concerned  ,a ,,bill  ,to     
extend the nonenforcement instruction   
for the ,medicare direct supervision    
requirement for therapeutic hospital    
outpatient services insofar as it       
applies to critical access hospitals and
 rural hospitals1 to require a study of 
the impact on critical access hospitals 
and rural hospitals of a failure to     
extend such instruction1 and for other  
purposes4  #a4 ,extension of            
nonenforcement instruction for the      

,medicare direct supervision requirement
 for therapeutic hospital outpatient    
services for critical access hospitals  
and rural hospitals2 study of impact of 
failure to extend such instruction  7a7 
,extension of therapy supervision       
nonenforcement instruction ,the         
,secretary of ,health and ,human        
,services shall1 during the extension   
period1 extend the therapy supervision  
nonenforcement instruction4  7b7        
,definitions ,in this section3 7#a7     
,therapy supervision nonenforcement     
instruction ,the term therapy           
supervision nonenforcement instruction  
means the enforcement instruction on    
supervision requirements for outpatient 
therapeutic services in critical access 
and small rural hospitals1 as extended  
for calendar year #bjac by the ,centers 
for ,medicare  ,medicaid ,services      
7released as of ,november #a1 #bjab74   
7#b7 ,critical access hospital2 small   
rural hospital ,the terms critical      
access hospital and small rural hospital

 have the meanings given such terms for 
purposes of the therapy supervision     
nonenforcement instruction4  7#c7       
,extension period ,the term extension   
period means calendar year #bjad1 and   
includes a subsequent calendar year     
unless the report under subsection      
7c77#b7 has been submitted at least #ij 
days before the end of the previous     
calendar year4  7c7 ,study and report on
 impact of failure ,to extend therapy   
supervision nonenforcement instruction  
7#a7 ,study ,the ,secretary of ,health  
and ,human ,services shall conduct a    
study on the impact 7including the      
economic impact and the impact upon     
hospital staffing needs1 if any7 on     
critical access hospitals and small     
rural hospitals of not extending the    
therapy supervision nonenforcement      
instruction4  7#b7 ,report ,the         
,secretary of ,health and ,human        
,services shall submit to ,congress a   
report on the findings of the study     
conducted under paragraph 7#a71         

including recommendations regarding on  
whether the therapy supervision         
nonenforcement instruction should be    
extended or made permanent4