,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #cgfi  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #ab1         
#bjac,mr4 ,smi? ( ,nebraska 7= himself &
 ,ms4 ,j5k9s7 introduc$ ! foll[+ bill2  
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce1 & 9 addition to ! ,committee 
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to ext5d !         
non5=cem5t in/ruction = ! ,m$ic>e direct
 sup]vision requirem5t = !rapeutic      
hospital outpati5t s]vices ins(> z x    
applies to critical access hospitals &  
rural hospitals1 to require a /udy ( !  
impact on critical access hospitals &   
rural hospitals ( a failure to ext5d su*
 in/ruction1 & = o!r purposes4  #a4     
,ext5sion ( non5=cem5t in/ruction = !   
,m$ic>e direct sup]vision requirem5t =  
!rapeutic hospital outpati5t s]vices =  
critical access hospitals & rural       
hospitals2 /udy ( impact ( failure to   

ext5d su* in/ruction  7a7 ,ext5sion (   
!rapy sup]vision non5=cem5t in/ruction  
,! ,secret>y ( ,heal? & ,human ,s]vices 
%all1 dur+ ! ext5sion p]iod1 ext5d !    
!rapy sup]vision non5=cem5t in/ruction4 
7b7 ,def9itions ,9 ?is section3 7#a7    
,!rapy sup]vision non5=cem5t in/ruction 
,! t]m !rapy sup]vision non5=cem5t      
in/ruction means ! en=cem5t in/ruction  
on sup]vision requirem5ts = outpati5t   
!rapeutic s]vices 9 critical access &   
small rural hospitals1 z ext5d$ = cal5d>
 ye> #bjac by ! ,c5t]s = ,m$ic>e        
,m$icaid ,s]vices 7releas$ z ( ,novemb] 
#a1 #bjab74  7#b7 ,critical access      
hospital2 small rural hospital ,! t]ms  
critical access hospital & small rural  
hospital h ! mean+s giv5 su* t]ms =     
purposes ( ! !rapy sup]vision non5=cem5t
 in/ruction4  7#c7 ,ext5sion p]iod ,!   
t]m ext5sion p]iod means cal5d> ye>     
#bjad1 & includes a subsequ5t cal5d> ye>
 unless ! report "u subsection 7c77#b7  
has be5 submitt$ at lea/ #ij days be=e !
 end ( ! previ\s cal5d> ye>4  7c7 ,/udy 

& report on impact ( failure ,to ext5d  
!rapy sup]vision non5=cem5t in/ruction  
7#a7 ,/udy ,! ,secret>y ( ,heal? &      
,human ,s]vices %all conduct a /udy on !
 impact 7includ+ ! economic impact & !  
impact ^u hospital /aff+ ne$s1 if any7  
on critical access hospitals & small    
rural hospitals ( n ext5d+ ! !rapy      
sup]vision non5=cem5t in/ruction4  7#b7 
,report ,! ,secret>y ( ,heal? & ,human  
,s]vices %all submit to ,congress a     
report on ! f9d+s ( ! /udy conduct$ "u  
p>agraph 7#a71 includ+ recomm5dations   
reg>d+ on :e!r ! !rapy sup]vision       
non5=cem5t in/ruction %\ld be ext5d$ or 
made p]man5t4