,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #gda  ,,in ,,the ,,house ,,of   
,,representatives  ,january #cj1        
#bjag,ms4 ,jenkins of ,kansas 7for      
herself1 ,mr4 ,loebsack1 and ,mr4 ,smith
 of ,nebraska7 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 amend title ,,xviii of   
the ,social ,security ,act to provide   
for a permanent extension of the        
enforcement instruction on ,medicare    
supervision requirements for outpatient 
therapeutic services in critical access 
and small rural hospitals4  #a4 ,short  
title ,this ,act may be cited as the    
,rural ,hospital ,regulatory ,relief    
,act of #bjag4  #b4 ,permanent extension
 of enforcement instruction on ,medicare

 supervision requirements for outpatient
 therapeutic services in critical access
 and small rural hospitals  7a7 ,in     
general ,section #ahcd of the ,social   
,security ,act 7#db ,u4,s4,c4 #aciem7 is
 amended by adding at the end the       
following new subsection3  7t7          
,permanent extension of enforcement     
instruction on supervision requirements 
for outpatient therapeutic services in  
critical access and small rural         
hospitals ,on and after ,january #a1    
#bjag1 the ,secretary shall continue to 
apply the enforcement instruction       
described in the notice of the ,centers 
for ,medicare  ,medicaid ,services      
entitled ,enforcement ,instruction on   
,supervision ,requirements for          
,outpatient ,therapeutic ,services in   
,critical ,access and ,small ,rural     
,hospitals for ,,cy #bjac1 dated        
,november #a1 #bjab 7providing for an   
exception to the restatement and        
clarification under the final rulemaking
 changes to the ,medicare hospital      

outpatient prospective payment system   
and calendar year #bjji payment rates   
7published in the ,federal ,register on 
,november #ah1 #bjjh1 #gc ,fed4 ,reg4   
#fhgjb through #fhgjd7 with respect to  
requirements for direct supervision by  
physicians for therapeutic hospital     
outpatient services71 as previously     
extended under section #a of ,public    
,law #aac-aih1 as amended by section #a 
of ,public ,law #aad-aab and section    
#afjjd7;a7 of the #bast ,century ,cures 
,act 7,public ,law #aad-bee74  4  7b7   
,repeal of required report ,section     
#afjjd of the #bast ,century ,cures ,act
 7,public ,law #aad-bee7 is amended by  
striking subsection 7b74