,,ii  #aafth ,,congress  #ast ,session  
,s4 #hie  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,march #bg1         
#bjai,mr4 ,thune 7for himself and ,ms4  
,stabenow7 introduced the following     
bill2 which was read twice and referred 
to the ,committee on ,finance  ,a ,,bill
  ,to provide for a permanent extension 
of the enforcement instruction on       
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 #bjai4  #b4 ,permanent extension
 of enforcement instruction on          
supervision requirements for outpatient 
therapeutic services in critical access 
and small rural hospitals ,section #ahcd
 of the ,social ,security ,act 7#db     
,u4,s4,c4 #aciem7 is amended by adding  
at the end the following new subsection3
  7x7 ,permanent extension of           
enforcement instruction on supervision  
requirements for outpatient therapeutic 

services in critical access and small   
rural hospitals ,on and after the date  
of the enactment of this subsection1 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 and extended by   
section #a of ,public ,law #aac-aih1    

section #a of ,public ,law #aad-aab1    
section #afjjd7;a7 of the #bast ,century
 ,cures ,act 7,public ,law #aad-bee71   
and section #eajjg of the ,bipartisan   
,budget ,act 7,public ,law #aae-abc71   
and reinstated for calendar years #bjah 
and #bjai under the final rule entitled 
,medicare ,program3 ,hospital           
,outpatient ,prospective ,payment and   
,ambulatory ,surgical ,center ,payment  
,systems and ,quality ,reporting        
,programs published on ,december #ad1   
#bjag 7#hb ,fed4 ,reg4 #eibaf74  4