,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #hie  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #bg1 #bjai,mr4    
,?une 7= himself & ,ms4 ,/ab5[7         
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to provide = a     
p]man5t ext5sion ( ! en=cem5t in/ruction
 on sup]vision requirem5ts = outpati5t  
!rapeutic s]vices 9 critical access &   
small rural hospitals4  #a4 ,%ort title 
,?is ,act may be cit$ z ! ,rural        
,hospital ,regulatory ,relief ,act (    
#bjai4  #b4 ,p]man5t ext5sion ( en=cem5t
 in/ruction on sup]vision requirem5ts = 
outpati5t !rapeutic s]vices 9 critical  
access & small rural hospitals ,section 
#ahcd ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #aciem7 is am5d$ by add+ at ! 
end ! foll[+ new subsection3  7x7       
,p]man5t ext5sion ( en=cem5t in/ruction 
on sup]vision requirem5ts = outpati5t   
!rapeutic s]vices 9 critical access &   
small rural hospitals ,on & aft] ! date 
( ! enactm5t ( ?is subsection1 !        

,secret>y %all cont9ue to apply !       
en=cem5t in/ruction describ$ 9 ! notice 
( ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices 
entitl$ ,en=cem5t ,in/ruction on        
,sup]vision ,requirem5ts = ,outpati5t   
,!rapeutic ,s]vices 9 ,critical ,access 
& ,small ,rural ,hospitals = ,,cy #bjac1
 dat$ ,novemb] #a1 #bjab 7provid+ = an  
exception to ! re/atem5t & cl>ification 
"u ! f9al rulemak+ *anges to ! ,m$ic>e  
hospital outpati5t prospective paym5t   
sy/em & cal5d> ye> #bjji paym5t rates   
7publi%$ 9 ! ,f$]al ,regi/] on ,novemb] 
#ah1 #bjjh1 #gc ,f$4 ,reg4 #fhgjb ?r\gh 
#fhgjd7 ) respect to requirem5ts =      
direct sup]vision by physicians =       
!rapeutic hospital outpati5t s]vices71 &
 ext5d$ by section #a ( ,public ,law    
#aac-aih1 section #a ( ,public ,law     
#aad-aab1 section #afjjd7;a7 ( ! #ba/   
,c5tury ,cures ,act 7,public ,law       
#aad-bee71 & section #eajjg ( !         
,bip>tisan ,budget ,act 7,public ,law   
#aae-abc71 & re9/at$ = cal5d> ye>s #bjah
 & #bjai "u ! f9al rule entitl$ ,m$ic>e 

,program3 ,hospital ,outpati5t          
,prospective ,paym5t & ,ambulatory      
,surgical ,c5t] ,paym5t ,sy/ems &       
,quality ,report+ ,programs publi%$ on  
,decemb] #ad1 #bjag 7#hb ,f$4 ,reg4     
#eibaf74  4