I 

114TH CONGRESS 

1ST SESSION H. R. 170 

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 hospitals, to require a 

study of the impact on critical access hospitals and rural hospitals 

of a failure to extend such instruction, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 6, 2015 

Mr. SMITH of Nebraska introduced the following bill; which was referred to 

the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined 

by the Speaker, 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 hospitals, to require a study of the 

impact on critical access hospitals and rural hospitals 

of a failure to extend such instruction, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Rural Health Care 

3 Provider Relief Act of 2015’’. 

4 SEC. 2. EXTENSION OF NONENFORCEMENT INSTRUCTION 

5 FOR THE MEDICARE DIRECT SUPERVISION 

6 REQUIREMENT FOR THERAPEUTIC HOSPITAL 

7 OUTPATIENT SERVICES FOR CRITICAL AC8 CESS HOSPITALS AND RURAL HOSPITALS; 

9 STUDY OF IMPACT OF FAILURE TO EXTEND 

10 SUCH INSTRUCTION. 

11 (a) EXTENSION OF THERAPY SUPERVISION NON12 ENFORCEMENT INSTRUCTION.—The Secretary of Health 

13 and Human Services shall, during the extension period, 

14 extend the therapy supervision nonenforcement instruc15 tion. 

16 (b) DEFINITIONS.—In this section: 

17 (1) THERAPY SUPERVISION NONENFORCEMENT

18 INSTRUCTION.—The term ‘‘therapy supervision non19 enforcement instruction’’ means the enforcement in20 struction on supervision requirements for outpatient 

21 therapeutic services in critical access and small rural 

22 hospitals, as extended for calendar year 2013 by the 

23 Centers for Medicare & Medicaid Services and 

24 through calendar year 2014 by Public Law 113–198 

25 (released as of November 1, 2012). 


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1 (2) CRITICAL ACCESS HOSPITAL; SMALL RURAL

2 HOSPITAL.—The terms ‘‘critical access hospital’’ and 

3 ‘‘small rural hospital’’ have the meanings given such 

4 terms for purposes of the therapy supervision non5 enforcement instruction. 

6 (3) EXTENSION PERIOD.—The term ‘‘extension 

7 period’’ means calendar year 2015, and includes a 

8 subsequent calendar year unless the report under 

9 subsection (c)(2) has been submitted at least 90 

10 days before the end of the previous calendar year. 

11 (c) STUDY AND REPORT ON IMPACT OF FAILURE TO

12 EXTEND THERAPY SUPERVISION NONENFORCEMENT IN13 STRUCTION.— 

14 (1) STUDY.—The Secretary of Health and 

15 Human Services shall conduct a study on the impact 

16 (including the economic impact and the impact upon 

17 hospital staffing needs, if any) on critical access hos18 pitals and small rural hospitals of not extending the 

19 therapy supervision nonenforcement instruction. 

20 (2) REPORT.—The Secretary of Health and 

21 Human Services shall submit to Congress a report 

22 on the findings of the study conducted under para23 graph (1), including recommendations regarding 


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1 whether the therapy supervision nonenforcement in2 struction should be extended or made permanent. 

Æ 


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