I 

113TH CONGRESS 

1ST SESSION H. R. 3769 

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 

DECEMBER 12, 2013 

Mr. SMITH of Nebraska (for himself and Ms. JENKINS) 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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•HR 3769 IH

1 SECTION 1. EXTENSION OF NONENFORCEMENT INSTRUC2 TION FOR THE MEDICARE DIRECT SUPER3 VISION REQUIREMENT FOR THERAPEUTIC 

4 HOSPITAL OUTPATIENT SERVICES FOR CRIT5 ICAL ACCESS HOSPITALS AND RURAL HOS6 PITALS; STUDY OF IMPACT OF FAILURE TO 

7 EXTEND SUCH INSTRUCTION. 

8 (a) EXTENSION OF THERAPY SUPERVISION NON9 ENFORCEMENT INSTRUCTION.—The Secretary of Health 

10 and Human Services shall, during the extension period, 

11 extend the therapy supervision nonenforcement instruc12 tion. 

13 (b) DEFINITIONS.—In this section: 

14 (1) THERAPY SUPERVISION NONENFORCEMENT

15 INSTRUCTION.—The term ‘‘therapy supervision non16 enforcement instruction’’ means the enforcement in17 struction on supervision requirements for outpatient 

18 therapeutic services in critical access and small rural 

19 hospitals, as extended for calendar year 2013 by the 

20 Centers for Medicare & Medicaid Services (released 

21 as of November 1, 2012). 

22 (2) CRITICAL ACCESS HOSPITAL; SMALL RURAL

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

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

25 terms for purposes of the therapy supervision non26 enforcement instruction. 


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•HR 3769 IH

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

2 period’’ means calendar year 2014, and includes a 

3 subsequent calendar year unless the report under 

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

5 days before the end of the previous calendar year. 

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

7 EXTEND THERAPY SUPERVISION NONENFORCEMENT IN8 STRUCTION.— 

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

10 Human Services shall conduct a study on the impact 

11 (including the economic impact and the impact upon 

12 hospital staffing needs, if any) on critical access hos13 pitals and small rural hospitals of not extending the 

14 therapy supervision nonenforcement instruction. 

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

16 Human Services shall submit to Congress a report 

17 on the findings of the study conducted under para18 graph (1), including recommendations regarding on 

19 whether the therapy supervision nonenforcement in20 struction should be extended or made permanent. 

Æ 


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