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 fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Mar 15 2010 
23:00 Dec 21, 2013
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3769.IH
H3769
sroberts on DSK5SPTVN1PROD with BILLS
SECTION 1. EXTENSION OF NONENFORCEMENT INSTRUC-
TION FOR THE MEDICARE DIRECT SUPER-
VISION REQUIREMENT FOR THERAPEUTIC 
HOSPITAL OUTPATIENT SERVICES FOR CRIT-
ICAL ACCESS HOSPITALS AND RURAL HOS-
PITALS; STUDY OF IMPACT OF FAILURE TO 
EXTEND SUCH INSTRUCTION. 
(a) EXTENSION OF THERAPY SUPERVISION NON-
ENFORCEMENT INSTRUCTION.—The Secretary of Health 
and Human Services shall, during the extension period, 
extend the therapy supervision nonenforcement instruc-
tion. 
(b) DEFINITIONS.—In this section: 
(1) THERAPY SUPERVISION NONENFORCEMENT 
INSTRUCTION.—The term ‘‘therapy supervision non-
enforcement instruction’’ means the enforcement in-
struction on supervision requirements for outpatient 
therapeutic services in critical access and small rural 
hospitals, as extended for calendar year 2013 by the 
Centers for Medicare & Medicaid Services (released 
as of November 1, 2012). 
(2) CRITICAL ACCESS HOSPITAL; SMALL RURAL 
HOSPITAL.—The terms ‘‘critical access hospital’’ and 
‘‘small rural hospital’’ have the meanings given such 
terms for purposes of the therapy supervision non-
enforcement instruction. 
VerDate Mar 15 2010 
23:00 Dec 21, 2013
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3769.IH
H3769
sroberts on DSK5SPTVN1PROD with BILLS
(3) EXTENSION PERIOD.—The term ‘‘extension 
period’’ means calendar year 2014, and includes a 
subsequent calendar year unless the report under 
subsection (c)(2) has been submitted at least 90 
days before the end of the previous calendar year. 
(c) STUDY AND REPORT ON IMPACT OF FAILURE TO 
EXTEND THERAPY SUPERVISION NONENFORCEMENT IN-
STRUCTION.— 
(1) STUDY.—The Secretary of Health and 
Human Services shall conduct a study on the impact 
(including the economic impact and the impact upon 
hospital staffing needs, if any) on critical access hos-
pitals and small rural hospitals of not extending the 
therapy supervision nonenforcement instruction. 
(2) REPORT.—The Secretary of Health and 
Human Services shall submit to Congress a report 
on the findings of the study conducted under para-
graph (1), including recommendations regarding on 
whether the therapy supervision nonenforcement in-
struction should be extended or made permanent. 
Æ 
VerDate Mar 15 2010 
23:00 Dec 21, 2013
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6301
E:\BILLS\H3769.IH
H3769
sroberts on DSK5SPTVN1PROD with BILLS