I 
115TH CONGRESS 
1ST SESSION 
H. R. 741 
To amend title XVIII of the Social Security Act to provide for a permanent 
extension of the enforcement instruction on Medicare supervision require-
ments for outpatient therapeutic services in critical access and small 
rural hospitals. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 30, 2017 
Ms. JENKINS of Kansas (for herself, Mr. LOEBSACK, and Mr. SMITH of Ne-
braska) introduced the following bill; which was referred to the Com-
mittee 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 amend title XVIII of the Social Security Act to provide 
for a permanent extension of the enforcement instruction 
on Medicare supervision requirements for outpatient 
therapeutic services in critical access and small rural 
hospitals. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Rural Hospital Regu-
latory Relief Act of 2017’’. 
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SEC. 2. PERMANENT EXTENSION OF ENFORCEMENT IN-
STRUCTION ON MEDICARE SUPERVISION RE-
QUIREMENTS 
FOR 
OUTPATIENT 
THERA-
PEUTIC SERVICES IN CRITICAL ACCESS AND 
SMALL RURAL HOSPITALS. 
(a) IN GENERAL.—Section 1834 of the Social Secu-
rity Act (42 U.S.C. 1395m) is amended by adding at the 
end the following new subsection: 
‘‘(t) PERMANENT EXTENSION OF ENFORCEMENT IN-
STRUCTION ON SUPERVISION REQUIREMENTS FOR OUT-
PATIENT THERAPEUTIC SERVICES IN CRITICAL ACCESS 
AND SMALL RURAL HOSPITALS.—On and after January 
1, 2017, the Secretary shall continue to apply the enforce-
ment instruction described in the notice of the Centers for 
Medicare & Medicaid Services entitled ‘Enforcement In-
struction on Supervision Requirements for Outpatient 
Therapeutic Services in Critical Access and Small Rural 
Hospitals for CY 2013’, dated November 1, 2012 (pro-
viding for an exception to the restatement and clarification 
under the final rulemaking changes to the Medicare hos-
pital outpatient prospective payment system and calendar 
year 2009 payment rates (published in the Federal Reg-
ister on November 18, 2008, 73 Fed. Reg. 68702 through 
68704) with respect to requirements for direct supervision 
by physicians for therapeutic hospital outpatient services), 
as previously extended under section 1 of Public Law 113– 
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198, as amended by section 1 of Public Law 114–112 and 
section 16004(a) of the 21st Century Cures Act (Public 
Law 114–255).’’. 
(b) REPEAL OF REQUIRED REPORT.—Section 16004 
of the 21st Century Cures Act (Public Law 114–255) is 
amended by striking subsection (b). 
Æ 
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