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 Com-
mittee 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Rural Health Care 
Provider Relief Act of 2015’’. 
SEC. 2. EXTENSION OF NONENFORCEMENT INSTRUCTION 
FOR THE MEDICARE DIRECT SUPERVISION 
REQUIREMENT FOR THERAPEUTIC HOSPITAL 
OUTPATIENT SERVICES FOR CRITICAL AC-
CESS HOSPITALS AND RURAL HOSPITALS; 
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 and 
through calendar year 2014 by Public Law 113–198 
(released as of November 1, 2012). 
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(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. 
(3) EXTENSION PERIOD.—The term ‘‘extension 
period’’ means calendar year 2015, 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 
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whether the therapy supervision nonenforcement in-
struction should be extended or made permanent. 
Æ 
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