II 115th CONGRESS 1st Session S. 243 IN THE SENATE OF THE UNITED STATES January 30, 2017 Mr. Thune (for himself and Ms. Heitkamp ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals.

1. Short title This Act may be cited as the Rural Hospital Regulatory Relief Act of 2017 . 2. Permanent extension of enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals (a) Extension Section 1834 of the Social Security Act ( 42 U.S.C. 1395m ) is amended by adding at the end the following new subsection: (v) Permanent extension of enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals On and after the date of the enactment of this subsection, the Secretary shall continue to apply the enforcement instruction described in the notice of the Centers for Medicare & Medicaid Services entitled Enforcement Instruction on Supervision Requirements for Outpatient Therapeutic Services in Critical Access and Small Rural Hospitals for CY 2013 , dated November 1, 2012 (providing for an exception to the restatement and clarification under the final rulemaking changes to the Medicare hospital outpatient prospective payment system and calendar year 2009 payment rates (published in the Federal Register on November 18, 2008, 73 Fed. Reg. 68702 through 68704) with respect to requirements for direct supervision by physicians for therapeutic hospital outpatient services) and extended by section 1 of Public Law 113–198 , section 1 of Public Law 114–112 , and section 16004(a) of the 21st Century Cures Act ( Public Law 114–255 ). . (b) Conforming repeal of report Subsection (b) of section 16004 of the 21st Century Cures Act ( Public Law 114–255 ) is repealed.