Representatives Loebsack, Jenkins Introduce Bill to Help Critical Access Hospitals

Written by Theresa Rose on January 31, 2017

WASHINGTON, D.C. – Recently, Congressman Dave Loebsack (D-IA) and Congresswoman Lynn Jenkins (R-KS) introduced legislation (H.R. 741) to prevent Medicare’s enforcement of unreasonable and inflexible direct supervision rules for outpatient therapy services at Critical Access Hospitals (CAHs) and other small, rural hospitals. An annual extension bill has been passed into law since 2014.


“We must keep fighting to ensure all Iowans have access to high-quality health care no matter where they live,” said Congressman Dave Loebsack. “Critical Access Hospitals play an important role in rural communities by providing access to primary, emergency, and acute care services. I have visited multiple CAHs across my district that have struggled to meet the direct supervision requirement, and this legislation will provide them with certainty that they deserve.”


“Critical Access Hospitals and small hospitals are the lifeblood of rural communities,” said Congresswoman Lynn Jenkins. “This important legislation will permanently extend the Centers for Medicare & Medicaid Services’ (CMS) enforcement moratorium on its “direct supervision” rule for outpatient therapeutic services provided in CAHs and small, rural hospitals with 100 or fewer beds. I look forward to working with my colleagues to – once again – get this bipartisan bill to the President’s desk and ensure all Americans, no matter where you live, receive quality care in a timely manner.”


Examples of direct supervision rules for outpatient therapy services:


  • Application of cast to a finger
  • Blood transfusions
  • Application of a splint to a finger
  • Demonstration and/or evaluation of a patient utilizing a nebulizer or metered dose inhaler
  • Alcohol and/or substance abuse (other than tobacco) structured assessment and brief intervention (such as advising of health risks and counseling for 15-30 mins)
  • Pulmonary rehabilitation, including exercise of one hour per session – up to two sessions per day