Sending Office: Honorable Lynn Jenkins
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Cosponsor The Rural Hospital Regulatory Relief Act of 2017

Dear Colleague,

We are writing to request your support for bipartisan legislation to provide regulatory relief for America’s Critical Access Hospitals (CAHs) and small, rural hospitals and to protect access to outpatient therapeutic services for patients living in rural
communities. Last year, H.R. 5613 was included in the 21st Century Cures Act of 2016.

The Rural Hospital Regulatory Relief Act of 2017 (H.R. 741) would 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. An annual extension bill has been passed into law since 2014.

Under current regulations, hospitals must perform most outpatient therapeutic services under the “direct supervision” of a physician or qualified non-physician practitioner, which can be challenging for small, rural hospitals due to already low numbers of
available health professionals and associated cost. When these services become too costly or difficult to provide under “direct supervision” requirements, they are at risk of being terminated, leaving patients without access to care in their communities. Examples
of outpatient therapeutic services include:

  • Application of a cast to a finger;
  • Demonstration and/or evaluation of a patient utilizing a nebulizer or metered dose inhaler; and
  • Pulmonary rehabilitation, including exercise of one hour per session – up to two sessions per day. 

These services have always been provided by licensed, skilled professionals under the overall supervision of a physician and with the assurance of rapid assistance from a team of caregivers, including a physician.

Urgent action is needed to prohibit the enforcement of CMS’ “direct supervision” rule, which went back into effect on January 1, 2017. Please consider adding your name as a cosponsor to this important legislation to protect access to patient care in rural
communities and provide regulatory relief to America’s small, rural hospitals.  If you would like more information or to sign on as a cosponsor, please contact Colin Brainard ( in Congresswoman Jenkins’ office at 5-6601 or Maddie
Bushnell ( in Congressman Loebsack’s office at 5-5506.



Lynn Jenkins, CPA                              Dave Loebsack

Member of Congress                           Member of Congress

Related Legislative Issues

Selected legislative information: HealthCare

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