Under a notice of nonenforcement in effect through the end of CY 2013, CAHs and small rural hospitals having 100 or fewer beds are, in effect, currently exempt from the requirement that all hospital outpatient therapeutic services must be furnished under direct supervision by a physician. Under the Proposed Rule, this period of nonenforcement would be permitted to expire at the end of CY 2013, such that all outpatient therapeutic services furnished in hospitals and CAHs would require a minimum of direct supervision unless the service is on the list of services that may be furnished under general supervision or is designated as a nonsurgical extended duration therapeutic service.