Amends title XVIII (Medicare) of the Social Security Act with respect to: (1) the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals; (2) extension of the temporary increase in payments to certain rural hospitals (Medicare hold harmless provision); (3) the Medicare inpatient hospital payment adjustment for low-volume hospitals; (4) Medicare wage index reclassifications for certain hospitals; (5) Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospitals in certain rural areas; (6) elimination of the isolation test for the cost-based ambulance reimbursement for critical access hospitals; (7) the capital infrastructure revolving loan program; (8) the Medicare incentive payment program for physician scarcity areas; (9) extension of the 1.00 floor on Medicare work geographic adjustment to payments for physician services; (10) permission for physician assistants to order post-hospital extended care services or hospice care; (11) Medicare home health care planning; (12) rural health clinics; (13) a temporary Medicare payment increase for home health services furnished in a rural area; (14) extension of increased Medicare payments for rural ground ambulance services; and (15) coverage of marriage and family therapist services and mental health counselor services under Medicare part B (Supplementary Medical Insurance).

Amends the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 to provide for the extension of the payment for the technical component of certain physician pathology services under Medicare.

Directs the Secretary of Health and Human Services (HHS) to encourage and facilitate the adoption of provisions allowing for multistate practitioner practice across state lines.

Amends title XVIII (Medicare) of the Social Security Act to extend Medicare part A (Hospital Insurance) coverage and payment, on a reasonable cost basis, to anesthesia services furnished by a physician anesthesiologist in certain rural hospitals in the same manner as payment is made for anesthesia services furnished by a certified registered nurse anesthetists (CRNAs) in such hospitals.

Establishes the floor at 1.00 on the practice expense geographic index for services furnished during a specified period in certain rural areas outside of frontier states under the Medicare physician fee schedule.

Revises the standard for designation of sole community hospitals.

Amends the Omnibus Budget Reconciliation Act of 1986, as amended by the Omnibus Budget Reconciliation Act of 1989, to include standby and on-call time costs for CRNAs in determination of the reasonable costs incurred by a hospital or critical access hospital for CRNA services.

Amends the Public Health Service Act to extend the authorization of appropriations for grants to states for operation of offices of rural health.