Medicare Rural Health Access Improvement Act of 2009

Medicare Rural Health Access Improvement Act of 2009 - Amends title XVIII (Medicare) of the Social Security Act to: (1) extend Medicare flex grants; (2) revise requirements for the Medicare-dependent hospital (MDH) program; (3) revise the Medicare inpatient hospital payment adjustment for low-volume hospitals; (4) eliminate temporarily the disproportionate share hospital (DSH) adjustment cap; and (5) extend and revise the Medicare hold harmless provision under the prospective payment system (PPS) for hospital outpatient department (HOPD) services for certain hospitals.

Revises requirements for the treatment of rural sole community hospitals and Medicare dependent, small rural hospitals under the PPS for HOPD services.

Provides for recognition of equality of physician work in all geographic areas under the Medicare physician fee schedule.

Revises the practice expense geographic adjustment under the Medicare physician fee schedule.

Extends the treatment of certain physician pathology services, and increased Medicare payments for rural ground ambulance services.

Directs the Secretary of Health and Human Services to set $92 as the maximum rate of payment per visit in 2010 for independent rural health clinics.

Requires the Secretary to exempt from competitive acquisition requirements rural areas and small metropolitan statistical areas (MSAs) with a population of 600,000 or less.

Permits physician assistants to order post-hospital extended care services. Recognizes attending physician assistants as attending physicians for the purpose of serving hospice patients.