Nick-Maximillien/medgate-compiler-data huggingface dataset:
Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

§482.60(b) Meet the Conditions of Participation specified in§§482.1 through 482.23 and §§482.25 through 482.57;

Interpretive Guidelines §482.60(b)

Guidance is pending and will be updated in future release.

A-1610

(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

§482.60(c) Maintain clinical records on all patients, including records sufficient to permit CMS to determine the degree and intensity of treatment furnished to Medicare beneficiaries as specified in §482.61; and

Interpretive Guidelines §482.60(c)

Guidance is pending and will be updated in future release.

A-1615

(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

§482.60(d) Meet the staffing requirements specified in §482.62.

Interpretive Guidelines §482.60(d)

Guidance is pending and will be updated in future release.

A-1620

(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

§482.61 Condition of Participation: Special Medical Record Requirements for Psychiatric Hospitals

The medical records maintained by a psychiatric hospital must permit determination of the degree and intensity of the treatment provided to individuals who are furnished services in the institution.

Interpretive Guidelines §482.61

The clinical record should provide information that indicates need for admission and treatment, treatment goals, changes in status of treatment and discharge planning, and follow-up and the outcomes experienced by patients. The structure and content of the individual patient's record must be an accurate functional representation of the actual experience of the individual in the facility. It must contain enough information to indicate that the facility knows the status of the patient, has adequate plans to intervene, and provides sufficient evidence of the effects of the intervention, and how their interventions served as a function of the outcomes experienced. You must be able to identify this through interviews with staff, and when possible with individuals being served, as well as through observations.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance", "integrity"], "logic_config": {"required_artifact": "Psychiatric patient medical record content demonstrating need for admission, treatment goals, changes in status, discharge planning, follow-up, and patient outcomes."}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "billing", "legal"]}
Guideline text:
Heart Rate must be above 110.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 110, "target_vital": "Heart Rate"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
Pre-treatment with a glycoprotein IIb/IIIa antagonist is not recommended.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"forbidden_treatment": "pre-treatment with a glycoprotein IIb/IIIa antagonist", "trigger_drug": null}, "rule_type": "contra", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

[The bylaws must:]

§482.22(c)(4) - Describe the qualifications to be met by a candidate in order for the medical staff to recommend that the candidate be appointed by the governing body.

## Interpretive Guidelines §482.22(c)(4)

The medical staff bylaws must describe the qualifications to be met by a candidate for medical staff membership/privileges in order for the medical staff to recommend the candidate be approved by the governing body.  The bylaws must describe the privileging process to be used in the hospital.  The process articulated in the medical staff bylaws must include criteria for determining the privileges that may be granted to individual practitioners and a procedure for applying the criteria to individual practitioners that considers:

- Individual character;
- Individual competence;
- Individual training;
- Individual experience; and
- Individual judgment.

The medical staff may not rely solely on the fact that a MD/DO is, or is not, board-certified in making a judgment on medical staff membership.  This does not mean that the medical staff is prohibited from requiring board certification when considering a MD/DO for medical staff membership; only that such certification is not the only factor that the hospital considers.  After analysis of all of the criteria, if all criteria are met except for board certification, the medical staff has the discretion to not recommend that individual for medical staff membership/privileges.

The bylaws must apply equally to all practitioners in each professional category of practitioners.

The medical staff then recommends individual candidates that meet those requirements to the governing body for appointment to the medical staff.

## Survey Procedures §482.22(c)(4)

- Verify that there are written criteria for appointments to the medical staff and granting of medical staff privileges.
- Verify that granting of medical staff membership or privileges, is based upon an individual practitioner's meeting the medical staff's membership/privileging criteria.
- Verify that at a minimum, criteria for appointment to the medical staff/granting of medical staff privileges are individual character, competence, training, experience, and judgment.
- Verify that written criteria for appointment to the medical staff and granting of medical staff privileges are not dependent solely upon certification, fellowship, or membership in a specialty body or society.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "written criteria and process for medical staff appointments and privileges as per \u00a7482.22(c)(4)"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
It is recommended that high-dose statin therapy is initiated or continued as early as possible, regardless of initial LDL-C values.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "initiation or continuation of high-dose statin therapy"}, "rule_type": "existence", "scope_tags": ["clinical"]}
Guideline text:
A temporary interruption of cancer therapy is recommended in patients in whom the cancer therapy is suspected to be a contributing cause of ACS.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "temporary interruption of cancer therapy", "trigger_assertion": "cancer therapy suspected as contributing cause of ACS"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

## §482.51(a) Standard:  Organization and Staffing

The organization of the surgical services must be appropriate to the scope of the services offered.

## Interpretive Guidelines  §482.51(a)

When the hospital offers surgical services, the hospital must provide the appropriate equipment and the appropriate types and numbers of qualified personnel necessary to furnish the surgical services offered by the hospital in accordance with acceptable standards of practice.

The scope of surgical services provided by the hospital should be defined in writing and approved by the medical staff.

## Survey Procedures  §482.51(a)

Review the hospital's organizational chart displaying the relationship of the operating room service to other services.  Confirm that the operating room's organization chart indicates lines of authority and delegation of responsibility within the department or service.

A-0942

(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

§482.51(a)(1) - The operating rooms must be supervised by an experienced registered nurse or a doctor of medicine or osteopathy.

## Interpretive Guidelines  §482.51(a)(1)

The operating room (inpatient and outpatient) must be supervised by an experienced RN or MD/DO.  The RN or MD/DO supervising the operating room must demonstrate appropriate education, background working in surgical services, and specialized training in the provision of surgical services/management of surgical service operations.  The hospital should address its required qualifications for the supervisor of the hospital's operating rooms in its policies and the supervisor's personnel file should contain information demonstrating compliance with the hospital's established qualifications.

## Survey Procedures  §482.51(a)(1)

- Verify that an RN or a doctor of medicine or osteopathy is assigned responsibility for supervision of the operating rooms.
- Request a copy of the supervisor's position description to determine that it specifies qualifications, duties and responsibilities of the position.  Verify that the supervisor is experienced and competent in the management of surgical services.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"qualifications": "experienced registered nurse or doctor of medicine or osteopathy", "required_artifact": "Operating Room Supervisor"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
It is recommended to adapt the choice and dosage of antithrombotic agent, as well as of secondary prevention medications, to renal function, co-medications, comorbidities, frailty, cognitive function, and specific contraindications.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "documented adaptation of antithrombotic and secondary prevention medication choice and dosage", "trigger_assertion": "presence of relevant patient factors (renal function, co-medications, comorbidities, frailty, cognitive function, or specific contraindications)"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
The use of low- or iso-osmolar contrast media (at the lowest possible volume) is recommended for invasive strategies. 691 – 693

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "low- or iso-osmolar contrast media used at the lowest possible volume", "trigger_assertion": "invasive strategies requiring contrast media"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
An immediate invasive strategy is recommended in patients with a working diagnosis of NSTE-ACS and with at least one of the following very high-risk criteria: • Haemodynamic instability or cardiogenic shock • Recurrent or refractory chest pain despite medical treatment

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "immediate invasive strategy", "trigger_assertion": "NSTE-ACS diagnosis with very high-risk criteria (haemodynamic instability, cardiogenic shock, or recurrent/refractory chest pain)"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
The committee met in 2024 to review the guidelines. [Ref: 311]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
Heart Rate must be above 91.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"min_value": 91, "target_vital": "Heart Rate"}, "rule_type": "threshold", "scope_tags": ["clinical"]}
Guideline text:
Limit nebulizer treatment to 1 units per session.

Structured rule (JSON):
{"intent_tags": ["safety"], "logic_config": {"event_type": "nebulizer", "max_count": 1}, "rule_type": "count_sanity", "scope_tags": ["clinical"]}
Guideline text:
Temperature control (i.e. continuous monitoring of core temperature and active prevention of fever [i.e. >37.7°C]) is recommended after either out-of-hospital or in-hospital cardiac arrest for adults who remain unresponsive after return of spontaneous circulation. 378 – 385 , 389

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "Temperature control, including continuous monitoring of core temperature and active prevention of fever (core temperature >37.7\u00b0C)", "trigger_assertion": "adults who remain unresponsive after return of spontaneous circulation following out-of-hospital or in-hospital cardiac arrest"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
It is recommended to intensify lipid-lowering therapy c during the index ACS hospitalization for patients who were on lipid-lowering therapy before admission.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "intensified lipid-lowering therapy", "trigger_assertion": "patient was on lipid-lowering therapy before admission AND is in index ACS hospitalization"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Intravenous beta-blockers (preferably metoprolol) should be considered at the time of presentation in patients undergoing PPCI with no signs of acute heart failure, an SBP >120 mmHg, and no other contraindications. 163 – 167 , 169

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "intravenous beta-blockers considered", "trigger_assertion": "patient undergoing PPCI with no signs of acute heart failure, SBP >120 mmHg, and no other contraindications"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
Implementation of these guidelines varies by facility. [Ref: 560]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
It is recommended to apply the same diagnostic and treatment strategies in older patients as in younger patients.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "diagnostic and treatment strategies applied uniformly regardless of patient age"}, "rule_type": "existence", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

§482.28(a) Standard:  Organization

## Interpretive Guidelines §482.28(a):

The hospital must ensure that the specific food and dietetic services organization requirements are met.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "specific food and dietetic services organization requirements being met"}, "rule_type": "existence", "scope_tags": ["clinical", "facility"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

§482.12(e)(1) The governing body must ensure that the  services  performed  under a contract are provided in a safe and effective manner.

## Interpretive Guidelines §482.12(e)(1)

Indirect arrangements may take into consideration services provided through formal contracts, joint ventures, informal agreements, shared services, or lease arrangements.  The patient care services, and all other services, provided under contract are subject to the same hospital-wide quality assessment and performance improvement (QAPI) evaluation as other services provided directly by the hospital.

## Survey Procedures §482.12(e)(1)

- Determine if the hospital has a mechanism to evaluate the quality of each contracted service and ensures that each contracted service is provided in a safe and effective manner.
- Review the QAPI plan to ensure that every contracted service is evaluated.

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"required_artifact": "mechanism for quality and safety evaluation of contracted services"}, "rule_type": "existence", "scope_tags": ["clinical", "facility", "legal"]}
Guideline text:
Management of MINOCA according to the final established underlying diagnosis is recommended, consistent with the appropriate disease-specific guidelines. 546 , 550 , 552

Structured rule (JSON):
{"intent_tags": ["quality", "safety"], "logic_config": {"required_artifact": "management plan consistent with appropriate disease-specific guidelines", "trigger_assertion": "final established underlying diagnosis for MINOCA"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
It is recommended to assess symptoms using methods that help patients to describe their experience.

Structured rule (JSON):
{"intent_tags": ["quality", "safety"], "logic_config": {"required_artifact": "symptom assessment using methods that help patients to describe their experience"}, "rule_type": "existence", "scope_tags": ["clinical"]}
Guideline text:
(Rev. 37, Issued:  10-17-08; Effective/Implementation Date:  10-17-08)

## §482.24(a) Standard: Organization and Staffing

The organization of the medical record service must be appropriate to the scope and complexity of the services performed.  The hospital must employ adequate personnel to ensure prompt completion, filing, and retrieval of records.

## Interpretive Guidelines §482.24(a)

The medical records service must be organized, equipped, and staffed in accordance with the scope and complexity of the hospital's services and in such a manner as to comply with the requirements of this regulation and other Federal and State laws and regulations.

There must be an established medical record system that is organized and employs adequate personnel to ensure prompt:

- Completion of medical records;
- Filing of medical records; and
- Retrieval of medical records.

The term 'employs adequate personnel' includes:

- That medical record personnel are employees of the hospital;
- That the hospital employs an adequate number of medical record personnel, employs adequate types of medical record personnel, and employs personnel who possess adequate education, skills, qualifications and experience to ensure the hospital complies with requirements of this regulation and other Federal and State laws and regulations.

## Survey Procedures §482.24(a)

- Verify that there is an established system that addresses at least the following activities of the medical records services:
- o Timely processing of records;
- o Coding/indexing of records;
- o Retrieval of records;
- o Compiling and retrieval of data of quality assurance activities.
- Verify that the system is reviewed and revised as needed.
- Interview staff, if needed, review written job descriptions and staffing schedules to determine if staff is carrying out all designated responsibilities.
- Verify that the hospital employs adequate medical record personnel as previously described.
- Are medical records promptly completed in accordance with State law and hospital policy?
- Select a sample of past patients of the hospital (inpatient and/or outpatient). Request those patients' medical records.  Can the hospital promptly retrieve those records?

Structured rule (JSON):
{"intent_tags": ["quality", "compliance", "integrity"], "logic_config": {"required_artifact": "An established, adequately staffed and organized medical record service ensuring prompt completion, filing, and retrieval of records"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
See Appendix A for a list of contributing authors. [Ref: 653]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
Patient preferences should be considered in all decisions. [Ref: 869]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
(Rev.172, Issued: 11-17-17, Effective: 11-17-17, Implementation: 11-17-17)

## §482.11(b) The hospital must be--

- (1)  Licensed; or
- (2)  Approved as meeting standards for licensing established by the agency of the State or locality responsible for licensing hospitals.

## Interpretive Guidelines §482.11(b)

Hospitals applying for initial Medicare certification as a hospital or hospitals currently participating in Medicare must, among other things, meet the statutory definition of a hospital under section 1861(e) of the Act. Section 1861(e)(7) of the Act  further requires that a hospital located in a state which provides for the licensing of hospitals, the hospital must be licensed in accordance with state law or approved as meeting standards for licensing as established by the agency of the State or locality responsible for the licensing of hospitals.

While a facility may have a license from a state to operate as a hospital or may have been approved by a state as a hospital under state or local standards and authorities, that facility may still not meet the Medicare definition of a hospital as per the Act.  The criteria used by a state to determine that a hospital meets the requirements for state licensure as a hospital is not the same criteria used to define a hospital for the purpose of participation in Medicare, and each state has its own criteria and standards for licensure.

The definition of a hospital and the issue of whether the facility is Primarily Engaged are issues not applicable to a Critical Access Hospital (CAH).

## Survey Procedures §482.11(b)

- Prior to the survey, determine whether the hospital has a current license by the state or local authority in which it operates, or, if it is located within a State that does not license hospitals, verify that the responsible State agency has approved the hospital as meeting the State's established standards for the licensing of hospitals.

Structured rule (JSON):
{"intent_tags": ["compliance", "quality", "safety"], "logic_config": {"required_artifact": "current state or local hospital operating license or state approval"}, "rule_type": "existence", "scope_tags": ["facility", "legal"]}
Guideline text:
Future research is needed to establish optimal thresholds. [Ref: 556]

Structured rule (JSON):
{"intent_tags": [], "logic_config": {}, "rule_type": "unsupported", "scope_tags": [], "summary": "Non-executable narrative text"}
Guideline text:
In selected patients with high-degree AV block in the context of an anterior wall MI and acute heart failure, early device implantation (cardiac resynchronization therapy—defibrillator/pacemaker) may be considered.

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"required_artifact": "early device implantation (cardiac resynchronization therapy\u2014defibrillator/pacemaker) consideration", "trigger_assertion": "selected patients with high-degree AV block in the context of an anterior wall MI and acute heart failure"}, "rule_type": "conditional_existence", "scope_tags": ["clinical"]}
Guideline text:
When fibrinolysis is the reperfusion strategy, it is recommended to initiate this treatment as soon as possible after diagnosis in the pre-hospital setting (aim for target of <10 min to lytic bolus).

Structured rule (JSON):
{"intent_tags": ["safety", "quality"], "logic_config": {"anchor": "diagnosis", "max_delay_minutes": 10, "operator": "<", "target": "lytic bolus initiation"}, "rule_type": "temporal", "scope_tags": ["clinical"]}