[Federal Register Volume 60, Number 5 (Monday, January 9, 1995)]
[Rules and Regulations]
[Pages 2325-2330]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-485]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 400, 405, 410, 484, 485, 486, and 498

[BPD-798-FC]


Medicare Program; Providers and Suppliers of Specialized 
Services: Technical Amendments

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Final rule with comment period.

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SUMMARY: This rule reorganizes Medicare regulations that pertain to 
providers and suppliers of specialized services, in order to facilitate 
the incorporation of future rules in logical order.
    The rule also makes minor technical and editorial changes to 
clarify the rules and eliminate duplication without substantive change.

DATES: Effective date: These rules are effective February 8, 1995.
    Comment date: We will consider comments received by March 10, 1995.

ADDRESSES: Please mail written comments (an original and 3 copies) to 
the following address: Health Care Financing Administration, Department 
of Health and Human Services, Attention: BPD-798-FC, P.O. Box 26676, 
Baltimore, Maryland 21207.
    If you prefer, you may deliver your written comments (an original 
and 3 copies) to one of the following addresses:

Room 309-G, Hubert H. Humphrey Building, 200 Independence Avenue, S.W., 
Washington, D.C. 20201, or
Room 132, East High Rise Building, 6325 Security Boulevard, Baltimore, 
Maryland 21207.

    Because of staffing and resource limitations, we cannot accept 
comments by facsimile (FAX) transmission. In commenting, please refer 
to file code BPD-798-FC. Comments received timely will be available for 
public inspection as they are received, generally beginning 
approximately 3 weeks after publication of a document, in Room 309-G of 
the Department's offices at 200 Independence Avenue, SW., Washington, 
DC, on Monday through Friday of each week from 8:30 a.m. to 5 p.m. 
(phone: (202) 690-7890).

FOR FURTHER INFORMATION CONTACT: Luisa V. Iglesias, (202) 690-6383.

SUPPLEMENTARY INFORMATION: This rule is part of an ongoing process of 
relocating the content of part 405 to separate parts devoted to 
particular aspects of the Medicare program. In this case, the rule--
    1. Transfers to part 485 the regulations that pertain to 
institutional providers of physical therapy and speech-language 
pathology services that were in subpart Q of part 405; and
    2. Establishes a new part 486 for suppliers of specialized 
services, including--
    <bullet> Suppliers of portable X-Ray services (from subpart N of 
part 405); and
    <bullet> Physical therapists in independent practice (from subpart 
Q of part 405).
    The following subparts, which also pertain to specialized services, 
are not relocated at this time for the reasons indicated:
    <bullet> Subpart D of part 485--Conditions for Coverage: Organ 
Procurement Organizations--A final rule that makes substantive changes 
is currently in clearance.
    <bullet> Subpart B of part 494--Conditions for Coverage of 
Screening Mammography Services--Recent statutory amendments require 
substantive changes.
    The rule also--
    <bullet> Simplifies and clarifies regulations, without substantive 
change, by removing extensive (and unnecessary) verbatim statutory 
citations and separating true definitions from personnel qualification 
requirements; and
    <bullet> In Sec. 400.310, which lists the regulation sections for 
which OMB control numbers have been assigned, conforms those section 
numbers to changes made by this rule.

Collection of Information Requirements

    This rule contains no new information collection requirements 
subject to review by the Office of Management and Budget under the 
Paperwork Reduction Act of 1980 (44 U.S.C. 3501 et seq.).

Response to Comments

    Although this is a final rule, we will consider timely comments 
from anyone who believes that the reorganization of 
[[Page 2326]] content and the clarifying technical and editorial 
changes affect the substance of the rules. If we revise this rule as a 
result of comments, we will discuss all timely comments in the preamble 
to the revised rule.

Waiver of Proposed Rulemaking

    The changes made by this rule are purely technical and editorial 
and have no substantive impact. Accordingly, we find that there is good 
cause to waive proposed rulemaking procedures as unnecessary.

Regulatory Flexibility Analysis

    Consistent with the Regulatory Flexibility Act (RFA) and section 
1102(b) of the Social Security Act, we prepare a regulatory flexibility 
analysis for each rule, unless the Secretary certifies that the 
particular rule will not have a significant economic impact on a 
substantial number of small entities, or a significant impact on the 
operation of a substantial number of small rural hospitals.
    The RFA defines ``small entity'' as a small business, a nonprofit 
enterprise, or a governmental jurisdiction (such as a county, city, or 
township) with a population of less than 50,000. We also consider all 
providers and suppliers of services to be small entities. For purposes 
of section 1102(b) of the Act, we define small rural hospital as a 
hospital that has fewer than 50 beds, and is located anywhere but in a 
metropolitan statistical area.
    We have not prepared a regulatory flexibility analysis because we 
have determined, and the Secretary certifies, that these rules will not 
have a significant economic impact on a substantial number of small 
entities or a significant impact on the operation of a substantial 
number of small rural hospitals.
    In accordance with the provisions of Executive Order 12866, this 
rule was not reviewed by the Office of Management and Budget.

List of Subjects

42 CFR Part 400

    Grant programs-health, Health facilities, Health maintenance 
organizations (HMO), Medicaid, Medicare, Reporting and recordkeeping 
requirements.

42 CFR Part 405

    Administrative practice and procedure, Health facilities, Health 
professions, Kidney diseases, Medicare, Reporting and recordkeeping 
requirements, Rural areas, X-rays.

42 CFR Part 410

    Health facilities, Health professions, Kidney diseases, 
Laboratories, Medicare, Rural areas, X-rays.

42 CFR Part 484

    Health facilities, Health professions, Medicare, Reporting and 
recordkeeping requirements.

42 CFR Part 485

    Grant programs-health, Health facilities, Medicaid, Medicare, 
Reporting and recordkeeping requirements.

42 CFR Part 486

    Health professionals, Medicare, Organ procurement, X-rays.

42 CFR Part 498

    Administrative practice and procedure, Health facilities, Health 
professions, Medicare, Reporting and recordkeeping requirements.

    42 CFR chapter IV is amended as set forth below:

PART 400--INTRODUCTION; DEFINITIONS

    A. Part 400 is amended as set forth below:
    1. The authority citation for part 400 continues to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395(hh)) and 44 U.S.C. Chapter 35.


Sec. 400.310  [Amended]

    2. In the left-hand column of Sec. 400.310, the following changes 
are made:
    a. ``405.1716, 405.1717, 405.1720, 405.1721, 405.1722, 405.1724, 
405.1725, 405.1726'' is revised to read ``485.709, 485.711, 485.717, 
485.719, 485.721, 485.725, 485.727, 485.729.''
    b. ``405.1733, 405.1736, 405.1737'' is revised to read ``486.155, 
486.161, 486.163''.

PART 405--FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED

    Part 405 is amended as set forth below:


Secs. 405.1411, 405.1412, 405.1413, 405.1414, 405.1415, 
1405.1416  [Redesignated]

    1. Subpart N, consisting of Secs. 405.1411 through 405.1416 is 
redesignated as subpart C under a new part 486, in accordance with the 
following redesignation table:

------------------------------------------------------------------------
Old section (subpart N of part 405)  New section (subpart C of part 486)
------------------------------------------------------------------------
405.1411...........................                  486.100            
405.1412...........................                  486.102            
405.1413...........................                  486.104            
405.1414...........................                  486.106            
405.1415...........................                  486.108            
405.1416...........................                  486.110            
------------------------------------------------------------------------

Secs. 405.1701, 405.1730  [Amended]

    2. In subpart Q, the undesignated centered headings preceding 
Sec. 405.1701 and Sec. 405.1730, respectively, are removed.


Secs. 405.1701, 405.1702, 405.1715-405.1726  [Redesignated]

    3. Subpart G to part 485 is added and reserved and Secs. 405.1701, 
405.1702, and 405.1715 through 405.1726 of subpart Q in part 405 are 
redesignated as new subpart H under part 485 in accordance with the 
following redesignation table:

------------------------------------------------------------------------
                                                           New section  
          Old section (subpart Q of part 405)             (subpart H of 
                                                            part 485)   
------------------------------------------------------------------------
405.1701..............................................  485.701         
405.1702, introductory text...........................  Removed.        
405.1702(a)...........................................  485.705(a)      
405.1702(b)...........................................  485.703(a)      
405.1702(c)...........................................  485.703(b)      
405.1702(d)...........................................  485.705(b)      
405.1702(e)...........................................  485.705(c)      
405.1702(f)...........................................  485.705(d)      
405.1702(g)...........................................  485.705(e)      
405.1702(h)...........................................  485.703(c)      
405.1702(i)...........................................  485.703(d)      
405.1702(j)...........................................  485.705(f)      
405.1702(k)...........................................  485.705(g)      
405.1702(l)...........................................  485.703(e)      
405.1702(m)...........................................  485.705(h)      
405.1715..............................................  485.707         
405.1716..............................................  485.709         
405.1717..............................................  485.711         
405.1718..............................................  485.713         
405.1719..............................................  485.715         
405.1720..............................................  485.717         
405.1721..............................................  485.719         
405.1722..............................................  485.721         
405.1723..............................................  485.723         
405.1724..............................................  485.725         
405.1725..............................................  485.727         
405.1726..............................................  485.729         
------------------------------------------------------------------------

Secs. 405.1730-405.1737  [Redesignated]

    4. Sections 405.1730 through 405.1737 are redesignated as subpart D 
under a new part 486, in accordance with the following redesignation 
table:

------------------------------------------------------------------------
Old section (subpart Q of part 405)  New section (subpart D of part 486)
------------------------------------------------------------------------
405.1730...........................                  486.150            
405.1731...........................                  486.151            
405.1732...........................                  486.153            
405.1733...........................                  486.155            
405.1734...........................                  486.157            
405.1735...........................                  486.159            
405.1736...........................                  486.161            
405.1737...........................                  486.163            
------------------------------------------------------------------------

[[Page 2327]] PART 485--CONDITIONS OF PARTICIPATION AND CONDITIONS 
FOR COVERAGE: SPECIALIZED PROVIDERS

    C. Part 485 is amended as set forth below.

    1. The authority citation for part 485 is revised to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395(hh).

    2. The heading of part 485 is revised to read as follows:

PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS


Sec. 485.70  [Amended]

    3. In Sec. 485.70, the following changes are made:
    a. In Sec. 485.70(e), ``Sec. 485.70(d) and (e) of this chapter.'' 
is revised to read ``paragraphs (b) and (c) of Sec. 485.705.''
    b. In Sec. 485.70(m), ``Sec. 405.1702(j) of this chapter.'' is 
revised to read ``Sec. 485.705(f).''.
    4. The heading and table of contents of newly designated subpart H 
read as follows:
Subpart H--Conditions of Participation for Clinics, Rehabilitation 
Agencies, and Public Health Agencies as Providers of Outpatient 
Physical Therapy and Speech-Language Pathology Services
Sec.
485.701  Basis and scope.
485.703  Definitions.
485.705  Personnel qualifications.
485.707  Condition of participation: Compliance with Federal, State, 
and local laws.
485.709  Condition of participation: Administrative management.
485.711  Condition of participation: Plan of care and physician 
involvement.
485.713  Condition of participation: Physical therapy services.
485.715  Condition of participation: Speech pathology services.
485.717  Condition of participation: Rehabilitation program.
485.719  Condition of participation: Arrangements for physical 
therapy and speech-language pathology services to be performed by 
other than salaried organization personnel.
485.721  Condition of participation: Clinical records.
485.723  Condition of participation: Physical environment.
485.725  Condition of participation: Infection control.
485.727  Condition of participation: Disaster preparedness.
485.729  Condition of participation: Program evaluation.


Secs. 485.707, 485.715, 485.723, 485.727, 485.729  [Amended]

    5. In newly designated subpart H, in the following sections, the 
section heading is amended to change the dash to a colon and to 
capitalize the first word after the colon:
    Secs. 485.707, 485.715, 485.721, 485.723, 485.727, and 485.729.
    6. Newly designated Sec. 485.701 is revised to read as follows:


Sec. 485.701  Basis and scope.

    This subpart implements section 1861(p)(4) of the Act, which--
    (a) Defines outpatient physical therapy and speech pathology 
services;
    (b) Imposes requirements with respect to adequate program, 
facilities, policies, staffing, and clinical records; and
    (c) Authorizes the Secretary to establish by regulation other 
health and safety requirements.


Sec. 485.703  [Amended]

    7. In newly designated Sec. 485.703, the heading is revised to read 
Definitions., and the paragraph designations are removed.


Sec. 485.705  [Amended]

    8. In newly designated Sec. 485.705, a section heading and 
introductory text are added, to read as follows:


Sec. 485.705  Personnel qualifications.

    The training, experience, and membership requirements for personnel 
involved in the furnishing of outpatient physical therapy and speech-
language pathology services are as follows:
* * * * *


Sec. 485.707  [Amended]

    9. In newly designated Sec. 485.707, the following changes are 
made:
    a. In the introductory text and paragraph (a), ``clinic, 
rehabilitation agency, or public health agency'' and the plural version 
of that phrase are revised to read ``organization'' and 
``organizations'', respectively.
    b. In paragraph (a), ``pursuant to such law'' is revised to read 
``in accordance with applicable laws''.


Sec. 485.709  [Amended]

    10. In newly designated Sec. 485.709, the following changes are 
made:
    a. Paragraph (b) is revised to read as set forth below.
    b. In paragraph (c), second sentence, ``where'' is revised to 
``if''.
    c. In paragraph (d), second sentence, ``which'' is revised to 
``that''.


Sec. 485.709  Condition of participation: Administrative management.

* * * * *
    (b) Standard: Administrator. The governing body--
    (1) Appoints a qualified full-time administrator;
    (2) Delegates to the administrator the internal operation of the 
clinic or rehabilitation agency in accordance with written policies;
    (3) Defines clearly the administrator's responsibilities for 
procurement and direction of personnel; and
    (4) Designates a competent individual to act during temporary 
absence of the administrator.
* * * * *


Sec. 485.711  [Amended]

    11. In newly designated Sec. 485.711, the following changes are 
made:
    a. In paragraph (a), introductory text, ``prior to'' is revised to 
read ``before''.
    b. Paragraph (b)(1) is revised to read as set forth below.
    c. In paragraph (b)(3), the parenthetical statement, ``at least 
every 30 days'' is inserted immediately before ``in accordance'', and 
``Sec. 424.25(e)'' is revised to read ``Sec. 410.61(e)''.
    d. Paragraph (b)(4) is revised to read as set forth below.
    e. In paragraph (c), second sentence, ``There are'' is revised to 
read ``The'', and ``that covers'' is revised to read ``cover''.


Sec. 485.711  Condition of participation: Plan of care and physician 
involvement.

* * * * *
    (b) Standard: Plan of care--(1) For each patient there is a written 
plan of care established by the physician or by the physical therapist 
or speech-language pathologist who furnishes the services.
* * * * *
    (4) Changes in the plan of care are noted in the clinical record. 
If the patient has an attending physician, the therapist or speech-
language pathologist who furnishes the services promptly notifies him 
or her of any change in the patient's condition or in the plan of care.
* * * * *


Sec. 485.713  [Amended]

    12. In newly designated Sec. 485.713, the following changes are 
made:
    a. The introductory text is revised to read as set forth below.
    b. In paragraph (a)(1) introductory text, ``will be'' is revised to 
read ``is''.
    c. In paragraph (a)(1)(i), ``utilizing'' is revised to ``using''.
    d. Paragraph (a)(2) is revised to read as set forth below.
    e. In paragraph (b), ``accepted'' is revised to read ``it 
accepts''.
    f. In paragraph (d), ``such'' is revised to ``these''. 
[[Page 2328]] 


Sec. 485.713  Conditions of participation: Physical therapy services.

    If the organization offers physical therapy services, it provides 
an adequate program of physical therapy and has an adequate number of 
qualified personnel and the equipment necessary to carry out its 
program and to fulfill its objectives.
    (a) Standard: Adequate program. * * *
    (2) A qualified physical therapist is present or readily available 
to offer supervision when a physical therapist assistant furnishes 
services.
    (i) If a qualified physical therapist is not on the premises during 
all hours of operation, patients are scheduled so as to ensure that the 
therapist is present when special skills are needed, for example, for 
evaluation and reevaluation.
    (ii) When a physical therapist assistant furnishes services off the 
organization's premises, those services are supervised by a qualified 
physical therapist who makes an onsite supervisory visit at least once 
every 30 days.
* * * * *


Sec. 485.715  [Amended]

    13. In newly designated Sec. 485.715, the following changes are 
made:
    a. In paragraph (a), ``will be'' is revised to read ``is''.
    b. In paragraph (b), ``accepted'' is revised to read ``it 
accepts''.
    c. In paragraph (c), ``rendered'' is revised to read ``furnished''.


Sec. 485.717  [Amended]

    14. In newly designated Sec. 485.717, the following changes are 
made:
    a. The undesignated introductory text is revised to read as set 
forth below.
    b. In paragraph (a), ``rendered, as applicable'' is revised to read 
``furnished as appropriate''.
    c. Paragraph (b) is revised to read as set forth below.


Sec. 485.717  Condition of participation: Rehabilitation program.

    This condition and its standards apply only to a rehabilitation 
agency's own patients, not to patients of hospitals, skilled nursing 
facilities (SNFs), or Medicaid nursing facilities (NFs) to whom the 
agency furnishes services. (The hospital, SNF, or NF is responsible for 
ensuring that qualified staff furnish services for which they arrange 
or contract for their patients.) The rehabilitation agency provides, in 
addition to physical therapy and speech-language pathology services, 
social or vocational adjustment services to all of its patients who 
need them. The agency provides for special qualified staff to evaluate 
the social and vocational factors, to counsel and advise on the social 
or vocational problems that arise from the patient's illness or injury, 
and to make appropriate referrals for needed services.
* * * * *
    (b) Standard: Arrangements for social or rehabilitation services--
(1) If a rehabilitation agency does not provide social or vocational 
adjustment services through salaried employees, it may provide those 
services through a written contract with others who meet the 
requirements and responsibilities set forth in this subpart for 
salaried personnel.
    (2) The contract must specify the term of the contract and the 
manner of termination or renewal and provide that the agency retains 
responsibility for the control and supervision of the services.


Sec. 485.719  [Amended]

    15. In newly designated Sec. 485.719, the following changes are 
made:
    a. In paragraph (a), ``when'' is revised to ``if''; ``and/or'' is 
revised to read ``or''; ``such'' is revised to ``the''(twice); 
``provides for retention by the organization'' is revised to read 
``provides that the organization retains''; and ``responsibility form 
and control and supervision of'' is corrected to read ``responsibility 
for, and control and supervision of,''.
    b. Paragraph (b) is revised to read as set forth below:


Sec. 485.719  Condition of participation: Arrangements for physical 
therapy and speech-language pathology services to be performed by other 
than salaried organization personnel.

* * * * *
    (b) Standard: Contract provisions. The contract--
    (1) Specifies the term of the contract and the manner of 
termination or renewal;
    (2) Requires that personnel who furnish the services meet the 
requirements that are set forth in this subpart for salaried personnel; 
and
    (3) Provides that the contracting outside resource may not bill the 
patient or Medicare for the services. This limitation is based on 
section 1861(w)(1) of the Act, which provides that--
    (i) Only the provider may bill the beneficiary for covered services 
furnished under arrangements; and
    (ii) Receipt of Medicare payment by the provider, on behalf of an 
entitled individual, discharges the liability of the individual or any 
other person to pay for those services.


Sec. 485.721  [Amended]

    16. In newly designated Sec. 485.721, the following changes are 
made:
    a. In paragraph (b), the commas at the end of paragraphs (b)(1) 
through (b)(6) are changed to periods; in paragraph (b)(1), 
``provided'' is revised to ``furnished''; and the ``and'' at the end of 
paragraph (b)(6) is removed.
    b. In paragraph (c), the last sentence is revised to read as set 
forth below.
    c. In paragraph (d), the commas at the end of the paragraphs (d)(1) 
and (d)(2)(1) are changed to semicolons, and in the introductory text, 
``a period of time of not less than'' is revised to read ``at least''.
    d. In paragraph (d)(1), ``That'' is revised to ``The period''.
    e. In paragraph (d)(2), introductory text, the colon is changed to 
a dash.


Sec. 485.721  Condition of Participation: Clinical records.

* * * * *
    (c) Standard: Completion of records and centralization of reports. 
* * *  Each physician signs the entries that he or she makes in the 
clinical record.
* * * * *


Sec. 485.723  [Amended]

    17. In newly designated Sec. 485.723, the following changes are 
made:
    a. In paragraph (a)(2), ``organization'' is revised to ``premises'' 
(twice).
    b. In paragraph (b), at the end of the introductory text, the colon 
is removed and ``that--'' is inserted.
    c. In paragraph (b)(1), ``That'' is revised to ``The'', and the 
comma is changed to a semicolon.
    d. In paragraph (b)(2), ``That the'' is revised to read ``The'', 
and ``which'' is revised to ``that''.
    e. In paragraph (c)(2), ``utilization'' is revised to ``use''.


Sec. 485.725  [Amended]

    18. In newly designated Sec. 485.725, the following changes are 
made:
    a. Paragraph (b) is revised to read as set forth below.
    b. In paragraph (c), the designation ``(1)'' is inserted 
immediately before the first sentence; ``such'' is revised to 
``housekeeping''; the designation ``(2)'' is inserted immediately 
before the third sentence; ``and/or'' is revised to read ``or'', and 
``meets'' is revised to read ``or both meet''.
    c. In paragraph (e), ``The organization is maintained'' is revised 
to read ``The organization's premises are maintained''.


Sec. 485.725  Condition of participation: Infection control.

* * * * * [[Page 2329]] 
    (b) All personnel follow written procedures for effective aseptic 
techniques. The procedures are reviewed annually and revised if 
necessary to improve them.


Sec. 485.727  [Amended]

    19. In newly designated Sec. 485.727, in the introductory text, 
``such disasters'' is revised to read ``a disaster''.


Sec. 485.729  [Amended]

    20. In newly designated Sec. 485.729, the following changes are 
made:
    a. In the introductory text, ``which'' is revised to ``that'', and 
``assure'' is revised to ``ensure''.
    b. In paragraph (a), ``assure'' is revised to ``ensure''.
    c. In paragraph (b) ``such statistical data as'' is revised to read 
``statistical data such as''.
    D. A new part 486 is added.
    1. The heading and the table of contents of the new part 486 read 
as follows:

PART 486--CONDITIONS FOR COVERAGE OF SERVICES OF SPECIALIZED 
SUPPLIERS

Subparts A and B--[Reserved]

Subpart C--Conditions for Coverage: Portable X-Ray Services

Sec.
486.100  Condition for coverage: Compliance with Federal, State, and 
local laws and regulations.
486.102  Condition for coverage: Supervision by a qualified 
physician.
486.104  Condition for coverage: Qualifications, orientation, and 
health of technical personnel.
486.106  Condition for coverage: Referral for service and 
preservation of records.
486.108  Condition for coverage: Safety standards.
486.110  Condition for coverage: Inspection of equipment.
Subpart D--Conditions for Coverage: Outpatient Physical Therapy 
Services Furnished by Physical Therapists in Independent Practice
486.150  Condition for coverage: General requirements.
486.151  Condition for coverage: Supervision.
486.153  Condition for coverage: Compliance with Federal, State, and 
local laws.
486.155  Condition for coverage: Plan of care.
486.157  Condition for coverage: Physical therapy services.
486.159  Condition for coverage: Coordination of services with other 
organizations, agencies, or individuals.
486.161  Condition for coverage: Clinical records.
486.163  Condition for coverage: Physical environment.

    Authority: Sections 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).

    2. In newly designated subpart D, in the following sections, the 
section heading is revised to change the dash to a colon and capitalize 
the first word after the colon: Secs. 486.153, 486.155, 486.157, and 
486.161.
    3. Newly designated Secs. 486.150 and 486.151 are revised to read 
as follows:


Sec. 486.150  Condition for coverage: General requirements.

    In order to be covered under Medicare as a supplier of outpatient 
physical therapy services, a physical therapist in independent practice 
must meet the following requirements:
    (a) Be licensed in the State in which he or she practices.
    (b) Meet one of the personnel qualifications specified in 
Sec. 485.705(b).
    (c) Furnish services under the circumstances described in 
Sec. 410.60 of this chapter.
    (d) Meet the requirements of this subpart.


Sec. 486.151  Condition for coverage: Supervision.

    The services are furnished by or under the direct supervision of a 
qualified physical therapist in independent practice.


Sec. 486.155  [Amended]

    4. In newly designated Sec. 486.155, the following changes are 
made:
    a. In paragraph (a), introductory text, ``The following information 
is obtained by the physical therapist prior to'' is revised to read 
``The physical therapist obtains the following information before''.
    b. In paragraph (b)(4), the second sentence is revised to read: 
``If the patient has an attending physician, the therapist who 
furnishes the services promptly notifies him or her of any change in 
the patient's condition or in the plan of care.''.
    c. In the parenthetical statement in paragraph (b)(4), 
``Sec. 424.25(e)'' is revised to read ``Sec. 410.61(e)''.
    5. Newly designated Sec. 486.159 is revised to read as follows:


Sec. 486.159  Condition for coverage: Coordination of services with 
other organizations, agencies, or individuals.

    The physical therapist coordinates her physical therapy services 
with the health and medical services the patient receives from 
organizations or agencies or other individual practitioners through 
exchange of information that meets the following standard:
    If a patient is receiving or has recently received, from other 
sources, services related to the physical therapy program, the physical 
therapist exchanges pertinent documented information with those other 
sources--
    (a) On a regular basis;
    (b) Subject to the requirements for protection of the 
confidentiality of medical records, as set forth in Sec. 485.721 of 
this chapter; and
    (c) With the aim of ensuring that the services effectively 
complement one another.


Sec. 486.163  [Amended]

    6. In newly designated Sec. 486.163, the following changes are 
made:
    a. In the introductory text, ``and/or'' is revised to read ``or''.
    b. In paragraph (b), first sentence, the word ``established'' is 
removed.
    c. In paragraph (c), second sentence, ``such'' is changed to 
``the''.
    d. Paragraph (d) is revised to read as follows:


Sec. 486.163  Condition for coverage: Physical environment.

* * * * *
    (d) The physical therapist is alert to the possibility of fire and 
other nonmedical emergencies and has written plans that include--
    (1) The means for leaving the office and the building safely, 
demonstrated, for example, by fire exit signs; and
    (2) Other provisions necessary to ensure the safety of patients.

E. Technical corrections.

PART 410--[AMENDED]

    1. In part 410, the following changes are made:
    a. the authority citation of part 410 is revised to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395 (hh)) unless otherwise indicated.

    b. In Sec. 410.60(a)(3)(ii), ``Sec. 405.1702(d) of this chapter'' 
is revised to read ``Sec. 485.705(b) of this chapter''.

PART 484--[AMENDED]

    2. In part 484, the following changes are made:
    a. The authority citation for part 484 is revised to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395 (hh)) unless otherwise indicated.


Sec. 484.38  [Amended]

    b. In Sec. 484.38, ``Secs. 405.1717 through 405.1719, 405.1721, 
405.1723, and 405.1725 of this chapter'' is revised to read ``subpart H 
of part 485 of this chapter''.
[[Page 2330]]

PART 498--[AMENDED]

    3. In part 498, the following changes are made:
    a. The authority citation for part 498 is revised to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395(hh)) unless otherwise indicated.


Sec. 498.3  [Amended]

    b. In Sec. 498.3(b)(6), ``Secs. 405.1730 through 405.1737, or in 
Sec. 410.22 of this chapter, respectively,'' is revised to read 
``subpart D of part 486 of this chapter and Sec. 410.22 of this 
chapter, respectively.''

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: September 2, 1994.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
    Dated: October 12, 1994.
Donna E. Shalala,
Secretary.
[FR Doc. 95-485 Filed 1-6-95; 8:45 am]
BILLING CODE 4120-01-P