and certifications developed by professional agencies 
shall be utilized as far as is consistent with the pur-
poses of this Act, and regard shall be had for the 
varying needs and the available resources in profes-
sional personnel of the States and of local health- 
service areas. 
SEC. 202. NURSES. 
Any individual shall be deemed qualified to render 
home-nursing services in a State as benefits under this 
title if such individual is— 
(1) a professional nurse registered in such 
State; or 
(2) a practical nurse— 
(A) who is qualified as such under State 
standards or requirements, or, in the absence of 
State standards or requirements, is found to be 
qualified under standards established by the 
Board after consultation with the Advisory 
Council and with nursing agencies; and 
(B) who furnishes nursing care under the 
direction or supervision of the State health 
agency, the health agency of a political subdivi-
sion of the State, or an organization supplying 
and supervising the services of registered pro-
fessional nurses in the State. 
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SEC. 203. HOSPITALS. 
Any hospital or other institution shall be deemed 
qualified to furnish all or particular classes of hospital 
services as benefits under this Act if— 
(1) it is qualified to furnish such services under 
State standards or requirements for the maintenance 
and operation of hospitals which apply to the class 
or classes of services to be furnished; or 
(2) in the absence of such State standards or 
requirements, it is found to afford professional serv-
ices, personnel, and equipment adequate to promote 
the health and safety of individuals requiring the 
class or classes of hospital services to be furnished, 
according to standards which the Board shall estab-
lish after consultation with the Advisory Council. 
SEC. 204. AUXILIARY SERVICES. 
Any person (as defined in section 901(1)) who— 
(1) is qualified under State standards or re-
quirements to furnish a class of services included as 
auxiliary services; or 
(2) in the absence of State standards or re-
quirements, is found to be qualified to furnish a 
class of such services under standards established 
for such class by the Board after consultation with 
the Advisory Council, 
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shall be deemed qualified to furnish such class of auxiliary 
services in that State as benefits under this Act. 
SEC. 205. AGREEMENTS WITH INDIVIDUAL PRACTITIONERS, 
HOSPITALS, AND OTHERS. 
Any individual (or, in the case of hospital or auxiliary 
services, any person) qualified under this title to furnish 
any class or classes of personal health services as benefits 
may enter into an agreement with the State agency which 
in accordance with title IV has assumed responsibility for 
the administration in the State of benefits under this Act 
(in this Act referred to as the ‘‘State agency’’), to furnish 
such class or classes of services as benefits to individuals 
eligible therefor under this Act. 
SEC. 206. AGREEMENTS WITH VOLUNTARY HEALTH INSUR-
ANCE AND OTHER ORGANIZATIONS. 
(a) IN GENERAL.—In the provision of personal health 
services, it shall be the policy to utilize individuals or orga-
nizations qualified under this title to render such services, 
including— 
(1) any organized group of individuals; 
(2) any partnership, association, or consumer 
cooperative; 
(3) any hospital or any hospital and its staff; 
or 
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(4) any organization operating a voluntary 
health-service insurance plan or other voluntary 
health-service plan. 
(b) AUTHORIZATION.—The State agency is author-
ized to enter into an agreement with any organization re-
ferred to in subsection (a) for the provision of personal 
health services under this Act. Any such organization, 
whether or not it enters into an agreement with the State 
agency on its own behalf, shall be permitted to act as 
agent for individuals or other persons in negotiating or 
in carrying out agreements with the State agency for ren-
dering personal health services under this Act. 
(c) QUALIFICATION OF PROVIDERS.—Any agreement 
under this section shall provide that each class of personal 
health services will be furnished only by individuals (or, 
in the case of hospital or auxiliary benefits, by persons, 
as defined in section 901(1)) who are qualified under this 
title to render such class of services and each of whom 
has agreed or has authorized an agreement to be made 
on the individual’s behalf with the State agency that the 
individual will furnish such services in accordance with 
this Act and with regulations prescribed thereunder. Each 
such individual or person shall be responsible, both to the 
State agency and (in accordance with applicable State 
law) to individuals eligible for personal health services as 
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benefits, for carrying out such agreement made by the in-
dividual or person or on behalf of the individual or person. 
SEC. 207. PROVISIONS COMMON TO ALL AGREEMENTS. 
(a) IN GENERAL.—Each agreement made under this 
title shall— 
(1) specify the class or classes of services to be 
furnished or provided pursuant to its terms; 
(2) contain an undertaking to comply with this 
Act and with regulations prescribed thereunder; 
(3) be made upon terms and conditions con-
sistent with the efficient and economical administra-
tion of this Act; and 
(4) continue in force for such period and be ter-
minable upon such notice as may be agreed upon. 
(b) TERM.—No agreement under section 206, and no 
designation of an agent, shall for more than one year pre-
clude any individual or person qualified to furnish per-
sonal health services from exercising such rights as the 
individual or person would otherwise have under this 
title— 
(1) to negotiate and enter into an agreement di-
rectly with the State agency; 
(2) to designate another agent for such negotia-
tion; or 
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(3) to participate in another agreement under 
section 206. 
(c) NON EXCLUSIVE AGREEMENTS.—No agreement 
made under this title shall confer upon any individual or 
other person, or any group or other organization, the right 
of furnishing or providing personal health services as bene-
fits, to the exclusion in whole or in part of other individ-
uals, persons, groups, or organizations qualified to furnish 
or provide such services. 
(d) DISQUALIFICATION.— 
(1) IN GENERAL.—If the State agency after in-
vestigation finds that an individual or other person 
under agreement to furnish or provide personal 
health services as benefits is no longer qualified to 
furnish or provide such services, or has committed a 
substantial breach of the agreement, it shall notify 
such person of its findings, together with the rea-
sons therefor, and in the absence of a request for a 
hearing by such person under title VI, or in the 
event of a final decision sustaining its findings after 
any hearing and further review provided under title 
VI, may terminate the agreement and withdraw the 
person’s name from the list published pursuant to 
title III. 
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(2) LIMITATION
ON
SUBSEQUENT
AGREE-
MENTS.—After an agreement has been so termi-
nated, no new agreement shall be entered into with 
such person under this Act unless and until such 
person gives reasonable assurances to the State 
agency of the person’s ability and willingness to dis-
charge all obligations and responsibilities under a 
new agreement satisfactorily in accordance with its 
provisions. 
SEC. 208. METHODS OF PAYMENTS FOR SERVICES. 
(a) PROFESSIONAL SERVICES.—Agreements for the 
furnishing of medical, dental, or podiatric services (other 
than specialist services) as benefits under this Act shall 
provide for payment— 
(1) on the basis of fees for services rendered as 
benefits, according to a fee schedule; 
(2) on a per capita basis, the amount being ac-
cording to the number of individuals eligible for ben-
efits who are on the practitioner’s list; 
(3) on a salary basis, whole time or part time; 
or 
(4) on such combinations or modifications of 
these bases, including separate provision for travel 
and related expenses, as may be approved by the 
State agency; 
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according in each health-service area as the majority of 
the medical practitioners or of the dental practitioners, re-
spectively, under agreement to furnish such services shall 
elect. Provision shall be made for another method or meth-
ods of payment (from among the methods listed in this 
subsection) to those medical practitioners or to those den-
tal practitioners who do not elect the method of such ma-
jority, when it is found that such alternative method of 
making payments contributes to carrying out the provi-
sions of section 305 or otherwise promotes the efficient 
and economical provision of medical or dental services in 
the area. 
(b) SPECIALIST SERVICES.—Agreements for the fur-
nishing of specialist services as benefits under this Act 
may provide for payments on the basis of fee for service, 
per case, per session, per capita, on salary (whole time 
or part time), or other basis, or combination thereof. 
(c) TREATMENT OF GROUPS.—Any of the methods 
of making payments from among the methods listed in 
subsection (a) or subsection (b) may be used in making 
payments to groups or practitioners or organizations or 
other agencies which undertake to provide specialist serv-
ices as well as general medical or general dental services. 
(d) HOSPITAL SERVICES.— 
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(1) USE OF REASONABLE COSTS.—Agreements 
for the furnishing of hospital services as benefits 
under this Act shall provide for payment on the 
basis of the reasonable costs of hospitalization fur-
nished as benefits. 
(2) MAXIMUM RATES.—The Board, after con-
sultation with the Advisory Council and with rep-
resentatives of interested hospital organizations, may 
by regulation prescribe maximum rates for hos-
pitalization furnished as benefits under this Act, and 
such maximum rates may be varied according to 
classes of localities or types of service. 
(3) PAYMENT
BASIS.—Payments to hospitals 
shall be based on the least expensive multiple-bed ac-
commodations available in the hospital unless the 
patient’s condition makes the use of private accom-
modations essential for the patient’s proper medical 
care. 
(4) ADDITIONAL
CHARGES.—An agreement 
made for furnishing such services shall not affect the 
right of the hospital or other person with whom the 
agreement is made to require payments from pa-
tients with respect to the additional cost of more ex-
pensive facilities occupied at the request of the pa-
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tient, or with respect to services not included as ben-
efits under this Act. 
(e) HOME-NURSING
SERVICES
AND
AUXILIARY 
SERVICES.—Agreements for the furnishing of home-nurs-
ing services or auxiliary services as benefits under this Act 
shall provide for payment in accordance with such meth-
ods as the State agency may approve from among those 
set forth in regulations prescribed pursuant to this Act. 
(f) PRO-RATING CERTAIN PER CAPITA PAYMENTS.— 
In any health-service area where agreements for the fur-
nishing of general medical or general dental services pro-
vide for payment only on a per capita basis, the per capita 
payments with respect to those individuals residing in the 
area who have failed to select a practitioner or other per-
son to furnish such services to them shall be made on a 
pro rata basis among the practitioners and other persons 
under agreement to furnish such services in the area. 
SEC. 209. AMOUNT OF PAYMENTS FOR SERVICES. 
(a) CONSIDERATION OF LOCAL CONDITIONS.— 
(1) IN GENERAL.—Rates or amounts of pay-
ment for particular services or classes of services 
furnished as benefits under this Act shall be adapted 
to take account of relevant regional, State, or local 
conditions and practices. 
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