Social Security Act §1861

(F)has a physician,physician assistant, or nurse practitioner responsible for the executionof policies described in subparagraph (E) and relating to the provisionof the clinics services;(G)directlyprovides routine diagnostic services, including clinical laboratoryservices, as prescribed in regulations by the Secretary, and has promptaccess to additional diagnostic services from facilities meeting requirementsunder this title;(H)in compliancewith State and Federal law, has available for administering to patientsof the clinic at least such drugs and biologicals as are determinedby the Secretary to be necessary for the treatment of emergency cases(as defined in regulations) and has appropriate procedures or arrangementsfor storing, administering, and dispensing any drugs and biologicals;(I)has a qualityassessment and performance improvement program, and appropriate proceduresfor review of utilization of clinic services, as the Secretary mayspecify;(J)has a nursepractitioner, a physician assistant, or a certified nurse-midwife(as defined in subsection (gg)) available to furnish patient careservices not less than 50 percent of the time the clinic operates;and(K)meets suchother requirements as the Secretary may find necessary in the interestof the health and safety of the individuals who are furnished servicesby the clinic.For the purposes of this title, such term includes only a facilitywhich (i) is located in an area that is not an urbanized area (asdefined by the Bureau of the Census) and in which there are insufficientnumbers of needed health care practitioners (as determined by theSecretary), and that, within the previous 4-year period, has beendesignated by the chief executive officer of the State and certifiedby the Secretary as an area with a shortage of personal health servicesor designated by the Secretary either (I) as an area with a shortageof personal health services under section 330(b)(3) or 1302(7) ofthe Public Health Service Act, (II) as a health professional shortagearea described in section 332(a)(1)(A) of that Act because of itsshortage of primary medical care manpower, (III) as a high impactarea described in section 329(a)(5) of that Act, of (IV) as an areawhich includes a population group which the Secretary determines hasa health manpower shortage under section 332(a)(1)(B) of that Act[525], (ii) has filed an agreement with theSecretary by which it agrees not to charge any individual or otherperson for items or services for which such individual is entitledto have payment made under this title, except for the amount of anydeductible or coinsurance amount imposed with respect to such itemsor services (not in excess of the amount customarily charged for suchitems and services by such clinic), pursuant to subsections (a) and(b) of section 1833, (iii) employs a physician assistant or nurse practitioner, and(iv) is not a rehabilitation agency or a facility which is primarilyfor the care and treatment of mental diseases. A facility that isin operation and qualifies as a rural health clinic under this titleor title XIX and that subsequently fails to satisfy the requirementof clause (i) shall be considered, for purposes of this title andtitle XIX, as still satisfying the requirement of such clause if itis determined, in accordance with criteria established by the Secretaryin regulations, to be essential to the delivery of primary care servicesthat would otherwise be unavailable in the geographic area servedby the clinic. If a State agency has determined under section 1864(a) that a facilityis a rural health clinic and the facility has applied to the Secretaryfor approval as such a clinic, the Secretary shall notify the facilityof the Secretarys approval or disapproval later than 60 daysafter the date of the State agency determination or the application(whichever is later).(3)The term Federally qualified health center services means(A)servicesof the type described in subparagraphs (A) through (C) of paragraph(1) and preventive services (as defined in section 1861(ddd)(3));and(B)preventiveprimary health services that a center is required to provide undersection 330 of the Public Health Service Act,[526]when furnished to an individual as an outpatient of a Federallyqualified health center and, for this purpose, any reference to arural health clinic or a physician described in paragraph (2)(B) isdeemed a reference to a Federally qualified health center by the centeror by a health care professional under contract with the center ora physician at the center, respectively.(4)The term Federally qualified health center means an entity which(A)(i)is receivinga grant under section 330 of the Public Health Service Act, or(ii)(I)is receivingfunding from such a grant under a contract with the recipient of sucha grant, and (II) meets the requirements to receive a grant undersection 330 of such Act;(B)based onthe recommendation of the Health Resources and Services Administrationwithin the Public Health Service, is determined by the Secretary tomeet the requirements for receiving such a grant;(C)was treatedby the Secretary, for purposes of part B, as a comprehensive Federallyfunded health center as of January 1, 1990; or(D)is an outpatienthealth program or facility operated by a tribe or tribal organizationunder the Indian Self-Determination Act or by an urban Indian organizationreceiving funds under title V of the Indian Health Care ImprovementAct[527].(5)(A)The term physician assistant and the term nurse practitioner mean, for purposes of this title, a physician assistant or nursepractitioner who performs such services as such individual is legallyauthorized to perform (in the State in which the individual performssuch services) in accordance with State law (or the State regulatorymechanism provided by State law), and who meets such training, education,and experience requirements (or any combination thereof) as the Secretarymay prescribe in regulations.(B)The term clinical nurse specialist means, for purposes of this title,an individual who(i)is a registerednurse and is licensed to practice nursing in the State in which theclinical nurse specialist services are performed; and(ii)holds a mastersdegree in a defined clinical area of nursing from an accredited educationalinstitution.(6)The term collaboration means a process in which a nurse practitionerworks with a physician to deliver health care services within thescope of the practitioners professional expertise, with medicaldirection and appropriate supervision as provided for in jointly developedguidelines or other mechanisms as defined by the law of the Statein which the services are performed.(7)(A)The Secretaryshall waive for a 1-year period the requirements of paragraph (2)that a rural health clinic employ a physician assistant, nurse practitioneror certified nurse midwife or that such clinic require such providersto furnish services at least 50 percent of the time that the clinicoperates for any facility that requests such waiver if the facilitydemonstrates that the facility has been unable, despite reasonableefforts, to hire a physician assistant, nurse practitioner, or certifiednurse-midwife in the previous 90-day period.(B)The Secretarymay not grant such a waiver under subparagraph (A) to a facility ifthe request for the waiver is made less than 6 months after the dateof the expiration of any previous such waiver for the facility, orif the facility has not yet been determined to meet the requirements(including subparagraph (J) of the first sentence of paragraph (2))of a rural health clinic.(C)A waiverwhich is requested under this paragraph shall be deemed granted unlesssuch request is denied by the Secretary within 60 days after the datesuch request is received.Services of a Certified Registered Nurse Anesthetist(bb)(1)The term services of a certified registered nurse anesthetist meansanesthesia services and related care furnished by a certified registerednurse anesthetist (as defined in paragraph (2)) which the nurse anesthetistis legally authorized to perform as such by the State in which theservices are furnished.(2)The term certified registered nurse anesthetist means a certifiedregistered nurse anesthetist licensed by the State who meets sucheducation, training, and other requirements relating to anesthesiaservices and related care as the Secretary may prescribe. In prescribingsuch requirements the Secretary may use the same requirements as thoseestablished by a national organization for the certification of nurseanesthetists. Such term also includes, as prescribed by the Secretary,an anesthesiologist assistant.Comprehensive Outpatient Rehabilitation Facility Services(cc)(1)The term comprehensive outpatient rehabilitation facility services means the following items and services furnished by a physicianor other qualified professional personnel (as defined in regulationsby the Secretary) to an individual who is an outpatient of a comprehensiveoutpatient rehabilitation facility under a plan (for furnishing suchitems and services to such individual) established and periodicallyreviewed by a physician(A)physiciansservices;(B)physicaltherapy, occupational therapy, speech-language pathology services,and respiratory therapy;(C)prostheticand orthotic devices, including testing, fitting, or training in theuse of prosthetic and orthotic devices;(D)social andpsychological services;(E)nursingcare provided by or under the supervision of a registered professionalnurse;(F)drugs andbiologicals which cannot, as determined in accordance with regulations,be self-administered;(G)suppliesand durable medical equipment; and(H)such otheritems and services as are medically necessary for the rehabilitationof the patient and are ordinarily furnished by comprehensive outpatientrehabilitation facilities,excluding, however, any item or service if it would not be includedunder subsection (b) if furnished to an inpatient of a hospital. Inthe case of physical therapy, occupational therapy, and speech pathologyservices, there shall be no requirement that the item or service befurnished at any single fixed location if the item or service is furnishedpursuant to such plan and payments are not otherwise made for theitem or service under this title.(2)The term comprehensive outpatient rehabilitation facility means afacility which(A)is primarilyengaged in providing (by or under the supervision of physicians) diagnostic,therapeutic, and restorative services to outpatients for the rehabilitationof injured, disabled, or sick persons;(B)providesat least the following comprehensive outpatient rehabilitation services:(i) physicians services (rendered by physicians, as definedin section 1861(r)(1), who are available at the facility on a full-or part-time basis);(ii) physical therapy; and (iii) social or psychological services;(C)maintainsclinical records on all patients;(D)has policiesestablished by a group of professional personnel (associated withthe facility), including one or more physicians defined in subsection(r)(1) to govern the comprehensive outpatient rehabilitation servicesit furnishes, and provides for the carrying out of such policies bya full-or part-time physician referred to in subparagraph (B)(i);(E)has a requirementthat every patient must be under the care of a physician;(F)in the caseof a facility in any State in which State or applicable local lawprovides for the licensing of facilities of this nature (i) is licensedpursuant to such law, or (ii) is approved by the agency of such Stateor locality, responsible for licensing facilities of this nature,as meeting the standards established for such licensing;(G)has in effecta utilization review plan in accordance with regulations prescribedby the Secretary;(H)has in effectan overall plan and budget that meets the requirements of subsection(z);(I)providesthe Secretary on a continuing basis with a surety bond in a form specifiedby the Secretary and in an amount that is not less than $50,000; and(J)meets suchother conditions of participation as the Secretary may find necessaryin the interest of the health and safety of individuals who are furnishedservices by such facility, including conditions concerning qualificationsof personnel in these facilities.Hospice Care; Hospice Program(dd)(1)Theterm hospice care means the following items and servicesprovided to a terminally ill individual by, or by others under arrangementsmade by, a hospice program under a written plan (for providing suchcare to such individual) established and periodically reviewed bythe individuals attending physician and by the medical director(and by the interdisciplinary group described in paragraph (2)(B))of the program(A)nursingcare provided by or under the supervision of a registered professionalnurse,(B)physicalor occupational therapy, or speech-language pathology services,(C)medicalsocial services under the direction of a physician,(D)(i)services ofa home health aide who has successfully completed a training programapproved by the Secretary and(ii)homemakerservices,(E)medicalsupplies (including drugs and biologicals) and the use of medicalappliances, while under such a plan,(F)physiciansservices,