Social Security Act §1861

(G)Any dischargeplanning evaluation or discharge plan required under this paragraphmust be developed by, or under the supervision of, a registered professionalnurse, social worker, or other appropriately qualified personnel.(H)Consistentwith section 1802, the discharge plan shall(i)not specifyor otherwise limit the qualified provider which may provide post-hospitalhome health services, and(ii)identify (ina form and manner specified by the Secretary) any entity to whom theindividual is referred in which the hospital has a disclosable financialinterest (as specified by the Secretary consistent with section 1866(a)(1)(S))or which has such an interest in the hospital.(3)With respectto a discharge plan for an individual who is enrolled with a Medicare+Choiceorganization under a Medicare+Choice plan and is furnished inpatienthospital services by a hospital under a contract with the organization(A)the dischargeplanning evaluation under paragraph (2)(D) is not required to includeinformation on the availability of home health services through individualsand entities which do not have a contract with the organization; and(B)notwithstandingsubparagraph (H)(i), the plan may specify or limit the provider (orproviders) of post-hospital home health services or other post-hospitalservices under the plan.Partial Hospitalization Services(ff)(1)The term partial hospitalization services means the items and servicesdescribed in paragraph (2) prescribed by a physician and providedunder a program described in paragraph (3) under the supervision ofa physician pursuant to an individualized, written plan of treatmentestablished and periodically reviewed by a physician (in consultationwith appropriate staff participating in such program), which plansets forth the physicians diagnosis, the type, amount, frequency,and duration of the items and services provided under the plan, andthe goals for treatment under the plan.(2)The items andservices described in this paragraph are(A)individualand group therapy with physicians or psychologists (or other mentalhealth professionals to the extent authorized under State law),(B)occupationaltherapy requiring the skills of a qualified occupational therapist,(C)servicesof social workers, trained psychiatric nurses, and other staff trainedto work with psychiatric patients,(D)drugs andbiologicals furnished for therapeutic purposes (which cannot, as determinedin accordance with regulations, be self-administered),(E)individualizedactivity therapies that are not primarily recreational or diversionary,(F)family counseling(the primary purpose of which is treatment of the individualscondition),(G)patienttraining and education (to the extent that training and educationalactivities are closely and clearly related to individuals careand treatment),(H)diagnosticservices, and(I)such otheritems and services as the Secretary may provide (but in no event toinclude meals and transportation);that are reasonable and necessary for the diagnosis or activetreatment of the individuals condition, reasonably expectedto improve or maintain the individuals condition and functionallevel and to prevent relapse or hospitalization, and furnished pursuantto such guidelines relating to frequency and duration of servicesas the Secretary shall by regulation establish (taking into accountaccepted norms of medical practice and the reasonable expectationof patient improvement).(3)(A)A programdescribed in this paragraph is a program which is furnished by a hospitalto its outpatients or by a community mental health center (as definedin subparagraph (B)), and which is a distinct and organized intensiveambulatory treatment service offering less than 24-hour-daily careother than in an individuals home or in an inpatient or residentialsetting.(B)For purposesof subparagraph (A), the term community mental health center means an entity that(i)(I)providesthe mental health services described in section 1913(c)(1) of thePublic Health Service Act; or(II)in thecase of an entity operating in a State that by law precludes the entityfrom providing itself the service described in subparagraph (E) ofsuch section, provides for such service by contract with an approvedorganization or entity (as determined by the Secretary);(ii)meets applicablelicensing or certification requirements for community mental healthcenters in the State in which it is located;(iii)providesat least 40 per cent of its services to individuals who are not eligiblefor benefits under this title; and(iv)meets suchadditional conditions as the Secretary shall specify to ensure (I)the health and safety of individuals being furnished such services,(II) the effective and efficient furnishing of such services, and(III) the compliance of such entity with the criteria described insection 1931(c)(1) of the Public Health Service Act.Certified Nurse-Midwife Services(gg)(1)The term certified nurse-midwife services means such services furnishedby a certified nurse-midwife (as defined in paragraph (2)) and suchservices and supplies furnished as an incident to the nurse-midwifesservice which the certified nurse-midwife is legally authorized toperform under State law (or the State regulatory mechanism providedby State law) as would otherwise be covered if furnished by a physicianor as an incident to a physicians service.(2)The term certified nurse-midwife means a registered nurse who hassuccessfully completed a program of study and clinical experiencemeeting guidelines prescribed by the Secretary, or has been certifiedby an organization recognized by the Secretary.Clinical Social Worker; Clinical Social Worker Services(hh)(1)The term clinical social worker means an individual who(A)possessesa masters or doctors degree in social work;(B)after obtainingsuch degree has performed at least 2 years of supervised clinicalsocial work; and(C)(i)is licensedor certified as a clinical social worker by the State in which theservices are performed, or(ii)in the caseof an individual in a State which does not provide for licensure orcertification(I)has completedat least 2 years or 3,000 hours of post-masters degree supervisedclinical social work practice under the supervision of a masterslevel social worker in an appropriate setting (as determined by theSecretary), and(II)meetssuch other criteria as the Secretary establishes.(2)The term clinical social worker services means services performedby a clinical social worker (as defined in paragraph (1)) for thediagnosis and treatment of mental illnesses (other than services furnishedto an inpatient of a hospital and other than services furnished toan inpatient of a skilled nursing facility which the facility is requiredto provide as a requirement for participation) which the clinicalsocial worker is legally authorized to perform under State law (orthe State regulatory mechanism provided by State law) of the Statein which such services are performed as would otherwise be coveredif furnished by a physician or as an incident to a physiciansprofessional service.Qualified Psychologist Services(ii)The term qualified psychologist services means such services and such services and supplies furnished asan incident to his service furnished by a clinical psychologist (asdefined by the Secretary) which the psychologist is legally authorizedto perform under State law (or the State regulatory mechanism providedby State law) as would otherwise be covered if furnished by a physicianor as an incident to a physicians service.Screening Mammography(jj)The term screening mammography means a radiologic procedure provided to a woman for the purposeof early detection of breast cancer and includes a physiciansinterpretation of the results of the procedure.Covered Osteoporosis Drug(kk)The term covered osteoporosis drug means an injectable drug approved for the treatment of post-menopausalosteoporosis provided to an individual by a home health agency if,in accordance with regulations promulgated by the Secretary(1)the individualsattending physician certifies that the individual has suffered a bonefracture related to post-menopausal osteoporosis and that the individualis unable to learn the skills needed to self-administer such drugor is otherwise physically or mentally incapable of self-administeringsuch drug; and(2)the individualis confined to the individuals home (except when receivingitems and services referred to in subsection (m)(7)).Speech-Language Pathology Services; Audiology Services(ll)(1)The term speech-language pathology services means such speech, language,and related function assessment and rehabilitation services furnishedby a qualified speech-language pathologist as the speech-languagepathologist is legally authorized to perform under State law (or theState regulatory mechanism provided by the State law) as would otherwisebe covered if furnished by a physician.(2)[530]The term outpatient speech-language pathologyservices has the meaning given the term outpatientphysical therapy services in subsection (p), except that inapplying such subsection(A)speech-languagepathology shall be substituted for physical therapy each place it appears; and(B)speech-languagepathologist shall be substituted for physical therapist each place it appears.(3)The term audiology services means such hearing and balance assessmentservices furnished by a qualified audiologist as the audiologist islegally authorized to perform under State law (or the State regulatorymechanism provided by State law), as would otherwise be covered iffurnished by a physician.(4)In this subsection:(A)The term qualified speech-language pathologist means an individualwith a masterss or doctoral degree in speech-language pathologywho(i)is licensedas a speech-language pathologist by the State in which the individualfurnishes such services, or(ii)in the caseof an individual who furnishes services in a State which does notlicense speech-language pathologists, has successfully completed 350clock hours of supervised clinical practicum (or is in the processof accumulating such supervised clinical experience), performed notless than 9 months of supervised full-time speech-language pathologyservices after obtaining a masters or doctoral degree in speech-languagepathology or a related field, and successfully completed a nationalexamination in speech-language pathology approved by the Secretary.(B)The term qualified audiologist means an individual with a mastersor doctoral degree in audiology who(i)is licensedas an audiologist by the State in which the individual furnishes suchservices, or(ii)in the caseof an individual who furnishes services in a State which does notlicense audiologists, has successfully completed 350 clock hours ofsupervised clinical practicum (or is in the process of accumulatingsuch supervised clinical experience), performed not less than 9 monthsof supervised full-time audiology services after obtaining a mastersor doctoral degree in audiology or a related field, and successfullycompleted a national examination in audiology approved by the Secretary.Critical Access Hospital; Critical Access Hospital Services(mm)(1)The term critical access hospital means a facility certified by theSecretary as a critical access hospital under section 1820(e).(2)The term inpatient critical access hospital services means items andservices, furnished to an inpatient of a critical access hospitalby such facility, that would be inpatient hospital services if furnishedto an inpatient of a hospital by a hospital.(3)The term outpatient critical access hospital services means medicaland other health services furnished by a critical access hospitalon an outpatient basis.Screening Pap Smear; Screening Pelvic Exam(nn)(1)The term screening pap smear means a diagnostic laboratory test consistingof a routine exfoliative cytology test (Papanicolaou test) providedto a woman for the purpose of early detection of cervical or vaginalcancer and includes a physicians interpretation of the resultsof the test, if the individual involved has not had such a test duringthe preceding 2 years, or during the preceding year in the case ofa woman described in paragraph (3).(2)The term screening pelvic exam means a pelvic examination providedto a woman if the woman involved has not had such an examination duringthe preceding 2 years, or during the preceding year in the case ofa woman described in paragraph (3), and includes a clinical breastexamination.(3)A woman describedin this paragraph is a woman who(A)is of childbearingage and has had a test described in this subsection during any ofthe preceding 3 years that indicated the presence of cervical or vaginalcancer or other abnormality; or(B)is at highrisk of developing cervical or vaginal cancer (as determined pursuantto factors identified by the Secretary).Prostate Cancer Screening Tests(oo)(1)The term prostate cancer screening test means a test that consistsof any (or all) of the procedures described in paragraph (2) providedfor the purpose of early detection of prostate cancer to a man over50 years of age who has not had such a test during the preceding year.(2)The proceduresdescribed in this paragraph are as follows:(A)A digitalrectal examination.(B)A prostate-specificantigen blood test.(C)For yearsbeginning after 2002, such other procedures as the Secretary findsappropriate for the purpose of early detection of prostate cancer,taking into account changes in technology and standards of medicalpractice, availability, effectiveness, costs, and such other factorsas the Secretary considers appropriate.Colorectal Cancer Screening Tests