Social Security Act §1861

Home Health Agency(o)The term home health agency meansa public agency or private organization, or a subdivision of suchan agency or organization, which(1)is primarily engagedin providing skilled nursing services and other therapeutic services;(2)has policies,established by a group of professional personnel (associated withthe agency or organization), including one or more physicians andone or more registered professional nurses, to govern the services(referred to in paragraph (1)) which it provides, and provides forsupervision of such services by a physician or registered professionalnurse;(3)maintains clinicalrecords on all patients;(4)in the case ofan agency or organization in any State in which State or applicablelocal law provides for the licensing of agencies or organizationsof this nature, (A) is licensed pursuant to such law, or (B) is approved,by the agency of such State or locality responsible for licensingagencies or organizations of this nature, as meeting the standardsestablished for such licensing;(5)has in effectan overall plan and budget that meets the requirements of subsection(z);(6)meets the conditionsof participation specified in section 1891(a) and such other conditions ofparticipation as the Secretary may find necessary in the interestof the health and safety of individuals who are furnished servicesby such agency or organization;(7)provides the Secretarywith a surety bond(A)in a formspecified by the Secretary and in an amount that is not less thanthe minimum of $50,000; and(B)that the Secretarydetermines is commensurate with the volume of payments to the homehealth agency; and[499](8)meets such additionalrequirements (including conditions relating to bonding or establishingof escrow accounts as the Secretary finds necessary for the financialsecurity of the program) as the Secretary finds necessary for theeffective and efficient operation of the program;except that for purposes of part A such term shall not includeany agency or organization which is primarily for the care and treatmentof mental diseases. The Secretary may waive the requirement of a suretybond under paragraph (7) in the case of an agency or organizationthat provides a comparable surety bond under State law.Outpatient Physical Therapy Services(p)The term outpatient physical therapyservices means physical therapy services furnished by a providerof services, a clinic, rehabilitation agency, or a public health agency,or by others under an arrangement with, and under the supervisionof, such provider, clinic, rehabilitation agency, or public healthagency to an individual as an outpatient(1)who is under thecare of a physician (as defined in paragraph (1), (3), or (4) of section 1861(r)), and(2)with respect towhom a plan prescribing the type, amount, and duration of physicaltherapy services that are to be furnished such individual has beenestablished by a physician (as so defined) or by a qualified physicaltherapist and is periodically reviewed by a physician (as so defined);excluding, however(3)any item or serviceif it would not be included under subsection (b) if furnished to aninpatient of a hospital; and(4)any such service(A)if furnishedby a clinic or rehabilitation agency, or by others under arrangementswith such clinic or agency, unless such clinic or rehabilitation agency(i)provides an adequateprogram of physical therapy services for outpatients and has the facilitiesand personnel required for such program or required for the supervisionof such a program, in accordance with such requirements as the Secretarymay specify,(ii)has policies,established by a group of professional personnel, including one ormore physicians (associated with the clinic or rehabilitation agency)and one or more qualified physical therapists, to govern the services(referred to in clause (i)) it provides,(iii)maintainsclinical records on all patients,(iv)if such clinicor agency is situated in a State in which State or applicable locallaw provides for the licensing of institutions of this nature, (I)is licensed pursuant to such law, or (II) is approved by the agencyof such State or locality responsible for licensing institutions ofthis nature, as meeting the standards established for such licensing;and(v)meets such otherconditions relating to the health and safety of individuals who arefurnished services by such clinic or agency on an outpatient basis,as the Secretary may find necessary, and provides the Secretary ona continuing basis with a surety bond in a form specified by the Secretaryand in an amount that is not less than $50,000, or(B)if furnishedby a public health agency, unless such agency meets such other conditionsrelating to health and safety of individuals who are furnished servicesby such agency on an outpatient basis, as the Secretary may find necessary.The term outpatient physical therapy services also includes physical therapy services furnished an individualby a physical therapist (in his office or in such individualshome) who meets licensing and other standards prescribed by the Secretaryin regulations, otherwise than under an arrangement with and underthe supervision of a provider of services, clinic, rehabilitationagency, or public health agency, if the furnishing of such servicesmeets such conditions relating to health and safety as the Secretarymay find necessary. In addition, such term includes physical therapyservices which meet the requirements of the first sentence of thissubsection except that they are furnished to an individual as an inpatientof a hospital or extended care facility. The term outpatientphysical therapy services also includes speech-language pathologyservices furnished by a provider of services, a clinic, rehabilitationagency, or by a public health agency, or by others under an arrangementwith, and under the supervision of, such provider, clinic, rehabilitationagency, or public health agency to an individual as an outpatient,subject to the conditions prescribed in this subsection. Nothing inthis subsection shall be construed as requiring, with respect to outpatientswho are not entitled to benefits under this title, a physical therapistto provide outpatient physical therapy services only to outpatientswho are under the care of a physician or pursuant to a plan of careestablished by a physician. The Secretary may waive the requirementof a surety bond under paragraph (4)(A)(v) in the case of a clinicor agency that provides a comparable surety bond under State law.Physicians Services(q)The term physicians services means professional services performed by physicians, including surgery,consultation, and home, office, and institutional calls (but not includingservices described in subsection (b)(6)).Physician(r)The term physician, when usedin connection with the performance of any function or action, means(1) a doctor of medicine or osteopathy legally authorized to practicemedicine and surgery by the State in which he performs such functionor action (including a physician within the meaning of section 1101(a)(7)), (2)a doctor of dental surgery or of dental medicine who is legally authorizedto practice dentistry by the State in which he performs such functionand who is acting within the scope of his license when he performssuch functions, (3) a doctor of podiatric medicine for the purposesof subsections (k), (m), (p)(1), and (s) of this section and sections 1814(a), 1832(a)(2)(F)(ii), and 1835 but only with respect to functionswhich he is legally authorized to perform as such by the State inwhich he performs them, (4) a doctor of optometry, but only for purposesof subsection (p)(1) of this section and with respect to the provisionof items or services described in subsection (s) which he is legallyauthorized to perform as a doctor of optometry by the State in whichhe performs them, or (5)[500]a chiropractor who is licensed as such by the State (or in a Statewhich does not license chiropractors as such, is legally authorizedto perform the services of a chiropractor in the jurisdiction in whichhe performs such services), and who meets uniform minimum standardspromulgated by the Secretary, but only for the purpose of sections 1861(s)(1) and 1861(s)(2)(A) and only with respectto treatment by means of manual manipulation of the spine (to correcta subluxation) which he is legally authorized to perform by the Stateor jurisdiction in which such treatment is provided. For the purposesof section 1862(a)(4) and subject to the limitations and conditions provided in the previoussentence, such term includes a doctor of one of the arts, specifiedin such previous sentence, legally authorized to practice such artin the country in which the inpatient hospital services (referredto in such section 1862(a)(4)) are furnished.Medical and Other Health Services(s)The term medical and other health services means any of the following items or services:(1)physiciansservices;(2)(A)servicesand supplies (including drugs and biologicals which are not usuallyself-administered by the patient) furnished as an incident to a physiciansprofessional service, of kinds which are commonly furnished in physiciansoffices and are commonly either rendered without charge or includedin the physicians bills (or would have been so included butfor the application of section 1847B);(B)hospitalservices (including drugs and biologicals which are not usually self-administeredby the patient) incident to physicians services rendered tooutpatients and partial hospitalization services incident to suchservices;(C)diagnosticservices which are(i)furnished toan individual as an outpatient by a hospital or by others under arrangementswith them made by a hospital, and(ii)ordinarilyfurnished by such hospital (or by others under such arrangements)to its outpatients for the purpose of diagnostic study;(D)outpatientphysical therapy services and outpatient occupational therapy services;(E)rural healthclinic services and Federally qualified health center services;(F)home dialysissupplies and equipment, self-care home dialysis support services,and institutional dialysis services and supplies, and, for items andservices furnished on or after January 1, 2011, renal dialysis services(as defined in section 1881(b)(14)(B)), including suchrenal dialysis services furnished on or after January 1, 2017, bya renal dialysis facility or provider of services paid under section1881(b)(14) to an individual with acute kidney injury (as definedin section 1834(r)(2));[501](G)antigens(subject to quantity limitations prescribed in regulations by theSecretary) prepared by a physician, as defined in section 1861(r)(1), fora particular patient, including antigens so prepared which are forwardedto another qualified person (including a rural health clinic) foradministration to such patient, from time to time, by or under thesupervision of another such physician;(H)(i)services furnishedpursuant to a contract under section 1876 to a member of an eligible organizationby a physician assistant or by a nurse practitioner (as defined insubsection (aa)(5)) and such services and supplies furnished as anincident to his service to such a member as would otherwise be coveredunder this part if furnished by a physician or as an incident to aphysicians service; and(ii)services furnishedpursuant to a risk-sharing contract under section 1876(g) to a memberof an eligible organization by a clinical psychologist (as definedby the Secretary) or by a clinical social worker (as defined in subsection(hh)(2)), and such services and supplies furnished as an incidentto such clinical psychologists services or clinical socialworkers services to such a member as would otherwise be coveredunder this part if furnished by a physician or as an incident to aphysicians service;(I)blood clottingfactors, for hemophilia patients competent to use such factors tocontrol bleeding without medical or other supervision, and items relatedto the administration of such factors, subject to utilization controlsdeemed necessary by the Secretary for the efficient use of such factors;(J)prescriptiondrugs used in immunosuppressive therapy furnished, to an individualwho receives an organ transplant for which payment is made under thistitle;(K)(i)services whichwould be physicians services and services described in subsections (ww)(1) and (hhh) if furnished by a physician(as defined in subsection (r)(1))and which are performed by a physician assistant (as defined in subsection (aa)(5)) under the supervisionof a physician (as so defined) and which the physician assistant islegally authorized to perform by the State in which the services areperformed, and such services and supplies furnished as incident tosuch services as would be covered under subparagraph (A) if furnishedincident to a physicians professional service, but only ifno facility or other provider charges or is paid any amounts withrespect to the furnishing of such services,