Social Security Act §1861

(2)Subject to paragraph(3), the term registered dietitian or nutrition professional means an individual who(A)holds abaccalaureate or higher degree granted by a regionally accreditedcollege or university in the United States (or an equivalent foreigndegree) with completion of the academic requirements of a programin nutrition or dietetics, as accredited by an appropriate nationalaccreditation organization recognized by the Secretary for this purpose;(B)has completedat least 900 hours of supervised dietetics practice under the supervisionof a registered dietitian or nutrition professional; and(C)(i)is licensedor certified as a dietitian or nutrition professional by the Statein which the services are performed; or(ii)in the caseof an individual in a State that does not provide for such licensureor certification, meets such other criteria as the Secretary establishes.(3)Subparagraphs(A) and (B) of paragraph (2) shall not apply in the case of an individualwho, as of the date of the enactment of this subsection, is licensedor certified as a dietitian or nutrition professional by the Statein which medical nutrition therapy services are performed.Initial Preventive Physical Examination(ww)(1)The term initial preventive physical examination means physiciansservicesconsisting of a physical examination (including measurement of height,weight, body mass index, and blood pressure) with the goal of healthpromotion and disease detection and includes education, counseling,and referral with respect to screening and other preventive servicesdescribed in paragraph (2), end-of-life planning (as defined in paragraph(3)) upon the agreement with the individual, and the furnishing ofa review of any current opioid prescriptions (as defined in paragraph(4)), but does not include clinical laboratory tests.[533](2)The screeningand other preventive services described in this paragraph includethe following:(A)Pneumococcal,influenza, and hepatitis B vaccine and administration under subsection(s)(10).(B)Screeningmammography as defined in subsection (jj).(C)Screeningpap smear and screening pelvic exam as defined in subsection (nn).(D)Prostatecancer screening tests as defined in subsection (oo).(E)Colorectalcancer screening tests as defined in subsection (pp).(F)Diabetesoutpatient self-management training services as defined in subsection(qq)(1).(G)Bone massmeasurement as defined in subsection (rr).(H)Screeningfor glaucoma as defined in subsection (uu).(I)Medicalnutrition therapy services as defined in subsection (vv).(J)Cardiovascularscreening blood tests as defined in subsection (xx)(1).(K)Diabetesscreening tests as defined in subsection (yy).(L)Ultrasoundscreening for abdominal aortic aneurysm as defined in section 1861(bbb).(M)An electrocardiogram.(N)Screeningfor potential substance use disorders.[534](O)Additionalpreventive services (as defined in subsection (ddd)(1)).(3)For purposesof paragraph (1), the term end-of-life planning meansverbal or written information regarding(A)an individualsability to prepare an advance directive in the case that an injuryor illness causes the individual to be unable to make health caredecisions; and(B)whetheror not the physician is willing to follow the individuals wishesas expressed in an advance directive.(4)For purposes ofparagraph (1), the term a review of any current opioid prescriptions means, with respect to an individual determined to have a currentprescription for opioids(A)a reviewof the potential risk factors to the individual for opioid use disorder;(B)an evaluationof the individuals severity of pain and current treatment plan;(C)the provisionof information on non-opioid treatment options; and(D)a referralto a specialist, as appropriate.[535]Cardiovascular Screening Blood Test(xx)(1)The term cardiovascular screening blood test means a blood test forthe early detection of cardiovascular disease (or abnormalities associatedwith an elevated risk of cardiovascular disease) that tests for thefollowing:(A)Cholesterollevels and other lipid or triglyceride levels.(B)Such otherindications associated with the presence of, or an elevated risk for,cardiovascular disease as the Secretary may approve for all individuals(or for some individuals determined by the Secretary to be at riskfor cardiovascular disease), including indications measured by noninvasivetesting. The Secretary may not approve an indication under subparagraph(B) for any individual unless a blood test for such is recommendedby the United States Preventive Services Task Force.(2)The Secretaryshall establish standards, in consultation with appropriate organizations,regarding the frequency for each type of cardiovascular screeningblood tests, except that such frequency may not be more often thanonce every 2 years.Diabetes Screening Tests(yy)(1)The term diabetes screening tests means testing furnished to an individualat risk for diabetes (as defined in paragraph (2)) for the purposeof early detection of diabetes, including(A)a fastingplasma glucose test; and(B)such othertests, and modifications to tests, as the Secretary determines appropriate,in consultation with appropriate organizations.(2)For purposesof paragraph (1), the term individual at risk for diabetes means an individual who has any of the following risk factors fordiabetes:(A)Hypertension.(B)Dyslipidemia.(C)Obesity,defined as a body mass index greater than or equal to 30 kg/m2.(D)Previousidentification of an elevated impaired fasting glucose.(E)Previousidentification of impaired glucose tolerance.(F)A risk factorconsisting of at least 2 of the following characteristics:(i)Overweight,defined as a body mass index greater than 25, but less than 30, kg/m2.(ii)A family historyof diabetes.(iii)A historyof gestational diabetes mellitus or delivery of a baby weighing greaterthan 9 pounds.(iv)65 years ofage or older.(3)The Secretaryshall establish standards, in consultation with appropriate organizations,regarding the frequency of diabetes screening tests, except that suchfrequency may not be more often than twice within the 12-month periodfollowing the date of the most recent diabetes screening test of thatindividual.Intravenous Immune Globulin(zz)The term intravenous immune globulin means an approved pooled plasma derivative for the treatment inthe patients home of a patient with a diagnosed primary immunedeficiency disease, but not including items or services related tothe administration of the derivative, if a physician determines administrationof the derivative in the patients home is medically appropriate.Extended Care in Religious Nonmedical Health Care Institutions(aaa)(1)The term home health agency also includes a religious nonmedical healthcare institution (as defined in subsection (ss)(1)), but only withrespect to items and services ordinarily furnished by such an institutionto individuals in their homes, and that are comparable to items andservices furnished to individuals by a home health agency that isnot religious nonmedical health care institution.(2)(A)Subjectto subparagraphs (B), payment may be made with respect to servicesprovided by such an institution only to such extent and under suchconditions, limitations, and requirements (in addition to or in lieuof the conditions, limitations, and requirements otherwise applicable)as may be provided in regulations consistent with section 1821.(B)Notwithstandingany other provision of this title, payment may not be made under subparagraph(A)(i)in a year insofaras such payments exceed $700,000; and(ii)after December31, 2006.Ultrasound Screening for Abdominal Aortic Aneurysm(bbb)The term ultrasound screening forabdominal aortic aneursym means(1)a procedureusing sound waves (or such other procedures using alternative technologies,of commensurate accurary and cost, that the Secretary may specify)provided for the early detection of abdominal aortic aneursym;(2)includes a physiciansinterpretation of the results of the procedure.Long-Term Care Hospital(ccc)The term long-term care hospitalmeans a hospital which(1)  is primarily engaged in providinginpatient services, by or under the supervision of a physician, toMedicare beneficiaries whose medically complex conditions requirea long hospital stay and programs of care provided by a long-termcare hospital;(2)  has an average inpatient lengthof stay (as determined by the Secretary) of greater than 25 days,or meets the requirements of clause (II) of section 1886(d)(1)(B)(iv);(3)  satisfies the requirements of subsection(e); and(4)  meets the following facility criteria:(A)  the institution has a patientreview process, documented in the patient medical record, that screenspatients prior to admission for appropriateness of admission to along-term care hospital, validates within 48 hours of admission thatpatients meet admission criteria for long-term care hospitals, regularlyevaluates patients throughout their stay for continuation of carein a long-term care hospital, and assesses the available dischargeoptions when patients no longer meet such continued stay criteria;(B)  the institution has active physicianinvolvement with patients during their treatment through an organizedmedical staff, physician-directed treatment with physician on-siteavailability on a daily basis to review patient progress, and consultingphysicians on call and capable of being at the patients sidewithin a moderate period of time, as determined by the Secretary;and(C)  the institution has interdisciplinaryteam treatment for patients, requiring interdisciplinary teams ofhealth care professionals, including physicians, to prepare and carryout an individualized treatment plan for each patient.Additional Preventive Services; Preventive Services(ddd)(1)The term additional preventive services means services not describedin subparagraph (A) or (C) of paragraph (3) that identify medicalconditions or risk factors and that the Secretary determines are(A)reasonableand necessary for the prevention or early detection of an illnessor disability;(B)recommendedwith a grade of A or B by the United States Preventive Services TaskForce; and(C)appropriatefor individuals entitled to benefits under part A or enrolled underpart B.(2)In making determinationsunder paragraph (1) regarding the coverage of a new service, the Secretaryshall use the process for making national coverage determinations(as defined in section 1869(f)(1)(B) ) under this title.As part of the use of such process, the Secretary may conduct an assessmentof the relation between predicted outcomes and the expenditures forsuch service and may take into account the results of such assessmentin making such determination.(3)The term preventive services means the following:(A)The screeningand preventive services described in subsection (ww)(2) (other thanthe service described in subparagraph (M) of such subsection).(B)An initialpreventive physical examination (as defined in subsection (ww)).(C)Personalizedprevention plan services (as defined in subsection (hhh)(1)).Cardiac Rehabilitation Program; Intensive Cardiac RehabilitationProgram(eee)(1)The term cardiac rehabilitation program means a program (as describedin paragraph (2)) that furnishes the items and services describedin paragraph (3) under the supervision of a physician (as definedin subsection (r)(1)) or a physician assistant, nurse practitioner,or clinical nurse specialist (as those terms are defined in subsection(aa)(5)).[536](2)A program describedin this paragraph is a program under which(A)items andservices under the program are delivered(i)in a physiciansoffice;(ii)in a hospitalon an outpatient basis; or(iii)in othersettings determined appropriate by the Secretary;[537](B)a physician(as defined in subsection (r)(1)) or a physician assistant, nursepractitioner, or clinical nurse specialist (as those terms are definedin subsection (aa)(5)) is immediately available and accessible formedical consultation and medical emergencies at all times items andservices are being furnished under the program, except that, in thecase of items and services furnished under such a program in a hospital,such availability shall be presumed; and[538](C)individualizedtreatment is furnished under a written plan established, reviewed,and signed by a physician every 30 days that describes(i)the individualsdiagnosis;(ii)the type,amount, frequency, and duration of the items and services furnishedunder the plan; and(iii)the goalsset for the individual under the plan.(3)The items andservices described in this paragraph are(A)physician-prescribedexercise;(B)cardiacrisk factor modification, including education, counseling, and behavioralintervention (to the extent such education, counseling, and behavioralintervention is closely related to the individuals care andtreatment and is tailored to the individuals needs);(C)psychosocialassessment;(D)outcomesassessment; and(E)such otheritems and services as the Secretary may determine, but only if suchitems and services are