Social Security Act §1861

(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(pp)(1)The term colorectal cancer screening test means any of the followingprocedures furnished to an individual for the purpose of early detectionof colorectal cancer:(A)Screeningfecal-occult blood test.(B)Screeningflexible sigmoidoscopy.(C)Screeningcolonoscopy.(D)Such othertests or procedures, and modifications to tests and procedures underthis subsection, with such frequency and payment limits, as the Secretarydetermines appropriate, in consultation with appropriate organizations.(2)An individualat high risk for colorectal cancer is an individual who, becauseof family history, prior experience of cancer or precursor neoplasticpolyps, a history of chronic digestive disease condition (includinginflammatory bowel disease, Crohns Disease, or ulcerative colitis),the presence of any appropriate recognized gene markers for colorectalcancer, or other predisposing factors, faces a high risk for colorectalcancer.[531]Diabetes Outpatient Self-Management Training Services(qq)(1)The term diabetes outpatient self-management training services meanseducational and training services furnished (at such times as theSecretary determines appropriate) to an individual with diabetes bya certified provider (as described in paragraph (2)(A)) in an outpatientsetting by an individual or entity who meets the quality standardsdescribed in paragraph (2)(B), but only if the physician who is managingthe individuals diabetic condition certifies that such servicesare needed under a comprehensive plan of care related to the individualsdiabetic condition to ensure therapy compliance or to provide theindividual with necessary skills and knowledge (including skills relatedto the self-administration of injectable drugs) to participate inthe management of the individuals condition.(2)In paragraph(1)(A)a certified provider is a physician, or other individual orentity designated by the Secretary, that, in addition to providingdiabetes outpatient self-management training services, provides otheritems or services for which payment may be made under this title;and(B)a physician,or such other individual or entity, meets the quality standards describedin this paragraph if the physician, or individual or entity, meetsquality standards established by the Secretary, except that the physicianor other individual or entity shall be deemed to have met such standardsif the physician or other individual or entity meets applicable standardsoriginally established by the National Diabetes Advisory Board andsubsequently revised by organizations who participated in the establishmentof standards by such Board, or is recognized by an organization thatrepresents individuals (including individuals under this title) withdiabetes as meeting standards for furnishing the services.Bone Mass Measurement(rr)(1)The term bone mass measurement means a radiologic or radioisotopicprocedure or other procedure approved by the Food and Drug Administrationperformed on a qualified individual (as defined in paragraph (2))for the purpose of identifying bone mass or detecting bone loss ordetermining bone quality, and includes a physicians interpretationof the results of the procedure.(2)For purposesof this subsection, the term qualified individual meansan individual who is (in accordance with regulations prescribed bythe Secretary)(A)an estrogen-deficientwoman at clinical risk for osteoporosis;(B)an individualwith vertebral abnormalities;(C)an individualreceiving long-term glucocorticoid steroid therapy;(D)an individualwith primary hyperparathyroidism; or(E)an individualbeing monitored to assess the response to or efficacy of an approvedosteoporosis drug therapy.(3)The Secretaryshall establish such standards regarding the frequency with whicha qualified individual shall be eligible to be provided benefits forbone mass measurement under this title.Religious Nonmedical Health Care Institution(ss)(1)The term religious nonmedical health care institution means an institutionthat(A)is describedin subsection (c)(3) of section 501 of the Internal Revenue Code of1986[532]and is exempt from taxes under subsection (a) of suchsection;(B)is lawfullyoperated under all applicable Federal, State, and local laws and regulations;(C)providesonly nonmedical nursing items and services exclusively to patientswho choose to rely solely upon a religious method of healing and forwhom the acceptance of medical health services would be inconsistentwith their religious beliefs;(D)providessuch nonmedical items and services exclusively through nonmedicalnursing personnel who are experienced in caring for the physical needsof such patients;(E)providessuch nonmedical items and services to inpatients on a 24-hour basis;(F)on the basisof its religious beliefs, does not provide through its personnel orotherwise medical items and services (including any medical screening,examination, diagnosis, prognosis, treatment, or the administrationof drugs) for its patients;(G)(i)is not ownedby, under common ownership with, or has an ownership interest in,a provider of medical treatment or services;(ii)is not affiliatedwith(I)a providerof medical treatment or services, or(II)an individualwho has an ownership interest in a provider of medical treatment orservices;(H)has in effecta utilization review plan which(i)provides forthe review of admissions to the institution, of the duration of staystherein, of cases of continuous extended duration, and of the itemsand services furnished by the institution,(ii)requires thatsuch reviews be made by an appropriate committee of the institutionthat includes the individuals responsible for overall administrationand for supervision of nursing personnel at the institution,(iii)providesthat records be maintained of the meetings, decisions, and actionsof such committee, and(iv)meets suchother requirements as the Secretary finds necessary to establish aneffective utilization review plan;(I)providesthe Secretary with such information as the Secretary may require toimplement section 1821, including information relating to quality of care and coveragedeterminations; and(J)meets suchother requirements as the Secretary finds necessary in the interestof the health and safety of individuals who are furnished servicesin the institution.(2)To the extentthat the Secretary finds that the accreditation of an institutionby a State, regional, or national agency or association provides reasonableassurances that any or all of the requirements of paragraph (1) aremet or exceeded, the Secretary may treat such institution as meetingthe condition or conditions with respect to which the Secretary madesuch finding.(3)(A)(i)In administeringthis subsection and section 1821, the Secretary shall not require any patient of a religiousnonmedical health care institution to undergo medical screening, examination,diagnosis, prognosis, or treatment or to accept any other medicalhealth care service, if such patient (or legal representative of thepatient) objects thereto on religious grounds.(ii)Clause (i)shall not be construed as preventing the Secretary from requiringunder section 1821(a)(2) the provision of sufficient information regarding an individualscondition as a condition for receipt of benefits under part A forservices provided in such an institution.(B)(i)In administeringthis subsection and section 1821, the Secretary shall not subject a religious nonmedicalhealth care institution or its personnel to any medical supervision,regulation, or control, insofar as such supervision, regulation, orcontrol would be contrary to the religious beliefs observed by theinstitution or such personnel.(ii)Clause (i)shall not be construed as preventing the Secretary from reviewingitems and services billed by the institution to the extent the Secretarydetermines such review to be necessary to determine whether such itemsand services were not covered under part A, are excessive, or arefraudulent.(4)(A)For purposesof paragraph (1)(G)(i), an ownership interest of less than 5 percentshall not be taken into account.(B)For purposesof paragraph (1)(G)(ii), none of the following shall be consideredto create an affiliation:(i)An individualserving as an uncompensated director, trustee, officer, or other memberof the governing body of a religious nonmedical health care institution.(ii)An individualwho is a director, trustee, officer, employee, or staff member ofa religious nonmedical health care institution having a family relationshipwith an individual who is affiliated with (or has an ownership interestin) a provider of medical treatment or services.(iii)An individualor entity furnishing goods or services as a vendor to both providersof medical treatment or services and religious nonmedical health careinstitutions.(tt)(1)The term post-institutional home health services means home healthservices furnished to an individual(A)after dischargefrom a hospital or critical access hospital in which the individualwas an inpatient for not less than 3 consecutive days before suchdischarge if such home health services were initiated within 14 daysafter the date of such discharge; or(B)after dischargefrom a skilled nursing facility in which the individual was providedposthospital extended care services if such home health serviceswere initiated within 14 days after the date of such discharge.(2)The term home health spell of illness with respect to any individualmeans a period of consecutive days(A)beginningwith the first day (not included in a previous home health spell ofillness) (i) on which such individual is furnished post-institutionalhome health services, and (ii) which occurs in a month for which theindividual is entitled to benefits under part A, and(B)ending withthe close of the first period of 60 consecutive days thereafter oneach of which the individual is neither an inpatient of a hospitalor critical access hospital nor an inpatient of a facility describedin section 1819(a)(1) or subsection (y)(1) nor provided home health services.(uu)The term screening for glaucoma means a dilated eye examination withan intraocular pressure measurement, and a direct ophthalmoscopy ora slitlamp biomicroscopic examination for the early detectionof glaucoma which is furnished by or under the direct supervisionof an optometrist or ophthalmologist who is legally authorized tofurnish such services under State law (or the State regulatory mechanismprovided by State law) of the State in which the services are furnished,as would otherwise be covered if furnished by a physician or as anincident to a physicians professional service, if the individualinvolved has not had such an examination in the preceding year.Medical Nutrition Therapy Services; Registered Dietitian orNutrition Professional(vv)(1)The term medical nutrition therapy services means nutritional diagnostic,therapy, and counseling services for the purpose of disease managementwhich are furnished by a registered dietitian or nutrition professional(as defined in paragraph (2)) pursuant to a referral by a physician(as defined in subsection (r)(1)).(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