evekhm/cms_iom_500 huggingface dataset:
Social Security Act §1861
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.
Social Security Act §1861
(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)
Social Security Act §1861
(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;
Social Security Act §1861
(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.
Social Security Act §1861
(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.
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(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.
Social Security Act §1861
(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
Social Security Act §1861
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
Social Security Act §1861
(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
Social Security Act §1861
(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.
Social Security Act §1861
(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;