evekhm/cms_iom_500 huggingface dataset:
Social Security Act §1861
(2)there will beinterchange of medical and other information necessary or useful inthe care and treatment of individuals transferred between the institutions,or in determining whether such individuals can be adequately caredfor otherwise than in either of such institutions.Any skilled nursing facility which does not have such an agreementin effect, but which is found by a State agency (of the State in whichsuch facility is situated) with which an agreement under section 1864 is in effect (or,in the case of a State in which no such agency has an agreement undersection 1864,by the Secretary) to have attempted in good faith to enter into suchan agreement with a hospital sufficiently close to the facility tomake feasible the transfer between them of patients and the informationreferred to in paragraph (2), shall be considered to have such anagreement in effect if and for so long as such agency (or the Secretary,as the case may be) finds that to do so is in the public interestand essential to assuring extended care services for persons in thecommunity who are eligible for payments with respect to such servicesunder this title.Home Health Services(m)The term home health services means the following items and services furnished to an individual,who is under the care of a physician, by a home health agency or byothers under arrangements with them made by such agency, under a plan(for furnishing such items and services to such individual) establishedand periodically reviewed by a physician, which items and servicesare, except as provided in paragraph (7), provided on a visiting basisin a place of residence used as such individuals home(1)part-time or intermittentnursing care provided by or under the supervision of a registeredprofessional nurse;(2)physical or occupationaltherapy or speech-language pathology services;(3)medical socialservices under the direction of a physician;(4)to the extentpermitted in regulations, part-time or intermittent services of ahome health aide who has successfully completed a training programapproved by the Secretary;
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(3)medical socialservices under the direction of a physician;(4)to the extentpermitted in regulations, part-time or intermittent services of ahome health aide who has successfully completed a training programapproved by the Secretary;(5)medical supplies(including catheters, catheter supplies, ostomy bags, and suppliesrelated to ostomy care, and a covered osteoporosis drug (as definedin subsection (kk)), but excluding other drugs and biologicals) anddurable medical equipment and applicable disposable devices (as definedin section 1834(s)(2)) while under such a plan;[496](6)in the case ofa home health agency which is affiliated or under common control witha hospital, medical services provided by an intern or resident-in-trainingof such hospital, under a teaching program of such hospital approvedas provided in the last sentence of subsection (b); and(7)any of the foregoingitems and services which are provided on an outpatient basis, underarrangements made by the home health agency, at a hospital or skillednursing facility, or at a rehabilitation center which meets such standardsas may be prescribed in regulations, and(A)the furnishingof which involves the use of equipment of such a nature that the itemsand services cannot readily be made available to the individual insuch place of residence, or(B)which arefurnished at such facility while he is there to receive any such itemor service described in clause (A),but not including transportation of the individual in connectionwith any such item or service;
Social Security Act §1861
(B)which arefurnished at such facility while he is there to receive any such itemor service described in clause (A),but not including transportation of the individual in connectionwith any such item or service;excluding, however, any item or service if it would not be includedunder subsection (b) if furnished to an inpatient of a hospital andhome infusion therapy (as defined in subsection (iii)(i)). For purposesof paragraphs (1) and (4), the term parttime or intermittentservices means skilled nursing and home health aide servicesfurnished any number of days per week as long as they are furnished(combined) less than 8 hours each day and 28 or fewer hours each week(or, subject to review on a case-by-case basis as to the need forcare, less than 8 hours each day and 35 or fewer hours per week).For purposes of sections 1814(a)(2)(C) and 1835(a)(2)(A), intermittent means skilled nursing care that is either providedor needed on fewer than 7 days each week, or less than 8 hours ofeach day for periods of 21 days or less (with extensions in exceptionalcircumstances when the need for additional care is finite and predictable).[497]Durable Medical Equipment
Social Security Act §1861
Durable Medical Equipment(n)The term durable medical equipment includes iron lungs, oxygen tents, hospital beds, and wheelchairs(which may include a power-operated vehicle that may be appropriatelyused as a wheelchair, but only where the use of such a vehicle isdetermined to be necessary on the basis of the individualsmedical and physical condition and the vehicle meets such safety requirementsas the Secretary may prescribe) used in the patients home (includingan institution used as his home other than an institution that meetsthe requirements of subsection (e)(1) of this section or section 1819(a)(1)), whetherfurnished on a rental basis or purchased, and includes blood-testingstrips and blood glucose monitors for individuals with diabetes withoutregard to whether the individual has Type I or Type II diabetes orto the individuals use of insulin (as determined under standardsestablished by the Secretary in consultation with the appropriateorganizations) and eye tracking and gaze interaction accessories forspeech generating devices furnished to individuals with a demonstratedmedical need for such accessories; except that such term does notinclude such equipment furnished by a supplier who has used, for thedemonstration and use of specific equipment, an individual who hasnot met such minimum training standards as the Secretary may establishwith respect to the demonstration and use of such specific equipment.With respect to a seat-lift chair, such term includes only the seat-liftmechanism and does not include the chair[498].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;
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(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
Social Security Act §1861
(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.
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(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
Social Security Act §1861
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
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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;
Social Security Act §1861
(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,
Social Security Act §1861
(ii)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 nurse practitioner or clinicalnurse specialist (as defined in subsection (aa)(5)) working in collaboration(as defined in subsection (aa)(6)) with a physician (as defined in subsection (r)(1)) which the nursepractitioner or clinical nurse specialist is legally authorized toperform by the State in which the services are performed, and suchservices and supplies furnished as an incident to such services aswould be covered under subparagraph (A) if furnished incident to aphysicians professional service, but only if no facility orother provider charges or is paid any amounts with respect to thefurnishing of such services;(L)certifiednurse-midwife services;(M)qualifiedpsychologist services;(N)clinicalsocial worker services (as defined in subsection (hh)(2));(O)erythropoietinfor dialysis patients competent to use such drug without medical orother supervision with respect to the administration of such drug,subject to methods and standards established by the Secretary by regulationfor the safe and effective use of such drug, and items related tothe administration of such drug;(P)prostatecancer screening tests (as defined in subsection (oo));(Q)an oral drug(which is approved by the Federal Food and Drug Administration) prescribedfor use as an anticancer chemotherapeutic agent for a given indication,and containing an active ingredient (or ingredients), which is thesame indication and active ingredient (or ingredients) as a drug whichthe carrier determines would be covered pursuant to subparagraph (A)or (B) if the drug could not be self-administered;(R)colorectalcancer screening tests (as defined in subsection (pp));(S)diabetesoutpatient self-management training services (as defined in subsection(qq));
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(R)colorectalcancer screening tests (as defined in subsection (pp));(S)diabetesoutpatient self-management training services (as defined in subsection(qq));(T)an oral drug(which is approved by the Federal Food and Drug Administration) prescribedfor use as an acute anti-emetic used as part of an anticancer chemotherapeuticregimen if the drug is administered by a physician (or as prescribedby a physician)(i)for use immediatelybefore, at, or within 48 hours after the time of the administrationof the anticancer chemotherapeutic agent; and(ii)as a full replacementfor the anti-emetic therapy which would otherwise be administeredintravenously;(U)screeningfor glaucoma (as defined in subsection (uu)) for individuals determinedto be at high risk for glaucoma, individuals with a family historyof glaucoma and individuals with diabetes;(V)medical nutritiontherapy services (as defined in subsection (vv)(1)) in the case ofa beneficiary with diabetes or a renal disease who(i)has not receiveddiabetes outpatient self-management training services within a timeperiod determined by the Secretary;(ii)is not receivingmaintenance dialysis for which payment is made under section 1881; and(iii)meets suchother criteria determined by the Secretary after consideration ofprotocols established by dietitian or nutrition professional organizations;(W)an initialpreventive physical examination (as defined in subsection (ww));(X)cardiovascularscreening blood tests (as defined in subsection (xx)(1));(Y)diabetesscreening tests (as defined in subsection (yy));(Z)intravenousimmune globulin for the treatment of primary immune deficiency diseasesin the home (as defined in subsection (zz));(AA)ultrasoundscreening for abdominal aortic aneurysm (as defined in subsection(bbb)) for an individual(i)who receivesa referral for such an ultrasound screening as a result of an initialpreventive physical examination (as defined in section 1861(ww)(1));(ii)who has notbeen previously furnished such an ultrasound screening under thistitle; and(iii)who