Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1129 - RURAL HEALTH CLINIC SERVICES › GENERAL PROVISIONS › Section 1129.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
					 have the following meanings, unless the context clearly indicates
					 otherwise:
Certified registered nurse practitioner
-A
					 registered nurse licensed in this Commonwealth who is currently certified by
					 the State Board of Medicine and the State Board of Nursing as a certified
					 registered nurse practitioner and who meets the qualifications for a nurse
					 practitioner as set forth at 42 CFR
					 481.2(b).
Covered service
-A benefit to which a MA
					 recipient is entitled under the Medical Assistance program.
Independent rural health clinic
-A clinic
					 that:
(i) Meets the requirements for
				  participation in the MA Program as set forth at
				  42 CFR
				  481.1.
(ii) Is not part of a hospital, skilled
				  nursing facility or home health agency.
Nurse midwife
-A registered nurse licensed
					 in this Commonwealth who is currently certified by the State Board of Medicine
					 to practice midwifery.
Physician
-An individual licensed to
					 practice medicine and surgery under section 10 of the Medical Practice Act of
					 1974 (63 P. S. §
											421.10)
					 (Repealed) or the Osteopathic Medical Practice Act (63 P. S. §§
											271.1-271.18).
Physician assistant
-An individual
					 currently certified as a physician assistant by the State Board of Medicine or
					 by the State Board of Osteopathic Medicine and who meets the qualifications for
					 a physician assistant as set forth at
					 42 CFR
					 481.2(d).
Provider rural health clinic
-A clinic
					 that:
(i) Meets the requirements for
				  participation in the MA Program as set forth at
				  42 CFR
				  481.1.
(ii) Is an integral part of a hospital,
				  skilled nursing facility or home health agency.
Registered nurse
-An individual licensed in
					 this Commonwealth by the State Board of Nursing to practice professional
					 nursing.
Rural health clinic personnel
-A physician,
					 certified registered nurse practitioner, registered nurse, nurse midwife or
					 physician assistant who by contract or agreement with a rural health clinic
					 provides medical services for the rural health clinic.
Rural health clinic service
-A service
					 provided by rural health clinic personnel or an item furnished incident to
					 services provided by rural health clinic personnel the cost of which is
					 included in allowable costs for Medicare purposes under the Medicare program as
					 set forth at 42 CFR
					 405.2401 -
					 405.2430.
Visit
-Face-to-face encounter between a
					 clinic patient and a physician, physician assistant, nurse practitioner, nurse
					 midwife, specialized nurse practitioner or visiting nurse for the purpose of
					 receiving medical services. Encounters with more than one health professional
					 and multiple encounters with the same health professional which take place on
					 the same day and at a single location constitute a single visit, except for
					 cases in which the patient, subsequent to the first encounter, suffers illness
					 or injury requiring additional diagnosis or treatment.
This section cited in 55 Pa. Code §
												1129.53 (relating to payment
						policy for independent rural health
						clinics).