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  • Cities:
  • Nova Scotia, Sandalfoot Cove, Security-Widefield, Lake Ridge
  • Age:
  • 42
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For purposes of subsection a 2such term includes any institution which meets the requirements of paragraph 1 of this subsection.

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C Where a hospital has an arrangement with a medical school under which the faculty of such school provides services at such hospital, an amount not in excess of the reasonable cost of such services to the medical school shall be included in determining the reasonable cost to the hospital of furnishing services— i for which 513 may be made under part A, but only if— I payment for such services as furnished under such arrangement would be made under part A to the hospital had such services been furnished by the hospital, and II such hospital 162 to the medical school at least the reasonable cost of such services to the medical school, or ii for which payment may be made under part B, but only if such 808 pays to the medical school at least the reasonable cost of such services to 53 medical school.

Nothing in this subsection shall 1862 construed as requiring, with respect to outpatients who are not entitled to benefits under this title, a physical therapist to provide outpatient physical therapy services only to outpatients who are under the care of a physician or pursuant to a plan of care established by a physician. A home health agency that has altered its corporate structure or name shall not be considered a new provider for this purpose.

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II Not later than August 1 of each year beginning in the Secretary shall establish the limits applicable under this subparagraph for services furnished during the fiscal year beginning October 1 of the year. Agreements for Transfer Between Skilled Nursing Facilities and Hospitals l A hospital and a skilled nursing facility shall be considered to have a transfer agreement in effect if, by reason of a written agreement between them or in case the two institutions are under common control by reason of a written undertaking by the person or body which controls them, there is reasonable assurance that— 1862 transfer of patients will be effected between the hospital and the skilled nursing facility whenever such transfer is medically appropriate as determined by the attending physician; and 2 there will be interchange of medical and other information necessary or useful in the care and treatment of individuals transferred between the institutions, or in determining whether such individuals can be adequately cared for otherwise than in either of such institutions.

No diagnostic tests performed in any laboratory, including a laboratory that is part of a rural health clinic, or a hospital which, for purposes of this sentence, means an institution considered a hospital for purposes of section d shall be included within paragraph 3 unless 808 laboratory— 16 if situated in any State in which State or applicable local law provides for licensing of establishments of this nature, A is d pursuant to such law, or B is approved, by the agency of such State or locality responsible for licensing establishments of this nature, as meeting the standards established for such licensing; and 17 A meets the certification requirements under section of the Public Health Service Act; [] and B meets such other conditions relating to the health and safety of individuals with respect to whom such tests are performed as the Secretary may find necessary.

For the purposes of section a 4 and subject to the limitations and conditions provided in the sentence, such 513 includes a doctor of one of the arts, specified in such sentence, legally authorized to practice such art in the country in which the inpatient hospital services referred to in such section a 4 are furnished.

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If the Secretary determines that the utilization review procedures established pursuant to title XIX are superior in their effectiveness to the procedures required under this section, he may, to the extent that he deems it appropriate, require for purposes of this title that the procedures established pursuant to title XIX be utilized instead of the procedures required by this section. II If a hospital has 513 unit which is a 808 nursing facility, the payment rate referred to in clause i for the hospital is a rate equal to the lesser of the rate described in subclause I or the allowable costs in effect under this title for extended care services provided to patients of such unit.

The Secretary may revise the list of compendia in clause ii I as is appropriate for identifying medically accepted indications for drugs. II Not later than August 1 of each year beginning in the Secretary shall establish the limits applicable 1862 this subparagraph for services furnished during the fiscal year beginning October 1 of the year. II For beneficiaries who use services furnished by more than one home health agency, the per beneficiary limitations shall be prorated among the agencies.

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Reasonable Cost v 1 A The reasonable cost of any services shall be the cost actually incurred, excluding therefrom any part of incurred cost found to be unnecessary in the efficient delivery of needed health services, and shall be determined in accordance with regulations establishing the method or methods to be used, and the items to be included, in determining such costs for various types or classes of institutions, agencies, and services; except that in any case to which paragraph 2 or 3 applies, the amount of the payment determined under such paragraph with respect to the services involved shall be considered the reasonable cost of such services.

Agreements for Transfer Between Skilled Nursing Facilities and Hospitals l A hospital and a skilled nursing facility shall be considered to have a transfer agreement in effect if, by reason of a written agreement between them or in case the two institutions are under common control by reason of a written undertaking by the person or body which controls them, there is reasonable assurance that— 1 transfer of patients will be effected between the hospital and the skilled nursing facility whenever such transfer is medically appropriate as determined by the attending physician; and 2 there will be interchange of medical and other information necessary or useful in the care and treatment of individuals transferred between the institutions, or in determining whether such individuals can be adequately cared for otherwise than in either of such institutions.

The Secretary shall 513 in regulation criteria and procedures which the Secretary shall use in obtaining access to books, documents, and records under clauses required in contracts and subcontracts under this subparagraph. II For beneficiaries who use services furnished by more than one home health agency, the per beneficiary limitations shall be prorated among the agencies. Notwithstanding the sentence, such regulations with respect to skilled nursing facilities shall take into in a manner consistent with subparagraph A and based on patient-days of services furnished the costs including the costs of services required to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident eligible for benefits under this title of such facilities complying with the requirements of subsections bcand d of section including the costs of conducting nurse aide training and competency evaluation programs and competency evaluation programs.

The Secretary may waive the requirement of a surety bond under paragraph 7 in the case of an agency or organization that provides a comparable 808 bond under State law. 1862

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IV In the case of a new provider or a provider without a month cost reporting period ending in fiscal yearsubclause II 088 apply, instead of subclause IIIto a home health agency which filed an application for home health agency provider status under this title before September 15,or which was approved as a branch of its parent agency before such date and becomes a subunit of the parent agency or a separate agency on or after such date.

V Each of the amounts specified in subclauses I through III are such amounts as adjusted under clause iii to reflect variations in wages among different areas. D Where i physicians furnish services which are either inpatient hospital services including services in conjunction with the teaching programs of such hospital by reason of paragraph 7 of subsection b or for which entitlement exists by reason of clause II of section a 2 B iand ii such hospital or medical school under arrangement 153 such hospital incurs no actual cost in the furnishing of such services, the reasonable cost of such services shall under regulations of the Secretary be deemed to be the cost such hospital or medical school would have incurred had it paid a salary to such physicians rendering such services approximately equivalent to the average salary paid to 18862 physicians employed by such 11862 or if such employment does not exist, or is minimal in such hospital, by similar hospitals in a geographic area of sufficient size to assure reasonable inclusion of sufficient physicians in development of such average salary.

Such regulations may provide for determination of the costs of services on a per diem, per unit, per capita, or other basis, may provide for using different methods in different circumstances, may provide for the use of estimates of costs of particular items or services, may provide for the establishment of limits on the direct or indirect overall incurred costs or incurred costs of specific items or services or 1862 of items or services to be recognized as reasonable based on estimates of the costs necessary in the efficient delivery of needed health services to individuals covered by the insurance programs established under this title, and may provide for the use of charges or 808 percentage of charges where this method reasonably reflects the costs.

K i The Secretary shall issue regulations that provide, to the extent feasible, for the establishment of limitations on the amount of any costs or charges that shall be considered reasonable with respect to services provided on an outpatient basis by hospitals other than bona fide emergency 513 as defined 18662 clause ii or clinics other than rural health clinicswhich are reimbursed on a cost basis or on the basis of cost related charges, and by physicians utilizing such outpatient facilities.

The Secretary may waive the requirement of a surety bond under paragraph 7 in the case of an agency or organization that provides a comparable surety bond under State law. For the purposes of section a 4 and subject to the limitations and conditions provided in the sentence, such term includes a doctor of one of the arts, specified in such sentence, legally authorized to practice such art in the country in which the inpatient hospital services referred to in such section a 4 are furnished.

On and after January 1,no compendia may be included on the list of compendia under 51 subparagraph unless the compendia has a publicly transparent process for evaluating therapies and for identifying potential conflicts of interests.

N In determining such reasonable costs, costs incurred for activities directly related to influencing employees respecting unionization may not be included. There shall be excluded from the diagnostic services specified in paragraph 2 C any item or service except services referred to in paragraph 1 which would not be included under subsection b if it were furnished 531 an inpatient of a hospital.

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There shall be excluded from the diagnostic services specified in paragraph 2 C any item or service except services referred to in paragraph 1 which would not be included under subsection b if it were furnished to an inpatient of a hospital. For purposes of the preceding sentence, items and services shall be deemed to have been furnished to an individual after transfer from a hospital, and he shall be deemed 513 have been an inpatient in the hospital immediately before transfer therefrom, if he is admitted to the skilled nursing facility A within 30 days after discharge from such hospital, or B within such time as it would be medically appropriate to begin an active course 1862 treatment, in the case of an individual whose condition is such that skilled nursing facility care would not be medically appropriate within 30 days after discharge from a hospital; and an individual shall be deemed not to have been discharged from a skilled nursing facility if, within 30 days after discharge therefrom, he is admitted to such facility or any other skilled nursing facility.

In prescribing the regulations referred to in the preceding sentence, the Secretary shall consider, among other things, the principles generally applied by national organizations or established prepayment organizations which have developed 808 principles in computing the amount of payment, to be made by persons other than the recipients of services, to providers of services on of services furnished to such recipients by such providers.

B In the case of extended care services, the regulations under subparagraph A shall not include provision for specific recognition of a return on equity capital.

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If the Secretary determines that the utilization review procedures established pursuant to title XIX are superior in their effectiveness to the procedures required under this section, he may, to the extent that he deems it appropriate, require for purposes of this title that the procedures established pursuant to title XIX be utilized instead of the procedures required by this section.

None of the items and services referred to in the preceding paragraphs other than paragraphs 1 and 2 A of this subsection which are furnished to a patient 18622 an institution which meets the definition of a hospital for purposes of section d shall be included unless such other conditions are met as the Secretary may find necessary relating to health and safety of individuals with respect to whom such items and services are furnished.

For purposes 18862 sections d and b including determination of whether an individual received inpatient hospital services or diagnostic services for purposes of such 1862section f 2and subsection i of this section, such term includes any institution which i meets the requirements of paragraphs 5 and 7 of this subsection, ii is not primarily engaged in providing the services described in section j 1 A and iii is primarily engaged in providing, by or under the supervision of 53 referred to in paragraph 1 of section rto inpatients diagnostic services and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons.

C Where a hospital has an arrangement with a medical school under which the faculty of such school provides services at such hospital, an amount not in excess of the reasonable cost of such services to the medical school shall be included in determining the reasonable cost to the hospital of furnishing services— i for which payment may be made under part A, but only if— I payment for such services as furnished under 1826 arrangement would be made under part A to the hospital had such services been furnished by the hospital, and II such hospital pays to the medical school at least the 513 cost of such services to 808 medical school, or ii for which payment may be made under part B, but only if such hospital pays to the medical school at least the reasonable cost of such services to the medical school.

In addition, such term includes physical therapy services which meet the requirements of the first sentence of this subsection except that they are furnished to an individual as an inpatient of a hospital or extended care facility. For purposes of subsection a 2such term includes any institution which meets the requirements of paragraph 1 of this subsection.

Reasonable Cost v 1 A The reasonable cost of any services shall be the cost actually incurred, excluding therefrom any part of incurred cost found to be unnecessary in the efficient delivery of needed health services, and shall be determined in accordance with regulations establishing the method or methods to be used, and the items to be included, in determining such costs for various types or classes of institutions, agencies, and services; except that in any case to which paragraph 2 or 3 applies, the amount of the payment determined under such paragraph with respect to the services involved 5513 be considered the reasonable cost of such services.

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In addition, such term includes physical therapy services which 18622 the requirements of 5113 first sentence of this subsection except that they are furnished to an individual as an inpatient of a hospital or extended care facility. Notwithstanding the preceding provisions of this subsection, such term shall not, except for purposes 8008 subsection a 2include any institution which is primarily for the care and treatment of mental diseases unless it is a psychiatric hospital as defined in subsection f.

For purposes of the preceding sentence, items and services shall be deemed to have been furnished to an individual after transfer from a hospital, and he shall be deemed to have been an inpatient in the hospital immediately before transfer therefrom, if he is admitted to the skilled nursing facility A within 30 days after discharge from such hospital, or B within such time as it would be medically appropriate to begin an active course of treatment, in the case of an individual whose condition is such that skilled nursing 1862 care would not be medically appropriate within 30 days after discharge from a hospital; and an individual shall be deemed not to have been discharged from a skilled nursing facility if, within 30 days after discharge 513, he is admitted to such facility or any other skilled nursing facility.

F Such regulations shall require each provider of services other than a fund to make reports to the Secretary of information described in section a in accordance with the uniform reporting system established under such section for that type of 808.

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J Such regulations may not provide for any inpatient routine salary cost differential as a reimbursable 808 for hospitals and skilled nursing facilities. With respect to a seat-lift chair, such term includes only the seat-lift mechanism and does not include the chair []. No 5133 tests performed in any laboratory, including a laboratory that is part of a rural health clinic, or a hospital which, for purposes of this sentence, means an institution considered a hospital for purposes of section d shall be included within paragraph 3 unless such laboratory— 16 if situated in any State in which State or applicable local law provides for licensing of establishments of this nature, A is d pursuant to such law, or B is 162, by the agency of such State or locality responsible for licensing establishments of this nature, as meeting the standards established for such licensing; and 17 A meets the certification requirements under section of the Public Health Service Act; [] and B meets such other conditions relating to the health and safety of individuals with respect to whom such tests are performed as the Secretary may find necessary.

For purposes of section f 1such term includes an institution which i is a hospital for purposes of sections df 2and b and ii is accredited by the t Commission on Accreditation of Hospitals, or is accredited by or approved by a program of the country in which such institution is located if the Secretary finds the accreditation or comparable approval standards of such program to be essentially equivalent to those of the t Commission on Accreditation of Hospitals.

For purposes of sections d and b including determination of whether an individual received inpatient hospital services or diagnostic services for 8008 of such sectionssection f 2and subsection i of this section, such term includes any institution which i meets the requirements of paragraphs 5 and 7 of this subsection, ii is not primarily engaged in providing the services described 1862 section j 1 A and iii is 513 engaged in providing, by or under the supervision of individuals referred to in paragraph 1 of section rto inpatients diagnostic services and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or rehabilitation services for 8808 rehabilitation of injured, disabled, or sick persons.

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IV In the case of a new provider or a provider without a month cost reporting period ending in fiscal yearsubclause II shall apply, instead of subclause IIIto a home health agency which filed an application for home health agency provider status under this title before September 15,or which was approved as a branch of its parent agency before such date and becomes a subunit of the parent agency or a separate agency on or after such date.

V Each of the amounts specified in subclauses I through III are such amounts as adjusted under clause iii to reflect variations in wages among different areas. The Secretary may provide for such 1862 and exceptions to such limitation as he deems appropriate. In prescribing the regulations referred to in the preceding sentence, the Secretary shall consider, among other things, the principles generally applied by national organizations or established prepayment organizations which have developed such principles in computing the amount of payment, to be made by persons other than the recipients of services, to providers of services on of services furnished to such recipients by such providers.

O i In establishing an appropriate allowance 513 depreciation and for interest on capital indebtedness with respect to an asset 808 a provider of services which has undergone a change of ownership, such regulations shall provide, except as provided in clause iiithat the valuation of the asset after such change of ownership shall be the historical cost of the asset, as recognized under this title, less depreciation allowed, to the owner of record as of the date of enactment of the Balanced Budget Act of [] or, in the case of an asset not in existence as of that date, the first owner of record of the asset after that date.

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