Sec. 302. Qualifications for providers
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/bill/116/hr/1384/ih/section-302·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A health care provider is considered to be qualified to furnish covered items and services under this Act if the provider is licensed or certified to furnish such items and services in the State in which such items or services are furnished and meets— the requirements of such State’s law to furnish such items and services; and applicable requirements of Federal law to furnish such items and services. An entity or provider shall not be qualified to furnish covered items and services under this Act if the entity or provider provides no items and services directly to individuals, including— entities or providers that contract with other entities or providers to provide such items and services; and entities that are currently approved to coordinate care plans under the Medicare Advantage program established in part C of title XVIII of the Social Security Act ( 42 U.S.C. 1851 et seq.) but do not directly provide items and services of such care plans.
The Secretary shall establish, evaluate, and update national minimum standards to ensure the quality of items and services provided under this Act and to monitor efforts by States to ensure the quality of such items and services. A State may establish additional minimum standards which providers shall meet with respect to items and services provided in such State. The Secretary shall establish national minimum standards under paragraph
(1)for institutional providers of services and individual health care practitioners. Except as the Secretary may specify in order to carry out this Act, a hospital, skilled nursing facility, or other institutional provider of services shall meet standards applicable to such a provider under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.). Such standards also may include, where appropriate, elements relating to— adequacy and quality of facilities; mandatory minimum safe registered nurse-to-patient staffing ratios and optimal staffing levels for physicians and other health care practitioners; training and competence of personnel (including requirements related to the number of or type of required continuing education hours); comprehensiveness of service; continuity of service; patient waiting time, access to services, and preferences; and performance standards, including organization, facilities, structure of services, efficiency of operation, and outcome in palliation, improvement of health, stabilization, cure, or rehabilitation. If the Secretary provides for additional requirements for providers under this subsection, any such additional requirement shall be implemented in a manner that provides for a reasonable period during which a previously qualified provider is permitted to meet such an additional requirement. With respect to any entity or provider certified to provide items and services described in section 201(a)(7), the Secretary may not prohibit such entity or provider from participating for reasons other than such entity’s or provider’s ability to provide such items and services. Any provider qualified to provide health care items and services through the Department of Veterans Affairs or Indian Health Service is a qualifying provider under this section with respect to any individual who qualifies for such items and services under applicable Federal law.
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- 42 USC 1851
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