21 (a) is primarily engaged in providing to inpatients (other than mentally ill persons) diagnostic, therapeutic, and rehabilitation services, furnished by or under the supervision of physicians, for medical diagnosis, treatment, care, and rehabilitation of injured, disabled, or sick persons; (b) maintains adequate clinical records on all patients; (c) has bylaws in effect with respect to its staff of physicians, and has filed with the Board an agreement that in granting or maintaining medical staff privileges it will not discriminate on any ground unrelated to professional qualifications; (d) has a requirement that every patient must be under the care of a physician; (e) provides twenty-four-hour nursing service rendered or supervised by a registered professional nurse, and has a licensed practical nurse or registered professional nurse on duty at all times; (f) has a pharmacy and drug therapeutics committee which establishes policies for the selection, acquisition, and utilization of drugs; (g) has in effect a hospital utilization review plan which meets the requirements of section 50; 1 2 3 4 5 6 7 22 (h) meets all applicable requirements of the law of the State in which it is situated; and (i) meets such other requirements as the Board finds necessary in the interest of the quality of the care and the safety of patients in the institution. PSYCHIATRIC HOSPITALS SEC. 44. Subject to the provisions of section 52, 8 hospital which is primarily engaged in furnishing psychiatric 9 services to inpatients who are mentally ill is a qualified pro10 vider if it (or a distinct part of it) is an institution (a) in which diagnostic, therapeutic, and rehabilitative services with respect to mental illness are furnished by or under the supervision of physicians; (b) which satisfies the requirements of subsections (b) through (i) of section 43; (c) which, on the basis of staffing and other factors it deems pertinent, the Board finds is qualified to furnish active treatment; (d) which maintains such records as the Board finds necessary to determine the degree and intensity of the treatment furnished; and (e) which is accredited by the Joint Commission on the Accreditation of Hospitals. 51-658 - 70 - 3 1 2 3 23 SKILLED NURSING HOMES SEC. 45. Subject to the provisions of sections 51 and 52 a skilled nursing home is a qualified provider if it (or a 4 distinct part of it) is an institution which— (a) is primarily engaged in providing to inpatients (other than mentally ill persons) skilled nursing care and related services for patients who require medical and nursing services; (b) has written policies, which are developed (and reviewed from time to time) with the advice of a group of professional personnel, including one or more physicians and one or more registered professional nurses, to govern the services it provides; (c) has a physician, a registered professional nurse, or a medical staff responsible for the execution of such policies; (d) operates under the supervision of an administrator licensed by the State in which such institution is situated; (e) has a requirement that the health care of every patient be under the supervision of a physician, and provides for having a physician available to furnish necessary medical care in case of emergency; 222 23 24 (f) maintains adequate clinical records on all pa tients; (g) provides twenty-four-hour nursing service sufficient to meet nursing needs in accordance with the policies developed as provided in subsection (b), and has at least one registered professional nurse employed full time; (h) provides appropriate methods and procedures for the dispensing and administering of drugs; (i) has in effect a utilization review plan which meets the requirements of section 50; (j) meets all applicable requirements of the law of the State in which it is situated, and (unless the Board finds that such law provides equivalent protection) meets the provisions of the Life Safety Code of the National Fire Protection Association applicable to nursing homes; and (k) meets such other requirements, including requirements relating to the physical facilities, as the Board may find necessary in the interest of the quality of care and the safety of patients in the institution. HOME HEALTH SERVICE AGENCIES SEC. 46. Subject to the provisions of section 51, a home 24 health service agency is a qualified provider if it is a public 25 agency or a nonprofit private organization, or a subdivision 26 of such an agency or organization, which— 1 2 3 4 5 6 7 བ 8 9 10 11 12 12 13 14 15 16 17 25 (a) is primarily engaged in furnishing, on an intermittent and visiting basis in patients' homes, skilled nursing and other therapeutic services to patients (other than mentally ill persons) who are under the case of physi cians; (b) has policies developed (and reviewed from time to time) by a group of professional personnel associated with the agency or organization, including one or more physicians and one or more registered professional nurses, to govern the services which it furnishes, and provides for supervision of such services by a physician or registered professional nurse; (c) maintains adequate clinical records on all patients; (d) meets all applicable requirements of the law of the State in which it furnishes services; and (e) meets such other requirements as the Board may find necessary in the interest of the quality of care and the safety of patients of the agency or organization. COMPREHENSIVE HEALTH SERVICE ORGANIZATION SEC. 47. A comprehensive health service organization 22 is a qualified provider of covered services if (a) the organization furnishes health services to an identified population (enrolled in the organization) in or near a specified service area, through arrangements |