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services; and provides for periodic reports, to the institution and the medical staff (and, when requested, to the Board), of statistical summaries of the review;

(b) in the case of a general or psychiatric hospital, for such review to be made either (1) by a staff committee of the hospital composed of two or more

physicians with or without participation of other professional personnel, or (2) by a group outside the hos

pital which is similarly composed and which, if prac

ticable, is established by the local medical society and 11 hospitals in the locality, or is established in such other

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manner as may be approved by the Board; but clause

(1) of this subseection shall be inapplicable to any hospital where, because of its small size or for such other

reason as may be specified in regulations, it is impracticable for the hospital to have a properly functioning staff committee for the purposes of this section;

(c) in the case of a skilled nursing home, for such review to be made by a committee, composed as provided in subsection (b), established by the State or local public health agency pursuant to a contract with the

Board, or by such a committee established by the Board;

(d) for such review, in each case of inpatient hospital services or skilled nursing home services furnished

to a patient during a continuous period of extended dura

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tion, as of such days of such period (which may differ for different classes of cases) as may be specified in regu

lations, with such review to be made as promptly as pos

sible after each day so specified, and in no event later

than one week following such day; and

(e) for prompt notification to the institution, the patient and his attending physician of any finding (made after opportunity for consultation to such attending physician) by the physician members of such committee or group that any admission, further stay, or furnishing of

particular services in the institution is not medically

necessary.

TRANSFER AND AFFILIATION AGREEMENTS

SEC. 51. (a) A skilled nursing home is a qualified pro15 vider only if it has in effect (or there is in effect a finding 16 under subsection (c) temporarily dispensing with) a transfer

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agreement with at least one participating hospital, providing 18 for the transfer of patients and of medical and other informa

19 tion between the institutions as medically appropriate.

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(b) After June 30, 1975, a skilled nursing home or a 21 home health service agency will be a qualified provider only 22 if it has in effect (or there is in effect a finding under sub23 section (c) temporarily dispening with) an affiliation agree24 ment with a participating hospital or a participating compre25 hensive health service organization, under which the medical

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1 staff of the hospital or organization (or a committee thereof) 2 will furnish, or will assume responsibility for, the profes3 sional services in the skilled nursing home, or the professional 4 services furnished by the home health agency, as the case 5 may be.

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(c) The requirement of a transfer agreement under 7 subsection (a), or of an affiliation agreement under subsec8 tion (b), shall not be applicable in any case if there is in 9 effect a finding by the Board that the lack of a suitable hos10 pital or organization within a reasonable distance makes 11 such an agreement impracticable, and that the services of the 12 skilled nursing home or the home health agency are essential 13 to the furnishing of adequate services to eligible persons. 14 Such a finding shall be reviewed periodically, and shall be 15 revoked whenever the Board finds its practicable to do so.

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NEWLY CONSTRUCTED FACILITIES

17 SEC. 52. A general or psychiatric hospital or a skilled 18 nursing home the construction or substantial enlargement of 19 which (whether or not in replacement of another institu20 tion) was undertaken (as defined in regulations) after De21 cember 31, 1970, is not a participating provider under the 22 construction or enlargement has been found, by a State 23 agency designated by the Governor of the State for this pur24 pose, or has been found by the Board, to be needed for the

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1 furnishing of adequate services to persons residing in the arca

2 to be served by the institution.

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CONSIDERATION OF PROFESSIONAL ASSOCIATION

STANDARDS

5 SEC. 53. In establishing requirements necessary in the

6 interest of the quality of care and the safety of eligible per

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sons, pursuant to section 43 (i), 45 (k), 46 (e), 49 (a), 8 49 (b), or 49 (c), the Board shall take into consideration 9 standards or criteria established or recommended by any 10 appropriate professional or other association or organization.

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COMPLIANCE WITH DIRECTIONS FOR BETTER ORGANIZATION

AND COORDINATION OF SERVICES

SEC. 54. If the Board finds that any participating pro14 vider of services (other than an individual professional pro15 vider) has, without reasonable cause, failed to comply with

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a direction issued pursuant to section 131, the provider shall, 17 at such time as may be specified by the Board, cease to be a

18 participating provider.

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EXCLUSION: FEDERAL PROVIDERS OF SERVICES

SEC. 55. No institution of the Department of Defense,

no institution of the Veterans' Administration, no institution

22 of the Department of Health, Education, and Welfare en

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gaged in the provision of services to merchant seamen or to 24 Indians or Alaskan natives, and no employee of any of the

25 foregoing acting as employee, is a participating provider.

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1 The Board shall, however, reimburse the proper appropria2 tion for any services furnished by any such institution or

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employee to an eligible person who is not, under any Act 4 other than this Act, eligible to receive the service from the 5 institution or employee.

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RESTRICTIVE STATE LAWS INOPERATIVE

SEC. 56. (a) In the furnishing of covered services to eligible persons (any law of a State or political subdivision to the contrary notwithstanding)

(1) A physician, dentist, optometrist, or podiatrist 11 who is legally authorized by a State to practice his profession

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and who meets national standards established by the Board

pursuant to section 42 (a) is hereby authorized to furnish 14 in any other State, either as an independent participating pro15 vider or on behalf of an institutional or other participating

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provider, the services which such other State authorizes to be 17 furnished by practitioners of his profession.

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(2) A professional nurse, or a practitioner of another health profession or occupation designated in regulations, who

meets national standards established by the Board for his profession or occupation is hereby authorized to furnish in

any State, on behalf of participating providers of services, the services which that State authorizes or permits to be fur

nished by practitioners of his profession or occupation. National standards applicable to professional nursing, or to any

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