[Code of Federal Regulations] [Title 12, Volume 1] [Revised as of January 1, 2003] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR440.170] [Page 243-245] TITLE 42--PUBLIC HEALTH CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES--(Continued) PART 440--SERVICES: GENERAL PROVISIONS--Table of Contents Subpart A--Definitions Sec. 440.170 Any other medical care or remedial care recognized under State law and specified by the Secretary. (a) Transportation. (1) ``Transportation'' includes expenses for transportation and other related travel expenses determined to be necessary by the agency to secure medical examinations and treatment for a recipient. (2) Transportation, as defined in this section, is furnished only by a provider to whom a direct vendor payment can appropriately be made by the agency. If other arrangements are made to assure transportation under Sec. 431.53 of this subchapter, FFP is available as an administrative cost. (3) ``Travel expenses'' include-- (i) The cost of transportation for the recipient by ambulance, taxicab, common carrier, or other appropriate means; (ii) The cost of meals and lodging en route to and from medical care, and while receiving medical care; and (iii) The cost of an attendant to accompany the recipient, if necessary, and the cost of the attendant's transportation, meals, lodging, and, if the attendant is not a member of the recipient's family, salary. (b) Services furnished in a religious nonmedical health care institution. Services furnished in a religious nonmedical health care institution are services furnished in an institution that: [[Page 244]] (1) Is an institution that is described in (c)(3) of section 501 of the Internal Revenue Code of 1986 and is exempt from taxes under section 501(a) of that section. (2) Is lawfully operated under all applicable Federal, State, and local laws and regulations. (3) Furnishes only nonmedical nursing items and services to patients who choose to rely solely upon a religious method of healing and for whom the acceptance of medical health services would be inconsistent with their religious beliefs. (4) Furnishes nonmedical items and services exclusively through nonmedical nursing personnel who are experienced in caring for the physical needs of nonmedical patients. (5) Furnishes these nonmedical items and services to inpatients on a 24-hour basis. (6) Does not furnish, on the basis of its religious beliefs, through its personnel or otherwise, medical items and services (including any medical screening, examination, diagnosis, prognosis, treatment, or the administration of drugs) for its patients. (7) Is not owned by, is not under common ownership with, or does not have an ownership interest of 5 percent or more in, a provider of medical treatment or services and is not affiliated with a provider of medical treatment or services or with an individual who has an ownership interest or 5 percent or more in a provider of medical treatment or services. Permissible affiliations are described in paragraph (c) of this section. (8) Has in effect a utilization review plan that meets the following criteria: (i) Provides for the review of admissions to the institution, duration of stays, cases of continuous extended duration, and items and services furnished by the institution. (ii) Requires that the reviews be made by a committee of the institution that included the individuals responsible for overall administration and for supervision of nursing personnel at the institution. (iii) Provides that records be maintained of the meetings, decisions, and actions of the utilization review committee. (iv) Meets other requirements as CMS finds necessary to establish an effective utilization review plan. (9) Provides information CMS may require to implement section 1821 of the Act, including information relating to quality of care and coverage determinations. (10) Meets other requirements as CMS finds necessary in the interest of the health and safety of patients who receive services in the institution. These requirements are the conditions of participation found at part 403, subpart G of this chapter. (c) Affiliations. An affiliation is permissible for purposes of paragraph (b)(7) of this section if it is between one of the following: (1) An individual serving as an uncompensated director, trustee, officer, or other member of the governing body of an RNHCI and a provider of medical treatment or services. (2) An individual who is a director, trustee, officer, employee, or staff member of an RNHCI and an another individual, with whom he or she has a family relationship, who is affiliated with (or has an ownership interest in) a provider of medical treatment or services. (3) The RNHCI and an individual or entity furnishing goods or services as a vendor to both providers of medical treatment or services and RNHCIs. (d) Skilled nursing facility services for individuals under age 21. ``Skilled nursing facility services for individuals under 21'' means those services specified in Sec. 440.40 that are provided to recipients under 21 years of age. (e) Emergency hospital services. ``Emergency hospital services'' means services that-- (1) Are necessary to prevent the death or serious impairment of the health of a recipient; and (2) Because of the threat to the life or health of the recipient necessitate the use of the most accessible hospital available that is equipped to furnish the services, even if the hospital does not currently meet-- (i) The conditions for participation under Medicare; or (ii) The definitions of inpatient or outpatient hospital services under Sec.Sec. 440.10 and 440.20. [[Page 245]] (f) [Reserved] (g) Critical access hospital (CAH). (1) CAH services means services that (i) are furnished by a provider that meet the requirements for participation in Medicare as a CAH (see subpart F of part 485 of this chapter), and (ii) are of a type that would be paid for by Medicare when furnished to a Medicare beneficiary. (2) Inpatient CAH services do not include nursing facility services furnished by a CAH with a swing-bed approval. [43 FR 45224, Sept. 29, 1978, as amended at 45 FR 24889, Apr. 11, 1980; 46 FR 48540, Oct. 1, 1981; 58 FR 30671, May 26, 1993; 62 FR 46037, Aug. 29, 1997; 64 FR 67051, Nov. 30, 1999]