[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR410.2]



[Page 317-318]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 410_SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS--Table of Contents

 

                      Subpart A_General Provisions

 

Sec. 410.2  Definitions.



    As used in this part--

    Community mental health center (CMHC) means an entity that--

    (1) Provides outpatient services, including specialized outpatient 

services for children, the elderly, individuals who are chronically 

mentally ill, and residents of its mental health service area who have 

been discharged from inpatient treatment at a mental health facility;



[[Page 318]]



    (2) Provides 24-hour-a-day emergency care services;

    (3) Provides day treatment or other partial hospitalization 

services, or psychosocial rehabilitation services;

    (4) Provides screening for patients being considered for admission 

to State mental health facilities to determine the appropriateness of 

this admission; and

    (5) Meets applicable licensing or certification requirements for 

CMHCs in the State in which it is located.

    Encounter means a direct personal contact between a patient and a 

physician, or other person who is authorized by State licensure law and, 

if applicable, by hospital or CAH staff bylaws, to order or furnish 

hospital services for diagnosis or treatment of the patient.

    Nominal charge provider means a provider that furnishes services 

free of charge or at a nominal charge, and is either a public provider 

or another provider that (1) demonstrates to CMS's satisfaction that a 

significant portion of its patients are low-income; and (2) requests 

that payment for its services be determined accordingly.

    Outpatient means a person who has not been admitted as an inpatient 

but who is registered on the hospital or CAH records as an outpatient 

and receives services (rather than supplies alone) directly from the 

hospital or CAH.

    Partial hospitalization services means a distinct and organized 

intensive ambulatory treatment program that offers less than 24-hour 

daily care and furnishes the services described in Sec. 410.43.

    Participating refers to a hospital, CAH, SNF, HHA, CORF, or hospice 

that has in effect an agreement to participate in Medicare; or a clinic, 

rehabilitation agency, or public health agency that has a provider 

agreement to participate in Medicare but only for purposes of providing 

outpatient physical therapy, occupational therapy, or speech pathology 

services; or a CMHC that has in effect a similar agreement but only for 

purposes of providing partial hospitalization services, and 

nonparticipating refers to a hospital, CAH, SNF, HHA, CORF, hospice, 

clinic, rehabilitation agency, public health agency, or CMHC that does 

not have in effect a provider agreement to participate in Medicare.



[59 FR 6577, Feb. 11, 1994, as amended at 62 FR 46025, Aug. 29, 1997; 65 

FR 18536, Apr. 7, 2000]