[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

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

[CITE: 42CFR491.9]



[Page 974-975]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 491_CERTIFICATION OF CERTAIN HEALTH FACILITIES--Table of Contents

 

Subpart A_Rural Health Clinics: Conditions for Certification; and FQHCs 

                         Conditions for Coverage

 

Sec.  491.9  Provision of services.



    (a) Basic requirements. (1) All services offered by the clinic or 

center are furnished in accordance with applicable Federal, State, and 

local laws; and

    (2) The clinic or center is primarily engaged in providing 

outpatient health services and meets all other conditions of this 

subpart.

    (3) The laboratory requirements in paragraph (c)(2) of this section 

apply to RHCs, but do not apply to FQHCs.

    (b) Patient care policies. (1) The clinic's or center's health care 

services are furnished in accordance with appropriate written policies 

which are consistent with applicable State law.

    (2) The policies are developed with the advice of a group of 

professional personnel that includes one or more physicians and one or 

more physician assistants or nurse practitioners. At least one member is 

not a member of the clinic or center staff.

    (3) The policies include:

    (i) A description of the services the clinic or center furnishes 

directly and those furnished through agreement or arrangement.

    (ii) Guidelines for the medical management of health problems which 

include the conditions requiring medical consultation and/or patient 

referral, the maintenance of health care records, and procedures for the 

periodic review and evaluation of the services furnished by the clinic 

or center.

    (iii) Rules for the storage, handling, and administration of drugs 

and biologicals.

    (4) These policies are reviewed at least annually by the group of 

professional personnel required under paragraph (b)(2) of this section 

and reviewed as necessary by the clinic or center.

    (c) Direct services--(1) General. The clinic or center staff 

furnishes those diagnostic and therapeutic services and supplies that 

are commonly furnished in a physician's office or at the entry point 

into the health care delivery system. These include medical history, 

physical examination, assessment of health status, and treatment for a 

variety of medical conditions.

    (2) Laboratory. These requirements apply to RHCs but not to FQHCs. 

The RHC provides laboratory services in accordance with part 493 of this 

chapter, which implements the provisions of section 353 of the Public 

Health Service



[[Page 975]]



Act. The RHC provides basic laboratory services essential to the 

immediate diagnosis and treatment of the patient, including:

    (i) Chemical examinations of urine by stick or tablet method or both 

(including urine ketones);

    (ii) Hemoglobin or hematocrit;

    (iii) Blood glucose;

    (iv) Examination of stool specimens for occult blood;

    (v) Pregnancy tests; and

    (vi) Primary culturing for transmittal to a certified laboratory.

    (3) Emergency. The clinic or center provides medical emergency 

procedures as a first response to common life-threatening injuries and 

acute illness and has available the drugs and biologicals commonly used 

in life saving procedures, such as analgesics, anesthetics (local), 

antibiotics, anticonvulsants, antidotes and emetics, serums and toxoids.

    (d) Services provided through agreements or arrangements. (1) The 

clinic or center has agreements or arrangements with one or more 

providers or suppliers participating under Medicare or Medicaid to 

furnish other services to its patients, including:

    (i) Inpatient hospital care;

    (ii) Physician(s) services (whether furnished in the hospital, the 

office, the patient's home, a skilled nursing facility, or elsewhere); 

and

    (iii) Additional and specialized diagnostic and laboratory services 

that are not available at the clinic or center.

    (2) If the agreements are not in writing, there is evidence that 

patients referred by the clinic or center are being accepted and 

treated.



[57 FR 24983, June 12, 1992, as amended at 58 FR 63536, Dec. 2, 1993]