Medicare Program; Providers and Suppliers of Specialized Services: Technical Amendments
Federal RegisterJan 9, 1995
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 400, 405, 410, 484, 485, 486, and 498
[BPD-798-FC]
Medicare Program; Providers and Suppliers of Specialized
Services: Technical Amendments
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Final rule with comment period.
-----------------------------------------------------------------------
SUMMARY: This rule reorganizes Medicare regulations that pertain to
providers and suppliers of specialized services, in order to facilitate
the incorporation of future rules in logical order.
The rule also makes minor technical and editorial changes to
clarify the rules and eliminate duplication without substantive change.
DATES: Effective date: These rules are effective February 8, 1995.
Comment date: We will consider comments received by March 10, 1995.
ADDRESSES: Please mail written comments (an original and 3 copies) to
the following address: Health Care Financing Administration, Department
of Health and Human Services, Attention: BPD-798-FC, P.O. Box 26676,
Baltimore, Maryland 21207.
If you prefer, you may deliver your written comments (an original
and 3 copies) to one of the following addresses:
Room 309-G, Hubert H. Humphrey Building, 200 Independence Avenue, S.W.,
Washington, D.C. 20201, or
Room 132, East High Rise Building, 6325 Security Boulevard, Baltimore,
Maryland 21207.
Because of staffing and resource limitations, we cannot accept
comments by facsimile (FAX) transmission. In commenting, please refer
to file code BPD-798-FC. Comments received timely will be available for
public inspection as they are received, generally beginning
approximately 3 weeks after publication of a document, in Room 309-G of
the Department's offices at 200 Independence Avenue, SW., Washington,
DC, on Monday through Friday of each week from 8:30 a.m. to 5 p.m.
(phone: (202) 690-7890).
FOR FURTHER INFORMATION CONTACT: Luisa V. Iglesias, (202) 690-6383.
SUPPLEMENTARY INFORMATION: This rule is part of an ongoing process of
relocating the content of part 405 to separate parts devoted to
particular aspects of the Medicare program. In this case, the rule--
1. Transfers to part 485 the regulations that pertain to
institutional providers of physical therapy and speech-language
pathology services that were in subpart Q of part 405; and
2. Establishes a new part 486 for suppliers of specialized
services, including--
Suppliers of portable X-Ray services (from subpart N of
part 405); and
Physical therapists in independent practice (from subpart
Q of part 405).
The following subparts, which also pertain to specialized services,
are not relocated at this time for the reasons indicated:
Subpart D of part 485--Conditions for Coverage: Organ
Procurement Organizations--A final rule that makes substantive changes
is currently in clearance.
Subpart B of part 494--Conditions for Coverage of
Screening Mammography Services--Recent statutory amendments require
substantive changes.
The rule also--
Simplifies and clarifies regulations, without substantive
change, by removing extensive (and unnecessary) verbatim statutory
citations and separating true definitions from personnel qualification
requirements; and
In Sec. 400.310, which lists the regulation sections for
which OMB control numbers have been assigned, conforms those section
numbers to changes made by this rule.
Collection of Information Requirements
This rule contains no new information collection requirements
subject to review by the Office of Management and Budget under the
Paperwork Reduction Act of 1980 (44 U.S.C. 3501 et seq.).
Response to Comments
Although this is a final rule, we will consider timely comments
from anyone who believes that the reorganization of
[[Page 2326]] content and the clarifying technical and editorial
changes affect the substance of the rules. If we revise this rule as a
result of comments, we will discuss all timely comments in the preamble
to the revised rule.
Waiver of Proposed Rulemaking
The changes made by this rule are purely technical and editorial
and have no substantive impact. Accordingly, we find that there is good
cause to waive proposed rulemaking procedures as unnecessary.
Regulatory Flexibility Analysis
Consistent with the Regulatory Flexibility Act (RFA) and section
1102(b) of the Social Security Act, we prepare a regulatory flexibility
analysis for each rule, unless the Secretary certifies that the
particular rule will not have a significant economic impact on a
substantial number of small entities, or a significant impact on the
operation of a substantial number of small rural hospitals.
The RFA defines ``small entity'' as a small business, a nonprofit
enterprise, or a governmental jurisdiction (such as a county, city, or
township) with a population of less than 50,000. We also consider all
providers and suppliers of services to be small entities. For purposes
of section 1102(b) of the Act, we define small rural hospital as a
hospital that has fewer than 50 beds, and is located anywhere but in a
metropolitan statistical area.
We have not prepared a regulatory flexibility analysis because we
have determined, and the Secretary certifies, that these rules will not
have a significant economic impact on a substantial number of small
entities or a significant impact on the operation of a substantial
number of small rural hospitals.
In accordance with the provisions of Executive Order 12866, this
rule was not reviewed by the Office of Management and Budget.
List of Subjects
42 CFR Part 400
Grant programs-health, Health facilities, Health maintenance
organizations (HMO), Medicaid, Medicare, Reporting and recordkeeping
requirements.
42 CFR Part 405
Administrative practice and procedure, Health facilities, Health
professions, Kidney diseases, Medicare, Reporting and recordkeeping
requirements, Rural areas, X-rays.
42 CFR Part 410
Health facilities, Health professions, Kidney diseases,
Laboratories, Medicare, Rural areas, X-rays.
42 CFR Part 484
Health facilities, Health professions, Medicare, Reporting and
recordkeeping requirements.
42 CFR Part 485
Grant programs-health, Health facilities, Medicaid, Medicare,
Reporting and recordkeeping requirements.
42 CFR Part 486
Health professionals, Medicare, Organ procurement, X-rays.
42 CFR Part 498
Administrative practice and procedure, Health facilities, Health
professions, Medicare, Reporting and recordkeeping requirements.
42 CFR chapter IV is amended as set forth below:
PART 400--INTRODUCTION; DEFINITIONS
A. Part 400 is amended as set forth below:
1. The authority citation for part 400 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395(hh)) and 44 U.S.C. Chapter 35.
Sec. 400.310 [Amended]
2. In the left-hand column of Sec. 400.310, the following changes
are made:
a. ``405.1716, 405.1717, 405.1720, 405.1721, 405.1722, 405.1724,
405.1725, 405.1726'' is revised to read ``485.709, 485.711, 485.717,
485.719, 485.721, 485.725, 485.727, 485.729.''
b. ``405.1733, 405.1736, 405.1737'' is revised to read ``486.155,
486.161, 486.163''.
PART 405--FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
Part 405 is amended as set forth below:
Secs. 405.1411, 405.1412, 405.1413, 405.1414, 405.1415,
1405.1416 [Redesignated]
1. Subpart N, consisting of Secs. 405.1411 through 405.1416 is
redesignated as subpart C under a new part 486, in accordance with the
following redesignation table:
------------------------------------------------------------------------
Old section (subpart N of part 405) New section (subpart C of part 486)
------------------------------------------------------------------------
405.1411........................... 486.100
405.1412........................... 486.102
405.1413........................... 486.104
405.1414........................... 486.106
405.1415........................... 486.108
405.1416........................... 486.110
------------------------------------------------------------------------
Secs. 405.1701, 405.1730 [Amended]
2. In subpart Q, the undesignated centered headings preceding
Sec. 405.1701 and Sec. 405.1730, respectively, are removed.
Secs. 405.1701, 405.1702, 405.1715-405.1726 [Redesignated]
3. Subpart G to part 485 is added and reserved and Secs. 405.1701,
405.1702, and 405.1715 through 405.1726 of subpart Q in part 405 are
redesignated as new subpart H under part 485 in accordance with the
following redesignation table:
------------------------------------------------------------------------
New section
Old section (subpart Q of part 405) (subpart H of
part 485)
------------------------------------------------------------------------
405.1701.............................................. 485.701
405.1702, introductory text........................... Removed.
405.1702(a)........................................... 485.705(a)
405.1702(b)........................................... 485.703(a)
405.1702(c)........................................... 485.703(b)
405.1702(d)........................................... 485.705(b)
405.1702(e)........................................... 485.705(c)
405.1702(f)........................................... 485.705(d)
405.1702(g)........................................... 485.705(e)
405.1702(h)........................................... 485.703(c)
405.1702(i)........................................... 485.703(d)
405.1702(j)........................................... 485.705(f)
405.1702(k)........................................... 485.705(g)
405.1702(l)........................................... 485.703(e)
405.1702(m)........................................... 485.705(h)
405.1715.............................................. 485.707
405.1716.............................................. 485.709
405.1717.............................................. 485.711
405.1718.............................................. 485.713
405.1719.............................................. 485.715
405.1720.............................................. 485.717
405.1721.............................................. 485.719
405.1722.............................................. 485.721
405.1723.............................................. 485.723
405.1724.............................................. 485.725
405.1725.............................................. 485.727
405.1726.............................................. 485.729
------------------------------------------------------------------------
Secs. 405.1730-405.1737 [Redesignated]
4. Sections 405.1730 through 405.1737 are redesignated as subpart D
under a new part 486, in accordance with the following redesignation
table:
------------------------------------------------------------------------
Old section (subpart Q of part 405) New section (subpart D of part 486)
------------------------------------------------------------------------
405.1730........................... 486.150
405.1731........................... 486.151
405.1732........................... 486.153
405.1733........................... 486.155
405.1734........................... 486.157
405.1735........................... 486.159
405.1736........................... 486.161
405.1737........................... 486.163
------------------------------------------------------------------------
[[Page 2327]] PART 485--CONDITIONS OF PARTICIPATION AND CONDITIONS
FOR COVERAGE: SPECIALIZED PROVIDERS
C. Part 485 is amended as set forth below.
1. The authority citation for part 485 is revised to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395(hh).
2. The heading of part 485 is revised to read as follows:
PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS
Sec. 485.70 [Amended]
3. In Sec. 485.70, the following changes are made:
a. In Sec. 485.70(e), ``Sec. 485.70(d) and (e) of this chapter.''
is revised to read ``paragraphs (b) and (c) of Sec. 485.705.''
b. In Sec. 485.70(m), ``Sec. 405.1702(j) of this chapter.'' is
revised to read ``Sec. 485.705(f).''.
4. The heading and table of contents of newly designated subpart H
read as follows:
Subpart H--Conditions of Participation for Clinics, Rehabilitation
Agencies, and Public Health Agencies as Providers of Outpatient
Physical Therapy and Speech-Language Pathology Services
Sec.
485.701 Basis and scope.
485.703 Definitions.
485.705 Personnel qualifications.
485.707 Condition of participation: Compliance with Federal, State,
and local laws.
485.709 Condition of participation: Administrative management.
485.711 Condition of participation: Plan of care and physician
involvement.
485.713 Condition of participation: Physical therapy services.
485.715 Condition of participation: Speech pathology services.
485.717 Condition of participation: Rehabilitation program.
485.719 Condition of participation: Arrangements for physical
therapy and speech-language pathology services to be performed by
other than salaried organization personnel.
485.721 Condition of participation: Clinical records.
485.723 Condition of participation: Physical environment.
485.725 Condition of participation: Infection control.
485.727 Condition of participation: Disaster preparedness.
485.729 Condition of participation: Program evaluation.
Secs. 485.707, 485.715, 485.723, 485.727, 485.729 [Amended]
5. In newly designated subpart H, in the following sections, the
section heading is amended to change the dash to a colon and to
capitalize the first word after the colon:
Secs. 485.707, 485.715, 485.721, 485.723, 485.727, and 485.729.
6. Newly designated Sec. 485.701 is revised to read as follows:
Sec. 485.701 Basis and scope.
This subpart implements section 1861(p)(4) of the Act, which--
(a) Defines outpatient physical therapy and speech pathology
services;
(b) Imposes requirements with respect to adequate program,
facilities, policies, staffing, and clinical records; and
(c) Authorizes the Secretary to establish by regulation other
health and safety requirements.
Sec. 485.703 [Amended]
7. In newly designated Sec. 485.703, the heading is revised to read
Definitions., and the paragraph designations are removed.
Sec. 485.705 [Amended]
8. In newly designated Sec. 485.705, a section heading and
introductory text are added, to read as follows:
Sec. 485.705 Personnel qualifications.
The training, experience, and membership requirements for personnel
involved in the furnishing of outpatient physical therapy and speech-
language pathology services are as follows:
* * * * *
Sec. 485.707 [Amended]
9. In newly designated Sec. 485.707, the following changes are
made:
a. In the introductory text and paragraph (a), ``clinic,
rehabilitation agency, or public health agency'' and the plural version
of that phrase are revised to read ``organization'' and
``organizations'', respectively.
b. In paragraph (a), ``pursuant to such law'' is revised to read
``in accordance with applicable laws''.
Sec. 485.709 [Amended]
10. In newly designated Sec. 485.709, the following changes are
made:
a. Paragraph (b) is revised to read as set forth below.
b. In paragraph (c), second sentence, ``where'' is revised to
``if''.
c. In paragraph (d), second sentence, ``which'' is revised to
``that''.
Sec. 485.709 Condition of participation: Administrative management.
* * * * *
(b) Standard: Administrator. The governing body--
(1) Appoints a qualified full-time administrator;
(2) Delegates to the administrator the internal operation of the
clinic or rehabilitation agency in accordance with written policies;
(3) Defines clearly the administrator's responsibilities for
procurement and direction of personnel; and
(4) Designates a competent individual to act during temporary
absence of the administrator.
* * * * *
Sec. 485.711 [Amended]
11. In newly designated Sec. 485.711, the following changes are
made:
a. In paragraph (a), introductory text, ``prior to'' is revised to
read ``before''.
b. Paragraph (b)(1) is revised to read as set forth below.
c. In paragraph (b)(3), the parenthetical statement, ``at least
every 30 days'' is inserted immediately before ``in accordance'', and
``Sec. 424.25(e)'' is revised to read ``Sec. 410.61(e)''.
d. Paragraph (b)(4) is revised to read as set forth below.
e. In paragraph (c), second sentence, ``There are'' is revised to
read ``The'', and ``that covers'' is revised to read ``cover''.
Sec. 485.711 Condition of participation: Plan of care and physician
involvement.
* * * * *
(b) Standard: Plan of care--(1) For each patient there is a written
plan of care established by the physician or by the physical therapist
or speech-language pathologist who furnishes the services.
* * * * *
(4) Changes in the plan of care are noted in the clinical record.
If the patient has an attending physician, the therapist or speech-
language pathologist who furnishes the services promptly notifies him
or her of any change in the patient's condition or in the plan of care.
* * * * *
Sec. 485.713 [Amended]
12. In newly designated Sec. 485.713, the following changes are
made:
a. The introductory text is revised to read as set forth below.
b. In paragraph (a)(1) introductory text, ``will be'' is revised to
read ``is''.
c. In paragraph (a)(1)(i), ``utilizing'' is revised to ``using''.
d. Paragraph (a)(2) is revised to read as set forth below.
e. In paragraph (b), ``accepted'' is revised to read ``it
accepts''.
f. In paragraph (d), ``such'' is revised to ``these''.
[[Page 2328]]
Sec. 485.713 Conditions of participation: Physical therapy services.
If the organization offers physical therapy services, it provides
an adequate program of physical therapy and has an adequate number of
qualified personnel and the equipment necessary to carry out its
program and to fulfill its objectives.
(a) Standard: Adequate program. * * *
(2) A qualified physical therapist is present or readily available
to offer supervision when a physical therapist assistant furnishes
services.
(i) If a qualified physical therapist is not on the premises during
all hours of operation, patients are scheduled so as to ensure that the
therapist is present when special skills are needed, for example, for
evaluation and reevaluation.
(ii) When a physical therapist assistant furnishes services off the
organization's premises, those services are supervised by a qualified
physical therapist who makes an onsite supervisory visit at least once
every 30 days.
* * * * *
Sec. 485.715 [Amended]
13. In newly designated Sec. 485.715, the following changes are
made:
a. In paragraph (a), ``will be'' is revised to read ``is''.
b. In paragraph (b), ``accepted'' is revised to read ``it
accepts''.
c. In paragraph (c), ``rendered'' is revised to read ``furnished''.
Sec. 485.717 [Amended]
14. In newly designated Sec. 485.717, the following changes are
made:
a. The undesignated introductory text is revised to read as set
forth below.
b. In paragraph (a), ``rendered, as applicable'' is revised to read
``furnished as appropriate''.
c. Paragraph (b) is revised to read as set forth below.
Sec. 485.717 Condition of participation: Rehabilitation program.
This condition and its standards apply only to a rehabilitation
agency's own patients, not to patients of hospitals, skilled nursing
facilities (SNFs), or Medicaid nursing facilities (NFs) to whom the
agency furnishes services. (The hospital, SNF, or NF is responsible for
ensuring that qualified staff furnish services for which they arrange
or contract for their patients.) The rehabilitation agency provides, in
addition to physical therapy and speech-language pathology services,
social or vocational adjustment services to all of its patients who
need them. The agency provides for special qualified staff to evaluate
the social and vocational factors, to counsel and advise on the social
or vocational problems that arise from the patient's illness or injury,
and to make appropriate referrals for needed services.
* * * * *
(b) Standard: Arrangements for social or rehabilitation services--
(1) If a rehabilitation agency does not provide social or vocational
adjustment services through salaried employees, it may provide those
services through a written contract with others who meet the
requirements and responsibilities set forth in this subpart for
salaried personnel.
(2) The contract must specify the term of the contract and the
manner of termination or renewal and provide that the agency retains
responsibility for the control and supervision of the services.
Sec. 485.719 [Amended]
15. In newly designated Sec. 485.719, the following changes are
made:
a. In paragraph (a), ``when'' is revised to ``if''; ``and/or'' is
revised to read ``or''; ``such'' is revised to ``the''(twice);
``provides for retention by the organization'' is revised to read
``provides that the organization retains''; and ``responsibility form
and control and supervision of'' is corrected to read ``responsibility
for, and control and supervision of,''.
b. Paragraph (b) is revised to read as set forth below:
Sec. 485.719 Condition of participation: Arrangements for physical
therapy and speech-language pathology services to be performed by other
than salaried organization personnel.
* * * * *
(b) Standard: Contract provisions. The contract--
(1) Specifies the term of the contract and the manner of
termination or renewal;
(2) Requires that personnel who furnish the services meet the
requirements that are set forth in this subpart for salaried personnel;
and
(3) Provides that the contracting outside resource may not bill the
patient or Medicare for the services. This limitation is based on
section 1861(w)(1) of the Act, which provides that--
(i) Only the provider may bill the beneficiary for covered services
furnished under arrangements; and
(ii) Receipt of Medicare payment by the provider, on behalf of an
entitled individual, discharges the liability of the individual or any
other person to pay for those services.
Sec. 485.721 [Amended]
16. In newly designated Sec. 485.721, the following changes are
made:
a. In paragraph (b), the commas at the end of paragraphs (b)(1)
through (b)(6) are changed to periods; in paragraph (b)(1),
``provided'' is revised to ``furnished''; and the ``and'' at the end of
paragraph (b)(6) is removed.
b. In paragraph (c), the last sentence is revised to read as set
forth below.
c. In paragraph (d), the commas at the end of the paragraphs (d)(1)
and (d)(2)(1) are changed to semicolons, and in the introductory text,
``a period of time of not less than'' is revised to read ``at least''.
d. In paragraph (d)(1), ``That'' is revised to ``The period''.
e. In paragraph (d)(2), introductory text, the colon is changed to
a dash.
Sec. 485.721 Condition of Participation: Clinical records.
* * * * *
(c) Standard: Completion of records and centralization of reports.
* * * Each physician signs the entries that he or she makes in the
clinical record.
* * * * *
Sec. 485.723 [Amended]
17. In newly designated Sec. 485.723, the following changes are
made:
a. In paragraph (a)(2), ``organization'' is revised to ``premises''
(twice).
b. In paragraph (b), at the end of the introductory text, the colon
is removed and ``that--'' is inserted.
c. In paragraph (b)(1), ``That'' is revised to ``The'', and the
comma is changed to a semicolon.
d. In paragraph (b)(2), ``That the'' is revised to read ``The'',
and ``which'' is revised to ``that''.
e. In paragraph (c)(2), ``utilization'' is revised to ``use''.
Sec. 485.725 [Amended]
18. In newly designated Sec. 485.725, the following changes are
made:
a. Paragraph (b) is revised to read as set forth below.
b. In paragraph (c), the designation ``(1)'' is inserted
immediately before the first sentence; ``such'' is revised to
``housekeeping''; the designation ``(2)'' is inserted immediately
before the third sentence; ``and/or'' is revised to read ``or'', and
``meets'' is revised to read ``or both meet''.
c. In paragraph (e), ``The organization is maintained'' is revised
to read ``The organization's premises are maintained''.
Sec. 485.725 Condition of participation: Infection control.
* * * * * [[Page 2329]]
(b) All personnel follow written procedures for effective aseptic
techniques. The procedures are reviewed annually and revised if
necessary to improve them.
Sec. 485.727 [Amended]
19. In newly designated Sec. 485.727, in the introductory text,
``such disasters'' is revised to read ``a disaster''.
Sec. 485.729 [Amended]
20. In newly designated Sec. 485.729, the following changes are
made:
a. In the introductory text, ``which'' is revised to ``that'', and
``assure'' is revised to ``ensure''.
b. In paragraph (a), ``assure'' is revised to ``ensure''.
c. In paragraph (b) ``such statistical data as'' is revised to read
``statistical data such as''.
D. A new part 486 is added.
1. The heading and the table of contents of the new part 486 read
as follows:
PART 486--CONDITIONS FOR COVERAGE OF SERVICES OF SPECIALIZED
SUPPLIERS
Subparts A and B--[Reserved]
Subpart C--Conditions for Coverage: Portable X-Ray Services
Sec.
486.100 Condition for coverage: Compliance with Federal, State, and
local laws and regulations.
486.102 Condition for coverage: Supervision by a qualified
physician.
486.104 Condition for coverage: Qualifications, orientation, and
health of technical personnel.
486.106 Condition for coverage: Referral for service and
preservation of records.
486.108 Condition for coverage: Safety standards.
486.110 Condition for coverage: Inspection of equipment.
Subpart D--Conditions for Coverage: Outpatient Physical Therapy
Services Furnished by Physical Therapists in Independent Practice
486.150 Condition for coverage: General requirements.
486.151 Condition for coverage: Supervision.
486.153 Condition for coverage: Compliance with Federal, State, and
local laws.
486.155 Condition for coverage: Plan of care.
486.157 Condition for coverage: Physical therapy services.
486.159 Condition for coverage: Coordination of services with other
organizations, agencies, or individuals.
486.161 Condition for coverage: Clinical records.
486.163 Condition for coverage: Physical environment.
Authority: Sections 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
2. In newly designated subpart D, in the following sections, the
section heading is revised to change the dash to a colon and capitalize
the first word after the colon: Secs. 486.153, 486.155, 486.157, and
486.161.
3. Newly designated Secs. 486.150 and 486.151 are revised to read
as follows:
Sec. 486.150 Condition for coverage: General requirements.
In order to be covered under Medicare as a supplier of outpatient
physical therapy services, a physical therapist in independent practice
must meet the following requirements:
(a) Be licensed in the State in which he or she practices.
(b) Meet one of the personnel qualifications specified in
Sec. 485.705(b).
(c) Furnish services under the circumstances described in
Sec. 410.60 of this chapter.
(d) Meet the requirements of this subpart.
Sec. 486.151 Condition for coverage: Supervision.
The services are furnished by or under the direct supervision of a
qualified physical therapist in independent practice.
Sec. 486.155 [Amended]
4. In newly designated Sec. 486.155, the following changes are
made:
a. In paragraph (a), introductory text, ``The following information
is obtained by the physical therapist prior to'' is revised to read
``The physical therapist obtains the following information before''.
b. In paragraph (b)(4), the second sentence is revised to read:
``If the patient has an attending physician, the therapist who
furnishes the services promptly notifies him or her of any change in
the patient's condition or in the plan of care.''.
c. In the parenthetical statement in paragraph (b)(4),
``Sec. 424.25(e)'' is revised to read ``Sec. 410.61(e)''.
5. Newly designated Sec. 486.159 is revised to read as follows:
Sec. 486.159 Condition for coverage: Coordination of services with
other organizations, agencies, or individuals.
The physical therapist coordinates her physical therapy services
with the health and medical services the patient receives from
organizations or agencies or other individual practitioners through
exchange of information that meets the following standard:
If a patient is receiving or has recently received, from other
sources, services related to the physical therapy program, the physical
therapist exchanges pertinent documented information with those other
sources--
(a) On a regular basis;
(b) Subject to the requirements for protection of the
confidentiality of medical records, as set forth in Sec. 485.721 of
this chapter; and
(c) With the aim of ensuring that the services effectively
complement one another.
Sec. 486.163 [Amended]
6. In newly designated Sec. 486.163, the following changes are
made:
a. In the introductory text, ``and/or'' is revised to read ``or''.
b. In paragraph (b), first sentence, the word ``established'' is
removed.
c. In paragraph (c), second sentence, ``such'' is changed to
``the''.
d. Paragraph (d) is revised to read as follows:
Sec. 486.163 Condition for coverage: Physical environment.
* * * * *
(d) The physical therapist is alert to the possibility of fire and
other nonmedical emergencies and has written plans that include--
(1) The means for leaving the office and the building safely,
demonstrated, for example, by fire exit signs; and
(2) Other provisions necessary to ensure the safety of patients.
E. Technical corrections.
PART 410--[AMENDED]
1. In part 410, the following changes are made:
a. the authority citation of part 410 is revised to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395 (hh)) unless otherwise indicated.
b. In Sec. 410.60(a)(3)(ii), ``Sec. 405.1702(d) of this chapter''
is revised to read ``Sec. 485.705(b) of this chapter''.
PART 484--[AMENDED]
2. In part 484, the following changes are made:
a. The authority citation for part 484 is revised to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395 (hh)) unless otherwise indicated.
Sec. 484.38 [Amended]
b. In Sec. 484.38, ``Secs. 405.1717 through 405.1719, 405.1721,
405.1723, and 405.1725 of this chapter'' is revised to read ``subpart H
of part 485 of this chapter''.
[[Page 2330]]
PART 498--[AMENDED]
3. In part 498, the following changes are made:
a. The authority citation for part 498 is revised to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395(hh)) unless otherwise indicated.
Sec. 498.3 [Amended]
b. In Sec. 498.3(b)(6), ``Secs. 405.1730 through 405.1737, or in
Sec. 410.22 of this chapter, respectively,'' is revised to read
``subpart D of part 486 of this chapter and Sec. 410.22 of this
chapter, respectively.''
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: September 2, 1994.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
Dated: October 12, 1994.
Donna E. Shalala,
Secretary.
[FR Doc. 95-485 Filed 1-6-95; 8:45 am]
BILLING CODE 4120-01-P
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