Other Providers and Services193
The Secretary will establish and implement quality standards for suppliers of items and services194 to be applied by independent accreditation organizations.195 Suppliers must submit evidence of accreditation as meeting applicable quality standards.196
Rural health clinics must maintain a quality assessment and improvement program.197
Comprehensive outpatient rehabilitation facilities must have in effect a utilization review plan.198
Religious nonmedical health care institutions must have in effect a utilization review plan that includes:
· Review by an appropriate committee of the institution199 of the following:200
o Admissions,
o The duration of stays,
o Cases of extended duration, and
o Furnished items and services.
· Provision for the maintenance of records of the meetings, decisions and actions of such committee.201
Personalized prevention plan services create a plan for an individual that, among other appropriate elements,202 includes:
· A health risk assessment completed prior to or as part of an individual’s visit with a health professional;203
· Identification of chronic diseases, injury risks, modifiable risk factors, and urgent health needs of the individual;204
· Establishment or update of the individual’s medical and family history;205
· A lists of current providers and suppliers that are regularly involved in providing care to the individual, including a list of all prescribed medication;206
· Height, weight, BMI, and blood pressure;207
· Detection of any cognitive impairment;208 and
· Establishment or update of a list of risk factors and conditions.209
In order to improve the health status of beneficiaries, the Secretary will encourage the use of, integration with, and coordination of health information technology to aid in the development of self-management skills as well as the management of and adherence to provider recommendations.210
Footnotes
- 193. Social Security Act §1834, 42 U.S.C. 1395m; Social Security Act § 1861, 42 U.S.C. 1395x; Social Security Act § 1886, 42 U.S.C. 1395ww.
- 194. Defined in Social Security Act § 1834(a)(20)(D), 42 U.S.C. 1395m(a)(20(D).
- 195. Social Security Act § 1834(a)(20)(A), 42 U.S.C. 1395m(a)(20)(A).
- 196. Social Security Act § 1834(a)(20(F)(i), 42 U.S.C. 1395m(a)(20)(F)(i).
- 197. Social Security Act § 1861(aa)(2)(I), 42 U.S.C. 1395x(aa)(2)(I).
- 198. Social Security Act § 1861(cc)(2)(G), 42 U.S.C. 1395x(cc)(2)(G).
- 199. Social Security Act § 1861(ss)(1)(H)(ii), 42 U.S.C. 1395x(ss)(1)(H)(ii).
- 200. Social Security Act § 1861(ss)(1)(H)(i), 42 U.S.C. 1395x(ss)(1)(H)(i).
- 201. Social Security Act § 1861(ss)(1)(H)(iii), 42 U.S.C. 1395x(ss)(1)(H)(iii).
- 202. Social Security Act § 1861(hhh)(2)(G), 42 U.S.C. 1395x(hhh)(2)(G).
- 203. Social Security Act § 1861(hhh)(1)(A), 42 U.S.C. 1395x(hhh)(1)(A) (“Health professional” defined in Social Security Act § 1861(hhh)(3), 42 U.S.C. 1395x(hhh)(3)).
- 204. Social Security Act § 1861(hhh)(4)(A)(i), 42 U.S.C. 1395x(hhh)(4)(A)(i).
- 205. Social Security Act § 1861(hhh)(2)(A), 42 U.S.C. 1395x(hhh)(2)(A).
- 206. Social Security Act § 1861(hhh)(2)(B), 42 U.S.C. 1395x(hhh)(2)(B).
- 207. Social Security Act § 1861(hhh)(2)(C), 42 U.S.C. 1395x(hhh)(2)(C).
- 208. Social Security Act § 1861(hhh)(2)(D), 42 U.S.C. 1395x(hhh)(2)(D).
- 209. Social Security Act § 1861(hhh)(2)(E)(ii), 42 U.S.C. 1395x(hhh)(2)(E)(ii).
- 210. Social Security Act § 1861(hhh)(4)(F), 42 U.S.C. 1395x(hhh)(4)(F).
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