Code of Federal Regulations (alpha)

CFR /  Title 42  /  Part 440  /  Sec. 440.40 Nursing facility services for individuals age 21 or older and family planning services and supplies.

(a) Nursing facility services. (1) ``Nursing facility services for individuals age 21 or older, other than services in an institution for mental diseases'', means services that are--

(1) ``Nursing facility services for individuals age 21 or older, other than services in an institution for mental diseases'', means services that are--

(i) Needed on a daily basis and required to be provided on an inpatient basis under Sec. Sec. 409.31 through 409.35 of this chapter.

(ii) Provided by--

(A) A facility or distinct part (as defined in Sec. 483.5(b) of this chapter) that meets the requirements for participation under subpart B of part 483 of this chapter, as evidenced by a valid agreement between the Medicaid agency and the facility for providing nursing facility services and making payments for services under the plan; or

(B) If specified in the State plan, a swing-bed hospital that has an approval from CMS to furnish skilled nursing facility services in the Medicare program; and

(iii) Ordered by and provided under the direction of a physician.

(2) Nursing facility services include services provided by any facility located on an Indian reservation and certified by the Secretary as meeting the requirements of subpart B of part 483 of this chapter.

(b) EPSDT. ``Early and periodic screening and diagnosis and treatment'' means--

(1) Screening and diagnostic services to determine physical or mental defects in beneficiaries under age 21; and

(2) Health care, treatment, and other measures to correct or ameliorate any defects and chronic conditions discovered. (See subpart B of part 441 of this chapter.)

(c) Family planning services and supplies for individuals of child-bearing age. [Reserved] [59 FR 56233, Nov. 10, 1994; 60 FR 50117, Sept. 28, 1995, as amended at 61 FR 59198, Nov. 21, 1996; 68 FR 46071, Aug. 4, 2003]