applicable beneficiary
(1) Definition In this section, the term “applicable beneficiary” means, with respect to a qualifying independence at home medical practice, an individual who the practice has determined— (A) is entitled to benefits under part A and enrolled for benefits under part B; (B) is not enrolled in a Medicare Advantage plan under part C or a PACE program under section 1395eee of this title ; (C) has 2 or more chronic illnesses, such as congestive heart failure, diabetes, other dementias designated by the Secretary, chronic obstructive pulmonary disease, ischemic heart disease, stroke, Alzheimer’s Disease and neurodegenerative diseases, and other diseases and conditions designated by the Secretary which result in high costs under this subchapter; (D) within the past 12 months has had a nonelective hospital admission; (E) within the past 12 months has received acute or subacute rehabilitation services; (F) has 2 or more functional dependencies requiring the assistance of another person (such as bathing, dressing, toileting, walking, or feeding); and (G) meets such other criteria as the Secretary determines appropriate.