Rural health clinic services
(b) Rural health clinic services. If nurse practitioners or physician assistants (as defined in 491.2 of this chapter) are not prohibited by State law from furnishing primary health care, rural health clinic services means the following services when furnished by a rural health clinic that has been certified in accordance with part 491 of this chapter. (1) Services furnished by a physician within the scope of practice of his profession under State law, if the physician performs the services in the clinic or the services are furnished away from the clinic and the physician has an agreement with the clinic providing that he will be paid by it for such services. (2) Services furnished by a physician assistant, nurse practitioner, nurse midwife or other specialized nurse practitioner (as defined in 405.2401 and 491.2 of this chapter) if the services are furnished in accordance with the requirements specified in 405.2414(a) of this chapter. (3) Services and supplies that are furnished as an incident to professional services furnished by a physician, physician assistant, nurse practitioner, nurse midwife, or specialized nurse practitioner. (See 405.2413 and 405.2415 of this chapter for the criteria for determining whether services and supplies are included under this paragraph.) (4) Part-time or intermittent visiting nurse care and related medical supplies (other than drugs and biologicals) if: (i) The clinic is located in an area in which the Secretary has determined that there is a shortage of home health agencies (see 405.2417 of this chapter): (ii) The services are furnished by a registered nurse or licensed practical nurse or a licensed vocational nurse employed by, or otherwise compensated for the services by, the clinic; (iii) The services are furnished under a written plan of treatment that is established and reviewed at least every 60 days by a supervising physician of the clinic or that is established by a physician, physician assistant, nurse practitioner, nurse midwife, or specialized nurse practitioner and reviewed and approved at least every 60 days by a supervising physician of the clinic; and (iv) The services are furnished to a homebound beneficiary. For purposes of visiting nurse care, a homebound beneficiary means one who is permanently or temporarily confined to his place of residence because of a medical or health condition. He may be considered homebound if he leaves the place of residence infrequently. For this purpose, place of residence does not include a hospital or a skilled nursing facility.