participating health care facility

(2) Definitions In this section: (A) Participating health care facility (i) In general The term “participating health care facility” means, with respect to an item or service and a group health plan or health insurance issuer offering group health insurance coverage, a health care facility described in clause (ii) that has a direct or indirect contractual relationship with the plan or issuer, respectively, with respect to the furnishing of such an item or service at the facility. (ii) Health care facility described A health care facility described in this clause, with respect to a group health plan or group health insurance coverage, is each of the following: (I) A hospital (as defined in 1861(e) of the Social Security Act [ 42 U.S.C. 1395x(e) ]). (II) A hospital outpatient department. (III) A critical access hospital (as defined in section 1861(mm)(1) of such Act [ 42 U.S.C. 1395x(mm)(1) ]). (IV) An ambulatory surgical center described in section 1833(i)(1)(A) of such Act [ 42 U.S.C. 1395 l(i)(1)(A)]. (V) Any other facility, specified by the Secretary, that provides items or services for which coverage is provided under the plan or coverage, respectively. (B) Visit The term “visit” shall, with respect to items and services furnished to an individual at a health care facility, include equipment and devices, telemedicine services, imaging services, laboratory services, preoperative and postoperative services, and such other items and services as the Secretary may specify, regardless of whether or not the provider furnishing such items or services is at the facility.


29 USC § 1185e(b)(2)

Scoping language

In this section
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