Is a federally qualified health center a “physician organization”?
No. A federally qualified health center (as defined at 42 C.F.R. 405.2401(b)) is not a “physician organization” as defined at 411.351. Federally qualified health centers are subject to the conditions for coverage at 42 C.F.R. Part 491. These regulations require, among other things, that the federally qualified health center have written policies and procedures, disclosure of certain information to patients, minimum staffing composition and levels, and that the federally qualified health center provides medical emergency procedures as a first response to common life-threatening injuries and acute illness. Federally qualified health centers may share some characteristics with physician medical practices. However, federally qualified health centers typically are not structured as physician medical practices in the traditional sense, nor are physician medical practices required to meet the same conditions for coverage as federally qualified health centers. Does the Phase III “stand in the
