Clinic Services

Definitions

Case Management Services: Face-to-face services furnished to assist people infected with TB gain access to needed medical services.

Community Health Board: A board of health established, operating, and eligible for a subsidy (from the Commissioner of Health). The board has general responsibility to develop and maintain an integrated system of community health services under local administration and within a system of state guidelines and standards.

Community Health Representative (CHR): Community-based health care providers who provide health promotion and disease prevention services in their communities and have completed an Indian Health Service (IHS) funded, tribally contracted/granted and directed program of training.

Community Health Worker (CHW): Is a health worker who is a trusted member of and/or has an unusually close understanding of the community served that enables the provision of information about health issues that affect the community and link individuals with the health and social services they need to achieve wellness.

Dental Encounter: Services provided during a dental visit.

Directly Observed Therapy: Physically watching the member take the drugs prescribed for TB.

Federally Qualified Health Center (FQHC): A facility that meets one of the following:

1. Is receiving a grant under sections 329 or 330 of the Public Health Service (PHS) Act (Title 42 United States Code [USC] Sections 254b-c), or is receiving funding from such a grant under a contract with the recipient of such a grant and meets the requirements to receive a grant under sections 329 or 330 of the PHS Act (42 USC 254b-c)
2. Is, based on the recommendation of the PHS, determined by the Centers for Medicare & Medicaid Services (CMS) to meet the requirements for receiving such a grant
3. Was treated by CMS, for purposes of Medicare Part B, as a comprehensive Federally funded health center (FFHC) as of January 1, 1990
4. Is an outpatient health program or facility operated by a tribe or tribal organization under Public Law 93-638 (the Indian Self-Determination and Education Assistance Act) or an urban Indian organization receiving funds under Public Law 94-437 (the Indian Health Care Improvement Act [IHCIA]).

Medical Encounter: Services provided during a medical visit, including but not limited to, the following:

1. Professional services
2. Supplies and pharmaceuticals incidental to professional services
3. Pharmaceuticals provided in compliance with pharmacy guidelines
4. Obstetrical and perinatal care
5. Clinic visits
6. FQHC or RHC professional services provided to FQHC or RHC members if covering inpatient hospital visits
7. FQHC or RHC professional services provided to FQHC or RHC members if surgical services are directly provided by the center or clinic
8. Mental health visits provided in compliance with mental health guidelines

People Infected with TB: Individuals infected with latent or active TB who have a positive TB skin test, or have a negative tuberculin skin test, but a positive sputum culture for the TB organism. An individual whose TB test is negative, but whose physician’s certification indicates the individual requires TB-related drug and/or surgical therapy can be considered TB infected.

Provider-Based Facility: A clinic that is an integral part of a hospital, Skilled Nursing Facility (SNF), or home health agency that is participating in Medicare and is used, governed, and supervised with other departments of the facility.

Rural Health Clinic (RHC): A freestanding or provider-based facility certified under Title 42 Code of Federal Regulations (CFR) Part 491.

PW_03-19_129
Updated_12/11/2025