---
kind: "section"
citation: "42 C.F.R. § 433.56"
title: "42"
number: "433.56"
heading: "Classes of health care services and providers defined."
url: "https://uscodex.org/cfr/42/433.56"
---

# §433.56. Classes of health care services and providers defined.

- (a) For purposes of this subpart, each of the following will be considered as a separate class of health care items or services:
  - (1) Inpatient hospital services;
  - (2) Outpatient hospital services;
  - (3) Nursing facility services (other than services of intermediate care facilities for individuals with intellectual disabilities);
  - (4) Intermediate care facility services for individuals with intellectual disabilities, and similar services furnished by community-based residences for individuals with intellectual disabilities, under a waiver under section 1915(c) of the Act, in a State in which, as of December 24, 1992, at least 85 percent of such facilities were classified as ICF/IIDs prior to the grant of the waiver;
  - (5) Physician services;
  - (6) Home health care services;
  - (7) Outpatient prescription drugs;
  - (8) Services of managed care organizations (including health maintenance organizations, preferred provider organizations);
  - (9) Ambulatory surgical center services, as described for purposes of the Medicare program in [section 1832(a)(2)(F)(i)](/cfr/42/1832.md?p=a-2-F-i) of the Social Security Act. These services are defined to include facility services only and do not include surgical procedures;
  - (10) Dental services;
  - (11) Podiatric services;
  - (12) Chiropractic services;
  - (13) Optometric/optician services;
  - (14) Psychological services;
  - (15) Therapist services, defined to include physical therapy, speech therapy, occupational therapy, respiratory therapy, audiological services, and rehabilitative specialist services;
  - (16) Nursing services, defined to include all nursing services, including services of nurse midwives, nurse practitioners, and private duty nurses;
  - (17) Laboratory and x-ray services, defined as services provided in a licensed, free-standing laboratory or x-ray facility. This definition does not include laboratory or x-ray services provided in a physician's office, hospital inpatient department, or hospital outpatient department;
  - (18) Emergency ambulance services; and
  - (19) Other health care items or services not listed above on which the State has enacted a licensing or certification fee, subject to the following:
    - (i) The fee must be broad based and uniform or the State must receive a waiver of these requirements;
    - (ii) The payer of the fee cannot be held harmless; and
    - (iii) The aggregate amount of the fee cannot exceed the State's estimated cost of operating the licensing or certification program.
- (b) Taxes that pertain to each class must apply to all items and services within the class, regardless of whether the items and services are furnished by or through a Medicaid-certified or licensed provider.

## Notes

### Amendments

[57 FR 55138, Nov. 24, 1992, as amended at 58 FR 43180, Aug. 13, 1993; 73 FR 9698, Feb. 22, 2008]

### Source

Source: 57 FR 55138, Nov. 24, 1992, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 43 FR 45201, Sept. 29, 1978, unless otherwise noted.

### Amendments

[57 FR 55138, Nov. 24, 1992, as amended at 58 FR 43180, Aug. 13, 1993; 73 FR 9698, Feb. 22, 2008]