; or (ii) as an employee of a provider or supplier of ambulance services. (6) Payment under this title for items and services identified under paragraph (3) or (4) furnished by such qualified group practices at such a facility in amounts determined under subsection (d). (c) Certifications (1) Qualified skilled nursing facilities For purposes of this section, the Secretary shall certify a skilled nursing facility as a qualified skilled nursing facility if the facility submits an application in a time and manner specified by the Secretary and meets the following requirements: (A) The facility has on-site diagnostic equipment necessary for a qualified group practice to furnish on-site items and services under the Program and real-time audio and visual capabilities. (B) The facility ensures that residents of such facility, upon entering such facility, are allowed to specify in an advanced care directive whether the resident wishes to receive items and services furnished at the facility under the Program in a case where communication with the resident is not possible. (C) The facility ensures that individuals to be furnished such items and services under the Program at such facility have the opportunity, at their request, to instead be transported to a hospital emergency department. (2) Qualified group practices For purposes of this section, the Secretary shall certify a group practice as a qualified group practice for a period of 3 years if the group practice submits an application in a time and manner specified by the Secretary and meets the following requirements: (A) The group practice offers to furnish all minimum required items and services identified under subsection (b)(3) under the Program. (B) The group practice submits a notification to the Secretary annually specifying which (if any) additional items and services identified under subsection (b)(4) for a year the group practice will offer to furnish for such year under the Program. (C) The group practice ensures that only individuals who meet the