; and (2) applicable requirements of Federal law to furnish such items and services. (b) Limitation An entity or provider shall not be qualified to furnish covered items and services under this Act if the entity or provider provides no items and services directly to individuals, including— (1) entities or providers that contract with other entities or providers to provide such items and services; and (2) entities that are currently approved to coordinate care plans under the Medicare Advantage program established in part C of title XVIII of the Social Security Act ( 42 U.S.C. 1851 et seq. ) but do not directly provide items and services of such care plans. (c) Minimum provider standards (1) In general The Secretary shall establish, evaluate, and update national minimum standards to ensure the quality of items and services provided under this Act and to monitor efforts by States to ensure the quality of such items and services. A State may establish additional minimum standards which providers shall meet with respect to items and services provided in such State. (2) National minimum standards The Secretary shall establish national minimum standards under paragraph (1) for institutional providers of services and individual health care practitioners. Except as the Secretary may specify in order to carry out this Act, a hospital, skilled nursing facility, or other institutional provider of services shall meet standards applicable to such a provider under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ). Such standards also may include, where appropriate, elements relating to— (A) adequacy and quality of facilities; (B) mandatory minimum safe registered nurse-to-patient staffing ratios and optimal staffing levels for physicians and other health care practitioners; (C) training and competence of personnel (including requirements related to the number of or type of required continuing education hours); (D) comprehensiveness of service; (E) continuity of service