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NOTES:
Source
(Aug. 14, 1935, ch. 531, title XVIII, § 1862, as added , title I, § 102(a), July 30, 1965, ; amended , title I, §§ 127(b),
128, Jan. 2, 1968, , 847; , title II, §§ 210,
,
,
, Oct. 30, 1972, , 1384, 1408, 1447; , § 18(k)(3), Dec. 31, 1973, ; , § 4(a), Oct. 26, 1974, ; , title I, § 103, Dec. 31, 1975, ; , §§ 7(a),
, (b)(1), (2), Oct. 25, 1977, , 1197, 1198; , § 1(f), Dec. 13, 1977, ; , title III, § 308(a), June 17, 1980, ; , title IX, §§ 913(b),
936
(c),
939
(a),
953, Dec. 5, 1980, , 2640, 2647; , § 1(a)(3), Dec. 28, 1980, ; , title XXI, §§ 2103(a)(1),
2146
(a),
, Aug. 13, 1981, , 800, 802; , title I, §§ 116(b),
, (g)(1),
128
(a)(2)–(4), 142, 148(a), Sept. 3, 1982, , 362, 366, 381, 394; , title III, § 309(b)(10), Jan. 12, 1983, ; , title VI, §§ 601(f),
, Apr. 20, 1983, , 163; , div. B, title III, §§ 2301(a),
,
,
–(c), 2354(b)(30), (31), July 18, 1984, , 1068, 1078, 1095, 1101, 1102; , title IX, §§ 9201(a),
,
, Apr. 7, 1986, , 193, 199; , title IX, §§ 9316(b),
9319
(a), (b),
9320
(h)(1),
9343
(c)(1), Oct. 21, 1986, , 2010, 2011, 2016, 2040; , § 2, Oct. 22, 1986, ; , §§ 8(c)(1), (3),
, Aug. 18, 1987, , 693, 696; , title IV, §§ 4009(j)(6)(C),
4034
(a),
4036
(a)(1),
4039
(c)(1),
,
4085
(i)(15), (16), Dec. 22, 1987, , 1330–77, 1330–79, 1330–82, 1330–117, 1330–133; , title II, §§ 202(d),
,
, title IV, § 411(f)(4)(D)(i), (i)(4)(D), July 1, 1988, , 729, 731, 778, 790; , title VI, § 608(d)(7), (24)(C), Oct. 13, 1988, , 2421; , title II, § 201(a), Dec. 13, 1989, ; , title VI, §§ 6003(g)(3)(D)(xi),
,
6115
(b),
, (b)(1), (e)(1),
6411
(d)(2), Dec. 19, 1989, , 2199, 2219, 2228, 2229, 2234, 2271; , title IV, §§ 4107(b),
,
,
4161
(a)(3)(C),
4163
(d)(2),
4203
(a)(1), (b), (c)(1),
4204
(g)(1), Nov. 5, 1990, , 1388–84, 1388–89, 1388–94, 1388–100, 1388–107, 1388–112; , title XIII, §§ 13561(a)(1), (b)–(d)(1), (e)(1), 13581(b)(1), Aug. 10, 1993, , 594, 611; , title I, §§ 145(c)(1),
,
151
(a)(1)(A), (C), (2)(A), (b)(3)(A), (B), (c)(1), (4)–(6), (9)(B), 156(a)(2)(D), 157(b)(7), Oct. 31, 1994, , 4430, 4432–4436, 4441, 4442; , § 1, Oct. 2, 1996, ; , § 1(b)(1), Oct. 2, 1996, ; , § 9(a)(1), Apr. 30, 1997, ; , title IV, §§ 4022(b)(1)(B),
,
,
,
,
4319
(b),
,
4507
(a)(2)(B),
,
,
,
4614
(a),
, (b), (c)(1),
,
, (b), Aug. 5, 1997, , 361, 362, 365, 373, 394, 420, 441, 442, 456, 471, 474, 486, 487; , div. B, § 1000(a)(6) [title III, §§ 305(b),
321
(k)(10)], Nov. 29, 1999, , 1501A–362, 1501A–367; , § 1(a)(6) [title I, § 102(c), title III, § 313(a), title IV, § 432(b)(1), title V, § 522(b)], Dec. 21, 2000, , 2763A–468, 2763A–499, 2763A–526, 2763A–546; , § 3(a), Dec. 27, 2001, .)
References in Text
Parts A and B of this subchapter, referred to in text, are classified to sections
et seq. and 1395j et seq., respectively, of this title.
Section
of this title, referred to in subsec. (a)(1)(D), was repealed by , title IV, § 4022(b)(1)(A)(i), Aug. 5, 1997, .
Part B of subchapter XI of this chapter, referred to in subsecs. (a)(15) and (g), is classified to section
et seq. of this title.
The Assisted Suicide Funding Restriction Act of 1997, referred to in subsec. (a)(16), is , Apr. 30, 1997, , which is classified principally to chapter 138 (§ 14401 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section
of this title and Tables.
The Internal Revenue Code of 1986, referred to in subsec. (b), is classified generally to Title 26, Internal Revenue Code.
Section 107(c)(3) of the Drug Amendments of 1962, referred to in subsec. (c)(1)(A), is section 107(c)(3) of , title I, Oct. 10, 1962, , which is set out as an Effective Date of 1962 Amendment note under section
of Title
, Food and Drugs.
Amendments
2001—Subsec. (a)(22). , § 3(a)(1), added par. (22).
Subsec. (h). , § 3(a)(2), added subsec. (h).
2000—Subsec. (a). , § 1(a)(6) [title V, § 522(b)], inserted at end “In making a national coverage determination (as defined in paragraph (1)(B) of section
of this title) the Secretary shall ensure that the public is afforded notice and opportunity to comment prior to implementation by the Secretary of the determination; meetings of advisory committees established under section
of this title with respect to the determination are made on the record; in making the determination, the Secretary has considered applicable information (including clinical experience and medical, technical, and scientific evidence) with respect to the subject matter of the determination; and in the determination, provide a clear statement of the basis for the determination (including responses to comments received from the public), the assumptions underlying that basis, and make available to the public the data (other than proprietary data) considered in making the determination.”
Subsec. (a)(1)(F). , § 1(a)(6) [title I, § 102(c)], struck out “and,” after “section
of this title,” and inserted at end “and, in the case of screening for glaucoma, which is performed more frequently than is provided under section
of this title,”.
Subsec. (a)(3). , § 1(a)(6) [title IV, § 432(b)(1)], struck out second comma after “section
of this title” and inserted “in the case of services for which payment may be made under section
of this title,” after “section
of this title,”.
Subsec. (a)(18). , § 1(a)(6) [title III, § 313(a)], substituted “during a period in which the resident is provided covered post-hospital extended care services (or, for services described in section
of this title, which are furnished to such an individual without regard to such period),” for “or of a part of a facility that includes a skilled nursing facility (as determined under regulations),”.
1999—Subsec. (a)(7). , § 1000(a)(6) [title III, § 321(k)(10)], substituted “subparagraph” for “subparagraphs”.
Subsec. (a)(21). , § 1000(a)(6) [title III, § 305(b)], inserted “(including medical supplies described in section
of this title, but excluding durable medical equipment to the extent provided for in such section)” after “home health services”.
1997—Subsec. (a)(1)(D). , § 4022(b)(1)(B), substituted “Medicare Payment Advisory Commission” for “Prospective Payment Assessment Commission”.
Subsec. (a)(1)(F). , § 4102(c), inserted “and screening pelvic exam” after “screening pap smear”.
Subsec. (a)(1)(G). , § 4103(c)(1), added subpar. (G).
Subsec. (a)(1)(H). , § 4104(c)(3)(A), added subpar. (H).
Subsec. (a)(1)(I). , § 4614(a), added subpar. (I).
Subsec. (a)(7). , § 4104(c)(3)(B), substituted “(G), or (H)” for “or (G)”.
, § 4103(c)(2), substituted “subparagraphs (B), (F), or (G) of paragraph (1)” for “paragraph (1)(B) or under paragraph (1)(F)”.
Subsec. (a)(14). , § 4511(a)(2)(C), substituted “section
of this title” for “section
or
of this title”.
, § 4201(c)(1), substituted “critical access” for “rural primary care” wherever appearing.
Subsec. (a)(16). added par. (16).
Subsec. (a)(17). , § 4319(b), added par. (17).
Subsec. (a)(18). , § 4432(b)(1), added par. (18).
Subsec. (a)(19). , § 4507(a)(2)(B), added par. (19).
Subsec. (a)(20). , § 4541(b), added par. (20).
Subsec. (a)(21). , § 4603(c)(2)(C), added par. (21).
Subsec. (b)(1)(B)(i). , § 4631(a)(1)(A), substituted “in clause (iii))” for “in clause (iv))”.
Subsec. (b)(1)(B)(iii), (iv). , § 4631(a)(1)(B), (C), redesignated cl. (iv) as (iii) and struck out heading and text of former cl. (iii). Text read as follows: “Clause (i) shall only apply to items and services furnished on or after January 1, 1987, and before October 1, 1998.”
Subsec. (b)(1)(C). , § 4631(b), in concluding provisions, substituted “August 5, 1997” for “October 1, 1998” and inserted at end “Effective for items and services furnished on or after August 5, 1997, (with respect to periods beginning on or after the date that is 18 months prior to August 5, 1997), clauses (i) and (ii) shall be applied by substituting ‘30-month’ for ‘12-month’ each place it appears.”
Subsec. (b)(1)(F). , § 4633(b), added subpar. (F).
Subsec. (b)(2)(B)(ii). , § 4633(a), substituted “(directly, as a third-party administrator, or otherwise) to make payment” for “under this subsection to pay” and inserted at end “The United States may not recover from a third-party administrator under this clause in cases where the third-party administrator would not be able to recover the amount at issue from the employer or group health plan and is not employed by or under contract with the employer or group health plan at the time the action for recovery is initiated by the United States or for whom it provides administrative services due to the insolvency or bankruptcy of the employer or plan.”
Subsec. (b)(2)(B)(v). , § 4632(a), added cl. (v).
Subsec. (b)(5)(C)(iii). , § 4631(c)(1), struck out heading and text of cl. (iii). Text read as follows: “Clause (ii) shall not apply to inquiries made after September 30, 1998.”
Subsec. (i). , § 4022(b)(1)(B), substituted “Medicare Payment Advisory Commission” for “Prospective Payment Assessment Commission” in introductory provisions.
1996—Subsec. (b)(5)(B). , § 1(b)(1)(A), substituted “under subparagraph (A) for purposes of carrying out this subsection” for “under—
“(i) subparagraph (A), and
“(ii) section
of this title,
for purposes of carrying out this subsection”.
Subsec. (b)(5)(C)(i). , § 1(b)(1)(B), substituted “disclosed under subparagraph (B)” for “disclosed under subparagraph (B)(i)”.
Subsec. (h). struck out subsec. (h) which required Secretary to provide registry of all cardiac pacemaker devices and pacemaker leads for which payment was made under this chapter.
1994—Subsec. (a)(1)(F). , § 145(c)(1), substituted “is not conducted by a facility described in section
of this title” for “or which does not meet the standards established under section
of this title”.
Subsec. (a)(14). , § 156(a)(2)(D)(i), inserted “or” at end.
, § 147(e)(6), substituted “section
or
of this title” for “section
of this title”.
Subsec. (a)(15). , § 156(a)(2)(D)(ii), substituted period for “; or” at end.
Subsec. (a)(16). , § 156(a)(2)(D)(iii), struck out par. (16) which read as follows: “furnished in connection with a surgical procedure for which a second opinion is required under section
of this title and has not been obtained.”
Subsec. (b)(1)(A)(i)(II). , § 151(c)(1)(A), substituted “older (and the spouse age 65 or older of any individual) who has current employment status with an employer” for “over (and the individual’s spouse age 65 or older) who is covered under the plan by virtue of the individual’s current employment status with an employer”.
Subsec. (b)(1)(A)(ii). , § 151(c)(1)(B), substituted “employer that has 20 or more employees” for “employer or employee organization that has 20 or more individuals in current employment status”.
Subsec. (b)(1)(A)(v). , § 151(c)(9)(B), made technical amendment to directory language of , § 13561(e)(1)(D). See 1993 Amendment note below.
Subsec. (b)(1)(C). , § 151(c)(5), substituted “paying benefits secondary to this subchapter when” for “taking into account that” in closing provisions.
, § 151(c)(4), substituted “this subparagraph” for “clauses (i) and (ii)” after “February 1, 1990),” in last sentence.
Subsec. (b)(2)(B)(i). , § 151(b)(3)(A), (B), substituted “Repayment required” for “Primary plans” in heading and inserted at end “If reimbursement is not made to the appropriate Trust Fund before the expiration of the 60-day period that begins on the date such notice or other information is received, the Secretary may charge interest (beginning with the date on which the notice or other information is received) on the amount of the reimbursement until reimbursement is made (at a rate determined by the Secretary in accordance with regulations of the Secretary of the Treasury applicable to charges for late payments).”
Subsec. (b)(2)(C). , § 151(a)(1)(C), added subpar. (C).
Subsec. (b)(3)(C). , § 157(b)(7), substituted “group health plan or a large group health plan” for “group health plan” in heading and text, struck out “, unless such incentive is also offered to all individuals who are eligible for coverage under the plan” after “(as defined in paragraph (2)(A))”, and substituted “(other than subsections (a) and (b))” for “(other than the first sentence of subsection (a) and other than subsection (b))”.
Subsec. (b)(5)(C)(i). , § 151(c)(6), substituted “section 6103(l)(12)(E)(iii) of such Code” for “section 6103(l)(12)(D)(iii) of such Code”.
Subsec. (b)(5)(D). , § 151(a)(1)(A), added subpar. (D).
Subsec. (b)(6). , § 151(a)(2)(A), added par. (6).
1993—Subsec. (b)(1)(A)(i). , § 13561(e)(1)(A), amended subcls. (I) and (II) generally. Prior to amendment, subcls. (I) and (II) read as follows:
“(I) may not take into account, for any item or service furnished to an individual 65 years of age or older at the time the individual is covered under the plan by reason of the current employment of the individual (or the individual’s spouse), that the individual is entitled to benefits under this subchapter under section
of this title, and
“(II) shall provide that any employee age 65 or older, and any employee’s spouse age 65 or older, shall be entitled to the same benefits under the plan under the same conditions as any employee, and the spouse of such employee, under age 65.”
Subsec. (b)(1)(A)(ii). , § 13561(e)(1)(B), substituted “unless the plan is a plan of, or contributed to by, an employer or employee organization that has 20 or more individuals in current employment status” for “unless the plan is sponsored by or contributed to by an employer that has 20 or more employees”.
Subsec. (b)(1)(A)(iii). , § 13561(e)(1)(C), substituted “by virtue of current employment status with an employer that does not have 20 or more individuals in current employment status for each working day in each of 20 or more calendar weeks in the current calendar year and” for “by virtue of employment with an employer that does not have 20 or more employees for each working day in each of 20 or more calendar weeks in the current calendar year or”.
Subsec. (b)(1)(A)(iv). , § 13561(c)(2), substituted “Subparagraph (C) shall apply instead of clause (i)” for “Clause (i) shall not apply” and inserted “(without regard to entitlement under section
of this title)” after “individual is, or”.
Subsec. (b)(1)(A)(v). , § 13561(e)(1)(D), as amended by , § 151(c)(9)(B), inserted before period at end “, without regard to section 5000(d) of such Code”.
Subsec. (b)(1)(B). , § 13561(e)(1)(E), substituted “individuals” for “active individuals” in heading.
Subsec. (b)(1)(B)(i). , § 13561(e)(1)(F), substituted “clause (iv)) may not take into account that an individual (or a member of the individual’s family) who is covered under the plan by virtue of the individual’s current employment status with an employer” for “clause (iv)(II)) may not take into account that an active individual (as defined in clause (iv)(I))”.
Subsec. (b)(1)(B)(ii). , § 13561(c)(2), substituted “Subparagraph (C) shall apply instead of clause (i)” for “Clause (i) shall not apply” and inserted “(without regard to entitlement under section
of this title)” after “individual is, or”.
Subsec. (b)(1)(B)(iii). , § 13561(b), substituted “1998” for “1995”.
Subsec. (b)(1)(B)(iv). , § 13561(e)(1)(G), amended heading and text generally. Prior to amendment, text defined “active individual” and “large group health plan”.
Subsec. (b)(1)(C). , § 13561(c)(1), (3), substituted “or eligible for benefits under this subchapter under” for “benefits under this subchapter solely by reason of” in cl. (i) and concluding provisions and substituted “before October 1, 1998” for “on or before January 1, 1996” in concluding provisions.
Subsec. (b)(1)(E). , § 13561(e)(1)(H), added cls. (ii) and (iii).
, § 13561(d)(1), added subpar. (E).
Subsec. (b)(5)(B). , § 13581(b)(1)(A), substituted “under—” for “under subparagraph (A) for the purposes of carrying out this subsection.” and added cls. (i) and (ii) and concluding provisions.
Subsec. (b)(5)(C)(i). , § 13581(b)(1)(B), substituted “subparagraph (B)(i)” for “subparagraph (B)”.
Subsec. (b)(5)(C)(iii). , § 13561(a)(1), substituted “1998” for “1995”.
1990—Subsec. (a). , § 4161(a)(3)(C)(iii), inserted at end “Paragraph (7) shall not apply to Federally qualified health center services described in section
of this title.”
Subsec. (a)(1)(A). , § 4163(d)(2)(A)(i), substituted “a succeeding subparagraph” for “subparagraph (B), (C), (D), or (E)”.
Subsec. (a)(1)(F). , § 4163(d)(2)(A)(ii)–(iv), added subpar. (F).
Subsec. (a)(2). , § 4161(a)(3)(C)(i), inserted before semicolon at end “, except in the case of Federally qualified health center services”.
Subsec. (a)(3). , § 4161(a)(3)(C)(ii), inserted “, in the case of Federally qualified health center services, as defined in section
of this title,” after “section
of this title,”.
Subsec. (a)(7). , § 4163(d)(2)(B), inserted “or under paragraph (1)(F)” after “paragraph (1)(B)”.
, § 4153(b)(2)(B), inserted “(other than eyewear described in section
of this title)” after first reference to “eyeglasses”.
Subsec. (a)(14). , § 4157(c)(1), inserted “, services described by section
of this title, certified nurse-midwife services, qualified psychologist services, and services of a certified registered nurse anesthetist,” after “this paragraph)” and struck out before semicolon at end “or are services of a certified registered nurse anesthetist”.
Subsec. (a)(15). , § 4107(b), designated existing provisions as par. (A), substituted “, or” for “; or” at end, and added par. (B).
Subsec. (b)(1)(B)(iii). , § 4203(b), substituted “October 1, 1995” for “January 1, 1992”.
Subsec. (b)(1)(C). , § 4203(c)(1)(B), inserted at end “Effective for items and services furnished on or after February 1, 1991, and on or before January 1, 1996, (with respect to periods beginning on or after February 1, 1990), clauses (i) and (ii) shall be applied by substituting ‘18-month’ for ‘12-month’ each place it appears.”
Subsec. (b)(1)(C)(i). , § 4203(c)(1)(A), substituted “during the 12-month period which begins with the first month in which the individual becomes entitled to benefits under part A of this subchapter under the provisions of section
of this title, or, if earlier, the first month in which the individual would have been entitled to benefits under such part under the provisions of section
of this title if the individual had filed an application for such benefits; and” for “during the 12-month period which begins with the earlier of—
“(I) the month in which a regular course of renal dialysis is initiated, or
“(II) in the case of an individual who receives a kidney transplant, the first month in which he would be eligible for benefits under part A of this subchapter (if he had filed an application for such benefits) under the provisions of section
of this title; and”.
Subsec. (b)(3)(C). , § 4204(g)(1), added subpar. (C).
Subsec. (b)(5)(C)(iii). , § 4203(a)(1), substituted “September 30, 1995” for “September 30, 1991”.
1989—, § 6202(b)(1)(A), inserted “and medicare as secondary payer” in section catchline.
Subsec. (a)(1)(A). repealed , § 204(d)(2)(A)(i), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, see 1988 Amendment note below.
Subsec. (a)(1)(E). , § 6103(b)(3)(B), substituted “section
” for “section
”.
Subsec. (a)(1)(F). , § 6115(b), inserted before semicolon at end “, and, in the case of screening pap smear, which is performed more frequently than is provided under 1395x(nn) of this title”.
repealed , § 204(d)(2)(A)(ii)–(iv), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, see 1988 Amendment note below.
Subsec. (a)(1)(G), (6), (7). repealed , §§ 204(d)(2)(B),
, and provided that the provisions of law amended or repealed by such sections are restored or revived as if such sections had not been enacted, see 1988 Amendment notes below.
Subsec. (a)(14). , § 6003(g)(3)(D)(xi), substituted “hospital or rural primary care hospital” for “hospital” in three places.
Subsec. (b). , § 6202(b)(1)(B), amended heading and text generally, substituting pars. (1) to (4) relating to medicare as secondary payer for former pars. (1) to (5) relating to items or services paid under workmen’s compensation laws and end stage renal disease program.
Subsec. (b)(1)(D). , § 6202(e)(1), added subpar. (D).
Subsec. (b)(5). , § 6202(a)(2)(A), added par. (5).
Subsec. (c). repealed , § 202(d), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, see 1988 Amendment note below.
Subsec. (e)(1). , § 6411(d)(2), inserted “, not including items or services furnished in an emergency room of a hospital” after “(other than an emergency item or service”.
1988—Subsec. (a)(1)(A). , § 204(d)(2)(A)(i), substituted “a succeeding subparagraph” for “subparagraph (B), (C), (D), or (E)”.
Subsec. (a)(1)(F). , § 204(d)(2)(A)(ii)–(iv), added subpar. (F) relating to screening mammography.
Subsec. (a)(1)(G). , § 205(e)(1)(A), as amended by , § 608(d)(7), added subpar. (G) relating to in-home care for chronically dependent individuals.
Subsec. (a)(6). , § 205(e)(1)(B), inserted “and except, in the case of in-home care, as is otherwise permitted under paragraph (1)(G)” after “paragraph (1)(C)”.
Subsec. (a)(7). , § 204(d)(2)(B), inserted “or under paragraph (1)(F)” after “(1)(B)”.
Subsec. (a)(15). , § 411(f)(4)(D)(i), inserted “(including subsequent insertion of an intraocular lens)” after “operation”.
Subsec. (c). , § 202(d), designated existing provisions as par. (1), redesignated former par. (1) as subpar. (A), redesignated former subpars. (A) to (D) as cls. (i) to (iv), redesignated former par. (2) as subpar. (B), redesignated former subpar. (A) as cl. (i) and substituted “subparagraph (A)” for “paragraph (1)”, redesignated former subpar. (B) as cl. (ii), and added par. (2) prohibiting payment for expenses incurred for a covered outpatient drug if the drug is dispensed in a quantity exceeding a supply of 30 days with an exception.
Subsec. (e)(1). , § 411(i)(4)(D)(i), as amended by , § 608(d)(24)(C)(i), designated existing provisions of subsec. (e) as par. (1), redesignated former par. (1) as subpar. (A), substituted “, 1320a–7a, 1320c–5 or 1395u(j)(2)” for “or section
”, redesignated former par. (2) as subpar. (B), and substituted “, 1320a–7a, 1320c–5 or 1395u(j)(2)” for “or section
”.
Subsec. (e)(2). , § 411(i)(4)(D)(ii), as amended by , § 608(d)(24)(C)(ii), amended former section
of this title by striking out the catchline “Limitation of liability of beneficiaries with respect to services furnished by excluded individuals and entities”, substituting “(2)” for the section designation, inserting “1395u(j)(2),” in text, and transferring the text to par. (2) of subsec. (e) of this section.
1987—Subsec. (a)(1)(A). , § 4085(i)(15), substituted “(D), or (E)” for “or (D)”.
Subsec. (a)(8). , § 4072(c), inserted “, other than shoes furnished pursuant to section
of this title” before semicolon.
Subsec. (a)(14). , § 4085(i)(16), substituted “a patient” for “an patient”.
, § 4009(j)(6)(C), made technical amendment to , § 9320(h)(1). See 1986 Amendment note below.
Subsec. (b)(2)(A)(ii). , § 4036(a)(1), substituted “can reasonably be expected to be made under such a plan” for “the Secretary determines will be made under such a plan as promptly as would otherwise be the case if payment were made by the Secretary under this subchapter”.
Subsec. (b)(4)(B)(i). , § 4034(a), substituted “subsection (b) of section
of the Internal Revenue Code of 1986 without regard to subsection (d) of such section” for “section 5000(b) of the Internal Revenue Code of 1986”.
Subsec. (d). , § 8(c)(1)(A), struck out subsec. (d), which provided that no payment be made under this subchapter for any item or services to an individual by a person where Secretary determines such person knowingly and willfully made any false statement or representation of a material fact, submitted excessive bills or requests, or furnished excessive services or supplies, and provided a dissatisfied person with a hearing on determination of the Secretary.
Subsec. (e) [formerly § 1395aaa]. , § 10, added par. (2). See 1988 Amendment note above.
, § 8(c)(1)(B), amended subsec. (e) generally. Prior to amendment, subsec. (e) read as follows: “No payment may be made under this subchapter with respect to any item or service furnished by a physician or other individual during the period when he is barred pursuant to section
of this title from participation in the program under this subchapter.”
Subsec. (h)(1)(B). , § 4039(c)(1)(A), substituted “law (and any amount paid to a provider under any such warranty),” for “law,”.
Subsec. (h)(1)(D). , § 4039(c)(1)(B), inserted “in determining the amount subject to repayment under paragraph (2)(C),” after “(3),”.
Subsec. (h)(2)(C). , § 4039(c)(1)(C), added subpar. (C).
Subsec. (h)(4). , § 8(c)(3), substituted “subsections (c), (f), and (g) of section
of this title” for “paragraphs (2) and (3) of subsection (d) of this section”.
Subsec. (h)(4)(B). , § 4039(c)(1)(D), substituted “, has improperly” for “or has improperly” and inserted “or has failed to make repayment to the Secretary as required under paragraph (2)(C),” after “(2)(B),”.
1986—Subsec. (a)(1)(E). , § 9316(b), added subpar. (E).
Subsec. (a)(14). , § 9343(c)(1), substituted “patient” for “inpatient”.
, § 9320(h)(1), as amended by , § 4009(j)(6)(C), inserted “or are services of a certified registered nurse anesthetist” after “hospital” at end.
Subsec. (a)(15). , § 9307(a), added par. (15).
Subsec. (a)(16). , § 9401(c)(1), added par. (16).
Subsec. (b)(2)(A). substituted “Internal Revenue Code of 1986” for “Internal Revenue Code of 1954”.
Subsec. (b)(3)(A)(i). , § 9201(a)(1), substituted “(or to the spouse of such individual)” for “who is under 70 years of age during any part of such month (or to the spouse of such individual, if the spouse is under 70 years of age during any part of such month)”.
Subsec. (b)(3)(A)(iii). , § 9201(a)(2), struck out “and ending with the month before the month in which such individual attains the age of 70” after “section
of this title”.
Subsec. (b)(3)(A)(iv). substituted “Internal Revenue Code of 1986” for “Internal Revenue Code of 1954”.
Subsec. (b)(4). , § 9319(a), added par. (4).
Subsec. (b)(5). , § 9319(b), added par. (5).
1984—Subsec. (a)(12). , § 2354(b)(30), struck out second comma after “dental procedure”.
Subsec. (b)(1). , § 2344(a), substituted “to be made promptly” for “to be made” and “has been or could be made under such a law” for “has been made under such a law”, and inserted “In order to recover payment made under this subchapter for an item or service, the United States may bring an action against any entity which would be responsible for payment with respect to such item or service (or any portion thereof) under such a law, policy, plan, or insurance, or against any entity (including any physician or provider) which has been paid with respect to such item or service under such law, policy, plan, or insurance, and may join or intervene in any action related to the events that gave rise to the need for such item or service. The United States shall be subrogated (to the extent of payment made under this subchapter for an item or service) to any right of an individual or any other entity to payment with respect to such item or service under such a law, policy, plan, or insurance.”
Subsec. (b)(2)(B). , § 2344(b), substituted “has been or could be made under a plan” for “has been made under a plan”, and inserted “In order to recover payment made under this subchapter for an item or service, the United States may bring an action against any entity which would be responsible for payment with respect to such item or service (or any portion thereof) under such a plan, or against any entity (including any physician or provider) which has been paid with respect to such item or service under such plan, and may join or intervene in any action related to the events that gave rise to the need for such item or service. The United States shall be subrogated (to the extent of payment made under this subchapter for an item or service) to any right of an individual or any other entity to payment with respect to such item or service under such a plan.”
Subsec. (b)(3)(A)(i). , § 2301(a), struck out “over 64 but” before “under 70 years” in two places.
Subsec. (b)(3)(A)(ii). , § 2344(c), substituted “has been or could be made under a group health plan” for “has been made under a group health plan”, and inserted “In order to recover payment made under this title for an item or service, the United States may bring an action against any entity which would be responsible for payment with respect to such item or service (or any portion thereof) under such a plan, or against any entity (including any physician or provider) which has been paid with respect to such item or service under such plan, and may join or intervene in any action related to the events that gave rise to the need for such item or service. The United States shall be subrogated (to the extent of payment made under this title for an item or service) to any right of an individual or any other entity to payment with respect to such item or service under such a plan.”
Subsec. (b)(3)(A)(iii). , § 2354(b)(31), inserted “before the month” after “ending with the month”.
Subsec. (h). , § 2304(c), added subsec. (h).
Subsec. (i). , § 2313(c), added subsec. (i).
1983—Subsec. (a)(1)(A). , § 601(f)(1), inserted reference to subpar. (D).
Subsec. (a)(1)(D). , § 601(f)(2)–(4), added subpar. (D).
Subsec. (a)(14). , § 602(e), added par. (14).
Subsec. (b)(3)(A)(i). inserted “in any month” after “service furnished”, and “during any part of such month” after “70 years of age” wherever appearing.
1982—Subsec. (a)(1). , § 122(f)(1), designated existing provisions as subpars. (A) and (B), in subpar. (A) as so designated inserted exception to provisions for items and services described in subpar. (B) or (C), substituted “and” for “or” as the connector between provisions, and added subpar. (C).
Subsec. (a)(6). , § 122(f)(2), inserted “(except, in the case of hospice care, as is otherwise permitted under paragraph (1)(C))”.
Subsec. (a)(7). , § 122(f)(3), substituted “paragraph (1)(B)” for “paragraph (1)”.
Subsec. (a)(9). , § 122(f)(4), inserted “(except, in the case of hospice care, as is otherwise permitted under paragraph (1)(C))”.
Subsec. (b)(1). , § 128(a)(2), struck out “or plan” after “service has been made under such a law”.
Subsec. (b)(2)(A). , § 128(a)(3), substituted “section
” for “section
”.
Subsec. (b)(2)(B). , § 128(a)(4), inserted “furnished” before “to an individual”.
Subsec. (b)(3). , § 116(b), added par. (3).
Subsec. (d)(1)(C). , § 148(a), substituted “on the basis of information acquired by the Secretary in the administration of this subchapter” for “, on the basis of reports transmitted to him in accordance with section
of this title (or, in the absence of any such report, on the basis of such data as he acquires in the administration of the program under this subchapter),”.
Subsec. (f). , § 122(g)(1), substituted “paragraph (1)(A)” for “paragraph (1)”.
Subsec. (g). , § 142, added subsec. (g).
1981—Subsec. (b). , § 2146(a), designated existing provisions as par. (1) and added par. (2).
Subsec. (c). , § 2103(a)(1), added subsec. (c).
Subsec. (f). , § 2152(a), added subsec. (f).
1980—Subsec. (a)(1). , § 1(a)(3)(A), inserted “, or, in the case of items and services described in section
of this title, which are not reasonable and necessary for the prevention of illness” after “of a malformed body member”.
Subsec. (a)(7). , § 1(a)(3)(B), inserted “(except as otherwise allowed under section
of this title and paragraph (1))” after “immunizations”.
Subsec. (a)(12). , § 936(c), inserted “or because of the severity of the dental procedure,” after “and clinical status”.
Subsec. (a)(13)(C). , § 939(a), struck out “, warts,” after “corns”.
Subsec. (b). , § 953, inserted “or under an automobile or liability insurance policy or plan (including a self-insured plan) or under no fault insurance” and “, policy, plan, or insurance” after “or a State” and “, policy, plan, or insurance” after “law or plan” and inserted provision authorizing the Secretary to waive the provisions of this subsection in the case of an individual claim if he determined that the probability of recovery or amount involved did not warrant the pursuit of the claim.
Subsec. (d)(4). added par. (4).
Subsec. (e). , § 913(b), substituted provisions barring payment under this subchapter with respect to items or services furnished by a physician or other individual during a period when such physician or other individual was barred pursuant to section
of this title from participation under this subchapter for provisions authorizing the Secretary to suspend a physician or individual practitioner from participation under this subchapter upon determining that such physician or practitioner had been convicted of a criminal offense related to such physician’s or practitioner’s involvement in the programs under this subchapter or the program under subchapter XIX of this chapter.
1977—Subsec. (a)(3). substituted “except in the case of rural health clinic services, as defined in section
of this title, and in such other cases as the Secretary may specify” for “except in such cases as the Secretary may specify”.
Subsec. (d)(1)(B). , § 13(b)(1), struck out requirement for concurrence of appropriate program review team for finding of Secretary under this paragraph.
Subsec. (d)(1)(C). , § 13(b)(2), substituted provisions relating to determinations by the Secretary on the basis of reports transmitted to him in accordance with section
of this title or other data acquired in the administration of this subchapter, for provisions relating to determinations by the Secretary with the concurrence of appropriate review team members.
Subsec. (d)(4). , § 13(a), struck out par. (4) which set forth provisions relating to appointment and functions of program review teams.
Subsec. (e). , § 7(a), added subsec. (e).
1975—Subsec. (c). struck out subsec. (c) prohibiting payments to Federal employees under this subchapter unless a determination and certification by the Secretary of a modification of any health benefits plan under chapter
of Title
was made which would allow a Federal employee benefits under part A or B of this subchapter.
1974—Subsec. (c). substituted “January 1, 1976” for “January 1, 1975”.
1973—Subsec. (a)(12). substituted “the provision of such dental services if the individual, because of his underlying medical condition and clinical status, requires hospitalization in connection with the provision of such services” for “a dental procedure where the individual suffers from impairments of such severity as to require hospitalization”.
1972—Subsec. (a)(4). , § 211(c)(1), inserted reference to physicians’ services and ambulance services furnished an individual in conjunction with emergency inpatient hospital services.
Subsec. (a)(12). , § 256(c), authorized payment under part A in the case of inpatient hospital services in connection with a dental procedure where the individual suffers from impairments of such severity as to require hospitalization.
Subsec. (c). , § 210, added subsec. (c).
Subsec. (d). , § 229(a), added subsec. (d).
1968—Subsec. (a)(7). , § 128, prohibited payment for procedures performed (during the course of any eye examination) to determine the refractive state of the eyes.
Subsec. (a)(13). , § 127(b), added par. (13).
Effective Date of 2001 Amendment
, § 3(b), Dec. 27, 2001, , provided that: “The amendments made by subsection (a) [amending this section] shall apply to claims submitted on or after October 16, 2003.”
Effective Date of 2000 Amendment
Amendment by section
[title I, § 102(c)] of applicable to services furnished on or after Jan. 1, 2002, see section
[title I, § 102(d)] of , set out as a note under section
of this title.
Amendment by section
[title III, § 313(a)] of applicable to services furnished on or after Jan. 1, 2001, see section
[title III, § 313(c)] of , set out as a note under section
of this title.
Amendment by section
[title IV, § 432(b)(1)] of applicable to services furnished on or after July 1, 2001 see section
[title IV, § 432(c)] of , set out as a note under section
of this title.
Amendment by section
[title V, § 522(b)] of applicable with respect to a review of any national or local coverage determination filed, a request to make such a determination made, and a national coverage determination made, on or after Oct. 1, 2001, see section
[title V, § 522(d)] of , set out as a note under section
of this title.
Effective Date of 1999 Amendment
Amendment by section
1000
(a)(6) [title III, § 305(b)] of applicable to payments for services provided on or after Nov. 29, 1999, see § 1000(a)(6) [title III, § 305(c)] of , set out as a note under section
of this title.
Amendment by section
1000
(a)(6) [title III, § 321(k)(10)] of effective as if included in the enactment of the Balanced Budget Act of 1997, , except as otherwise provided, see section
1000
(a)(6) [title III, § 321(m)] of , set out as a note under section
of this title.
Effective Date of 1997 Amendments
Amendment by effective Apr. 30, 1997, and applicable to Federal payments made pursuant to obligations incurred after Apr. 30, 1997, for items and services provided on or after such date, subject to also being applicable with respect to contracts entered into, renewed, or extended after Apr. 30, 1997, as well as contracts entered into before Apr. 30, 1997, to the extent permitted under such contracts, see section 11 of , set out as an Effective Date note under section
of this title.
Amendment by section 4022(b)(1)(B) of effective Nov. 1, 1997, the date of termination of the Prospective Payment Assessment Commission and the Physician Payment Review Commission, see section 4022(c)(2) of , set out as an Effective Date; Transition; Transfer of Functions note under section
of this title.
Amendment by section 4102(c) of applicable to items and services furnished on or after Jan. 1, 1998, see section 4102(e) of , set out as a note under section
of this title.
Amendment by section 4103(c) of applicable to items and services furnished on or after Jan. 1, 2000, see section 4103(e) of , set out as a note under section
of this title.
Amendment by section 4104(c)(3) of applicable to items and services furnished on or after Jan. 1, 1998, see section 4104(e) of , set out as a note under section
of this title.
Amendment by section 4201(c)(1) of applicable to services furnished on or after Oct. 1, 1997, see section 4201(d) of , set out as a note under section
of this title.
Amendment by section 4432(b)(1) of applicable to items and services furnished on or after July 1, 1998, see section 4432(d) of , set out as a note under section
of this title.
Amendment by section 4507(a)(2)(B) of applicable with respect to contracts entered into on and after Jan. 1, 1998, see section 4507(c) of , set out as a note under section
of this title.
Amendment by section 4511(a)(2)(C) of applicable with respect to services furnished and supplies provided on and after Jan. 1, 1998, see section 4511(e) of , set out as a note under section
of this title.
Amendment by section 4541(b) of applicable to services furnished on or after Jan. 1, 1998, including portions of cost reporting periods occurring on or after such date, see section 4541(e) of , set out as a note under section
of this title.
Amendment by section 4603(c)(2)(C) of applicable to cost reporting periods beginning on or after Oct. 1, 1999, except as otherwise provided, see section 4603(d) of , set out as an Effective Date note under section
of this title.
Section 4614(c) of provided that: “The amendments made by this section [amending this section] apply to services furnished on or after October 1, 1997.”
Section 4632(b) of provided that: “The amendments made by this section [amending this section] apply to items and services furnished on or after the date of the enactment of this Act [Aug. 5, 1997].”
Section 4633(c) of provided that: “The amendments made by this section [amending this section] apply to items and services furnished on or after the date of the enactment of this Act [Aug. 5, 1997].”
Effective Date of 1994 Amendment
Amendment by section 145(c)(1) of applicable to mammography furnished by a facility on and after the first date that the certificate requirements of section
of this title apply to such mammography conducted by such facility, see section 145(d) of , set out as a note under section
of this title.
Amendment by section 147(e)(6) of effective as if included in the enactment of , see section 147(g) of , set out as a note under section
of this title.
Section 151(a)(2)(B) of provided that: “The amendment made by subparagraph (A) [amending this section] shall apply with respect to items and services furnished on or after the expiration of the 120-day period beginning on the date of the enactment of this Act [Oct. 31, 1994].”
Section 151(b)(3)(C) of provided that: “The amendments made by this paragraph [amending this section] shall apply to payments for items and services furnished on or after the date of the enactment of this Act [Oct. 31, 1994].”
Section 151(c)(1), (9) of provided that the amendment made by that section is effective as if included in the enactment of .
Section 151(c)(4) of provided that the amendment made by that section is effective as if included in the enactment of .
Section 151(c)(5), (6) of provided that the amendment made by that section is effective as if included in the enactment of .
Amendment by section 156(a)(2)(D) of applicable to services provided on or after Oct. 31, 1994, see section 156(a)(3) of , set out as a note under section
of this title.
Section 157(b)(8) of provided that: “The amendments made by this subsection [amending this section, section
of this title, and provisions set out as notes under section
of this title] shall take effect as if included in the enactment of OBRA–1990 [].”
Effective Date of 1993 Amendment
Section 151(c)(10) of provided that: “The amendment made by section 13561(e)(1)(G) of OBRA–1993 [, amending this section], to the extent it relates to the definition of large group health plan, shall be effective as if included in the enactment of OBRA–1989 [].”
Amendment by section 13561(d)(1) of effective 90 days after Aug. 10, 1993, see section 13561(d)(3) of , set out as a note under section
of Title
, Internal Revenue Code.
Section 13561(e)(1)(D) of , as amended by , title I, § 151(c)(9)(A), Oct. 31, 1994, , provided that the amendment made by that section is effective as if included in the enactment of .
Section 13581(d) of provided that: “The amendments made by this section [enacting section
of this title and amending this section, section
of this title, and section
of Title
, Government Organization and Employees] shall take effect on January 1, 1994.”
Effective Date of 1990 Amendment
Amendment by section 4153(b)(2)(B) of applicable to items furnished on or after Jan. 1, 1991, see section 4153(b)(2)(C) of , set out as a note under section
of this title.
Amendment by section 4157(c)(1) of applicable to services furnished on or after Jan. 1, 1991, see section 4157(d) of , set out as a note under section
of this title.
Amendment by section 4161(a)(3)(C) of applicable to services furnished on or after Oct. 1, 1991, see section 4161(a)(8) of , set out as a note under section
of this title.
Amendment by section
4163
(d)(2)(A)(i)–(iii), (B) of applicable to screening mammography performed on or after Jan. 1, 1991, see section 4163(e) of , as amended, set out as a note under section
of this title.
Section 4163(d)(3) of , as added by , title I, § 147(f)(5)(A), Oct. 31, 1994, , provided that: “The amendment made by paragraph (2)(A)(iv) [amending this section] shall apply to screening pap smears performed on or after July 1, 1990.”
Section 4204(g)(2) of provided that: “The amendment made by paragraph (1) [amending this section] shall apply to incentives offered on or after the date of the enactment of this Act [Nov. 5, 1990].”
Effective Date of 1989 Amendments
Amendment by section 6115(b) of applicable to screening pap smears performed on or after July 1, 1990, see section 6115(d) of , set out as a note under section
of this title.
Amendment by section 6202(b)(1) of applicable to items and services furnished after Dec. 19, 1989, see section 6202(b)(5) of , set out as a note under section
of Title
, Internal Revenue Code.
Section 6202(e)(2) of provided that: “The amendment made by paragraph (1) [amending this section] shall apply to items and services furnished on or after October 1, 1989.”
Amendment by effective Jan. 1, 1990, see section 201(c) of , set out as a note under section
of this title.
Effective Date of 1988 Amendments
Amendment by effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, , see section 608(g)(1) of , set out as a note under section
of this title.
Amendment by section 202(d) of applicable to items dispensed on or after Jan. 1, 1990, see section 202(m)(1) of , set out as a note under section
of this title.
Amendment by section 204(d)(2) of applicable to screening mammography performed on or after Jan. 1, 1990, see section 204(e) of , set out as a note under section
of this title.
Amendment by section 205(e)(1) of applicable to items and services furnished on or after Jan. 1, 1990, see section 205(f) of , set out as a note under section
of this title.
Except as specifically provided in section 411 of , amendment by section 411(i)(4)(D) of , as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, , effective as if included in the enactment of that provision in , see section 411(a) of , set out as a Reference to OBRA; Effective Date note under section
of Title
, General Provisions.
Section 411(f)(4)(D)(ii) of provided that: “The amendment made by clause (i) [amending this section] shall apply to operations performed on or after 60 days after the date of the enactment of this Act [July 1, 1988].”
Effective Date of 1987 Amendments
Section 4009(j)(6) of , provided that the amendment made by that section is effective as if included in the enactment of .
Section 4034(b) of provided that: “The amendment made by subsection (a) [amending this section] shall be effective as if included in the enactment of section 9319(a) of the Omnibus Budget Reconciliation Act of 1986 [].”
Section 4036(a)(2) of provided that: “The amendment made by paragraph (1) [amending this section] shall apply with respect to items and services furnished on or after 30 days after the date of the enactment of this Act [Dec. 22, 1987].”
Section 4039(c)(2) of provided that: “The amendments made by paragraph (1) [amending this section] shall become effective on January 1, 1988.”
For effective date of amendment by section 4072(c) of , see section 4072(e) of , set out as a note under section
of this title.
Amendment by effective at end of fourteen-day period beginning Aug. 18, 1987, and inapplicable to administrative proceedings commenced before end of such period, see section 15(a) of , set out as a note under section
of this title.
Effective Date of 1986 Amendments
Section 9319(f) of provided that:
“(1) Except as provided in paragraph (2), the amendments made by this section [enacting section
of Title
, Internal Revenue Code, and amending this section and sections
and
of this title] shall apply to items and services furnished on or after January 1, 1987.
“(2) The amendments made by subsection (c) [amending sections
and
of this title] shall apply to enrollments occurring on or after January 1, 1987.”
Amendment by section 9320(h)(1) of applicable to services furnished on or after Jan. 1, 1989, with exceptions for hospitals located in rural areas which meet certain requirements related to certified registered nurse anesthetists, see section 9320(i), (k) of , as amended, set out as notes under section
of this title.
Amendment by section 9343(c)(1) of applicable to services furnished after June 30, 1987, see section 9343(h)(2) of , as amended, set out as a note under section
of this title.
Section 9201(d)(1) of provided that: “The amendments made by subsection (a) [amending this section] shall apply with respect to items and services furnished on or after May 1, 1986.”
Amendment by section 9307(a) of applicable to services performed on or after Apr. 1, 1986, see section 9307(e) of , set out as a note under section
of this title.
Effective Date of 1984 Amendment
Section 2301(c)(1) of provided that: “The amendment made by subsection (a) [amending this section] shall be effective with respect to items and services furnished on or after January 1, 1985.”
Amendment by section 2304(c) of applicable to pacemaker devices and leads implanted or removed on or after the effective date of final regulations promulgated to carry out such amendment, see section 2304(d) of , set out as a note below.
Section 2313(e) of provided that: “The amendments made by this section [amending this section and section
of this title] shall become effective on the date of the enactment of this Act [July 18, 1984].”
Section 2344(d) of provided that: “The amendments made by this section [amending this section] shall apply to items and services furnished on or after the date of the enactment of this Act [July 18, 1984].”
Amendment by section 2354(b)(30), (31) of effective July 18, 1984, but not to be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date, see section 2354(e)(1) of , set out as a note under section
of this title.
Effective Date of 1983 Amendments
Amendment by section 601(f) of applicable to items and services furnished by or under arrangement with a hospital beginning with its first cost reporting period that begins on or after Oct. 1, 1983, any change in a hospital’s cost reporting period made after November 1982 to be recognized for such purposes only if the Secretary finds good cause therefor, and amendment by section 602(e)(3) of effective Oct. 1, 1983, see section 604(a)(1), (2) of , set out as a note under section
of this title.
Amendment by effective as if originally included as a part of this section as this section was amended by the Tax Equity and Fiscal Responsibility Act of 1982, , see section 309(c)(2) of , set out as a note under section
of this title.
Effective Date of 1982 Amendment
Amendment by section 116(b) of applicable with respect to items and services furnished on or after Jan. 1, 1983, see section 116(c) of , set out as a note under section
of Title
, Labor.
Amendment by section 122(f), (g)(1) of applicable to hospice care provided on or after Nov. 1, 1983, see section 122(h)(1) of , as amended, set out as a note under section
of this title.
Amendment by section
128
(a)(2)–(4) of effective as if originally included as part of this section as this section was amended by the Omnibus Budget Reconciliation Act of 1981, , see section 128(e)(2) of , set out as a note under section
of this title.
Amendment by sections 142 and 148(a) of effective with respect to contracts entered into or renewed on or after Sept. 3, 1982, see section 149 of , set out as an Effective Date note under section
of this title.
Effective Date of 1981 Amendment
Section 2103(a)(2) of provided that: “The amendment made by paragraph (1) [amending this section] shall apply with respect to expenses incurred on or after October 1, 1981.”
Section 2146(c)(1) of provided that: “The amendments made by subsection (a) [amending this section] shall become effective on October 1, 1981.”
Effective Date of 1980 Amendments
Amendment by effective July 1, 1981, and applicable to services furnished on or after that date, see section 2 of , set out as a note under section
of this title.
Amendment by section 936(c) of applicable with respect to services provided on or after July 1, 1981, see section 936(d) of , set out as a note under section
of this title.
Section 939(b) of provided that: “The amendment made by subsection (a) [amending this section] shall apply with respect to services furnished on or after July 1, 1981.”
Effective Date of 1977 Amendments
Amendment by applicable to services rendered on or after first day of third calendar month which begins after Dec. 31, 1977, see section 1(j) of , set out as a note under section
of this title.
Section 13(c) of provided that: “The amendments made by this section [amending this section and sections
and
of this title] shall take effect on the date of the enactment of this Act [Oct. 25, 1977].”
Effective Date of 1973 Amendment
Amendment by effective with respect to admissions subject to the provisions of section
of this title which occur after Dec. 31, 1973, see section
(z–3)(2) of , set out as a note under section
of this title.
Effective Date of 1972 Amendment
Amendment by section 211(c)(1) of applicable to services furnished with respect to admissions occurring after Dec. 31, 1972, see section 211(d) of , set out as a note under section
of this title.
Amendment by section 256(c) of applicable with respect to admissions occurring after the second month following the month of enactment of which was approved on Oct. 30, 1972, see section 256(d) of , set out as a note under section
of this title.
Effective Date of 1968 Amendment
Amendment by section 127(b) of applicable with respect to services furnished after Dec. 31, 1967, see section 127(c) of , set out as a note under section
of this title.
Notification to Physicians of Excessive Home Health Visits
Section 4614(b) of provided that: “The Secretary of Health and Human Services may establish a process for notifying a physician in cases in which the number of home health visits, furnished under title XVIII of the Social Security Act [this subchapter] pursuant to a prescription or certification of the physician, significantly exceeds such threshold (or thresholds) as the Secretary specifies. The Secretary may adjust such threshold to reflect demonstrated differences in the need for home health services among different beneficiaries.”
Distribution of Questionnaire by Contractor
Section 151(a)(1)(B) of provided that: “The Secretary of Health and Human Services shall enter into an agreement with an entity not later than 60 days after the date of the enactment of the Social Security Act Amendments of 1994 [Oct. 31, 1994], to distribute the questionnaire described in section 1862(b)(5)(D) of the Social Security Act [subsec. (b)(5)(D) of this section] (as added by subparagraph (A)).”
Retroactive Exemption for Certain Situations Involving Religious Orders
Section 13561(f) of provided that: “Section 1862(b)(1)(D) of the Social Security Act [subsec. (b)(1)(D) of this section] applies, with respect to items and services furnished before October 1, 1989, to any claims that the Secretary of Health and Human Services had not identified as of that date as subject to the provisions of section 1862(b) of such Act.”
GAO Study of Extension of Secondary Payer Period
Section 4203(c)(2) of , as amended by , title I, § 151(c)(7), Oct. 31, 1994, , directed Comptroller General to conduct study of impact of second sentence of subsec. (b)(1)(C) of this section and to submit preliminary report to Congress not later than Jan. 1, 1993, and final report not later than Jan. 1, 1995.
Deadline for First Transmittal and Request of Matching Information
Section 6202(a)(2)(B) of provided that: “The Commissioner of Social Security shall first—
“(i) transmit to the Secretary of the Treasury information under paragraph (5)(A)(i) of section 1862(b) of the Social Security Act [subsec. (b)(5)(A)(i) of this section] (as inserted by subparagraph (A)), and
“(ii) request from the Secretary disclosure of information described in section 6013(l)(12)(A) of the Internal Revenue Code of 1986 [ U.S.C.
],
by not later than 14 days after the date of the enactment of this Act [Dec. 19, 1989].”
Designation of Pediatric Hospitals as Meeting Certification as Heart Transplant Facility
Section 4009(b) of provided that: “For purposes of determining whether a pediatric hospital that performs pediatric heart transplants meets the criteria established by the Secretary of Health and Human Services for facilities in which the heart transplants performed will be considered to meet the requirement of section 1862(a)(1)(A) of the Social Security Act [subsec. (a)(1)(A) of this section], the Secretary shall treat such a hospital as meeting such criteria if—
“(1) the hospital’s pediatric heart transplant program is operated jointly by the hospital and another facility that meets such criteria,
“(2) the unified program shares the same transplant surgeons and quality assurance program (including oversight committee, patient protocol, and patient selection criteria), and
“(3) the hospital demonstrates to the satisfaction of the Secretary that it is able to provide the specialized facilities, services, and personnel that are required by pediatric heart transplant patients.”
Approval of Surgical Assistants for Procedures Performed April 1, 1986, to December 15, 1986
Section 1895(b)(16)(C) of provided that: “For purposes of section 1862(a)(15) of the Social Security Act ( U.S.C.
), added by section 9307(a)(3) of COBRA, and for surgical procedures performed during the period beginning on April 1, 1986, and ending on December 15, 1986, a carrier is deemed to have approved the use of an assistant in a surgical procedure, before the surgery is performed, based on the existence of a complicating medical condition if the carrier determines after the surgery is performed that the use of the assistant in the procedure was appropriate based on the existence of a complicating medical condition before or during the surgery.”
Extending Waiver of Liability Provisions to Hospice Programs
Section 9305(f) of , as amended by , title IV, § 426(a), July 1, 1988, ; , title IV, § 4008(a)(2), Nov. 5, 1990, , provided that:
“(1) In general.—The Secretary of Health and Human Services shall, for purposes of determining whether payments to a hospice program should be denied pursuant to section 1862(a)(1)(C) of the Social Security Act [subsec. (a)(1)(C) of this section], apply (under section 1879(a) of such Act [section
of this title]) a presumption of compliance of 2.5 percent (based on the number of days of hospice care billed) in a manner substantially similar to that provided to home health agencies under policies in effect as of July 1, 1985.
“(2) Effective date.—Paragraph (1) shall apply to hospice care furnished on or after the first day of the first month that begins at least 6 months after the date of the enactment of this Act [Oct. 21, 1986] and before December 31, 1995.”
[Section 4008(a)(3) of provided that: “The amendments made by paragraphs (1) and (2) [amending section 9305(f) of , set out above, and section 9126(c) of , set out below] shall take effect on the date of the enactment of this Act [Nov. 5, 1990].”]
Study of Impact on Disabled Beneficiaries and Family of Amendments Relating to Large Group Health Plans and Medicare as Secondary Payer
Section 9319(e) of directed Comptroller General to study and report to Congress, not later than Mar. 1, 1990, the impact of the amendments made by this section (enacting section
of Title
, Internal Revenue Code, and amending this section and sections
and
of this title) on access of disabled individuals and members of their family to employment and health insurance, such report to include information relating to number of disabled medicare beneficiaries for whom medicare has become secondary, either through their employment or the employment of a family member, amount of savings to the medicare program achieved annually through this provision, and effect on employment, and employment-based health coverage, of disabled individuals and family members.
Reinstatement of Waiver of Liability Presumption
Section 9126(c) of , as amended by , title IV, § 426(b), July 1, 1988, ; , title IV, § 4008(a)(1), Nov. 5, 1990, , provided that: “The Secretary of Health and Human Services shall, for purposes of determining whether payments to a skilled nursing facility should be denied pursuant to section 1862(a)(1)(A) of the Social Security Act [subsec. (a)(1)(A) of this section], apply the same presumption of compliance (5 percent) as in effect under regulations as of July 1, 1985. Such presumption shall apply for the period beginning with the first month beginning after the date of the enactment of this Act [Apr. 7, 1986] and ending on December 31, 1995.”
Home Health Waiver of Liability
Section 9205 of , as amended by , title IV, § 426(d), July 1, 1988, ; , title I, § 158(b)(1), Oct. 31, 1994, , provided that: “The Secretary of Health and Human Services shall, for purposes of determining whether payments to a home health agency should be denied pursuant to section 1862(a)(1)(A) of the Social Security Act [subsec. (a)(1)(A) of this section], apply a presumption of compliance (2.5 percent) in the same manner as under the regulations in effect as of July 1, 1985. Such presumption shall apply until December 31, 1995.”
[Section 158(b)(2) of provided that: “The amendment made by paragraph (1) [amending section 9205 of , set out above] shall take effect as if included in the enactment of OBRA–1990 [].”]
Recommendations and Guidelines for Elimination of Assistants at Surgery; Report to Congress
Section 9307(d) of provided that the Secretary of Health and Human Services, after consultation with the Physician Payment Review Commission, develop recommendations and guidelines respecting other surgical procedures for which an assistant at surgery was generally not medically necessary and circumstances under which use of an assistant at surgery was generally appropriate but should be subject to prior approval of an appropriate entity and that the Secretary report to Congress, not later than January 1, 1987, on these recommendations and guidelines.
Pacemaker Reimbursement Review and Reform; Promulgation of Regulations; Effective Date of Pacemaker Registration
Section 2304(d) of provided that: “The Secretary of Health and Human Services shall promulgate final regulations to carry out this section and the amendment made by this section [amending this section and enacting provisions set out as a note under section
of this title] prior to January 1, 1985, and the amendment made by subsection (c) [amending this section] shall apply to pacemaker devices and leads implanted or removed on or after the effective date of such regulations.”
Payment for Debridement of Mycotic Toenails
Section 2325 of provided that: “The Secretary shall provide, pursuant to section 1862(a) of the Social Security Act [subsec. (a) of this section], that payment will not be made under part B of title XVIII of such Act [part B of this subchapter] for a physician’s debridement of mycotic toenails to the extent such debridement is performed for a patient more frequently than once every 60 days, unless the medical necessity for more frequent treatment is documented by the billing physician.”
Interim Waiver in Certain Cases of Billing Rule for Items and Services Other Than Physicians’ Services
Section 602(k) of , as amended by , title IX, § 9112(a), Apr. 7, 1986, , provided that:
“(1) The Secretary of Health and Human Services may, for any cost reporting period beginning prior to October 1, 1986, waive the requirements of sections 1862(a)(14) and 1866(a)(1)(H) of the Social Security Act [subsec. (a)(14) of this section and section
of this title] in the case of a hospital which has followed a practice, since prior to October 1, 1982, of allowing direct billing under part B of title XVIII of such Act [part B of this subchapter] for services (other than physicians’ services) so extensively, that immediate compliance with those requirements would threaten the stability of patient care. Any such waiver shall provide that such billing may continue to be made under part B of such title but that the payments to such hospital under part A of such title [part A of this subchapter] shall be reduced by the amount of the billings for such services under part B of such title. If such a waiver is granted, at the end of the waiver period the Secretary may provide for such methods of payments under part A as is appropriate, given the organizational structure of the institution.
“(2) In the case of a hospital which is receiving payments pursuant to a waiver under paragraph (1), payment of the adjustment for indirect costs of approved educational activities shall be made as if the hospital were receiving under part A of title XVIII of the Social Security Act all the payments which are made under part B of such title solely by reason of such waiver.
“(3) Any waiver granted under paragraph (1) shall provide that, with respect to those items and services billed under part B of title XVIII of the Social Security Act solely by reason of such waiver—
“(A) payment under such part shall be equal to 100 percent of the reasonable charge or other applicable payment base for the items and services; and
“(B) the entity furnishing the items and services must agree to accept the amount paid pursuant to subparagraph (A) as the full charge for the items and services.”
[Section 9112(b) of provided that:
[“(1) Section 602(k)(2) of the Social Security Amendments of 1983 (as added by subsection (a)) [set out above] shall apply to cost reporting periods beginning on or after January 1, 1986.
[“(2) Section 602(k)(3) of the Social Security Amendments of 1983 (as added by subsection (a)) [set out above] shall apply to items and services furnished after the end of the 10-day period beginning on the date of the enactment of this Act [Apr. 7, 1986].”]
Prohibition of Payment for Ineffective Drugs
Section 115(b) of provided that: “No provision of law limiting the use of funds for purposes of enforcing or implementing section
[subsec. (c) of this section] or section
[section
of this title] of the Social Security Act, section 2103 of the Omnibus Budget Reconciliation Act of 1981 [section 2103 of , amending sections
and
of this title and enacting provisions set out as notes under sections
and
of this title], or any rule or regulation issued pursuant to any such section (including any provision contained in, or incorporated by reference into, any appropriation Act or resolution making continuing appropriations) shall apply to any period after September 30, 1982, unless such provision of law is enacted after the date of the enactment of this Act [Sept. 3, 1982] and specifically states that such provision is to supersede this section.”
Establishment and Implementation of Guidelines
Section 2152(b) of directed the Secretary of Health and Human Services to establish, and provide for the implementation of, the guidelines described in subsec. (f) of this section not later than Oct. 1, 1981.
Report to Congressional Committees on Implementation of Certification Requirements Relating to Modification of Health Benefits Plan or Program; Failure To Submit Report
Section 4(b) of provided that the Civil Service Commission and the Secretary of Health, Education, and Welfare submit a report on or before Mar. 1, 1975, on the steps which have been taken, and the steps which are planned, to enable the Secretary to make the determination and certification referred to in former subsec. (c) of this section and that if such report is not submitted by Mar. 1, 1975, the date specified in former subsec. (c) shall be deemed to be July 1, 1975, rather than Jan. 1, 1976.
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