CHAPTER 7-SOCIAL SECURITY
SUBCHAPTER I-GRANTS TO STATES FOR OLD-AGE ASSISTANCE
(a)
Contents.
(b)
Approval by Secretary.
(c)
Limitation on number of plans.
(a)
Computation of amounts.
(b)
Method of computing and paying amounts.
SUBCHAPTER II-FEDERAL OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE BENEFITS
(a)
Federal Old-Age and Survivors Insurance Trust Fund.
(b)
Federal Disability Insurance Trust Fund.
(c)
Board of Trustees; duties; reports to Congress.
(d)
Investments.
(e)
Sale of acquired obligations.
(f)
Proceeds from sale or redemption of obligations; interest.
(g)
Payments into Treasury.
(h)
Benefit payments.
(i)
Gifts and bequests.
(j)
Travel expenses.
(k)
Experiment and demonstration project expenditures.
(l)
Interfund borrowing.
(m)
Accounting for unnegotiated benefit checks.
(a)
Old-age insurance benefits.
(b)
Wife's insurance benefits.
(c)
Husband's insurance benefits.
(d)
Child's insurance benefits.
(e)
Widow's insurance benefits.
(f)
Widower's insurance benefits.
(g)
Mother's and father's insurance benefits.
(h)
Parent's insurance benefits.
(i)
Lump-sum death payments.
(j)
Application for monthly insurance benefits.
(k)
Simultaneous entitlement to benefits.
(l)
Entitlement to survivor benefits under railroad retirement provisions.
(m)
Repealed.
(n)
Termination of benefits upon deportation of primary beneficiary.
(o)
Application for benefits by survivors of members and former members of uniformed services.
(p)
Extension of period for filing proof of support and applications for lump-sum death payment.
(q)
Reduction of benefit amounts for certain beneficiaries.
(r)
Presumed filing of application by individuals eligible for old-age insurance benefits and for wife's or husband's insurance benefits.
(s)
Child over specified age to be disregarded for certain benefit purposes unless disabled.
(t)
Suspension of benefits of aliens who are outside United States; residency requirements for dependents and survivors.
(u)
Conviction of subversive activities, etc.
(v)
Waiver of benefits.
(w)
Increase in old-age insurance benefit amounts on account of delayed retirement.
(x)
Limitation on payments to prisoners and certain other inmates of publicly funded institutions.
(y)
Limitation on payments to aliens.
(a)
Maximum benefits.
(b)
Deductions on account of work.
(c)
Deductions on account of noncovered work outside United States or failure to have child in care.
(d)
Deductions from dependent's benefits on account of noncovered work outside United States by old-age insurance beneficiary.
(e)
Occurrence of more than one event.
(f)
Months to which earnings are charged.
(g)
Penalty for failure to report certain events.
(h)
Report of earnings to Commissioner.
(i)
Repealed.
(j)
Attainment of age seventy.
(k)
Noncovered remunerative activity outside United States.
(l)
Good cause for failure to make reports required.
(a)
Procedure for adjustment or recovery.
(b)
No recovery from persons without fault.
(c)
Nonliability of certifying and disbursing officers.
(d)
Payment to survivors or heirs when eligible person is deceased.
(e)
Adjustments due to supplemental security income payments.
(f)
Collection of delinquent amounts.
(g)
Recovery of overpayment of supplemental security income benefits.
(a)
Rules and regulations; procedures.
(b)
Administrative determination of entitlement to benefits; findings of fact; hearings; investigations; evidentiary hearings in reconsiderations of disability benefit terminations; subsequent applications.
(c)
Wage records.
(d)
Issuance of subpenas in administrative proceedings.
(e)
Judicial enforcement of subpenas; contempt.
(f)
Repealed.
(g)
Judicial review.
(h)
Finality of Commissioner's decision.
(i)
Certification for payment.
(j)
Representative payees.
(k)
Payments to incompetents.
(l)
Delegation of powers and duties by Commissioner.
(m)
Repealed.
(n)
Joint payments.
(o)
Crediting of compensation under Railroad Retirement Act.
(p)
Special rules in case of Federal service.
(q)
Expedited benefit payments.
(r)
Use of death certificates to correct program information.
(s)
Notice requirements.
(t)
Same-day personal interviews at field offices in cases where time is of essence.
(u)
Redetermination of entitlement.
(a)
Recognition of representatives; fees for representation before Commissioner.
(b)
Fees for representation before court.
(c)
Notification of options for obtaining attorneys.
(d)
Assessment on attorneys.
(a)
In general.
(b)
Amendment of section.
(c)
Withholding of taxes.
(a)
In general.
(b)
Violations by certified payees.
(c)
Effect upon certification as payee; definitions.
(d)
Application of subsection (a)(6) and (7) to certain aliens.
(a)
In general.
(b)
Regulations providing exclusions from term.
(c)
Individuals performing domestic services.
(d)
Members of uniformed services.
(e)
Peace Corps volunteers.
(f)
Tips.
(g)
Members of religious orders.
(h)
Retired justices and judges.
(i)
Employer contributions under sections 401(k) and 414(h)(2) of Internal Revenue Code.
(j)
Amounts deferred under nonqualified deferred compensation plans.
(k)
"National average wage index" and "deferred compensation amount" defined.
(a)
Employment.
(b)
Included and excluded service.
(c)
American vessel.
(d)
American aircraft.
(e)
American employer.
(f)
Agricultural labor.
(g)
Farm.
(h)
State.
(i)
United States.
(j)
Employee.
(k)
Covered transportation service.
(l)
Service in uniformed services.
(m)
Member of a uniformed service.
(n)
Crew leader.
(o)
Peace Corps volunteer service.
(p)
Medicare qualified government employment.
(q)
Treatment of real estate agents and direct sellers.
(r)
Service in employ of international organizations by certain transferred Federal employees.
(a)
Net earnings from self-employment.
(b)
Self-employment income.
(c)
Trade or business.
(d)
Partnership and partner.
(e)
Taxable year.
(f)
Partner's taxable year ending as result of death.
(g)
Regular basis.
(h)
Option dealers and commodity dealers.
(i)
Church employee income.
(j)
Codification of treatment of certain termination payments received by former insurance salesmen.
(a)
Definitions.
(b)
Crediting of wages paid in 1937.
(c)
Alternative method for determining quarters of coverage with respect to wages in period from 1937 to 1950.
(d)
Amount required for a quarter of coverage.
(a)
"Fully insured individual" defined.
(b)
"Currently insured individual" defined.
(a)
Primary insurance amount.
(b)
Average indexed monthly earnings; average monthly wage.
(c)
Application of prior provisions in certain cases.
(d)
Primary insurance amount under 1939 Act.
(e)
Certain wages and self-employment income not to be counted.
(f)
Recomputation of benefits.
(g)
Rounding of benefits.
(h)
Service of certain Public Health Service Officers.
(i)
Cost-of-living increases in benefits.
(a)
Spouse; surviving spouse.
(b)
Wife.
(c)
Widow.
(d)
Divorced spouses; divorce.
(e)
Child.
(f)
Husband.
(g)
Widower.
(h)
Determination of family status.
(i)
Disability; period of disability.
(j)
Periods of limitation ending on nonwork days.
(k)
Waiver of nine-month requirement for widow, stepchild, or widower in case of accidental death or in case of serviceman dying in line of duty, or in case of remarriage to same individual.
(l)
Retirement age.
(a)
Determination of benefits.
(b)
Determination of insurance status.
(c)
Filing proof of support.
(d)
Definitions.
(e)
Determination based on wages and self-employment.
(f)
Right to annuity; waiver.
(g)
Appropriation to trust funds.
(h)
Determination of veterans status.
(a)
Purpose of agreement.
(b)
Definitions.
(c)
Services covered.
(d)
Positions covered by retirement systems.
(e)
Effective date of agreement; retroactive coverage.
(f)
Duration of agreement.
(g)
Instrumentalities of two or more States.
(h)
Delegation of functions.
(i)
Wisconsin Retirement Fund.
(j)
Certain positions no longer covered by retirement systems.
(k)
Certain employees of State of Utah.
(l)
Policemen and firemen in certain States.
(m)
Positions compensated solely on a fee basis.
(n)
Optional medicare coverage of current employees.
(a)
State agencies.
(b)
Determinations by Commissioner.
(c)
Review of determination by Commissioner.
(d)
Hearings and judicial review.
(e)
State's right to cost from Trust Funds.
(f)
Use of funds.
(g)
Regulations governing determinations in certain cases.
(h)
Evaluation of mental impairments by qualified medical professionals.
(i)
Review of disability cases to determine continuing eligibility; permanent disability cases; appropriate number of cases reviewed; reporting requirements.
(j)
Rules and regulations; consultative examinations.
(k)
Establishment of uniform standards for determination of disability.
(l)
Special notice to blind individuals with respect to hearings and other official actions.
(m)
Work activity as basis for review.
(a), (b)
Repealed.
(c)
"Period of trial work" defined.
(d)
Cost of rehabilitation services from trust funds.
(e)
Treatment referrals for individuals with alcoholism or drug addiction condition.
(a)
Disability insurance benefits.
(b)
Filing application.
(c)
Definitions; insured status; waiting period.
(d)
"Disability" defined.
(e)
Engaging in substantial gainful activity.
(f)
Standard of review for termination of disability benefits.
(g)
Continued payment of disability benefits during appeal.
(h)
Interim benefits in cases of delayed final decisions.
(i)
Reinstatement of entitlement.
(j)
Limitation on payments to prisoners.
(a)
Conditions for reduction; computation.
(b)
Reduction where benefits payable on other than monthly basis.
(c)
Reductions and deductions under other provisions.
(d)
Exception.
(e)
Conditions for payment.
(f)
Redetermination of reduction.
(g)
Proportionate reduction; application of excess.
(h)
Furnishing of information.
(a)
Suspension of benefits.
(b)
Continued payments during rehabilitation program.
(a)
Individuals over 65 years.
(b)
Individuals under 65 years.
(c)
Conditions.
(d)
"Qualified railroad retirement beneficiary" defined.
(e)
Benefits for widows and widowers.
(f)
Medicare waiting period for recipients of disability benefits.
(g)
Information regarding eligibility of Federal employees.
(h)
Certain uninsured individuals.
(i)
Continuing eligibility of certain terminated individuals.
(a)
Entitlement to benefits.
(b)
Duration of period of entitlement.
(c)
Individuals participating in self-care dialysis training programs; kidney transplant failures; resumption of previously terminated regular course of dialysis.
(c)
Continuing eligibility of certain terminated individuals.
(a)
Entitlement to benefits.
(b)
Persons ineligible.
(c)
Authorization of appropriations.
(a)
Determination of entitlement to benefits under section 402(a) to (c) of this title.
(b)
Determination of entitlement to surviving spouse's benefits under section 402(e) or (f) of this title.
(c)
Deceased individual entitled to benefits by reason of subsection (a) deemed to meet requirements of subsection (b).
(a)
Eligibility.
(b)
Amount of benefits.
(c)
Reduction for government pension system benefits.
(d)
Suspension for months in which cash payments are made under public assistance or in which supplemental security income benefits are payable.
(e)
Suspension where individual is residing outside United States.
(f)
Treatment as monthly insurance benefits.
(g)
Annual reimbursement of Federal Old-Age and Survivors Insurance Trust Fund.
(h)
Definitions.
(a)
Determination and publication by Commissioner in Federal Register subsequent to cost-of-living benefit increase; effective date.
(b)
Determination of amount.
(c)
Amount of base for period prior to initial cost-of-living benefit increase.
(d)
Determinations for calendar years after 1976 for purposes of retirement benefit plans.
(a)
"Internee" defined.
(b)
Applicability in determining entitlement to and amount of monthly benefits and lump-sum death payments, and period of disability; effect of payment of benefits by other agency or instrumentality of United States.
(c)
Authorization of appropriations.
(a)
Purpose of agreement.
(b)
Definitions.
(c)
Crediting periods of coverage; conditions of payment of benefits.
(d)
Regulations.
(e)
Reports to Congress; effective date of agreements.
(a)
Authority.
(b)
Requirements.
(c)
Authority to waive compliance with benefits requirements.
(d)
Reports.
SUBCHAPTER III-GRANTS TO STATES FOR UNEMPLOYMENT COMPENSATION ADMINISTRATION
(a)
Certification of amounts.
(b)
Payment of amounts.
(c)
Mailing costs.
(a)
Provisions required.
(b)
Failure to comply; payments stopped.
(c)
Denial of certification; availability of records to Railroad Retirement Board; cooperation with Federal agencies.
(d)
Disclosure of unemployment compensation information; deduction and withholding of amounts owed to State food stamp agencies; reimbursement of administrative costs; non-compliance of State agency.
(e)
Disclosure of wage information; non-compliance of State agency.
(f)
Income and eligibility verification system.
(g)
Recovery of unemployment benefit payments.
(h)
Disclosure to Secretary of Health and Human Services of wage and unemployment compensation claims information; suspension by Secretary of Labor of payments to State for noncompliance.
(i)
Access to State employment records.
(j)
Worker profiling.
(a)
Finding by Secretary of Labor; petition for review; filing of record.
(b)
Findings of fact by Secretary of Labor; new or modified findings.
(c)
Affirmance or setting aside of Secretary's action; review by Supreme Court.
(d)
Stay of Secretary's action.
SUBCHAPTER IV-GRANTS TO STATES FOR AID AND SERVICES TO NEEDY FAMILIES WITH CHILDREN AND FOR CHILD-WELFARE SERVICES
Part A-Block Grants to States for Temporary Assistance for Needy Families
(a)
In general.
(b)
No individual entitlement.
(a)
In general.
(b)
Plan amendments.
(c)
Public availability of State plan summary.
(a)
Grants.
(b)
Contingency Fund.
(a)
General rules.
(b)
Limitation on use of grant for administrative purposes.
(c)
Authority to treat interstate immigrants under rules of former State.
(d)
Authority to use portion of grant for other purposes.
(e)
Authority to reserve certain amounts for assistance.
(f)
Authority to operate employment placement program.
(g)
Implementation of electronic benefit transfer system.
(h)
Use of funds for individual development accounts.
(i)
Sanction welfare recipients for failing to ensure that minor dependent children attend school.
(j)
Requirement for high school diploma or equivalent.
(k)
Limitations on use of grant for matching under certain Federal transportation program.
(a)
In general.
(b)
Religious organizations.
(c)
Nondiscrimination against religious organizations.
(d)
Religious character and freedom.
(e)
Rights of beneficiaries of assistance.
(f)
Employment practices.
(g)
Nondiscrimination against beneficiaries.
(h)
Fiscal accountability.
(i)
Compliance.
(j)
Limitations on use of funds for certain purposes.
(k)
Preemption.
(a)
Quarterly.
(b)
Notification.
(c)
Computation and certification of payments to States.
(d)
Payment method.
(a)
Loan authority.
(b)
Rate of interest.
(c)
Use of loan.
(d)
Limitation on total amount of loans to State.
(e)
Limitation on total amount of outstanding loans.
(f)
Appropriation.
(a)
Participation rate requirements.
(b)
Calculation of participation rates.
(c)
Engaged in work.
(d)
"Work activities" defined.
(e)
Penalties against individuals.
(f)
Nondisplacement in work activities.
(g)
Sense of Congress.
(h)
Sense of Congress that States should impose certain requirements on noncustodial, nonsupporting minor parents.
(i)
Review of implementation of State work programs.
(a)
In general.
(b)
Individual responsibility plans.
(c)
Sanctions against recipients not considered wage reductions.
(d)
Nondiscrimination provisions.
(e)
Special rules relating to treatment of certain aliens.
(f)
Special rules relating to treatment of non-213A aliens.
(g)
State required to provide certain information.
(a)
In general.
(b)
Welfare or public assistance programs for which Federal funds are appropriated.
(a)
In general.
(b)
Reasonable cause exception.
(c)
Corrective compliance plan.
(d)
Limitation on amount of penalties.
(a)
In general.
(b)
Administrative review.
(c)
Judicial review of adverse decision.
(a)
Quarterly reports by States.
(b)
Annual reports to Congress by Secretary.
(a)
Grants for Indian tribes.
(b)
3-year tribal family assistance plan.
(c)
Minimum work participation requirements and time limits.
(d)
Emergency assistance.
(e)
Accountability.
(f)
Eligibility for Federal loans.
(g)
Penalties.
(h)
Data collection and reporting.
(i)
Special rule for Indian tribes in Alaska.
(a)
Research.
(b)
Development and evaluation of innovative approaches to reducing welfare dependency and increasing child well-being.
(c)
Dissemination of information.
(d)
Annual ranking of States and review of most and least successful work programs.
(e)
Annual ranking of States and review of issues relating to out-of-wedlock births.
(f)
State-initiated evaluations.
(g)
Report on circumstances of certain children and families.
(h)
Funding of studies and demonstrations.
(i)
Child poverty rates.
(j)
Evaluation of welfare-to-work programs.
(a)
In general.
(b)
Appropriation.
(a)
Continuation of waivers.
(b)
State option to terminate waiver.
(c)
Secretarial encouragement of current waivers.
(d)
Continuation of individual waivers.
(a)
General child care entitlement.
(b)
Use of funds.
(c)
Application of Child Care and Development Block Grant Act of 1990.
(d)
"State" defined.
Part B-Child and Family Services
subpart 1-child welfare services
(a)
Allotment formula.
(b)
Allotment percentage.
(c)
Promulgation of allotment percentage.
(d)
"United States" defined.
(a)
Joint development.
(b)
Requisite features of State plans.
(a)
Payment schedule.
(b)
Computation and method of payment.
(c)
Prohibited payments; exceptions.
(d)
Minimum State expenditures.
(a)
In general.
(b)
Exception relating to foster child protections.
(a)
Authorization of appropriations.
(b)
Appropriations for demonstration projects for development of alternate care arrangements for infants not requiring hospitalization.
(c)
Payments; advances or reimbursements; installments; conditions.
(a)
Amounts.
(b)
Inclusion in State allotment.
(c)
"Indian tribe" and "tribal organization" defined.
(a)
In general.
(b)
Requirements.
(c)
Preferred contents.
(d)
Reports.
(e)
Appropriation.
subpart 2-promoting safe and stable families
(a)
Purposes; limitations on authorization of appropriations.
(b)
Description of amounts.
(c)
Inflation percentage.
(d)
Reservation of certain amounts.
(a)
In general.
(b)
Other terms.
(a)
Plan requirements.
(b)
Approval of plans.
(a)
Indian tribes.
(b)
Territories.
(c)
Other States.
(a)
Entitlement.
(b)
Prohibitions.
(c)
Direct payments to tribal organizations of Indian tribes.
(a)
Evaluations.
(b)
Coordination of evaluations.
Part C-Work Incentive Program for Recipients of Aid Under State Plan Approved Under Part A
Part D-Child Support and Establishment of Paternity
(a)
Establishment of separate organizational unit; duties.
(b)
Certification of child support obligations to Secretary of the Treasury for collection.
(c)
Payment of child support collections to States.
(d)
Child support management information system.
(e)
Technical assistance to States.
(f)
Regulations.
(g)
Performance standards for State paternity establishment programs.
(h)
Prompt State response to requests for child support assistance.
(i)
Prompt State distribution of amounts collected as child support.
(j)
Training of Federal and State staff, research and demonstration programs, and special projects of regional or national significance.
(k)
Denial of passports for nonpayment of child support.
(l)
Facilitation of agreements between State agencies and financial institutions.
(a)
Establishment; purpose.
(b)
Disclosure of information to authorized persons.
(c)
"Authorized person" defined.
(d)
Form and manner of request for information.
(e)
Compliance with request; search of files and records by head of any department, etc., of United States; transmittal of information to Secretary; reimbursement for cost of search; fees.
(f)
Arrangements and cooperation with State agencies.
(g)
Reimbursement for reports by State agencies.
(h)
Federal Case Registry of Child Support Orders.
(i)
National Directory of New Hires.
(j)
Information comparisons and other disclosures.
(k)
Fees.
(l)
Restriction on disclosure and use.
(m)
Information integrity and security.
(n)
Federal Government reporting.
(o)
Use of set-aside funds.
(p)
"Support order" defined.
(a)
Establishment.
(b)
Employer information.
(c)
Reporting format and method.
(d)
Civil money penalties on noncomplying employers.
(e)
Entry of employer information.
(f)
Information comparisons.
(g)
Transmission of information.
(h)
Other uses of new hire information.
(a)
In general.
(b)
Program management.
(c)
Calculation of performance indicators.
(d)
Information integrity and security.
(e)
State case registry.
(f)
Information comparisons and other disclosures of information.
(g)
Collection and distribution of support payments.
(h)
Expedited administrative procedures.
(a)
State disbursement unit.
(b)
Required procedures.
(c)
Timing of disbursements.
(d)
"Business day" defined.
(a)
Amounts payable each quarter.
(b)
Estimate of amounts payable; installment payments.
(c)
Repealed.
(d)
State reports.
(e)
Special project grants for interstate enforcement; appropriations.
(b)
Direct Federal funding to Indian tribes and tribal organizations.
(a)
Collection processes.
(b)
Nondischargeability.
(a)
In general.
(b)
Continuation of assignments.
(c)
Definitions.
(d)
Hold harmless provision.
(e)
Gap payments not subject to distribution under this section.
(f)
Amounts collected for child for whom foster care maintenance payments are made.
(a)
Purpose; requirement; quarterly payments.
(b)
Incentive formula.
(c)
Increase in percentage; laboratory costs.
(d)
Support collected on behalf of individuals residing in another State.
(e)
Estimates by Secretary; quarterly payments.
(a)
In general.
(b)
Amount of incentive payment.
(c)
Treatment of interstate collections.
(d)
Administrative provisions.
(e)
Regulations.
(f)
Reinvestment.
(a)
Consent to support enforcement.
(b)
Consent to requirements applicable to private person.
(c)
Designation of agent; response to notice or process.
(d)
Priority of claims.
(e)
No requirement to vary pay cycles.
(f)
Relief from liability.
(g)
Regulations.
(h)
Moneys subject to process.
(i)
Definitions.
(a)
Authority for declarations.
(b)
Standards for foreign support enforcement procedures.
(c)
Designation of United States Central Authority.
(d)
Effect on other laws.
(a)
Agreements with States for use of Federal Parent Locator Service.
(b)
Requests from authorized persons for information.
(c)
Information which may be disclosed.
(d)
"Custody or visitation determination" and "authorized person" defined.
(e)
Agreement on use of Federal Parent Locator Service with United States Central Authority under Convention on the Civil Aspects of International Child Abduction.
(f)
Agreement to assist in locating missing children under Federal Parent Locator Service.
(a)
Procedures applicable; distribution.
(b)
Regulations; contents, etc.
(c)
"Past-due support" defined.
(a)
Mandatory allotment; notice upon failure to make; amount of allotment; adjustment or discontinuance; consultation.
(b)
"Authorized person" defined.
(c)
Regulations.
(a)
Types of procedures required.
(b)
Withholding from income of amounts payable as support.
(c)
Expedited procedures.
(d)
Exemption of States.
(e)
"Overdue support" defined.
(f)
Uniform Interstate Family Support Act.
(g)
Laws voiding fraudulent transfers.
(a)
Establishment of guidelines; method.
(b)
Availability of guidelines; rebuttable presumption.
(c)
Technical assistance to States; State to furnish Secretary with copies.
(a)
In general.
(b)
Types of services.
(c)
Types of service recipients.
(d)
Rule of interpretation.
(a)
In general.
(b)
Prohibition of disclosure of financial record obtained by State child support enforcement agency.
(c)
Civil damages for unauthorized disclosure.
(d)
Definitions.
(a)
In general.
(b)
Amount of grant.
(c)
Allotments to States.
(d)
No supplantation of State expenditures for similar activities.
(e)
State administration.
Part E-Federal Payments for Foster Care and Adoption Assistance
(a)
Requisite features of State plan.
(b)
Approval of plan by Secretary.
(a)
Qualifying children.
(b)
Additional qualifications.
(c)
"Foster family home" and "child-care institution" defined.
(d)
Children removed from their homes pursuant to voluntary placement agreements.
(e)
Placements in best interest of child.
(f)
"Voluntary placement" and "voluntary placement agreement" defined.
(g)
Revocation of voluntary placement agreement.
(h)
Aid for dependent children; assistance for minor children in needy families.
(a)
Agreements with adoptive parents of children with special needs; State payments; qualifying children; amount of payments; changes in circumstances; placement period prior to adoption; nonrecurring adoption expenses.
(b)
Aid for dependent children; assistance for minor children in needy families.
(c)
Children with special needs.
(a)
Grant authority.
(b)
Incentive-eligible State.
(c)
Data requirements.
(d)
Adoption incentive payment.
(e)
2-year availability of incentive payments.
(f)
Limitations on use of incentive payments.
(g)
Definitions.
(h)
Limitations on authorization of appropriations.
(i)
Technical assistance.
(j)
Supplemental grants.
(a)
Amounts.
(b)
Quarterly estimates of State's entitlement for next quarter; payments; United States' pro rata share of amounts recovered as overpayment; allowance, disallowance, or deferral of claim.
(c)
Automated data collection expenditures.
(d)
Reduction for violation of plan requirement.
(a)
Technical assistance to States.
(b)
Data collection and evaluation.
(a)
Purpose.
(b)
Applications.
(c)
Allotments to States.
(d)
Use of funds.
(e)
Penalties.
(f)
Data collection and performance measurement.
(g)
Evaluations.
(h)
Limitations on authorization of appropriations.
(a)
Advisory Committee on Adoption and Foster Care Information.
(b)
Report to Congress; regulations.
(c)
Data collection system.
Part F-Job Opportunities and Basic Skills Training Program
SUBCHAPTER V-MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT
(a)
Special projects.
(b)
Excess funds; preference.
(c)
Allotments to States.
(d)
Re-allotment of unallotted funds.
(a)
Statutory provisions applicable.
(b)
Unobligated allotments.
(c)
Reduction of payments; fair market value of supplies or equipment, value of salaries, travel expenses, etc.
(a)
Covered services.
(b)
Restrictions.
(c)
Use of portion of funds.
(d)
Limitation on use of funds for administrative costs.
(a)
Annual reporting requirements; form, etc.
(b)
Audits; implementation, standards, etc.
(c)
Public inspection of reports and audits.
(d)
Access to books, records, etc.; creation of new records.
(a)
Federally funded activities.
(b)
Compliance.
(c)
Authority of Attorney General; civil actions.
(a)
In general.
(b)
Purpose of allotment.
(c)
Applicability of sections 703, 707, and 708.
(d)
Appropriations.
SUBCHAPTER VI-GRANTS TO STATES FOR SERVICES TO AGED, BLIND, OR DISABLED
SUBCHAPTER VII-ADMINISTRATION
(a)
Commissioner of Social Security.
(b)
Deputy Commissioner of Social Security.
(c)
Chief Actuary.
(d)
Chief Financial Officer.
(e)
Inspector General.
(a)
Establishment of Board.
(b)
Functions of Board.
(c)
Structure and membership of Board.
(d)
Terms of appointment.
(e)
Chairman.
(f)
Expenses and per diem.
(g)
Meetings.
(h)
Federal Advisory Committee Act.
(i)
Personnel.
(j)
Authorization of appropriations.
(a)
Personnel.
(b)
Budgetary matters.
(c)
Employment restriction.
(d)
Seal of office.
(e)
Data exchanges.
(a)
Authorization of appropriations.
(b)
Allocation for carrying out direct grant programs.
(c)
Payments to States for cost of grant programs to certain agencies and institutions.
(d)
Advance payments to States.
(e)
Reallotments.
(f)
Direct grants to certain agencies and institutions.
(a)
Establishment; membership; Chairman and Vice Chairman; quorum; terms of office; vacancies; per diem and expense reimbursement; meetings.
(b)
Continuing study, investigation, and review of social security program; scope of study, etc., and public participation.
(c)
Special, annual, and final reports to President and Congress concerning implementation, etc., of study, investigation, and review responsibilities; termination of Commission.
(d)
Executive Director and additional personnel; appointment and compensation.
(e)
Administrative procedures.
(f)
Data and information from other Federal departments and agencies.
(g)
Administrative support services from General Services Administration; reimbursement.
(h)
Authorization of appropriations.
(a)
Saturdays, Sundays, and holidays.
(b)
Recovery of overpayments.
(c)
Early delivery.
(a)
Terms and conditions of recommendations.
(b)
"Balance ratio" defined.
SUBCHAPTER VIII-SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS
(a)
In general.
(b)
Requirement for Attorney General.
(a)
In general.
(b)
Verification requirement.
(a)
In general.
(b)
Examination of fitness of prospective representative payee.
(c)
Requirement for maintaining lists of undesirable payees.
(d)
Persons ineligible to serve as representative payees.
(e)
Deferral of payment pending appointment of representative payee.
(f)
Hearing.
(g)
Notice requirements.
(h)
Accountability monitoring.
(i)
Restitution.
(a)
In general.
(b)
No effect on subchapter VIII eligibility or benefit amount.
(c)
Waiver of recovery of overpayment.
(d)
Limited immunity for disbursing officers.
(e)
Authorized collection practices.
(a)
Hearings.
(b)
Judicial review.
(a)
Regulations and administrative arrangements.
(b)
Payment of benefits.
(c)
Entitlement redeterminations.
(d)
Suspension and termination of benefits.
(a)
In general.
(b)
Restitution by representative payee.
SUBCHAPTER IX-EMPLOYMENT SECURITY ADMINISTRATIVE FINANCING
(a)
Establishment.
(b)
Amount credited to Account; transfer of funds; adjustments; repayment of internal revenue refunds.
(c)
Administrative expenditures; necessary expenses; quarterly transfer of funds; adjustments; limitation; estimate of net receipts.
(d)
Additional tax attributable to reduced credits; transfer of funds.
(e)
Revolving fund; appropriations; advances to Account; repayment; interest.
(f)
Determination of excess in Account; limitation on amount to be retained; use of balance in Account during certain fiscal years; net balance.
(a)
Determination of excess; amount transferred.
(b)
Unemployment account excesses.
(c)
Report to Congress.
(a)
Determination and certification by Secretary of Labor.
(b)
Transfer of funds where State is ineligible.
(c)
Use of funds.
(a)
Establishment.
(b)
Investments.
(c)
Sale or redemption of obligations.
(d)
Treatment of interest and proceeds.
(e)
Separate book accounts.
(f)
Payment to State agencies and Railroad Retirement Board.
(g)
Federal unemployment account; establishment.
(a)
Establishment.
(b)
Transfers to account.
(c)
Transfers to State accounts.
(d)
Advances to account; repayment.
(a)
Creation of program.
(b)
Repayment of costs.
(c)
Detail of Federal and State employees.
(d)
Authorization of appropriations.
(a)
Establishment.
(b)
Function.
(c)
Members.
(d)
Staff and other assistance.
(e)
Compensation.
(f)
Report.
(a)
In general.
(b)
Treatment of advance.
(c)
Repayment.
SUBCHAPTER X-GRANTS TO STATES FOR AID TO BLIND
(a)
Authorization of payments.
(b)
Computation of amounts.
SUBCHAPTER XI-GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE SIMPLIFICATION
Part A-General Provisions
(a)
Disclosure prohibited; exceptions.
(b)
Requests for information and services.
(c)
Cost reimbursement.
(d)
Compliance with requests.
(e)
Public inspection.
(f)
Opportunity for review.
(a)
Limitation on total payments to each territory.
(b)
Entitlement to matching grant.
(c)
Definitions.
(d)
Authority to transfer funds to certain programs.
(e)
Repealed.
(f)
Total amount certified under subchapter XIX.
(g)
Medicaid payments to territories for fiscal year 1998 and thereafter.
(a)
Authorization; reimbursement; utilization of facilities of public or private agencies and organizations.
(b)
Plans and arrangements for assistance; consultations.
(c)
"Temporary assistance" defined.
(d)
Maximum total amount of temporary assistance.
(e)
Authority of Secretary to accept gifts.
(a)
Advisory Council on Public Welfare; appointment and functions of initial Council.
(b)
Membership and representation of interests on initial Council.
(c)
Technical and other assistance for initial Council; availability of data.
(d)
Termination of initial Council's existence on submission of report.
(e)
Succeeding Councils; appointment; functions; membership; representation of interests; assistance and data; termination.
(f)
Advisory committees; functions; reports by Secretary.
(g)
Compensation and travel expenses.
(h)
Exemption from conflict of interest laws of members of Council or advisory committees; exceptions.
(a)
Congressional policy.
(b)
Development of welfare indicators and predictors.
(c)
Advisory Board on Welfare Indicators.
(d)
Annual welfare indicators report.
(e)
Short title.
(a)
Waiver of State plan requirements; costs regarded as State plan expenditures; availability of appropriations.
(b)
Child support enforcement programs.
(c)
Demonstration projects to test alternative definitions of unemployment.
(e)
Extensions of State-wide comprehensive demonstration projects for which waivers granted.
(a)
Determination of conformity with requirements for approval; petition for reconsideration; hearing; time limitations; review by court of appeals.
(b)
Amendment of plans.
(c)
Restitution when Secretary reverses his determination.
(d)
Items covered under other subchapters; disallowance.
(a)
Establishment; criteria for regulations; requirements for hospitals.
(b)
Monitoring, etc., of systems by Secretary.
(c)
Availability of information to appropriate agencies and organizations.
(a)
Use of reimbursement for planning activities for health services and facilities.
(b)
Agreement between Secretary and State for submission of proposed capital expenditures related to health care facilities and procedures for appeal from recommendations.
(c)
Manner of payment to States for carrying out agreement.
(d)
Determination of amount of exclusions from Federal payments.
(e)
Treatment of lease or comparable arrangement of any facility or equipment for a facility in determining amount of exclusions from Federal payments.
(f)
Reconsideration by Secretary of determinations.
(g)
"Capital expenditure" defined.
(h)
Applicability to Christian Science sanatoriums.
(i)
National advisory council; establishment or designation of existing council; functions; consultations with other appropriate national advisory councils; composition; compensation and travel expenses.
(j)
Capital expenditure review exception for eligible organization health care facilities.
(a)
In general.
(b)
Elements of review system.
(c)
Provisions for administrative and judicial review.
(a)
Disclosure required to receive payment.
(b)
Updates to information supplied.
(c)
Verification.
(d)
Definitions.
(a)
Authorization; scope; service and proof of service.
(b)
Contumacy or refusal to obey subpena; contempt proceedings.
(c)
Nondisclosure of personal medical records by General Accounting Office.
(a)
Reduction in benefits.
(b)
"Supplemental security income benefits" defined.
(c)
Reimbursement of the State.
(a)
Mandatory exclusion.
(b)
Permissive exclusion.
(c)
Notice, effective date, and period of exclusion.
(d)
Notice to State agencies and exclusion under State health care programs.
(e)
Notice to State licensing agencies.
(f)
Notice, hearing, and judicial review.
(g)
Application for termination of exclusion.
(h)
"State health care program" defined.
(i)
"Convicted" defined.
(j)
Definition of immediate family member and member of household.
(a)
Improperly filed claims.
(b)
Payments to induce reduction or limitation of services.
(c)
Initiation of proceeding; authorization by Attorney General, notice, etc., estoppel, failure to comply with order or procedure.
(d)
Amount or scope of penalty, assessment, or exclusion.
(e)
Review by courts of appeals.
(f)
Compromise of penalties and assessments; recovery; use of funds recovered.
(g)
Finality of determination respecting penalty, assessment or exclusion.
(h)
Notification of appropriate entities of finality of determination.
(i)
Definitions.
(j)
Subpoenas.
(k)
Injunctions.
(l)
Liability of principal for acts of agent.
(m)
Claims within jurisdiction of other departments or agencies.
(n)
Safe harbor for payment of medigap premiums.
(a)
Making or causing to be made false statements or representations.
(b)
Illegal remunerations.
(c)
False statements or representations with respect to condition or operation of institutions.
(d)
Illegal patient admittance and retention practices.
(e)
Violation of assignment terms.
(f)
"Federal health care program" defined.
(a)
Establishment of program.
(b)
Additional use of funds by Inspector General.
(c)
"Health plan" defined.
(a)
Solicitation and publication of modifications to existing safe harbors and new safe harbors.
(b)
Advisory opinions.
(c)
Special fraud alerts.
(a)
General purpose.
(b)
Reporting of information.
(c)
Disclosure and correction of information.
(d)
Access to reported information.
(e)
Protection from liability for reporting.
(f)
Coordination with National Practitioner Data Bank.
(g)
Definitions and special rules.
(a)
False statements or representations of material fact; proceedings to exclude.
(b)
Initiation of proceedings; hearing; sanctions.
(c)
Amount or scope of penalties, assessments, or exclusions.
(d)
Judicial review.
(e)
Compromise of money penalties and assessments; recovery; use of funds recovered.
(f)
Finality of determination respecting penalty, assessment, or exclusion.
(g)
Notification of appropriate entities of finality of determination.
(h)
Injunction.
(i)
Delegation of authority.
(j)
"State agency" defined.
(k)
Liability of principal for acts of agents.
(l)
Protection of ongoing criminal investigations.
(a)
In general.
(b)
Penalty.
(c)
Duration of penalty.
(d)
Effect on other assistance.
(e)
Definition.
(f)
Consultations.
(a)
Authority to approve demonstration projects.
(b)
Waiver authority.
(c)
Treatment as program expenditures.
(d)
Duration of demonstration.
(e)
Application.
(f)
Evaluations; report.
(g)
Cost neutrality.
(a)
Claims.
(b)
Waiver.
(a)
Supplemental Security Income program.
(b)
Period of effectiveness.
(a)
In general.
(b)
Notice, effective date, and period of exclusion.
(c)
Notice to State agencies.
(d)
Notice to State licensing agencies.
(e)
Notice, hearing, and judicial review.
(f)
Application for termination of exclusion.
(g)
Availability of records of excluded representatives and health care providers.
(h)
Reporting requirement.
(i)
Delegation of authority.
(j)
Definitions.
(a)
Requirements of State eligibility systems.
(b)
Applicable programs.
(c)
Protection of applicants from improper use of information.
(d)
Citizenship or immigration status requirements; documentation; verification by Immigration and Naturalization Service; denial of benefits; hearing.
(e)
Erroneous State citizenship or immigration status determinations; penalties not required.
(f)
Medical assistance to aliens for treatment of emergency conditions.
(a)
Establishment.
(b)
Membership.
(c)
Duties and functions of Commission; public hearings in different geographical areas; broad spectrum of witnesses and testimony.
(d)
Interim and final report to President and Congress; recommendations.
(e)
Time of appointment of members; vacancies; election of Chairman; quorum; calling of meetings; number of meetings; voting; compensation and expenses.
(f)
Executive Director and additional personnel; appointment and compensation; consultants.
(g)
Time and place of hearings and nature of testimony authorized.
(h)
Data and information from other agencies and departments.
(i)
Support services by General Services Administration.
(j)
Authorization of appropriations.
(k)
Donations accepted and deposited in Treasury in separate fund; expenditures; gift or bequest to or for use of United States.
(l)
Public surveys.
(a)
Prohibited acts.
(b)
Civil penalties.
(c)
Application of other law; compromise, recovery, and deposit into Treasury of civil money penalties.
(d)
Enforcement.
(a)
In general.
(b)
Provision of address information.
(c)
Manner and form of requests.
(d)
Procedures and safeguards.
(e)
Arrangements with State agencies and authorized persons.
(f)
Procedures for administrative review.
(g)
Unauthorized disclosure of information.
(h)
Definitions.
(a)
Establishment of program.
(b)
Priorities.
(c)
Methodologies and criteria for evaluations.
(d)
Standards for data bases.
(e)
Dissemination of research findings and guidelines.
(f)
Evaluations.
(g)
Research with respect to dissemination.
(h)
Report to Congress.
(i)
Authorization of appropriations.
(a)
Provision upon request.
(b)
Notice to eligible individuals.
(c)
Mandatory provision of statements.
(a)
In general.
(b)
"Public debt obligation" defined.
(c)
"Federal fund" defined.
(a)
In general.
(b)
No effect on SSI eligibility or benefit amount.
(a)
In general.
(b)
Ticket system.
(c)
State participation.
(d)
Responsibilities of the Commissioner.
(e)
Program managers.
(f)
Employment networks.
(g)
Individual work plans.
(h)
Employment network payment systems.
(i)
Suspension of disability reviews.
(j)
Authorizations.
(k)
Definitions.
(l)
Regulations.
(a)
Establishment.
(b)
Conditions.
(c)
Definitions.
(d)
Authorization of appropriations.
(a)
In general.
(b)
Services provided.
(c)
Application.
(d)
Amount of payments.
(e)
Annual report.
(f)
Funding.
(g)
Definitions.
(h)
Authorization of appropriations.
(a)
Establishment.
(b)
Grants for infrastructure and outreach.
(c)
Availability of funds.
(d)
Annual report.
(e)
Appropriation.
(f)
Recommendation.
Part B-Peer Review of Utilization and Quality of Health Care Services
(a)
Establishment and consolidation of geographic areas.
(b)
Organizations entitled to contract with Secretary.
(c)
Terms of contract.
(d)
Review prior to termination of contract; modification and termination; reviewing panel.
(e)
Authority of Secretary.
(f)
Termination not subject to judicial review.
(g)
Timely provision of hospital data to peer review organizations.
(h)
Publication of new policy or procedure and general criteria and standards for evaluation; performance comparison report.
(i)
Preference in contracting with in-State organizations.
(a)
Review of professional activities; determination of payment; determination of review authority; consultation with professional health care practitioners; standards of health care; other duties.
(b)
Review by physicians; physician's family defined.
(c)
Utilization of services of physicians to make final determinations of denial decisions with respect to professional conduct of other physicians.
(d)
Review of ambulatory surgical procedures.
(e)
Review of hospital denial notices.
(f)
Identification of methods for identifying cases of substandard care.
(a)
Assurances regarding services and items ordered or provided by practitioner or provider.
(b)
Sanctions and penalties; hearings and review.
(c)
Enlistment of support of other organizations to assure practitioner's or provider's compliance with obligations.
(a)
Providers of information to organizations having a contract with Secretary.
(b)
Employees and fiduciaries of organizations having contracts with Secretary.
(c)
Physicians and providers.
(d)
Reimbursement by Secretary for expenses incurred in defense of legal proceedings.
(a)
State plan provision that functions of peer review organizations may be performed by contract with such organization.
(b)
Federal share of expenditures.
(a)
Freedom of Information Act inapplicable; exceptions to nondisclosure.
(b)
Disclosure of information permitted.
(c)
Penalties.
(d)
Subpoena and discovery proceedings regarding patient records.
(e)
Organizations with contracts.
Part C-Administrative Simplification
(a)
Applicability.
(b)
Reduction of costs.
(c)
Role of standard setting organizations.
(d)
Implementation specifications.
(e)
Protection of trade secrets.
(f)
Assistance to Secretary.
(g)
Application to modifications of standards.
(a)
Standards to enable electronic exchange.
(b)
Unique health identifiers.
(c)
Code sets.
(d)
Security standards for health information.
(e)
Electronic signature.
(f)
Transfer of information among health plans.
(a)
Initial standards.
(b)
Additions and modifications to standards.
(a)
Conduct of transactions by plans.
(b)
Compliance with standards.
(a)
General penalty.
(b)
Limitations.
(a)
Offense.
(b)
Penalties.
(a)
General effect.
(b)
Public health.
(c)
State regulatory reporting.
SUBCHAPTER XII-ADVANCES TO STATE UNEMPLOYMENT FUNDS
(a)
Repayment by State; certification; transfer.
(b)
Interest on loan.
(c)
Credit of interest on loan.
SUBCHAPTER XIII-RECONVERSION UNEMPLOYMENT BENEFITS FOR SEAMEN
SUBCHAPTER XIV-GRANTS TO STATES FOR AID TO PERMANENTLY AND TOTALLY DISABLED
SUBCHAPTER XV-UNEMPLOYMENT COMPENSATION FOR FEDERAL EMPLOYEES
SUBCHAPTER XVI-SUPPLEMENTAL SECURITY INCOME FOR AGED, BLIND, AND DISABLED
Part A-Determination of Benefits
(a)
"Eligible individual" defined.
(b)
Amount of benefits.
(c)
Period for determination of benefits.
(d)
Limitation on amount of gross income earned; "gross income" defined.
(e)
Limitation on eligibility of certain individuals.
(f)
Individuals outside United States; determination of status.
(g)
Individuals deemed to meet resources test.
(h)
Individuals deemed to meet income test.
(i)
Application and review requirements for certain individuals.
(a)
Exclusions from resources.
(b)
Disposition of resources; grounds for exemption from disposition requirements.
(c)
Disposal of resources for less than fair market value.
(d)
Funds set aside for burial expenses.
(e)
Trusts.
(a)
Referral by Commissioner of eligible individuals to appropriate State agency.
(b), (c)
Repealed.
(d)
Reimbursement by Commissioner to State agency of costs of providing services to referred individuals.
(e)
Reimbursement for vocational rehabilitation services furnished during certain months of nonpayment of insurance benefits.
(a)
Exclusion of cash payments in determination of income of individuals for purposes of eligibility for benefits; agreement by Commissioner and State for Commissioner to make supplementary payments on behalf of State or subdivision.
(b)
Agreement between Commissioner and State; contents.
(c)
Residence requirement by State or subdivision for supplementary payments; disregarding amounts of certain income by State or subdivision in determining eligibility for supplementary payments.
(d)
Payment to Commissioner by State of amount equal to expenditures by Commissioner as supplementary payments; time and manner of payment by State; fees for Federal administration of State supplementary payments.
(e)
State standards; establishment; annual public review; annual certification; payments to individuals.
(a)
Increase of dollar amounts.
(b)
Publication in Federal Register of new dollar amounts.
(c)
Additional increases.
(a)
Eligibility; agreement with Commissioner.
(b)
Levels of supplementary payments.
(c)
Election to apply subsection (a)(4).
(d)
Determinations respecting any portion of period July 1, 1980, through June 30, 1981.
(e)
Meeting subsection (a)(4) requirements for any month after March 1983.
(f)
Passthrough relating to optional State supplementation.
(g)
Mandatory pass-through of increased personal needs allowance.
(a)
Eligible individuals.
(b)
Blind or disabled individuals receiving supplemental security income benefits.
(c)
Continuing disability or blindness reviews; limitation.
(d)
Information and training programs.
(a)
Authorization of appropriations for pilot program.
(b)
State allotments.
(c)
Requisite features of State plans.
(d)
Payments to States; computation of payments.
(e)
Rules and regulations.
(f)
Reports.
(a)
Attribution as unearned income.
(b)
Determination of amount and resources.
(c)
Support and maintenance.
(d)
Information and documentation; agreements with Secretary of State and Attorney General.
(e)
Joint and several liability of alien and sponsor for overpayments.
(f)
Exemptions.
Part B-Procedural and General Provisions
(a)
Time, manner, form, and duration of payments; representative payees; promulgation of regulations.
(b)
Overpayments and underpayments; adjustment, recovery, or payment of amounts by Commissioner.
(c)
Hearing to determine eligibility or amount of benefits; subsequent application; time within which to request hearing; time for determinations of Commissioner pursuant to hearing; judicial review.
(d)
Procedures applicable; prohibition on assignment of payments; representation of claimants; maximum fees; penalties for violations.
(e)
Administrative requirements prescribed by Commissioner; criteria; reduction of benefits to individual for noncompliance with requirements; payment to homeless.
(f)
Furnishing of information by Federal agencies.
(g)
Reimbursement to States for interim assistance payments.
(h)
Payment of certain travel expenses.
(i)
Unnegotiated checks; notice to Commissioner; payment to States; notice to States; investigation of payees.
(j)
Application and review requirements for certain individuals.
(k)
Notifications to applicants and recipients.
(l)
Special notice to blind individuals with respect to hearings and other official actions.
(m)
Pre-release procedures for institutionalized persons.
(n)
Concurrent SSI and food stamp applications by institutionalized individuals.
(o)
Notice requirements.
(p)
Reinstatement of eligibility on the basis of blindness or disability.
(a)
Authority of Commissioner.
(b)
Examination to determine blindness.
(c)
Notification of review.
(d)
Regulations regarding completion of plans for achieving self-support.
(a)
Determination by Commissioner pursuant to agreement between Commissioner and State; costs.
(b)
Preservation of benefit status for certain disabled widows and widowers.
(c)
Loss of benefits upon entitlement to child's insurance benefits based on disability.
(d)
Retention of medicaid when SSI benefits are lost upon entitlement to early widow's or widower's insurance benefits.
(a)
Establishment.
(b)
Requirements.
(a)
In general.
(b)
Views of individual members of Social Security Advisory Board.
SUBCHAPTER XVII-GRANTS FOR PLANNING COMPREHENSIVE ACTION TO COMBAT MENTAL RETARDATION
SUBCHAPTER XVIII-HEALTH INSURANCE FOR AGED AND DISABLED
(a)
Basic freedom of choice.
(b)
Use of private contracts by medicare beneficiaries.
(a)
Grants and contracts to develop and engage in experiments and demonstration projects.
(b)
Waiver of certain payment or reimbursement requirements; advice and recommendations of specialists preceding experiments and demonstration projects.
(a)
Notice of medicare benefits.
(b)
Medicare and medigap information.
(c)
Contents of notice.
(a)
In general.
(b)
Outreach elements.
(c)
Assistance provided.
(d)
Educational material.
(e)
Notice to beneficiaries.
(f)
Report.
(a)
Grants.
(b)
Grant applications.
(c)
Special grants.
(d)
Criteria for issuing grants.
(e)
Annual State report.
(f)
Report to Congress.
(g)
Authorization of appropriations for grants.
(a)
Repealed.
(b)
Program to collect information on fraud and abuse.
(c)
Program to collect information on program efficiency.
(a)
Establishment.
(b)
Duties.
(c)
Membership.
(d)
Director and staff; experts and consultants.
(e)
Powers.
(f)
Authorization of appropriations.
(a)
In general.
(b)
Request for itemized statement for medicare items and services.
Part A-Hospital Insurance Benefits for Aged and Disabled
(a)
Entitlement to payment for inpatient hospital services, post-hospital extended care services, home health services, and hospice care.
(b)
Services not covered.
(c)
Inpatients of psychiatric hospitals.
(d)
Hospice care; election; waiver of rights; revocation; change of election.
(e)
Services taken into account.
(f)
Coverage of extended care services without regard to three-day prior hospitalization requirement.
(g)
"Spell of illness" defined.
(a)
Inpatient hospital services; outpatient hospital diagnostic services; blood; post-hospital extended care services.
(b)
Inpatient hospital deductible; application.
(a)
Requirement of requests and certifications.
(b)
Amount paid to provider of services.
(c)
No payments to Federal providers of services.
(d)
Payments for emergency hospital services.
(e)
Payment for inpatient hospital services prior to notification of noneligibility.
(f)
Payment for certain inpatient hospital services furnished outside United States.
(g)
Payments to physicians for services rendered in teaching hospitals.
(h)
Payment for specified hospital services provided in Department of Veterans Affairs hospitals; amount of payment.
(i)
Payment for hospice care.
(j)
Elimination of lesser-of-cost-or-charges provision.
(k)
Payments to home health agencies for durable medical equipment.
(l)
Payment for inpatient critical access hospital services.
(a)
Determination of amount.
(b)
Conditions.
(c)
Payments under assignment or power of attorney.
(d)
Accrual of interest on balance of excess or deficit not paid.
(e)
Periodic interim payments.
(a)
Authorization for agreement by Secretary for implementation; scope of agreement.
(b)
Prerequisites for agreement or renewal of agreement by Secretary.
(c)
Terms and conditions of agreements; prompt payment of claims.
(d)
Nomination of agency or organization; withdrawal.
(e)
Assignment or reassignment of provider of services; designation of agency or organization to perform provider services and home health agency functions.
(f)
Development of standards, criteria, and procedures by Secretary for evaluation of agency or organization performance.
(g)
Termination of agreement; procedures applicable.
(h)
Bonding requirement under agreement for officers and employees of agency or organization.
(i)
Liability of certifying and disbursing officers designated under agreement for negligent, etc., payments.
(j)
Denial of claim; notification and reconsideration.
(k)
Annual reporting requirement on erroneous payment recovery.
(l)
No authority for activities carried out under Medicare Integrity Program.
(a)
Creation; deposits; transfers from Treasury.
(b)
Board of Trustees; composition; meetings; duties.
(c)
Investment of Trust Fund by Managing Trustee.
(d)
Authority of Managing Trustee to sell obligations.
(e)
Interest on and proceeds from sale or redemption of obligations.
(f)
Payment of estimated taxes.
(g)
Transfers from other Funds.
(h)
Payments from Trust Fund amounts certified by Secretary.
(i)
Payment of travel expenses for travel within United States; reconsideration interviews and proceedings before administrative law judges.
(j)
Loans from other Funds; interest; repayment; report to Congress.
(k)
Health Care Fraud and Abuse Control Account.
(a)
Individuals eligible to enroll.
(b)
Time, manner, and form of enrollment.
(c)
Period of enrollment; scope of coverage.
(d)
Monthly premiums.
(e)
Contract or other arrangement for payment of monthly premiums.
(f)
Deposit of amounts into Treasury.
(g)
Buy-in under this part for qualified medicare beneficiaries.
(a)
Eligibility.
(b)
Enrollment.
(c)
Coverage period.
(d)
Payment of premiums.
(a)
"Skilled nursing facility" defined.
(b)
Requirements relating to provision of services.
(c)
Requirements relating to residents' rights.
(d)
Requirements relating to administration and other matters.
(e)
State requirements relating to skilled nursing facility requirements.
(f)
Responsibilities of Secretary relating to skilled nursing facility requirements.
(g)
Survey and certification process.
(h)
Enforcement process.
(i)
Construction.
(a)
Establishment.
(b)
Application.
(c)
Medicare rural hospital flexibility program described.
(d)
"Rural health network" defined.
(e)
Certification by Secretary.
(f)
Permitting maintenance of swing beds.
(g)
Grants.
(h)
Grandfathering of certain facilities.
(i)
Waiver of conflicting part A provisions.
(j)
Authorization of appropriations.
(a)
In general.
(b)
Election.
(c)
Monitoring and safeguard against excessive expenditures.
(d)
Sunset.
(e)
Annual report.
Part B-Supplementary Medical Insurance Benefits for Aged and Disabled
(a)
Scope of benefits.
(b)
Extension of coverage of immunosuppressive drugs.
(c)
Definitions.
(a)
Amounts.
(b)
Deductible provision.
(c)
Mental disorders.
(d)
Nonduplication of payments.
(e)
Information for determination of amounts due.
(f)
Maximum rate of payment per visit for independent rural health clinics.
(g)
Physical therapy services.
(h)
Fee schedules for clinical diagnostic laboratory tests; percentage of prevailing charge level; nominal fee for samples; adjustments; recipients of payments; negotiated payment rate.
(i)
Outpatient surgery.
(j)
Accrual of interest on balance of excess or deficit not paid.
(k)
Hepatitis B vaccine.
(l)
Fee schedule for services of certified registered nurse anesthetists.
(m)
Incentive payments for physicians' services furnished in underserved areas.
(n)
Payments to hospital outpatient departments for radiology; amount; definitions.
(o)
Limitation on benefit for payment for therapeutic shoes for individuals with severe diabetic foot disease.
(p)
Repealed.
(q)
Requests for payment to include information on referring physician.
(r)
Cap on prevailing charge; billing on assignment-related basis.
(s)
Other prepaid organizations.
(t)
Prospective payment system for hospital outpatient department services.
(a)
Payment for durable medical equipment.
(b)
Fee schedules for radiologist services.
(c)
Payments and standards for screening mammography.
(d)
Frequency limits and payment for colorectal cancer screening tests.
(e)
Repealed.
(f)
Reduction in payments for physician pathology services during 1991.
(g)
Payment for outpatient critical access hospital services.
(h)
Payment for prosthetic devices and orthotics and prosthetics.
(i)
Payment for surgical dressings.
(j)
Requirements for suppliers of medical equipment and supplies.
(k)
Payment for outpatient therapy services and comprehensive outpatient rehabilitation services.
(l)
Establishment of fee schedule for ambulance services.
(a)
Conditions for payment for services described in section 1395k(a)(2) of this title.
(b)
Conditions for payment for services described in section 1395x(s) of this title.
(c)
Collection of charges from individuals for services specified in section 1395x(s) of this title.
(d)
Payment to Federal provider of services or other Federal agencies prohibited.
(e)
Payment to fund designated by medical staff or faculty of medical school.
(a)
Generally; regulations.
(b)
Repealed.
(c)
Initial general enrollment period; eligible individuals before March 1, 1966.
(d)
Eligible individuals on or after March 1, 1966.
(e)
General enrollment period.
(f)
Individuals deemed enrolled in medical insurance program.
(g)
Commencement of enrollment period.
(h)
Waiver of enrollment period requirements where individual's rights were prejudiced by administrative error or inaction.
(i)
Special enrollment periods.
(a)
Commencement.
(b)
Continuation.
(c)
Termination.
(d)
Payment of expenses incurred during coverage period.
(e)
Commencement of coverage for special enrollment periods.
(a)
Determination of monthly actuarial rates and premiums.
(b)
Increase in monthly premium.
(c)
Premiums rounded to nearest multiple of ten cents.
(d)
"Continuous period of eligibility" defined.
(e)
State payment of part B late enrollment premium increases.
(f)
Limitation on increase in monthly premium.
(g)
Exclusions from estimate of benefits and administrative costs.
(a)
Deductions from section 402 or 423 monthly benefits.
(b)
Deductions from railroad retirement annuities or pensions.
(c)
Portion of monthly premium in excess of deducted amount.
(d)
Deductions from civil service retirement annuities.
(e)
Manner and time of payment prescribed by Secretary.
(f)
Deposit of amounts in Treasury.
(g)
Premium payability period.
(h)
Exempted monthly benefits.
(a)
Creation; deposits; fund transfers.
(b)
Board of Trustees; composition; meetings; duties.
(c)
Investment of Trust Fund by Managing Trustee.
(d)
Authority of Managing Trustee to sell obligations.
(e)
Interest on or proceeds from sale or redemption of obligations.
(f)
Transfers to other Funds.
(g)
Payments from Trust Fund of amounts provided for by this part or with respect to administrative expenses.
(h)
Payments from Trust Fund of costs incurred by Director of Office of Personnel Management.
(i)
Payments from Trust Fund of costs incurred by Railroad Retirement Board.
(a)
Authority of Secretary to enter into contracts with carriers.
(b)
Applicability of competitive bidding provisions; findings as to financial responsibility, etc., of carrier; contractual duties imposed by contract.
(c)
Advances of funds to carrier; prompt payment of claims.
(d)
Surety bonds.
(e)
Liability of certifying or disbursing officers or carriers.
(f)
"Carrier" defined.
(g)
Authority of Railroad Retirement Board to enter into contracts with carriers.
(h)
Participating physician or supplier; agreement with Secretary; publication of directories; availability; inclusion of program in explanation of benefits; payment of claims on assignment-related basis.
(i)
Definitions.
(j)
Monitoring of charges of nonparticipating physicians; sanctions; restitution.
(k)
Sanctions for billing for services of assistant at cataract operations.
(l)
Prohibition of unassigned billing of services determined to be medically unnecessary by carrier.
(m)
Disclosure of information of unassigned claims for certain physicians' services.
(n)
Elimination of markup for certain purchased services.
(o)
Reimbursement for drugs and biologicals.
(p)
Requiring submission of diagnostic information.
(q)
Anesthesia services; counting actual time units.
(r)
Establishment of physician identification system.
(s)
Application of fee schedule.
(t)
Facility provider number required on claims submitted by physicians.
(a)
Duty of Secretary; enrollment of eligible individuals.
(b)
Coverage of groups to which applicable.
(c)
Eligible individuals.
(d)
Monthly premiums; coverage periods.
(e)
Subsection (d)(3) terminations deemed resulting in section 1395p enrollment.
(f)
"Carrier" as including State agency; provisions facilitating deductions, coinsurance, etc., and leading to economy and efficiency of operation.
(g)
Subsection (b) exclusions from coverage groups.
(h)
Modifications respecting subsection (b) coverage groups.
(i)
Enrollment of qualified medicare beneficiaries.
(a)
Establishment of demonstration project bidding areas.
(b)
Awarding of contracts in areas.
(c)
Expansion of projects.
(d)
Services described.
(e)
Termination.
(a)
Payment based on fee schedule.
(b)
Establishment of fee schedules.
(c)
Determination of relative values for physicians' services.
(d)
Conversion factors.
(e)
Geographic adjustment factors.
(f)
Sustainable growth rate.
(g)
Limitation on beneficiary liability.
(h)
Sending information to physicians.
(i)
Miscellaneous provisions.
(j)
Definitions.
Part C-Medicare+Choice Program
(a)
Choice of medicare benefits through Medicare+Choice plans.
(b)
Special rules.
(c)
Process for exercising choice.
(d)
Providing information to promote informed choice.
(e)
Coverage election periods.
(f)
Effectiveness of elections and changes of elections.
(g)
Guaranteed issue and renewal.
(h)
Approval of marketing material and application forms.
(i)
Effect of election of Medicare+Choice plan option.
(a)
Basic benefits.
(b)
Antidiscrimination.
(c)
Disclosure requirements.
(d)
Access to services.
(e)
Quality assurance program.
(f)
Grievance mechanism.
(g)
Coverage determinations, reconsiderations, and appeals.
(h)
Confidentiality and accuracy of enrollee records.
(i)
Information on advance directives.
(j)
Rules regarding provider participation.
(k)
Treatment of services furnished by certain providers.
(a)
Payments to organizations.
(b)
Annual announcement of payment rates.
(c)
Calculation of annual Medicare+Choice capitation rates.
(d)
"Medicare+Choice payment area" defined.
(e)
Special rules for individuals electing MSA plans.
(f)
Payments from Trust Fund.
(g)
Special rule for certain inpatient hospital stays.
(h)
Special rule for hospice care.
(i)
New entry bonus.
(a)
Submission of proposed premiums and related information.
(b)
Monthly premium charged.
(c)
Uniform premium.
(d)
Terms and conditions of imposing premiums.
(e)
Limitation on enrollee liability.
(f)
Requirement for additional benefits.
(g)
Prohibition of State imposition of premium taxes.
(h)
Permitting use of segments of service areas.
(a)
Organized and licensed under State law.
(b)
Assumption of full financial risk.
(c)
Certification of provision against risk of insolvency for unlicensed PSOs.
(d)
"Provider-sponsored organization" defined.
(a)
Establishment of solvency standards for provider-sponsored organizations.
(b)
Establishment of other standards.
(a)
In general.
(b)
Minimum enrollment requirements.
(c)
Contract period and effectiveness.
(d)
Protections against fraud and beneficiary protections.
(e)
Additional contract terms.
(f)
Prompt payment by Medicare+Choice organization.
(g)
Intermediate sanctions.
(h)
Procedures for termination.
(a)
Definitions relating to Medicare+Choice organizations.
(b)
Definitions relating to Medicare+Choice plans.
(c)
Other references to other terms.
(d)
Coordinated acute and long-term care benefits under Medicare+Choice plan.
(e)
Restriction on enrollment for certain Medicare+Choice plans.
Part D-Miscellaneous Provisions
(a)
Spell of illness.
(b)
Inpatient hospital services.
(c)
Inpatient psychiatric hospital services.
(d)
Repealed.
(e)
Hospital.
(f)
Psychiatric hospital.
(g)
Outpatient occupational therapy services.
(h)
Extended care services.
(i)
Post-hospital extended care services.
(j)
Skilled nursing facility.
(k)
Utilization review.
(l)
Agreements for transfer between skilled nursing facilities and hospitals.
(m)
Home health services.
(n)
Durable medical equipment.
(o)
Home health agency.
(p)
Outpatient physical therapy services.
(q)
Physicians' services.
(r)
Physician.
(s)
Medical and other health services.
(t)
Drugs and biologicals.
(u)
Provider of services.
(v)
Reasonable costs.
(w)
Arrangements for certain services; payments pursuant to arrangements for utilization review activities.
(x)
State and United States.
(y)
Extended care in religious nonmedical health care institutions.
(z)
Institutional planning.
(aa)
Rural health clinic services and Federally qualified health center services.
(bb)
Services of a certified registered nurse anesthetist.
(cc)
Comprehensive outpatient rehabilitation facility services.
(dd)
Hospice care; hospice program; definitions; certification; waiver by Secretary.
(ee)
Discharge planning process.
(ff)
Partial hospitalization services.
(gg)
Certified nurse-midwife services.
(hh)
Clinical social worker; clinical social worker services.
(ii)
Qualified psychologist services.
(jj)
Screening mammography.
(kk)
Covered osteoporosis drug.
(ll)
Speech-language pathology services; audiology services.
(mm)
Critical access hospital; critical access hospital services.
(nn)
Screening pap smear; screening pelvic exam.
(oo)
Prostate cancer screening tests.
(pp)
Colorectal cancer screening tests.
(qq)
Diabetes outpatient self-management training services.
(rr)
Bone mass measurement.
(ss)
Religious nonmedical health care institution.
(tt)
Post-institutional home health services; home health spell of illness.
(a)
Items or services specifically excluded.
(b)
Medicare as secondary payer.
(c)
Drug products.
(d)
Repealed.
(e)
Item or service by excluded individual or entity or at direction of excluded physician; limitation of liability of beneficiaries with respect to services furnished by excluded individuals and entities.
(f)
Utilization guidelines for provision of home health services.
(g)
Contracts with utilization and quality control peer review organizations.
(h)
Repealed.
(i)
Awards and contracts for original research and experimentation of new and existing medical procedures; conditions.
(a)
Use of State agencies to determine compliance by providers of services with conditions of participation.
(b)
Payment in advance or by way of reimbursement to State for performance of functions of subsection (a).
(c)
Use of State or local agencies to survey hospitals.
(d)
Fulfillment of requirements by States.
(e)
Prohibition of user fees for survey and certification.
(a)
In general.
(b)
Accreditation by American Osteopathic Association or other national accreditation body.
(c)
Disclosure of accreditation survey.
(d)
Deficiencies.
(e)
State or local accreditation.
(a)
Filing of agreements; eligibility for payment; charges with respect to items and services.
(b)
Termination or nonrenewal of agreements.
(c)
Refiling after termination or nonrenewal; agreements with skilled nursing facilities.
(d)
Decision to withhold payment for failure to review long-stay cases.
(e)
"Provider of services" defined.
(f)
Maintenance of written policies and procedures.
(g)
Penalties for improper billing.
(h)
Dissatisfaction with determination of Secretary; appeal by institutions or agencies; single notice and hearing.
(i)
Intermediate sanctions for psychiatric hospitals.
(a)
Medical screening requirement.
(b)
Necessary stabilizing treatment for emergency medical conditions and labor.
(c)
Restricting transfers until individual stabilized.
(d)
Enforcement.
(e)
Definitions.
(f)
Preemption.
(g)
Nondiscrimination.
(h)
No delay in examination or treatment.
(i)
Whistleblower protections.
(a)
Appointment.
(b)
Meetings.
(c)
Reimbursement of expenses.
(a)
Entitlement to and amount of benefits.
(b)
Appeal by individuals; provider representation of beneficiaries.
(a)
Payments to providers of services or other person regarded as payment to individuals.
(b)
Incorrect payments on behalf of individuals; payment adjustment.
(c)
Exception to subsection (b) payment adjustment.
(d)
Liability of certifying or disbursing officer for failure to recoup.
(e)
Settlement of claims for benefits under this subchapter on behalf of deceased individuals.
(f)
Settlement of claims for section 1395k benefits on behalf of deceased individuals.
(g)
Refund of premiums for deceased individuals.
(a)
Authority to prescribe regulations; ineffectiveness of substantive rules not promulgated by regulation.
(b)
Notice of proposed regulations; public comment.
(c)
Publication of certain rules; public inspection; changes in data collection and retrieval.
(a)
Functions of Secretary; performance directly or by contract.
(b)
Contracts to secure special data, actuarial information, etc.
(c)
Oaths and affirmations.
(a)
Health care of the aged and disabled.
(b)
Operation and administration of insurance programs.
(a)
Rates and adjustments.
(b)
Definitions; requirements.
(c)
Enrollment in plan; duties of organization to enrollees.
(d)
Right to enroll with contracting organization in geographic area.
(e)
Limitation on charges; election of coverage; "adjusted community rate" defined; workmen's compensation and insurance benefits.
(f)
Membership requirements.
(g)
Risk-sharing contract.
(h)
Reasonable cost reimbursement contract; requirements.
(i)
Duration, termination, effective date, and terms of contract; powers and duties of Secretary.
(j)
Payment in full and limitation on actual charges; physicians, providers of services, or renal dialysis facilities not under contract with organization.
(k)
Risk-sharing contracts.
(a)
Prohibition of certain referrals.
(b)
General exceptions to both ownership and compensation arrangement prohibitions.
(c)
General exception related only to ownership or investment prohibition for ownership in publicly-traded securities and mutual funds.
(d)
Additional exceptions related only to ownership or investment prohibition.
(e)
Exceptions relating to other compensation arrangements.
(f)
Reporting requirements.
(g)
Sanctions.
(h)
Definitions and special rules.
(a)
Establishment.
(b)
Appeals by groups.
(c)
Right to counsel; rules of evidence.
(d)
Decisions of Board.
(e)
Rules and regulations.
(f)
Finality of decision; judicial review; determinations of Board authority; jurisdiction; venue; interest on amount in controversy.
(g)
Certain findings not reviewable.
(h)
Composition and compensation.
(i)
Technical and clerical assistance.
(j)
"Provider of services" defined.
(a)
Conditions prerequisite to payment for items and services notwithstanding determination of disallowance.
(b)
Knowledge of person or provider that payment could not be made; indemnification of individual.
(c)
Knowledge of both provider and individual to whom items or services were furnished that payment could not be made.
(d)
Exercise of rights.
(e)
Payment where beneficiary not at fault.
(f)
Presumption with respect to coverage denial; rebuttal; requirements; "fiscal intermediary" defined.
(g)
Coverage denial defined.
(h)
Supplier responsibility for items furnished on assignment basis.
(a)
Eligibility for payments; conditions and requirements.
(b)
Eligibility based on submission of plan to achieve compliance with conditions and requirements; twelve-month period.
(c)
Payments into special fund for improvements to achieve compliance with conditions and requirements; certification of compliance by Secretary.
(d)
Report by Secretary; status of facilities in complying with conditions and requirements.
(a)
Type, duration, and scope of benefits.
(b)
Payments with respect to services; dialysis; regulations; physicians' services; target reimbursement rates; home dialysis supplies and equipment; self-care home dialysis support services; self-care dialysis units; hepatitis B vaccine.
(c)
Renal disease network areas; coordinating councils, executive committees, and medical review boards; national end stage renal disease medical information system; functions of network organizations.
(d)
Donors of kidney for transplant surgery.
(e)
Reimbursement of providers, facilities, and nonprofit entities for costs of artificial kidney and automated dialysis peritoneal machines for home dialysis.
(f)
Experiments, studies, and pilot projects.
(g)
Conditional approval of dialysis facilities; restriction-of-payments notice to public and facility; notice and hearing; judicial review.
(a)
Submission of policy by insurer.
(b)
Standards and requirements; periodic review by Secretary.
(c)
Requisite findings.
(d)
Criminal penalties; civil penalties for certain violations.
(e)
Dissemination of information.
(f)
Study and evaluation of comparative effectiveness of various State approaches to regulating medicare supplemental policies; report to Congress no later than January 1, 1982; periodic evaluations.
(g)
Definitions.
(h)
Rules and regulations.
(i)
Commencement of certification program.
(j)
State regulation of policies issued in other States.
(k)
Amended NAIC Model Regulation or Federal model standards applicable; effective date; medicare supplemental policy and State regulatory program meeting applicable standards.
(l)
Transitional compliance with NAIC Model Transition Regulation; "qualifying medicare supplemental policy" and "NAIC Model Transition Regulation" defined.
(m)
Revision of amended NAIC Model Regulation and amended Federal model standards; effective dates; medicare supplemental policy and State regulatory program meeting applicable standards.
(n)
Transition compliance with revision of NAIC Model Regulation and Federal model standards.
(o)
Requirements of group benefits; core group benefits; uniform outline of coverage.
(p)
Standards for group benefits.
(q)
Guaranteed renewal of policies; termination; suspension.
(r)
Required ratio of aggregate benefits to aggregate premiums.
(s)
Coverage for pre-existing conditions.
(t)
Medicare select policies.
(u)
Additional rules relating to individuals enrolled in MSA plans and in private fee-for-service plans.
(a)
Hospital facility agreements; reasonable costs of services.
(b)
Eligible facilities.
(c)
Terms and conditions of facility agreements.
(d)
Post-hospital extended care services.
(e)
Reimbursement for routine hospital services.
(f)
Conditions applicable to skilled nursing facilities.
(g)
Agreements on demonstration basis.
(a)
Transitional allowances; procedures applicable.
(b)
Allowable costs as transitional allowances; findings and determinations.
(c)
Factors determinative of transitional allowance.
(d)
Hearing to review determination.
(a)
Adjustments by Secretary.
(b)
Implementing regulations; notice, opportunity to be heard, etc.
(c)
Payment to States of amounts recovered.
(a)
Determination of costs for inpatient hospital services; limitations; exemptions; "operating costs of inpatient hospital services" defined.
(b)
Computation of payment; definitions; exemptions; adjustments.
(c)
Payment in accordance with State hospital reimbursement control system; amount of payment; discontinuance of payments.
(d)
Inpatient hospital service payments on basis of prospective rates; Medicare Geographical Classification Review Board.
(e)
Proportional adjustments in applicable percentage increases.
(f)
Reporting of costs of hospitals receiving payments on basis of prospective rates.
(g)
Prospective payment for capital-related costs; return on equity capital for hospitals.
(h)
Payments for direct graduate medical education costs.
(i)
Avoiding duplicative payments to hospitals participating in rural demonstration programs.
(j)
Prospective payment for inpatient rehabilitation services.
(k)
Payment to nonhospital providers.
(l)
Payment for nursing and allied health education for managed care enrollees.
(a)
Criteria; amount of payments.
(b)
Prohibition of recognition of payments under certain percentage agreements.
(a)
Per diem limitations.
(b)
Excess overhead allocations for hospital-based facilities.
(c)
Adjustments in limitations; publication of data.
(d)
Access to skilled nursing facilities.
(e)
Prospective payment.
(a)
Conditions of participation; protection of individual rights; notification of State entities; use of home health aides; medical equipment; individual's plan of care; compliance with Federal, State, and local laws and regulations.
(b)
Duty of Secretary.
(c)
Surveys of home health agencies.
(d)
Assessment process; reports to Congress.
(e)
Enforcement.
(f)
Intermediate sanctions.
(g)
Payment on basis of location of service.
(a)
In general.
(b)
Past-due obligation.
(c)
Collection under this section shall not be exclusive.
(d)
Collection from providers and health maintenance organizations.
(e)
Transfer from trust funds.
(a)
Establishment of Program.
(b)
Activities described.
(c)
Eligibility of entities.
(d)
Process for entering into contracts.
(e)
Limitation on contractor liability.
(a)
Receipt of benefits through enrollment in PACE program; definitions for PACE program related terms.
(b)
Scope of benefits; beneficiary safeguards.
(c)
Eligibility determinations.
(d)
Payments to PACE providers on capitated basis.
(e)
PACE program agreement.
(f)
Regulations.
(g)
Waivers of requirements.
(h)
Demonstration project for for-profit entities.
(i)
Miscellaneous provisions.
(a)
In general.
(b)
System of prospective payment for home health services.
(c)
Requirements for payment information.
(d)
Limitation on review.
(a)
Definitions.
(b)
Demonstration project.
(c)
Crediting of payments.
(d)
Waiver of certain medicare requirements.
(e)
Inspector General.
(f)
Voluntary participation.
(g)
TRICARE health care plans.
(h)
Additional plans.
(i)
Payments based on regular medicare payment rates.
(j)
Maintenance of effort.
(k)
Evaluation and reports.
SUBCHAPTER XIX-GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
(a)
Contents.
(b)
Approval by Secretary.
(c)
Lower payment levels or applying for benefits as condition of applying for, or receiving, medical assistance.
(d)
Performance of medical or utilization review functions.
(e)
Continued eligibility of families determined ineligible because of income and resources or hours of work limitations of plan; individuals enrolled with health maintenance organizations; persons deemed recipients of supplemental security income or State supplemental payments; entitlement for certain newborns; postpartum eligibility for pregnant women.
(f)
Effective date of State plan as determinative of duty of State to provide medical assistance to aged, blind, or disabled individuals.
(g)
Reduction of aid or assistance to providers of services attempting to collect from beneficiary in violation of third-party provisions.
(h)
Payments for hospitals serving disproportionate number of low-income patients and for home and community care.
(i)
Termination of certification for participation of and suspension of State payments to intermediate care facilities for the mentally retarded.
(j)
Waiver or modification of subchapter requirements with respect to medical assistance program in American Samoa.
(k)
Repealed.
(l)
Description of group.
(m)
Description of individuals.
(n)
Payment amounts.
(o)
Certain benefits disregarded for purposes of determining post-eligibility contributions.
(p)
Exclusion power of State; exclusion as prerequisite for medical assistance payments; "exclude" defined.
(q)
Minimum monthly personal needs allowance deduction; "institutionalized individual or couple" defined.
(r)
Disregarding payments for certain medical expenses by institutionalized individuals.
(s)
Adjustment in payment for hospital services furnished to low-income children under age of 6 years.
(t)
Limitation on payments to States for expenditures attributable to taxes.
(u)
Qualified COBRA continuation beneficiaries.
(v)
State agency disability and blindness determinations for medical assistance eligibility.
(w)
Maintenance of written policies and procedures respecting advance directives.
(x)
Physician identifier system; establishment.
(y)
Intermediate sanctions for psychiatric hospitals.
(z)
Optional coverage of TB-related services.
(a)
Computation of amount.
(b)
Quarterly expenditures beginning after December 31, 1969.
(c)
Treatment of educationally-related services.
(d)
Estimates of State entitlement; installments; adjustments to reflect overpayments or underpayments; time for recovery or adjustment; uncollectable or discharged debts; obligated appropriations; disputed claims.
(e)
Transition costs of closures or conversions permitted.
(f)
Limitation on Federal participation in medical assistance.
(g)
Decrease in Federal medical assistance percentage of amounts paid for services furnished under State plan after June 30, 1973.
(h)
Repealed.
(i)
Payment for organ transplants; item or service furnished by excluded individual, entity, or physician; other restrictions.
(j)
Adjustment of amount.
(k)
Technical assistance to States.
(l)
Repealed.
(m)
"Medicaid managed care organization" defined; duties and functions of Secretary; payments to States; reporting requirements; remedies.
(n)
Repealed.
(o)
Restrictions on authorized payments to States.
(p)
Assignment of rights of payment; incentive payments for enforcement and collection.
(q)
"State medicaid fraud control unit" defined.
(r)
Mechanized claims processing and information retrieval systems; operational, etc., requirements.
(s)
Limitations on certain physician referrals.
(t)
Repealed.
(u)
Limitation of Federal financial participation in erroneous medical assistance expenditures.
(v)
Medical assistance to aliens not lawfully admitted for permanent residence.
(w)
Prohibition on use of voluntary contributions, and limitation on use of provider-specific taxes to obtain Federal financial participation under medicaid.
(a)
Medical assistance.
(b)
Federal medical assistance percentage; State percentage; Indian health care percentage.
(c)
Nursing facility.
(d)
Intermediate care facility for mentally retarded.
(e)
Physicians' services.
(f)
Nursing facility services.
(g)
Chiropractors' services.
(h)
Inpatient psychiatric hospital services for individuals under age 21.
(i)
Institution for mental diseases.
(j)
State supplementary payment.
(k)
Supplemental security income benefits.
(l)
Rural health clinics.
(m)
Qualified family member.
(n)
"Qualified pregnant woman or child" defined.
(o)
Optional hospice benefits.
(p)
Qualified medicare beneficiary; medicare cost-sharing.
(q)
Qualified severely impaired individual.
(r)
Early and periodic screening, diagnostic, and treatment services.
(s)
Qualified disabled and working individual.
(t)
Primary care case management services; primary care case manager; primary care case management contract; and primary care.
(u)
Conditions for State plans.
(v)
Employed individual with a medically improved disability.
(w)
Independent foster care adolescent.
(a)
Requirements of each State plan; guidelines.
(b)
Timing of enrollment; failure to enroll.
(c)
Premiums considered payments for medical assistance; eligibility.
(d)
Repealed.
(e)
Definitions.
(a)
Nature of State program.
(b)
Licensing by State agency or board representative of concerned professions and institutions.
(c)
Functions and duties of State agency or board.
(d)
Waiver of standards other than good character or suitability standards.
(e)
"Nursing home" and "nursing home administrator" defined.
(a)
In general.
(b)
"Insurer" defined.
(a)
Eligibility for reimbursement for medical assistance.
(b)
Facilities deemed to meet requirements upon submission of acceptable plan for achieving compliance.
(c)
Agreement to reimburse State agency for providing care and services.
(a)
Adjustment of Federal matching payments.
(b)
Reductions in payments to and by States.
(c)
Notice.
(d)
Regulations.
(e)
Restoration to trust funds of recovered amounts.
(f)
Liability of States for withheld payments.
(a)
Activities deemed as compliance.
(b)
Waivers to promote cost-effectiveness and efficiency.
(c)
Waiver respecting medical assistance requirement in State plan; scope, etc.; "habilitation services" defined; imposition of certain regulatory limits prohibited; computation of expenditures for certain disabled patients; coordinated services; substitution of participants.
(d)
Home and community-based services for elderly.
(e)
Waiver for children infected with AIDS or drug dependent at birth.
(f)
Monitor of implementation of waivers; termination of waiver for noncompliance; time limitation for action on requests for plan approval, amendments, or waivers.
(g)
Optional targeted case management services.
(h)
Period of waivers; continuations.
(a)
Imposition of certain charges under plan in case of individuals described in section 1396a(a)(10)(A) or (E).
(b)
Imposition of certain charges under plan in case of individuals other than those described in section 1396a(a)(10)(A) or (E).
(c)
Imposition of monthly premium; persons affected; amount; prepayment; failure to pay; use of funds from other programs.
(d)
Premiums for qualified disabled and working individuals described in section 1396d(s).
(e)
Prohibition of denial of services on basis of individual's inability to pay certain charges.
(f)
Charges imposed under waiver authority of Secretary.
(g)
Individuals provided medical assistance under section 1396a(a)(10)(A)(ii)(XV) or (XVI).
(a)
Imposition of lien against property of an individual on account of medical assistance rendered to him under a State plan.
(b)
Adjustment or recovery of medical assistance correctly paid under a State plan.
(c)
Taking into account certain transfers of assets.
(d)
Treatment of trust amounts.
(e)
Definitions.
(a)
"Nursing facility" defined.
(b)
Requirements relating to provision of services.
(c)
Requirements relating to residents' rights.
(d)
Requirements relating to administration and other matters.
(e)
State requirements relating to nursing facility requirements.
(f)
Responsibilities of Secretary relating to nursing facility requirements.
(g)
Survey and certification process.
(h)
Enforcement process.
(i)
Construction.
(a)
Ambulatory prenatal care.
(b)
Definitions.
(c)
Duties of State agency, qualified providers, and presumptively eligible pregnant women.
(d)
Ambulatory prenatal care as medical assistance.
(a)
In general.
(b)
Definitions; regulations.
(c)
Application for medical assistance; procedure upon determination of presumptive eligibility.
(d)
Treatment of medical assistance.
(a)
Information reporting requirement.
(b)
Form of information.
(c)
Confidentiality of information provided.
(d)
Appropriate coordination.
(a)
Written plans to remedy substantial deficiencies; time for submission.
(b)
Conditions for approval of reduction plans.
(c)
Contents of reduction plan.
(d)
Notice and comment; approval of more than 15 reduction plans in any fiscal year; corrections costing $2,000,000 or more.
(e)
Termination of provider agreements; disallowance of percentage amounts for purposes of Federal financial participation.
(f)
Applicability of section limited to plans approved by January 1, 1990.
(a)
Implementation of requirement.
(b)
Hospitals deemed disproportionate share.
(c)
Payment adjustment.
(d)
Requirements to qualify as disproportionate share hospital.
(e)
Special rule.
(f)
Limitation on Federal financial participation.
(g)
Limit on amount of payment to hospital.
(h)
Limitation on certain State DSH expenditures.
(i)
Requirement for direct payment.
(a)
Special treatment for institutionalized spouses.
(b)
Rules for treatment of income.
(c)
Rules for treatment of resources.
(d)
Protecting income for community spouse.
(e)
Notice and fair hearing.
(f)
Permitting transfer of resources to community spouse.
(g)
Indexing dollar amounts.
(h)
Definitions.
(a)
Initial 6-month extension.
(b)
Additional 6-month extension.
(c)
Applicability in States and territories.
(d)
General disqualification for fraud.
(e)
"Caretaker relative" defined.
(f)
Sunset.
(a)
Requirement for rebate agreement.
(b)
Terms of rebate agreement.
(c)
Determination of amount of rebate.
(d)
Limitations on coverage of drugs.
(e)
Treatment of pharmacy reimbursement limits.
(f)
Repealed and redesignated.
(g)
Drug use review.
(h)
Electronic claims management.
(i)
Annual report.
(j)
Exemption of organized health care settings.
(k)
Definitions.
(a)
Establishment of program.
(b)
Vaccine-eligible children.
(c)
Program-registered providers.
(d)
Negotiation of contracts with manufacturers.
(e)
Use of pediatric vaccines list.
(f)
Requirement of State maintenance of immunization laws.
(g)
Termination.
(h)
Definitions.
(a)
"Home and community care" defined.
(b)
"Functionally disabled elderly individual" defined.
(c)
Determinations of functional disability.
(d)
Individual community care plan (ICCP).
(e)
Ceiling on payment amounts and maintenance of effort.
(f)
Minimum requirements for home and community care.
(g)
Minimum requirements for small community care settings.
(h)
Minimum requirements for large community care settings.
(i)
Survey and certification process.
(j)
Enforcement process for providers of community care.
(k)
Secretarial responsibilities.
(l)
Waiver of statewideness.
(m)
Limitation on amount of expenditures as medical assistance.
(a)
Community supported living arrangements services.
(b)
"Developmentally disabled individual" defined.
(c)
Criteria for selection of participating States.
(d)
Quality assurance.
(e)
Maintenance of effort.
(f)
Excluded services.
(g)
Waiver of requirements.
(h)
Minimum protections.
(i)
Treatment of funds.
(j)
Limitation on amounts of expenditures as medical assistance.
(a)
References to subchapter IV–A are references to pre-welfare-reform provisions.
(b)
Application of pre-welfare-reform eligibility criteria.
(c)
Treatment for purposes of transitional coverage provisions.
(d)
Waivers.
(e)
State option to use 1 application form.
(f)
Additional rules of construction.
(g)
Relation to other provisions.
(h)
Transitional increased Federal matching rate for increased administrative costs.
(i)
Welfare reform effective date.
(a)
State option to use managed care.
(b)
Beneficiary protections.
(c)
Quality assurance standards.
(d)
Protections against fraud and abuse.
(e)
Sanctions for noncompliance.
(f)
Timeliness of payment.
(a)
In general.
(b)
Selection of qualifying individuals.
(c)
Allocation.
(d)
Applicable FMAP.
(e)
Limitation on entitlement.
(f)
Coverage of costs through part B of medicare program.
(a)
State option.
(b)
Scope of benefits; beneficiary safeguards.
(c)
Eligibility determinations.
(d)
Payments to PACE providers on a capitated basis.
(e)
PACE program agreement.
(f)
Regulations.
(g)
Waivers of requirements.
(h)
Demonstration project for for-profit entities.
(i)
Post-eligibility treatment of income.
(j)
Miscellaneous provisions.
(a)
Authority or requirements to cover additional individuals.
(b)
Additional State plan requirements.
SUBCHAPTER XX-BLOCK GRANTS TO STATES FOR SOCIAL SERVICES
(a)
Amount; covered services.
(b)
Funding requirements.
(c)
Expenditure of funds.
(d)
Transfers of funds.
(e)
Use of portion of funds.
(f)
Authority to use vouchers.
(a)
Computation of amounts for jurisdictions of Puerto Rico, Guam, etc.
(b)
Computation of amounts for each State other than jurisdictions of Puerto Rico, Guam, etc.
(c)
Appropriations.
(a)
Reporting requirements; form, contents, etc.
(b)
Audits; implementation, etc.
(c)
State reports on expenditure and use of social services funds.
(d)
Additional accounting requirements.
(a)
Entitlement.
(b)
Program options.
(c)
Use of grants.
(d)
Remittance of certain amounts.
(e)
Reallocation of remaining funds.
(f)
Definitions.
SUBCHAPTER XXI-STATE CHILDREN'S HEALTH INSURANCE PROGRAM
(a)
Purpose.
(b)
State child health plan required.
(c)
State entitlement.
(d)
Effective date.
(a)
General background and description.
(b)
General description of eligibility standards and methodology.
(c)
Outreach and coordination.
(a)
Required scope of health insurance coverage.
(b)
Benchmark benefit packages.
(c)
Categories of services; determination of actuarial value of coverage.
(d)
Description of existing comprehensive State-based coverage.
(e)
Cost-sharing.
(f)
Application of certain requirements.
(a)
Appropriation; total allotment.
(b)
Allotments to 50 States and District of Columbia.
(c)
Allotments to territories.
(d)
Certain medicaid expenditures counted against individual State allotments.
(e)
3-year availability of amounts allotted.
(f)
Procedure for redistribution of unused allotments.
(a)
In general.
(b)
Enhanced FMAP.
(c)
Limitation on certain payments for certain expenditures.
(d)
Maintenance of effort.
(e)
Advance payment; retrospective adjustment.
(f)
Flexibility in submittal of claims.
(a)
Initial plan.
(b)
Plan amendments.
(c)
Disapproval of plans and plan amendments.
(d)
Program operation.
(e)
Continued approval.
(a)
Strategic objectives and performance goals.
(b)
Records, reports, audits, and evaluation.
(c)
Program development process.
(d)
Program budget.
(e)
Application of certain general provisions.
(a)
Annual report.
(b)
State evaluations.
(c)
Federal evaluation.
(d)
Inspector General audit and GAO report.
(a)
Relation to other laws.
(b)
Adjustment to Current Population Survey to include State-by-State data relating to children without health insurance coverage.
(a)
Child health assistance.
(b)
"Targeted low-income child" defined.
(c)
Additional definitions.
Chapter Referred to in Other Sections
This chapter is referred to in sections 256b, 299a, 907a, 1437f, 4636, 11606, 12637, 13021 of this title; title 2 section 651; title 5 sections 8403, 8442; title 7 sections 2012, 2015; title 8 section 1324a; title 12 section 1701z–11; title 22 sections 3968, 4071i; title 25 sections 13d, 459e, 609c–1, 640d–21, 1264, 1300d–25, 1407, 1408, 2307, 3304; title 26 sections 86, 162, 401, 412, 415, 1402, 6103; title 29 sections 716, 728, 1082, 1552, 2931; title 31 sections 1516, 3701, 3716; title 38 sections 5303A, 8126; title 40 App. section 202; title 43 section 1626; title 45 sections 231, 231a, 231b, 231c, 231d, 231e, 231f, 231q, 231r, 231u; title 50 App. section 1291.