§1395b. Option to individuals to obtain other health insurance protection

Nothing contained in this subchapter shall be construed to preclude any State from providing, or any individual from purchasing or otherwise securing, protection against the cost of any health services.

(Aug. 14, 1935, ch. 531, title XVIII, §1803, as added Pub. L. 89–97, title I, §102(a), July 30, 1965, 79 Stat. 291 .)

Impact of Increased Investments in Health Research on Future Medicare Costs

Pub. L. 105–78, title II, Nov. 13, 1997, 111 Stat. 1484 , provided in part: "That in carrying out its legislative mandate, the National Bipartisan Commission on the Future of Medicare shall examine the impact of increased investments in health research on future Medicare costs, and the potential for coordinating Medicare with cost-effective long-term care services".

National Bipartisan Commission on the Future of Medicare

Pub. L. 105–33, title IV, §4021, Aug. 5, 1997, 111 Stat. 347 , provided that:

"(a) Establishment.-There is established a commission to be known as the National Bipartisan Commission on the Future of Medicare (in this section referred to as the 'Commission').

"(b) Duties of the Commission.-The Commission shall-

"(1) review and analyze the long-term financial condition of the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.);

"(2) identify problems that threaten the financial integrity of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund established under that title (42 U.S.C. 1395i, 1395t), including-

"(A) the financial impact on the medicare program of the significant increase in the number of medicare eligible individuals which will occur beginning approximately during 2010 and lasting for approximately 25 years, and

"(B) the extent to which current medicare update indexes do not accurately reflect inflation;

"(3) analyze potential solutions to the problems identified under paragraph (2) that will ensure both the financial integrity of the medicare program and the provision of appropriate benefits under such program, including methods used by other nations to respond to comparable demographic patterns in eligibility for health care benefits for elderly and disabled individuals and trends in employment-related health care for retirees;

"(4) make recommendations to restore the solvency of the Federal Hospital Insurance Trust Fund and the financial integrity of the Federal Supplementary Medical Insurance Trust Fund;

"(5) make recommendations for establishing the appropriate financial structure of the medicare program as a whole;

"(6) make recommendations for establishing the appropriate balance of benefits covered and beneficiary contributions to the medicare program;

"(7) make recommendations for the time periods during which the recommendations described in paragraphs (4), (5), and (6) should be implemented;

"(8) make recommendations regarding the financing of graduate medical education (GME), including consideration of alternative broad-based sources of funding for such education and funding for institutions not currently eligible for such GME support that conduct approved graduate medical residency programs, such as children's hospitals;

"(9) make recommendations on modifying age-based eligibility to correspond to changes in age-based eligibility under the OASDI program and on the feasibility of allowing individuals between the age of 62 and the medicare eligibility age to buy into the medicare program;

"(10) make recommendations on the impact of chronic disease and disability trends on future costs and quality of services under the current benefit, financing, and delivery system structure of the medicare program;

"(11) make recommendations regarding a comprehensive approach to preserve the program; and

"(12) review and analyze such other matters as the Commission deems appropriate.

"(c) Membership.-

"(1) Number and appointment.-The Commission shall be composed of 17 members, of whom-

"(A) four shall be appointed by the President;

"(B) six shall be appointed by the Majority Leader of the Senate, in consultation with the Minority Leader of the Senate, of whom not more than 4 shall be of the same political party;

"(C) six shall be appointed by the Speaker of the House of Representatives, in consultation with the Minority Leader of the House of Representatives, of whom not more than 4 shall be of the same political party; and

"(D) one, who shall serve as Chairman of the Commission, appointed jointly by the President, Majority Leader of the Senate, and the Speaker of the House of Representatives.

"(2) Deadline for appointment.-Members of the Commission shall be appointed by not later than December 1, 1997.

"(3) Terms of appointment.-The term of any appointment under paragraph (1) to the Commission shall be for the life of the Commission.

"(4) Meetings.-The Commission shall meet at the call of its Chairman or a majority of its members.

"(5) Quorum.-A quorum shall consist of 8 members of the Commission, except that 4 members may conduct a hearing under subsection (e).

"(6) Vacancies.-A vacancy on the Commission shall be filled in the same manner in which the original appointment was made not later than 30 days after the Commission is given notice of the vacancy and shall not affect the power of the remaining members to execute the duties of the Commission.

"(7) Compensation.-Members of the Commission shall receive no additional pay, allowances, or benefits by reason of their service on the Commission.

"(8) Expenses.-Each member of the Commission shall receive travel expenses and per diem in lieu of subsistence in accordance with sections 5702 and 5703 of title 5, United States Code.

"(d) Staff and Support Services.-

"(1) Executive director.-

"(A) Appointment.-The Chairman shall appoint an executive director of the Commission.

"(B) Compensation.-The executive director shall be paid the rate of basic pay for level V of the Executive Schedule.

"(2) Staff.-With the approval of the Commission, the executive director may appoint such personnel as the executive director considers appropriate.

"(3) Applicability of civil service laws.-The staff of the Commission shall be appointed without regard to the provisions of title 5, United States Code, governing appointments in the competitive service, and shall be paid without regard to the provisions of chapter 51 and subchapter III of chapter 53 of such title (relating to classification and General Schedule pay rates).

"(4) Experts and consultants.-With the approval of the Commission, the executive director may procure temporary and intermittent services under section 3109(b) of title 5, United States Code.

"(5) Physical facilities.-The Administrator of the General Services Administration shall locate suitable office space for the operation of the Commission. The facilities shall serve as the headquarters of the Commission and shall include all necessary equipment and incidentals required for the proper functioning of the Commission.

"(e) Powers of Commission.-

"(1) Hearings and other activities.-For the purpose of carrying out its duties, the Commission may hold such hearings and undertake such other activities as the Commission determines to be necessary to carry out its duties.

"(2) Studies by gao.-Upon the request of the Commission, the Comptroller General shall conduct such studies or investigations as the Commission determines to be necessary to carry out its duties.

"(3) Cost estimates by congressional budget office and office of the chief actuary of hcfa.-

"(A) The Director of the Congressional Budget Office or the Chief Actuary of the Health Care Financing Administration, or both, shall provide to the Commission, upon the request of the Commission, such cost estimates as the Commission determines to be necessary to carry out its duties.

"(B) The Commission shall reimburse the Director of the Congressional Budget Office for expenses relating to the employment in the office of the Director of such additional staff as may be necessary for the Director to comply with requests by the Commission under subparagraph (A).

"(4) Detail of federal employees.-Upon the request of the Commission, the head of any Federal agency is authorized to detail, without reimbursement, any of the personnel of such agency to the Commission to assist the Commission in carrying out its duties. Any such detail shall not interrupt or otherwise affect the civil service status or privileges of the Federal employee.

"(5) Technical assistance.-Upon the request of the Commission, the head of a Federal agency shall provide such technical assistance to the Commission as the Commission determines to be necessary to carry out its duties.

"(6) Use of mails.-The Commission may use the United States mails in the same manner and under the same conditions as Federal agencies and shall, for purposes of the frank, be considered a commission of Congress as described in section 3215 of title 39, United States Code.

"(7) Obtaining information.-The Commission may secure directly from any Federal agency information necessary to enable it to carry out its duties, if the information may be disclosed under section 552 of title 5, United States Code. Upon request of the Chairman of the Commission, the head of such agency shall furnish such information to the Commission.

"(8) Administrative support services.-Upon the request of the Commission, the Administrator of General Services shall provide to the Commission on a reimbursable basis such administrative support services as the Commission may request.

"(9) Printing.-For purposes of costs relating to printing and binding, including the cost of personnel detailed from the Government Printing Office, the Commission shall be deemed to be a committee of the Congress.

"(f) Report.-Not later than March 1, 1999, the Commission shall submit a report to the President and Congress which shall contain a detailed statement of only those recommendations, findings, and conclusions of the Commission that receive the approval of at least 11 members of the Commission.

"(g) Termination.-The Commission shall terminate 30 days after the date of submission of the report required in subsection (f).

"(h) Authorization of Appropriations.-There are authorized to be appropriated $1,500,000 to carry out this section. 60 percent of such appropriation shall be payable from the Federal Hospital Insurance Trust Fund, and 40 percent of such appropriation shall be payable from the Federal Supplementary Medical Insurance Trust Fund under title XVIII of the Social Security Act (42 U.S.C. 1395i, 1395t)."

Exclusion From Wages and Compensation of Refunds Required From Employers To Compensate for Duplication of Medicare Benefits by Health Care Benefits Provided by Employers

Pub. L. 101–239, title X, §10202, Dec. 19, 1989, 103 Stat. 2473 , provided that:

"(a) Old-Age, Survivors, and Disability, and Hospital Insurance Programs.-For purposes of title II of the Social Security Act [subchapter II of this chapter] and chapter 21 of the Internal Revenue Code of 1986 [26 U.S.C. 3101 et seq.], the term 'wages' shall not include the amount of any refund required under section 421 of the Medicare Catastrophic Coverage Act of 1988 [section 421 of Pub. L. 100–360, formerly set out as a note below].

"(b) Railroad Retirement Program.-For purposes of chapter 22 of the Internal Revenue Code of 1986 [26 U.S.C. 3201 et seq.], the term 'compensation' shall not include the amount of any refund required under section 421 of the Medicare Catastrophic Coverage Act of 1988.

"(c) Federal Unemployment Programs.-

"(1) Federal unemployment tax.-For purposes of chapter 23 of the Internal Revenue Code of 1986 [26 U.S.C. 3301 et seq.], the term 'wages' shall not include the amount of any refund required under section 421 of the Medicare Catastrophic Coverage Act of 1988.

"(2) Railroad unemployment contributions.-For purposes of the Railroad Unemployment Insurance Act [45 U.S.C. 351 et seq.], the term 'compensation' shall not include the amount of any refund required under section 421 of the Medicare Catastrophic Coverage Act of 1988.

"(3) Railroad unemployment repayment tax.-For purposes of chapter 23A of the Internal Revenue Code of 1986 [26 U.S.C. 3321 et seq.], the term 'rail wages' shall not include the amount of any refund required under section 421 of the Medicare Catastrophic Coverage Act of 1988.

"(d) Reporting Requirements.-Any refund required under section 421 of the Medicare Catastrophic Coverage Act of 1988 shall be reported to the Secretary of the Treasury or his delegate and to the person to whom such refund is made in such manner as the Secretary of the Treasury or his delegate shall prescribe.

"(e) Effective Date.-This section shall apply with respect to refunds provided on or after January 1, 1989."

United States Bipartisan Commission on Comprehensive Health Care

Pub. L. 100–360, title IV, subtitle A, §§401–408, July 1, 1988, 102 Stat. 765–768 , as amended by Pub. L. 100–647, title VIII, §8414, Nov. 10, 1988, 102 Stat. 3801 ; Pub. L. 101–239, title VI, §6220, Dec. 19, 1989, 103 Stat. 2254 , provided that:

"SEC. 401. ESTABLISHMENT.

"There is established a commission to be known as the United States Bipartisan Commission on Comprehensive Health Care (in this title [probably should be 'this subtitle' which enacted this note] referred to as the 'Commission') and also to be known as the 'Claude Pepper Commission' or the 'Pepper Commission'.

"SEC. 402. DUTIES.

"(a) In General.-The Commission shall-

"(1) examine shortcomings in the current health care delivery and financing mechanisms that limit or prevent access of all individuals in the United States to comprehensive health care, and

"(2) make specific recommendations to the Congress respecting Federal programs, policies, and financing needed to assure the availability of-

"(A) comprehensive long-term care services for the elderly and disabled,

"(B) comprehensive health care services for the elderly and disabled, and

"(C) comprehensive health care services for all individuals in the United States.

"(b) Considerations in Recommendations.-In making its recommendations, the Commission shall consider-

"(1) the amount and sources (consistent with principles of social insurance) of Federal funds to finance the needed services, including reallocations of existing Federal program funds, and

"(2) the most efficient and effective manner of administering such programs.

"(c) Definitions.-In this title [probably should be 'this subtitle' which enacted this note]:

"(1) The term 'comprehensive health care services' includes-

"(A) inpatient hospital services (including mental health services);

"(B) skilled nursing facility services, intermediate care facility services, home health services, and other long-term health care services;

"(C) physician services and other outpatient health care services (including mental health services);

"(D) periodic general physical examinations, eye examinations, hearing examinations, dental examinations, foot examinations, and other preventive health care services; and

"(E) prescription drugs, eyeglasses, hearing aids, orthopedic equipment, and dentures (both complete and partial).

"(2) The term 'comprehensive long-term care services' includes custodial and noncustodial services in facilities, as well as home and community-based services.

"SEC. 403. MEMBERSHIP.

"(a) Appointment.-The Commission shall be composed of 15 members appointed as follows:

"(1) The President shall appoint 3 members.

"(2) The President pro tempore of the Senate shall appoint, after consultation with the minority leader of the Senate, 6 members of the Senate, of whom not more than 4 may be of the same political party.

"(3) The Speaker of the House of Representatives shall appoint, after consultation with the minority leader of the House of Representatives, 6 members of the House, of whom not more than 4 may be of the same political party.

"(b) Chairman and Vice Chairmen.-The Commission shall elect a chairman and 4 vice chairmen from among its members.

"(c) Vacancies.-Any vacancy in the membership of the Commission shall be filled in the manner in which the original appointment was made and shall not affect the power of the remaining members to execute the duties of the Commission.

"(d) Quorum.-A quorum shall consist of 8 members of the Commission, except that 4 members may conduct a hearing under section 405(a).

"(e) Meetings.-The Commission shall meet at the call of its chairman or a majority of its members.

"(f) Compensation and Reimbursement of Expenses.-Members of the Commission are not entitled to receive compensation for service on the Commission. Members may be reimbursed for travel, subsistence, and other necessary expenses incurred in carrying out the duties of the Commission.

"SEC. 404. STAFF AND CONSULTANTS.

"(a) Staff.-The Commission may appoint and determine the compensation of such staff as may be necessary to carry out the duties of the Commission. Such appointments and compensation may be made without regard to the provisions of title 5, United States Code, that govern appointments in the competitive services, and the provisions of chapter 51 and subchapter III of chapter 53 of such title that relate to classifications and the General Schedule pay rates.

"(b) Consultants.-The Commission may procure such temporary and intermittent services of consultants under section 3109(b) of title 5, United States Code, as the Commission determines to be necessary to carry out the duties of the Commission.

"SEC. 405. POWERS.

"(a) Hearings and Other Activities.-For the purpose of carrying out its duties, the Commission may hold such hearings and undertake such other activities as the Commission determines to be necessary to carry out its duties.

"(b) Studies by General Accounting Office.-Upon the request of the Commission, the Comptroller General shall conduct such studies or investigations as the Commission determines to be necessary to carry out its duties.

"(c) Cost Estimates by Congressional Budget Office.-

"(1) Upon the request of the Commission, the Director of the Congressional Budget Office shall provide to the Commission such cost estimates as the Commission determines to be necessary to carry out its duties.

"(2) The Commission shall reimburse the Director of the Congressional Budget Office for expenses relating to the employment in the office of the Director of such additional staff as may be necessary for the Director to comply with requests by the Commission under paragraph (1).

"(d) Detail of Federal Employees.-Upon the request of the Commission, the head of any Federal agency is authorized to detail, without reimbursement, any of the personnel of such agency to the Commission to assist the Commission in carrying out its duties. Any such detail shall not interrupt or otherwise affect the civil service status or privileges of the Federal employee.

"(e) Technical Assistance.-Upon the request of the Commission, the head of a Federal agency shall provide such technical assistance to the Commission as the Commission determines to be necessary to carry out its duties.

"(f) Use of Mails.-The Commission may use the United States mails in the same manner and under the same conditions as Federal agencies, and shall, for purposes of the frank, be considered a commission of Congress as described in section 3215 of title 39, United States Code.

"(g) Obtaining Information.-The Commission may secure directly from any Federal agency information necessary to enable it to carry out its duties, if the information may be disclosed under section 552 of title 5, United States Code. Upon request of the Chairman of the Commission, the head of such agency shall furnish such information to the Commission.

"(h) Administrative Support Services.-Upon the request of the Commission, the Administrator of General Services shall provide to the Commission on a reimbursable basis such administrative support services as the Commission may request.

"(i) Acceptance of Donations.-The Commission may accept, use, and dispose of gifts or donations of services or property.

"(j) Printing.-For purposes of costs relating to printing and binding, including the costs of personnel detailed from the Government Printing Office, the Commission shall be deemed to be a committee of the Congress.

"SEC. 406. REPORT.

"(a) Report on Comprehensive Long-Term Care Services for the Elderly and Disabled.-The Commission shall submit to Congress a report containing its findings and recommendations regarding comprehensive long-term care services for the elderly and disabled. The report shall include detailed recommendations for appropriate legislative initiatives respecting such services.

"(b) Report on Comprehensive Health Care Services.-The Commission shall submit to Congress a report containing its findings and recommendations regarding comprehensive health care services for the elderly and disabled and comprehensive health care services for all individuals in the United States. The report shall include detailed recommendations for appropriate legislative initiatives respecting such services.

"(c) Deadlines.-The two reports required under this section shall be submitted concurrently by not later than November 9, 1989.

"SEC. 407. TERMINATION.

"The Commission shall terminate 30 days after the date of submission of the report required in section 406(b).

"SEC. 408. AUTHORIZATION OF APPROPRIATIONS.

"There are authorized to be appropriated $1,500,000 to carry out this title [probably should be 'this subtitle' which enacted this note]."

Maintenance of Effort Regarding Duplicative Benefits

Pub. L. 100–360, title IV, §421, July 1, 1988, 102 Stat. 808 , as amended by Pub. L. 100–485, title VI, §608(a), Oct. 13, 1988, 102 Stat. 2411 , which required employers who had been providing health care benefits to employees that were duplicative part A and part B benefits to provide the employees with additional benefits equal to the total actuarial value of such duplicative benefits, was repealed by Pub. L. 101–234, title III, §301(a), Dec. 13, 1989, 103 Stat. 1985 . [Repeal not applicable to duplicative part A benefits for periods before Jan. 1, 1990, see section 301(e)(1) of Pub. L. 101–234, set out as an Effective Date of 1989 Amendment note under section 1395u of this title.]

Task Force on Long-Term Health Care Policies

Pub. L. 99–272, title IX, §9601, Apr. 7, 1986, 100 Stat. 221 , as amended by Pub. L. 105–362, title VI, §601(b)(3), Nov. 10, 1998, 112 Stat. 3286 , provided that:

"(a) Establishment of Task Force.-(1) [sic] The Secretary of Health and Human Services (hereinafter in this section referred to as the 'Secretary') shall establish a Task Force on Long-Term Health Care Policies (hereinafter in this section referred to as the 'Task Force'). The Task Force shall be established not later than 60 days after the date of the enactment of this Act [Apr. 7, 1986] and in consultation with the National Association of Insurance Commissioners.

"(b) Composition of Task Force.-The Task Force shall be composed of 18 members, which shall include-

"(1) two members representing the National Association of Insurance Commissioners,

"(2) three members representing Federal and State agencies with responsibilities relating to health or the elderly,

"(3) three members representing private insurers,

"(4) three members from organizations representing consumers or the elderly, and

"(5) three members from organizations representing providers of long-term health care services.

The Secretary shall designate a member of the Task Force as chair.

"(c) Development of Recommendations.-The Task Force shall develop recommendations for long-term health care policies, including recommendations designed-

"(1) to limit marketing and agent abuse for those policies,

"(2) to assure the dissemination of such information to consumers as is necessary to permit informed choice in purchasing the policies and to reduce the purchase of unnecessary or duplicative coverage,

"(3) to assure that benefits provided under the policies are reasonable in relationship to premiums charged, and

"(4) to promote the development and availability of long-term health care policies which meet these recommendations.

"(d) Report.-Not later than 18 months after the date of the enactment of this Act [Apr. 7, 1986], the Task Force shall report to the Secretary, to the Committee on Energy and Commerce of the House of Representatives and to the Committee on Labor and Human Resources of the Senate respecting-

"(1) the recommendations developed under subsection (c), including an explanation of the reasons for their selection, and

"(2) such recommendations for additional activities respecting long-term health care policies as the Task Force finds appropriate.

The Secretary, in cooperation with the National Association of Insurance Commissioners, shall provide for the dissemination of the report to each of the States.

"(e) Termination of Task Force.-The Task Force shall terminate 90 days after the date of submission of the report required under subsection (d).

"[(f) Repealed. Pub. L. 105–362, title VI, §601(b)(3), Nov. 10, 1998, 112 Stat. 3286 .]

"(g) Long-Term Health Care Policy Defined.-In this section, the term 'long-term health care policy' means an insurance policy, or similar health benefits plan, which is designed for or marketed as providing (or making payments for) health care services (such as nursing home care and home health care) or related services (which may include home and community-based services), or both, over an extended period of time.

"(h) Assurance of States' Jurisdiction.-Nothing in this section shall be construed as recommending Federal preemption of the States in overseeing the operation and regulation of insurance carriers in their respective jurisdictions."