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42 U.S.C. § 1395ccc — Medicare coverage for individuals exposed to environmental health hazards
Federal law — U.S. Code and appendices · legal_authorities
**(a) Deeming of individuals as eligible for medicare benefits**
(1) **In general** — For purposes of eligibility for benefits under this subchapter, an individual determined under subsection (c) to be an environmental exposure affected individual described in subsection (e)(2) shall be deemed to meet the conditions specified in [section 426(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426/a&num=0&edition=prelim).
(2) **Discretionary deeming** — For purposes of eligibility for benefits under this subchapter, the Secretary may deem an individual determined under subsection (c) to be an environmental exposure affected individual described in subsection (e)(3) to meet the conditions specified in [section 426(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426/a&num=0&edition=prelim).
(3) **Effective date of coverage** — An Individual 11 So in original. Probably should not be capitalized. who is deemed eligible for benefits under this subchapter under paragraph (1) or (2) shall be—
(A) entitled to benefits under the program under Part 1 A as of the date of such deeming; and
(B) eligible to enroll in the program under Part 1 B beginning with the month in which such deeming occurs.
**(b) Pilot program for care of certain individuals residing in emergency declaration areas**
(1) **Program; purpose**
(A) *Primary pilot program* — The Secretary shall establish a pilot program in accordance with this subsection to provide innovative approaches to furnishing comprehensive, coordinated, and cost-effective care under this subchapter to individuals described in paragraph (2)(A).
(B) *Optional pilot programs* — The Secretary may establish a separate pilot program, in accorda
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Stable record: federal_law:legal_authorities:record_usc_0575c7cb5efb0039294126b3
Source file: Laws/federal/codes/united-states-code/title-42/section-1395ccc-medicare-coverage-for-individuals-exposed-to-environmental-health-hazard--ae4e45ee59.md
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Source location: Title 42, Chapter 7, § 1395ccc; chapter-007-social-security.md
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**(a) Deeming of individuals as eligible for medicare benefits**
(1) **In general** — For purposes of eligibility for benefits under this subchapter, an individual determined under subsection (c) to be an environmental exposure affected individual described in subsection (e)(2) shall be deemed to meet the conditions specified in [section 426(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426/a&num=0&edition=prelim).
(2) **Discretionary deeming** — For purposes of eligibility for benefits under this subchapter, the Secretary may deem an individual determined under subsection (c) to be an environmental exposure affected individual described in subsection (e)(3) to meet the conditions specified in [section 426(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426/a&num=0&edition=prelim).
(3) **Effective date of coverage** — An Individual 11 So in original. Probably should not be capitalized. who is deemed eligible for benefits under this subchapter under paragraph (1) or (2) shall be—
(A) entitled to benefits under the program under Part 1 A as of the date of such deeming; and
(B) eligible to enroll in the program under Part 1 B beginning with the month in which such deeming occurs.
**(b) Pilot program for care of certain individuals residing in emergency declaration areas**
(1) **Program; purpose**
(A) *Primary pilot program* — The Secretary shall establish a pilot program in accordance with this subsection to provide innovative approaches to furnishing comprehensive, coordinated, and cost-effective care under this subchapter to individuals described in paragraph (2)(A).
(B) *Optional pilot programs* — The Secretary may establish a separate pilot program, in accordance with this subsection, with respect to each geographic area subject to an emergency declaration (other than the declaration of June 17, 2009), in order to furnish such comprehensive, coordinated and cost-effective care to individuals described in subparagraph (2)(B) who reside in each such area.
(2) **Individual described** — For purposes of paragraph (1), an individual described in this paragraph is an individual who enrolls in part B, submits to the Secretary an application to participate in the applicable pilot program under this subsection, and—
(A) is an environmental exposure affected individual described in subsection (e)(2) who resides in or around the geographic area subject to an emergency declaration made as of June 17, 2009; or
(B) is an environmental exposure affected individual described in subsection (e)(3) who—
(i) is deemed under subsection (a)(2); and
(ii) meets such other criteria or conditions for participation in a pilot program under paragraph (1)(B) as the Secretary specifies.
(3) **Flexible benefits and services** — A pilot program under this subsection may provide for the furnishing of benefits, items, or services not otherwise covered or authorized under this subchapter, if the Secretary determines that furnishing such benefits, items, or services will further the purposes of such pilot program (as described in paragraph (1)).
(4) **Innovative reimbursement methodologies** — For purposes of the pilot program under this subsection, the Secretary—
(A) shall develop and implement appropriate methodologies to reimburse providers for furnishing benefits, items, or services for which payment is not otherwise covered or authorized under this subchapter, if such benefits, items, or services are furnished pursuant to paragraph (3); and
(B) may develop and implement innovative approaches to reimbursing providers for any benefits, items, or services furnished under this subsection.
(5) **Limitation** — Consistent with [section 1395y(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395y/b&num=0&edition=prelim), no payment shall be made under the pilot program under this subsection with respect to benefits, items, or services furnished to an environmental exposure affected individual (as defined in subsection (e)) to the extent that such individual is eligible to receive such benefits, items, or services through any other public or private benefits plan or legal agreement.
(6) **Waiver authority** — The Secretary may waive such provisions of this subchapter and subchapter XI as are necessary to carry out pilot programs under this subsection.
(7) **Funding** — For purposes of carrying out pilot programs under this subsection, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under [section 1395i of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i&num=0&edition=prelim) and the Federal Supplementary Medical Insurance Trust Fund under [section 1395t of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395t&num=0&edition=prelim), in such proportion as the Secretary determines appropriate, of such sums as the Secretary determines necessary, to the Centers for Medicare & Medicaid Services Program Management Account.
(8) **Waiver of budget neutrality** — The Secretary shall not require that pilot programs under this subsection be budget neutral with respect to expenditures under this subchapter.
**(c) Determinations**
(1) **By the Commissioner of Social Security** — For purposes of this section, the Commissioner of Social Security, in consultation with the Secretary, and using the cost allocation method prescribed in [section 401(g) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section401/g&num=0&edition=prelim), shall determine whether individuals are environmental exposure affected individuals.
(2) **By the Secretary** — The Secretary shall determine eligibility for pilot programs under subsection (b).
**(d) Emergency declaration defined** For purposes of this section, the term “emergency declaration” means a declaration of a public health emergency under [section 9604(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section9604/a&num=0&edition=prelim).
**(e) Environmental exposure affected individual defined**
(1) **In general** — For purposes of this section, the term “environmental exposure affected individual” means—
(A) an individual described in paragraph (2); and
(B) an individual described in paragraph (3).
(2) **Individual described**
(A) *In general* — An individual described in this paragraph is any individual who—
(i) is diagnosed with 1 or more conditions described in subparagraph (B);
(ii) as demonstrated in such manner as the Secretary determines appropriate, has been present for an aggregate total of 6 months in the geographic area subject to an emergency declaration specified in subsection (b)(2)(A), during a period ending—
(I) not less than 10 years prior to such diagnosis; and
(II) prior to the implementation of all the remedial and removal actions specified in the Record of Decision for Operating Unit 4 and the Record of Decision for Operating Unit 7;
(iii) files an application for benefits under this subchapter (or has an application filed on behalf of the individual), including pursuant to this section; and
(iv) is determined under this section to meet the criteria in this subparagraph.
(B) *Conditions described* — For purposes of subparagraph (A), the following conditions are described in this subparagraph:
(i) Asbestosis, pleural thickening, or pleural plaques as established by—
(I) interpretation by a “B Reader” qualified physician of a plain chest x-ray or interpretation of a computed tomographic radiograph of the chest by a qualified physician, as determined by the Secretary; or
(II) such other diagnostic standards as the Secretary specifies,
except that this clause shall not apply to pleural thickening or pleural plaques unless there are symptoms or conditions requiring medical treatment as a result of these diagnoses.
(ii) Mesothelioma, or malignancies of the lung, colon, rectum, larynx, stomach, esophagus, pharynx, or ovary, as established by—
(I) pathologic examination of biopsy tissue;
(II) cytology from bronchioalveolar lavage; or
(III) such other diagnostic standards as the Secretary specifies.
(iii) Any other diagnosis which the Secretary, in consultation with the Commissioner of Social Security, determines is an asbestos-related medical condition, as established by such diagnostic standards as the Secretary specifies.
(3) **Other individual described** — An individual described in this paragraph is any individual who—
(A) is not an individual described in paragraph (2);
(B) is diagnosed with a medical condition caused by the exposure of the individual to a public health hazard to which an emergency declaration applies, based on such medical conditions, diagnostic standards, and other criteria as the Secretary specifies;
(C) as demonstrated in such manner as the Secretary determines appropriate, has been present for an aggregate total of 6 months in the geographic area subject to the emergency declaration involved, during a period determined appropriate by the Secretary;
(D) files an application for benefits under this subchapter (or has an application filed on behalf of the individual), including pursuant to this section; and
(E) is determined under this section to meet the criteria in this paragraph.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Grants** The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall make grants to States, with approved State regulatory programs under [section 1395ss of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395ss&num=0&edition=prelim), that submit applications to the Secretary that meet the requirements of this section for the purpose of providing information, counseling, and assistance relating to the procurement of adequate and appropriate health insurance coverage to individuals who are eligible to receive benefits under this subchapter (in this section referred to as “eligible individuals”). The Secretary shall prescribe regulations to establish a minimum level of funding for a grant issued under this section.
**(b) Grant applications**
(1) In submitting an application under this section, a State may consolidate and coordinate an application that consists of parts prepared by more than one agency or department of such State.
(2) As part of an application for a grant under this section, a State shall submit a plan for a State-wide health insurance information, counseling, and assistance program. Such program shall—
(A) establish or improve upon a health insurance information, counseling, and assistance program that provides counseling and assistance to eligible individuals in need of health insurance information, including—
(i) information that may assist individuals in obtaining benefits and filing claims under this subchapter and subchapter XIX of this chapter;
(ii) policy comparison information for medicare supplemental policies (as described in [section 1395ss(g)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395ss/g/1
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395i
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Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** Subject to subsections (c) and (d), payment under this part may be made for inpatient hospital services or post-hospital extended care services furnished an individual in a religious nonmedical health care institution and for home health services furnished an individual by a religious nonmedical health care institution only if—
(1) the individual has an election in effect for such benefits under subsection (b); and
(2) the individual has a condition such that the individual would qualify for benefits under this part for inpatient hospital services, extended care services, or home health services, respectively, if the individual were an inpatient or resident in a hospital or skilled nursing facility, or receiving services from a home health agency, that was not such an institution.
**(b) Election**
(1) **In general** — An individual may make an election under this subsection in a form and manner specified by the Secretary consistent with this subsection. Unless otherwise provided, such an election shall take effect immediately upon its execution. Such an election, once made, shall continue in effect until revoked.
(2) **Form** — The election form under this subsection shall include the following:
(A) A written statement, signed by the individual (or such individual’s legal representative), that—
(i) the individual is conscientiously opposed to acceptance of nonexcepted medical treatment; and
(ii) the individual’s acceptance of nonexcepted medical treatment would be inconsistent with the individual’s sincere religious beliefs.
(B) A statement that the receipt of nonexcepted medical services shall constitute a revocation of the election and may limit further receipt of services described in subsection (a).
(3) **Revocation** — An el
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395t
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Establishment**
(1) The Secretary, acting through the Service, shall establish a program to be known as the Indian Health Service Loan Repayment Program (hereinafter referred to as the “Loan Repayment Program”) in order to assure an adequate supply of trained health professionals necessary to maintain accreditation of, and provide health care services to Indians through, Indian health programs.
(2) For the purposes of this section—
(A) the term “Indian health program” means any health program or facility funded, in whole or part, by the Service for the benefit of Indians and administered—
(i) directly by the Service;
(ii) by any Indian tribe or tribal or Indian organization pursuant to a contract under—
(I) the Indian Self-Determination Act [[25 U.S.C. 5321](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title25-section5321&num=0&edition=prelim) et seq.], or
(II) section 23 of the Act of April 30, 1908 11 See References in Text note below. ([25 U.S.C. 47](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title25-section47&num=0&edition=prelim)), popularly known as the “Buy-Indian” Act; or
(iii) by an urban Indian organization pursuant to subchapter IV of this chapter; and
(B) the term “State” has the same meaning given such term in section 254d(i)(4) 1 of title 42.
**(b) Eligibility** To be eligible to participate in the Loan Repayment Program, an individual must—
(1)
(A) be enrolled—
(i) in a course of study or program in an accredited institution, as determined by the Secretary, within any State and be scheduled to complete such course of study in the same year such individual applies to participate in such program; or
(ii) in an approved graduate training program in a health profession
Source: Supplied U.S. Code snapshot — release unconfirmed · 25 U.S.C. § 1616c
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Failure to maintain academic standing; dismissal from institution; voluntary termination; liability; failure to accept payment**
(1) An individual who has entered into a written contract with the Secretary under section 254l of this title and who—
(A) fails to maintain an acceptable level of academic standing in the educational institution in which he is enrolled (such level determined by the educational institution under regulations of the Secretary);
(B) is dismissed from such educational institution for disciplinary reasons; or
(C) voluntarily terminates the training in such an educational institution for which he is provided a scholarship under such contract, before the completion of such training,
in lieu of any service obligation arising under such contract, shall be liable to the United States for the amount which has been paid to him, or on his behalf, under the contract.
(2) An individual who has entered into a written contract with the Secretary under section 254l–1 of this title and who—
(A) in the case of an individual who is enrolled in the final year of a course of study, fails to maintain an acceptable level of academic standing in the educational institution in which such individual is enrolled (such level determined by the educational institution under regulations of the Secretary) or voluntarily terminates such enrollment or is dismissed from such educational institution before completion of such course of study; or
(B) in the case of an individual who is enrolled in a graduate training program, fails to complete such training program and does not receive a waiver from the Secretary under section 254l–1(b)(1)(B)(ii) of this title,
in lieu of any service obligation arising under such contract shall be liable to the United Stat
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 254o
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Conditions for payment to beneficiary**
(1) **In general** — Upon default by the borrower on any loan covered by Federal loan insurance pursuant to this subpart, and after a substantial collection effort (including, subject to subsection (h), commencement and prosecution of an action) as determined under regulations of the Secretary, the insurance beneficiary shall promptly notify the Secretary and the Secretary shall, if requested (at that time or after further collection efforts) by the beneficiary, or may on his own motion, if the insurance is still in effect, pay to the beneficiary the amount of the loss sustained by the insured upon that loan as soon as that amount has been determined, except that, if the insurance beneficiary including any servicer of the loan is not designated for “exceptional performance”, as set forth in paragraph (2), the Secretary shall pay to the beneficiary a sum equal to 98 percent of the amount of the loss sustained by the insured upon that loan.
(2) **Exceptional performance**
(A) *Authority* — Where the Secretary determines that an eligible lender, holder, or servicer has a compliance performance rating that equals or exceeds 97 percent, the Secretary shall designate that eligible lender, holder, or servicer, as the case may be, for exceptional performance.
(B) *Compliance performance rating* — For purposes of subparagraph (A), a compliance performance rating is determined with respect to compliance with due diligence in the disbursement, servicing, and collection of loans under this subpart for each year for which the determination is made. Such rating shall be equal to the percentage of all due diligence requirements applicable to each loan, on average, as established by the Secretary, with respect to loans serviced duri
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 292f
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Federal law — U.S. Code and appendices · legal_authorities
Page 3965
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1395ccc
each day of noncompliance’’ for ‘‘for each day of non-
compliance’’.
1987—Subsecs. (c), (d). Pub. L. 100–203, § 4022(a), added
subsecs. (c) and (d).
Subsecs. (e), (f). Pub. L. 100–203, § 4023(a), as amended
by Pub. L. 100–360, § 411(d)(3)(A), added subsecs. (e) and
(f).
Statutory Notes and Related Subsidiaries
EFFECTIVE DATE OF 1997 AMENDMENT
Amendment by Pub. L. 105–33 applicable to cost re-
porting periods beginning on or after Oct. 1, 1997, see
section 4604(c) of Pub. L. 105–33, set out as a note under
section 1395x of this title.
EFFECTIVE DATE OF 1990 AMENDMENT
Amendment by section 4206(d)(2) of Pub. L. 101–508 ap-
plicable with respect to services furnished on or after
the first day of the first month beginning more than 1
year after Nov. 5, 1990, see section 4206(e)(1) of Pub. L.
101–508, set out as a note under section 1395i–3 of this
title.
Pub.
L.
101–508,
title
IV,
§ 4207(i)(1),
formerly
§ 4027(i)(1), Nov. 5, 1990, 104 Stat. 1388–123, as renumbered
by Pub. L. 103–432, title I, § 160(d)(4), Oct. 31, 1994, 108
Stat. 4444, provided that the amendment made by that
section is effective as if included in the enactment of
the Omnibus Budget Reconciliation Act of 1987, Pub. L.
100–203.
Pub.
L.
101–508,
title
IV,
§ 4207(i)(2),
formerly
§ 4027(i)(2), Nov. 5, 1990, 104 Stat. 1388–124, as renumbered
and amended by Pub. L. 103–432, title I, § 160(d)(4), (11),
Oct. 31, 1994, 108 Stat. 4444, provided that: ‘‘The amend-
ments made by paragraph (1) [amending this section]
shall take effect as if included in the enactment of the
Omnibus Budget Reconciliation Act of 1987 [Pub. L.
100–203], except that the Secretary may not permit ap-
proval of a training and competency evaluatio
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1395ccc
Stored review status: historical_2024_not_currentness_verified. Same stored citation; legal effect and authority still require review.