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42 U.S.C. § 1395aa — Medicare Prescription Drug Account in the Federal Supplementary Medical Insurance Trust Fund

Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1395aa — Medicare Prescription Drug Account in the Federal Supplementary Medical Insurance Trust Fund

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Source file: Laws/federal/codes/united-states-code/title-42/section-1395aa-medicare-prescription-drug-account-in-the-federal-supplementary-medical--763c1edbc4.md
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Source location: Title 42, Chapter 7, § 1395aa; chapter-007-social-security.md

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**(a) Establishment and operation of Account** (1) **Establishment** — There is created within the Federal Supplementary Medical Insurance Trust Fund established by [section 1395t of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395t&num=0&edition=prelim) an account to be known as the “Medicare Prescription Drug Account” (in this section referred to as the “Account”). (2) **Funding** — The Account shall consist of such gifts and bequests as may be made as provided in [section 401(i)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section401/i/1&num=0&edition=prelim), accrued interest on balances in the Account, and such amounts as may be deposited in, or appropriated to, such Account as provided in this part. (3) **Separate from rest of Trust Fund** — Funds provided under this part to the Account shall be kept separate from all other funds within the Federal Supplementary Medical Insurance Trust Fund, but shall be invested, and such investments redeemed, in the same manner as all other funds and investments within such Trust Fund. **(b) Payments from Account** (1) **In general** — The Managing Trustee shall pay from time to time from the Account such amounts as the Secretary certifies are necessary to make payments to operate the program under this part, including— (A) payments under [section 1395w–114 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w-114&num=0&edition=prelim) (relating to low-income subsidy payments); (B) payments under [section 1395w–115 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w-115&num=0&edition=prelim) (relating to subsidy payments and payments for fallback plans); (C) payments to sponsors of qualified retiree prescription drug plans under [section 1395w–132(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–132/a&num=0&edition=prelim); (D) payments with respect to administrative expenses under this part in accordance with [section 401(g) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section401/g&num=0&edition=prelim); and (E) payments under [section 1395w–114d of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w-114d&num=0&edition=prelim) (relating to selected drug subsidy payments). (2) **Transfers to Medicaid account for increased administrative costs** — The Managing Trustee shall transfer from time to time from the Account to the Grants to States for Medicaid account amounts the Secretary certifies are attributable to increases in payment resulting from the application of [section 1396u–5(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396u–5/b&num=0&edition=prelim). (3) **Payments of premiums withheld** — The Managing Trustee shall make payment to the PDP sponsor or MA organization involved of the premiums (and the portion of late enrollment penalties) that are collected in the manner described in [section 1395w–24(d)(2)(A) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–24/d/2/A&num=0&edition=prelim) and that are payable under a prescription drug plan or MA–PD plan offered by such sponsor or organization. (4) **Treatment in relation to part B premium** — Amounts payable from the Account shall not be taken into account in computing actuarial rates or premium amounts under [section 1395r of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395r&num=0&edition=prelim). **(c) Deposits into Account** (1) **Low-income transfer** — Amounts paid under [section 1396u–5(c) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396u–5/c&num=0&edition=prelim) (and any amounts collected or offset under paragraph (1)(C) of such section) are deposited into the Account. (2) **Amounts withheld** — Pursuant to sections 1395w–113(c) and 1395w–24(d) of this title (as applied under this part), amounts that are withheld (and allocated) to the Account are deposited into the Account. (3) **Appropriations to cover Government contributions** — There are authorized to be appropriated from time to time, out of any moneys in the Treasury not otherwise appropriated, to the Account, an amount equivalent to the amount of payments made from the Account under subsection (b) plus such amounts as the Managing Trustee certifies is necessary to maintain an appropriate contingency margin, reduced by the amounts deposited under paragraph (1) or subsection (a)(2). (4) **Initial funding and reserve** — In order to assure prompt payment of benefits provided under this part and the administrative expenses thereunder during the early months of the program established by this part and to provide an initial contingency reserve, there are authorized to be appropriated to the Account, out of any moneys in the Treasury not otherwise appropriated, such amount as the Secretary certifies are required, but not to exceed 10 percent of the estimated total expenditures from such Account in 2006. (5) **Transfer of any remaining balance from Transitional Assistance Account** — Any balance in the Transitional Assistance Account that is transferred under [section 1395w–141(k)(5) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–141/k/5&num=0&edition=prelim) shall be deposited into the Account.

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1395t — Conditions for coverage of religious nonmedical health care institutional services

**(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

42 U.S.C. § 1395r — Protecting residents of long-term care facilities

(1) **National Training Institute for surveyors** (A) *In general* — The Secretary of Health and Human Services shall enter into a contract with an entity for the purpose of establishing and operating a National Training Institute for Federal and State surveyors. Such Institute shall provide and improve the training of surveyors with respect to investigating allegations of abuse, neglect, and misappropriation of property in programs and long-term care facilities that receive payments under title XVIII or XIX of the Social Security Act [[42 U.S.C. 1395](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395&num=0&edition=prelim) et seq., 1396 et seq.]. (B) *Activities carried out by the Institute* — The contract entered into under subparagraph (A) shall require the Institute established and operated under such contract to carry out the following activities: (i) Assess the extent to which State agencies use specialized surveyors for the investigation of reported allegations of abuse, neglect, and misappropriation of property in such programs and long-term care facilities. (ii) Evaluate how the competencies of surveyors may be improved to more effectively investigate reported allegations of such abuse, neglect, and misappropriation of property, and provide feedback to Federal and State agencies on the evaluations conducted. (iii) Provide a national program of training, tools, and technical assistance to Federal and State surveyors on investigating reports of such abuse, neglect, and misappropriation of property. (iv) Develop and disseminate information on best practices for the investigation of such abuse, neglect, and misappropriation of property. (v) Assess the performance of State complaint intake systems, in orde

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1395 — Conditions of participation for home health agencies; home health quality

**(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** The conditions of participation that a home health agency is required to meet under this subsection are as follows: (1) The agency protects and promotes the rights of each individual under its care, including each of the following rights: (A) The right to be fully informed in advance about the care and treatment to be provided by the agency, to be fully informed in advance of any changes in the care or treatment to be provided by the agency that may affect the individual’s well-being, and (except with respect to an individual adjudged incompetent) to participate in planning care and treatment or changes in care or treatment. (B) The right to voice grievances with respect to treatment or care that is (or fails to be) furnished without discrimination or reprisal for voicing grievances. (C) The right to confidentiality of the clinical records described in section 1395x(o)(3) of this title. (D) The right to have one’s property treated with respect. (E) The right to be fully informed orally and in writing (in advance of coming under the care of the agency) of— (i) all items and services furnished by (or under arrangements with) the agency for which payment may be made under this subchapter, (ii) the coverage available for such items and services under this subchapter, subchapter XIX, and any other Federal program of which the agency is reasonably aware, (iii) any charges for items and services not covered under this subchapter and any charges the individual may have to pay with respect to items and services furn

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1395dd — Definitions

For purposes of this subchapter— **(a) Spell of illness** The term “spell of illness” with respect to any individual means a period of consecutive days— (1) beginning with the first day (not included in a previous spell of illness) (A) on which such individual is furnished inpatient hospital services, inpatient critical access hospital services or extended care services, and (B) which occurs in a month for which he is entitled to benefits under part A, and (2) ending with the close of the first period of 60 consecutive days thereafter on each of which he is neither an inpatient of a hospital or critical access hospital nor an inpatient of a facility described in [section 1395i–3(a)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i–3/a/1&num=0&edition=prelim) or subsection (y)(1). **(b) Inpatient hospital services** The term “inpatient hospital services” means the following items and services furnished to an inpatient of a hospital and (except as provided in paragraph (3)) by the hospital— (1) bed and board; (2) such nursing services and other related services, such use of hospital facilities, and such medical social services as are ordinarily furnished by the hospital for the care and treatment of inpatients, and such drugs, biologicals, supplies, appliances, and equipment, for use in the hospital, as are ordinarily furnished by such hospital for the care and treatment of inpatients; and (3) such other diagnostic or therapeutic items or services, furnished by the hospital or by others under arrangements with them made by the hospital, as are ordinarily furnished to inpatients either by such hospital or by others under such arrangements; (4) medical or surgical services provided by a physician, resident, or intern

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395dd

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1395gg — Agreements with States

**(a) Use of State agencies to determine compliance by providers of services with conditions of participation** The Secretary shall make an agreement with any State which is able and willing to do so under which the services of the State health agency or other appropriate State agency (or the appropriate local agencies) will be utilized by him for the purpose of determining whether an institution therein is a hospital or skilled nursing facility, or whether an agency therein is a home health agency, or whether an agency is a hospice program or whether a facility therein is a rural health clinic as defined in [section 1395x(aa)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/aa/2&num=0&edition=prelim), a critical access hospital, as defined in [section 1395x(mm)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/mm/1&num=0&edition=prelim), or a comprehensive outpatient rehabilitation facility as defined in [section 1395x(cc)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/cc/2&num=0&edition=prelim), or whether a laboratory meets the requirements of paragraphs (16) and (17) of [section 1395x(s) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/s&num=0&edition=prelim), or whether a clinic, rehabilitation agency or public health agency meets the requirements of subparagraph (A) or (B), as the case may be, of [section 1395x(p)(4) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/p/4&num=0&edition=prelim), or whether an ambulatory surgical center meets the standards specified under [section 1395k(a)(2)(F)(i) of this title](https://us

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395gg

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1395hh — Effect of accreditation

**(a) Accreditation by American Osteopathic Association or other national accreditation body** (1) If the Secretary finds that accreditation of a provider entity (as defined in paragraph (4)) by the American Osteopathic Association or any other national accreditation body demonstrates that all of the applicable conditions or requirements of this subchapter (other than the requirements of [section 1395m(j) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395m/j&num=0&edition=prelim)) are met or exceeded— (A) in the case of a provider entity not described in paragraph (3)(B), the Secretary shall treat such entity as meeting those conditions or requirements with respect to which the Secretary made such finding; or (B) in the case of a provider entity described in paragraph (3)(B), the Secretary may treat such entity as meeting those conditions or requirements with respect to which the Secretary made such finding. (2) In making such a finding, the Secretary shall consider, among other factors with respect to a national accreditation body, its requirements for accreditation, its survey procedures, its ability to provide adequate resources for conducting required surveys and supplying information for use in enforcement activities, its monitoring procedures for provider entities found out of compliance with the conditions or requirements, and its ability to provide the Secretary with necessary data for validation. (3) (A) Except as provided in subparagraph (B), not later than 60 days after the date of receipt of a written request for a finding under paragraph (1) (with any documentation necessary to make a determination on the request), the Secretary shall publish a notice identifying the national accreditation body making

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395hh

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1395q — Requirements for, and assuring quality of care in, skilled nursing facilities

**(a) “Skilled nursing facility” defined** In this subchapter, the term “skilled nursing facility” means an institution (or a distinct part of an institution) which— (1) is primarily engaged in providing to residents— (A) skilled nursing care and related services for residents who require medical or nursing care, or (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement (meeting the requirements of section 1395x(l) of this title) with one or more hospitals having agreements in effect under [section 1395cc of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395cc&num=0&edition=prelim); and (3) meets the requirements for a skilled nursing facility described in subsections (b), (c), and (d) of this section. **(b) Requirements relating to provision of services** (1) **Quality of life** (A) *In general* — A skilled nursing facility must care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident. (B) *Quality assessment and assurance* — A skilled nursing facility must maintain a quality assessment and assurance committee, consisting of the director of nursing services, a physician designated by the facility, and at least 3 other members of the facility’s staff, which (i) meets at least quarterly to identify issues with respect to which quality assessment and assurance activities are necessary and (ii) develops and implements appropriate plans of action to correct identified quality deficiencies. A State or the Secretary may not require disclosure of the records of such committee except ins

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395q

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1396a — State plans for medical assistance

**(a) Contents** A State plan for medical assistance must— (1) provide that it shall be in effect in all political subdivisions of the State, and, if administered by them, be mandatory upon them; (2) provide for financial participation by the State equal to not less than 40 per centum of the non-Federal share of the expenditures under the plan with respect to which payments under [section 1396b of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396b&num=0&edition=prelim) are authorized by this subchapter; and, effective July 1, 1969, provide for financial participation by the State equal to all of such non-Federal share or provide for distribution of funds from Federal or State sources, for carrying out the State plan, on an equalization or other basis which will assure that the lack of adequate funds from local sources will not result in lowering the amount, duration, scope, or quality of care and services available under the plan; (3) provide for granting an opportunity for a fair hearing before the State agency to any individual whose claim for medical assistance under the plan is denied or is not acted upon with reasonable promptness; (4) provide (A) such methods of administration (including methods relating to the establishment and maintenance of personnel standards on a merit basis, except that the Secretary shall exercise no authority with respect to the selection, tenure of office, and compensation of any individual employed in accordance with such methods, including provision for utilization of professional medical personnel in the administration and, where administered locally, supervision of administration of the plan, and, subject to [section 1396b(i) of this title](https://uscode.house.gov/view.xhtml?req=granulei

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1396a

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 263a–2 — Certification of embryo laboratories

**(a) In general** (1) **Development** — Not later than 2 years after October 24, 1992, the Secretary, through the Centers for Disease Control, shall develop a model program for the certification of embryo laboratories (referred to in this section as a “certification program”) to be carried out by the States. (2) **Consultation** — In developing the certification program under paragraph (1), the Secretary shall consult with appropriate consumer and professional organizations with expertise in using, providing, and evaluating professional services and embryo laboratories associated with the assisted reproductive technology programs. **(b) Distribution** The Secretary shall distribute a description of the certification program to— (1) the Governor of each State, (2) the presiding officers of each State legislature, (3) the public health official of each State, and (4) the official responsible in each State for the operation of the State’s contract with the Secretary under [section 1395aa of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395aa&num=0&edition=prelim), and shall encourage such officials to assist in the State adopting such program. **(c) Requirements** The certification program shall include the following requirements: (1) **Administration** — The certification program shall be administered by the State and shall provide for the inspection and certification of embryo laboratories in the State by the State or by approved accreditation organizations. (2) **Application requirements** — The certification program shall provide for the submission of an application to a State by an embryo laboratory for certification, in such form as may be specified by the State. Such an application shall include— (A) assurance

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 263a–2

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Federal law — U.S. Code and appendices · legal_authorities

42 U.S.C. § 1395aa — Agreements with States

Page 3619 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395aa Pub. L. 98–369, § 2354(b)(32), substituted ‘‘(j)(15)’’ for ‘‘(j)(11)’’. Pub. L. 98–369, § 2349(b)(1), substituted ‘‘appropriate State agencies’’ for ‘‘the Health Insurance Benefits Ad- visory Council established by section 1395dd of this title, appropriate State agencies,’’. 1982—Pub. L. 97–248 substituted ‘‘(cc)(2)(I), and (dd)(2)’’ for ‘‘and (cc)(2)(I)’’. 1980—Pub. L. 96–499, § 933(f), substituted ‘‘(o)(6), and (cc)(2)(I) of section 1395x’’ for ‘‘and (o)(6) of section 1395x’’. Pub. L. 96–499, § 934(c)(1), inserted ‘‘or by ambulatory surgical centers under section 1395k(a)(2)(F)(i) of this title,’’. 1972—Pub. L. 92–603 substituted ‘‘subsections (e)(9), (f)(4), (g)(4), (j)(11), and (o)(6) of section 1395x of this title’’ for ‘‘subsections (e)(8), (f)(4), (g)(4), (j)(10), and (o)(5) of section 1395x of this title’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1994 AMENDMENT Amendment by Pub. L. 103–432 applicable to mam- mography furnished by a facility on and after the first date that the certificate requirements of section 263b(b) of this title apply to such mammography conducted by such facility, see section 145(d) of Pub. L. 103–432, set out as a note under section 1395m of this title. EFFECTIVE DATE OF 1990 AMENDMENT Amendment by Pub. L. 101–508 applicable to screening mammography performed on or after Jan. 1, 1991, see section 4163(e) of Pub. L. 101–508, set out as a note under section 1395l of this title. EFFECTIVE DATE OF 1989 AMENDMENT Amendment by Pub. L. 101–234 effective Jan. 1, 1990, see section 201(c) of Pub. L. 101–234, set out as a note under section 1320a–7a of this title. EFFECTIVE DATE OF 1988 AMENDMENT Amendment by section 203(e)(2) of Pub.

Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1395aa

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