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10 U.S.C. § 1074j — Sub-acute care program

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

10 U.S.C. § 1074j — Sub-acute care program

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Source location: Title 10, Chapter 55, § 1074j; chapter-055-medical-and-dental-care.md

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**(a) Establishment.—** The Secretary of Defense shall establish an effective, efficient, and integrated sub-acute care benefits program under this chapter (hereinafter referred to in this section as the “program”). Except as otherwise provided in this section, the types of health care authorized under the program shall be the same as those provided under [section 1079 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079&num=0&edition=prelim). The Secretary, after consultation with the other administering Secretaries, shall promulgate regulations to carry out this section. **(b) Benefits.—** (1) The program shall include a uniform skilled nursing facility benefit that shall be provided in the manner and under the conditions described in section 1861 (h) and (i) of the Social Security Act ([42 U.S.C. 1395x](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x&num=0&edition=prelim) (h) and (i)), except that the limitation on the number of days of coverage under section 1812 (a) and (b) of such Act ([42 U.S.C. 1395d](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395d&num=0&edition=prelim) (a) and (b)) shall not be applicable under the program. Skilled nursing facility care for each spell of illness shall continue to be provided for as long as medically necessary and appropriate. (2) In this subsection: (A) The term “skilled nursing facility” has the meaning given such term in section 1819(a) of the Social Security Act ([42 U.S.C. 1395i–3(a)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i–3/a&num=0&edition=prelim)). (B) The term “spell of illness” has the meaning given such term in section 1861(a) of such Act ([42 U.S.C. 1395x(a)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/a&num=0&edition=prelim)). (3) The program shall include a comprehensive, part-time or intermittent home health care benefit that shall be provided in the manner and under the conditions described in section 1861(m) of the Social Security Act ([42 U.S.C. 1395x(m)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/m&num=0&edition=prelim)). (4) The Secretary of Defense may take such actions as are necessary to ensure that there is an effective transition in the furnishing of part-time or intermittent home health care benefits for covered beneficiaries who were receiving such benefits before the establishment of the program under this section. The actions taken under this paragraph may include the continuation of such benefits on an extended basis for such time as the Secretary determines appropriate.

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

42 U.S.C. § 1395d — Free choice by patient guaranteed

**(a) Basic freedom of choice** Any individual entitled to insurance benefits under this subchapter may obtain health services from any institution, agency, or person qualified to participate under this subchapter if such institution, agency, or person undertakes to provide him such services. **(b) Use of private contracts by medicare beneficiaries** (1) **In general** — Subject to the provisions of this subsection, nothing in this subchapter shall prohibit a physician or practitioner from entering into a private contract with a medicare beneficiary for any item or service— (A) for which no claim for payment is to be submitted under this subchapter, and (B) for which the physician or practitioner receives— (i) no reimbursement under this subchapter directly or on a capitated basis, and (ii) receives no amount for such item or service from an organization which receives reimbursement for such item or service under this subchapter directly or on a capitated basis. (2) **Beneficiary protections** (A) *In general* — Paragraph (1) shall not apply to any contract unless— (i) the contract is in writing and is signed by the medicare beneficiary before any item or service is provided pursuant to the contract; (ii) the contract contains the items described in subparagraph (B); and (iii) the contract is not entered into at a time when the medicare beneficiary is facing an emergency or urgent health care situation. (B) *Items required to be included in contract* — Any contract to provide items and services to which paragraph (1) applies shall clearly indicate to the medicare beneficiary that by signing such contract the beneficiary— (i) agrees not to submit a claim (or to request that the physician or practitioner submit a claim) under t

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

42 U.S.C. § 1395x — Manufacturer discount program

**(a) Establishment** The Secretary shall establish a manufacturer discount program (in this section referred to as the “program”). Under the program, the Secretary shall enter into agreements described in subsection (b) with manufacturers and provide for the performance of the duties described in subsection (c). **(b) Terms of agreement** (1) **In general** (A) *Agreement* — An agreement under this section shall require the manufacturer to provide, in accordance with this section, discounted prices for applicable drugs of the manufacturer that are dispensed to applicable beneficiaries on or after January 1, 2025. (B) *Clarification* — Nothing in this section shall be construed as affecting— (i) the application of a coinsurance of 25 percent of the negotiated price, as applied under paragraph (2)(A) of [section 1395w–102(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–102/b&num=0&edition=prelim), for costs described in such paragraph; or (ii) the application of the copayment amount described in paragraph (4)(A) of such section, with respect to costs described in such paragraph. (C) *Timing of agreement* (i) *Special rule for 2025* — In order for an agreement with a manufacturer to be in effect under this section with respect to the period beginning on January 1, 2025, and ending on December 31, 2025, the manufacturer shall enter into such agreement not later than March 1, 2024. (ii) *2026 and subsequent years* — In order for an agreement with a manufacturer to be in effect under this section with respect to plan year 2026 or a subsequent plan year, the manufacturer shall enter into such agreement not later than a calendar quarter or semi-annual deadline established by the Secretary. (2)

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

10 U.S.C. § 1079 — Contracts for medical care for spouses and children: plans

**(a)** To assure that medical care is available for dependents, as described in subparagraphs (A), (D), and (I) of [section 1072(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1072/2&num=0&edition=prelim), of members of the uniformed services who are on active duty for a period of more than 30 days, the Secretary of Defense, after consulting with the other administering Secretaries, shall contract, under the authority of this section, for medical care for those persons under such insurance, medical service, or health plans as he considers appropriate. The types of health care authorized under this section shall be the same as those provided under [section 1076 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1076&num=0&edition=prelim), except as follows: (1) With respect to dental care— (A) except as provided in subparagraph (B), only that care required as a necessary adjunct to medical or surgical treatment may be provided; and (B) in connection with dental treatment for patients with developmental, mental, or physical disabilities or for pediatric patients age 5 or under, only institutional and anesthesia services may be provided. (2) Consistent with such regulations as the Secretary of Defense may prescribe regarding the content of health promotion and disease prevention visits, the schedule and method of cervical cancer screenings and breast cancer screenings, the schedule and method of colon and prostate cancer screenings, and the types and schedule of immunizations— (A) for dependents under six years of age, both health promotion and disease prevention visits and immunizations may be provided; and (B) for dependents six years of age or older, health promotion an

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

10 U.S.C. § 1074j — Sub-acute care program

Page 1068 TITLE 10—ARMED FORCES § 1074j the date of the enactment of this Act [Dec. 23, 2024], the Secretary of Defense shall issue guidance with respect to the authority of the Secretary under section 1074i(b) of title 10, United States Code.’’ § 1074j. Sub-acute care program (a) ESTABLISHMENT.—The Secretary of Defense shall establish an effective, efficient, and inte- grated sub-acute care benefits program under this chapter (hereinafter referred to in this sec- tion as the ‘‘program’’). Except as otherwise pro- vided in this section, the types of health care authorized under the program shall be the same as those provided under section 1079 of this title. The Secretary, after consultation with the other administering Secretaries, shall promulgate reg- ulations to carry out this section. (b) BENEFITS.—(1) The program shall include a uniform skilled nursing facility benefit that shall be provided in the manner and under the conditions described in section 1861 (h) and (i) of the Social Security Act (42 U.S.C. 1395x (h) and (i)), except that the limitation on the number of days of coverage under section 1812 (a) and (b) of such Act (42 U.S.C. 1395d (a) and (b)) shall not be applicable under the program. Skilled nursing facility care for each spell of illness shall con- tinue to be provided for as long as medically necessary and appropriate. (2) In this subsection: (A) The term ‘‘skilled nursing facility’’ has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395i–3(a)). (B) The term ‘‘spell of illness’’ has the mean- ing given such term in section 1861(a) of such Act (42 U.S.C. 1395x(a)). (3) The program shall include a comprehen- sive, part-time or intermittent home health care benefit that shall b

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

42 U.S.C. § 1395d — Scope of benefits

Page 2931 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395d such services entered into an agreement under sec- tion 1866 of the Social Security Act [42 U.S.C. 1395cc] and (ii) the hospital’s plan for utilization re- view, as provided for in section 1861(k) of such Act [42 U.S.C. 1395x(k)], has, in accordance with section 1814 of such Act [42 U.S.C. 1395f], been applied to the services furnished such individual, or ‘‘(B) 20 days in any spell of illness, if the hospital did not meet the conditions of clauses (i) and (ii) of subparagraph (A). ‘‘(c)(1) The amounts payable in accordance with sub- section (a) with respect to inpatient hospital services shall, subject to paragraph (2) of this subsection, be paid from the Federal Hospital Insurance Trust Fund in amounts equal to 60 percent of the hospital’s reason- able charges for routine services furnished in the ac- commodations occupied by the individual or in semi- private accommodations (as defined in section 1861(v)(4) of the Social Security Act [42 U.S.C. 1395x(v)(4)]) which- ever is less, plus 80 percent of the hospital’s reasonable charges for ancillary services. If separate charges for routine and ancillary services are not made by the hos- pital, reimbursement may be based on two-thirds of the hospital’s reasonable charges for the services received but not to exceed the charges which would have been made if the patient had occupied semi-private accom- modations (as so defined). For purposes of the pre- ceding provisions of this paragraph, the term ‘routine services’ shall mean the regular room, dietary, and nursing services, minor medical and surgical supplies and the use of equipment and facilities for which a sep- arate charge is not customarily made; the term ‘ancil- lary services’ shall mean th

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

42 U.S.C. § 1395i — Health insurance information, counseling, and assistance grants

**(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

42 U.S.C. § 1395i — Federal Hospital Insurance Trust Fund

Page 2966 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395i amendments to agreements under section 1816 [42 U.S.C. 1395h] and contracts under section 1842 of the So- cial Security Act [42 U.S.C. 1395u], and regulations, to such extent as may be necessary to implement the amendments made by subsections (a) and (b) [amending this section] on a timely basis.’’ REPLACEMENT OF AGENCY, ORGANIZATION, OR CARRIER PROCESSING MEDICARE CLAIMS; NUMBER OF AGREE- MENTS AND CONTRACTS AUTHORIZED FOR FISCAL YEARS 1985 THROUGH 1993 Pub. L. 98–369, div. B, title III, § 2326(a), July 18, 1984, 98 Stat. 1087, as amended by Pub. L. 98–617, § 3(a)(2), Nov. 8, 1984, 98 Stat. 3295; Pub. L. 99–509, title IX, § 9321(b), Oct. 21, 1986, 100 Stat. 2016; Pub. L. 101–239, title VI, § 6215(a), Dec. 19, 1989, 103 Stat. 2252; Pub. L. 103–432, title I, § 159(a), Oct. 31, 1994, 108 Stat. 4443, pro- vided that: ‘‘During each fiscal year (beginning with fiscal year 1985 and ending with fiscal year 1993), the Secretary of Health and Human Services may enter into not more than two agreements under section 1816 of the Social Security Act [42 U.S.C. 1395h], and not more than two contracts under section 1842 of such Act [42 U.S.C. 1395u], on the basis of competitive bidding, without regard to the nominating process under section 1816(a) of such Act or cost reimbursement provisions under sections 1816(c) or 1842(c) of such Act during the term of the agreement. Such procedure may be used only for the purpose of replacing an agency or organiza- tion or carrier which over a 2-year period of time has been in the lowest 20th percentile of agencies and orga- nizations or carriers having agreements or contracts under the respective section, as measured by the Sec- retary’s cost and performance criter

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

42 U.S.C. § 1395x — Definitions

Page 3523 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395x Revenue Code of 1986 with respect to the man- ufacturer. (d) Definition of manufacturer In this section, the term ‘‘manufacturer’’ has the meaning given such term in section 1395w–114a(g)(5) of this title. (Aug. 14, 1935, ch. 531, title XVIII, § 1860D–43, as added Pub. L. 111–148, title III, § 3301(a), Mar. 23, 2010, 124 Stat. 461; amended Pub. L. 111–152, title I, § 1101(b)(1), Mar. 30, 2010, 124 Stat. 1037; Pub. L. 117–169, title I, §§ 11001(b)(1)(G)(i), 11201(e)(7), Aug. 16, 2022, 136 Stat. 1853, 1892.) Editorial Notes REFERENCES IN TEXT Section 5000D(c)(1) of the Internal Revenue Code of 1986, referred to in subsec. (c)(2), is classified to section 5000D(c)(1) of Title 26, Internal Revenue Code. AMENDMENTS 2022—Subsec. (a)(1). Pub. L. 117–169, § 11201(e)(7)(A)(i), added par. (1) and struck out former par. (1) which read as follows: ‘‘participate in the Medicare coverage gap discount program under section 1395w–114a of this title;’’. Subsec. (a)(2). Pub. L. 117–169, § 11201(e)(7)(A)(ii), added par. (2) and struck out former par. (2) which read as follows: ‘‘have entered into and have in effect an agreement described in subsection (b) of such section with the Secretary; and’’. Subsec. (a)(3). Pub. L. 117–169, § 11201(e)(7)(A)(iii), sub- stituted ‘‘section 1395w–114a of this title’’ for ‘‘such sec- tion’’. Subsec. (b). Pub. L. 117–169, § 11201(e)(7)(B), added sub- sec. (b) and struck out former subsec. (b). Prior to amendment, text read as follows: ‘‘Subsection (a) shall apply to covered part D drugs dispensed under this part on or after January 1, 2011.’’ Subsec. (c). Pub. L. 117–169, § 11001(b)(1)(G)(i), des- ignated existing provisions as par. (1) and inserted heading, sub

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

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