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42 U.S.C. § 1395i–2 — Explanation of medicare benefits
Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** The Secretary shall furnish to each individual for whom payment has been made under this subchapter (or would be made without regard to any deductible) a statement which—
(1) lists the item or service for which payment has been made and the amount of such payment for each item or service; and
(2) includes a notice of the individual’s right to request an itemized statement (as provided in subsection (b)).
**(b) Request for itemized statement for medicare items and services**
(1) **In general** — An individual may submit a written request to any physician, provider, supplier, or any other person (including an organization, agency, or other entity) for an itemized statement for any item or service provided to such individual by such person with respect to which payment has been made under this subchapter.
(2) **30-day period to furnish statement**
(A) *In general* — Not later than 30 days after the date on which a request under paragraph (1) has been made, a person described in such paragraph shall furnish an itemized statement describing each item or service provided to the individual requesting the itemized statement.
(B) *Penalty* — Whoever knowingly fails to furnish an itemized statement in accordance with subparagraph (A) shall be subject to a civil money penalty of not more than $100 for each such failure. Such penalty shall be imposed and collected in the same manner as civil money penalties under subsection (a) of [section 1320a–7a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a-7a&num=0&edition=prelim) are imposed and collected under that section.
(3) **Review of itemized statement**
(A) *In general* — Not later than 90 days after the receipt of an itemized statement furnished under
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395i–2
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Stable record: federal_law:legal_authorities:record_usc_2c8369bff41629fb0a5ceb28
Source file: Laws/federal/codes/united-states-code/title-42/section-1395i2-explanation-of-medicare-benefits--0907d97dff.md
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Passage SHA-256: 02b07076348723042aed7a77d76285ebb125873e425ff984805eeec260d9a20d
Source location: Title 42, Chapter 7, § 1395i–2; chapter-007-social-security.md
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**(a) In general** The Secretary shall furnish to each individual for whom payment has been made under this subchapter (or would be made without regard to any deductible) a statement which—
(1) lists the item or service for which payment has been made and the amount of such payment for each item or service; and
(2) includes a notice of the individual’s right to request an itemized statement (as provided in subsection (b)).
**(b) Request for itemized statement for medicare items and services**
(1) **In general** — An individual may submit a written request to any physician, provider, supplier, or any other person (including an organization, agency, or other entity) for an itemized statement for any item or service provided to such individual by such person with respect to which payment has been made under this subchapter.
(2) **30-day period to furnish statement**
(A) *In general* — Not later than 30 days after the date on which a request under paragraph (1) has been made, a person described in such paragraph shall furnish an itemized statement describing each item or service provided to the individual requesting the itemized statement.
(B) *Penalty* — Whoever knowingly fails to furnish an itemized statement in accordance with subparagraph (A) shall be subject to a civil money penalty of not more than $100 for each such failure. Such penalty shall be imposed and collected in the same manner as civil money penalties under subsection (a) of [section 1320a–7a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a-7a&num=0&edition=prelim) are imposed and collected under that section.
(3) **Review of itemized statement**
(A) *In general* — Not later than 90 days after the receipt of an itemized statement furnished under paragraph (1), an individual may submit a written request for a review of the itemized statement to the Secretary.
(B) *Specific allegations* — A request for a review of the itemized statement shall identify—
(i) specific items or services that the individual believes were not provided as claimed, or
(ii) any other billing irregularity (including duplicate billing).
(4) **Findings of Secretary** — The Secretary shall, with respect to each written request submitted under paragraph (3), determine whether the itemized statement identifies specific items or services that were not provided as claimed or any other billing irregularity (including duplicate billing) that has resulted in unnecessary payments under this subchapter.
(5) **Recovery of amounts** — The Secretary shall take all appropriate measures to recover amounts unnecessarily paid under this subchapter with respect to a statement described in paragraph (4).
**(c) Format of statements from Secretary**
(1) **Electronic option beginning in 2016** — Subject to paragraph (2), for statements described in subsection (a) that are furnished for a period in 2016 or a subsequent year, in the case that an individual described in subsection (a) elects, in accordance with such form, manner, and time specified by the Secretary, to receive such statement in an electronic format, such statement shall be furnished to such individual for each period subsequent to such election in such a format and shall not be mailed to the individual.
(2) **Limitation on revocation option**
(A) *In general* — Subject to subparagraph (B), the Secretary may determine a maximum number of elections described in paragraph (1) by an individual that may be revoked by the individual.
(B) *Minimum of one revocation option* — In no case may the Secretary determine a maximum number under subparagraph (A) that is less than one.
(3) **Notification** — The Secretary shall ensure that, in the most cost effective manner and beginning January 1, 2017, a clear notification of the option to elect to receive statements described in subsection (a) in an electronic format is made available, such as through the notices distributed under [section 1395b–2 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395b-2&num=0&edition=prelim), to individuals described in subsection (a).
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Federal law — U.S. Code and appendices · legal_authorities
Nothing in this subchapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395c
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Federal law — U.S. Code and appendices · legal_authorities
**(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
**(a) Definitions.—** In this section—
(1) the term “covered Medicare individual” means an individual who is entitled to benefits under Medicare part A, but excluding an individual who is eligible to enroll under such part under section 1818 or 1818A of the Social Security Act ([42 U.S.C. 1395i–2](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i–2&num=0&edition=prelim), 1395i–2a);
(2) the term “initial contract year” means the contract year beginning in January of 2025;
(3) the term “initial participating carrier” means a carrier that enters into a contract with the Office to participate in the Program during the initial contract year;
(4) the term “Medicare part A” means part A of title XVIII of the Social Security Act ([42 U.S.C. 1395c](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395c&num=0&edition=prelim) et seq.);
(5) the term “Medicare part B” means part B of title XVIII of the Social Security Act ([42 U.S.C. 1395j](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395j&num=0&edition=prelim) et seq.);
(6) the term “Office” means the Office of Personnel Management;
(7) the term “Postal Service” means the United States Postal Service;
(8) the term “Postal Service annuitant” means an annuitant enrolled in a health benefits plan under this chapter whose Government contribution is required to be paid under section 8906(g)(2);
(9) the term “Postal Service employee” means an employee of the Postal Service enrolled in a health benefits plan under this chapter whose Government contribution is paid by the Postal Service;
(10) the term “Postal Service Medicare covered annuitant” means an individual who—
(A) is a Postal Service annuitant; and
(B) is a covered Medicare i
Source: Supplied U.S. Code snapshot — release unconfirmed · 5 U.S.C. § 8903c
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