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10 U.S.C. § 1086 — Contracts for health benefits for certain members, former members, and their dependents
Federal law — U.S. Code and appendices · legal_authorities
**(a)** To assure that health benefits are available for the persons covered by subsection (c), the Secretary of Defense, after consulting with the other administering Secretaries, shall contract under the authority of this section for health benefits for those persons under the same insurance, medical service, or health plans he contracts for under [section 1079(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/a&num=0&edition=prelim). However, eye examinations and (except as provided in subsection (i)) treatments for eating disorders may not be provided under such plans for persons covered by subsection (c).
**(b)** For persons covered by this section the plans contracted for under [section 1079(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/a&num=0&edition=prelim) shall contain the following provisions for payment by the patient:
(1) Except as provided in paragraph (2), the first $150 each calendar year of the charges for all types of care authorized by this section and received while in an outpatient status and 25 percent of all subsequent charges for such care during a calendar year.
(2) A family group of two or more persons covered by this section shall not be required to pay collectively more than the first $300 each calendar year of the charges for all types of care authorized by this section and received while in an outpatient status and 25 percent of the additional charges for such care during a calendar year.
(3) 25 percent of the charges for inpatient care, except that in no case may the charges for inpatient care for a patient exceed $535 per day during the period beginning on April 1, 2006, and ending on September 30, 2011. The Secretary of Defense may
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Source file: Laws/federal/codes/united-states-code/title-10/section-1086-contracts-for-health-benefits-for-certain-members-former-members-and-the--48e29c8493.md
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Source location: Title 10, Chapter 55, § 1086; chapter-055-medical-and-dental-care.md
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**(a)** To assure that health benefits are available for the persons covered by subsection (c), the Secretary of Defense, after consulting with the other administering Secretaries, shall contract under the authority of this section for health benefits for those persons under the same insurance, medical service, or health plans he contracts for under [section 1079(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/a&num=0&edition=prelim). However, eye examinations and (except as provided in subsection (i)) treatments for eating disorders may not be provided under such plans for persons covered by subsection (c).
**(b)** For persons covered by this section the plans contracted for under [section 1079(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/a&num=0&edition=prelim) shall contain the following provisions for payment by the patient:
(1) Except as provided in paragraph (2), the first $150 each calendar year of the charges for all types of care authorized by this section and received while in an outpatient status and 25 percent of all subsequent charges for such care during a calendar year.
(2) A family group of two or more persons covered by this section shall not be required to pay collectively more than the first $300 each calendar year of the charges for all types of care authorized by this section and received while in an outpatient status and 25 percent of the additional charges for such care during a calendar year.
(3) 25 percent of the charges for inpatient care, except that in no case may the charges for inpatient care for a patient exceed $535 per day during the period beginning on April 1, 2006, and ending on September 30, 2011. The Secretary of Defense may exempt a patient from paying such charges if the hospital to which the patient is admitted does not impose a legal obligation on any of its patients to pay for inpatient care.
(4) A member or former member of a uniformed service covered by this section by reason of [section 1074(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1074/b&num=0&edition=prelim), or an individual or family group of two or more persons covered by this section, may not be required to pay a total of more than $3,000 for health care received during any calendar year under a plan contracted for under [section 1079(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/a&num=0&edition=prelim).
**(c)** Except as provided in subsection (d), the following persons are eligible for health benefits under this section:
(1) Those covered by sections 1074(b) and 1076(b) of this title, except those covered by [section 1072(2)(E) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1072/2/E&num=0&edition=prelim).
(2) A dependent (other than a dependent covered by [section 1072(2)(E) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1072/2/E&num=0&edition=prelim)) of a member of a uniformed service—
(A) who died while on active duty for a period of more than 30 days; or
(B) who died from an injury, illness, or disease incurred or aggravated—
(i) while on active duty under a call or order to active duty of 30 days or less, on active duty for training, or on inactive duty training; or
(ii) while traveling to or from the place at which the member is to perform, or has performed, such active duty, active duty for training, or inactive duty training.
(3) A dependent covered by clause (F), (G), or (H) of [section 1072(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1072/2&num=0&edition=prelim) who is not eligible under paragraph (1).
**(d)**
(1) A person who is entitled to hospital insurance benefits under 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.) is not eligible for health benefits under this section.
(2) The prohibition contained in paragraph (1) shall not apply to a person referred to in subsection (c) who—
(A) is enrolled in the supplementary medical insurance program under part B of such title ([42 U.S.C. 1395j](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395j&num=0&edition=prelim) et seq.); and
(B) in the case of a person under 65 years of age, is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act pursuant to subparagraph (A) or (C) of section 226(b)(2) of such Act ([42 U.S.C. 426(b)(2)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426/b/2&num=0&edition=prelim)) or section 226A(a) of such Act ([42 U.S.C. 426–1(a)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426–1/a&num=0&edition=prelim)).
(3)
(A) Subject to subparagraph (B), if a person described in paragraph (2) receives medical or dental care for which payment may be made under medicare and a plan contracted for under subsection (a), the amount payable for that care under the plan shall be the amount of the actual out-of-pocket costs incurred by the person for that care over the sum of—
(i) the amount paid for that care under medicare; and
(ii) the total of all amounts paid or payable by third party payers other than medicare.
(B) The amount payable for care under a plan pursuant to subparagraph (A) may not exceed the total amount that would be paid under the plan if payment for that care were made solely under the plan.
(C) In this paragraph:
(i) The term “medicare” means title XVIII 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.).
(ii) The term “third party payer” has the meaning given such term in [section 1095(h)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1095/h/1&num=0&edition=prelim).
(4)
(A) If a person referred to in subsection (c) and described by paragraph (2)(B) is subject to a retroactive determination by the Social Security Administration of entitlement to hospital insurance benefits described in paragraph (1), the person shall, during the period described in subparagraph (B), be deemed for purposes of health benefits under this section—
(i) not to have been covered by paragraph (1); and
(ii) not to have been subject to the requirements of [section 1079(i)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/i/1&num=0&edition=prelim), whether through the operation of such section or subsection (g) of this section.
(B) The period described in this subparagraph with respect to a person covered by subparagraph (A) is the period that—
(i) begins on the date that eligibility of the person for hospital insurance benefits referred to in paragraph (1) is effective under the retroactive determination of eligibility with respect to the person as described in subparagraph (A); and
(ii) ends on the date of the issuance of such retroactive determination of eligibility by the Social Security Administration.
(5) The administering Secretaries shall develop a mechanism by which persons described in subparagraph (B) of paragraph (2) who do not satisfy the condition specified in subparagraph (A) of such paragraph are promptly notified of their ineligibility for health benefits under this section. In developing the notification mechanism, the administering Secretaries shall consult with the Administrator of the Centers for Medicare & Medicaid Services.
**(e)** A person covered by this section may elect to receive inpatient medical care either in (1) Government facilities, under the conditions prescribed in sections 1074 and 1076–1078 of this title, or (2) the facilities provided under a plan contracted for under this section. However, under joint regulations issued by the administering Secretaries, the right to make this election may be limited for those persons residing in an area where adequate facilities of the uniformed service are available. In addition, subsections (b) and (c) of [section 1080 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1080&num=0&edition=prelim) shall apply in making the determination whether to issue a nonavailability of health care statement for a person covered by this section.
**(f)** The provisions of [section 1079(h) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/h&num=0&edition=prelim) shall apply to payments for services by an individual health-care professional (or other noninstitutional health-care provider) under a plan contracted for under subsection (a).
**(g)** [Section 1079(i) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/i&num=0&edition=prelim) shall apply to a plan contracted for under this section, except that no person eligible for health benefits under this section may be denied benefits under this section with respect to care or treatment for any service-connected disability which is compensable under chapter 11 of title 38 solely on the basis that such person is entitled to care or treatment for such disability in facilities of the Department of Veterans Affairs.
**(h)**
(1) Subject to paragraph (2), the Secretary of Defense may, upon request, make payments under this section for a charge for services for which a claim is submitted under a plan contracted for under subsection (a) to a hospital that does not impose a legal obligation on any of its patients to pay for such services.
(2) A payment under paragraph (1) may not exceed the average amount paid for comparable services in the geographic area in which the hospital is located or, if no comparable services are available in that area, in an area similar to the area in which the hospital is located.
(3) The Secretary of Defense shall periodically review the billing practices of each hospital the Secretary approves for payment under this subsection to ensure that the hospital’s practices of not billing patients for payment are not resulting in increased costs to the Government.
(4) The Secretary of Defense may require each hospital the Secretary approves for payment under this subsection to provide evidence that it has sources of revenue to cover unbilled costs.
**(i)** If, prior to October 1, 2022, a category of persons covered by this section was eligible to receive a specific type of treatment for eating disorders under a plan contracted for under subsection (a), the general prohibition on the provision of treatments for eating disorders specified in such subsection shall not apply with respect to the provision of the specific type of treatment to such category of persons.
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Federal law — U.S. Code and appendices · legal_authorities
**(a)**
(1) A dependent described in paragraph (2) is entitled, upon request, to the medical and dental care prescribed by [section 1077 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1077&num=0&edition=prelim) in facilities of the uniformed services, subject to the availability of space and facilities and the capabilities of the medical and dental staff.
(2) A dependent referred to in paragraph (1) is a dependent of a member of a uniformed service described in one of the following subparagraphs:
(A) A member who is on active duty for a period of more than 30 days or died while on that duty.
(B) A member who died from an injury, illness, or disease incurred or aggravated—
(i) while the member was on active duty under a call or order to active duty of 30 days or less, on active duty for training, or on inactive-duty training; or
(ii) while the member was traveling to or from the place at which the member was to perform, or had performed, such active duty, active duty for training, or inactive-duty training.
(C) A member who died from an injury, illness, or disease incurred or aggravated in the line of duty while the member remained overnight immediately before the commencement of inactive-duty training, or while the member remained overnight between successive periods of inactive-duty training, at or in the vicinity of the site of the inactive-duty training.
(D) A member on active duty who is entitled to benefits under subsection (e) of [section 1074a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1074a&num=0&edition=prelim) by reason of paragraph (1), (2), or (3) of subsection (a) of such section.
(E) A member who died from an injury, illness, or disease in
Source: Supplied U.S. Code snapshot — release unconfirmed · 10 U.S.C. § 1076
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Federal law — U.S. Code and appendices · legal_authorities
**(a)** Under joint regulations prescribed by the administering Secretaries, the following persons are entitled to the benefits described in subsection (b):
(1) Each member of a uniformed service who incurs or aggravates an injury, illness, or disease in the line of duty while performing—
(A) active duty for a period of 30 days or less;
(B) inactive-duty training; or
(C) service on funeral honors duty under [section 12503 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section12503&num=0&edition=prelim) or [section 115 of title 32](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title32-section115&num=0&edition=prelim).
(2) Each member of a uniformed service who incurs or aggravates an injury, illness, or disease while traveling directly to or from the place at which that member is to perform or has performed—
(A) active duty for a period of 30 days or less;
(B) inactive-duty training; or
(C) service on funeral honors duty under [section 12503 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section12503&num=0&edition=prelim) or [section 115 of title 32](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title32-section115&num=0&edition=prelim).
(3) Each member of the armed forces who incurs or aggravates an injury, illness, or disease in the line of duty while remaining overnight immediately before the commencement of inactive-duty training, or while remaining overnight, between successive periods of inactive-duty training, at or in the vicinity of the site of the inactive-duty training.
(4) Each member of the armed forces who incurs or aggravates an injury, illness, or disease in the line of duty while remaining overnight immediately before serving on fu
Source: Supplied U.S. Code snapshot — release unconfirmed · 10 U.S.C. § 1074a
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Federal law — U.S. Code and appendices · legal_authorities
In this chapter:
(1) The term “uniformed services” means the armed forces and the Commissioned Corps of the National Oceanic and Atmospheric Administration and of the Public Health Service.
(2) The term “dependent”, with respect to a member or former member of a uniformed service, means—
(A) the spouse;
(B) the unremarried widow;
(C) the unremarried widower;
(D) a child who—
(i) has not attained the age of 21;
(ii) has not attained the age of 23, is enrolled in a full-time course of study at an institution of higher learning approved by the administering Secretary and is, or was at the time of the member’s or former member’s death, in fact dependent on the member or former member for over one-half of the child’s support; or
(iii) is incapable of self-support because of a mental or physical incapacity that occurs while a dependent of a member or former member under clause (i) or (ii) and is, or was at the time of the member’s or former member’s death, in fact dependent on the member or former member for over one-half of the child’s support;
(E) a parent or parent-in-law who is, or was at the time of the member’s or former member’s death, in fact dependent on him for over one-half of his support and residing in his household;
(F) the unremarried former spouse of a member or former member who (i) on the date of the final decree of divorce, dissolution, or annulment, had been married to the member or former member for a period of at least 20 years during which period the member or former member performed at least 20 years of service which is creditable in determining that member’s or former member’s eligibility for retired or retainer pay, or equivalent pay, and (ii) does not have medical coverage under an employer-sponsored health plan;
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Election.—** A dependent covered by [section 1079 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079&num=0&edition=prelim) may elect to receive inpatient medical care either in (1) the facilities of the uniformed services, under the conditions prescribed by sections 1076–1078 of this title, or (2) the facilities provided under a plan contracted for under [section 1079 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079&num=0&edition=prelim). However, under such regulations as the Secretary of Defense, after consulting the other administering Secretaries, may prescribe, the right to make this election may be limited for dependents residing in the area where the member concerned is assigned, if adequate medical facilities of the uniformed services are available in that area for those dependents.
**(b) Issuance of Nonavailability-of-Health-Care Statements.—** In determining whether to issue a nonavailability-of-health-care statement for a dependent described in subsection (a), the commanding officer of a facility of the uniformed services may consider the availability of health care services for the dependent pursuant to any contract or agreement entered into under this chapter for the provision of health care services. Notwithstanding any other provision of law, with respect to obstetrics and gynecological care for beneficiaries not enrolled in a managed care plan offered pursuant to any contract or agreement under this chapter, a nonavailability-of-health-care statement shall be required for receipt of health care services related to outpatient prenatal, outpatient or inpatient delivery, and outpatient post-partum care subsequent to the visit which confirms the pregnancy.
**(
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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.
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Federal law — U.S. Code and appendices · legal_authorities
This chapter may be cited as the “Social Security Act”.
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Federal law — U.S. Code and appendices · legal_authorities
**(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
Source: Supplied U.S. Code snapshot — release unconfirmed · 10 U.S.C. § 1079
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Transitional allowances; procedures applicable** Any hospital may file an application with the Secretary (in such form and including such data and information as the Secretary may require) for establishment of a transitional allowance under this subchapter with respect to the closing or conversion of an underutilized hospital facility. The Secretary also may establish procedures, consistent with this section, by which a hospital, before undergoing an actual closure or conversion of a hospital facility, can have a determination made as to whether or not it will be eligible for a transitional allowance under this section with respect to such closure or conversion.
**(b) Allowable costs as transitional allowances; findings and determinations** If the Secretary finds, after consideration of an application under subsection (a), that—
(1) the hospital’s closure or conversion—
(A) is formally initiated after September 30, 1981,
(B) is expected to benefit the program under this subchapter by (i) eliminating excess bed capacity, (ii) discontinuing an underutilized service for which there are adequate alternative sources, or (iii) substituting for the underutilized service some other service which is needed in the area, and
(C) is consistent with the findings of an appropriate health planning agency and with any applicable State program for reduction in the number of hospital beds in the State, and
(2) in the case of a complete closure of a hospital—
(A) the hospital is a private nonprofit hospital or a local governmental hospital, and
(B) the closure is not for replacement of the hospital,
the Secretary may include as an allowable cost in the hospital’s reasonable cost (for the purpose of making payments to the hospital under this subchapter) an amount (i
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395ggg
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Requirement of requests and certifications** Except as provided in subsections (d) and (g) and in [section 1395mm of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395mm&num=0&edition=prelim), payment for services furnished an individual may be made only to providers of services which are eligible therefor under [section 1395cc of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395cc&num=0&edition=prelim) and only if—
(1) written request, signed by such individual, except in cases in which the Secretary finds it impracticable for the individual to do so, is filed for such payment in such form, in such manner, and by such person or persons as the Secretary may by regulation prescribe, no later than the close of the period ending 1 calendar year after the date of service;
(2) a physician, or, in the case of services described in subparagraph (B), a physician, or a nurse practitioner, a clinical nurse specialist, or a physician assistant (as those terms are defined in [section 1395x(aa)(5) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/aa/5&num=0&edition=prelim)) who does not have a direct or indirect employment relationship with the facility but is working in collaboration with a physician,,11 So in original. or, in the case of services described in subparagraph (C), a physician, a nurse practitioner or clinical nurse specialist (as such terms are defined in [section 1395x(aa)(5) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/aa/5&num=0&edition=prelim)) who is working in accordance with State law, or a physician assistant (as defined in [section 1395x(aa)(5) of this title](https://usc
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395j
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Definitions.—** In this section:
(1) The term “court” means—
(A) any court of competent jurisdiction of any State, the District of Columbia, the Commonwealth of Puerto Rico, Guam, American Samoa, the Virgin Islands, the Northern Mariana Islands, and the Trust Territory of the Pacific Islands;
(B) any court of the United States (as defined in [section 451 of title 28](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title28-section451&num=0&edition=prelim)) having competent jurisdiction;
(C) any court of competent jurisdiction of a foreign country with which the United States has an agreement requiring the United States to honor any court order of such country; and
(D) any administrative or judicial tribunal of a State competent to enter orders for support or maintenance (including a State agency administering a program under a State plan approved under part D of title IV of the Social Security Act), and, for purposes of this subparagraph, the term “State” includes the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa.
(2) The term “court order” means a final decree of divorce, dissolution, annulment, or legal separation issued by a court, or a court ordered, ratified, or approved property settlement incident to such a decree (including a final decree modifying the terms of a previously issued decree of divorce, dissolution, annulment, or legal separation, or a court ordered, ratified, or approved property settlement incident to such previously issued decree), or a support order, as defined in section 453(p) of the Social Security Act ([42 U.S.C. 653(p)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section653/p&num=0&edition=prelim)), which—
(A) is issued in accor
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