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42 U.S.C. § 18002 — Reinsurance for early retirees
Federal law — U.S. Code and appendices · legal_authorities
**(a) Administration**
(1) **In general** — Not later than 90 days after March 23, 2010, the Secretary shall establish a temporary reinsurance program to provide reimbursement to participating employment-based plans for a portion of the cost of providing health insurance coverage to early retirees (and to the eligible spouses, surviving spouses, and dependents of such retirees) during the period beginning on the date on which such program is established and ending on January 1, 2014.
(2) **Reference** — In this section:
(A) *Health benefits* — The term “health benefits” means medical, surgical, hospital, prescription drug, and such other benefits as shall be determined by the Secretary, whether self-funded, or delivered through the purchase of insurance or otherwise.
(B) *Employment-based plan* — The term “employment-based plan” means a group benefits plan providing health benefits that—
(i) is—
(I) maintained by one or more current or former employers (including without limitation any State or local government or political subdivision thereof or any agency or instrumentality of any of the foregoing), employee organization, a voluntary employees’ beneficiary association, or a committee or board of individuals appointed to administer such plan; or
(II) a multiemployer plan (as defined in [section 1002(37) of title 29](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1002/37&num=0&edition=prelim)); and
(ii) provides health benefits to early retirees.
(C) *Early retirees* — The term “early retirees” means individuals who are age 55 and older but are not eligible for coverage under title XVIII of the Social Security Act [[42 U.S.C. 1395](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section
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Source file: Laws/federal/codes/united-states-code/title-42/section-18002-reinsurance-for-early-retirees--7f462f5360.md
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Source location: Title 42, Chapter 157, § 18002; chapter-157-quality-affordable-health-care-for-all-americans.md
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**(a) Administration**
(1) **In general** — Not later than 90 days after March 23, 2010, the Secretary shall establish a temporary reinsurance program to provide reimbursement to participating employment-based plans for a portion of the cost of providing health insurance coverage to early retirees (and to the eligible spouses, surviving spouses, and dependents of such retirees) during the period beginning on the date on which such program is established and ending on January 1, 2014.
(2) **Reference** — In this section:
(A) *Health benefits* — The term “health benefits” means medical, surgical, hospital, prescription drug, and such other benefits as shall be determined by the Secretary, whether self-funded, or delivered through the purchase of insurance or otherwise.
(B) *Employment-based plan* — The term “employment-based plan” means a group benefits plan providing health benefits that—
(i) is—
(I) maintained by one or more current or former employers (including without limitation any State or local government or political subdivision thereof or any agency or instrumentality of any of the foregoing), employee organization, a voluntary employees’ beneficiary association, or a committee or board of individuals appointed to administer such plan; or
(II) a multiemployer plan (as defined in [section 1002(37) of title 29](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1002/37&num=0&edition=prelim)); and
(ii) provides health benefits to early retirees.
(C) *Early retirees* — The term “early retirees” means individuals who are age 55 and older but are not eligible for coverage under 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.], and who are not active employees of an employer maintaining, or currently contributing to, the employment-based plan or of any employer that has made substantial contributions to fund such plan.
**(b) Participation**
(1) **Employment-based plan eligibility** — A participating employment-based plan is an employment-based plan that—
(A) meets the requirements of paragraph (2) with respect to health benefits provided under the plan; and
(B) submits to the Secretary an application for participation in the program, at such time, in such manner, and containing such information as the Secretary shall require.
(2) **Employment-based health benefits** — An employment-based plan meets the requirements of this paragraph if the plan—
(A) implements programs and procedures to generate cost-savings with respect to participants with chronic and high-cost conditions;
(B) provides documentation of the actual cost of medical claims involved; and
(C) is certified by the Secretary.
**(c) Payments**
(1) **Submission of claims**
(A) *In general* — A participating employment-based plan shall submit claims for reimbursement to the Secretary which shall contain documentation of the actual costs of the items and services for which each claim is being submitted.
(B) *Basis for claims* — Claims submitted under subparagraph (A) shall be based on the actual amount expended by the participating employment-based plan involved within the plan year for the health benefits provided to an early retiree or the spouse, surviving spouse, or dependent of such retiree. In determining the amount of a claim for purposes of this subsection, the participating employment-based plan shall take into account any negotiated price concessions (such as discounts, direct or indirect subsidies, rebates, and direct or indirect remunerations) obtained by such plan with respect to such health benefit. For purposes of determining the amount of any such claim, the costs paid by the early retiree or the retiree’s spouse, surviving spouse, or dependent in the form of deductibles, co-payments, or co-insurance shall be included in the amounts paid by the participating employment-based plan.
(2) **Program payments** — If the Secretary determines that a participating employment-based plan has submitted a valid claim under paragraph (1), the Secretary shall reimburse such plan for 80 percent of that portion of the costs attributable to such claim that exceed $15,000, subject to the limits contained in paragraph (3).
(3) **Limit** — To be eligible for reimbursement under the program, a claim submitted by a participating employment-based plan shall not be less than $15,000 nor greater than $90,000. Such amounts shall be adjusted each fiscal year based on the percentage increase in the Medical Care Component of the Consumer Price Index for all urban consumers (rounded to the nearest multiple of $1,000) for the year involved.
(4) **Use of payments** — Amounts paid to a participating employment-based plan under this subsection shall be used to lower costs for the plan. Such payments may be used to reduce premium costs for an entity described in subsection (a)(2)(B)(i) or to reduce premium contributions, co-payments, deductibles, co-insurance, or other out-of-pocket costs for plan participants. Such payments shall not be used as general revenues for an entity described in subsection (a)(2)(B)(i). The Secretary shall develop a mechanism to monitor the appropriate use of such payments by such entities.
(5) **Payments not treated as income** — Payments received under this subsection shall not be included in determining the gross income of an entity described in subsection (a)(2)(B)(i) that is maintaining or currently contributing to a participating employment-based plan.
(6) **Appeals** — The Secretary shall establish—
(A) an appeals process to permit participating employment-based plans to appeal a determination of the Secretary with respect to claims submitted under this section; and
(B) procedures to protect against fraud, waste, and abuse under the program.
**(d) Audits** The Secretary shall conduct annual audits of claims data submitted by participating employment-based plans under this section to ensure that such plans are in compliance with the requirements of this section.
**(e) Funding** There is appropriated to the Secretary, out of any moneys in the Treasury not otherwise appropriated, $5,000,000,000 to carry out the program under this section. Such funds shall be available without fiscal year limitation.
**(f) Limitation** The Secretary has the authority to stop taking applications for participation in the program based on the availability of funding under subsection (e).
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Federal law — U.S. Code and appendices · legal_authorities
This chapter may be cited as the “Social Security Act”.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1305
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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) Internet portal to affordable coverage options**
(1) **Immediate establishment** — Not later than July 1, 2010, the Secretary, in consultation with the States, shall establish a mechanism, including an Internet website, through which a resident of, or small business in, any State may identify affordable health insurance coverage options in that State.
(2) **Connecting to affordable coverage** — An Internet website established under paragraph (1) shall, to the extent practicable, provide ways for residents of, and small businesses in, any State to receive information on at least the following coverage options:
(A) Health insurance coverage offered by health insurance issuers, other than coverage that provides reimbursement only for the treatment or mitigation of—
(i) a single disease or condition; or
(ii) an unreasonably limited set of diseases or conditions (as determined by the Secretary).
(B) Medicaid coverage under title XIX of the Social Security Act [[42 U.S.C. 1396](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396&num=0&edition=prelim) et seq.].
(C) Coverage under title XXI of the Social Security Act [[42 U.S.C. 1397aa](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1397aa&num=0&edition=prelim) et seq.].
(D) A State health benefits high risk pool, to the extent that such high risk pool is offered in such State; and
(E) Coverage under a high risk pool under [section 18001 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18001&num=0&edition=prelim).
(F) Coverage within the small group market for small businesses and their employees, including reinsurance for early retirees under [section 18002 of this title](https://uscode.house.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18003
Stored review status: release_metadata_unconfirmed. Incoming connection: Explicit cross-reference supplied in source Markdown; currentness and applicability require review.
Federal law — U.S. Code and appendices · legal_authorities
Page 2893
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1395a
(i) shared savings and competitive bidding in FFS
Medicare;
(ii) use of MA-negotiated rates to set FFS Medicare
rates; and
(iii) novel approaches to information development
and sharing that may enable markets to lower cost and
improve quality for FFS Medicare beneficiaries.
SEC. 10. Reducing Obstacles to Improved Patient Care.
Within 1 year of the date of this order, the Secretary
shall propose regulatory changes to the Medicare pro-
gram to reduce the burden on providers and eliminate
regulations that create inefficiencies or otherwise un-
dermine patient outcomes.
SEC. 11. Maximizing Freedom for Medicare Patients and
Providers. (a) Within 180 days of the date of this order,
the Secretary, in coordination with the Commissioner
of Social Security, shall revise current rules or policies
to preserve the Social Security retirement insurance
benefits of seniors who choose not to receive benefits
under Medicare Part A, and propose other administra-
tive improvements to Medicare enrollment processes
for beneficiaries.
(b) Within 1 year of the date of this order, the Sec-
retary shall identify and remove unnecessary barriers
to private contracts that allow Medicare beneficiaries
to obtain the care of their choice and facilitate the de-
velopment of market-driven prices.
SEC. 12. General Provisions. (a) Nothing in this order
shall be construed to impair or otherwise affect:
(i) the authority granted by law to an executive de-
partment or agency, or the head thereof; or
(ii) the functions of the Director of the Office of Man-
agement and Budget relating to budgetary, administra-
tive, or legislative proposals.
(b) This order shall be implemented consistent with
applicable law and subject to the
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1395
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 1395. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
Page 9089
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 18002
Medicaid coverage for up to 1 year postpartum, includ-
ing through initiatives in Illinois, New Jersey, Vir-
ginia, and Louisiana;
(c) operating a Special Enrollment Period during 2021
that allowed 2.8 million Americans to newly enroll in
coverage under the ACA;
(d) extending the length of the HealthCare.gov Open
Enrollment Period by 1 month and operating the most
successful Open Enrollment Period ever, with a historic
14.5 million Americans enrolling in coverage through
the ACA Marketplaces and an additional 1 million peo-
ple enrolling in Basic Health Program coverage, result-
ing in a 20 percent increase over the prior year across
both programs combined;
(e) increasing outreach and enrollment funding for
organizations that help Americans apply for ACA and
Medicaid coverage, including quadrupling the number
of trained Navigators to more than 1,500 people in
States using HealthCare.gov;
(f) lowering maximum out-of-pocket costs for con-
sumers with employer and ACA coverage by $400 in
2022;
(g) reducing paperwork burdens for people enrolling
in Medicaid and the ACA by eliminating unnecessary
documentation requirements;
(h) allowing low-income Americans to enroll in af-
fordable ACA coverage year-round;
(i) strengthening Medicaid and ACA section 1332 [42
U.S.C. 18052] waiver policies to partner with States to
develop innovative coverage options, strengthen bene-
fits, and lower costs;
(j) proposing rules that would better ensure com-
prehensive and standardized coverage and improve the
adequacy of ACA provider networks; and
(k) making efforts to improve the affordability of
ACA coverage for families by proposing rules to correct
a regulatory gap that prevents family members from
accessi
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 18002
Stored review status: historical_2024_not_currentness_verified. Same stored citation; legal effect and authority still require review.