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38 U.S.C. § 1725 — Reimbursement for emergency treatment

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

38 U.S.C. § 1725 — Reimbursement for emergency treatment

**(a) General Authority.—** (1) Subject to subsections (c) and (d), the Secretary shall reimburse a veteran described in subsection (b) for the reasonable value of emergency treatment furnished the veteran in a non-Department facility. (2) In any case in which reimbursement is authorized under subsection (a)(1), the Secretary, in the Secretary’s discretion, may, in lieu of reimbursing the veteran, make payment of the reasonable value of the furnished emergency treatment directly— (A) to a hospital or other health care provider that furnished the treatment; or (B) to the person or organization that paid for such treatment on behalf of the veteran. **(b) Eligibility.—** (1) A veteran referred to in subsection (a)(1) is an individual who is an active Department health-care participant who is personally liable for emergency treatment furnished the veteran in a non-Department facility. (2) A veteran is an active Department health-care participant if— (A) the veteran is enrolled in the health care system established under [section 1705(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1705/a&num=0&edition=prelim); and (B) the veteran received care under this chapter within the 24-month period preceding the furnishing of such emergency treatment. (3) A veteran is personally liable for emergency treatment furnished the veteran in a non-Department facility if the veteran— (A) is financially liable to the provider of emergency treatment for that treatment; (B) has no entitlement to care or services under a health-plan contract (determined, in the case of a health-plan contract as defined in subsection (h)(2)(B) or (h)(2)(C), without regard to any requirement or limitation relating to eligibility for care or servi

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Source location: Title 38, Chapter 17, § 1725; chapter-017-hospital-nursing-home-domiciliary-and-medical-care.md

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**(a) General Authority.—** (1) Subject to subsections (c) and (d), the Secretary shall reimburse a veteran described in subsection (b) for the reasonable value of emergency treatment furnished the veteran in a non-Department facility. (2) In any case in which reimbursement is authorized under subsection (a)(1), the Secretary, in the Secretary’s discretion, may, in lieu of reimbursing the veteran, make payment of the reasonable value of the furnished emergency treatment directly— (A) to a hospital or other health care provider that furnished the treatment; or (B) to the person or organization that paid for such treatment on behalf of the veteran. **(b) Eligibility.—** (1) A veteran referred to in subsection (a)(1) is an individual who is an active Department health-care participant who is personally liable for emergency treatment furnished the veteran in a non-Department facility. (2) A veteran is an active Department health-care participant if— (A) the veteran is enrolled in the health care system established under [section 1705(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1705/a&num=0&edition=prelim); and (B) the veteran received care under this chapter within the 24-month period preceding the furnishing of such emergency treatment. (3) A veteran is personally liable for emergency treatment furnished the veteran in a non-Department facility if the veteran— (A) is financially liable to the provider of emergency treatment for that treatment; (B) has no entitlement to care or services under a health-plan contract (determined, in the case of a health-plan contract as defined in subsection (h)(2)(B) or (h)(2)(C), without regard to any requirement or limitation relating to eligibility for care or services from any department or agency of the United States); (C) has no other contractual or legal recourse against a third party that would, in whole, extinguish such liability to the provider; and (D) is not eligible for reimbursement for medical care or services under [section 1728 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1728&num=0&edition=prelim). **(c) Limitations on Reimbursement.—** (1) The Secretary, in accordance with regulations prescribed by the Secretary, shall— (A) establish the maximum amount payable under subsection (a); (B) delineate the circumstances under which such payments may be made, to include such requirements on requesting reimbursement as the Secretary shall establish; and (C) provide that in no event may a payment under that subsection include any amount for which the veteran is not personally liable. (2) Subject to paragraph (1), the Secretary may provide reimbursement under this section only after the veteran or the provider of emergency treatment has exhausted without success all claims and remedies reasonably available to the veteran or provider against a third party for payment of such treatment. (3) Payment by the Secretary under this section on behalf of a veteran to a provider of emergency treatment shall, unless rejected and refunded by the provider within 30 days of receipt, extinguish any liability on the part of the veteran for that treatment. Neither the absence of a contract or agreement between the Secretary and the provider nor any provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate the requirement in the preceding sentence. (4) (A) If the veteran has contractual or legal recourse against a third party that would only, in part, extinguish the veteran’s liability to the provider of the emergency treatment, and payment for the treatment may be made both under subsection (a) and by the third party, the amount payable for such treatment under such subsection shall be the amount by which the costs for the emergency treatment exceed the amount payable or paid by the third party, except that the amount payable may not exceed the maximum amount payable established under paragraph (1)(A). (B) In any case in which a third party is financially responsible for part of the veteran’s emergency treatment expenses, the Secretary shall be the secondary payer. (C) A payment in the amount payable under subparagraph (A) shall be considered payment in full and shall extinguish the veteran’s liability to the provider. (D) The Secretary may not reimburse a veteran under this section for any copayment or similar payment that the veteran owes the third party or for which the veteran is responsible under a health-plan contract. **(d) Independent Right of Recovery.—** (1) In accordance with regulations prescribed by the Secretary, the United States shall have the independent right to recover any amount paid under this section when, and to the extent that, a third party subsequently makes a payment for the same emergency treatment. (2) Any amount paid by the United States to the veteran (or the veteran’s personal representative, successor, dependents, or survivors) or to any other person or organization paying for such treatment shall constitute a lien in favor of the United States against any recovery the payee subsequently receives from a third party for the same treatment. (3) Any amount paid by the United States to the provider that furnished the veteran’s emergency treatment shall constitute a lien against any subsequent amount the provider receives from a third party for the same emergency treatment for which the United States made payment. (4) The veteran (or the veteran’s personal representative, successor, dependents, or survivors) shall ensure that the Secretary is promptly notified of any payment received from any third party for emergency treatment furnished to the veteran. The veteran (or the veteran’s personal representative, successor, dependents, or survivors) shall immediately forward all documents relating to such payment, cooperate with the Secretary in the investigation of such payment, and assist the Secretary in enforcing the United States right to recover any payment made under subsection (c)(3). **(e) Waiver.—** The Secretary, in the Secretary’s discretion, may waive recovery of a payment made to a veteran under this section that is otherwise required by subsection (d)(1) when the Secretary determines that such waiver would be in the best interest of the United States, as defined by regulations prescribed by the Secretary. **(f) Submittal of Claims for Direct Payment.—** An individual or entity seeking payment under subsection (a)(2) for treatment provided to a veteran in lieu of reimbursement to the veteran shall submit a claim for such payment not later than 180 days after the latest date on which such treatment was provided. **(g) Hold Harmless.—** No veteran described in subsection (b) may be held liable for payment for emergency treatment described in such subsection if— (1) a claim for direct payment was submitted by an individual or entity under subsection (f); and (2) such claim was submitted after the deadline established by such subsection due to— (A) an administrative error made by the individual or entity, such as submission of the claim to the wrong Federal agency, under the wrong reimbursement authority (such as [section 1728 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1728&num=0&edition=prelim)), or submission of the claim after the deadline; or (B) an administrative error made by the Department, such as misplacement of a paper claim or deletion of an electronic claim. **(h) Definitions.—** For purposes of this section: (1) The term “emergency treatment” means medical care or services furnished, in the judgment of the Secretary— (A) when Department or other Federal facilities are not feasibly available and an attempt to use them beforehand would not be reasonable; (B) when such care or services are rendered in a medical emergency of such nature that a prudent layperson reasonably expects that delay in seeking immediate medical attention would be hazardous to life or health; and (C) until— (i) such time as the veteran can be transferred safely to a Department facility or other Federal facility and such facility is capable of accepting such transfer; or (ii) such time as a Department facility or other Federal facility accepts such transfer if— (I) at the time the veteran could have been transferred safely to a Department facility or other Federal facility, no Department facility or other Federal facility agreed to accept such transfer; and (II) the non-Department facility in which such medical care or services was furnished made and documented reasonable attempts to transfer the veteran to a Department facility or other Federal facility. (2) The term “health-plan contract” includes any of the following: (A) An insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar arrangement under which health services for individuals are provided or the expenses of such services are paid. (B) An insurance program described in section 1811 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)) or established by section 1831 of that Act ([42 U.S.C. 1395j](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395j&num=0&edition=prelim)). (C) A State plan for medical assistance approved under title XIX of such Act ([42 U.S.C. 1396](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396&num=0&edition=prelim) et seq.). (D) A workers’ compensation law or plan described in [section 1729(a)(2)(A) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1729/a/2/A&num=0&edition=prelim). (3) The term “third party” means any of the following: (A) A Federal entity. (B) A State or political subdivision of a State. (C) An employer or an employer’s insurance carrier. (D) An automobile accident reparations insurance carrier. (E) A person or entity obligated to provide, or to pay the expenses of, health services under a health-plan contract.

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

42 U.S.C. § 1396 — Medicaid and CHIP Payment and Access Commission

**(a) Establishment** There is hereby established the Medicaid and CHIP Payment and Access Commission (in this section referred to as “MACPAC”). **(b) Duties** (1) **Review of access policies for all States and annual reports** — MACPAC shall— (A) review policies of the Medicaid program established under this subchapter (in this section referred to as “Medicaid”) and the State Children’s Health Insurance Program established under subchapter XXI (in this section referred to as “CHIP”) affecting access to covered items and services, including topics described in paragraph (2); (B) make recommendations to Congress, the Secretary, and States concerning such access policies; (C) by not later than March 15 of each year (beginning with 2010), submit a report to Congress containing the results of such reviews and MACPAC’s recommendations concerning such policies; and (D) by not later than June 15 of each year (beginning with 2010), submit a report to Congress containing an examination of issues affecting Medicaid and CHIP, including the implications of changes in health care delivery in the United States and in the market for health care services on such programs. (2) **Specific topics to be reviewed** — Specifically, MACPAC shall review and assess the following: (A) *Medicaid and CHIP payment policies* — Payment policies under Medicaid and CHIP, including— (i) the factors affecting expenditures for the efficient provision of items and services in different sectors, including the process for updating payments to medical, dental, and health professionals, hospitals, residential and long-term care providers, providers of home and community based services, Federally-qualified health centers and rural health clinics, managed care entities, and providers of ot

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

42 U.S.C. § 1395c — Prohibition against any Federal interference

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

38 U.S.C. § 1728 — Reimbursement of certain medical expenses

**(a)** The Secretary shall, under such regulations as the Secretary prescribes, reimburse veterans eligible for hospital care or medical services under this chapter for the customary and usual charges of emergency treatment (including travel and incidental expenses under the terms and conditions set forth in [section 111 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section111&num=0&edition=prelim)) for which such veterans have made payment, from sources other than the Department, where such emergency treatment was rendered to such veterans in need thereof for any of the following: (1) An adjudicated service-connected disability. (2) A non-service-connected disability associated with and held to be aggravating a service-connected disability. (3) Any disability of a veteran if the veteran has a total disability permanent in nature from a service-connected disability. (4) Any illness, injury, or dental condition of a veteran who— (A) is a participant in a vocational rehabilitation program (as defined in [section 3101 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section3101&num=0&edition=prelim)); and (B) is medically determined to have been in need of care or treatment to make possible the veteran’s entrance into a course of training, or prevent interruption of a course of training, or hasten the return to a course of training which was interrupted because of such illness, injury, or dental condition. **(b)** In any case where reimbursement would be in order under subsection (a) of this section, the Secretary may, in lieu of reimbursing such veteran, make payment of the reasonable value of emergency treatment directly— (1) to the hospital or other health facility furnishing the emerg

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

42 U.S.C. § 1305 — Short title of chapter

This chapter may be cited as the “Social Security Act”.

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

42 U.S.C. § 1395j — Conditions of and limitations on payment for services

**(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

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

38 U.S.C. § 1720J — Emergent suicide care

**(a) Emergent Suicide Care.—** Pursuant to this section, the Secretary shall— (1) furnish emergent suicide care to an eligible individual at a medical facility of the Department; (2) pay for emergent suicide care provided to an eligible individual at a non-Department facility; and (3) reimburse an eligible individual for emergent suicide care provided to the eligible individual at a non-Department facility. **(b) Eligibility.—** An individual is eligible for emergent suicide care under subsection (a) if the individual is in an acute suicidal crisis and is either of the following: (1) A veteran (as defined in section 101). (2) An individual described in [section 1720I(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1720I/b&num=0&edition=prelim). **(c) Period of Care.—** (1) Emergent suicide care provided under subsection (a) shall be furnished to an eligible individual— (A) through inpatient or crisis residential care, for a period not to exceed 30 days; or (B) if care under subparagraph (A) is unavailable, or if such care is not clinically appropriate, as outpatient care for a period not to exceed 90 days. (2) If, upon the expiration of a period under paragraph (1), the Secretary determines that the eligible individual remains in an acute suicidal crisis, the Secretary may extend such period as the Secretary determines appropriate. **(d) Notification.—** An eligible individual who receives emergent suicide care under subsection (a) at a non-Department facility (or a person acting on behalf of the individual) shall notify the Secretary of such care within seven days of admission to such facility. **(e) Outreach.—** During any period when an eligible individual is receiving emergent suicide care under subsect

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

38 U.S.C. § 1729A — Department of Veterans Affairs Medical Care Collections Fund

**(a)** There is in the Treasury a fund to be known as the Department of Veterans Affairs Medical Care Collections Fund. **(b)** Amounts recovered or collected under any of the following provisions of law shall be deposited in the fund: (1) [Section 1710(f) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1710/f&num=0&edition=prelim). (2) [Section 1710(g) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1710/g&num=0&edition=prelim). (3) [Section 1711 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1711&num=0&edition=prelim). (4) [Section 1722A of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1722a&num=0&edition=prelim). (5) [Section 1725 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1725&num=0&edition=prelim). (6) [Section 1729 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1729&num=0&edition=prelim). (7) [Section 1784 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1784&num=0&edition=prelim). (8) [Section 8165(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section8165/a&num=0&edition=prelim). (9) Section 113 of the Veterans Millennium Health Care and Benefits Act (Public Law 106–117; [38 U.S.C. 8111](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section8111&num=0&edition=prelim) note). (10) Public Law 87–693, popularly known as the “Federal Medical Care Recovery Act” ([42 U.S.C. 2651](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section2651&num=0&edition=prelim) et seq.), to th

Source: Supplied U.S. Code snapshot — release unconfirmed · 38 U.S.C. § 1729A

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

38 U.S.C. § 1725 — Reimbursement for emergency treatment

Page 456 TITLE 38—VETERANS’ BENEFITS § 1725 Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1976 AMENDMENT Amendment by Pub. L. 94–581 effective Oct. 21, 1976, see section 211 of Pub. L. 94–581, set out as a note under section 111 of this title. EFFECTIVE DATE OF 1973 AMENDMENT Amendment by Pub. L. 93–82 effective Sept. 1, 1973, see section 501 of Pub. L. 93–82, set out as a note under section 1701 of this title. § 1725. Reimbursement for emergency treatment (a) GENERAL AUTHORITY.—(1) Subject to sub- sections (c) and (d), the Secretary shall reim- burse a veteran described in subsection (b) for the reasonable value of emergency treatment furnished the veteran in a non-Department facil- ity. (2) In any case in which reimbursement is au- thorized under subsection (a)(1), the Secretary, in the Secretary’s discretion, may, in lieu of re- imbursing the veteran, make payment of the reasonable value of the furnished emergency treatment directly— (A) to a hospital or other health care pro- vider that furnished the treatment; or (B) to the person or organization that paid for such treatment on behalf of the veteran. (b) ELIGIBILITY.—(1) A veteran referred to in subsection (a)(1) is an individual who is an ac- tive Department health-care participant who is personally liable for emergency treatment fur- nished the veteran in a non-Department facility. (2) A veteran is an active Department health- care participant if— (A) the veteran is enrolled in the health care system established under section 1705(a) of this title; and (B) the veteran received care under this chapter within the 24-month period preceding the furnishing of such emergency treatment. (3) A veteran is personally liable for emer- gency treatment furnished the veteran in a non- Dep

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

42 U.S.C. § 1395c — Description of program

Page 2928 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395b–10 (A) are from entities that manufacture pharmaceutical, biotechnology, medical de- vice, or diagnostic products that are covered or for which coverage is being sought under this subchapter; and (B) are with respect to coverage, coding, or payment under this subchapter for such products. (2) Application The second sentence of subsection (c)(2) shall apply to the ombudsman under subpara- graph (A) in the same manner as such sentence applies to the Medicare Beneficiary Ombuds- man under subsection (c). (e) Funding for implementation of beneficiary enrollment simplification For purposes of carrying out the provisions of and the amendments made by section 120 of divi- sion CC of the Consolidated Appropriations Act, 2021, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1395i of this title and the Federal Supplementary Medical Insurance Trust Fund under section 1395t of this title (in such propor- tion as the Secretary determines appropriate), to the Centers for Medicare & Medicaid Services Program Management Account, of $2,000,000 for each of fiscal years 2021 through 2030, to remain available until expended. (Aug. 14, 1935, ch. 531, title XVIII, § 1808, as added and amended Pub. L. 108–173, title IX, §§ 900(a), (b), 923(a), Dec. 8, 2003, 117 Stat. 2369, 2393; Pub. L. 114–255, div. A, title IV, § 4010, Dec. 13, 2016, 130 Stat. 1185; Pub. L. 116–260, div. CC, title I, § 120(b), Dec. 27, 2020, 134 Stat. 2955.) Editorial Notes REFERENCES IN TEXT Section 120 of division CC of the Consolidated Appro- priations Act, 2021, referred to in subsec. (e), is section 120 of div. CC of Pub. L. 116–260, which amended this section and sections

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

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

42 U.S.C. § 1395j — Establishment of supplementary medical

Page 3018 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395j (I) a range of remedies to apply to hos- pice programs under the conditions de- scribed in paragraphs (1) through (4); and (II) appropriate procedures for appeal- ing determinations relating to the impo- sition of such remedies. Remedies developed pursuant to the pre- ceding sentence shall include the remedies specified in subparagraph (B). (ii) Conditions of imposition of remedies Not later than October 1, 2022, the Sec- retary shall develop and implement spe- cific procedures with respect to the condi- tions under which each of the remedies de- veloped under clause (i) is to be applied, including the amount of any fines and the severity of each of these remedies. Such procedures shall be designed so as to mini- mize the time between identification of de- ficiencies and imposition of these remedies and shall provide for the imposition of in- crementally more severe fines for repeated or uncorrected deficiencies. (B) Specified remedies The remedies specified in this subpara- graph are the following: (i) Civil money penalties in an amount not to exceed $10,000 for each day of non- compliance by a hospice program with the requirements specified in section 1395x(dd) of this title. (ii) Suspension of all or part of the pay- ments to which a hospice program would otherwise be entitled under this sub- chapter with respect to items and services furnished by a hospice program on or after the date on which the Secretary deter- mines that remedies should be imposed pursuant to paragraphs (1) and (2). (iii) The appointment of temporary man- agement to oversee the operation of the hospice program and to protect and assure the health and safety of the individuals under the care of the program while im-

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

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