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

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

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

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Source file: Laws/federal/codes/united-states-code/title-42/section-1395i-health-insurance-information-counseling-and-assistance-grants--b4f69b8927.md
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Source location: Title 42, Chapter 7, § 1395i; chapter-007-social-security.md

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**(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&num=0&edition=prelim)) and information that may assist individuals in filing claims under such medicare supplemental policies; (iii) information regarding long-term care insurance; and (iv) information regarding other types of health insurance benefits that the Secretary determines to be appropriate; (B) in conjunction with the health insurance information, counseling, and assistance program described in subparagraph (A), establish a system of referral to appropriate Federal or State departments or agencies for assistance with problems related to health insurance coverage (including legal problems), as determined by the Secretary; (C) provide for a sufficient number of staff positions (including volunteer positions) necessary to provide the services of the health insurance information, counseling, and assistance program; (D) provide assurances that staff members (including volunteer staff members) of the health insurance information, counseling, and assistance program have no conflict of interest in providing the counseling described in subparagraph (A); (E) provide for the collection and dissemination of timely and accurate health care information to staff members; (F) provide for training programs for staff members (including volunteer staff members); (G) provide for the coordination of the exchange of health insurance information between the staff of departments and agencies of the State government and the staff of the health insurance information, counseling, and assistance program; (H) make recommendations concerning consumer issues and complaints related to the provision of health care to agencies and departments of the State government and the Federal Government responsible for providing or regulating health insurance; (I) establish an outreach program to provide the health insurance information and counseling described in subparagraph (A) and the referrals described in subparagraph (B) to eligible individuals; and (J) demonstrate, to the satisfaction of the Secretary, an ability to provide the counseling and assistance required under this section. **(c) Special grants** (1) A State that is conducting a health insurance information, counseling, and assistance program that is substantially similar to a program described in subsection (b)(2) shall, as a requirement for eligibility for a grant under this section, demonstrate, to the satisfaction of the Secretary, that such State shall maintain the activities of such program at least at the level that such activities were conducted immediately preceding the date of the issuance of any grant during the period of time covered by such grant under this section. (2) If the Secretary determines that the existing health insurance information, counseling, and assistance program is substantially similar to a program described in subsection (b)(2), the Secretary may waive some or all of the requirements described in such subsection and issue a grant to the State for the purpose of increasing the number of services offered by the health insurance information, counseling, and assistance program, experimenting with new methods of outreach in conducting such program, or expanding such program to geographic areas of the State not previously served by the program. **(d) Criteria for issuing grants** In issuing a grant under this section, the Secretary shall consider— (1) the commitment of the State to carrying out the health insurance information, counseling, and assistance program described in subsection (b)(2), including the level of cooperation demonstrated— (A) by the office of the chief insurance regulator of the State, or the equivalent State entity; (B) other officials of the State responsible for overseeing insurance plans issued by nonprofit hospital and medical service associations; and (C) departments and agencies of such State responsible for— (i) administering funds under subchapter XIX of this chapter, and (ii) administering funds appropriated under the Older Americans Act [[42 U.S.C. 3001](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section3001&num=0&edition=prelim) et seq.]; (2) the population of eligible individuals in such State as a percentage of the population of such State; and (3) in order to ensure the needs of rural areas in such State, the relative costs and special problems associated with addressing the special problems of providing health care information, counseling, and assistance eligible 11 So in original. Probably should be preceded by “to”. individuals residing in rural areas of such State. **(e) Annual State report** A State that receives a grant under this section shall, not later than 180 days after receiving such grant, and annually thereafter during the period of the grant, issue a report to the Secretary that includes information concerning— (1) the number of individuals served by the health insurance information, counseling and assistance program of such State; (2) an estimate of the amount of funds saved by the State, and by eligible individuals in the State, in the implementation of such program; and (3) the problems that eligible individuals in such State encounter in procuring adequate and appropriate health care coverage. **(f) Report to Congress** Beginning with 1992, and annually thereafter, the Secretary shall issue a report to the Committee on Finance of the Senate, the Special Committee on Aging of the Senate, the Committee on Ways and Means of the House of Representatives, and the Committee on Energy and Commerce of the House of Representatives that— (1) summarizes the allocation of funds authorized for grants under this section and the expenditure of such funds; (2) outlines the problems that eligible individuals encounter in procuring adequate and appropriate health care coverage; (3) makes recommendations that the Secretary determines to be appropriate to address the problems described in paragraph (3); 22 So in original. Probably should be paragraph “(2)”. and (4) in the case of the report issued 2 years after November 5, 1990, evaluates the effectiveness of counseling programs established under this program, and makes recommendations regarding continued authorization of funds for these purposes. **(g) Authorization of appropriations for grants** There are authorized to be appropriated, in equal parts from the Federal Hospital Insurance Trust Fund and from the Federal Supplementary Medical Insurance Trust Fund, $10,000,000 for each of fiscal years 1991, 1992, 1993, 1994, 1995, and 1996, to fund the grant programs described in this section.

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

42 U.S.C. § 1395ss — Application of certain provisions of subchapter II

The provisions of sections 406 and 416(j) of this title, and of subsections (a), (d), (e), (h), (i), (j), (k), and (l) of [section 405 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section405&num=0&edition=prelim), shall also apply with respect to this subchapter to the same extent as they are applicable with respect to subchapter II, except that, in applying such provisions with respect to this subchapter, any reference therein to the Commissioner of Social Security or the Social Security Administration shall be considered a reference to the Secretary or the Department of Health and Human Services, respectively.

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395ss

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2 U.S.C. § 21 — Oath of Senators

The oath of office shall be administered by the President of the Senate to each Senator who shall be elected, previous to his taking his seat.

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42 U.S.C. § 3001 — Congressional declaration of objectives

The Congress hereby finds and declares that, in keeping with the traditional American concept of the inherent dignity of the individual in our democratic society, the older people of our Nation are entitled to, and it is the joint and several duty and responsibility of the governments of the United States, of the several States and their political subdivisions, and of Indian tribes to assist our older people to secure equal opportunity to the full and free enjoyment of the following objectives: (1) An adequate income in retirement in accordance with the American standard of living. (2) The best possible physical and mental health (including access to person-centered, trauma-informed services as appropriate) which science can make available and without regard to economic status. (3) Obtaining and maintaining suitable housing, independently selected, designed and located with reference to special needs and available at costs which older citizens can afford. (4) Full restoration services for those who require institutional care, and a comprehensive array of community-based, long-term care services adequate to appropriately sustain older people in their communities and in their homes, including support to family members and other persons providing voluntary care to older individuals needing long-term care services. (5) Opportunity for employment with no discriminatory personnel practices because of age. (6) Retirement in health, honor, dignity—after years of contribution to the economy. (7) Participating in and contributing to meaningful activity within the widest range of civic, cultural, education and training and recreational opportunities. (8) Efficient community services, including access to low-cost transportation, which provide a choice in supported living ar

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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

29 U.S.C. § 1136 — Coordination and responsibility of agencies enforcing this subchapter and related Federal laws

**(a) Coordination with other agencies and departments** In order to avoid unnecessary expense and duplication of functions among Government agencies, the Secretary may make such arrangements or agreements for cooperation or mutual assistance in the performance of his functions under this subchapter and the functions of any such agency as he may find to be practicable and consistent with law. The Secretary may utilize, on a reimbursable or other basis, the facilities or services of any department, agency, or establishment of the United States or of any State or political subdivision of a State, including the services of any of its employees, with the lawful consent of such department, agency, or establishment; and each department, agency, or establishment of the United States is authorized and directed to cooperate with the Secretary and, to the extent permitted by law, to provide such information and facilities as he may request for his assistance in the performance of his functions under this subchapter. The Attorney General or his representative shall receive from the Secretary for appropriate action such evidence developed in the performance of his functions under this subchapter as may be found to warrant consideration for criminal prosecution under the provisions of this subchapter or other Federal law. **(b) Responsibility for detecting and investigating civil and criminal violations of this subchapter and related Federal laws** The Secretary shall have the responsibility and authority to detect and investigate and refer, where appropriate, civil and criminal violations related to the provisions of this subchapter and other related Federal laws, including the detection, investigation, and appropriate referrals of related violations of title 18. Nothing in this s

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31 U.S.C. § 1105 — Budget contents and submission to Congress

**(a)** On or after the first Monday in January but not later than the first Monday in February of each year, the President shall submit a budget of the United States Government for the following fiscal year. Each budget shall include a budget message and summary and supporting information. The President shall include in each budget the following: (1) information on activities and functions of the Government. (2) when practicable, information on costs and achievements of Government programs. (3) other desirable classifications of information. (4) a reconciliation of the summary information on expenditures with proposed appropriations. (5) except as provided in subsection (b) of this section, estimated expenditures and proposed appropriations the President decides are necessary to support the Government in the fiscal year for which the budget is submitted and the 4 fiscal years after that year. (6) estimated receipts of the Government in the fiscal year for which the budget is submitted and the 4 fiscal years after that year under— (A) laws in effect when the budget is submitted; and (B) proposals in the budget to increase revenues. (7) appropriations, expenditures, and receipts of the Government in the prior fiscal year. (8) estimated expenditures and receipts, and appropriations and proposed appropriations, of the Government for the current fiscal year. (9) balanced statements of the— (A) condition of the Treasury at the end of the prior fiscal year; (B) estimated condition of the Treasury at the end of the current fiscal year; and (C) estimated condition of the Treasury at the end of the fiscal year for which the budget is submitted if financial proposals in the budget are adopted. (10) essential information about the debt of the Government.

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

42 U.S.C. § 1320b–12 — Research on outcomes of health care services and procedures

**(a) Establishment of program** (1) **In general** — The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall— (A) conduct and support research with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically; and (B) assure that the needs and priorities of the program under subchapter XVIII are appropriately reflected in the development and periodic review and updating (through the process set forth in section 299b–2 11 See References in Text note below. of this title) of treatment-specific or condition-specific practice guidelines for clinical treatments and conditions in forms appropriate for use in clinical practice, for use in educational programs, and for use in reviewing quality and appropriateness of medical care. (2) **Evaluations of alternative services and procedures** — In carrying out paragraph (1), the Secretary shall conduct or support evaluations of the comparative effects, on health and functional capacity, of alternative services and procedures utilized in preventing, diagnosing, treating, and clinically managing diseases, disorders, and other health conditions. (3) **Initial guidelines** (A) In carrying out paragraph (1)(B) of this subsection, and section 299b–1(d) 1 of this title, the Secretary shall, by not later than January 1, 1991, assure the development of an initial set of the guidelines specified in paragraph (1)(B) that shall include not less than 3 clinical treatments or conditions that— (i) (I) account for a significant portion of expenditures under sub

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42 U.S.C. § 1320e–2 — Trust Fund transfers to Patient-Centered Outcomes Research Trust Fund

**(a) In general** The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under [section 1395i of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i&num=0&edition=prelim) and the Federal Supplementary Medical Insurance Trust Fund under [section 1395t of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395t&num=0&edition=prelim), in proportion (as estimated by the Secretary) to the total expenditures during such fiscal year that are made under subchapter XVIII from the respective trust fund, to the Patient-Centered Outcomes Research Trust Fund (referred to in this section as the “PCORTF”) under section 9511 of the Internal Revenue Code of 1986, of the following: (1) For fiscal year 2013, an amount equal to $1 multiplied by the average number of individuals entitled to benefits under part A, or enrolled under part B, of subchapter XVIII during such fiscal year. (2) For each of fiscal years 2014, 2015, 2016, 2017, 2018, and 2019, an amount equal to $2 multiplied by the average number of individuals entitled to benefits under part A, or enrolled under part B, of subchapter XVIII during such fiscal year. **(b) Adjustments for increases in health care spending** In the case of any fiscal year beginning after September 30, 2014, the dollar amount in effect under subsection (a)(2) for such fiscal year shall be equal to the sum of such dollar amount for the previous fiscal year (determined after the application of this subsection), plus an amount equal to the product of— (1) such dollar amount for the previous fiscal year, multiplied by (2) the percentage increase in the projected per capita amount of National Health Expenditures, as most recently publish

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42 U.S.C. § 1395b — Medicare Integrity Program

**(a) Establishment of Program** There is hereby established the Medicare Integrity Program (in this section referred to as the “Program”) under which the Secretary shall promote the integrity of the medicare program by entering into contracts in accordance with this section with eligible entities, or otherwise, to carry out the activities described in subsection (b). **(b) Activities described** The activities described in this subsection are as follows: (1) Review of activities of providers of services or other individuals and entities furnishing items and services for which payment may be made under this subchapter (including skilled nursing facilities and home health agencies), including medical and utilization review and fraud review (employing similar standards, processes, and technologies used by private health plans, including equipment and software technologies which surpass the capability of the equipment and technologies used in the review of claims under this subchapter as of August 21, 1996). (2) Audit of cost reports. (3) Determinations as to whether payment should not be, or should not have been, made under this subchapter by reason of [section 1395y(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395y/b&num=0&edition=prelim), and recovery of payments that should not have been made. (4) Education of providers of services, beneficiaries, and other persons with respect to payment integrity and benefit quality assurance issues. (5) Developing (and periodically updating) a list of items of durable medical equipment in accordance with [section 1395m(a)(15) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395m/a/15&num=0&edition=prelim) which are subject to prior aut

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42 U.S.C. § 1395b–2 — Prospective payment for home health services

**(a) In general** Notwithstanding [section 1395x(v) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/v&num=0&edition=prelim), the Secretary shall provide, for portions of cost reporting periods occurring on or after October 1, 2000, for payments for home health services in accordance with a prospective payment system established by the Secretary under this section. **(b) System of prospective payment for home health services** (1) **In general** — The Secretary shall establish under this subsection a prospective payment system for payment for all costs of home health services. Under the system under this subsection all services covered and paid on a reasonable cost basis under the medicare home health benefit as of August 5, 1997, including medical supplies, shall be paid for on the basis of a prospective payment amount determined under this subsection and applicable to the services involved. In implementing the system, the Secretary may provide for a transition (of not longer than 4 years) during which a portion of such payment is based on agency-specific costs, but only if such transition does not result in aggregate payments under this subchapter that exceed the aggregate payments that would be made if such a transition did not occur. (2) **Unit of payment** (A) *In general* — In defining a prospective payment amount under the system under this subsection, the Secretary shall consider an appropriate unit of service and the number, type, and duration of visits provided within that unit, potential changes in the mix of services provided within that unit and their cost, and a general system design that provides for continued access to quality services. (B) *30-day unit of service* — For purposes of implementing t

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395b–2

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