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42 U.S.C. § 1320b–5 — Authority to waive requirements during national emergencies

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42 U.S.C. § 1320b–5 — Authority to waive requirements during national emergencies

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Source location: Title 42, Chapter 7, § 1320b–5; chapter-007-social-security.md

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**(a) Purpose** The purpose of this section is to enable the Secretary to ensure to the maximum extent feasible, in any emergency area and during an emergency period (as defined in subsection (g)(1))— (1) that sufficient health care items and services are available to meet the needs of individuals in such area enrolled in the programs under subchapters XVIII, XIX, and XXI; and (2) that health care providers (as defined in subsection (g)(2)) that furnish such items and services in good faith, but that are unable to comply with one or more requirements described in subsection (b), may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse. **(b) Secretarial authority** To the extent necessary to accomplish the purpose specified in subsection (a), the Secretary is authorized, subject to the provisions of this section, to temporarily waive or modify the application of, with respect to health care items and services furnished by a health care provider (or classes of health care providers) in any emergency area (or portion of such an area) during any portion of an emergency period, the requirements of subchapters XVIII, XIX, or XXI, or any regulation thereunder (and the requirements of this subchapter other than this section, and regulations thereunder, insofar as they relate to such subchapters), pertaining to— (1) (A) conditions of participation or other certification requirements for an individual health care provider or types of providers, (B) program participation and similar requirements for an individual health care provider or types of providers, and (C) pre-approval requirements; (2) requirements that physicians and other health care professionals be licensed in the State in which they provide such services, if they have equivalent licensing in another State and are not affirmatively excluded from practice in that State or in any State a part of which is included in the emergency area; (3) actions under [section 1395dd of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395dd&num=0&edition=prelim) (relating to examination and treatment for emergency medical conditions and women in labor) for— (A) a transfer of an individual who has not been stabilized in violation of subsection (c) of such section if the transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period; or (B) the direction or relocation of an individual to receive medical screening in an alternative location— (i) pursuant to an appropriate State emergency preparedness plan; or (ii) in the case of a public health emergency described in subsection (g)(1)(B) that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan or a plan referred to in clause (i), whichever is applicable in the State; (4) sanctions under [section 1395nn(g) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395nn/g&num=0&edition=prelim) (relating to limitations on physician referral); (5) deadlines and timetables for performance of required activities, except that such deadlines and timetables may only be modified, not waived; (6) limitations on payments under [section 1395w–21(i) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–21/i&num=0&edition=prelim) for health care items and services furnished to individuals enrolled in a Medicare+Choice plan by health care professionals or facilities not included under such plan; (7) sanctions and penalties that arise from noncompliance with the following requirements (as promulgated under the authority of section 264(c) of the Health Insurance Portability and Accountability Act of 1996 ([42 U.S.C. 1320d–2](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320d-2&num=0&edition=prelim) note)— 11 So in original. A second closing parenthesis probably should precede the dash. (A) section 164.510 of title 45, Code of Federal Regulations, relating to— (i) requirements to obtain a patient’s agreement to speak with family members or friends; and (ii) the requirement to honor a request to opt out of the facility directory; (B) section 164.520 of such title, relating to the requirement to distribute a notice; or (C) section 164.522 of such title, relating to— (i) the patient’s right to request privacy restrictions; and (ii) the patient’s right to request confidential communications; (8) in the case of a telehealth service (as defined in paragraph (4)(F) of [section 1395m(m) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395m/m&num=0&edition=prelim)) furnished in any emergency area (or portion of such an area) during any portion of any emergency period, the requirements of [section 1395m(m) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395m/m&num=0&edition=prelim); and (9) any requirement under [section 1395x(s)(7) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/s/7&num=0&edition=prelim) or section 1395m(l) of this title that an ambulance service include the transport of an individual to the extent necessary to allow payment for ground ambulance services furnished in response to a 911 call (or the equivalent in areas without a 911 call system) in cases in which an individual would have been transported to a destination permitted under Medicare regulations (as described in section 410.40 to title 42, Code of Federal Regulations (or successor regulations)) but such transport did not occur as a result of community-wide emergency medical service (EMS) protocols due to the public health emergency described in subsection (g)(1)(B). Insofar as the Secretary exercises authority under paragraph (6) with respect to individuals enrolled in a Medicare+Choice plan, to the extent possible given the circumstances, the Secretary shall reconcile payments made on behalf of such enrollees to ensure that the enrollees do not pay more than would be required had they received services from providers within the network of the plan and may reconcile payments to the organization offering the plan to ensure that such organization pays for services for which payment is included in the capitation payment it receives under part C of subchapter XVIII. A waiver or modification provided for under paragraph (3) or (7) shall only be in effect if such actions are taken in a manner that does not discriminate among individuals on the basis of their source of payment or of their ability to pay, and, except in the case of a waiver or modification to which the fifth sentence of this subsection applies, shall be limited to a 72-hour period beginning upon implementation of a hospital disaster protocol. A waiver or modification under such paragraph (7) shall be withdrawn after such period and the provider shall comply with the requirements under such paragraph for any patient still under the care of the provider. If a public health emergency described in subsection (g)(1)(B) involves a pandemic infectious disease (such as pandemic influenza), the duration of a waiver or modification under paragraph (3) shall be determined in accordance with subsection (e) as such subsection applies to public health emergencies. Ground ambulance services for which payment is made pursuant to paragraph (9) shall be paid at the base rate that would have been paid under the fee schedule established under 22 So in original. The word “section” probably should appear. 1395m(l) of this title (excluding any mileage payment) if the individual had been so transported and, with respect to ambulance services furnished by a critical access hospital or an entity described in paragraph (8) of such section, at the amount that otherwise would be paid under such paragraph. **(c) Authority for retroactive waiver** A waiver or modification of requirements pursuant to this section may, at the Secretary’s discretion, be made retroactive to the beginning of the emergency period or any subsequent date in such period specified by the Secretary. **(d) Certification to Congress** The Secretary shall provide a certification and advance written notice to the Congress at least two days before exercising the authority under this section with respect to an emergency area. Such a certification and notice shall include— (1) a description of— (A) the specific provisions that will be waived or modified; (B) the health care providers to whom the waiver or modification will apply; (C) the geographic area in which the waiver or modification will apply; and (D) the period of time for which the waiver or modification will be in effect; and (2) a certification that the waiver or modification is necessary to carry out the purpose specified in subsection (a). **(e) Duration of waiver** (1) **In general** — A waiver or modification of requirements pursuant to this section terminates upon— (A) the termination of the applicable declaration of emergency or disaster described in subsection (g)(1)(A); (B) the termination of the applicable declaration of public health emergency described in subsection (g)(1)(B); or (C) subject to paragraph (2), the termination of a period of 60 days from the date the waiver or modification is first published (or, if applicable, the date of extension of the waiver or modification under paragraph (2)). (2) **Extension of 60-day periods** — The Secretary may, by notice, provide for an extension of a 60-day period described in paragraph (1)(C) (or an additional period provided under this paragraph) for additional period or periods (not to exceed, except as subsequently provided under this paragraph, 60 days each), but any such extension shall not affect or prevent the termination of a waiver or modification under subparagraph (A) or (B) of paragraph (1). **(f) Report to Congress** Within one year after the end of the emergency period in an emergency area in which the Secretary exercised the authority provided under this section, the Secretary shall report to the Congress regarding the approaches used to accomplish the purposes described in subsection (a), including an evaluation of such approaches and recommendations for improved approaches should the need for such emergency authority arise in the future. **(g) Definitions** For purposes of this section: (1) **Emergency area; emergency period** (A) *In general* — Subject to subparagraph (B), an “emergency area” is a geographical area in which, and an “emergency period” is the period during which, there exists— (i) an emergency or disaster declared by the President pursuant to the National Emergencies Act [[50 U.S.C. 1601](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title50-section1601&num=0&edition=prelim) et seq.] or the Robert T. Stafford Disaster Relief and Emergency Assistance Act [[42 U.S.C. 5121](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section5121&num=0&edition=prelim) et seq.]; and (ii) a public health emergency declared by the Secretary pursuant to [section 247d of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section247d&num=0&edition=prelim). (B) *Exception* — For purposes of paragraphs (8) and (9) of subsection (b), an “emergency area” is a geographical area in which, and an “emergency period” is the period during which, there exists— (i) the public health emergency declared by the Secretary pursuant to [section 247d of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section247d&num=0&edition=prelim) on January 31, 2020, entitled “Determination that a Public Health Emergency Exists Nationwide as the Result of the 2019 Novel Coronavirus”; and (ii) any renewal of such declaration pursuant to such [section 247d of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section247d&num=0&edition=prelim). (2) **Health care provider** — The term “health care provider” means any entity that furnishes health care items or services, and includes a hospital or other provider of services, a physician or other health care practitioner or professional, a health care facility, or a supplier of health care items or services.

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

29 U.S.C. § 1191b — Definitions

**(a) Group health plan** For purposes of this part— (1) **In general** — The term “group health plan” means an employee welfare benefit plan to the extent that the plan provides medical care (as defined in paragraph (2) and including items and services paid for as medical care) to employees or their dependents (as defined under the terms of the plan) directly or through insurance, reimbursement, or otherwise. Such term shall not include any qualified small employer health reimbursement arrangement (as defined in [section 9831(d)(2) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section9831/d/2&num=0&edition=prelim)). (2) **Medical care** — The term “medical care” means amounts paid for— (A) the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body, (B) amounts paid for transportation primarily for and essential to medical care referred to in subparagraph (A), and (C) amounts paid for insurance covering medical care referred to in subparagraphs (A) and (B). **(b) Definitions relating to health insurance** For purposes of this part— (1) **Health insurance coverage** — The term “health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer. (2) **Health insurance issuer** — The term “health insurance issuer” means an insurance company, insurance service, or insurance organization (including a health maintenance organ

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42 U.S.C. § 5121 — Congressional findings and declarations

**(a)** The Congress hereby finds and declares that— (1) because disasters often cause loss of life, human suffering, loss of income, and property loss and damage; and (2) because disasters often disrupt the normal functioning of governments and communities, and adversely affect individuals and families with great severity; special measures, designed to assist the efforts of the affected States in expediting the rendering of aid, assistance, and emergency services, and the reconstruction and rehabilitation of devastated areas, are necessary. **(b)** It is the intent of the Congress, by this chapter, to provide an orderly and continuing means of assistance by the Federal Government to State and local governments in carrying out their responsibilities to alleviate the suffering and damage which result from such disasters by— (1) revising and broadening the scope of existing disaster relief programs; (2) encouraging the development of comprehensive disaster preparedness and assistance plans, programs, capabilities, and organizations by the States and by local governments; (3) achieving greater coordination and responsiveness of disaster preparedness and relief programs; (4) encouraging individuals, States, and local governments to protect themselves by obtaining insurance coverage to supplement or replace governmental assistance; (5) encouraging hazard mitigation measures to reduce losses from disasters, including development of land use and construction regulations; (6) providing Federal assistance programs for both public and private losses sustained in disasters; and (7) identifying and improving the climate and natural hazard resilience of vulnerable communities.

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42 U.S.C. § 1395dd — Definitions

For purposes of this subchapter— **(a) Spell of illness** The term “spell of illness” with respect to any individual means a period of consecutive days— (1) beginning with the first day (not included in a previous spell of illness) (A) on which such individual is furnished inpatient hospital services, inpatient critical access hospital services or extended care services, and (B) which occurs in a month for which he is entitled to benefits under part A, and (2) ending with the close of the first period of 60 consecutive days thereafter on each of which he is neither an inpatient of a hospital or critical access hospital nor an inpatient of a facility described in [section 1395i–3(a)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i–3/a/1&num=0&edition=prelim) or subsection (y)(1). **(b) Inpatient hospital services** The term “inpatient hospital services” means the following items and services furnished to an inpatient of a hospital and (except as provided in paragraph (3)) by the hospital— (1) bed and board; (2) such nursing services and other related services, such use of hospital facilities, and such medical social services as are ordinarily furnished by the hospital for the care and treatment of inpatients, and such drugs, biologicals, supplies, appliances, and equipment, for use in the hospital, as are ordinarily furnished by such hospital for the care and treatment of inpatients; and (3) such other diagnostic or therapeutic items or services, furnished by the hospital or by others under arrangements with them made by the hospital, as are ordinarily furnished to inpatients either by such hospital or by others under such arrangements; (4) medical or surgical services provided by a physician, resident, or intern

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29 U.S.C. § 1181 — Increased portability through limitation on preexisting condition exclusions

**(a) Limitation on preexisting condition exclusion period; crediting for periods of previous coverage** Subject to subsection (d), a group health plan, and a health insurance issuer offering group health insurance coverage, may, with respect to a participant or beneficiary, impose a preexisting condition exclusion only if— (1) such exclusion relates to a condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the enrollment date; (2) such exclusion extends for a period of not more than 12 months (or 18 months in the case of a late enrollee) after the enrollment date; and (3) the period of any such preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage (if any, as defined in subsection (c)(1)) applicable to the participant or beneficiary as of the enrollment date. **(b) Definitions** For purposes of this part— (1) **Preexisting condition exclusion** (A) *In general* — The term “preexisting condition exclusion” means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date. (B) *Treatment of genetic information* — Genetic information shall not be treated as a condition described in subsection (a)(1) in the absence of a diagnosis of the condition related to such information. (2) **Enrollment date** — The term “enrollment date” means, with respect to an individual covered under a group health plan or health insurance coverage, the date of e

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50 U.S.C. § 1601 — Termination of existing declared emergencies

**(a)** All powers and authorities possessed by the President, any other officer or employee of the Federal Government, or any executive agency, as defined in [section 105 of title 5](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section105&num=0&edition=prelim), as a result of the existence of any declaration of national emergency in effect on September 14, 1976, are terminated two years from September 14, 1976. Such termination shall not affect— (1) any action taken or proceeding pending not finally concluded or determined on such date; (2) any action or proceeding based on any act committed prior to such date; or (3) any rights or duties that matured or penalties that were incurred prior to such date. **(b)** For the purpose of this section, the words “any national emergency in effect” means a general declaration of emergency made by the President.

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

42 U.S.C. § 300gg — Fair health insurance premiums

**(a) 11 So in original. No subsec. (b) has been enacted. Prohibiting discriminatory premium rates** (1) **In general** — With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market— (A) such rate shall vary with respect to the particular plan or coverage involved only by— (i) whether such plan or coverage covers an individual or family; (ii) rating area, as established in accordance with paragraph (2); (iii) age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with [section 300gg–6(c) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–6/c&num=0&edition=prelim)); and (iv) tobacco use, except that such rate shall not vary by more than 1.5 to 1; and (B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A). (2) **Rating area** (A) *In general* — Each State shall establish 1 or more rating areas within that State for purposes of applying the requirements of this subchapter. (B) *Secretarial review* — The Secretary shall review the rating areas established by each State under subparagraph (A) to ensure the adequacy of such areas for purposes of carrying out the requirements of this subchapter. If the Secretary determines a State’s rating areas are not adequate, or that a State does not establish such areas, the Secretary may establish rating areas for that State. (3) **Permissible age bands** — The Secretary, in consultation with the National Association of Insurance Commissioners, shall define the permissible age bands for rating purposes under paragraph (1)(A)(iii). (4) **Application of variat

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

21 U.S.C. § 360bbb–3 — Authorization for medical products for use in emergencies

**(a) In general** (1) **Emergency uses** — Notwithstanding any provision of this chapter and section 351 of the Public Health Service Act [[42 U.S.C. 262](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section262&num=0&edition=prelim)], and subject to the provisions of this section, the Secretary may authorize the introduction into interstate commerce, during the effective period of a declaration under subsection (b), of a drug, device, or biological product intended for use in an actual or potential emergency (referred to in this section as an “emergency use”). (2) **Approval status of product** — An authorization under paragraph (1) may authorize an emergency use of a product that— (A) is not approved, licensed, or cleared for commercial distribution under section 355, 360(k), 360b, or 360e of this title or section 351 of the Public Health Service Act [[42 U.S.C. 262](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section262&num=0&edition=prelim)] or conditionally approved under [section 360ccc of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title21-section360ccc&num=0&edition=prelim) (referred to in this section as an “unapproved product”); or (B) is approved, conditionally approved under [section 360ccc of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title21-section360ccc&num=0&edition=prelim), licensed, or cleared under such a provision, but which use is not under such provision an approved, conditionally approved under [section 360ccc of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title21-section360ccc&num=0&edition=prelim), licensed, or cleared use of the product (referred to in this section as an “unapproved use of an approved

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42 U.S.C. § 247d — Public health emergencies

**(a) Emergencies** If the Secretary determines, after consultation with such public health officials as may be necessary, that— (1) a disease or disorder presents a public health emergency; or (2) a public health emergency, including significant outbreaks of infectious diseases or bioterrorist attacks, otherwise exists, the Secretary may take such action as may be appropriate to respond to the public health emergency, including making grants, providing awards for expenses, and entering into contracts and conducting and supporting investigations into the cause, treatment, or prevention of a disease or disorder as described in paragraphs (1) and (2). Any such determination of a public health emergency terminates upon the Secretary declaring that the emergency no longer exists, or upon the expiration of the 90-day period beginning on the date on which the determination is made by the Secretary, whichever occurs first. Determinations that terminate under the preceding sentence may be renewed by the Secretary (on the basis of the same or additional facts), and the preceding sentence applies to each such renewal. Not later than 48 hours after making a determination under this subsection of a public health emergency (including a renewal), the Secretary shall submit to the Congress written notification of the determination. **(b) Public Health Emergency Fund** (1) **In general** — There is established in the Treasury a fund to be designated as the “Public Health Emergency Fund” to be made available to the Secretary without fiscal year limitation to carry out subsection (a) only if a public health emergency has been declared by the Secretary under such subsection or if the Secretary determines there is the significant potential for a public health emergency, to allow the Se

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

26 U.S.C. § 9832 — Definitions

**(a) Group health plan** For purposes of this chapter, the term “group health plan” has the meaning given to such term by section 5000(b)(1). **(b) Definitions relating to health insurance** For purposes of this chapter— (1) **Health insurance coverage** (A) *In general* — Except as provided in subparagraph (B), the term “health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer. (B) *No application to certain excepted benefits* — In applying subparagraph (A), excepted benefits described in subsection (c)(1) shall not be treated as benefits consisting of medical care. (2) **Health insurance issuer** — The term “health insurance issuer” means an insurance company, insurance service, or insurance organization (including a health maintenance organization, as defined in paragraph (3)) which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance (within the meaning of section 514(b)(2) of the Employee Retirement Income Security Act of 1974, as in effect on the date of the enactment of this section). Such term does not include a group health plan. (3) **Health maintenance organization** — The term “health maintenance organization” means— (A) a federally qualified health maintenance organization (as defined in section 1301(a) of the Public Health Service Act ([42 U.S.C. 300e(a)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300e/a&num=0&edition=prelim))), (B) an organization recognized under State law as

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

26 U.S.C. § 9811 — Standards relating to benefits for mothers and newborns

**(a) Requirements for minimum hospital stay following birth** (1) **In general** — A group health plan may not— (A) except as provided in paragraph (2)— (i) restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less than 48 hours, or (ii) restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a caesarean section, to less than 96 hours; or (B) require that a provider obtain authorization from the plan or the issuer for prescribing any length of stay required under subparagraph (A) (without regard to paragraph (2)). (2) **Exception** — Paragraph (1)(A) shall not apply in connection with any group health plan in any case in which the decision to discharge the mother or her newborn child prior to the expiration of the minimum length of stay otherwise required under paragraph (1)(A) is made by an attending provider in consultation with the mother. **(b) Prohibitions** A group health plan may not— (1) deny to the mother or her newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the requirements of this section; (2) provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum protections available under this section; (3) penalize or otherwise reduce or limit the reimbursement of an attending provider because such provider provided care to an individual participant or beneficiary in accordance with this section; (4) provide incentives (monetary or otherwise) to an attending provider to induce such provider to provide care to an individual participant o

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