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42 U.S.C. § 1395bb — Application to Medicare Advantage program and related managed care programs
Federal law — U.S. Code and appendices · legal_authorities
**(a) Special rules relating to offering of qualified prescription drug coverage**
(1) **In general** — An MA organization on and after January 1, 2006—
(A) may not offer an MA plan described in [section 1395w–21(a)(2)(A) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–21/a/2/A&num=0&edition=prelim) in an area unless either that plan (or another MA plan offered by the organization in that same service area) includes required prescription drug coverage (as defined in paragraph (2)); and
(B) may not offer prescription drug coverage (other than that required under parts A and B) to an enrollee—
(i) under an MSA plan; or
(ii) under another MA plan unless such drug coverage under such other plan provides qualified prescription drug coverage and unless the requirements of this section with respect to such coverage are met.
(2) **Qualifying coverage** — For purposes of paragraph (1)(A), the term “required coverage” means with respect to an MA–PD plan—
(A) basic prescription drug coverage; or
(B) qualified prescription drug coverage that provides supplemental prescription drug coverage, so long as there is no MA monthly supplemental beneficiary premium applied under the plan (due to the application of a credit against such premium of a rebate under [section 1395w–24(b)(1)(C) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–24/b/1/C&num=0&edition=prelim)).
**(b) Application of default enrollment rules**
(1) **Seamless continuation** — In applying [section 1395w–21(c)(3)(A)(ii) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–21/c/3/A/ii&num=0&edition=prelim), an individual who is enrolled in a health benefits p
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Stable record: federal_law:legal_authorities:record_usc_d25106ad9ef83d150cc703cd
Source file: Laws/federal/codes/united-states-code/title-42/section-1395bb-application-to-medicare-advantage-program-and-related-managed-care-progr--d888004c91.md
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Source location: Title 42, Chapter 7, § 1395bb; chapter-007-social-security.md
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**(a) Special rules relating to offering of qualified prescription drug coverage**
(1) **In general** — An MA organization on and after January 1, 2006—
(A) may not offer an MA plan described in [section 1395w–21(a)(2)(A) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–21/a/2/A&num=0&edition=prelim) in an area unless either that plan (or another MA plan offered by the organization in that same service area) includes required prescription drug coverage (as defined in paragraph (2)); and
(B) may not offer prescription drug coverage (other than that required under parts A and B) to an enrollee—
(i) under an MSA plan; or
(ii) under another MA plan unless such drug coverage under such other plan provides qualified prescription drug coverage and unless the requirements of this section with respect to such coverage are met.
(2) **Qualifying coverage** — For purposes of paragraph (1)(A), the term “required coverage” means with respect to an MA–PD plan—
(A) basic prescription drug coverage; or
(B) qualified prescription drug coverage that provides supplemental prescription drug coverage, so long as there is no MA monthly supplemental beneficiary premium applied under the plan (due to the application of a credit against such premium of a rebate under [section 1395w–24(b)(1)(C) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–24/b/1/C&num=0&edition=prelim)).
**(b) Application of default enrollment rules**
(1) **Seamless continuation** — In applying [section 1395w–21(c)(3)(A)(ii) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–21/c/3/A/ii&num=0&edition=prelim), an individual who is enrolled in a health benefits plan shall not be considered to have been deemed to make an election into an MA–PD plan unless such health benefits plan provides any prescription drug coverage.
(2) **MA continuation** — In applying [section 1395w–21(c)(3)(B) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–21/c/3/B&num=0&edition=prelim), an individual who is enrolled in an MA plan shall not be considered to have been deemed to make an election into an MA–PD plan unless—
(A) for purposes of the election as of January 1, 2006, the MA plan provided as of December 31, 2005, any prescription drug coverage; or
(B) for periods after January 1, 2006, such MA plan is an MA–PD plan.
(3) **Discontinuance of MA–PD election during first year of eligibility** — In applying the second sentence of [section 1395w–21(e)(4) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–21/e/4&num=0&edition=prelim) in the case of an individual who is electing to discontinue enrollment in an MA–PD plan, the individual shall be permitted to enroll in a prescription drug plan under part D at the time of the election of coverage under the original medicare fee-for-service program.
(4) **Rules regarding enrollees in MA plans not providing qualified prescription drug coverage** — In the case of an individual who is enrolled in an MA plan (other than an MSA plan) that does not provide qualified prescription drug coverage, if the organization offering such coverage discontinues the offering with respect to the individual of all MA plans that do not provide such coverage—
(i) the individual is deemed to have elected the original medicare fee-for-service program option, unless the individual affirmatively elects to enroll in an MA–PD plan; and
(ii) in the case of such a deemed election, the disenrollment shall be treated as an involuntary termination of the MA plan described in subparagraph (B)(ii) of [section 1395ss(s)(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395ss/s/3&num=0&edition=prelim) for purposes of applying such section.
The information disclosed under [section 1395w–22(c)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–22/c/1&num=0&edition=prelim) for individuals who are enrolled in such an MA plan shall include information regarding such rules.
**(c) Application of part D rules for prescription drug coverage** With respect to the offering of qualified prescription drug coverage by an MA organization under this part on and after January 1, 2006—
(1) **In general** — Except as otherwise provided, the provisions of this part shall apply under part C with respect to prescription drug coverage provided under MA–PD plans in lieu of the other provisions of part C that would apply to such coverage under such plans.
(2) **Waiver** — The Secretary shall waive the provisions referred to in paragraph (1) to the extent the Secretary determines that such provisions duplicate, or are in conflict with, provisions otherwise applicable to the organization or plan under part C or as may be necessary in order to improve coordination of this part with the benefits under this part.
(3) **Treatment of MA owned and operated pharmacies** — The Secretary may waive the requirement of [section 1395w–104(b)(1)(C) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–104/b/1/C&num=0&edition=prelim) in the case of an MA–PD plan that provides access (other than mail order) to qualified prescription drug coverage through pharmacies owned and operated by the MA organization, if the Secretary determines that the organization’s pharmacy network is sufficient to provide comparable access for enrollees under the plan.
**(d) Special rules for private fee-for-service plans that offer prescription drug coverage** With respect to an MA plan described in [section 1395w–21(a)(2)(C) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–21/a/2/C&num=0&edition=prelim) that offers qualified prescription drug coverage, on and after January 1, 2006, the following rules apply:
(1) **Requirements regarding negotiated prices** — Subsections (a)(1) and (d)(1) of [section 1395w–102 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w-102&num=0&edition=prelim) and [section 1395w–104(b)(2)(A) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–104/b/2/A&num=0&edition=prelim) shall not be construed to require the plan to provide negotiated prices (described in subsection (d)(1)(B) of such section), but shall apply to the extent the plan does so.
(2) **Modification of pharmacy access standard and disclosure requirement** — If the plan provides coverage for drugs purchased from all pharmacies, without charging additional cost-sharing, and without regard to whether they are participating pharmacies in a network or have entered into contracts or agreements with pharmacies to provide drugs to enrollees covered by the plan, subsections (b)(1)(C) and (k) of [section 1395w–104 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w-104&num=0&edition=prelim) shall not apply to the plan.
(3) **Drug utilization management program and medication therapy management program not required** — The requirements of subparagraphs (A) and (C) of [section 1395w–104(c)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–104/c/1&num=0&edition=prelim) shall not apply to the plan.
(4) **Application of reinsurance** — The Secretary shall determine the amount of reinsurance payments under [section 1395w–115(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–115/b&num=0&edition=prelim) using a methodology that—
(A) bases such amount on the Secretary’s estimate of the amount of such payments that would be payable if the plan were an MA–PD plan described in [section 1395w–21(a)(2)(A)(i) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–21/a/2/A/i&num=0&edition=prelim) and the previous provisions of this subsection did not apply; and
(B) takes into account the average reinsurance payments made under [section 1395w–115(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–115/b&num=0&edition=prelim) for populations of similar risk under MA–PD plans described in such section.
(5) **Exemption from risk corridor provisions** — The provisions of [section 1395w–115(e) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–115/e&num=0&edition=prelim) shall not apply.
(6) **Exemption from negotiations** — Subsections (d) and (e)(2)(C) of [section 1395w–111 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w-111&num=0&edition=prelim) shall not apply and the provisions of [section 1395w–24(a)(5)(B) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–24/a/5/B&num=0&edition=prelim) prohibiting the review, approval, or disapproval of amounts described in such section shall apply to the proposed bid and terms and conditions described in [section 1395w–111(d) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–111/d&num=0&edition=prelim).
(7) **Treatment of incurred costs without regard to formulary** — The exclusion of costs incurred for covered part D drugs which are not included (or treated as being included) in a plan’s formulary under [section 1395w–102(b)(4)(C)(i) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–102/b/4/C/i&num=0&edition=prelim) shall not apply insofar as the plan does not utilize a formulary.
**(e) Application to reasonable cost reimbursement contractors**
(1) **In general** — Subject to paragraphs (2) and (3) and rules established by the Secretary, in the case of an organization that is providing benefits under a reasonable cost reimbursement contract under [section 1395mm(h) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395mm/h&num=0&edition=prelim) and that elects to provide qualified prescription drug coverage to a part D eligible individual who is enrolled under such a contract, the provisions of this part (and related provisions of part C) shall apply to the provision of such coverage to such enrollee in the same manner as such provisions apply to the provision of such coverage under an MA–PD local plan described in [section 1395–21(a)(2)(A)(i) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395–21/a/2/A/i&num=0&edition=prelim) and coverage under such a contract that so provides qualified prescription drug coverage shall be deemed to be an MA–PD local plan.
(2) **Limitation on enrollment** — In applying paragraph (1), the organization may not enroll part D eligible individuals who are not enrolled under the reasonable cost reimbursement contract involved.
(3) **Bids not included in determining national average monthly bid amount** — The bid of an organization offering prescription drug coverage under this subsection shall not be taken into account in computing the national average monthly bid amount and low-income benchmark premium amount under this part.
**(f) Application to PACE**
(1) **In general** — Subject to paragraphs (2) and (3) and rules established by the Secretary, in the case of a PACE program under [section 1395eee of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395eee&num=0&edition=prelim) that elects to provide qualified prescription drug coverage to a part D eligible individual who is enrolled under such program, the provisions of this part (and related provisions of part C) shall apply to the provision of such coverage to such enrollee in a manner that is similar to the manner in which such provisions apply to the provision of such coverage under an MA–PD local plan described in [section 1395w–21(a)(2)(A)(ii) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–21/a/2/A/ii&num=0&edition=prelim) and a PACE program that so provides such coverage may be deemed to be an MA–PD local plan.
(2) **Limitation on enrollment** — In applying paragraph (1), the organization may not enroll part D eligible individuals who are not enrolled under the PACE program involved.
(3) **Bids not included in determining standardized bid amount** — The bid of an organization offering prescription drug coverage under this subsection is not be taken into account in computing any average benchmark bid amount and low-income benchmark premium amount under this part.
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Federal law — U.S. Code and appendices · legal_authorities
Any health insurance policy that provides reimbursement for expenses incurred for items and services for which payment may be made 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.] but which are not reimbursable by reason of the applicability of deductibles, coinsurance, copayments or other limitations imposed by a Medicare Advantage plan (including a Medicare Advantage private fee-for-service plan) under part C of such title [[42 U.S.C. 1395w–21](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w-21&num=0&edition=prelim) et seq.] shall comply with the requirements of section 1882(o) of the such 11 So in original. Act ([42 U.S.C. 1395ss](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395ss&num=0&edition=prelim)(o)).
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395eee
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Freedom of Information Act inapplicable; exceptions to nondisclosure** An organization, in carrying out its functions under a contract entered into under this part, shall not be a Federal agency for purposes of the provisions of [section 552 of title 5](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section552&num=0&edition=prelim) (commonly referred to as the Freedom of Information Act). Any data or information acquired by any such organization in the exercise of its duties and functions shall be held in confidence and shall not be disclosed to any person except—
(1) to the extent that may be necessary to carry out the purposes of this part,
(2) in such cases and under such circumstances as the Secretary shall by regulations provide to assure adequate protection of the rights and interests of patients, health care practitioners, or providers of health care, or
(3) in accordance with subsection (b).
**(b) Disclosure of information permitted** An organization having a contract with the Secretary under this part shall provide in accordance with procedures and safeguards established by the Secretary, data and information—
(1) which may identify specific providers or practitioners as may be necessary—
(A) to assist Federal and State agencies recognized by the Secretary as having responsibility for identifying and investigating cases or patterns of fraud or abuse, which data and information shall be provided by the quality improvement organization to any such agency at the request of such agency relating to a specific case or pattern;
(B) to assist appropriate Federal and State agencies recognized by the Secretary as having responsibility for identifying cases or patterns involving risks to the public health, which data and information s
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1320c–9
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Federal law — U.S. Code and appendices · legal_authorities
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
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395dd
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Use of State agencies to determine compliance by providers of services with conditions of participation** The Secretary shall make an agreement with any State which is able and willing to do so under which the services of the State health agency or other appropriate State agency (or the appropriate local agencies) will be utilized by him for the purpose of determining whether an institution therein is a hospital or skilled nursing facility, or whether an agency therein is a home health agency, or whether an agency is a hospice program or whether a facility therein is a rural health clinic as defined in [section 1395x(aa)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/aa/2&num=0&edition=prelim), a critical access hospital, as defined in [section 1395x(mm)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/mm/1&num=0&edition=prelim), or a comprehensive outpatient rehabilitation facility as defined in [section 1395x(cc)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/cc/2&num=0&edition=prelim), or whether a laboratory meets the requirements of paragraphs (16) and (17) of [section 1395x(s) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/s&num=0&edition=prelim), or whether a clinic, rehabilitation agency or public health agency meets the requirements of subparagraph (A) or (B), as the case may be, of [section 1395x(p)(4) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/p/4&num=0&edition=prelim), or whether an ambulatory surgical center meets the standards specified under [section 1395k(a)(2)(F)(i) of this title](https://us
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395gg
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Accreditation by American Osteopathic Association or other national accreditation body**
(1) If the Secretary finds that accreditation of a provider entity (as defined in paragraph (4)) by the American Osteopathic Association or any other national accreditation body demonstrates that all of the applicable conditions or requirements of this subchapter (other than the requirements of [section 1395m(j) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395m/j&num=0&edition=prelim)) are met or exceeded—
(A) in the case of a provider entity not described in paragraph (3)(B), the Secretary shall treat such entity as meeting those conditions or requirements with respect to which the Secretary made such finding; or
(B) in the case of a provider entity described in paragraph (3)(B), the Secretary may treat such entity as meeting those conditions or requirements with respect to which the Secretary made such finding.
(2) In making such a finding, the Secretary shall consider, among other factors with respect to a national accreditation body, its requirements for accreditation, its survey procedures, its ability to provide adequate resources for conducting required surveys and supplying information for use in enforcement activities, its monitoring procedures for provider entities found out of compliance with the conditions or requirements, and its ability to provide the Secretary with necessary data for validation.
(3)
(A) Except as provided in subparagraph (B), not later than 60 days after the date of receipt of a written request for a finding under paragraph (1) (with any documentation necessary to make a determination on the request), the Secretary shall publish a notice identifying the national accreditation body making
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395hh
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Payment for durable medical equipment**
(1) **General rule for payment**
(A) *In general* — With respect to a covered item (as defined in paragraph (13)) for which payment is determined under this subsection, payment shall be made in the frequency specified in paragraphs (2) through (7) and in an amount equal to 80 percent of the payment basis described in subparagraph (B).
(B) *Payment basis* — Subject to subparagraph (F)(i), the payment basis described in this subparagraph is the lesser of—
(i) the actual charge for the item, or
(ii) the payment amount recognized under paragraphs (2) through (7) of this subsection for the item;
except that clause (i) shall not apply if the covered item is furnished by a public home health agency (or by another home health agency which demonstrates to the satisfaction of the Secretary that a significant portion of its patients are low income) free of charge or at nominal charges to the public.
(C) *Exclusive payment rule* — Subject to subparagraph (F)(ii), this subsection shall constitute the exclusive provision of this subchapter for payment for covered items under this part or under part A to a home health agency.
(D) *Reduction in fee schedules for certain items* — With respect to a seat-lift chair or transcutaneous electrical nerve stimulator furnished on or after April 1, 1990, the Secretary shall reduce the payment amount applied under subparagraph (B)(ii) for such an item by 15 percent, and, in the case of a transcutaneous electrical nerve stimulator furnished on or after January 1, 1991, the Secretary shall further reduce such payment amount (as previously reduced) by 45 percent.
(E) *Clinical conditions for coverage*
(i) *In general* — The Secretary shall establish standards for clinica
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395w–1
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Basic benefits**
(1) **Requirement**
(A) *In general* — Except as provided in [section 1395w–28(b)(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–28/b/3&num=0&edition=prelim) for MSA plans and except as provided in paragraph (6) for MA regional plans, each Medicare+Choice plan shall provide to members enrolled under this part, through providers and other persons that meet the applicable requirements of this subchapter and part A of subchapter XI, benefits under the original medicare fee-for-service program option (and, for plan years before 2006, additional benefits required under [section 1395w–24(f)(1)(A) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–24/f/1/A&num=0&edition=prelim)).
(B) *Benefits under the original medicare fee-for-service program option defined*
(i) *In general* — For purposes of this part, the term “benefits under the original medicare fee-for-service program option” means, subject to subsection (m), those items and services (other than hospice care or coverage for organ acquisitions for kidney transplants, including as covered under [section 1395rr(d) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395rr/d&num=0&edition=prelim)) for which benefits are available under parts A and B to individuals entitled to benefits under part A and enrolled under part B, with cost-sharing for those services as required under parts A and B or, subject to clause (iii), an actuarially equivalent level of cost-sharing as determined in this part.
(ii) *Special rule for regional plans* — In the case of an MA regional plan in determining an actuarially equivalent level of cost-sharing with respect to be
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395w–111
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Health care of the aged and disabled** The Secretary shall carry on studies and develop recommendations to be submitted from time to time to the Congress relating to health care of the aged and the disabled, including studies and recommendations concerning (1) the adequacy of existing personnel and facilities for health care for purposes of the programs under parts A and B of this subchapter; (2) methods for encouraging the further development of efficient and economical forms of health care which are a constructive alternative to inpatient hospital care; and (3) the effects of the deductibles and coinsurance provisions upon beneficiaries, persons who provide health services, and the financing of the program.
**(b) Operation and administration of insurance programs** The Secretary shall make a continuing study of the operation and administration of this subchapter (including a validation of the accreditation process of national accreditation bodies under [section 1395bb(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395bb/a&num=0&edition=prelim) 11 So in original. Probably should be followed by a comma. the operation and administration of health maintenance organizations authorized by section 226 of the Social Security Amendments of 1972 [[42 U.S.C. 1395mm](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395mm&num=0&edition=prelim)], the experiments and demonstration projects authorized by section 402 of the Social Security Amendments of 1967 [[42 U.S.C. 1395b–1](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395b-1&num=0&edition=prelim)] and the experiments and demonstration projects authorized by section 222(a) of the Social Security Amendments of 1972 [[4
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395ww
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 3623
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1395bb
tion 4204(a) of Pub. L. 100–203, as amended, set out as an
Effective Date note under section 1395i–3 of this title.
Amendment by section 4203(a)(1) of Pub. L. 100–203 ap-
plicable Jan. 1, 1988, except as otherwise specifically
provided in section 1395i–3 of this title, without regard
to whether regulations to implement such amendment
are promulgated by such date, and in applying amend-
ment by section 4203(a)(1) of Pub. L. 100–203 for services
furnished by a skilled nursing facility before Oct. 1,
1990, any reference to a requirement of section
1395i–3(b), (c), or (d) of this title is deemed a reference
to section 1395x(j) of this title, see section 4204(b) of
Pub. L. 100–203, as added by Pub. L. 100–485, set out as
an Effective Date note under section 1395i–3 of this
title.
EFFECTIVE DATE OF 1986 AMENDMENT
Amendment by Pub. L. 99–509 applicable to services
furnished on or after Jan. 1, 1989, with exceptions for
hospitals located in rural areas which meet certain re-
quirements related to certified registered nurse anes-
thetists, see section 9320(i), (k) of Pub. L. 99–509, as
amended, set out as notes under section 1395k of this
title.
EFFECTIVE DATE OF 1984 AMENDMENT
Amendment by Pub. L. 98–369 effective July 18, 1984,
but not to be construed as changing or affecting any
right, liability, status, or interpretation which existed
(under the provisions of law involved) before that date,
see section 2354(e)(1) of Pub. L. 98–369, set out as a note
under section 1320a–1 of this title.
EFFECTIVE DATE OF 1982 AMENDMENT
Amendment by Pub. L. 97–248 applicable to hospice
care provided on or after Nov. 1, 1983, see section
122(h)(1) of Pub. L. 97–248, as amended, set out as a note
under secti
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1395bb
Stored review status: historical_2024_not_currentness_verified. Same stored citation; legal effect and authority still require review.