Browse Arkansas Code titles and sections
42 U.S.C. § 1395kk — Provisions for administration of demonstration program
Federal law — U.S. Code and appendices · legal_authorities
**(a) General administrative authority**
(1) **Beneficiary eligibility** — Except as otherwise provided by the Secretary, an individual shall only be eligible to receive benefits under the program under [section 1395cc–1 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395cc-1&num=0&edition=prelim) (in this section referred to as the “demonstration program”) if such individual—
(A) is enrolled under the program under part B and entitled to benefits under part A; and
(B) is not enrolled in a Medicare+Choice plan under part C, an eligible organization under a contract under [section 1395mm of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395mm&num=0&edition=prelim) (or a similar organization operating under a demonstration project authority), an organization with an agreement under section 1395l(a)(1)(A) of this title, or 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).
(2) **Secretary’s discretion as to scope of program** — The Secretary may limit the implementation of the demonstration program to—
(A) a geographic area (or areas) that the Secretary designates for purposes of the program, based upon such criteria as the Secretary finds appropriate;
(B) a subgroup (or subgroups) of beneficiaries or individuals and entities furnishing items or services (otherwise eligible to participate in the program), selected on the basis of the number of such participants that the Secretary finds consistent with the effective and efficient implementation of the program;
(C) an element (or elements) of the program that the Secretary determines to be suitable for implementation
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395kk
Stored review status: release_metadata_unconfirmed. A text match is a research starting point; applicability is not established.
Original supplied file — preserved unchanged
Download original Markdown file
File SHA-256: 155b57a3f5c67494597d1459a2eb48b8db99791400f1e60f36b313f48db1d8d9. The original may include catalog metadata, neighboring provisions, or embedded records outside this collection's scope. Search shows only the selected federal record. Historical editions and unverified snapshots are not a statement of current law.
Authority boundary: historical or unconfirmed source not current law verified.
Open the recorded source website ↗
Record provenance
Stable record: federal_law:legal_authorities:record_usc_d861358b616ad626ca428bad
Source file: Laws/federal/codes/united-states-code/title-42/section-1395kk-provisions-for-administration-of-demonstration-program--30ad641b88.md
Pages: Not recorded – Not recorded
Passage SHA-256: 41d42aad046cf5c040a8e526a1953ee55a2971d2279f90d7391bf240262513a9
Source location: Title 42, Chapter 7, § 1395kk; chapter-007-social-security.md
Stored source content
**(a) General administrative authority**
(1) **Beneficiary eligibility** — Except as otherwise provided by the Secretary, an individual shall only be eligible to receive benefits under the program under [section 1395cc–1 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395cc-1&num=0&edition=prelim) (in this section referred to as the “demonstration program”) if such individual—
(A) is enrolled under the program under part B and entitled to benefits under part A; and
(B) is not enrolled in a Medicare+Choice plan under part C, an eligible organization under a contract under [section 1395mm of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395mm&num=0&edition=prelim) (or a similar organization operating under a demonstration project authority), an organization with an agreement under section 1395l(a)(1)(A) of this title, or 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).
(2) **Secretary’s discretion as to scope of program** — The Secretary may limit the implementation of the demonstration program to—
(A) a geographic area (or areas) that the Secretary designates for purposes of the program, based upon such criteria as the Secretary finds appropriate;
(B) a subgroup (or subgroups) of beneficiaries or individuals and entities furnishing items or services (otherwise eligible to participate in the program), selected on the basis of the number of such participants that the Secretary finds consistent with the effective and efficient implementation of the program;
(C) an element (or elements) of the program that the Secretary determines to be suitable for implementation; or
(D) any combination of any of the limits described in subparagraphs (A) through (C).
(3) **Voluntary receipt of items and services** — Items and services shall be furnished to an individual under the demonstration program only at the individual’s election.
(4) **Agreements** — The Secretary is authorized to enter into agreements with individuals and entities to furnish health care items and services to beneficiaries under the demonstration program.
(5) **Program standards and criteria** — The Secretary shall establish performance standards for the demonstration program including, as applicable, standards for quality of health care items and services, cost-effectiveness, beneficiary satisfaction, and such other factors as the Secretary finds appropriate. The eligibility of individuals or entities for the initial award, continuation, and renewal of agreements to provide health care items and services under the program shall be conditioned, at a minimum, on performance that meets or exceeds such standards.
(6) **Administrative review of decisions affecting individuals and entities furnishing services** — An individual or entity furnishing services under the demonstration program shall be entitled to a review by the program administrator (or, if the Secretary has not contracted with a program administrator, by the Secretary) of a decision not to enter into, or to terminate, or not to renew, an agreement with the entity to provide health care items or services under the program.
(7) **Secretary’s review of marketing materials** — An agreement with an individual or entity furnishing services under the demonstration program shall require the individual or entity to guarantee that it will not distribute materials that market items or services under the program without the Secretary’s prior review and approval.
(8) **Payment in full**
(A) *In general* — Except as provided in subparagraph (B), an individual or entity receiving payment from the Secretary under a contract or agreement under the demonstration program shall agree to accept such payment as payment in full, and such payment shall be in lieu of any payments to which the individual or entity would otherwise be entitled under this subchapter.
(B) *Collection of deductibles and coinsurance* — Such individual or entity may collect any applicable deductible or coinsurance amount from a beneficiary.
**(b) Contracts for program administration**
(1) **In general** — The Secretary may administer the demonstration program through a contract with a program administrator in accordance with the provisions of this subsection.
(2) **Scope of program administrator contracts** — The Secretary may enter into such contracts for a limited geographic area, or on a regional or national basis.
(3) **Eligible contractors** — The Secretary may contract for the administration of the program with—
(A) an entity that, under a contract under section 1395h or 1395u of this title, determines the amount of and makes payments for health care items and services furnished under this subchapter; or
(B) any other entity with substantial experience in managing the type of program concerned.
(4) **Contract award, duration, and renewal**
(A) *In general* — A contract under this subsection shall be for an initial term of up to three years, renewable for additional terms of up to three years.
(B) *Noncompetitive award and renewal for entities administering part A or part B payments* — The Secretary may enter or renew a contract under this subsection with an entity described in paragraph (3)(A) without regard to the requirements of [section 6101 of title 41](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title41-section6101&num=0&edition=prelim).
(5) **Applicability of Federal Acquisition Regulation** — The Federal Acquisition Regulation shall apply to program administration contracts under this subsection.
(6) **Performance standards** — The Secretary shall establish performance standards for the program administrator including, as applicable, standards for the quality and cost-effectiveness of the program administered, and such other factors as the Secretary finds appropriate. The eligibility of entities for the initial award, continuation, and renewal of program administration contracts shall be conditioned, at a minimum, on performance that meets or exceeds such standards.
(7) **Functions of program administrator** — A program administrator shall perform any or all of the following functions, as specified by the Secretary:
(A) *Agreements with entities furnishing health care items and services* — Determine the qualifications of entities seeking to enter or renew agreements to provide services under the demonstration program, and as appropriate enter or renew (or refuse to enter or renew) such agreements on behalf of the Secretary.
(B) *Establishment of payment rates* — Negotiate or otherwise establish, subject to the Secretary’s approval, payment rates for covered health care items and services.
(C) *Payment of claims or fees* — Administer payments for health care items or services furnished under the program.
(D) *Payment of bonuses* — Using such guidelines as the Secretary shall establish, and subject to the approval of the Secretary, make bonus payments as described in subsection (c)(2)(B) to entities furnishing items or services for which payment may be made under the program.
(E) *Oversight* — Monitor the compliance of individuals and entities with agreements under the program with the conditions of participation.
(F) *Administrative review* — Conduct reviews of adverse determinations specified in subsection (a)(6).
(G) *Review of marketing materials* — Conduct a review of marketing materials proposed by an entity furnishing services under the program.
(H) *Additional functions* — Perform such other functions as the Secretary may specify.
(8) **Limitation of liability** — The provisions of [section 1320c–6(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320c–6/b&num=0&edition=prelim) shall apply with respect to activities of contractors and their officers, employees, and agents under a contract under this subsection.
(9) **Information sharing** — Notwithstanding [section 1306 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1306&num=0&edition=prelim) and [section 552a of title 5](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section552a&num=0&edition=prelim), the Secretary is authorized to disclose to an entity with a program administration contract under this subsection such information (including medical information) on individuals receiving health care items and services under the program as the entity may require to carry out its responsibilities under the contract.
**(c) Rules applicable to both program agreements and program administration contracts**
(1) **Records, reports, and audits** — The Secretary is authorized to require entities with agreements to provide health care items or services under the demonstration program, and entities with program administration contracts under subsection (b), to maintain adequate records, to afford the Secretary access to such records (including for audit purposes), and to furnish such reports and other materials (including audited financial statements and performance data) as the Secretary may require for purposes of implementation, oversight, and evaluation of the program and of individuals’ and entities’ effectiveness in performance of such agreements or contracts.
(2) **Bonuses** — Notwithstanding any other provision of law, but subject to subparagraph (B)(ii), the Secretary may make bonus payments under the demonstration program from the Federal Health Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund in amounts that do not exceed the amounts authorized under the program in accordance with the following:
(A) *Payments to program administrators* — The Secretary may make bonus payments under the program to program administrators.
(B) *Payments to entities furnishing services*
(i) *In general* — Subject to clause (ii), the Secretary may make bonus payments to individuals or entities furnishing items or services for which payment may be made under the demonstration program, or may authorize the program administrator to make such bonus payments in accordance with such guidelines as the Secretary shall establish and subject to the Secretary’s approval.
(ii) *Limitations* — The Secretary may condition such payments on the achievement of such standards related to efficiency, improvement in processes or outcomes of care, or such other factors as the Secretary determines to be appropriate.
(3) **Antidiscrimination limitation** — The Secretary shall not enter into an agreement with an entity to provide health care items or services under the demonstration program, or with an entity to administer the program, unless such entity guarantees that it will not deny, limit, or condition the coverage or provision of benefits under the program, for individuals eligible to be enrolled under such program, based on any health status-related factor described in section 2702(a)(1) 11 See References in Text note below. of the Public Health Service Act.
**(d) Limitations on judicial review** The following actions and determinations with respect to the demonstration program shall not be subject to review by a judicial or administrative tribunal:
(1) Limiting the implementation of the program under subsection (a)(2).
(2) Establishment of program participation standards under subsection (a)(5) or the denial or termination of, or refusal to renew, an agreement with an entity to provide health care items and services under the program.
(3) Establishment of program administration contract performance standards under subsection (b)(6), the refusal to renew a program administration contract, or the noncompetitive award or renewal of a program administration contract under subsection (b)(4)(B).
(4) Establishment of payment rates, through negotiation or otherwise, under a program agreement or a program administration contract.
(5) A determination with respect to the program (where specifically authorized by the program authority or by subsection (c)(2))—
(A) as to whether cost savings have been achieved, and the amount of savings; or
(B) as to whether, to whom, and in what amounts bonuses will be paid.
**(e) Application limited to parts A and B** None of the provisions of this section or of the demonstration program shall apply to the programs under part C.
**(f) Reports to Congress** Not later than two years after December 21, 2000, and biennially thereafter for six years, the Secretary shall report to Congress on the use of authorities under the demonstration program. Each report shall address the impact of the use of those authorities on expenditures, access, and quality under the programs under this subchapter.
Cross-references
Connections may be documented source relationships, shared citations or nearby passages. Each explains its basis; a connection alone does not establish applicability to your situation.
Federal law — U.S. Code and appendices · legal_authorities
**(a) Implementation of 4-year demonstration program**
(1) **In general** — Not later than January 1, 2021, the Secretary shall implement a 4-year demonstration program under this subchapter (in this section referred to as the “Program”) to increase access of applicable beneficiaries to opioid use disorder treatment services, improve physical and mental health outcomes for such beneficiaries, and to the extent possible, reduce expenditures under this subchapter. Under the Program, the Secretary shall make payments under subsection (e) to participants (as defined in subsection (c)(1)(A)) for furnishing opioid use disorder treatment services delivered through opioid use disorder care teams, or arranging for such services to be furnished, to applicable beneficiaries participating in the Program.
(2) **Opioid use disorder treatment services** — For purposes of this section, the term “opioid use disorder treatment services”—
(A) means, with respect to an applicable beneficiary, services that are furnished for the treatment of opioid use disorders and that utilize drugs approved under [section 355 of title 21](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title21-section355&num=0&edition=prelim) for the treatment of opioid use disorders in an outpatient setting; and
(B) includes—
(i) medication-assisted treatment;
(ii) treatment planning;
(iii) psychiatric, psychological, or counseling services (or any combination of such services), as appropriate;
(iv) social support services, as appropriate; and
(v) care management and care coordination services, including coordination with other providers of services and suppliers not on an opioid use disorder care team.
**(b) Program design**
(1) **In general** — The Secretary shall design
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395mm
Stored review status: release_metadata_unconfirmed. Explicit cross-reference supplied in source Markdown; currentness and applicability require review.
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
Stored review status: release_metadata_unconfirmed. Explicit cross-reference supplied in source Markdown; currentness and applicability require review.
Federal law — U.S. Code and appendices · legal_authorities
**(a) Definitions.—** For purposes of this section—
(1) the term “agency” means agency as defined in section 552(e) 11 See References in Text note below. of this title;
(2) the term “individual” means a citizen of the United States or an alien lawfully admitted for permanent residence;
(3) the term “maintain” includes maintain, collect, use, or disseminate;
(4) the term “record” means any item, collection, or grouping of information about an individual that is maintained by an agency, including, but not limited to, his education, financial transactions, medical history, and criminal or employment history and that contains his name, or the identifying number, symbol, or other identifying particular assigned to the individual, such as a finger or voice print or a photograph;
(5) the term “system of records” means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual;
(6) the term “statistical record” means a record in a system of records maintained for statistical research or reporting purposes only and not used in whole or in part in making any determination about an identifiable individual, except as provided by [section 8 of title 13](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title13-section8&num=0&edition=prelim);
(7) the term “routine use” means, with respect to the disclosure of a record, the use of such record for a purpose which is compatible with the purpose for which it was collected;
(8) the term “matching program”—
(A) means any computerized comparison of—
(i) two or more automated systems of records or a system of records with non-Federal records for the purpose
Source: Supplied U.S. Code snapshot — release unconfirmed · 5 U.S.C. § 552a
Stored review status: release_metadata_unconfirmed. Explicit cross-reference supplied in source Markdown; currentness and applicability require review.
Federal law — U.S. Code and appendices · legal_authorities
**(a) Disclosure prohibited; exceptions**
(1) No disclosure of any return or portion of a return (including information returns and other written statements) filed with the Commissioner of Internal Revenue under title VIII of the Social Security Act or under subchapter E of chapter 1 or subchapter A of chapter 9 of the Internal Revenue Code [of 1939], or under regulations made under authority thereof, which has been transmitted to the head of the applicable agency by the Commissioner of Internal Revenue, or of any file, record, report, or other paper, or any information, obtained at any time by the head of the applicable agency or by any officer or employee of the applicable agency in the course of discharging the duties of the head of the applicable agency under this chapter, and no disclosure of any such file, record, report, or other paper, or information, obtained at any time by any person from the head of the applicable agency or from any officer or employee of the applicable agency, shall be made except as the head of the applicable agency may by regulations prescribe and except as otherwise provided by Federal law. Any person who shall violate any provision of this section shall be deemed guilty of a felony and, upon conviction thereof, shall be punished by a fine not exceeding $10,000 for each occurrence of a violation, or by imprisonment not exceeding 5 years, or both.
(2) For purposes of this subsection and subsection (b), the term “applicable agency” means—
(A) the Social Security Administration, with respect to matter transmitted to or obtained by such Administration or matter disclosed by such Administration, or
(B) the Department of Health and Human Services, with respect to matter transmitted to or obtained by such Department or matter disclosed b
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1306
Stored review status: release_metadata_unconfirmed. Explicit cross-reference supplied in source Markdown; currentness and applicability require review.
Federal law — U.S. Code and appendices · legal_authorities
**(a) Definitions.—** In this section—
(1) **Appropriation.—** — The term “appropriation” includes amounts made available by legislation under [section 9104 of title 31](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title31-section9104&num=0&edition=prelim).
(2) **Federal government.—** — The term “Federal Government” includes the government of the District of Columbia.
**(b) Purchases.—**
(1) **In general.—** — Unless otherwise provided in the appropriation concerned or other law, purchases and contracts for supplies or services for the Federal Government may be made or entered into only after advertising for proposals for a sufficient time.
(2) **Limitations on applicability.—** — Paragraph (1) does not apply when—
(A) the amount involved in any one case does not exceed $25,000;
(B) public exigencies require the immediate delivery of articles or performance of services;
(C) only one source of supply is available and the Federal Government purchasing or contracting officer so certifies; or
(D) services are required to be performed by a contractor in person and are—
(i) of a technical and professional nature; or
(ii) under Federal Government supervision and paid for on a time basis.
**(c) Sales.—** Except when otherwise authorized by law or when the reasonable value involved in any one case does not exceed $500, sales and contracts of sale by the Federal Government are governed by the requirements of this section for advertising.
**(d) Application to Wholly Owned Government Corporations.—** For wholly owned Government corporations, this section applies only to administrative transactions.
Source: Supplied U.S. Code snapshot — release unconfirmed · 41 U.S.C. § 6101
Stored review status: release_metadata_unconfirmed. Explicit cross-reference supplied in source Markdown; currentness and applicability require review.
Federal law — U.S. Code and appendices · legal_authorities
**(a)** After trying to collect a claim from a person under [section 3711(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title31-section3711/a&num=0&edition=prelim), the head of an executive, judicial, or legislative agency may collect the claim by administrative offset. The head of the agency may collect by administrative offset only after giving the debtor—
(1) written notice of the type and amount of the claim, the intention of the head of the agency to collect the claim by administrative offset, and an explanation of the rights of the debtor under this section;
(2) an opportunity to inspect and copy the records of the agency related to the claim;
(3) an opportunity for a review within the agency of the decision of the agency related to the claim; and
(4) an opportunity to make a written agreement with the head of the agency to repay the amount of the claim.
**(b)** Before collecting a claim by administrative offset, the head of an executive, judicial, or legislative agency must either—
(1) adopt, without change, regulations on collecting by administrative offset promulgated by the Department of Justice, the Government Accountability Office, or the Department of the Treasury; or
(2) prescribe regulations on collecting by administrative offset consistent with the regulations referred to in paragraph (1).
**(c)**
(1)
(A) Except as otherwise provided in this subsection, a disbursing official of the Department of the Treasury, the Department of Defense, the United States Postal Service, the Department of Health and Human Services, or any other government corporation, or any disbursing official of the United States designated by the Secretary of the Treasury, shall offset at least annually the amount of a payment which a payment
Source: Supplied U.S. Code snapshot — release unconfirmed · 31 U.S.C. § 3716
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
There are authorized to be appropriated to the Federal Hospital Insurance Trust Fund (established by [section 1395i of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i&num=0&edition=prelim)) from time to time such sums as the Secretary deems necessary for any fiscal year, on account of—
(1) payments made or to be made during such fiscal year from such Trust Fund under this part with respect to individuals who are qualified railroad retirement beneficiaries (as defined in section 426(c) 11 See References in Text note below. of this title) and who are not, and upon filing application for monthly insurance benefits under [section 402 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section402&num=0&edition=prelim) would not be, entitled to such benefits if service as an employee (as defined in the Railroad Retirement Act of 1937 [[45 U.S.C. 228a](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title45-section228a&num=0&edition=prelim) et seq.]) after December 31, 1936, had been included in the term “employment” as defined in this chapter,
(2) the additional administrative expenses resulting or expected to result therefrom, and
(3) any loss of interest to such Trust Fund resulting from the payment of such amounts,
in order to place such Trust Fund in the same position at the end of such fiscal year in which it would have been if the individuals described in paragraph (1) had not been entitled to benefits under this part.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395m–1
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
**(a) Functions of Secretary; performance directly or by contract** Except as otherwise provided in this subchapter and in the Railroad Retirement Act of 1974 [[45 U.S.C. 231](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title45-section231&num=0&edition=prelim) et seq.], the insurance programs established by this subchapter shall be administered by the Secretary. The Secretary may perform any of his functions under this subchapter directly, or by contract providing for payment in advance or by way of reimbursement, and in such installments, as the Secretary may deem necessary.
**(b) Contracts to secure special data, actuarial information, etc.** The Secretary may contract with any person, agency, or institution to secure on a reimbursable basis such special data, actuarial information, and other information as may be necessary in the carrying out of his functions under this subchapter.
**(c) Oaths and affirmations** In the course of any hearing, investigation, or other proceeding that he is authorized to conduct under this subchapter, the Secretary may administer oaths and affirmations.
**(d) Inclusion of Medicare provider and supplier payments in Federal Payment Levy Program**
(1) **In general** — The Centers for Medicare & Medicaid Services shall take all necessary steps to participate in the Federal Payment Levy Program under section 6331(h) of the Internal Revenue Code of 1986 as soon as possible and shall ensure that—
(A) at least 50 percent of all payments under parts A and B are processed through such program beginning within 1 year after July 15, 2008; 11 See References in Text note below.
(B) at least 75 percent of all payments under parts A and B are processed through such program beginning within 2 years after July 15, 2008; and
(
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395tt
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
**(a) Expanding uses of Medicare data by qualified entities**
(1) **Additional analyses**
(A) *In general* — Subject to subparagraph (B), to the extent consistent with applicable information, privacy, security, and disclosure laws (including paragraph (3)), notwithstanding paragraph (4)(B) of section 1874(e) of the Social Security Act ([42 U.S.C. 1395kk(e)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395kk/e&num=0&edition=prelim)) and the second sentence of paragraph (4)(D) of such section, beginning July 1, 2016, a qualified entity may use the combined data described in paragraph (4)(B)(iii) of such section received by such entity under such section, and information derived from the evaluation described in such paragraph (4)(D), to conduct additional non-public analyses (as determined appropriate by the Secretary) and provide or sell such analyses to authorized users for non-public use (including for the purposes of assisting providers of services and suppliers to develop and participate in quality and patient care improvement activities, including developing new models of care).
(B) *Limitations with respect to analyses*
(i) *Employers* — Any analyses provided or sold under subparagraph (A) to an employer described in paragraph (9)(A)(iii) may only be used by such employer for purposes of providing health insurance to employees and retirees of the employer.
(ii) *Health insurance issuers* — A qualified entity may not provide or sell an analysis to a health insurance issuer described in paragraph (9)(A)(iv) unless the issuer is providing the qualified entity with data under section 1874(e)(4)(B)(iii) of the Social Security Act ([42 U.S.C. 1395kk(e)(4)(B)(iii)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395vv
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 3692
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1395ii
Section 4039(g) of title IV of Pub. L. 100–203 provided
that: ‘‘The Secretary of Health and Human Services
shall issue such regulations (on an interim or other
basis) as may be necessary to implement this subtitle
and the amendments made by this subtitle [subtitle A
(§§ 4001–4097) of title IV of Pub. L. 100–203, see Tables for
classification].’’
REQUIRING
THE
POSTING
AND
PERIODIC
UPDATE
OF
OPIOID PRESCRIBING GUIDANCE
FOR MEDICARE BENE-
FICIARIES
Pub. L. 115–271, title VI, § 6095, Oct. 24, 2018, 132 Stat.
4003, provided that:
‘‘(a) IN GENERAL.—Not later than 180 days after the
date of the enactment of this Act [Oct. 24, 2018], the
Secretary of Health and Human Services (in this sec-
tion referred to as the ‘Secretary’) shall post on the
public website of the Centers for Medicare & Medicaid
Services all guidance published by the Department of
Health and Human Services on or after January 1, 2016,
relating to the prescribing of opioids and applicable to
opioid prescriptions for individuals entitled to benefits
under part A of title XVIII of the Social Security Act
(42 U.S.C. 1395c et seq.) or enrolled under part B of such
title of such Act (42 U.S.C. 1395j et seq.).
‘‘(b) UPDATE OF GUIDANCE.—
‘‘(1) PERIODIC UPDATE.—The Secretary shall, in con-
sultation with the entities specified in paragraph (2),
periodically (as determined appropriate by the Sec-
retary) update guidance described in subsection (a)
and revise the posting of such guidance on the
website described in such subsection.
‘‘(2) CONSULTATION.—The entities specified in this
paragraph are the following:
‘‘(A) Medical professional organizations.
‘‘(B) Providers and suppliers of services (as such
terms are defined in section 1861
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1395kk
Stored review status: historical_2024_not_currentness_verified. Same stored citation; legal effect and authority still require review.