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42 U.S.C. § 1395r — Protecting residents of long-term care facilities
Federal law — U.S. Code and appendices · legal_authorities
(1) **National Training Institute for surveyors**
(A) *In general* — The Secretary of Health and Human Services shall enter into a contract with an entity for the purpose of establishing and operating a National Training Institute for Federal and State surveyors. Such Institute shall provide and improve the training of surveyors with respect to investigating allegations of abuse, neglect, and misappropriation of property in programs and long-term care facilities that receive payments under title XVIII or XIX 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., 1396 et seq.].
(B) *Activities carried out by the Institute* — The contract entered into under subparagraph (A) shall require the Institute established and operated under such contract to carry out the following activities:
(i) Assess the extent to which State agencies use specialized surveyors for the investigation of reported allegations of abuse, neglect, and misappropriation of property in such programs and long-term care facilities.
(ii) Evaluate how the competencies of surveyors may be improved to more effectively investigate reported allegations of such abuse, neglect, and misappropriation of property, and provide feedback to Federal and State agencies on the evaluations conducted.
(iii) Provide a national program of training, tools, and technical assistance to Federal and State surveyors on investigating reports of such abuse, neglect, and misappropriation of property.
(iv) Develop and disseminate information on best practices for the investigation of such abuse, neglect, and misappropriation of property.
(v) Assess the performance of State complaint intake systems, in orde
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395r
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Stable record: federal_law:legal_authorities:record_usc_e000c433b5244529e2cde14b
Source file: Laws/federal/codes/united-states-code/title-42/section-1395r-protecting-residents-of-long-term-care-facilities--cd44a9b2c8.md
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Source location: Title 42, Chapter 7, § 1395r; chapter-007-social-security.md
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(1) **National Training Institute for surveyors**
(A) *In general* — The Secretary of Health and Human Services shall enter into a contract with an entity for the purpose of establishing and operating a National Training Institute for Federal and State surveyors. Such Institute shall provide and improve the training of surveyors with respect to investigating allegations of abuse, neglect, and misappropriation of property in programs and long-term care facilities that receive payments under title XVIII or XIX 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., 1396 et seq.].
(B) *Activities carried out by the Institute* — The contract entered into under subparagraph (A) shall require the Institute established and operated under such contract to carry out the following activities:
(i) Assess the extent to which State agencies use specialized surveyors for the investigation of reported allegations of abuse, neglect, and misappropriation of property in such programs and long-term care facilities.
(ii) Evaluate how the competencies of surveyors may be improved to more effectively investigate reported allegations of such abuse, neglect, and misappropriation of property, and provide feedback to Federal and State agencies on the evaluations conducted.
(iii) Provide a national program of training, tools, and technical assistance to Federal and State surveyors on investigating reports of such abuse, neglect, and misappropriation of property.
(iv) Develop and disseminate information on best practices for the investigation of such abuse, neglect, and misappropriation of property.
(v) Assess the performance of State complaint intake systems, in order to ensure that the intake of complaints occurs 24 hours per day, 7 days a week (including holidays).
(vi) To the extent approved by the Secretary of Health and Human Services, provide a national 24 hours per day, 7 days a week (including holidays), back-up system to State complaint intake systems in order to ensure optimum national responsiveness to complaints of such abuse, neglect, and misappropriation of property.
(vii) Analyze and report annually on the following:
(I) The total number and sources of complaints of such abuse, neglect, and misappropriation of property.
(II) The extent to which such complaints are referred to law enforcement agencies.
(III) General results of Federal and State investigations of such complaints.
(viii) Conduct a national study of the cost to State agencies of conducting complaint investigations of skilled nursing facilities and nursing facilities under sections 1819 and 1919, respectively, of the Social Security Act ([42 U.S.C. 1395i–3](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i-3&num=0&edition=prelim); 1396r), and making recommendations to the Secretary of Health and Human Services with respect to options to increase the efficiency and cost-effectiveness of such investigations.
(C) *Authorization* — There are authorized to be appropriated to carry out this paragraph, for the period of fiscal years 2011 through 2014, $12,000,000.
(2) **Grants to State survey agencies**
(A) *In general* — The Secretary of Health and Human Services shall make grants to State agencies that perform surveys of skilled nursing facilities or nursing facilities under sections 1819 or 1919, respectively, of the Social Security Act ([42 U.S.C. 1395i–3](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i-3&num=0&edition=prelim); 1395r [1396r]).
(B) *Use of funds* — A grant awarded under subparagraph (A) shall be used for the purpose of designing and implementing complaint investigations systems that—
(i) promptly prioritize complaints in order to ensure a rapid response to the most serious and urgent complaints;
(ii) respond to complaints with optimum effectiveness and timeliness; and
(iii) optimize the collaboration between local authorities, consumers, and providers, including—
(I) such State agency;
(II) the State Long-Term Care Ombudsman;
(III) local law enforcement agencies;
(IV) advocacy and consumer organizations;
(V) State aging units;
(VI) Area Agencies on Aging; and
(VII) other appropriate entities.
(C) *Authorization* — There are authorized to be appropriated to carry out this paragraph, for each of fiscal years 2011 through 2014, $5,000,000.
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Federal law — U.S. Code and appendices · legal_authorities
Not later than October 1, 2014, the Secretary shall submit to the Elder Justice Coordinating Council established under [section 1397k of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1397k&num=0&edition=prelim), the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives, and the Committee on Finance of the Senate a report—
(1) compiling, summarizing, and analyzing the information contained in the State reports submitted under subsections (b)(4) and (c)(4) 11 See References in Text note below. of [section 1397m–1 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1397m-1&num=0&edition=prelim); and
(2) containing such recommendations for legislative or administrative action as the Secretary determines to be appropriate.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1397j
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Federal law — U.S. Code and appendices · legal_authorities
This chapter may be cited as the “Social Security Act”.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1305
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Conditions of participation; protection of individual rights; notification of State entities; use of home health aides; medical equipment; individual’s plan of care; compliance with Federal, State, and local laws and regulations** The conditions of participation that a home health agency is required to meet under this subsection are as follows:
(1) The agency protects and promotes the rights of each individual under its care, including each of the following rights:
(A) The right to be fully informed in advance about the care and treatment to be provided by the agency, to be fully informed in advance of any changes in the care or treatment to be provided by the agency that may affect the individual’s well-being, and (except with respect to an individual adjudged incompetent) to participate in planning care and treatment or changes in care or treatment.
(B) The right to voice grievances with respect to treatment or care that is (or fails to be) furnished without discrimination or reprisal for voicing grievances.
(C) The right to confidentiality of the clinical records described in section 1395x(o)(3) of this title.
(D) The right to have one’s property treated with respect.
(E) The right to be fully informed orally and in writing (in advance of coming under the care of the agency) of—
(i) all items and services furnished by (or under arrangements with) the agency for which payment may be made under this subchapter,
(ii) the coverage available for such items and services under this subchapter, subchapter XIX, and any other Federal program of which the agency is reasonably aware,
(iii) any charges for items and services not covered under this subchapter and any charges the individual may have to pay with respect to items and services furn
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Establishment and operation of Account**
(1) **Establishment** — There is created within the Federal Supplementary Medical Insurance Trust Fund established by [section 1395t of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395t&num=0&edition=prelim) an account to be known as the “Medicare Prescription Drug Account” (in this section referred to as the “Account”).
(2) **Funding** — The Account shall consist of such gifts and bequests as may be made as provided in [section 401(i)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section401/i/1&num=0&edition=prelim), accrued interest on balances in the Account, and such amounts as may be deposited in, or appropriated to, such Account as provided in this part.
(3) **Separate from rest of Trust Fund** — Funds provided under this part to the Account shall be kept separate from all other funds within the Federal Supplementary Medical Insurance Trust Fund, but shall be invested, and such investments redeemed, in the same manner as all other funds and investments within such Trust Fund.
**(b) Payments from Account**
(1) **In general** — The Managing Trustee shall pay from time to time from the Account such amounts as the Secretary certifies are necessary to make payments to operate the program under this part, including—
(A) payments under [section 1395w–114 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w-114&num=0&edition=prelim) (relating to low-income subsidy payments);
(B) payments under [section 1395w–115 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w-115&num=0&edition=prelim) (relating to subsidy payments and payments for fallback
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395aa
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Establishment of program**
(1) **In general** — The Secretary shall establish a program under this section—
(A) to endorse prescription drug discount card programs that meet the requirements of this section in order to provide access to prescription drug discounts through prescription drug card sponsors for discount card eligible individuals throughout the United States; and
(B) to provide for transitional assistance for transitional assistance eligible individuals enrolled in such endorsed programs.
(2) **Period of operation**
(A) *Implementation deadline* — The Secretary shall implement the program under this section so that discount cards and transitional assistance are first available by not later than 6 months after December 8, 2003.
(B) *Expediting implementation* — The Secretary shall promulgate regulations to carry out the program under this section which may be effective and final immediately on an interim basis as of the date of publication of the interim final regulation. If the Secretary provides for an interim final regulation, the Secretary shall provide for a period of public comments on such regulation after the date of publication. The Secretary may change or revise such regulation after completion of the period of public comment.
(C) *Termination and transition*
(i) *In general* — Subject to clause (ii)—
(I) the program under this section shall not apply to covered discount card drugs dispensed after December 31, 2005; and
(II) transitional assistance shall be available after such date to the extent the assistance relates to drugs dispensed on or before such date.
(ii) *Transition* — In the case of an individual who is enrolled in an endorsed discount card program as of December 31, 2005, during the indivi
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395cc–3
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Entitlement to payment for inpatient hospital services, post-hospital extended care services, home health services, and hospice care** The benefits provided to an individual by the insurance program under this part shall consist of entitlement to have payment made on his behalf or, in the case of payments referred to in [section 1395f(d)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395f/d/2&num=0&edition=prelim) to him (subject to the provisions of this part) for—
(1) inpatient hospital services or inpatient critical access hospital services for up to 150 days during any spell of illness minus 1 day for each day of such services in excess of 90 received during any preceding spell of illness (if such individual was entitled to have payment for such services made under this part unless he specifies in accordance with regulations of the Secretary that he does not desire to have such payment made);
(2)
(A) post-hospital extended care services for up to 100 days during any spell of illness, and (B) to the extent provided in subsection (f), extended care services that are not post-hospital extended care services;
(3) in the case of individuals not enrolled in part B, home health services, and in the case of individuals so enrolled, post-institutional home health services furnished during a home health spell of illness for up to 100 visits during such spell of illness;
(4) in lieu of certain other benefits, hospice care with respect to the individual during up to two periods of 90 days each and an unlimited number of subsequent periods of 60 days each with respect to which the individual makes an election under subsection (d)(1); and
(5) for individuals who are terminally ill, have not made an election under subse
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395i–5
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Creation; deposits; transfers from Treasury** There is hereby created on the books of the Treasury of the United States a trust fund to be known as the “Federal Hospital Insurance Trust Fund” (hereinafter in this section referred to as the “Trust Fund”). The Trust Fund shall consist of such gifts and bequests as may be made as provided in [section 401(i)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section401/i/1&num=0&edition=prelim), and such amounts as may be deposited in, or appropriated to, such fund as provided in this part. There are hereby appropriated to the Trust Fund for the fiscal year ending June 30, 1966, and for each fiscal year thereafter, out of any moneys in the Treasury not otherwise appropriated, amounts equivalent to 100 per centum of—
(1) the taxes imposed by sections 3101(b) and 3111(b) of the Internal Revenue Code of 1986 with respect to wages reported to the Secretary of the Treasury or his delegate pursuant to subtitle F of such Code after December 31, 1965, as determined by the Secretary of the Treasury by applying the applicable rates of tax under such sections to such wages, which wages shall be certified by the Commissioner of Social Security on the basis of records of wages established and maintained by the Commissioner of Social Security in accordance with such reports; and
(2) the taxes imposed by section 1401(b) of the Internal Revenue Code of 1986 with respect to self-employment income reported to the Secretary of the Treasury or his delegate on tax returns under subtitle F of such Code, as determined by the Secretary of the Treasury by applying the applicable rate of tax under such section to such self-employment income, which self-employment income shall be certified by the Commission
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395m
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Individuals eligible to enroll** Every individual who—
(1) has attained the age of 65,
(2) is enrolled under part B of this subchapter,
(3) is a resident of the United States, and is either (A) a citizen or (B) an alien lawfully admitted for permanent residence who has resided in the United States continuously during the 5 years immediately preceding the month in which he applies for enrollment under this section, and
(4) is not otherwise entitled to benefits under this part,
shall be eligible to enroll in the insurance program established by this part. Except as otherwise provided, any reference to an individual entitled to benefits under this part includes an individual entitled to benefits under this part pursuant to an enrollment under this section or [section 1395i–2a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i-2a&num=0&edition=prelim).
**(b) Time, manner, and form of enrollment** An individual may enroll under this section only in such manner and form as may be prescribed in regulations, and only during an enrollment period prescribed in or under this section.
**(c) Period of enrollment; scope of coverage** The provisions of [section 1395p of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p&num=0&edition=prelim) (except subsections (f) and (o) thereof), [section 1395q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395q&num=0&edition=prelim), subsection (b) of [section 1395r of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395r&num=0&edition=prelim), and subsections (f) and (h) of [section 1395s of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395o
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Choice of medicare benefits through Medicare+Choice plans**
(1) **In general** — Subject to the provisions of this section, each Medicare+Choice eligible individual (as defined in paragraph (3)) is entitled to elect to receive benefits (other than qualified prescription drug benefits) under this subchapter—
(A) through the original medicare fee-for-service program under parts A and B, or
(B) through enrollment in a Medicare+Choice plan under this part,
and may elect qualified prescription drug coverage in accordance with [section 1395w–101 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w-101&num=0&edition=prelim).
(2) **Types of Medicare+Choice plans that may be available** — A Medicare+Choice plan may be any of the following types of plans of health insurance:
(A) *Coordinated care plans (including regional plans)*
(i) *In general* — Coordinated care plans which provide health care services, including but not limited to health maintenance organization plans (with or without point of service options), plans offered by provider-sponsored organizations (as defined in [section 1395w–25(d) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–25/d&num=0&edition=prelim)), and regional or local preferred provider organization plans (including MA regional plans).
(ii) *Specialized MA plans for special needs individuals* — Specialized MA plans for special needs individuals (as defined in [section 1395w–28(b)(6) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–28/b/6&num=0&edition=prelim)) may be any type of coordinated care plan.
(B) *Combination of MSA plan and contributions to Medicare+Choice MSA* — An MSA p
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395w–104
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Payments to organizations**
(1) **Monthly payments**
(A) *In general* — Under a contract under [section 1395w–27 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w-27&num=0&edition=prelim) and subject to subsections (e), (g), (i), and (l) and [section 1395w–28(e)(4) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–28/e/4&num=0&edition=prelim), the Secretary shall make monthly payments under this section in advance to each Medicare+Choice organization, with respect to coverage of an individual under this part in a Medicare+Choice payment area for a month, in an amount determined as follows:
(i) *Payment before 2006* — For years before 2006, the payment amount shall be equal to 1⁄12 of the annual MA capitation rate (as calculated under subsection (c)(1)) with respect to that individual for that area, adjusted under subparagraph (C) and reduced by the amount of any reduction elected under [section 1395w–24(f)(1)(E) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–24/f/1/E&num=0&edition=prelim).
(ii) *Payment for original fee-for-service benefits beginning with 2006* — For years beginning with 2006, the amount specified in subparagraph (B).
(B) *Payment amount for original fee-for-service benefits beginning with 2006*
(i) *Payment of bid for plans with bids below benchmark* — In the case of a plan for which there are average per capita monthly savings described in section 1395w–24(b)(3)(C) or 1395w–24(b)(4)(C) of this title, as the case may be, the amount specified in this subparagraph is equal to the unadjusted MA statutory non-drug monthly bid amount, adjusted under subparagraph (C) and (if applicable) un
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395w–112
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