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42 U.S.C. § 1395ggg — Payments to promote closing or conversion of underutilized hospital facilities
Federal law — U.S. Code and appendices · legal_authorities
**(a) Transitional allowances; procedures applicable** Any hospital may file an application with the Secretary (in such form and including such data and information as the Secretary may require) for establishment of a transitional allowance under this subchapter with respect to the closing or conversion of an underutilized hospital facility. The Secretary also may establish procedures, consistent with this section, by which a hospital, before undergoing an actual closure or conversion of a hospital facility, can have a determination made as to whether or not it will be eligible for a transitional allowance under this section with respect to such closure or conversion.
**(b) Allowable costs as transitional allowances; findings and determinations** If the Secretary finds, after consideration of an application under subsection (a), that—
(1) the hospital’s closure or conversion—
(A) is formally initiated after September 30, 1981,
(B) is expected to benefit the program under this subchapter by (i) eliminating excess bed capacity, (ii) discontinuing an underutilized service for which there are adequate alternative sources, or (iii) substituting for the underutilized service some other service which is needed in the area, and
(C) is consistent with the findings of an appropriate health planning agency and with any applicable State program for reduction in the number of hospital beds in the State, and
(2) in the case of a complete closure of a hospital—
(A) the hospital is a private nonprofit hospital or a local governmental hospital, and
(B) the closure is not for replacement of the hospital,
the Secretary may include as an allowable cost in the hospital’s reasonable cost (for the purpose of making payments to the hospital under this subchapter) an amount (i
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Source file: Laws/federal/codes/united-states-code/title-42/section-1395ggg-payments-to-promote-closing-or-conversion-of-underutilized-hospital-faci--40f5a03a7a.md
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Source location: Title 42, Chapter 7, § 1395ggg; chapter-007-social-security.md
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**(a) Transitional allowances; procedures applicable** Any hospital may file an application with the Secretary (in such form and including such data and information as the Secretary may require) for establishment of a transitional allowance under this subchapter with respect to the closing or conversion of an underutilized hospital facility. The Secretary also may establish procedures, consistent with this section, by which a hospital, before undergoing an actual closure or conversion of a hospital facility, can have a determination made as to whether or not it will be eligible for a transitional allowance under this section with respect to such closure or conversion.
**(b) Allowable costs as transitional allowances; findings and determinations** If the Secretary finds, after consideration of an application under subsection (a), that—
(1) the hospital’s closure or conversion—
(A) is formally initiated after September 30, 1981,
(B) is expected to benefit the program under this subchapter by (i) eliminating excess bed capacity, (ii) discontinuing an underutilized service for which there are adequate alternative sources, or (iii) substituting for the underutilized service some other service which is needed in the area, and
(C) is consistent with the findings of an appropriate health planning agency and with any applicable State program for reduction in the number of hospital beds in the State, and
(2) in the case of a complete closure of a hospital—
(A) the hospital is a private nonprofit hospital or a local governmental hospital, and
(B) the closure is not for replacement of the hospital,
the Secretary may include as an allowable cost in the hospital’s reasonable cost (for the purpose of making payments to the hospital under this subchapter) an amount (in this section referred to as a “transitional allowance”), as provided in subsection (c).
**(c) Factors determinative of transitional allowance**
(1) Each transitional allowance established shall be reasonably related to the prior or prospective use of the facility involved under this subchapter and shall recognize—
(A) in the case of a facility conversion or closure (other than a complete closure of a hospital)—
(i) in the case of a private nonprofit or local governmental hospital, that portion of the hospital’s costs attributable to capital assets of the facility which have been taken into account in determining reasonable cost for purposes of determining the amount of payment to the hospital under this subchapter, and
(ii) in the case of any hospital, transitional operating cost increases related to the conversion or closure to the extent that such operating costs exceed amounts ordinarily reimbursable under this subchapter; and
(B) in the case of complete closure of a hospital, the outstanding portion of actual debt obligations previously recognized as reasonable for purposes of reimbursement under this subchapter, less any salvage value of the hospital.
(2) A transitional allowance shall be for a period (not to exceed 20 years) specified by the Secretary, except that, in the case of a complete closure described in paragraph (1)(B), the Secretary may provide for a lump-sum allowance where the Secretary determines that such a one-time allowance is more efficient and economical.
(3) A transitional allowance shall take effect on a date established by the Secretary, but not earlier than the date of completion of the closure or conversion concerned.
(4) A transitional allowance shall not be considered in applying the limits to costs recognized as reasonable pursuant to the third sentence of subparagraph (A) and subparagraph (L)(i) of [section 1395x(v)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/v/1&num=0&edition=prelim), or in determining whether the reasonable cost exceeds the customary charges for a service for purposes of determining the amount to be paid to a provider pursuant to sections 1395f(b) and 1395l(a)(2) of this title.
**(d) Hearing to review determination** A hospital dissatisfied with a determination of the Secretary on its application under this section may obtain an informal or formal hearing, at the discretion of the Secretary, by filing (in such form and within such time period as the Secretary establishes) a request for such a hearing. The Secretary shall make a final determination on such application within 30 days after the last day of such hearing.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Establishment** The Secretary shall establish a manufacturer discount program (in this section referred to as the “program”). Under the program, the Secretary shall enter into agreements described in subsection (b) with manufacturers and provide for the performance of the duties described in subsection (c).
**(b) Terms of agreement**
(1) **In general**
(A) *Agreement* — An agreement under this section shall require the manufacturer to provide, in accordance with this section, discounted prices for applicable drugs of the manufacturer that are dispensed to applicable beneficiaries on or after January 1, 2025.
(B) *Clarification* — Nothing in this section shall be construed as affecting—
(i) the application of a coinsurance of 25 percent of the negotiated price, as applied under paragraph (2)(A) of [section 1395w–102(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–102/b&num=0&edition=prelim), for costs described in such paragraph; or
(ii) the application of the copayment amount described in paragraph (4)(A) of such section, with respect to costs described in such paragraph.
(C) *Timing of agreement*
(i) *Special rule for 2025* — In order for an agreement with a manufacturer to be in effect under this section with respect to the period beginning on January 1, 2025, and ending on December 31, 2025, the manufacturer shall enter into such agreement not later than March 1, 2024.
(ii) *2026 and subsequent years* — In order for an agreement with a manufacturer to be in effect under this section with respect to plan year 2026 or a subsequent plan year, the manufacturer shall enter into such agreement not later than a calendar quarter or semi-annual deadline established by the Secretary.
(2)
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395x
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Computation of amount** From the sums appropriated therefor, the Secretary (except as otherwise provided in this section) shall pay to each State which has a plan approved under this subchapter, for each quarter, beginning with the quarter commencing January 1, 1966—
(1) an amount equal to the Federal medical assistance percentage (as defined in [section 1396d(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396d/b&num=0&edition=prelim), subject to subsections (g) and (j) of this section and [section 1396r–4(f) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396r–4/f&num=0&edition=prelim)) of the total amount expended during such quarter as medical assistance under the State plan; plus
(2)
(A) an amount equal to 75 per centum of so much of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the State plan) as are attributable to compensation or training of skilled professional medical personnel, and staff directly supporting such personnel, of the State agency or any other public agency; plus
(B) notwithstanding paragraph (1) or subparagraph (A), with respect to amounts expended for nursing aide training and competency evaluation programs, and competency evaluation programs, described in [section 1396r(e)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396r/e/1&num=0&edition=prelim) (including the costs for nurse aides to complete such competency evaluation programs), regardless of whether the programs are provided in or outside nursing facilities or of the skill of the personnel involved in such programs, an amount equal to 50 percent (or, for calendar
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1396b
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Federal law — U.S. Code and appendices · legal_authorities
**(a)** To assure that health benefits are available for the persons covered by subsection (c), the Secretary of Defense, after consulting with the other administering Secretaries, shall contract under the authority of this section for health benefits for those persons under the same insurance, medical service, or health plans he contracts for under [section 1079(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/a&num=0&edition=prelim). However, eye examinations and (except as provided in subsection (i)) treatments for eating disorders may not be provided under such plans for persons covered by subsection (c).
**(b)** For persons covered by this section the plans contracted for under [section 1079(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/a&num=0&edition=prelim) shall contain the following provisions for payment by the patient:
(1) Except as provided in paragraph (2), the first $150 each calendar year of the charges for all types of care authorized by this section and received while in an outpatient status and 25 percent of all subsequent charges for such care during a calendar year.
(2) A family group of two or more persons covered by this section shall not be required to pay collectively more than the first $300 each calendar year of the charges for all types of care authorized by this section and received while in an outpatient status and 25 percent of the additional charges for such care during a calendar year.
(3) 25 percent of the charges for inpatient care, except that in no case may the charges for inpatient care for a patient exceed $535 per day during the period beginning on April 1, 2006, and ending on September 30, 2011. The Secretary of Defense may
Source: Supplied U.S. Code snapshot — release unconfirmed · 10 U.S.C. § 1086
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Federal law — U.S. Code and appendices · legal_authorities
**(a) FEHBP Option Demonstration.—** The Secretary of Defense, after consulting with the other administering Secretaries, shall enter into an agreement with the Office of Personnel Management to conduct a demonstration project (in this section referred to as the “demonstration project”) under which eligible beneficiaries described in subsection (b) and residing within one of the areas covered by the demonstration project may enroll in health benefits plans offered through the Federal Employees Health Benefits program under chapter 89 of title 5. The number of eligible beneficiaries and family members of such beneficiaries under subsection (b)(2) who may be enrolled in health benefits plans during the enrollment period under subsection (d)(2) may not exceed 66,000.
**(b) Eligible Beneficiaries; Coverage.—**
(1) An eligible beneficiary under this subsection is—
(A) a member or former member of the uniformed services described in [section 1074(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1074/b&num=0&edition=prelim) who is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act ([42 U.S.C. 1395c](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395c&num=0&edition=prelim) et seq.);
(B) an individual who is an unremarried former spouse of a member or former member described in section 1072(2)(F) or 1072(2)(G));
(C) an individual who is—
(i) a dependent of a deceased member or former member described in section 1076(b) or 1076(a)(2)(B) of this title or of a member who died while on active duty for a period of more than 30 days; and
(ii) a member of family as defined in [section 8901(5) of title 5](https://uscode.house.gov/view.xhtml?req=gran
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Federal law — U.S. Code and appendices · legal_authorities
Page 3994
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1395ggg
the Outcome and Assessment Information Set
(OASIS).
‘‘(B)
OUTCOME
AND
ASSESSMENT
INFORMATION
SET.—The term ‘Outcome and Assessment Informa-
tion Set’ means the standard provided under the
rule relating to data items that must be used in
conducting a comprehensive assessment of pa-
tients.’’
REPORT TO CONGRESS ON NEED FOR REDUCTIONS
Pub. L. 106–113, div. B, § 1000(a)(6) [title III, § 302(c)],
Nov. 29, 1999, 113 Stat. 1536, 1501A–360, as amended by
Pub. L. 106–554, § 1(a)(6) [title V, § 501(b)], Dec. 21, 2000,
114 Stat. 2763, 2763A–529, provided that: ‘‘Not later than
April 1, 2002, the Comptroller General of the United
States shall submit to Congress a report analyzing the
need for the 15 percent reduction under subsection
(b)(3)(A)(ii)
of
such
section
[42
U.S.C.
1395fff(b)(3)(A)(ii)], or for any reduction, in the com-
putation of the base payment amounts under the pro-
spective payment system for home health services es-
tablished under such section.’’
STUDY
AND REPORT
TO CONGRESS REGARDING EXEMP-
TION
OF
RURAL
AGENCIES
AND
POPULATIONS
FROM
INCLUSION
IN HOME HEALTH PROSPECTIVE PAYMENT
SYSTEM
Pub. L. 106–113, div. B, § 1000(a)(6) [title III, § 307], Nov.
29, 1999, 113 Stat. 1536, 1501A–362, provided that:
‘‘(a) STUDY.—The Medicare Payment Advisory Com-
mission (referred to in this section as ‘MedPAC’) shall
conduct a study to determine the feasibility and advis-
ability of exempting home health services provided by
a home health agency (or by others under arrange-
ments with such agency) located in a rural area, or to
an individual residing in a rural area, from payment
under the prospective payment system for such services
established by the Secretary of Health and Human
Services
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1395ggg
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