42 U.S.C. § 1395b — Option to individuals to obtain other

Page 2895 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395b (C) Practitioner The term ‘‘practitioner’’ has the meaning given such term by section 1395u(b)(18)(C) of this title. (D) Opt-out physician or practitioner The term ‘‘opt-out physician or practi- tioner’’ means a physician or practitioner who has in effect an affidavit under para- graph (3)(B). (Aug. 14, 1935, ch. 531, title XVIII, § 1802, as added Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79 Stat. 291; amended Pub. L. 105–33, title IV, § 4507(a)(1), (2)(A), Aug. 5, 1997, 111 Stat. 439, 441; Pub. L. 108–173, title VI, § 603, Dec. 8, 2003, 117 Stat. 2301; Pub. L. 114–10, title I, § 106(a)(1)(A), (2), Apr. 16, 2015, 129 Stat. 137, 138.) Editorial Notes AMENDMENTS 2015—Subsec. (b)(3)(B)(ii). Pub. L. 114–10, § 106(a)(1)(A)(i), substituted ‘‘during the applicable 2- year period (as defined in subparagraph (D))’’ for ‘‘dur- ing the 2-year period beginning on the date the affi- davit is signed’’. Subsec. (b)(3)(C). Pub. L. 114–10, § 106(a)(1)(A)(ii), sub- stituted ‘‘during the applicable 2-year period’’ for ‘‘dur- ing the 2-year period described in subparagraph (B)(ii)’’ in introductory provisions. Subsec. (b)(3)(D). Pub. L. 114–10, § 106(a)(1)(A)(iii), added subpar. (D). Subsec. (b)(5). Pub. L. 114–10, § 106(a)(2)(C), added par. (5). Former par. (5) redesignated (6). Subsec. (b)(5)(D). Pub. L. 114–10, § 106(a)(2)(A), added subpar. (D). Subsec. (b)(6). Pub. L. 114–10, § 106(a)(2)(B), redesig- nated par. (5) as (6). 2003—Subsec. (b)(5)(B). Pub. L. 108–173 substituted ‘‘paragraphs (1), (2), (3), and (4) of section 1395x(r)’’ for ‘‘section 1395x(r)(1)’’. 1997—Pub. L. 105–33 designated existing provisions as subsec. (a), inserted heading, and added subsec. (b). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2015 AMENDMENT Pub. L. 114–10, title I, § 106(a)(1)(B), Apr. 16, 2015, 129 Stat. 138, provided that: ‘‘The amendments made by subparagraph (A) [amending this section] shall apply to affidavits entered into on or after the date that is 60 days after the date of the enactment of this Act [Apr. 16, 2015].’’ EFFECTIVE DATE OF 1997 AMENDMENT Pub. L. 105–33, title IV, § 4507(c), Aug. 5, 1997, 111 Stat. 442, provided that: ‘‘The amendment made by sub- section (a) [amending this section and section 1395y of this title] shall apply with respect to contracts entered into on and after January 1, 1998.’’ UPDATING THE WELCOME TO MEDICARE PACKAGE Pub. L. 114–255, div. C, title XVII, § 17003, Dec. 13, 2016, 130 Stat. 1331, provided that: ‘‘(a) IN GENERAL.—Not later than 12 months after the last day of the period for the request of information de- scribed in subsection (b), the Secretary of Health and Human Services shall, taking into consideration infor- mation collected pursuant to subsection (b), update the information included in the Welcome to Medicare pack- age to include information, presented in a clear and simple manner, about options for receiving benefits under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), including through the original medicare fee-for-service program under parts A and B of such title (42 U.S.C. 1395c et seq., 42 U.S.C. 1395j et seq.), Medicare Advantage plans under part C of such title (42 U.S.C. 1395w–21 et seq.), and prescription drug plans under part D of such title (42 U.S.C. 1395w–101 et seq.)). The Secretary shall make subsequent updates to the information included in the Welcome to Medicare package as appropriate. ‘‘(b) REQUEST FOR INFORMATION.—Not later than 6 months after the date of the enactment of this Act [Dec. 13, 2016], the Secretary of Health and Human Services shall request information, including rec- ommendations, from stakeholders (including patient advocates, issuers, and employers) on information in- cluded in the Welcome to Medicare package, including pertinent data and information regarding enrollment and coverage for Medicare eligible individuals.’’ REPORT TO CONGRESS ON EFFECT OF PRIVATE CONTRACTS Pub. L. 105–33, title IV, § 4507(b), Aug. 5, 1997, 111 Stat. 441, required a report to be submitted to Congress, no later than Oct. 1, 2001, on the effect on the program under title IV of Pub. L. 105–33 of certain private con- tracts. § 1395b. Option to individuals to obtain other health insurance protection Nothing contained in this subchapter shall be construed to preclude any State from providing, or any individual from purchasing or otherwise securing, protection against the cost of any health services. (Aug. 14, 1935, ch. 531, title XVIII, § 1803, as added Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79 Stat. 291.) Statutory Notes and Related Subsidiaries IMPACT OF INCREASED INVESTMENTS IN HEALTH RESEARCH ON FUTURE MEDICARE COSTS Pub. L. 105–78, title II, Nov. 13, 1997, 111 Stat. 1484, provided in part: ‘‘That in carrying out its legislative mandate, the National Bipartisan Commission on the Future of Medicare shall examine the impact of in- creased investments in health research on future Medi- care costs, and the potential for coordinating Medicare with cost-effective long-term care services’’. NATIONAL BIPARTISAN COMMISSION ON THE FUTURE OF MEDICARE Pub. L. 105–33, title IV, § 4021, Aug. 5, 1997, 111 Stat. 347, established National Bipartisan Commission on the Future of Medicare which was directed to review and analyze long-term financial condition of medicare pro- gram, identify problems that threaten financial integ- rity of Federal Hospital Insurance Trust Fund and Fed- eral Supplementary Medical Insurance Trust Fund, analyze potential solutions that will ensure both finan- cial integrity of medicare program and provision of ap- propriate benefits under such program, and make rec- ommendations for, among other things, restoring sol- vency of Federal Hospital Insurance Trust Fund and fi- nancial integrity of Federal Supplementary Medical In- surance Trust Fund, establishing appropriate financial structure of medicare program as a whole, and estab- lishing appropriate balance of benefits covered and ben- eficiary contributions to medicare program, further provided for membership of Commission, meetings, per- sonnel and staff matters, powers of Commission, appro- priations, submission of final report to Congress not later than Mar. 1, 1999, and termination of Commission 30 days after submission of final report. EXCLUSION FROM WAGES AND COMPENSATION OF RE- FUNDS REQUIRED FROM EMPLOYERS TO COMPENSATE FOR DUPLICATION OF MEDICARE BENEFITS BY HEALTH CARE BENEFITS PROVIDED BY EMPLOYERS Pub. L. 101–239, title X, § 10202, Dec. 19, 1989, 103 Stat. 2473, provided that: Page 2896 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395b–1 1 See References in Text note below. ‘‘(a) OLD-AGE, SURVIVORS, AND DISABILITY, AND HOS- PITAL INSURANCE PROGRAMS.—For purposes of title II of the Social Security Act [42 U.S.C. 401 et seq.] and chap- ter 21 of the Internal Revenue Code of 1986 [26 U.S.C. 3101 et seq.], the term ‘wages’ shall not include the amount of any refund required under section 421 of the Medicare Catastrophic Coverage Act of 1988 [section 421 of Pub. L. 100–360, formerly set out as a note below]. ‘‘(b) RAILROAD RETIREMENT PROGRAM.—For purposes of chapter 22 of the Internal Revenue Code of 1986 [26 U.S.C. 3201 et seq.], the term ‘compensation’ shall not include the amount of any refund required under sec- tion 421 of the Medicare Catastrophic Coverage Act of 1988. ‘‘(c) FEDERAL UNEMPLOYMENT PROGRAMS.— ‘‘(1) FEDERAL UNEMPLOYMENT TAX.—For purposes of chapter 23 of the Internal Revenue Code of 1986 [26 U.S.C. 3301 et seq.], the term ‘wages’ shall not include the amount of any refund required under section 421 of the Medicare Catastrophic Coverage Act of 1988. ‘‘(2) RAILROAD UNEMPLOYMENT CONTRIBUTIONS.—For purposes of the Railroad Unemployment Insurance Act [45 U.S.C. 351 et seq.], the term ‘compensation’ shall not include the amount of any refund required under section 421 of the Medicare Catastrophic Cov- erage Act of 1988. ‘‘(3) RAILROAD UNEMPLOYMENT REPAYMENT TAX.—For purposes of chapter 23A of the Internal Revenue Code of 1986 [26 U.S.C. 3321 et seq.], the term ‘rail wages’ shall not include the amount of any refund required under section 421 of the Medicare Catastrophic Cov- erage Act of 1988. ‘‘(d) REPORTING REQUIREMENTS.—Any refund required under section 421 of the Medicare Catastrophic Cov- erage Act of 1988 shall be reported to the Secretary of the Treasury or his delegate and to the person to whom such refund is made in such manner as the Secretary of the Treasury or his delegate shall prescribe. ‘‘(e) EFFECTIVE DATE.—This section shall apply with respect to refunds provided on or after January 1, 1989.’’ UNITED STATES BIPARTISAN COMMISSION ON COMPREHENSIVE HEALTH CARE Pub. L. 100–360, title IV, subtitle A, §§ 401–408, July 1, 1988, 102 Stat. 765–768, as amended by Pub. L. 100–647, title VIII, § 8414, Nov. 10, 1988, 102 Stat. 3801; Pub. L. 101–239, title VI, § 6220, Dec. 19, 1989, 103 Stat. 2254, es- tablished the United States Bipartisan Commission on Comprehensive Health Care, also known as the ‘‘Claude Pepper Commission’’ or the ‘‘Pepper Commission’’, and directed Commission to examine shortcomings in health care delivery and financing mechanisms that limit or prevent access of all individuals in United States to comprehensive health care, and make specific recommendations respecting Federal programs, poli- cies, and financing needed to assure the availability of comprehensive long-term care services for elderly and disabled, as well as comprehensive health care services for all individuals in the United States, and further provided for membership of Commission, staff and con- sultants, powers, authorization of appropriations, sub- mission of findings and recommendations to Congress not later than Nov. 9, 1989, and for termination of Com- mission 30 days after submissions to Congress. MAINTENANCE OF EFFORT REGARDING DUPLICATIVE BENEFITS Pub. L. 100–360, title IV, § 421, July 1, 1988, 102 Stat. 808, as amended by Pub. L. 100–485, title VI, § 608(a), Oct. 13, 1988, 102 Stat. 2411, which required employers who had been providing health care benefits to employees that were duplicative part A and part B benefits to pro- vide the employees with additional benefits equal to the total actuarial value of such duplicative benefits, was repealed by Pub. L. 101–234, title III, § 301(a), Dec. 13, 1989, 103 Stat. 1985. [Repeal not applicable to dupli- cative part A benefits for periods before Jan. 1, 1990, see section 301(e)(1) of Pub. L. 101–234, set out as an Effec- tive Date of 1989 Amendment note under section 1395u of this title.] TASK FORCE ON LONG-TERM HEALTH CARE POLICIES Pub. L. 99–272, title IX, § 9601, Apr. 7, 1986, 100 Stat. 221, as amended by Pub. L. 105–362, title VI, § 601(b)(3), Nov. 10, 1998, 112 Stat. 3286, directed Secretary of Health and Human Services, in consultation with Na- tional Association of Insurance Commissioners, to es- tablish Task Force on Long-Term Health Care Policies to develop recommendations for long-term health care policies designed to limit marketing and agent abuse for those policies, to assure dissemination of such in- formation to consumers as is necessary to permit in- formed choice in purchasing policies and to reduce pur- chase of unnecessary or duplicative coverage, to assure that benefits provided under policies are reasonable in relationship to premiums charged, and to promote de- velopment and availability of long-term health care policies which meet these recommendations, and fur- ther provided for composition of Task Force, definition of long-term health care policy, assurance of States’ ju- risdiction, submission of recommendations to Sec- retary and Congress not later than 18 months after Apr. 7, 1986, and termination of Task Force 90 days after sub- mission of recommendations. § 1395b–1. Incentives for economy while main- taining or improving quality in provision of health services (a) Grants and contracts to develop and engage in experiments and demonstration projects (1) The Secretary of Health and Human Serv- ices is authorized, either directly or through grants to public or private agencies, institu- tions, and organizations or contracts with public or private agencies, institutions, and organiza- tions, to develop and engage in experiments and demonstration projects for the following pur- poses: (A) to determine whether, and if so which, changes in methods of payment or reimburse- ment (other than those dealt with in section 222(a) of the Social Security Amendments of 1972) for health care and services under health programs established by this chapter, includ- ing a change to methods based on negotiated rates, would have the effect of increasing the efficiency and economy of health services under such programs through the creation of additional incentives to these ends without adversely affecting the quality of such serv- ices; (B) to determine whether payments for serv- ices other than those for which payment may be made under such programs (and which are incidental to services for which payment may be made under such programs) would, in the judgment of the Secretary, result in more eco- nomical provision and more effective utiliza- tion of services for which payment may be made under such program, where such services are furnished by organizations and institu- tions which have the capability of providing— (i) comprehensive health care services, (ii) mental health care services (as defined by section 2691(c) 1 of this title), (iii) ambulatory health care services (in- cluding surgical services provided on an out- patient basis), or (iv) institutional services which may sub- stitute, at lower cost, for hospital care; (C) to determine whether the rates of pay- ment or reimbursement for health care serv-