42 U.S.C. § 1395z — Consultation with State agencies and

Page 3618 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395z 1 See References in Text note below. 2 So in original. The word ‘‘and’’ probably should not appear. educational activities shall be made as if the hospital were receiving under part A of title XVIII of the Social Security Act all the payments which are made under part B of such title solely by reason of such waiver. ‘‘(3) Any waiver granted under paragraph (1) shall provide that, with respect to those items and services billed under part B of title XVIII of the Social Security Act solely by reason of such waiver— ‘‘(A) payment under such part shall be equal to 100 percent of the reasonable charge or other applicable payment base for the items and services; and ‘‘(B) the entity furnishing the items and services must agree to accept the amount paid pursuant to subparagraph (A) as the full charge for the items and services.’’ [Pub. L. 99–272, title IX, § 9112(b), Apr. 7, 1986, 100 Stat. 163, provided that: [‘‘(1) Section 602(k)(2) of the Social Security Amend- ments of 1983 (as added by subsection (a)) [set out above] shall apply to cost reporting periods beginning on or after January 1, 1986. [‘‘(2) Section 602(k)(3) of the Social Security Amend- ments of 1983 (as added by subsection (a)) [set out above] shall apply to items and services furnished after the end of the 10-day period beginning on the date of the enactment of this Act [Apr. 7, 1986].’’] PROHIBITION OF PAYMENT FOR INEFFECTIVE DRUGS Pub. L. 97–248, title I, § 115(b), Sept. 3, 1982, 96 Stat. 353, provided that: ‘‘No provision of law limiting the use of funds for purposes of enforcing or implementing section 1862(c) [42 U.S.C. 1395y(c)] or section 1903(i)(5) [42 U.S.C. 1396b(i)(5)] of the Social Security Act, section 2103 of the Omnibus Budget Reconciliation Act of 1981 [section 2103 of Pub. L. 97–35, amending sections 1395y and 1396b of this title and enacting provisions set out as notes under sections 1395y and 1396b of this title], or any rule or regulation issued pursuant to any such sec- tion (including any provision contained in, or incor- porated by reference into, any appropriation Act or res- olution making continuing appropriations) shall apply to any period after September 30, 1982, unless such pro- vision of law is enacted after the date of the enactment of this Act [Sept. 3, 1982] and specifically states that such provision is to supersede this section.’’ ESTABLISHMENT AND IMPLEMENTATION OF GUIDELINES Pub. L. 97–35, title XXI, § 2152(b), Aug. 13, 1981, 95 Stat. 802, directed the Secretary of Health and Human Serv- ices to establish, and provide for the implementation of, the guidelines described in subsec. (f) of this section not later than Oct. 1, 1981. REPORT TO CONGRESSIONAL COMMITTEES ON IMPLEMEN- TATION OF CERTIFICATION REQUIREMENTS RELATING TO MODIFICATION OF HEALTH BENEFITS PLAN OR PRO- GRAM; FAILURE TO SUBMIT REPORT Pub. L. 93–480, § 4(b), Oct. 26, 1974, 88 Stat. 1454, pro- vided that the Civil Service Commission and the Sec- retary of Health, Education, and Welfare submit a re- port on or before Mar. 1, 1975, on the steps which have been taken, and the steps which are planned, to enable the Secretary to make the determination and certifi- cation referred to in former subsec. (c) of this section and that if such report is not submitted by Mar. 1, 1975, the date specified in former subsec. (c) shall be deemed to be July 1, 1975, rather than Jan. 1, 1976. § 1395z. Consultation with State agencies and other organizations to develop conditions of participation for providers of services In carrying out his functions, relating to de- termination of conditions of participation by providers of services, under subsections (e)(9), (f)(4), (j)(15),1 (o)(6), (cc)(2)(I), and 2 (dd)(2), and (mm)(1) of section 1395x of this title, or by am- bulatory surgical centers under section 1395k(a)(2)(F)(i) of this title, the Secretary shall consult with appropriate State agencies and rec- ognized national listing or accrediting bodies, and may consult with appropriate local agen- cies. Such conditions prescribed under any of such subsections may be varied for different areas or different classes of institutions or agen- cies and may, at the request of a State, provide higher requirements for such State than for other States; except that, in the case of any State or political subdivision of a State which imposes higher requirements on institutions as a condition to the purchase of services (or of certain specified services) in such institutions under a State plan approved under subchapter I, XVI, or XIX, the Secretary shall impose like re- quirements as a condition to the payment for services (or for the services specified by the State or subdivision) in such institutions in such State or subdivision. (Aug. 14, 1935, ch. 531, title XVIII, § 1863, as added Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79 Stat. 325; amended Pub. L. 92–603, title II, § 234(g)(2), Oct. 30, 1972, 86 Stat. 1413; Pub. L. 96–499, title IX, §§ 933(f), 934(c)(1), Dec. 5, 1980, 94 Stat. 2636, 2639; Pub. L. 97–248, title I, § 122(g)(2), Sept. 3, 1982, 96 Stat. 362; Pub. L. 98–369, div. B, title III, §§ 2335(c), 2349(b)(1), 2354(b)(32), July 18, 1984, 98 Stat. 1090, 1097, 1102; Pub. L. 100–360, title II, §§ 203(e)(2), 204(c)(1), July 1, 1988, 102 Stat. 725, 728; Pub. L. 101–234, title II, § 201(a), Dec. 13, 1989, 103 Stat. 1981; Pub. L. 101–239, title VI, § 6003(g)(3)(C)(ii), Dec. 19, 1989, 103 Stat. 2152; Pub. L. 101–508, title IV, § 4163(c)(1), Nov. 5, 1990, 104 Stat. 1388–99; Pub. L. 103–432, title I, § 145(c)(2), Oct. 31, 1994, 108 Stat. 4427.) Editorial Notes REFERENCES IN TEXT Subsection (j) of section 1395x of this title, referred to in text, was amended generally by Pub. L. 100–203, title IV, § 4201(a)(1), Dec. 22, 1987, 101 Stat. 1330–160, and, as so amended, does not contain a par. (15). AMENDMENTS 1994—Pub. L. 103–432 struck out ‘‘or whether screen- ing mammography meets the standards established under section 1395m(c)(3) of this title,’’ before ‘‘the Sec- retary shall consult’’. 1990—Pub. L. 101–508 inserted ‘‘or whether screening mammography meets the standards established under section 1395m(c)(3) of this title,’’ after ‘‘section 1395k(a)(2)(F)(i) of this title,’’. 1989—Pub. L. 101–239 substituted ‘‘(jj)(3), and (mm)(1)’’ for ‘‘and (jj)(3)’’. Pub. L. 101–234 repealed Pub. L. 100–360, §§ 203(e)(2), 204(c)(1), and provided that the provisions of law amended or repealed by such sections are restored or revived as if such sections had not been enacted. In the case of the amendment by Pub. L. 100–360, § 203(e)(2), Pub. L. 101–234 was given effect by substituting ‘‘and (dd)(2)’’ for ‘‘(dd)(2), (jj)(3)’’ because of the intervening amendment by Pub. L. 101–239, see note above and 1988 Amendment note below. 1988—Pub. L. 100–360, § 204(c)(1), inserted ‘‘or whether screening mammography meets the standards estab- lished under section 1395m(e)(3) of this title,’’ after ‘‘1395k(a)(2)(F)(i) of this title,’’. Pub. L. 100–360, § 203(e)(2), substituted ‘‘(dd)(2), and (jj)(3)’’ for ‘‘and (dd)(2)’’. 1984—Pub. L. 98–369, § 2335(c), struck out ‘‘(g)(4),’’ after ‘‘(e)(9), (f)(4),’’. Page 3619 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395aa Pub. L. 98–369, § 2354(b)(32), substituted ‘‘(j)(15)’’ for ‘‘(j)(11)’’. Pub. L. 98–369, § 2349(b)(1), substituted ‘‘appropriate State agencies’’ for ‘‘the Health Insurance Benefits Ad- visory Council established by section 1395dd of this title, appropriate State agencies,’’. 1982—Pub. L. 97–248 substituted ‘‘(cc)(2)(I), and (dd)(2)’’ for ‘‘and (cc)(2)(I)’’. 1980—Pub. L. 96–499, § 933(f), substituted ‘‘(o)(6), and (cc)(2)(I) of section 1395x’’ for ‘‘and (o)(6) of section 1395x’’. Pub. L. 96–499, § 934(c)(1), inserted ‘‘or by ambulatory surgical centers under section 1395k(a)(2)(F)(i) of this title,’’. 1972—Pub. L. 92–603 substituted ‘‘subsections (e)(9), (f)(4), (g)(4), (j)(11), and (o)(6) of section 1395x of this title’’ for ‘‘subsections (e)(8), (f)(4), (g)(4), (j)(10), and (o)(5) of section 1395x of this title’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1994 AMENDMENT Amendment by Pub. L. 103–432 applicable to mam- mography furnished by a facility on and after the first date that the certificate requirements of section 263b(b) of this title apply to such mammography conducted by such facility, see section 145(d) of Pub. L. 103–432, set out as a note under section 1395m of this title. EFFECTIVE DATE OF 1990 AMENDMENT Amendment by Pub. L. 101–508 applicable to screening mammography performed on or after Jan. 1, 1991, see section 4163(e) of Pub. L. 101–508, set out as a note under section 1395l of this title. EFFECTIVE DATE OF 1989 AMENDMENT Amendment by Pub. L. 101–234 effective Jan. 1, 1990, see section 201(c) of Pub. L. 101–234, set out as a note under section 1320a–7a of this title. EFFECTIVE DATE OF 1988 AMENDMENT Amendment by section 203(e)(2) of Pub. L. 100–360 ap- plicable to items and services furnished on or after Jan. 1, 1990, see section 203(g) of Pub. L. 100–360, set out as a note under section 1320c–3 of this title. Amendment by section 204(c)(1) of Pub. L. 100–360 ap- plicable to screening mammography performed on or after Jan. 1, 1990, see section 204(e) of Pub. L. 100–360, set out as a note under section 1395m of this title. EFFECTIVE DATE OF 1984 AMENDMENT Amendment by section 2335(c) of Pub. L. 98–369 effec- tive July 18, 1984, see section 2335(g) of Pub. L. 98–369, set out as a note under section 1395f of this title. Amendment by section 2349(b)(1) of Pub. L. 98–369 ef- fective July 18, 1984, see section 2349(c) of Pub. L. 98–369, set out as a note under section 907a of this title. Amendment by section 2354(b)(32) of Pub. L. 98–369 ef- fective July 18, 1984, but not to be construed as chang- ing or affecting any right, liability, status, or interpre- tation which existed (under the provisions of law in- volved) 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, set out as a note under sec- tion 1395c of this title. EFFECTIVE DATE OF 1980 AMENDMENT Amendment by section 933(f) of Pub. L. 96–499 effec- tive with respect to a comprehensive outpatient reha- bilitation facility’s first accounting period beginning on or after July 1, 1981, see section 933(h) of Pub. L. 96–499, set out as a note under section 1395k of this title. EFFECTIVE DATE OF 1972 AMENDMENT Amendment by Pub. L. 92–603 applicable with respect to providers of services for fiscal years beginning after the fifth month following October 1972, see section 234(i) of Pub. L. 92–603, set out as a note under section 1395x of this title. TERMINATION OF ADVISORY COUNCILS Advisory councils in existence on Jan. 5, 1973, to ter- minate not later than the expiration of the 2-year pe- riod following Jan. 5, 1973, unless, in the case of a coun- cil established by the President or an officer of the Federal Government, such council is renewed by appro- priate action prior to the expiration of such 2-year pe- riod, or in the case of a council established by the Con- gress, its duration is otherwise provided by law. See sections 1001(2) and 1013 of Title 5, Government Organi- zation and Employees. § 1395aa. Agreements with States (a) Use of State agencies to determine compli- ance 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, a critical access hos- pital, as defined in section 1395x(mm)(1) of this title, or a comprehensive outpatient rehabilita- tion facility as defined in section 1395x(cc)(2) of this title, or whether a laboratory meets the re- quirements of paragraphs (16) and (17) of section 1395x(s) of this title, or whether a clinic, reha- bilitation 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, or whether an ambulatory surgical center meets the standards specified under section 1395k(a)(2)(F)(i) of this title, or whether a facil- ity is a rural emergency hospital as defined in section 1395x(kkk)(2) of this title. To the extent that the Secretary finds it appropriate, an insti- tution or agency which such a State (or local) agency certifies is a hospital, skilled nursing fa- cility, rural health clinic, comprehensive out- patient rehabilitation facility, home health agency, or hospice program (as those terms are defined in section 1395x of this title) may be treated as such by the Secretary. Any State agency which has such an agreement may (sub- ject to approval of the Secretary) furnish to a skilled nursing facility, after proper request by such facility, such specialized consultative serv- ices (which such agency is able and willing to furnish in a manner satisfactory to the Sec- retary) as such facility may need to meet one or more of the conditions specified in section 1395i–3(a) of this title. Any such services fur- nished by a State agency shall be deemed to have been furnished pursuant to such agree- ment. Within 90 days following the completion of each survey of any health care facility, ambu- latory surgical center, rural health clinic, com- prehensive outpatient rehabilitation facility,