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Revised December 1980

TITLE XVIII—HEALTH INSURANCE FOR THE AGED AND

DISABLED

Page1

Sec. 1801. Prohibition Against Any Federal Interference..
Sec. 1802. Free Choice by Patient Guaranteed..

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407

Sec. 1803. Option to Individuals To Obtain Other Health Insurance Protection....

407

Part A-Hospital Insurance BENEFITS FOR THE Aged and DisaBLED

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(f) Terms Defined in Section 1861.

(c) Limitation on Psychiatric Hospital Services..
Limitation on Post-Hospital Home Health Services..
Service Not Taken Into Account for Purposes of Limita-
tion...

Sec. 1813. Deductibles and Coinsurance..

(a) Reduction for Inpatient Hospital Deductible and Co-
insurance Amounts.

(b) Amount of Inpatient Hospital Deductible..--

Sec. 1814. Conditions of and Limitations on Payment for Services..

Requirement of Requests and Certifications....
Amount Paid to Providers..

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No payments to Federal Providers of Services--
Payments for Emergency Hospital Services---
Payment for Inpatient Hospital Services Prior to Notifi-
cation of Noneligibility...

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(f) Payment for Certain Inpatient Hospital Services Fur-
nished Outside the United States.

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(g) Payment for Services of a Physician Rendered in
Teaching Hospital..

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Payment to Providers of Services...

(h) Payment for Certain Hospital Services Provided in
Veterans' Administration Hospitals--

Sec. 1815. Payment to Providers of Services--

Sec. 1816. Use of Public Agencies or Private Organizations To Facilitate

Sec. 1817. Federal Hospital Insurance Trust Fund..

Sec. 1818. Hospital Insurance Benefits for Uninsured Individuals Not
Otherwise Eligible...----

PART B-SUPPLEMENTARY MEDICAL INSURANCE BENEFITS FOR THE

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Sec. 1835. Procedure for Payment of Claims of Providers of Services

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Psychiatric Hospital.

Tuberculosis Hospital..

Extended Care Services...

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PART B-SUPPLEMENTARY MEDICAL INSURANCE BENEFITS
FOR THE AGED AND DISABLED

Continued

Sec. 1841. Federal Supplementary Medical Insurance Trust Fund............
Sec. 1842. Use of Carriers for Administration of Benefits..
Sec. 1843. State Agreements for Coverage of Eligible Individuals Who Are
Receiving Money Payments Under Public Assistance Pro-
grams (or Are Eligible for Medical Assistance)‒‒‒‒‒‒‒‒‒
Sec. 1844. Appropriations To Cover Government Contributions and
Contingency Reserve...

PART C-MISCELLANEOUS PROVISIONS

Sec. 1861. Definition of Services, Institutions, etc...-(a) Spell of Illness...

(b) Inpatient Hospital Services

(c) Inpatient Psychiatric Hospital Services..

(d) Inpatient Tuberculosis Hospital Services..
(e) Hospital........

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448-C

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455-B

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Agreements for Transfer Between Skilled Nursing

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(n)

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[Repealed.]

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Home Health Agency

Physicians' Services....

(u) Provider of Services_.

Outpatient Physical Therapy Services..

(Physician

Drugs and Biologicals.

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Medical and Other Health Services..

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(y) Post-Hospital Extended Care in Christian Science

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(aa) Rural Health Clinic Services.

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Sec. 1862. Exclusions From Coverage__

Sec. 1863. Consultation With State Agencies and Other Organizations To
Develop Conditions of Participation for Providers of Services.
Sec. 1864. Use of State Agencies To Determine Compliance by Providers
of Services With Conditions of Participation..

Sec. 1865. Effect of Accreditation___

Sec. 1867. Health Insurance Benefits Advisory Council..

Sec. 1869. Determinations; Appeals.

Sec. 1870. Overpayments on Behalf of Individuals and Settlement of

Sec. 1871. Regulations...

Sec. 1872. Application of Certain Provisions of Title II.

Sec. 1873. Designation of Organization or Publication by Name.
Sec. 1874. Administration....

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Claims for Benefits on Behalf of Deceased Individuals.

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Sec. 1879. Limitation on Liability of Beneficiary Where Medicare Claims

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Sec. 1880. Indian Health Service Facilities..

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Sec. 1881. Medicare Coverage for End Stage Renal Disease Patients---- 506-A Sec. 1882. Voluntary Certification of Medicare Supplemental Health Insurance Policies__-

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Sec. 1883. Hospital Providers of Extended Care Services..
Sec. 1884. Payments to Promote Closing and Conversion of Underutilized
Hospital Facilities..

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Sec. 1885. Withholding of Payments for Certain Medicaid Providers___

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Prohibition Against Any Federal Interference

Section 1801. Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.

Free Choice by Patient Guaranteed

Sec. 1802. Any individual entitled to insurance benefits under this title may obtain health services from any institution, agency, or person qualified to participate under this title if such institution, agency, or person undertakes to provide him such services.

Option to Individuals To Obtain Other Health Insurance

Protection

Sec. 1803. Nothing contained in this title 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.

Part A-Hospital Insurance Benefits for the Aged and Disabled

Description of Program

Sec. 1811. The insurance program for which entitlement is established by sections 226 and 226A provides basic protection against the costs of hospital, related post-hospital, and home health services in accordance with this part for (1) individuals who are age 65 or over and are eligible for retirement benefits under title II of this Act or under the railroad retirement system, (2) individuals under age 65 who have been entitled for not less than 24 months to benefits under title II of this Act or under the railroad retirement system on the basis of a disability, and (3) certain individuals who do not meet the conditions specified in either clause (1) or (2) but who are medically determined to have end stage renal disease.1

Scope of Benefits

Sec. 1812. (a) 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 1814 (d) (2) to him (subject to the provisions of this part) for

(1) inpatient hospital services for up to 150 days during any spell of illness minus one day for each day of inpatient hospital

1 Sec. 1811 was amended by sec. 4(a) of P.L. 95-292, sec. 103 of P.L. 96-265, by sec. 2(b) of P.L. 96-473, and, with respect to services furnished on or after July 1, 1981, by sec. 930 (a) of P.L. 96-499.

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