Revised December 1980 TITLE XVIII—HEALTH INSURANCE FOR THE AGED AND DISABLED Page1 Sec. 1801. Prohibition Against Any Federal Interference.. 407 407 Sec. 1803. Option to Individuals To Obtain Other Health Insurance Protection.... 407 Part A-Hospital Insurance BENEFITS FOR THE Aged and DisaBLED (f) Terms Defined in Section 1861. (c) Limitation on Psychiatric Hospital Services.. Sec. 1813. Deductibles and Coinsurance.. (a) Reduction for Inpatient Hospital Deductible and Co- (b) Amount of Inpatient Hospital Deductible..-- Sec. 1814. Conditions of and Limitations on Payment for Services.. Requirement of Requests and Certifications.... 408 408 409 409 409 409 410 410 410 413 No payments to Federal Providers of Services-- 413-A 414 414 (f) Payment for Certain Inpatient Hospital Services Fur- 415 (g) Payment for Services of a Physician Rendered in 416 Payment to Providers of Services... (h) Payment for Certain Hospital Services Provided in 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 PART B-SUPPLEMENTARY MEDICAL INSURANCE BENEFITS FOR THE 417 417 420 420-D 424 Sec. 1835. Procedure for Payment of Claims of Providers of Services 433 Psychiatric Hospital. Tuberculosis Hospital.. Extended Care Services... PART B-SUPPLEMENTARY MEDICAL INSURANCE BENEFITS Continued Sec. 1841. Federal Supplementary Medical Insurance Trust Fund............ 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.. Page 441 443 448-C 451 452 452 452 453 453 453 455-B 456 457 457 458 460 Agreements for Transfer Between Skilled Nursing 461 (n) 462 [Repealed.] 463 Home Health Agency Physicians' Services.... (u) Provider of Services_. Outpatient Physical Therapy Services.. (Physician Drugs and Biologicals. 463 464 465 Medical and Other Health Services.. 465 466 468 468-A 468-A 472 473 (y) Post-Hospital Extended Care in Christian Science 473 474 (aa) Rural Health Clinic Services. 475 Sec. 1862. Exclusions From Coverage__ Sec. 1863. Consultation With State Agencies and Other Organizations To 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. 477 477 479 480 480 482 483 485 486 Claims for Benefits on Behalf of Deceased Individuals. 487 490 490-A 491 491 491 Sec. 1879. Limitation on Liability of Beneficiary Where Medicare Claims 502-A 504 Sec. 1880. Indian Health Service Facilities.. 506 Sec. 1881. Medicare Coverage for End Stage Renal Disease Patients---- 506-A Sec. 1882. Voluntary Certification of Medicare Supplemental Health Insurance Policies__- 506-I Sec. 1883. Hospital Providers of Extended Care Services.. 506-0 506-Q Sec. 1885. Withholding of Payments for Certain Medicaid Providers___ 506-S 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. |