Page Sec. 1118. Alternative Federal payment with respect to public assistance 557 expenditures. Sec. 1119. Federal participation in payments for repairs to home owned by 557 recipient of aid or assistance. Sec. 1120. Approval of certain projects 558 Sec. 1121. Uniform reporting systems for health services facilities and or- 558 Sec. 1122. Sec. 1123A. Limitation on Federal participation for capital expenditures 559 Reviews of child and family services programs, and of foster Sec. 1124. Disclosure of ownership and related information 564 Sec. 1124A. Disclosure requirements for other providers under part B of 566 Sec. 1125. Issuance of subpenas by Comptroller General 567 Sec. 1126. Disclosure by institutions, organizations, and agencies of own- 567 Adjustments in SSI benefits on account of retroactive benefits 568 under Title II. Exclusion of certain individuals and entities from participation 569 in medicare and State health care programs. 577 Guidance regarding application of health care fraud and abuse 590 Sec. 1128E. Sec. 1128F. Health care fraud and abuse data collection program 593 Sec. 1129. Coordination of Medicare and Medicaid Surety Bond Provisions 595 596 Notification of social security claimant with respect to deferred 603 vested benefits. Sec. 1132. Period within which certain claims must be filed 604 Sec. 1133. Applicants or recipients under public assistance programs not 605 Exclusion of representatives and health care providers con- 606 Sec. 1137. Income and eligibility verification system 609 Sec. 1138. Hospital protocols for organ procurement and standards for 613 organ procurement agencies. Sec. 1139. National Commission on Children 615 Sec. 1140. Prohibition of misuse of symbols, emblems, or names in ref- 619 erence to social security or medicare. Research on outcomes of health care services and procedures Outreach efforts to increase awareness of the availability of 629 624 628 Sec. 1145. Protection of social security and medicare trust funds 630 Page Sec. 1146. Public disclosure of certain information on hospital financial in- 630 Sec. 1147. Recovery of SSI overpayments from other benefits 630 Sec. 1147A. Recovery of social security benefit overpayments from title viii 631 Sec. 1150. State grants for work incentives assistance to disabled bene- 644 646 Part B-Peer Review of the Utilization and Quality of Health Care Services Sec. 1151. Purpose 646 Sec. 1152. Definition of utilization and quality control peer review organi- 646 Sec. 1153. Contracts with utilization and quality control peer review orga- 646 Obligations of health care practitioners and providers of health 659 660 Sec. 1158. Application of this part to certain State programs receiving 661 Sec. 1159. Authorization for use of certain funds to administer the provi- 662 sions of this part. Exemptions for religious nonmedical health care institutions 664 664 Standards for information transactions and data elements 668 670 SEC. 1101. [42 U.S.C. 1301] (a) When used in this Act(1) The term "State", except where otherwise provided, includes the District of Columbia and the Commonwealth of Puerto Rico, and when used in titles IV, V, VII, XI, XIX, and XXI includes the Virgin Islands and Guam. Such term when 74-130 2001-18 used in titles III, IX, and XII also includes the Virgin Islands. Such term when used in title V and in part B of this title also includes American Samoa, the Northern Mariana Islands, and the Trust Territory of the Pacific Islands. Such term when used in titles XIX and XXI also includes the Northern Mariana Islandsand American Samoa. In the case of Puerto Rico, the Virgin Islands, and Guam, titles I, X, and XIV, and title XVI (as in effect without regard to the amendment made by section 301 of the Social Security Amendments of 19723) shall continue to apply, and the term "State" when used in such titles (but not in title XVI as in effect pursuant to such amendment after December 31, 1973) includes Puerto Rico, the Virgin Islands, and Guam. Such term when used in title XX also includes the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Such term when used in title IV also includes American Samoa. (2) The term "United States" when used in a geographical sense means, except where otherwise provided, the States. (3) The term "person" means an individual, a trust or estate, a partnership, or a corporation. (4) The term "corporation" includes associations, joint-stock companies, and insurance companies. (5) The term "shareholder" includes a member in an association, joint-stock company, or insurance company. (6) The term "Secretary", except when the context otherwise requires, means the Secretary of Health and Human Services. (7) The terms "physician" and "medical care" and "hospitalization" include osteopathic practitioners or the services of osteopathic practitioners and hospitals within the scope of their practice as defined by State law. (8)(A) The "Federal percentage" for any State (other than Puerto Rico, the Virgin Islands, and Guam) shall be 100 per centum less the State percentage; and the State percentage shall be that percentage which bears the same ratio to 50 per centum as the square of the per capita income of such State bears to the square of the per capita income of the United States; except that the Federal percentage shall in no case be less than 50 per centum or more than 65 per centum. (B) The Federal percentage for each State (other than Puerto Rico, the Virgin Islands, and Guam) shall be promulgated by the Secretary between October 1 and November 30 of each year, on the basis of the average per capita income of each State and of the United States for the three most recent calendar years for which satisfactory data are available from the Department of Commerce. Such promulgation shall be conclusive for each of the four quarters in the period beginning October 1 next succeeding such promulgation: Provided, That the Secretary shall promulgate such percentages as soon as possible after the enactment of the Social Security Amendments of 19584, which promulgation shall be conclusive for each of the eleven quarters in the period beginning October 1, 1958, and ending with the close of June 30, 1961. 3 P.L. 92-603, §301, added Title XVI, Supplemental Security Income for the Aged, Blind, and Disabled. 4 August 28, 1958 [P.L. 85-840; 72 Stat. 1013]. (C) The term "United States" means (but only for purposes of subparagraphs (A) and (B) of this paragraph) the fifty States and the District of Columbia. (D) Promulgations made before satisfactory data are available from the Department of Commerce for a full year on the per capita income of Alaska shall prescribe a Federal percentage for Alaska of 50 per centum and, for purposes of such promulgations, Alaska shall not be included as part of the "United States". Promulgations made thereafter but before per capita income data for Alaska for a full three-year period are available from the Department of Commerce shall be based on satisfactory data available therefrom for Alaska for such one full year or, when such data are available for a two-year period, for such two years. (9) The term "shared health facility" means any arrangement whereby (A) two or more health care practitioners practice their professions at a common physical location; (B) such practitioners share (i) common waiting areas, examining rooms, treatment rooms, or other space, (ii) the services of supporting staff, or (iii) equipment; (C) such practitioners have a person (who may himself be a practitioner)— (i) who is in charge of, controls, manages, or supervises substantial aspects of the arrangement or operation for the delivery of health or medical services at such common physical location, other than the direct furnishing of professional health care services by the practitioners to their patients; or (ii) who makes available to such practitioners the services of supporting staff who are not employees of such practitioners; and who is compensated in whole or in part, for the use of such common physical location or support services pertaining thereto, on a basis related to amounts charged or collected for the services rendered or ordered at such location or on any basis clearly unrelated to the value of the services provided by the person; and (D) at least one of such practitioners received payments on a fee-for-service basis under titles XVIII and XIX in an amount exceeding $5,000 for any one month during the preceding 12 months or in an aggregate amount exceeding $40,000 during the preceding 12 months; except that such term does not include a provider of services (as defined in section 1861(u) of this Act), a health maintenance organization (as defined in section 1301(a) of the Public Health Service Act 5), a hospital cooperative shared services organization meeting the requirements of section 501(e) of the Internal Revenue Code of 19546, or any public entity. (10) The term "Administration" means the Social Security Administration, except where the context requires otherwise. "See Vol. II, P.L. 78-410. "See Vol. II, P.L. 83-591. P.L. 99-514, $2, provides, except when inappropriate, that any reference to the Internal Revenue Code of 1954 shall include a reference to the Internal Revenue Code of 1986. (b) The terms "includes" and "including" when used in a definition contained in this Act shall not be deemed to exclude other things otherwise within the meaning of the term defined. (c) Whenever under this Act or any Act of Congress, or under the law of any State, an employer is required or permitted to deduct any amount from the remuneration of an employee and to pay the amount deducted to the United States, a State, or any political subdivision thereof, then for the purposes of this Act the amount so deducted shall be considered to have been paid to the employee at the time of such deduction. (d) Nothing in this Act shall be construed as authorizing any Federal official, agent, or representative, in carrying out any of the provisions of this Act, to take charge of any child over the objection of either of the parents of such child, or of the person standing in loco parentis to such child. RULES AND REGULATIONS SEC. 1102. [42 U.S.C. 1302] (a) The Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services, respectively, shall make and publish such rules and regulations, not inconsistent with this Act, as may be necessary to the efficient administration of the functions with which each is charged under this Act. (b)(1) Whenever the Secretary publishes a general notice of proposed rulemaking for any rule or regulation proposed under title XVIII, title XIX, or part B of this title that may have a significant impact on the operations of a substantial number of small rural hospitals, the Secretary shall prepare and make available for public comment an initial regulatory impact analysis. Such analysis shall describe the impact of the proposed rule or regulation on such hospitals and shall set forth, with respect to small rural hospitals, the matters required under section 603 of title 5, United States Code, to be set forth with respect to small entities. The initial regulatory impact analysis (or a summary) shall be published in the Federal Register at the time of the publication of general notice of proposed rulemaking for the rule or regulation. (2) Whenever the Secretary promulgates a final version of a rule or regulation with respect to which an initial regulatory impact analysis is required by paragraph (1), the Secretary shall prepare a final regulatory impact analysis with respect to the final version of such rule or regulation. Such analysis shall set forth, with respect to small rural hospitals, the matters required under section 604 of title 5, United States Code, to be set forth with respect to small entities. The Secretary shall make copies of the final regulatory impact analysis available to the public and shall publish, in the Federal Register at the time of publication of the final version of the rule or regulation, a statement describing how a member of the public may obtain a copy of such analysis. (3) If a regulatory flexibility analysis is required by chapter 6 of title 5, United States Code, for a rule or regulation to which this 7See Vol. II, P.L. 94-437, §802(b), with respect to regulations regarding Indian health serv8 See Vol. II, Title 5, §§603 and 604. ices. |