TITLE XI-GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE SIMPLIFICATION 1 Penalty for fraud 545 Sec. 1108. Additional grants to Puerto Rico, the Virgin Islands, Guam, 546 Sec. 1109. Amounts disregarded not to be taken into account in determin- 548 Sec. 1110. Sec. 1111. Cooperative research or demonstration projects 549 551 Sec. 1112. 551 Sec. 1113. 551 Sec. 1114. Sec. 1117. Medical care guides and reports for public assistance and medi- Assistance for United States citizens returned from foreign Appointment of Advisory Council and other advisory groups Administrative and judicial review of certain administrative de- Appointment of the Administrator and Chief Actuary of the 558 Title XI of the Social Security Act is administered by the Department of Health and Human Services and by the Department of Labor. Title XI appears in the United States Code as §§1301-1320d-8, subchapter XI, chapter 7, Title 42. Regulations of the Secretary of Health and Human Services relating to Title XI are contained in chapter III, Title 20, in chapters I, II, and IV, Title 42, and in subtitle A and chapters I, III, and XIII, Title 45, Code of Federal Regulations. Regulations of the Secretary of Labor relating to Title XI are contained in chapter V, Title 20, and subtitle A, Title 29, Code of Federal Regulations. See Vol. II, P.L. 88-164, §124(b)(4), with respect to the membership of the State Planning Councils. See Vol. II, P.L. 88-352, §601, for prohibition against discrimination in federally assisted programs. See Vol. II, P.L. 100-204, §724(d), with respect to furnishing information to the United States Commission on Improving the Effectiveness of the United Nations; and §725(b), with respect to the detailing of Government personnel. See Vol. II, P.L. 100-235, 885-8, with respect to responsibilities of each Federal agency for computer systems security and privacy. See Vol. II, P.L. 101-508, §5120, with respect to vocational rehabilitation demonstration projects. See Vol. II, P.L. 103-432, §232, with respect to measurement and reporting of welfare receipt. 2 This table of contents does not appear in the law. Page Sec. 1118. Alternative Federal payment with respect to public assistance 559 Sec. 1119. Federal participation in payments for repairs to home owned by 559 Sec. 1120. Approval of certain projects 560 Sec. 1121. Uniform reporting systems for health services facilities and or- 560 Sec. 1123. Sec. 1122. Sec. 1123A. Limitation on Federal participation for capital expenditures 561 564 Reviews of child and family services programs, and of foster 565 Sec. 1124. Sec. 1124A. Disclosure of ownership and related information 566 567 Sec. 1125. Issuance of subpenas by Comptroller General 569 Sec. 1126. Disclosure by institutions, organizations, and agencies of own- 569 Sec. 1127. Adjustments in SSI benefits on account of retroactive benefits 570 Sec. 1128. Exclusion of certain individuals and entities from participation 571 Sec. 1128A. Civil monetary penalties...... 579 Sec. 1128B. Criminal penalties for acts involving Federal health care pro- 586 Sec. 1128C. Fraud and abuse control program 590 Sec. 1128D. Guidance regarding application of health care fraud and abuse 591 Sec. 1128E. Health care fraud and abuse data collection program 594 Sec. 1128F. Coordination of Medicare and Medicaid Surety Bond Provisions 597 597 Notification of social security claimant with respect to deferred 605 Sec. 1132. Period within which certain claims must be filed 606 Sec. 1133. Applicants or recipients under public assistance programs not 606 Sec. 1134. Nonprofit hospital philanthropy 607 Sec. 1135. Authority to waive requirements during national emergencies 608 Prohibition of misuse of symbols, emblems, or names in ref 623 Research on outcomes of health care services and procedures 628 632 Sec. 1144. Outreach efforts to increase awareness of the availability of 633 Sec. 1145. Protection of social security and medicare trust funds 634 Page Sec. 1146. Public disclosure of certain information on hospital financial in- 634 Sec. 1147. Recovery of SSI overpayments from other benefits 634 Sec. 1147A. Recovery of social security benefit overpayments from title VIII 635 Sec. 1148. The ticket to work and self-sufficiency program 635 Work incentives outreach program 645 Sec. 1150. State grants for work incentives assistance to disabled bene- 648 Sec. 1151. Sec. 1152. Part B-Peer Review of the Utilization and Quality of Health Care Services Purpose Definition of utilization and quality control peer review organi zation. 649 649 Sec. 1153. Contracts with utilization and quality control peer review orga- 650 Obligations of health care practitioners and providers of health 662 664 Sec. 1158. Application of this part to certain State programs receiving 665 Sec. 1159. Authorization for use of certain funds to administer the provi- 665 Exemptions for religious nonmedical health care institutions Part C-Administrative Simplification Definitions 668 Sec. 1171. 668 Sec. 1172. General requirements for adoption of standards 670 Sec. 1173. Sec. 1174. Standards for information transactions and data elements 671 673 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 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. (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. 3P.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]. |