TITLE XVIII-HEALTH INSURANCE FOR THE AGED AND DISABLED 1 Title XVIII of the Social Security Act is administered by the Health Care Financing Administration. Title XVIII appears in the United States Code as §§1395-1395ccc, subchapter XVIII, chapter 7, Title 42. Regulations of the Secretary of Health and Human Services relating to Title XVIII are contained in chapter IV, Title 42, and in subtitle A, Title 45, Code of Federal Regulations. See Vol. II, P.L. 78-410, $353(i)(3) and (n), with respect to clinical laboratories. See Vol. II, P.L. 88-352, §601, for prohibition against discrimination in Federally assisted programs. See Vol. II, P.L. 89-73, §§203 and 422(c), with respect to consultation with respect to programs and services for the aged. See Vol. II, P.L. 93-288, §312(d), with respect to exclusion from income and resources of certain Federal major disaster and emergency assistance. See Vol. II, P.L. 95-250, §201(19), with respect to trust fund contributions, and §204(b)(4), with respect to Title XVIII ineligibility. See Vol. II, P.L. 95–521, §102(i), with respect to reporting of benefits received under the Social Security Act. See Vol. II, P.L. 96-265, §505, with respect to experiments, demonstration projects, and required reports to Congress. See Vol. II, P.L. 97-248, §119, with respect to private sector review initiative and restriction against recovery from beneficiaries. See Vol. II, P.L. 98-21, §603, with respect to a variety of studies and reports to Congress. See Vol. II, P.L. 98-369, §2355, with respect to waivers for social health maintenance organizations. See Vol. II, P.L. 99-177, §257(b)(3) and (c)(3), with respect to the calculation of the baseline. See Vol. II, P.L. 99-272, §9220, with respect to extension, terms, conditions, and period of approval of the extension of On Lok waiver; and §9314, with respect to a demonstration program designed to reduce disability and dependency through the provision of preventive health services to medicare beneficiaries; and §9215, with respect to the extension of certain medicare health services demonstration projects. See Vol. II, P.L. 99-319, §105, with respect to systems requirements. See Vol. II, P.L. 99-509, §9339(d) with respect to State standards for directors of clinical laboratories; §9342 with respect to Alzheimer's disease demonstration projects; §9353(a)(4) with respect to a small-area analysis; and §9412 with respect to the waiver authority for chronically mentally ill and frail elderly. See Vol. II, P.L. 99-660, Title IV, with respect to professional review activities. See Vol. II, P.L. 100-203, §4008(d)(3), with respect to a report regarding hospital outlier pay ments. 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, §§5-8, with respect to responsibilities of each Federal agency for computer systems security and privacy. See Vol. II, P.L. 100-383, §§105(fX2) and 206(d)(2), with respect to exclusions from income and resources of certain payments to certain individuals. See Vol. II, P.L. 100-407, §105(g), with respect to the effect of financial assistance under that Act. See Vol. II, P.L. 100-411, §2(d)3XB), with respect to the effect of per capita payments. See Vol. II, P.L. 100-581, §§501, 502(b)(1), and 503, with respect to exclusion from income and resources of certain judgment funds. See Vol. II, P.L. 100-647, §8411, with respect to treatment of certain nursing education programs. See Vol. II, P.L. 100-690, §5301(aX1XC) and (dX1X(B), with respect to benefits of drug traffickers and possessors. See Vol. II, P.L. 100-713, §712, with respect to the provision of services in Montana. See Vol. II, P.L. 101-121, with respect to the amounts collected by the Secretary of Health and Human Services under the authority of title IV of the Indian Health Care Improvement Act. See Vol. II, P.L. 101-239, §6025, with respect to a dentist's serving as hospital medical director; §6205(a)(1)(A) and (a)(2), with respect to recognition of costs of certain hospital-based nursing schools. Continued Sec. 1803. Option to individuals to obtain other health insurance protec- 787 Sec. 1804. Sec. 1805. Notice of medicare benefits: medicare and medigap information 787 788 Sec. 1806. Explanation of medicare benefits 792 Part A-Hospital Insurance Benefits for the Aged and Disabled Sec. 1816. Use of public agencies or private organizations to facilitate pay- 810 Sec. 1817. Federal Hospital Insurance Trust Fund 816 See Vol. II, P.L. 101-508, §4008(i)(1), with respect to Secretarial waiver authority; §4008(k), with respect to the prospective payment system for skilled nursing facility services; §4008(1), with respect to regulations for rural hospitals; §4161(b)(3), with respect to productivity screens; §4202, with respect to a staff-assisted home dialysis demonstration project; §4204(b), with respect to the requirements for actuarial equivalence of AAPCC; §4207(b)(1), with respect to the prohibition of cost savings policies before the beginning of the fiscal year, §4207(b)(2), with respect to the prohibition of payment cycle changes; §4207(c), with respect to the development of a prospective payment system for home health services; §4359, with respect to health insurance advisory service for medicare beneficiaries; §4360, with respect to health insurance information, counseling, and assistance grants; §4801(e)17)(B), with respect to a study and report on staffing requirements in nursing facilities; §13301, with respect to off-budget status of OASDI trust funds; and §13302, with respect to protection of OASDI trust funds in the House of Representatives. See Vol. II, P.L. 103-432, §154, with respect to the qualified medicare beneficiary outreach. See Vol. II, P.L. 104-134, §516(d), with respect to a study and report on deeming for nursing facilities and renal dialysis facilities. See Vol. II, P.L. 105-13, §1, with respect to the extension of term of appointment of certain members of the Prospective Payment Assessment Commission and the Physician Payment Review Commission. See Vol. II, P.L. 105-33, §4002(c), with respect to an enrollment transition rule; §4011, with respect to Medicare+Choice competitive pricing demonstration project; §4012, with respect to advisory committees; §4014(c), with respect to the report on integration and transition; §4016, with respect to Medicare Coordinated Care Demonstration Project; §4021, with respect to a National Bipartisan Commission on the future of Medicare; §4207, with the Informatics, Telemedicine, and Education Demonstration Project; §4611(e), with respect to a transition for the aggregate amount of expenditures transferred from part A to part B of title XVIII; §4018, with respect to the Medicare enrollment demonstration project; §4019, with respect to an extension of certain Medicare community nursing organization demonstration projects; §4022(c)(3), with respect to continuing responsibility for reports; §4031(e), with respect to transition provisions; §4105(c), with respect to the establishment of outcome measures for beneficiaries with diabetes; §4107, with respect to the vaccines outreach expansion; $4108, with respect to a study on preventive and enhanced benefits; §4206, with respect to Medicare reimbursement for Telehealth services; §4315(d), with respect to developing a fee schedule for particular services; §4432(c), with respect to a medical review process; §4506, with respect to dissemination of information on high per discharge relative values for in-hospital physicians' services; §4513(c), with respect to utilization guidelines; §4532, with respect to demonstration of coverage of ambulance services under Medicare through contracts with units of local government; §4551(b), with respect to payment freeze for parental and eternal nutrients, supplies, and equipment; §4552(c), with respect to service standards for persons seeking payment under part B of title XVIII; §4552(d), with respect to access to home oxygen equipment; §4553(c), with respect to a study and report on clinical laboratory tests; §4554, with respect to improvements in administration of laboratory tests benefit; $4558, with respect to renal dialysis-related services; §4602(e), with respect to the submission of data for case mix system; §4616, with respect to reports to Congress regarding home health cost containment; §4628, with respect to a demonstration project on use of consortia; §4629, with respect to recommendations on long-term policies regarding teaching hospitals and graduate medical education. See Vol. II, P.L. 106-554, §1(a)6) [121], with respect to a demonstration project for disease management for severely chronically ill Medicare beneficiaries; [122], with respect to cancer prevention and treatment demonstrations for ethnic and racial minorities; and [128] with respect to a lifestyle modification program demonstration. 2 This table of contents does not appear in the law. Page Sec. 1818. Hospital insurance benefits for uninsured elderly individuals 825 Sec. 1818A. Hospital insurance benefits for disabled individuals who have 829 Sec. 1819. Requirements for, and assuring quality of care in, skilled nurs- 831 Sec. 1820. Medicare rural hospital flexibility program 856 Conditions for coverage of religious nonmedical health care in- 860 Part B Supplementary Medical Insurance Benefits for the Aged and Disabled Sec. 1831. Establishment of supplementary medical insurance program for 863 Sec. 1832. Scope of benefits 864 Sec. 1833. Payment of benefits 866 receiving money payments under public assistance programs Sec. 1844. Appropriations to cover Government contributions and contin- 979 [Sec. 1845. Repealed.] 980 Sec. 1846. Intermediate sanctions for providers or suppliers of clinical di- 980 Sec. 1847. Demonstration projects for competitive acquisition of items and 981 Exclusions from coverage and medicare as secondary payer Consultation with State agencies and other organizations to de- 1123 velop conditions of participation for providers of services. Use of State agencies to determine compliance by providers of 1123 services with conditions of participation. Sec. 1865. Effect of accreditation Agreements with providers of services 1125 1127 Demonstration of application of physician volume increases to 1136 group practices. Page Sec. 1867. Sec. 1866B. Provisions for administration of demonstration program 1138 Examination and treatment for emergency medical conditions 1142 and women in labor. Sec. 1870. Overpayment on behalf of individuals and settlement of claims 1159 Sec. 1879. Limitation on liability of beneficiary where medicare claims are 1196 disallowed. Hospital providers of extended care services 1238 Sec. 1884. Payments to promote closing and conversion of underutilized 1240 hospital facilities. Sec. 1885. Sec. 1886. Withholding of payments for certain medicaid providers 1241 1242 Sec. 1887. Payment of provider-based physicians and payment under cer- 1306 tain percentage arrangements. Sec. 1888. [Sec. 1889. Payment to skilled nursing facilities for routine service costs.... 1307 1318 [Sec. 1890. Redesignated.] 1318 Sec. 1891. Conditions of participation for home health agencies; Home 1318 health quality. Sec. 1892. Offset of payments to individuals to collect past-due obligations 1324 arising from breach of scholarship and loan contract. Sec. 1893. Medicare integrity program 1327 Sec. 1894. Sec. 1895. Payments to, and coverage of benefits under, programs of all- 1328 1338 Sec. 1896. Medicare subvention for military retirees 1342 PROHIBITION AGAINST ANY FEDERAL INTERFERENCE SEC. 1801. [42 U.S.C. 1395] 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. [42 U.S.C. 1395a] (a) BASIC FREEDOM OF CHOICE.Any individual entitled to insurance benefits under this title may obtain health services from any institution, agency, or person quali fied to participate under this title if such institution, agency, or person undertakes to provide him such services. (b) USE OF PRIVATE CONTRACTS BY MEDICARE BENEFICIARIES. (1) IN GENERAL.-Subject to the provisions of this subsection, nothing in this title shall prohibit a physician or practitioner from entering into a private contract with a medicare beneficiary for any item or service (A) for which no claim for payment is to be submitted under this title, and (B) for which the physician or practitioner receives (i) no reimbursement under this title directly or on a capitated basis, and (ii) receives no amount for such item or service from an organization which receives reimbursement for such item or service under this title directly or on a capitated basis. (2) BENEFICIARY PROTECTIONS.— (A) IN GENERAL.-Paragraph (1) shall not apply to any contract unless (i) the contract is in writing and is signed by the medicare beneficiary before any item or service is provided pursuant to the contract; (ii) the contract contains the items described in subparagraph (B); and (iii) the contract is not entered into at a time when the medicare beneficiary is facing an emergency or urgent health care situation. (B) ITEMS REQUIRED TO BE INCLUDED IN CONTRACT.—Any contract to provide items and services to which paragraph (1) applies shall clearly indicate to the medicare beneficiary that by signing such contract the beneficiary (i) agrees not to submit a claim (or to request that the physician or practitioner submit a claim) under this title for such items or services even if such items or services are otherwise covered by this title; (ii) agrees to be responsible, whether through insurance or otherwise, for payment of such items or services and understands that no reimbursement will be provided under this title for such items or services; (iii) acknowledges that no limits under this title (including the limits under section 1848(g)) apply to amounts that may be charged for such items or services; (iv) acknowledges that Medigap plans under section 1882 do not, and other supplemental insurance plans may elect not to, make payments for such items and services because payment is not made under this title; and (v) acknowledges that the medicare beneficiary has the right to have such items or services provided by other physicians or practitioners for whom payment would be made under this title. |