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TITLE XVII-GRANTS FOR PLANNING COMPREHENSIVE ACTION TO COMBAT MENTAL

RETARDATION 1

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AUTHORIZATION OF APPROPRIATIONS

SEC. 1701. [42 U.S.C. 1391] For the purpose of assisting the States (including the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa) to plan for and take other steps leading to comprehensive State and community action to combat mental retardation, there is authorized to be appropriated the sum of $2,200,000. There are also authorized to be appropriated, for assisting such States in initiating the implementation and carrying out of planning and other steps to combat mental retardation, $2,750,000 for the fiscal year ending June 30, 1966, and $2,750,000 for the fiscal year ending June 30, 1967.

GRANTS TO STATES

SEC. 1702. [42 U.S.C. 1392] The sums appropriated pursuant to the first sentence of section 1701 shall be available for grants to States by the Secretary during the fiscal year ending June 30, 1964, and the succeeding fiscal year; and the sums appropriated pursuant to the second sentence of such section for the fiscal year ending June 30, 1966, shall be available for such grants during such year and the next two fiscal years, and sums appropriated pursuant thereto for the fiscal year ending June 30, 1967, shall be available for such grants during such year and the succeeding fiscal year. Any such grant to a State, which shall not exceed 75 per centum of the cost of the planning and related activities involved, may be used by it to determine what action is needed to combat mental retardation in the State and the resources available for this

Title XVII of the Social Security Act is administered by the Rehabilitation Services Administration, Office of Special Education and Rehabilitative Services, Department of Education. Title XVII appears in the United States Code as §§1391-1394, subchapter XVII, chapter 7, Title 42.

No regulations have been promulgated for Title XVII.

Title XVII was added to the Social Security Act by P.L. 88-156, "Maternal and Child Health and Mental Retardation Planning Amendments of 1963", §5 (77 Stat. 273, 275), effective October 24, 1963; however, it now is inactive.

2 This table of contents does not appear in the law.

purpose, to develop public awareness of the mental retardation problem and of the need for combating it, to coordinate State and local activities relating to the various aspects of mental retardation and its prevention, treatment, or amelioration, and to plan other activities leading to comprehensive State and community action to combat mental retardation.

APPLICATIONS

SEC. 1703. [42 U.S.C. 1393] In order to be eligible for a grant under section 1702, a State must submit an application therefor which

(1) designates or establishes a single State agency, which may be an interdepartmental agency, as the sole agency for carrying out the purposes of this title;

(2) indicates the manner in which provision will be made to assure full consideration of all aspects of services essential to planning for comprehensive State and community action to combat mental retardation, including services in the fields of education, employment, rehabilitation, welfare, health, and the law, and services provided through community programs for and institutions for the mentally retarded;

(3) sets forth its plans for expenditure of such grant, which plans provide reasonable assurance of carrying out the purposes of this title;

(4) provides for submission of a final report of the activities of the State agency in carrying out the purposes of this title, and for submission of such other reports, in such form and containing such information, as the Secretary 3 may from time to time find necessary for carrying out the purposes of this title and for keeping such records and affording such access thereto as he may find necessary to assure the correctness and verification of such reports; and

(5) provides for such fiscal control and fund accounting procedures as may be necessary to assure proper disbursement of and accounting for funds paid to the State under this title.

PAYMENTS

SEC. 1704. [42 U.S.C. 1394] Payment of grants under this title may be made (after necessary adjustment on account of previously made underpayments or overpayments) in advance or by way of reimbursement, and in such installments and on such conditions, as the Secretary may determine.

3P.L. 88-156, §6, provides that the term "Secretary" means the Secretary of Health, Education, and Welfare (now Secretary of Health and Human Services).

TITLE XVIII-HEALTH INSURANCE FOR THE
AGED AND DISABLED 1

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(f)(2) 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)(3)(B), 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(a)(1)(C) and (d)(1)(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

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Sec. 1803.

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Sec. 1805.

Sec. 1806.

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Sec. 1813.

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Sec. 1815.

Sec. 1816.

Sec. 1817.
Sec. 1818.

Sec. 1818A.

TABLE OF CONTENTS OF TITLE 2

Prohibition against any Federal interference
Free choice by patient guaranteed

Option to individuals to obtain other health insurance protec-
tion.

Notice of medicare benefits: medicare and medigap information
Medicare payment advisory commission
Explanation of medicare benefits

Part A-Hospital Insurance Benefits for the Aged and Disabled

Description of program

Scope of benefits

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Deductibles and coinsurance

Conditions of and limitations on payment for services
Payment to providers of services

Use of public agencies or private organizations to facilitate pay-
ment to providers of services.

Federal Hospital Insurance Trust Fund

Hospital insurance benefits for uninsured elderly individuals
not otherwise eligible.

Hospital insurance benefits for disabled individuals who have
exhausted other entitlement.

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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; 84012, 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.

2 This table of contents does not appear in the law.

Sec. 1819.

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Sec. 1832.
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[Sec. 1845. Sec. 1846.

Sec. 1847.

Sec. 1848.

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Sec. 1852.
Sec. 1853.
Sec. 1854.
Sec. 1855.

Part B Supplementary Medical Insurance Benefits for the Aged and Disabled

Sec. 1831.

Establishment of supplementary medical insurance program for
the aged and the disabled.
Scope of benefits ....

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Sec. 1857.
Sec. 1859.

Sec. 1861.
Sec. 1862.
Sec. 1863.

Sec. 1864.

Sec. 1865.
Sec. 1866.
Sec. 1867.

Sec. 1868.
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Sec. 1870.

Requirements for, and assuring quality of care in, skilled nurs-
ing facilities.

Medicare rural hospital flexibility program

Conditions for coverage of religious nonmedical health care in-
stitutional services.

Payment of benefits

Special payment rules for particular items and services
Procedure for payment of claims of providers of services
Eligible individuals
Enrollment periods
Coverage period

Amounts of premiums

Payment of premiums

Federal supplementary medical insurance trust fund
Use of carriers for administration of benefits

State agreements for coverage of eligible individuals who are
receiving money payments under public assistance programs
or are eligible for medical assistance.
Appropriations to cover Government contributions and contin-
gency reserve.
Repealed.]

Intermediate sanctions for providers or suppliers of clinical di-
agnostic laboratory tests.

Demonstration projects for competitive acquisition of items and

services.

Payment for physicians' services

Part C-Medicare+Choice Program

Eligibility, election, and enrollment
Benefits and beneficiary protections
Payments to Medicare+Choice org tions

Premiums

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803

Part D-Miscellaneous Provisions

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Organizational and financial requirements for Medicare+Choice 1000

organizations; provider-sponsored organizations.

Establishment of standards

Contracts with Medicare+Choice organizations
Definitions; miscellaneous provisions

1004

1007

1013

Definitions of services, institutions, etc.

1015

1064

Exclusions from coverage and medicare as secondary payer
Consultation with State agencies and other organizations to de- 1077

velop conditions of participation for providers of services.

Use of State agencies to determine compliance by providers of 1077 services with conditions of participation.

Effect of accreditation

1080

Agreements with providers of services

1082

Examination and treatment for emergency medical conditions 1092 and women in labor.

1097

1097

Practicing physicians advisory council
Determinations; appeals ......
Overpayment on behalf of individuals and settlement of claims 1099
for benefits on behalf of deceased individuals.

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