nation, or (B) if such plan is established before such effective date, with respect to such services furnished to such individual after the calendar year in which such termination is effective, and "(5) with respect to outpatient hospital diagnostic services furnished on or after the effective date of such termination. "(c) Nothing in this title shall preclude any provider of services or any group or groups of such providers from being represented by an individual, association, or organization authorized by such provider or providers of services to act on their behalf in negotiating with respect to their participation under this title and the terms, methods, and amounts of payments for services to be provided thereunder. "(d) Where an agreement filed under this title by a provider of services has been terminated by the Secretary, such provider may not file another agreement under this title unless the Secretary finds that the reason for the termination has been removed and there is reasonable assurance that it will not recur. "(e) If the Secretary finds that timely review in accordance with section 1706 (e) of long-stay cases in a hospital or skilled nursing facility is not being made with reasonable regularity, he may, in lieu of terminating his agreement with such hospital or facility, decide that, with respect to any individual admitted to such hospital or skilled nursing facility after a date specified by him, no payment shall be made for inpatient hospital services or skilled nursing facility services after the twenty-first day of a continuous period of such services. Such decision may be made only after such notice to the hospital, or (in the case of a skilled nursing facility) to the hospital and the facility, and to the public as may be prescribed by regulations, and its effectiveness shall be rescinded when the Secretary finds that the reason therefor has been removed and there is reasonable assurance that it will not recur. "PAYMENT TO PROVIDERS OF SERVICES "SEC. 1711. The Secretary shall periodically determine the amount which should be paid to each provider of services under this title with respect to the services furnished by it, and the provider shall be paid, at such time or times as the Secretary believes appropriate and prior to audit or settlement by the General Accounting Office, from the Federal Hospital Insurance Trust Fund the amounts so determined; except that such amounts may be reduced or increased, as the case may be, by any sum by which the Secretary finds that the amount paid to such provider of services for any prior period was greater or less than the amount which should have been paid to it for such period. "HOSPITAL INSURANCE BENEFITS ADVISORY COUNCIL "SEC. 1712. For the purpose of advising the Secretary on matters of general policy in the administration of this title and in the formulation of regulations under this title, there is hereby created a Hospital Insurance Benefits Advisory Council which shall consist of 14 persons, not otherwise in the employ of the United States, appointed by the Secretary without regard to the civil service laws. The Secretary shall from time to time appoint one of the members to serve as Chairman. Not less than 4 of the appointed members shall be persons who are outstanding in the fields pertaining to hospitals and health activities. Each appointed member shall hold office for a term of 4 years, except that any member appointed to fill a vacancy occurring prior to the expiration of the term for which his predecessor was appointed shall be appointed for the remainder of such term, and except that the terms of office of the members first taking office shall expire, as designed by the Secretary at the time of appointment, 3 at the end of the first year, 4 at the end of the second year, 3 at the end of the third year, and 4 at the end of the fourth year after the date of appointment. An appointed member shall not be eligible to serve continuously for more than 2 terms. The Secretary may, at the request of the Council, appoint such special advisory or technical committees as may be useful in carrying out its functions. Appointed members of the Advisory Council and members of its advisory or technical committees, while attending meetings or conferences thereof or otherwise serving on business of the Advisory Council or of such a committee or committees, shall be entitled to receive compensation at rates fixed by the Secretary, but not exceeding $100 per day, and while so serving away from their homes or regular places of business they may be allowed travel expenses, including per diem in lieu of subsistence, as authorizd by section 5 of the Administrative Expenses Act of 1946 (5 U.S.C. 73b-2) for persons in the Government service employed intermittently. The Advisory Council shall meet as frequently as the Secretary deems necessary. Upon request of 4 or more members, it shall be the duty of the Secretary to call a meeting of the Advisory Council. "REVIEW OF DETERMINATIONS "SEC. 1713. Any individual dissatisfied with any determination made by the Secretary that he is not entitled to insurance benefits under this title or that he is not entitled to have payment made under this title with respect to any class of services furnished him, shall be entitled to a hearing thereon by the Secretary to the same extent as is provided in section 205 (b) with respect to decisions of the Secretary, and to judicial review of the Secretary's final decision after such hearing as is provided in section 205 (g). "OVERPAYMENTS TO INDIVIDUALS "SEC. 1714. (a) Any payment under this title to any provider of services with respect to inpatient hospital services, skilled nursing facility services, home health services, or outpatient hospital diagnostic services, furnished any individual shall be regarded as a payment to such individual. "(b) Where "(1) more than the correct amount is paid under this title to a provider of services for services furnished an individual and the Secretary determines that, within such period as he may specify, the excess over the correct amount cannot be recouped from such provider of services, or "(2) any payment has been made under section 1709(g) to a provider of services for services furnished an individual, proper adjustments shall be made, under regulations prescribed by the Secretary, by decreasing subsequent payments "(3) to which such individual is entitled under title II, or "(4) if such individual dies before such adjustment has been completed, to which any other individual is entitled under title II with respect to the wages and self-employment income which were the basis of benefits of such deceased individual under such title. "(c) There shall be no adjustment as provided in subsection (b) (nor shall there be recovery) in any case where the incorrect payment has been made (including payments under section 1709 (g)) for services furnished to an individual who is without fault and where such adjustment (or recovery) would defeat the purposes of title II or would be against equity and good conscience. "(d) No certifying or disbursing officer shall be held liable for any amount certified or paid by him to any provider of services where the adjustment or recovery of such amount is waived under subsection (c) or where adjustment under subsection (b) is not completed prior to the death of all persons against whose benefits such adjustment is authorized. "USE OF PRIVATE ORGANIZATIONS TO FACILITATE PAYMENT TO PROVIDERS OF SERVICE "SEC. 1715. (a) The Secretary is authorized to enter into an agreement with any organization, which has been designated by any group of providers of services, or by an association of such providers on behalf of its members, to receive payments under section 1711 on behalf of such providers, providing for the determination by such organization (subject to such review by the Secretary as may be provided for in the agreement) of the amount of payments required pursuant to this title to be made to such providers, and for making such payments. The Secretary shall not enter into an agreement with any organization under this section unless he finds it consistent with effective and efficient administration of this title. "(b) To the extent that the Secretary finds that performance of any of the following functions by an organization with which he has entered into an agreement under subsection (a) will be advantageous and will promote the efficient administration of this title, he may also include in the agreement provision that the organization shall (with respect to providers of services which are to receive payments through the organization— "(1) serve as a center for, and communicate to providers, any in formation or instructions furnished to it by the Secretary, and serve as a channel of communication from providers to the Secretary: "(2) make such audits of the records of providers as may be necessary to insure that proper payments are made under this title ; "(3) assist in the application of safeguards against unnecessary utilization of services furnished by providers to individuals entitled to have payment made under this title with respect to services furnished them; "(4) perform such other duties as are necessary to carry out the functions specified in subsection (a) and this subsection. "(c) An agreement with any organization under this section may contain such terms and conditions as the Secretary finds necessary or appropriate, and may provide for advances of funds to the organization for the making of payments by it under subsection (a) and shall provide for payment of the reasonable cost of administration of the organization as determined by the Secretary to be necessary and proper for carrying out the functions covered by the agreement. "(d) If the designation of an organization as provided in this section is made by an association of providers of services, it shall not be binding on members of the association which notify the Secretary of their election to that effect. Any provider may, upon such notice as may be specified in the agreement with an organization, withdraw his designation to receive payments through such organization and any provider who has not designated an organization may elect to receive payments from an organization which has entered into agreement with the Secretary under this section, if the Secretary and the organization agree to it. "(e) An agreement with the Secretary under this section may be terminated"(1) by the organization entering into such agreement at such time and upon such notice to the Secretary, to the public, and to the providers as may be provided in regulations, or "(2) by the Secretary at such time and upon such notice to the organization, and to the providers which have designated it for purposes of this section, as may be provided in regulations, but only if he finds, after reasonable notice and opportunity for hearing to the organization, that (A) the organization has failed substantially to carry out the agreement, or (B) the continuation of some or all of the functions provided for in the agreement with the organization is disadvantageous or is inconsistent with efficient administration of this title. "(f) An agreement with an organization under this section may require any of its officers or employees certifying payments or disbursing funds pursuant to the agreement, or otherwise participating in carrying out the agreement, to give surety bond to the United States in such amount as the Secretary may deem appropriate, and many provide for the payment of the charges for such bond from the Federal Hospital Insurance Trust Fund. "(g) (1) No individual designated pursuant to an agreement under this section as a certifying officer shall, in the absence of gross negligence or intent to defraud the United States, be liable with respect to any payments certified by him under this section. "(2) No disbursing officer shall, in the absence of gross negligence or intent to defraud the United States, be liable with respect to any payment by him under this section if it was based upon a voucher signed by a certifying officer designated as provided in paragraph (1) of this subsection. "OPTION TO INDIVIDUALS TO OBTAIN SUPPLEMENTARY PRIVATE HEALTH INSURANCE PROTECTION "SEC. 1716. (a) 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 health or medical care services in addition to those for which payment may be made under this title. "(b) The Secretary shall consult with providers of hospital or other medical care services, and with insurance companies and other similar organizations providing protection against the costs of any of such services, and representatives of such providers, insurance companies, or other similar organizations, and with appropriate State and other public or private agencies or organizations to the end that they are encouraged and assisted in developing and providing protection, which supplements that provided under this title, against the costs of health or other medical care services for which payments may not be made under this title. "REGULATIONS "SEC. 1717. When used in this title, the term 'regulations' means, unless the context otherwise requires, regulations prescribed by the Secretary. "APPLICATION OF CERTAIN PROVISIONS OF TITLE II "SEC. 1718. The provisions of sections 206, 208, and 216(j), and of subsections (a), (d), (e), (f), and (h) of section 205 shall also apply with respect to this title to the same extent as they are applicable with respect to title II. 27-166-64-pt. 1- 4 "DESIGNATION OF ORGANIZATION OR PUBLICATION BY NAME "SEC. 1719. Designation in this title, by name, of any nongovernmental organization or publication shall not be affected by change of name of such organization or publication, and shall apply to any successor organization or publication which the Secretary finds serves the purpose for which such designation is made." FEDERAL HOSPITAL INSURANCE TRUST FUND SEC. 102. (a) Section 201 of the Social Security Act is amended by redesignating subsections (c), (d), (e), (f), (g), and (h) as subsections (d), (e), (f), (g), (h), and (i), respectively, and by adding after subsection (b) the following new subsection: "(c) There is hereby created on the books of the Treasury of the United States a trust fund to be known as the 'Federal Hospital Insurance Trust Fund'. The Federal Hospital Insurance Trust Fund shall consist of such amounts as may be appropriated to or deposited in, such fund as provided in this section. There is hereby appropriated to the Federal Hospital Insurance Trust Fund for the fiscal year ending June 30, 1965, and for each fiscal year thereafter, out of any moneys in the Treasury not otherwise appropriated, amounts equivalent to 100 per centum of— "(1) 0.68 of 1 per centum of the wages (as defined in section 3121 of the Internal Revenue Code of 1954) paid after December 31, 1964, and reported to the Secretary of the Treasury or his delegate pursuant to subtitle F of the Internal Revenue Code of 1954, which wages shall be certified by the Secretary of Health, Education, and Welfare on the basis of the records of wages established and maintained by such Secretary in accordance with such reports; and "(2) 0.51 of 1 per centum of the amount of self-employment income (as defined in section 1402 of the Internal Revenue Code of 1954) reported to the Secretary of the Treasury or his delegate on tax returns under subtitle F of the Internal Revenue Code of 1954 for any taxable year beginning after December 31, 1964, which self-employment income shall be certified by the Secretary of Health, Education, and Welfare on the basis of the records of self-employment income established and maintained by the Secretary of Health, Education, and Welfare in accordance with such returns." (b) (1) The heading of section 201 of the Social Security Act is amended to read: "FEDERAL OLD-AGE AND SURVIVORS INSURANCE TRUST FUND, FEDERAL DISABILITY INSURANCE TRUST FUND, AND FEDERAL HOSPITAL INSURANCE TRUST FUND". (2) Subsection (a) of section 201 of such Act is amended by inserting “and the amounts specified in clause (1) of subsection (c) of this section" immediately before the semicolon in clause (3) thereof, by inserting "and the amount specified in clause (2) of subsection (c) of this section" immediately before the period in clause (4) thereof, and by striking out the last sentence and inserting in lieu thereof: "The amounts appropriated by clauses (3) and (4) shall be transferred from time to time from the general fund in the Treasury to the Federal Old-Age and Survivors Insurance Trust Fund, the amounts appropriated by clauses (1) and (2) of subsection (b) shall be transferred from time to time from the general fund in the Treasury to the Federal Disability Insurance Trust Fund, and the amounts appropriated by clauses (1) and (2) of subsection (c) shall be transferred from time to time from the general fund in the Treasury to the Federal Hospital Insurance Trust Fund, such amounts to be determined on the basis of estimates by the Secretary of the Treasury of the taxes, specified in clauses (3) and (4) of this subsection, paid to or deposited into the Treasury; and proper adjustment shall be made in amounts subsequently transferred to the extent prior estimates were in excess of or were less than the taxes specified in such clauses (3) and (4) of this subsection." (c) The first sentence of the subsection of such section 201 herein redesignated as subsection (d) is amended by striking out "and the Federal Disability Insurance Trust Fund" and inserting in lieu thereof ", the Federal Disability Insurance Trust Fund, and the Federal Hospital Insurance Trust Fund". (d) Paragraph (1) of the subsection of such section 201 herein redesignated as subsection (h) is amended by striking out "titles II and VIII" and "this title" wherever they appear and inserting in lieu thereof "this title XVII". (e) The last sentence of paragraph (2) of such subsection is amended by striking out “and clause (1) of subsection (b)” and inserting in lieu thereof “, clause (1) of subsection (b), and clause (1) of subsection (c)”. (f) The subsection of such section herein redesignated as subsection (i) is amended by adding at the end thereof the following new sentence: "Payments required to be made under title XVII shall be made only from the Federal Hospital Insurance Trust Fund." (g) Section 218(h) (1) of such Act is amended by striking out "and (b) (1)" and inserting in lieu thereof “, (b) (1), and (c) (1)”. (h) Section 221 (e) of such Act is amended (A) by striking out "Trust Funds" wherever that appears and inserting in lieu thereof "Trust Funds (except the Federal Hospital Insurance Trust Fund)"; (B) by striking out "subsection (g) of section 201" and inserting in lieu thereof "subsection (h) of section 201"; and (C) by inserting "under this title" before the period at the end thereof. (i) Section 1106(b) of such Act is amended by striking out "and the Federal Disability Insurance Trust Fund" and inserting in lieu thereof “, the Federal Disability Insurance Trust Fund, and the Federal Hospital Insurance Trust Fund". TRANSITIONAL PROVISION FOR ELIGIBILITY FOR PRESENTLY UNINSURED INDIVIDUALS SEC. 103. (a) Anyone who (1) has attained the age of 65. (2) (A) attained such age before 1967, or (B) has not less than 3 quarters of coverage (as defined in title II of the Socitl Security Act or section 5(1) of the Railroad Retirement Act of 1937), whenever acquired, for each calendar year elapsing after 1964 and before the year in which he attained such age, (3) is not, and upon filing application therefor would not be, entitled to monthly insurance benefits under section 202 of the Social Security Act and not meet the requirements set forth in subparagraph (B) of section 21(b) of the Railroad Retirement Act of 1937, and (4) has filed an application under this section at such time, in such manner, and in accordance with such other requirements as may be prescribed in regulations of the Secretary, shall (subject to the limitations in this section) be deemed, solely for purposes of section 1705 of the Social Security Act, to be entitled to monthly insurance benefits under such section 202 for each month, beginning with the first month in which he meets the requirements of this subsection and ending with the month in which he dies or, if earlier, the month before the month in which he becomes entitled to monthly insurance benefits under such section 202 or meets the requirements set forth in subparagraph (B) of section 21(b) of the Railroad Retirement Act of 1937. (b) The provisions of subsection (a) shall apply only in the case of an individual who (1) is a resident of the United States (as defined in section 210 of the Social Security Act), and (2) is a citizen of the United States or has resided in the United States (as so defined) continuously for not less than 10 years. (c) The provisions of subsection (a) shall not apply to any individual who(1) is a member of any organization referred to in section 210(a) (17) of the Social Security Act, (2) has been convicted of any offense listed in section 202 (u) of the Social Security Act, (3) is an employee of the United States, or (4) is eligible for the benefits of the Federal Employees Health Benefits Act of 1959 or the Retired Federal Employees Health Benefits Act. (d) There are authorized to be appropriated to the Federal Hospital Insurance Trust Fund (established by section 201 of the Social Security Act) from time to time such sums as the Secretary deems necessary, on account of— (a) payments made from such Trust Fund under title XVII of such Act with respect to individuals who are entitled to insurance benefits under such title solely by reason of this section, (b) the additional administrative expenses resulting therefrom, and (c) any loss in interest to such Trust Fund resulting from the payment of such amounts, in order to place such Trust Fund in the same position in which it would have been if subsections (a) and (b) of this section had not been enacted. |