TITLE XVIII—HEALTH INSURANCE FOR THE AGED AND DISABLED^[1]

TABLE OF CONTENTS OF TITLE^[2]

Sec. 1801. Prohibition against any Federal interference

Sec. 1802. Free choice by patient guaranteed

Sec. 1803. Option to individuals to obtain other health insurance protection

Sec. 1804. Notice of medicare benefits: medicare and medigap information

Sec. 1805. Medicare payment advisory commission

Sec. 1806. Explanation of medicare benefits

Sec. 1807. Chronic care improvement

Sec. 1808. Provisions relating to administration

Part A—Hospital Insurance Benefits for the Aged and Disabled

Sec. 1811. Description of program

Sec. 1812. Scope of benefits

Sec. 1813. Deductibles and coinsurance

Sec. 1814. Conditions of and limitations on payment for services

Sec. 1815. Payment to providers of services

Sec. 1816. Use of public agencies or private organizations to facilitate payment to providers of services

Sec. 1817. Federal Hospital Insurance Trust Fund

Sec. 1818. Hospital insurance benefits for uninsured elderly individuals not otherwise eligible

Sec. 1818A. Hospital insurance benefits for disabled individuals who have exhausted other entitlement

Sec. 1819. Requirements for, and assuring quality of care in, skilled nursing facilities

Sec. 1820. Medicare rural hospital flexibility program

Sec. 1821. Conditions for coverage of religious nonmedical health care institutional services

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

Sec. 1832. Scope of benefits

Sec. 1833. Payment of benefits

Sec. 1834. Special payment rules for particular items and services

Sec. 1835. Procedure for payment of claims of providers of services

Sec. 1836. Eligible individuals

Sec. 1837. Enrollment periods

Sec. 1838. Coverage period

Sec. 1839. Amounts of premiums

Sec. 1840. Payment of premiums

Sec. 1841. Federal supplementary medical insurance trust fund

Sec. 1842. Use of carriers for administration of benefits

Sec. 1843. State agreements for coverage of eligible individuals who are receiving money payments under public assistance programs or are eligible for medical assistance

Sec. 1844. Appropriations to cover Government contributions and contingency reserve

[Sec. 1845. Repealed.]

Sec. 1846. Intermediate sanctions for providers or suppliers of clinical diagnostic laboratory tests

Sec. 1847. Demonstration projects for competitive acquisition of items and services

Sec. 1847A. Use of average sales price payment methodology

Sec. 1847B. Competitive acquisition of outpatient drugs and biologicals

Sec. 1848. Payment for physicians' services

Part C—Medicare+Choice Program

Sec. 1851. Eligibility, election, and enrollment

Sec. 1852. Benefits and beneficiary protections

Sec. 1853. Payments to Medicare+Choice organizations

Sec. 1854. Premiums

Sec. 1855. Organizational and financial requirements for Medicare+Choice organizations; provider-sponsored organizations

Sec. 1856. Establishment of standards

Sec. 1857. Contracts with Medicare+Choice organizations

Sec. 1858. Special rules for MA regional plans

Sec. 1859. Definitions; miscellaneous provisions

Part D—Voluntary Prescription Drug Benefit Program

Subpart 1—Eligible Individuals and Prescription Drug Benefits

Sec. 1860D-1. Eligibility, enrollment, and information

Sec. 1860D-2. Prescription drug benefits

Sec. 1860D-3. Access to a choice of qualified prescription drug coverage

Sec. 1860D-4. Beneficiary protections for qualified prescription drug coverage

Subpart 2—Prescription Drug Plans; PDP Sponsors; Financing

Sec. 1860D-11. PDP regions; submission of bids; plan approval

Sec. 1860D-12. Requirements for and contracts with prescription drug plan (PDP) sponsors

Sec. 1860D-13. Premiums; late enrollment penalty

Sec. 1860D-14. Premium and cost-sharing subsidies for low-income individuals

Sec. 1860D-15. Subsidies for Part D eligible individuals for qualified prescription drug coverage

Sec. 1860D-16. Medicare prescription drug account in the federal supplementary medical insurance trust fund

Subpart 3—Application to Medicare Advantage Program and Treatment of Employer-Sponsored Programs and Other Prescription Drug Plans

Sec. 1860D-21. Application to medicare advantage program and related managed care programs

Sec. 1860D-22. Special rules for employer-sponsored programs

Sec. 1860D-23. State pharmaceutical assistance programs

Sec. 1860D-24. Coordination requirements for plans providing prescription drug coverage

Subpart 4—Medicare Prescription Drug Discount Card and Transitional Assistance Program

Sec. 1860D-31. Medicare prescription drug discount card and transitional assistance program

Subpart 5—Definitions and Miscellaneous Provisions

Sec. 1860D-41. Definitions; treatment of references to provisions in Part C

Sec. 1860D-42. Miscellaneous provisions

Part E—Miscellaneous Provisions

Sec. 1861. Definitions of services, institutions, etc.

Sec. 1862. Exclusions from coverage and medicare as secondary payer

Sec. 1863. Consultation with State agencies and other organizations to develop conditions of participation for providers of services

Sec. 1864. Use of State agencies to determine compliance by providers of services with conditions of participation

Sec. 1865. Effect of accreditation

Sec. 1866. Agreements with providers of services; enrollment processes

Sec. 1866A. Demonstration of application of physician volume increases to group practices

Sec. 1866B. Provisions for administration of demonstration program

Sec. 1866C. Health care quality demonstration program

Sec. 1867. Examination and treatment for emergency medical conditions and women in labor

Sec. 1868. Practicing physicians advisory council; council for technology and innovation

Sec. 1869. Determinations; Appeals

Sec. 1870. Overpayment on behalf of individuals and settlement of claims for benefits on behalf of deceased individuals

Sec. 1871. Regulations

Sec. 1872. Application of certain provisions of title II

Sec. 1873. Designation of organization or publication by name

Sec. 1874. Administration

Sec. 1874A. Contracts with medicare administrative contractors

Sec. 1875. Studies and recommendations

Sec. 1876. Payments to health maintenance organizations and competitive medical plans

Sec. 1877. Limitation on certain physician referrals

Sec. 1878. Provider reimbursement review board

Sec. 1879. Limitation on liability of beneficiary where medicare claims are disallowed

Sec. 1880. Indian health service facilities

Sec. 1881. Medicare coverage for end stage renal disease patients

Sec. 1882. Certification of medicare supplemental health insurance policies

Sec. 1883. Hospital providers of extended care services

Sec. 1884. Payments to promote closing and conversion of underutilized hospital facilities

Sec. 1885. Withholding of payments for certain medicaid providers

Sec. 1886. Payment to hospitals for inpatient hospital services

Sec. 1887. Payment of provider-based physicians and payment under certain percentage arrangements

Sec. 1888. Payment to skilled nursing facilities for routine service costs

[Sec. 1889. Provider education and technical assistance]

[Sec. 1890. Redesignated.]

Sec. 1891. Conditions of participation for home health agencies; Home health quality

Sec. 1892. Offset of payments to individuals to collect past-due obligations arising from breach of scholarship and loan contract

Sec. 1893. Medicare integrity program

Sec. 1894. Payments to, and coverage of benefits under, programs of all-inclusive care for the elderly (PACE)

Sec. 1895. Prospective payment for home health services

Sec. 1896. Medicare subvention for military retirees

Sec. 1897. Health care infrastructure improvement program

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^[1] Title XVIII of the Social Security Act is administered by the Centers for Medicare and Medicaid Services.

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 payments.

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.

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(l), 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.