
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC1395b-4]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XVIII--HEALTH INSURANCE FOR AGED AND DISABLED
 
Sec. 1395b-4. Health insurance information, counseling, and 
        assistance grants
        

(a) Grants

    The Secretary of Health and Human Services (in this section referred 
to as the ``Secretary'') shall make grants to States, with approved 
State regulatory programs under section 1395ss of this title, that 
submit applications to the Secretary that meet the requirements of this 
section for the purpose of providing information, counseling, and 
assistance relating to the procurement of adequate and appropriate 
health insurance coverage to individuals who are eligible to receive 
benefits under this subchapter (in this section referred to as 
``eligible individuals''). The Secretary shall prescribe regulations to 
establish a minimum level of funding for a grant issued under this 
section.

(b) Grant applications

    (1) In submitting an application under this section, a State may 
consolidate and coordinate an application that consists of parts 
prepared by more than one agency or department of such State.
    (2) As part of an application for a grant under this section, a 
State shall submit a plan for a State-wide health insurance information, 
counseling, and assistance program. Such program shall--
        (A) establish or improve upon a health insurance information, 
    counseling, and assistance program that provides counseling and 
    assistance to eligible individuals in need of health insurance 
    information, including--
            (i) information that may assist individuals in obtaining 
        benefits and filing claims under this subchapter and subchapter 
        XIX of this chapter;
            (ii) policy comparison information for medicare supplemental 
        policies (as described in section 1395ss(g)(1) of this title) 
        and information that may assist individuals in filing claims 
        under such medicare supplemental policies;
            (iii) information regarding long-term care insurance; and
            (iv) information regarding other types of health insurance 
        benefits that the Secretary determines to be appropriate;

        (B) in conjunction with the health insurance information, 
    counseling, and assistance program described in subparagraph (A), 
    establish a system of referral to appropriate Federal or State 
    departments or agencies for assistance with problems related to 
    health insurance coverage (including legal problems), as determined 
    by the Secretary;
        (C) provide for a sufficient number of staff positions 
    (including volunteer positions) necessary to provide the services of 
    the health insurance information, counseling, and assistance 
    program;
        (D) provide assurances that staff members (including volunteer 
    staff members) of the health insurance information, counseling, and 
    assistance program have no conflict of interest in providing the 
    counseling described in subparagraph (A);
        (E) provide for the collection and dissemination of timely and 
    accurate health care information to staff members;
        (F) provide for training programs for staff members (including 
    volunteer staff members);
        (G) provide for the coordination of the exchange of health 
    insurance information between the staff of departments and agencies 
    of the State government and the staff of the health insurance 
    information, counseling, and assistance program;
        (H) make recommendations concerning consumer issues and 
    complaints related to the provision of health care to agencies and 
    departments of the State government and the Federal Government 
    responsible for providing or regulating health insurance;
        (I) establish an outreach program to provide the health 
    insurance information and counseling described in subparagraph (A) 
    and the referrals described in subparagraph (B) to eligible 
    individuals; and
        (J) demonstrate, to the satisfaction of the Secretary, an 
    ability to provide the counseling and assistance required under this 
    section.

(c) Special grants

    (1) A State that is conducting a health insurance information, 
counseling, and assistance program that is substantially similar to a 
program described in subsection (b)(2) of this section shall, as a 
requirement for eligibility for a grant under this section, demonstrate, 
to the satisfaction of the Secretary, that such State shall maintain the 
activities of such program at least at the level that such activities 
were conducted immediately preceding the date of the issuance of any 
grant during the period of time covered by such grant under this 
section.
    (2) If the Secretary determines that the existing health insurance 
information, counseling, and assistance program is substantially similar 
to a program described in subsection (b)(2) of this section, the 
Secretary may waive some or all of the requirements described in such 
subsection and issue a grant to the State for the purpose of increasing 
the number of services offered by the health insurance information, 
counseling, and assistance program, experimenting with new methods of 
outreach in conducting such program, or expanding such program to 
geographic areas of the State not previously served by the program.

(d) Criteria for issuing grants

    In issuing a grant under this section, the Secretary shall 
consider--
        (1) the commitment of the State to carrying out the health 
    insurance information, counseling, and assistance program described 
    in subsection (b)(2) of this section, including the level of 
    cooperation demonstrated--
            (A) by the office of the chief insurance regulator of the 
        State, or the equivalent State entity;
            (B) other officials of the State responsible for overseeing 
        insurance plans issued by nonprofit hospital and medical service 
        associations; and
            (C) departments and agencies of such State responsible for--
                (i) administering funds under subchapter XIX of this 
            chapter, and
                (ii) administering funds appropriated under the Older 
            Americans Act [42 U.S.C. 3001 et seq.];

        (2) the population of eligible individuals in such State as a 
    percentage of the population of such State; and
        (3) in order to ensure the needs of rural areas in such State, 
    the relative costs and special problems associated with addressing 
    the special problems of providing health care information, 
    counseling, and assistance eligible \1\ individuals residing in 
    rural areas of such State.
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    \1\ So in original. Probably should be preceded by ``to''.
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(e) Annual State report

    A State that receives a grant under this section shall, not later 
than 180 days after receiving such grant, and annually thereafter during 
the period of the grant, issue a report to the Secretary that includes 
information concerning--
        (1) the number of individuals served by the health insurance 
    information, counseling and assistance program of such State;
        (2) an estimate of the amount of funds saved by the State, and 
    by eligible individuals in the State, in the implementation of such 
    program; and
        (3) the problems that eligible individuals in such State 
    encounter in procuring adequate and appropriate health care 
    coverage.

(f) Report to Congress

    Beginning with 1992, and annually thereafter, the Secretary shall 
issue a report to the Committee on Finance of the Senate, the Special 
Committee on Aging of the Senate, the Committee on Ways and Means of the 
House of Representatives, and the Committee on Energy and Commerce of 
the House of Representatives that--
        (1) summarizes the allocation of funds authorized for grants 
    under this section and the expenditure of such funds;
        (2) outlines the problems that eligible individuals encounter in 
    procuring adequate and appropriate health care coverage;
        (3) makes recommendations that the Secretary determines to be 
    appropriate to address the problems described in paragraph (3); \2\ 
    and
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    \2\ So in original. Probably should be paragraph ``(2)''.
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        (4) in the case of the report issued 2 years after November 5, 
    1990, evaluates the effectiveness of counseling programs established 
    under this program, and makes recommendations regarding continued 
    authorization of funds for these purposes.

(g) Authorization of appropriations for grants

    There are authorized to be appropriated, in equal parts from the 
Federal Hospital Insurance Trust Fund and from the Federal Supplementary 
Medical Insurance Trust Fund, $10,000,000 for each of fiscal years 1991, 
1992, 1993, 1994, 1995, and 1996, to fund the grant programs described 
in this section.

(Pub. L. 101-508, title IV, Sec. 4360, Nov. 5, 1990, 104 Stat. 1388-138; 
Pub. L. 103-432, title I, Sec. 171(i), Oct. 31, 1994, 108 Stat. 4450; 
Pub. L. 103-437, Sec. 15(b), Nov. 2, 1994, 108 Stat. 4591; Pub. L. 105-
362, title VI, Sec. 602(b)(2), Nov. 10, 1998, 112 Stat. 3286.)

                       References in Text

    The Older Americans Act, referred to in subsec. (d)(1)(C)(ii), 
probably means the Older Americans Act of 1965, which is Pub. L. 89-73, 
July 14, 1965, 79 Stat. 218, as amended, and is classified generally to 
chapter 35 (Sec. 3001 et seq.) of this title. For complete 
classification of this Act to the Code, see Short Title note set out 
under section 3001 of this title and Tables.

                          Codification

    Section was enacted as part of the Omnibus Budget Reconciliation Act 
of 1990, and not as part of the Social Security Act which comprises this 
chapter.


                               Amendments

    1998--Subsec. (f). Pub. L. 105-362 substituted ``Beginning with 
1992'' for ``Not later than 180 days after November 5, 1990''.
    1994--Subsec. (b)(2)(A)(ii). Pub. L. 103-432, Sec. 171(i)(1), 
inserted closing parenthesis after ``of this title''.
    Subsec. (b)(2)(D). Pub. L. 103-432, Sec. 171(i)(2), substituted 
``counseling'' for ``services'' before ``described in subparagraph 
(A)''.
    Subsec. (b)(2)(I). Pub. L. 103-432, Sec. 171(i)(3), substituted 
``referrals'' for ``assistance''.
    Subsec. (c)(1). Pub. L. 103-432, Sec. 171(i)(4), struck out ``and 
that such activities will continue to be maintained at such level'' 
after ``covered by such grant under this section''.
    Subsec. (d)(3). Pub. L. 103-432, Sec. 171(i)(5), substituted 
``eligible individuals residing in rural areas'' for ``to the rural 
areas''.
    Subsec. (e). Pub. L. 103-432, Sec. 171(i)(6)(A), (B), in 
introductory provisions, substituted ``this section'' for ``subsection 
(c) or (d) of this section'' and ``and annually thereafter during the 
period of the grant, issue a report'' for ``and annually thereafter, 
issue an annual report''.
    Subsec. (e)(1). Pub. L. 103-432, Sec. 171(i)(6)(C), struck out 
``State-wide'' before ``health insurance information''.
    Subsec. (f). Pub. L. 103-437, Sec. 15(b)(1), in introductory 
provisions, substituted ``and the Committee on Energy and Commerce'' for 
``the Committee on Energy and Commerce of the House of Representatives, 
and the Select Committee on Aging''.
    Pub. L. 103-432, Sec. 171(i)(8)(B), and Pub. L. 103-437, 
Sec. 15(b)(2), made identical amendments, redesignating subsec. (f), 
relating to authorization of appropriations for grants, as (g).
    Pub. L. 103-432, Sec. 171(i)(8)(A), in subsec. (f), relating to 
authorization of appropriations for grants, substituted ``1993, 1994, 
1995, and 1996'' for ``and 1993''.
    Subsec. (f)(2) to (5). Pub. L. 103-432, Sec. 171(i)(7), in subsec. 
(f), relating to report to Congress, redesignated pars. (3) to (5) as 
(2) to (4), respectively, and struck out former par. (2) which read as 
follows: ``summarizes the scope and content of training conferences 
convened under this section;''.
    Subsec. (g). Pub. L. 103-432, Sec. 171(i)(8)(B), and Pub. L. 103-
437, Sec. 15(b)(2), made identical amendments, redesignating subsec. 
(f), relating to authorization of appropriations for grants, as (g).

                         Change of Name

    Committee on Energy and Commerce of House of Representatives treated 
as referring to Committee on Commerce of House of Representatives by 
section 1(a) of Pub. L. 104-14, set out as a note preceding section 21 
of Title 2, The Congress.


                    Effective Date of 1994 Amendment

    Amendment by Pub. L. 103-432 effective as if included in the 
enactment of Pub. L. 101-508, see section 171(l) of Pub. L. 103-432, set 
out as a note under section 1395ss of this title.


                        State Regulatory Programs

    For provisions relating to changes required to conform State 
regulatory programs to amendments by section 171 of Pub. L. 103-432, see 
section 171(m) of Pub. L. 103-432, set out as a note under section 
1395ss of this title.

                  Section Referred to in Other Sections

    This section is referred to in sections 1395w-27, 3058k of this 
title.
