
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 23, 2000]
[Document affected by Public Law 106-554 Section 1(a)(6)]
[CITE: 42USC1395cc]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XVIII--HEALTH INSURANCE FOR AGED AND DISABLED
 
                    Part D--Miscellaneous Provisions
 
Sec. 1395cc. Agreements with providers of services


(a) Filing of agreements; eligibility for payment; charges with respect 
        to items and services

    (1) Any provider of services (except a fund designated for purposes 
of section 1395f(g) and section 1395n(e) of this title) shall be 
qualified to participate under this subchapter and shall be eligible for 
payments under this subchapter if it files with the Secretary an 
agreement--
        (A)(i) not to charge, except as provided in paragraph (2), any 
    individual or any other person for items or services for which such 
    individual is entitled to have payment made under this subchapter 
    (or for which he would be so entitled if such provider of services 
    had complied with the procedural and other requirements under or 
    pursuant to this subchapter or for which such provider is paid 
    pursuant to the provisions of section 1395f(e) of this title), and 
    (ii) not to impose any charge that is prohibited under section 
    1396a(n)(3) of this title,
        (B) not to charge any individual or any other person for items 
    or services for which such individual is not entitled to have 
    payment made under this subchapter because payment for expenses 
    incurred for such items or services may not be made by reason of the 
    provisions of paragraph (1) or (9) of section 1395y(a) of this 
    title, but only if (i) such individual was without fault in 
    incurring such expenses and (ii) the Secretary's determination that 
    such payment may not be made for such items and services was made 
    after the third year following the year in which notice of such 
    payment was sent to such individual; except that the Secretary may 
    reduce such three-year period to not less than one year if he finds 
    such reduction is consistent with the objectives of this subchapter,
        (C) to make adequate provision for return (or other disposition, 
    in accordance with regulations) of any moneys incorrectly collected 
    from such individual or other person,
        (D) to promptly notify the Secretary of its employment of an 
    individual who, at any time during the year preceding such 
    employment, was employed in a managerial, accounting, auditing, or 
    similar capacity (as determined by the Secretary by regulation) by 
    an agency or organization which serves as a fiscal intermediary or 
    carrier (for purposes of part A or part B, or both, of this 
    subchapter) with respect to the provider,
        (E) to release data with respect to patients of such provider 
    upon request to an organization having a contract with the Secretary 
    under part B of subchapter XI of this chapter as may be necessary 
    (i) to allow such organization to carry out its functions under such 
    contract, or (ii) to allow such organization to carry out similar 
    review functions under any contract the organization may have with a 
    private or public agency paying for health care in the same area 
    with respect to patients who authorize release of such data for such 
    purposes,
        (F)(i) in the case of hospitals which provide inpatient hospital 
    services for which payment may be made under subsection (b), (c), or 
    (d) of section 1395ww of this title, to maintain an agreement with a 
    professional standards review organization (if there is such an 
    organization in existence in the area in which the hospital is 
    located) or with a utilization and quality control peer review 
    organization which has a contract with the Secretary under part B of 
    subchapter XI of this chapter for the area in which the hospital is 
    located, under which the organization will perform functions under 
    that part with respect to the review of the validity of diagnostic 
    information provided by such hospital, the completeness, adequacy, 
    and quality of care provided, the appropriateness of admissions and 
    discharges, and the appropriateness of care provided for which 
    additional payments are sought under section 1395ww(d)(5) of this 
    title, with respect to inpatient hospital services for which payment 
    may be made under part A of this subchapter (and for purposes of 
    payment under this subchapter, the cost of such agreement to the 
    hospital shall be considered a cost incurred by such hospital in 
    providing inpatient services under part A of this subchapter, and 
    (I) shall be paid directly by the Secretary to such organization on 
    behalf of such hospital in accordance with a rate per review 
    established by the Secretary, (II) shall be transferred from the 
    Federal Hospital Insurance Trust Fund, without regard to amounts 
    appropriated in advance in appropriation Acts, in the same manner as 
    transfers are made for payment for services provided directly to 
    beneficiaries, and (III) shall not be less in the aggregate for a 
    fiscal year than the aggregate amount expended in fiscal year 1988 
    for direct and administrative costs (adjusted for inflation and for 
    any direct or administrative costs incurred as a result of review 
    functions added with respect to a subsequent fiscal year) of such 
    reviews),
        (ii) in the case of hospitals, critical access hospitals, 
    skilled nursing facilities, and home health agencies, to maintain an 
    agreement with a utilization and quality control peer review 
    organization (which has a contract with the Secretary under part B 
    of subchapter XI of this chapter for the area in which the hospital, 
    facility, or agency is located) to perform the functions described 
    in paragraph (3)(A),
        (G) in the case of hospitals which provide inpatient hospital 
    services for which payment may be made under subsection (b) or (d) 
    of section 1395ww of this title, not to charge any individual or any 
    other person for inpatient hospital services for which such 
    individual would be entitled to have payment made under part A of 
    this subchapter but for a denial or reduction of payments under 
    section 1395ww(f)(2) of this title,
        (H)(i) in the case of hospitals which provide services for which 
    payment may be made under this subchapter and in the case of 
    critical access hospitals which provide critical access hospital 
    services, to have all items and services (other than physicians' 
    services as defined in regulations for purposes of section 
    1395y(a)(14) of this title, and other than services described by 
    section 1395x(s)(2)(K) of this title, certified nurse-midwife 
    services, qualified psychologist services, and services of a 
    certified registered nurse anesthetist) (I) that are furnished to an 
    individual who is a patient of the hospital, and (II) for which the 
    individual is entitled to have payment made under this subchapter, 
    furnished by the hospital or otherwise under arrangements (as 
    defined in section 1395x(w)(1) of this title) made by the hospital,
        (ii) in the case of skilled nursing facilities which provide 
    covered skilled nursing facility services--
            (I) that are furnished to an individual who is a resident of 
        the skilled nursing facility, and
            (II) for which the individual is entitled to have payment 
        made under this subchapter,

    to have items and services (other than services described in section 
    1395yy(e)(2)(A)(ii) of this title) furnished by the skilled nursing 
    facility or otherwise under arrangements (as defined in section 
    1395x(w)(1) of this title) made by the skilled nursing facility,
        (I) in the case of a hospital or critical access hospital--
            (i) to adopt and enforce a policy to ensure compliance with 
        the requirements of section 1395dd of this title and to meet the 
        requirements of such section,
            (ii) to maintain medical and other records related to 
        individuals transferred to or from the hospital for a period of 
        five years from the date of the transfer, and
            (iii) to maintain a list of physicians who are on call for 
        duty after the initial examination to provide treatment 
        necessary to stabilize an individual with an emergency medical 
        condition,

        (J) in the case of hospitals which provide inpatient hospital 
    services for which payment may be made under this subchapter, to be 
    a participating provider of medical care under any health plan 
    contracted for under section 1079 or 1086 of title 10, or under 
    section 1713 of title 38, in accordance with admission practices, 
    payment methodology, and amounts as prescribed under joint 
    regulations issued by the Secretary and by the Secretaries of 
    Defense and Transportation, in implementation of sections 1079 and 
    1086 of title 10,
        (K) not to charge any individual or any other person for items 
    or services for which payment under this subchapter is denied under 
    section 1320c-3(a)(2) of this title by reason of a determination 
    under section 1320c-3(a)(1)(B) of this title,
        (L) in the case of hospitals which provide inpatient hospital 
    services for which payment may be made under this subchapter, to be 
    a participating provider of medical care under section 1703 of title 
    38, in accordance with such admission practices, and such payment 
    methodology and amounts, as are prescribed under joint regulations 
    issued by the Secretary and by the Secretary of Veterans Affairs in 
    implementation of such section,
        (M) in the case of hospitals, to provide to each individual who 
    is entitled to benefits under part A of this subchapter (or to a 
    person acting on the individual's behalf), at or about the time of 
    the individual's admission as an inpatient to the hospital, a 
    written statement (containing such language as the Secretary 
    prescribes consistent with this paragraph) which explains--
            (i) the individual's rights to benefits for inpatient 
        hospital services and for post-hospital services under this 
        subchapter,
            (ii) the circumstances under which such an individual will 
        and will not be liable for charges for continued stay in the 
        hospital,
            (iii) the individual's right to appeal denials of benefits 
        for continued inpatient hospital services, including the 
        practical steps to initiate such an appeal, and
            (iv) the individual's liability for payment for services if 
        such a denial of benefits is upheld on appeal,

    and which provides such additional information as the Secretary may 
    specify,
        (N) in the case of hospitals and critical access hospitals--
            (i) to make available to its patients the directory or 
        directories of participating physicians (published under section 
        1395u(h)(4) of this title) for the area served by the hospital 
        or critical access hospital,
            (ii) if hospital personnel (including staff of any emergency 
        or outpatient department) refer a patient to a nonparticipating 
        physician for further medical care on an outpatient basis, the 
        personnel must inform the patient that the physician is a 
        nonparticipating physician and, whenever practicable, must 
        identify at least one qualified participating physician who is 
        listed in such a directory and from whom the patient may receive 
        the necessary services,
            (iii) to post conspicuously in any emergency department a 
        sign (in a form specified by the Secretary) specifying rights of 
        individuals under section 1395dd of this title with respect to 
        examination and treatment for emergency medical conditions and 
        women in labor, and
            (iv) to post conspicuously (in a form specified by the 
        Secretary) information indicating whether or not the hospital 
        participates in the medicaid program under a State plan approved 
        under subchapter XIX of this chapter,

        (O) to accept as payment in full for services that are covered 
    under this subchapter and are furnished to any individual enrolled 
    with a Medicare+Choice organization under part C of this subchapter 
    or with an eligible organization (i) with a risk-sharing contract 
    under section 1395mm of this title, under section 1395mm(i)(2)(A) of 
    this title (as in effect before February 1, 1985), under section 
    1395b-1(a) of this title, or under section 222(a) of the Social 
    Security Amendments of 1972, and (ii) which does not have a contract 
    establishing payment amounts for services furnished to members of 
    the organization the amounts that would be made as a payment in full 
    under this subchapter (less any payments under sections 
    1395ww(d)(11) and 1395ww(h)(3)(D) of this title) if the individuals 
    were not so enrolled,
        (P) in the case of home health agencies which provide home 
    health services to individuals entitled to benefits under this 
    subchapter who require catheters, catheter supplies, ostomy bags, 
    and supplies related to ostomy care (described in section 
    1395x(m)(5) of this title), to offer to furnish such supplies to 
    such an individual as part of their furnishing of home health 
    services,
        (Q) in the case of hospitals, skilled nursing facilities, home 
    health agencies, and hospice programs, to comply with the 
    requirement of subsection (f) of this section (relating to 
    maintaining written policies and procedures respecting advance 
    directives),
        (R) to contract only with a health care clearinghouse (as 
    defined in section 1320d of this title) that meets each standard and 
    implementation specification adopted or established under part C of 
    subchapter XI of this chapter on or after the date on which the 
    health care clearinghouse is required to comply with the standard or 
    specification, and
        (S) in the case of a hospital that has a financial interest (as 
    specified by the Secretary in regulations) in an entity to which 
    individuals are referred as described in section 1395x(ee)(2)(H)(ii) 
    of this title, or in which such an entity has such a financial 
    interest, or in which another entity has such a financial interest 
    (directly or indirectly) with such hospital and such an entity, to 
    maintain and disclose to the Secretary (in a form and manner 
    specified by the Secretary) information on--
            (i) the nature of such financial interest,
            (ii) the number of individuals who were discharged from the 
        hospital and who were identified as requiring home health 
        services, and
            (iii) the percentage of such individuals who received such 
        services from such provider (or another such provider).

In the case of a hospital which has an agreement in effect with an 
organization described in subparagraph (F), which organization's 
contract with the Secretary under part B of subchapter XI of this 
chapter is terminated on or after October 1, 1984, the hospital shall 
not be determined to be out of compliance with the requirement of such 
subparagraph during the six month period beginning on the date of the 
termination of that contract.
    (2)(A) A provider of services may charge such individual or other 
person (i) the amount of any deduction or coinsurance amount imposed 
pursuant to section 1395e(a)(1), (a)(3), or (a)(4), section 1395l(b), or 
section 1395x(y)(3) of this title with respect to such items and 
services (not in excess of the amount customarily charged for such items 
and services by such provider), and (ii) an amount equal to 20 per 
centum of the reasonable charges for such items and services (not in 
excess of 20 per centum of the amount customarily charged for such items 
and services by such provider) for which payment is made under part B of 
this subchapter or which are durable medical equipment furnished as home 
health services (but in the case of items and services furnished to 
individuals with end-stage renal disease, an amount equal to 20 percent 
of the estimated amounts for such items and services calculated on the 
basis established by the Secretary). In the case of items and services 
described in section 1395l(c) of this title, clause (ii) of the 
preceding sentence shall be applied by substituting for 20 percent the 
proportion which is appropriate under such section. A provider of 
services may not impose a charge under clause (ii) of the first sentence 
of this subparagraph with respect to items and services described in 
section 1395x(s)(10)(A) of this title and with respect to clinical 
diagnostic laboratory tests for which payment is made under part B of 
this subchapter. Notwithstanding the first sentence of this 
subparagraph, a home health agency may charge such an individual or 
person, with respect to covered items subject to payment under section 
1395m(a) of this title, the amount of any deduction imposed under 
section 1395l(b) of this title and 20 percent of the payment basis 
described in section 1395m(a)(1)(B) of this title. In the case of items 
and services for which payment is made under part B of this subchapter 
under the prospective payment system established under section 1395l(t) 
of this title, clause (ii) of the first sentence shall be applied by 
substituting for 20 percent of the reasonable charge, the applicable 
copayment amount established under section 1395l(t)(5) \1\ of this 
title. In the case of services described in section 1395l(a)(8) of this 
title or section 1395l(a)(9) of this title for which payment is made 
under part B of this subchapter under section 1395m(k) of this title, 
clause (ii) of the first sentence shall be applied by substituting for 
20 percent of the reasonable charge for such services 20 percent of the 
lesser of the actual charge or the applicable fee schedule amount (as 
defined in such section) for such services.
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    \1\ See References in Text note below.
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    (B) Where a provider of services has furnished, at the request of 
such individual, items or services which are in excess of or more 
expensive than the items or services with respect to which payment may 
be made under this subchapter, such provider of services may also charge 
such individual or other person for such more expensive items or 
services to the extent that the amount customarily charged by it for the 
items or services furnished at such request exceeds the amount 
customarily charged by it for the items or services with respect to 
which payment may be made under this subchapter.
    (C) A provider of services may in accordance with its customary 
practice also appropriately charge any such individual for any whole 
blood (or equivalent quantities of packed red blood cells, as defined 
under regulations) furnished him with respect to which a deductible is 
imposed under section 1395e(a)(2) of this title, except that (i) any 
excess of such charge over the cost to such provider for the blood (or 
equivalent quantities of packed red blood cells, as so defined) shall be 
deducted from any payment to such provider under this subchapter, (ii) 
no such charge may be imposed for the cost of administration of such 
blood (or equivalent quantities of packed red blood cells, as so 
defined), and (iii) such charge may not be made to the extent such blood 
(or equivalent quantities of packed red blood cells, as so defined) has 
been replaced on behalf of such individual or arrangements have been 
made for its replacement on his behalf. For purposes of this 
subparagraph, whole blood (or equivalent quantities of packed red blood 
cells, as so defined) furnished an individual shall be deemed replaced 
when the provider of services is given one pint of blood for each pint 
of blood (or equivalent quantities of packed red blood cells, as so 
defined) furnished such individual with respect to which a deduction is 
imposed under section 1395e(a)(2) of this title.
    (D) Where a provider of services customarily furnishes items or 
services which are in excess of or more expensive than the items or 
services with respect to which payment may be made under this 
subchapter, such provider, notwithstanding the preceding provisions of 
this paragraph, may not, under the authority of subparagraph (B)(ii) of 
this paragraph, charge any individual or other person any amount for 
such items or services in excess of the amount of the payment which may 
otherwise be made for such items or services under this subchapter if 
the admitting physician has a direct or indirect financial interest in 
such provider.
    (3)(A) Under the agreement required under paragraph (1)(F)(ii), the 
peer review organization must perform functions (other than those 
covered under an agreement under paragraph (1)(F)(i)) under the third 
sentence of section 1320c-3(a)(4)(A) of this title and under section 
1320c-3(a)(14) of this title with respect to services, furnished by the 
hospital, critical access hospital, facility, or agency involved, for 
which payment may be made under this subchapter.
    (B) For purposes of payment under this subchapter, the cost of such 
an agreement to the hospital, critical access hospital, facility, or 
agency shall be considered a cost incurred by such hospital, critical 
access hospital, facility, or agency in providing covered services under 
this subchapter and shall be paid directly by the Secretary to the peer 
review organization on behalf of such hospital, critical access 
hospital, facility, or agency in accordance with a schedule established 
by the Secretary.
    (C) Such payments--
        (i) shall be transferred in appropriate proportions from the 
    Federal Hospital Insurance Trust Fund and from the Federal 
    Supplementary Medical Insurance Trust Fund, without regard to 
    amounts appropriated in advance in appropriation Acts, in the same 
    manner as transfers are made for payment for services provided 
    directly to beneficiaries, and
        (ii) shall not be less in the aggregate for a fiscal year--
            (I) in the case of hospitals, than the amount specified in 
        paragraph (1)(F)(i)(III), and
            (II) in the case of facilities, critical access hospitals, 
        and agencies, than the amounts the Secretary determines to be 
        sufficient to cover the costs of such organizations' conducting 
        the activities described in subparagraph (A) with respect to 
        such facilities, critical access hospitals, or agencies under 
        part B of subchapter XI of this chapter.

(b) Termination or nonrenewal of agreements

    (1) A provider of services may terminate an agreement with the 
Secretary under this section at such time and upon such notice to the 
Secretary and the public as may be provided in regulations, except that 
notice of more than six months shall not be required.
    (2) The Secretary may refuse to enter into an agreement under this 
section or, upon such reasonable notice to the provider and the public 
as may be specified in regulations, may refuse to renew or may terminate 
such an agreement after the Secretary--
        (A) has determined that the provider fails to comply 
    substantially with the provisions of the agreement, with the 
    provisions of this subchapter and regulations thereunder, or with a 
    corrective action required under section 1395ww(f)(2)(B) of this 
    title,
        (B) has determined that the provider fails substantially to meet 
    the applicable provisions of section 1395x of this title,
        (C) has excluded the provider from participation in a program 
    under this subchapter pursuant to section 1320a-7 of this title or 
    section 1320a-7a of this title, or
        (D) has ascertained that the provider has been convicted of a 
    felony under Federal or State law for an offense which the Secretary 
    determines is detrimental to the best interests of the program or 
    program beneficiaries.

    (3) A termination of an agreement or a refusal to renew an agreement 
under this subsection shall become effective on the same date and in the 
same manner as an exclusion from participation under the programs under 
this subchapter becomes effective under section 1320a-7(c) of this 
title.

(c) Refiling after termination or nonrenewal; agreements with skilled 
        nursing facilities

    (1) Where the Secretary has terminated or has refused to renew an 
agreement under this subchapter with a provider of services, such 
provider may not file another agreement under this subchapter unless the 
Secretary finds that the reason for the termination or nonrenewal has 
been removed and that there is reasonable assurance that it will not 
recur.
    (2) Where the Secretary has terminated or has refused to renew an 
agreement under this subchapter with a provider of services, the 
Secretary shall promptly notify each State agency which administers or 
supervises the administration of a State plan approved under subchapter 
XIX of this chapter of such termination or nonrenewal.

(d) Decision to withhold payment for failure to review long-stay cases

    If the Secretary finds that there is a substantial failure to make 
timely review in accordance with section 1395x(k) of this title of long-
stay cases in a hospital, he may, in lieu of terminating his agreement 
with such hospital, decide that, with respect to any individual admitted 
to such hospital after a subsequent date specified by him, no payment 
shall be made under this subchapter for inpatient hospital services 
(including inpatient psychiatric hospital services) after the 20th day 
of a continuous period of such services. Such decision may be made 
effective only after such notice to the hospital and to the public, as 
may be prescribed by regulations, and its effectiveness shall terminate 
when the Secretary finds that the reason therefor has been removed and 
that there is reasonable assurance that it will not recur. The Secretary 
shall not make any such decision except after reasonable notice and 
opportunity for hearing to the institution or agency affected thereby.

(e) ``Provider of services'' defined

    For purposes of this section, the term ``provider of services'' 
shall include--
        (1) a clinic, rehabilitation agency, or public health agency if, 
    in the case of a clinic or rehabilitation agency, such clinic or 
    agency meets the requirements of section 1395x(p)(4)(A) of this 
    title (or meets the requirements of such section through the 
    operation of section 1395x(g) of this title), or if, in the case of 
    a public health agency, such agency meets the requirements of 
    section 1395x(p)(4)(B) of this title (or meets the requirements of 
    such section through the operation of section 1395x(g) of this 
    title), but only with respect to the furnishing of outpatient 
    physical therapy services (as therein defined) or (through the 
    operation of section 1395x(g) of this title) with respect to the 
    furnishing of outpatient occupational therapy services; and
        (2) a community mental health center (as defined in section 
    1395x(ff)(3)(B) of this title), but only with respect to the 
    furnishing of partial hospitalization services (as described in 
    section 1395x(ff)(1) of this title).

(f) Maintenance of written policies and procedures

    (1) For purposes of subsection (a)(1)(Q) of this section and 
sections 1395i-3(c)(2)(E), 1395l(s), 1395w-25(i), 1395mm(c)(8), and 
1395bbb(a)(6) of this title, the requirement of this subsection is that 
a provider of services, Medicare+Choice organization, or prepaid or 
eligible organization (as the case may be) maintain written policies and 
procedures with respect to all adult individuals receiving medical care 
by or through the provider or organization--
        (A) to provide written information to each such individual 
    concerning--
            (i) an individual's rights under State law (whether 
        statutory or as recognized by the courts of the State) to make 
        decisions concerning such medical care, including the right to 
        accept or refuse medical or surgical treatment and the right to 
        formulate advance directives (as defined in paragraph (3)), and
            (ii) the written policies of the provider or organization 
        respecting the implementation of such rights;

        (B) to document in a prominent part of the individual's current 
    medical record whether or not the individual has executed an advance 
    directive;
        (C) not to condition the provision of care or otherwise 
    discriminate against an individual based on whether or not the 
    individual has executed an advance directive;
        (D) to ensure compliance with requirements of State law (whether 
    statutory or as recognized by the courts of the State) respecting 
    advance directives at facilities of the provider or organization; 
    and
        (E) to provide (individually or with others) for education for 
    staff and the community on issues concerning advance directives.

Subparagraph (C) shall not be construed as requiring the provision of 
care which conflicts with an advance directive.
    (2) The written information described in paragraph (1)(A) shall be 
provided to an adult individual--
        (A) in the case of a hospital, at the time of the individual's 
    admission as an inpatient,
        (B) in the case of a skilled nursing facility, at the time of 
    the individual's admission as a resident,
        (C) in the case of a home health agency, in advance of the 
    individual coming under the care of the agency,
        (D) in the case of a hospice program, at the time of initial 
    receipt of hospice care by the individual from the program, and
        (E) in the case of an eligible organization (as defined in 
    section 1395mm(b) of this title) or an organization provided 
    payments under section 1395l(a)(1)(A) of this title or a Medicare+
    Choice organization, at the time of enrollment of the individual 
    with the organization.

    (3) In this subsection, the term ``advance directive'' means a 
written instruction, such as a living will or durable power of attorney 
for health care, recognized under State law (whether statutory or as 
recognized by the courts of the State) and relating to the provision of 
such care when the individual is incapacitated.
    (4) For construction relating to this subsection, see section 14406 
of this title (relating to clarification respecting assisted suicide, 
euthanasia, and mercy killing).

(g) Penalties for improper billing

    Except as permitted under subsection (a)(2) of this section, any 
person who knowingly and willfully presents, or causes to be presented, 
a bill or request for payment inconsistent with an arrangement under 
subsection (a)(1)(H) of this section or in violation of the requirement 
for such an arrangement, is subject to a civil money penalty of not to 
exceed $2,000. The provisions of section 1320a-7a of this title (other 
than subsections (a) and (b)) shall apply to a civil money penalty under 
the previous sentence in the same manner as such provisions apply to a 
penalty or proceeding under section 1320a-7a(a) of this title.

(h) Dissatisfaction with determination of Secretary; appeal by 
        institutions or agencies; single notice and hearing

    (1) Except as provided in paragraph (2), an institution or agency 
dissatisfied with a determination by the Secretary that it is not a 
provider of services or with a determination described in subsection 
(b)(2) of this section shall be entitled to a hearing thereon by the 
Secretary (after reasonable notice) to the same extent as is provided in 
section 405(b) of this title, and to judicial review of the Secretary's 
final decision after such hearing as is provided in section 405(g) of 
this title, except that, in so applying such sections and in applying 
section 405(l) of this title thereto, any reference therein to the 
Commissioner of Social Security or the Social Security Administration 
shall be considered a reference to the Secretary or the Department of 
Health and Human Services, respectively.
    (2) An institution or agency is not entitled to separate notice and 
opportunity for a hearing under both section 1320a-7 of this title and 
this section with respect to a determination or determinations based on 
the same underlying facts and issues.

(i) Intermediate sanctions for psychiatric hospitals

    (1) If the Secretary determines that a psychiatric hospital which 
has an agreement in effect under this section no longer meets the 
requirements for a psychiatric hospital under this subchapter and 
further finds that the hospital's deficiencies--
        (A) immediately jeopardize the health and safety of its 
    patients, the Secretary shall terminate such agreement; or
        (B) do not immediately jeopardize the health and safety of its 
    patients, the Secretary may terminate such agreement, or provide 
    that no payment will be made under this subchapter with respect to 
    any individual admitted to such hospital after the effective date of 
    the finding, or both.

    (2) If a psychiatric hospital, found to have deficiencies described 
in paragraph (1)(B), has not complied with the requirements of this 
subchapter--
        (A) within 3 months after the date the hospital is found to be 
    out of compliance with such requirements, the Secretary shall 
    provide that no payment will be made under this subchapter with 
    respect to any individual admitted to such hospital after the end of 
    such 3-month period, or
        (B) within 6 months after the date the hospital is found to be 
    out of compliance with such requirements, no payment may be made 
    under this subchapter with respect to any individual in the hospital 
    until the Secretary finds that the hospital is in compliance with 
    the requirements of this subchapter.

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1866, as added Pub. L. 89-97, 
title I, Sec. 102(a), July 30, 1965, 79 Stat. 327; amended Pub. L. 90-
248, title I, Secs. 129(c)(12), 133(c), 135(b), Jan. 2, 1968, 81 Stat. 
849, 851, 852; Pub. L. 92-603, title II, Secs. 223(e), (g), 227(d)(2), 
229(b), 249A(b)-(d), 278(a)(17), (b)(18), 281(c), Oct. 30, 1972, 86 
Stat. 1394, 1406, 1409, 1427, 1453-1455; Pub. L. 95-142, Secs. 3(b), 
8(b), 13(b)(3), 15(a), Oct. 25, 1977, 91 Stat. 1178, 1194, 1195, 1198, 
1200; Pub. L. 95-210, Sec. 2(e), Dec. 13, 1977, 91 Stat. 1489; Pub. L. 
95-292, Sec. 4(e), June 13, 1978, 92 Stat. 315; Pub. L. 96-272, title 
III, Sec. 308(b), June 17, 1980, 94 Stat. 531; Pub. L. 96-499, title IX, 
Sec. 916(a), Dec. 5, 1980, 94 Stat. 2623; Pub. L. 96-611, Sec. 1(b)(4), 
Dec. 28, 1980, 94 Stat. 3566; Pub. L. 97-35, title XXI, Sec. 2153, Aug. 
13, 1981, 95 Stat. 802; Pub. L. 97-248, title I, Secs. 122(g)(5), (6), 
128(a)(5), (d)(4), 144, Sept. 3, 1982, 96 Stat. 362, 366, 367, 393; Pub. 
L. 97-448, title III, Sec. 309(a)(5), (b)(11), Jan. 12, 1983, 96 Stat. 
2408, 2409; Pub. L. 98-21, title VI, Sec. 602(f), (l), Apr. 20, 1983, 97 
Stat. 163, 166; Pub. L. 98-369, div. B, title III, Secs. 2303(f), 
2315(d), 2321(c), 2323(b)(3), 2335(d), 2347(a), 2348(a), 2354(b)(33), 
(34), July 18, 1984, 98 Stat. 1066, 1080, 1084, 1086, 1090, 1096, 1097, 
1102; Pub. L. 99-272, title IX, Secs. 9121(a), 9122(a), 9401(b)(2)(F), 
9402(a), 9403(b), Apr. 7, 1986, 100 Stat. 164, 167, 199, 200; Pub. L. 
99-509, title IX, Secs. 9305(b)(1), 9320(h)(2), 9332(e)(1), 9337(c)(2), 
9343(c)(2), (3), 9353(e)(1), Oct. 21, 1986, 100 Stat. 1989, 2016, 2025, 
2034, 2040, 2047; Pub. L. 99-514, title XVIII, Sec. 1895(b)(5), Oct. 22, 
1986, 100 Stat. 2933; Pub. L. 99-576, title II, Sec. 233(a), Oct. 28, 
1986, 100 Stat. 3265; Pub. L. 100-93, Sec. 8(d), Aug. 18, 1987, 101 
Stat. 693; Pub. L. 100-203, title IV, Secs. 4012(a), 4062(d)(4), 
4085(i)(17), (28), 4097(a), (b), 4212(e)(4), Dec. 22, 1987, 101 Stat. 
1330-60, 1330-109, 1330-133, 1330-140, 1330-213, as amended Pub. L. 100-
360, title IV, Sec. 411(i)(4)(C)(vi), (j)(5), July 1, 1988, 102 Stat. 
790, 791; Pub. L. 100-360, title I, Sec. 104(d)(5), title II, 
Secs. 201(b), (d), 202(h)(1), title IV, Sec. 411(c)(2)(A)(i), (C), 
(g)(1)(D), July 1, 1988, 102 Stat. 689, 702, 718, 772, 782, as amended 
Pub. L. 100-485, title VI, Sec. 608(d)(3)(F), (19)(A), Oct. 13, 1988, 
102 Stat. 2414, 2419; Pub. L. 100-485, title VI, Sec. 608(f)(1), Oct. 
13, 1988, 102 Stat. 2424; Pub. L. 101-234, title I, Sec. 101(a), title 
II, Sec. 201(a), title III, Sec. 301(b)(4), (d)(1), Dec. 13, 1989, 103 
Stat. 1979, 1981, 1985, 1986; Pub. L. 101-239, title VI, 
Secs. 6003(g)(3)(D)(xii), (xiii), 6017, 6018(a), 6020, 6112(e)(3), Dec. 
19, 1989, 103 Stat. 2154, 2165, 2166, 2216; Pub. L. 101-508, title IV, 
Secs. 4008(b)(3)(B), (m)(3)(G)[(F)], 4153(d)(1), 4157(c)(2), 4162(b)(2), 
4206(a), Nov. 5, 1990, 104 Stat. 1388-44, 1388-54, 1388-84, 1388-89, 
1388-96, 1388-115; Pub. L. 102-54, Sec. 13(q)(3)(F), June 13, 1991, 105 
Stat. 280; Pub. L. 102-83, Sec. 5(c)(2), Aug. 6, 1991, 105 Stat. 406; 
Pub. L. 103-296, title I, Sec. 108(c)(5), Aug. 15, 1994, 108 Stat. 1485; 
Pub. L. 103-432, title I, Secs. 106(b)(1)(B), 147(e)(7), 156(a)(2)(E), 
160(d)(2), Oct. 31, 1994, 108 Stat. 4406, 4430, 4441, 4443; Pub. L. 104-
191, title II, Sec. 262(b)(1), Aug. 21, 1996, 110 Stat. 2031; Pub. L. 
105-12, Sec. 9(a)(2), Apr. 30, 1997, 111 Stat. 26; Pub. L. 105-33, title 
IV, Secs. 4002(d), (e), 4201(c)(1), 4302(a), 4321(b), 4432(b)(5)(F), 
4511(a)(2)(D), 4523(b), 4541(a)(3), 4641(a), 4714(b)(1), Aug. 5, 1997, 
111 Stat. 329, 373, 382, 395, 422, 442, 449, 456, 487, 510; Pub. L. 106-
113, div. B, Sec. 1000(a)(6) [title III, Sec. 321(k)(11), (12)], Nov. 
29, 1999, 113 Stat. 1536, 1501A-368.)

                       References in Text

    Parts A and B of this subchapter, referred to in subsec. (a), are 
classified to sections 1395c et seq. and 1395j et seq., respectively, of 
this title.
    Part B of subchapter XI of this chapter, referred to in subsec. 
(a)(1), (3)(C)(ii)(II), is classified to section 1320c et seq. of this 
title.
    Part C of this subchapter, referred to in subsec. (a)(1)(O), is 
classified to section 1395w-21 et seq. of this title.
    Section 222(a) of the Social Security Amendments of 1972, referred 
to in subsec. (a)(1)(O)(i), is section 222(a) of Pub. L. 92-603, which 
is set out as a note under section 1395b-1 of this title.
    Part C of subchapter XI of this chapter, referred to in subsec. 
(a)(1)(R), is classified to section 1320d et seq. of this title.
    Section 1395l(t)(5) of this title, referred to in subsec. (a)(2)(A), 
was redesignated section 1395l(t)(8) of this title by Pub. L. 106-113, 
div. B, Sec. 1000(a)(6) [title II, Secs. 201(a)(1), 202(a)(2)], Nov. 29, 
1999, 113 Stat. 1536, 1501A-336, 1501A-342.


                               Amendments

    1999--Subsec. (a)(1)(I)(iii). Pub. L. 106-113, Sec. 1000(a)(6) 
[title III, Sec. 321(k)(11)(A)], substituted comma for semicolon at end.
    Subsec. (a)(1)(N)(iv). Pub. L. 106-113, Sec. 1000(a)(6) [title III, 
Sec. 321(k)(11)(B)], struck out ``and'' at end.
    Subsec. (a)(1)(O). Pub. L. 106-113, Sec. 1000(a)(6) [title III, 
Sec. 321(k)(11)(C)], substituted comma for semicolon at end.
    Subsec. (a)(1)(Q). Pub. L. 106-113, Sec. 1000(a)(6) [title III, 
Sec. 321(k)(12)(A)], substituted comma for semicolon at end.
    Subsec. (a)(1)(R). Pub. L. 106-113, Sec. 1000(a)(6) [title III, 
Sec. 321(k)(12)(B)], inserted ``, and'' at end.
    1997--Subsec. (a)(1)(A). Pub. L. 105-33, Sec. 4714(b)(1), designated 
existing provisions as cl. (i) and inserted before comma at end ``, and 
(ii) not to impose any charge that is prohibited under section 
1396a(n)(3) of this title''.
    Subsec. (a)(1)(F)(ii). Pub. L. 105-33, Sec. 4201(c)(1), substituted 
``critical access'' for ``rural primary care''.
    Subsec. (a)(1)(H). Pub. L. 105-33, Sec. 4511(a)(2)(D), substituted 
``section 1395x(s)(2)(K) of this title'' for ``section 1395x(s)(2)(K)(i) 
or 1395x(s)(2)(K)(iii) of this title''.
    Pub. L. 105-33, Sec. 4432(b)(5)(F), designated existing provisions 
as cl. (i), redesignated former cls. (i) and (ii) as subcls. (I) and 
(II), respectively, and added cl. (ii).
    Pub. L. 105-33, Sec. 4201(c)(1), substituted ``critical access'' for 
``rural primary care'' in two places.
    Subsec. (a)(1)(I), (N). Pub. L. 105-33, Sec. 4201(c)(1), substituted 
``critical access'' for ``rural primary care'' in introductory 
provisions of subpars. (I) and (N) and in subpar. (N)(i).
    Subsec. (a)(1)(O). Pub. L. 105-33, Sec. 4002(e), struck out ``in the 
case of hospitals and skilled nursing facilities,'' before ``to accept 
as payment in full for'', ``inpatient hospital and extended care'' after 
``to accept as payment in full for'', and ``(in the case of hospitals) 
or limits (in the case of skilled nursing facilities)'' after ``the 
organization the amounts''; inserted ``with a Medicare+Choice 
organization under part C of this subchapter or'' after ``any individual 
enrolled'' and ``(less any payments under sections 1395ww(d)(11) and 
1395ww(h)(3)(D) of this title)'' after ``under this subchapter''.
    Subsec. (a)(1)(S). Pub. L. 105-33, Sec. 4321(b), added subpar. (S).
    Subsec. (a)(2)(A). Pub. L. 105-33, Sec. 4541(a)(3), which directed 
the amendment of subsec. (a)(2)(A)(ii) by inserting the following at the 
end ``In the case of services described in section 1395l(a)(8) of this 
title or section 1395l(a)(9) of this title for which payment is made 
under part B of this subchapter under section 1395m(k) of this title, 
clause (ii) of the first sentence shall be applied by substituting for 
20 percent of the reasonable charge for such services 20 percent of the 
lesser of the actual charge or the applicable fee schedule amount (as 
defined in such section) for such services.'', was executed by inserting 
the material at the end of subpar. (A) to reflect the probable intent of 
Congress.
    Pub. L. 105-33, Sec. 4523(b), which directed the amendment of 
subsec. (a)(2)(A)(ii) by inserting the following at the end ``In the 
case of items and services for which payment is made under part B of 
this subchapter under the prospective payment system established under 
section 1395l(t) of this title, clause (ii) of the first sentence shall 
be applied by substituting for 20 percent of the reasonable charge, the 
applicable copayment amount established under section 1395l(t)(5) of 
this title.'', was executed by inserting the material at the end of 
subpar. (A) to reflect the probable intent of Congress.
    Subsec. (a)(3). Pub. L. 105-33, Sec. 4201(c)(1), substituted 
``critical access'' for ``rural primary care'' wherever appearing.
    Subsec. (b)(2)(D). Pub. L. 105-33, Sec. 4302(a), added subpar. (D).
    Subsec. (f)(1). Pub. L. 105-33, Sec. 4002(d)(1), inserted ``1395w-
25(i),'' after ``1395l(s),'' and ``, Medicare+Choice organization,'' 
after ``provider of services'' in introductory provisions.
    Subsec. (f)(1)(B). Pub. L. 105-33, Sec. 4641(a), substituted ``in a 
prominent part of the individual's current medical record'' for ``in the 
individual's medical record''.
    Subsec. (f)(2)(E). Pub. L. 105-33, Sec. 4002(d)(2), inserted ``or a 
Medicare+Choice organization'' after ``section 1395l(a)(1)(A) of this 
title''.
    Subsec. (f)(4). Pub. L. 105-12 added par. (4).
    1996--Subsec. (a)(1)(R). Pub. L. 104-191 added subpar. (R).
    1994--Subsec. (a)(1)(H). Pub. L. 103-432, Sec. 147(e)(7), 
substituted ``section 1395x(s)(2)(K)(i) or 1395x(s)(2)(K)(iii) of this 
title'' for ``section 1395x(s)(2)(K)(i) of this title''.
    Subsec. (a)(2)(A). Pub. L. 103-432, Sec. 156(a)(2)(E), struck out 
``, with respect to items and services furnished in connection with 
obtaining a second opinion required under section 1320c-13(c)(2) of this 
title (or a third opinion, if the second opinion was in disagreement 
with the first opinion),'' after ``section 1395x(s)(10)(A) of this 
title''.
    Subsec. (d). Pub. L. 103-432, Sec. 106(b)(1)(B), substituted ``long-
stay cases in a hospital'' for ``long-stay cases in a hospital or 
skilled nursing facility'', ``such hospital'' for ``such hospital or 
facility'' in two places, ``period of such services'' for ``period of 
such services or for post-hospital extended care services after such day 
of a continuous period of such care as is prescribed in or pursuant to 
regulations, as the case may be'', and ``notice to the hospital'' for 
``notice to the hospital, or (in the case of a skilled nursing facility) 
to the facility and the hospital or hospitals with which it has a 
transfer agreement,''.
    Subsec. (f)(1). Pub. L. 103-432, Sec. 160(d)(2), substituted 
``1395l(s)'' for ``1395l(r)'' in introductory provisions.
    Subsec. (h)(1). Pub. L. 103-296 inserted before period at end ``, 
except that, in so applying such sections and in applying section 405(l) 
of this title thereto, any reference therein to the Commissioner of 
Social Security or the Social Security Administration shall be 
considered a reference to the Secretary or the Department of Health and 
Human Services, respectively''.
    1991--Subsec. (a)(1)(J). Pub. L. 102-83 substituted ``section 1713 
of title 38'' for ``section 613 of title 38''.
    Subsec. (a)(1)(L). Pub. L. 102-83 substituted ``section 1703 of 
title 38'' for ``section 603 of title 38''.
    Pub. L. 102-54 substituted ``Secretary of Veterans Affairs'' for 
``Administrator of Veterans' Affairs''.
    1990--Subsec. (a)(1)(F)(i). Pub. L. 101-508, 
Sec. 4008(m)(3)(G)[(F)](i), substituted ``),'' for comma at end.
    Subsec. (a)(1)(F)(ii). Pub. L. 101-508, Sec. 4008(m)(3)(G)[(F)](ii), 
substituted ``paragraph (3)(A),'' for ``paragraph (4)(A);''.
    Subsec. (a)(1)(H). Pub. L. 101-508, Sec. 4157(c)(2), inserted 
``services described by section 1395x(s)(2)(K)(i) of this title, 
certified nurse-midwife services, qualified psychologist services, and'' 
after ``and other than''.
    Subsec. (a)(1)(I)(i). Pub. L. 101-508, Sec. 4008(b)(3)(B), inserted 
``and to meet the requirements of such section'' after ``section 1395dd 
of this title''.
    Subsec. (a)(1)(P). Pub. L. 101-508, Sec. 4153(d)(1), substituted 
``catheters, catheter supplies, ostomy bags, and supplies related to 
ostomy care'' for ``ostomy supplies''.
    Subsec. (a)(1)(Q). Pub. L. 101-508, Sec. 4206(a)(1), added subpar. 
(Q).
    Subsec. (e). Pub. L. 101-508, Sec. 4162(b)(2), substituted 
``include--'' and pars. (1) and (2) for ``include a clinic, 
rehabilitation agency, or public health agency if, in the case of a 
clinic or rehabilitation agency, such clinic or agency meets the 
requirements of section 1395x(p)(4)(A) of this title (or meets the 
requirements of such section through the operation of section 1395x(g) 
of this title), or if, in the case of a public health agency, such 
agency meets the requirements of section 1395x(p)(4)(B) of this title 
(or meets the requirements of such section through the operation of 
section 1395x(g) of this title), but only with respect to the furnishing 
of outpatient physical therapy services (as therein defined) or (through 
the operation of section 1395x(g) of this title) with respect to the 
furnishing of outpatient occupational therapy services.''
    Subsec. (f). Pub. L. 101-508, Sec. 4206(a)(2), added subsec. (f).
    1989--Subsec. (a)(1)(F)(i)(III). Pub. L. 101-234, Sec. 301(b)(4), 
(d)(1), amended subcl. (III) identically substituting ``fiscal year)'' 
for ``fiscal year))'' before ``of such reviews,'' at end.
    Subsec. (a)(1)(F)(ii). Pub. L. 101-239, Sec. 6003(g)(3)(D)(xii)(I), 
inserted ``rural primary care hospitals,'' after ``hospitals,''.
    Subsec. (a)(1)(H). Pub. L. 101-239, Sec. 6003(g)(3)(D)(xii)(II), 
inserted ``and in the case of rural primary care hospitals which provide 
rural primary care hospital services'' after ``payment may be made under 
this subchapter''.
    Subsec. (a)(1)(I). Pub. L. 101-239, Sec. 6018(a)(1), amended subpar. 
(I) generally. Prior to amendment, subpar. (I) read as follows: ``in the 
case of a hospital and in the case of a rural primary care hospital, to 
comply with the requirements of section 1395dd of this title to the 
extent applicable,''.
    Pub. L. 101-239, Sec. 6003(g)(3)(D)(xii)(III), inserted ``and in the 
case of a rural primary care hospital'' after ``hospital''.
    Subsec. (a)(1)(N). Pub. L. 101-239, Sec. 6003(g)(3)(D)(xii)(IV), 
substituted ``hospitals and rural primary care hospitals'' for 
``hospitals'' in introductory provisions and ``hospital or rural primary 
care hospital,'' for ``hospital,'' in cl. (i).
    Subsec. (a)(1)(N)(iii), (iv). Pub. L. 101-239, Sec. 6018(a)(2), 
added cls. (iii) and (iv).
    Subsec. (a)(1)(P). Pub. L. 101-239, Sec. 6112(e)(3), added subpar. 
(P).
    Subsec. (a)(2)(A). Pub. L. 101-234, Sec. 201(a), repealed Pub. L. 
100-360, Secs. 201(b), (d), 202(h)(1), and provided that the provisions 
of law amended or repealed by such sections are restored or revived as 
if such sections had not been enacted, see 1988 Amendment notes below.
    Subsec. (a)(2)(B). Pub. L. 101-239, Sec. 6017, redesignated cl. (i) 
as subpar. (B) and struck out cl. (ii) which authorized charges for 
items or services more expensive than determined to be necessary and 
which have not been requested by the individual to the extent that such 
costs in the second fiscal period preceding the fiscal period in which 
such charges are imposed exceed necessary costs, under certain 
circumstances.
    Subsec. (a)(3)(A), (B). Pub. L. 101-239, 
Sec. 6003(g)(3)(D)(xiii)(I), substituted ``hospital, rural primary care 
hospital,'' for ``hospital,'' wherever appearing.
    Subsec. (a)(3)(C)(ii)(II). Pub. L. 101-239, 
Sec. 6003(g)(3)(D)(xiii)(II), substituted ``facilities, rural primary 
care hospitals,'' for ``facilities'' in two places.
    Subsec. (d). Pub. L. 101-234, Sec. 101(a), repealed Pub. L. 100-360, 
Sec. 104(d)(5), and provided that the provisions of law amended or 
repealed by such section are restored or revived as if such section had 
not been enacted, see 1988 Amendment note below.
    Subsec. (i). Pub. L. 101-239, Sec. 6020, added subsec. (i).
    1988--Subsec. (a)(1)(M). Pub. L. 100-360, Sec. 411(c)(2)(C)(i), as 
added by Pub. L. 100-485, Sec. 608(d)(19)(A), struck out ``and'' at end.
    Subsec. (a)(1)(N). Pub. L. 100-360, Sec. 411(c)(2)(C)(ii), as added 
by Pub. L. 100-485, Sec. 608(d)(19)(A), substituted ``, and'' for period 
at end.
    Subsec. (a)(1)(O). Pub. L. 100-360, Sec. 411(c)(2)(A)(i), 
substituted cls. (i) and (ii) for ``with a risk-sharing contract under 
section 1395mm of this title''.
    Subsec. (a)(2)(A). Pub. L. 100-360, Sec. 201(d), substituted 
``section 1395l(d)(1) of this title'' for ``section 1395l(c) of this 
title'' in second sentence.
    Pub. L. 100-360, Sec. 411(g)(1)(D), substituted ``section 
1395m(a)(1)(B) of this title'' for ``section 1395m(a)(2) of this title'' 
in last sentence.
    Pub. L. 100-360, Sec. 202(h)(1), inserted ``1395m(c),'' after 
``1395l(b),'' and ``and in the case of covered outpatient drugs, 
applicable coinsurance percent (specified in section 1395m(c)(2)(C) of 
this title) of the lesser of the actual charges for the drugs or the 
payment limit (established under section 1395m(c)(3) of this title)'' 
after ``established by the Secretary''.
    Pub. L. 100-360, Sec. 201(b), inserted at end ``A provider of 
services may not impose a charge under the first sentence of this 
subparagraph for services for which payment is made to the provider 
pursuant to section 1395l(c) of this title (relating to catastrophic 
benefits).''
    Subsec. (a)(3)(C)(ii). Pub. L. 100-360, Sec. 411(j)(5), made 
technical correction to directory language of Pub. L. 100-203, 
Sec. 4097(b), see 1987 Amendment note below.
    Subsec. (d). Pub. L. 100-360, Sec. 104(d)(5), as amended by Pub. L. 
100-485, Sec. 608(d)(3)(F), struck out ``post-hospital'' before 
``extended care services''.
    Subsec. (f). Pub. L. 100-485, Sec. 608(f)(1), struck out subsec. (f) 
which provided for termination or decertification and alternatives 
thereto.
    Subsec. (g). Pub. L. 100-360, Sec. 411(i)(4)(C)(vi), added Pub. L. 
100-203, Sec. 4085(i)(28), see 1987 Amendment note below.
    1987--Subsec. (a)(1)(F)(i)(III). Pub. L. 100-203, Sec. 4097(a), 
substituted ``1988'' for ``1986'' and inserted ``and for any direct or 
administrative costs incurred as a result of review functions added with 
respect to a subsequent fiscal year'' after ``inflation''.
    Subsec. (a)(1)(O). Pub. L. 100-203, Sec. 4012(a), added subpar. (O).
    Subsec. (a)(2)(A). Pub. L. 100-203, Sec. 4062(d)(4), inserted at end 
``Notwithstanding the first sentence of this subparagraph, a home health 
agency may charge such an individual or person, with respect to covered 
items subject to payment under section 1395m(a) of this title, the 
amount of any deduction imposed under section 1395l(b) of this title and 
20 percent of the payment basis described in section 1395m(a)(2) of this 
title.''
    Subsec. (a)(3). Pub. L. 100-93, Sec. 8(d)(1), redesignated par. (4) 
as (3) and struck out former par. (3) which read as follows: ``The 
Secretary may refuse to enter into or renew an agreement under this 
section with a provider of services if any person who has a direct or 
indirect ownership or control interest of 5 percent or more in such 
provider, or who is an officer, director, agent, or managing employee 
(as defined in section 1320a-5(b) of this title) of such provider, is a 
person described in section 1320a-5(a) of this title.''
    Subsec. (a)(3)(C)(ii). Pub. L. 100-203, Sec. 4097(b), as amended by 
Pub. L. 100-360, Sec. 411(j)(5), amended cl. (ii) generally. Prior to 
amendment, cl. (ii) read as follows: ``shall not be less in the 
aggregate for hospitals, facilities, and agencies for a fiscal year than 
the amounts the Secretary determines to be sufficient to cover the costs 
of such organizations' conducting the activities described in 
subparagraph (A) with respect to such hospitals, facilities, or agencies 
under part B of subchapter XI of this chapter.''
    Subsec. (a)(4). Pub. L. 100-93, Sec. 8(d)(1)(B), redesignated par. 
(4) as (3).
    Subsec. (b). Pub. L. 100-93, Sec. 8(d)(2), amended subsec. (b) 
generally, substituting pars. (1) to (3) for former pars. (1) to (5).
    Subsec. (c)(1). Pub. L. 100-93, Sec. 8(d)(3), (4), substituted ``the 
Secretary has terminated or has refused to renew an agreement under this 
subchapter with a provider of services'' for ``an agreement filed under 
this subchapter by a provider of services has been terminated by the 
Secretary'' and inserted ``or nonrenewal'' after ``termination''.
    Subsec. (c)(2). Pub. L. 100-203, Sec. 4212(e)(4), redesignated par. 
(3) as (2) and struck out former par. (2) which read as follows: ``In 
the case of a skilled nursing facility participating in the programs 
established by this subchapter and subchapter XIX of this chapter, the 
Secretary may enter into an agreement under this section only if such 
facility has been approved pursuant to section 1396i(a) of this title, 
and the term of any such agreement shall be in accordance with the 
period of approval of eligibility specified by the Secretary pursuant to 
such section.''
    Subsec. (c)(3). Pub. L. 100-203, Sec. 4212(e)(4), redesignated par. 
(3) as (2).
    Pub. L. 100-93, Sec. 8(d)(3), (4), substituted ``the Secretary has 
terminated or has refused to renew an agreement under this subchapter 
with a provider of services'' for ``an agreement filed under this 
subchapter by a provider of services has been terminated by the 
Secretary'' and inserted ``or nonrenewal'' after ``termination''.
    Subsec. (g). Pub. L. 100-203, Sec. 4085(i)(28), as added by Pub. L. 
100-360, Sec. 411(i)(4)(C)(vi), substituted ``money penalty'' for 
``monetary penalty'' in first sentence and amended second sentence 
generally. Prior to amendment, second sentence read as follows: ``Such a 
penalty shall be imposed in the same manner as civil monetary penalties 
are imposed under section 1320a-7a of this title with respect to actions 
described in subsection (a) of that section.''
    Pub. L. 100-203, Sec. 4085(i)(17), substituted ``inconsistent with 
an arrangement under subsection (a)(1)(H) of this section or in 
violation of the requirement for such an arrangement'' for ``for a 
hospital outpatient service for which payment may be made under part B 
of this subchapter and such bill or request violates an arrangement 
under subsection (a)(1)(H) of this section''.
    Subsec. (h). Pub. L. 100-93, Sec. 8(d)(5), added subsec. (h).
    1986--Subsec. (a)(1)(F). Pub. L. 99-509, Sec. 9353(e)(1)(A), 
designated existing provisions as cl. (i) and in cl. (i), as so 
designated, redesignated former cls. (i) to (iii) as subcls. (I) to 
(III), and added cl. (ii).
    Pub. L. 99-272, Sec. 9402(a), redesignated cl. (iv) as (iii) and in 
cl. (iii), as so redesignated, substituted ``1986'' for ``1982'', and 
struck out former cl. (iii) which provided that the cost of such 
agreement to the hospital shall not be less than amount which reflects 
the rates per review established in fiscal year 1982 for both direct and 
administrative costs (adjusted for inflation).
    Subsec. (a)(1)(H). Pub. L. 99-509, Sec. 9343(c)(2), struck out 
``inpatient hospital'' after ``hospitals which provide'' and substituted 
``a patient'' for ``an inpatient''.
    Pub. L. 99-509, Sec. 9320(h)(2), inserted ``, and other than 
services of a certified registered nurse anesthetist'' after ``section 
1395y(a)(14) of this title''.
    Subsec. (a)(1)(I). Pub. L. 99-514 redesignated subpar. (I) relating 
to agreement not to charge for certain items and services as subpar. 
(K).
    Pub. L. 99-272, Sec. 9403(b), added subpar. (I) relating to 
agreement not to charge for certain items or services.
    Pub. L. 99-272, Sec. 9121(a), added subpar. (I) relating to 
compliance with the requirements of section 1395dd of this title.
    Subsec. (a)(1)(J). Pub. L. 99-272, Sec. 9122(a), added subpar. (J).
    Subsec. (a)(1)(K). Pub. L. 99-514 redesignated subpar. (I) relating 
to agreement not to charge for certain items and services as subpar. 
(K).
    Subsec. (a)(1)(L). Pub. L. 99-576 added subpar. (L).
    Subsec. (a)(1)(M). Pub. L. 99-509, Sec. 9305(b)(1), added subpar. 
(M).
    Subsec. (a)(1)(N). Pub. L. 99-509, Sec. 9332(e)(1), added subpar. 
(N).
    Subsec. (a)(2)(A). Pub. L. 99-272, Sec. 9401(b)(2)(F), inserted ``, 
with respect to items and services furnished in connection with 
obtaining a second opinion required under section 1320c-13(c)(2) of this 
title (or a third opinion, if the second opinion was in disagreement 
with the first opinion),'' after ``1395x(s)(10)(A) of this title'' in 
last sentence.
    Subsec. (a)(4). Pub. L. 99-509, Sec. 9353(e)(1)(B), added par. (4).
    Subsec. (e). Pub. L. 99-509, Sec. 9337(c)(2), inserted in second 
sentence ``(or meets the requirements of such section through the 
operation of section 1395x(g) of this title)'' in two places, and 
inserted ``or (through the operation of section 1395x(g) of this title) 
with respect to the furnishing of outpatient occupational therapy 
services'' after ``(as therein defined)''.
    Subsec. (g). Pub. L. 99-509, Sec. 9343(c)(3), added subsec. (g).
    1984--Subsec. (a)(1)(E). Pub. L. 98-369, Sec. 2354(b)(33), inserted 
a comma at end.
    Subsec. (a)(1)(F). Pub. L. 98-369, Sec. 2315(d), substituted ``(b), 
(c), or (d)'' for ``(c) or (d)''.
    Pub. L. 98-369, Sec. 2347(a)(1), substituted ``maintain an agreement 
with a professional standards review organization (if there is such an 
organization in existence in the area in which the hospital is located) 
or with a utilization and quality control peer review organization which 
has a contract with the Secretary under part B of subchapter XI of this 
chapter for the area in which the hospital is located, under which the 
organization'' for ``maintain an agreement with a utilization and 
quality control peer review organization (if there is such an 
organization which has a contract with the Secretary under part B of 
subchapter XI of this chapter for the area in which the hospital is 
located) under which the organization''.
    Pub. L. 98-369, Sec. 2347(a)(2), repealed amendment made by Pub. L. 
98-21, Sec. 602(l)(1). See 1983 Amendment note below.
    Subsec. (a)(2)(A). Pub. L. 98-369, Sec. 2303(f), inserted ``and with 
respect to clinical diagnostic laboratory tests'' after ``section 
1395x(s)(10) of this title''.
    Pub. L. 98-369, Sec. 2321(c), inserted ``or which are durable 
medical equipment furnished as home health services'' after ``part B of 
this subchapter''.
    Pub. L. 98-369, Sec. 2323(b)(3), substituted ``section 
1395x(s)(10)(A) of this title'' for ``section 1395x(s)(10) of this 
title''.
    Subsec. (b)(3). Pub. L. 98-369, Sec. 2335(d)(1), substituted 
``(including inpatient psychiatric hospital services)'' for ``(including 
tuberculosis hospital services and inpatient psychiatric hospital 
services)''.
    Pub. L. 98-369, Sec. 2354(b)(34), realigned margin of par. (3).
    Subsec. (b)(4). Pub. L. 98-369, Sec. 2348(a), substituted ``more 
than 30 days after such effective date'' for ``after the calendar year 
in which such termination is effective''.
    Subsec. (d). Pub. L. 98-369, Sec. 2335(d)(2), substituted 
``(including inpatient psychiatric hospital services)'' for ``(including 
inpatient tuberculosis hospital services and inpatient psychiatric 
hospital services)''.
    1983--Subsec. (a)(1). Pub. L. 98-21, Sec. 602(l)(2), inserted 
provision at end of par. (1) that in the case of a hospital which has an 
agreement in effect with an organization described in subparagraph (F), 
which organization's contract with the Secretary under part B of 
subchapter XI terminates on or after October 1, 1984, the hospital shall 
not be determined to be out of compliance with the requirement of such 
subparagraph during the six month period beginning on the date of the 
termination of that contract.
    Subsec. (a)(1)(F). Pub. L. 98-21, Sec. 602(l)(1), which provided 
that, effective Oct. 1, 1984, subpar. (F) is amended by substituting 
``(with an organization'' for ``(if there is such an organization'', was 
repealed by Pub. L. 98-369, Sec. 2347(a)(2), effective July 18, 1984.
    Subsec. (a)(1)(F) to (H). Pub. L. 98-21, Sec. 602(f)(1), added 
subpars. (F) to (H).
    Subsec. (a)(2)(A). Pub. L. 97-448, Sec. 309(b)(11), inserted a comma 
after ``1395e(a)(1)''.
    Pub. L. 97-448, Sec. 309(a)(5), amended directory language of Pub. 
L. 97-248, Sec. 122(g)(5), to correct an error, and did not involve any 
change in text. See 1982 Amendment note below.
    Subsec. (a)(2)(B)(ii). Pub. L. 98-21, Sec. 602(f)(2), inserted ``and 
except with respect to inpatient hospital costs with respect to which 
amounts are payable under section 1395ww(d) of this title'' after 
``(except with respect to emergency services)'' in provision preceding 
subcl. (I).
    1982--Subsec. (a)(1)(B). Pub. L. 97-248, Sec. 128(d)(4), inserted 
``of section 1395y(a) of this title''.
    Subsec. (a)(1)(E). Pub. L. 97-248, Sec. 144, added subpar. (E).
    Subsec. (a)(2)(A). Pub. L. 97-248, Sec. 122(g)(5), as amended by 
Pub. L. 97-448, Sec. 309(a)(5), substituted ``(a)(3), or (a)(4)'' for 
``or (a)(3)''.
    Subsec. (b). Pub. L. 97-248, Sec. 128(a)(5), in provisions preceding 
par. (1), struck out ``(and in the case of a skilled nursing facility, 
prior to the end of the term specified in subsection (a)(1) of this 
section)'' after ``may be terminated''.
    Subsec. (b)(4)(A). Pub. L. 97-248, Sec. 122(g)(6), inserted ``or 
hospice care'' after ``home health services''.
    1981--Subsec. (a)(1). Pub. L. 97-35 struck out provision following 
subpar. (D) which provided that an agreement with a skilled nursing 
facility be for a term not exceeding 12 months with the exception that 
the Secretary could extend the time in specified situations.
    1980--Subsec. (a)(2)(A). Pub. L. 96-611 inserted provision that a 
provider of services may not impose a charge under clause (ii) of the 
first sentence of this subparagraph with respect to items and services 
described in section 1395x(s)(10) of this title for which payment is 
made under part B of this subchapter.
    Subsec. (c)(3). Pub. L. 96-272 added par. (3).
    Subsec. (f). Pub. L. 96-499 added subsec. (f).
    1978--Subsec. (a)(2)(A). Pub. L. 95-292 provided for computation of 
and charging of coinsurance amounts for items and services furnished 
individuals with end stage renal disease on the basis established by the 
Secretary.
    Subsec. (a)(3). Pub. L. 95-142, Sec. 8(b)(1), added par. (3).
    Subsec. (b)(2)(G). Pub. L. 95-142, Sec. 8(b)(2), added cl. (G).
    1977--Subsec. (a)(1)(D). Pub. L. 95-142, Sec. 15(a), added subpar. 
(D).
    Subsec. (b)(2)(C). Pub. L. 95-142, Sec. 3(b), designated existing 
provisions as subcl. (i) and added subcl. (ii).
    Subsec. (b)(2)(F). Pub. L. 95-142, Sec. 13(b)(3), substituted ``of a 
quality which fails to meet professionally recognized standards of 
health care'' for ``harmful to individuals or to be of a grossly 
inferior quality'', and struck out provisions relating to approval by an 
appropriate program review team.
    Subsec. (c)(2). Pub. L. 95-210 substituted ``section 1396i(a) of 
this title'' for ``section 1396i of this title''.
    1972--Subsec. (a)(1). Pub. L. 92-603, Secs. 227(d)(2), 249A(b), 
278(a)(17), (b)(18), 281(c), substituted ``Any provider of services 
(except a fund designated for purposes of section 1395f(g) and section 
1395n(e) of this title)'' for ``Any provider of services'', ``skilled 
nursing facility'' for ``extended care facility'', inserted provision 
that the agreement be for a term of not to exceed 12 months with an 
allowable extension of 2 months under specified circumstances, 
redesignated subpar. (B) as (C) and added subpar. (B).
    Subsec. (a)(2)(B). Pub. L. 92-603, Sec. 223(e), designated existing 
provisions as cl. (i) and added cl. (ii).
    Subsec. (a)(2)(C). Pub. L. 92-603, Sec. 223(g)(2), substituted 
``this subparagraph'' for ``clause (iii) of the preceding sentence''.
    Subsec. (a)(2)(D). Pub. L. 92-603, Sec. 223(g)(1), added subpar. 
(D).
    Subsec. (b). Pub. L. 92-603, Secs. 229(b), 249A(c), 278(a)(17), 
inserted ``(and in the case of an extended care facility, prior to the 
end of the term specified in subsection (a)(1) of this section)'' in 
provision preceding par. (1), in par. (2), added cls. (D) to (F), and in 
par. (3), substituted ``(including tuberculosis hospital services and 
inpatient psychiatric hospital services) or post-hospital extended care 
services, with respect to services furnished after the effective date of 
such termination, except that payment may be made for up to thirty days 
with respect to inpatient institutional services furnished to any 
eligible individual who was admitted to such institution prior to'' for 
``(including inpatient tuberculosis hospital services and inpatient 
psychiatric hospital services) or post-hospital extended care services, 
with respect to such services furnished to any individual who is 
admitted to the hospital or extended care facility furnishing such 
services on or after'' and substituted ``skilled nursing facility'' for 
``extended care facility''.
    Subsec. (c). Pub. L. 92-603, Sec. 249A(d), designated existing 
provisions as par. (1) and added par. (2).
    Subsec. (d). Pub. L. 92-603, Sec. 278(a)(17), substituted ``skilled 
nursing facility'' for ``extended care facility'' and ``a'' for ``an''.
    1968--Subsec. (a)(2)(A). Pub. L. 90-248, Sec. 129(c)(12)(A)(i), 
(ii), substituted ``or (a)(3)'' for ``, (a)(2), or (a)(4)'' in cl. (i), 
and deleted ``or, in the case of outpatient hospital diagnostic 
services, for which payment is made under part A'' in cl. (ii).
    Subsec. (a)(2)(C). Pub. L. 90-248, Sec. 129(c)(12)(B), substituted 
``1395e(a)(2)'' for ``1395e(a)(3)''.
    Pub. L. 90-248, Sec. 135(b), authorized a provider of services to 
charge for blood in accordance with its customary practices, included, 
in addition to whole blood for which a provider of services may charge, 
equivalent quantities of packed red blood cells, and provided that blood 
furnished an individual will be deemed replaced when the provider is 
given one pint of blood for each pint of blood (or equivalent quantities 
of packed red blood cells) furnished the individual to which the three 
pint deductible applies.
    Subsec. (e). Pub. L. 90-248, Sec. 133(c), added subsec. (e).


                    Effective Date of 1999 Amendment

    Amendment by Pub. L. 106-113 effective as if included in the 
enactment of the Balanced Budget Act of 1997, Pub. L. 105-33, except as 
otherwise provided, see section 1000(a)(6) [title III, Sec. 321(m)] of 
Pub. L. 106-113, set out as a note under section 1395d of this title.


                    Effective Date of 1997 Amendments

    Amendment by Pub. L. 105-12 effective Apr. 30, 1997, and applicable 
to Federal payments made pursuant to obligations incurred after Apr. 30, 
1997, for items and services provided on or after such date, subject to 
also being applicable with respect to contracts entered into, renewed, 
or extended after Apr. 30, 1997, as well as contracts entered into 
before Apr. 30, 1997, to the extent permitted under such contracts, see 
section 11 of Pub. L. 105-12, set out as an Effective Date note under 
section 14401 of this title.
    Amendment by section 4201(c)(1) of Pub. L. 105-33 applicable to 
services furnished on or after Oct. 1, 1997, see section 4201(d) of Pub. 
L. 105-33, set out as a note under section 1395f of this title.
    Amendment by section 4302(a) of Pub. L. 105-33 effective Aug. 5, 
1997, and applicable to the entry and renewal of contracts on or after 
such date, see section 4302(c) of Pub. L. 105-33, set out as a note 
under section 1395u of this title.
    Amendment by section 4321(b) of Pub. L. 105-33 effective as of date 
specified by Secretary of Health and Human Services in regulations to be 
issued by Secretary not later than date which is one year after Aug. 5, 
1997, see section 4321(d)(2) of Pub. L. 105-33, set out as an Effective 
Date note under section 1320b-16 of this title.
    Amendment by section 4432(b)(5)(F) of Pub. L. 105-33 applicable to 
items and services furnished on or after July 1, 1998, see section 
4432(d) of Pub. L. 105-33, set out as a note under section 1395i-3 of 
this title.
    Amendment by section 4511(a)(2)(D) of Pub. L. 105-33 applicable with 
respect to services furnished and supplies provided on and after Jan. 1, 
1998, see section 4511(e) of Pub. L. 105-33, set out as a note under 
section 1395k of this title.
    Amendment by section 4541(a)(3) of Pub. L. 105-33 applicable to 
services furnished on or after Jan. 1, 1999, see section 4541(e) of Pub. 
L. 105-33, set out as a note under section 1395l of this title.
    Section 4641(b) of Pub. L. 105-33 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to provider 
agreements entered into, renewed, or extended on or after such date (not 
later than 1 year after the date of the enactment of this Act [Aug. 5, 
1997]) as the Secretary of Health and Human Services specifies.''
    Amendments by section 4714(b)(1) of Pub. L. 105-33 applicable to 
payment for (and with respect to provider agreements with respect to) 
items and services furnished on or after Aug. 5, 1997, see section 
4714(c) of Pub. L. 105-33, set out as a note under section 1396a of this 
title.


                    Effective Date of 1994 Amendments

    Section 106(b)(2) of Pub. L. 103-432 provided that: ``The amendments 
made by paragraph (1) [amending this section and section 1395f of this 
title] shall take effect as if included in the enactment of OBRA-1987 
[Pub. L. 100-203].''
    Amendment by section 147(e)(7) of Pub. L. 103-432 effective as if 
included in the enactment of Pub. L. 101-508, see section 147(g) of Pub. 
L. 103-432, set out as a note under section 1320a-3a of this title.
    Amendment by section 156(a)(2)(E) of Pub. L. 103-432 applicable to 
services provided on or after Oct. 31, 1994, see section 156(a)(3) of 
Pub. L. 103-432, set out as a note under section 1320c-3 of this title.
    Amendment by Pub. L. 103-296 effective Mar. 31, 1995, see section 
110(a) of Pub. L. 103-296, set out as a note under section 401 of this 
title.


                    Effective Date of 1990 Amendment

    Section 4008(b)(4) of Pub. L. 101-508 provided that: ``The 
amendments made by this subsection [amending this section and section 
1395dd of this title] shall apply to actions occurring on or after the 
first day of the sixth month beginning after the date of the enactment 
of this Act [Nov. 5, 1990].''
    Section 4153(d)(2) of Pub. L. 101-508, as amended by Pub. L. 103-
432, title I, Sec. 135(e)(7), Oct. 31, 1994, 108 Stat. 4424, provided 
that: ``The amendment made by paragraph (1) [amending this section] 
shall take effect as if included in the enactment of the Omnibus Budget 
Reconciliation Act of 1989 [Pub. L. 101-239].''
    Amendment by section 4157(c)(2) of Pub. L. 101-508 applicable to 
services furnished on or after Jan. 1, 1991, see section 4157(d) of Pub. 
L. 101-508, set out as a note under section 1395k of this title.
    Amendment by section 4162(b)(2) of Pub. L. 101-508 applicable with 
respect to partial hospitalization services provided on or after Oct. 1, 
1991, see section 4162(c) of Pub. L. 101-508, set out as a note under 
section 1395k of this title.
    Amendment by section 4206(a) of Pub. L. 101-508 applicable with 
respect to services furnished on or after the first day of the first 
month beginning more than 1 year after Nov. 5, 1990, see section 
4206(e)(1) of Pub. L. 101-508, set out as a note under section 1395i-3 
of this title.


                    Effective Date of 1989 Amendments

    Section 6018(b) of Pub. L. 101-239 provided that: ``The amendments 
made by subsection (a) [amending this section] shall take effect on the 
first day of the first month that begins more than 180 days after the 
date of the enactment of this Act [Dec. 19, 1989], without regard to 
whether regulations to carry out such amendments have been promulgated 
by such date.''
    Amendment by section 6112(e)(3) of Pub. L. 101-239 applicable with 
respect to items furnished on or after Jan. 1, 1990, see section 
6112(e)(4) of Pub. L. 101-239, set out as a note under section 1395m of 
this title.
    Amendment by section 101(a) of Pub. L. 101-234 effective Jan. 1, 
1990, see section 101(d) of Pub. L. 101-234, set out as a note under 
section 1395c of this title.
    Amendment by section 201(a) of Pub. L. 101-234 effective Jan. 1, 
1990, see section 201(c) of Pub. L. 101-234, set out as a note under 
section 1320a-7a of this title.


                    Effective Date of 1988 Amendments

    Amendment by section 608(d)(3)(F), (19)(A) of Pub. L. 100-485 
effective as if included in the enactment of the Medicare Catastrophic 
Coverage Act of 1988, Pub. L. 100-360, and amendment by section 
608(f)(1) of Pub. L. 100-485 effective Oct. 13, 1988, see section 
608(g)(1), (2) of Pub. L. 100-485, set out as a note under section 704 
of this title.
    Amendment by section 104(d)(5) of Pub. L. 100-360 effective Jan. 1, 
1989, except as otherwise provided, and applicable to inpatient hospital 
deductible for 1989 and succeeding years, to care and services furnished 
on or after Jan. 1, 1989, to premiums for January 1989 and succeeding 
months, and to blood or blood cells furnished on or after Jan. 1, 1989, 
see section 104(a) of Pub. L. 100-360, set out as a note under section 
1395d of this title.
    Amendment by section 202(h)(1) of Pub. L. 100-360 applicable to 
items dispensed on or after Jan. 1, 1990, see section 202(m)(1) of Pub. 
L. 100-360, set out as a note under section 1395u of this title.
    Except as specifically provided in section 411 of Pub. L. 100-360, 
amendment by section 411(c)(2)(C), (g)(1)(D), (i)(4)(C)(vi), (j)(5) of 
Pub. L. 100-360, as it relates to a provision in the Omnibus Budget 
Reconciliation Act of 1987, Pub. L. 100-203, effective as if included in 
the enactment of that provision in Pub. L. 100-203, see section 411(a) 
of Pub. L. 100-360, set out as a Reference to OBRA; Effective Date note 
under section 106 of Title 1, General Provisions.
    Section 411(c)(2)(A)(ii) of Pub. L. 100-360 provided that: ``The 
amendment made by clause (i) [amending this section] shall apply to 
admissions occurring on or after the first day of the fourth month 
beginning after the date of the enactment of this Act [July 1, 1988].''


                    Effective Date of 1987 Amendments

    Amendment by section 4012(a) of Pub. L. 100-203 applicable to 
admissions occurring on or after Apr. 1, 1988, or, if later, the 
earliest date the Secretary can provide the information required under 
section 4012(c) of Pub. L. 100-203 [42 U.S.C. 1395mm note] in machine 
readable form, see section 4012(d) of Pub. L. 100-203, set out as a note 
under section 1395mm of this title.
    Amendment by section 4062(d)(4) of Pub. L. 100-203 applicable to 
covered items (other than oxygen and oxygen equipment) furnished on or 
after Jan. 1, 1989, and to oxygen and oxygen equipment furnished on or 
after June 1, 1989, see section 4062(e) of Pub. L. 100-203, as amended, 
set out as a note under section 1395f of this title.
    Section 4085(i)(17) of Pub. L. 100-203 provided that the amendment 
made by such section 4085(i)(17) is effective as if included in the 
enactment of Pub. L. 99-509.
    Section 4097(c) of Pub. L. 100-203 provided that: ``The amendments 
made by this section [amending this section] shall apply with respect to 
fiscal years beginning on or after October 1, 1988.''
    Amendment by section 4212(e)(4) of Pub. L. 100-203 applicable to 
nursing facility services furnished on or after Oct. 1, 1990, without 
regard to whether regulations implementing such amendment are 
promulgated by such date, except as otherwise specifically provided in 
section 1396r of this title, with transitional rule, see section 
4214(a), (b)(2) of Pub. L. 100-203, as amended, set out as an Effective 
Date note under section 1396r of this title.
    Amendment by Pub. L. 100-93 effective at end of fourteen-day period 
beginning Aug. 18, 1987, and inapplicable to administrative proceedings 
commenced before end of such period, see section 15(a) of Pub. L. 100-
93, set out as a note under section 1320a-7 of this title.


                    Effective Date of 1986 Amendments

    Section 233(b) of Pub. L. 99-576 provided that: ``The amendments 
made by subsection (a) [amending this section] shall apply to inpatient 
hospital services provided pursuant to admissions to hospitals occurring 
after June 30, 1987.''
    Amendment by Pub. L. 99-514 effective, except as otherwise provided, 
as if included in enactment of the Consolidated Omnibus Budget 
Reconciliation Act of 1985, Pub. L. 99-272, see section 1895(e) of Pub. 
L. 99-514, set out as a note under section 162 of Title 26, Internal 
Revenue Code.
    Section 9305(b)(2) of Pub. L. 99-509 provided that: ``The Secretary 
of Health and Human Services shall first prescribe the language required 
under section 1866(a)(1)(M) of the Social Security Act [subsec. 
(a)(1)(M) of this section] not later than six months after the date of 
the enactment of this Act [Oct. 21, 1986]. The requirement of such 
section shall apply to admissions to hospitals occurring on such date 
(not later than 60 days after the date such language is first 
prescribed) as the Secretary shall provide.''
    Amendment by section 9320(h)(2) of Pub. L. 99-509 applicable to 
services furnished on or after Jan. 1, 1989, with exceptions for 
hospitals located in rural areas which meet certain requirements related 
to certified registered nurse anesthetists, see section 9320(i), (k) of 
Pub. L. 99-509, as amended, set out as notes under section 1395k of this 
title.
    Section 9332(e)(2) of Pub. L. 99-509 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall apply to agreements 
under section 1866(a) of the Social Security Act [subsec. (a) of this 
section] as of October 1, 1987.''
    Amendment by section 9337(c)(2) of Pub. L. 99-509 applicable to 
expenses incurred for outpatient occupational therapy services furnished 
on or after July 1, 1987, see section 9337(e) of Pub. L. 99-509, set out 
as a note under section 1395k of this title.
    Amendment by section 9343(c)(2), (3) of Pub. L. 99-509 applicable to 
services furnished after June 30, 1987, see section 9343(h)(4) of Pub. 
L. 99-509, as amended, set out as a note under section 1395l of this 
title.
    Section 9353(e)(3)(A) of Pub. L. 99-509 provided that: ``The 
amendments made by paragraph (1) [amending this section] shall apply to 
provider agreements as of October 1, 1987.''
    Amendment by section 9121(a) of Pub. L. 99-272 effective on first 
day of first month that begins at least 90 days after Apr. 7, 1986, see 
section 9121(c) of Pub. L. 99-272, set out as a note under section 
1395dd of this title.
    Section 9122(b) of Pub. L. 99-272, as amended by Pub. L. 99-514, 
title XVIII, Sec. 1895(b)(6), Oct. 22, 1986, 100 Stat. 2933, provided 
that: ``The amendments made by subsection (a) [amending this section] 
shall apply to inpatient hospital services provided pursuant to 
admissions to hospitals occurring on or after January 1, 1987.''
    Section 9402(c)(1) of Pub. L. 99-272 provided that: ``The amendments 
made by subsection (a) [amending this section] shall become effective on 
the date of the enactment of this Act [Apr. 7, 1986].''
    Amendment by section 9403(b) of Pub. L. 99-272 effective Apr. 7, 
1986, see section 9403(c) of Pub. L. 99-272, set out as a note under 
section 1320c-3 of this title.


                    Effective Date of 1984 Amendment

    Amendment by section 2303(f) of Pub. L. 98-369 applicable to 
clinical diagnostic laboratory tests furnished on or after July 1, 1984, 
but not applicable to clinical diagnostic laboratory tests furnished to 
inpatients of a provider operating under a waiver granted pursuant to 
section 602(k) of Pub. L. 98-21, set out as a note under section 1395y 
of this title, see section 2303(j)(1), (3) of Pub. L. 98-369, set out as 
a note under section 1395l of this title.
    Amendment by section 2315(d) of Pub. L. 98-369 effective as though 
included in the enactment of the Social Security Amendments of 1983, 
Pub. L. 98-21, see section 2315(g) of Pub. L. 98-369, set out as an 
Effective and Termination Dates of 1984 Amendment note under section 
1395ww of this title.
    Amendment by section 2321(c) of Pub. L. 98-369 applicable to items 
and services furnished on or after July 18, 1984, see section 2321(g) of 
Pub. L. 98-369, set out as a note under section 1395f of this title.
    Amendment by section 2323(b)(3) of Pub. L. 98-369 applicable to 
services furnished on or after Sept. 1, 1984, see section 2323(d) of 
Pub. L. 98-369, set out as a note under section 1395l of this title.
    Amendment by section 2335(d) of Pub. L. 98-369 effective July 18, 
1984, see section 2335(g) of Pub. L. 98-369, set out as a note under 
section 1395f of this title.
    Amendment by section 2347(a) of Pub. L. 98-369 effective July 18, 
1984, see section 2347(d) of Pub. L. 98-369, set out as a note under 
section 1320c-2 of this title.
    Section 2348(b) of Pub. L. 98-369 provided that: ``The amendment 
made by this section [amending this section] shall apply to terminations 
issued on or after the date of the enactment of this Act [July 18, 
1984].''
    Amendment by section 2354(b)(33), (34) of Pub. L. 98-369 effective 
July 18, 1984, but not to be construed as changing or affecting any 
right, liability, status, or interpretation which existed (under the 
provisions of law involved) before that date, see section 2354(e)(1) of 
Pub. L. 98-369, set out as a note under section 1320a-1 of this title.


                    Effective Date of 1983 Amendments

    Section 602(l) of Pub. L. 98-21, as amended by Pub. L. 98-369, div. 
B, title III, Sec. 2347(a)(2), July 18, 1984, 98 Stat. 1096, provided 
that the amendment made by that section is effective Oct. 1, 1984.
    Amendment by section 602(f)(2) of Pub. L. 98-21 applicable to items 
and services furnished by or under arrangement with a hospital beginning 
with its first cost reporting period that begins on or after Oct. 1, 
1983, any change in a hospital's cost reporting period made after 
November 1982 to be recognized for such purposes only if the Secretary 
finds good cause therefor, see section 604(a)(1) of Pub. L. 98-21, set 
out as a note under section 1395ww of this title.
    Subsec. (a)(1)(F) to (H) of this section, as added by section 
602(f)(1)(C) of Pub. L. 98-21, effective Oct. 1, 1983, see section 
604(a)(2) of Pub. L. 98-21, set out as a note under section 1395ww of 
this title.
    Amendment by section 309(a)(5) of Pub. L. 97-448 effective as if 
originally included in the provision of the Tax Equity and Fiscal 
Responsibility Act of 1982, Pub. L. 97-248, to which such amendment 
relates, see section 309(c)(1) of Pub. L. 97-448, set out as a note 
under section 426 of this title.
    Amendment by section 309(b)(11) of Pub. L. 97-448 effective as if 
originally included as a part of this section as this section was 
amended by the Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 
97-248, see section 309(c)(2) of Pub. L. 97-448, set out as a note under 
section 426-1 of this title.


                    Effective Date of 1982 Amendment

    Amendment by section 122(g)(5), (6) of Pub. L. 97-248 applicable to 
hospice care provided on or after Nov. 1, 1983, see section 122(h)(1) of 
Pub. L. 97-248, as amended, set out as a note under section 1395c of 
this title.
    Amendment by section 128(a)(5) of Pub. L. 97-248 effective as if 
originally included as part of this section as this section was amended 
by the Omnibus Budget Reconciliation Act of 1981, Pub. L. 97-35, see 
section 128(e)(2) of Pub. L. 97-248, set out as a note under section 
1395x of this title.
    Amendment by section 128(d)(4) of Pub. L. 97-248 effective Sept. 3, 
1982, see section 128(e)(3) of Pub. L. 97-248, set out as a note under 
section 1395x of this title.
    Amendment by section 144 of Pub. L. 97-248 effective with respect to 
contracts entered into or renewed on or after Sept. 3, 1982, see section 
149 of Pub. L. 97-248, set out as an Effective Date note under section 
1320c of this title.


                    Effective Date of 1980 Amendment

    Amendment by Pub. L. 96-611 effective July 1, 1981, and applicable 
to services furnished on or after that date, see section 2 of Pub. L. 
96-611, set out as a note under section 1395l of this title.


                    Effective Date of 1978 Amendment

    Amendment by Pub. L. 95-292 effective with respect to services, 
supplies, and equipment furnished after the third calendar month 
beginning after June 13, 1978, except that provisions for the 
implementation of an incentive reimbursement system for dialysis 
services furnished in facilities and providers to become effective with 
respect to a facility's or provider's first accounting period beginning 
after the last day of the twelfth month following the month of June 
1978, and except that provisions for reimbursement rates for home 
dialysis to become effective on Apr. 1, 1979, see section 6 of Pub. L. 
95-292, set out as a note under section 426 of this title.


                    Effective Date of 1977 Amendments

    Section 2(f) of Pub. L. 95-210 provided that:
    ``(1) The amendments made by this section [amending this section and 
sections 1396a, 1396d, and 1396i of this title] shall (except as 
otherwise provided in paragraph (2)) apply to medical assistance 
provided, under a State plan approved under title XIX of the Social 
Security Act [subchapter XIX of this chapter], on and after the first 
day of the first calendar quarter that begins more than six months after 
the date of enactment of this Act [Dec. 13, 1977].
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [subchapter XIX of this chapter] which 
the Secretary determines requires State legislation in order for the 
plan to meet the additional requirements imposed by the amendments made 
by this section, the State plan shall not be regarded as failing to 
comply with the requirements of such title [subchapter] solely on the 
basis of its failure to meet these additional requirements before the 
first day of the first calendar quarter beginning after the close of the 
first regular session of the State legislature that begins after the 
date of enactment of this Act [Dec. 13, 1977].''
    Amendment by section 3(b) of Pub. L. 95-142 effective Oct. 25, 1977, 
see section 3(e) of Pub. L. 95-142, set out as an Effective Date note 
under section 1320a-3 of this title.
    Amendment by section 8(b) of Pub. L. 95-142 [amending this section] 
applicable with respect to contracts, agreements, etc., made on and 
after first day of fourth month beginning after Oct. 25, 1977, see 
section 8(e) of Pub. L. 95-142, set out as an Effective Date note under 
section 1320a-5 of this title.
    Amendment by section 13(b)(3) of Pub. L. 95-142 effective Oct. 25, 
1977, see section 13(c) of Pub. L. 95-142, set out as a note under 
section 1395y of this title.
    Section 15(b) of Pub. L. 95-142 provided that: ``The amendments made 
by subsection (a) [amending this section] shall apply with respect to 
agreements entered into or renewed on and after the date of enactment of 
this Act [Oct. 25, 1977].''


                    Effective Date of 1972 Amendment

    Amendment by section 223(e), (g) of Pub. L. 92-603 effective with 
respect to accounting periods beginning after Dec. 31, 1972, see section 
223(h) of Pub. L. 92-603, set out as a note under section 1395x of this 
title.
    Amendment by section 227(d)(2) of Pub. L. 92-603 applicable with 
respect to accounting periods beginning after June 30, 1973, see section 
227(g) of Pub. L. 92-603, set out as a note under section 1395x of this 
title.
    Section 249A(e) of Pub. L. 92-603 provided that: ``The provisions of 
this section [enacting section 1396 of this title and amending this 
section] shall be effective with respect to agreements filed with the 
Secretary under section 1866 of the Social Security Act [this section] 
by skilled nursing facilities (as defined in section 1861(j) of such Act 
[section 1395x(j) of this title]) before, on, or after the date of 
enactment of this Act [Oct. 30, 1972], but accepted by him on or after 
such date.''
    Amendment by section 281(c) of Pub. L. 92-603 applicable in the case 
of notices sent to individuals after 1968, see section 281(g) of Pub. L. 
92-603, set out as a note under section 1395gg of this title.


                    Effective Date of 1968 Amendment

    Amendment by section 129(c)(12) of Pub. L. 90-248 applicable with 
respect to services furnished after Mar. 31, 1968, see section 129(d) of 
Pub. L. 90-248, set out as a note under section 1395d of this title.
    Amendment by section 133(c) of Pub. L. 90-248 applicable with 
respect to services furnished after June 30, 1968, see section 133(g) of 
Pub. L. 90-248, set out as a note under section 1395k of this title.
    Amendment by section 135(b) of Pub. L. 90-248 applicable with 
respect to payment for blood (or packed red blood cells) furnished an 
individual after Dec. 31, 1967, see section 135(d) of Pub. L. 90-248, 
set out as a note under section 1395e of this title.


                           Effect on State Law

    Section 4206(c) of Pub. L. 101-508 provided that: ``Nothing in 
subsections (a) and (b) [amending this section and sections 1395l and 
1395mm of this title] shall be construed to prohibit the application of 
a State law which allows for an objection on the basis of conscience for 
any health care provider or any agent of such provider which, as a 
matter of conscience, cannot implement an advance directive.''


 Reports to Congress on Number of Hospitals Terminating or Not Renewing 
                           Provider Agreements

    Section 233(c) of Pub. L. 99-576 provided that:
    ``(1) The Secretary of Health and Human Services shall periodically 
submit to the Congress a report on the number of hospitals that have 
terminated or failed to renew an agreement under section 1866 of the 
Social Security Act [this section] as a result of the additional 
conditions imposed under the amendments made by subsection (a) [amending 
this section].
    ``(2) Not later than October 1, 1987, the Administrator of Veterans' 
Affairs shall submit to the Committees on Veterans' Affairs of the 
Senate and House of Representatives a report regarding implementation of 
this section [amending this section]. Thereafter, the Administrator 
shall notify such committees if any hospital terminates or fails to 
renew an agreement described in paragraph (1) for the reasons described 
in that paragraph.''
    Section 9122(d) of Pub. L. 99-272 provided that: ``The Secretary of 
Health and Human Services shall report to Congress periodically on the 
number of hospitals that have terminated or failed to renew an agreement 
under section 1866 of the Social Security Act [this section] as a result 
of the additional conditions imposed under the amendments made by 
subsection (a) [amending this section].''


     Delay in Implementation of Requirement That Hospitals Maintain 
Agreements With Utilization and Quality Control Peer Review Organization

    Section 2347(b) of Pub. L. 98-369 provided that: ``Notwithstanding 
section 604(a)(2) of the Social Security Amendments of 1983 [section 
604(a)(2) of Pub. L. 98-21, set out as an Effective Date of 1983 
Amendment note under section 1395ww of this title], the requirement that 
a hospital maintain an agreement with a utilization and quality control 
peer review organization, as contained in section 1866(a)(1)(F) of the 
Social Security Act [subsec. (a)(1)(F) of this section], shall become 
effective on November 15, 1984.''


 Interim Waiver in Certain Cases of Billing Rule for Items and Services 
                     Other Than Physicians' Services

    For authority to waive the requirements of subsec. (a)(1)(H) of this 
section for any cost period prior to Oct. 1, 1986, where immediate 
compliance would threaten the stability of patient care, see section 
602(k) of Pub. L. 98-21, set out as a note under section 1395y of this 
title.


                    Private Sector Review Initiative

    Section 119 of Pub. L. 97-248 provided that:
    ``(a) The Secretary of Health and Human Services shall undertake an 
initiative to improve medical review by intermediaries and carriers 
under title XVIII of the Social Security Act [this subchapter] and to 
encourage similar review efforts by private insurers and other private 
entities. The initiative shall include the development of specific 
standards for measuring the performance of such intermediaries and 
carriers with respect to the identification and reduction of unnecessary 
utilization of health services.
    ``(b) Where such review activity results in the denial of payment to 
providers of services under title XVIII of the Social Security Act [this 
subchapter], such providers shall be prohibited, in accordance with 
sections 1866 and 1879 of such title [this section and section 1395pp of 
this title], from collecting any payments from beneficiaries unless 
otherwise provided under such title.''


 Agreements Filed and Accepted Prior to Oct. 30, 1972, Deemed To Be for 
                   Specified Term Ending Dec. 31, 1973

    Section 249A(f) of Pub. L. 92-603 provided that: ``Notwithstanding 
any other provision of law, any agreement, filed by a skilled nursing 
facility (as defined in section 1861(j) of the Social Security Act 
[section 1395x(j) of this title]) with the Secretary under section 1866 
of such Act [this section] and accepted by him prior to the date of 
enactment of this Act [Oct. 30, 1972], which was in effect on such date 
shall be deemed to be for a specified term ending on December 31, 
1973.''

                  Section Referred to in Other Sections

    This section is referred to in sections 1320a-7a, 1320b-16, 1395f, 
1395i-3, 1395l, 1395m, 1395n, 1395w-22, 1395x, 1395y, 1395dd, 1395mm, 
1395tt, 1395vv, 1395ww, 1395bbb, 1395ccc, 1396a, 1396i, 1396m, 1396r, 
14406 of this title; title 5 section 8904.
