
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document affected by Public Law 106-554 Section 1(a)(6)[323]]
[CITE: 42USC1395d]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XVIII--HEALTH INSURANCE FOR AGED AND DISABLED
 
        Part A--Hospital Insurance Benefits for Aged and Disabled
 
Sec. 1395d. Scope of benefits


(a) Entitlement to payment for inpatient hospital services, post-
        hospital extended care services, home health services, and 
        hospice care

    The benefits provided to an individual by the insurance program 
under this part shall consist of entitlement to have payment made on his 
behalf or, in the case of payments referred to in section 1395f(d)(2) of 
this title to him (subject to the provisions of this part) for--
        (1) inpatient hospital services or inpatient critical access 
    hospital services for up to 150 days during any spell of illness 
    minus 1 day for each day of such services in excess of 90 received 
    during any preceding spell of illness (if such individual was 
    entitled to have payment for such services made under this part 
    unless he specifies in accordance with regulations of the Secretary 
    that he does not desire to have such payment made);
        (2)(A) post-hospital extended care services for up to 100 days 
    during any spell of illness, and (B) to the extent provided in 
    subsection (f) of this section, extended care services that are not 
    post-hospital extended care services;
        (3) for individuals not enrolled in part B of this subchapter, 
    home health services, and for individuals so enrolled, post-
    institutional home health services furnished during a home health 
    spell of illness for up to 100 visits during such spell of illness; 
    and
        (4) in lieu of certain other benefits, hospice care with respect 
    to the individual during up to two periods of 90 days each and an 
    unlimited number of subsequent periods of 60 days each with respect 
    to which the individual makes an election under subsection (d)(1) of 
    this section.

(b) Services not covered

    Payment under this part for services furnished an individual during 
a spell of illness may not (subject to subsection (c) of this section) 
be made for--
        (1) inpatient hospital services furnished to him during such 
    spell after such services have been furnished to him for 150 days 
    during such spell minus 1 day for each day of inpatient hospital 
    services in excess of 90 received during any preceding spell of 
    illness (if such individual was entitled to have payment for such 
    services made under this part unless he specifies in accordance with 
    regulations of the Secretary that he does not desire to have such 
    payment made);
        (2) post-hospital extended care services furnished to him during 
    such spell after such services have been furnished to him for 100 
    days during such spell; or
        (3) inpatient psychiatric hospital services furnished to him 
    after such services have been furnished to him for a total of 190 
    days during his lifetime.

Payment under this part for post-institutional home health services 
furnished an individual during a home health spell of illness may not be 
made for such services beginning after such services have been furnished 
for a total of 100 visits during such spell.

(c) Inpatients of psychiatric hospitals

    If an individual is an inpatient of a psychiatric hospital on the 
first day of the first month for which he is entitled to benefits under 
this part, the days on which he was an inpatient of such a hospital in 
the 150-day period immediately before such first day shall be included 
in determining the number of days limit under subsection (b)(1) of this 
section insofar as such limit applies to (1) inpatient psychiatric 
hospital services, or (2) inpatient hospital services for an individual 
who is an inpatient primarily for the diagnosis or treatment of mental 
illness (but shall not be included in determining such number of days 
limit insofar as it applies to other inpatient hospital services or in 
determining the 190-day limit under subsection (b)(3) of this section).

(d) Hospice care; election; waiver of rights; revocation; change of 
        election

    (1) Payment under this part may be made for hospice care provided 
with respect to an individual only during two periods of 90 days each 
and an unlimited number of subsequent periods of 60 days each during the 
individual's lifetime and only, with respect to each such period, if the 
individual makes an election under this paragraph to receive hospice 
care under this part provided by, or under arrangements made by, a 
particular hospice program instead of certain other benefits under this 
subchapter.
    (2)(A) Except as provided in subparagraphs (B) and (C) and except in 
such exceptional and unusual circumstances as the Secretary may provide, 
if an individual makes such an election for a period with respect to a 
particular hospice program, the individual shall be deemed to have 
waived all rights to have payment made under this subchapter with 
respect to--
        (i) hospice care provided by another hospice program (other than 
    under arrangements made by the particular hospice program) during 
    the period, and
        (ii) services furnished during the period that are determined 
    (in accordance with guidelines of the Secretary) to be--
            (I) related to the treatment of the individual's condition 
        with respect to which a diagnosis of terminal illness has been 
        made or
            (II) equivalent to (or duplicative of) hospice care;

except that clause (ii) shall not apply to physicians' services 
furnished by the individual's attending physician (if not an employee of 
the hospice program) or to services provided by (or under arrangements 
made by) the hospice program.
    (B) After an individual makes such an election with respect to a 90-
day period or a subsequent 60-day period, the individual may revoke the 
election during the period, in which case--
        (i) the revocation shall act as a waiver of the right to have 
    payment made under this part for any hospice care benefits for the 
    remaining time in such period and (for purposes of subsection (a)(4) 
    of this section and subparagraph (A)) the individual shall be deemed 
    to have been provided such benefits during such entire period, and
        (ii) the individual may at any time after the revocation execute 
    a new election for a subsequent period, if the individual otherwise 
    is entitled to hospice care benefits with respect to such a period.

    (C) An individual may, once in each such period, change the hospice 
program with respect to which the election is made and such change shall 
not be considered a revocation of an election under subparagraph (B).
    (D) For purposes of this subchapter, an individual's election with 
respect to a hospice program shall no longer be considered to be in 
effect with respect to that hospice program after the date the 
individual's revocation or change of election with respect to that 
election takes effect.

(e) Services taken into account

    For purposes of subsections (b) and (c) of this section, inpatient 
hospital services, inpatient psychiatric hospital services, and post-
hospital extended care services shall be taken into account only if 
payment is or would be, except for this section or the failure to comply 
with the request and certification requirements of or under section 
1395f(a) of this title, made with respect to such services under this 
part.

(f) Coverage of extended care services without regard to three-day prior 
        hospitalization requirement

    (1) The Secretary shall provide for coverage, under clause (B) of 
subsection (a)(2) of this section, of extended care services which are 
not post-hospital extended care services at such time and for so long as 
the Secretary determines, and under such terms and conditions (described 
in paragraph (2)) as the Secretary finds appropriate, that the inclusion 
of such services will not result in any increase in the total of 
payments made under this subchapter and will not alter the acute care 
nature of the benefit described in subsection (a)(2) of this section.
    (2) The Secretary may provide--
        (A) for such limitations on the scope and extent of services 
    described in subsection (a)(2)(B) of this section and on the 
    categories of individuals who may be eligible to receive such 
    services, and
        (B) notwithstanding sections 1395f, 1395x(v), and 1395ww of this 
    title, for such restrictions and alternatives on the amounts and 
    methods of payment for services described in such subsection,

as may be necessary to carry out paragraph (1).

(g) ``Spell of illness'' defined

    For definitions of ``spell of illness'', and for definitions of 
other terms used in this part, see section 1395x of this title.

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1812, as added Pub. L. 89-97, 
title I, Sec. 102(a), July 30, 1965, 79 Stat. 291; amended Pub. L. 90-
248, title I, Secs. 129(c)(2), 137(a), 138(a), 143(b), 146(a), Jan. 2, 
1968, 81 Stat. 847, 853, 854, 857, 859; Pub. L. 96-499, title IX, 
Secs. 930(b)-(d), 931(a), Dec. 5, 1980, 94 Stat. 2631, 2633; Pub. L. 97-
35, title XXI, Sec. 2121(a), Aug. 13, 1981, 95 Stat. 796; Pub. L. 97-
248, title I, Secs. 122(b), 123, Sept. 3, 1982, 96 Stat. 356, 364; Pub. 
L. 97-448, title III, Sec. 309(b)(5), Jan. 12, 1983, 96 Stat. 2409; Pub. 
L. 100-360, title I, Sec. 101, July 1, 1988, 102 Stat. 684; Pub. L. 101-
234, title I, Sec. 101(a), Dec. 13, 1989, 103 Stat. 1979; Pub. L. 101-
239, title VI, Sec. 6003(g)(3)(B)(i), Dec. 19, 1989, 103 Stat. 2152; 
Pub. L. 101-508, title IV, Sec. 4006(a), Nov. 5, 1990, 104 Stat. 1388-
43; Pub. L. 103-432, title I, Sec. 102(g)(1), Oct. 31, 1994, 108 Stat. 
4404; Pub. L. 105-33, title IV, Secs. 4201(c)(1), 4443(a), (b)(1), 
4611(a), Aug. 5, 1997, 111 Stat. 373, 423, 472; Pub. L. 106-113, div. B, 
Sec. 1000(a)(6) [title III, Sec. 321(k)(1)], Nov. 29, 1999, 113 Stat. 
1536, 1501A-366.)

                       References in Text

    Part B of this subchapter, referred to in subsec. (a)(3), is 
classified to section 1395j et seq. of this title.


                               Amendments

    1999--Subsec. (b). Pub. L. 106-113 inserted ``during'' after ``100 
visits'' in concluding provisions.
    1997--Subsec. (a)(1). Pub. L. 105-33, Sec. 4201(c)(1), substituted 
``critical access'' for ``rural primary care''.
    Subsec. (a)(3). Pub. L. 105-33, Sec. 4611(a)(1), substituted ``for 
individuals not enrolled in part B of this subchapter, home health 
services, and for individuals so enrolled, post-institutional home 
health services furnished during a home health spell of illness for up 
to 100 visits during such spell of illness'' for ``home health 
services''.
    Subsec. (a)(4). Pub. L. 105-33, Sec. 4443(a), substituted ``and an 
unlimited number of subsequent periods of 60 days each'' for ``, a 
subsequent period of 30 days, and a subsequent extension period''.
    Subsec. (b). Pub. L. 105-33, Sec. 4611(a)(2), inserted closing 
provisions.
    Subsec. (d)(1). Pub. L. 105-33, Sec. 4443(a), substituted ``and an 
unlimited number of subsequent periods of 60 days each'' for ``, a 
subsequent period of 30 days, and a subsequent extension period''.
    Subsec. (d)(2)(B). Pub. L. 105-33, Sec. 4443(b)(1), substituted 
``90-day period or a subsequent 60-day period'' for ``90- or 30-day 
period or a subsequent extension period''.
    1994--Subsec. (a)(1). Pub. L. 103-432 substituted ``inpatient 
hospital services or inpatient rural primary care hospital services'' 
for ``inpatient hospital services'' before ``for up to 150 days'' and 
``such services'' for ``inpatient hospital services'' before ``in excess 
of 90'' and struck out ``and inpatient rural primary care hospital 
services'' after ``such payment made)''.
    1990--Subsec. (a)(4). Pub. L. 101-508, Sec. 4006(a)(1), substituted 
``90 days each, a subsequent period of 30 days, and a subsequent 
extension period'' for ``90 days each and one subsequent period of 30 
days''.
    Subsec. (d)(1). Pub. L. 101-508, Sec. 4006(a)(2)(A), substituted 
``90 days each, a subsequent period of 30 days, and a subsequent 
extension period during the individual's lifetime'' for ``90 days each 
and one subsequent period of 30 days during the individual's lifetime''.
    Subsec. (d)(2)(B). Pub. L. 101-508, Sec. 4006(a)(2)(B), substituted 
``a 90- or 30-day period or a subsequent extension period'' for ``a 90- 
or 30-day period''.
    1989--Subsec. (a). Pub. L. 101-234 repealed Pub. L. 100-360, 
Sec. 101(1), 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. (a)(1). Pub. L. 101-239 inserted ``and inpatient rural 
primary care hospital services'' before semicolon at end.
    Subsecs. (b) to (d)(1), (2)(B), (e) to (g). Pub. L. 101-234 repealed 
Pub. L. 100-360, Sec. 101(2)-(6), 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 notes below.
    1988--Subsec. (a). Pub. L. 100-360, Sec. 101(1), struck out former 
pars. (1) to (4) and added new pars. (1) to (4) which read as follows:
    ``(1) inpatient hospital services;
    ``(2) extended care services for up to 150 days during any calendar 
year;
    ``(3) home health services; and
    ``(4) in lieu of certain other benefits, hospice care with respect 
to the individual during up to two periods of 90 days each, a subsequent 
period of 30 days, and a subsequent extension period with respect to 
which the individual makes an election under subsection (d)(1) of this 
section.''
    Subsec. (b). Pub. L. 100-360, Sec. 101(2), amended subsec. (b) 
generally, striking out par. (1) and renumbering and amending pars. (2) 
and (3) as (1) and (2), respectively.
    Subsec. (c). Pub. L. 100-360, Sec. 101(3), amended subsec. (c) 
generally, substituting pars. (1) to (4) limiting periods for inpatients 
of psychiatric hospitals for former single paragraph.
    Subsec. (d)(1). Pub. L. 100-360, Sec. 101(4)(A), substituted ``, a 
subsequent period of 30 days, and a subsequent extension period'' for 
``and one subsequent period of 30 days''.
    Subsec. (d)(2)(B). Pub. L. 100-360, Sec. 101(4)(B), inserted ``or a 
subsequent extension period'' after ``30-day period'' in introductory 
provisions.
    Subsec. (e). Pub. L. 100-360, Sec. 101(5), struck out ``post-
hospital'' before ``extended care services''.
    Subsec. (f). Pub. L. 100-360, Sec. 101(6), struck out subsec. (f) 
which provided coverage of extended care services without regard to 
three-day prior hospitalization requirement.
    Subsec. (g). Pub. L. 100-360, Sec. 101(6), struck out subsec. (g) 
which cross-referenced section 1395x of this title for definitions of 
``spell of illness'' and other terms used in this part.
    1983--Subsec. (d)(2)(A). Pub. L. 97-448 substituted ``or to 
services'' for ``or to other than services'' after ``(if not an employee 
of the hospice program)''.
    1982--Subsec. (a)(2). Pub. L. 97-248, Sec. 123(a), redesignated 
existing provisions as subpar. (A) and added subpar. (B).
    Subsec. (a)(4). Pub. L. 97-248, Sec. 122(b)(1), added par. (4).
    Subsec. (d). Pub. L. 97-248, Sec. 122(b)(2), added subsec. (d).
    Subsecs. (f), (g). Pub. L. 97-248, Sec. 123(b), added subsec. (f) 
and redesignated former subsec. (f) as (g).
    1981--Subsec. (a). Pub. L. 97-35 struck out par. (4) which related 
to alcohol detoxification facility services.
    1980--Subsec. (a)(3). Pub. L. 96-499, Sec. 930(b), substituted 
``home health services'' for ``post-hospital home health services for up 
to 100 visits (during the one-year period described in section 1395x(n) 
of this title) after the beginning of one spell of illness and before 
the beginning of the next''.
    Subsec. (a)(4). Pub. L. 96-499, Sec. 931(a), added par. (4).
    Subsec. (d). Pub. L. 96-499, Sec. 930(c), struck out subsec. (d) 
which authorized payment for post-hospital home health services 
furnished an individual only during the one year period described in 
section 1395x(n) of this title following his most recent hospital 
discharge which met the requirements of such section and only for the 
first 100 visits in such period.
    Subsec. (e). Pub. L. 96-499, Sec. 930(d), substituted ``subsections 
(b) and (c)'' for ``subsections (b), (c), and (d)'' and ``and post-
hospital extended care services'' for ``post-hospital extended care 
services, and post-hospital home health services''.
    1968--Subsec. (a). Pub. L. 90-248, Sec. 143(b), inserted ``or, in 
the case of payments referred to in section 1395f(d)(2) of this title to 
him'' after ``on his behalf'' in text preceding par. (1).
    Subsec. (a)(1). Pub. L. 90-248, Sec. 137(a)(1), increased the 
maximum duration of benefits from 90 to 150 days minus 1 day for each 
day of inpatient hospital services in excess of 90 received during any 
preceding spell of illness (if such individual was entitled to have 
payment for such services made under this part unless he specifies that 
he does not desire to have such payment made).
    Subsec. (a)(4). Pub. L. 90-248, Sec. 129(c)(2), struck out par. (4) 
which provided for payment for outpatient hospital diagnostic services.
    Subsec. (b)(1). Pub. L. 90-248, Sec. 137(a)(2), changed the 
limitation on payments from 90 to 150 days minus 1 day for each day of 
inpatient hospital services in excess of 90 received during any 
preceding spell of illness (if such individual was entitled to have 
payment for such services made under this part unless he specifies that 
he does not desire to have such payment made).
    Subsec. (c). Pub. L. 90-248, Sec. 138(a), increased the limit from 
90 to 150 days so that if an individual was an inpatient of a 
psychiatric or tuberculosis hospital on the first day of the first month 
for which he is entitled to benefits, the days he was an inpatient in 
the 150-day period immediately before such first day are included in 
determining the limit under subsec. (b)(1) insofar as such limit applies 
to (1) inpatient psychiatric hospital services and inpatient 
tuberculosis hospital services, or (2) inpatient hospital services for 
an individual who is an inpatient primarily for the diagnosis or 
treatment of mental illness or tuberculosis (but are not included in 
determining such limit as it applies to other inpatient hospital 
services or in determining the 190-day limit under subsec. (b)(3)).
    Pub. L. 90-248, Sec. 146(a), provided that the limitation of 
allowable days of inpatient hospital services will not apply to services 
provided to an inpatient of a tuberculosis hospital.


                    Effective Date of 1999 Amendment

    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title III, Sec. 321(m)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-368, provided that: ``Except as 
otherwise provided, the amendments made by this section [amending this 
section and sections 1395i, 1395i-4, 1395l, 1395m, 1395u, 1395w-3, 
1395w-4, 1395w-21, 1395w-22, 1395w-24, 1395x, 1395y, 1395cc, 1395ss, 
1395ww, 1395yy, and 1395fff of this title, repealing section 1320b-5 of 
this title, and amending provisions set out as notes under sections 
1395f and 1395ww of this title] shall take effect as if included in the 
enactment of BBA [Balanced Budget Act of 1997, Pub. L. 105-33].''


                    Effective Date of 1997 Amendment

    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.
    Section 4449 of title IV of Pub. L. 105-33 provided that: ``Except 
as otherwise provided in this chapter [chapter 4 (Secs. 4441-4449) of 
subtitle E of title IV of Pub. L. 105-33, amending this section and 
sections 1395f, 1395x, and 1395pp of this title and enacting provisions 
set out as notes under section 1395f and 1395x of this title], the 
amendments made by this chapter apply to benefits provided on or after 
the date of the enactment of this chapter [Aug. 5, 1997], regardless of 
whether or not an individual has made an election under section 1812(d) 
of the Social Security Act (42 U.S.C. 1395d(d)) before such date.''
    Section 4611(f) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section and sections 1395u, 1395x, 
and 1395ff of this title] apply to services furnished on or after 
January 1, 1998. For purpose of applying such amendments, any home 
health spell of illness that began, but not [sic] did not end, before 
such date shall be considered to have begun as of such date.''


                    Effective Date of 1994 Amendment

    Section 102(i) of Pub. L. 103-432 provided that: ``The amendments 
made by this section [amending this section and sections 1395e, 1395f, 
1395i-4, 1395m, 1395x, and 1395ww of this title] shall take effect on 
the date of the enactment of this Act [Oct. 31, 1994].''


                    Effective Date of 1990 Amendment

    Section 4006(c) of Pub. L. 101-508 provided that: ``The amendments 
made by this section [amending this section and section 1395f of this 
title] shall apply with respect to care and services furnished on or 
after January 1, 1990.''


                    Effective Date of 1989 Amendment

    Amendment by 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.


                    Effective Date of 1988 Amendment

    Section 104(a) of Pub. L. 100-360, as amended by Pub. L. 100-485, 
title VI, Sec. 608(d)(3)(A), Oct. 13, 1988, 102 Stat. 2413, provided 
that:
    ``(1) In general.--Except as provided in paragraph (2) and 
subsection (b), the amendments made by this subtitle [subtitle A 
(Secs. 101-104) of title I of Pub. L. 100-360, amending this section and 
sections 1395c, 1395e, 1395f, 1395i-2, 1395k, 1395x, 1395cc, and 1395tt 
of this title] shall take effect on January 1, 1989, and shall apply--
        ``(A) to the inpatient hospital deductible for 1989 and 
    succeeding years,
        ``(B) to care and services furnished on or after January 1, 
    1989,
        ``(C) to premiums for January 1989 and succeeding months, and
        ``(D) to blood or blood cells furnished on or after January 1, 
    1989.
    ``(2) Elimination of post-hospital requirement for extended care 
services.--The amendments made by this subtitle, insofar as they 
eliminate the requirement (under section 1812(a)(2) of the Social 
Security Act [subsec. (a)(2) of this section]) that extended care 
services are only covered under title XVIII of such Act [this 
subchapter] if they are post-hospital extended care services, shall only 
apply to extended care services furnished pursuant to an admission to a 
skilled nursing facility occurring on or after January 1, 1989.''


                    Effective Date of 1983 Amendment

    Amendment by 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(b) 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.


                    Effective Date of 1981 Amendment

    Section 2121(i) of Pub. L. 97-35 provided that: ``The amendments 
made by this section [amending this section and sections 1320c-3, 1320c-
4, 1320c-7, 1395f, and 1395x of this title] (other than by subsection 
(h) [repealing provisions set out as a note under section 1395ll of this 
title]) shall apply to services furnished in detoxification facilities 
for inpatient stays beginning on or after the tenth day after the date 
of the enactment of this Act [Aug. 13, 1981].''


                    Effective Date of 1980 Amendment

    Amendment by section 930(b)-(d) of Pub. L. 96-499 effective with 
respect to services furnished on or after July 1, 1981, see section 
930(s)(1) of Pub. L. 96-499, set out as a note under section 1395x of 
this title.
    Section 931(e) of Pub. L. 96-499 provided that: ``The amendments 
made by subsections (a) through (d) of this section [amending this 
section and sections 1395f and 1395x of this title] shall become 
effective on April 1, 1981.''


                    Effective Date of 1968 Amendment

    Section 129(d) of Pub. L. 90-248 provided that: ``The amendments 
made by this section [amending this section and sections 426, 1395e, 
1395f, 1395k, 1395l, 1395n, 1395x, and 1395cc of this title and section 
228s-2 of Title 45, Railroads] shall apply with respect to services 
furnished after March 31, 1968, except that subsection (c)(5) of such 
section [amending section 1395f of this title] shall become effective 
with respect to services furnished after the date of enactment of this 
Act [Jan. 2, 1968].''
    Section 137(c) of Pub. L. 90-248 provided that: ``The amendments 
made by subsections (a) and (b) [amending this section and section 1395e 
of this title] shall apply with respect to services furnished after 
December 31, 1967.''
    Section 138(b) of Pub. L. 90-248 provided that: ``The amendments 
made by subsection (a) [amending this section] shall apply with respect 
to payment for services furnished after December 31, 1967.''
    Section 143(d) of Pub. L. 90-248 provided that: ``The provisions 
made by subsection (a) of this section [amending section 1395x of this 
title] shall become effective as of July 1, 1966, and the provisions 
made by subsections (b) and (c) of this section [amending this section 
and section 1395f of this title] shall apply to services furnished with 
respect to admissions occurring after December 31, 1967, and to 
outpatient hospital diagnostic services furnished after December 31, 
1967, and before April 1, 1968.''
    Section 146(b) of Pub. L. 90-248 provided that: ``The amendment made 
by subsection (a) [amending this section] shall apply with respect to 
payment for services furnished after December 31, 1967.''


                               Transition

    Section 4611(e) of Pub. L. 105-33 provided that:
    ``(1) In general.--Notwithstanding any provision of title XVIII of 
the Social Security Act [this subchapter], the Secretary of Health and 
Human Services shall establish a transition for the aggregate amount of 
expenditures that are transferred from part A, to part B, of title XVIII 
of the Social Security Act [this part and part B of this subchapter], as 
a result of the amendments made by this section [amending this section 
and sections 1395u, 1395x, and 1395ff of this title], during each of the 
years during the period beginning with 1998 and ending with 2002 
according to this subsection. Under the transition for each such year, 
the Secretary shall effect such transfer, between the trust funds under 
such parts, as will result in only the proportion (specified in 
paragraph (2)) of such aggregate expenditures for the year being 
transferred from such part A to such part B.
    ``(2) Proportion specified.--The proportion specified in this 
paragraph for--
        ``(A) 1998 is \1/6\,
        ``(B) 1999 is \1/3\,
        ``(C) 2000 is \1/2\,
        ``(D) 2001 is \2/3\, and
        ``(E) 2002 is \5/6\.
    ``(3) Application in establishing monthly premiums for 1998 through 
2003.--
        ``(A) In general.--For purposes only of computing the monthly 
    premium under section 1839 of the Social Security Act (42 U.S.C. 
    1395r), the monthly actuarial rate for enrollees age 65 and over 
    shall be computed as though any reference in paragraph (1) of this 
    subsection to 2002 were a reference to 2003 and as if the following 
    proportions were substituted for the proportions specified in 
    paragraph (2):
            ``(i) For 1998, \1/7\.
            ``(ii) For 1999, \2/7\.
            ``(iii) For 2000, \3/7\.
            ``(iv) For 2001, \4/7\.
            ``(v) For 2002, \5/7\.
            ``(vi) For 2003, \6/7\.
        ``(B) No impact on government contribution.--Subparagraph (A) 
    does not apply in determining the amount of the Government 
    contribution under section 1844 of the Social Security Act (42 
    U.S.C. 1395w).''


          Repeal of 1988 Expansion of Medicare Part A Benefits

    For provisions repealing amendment by section 101 of Pub. L. 100-
360, restoring or reviving this section as if section 101 of Pub. L. 
100-360 had not been enacted, and providing a transition period for 
medicare beneficiaries with respect to inpatient hospital services and 
extended care services provided on or after Jan. 1, 1990, and providing 
an exception to such restoration for certain hospice care, see section 
101(a)-(b)(2) of Pub. L. 101-234, set out as a note under section 1395e 
of this title.

                  Section Referred to in Other Sections

    This section is referred to in sections 1395e, 1395f, 1395w-23, 
1395x, 1395eee, 1396b, 1396d, 1396r-8 of this title.
