
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC1395g]

 
                 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. 1395g. Payments to providers of services


(a) Determination of amount

    The Secretary shall periodically determine the amount which should 
be paid under this part to each provider of services with respect to the 
services furnished by it, and the provider of services shall be paid, at 
such time or times as the Secretary believes appropriate (but not less 
often than monthly) and prior to audit or settlement by the General 
Accounting Office, from the Federal Hospital Insurance Trust Fund, the 
amounts so determined, with necessary adjustments on account of 
previously made overpayments or underpayments; except that no such 
payments shall be made to any provider unless it has furnished such 
information as the Secretary may request in order to determine the 
amounts due such provider under this part for the period with respect to 
which the amounts are being paid or any prior period.

(b) Conditions

    No payment shall be made to a provider of services which is a 
hospital for or with respect to services furnished by it for any period 
with respect to which it is deemed, under section 1395x(w)(2) of this 
title, to have in effect an arrangement with a quality control and peer 
review organization for the conduct of utilization review activities by 
such organization unless such hospital has paid to such organization the 
amount due (as determined pursuant to such section) to such organization 
for the review activities conducted by it pursuant to such arrangements 
or such hospital has provided assurances satisfactory to the Secretary 
that such organization will promptly be paid the amount so due to it 
from the proceeds of the payment claimed by the hospital. Payment under 
this subchapter for utilization review activities provided by a quality 
control and peer review organization pursuant to an arrangement or 
deemed arrangement with a hospital under section 1395x(w)(2) of this 
title shall be calculated without any requirement that the reasonable 
cost of such activities be apportioned among the patients of such 
hospital, if any, to whom such activities were not applicable.

(c) Payments under assignment or power of attorney

    No payment which may be made to a provider of services under this 
subchapter for any service furnished to an individual shall be made to 
any other person under an assignment or power of attorney; but nothing 
in this subsection shall be construed (1) to prevent the making of such 
a payment in accordance with an assignment from the provider if such 
assignment is made to a governmental agency or entity or is established 
by or pursuant to the order of a court of competent jurisdiction, or (2) 
to preclude an agent of the provider of services from receiving any such 
payment if (but only if) such agent does so pursuant to an agency 
agreement under which the compensation to be paid to the agent for his 
services for or in connection with the billing or collection of payments 
due such provider under this subchapter is unrelated (directly or 
indirectly) to the amount of such payments or the billings therefor, and 
is not dependent upon the actual collection of any such payment.

(d) Accrual of interest on balance of excess or deficit not paid

    Whenever a final determination is made that the amount of payment 
made under this part to a provider of services was in excess of or less 
than the amount of payment that is due, and payment of such excess or 
deficit is not made (or effected by offset) within 30 days of the date 
of the determination, interest shall accrue on the balance of such 
excess or deficit not paid or offset (to the extent that the balance is 
owed by or owing to the provider) at a rate determined in accordance 
with the regulations of the Secretary of the Treasury applicable to 
charges for late payments.

(e) Periodic interim payments

    (1) The Secretary shall provide payment under this part for 
inpatient hospital services furnished by a subsection (d) hospital (as 
defined in section 1395ww(d)(1)(B) of this title, and including a 
distinct psychiatric or rehabilitation unit of such a hospital) and a 
subsection (d) Puerto Rico hospital (as defined in section 
1395ww(d)(9)(A) of this title) on a periodic interim payment basis 
(rather than on the basis of bills actually submitted) in the following 
cases:
        (A) Upon the request of a hospital which is paid through an 
    agency or organization with an agreement with the Secretary under 
    section 1395h of this title, if the agency or organization, for 
    three consecutive calendar months, fails to meet the requirements of 
    subsection (c)(2) of such section and if the hospital meets the 
    requirements (in effect as of October 1, 1986) applicable to payment 
    on such a basis, until such time as the agency or organization meets 
    such requirements for three consecutive calendar months.
        (B) In the case of \1\ hospital that--
---------------------------------------------------------------------------
    \1\ So in original. Probably should be followed by ``a''.
---------------------------------------------------------------------------
            (i) has a disproportionate share adjustment percentage (as 
        established in clause (iv) of such section) of at least 5.1 
        percent (as computed for purposes of establishing the average 
        standardized amounts for discharges occurring during fiscal year 
        1987), and
            (ii) requests payment on such basis,

    but only if the hospital was being paid for inpatient hospital 
    services on such a periodic interim payment basis as of June 30, 
    1987, and continues to meet the requirements (in effect as of 
    October 1, 1986) applicable to payment on such a basis.
        (C) In the case of a hospital that--
            (i) is located in a rural area,
            (ii) has 100 or fewer beds, and
            (iii) requests payment on such basis,

    but only if the hospital was being paid for inpatient hospital 
    services on such a periodic interim payment basis as of June 30, 
    1987, and continues to meet the requirements (in effect as of 
    October 1, 1986) applicable to payment on such a basis.

    (2) The Secretary shall provide (or continue to provide) for payment 
on a periodic interim payment basis (under the standards established 
under section 405.454(j) of title 42, Code of Federal Regulations, as in 
effect on October 1, 1986) with respect to--
        (A) inpatient hospital services of a hospital that is not a 
    subsection (d) hospital (as defined in section 1395ww(d)(1)(B) of 
    this title);
        (B) a hospital which is receiving payment under a State hospital 
    reimbursement system under section 1395f(b)(3) or 1395ww(c) of this 
    title, if payment on a periodic interim payment basis is an integral 
    part of such reimbursement system;
        (C) extended care services; and
        (D) hospice care;

if the provider of such services elects to receive, and qualifies for, 
such payments.
    (3) In the case of a subsection (d) hospital or a subsection (d) 
Puerto Rico hospital (as defined for purposes of section 1395ww of this 
title) which has significant cash flow problems resulting from 
operations of its intermediary or from unusual circumstances of the 
hospital's operation, the Secretary may make available appropriate 
accelerated payments.
    (4) A hospital created by the merger or consolidation of 2 or more 
hospitals or hospital campuses shall be eligible to receive periodic 
interim payment on the basis described in paragraph (1)(B) if--
        (A) at least one of the hospitals or campuses received periodic 
    interim payment on such basis prior to the merger or consolidation; 
    and
        (B) the merging or consolidating hospitals or campuses would 
    each meet the requirement of paragraph (1)(B)(i) if such hospitals 
    or campuses were treated as independent hospitals for purposes of 
    this subchapter.

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1815, as added Pub. L. 89-97, 
title I, Sec. 102(a), July 30, 1965, 79 Stat. 297; amended Pub. L. 94-
182, title I, Sec. 112(a)(2), Dec. 31, 1975, 89 Stat. 1055; Pub. L. 95-
142, Sec. 2(a)(2), Oct. 25, 1977, 91 Stat. 1175; Pub. L. 96-473, 
Sec. 6(i), Oct. 19, 1980, 94 Stat. 2266; Pub. L. 97-248, title I, 
Secs. 117(a)(1), 148(b), Sept. 3, 1982, 96 Stat. 354, 394; Pub. L. 99-
509, title IX, Sec. 9311(a)(1), Oct. 21, 1986, 100 Stat. 1996; Pub. L. 
101-239, title VI, Sec. 6021(a), Dec. 19, 1989, 103 Stat. 2166; Pub. L. 
105-33, title IV, Sec. 4603(b), Aug. 5, 1997, 111 Stat. 470.)


                               Amendments

    1997--Subsec. (e)(2)(C) to (E). Pub. L. 105-33 inserted ``and'' at 
end of subpar. (C), redesignated subpar. (E) as (D), and struck out 
former subpar. (D) which read as follows: ``home health services; and''.
    1989--Subsec. (e)(4). Pub. L. 101-239 added par. (4).
    1986--Subsec. (e). Pub. L. 99-509 added subsec. (e).
    1982--Subsec. (b). Pub. L. 97-248, Sec. 148(b), substituted 
``quality control and peer review organization'' for ``Professional 
Standards Review Organization'' wherever appearing.
    Subsec. (d). Pub. L. 97-248, Sec. 117(a)(1), added subsec. (d).
    1980--Subsec. (c). Pub. L. 96-473 substituted ``for or in connection 
with'' for ``for on in connection with''.
    1977--Subsec. (c). Pub. L. 95-142 added subsec. (c).
    1975--Pub. L. 94-182 designated existing provisions as subsec. (a) 
and added subsec. (b).


                    Effective Date of 1997 Amendment

    Amendment by Pub. L. 105-33 applicable to cost reporting periods 
beginning on or after Oct. 1, 1999, except as otherwise provided, see 
section 4603(d) of Pub. L. 105-33, set out as an Effective Date note 
under section 1395fff of this title.


                    Effective Date of 1989 Amendment

    Section 6021(b) of Pub. L. 101-239 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to payments 
made for discharges occurring on or after the expiration of the 30-day 
period that begins on the date of the enactment of this Act [Dec. 19, 
1989], regardless of the date of the merger or consolidation involved.''


                    Effective Date of 1986 Amendment

    Section 9311(a)(2) of Pub. L. 99-509 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall apply to claims 
received on or after July 1, 1987.''


                    Effective Date of 1982 Amendment

    Section 117(b) of Pub. L. 97-248 provided that: ``The amendments 
made by subsection (a) [amending this section and section 1395l of this 
title] apply to final determinations made on or after the date of the 
enactment of this Act [Sept. 3, 1982].''
    Amendment by section 148(b) 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 1977 Amendment

    Section 2(a)(4) of Pub. L. 95-142 provided that: ``The amendments 
made by this subsection [amending this section and sections 1395u and 
1396a of this title] shall apply with respect to care and services 
furnished on or after the date of the enactment of this Act [Oct. 25, 
1977].''


                    Effective Date of 1975 Amendment

    Amendment by Pub. L. 94-182 effective with respect to utilization 
review activities conducted on and after the first day of the first 
month which begins more than 30 days after Dec. 31, 1975, see section 
112(d) of Pub. L. 94-182, set out as a note under section 1395x of this 
title.


                               Transition

    Section 9311(a)(3) of Pub. L. 99-509 provided that: ``Upon the 
request of a hospital which--
        ``(A) as of June 30, 1987, is receiving payments under part A of 
    title XVIII of such Act [this part] for inpatient hospital services 
    on a periodic interim payment basis,
        ``(B) requests continuation of payment on such basis, and
        ``(C) is paid through an agency or organization with an 
    agreement under section 1816 of such Act [section 1395h of this 
    title],
the Secretary of Health and Human Services shall continue payment on 
such a basis until not earlier than the end of the first period of three 
consecutive calendar months (beginning no earlier than April 1987) 
during all of which the agency or organization has met the requirements 
of section 1816(c)(2) of such Act (relating to prompt payment of 
claims).''


                   Delay in Periodic Interim Payments

    Section 120 of Pub. L. 97-248 provided that: ``Notwithstanding 
section 1815(a) of the Social Security Act [subsec. (a) of this 
section], in the case of a hospital which is paid periodic interim 
payments under such section, the Secretary of Health and Human Services 
shall provide that--
        ``(1) with respect to the last 21 days for which such payments 
    would otherwise be made during fiscal year 1983, such payments shall 
    be deferred until fiscal year 1984; and
        ``(2) with respect to the last 21 days for which such payments 
    would otherwise be made during fiscal year 1984, such payments shall 
    be deferred until fiscal year 1985.''
    Pub. L. 96-499, title IX, Sec. 959, Dec. 5, 1980, 94 Stat. 2650, 
provided for deferral of interim payments to be made during last twenty-
one days of fiscal year 1981 until fiscal year 1982, prior to repeal by 
Pub. L. 97-35, title XXI, Sec. 2155, Aug. 13, 1981, 95 Stat. 802.
