
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC1395v]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XVIII--HEALTH INSURANCE FOR AGED AND DISABLED
 
 Part B--Supplementary Medical Insurance Benefits for Aged and Disabled
 
Sec. 1395v. Agreements with States


(a) Duty of Secretary; enrollment of eligible individuals

    The Secretary shall, at the request of a State made before January 
1, 1970, or during 1981 or after 1988, enter into an agreement with such 
State pursuant to which all eligible individuals in either of the 
coverage groups described in subsection (b) of this section (as 
specified in the agreement) will be enrolled under the program 
established by this part.

(b) Coverage of groups to which applicable

    An agreement entered into with any State pursuant to subsection (a) 
of this section may be applicable to either of the following coverage 
groups:
        (1) individuals receiving money payments under the plan of such 
    State approved under subchapter I of this chapter or subchapter XVI 
    of this chapter; or
        (2) individuals receiving money payments under all of the plans 
    of such State approved under subchapters I, X, XIV, and XVI of this 
    chapter, and part A of subchapter IV of this chapter.

Except as provided in subsection (g) of this section, there shall be 
excluded from any coverage group any individual who is entitled to 
monthly insurance benefits under subchapter II of this chapter or who is 
entitled to receive an annuity under the Railroad Retirement Act of 1974 
[45 U.S.C. 231 et seq.]. Effective January 1, 1974, and subject to 
section 1396a(f) of this title, the Secretary shall, at the request of 
any State not eligible to participate in the State plan program 
established under subchapter XVI of this chapter, continue in effect the 
agreement entered into under this section with such State subject to 
such modifications as the Secretary may by regulations provide to take 
account of the termination of any plans of such State approved under 
subchapters I, X, XIV, and XVI of this chapter and the establishment of 
the supplemental security income program under subchapter XVI of this 
chapter.

(c) Eligible individuals

    For purposes of this section, an individual shall be treated as an 
eligible individual only if he is an eligible individual (within the 
meaning of section 1395o of this title) on the date an agreement 
covering him is entered into under subsection (a) of this section or he 
becomes an eligible individual (within the meaning of such section) at 
any time after such date; and he shall be treated as receiving money 
payments described in subsection (b) of this section if he receives such 
payments for the month in which the agreement is entered into or any 
month thereafter.

(d) Monthly premiums; coverage periods

    In the case of any individual enrolled pursuant to this section--
        (1) the monthly premium to be paid by the State shall be 
    determined under section 1395r of this title (without any increase 
    under subsection (b) thereof);
        (2) his coverage period shall begin on whichever of the 
    following is the latest:
            (A) July 1, 1966;
            (B) the first day of the third month following the month in 
        which the State agreement is entered into;
            (C) the first day of the first month in which he is both an 
        eligible individual and a member of a coverage group specified 
        in the agreement under this section; or
            (D) such date as may be specified in the agreement; and

        (3) his coverage period attributable to the agreement with the 
    State under this section shall end on the last day of whichever of 
    the following first occurs:
            (A) the month in which he is determined by the State agency 
        to have become ineligible both for money payments of a kind 
        specified in the agreement and (if there is in effect a 
        modification entered into under subsection (h) of this section) 
        for medical assistance, or
            (B) the month preceding the first month for which he becomes 
        entitled to monthly benefits under subchapter II of this chapter 
        or to an annuity or pension under the Railroad Retirement Act of 
        1974 [45 U.S.C. 231 et seq.].

(e) Subsection (d)(3) terminations deemed resulting in section 1395p 
        enrollment

    Any individual whose coverage period attributable to the State 
agreement is terminated pursuant to subsection (d)(3) of this section 
shall be deemed for purposes of this part (including the continuation of 
his coverage period under this part) to have enrolled under section 
1395p of this title in the initial general enrollment period provided by 
section 1395p(c) of this title. The coverage period under this part of 
any such individual who (in the last month of his coverage period 
attributable to the State agreement or in any of the following six 
months) files notice that he no longer wishes to participate in the 
insurance program established by this part, shall terminate at the close 
of the month in which the notice is filed.

(f) ``Carrier'' as including State agency; provisions facilitating 
        deductions, coinsurance, etc., and leading to economy and 
        efficiency of operation

    With respect to eligible individuals receiving money payments under 
the plan of a State approved under subchapter I, X, XIV, or XVI of this 
chapter, or part A of subchapter IV of this chapter, or eligible to 
receive medical assistance under the plan of such State approved under 
subchapter XIX of this chapter, if the agreement entered into under this 
section so provides, the term ``carrier'' as defined in section 1395u(f) 
of this title also includes the State agency, specified in such 
agreement, which administers or supervises the administration of the 
plan of such State approved under subchapter I, XVI, or XIX of this 
chapter. The agreement shall also contain such provisions as will 
facilitate the financial transactions of the State and the carrier with 
respect to deductions, coinsurance, and otherwise, and as will lead to 
economy and efficiency of operation, with respect to individuals 
receiving money payments under plans of the State approved under 
subchapters I, X, XIV, and XVI of this chapter, and part A of subchapter 
IV of this chapter, and individuals eligible to receive medical 
assistance under the plan of the State approved under subchapter XIX of 
this chapter.

(g) Subsection (b) exclusions from coverage groups

    (1) The Secretary shall, at the request of a State made before 
January 1, 1970, or during 1981 or after 1988, enter into a modification 
of an agreement entered into with such State pursuant to subsection (a) 
of this section under which the second sentence of subsection (b) of 
this section shall not apply with respect to such agreement.
    (2) In the case of any individual who would (but for this 
subsection) be excluded from the applicable coverage group described in 
subsection (b) of this section by the second sentence of such 
subsection--
        (A) subsections (c) and (d)(2) of this section shall be applied 
    as if such subsections referred to the modification under this 
    subsection (in lieu of the agreement under subsection (a) of this 
    section), and
        (B) subsection (d)(3)(B) of this section shall not apply so long 
    as there is in effect a modification entered into by the State under 
    this subsection.

(h) Modifications respecting subsection (b) coverage groups

    (1) The Secretary shall, at the request of a State made before 
January 1, 1970, or during 1981 or after 1988, enter into a modification 
of an agreement entered into with such State pursuant to subsection (a) 
of this section under which the coverage group described in subsection 
(b) of this section and specified in such agreement is broadened to 
include (A) individuals who are eligible to receive medical assistance 
under the plan of such State approved under subchapter XIX of this 
chapter, or (B) qualified medicare beneficiaries (as defined in section 
1396d(p)(1) of this title).
    (2) For purposes of this section, an individual shall be treated as 
eligible to receive medical assistance under the plan of the State 
approved under subchapter XIX of this chapter if, for the month in which 
the modification is entered into under this subsection or for any month 
thereafter, he has been determined to be eligible to receive medical 
assistance under such plan. In the case of any individual who would (but 
for this subsection) be excluded from the agreement, subsections (c) and 
(d)(2) of this section shall be applied as if they referred to the 
modification under this subsection (in lieu of the agreement under 
subsection (a) of this section), and subsection (d)(2)(C) of this 
section shall be applied (except in the case of qualified medicare 
beneficiaries, as defined in section 1396d(p)(1) of this title) by 
substituting ``second month following the first month'' for ``first 
month''.
    (3) In this subsection, the term ``qualified medicare beneficiary'' 
also includes an individual described in section 1396a(a)(10)(E)(iii) of 
this title.

(i) Enrollment of qualified medicare beneficiaries

    For provisions relating to enrollment of qualified medicare 
beneficiaries under part A of this subchapter, see section 1395i-2(g) of 
this title.

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1843, as added Pub. L. 89-97, 
title I, Sec. 102(a), July 30, 1965, 79 Stat. 312; amended Pub. L. 89-
384, Sec. 4(a), (b), Apr. 8, 1966, 80 Stat. 105; Pub. L. 90-248, title 
II, Secs. 222(a), (b), (e), 241(e), Jan. 2, 1968, 81 Stat. 900, 901, 
917; Pub. L. 93-233, Sec. 18(l), Dec. 31, 1973, 87 Stat. 970; Pub. L. 
93-445, title III, Sec. 308, Oct. 16, 1974, 88 Stat. 1358; Pub. L. 96-
499, title IX, Secs. 945(e), 947(a), (c), Dec. 5, 1980, 94 Stat. 2642, 
2643; Pub. L. 98-21, title VI, Sec. 606(a)(3)(E), Apr. 20, 1983, 97 
Stat. 171; Pub. L. 98-369, div. B, title III, Sec. 2354(b)(15), July 18, 
1984, 98 Stat. 1101; Pub. L. 100-360, title III, Sec. 301(e)(1), July 1, 
1988, 102 Stat. 749; Pub. L. 100-485, title VI, Sec. 608(d)(14)(H), Oct. 
13, 1988, 102 Stat. 2416; Pub. L. 101-239, title VI, Sec. 6013(b), Dec. 
19, 1989, 103 Stat. 2164; Pub. L. 101-508, title IV, Sec. 4501(d), Nov. 
5, 1990, 104 Stat. 1388-165.)

                       References in Text

    Part A of subchapter IV of this chapter, referred to in subsecs. 
(b)(2) and (f), is classified to section 601 et seq. of this title.
    The Railroad Retirement Act of 1974, referred to in subsec. 
(d)(3)(B), is act Aug. 29, 1935, ch. 812, as amended generally by Pub. 
L. 93-445, title I, Sec. 101, Oct. 16, 1974, 88 Stat. 1305, which is 
classified generally to subchapter IV (Sec. 231 et seq.) of chapter 9 of 
Title 45, Railroads. For further details and complete classification of 
this Act to the Code, see Codification note set out preceding section 
231 of Title 45, section 231t of Title 45, and Tables.
    Part A of this subchapter, referred to in subsec. (i), is classified 
to section 1395c et seq. of this title.


                               Amendments

    1990--Subsec. (h)(3). Pub. L. 101-508 added par. (3).
    1989--Subsec. (i). Pub. L. 101-239 added subsec. (i).
    1988--Subsecs. (a), (g)(1). Pub. L. 100-360, Sec. 301(e)(1)(A), 
formerly Sec. 301(e)(1), as redesignated by Pub. L. 100-485, 
Sec. 608(d)(14)(H)(i), inserted ``or after 1988'' after ``during 1981''.
    Subsec. (h)(1). Pub. L. 100-360, Sec. 301(e)(1)(A), formerly 
Sec. 301(e)(1), as redesignated by Pub. L. 100-485, 
Sec. 608(d)(14)(H)(i), inserted ``or after 1988'' after ``during 1981''.
    Pub. L. 100-360, Sec. 301(e)(1)(B), as added by Pub. L. 100-485, 
Sec. 608(d)(14)(H)(ii), inserted cl. (A) designation after ``include'' 
and added cl. (B).
    Subsec. (h)(2). Pub. L. 100-360, Sec. 301(e)(1)(C), as added by Pub. 
L. 100-485, Sec. 608(d)(14)(H)(ii), inserted ``(except in the case of 
qualified medicare beneficiaries, as defined in section 1396d(p)(1) of 
this title)'' after ``shall be applied''.
    1984--Subsec. (d)(3)(B). Pub. L. 98-369 substituted ``1974'' for 
``1937''.
    1983--Subsec. (d)(1). Pub. L. 98-21 substituted ``without any 
increase under subsection (b) thereof'' for ``without any increase under 
subsection (c) thereof''.
    1980--Subsec. (a). Pub. L. 96-499, Sec. 945(e), inserted ``or during 
1981,'' after ``January 1, 1970,''.
    Subsec. (e). Pub. L. 96-499, Sec. 947(a), inserted provision that 
the coverage period under this part of any individual who filed notice 
that he no longer wished to participate in the insurance program 
established by this part was to terminate at the close of the month in 
which the notice was filed.
    Subsec. (g)(1). Pub. L. 96-499, Sec. 945(e), inserted ``or during 
1981,'' after ``January 1, 1970,''.
    Subsec. (g)(2)(C). Pub. L. 96-499, Sec. 947(c)(3), struck out cl. 
(C) which authorized individuals facing exclusion from the applicable 
coverage group to terminate their enrollment under this part by the 
filing of a notice indicating he no longer wished to participate in the 
insurance program established by this part.
    Subsec. (h)(1). Pub. L. 96-499, Sec. 945(e), inserted ``or during 
1981,'' after ``January 1, 1970,''.
    1974--Subsec. (b). Pub. L. 93-445 substituted ``under the Railroad 
Retirement Act of 1974'' for ``or pension under the Railroad Retirement 
Act of 1937''.
    1973--Subsec. (b). Pub. L. 93-233 provided for continuation of State 
agreements for coverage of certain individuals in connection with 
establishment of supplemental security income program.
    1968--Pub. L. 90-248, Sec. 222(b)(4), inserted ``(or are eligible 
for medical assistance)'' in section catchline.
    Subsec. (a). Pub. L. 90-248, Sec. 222(e)(1), substituted ``1970'' 
for ``1968''.
    Subsec. (b)(2). Pub. L. 90-248, Sec. 241(e)(1), struck out ``IV,'' 
after ``I,'' and inserted ``, and part A of subchapter IV of this 
chapter'' after ``XVI of this chapter''.
    Subsec. (c). Pub. L. 90-248, Sec. 222(e)(2), struck out ``and before 
January 1, 1968'' after ``such date'' and ``before January 1968'' after 
``thereafter'' just before the period.
    Subsec. (d)(2)(D). Pub. L. 90-248, Sec. 222(e)(3), struck out ``(not 
later than January 1, 1968)'' after ``such date''.
    Subsec. (d)(3)(A). Pub. L. 90-248, Sec. 222(b)(1), substituted 
``ineligible both for money payments of a kind specified in the 
agreement and (if there is in effect a modification entered into under 
subsection (h) of this section) for medical assistance'' for 
``ineligible for money payments of a kind specified in the agreement''.
    Subsec. (f). Pub. L. 90-248, Sec. 222(b)(2), inserted ``or eligible 
to receive medical assistance under the plan of such State approved 
under subchapter XIX of this chapter'' and ``, and individuals eligible 
to receive medical assistance under the plan of the State approved under 
subchapter XIX of this chapter'' after ``or part A of subchapter IV of 
this chapter'' and ``, and part A of subchapter IV of this chapter'', 
respectively.
    Pub. L. 90-248, Sec. 241(e)(2), struck out ``IV,'' before ``X,'' in 
two places, and inserted ``or part A of subchapter IV of this chapter,'' 
after ``XVI of this chapter,'' first place it appears in first sentence 
and ``, and part A of subchapter IV of this chapter'' after ``XVI of 
this chapter'' in second sentence.
    Subsec. (g)(1). Pub. L. 90-248, Sec. 222(b)(3), substituted ``1970'' 
for ``1968''.
    Subsec. (h). Pub. L. 90-248, Sec. 222(a), added subsec. (h).
    1966--Subsec. (b). Pub. L. 89-384, Sec. 4(a), inserted reference to 
subsec. (g) in exclusionary provision.
    Subsec. (g). Pub. L. 89-384, Sec. 4(b), added subsec. (g).


                    Effective Date of 1990 Amendment

    Amendment by Pub. L. 101-508 applicable to calendar quarters 
beginning on or after Jan. 1, 1991, without regard to whether or not 
regulations to implement such amendment are promulgated by such date, 
see section 4501(f) of Pub. L. 101-508, set out as a note under section 
1396a of this title.


                    Effective Date of 1989 Amendment

    Amendment by Pub. L. 101-239 effective Jan. 1, 1990, see section 
6013(c) of Pub. L. 101-239, set out as a note under section 1395i-2 of 
this title.


                    Effective Date of 1988 Amendments

    Amendment by Pub. L. 100-485 effective as if included in the 
enactment of the Medicare Catastrophic Coverage Act of 1988, Pub. L. 
100-360, see section 608(g)(1) of Pub. L. 100-485, set out as a note 
under section 704 of this title.
    Section 301(e)(3) of Pub. L. 100-360 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall take effect on 
January 1, 1989, and the amendments made by paragraph (2) [amending 
section 1396a of this title] shall take effect on July 1, 1989.''


                    Effective Date of 1984 Amendment

    Amendment by 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 Amendment; Transitional Rule

    Amendment by Pub. L. 98-21 applicable to premiums for months 
beginning with January 1984, but for months after June 1983 and before 
January 1984, the monthly premium for June 1983 shall apply to 
individuals enrolled under parts A and B of this subchapter, see section 
606(c) of Pub. L. 98-21, set out as a note under section 1395r of this 
title.


                    Effective Date of 1980 Amendment

    Section 947(d) of Pub. L. 96-499 provided that: ``The amendments 
made by this section [amending this section and section 1395q of this 
title] apply to notices filed after the third calendar month beginning 
after the date of the enactment of this Act [Dec. 5, 1980].''


                    Effective Date of 1974 Amendment

    Amendment by Pub. L. 93-445 effective Jan. 1, 1975, see section 603 
of Pub. L. 93-445, set out as a note under section 402 of this title.


                    Effective Date of 1973 Amendment

    Amendment by Pub. L. 93-233 effective Jan. 1, 1974, see section 
18(z-3)(1) of Pub. L. 93-233.


  Termination Period for Certain Individuals Covered Pursuant to State 
                               Agreements

    Section 947(e) of Pub. L. 96-499 provided that: ``The coverage 
period under part B of title XVIII of the Social Security Act [this 
part] of an individual whose coverage period attributable to a State 
agreement under section 1843 of such Act [this section] is terminated 
and who has filed notice before the end of the third calendar month 
beginning after the date of the enactment of this Act [Dec. 5, 1980] 
that he no longer wishes to participate in the insurance program 
established by part B of title XVIII shall terminate on the earlier of 
(1) the day specified in section 1838 [section 1395q of this title] 
without the amendments made by this section, or (2) (unless the 
individual files notice before the day specified in this clause that he 
wishes his coverage period to terminate as provided in clause (1)) the 
day on which his coverage period would terminate if the individual filed 
notice in the fourth calendar month beginning after the date of the 
enactment of this Act.''


   District of Columbia; Agreement of Commissioner With Secretary for 
                     Supplementary Medical Insurance

    Pub. L. 90-227, Sec. 2, Dec. 27, 1967, 81 Stat. 745, provided that: 
``The Commissioner [now Mayor of District of Columbia] may enter into an 
agreement (and any modifications of such agreement) with the Secretary 
under section 1843 of the Social Security Act [this section] pursuant to 
which (1) eligible individuals (as defined in section 1836 of the Social 
Security Act) [section 1395o of this title] who are eligible to receive 
medical assistance under the District of Columbia's plan for medical 
assistance approved under title XIX of the Social Security Act 
[subchapter XIX of this chapter] will be enrolled in the supplementary 
medical insurance program established under part B of title XVIII of the 
Social Security Act [this part], and (2) provisions will be made for 
payment of the monthly premiums of such individuals for such program.''

                  Section Referred to in Other Sections

    This section is referred to in sections 1395i-2, 1395q, 1395s, 1396a 
of this title.
