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Revised December 1980

TITLE XVIII–HEALTH INSURANCE FOR THE AGED AND DISABLED

Pages Sec. 1801. Prohibition Against Any Federal Interference...

407 Sec. 1802. Free Choice by Patient Guaranteed..

407 Sec. 1803. Option to Individuals To Obtain Other Health Insurance Pro tection...

407 PART A-HOSPITAL INSURANCE BENEFITS FOR THE AGED AND DISABLED Sec. 1811. Description of Program..

407 Sec. 1812. Scope of Benefits...

407 Services Included.

407 Services Excluded..

408 Limitation on Psychiatric Hospital Services.

408 Limitation on Post-Hospital Home Health Services. 408 Service Not Taken Into Account for Purposes of Limitation..

409 (1) Terms Defined in Section 1861..

409 Sec. 1813. Deductibles and Coinsurance..

409 (a) Reduction for Inpatient Hospital Deductible and Coinsurance Amounts..

409 (b) Amount of Inpatient Hospital Deductible...

410 Sec. 1814. Conditions of and Limitations on Payment for Services.

410 Requirement of Requests and Certifications...... 410 Amount Paid to Providers.

413 (c) No payments to Federal Providers of Services -- 413-A Payments for Emergency Hospital Services.

414 Payment for Inpatient Hospital Services Prior to Notifcation of Noneligibility.

414 (1) Payment for Certain Inpatient Hospital Services Furnished Outside the United States...

415 (8) Payment for Services of a Physician Rendered in Teaching Hospital

416 (b) Payment for Certain Hospital Services Provided in Veterans'. Administration Hospitals.

417 Sec. 1815. Payment to Providers of Services.

417 Sec. 1816. Use of Public Agencies or Private Organizations To Facilitate Payment to Providers of Services...

420 Sec. 1817. Federal Hospital Insurance Trust Fund..

420-D Sec. 1818. Hospital Insurance Benefits for Uninsured Individuals Not Otherwise Eligible....

424 PART B-SUPPLEMENTARY MEDICAL INSURANCE BENEFITS FOR THE

AGED AND DISABLED Sec. 1831. Establishment of Supplementary Medical Insurance Program for the Aged and the Disabled....

425 Sec. 1832. Scope of Benefits..

426 Sec. 1833. Payments of Benefits..

427 Sec. 1834. [Repealed.)

433 Sec. 1835. Procedure for Payment of Claims of Providers of Services-- 433 Sec. 1836. E'igit le Individuals.

437 Sec. 1837. Enrollment Periods_

437 Sec. 1838. Coverage Period.-

438-A Sec. 1839. Amounts of Premiums..

438-0 Sec. 1840. Payment of Premiums.

439 1 Thla table of contenta dous not appear in the law.

PART B-SUPPLEMENTARY MEDICAL INBURANCE BENEFITS
POB THE AGED AND DISABLED Continued

Page Sec. 1841. Federal Supplementary Medical Insurance Trust Fund... 441 Sec. 1842. Use of Carriers for Administration of Benefits...

443 Sec. 1843. State Agreements for Coverage of Eligible Individuals Who Are

Receiving Money Payments Under Public Assistance Pro-
grams (or Are Eligible for Medical Assistance)

448-C Sec. 1844. Appropriations To Cover Government Contributions and Contingency Reserve...

451 PART C-MISCELLANEOUS PROVISIONS Sec. 1861. Definition of Services, Institutions, etc.

452 Spell of Illness.

452 Inpatient Hospital Services..

452 Inpatient Psychiatric Hospital Services.

453 Inpatient Tuberculosis Hospital Services.

453 Hospital.

453 (1) Psychiatric Hospital. .

456-B & Tuberculosis Hospital.

456 Extended Care Services..

457 Post-Hospital Extended Care Services..

457 Skilled Nursing Facility-.

458 Utilization Review..

460 Agreements for Transfer Between Skilled Nursing Facilities and Hospitals.

461 Home Health Services..

462 (n) (Repealed.] Home Health Agency..

463 Outpatient Physical Therapy Services.

464 Physicians' Services....

465 Physician

465 Medical and Other Health Services.

466 Drugs and Biologicals..

468 1) Provider of Services_

468-A Reasonable Cost....

488-A Arrangements for Certain Services.

472 State and United States..

473 Post-Hospital Extended Care in Christian Science Skilled Nursing Facilities.

473 (z) Institutional Planning-

474 (aa) Rural Health Clinic Services.

475 (bb) (Repealed.]

477 (cc) Comprehensive Outpatient Rehabilitation Facility Services

477 Sec. 1862. Exclusions From Coverage.

479 Sec. 1863. Consultation With State Agencies and Other Organizations To

Develop Conditions of Participation for Providers of Services.
Sec. 1864. Use of State Agencies To Determine Compliance by Providers

of Services With Conditions of Participation..
Sec. 1865. Effect of Accreditation...
Sec. 1866. Agreements With Providers of Services.
Sec. 1867. Health Insurance Benefits Advisory Council.

485 Sec. 1868. (Repealed.) Sec. 1869. Determinations; Appeals.

486 Sec. 1870. Overpayments on Behalf of Individuals and Settlement of

Claims for Benefits on Behalf of Deceased Individuals.... 487 Sec. 1871. Regulations.

490 Sec. 1872. Application of Certain Provisions of Title II..

490-A Sec. 1873. Designation of Organization or Publication by Name.

491 Sec. 1874. Administration..

491 Sec. 1875. Studies and Recommendations...

491 Sec. 1876. Payments to Health Maintenance Organizations.

492 Sec. 1977. Penalties..

501 Sec. 1878. Provider Reimbursement Review Board.

502-A Sec. 1879. Limitation on Liability of Beneficiary Where Medicare Claims Are Disallowed...

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Sec. 1880. Indian Health Service Facilities..

506 Sec. 1881. Medicare Coverage for End Stage Renal Disease Patients.--- 506-A Sec. 1882. Voluntary Certification of Medicare Supplemental Health Insurance Policies..

506-1 Sec. 1883. Hospital Providers of Extended Care Services..

608-0 Sec. 1884. Payments to Promote Closing and Conversion of Underutilized Hospital Facilities.

506-Q Sec. 1885. Withholding of Payments for Certain Medicaid Providers.- 606-8

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Prohibition Against Any Federal Interference Section 1801. Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.

Free Choice by Patient Guaranteed Sec. 1802. Any individual entitled to insurance benefits under this title may obtain health services from any institution, agency, or person qualified to participate under this title if such institution, agency, or person undertakes to provide him such services. Option to Individuals To Obtain Other Health Insurance

Protection Sec. 1803. Nothing contained in this title shall be construed to preclude any State from providing, or any individual from purchasing or otherwise securing, protection against the cost of any health services.

Part A-Hospital Insurance Benefits for the Aged and Disabled

Description of Program Sec. 1811. The insurance program for which entitlement is established by sections 226 and 226A provides basic protection against the costs of hospital, related post-hospital, and home health services in accordance with this part for (1) individuals who are age 65 or over and are eligible for retirement benefits under title II of this Act or under the railroad retirement system, (2) individuals under age 65 who have been entitled for not less than 24 months to benefits under title II of this Act or under the railroad retirement system on the basis of a disability, and (3) certain individuals who do not meet the conditions specified in either clause (1) or (2) but who are medically determined to have end stage renal disease.”

Scope of Benefits Sec. 1812. (a) 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 1814(d) (2) to him (subject to the provisions of this part) for

(1) inpatient hospital services for up to 150 days during any spell of illness minus one day for each day of inpatient hospital

1 Sec. 1811 was amended by sec. 4(a) of P.L. 95–292, sec. 103 of P.L. 96–265, by sec. 2(b) of P.L. 96-473, and, with respect to services furnished on or after July 1, 1981, by sec. 930(a) of P.L 96–499.

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