text:
Page:United States Statutes at Large Volume 86.djvu/1404

 1362

Ante, pp. 1341, 1350, 1351.

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

such period was determined (under section 216(i) of the Social Security Act) to be a period of disability as to such individual; and (2) the application giving rise to the determination (under such / i section 216(i)) that such period is a period of disability as to such individual would not have been accepted as an application for such a determination except for the provisions of section 216(i) (2)(F). (b) No payment shall be made to any individual by reason of the l^rovisions of subsection (a) except upon the basis of an application filed after the date of enactment of this sedtion. R E C O M P U T A T I O N OF B E N E F I T S BASED O N COMBINED RAILROAD A N D SOCIAL n.H;;vK';n, '-i,,,r fu,;^^.-,:;

42 USC 4 1 5.

Ante, p. 1340. Ante, p p. 1350, 1351.

42 USC 4 0 5. 81 Stat. 864; Post, p. 1369. 42 USC 4 1 5.

SECURITY E A R N I N G S

SEC. 134. (a) Section 215(f) of the Social Security Act is amended— (1) by striking out subparagraph (B) of paragraph (2) and inserting in lieu thereof the following: " (B) in the case of an individual who died in such year, for ty monthly benefits beginning with benefits for the month in which he died."; and (2) by adding at the end the following new paragraph: "(6) Upon the death after 1967 of an individual entitled to benefits under section 202(a) or section 223, if any person is entitled to monthly benefits or a lump-sum death payment, on the wages and selfemployment income of such individual, the Secretary shall recompute the decedent's primary insurance amount, but only if the decedent during his lifetime was paid compensation which was treated under section 205(o) as remuneration for employment." (b) Section 215(d)(2) of such Act is amended by inserting "or (6) " before the period at the end thereof. C H A N G E S I N TAX

79 Stat. 394; 81 Stat. 8 3 5. 26 USC 1401.

26 USC 3 1 0 1.

,;;

SCHEDUI^S

SEC. 135. (a)(1) Section 1401(a) of the Internal Revenue Code of 1954 (relating to rate of tax on self-employment income for purposes of old-age, survivors, and disability insurance) is amended— (A) by striking out "1978" in paragraph (3) and inserting in lieu thereof "1973"; and (B) by striking out paragraphs (4) and (5) and inserting in i' lieu thereof the following: "(4) in the case of any taxable year beginning after December 31, 1972, the tax shall be equal to 7.0 percent of the amount of the self-employment income for such taxable year." (2) Section 3101(a) of such Code (relating to rate of tax on employees for purposes of old-age, survivors, and disability insurance) is amended (A) by striking out "any of the calendar years 1971 through 1977" and inserting in lieu thereof "the calendar years 1971 and 1972" and (B) by striking out paragraphs (4) and (5) and inserting in lieu thereof the following:

�


text:
Page:United States Statutes at Large Volume 86.djvu/1405

 86 STAT. ]

PUBLIC LAW 92-603-OCT. 30, 1972

"(4) with respect to wages received during the calendar years 1973, 1974, 1975, 1976, and 1977, the rate shall be 4.85 percent; "(5) with respect to wages received during the calendar years 1978 through 2010, the rate shall be 4.80 percent; and "(6) with respect to wages received after December 31, 2010, the rate shall be 5.85 percent." (3) Section 3111(a) of such Code (relating to rate of tax on employers for purposes of old-age, survivors, and disability insurance) is amended (A) by striking out "any of the calendar years 1971 through 1977" and inserting in lieu thereof "the calendar years 1971 and 1972" and (B) by striking out paragraphs (4) and (5) and inserting in lieu thereof the following: " (4) with respect to wages paid during the calendar years 1973, 1974, 1975, 1976, and 1977, the rate shall be 4.85 percent; " (5) with respect to wages paid during the calendar years 1978 through 2010, the rate shall be 4.80 percent; and "(6) with respect to wages paid after December 31, 2010, the rate shall be 5.85 percent." (b)(1) Section 1401(b) of such Code (relating to rate of tax on self-employment income for purposes of hospital insurance) is amended by striking out paragraphs (2) through (5) and inserting in lieu thereof the following: "(2) in the case of any taxable year beginning after December 31, 1972, and before January 1, 1978, the tax shall be equal to 1.0 percent of the amount of the self-employment income for such taxable year; "(3) in the case of any taxable year beginning after December 31, 1977, and before January 1, 1981, the tax shall be equal to 1.25 percent of the amount of the self-employment income for such taxable year; "(4) in the case of any taxable year beginning after December 31, 1980, and before January 1, 1986, the tax shall be equal to 1.35 percent of the amount of the self-employment income for such taxable year; "(5) in the case of any taxable year beginning after December 31, 1985, the tax shall be equal to 1.45 percent of the amount of the self-employment income for such taxable year." (2) Section 3101(b) of such Code (relating to rate of tax on employees for purposes of hospital insurance) is amended by striking out paragraphs (2) through (5) and inserting in lieu thereof the following: "(2) with respect to wages received during the calendar years 1973, 1974, 1975, 1976, and 1977, the rate shall be 1.0 percent; "(3) with respect to wages received during the calendar years 1978, 1979, and 1980, the rate shall be 1.25 percent; "(4) with respect to wages received during the calendar years 1981, 1982, 1983, 1984, and 1985, the rate shall be 1.35 percent; and "(5) with respect to wages received after December 31, 1985, the rate shall be 1.45 percent."

1363

^"'^' P- 42i.

•;.,

^"'«. P- 42I.

^"<e, p. 421.

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license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/


text:
Page:United States Statutes at Large Volume 86.djvu/1406

 1364

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

Ante, p. 422.

(3^ Section 3111(b) of such Code (relating to rate of tax on employers for purposes of hospital insurance) is amended by striking out paragraphs (2) through (5) and inserting in lieu thereof the following: "(2) with respect to wages paid during the calendar years 1973, 1974, 1975, 1976, and 1977, the rate shall be 1.0 percent; ' "(3) with respect to wages paid during the calendar years i." 1978, 1979, and 1980, the rate shall be 1.25 percent; "(4) with respect to wages paid during the calendar years 1981, 1982, 1983, 1984, and 1985, the rate shall be 1.35 percent; and i. "(5) with respect to wages paid after December 31, 1985, the rate shall be 1.45 percent." Effective date. (c) The amendments made by subsectious (a)(1) and (b)(1) shall apply only with respect to taxable years beginning after December 31, 1972. The remaining amendments made by this section shall apply only with respect to remuneration paid after December 31, 1972. ALLOCATION TO DISABILITY INSURANCE T R U S T F U N D

Ante, p. 422.

g^c. 136. (a) Section 201(b)(1) of the Social Security amended— (1) by striking out " (E) 1.0" and inserting in lieu " (E) 1.1", (2) by striking out " (F) 1.1" and inserting in lieu (3) by striking out " (G) 1.4" and inserting in lieu " (G) 1.5". (b) Section 201(b)(2) of such Act is amended— (1) by striking out " (E) 0.75" and inserting in lieu ' " (E) 0.795", (2) by striking out " (F) 0.825" and inserting in lieu ,'; " (F) 0.84", and ' (3) by striking out " (G) 0.915" and inserting in lieu ' " (G) 0.895". M E T H O D OF I S S U A N C E OF SOCIAL SECURITY ACCOUNT
 * " (F) 1.15", and

64 Stat. 518. ^' ""^"^ ^°^-

Act is thereof thereof thereof thereof thereof thereof

NUMBERS

g^c. 137. Section 205(c)(2) of the Social Security Act is amended— (1) by inserting " (A) " immediately after " (2) "; and (2) by adding at the end thereof the following new subparagraph: " (B)(i) I n carrying out his duties under subparagraph (A), the Secretary shall take affirmative measures to assure that social security account numbers will, to the maximum extent practicable, be assigned to all members of appropriate groups or categories of individuals by assigning such numbers (or ascertaining that such numbers have already been assigned): " (I) to aliens at the time of their lawful admission to the United States either for permanent residence or under other authority of law permitting them to engage in employment in the United States and to other aliens at such time as their status is so changed as to make it lawful for them to engage in such employment; " ( II) to any individual who is an applicant for or recipient of benefits under any program financed in whole or in part from

�


text:
Page:United States Statutes at Large Volume 86.djvu/1407

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PUBLIC LAW 92-603-OCT. 30, 1972

1365

Federal funds including any child on whose behalf such benefits are claimed by another person; and " ( III) to any other individual when it appears that he could have been but was not assigned an account number under the provisions of subclauses (I) or ( II) but only after such investigation as is necessary to establish to the satisfaction of the Secretary, the identity of such individual, the fact that an account number has not already been assigned to such individual, and the fact that such individual is a citizen or a noncitizen who is not, because of his alien status, prohibited from engaging in employment; and, in carrying out such duties, the Secretary is authorized to take affirmative measures to assure the issuance of social security numbers: " ( IV) to or on behalf of children who are below school age at the request of their parents or guardians; and " (V) to children of school age at the time of their first enrollment in school, "(ii) The Secretary shall require of applicants for social security account numbers such evidence as may be necessary to establish the age, citizenship, or alien status, and true identity of such applicants, and to determine which (if any) social security account number has previously been assigned to such individual. "(iii) In carrying out the requirements of this subparagraph, the Secretary shall enter into such agreements as may be necessary with the Attorney General and other officials and with State and local welfare agencies and school authorities (including non-public school authorities)." PAYMENTS BY EMPLOYER TO DISABLED FORMER EMPLOYEE

SEC. 138. (a) Section 209 of the Social Security Act (as amended by section 122(a) of this Act) is further amended by striking out "or" Ante, p. 1354. at the end of subsection (m), by striking out the period at the end of subsection (n) and inserting in lieu thereof "; or", and by inserting after subsection (n) the following new subsection: " (o) Any payment made by an employer to an employee, if at the time such payment is made such employee is entitled to disability insurance benefits under section 223(a) and such entitlement com- ^n'e. P-1351. menced prior to the calendar year in which such payment is made, and if such employee did not perform any services for such employer during the period for which such payment is made." (b) Section 3121(a) of the Internal Revenue Code of 1954 (relating to definition of wages, and as amended by section 122(b) of this Act) Ante, p. i3S4. is further amended by striking out "or" at the end of paragraph (13), by striking out the period at the end of paragraph (14) and inserting in lieu thereof "; or", and by inserting after paragraph (14) the following new paragraph: "(15) any payment made by an employer to an employee, if
 * v-a

at the time such payment is made such employee is entitled to disability insurance benefits under section 223(a) of the Social ^' Security Act and such entitlement commenced prior to the cal-

�


text:
Page:United States Statutes at Large Volume 86.djvu/1408

 1366

PUBLIC LAW 92-603-OCT. 30, 1972

Effective date.

[86 STAT.

,,ll endar year in which such payment is made, and if such employee did not perform any services for such employer during the period for which such payment is made." (c) The amendments made by this section shall apply in the case of any payment made after December 1972. TERMINATION OF COVERAGE OF REGISTRARS OF VOTERS IN

42 USC'418".

LOUISIANA

SEC. 139. (a) Xotwithstanding the provisions of section 218(g)(1) ^^ *^^^ Social Security Act, the Secretary may, under such conditions as he deems appropriate, permit the State of Louisiana to modify its agreement entered into under section 218 of such Act so as to terminate the coverage of all employees who are in positions under the Registrars of Voters Employees' Retirement System, effective after December 1975, but only if such State files with him notice of termination on or before December 31, 1973. (b) If the coverage of such employees in positions under such retirement system is terminated pursuant to subsection (a), coverage cannot later be extended to employees in positions under such retirement system. COMPUTATION

OF INCOME

OF AMERICAN

MINISTERS A N D MEMBERS OF

RELIGIOUS ORDERS PERFORMING SERVICES OUTSIDE THE UNITED STATES

71 Stat. 523. ^2^^^^^^-

42 USC 410.

71 Stat. 523. 26 USC 1402

'J I.<!,®^a^

Effective date.

SEC. 140. (a) Section 211(a)(7) of the Social Security Act is amended(1) by striking out "and section 119" and inserting in lieu thereof ", section 119"; (2) by striking out "of the Internal Revenue Code of 1954 and, in addition, if he is a citizen of the United States performing such service as an employee of an American employer (as defined in section 210(e)_) or as a minister in a foreign country who has a congregation which is composed predominantly of citizens of the United States, without regard to " and inserting in lieu thereof a <4ii comma; and (3) by striking out "such Code" and inserting in lieu thereof "the Internal Revenue Code of 1954". (b) Section 1402(a)(8) of the Internal Revenue Code is amended— (1) by striking out "and section 119" and inserting in lieu thereof ", section 119"; and (2) by stiiking out "and, in addition, if he is a citizen of the United States performing such service as an employee of an American employer (as defined in section 3121(h)) or as a minister in a foreign country who has a congregation which is composed predominantly of citizens of the United States, without regard to " and inserting in lieu thereof a comma. (c) The amendments made by this section shall apply with respect to taxable years beginning after December 31, 1972. MODIFICATION OF STATE AGREEMENTS W I T H RESPECT TO CERTAIN STUDENTS A N D CERTAIN PART-TIME

42 USC 418.

EMPLOYEES

SEC. 141. ^a) Notwithstanding any provision of section 218 of the Social Security Act, the agreement with any State (or any modifications thereof) entered into pursuant to such section may, at the option of such State, be modified at any time prior to January 1, 1974, so as to exclude either or both of the following:

�


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Page:United States Statutes at Large Volume 86.djvu/1409

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PUBLIC LAW 92-603-OCT. 30, 1972

(1) service in any class or classes of part-time positions; or (2) service performed in the employ of a school, college, or university if such service is performed by a student who is enrolled and is regularly attending classes at such school, college, or university. (b) Any modification of such agreement pursuant to this section shall be effective with respect to services performed after the end of the calendar quarter following the calendar quarter in which such agreement is modified. (c) If any such modification terminates coverage with respect to service in any class or classes of part-time positions in any coverage roup, the Secretary of Health, Education, and Welfare and the tate may not thereafter modify such agreement so as to again make the agreement applicable to service in such positions in such coverage group; if such modification terminates coverage with respect to se]-vice performed in the employ of a school, college, or university, by a student who is enrolled and regularly attending classes at such school, college, or university, the Secretary of Health, Education, and Welfare and the State may not thereafter modify such agreement so as to again make the agreement applicable to such service performed in the employ of such school, college, or university.

1367

Effective date,

§

BENEFITS IN CASE OF CERTAIN INDIVIDUALS INTERNED DURING WORLD WAR II

SEC. 142. (a) Title II of the Social Security Act (as amended by this Act) is amended by adding at the end thereof a new section as follows:

" B E N E F I T S I N CASE OF CERTAIN INDIVIDUALS INTERNED DURING WORI^D WAR II

"SEC. 281. (a) For the purposes of this section the term 'internee' means an individual wlxo was interned during any period of time from T^ecember 7, 1941, through December 31, 1946, at a place within the United States operated by the Government of the United States for the internment of United States citizens of Japanese ancestry. "(b)(1) For purposes of determining entitlement to and the amount of any monthly benefit for any month after December 1972, or entitlement to and the amount of any lump-sum death payment in the case of a death after such month, payable under this title on the basis of the wages and self-employment income of any individual, and for puroses of section 216(i)(3), such individual shall be deemed to nave een paid during any period after he attained age 18 and for which he was an internee, wages (in addition to any wages actually paid to him) at a weekly rate of basic pay during such period as follows— "(A) in the case such individual was not employed prior to the beginning of such period, 40 multiplied by the minimum hourly rate or rates in effect at any such time under section 206(a)(1) of title 29, United States (Jode, for each full week during such period; and "^B) in the case such individual who was employed prior to the oeginning of such period, 40 multiplied by the greater of (i) the highest hourly rate received during any such employment, or (ii) the minimum hourly rate or rates m effect at any such time under section 206(a)(1) of title 29, United States Code, for each full week during such period. "(2) This subsection shall not be applicable in the case of any monthly benefit or lump-sum death payment if—

E

82-081 O - 73 - 89

"intemee."

^"<e, p. uso.

so Stat. ass.

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text:
Page:United States Statutes at Large Volume 86.djvu/1410

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PUBLIC LAW 92-603-OCT. 30, 1972

Nonapplicability.

Ante, p p, 1333, 1334, 1362. Ante,

p. 1350.

Appropriation.

42 USC 4 1 5.

[86 STAT.

" (A) a larger such benefit or payment, as the case may be, would be payable without its application; or (B) a benefit (other than a benefit payable in a lump-sum unless it is a commutation of, or a substitute for, periodic payments) which is based, in whole or in part, upon internment during any period from December 7, 1941, through December 31, 1946, at a place within the United States operated by the Government of the United States for the internment of United States citizens of Japanese ancestry, is determined by any agency or wholly owned instrumentality of the United States to be payable by it under any other law of the United States or under a system established by such agency or instrumentality. The provisions of clause (B) shall not apply in the case of any monthly benefit or lump-sum death payment under this title if its application would reduce by $0.50 or less the primary insurance amount (as computed under section 215 prior to any recomputation thereof pursuant to subsection (f) of such section) of the individual on whose wages and self-employment income such benefit or payment is based. The provisions of clause (B) shall also not apply for purposes of section 216(i)(3). "(3) Upon application for benefits, a recalculation of benefits (by reason of this section), or a lump-sum death payment on the basis of the wages and self-employment income of any individual who was an internee, the Secretary of Health, Education, and Welfare shall accept the certification of the Secretary of Defense or his designee concerning any period of time for which an internee is to receive credit under paragraph (1) and shall make a decision without regard to clause (B) of paragraph (2) of this subsection unless he has been notified by some other agency or instrumentality of the United States that, on the basis of the period for which such individual was an internee, a benefit described in clause (B) of paragraph (2) has been determined by such agency or instrumentality to be payable by it. If the Secretary of Health, Education, and Welfare has not been so notified, he shall then ascertain whether some other agency or wholly owned instrumentality of the United States has decided that a benefit described in clause (B) of paragraph (2) is payable by it. If any such agency or instrumentality has decided, or thereafter decides, that such a benefit is payable by it, it shall so notify the Secretary of Health, Education, and Welfare, and the Secretary shall certify no further benefits for payment or shall recompute the amount of any further benefits payable, as may be required by this section. "(4) Any agency or wholly owned instrumentality of the United States which is authorized by any law of the United States to pay benefits, or has a system of benefits which are based, in whole or in part, on any period for which any individual was an internee shall, at the request of the Secretary of Health, Education, and Welfare, certify to him, with respect to any individual who was an internee, such information as the Secretary deems necessary to carry out his functions under paragraph (3) of this subsection. "(c) There are authorized to be appropriated to the Trust Funds and the Federal Hospital Insurance Trust F u n d for the fiscal year ending June 30, 1978, such sums as the Secretary determines would place the Trust Funds and the Federal Hospital Insurance Trust Fund in the position in which they would have been if the preceding provisions of this section had not been enacted." (b) Section 2 1 5 (d)(1)(C) of such Act is amended by striking out "and" at the end of clause (ii), by striking out the period at the end of clause (iii), and inserting in lieu thereof ", and", and by inserting after clause (iii) the following new clause:

�


text:
Page:United States Statutes at Large Volume 86.djvu/1411

 86 STAT. ]

PUBLIC LAW 92-603-OCT. 30, 1972

"(iv) wages deemed paid prior to 1951 to such individual under section 231.". (c) Section 215(d)(2) of such Act (as amended by section 134 of this Act) is further amended by striking out the period at the end thereof and inserting in lieu thereof "or section 231.".

1369

tl'^^scUil^^'

M O D I F I C A T I O N OF A G R E E M E N T W I T H W E S T VI R G I N I A TO PROVIDE COVERAGE FOR CERTAIN P O L I C E M E N A N D

FIREMEN

SEC. 143. (a) Notwithstanding the provisions of subsection (d)(5) (A) of section 218 of the Social Security Act and the references thereto in subsections (d)(1) and (d)(3) of such section 218, the agreement with the State of West Virginia heretofore entered into pursuant to such section 218 may, at any time prior to 1974, be modified pursuant to subsection (c)(4) of such section 218 so as to apply to services performed in policemen's or firemen's positions covered by a retirement system on the date of the enactment of this Act by individuals as employees of any class III or class IV municipal corporation (as defined in or under the laws of the State) if the State of West Virginia has at any time prior to the date of the enactment of this Act paid to the Secretary of the Treasury, with respect to any of the services performed in such positions by individuals as employees of such municipal corporation, the sums prescribed pursuant to subsection (e)(1) of such section 218. For purposes of this subsection, a retirement system which covers positions of policemen or firemen, or both, and other positions, shall, if the State of West Virginia so desires, be deemed to be a separate retirement system with respect to the positions of such policemen or firemen, or both, as the case may be. (b) Notwithstanding the provisions of subsection (f) of section 218 of the Social Security Act, any modification in the agreement with the State of West Virginia under subsection (a) of this section, to the extent it involves services performed by individuals as employees of any class III or class IV municipal corporation, may be made effective with respect to— (1) all services performed by such individual, in any policeman's or fireman's position to which the modification relates, on or after the date of the enactment of this Act; and (2) all services performed by such individual in such a position before such date of enactment with respect to which the State of West Virginia has paid to the Secretary of the Treasury the sums prescribed pursuant to subsection (e)(1) of such section 218 at the time or times established pursuant to such subsection (e)(1), if and to the extent that— (A) no refund of the sums so paid has been obtained, or (B) a refund of part or all of the sums so paid has been obtained but the State of West Virginia repays to the Secretary of the Treasury the amount of such refund within ninety days after the date that the modification is agreed to by the State and the Secretary of Health, Education, and Welfare.

42 USC 4i8.

,;.

'" ' '

P E R F E C T I N G AMENDMENTS RELATED TO THE 2 0 - P E R C E N T INCREASE PROVISION ENACTED I N P U B L I C LAW 9 2 - 3 a 6

SEC, 144. (a)(1) The table in section 215(a) of the Social Security Act (as inserted by section 201(a) of Public Law 92-336) is amended— (A) in column II of such table, by striking out "251.40" and inserting in lieu thereof "254.40", and (B) in column III of such table, by striking out "699" and inserting in lieu thereof "696".

^"'e, p. 406.

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text:
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PUBLIC LAW 92-^03-OCT. 30, 1972

Ante,

p. 410.

Ante,

p. 415.

Ante,

p. 417.

Ante,

p. 406.

Ante,

p. 417.

26 USC 6413.

[86 STAT.

(2) Section 2 0 3 (a)(2)(B) of such Act (as amended by section 201(b) of Public Law 92-336) is amended by striking out "for each person" and inserting in lieu thereof "for each such person". (3) Section 2 0 3 (a)(2)(C) of such Act (as amended by section 2 0 2 (a)(2)(B) of Public Law 92-336) is amended by striking out "month including" and inserting in lieu thereof "month (including". (4) Section 230(b)(2) of such Act (as added by section 202(b)(1) of Public Law 92-336) is amended by striking out "or" at the end of clause (A) and inserting in lieu thereof "of". (b) The amendments made by each of the paragraphs in subsection (a) shall be effective in like manner as if such amendment had been included in title II of Public Law 92-336 in the particular provision of such title referred to in such paragraph. (c) Section 203(b)(6) of Public Law 92-336 is amended, effective July 1, 1972, by striking out "Section 6413(a)(2)(A) " and inserting in heu thereof "Section 6413(c)(2)(A) ". E L I M IX A T I O N OF D U R A T I O N - O F - RELATIONSHIP REQUIREMENT I N CERTAIN CASES INVOLVING SURVIVOR B E N E F I T S ( W H E R E I N S U R E D ' S DEATH WAS ACCIDENTAL OR OCCURRED I N L I N E OF DUTY W H I L E H E WAS A SERVICEMAN)

Ante,

p. 1349.

42 USC 4 0 1.

SEC. 145. (a) The first sentence of section 216(k) of the Social Security Act (as amended by section 115 of this Act) is further amended— (1) by striking out "and he would satisfy such requirement if a three-month period were substituted for the nine-month period" and inserting in lieu thereof "unless the Secretary determines that at the time of the marriage involved the individual could not have reasonably been expected to live for nine months"; and (2) by striking out "except that this subsection shall not apply" and inserting in lieu thereof "except that paragraph (2) of this subsection shall not apply". (b) The amendments made by this section shall apply only with respect to benefits payable under title II of the Social Security Act for months after December 1972 on the basis of applications filed in or after the month in which this Act is enacted. TITLE II — PROVISIONS R E L A T I N G TO M E D I C A R E, M E D I C A I D, AND M A T E R N A L AND C H I L D H E A L T H C O V E R A G E FOR DISABILITY B E N E F I C I A R I E S UNDER

MEDICARE

SEC. 201. (a)(1)(A) The heading of title X VIII of the Social Security Act is amended to read as follows: "TITLE X VIII — H E A L T H INSURANCE FOR THE AGED AND DISABLED". (B) The heading of part A of such title is amended to read as follows: "PART A—HOSPITAL INSURANCE BENEFITS FOR THE AGED AND

DISABLED".

(C) The heading of part B of such title is amended to read as follows:

�


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1371

"PART B—SUPPLEMENTARY MEDICAL INSURANCE BENEFITS FOR THE AGED AND DISABLED".

(2) The text of section 1811 of such Act is amended to read as follows:

.

.

.

"SEC. 1811. The insurance program for which entitlement is established by section 226 provides basic protection against the costs of hospital and related posthospital services in accordance with this part for (I) individuals who are age 65 or over and are entitled to retirement benefits under title II of this Act or under the railroad retirement systern and (2) individuals under age 65 who have been entitled for not less than 24 consecutive months to benefits under title II of this Act or under the railroad retirement system on the basis of a disability." (3) Section 1831 of such Act is amended— (A) by inserting "AND THE DISABLED" after "AGED" in the heading, and (B) by striking out "individuals 65 years of age or over" and inserting in lieu thereof "aged and disabled individuals". (b)(1) Section 226(a) of such Act is amended to read as follows: " (a)(1) Every individual who— " (A) has attained age 65, and " (B) is entitled to monthly insurance benefits under section 202 or is a qualified railroad retirement beneficiary, shall be entitled to hospital insurance benefits under part A of title X VIII for each month for which he meets the condition specified in subparagraph (B), beginning with the first month after June 1966 for which he meets the conditions specified in subparagraphs (A) and (B). "(b) Every individual who— " (1) has not attained age 65, and "(2)(A) is entitled to, and has for 24 consecutive calendar months been entitled to, (i) disability insurance benefits under section 223 or (ii) child's insurance benefits under section 202(d) by reason of a disability (as defined in section 223(d)) or (iii) widow's insurance benefits under section 202(e) or widowers insurance benefits under section 202(f) by reason of a disability (as defined in section 223(d)), or (B) is, and has been for not less than 24 consecutive months a disabled qualified railroad retirement beneficiary, within the meaning of section 22 of the Railroad Retirement Act of 1937, shall be entitled to hospital insurance benefits under part (A) of title X VIII for each month beginning with the later of (I) July 1973 or ( II) the twenty-fifth consecutive month of his entitlement or status as a qualified railroad retirement beneficiary described in paragraph (2), and ending with the month following the month in which notice of termination of such entitlement to benefits or status as a qualified railroad retirement beneficiary described in paragraph (2) is mailed to him, or if earlier, with the month before the month in which he attains age 65." (2) Section 226(b) of such Act is amended by striking out "occurred after June 30, 1966, or on or after the first day of the month in which he attains age 65, whichever is later" and inserting in lieu thereof "occurred (i) after June 30, 1966, or on or after the first day of the month in which he attains age 65, whichever is later, or (ii) if he was entitled to hospital insurance benefits pursuant to subsection (b), at a time when he was so entitled". (3) Section 226(b)(2) of such Act is amended by striking out "an individual shall be deemed entitled to monthly insurance benefits under section 202," and inserting in lieu thereof "an individual shall be

79 Stat. 291. 42 USC 1395C.

^"^'•«42 USC 40i.

79 Stat. 301. ^'^ ^^^ i395j.

79 stajt^-290

42 USC 426.

Ante, pp. 13351350.

^2 USC 1395.

^2 USC 423. "'*' ^' ^^^^

Post, p. 1373

42 USC 426.

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text:
Page:United States Statutes at Large Volume 86.djvu/1414

 1372

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

deemed entitled to monthly insurance benefits under section 202 or 42 USC 402, section 223,". '^"i use 426. C"^) Section 226(c) of such Act is amended by inserting "or section 22" after "section 21*' wherever it appears. Ante, p. 1371. (5) SectioH 226 of such Act is further amended by redesignating subsection (b) as subsection (c), subsection (c^ as subsection (d), and subsection (d) as subsection (f), and by inserting after subsection (d) the following new subsection: "(e)(1) For purposes of determining entitlement to hospital insurance benefits under subsection (b) in the case of widows and widowers described in paragraph (2)(A) (iii) thereof— " (A) the term 'age 60' in sections 202(e)(1)(B) (ii) and 202(e) (5), and the term 'age 62' in sections 202(f)(1)(B) (ii), and 202 (f)(6) shall be deemed to read 'age 65'; and " (B) the phrase 'before she attained age 60' in the matter following subparagraph (F) of section 202(e)(1) shall be deemed to read 'based on a disability'. "(2) For purposes of determining entitlement to hospital insurance benefits under subsection (a)(2) in the case of an individual under age 65 who is entitled to benefits under section 202, and who was entitled to widow's insurance benefits or widower's insurance benefits based on disability for the month before the first month in which such individual was so entitled to old-age insurance benefits (but ceased to be entitled to such widow's or widower's insurance benefits upon becoming entitled to such old-age insurance benefits), such individual shall be deemed to have continued to be entitled to such widow's insurance benefits or widower's insurance benefits for and after such first month. "(3) For purposes of determining entitlement to hospital insurance benefits under subsection (a)(2) any disabled widow age 50 or older who is entitled to mother's insurance benefits (and who would have been entitled to widow's insurance benefits by reason of disability if she had filed for such widow's benefits) shall, upon application, for such hospital insurance benefits be deemed to have filed for such widow's benefits and shall, upon furnishing proof of such disability prior to July 1, 1974, under such procedures as the Secretary may prescribe, be deemed to have been entitled to such widow's benefits as of the time she would have been entitled to such widow's benefits if she had filed a timely application therefor." 79 Stat. 304. (c)(1) Section 1836 of such Act is amended to read as follows: 42 USC 1395o.

V / V / u ELIGIBLE

42 USC i39Sp.

^'^"-

INDIVIDUALS

"SEC. 1836. Every individual who— " (1) is entitled to hospital insurance benefits under part A, or "(2) has attained age 65 and is a resident of the United States, and is either (A) a citizen or (B) an alien Lawfully admitted for permanent residence who has resided in the United States continuously during the 5 years immediately preceding the month in which he applies for enrollment under this part, is eligible to enroll in the insurance program established by this part." (2)(A) The first sentence of section 1837(c) of such Act is amended by striking out "paragraphs (1) and (2) " and inserting in lieu thereof "paragraph (1) or (2)". (B) The second sentence of section 1837(c) of such Act is amended to read as follows: "For purposes of this subsection and subsection (d), an individual who has attained age 65 and who satisfies paragraph (1) of section 1836 but not paragraph (2) of such section shall be treated as satisfying such paragraph (1) on the first day on which he is (or on filing application would have been) entitled to hospital insurance benefits under part A."

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Page:United States Statutes at Large Volume 86.djvu/1415

 86 STAT.]

1373

PUBLIC LAW 92-603-OCT. 30, 1972

(C) The first sentence of 1837(d) of such Act is amended by striking out "paragraphs (1) and (2) " and inserting in lieu thereof "paragraph (1) or (2)". (3)(A) Section 1838(a) of such Act is amended by striking out "July 1, 1966" in paragraph (1) and inserting in lieu thereof "July 1, 1966 or (in the case of a disabled individual who has not attained age 65) July 1, 1973". (B) Section 1838(a) of such Act is further amended— (i) by striking out "paragraphs (1) and (2) " in paragraph (2)(A) and inserting in lieu thereof "paragraph (1) or (2) "; and (ii) by striking out "such paragraphs" in subparagraphs (B), (C), and (D) and inserting in lieu thereof "such paragraph". (C) Section 1838 of such Act is further amended by redesignating subsection (c) as subsection (d), and by inserting after subsection (b) the following new subsection: "(c) In the case of an individual satisfying paragraph (1) of section 1836 whose entitlement to hospital insurance benefits under part A is based on a disability rather than on his having attained the age of 65, his coverage period (and his enrollment under this part) shall be terminated as of the close of the last month for which he is entitled to hospital insurance benefits." (4) Section 1839(c) of such Act is amended— (A) by inserting "(in the same continuous period of eligibility)" after "for each full 12 months"; and (B) by adding at the end thereof the following new sentence: "Any increase in an individual's monthly premium under the first sentence of this subsection with respect to a particular continuous period of eligibility shall not be applicable with respect to any other continuous period of eligibility which such individual may have." (5) Section 1839 of such Act is further amended by adding at the end thereof the following new subsection: "(e) For purposes of subsection (c) (and section 1837(g)(1)), an individual's 'continuous period of eligibility' is the period beginning with the first day on which he is eligible to enroll under section 1836 and ending with his death; except that any period during all of which an individual satisfied paragraph (i) of section 1836 and which terminated in or before the month preceding the month in which he attained age 65 shall be a separate 'continuous period of eligibility' with respect to such individual (and each such period which terminates shall be deemed not to have existed for purposes of subsequently applying this section)." (6)(A) Section 1840(a)(1) of such Act is amended by striking out "section 202" and inserting in lieu thereof "section 202 or 223". (B) Section 1840(a)(2) of such Act is amended by striking out "section 202" and inserting in lieu thereof "section 202 or 223". (7) Section 1875(a) of such Act is amended by striking out "aged" and inserting in lieu thereof "aged and the disabled". (d) The Railroad Retirement Act of 1937 is a«iended by adding after section 21 the following: new section:

42 USC 13.95p.

42 USC 1395q.

Ante,

p. 1372.

42 USC 139Sr.

Post,

p. 1376.

"continuous period of eligibility." Post, p. 1378. Ante,

p. 1372.

42 USC 1395s.

42 USC

139SII.

45 USC 228S-2.

H O S P I T A L INSURANCE B E X E F I T S FOR THE DISABLED

"SEC. 22. Individuals under age 65— "(1) who have been entitled to annuities for not less than 24 consecutive months during each of which the first proviso of section 3(e) could have applied on the basis of an application which has been filed under paragraph 4 or 5 of section 2(a), and are currently entitled to such annuities, or who are entitled to annui-

45 USC 228c. 45 USC 228b.

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text:
Page:United States Statutes at Large Volume 86.djvu/1416

 1374 45 USC 228b. 42 USC 423.

45 USC 228S-2.

42 USC 401. 4"use 13^5°'

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

ties under paragraph 2 or 3 of section 2(a) and could have been paid annuities for not less than 24 consecutive months under section 223 of the Social Security Act if their service as employees were included in the term 'employment' as defined in that Act, or "(2) who have been entitled to annunities under section 5(a) on the basis of disability, or could have been so entitled had they not been entitled on the basis of age or had they not been entitled under section 5(b) on the basis of having the custody of children, for not less than 24 consecutive months during each of which the first proviso of section 3(e) could have been applied on the basis of disability if an application for disability benefits had been filed, or "(3) who have been entitled to annuities for not less than 24 consecutive months under section 5(c) on the basis of a disability (within the meaning of section 5(1)(1) (ii)) or who could have been includible as disabled children for not less than 24 consecutive months in the computation of an annuity under the first proviso in section 3(e) and could currently be includible in such a computation, shall be certified by the Board in the same manner, for the same purposes, and subject to the same conditions, restrictions, and other provisions as individuals specifically described in section 21, and also subject to the same conditions, restrictions, and other provisions as .^YQ disability beneficiaries under title II of the Social Security Act in connection with their eligibility for hospital insurance benefits ^"ider pait A of title X VIII of such Act and their eligibility to enroll under part B of such title X VIII; and for the purposes of this Act and title X VIII of the Social Security Act, individuals certified as provided in this section shall be considered individuals described in and certified under such section 21. Notwithstanding the other provisions of this section it shall not apply to any individual who could not be taken into account on the basis of disability in calculating the annuity under the first proviso of section 3(e) without regard to the second paragraph of such section." HOSPITAL INSURANCE BENKFITS FOR UNINSURED INDIVIDUALS NOT ELIGIBLE UNDER TRANSITIONAL PROVISION

It ^l^J^"?^^' 42 USC 13951.

SEC. 202. Title X VIII of the Social Security Act is amended by adding after section 1817 the following new section: " H O S P I T A L INSURANCE BENEFITS?^0R I^NINSURED IXDHIDUALS NOT OTHERWISE ELIOIBLE

"SEC. 1818. (a) Every individual who— " (1) has attained the age of 65, " (2) is enrolled under part B of this title, "(3) is a resident of the United States, and is either (A) a citizen or (B) an alien lawfully admitted for permanent r-esidence who has resided in the Ignited States continuously during the 5 years immediately preceding the month in which he applies for enrollment under this section, and "(4) is not otherwise entitled to benefits under this part, shall be eligible to enroll in the insurance program established by this part. " (b) An individual may enroll under this section only in such manner and form as may be prescribed in regulations, and only during an enrollment period prescribed in or under this section.

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text:
Page:United States Statutes at Large Volume 86.djvu/1417

 86 STAT. ]

PUBLIC LAW 92-603-OCT. 30, 1972

1375

"(c) The provisions of section 1887 (except subsection (f) thereof), ^nte.p. 1372. section 1838, subsection (c) of section 1839, and subsections (f) Ante, p. 1373. and (h) of section 1840 shall apply to persons authorized to enroll under this section except that— "(1) individuals who meet the conditions of subsection (a) (1), (3), and (4) on or before the last day of the seventh month after the month in which this section is enacted may enroll under this part and (if not already so enrolled) may also enroll under part B durinjr an initial general enrollment period which shall begin on the first day of the second month which begins after the date on which this section is enacted and shall end on the last day of the tenth month after the month in which this Act is enacted; " (2) in the case of an individual who first meets the conditions of eligibility under this section on or after the first day of the eighth month after the month in which this section is enacted, the initial enrollment period shall begin on the first day of the third month before the month in which he first becomes eligible and shall end 7 months later; " (3) in the case of an individual who enrolls pursuant to paragraph (1) of this subsection, entitlement to benefits shall begin on— " (A) the first day of the second month after the month in which he enrolls, " (B) July 1, 1973, or " (C) the first day of the first month in which he meets the requirements of subsection (a), whichever is the latest; " (4) termination of coverage under this section by the filing of notice that the individual no longer wishes to participate in the hospital insurance program shall take effect at the close of the month following the month in which such notice is filed; " (5) an individual's entitlement under this section shall terminate with the month before the first month in which he becomes eligible for hospital insurance benefits under section 226 of this Act or section 103 of the Social Security Amendments of 1965; and ptstl%!^i46V ^' upon such termination, such individual shall be deemed, solely 42'use 426a. for purposes of hospital insurance entitlement, to have filed in such first month the application required to establish such entitlement; and '• (6) termination of coverage for supplementary medical insurance shall result in simultaneous termination of hospital inpurance benefits for uninsured individuals Avho are not otherwise entitled to benefits under this Act. " (d)(1) The monthly premium of each individual for each month Monthly prein his coverage period before July 1974 shall be $33. '"^"'"^' "(2) The Secretary shall, during the last calendar quarter of each year, beginning in 1973, determine and promulgate the dollar amount (whether or not such dollar amount was applicable for premiums for any prior month) which shall be applicable for premiums for months occurring in the 12-month period commencing July 1 of the next year. Such amount shall be equal to $33, multiplied by the ratio of (A) the inpatient hospital deductible for such next year, as promulgated under section 1813(b)(2), to (B) such deductible promulgated for 42 USC lagse. 1973. Any amount determined under the preceding sentence which is not a multiple of $1 shall be rounded to the nearest multiple of $1, or if midway between multiples of $1 to the next higher multiple of $1. "(e) Payment of the monthly premiums on behalf of any individual

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text:
Page:United States Statutes at Large Volume 86.djvu/1418

 1376

PUBLIC LAW 92-^03-OCT. 30, 1972

[86 STAT.

who meets the conditions of subsection (a) may be made by any public or private agency or organization under a contract or other arrangement entered nito between it and the Secretary if the Secretary determines that payment of such premiums under such contract or arrangement is administratively feasible. " (f) Amounts paid to the Secretary for coverage under this section shall be deposited in the Treasury to the credit of the Federal Hospital Insurance Trust Fund." A M O U N T OF S U P P L E M E N T A R Y MEDICAL INSURANCE

42 USC i395r.

Ante,

p. 1373.

Ante,

pp. 1333,

1334, 1369.

PREMIUM

SEC. 203. (a) Section 1839(b)(1) of the Social Security Act is amended b)^ inserting "and before July 1, 1973," after "1967". (b) Section 1839(b)(2) of such Act is amended by striking out "thereafter" and inserting in lieu thereof "ending on or before December 31, 1971". (c) Section 1839 of such Act (as amended by section 201(c)(4) and (5) of this Act) is further amended by redesignating subsections (c), (d), and (e) as subsections (d), (e), and (f), respectively, and by inserting after subsection (b) the following new subsection: "(c)(1) The Secretary shall, during December of 1972 and of each year thereafter, determine the monthly actuarial rate for enrollees age 65 and over which shall be applicable for the 12-month period commencing July 1 in the succeeding year. Such actuarial rate shall be the amount the Secretary estimates to be necessary so that the aggregate amount for such 12-month period with respect to those enrollees age 65 and over will equal one-half of the total of the benefits and administrative costs which he estimates will be payable from the Federal Supplementary Medical Insurance Trust Fund for services performed and related administrative costs incurred in such 12-month period. In calculating the monthly actuarial rate, the Secretary shall include an appropriate amount for a contingency margin. "(2J The monthly premium of each individual enrolled under this part for each month after June 1973 shall, except as provided in subsection (d), be the amount determined under paragraph (3). "(3) The Secretary shall, during December of 1972 and of each year thereafter, determine and promulgate the monthly premium applicable for the individuals enrolled under this part for the 12-month period commencing July 1 in the succeeding year. The monthly premium shall be equal to the smaller of— " (A) the monthly actuarial rate for enrollees age 65 and over, determined according to paragraph (1) of this subsection, for that 12-month period, or " (B) the monthly premium rate most recently promulgated by the Secretary under this paragraph or, in the case of the determination made in December 1971, such rate promulgated under subsection (b)(2) multiplied by the ratio of (i) the amount in column IV of the table which, by reason of the law in effect at the time the promulgation is made, will be in effect as of June 1 next following such determination appears (or is deemed to appear) in section 215(a) on the line which includes the figure '750' j ^ column III of such table to (ii) the amount in column IV of the table which appeared (or was deemed to appear) in section 215(a) on the line which included the figure '750' in column III as of June 1 of the year in which such determination is made. Whenever the Secretary promulgates the dollar amount which shall be applicable as the monthly premium for any period, he shall, at the time such promulgation is announced, issue a public statement setting forth the actuarial assumptions and bases emf)loyed by him in arriving

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Page:United States Statutes at Large Volume 86.djvu/1419

 86 STAT. ]

PUBLIC LAW 92-603-OCT. 30, 1972

1377

at the amount of an adequate actuarial rate for enrollees age 65 aiul over as provided in paragraph (1) and the derivation of the dolhir amounts specified in this paragraph. "(4) The Secretary shall also, during December of 1972 and of each year thereafter, determine the monthly actuarial rate for disabled enrollees under age 65 which shall be applicable for the 12-month period commencing July 1 in the succeeding year. Such actuarial rate shall be the amount the Secretary estimates to l>e necessary so that the aggregate amount for such 12-month period with respect to disabled enrollees under age 65 will equal one-half of the total of the benefits and administrative costs which he estimates will be incurred in the Federal Supplementary Medical Insurance Trust Fund for such 12-month period with respect to such enrollees. In calculating the monthly actuarial rate under this paragraph, the Secretary shall include an appropriate amount for a contingency margin."' (d)(1) Section 1839(d) of such Act, as redesignated by subsection (c) of this section, is amended by inserting "or (c)'' after "subsection (b)". (2) Section 1839(f) of such Act, as redesignated by subsection (c) of this section, is amended by striking out "subsection (c) " and inserting in lieu thereof "subsection (d) ". (e) Effective with respect to enrollee premiums payable for months after June 1973, section 1844(a)(1) of such Act is amended to read as p tt

'

\

/ \

/

42 USC l395w.

follows: " (1)(A) a Government contribution equal to the aggregate premiums payable for a month for enrollees age 65 and over under this part and deposited in the Trust Fund, multiplied by the ratio of— " (i) twice the dollar amount of the actuarially adequate rate per enrollee age 65 and over as determined mider section 1839(c)(1) for such month minus the dollar amount of the premium per enrollee for such month, as determined under section 1839(c)(3), to "(ii) the dollar amount of the premium per enrollee for such month, plus " (B) a Government contribution equal to the aggregate premiums pavable for a month for enrollees under age 65 under this part and deposited in the Trust Fund, multiplied by the ratio of— "(i) twice the dollar amount of the actuarially adequate rate per enrollee under age 65 as determined under section 1839(c)(4) for such month minus the dollar amount of the pi-emium per enrollee for such month, as determined under section 1839(c)(3), to "(ii) the dollar amount of the premium per enrollee for such month." CHANGE IX SUPPLEMENTARY

MEDICAL INSURANCE

Effective date. ^^ f ^ f J„^: -

'^"^^' ^- ^^'^^•

.,

DEDUCTIBLE

SEC. 204. (a) Section 1833(b) of the Social Security Act is amended jg sta^. 3 0 ^^ ^ 2. by striking out "shall be reduced by a deductible of $50'' and inserting in lieu thereof "shall be reduced by a deductible of $60"'. (b) Section 1835(c) of such Act is amended by striking out "but ^i sta^-849. only if such charges tor such services do not exceed $50" and insert"' ing in lieu thereof "but only if such charges for such services do not exceed the applicable supplementary medical insurance deductible". (c) The amendments made by this section shall be effective with Effective date. respect to calendar years after 1972 (except that, for purposes of applying clause (1) of the first sentence of section 1833(b) of the Social Security Act, such amendments shall be deemed to have taken supra. effect on January 1, 1972).

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text:
Page:United States Statutes at Large Volume 86.djvu/1420

 1378

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

AUTOMATIC EXROLLMEXT FOR SUPPLEMENTARY MEDICAL INSURANCE

79 Stat. 304;
 * ^42 USC^13*95

SEC. 206. (a) Section 1837 of the Social Security Act is amended ^^y Idii^g ^t the end thereof the following new subsections: " (f) Any individual— Ante, p. 1372. "(1) who is eligible under section 1836 to enroll in the medical insurance program by reason of entitlement to hospital insurance benefits as described in paragraph (1) of such section, and "(2) whose initial enrollment period under subsection (d) begins after March 31, 1973, and "(3) who is residing in the United States, exclusive of Puerto Rico, shall be deemed to have enrolled in the medical insurance program established by this part. " (g) All of the provisions of this section shall apply to individuals satisfying subsection (f), except that— "(1) in the case of an individual who satisfies subsection (f) by reason of entitlement to disability insurance benefits described Ante, p. 1371. In section 2 2 6 (a)(2)(B), his initial enrollment period shall begin on the first day of the later of (A) April 1973 or (B) the third month before the 25th consecutive month of such entitlement, and shall reoccur with each continuous period of eliAnte.p. 1376. gibility (as defined in section 1839(e)) and upon attainment of age 65; "(2)(A) in the case of an individual who is entitled to monthly 42 USC 402, benefits under section 202 or 223 on the first day of his initial 423 enrollment period or becomes entitled to monthly benefits under section 202 during the first 3 months of such period, his enrollment shall be deemed to have occurred in the third month of his initial enrollment period, and " (B) in the case of an individual who is not entitled to benefits under section 202 on the first day of his initial enrollment period and does not become so entitled during the first 3 months of such period, his enrollment shall be deemed to have occurred in the month in which he files the application establishing his entitlement to hospital insurance benefits provided such filing occurs during the last 4 months of his initial enrollment period; and "(3) in the case of an individual who would otherwise satisfy subsection (f) but does not establish his entitlement to hospital insurance benefits until after the last day of his initial enrollment period (as defined in subsection (d) of this section), his enrollment shall be deemed to have occurred on the first day of the earlier of the then current or immediately succeeding general enrollment period (as defined in subsection (e) of this section)." Ante. p. 1373. ^^j Section 1838(a) of such Act is amended— (1) by striking out the period at the end of subsection (a) and by inserting in lieu thereof "; or"; and (2) by adding at the end of subsection (a) the following new paragraph: "(3)(A) in the case of an individual who is deemed to have enrolled on or before the last day of the third month of his initial enrollment period, the first day of the month in which he first meets the applicable requirements of section 1836 or July 1, 1973, whichever is later, or " (B) in the case of an individual who is deemed to have enrolled on or after the first day of the fourth month of his initial enrollment period, as prescribed under subparagraphs (B), (C), (D), and (E) of paragraph (2) of this subsection." (c) Section 1838(b) of such Act (as amended by section 257(a) of ^^^t'c.^'.K'^^J' this Act) is further amended by adding at the end thereof the fol42 USC 1395q.

,

.

'

,

J owing new paragraph:

J

fe

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text:
Page:United States Statutes at Large Volume 86.djvu/1421

 86 STAT. ]

PUBLIC LAW 92-603-OCT. 30, 1972

"Where an individual who is deemed to have enrolled for medical insurance pursuant to section 1837(f) files a notice before the first day of the month in which his coverage period begins advising that he does not wish to be so enrolled, the termination of the coverage period resulting from such deemed enrollment shall take effect with the first day of the month the coverage would have been effective and such notice shall not be considered a disenrollment for the purposes of section 1837(b). Where an individual who is deemed enrolled for medical insurance benefits pursuant to section 1837(f) files a notice requesting termination of his deemed coverage in or after the month in which such coverage becomes effective, the termination of such coverage shall take effect at the close of the calendar quarter following the calendar quarter in which the notice is filed."

1379 ^"'e- P- ^378.

^°^'' P- ^'*'*^'

I N C E N T IV E S FOR STATES TO E S T A B L I S H EFFECTIVE U T I L I Z A T I O N REVIEW PROCEDURES UNDER MEDICAID

SEC. 207. (a)(1) Section 1903 of the Social Security Act is amended giltf^ s/s"!^' by adding at the end thereof the following new subsections: 42 USC uWb. " (g)(1) With respect to amounts paid for the following services furnished under the State plan after June 30, 1973 (other than services furnished pursuant to a contract with a health maintenance organization as defined in section 1876), the Federal medical assistance per- Post, pp. 1396, centage shall be decreased as follows: After an individual has received ^'^^^' care as an inpatient in a hospital (including an institution for tuberculosis), skilled nursing home or intermediate care facility on 60 days, or in a hospital for mental diseases on 90 days (whether or not such days are consecutive), during any fiscal year, which for purposes of this section means the four calendar quarters ending with June 30, the Federal medical assistance percentage with respect to amounts paid for any such care furnished thereafter to such individual in the same fiscal year shall be decreased by 33l^ per centum thereof unless the State agency responsible for the administration of the plan makes a showing satisfactory to the Secretary that, with respect to each calendar quarter for which the State submits a request for payment at the full Federal medical assistance percentage for amounts paid for inpatient hospital services (including tuberculosis hospitals), skilled nursing home services, or intermediate care facility services furnished beyond 60 days (or inpatient mental hospital services furnished beyond 90 days), there is in operation in the State an effective program of control over utilization of such services; such a showing must include evidence that— " (A) in each case for which payment is made under the State plan, a physician certifies at the time of admission, or, if later, the time the individual applies for medical assistance under the State plan (and recertifies, where such services are furnished over a period of time, in such cases, at least every 60 days, and accompanied by such supporting material, appropriate to the case involved, as niay be provided in regulations of the Secretary), that such services are or were required to be given on an inpatient basis because the individual needs or needed such services; and " (B) in each such case, such services were furnished under a plan established and periodically reviewed and evaluated by a physician; " (C) such State has in effect a continuous program of review of utilization pursuant to section 1902(a) (30) whereby the neces- ^°^*' P- ^^le. sity for adnriission and the continued stay of each patient in such institution is periodically reviewed and evaluated (with such

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text:
Page:United States Statutes at Large Volume 86.djvu/1422

 1380

85*stat^809°^' 42 USC 1396a.

42 USC i395d.

Costdifferen-

tial

"eost.»» 42 USC 1396b. Effective date.

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

frequency as may be prescribed in regulations of the Secretary) by medical and other professional personnel who are not themselves directly responsible for the care of the patient and who are not employed by or financially interested in any such institution; and " (D) such State has an effective program of medical review of the care of patients in mental hospitals, skilled nursing homes, and intermediate care facilities pursuant to section 1902(a) (26) and ^^^^ whcreby the professional management of each case is revicwed aud evaluated at least annually by independent professional review teams. In determining the number of days on which an individual has received services described in this subsection, there shall not be counted any days with respect to which such individual is entitled to have payments made (in whole or in pail) on his behalf under section 1812, "(2) The Secretary shall, as part of his validation procedures under this subsection, conduct sample onsite surveys of private and public institutions in which recipients of medical assistance may receive care and services under a State plan approved under this title, and his findings with respect to such surveys (RS well as the showings of the State agency required under this subsection) shall be made available for public inspection. " (h)(1) If the Secretary determines for any calendar quarter beginning after June 30, 1973, with respect to any State that there does not exist a reasonable cost differential between the statewide average cost of skilled nursing home services and the statewide average cost of intermediate care facility services in such State, the Secretary may reduce the amount which would otherwise be considered as expenditures under the State plan by any amount which in his judgment is a reasonable equivalent of the difference between the amount of the expenditures by such State for intermediate care facility services and the amount that would have been expended by such State for such services if there had been a reasonable cost differential between the cost of skilled nursing home services and the cost of intermediate care facility services. "(2) In determining whether any such cost differential in any State is reasonable the Secretary shall take into consideration the range of such cost differentials in all States. "(3) For the purposes of this subsection, the term 'cost differential' for any State for any quarter means, as determined by the Secretary on the basis of the data for the most recent calendar quarter for which satisfactory data are available, the excess of— " (A) the average amount paid in such State (regardless of the source of payment) per inpatient day for skilled nursing home services, over " (B) the average amount paid in such State (regardless of the source of payment) per inpatient day for intermediate care facility services. "(4) For purposes of this subsection, the term 'cost' shall mean amounts reimbursable by the State under a State plan approved under this title." (2) Section 1903(a)(1) of such Act is amended by inserting ", subject to subsections (g) and (h) of this section" after "section 1905(b)". ^j^^ rpj^g amendments made by subsection (a) shall, except as otherwise provided therein, be effective July 1, 1973.

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Page:United States Statutes at Large Volume 86.djvu/1423

 86 STAT. ]

PUBLIC LAW 92-603-OCT. 30, 1972 COST-SHARING U N D E R

1381

MEDICAID

SEC. 208. (a) Section 1902(a) (14) of the Social Security Act is 42 USC 1396a. amended to read as follows: "(14) effective January 1, 1973, provide that— " (A) in the case of individuals receiving aid or assistance under a State plan approved under title I, X, X IV, or X VI, or part A of title IV, or who meet the income and resources, ^2 USC 301, requirements of the one of such State plans which is goi. ' appropriate— "(i) no enrollment fee, premium, or similar charge, and no deduction, cost sharing, or similar charge with respect to the care and services listed in clauses (1) through (5) and (7) of section 1905(a), will be imposed 42 USC i396d. under the plan, and "(ii) any deduction, cost sharing, or similar charge imposed under the plan with respect to other care and services will be nominal in amount (as determined in accordance with standards approved by the Secretary and included in the plan), and " (B) with respect to individuals who are not receiving aid or assistance under any such State plan and who do not meet the income and resources requirements of the one of such State plans which is appropriate or who, after December 31, 1973, are included under the State plan for medical assistance pursuant to section 1902(a) (10)(B) approved under title XIX— " (i) there shall be imposed an enrollment fee, premium, or similar charge which (as determined in accordance with standards prescribed by the Secretary) is related to the individual's income, and "(ii) any deductible, cost-sharing, or similar charge imposed under the plan will be nominal;", (b) The amendment made by subsection (a) shall be effective Jan- Effective date. uary 1, 1973 (or earlier if the State plan so provided). MEDICAID CONDITIONS OF E L I G I B I L I T Y FOR CERTAIN EMPLOYED F A M I L I E S

SEC. 209. (a) Section 1902 of the Social Security Act is amended by adding at the end thereof the following new subsection: "(e) Notwithstanding any other provision of this title, effective January 1, 1974, each State plan approved under this title must provide that each family which was eligible for assistance pursuant to part A of title IV in at least 3 of the 6 months immediately preceding the month in which such family became ineligible for such assistance because of increased income from employment, shall, while a member of such family is employed, remain eligible for such assistance for 4 calendar months following the month in which such family would otherwise be determined to be ineligible for such assistance because of the income and resources limitations contained in such plan." (b)(1) Section 1902 of the Social Security Act, as amended by this section, is further amended by adding at the end thereof the following new subsection: "(f) Notwithstanding any other provision of this title, except as provided in subsection (e), no State shall be required to provide medical assistance to any aged, blind, or disabled individual (within the meaning of title X VI) for any month unless such State would be (or would have been) required to provide medical assistance to such individual for such month had its plan for medical assistance approved under this title and in effect on January 1, 1972, been in effect in such

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Page:United States Statutes at Large Volume 86.djvu/1424

 1382

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

Jiionth, except that for this purpose any such individual shall be deemed eligible for medical assistance under such State plan if (in addition to meeting such other requirements as are or may be imposed under the State plan) the income of any such individual as determined 42 USC 1396b. in accordance with section 1908(f) (after deducting such individual's 42 USC 1381. payment under title X VI, and incurred expenses for medical care as 26 USC 213. defined in section 213 of the Internal Revenue Code of 1954) is not in excess of the standard for medical assistance established under the State plan as in effect on January 1, 1972." Effective date. (2) The amendment made by this subsection shall become effective on January 1, 1974. P A Y M E N T U N D E R MEDICARE TO I N D IV I D U A L S COVERED BY FEDERAL E M P L O Y E E S H E A L T H B E N E F I T S PROGRAM

79 Stat. 325; ^ ^ruse^l 3 95

5 USC 8901.

SFC. 210. Section 1862 of the Social Security Act is amended by adding at the end thereof the following new subsection: "(c) No payment may be made under this title with respect to any item or service furnished to or on behalf of any individual on or after January 1, 1975, if such item or service is covered under a health benefits plan in which such individual is enrolled under chapter 89 of title 5, United States Code, unless prior to the date on which such item or service is so furnished the Secretary shall have determined and certified that such plan or the Federal employees health benefits program under chapter 89 of such title 5 has been modified so as to assure that— "(1) there is available to each Federal employee or annuitant enrolled in such plan, upon becoming entitled to benefits under part A or B, or both parts A and B of this title, in addition to the health benefits plans available before he becomes so entitled, one or more health benefits plans which offer protection supplementing the protection he has under this title, and "(2) the Government or such plan will make available to such Federal employee or annuitant a contribution in an amount at least equal to the conti-ibution which the Government makes toward the health insurance of any employee or annuitant enrolled for high option coverage under the Government-wide plans established under chapter 89 of such title 5, with such contribution being in the form of (A) a contribution toward the supplementary protection referred to in paragraph (1), (B) a payment to or on behalf of such employee or annuitant to offset the cost to him of his coverage under this title, or (C) a combination of such contribution and such payment.'' P A Y M E N T U N D E R MEDICARE FOR CERTAIN I N P A T I E N T H O S P I T A L A N D RELATED P H Y S I C I A N S ' SERVICES F U R N I S H E D OUTSIDE THE UNITED STATES

42 USC i395f.

SEC. 211. (a) Section 1814(f) of the Social Security Act is amended to read as follows: ''Payment for (^ertain Inpatient Hospital Services Furnished Outside the Ignited States

"(f)(1) Payment shall be made for inpatient hospital services furnished to an individual entitled to hospital insurance benefits under Ante. p. 1371. section 226 by a hospital located outside the United States, or under 42 USC 1395X. arrangements (as defined in section 1861(w)) with it, if— " (A) such individual is a resident of the United States, and " (B) such hospital was closer to, or substantially more acces-

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Page:United States Statutes at Large Volume 86.djvu/1425

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STAT.]

1383

PUBLIC LAW 92-603-OCT. 30, 1972

sible from, the residence of such individual than the nearest hospital within the United States which was adequately equipped to deal with, and was available for the treatment of, such individual's illness or injury. "(2) Payment may also be made for emergency inpatient hospital services furnished to an individual entitled to hospital insurance benefits under section 226 by a hospital located outside the United States " (A) such individual was physically present— " (i) in a place within the United States; or " ( i i) at a place within Canada while traveling without unreasonable delay by the most direct route (as determined by the Secretary) between Alaska and another State; at the time the emergency which necessitated such inpatient hospital services occurred, and " (B) such hospital was closer to, or substantially more accessible from, such place than the nearest hospital within the United States which was adequately equipped to deal with, and was available for the treatment of, such individual's illness or injury. "(3) Payment shall be made in the amount provided under subsection (b) to any hospital for the inpatient hospital services described in paragraph (1) or (2) furnished to an individual by the hospital or under arrangements (as defined in section 1861(w)) with it if (A) the Secretary would be required to make such payment if the hospital had an agreement in effect under this title and otherwise met the conditions of payment hereunder, (B) such hospital elects to claim such payment, and (C) such hospital agrees to comply, with respect to such services, with the provisions of section 1866(a). "(4) Payment for the inpatient hospital services described in paragraph (1) or (2) furnished to an individual entitled to hospital insurance benefits under section 226 may be made on the basis of an itemized bill to such individual if (A) payment for such services cannot be made under paragraph (3) solely because the hospital does not elect to claim such payment, and (B) such individual files application (submitted within such time and in such form and manner and by such person, and continuing and supported by such information as the Secretary shall by regulations prescribe) for reimbursement. The amount payable with respect to such services shall, subject to the provisions of section 1813, be equal to the amount which would be payable under subsection (d)(3)." (b) Section 1861(e) of such Act is amended— (1) by striking out "except for purposes of sections 1814(d) and 1835 (b) " and inserting in lieu thereof "except for purposes of sections 1814(d), 1814(f), and 1835(b)"; (2) by inserting "section 1814(f)(2)," immediately after "For purposes of sections 1814(d) and 1835(b) (including determination of whether an individual received inpatient hospital services or diagnostic services for purposes of such sections),"; and (3) by inserting immediately after the third sentence the following new sentence: "For purposes of section 1814(f)(1), such term includes an institution which (i) is a hospital for purposes of sections 1814(d), 1814(f)(2), and 1835(b) and (ii) is accredited by the Joint Commission on Accreditation of Hospitals, or is accredited by or approved by a program of the country in which such institution is located if the Secretary finds the accreditation or comparable approval standards of such program to be essentially equivalent to those of the Joint Commission on Accreditation of Hospitals." 82-081 O - 73 - 90

Ante,

p. 1371.

42 USC 1395X.

42 USC 1395CC.

42 USC 1395e. 42 USC 1395x.

42 USC 1395f. Ante, p. 1382. 42 USC 139Sn.

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Page:United States Statutes at Large Volume 86.djvu/1426

 1384 42 USC i395y.

42 USC 1395X. 1449! 14T1'. '

42 USC 1395U.

42 USC i395gg. 42 USC 1395Z.

Effective date.

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

(c)(1) Section 1862(a)(4) of such Act is amended— (A) by striking out "emergency"; and (B) by inserting after "1814(f)" the following: "and, subject to such conditions, limitations, and requirements as are provided under or pursuant to this title, physicians' services and ambulance services furnished an individual in conjunction with such inpatient hospital services but only for the period during which such inpatient hospital services were furnished". (2) Section 1861(r) of such Act (as amended by sections 256(b) aud 264 of this Act) is further amended by adding at the end thereof the following new sentence: "For the purposes of section 1862(a)(4) and subject to the limitations and conditions provided in the previous sentence, such term includes a doctor of one of the arts, specified in such previous sentence, legally authorized to practice such art in the country in which the inpatient hospital services (referred to in such section 1862(a)(4)) are furnished." (3) Section 1842(b)(3)(B) (ii) of such Act is amended by striking out "service;" and inserting in lieu thereof the following: "service (except in the case of physicians' services and ambulance service furnished as described in section 1862(a)(4), other than for purposes of section 1870(f));". (4) Section 1838(a)(1) of such Act is amended by striking out "and" before " (B) ", and by inserting before the semicolon at the end thereof the following: ", and (C) with respect to expenses incurred for those physicians' services for which payment may be made under this part that are described in section 1862(a)(4), the amounts paid shall be subject to such limitations as may be prescribed by regulations". ((J) The amendments made by this section shall applv to services furnished with respect to admissions occurring after December 31, 1972. OPTOMETRISTS' SERVICES UNDER MEDICAID

42 USC i396d.

SEC. 212. (a) Section 1905 of the Social Security Act is amended by inserting at the end thereof the following ncAv subsection: "(e) In the case of any State the State plan of which (as approved under this title) — "(1) does not provide for the payment of services (other than 42 USC 1396a. services covered under section 1902(a) (12)) provided by an optometrist; but "(2) at a prior period did provide for the payment of services referred to in paragraph (1); services^'*'^"^' ^^^ tcTm 'physiciaus' services' (as used in subsection (a)(5)) shall include services of the type which an optometrist is legally authorized to perform where the State plan specifically provides that the term 'physicians' services', as employed m such plan, includes services of the type which an optometrist is legally authorized to perform, and shall be reimbursed whether furnished by a physician or an optometrist." Effective date. (b) The provisions of subsection (e) of section 1905 of the Social Security Act (as added by subsection (a) of this section) shall be applicable in the case of services performed on or after the date of enactment of this Act. LIMITATION ON LIABILITY OF BENEFICIARY WHERE MEDICARE CLAIMS ARE DISALLOWED

SEC. 213. (a) Title X VIII of the Social Security Act, as amended i4r9°*i'420* ^^^^' ^y sections 226, 242, and 243 of this Act, is further amended by adding at the end thereof the following new section:

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PUBLIC LAW 92-603-OCT. 30, 1972

1385

" L T M I T A T I O X O X L I A B I L I T Y O F BENErlCIARY WHERE MEDICARE CLAIMS ARE DISALLOWED

"SEC. 1879. (a) Where— "(1) a determination is made that, by reason of section 1862(a) (1) or (9), payment may not be made under part A or part B 42 USC i395y. of this title for any expenses incurred for items or services fur- 42 USC 1395c, nished an individual by a provider of services or by another per- Json pursuant to an assignment under section 1842(b)(3)(B) (ii), ^"'«'' P- I384. and "(2) both such individual and such provider of services or such other person, as the case may be, did not know, and could not reasonably have been expected to know, that payment would not be made for such items or services under such part A or part B, then to the extent permitted by this title, payment shall, notwithstanding such determination, be made for such items or services (and for such period of time as the Secretary finds will carry out the objectives of this title), as though section 1862(a)(1) and section 1862(a)(9) did not apply. I n each such case the Secretary shall notify both such individual and such provider of services or such other person, as the case may be, of the conditions under which payment for such items or services was made and in the case of comparable situations arising thereafter with respect to such individual or such provider or such other person, each shall, by reason of such notice (or similar notices provided before the enactment of this section), be deemed to have knowledge that payment cannot be made for such items or services or reasonably comparable items or services. "(b) In any case in which the provisions of paragraphs (1) and (2) of subsection (a) are met, except that such provider or such other person, as the case may be, knew, or could be expected to know, that payment for such services or items could not be made under such l)art A or part B, then the Secretary shall, upon proper application filed within such time as may be prescribed in regulations, indemnify the individual (referred to in such paragraphs), subject to the deductible and coinsurance provisions of this title, for any payments received from such individual by such provider or such other person, as the case may be, for such items or sendees. Any payments made by the Secretary as indemnification shall be deemed to have been made to such provider or such other person, as the case may be, and shall be treated as overpayments, recoverable from such provider or such other person, as the case may be, under applicable provisions of law. I n each such case the Secretary shall notify such individual of the conditions under which indemnification is made and in the case of com]>arable situations arising thereafter with respect to such individual, he shall, by reason of such notice (or similar notices provided before the enactment of this section), be deemed to have knowledge that payment cannot be made for such items or services. "(c) No payments shall be made under this title in any cases in which the provisions of paragraph (1) of subsection (a) are met, but both the individual to whom the items or services were furnished and the provider of service or other person, as the case may be, who furnished the items or services knew, or could reasonably have been expected to know, that payment could not be made for items or services under part A or part B by reason of section 1862(a)(1) or (a)(9). " (d) In any case arising under subsection (b) (but without regard to whether payments have been made by the individual to the provider or other person) or subsection (c), the provider or other person shall have the same rights that an individual has under section 1869(b) Post, p. i464. (when the determination is under part A) or section 1842(b)(3)(C) ^°®'' P* ^'*'*^-

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Page:United States Statutes at Large Volume 86.djvu/1428

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1386 42 USC 1395J.

Effective date. 42 USC 1395c, 1395J.

(when the determination is under part B) wlien the amount of benefit or payments is in controversy, except that such rights may, under prescribed regulations, be exercised by such provider or other person only after the Secretary determines that the individual will not exercise such rights under such sections." (b) The amendments made by this section shall be effective with respect to claims under part A or part B of title X VIII of the Social Security Act, filed with respect to items or services furnished after the date of the enactment of this Act. LIMITATIOX

42 USC 1301.

58 Stat. 42 USC note. 77 Stat. 42 USC note.

682. 201 282. 2661

OX FEDERAL r A K T I C I P A T I O N FOR CAPITAL

EXPENDITURES

SEC. 221. (a) Title X I of the Social Security Act is amended by adding at the end thereof the following new section: "LIMITATION

42 USC 701, 1395, 1396.

[86 STAT.

O X FEDERAL PARTK I P A T I O X FOR CAPITAL E X P E X D I T t ' R E S

"SEC. 1122. (a) The purpose of this section is to assure that Federal funds appropriated under titles V, X VIII, and X IX are not used to support unnecessary capital expenditures made by or on behalf of health care facilities or health maintenance organizations which are reimbursed under any of such titles and that, to the extent possible, reimbursement under such titles shall support planning activities with respect to health services and facilities in the various States. (b) The Secretary, after consultation with the Governor (or other chief executive officer) and with appropriate local public officials, shall make an agreement with any State which is able and willing to do so under which a designated planning agency (which shall be an agency described in clause (ii) of subsection (d)(1)(B) that has a governing body or advisory board at least half of whose members represent consumer interests) will— "(1) make, and submit to the Secretary together with such supporting materials as he may find necessary, findings and recommendations with respect to capital expenditures proposed by or on behalf of any health care facility or health maintenance organization in such State within the field of its responsibilities, (2) receive from other agencies described in clause (ii) of subsection (d)(1)(B), and submit to the Secretary together with such supporting material as he may find necessary, the findings and recommendations of such other agencies with respect to capital expenditures proposed by or on behalf of health care facilities or health maintenance organizations in such State within the fields of their respective responsibilities, and "(3) establish and maintain procedures pursuant to which a person proposing any such capital expenditure may appeal a recommendation by the designated agency and will be granted an opportunity for a fair hearing by such agency or person other than the designated agency as the Governor (or other chief executive officer) may designate to hold such hearings, whenever and to the extent that the findings of such designated agency or any such other agency indicate that any such expenditure is not consistent with the standards, criteria, or plans developed pursuant to the Public Health Service Act (or the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963) to meet the need for adequate health care facilities in the area covered by the plan or plans so developed. "(c) The Secretary shall pay any such State from the Federal Hospital Insurance Trust Fund, in advance or by way of reimbursement as may be provided in the agreement with it (and may make

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adjustments in such payments on account of overpayments or underpayments previously made), for the reasonable cost of performing the functions specified in subsection (b). ' ' (d)(1) Except as provided in paragraph (2), if the Secretary determines that— " (A) neither the planning agency designated in the agreement described in subsection (b) nor an agency described in clause (ii) of subparagraph (B) of this jjaragraph had been given notice of any proposed capital expenditure (in accordance with such procedure or in such detail as may be required by such agency) at least 60 days prior to obligation for such expenditure; or '''(B)(i) the planning agency so designated or an agency so described had received such timely notice of the intention to make such capital expenditure and had, within a reasonable period after receiving such notice and prior to obligation for such expenditure, notified the person proposing such expenditure that the expenditure would not be in conformity with the standards, criteria, or plans developed by such agency or any other agency described in clause (ii) for adecpiate health care facilities in such State or in the area for which such other agency has responsibility, and "'(ii) the planning agency so designated had, prior to submitting to the Secretary the findings referred to in subsection (b) — ' ' (I) consulted with, and taken into consideration the findings and recommendations of, the State planning agencies established pursuant to sections 314(a) and 604(a) of the Public Health Service Act (to the extent that either such ^„'*,2 "^^ 2^^' 291d. agency is not the agency so designated) as well as the public or nonprofit private agency or organization responsible for the comprehensive regional, metropolitan area, or other local area plan or plans referred to in section 814(b) of the Public Health Service Act and covering the area in which the health care facility or health maintenance organization proposing such capital expenditure is located (where such agency is not the agency designated in the agreement), or, if there is no such agency, such other public or nonprofit private agency or organization (if any) as performs, as determined in accordance with criteria included in regulations, similar functions, and " ( II) granted to the person proposing such capital expenditure an opportunity for a fair hearing with respect to such findings; then, for such period as he finds necessary in any case to effectuate the purpose of this section, he shall, in determining the Federal payments to be made under titles V, X VIII, and X IX with respect to services 42 USC 701, furnished in the health care facility for which such capital expendi- 1 3 9 5, 1 3 9 6. ture is made, not include any amount which is attributable to depreciation, interest on borrowed funds, a return on equity capital (in the case of proprietary facilities), or other expenses related to such capital expenditure. With respect to any organization which is reimbursed on a per capita basis, in determining the Federal payments to be made under titles V, X VIII, and X IX, the Secretary shall exclude an amount which in his judgment is a reasonable equivalent to the amount which would otherwise be excluded under this subsection if payment were to be made on othei' than a per capita basis. "(2) If the Secretary, after submitting the matters involved to the advisory council established or designated under subsection (i), determines that an exclusion of expenses related to any capital expenditure of any health care facility or health maintenance organization would discoirrage the operation or expansion of such facility

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Page:United States Statutes at Large Volume 86.djvu/1430

 1388

42 USC 701, 1395, 1396.

" C a p i t a l expenditure."

National advisory c o u n c i l, establishment.

Membership.

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

or organization, or of any facility of such organization, which has demonstrated to his satisfaction proof of capability to provide comprehensive health care services (including institutional services) efficiently, effectively, and economically, or would otherwise be inconsistent with the effective organization and delivery of health services or the effective administration of title V, X VIII, or X IX, he shall not include such expenses pursuant to paragraph (1). "(e) Where a person obtains under lease or comparable arrangement any facility or part thereof, or equipment for a facility, which would have been siibject to an exclusion under subsection (d) if the person had acquired it by purchase, the Secretary shall (1) in computing such person's rental expense in determining the Federal payments to be made under titles V, X VIII, and X IX with respect to services furnished in such facility, deduct the amount which in his judgment is a reasonable equivalent of the amount that would have been excluded if the person had acquired such facility or such equipment by purchase, and (2) in computing such person's return on equity capital deduct any amount deposited under the terms of the lease or comparable arrangement. "(f) Any person dissatisfied with a determination by the Secretary under this section may within six months following notification of such determination request the Secretary to reconsider such determination. A determination by the Secretary under this section shall not be subject to administrative or judicial review. " (g) For the puriDOses of this section, a 'capital expenditure" is an expenditure which, under generally accepted accounting principles, is not properly chargeable as an expense of operation and maintenance and which (1) exceeds $100,000, (2) changes the bed capacity of the facility M'ith respect to which such expenditure is made, or (3) substantiailv changes the services of the facility with respect to which such expenditure is made. For purj^oses of clause (1) of the preceding sentence, the cost of the studies, surveys, designs, plans, working drawings, specifications, and other activities essential to the acquisition, improvement, expansion, or replacement of the plant and equipment with respect to which such expenditure is made shall be included in determining whether such expenditure exceeds $100,000. " (h) The provisions of this section shall not apply to Christian Science sanatoriums operated, or listed and certified, by the First Church of Christ, Scientist, Boston, Massachusetts. " (i)(l) The Secretary shall establish a national advisory council, or designate an appropriate existing national advisory council, to advise and assist him in the preparation of general regulations to carry out the purposes of this section and on policy matters arising in the administration of this section, including the coordination of activities under this section with those under other parts of this Act or under other Federal or federally assisted health programs. "(2) The Secretary shall make appropriate provision for consultation between and coordination of the work of the advisory council established or designated under paragraph (1) and the Federal Hospital Council, the National Advisory Health Council, the Health Insurance Benefits Advisory Council, and other appropriate national advisory councils with respect to matters bearing on the purposes and administration of this section and the coordination of activities under this section with related Federal health programs. "(3) If an advisory council is established by the Secretary under paragraph (1). it shall be composed of members who are not otherwise in the regular full-time employ of the United States, and who shall be appointed by the Secretary without regard to the civil service laws from among leaders in the fields of the fundamental sciences, the med-

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PUBLIC LAW 92^03-OCT. 30, 1972

1389

ical sciences, and the organization, delivery, and financing of health care, and persons who are State or local officials or are active in community affairs or public or civic affairs or who are representative of minority groups. 5lembers of such advisory council, while attending meetings of the council or otherwise serving on business of the council, shall be entitled to receive compensation at rates fixed by the Secretary, but not exceeding the maximum rate specified at the time of such service for grade GS-18 in section 5332 of title 5, United States Code, ^^\^^^ ^^^^ including traveltime, and while away from their homes or regular places of business they may also be allowed travel expenses, including per diem in lieu of subsistence, as authorized by section 5703(b) of such title 5 for persons in the Government service employed intermittently." ^o ^'^t- 499. (b) The amendment made by subsection (a) shall apply only with Effective date, respect to a capital expenditure the obligation for which is incurred by or on behalf of a health care facility or health maintenance organization subsequent to whichever of the following is earlier: (A) December 31, 1972, or (B) with respect to any State or any part thereof specified by such State, the last day of the calendar quarter in which the State requests that the amendment made by subsection (a) of this section apply in such State or such part thereof. (c)(1) Section 505(a)(6) of such Act (as amended by section 232(b) of this Act) is further amended by inserting ", consistent Posf, p. u i i. with section 1122," after "standards" where it first appears. (2) Section 506 of such Act (as amended by sections 224(d), 229 (d). 233(d), and 237(b) of this Act) is further amended by adding °«^ P- ^^^S. at the end thereof the following new subsection: " (g) For limitatioji on Federal participation for capital expenditures which are out of conformity with a comprehensive plan of a State or area wide planning agency, see section 1122." ^"fe. p. lase. (3) Clause (2) of the second sentence of section 509(a) of such Act is amended by inserting ", consistent with section 1122," after ^ "^^ ^°^* "standards". (4) Section 1861(v) of such Act is amended by adding at the end ^^ usc u9s thereof the following new paragraph: "(5) For limitation on Federal participation for capital expenditures which are out of conformity with a comprehensive plan of a State or areawide planning agency, see section 1122." (5) Section 1902(a) (13)(D) of such Act (as amended by section 232(a) of this Act) is further amended by inserting ", consistent with ^°s'' P- ^^lo. s?ction 1122," after "standards" where it fiist appears. (6) Section 1903(b) of such Act is amended by adding at the end '*2 USC 1396b. thereof the following new paragraph: "(3) For limitation on Federal participation for capital expenditures which are out of conformity with a comprehensive plan of a State or areawide planning agency, see section 1122." (d) In the case of a health care facility providing health care services as of December 18, 1970, which on such date is committed to a formal plan of expansion or replacement, the amendments made by the preceding provisions of this section shall not apply with respect to such expenditures as may be made or obligations incurred for capital items included in such plan where preliminary expenditures toward the plan of expansion or replacement (including payments for studies, surveys, designs, plans, working drawings, specifications, and site acquisition, essential to the acquisition, improvement, expansion, or replacement of the health care facility or equipment concerned) of $100^000 or more, had been made during the three-year period ended December 17, 1970.

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