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1445

to assist such organizations in developing a proper plan to be submitted to the Secretary and otherwise in preparing to meet the requirements of this pait for designation as a Professional Standards Eeview Organization. a EXEMPTIOXS OP CHRISTIAN SCIEXCE SANATORHJMS

"SEC. 1170. The provisions of this part shall not apply with respect to a Christian Science sanatorium operated, or listed and certified, by the First Church of Christ, Scientist, Boston, Massachusetts." PHYSICAL THERAPY SERVICES A N D OTHER THERAPY SERVICES MEDICARE

UNDER

SEC. 251. (a)(1) Section 1861(p) of the Social Security Act is amended by adding at the end thereof (after and below paragraph (4)(B)) the following new sentence: "The term 'outpatient physical therapy services' also includes physical therapy services furnished an individual by a physical therapist (in his office or in such individual's home) who meets licensing and other standards prescribed by the Secretary in regulations, otherwise than under an arrangement with and under the supervision of a provider of services, clinic, rehabilitation agency, or public health agency, if the furnishing of such services meets such conditions relating to health and safety as the Secretary may find necessary." (2) Section 1833 of such Act is amended, by adding at the end thereof the following new subsection: " (g) I n the case of services described in the next to last sentence of section 1861(p), with respect to expenses incurred in any calendar year, no more than $100 shall be considered as incurred expenses for purposes of subsections (a) and (b). " (3) Section 1833(a)(2) of such Act (as amended by section 233(b) of this Act) is further amended by striking out the period at the end of subparagraph (B) and inserting in lieu thereof "; or", and by adding after subparagraph (B) the following new subparagraph: " (C) if such services are services to which the next to last sentence of section 1861(p) applies, the reasonable charges for such services." (4) Section 1832(a)(2)(C) of such Act is amended by striking out "services." and inserting in lieu thereof "services, other than services to which the next to last sentence of section 1861(p) applies." (b)(1) Section 1861(p) of such Act (as amended by subsection (a)(1) of this section) is further amended by adding at the end thereof the following new sentence: "In addition, such term includes physical therapy services which meet the requirements of the first sentence of this subsection except that they are furnished to an individual as an inpatient of a hospital or extended care facility." (2) Section 1835(a)(2)(C) of such Act is amended by striking out "on an outpatient basis". (c) Section 1861(v) of such Act (as amended by sections 221(c)(4) and 223(f) of this Act) is further amended by redesignating pararaphs (5) and (6) as paragraphs (6) and (7), respectively, and y inserting after paragraph (4) the following new paragraph: "(5)(A) Where physical therapy services, occupational therapy services, speech therapy services, or other therapy services or services of other health-related personnel (other than physicians) are furnished under an arrangement with a provider of services or other organization, specified in the first sentence of section 1861(p) the

f

si Stat. sso. '*^ ^^^ ^^^^^

^^te, p. 1424

Ante, p. 1411.

81 Stat. 851. 42 USC 139Sk:.

si Stat. ssi. 42 USC i395r ^"'®» P- 1394

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81 Stat. 850. 42 USC 1395x.

Effective date.

[86 STAT;'

amount included in any payment to such provider or other organization under this title as the reasonable cost of such services (as furnished under such arrangements) shall not exceed an amount equal to the salary which would reasonably have been paid for such services (together with any additional costs that would have been incurred by the provider or other organization) to the person performing them if they had been performed in an employment relationship with such provider or other organization (rather than under such arrangement) plus the cost of such other expenses (including a reasonable allowance for traveltime and other reasonable types of expense related to any differences in acceptable methods of organization for the provision of such therapy) incurred by such person, as the Secretary may in regulations determine to be appropriate. " (B) Notwithstanding the provisions of subparagraph (A), if a provider of services or other organization specified in the first sentence of section 1861(p) requires the services of a therapist on a limited part-time basis, or only to perform intermittent services, the Secretary may make payment on the basis of a reasonable rate per unit of service, even though such rate is greater per unit of time than salary related amounts, where he finds that such greater payment is, in the aggregate, less than the amount that would have been paid if such organization had employed a therapist on a full- or part-time salary basis." (d)(1) The amendments made by subsection (a) shall apply with respect to services furnished on or after July 1, 1973. (2) The amendments made by subsection (b) shall apply with respect to services furnished on or after the date of enactment of this Act. (3) The amendments made by subsection (c) shall be effective with respect to accounting periods beginning after December 31, 1972. COVERAGE OF S U P P L I E S RELATED TO COLOSTOMIES

79 Stat. 3 U. 42 USC 1395x.

Effective date.

SEC. 252. (a) Section 1861(s)(8) of the Social Security Act is amended by inserting after "organ" the following: "(including colostomy bags and supplies directly related to colostomy care)". (b) The amendment made by subsection (a) shall apply only with respect to items furnished on or after the date of the enactment of this Act. C O V E R A G E P R I O R TO APPLICATION FOR M E D I C A L ASSISTANCE

Ante, 1417.

p p. 1415,

Effective date.

SEC. 255. (a) Section 1902(a) of the Social Security Act (as amended by sections 236(b) and 239(b) of this Act) is furither amended— (1) by striking out "and" at the end of paragraph (32); (2) by striking out the period at the end of paragraph (33) and inserting in lieu thereof "; and"; and (3) by inserting after paragraph (33) the following new paragraph: "(34) provide that in the case of any individual who has been determined to be eligible for medical assistance under the plan, such assistance will \^ made available to him for care and services included under the plan and furnished in or after the third month before the month in which he made application for such assistance if such individual was (or upon application would have been) eligible for such assistance at the time such care and services were furnished." (b) The amendments made by subsection (a) shall be effective July 1, 1973. , ,, ,

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


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HOSPITAL ADMISSIONS FOR DENTAL SERVICES UNDER MEDICARE

SEC. 256. (a) Section 1814(a)(2) of the Social Security Act is amended by striking out "or" at the end of subparagraph (C), by adding "or" after the semicolon at the end of the subparagraph (D), and by inserting after subparagraph (D) the following new subparagraph: " (E) in the case of inpatient hospital services in connection with a dental procedure, the individual suffers from impairments of such severity as to require hospitalization;". (b) Section 1861(r) of such Act is amended by inserting after "or any facial bone," the following: "or (C) the certification required by section 1814(a)(2)(E) of this Act,". (c) Section 1862(a) (12) of such Act is amended by inserting before the semicolon the following: ", except that payment may be made under part A in the case of inpatient hospital services in connection with a dental procedure where the individual suffers from impairments of such severity as to require hospitalization". (d) The amendments made by this section shall apply with respect to admissions occurring after the second month following the month in which this Act is enacted.

Ante, p. 1413.

79 Stat. 3 2 1. 42 USC 139Sx.

42 USC 1395y.

Effective date.

EXTENSION OF GRACE PERIOD FOR TERMINATION OF SUPPLEMENTARY MEDICAL INSURANCE COVERAGE WHERE FAILURE TO PAY PREMIUMS IS DUE TO GOOD CAUSE

SEC. 257. (a) Section 1838(b) of the Social Security Act is amended by striking out " (not in excess of 90 d a y s) " in the third sentence, and by adding at the end thereof the following new sentence: "The grace period determined under the preceding sentence shall not exceed 90 days; except that it may be extended to not to exceed 180 days in any case where the Secretary determines that there was good cause for failure to pay the overdue premiums within such 90-day period." (b) The amendments made by subsection (a) shall apply with respect to nonpayment of premiums which become due and payable on or after the date of the enactment of this Act or which became payable within the 90-day period immediately preceding such date; and for purposes of such amendments any premium which became due and payable within such 90-day period shall be considered a premium becoming due and payable on the date of the enactment of this Act.

Ante, p. 1378.

Effective date.

EXTENSION OF T I M E FOR FILING CLAIM FOR SUPPLEMENTARY MEDICAL INSURANCE BENEFITS WHERE DELAY IS DUE TO ADMINISTRATIVE ERROR

SEC. 258. (a) Section 1842(b)(3) of the Social Security Act (as amended by section 224(a) of this Act) is further amended by adding at the end thereof the following new sentence: "The requirement in subparagraph (B) that a bill be submitted or request for payment be made by the close of the following calendar year shall not apply if (i) failure to submit the bill or request the payment by the close of such year is due to the error or misrepresentation of an officer, employee, fiscal intermediary, carrier, or agent of the Department of Health, Education, and Welfare performing functions under this title and acting within the scope of his or its authority, and (ii) the bill is submitted or the payment is requested promptly after such error or misrepresentation is eliminated or corrected." (b) The amendment made by subsection (a) shall apply with respect to bills submitted and requests for payment made after March 1968. 82-081 O - 73 - 94

Ante, p. 1395.

Effective date.

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[86

STAT.

WAIVER OF E N R O L L M E N T PERIOD REQUIREMENTS W H E R E I N D IV I D U A L ' S R I G H T S W E R E P R E J U D I C E D BY ADMINISTRATIVE ERROR OR I N ACTION

Ante,

p. 1378,

Ante,

p. 1374.

Effective date.

SEC. 259. (a) Section 1837 of the Social Security Act (after the new subsections added by section 206(a) of this Act) is amended by adding at the end thereof the following new subsection: " (h) I n any case where the Secretary finds that an individual's enrollment or nonenrollment in the insurance program established by this part or part A pursuant to section 1818 is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, or inaction of an officer, employee, or agent of the Federal Government, or its instrumentalities, the Secretary may take such action (including the designation for such individual of a special initial or subsequent enrollment period, with a coverage period determined on the basis thereof and with appropriate adjustments of premiums) as may be necessary to correct or eliminate the effects of such error, misrepresentation, or inaction." (b) The amendment made by subsection (a) shall be effective as of July 1, 1966. E L I M I N A T I O N OF PROVISIONS P R E V E N T I N G E N R O L L M E N T I N S U P P L E M E N TARY MEDICAL INSURANCE PROGRAM MORE T H A N T H R E E YEARS AFTER FIRST OPPORTUNITY

42 USC 1395p.

SEC. 260. Section 1837(b) of the Social Security Act is amended to read as follows: "(b) No individual may enroll under this part more than twice." WAIVER OF R E C O V E R Y OF INCORRECT P A Y M E N T S FROM SURVIVOR W H O W I T H O U T F A U L T U N D E R MEDICARE

42 USC i395gg.

Effective date.

IS

SEC. 261. (a) Section 1870(c) of the Social Security Act is amended by striking out "and where" and inserting in lieu thereof the following: "or where the adjustment (or recovery) would be made by decreasing payments to which another person wno is without fault is entitled as provided in subsection (b)(4), if". (b) The amendment made by subsection (a) shall apply with respect to waiver actions considered after the date of the enactment of this Act. REQUIREMENT OF MINIMUM A M O U N T OF C L A I M TO E S T A B L I S H ENTITLEMENT TO H E A R I N G U N D E R S U P P L E M E N T A R Y MEDICAL INSURANCE PROGRAM

42 USC 139Su.

Effective date.

SEC. 262. (a) Section 1842(b)(3)(C) of the Social Security Act is amended by inserting after "a fair hearing by the carrier" the following: ", in any case where the amount in controversy is $100 or more,". (b) The amendment made by subsection (a) shall apply with respect to hearings requested (under the procedures established under section 1842(b)(3)(C) of the Social Security Act) after the date of the enactment of this Act. COLLECTION OF S U P P L E M E N T A R Y M E D I C A L INSURANCE P R E M I U M S FROM I N D IV I D U A L S E N TITLE D TO B O T H SOCIAL SECURITY A N D RAILROAD RETIREMENT BENEFITS

42 USC 1395s.

SEC. 263. (a) Section 1840(a)(1) of the Social Security Act is amended by striking out "subsection (d) " and inserting in lieu thereof "subsections (b)(1) and (c)".

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(b) Section 1840(b)(1) of such Act is amended by inserting "(Avhetlier or not such individual is also entitled for such month to a monthly insurance benefit under section 202)" after "1937", and by striking out "subsection (d) " and inserting in lieu thereof "subsection (c)". (c) Section 1840 of such Act is further amended by striking out subsection (c), and by redesignating subsections (d) through (i) as subsections (c) through (h), respectively. (d)(1) Section 1840(e) of such Act (as so redesignated) is amended by striking out "subsection (d) " and inserting in lieu thereof "subsection (c)". (2) Section 1840(f) of such Act Cas so redesignated) is amended by striking out "subsection (d) or (f) " and inserting in lieu thereof "subsection (c) or (e)". (3) Section 1840(h) of such Act (as so redesignated) is amended by striking out " (c), (d), and (e) " and inserting in lieu thereof " (c), and(d)". (4) Section 1841(h) of such Act is amended by striking out "1840(e)" and inserting in lieu thereof "1840(d)". (5) Section 1842 of such Act is amended by adding at the end thereof the following new subsection: " (g) The Railroad Retirement Board shall, in accordance with such regulations as the Secretary may prescribe, contract with a carrier or carriers to perform the functions set out in this section with respect to individuals entitled to benefits as qualified railroad retirement beneficiaries pursuant to section 226(a) of this Act and section 21(b) of the Railroad Retirement Act of 1937." (e) Section 1841 of such Act is amended by adding at the end thereof the following new subsection: " (i) The Managing Trustee shall pay from time to time from the Trust Fund such amounts as the Secretary of Health, Education, and Welfare certifies are necessary to pay the costs incurred by the Railroad Retirement Board for services performed pursuant to section 1840(b)(1) and section 1842(g). During each fiscal year or after the close of such fiscal year, the Railroad Retirement Board shall certify to the Secretary the amount of the costs it incurred in performing such services and such certified amount shall be the basis for the amount of such costs certified by the Secretary to the Managing Trustee." (f) The amendments made by this section with respect to collection of premiums shall apply to premiums becoming due and payable after the fourth month following the month in which this Act is enacted.

1449 42 USC 139SS.

42 USC 1395t. 42 USC 1395u.

Ante, p. 1371. 79 Stat. 340. 45 USC 2288-2. 42 USC 1395t.

Effective date.

PROSTHETIC LENSES F U R N I S H E D BY OPTOMETRISTS UNDER SUPPLEMENTARY MEDICAL INSURANCE PROGRAM

SEC. 264. (a) Section 1861(r) of the Social Security Act (as amended by sections 211(c)(2) and 256(b) of this Act) is further amended (1) by striking out "or (3) " and inserting in lieu thereof " (3) ", and (2) by inserting before the period at the end thereof the following: ", or (4) a doctor of optometry who is legally authorized to practice optometry by the State in which he performs such function, but only with respect to establishing the necessity for prosthetic lenses". (b) The amendment made by subsection (a) shall apply only with respect to services performed on or after the date of the enactment of this Act.

Ante, pp. 1384, 1447.

Effective date.

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[86 STAT.

PROVISION OF MEDICAL SOCLVL SERVICES NOT MANDATORY FOR EXTENDED CARE FACILITIES

SEC. 265. Section 1861(j) (11) of the Social Security Act (as redesigAnte. pp. 1412, nated by section 234(d) of this Act) is amended by inserting before ^'*^'*' the semicolon at the end thereof the following: ", except that the Secretary shall not require as a condition of participation that medical social services be furnished in any such institution". R E F U N D o p EXCESS P R E M I U M S UNDER MEDICARE

42 USC i39sgg.

SEC. 266. Section 1870 of the Social Security Act is amended by adding at the end thereof the following new subsection: " (g) If an individual, who is enrolled under section 1818(c) of the Ante, p. 1374. Social Security Act or under section 1837, dies, and premiums with 42 USC i395p. respect; tx) such enrollment have been received with respect to such individual for any month after the month of his death, such premiums shall be refunded to the person or persons determined by the Secretary under regulations to have paid such premiums or if payment for such premiums was made by the deceased individual before his death, to the legal representative of the estate of such deceased individual, if any. If there is no person who meets the requirements of the preceding sentence such premiums shall be refunded to the person or persons in the priorities specified in paragraphs (2) through (7) of subsection (e)." WAIVER OF REGISTERED NURSE REQUIREMENT I N SKILLED N U R S I N G FACILITIES I N RURAL AREAS

SEC. 267. Section 1861(j) of the Social Security Act, as amended by Ante, pp. 1412, sectious 234(d) and 246(b) of this Act, is further amended by adding 1424 at the end thereof the following new sentence: "To the extent that paragraph (6) of this subsection may be deemed to require that any skilled nursing facility engage the services of a registered professional nurse for more than 40 hours a week, the Secretary is authorized to Avaive such requirement if he finds that— " (A) such facility is located in a rural area and the supply of skilled nursing facility services in such area is not sufficient to meet the needs of individuals residing therein, " (B) such facility has one full-time registered professional nurse who is regularly on duty at such facility 40 hours a week, and " (C) such facility (i) has only patients whose physicians have indicated (through physicians' orders or admission notes) that each such patient does not require the services of a registered nurse or a physician for a 48-hour period, or (ii) has made arrangements for a registered professional nurse or a physician to spend such time at such facility as may be indicated as necessary by the physician to provide necessary skilled nursing services on days when the regular full-time registered professional nurse is not on duty." EXEMPTION OF CHRISTIAN SCIENCE SANATORIUMS FROM CERTAIN N U R S I N G HOME REQUIREMENTS UNDER MEDICAID

42 USC 1396a. Ante, p. 1415.

gfic. 268. (a) Section 1902(a) of the Social Security Act is amended by adding at the end thereof the following new sentence: "For purposes of paragraphs (9)(A), (29), (31), and (33), and of section 1903 (1)(4), the terms 'skilled nursing home' and 'nursing home' do not

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include a Christian Science sanatorium operated, or listed and certified, by the First Church of Christ, Scientist, Boston, Massachusetts." (b) Section 1908(g)(1) of such Act is amended by inserting after "Secretary'- the following: ", but does not include a Christian Science sanatorium operated, or listed and certified, by the First Church of Christ, Scientist,. Boston, Massachusetts". (c) The amendments made by this section shall be effective on the date of the enactment of this Act.

1451

81 Stat. 908. 42 USC 1396g.

Effective date.

HEQUIREMENTS FOR N U R S I N G HOME ADMINISTRATORS

SEC. 269. Section 1908(d) of the Social Security Act is amended by striking out "No State" and inserting in lieu thereof the following: "No State shall be considered to have failed to comply with the provisions of section 1902(a) (29) because the agency or board of such State (established pursuant to subsection (b)) shall have granted any waiver, with respect to any individual who, during all of the three calendar years immediately preceding the calendar year in which the requirements prescribed in section 1902(a) (29) are first met by the State, has served as a nursing home administrator, of any of the standards developed, imposed, and enforced by such agency or board pursuant to subsection (c). No State".

42 USC 1396a.

INCREASE I N LIMITATION ON P A Y M E N T S TO PUERTO RICO A N D THE VIRGIN ISLANDS FOR MEDICAL ASSISTANCE

SEC. 271. (a) Section 1108(c)(1) of the Social Security Act is amended by striking out "$20,000,000" and inserting in lieu thereof "$30,000,000". (b) Section 1108(c)(2) of such Act is amended by striking out "$650,000" and inserting in lieu thereof "$1,000,000". (c) The amendments made by subsections (a) and (b) shall apply with respect to fiscal years beginning after June 30, 1971.

42 USC 1308.

Effective date.

MEDICAL ASSISTANCE I N PUERTO RICO, THE VIRGIN ISLANDS, A N D GUAM

SEC. 271A. (a) Section 227(b) of the Social Security Amendments of 1967 is amended by striking out "June 30, 1972" and inserting in lieu thereof "June 30, 1975". (b) The amendment made by subsection (a) shall be effective from and after July 1, 1972.

81 Stat. 903. 42 USC 1396a note. Effective date.

EXTENSION OF TITLE V TO AMERICAN SAMOA A N D THE TRUST TERRITORY OF THE PACIFIC ISLANDS

SEC 272. (a) Section 1101(a)(1) of the Social Security Act is amended by adding at the end thereof the following,new sentence: "Such term when used in title V also includes American Samoa and the Trust Territory of the Pacific Islands." (b) Section 1108(d) of such Act is amended by inserting, after "allot such smaller amount to Guam", the following: ", American Samoa, and the Trust Temtory of the Pacific Islands". (c) The amendments made by this section shall apply with respect to fiscal years beginning after June 30, 1971.

42 USC 1301.

42 USC 1308.

Effective date.

I N C L U S I O N OF CHIROPRACTOR SERVICES UNDER MEDICARE

SEC. 273. (a) Section 1861(r) of the Social Security Act (as amended by sections 256(b) and 264(a) of this Act) is further amended by—

Ante, p. 1449.

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[86

STAT.

(1) striking out "or (4) " and inserting in lieu thereof " (4) ", and (2) inserting before the period at the end thereof the following ", or (5) a chiropractor who is licensed as such by the State (or in a State which does not license chiropractors as such, is legally authorized to perform the services of a chiropractor in the jurisdiction in which he performs such services), -and who meets uniform minimum standards promulgated by the Secretary, but only for the purpose of sections 1861(s)(1) and 1861 (s)(2)(A) and only with respect to treatment by means of manual manipulation of the spine (to correct a subluxation demonstrated by X-ray to exist) which he is legally authorized to perform by the State or jurisdiction in which such treatment is provided". (b) The amendments made by this section shall be effective with respect to services furnished after June 30, 1973. MISCELLANEOUS TECHNICAL A N D CLERICAL AMENDMENTS

42 USC 1396a.

42 USC 1396gs.

SEC. 274. (a) Clause (A) of section 1902(a) (26) of the Social Security Act is amended by striking out "evaluation" and inserting in lieu thereof "evaluation)", and by striking out "care)" and inserting in lieu thereof "care". (b) Section 1908(d) of such Act is amended by striking out "subsection (b)(1) " and inserting in lieu thereof "subsection (c)(1)". CHIROPRACTORS' SEflRVICES UNDER MEDICAID

Effective date.

SEC. 275. (a) Section 1905 of the Social Security Act is amended by adding after subsection (f), as added by section 247 of this Act, the following new subsection: " (g) If the State plan includes provision of chiropractors' services, such services include only— "(1) services provided by a chiropractor (A) who is licensed as such by the State and (B) who meets uniform minimum standards promulgated by the Secretary under section 1861(r)(5); and "(2) services which consist of treatment by means of manual manipulation of the spine which the chiropractor is legally authorized to perform by the State." (b) The amendment made by this section shall be effective with respect to services furnished after June 30, 1973. SERVICES OF FODIATRIC I N T E R N S A N D RESIDENTS UNDER PART A OF MEDICARE

Effective date.

S E C 276. (a) Section 1861(b)(6), as added by section 227(a) of this Act, is amended by deleting "; or" and inserting in lieu thereof the following: ", or in the case of services in a hospital or osteopathic hospital by an intern or resident-in-training in the field of podiatry, approved by the Council on Podiatry Education of the American Podiatry Association; or". (b) The amendment made by this section shall apply with respect to accounting periods beginning after December 31, 1972. U S E OP CONSULTANTS FOR EXTENDED CARE FACILITIES

42 USC 1395aa.

SEC. 277. Section 1864(a) of the Social Security Act is amended by adding at the end the following new sentence: "Any State agency which has such an agreement may (subject to approval of the Seci-e-

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tary) furnish to an extended care facility, after proper request by such facility, such specialized consultative services (which such agency is able and willing to furnish in a manner satisfactory to the Secretary) as such f aciLty may need to meet one or more of the conditions specified in section 1861(j). Any such services furnished by a State agency shall be deemed to have been furnished pursuant to such agreement."

1453

42 USC

ISQSX.

DESIGNATION OF EXTENDED CARE FACILITIES A N D SKILLED N U R S I N G HOMES AS SKILLED NURSING FACILITIES

SEC. 278. (a) The following sections of the Social Security Act are amended by striking out "extended care facility", "extended care facilities", "'skilled nursing home", and "skilled nursing homes" each time they appear therein and inserting in lieu thereof "skilled nursing facility" or "skilled nursing facilities", as the case may be, and by changing "an" to "a" as appropriate: (1) section 1814(a)(2)(C); (2) section 1814(a)(6); (3) section 1814(a)(7): (4) section 1861(a)(2); (5) section 1861(h); (6) section 1861(i); (7) section 1861(j); (8) section 1861(k); (9) section 1861(1); (10) section 1861(m)(7); (11) section 1861(n); (12) section 1861(u); (13) section 1861(v)(3); (14) section 1861(w); (15) section 1861(y); (16) section 1864(a); (17) section 1866; (18) section 1902(a) (13); (19) section 1902(a) (26); (20) section 1902(a) (28); (21) section 1905(a)(4); (22) section 1905(a)(5); (23) section 1905(a) (14); and (24) section 1121. (b) The following sections of the Social Security Act, as amended or added by the provisions of this Act, are further amended by striking out the terms "extended care facility", "extended care facilities", "skilled nursing home", and "skilled nursing homes" each time they appear therein and inserting in lieu thereof "skilled nursing facility" or "skilled nursing facilities", as the case may be, and by changing "an" to "a" as appropriate: (1) section 1903(g) and (h) of the Social Security Act as added by section 207 of this Act; (2) section 402(a)(1)(E) of the Social Security Amendments of 1967 as amended by section 222 of this Act; (3) section 1876 of the Social Security Act as added by section 226(a) of this Act; (4) section 1814(h) of such Act as added by section 228(a) of this Act; (5) section 1903(h) of such Act as added by section 207(a)(1) of this Act; (6) section 1861(z) of such Act as added by section 234(f) of this Act;

Ante. p. 1425. 42 USC i395f. 42 USC 1395x.

42 USC 1395aa 42 USC 139SCC 42 USC 1396a. Ante, p 1424. 42 USC 1396d, Ante, p. 1459.

42 USC 1320a.

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[86 STAT.

. (7) section 1903(i)(4) of such Act as added by section 237(a) of this Act; (8) section 1877(c) of such Act as added by section 242(b) of this Act; (9) section 1909(c) of such Act as added by section 242(c) of this Act; (10) section 1861(i) of such Act as amended by section 248 of this Act: (11) section 1861(v)(1)(E) of such Act as added by section 249(b) of this Act; (12) section 1910 of such Act as added by section 249A of this Act; (13) section 1861(j) of such Act as amended by section 267 of this Act; (14) section 1902(a) of such Act as amended by section 268 of this Act; (15) section 1864(a) of such Act as amended by section 277 of this Act; (16) section 1903(j) of such Act as added by section 225 of this Act; (17) section 1814(h) of such Act as added by section 228(a) of this Act; and (18) section 1866(a)(1) of such Act as amended by section 249A of this Act. DIRECT LABORATORY BILLING OF PATIENTS

SEC. 279. (a) Section 1833(a)(1) of the Social Security Act (as Ante, p. 1384. amended by section 211(c)(4) of this Act) is further amended by— (1) striking out "and" before " (C) "; (2) inserting before the semicolon at the end thereof the following: ", and (D) with respect.to diagnostic tests performed in a laboratory for which payment is made under this part to the laboratory, the amounts paid shall be equal to 100 percent of the negotiated rate for such tests (as determined pursuant to subsection (g) of this section)". Ante, p. 1445. (b) Section 1833 of such Act is amended by adding at the end thereof the following subsection: " (g) With respect to diagnostic tests performed in a laboratory for which payment is made under this part to the laboratory, the Secretary is authorized to establish a payment rate which is acceptable to the laboratory and which would be considered the full charge for such tests. Such negotiated rate shall be limited to an amount not in excess of the total payment that would have been made for the services in the absence of such a rate." CLARIFICATION OF M E A N I N G OF " p H Y S I C I A N S ' SERVICES" UNDER TITLE XIX

42 USC i396d.

S E C 280. Section 1905(a)(5) of the Social Security Act is amended by inserting "furnished by a physician (as defined in section 1861(r) (1)) " after "physicians' services". L13IITATION ON ADJUSTMENT OR RECOVERY OF INCORRECT P A Y M E N T S UNDER THE MEDICARE PROGRAM

42 USC i395gg.

S E C 281. (a)(1) Section 1870(b)(1) of.the Social Security Act is amended by— (A) inserting " (A) " after "the Secretary determines"; and (B) inserting at the end of paragraph (1) the following:

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" (B) that such provider of services or other person was without fault with respect to the payment of such excess over the correct amount, or". (2) Section 1870(b) of such Act is amended by adding at the end the following new sentence: "For purposes of clause (B) of paragraph (1), such provider of services or such other person shall, in the absence of evidence to the contrary, be deemed to be without fault if the Secretary's determination that more than such correct amount was paid was made subsequent to the third year following the year in which notice was sent to such individual that such amount had been paid; except that the Secretary may reduce such three-year period to not less than one year if he finds such reduction is consistent with the objectives of this title." (b) Section 1870(c) of such Act (as amended by section 261 of this Act) is further amended by— (1) inserting "or title X VIII " after "title II ", and (2) adding at the end the following new sentence: "Adjustment or recovery of an incorrect payment (or only such part of an incorrect payment as the Secretary determines to be inconsistent with the purposes of this title) against an individual who is without fault shall be deemed to be against equity and good conscience if (A) the incorrect payment was made for expenses incurred for items or services for which payment may not be made under this title by reason of the provisions of paragraph (1) or (9) of section 1862 and (B) if the Secretary's determination that such payment was incorrect was made subsequent to the third year following the year in which notice of such payment was sent to such individual; except that the Secretary may reduce such three-year period to not less than one year if he finds such reduction is consistent wnth the objectives of this title." (c) Section 1866(a)(1) of such Act (as amended by section 227(d)(2) of this Act) is further amended by— (1) redesignating subparagraph (B) as subparagraph (C), and (2) inserting after subparagraph (A) the following new subparagraph: " (B) not to charge any individual or any other person for items or services for which such individual is not entitled to have payment made under this title because payment for expenses incurred for such items or services may not be made by reason of the provisions of paragraph (1) or (9), but only if (i) such individual was without fault in incurring such expenses and (ii) the Secretary's determination that such payment may not be made for such items and services was made after the third year following the year in which notice of such payment was sent to such individual; except that the Secretary may reduce such three-year period to not less than one year if he finds such reduction is consistent with the objectives of this title, and" (d) Section 1842(b)(3)(B) (ii) of such Act (as amended by section 211(c)(3) of this Act) is further amended by— (1) inserting " (I) " after "of which"; and (2) inserting after "service" the following: "and ( II) the physician or other person furnishing such service agrees not to charge for such service if payment may not be made therefor by reason of the provisions of paragraph (1) of section 1862, and if the individual to whom such service was furnished was without fault in incurring the expenses of such service, and if the

1455

42 USC i39Sgg.

' ^^

^2 USC i395y.

-rosiijr

,,,

. ^^^^p.^

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42 USC 1395f.

42 USC 1395n.

Effective date.

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

Secretary's determination that payment (pursuant to such assignment) was incorrect and was made subsequent to the third year following the year in which notice of such payment was sent to such individual; except that the Secretary may reduce such threeyear period to not less than one year if he nnds such reduction IS consistent with the objectives of this title." (e) Section 1814(a)(1) of such Act is amended to read as follows: " ( I J written request, signed by such individual, except in cases in which the Secretary finds it impracticable for the mdividual to do so, is filed for such payment in such form, in such manner, and by such person or persons as the Secretary may by regulation prescribe, no later than the close of the period of 3 calendar years following the year in which such services are furnished (deeming any services furnished in the last 3 calendar months of any calendar year to have been furnished in the succeeding calendar year) except that where the Secretary deems that efficient administration so requires, such period may be reduced to not less than 1 calendar year;". (f) Section 1835(a)(1) of such Act is amended to read as follows: "(1) written request, signed by such individual, except in cases in which the Secretary finds it impracticable for the individual to do so, is filed for such payment m such form, in such manner and by such person or persons as the Secretary may by regulation prescribe, no later than the close of the period of 3 calendar years following the year in which such services are furnished (deeming any services furnished in the last 3 calendar months of any calendar year to have been furnished in the succeeding calendar year) except that, where the Secretary deems that efficient administration so requires, such period may be reduced to not less than 1 calendar year; and". (g) The provisions of subsection (a)(1) shall apply with respect to notices of payment sent to individuals after the date of enactment of this Act. The provisions of subsections (a)(2), (b), (c), and (d) shall apply in the case of notices sent to individuals after 1968. The provisions of subsections (e) and (f) shall apply in the case of services furnished (or deemed to have been furnished) aiter 1970. COVERAGE OF OUTPATIENT SPEECH PATHOLOGY SERVICES TJNDER MEDICARE

Ante, p. 1445.

Effective date.

SEC. 283. (a) Section 1861(p) of the Social Security Act is amended by adding at the end thereof the following new sentence: "The term 'outpatient physical therapy services' also includes speech pathology services furnished by a provider of services, a clinic, rehabilitation agency, or by a public health agency, or by others under an arrangement with, and under the supervision of, such provider, clinic, rehabilitation agency, or public health agency to an individual as an outpatient, subject to the conditions prescribed in this subsection.". ^b) Section 1835(a)(2) of such Act (as amended by section 251 of this Act) is further amended— (1) by striking out the period at the end of subparagraph (C) and inserting in lieu thereof "; and"; and (2) by adding after subparagraph (C) the following new subparagraph: " (D) in the case of outpatient speech pathology services, (i) such services are or were required because the individual needed speech pathology services, (ii) a plan for furnishing such services has been established and is periodically reviewed by a physician, and (iii) such services are or were furnished while the individual is or was under the care of a physician.", (c) The provisions of this section shall apply with respect to services rendered after December 31, 1972.

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1457

TERMINATION OF 3IEDICAL ASSISTANCE ADVISORY COUNCIL

SEC. 287. (a) Section 1906 of the Social Security Act is repealed. (b) The provisions of subsection (a) shall become effective on the first day of the third calendar month following the month in which this Act is enacted.

^* u^'sc i396e 2* Effective date.

MODIFICATION OF THE ROLE OF THE HEALTH INSURANCE BENEFITS ADVISORY COUNCIL

SEC. 288. (a) Section 1867(a) of the Social Security Act is amended 42 USC 1395dd. to read as follows: " (a) There is hereby created a Health Insurance Benefits Advisory Council which shall consist of 19 persons, not otherwise in the employ of the United States, appointed by the Secretary without regard to. 5 the provisions of title 5, United States Code, governing appointments seq. u s e 101 et in the competitive services. The Secretary shall from time to time appoint one of the members to serve as Chairman. The members shall include persons who are outstanding in fields related to hospital, medical, and other health activities, persons who are representative of organizations and associations of professional personnel in the field of medicine, and at least one person who is representative of the general public. Each member shall hold office for a term of four years, except that any member appointed to fill a vacancy occurring prior to the expiration of the term for which his predecessor was appointed shall be appointed for the remainder of such term. A member shall Per and not be eligible to serve continuously for more than two terms. Mem- travel dieme n s e s. exp bers of the Advisory Council, while attending meetings or conferences thereof or otherwise serving on business of the Advisory Council, shall be entitled to receive compensation at rates fixed by the Secretary, but not exceeding $100 per day, including traveltime, and while so serving away from their homes or regular places of business they may be allowed travel expenses, including per diem in lieu of subsistence, as authorized by section 5703 of title 5, United States Code, for persons in the Government service employed intermittently. The Advisory Council shall meet as the Secretary deems necessary, but not less than annually." (b) Section 1867(b) of spch Act is amended to read as follows: "(b) It shall be the function of the Advisory Council to provide advice and recommendations for the consideration of the Secretary on 42 USC 1395, matters of general policy with respect to this title and title XIX." 1396. (c) Section 1867 of such Act is further amended by striking out subsection (c). AUTHORITY OF SECRETARY TO ADMINISTER OATHS I N MEDICARE PROCEEDINGS

SEC. 289. Section 1874 of the Social Security Act is amended by adding at the end thereof the following new subsection: "(c) In the course of any hearing, investigation, or other proceeding that he is authorized to conduct under this title, the Secretary may administer oaths and affirmations."

42 USC 1395kk.

WITHHOLDING OF FEDERAL P A Y M E N T S UNDER MEDICAID W I T H RESPECT TO CERTAIN H E A L T H CARE FACILITIES

SEC. 290. Section 1903 of the Social Security Act is amended by adding after subsection (i) thereof the following new subsection: "(j)(1) Notwithstanding the preceding provisions of this section, no payment shall be made to a State (except as provided under this

Ante, pp. 1454.

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[86 STAT.

subsection) with lespect to expenditures incurred by it for services provided by any institution during any period that an order for suspension of payment (as authorized by this subsection) is effective with respect to such institution. "(2) The Secretary may issue a suspension of payment order with respect to any institution if— "(A) such institution (i) does not (at the time such order is issued) have in effect an agreement with the Secretary which is 42 USC 139SCC. entered into pursuant to section 1866; and (ii) did (prior to the time such order is issued) have in effect such an agreement; and ''(B)(i) the Secretary has been unable to collect (or make satisfactory arrangement for the collection of) amounts due on account oi overpavments made to such institution under title 42 USC 1395. X VIII; or "(ii) the Secretary has been unable to obtain from such institution the data and information necessary to enable him to determine the amount (if any) of the overpayments made to such institution under title XVIII. Notice. "(3) Whenever the Secretary issues any order for suspension of payment under this subsection with respect to any institution, he shall submit a notice of such order to the single State agency (referred 42 USC 1396a. ^Q in section 1902(a)(5)) of each State which he has reason to believe does or may utilize the services of such institution in providing medical assistance under a plan approved under this title. " (4) Any order for suspension of payment issued with respect to any institution under this subsection shall become effective, in the case of any state plan approved under this title, on the 60th day after the date the State agency (referred to in section 1902(a)(5)) administering or supervising the administration of such plan receives notice of such order submitted pursuant to paragraph (3). Any such order shall cease to be effective at such time as the Secretary is satisfied that the institution is participating in substantial negotiations which seek to remedy the conditions which gave rise to his order of suspension of payments, or that the amounts (referred to in paragraph (2)) are no longer due from such institution or that a satisfactory arrangement has been made for the payment by such institution of any such amounts. Upon the determination of the Secretary that any such order with respect to any such institution shall cease to be effective, he shall forthwith notify each State agency to which he has theretofore submitted notice under paragraph (3) with respect to such institution. "(5) Whenever any order which has been issued by the Secretary under the pi-eceding provisions of this subsection with respect to an institution cea^s to be effective, any payment to which any State would (except for the preceding provisions of this subsection) have been entitled under this section on account of services provided by such institution shall be made to such State for the month in which such order ceases to be effective." INTERMEDIATE CARE SERVICES IX STATES WHICH DO NOT IIA^T: A MEDICAID PROGRAM

SEC 292. Section 4(d) of Public Law 92-223i (approved December 85 Stat. 810. 2gj 1971) is amended by inserting immediately before the period at 42 USC 1396a ^j^^ ^^^ thercof the following: '"; except that the repeal made by pote subsection (c) shall not become effective in the case of any State, which on January 1, 1972 did not have in effect a State plan approved 42 USC 1396. under title X IX of the Social Security Act, until the first day of the first month (occurring after such date) that such State does have in effect a State plan approved under such title".

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1459

KEQUIRED INFORMATION RELATING TO EXCESS MEDICARE TAX P A Y M E N T S BY ILilLROAD EMPLOYEES

SEC. 293. (a) Section 6051(a) of the Internal Revenue Code of 1954 (relating to requirement of receipts for employees) is amended— (1) by striking out "section 3101, 3201, or 3402" in the matter preceding paragraph (1) and inserting in lieu thereof "section 3101 or 3402"; (2) by inserting "and" at the end of paragraph (5), and by striking out the comma at the end of paragraph (6) and inserting in lieu thereof a period; and (3) by striking out paragraphs (7) and (8). (b) Section 6051(c) 'of such Code (relating to additional requirements (is amended by striking out "sections 3101 and 3201" in the second sentence and inserting in lieu thereof "section 3101". (c) Section 6051 of such Code (relating to receipts for employees) is amended by adding at the end thereof the following new subsection: "(e)

68A Stat. 747. 26 USC 6051.

RAILROAD EMPLOYEES.—

"(1)

ADDITIONAL REQUIREMENT.—Every person required to

deduct and withhold tax under section 3201 from an employee shall include on or with the statement required to be furnished such employee under subsection (a) a notice concerning the provisions of this title with respect to the allowance of a credit or refund of the tax on wages imposed by section 3101(b) and the tax on compensation imposed by section 3201 or 3211 which is treated as a tax on wages imposed by section 3101(b). " (2) INFORMATION TO BE SUPPLIED TO EMPLOYEES.—Each person required to deduct and withhold tax under section 3201 during any year from an employee who has also received wages during such year subject to the tax imposed by section 3101(b) shall, upon request of such employee, furnish to him a written statement showing— " (A) the total amount of compensation with respect to which the tax imposed by section 3201 was deducted, " (B) the total amount deducted as tax under section 3201, and " (C) the portion of the total amount deducted as tax under section 3201 which is for financing the cost of hospital insurance under part A of title X VIII of the Social Security Act." (d) The amendments made by this section shall apply in respect to remuneration paid after December 31, 1971.

42 USC 139Se. Effective date.

APPOINTMENT AND CONFIRMATION OF ADMINISTRATOR OF SOCIAL AND REHABILITATION SERVICE

SEC. 294. Appointments made on or after the date of enactment of this Act to the office of Administrator of the Social and Rehabilitation Service, within the Department of Health, Education, and Welfare, shall be made by the President, by and with the advice and consent of the Senate. REPEAL OF S E C T I O N

1903(b)(1)

SEC. 295. Section 1903(b)(1) of the Social Security Act is repealed.

42 USC i396b.

COVERAGE UNDER MEDICAID OF INTERMEDIATE CARE F U R N I S H E D I N M E N T A L AND T U B E R C U IX) 8 I S INSTITUTIONS

SEC. 297. (a) Section 1905(a) (14) of the Social Security Act is amended to read as follows:

42 USC 1396d.

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Effective date.

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[86

STAT.

"(14) inpatient hospital services, skilled nursing home services, and intermediate care facility services for individuals 65 years of age or over in an institution for tuberculosis or mental diseases;" (b) The amendment made by this section shall apply with respect to services furnished after December 31, 1972. IX D E P E X D E X T REVIEW OF INTERMEDIATE CARE FACILITY PATIENTS

85 Stat. 809. 42 USC 1396a.

SEC. 298. Section 1902(a) (31)(A) of the Social Security Act, as added by Public Law 92-223, is amended by striking out the phrase "which provides more than a minimum level of health care services." INTERMEDIATE CARE, M A I N T E N A N C E OF EFFORT I N PUBLIC INSTITUTIONS

42 USC 1396d.

SEC. 299. Section 1905(d)(3) of the Social Security Act, as added by Public Law 92-223, is amended to read as follows: " (3) the State or political subdivision responsible for the operation of such institution has agreed that the non-Federal expenditures in any calendar quarter prior to January 1, 1975, with respect to services furnished to patients in such institution (or distinct part thereof) in the State will not, because of payments made under this title, be reduced below the average amount expended for such services in such institution in the four quarters immediately preceding the quarter in which the State in which such institution is located elected to make such services available under its plan approved under this title." DISCLOSURE OF OWNERSHIP OF OPERATIONS OF INTERMEDIATE CARE FACILITIES

SEC. 299A. Section 1902(a) of the Social Security Act, as amended by sections 236,239, and 255 of this Act, is further amended— (1) by striking out "and" at the end of paragraph- (33); (2) by striking out the period at the end of paragraph (34) and inserting in lieu thereof "; and"; and (3) by inserting after paragraph (34) the following new paragraph: "(35) effective January 1, 1973, provide that any intermediate care facility receiving payments under such plan must supply to the licensing agency of the State full and complete information as to the identity (A) of each person having (directly or indirectly) an ownership interest of 10 per centum or more in such intermediate care facility, (B) in case an intermediate care facility is organized as a corporation, of each officer and director of the corporation, and (C) in case an intermediate care facility is organized as a partnership, of each partner; and promptly report any changes which would affect the current accuracy of the information so required to be supplied." TREATMENT I N M E N T A L HOSPITALS FOR INDIVIDUALS UNDER AGE 2 1

SEC. 299B. (a) Section 1905(a) of the Social Security Act is amended— (1) by striking the word "and" in paragraph ( 1 5); (2) by redesignating paragraph (15) as paragraph (17); (3) by redesignating paragraph (16) as paragraph (15); (4) by inserting after paragraph (15) the following new paragraph:

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"(16) effective January 1, 1973, inpatient psychiatric hospital services for individuals under 21, as defined in subsection (e); ". (b) Section 1905 of such Act, as amended by sections 212(a), 247 (b) and 275(e) of this Act, is further amended by adding after subsection (g) the following new subsection: " (h)(1) For purposes of paragraph (16) of subsection (a), the term 'inpatient psychiatric hospital services for individuals under age 21' includes only— " (A) inpatient services which are provided in an institution which is accredited as a psychiatric hospital by the Joint Commission on Accreditation of Hospitals; " (B) inpatient services which, in the case of any individual, involves active treatment (i) which meets such standards as may be prescribed pursuant to title X VIII in regulations by the Secretary, and (ii) which a team, consisting of physicians and other personnel qualified to make determinations with respect to mental health conditions and the treatment thereof, has determined are necessary on an inpatient basis and can reasonably be expected to improve the condition, by reason of which such services are necessary, to the extent that eventually such services will no longer be necessary; and " (C) inpatient services which, in the case of any individual, are provided prior to (A) the date such individual attains age 21, or (B) in the case of an individual who was receiving such services in the period immediately preceding the date on which he attained age 21, (i) the date such individual no longer requires such services, or (ii) if earlier, the date such individual attains age 22; "(2) Such term does not include services provided during any calendar quarter under the State plan of any State if the total amount of the funds expended, during such quarter, by the State (and the political subdivisions thereof) from non-Federal funds for inpatient services included under paragraph (e)(1), and for active psychiatric care and treatment provided on an outpatient basis for eligible mentally ill children, is less than the average quarterly amount of the funds expended, during the 4-quarter period ending December 31, 1971, by the State (and the political subdivisions thereof) from non-Federal funds for such services." (c) Section 1905(a) is further amended by striking out, in the part which follows paragraph (17) (as redesignated by subsection (a) of this section), "except that" and inserting in lieu thereof "except as otherwise provided in paragraph (16),".

1461

Ante, p. 1452. Definition.

42 USC 139s.

PUBLIC DISCLOSURE OF INFORMATION CONCERNING SURVEY REPORTS OF A N INSTITUTION

SEC. 299D. (a) Section 1864(a) of the Social Security Act is Ante, pp. 1452. amended by adding at the end thereof the following new sentence: ^'*^'* "Within 90 days following the completion of each survey of any health care facility, laboratory, clinic, agency, or organization by the appropriate State or local agency described in the first sentence of this subsection, the Secretary shall make public in readily available form and place the pertinent findings of each such survey relating to the compliance of each such health care facility, laboratory, clinic, agency, or organization with (1) the statutory conditions of participation imposed under this title and (2) the major additional conditions which the Secretary finds necessary in the interest of health and safety of individuals who are furnished care or services by any such facility, laboratory, clinic, agency, or organization.".

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PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

•'• (b) Section 1902(a) of the Social Security Act, as amended by sections 236, 239, 255, and 299A of this Act, is further amended— (1) by striking out "and" at the end of paragraph (35); (2) by striking out the period at the end of paragraph (36) and inserting in lieu thereof "; and"; and (3) by inserting after paragraph (36) the following new paragraph: "(37) provide that within 90 days following the completion of eacn survey of any health care facility, laboratory, agency, clinic, or organization, by the appropriate State agency described in paragraph (9), such agency shall (in accordance with regulations of the Secretary) make public in readily available form and place the pertinent findings of each such survey relating to the J compliance of each such health care facility, laboratory, clinic, - agency, or organization with (A) the statutory conditions of participation imposed under this title, and (B) the major additional conditions which the Secretary finds necessary in the interest of health and safety of individuals who are furnished care or services by any such facility, laboratory, clinic, agency, or organization, (c) The provisions of this section shall be effective beginning January 1, 1973, or within 6 months following the enactment of this Act, whichever is later. F A M I L Y P L A N N I N G SERVICES MANDATORY UNDER MEDICAID

Ante. p. 1428.

79 Stat. 351; 81 Stat. 929. 42 USC 1396d.

85 Stat. 803. 42 USC 602.

49 Stat. 628; 85 Stat. 80S. 42 USC 603.

SEC. 299E. (a) Section 1903(a) of the Social Security Act, as amended by sections 235 and 249B of this Act, is further amended by redesignating paragraph (5) as paragraph (6), and by inserting after paragraph (4) the following new paragraph: "(5) an amount equal to 90 per centum of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the plan) which are attributable to the offering, arranging, and furnishing (directly or on a contract basis) of family planning services and supplies;". (b) Section 1905(a)(4) of the Social Security Act is amended by adding after clause (B) the following: "and (C) family planning services and supplies furnished (directly or under arrangements with others) to individuals of child-bearing age (including minors who can be considered to be sexually active) who are eligible under the State plan and who desire such services and supplies;". (c) Section 402(a) (15)(B) of such Act is amended, effective January 1, 1973, (1) by adding after "in all appropriate cases" the following: "(including minors who can be considered to be sexually active)", and (2) by adding after "family planning services are offered them" the following: "and are provided promptly (directly or under arrangements with others) to all individuals voluntarily requesting such services". (d) Section 403 of such Act is amended by adding at the end thereof the following new sections: "(e) Notwithstanding any^ other provision of subsection (a), with respect to expenditures during any calendar quarter beginning after December 31, 1972 (as found necessary by the Secretary for the proper and efficient administration of the plan) which are attributable to the offering, arranging, and furnishing, directly or on a contract basis, of family planning services and supplies, the amount payable to any State under this part shall be 90 per centum of such expenditures.

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"(f) Notwithstanding any other provision of this section, the amount payable to any State under this part for quarters in a fiscal year shall with respect to quarters in fiscal years beginning after June 30, 1973, be reduced by 1 per centum (calculated without regard to any reduction under section 403(g)) of such amount if such State— "(1) in the immediately preceding fiscal year failed to carry out the provisions of section 402(a) (15)(B) as pertain to requiring the offering and arrangement for provision of family planning services; or "(2) in the immediately preceding fiscal year (but, in the case of the fiscal year beginning July 1, 1972, only considering the third and fourth quarters thereof), tailed to carry out the provisions of section 402(a) (15)(B) of the Social Security Act with respect to any individual who, within such period or periods as the Secretary may prescribe, has been an applicant for or recipient of aid to families with dependent children under the plan of the State approved under this part."

Infra, Ante, p. 1462.

PENALTY FOR FAILURE TO PROVIDE CHILD H E A L T H SCREENING SERVICES UNDER MEDICAID

SEC. 299F. Section 403 of the Social Security Act is amended by adding at the end thereof the following: "(g) Notwithstanding any otner provision of this section, the amount payable to any State under this part for quarters in a fiscal year shall with respect to quarters in fiscal years beginning after June 30, 1974, be reduced b5^ 1 per centum (calculated without regard to any reduction under section 403(f)) of such amount if such State fails to— "(1) inform all families in the State receiving aid to families with dependent children under the plan of the State approved under this part of the availability of child health screening services under the plan of such State approved under title XIX, "(2) provide or arrange for the provision of such screening services m all cases where they are requested, or "(3) arrange for (directly or through referral to appropriate agencies, organizations, or individuals) corrective treatment the need for which is disclosed by such child health screening services." CHRONIC RENAL DISEASE CONSIDERED TO CONSTITUTE

Ante, p. 1426.

DISABILITY

SEC. 2991. Effective with respect to services provided on and after July 1, 1973, section 226 of the Social Security Act (as amended by section 201(b)(5) of this Act) is amended by redesignating subsection (e) as subsection (f), and by inserting after subsection (d) the following new subsection: "(e) Notwithstanding the foregoing provisions of this section, every individual who— "(1) has not attained the a^e of 65; " (2)(A) is fully or currently insured (as such terms are defined in section 214 of this Act), or (B) is entitled to monthly insurance benefits under title II of this Act, or (C) is the spouse or dependent child (as defined in regulations) of an individual who is fully or currently insured, or (D) is the spKJuse or dependent child (as defined in regulations) of an individual entitled to monthly insurance benefits under title II of this Act; and "(3) is medically determined to have chronic renal disease and who requires hemodialysis or renal transplantation for such disease; -081 O - 73 - 95

Supra,

Effective date. Ante, p. 1372.

Ante, p. 1341. 42 USC 401.

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42 USC 1395.

PUBLIC LAW 92-603-OCT. 30, 1972

[86

STAT..

shall be deemed to be disabled for purposes of coverage under parts A and B of Medicare subject to the deductible, premium, and copayment provisions of title X VIII. " (f) Medicare eligibility on the basis of chronic kidney failure shall begin with the third month after the month in which a course of renal dialysis is initiated and would end with the twelfth month after the month in which the person has a renal transplant or such course of dialysis is terminated. " (g) The Secretary is authorized to limit reimbursement under Medicare for kidney transplant and dialysis to kidney disease treatment centers which meet such requirements as he may by regulation prescribe: Provided, That such requirements must include at least requirements for a minimal utilization rate for covered procedures and for a medical review board to screen the appropriateness of patients for the proposed treatment procedures." E L I M IX A T I O N OF COINSURANCE P A Y M E N T W I T H RESPECT TO H O M E H E A L T H SERVICES UNDER PART B OF MEDICARE

Ante, p. 1411.

Effective date.

SEC. 299K. (a) Section 1833(a)(2) of the Social Security Act is amended by striking out "80 percent" and inserting in lieu thereof "with respect to home health services, 100 percent, and with respect to other services, 80 percent." (b) The amendment made by subsection (a) shall apply to services furnished by home health agencies in accounting periods beginning after D e c e m W 31, 1972. CERTIFICATION OP INTERMEDIATE CARE FACILITIES AND SKILLED N U R S I N G FACILITIES LOCATED ON A N I N D I A N RESERVATION

85 Stat. 809. 42 USC 1396d.

"Skilled nursing f a c i l i t y. " Ante, p. 1452.

42 USC 1395x.

SEC. 299L. (a) Section 1905(c) of the Social Security Act, as added by Public Law 92-223, is amended by adding after the penultimate sentence thereof the following: "The term 'intermediate care facility' also includes any institution which is l o c a t e in a State on an Indian reservation and is certified by the Secretary as meeting the requirements of clauses (2) and (3) of this subsection and providing the care and services required under clauses (1).". (b) Section 1905 of the Social Security Act, as amended by this Act, is amended by adding at the end thereof the following new subsection: " (h) For purposes of this title, the term 'skilled nursing facility' also includes any institution which is located in a State on an Indian reservation and is certified by the Secretary as being a qualified skilled nureing facility by meeting the requirements of section 1861(j). " DETERMINATIONS A N D APPEALS

79 Stat. 330. 42 USC 1395£f.

42 USC 426. 79 Stat. 333; 81 Stat. 854. 42 USC 426a. 42 USC 1395J. Ante, p. 1374. 42 USC 139Sc.

SEC. 2990. (a) Section 1869(b) of the Social Security Act is amended to read as follows: " (b)(1) Any individual dissatisfied with any determination under subsection (a) as to— " (A) whether he meets the conditions of section 226 of this Act or section 103 of the Social Security Amendments of 1965, or " (B) whether he is eligible to enroll and has enrolled pursuant to the provisions of part B of this title, or section 1818, or section 1819,or " (C) the amount of benefits under ^a rt A (including a determination where such amount is determined to be zero)

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shall be entitled to a hearing thereon by the Secretary to the same extent as is provided in section 205(b) and to judicial review of the Secretary's final decision after such hearing as is provided in section 205(g). "(2) Notwithstanding the provisions of subparagraph (C) of paragraph (1) of this subsection, a hearing shall not be available to an individual by reason of such subparagraph (C) if the amount in controversy is less than $100; nor shall judicial review be available to an individual by reason of such subparagraph (C) if the amount in controversy is less than $1,000." (b)(1) The provisions of subparagraphs (A) and (B) of section 1869(b)(1) of the Social Security Act, as amended by subsection (a) of this section, shall be effective on the date of enactment of this Act. (2) The provisions of paragraph (2) and of subparagraph (C) of paragraph (1) of section 1869(b) of the Social Security Act, as amended by subsection (a) of this section, shall be effective with respect to any claims under part A of title X VIII of such Act, filed— (A) in or after the month in which this Act is enacted, or (B) before the month in which this Act is enacted, but only if a civil action with respect to a final decision of the Secretary of Health, Education, and Welfare on such claim has not been commenced under such section 1869(b) before such month.

42 USC 405.

Effective dates.

42 USC 1395c.

TITLE III — S U P P L E M E N T A L S E C U K I T Y INCOME FOR THE AGED, BLIND, AND DISABLED ESTABLISHMENT OF PROGRAM

SEC. 301. Effective January 1, 1974, title X VI of the Social Security Act is amended to read as follows: "

Effective date. 76 Stat. i97; 81 Stat. 896.

" TITLE X VI — S U P P L E M E N T A L S E C U R I T Y INCOME FOR THE AGED, BLIND, AND DISABLED uP U R P O S E; APPROPRIATIONS

"SEC. 1601. For the purpose of establishing a national program to provide supplemental security income to individuals who have attained age 65 or are blind or disabled, there are authorized to be appropriated sums sufficient to carry out this title. U-

BASIC ELIGIBILITY TOR BENEFITS

"SEC. 1602. Every aged, blind, or disabled individual who is determined under part A to be eligible on the basis of his income and resources shall, in accordance with and subject to the provisions of this title, be paid benefits by the Secretary of Health, Education, and Welfare.

'*' "^"^ '^*^-

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[86 STAT.

" P A R T A—DETERMINATION OF BENEFITS .eo?-. -JC'.' •

"ELIGIBILITY FOR AND AMOUNT OF BENEFITS

•

'>»r;

"Definition of Eligible Individual "SEC. 1611. (a)(1) Each aged, blind, or disabled individual who does not have an eligible spouse and— " (A) whose income, other than income excluded pursuant to section 1612(b), is at a rate of not more than $1,560 for the calendar year 1974 or any calendar year thereafter, and " (B) whose resources, other than resources excluded pursuant to section 1613(a), are not more than (i) in case such individual has a spouse with whom he is living, $2,250, or (ii) in case such individual has no spouse with whom he is living, $1,500, shall be an eligible individual for purposes of this title. "(2) Each aged, blind, or disabled individual who has an eligible spouse and— " (A) whose income (together with the income of such sjjouse), other than income excluded pursuant to section 1612(b), is at a rate of not more than $2,340 for the calendar year 1974, or any calendar year thereafter, and " (B) whose resources (together with the resources of such spouse), other than resources excluded pursuant to section 1613 (a), are not more than $2,250, shall be an eligible individual for purposes of this title. "Amounts of Benefits " (b)(1) The benefit under this title for an individual who does not have an eligible spouse shall be payable at the rate of $1,560 for the calendar year 1974 and any calendar year thereafter, reduced by the amount of income, not excluded pursuant to section 1612(b), of such individual. " (2) The benefit under this title for an individual who has an eligible spouse shall be payable at the rate of $2,340 for the calendar year 1974 and any calendar year thereafter, reduced by the amount of income, not excluded pursuant to section 1612(b), of such individual and spouse. "Period for Determination of Benefits "(c)(1) An individual's eligibility for benefits under this title and the amount of such benefits shall be determined for each quarter of a calendar year except that, if the initial application for benefits is filed in the second or third month of a calendar quarter, such determinations shall be made for each month in such quarter. Eligibility for and the amount of such benefits for any quarter shall be redetermined at such time or times as may be provided by the Secretary. "(2) For purposes of this subsection an application shall be considered to be effective as of the first day of the month in which it was actually filed. "Special Limits on Gross Income " (d) The Secretary may prescribe the circumstances under which, consistently with the purposes of this title, the' gross income from a trade or business (including farming) will be considered sufficiently large to make an individual ineligible for benefits under this title. For purposes of this subsection, the term 'gross income' has the same

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meaning as when used in chapter 1 of the Internal Revenue Code of 1954. "Limitation on Eligibility of Certain Individuals

1467 26 USC 1 et

" (e)(1)(A) Except as provided in subparagraph (B), no person shall be an eligible individual or eligible spouse for purposes of this title with respect to any month if throughout such month he is an inmate of a public institution. " (B) In any case where an eligible individual or his eligible spouse (if any) is, throughout any month, in a hospital, extended care facility, nursing home, or intermediate care facility receiving payments (with respect to such individual or spouse) under a State plan approved under title X IX, the benefit under this title for such indi- '•2 USC 1396. vidual for such month shall be payable— " (i) at a rate not in excess of $300 per year (reduced by the amount of any income not excluded pursuant to section 1612(b)) in the case of an individual who does not have an eligible spouse; "(ii) at a rate not in excess of the sum of the applicable rate specified in subsection (b)(1) and the rate of $300 per year (reduced by the amount of any income not excluded pursuant to section 1612(b)) in the case of an individual who has an eligible .; spouse, if only one of them is in such a hospital, home, or facility throughout such month; and "(iii) at a rate not in excess of $600 per year (reduced by the amount of any income not excluded pursuant to section 1612(b)) in the case of an individual who has an eligible spouse, if both of them are in such a hospital, home, or facility throughout such month. "(2) No person shall be an eligible individual or eligible spouse for purposes of this title if, after notice to such person by the Secretary that it is likely that such person is eligible for any payments of the type enumerated in section 1 6 1 2 (a)(2)(B), such person fails within 30 days to take all appropriate steps to apply for and (if eligible) obtain any such payments. "(3)(A) No person who is an aged, blind, or disabled individual solely by reason of disability (as determined under section 1614(a) (3)) shall be an eligible individual or eligible spouse for purposes of this title with respect to any month if such individual is medically determined to be a drug addict or an alcoholic unless such individual is undergoing any treatment that may be appropriate for his condition as a drug addict or alcoholic (as the case may be) at an institution or facility approved for purposes of this paragraph by the Secretary (so lon^ as such treatment is available) and demonstrates that ho is complying with the terms, conditions, and requirements of such treatment and with requirements imposed by the Secretary under subparagraph (B). " (B) The Secretary shall provide for the monitoring and testing of all individuals who are receiving benefits under this title and who as a condition of such benefits are required to be undergoing treatment and complying with the terms, conditions, and requirements ^^ thereof as described in subparagraph (A), in order to assure such compliance and to determine the extent to which the imposition of such requirement is contributing to the achievement of the purposes of this title. The Secretary shall annually submit to the Congress ^ f ^* " *° ^°"' ^^ f " * gress. a full and complete report on his activities under this paragraph.

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[86 STAT.

"Suspension of Payments to Individuals Who Are Outside the United States " (f) Notwithstanding any other provision of this title, no individual shall be considered an eligible individual for purposes of this title for any month during all of which such individual is outside the United States (and no person shall be considered the eligible spouse of an individual for purposes of this title with respect to any month during all of which such person is outside the United States). For purposes of the preceding sentence, after an individual has been outside the United States for any period of 30 consecutive days, he shall be treated as remaining outside the United States until he has been in the United States for a period of 30 consecutive days. "Certain Individuals Deemed To Meet Resources Test " (g) I n the case of any individual or any individual and his spouse (as the case may be) who for the month of December 1973 was a recipient of aid or assistance under a State plan approved under title 42 USC 301, I, X, X IV, or X VI, the resources of such individual or such individual Ante^p^'ues. *^^^ ^^^ spouse shall be deemed not to exceed the amount specified in sections 1611(a)(1)(B) and 1611(a)(2)(B) during any period that the resources of such individual or individual and his spouse (as the case may be) does not exceed the maximum amount of resources, as specified in the State plan (above referred to, and as in effect in October 1972) under which he or they were entitled to aid or assistance for the month of December 1972. "Certain Individuals Deemed To Meet Income Test " (h) I n determining eligibility for, and the amount of, benefits payable under this section in the case of any individual or any individual and his spouse (as the case may be) who is blind (as that term is defined under a State plan approved under title X or X VI as in effect in October 1972) and who for the month of December 1973 was a recipient of aid or assistance under a State plan approved under title X or X VI, there shall be disregarded an amount equal to the greater of the amounts determined as follows— "(1) the maximum amount of any earned or unearned income which could have been disregarded under the State plan (above referred to, and as in effect in October 1972), or "(2) the amount which would be required to be disregarded under section 1612 without application of this subsection. "INCOME

"Meaning of Income

42 USC 403. Ante, p. 1353.

"SEC. 1612. (a) For purposes of this title, income means both earned income and unearned income; and— "(1) earned income means only— " (A) wages as determined under section 203(f)(5)(C); and " (B) net earnings from self-employment, as defined in section 211 (without the application of the second and third sentences following subsection (a) (10), and the last par-

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1469

agrapli of subsection (a)), including earnings for services described in paragraphs (4), (5), and (6) of subsection (c); and "(2) unearned income means all other income, including— " (A) support and maintenance furnished in cash or kind; except that in the case of any individual (and his eligible spouse, if any) living in another person's household and receiving support and maintenance in kind from such person, the dollar amounts otherwise applicable to such individual (and spouse) as specified in subsections (a) and (b) of section 1611 shall be reduced by ZSy^ percent in lieu of including such support and maintenance in the unearned income of such individual (and spouse) as otherwise required by this subparagraph; " (B) any payments received as an annuity, pension, retirement, or disability benefit, including veterans' compensation and pensions, workmen's compensation payments, old-age, survivors, and disability insurance benefits, railroad retirement annuities and pensions, and unemployment insurance benefits; " (C) prizes and awards; " (D) the proceeds of any life insurance policy to the extent that they exceed the amount expended by the beneficiary for purposes of the insured individual's last illness and burial or $1,500, whichever is less; " (E) gifts (cash or otherwise), support and alimony payments, and inheritances; and " (F) rents, dividends, interest, and royalties. "Exclusions From Income " (b) In determining the income of an individual (and his eligible spouse) there shall be excluded— "(1) subject to limitations (as to amount or otherwise) prescribed by the Secretary, if such individual is a child who is, as determined by the Secretary, a student regularly attending a school, college, or university, or a course of vocational or technical training designed to prepare him for gainful employment, the earned income of such individual; "(2) the first $240 per year (or proportionately smaller amounts for shorter periods) of income (whether earned or unearned) other than income which is paid on the basis of the need of the eligible individual; "(3)(A) the total unearned income of such individual (and such spouse, if any) in a calendar quarter which, as determined in accordance with criteria prescribed by the Secretary, is received too infrequently or iregularly to be included, if such income so received does not exceed $60 in such quarter, and (B) the total earned income of such individual (and such spouse, if any) in a calendar quarter which, as determined in accordance with such criteria, is received too infrequently or iregularly to be included, if such income so received does not exceed $30 in such quarter; "(4)(A) if such individual (or such spouse) is blind (and has not attained age 65, or received benefits under this title (or aid under a State plan approved under section 1002 or 1602) for the month before the month in which he attained age 65), (i) the first $780 per year (or proportionately smaller amounts for shorter periods) of earned income not excluded by the preceding para-

''osf, p. uss.

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Post, p. 1488.

PUBLIC LAW 92-603-OCT. 30, 1972

[86 STAT.

graphs of this subsection, plus one-half of the remainder thereof, (ii) an amount equal to any expenses reasonably attributable to the earning of any income, and (^iii) such additional amounts of other income, where such individual has a plan for achieving self-support approved by the Secretary, as may be necessary for the fulfillment of such plan, " (B) if such individual (or such spouse) is disabled but not blind (and has not attained age 65, or received benefits under this title (or aid under a State plan approved under section 1402 or 1602) for the month before the month in which he attained age 65), (i) the first $780 per year (or proportionately smaller amounts for shorter periods) of earned income not excluded by the preceding paragraphs of this subsection, plus one-half of the remainder thereof, and (ii) such additional amounts of other income, where such individual has a plan for achieving selfsupport approved by the Secretary, as may be necessary for the fulfillment of such plan, or " (C) if such individual (or such spouse) has attained age 65 and is not included under subparagraph (A) or (BY, the first $780 per year (or proportionately smaller amounts tor shorter periods) of earned income not excluded by the preceding paragraphs of this subsection, plus one-half of the remainder thereof; "(5) any amount received from any public agency as a return or refund of taxes paid on real property or on food purchased by such individual (or such spouse); "(6) assistance described m section 1616(a) which is based on need and furnished by any State or political subdivision of a State; "^7) any portion of any grant, scholarship, or fellowship received for use in paying the cost of tuition and fees at any educational (including technical or vocational education) institution; "(8) home produce of such individual (or spouse) utilized by the household for its own consumption; " (9) if such individual is a child one-third of any payment for his support received from an absent parent; and "(10) any amounts received for the foster care of a child who is not an eligible individual but who is living in the same home as such individual and was placed in such home by a public or nonprofit private child-placement or child-care agency. "RESOURCES

"Exclusions From Resources "SEC. 1613. (a) I n determining the resources of an individual (and his eligible spouse, if any) there shall be excluded— " (1) the home (including the land that appertains thereto), to the extent that its value does not exceed such amount as the Secretary determines to be reasonable; "(2) household ^oods, personal effects, and an automobile, to the extent that their total value does not exceed such amount as the Secretary determines to be reasonable j "(3) other property which, as determined in accordance with and subject to limitations prescribed by the Secretary, is so essential to the means of self-support of such individual (and such spouse) as to warrant its exclusion; "(4) such resources of an individual who is blind or disabled and who has a plan for achieving self-support approved by the

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,

1471

Secretary, as may be necessary for the fulfillment of such plan; and "(5) in the case of Natives of Alaska, shares of stock held in a Regional or a Village Corporation, during the period of twenty years in which such stock is inalienable, as provided in section 7(h) and section 8(c) of the Alaska Native Claims Settlement Act.

85 Stat. 691.

I n determining the resources of an individual (or eligible spouse) an ^J'^y^^^ lew, insurance policy shall be taken into account only to the extent of its cash surrender value; except that if the total race value of all life insurance policies on any person is $1,500 or less, no part of the value of any such policy shall be taken into account. "Disposition of Resources

 * .iViC

" (b) The Secretary shall prescribe the period or periods of time within which, and the manner in which, various kinds of property must be disposed of in order not to be included in determining an individual's eligibility for benefits. Any portion of the individual's benefits paid for any such period shall be conditioned upon such disposal; and any benefits so paid shall (at the time of the disposal) be considered overpayments to the extent they would not have been paid had the disposal occurred at the beginning of the period for which such benefits were paid. " M E A N I N G o r TERMS

"Aged, Blind, or Disabled Individual "SEC. 1614. (a)(1) For purposes of this title, the term 'aged, blind, or disabled individual' means an individual who— " (A) is 65 years of age or older, is blind (as determined under paragraph (2)), or is disabled (as determined under paragraph (3)), and " (B) is a resident of the United States, and is either (i) a citizen or (ii) an alien lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law (including any alien who is lawfully present in the United States as a result of the application of the provisions of section 203(a)(7) or section 212(d)(5) of the Immigration and Nationality Act). H «;«;• JJ2. " (2) An individual shall be considered to be blind for purposes s use iis3,' of this title if he has central visual acuity of 20/200 or less in the i*82. better eye with the use of a correcting lens. An eye which is accompanied by a limitation in the fields of visicm such that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered for purposes of the first sentence of this subsection as having a central visual acuity of 20/200 or less. An individual shall also be considered to be blind for purposes of this title if he is blind as defined under a State plan approved under title X or X VI as in effect for October 1972 and received aid under such plan ^^^^^^^ ^^°^' (on the basis of blindness) for December 1973, so long as he is continuously blind as so defined. "(3)(A) An individual shall be considered to be disabled for purposes of this title if he is unable to engage in any substantial gainful activity by reason of any medically determinable phvsical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months (or, in the case of a child under the age of 18, if he suffers from any medically determinable physical or mental impairment of comparable severity). A n individual shall also be

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Page:United States Statutes at Large Volume 86.djvu/1514

 1472

42 USC 1351, 1381.

Definition.

Definition.

PUBLIC LAW 92-603-OCT. 30, 1972

[86

STAT.

considered to be disabled for purposes of this title if he is permanently and totally disabled as defined under a State plan approved under title X IV or X VI as in effect for October 1972 and received aid under such plan (on the basis of disability) for December 1973, so long as he is continuously disabled as so defined. " (B) For purposes of subparagraph (A), an individual shall be determined to be under a disability only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work. For purposes of the preceding sentence (with respect to any individual), 'work which exists in the national economy' means work which exists in significant numbers either in the region where such individual lives or in several regions of the country. " (C) For purposes of this paragraph, a physical or mental impairment is an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques. " (D) The Secretary shall by regulations prescribe the criteria for determining when services performed or earnings derived from services demonstrate an individual's ability to engage in substantial gainful activity. Notwithstanding the provisions of subparagraph (B), an individual whose services or earnings meet such criteria, except for purposes of naragraph (4), shall be found not to be disabled. "(4)(A) For purposes of this title, any services rendered during a period of trial work (as defined in subparagraph (B)) by an individual who is an aged, blind, or disabled individual solely by reason of disability (as determined under paragraph (3) of this subsection) shall be deemed not to have been rendered by such individual in determining whether his disability has ceased in a month during such period. As used in this paragraph, the term 'services' means activity which is performed for remuneration or gain or is determined by the Secretary to be of a type normally performed for remuneration or gain. " (B) The term 'period of trial work', with respect to an individual who is an aged, blind, or disabled individual solely by reason of disability (as determined under paragraph (3) of this subsection), means a period of months beginning and ending as provided in subparagraphs (C) and (D). " (C) A period of trial work for any individual shall begin with the month in which he becomes eligible for benefits under this title on the basis of his disability; but no such period may begin for an individual who is eligible for l>enefits under this title on the basis of a disability if he has had a previous period of trial work while eligible for benefits on the basis of the same disability. " (D) A period of trial A)v^ork for any individual shall end with the close of whichever of the following months is the earlier: " (i) the ninth month, beginning on or after the first day of such period, in which the individual renders services (whether or not such nine months are consecutive); or "(ii) the month in which his disability (as determined under p a r a ^ a p h (3) of this subsection) ceases (as determined after the application of subparagraph (A) of this paragraph).

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"Eligible Spouse "(b) For purposes of this title, the term 'eligible spouse' means an aged, blind, or disabled individual who is the husband or wife of another aged, blind, or disabled individual and who has not been living apart from such other aged, blind, or disabled individual for more than six months. If two aged, blind, or disabled individuals are husband and wife as described m the preceding sentence, onlv one of them may be an 'eligible individual' within the meaning of section 1611(a). "Definition of Child "(c) For purposes of this title, the term 'child' means an individual who is neither married nor (as determined by the Secretary) the head of a household, and who is Q) under the age of eighteen, or (2) under the age of twenty-two and (as determined by the Secretary) a student regularly attending a school, college, or university, or a course of vocational or technical training designed to prepare him for gainful employment. "Determination of Marital Relationships "(d) In determining whether two individuals are husband and wife for purposes of this title, appropriate State law shall be applied; except that— " (1) if a man and women have been determined to be husband and wife under section 216(h)(1) for purposes of title II they shall be considered (from and after the date of such determination or the date of their application for benefits under this title, whichever is later) to be husband and wife for purposes of this title, or "(2) if a man and woman are found to be holding themselves out to the community in which they reside as husband and wife, they shall be so considered for purposes of this title notwithstanding any other provision of this section. "United States " (e) For purposes of this title, the term 'United States', when used in a geograj^hical sense, means the 50 States and the District of Columbia. "Income and Resources of Individuals Other Than Eligible Individuals and Eligible Spouses "(f)(1) For purposes of determining eligibility for and the amount of benefits for any individual who is married and whose spouse is living with him in the same household but is not an eligible spouse, such individual's income and resources shall be deemed to include any income and resources of such spouse, whether or not available to such individual, except to the extent determined by the Secretary to be inequitable under the circumstances. " (2) For purposes of determining eligibility for and the amount of benefits for any individual who is a child under age 21, such individual's income and resources shall be deemed to include any income and resources of a parent of such individual (or the spouse of such a parent) who is living in the same household as such individual,

42 USC 4oi.

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[86 STAT.

"whetlxer or not available to such individual, except to the extent determined by the Secretary to be inequitable under the circumstances. uREHABILITATION SERVICES FOR BLIND AND DISABLED INDIVIDUALS

"SEC. 1615. (a) I n the case of any blind or disabled individual who— " (1) has not attained age 65, and "(2) is receiving benefits (or with respect to whom benefits are paid) under this title, the Secretary shall make provision for referral of such individual to the appropriate State agency administering the State plan for vocational rehabilitation services approved under the Vocational Rehabiliol fisn ^^l^^^. tatidfi Act, and (except in such cases as he may determine) for a review 29 uIs er-31 1 ^^,^ ^^^ j ^ ^ ^ often than quarterljy^ of such individual's blindness or disability oa T ^ note. and his need for and utilization of the rehabilitation services made available to him under such plan. " (b) Every individual with respect to whom the Secretary is required to make provision for referral under subsection (a) shall accept such rehabilitation services as are made available to him under the State plan for vocational rehabilitation services approved under the Vocational Rehabilitation Act; and the Secretary is authorized to pay to the State agency administering or supervising the administration of such State plan the costs incurred in the provision of such services to individuals so referred. "(c) No individual shall be an eligible individual or eligible spouse for purposes of this title if he refuses without good cause to accept vocational rehabilitation services for which he is referred under subsection (a). " O P T I O N A L STATE SUPPLEMENTATION

"SEC. 1616. (a) Any cash payments which are made by a State (or political subdivision thereof) on a regular basis to individuals who are receiving benefits under this title or who would but for their income be eligible to receive benefits under this title, as assistance based on need in supplementation of such benefits (as determined by the Secretary), shall be excluded under section 1612(b)(6) in determining the income of such individuals for purposes of this title and the Secretary and such State may enter into an agreement which satisfies subsection (b) under which the Secretary will, on behalf of such State (or subdivision) make such supplementary payments to all such individuals. "(b) Any agreement between the Secretary and a State entered into under subsection (a) shall provide— "(1) that such payments will be made (subject to subsection (c)) to all individuals residing in such State (or subdivision) who are receiving benefits under this title, and "(2) such other rules with respect to eligibility for or amount of the supplementary payments, and such procedural or other general administrative provisions, as the Secretary finds necessary (subject to subsection (c)) to achieve efficient and effective administration of both the program which he conducts under this title and the optional State supplementation. "(c)(1) Any State (or political subdivision) making supplementary payments described in subsection (a) may at its option impose as a condition of eligiblity for such payments, and include in the State's agreement with the Secretary under such subsection, a residence requirement which excludes individuals who have resided in the State (or political subdivision) for less than a minimum period prior to application for such payments.

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