US (United States) Code. Title 42. Chapter 7: Social Security

Codificación normativa de EEUU (Estados Unidos). Legislación federal estadounidense # The Public Health and Welfare

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MISC1-

AMENDMENTS

1997 - Subsec. (a)(2)(B), (C). Pub. L. 105-78 substituted

"employer, employee," for "employee".

1990 - Subsec. (c)(2). Pub. L. 101-508, Sec. 5111(a)(2),

substituted "an annual" for "a biennial".

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in title 26 section 6103.

-End-

-CITE-

42 USC Sec. 1320b-14 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part A - General Provisions

-HEAD-

Sec. 1320b-14. Outreach efforts to increase awareness of the

availability of medicare cost-sharing

-STATUTE-

(a) Outreach

(1) In general

The Commissioner of Social Security (in this section referred

to as the "Commissioner") shall conduct outreach efforts to -

(A) identify individuals entitled to benefits under the

medicare program under subchapter XVIII of this chapter who may

be eligible for medical assistance for payment of the cost of

medicare cost-sharing under the medicaid program pursuant to

sections 1396a(a)(10)(E) and 1396u-3 of this title; and

(B) notify such individuals of the availability of such

medical assistance under such sections.

(2) Content of notice

Any notice furnished under paragraph (1) shall state that

eligibility for medicare cost-sharing assistance under such

sections is conditioned upon -

(A) the individual providing to the State information about

income and resources (in the case of an individual residing in

a State that imposes an assets test for such eligibility); and

(B) meeting the applicable eligibility criteria.

(b) Coordination with States

(1) In general

In conducting the outreach efforts under this section, the

Commissioner shall -

(A) furnish the agency of each State responsible for the

administration of the medicaid program and any other

appropriate State agency with information consisting of the

name and address of individuals residing in the State that the

Commissioner determines may be eligible for medical assistance

for payment of the cost of medicare cost-sharing under the

medicaid program pursuant to sections 1396a(a)(10)(E) and

1396u-3 of this title; and

(B) update any such information not less frequently than once

per year.

(2) Information in periodic updates

The periodic updates described in paragraph (1)(B) shall

include information on individuals who are or may be eligible for

the medical assistance described in paragraph (1)(A) because such

individuals have experienced reductions in benefits under

subchapter II of this chapter.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1144, as added Pub. L.

106-554, Sec. 1(a)(6) [title IX, Sec. 911(a)(1)], Dec. 21, 2000,

114 Stat. 2763, 2763A-583.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320b-14, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1144, as added Pub. L. 103-66, title XIII, Sec. 13581(a), Aug.

10, 1993, 107 Stat. 609; Pub. L. 105-34, title XV, Sec. 1503(e),

Aug. 5, 1997, 111 Stat. 1063, related to Medicare and Medicaid

Coverage Data Bank, prior to repeal by Pub. L. 104-226, Sec. 1(a),

Oct. 2, 1996, 110 Stat. 3033.

EFFECTIVE DATE

Pub. L. 106-554, Sec. 1(a)(6) [title IX, Sec. 911(c)], Dec. 21,

2000, 114 Stat. 2763, 2763A-584, provided that: "The amendments

made by subsection (a) [enacting this section and amending section

1396d of this title] shall take effect one year after the date of

the enactment of this Act [Dec. 21, 2000]."

GAO REPORT

Pub. L. 106-554, Sec. 1(a)(6) [title IX, Sec. 911(b)], Dec. 21,

2000, 114 Stat. 2763, 2763A-584, provided that: "The Comptroller

General of the United States shall conduct a study of the impact of

section 1144 of the Social Security Act [this section] (as added by

subsection (a)(1)) on the enrollment of individuals for medicare

cost-sharing under the medicaid program. Not later than 18 months

after the date that the Commissioner of Social Security first

conducts outreach under section 1144 of such Act, the Comptroller

General shall submit to Congress a report on such study. The report

shall include such recommendations for legislative changes as the

Comptroller General deems appropriate."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1396d of this title.

-End-

-CITE-

42 USC Sec. 1320b-15 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part A - General Provisions

-HEAD-

Sec. 1320b-15. Protection of social security and medicare trust

funds

-STATUTE-

(a) In general

No officer or employee of the United States shall -

(1) delay the deposit of any amount into (or delay the credit

of any amount to) any Federal fund or otherwise vary from the

normal terms, procedures, or timing for making such deposits or

credits,

(2) refrain from the investment in public debt obligations of

amounts in any Federal fund, or

(3) redeem prior to maturity amounts in any Federal fund which

are invested in public debt obligations for any purpose other

than the payment of benefits or administrative expenses from such

Federal fund.

(b) "Public debt obligation" defined

For purposes of this section, the term "public debt obligation"

means any obligation subject to the public debt limit established

under section 3101 of title 31.

(c) "Federal fund" defined

For purposes of this section, the term "Federal fund" means -

(1) the Federal Old-Age and Survivors Insurance Trust Fund;

(2) the Federal Disability Insurance Trust Fund;

(3) the Federal Hospital Insurance Trust Fund; and

(4) the Federal Supplementary Medical Insurance Trust Fund.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1145, as added Pub. L.

104-121, title I, Sec. 107(a), Mar. 29, 1996, 110 Stat. 856.)

-MISC1-

EFFECTIVE DATE

Section 107(b) of Pub. L. 104-121 provided that: "The amendment

made by this section [enacting this section] shall take effect on

the date of the enactment of this Act [Mar. 29, 1996]."

-End-

-CITE-

42 USC Sec. 1320b-16 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part A - General Provisions

-HEAD-

Sec. 1320b-16. Public disclosure of certain information on hospital

financial interest and referral patterns

-STATUTE-

The Secretary shall make available to the public, in a form and

manner specified by the Secretary, information disclosed to the

Secretary pursuant to section 1395cc(a)(1)(S) of this title.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1146, as added Pub. L.

105-33, title IV, Sec. 4321(c), Aug. 5, 1997, 111 Stat. 395.)

-MISC1-

EFFECTIVE DATE

Section 4321(d)(2) of Pub. L. 105-33 provided that: "The

Secretary of Health and Human Services shall issue regulations by

not later than the date which is 1 year after the date of the

enactment of this Act [Aug. 5, 1997] to carry out the amendments

made by subsections (b) and (c) [enacting this section and amending

section 1395cc of this title] and such amendments shall take effect

as of such date (on or after the issuance of such regulations) as

the Secretary specifies in such regulations."

-End-

-CITE-

42 USC Sec. 1320b-17 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part A - General Provisions

-HEAD-

Sec. 1320b-17. Recovery of SSI overpayments from other benefits

-STATUTE-

(a) In general

(1) Whenever the Commissioner of Social Security determines that

more than the correct amount of any payment has been made under the

supplemental security income program under subchapter XVI of this

chapter (including, for purposes of this section, under section

1382e(a) of this title or section 212(b) of Public Law 93-66) to a

person who is not currently eligible for cash benefits under the

program, the Commissioner, notwithstanding section 407 of this

title but subject to paragraph (2) of this subsection, may recover

the amount incorrectly paid by decreasing any amount which is

payable to the person under subchapter II or VIII of this chapter

in any month by not more than 10 percent of the amount payable

under such subchapter.

(2) The 10 percent limitation set forth in paragraph (1) shall

not apply to an overpayment made to a person if -

(A) the person or the spouse of the person was involved in

willful misrepresentation or concealment of material information

in connection with the overpayment; or

(B) the person so requests.

(b) No effect on SSI eligibility or benefit amount

In any case in which the Commissioner of Social Security takes

action in accordance with subsection (a) of this section to recover

an amount incorrectly paid to any person, neither that person, nor

any individual whose eligibility for benefits under the

supplemental security income program under subchapter XVI of this

chapter, or whose amount of such benefits, is determined by

considering any part of that person's income, shall, as a result of

such action -

(1) become eligible for benefits under such program; or

(2) if such person or individual is otherwise so eligible,

become eligible for increased benefits under such program.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1147, as added Pub. L.

105-306, Sec. 8(a), Oct. 28, 1998, 112 Stat. 2928; amended Pub. L.

106-169, title II, Sec. 251(b)(7), Dec. 14, 1999, 113 Stat. 1855.)

-REFTEXT-

REFERENCES IN TEXT

Section 212(b) of Public Law 93-66, referred to in subsec. (a),

is section 212(b) of Pub. L. 93-66, title II, July 9, 1973, 87

Stat. 156, as amended, which is set out as a note under section

1382 of this title.

-MISC1-

AMENDMENTS

1999 - Pub. L. 106-169, Sec. 251(b)(7)(B), substituted "other"

for "social security" in section catchline.

Subsec. (a)(1). Pub. L. 106-169, Sec. 251(b)(7)(A), inserted "or

VIII" after "person under subchapter II" and substituted "payable

under such subchapter" for "payable under subchapter II of this

chapter".

EFFECTIVE DATE

Section effective Oct. 28, 1998, and applicable to amounts

incorrectly paid which remain outstanding on or after such date,

see section 8(c) of Pub. L. 105-306, set out as an Effective Date

of 1998 Amendment note under section 404 of this title.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 404, 1383 of this title.

-End-

-CITE-

42 USC Sec. 1320b-18 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part A - General Provisions

-HEAD-

Sec. 1320b-18. Recovery of social security benefit overpayments

from subchapter VIII benefits

-STATUTE-

Whenever the Commissioner of Social Security determines that more

than the correct amount of any payment has been made under

subchapter II of this chapter to an individual who is not currently

receiving benefits under that subchapter but who is receiving

benefits under subchapter VIII of this chapter, the Commissioner

may recover the amount incorrectly paid under subchapter II of this

chapter by decreasing any amount which is payable to the individual

under subchapter VIII of this chapter.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1147A, as added Pub. L.

106-169, title II, Sec. 251(b)(8), Dec. 14, 1999, 113 Stat. 1856.)

-End-

-CITE-

42 USC Sec. 1320b-19 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part A - General Provisions

-HEAD-

Sec. 1320b-19. The Ticket to Work and Self-Sufficiency Program

-STATUTE-

(a) In general

The Commissioner shall establish a Ticket to Work and

Self-Sufficiency Program, under which a disabled beneficiary may

use a ticket to work and self-sufficiency issued by the

Commissioner in accordance with this section to obtain employment

services, vocational rehabilitation services, or other support

services from an employment network which is of the beneficiary's

choice and which is willing to provide such services to such

beneficiary.

(b) Ticket system

(1) Distribution of tickets

The Commissioner may issue a ticket to work and

self-sufficiency to disabled beneficiaries for participation in

the Program.

(2) Assignment of tickets

A disabled beneficiary holding a ticket to work and

self-sufficiency may assign the ticket to any employment network

of the beneficiary's choice which is serving under the Program

and is willing to accept the assignment.

(3) Ticket terms

A ticket issued under paragraph (1) shall consist of a document

which evidences the Commissioner's agreement to pay (as provided

in paragraph (4)) an employment network, which is serving under

the Program and to which such ticket is assigned by the

beneficiary, for such employment services, vocational

rehabilitation services, and other support services as the

employment network may provide to the beneficiary.

(4) Payments to employment networks

The Commissioner shall pay an employment network under the

Program in accordance with the outcome payment system under

subsection (h)(2) of this section or under the outcome-milestone

payment system under subsection (h)(3) of this section (whichever

is elected pursuant to subsection (h)(1) of this section). An

employment network may not request or receive compensation for

such services from the beneficiary.

(c) State participation

(1) In general

Each State agency administering or supervising the

administration of the State plan approved under title I of the

Rehabilitation Act of 1973 (29 U.S.C. 720 et seq.) may elect to

participate in the Program as an employment network with respect

to a disabled beneficiary. If the State agency does elect to

participate in the Program, the State agency also shall elect to

be paid under the outcome payment system or the outcome-milestone

payment system in accordance with subsection (h)(1) of this

section. With respect to a disabled beneficiary that the State

agency does not elect to have participate in the Program, the

State agency shall be paid for services provided to that

beneficiary under the system for payment applicable under section

422(d) of this title and subsections (d) and (e) of section 1382d

of this title. The Commissioner shall provide for periodic

opportunities for exercising such elections.

(2) Effect of participation by State agency

(A) State agencies participating

In any case in which a State agency described in paragraph

(1) elects under that paragraph to participate in the Program,

the employment services, vocational rehabilitation services,

and other support services which, upon assignment of tickets to

work and self-sufficiency, are provided to disabled

beneficiaries by the State agency acting as an employment

network shall be governed by plans for vocational

rehabilitation services approved under title I of the

Rehabilitation Act of 1973 (29 U.S.C. 720 et seq.).

(B) State agencies administering maternal and child health

services programs

Subparagraph (A) shall not apply with respect to any State

agency administering a program under subchapter V of this

chapter.

(3) Agreements between State agencies and employment networks

State agencies and employment networks shall enter into

agreements regarding the conditions under which services will be

provided when an individual is referred by an employment network

to a State agency for services. The Commissioner shall establish

by regulations the timeframe within which such agreements must be

entered into and the mechanisms for dispute resolution between

State agencies and employment networks with respect to such

agreements.

(d) Responsibilities of the Commissioner

(1) Selection and qualifications of program managers

The Commissioner shall enter into agreements with 1 or more

organizations in the private or public sector for service as a

program manager to assist the Commissioner in administering the

Program. Any such program manager shall be selected by means of a

competitive bidding process, from among organizations in the

private or public sector with available expertise and experience

in the field of vocational rehabilitation or employment services.

(2) Tenure, renewal, and early termination

Each agreement entered into under paragraph (1) shall provide

for early termination upon failure to meet performance standards

which shall be specified in the agreement and which shall be

weighted to take into account any performance in prior terms.

Such performance standards shall include -

(A) measures for ease of access by beneficiaries to services;

and

(B) measures for determining the extent to which failures in

obtaining services for beneficiaries fall within acceptable

parameters, as determined by the Commissioner.

(3) Preclusion from direct participation in delivery of services

in own service area

Agreements under paragraph (1) shall preclude -

(A) direct participation by a program manager in the delivery

of employment services, vocational rehabilitation services, or

other support services to beneficiaries in the service area

covered by the program manager's agreement; and

(B) the holding by a program manager of a financial interest

in an employment network or service provider which provides

services in a geographic area covered under the program

manager's agreement.

(4) Selection of employment networks

(A) In general

The Commissioner shall select and enter into agreements with

employment networks for service under the Program. Such

employment networks shall be in addition to State agencies

serving as employment networks pursuant to elections under

subsection (c) of this section.

(B) Alternate participants

In any State where the Program is being implemented, the

Commissioner shall enter into an agreement with any alternate

participant that is operating under the authority of section

422(d)(2) of this title in the State as of December 17, 1999,

and chooses to serve as an employment network under the

Program.

(5) Termination of agreements with employment networks

The Commissioner shall terminate agreements with employment

networks for inadequate performance, as determined by the

Commissioner.

(6) Quality assurance

The Commissioner shall provide for such periodic reviews as are

necessary to provide for effective quality assurance in the

provision of services by employment networks. The Commissioner

shall solicit and consider the views of consumers and the program

manager under which the employment networks serve and shall

consult with providers of services to develop performance

measurements. The Commissioner shall ensure that the results of

the periodic reviews are made available to beneficiaries who are

prospective service recipients as they select employment

networks. The Commissioner shall ensure that the periodic surveys

of beneficiaries receiving services under the Program are

designed to measure customer service satisfaction.

(7) Dispute resolution

The Commissioner shall provide for a mechanism for resolving

disputes between beneficiaries and employment networks, between

program managers and employment networks, and between program

managers and providers of services. The Commissioner shall afford

a party to such a dispute a reasonable opportunity for a full and

fair review of the matter in dispute.

(e) Program managers

(1) In general

A program manager shall conduct tasks appropriate to assist the

Commissioner in carrying out the Commissioner's duties in

administering the Program.

(2) Recruitment of employment networks

A program manager shall recruit, and recommend for selection by

the Commissioner, employment networks for service under the

Program. The program manager shall carry out such recruitment and

provide such recommendations, and shall monitor all employment

networks serving in the Program in the geographic area covered

under the program manager's agreement, to the extent necessary

and appropriate to ensure that adequate choices of services are

made available to beneficiaries. Employment networks may serve

under the Program only pursuant to an agreement entered into with

the Commissioner under the Program incorporating the applicable

provisions of this section and regulations thereunder, and the

program manager shall provide and maintain assurances to the

Commissioner that payment by the Commissioner to employment

networks pursuant to this section is warranted based on

compliance by such employment networks with the terms of such

agreement and this section. The program manager shall not impose

numerical limits on the number of employment networks to be

recommended pursuant to this paragraph.

(3) Facilitation of access by beneficiaries to employment

networks

A program manager shall facilitate access by beneficiaries to

employment networks. The program manager shall ensure that each

beneficiary is allowed changes in employment networks without

being deemed to have rejected services under the Program. When

such a change occurs, the program manager shall reassign the

ticket based on the choice of the beneficiary. Upon the request

of the employment network, the program manager shall make a

determination of the allocation of the outcome or

milestone-outcome payments based on the services provided by each

employment network. The program manager shall establish and

maintain lists of employment networks available to beneficiaries

and shall make such lists generally available to the public. The

program manager shall ensure that all information provided to

disabled beneficiaries pursuant to this paragraph is provided in

accessible formats.

(4) Ensuring availability of adequate services

The program manager shall ensure that employment services,

vocational rehabilitation services, and other support services

are provided to beneficiaries throughout the geographic area

covered under the program manager's agreement, including rural

areas.

(5) Reasonable access to services

The program manager shall take such measures as are necessary

to ensure that sufficient employment networks are available and

that each beneficiary receiving services under the Program has

reasonable access to employment services, vocational

rehabilitation services, and other support services. Services

provided under the Program may include case management, work

incentives planning, supported employment, career planning,

career plan development, vocational assessment, job training,

placement, follow-up services, and such other services as may be

specified by the Commissioner under the Program. The program

manager shall ensure that such services are available in each

service area.

(f) Employment networks

(1) Qualifications for employment networks

(A) In general

Each employment network serving under the Program shall

consist of an agency or instrumentality of a State (or a

political subdivision thereof) or a private entity, that

assumes responsibility for the coordination and delivery of

services under the Program to individuals assigning to the

employment network tickets to work and self-sufficiency issued

under subsection (b) of this section.

(B) One-stop delivery systems

An employment network serving under the Program may consist

of a one-stop delivery system established under subtitle B of

title I of the Workforce Investment Act of 1998 (29 U.S.C. 2811

et seq.).

(C) Compliance with selection criteria

No employment network may serve under the Program unless it

meets and maintains compliance with both general selection

criteria (such as professional and educational qualifications,

where applicable) and specific selection criteria (such as

substantial expertise and experience in providing relevant

employment services and supports).

(D) Single or associated providers allowed

An employment network shall consist of either a single

provider of such services or of an association of such

providers organized so as to combine their resources into a

single entity. An employment network may meet the requirements

of subsection (e)(4) of this section by providing services

directly, or by entering into agreements with other individuals

or entities providing appropriate employment services,

vocational rehabilitation services, or other support services.

(2) Requirements relating to provision of services

Each employment network serving under the Program shall be

required under the terms of its agreement with the Commissioner

to -

(A) serve prescribed service areas; and

(B) take such measures as are necessary to ensure that

employment services, vocational rehabilitation services, and

other support services provided under the Program by, or under

agreements entered into with, the employment network are

provided under appropriate individual work plans that meet the

requirements of subsection (g) of this section.

(3) Annual financial reporting

Each employment network shall meet financial reporting

requirements as prescribed by the Commissioner.

(4) Periodic outcomes reporting

Each employment network shall prepare periodic reports, on at

least an annual basis, itemizing for the covered period specific

outcomes achieved with respect to specific services provided by

the employment network. Such reports shall conform to a national

model prescribed under this section. Each employment network

shall provide a copy of the latest report issued by the

employment network pursuant to this paragraph to each beneficiary

upon enrollment under the Program for services to be received

through such employment network. Upon issuance of each report to

each beneficiary, a copy of the report shall be maintained in the

files of the employment network. The program manager shall ensure

that copies of all such reports issued under this paragraph are

made available to the public under reasonable terms.

(g) Individual work plans

(1) Requirements

Each employment network shall -

(A) take such measures as are necessary to ensure that

employment services, vocational rehabilitation services, and

other support services provided under the Program by, or under

agreements entered into with, the employment network are

provided under appropriate individual work plans that meet the

requirements of subparagraph (C);

(B) develop and implement each such individual work plan, in

partnership with each beneficiary receiving such services, in a

manner that affords such beneficiary the opportunity to

exercise informed choice in selecting an employment goal and

specific services needed to achieve that employment goal;

(C) ensure that each individual work plan includes at least -

(i) a statement of the vocational goal developed with the

beneficiary, including, as appropriate, goals for earnings

and job advancement;

(ii) a statement of the services and supports that have

been deemed necessary for the beneficiary to accomplish that

goal;

(iii) a statement of any terms and conditions related to

the provision of such services and supports; and

(iv) a statement of understanding regarding the

beneficiary's rights under the Program (such as the right to

retrieve the ticket to work and self-sufficiency if the

beneficiary is dissatisfied with the services being provided

by the employment network) and remedies available to the

individual, including information on the availability of

advocacy services and assistance in resolving disputes

through the State grant program authorized under section

1320b-21 of this title;

(D) provide a beneficiary the opportunity to amend the

individual work plan if a change in circumstances necessitates

a change in the plan; and

(E) make each beneficiary's individual work plan available to

the beneficiary in, as appropriate, an accessible format chosen

by the beneficiary.

(2) Effective upon written approval

A beneficiary's individual work plan shall take effect upon

written approval by the beneficiary or a representative of the

beneficiary and a representative of the employment network that,

in providing such written approval, acknowledges assignment of

the beneficiary's ticket to work and self-sufficiency.

(h) Employment network payment systems

(1) Election of payment system by employment networks

(A) In general

The Program shall provide for payment authorized by the

Commissioner to employment networks under either an outcome

payment system or an outcome-milestone payment system. Each

employment network shall elect which payment system will be

utilized by the employment network, and, for such period of

time as such election remains in effect, the payment system so

elected shall be utilized exclusively in connection with such

employment network (except as provided in subparagraph (B)).

(B) No change in method of payment for beneficiaries with

tickets already assigned to the employment networks

Any election of a payment system by an employment network

that would result in a change in the method of payment to the

employment network for services provided to a beneficiary who

is receiving services from the employment network at the time

of the election shall not be effective with respect to payment

for services provided to that beneficiary and the method of

payment previously selected shall continue to apply with

respect to such services.

(2) Outcome payment system

(A) In general

The outcome payment system shall consist of a payment

structure governing employment networks electing such system

under paragraph (1)(A) which meets the requirements of this

paragraph.

(B) Payments made during outcome payment period

The outcome payment system shall provide for a schedule of

payments to an employment network, in connection with each

individual who is a beneficiary, for each month, during the

individual's outcome payment period, for which benefits

(described in paragraphs (3) and (4) of subsection (k) of this

section) are not payable to such individual because of work or

earnings.

(C) Computation of payments to employment network

The payment schedule of the outcome payment system shall be

designed so that -

(i) the payment for each month during the outcome payment

period for which benefits (described in paragraphs (3) and

(4) of subsection (k) of this section) are not payable is

equal to a fixed percentage of the payment calculation base

for the calendar year in which such month occurs; and

(ii) such fixed percentage is set at a percentage which

does not exceed 40 percent.

(3) Outcome-milestone payment system

(A) In general

The outcome-milestone payment system shall consist of a

payment structure governing employment networks electing such

system under paragraph (1)(A) which meets the requirements of

this paragraph.

(B) Early payments upon attainment of milestones in advance of

outcome payment periods

The outcome-milestone payment system shall provide for 1 or

more milestones, with respect to beneficiaries receiving

services from an employment network under the Program, that are

directed toward the goal of permanent employment. Such

milestones shall form a part of a payment structure that

provides, in addition to payments made during outcome payment

periods, payments made prior to outcome payment periods in

amounts based on the attainment of such milestones.

(C) Limitation on total payments to employment network

The payment schedule of the outcome milestone payment system

shall be designed so that the total of the payments to the

employment network with respect to each beneficiary is less

than, on a net present value basis (using an interest rate

determined by the Commissioner that appropriately reflects the

cost of funds faced by providers), the total amount to which

payments to the employment network with respect to the

beneficiary would be limited if the employment network were

paid under the outcome payment system.

(4) Definitions

In this subsection:

(A) Payment calculation base

The term "payment calculation base" means, for any calendar

year -

(i) in connection with a title II disability beneficiary,

the average disability insurance benefit payable under

section 423 of this title for all beneficiaries for months

during the preceding calendar year; and

(ii) in connection with a title XVI disability beneficiary

(who is not concurrently a title II disability beneficiary),

the average payment of supplemental security income benefits

based on disability payable under subchapter XVI of this

chapter (excluding State supplementation) for months during

the preceding calendar year to all beneficiaries who have

attained 18 years of age but have not attained 65 years of

age.

(B) Outcome payment period

The term "outcome payment period" means, in connection with

any individual who had assigned a ticket to work and

self-sufficiency to an employment network under the Program, a

period -

(i) beginning with the first month, ending after the date

on which such ticket was assigned to the employment network,

for which benefits (described in paragraphs (3) and (4) of

subsection (k) of this section) are not payable to such

individual by reason of engagement in substantial gainful

activity or by reason of earnings from work activity; and

(ii) ending with the 60th month (consecutive or otherwise),

ending after such date, for which such benefits are not

payable to such individual by reason of engagement in

substantial gainful activity or by reason of earnings from

work activity.

(5) Periodic review and alterations of prescribed schedules

(A) Percentages and periods

The Commissioner shall periodically review the percentage

specified in paragraph (2)(C), the total payments permissible

under paragraph (3)(C), and the period of time specified in

paragraph (4)(B) to determine whether such percentages, such

permissible payments, and such period provide an adequate

incentive for employment networks to assist beneficiaries to

enter the workforce, while providing for appropriate economies.

The Commissioner may alter such percentage, such total

permissible payments, or such period of time to the extent that

the Commissioner determines, on the basis of the Commissioner's

review under this paragraph, that such an alteration would

better provide the incentive and economies described in the

preceding sentence.

(B) Number and amounts of milestone payments

The Commissioner shall periodically review the number and

amounts of milestone payments established by the Commissioner

pursuant to this section to determine whether they provide an

adequate incentive for employment networks to assist

beneficiaries to enter the workforce, taking into account

information provided to the Commissioner by program managers,

the Ticket to Work and Work Incentives Advisory Panel

established by section 101(f) of the Ticket to Work and Work

Incentives Improvement Act of 1999, and other reliable sources.

The Commissioner may from time to time alter the number and

amounts of milestone payments initially established by the

Commissioner pursuant to this section to the extent that the

Commissioner determines that such an alteration would allow an

adequate incentive for employment networks to assist

beneficiaries to enter the workforce. Such alteration shall be

based on information provided to the Commissioner by program

managers, the Ticket to Work and Work Incentives Advisory Panel

established by section 101(f) of the Ticket to Work and Work

Incentives Improvement Act of 1999, or other reliable sources.

(C) Report on the adequacy of incentives

The Commissioner shall submit to the Congress not later than

36 months after December 17, 1999, a report with

recommendations for a method or methods to adjust payment rates

under subparagraphs (A) and (B), that would ensure adequate

incentives for the provision of services by employment networks

of -

(i) individuals with a need for ongoing support and

services;

(ii) individuals with a need for high-cost accommodations;

(iii) individuals who earn a subminimum wage; and

(iv) individuals who work and receive partial cash

benefits.

The Commissioner shall consult with the Ticket to Work and Work

Incentives Advisory Panel established under section 101(f) of

the Ticket to Work and Work Incentives Improvement Act of 1999

during the development and evaluation of the study. The

Commissioner shall implement the necessary adjusted payment

rates prior to full implementation of the Ticket to Work and

Self-Sufficiency Program.

(i) Suspension of disability reviews

During any period for which an individual is using, as defined by

the Commissioner, a ticket to work and self-sufficiency issued

under this section, the Commissioner (and any applicable State

agency) may not initiate a continuing disability review or other

review under section 421 of this title of whether the individual is

or is not under a disability or a review under subchapter XVI of

this chapter similar to any such review under section 421 of this

title.

(j) Authorizations

(1) Payments to employment networks

(A) Title II disability beneficiaries

There are authorized to be transferred from the Federal

Old-Age and Survivors Insurance Trust Fund and the Federal

Disability Insurance Trust Fund each fiscal year such sums as

may be necessary to make payments to employment networks under

this section. Money paid from the Trust Funds under this

section with respect to title II disability beneficiaries who

are entitled to benefits under section 423 of this title or who

are entitled to benefits under section 402(d) of this title on

the basis of the wages and self-employment income of such

beneficiaries, shall be charged to the Federal Disability

Insurance Trust Fund, and all other money paid from the Trust

Funds under this section shall be charged to the Federal

Old-Age and Survivors Insurance Trust Fund.

(B) Title XVI disability beneficiaries

Amounts authorized to be appropriated to the Social Security

Administration under section 1381 of this title shall include

amounts necessary to carry out the provisions of this section

with respect to title XVI disability beneficiaries.

(2) Administrative expenses

The costs of administering this section (other than payments to

employment networks) shall be paid from amounts made available

for the administration of subchapter II of this chapter and

amounts made available for the administration of subchapter XVI

of this chapter, and shall be allocated among such amounts as

appropriate.

(k) Definitions

In this section:

(1) Commissioner

The term "Commissioner" means the Commissioner of Social

Security.

(2) Disabled beneficiary

The term "disabled beneficiary" means a title II disability

beneficiary or a title XVI disability beneficiary.

(3) Title II disability beneficiary

The term "title II disability beneficiary" means an individual

entitled to disability insurance benefits under section 423 of

this title or to monthly insurance benefits under section 402 of

this title based on such individual's disability (as defined in

section 423(d) of this title). An individual is a title II

disability beneficiary for each month for which such individual

is entitled to such benefits.

(4) Title XVI disability beneficiary

The term "title XVI disability beneficiary" means an individual

eligible for supplemental security income benefits under

subchapter XVI of this chapter on the basis of blindness (within

the meaning of section 1382c(a)(2) of this title) or disability

(within the meaning of section 1382c(a)(3) of this title). An

individual is a title XVI disability beneficiary for each month

for which such individual is eligible for such benefits.

(5) Supplemental security income benefit

The term "supplemental security income benefit under subchapter

XVI of this chapter" means a cash benefit under section 1382 or

1382h(a) of this title, and does not include a State

supplementary payment, administered federally or otherwise.

(l) Regulations

Not later than 1 year after December 17, 1999, the Commissioner

shall prescribe such regulations as are necessary to carry out the

provisions of this section.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1148, as added Pub. L.

106-170, title I, Sec. 101(a), Dec. 17, 1999, 113 Stat. 1863.)

-REFTEXT-

REFERENCES IN TEXT

The Rehabilitation Act of 1973, referred to in subsec. (c)(1),

(2)(A), is Pub. L. 93-112, Sept. 26, 1973, 87 Stat. 355, as

amended. Title I of the Act is classified generally to subchapter I

(Sec. 720 et seq.) of chapter 16 of Title 29, Labor. For complete

classification of this Act to the Code, see Short Title note set

out under section 701 of Title 29 and Tables.

The Workforce Investment Act of 1998, referred to in subsec.

(f)(1)(B), is Pub. L. 105-220, Aug. 7, 1998, 112 Stat. 936, as

amended. Subtitle B of title I of the Act is classified generally

to subchapter II (Sec. 2811 et seq.) of chapter 30 of Title 29,

Labor. For complete classification of this Act to the Code, see

Short Title note set out under section 9201 of Title 20, Education,

and Tables.

Section 101(f) of the Ticket to Work and Work Incentives

Improvement Act of 1999, referred to in subsec. (h)(5)(B), (C), is

section 101(f) of Pub. L. 106-170, which is set out as a note

below.

-MISC1-

EFFECTIVE DATE

Pub. L. 106-170, title I, Sec. 101(c), 113 Stat. 1874, provided

that: "Subject to subsection (d) [set out as a note below], the

amendments made by subsections (a) and (b) [enacting this section

and amending sections 421, 422, 425, 1382d, 1383, and 1383b of this

title] shall take effect with the first month following 1 year

after the date of the enactment of this Act [Dec. 17, 1999]."

REGULATIONS

Pub. L. 106-170, title I, Sec. 101(e), Dec. 17, 1999, 113 Stat.

1877, provided that:

"(1) In general. - The Commissioner of Social Security shall

prescribe such regulations as are necessary to implement the

amendments made by this section [enacting this section and amending

sections 421, 422, 425, 1382d, 1383, and 1383b of this title].

"(2) Specific matters to be included in regulations. - The

matters which shall be addressed in such regulations shall include

-

"(A) the form and manner in which tickets to work and

self-sufficiency may be distributed to beneficiaries pursuant to

section 1148(b)(1) of the Social Security Act [subsec. (b)(1) of

this section];

"(B) the format and wording of such tickets, which shall

incorporate by reference any contractual terms governing service

by employment networks under the Program;

"(C) the form and manner in which State agencies may elect

participation in the Ticket to Work and Self-Sufficiency Program

pursuant to section 1148(c)(1) of such Act and provision for

periodic opportunities for exercising such elections;

"(D) the status of State agencies under section 1148(c)(1) of

such Act at the time that State agencies exercise elections under

that section;

"(E) the terms of agreements to be entered into with program

managers pursuant to section 1148(d) of such Act, including -

"(i) the terms by which program managers are precluded from

direct participation in the delivery of services pursuant to

section 1148(d)(3) of such Act;

"(ii) standards which must be met by quality assurance

measures referred to in paragraph (6) of section 1148(d) of

such Act and methods of recruitment of employment networks

utilized pursuant to paragraph (2) of section 1148(e) of such

Act; and

"(iii) the format under which dispute resolution will operate

under section 1148(d)(7) of such Act;

"(F) the terms of agreements to be entered into with employment

networks pursuant to section 1148(d)(4) of such Act, including -

"(i) the manner in which service areas are specified pursuant

to section 1148(f)(2)(A) of such Act;

"(ii) the general selection criteria and the specific

selection criteria which are applicable to employment networks

under section 1148(f)(1)(C) of such Act in selecting service

providers;

"(iii) specific requirements relating to annual financial

reporting by employment networks pursuant to section 1148(f)(3)

of such Act; and

"(iv) the national model to which periodic outcomes reporting

by employment networks must conform under section 1148(f)(4) of

such Act;

"(G) standards which must be met by individual work plans

pursuant to section 1148(g) of such Act;

"(H) standards which must be met by payment systems required

under section 1148(h) of such Act, including -

"(i) the form and manner in which elections by employment

networks of payment systems are to be exercised pursuant to

section 1148(h)(1)(A) of such Act;

"(ii) the terms which must be met by an outcome payment

system under section 1148(h)(2) of such Act;

"(iii) the terms which must be met by an outcome-milestone

payment system under section 1148(h)(3) of such Act;

"(iv) any revision of the percentage specified in paragraph

(2)(C) of section 1148(h) of such Act or the period of time

specified in paragraph (4)(B) of such section 1148(h) of such

Act; and

"(v) annual oversight procedures for such systems; and

"(I) procedures for effective oversight of the Program by the

Commissioner of Social Security, including periodic reviews and

reporting requirements."

FINDINGS AND PURPOSES

Pub. L. 106-170, Sec. 2, Dec. 17, 1999, 113 Stat. 1862, provided

that:

"(a) Findings. - The Congress makes the following findings:

"(1) It is the policy of the United States to provide

assistance to individuals with disabilities to lead productive

work lives.

"(2) Health care is important to all Americans.

"(3) Health care is particularly important to individuals with

disabilities and special health care needs who often cannot

afford the insurance available to them through the private

market, are uninsurable by the plans available in the private

sector, and are at great risk of incurring very high and

economically devastating health care costs.

"(4) Americans with significant disabilities often are unable

to obtain health care insurance that provides coverage of the

services and supports that enable them to live independently and

enter or rejoin the workforce. Personal assistance services (such

as attendant services, personal assistance with transportation to

and from work, reader services, job coaches, and related

assistance) remove many of the barriers between significant

disability and work. Coverage for such services, as well as for

prescription drugs, durable medical equipment, and basic health

care are powerful and proven tools for individuals with

significant disabilities to obtain and retain employment.

"(5) For individuals with disabilities, the fear of losing

health care and related services is one of the greatest barriers

keeping the individuals from maximizing their employment, earning

potential, and independence.

"(6) Social Security Disability Insurance and Supplemental

Security Income beneficiaries risk losing medicare or medicaid

coverage that is linked to their cash benefits, a risk that is an

equal, or greater, work disincentive than the loss of cash

benefits associated with working.

"(7) Individuals with disabilities have greater opportunities

for employment than ever before, aided by important public policy

initiatives such as the Americans with Disabilities Act of 1990

(42 U.S.C. 12101 et seq.), advancements in public understanding

of disability, and innovations in assistive technology, medical

treatment, and rehabilitation.

"(8) Despite such historic opportunities and the desire of

millions of disability recipients to work and support themselves,

fewer than one-half of one percent of Social Security Disability

Insurance and Supplemental Security Income beneficiaries leave

the disability rolls and return to work.

"(9) In addition to the fear of loss of health care coverage,

beneficiaries cite financial disincentives to work and earn

income and lack of adequate employment training and placement

services as barriers to employment.

"(10) Eliminating such barriers to work by creating financial

incentives to work and by providing individuals with disabilities

real choice in obtaining the services and technology they need to

find, enter, and maintain employment can greatly improve their

short and long-term financial independence and personal

well-being.

"(11) In addition to the enormous advantages such changes

promise for individuals with disabilities, redesigning government

programs to help individuals with disabilities return to work may

result in significant savings and extend the life of the Social

Security Disability Insurance Trust Fund.

"(12) If only an additional one-half of one percent of the

current Social Security Disability Insurance and Supplemental

Security Income recipients were to cease receiving benefits as a

result of employment, the savings to the Social Security Trust

Funds and to the Treasury in cash assistance would total

$3,500,000,000 over the worklife of such individuals, far

exceeding the cost of providing incentives and services needed to

assist them in entering work and achieving financial independence

to the best of their abilities.

"(b) Purposes. - The purposes of this Act [see Tables for

classification] are as follows:

"(1) To provide health care and employment preparation and

placement services to individuals with disabilities that will

enable those individuals to reduce their dependency on cash

benefit programs.

"(2) To encourage States to adopt the option of allowing

individuals with disabilities to purchase medicaid coverage that

is necessary to enable such individuals to maintain employment.

"(3) To provide individuals with disabilities the option of

maintaining medicare coverage while working.

"(4) To establish a return to work ticket program that will

allow individuals with disabilities to seek the services

necessary to obtain and retain employment and reduce their

dependency on cash benefit programs."

GRADUATED IMPLEMENTATION OF PROGRAM

Pub. L. 106-170, title I, Sec. 101(d), Dec. 17, 1999, 113 Stat.

1874, provided that:

"(1) In general. - Not later than 1 year after the date of the

enactment of this Act [Dec. 17, 1999], the Commissioner of Social

Security shall commence implementation of the amendments made by

this section [enacting this section and amending sections 421, 422,

425, 1382d, 1383, and 1383b of this title] (other than paragraphs

(1)(C) and (2)(B) of subsection (b) [amending sections 422 and

1382d of this title]) in graduated phases at phase-in sites

selected by the Commissioner. Such phase-in sites shall be selected

so as to ensure, prior to full implementation of the Ticket to Work

and Self-Sufficiency Program, the development and refinement of

referral processes, payment systems, computer linkages, management

information systems, and administrative processes necessary to

provide for full implementation of such amendments. Subsection (c)

[set out as a note above] shall apply with respect to paragraphs

(1)(C) and (2)(B) of subsection (b) without regard to this

subsection.

"(2) Requirements. - Implementation of the Program at each

phase-in site shall be carried out on a wide enough scale to permit

a thorough evaluation of the alternative methods under

consideration, so as to ensure that the most efficacious methods

are determined and in place for full implementation of the Program

on a timely basis.

"(3) Full implementation. - The Commissioner shall ensure that

ability to provide tickets and services to individuals under the

Program exists in every State as soon as practicable on or after

the effective date specified in subsection (c) but not later than 3

years after such date.

"(4) Ongoing evaluation of program. -

"(A) In general. - The Commissioner shall provide for

independent evaluations to assess the effectiveness of the

activities carried out under this section [enacting this section,

amending sections 421, 422, 425, 1382d, 1383, and 1383b of this

title, and enacting provisions set out as notes under this

section] and the amendments made thereby. Such evaluations shall

address the cost-effectiveness of such activities, as well as the

effects of this section and the amendments made thereby on work

outcomes for beneficiaries receiving tickets to work and

self-sufficiency under the Program.

"(B) Consultation. - Evaluations shall be conducted under this

paragraph after receiving relevant advice from experts in the

fields of disability, vocational rehabilitation, and program

evaluation and individuals using tickets to work and

self-sufficiency under the Program and in consultation with the

Ticket to Work and Work Incentives Advisory Panel established

under section 101(f) of this Act [set out as a note below], the

Comptroller General of the United States, other agencies of the

Federal Government, and private organizations with appropriate

expertise.

"(C) Methodology. -

"(i) Implementation. - The Commissioner, in consultation with

the Ticket to Work and Work Incentives Advisory Panel

established under section 101(f) of this Act, shall ensure that

plans for evaluations and data collection methods under the

Program are appropriately designed to obtain detailed

employment information.

"(ii) Specific matters to be addressed. - Each such

evaluation shall address (but is not limited to) -

"(I) the annual cost (including net cost) of the Program

and the annual cost (including net cost) that would have been

incurred in the absence of the Program;

"(II) the determinants of return to work, including the

characteristics of beneficiaries in receipt of tickets under

the Program;

"(III) the types of employment services, vocational

rehabilitation services, and other support services furnished

to beneficiaries in receipt of tickets under the Program who

return to work and to those who do not return to work;

"(IV) the duration of employment services, vocational

rehabilitation services, and other support services furnished

to beneficiaries in receipt of tickets under the Program who

return to work and the duration of such services furnished to

those who do not return to work and the cost to employment

networks of furnishing such services;

"(V) the employment outcomes, including wages, occupations,

benefits, and hours worked, of beneficiaries who return to

work after receiving tickets under the Program and those who

return to work without receiving such tickets;

"(VI) the characteristics of individuals in possession of

tickets under the Program who are not accepted for services

and, to the extent reasonably determinable, the reasons for

which such beneficiaries were not accepted for services;

"(VII) the characteristics of providers whose services are

provided within an employment network under the Program;

"(VIII) the extent (if any) to which employment networks

display a greater willingness to provide services to

beneficiaries with a range of disabilities;

"(IX) the characteristics (including employment outcomes)

of those beneficiaries who receive services under the outcome

payment system and of those beneficiaries who receive

services under the outcome-milestone payment system;

"(X) measures of satisfaction among beneficiaries in

receipt of tickets under the Program; and

"(XI) reasons for (including comments solicited from

beneficiaries regarding) their choice not to use their

tickets or their inability to return to work despite the use

of their tickets.

"(D) Periodic evaluation reports. - Following the close of the

third and fifth fiscal years ending after the effective date

under subsection (c), and prior to the close of the seventh

fiscal year ending after such date, the Commissioner shall

transmit to the Committee on Ways and Means of the House of

Representatives and the Committee on Finance of the Senate a

report containing the Commissioner's evaluation of the progress

of activities conducted under the provisions of this section and

the amendments made thereby. Each such report shall set forth the

Commissioner's evaluation of the extent to which the Program has

been successful and the Commissioner's conclusions on whether or

how the Program should be modified. Each such report shall

include such data, findings, materials, and recommendations as

the Commissioner may consider appropriate.

"(5) Extent of state's right of first refusal in advance of full

implementation of amendments in such state. -

"(A) In general. - In the case of any State in which the

amendments made by subsection (a) [enacting this section] have

not been fully implemented pursuant to this subsection, the

Commissioner shall determine by regulation the extent to which -

"(i) the requirement under section 222(a) of the Social

Security Act (42 U.S.C. 422(a)) for prompt referrals to a State

agency; and

"(ii) the authority of the Commissioner under section

222(d)(2) of such Act (42 U.S.C. 422(d)(2)) to provide

vocational rehabilitation services in such State by agreement

or contract with other public or private agencies,

organizations, institutions, or individuals,

shall apply in such State.

"(B) Existing agreements. - Nothing in subparagraph (A) or the

amendments made by subsection (a) [enacting this section] shall

be construed to limit, impede, or otherwise affect any agreement

entered into pursuant to section 222(d)(2) of the Social Security

Act (42 U.S.C. 422(d)(2)) before the date of the enactment of

this Act [Dec. 17, 1999] with respect to services provided

pursuant to such agreement to beneficiaries receiving services

under such agreement as of such date, except with respect to

services (if any) to be provided after 3 years after the

effective date provided in subsection (c)."

TICKET TO WORK AND WORK INCENTIVES ADVISORY PANEL

Pub. L. 106-170, title I, Sec. 101(f), Dec. 17, 1999, 113 Stat.

1878, provided that:

"(1) Establishment. - There is established within the Social

Security Administration a panel to be known as the 'Ticket to Work

and Work Incentives Advisory Panel' (in this subsection referred to

as the 'Panel').

"(2) Duties of panel. - It shall be the duty of the Panel to -

"(A) advise the President, the Congress, and the Commissioner

of Social Security on issues related to work incentives programs,

planning, and assistance for individuals with disabilities,

including work incentive provisions under titles II, XI, XVI,

XVIII, and XIX of the Social Security Act (42 U.S.C. 401 et seq.,

1301 et seq., 1381 et seq., 1395 et seq., 1396 et seq.); and

"(B) with respect to the Ticket to Work and Self-Sufficiency

Program established under section 1148 of such Act [this section]

-

"(i) advise the Commissioner of Social Security with respect

to establishing phase-in sites for such Program and fully

implementing the Program thereafter, the refinement of access

of disabled beneficiaries to employment networks, payment

systems, and management information systems, and advise the

Commissioner whether such measures are being taken to the

extent necessary to ensure the success of the Program;

"(ii) advise the Commissioner regarding the most effective

designs for research and demonstration projects associated with

the Program or conducted pursuant to section 302 of this Act

[set out as a note under section 434 of this title];

"(iii) advise the Commissioner on the development of

performance measurements relating to quality assurance under

section 1148(d)(6) of the Social Security Act [subsec. (d)(6)

of this section]; and

"(iv) furnish progress reports on the Program to the

Commissioner and each House of Congress.

"(3) Membership. -

"(A) Number and appointment. - The Panel shall be composed of

12 members as follows:

"(i) four members appointed by the President, not more than

two of whom may be of the same political party;

"(ii) two members appointed by the Speaker of the House of

Representatives, in consultation with the Chairman of the

Committee on Ways and Means of the House of Representatives;

"(iii) two members appointed by the minority leader of the

House of Representatives, in consultation with the ranking

member of the Committee on Ways and Means of the House of

Representatives;

"(iv) two members appointed by the majority leader of the

Senate, in consultation with the Chairman of the Committee on

Finance of the Senate; and

"(v) two members appointed by the minority leader of the

Senate, in consultation with the ranking member of the

Committee on Finance of the Senate.

"(B) Representation. -

"(i) In general. - The members appointed under subparagraph

(A) shall have experience or expert knowledge as a recipient,

provider, employer, or employee in the fields of, or related

to, employment services, vocational rehabilitation services,

and other support services.

"(ii) Requirement. - At least one-half of the members

appointed under subparagraph (A) shall be individuals with

disabilities, or representatives of individuals with

disabilities, with consideration given to current or former

title II [subchapter II of this chapter] disability

beneficiaries or title XVI [subchapter XVI of this chapter]

disability beneficiaries (as such terms are defined in section

1148(k) of the Social Security Act [subsec. (k) of this

section] (as added by subsection (a)).

"(C) Terms. -

"(i) In general. - Each member shall be appointed for a term

of 4 years (or, if less, for the remaining life of the Panel),

except as provided in clauses (ii) and (iii). The initial

members shall be appointed not later than 90 days after the

date of the enactment of this Act [Dec. 17, 1999].

"(ii) Terms of initial appointees. - Of the members first

appointed under each clause of subparagraph (A), as designated

by the appointing authority for each such clause -

"(I) one-half of such members shall be appointed for a term

of 2 years; and

"(II) the remaining members shall be appointed for a term

of 4 years.

"(iii) Vacancies. - Any member appointed to fill a vacancy

occurring before the expiration of the term for which the

member's predecessor was appointed shall be appointed only for

the remainder of that term. A member may serve after the

expiration of that member's term until a successor has taken

office. A vacancy in the Panel shall be filled in the manner in

which the original appointment was made.

"(D) Basic pay. - Members shall each be paid at a rate, and in

a manner, that is consistent with guidelines established under

section 7 of the Federal Advisory Committee Act (5 U.S.C. App.).

"(E) Travel expenses. - Each member shall receive travel

expenses, including per diem in lieu of subsistence, in

accordance with sections 5702 and 5703 of title 5, United States

Code.

"(F) Quorum. - Eight members of the Panel shall constitute a

quorum but a lesser number may hold hearings.

"(G) Chairperson. - The Chairperson of the Panel shall be

designated by the President. The term of office of the

Chairperson shall be 4 years.

"(H) Meetings. - The Panel shall meet at least quarterly and at

other times at the call of the Chairperson or a majority of its

members.

"(4) Director and staff of panel; experts and consultants. -

"(A) Director. - The Panel shall have a Director who shall be

appointed by the Chairperson, and paid at a rate, and in a

manner, that is consistent with guidelines established under

section 7 of the Federal Advisory Committee Act (5 U.S.C. App.).

"(B) Staff. - Subject to rules prescribed by the Commissioner

of Social Security, the Director may appoint and fix the pay of

additional personnel as the Director considers appropriate.

"(C) Experts and consultants. - Subject to rules prescribed by

the Commissioner of Social Security, the Director may procure

temporary and intermittent services under section 3109(b) of

title 5, United States Code.

"(D) Staff of federal agencies. - Upon request of the Panel,

the head of any Federal department or agency may detail, on a

reimbursable basis, any of the personnel of that department or

agency to the Panel to assist it in carrying out its duties under

this Act [see Tables for classification].

"(5) Powers of panel. -

"(A) Hearings and sessions. - The Panel may, for the purpose of

carrying out its duties under this subsection, hold such

hearings, sit and act at such times and places, and take such

testimony and evidence as the Panel considers appropriate.

"(B) Powers of members and agents. - Any member or agent of the

Panel may, if authorized by the Panel, take any action which the

Panel is authorized to take by this section [enacting this

section, amending sections 421, 422, 425, 1382d, 1383, and 1383b

of this title, and enacting provisions set out as notes above].

"(C) Mails. - The Panel may use the United States mails in the

same manner and under the same conditions as other departments

and agencies of the United States.

"(6) Reports. -

"(A) Interim reports. - The Panel shall submit to the President

and the Congress interim reports at least annually.

"(B) Final report. - The Panel shall transmit a final report to

the President and the Congress not later than eight years after

the date of the enactment of this Act [Dec. 17, 1999]. The final

report shall contain a detailed statement of the findings and

conclusions of the Panel, together with its recommendations for

legislation and administrative actions which the Panel considers

appropriate.

"(7) Termination. - The Panel shall terminate 30 days after the

date of the submission of its final report under paragraph (6)(B).

"(8) Authorization of appropriations. - There are authorized to

be appropriated from the Federal Old-Age and Survivors Insurance

Trust Fund, the Federal Disability Insurance Trust Fund, and the

general fund of the Treasury, as appropriate, such sums as are

necessary to carry out this subsection."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 421, 425, 434, 1320b-20,

1320b-21, 1320b-22, 1383, 1383b of this title.

-End-

-CITE-

42 USC Sec. 1320b-20 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part A - General Provisions

-HEAD-

Sec. 1320b-20. Work incentives outreach program

-STATUTE-

(a) Establishment

(1) In general

The Commissioner, in consultation with the Ticket to Work and

Work Incentives Advisory Panel established under section 101(f)

of the Ticket to Work and Work Incentives Improvement Act of

1999, shall establish a community-based work incentives planning

and assistance program for the purpose of disseminating accurate

information to disabled beneficiaries on work incentives programs

and issues related to such programs.

(2) Grants, cooperative agreements, contracts, and outreach

Under the program established under this section, the

Commissioner shall -

(A) establish a competitive program of grants, cooperative

agreements, or contracts to provide benefits planning and

assistance, including information on the availability of

protection and advocacy services, to disabled beneficiaries,

including individuals participating in the Ticket to Work and

Self-Sufficiency Program established under section 1320b-19 of

this title, the program established under section 1382h of this

title, and other programs that are designed to encourage

disabled beneficiaries to work;

(B) conduct directly, or through grants, cooperative

agreements, or contracts, ongoing outreach efforts to disabled

beneficiaries (and to the families of such beneficiaries) who

are potentially eligible to participate in Federal or State

work incentive programs that are designed to assist disabled

beneficiaries to work, including -

(i) preparing and disseminating information explaining such

programs; and

(ii) working in cooperation with other Federal, State, and

private agencies and nonprofit organizations that serve

disabled beneficiaries, and with agencies and organizations

that focus on vocational rehabilitation and work-related

training and counseling;

(C) establish a corps of trained, accessible, and responsive

work incentives specialists within the Social Security

Administration who will specialize in disability work

incentives under subchapters II and XVI of this chapter for the

purpose of disseminating accurate information with respect to

inquiries and issues relating to work incentives to -

(i) disabled beneficiaries;

(ii) benefit applicants under subchapters II and XVI of

this chapter; and

(iii) individuals or entities awarded grants under

subparagraphs (!1) (A) or (B); and

(D) provide -

(i) training for work incentives specialists and

individuals providing planning assistance described in

subparagraph (C); and

(ii) technical assistance to organizations and entities

that are designed to encourage disabled beneficiaries to

return to work.

(3) Coordination with other programs

The responsibilities of the Commissioner established under this

section shall be coordinated with other public and private

programs that provide information and assistance regarding

rehabilitation services and independent living supports and

benefits planning for disabled beneficiaries including the

program under section 1382h of this title, the plans for

achieving self-support program (PASS), and any other Federal or

State work incentives programs that are designed to assist

disabled beneficiaries, including educational agencies that

provide information and assistance regarding rehabilitation,

school-to-work programs, transition services (as defined in, and

provided in accordance with, the Individuals with Disabilities

Education Act (20 U.S.C. 1400 et seq.)), a one-stop delivery

system established under subtitle B of title I of the Workforce

Investment Act of 1998 (29 U.S.C. 2811 et seq.), and other

services.

(b) Conditions

(1) Selection of entities

(A) Application

An entity shall submit an application for a grant,

cooperative agreement, or contract to provide benefits planning

and assistance to the Commissioner at such time, in such

manner, and containing such information as the Commissioner may

determine is necessary to meet the requirements of this

section.

(B) Statewideness

The Commissioner shall ensure that the planning, assistance,

and information described in paragraph (2) shall be available

on a statewide basis.

(C) Eligibility of States and private organizations

(i) In general

The Commissioner may award a grant, cooperative agreement,

or contract under this section to a State or a private agency

or organization (other than Social Security Administration

Field Offices and the State agency administering the State

medicaid program under subchapter XIX of this chapter,

including any agency or entity described in clause (ii), that

the Commissioner determines is qualified to provide the

planning, assistance, and information described in paragraph

(2)).

(ii) Agencies and entities described

The agencies and entities described in this clause are the

following:

(I) Any public or private agency or organization

(including Centers for Independent Living established under

title VII of the Rehabilitation Act of 1973 (29 U.S.C. 796

et seq.), protection and advocacy organizations, client

assistance programs established in accordance with section

112 of the Rehabilitation Act of 1973 (29 U.S.C. 732), and

State Developmental Disabilities Councils established in

accordance with section 6024 (!2) of this title) that the

Commissioner determines satisfies the requirements of this

section.

(II) The State agency administering the State program

funded under part A of subchapter IV of this chapter.

(D) Exclusion for conflict of interest

The Commissioner may not award a grant, cooperative

agreement, or contract under this section to any entity that

the Commissioner determines would have a conflict of interest

if the entity were to receive a grant, cooperative agreement,

or contract under this section.

(2) Services provided

A recipient of a grant, cooperative agreement, or contract to

provide benefits planning and assistance shall select individuals

who will act as planners and provide information, guidance, and

planning to disabled beneficiaries on the -

(A) availability and interrelation of any Federal or State

work incentives programs designed to assist disabled

beneficiaries that the individual may be eligible to

participate in;

(B) adequacy of any health benefits coverage that may be

offered by an employer of the individual and the extent to

which other health benefits coverage may be available to the

individual; and

(C) availability of protection and advocacy services for

disabled beneficiaries and how to access such services.

(3) Amount of grants, cooperative agreements, or contracts

(A) Based on population of disabled beneficiaries

Subject to subparagraph (B), the Commissioner shall award a

grant, cooperative agreement, or contract under this section to

an entity based on the percentage of the population of the

State where the entity is located who are disabled

beneficiaries.

(B) Limitations

(i) Per grant

No entity shall receive a grant, cooperative agreement, or

contract under this section for a fiscal year that is less

than $50,000 or more than $300,000.

(ii) Total amount for all grants, cooperative agreements, and

contracts

The total amount of all grants, cooperative agreements, and

contracts awarded under this section for a fiscal year may

not exceed $23,000,000.

(4) Allocation of costs

The costs of carrying out this section shall be paid from

amounts made available for the administration of subchapter II of

this chapter and amounts made available for the administration of

subchapter XVI of this chapter, and shall be allocated among

those amounts as appropriate.

(c) Definitions

In this section:

(1) Commissioner

The term "Commissioner" means the Commissioner of Social

Security.

(2) Disabled beneficiary

The term "disabled beneficiary" has the meaning given that term

in section 1320b-19(k)(2) of this title.

(d) Authorization of appropriations

There are authorized to be appropriated to carry out this section

$23,000,000 for each of the fiscal years 2000 through 2004.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1149, as added Pub. L.

106-170, title I, Sec. 121, Dec. 17, 1999, 113 Stat. 1887.)

-REFTEXT-

REFERENCES IN TEXT

Section 101(f) of the Ticket to Work and Work Incentives

Improvement Act of 1999, referred to in subsec. (a)(1), is section

101(f) of Pub. L. 106-170, which is set out as a note under section

1320b-19 of this title.

The Individuals with Disabilities Education Act, referred to in

subsec. (a)(3), is title VI of Pub. L. 91-230, Apr. 13, 1970, 84

Stat. 175, as amended, which is classified generally to chapter 33

(Sec. 1400 et seq.) of Title 20, Education. For complete

classification of this Act to the Code, see section 1400 of Title

20 and Tables.

The Workforce Investment Act of 1998, referred to in subsec.

(a)(3), is Pub. L. 105-220, Aug. 7, 1998, 112 Stat. 936, as

amended. Subtitle B of title I of the Act is classified generally

to subchapter II (Sec. 2811 et seq.) of chapter 30 of Title 29,

Labor. For complete classification of this Act to the Code, see

Short Title note set out under section 9201 of Title 20, Education,

and Tables.

The Rehabilitation Act of 1973, referred to in subsec.

(b)(1)(C)(ii)(I), is Pub. L. 93-112, Sept. 26, 1973, 87 Stat. 355,

as amended. Title VII of the Act is classified generally to

subchapter VII (Sec. 796 et seq.) of chapter 16 of Title 29, Labor.

For complete classification of this Act to the Code, see Short

Title note set out under section 701 of Title 29 and Tables.

Section 6024 of this title, referred to in subsec.

(b)(1)(C)(ii)(I), was repealed by Pub. L. 106-402, title IV, Sec.

401(a), Oct. 30, 2000, 114 Stat. 1737. See section 15025 of this

title.

Part A of subchapter IV of this chapter, referred to in subsec.

(b)(1)(C)(ii)(II), is classified to section 601 et seq. of this

title.

-FOOTNOTE-

(!1) So in original. Probably should be "subparagraph".

(!2) See References in Text note below.

-End-

-CITE-

42 USC Sec. 1320b-21 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part A - General Provisions

-HEAD-

Sec. 1320b-21. State grants for work incentives assistance to

disabled beneficiaries

-STATUTE-

(a) In general

Subject to subsection (c) of this section, the Commissioner may

make payments in each State to the protection and advocacy system

established pursuant to part C of title I of the Developmental

Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6041 et

seq.) (!1) for the purpose of providing services to disabled

beneficiaries.

(b) Services provided

Services provided to disabled beneficiaries pursuant to a payment

made under this section may include -

(1) information and advice about obtaining vocational

rehabilitation and employment services; and

(2) advocacy or other services that a disabled beneficiary may

need to secure or regain gainful employment.

(c) Application

In order to receive payments under this section, a protection and

advocacy system shall submit an application to the Commissioner, at

such time, in such form and manner, and accompanied by such

information and assurances as the Commissioner may require.

(d) Amount of payments

(1) In general

Subject to the amount appropriated for a fiscal year for making

payments under this section, a protection and advocacy system

shall not be paid an amount that is less than -

(A) in the case of a protection and advocacy system located

in a State (including the District of Columbia and Puerto Rico)

other than Guam, American Samoa, the United States Virgin

Islands, and the Commonwealth of the Northern Mariana Islands,

the greater of -

(i) $100,000; or

(ii) 1/3 of 1 percent of the amount available for

payments under this section; and

(B) in the case of a protection and advocacy system located

in Guam, American Samoa, the United States Virgin Islands, and

the Commonwealth of the Northern Mariana Islands, $50,000.

(2) Inflation adjustment

For each fiscal year in which the total amount appropriated to

carry out this section exceeds the total amount appropriated to

carry out this section in the preceding fiscal year, the

Commissioner shall increase each minimum payment under

subparagraphs (A) and (B) of paragraph (1) by a percentage equal

to the percentage increase in the total amount so appropriated to

carry out this section.

(e) Annual report

Each protection and advocacy system that receives a payment under

this section shall submit an annual report to the Commissioner and

the Ticket to Work and Work Incentives Advisory Panel established

under section 101(f) of the Ticket to Work and Work Incentives

Improvement Act of 1999 on the services provided to individuals by

the system.

(f) Funding

(1) Allocation of payments

Payments under this section shall be made from amounts made

available for the administration of subchapter II of this chapter

and amounts made available for the administration of subchapter

XVI of this chapter, and shall be allocated among those amounts

as appropriate.

(2) Carryover

Any amounts allotted for payment to a protection and advocacy

system under this section for a fiscal year shall remain

available for payment to or on behalf of the protection and

advocacy system until the end of the succeeding fiscal year.

(g) Definitions

In this section:

(1) Commissioner

The term "Commissioner" means the Commissioner of Social

Security.

(2) Disabled beneficiary

The term "disabled beneficiary" has the meaning given that term

in section 1320b-19(k)(2) of this title.

(3) Protection and advocacy system

The term "protection and advocacy system" means a protection

and advocacy system established pursuant to part C of title I of

the Developmental Disabilities Assistance and Bill of Rights Act

(42 U.S.C. 6041 et seq.).(!1)

(h) Authorization of appropriations

There are authorized to be appropriated to carry out this section

$7,000,000 for each of the fiscal years 2000 through 2004.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1150, as added Pub. L.

106-170, title I, Sec. 122, Dec. 17, 1999, 113 Stat. 1890.)

-REFTEXT-

REFERENCES IN TEXT

The Developmental Disabilities Assistance and Bill of Rights Act,

referred to in subsecs. (a) and (g)(3), is title I of Pub. L.

88-164, Oct. 31, 1963, 77 Stat. 282, as amended generally by Pub.

L. 98-527, Sec. 2, Oct. 19, 1984, 98 Stat. 2662, and as further

amended, which was repealed by Pub. L. 106-402, title IV, Sec.

401(a), Oct. 30, 2000, 114 Stat. 1737. Part C of the Act was

classified generally to subchapter III (Sec. 6041 et seq.) of

chapter 75 of this title. For complete classification of this Act

to the Code, see Tables.

Section 101(f) of the Ticket to Work and Work Incentives

Improvement Act of 1999, referred to in subsec. (e), is section

101(f) of Pub. L. 106-170, which is set out as a note under section

1320b-19 of this title.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1320b-19 of this title.

-FOOTNOTE-

(!1) See References in Text note below.

-End-

-CITE-

42 USC Sec. 1320b-22 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part A - General Provisions

-HEAD-

Sec. 1320b-22. Grants to develop and establish State

infrastructures to support working individuals with disabilities

-STATUTE-

(a) Establishment

(1) In general

The Secretary of Health and Human Services (in this section

referred to as the "Secretary") shall award grants described in

subsection (b) of this section to States to support the design,

establishment, and operation of State infrastructures that

provide items and services to support working individuals with

disabilities.

(2) Application

In order to be eligible for an award of a grant under this

section, a State shall submit an application to the Secretary at

such time, in such manner, and containing such information as the

Secretary shall require.

(3) Definition of State

In this section, the term "State" means each of the 50 States,

the District of Columbia, Puerto Rico, Guam, the United States

Virgin Islands, American Samoa, and the Commonwealth of the

Northern Mariana Islands.

(b) Grants for infrastructure and outreach

(1) In general

Out of the funds appropriated under subsection (e) of this

section, the Secretary shall award grants to States to -

(A) support the establishment, implementation, and operation

of the State infrastructures described in subsection (a) of

this section; and

(B) conduct outreach campaigns regarding the existence of

such infrastructures.

(2) Eligibility for grants

(A) In general

No State may receive a grant under this subsection unless the

State demonstrates to the satisfaction of the Secretary that

the State makes personal assistance services available under

the State plan under subchapter XIX of this chapter to the

extent necessary to enable individuals with disabilities to

remain employed, including individuals described in section

1396a(a)(10)(A)(ii)(XIII) of this title if the State has

elected to provide medical assistance under such plan to such

individuals.

(B) Definitions

In this section:

(i) Employed

The term "employed" means -

(I) earning at least the applicable minimum wage

requirement under section 206 of title 29 and working at

least 40 hours per month; or

(II) being engaged in a work effort that meets

substantial and reasonable threshold criteria for hours of

work, wages, or other measures, as defined and approved by

the Secretary.

(ii) Personal assistance services

The term "personal assistance services" means a range of

services, provided by 1 or more persons, designed to assist

an individual with a disability to perform daily activities

on and off the job that the individual would typically

perform if the individual did not have a disability. Such

services shall be designed to increase the individual's

control in life and ability to perform everyday activities on

or off the job.

(3) Determination of awards

(A) In general

Subject to subparagraph (B), the Secretary shall develop a

methodology for awarding grants to States under this section

for a fiscal year in a manner that -

(i) rewards States for their efforts in encouraging

individuals described in paragraph (2)(A) to be employed; and

(ii) does not provide a State that has not elected to

provide medical assistance under subchapter XIX of this

chapter to individuals described in section

1396a(a)(10)(A)(ii)(XIII) of this title with proportionally

more funds for a fiscal year than a State that has exercised

such election.

(B) Award limits

(i) Minimum awards

(I) In general

Subject to subclause (II), no State with an approved

application under this section shall receive a grant for a

fiscal year that is less than $500,000.

(II) Pro rata reductions

If the funds appropriated under subsection (e) of this

section for a fiscal year are not sufficient to pay each

State with an application approved under this section the

minimum amount described in subclause (I), the Secretary

shall pay each such State an amount equal to the pro rata

share of the amount made available.

(ii) Maximum awards

(I) States that elected optional medicaid eligibility

No State that has an application that has been approved

under this section and that has elected to provide medical

assistance under subchapter XIX of this chapter to

individuals described in section 1396a(a)(10)(A)(ii)(XIII)

of this title shall receive a grant for a fiscal year that

exceeds 10 percent of the total expenditures by the State

(including the reimbursed Federal share of such

expenditures) for medical assistance provided under such

subchapter for such individuals, as estimated by the State

and approved by the Secretary.

(II) Other States

The Secretary shall determine, consistent with the limit

described in subclause (I), a maximum award limit for a

grant for a fiscal year for a State that has an application

that has been approved under this section but that has not

elected to provide medical assistance under subchapter XIX

of this chapter to individuals described in section

1396a(a)(10)(A)(ii)(XIII) of this title.

(c) Availability of funds

(1) Funds awarded to States

Funds awarded to a State under a grant made under this section

for a fiscal year shall remain available until expended.

(2) Funds not awarded to States

Funds not awarded to States in the fiscal year for which they

are appropriated shall remain available in succeeding fiscal

years for awarding by the Secretary.

(d) Annual report

A State that is awarded a grant under this section shall submit

an annual report to the Secretary on the use of funds provided

under the grant. Each report shall include the percentage increase

in the number of title II disability beneficiaries, as defined in

section 1320b-19(k)(3) of this title in the State, and title XVI

disability beneficiaries, as defined in section 1320b-19(k)(4) of

this title in the State who return to work.

(e) Appropriation

(1) In general

Out of any funds in the Treasury not otherwise appropriated,

there is appropriated to make grants under this section -

(A) for fiscal year 2001, $20,000,000;

(B) for fiscal year 2002, $25,000,000;

(C) for fiscal year 2003, $30,000,000;

(D) for fiscal year 2004, $35,000,000;

(E) for fiscal year 2005, $40,000,000; and

(F) for each of fiscal years 2006 through 2011, the amount

appropriated for the preceding fiscal year increased by the

percentage increase (if any) in the Consumer Price Index for

All Urban Consumers (United States city average) for the

preceding fiscal year.

(2) Budget authority

This subsection constitutes budget authority in advance of

appropriations Acts and represents the obligation of the Federal

Government to provide for the payment of the amounts appropriated

under paragraph (1).

(f) Recommendation

Not later than October 1, 2010, the Secretary, in consultation

with the Ticket to Work and Work Incentives Advisory Panel

established by section 101(f) of this Act, shall submit a

recommendation to the Committee on Commerce of the House of

Representatives and the Committee on Finance of the Senate

regarding whether the grant program established under this section

should be continued after fiscal year 2011.

-SOURCE-

(Pub. L. 106-170, title II, Sec. 203, Dec. 17, 1999, 113 Stat.

1894.)

-REFTEXT-

REFERENCES IN TEXT

Section 101(f) of this Act, referred to in subsec. (f), is

section 101(f) of the Ticket to Work and Work Incentives

Improvement Act of 1999, Pub. L. 106-170, which is set out as a

note under section 1320b-19 of this title.

-COD-

CODIFICATION

Section was enacted as part of the Ticket to Work and Work

Incentives Improvement Act of 1999, and not as part of the Social

Security Act which comprises this chapter.

-CHANGE-

CHANGE OF NAME

Committee on Commerce of House of Representatives changed to

Committee on Energy and Commerce of House of Representatives, and

jurisdiction over matters relating to securities and exchanges and

insurance generally transferred to Committee on Financial Services

of House of Representatives by House Resolution No. 5, One Hundred

Seventh Congress, Jan. 3, 2001.

-End-

-CITE-

42 USC Sec. 1320b-23 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part A - General Provisions

-HEAD-

Sec. 1320b-23. Repealed. Pub. L. 106-554, Sec. 1(a)(4) [div. A,

Sec. 213(a)(6)], Dec. 21, 2000, 114 Stat. 2763, 2763A-180

-MISC1-

Section, act Aug. 14, 1935, ch. 531, title XI, Sec. 1150A, as

added Pub. L. 106-553, Sec. 1(a)(2) [title VI, Sec. 635(c)(1)],

Dec. 21, 2000, 114 Stat. 2762, 2762A-115, related to prohibition of

certain misuses of social security numbers.

EFFECTIVE DATE OF REPEAL

Repeal effective as if included in Pub. L. 106-553 on Dec. 21,

2000, see Sec. 1(a)(4) [div. A, Sec. 213(b)] of Pub. L. 106-554,

set out as an Effective Date of 2000 Amendment note under section

408 of this title.

CONGRESSIONAL FINDINGS

Pub. L. 106-553, Sec. 1(a)(2) [title VI, Sec. 635(b)], Dec. 21,

2000, 114 Stat. 2762, 2762A-114, which set forth congressional

findings, was repealed by Pub. L. 106-554, Sec. 1(a)(4) [div. A,

Sec. 213(a)(6), (b)], Dec. 21, 2000, 114 Stat. 2763, 2763A-180,

effective as if included in Pub. L. 106-553 on Dec. 21, 2000.

STUDY AND REPORT ON FEASIBILITY OF ADDITIONAL PROHIBITIONS

Pub. L. 106-553, Sec. 1(a)(2) [title VI, Sec. 635(d)], Dec. 21,

2000, 114 Stat. 2762, 2762A-117, which directed the Comptroller

General to conduct a study of the feasibility of imposing

additional limitations or prohibitions on the use of social

security numbers in public records and to submit a report to

Congress, was repealed by Pub. L. 106-554, Sec. 1(a)(4) [div. A,

Sec. 213(a)(6), (b)], Dec. 21, 2000, 114 Stat. 2763, 2763A-180,

effective as if included in Pub. L. 106-553 on Dec. 21, 2000.

-End-

-CITE-

42 USC Part B - Peer Review of Utilization and Quality of

Health Care Services 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

PART B - PEER REVIEW OF UTILIZATION AND QUALITY OF HEALTH CARE

SERVICES

-SECREF-

PART REFERRED TO IN OTHER SECTIONS

This part is referred to in sections 1301, 1395b-1, 1395h, 1395k,

1395x, 1395u, 1395y, 1395cc, 13955dd, 1395ff, 1395mm, 1395ww,

1396a, 1396r-2 of this title; title 10 section 1079.

-End-

-CITE-

42 USC Sec. 1320c 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c. Purpose

-STATUTE-

The purpose of this part is to establish the contracting process

which the Secretary must follow pursuant to the requirements of

section 1395y(g) of this title, including the definition of the

utilization and quality control peer review organizations with

which the Secretary shall contract, the functions such peer review

organizations are to perform, the confidentiality of medical

records, and related administrative matters to facilitate the

carrying out of the purposes of this part.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1151, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 382.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c, act Aug. 14, 1935, ch. 531, title XI, Sec.

1151, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1429; amended Aug. 13, 1981, Pub. L. 97-35, title

XXI, Sec. 2113(a), 95 Stat. 794, set out the Congressional

declaration of purpose of former part B, in the general revision of

this part by Pub. L. 97-248.

EFFECTIVE DATE

Section 149 of Pub. L. 97-248, as amended by Pub. L. 98-369, div.

B, title III, Sec. 2354(c)(3)(C), July 18, 1984, 98 Stat. 1102,

provided that: "The amendments made by this subtitle [subtitle C

(Secs. 141-150) of title I of Pub. L. 97-248, enacting this part,

amending sections 1395b-1, 1395g, 1395k, 1395l, 1395x, 1395y,

1395cc, 1395pp, 1396a, and 1396b of this title, and enacting

provisions set out as notes under sections 1305 and 1320c of this

title] shall, subject to section 150 [section 150 of Pub. L.

97-248, set out as a note below], be effective with respect to

contracts entered into or renewed on or after the date of the

enactment of this Act [Sept. 3, 1982]."

COORDINATION OF PROS AND CARRIERS

Pub. L. 101-508, title IV, Sec. 4205(c), Nov. 5, 1990, 104 Stat.

1388-113, provided that:

"(1) Development and implementation of plan. - The Secretary of

Health and Human Services shall develop and implement a plan to

coordinate the physician review activities of peer review

organizations and carriers. Such plan shall include -

"(A) the development of common utilization and medical review

criteria;

"(B) criteria for the targetting of reviews by peer review

organizations and carriers; and

"(C) improved methods for exchange of information among peer

review organizations and carriers.

"(2) Report. - Not later than January 1, 1992, the Secretary

shall submit to Congress a report on the development of the plan

described under paragraph (1) and shall include in the report such

recommendations for changes in legislation as may be appropriate."

EVALUATION OF PROFESSIONAL STANDARDS REVIEW ORGANIZATIONS

Pub. L. 97-448, title III, Sec. 309(d), Jan. 12, 1983, 96 Stat.

2410, provided that: "In order to avoid unfairly discriminating

against professional standards review organizations whose

performance was evaluated during the first and second calendar

quarters of 1982, the Secretary of Health and Human Services shall

disregard the results of such evaluations and shall carry out such

new evaluations of such organizations as may be necessary to select

utilization and quality control peer review organizations in

accordance with subtitle C of title I of the Tax Equity and Fiscal

Responsibility Act of 1982 [sections 141-150 of Pub. L. 97-248] and

part B of title XI of the Social Security Act [this part] as

amended by such subtitle."

MAINTENANCE OF CURRENT PROFESSIONAL STANDARDS REVIEW ORGANIZATION

AGREEMENTS

Section 150 of Pub. L. 97-248, as amended by Pub. L. 97-448,

title III, Sec. 309(a)(9), Jan. 12, 1983, 96 Stat. 2408, provided

that:

"(a) The Secretary of Health and Human Services shall not

terminate or fail to renew any agreement in effect with a

professional standards review organization under part B of title XI

of the Social Security Act [this part] on the earlier of the date

of the enactment of this Act [Sept. 3, 1982] or September 30, 1982

until such time as he enters into a contract with a utilization and

quality control peer review organization under such part, as

amended by this subtitle [subtitle C (Secs. 141-150) of title I of

Pub. L. 97-248], for the area served by such professional standards

review organization. In complying with this subsection, the

Secretary may renew any such agreement with a professional

standards review organization for a period of less than 12 months.

"(b) The provisions of part B of title XI of the Social Security

Act [this part] as in effect prior to the amendments made by this

subtitle [subtitle C (Secs. 141-150) of title I of Pub. L. 97-248]

shall remain in effect with respect to agreements with professional

standards review organizations in effect on the earlier of the date

of the enactment of this Act [Sept. 3, 1982] or September 30, 1982,

until such time as such agreement is terminated or is not renewed,

in accordance with subsection (a). Any matters awaiting a

determination by a Statewide Professional Standards Review Council

on the date of the enactment of this Act shall be transferred to

the Secretary of Health and Human Services for a determination

unless such determination is made by such Council within 30 days

after the date of the enactment of this Act. No payments shall be

made under part B of title XI of the Social Security Act to

Statewide Professional Standards Review Councils for services

performed under section 1162 of such Act [section 1320c-11 of this

title] after the end of such 30-day period."

-End-

-CITE-

42 USC Sec. 1320c-1 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-1. "Utilization and quality control peer review

organization" defined

-STATUTE-

The term "utilization and quality control peer review

organization" means an entity which -

(1)(A) is composed of a substantial number of the licensed

doctors of medicine and osteopathy engaged in the practice of

medicine or surgery in the area and who are representative of the

practicing physicians in the area, designated by the Secretary

under section 1320c-2 of this title, with respect to which the

entity shall perform services under this part, or (B) has

available to it, by arrangement or otherwise, the services of a

sufficient number of licensed doctors of medicine or osteopathy

engaged in the practice of medicine or surgery in such area to

assure that adequate peer review of the services provided by the

various medical specialties and subspecialties can be assured;

(2) is able, in the judgment of the Secretary, to perform

review functions required under section 1320c-3 of this title in

a manner consistent with the efficient and effective

administration of this part and to perform reviews of the pattern

of quality of care in an area of medical practice where actual

performance is measured against objective criteria which define

acceptable and adequate practice; and

(3) has at least one individual who is a representative of

consumers on its governing body.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1152, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 382; amended

Pub. L. 99-509, title IX, Sec. 9353(b)(1), Oct. 21, 1986, 100 Stat.

2046.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c-1, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1152, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1430; amended Dec. 31, 1975, Pub. L. 94-182,

title I, Secs. 105, 108(a), 89 Stat. 1052, 1053; Oct. 25, 1977,

Pub. L. 95-142, Sec. 5(a), (d)(2)(A), (B), (o)(1), 91 Stat. 1183,

1185, 1191; Dec. 5, 1980, Pub. L. 96-499, title IX, Sec. 921, 94

Stat. 2627; Aug. 13, 1981, Pub. L. 97-35, title XXI, Secs.

2112(a)(2)(A), (B), 2113(b), (c), 95 Stat. 793, 794, related to the

designation of Professional Standards Review Organizations, prior

to the general revision of this part by Pub. L. 97-248.

AMENDMENTS

1986 - Par. (3). Pub. L. 99-509 added par. (3).

EFFECTIVE DATE OF 1986 AMENDMENT

Section 9353(b)(2) of Pub. L. 99-509 provided that: "The

amendment made by paragraph (1) [amending this section] shall apply

to contracts entered into or renewed on or after January 1, 1987."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320c-2, 1320c-3, 1396a,

1396b of this title.

-End-

-CITE-

42 USC Sec. 1320c-2 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-2. Contracts with utilization and quality control peer

review organizations

-STATUTE-

(a) Establishment and consolidation of geographic areas

(1) The Secretary shall establish throughout the United States

geographic areas with respect to which contracts under this part

will be made. In establishing such areas, the Secretary shall use

the same areas as established under section 1320c-1 of this title

as in effect immediately prior to September 3, 1982, but subject to

the provisions of paragraph (2).

(2) As soon as practicable after September 3, 1982, the Secretary

shall consolidate such geographic areas, taking into account the

following criteria:

(A) Each State shall generally be designated as a geographic

area for purposes of paragraph (1).

(B) The Secretary shall establish local or regional areas

rather than State areas only where the volume of review activity

or other relevant factors (as determined by the Secretary)

warrant such an establishment, and the Secretary determines that

review activity can be carried out with equal or greater

efficiency by establishing such local or regional areas. In

applying this subparagraph the Secretary shall take into account

the number of hospital admissions within each State for which

payment may be made under subchapter XVIII of this chapter or a

State plan approved under subchapter XIX of this chapter, with

any State having fewer than 180,000 such admissions annually

being established as a single statewide area, and no local or

regional area being established which has fewer than 60,000 total

hospital admissions (including public and private pay patients)

under review annually, unless the Secretary determines that other

relevant factors warrant otherwise.

(C) No local or regional area shall be designated which is not

a self-contained medical service area, having a full spectrum of

services, including medical specialists' services.

(b) Organizations entitled to contract with Secretary

(1) The Secretary shall enter into a contract with a utilization

and quality control peer review organization for each area

established under subsection (a) of this section if a qualified

organization is available in such area and such organization and

the Secretary have negotiated a proposed contract which the

Secretary determines will be carried out by such organization in a

manner consistent with the efficient and effective administration

of this part. If more than one such qualified organization meets

the requirements of the preceding sentence, priority shall be given

to any such organization which is described in section

1320c-1(1)(A) of this title.

(2)(A) Prior to November 15, 1984, the Secretary shall not enter

into a contract under this part with any entity which is, or is

affiliated with (through management, ownership, or common control),

an entity (other than a self-insured employer) which directly or

indirectly makes payments to any practitioner or provider whose

health care services are reviewed by such entity or would be

reviewed by such entity if it entered into a contract with the

Secretary under this part. For purposes of this paragraph, an

entity shall not be considered to be affiliated with another entity

which makes payments (directly or indirectly) to any practitioner

or provider, by reason of management, ownership, or common control,

if the management, ownership, or common control consists only of

members of the governing board being affiliated (through

management, ownership, or common control) with a health maintenance

organization or competitive medical plan which is an "eligible

organization" as defined in section 1395mm(b) of this title.

(B) If, after November 14, 1984, the Secretary determines that

there is no other entity available for an area with which the

Secretary can enter into a contract under this part, the Secretary

may then enter into a contract under this part with an entity

described in subparagraph (A) for such area if such entity

otherwise meets the requirements of this part.

(3)(A) The Secretary shall not enter into a contract under this

part with any entity which is, or is affiliated with (through

management, ownership, or common control), a health care facility,

or association of such facilities, within the area served by such

entity or which would be served by such entity if it entered into a

contract with the Secretary under this part.

(B) For purposes of subparagraph (A), an entity shall not be

considered to be affiliated with a health care facility or

association of facilities by reason of management, ownership, or

common control if the management, ownership, or common control

consists only of not more than 20 percent of the members of the

governing board of the entity being affiliated (through management,

ownership, or common control) with one or more of such facilities

or associations.

(c) Terms of contract

Each contract with an organization under this section shall

provide that -

(1) the organization shall perform the functions set forth in

section 1320c-3(a) of this section, or may subcontract for the

performance of all or some of such functions (and for purposes of

paragraphs (2) and (3) of subsection (b) of this section, a

subcontract under this paragraph shall not constitute an

affiliation with the subcontractor);

(2) the Secretary shall have the right to evaluate the quality

and effectiveness of the organization in carrying out the

functions specified in the contract;

(3) the contract shall be for an initial term of three years

and shall be renewable on a triennial basis thereafter;

(4) if the Secretary intends not to renew a contract, he shall

notify the organization of his decision at least 90 days prior to

the expiration of the contract term, and shall provide the

organization an opportunity to present data, interpretations of

data, and other information pertinent to its performance under

the contract, which shall be reviewed in a timely manner by the

Secretary;

(5) the organization may terminate the contract upon 90 days

notice to the Secretary;

(6) the Secretary may terminate the contract prior to the

expiration of the contract term upon 90 days notice to the

organization if the Secretary determines that -

(A) the organization does not substantially meet the

requirements of section 1320c-1 of this title; or

(B) the organization has failed substantially to carry out

the contract or is carrying out the contract in a manner

inconsistent with the efficient and effective administration of

this part, but only after such organization has had an

opportunity to submit data and have such data reviewed by the

panel established under subsection (d) of this section;

(7) the Secretary shall include in the contract negotiated

objectives against which the organization's performance will be

judged, and negotiated specifications for use of regional norms,

or modifications thereof based on national norms, for performing

review functions under the contract; and

(8) reimbursement shall be made to the organization on a

monthly basis, with payments for any month being made not later

than 15 days after the close of such month.

In evaluating the performance of utilization and quality control

peer review organizations under contracts under this part, the

Secretary shall place emphasis on the performance of such

organizations in educating providers and practitioners

(particularly those in rural areas) concerning the review process

and criteria being applied by the organization.

(d) Review prior to termination of contract; modification and

termination; reviewing panel

(1) Prior to making any termination under subsection (c)(6)(B) of

this section, the Secretary must provide the organization with an

opportunity to provide data, interpretations of data, and other

information pertinent to its performance under the contract. Such

data and other information shall be reviewed in a timely manner by

a panel appointed by the Secretary, and the panel shall submit a

report of its findings to the Secretary in a timely manner. The

Secretary shall make a copy of the report available to the

organization.

(2) The Secretary may accept or not accept the findings of the

panel. After the panel has submitted a report with respect to an

organization, the Secretary may, with the concurrence of the

organization, amend the contract to modify the scope of the

functions to be carried out by the organization, or in any other

manner. The Secretary may terminate a contract under the authority

of subsection (c)(6)(B) of this section upon 90 days notice after

the panel has submitted a report, or earlier if the organization so

agrees.

(3) A panel appointed by the Secretary under this subsection

shall consist of not more than five individuals, each of whom shall

be a member of a utilization and quality control peer review

organization having a contract with the Secretary under this part.

While serving on such panel individuals shall be paid at a per diem

rate not to exceed the current per diem equivalent at the time that

service on the panel is rendered for grade GS-18 under section 5332

of title 5. Appointments shall be made without regard to title 5.

(4) During the period after the Secretary has given notice of

intent to terminate a contract, and prior to the time that the

Secretary enters into a contract with another utilization and

quality control peer review organization, the Secretary may

transfer review responsibilities of the organization under the

contract being terminated to another utilization and quality

control peer review organization, or to an intermediary or carrier

having an agreement under section 1395h of this title or a contract

under section 1395u of this title.

(e) Authority of Secretary

(1) Except as provided in paragraph (2), contracting authority of

the Secretary under this section may be carried out without regard

to any provision of law relating to the making, performance,

amendment, or modification of contracts of the United States as the

Secretary may determine to be inconsistent with the purposes of

this part. The Secretary may use different contracting methods with

respect to different geographical areas.

(2) If a peer review organization with a contract under this

section is required to carry out a review function in addition to

any function required to be carried out at the time the Secretary

entered into or renewed the contract with the organization, the

Secretary shall, before requiring such organization to carry out

such additional function, negotiate the necessary contractual

modifications, including modifications that provide for an

appropriate adjustment (in light of the cost of such additional

function) to the amount of reimbursement made to the organization.

(f) Termination not subject to judicial review

Any determination by the Secretary to terminate or not to renew a

contract under this section shall not be subject to judicial

review.

(g) Timely provision of hospital data to peer review organizations

The Secretary shall provide that fiscal intermediaries furnish to

peer review organizations, each month on a timely basis, data

necessary to initiate the review process under section 1320c-3(a)

of this title on a timely basis. If the Secretary determines that a

fiscal intermediary is unable to furnish such data on a timely

basis, the Secretary shall require the hospital to do so.

(h) Publication of new policy or procedure and general criteria and

standards for evaluation; performance comparison report

(1) The Secretary shall publish in the Federal Register any new

policy or procedure adopted by the Secretary that affects

substantially the performance of contract obligations under this

section not less than 30 days before the date on which such policy

or procedure is to take effect. This paragraph shall not apply to

the extent it is inconsistent with a statutory deadline.

(2) The Secretary shall publish in the Federal Register the

general criteria and standards used for evaluating the efficient

and effective performance of contract obligations under this

section and shall provide opportunity for public comment with

respect to such criteria and standards.

(3) The Secretary shall regularly furnish each peer review

organization with a contract under this section with a report that

documents the performance of the organization in relation to the

performance of other such organizations.

(i) Preference in contracting with in-State organizations

(1) Notwithstanding any other provision of this section, the

Secretary shall not renew a contract with any organization that is

not an in-State organization (as defined in paragraph (3)) unless

the Secretary has first complied with the requirements of paragraph

(2).

(2)(A) Not later than six months before the date on which a

contract period ends with respect to an organization that is not an

in-State organization, the Secretary shall publish in the Federal

Register -

(i) the date on which such period ends; and

(ii) the period of time in which an in-State organization may

submit a proposal for the contract ending on such date.

(B) If one or more qualified in-State organizations submits a

proposal within the period of time specified under subparagraph

(A)(ii), the Secretary shall not automatically renew the current

contract on a noncompetitive basis, but shall provide for

competition for the contract in the same manner as a new contract

under subsection (b) of this section.

(3) For purposes of this subsection, an in-State organization is

an organization that has its primary place of business in the State

in which review will be conducted (or, which is owned by a parent

corporation the headquarters of which is located in such State).

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1153, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 382; amended

Pub. L. 97-448, title III, Sec. 309(b)(2), Jan. 12, 1983, 96 Stat.

2408; Pub. L. 98-21, title VI, Sec. 602(a), Apr. 20, 1983, 97 Stat.

163; Pub. L. 98-369, div. B, title III, Secs. 2334(a), (b),

2347(c), July 18, 1984, 98 Stat. 1090, 1097; Pub. L. 99-272, title

IX, Secs. 9402(b), 9404(a), 9406(a), Apr. 7, 1986, 100 Stat. 200,

201; Pub. L. 99-509, title IX, Sec. 9352(a)(1), Oct. 21, 1986, 100

Stat. 2044; Pub. L. 100-203, title IV, Secs. 4091(a)(2)(A), (b)(1),

(2), 4092(a), 4094(d)(1), Dec. 22, 1987, 101 Stat. 1330-134,

1330-135, 1330-137.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c-2, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1153, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1432, related to review pending designation of a

Professional Standards Review Organization in a given area, prior

to the general revision of this part by Pub. L. 97-248.

AMENDMENTS

1987 - Subsec. (c). Pub. L. 100-203, Sec. 4094(d)(1), inserted

after and below par. (8) the following: "In evaluating the

performance of utilization and quality control peer review

organizations under contracts under this part, the Secretary shall

place emphasis on the performance of such organizations in

educating providers and practitioners (particularly those in rural

areas) concerning the review process and criteria being applied by

the organization."

Subsec. (c)(3). Pub. L. 100-203, Sec. 4091(a)(2)(A), substituted

"three" for "two" and "triennial" for "biennial".

Subsec. (e). Pub. L. 100-203, Sec. 4091(b)(2), designated

existing provisions as par. (1), substituted "Except as provided in

paragraph (2), contracting" for "Contracting", and added par. (2).

Subsec. (h). Pub. L. 100-203, Sec. 4091(b)(1), added subsec. (h).

Subsec. (i). Pub. L. 100-203, Sec. 4092(a), added subsec. (i).

1986 - Subsec. (b)(2)(A). Pub. L. 99-272, Sec. 9404(a),

substituted "consists only of members of the governing board" for

"consists only of one individual member of the governing board".

Subsec. (c)(8). Pub. L. 99-272, Sec. 9402(b), amended par. (8)

generally. Prior to amendment, par. (8) read as follows:

"reimbursement shall be made to the organization in accordance with

the terms of the contract."

Subsec. (d)(4). Pub. L. 99-272, Sec. 9406(a), added par. (4).

Subsec. (g). Pub. L. 99-509 added subsec. (g).

1984 - Subsec. (b)(2)(A). Pub. L. 98-369, Sec. 2347(c)(1),

substituted "Prior to November 15, 1984" for "During the first

twelve months in which the Secretary is entering into contracts

under this section".

Pub. L. 98-369, Sec. 2334(b), inserted "(other than a

self-insured employer)" and provision that for purposes of this

paragraph an entity shall not be considered to be affiliated with

another entity which makes payments (directly or indirectly) to any

practitioner or provider, by reason of management, ownership, or

common control, if the management, ownership, or common control

consists only of one individual member of the governing board being

affiliated (through management, ownership, or common control) with

a health maintenance organization or competitive medical plan which

is an "eligible organization" as defined in section 1395mm(b) of

this title.

Subsec. (b)(2)(B). Pub. L. 98-369, Sec. 2347(c)(2), substituted

"after November 14, 1984" for "after the expiration of the

twelve-month period referred to in subparagraph (A)".

Subsec. (b)(2)(C). Pub. L. 98-369, Sec. 2347(c)(3), struck out

subpar. (C) which provided that the twelve-month period formerly

referred to in subpar. (A) would be deemed to have begun not later

than October 1983.

Subsec. (b)(3). Pub. L. 98-369, Sec. 2334(a), designated existing

provisions as subpar. (A) and added subpar. (B).

1983 - Subsec. (b)(2)(C). Pub. L. 98-21 added subpar. (C).

Subsec. (d). Pub. L. 97-448 substituted reference to "subsection

(c)(6)(B)" for "subsection (c)(5)(B)" and "subsection (c)(5)(C)" in

pars. (1) and (2), respectively.

EFFECTIVE DATE OF 1987 AMENDMENT

Section 4091(a)(2)(B) of Pub. L. 100-203 provided that: "The

amendment made by subparagraph (A) [amending this section] shall

apply with respect to contracts entered into or renewed on or after

the date of the enactment of this Act [Dec. 22, 1987]."

Section 4091(b)(3) of Pub. L. 100-203 provided that: "The

amendment made by paragraphs (1) and (2) [amending this section]

shall become effective on the date of enactment of this Act [Dec.

22, 1987]."

Section 4092(b) of Pub. L. 100-203 provided that: "The amendment

made by subsection (a) [amending this section] shall apply with

respect to contracts scheduled to be renewed on or after the first

day of the eighth month to begin after the date of enactment of

this Act [Dec. 22, 1987]."

Section 4094(d)(2) of Pub. L. 100-203 provided that: "The

amendment made by paragraph (1) [amending this section] shall apply

to contracts under part B of title XI of the Social Security Act

[this part] as of January 1, 1988."

EFFECTIVE DATE OF 1986 AMENDMENTS

Section 9352(c)(1) of Pub. L. 99-509 provided that: "The

Secretary of Health and Human Services shall implement the

amendment made by subsection (a) [amending this section and section

1395h of this title] not later than 6 months after the date of the

enactment of this Act [Oct. 21, 1986]."

Section 9402(c)(2) of Pub. L. 99-272 provided that: "The

amendment made by subsection (b) [amending this section] shall

apply to contracts entered into or renewed on or after the date of

the enactment of this Act [Apr. 7, 1986]."

Section 9404(b) of Pub. L. 99-272 provided that: "The amendment

made by this section [amending this section] shall become effective

on the date of the enactment of this Act [Apr. 7, 1986]."

Section 9406(b) of Pub. L. 99-272 provided that: "The amendment

made by this section [amending this section] shall become effective

on the date of the enactment of this Act [Apr. 7, 1986]."

EFFECTIVE DATE OF 1984 AMENDMENT

Section 2334(c) of Pub. L. 98-369 provided that: "The amendments

made by this section [amending this section] shall become effective

on the date of the enactment of this Act [July 18, 1984]."

Section 2347(d) of Pub. L. 98-369 provided that: "The provisions

of, and amendments made by, this section [amending this section and

section 1395cc of this title and enacting provisions set out as a

note under section 1395cc of this title] shall become effective on

the date of the enactment of this Act [July 18, 1984]."

EFFECTIVE DATE OF 1983 AMENDMENTS

Amendment by Pub. L. 98-21 applicable to items and services

furnished by or under arrangement with a hospital beginning with

its first cost reporting period that begins on or after Oct. 1,

1983, any change in a hospital's cost reporting period made after

November 1982 to be recognized for such purposes only if the

Secretary finds good cause therefor, see section 604(a)(1) of Pub.

L. 98-21, set out as a note under section 1395ww of this title.

Amendment by Pub. L. 97-448 effective as if originally included

as a part of this section as this section was added by the Tax

Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248, see

section 309(c)(2) of Pub. L. 97-448, set out as a note under

section 426-1 of this title.

REFERENCES IN OTHER LAWS TO GS-16, 17, OR 18 PAY RATES

References in laws to the rates of pay for GS-16, 17, or 18, or

to maximum rates of pay under the General Schedule, to be

considered references to rates payable under specified sections of

Title 5, Government Organization and Employees, see section 529

[title I, Sec. 101(c)(1)] of Pub. L. 101-509, set out in a note

under section 5376 of Title 5.

EXTENSIONS OF PEER REVIEW CONTRACT PERIOD; ONE-TIME EXTENSIONS TO

PERMIT STAGGERING OF EXPIRATION DATES

Section 4091(a)(1) of Pub. L. 100-203, as amended by Pub. L.

100-360, title IV, Sec. 411(j)(1), July 1, 1988, 102 Stat. 790,

provided that:

"(A) In general. - In order to permit the Secretary of Health and

Human Services an adequate time to complete contract renewal

negotiations with utilization and quality control peer review

organizations under part B of title XI of the Social Security Act

[this part] and to provide for a staggered period of contract

expiration dates, notwithstanding section 1153(c) of such Act

[subsec. (c) of this section], the Secretary may provide for

extensions of existing contracts, but the total of such extensions

may not exceed 24 months for any contract.

"(B) Effective date. - The amendment made by subparagraph (A)

shall apply to contracts expiring on or after the date of the

enactment of this Act [Dec. 22, 1987]."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320c-1, 1320c-3, 1320c-6

of this title.

-End-

-CITE-

42 USC Sec. 1320c-3 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-3. Functions of peer review organizations

-STATUTE-

(a) Review of professional activities; determination of payment;

determination of review authority; consultation with professional

health care practitioners; standards of health care; other duties

Any utilization and quality control peer review organization

entering into a contract with the Secretary under this part must

perform the following functions:

(1) The organization shall review some or all of the

professional activities in the area, subject to the terms of the

contract and subject to the requirements of subsection (d) of

this section, of physicians and other health care practitioners

and institutional and noninstitutional providers of health care

services in the provision of health care services and items for

which payment may be made (in whole or in part) under subchapter

XVIII of this chapter (including where payment is made for such

services to eligible organizations pursuant to contracts under

section 1395mm of this title) for the purpose of determining

whether -

(A) such services and items are or were reasonable and

medically necessary and whether such services and items are not

allowable under subsection (a)(1) or (a)(9) of section 1395y of

this title;

(B) the quality of such services meets professionally

recognized standards of health care; and

(C) in case such services and items are proposed to be

provided in a hospital or other health care facility on an

inpatient basis, such services and items could, consistent with

the provision of appropriate medical care, be effectively

provided more economically on an outpatient basis or in an

inpatient health care facility of a different type.

If the organization performs such reviews with respect to a type

of health care practitioner other than medical doctors, the

organization shall establish procedures for the involvement of

health care practitioners of that type in such reviews.

(2) The organization shall determine, on the basis of the

review carried out under subparagraphs (A), (B), and (C) of

paragraph (1), whether payment shall be made for services under

subchapter XVIII of this chapter. Such determination shall

constitute the conclusive determination on those issues for

purposes of payment under subchapter XVIII of this chapter,

except that payment may be made if -

(A) such payment is allowed by reason of section 1395pp of

this title;

(B) in the case of inpatient hospital services or extended

care services, the peer review organization determines that

additional time is required in order to arrange for

postdischarge care, but payment may be continued under this

subparagraph for not more than two days, but only in the case

where the provider of such services did not know and could not

reasonably have been expected to know (as determined under

section 1395pp of this title) that payment would not otherwise

be made for such services under subchapter XVIII of this

chapter prior to notification by the organization under

paragraph (3);

(C) such determination is changed as the result of any

hearing or review of the determination under section 1320c-4 of

this title; or

(D) such payment is authorized under section 1395x(v)(1)(G)

of this title.

The organization shall identify cases for which payment should

not be made by reason of paragraph (1)(B) only through the use of

criteria developed pursuant to guidelines established by the

Secretary.

(3)(A) Subject to subparagraphs (B) and (D), whenever the

organization makes a determination that any health care services

or items furnished or to be furnished to a patient by any

practitioner or provider are disapproved, the organization shall

promptly notify such patient and the agency or organization

responsible for the payment of claims under subchapter XVIII of

this chapter of such determination.

(B) The notification under subparagraph (A) with respect to

services or items disapproved by reason of subparagraph (A) or

(C) of paragraph (1) shall not occur until 20 days after the date

that the organization has -

(i) made a preliminary notification to such practitioner or

provider of such proposed determination, and

(ii) provided such practitioner or provider an opportunity

for discussion and review of the proposed determination.

(C) The discussion and review conducted under subparagraph

(B)(ii) shall not affect the rights of a practitioner or provider

to a formal reconsideration of a determination under this part

(as provided under section 1320c-4 of this title).

(D) The notification under subparagraph (A) with respect to

services or items disapproved by reason of paragraph (1)(B) shall

not occur until after -

(i) the organization has notified the practitioner or

provider involved of the determination and of the

practitioner's or provider's right to a formal reconsideration

of the determination under section 1320c-4 of this title, and

(ii) if the provider or practitioner requests such a

reconsideration, the organization has made such a

reconsideration.

If a provider or practitioner is provided a reconsideration, such

reconsideration shall be in lieu of any subsequent

reconsideration to which the provider or practitioner may be

otherwise entitled under section 1320c-4 of this title, but shall

not affect the right of a beneficiary from seeking

reconsideration under such section of the organization's

determination (after any reconsideration requested by the

provider or physician under clause (ii)).

(E)(i) In the case of services and items provided by a

physician that were disapproved by reason of paragraph (1)(B),

the notice to the patient shall state the following: "In the

judgment of the peer review organization, the medical care

received was not acceptable under the medicare program. The

reasons for the denial have been discussed with your physician."

(ii) In the case of services or items provided by an entity or

practitioner other than a physician, the Secretary may substitute

the entity or practitioner which provided the services or items

for the term "physician" in the notice described in clause (i).

(4)(A) The organization shall, after consultation with the

Secretary, determine the types and kinds of cases (whether by

type of health care or diagnosis involved, or whether in terms of

other relevant criteria relating to the provision of health care

services) with respect to which such organization will, in order

to most effectively carry out the purposes of this part, exercise

review authority under the contract. The organization shall

notify the Secretary periodically with respect to such

determinations. Each peer review organization shall provide that

a reasonable proportion of its activities are involved with

reviewing, under paragraph (1)(B), the quality of services and

that a reasonable allocation of such activities is made among the

different cases and settings (including post-acute-care settings,

ambulatory settings, and health maintenance organizations). In

establishing such allocation, the organization shall consider (i)

whether there is reason to believe that there is a particular

need for reviews of particular cases or settings because of

previous problems regarding quality of care, (ii) the cost of

such reviews and the likely yield of such reviews in terms of

number and seriousness of quality of care problems likely to be

discovered as a result of such reviews, and (iii) the

availability and adequacy of alternative quality review and

assurance mechanisms.

(B) The contract of each organization shall provide for the

review of services (including both inpatient and outpatient

services) provided by eligible organizations pursuant to a

risk-sharing contract under section 1395mm of this title (or that

is subject to review under section 1395ss(t)(3) of this title)

for the purpose of determining whether the quality of such

services meets professionally recognized standards of health

care, including whether appropriate health care services have not

been provided or have been provided in inappropriate settings and

whether individuals enrolled with an eligible organization have

adequate access to health care services provided by or through

such organization (as determined, in part, by a survey of

individuals enrolled with the organization who have not yet used

the organization to receive such services). The contract of each

organization shall also provide that with respect to health care

provided by a health maintenance organization or competitive

medical plan under section 1395mm of this title, the organization

shall maintain a beneficiary outreach program designed to apprise

individuals receiving care under such section of the role of the

peer review system, of the rights of the individual under such

system, and of the method and purposes for contacting the

organization. The previous two sentences shall not apply with

respect to a contract year if another entity has been awarded a

contract under subparagraph (C). Under the contract the level of

effort expended by the organization on reviews under this

subparagraph shall be equivalent, on a per enrollee basis, to the

level of effort expended by the organization on utilization and

quality reviews performed with respect to individuals not

enrolled with an eligible organization.

(C) The Secretary may provide, by contract under competitive

procurement procedures on a State-by-State basis in up to 25

States, for the review described in subparagraph (B) by an

appropriate entity (which may be a peer review organization

described in that subparagraph). In selecting among States in

which to conduct such competitive procurement procedures, the

Secretary may not select States which, as a group, have more than

50 percent of the total number of individuals enrolled with

eligible organizations under section 1395mm of this title. Under

a contract with an entity under this subparagraph -

(i) the entity must be, or must meet all the requirements

under section 1320c-1 of this title to be, a utilization and

quality control peer review organization (other than the

ability to perform review functions under this section that are

not described in subparagraph (B)),

(ii) the contract must meet the requirement of section

1320c-2(b)(3) of this title, and

(iii) the level of effort expended under the contract shall

be, to the extent practicable, not less than the level of

effort that would otherwise be required under the third

sentence of subparagraph (B) if this subparagraph did not

apply.

(5) The organization shall consult with nurses and other

professional health care practitioners (other than physicians

described in section 1395x(r)(1) of this title) and with

representatives of institutional and noninstitutional providers

of health care services, with respect to the organization's

responsibility for the review under paragraph (1) of the

professional activities of such practitioners and providers.

(6)(A) The organization shall, consistent with the provisions

of its contract under this part, apply professionally developed

norms of care, diagnosis, and treatment based upon typical

patterns of practice within the geographic area served by the

organization as principal points of evaluation and review, taking

into consideration national norms where appropriate. Such norms

with respect to treatment for particular illnesses or health

conditions shall include -

(i) the types and extent of the health care services which,

taking into account differing, but acceptable, modes of

treatment and methods of organizing and delivering care, are

considered within the range of appropriate diagnosis and

treatment of such illness or health condition, consistent with

professionally recognized and accepted patterns of care; and

(ii) the type of health care facility which is considered,

consistent with such standards, to be the type in which health

care services which are medically appropriate for such illness

or condition can most economically be provided.

As a component of the norms described in clause (i) or (ii), the

organization shall take into account the special problems

associated with delivering care in remote rural areas, the

availability of service alternatives to inpatient

hospitalization, and other appropriate factors (such as the

distance from a patient's residence to the site of care, family

support, availability of proximate alternative sites of care, and

the patient's ability to carry out necessary or prescribed

self-care regimens) that could adversely affect the safety or

effectiveness of treatment provided on an outpatient basis.

(B) The organization shall -

(i) offer to provide, several times each year, for a

physician representing the organization to meet (at a hospital

or at a regional meeting) with medical and administrative staff

of each hospital (the services of which are reviewed by the

organization) respecting the organization's review of the

hospital's services for which payment may be made under

subchapter XVIII of this chapter, and

(ii) publish (not less often than annually) and distribute to

providers and practitioners whose services are subject to

review a report that describes the organization's findings with

respect to the types of cases in which the organization has

frequently determined that (I) inappropriate or unnecessary

care has been provided, (II) services were rendered in an

inappropriate setting, or (III) services did not meet

professionally recognized standards of health care.

(7) The organization, to the extent necessary and appropriate

to the performance of the contract, shall -

(A)(i) make arrangements to utilize the services of persons

who are practitioners of, or specialists in, the various areas

of medicine (including dentistry, optometry, and podiatry), or

other types of health care, which persons shall, to the maximum

extent practicable, be individuals engaged in the practice of

their profession within the area served by such organization;

and

(ii) in the case of psychiatric and physical rehabilitation

services, make arrangements to ensure that (to the extent

possible) initial review of such services be made by a

physician who is trained in psychiatry or physical

rehabilitation (as appropriate).(!1)

(B) undertake such professional inquiries either before or

after, or both before and after, the provision of services with

respect to which such organization has a responsibility for

review which in the judgment of such organization will

facilitate its activities;

(C) examine the pertinent records of any practitioner or

provider of health care services providing services with

respect to which such organization has a responsibility for

review under paragraph (1); and

(D) inspect the facilities in which care is rendered or

services are provided (which are located in such area) of any

practitioner or provider of health care services providing

services with respect to which such organization has a

responsibility for review under paragraph (1).

(8) The organization shall perform such duties and functions

and assume such responsibilities and comply with such other

requirements as may be required by this part or under regulations

of the Secretary promulgated to carry out the provisions of this

part or as may be required to carry out section 1395y(a)(15) of

this title.

(9)(A) The organization shall collect such information relevant

to its functions, and keep and maintain such records, in such

form as the Secretary may require to carry out the purposes of

this part, and shall permit access to and use of any such

information and records as the Secretary may require for such

purposes, subject to the provisions of section 1320c-9 of this

title.

(B) If the organization finds, after reasonable notice to and

opportunity for discussion with the physician or practitioner

concerned, that the physician or practitioner has furnished

services in violation of section 1320c-5(a) of this title and the

organization determines that the physician or practitioner should

enter into a corrective action plan under section 1320c-5(b)(1)

of this title, the organization shall notify the State board or

boards responsible for the licensing or disciplining of the

physician or practitioner of its finding and of any action taken

as a result of the finding.

(10) The organization shall coordinate activities, including

information exchanges, which are consistent with economical and

efficient operation of programs among appropriate public and

private agencies or organizations including -

(A) agencies under contract pursuant to sections 1395h and

1395u of this title;

(B) other peer review organizations having contracts under

this part; and

(C) other public or private review organizations as may be

appropriate.

(11) The organization shall make available its facilities and

resources for contracting with private and public entities paying

for health care in its area for review, as feasible and

appropriate, of services reimbursed by such entities.

(12) Repealed. Pub. L. 103-432, title I, Sec. 156(a)(2)(A)(i),

Oct. 31, 1994, 108 Stat. 4440.

(13) Notwithstanding paragraph (4), the organization shall

perform the review described in paragraph (1) with respect to

early readmission cases to determine if the previous inpatient

hospital services and the post-hospital services met

professionally recognized standards of health care. Such reviews

may be performed on a sample basis if the organization and the

Secretary determine it to be appropriate. In this paragraph, an

"early readmission case" is a case in which an individual, after

discharge from a hospital, is readmitted to a hospital less than

31 days after the date of the most recent previous discharge.

(14) The organization shall conduct an appropriate review of

all written complaints about the quality of services (for which

payment may otherwise be made under subchapter XVIII of this

chapter) not meeting professionally recognized standards of

health care, if the complaint is filed with the organization by

an individual entitled to benefits for such services under such

subchapter (or a person acting on the individual's behalf). The

organization shall inform the individual (or representative) of

the organization's final disposition of the complaint. Before the

organization concludes that the quality of services does not meet

professionally recognized standards of health care, the

organization must provide the practitioner or person concerned

with reasonable notice and opportunity for discussion.

(15) During each year of the contract entered into under

section 1320c-2(b) of this title, the organization shall perform

significant on-site review activities, including on-site review

in at least 20 percent of the rural hospitals in the

organization's area.

(16) The organization shall provide for a review and report to

the Secretary when requested by the Secretary under section

1395dd(d)(3) of this title. The organization shall provide

reasonable notice of the review to the physician and hospital

involved. Within the time period permitted by the Secretary, the

organization shall provide a reasonable opportunity for

discussion with the physician and hospital involved, and an

opportunity for the physician and hospital to submit additional

information, before issuing its report to the Secretary under

such section.

(b) Review by physicians; physician's family defined

(1) No physician shall be permitted to review -

(A) health care services provided to a patient if he was

directly responsible for providing such services; or

(B) health care services provided in or by an institution,

organization, or agency, if he or any member of his family has,

directly or indirectly, a significant financial interest in such

institution, organization, or agency.

(2) For purposes of this subsection, a physician's family

includes only his spouse (other than a spouse who is legally

separated from him under a decree of divorce or separate

maintenance), children (including legally adopted children),

grandchildren, parents, and grandparents.

(c) Utilization of services of physicians to make final

determinations of denial decisions with respect to professional

conduct of other physicians

No utilization and quality control peer review organization shall

utilize the services of any individual who is not a duly licensed

doctor of medicine, osteopathy, dentistry, optometry, or podiatry

to make final determinations of denial decisions in accordance with

its duties and functions under this part with respect to the

professional conduct of any other duly licensed doctor of medicine,

osteopathy, dentistry, optometry, or podiatry, or any act performed

by any duly licensed doctor of medicine, osteopathy, dentistry,

optometry, or podiatry in the exercise of his profession.

(d) Review of ambulatory surgical procedures

Each contract under this part shall require that the utilization

and quality control peer review organization's review

responsibility pursuant to subsection (a)(1) of this section will

include review of all ambulatory surgical procedures specified

pursuant to section 1395l(i)(1)(A) of this title which are

performed in the area, or, at the discretion of the Secretary a

sample of such procedures.

(e) Review of hospital denial notices

(1) If -

(A) a hospital has determined that a patient no longer requires

inpatient hospital care, and

(B) the attending physician has agreed with the hospital's

determination,

the hospital may provide the patient (or the patient's

representative) with a notice (meeting conditions prescribed by the

Secretary under section 1395pp of this title) of the determination.

(2) to (4) Repealed. Pub. L. 106-554, Sec. 1(a)(6) [title V, Sec.

521(c)], Dec. 21, 2000, 114 Stat. 2763, 2763A-543.

(5) In any review conducted under paragraph (2) or (3), the

organization shall solicit the views of the patient involved (or

the patient's representative).

(f) Identification of methods for identifying cases of substandard

care

The Secretary, in consultation with appropriate experts, shall

identify methods that would be available to assist peer review

organizations (under subsection (a)(4) of this section) in

identifying those cases which are more likely than others to be

associated with a quality of services which does not meet

professionally recognized standards of health care.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1154, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 385; amended

Pub. L. 97-448, title III, Sec. 309(b)(3), (4), Jan. 12, 1983, 96

Stat. 2408, 2409; Pub. L. 99-272, title IX, Secs. 9307(b), 9401(a),

9403(a), 9405(a), Apr. 7, 1986, 100 Stat. 193, 196, 200, 201; Pub.

L. 99-509, title IX, Secs. 9343(d), 9351(a), 9352(b),

9353(a)(1)-(3), (c)(1), Oct. 21, 1986, 100 Stat. 2040, 2043,

2044-2047; Pub. L. 100-203, title IV, Secs. 4039(h)(3), (4),

4093(a), 4094(a)-(c)(1)(A), (2)(A), (B), 4096(c), Dec. 22, 1987,

101 Stat. 1330-135 to 1330-137, 1330-139, as amended Pub. L.

100-360, title IV, Sec. 411(e)(3), (j)(3)(A), July 1, 1988, 102

Stat. 775, 791; Pub. L. 100-360, title II, Sec. 203(d)(2), title

IV, Sec. 411(j)(2), (3)(B), (4)(C), July 1, 1988, 102 Stat. 724,

775, 791; Pub. L. 100-485, title VI, Sec. 608(d)(25)(B), Oct. 13,

1988, 102 Stat. 2421; Pub. L. 101-234, title II, Sec. 201(a), Dec.

13, 1989, 103 Stat. 1981; Pub. L. 101-239, title VI, Sec.

6224(a)(1), (b)(1), Dec. 19, 1989, 103 Stat. 2257; Pub. L. 101-508,

title IV, Secs. 4205(b)(1), (d)(1)(A), (g)(1)(A), (2)(A),

4207(a)(1)(B), formerly 4027(a)(1)(B), 4358(b)(3), Nov. 5, 1990,

104 Stat. 1388-113 to 1388-115, 1388-117, 1388-137; Pub. L.

103-432, title I, Secs. 156(a)(2)(A), (b)(2)(A), 160(d)(4),

171(h)(2), Oct. 31, 1994, 108 Stat. 4440, 4441, 4444, 4450; Pub. L.

106-554, Sec. 1(a)(6) [title V, Sec. 521(c)], Dec. 21, 2000, 114

Stat. 2763, 2763A-543.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c-3, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1154, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1432; amended Oct. 25, 1977, Pub. L. 95-142, Sec.

5(b), (d)(2)(C), 91 Stat. 1184, 1186; Dec. 5, 1980, Pub. L. 96-499,

title IX, Sec. 924(a), 94 Stat. 2628; Aug. 13, 1981, Pub. L. 97-35,

title XXI, Secs. 2112(a)(1), (2)(B), (b), 2113(c), 2121(e), 95

Stat. 793, 794, 796, related to trial period for Professional

Standards Review Organizations, prior to the general revision of

this part by Pub. L. 97-248.

AMENDMENTS

2000 - Subsec. (e)(2) to (4). Pub. L. 106-554 struck out pars.

(2) to (4), which had: in par. (2), authorized peer review

organization review of validity of hospital's determination that a

patient no longer required inpatient hospital care but attending

physician had not agreed with the hospital's determination; in par.

(3), authorized review of the determination where patient or

patient's representative had received a notice under par. (1) and

requested the review; and in par. (4), directed that hospital could

not charge patient for inpatient services furnished before noon of

the day after the date the patient or representative received

notice of the decision where request for review had been made not

later than noon of the first working day after notice under par.

(1) had been received and section 1395pp(a)(2) conditions had been

met.

1994 - Subsec. (a)(4)(B). Pub. L. 103-432, Sec. 171(h)(2),

substituted "(or that is subject to review under section

1395ss(t)(3) of this title)" for "(or subject to review under

section 1395ss(t) of this title)".

Subsec. (a)(9)(B). Pub. L. 103-432, Sec. 156(b)(2)(B), amended

subpar. (B) generally. Prior to amendment, subpar. (B) read as

follows: "If the organization finds, after notice and hearing, that

a physician has furnished services in violation of this subsection,

the organization shall notify the State board or boards responsible

for the licensing or disciplining of the physician of its finding

and decision."

Subsec. (a)(12). Pub. L. 103-432, Sec. 156(a)(2)(A)(i), struck

out par. (12) which read as follows: "The organization shall

perform the review, referral, and other functions required under

section 1320c-13 of this title."

Subsec. (d). Pub. L. 103-432, Sec. 156(a)(2)(A)(ii), struck out

"(and except as provided in section 1320c-13 of this title)" after

"discretion of the Secretary".

1990 - Subsec. (a)(2). Pub. L. 101-508, Sec. 4205(g)(2)(A),

inserted third sentence and struck out former third sentence which

read as follows: "Determinations that payment should not be made by

reason of subparagraph (B) of paragraph (1) shall be made only on

the basis of criteria which are consistent with guidelines

established by the Secretary."

Subsec. (a)(3)(E). Pub. L. 101-508, Sec. 4205(g)(1)(A),

designated existing provisions as cl. (i), inserted "provided by a

physician that were" after "items", substituted "physician." for

"physician and hospital.", and added cl. (ii).

Subsec. (a)(4)(B). Pub. L. 101-508, Sec. 4358(b)(3), inserted

"(or subject to review under section 1395ss(t) of this title)"

after "section 1395mm of this title" in first sentence.

Subsec. (a)(7)(A)(i). Pub. L. 101-508, Sec. 4205(b)(1)(A),

inserted ", optometry, and podiatry" after "dentistry".

Subsec. (a)(9). Pub. L. 101-508, Sec. 4205(d)(1)(A), designated

existing provisions as subpar. (A) and added subpar. (B).

Subsec. (a)(16). Pub. L. 101-508, Sec. 4207(a)(1)(B), formerly

Sec. 4027(a)(1)(B), as renumbered by Pub. L. 103-432, Sec.

160(d)(4), added par. (16).

Subsec. (c). Pub. L. 101-508, Sec. 4205(b)(1)(B), substituted

"dentistry, optometry, or podiatry" for "or dentistry" in three

places.

1989 - Subsec. (a)(1). Pub. L. 101-239, Sec. 6224(a)(1), inserted

at end "If the organization performs such reviews with respect to a

type of health care practitioner other than medical doctors, the

organization shall establish procedures for the involvement of

health care practitioners of that type in such reviews."

Subsec. (a)(3)(A). Pub. L. 101-239, Sec. 6224(b)(1)(A),

substituted "subparagraphs (B) and (D)" for "subparagraph (B)".

Subsec. (a)(3)(B). Pub. L. 101-239, Sec. 6224(b)(1)(B), inserted

"with respect to services or items disapproved by reason of

subparagraph (A) or (C) of paragraph (1)" after "under subparagraph

(A)".

Subsec. (a)(3)(D), (E). Pub. L. 101-239, Sec. 6224(b)(1)(C),

added subpars. (D) and (E).

Subsec. (a)(16). Pub. L. 101-234, repealed Pub. L. 100-360, Sec.

203(d)(2), and provided that the provisions of law amended or

repealed by such section are restored or revived as if such section

had not been enacted, see 1988 Amendment note below.

1988 - Subsec. (a)(3)(C). Pub. L. 100-360, Sec. 411(j)(2),

designated last sentence of par. (3) as subpar. (C).

Subsec. (a)(4). Pub. L. 100-360, Sec. 411(e)(3), added Pub. L.

100-203, Sec. 4039(h)(3), see 1987 Amendment note below.

Subsec. (a)(6). Pub. L. 100-360, Sec. 411(j)(3)(A), made

technical amendment to directory language of Pub. L. 100-203, Sec.

4094(a), see 1987 Amendment note below.

Subsec. (a)(15). Pub. L. 100-360, Sec. 411(j)(3)(B), substituted

"review in at least" for "review at at least".

Subsec. (a)(16). Pub. L. 100-360, Sec. 203(d)(2), added par. (16)

which related to review of home intravenous drug therapy services.

Subsec. (d). Pub. L. 100-360, Sec. 411(e)(3), added Pub. L.

100-203, Sec. 4039(h)(4), see 1987 Amendment note below.

Subsec. (e)(3)(A)(i). Pub. L. 100-360, Sec. 411(j)(4)(C), as

amended by Pub. L. 100-485, Sec. 608(d)(25)(B), substituted

"paragraph (1)" for "paragraph (1) or (2)".

Subsec. (e)(3)(B). Pub. L. 100-360, Sec. 411(j)(4)(C), as amended

by Pub. L. 100-485, Sec. 608(d)(25)(B), substituted "paragraph (1)"

for "paragraph (1) or (2)" in introductory provisions.

1987 - Subsec. (a)(3). Pub. L. 100-203, Sec. 4093(a), amended

par. (3) generally. Prior to amendment, par. (3) read as follows:

"Whenever the organization makes a determination that any health

care services or items furnished or to be furnished to a patient by

any practitioner or provider are disapproved, the organization

shall promptly notify such practitioner or provider, such patient,

and the agency or organization responsible for the payment of

claims under subchapter XVIII of this chapter. In the case of

practitioners and providers of services, the organization shall

provide an opportunity for discussion and review of the

determination."

Subsec. (a)(4). Pub. L. 100-203, Sec. 4039(h)(3), as added by

Pub. L. 100-360, Sec. 411(e)(3), realigned margins for subpars. (B)

and (C) and cls. (i) to (iii) of subpar. (C), in subpar. (B),

substituted "risk sharing contract under section 1395mm" for

"contract under section 1395mm", and in subpar. (C), inserted

"(other than the ability to perform review functions under this

section that are not described in subparagraph (B))".

Subsec. (a)(4)(B). Pub. L. 100-203, Sec. 4094(c)(2)(A), inserted

before period at end of first sentence "and whether individuals

enrolled with an eligible organization have adequate access to

health care services provided by or through such organization (as

determined, in part, by a survey of individuals enrolled with the

organization who have not yet used the organization to receive such

services). The contract of each organization shall also provide

that with respect to health care provided by a health maintenance

organization or competitive medical plan under section 1395mm of

this title, the organization shall maintain a beneficiary outreach

program designed to apprise individuals receiving care under such

section of the role of the peer review system, of the rights of the

individual under such system, and of the method and purposes for

contacting the organization" and substituted "previous two

sentences" for "previous sentence" in penultimate sentence.

Subsec. (a)(6). Pub. L. 100-203, Sec. 4094(c)(1)(A), designated

existing provisions as subpar. (A), redesignated former subpars.

(A) and (B) as cls. (i) and (ii), respectively, and added subpar.

(B).

Pub. L. 100-203, Sec. 4094(a), as amended by Pub. L. 100-360,

Sec. 411(j)(3)(A), inserted after and below subpar. (A) the

following: "As a component of the norms described in clause (i) or

(ii), the organization shall take into account the special problems

associated with delivering care in remote rural areas, the

availability of service alternatives to inpatient hospitalization,

and other appropriate factors (such as the distance from a

patient's residence to the site of care, family support,

availability of proximate alternative sites of care, and the

patient's ability to carry out necessary or prescribed self-care

regimens) that could adversely affect the safety or effectiveness

of treatment provided on an outpatient basis."

Subsec. (a)(7)(A). Pub. L. 100-203, Sec. 4094(c)(2)(B),

designated existing provisions as cl. (i) and added cl. (ii).

Subsec. (a)(15). Pub. L. 100-203, Sec. 4094(b), added par. (15).

Subsec. (d). Pub. L. 100-203, Sec. 4039(h)(4), as added by Pub.

L. 100-360, Sec. 411(e)(3), substituted "1320c-13 of this title"

for "1320c-13(b)(4) of this title".

Subsec. (e)(2). Pub. L. 100-203, Sec. 4096(c)(1), inserted

provision at end requiring hospital to notify patient if it has

requested a review.

Subsec. (e)(3)(A)(i), (B). Pub. L. 100-203, Sec. 4096(c)(2),

inserted "or (2)" after "paragraph (1)".

1986 - Subsec. (a)(1). Pub. L. 99-509, Sec. 9343(d)(1), inserted

"and subject to the requirements of subsection (d) of this section"

after "subject to the terms of the contract" in introductory

provisions.

Pub. L. 99-272, Sec. 9405(a), inserted "(including where payment

is made for such services to eligible organizations pursuant to

contracts under section 1395mm of this title)" after "subchapter

XVIII of this chapter" in introductory provisions.

Subsec. (a)(2). Pub. L. 99-272, Sec. 9403(a), in introductory

provisions substituted "subparagraphs (A), (B), and (C)" for

"subparagraphs (A) and (C)", and following subpar. (D) inserted

provision that determinations that payment should not be made by

reason of subpar. (B) of par. (1) shall be made only on the basis

of criteria which are consistent with guidelines established by the

Secretary.

Subsec. (a)(4)(A). Pub. L. 99-509, Sec. 9353(a)(1), inserted at

end "Each peer review organization shall provide that a reasonable

proportion of its activities are involved with reviewing, under

paragraph (1)(B), the quality of services and that a reasonable

allocation of such activities is made among the different cases and

settings (including post-acute-care settings, ambulatory settings,

and health maintenance organizations). In establishing such

allocation, the organization shall consider (i) whether there is

reason to believe that there is a particular need for reviews of

particular cases or settings because of previous problems regarding

quality of care, (ii) the cost of such reviews and the likely yield

of such reviews in terms of number and seriousness of quality of

care problems likely to be discovered as a result of such reviews,

and (iii) the availability and adequacy of alternative quality

review and assurance mechanisms."

Pub. L. 99-509, Sec. 9353(a)(2)(A), inserted "(A)" after "(4)".

Subsec. (a)(4)(B). Pub. L. 99-509, Sec. 9353(a)(2)(C), inserted

at end "Under the contract the level of effort expended by the

organization on reviews under this subparagraph shall be

equivalent, on a per enrollee basis, to the level of effort

expended by the organization on utilization and quality reviews

performed with respect to individuals not enrolled with an eligible

organization."

Pub. L. 99-509, Sec. 9353(a)(2)(B), added subpar. (B).

Subsec. (a)(4)(C). Pub. L. 99-509, Sec. 9353(a)(2)(D), added

subpar. (C).

Subsec. (a)(8). Pub. L. 99-272, Sec. 9307(b), inserted "or as may

be required to carry out section 1395y(a)(15) of this title" before

the period at end.

Subsec. (a)(12). Pub. L. 99-272, Sec. 9401(a), added par. (12).

Subsec. (a)(13). Pub. L. 99-509, Sec. 9352(b), added par. (13).

Subsec. (a)(14). Pub. L. 99-509, Sec. 9353(c)(1), added par.

(14).

Subsec. (d). Pub. L. 99-509, Sec. 9343(d)(2), added subsec. (d).

Subsec. (e). Pub. L. 99-509, Sec. 9351(a), added subsec. (e).

Subsec. (f). Pub. L. 99-509, Sec. 9353(a)(3), added subsec. (f).

1983 - Subsec. (a)(1)(A). Pub. L. 97-448, Sec. 309(b)(3),

substituted "and whether such services and items are not allowable

under subsection (a)(1) or (a)(9) of section 1395y of this title"

for "or otherwise allowable under section 1395y(a)(1) of this

title".

Subsec. (a)(2)(B). Pub. L. 97-448, Sec. 309(b)(4), struck out

"posthospital" before "extended care services".

EFFECTIVE DATE OF 2000 AMENDMENT

Pub. L. 106-554, Sec. 1(a)(6) [title V, Sec. 521(d)], Dec. 21,

2000, 114 Stat. 2763, 2763A-543, provided that: "The amendments

made by this section [amending this section and sections 1395w-22

and 1395ff of this title] shall apply with respect to initial

determinations made on or after October 1, 2002."

EFFECTIVE DATE OF 1994 AMENDMENT

Section 156(a)(3) of Pub. L. 103-432 provided that: "The

amendments made by this subsection [amending this section and

sections 1395l, 1395m, 1395y, and 1395cc of this title and

repealing section 1320c-13 of this title] shall apply to services

provided on or after the date of the enactment of this Act [Oct.

31, 1994]."

Amendment by section 171(h)(2) of Pub. L. 103-432 effective as if

included in the enactment of Pub. L. 101-508, see section 171(l) of

Pub. L. 103-432, set out as a note under section 1395ss of this

title.

EFFECTIVE DATE OF 1990 AMENDMENT

Section 4205(b)(2) of Pub. L. 101-508 provided that: "The

amendments made by paragraph (1) [amending this section] shall

apply to contracts entered into or renewed on or after the date of

the enactment of this Act [Nov. 5, 1990]."

Section 4205(d)(1)(C) of Pub. L. 101-508 provided that: "The

amendments made by this paragraph [amending this section and

section 1320c-9 of this title] shall apply to notices of proposed

sanctions issued more than 60 days after the date of the enactment

of this Act [Nov. 5, 1990]."

Section 4205(g)(1)(B) of Pub. L. 101-508 provided that: "The

amendments made by subparagraph (A) [amending this section] shall

take effect as if included in the enactment of the Omnibus Budget

Reconiliation [sic] Act of 1989 [Pub. L. 101-239]."

Section 4205(g)(2)(B) of Pub. L. 101-508 provided that: "The

amendment made by subparagraph (A) [amending this section] shall

take effect as if included in the enactment of the Consolidated

Omnibus Budget Reconciliation Act of 1985 [Pub. L. 99-272]."

Section 4207(a)(1)(C), formerly 4027(a)(1)(C), of Pub. L.

101-508, as renumbered by Pub. L. 103-432, title I, Sec. 160(d)(4),

Oct. 31, 1994, 108 Stat. 4444, provided that: "The amendment made

by subparagraph (A) [amending section 1395dd of this title] shall

take effect on the first day of the first month beginning more than

60 days after the date of the enactment of this Act [Nov. 5, 1990].

The amendment made by subparagraph (B) [amending this section]

shall apply to contracts under part B of title XI of the Social

Security Act [this part] as of the first day of the first month

beginning more than 60 days after the date of the enactment of this

Act."

Section 4358(c) of Pub. L. 101-508, as amended by Pub. L.

103-432, title I, Sec. 172(a), Oct. 31, 1994, 108 Stat. 4452; Pub.

L. 104-18, Sec. 1, July 7, 1995, 109 Stat. 192, provided that:

"(1) The amendments made by this section [amending this section

and section 1395ss of this title] shall only apply -

"(A) in 15 States (as determined by the Secretary of Health and

Human Services) and such other States as elect such amendments to

apply to them, and

"(B) subject to paragraph (2), during the 6 1/2 -year period

beginning with 1992.

For purposes of this paragraph, the term 'State' has the meaning

given such term by section 210(h) of the Social Security Act (42

U.S.C. 410(h)).

"(2)(A) The Secretary of Health and Human Services shall conduct

a study that compares the health care costs, quality of care, and

access to services under medicare select policies with that under

other medicare supplemental policies. The study shall be based on

surveys of appropriate age-adjusted sample populations. The study

shall be completed by June 30, 1997.

"(B) Not later than December 31, 1997, the Secretary shall

determine, based on the results of the study under subparagraph

(A), if any of the following findings are true:

"(i) The amendments made by this section have not resulted in

savings of premium costs to those enrolled in medicare select

policies (in comparison to their enrollment in medicare

supplemental policies that are not medicare select policies and

that provide comparable coverage).

"(ii) There have been significant additional expenditures under

the medicare program as a result of such amendments.

"(iii) Access to and quality of care has been significantly

diminished as a result of such amendments.

"(C) The amendments made by this section shall remain in effect

beyond the 6 1/2 -year period described in paragraph (1)(B) unless

the Secretary determines that any of the findings described in

clause (i), (ii), or (iii) of subparagraph (B) are true.

"(3) The Comptroller General shall conduct a study to determine

the extent to which individuals who are continuously covered under

a medicare supplemental policy are subject to medical underwriting

if they change the policy under which they are covered, and to

identify options, if necessary, for modifying the medicare

supplemental insurance market to make sure that continuously

insured beneficiaries are able to switch plans without medical

underwriting. By not later than June 30, 1996, the Comptroller

General shall submit to the Congress a report on the study. The

report shall include a description of the potential impact on the

cost and availability of medicare supplemental policies of each

option identified in the study."

[Section 172(b) of Pub. L. 103-432 provided that: "The amendment

made by subsection (a) [amending section 4358(c) of Pub. L.

101-508, set out above] shall take effect as if included in the

enactment of the Omnibus Budget Reconciliation Act of 1990 [Pub. L.

101-508]."]

EFFECTIVE DATE OF 1989 AMENDMENTS

Section 6224(a)(2) of Pub. L. 101-239 provided that: "The

amendment made by paragraph (1) [amending this section] shall apply

to contracts entered into after the date of the enactment of this

Act [Dec. 19, 1989]."

Section 6224(b)(3) of Pub. L. 101-239 provided that: "The

amendments made by this subsection [amending this section and

section 1320c-4 of this title] shall apply to determinations by

utilization and quality control peer review organizations with

respect to which preliminary notifications were made under section

1154(a)(3)(B) of the Social Security Act [subsec. (a)(3)(B) of this

section] more than 30 days after the date of the enactment of this

Act [Dec. 19, 1989]."

Amendment by Pub. L. 101-234 effective Jan. 1, 1990, see section

201(c) of Pub. L. 101-234, set out as a note under section 1320a-7a

of this title.

EFFECTIVE DATE OF 1988 AMENDMENTS

Amendment by Pub. L. 100-485 effective as if included in the

enactment of the Medicare Catastrophic Coverage Act of 1988, Pub.

L. 100-360, see section 608(g)(1) of Pub. L. 100-485, set out as a

note under section 704 of this title.

Section 203(g) of Pub. L. 100-360, which had provided that the

amendments made by section 203 of Pub. L. 100-360 (amending this

section and sections 1395h, 1395k to 1395n, 1395w-2, 1395x, 1395z,

and 1395aa of this title) were to apply to items and services

furnished on or after January 1, 1990, was repealed by Pub. L.

101-234, title II, Sec. 201(a), Dec. 13, 1989, 103 Stat. 1981.

Except as specifically provided in section 411 of Pub. L.

100-360, amendment by section 411(e)(3), (j)(2), (3), (4)(C) of

Pub. L. 100-360, as it relates to a provision in the Omnibus Budget

Reconciliation Act of 1987, Pub. L. 100-203, effective as if

included in the enactment of that provision in Pub. L. 100-203, see

section 411(a) of Pub. L. 100-360, set out as a Reference to OBRA;

Effective Date note under section 106 of Title 1, General

Provisions.

EFFECTIVE DATE OF 1987 AMENDMENT

Section 4093(b) of Pub. L. 100-203 provided that: "The amendment

made by subsection (a) [amending this section] shall apply with

respect to determinations made on or after April 1, 1988."

Section 4094(c)(1)(B) of Pub. L. 100-203 provided that: "The

amendments made by subparagraph (A) [amending this section] shall

apply to contracts under part B of title XI of the Social Security

Act [42 U.S.C. 1320c et seq.] entered into or renewed more than 6

months after the date of the enactment of this Act [Dec. 22,

1987]."

Section 4094(c)(2)(C) of Pub. L. 100-203 provided that: "The

amendments made by this paragraph [amending this section] shall

apply with respect to contracts entered into or renewed on or after

the date of enactment of this Act [Dec. 22, 1987]."

Section 4096(d) of Pub. L. 100-203 provided that: "The amendments

made by this section [amending this section and sections 1395u,

1395gg, and 1395pp of this title] shall apply to services furnished

on or after January 1, 1988."

EFFECTIVE DATE OF 1986 AMENDMENTS

Amendment by section 9343(d) of Pub. L. 99-509 applicable to

contracts entered into or renewed after Jan. 1, 1987, see section

9343(h)(4) of Pub. L. 99-509, as amended, set out as a note under

section 1395l of this title.

Section 9351(b) of Pub. L. 99-509 provided that:

"(1) Except as provided in paragraph (2), the amendment made by

subsection (a) [amending this section] shall apply to denial

notices furnished by hospitals to individuals on or after the first

day of the first month that begins more than 30 days after the date

of the enactment of this Act [Oct. 21, 1986].

"(2) Section 1154(e)(4) of the Social Security Act [subsec.

(e)(4) of this section] (as added by the amendment made by

subsection (a)) shall take effect on the date of the enactment of

this Act [Oct. 21, 1986]."

Section 9352(c)(2) of Pub. L. 99-509 provided that: "The

amendment made by subsection (b) [amending this section] shall

apply to contracts entered into or renewed on or after January 1,

1987, except that in applying such amendment before January 1,

1989, the term 'post-hospital services' does not include

physicians' services, other than physicians' services furnished in

a hospital, other inpatient facility, ambulatory surgical center,

or rural health clinic."

Section 9353(a)(6) of Pub. L. 99-509, as amended by Pub. L.

100-203, title IV, Sec. 4039(h)(9)(A), (B), as added Pub. L.

100-360, title IV, Sec. 411(e)(3), July 1, 1988, 102 Stat. 776,

provided that:

"(A)(i) Except as provided in clause (ii), the amendments made by

paragraph (1) [amending this section] shall apply to contracts

entered into or renewed on or after January 1, 1987.

"(ii) The amendment made by paragraph (1) shall not be construed

as requiring, before January 1, 1989, the review of physicians'

services, other than physicians' services furnished in a hospital,

other inpatient facility, ambulatory surgical center, or rural

health clinic.

"(B) The amendments made by paragraphs (2)(B) and (2)(D)

[amending this section] shall apply to contracts as of April 1,

1987.

"(C) The amendment made by paragraph (2)(C) [amending this

section] shall apply to review activities conducted by

organizations on or after January 1, 1988.

"(D) The amendment made by paragraph (3) [amending this section]

becomes effective on the date of the enactment of this Act [Oct.

21, 1986]."

Section 9353(c)(2) of Pub. L. 99-509 provided that: "The

amendment made by paragraph (1) [amending this section] shall apply

to complaints received on or after the first day of the first month

that begins more than 9 months after the date of the enactment of

this Act [Oct. 21, 1986]."

Section 9307(e) of Pub. L. 99-272 provided that: "The amendments

made by this section [amending this section and sections 1395u and

1395y of this title] shall apply to services performed on or after

April 1, 1986."

Section 9401(d) of Pub. L. 99-272 provided that: "The amendments

made by subsection (a) [amending this section] shall apply to items

and services furnished on or after January 1, 1987. The Secretary

of Health and Human Services shall provide for such modification of

contracts under part B of title XI of the Social Security Act [this

part] that are in effect on that date as may be necessary to effect

these amendments on a timely basis."

Section 9403(c) of Pub. L. 99-272 provided that: "The amendments

made by this section [amending this section and section 1395cc of

this title] shall become effective on the date of the enactment of

this Act [Apr. 7, 1986]."

Section 9405(b) of Pub. L. 99-272, as amended by Pub. L. 99-509,

title IX, Sec. 9353(a)(5), Oct. 21, 1986, 100 Stat. 2046, provided

that: "The amendment made by this section [amending this section]

shall apply to items and services furnished on or after April 1,

1987."

EFFECTIVE DATE OF 1983 AMENDMENT

Amendment by Pub. L. 97-448 effective as if originally included

as a part of this section as this section was added by the Tax

Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248, see

section 309(c)(2) of Pub. L. 97-448, set out as a note under

section 426-1 of this title.

STATE REGULATORY PROGRAMS

For provisions relating to changes required to conform State

regulatory programs to amendments by section 171 of Pub. L.

103-432, see section 171(m) of Pub. L. 103-432, set out as a note

under section 1395ss of this title.

REVIEW AND ANALYSIS OF VARIATIONS IN UTILIZATION OF HOSPITAL AND

OTHER HEALTH CARE SERVICES

Section 9353(a)(4) of Pub. L. 99-509 provided that: "The

Secretary of Health and Human Services shall provide, to at least

12 utilization and quality control peer review organizations with

contracts under part B of title XI of the Social Security Act [this

part], data and data processing assistance to allow each of these

organizations to review and analyze small-area variations, in the

service area of the organization, in the utilization of hospital

and other health care services for which payment is made under

title XVIII of such Act [subchapter XVIII of this chapter]."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320c-1, 1320c-2,

1320c-4, 1320c-7, 1320c-9, 1395u, 1395w-22, 1395cc, 1395ff, 1395mm,

1396r-2 of this title.

-FOOTNOTE-

(!1) So in original. The period probably should be a semicolon.

-End-

-CITE-

42 USC Sec. 1320c-4 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-4. Right to hearing and judicial review

-STATUTE-

Any beneficiary who is entitled to benefits under subchapter

XVIII of this chapter, and, subject to section 1320c-3(a)(3)(D) of

this title, any practitioner or provider, who is dissatisfied with

a determination made by a contracting peer review organization in

conducting its review responsibilities under this part, shall be

entitled to a reconsideration of such determination by the

reviewing organization. Where the reconsideration is adverse to the

beneficiary and where the matter in controversy is $200 or more,

such beneficiary shall be entitled to a hearing by the Secretary

(to the same extent as beneficiaries under subchapter II of this

chapter are entitled to a hearing by the Commissioner of Social

Security under section 405(b) of this title). For purposes of the

preceding sentence, subsection (l) of section 405 of this title

shall apply, except that any reference in such subsection to the

Commissioner of Social Security or the Social Security

Administration shall be deemed a reference to the Secretary or the

Department of Health and Human Services, respectively. Where the

amount in controversy is $2,000 or more, such beneficiary shall be

entitled to judicial review of any final decision relating to a

reconsideration described in this subsection.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1155, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 388; amended

Pub. L. 101-239, title VI, Sec. 6224(b)(2), Dec. 19, 1989, 103

Stat. 2257; Pub. L. 103-296, title I, Sec. 108(b)(14), Aug. 15,

1994, 108 Stat. 1485.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c-4, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1155, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1433; amended Oct. 25, 1977, Pub. L. 95-142, Sec.

5(c)(1), (d)(3), (o)(2), (p), 91 Stat. 1184, 1188, 1191, 1192; Dec.

5, 1980, Pub. L. 96-499, title IX, Secs. 924(b)-(d), 925-927(a),

931(g), 94 Stat. 2629, 2630, 2634; Aug. 13, 1981, Pub. L. 97-35,

title XXI, Secs. 2111, 2113(d), 2121(f), 95 Stat. 793, 794, 796,

related to functions and duties of Professional Standards Review

Organizations, prior to the general revision of this part by Pub.

L. 97-248.

AMENDMENTS

1994 - Pub. L. 103-296 substituted "(to the same extent as

beneficiaries under subchapter II of this chapter are entitled to a

hearing by the Commissioner of Social Security under section 405(b)

of this title). For purposes of the preceding sentence, subsection

(l) of section 405 of this title shall apply, except that any

reference in such subsection to the Commissioner of Social Security

or the Social Security Administration shall be deemed a reference

to the Secretary or the Department of Health and Human Services,

respectively. Where the amount in controversy is $2,000 or more,

such beneficiary shall be entitled to judicial review of any final

decision relating to a reconsideration described in this

subsection." for "(to the same extent as is provided in section

405(b) of this title), and, where the amount in controversy is

$2,000 or more, to judicial review of the Secretary's final

decision."

1989 - Pub. L. 101-239 inserted ", subject to section

1320c-3(a)(3)(D) of this title," before "any practitioner or

provider".

EFFECTIVE DATE OF 1994 AMENDMENT

Amendment by Pub. L. 103-296 effective Mar. 31, 1995, see section

110(a) of Pub. L. 103-296, set out as a note under section 401 of

this title.

EFFECTIVE DATE OF 1989 AMENDMENT

Amendment by Pub. L. 101-239 applicable to determinations by

utilization and quality control peer review organizations with

respect to which preliminary notifications were made under section

1320c-3(a)(3)(B) of this title more than 30 days after Dec. 19,

1989, see section 6224(b)(3) of Pub. L. 101-239, set out as a note

under section 1320c-3 of this title.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1320c-3 of this title.

-End-

-CITE-

42 USC Sec. 1320c-5 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-5. Obligations of health care practitioners and

providers of health care services; sanctions and penalties;

hearings and review

-STATUTE-

(a) Assurances regarding services and items ordered or provided by

practitioner or provider

It shall be the obligation of any health care practitioner and

any other person (including a hospital or other health care

facility, organization, or agency) who provides health care

services for which payment may be made (in whole or in part) under

this chapter, to assure, to the extent of his authority that

services or items ordered or provided by such practitioner or

person to beneficiaries and recipients under this chapter -

(1) will be provided economically and only when, and to the

extent, medically necessary;

(2) will be of a quality which meets professionally recognized

standards of health care; and

(3) will be supported by evidence of medical necessity and

quality in such form and fashion and at such time as may

reasonably be required by a reviewing peer review organization in

the exercise of its duties and responsibilities.

(b) Sanctions and penalties; hearings and review

(1) If after reasonable notice and opportunity for discussion

with the practitioner or person concerned, and, if appropriate,

after the practitioner or person has been given a reasonable

opportunity to enter into and complete a corrective action plan

(which may include remedial education) agreed to by the

organization, and has failed successfully to complete such plan,

any organization having a contract with the Secretary under this

part determines that such practitioner or person has -

(A) failed in a substantial number of cases substantially to

comply with any obligation imposed on him under subsection (a) of

this section, or

(B) grossly and flagrantly violated any such obligation in one

or more instances,

such organization shall submit a report and recommendations to the

Secretary. If the Secretary agrees with such determination, the

Secretary (in addition to any other sanction provided under law)

may exclude (permanently or for such period as the Secretary may

prescribe, except that such period may not be less than 1 year)

such practitioner or person from eligibility to provide services

under this chapter on a reimbursable basis. If the Secretary fails

to act upon the recommendations submitted to him by such

organization within 120 days after such submission, such

practitioner or person shall be excluded from eligibility to

provide services on a reimbursable basis until such time as the

Secretary determines otherwise.

(2) A determination made by the Secretary under this subsection

to exclude a practitioner or person shall be effective on the same

date and in the same manner as an exclusion from participation

under the programs under this chapter becomes effective under

section 1320a-7(c) of this title, and shall (subject to the minimum

period specified in the second sentence of paragraph (1)) remain in

effect until the Secretary finds and gives reasonable notice to the

public that the basis for such determination has been removed and

that there is reasonable assurance that it will not recur.

(3) In lieu of the sanction authorized by paragraph (1), the

Secretary may require that (as a condition to the continued

eligibility of such practitioner or person to provide such health

care services on a reimbursable basis) such practitioner or person

pays (!1) to the United States, in case such acts or conduct

involved the provision or ordering by such practitioner or person

of health care services which were medically improper or

unnecessary, an amount not in excess of up to $10,000 for each

instance of the medically improper or unnecessary services so

provided. Such amount may be deducted from any sums owing by the

United States (or any instrumentality thereof) to the practitioner

or person from whom such amount is claimed.

(4) Any practitioner or person furnishing services described in

paragraph (1) who is dissatisfied with a determination made by the

Secretary under this subsection shall be entitled to reasonable

notice and opportunity for a hearing thereon by the Secretary to

the same extent as is provided in section 405(b) of this title, and

to judicial review of the Secretary's final decision after such

hearing as is provided in section 405(g) of this title.

(5) Before the Secretary may effect an exclusion under paragraph

(2) in the case of a provider or practitioner located in a rural

health professional shortage area or in a county with a population

of less than 70,000, the provider or practitioner adversely

affected by the determination is entitled to a hearing before an

administrative law judge (described in section 405(b) of this

title) respecting whether the provider or practitioner should be

able to continue furnishing services to individuals entitled to

benefits under this chapter, pending completion of the

administrative review procedure under paragraph (4). If the judge

does not determine, by a preponderance of the evidence, that the

provider or practitioner will pose a serious risk to such

individuals if permitted to continue furnishing such services, the

Secretary shall not effect the exclusion under paragraph (2) until

the provider or practitioner has been provided reasonable notice

and opportunity for an administrative hearing thereon under

paragraph (4).

(6) When the Secretary effects an exclusion of a physician under

paragraph (2), the Secretary shall notify the State board

responsible for the licensing of the physician of the exclusion.

(c) Enlistment of support of other organizations to assure

practitioner's or provider's compliance with obligations

It shall be the duty of each utilization and quality control peer

review organization to use such authority or influence it may

possess as a professional organization, and to enlist the support

of any other professional or governmental organization having

influence or authority over health care practitioners and any other

person (including a hospital or other health care facility,

organization, or agency) providing health care services in the area

served by such review organization, in assuring that each

practitioner or person (referred to in subsection (a) of this

section) providing health care services in such area shall comply

with all obligations imposed on him under subsection (a) of this

section.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1156, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 388; amended

Pub. L. 100-93, Sec. 6, Aug. 18, 1987, 101 Stat. 691; Pub. L.

100-203, title IV, Sec. 4095(a), Dec. 22, 1987, 101 Stat. 1330-138;

Pub. L. 100-203, title IV, Sec. 4039(h)(5), Dec. 22, 1987, as added

Pub. L. 100-360, title IV, Sec. 411(e)(3), July 1, 1988, 102 Stat.

775; Pub. L. 101-508, title IV, Sec. 4205(a)(1), (d)(2)(A), Nov. 5,

1990, 104 Stat. 1388-112, 1388-114; Pub. L. 101-597, title IV, Sec.

401(c)(1), Nov. 16, 1990, 104 Stat. 3035; Pub. L. 103-432, title I,

Sec. 156(b)(1), Oct. 31, 1994, 108 Stat. 4441; Pub. L. 104-191,

title II, Secs. 214, 231(f), Aug. 21, 1996, 110 Stat. 2005, 2014.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c-5, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1156, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1435, provided for development of norms of health

care services by Professional Standards Review Organizations, prior

to the general revision of this part by Pub. L. 97-248.

AMENDMENTS

1996 - Subsec. (b)(1). Pub. L. 104-191, Sec. 214(b)(2), struck

out in concluding provisions "In determining whether a practitioner

or person has demonstrated an unwillingness or lack of ability

substantially to comply with such obligations, the Secretary shall

consider the practitioner's or person's willingness or lack of

ability, during the period before the organization submits its

report and recommendations, to enter into and successfully complete

a corrective action plan." after "chapter on a reimbursable basis."

Pub. L. 104-191, Sec. 214(b)(1), struck out in concluding

provisions "and determines that such practitioner or person, in

providing health care services over which such organization has

review responsibility and for which payment (in whole or in part)

may be made under this chapter, has demonstrated an unwillingness

or a lack of ability substantially to comply with such

obligations," after "agrees with such determination,".

Pub. L. 104-191, Sec. 214(a)(1), substituted "may prescribe,

except that such period may not be less than 1 year)" for "may

prescribe)" in concluding provisions.

Subsec. (b)(2). Pub. L. 104-191, Sec. 214(a)(2), substituted

"shall (subject to the minimum period specified in the second

sentence of paragraph (1)) remain" for "shall remain".

Subsec. (b)(3). Pub. L. 104-191, Sec. 231(f), substituted "up to

$10,000 for each instance" for "the actual or estimated cost".

1994 - Subsec. (b)(1). Pub. L. 103-432 substituted "whether" for

"whehter" in third sentence.

1990 - Subsec. (b)(1). Pub. L. 101-508, Sec. 4205(a)(1), inserted

"and, if appropriate, after the practitioner or person has been

given a reasonable opportunity to enter into and complete a

corrective action plan (which may include remedial education)

agreed to by the organization, and has failed successfully to

complete such plan," after "concerned," in introductory provisions

and inserted after second sentence "In determining whehter [sic] a

practitioner or person has demonstrated an unwillingness or lack of

ability substantially to comply with such obligations, the

Secretary shall consider the practitioner's or person's willingness

or lack of ability, during the period before the organization

submits its report and recommendations, to enter into and

successfully complete a corrective action plan."

Subsec. (b)(5). Pub. L. 101-597 substituted "health professional

shortage area" for "health manpower shortage area (HMSA)".

Subsec. (b)(6). Pub. L. 101-508, Sec. 4205(d)(2)(A), added par.

(6).

1988 - Subsec. (b). Pub. L. 100-360 added Pub. L. 100-203, Sec.

4039(h)(5), see 1987 Amendment notes below.

1987 - Subsec. (a). Pub. L. 100-93, Sec. 6(1), substituted "this

chapter" for "subchapter XVIII of this chapter" and "this

subchapter".

Subsec. (b)(1). Pub. L. 100-203, Sec. 4039(h)(5)(A), as added by

Pub. L. 100-360, substituted "services under this chapter" for

"such services".

Pub. L. 100-93, Sec. 6(2), substituted "this chapter" for

"subchapter XVIII of this chapter".

Subsec. (b)(2). Pub. L. 100-203, Sec. 4039(h)(5)(B), as added by

Pub. L. 100-360, substituted "on the same date and in the same

manner as an exclusion from participation under the programs under

this chapter becomes effective under section 1320a-7(c) of this

title" for "at such time and upon such reasonable notice to the

public and to the practitioner or person furnishing the services

involved as may be specified in regulations. Such determination

shall be effective with respect to services furnished to an

individual on or after the effective date of such determination

(except that in the case of institutional health care services such

determination shall be effective in the manner provided in this

chapter with respect to terminations of provider agreements)".

Pub. L. 100-93, Sec. 6(2), substituted "this chapter" for

"subchapter XVIII of this chapter".

Subsec. (b)(5). Pub. L. 100-203 added par. (5).

EFFECTIVE DATE OF 1996 AMENDMENT

Amendment by section 214 of Pub. L. 104-191 effective Jan. 1,

1997, except as otherwise provided, see section 218 of Pub. L.

104-191, set out as a note under section 1320a-7 of this title.

Amendment by section 231(f) of Pub. L. 104-191 applicable to acts

or omissions occurring on or after Jan. 1, 1997, see section 231(i)

of Pub. L. 104-191, set out as a note under section 1320a-7a of

this title.

EFFECTIVE DATE OF 1994 AMENDMENT

Amendment by Pub. L. 103-432 effective as if included in the

enactment of Pub. L. 101-508, see section 156(b)(6)(A) of Pub. L.

103-432, set out as a note under section 1320c-9 of this title.

EFFECTIVE DATE OF 1990 AMENDMENT

Section 4205(a)(2) of Pub. L. 101-508 provided that: "The

amendments made by paragraph (1) [amending this section] shall

apply to initial determinations made by organizations on or after

the date of the enactment of this Act [Nov. 5, 1990]."

Section 4205(d)(2)(B) of Pub. L. 101-508, as amended by Pub. L.

103-432, title I, Sec. 156(b)(3), Oct. 31, 1994, 108 Stat. 4441,

provided that: "The amendment made by this paragraph [amending this

section] shall apply to sanctions effected more than 60 days after

the date of the enactment of this Act [Nov. 5, 1990]."

EFFECTIVE DATE OF 1988 AMENDMENT

Except as specifically provided in section 411 of Pub. L.

100-360, amendment by Pub. L. 100-360, as it relates to a provision

in the Omnibus Budget Reconciliation Act of 1987, Pub. L. 100-203,

effective as if included in the enactment of that provision in Pub.

L. 100-203, see section 411(a) of Pub. L. 100-360, set out as a

Reference to OBRA; Effective Date note under section 106 of Title

1, General Provisions.

EFFECTIVE DATE OF 1987 AMENDMENTS

Section 4095(b) of Pub. L. 100-203 provided that: "The amendment

made by subsection (a) [amending this section] shall apply to

determinations made by the Secretary of Health and Human Services

under section 1156(b) of the Social Security Act [subsec. (b) of

this section] on or after the date of the enactment of this Act

[Dec. 22, 1987]."

Amendment by Pub. L. 100-93 effective at end of fourteen-day

period beginning Aug. 18, 1987, and inapplicable to administrative

proceedings commenced before end of such period, see section 15(a)

of Pub. L. 100-93, set out as a note under section 1320a-7 of this

title.

TELECOMMUNICATIONS DEMONSTRATION PROJECTS

Section 4094(e) of Pub. L. 100-203, as amended by Pub. L.

100-360, title IV, Sec. 411(j)(3)(C), as added by Pub. L. 100-485,

title VI, Sec. 608(d)(25)(A), Oct. 13, 1988, 102 Stat. 2421,

provided that: "The Secretary of Health and Human Services shall

enter into agreements with entities submitting applications under

this subsection (in such form as the Secretary may provide) to

establish demonstration projects to examine the feasibility of

requiring instruction and oversight of rural physicians, in lieu of

imposing sanctions, through use of video communication between

rural hospitals and teaching hospitals under this title [probably

means title XI of the Social Security Act which is classified to

this subchapter]. Under such demonstration projects, the Secretary

may provide for payments to physicians consulted via video

communication systems. No funds may be expended under the

demonstration projects for the acquisition of capital items

including computer hardware."

PREEXCLUSION HEARINGS; TRANSITION FOR CURRENT CASES AND

REDETERMINATION IN CERTAIN CASES

Section 4095(c), (d) of Pub. L. 100-203 provided that:

"(c) Transition for Current Cases. - In the case of a

practitioner or person -

"(1) for whom a notice of determination under section 1156(b)

of the Social Security Act [subsec. (b) of this section] has been

provided within 365 days before the date of the enactment of this

Act [Dec. 22, 1987],

"(2) who has not exhausted the administrative remedies

available under section 1156(b)(4) of such Act for review of the

determination, and

"(3) who requests, within 90 days after the date of the

enactment of this Act, a hearing established under this

subsection,

the Secretary of Health and Human Services shall provide for a

hearing described in section 1156(b)(5) of the Social Security Act

(as amended by subsection (a) of this section).

"(d) Redeterminations in Certain Cases. - If, in hearing under

subsection (c), the judge does not determine, by a preponderance of

the evidence, that the provider or practitioner will pose a serious

risk to individuals entitled to benefits under title XVIII of the

Social Security Act [subchapter XVIII of this chapter] if permitted

to continue or resume furnishing such services, the Secretary shall

not effect the exclusion (or shall suspend the exclusion, if

previously effected) under paragraph (2) of section 1156(b) of such

Act [subsec. (b) of this section] until the provider or

practitioner has been provided an administrative hearing thereon

under paragraph (4) of such section, notwithstanding any failure by

the provider or practitioner to request the hearing on a timely

basis."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 704, 1320a-7, 1320a-7a,

1320c-3, 1320c-9, 1395y, 1396b, 1397d of this title.

-FOOTNOTE-

(!1) So in original. Probably should be "pay".

-End-

-CITE-

42 USC Sec. 1320c-6 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-6. Limitation on liability

-STATUTE-

(a) Providers of information to organizations having a contract

with Secretary

Notwithstanding any other provision of law, no person providing

information to any organization having a contract with the

Secretary under this part shall be held, by reason of having

provided such information, to have violated any criminal law, or to

be civilly liable under any law of the United States or of any

State (or political subdivision thereof) unless -

(1) such information is unrelated to the performance of the

contract of such organization; or

(2) such information is false and the person providing it knew,

or had reason to believe, that such information was false.

(b) Employees and fiduciaries of organizations having contracts

with Secretary

No organization having a contract with the Secretary under this

part and no person who is employed by, or who has a fiduciary

relationship with, any such organization or who furnishes

professional services to such organization, shall be held by reason

of the performance of any duty, function, or activity required or

authorized pursuant to this part or to a valid contract entered

into under this part, to have violated any criminal law, or to be

civilly liable under any law of the United States or of any State

(or political subdivision thereof) provided due care was exercised

in the performance of such duty, function, or activity.

(c) Physicians and providers

No doctor of medicine or osteopathy and no provider (including

directors, trustees, employees, or officials thereof) of health

care services shall be civilly liable to any person under any law

of the United States or of any State (or political subdivision

thereof) on account of any action taken by him in compliance with

or reliance upon professionally developed norms of care and

treatment applied by an organization under contract pursuant to

section 1320c-2 of this title operating in the area where such

doctor of medicine or osteopathy or provider took such action; but

only if -

(1) he takes such action in the exercise of his profession as a

doctor of medicine or osteopathy or in the exercise of his

functions as a provider of health care services; and

(2) he exercised due care in all professional conduct taken or

directed by him and reasonably related to, and resulting from,

the actions taken in compliance with or reliance upon such

professionally accepted norms of care and treatment.

(d) Reimbursement by Secretary for expenses incurred in defense of

legal proceedings

The Secretary shall make payment to an organization under

contract with him pursuant to this part, or to any member or

employee thereof, or to any person who furnishes legal counsel or

services to such organization, in an amount equal to the reasonable

amount of the expenses incurred, as determined by the Secretary, in

connection with the defense of any suit, action, or proceeding

brought against such organization, member, or employee related to

the performance of any duty or function under such contract by such

organization, member, or employee.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1157, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 389; amended

Pub. L. 101-508, title IV, Sec. 4205(f), Nov. 5, 1990, 104 Stat.

1388-114.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c-6, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1157, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1437; amended Oct. 25, 1977, Pub. L. 95-142, Sec.

13(b)(4), 91 Stat. 1198, related to submission of reports by

Professional Standards Review Organizations, prior to the general

revision of this part by Pub. L. 97-248.

AMENDMENTS

1990 - Subsec. (b). Pub. L. 101-508 inserted "organization having

a contract with the Secretary under this part and no" after "No",

struck out "by him" after "the performance", and substituted "due

care was exercised in the performance of such duty, function, or

activity" for "he has exercised due care".

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320a-7c, 1320c-9,

1395cc-2, 1395rr, 1395ddd of this title.

-End-

-CITE-

42 USC Sec. 1320c-7 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-7. Application of this part to certain State programs

receiving Federal financial assistance

-STATUTE-

(a) State plan provision that functions of peer review

organizations may be performed by contract with such organization

A State plan approved under subchapter XIX of this chapter may

provide that the functions specified in section 1320c-3 of this

title may be performed in an area by contract with a utilization

and quality control peer review organization that has entered into

a contract with the Secretary in accordance with the provisions of

section 1395y(g) of this title.

(b) Federal share of expenditures

In the event a State enters into a contract in accordance with

subsection (a) of this section, the Federal share of the

expenditures made to the contracting organization for its costs in

the performance of its functions under the State plan shall be 75

percent (as provided in section 1396b(a)(3)(C) of this title).

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1158, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 390.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c-7, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1158, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1437; amended Oct. 25, 1977, Pub. L. 95-142,

Secs. 5(d)(1), 22(a), 91 Stat. 1185, 1208; Dec. 5, 1980, Pub. L.

96-499, title IX, Secs. 902(a)(3), 931(h), 94 Stat. 2613, 2634;

Aug. 13, 1981, Pub. L. 97-35, title XXI, Secs. 2113(e), 2121(g), 95

Stat. 794, 796, related to review approval as a condition of

payment of claims, prior to the general revision of this part by

Pub. L. 97-248.

-End-

-CITE-

42 USC Sec. 1320c-8 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-8. Authorization for use of certain funds to administer

provisions of this part

-STATUTE-

Expenses incurred in the administration of the contracts

described in section 1395y(g) of this title shall be payable from -

(1) funds in the Federal Hospital Insurance Trust Fund; and

(2) funds in the Federal Supplementary Medical Insurance Trust

Fund,

in such amounts from each of such Trust Funds as the Secretary

shall deem to be fair and equitable after taking into consideration

the expenses attributable to the administration of this part with

respect to each of such programs. The Secretary shall make such

transfers of moneys between such Trust Funds as may be appropriate

to settle accounts between them in cases where expenses properly

payable from one such Trust Fund have been paid from the other such

Trust Fund.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1159, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 390.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c-8, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1159, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1437; amended Aug. 13, 1981, Pub. L. 97-35, title

XXI, Sec. 2113(f), 95 Stat. 795, related to reconsideration hearing

and review, prior to the general revision of this part by Pub. L.

97-248.

-End-

-CITE-

42 USC Sec. 1320c-9 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-9. Prohibition against disclosure of information

-STATUTE-

(a) Freedom of Information Act inapplicable; exceptions to

nondisclosure

An organization, in carrying out its functions under a contract

entered into under this part, shall not be a Federal agency for

purposes of the provisions of section 552 of title 5 (commonly

referred to as the Freedom of Information Act). Any data or

information acquired by any such organization in the exercise of

its duties and functions shall be held in confidence and shall not

be disclosed to any person except -

(1) to the extent that may be necessary to carry out the

purposes of this part,

(2) in such cases and under such circumstances as the Secretary

shall by regulations provide to assure adequate protection of the

rights and interests of patients, health care practitioners, or

providers of health care, or

(3) in accordance with subsection (b) of this section.

(b) Disclosure of information permitted

An organization having a contract with the Secretary under this

part shall provide in accordance with procedures and safeguards

established by the Secretary, data and information -

(1) which may identify specific providers or practitioners as

may be necessary -

(A) to assist Federal and State agencies recognized by the

Secretary as having responsibility for identifying and

investigating cases or patterns of fraud or abuse, which data

and information shall be provided by the peer review

organization to any such agency at the request of such agency

relating to a specific case or pattern;

(B) to assist appropriate Federal and State agencies

recognized by the Secretary as having responsibility for

identifying cases or patterns involving risks to the public

health, which data and information shall be provided by the

peer review organization to any such agency -

(i) at the discretion of the peer review organization, at

the request of such agency relating to a specific case or

pattern with respect to which such agency has made a finding,

or has a reasonable belief, that there may be a substantial

risk to the public health, or

(ii) upon a finding by, or the reasonable belief of, the

peer review organization that there may be a substantial risk

to the public health;

(C) to assist appropriate State agencies recognized by the

Secretary as having responsibility for licensing or

certification of providers or practitioners or to assist

national accreditation bodies acting pursuant to section 1395bb

of this title in accrediting providers for purposes of meeting

the conditions described in subchapter XVIII of this chapter,

which data and information shall be provided by the peer review

organization to any such agency or body at the request of such

agency or body relating to a specific case or to a possible

pattern of substandard care, but only to the extent that such

data and information are required by the agency or body to

carry out its respective function which is within the

jurisdiction of the agency or body under State law or under

section 1395bb of this title; and

(D) to provide notice in accordance with section

1320c-3(a)(9)(B) of this title;

(2) to assist the Secretary, and such Federal and State

agencies recognized by the Secretary as having health planning or

related responsibilities under Federal or State law (including

health systems agencies and State health planning and development

agencies), in carrying out appropriate health care planning and

related activities, which data and information shall be provided

in such format and manner as may be prescribed by the Secretary

or agreed upon by the responsible Federal and State agencies and

such organization, and shall be in the form of aggregate

statistical data (without explicitly identifying any individual)

on a geographic, institutional, or other basis reflecting the

volume and frequency of services furnished, as well as the

demographic characteristics of the population subject to review

by such organization.

The penalty provided in subsection (c) of this section shall not

apply to the disclosure of any information received under this

subsection, except that such penalty shall apply to the disclosure

(by the agency receiving such information) of any such information

described in paragraph (1) unless such disclosure is made in a

judicial, administrative, or other formal legal proceeding

resulting from an investigation conducted by the agency receiving

the information. An organization may require payment of a

reasonable fee for providing information under this subsection in

response to a request for such information.

(c) Penalties

It shall be unlawful for any person to disclose any such

information described in subsection (a) of this section other than

for the purposes provided in subsections (a) and (b) of this

section, and any person violating the provisions of this section

shall, upon conviction, be fined not more than $1,000, and

imprisoned for not more than 6 months, or both, and shall be

required to pay the costs of prosecution.

(d) Subpoena and discovery proceedings regarding patient records

No patient record in the possession of an organization having a

contract with the Secretary under this part shall be subject to

subpoena or discovery proceedings in a civil action. No document or

other information produced by such an organization in connection

with its deliberations in making determinations under section

1320c-3(a)(1)(B) or 1320c-5(a)(2) of this title shall be subject to

subpoena or discovery in any administrative or civil proceeding;

except that such an organization shall provide, upon request of a

practitioner or other person adversely affected by such a

determination, a summary of the organization's findings and

conclusions in making the determination.

(e) Organizations with contracts

For purposes of this section and section 1320c-6 of this title,

the term "organization with a contract with the Secretary under

this part" includes an entity with a contract with the Secretary

under section 1320c-3(a)(4)(C) of this title.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1160, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 391; amended

Pub. L. 99-509, title IX, Sec. 9353(d)(1), Oct. 21, 1986, 100 Stat.

2047; Pub. L. 100-203, title IV, Sec. 4039(h)(6), Dec. 22, 1987, as

added Pub. L. 100-360, title IV, Sec. 411(e)(3), July 1, 1988, 102

Stat. 776; Pub. L. 101-508, title IV, Sec. 4205(d)(1)(B), (e)(1),

Nov. 5, 1990, 104 Stat. 1388-113, 1388-114; Pub. L. 103-432, title

I, Sec. 156(b)(2)(B), (4), Oct. 31, 1994, 108 Stat. 4441.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c-9, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1160, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1438; amended Oct. 25, 1977, Pub. L. 95-142, Sec.

5(e), (o)(3), 91 Stat. 1189, 1191; Aug. 13, 1981, Pub. L. 97-35,

title XXI, Sec. 2113(g), 95 Stat. 795, enumerated obligations of

health care practitioners and providers of health care services,

prior to the general revision of this part by Pub. L. 97-248.

AMENDMENTS

1994 - Subsec. (b)(1)(D). Pub. L. 103-432, Sec. 156(b)(2)(B),

amended subpar. (D) generally. Prior to amendment, subpar. (D) read

as follows: "to provide notice to the State medical board in

accordance with section 1320c-3(a)(9)(B) of this title when the

organization submits a report and recommendations to the Secretary

under section 1320c-5(b)(1) of this title with respect to a

physician whom the board is responsible for licensing;".

Subsec. (d). Pub. L. 103-432, Sec. 156(b)(4), which directed

amendment of subsec. (d) by substituting "subpoena" for "subpena",

was executed by making the substitution in two places to reflect

the probable intent of Congress.

1990 - Subsec. (b)(1)(D). Pub. L. 101-508, Sec. 4205(d)(1)(B),

added subpar. (D).

Subsec. (d). Pub. L. 101-508, Sec. 4205(e)(1), inserted at end

"No document or other information produced by such an organization

in connection with its deliberations in making determinations under

section 1320c-3(a)(1)(B) or 1320c-5(a)(2) of this title shall be

subject to subpena or discovery in any administrative or civil

proceeding; except that such an organization shall provide, upon

request of a practitioner or other person adversely affected by

such a determination, a summary of the organization's findings and

conclusions in making the determination."

1988 - Subsec. (e). Pub. L. 100-360 added Pub. L. 100-203, Sec.

4039(h)(6), see 1987 Amendment note below.

1987 - Subsec. (e). Pub. L. 100-203, Sec. 4039(h)(6), as added by

Pub. L. 100-360, added subsec. (e).

1986 - Subsec. (b)(1)(C). Pub. L. 99-509 amended subpar. (C)

generally. Prior to amendment, subpar. (C) read as follows: "to

assist appropriate State agencies recognized by the Secretary as

having responsibility for licensing or certification of providers

or practitioners, which data and information shall be provided by

the peer review organization to any such agency at the request of

such agency relating to a specific case, but only to the extent

that such data and information is required by the agency in

carrying out a function which is within the jurisdiction of such

agency under State law; and".

EFFECTIVE DATE OF 1994 AMENDMENT

Section 156(b)(6) of Pub. L. 103-432 provided that:

"(A) Except as provided in subparagraph (B), the amendments made

by this subsection [amending this section, sections 1320c-3 and

1320c-5 of this title, and provisions set out as notes under this

section and section 1320c-5 of this title] shall take effect as if

included in the enactment of OBRA-1990 [Pub. L. 101-508].

"(B) The amendments made by paragraph (2) [amending this section

and section 1320c-3 of this title] (relating to the requirement on

reporting of information to State boards) shall take effect on the

date of the enactment of this Act [Oct. 31, 1994]."

EFFECTIVE DATE OF 1990 AMENDMENT

Amendment by section 4205(d)(1)(B) of Pub. L. 101-508 applicable

to notices of proposed sanctions issued more than 60 days after

Nov. 5, 1990, see section 4205(d)(1)(C) of Pub. L. 101-508, set out

as a note under section 1320c-3 of this title.

Section 4205(e)(2) of Pub. L. 101-508, as amended by Pub. L.

103-432, title I, Sec. 156(b)(5), Oct. 31, 1994, 108 Stat. 4441,

provided that: "The amendment made by paragraph (1) [amending this

section] shall apply to proceedings as of the date of the enactment

of this Act [Nov. 5, 1990]."

EFFECTIVE DATE OF 1988 AMENDMENT

Except as specifically provided in section 411 of Pub. L.

100-360, amendment by Pub. L. 100-360, as it relates to a provision

in the Omnibus Budget Reconciliation Act of 1987, Pub. L. 100-203,

effective as if included in the enactment of that provision in Pub.

L. 100-203, see section 411(a) of Pub. L. 100-360, set out as a

Reference to OBRA; Effective Date note under section 106 of Title

1, General Provisions.

EFFECTIVE DATE OF 1986 AMENDMENT

Section 9353(d)(2) of Pub. L. 99-509 provided that: "The

amendments made by paragraph (1) [amending this section] shall

apply to requests for data and information made on and after the

end of the 6-month period beginning on the date of the enactment of

this Act [Oct. 21, 1986]."

FREEDOM OF INFORMATION ACT REQUEST

Pub. L. 96-499, title IX, Sec. 928, Dec. 5, 1980, 94 Stat. 2630,

provided that: "No Professional Standards Review Organization

designated (conditionally or otherwise) under part B of title XI of

the Social Security Act [this part] shall be required to make

available any records pursuant to a request made under section 552

of title 5, United States Code, until the later of (1) one year

after the date of entry of a final court order requiring that such

records be made available, or (2) the last date of the Congress

during which the court order was entered."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320c-3, 1395y, 1395rr of

this title.

-End-

-CITE-

42 USC Sec. 1320c-10 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-10. Annual reports

-STATUTE-

The Secretary shall submit to the Congress not later than April 1

of each year, a full and complete report on the administration,

impact, and cost of the program under this part during the

preceding fiscal year, including data and information on -

(1) the number, status, and service areas of all utilization

and quality control peer review organizations participating in

the program;

(2) the number of health care institutions and practitioners

whose services are subject to review by such organizations, and

the number of beneficiaries and recipients who received services

subject to such review during such year;

(3) the various methods of reimbursement utilized in contracts

under this part, and the relative efficiency of each such method

of reimbursement;

(4) the imposition of penalties and sanctions under this title

for violations of law and for failure to comply with the

obligations imposed by this part;

(5) the total costs incurred under subchapters XVIII and XIX of

this chapter in the implementation and operation of all

procedures required by such subchapters for the review of

services to determine their medical necessity, appropriateness of

use, and quality; and

(6) descriptions of the criteria upon which decisions are made,

and the selection and relative weights of such criteria.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1161, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 392.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c-10, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1161, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1440, related to giving of notice to a

practitioner or provider by a Professional Standards Review

Organization immediately after taking certain action or making

certain determinations, prior to the general revision of this part

by Pub. L. 97-248.

PERFORMANCE OF PROFESSIONAL STANDARDS REVIEW ORGANIZATIONS; REPORT

TO CONGRESS

Pub. L. 97-35, title XXI, Sec. 2112(a)(2)(D), Aug. 13, 1981, 95

Stat. 793, provided that the Secretary of Health and Human

Services, not later than September 30, 1982, was to report to the

Congress on his assessment (under former section 1320c-3(g) of this

title) of the relative performance of Professional Standards Review

Organizations and on any determinations made not to renew

agreements with such Organizations on the basis of such

performance.

-End-

-CITE-

42 USC Sec. 1320c-11 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-11. Exemptions for religious nonmedical health care

institutions

-STATUTE-

The provisions of this part shall not apply with respect to a

religious nonmedical health care institution (as defined in section

1395x(ss)(1) of this title).

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1162, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 393; amended

Pub. L. 105-33, title IV, Sec. 4454(c)(2), Aug. 5, 1997, 111 Stat.

431.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c-11, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1162, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1440; amended Dec. 5, 1980, Pub. L. 96-499, title

IX, Secs. 922(a), 927(b), 94 Stat. 2628, 2630; Aug. 13, 1981,

97-35, title XXI, Sec. 2113(h), 95 Stat. 795, related to Statewide

Professional Standards Review Councils, prior to the general

revision of this part by Pub. L. 97-248.

AMENDMENTS

1997 - Pub. L. 105-33 substituted "Exemptions for religious

nonmedical health care institutions" for "Exemptions of Christian

Science sanatoriums" in section catchline and substituted

"religious nonmedical health care institution (as defined in

section 1395x(ss)(1) of this title)" for "Christian Science

sanatorium operated, or listed and certified, by the First Church

of Christ, Scientist, Boston, Massachusetts" in text.

EFFECTIVE DATE OF 1997 AMENDMENT

Amendment by Pub. L. 105-33 effective Aug. 5, 1997, and

applicable to items and services furnished on or after such date,

with provision that Secretary of Health and Human Services issue

regulations to carry out such amendment by not later than July 1,

1998, see section 4454(d) of Pub. L. 105-33, set out as an

Effective Date note under section 1395i-5 of this title.

-End-

-CITE-

42 USC Sec. 1320c-12 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-12. Medical officers in American Samoa, Northern Mariana

Islands, and Trust Territory of Pacific Islands to be included in

utilization and quality control peer review program

-STATUTE-

For purposes of applying this part to American Samoa, the

Northern Mariana Islands, and the Trust Territory of the Pacific

Islands, individuals licensed to practice medicine in those places

shall be considered to be physicians and doctors of medicine.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1163, as added Pub. L.

97-248, title I, Sec. 143, Sept. 3, 1982, 96 Stat. 393.)

-MISC1-

PRIOR PROVISIONS

A prior section 1320c-12, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1163, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1441; amended Oct. 25, 1977, Pub. L. 95-142, Sec.

5(f), (g), 91 Stat. 1189; Dec. 5, 1980, Pub. L. 96-499, title IX,

Sec. 923(a)-(d), 94 Stat. 2628, related to establishment and

membership of the National Professional Standards Review Council,

prior to the general revision of this part by Pub. L. 97-248.

-TRANS-

TERMINATION OF TRUST TERRITORY OF THE PACIFIC ISLANDS

For termination of Trust Territory of the Pacific Islands, see

note set out preceding section 1681 of Title 48, Territories and

Insular Possessions.

-End-

-CITE-

42 USC Sec. 1320c-13 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-13. Repealed. Pub. L. 103-432, title I, Sec. 156(a)(1),

Oct. 31, 1994, 108 Stat. 4440

-MISC1-

Section, act Aug. 14, 1935, ch. 531, title XI, Sec. 1164, as

added Apr. 7, 1986, Pub. L. 99-272, title IX, Sec. 9401(b), 100

Stat. 196; amended Oct. 22, 1986, Pub. L. 99-514, title XVIII, Sec.

1895(b)(17), 100 Stat. 2934; Dec. 19, 1989, Pub. L. 101-239, title

VI, Sec. 6003(g)(3)(D)(v), 103 Stat. 2153, related to 100 percent

peer review for certain surgical procedures.

EFFECTIVE DATE OF REPEAL

Repeal applicable to services provided on or after Oct. 31, 1994,

see section 156(a)(3) of Pub. L. 103-432, set out as an Effective

Date of 1994 Amendment note under section 1320c-3 of this title.

-End-

-CITE-

42 USC Secs. 1320c-14 to 1320c-19 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Secs. 1320c-14 to 1320c-19. Omitted

-COD-

CODIFICATION

Sections 1320c-14 to 1320c-19 were omitted in the general

revision of this part by Pub. L. 97-248, title I, Sec. 143, Sept.

3, 1982, 96 Stat. 382.

Section 1320c-14, act Aug. 14, 1935, ch. 531, title XI, Sec.

1165, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1443, related to correlation of functions between

Professional Standards Review Organizations and administrative

instrumentalities.

Section 1320c-15, act Aug. 14, 1935, ch. 531, title XI, Sec.

1166, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1443; amended Oct. 25, 1977, Pub. L. 95-142, Sec.

5(h), 91 Stat. 1189, related to general prohibition against

disclosure of data or information and exceptions to such

prohibition. See section 1320c-9 of this title.

Section 1320c-16, act Aug. 14, 1935, ch. 531, title XI, Sec.

1167, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1443; amended Oct. 25, 1977, Pub. L. 95-142, Sec.

5(i), (n), 91 Stat. 1190, 1191, related to limitation of liability

of persons providing information to Professional Standards Review

Organizations and Statewide Professional Standards Review Councils.

See section 1320c-6 of this title.

Section 1320c-17, act Aug. 14, 1935, ch. 531, title XI, Sec.

1168, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1444; amended Dec. 31, 1975, Pub. L. 94-182,

title I, Sec. 112(c), 89 Stat. 1055; Oct. 25, 1977, Pub. L. 95-142,

Sec. 5(j), 91 Stat. 1190; Aug. 13, 1981, Pub. L. 97-35, title XXI,

Sec. 2113(j), 95 Stat. 795, related to authorization for use of

funds for administering professional review program, transfer of

moneys between funds, and payments for Professional Standards

Review Organizations. See section 1320c-8 of this title.

Section 1320c-18, act Aug. 14, 1935, ch. 531, title XI, Sec.

1169, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1444, related to technical assistance given to

organizations desiring to be designated as Professional Standards

Review Organizations.

Section 1320c-19, act Aug. 14, 1935, ch. 531, title XI, Sec.

1170, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

249F(b), 86 Stat. 1445, related to exemptions of Christian Science

sanatoriums. See section 1320c-11 of this title.

-End-

-CITE-

42 USC Sec. 1320c-20 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Sec. 1320c-20. Repealed. Pub. L. 97-35, title XXI, Sec. 2113(k),

Aug. 13, 1981, 95 Stat. 795

-MISC1-

Section, act Aug. 14, 1935, ch. 531, title XI, Sec. 1171, as

added Oct. 25, 1977, Pub. L. 95-142, Sec. 5(d)(2)(D), 91 Stat.

1186, set forth provisions respecting Federal-State relations

regarding memorandum of understanding between Organization and

State agency.

EFFECTIVE DATE OF REPEAL

Repeal applicable to agreements with Professional Standards

Review Organizations entered into on or after Oct. 1, 1981, see

section 2113(o) of Pub. L. 97-35, set out as an Effective Date of

1981 Amendment note under section 1396a of this title.

-End-

-CITE-

42 USC Secs. 1320c-21, 1320c-22 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part B - Peer Review of Utilization and Quality of Health Care

Services

-HEAD-

Secs. 1320c-21, 1320c-22. Omitted

-COD-

CODIFICATION

Sections 1320c-21 and 1320c-22 were omitted in the general

revision of this part by Pub. L. 97-248, title I, Sec. 143, Sept.

3, 1982, 96 Stat. 382.

Section 1320c-21, act Aug. 14, 1935, ch. 531, title XI, Sec.

1172, as added Oct. 25, 1977, Pub. L. 95-142, Sec. 5(k), 91 Stat.

1190; amended Aug. 13, 1981, Pub. L. 97-35, title XXI, Secs.

2113(l), 2193(c)(7), 95 Stat. 795, 827, related to annual reports

submitted to Congress by Secretary. See section 1320c-10 of this

title.

Section 1320c-22, act Aug. 14, 1935, ch. 531, title XI, Sec.

1173, as added Oct. 25, 1977, Pub. L. 95-142, Sec. 5(l)(1), 91

Stat. 1191; amended Dec. 5, 1980, Pub. L. 96-499, title IX, Sec.

923(e), 94 Stat. 2628, provided that medical officers in American

Samoa, the Northern Mariana Islands, and the Trust Territory of the

Pacific Islands were includable in program under former Part B. See

section 1320c-12 of this title.

-End-

-CITE-

42 USC Part C - Administrative Simplification 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part C - Administrative Simplification

-HEAD-

PART C - ADMINISTRATIVE SIMPLIFICATION

-SECREF-

PART REFERRED TO IN OTHER SECTIONS

This part is referred to in sections 242k, 299c-2, 1395cc, 1396b

of this title.

-End-

-CITE-

42 USC Sec. 1320d 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part C - Administrative Simplification

-HEAD-

Sec. 1320d. Definitions

-STATUTE-

For purposes of this part:

(1) Code set

The term "code set" means any set of codes used for encoding

data elements, such as tables of terms, medical concepts, medical

diagnostic codes, or medical procedure codes.

(2) Health care clearinghouse

The term "health care clearinghouse" means a public or private

entity that processes or facilitates the processing of

nonstandard data elements of health information into standard

data elements.

(3) Health care provider

The term "health care provider" includes a provider of services

(as defined in section 1395x(u) of this title), a provider of

medical or other health services (as defined in section 1395x(s)

of this title), and any other person furnishing health care

services or supplies.

(4) Health information

The term "health information" means any information, whether

oral or recorded in any form or medium, that -

(A) is created or received by a health care provider, health

plan, public health authority, employer, life insurer, school

or university, or health care clearinghouse; and

(B) relates to the past, present, or future physical or

mental health or condition of an individual, the provision of

health care to an individual, or the past, present, or future

payment for the provision of health care to an individual.

(5) Health plan

The term "health plan" means an individual or group plan that

provides, or pays the cost of, medical care (as such term is

defined in section 300gg-91 of this title). Such term includes

the following, and any combination thereof:

(A) A group health plan (as defined in section 300gg-91(a) of

this title), but only if the plan -

(i) has 50 or more participants (as defined in section

1002(7) of title 29); or

(ii) is administered by an entity other than the employer

who established and maintains the plan.

(B) A health insurance issuer (as defined in section

300gg-91(b) of this title).

(C) A health maintenance organization (as defined in section

300gg-91(b) of this title).

(D) Parts (!1) A, B, or C of the Medicare program under

subchapter XVIII of this chapter.

(E) The medicaid program under subchapter XIX of this

chapter.

(F) A Medicare supplemental policy (as defined in section

1395ss(g)(1) of this title).

(G) A long-term care policy, including a nursing home fixed

indemnity policy (unless the Secretary determines that such a

policy does not provide sufficiently comprehensive coverage of

a benefit so that the policy should be treated as a health

plan).

(H) An employee welfare benefit plan or any other arrangement

which is established or maintained for the purpose of offering

or providing health benefits to the employees of 2 or more

employers.

(I) The health care program for active military personnel

under title 10.

(J) The veterans health care program under chapter 17 of

title 38.

(K) The Civilian Health and Medical Program of the Uniformed

Services (CHAMPUS), as defined in section 1072(4) of title 10.

(L) The Indian health service program under the Indian Health

Care Improvement Act (25 U.S.C. 1601 et seq.).

(M) The Federal Employees Health Benefit Plan under chapter

89 of title 5.

(6) Individually identifiable health information

The term "individually identifiable health information" means

any information, including demographic information collected from

an individual, that -

(A) is created or received by a health care provider, health

plan, employer, or health care clearinghouse; and

(B) relates to the past, present, or future physical or

mental health or condition of an individual, the provision of

health care to an individual, or the past, present, or future

payment for the provision of health care to an individual, and

-

(i) identifies the individual; or

(ii) with respect to which there is a reasonable basis to

believe that the information can be used to identify the

individual.

(7) Standard

The term "standard", when used with reference to a data element

of health information or a transaction referred to in section

1320d-2(a)(1) of this title, means any such data element or

transaction that meets each of the standards and implementation

specifications adopted or established by the Secretary with

respect to the data element or transaction under sections 1320d-1

through 1320d-3 of this title.

(8) Standard setting organization

The term "standard setting organization" means a standard

setting organization accredited by the American National

Standards Institute, including the National Council for

Prescription Drug Programs, that develops standards for

information transactions, data elements, or any other standard

that is necessary to, or will facilitate, the implementation of

this part.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1171, as added Pub. L.

104-191, title II, Sec. 262(a), Aug. 21, 1996, 110 Stat. 2021;

amended Pub. L. 107-105, Sec. 4, Dec. 27, 2001, 115 Stat. 1007.)

-REFTEXT-

REFERENCES IN TEXT

The Indian Health Care Improvement Act, referred to in par.

(5)(L), is Pub. L. 94-437, Sept. 30, 1976, 90 Stat. 1400, as

amended, which is classified principally to chapter 18 (Sec. 1601

et seq.) of Title 25, Indians. For complete classification of this

Act to the Code, see Short Title note set out under section 1601 of

Title 25 and Tables.

-MISC1-

PRIOR PROVISIONS

A prior section 1171 of act Aug. 14, 1935, was classified to

section 1320c-20 of this title prior to repeal by Pub. L. 97-35.

AMENDMENTS

2001 - Par. (5)(D). Pub. L. 107-105 substituted "Parts A, B, or

C" for "Part A or part B".

PURPOSE

Section 261 of title II of Pub. L. 104-191 provided that: "It is

the purpose of this subtitle [subtitle F (Secs. 261-264) of title

II of Pub. L. 104-191, enacting this part, amending sections 242k

and 1395cc of this title, and enacting provisions set out as a note

under section 1320d-2 of this title] to improve the Medicare

program under title XVIII of the Social Security Act [subchapter

XVIII of this chapter], the medicaid program under title XIX of

such Act [subchapter XIX of this chapter], and the efficiency and

effectiveness of the health care system, by encouraging the

development of a health information system through the

establishment of standards and requirements for the electronic

transmission of certain health information."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1395cc of this title.

-FOOTNOTE-

(!1) So in original. Probably should be "Part".

-End-

-CITE-

42 USC Sec. 1320d-1 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part C - Administrative Simplification

-HEAD-

Sec. 1320d-1. General requirements for adoption of standards

-STATUTE-

(a) Applicability

Any standard adopted under this part shall apply, in whole or in

part, to the following persons:

(1) A health plan.

(2) A health care clearinghouse.

(3) A health care provider who transmits any health information

in electronic form in connection with a transaction referred to

in section 1320d-2(a)(1) of this title.

(b) Reduction of costs

Any standard adopted under this part shall be consistent with the

objective of reducing the administrative costs of providing and

paying for health care.

(c) Role of standard setting organizations

(1) In general

Except as provided in paragraph (2), any standard adopted under

this part shall be a standard that has been developed, adopted,

or modified by a standard setting organization.

(2) Special rules

(A) Different standards

The Secretary may adopt a standard that is different from any

standard developed, adopted, or modified by a standard setting

organization, if -

(i) the different standard will substantially reduce

administrative costs to health care providers and health

plans compared to the alternatives; and

(ii) the standard is promulgated in accordance with the

rulemaking procedures of subchapter III of chapter 5 of title

5.

(B) No standard by standard setting organization

If no standard setting organization has developed, adopted,

or modified any standard relating to a standard that the

Secretary is authorized or required to adopt under this part -

(i) paragraph (1) shall not apply; and

(ii) subsection (f) of this section shall apply.

(3) Consultation requirement

(A) In general

A standard may not be adopted under this part unless -

(i) in the case of a standard that has been developed,

adopted, or modified by a standard setting organization, the

organization consulted with each of the organizations

described in subparagraph (B) in the course of such

development, adoption, or modification; and

(ii) in the case of any other standard, the Secretary, in

complying with the requirements of subsection (f) of this

section, consulted with each of the organizations described

in subparagraph (B) before adopting the standard.

(B) Organizations described

The organizations referred to in subparagraph (A) are the

following:

(i) The National Uniform Billing Committee.

(ii) The National Uniform Claim Committee.

(iii) The Workgroup for Electronic Data Interchange.

(iv) The American Dental Association.

(d) Implementation specifications

The Secretary shall establish specifications for implementing

each of the standards adopted under this part.

(e) Protection of trade secrets

Except as otherwise required by law, a standard adopted under

this part shall not require disclosure of trade secrets or

confidential commercial information by a person required to comply

with this part.

(f) Assistance to Secretary

In complying with the requirements of this part, the Secretary

shall rely on the recommendations of the National Committee on

Vital and Health Statistics established under section 242k(k) of

this title, and shall consult with appropriate Federal and State

agencies and private organizations. The Secretary shall publish in

the Federal Register any recommendation of the National Committee

on Vital and Health Statistics regarding the adoption of a standard

under this part.

(g) Application to modifications of standards

This section shall apply to a modification to a standard

(including an addition to a standard) adopted under section

1320d-3(b) of this title in the same manner as it applies to an

initial standard adopted under section 1320d-3(a) of this title.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1172, as added Pub. L.

104-191, title II, Sec. 262(a), Aug. 21, 1996, 110 Stat. 2023.)

-MISC1-

PRIOR PROVISIONS

A prior section 1172 of act Aug. 14, 1935, was classified to

section 1320c-21 of this title prior to the general amendment of

part B of this subchapter by Pub. L. 97-248.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320d, 1320d-2, 1320d-4,

1320d-7 of this title.

-End-

-CITE-

42 USC Sec. 1320d-2 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part C - Administrative Simplification

-HEAD-

Sec. 1320d-2. Standards for information transactions and data

elements

-STATUTE-

(a) Standards to enable electronic exchange

(1) In general

The Secretary shall adopt standards for transactions, and data

elements for such transactions, to enable health information to

be exchanged electronically, that are appropriate for -

(A) the financial and administrative transactions described

in paragraph (2); and

(B) other financial and administrative transactions

determined appropriate by the Secretary, consistent with the

goals of improving the operation of the health care system and

reducing administrative costs.

(2) Transactions

The transactions referred to in paragraph (1)(A) are

transactions with respect to the following:

(A) Health claims or equivalent encounter information.

(B) Health claims attachments.

(C) Enrollment and disenrollment in a health plan.

(D) Eligibility for a health plan.

(E) Health care payment and remittance advice.

(F) Health plan premium payments.

(G) First report of injury.

(H) Health claim status.

(I) Referral certification and authorization.

(3) Accommodation of specific providers

The standards adopted by the Secretary under paragraph (1)

shall accommodate the needs of different types of health care

providers.

(b) Unique health identifiers

(1) In general

The Secretary shall adopt standards providing for a standard

unique health identifier for each individual, employer, health

plan, and health care provider for use in the health care system.

In carrying out the preceding sentence for each health plan and

health care provider, the Secretary shall take into account

multiple uses for identifiers and multiple locations and

specialty classifications for health care providers.

(2) Use of identifiers

The standards adopted under paragraph (1) shall specify the

purposes for which a unique health identifier may be used.

(c) Code sets

(1) In general

The Secretary shall adopt standards that -

(A) select code sets for appropriate data elements for the

transactions referred to in subsection (a)(1) of this section

from among the code sets that have been developed by private

and public entities; or

(B) establish code sets for such data elements if no code

sets for the data elements have been developed.

(2) Distribution

The Secretary shall establish efficient and low-cost procedures

for distribution (including electronic distribution) of code sets

and modifications made to such code sets under section 1320d-3(b)

of this title.

(d) Security standards for health information

(1) Security standards

The Secretary shall adopt security standards that -

(A) take into account -

(i) the technical capabilities of record systems used to

maintain health information;

(ii) the costs of security measures;

(iii) the need for training persons who have access to

health information;

(iv) the value of audit trails in computerized record

systems; and

(v) the needs and capabilities of small health care

providers and rural health care providers (as such providers

are defined by the Secretary); and

(B) ensure that a health care clearinghouse, if it is part of

a larger organization, has policies and security procedures

which isolate the activities of the health care clearinghouse

with respect to processing information in a manner that

prevents unauthorized access to such information by such larger

organization.

(2) Safeguards

Each person described in section 1320d-1(a) of this title who

maintains or transmits health information shall maintain

reasonable and appropriate administrative, technical, and

physical safeguards -

(A) to ensure the integrity and confidentiality of the

information;

(B) to protect against any reasonably anticipated -

(i) threats or hazards to the security or integrity of the

information; and

(ii) unauthorized uses or disclosures of the information;

and

(C) otherwise to ensure compliance with this part by the

officers and employees of such person.

(e) Electronic signature

(1) Standards

The Secretary, in coordination with the Secretary of Commerce,

shall adopt standards specifying procedures for the electronic

transmission and authentication of signatures with respect to the

transactions referred to in subsection (a)(1) of this section.

(2) Effect of compliance

Compliance with the standards adopted under paragraph (1) shall

be deemed to satisfy Federal and State statutory requirements for

written signatures with respect to the transactions referred to

in subsection (a)(1) of this section.

(f) Transfer of information among health plans

The Secretary shall adopt standards for transferring among health

plans appropriate standard data elements needed for the

coordination of benefits, the sequential processing of claims, and

other data elements for individuals who have more than one health

plan.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1173, as added Pub. L.

104-191, title II, Sec. 262(a), Aug. 21, 1996, 110 Stat. 2024.)

-MISC1-

PRIOR PROVISIONS

A prior section 1173 of act Aug. 14, 1935, was classified to

section 1320c-22 of this title prior to the general amendment of

part B of this subchapter by Pub. L. 97-248.

RECOMMENDATIONS WITH RESPECT TO PRIVACY OF CERTAIN HEALTH

INFORMATION

Section 264 of Pub. L. 104-191 directed Secretary of Health and

Human Services, in consultation with the National Committee on

Vital and Health Statistics and the Attorney General, to submit to

Congress, not later than the date that is 12 months after Aug. 21,

1996, detailed recommendations on standards with respect to the

privacy of individually identifiable health information, which

recommendations were to address at least the rights that an

individual who is a subject of individually identifiable health

information should have, the procedures that should be established

for the exercise of such rights, and the uses and disclosures of

such information that should be authorized or required, further

provided that if legislation governing such standards was not

enacted by the date that is 36 months after Aug. 21, 1996, the

Secretary was to promulgate final regulations containing such

standards not later than the date that is 42 months after Aug. 21,

1996, and further provided for preemption of regulations.

-EXEC-

EX. ORD. NO. 13181. TO PROTECT THE PRIVACY OF PROTECTED HEALTH

INFORMATION IN OVERSIGHT INVESTIGATIONS

Ex. Ord. No. 13181, Dec. 20, 2000, 65 F.R. 81321, provided:

By the authority vested in me as President of the United States

by the Constitution and the laws of the United States of America,

it is ordered as follows:

Section 1. Policy.

It shall be the policy of the Government of the United States

that law enforcement may not use protected health information

concerning an individual that is discovered during the course of

health oversight activities for unrelated civil, administrative, or

criminal investigations of a non-health oversight matter, except

when the balance of relevant factors weighs clearly in favor of its

use. That is, protected health information may not be so used

unless the public interest and the need for disclosure clearly

outweigh the potential for injury to the patient, to the

physician-patient relationship, and to the treatment services.

Protecting the privacy of patients' protected health information

promotes trust in the health care system. It improves the quality

of health care by fostering an environment in which patients can

feel more comfortable in providing health care professionals with

accurate and detailed information about their personal health. In

order to provide greater protections to patients' privacy, the

Department of Health and Human Services is issuing final

regulations concerning the confidentiality of individually

identifiable health information under the Health Insurance

Portability and Accountability Act of 1996 [Pub. L. 104-191, see

Tables for classification] (HIPAA). HIPAA applies only to "covered

entities," such as health care plans, providers, and

clearinghouses. HIPAA regulations therefore do not apply to other

organizations and individuals that gain access to protected health

information, including Federal officials who gain access to health

records during health oversight activities.

Under the new HIPAA regulations, health oversight investigators

will appropriately have ready access to medical records for

oversight purposes. Health oversight investigators generally do not

seek access to the medical records of a particular patient, but

instead review large numbers of records to determine whether a

health care provider or organization is violating the law, such as

through fraud against the Medicare system. Access to many health

records is often necessary in order to gain enough evidence to

detect and bring enforcement actions against fraud in the health

care system. Stricter rules apply under the HIPAA regulations,

however, when law enforcement officials seek protected health

information in order to investigate criminal activity outside of

the health oversight realm.

In the course of their efforts to protect the health care system,

health oversight investigators may also uncover evidence of

wrongdoing unrelated to the health care system, such as evidence of

criminal conduct by an individual who has sought health care. For

records containing that evidence, the issue thus arises whether the

information should be available for law enforcement purposes under

the less restrictive oversight rules or the more restrictive rules

that apply to non-oversight criminal investigations.

A similar issue has arisen in other circumstances. Under 18

U.S.C. 3486, an individual's health records obtained for health

oversight purposes pursuant to an administrative subpoena may not

be used against that individual patient in an unrelated

investigation by law enforcement unless a judicial officer finds

good cause. Under that statute, a judicial officer determines

whether there is good cause by weighing the public interest and the

need for disclosure against the potential for injury to the

patient, to the physician-patient relationship, and to the

treatment services. It is appropriate to extend limitations on the

use of health information to all situations in which the government

obtains medical records for a health oversight purpose. In

recognition of the increasing importance of protecting health

information as shown in the medical privacy rule, a higher standard

than exists in 18 U.S.C. 3486 is necessary. It is, therefore, the

policy of the Government of the United States that law enforcement

may not use protected health information concerning an individual,

discovered during the course of health oversight activities for

unrelated civil, administrative, or criminal investigations,

against that individual except when the balance of relevant factors

weighs clearly in favor of its use. That is, protected health

information may not be so used unless the public interest and the

need for disclosure clearly outweigh the potential for injury to

the patient, to the physician-patient relationship, and to the

treatment services.

Sec. 2. Definitions.

(a) "Health oversight activities" shall include the oversight

activities enumerated in the regulations concerning the

confidentiality of individually identifiable health information

promulgated by the Secretary of Health and Human Services pursuant

to the "Health Insurance Portability and Accountability Act of

1996," as amended [Pub. L. 104-191, see Tables for classification].

(b) "Protected health information" shall have the meaning

ascribed to it in the regulations concerning the confidentiality of

individually identifiable health information promulgated by the

Secretary of Health and Human Services pursuant to the "Health

Insurance Portability and Accountability Act of 1996," as amended.

(c) "Injury to the patient" includes injury to the privacy

interests of the patient.

Sec. 3. Implementation.

(a) Protected health information concerning an individual patient

discovered during the course of health oversight activities shall

not be used against that individual patient in an unrelated civil,

administrative, or criminal investigation of a non-health oversight

matter unless the Deputy Attorney General of the U.S Department of

Justice, or insofar as the protected health information involves

members of the Armed Forces, the General Counsel of the U.S.

Department of Defense, has authorized such use.

(b) In assessing whether protected health information should be

used under subparagraph (a) of this section, the Deputy Attorney

General shall permit such use upon concluding that the balance of

relevant factors weighs clearly in favor of its use. That is, the

Deputy Attorney General shall permit disclosure if the public

interest and the need for disclosure clearly outweigh the potential

for injury to the patient, to the physician-patient relationship,

and to the treatment services.

(c) Upon the decision to use protected health information under

subparagraph (a) of this section, the Deputy Attorney General, in

determining the extent to which this information should be used,

shall impose appropriate safeguards against unauthorized use.

(d) On an annual basis, the Department of Justice, in

consultation with the Department of Health and Human Services,

shall provide to the President of the United States a report that

includes the following information:

(i) the number of requests made to the Deputy Attorney General

for authorization to use protected health information discovered

during health oversight activities in a non-health oversight,

unrelated investigation;

(ii) the number of requests that were granted as applied for,

granted as modified, or denied;

(iii) the agencies that made the applications, and the number of

requests made by each agency; and

(iv) the uses for which the protected health information was

authorized.

(e) The General Counsel of the U.S. Department of Defense will

comply with the requirements of subparagraphs (b), (c), and (d),

above. The General Counsel also will prepare a report, consistent

with the requirements of subparagraphs (d)(i) through (d)(iv),

above, and will forward it to the Department of Justice where it

will be incorporated into the Department's annual report to the

President.

Sec. 4. Exceptions.

(a) Nothing in this Executive Order shall place a restriction on

the derivative use of protected health information that was

obtained by a law enforcement agency in a non-health oversight

investigation.

(b) Nothing in this Executive Order shall be interpreted to place

a restriction on a duty imposed by statute.

(c) Nothing in this Executive Order shall place any additional

limitation on the derivative use of health information obtained by

the Attorney General pursuant to the provisions of 18 U.S.C. 3486.

(d) This order does not create any right or benefit, substantive

or procedural, enforceable at law by a party against the United

States, the officers and employees, or any other person.

William J. Clinton.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320d, 1320d-1, 1320d-3,

1320d-4, 1320d-7, 1396u-2 of this title.

-End-

-CITE-

42 USC Sec. 1320d-3 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part C - Administrative Simplification

-HEAD-

Sec. 1320d-3. Timetables for adoption of standards

-STATUTE-

(a) Initial standards

The Secretary shall carry out section 1320d-2 of this title not

later than 18 months after August 21, 1996, except that standards

relating to claims attachments shall be adopted not later than 30

months after August 21, 1996.

(b) Additions and modifications to standards

(1) In general

Except as provided in paragraph (2), the Secretary shall review

the standards adopted under section 1320d-2 of this title, and

shall adopt modifications to the standards (including additions

to the standards), as determined appropriate, but not more

frequently than once every 12 months. Any addition or

modification to a standard shall be completed in a manner which

minimizes the disruption and cost of compliance.

(2) Special rules

(A) First 12-month period

Except with respect to additions and modifications to code

sets under subparagraph (B), the Secretary may not adopt any

modification to a standard adopted under this part during the

12-month period beginning on the date the standard is initially

adopted, unless the Secretary determines that the modification

is necessary in order to permit compliance with the standard.

(B) Additions and modifications to code sets

(i) In general

The Secretary shall ensure that procedures exist for the

routine maintenance, testing, enhancement, and expansion of

code sets.

(ii) Additional rules

If a code set is modified under this subsection, the

modified code set shall include instructions on how data

elements of health information that were encoded prior to the

modification may be converted or translated so as to preserve

the informational value of the data elements that existed

before the modification. Any modification to a code set under

this subsection shall be implemented in a manner that

minimizes the disruption and cost of complying with such

modification.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1174, as added Pub. L.

104-191, title II, Sec. 262(a), Aug. 21, 1996, 110 Stat. 2026.)

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320d, 1320d-1, 1320d-2,

1320d-4, 1320d-7 of this title.

-End-

-CITE-

42 USC Sec. 1320d-4 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part C - Administrative Simplification

-HEAD-

Sec. 1320d-4. Requirements

-STATUTE-

(a) Conduct of transactions by plans

(1) In general

If a person desires to conduct a transaction referred to in

section 1320d-2(a)(1) of this title with a health plan as a

standard transaction -

(A) the health plan may not refuse to conduct such

transaction as a standard transaction;

(B) the insurance plan may not delay such transaction, or

otherwise adversely affect, or attempt to adversely affect, the

person or the transaction on the ground that the transaction is

a standard transaction; and

(C) the information transmitted and received in connection

with the transaction shall be in the form of standard data

elements of health information.

(2) Satisfaction of requirements

A health plan may satisfy the requirements under paragraph (1)

by -

(A) directly transmitting and receiving standard data

elements of health information; or

(B) submitting nonstandard data elements to a health care

clearinghouse for processing into standard data elements and

transmission by the health care clearinghouse, and receiving

standard data elements through the health care clearinghouse.

(3) Timetable for compliance

Paragraph (1) shall not be construed to require a health plan

to comply with any standard, implementation specification, or

modification to a standard or specification adopted or

established by the Secretary under sections 1320d-1 through

1320d-3 of this title at any time prior to the date on which the

plan is required to comply with the standard or specification

under subsection (b) of this section.

(b) Compliance with standards

(1) Initial compliance

(A) In general

Not later than 24 months after the date on which an initial

standard or implementation specification is adopted or

established under sections 1320d-1 and 1320d-2 of this title,

each person to whom the standard or implementation

specification applies shall comply with the standard or

specification.

(B) Special rule for small health plans

In the case of a small health plan, paragraph (1) shall be

applied by substituting "36 months" for "24 months". For

purposes of this subsection, the Secretary shall determine the

plans that qualify as small health plans.

(2) Compliance with modified standards

If the Secretary adopts a modification to a standard or

implementation specification under this part, each person to whom

the standard or implementation specification applies shall comply

with the modified standard or implementation specification at

such time as the Secretary determines appropriate, taking into

account the time needed to comply due to the nature and extent of

the modification. The time determined appropriate under the

preceding sentence may not be earlier than the last day of the

180-day period beginning on the date such modification is

adopted. The Secretary may extend the time for compliance for

small health plans, if the Secretary determines that such

extension is appropriate.

(3) Construction

Nothing in this subsection shall be construed to prohibit any

person from complying with a standard or specification by -

(A) submitting nonstandard data elements to a health care

clearinghouse for processing into standard data elements and

transmission by the health care clearinghouse; or

(B) receiving standard data elements through a health care

clearinghouse.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1175, as added Pub. L.

104-191, title II, Sec. 262(a), Aug. 21, 1996, 110 Stat. 2027.)

-MISC1-

EXTENSION OF DEADLINE FOR COVERED ENTITIES SUBMITTING COMPLIANCE

PLANS

Pub. L. 107-105, Sec. 2, Dec. 27, 2001, 115 Stat. 1003, provided

that:

"(a) In General. -

"(1) Extension. - Subject to paragraph (2), notwithstanding

section 1175(b)(1)(A) of the Social Security Act (42 U.S.C.

1320d-4(b)(1)(A)) and section 162.900 of title 45, Code of

Federal Regulations, a health care provider, health plan (other

than a small health plan), or a health care clearinghouse shall

not be considered to be in noncompliance with the applicable

requirements of subparts I through R of part 162 of title 45,

Code of Federal Regulations, before October 16, 2003.

"(2) Condition. - Paragraph (1) shall apply to a person

described in such paragraph only if, before October 16, 2002, the

person submits to the Secretary of Health and Human Services a

plan of how the person will come into compliance with the

requirements described in such paragraph not later than October

16, 2003. Such plan shall be a summary of the following:

"(A) An analysis reflecting the extent to which, and the

reasons why, the person is not in compliance.

"(B) A budget, schedule, work plan, and implementation

strategy for achieving compliance.

"(C) Whether the person plans to use or might use a

contractor or other vendor to assist the person in achieving

compliance.

"(D) A timeframe for testing that begins not later than April

16, 2003.

"(3) Electronic submission. - Plans described in paragraph (2)

may be submitted electronically.

"(4) Model form. - Not later than March 31, 2002, the Secretary

of Health and Human Services shall promulgate a model form that

persons may use in drafting a plan described in paragraph (2).

The promulgation of such form shall be made without regard to

chapter 35 of title 44, United States Code (commonly known as the

'Paperwork Reduction Act').

"(5) Analysis of plans; reports on solutions. -

"(A) Analysis of plans. -

"(i) Furnishing of plans. - Subject to subparagraph (D),

the Secretary of Health and Human Services shall furnish the

National Committee on Vital and Health Statistics with a

sample of the plans submitted under paragraph (2) for

analysis by such Committee.

"(ii) Analysis. - The National Committee on Vital and

Health Statistics shall analyze the sample of the plans

furnished under clause (i).

"(B) Reports on solutions. - The National Committee on Vital

and Health Statistics shall regularly publish, and widely

disseminate to the public, reports containing effective

solutions to compliance problems identified in the plans

analyzed under subparagraph (A). Such reports shall not relate

specifically to any one plan but shall be written for the

purpose of assisting the maximum number of persons to come into

compliance by addressing the most common or challenging

problems encountered by persons submitting such plans.

"(C) Consultation. - In carrying out this paragraph, the

National Committee on Vital and Health Statistics shall consult

with each organization -

"(i) described in section 1172(c)(3)(B) of the Social

Security Act (42 U.S.C. 1320d-1(c)(3)(B)); or

"(ii) designated by the Secretary of Health and Human

Services under section 162.910(a) of title 45, Code of

Federal Regulations.

"(D) Protection of confidential information. -

"(i) In general. - The Secretary of Health and Human

Services shall ensure that any material provided under

subparagraph (A) to the National Committee on Vital and

Health Statistics or any organization described in

subparagraph (C) is redacted so as to prevent the disclosure

of any -

"(I) trade secrets;

"(II) commercial or financial information that is privileged

or confidential; and

"(III) other information the disclosure of which would

constitute a clearly unwarranted invasion of personal

privacy.

"(ii) Construction. - Nothing in clause (i) shall be

construed to affect the application of section 552 of title

5, United States Code (commonly known as the 'Freedom of

Information Act'), including the exceptions from disclosure

provided under subsection (b) of such section.

"(6) Enforcement through exclusion from participation in

medicare. -

"(A) In general. - In the case of a person described in

paragraph (1) who fails to submit a plan in accordance with

paragraph (2), and who is not in compliance with the applicable

requirements of subparts I through R of part 162 of title 45,

Code of Federal Regulations, on or after October 16, 2002, the

person may be excluded at the discretion of the Secretary of

Health and Human Services from participation (including under

part C or as a contractor under sections 1816, 1842, and 1893)

[42 U.S.C. 1395h, 1395u, 1395ddd] in title XVIII of the Social

Security Act (42 U.S.C. 1395 et seq.).

"(B) Procedure. - The provisions of section 1128A of the

Social Security Act (42 U.S.C. 1320a-7a) (other than the first

and second sentences of subsection (a) and subsection (b))

shall apply to an exclusion under this paragraph in the same

manner as such provisions apply with respect to an exclusion or

proceeding under section 1128A(a) of such Act.

"(C) Construction. - The availability of an exclusion under

this paragraph shall not be construed to affect the imposition

of penalties under section 1176 of the Social Security Act (42

U.S.C. 1320d-5).

"(D) Nonapplicability to complying persons. - The exclusion

under subparagraph (A) shall not apply to a person who -

"(i) submits a plan in accordance with paragraph (2); or

"(ii) who is in compliance with the applicable requirements

of subparts I through R of part 162 of title 45, Code of

Federal Regulations, on or before October 16, 2002.

"(b) Special Rules. -

"(1) Rules of construction. - Nothing in this section shall be

construed -

"(A) as modifying the October 16, 2003, deadline for a small

health plan to comply with the requirements of subparts I

through R of part 162 of title 45, Code of Federal Regulations;

or

"(B) as modifying -

"(i) the April 14, 2003, deadline for a health care

provider, a health plan (other than a small health plan), or

a health care clearinghouse to comply with the requirements

of subpart E of part 164 of title 45, Code of Federal

Regulations; or

"(ii) the April 14, 2004, deadline for a small health plan

to comply with the requirements of such subpart.

"(2) Applicability of privacy standards before compliance

deadline for information transaction standards. -

"(A) In general. - Notwithstanding any other provision of

law, during the period that begins on April 14, 2003, and ends

on October 16, 2003, a health care provider or, subject to

subparagraph (B), a health care clearinghouse, that transmits

any health information in electronic form in connection with a

transaction described in subparagraph (C) shall comply with the

requirements of subpart E of part 164 of title 45, Code of

Federal Regulations, without regard to whether the transmission

meets the standards required by part 162 of such title.

"(B) Application to health care clearinghouses. - For

purposes of this paragraph, during the period described in

subparagraph (A), an entity that processes or facilitates the

processing of information in connection with a transaction

described in subparagraph (C) and that otherwise would be

treated as a health care clearinghouse shall be treated as a

health care clearinghouse without regard to whether the

processing or facilitation produces (or is required to produce)

standard data elements or a standard transaction as required by

part 162 of title 45, Code of Federal Regulations.

"(C) Transactions described. - The transactions described in

this subparagraph are the following:

"(i) A health care claims or equivalent encounter

information transaction.

"(ii) A health care payment and remittance advice

transaction.

"(iii) A coordination of benefits transaction.

"(iv) A health care claim status transaction.

"(v) An enrollment and disenrollment in a health plan

transaction.

"(vi) An eligibility for a health plan transaction.

"(vii) A health plan premium payments transaction.

"(viii) A referral certification and authorization

transaction.

"(c) Definitions. - In this section -

"(1) the terms 'health care provider', 'health plan', and

'health care clearinghouse' have the meaning given those terms in

section 1171 of the Social Security Act (42 U.S.C. 1320d) and

section 160.103 of title 45, Code of Federal Regulations;

"(2) the terms 'small health plan' and 'transaction' have the

meaning given those terms in section 160.103 of title 45, Code of

Federal Regulations; and

"(3) the terms 'health care claims or equivalent encounter

information transaction', 'health care payment and remittance

advice transaction', 'coordination of benefits transaction',

'health care claim status transaction', 'enrollment and

disenrollment in a health plan transaction', 'eligibility for a

health plan transaction', 'health plan premium payments

transaction', and 'referral certification and authorization

transaction' have the meanings given those terms in sections

162.1101, 162.1601, 162.1801, 162.1401, 162.1501, 162.1201,

162.1701, and 162.1301 of title 45, Code of Federal Regulations,

respectively."

-End-

-CITE-

42 USC Sec. 1320d-5 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part C - Administrative Simplification

-HEAD-

Sec. 1320d-5. General penalty for failure to comply with

requirements and standards

-STATUTE-

(a) General penalty

(1) In general

Except as provided in subsection (b) of this section, the

Secretary shall impose on any person who violates a provision of

this part a penalty of not more than $100 for each such

violation, except that the total amount imposed on the person for

all violations of an identical requirement or prohibition during

a calendar year may not exceed $25,000.

(2) Procedures

The provisions of section 1320a-7a of this title (other than

subsections (a) and (b) and the second sentence of subsection

(f)) shall apply to the imposition of a civil money penalty under

this subsection in the same manner as such provisions apply to

the imposition of a penalty under such section 1320a-7a of this

title.

(b) Limitations

(1) Offenses otherwise punishable

A penalty may not be imposed under subsection (a) of this

section with respect to an act if the act constitutes an offense

punishable under section 1320d-6 of this title.

(2) Noncompliance not discovered

A penalty may not be imposed under subsection (a) of this

section with respect to a provision of this part if it is

established to the satisfaction of the Secretary that the person

liable for the penalty did not know, and by exercising reasonable

diligence would not have known, that such person violated the

provision.

(3) Failures due to reasonable cause

(A) In general

Except as provided in subparagraph (B), a penalty may not be

imposed under subsection (a) of this section if -

(i) the failure to comply was due to reasonable cause and

not to willful neglect; and

(ii) the failure to comply is corrected during the 30-day

period beginning on the first date the person liable for the

penalty knew, or by exercising reasonable diligence would

have known, that the failure to comply occurred.

(B) Extension of period

(i) No penalty

The period referred to in subparagraph (A)(ii) may be

extended as determined appropriate by the Secretary based on

the nature and extent of the failure to comply.

(ii) Assistance

If the Secretary determines that a person failed to comply

because the person was unable to comply, the Secretary may

provide technical assistance to the person during the period

described in subparagraph (A)(ii). Such assistance shall be

provided in any manner determined appropriate by the

Secretary.

(4) Reduction

In the case of a failure to comply which is due to reasonable

cause and not to willful neglect, any penalty under subsection

(a) of this section that is not entirely waived under paragraph

(3) may be waived to the extent that the payment of such penalty

would be excessive relative to the compliance failure involved.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1176, as added Pub. L.

104-191, title II, Sec. 262(a), Aug. 21, 1996, 110 Stat. 2028.)

-End-

-CITE-

42 USC Sec. 1320d-6 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part C - Administrative Simplification

-HEAD-

Sec. 1320d-6. Wrongful disclosure of individually identifiable

health information

-STATUTE-

(a) Offense

A person who knowingly and in violation of this part -

(1) uses or causes to be used a unique health identifier;

(2) obtains individually identifiable health information

relating to an individual; or

(3) discloses individually identifiable health information to

another person,

shall be punished as provided in subsection (b) of this section.

(b) Penalties

A person described in subsection (a) of this section shall -

(1) be fined not more than $50,000, imprisoned not more than 1

year, or both;

(2) if the offense is committed under false pretenses, be fined

not more than $100,000, imprisoned not more than 5 years, or

both; and

(3) if the offense is committed with intent to sell, transfer,

or use individually identifiable health information for

commercial advantage, personal gain, or malicious harm, be fined

not more than $250,000, imprisoned not more than 10 years, or

both.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1177, as added Pub. L.

104-191, title II, Sec. 262(a), Aug. 21, 1996, 110 Stat. 2029.)

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1320d-5 of this title.

-End-

-CITE-

42 USC Sec. 1320d-7 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part C - Administrative Simplification

-HEAD-

Sec. 1320d-7. Effect on State law

-STATUTE-

(a) General effect

(1) General rule

Except as provided in paragraph (2), a provision or requirement

under this part, or a standard or implementation specification

adopted or established under sections 1320d-1 through 1320d-3 of

this title, shall supersede any contrary provision of State law,

including a provision of State law that requires medical or

health plan records (including billing information) to be

maintained or transmitted in written rather than electronic form.

(2) Exceptions

A provision or requirement under this part, or a standard or

implementation specification adopted or established under

sections 1320d-1 through 1320d-3 of this title, shall not

supersede a contrary provision of State law, if the provision of

State law -

(A) is a provision the Secretary determines -

(i) is necessary -

(I) to prevent fraud and abuse;

(II) to ensure appropriate State regulation of insurance

and health plans;

(III) for State reporting on health care delivery or

costs; or

(IV) for other purposes; or

(ii) addresses controlled substances; or

(B) subject to section 264(c)(2) of the Health Insurance

Portability and Accountability Act of 1996, relates to the

privacy of individually identifiable health information.

(b) Public health

Nothing in this part shall be construed to invalidate or limit

the authority, power, or procedures established under any law

providing for the reporting of disease or injury, child abuse,

birth, or death, public health surveillance, or public health

investigation or intervention.

(c) State regulatory reporting

Nothing in this part shall limit the ability of a State to

require a health plan to report, or to provide access to,

information for management audits, financial audits, program

monitoring and evaluation, facility licensure or certification, or

individual licensure or certification.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1178, as added Pub. L.

104-191, title II, Sec. 262(a), Aug. 21, 1996, 110 Stat. 2029.)

-REFTEXT-

REFERENCES IN TEXT

Section 264(c)(2) of the Health Insurance Portability and

Accountability Act of 1996, referred to in subsec. (a)(2)(B),

is section 264(c)(2) of Pub. L. 104-191, which is set out as

a note under section 1320d-2 of this title.

-End-

-CITE-

42 USC Sec. 1320d-8 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

Part C - Administrative Simplification

-HEAD-

Sec. 1320d-8. Processing payment transactions by financial

institutions

-STATUTE-

To the extent that an entity is engaged in activities of a

financial institution (as defined in section 3401 of title 12), or

is engaged in authorizing, processing, clearing, settling, billing,

transferring, reconciling, or collecting payments, for a financial

institution, this part, and any standard adopted under this part,

shall not apply to the entity with respect to such activities,

including the following:

(1) The use or disclosure of information by the entity for

authorizing, processing, clearing, settling, billing,

transferring, reconciling or collecting, a payment for, or

related to, health plan premiums or health care, where such

payment is made by any means, including a credit, debit, or other

payment card, an account, check, or electronic funds transfer.

(2) The request for, or the use or disclosure of, information

by the entity with respect to a payment described in paragraph

(1) -

(A) for transferring receivables;

(B) for auditing;

(C) in connection with -

(i) a customer dispute; or

(ii) an inquiry from, or to, a customer;

(D) in a communication to a customer of the entity regarding

the customer's transactions, payment card, account, check, or

electronic funds transfer;

(E) for reporting to consumer reporting agencies; or

(F) for complying with -

(i) a civil or criminal subpoena; or

(ii) a Federal or State law regulating the entity.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1179, as added Pub. L.

104-191, title II, Sec. 262(a), Aug. 21, 1996, 110 Stat. 2030.)

-End-

-CITE-

42 USC SUBCHAPTER XII - ADVANCES TO STATE UNEMPLOYMENT

FUNDS 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XII - ADVANCES TO STATE UNEMPLOYMENT FUNDS

-HEAD-

SUBCHAPTER XII - ADVANCES TO STATE UNEMPLOYMENT FUNDS

-SECREF-

SUBCHAPTER REFERRED TO IN OTHER SECTIONS

This subchapter is referred to in sections 503, 1103 of this

title; title 2 section 906; title 26 sections 3302, 3304.

-End-

-CITE-

42 USC Sec. 1321 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XII - ADVANCES TO STATE UNEMPLOYMENT FUNDS

-HEAD-

Sec. 1321. Eligibility requirements for transfer of funds;

reimbursement by State; application; certification; limitation

-STATUTE-

(a)(1) Advances shall be made to the States from the Federal

unemployment account in the Unemployment Trust Fund as provided in

this section, and shall be repayable, with interest to the extent

provided in section 1322(b) of this title, in the manner provided

in sections 1101(d)(1), 1103(b)(2), and 1322 of this title. An

advance to a State for the payment of compensation in any 3-month

period may be made if -

(A) the Governor of the State applies therefor no earlier than

the first day of the month preceding the first month of such

3-month period, and

(B) he furnishes to the Secretary of Labor his estimate of the

amount of an advance which will be required by the State for the

payment of compensation in each month of such 3-month period.

(2) In the case of any application for an advance under this

section to any State for any 3-month period, the Secretary of Labor

shall -

(A) determine the amount (if any) which he finds will be

required by such State for the payment of compensation in each

month of such 3-month period, and

(B) certify to the Secretary of the Treasury the amount (not

greater than the amount estimated by the Governor of the State)

determined under subparagraph (A).

The aggregate of the amounts certified by the Secretary of Labor

with respect to any 3-month period shall not exceed the amount

which the Secretary of the Treasury reports to the Secretary of

Labor is available in the Federal unemployment account for advances

with respect to each month of such 3-month period.

(3) For purposes of this subsection -

(A) an application for an advance shall be made on such forms,

and shall contain such information and data (fiscal and

otherwise) concerning the operation and administration of the

State unemployment compensation law, as the Secretary of Labor

deems necessary or relevant to the performance of his duties

under this subchapter,

(B) the amount required by any State for the payment of

compensation in any month shall be determined with due allowance

for contingencies and taking into account all other amounts that

will be available in the State's unemployment fund for the

payment of compensation in such month, and

(C) the term "compensation" means cash benefits payable to

individuals with respect to their unemployment, exclusive of

expenses of administration.

(b) The Secretary of the Treasury shall, prior to audit or

settlement by the General Accounting Office, transfer in monthly

installments from the Federal unemployment account to the account

of the State in the Unemployment Trust Fund the amount certified

under subsection (a) of this section by the Secretary of Labor (but

not exceeding that portion of the balance in the Federal

unemployment account at the time of the transfer which is not

restricted as to use pursuant to section 1103(b)(1) of this title).

The amount of any monthly installment so transferred shall not

exceed the amount estimated by the State to be required for the

payment of compensation for the month with respect to which such

installment is made.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XII, Sec. 1201, as added Oct. 3,

1944, ch. 480, title IV, Sec. 402, 58 Stat. 790; amended Aug. 6,

1947, ch. 510, Sec. 5(b), 61 Stat. 794; 1949 Reorg. Plan No. 2,

Sec. 1, eff. Aug. 19, 1949, 14 F.R. 5225, 63 Stat. 1065; Aug. 28,

1950, ch. 809, title IV, Sec. 404(a), 64 Stat. 560; Aug. 5, 1954,

ch. 657, Sec. 3, 68 Stat. 671; Pub. L. 86-778, title V, Sec.

522(a), Sept. 13, 1960, 74 Stat. 978; Pub. L. 94-566, title II,

Sec. 213(a)-(c), Oct. 20, 1976, 90 Stat. 2677; Pub. L. 97-35, title

XXIV, Sec. 2407(b)(1), Aug. 13, 1981, 95 Stat. 880.)

-MISC1-

AMENDMENTS

1981 - Subsec. (a)(1). Pub. L. 97-35 substituted "with interest

to the extent provided in section 1322(b) of this title" for

"without interest".

1976 - Subsec. (a)(1). Pub. L. 94-566, Sec. 213(a), substituted

"any 3-month period" for "any month" in provisions preceding

subpar. (A), "the month preceding the first month of such 3-month

period" for "the preceding month" in subpar. (A), and "each month

of such 3-month period" for "such month" in subpar. (B).

Subsec. (a)(2). Pub. L. 94-566, Sec. 213(b), substituted "any

3-month period" for "any month" in provisions preceding subpar. (A)

and following subpar. (B), and "each month of such 3-month period"

for "such month" in subpar. (A) and provisions following subpar.

(B).

Subsec. (b). Pub. L. 94-566, Sec. 213(c), provided that the

transfer of amounts by the Secretary of the Treasury from the

Federal unemployment account to the account of the States in the

Unemployment Trust Fund be made in monthly installments and that

the amount of any monthly installment so transferred not exceed the

amount estimated by the State to be required for the payment of

compensation for the month with respect to which the installment is

made.

1960 - Subsec. (a). Pub. L. 86-778 amended subsec. (a) generally,

substituting provisions relating to advances on a monthly basis

upon application of the Governor and the furnishing of an estimate

of amount of requisite advance and determination and certification

by the Secretary of Labor of the requisite amount limited to a sum

which is available in the Federal unemployment account for advances

for the month for former provisions relating to advances on a

quarterly basis upon application of the Governor for a specified

amount not to exceed the highest total compensation paid out under

the unemployment compensation law of the State during any one of

the four calendar quarters preceding the quarter in which the

application is made, where the balance in the unemployment fund of

the State in the Unemployment Trust Fund at the close of Sept. 30,

1953, or the last day in any ensuing calendar quarter is less than

the total compensation paid out under the unemployment compensation

law of the State during the twelve-month period at the close of

such day; incorporating former provisions of subsec. (b), relating

to repayment of advances, in par. (1), inserting provision for

repayment under section 1103(b)(2) of this title, and provisions

formerly designated as cl. (A) and (B) in par. (3)(A) and (C); and

adding par. (3)(B).

Subsec. (b). Pub. L. 86-778 amended subsec. (b) generally,

striking out provision for repayment of advances which is now

incorporated in subsec. (a)(1) in the reference to repayment under

sections 1101(d)(1) and 1322 of this title.

1954 - Act Aug. 5, 1954, amended section generally to provide

that: (1) the first condition of eligibility for an advance is that

the balance in the State unemployment fund at the close of a

calendar quarter be less than the total of cash payments made by

the State to individuals during the 12-month period which ends with

such quarter; (2) the Governor of the State must apply for an

advance during the quarter following the quarter specified in

paragraph (1) of this section; and (3) the total amount certified

for any one application may not exceed the amount paid out by the

State for cash benefits in that particular quarter.

1950 - Subsec. (a). Act Aug. 28, 1950, substituted "January 1,

1952" for "January 1, 1950".

1947 - Subsec. (a). Act Aug. 6, 1947, substituted "June 30, 1947"

for "June 30, 1945" and "January 1, 1950" for "July 1, 1947".

EFFECTIVE DATE OF 1976 AMENDMENT

Section 213(d) of Pub. L. 94-566 provided that: " The amendments

made by this section [amending this section] shall take effect on

the date of the enactment of this Act [Oct. 20, 1976]."

EFFECTIVE DATE OF 1950 AMENDMENT

Amendment by act Aug. 28, 1950, effective Jan. 1, 1950, see

section 404(c) of act Aug. 28, 1950, set out as a note under

section 1104 of this title.

TERMINATION DATE

Section 4 of act Aug. 6, 1947, provided that: "Section 603 of the

War Mobilization and Reconversion Act of 1944 [section 1651 note of

Appendix to Title 50, War and National Defense] (terminating the

provisions of such Act [sections 1651 to 1678 of Appendix to Title

50] on June 30, 1947) shall not be applicable in the case of the

amendments made by title IV of such Act [sections 1666 and 1667 of

Appendix to Title 50] to the Social Security Act [this section and

section 1104 of this title]."

APPLICATIONS FOR TRANSFER OF FUNDS UNDER FORMER PROVISIONS OF

SECTION 1321(A); LIMITATIONS

Section 522(b) of Pub. L. 86-778 provided that:

"(1) No amount shall be transferred on or after the date of the

enactment of this Act [Sept. 13, 1960] from the Federal

unemployment account to the account of any State in the

Unemployment Trust Fund pursuant to any application made under

section 1201(a) of the Social Security Act [subsec. (a) of this

section] as in effect before such date; except that, if -

"(A) some but not all of an amount certified by the Secretary

of Labor to the Secretary of the Treasury for transfer to the

account of any State was transferred to such account before such

date, and

"(B) the Governor of such State, after the date of the

enactment of this Act [Sept. 13, 1960], requests the Secretary of

the Treasury to transfer all or any part of the remainder to such

account,

the Secretary of the Treasury shall, prior to audit or settlement

by the General Accounting Office, transfer from the Federal

unemployment account to the account of such State in the

Unemployment Trust Fund the amount so requested or (if smaller) the

amount available in the Federal unemployment account at the time of

the transfer. No such amount shall be transferred under this

paragraph after the one-year period beginning on the date of the

enactment of this Act [Sept. 13, 1960].

"(2) For purposes of section 3302(c) of the Federal Unemployment

Tax Act [section 3302(c) of Title 26, Internal Revenue Code] and

titles IX and XII of the Social Security Act [subchapter IX and XII

of this chapter], if any amount is transferred pursuant to

paragraph (1) to the unemployment account of any State, such amount

shall be treated as an advance made before the date of the

enactment of this Act [Sept. 13, 1960]."

ADVANCES TO ALASKA

Act June 1, 1955, ch. 118, 69 Stat. 81, authorized the Governor

of Alaska to obtain from the Federal Unemployment Fund such

advances as the Territory of Alaska might qualify for and as might

be necessary to obtain for the payment of unemployment compensation

benefits to claimants entitled thereto under the Alaska employment

security law and provided for the reimbursement of the general fund

of the Territory of Alaska from which advances have been made for

the payment of unemployment compensation benefits from advances

made through the Governor of Alaska from the Federal Unemployment

Fund.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1101, 1104, 1322 of this

title.

-End-

-CITE-

42 USC Sec. 1322 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XII - ADVANCES TO STATE UNEMPLOYMENT FUNDS

-HEAD-

Sec. 1322. Repayment by State; certification; transfer; interest on

loan; credit of interest on loan

-STATUTE-

(a) Repayment by State; certification; transfer

The Governor of any State may at any time request that funds be

transferred from the account of such State to the Federal

unemployment account in repayment of part or all of that balance of

advances, made to such State under section 1321 of this title,

specified in the request. The Secretary of Labor shall certify to

the Secretary of the Treasury the amount and balance specified in

the request; and the Secretary of the Treasury shall promptly

transfer such amount in reduction of such balance.

(b) Interest on loan

(1) Except as otherwise provided in this subsection, each State

shall pay interest on any advance made to such State under section

1321 of this title. Interest so payable with respect to periods

during any calendar year shall be at the rate determined under

paragraph (4) for such calendar year.

(2) No interest shall be required to be paid under paragraph (1)

with respect to any advance or advances made during any calendar

year if -

(A) such advances are repaid in full before the close of

September 30 of the calendar year in which the advances were

made,

(B) no other advance was made to such State under section 1321

of this title during such calendar year and after the date on

which the repayment of the advances was completed, and

(C) such State meets funding goals, established under

regulations issued by the Secretary of Labor, relating to the

accounts of the States in the Unemployment Trust Fund.

(3)(A) Interest payable under paragraph (1) which was

attributable to periods during any fiscal year shall be paid by the

State to the Secretary of the Treasury prior to the first day of

the following fiscal year. If interest is payable under paragraph

(1) on any advance (hereinafter in this subparagraph referred to as

the "first advance") by reason of another advance made to such

State after September 30 of the calendar year in which the first

advance was made, interest on such first advance attributable to

periods before such September 30 shall be paid not later than the

day after the date on which the other advance was made.

(B) Notwithstanding subparagraph (A), in the case of any advance

made during the last 5 months of any fiscal year, interest on such

advance attributable to periods during such fiscal year shall not

be required to be paid before the last day of the succeeding

taxable year. Any interest the time for payment of which is

deferred by the preceding sentence shall bear interest in the same

manner as if it were an advance made on the day on which it would

have been required to be paid but for this subparagraph.

(C)(i) In the case of any State which meets the requirements of

clause (ii) for any calendar year, any interest otherwise required

to be paid under this subsection during such calendar year shall be

paid as follows -

(I) 25 percent of the amount otherwise required to be paid on

or before any day during such calendar year shall be paid on or

before such day; and

(II) 25 percent of the amount otherwise required to be paid on

or before such day shall be paid on or before the corresponding

day in each of the 3 succeeding calendar years.

No interest shall accrue on such deferred interest.

(ii) A State meets the requirements of this clause for any

calendar year if the rate of insured unemployment (as determined

for purposes of section 203 of the Federal-State Extended

Unemployment Compensation Act of 1970) under the State law of the

period consisting of the first 6 months of the preceding calendar

year equaled or exceeded 7.5 percent.

(4) The interest rate determined under this paragraph with

respect to any calendar year is a percentage (but not in excess of

10 percent) determined by dividing -

(A) the aggregate amount credited under section 1104(e) of this

title to State accounts on the last day of the last calendar

quarter of the immediately preceding calendar year, by

(B) the aggregate of the average daily balances of the State

accounts for such quarter as determined under section 1104(e) of

this title.

(5) Interest required to be paid under paragraph (1) shall not be

paid (directly or indirectly) by a State from amounts in its

unemployment fund. If the Secretary of Labor determines that any

State action results in the paying of such interest directly or

indirectly (by an equivalent reduction in State unemployment taxes

or otherwise) from such unemployment fund, the Secretary of Labor

shall not certify such State's unemployment compensation law under

section 3304 of the Internal Revenue Code of 1986. Such

noncertification shall be made in accordance with section 3304(c)

of such Code.

(6)(A) For purposes of paragraph (2), any voluntary repayment

shall be applied against advances made under section 1321 of this

title on the last made first repaid basis. Any other repayment of

such an advance shall be applied against advances on a first made

first repaid basis.

(B) For purposes of this paragraph, the term "voluntary

repayment" means any repayment made under subsection (a) of this

section.

(7) This subsection shall only apply to advances made on or after

April 1, 1982.

(8)(A) With respect to interest due under this section on

September 30 of 1983, 1984, or 1985 (other than interest previously

deferred under paragraph (3)(C)), a State may pay 80 percent of

such interest in four annual installments of at least 20 percent

beginning with the year after the year in which it is otherwise

due, if such State meets the criteria of subparagraph (B). No

interest shall accrue on such deferred interest.

(B) To meet the criteria of this subparagraph a State must -

(i) have taken no action since October 1, 1982, which would

reduce its net unemployment tax effort or the net solvency of its

unemployment system (as determined for purposes of section

3302(f) of the Internal Revenue Code of 1986); and

(ii)(I) have taken an action (as certified by the Secretary of

Labor) after March 31, 1982, which would have increased revenue

liabilities and decreased benefits under the State's unemployment

compensation system (hereinafter referred to as a "solvency

effort") by a combined total of the applicable percentage (as

compared to such revenues and benefits as would have been in

effect without such State action) for the calendar year for which

the deferral is requested; or

(II) have had, for taxable year 1982, an average unemployment

tax rate which was equal to or greater than 2.0 percent of the

total of the wages (as determined without any limitation on

amount) attributable to such State subject to contribution under

the State unemployment compensation law with respect to such

taxable year.

In the case of the first year for which there is a deferral (over a

4-year period) of the interest otherwise payable for such year, the

applicable percentage shall be 25 percent. In the case of the

second such year, the applicable percentage shall be 35 percent. In

the case of the third such year, the applicable percentage shall be

50 percent.

(C)(i) The base year is the first year for which deferral under

this provision is requested and subsequently granted. The Secretary

of Labor shall estimate the unemployment rate for the base year. To

determine whether a State meets the requirements of subparagraph

(B)(ii)(I), the Secretary of Labor shall determine the percentage

by which the benefits and taxes in the base year with the

application of the action referred to in subparagraph (B)(ii)(I)

are lower or greater, as the case may be, than such benefits and

taxes would have been without the application of such action. In

making this determination, the Secretary shall deem the application

of the action referred to in subparagraph (B)(ii)(I) to have been

effective for the base year to the same extent as such action is

effective for the year following the year for which the deferral is

sought. Once a deferral is approved under clause (ii)(I) of

subparagraph (B) a State must continue to maintain its solvency

effort. Failure to do so shall result in the State being required

to make immediate payment of all deferred interest.

(ii) Increases in the taxable wage base from $6,000 to $7,000 or

increases after 1984 in the maximum tax rate to 5.4 percent shall

not be counted for purposes of meeting the requirement of

subparagraph (B).

(D) In the case of a State which produces a solvency effort of 50

percent, 80 percent, and 90 percent rather than the 25 percent, 35

percent, and 50 percent required under subparagraph (B), the

interest shall be computed at an interest rate which is 1

percentage point less than the otherwise applicable interest rate.

(9) Any interest otherwise due from a State on September 30 of a

calendar year after 1982 may be deferred (and no interest shall

accrue on such deferred interest) for a grace period of not to

exceed 9 months if, for the most recent 12-month period for which

data are available before the date such interest is otherwise due,

the State had an average total unemployment rate of 13.5 percent or

greater.

(c) Credit of interest on loan

Interest paid by States in accordance with this section shall be

credited to the Federal unemployment account established by section

1104(g) of this title in the Unemployment Trust Fund.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XII, Sec. 1202, as added Aug. 5,

1954, ch. 657, Sec. 3, 68 Stat. 672; amended Pub. L. 86-778, title

V, Sec. 522(a), Sept. 13, 1960, 74 Stat. 979; Pub. L. 97-35, title

XXIV, Sec. 2407(a), (b)(2), Aug. 13, 1981, 95 Stat. 879, 880; Pub.

L. 97-248, title II, Sec. 274(a), Sept. 3, 1982, 96 Stat. 557; Pub.

L. 98-21, title V, Secs. 511, 514, Apr. 20, 1983, 97 Stat. 144,

147; Pub. L. 98-118, Sec. 5(a), Oct. 11, 1983, 97 Stat. 804; Pub.

L. 99-514, Sec. 2, Oct. 22, 1986, 100 Stat. 2095; Pub. L. 100-203,

title IX, Sec. 9156(a), Dec. 22, 1987, 101 Stat. 1330-327; Pub. L.

105-33, title V, Sec. 5404(a), Aug. 5, 1997, 111 Stat. 604.)

-REFTEXT-

REFERENCES IN TEXT

Section 203 of the Federal-State Extended Unemployment

Compensation Act of 1970, referred to in subsec. (b)(3)(C)(ii), is

section 203 of Pub. L. 91-373, title II, Aug. 10, 1970, 84 Stat.

709, as amended, which is set out as a note under section 3304 of

Title 26, Internal Revenue Code.

The Internal Revenue Code of 1986, referred to in subsec. (b)(5),

(8)(B)(i), is classified generally to Title 26.

-MISC1-

AMENDMENTS

1997 - Subsec. (b)(2)(C). Pub. L. 105-33 added subpar. (C).

1987 - Subsec. (c). Pub. L. 100-203 added subsec. (c).

1986 - Subsec. (b)(5), (8)(B)(i). Pub. L. 99-514 substituted

"Internal Revenue Code of 1986" for "Internal Revenue Code of

1954".

1983 - Subsec. (b)(2). Pub. L. 98-118, Sec. 5(a)(1), substituted

"advance or advances" for "advance" in provisions preceding subpar.

(A).

Subsec. (b)(2)(A). Pub. L. 98-118, Sec. 5(a)(2), (3), substituted

"advances are" for "advance is" and "advances were" for "advance

was".

Subsec. (b)(2)(B). Pub. L. 98-118, Sec. 5(a)(4), substituted

"advances was completed" for "advance was completed".

Subsec. (b)(3)(A). Pub. L. 98-21, Sec. 514, which directed

substitution of "prior to" for "not later than" was executed, as

the probable intent of Congress, by making that substitution the

first time the phrase appeared following "Secretary of Treasury"

and not the second time that phrase appeared.

Subsec. (b)(3)(C)(i). Pub. L. 98-21, Sec. 511(c), substituted,

after subcl. II, provision that no interest shall accrue on such

deferred interest for provision that any interest the time for

payment of which was deferred under this subparagraph would bear

interest in the same manner as if it had been an advance made on

the day on which it would have been required to be paid but for

this subparagraph.

Subsec. (b)(7). Pub. L. 98-21, Sec. 511(b), struck out ", and

before January 1, 1988" after "April 1, 1982".

Subsec. (b)(8), (9). Pub. L. 98-21, Sec. 511(a), added pars. (8)

and (9).

1982 - Subsec. (b)(3)(C). Pub. L. 97-248 added subpar. (C).

1981 - Subsec. (a). Pub. L. 97-35, Sec. 2407(b)(2), designated

existing provision as subsec. (a).

Subsec. (b). Pub. L. 97-35, Sec. 2407(a), added subsec. (b).

1960 - Pub. L. 86-778 amended section generally, designating

provisions constituting subsec. (a) as entire section, substituting

"that balance of advances, made to such State under section 1321 of

this title, specified in the request" for "any remaining balance of

advances made to such State under section 1321 of this title" and

inserting "in reduction of such balance" and omitting subsecs. (b)

and (c) pertaining to appropriations and repayable advances which

were incorporated in sections 1101(d)(1) and 1323 of this title.

EFFECTIVE DATE OF 1997 AMENDMENT

Section 5404(b) of Pub. L. 105-33 provided that: "The amendments

made by this section [amending this section] shall apply to

calendar years beginning after the date of the enactment of this

Act [Aug. 5, 1997]."

EFFECTIVE DATE OF 1987 AMENDMENT

Section 9156(b) of Pub. L. 100-203 provided that: "The amendment

made by subsection (a) [amending this section] shall apply to

interest paid on advances made on or after the date of the

enactment of this Act [Dec. 22, 1987]."

EFFECTIVE DATE OF 1983 AMENDMENT

Section 5(b) of Pub. L. 98-118 provided that: "The amendments

made by this section [amending this section] shall apply to

advances made on or after April 1, 1982."

EFFECTIVE DATE OF 1982 AMENDMENT

Section 274(b) of Pub. L. 97-248 provided that: "The amendment

made by subsection (a) [amending this section] shall apply to

interest required to be paid after December 31, 1982."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1321 of this title; title

26 section 3302.

-End-

-CITE-

42 USC Sec. 1323 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XII - ADVANCES TO STATE UNEMPLOYMENT FUNDS

-HEAD-

Sec. 1323. Repayable advances to Federal Unemployment Account

-STATUTE-

There are hereby authorized to be appropriated to the Federal

unemployment account, as repayable advances, such sums as may be

necessary to carry out the purposes of this subchapter. Amounts

appropriated as repayable advances shall be repaid by transfers

from the Federal unemployment account to the general fund of the

Treasury, at such times as the amount in the Federal unemployment

account is determined by the Secretary of the Treasury, in

consultation with the Secretary of Labor, to be adequate for such

purpose. Any amount transferred as a repayment under this section

shall be credited against, and shall operate to reduce, any balance

of advances repayable under this section. Whenever, after the

application of sections 1101(f)(3) and 1102(a) of this title with

respect to the excess in the employment security administration

account as of the close of any fiscal year, there remains any

portion of such excess, so much of such remainder as does not

exceed the balance of advances made pursuant to this section shall

be transferred to the general fund of the Treasury and shall be

credited against, and shall operate to reduce, such balance of

advances. Amounts appropriated as repayable advances for purposes

of this subsection shall bear interest at a rate equal to the

average rate of interest, computed as of the end of the calendar

month next preceding the date of such advance, borne by all

interest bearing obligations of the United States then forming part

of the public debt; except that in cases in which such average rate

is not a multiple of one-eighth of 1 percent, the rate of interest

shall be the multiple of one-eighth of 1 percent next lower than

such average rate.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XII, Sec. 1203, as added Aug. 5,

1954, ch. 657, Sec. 3, 68 Stat. 672; amended Pub. L. 86-778, title

V, Sec. 522(a), Sept. 13, 1960, 74 Stat. 979; Pub. L. 91-373, title

III, Sec. 304(c), Aug. 10, 1970, 84 Stat. 716; Pub. L. 98-135,

title II, Sec. 205(a), Oct. 24, 1983, 97 Stat. 861; Pub. L.

100-203, title IX, Sec. 9155(b), Dec. 22, 1987, 101 Stat.

1330-327.)

-MISC1-

PRIOR PROVISIONS

Provisions similar to those comprising the first sentence of this

section were contained in section 1322(c), act Aug. 14, 1935, ch.

531, title XII, Sec. 1202(c), as added Aug. 5, 1954, ch. 657, Sec.

3, 68 Stat. 672, prior to amendment by Pub. L. 86-778.

AMENDMENTS

1987 - Pub. L. 100-203 struck out "(without interest)" after

"account, as repayable advances" and ", without interest," after

"shall be repaid", and inserted sentence at end relating to amounts

appropriated as repayable advances for purposes of this subsection.

1983 - Pub. L. 98-135 inserted provision requiring that amounts

appropriated as repayable advances be repaid, without interest, by

transfers from the Federal unemployment account to the general fund

of the Treasury, at such times as the amount in the Federal

unemployment account is determined by the Secretary of the

Treasury, in consultation with the Secretary of Labor, to be

adequate for such purpose, and that any amount transferred as a

repayment under this section be credited against, and operate to

reduce, any balance of advances repayable under this section.

1970 - Pub. L. 91-373 inserted reference to section 1102(a) of

this title.

1960 - Pub. L. 86-778 amended section generally, substituting

provisions relating to repayable advances to the Federal

unemployment account for former provision defining "Governor" and

now incorporated in section 1324 of this title.

EFFECTIVE DATE OF 1987 AMENDMENT

Amendment by Pub. L. 100-203 applicable to advances made on or

after Dec. 22, 1987, see section 9155(d) of Pub. L. 100-203, set

out as a note under section 1103 of this title.

RETRANSFER OF AMOUNTS TRANSFERRED FROM FEDERAL UNEMPLOYMENT ACCOUNT

TO EMPLOYMENT SECURITY ADMINISTRATION ACCOUNT AS OF SEPTEMBER 30,

1983

Section 205(b) of Pub. L. 98-135 provided that: "Any amounts

transferred from the Federal unemployment account to the employment

security administration account as of September 30, 1983, shall be

transferred back to the Federal unemployment account."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1103, 1104 of this title;

title 2 section 906.

-End-

-CITE-

42 USC Sec. 1324 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XII - ADVANCES TO STATE UNEMPLOYMENT FUNDS

-HEAD-

Sec. 1324. "Governor" defined

-STATUTE-

When used in this subchapter, the term "Governor" includes the

Mayor of the District of Columbia.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XII, Sec. 1204, as added Pub. L.

86-778, title V, Sec. 522(a), Sept. 13, 1960, 74 Stat. 979; amended

1967 Reorg. Plan No. 3, Sec. 401, eff. Nov. 3, 1967, 32 F.R. 11669,

81 Stat. 951; Pub. L. 93-198, title IV, Sec. 421, Dec. 24, 1973, 87

Stat. 789.)

-MISC1-

PRIOR PROVISIONS

Provisions similar to those comprising this section were

contained in section 1323, act Aug. 14, 1935, ch. 531, title XII,

Sec. 1203, as added Aug. 5, 1954, ch. 657, Sec. 3, 68 Stat. 672,

prior to amendment by Pub. L. 86-778.

-TRANS-

TRANSFER OF FUNCTIONS

Except as otherwise provided in Reorg. Plan No. 3 of 1967, eff.

Nov. 3, 1967 (in part), 32 F.R. 11669, 81 Stat. 948, functions of

Board of Commissioners of District of Columbia transferred to

Commissioner of District of Columbia by section 401 of Reorg. Plan

No. 3 of 1967. Office of Commissioner of District of Columbia, as

established by Reorg. Plan No. 3 of 1967, abolished as of noon Jan.

2, 1975, by Pub. L. 93-198, title VII, Sec. 711, Dec. 24, 1973, 87

Stat. 818, and replaced by office of Mayor of District of Columbia

by section 421 of Pub. L. 93-198. Accordingly, "Mayor" substituted

in text for "Commissioners".

-End-

-CITE-

42 USC SUBCHAPTER XIII - RECONVERSION UNEMPLOYMENT

BENEFITS FOR SEAMEN 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XIII - RECONVERSION UNEMPLOYMENT BENEFITS FOR SEAMEN

-HEAD-

SUBCHAPTER XIII - RECONVERSION UNEMPLOYMENT BENEFITS FOR SEAMEN

-End-

-CITE-

42 USC Secs. 1331 to 1336 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XIII - RECONVERSION UNEMPLOYMENT BENEFITS FOR SEAMEN

-HEAD-

Secs. 1331 to 1336. Repealed. Pub. L. 98-369, div. B, title VI,

Sec. 2663(f), July 18, 1984, 98 Stat. 1168

-MISC1-

Section 1331, act Aug. 14, 1935, ch. 531, title XIII, Sec. 1301,

as added Aug. 10, 1946, ch. 951, title III, Sec. 306, 60 Stat. 982;

amended 1949 Reorg. Plan No. 2, Sec. 1, eff. Aug. 19, 1949, 14 F.R.

5225, 63 Stat. 1065, provided for administration of this chapter by

Secretary of Labor.

Section 1332, act Aug. 14, 1935, ch. 531, title XIII, Sec. 1302,

as added Aug. 10, 1946, ch. 951, title III, Sec. 306, 60 Stat. 982;

amended July 16, 1949, ch. 342, Secs. 1-3, 63 Stat. 445, defined

"reconversion period", "compensation", "Federal maritime service",

and "Federal maritime wages".

Section 1333, act Aug. 14, 1935, ch. 531, title XIII, Sec. 1303,

as added Aug. 10, 1946, ch. 951, title III, Sec. 306, 60 Stat. 982;

amended 1949 Reorg. Plan No. 2, Sec. 1, eff. Aug. 20, 1949, 14 F.R.

5225, 63 Stat. 1065, related to compensation for seamen, agreements

with states, payments in absence of agreements, wage information,

and determination of wages.

Section 1334, act Aug. 14, 1935, ch. 531, title XIII, Sec. 1304,

as added Aug. 10, 1946, ch. 951, title III, Sec. 306, 60 Stat. 982;

amended 1949 Reorg. Plan No. 2, Sec. 1, eff. Aug. 19, 1949, 14 F.R.

5225, 63 Stat. 1065, related to review of determinations and

reports.

Section 1335, act Aug. 14, 1935, ch. 531, title XIII, Sec. 1305,

as added Aug. 10, 1946, ch. 951, title III, Sec. 306, 60 Stat. 982;

amended 1949 Reorg. Plan No. 2, Sec. 1, eff. Aug. 19, 1949, 14 F.R.

5225, 63 Stat. 1065, related to payments to States, certification

of such payments by Secretary of Labor to Secretary of the

Treasury, and return of unused funds.

Section 1336, act Aug. 14, 1935, ch. 531, title XIII, Sec. 1306,

as added Aug. 10, 1946, ch. 951, title III, Sec. 306, 60 Stat. 982;

amended 1949 Reorg. Plan No. 2, Sec. 1, eff. Aug. 19, 1949, 14 F.R.

5225, 63 Stat. 1065, related to penalties.

EFFECTIVE DATE OF REPEAL

Repeal effective July 18, 1984, but such repeal shall not be

construed as changing or affecting any right, liability, status, or

interpretation which existed before that date, see section 2664(b)

of Pub. L. 98-369, set out as an Effective Date of 1984 Amendment

note under section 401 of this title.

-End-

-CITE-

42 USC SUBCHAPTER XIV - GRANTS TO STATES FOR AID TO

PERMANENTLY AND TOTALLY DISABLED 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XIV - GRANTS TO STATES FOR AID TO PERMANENTLY AND TOTALLY

DISABLED

-HEAD-

SUBCHAPTER XIV - GRANTS TO STATES FOR AID TO PERMANENTLY AND

TOTALLY DISABLED

-STATAMEND-

REPEAL OF SUBCHAPTER; INAPPLICABILITY OF REPEAL TO PUERTO RICO,

GUAM, AND VIRGIN ISLANDS

Pub. L. 92-603, title III, Sec. 303(a), (b), Oct. 30, 1972, 86

Stat. 1484, provided that this subchapter is repealed effective

Jan. 1, 1974, except with respect to Puerto Rico, Guam, and the

Virgin Islands.

-SECREF-

SUBCHAPTER REFERRED TO IN OTHER SECTIONS

This subchapter is referred to in sections 428, 611, 671, 1301,

1306a, 1308, 1309, 1311, 1315, 1316, 1318, 1319, 1320b-2, 1320b-3,

1320b-7, 1382, 1382c, 1395v, 1396a, 1396b, 1396d of this title;

title 7 sections 2012, 2014; title 8 section 1255a; title 26

section 6103.

-End-

-CITE-

42 USC Sec. 1351 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XIV - GRANTS TO STATES FOR AID TO PERMANENTLY AND TOTALLY

DISABLED

-HEAD-

Sec. 1351. Authorization of appropriations

-STATUTE-

For the purpose of enabling each State to furnish financial

assistance, as far as practicable under the conditions in such

State, to needy individuals eighteen years of age and older who are

permanently and totally disabled, there is hereby authorized to be

appropriated for each fiscal year a sum sufficient to carry out the

purposes of this subchapter. The sums made available under this

section shall be used for making payments to States which have

submitted, and had approved by the Secretary, State plans for aid

to the permanently and totally disabled.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XIV, Sec. 1401, as added Aug. 28,

1950, ch. 809, title III, pt. 5, Sec. 351, 64 Stat. 555; amended

1953 Reorg. Plan No. 1, Secs. 5, 8, eff. Apr. 11, 1953, 18 F.R.

2053, 67 Stat. 631; Aug. 1, 1956, ch. 836, title III, Sec. 314(a),

70 Stat. 849; Pub. L. 87-543, title I, Sec. 104(c)(4), July 25,

1962, 76 Stat. 186; Pub. L. 97-35, title XXI, Sec. 2184(c)(1), Aug.

13, 1981, 95 Stat. 817.)

-STATAMEND-

REPEAL OF SECTION

Pub. L. 92-603, title III, Sec. 303(a), (b), Oct. 30, 1972, 86

Stat. 1484, provided that this section is repealed effective Jan.

1, 1974, except with respect to Puerto Rico, Guam, and the Virgin

Islands.

-MISC1-

AMENDMENTS

1981 - Pub. L. 97-35 struck out "and of encouraging each State,

as far as practicable under such conditions, to furnish

rehabilitation and other services to help such individuals attain

and retain capability for self-support or self-care" after "and

totally disabled".

1962 - Pub. L. 87-543 inserted "to furnish rehabilitation and

other services" before "to help such individuals" and "or retain

capability for" after "attain".

1956 - Act Aug. 1, 1956, restated purpose to include assistance

to individuals to attain self-support of self-care.

-TRANS-

TRANSFER OF FUNCTIONS

Functions of Federal Security Administrator transferred to

Secretary of Health, Education, and Welfare and all agencies of

Federal Security Agency transferred to Department of Health,

Education, and Welfare by section 5 of Reorg. Plan No. 1 of 1953,

set out as a note under section 3501 of this title. Federal

Security Agency and office of Administrator abolished by section 8

of Reorg. Plan No. 1 of 1953. Secretary and Department of Health,

Education, and Welfare redesignated Secretary and Department of

Health and Human Services by section 509(b) of Pub. L. 96-88 which

is classified to section 3508(b) of Title 20, Education.

-End-

-CITE-

42 USC Sec. 1352 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XIV - GRANTS TO STATES FOR AID TO PERMANENTLY AND TOTALLY

DISABLED

-HEAD-

Sec. 1352. State plans for aid to permanently and totally disabled

-STATUTE-

(a) A State plan for aid to the permanently and totally disabled

must (1) except to the extent permitted by the Secretary with

respect to services, provide that it shall be in effect in all

political subdivisions of the State, and, if administered by them,

be mandatory upon them; (2) provide for financial participation by

the State; (3) either provide for the establishment or designation

of a single State agency to administer the plan, or provide for the

establishment or designation of a single State agency to supervise

the administration of the plan; (4) provide (A) for granting an

opportunity for a fair hearing before the State agency to any

individual whose claim for aid to the permanently and totally

disabled is denied or is not acted upon with reasonable promptness,

and (B) that if the State plan is administered in each of the

political subdivisions of the State by a local agency and such

local agency provides a hearing at which evidence may be presented

prior to a hearing before the State agency, such local agency may

put into effect immediately upon issuance its decision upon the

matter considered at such hearing; (5) provide (A) such methods of

administration (including methods relating to the establishment and

maintenance of personnel standards on a merit basis, except that

the Secretary shall exercise no authority with respect to the

selection, tenure of office, and compensation of any individual

employed in accordance with such methods) as are found by the

Secretary to be necessary for the proper and efficient operation of

the plan, and (B) for the training and effective use of paid

subprofessional staff, with particular emphasis on the full-time or

part-time employment of recipients and other persons of low income,

as community service aides, in the administration of the plan and

for the use of nonpaid or partially paid volunteers in a social

service volunteer program in providing services to applicants and

recipients and in assisting any advisory committees established by

the State agency; (6) provide that the State agency will make such

reports, in such form and containing such information, as the

Secretary may from time to time require, and comply with such

provisions as the Secretary may from time to time find necessary to

assure the correctness and verification of such reports; (7)

provide that no aid will be furnished any individual under the plan

with respect to any period with respect to which he is receiving

old-age assistance under the State plan approved under section 302

of this title, assistance under a State program funded under part A

of subchapter IV of this chapter, or aid to the blind under the

State plan approved under section 1202 of this title; (8) provide

that the State agency shall, in determining need, take into

consideration any other income and resources of an individual

claiming aid to the permanently and totally disabled, as well as

any expenses reasonably attributable to the earning of any such

income; except that, in making such determination, (A) the State

agency may disregard not more than $7.50 of any income, (B) of the

first $80 per month of additional income which is earned the State

agency may disregard not more than the first $20 thereof plus

one-half of the remainder, and (C) the State agency may, for a

period not in excess of 36 months, disregard such additional

amounts of other income and resources, in the case of an individual

who has a plan for achieving self-support approved by the State

agency, as may be necessary for the fulfillment of such plan, but

only with respect to the part or parts of such period during

substantially all of which he is actually undergoing vocational

rehabilitation; (9) provide safeguards which permit the use or

disclosure of information concerning applicants or recipients only

(A) to public officials who require such information in connection

with their official duties, or (B) to other persons for purposes

directly connected with the administration of the State plan; (10)

provide that all individuals wishing to make application for aid to

the permanently and totally disabled shall have opportunity to do

so, and that aid to the permanently and totally disabled shall be

furnished with reasonable promptness to all eligible individuals;

(11) effective July 1, 1953, provide, if the plan includes payments

to individuals in private or public institutions, for the

establishment or designation of a State authority or authorities

which shall be responsible for establishing and maintaining

standards for such institutions; (12) provide a description of the

services (if any) which the State agency makes available (using

whatever internal organizational arrangement it finds appropriate

for this purpose) to applicants for and recipients of aid to the

permanently and totally disabled to help them attain self-support

or self-care, including a description of the steps taken to assure,

in the provision of such services, maximum utilization of other

agencies providing similar or related services; and (13) provide

that information is requested and exchanged for purposes of income

and eligibility verification in accordance with a State system

which meets the requirements of section 1320b-7 of this title.

(b) The Secretary shall approve any plan which fulfills the

conditions specified in subsection (a) of this section, except that

he shall not approve any plan which imposes, as a condition of

eligibility for aid to the permanently and totally disabled under

the plan -

(1) Any residence requirement which excludes any resident of

the State who has resided therein five years during the nine

years immediately preceding the application for aid to the

permanently and totally disabled and has resided therein

continuously for one year immediately preceding the application;

(2) Any citizenship requirement which excludes any citizen of

the United States.

At the option of the State, the plan may provide that manuals and

other policy issuances will be furnished to persons without charge

for the reasonable cost of such materials, but such provision shall

not be required by the Secretary as a condition for the approval of

such plan under this subchapter.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XIV, Sec. 1402, as added Aug. 28,

1950, ch. 809, title III, pt. 5, Sec. 351, 64 Stat. 555; amended

1953 Reorg. Plan No. 1, Secs. 5, 8, eff. Apr. 11, 1953, 18 F.R.

2053, 67 Stat. 631; Aug. 1, 1956, ch. 836, title III, Sec. 314(b),

70 Stat. 850; Pub. L. 87-543, title I, Secs. 104(a)(3)(I),

106(a)(3), July 25, 1962, 76 Stat. 185, 188; Pub. L. 89-97, title

IV, Sec. 403(d) July 30, 1965, 79 Stat. 418; Pub. L. 90-248, title

II, Secs. 210(a)(4), 213(a)(3), Jan. 2, 1968, 81 Stat. 896, 898;

Pub. L. 92-603, title IV, Secs. 405(c), 406(c), 407(c), 410(c),

413(c), Oct. 30, 1972, 86 Stat. 1488, 1489, 1491, 1492; Pub. L.

98-369, div. B, title VI, Sec. 2651(g), July 18, 1984, 98 Stat.

1150; Pub. L. 104-193, title I, Sec. 108(h), Aug. 22, 1996, 110

Stat. 2169.)

-STATAMEND-

REPEAL OF SECTION

Pub. L. 92-603, title III, Sec. 303(a), (b), Oct. 30, 1972, 86

Stat. 1484, provided that this section is repealed effective Jan.

1, 1974, except with respect to Puerto Rico, Guam, and the Virgin

Islands.

-REFTEXT-

REFERENCES IN TEXT

Part A of subchapter IV of this chapter, referred to in subsec.

(a)(7), is classified to section 601 et seq. of this title.

-MISC1-

AMENDMENTS

1996 - Subsec. (a)(7). Pub. L. 104-193 substituted "assistance

under a State program funded under part A of subchapter IV of this

chapter" for "aid to families with dependent children under the

State plan approved under section 602 of this title".

1984 - Subsec. (a)(13). Pub. L. 98-369 added cl. (13).

1972 - Subsec. (a)(1). Pub. L. 92-603, Sec. 410(c), inserted

"except to the extent permitted by the Secretary with respect to

services" before "provide".

Subsec. (a)(4). Pub. L. 92-603, Sec. 407(c), designated existing

provisions as subcl. (A) and added subcl. (B).

Subsec. (a)(9). Pub. L. 92-603, Sec. 413(c), substituted

provisions permitting the use or disclosure of information

concerning applicants or recipients to public officials requiring

such information in connection with their official duties and to

other persons for purposes directly connected with the

administration of the State plan, for provisions restricting the

use or disclosure of such information to purposes directly

connected with the administration of aid to the permanently and

totally disabled.

Subsec. (a)(12). Pub. L. 92-603, Sec. 405(c), inserted provision

relating to the use of whatever internal organizational arrangement

found appropriate.

Subsec. (b). Pub. L. 92-603, Sec. 406(c), inserted provision

relating to the furnishing of manuals and other policy issuances to

persons without charge and at the option of the State.

1968 - Subsec. (a)(5). Pub. L. 90-248, Sec. 210(a)(4), designated

existing provisions as subcl. (A) and added subcl. (B).

Subsec. (a)(8)(A). Pub. L. 90-248 Sec. 213(a)(3), increased from

$5 to $7.50 limitation on amount of any income which the State may

disregard in making its determination of need.

1965 - Subsec. (a)(8). Pub. L. 89-97 inserted exception

prohibiting disregard by State in making its determination of need

of more than $5 of any income or of more than the first $20 of the

first $80 per month of additional income which is earned and

allowing disregard, for a period not in excess of 36 months, of

such additional amounts of other income and resources as may be

necessary to the fulfillment of approved plan for achieving

self-support but only as to the part or parts of such period during

substantially all of which he is actually undergoing vocational

rehabilitation.

1962 - Subsec. (a)(7). Pub. L. 87-543, Sec. 104(a)(3)(I),

substituted "aid to families with dependent children" for "aid to

dependent children".

Subsec. (a)(8). Pub. L. 87-543, Sec. 106(a)(3), inserted ", as

well as any expenses reasonably attributable to the earning of any

such income".

1956 - Subsec. (a)(12). Act Aug. 1, 1956, added cl. (12).

EFFECTIVE DATE OF 1996 AMENDMENT

Amendment by Pub. L. 104-193 effective July 1, 1997, with

transition rules relating to State options to accelerate such date,

rules relating to claims, actions, and proceedings commenced before

such date, rules relating to closing out of accounts for terminated

or substantially modified programs and continuance in office of

Assistant Secretary for Family Support, and provisions relating to

termination of entitlement under AFDC program, see section 116 of

Pub. L. 104-193, as amended, set out as an Effective Date note

under section 601 of this title.

EFFECTIVE DATE OF 1984 AMENDMENT

Amendment by Pub. L. 98-369 effective Apr. 1, 1985, except as

otherwise provided, see section 2651(l)(2) of Pub. L. 98-369, set

out as an Effective Date note under section 1320b-7 of this title.

EFFECTIVE DATE OF 1968 AMENDMENT

Amendment by section 210(a)(4) of Pub. L. 90-248 effective July

1, 1969, or, if earlier (with respect to a State's plan approved

under this subchapter) on the date as of which the modification of

the State plan to comply with such amendment is approved, see

section 210(b) of Pub. L. 90-248, set out as a note under section

302 of this title.

EFFECTIVE DATE OF 1965 AMENDMENT

Section 403(d) of Pub. L. 89-97 provided that the amendment made

by that section is effective Oct. 1, 1965.

EFFECTIVE DATE OF 1962 AMENDMENT

Amendment by section 106(a)(3) of Pub. L. 87-543 effective July

1, 1963, see section 202(a) of Pub. L. 87-543, set out as a note

under section 302 of this title.

EFFECTIVE DATE OF 1956 AMENDMENT

Amendment by act Aug. 1, 1956, effective July 1, 1957, see

section 314 [315] of act Aug. 1, 1956, set out as a note under

section 302 of this title.

-TRANS-

TRANSFER OF FUNCTIONS

Functions, powers, and duties of Secretary under subsec.

(a)(5)(A) of this section, insofar as relates to the prescription

of personnel standards on a merit basis, transferred to Office of

Personnel Management, see section 4728(a)(3)(D) of this title.

Functions of Federal Security Administrator transferred to

Secretary of Health, Education, and Welfare and all agencies of

Federal Security Agency transferred to Department of Health,

Education, and Welfare by section 5 of Reorg. Plan No. 1 of 1953,

set out as a note under section 3501 of this title. Federal

Security Agency and office of Administrator abolished by section 8

of Reorg. Plan No. 1 of 1953. Secretary and Department of Health,

Education, and Welfare redesignated Secretary and Department of

Health and Human Services by section 509(b) of Pub. L. 96-88 which

is classified to section 3508(b) of Title 20, Education.

-MISC2-

PUBLIC ACCESS TO STATE DISBURSEMENT RECORDS

Public access to State records of disbursements of funds and

payments under this subchapter, see note set out under section 302

of this title.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1315, 1354, 1355, 1382a,

4728 of this title; title 25 section 996.

-End-

-CITE-

42 USC Sec. 1353 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XIV - GRANTS TO STATES FOR AID TO PERMANENTLY AND TOTALLY

DISABLED

-HEAD-

Sec. 1353. Payments to States

-STATUTE-

(a) From the sums appropriated therefor, the Secretary of the

Treasury shall pay to each State which has an approved plan for aid

to the permanently and totally disabled, for each quarter,

beginning with the quarter commencing October 1, 1958 -

(1) Repealed. Pub. L. 97-35, title XXI, Sec. 2184(c)(2)(A),

Aug. 13, 1981, 95 Stat. 817.

(2) in the case of Puerto Rico, the Virgin Islands, and Guam,

an amount equal to one-half of the total of the sums expended

during such quarter as aid to the permanently and totally

disabled under the State plan, not counting so much of any

expenditure with respect to any month as exceeds $37.50

multiplied by the total number of recipients of aid to the

permanently and totally disabled for such month; and

(3) in the case of any State, an amount equal to 50 percent of

the total amounts expended during such quarter as found necessary

by the Secretary for the proper and efficient administration of

the State plan.

(b) The method of computing and paying such amounts shall be as

follows:

(1) The Secretary of Health and Human Services shall, prior to

the beginning of each quarter, estimate the amount to be paid to

the State for such quarter under the provisions of subsection (a)

of this section, such estimate to be based on (A) a report filed

by the State containing its estimate of the total sum to be

expended in such quarter in accordance with the provisions of

subsection (a) of this section, and stating the amount

appropriated or made available by the State and its political

subdivisions for such expenditures in such quarter, and if such

amount is less than the State's proportionate share of the total

sum of such estimated expenditures, the source or sources from

which the difference is expected to be derived, (B) records

showing the number of permanently and totally disabled

individuals in the State, and (C) such other investigation as the

Secretary of Health and Human Services may find necessary.

(2) The Secretary of Health and Human Services shall then

certify to the Secretary of the Treasury the amount so estimated

by the Secretary of Health and Human Services, (A) reduced or

increased, as the case may be, by any sum by which he finds that

his estimate for any prior quarter was greater or less than the

amount which should have been paid to the State under subsection

(a) of this section for such quarter, and (B) reduced by a sum

equivalent to the pro rata share to which the United States is

equitably entitled, as determined by the Secretary of Health and

Human Services, of the net amount recovered during a prior

quarter by the State or any political subdivision thereof with

respect to aid to the permanently and totally disabled furnished

under the State plan; except that such increases or reductions

shall not be made to the extent that such sums have been applied

to make the amount certified for any prior quarter greater or

less than the amount estimated by the Secretary of Health and

Human Services for such prior quarter: Provided, That any part of

the amount recovered from the estate of a deceased recipient

which is not in excess of the amount expended by the State or any

political subdivision thereof for the funeral expenses of the

deceased shall not be considered as a basis for reduction under

clause (B) of this paragraph.

(3) The Secretary of the Treasury shall thereupon, through the

Fiscal Service of the Treasury Department, and prior to audit or

settlement by the General Accounting Office, pay to the State, at

the time or times fixed by the Secretary of Health and Human

Services, the amount so certified.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XIV, Sec. 1403, as added Aug. 28,

1950, ch. 809, title III, pt. 5, Sec. 351, 64 Stat. 556; amended

July 18, 1952, ch. 945, Sec. 8(d), 66 Stat. 779; 1953 Reorg. Plan

No. 1, Secs. 5, 8, eff. Apr. 11, 1953, 18 F.R. 2053, 67 Stat. 631;

Aug. 1, 1956, ch. 836, title III, Secs. 304, 314(c), 344, 70 Stat.

847, 850, 854; Pub. L. 85-840, title V, Sec. 504, Aug. 28, 1958, 72

Stat. 1049; Pub. L. 87-64, title III, Sec. 303(c), June 30, 1961,

75 Stat. 143; Pub. L. 87-543, title I, Secs. 101(a)(4), (b)(4),

132(c), July 25, 1962, 76 Stat. 178, 181, 195; Pub. L. 89-97, title

I, Sec. 122, title IV, Sec. 401(e), July 30, 1965, 79 Stat. 353,

415; Pub. L. 90-248, title II, Sec. 212(c), Jan. 2, 1968, 81 Stat.

897; Pub. L. 92-512, title III, Sec. 301(b), (d), Oct. 20, 1972, 86

Stat. 946, 947; Pub. L. 93-647, Secs. 3(e)(2), 5(d), Jan. 4, 1975,

88 Stat. 2349, 2350; Pub. L. 96-88, title V, Sec. 509(b), Oct. 17,

1979, 93 Stat. 695; Pub. L. 97-35, title XXI, Sec. 2184(c)(2),

title XXV, Sec. 2353(l), Aug. 13, 1981, 95 Stat. 817, 873; Pub. L.

99-603, title I, Sec. 121(b)(4), Nov. 6, 1986, 100 Stat. 3391; Pub.

L. 103-66, title XIII, Sec. 13741(b), Aug. 10, 1993, 107 Stat.

663.)

-STATAMEND-

REPEAL OF SECTION

Pub. L. 92-603, title III, Sec. 303(a), (b), Oct. 30, 1972, 86

Stat. 1484, provided that this section is repealed effective Jan.

1, 1974, except with respect to Puerto Rico, Guam, and the Virgin

Islands.

-MISC1-

AMENDMENTS

1993 - Subsec. (a)(3). Pub. L. 103-66 substituted "50 percent of

the total amounts expended during such quarter as found necessary

by the Secretary for the proper and efficient administration of the

State plan." for "the sum of the following proportions of the total

amounts expended during such quarter as found necessary by the

Secretary of Health and Human Services for the proper and official

administration of the State plan -

"(A) 75 per centum of so much of such expenditures as are for

the training (including both short- and long-term training at

educational institutions through grants to such institutions or

by direct financial assistance to students enrolled in such

institutions) of personnel employed or preparing for employment

by the State agency or by the local agency administering the plan

in the political subdivision; plus

"(B) 100 percent of so much of such expenditures as are for the

costs of the implementation and operation of the immigration

status verification system described in section 1320b-7(d) of

this title; plus

"(C) one-half of the remainder of such expenditures."

1986 - Subsec. (a)(3)(B), (C). Pub. L. 99-603 added subpar. (B)

and redesignated former subpar. (B) as (C).

1981 - Subsec. (a)(1). Pub. L. 97-35, Sec. 2184(c)(2)(A), struck

out par. (1) which provided for computation of the amount of

payments in the case of any State other than Puerto Rico, the

Virgin Islands, and Guam.

Subsec. (a)(2). Pub. L. 97-35, Sec. 2184(c)(2)(B), struck out

"(including expenditures for premiums under part B of subchapter

XVIII of this chapter for individuals who are recipients of money

payments under such plan and other insurance premiums for medical

or any other type of remedial care or the cost thereof)".

Subsec. (a)(3). Pub. L. 97-35, Sec. 2353(l)(1)(A), redesignated

subpar. (A)(iv) as subpar. (A), struck out former subpars. (A)(i),

which included services prescribed pursuant to subsec. (c)(1) of

this section and provided to applicants for or recipients of aid to

the permanently and totally disabled to help them attain

self-support, (A)(ii), which included other services, specified by

the Secretary as likely to prevent or reduce dependency, and

(A)(iii), which included any of the services in subpars. (A)(i) and

(ii) deemed appropriate for individuals likely to become applicants

for or recipients of aid to the permanently and totally disabled,

redesignated former subpar. (C) as (B), and struck out former

subpar. (B), which included one-half of so much of the

expenditures, not included in subpar. (A), as are for services for

applicants for or recipients of aid to the permanently and totally

disabled or individuals likely to become applicants or recipients,

and subpars. (D) and (E) and provision following subpar. (E), which

specified what services were includible.

Subsec. (a)(4). Pub. L. 97-35, Sec. 2353(l)(1)(B), struck out

par. (4), which provided payment, in the case of any State whose

plan approved under section 1352 of this title did not meet the

requirements of subsec. (c)(1) of this section, of an amount equal

to one-half of the total of the sums expended during the quarter as

found necessary by the Secretary for the proper and efficient

administration of the State plan.

Subsec. (c). Pub. L. 97-35, Sec. 2353(l)(2), struck out subsec.

(c) which prescribed eligibility requirements for payments.

1975 - Subsec. (a). Pub. L. 93-647, Sec. 3(e)(2), struck out

"(subject to section 1320b of this title)" after "the Secretary of

the Treasury shall".

Subsec. (a)(3)(A)(iv). Pub. L. 93-647, Sec. 5(d), inserted

"(including both short- and long-term training at educational

institutions through grants to such institutions or by direct

financial assistance to students enrolled in such institutions)"

after "training".

1972 - Subsec. (a). Pub. L. 92-512, Sec. 301(d), substituted

"shall (subject to section 1320b of this title) pay" for "shall

pay" in provisions preceding par. (1).

Subsec. (a)(3)(E). Pub. L. 92-512, Sec. 301(b), substituted

"under conditions which shall be" for "subject to limitations".

1968 - Subsec. (a)(3)(D). Pub. L. 90-248 inserted, "except to the

extent specified by the Secretary" after "shall" in introductory

text to subpar. (D).

1965 - Subsec. (a)(1). Pub. L. 89-97, Secs. 122, 401(e), inserted

"premiums under part B of subchapter XVIII of this chapter for

individuals who are recipients of money payments under such plan

and other" after "expenditures for" in parenthetical phrase

appearing in so much of par. (1) as precedes clause (A); and

substituted "31/37" and "$37" for "29/35" and "$35" in subpar. (A)

and "$75" for "$70" in subpar. (B), respectively.

Subsec. (a)(2). Pub. L. 89-97, Sec. 122, inserted "premiums under

part B of subchapter XVIII of this chapter for individuals who are

recipients of money payments under such plan and other" after

"expenditures for" in parenthetical phrase.

1962 - Subsec. (a)(1). Pub. L. 87-543, Sec. 132(c), substituted

"29/35" and "$35" for "four-fifths" and "$31", respectively, in

subpar. (A) and "$70" for "$66" in subpar. (B).

Subsec. (a)(2). Pub. L. 87-543, Sec. 132(c), substituted "$37.50"

for "$35.50".

Subsec. (a)(3). Pub. L. 87-543, Sec. 101(a)(4), (b)(4)(A),

inserted in opening provisions "whose State plan approved under

section 1352 of this title meets the requirements of subsection

(c)(1) of this section" after "any State", and substituted

provisions which increased the Federal share of expenses of

administration of State public assistance plans by providing

quarterly payments of the sum of 75 per centum of the quarterly

expenses for certain prescribed services to help attain and retain

capability for self-support or self-care, services likely to

prevent or reduce dependency, and services appropriate for

individuals who were or are likely to become applicants for or

recipients of aid to the permanently and totally disabled and

request such services, and training of State or local public

assistance personnel administering such plans and one-half of other

administrative expenses for other services, permitted State health

or vocational rehabilitation or other appropriate State agencies to

furnish such services, except vocational rehabilitation services,

and required the determination of the portion of expenses covered

by the 75 and 50 per centum provisions in accordance with methods

and procedures permitted by the Secretary, for former provisions

requiring quarterly payments of one-half of quarterly expenses of

administration of State plans, including staff services of State or

local public assistance agencies to applicants for and recipients

of aid to the permanently and totally disabled to help them attain

self-support or self-care.

Subsec. (a)(4). Pub. L. 87-543, Sec. 101(b)(4)(B), added par.

(4).

Subsec. (c). Pub. L. 87-543, Sec. 101(b)(4)(C), added subsec.

(c).

1961 - Subsec. (a). Pub. L. 87-64 substituted "$31" for "$30" and

"$66" for "$65" in cl. (1), and "$35.50" for "$35" in cl. (2).

1958 - Subsec. (a). Pub. L. 85-840 increased the payments to the

States to four-fifths of the first $30 of the average monthly

payment per recipient, including assistance in the form of money

payments and in the form of medical or any other type of remedial

care, plus the Federal percentage of the amount by which the

expenditures exceed the maximum which may be counted under cl. (A),

but excluding that part of the average monthly payment per

recipient in excess of $65, increased the average monthly payment

to Puerto Rico and the Virgin Islands from $30 to $35, excluded

Guam from the provisions which authorize an average monthly payment

of $65 and included Guam within the provisions which authorize an

average monthly payment of $35, and permitted the counting of

individuals with respect to whom expenditures were made as old-age

assistance in the form of medical or any other type of remedial

care in determining the total number of recipients.

1956 - Subsec. (a). Act Aug. 1, 1956, Sec. 304, substituted

"during such quarter as aid to the permanently and totally disabled

in the form of money payments under the State plan" for "during

such quarter as aid to the permanently and totally disabled under

the State plan" in cls. (1) and (2), "who received aid to the

permanently and totally disabled in the form of money payments for

each month" for "who received aid to the permanently and totally

disabled for such month" in par. (A) of cl. (1), and inserted cl.

(4).

Act Aug. 1, 1956, Sec. 314(c), struck out ", which shall be used

exclusively as aid to the permanently and totally disabled," after

"the Virgin Islands, an amount" in cls. (1) and (2), and

substituted "including services which are provided by the staff of

the State agency (or of the local agency administering the State

plan in the political subdivision) to applicants for and recipients

of such aid to help them attain self-support or self-care" for

"which amount shall be used for paying the costs of administering

the State plan or for aid to the permanently and totally disabled

or both, and for no other purpose" in cl. (3).

Act Aug. 1, 1956, Sec. 344, substituted "October 1, 1956" for

"October 1, 1952", struck out ", which shall be used exclusively as

aid to the permanently and totally disabled," after "the Virgin

Islands, an amount" in cls. (1) and (2), and substituted "$60" for

"$55", "the product of "$30" for "the product of $25", "Secretary

of Health, Education, and Welfare" for "Secretary", and "including

services which are provided by the staff of the State agency (or of

the local agency administering the State plan in the political

subdivision) to applicants for and recipients of such aid to help

them attain self-support or self-care" for "which amount shall be

used for paying the costs of administering the State plan or for

aid to the permanently and totally disabled, or both, and for no

other purpose".

1952 - Subsec. (a). Act July 18, 1952, increased the Federal

share of the State's average monthly payment to four-fifths of the

first $25 plus one-half of the remainder within individual maximums

of $55, and changed formulas for computing the Federal share of

public assistance for Puerto Rico and the Virgin Islands.

EFFECTIVE DATE OF 1993 AMENDMENT

Amendment by Pub. L. 103-66 effective with respect to calendar

quarters beginning on or after Apr. 1, 1994, with special rule for

States whose legislature meets biennially, and does not have

regular session scheduled in calendar year 1994, see section

13741(c) of Pub. L. 103-66, set out as a note under section 303 of

this title.

EFFECTIVE DATE OF 1986 AMENDMENT

Amendment by Pub. L. 99-603 effective Oct. 1, 1987, see section

121(c)(2) of Pub. L. 99-603, set out as a note under section 502 of

this title.

EFFECTIVE DATE OF 1981 AMENDMENT

Amendment by section 2353(l) of Pub. L. 97-35 effective Oct. 1,

1981, except as otherwise explicitly provided, see section 2354 of

Pub. L. 97-35, set out as an Effective Date note under section 1397

of this title.

EFFECTIVE DATE OF 1975 AMENDMENT

Amendment by section 3(e)(2) of Pub. L. 93-647 effective with

respect to payments under sections 603 and 803 of this title for

quarters commencing after Sept. 30, 1975, and amendment by section

5(d) of Pub. L. 93-647 effective with respect to payments for

quarters commencing after Sept. 30, 1975, see section 7(a), (b) of

Pub. L. 93-647, set out as a note under section 303 of this title.

EFFECTIVE DATE OF 1972 AMENDMENT

Amendments by Pub. L. 92-512 effective July 1, 1972, and Jan. 1,

1973, respectively, see section 301(e) of Pub. L. 92-512, set out

as a note under section 303 of this title.

EFFECTIVE DATE OF 1968 AMENDMENT

Amendment by Pub. L. 90-248 effective Jan. 1, 1968, see section

212(e) of Pub. L. 90-248, set out as a note under section 303 of

this title.

EFFECTIVE DATE OF 1965 AMENDMENT

Amendment by section 401(e) of Pub. L. 89-97 applicable in the

case of expenditures made after December 31, 1965, under a State

plan approved under subchapter I, IV, X, XIV, or XVI of this

chapter, see section 401(f) of Pub. L. 89-97, set out as a note

under section 303 of this title.

EFFECTIVE DATE OF 1962 AMENDMENT

Amendment by section 101(a)(4) of Pub. L. 87-543 applicable in

the case of expenditures, under a State plan approved under

subchapter I, IV, X, or XIV of this chapter, as the case may be,

made after Aug. 31, 1962, amendment by section 101(b)(4) of Pub. L.

87-543 applicable in the case of expenditures, under a State plan

approved under subchapter I, IV, X, or XIV of this chapter, as the

case may be, made after June 30, 1963, and amendment by section

132(c) of Pub. L. 87-543 applicable in the case of expenditures,

under a State plan approved under subchapter I, IV, X, or XIV of

this chapter, as the case may be, made after Sept. 30, 1962, see

section 202(d), (f) of Pub. L. 87-543, set out as a note under

section 303 of this title.

EFFECTIVE DATE OF 1961 AMENDMENT

Amendment by Pub. L. 87-64 applicable only in the case of

expenditures made after Sept. 30, 1961, and before July 1, 1962,

under a State plan approved under subchapters I, X, or XIV of this

chapter, see section 303(e) of Pub. L. 87-64, set out as a note

under section 303 of this title.

EFFECTIVE DATE OF 1958 AMENDMENT

For effective date of amendment by Pub. L. 85-840, see section

512 of Pub. L. 85-840, set out as a note under section 303 of this

title.

EFFECTIVE AND TERMINATION DATE OF 1956 AMENDMENT

Amendment by section 304 of act Aug. 1, 1956, effective July 1,

1957, see section 305 of act Aug. 1, 1956, set out as a note under

section 303 of this title.

Amendment by section 344 of act Aug. 1, 1956, effective only for

period beginning Oct. 1, 1956, and ending with close of June 30,

1959, see section 345 of such act Aug. 1, 1956, set out as a note

under section 303 of this title.

EFFECTIVE AND TERMINATION DATE OF 1952 AMENDMENT

Amendment by act July 18, 1952, effective for period beginning

Oct. 1, 1952, and ending Sept. 30, 1956, see section 8(e) of act

July 18, 1952, set out as a note set out under section 303 of this

title.

-TRANS-

TRANSFER OF FUNCTIONS

Functions of Federal Security Administrator transferred to

Secretary of Health, Education, and Welfare and all agencies of

Federal Security Agency transferred to Department of Health,

Education, and Welfare by section 5 of Reorg. Plan No. 1 of 1953,

set out as a note under section 3501 of this title. Federal

Security Agency and Office of Administrator abolished by section 8

of Reorg. Plan No. 1 of 1953. Secretary and Department of Health,

Education, and Welfare redesignated Secretary and Department of

Health and Human Services by section 509(b) of Pub. L. 96-88 which

is classified to section 3508(b) of Title 20, Education.

-MISC2-

NONDUPLICATION OF PAYMENTS TO STATES: PROHIBITION OF PAYMENTS AFTER

DECEMBER 31, 1969

Prohibition of payments under this subchapter to States with

respect to aid or assistance in form of medical or other type of

remedial care for any period for which States received payments

under subchapter XIX of this chapter or for any period after Dec.

31, 1969, see section 121(b) of Pub. L. 89-97, set out as a note

under section 1396b of this title.

ELECTION OF PAYMENTS UNDER COMBINED STATE PLAN RATHER THAN SEPARATE

PLANS

Payments to States under combined State plan under subchapter XVI

or this chapter as precluding payment under State plan conforming

to this subchapter, see section 141(b) of Pub. L. 87-543, set out

as a note under section 1382e of this title.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1315, 1318, 1319 of this

title.

-End-

-CITE-

42 USC Sec. 1354 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XIV - GRANTS TO STATES FOR AID TO PERMANENTLY AND TOTALLY

DISABLED

-HEAD-

Sec. 1354. Operation of State plans

-STATUTE-

In the case of any State plan for aid to the permanently and

totally disabled which has been approved by the Secretary of Health

and Human Services, if the Secretary after reasonable notice and

opportunity for hearing to the State agency administering or

supervising the administration of such plan, finds -

(1) that the plan has been so changed as to impose any

residence or citizenship requirement prohibited by section

1352(b) of this title, or that in the administration of the plan

any such prohibited requirement is imposed, with the knowledge of

such State agency, in a substantial number of cases; or

(2) that in the administration of the plan there is a failure

to comply substantially with any provision required by section

1352(a) of this title to be included in the plan;

the Secretary shall notify such State agency that further payments

will not be made to the State (or, in his discretion, that payments

will be limited to categories under or parts of the State plan not

affected by such failure) until he is satisfied that such

prohibited requirement is no longer so imposed, and that there is

no longer any such failure to comply. Until he is so satisfied he

shall make no further payments to such State (or shall limit

payments to categories under or parts of the State plan not

affected by such failure).

-SOURCE-

(Aug. 14, 1935, ch. 531, title XIV, Sec. 1404, as added Aug. 28,

1950, ch. 809, title III, pt. 5, Sec. 351, 64 Stat. 557; amended

1953 Reorg. Plan No. 1, Secs. 5, 8 eff. Apr. 11, 1953, 18 F.R.

2053, 67 Stat. 631; Pub. L. 90-248, title II, Sec. 245, Jan. 2,

1968, 81 Stat. 918; Pub. L. 96-88, title V, Sec. 509(b), Oct. 17,

1979, 93 Stat. 695.)

-STATAMEND-

REPEAL OF SECTION

Pub. L. 92-603, title III, Sec. 303(a), (b), Oct. 30, 1972, 86

Stat. 1484, provided that this section is repealed effective Jan.

1, 1974, except with respect to Puerto Rico, Guam, and the Virgin

Islands.

-MISC1-

AMENDMENTS

1968 - Pub. L. 90-248 inserted "(or, in his discretion, that

payments will be limited to categories under or parts of the State

plan not affected by such failure)" after "further payments will

not be made to the State" and substituted in last sentence "further

payments to such State (or shall limit payments to categories under

or parts of the State plan not affected by such failure)" for

"further certification to the Secretary of the Treasury with

respect to such State".

-TRANS-

TRANSFER OF FUNCTIONS

Functions of Federal Security Administrator transferred to

Secretary of Health, Education, and Welfare and all agencies of

Federal Security Agency transferred to Department of Health,

Education, and Welfare by section 5 of Reorg. Plan No. 1 of 1953,

set out as a note under section 3501 of this title. Federal

Security Agency and office of Administrator abolished by section 8

of Reorg. Plan No. 1 of 1953. Secretary and Department of Health,

Education, and Welfare redesignated Secretary and Department of

Health and Human Services by section 509(b) of Pub. L. 96-88 which

is classified to section 3508(b) of Title 20, Education.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1316 of this title.

-End-

-CITE-

42 USC Sec. 1355 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XIV - GRANTS TO STATES FOR AID TO PERMANENTLY AND TOTALLY

DISABLED

-HEAD-

Sec. 1355. Definitions

-STATUTE-

For the purposes of this subchapter, the term "aid to the

permanently and totally disabled" means money payments to needy

individuals eighteen years of age or older who are permanently and

totally disabled, but does not include any such payments to or care

in behalf of any individual who is an inmate of a public

institution (except as a patient in a medical institution) or any

individual who is a patient in an institution for tuberculosis or

mental diseases. Such term also includes payments which are not

included within the meaning of such term under the preceding

sentence, but which would be so included except that they are made

on behalf of such a needy individual to another individual who (as

determined in accordance with standards prescribed by the

Secretary) is interested in or concerned with the welfare of such

needy individual, but only with respect to a State whose State plan

approved under section 1352 of this title includes provision for -

(1) determination by the State agency that such needy

individual has, by reason of his physical or mental condition,

such inability to manage funds that making payments to him would

be contrary to his welfare and, therefore, it is necessary to

provide such aid through payments described in this sentence;

(2) making such payments only in cases in which such payments

will, under the rules otherwise applicable under the State plan

for determining need and the amount of aid to the permanently and

totally disabled to be paid (and in conjunction with other income

and resources), meet all the need (!1) of the individuals with

respect to whom such payments are made;

(3) undertaking and continuing special efforts to protect the

welfare of such individual and to improve, to the extent

possible, his capacity for self-care and to manage funds;

(4) periodic review by such State agency of the determination

under paragraph (1) to ascertain whether conditions justifying

such determination still exist, with provision for termination of

such payments if they do not and for seeking judicial appointment

of a guardian or other legal representative, as described in

section 1311 of this title, if and when it appears that such

action will best serve the interests of such needy individual;

and

(5) opportunity for a fair hearing before the State agency on

the determination referred to in paragraph (1) for any individual

with respect to whom it is made.

At the option of a State (if its plan approved under this

subchapter so provides), such term (i) need not include money

payments to an individual who has been absent from such State for a

period in excess of ninety consecutive days (regardless of whether

he has maintained his residence in such State during such period)

until he has been present in such State for thirty consecutive days

in the case of such an individual who has maintained his residence

in such State during such period or ninety consecutive days in the

case of any other such individual, and (ii) may include rent

payments made directly to a public housing agency on behalf of a

recipient or a group or groups of recipients of aid under such

plan.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XIV, Sec. 1405, as added Aug. 28,

1950, ch. 809, title III, pt. 5, Sec. 351, 64 Stat. 557; amended

Pub. L. 87-543, title I, Sec. 156(d), July 25, 1962, 76 Stat. 207;

Pub. L. 89-97, title II, Sec. 221(c), title IV, Sec. 402(d), July

30, 1965, 79 Stat. 358, 417; Pub. L. 92-603, title IV, Secs.

408(c), 409(c), Oct. 30, 1972, 86 Stat. 1490, 1491; Pub. L. 97-35,

title XXI, Sec. 2184(c)(3), Aug. 13, 1981, 95 Stat. 817.)

-STATAMEND-

REPEAL OF SECTION

Pub. L. 92-603, title III, Sec. 303(a), (b), Oct. 30, 1972, 86

Stat. 1484, provided that this section is repealed effective Jan.

1, 1974, except with respect to Puerto Rico, Guam, and the Virgin

Islands.

-MISC1-

AMENDMENTS

1981 - Pub. L. 97-35 struck out in provision preceding par. (1)

", or (if provided on or after the third month before the month in

which the recipient makes application for aid) medical care in

behalf of, or any type of remedial care recognized under State law

in behalf of," after "money payments to".

1972 - Pub. L. 92-603 authorized the State, at its option, to

include within "aid to the permanently and totally disabled"

provisions relating to money payments to an individual absent from

such State for more than 90 consecutive days, and provisions

relating to rent payments made directly to a public housing agency.

1965 - Pub. L. 89-97 struck out from definition of "aid to the

permanently and totally disabled" the exclusion of payments to or

medical care in behalf of any individual who has been diagnosed as

having tuberculosis or psychosis and is a patient in a medical

institution as a result thereof; and extended definition of "aid to

the permanently and totally disabled" to include payments made on

behalf of the needy individual to another individual who (as

determined in accordance with standards determined by the

Secretary) is interested in or concerned with the welfare of such

needy individual and enumerated the five characteristics required

of state plans under which such payments can be made, including

provision for finding of inability to manage funds, payment to meet

all needs of the individual, special efforts to protect welfare,

periodic review, and opportunity for fair hearing, respectively.

1962 - Pub. L. 87-543 inserted "(if provided in or after the

third month before the month in which the recipient makes

application for aid)" before "medical care".

EFFECTIVE DATE OF 1965 AMENDMENT

Amendment by section 221(c) of Pub. L. 89-97 applicable in the

case of expenditures made after Dec. 31, 1965, under a State plan

approved under this subchapter, see section 221(e) of Pub. L.

89-97, set out as a note under section 303 of this title.

Amendment by section 402(d) of Pub. L. 89-97 applicable in the

case of expenditures made after Dec. 31, 1965, under a state plan

approved under subchapter I, X, XIV, or XVI of this chapter, see

section 402(e) of Pub. L. 89-97, set out as a note under section

306 of this title.

EFFECTIVE DATE OF 1962 AMENDMENT

Amendment by Pub. L. 87-543 applicable in the case of

applications made after Sept. 30, 1962, under a State plan approved

under subchapter I, IV, X, or XIV of this chapter, see section

156(e) of Pub. L. 87-543, set out as a note under section 306 of

this title.

-FOOTNOTE-

(!1) So in original. Probably should be "needs".

-End-

-CITE-

42 USC SUBCHAPTER XV - UNEMPLOYMENT COMPENSATION FOR

FEDERAL EMPLOYEES 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XV - UNEMPLOYMENT COMPENSATION FOR FEDERAL EMPLOYEES

-HEAD-

SUBCHAPTER XV - UNEMPLOYMENT COMPENSATION FOR FEDERAL EMPLOYEES

-End-

-CITE-

42 USC Secs. 1361 to 1364 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XV - UNEMPLOYMENT COMPENSATION FOR FEDERAL EMPLOYEES

-HEAD-

Secs. 1361 to 1364. Repealed. Pub. L. 89-554, Sec. 8(a), Sept. 6,

1966, 80 Stat. 658, 660, 661

-MISC1-

Section 1361, act Aug. 14, 1935, ch. 531, title XV, Sec. 1501, as

added Sept. 1, 1954, ch. 1212, Sec. 4(a), 68 Stat. 1130; amended

Aug. 28, 1958, Pub. L. 85-848, Sec. 2, 72 Stat. 1087; July 12,

1960, Pub. L. 86-624, Sec. 30(g), 74 Stat. 420; Sept. 13, 1960,

Pub. L. 86-778, title V, Secs. 531(e), 542(d), 74 Stat. 984, 986,

defined terms used in this subchapter. See section 8501 of Title 5,

Government Organization and Employees.

Pub. L. 90-248, title IV, Sec. 403(f), Jan. 2, 1968, 81 Stat.

932, amended section 1361(a)(6), (9), without reference to repeal

of such section by Pub. L. 89-554, Sec. 8(a).

Section 1362, act Aug. 14, 1935, ch. 531, title XV, Sec. 1502, as

added Sept. 1, 1954, ch. 1212, Sec. 4(a), 68 Stat. 1131; amended

Sept. 13, 1960, Pub. L. 86-778, title V, Sec. 543(b)(1)(A), 74

Stat. 985, provided for compensation of Federal employees under

State agreements. See section 8502 of Title 5.

Section 1363, act Aug. 14, 1935, ch. 531, title XV, Sec. 1503, as

added Sept. 1, 1954, ch. 1212, Sec. 4(a), 68 Stat. 1132; amended

Sept. 13, 1960, Pub. L. 86-778, title V, Sec. 543(b)(1)(B), (C),

(c)(1), 74 Stat. 986, provided for compensation of Federal

employees in absence of State agreement. See section 8503 of Title

5.

Section 1364, act Aug. 14, 1935, ch. 531, title XV, Sec. 1504, as

added Sept. 1, 1954, ch. 1212, Sec. 4(a), 68 Stat. 1133; amended

Sept. 13, 1960, Pub. L. 86-778, title V, Sec. 542(b)(2), 74 Stat.

986, related to assignment to State of Federal service and wages.

See section 8504 of Title 5.

-End-

-CITE-

42 USC Sec. 1365 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XV - UNEMPLOYMENT COMPENSATION FOR FEDERAL EMPLOYEES

-HEAD-

Sec. 1365. Repealed. Pub. L. 86-442, Sec. 1, Apr. 22, 1960, 74

Stat. 81

-MISC1-

Section, act Aug. 14, 1935, ch. 531, title XV, Sec. 1505, as

added Sept. 1, 1954, ch. 1212, Sec. 4(a), 68 Stat. 1133, related to

status of a Federal employee who was performing Federal service at

time of separation from employment by the United States.

EFFECTIVE DATE OF REPEAL

Repeal effective only with respect to benefit years which began

more than thirty days after Apr. 22, 1960, see section 1 of Pub. L.

86-442.

-End-

-CITE-

42 USC Secs. 1366 to 1371 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XV - UNEMPLOYMENT COMPENSATION FOR FEDERAL EMPLOYEES

-HEAD-

Secs. 1366 to 1371. Repealed. Pub. L. 89-554, Sec. 8(a), Sept. 6,

1966, 80 Stat. 658, 660, 661

-MISC1-

Section 1366, act Aug. 14, 1935, ch. 531, title XV, Sec. 1506, as

added Sept. 1, 1954, ch. 1212, Sec. 4(a), 68 Stat. 1133, provided

for payments to States. See section 8505 of Title 5, Government

Organization and Employees.

Section 1367, act Aug. 14, 1935, ch. 531, title XV, Sec. 1507, as

added Sept. 1, 1954, ch. 1212, Sec. 4(a), 68 Stat. 1134; amended

Aug. 28, 1958, Pub. L. 85-848, Sec. 4, 72 Stat. 1089; Sept. 13,

1960, Pub. L. 86-778, title V, Sec. 531(f), 74 Stat. 984, provided

for dissemination of information by both Federal and State

agencies. See section 8506 of Title 5.

Section 1368, act Aug. 14, 1935, ch. 531, title XV, Sec. 1508, as

added Sept. 1, 1954, ch. 1212, Sec. 4(a), 68 Stat. 1135, related to

penalties. See section 8507 of Title 5 and section 1919 of Title

18, Crimes and Criminal Procedure.

Section 1369, act Aug. 14, 1935, ch. 531, title XV, Sec. 1509, as

added Sept. 1, 1954, ch. 1212, Sec. 4(a), 68 Stat. 1135, related to

rules and regulations. See section 8508 of Title 5.

Section 1370, act Aug. 14, 1935, ch. 531, title XV, Sec. 1510, as

added Sept. 1, 1954, ch. 1212, Sec. 4(a), 68 Stat. 1135, related to

authorization of appropriations. See section 5509 of Title 5.

Section 1371, act Aug. 14, 1935, ch. 531, title XV, Sec. 1511, as

added Aug. 28, 1958, Pub. L. 85-848, Sec. 3, 72 Stat. 1087; amended

Sept. 2, 1958, Pub. L. 85-857, Sec. 13(i)(3), 72 Stat. 1265; Apr.

22, 1960, Pub. L. 86-442, Sec. 2, 74 Stat. 82; Sept. 13, 1960, Pub.

L. 86-778, title V, Sec. 542(c), 74 Stat. 986, provided an

ex-servicemen's unemployment compensation program. See sections

8521 to 8525 of Title 5.

-End-

-CITE-

42 USC SUBCHAPTER XVI - SUPPLEMENTAL SECURITY INCOME FOR

AGED, BLIND, AND DISABLED 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XVI - SUPPLEMENTAL SECURITY INCOME FOR AGED, BLIND, AND

DISABLED

-HEAD-

SUBCHAPTER XVI - SUPPLEMENTAL SECURITY INCOME FOR AGED, BLIND, AND

DISABLED

-SECREF-

SUBCHAPTER REFERRED TO IN OTHER SECTIONS

This subchapter is referred to in sections 290cc-22, 300bb-2,

300bb-6, 401, 402, 404, 405, 406, 426, 428, 603, 608, 611, 664,

671, 673, 701, 903, 909, 1002, 1005, 1007, 1012, 1301, 1306a,

1306b, 1308, 1309, 1310, 1311, 1314a, 1315, 1316, 1318, 1319,

1320a-6, 1320a-8, 1320a-8a, 1320b-2, 1320b-3, 1320b-6, 1320b-7,

1320b-17, 1320b-19, 1320b-20, 1320b-21, 1320b-22, 1382, 1382c,

1395v, 1395z, 1395ww, 1396a, 1396b, 1396d, 1396p, 1396r, 1396t,

1396u-2, 1766, 1997, 3012, 3013, 3058e, 6862, 8013, 8622, 8624,

11201, 11291 of this title; title 7 sections 2012, 2014, 2015,

2026; title 8 sections 1255a, 1522, 1611, 1612; title 20 section

1413; title 26 sections 51, 4980B, 6103, 6334; title 29 sections

722, 762a, 772, 1162, 1166, 1322; title 31 sections 3716, 3803;

title 48 section 1421q.

-End-

-CITE-

42 USC Sec. 1381 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XVI - SUPPLEMENTAL SECURITY INCOME FOR AGED, BLIND, AND

DISABLED

-HEAD-

Sec. 1381. Statement of purpose; authorization of appropriations

-STATUTE-

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 subchapter.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XVI, Sec. 1601, as added Pub. L.

92-603, title III, Sec. 301, Oct. 30, 1972, 86 Stat. 1465.)

-MISC1-

PRIOR PROVISIONS

A prior section 1381, act Aug. 14, 1935, ch. 531, title XVI, Sec.

1601, as added July 25, 1962, Pub. L. 87-543, title I, Sec. 141(a),

76 Stat. 197, authorized appropriations for grants to States for

aid to aged, blind, or disabled, and for medical assistance for

aged, prior to the general amendment of title XVI of the Social

Security Act by Pub. L. 92-603, Sec. 301, but is set out as a note

below in view of its continued applicability to Puerto Rico, Guam,

and the Virgin Islands.

EFFECTIVE DATE

Section 301 of Pub. L. 92-603 provided that this section is

effective Jan. 1, 1974.

CONTINUATION OF FEDERAL FINANCIAL PARTICIPATION IN EXPERIMENTAL,

PILOT, OR DEMONSTRATION PROJECTS APPROVED BEFORE OCTOBER 1973, FOR

PERIOD ON-AND-AFTER DECEMBER 31, 1973, WITHOUT DENIAL OR REDUCTION

ON ACCOUNT OF SUBCHAPTER XVI PROVISIONS; WAIVER OF SUBCHAPTER XVI

RESTRICTIONS FOR INDIVIDUALS; FEDERAL PAYMENTS OF NON-FEDERAL SHARE

AS SUPPLEMENTARY PAYMENTS

Subchapter provisions without effect on Federal Financial

Participation in Experimental, Pilot or Demonstration Projects

approved before Oct. 1, 1973, for period on-and-after Dec. 31,

1973, see section 11 of Pub. L. 93-233, Dec. 31, 1973, 87 Stat.

958, set out as a note under section 1315 of this title.

APPLICATION TO NORTHERN MARIANA ISLANDS

For applicability of this section to the Northern Mariana

Islands, see section 502(a)(1) of the Covenant to Establish a

Commonwealth of the Northern Mariana Islands in Political Union

with the United States of America and Proc. No. 4534, Oct. 24,

1977, 42 F.R. 6593, set out as notes under section 1801 of Title

48, Territories and Insular Possessions.

PUERTO RICO, GUAM, AND VIRGIN ISLANDS

Enactment of section 1601 of the Social Security Act [this

section] by Pub. L. 92-603, eff. Jan. 1, 1974, was not applicable

to Puerto Rico, Guam, and the Virgin Islands. See section 303(b) of

Pub. L. 92-603, set out as a note under section 301 of this title.

Therefore, as to Puerto Rico, Guam, and the Virgin Islands, section

1601 of the Social Security Act [this section] as it existed prior

to reenactment by Pub. L. 92-603, and as amended, continues to

apply and reads as follows:

Sec. 1381. Authorization of appropriations

For the purpose of enabling each State, as far as practicable

under the conditions in such State, to furnish financial assistance

to needy individuals who are 65 years of age or over, are blind, or

are 18 years of age or over and permanently and totally disabled,

there is hereby authorized to be appropriated for each fiscal year

a sum sufficient to carry out the purposes of this subchapter. The

sums made available under this section shall be used for making

payments to States which have submitted, and had approved by the

Commissioner of Social Security, State plans for aid to the aged,

blind, or disabled.

(Aug. 14, 1935, ch. 531, title XVI, Sec. 1601, as added July 25,

1962, Pub. L. 87-543, title I, Sec. 141(a), 76 Stat. 197; amended

Oct. 17, 1979, Pub. L. 96-88, title V, Sec. 509(b), 93 Stat. 695;

Aug. 13, 1981, Pub. L. 97-35, title XXI, Sec. 2184(d)(3), title

XXIII, Sec. 2353(m)(1), 95 Stat. 817, 873; Aug. 15, 1994, Pub. L.

103-296, title I, Sec. 107(a)(1), 108 Stat. 1477.)

[Amendment by section 107(a)(1) of Pub. L. 103-296 effective Mar.

31, 1995, see section 110(a) of Pub. L. 103-296, set out as an

Effective Date of 1994 Amendment note under section 401 of this

title.]

PAYMENTS UNDER CHAPTER PROVISIONS IN EFFECT BEFORE JANUARY 1, 1974,

FOR: ACTIVITIES CARRIED OUT THROUGH DECEMBER 31, 1973, UNDER STATE

PLANS APPROVED UNDER SUBCHAPTER I, X, XIV, OR XVI PROVISIONS; AND

FOR ADMINISTRATIVE ACTIVITIES AFTER JANUARY 1, 1974, CLOSING OUT

SUCH ACTIVITIES

Pub. L. 93-233, Sec. 19(b), Dec. 31, 1973, 87 Stat. 974, provided

that: "Notwithstanding the provisions of section 301 of the Social

Security Amendments of 1972 [enacting this subchapter], the

Secretary of Health, Education, and Welfare shall make payments to

the 50 States and the District of Columbia after December 31, 1973,

in accordance with the provisions of the Social Security Act [this

chapter] as in effect prior to January 1, 1974, for (1) activities

carried out through the close of December 31, 1973, under State

plans approved under title I, X, XIV, or XVI, of such Act

[subchapter I, X, XIV, or XVI of this chapter], and (2)

administrative activities carried out after December 31, 1973,

which such Secretary determines are necessary to bring to a close

activities carried out under such State plans."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1320b-19 of this title.

-End-

-CITE-

42 USC Sec. 1381a 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XVI - SUPPLEMENTAL SECURITY INCOME FOR AGED, BLIND, AND

DISABLED

-HEAD-

Sec. 1381a. Basic entitlement to benefits

-STATUTE-

Every aged, blind, or disabled individual who is determined under

part A of this subchapter to be eligible on the basis of his income

and resources shall, in accordance with and subject to the

provisions of this subchapter, be paid benefits by the Commissioner

of Social Security.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XVI, Sec. 1602, as added Pub. L.

92-603, title III, Sec. 301, Oct. 30, 1972, 86 Stat. 1465; amended

Pub. L. 98-369, div. B, title VI, Sec. 2663(j)(2)(E), July 18,

1984, 98 Stat. 1170; Pub. L. 103-296, title I, Sec. 107(a)(1), Aug.

15, 1994, 108 Stat. 1477.)

-MISC1-

PRIOR PROVISIONS

A prior section 1602 of act Aug. 14, 1935, ch. 531, title XVI, as

added July 25, 1962, Pub. L. 87-543, title I, Sec. 141(a), 76 Stat.

198; amended Oct. 13, 1964, Pub. L. 88-650, Sec. 5(b), 78 Stat.

1078; July 30, 1965, Pub. L. 89-97, title II, Sec. 221(d)(3), title

IV, Sec. 403(e), 79 Stat. 358, 418; Jan. 2, 1968, Pub. L. 90-248,

title II, Secs. 210(a)(5), 213(a)(4), 241(d), 81 Stat. 896, 898,

917, formerly classified to section 1382 of this title, set forth

the required contents of State plans for aid to the aged, blind, or

disabled, and for medical assistance for the aged, prior to the

general amendment of title XVI of the Social Security Act by Pub.

L. 92-603, Sec. 301.

AMENDMENTS

1994 - Pub. L. 103-296 substituted "Commissioner of Social

Security" for "Secretary of Health and Human Services".

1984 - Pub. L. 98-369 substituted "Health and Human Services" for

"Health, Education, and Welfare".

EFFECTIVE DATE OF 1994 AMENDMENT

Amendment by Pub. L. 103-296 effective Mar. 31, 1995, see section

110(a) of Pub. L. 103-296, set out as a note under section 401 of

this title.

EFFECTIVE DATE OF 1984 AMENDMENT

Amendment by Pub. L. 98-369 effective July 18, 1984, but not to

be construed as changing or affecting any right, liability, status,

or interpretation which existed (under the provisions of law

involved) before that date, see section 2664(b) of Pub. L. 98-369,

set out as a note under section 401 of this title.

EFFECTIVE DATE

Section 301 of Pub. L. 92-603 provided that this section is

effective Jan. 1, 1974.

APPLICATION TO NORTHERN MARIANA ISLANDS

For applicability of this section to the Northern Mariana

Islands, see section 502(a)(1) of the Covenant to Establish a

Commonwealth of the Northern Mariana Islands in Political Union

with the United States of America and Proc. No. 4534, Oct. 24,

1977, 42 F.R. 6593, set out as notes under section 1801 of Title

48, Territories and Insular Possessions.

PUERTO RICO, GUAM, AND VIRGIN ISLANDS

Enactment of provisions of Pub. L. 92-603, eff. Jan. 1, 1974, not

applicable to Puerto Rico, Guam, and the Virgin Islands, see

section 303(b) of Pub. L. 92-603, set out as a note under section

301 of this title.

-End-

-CITE-

42 USC Part A - Determination of Benefits 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XVI - SUPPLEMENTAL SECURITY INCOME FOR AGED, BLIND, AND

DISABLED

Part A - Determination of Benefits

-HEAD-

PART A - DETERMINATION OF BENEFITS

-SECREF-

PART REFERRED TO IN OTHER SECTIONS

This part is referred to in section 1381a of this title.

-End-

-CITE-

42 USC Sec. 1382 01/06/03

-EXPCITE-

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 7 - SOCIAL SECURITY

SUBCHAPTER XVI - SUPPLEMENTAL SECURITY INCOME FOR AGED, BLIND, AND

DISABLED

Part A - Determination of Benefits

-HEAD-

Sec. 1382. Eligibility for benefits

-STATUTE-

(a) "Eligible individual" defined

(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 1382a(b) of this title, is at a rate of not more than

$1,752 (or, if greater, the amount determined under section 1382f

of this title) for the calendar year 1974 or any calendar year

thereafter, and

(B) whose resources, other than resources excluded pursuant to

section 1382b(a) of this title, are not more than (i) in case

such individual has a spouse with whom he is living, the

applicable amount determined under paragraph (3)(A), or (ii) in

case such individual has no spouse with whom he is living, the

applicable amount determined under paragraph (3)(B),

shall be an eligible individual for purposes of this subchapter.

(2) Each aged, blind, or disabled individual who has an eligible

spouse and -

(A) whose income (together with the income of such spouse),

other than income excluded pursuant to section 1382a(b) of this

title, is at a rate of not more than $2,628 (or, if greater, the

amount determined under section 1382f of this title) 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

1382b(a) of this title, are not more than the applicable amount

determined under paragraph (3)(A),

shall be an eligible individual for purposes of this subchapter.

(3)(A) The dollar amount referred to in clause (i) of paragraph

(1)(B), and in paragraph (2)(B), shall be $2,250 prior to January

1, 1985, and shall be increased to $2,400 on January 1, 1985, to

$2,550 on January 1, 1986, to $2,700 on January 1, 1987, to $2,850

on January 1, 1988, and to $3,000 on January 1, 1989.

(B) The dollar amount referred to in clause (ii) of paragraph

(1)(B), shall be $1,500 prior to January 1, 1985, and shall be

increased to $1,600 on January 1, 1985, to $1,700 on January 1,

1986, to $1,800 on January 1, 1987, to $1,900 on January 1, 1988,

and to $2,000 on January 1, 1989.

(b) Amount of benefits

(1) The benefit under this subchapter for an individual who does

not have an eligible spouse shall be payable at the rate of $1,752

(or, if greater, the amount determined under section 1382f of this

title) for the calendar year 1974 and any calendar year thereafter,

reduced by the amount of income, not excluded pursuant to section

1382a(b) of this title, of such individual.

(2) The benefit under this subchapter for an individual who has

an eligible spouse shall be payable at the rate of $2,628 (or, if

greater, the amount determined under section 1382f of this title)

for the calendar year 1974 and any calendar year thereafter,

reduced by the amount of income, not excluded pursuant to section

1382a(b) of this title, of such individual and spouse.

(c) Period for determination of benefits

(1) An individual's eligibility for a benefit under this

subchapter for a month shall be determined on the basis of the

individual's (and eligible spouse's, if any) income, resources, and

other relevant characteristics in such month, and, except as

provided in paragraphs (2), (3), (4), (5), and (6), the amount of

such benefit shall be determined for such month on the basis of

income and other characteristics in the first or, if the

Commissioner of Social Security so determines, second month

preceding such month. Eligibility for and the amount of such

benefits shall be redetermined at such time or times as may be

provided by the Commissioner of Social Security.

(2) The amount of such benefit for the month in which an

application for benefits becomes effective (or, if the Commissioner

of Social Security so determines, for such month and the following

month) and for any month immediately following a month of

ineligibility for such benefits (or, if the Commissioner of Social

Security so determines, for such month and the following month)

shall -

(A) be determined on the basis of the income of the individual

and the eligible spouse, if any, of such individual and other

relevant circumstances in such month; and

(B) in the case of the month in which an application becomes

effective or the first month following a period of ineligibility,

if such application becomes effective, or eligibility is

restored, after the first day of such month, bear the same ratio

to the amount of the benefit which would have been payable to

such individual if such application had become effective, or

eligibility had been restored, on the first day of such month as

the number of days in such month including and following the

effective date of such application or restoration of eligibility

bears to the total number of days in such month.

(3) For purposes of this subsection, an increase in the benefit

amount payable under subchapter II of this chapter (over the amount

payable in the preceding month, or, at the election of the

Commissioner of Social Security, the second preceding month) to an

individual receiving benefits under this subchapter shall be

included in the income used to determine the benefit under this

subchapter of such individual for any month which is -

(A) the first month in which the benefit amount payable to such

individual under this title is increased pursuant to section

1382f of this title, or

(B) at the election of the Commissioner of Social Security, the

month immediately following such month.

(4)(A) Notwithstanding paragraph (3), if the Commissioner of

Social Security determines that reliable information is currently

available with respect to the income and other circumstances of an

individual for a month (including information with respect to a

class of which such individual is a member and information with

respect to scheduled cost-of-living adjustments under other benefit

programs), the benefit amount of such individual under this

subchapter for such month may be determined on the basis of such

information.

(B) The Commissioner of Social Security shall prescribe by

regulation the circumstances in which information with respect to

an event may be taken into account pursuant to subparagraph (A) in

determining benefit amounts under this subchapter.

(5) Notwithstanding paragraphs (1) and (2), any income which is

paid to or on behalf of an individual in any month pursuant to (A)

a State program funded under part A of subchapter IV of this

chapter, (B) section 672 of this title (relating to foster care

assistance), (C) section 1522(e) of title 8 (relating to assistance

for refugees), (D) section 501(a) of Public Law 96-422 (relating to

assistance for Cuban and Haitian entrants), or (E) section 13 of

title 25 (relating to assistance furnished by the Bureau of Indian

Affairs), shall be taken into account in determining the amount of

the benefit under this subchapter of such individual (and his

eligible spouse, if any) only for that month, and shall not be

taken into account in determining the amount of the benefit for any

other month.

(6) The dollar amount in effect under subsection (b) of this

section as a result of any increase in benefits under this

subchapter by reason of section 1382f of this title shall be used

to determine the value of any in-kind support and maintenance

required to be taken into account in determining the benefit

payable under this subchapter to an individual (and the eligible

spouse, if any, of the individual) for the 1st 2 months for which

the increase in benefits applies.

(7) For purposes of this subsection, an application of an

individual for benefits under this subchapter shall be effective on

the later of -

(A) the first day of the month following the date such

application is filed, or

(B) the first day of the month following the date such

individual becomes eligible for such benefits with respect to

such application.

(8) The Commissioner of Social Security may waive the limitations

specified in subparagraphs (A) and (B) of subsection (e)(1) of this

section on an individual's eligibility and benefit amount for a

month (to the extent either such limitation is applicable by reason

of such individual's presence throughout such month in a hospital,

extended care facility, nursing home, or intermediate care

facility) if such waiver would promote the individual's removal

from such institution or facility. Upon waiver of such limitations,

the Commissioner of Social Security shall apply, to the month

preceding the month of removal, or, if the Commissioner of Social

Security so determines, the two months preceding the month of

removal, the benefit rate that is appropriate to such individual's

living arrangement subsequent to his removal from such institution

or facility.

(d) Limitation on amount of gross income earned; "gross income"

defined

The Commissioner of Social Security may prescribe the

circumstances under which, consistently with the purposes of this

subchapter, the gross income from a trade or business (including

farming) will be considered sufficiently large to make an

individual ineligible for benefits under this subchapter. For

purposes of this subsection, the term "gross income" has the same

meaning as when used in chapter 1 of the Internal Revenue Code of

1986.

(e) Limitation on eligibility of certain individuals

(1)(A) Except as provided in subparagraphs (B), (C), (D), (E),

and (G), no person shall be an eligible individual or eligible

spouse for purposes of this subchapter 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 (subject to subparagraph

(G)), in a medical treatment facility receiving payments (with

respect to such individual or spouse) under a State plan approved

under subchapter XIX of this chapter, or an eligible individual is

a child described in section 1382c(f)(2)(B) of this title, or, in

the case of an eligible individual who is a child under the age of

18, receiving payments (with respect to such individual) under any

health insurance policy issued by a private provider of such

insurance the benefit under this subchapter for such individual for

such month shall be payable (subject to subparagraph (E)) -

(i) at a rate not in excess of $360 per year (reduced by the

amount of any income not excluded pursuant to section 1382a(b) of

this title) in the case of an individual who does not have an

eligible spouse;

(ii) in the case of an individual who has an eligible spouse,

if only one of them is in such a facility throughout such month,

at a rate not in excess of the sum of -

(I) the rate of $360 per year (reduced by the amount of any

income, not excluded pursuant to section 1382a(b) of this

title, of the one who is in such facility), and

(II) the applicable rate specified in subsection (b)(1) of

this section (reduced by the amount of any income, not excluded

pursuant to section 1382a(b) of this title, of the other); and

(iii) at a rate not in excess of $720 per year (reduced by the

amount of any income not excluded pursuant to section 1382a(b) of

this title) in the case of an individual who has an eligible

spouse, if both of them are in such a facility throughout such

month.

For purposes of this subsection, a medical treatment facility that

provides services described in section 1396p(c)(1)(C) of this title

shall be considered to be receiving payments with respect to an

individual under a State plan approved under subchapter XIX of this

chapter during any period of ineligibility of such individual

provided for under the State plan pursuant to section 1396p(c) of

this title.

(C) As used in subparagraph (A), the term "public institution"

does not include a publicly operated community residence which

serves no more than 16 residents.

(D) A person may be an eligible individual or eligible spouse for

purposes of this subchapter with respect to any month throughout

which he is a resident of a public emergency shelter for the

homeless (as defined in regulations which shall be prescribed by

the Commissioner of Social Security); except that no person shall

be an eligible individual or eligible spouse by reason of this

subparagraph more than 6 months in any 9-month period.

(E) Notwithstanding subparagraphs (A) and (B), any individual who

-

(i)(I) is an inmate of a public institution, the primary

purpose of which is the provision of medical or psychiatric care,

throughout any month as described in subparagraph (A), or

(II) is in a medical treatment facility throughout any month as

described in subparagraph (B),

(ii) was eligible under section 1382h(a) or (b) of this title

for the month preceding such month, and

(iii) under an agreement of the public institution or the

medical treatment facility is permitted to retain any benefit

payable by reason of this subparagraph,

may be an eligible individual or eligible spouse for purposes of

this subchapter (and entitled to a benefit determined on the basis

of the rate applicable under subsection (b) of this section) for

the month referred to in subclause (I) or (II) of clause (i) and,

if such subclause still applies, for the succeeding month.

(F) An individual who is an eligible individual or an eligible

spouse for a month by reason of subparagraph (E) shall not be

treated as being eligible under section 1382h(a) or (b) of this

title for such month for purposes of clause (ii) of such

subparagraph.

(G) A person may be an eligible individual or eligible spouse for

purposes of this subchapter, and subparagraphs (A) and (B) shall

not apply, with respect to any particular month throughout which he

or she is an inmate of a public institution the primary purpose of

which is the provision of medical or psychiatric care, or is in a

medical treatment facility receiving payments (with respect to such

individual or spouse) under a State plan approved under subchapter

XIX of this chapter or, in the case of an individual who is a child

under the age of 18, under any health insurance policy issued by a

private provider of such insurance, if it is determined in

accordance with subparagraph (H) or (J) that -

(i) such person's stay in that institution or facility (or in

that institution or facility and one or more other such

institutions or facilities during a continuous period of

institutionalization) is likely (as certified by a physician) not

to exceed 3 months, and the particular month involved is one of

the first 3 months throughout which such person is in such an

institution or facility during a continuous period of

institutionalization; and

(ii) such person needs to continue to maintain and provide for

the expenses of the home or living arrangement to which he or she

may return upon leaving the institution or facility.

The benefit of any person under this subchapter (including State

supplementation if any) for each month to which this subparagraph

applies shall be payable, without interruption of benefit payments

and on the date the benefit involved is regularly due, at the rate

that was applicable to such person in the month prior to the first

month throughout which he or she is in the institution or facility.

(H) The Commissioner of Social Security shall establish

procedures for the determinations required by clauses (i) and (ii)

of subparagraph (G), and may enter into agreements for making such

determinations (or for providing information or assistance in

connection with the making of such determinations) with appropriate

State and local public and private agencies and organizations. Such

procedures and agreements shall include the provision of

appropriate assistance to individuals who, because of their

physical or mental condition, are limited in their ability to

furnish the information needed in connection with the making of

such determinations.

(I)(i) The Commissioner shall enter into an agreement, with any

interested State or local institution comprising a jail, prison,

penal institution, or correctional facility, or with any other

interested State or local institution a purpose of which is to

confine individuals as described in section 402(x)(1)(A)(ii) of

this title, under which -

(I) the institution shall provide to the Commissioner, on a

monthly basis and in a manner specified by the Commissioner, the

names, social security account numbers, dates of birth,

confinement commencement dates, and, to the extent available to

the institution, such other identifying information concerning

the inmates of the institution as the Commissioner may require

for the purpose of carrying out this paragraph and the other

provisions of this subchapter; and

(II) the Commissioner shall pay to any such institution, with

respect to each individual who receives in the month preceding

the first month throughout which such individual is an inmate of

the jail, prison, penal institution, or correctional facility

that furnishes information respecting such individual pursuant to

subclause (I), or is confined in the institution (that so

furnishes such information) as described in section

402(x)(1)(A)(ii) of this title, a benefit under this subchapter

for such preceding month, and who is determined by the

Commissioner to be ineligible for benefits under this subchapter

by reason of confinement based on the information provided by

such institution, $400 (subject to reduction under clause (ii))

if the institution furnishes the information described in

subclause (I) to the Commissioner within 30 days after the date

such individual becomes an inmate of such institution, or $200

(subject to reduction under clause (ii)) if the institution

furnishes such information after 30 days after such date but

within 90 days after such date.

(ii) The dollar amounts specified in clause (i)(II) shall be

reduced by 50 percent if the Commissioner is also required to make

a payment to the institution with respect to the same individual

under an agreement entered into under section 402(x)(3)(B) of this

title.

(iii) The Commissioner shall maintain, and shall provide on a

reimbursable basis, information obtained pursuant to agreements

entered into under clause (i) to any Federal or federally-assisted

cash, food, or medical assistance program for eligibility and other

administrative purposes under such program.

(iv) Payments to institutions required by clause (i)(II) shall be

made from funds otherwise available for the payment of benefits

under this subchapter and shall be treated as direct spending for

purposes of the Balanced Budget and Emergency Deficit Control Act

of 1985 [2 U.S.C. 900 et seq.].

(J) For the purpose of carrying out this paragraph, the

Commissioner of Social Security shall conduct periodic computer

matches with data maintained by the Secretary of Health and Human

Services under subchapter XVIII or XIX of this chapter. The

Secretary shall furnish to the Commissioner, in such form and

manner and under such terms as the Commissioner and the Secretary

shall mutually agree, such information as the Commissioner may

request for this purpose. Information obtained pursuant to such a

match may be substituted for the physician's certification

otherwise required under subparagraph (G)(i).

(2) No person shall be an eligible individual or eligible spouse

for purposes of this subchapter if, after notice to such person by

the Commissioner of Social Security that it is likely that such

person is eligible for any payments of the type enumerated in

section 1382a(a)(2)(B) of this title, such person fails within 30

days to take all appropriate steps to apply for and (if eligible)

obtain any such payments.

(3) Notwithstanding anything to the contrary in the criteria

being used by the Commissioner of Social Security in determining

when a husband and wife are to be considered two eligible

individuals for purposes of this subchapter and when they are to be

considered an eligible individual with an eligible spouse, the

State agency administering or supervising the administration of a

State plan under any other program under this chapter may (in the

administration of such plan) treat a husband and wife living in the

same medical treatment facility described in paragraph (1)(B) as

though they were an eligible individual with his or her eligible

spouse for purposes of this subchapter (rather than two eligible

individuals), after they have continuously lived in the same such

facility for 6 months, if treating such husband and wife as two

eligible individuals would prevent either of them from receiving

benefits or assistance under such plan or reduce the amount

thereof.

(4) No person shall be considered an eligible individual or

eligible spouse for purposes of this subchapter with respect to any

month if during such month the person is -

(A) fleeing to avoid prosecution, or custody or confinement

after conviction, under the laws of the place from which the

person flees, for a crime, or an attempt to commit a crime, which

is a felony under the laws of the place from which the person

flees, or which, in the case of the State of New Jersey, is a

high misdemeanor under the laws of such State; or

(B) violating a condition of probation or parole imposed under

Federal or State law.

(5) Notwithstanding any other provision of law (other than

section 6103 of the Internal Revenue Code of 1986 and section

1306(c) of this title), the Commissioner shall furnish any Federal,

State, or local law enforcement officer, upon the written request

of the officer, with the current address, Social Security number,

and photograph (if applicable) of any recipient of benefits under

this subchapter, if the officer furnishes the Commissioner with the

name of the recipient, and other identifying information as

reasonably required by the Commissioner to establish the unique

identity of the recipient, and notifies the Commissioner that -

(A) the recipient -

(i) is described in subparagraph (A) or (B) of paragraph (4);

and

(ii) has information that is necessary for the officer to

conduct the officer's official duties; and

(B) the location or apprehension of the recipient is within the

officer's official duties.

(f) Individuals outside United States; determination of status

(1) Notwithstanding any other provision of this subchapter, no

individual (other than a child described in section

1382c(a)(1)(B)(ii) of this title) shall be considered an eligible

individual for purposes of this subchapter 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 subchapter 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.

(2) For a period of not more than 1 year, the first sentence of

paragraph (1) shall not apply to any individual who -

(A) was eligible to receive a benefit under this subchapter for

the month immediately preceding the first month during all of

which the individual was outside the United States; and

(B) demonstrates to the satisfaction of the Commissioner of

Social Security that the absence of the individual from the

United States will be -

(i) for not more than 1 year; and

(ii) for the purpose of conducting studies as part of an

educational program that is -

(I) designed to substantially enhance the ability of the

individual to engage in gainful employment;

(II) sponsored by a school, college, or university in the

United States; and

(III) not available to the individual in the United States.

(g) Individuals deemed to meet resources test

In the case of any individual or any individual and his spouse

(as the case may be) who -

(1) received aid or assistance for December 1973 under a plan

of a State approved under subchapter I, X, XIV, or XVI of this

chapter,

(2) has, since December 31, 1973, continuously resided in the

State under the plan of which he or they received such aid or

assistance for December 1973, and

(3) has, since December 31, 1973, continuously been (except for

periods not in excess of six consecutive months) an eligible

individual or eligible spouse with respect to whom supplemental

security income benefits are payable,

the resources of such individual or such individual and his spouse

(as the case may be) shall be deemed not to exceed the amount

specified in subsections (a)(1)(B) and (a)(2)(B) of this section

during any period that the resources of such individual or such

individual and his spouse (as the case may be) does not exceed the

maximum amount of resources specified in the State plan, as in

effect for October 1972, under which he or they received such aid

or assistance for December 1973.

(h) Individuals deemed to meet income test

In 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 -

(1) received aid or assistance for December 1973 under a plan

of a State approved under subchapter X or XVI of this chapter,

(2) is blind under the definition of that term in the plan, as

in effect for October 1972, under which he or they received such

aid or assistance for December 1973,

(3) has, since December 31, 1973, continuously resided in the

State under the plan of which he or they received such aid or

assistance for December 1973, and

(4) has, since December 31, 1973, continuously been (except for

periods not in excess of six consecutive months) an eligible

individual or an eligible spouse with respect to whom

supplemental security income benefits are payable,

there shall be disregarded an amount equal to the greater of (A)

the maximum amount of any earned or unearned income which could

have been disregarded under the State plan, as in effect for

October 1972, under which he or they received such aid or

assistance for December 1973, and (B) the amount which would be

required to be disregarded under section 1382a of this title

without application of this subsection.

(i) Application and review requirements for certain individuals

For application and review requirements affecting the eligibility

of certain individuals, see section 1383(j) of this title.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XVI, Sec. 1611, as added Pub. L.

92-603, title III, Sec. 301, Oct. 30, 1972, 86 Stat. 1466; amended

Pub. L. 93-66, title II, Sec. 210(a), (b), July 9, 1973, 87 Stat.

154; Pub. L. 93-233, Secs. 4(b)(1), (2), 18(d), (e), Dec. 31, 1973,

87 Stat. 953, 968; Pub. L. 93-368, Sec. 6(a), Aug. 7, 1974, 88

Stat. 421; Pub. L. 94-566, title V, Secs. 502, 505(a), Oct. 20,

1976, 90 Stat. 2685, 2686; Pub. L. 96-265, title III, Sec.

303(c)(2), June 9, 1980, 94 Stat. 453; Pub. L. 97-35, title XXIII,

Sec. 2341(a), Aug. 13, 1981, 95 Stat. 865; Pub. L. 97-248, title I,

Secs. 181(a), 183(a), Sept. 3, 1982, 96 Stat. 404, 405; Pub. L.

98-21, title IV, Sec. 403(a), Apr. 20, 1983, 97 Stat. 140; Pub. L.

98-369, div. B, title VI, Secs. 2611(a)-(c), 2663(g)(1), (2), July

18, 1984, 98 Stat. 1130, 1168; Pub. L. 99-514, Sec. 2, Oct. 22,

1986, 100 Stat. 2095; Pub. L. 99-643, Secs. 3(a), 4(c)(3), (d)(1),

9(a), Nov. 10, 1986, 100 Stat. 3574, 3577, 3579; Pub. L. 100-203,

title IX, Secs. 9106(a), 9107, 9113(a), 9115(a), 9119(a), Dec. 22,

1987, 101 Stat. 1330-301, 1330-302, 1330-304, 1330-308; Pub. L.

100-360, title III, Sec. 303(c)(2), July 1, 1988, 102 Stat. 762;

Pub. L. 101-239, title VIII, Secs. 8009(a), 8010(b), Dec. 19, 1989,

103 Stat. 2463, 2464; Pub. L. 103-66, title XIII, Sec. 13735(a),

Aug. 10, 1993, 107 Stat. 662; Pub. L. 103-296, title I, Sec.

107(a)(4), title II, Secs. 201(b)(3)(A), (B)(i), 204(a), Aug. 15,

1994, 108 Stat. 1478, 1502, 1504, 1508; Pub. L. 104-121, title I,

Sec. 105(b)(4)(A), Mar. 29, 1996, 110 Stat. 854; Pub. L. 104-193,

title I, Sec. 108(j), title II, Secs. 201(a), 202(a), (b),

203(a)(1), 204(a), 214(a), Aug. 22, 1996, 110 Stat. 2169,

2185-2187, 2195; Pub. L. 105-33, title V, Secs. 5521, 5522(c), Aug.

5, 1997, 111 Stat. 621, 623; Pub. L. 106-169, title II, Secs. 204,

207(c), 212, Dec. 14, 1999, 113 Stat. 1833, 1838, 1843; Pub. L.

106-170, title IV, Sec. 402(a)(3), (c)(1)-(3), Dec. 17, 1999, 113

Stat. 1908, 1909.)

-REFTEXT-

REFERENCES IN TEXT

Part A of subchapter IV of this chapter, referred to in subsec.

(c)(5), is classified to section 601 et seq. of this title.

Section 501(a) of Public Law 96-422, referred to in subsec.

(c)(5), is section 501(a) of Pub. L. 96-422, which is set out as a

note under section 1522 of Title 8, Aliens and Nationality.

The Internal Revenue Code of 1986, referred to in subsecs. (d)

and (e)(5), is classified generally to Title 26, Internal Revenue

Code.

The Balanced Budget and Emergency Deficit Control Act of 1985,

referred to in subsec. (e)(1)(I)(iv), is title II of Pub. L.

99-177, Dec. 12, 1985, 99 Stat. 1038, as amended, which enacted

chapter 20 (Sec. 900 et seq.) and sections 654 to 656 of Title 2,

The Congress, amended sections 602, 622, 631 to 642, and 651 to 653

of Title 2, sections 1104 to 1106, and 1109 of Title 31, Money and

Finance, and section 911 of this title, repealed section 661 of

Title 2, enacted provisions set out as notes under section 900 of

Title 2 and section 911 of this title, and amended provisions set

out as a note under section 621 of Title 2. For complete

classification of this Act to the Code, see Short Title note set

out under section 900 of Title 2 and Tables.

-MISC1-

PRIOR PROVISIONS

A prior section 1382, act Aug. 14, 1935, ch. 531, title XVI, Sec.

1602, as added July 25, 1962, Pub. L. 87-543, title I, Sec. 141(a),

76 Stat. 198; amended Oct. 13, 1964, Pub. L. 88-650, Sec. 5(b), 78

Stat. 1078; July 30, 1965, Pub. L. 89-97, title II, Sec. 221(d)(3),

title IV, Sec. 403(e), 79 Stat. 358, 418; Jan. 2, 1968, Pub. L.

90-248, title II, Secs. 210(a)(5), 213(a)(4), 241(d), 81 Stat. 896,

898, 917; Oct. 30, 1972, Pub. L. 92-603, title IV, Secs. 405(d),

406(d), 407(d), 410(d), 413(d), 86 Stat. 1488, 1489, 1491, 1492,

set forth required contents of State plans for aid to aged, blind,

or disabled, and for medical assistance for aged, prior to the

general amendment of title XVI of the Social Security Act by Pub.

L. 92-603, Sec. 301, but is set out as a note below in view of its

continued applicability to Puerto Rico, Guam, and the Virgin

Islands.

AMENDMENTS

1999 - Subsec. (e)(1)(G). Pub. L. 106-169, Sec. 212(b),

substituted "subparagraph (H) or (J)" for "subparagraph (H)" in

introductory provisions.

Subsec. (e)(1)(I)(i). Pub. L. 106-170, Sec. 402(c)(2),

substituted "institution comprising a jail, prison, penal

institution, or correctional facility, or with any other interested

State or local institution a purpose of which is to confine

individuals as described in section 402(x)(1)(A)(ii) of this

title," for "institution described in clause (i) or (ii) of section

402(x)(1)(A) of this title the primary purpose of which is to

confine individuals as described in section 402(x)(1)(A) of this

title,".

Subsec. (e)(1)(I)(i)(I). Pub. L. 106-170, Sec. 402(a)(3)(A),

substituted "and the other provisions of this subchapter; and" for

"; and".

Subsec. (e)(1)(I)(i)(II). Pub. L. 106-170, Sec. 402(c)(1)(A),

inserted "(subject to reduction under clause (ii))" after "$400"

and "$200".

Subsec. (e)(1)(I)(ii). Pub. L. 106-170, Sec. 402(c)(1)(C), added

cl. (ii). Former cl. (ii) redesignated (iii).

Subsec. (e)(1)(I)(ii)(II). Pub. L. 106-170, Sec. 402(a)(3)(B),

substituted "shall maintain, and shall provide on a reimbursable

basis," for "is authorized to provide, on a reimbursable basis,".

Pub. L. 106-169, Sec. 204, which directed substitution of "shall"

for "is authorized to" in cl. (ii)(II), could not be executed in

view of the redesignation of cl. (ii) as (iii) by Pub. L. 106-170,

Sec. 402(c)(1)(B). See note above and Effective Date of 1999

Amendment note below.

Subsec. (e)(1)(I)(iii). Pub. L. 106-170, Sec. 402(c)(3)(B),

substituted "eligibility and other administrative purposes under

such program" for "eligibility purposes".

Pub. L. 106-170, Sec. 402(c)(3)(A), struck out "(II)" before "The

Commissioner" and struck out subcl. (I) which read as follows: "The

provisions of section 552a of title 5 shall not apply to any

agreement entered into under clause (i) or to information exchanged

pursuant to such agreement."

Pub. L. 106-170, Sec. 402(c)(1)(B), redesignated cl. (ii) as

(iii). Former cl. (iii) redesignated (iv).

Subsec. (e)(1)(I)(iv). Pub. L. 106-170, Sec. 402(c)(1)(B),

redesignated cl. (iii) as (iv).

Subsec. (e)(1)(J). Pub. L. 106-169, Sec. 212(a), added subpar.

(J).

Subsec. (e)(4). Pub. L. 106-169, Sec. 207(c)(1), (3),

redesignated par. (5) as (4) and struck out former par. (4) which

read as follows:

"(4)(A) No person shall be considered an eligible individual or

eligible spouse for purposes of this subchapter during the 10-year

period that begins on the date the person is convicted in Federal

or State court of having made a fraudulent statement or

representation with respect to the place of residence of the person

in order to receive assistance simultaneously from 2 or more States

under programs that are funded under subchapter IV of this chapter,

subchapter XIX of this chapter, or the Food Stamp Act of 1977, or

benefits in 2 or more States under the supplemental security income

program under this subchapter.

"(B) As soon as practicable after the conviction of a person in a

Federal or State court as described in subparagraph (A), an

official of such court shall notify the Commissioner of such

conviction."

Subsec. (e)(5). Pub. L. 106-169, Sec. 207(c)(3), redesignated

par. (6) as (5). Former par. (5) redesignated (4).

Subsec. (e)(6). Pub. L. 106-169, Sec. 207(c)(2), (3),

redesignated par. (6) as (5) and substituted "(4)" for "(5)".

1997 - Subsec. (e)(1)(B). Pub. L. 105-33, Sec. 5522(c)(1)(A),

(D), in introductory provisions, substituted "medical treatment

facility" for "hospital, extended care facility, nursing home, or

intermediate care facility" and in closing provisions, substituted

"medical treatment facility that provides services described in

section 1396p(c)(1)(C) of this title" for "hospital, extended care

facility, nursing home, or intermediate care facility which is a

'medical institution or nursing facility' within the meaning of

section 1396p(c) of this title".

Subsec. (e)(1)(B)(ii). Pub. L. 105-33, Sec. 5522(c)(1)(B), struck

out "hospital, home or" before "facility" in introductory

provisions and "hospital, home, or" before "facility" in subcl.

(I).

Subsec. (e)(1)(B)(iii). Pub. L. 105-33, Sec. 5522(c)(1)(C),

struck out "hospital, home, or" before "facility".

Subsec. (e)(1)(E)(i)(II), (iii). Pub. L. 105-33, Sec. 5522(c)(2),

substituted "medical treatment facility" for "hospital, extended

care facility, nursing home, or intermediate care facility".

Subsec. (e)(1)(G). Pub. L. 105-33, Sec. 5522(c)(3), substituted

"or is in a medical treatment" for "or which is a hospital,

extended care facility, nursing home, or intermediate care" and

inserted "or, in the case of an individual who is a child under the

age of 18, under any health insurance policy issued by a private

provider of such insurance" after "subchapter XIX of this chapter".

Subsec. (e)(1)(I)(i)(I). Pub. L. 105-33, Sec. 5521(c),

substituted "this paragraph" for "paragraph (1)".

Subsec. (e)(1)(I)(i)(II). Pub. L. 105-33, Sec. 5521(b),

substituted "individual who receives in the month preceding the

first month throughout which such individual is an inmate of the

jail, prison, penal institution, or correctional facility that

furnishes information respecting such individual pursuant to

subclause (I), or is confined in the institution (that so furnishes

such information) as described in section 402(x)(1)(A)(ii) of this

title, a benefit under this subchapter for such preceding month,

and who is determined by the Commissioner to be ineligible for

benefits under this subchapter by reason of confinement based on

the information provided by such institution" for "inmate of the

institution who is eligible for a benefit under this subchapter for

the month preceding the first month throughout which such inmate is

in such institution and becomes ineligible for such benefit as a

result of the application of this subparagraph".

Subsec. (e)(3). Pub. L. 105-33, Sec. 5522(c)(4), substituted

"same medical treatment facility" for "same hospital, home, or

facility" and "same such facility" for "same such hospital, home,

or facility".

Subsec. (e)(6). Pub. L. 105-33, Sec. 5521(a), inserted "and

section 1306(c) of this title" after "of 1986".

1996 - Subsec. (c)(5)(A). Pub. L. 104-193, Sec. 108(j), amended

subpar. (A) generally. Prior to amendment, subpar. (A) read as

follows: "a State plan approved under part A of subchapter IV of

this chapter (relating to aid to families with dependent

children),".

Subsec. (c)(7)(A), (B). Pub. L. 104-193, Sec. 204(a), amended

subpars. (A) and (B) generally. Prior to amendment, subpars. (A)

and (B) read as follows:

"(A) the date such application is filed, or

"(B) the date such individual first becomes eligible for such

benefits with respect to such application."

Subsec. (e)(1)(B). Pub. L. 104-193, Sec. 214(a), inserted "or, in

the case of an eligible individual who is a child under the age of

18, receiving payments (with respect to such individual) under any

health insurance policy issued by a private provider of such

insurance" after "section 1382c(f)(2)(B) of this title,".

Subsec. (e)(1)(I). Pub. L. 104-193, Sec. 203(a)(1), added subpar.

(I).

Subsec. (e)(3). Pub. L. 104-193, Sec. 201(a), redesignated par.

(5) as (3).

Pub. L. 104-121 struck out par. (3) which related to limitation

on eligibility for benefits by reason of disability based on

alcoholism or drug addiction.

Subsec. (e)(4). Pub. L. 104-193, Sec. 201(a), added par. (4).

Subsec. (e)(5). Pub. L. 104-193, Secs. 201(a), 202(a), added par.

(5) and redesignated former par. (5) as (3).

Subsec. (e)(6). Pub. L. 104-193, Sec. 202(b), added par. (6).

1994 - Subsecs. (c), (d), (e)(1)(D), (H), (2). Pub. L. 103-296,

Sec. 107(a)(4), substituted "Commissioner of Social Security" for

"Secretary" wherever appearing.

Subsec. (e)(3)(A). Pub. L. 103-296, Sec. 201(b)(3)(A), amended

subpar. (A) generally. Prior to amendment, subpar. (A) read as

follows: "No person who is an aged, blind, or disabled individual

solely by reason of disability (as determined under section

1382c(a)(3) of this title) shall be an eligible individual or

eligible spouse for purposes of this subchapter 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 long as such treatment is available) and demonstrates that he

is complying with the terms, conditions, and requirements of such

treatment and with requirements imposed by the Secretary under

subparagraph (B)."

Pub. L. 103-296, Sec. 107(a)(4), in subpar. (A) as amended by

Pub. L. 103-296, Sec. 201(b)(3)(A), substituted "Commissioner of

Social Security" for "Secretary" and "Commissioner's" for

"Secretary's" wherever appearing.

Subsec. (e)(3)(B). Pub. L. 103-296, Sec. 201(b)(3)(B)(i),

designated existing provisions as cl. (i), struck out "The

Secretary shall annually submit to the Congress a full and complete

report on his activities under this paragraph." after first

sentence, and added cls. (ii) and (iii).

Pub. L. 103-296, Sec. 107(a)(4), in subpar. (B) as amended by

Pub. L. 103-296, Sec. 201(b)(3)(B)(i), substituted "Commissioner of

Social Security" for "Secretary" wherever appearing and

"Commissioner's" for "Secretary's" in cl. (iii)(II)(aa).

Subsec. (e)(5). Pub. L. 103-296, Sec. 107(a)(4), substituted

"Commissioner of Social Security" for "Secretary".

Subsec. (f). Pub. L. 103-296, Sec. 204(a), designated existing

provisions as par. (1) and added par. (2).

Subsec. (f)(2)(B). Pub. L. 103-296, Sec. 107(a)(4), in subpar.

(B) as added by Pub. L. 103-296, Sec. 204(a), substituted

"Commissioner of Social Security" for "Secretary".

1993 - Subsec. (c)(1). Pub. L. 103-66, Sec. 13735(a)(1),

substituted "(5), and (6)" for "and (5)".

Subsec. (c)(6) to (8). Pub. L. 103-66, Sec. 13735(a)(2), (3),

added par. (6) and redesignated former pars. (6) and (7) as (7) and

(8), respectively.

1989 - Subsec. (e)(1)(B). Pub. L. 101-239, Sec. 8010(b), inserted

"or an eligible individual is a child described in section

1382c(f)(2)(B) of this title," before "the benefit under this

subchapter" in introductory provisions.

Subsec. (f). Pub. L. 101-239, Sec. 8009(a), inserted "(other than

a child described in section 1382c(a)(1)(B)(ii) of this title)"

after "no individual".

1988 - Subsec. (e)(1)(B). Pub. L. 100-360 inserted at end "For

purposes of this subsection, a hospital, extended care facility,

nursing home, or intermediate care facility which is a 'medical

institution or nursing facility' within the meaning of section

1396p(c) of this title shall be considered to be receiving payments

with respect to an individual under a State plan approved under

subchapter XIX of this chapter during any period of ineligibility

of such individual provided for under the State plan pursuant to

section 1396p(c) of this title."

1987 - Subsec. (c)(1). Pub. L. 100-203, Sec. 9106(a)(1),

substituted "paragraphs (2), (3), (4), and (5)" for "paragraphs

(2), (3), and (4)".

Subsec. (c)(5) to (7). Pub. L. 100-203, Sec. 9106(a)(2), (3),

added par. (5) and redesignated former pars. (5) and (6) as (6) and

(7), respectively.

Subsec. (e)(1)(A). Pub. L. 100-203, Sec. 9115(a)(1), substituted

"(E), and (G)" for "and (E)".

Subsec. (e)(1)(B). Pub. L. 100-203, Sec. 9115(a)(2), inserted

"(subject to subparagraph (G))" after "throughout any month".

Subsec. (e)(1)(B)(i) to (iii). Pub. L. 100-203, Sec. 9119(a), in

cls. (i) and (ii)(I) substituted "$360 per year" for "$300 per

year" and in cl. (iii) substituted "$720 per year" for "$600 per

year".

Subsec. (e)(1)(D). Pub. L. 100-203, Sec. 9113(a), substituted "6

months in any 9-month period" for "three months in any 12-month

period".

Subsec. (e)(1)(G), (H). Pub. L. 100-203, Sec. 9115(a)(3), added

subpars. (G) and (H).

Subsec. (e)(5). Pub. L. 100-203, Sec. 9107, substituted "living

in the same hospital, home, or facility" for "sharing a room or

comparable accommodation in a hospital, home, or facility" and

"lived in the same such hospital, home, or facility" for "shared

such a room or accommodation".

1986 - Subsec. (d). Pub. L. 99-514 substituted "Internal Revenue

Code of 1986" for "Internal Revenue Code of 1954".

Subsec. (e)(1). Pub. L. 99-643, Sec. 3(a), in subpar. (A)

substituted "(D), and (E)" for "and (D)", in subpar. (B) inserted

"(subject to subparagraph (E))" after "shall be payable", and added

subpars. (E) and (F).

Subsec. (e)(4). Pub. L. 99-643, Sec. 4(d)(1), struck out par. (4)

which read as follows: "No benefit shall be payable under this

subchapter, except as provided in section 1382h of this title (or

section 1382e(c)(3) of this title), with respect to an eligible

individual or his eligible spouse who is an aged, blind, or

disabled individual solely by application of section 1382c(a)(3)(F)

of this title for any month, after the third month, in which he

engages in substantial gainful activity during the fifteen-month

period following the end of his trial work period determined by

application of section 1382c(a)(4)(D)(i) of this title."

Subsec. (e)(5). Pub. L. 99-643, Sec. 9(a), added par. (5).

Subsec. (i). Pub. L. 99-643, Sec. 4(c)(3), added subsec. (i).

1984 - Subsec. (a)(1)(B). Pub. L. 98-369, Sec. 2611(a),

substituted "the applicable amount determined under paragraph

(3)(A)" for "$2,250" and "the applicable amount determined under

paragraph (3)(B)" for "$1,500".

Subsec. (a)(2)(B). Pub. L. 98-369, Sec. 2611(b), substituted "the

applicable amount determined under paragraph (3)(A)" for "$2,250".

Subsec. (a)(3). Pub. L. 98-369, Sec. 2611(c), added par. (3).

Subsec. (c). Pub. L. 98-369, Sec. 2663(g)(1), amended heading.

Subsec. (g). Pub. L. 98-369, Sec. 2663(g)(2), substituted "or

such individual" for "or individuals" in provisions following par.

(3).

1983 - Subsec. (e)(1)(A). Pub. L. 98-21, Sec. 403(a)(1), inserted

reference to subpar. (D).

Subsec. (e)(1)(D). Pub. L. 98-21, Sec. 403(a)(2), added subpar.

(D).

1982 - Subsec. (c)(1). Pub. L. 97-248, Sec. 183(a)(1), inserted

reference to pars. (3) and (4).

Subsec. (c)(2). Pub. L. 97-248, Sec. 181(a), in par. (2)

redesignated existing provisions as provisions preceding subpar.

(A) and subpar. (A), and added subpar. (B).

Subsec. (c)(3) to (6). Pub. L. 97-248, Secs. 181(a), 183(a)(2),

(3), struck out par. (3) providing that an application shall be

effective as of the first day of the month in which it is filed,

added par. (3) providing that an application shall be effective on

the later of the date it is filed or the date such individual first

becomes eligible for such benefits with respect to such application

and redesignated such par. (3) as (5), redesignated par. (4) as

(6), and added pars. (3) and (4).

1981 - Subsec. (c). Pub. L. 97-35 substituted provision that

eligibility and benefit amount generally be determined on a

one-month retrospective basis, with for the first month of

eligibility, the month in which the application is filed,

eligibility and benefit amount both determined on a prospective

basis for provision that eligibility and benefit amount be

determined on a quarterly prospective basis and inserted provision

authorizing the Secretary to grant waivers.

1980 - Subsec. (e)(4). Pub. L. 96-265 added par. (4).

1976 - Subsec. (e)(1)(A). Pub. L. 94-566, Sec. 505(a), inserted

reference to subparagraph (C).

Subsec. (e)(1)(B)(ii). Pub. L. 94-566, Sec. 502, inserted "of the

one who is in such hospital, home, or facility" after "section

1382a(b) of this title" in parenthetical provisions that follow

"the rate of $300 per year" and inserted "(reduced by the amount of

any income, not excluded pursuant to section 1382a(b) of this

title, of the other)" after "the applicable rate specified in

subsection (b)(1) of this section".

Subsec. (e)(1)(C). Pub. L. 94-566, Sec. 505(a), added subpar.

(C).

1974 - Pub. L. 93-368 inserted "(or, if greater, the amount

determined under section 1382f of this title)" after "$1,752" in

subsecs. (a)(1)(A) and (b)(1) and "$2,628" in subsecs. (a)(2)(A)

and (b)(2).

1973 - Subsec. (a)(1)(A). Pub. L. 93-233, Sec. 4(b)(1),

substituted "$1,752" for "$1,680".

Pub. L. 93-66, Sec. 210(a), substituted "$1,680" for "$1,560".

Subsec. (a)(2)(A). Pub. L. 93-233, Sec. 4(b)(2), substituted

"$2,628" for "$2,520".

Pub. L. 93-66, Sec. 210(b), substituted "$2,520" for "$2,340".

Subsec. (b)(1). Pub. L. 93-233, Sec. 4(b)(1), substituted

"$1,752" for "$1,680".

Pub. L. 93-66, Sec. 210(a), substituted "$1,680" for "$1,560".

Subsec. (b)(2). Pub. L. 93-233, Sec. 4(b)(2), substituted

"$2,628" for "$2,520".

Pub. L. 93-66, Sec. 210(b), substituted "$2,520" for "$2,340".

Subsec. (g). Pub. L. 93-233, Sec. 18(d), incorporated existing

provisions in text designated as cl. (1), added cls. (2) and (3),

and substituted final December "1973" for "1972".

Subsec. (h). Pub. L. 93-233, Sec. 18(e), incorporated existing

text in provisions designated as cls. (1) and (2), added cls. (3)

and (4), redesignated former cls. (1) and (2) as items (A) and (B),

and in item (A) inserted "under which he or they received such aid

or assistance for December 1973".

EFFECTIVE DATE OF 1999 AMENDMENTS

Amendment by section 402(a)(3) of Pub. L. 106-170 applicable to

individuals whose period of confinement in an institution commences

on or after the first day of the fourth month beginning after

December 1999, see section 402(a)(4) of Pub. L. 106-170, set out as

a note under section 402 of Title 42, The Public Health and

Welfare.

Pub. L. 106-170, title IV, Sec. 402(c)(4), Dec. 17, 1999, 113

Stat. 1909, provided that: "The amendments made by this subsection

[amending this section] shall take effect as if included in the

enactment of section 203(a) of the Personal Responsibility and Work

Opportunity Reconciliation Act of 1996 (Public Law 104-193; 110

Stat. 2186). The reference to section 202(x)(1)(A)(ii) of the

Social Security Act [section 402(x)(1)(A)(ii) of this title] in

section 1611(e)(1)(I)(i) of the Social Security Act [subsec.

(e)(1)(I)(i) of this section], as amended by paragraph (2) of this

subsection, shall be deemed a reference to such section

202(x)(1)(A)(ii) of such Act as amended by subsection (b)(1)(C) of

this section."

Amendment by section 207(c) of Pub. L. 106-169 applicable to

statements and representations made on or after Dec. 14, 1999, see

section 207(e) of Pub. L. 106-169, set out as a note under section

402 of this title.

EFFECTIVE DATE OF 1997 AMENDMENT

Amendment by Pub. L. 105-33 effective as if included in the

enactment of title II of the Personal Responsibility and Work

Opportunity Reconciliation Act of 1996, Pub. L. 104-193, see

section 5528(a) of Pub. L. 105-33, set out as a note under section

903 of this title.

EFFECTIVE DATE OF 1996 AMENDMENTS

Amendment by section 108(j) of Pub. L. 104-193 effective July 1,

1997, with transition rules relating to State options to accelerate

such date, rules relating to claims, actions, and proceedings

commenced before such date, rules relating to closing out of

accounts for terminated or substantially modified programs and

continuance in office of Assistant Secretary for Family Support,

and provisions relating to termination of entitlement under AFDC

program, see section 116 of Pub. L. 104-193, as amended, set out as

an Effective Date note under section 601 of this title.

Section 201(b) of Pub. L. 104-193 provided that: "The amendment

made by this section [amending this section] shall take effect on

the date of the enactment of this Act [Aug. 22, 1996]."

Section 202(c) of Pub. L. 104-193 provided that: "The amendments

made by this section [amending this section] shall take effect on

the date of the enactment of this Act [Aug. 22, 1996]."

Section 203(a)(2) of Pub. L. 104-193 provided that: "The

amendment made by this subsection [amending this section] shall

apply to individuals whose period of confinement in an institution

commences on or after the first day of the seventh month beginning

after the month in which this Act is enacted [August 1996]."

Section 204(d) of Pub. L. 104-193 provided that:

"(1) In general. - The amendments made by this section [amending

this section and sections 1382c and 1383 of this title] shall apply

to applications for benefits under title XVI of the Social Security

Act [this subchapter] filed on or after the date of the enactment

of this Act [Aug. 22, 1996], without regard to whether regulations

have been issued to implement such amendments.

"(2) Benefits under title xvi. - For purposes of this subsection,

the term 'benefits under title XVI of the Social Security Act'

includes supplementary payments pursuant to an agreement for

Federal administration under section 1616(a) of the Social Security

Act [section 1382e(a) of this title], and payments pursuant to an

agreement entered into under section 212(b) of Public Law 93-66

[set out below]."

Section 214(b) of Pub. L. 104-193 provided that: "The amendment

made by this section [amending this section] shall apply to

benefits for months beginning 90 or more days after the date of the

enactment of this Act [Aug. 22, 1996], without regard to whether

regulations have been issued to implement such amendments."

Section 105(b)(5) of Pub. L. 104-121, as amended by Pub. L.

105-33, title V, Sec. 5525(a), (b), Aug. 5, 1997, 111 Stat. 624,

provided that:

"(A) The amendments made by paragraphs (1) and (4) [amending this

section and sections 1382c and 1383c of this title] shall apply to

any individual who applies for, or whose claim is finally

adjudicated with respect to, supplemental security income benefits

under title XVI of the Social Security Act [this subchapter] based

on disability on or after the date of the enactment of this Act

[Mar. 29, 1996], and, in the case of any individual who has applied

for, and whose claim has been finally adjudicated with respect to,

such benefits before such date of enactment, such amendments shall

apply only with respect to such benefits for months beginning on or

after January 1, 1997.

"(B) The amendments made by paragraphs (2) and (3) [enacting

section 1383e of this title and amending section 1383 of this

title] shall take effect on July 1, 1996, with respect to any

individual -

"(i) whose claim for benefits is finally adjudicated on or

after the date of the enactment of this Act [Mar. 29, 1996], or

"(ii) whose eligibility for benefits is based upon an

eligibility redetermination made pursuant to subparagraph (C).

"(C) Within 90 days after the date of the enactment of this Act

[Mar. 29, 1996], the Commissioner of Social Security shall notify

each individual who is eligible for supplemental security income

benefits under title XVI of the Social Security Act [this

subchapter] for the month in which this Act is enacted and whose

eligibility for such benefits would terminate by reason of the

amendments made by this subsection [enacting section 1383e of this

title and amending this section and sections 1382c, 1383, and 1383c

of this title]. If such an individual reapplies for supplemental

security income benefits under title XVI of such Act (as amended by

this Act) within 120 days after the date of the enactment of this

Act, the Commissioner of Social Security shall, not later than

January 1, 1997, complete the eligibility redetermination

(including a new medical determination) with respect to such

individual pursuant to the procedures of such title.

"(D) For purposes of this paragraph, an individual's claim, with

respect to supplemental security income benefits under title XVI of

the Social Security Act [this subchapter] based on disability,

which has been denied in whole before the date of the enactment of

this Act [Mar. 29, 1996], may not be considered to be finally

adjudicated before such date if, on or after such date -

"(i) there is pending a request for either administrative or

judicial review with respect to such claim, or

"(ii) there is pending, with respect to such claim, a

readjudication by the Commissioner of Social Security pursuant to

relief in a class action or implementation by the Commissioner of

a court remand order.

"(E) Notwithstanding the provisions of this paragraph, with

respect to any individual for whom the Commissioner does not

perform the eligibility redetermination before the date prescribed

in subparagraph (C), the Commissioner shall perform such

eligibility redetermination in lieu of a continuing disability

review whenever the Commissioner determines that the individual's

eligibility is subject to redetermination based on the preceding

provisions of this paragraph, and the provisions of section

1614(a)(4) of the Social Security Act [section 1382c(a)(4) of this

title] shall not apply to such redetermination.

"(F) For purposes of this paragraph, the phrase 'supplemental

security income benefits under title XVI of the Social Security

Act' includes supplementary payments pursuant to an agreement for

Federal administration under section 1616(a) of the Social Security

Act [section 1382e(a) of this title] and payments pursuant to an

agreement entered into under section 212(b) of Public Law 93-66

[set out below]."

[Amendment by Pub. L. 105-33 to section 105(b)(5) of Pub. L.

104-121, set out above, effective as if included in the enactment

of section 105 of Pub. L. 104-121, see section 5528(c)(1) of Pub.

L. 105-33, set out as an Effective Date of 1997 Amendment note

under section 903 of this title.]

EFFECTIVE DATE OF 1994 AMENDMENT; SUNSET PROVISION

Amendment by section 107(a)(4) of Pub. L. 103-296 effective Mar.

31, 1995, see section 110(a) of Pub. L. 103-296, set out as a note

under section 401 of this title.

Section 201(b)(3)(C), (E), of Pub. L. 103-296 provided that:

"(C) Sunset of 36-month rule. - Section 1611(e)(3)(A)(v) of the

Social Security Act [subsec. (e)(3)(A)(v) of this section] (added

by subparagraph (A) of this paragraph) shall cease to be effective

with respect to benefits for months after September 2004.

"(E) Effective date. -

"(i) In general. - Except as otherwise provided in this

paragraph [amending this section and section 1383c of this title

and enacting provisions set out as notes below], the amendments

made by this paragraph shall apply with respect to supplemental

security income benefits under title XVI of the Social Security

Act [this subchapter] by reason of disability which are otherwise

payable in months beginning after 180 days after the date of the

enactment of this Act [Aug. 15, 1994]. The Secretary of Health

and Human Services shall issue regulations necessary to carry out

the amendments made by this paragraph not later than 180 days

after such date of enactment.

"(ii) Referral and monitoring agencies. - The amendments made

by subparagraph (B) [amending this section] shall take effect 180

days after the date of the enactment of this Act [Aug. 15, 1994].

"(iii) Termination after 36 months. - Clause (v) of section

1611(e)(3)(A) of the Social Security Act [subsec. (e)(3)(A) of

this section] (added by the amendment made by subparagraph (A) of

this paragraph) shall apply with respect to supplemental security

income benefits under title XVI of the Social Security Act [this

subchapter] by reason of disability for months beginning after

180 days after the date of the enactment of this Act [Aug. 15,

1994]."

Section 204(b) of Pub. L. 103-296 provided that: "The amendment

made by subsection (a) [amending this section] shall take effect on

January 1, 1995."

EFFECTIVE DATE OF 1993 AMENDMENT

Section 13735(b) of Pub. L. 103-66 provided that: "The amendments

made by subsection (a) [amending this section] shall apply to

benefits paid for months after the calendar year 1994."

EFFECTIVE DATE OF 1989 AMENDMENT

Section 8009(c) of Pub. L. 101-239 provided that: "The amendments

made by subsections (a) and (b) [amending this section and section

1382c of this title] shall apply with respect to benefits for

months after March 1990."

Section 8010(c) of Pub. L. 101-239 provided that: "The amendments

made by subsections (a) and (b) [amending this section and section

1382c of this title] shall take effect on the 1st day of the 6th

calendar month beginning after the date of the enactment of this

Act [Dec. 19, 1989]."

EFFECTIVE DATE OF 1988 AMENDMENT

Amendment by Pub. L. 100-360 applicable to transfers occurring on

or after July 1, 1988, without regard to whether or not final

regulations to carry out such amendment have been promulgated by

such date, see section 303(g)(3) of Pub. L. 100-360, set out as a

note under section 1396r-5 of this title.

EFFECTIVE DATE OF 1987 AMENDMENT

Section 9106(b) of Pub. L. 100-203 provided that: "The amendments

made by subsection (a) [amending this section] shall become

effective April 1, 1988."

Section 9107 of Pub. L. 100-203 provided that the amendment made

by that section is effective Nov. 10, 1986.

Section 9113(b) of Pub. L. 100-203 provided that:

"(1) The amendment made by subsection (a) [amending this section]

shall become effective January 1, 1988.

"(2) In the application of section 1611(e)(1)(D) of the Social

Security Act [subsec. (e)(1)(D) of this section] on and after the

effective date of such amendment, months before January 1988 in

which a person was an eligible individual or eligible spouse by

reason of such section shall not be taken into account."

Section 9115(c) of Pub. L. 100-203 provided that: "The amendments

made by this section [amending this section and section 1396a of

this title] shall become effective July 1, 1988."

Section 9119(c) of Pub. L. 100-203 provided that: "The amendments

made by subsections (a) and (b) [amending this section and section

1382g of this title] shall become effective July 1, 1988."

EFFECTIVE DATE OF 1986 AMENDMENT

Amendment by sections 3(a) and 4(c)(3), (d)(1) of Pub. L. 99-643

effective July 1, 1987, except as otherwise provided, see section

10(b) of Pub. L. 99-643, set out as a note under section 1396a of

this title.

Section 9(b) of Pub. L. 99-643 provided that: "The amendment made

by subsection (a) [amending this section] shall take effect on the

date of the enactment of this Act [Nov. 10, 1986]."

EFFECTIVE DATE OF 1984 AMENDMENT

Amendment by section 2611(a)-(c) of Pub. L. 98-369 effective Oct.

1, 1984, except as otherwise specifically provided, see section

2646 of Pub. L. 98-369, set out as a note under section 657 of this

title.

Amendment by section 2663(g)(1), (2) of Pub. L. 98-369 effective

July 18, 1984, but not to be construed as changing or affecting any

right, liability, status, or interpretation which existed (under

the provisions of law involved) before that date, see section

2664(b) of Pub. L. 98-369, set out as a note under section 401 of

this title.

EFFECTIVE DATE OF 1983 AMENDMENT

Section 403(b) of Pub. L. 98-21 provided that: "The amendments

made by subsection (a) [amending this section] shall be effective

with respect to months after the month in which this Act is enacted

[April 1983]."

EFFECTIVE DATE OF 1982 AMENDMENT

Section 181(b) of Pub. L. 97-248 provided that: "The amendment

made by this section [amending this section] shall become effective

on October 1, 1982."

Section 183(b) of Pub. L. 97-248 provided that: "The amendment

made by subsection (a) [amending this section] shall become

effective October 1, 1982."

EFFECTIVE DATE OF 1981 AMENDMENT AND TRANSITIONAL PROVISIONS

Section 2341(c) of Pub. L. 97-35 provided that:

"(1) The amendments made by this section [amending this section

and section 1382a of this title] shall be effective with respect to

months after the first calendar quarter which ends more than five

months after the month in which this Act is enacted [August 1981].

"(2) The Secretary of Health and Human Services may, under

conditions determined by him to be necessary and appropriate, make

a transitional payment or payments during the first two months for

which the amendments made by this section are effective. A

transitional payment made under this section shall be deemed to be

a payment of supplemental security income benefits."

EFFECTIVE DATE OF 1980 AMENDMENT

Amendment by Pub. L. 96-265 effective on first day of sixth month

which begins after June 9, 1980, and applicable with respect to any

individual whose disability has not been determined to have ceased

prior to such first day, see section 303(d) of Pub. L. 96-265, set

out as a note under section 402 of this title.

EFFECTIVE DATE OF 1976 AMENDMENT

Section 505(e) of Pub. L. 94-566 provided that: "The amendments

[amending this section and section 1382a of this title] and repeals

[repealing section 1382e(e) of this title] made by this section,

unless otherwise specified therein, shall take effect on October 1,

1976."

EFFECTIVE DATE OF 1973 AMENDMENTS

Section 4(b) of Pub. L. 93-233 provided that the amendments made

by section 4(b)(1), (2) of Pub. L. 93-233 are effective with

respect to payments for months after June 1974.

Section 210(c) of Pub. L. 93-66, as amended Pub. L. 93-233, Sec.

4(a)(1), Dec. 31, 1973, 87 Stat. 953, provided: "The amendments

made by this section [amending this section] shall apply with

respect to payments for months after December 1973."

EFFECTIVE DATE

Section 301 of Pub. L. 92-603 provided that this section is

effective Jan. 1, 1974.

REGULATIONS

Section 215 of title II of Pub. L. 104-193 provided that: "Within

3 months after the date of the enactment of this Act [Aug. 22,

1996], the Commissioner of Social Security shall prescribe such

regulations as may be necessary to implement the amendments made by

this subtitle [subtitle B (Secs. 211-215) of title II of Pub. L.

104-193, amending this section, sections 1382a to 1382c and 1383 of

this title, sections 665e and 901 of Title 2, The Congress, and

provisions set out as a note under section 401 of this title, and

repealing provisions set out as a note below]."

CONSTRUCTION OF 1999 AMENDMENT

Amendment by Pub. L. 106-170 to be executed as if Pub. L. 106-169

had been enacted after the enactment of Pub. L. 106-170, see

section 121(c)(1) of Pub. L. 106-169, set out as a note under

section 1396a of this title.

STUDY OF DENIAL OF SSI BENEFITS FOR FAMILY FARMERS

Pub. L. 106-169, title II, Sec. 261, Dec. 14, 1999, 113 Stat.

1856, provided that:

"(a) In General. - The Commissioner of Social Security shall

conduct a study of the reasons why family farmers with resources of

less than $100,000 are denied supplemental security income benefits

under title XVI of the Social Security Act [this subchapter],

including whether the deeming process unduly burdens and

discriminates against family farmers who do not institutionalize a

disabled dependent, and shall determine the number of such farmers

who have been denied such benefits during each of the preceding 10

years.

"(b) Report to the Congress. - Within 1 year after the date of

the enactment of this Act [Dec. 14, 1999], the Commissioner of

Social Security shall prepare and submit to the Committee on Ways

and Means of the House of Representatives and the Committee on

Finance of the Senate a report that contains the results of the

study, and the determination, required by subsection (a)."

STUDY OF OTHER POTENTIAL IMPROVEMENTS IN COLLECTION OF INFORMATION

RESPECTING PUBLIC INMATES

Section 203(b) of Pub. L. 104-193 provided that:

"(1) Study. - The Commissioner of Social Security shall conduct a

study of the desirability, feasibility, and cost of -

"(A) establishing a system under which Federal, State, and

local courts would furnish to the Commissioner such information

respecting court orders by which individuals are confined in

jails, prisons, or other public penal, correctional, or medical

facilities as the Commissioner may require for the purpose of

carrying out section 1611(e)(1) of the Social Security Act

[subsec. (e)(1) of this section]; and

"(B) requiring that State and local jails, prisons, and other

institutions that enter into agreements with the Commissioner

under section 1611(e)(1)(I) of the Social Security Act [subsec.

(e)(1)(I) of this section] furnish the information required by

such agreements to the Commissioner by means of an electronic or

other sophisticated data exchange system.

"(2) Report. - Not later than 1 year after the date of the

enactment of this Act [Aug. 22, 1996], the Commissioner of Social

Security shall submit a report on the results of the study

conducted pursuant to this subsection to the Committee on Finance

of the Senate and the Committee on Ways and Means of the House of

Representatives."

ADDITIONAL REPORT TO CONGRESS

Section 203(c) of Pub. L. 104-193 provided that: "Not later than

October 1, 1998, the Commissioner of Social Security shall provide

to the Committee on Finance of the Senate and the Committee on Ways

and Means of the House of Representatives a list of the

institutions that are and are not providing information to the

Commissioner under section 1611(e)(1)(I) of the Social Security Act

(as added by this section) [subsec. (e)(1)(I) of this section]."

STUDY BY GENERAL ACCOUNTING OFFICE

Section 232 of title II of Pub. L. 104-193 provided that: "Not

later than January 1, 1999, the Comptroller General of the United

States shall study and report on -

"(1) the impact of the amendments made by, and the provisions

of, this title [enacting section 1383f of this title, amending

this section, sections 1382a to 1382c, and 1383 of this title,

and sections 665e and 901 of Title 2, The Congress, enacting

provisions set out as notes under this section and sections

1382a, 1382c, and 1383 of this title, amending provisions set out

as a note under section 401 of this title, and repealing

provisions set out as a note below] on the supplemental security

income program under title XVI of the Social Security Act [this

subchapter]; and

"(2) extra expenses incurred by families of children receiving

benefits under such title that are not covered by other Federal,

State, or local programs."

REPORT TO CONGRESS ON REFERRAL, MONITORING AND TREATMENT ACTIVITIES

RELATING TO ALCOHOLICS AND DRUG ADDICTS

Section 201(b)(3)(B)(ii) of Pub. L. 103-296, which directed

Secretary of Health and Human Services to submit to Congress, not

later than Dec. 31, 1996, a report on the Secretary's activities

under subsec. (e)(3)(B) of this section, was repealed by Pub. L.

105-33, title V, Sec. 5525(c), Aug. 5, 1997, 111 Stat. 625.

TRANSITION RULES FOR CURRENT BENEFICIARIES

Section 201(b)(3)(F) of Pub. L. 103-296 provided that: "In any

case in which an individual is eligible for supplemental security

income benefits under title XVI of the Social Security Act [this

subchapter] by reason of disability, the determination of

disability was made by the Secretary of Health and Human Services

during or before the 180-day period following the date of the

enactment of this Act [Aug. 15, 1994], and alcoholism or drug

addiction is a contributing factor material to the Secretary's

determination that the individual is disabled, for purposes of

section 1611(e)(3)(A)(v) of the Social Security Act [subsec.

(e)(3)(A)(v) of this section] (added by the amendment made by

subparagraph (A) of this paragraph) -

"(i) the first month of such eligibility beginning after 180

days after the date of the enactment of this Act shall be treated

as the individual's first month of such eligibility; and

"(ii) the Secretary shall notify the individual of the

requirements of the amendments made by this paragraph [amending

this section and section 1383c of this title] no later than 180

days after the date of the enactment of this Act."

COMMISSION ON CHILDHOOD DISABILITY

Section 202 of Pub. L. 103-296 provided for establishment of a

Commission on the Evaluation of Disability to conduct a study, in

consultation with the National Academy of Sciences, of effects of

definition of "disability" under this subchapter in effect on Aug.

15, 1994, as such definition applied to determining whether a child

under age of 18 was eligible to receive benefits under this

subchapter, the appropriateness of such definition, and the

advantages and disadvantages of using any alternative definition of

disability in determining whether a child under age 18 was eligible

to receive benefits under this subchapter, and further provided for

contents of study, appointment of Commission members,

administrative provisions, assistance of experts, and for

submission of report to Congress not later than Nov. 30, 1995.

DISABILITY REVIEW REQUIRED FOR SSI RECIPIENTS WHO ARE 18 YEARS OF

AGE

Section 207 of Pub. L. 103-296, which required applicable State

agency or Secretary of Health and Human Services to redetermine

eligibility of qualified individual for supplemental security

income benefits under this subchapter by reason of disability, by

applying criteria used in determining eligibility for such benefits

of applicants who have attained 18 years of age during 1-year

period beginning on date qualified individual attains 18 years of

age, and Secretary to conduct such redeterminations with respect to

not less than 1/3 of qualified individuals in each of fiscal

years 1996 through 1998, defined term "qualified individual", and

provided that such redetermination was to be considered substitute

for review required under section 1382c(a)(3)(G) of this title,

that redetermination requirement was to have no force or effect

after Oct. 1, 1998, and that not later than Oct. 1, 1998, Secretary

was to submit to House Ways and Means and Senate Finance Committees

report on such activities, was repealed by Pub. L. 104-193, title

II, Sec. 212(b)(2), Aug. 22, 1996, 110 Stat. 2193.

CONTINUING DISABILITY REVIEWS

Section 208 of Pub. L. 103-296 provided that:

"(a) Temporary Annual Minimum Number of Reviews. - During each

year of the 3-year period that begins on October 1, 1995, the

Secretary of Health and Human Services shall apply section 221(i)

of the Social Security Act [section 421(i) of this title] in making

disability determinations under title XVI of such Act [this

subchapter] with respect to at least 100,000 recipients of

supplemental security income benefits under such title.

"(b) Report to the Congress. - Not later than October 1, 1998,

the Secretary of Health and Human Services shall submit to the

Committee on Ways and Means of the House of Representatives and the

Committee on Finance of the Senate a report on the activities

conducted under subsection (a)."

NOTIFICATION OF POSSIBLE BENEFIT AVAILABILITY TO POTENTIAL

SUPPLEMENTAL SECURITY INCOME RECIPIENTS

Section 405 of Pub. L. 98-21 provided that: "Prior to July 1,

1984, the Secretary of Health and Human Services shall notify all

elderly recipients of benefits under title II of the Social

Security Act [subchapter II of this chapter] who may be eligible

for supplemental security income benefits under title XVI of such

Act [this subchapter] of the availability of the supplemental

security income program, and shall encourage such recipients to

contact the Social Security district office. Such notification

shall also be made to all recipients prior to attainment of age 65,

with the notification made with respect to eligibility for

supplementary medical insurance."

ASSISTANCE PAID UNDER CERTAIN HOUSING ACTS NOT CONSIDERED IN

DETERMINING ELIGIBILITY FOR BENEFITS UNDER THIS SUBCHAPTER;

EFFECTIVE DATE

Pub. L. 94-375, Sec. 2(h), Aug. 3, 1976, 90 Stat. 1068, provided

that: "Notwithstanding any other provision of law, the value of any

assistance paid with respect to a dwelling unit under the United

States Housing Act of 1937 [section 1437 et seq. of this title],

the National Housing Act [section 1701 et seq. of Title 12, Banks

and Banking], section 101 of the Housing and Urban Development Act

of 1965 [section 1701s of Title 12 and sections 1451 and 1465 of

this title], or title V of the Housing Act of 1949 [section 1471 et

seq. of this title] may not be considered as income or a resource

for the purpose of determining the eligibility of, or the amount of

the benefits payable to, any person living in such unit for

assistance under title XVI of the Social Security Act [this

subchapter]. This subsection shall become effective on October 1,

1976."

SPECIAL $50 PAYMENT UNDER TAX REDUCTION ACT OF 1975

Special payment of $50 as soon as practicable after Mar. 29,

1975, by the Secretary of the Treasury to each individual who, for

the month of March, 1975, was entitled to a benefit under the

supplemental security income benefits program established by this

subchapter, see section 702 of Pub. L. 94-12, set out as a note

under section 402 of this title.

ADJUSTMENT OF INDIVIDUAL'S MONTHLY SUPPLEMENTAL SECURITY INCOME

PAYMENTS; REGULATIONS; LIMITATIONS

Pub. L. 93-335, Sec. 2(b)(2), July 8, 1974, 88 Stat. 291,

authorized the Secretary of Health, Education, and Welfare to

prescribe regulations for the adjustment of an individual's monthly

supplemental security income payment in accordance with any

increase to which such individual might be entitled under the

amendment made by subsection (a) of this section [amending section

212(a)(3)(B)(i) of Pub. L. 93-66, set out below]; provided that

such adjustment in monthly payment, together with the remittance of

any prior unpaid increments to which such individual might be

entitled under such amendment, was to be made no later than the

first day of the first month beginning more than sixty days after

July 8, 1974.

MEDICAID ELIGIBILITY FOR INDIVIDUALS RECEIVING MANDATORY STATE

SUPPLEMENTARY PAYMENTS; EFFECTIVE DATE

Additional requirement for approval of subchapter XIX State plan

for medical assistance respecting medicaid eligibility for

individuals receiving mandatory State supplementary payments, see

section 13(c) of Pub. L. 93-233, set out as a note under section

1396a of this title.

FEDERAL PROGRAM OF SUPPLEMENTAL SECURITY INCOME; SUPPLEMENTAL

SECURITY INCOME BENEFITS FOR ESSENTIAL PERSONS; DEFINITIONS OF

QUALIFIED INDIVIDUAL AND ESSENTIAL PERSON

Section 211 of Pub. L. 93-66, as amended by Pub. L. 93-233, Sec.

4(a)(2), (b)(3), Dec. 31, 1973, 87 Stat. 953, provided that:

"(a)(1) In determining (for purposes of title XVI of the Social

Security Act [this subchapter], as in effect after December 1973)

the eligibility for and the amount of the supplemental security

income benefit payable to any qualified individual (as defined in

subsection (b)), with respect to any period for which such

individual has in his home an essential person (as defined in

subsection (c)) -

"(A) the dollar amounts specified in subsection (a)(1)(A) and

(2)(A), and subsection (b)(1) and (2), of section 1611 of such

Act [this section], shall each be increased by $876 for each such

essential person, and

"(B) the income and resources of such individual shall (for

purposes of such title XVI [this subchapter]) be deemed to

include the income and resources of such essential person;

except that the provisions of this subsection shall not, in the

case of any individual, be applicable for any period which begins

in or after the first month that such individual -

"(C) does not but would (except for the provisions of

subparagraph (B)) meet -

"(i) the criteria established with respect to income in

section 1611(a) of such Act [subsec. (a) of this section], or

"(ii) the criteria established with respect to resources by

such section 1611(a) [subsec. (a) of this section] (or, if

applicable, by section 1611(g) of such Act [subsec. (g) of this

section]).

"(2) The provisions of section 1611(g) of the Social Security Act

[subsec. (g) of this section] (as in effect after December 1973)

shall, in the case of any qualified individual (as defined in

subsection (b)), be applied so as to include, in the resources of

such individual, the resources of any person (described in

subsection (b)(2)) whose needs were taken into account in

determining the need of such individual for the aid or assistance

referred to in subsection (b)(1).

"(b) For purposes of this section, an individual shall be a

'qualified individual' only if -

"(1) for the month of December 1973 such individual was a

recipient of aid or assistance under a State plan approved under

title I, X, XIV, or XVI of the Social Security Act [subchapter I,

X, XIV, or XVI of this chapter], and

"(2) in determining the need of such individual for such aid or

assistance for such month under such State plan, there were taken

into account the needs of a person (other than such individual)

who -

"(A) was living in the home of such individual, and

"(B) was not eligible (in his or her own right) for aid or

assistance under such State plan for such month.

"(c) The term 'essential person', when used in connection with

any qualified individual, means a person who -

"(1) for the month of December 1973 was a person (described in

subsection (b)(2)) whose needs were taken into account in

determining the need of such individual for aid or assistance

under a State plan referred to in subsection (b)(1) as such State

plan was in effect for June 1973,

"(2) lives in the home of such individual,

"(3) is not eligible (in his or her own right) for supplemental

security income benefits under title XVI of the Social Security

Act [this subchapter] (as in effect after December 1973), and

"(4) is not the eligible spouse (as that term is used in such

title XVI [this subchapter]) of such individual or any other

individual.

If for any month after December 1973 any person fails to meet the

criteria specified in paragraph (2), (3), or (4) of the preceding

sentence, such person shall not, for such month or any month

thereafter be considered to be an essential person."

[Amendment of section 211(a)(1)(A) of Pub. L. 93-66, set out

above, by Pub. L. 93-233 effective with respect to payments for

months after June 1974, see section 4(b) of Pub. L. 93-233.]

MANDATORY MINIMUM STATE SUPPLEMENTATION OF SUPPLEMENTAL SECURITY

INCOME BENEFITS PROGRAM; DECEMBER 1973 INCOME; TITLE XVI BENEFIT

PLUS OTHER INCOME; REDUCTION OF AMOUNT; ADMINISTRATION AGREEMENT;

PAYMENTS TO COMMISSIONER; STATE CONSTITUTIONAL RESTRICTION

Section 212 of Pub. L. 93-66, as amended by Pub. L. 93-233, Sec.

10, Dec. 31, 1973, 87 Stat. 957; Pub. L. 93-335, Sec. 2(a), July 8,

1974, 88 Stat. 291; Pub. L. 96-265, title II, Sec. 201(b)(2), June

9, 1980, 94 Stat. 446; Pub. L. 103-66, title XIII, Sec.

13731(a)(2), Aug. 10, 1993, 107 Stat. 661; Pub. L. 105-33, title V,

Sec. 5102(a)(2), (b)(1)(B), Aug. 5, 1997, 111 Stat. 595, 596; Pub.

L. 105-78, title V, Sec. 516(a)(2), (b)(1)(B), Nov. 13, 1997, 111

Stat. 1518, 1519; Pub. L. 106-170, title IV, Sec. 410(a)(2), Dec.

17, 1999, 113 Stat. 1916, provided that:

"(a)(1) In order for any State (other than the Commonwealth of

Puerto Rico, Guam, or the Virgin Islands) to be eligible for

payments pursuant to title XIX [subchapter XIX of this chapter],

with respect to expenditures for any quarter beginning after

December 1973, such State must have in effect an agreement with the

Commissioner of Social Security (hereinafter in this section

referred to as the 'Commissioner of Social Security') whereby the

State will provide to individuals residing in the State

supplementary payments as required under paragraph (2).

"(2) Any agreement entered into by a State pursuant to paragraph

(1) shall provide that each individual who -

"(A) is an aged, blind, or disabled individual (within the

meaning of section 1614(a) of the Social Security Act [section

1382c(a) of this title], as enacted by section 301 of the Social

Security Amendments of 1972), and

"(B) for the month of December 1973 was a recipient of (and was

eligible to receive) aid or assistance (in the form of money

payments) under a State plan of such State (approved under title

I, X, XIV, or XVI, of the Social Security Act [subchapter I, X,

XIV, or XVI of this chapter])

shall be entitled to receive, from the State, the supplementary

payment described in paragraph (3) for each month, beginning with

January 1974, and ending with whichever of the following first

occurs:

"(C) the month in which such individual dies, or

"(D) the first month in which such individual ceases to meet

the condition specified in subparagraph (A);

except that no individual shall be entitled to receive such

supplementary payment for any month, if, for such month, such

individual was ineligible to receive supplemental income benefits

under title XVI of the Social Security Act [this chapter] by reason

of the provisions of section 1611(e)(1)(A), (2), or (3) [subsec.

(e)(1)(A), (2), or (3) of this section], 1611(f) [subsec. (f) of

this section], or 1615(c) of such Act [section 1382d(c) of this

title].

"(3)(A) The supplementary payment referred to in paragraph (2)

which shall be paid for any month to any individual who is entitled

thereto under an agreement entered into pursuant to this subsection

shall (except as provided in subparagraphs (D) and (E)) be an

amount equal to (i) the amount by which such individual's 'December

1973 income' (as determined under subparagraph (B)) exceeds the

amount of such individual's 'title XVI benefit plus other income'

(as determined under subparagraph (C)) for such month, or (ii) if

greater, such amount as the State may specify.

"(B) For purposes of subparagraph (A), an individual's 'December

1973 income' means an amount equal to the aggregate of -

"(i) the amount of the aid or assistance (in the form of money

payments) which such individual would have received (including

any part of such amount which is attributable to meeting the

needs of any other person whose presence in such individual's

home is essential to such individual's well-being) for the month

of December 1973 under a plan (approved under title I, X, XIV, or

XVI, of the Social Security Act [subchapter I, X, XIV, or XVI of

this chapter]) of the State entering into an agreement under this

subsection, if the terms and conditions of such plan (relating to

eligibility for and amount of such aid or assistance payable

thereunder) were, for the month of December 1973, the same as

those in effect, under such plan, for the month of June 1973,

together with the bonus value of food stamps for January 1972, as

defined in section 401(b)(3) of Public Law 92-603 [set out as a

note under section 1382e of this title], if, for such month, such

individual resides in a State which provides State supplementary

payments (I) of the type described in section 1616(a) of the

Social Security Act [section 1382e(a) of this title], and (II)

the level of which has been found by the Commissioner of Social

Security pursuant to section 8 of Public Law 93-233 [set out as

notes under section 1382e of this title and sections 612c, 1431

and 2012 of Title 7, Agriculture] to have been specifically

increased so as to include the bonus value of food stamps, and

"(ii) the amount of the income of such individual (other than

the aid or assistance described in clause (i)) received by such

individual in December 1973, minus any such income which did not

result, but which if properly reported would have resulted in a

reduction in the amount of such aid or assistance.

"(C) For purposes of subparagraph (A), the amount of an

individual's 'title XVI benefit plus other income' for any month

means an amount equal to the aggregate of -

"(i) the amount (if any) of the supplemental security income

benefit to which such individual is entitled for such month under

title XVI of the Social Security Act [this subchapter], and

"(ii) the amount of any income of such individual for such

month (other than income in the form of a benefit described in

clause (i)).

"(D) If the amount determined under subparagraph (B)(i) includes,

in the case of any individual, an amount which was payable to such

individual solely because of -

"(i) a special need of such individual (including any special

allowance for housing, or the rental value of housing furnished

in kind to such individual in lieu of a rental allowance) which

existed in December 1973, or

"(ii) any special circumstance (such as the recognition of the

needs of a person whose presence in such individual's home, in

December 1973, was essential to such individual's well-being),

and, if for any month after December 1973 there is a change with

respect to such special need or circumstance which, if such change

had existed in December 1973, the amount described in subparagraph

(B)(i) with respect to such individual would have been reduced on

account of such change, then, for such month and for each month

thereafter the amount of the supplementary payment payable under

the agreement entered into under this subsection to such individual

shall (unless the State, at its option, otherwise specifies) be

reduced by an amount equal to the amount by which the amount

(described in subparagraph (B)(i)) would have been so reduced.

"(E)(i) In the case of an individual who, for December 1973 lived

as a member of a family unit other members of which received aid

(in the form of money payments) under a State plan of a State

approved under part A of title IV of the Social Security Act [part

A of subchapter IV of this chapter], such State at its option, may

(subject to clause (ii)) reduce such individual's December 1973

income (as determined under subparagraph (B)) to such extent as may

be necessary to cause the supplementary payment (referred to in

paragraph (2)) payable to such individual for January 1974 or any

month thereafter to be reduced to a level designed to assure that

the total income of such individual (and of the members of such

family unit) for any month after December 1973 does not exceed the

total income of such individual (and of the members of such family

unit) for December 1973.

"(ii) The amount of the reduction (under clause (i)) of any

individual's December 1973 income shall not be in an amount which

would cause the supplementary payment (referred to in paragraph

(2)) payable to such individual to be reduced below the amount of

such supplementary payment which would be payable to such

individual if he had, for the month of December 1973 not lived in a

family, members of which were receiving aid under part A of title

IV of the Social Security Act [part A of subchapter IV of this

chapter], and had had no income for such month other than that

received as aid or assistance under a State plan approved under

title I, X, XIV, or XVI of the Social Security Act [subchapter I,

X, XIV, or XVI of this chapter].

"(4) Any State having an agreement with the Commissioner of

Social Security under paragraph (1) may, at its option, include

individuals receiving benefits under section 1619 of the Social

Security Act [section 1382h of this title], or who would be

eligible to receive such benefits but for their income, under the

agreement as though they are aged, blind, or disabled individuals

as specified in paragraph (2)(A).

"(b)(1) Any State having an agreement with the Commissioner of

Social Security under subsection (a) may enter into an

administration agreement with the Commissioner of Social Security

whereby the Commissioner of Social Security will, on behalf of such

State, make the supplementary payments required under the agreement

entered into under subsection (a).

"(2) Any such administration agreement between the Commissioner

of Social Security and a State entered into under this subsection

shall provide that the State will (A) certify to the Commissioner

of Social Security the names of each individual who, for December

1973, was a recipient of aid or assistance (in the form of money

payments) under a plan of such State approved under title I, X,

XIV, or XVI of the Social Security Act [subchapter I, X, XIV, or

XVI of this chapter], together with the amount of such assistance

payable to each such individual and the amount of such individual's

December 1973 income (as defined in subsection (a)(3)(B)), and (B)

provide the Commissioner of Social Security with such additional

data at such times as the Commissioner of Social Security may

reasonably require in order properly, economically, and efficiently

to carry out such administration agreement.

"(3)(A) Any State which has entered into an administration

agreement under this subsection shall, in accordance with

subparagraph (E), pay to the Commissioner of Social Security an

amount equal to the expenditures made by the Commissioner of Social

Security as supplementary payments to individuals entitled thereto

under the agreement entered into with such State under subsection

(a), plus an administration fee assessed in accordance with

subparagraph (B) and any additional services fee charged in

accordance with subparagraph (C).

"(B)(i) The Commissioner of Social Security shall assess each

State an administration fee in an amount equal to -

"(I) the number of supplementary payments made by the

Commissioner of Social Security on behalf of the State under this

subsection for any month in a fiscal year; multiplied by

"(II) the applicable rate for the fiscal year.

"(ii) As used in clause (i), the term 'applicable rate' means -

"(I) for fiscal year 1994, $1.67;

"(II) for fiscal year 1995, $3.33;

"(III) for fiscal year 1996, $5.00;

"(IV) for fiscal year 1997, $5.00;

"(V) for fiscal year 1998, $6.20;

"(VI) for fiscal year 1999, $7.60;

"(VII) for fiscal year 2000, $7.80;

"(VIII) for fiscal year 2001, $8.10;

"(IX) for fiscal year 2002, $8.50; and

"(X) for fiscal year 2003 and each succeeding fiscal year -

"(aa) the applicable rate in the preceding fiscal year,

increased by the percentage, if any, by which the Consumer

Price Index for the month of June of the calendar year of the

increase exceeds the Consumer Price Index for the month of June

of the calendar year preceding the calendar year of the

increase, and rounded to the nearest whole cent; or

"(bb) such different rate as the Commissioner determines is

appropriate for the State.

"(iii) Upon making a determination under clause (ii)(X)(bb), the

Commissioner of Social Security shall promulgate the determination

in regulations, which may take into account the complexity of

administering the State's supplementary payment program.

"(iv) All fees assessed pursuant to this subparagraph shall be

transferred to the Commissioner of Social Security at the same time

that amounts for such supplementary payments are required to be so

transferred.

"(C)(i) The Commissioner of Social Security may charge a State an

additional services fee if, at the request of the State, the

Commissioner of Social Security provides additional services beyond

the level customarily provided, in the administration of State

supplementary payments pursuant to this subsection.

"(ii) The additional services fee shall be in an amount that the

Commissioner of Social Security determines is necessary to cover

all costs (including indirect costs) incurred by the Federal

Government in furnishing the additional services referred to in

clause (i).

"(D)(i) The first $5 of each administration fee assessed pursuant

to subparagraph (B), upon collection, shall be deposited in the

general fund of the Treasury of the United States as miscellaneous

receipts.

"(ii) The portion of each administration fee in excess of $5, and

100 percent of each additional services fee charged pursuant to

subparagraph (C), upon collection for fiscal year 1998 and each

subsequent fiscal year, shall be credited to a special fund

established in the Treasury of the United States for State

supplementary payment fees. The amounts so credited, to the extent

and in the amounts provided in advance in appropriations Acts,

shall be available to defray expenses incurred in carrying out this

section and title XVI of the Social Security Act [this subchapter]

and related laws.

"(E)(i) Any State which has entered into an agreement with the

Commissioner of Social Security under this section shall remit the

payments and fees required under this paragraph with respect to

monthly benefits paid to individuals under title XVI of the Social

Security Act [this subchapter] no later than -

"(I) the business day preceding the date that the Commissioner

pays such monthly benefits; or

"(II) with respect to such monthly benefits paid for the month

that is the last month of the State's fiscal year, the fifth

business day following such date.

"(ii) The Cash Management Improvement Act of 1990 [see Short

Title of 1990 Amendment note set out under section 6501 of Title

31, Money and Finance] shall not apply to any payments or fees

required under this paragraph that are paid by a State before the

date required by clause (i).

"(iii) Notwithstanding clause (i), the Commissioner may make

supplementary payments on behalf of a State with funds appropriated

for payment of supplemental security income benefits under title

XVI of the Social Security Act [this subchapter], and subsequently

to be reimbursed for such payments by the State at such times as

the Commissioner and State may agree. Such authority may be

exercised only if extraordinary circumstances affecting a State's

ability to make payment when required by clause (i) are determined

by the Commissioner to exist.

"(c)(1) Supplementary payments made pursuant to an agreement

entered into under subsection (a) shall be excluded under section

1612(b)(6) of the Social Security Act [section 1382a(b)(6) of this

title] (as in effect after December 1973) in determining income of

individuals for purposes of title XVI of such Act [this subchapter]

(as so in effect).

"(2) Supplementary payments made by the Commissioner of Social

Security (pursuant to an administration agreement entered into

under subsection (b)) shall, for purposes of section 401 of the

Social Security Amendments of 1972 [set out as a note under section

1382e of this title], be considered to be payments made under an

agreement entered into under section 1616 of the Social Security

Act [section 1382e of this title] (as enacted by section 301 of the

Social Security Amendments of 1972); except that nothing in this

paragraph shall be construed to waive, with respect to the payments

so made by the Commissioner of Social Security, the provisions of

subsection (b) of such section 401 [set out as a note under section

1382e of this title].

"(d) For purposes of subsection (a)(1), a State shall be deemed

to have entered into an agreement under subsection (a) of this

section if such State has entered into an agreement with the

Commissioner of Social Security under section 1616 of the Social

Security Act [section 1382e of this title] under which -

"(1) individuals, other than individuals described in

subsection (a)(2)(A) and (B), are entitled to receive

supplementary payments, and

"(2) supplementary benefits are payable, to individuals

described in subsection (a)(2)(A) and (B) at a level and under

terms and conditions which meet the minimum requirements

specified in subsection (a).

"(e) Except as the Commissioner of Social Security may by

regulations otherwise provide, the provisions of title XVI of the

Social Security Act [this subchapter] (as enacted by section 301 of

the Social Security Amendments of 1972), including the provisions

of part B of such title [part B of this subchapter], relating to

the terms and conditions under which the benefits authorized by

such title [this subchapter] are payable shall, where not

inconsistent with the purposes of this section, be applicable to

the payments made under an agreement under subsection (b) of this

section; and the authority conferred upon the Commissioner of

Social Security by such title [this subchapter] may, where

appropriate, be exercised by him in the administration of this

section.

"(f) The provisions of subsection (a)(1) shall not be applicable

in the case of any State -

"(1) the Constitution of which contains provisions which make

it impossible for such State to enter into and commence carrying

out (on January 1, 1974) an agreement referred to in subsection

(a), and

"(2) the Attorney General (or other appropriate State official)

of which has, prior to July 1, 1973, made a finding that the

State Constitution of such State contains limitations which

prevent such State from making supplemental payments of the type

described in section 1616 of the Social Security Act [section

1382e of this title]."

[For effective date of amendment to section 212 of Pub. L. 93-66,

set out above, by Pub. L. 106-170, see section 410(b) of Pub. L.

106-170, set out as an Effective Date of 1999 Amendment note under

section 1382e of this title.]

[For effective date of amendment to section 212 of Pub. L. 93-66,

set out above, by Pub. L. 103-66, see section 13731(b) of Pub. L.

103-66, set out as an Effective Date of 1993 Amendment note under

section 1382e of this title.]

[Section 2(b)(1) of Pub. L. 93-335, July 8, 1974, 88 Stat. 291,

provided that the amendment of section 212 of Pub. L. 93-66, set

out above, by Pub. L. 93-335 is effective Jan. 1, 1974.]

[Amendment of section 212 of Pub. L. 93-66, set out above, by

Pub. L. 96-265 effective Jan. 1, 1981, see section 201(d) of Pub.

L. 96-265, as amended, set out as an Effective Date note under

section 1382h of this title.]

APPLICATION TO NORTHERN MARIANA ISLANDS

For applicability of this section to the Northern Mariana

Islands, see section 502(a)(1) of the Covenant to Establish a

Commonwealth of the Northern Mariana Islands in Political Union

with the United States of America and Proc. No. 4534, Oct. 24,

1977, 42 F.R. 6593, set out as notes under section 1801 of Title

48, Territories and Insular Possessions.

PUERTO RICO, GUAM, AND VIRGIN ISLANDS

Enactment of section 1602 of the Social Security Act [this

section] by Pub. L. 92-603, eff. Jan. 1, 1974, was not applicable

to Puerto Rico, Guam, and the Virgin Islands. See section 303(b) of

Pub. L. 92-603, set out as a note under section 301 of this title.

Therefore, as to Puerto Rico, Guam, and the Virgin Islands, section

1602 of the Social Security Act [this section] as it existed prior

to reenactment by Pub. L. 92-603, and as amended, continues to

apply and reads as follows:

Sec. 1382. State plans for aid to aged, blind, or disabled

(a) Contents

A State plan for aid to the aged, blind, or disabled, must -

(1) except to the extent permitted by the Commissioner of

Social Security with respect to services, provide that it shall

be in effect in all political subdivisions of the State, and, if

administered by them, be mandatory upon them;

(2) provide for financial participation by the State;

(3) either provide for the establishment or designation of a

single State agency to administer the plan, or provide for the

establishment or designation of a single State agency to

supervise the administration of the plan;

(4) provide (A) for granting an opportunity for a fair hearing

before the State agency to any individual whose claim for aid or

assistance under the plan is denied or is not acted upon with

reasonable promptness, and (B) that if the State plan is

administered in each of the political subdivisions of the State

by a local agency and such local agency provides a hearing at

which evidence may be presented prior to a hearing before the

State agency, such local agency may put into effect immediately

upon issuance its decision upon the matter considered at such

hearing;

(5) provide (A) such methods of administration (including

methods relating to the establishment and maintenance of

personnel standards on a merit basis, except that the

Commissioner of Social Security shall exercise no authority with

respect to the selection, tenure of office, and compensation of

any individual employed in accordance with such methods) as are

found by the Commissioner of Social Security to be necessary for

the proper and efficient operation of the plan, and (B) for the

training and effective use of paid subprofessional staff, with

particular emphasis on the full-time or part-time employment of

recipients and other persons of low income, as community service

aides, in the administration of the plan and for the use of

nonpaid or partially paid volunteers in a social service

volunteer program in providing services to applicants and

recipients and in assisting any advisory committees established

by the State agency;

(6) provide that the State agency will make such reports, in

such form and containing such information, as the Commissioner of

Social Security may from time to time require, and comply with

such provisions as the Commissioner of Social Security may from

time to time find necessary to assure the correctness and

verification of such reports;

(7) provide safeguards which permit the use or disclosure of

information concerning applicants or recipients only (A) to

public officials who require such information in connection with

their official duties, or (B) to other persons for purposes

directly connected with the administration of the State plan;

(8) provide that all individuals wishing to make application

for aid or assistance under the plan shall have opportunity to do

so, and that such aid or assistance shall be furnished with

reasonable promptness to all eligible individuals;

(9) provide, if the plan includes aid or assistance to or on

behalf of individuals in private or public institutions, for the

establishment or designation of a State authority or authorities

which shall be responsible for establishing and maintaining

standards for such institutions;

(10) provide a description of the services (if any) which the

State agency makes available (using whatever internal

organizational arrangement it finds appropriate for this purpose)

to applicants for or recipients of aid or assistance under the

plan to help them attain self-support or self-care, including a

description of the steps taken to assure, in the provision of

such services, maximum utilization of other agencies providing

similar or related services;

(11) provide that no aid or assistance will be furnished any

individual under the plan with respect to any period with respect

to which he is receiving assistance under the State plan approved

under subchapter I of this chapter or assistance under a State

program funded under part A of subchapter IV of this chapter or

under subchapter X or XIV of this chapter;

(12) provide that, in determining whether an individual is

blind, there shall be an examination by a physician skilled in

the diseases of the eye or by an optometrist, whichever the

individual may select;

(13) include reasonable standards, consistent with the

objectives of this subchapter, for determining eligibility for

and the extent of aid or assistance under the plan;

(14) provide that the State agency shall, in determining need

for aid to the aged, blind, or disabled, take into consideration

any other income and resources of an individual claiming such

aid, as well as any expenses reasonably attributable to the

earning of any such income; except that, in making such

determination with respect to any individual -

(A) if such individual is blind, the State agency (i) shall

disregard the first $85 per month of earned income plus

one-half of earned income in excess of $85 per month, and (ii)

shall, for a period not in excess of 12 months, and may, for a

period not in excess of 36 months, disregard such additional

amounts of other income and resources, in the case of any such

individual who has a plan for achieving self-support approved

by the State agency, as may be necessary for the fulfillment of

such plan,

(B) if such individual is not blind but is permanently and

totally disabled, (i) of the first $80 per month of earned

income, the State agency may disregard not more than the first

$20 thereof plus one-half of the remainder, and (ii) the State

agency may, for a period not in excess of 36 months, disregard

such additional amounts of other income and resources, in the

case of any such individual who has a plan for achieving

self-support approved by the State agency, as may be necessary

for the fulfillment of such plan, but only with respect to the

part or parts of such period during substantially all of which

he is actually undergoing vocational rehabilitation,

(C) if such individual has attained age 65 and is neither

blind nor permanently and totally disabled, of the first $80

per month of earned income the State agency may disregard not

more than the first $20 thereof plus one-half of the remainder,

and

(D) the State agency may, before disregarding the amounts

referred to above in this paragraph (14), disregard not more

than $7.50 of any income; and

(15) provide that information is requested and exchanged for

purposes of income and eligibility verification in accordance

with a State system which meets the requirements of section

1320b-7 of this title.

Notwithstanding paragraph (3), if on January 1, 1962, and on the

date on which a State submits its plan for approval under this

subchapter, the State agency which administered or supervised the

administration of the plan of such State approved under subchapter

X of this chapter was different from the State agency which

administered or supervised the administration of the plan of such

State approved under subchapter I of this chapter and the State

agency which administered or supervised the administration of the

plan of such State approved under subchapter XIV of this chapter,

the State agency which administered or supervised the

administration of such plan approved under subchapter X of this

chapter may be designated to administer or supervise the

administration of the portion of the State plan for aid to the

aged, blind, or disabled which relates to blind individuals and a

separate State agency may be established or designated to

administer or supervise the administration of the rest of such

plan; and in such case the part of the plan which each such agency

administers, or the administration of which each such agency

supervises, shall be regarded as a separate plan for purposes of

this subchapter.

(b) Approval by Commissioner

The Commissioner of Social Security shall approve any plan which

fulfills the conditions specified in subsection (a) of this

section, except that the Commissioner shall not approve any plan

which imposes, as a condition of eligibility for aid or assistance

under the plan -

(1) an age requirement of more than sixty-five years; or

(2) any residence requirement which excludes any resident of

the State who has resided therein five years during the nine

years immediately preceding the application for such aid and has

resided therein continuously for one year immediately preceding

the application; or

(3) any citizenship requirement which excludes any citizen of

the United States.

At the option of the State, the plan may provide that manuals and

other policy issuances will be furnished to persons without charge

for the reasonable cost of such materials, but such provision shall

not be required by the Commissioner of Social Security as a

condition for the approval of such plan under this subchapter. In

the case of any State to which the provisions of section 344 of the

Social Security Act Amendments of 1950 were applicable on January

1, 1962, and to which the sentence of section 1202(b) of this title

following paragraph (2) thereof is applicable on the date on which

its State plan for aid to the aged, blind, or disabled was

submitted for approval under this subchapter, the Commissioner of

Social Security shall approve the plan of such State for aid to the

aged, blind, or disabled for purposes of this subchapter, even

though it does not meet the requirements of paragraph (14) of

subsection (a) of this section, if it meets all other requirements

of this subchapter for an approved plan for aid to the aged, blind,

or disabled; but payments under section 1383 of this title shall be

made, in the case of any such plan, only with respect to

expenditures thereunder which would be included as expenditures for

the purposes of section 1383 of this title under a plan approved

under this section without regard to the provisions of this

sentence.

(c) Limitation on number of plans

Subject to the last sentence of subsection (a) of this section,

nothing in this subchapter shall be construed to permit a State to

have in effect with respect to any period more than one State plan

approved under this subchapter.

(Aug. 14, 1935, ch. 531, title XVI, Sec. 1602, as added July 25,

1962, Pub. L. 87-543, title I, Sec. 141(a), 76 Stat. 198; amended

Oct. 13, 1964, Pub. L. 88-650, Sec. 5(b), 78 Stat. 1078; July 30,

1965, Pub. L. 89-97, title II, Sec. 221(d)(3), title IV, Sec.

403(e), 79 Stat. 358, 418; Jan. 2, 1968, Pub. L. 90-248, title II,

Secs. 210(a)(5), 213(a)(4), 241(d), 81 Stat. 896, 898, 917; Oct.

30, 1972, Pub. L. 92-603, title IV, Secs. 405(d), 406(d), 407(d),

410(d), 413(d), 86 Stat. 1488, 1489, 1491, 1492; Aug. 13, 1981,

Pub. L. 97-35, title XXI, Sec. 2184(d)(4), 95 Stat. 817; July 18,

1984, Pub. L. 98-369, div. B, title VI, Sec. 2651(h), 98 Stat.

1150; Aug. 15, 1994, Pub. L. 103-296, title I, Sec. 107(a)(4), 108

Stat. 1478; Aug. 22, 1996, Pub. L. 104-193, title I, Sec. 108(i),

110 Stat. 2169.)

[Amendment by Pub. L. 104-193 effective July 1, 1997, with

transition rules relating to State options to accelerate such date,

rules relating to claims, actions, and proceedings commenced before

such date, rules relating to closing out of accounts for terminated

or substantially modified programs and continuance in office of

Assistant Secretary for Family Support, and provisions relating to

termination of entitlement under AFDC program, see section 116 of

Pub. L. 104-193, as amended, set out as an Effective Date note

under section 601 of this title.]

[Amendment by section 107(a)(4) of Pub. L. 103-296 effective Mar.

31, 1995, see section 110(a) of Pub. L. 103-296, set out as an

Effective Date of 1994 Amendment note under section 401 of this

title.]

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 402, 1315, 1320b-19,

1382a, 1382b, 1382c, 1382d, 1382e, 1382f, 1382g, 1382h, 1382i,

1382j, 1383, 1385, 1396a, 1396b, 1396d, 1396r, 1396v, 4728, 8624,

11398 of this title; title 5 section 552a; title 7 section 2020.

-End-