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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AMENDMENTS

1981 - Pub. L. 97-35 struck out in provision preceding par. (1)

", or (if provided in 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 term "aid to the blind" 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

blind" 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 blind" 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".

1950 - Act Aug. 28, 1950, redefined "aid to the blind".

1939 - Act Aug. 10, 1939, redefined "aid to the blind" to include

those individuals who are needy.

EFFECTIVE DATE OF 1965 AMENDMENT

Amendment by section 221(b) 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 302 of this title.

Amendment by section 402(c) of Pub. L. 89-97 applicable in the

case of expenditures made after December 31, 1965, under a State

plan approved under subchapters 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 section 156(c) of 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.

EFFECTIVE DATE OF 1950 AMENDMENT

Section 343(b) of act Aug. 28, 1950, provided that: "The

amendment made by subsection (a) [amending this section] shall take

effect October 1, 1950, except that the exclusion of money payments

to needy individuals described in clause (a) or (b) of section 1006

of the Social Security Act [this section] as so amended shall, in

the case of any of such individuals who are not patients in a

public institution, be effective July 1, 1952."

-FOOTNOTE-

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

-End-

-CITE-

42 USC SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW,

AND 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

-HEAD-

SUBCHAPTER XI - GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE

SIMPLIFICATION

-SECREF-

SUBCHAPTER REFERRED TO IN OTHER SECTIONS

This subchapter is referred to in sections 432, 901, 1395i,

1395x, 1395ff, 1397gg, 3012 of this title.

-End-

-CITE-

42 USC Part A - General Provisions 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-

PART A - GENERAL PROVISIONS

-SECREF-

PART REFERRED TO IN OTHER SECTIONS

This part is referred to in sections 1395w-22, 1395mm, 1396a of

this title.

-End-

-CITE-

42 USC Sec. 1301 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. 1301. Definitions

-STATUTE-

(a) When used in this chapter -

(1) The term "State", except where otherwise provided, includes

the District of Columbia and the Commonwealth of Puerto Rico, and

when used in subchapters IV, V, VII, XI, XIX, and XXI of this

chapter includes the Virgin Islands and Guam. Such term when used

in subchapters III, IX, and XII of this chapter also includes the

Virgin Islands. Such term when used in subchapter V and in part B

of this subchapter of this chapter also includes American Samoa,

the Northern Mariana Islands, and the Trust Territory of the

Pacific Islands. Such term when used in subchapters XIX and XXI

of this chapter also includes the Northern Mariana Islands and

American Samoa. In the case of Puerto Rico, the Virgin Islands,

and Guam, subchapters I, X, and XIV, and subchapter XVI of this

chapter (as in effect without regard to the amendment made by

section 301 of the Social Security Amendments of 1972) shall

continue to apply, and the term "State" when used in such

subchapters (but not in subchapter XVI of this chapter as in

effect pursuant to such amendment after December 31, 1973)

includes Puerto Rico, the Virgin Islands, and Guam. Such term

when used in subchapter XX of this chapter also includes the

Virgin Islands, Guam, American Samoa, and the Northern Mariana

Islands. Such term when used in subchapter IV of this chapter

also includes American Samoa.

(2) The term "United States" when used in a geographical sense

means, except where otherwise provided, the States.

(3) The term "person" means an individual, a trust or estate, a

partnership, or a corporation.

(4) The term "corporation" includes associations, joint-stock

companies, and insurance companies.

(5) The term "shareholder" includes a member in an association,

joint-stock company, or insurance company.

(6) The term "Secretary", except when the context otherwise

requires, means the Secretary of Health and Human Services.

(7) The terms "physician" and "medical care" and

"hospitalization" include osteopathic practitioners or the

services of osteopathic practitioners and hospitals within the

scope of their practice as defined by State law.

(8)(A) The "Federal percentage" for any State (other than

Puerto Rico, the Virgin Islands, and Guam) shall be 100 per

centum less the State percentage; and the State percentage shall

be that percentage which bears the same ratio to 50 per centum as

the square of the per capita income of such State bears to the

square of the per capita income of the United States; except that

the Federal percentage shall in no case be less than 50 per

centum or more than 65 per centum.

(B) The Federal percentage for each State (other than Puerto

Rico, the Virgin Islands, and Guam) shall be promulgated by the

Secretary between October 1 and November 30 of each year, on the

basis of the average per capita income of each State and of the

United States for the three most recent calendar years for which

satisfactory data are available from the Department of Commerce.

Such promulgation shall be conclusive for each of the four

quarters in the period beginning October 1 next succeeding such

promulgation: Provided, That the Secretary shall promulgate such

percentages as soon as possible after August 28, 1958, which

promulgation shall be conclusive for each of the eleven quarters

in the period beginning October 1, 1958, and ending with the

close of June 30, 1961.

(C) The term "United States" means (but only for purposes of

subparagraphs (A) and (B) of this paragraph) the fifty States and

the District of Columbia.

(D) Promulgations made before satisfactory data are available

from the Department of Commerce for a full year on the per capita

income of Alaska shall prescribe a Federal percentage for Alaska

of 50 per centum and, for purposes of such promulgations, Alaska

shall not be included as part of the "United States".

Promulgations made thereafter but before per capita income data

for Alaska for a full three-year period are available from the

Department of Commerce shall be based on satisfactory data

available therefrom for Alaska for such one full year or, when

such data are available for a two-year period, for such two

years.

(9) The term "shared health facility" means any arrangement

whereby -

(A) two or more health care practitioners practice their

professions at a common physical location;

(B) such practitioners share (i) common waiting areas,

examining rooms, treatment rooms, or other space, (ii) the

services of supporting staff, or (iii) equipment;

(C) such practitioners have a person (who may himself be a

practitioner) -

(i) who is in charge of, controls, manages, or supervises

substantial aspects of the arrangement or operation for the

delivery of health or medical services at such common

physical location, other than the direct furnishing of

professional health care services by the practitioners to

their patients; or

(ii) who makes available to such practitioners the services

of supporting staff who are not employees of such

practitioners;

and who is compensated in whole or in part, for the use of such

common physical location or support services pertaining

thereto, on a basis related to amounts charged or collected for

the services rendered or ordered at such location or on any

basis clearly unrelated to the value of the services provided

by the person; and

(D) at least one of such practitioners received payments on a

fee-for-service basis under subchapters XVIII and XIX of this

chapter in an amount exceeding $5,000 for any one month during

the preceding 12 months or in an aggregate amount exceeding

$40,000 during the preceding 12 months;

except that such term does not include a provider of services (as

defined in section 1395x(u) of this title), a health maintenance

organization (as defined in section 300e(a) of this title), a

hospital cooperative shared services organization meeting the

requirements of section 501(e) of the Internal Revenue Code of

1986, or any public entity.

(10) The term "Administration" means the Social Security

Administration, except where the context requires otherwise.

(b) The terms "includes" and "including" when used in a

definition contained in this chapter shall not be deemed to exclude

other things otherwise within the meaning of the term defined.

(c) Whenever under this chapter or any Act of Congress, or under

the law of any State, an employer is required or permitted to

deduct any amount from the remuneration of an employee and to pay

the amount deducted to the United States, a State, or any political

subdivision thereof, then for the purposes of this chapter the

amount so deducted shall be considered to have been paid to the

employee at the time of such deduction.

(d) Nothing in this chapter shall be construed as authorizing any

Federal official, agent, or representative, in carrying out any of

the provisions of this chapter, to take charge of any child over

the objection of either of the parents of such child, or of the

person standing in loco parentis to such child.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1101, 49 Stat. 647; Aug.

10, 1939, ch. 666, title VIII, Sec. 801, 53 Stat. 1398; Aug. 10,

1946, ch. 951, title IV, Sec. 401(a), 60 Stat. 986; June 14, 1948,

ch. 468, Sec. 2(a), 62 Stat. 438; Aug. 28, 1950, ch. 809, title IV,

Sec. 403(a)(1), (2), (b), 64 Stat. 559; Aug. 16, 1956, ch. 836,

title III, Sec. 333, 70 Stat. 852; Pub. L. 85-840, title V, Secs.

505, 506, Aug. 28, 1958, 72 Stat. 1050, 1051; Pub. L. 86-70, Sec.

32(a), (d), June 25, 1959, 73 Stat. 149; Pub. L. 86-624, Sec.

30(a), (d), July 12, 1960, 74 Stat. 419, 420; Pub. L. 86-778, title

V, Sec. 541, Sept. 13, 1960, 74 Stat. 985; Pub. L. 87-543, title I,

Sec. 153, July 25, 1962, 76 Stat. 206; Pub. L. 89-97, title I, Sec.

121(c)(1), July 30, 1965, 79 Stat. 352; Pub. L. 92-603, title II,

Sec. 272(a), Oct. 30, 1972, 86 Stat. 1451; Pub. L. 93-233, Sec.

18(z-2)(1)(A), Dec. 31, 1973, 87 Stat. 973; Pub. L. 94-273, Sec.

22, Apr. 21, 1976, 90 Stat. 379; Pub. L. 94-566, title I, Sec.

116(a), Oct. 20, 1976, 90 Stat. 2672; Pub. L. 95-142, Sec. 5(c)(2),

(l)(2), Oct. 25, 1977, 91 Stat. 1184, 1191; Pub. L. 97-35, title

XXI, Secs. 2162(a)(1), 2193(c)(2), title XXIII, Sec. 2352(b), Aug.

13, 1981, 95 Stat. 806, 827, 871; Pub. L. 97-248, title I, Secs.

136(a), 160(c), Sept. 3, 1982, 96 Stat. 375, 400; Pub. L. 98-369,

div. B, title VI, Sec. 2663(e)(1), (j)(1), July 18, 1984, 98 Stat.

1167, 1170; Pub. L. 99-272, title IX, Sec. 9528(a), Apr. 7, 1986,

100 Stat. 219; Pub. L. 99-514, Sec. 2, title XVIII, Secs.

1883(c)(1), 1895(c)(6), Oct. 22, 1986, 100 Stat. 2095, 2918, 2936;

Pub. L. 100-203, title IX, Sec. 9135(a)(1), (b)(1), Dec. 22, 1987,

101 Stat. 1330-315; Pub. L. 100-485, title VI, Sec. 601(a), Oct.

13, 1988, 102 Stat. 2407; Pub. L. 103-296, title I, Sec. 108(b)(1),

Aug. 15, 1994, 108 Stat. 1481; Pub. L. 105-33, title IV, Sec.

4901(b)(1), Aug. 5, 1997, 111 Stat. 570.)

-REFTEXT-

REFERENCES IN TEXT

Section 301 of the Social Security Amendments of 1972, referred

to in subsec. (a)(1), is section 301 of Pub. L. 92-603, title III,

Oct. 30, 1972, 86 Stat. 1465, which enacted sections 1381 to 1382e

and 1383 to 1383c of this title.

The Internal Revenue Code of 1986, referred to in subsec. (a)(9),

is classified generally to Title 26, Internal Revenue Code.

-MISC1-

AMENDMENTS

1997 - Subsec. (a)(1). Pub. L. 105-33 substituted "XIX, and XXI"

for "and XIX" and "subchapters XIX and XXI" for "subchapter XIX".

1994 - Subsec. (a)(10). Pub. L. 103-296 added par. (10).

1988 - Subsec. (a)(1). Pub. L. 100-485 amended last sentence

generally. Prior to amendment, last sentence read as follows: "Such

term when used in part B of subchapter IV of this chapter also

includes American Samoa."

1987 - Subsec. (a)(1). Pub. L. 100-203, Sec. 9135(a)(1), inserted

"American Samoa," after "Guam,".

Pub. L. 100-203, Sec. 9135(b)(1), inserted at end "Such term when

used in part B of subchapter IV of this chapter also includes

American Samoa."

1986 - Subsec. (a)(3) to (5). Pub. L. 99-514, Sec. 1883(c)(1),

realigned margins of pars. (3) to (5).

Subsec. (a)(8)(B). Pub. L. 99-514, Sec. 1895(c)(6), amended

directory language of Pub. L. 99-272, Sec. 9528(a), and did not

involve any change in text. See note below.

Pub. L. 99-272, Sec. 9528(a), as amended by Pub. L. 99-514, Sec.

1895(c)(6), struck out "even-numbered" after "November 30 of each"

and substituted "for each of the four quarters" for "for each of

the eight quarters".

Subsec. (a)(9). Pub. L. 99-514, Sec. 2, substituted "Internal

Revenue Code of 1986" for "Internal Revenue Code of 1954" in

closing provisions.

1984 - Subsec. (a)(6). Pub. L. 98-369, Sec. 2663(j)(1),

substituted "means the Secretary of Health and Human Services" for

"means the Secretary of Health, Education, and Welfare".

Subsec. (a)(8), (9). Pub. L. 98-369, Sec. 2663(e)(1), realigned

margins of pars. (8) and (9).

1982 - Subsec. (a)(1). Pub. L. 97-248, Sec. 136(a), inserted "and

American Samoa" after "includes the Northern Mariana Islands".

Pub. L. 97-248, Sec. 160(c), substituted "Guam, and the Northern

Mariana Islands" for "American Samoa, the Northern Mariana Islands,

and the Trust Territory of the Pacific Islands".

1981 - Subsec. (a)(1). Pub. L. 97-35, Secs. 2162(a)(1), 2352(b),

substituted "American Samoa, the Northern Mariana Islands, and" for

"American Samoa and" and inserted provisions that "State" when used

in subchapter XIX of this chapter also includes the Northern

Mariana Islands and when used in subchapter XX of this chapter also

includes the Virgin Islands, American Samoa, the Northern Mariana

Islands, and the Trust Territory of the Pacific Islands.

Subsec. (a)(9)(D). Pub. L. 97-35, Sec. 2193(c)(2), substituted

"subchapters XVIII, and XIX of this chapter" for "subchapters V,

XVIII, and XIX of this chapter".

1977 - Subsec. (a)(1). Pub. L. 95-142, Sec. 5(l)(2), which

directed that second sentence of par. (1) be amended by inserting

provision that "State" when used in part B of this subchapter also

includes American Samoa and the Trust Territory of the Pacific

Islands, was executed by inserting that provision to third

sentence.

Subsec. (a)(9). Pub. L. 95-142, Sec. 5(c)(2), added par. (9).

1976 - Subsec. (a)(1). Pub. L. 94-566 inserted provision that

"State", when used in subchapters III, IX, and XII of this chapter,

also includes the Virgin Islands.

Subsec. (a)(8)(B). Pub. L. 94-273 substituted "October" for

"July" in two places and "November 30" for "August 31".

1973 - Subsec. (a)(1). Pub. L. 93-233 struck out in first

sentence references to subchapters I, X, XIV, and XVI of this

chapter and inserted third sentence respecting the case of Puerto

Rico, the Virgin Islands, and Guam.

1972 - Subsec. (a)(1). Pub. L. 92-603 extended benefits of

subchapter V of this chapter to American Samoa and the Trust

Territory of the Pacific Islands.

1965 - Subsec. (a)(1). Pub. L. 89-97 included subchapter XIX of

this chapter.

1962 - Subsec. (a)(1). Pub. L. 87-543, Sec. 153(a), included in

enumeration subchapters XI and XVI of this chapter.

Subsec. (a)(2). Pub. L. 87-543, Sec. 153(b), struck out ", the

District of Columbia, and the Commonwealth of Puerto Rico" after

"the States,".

1960 - Subsec. (a)(1). Pub. L. 86-778 substituted "The term

'State', except where otherwise provided, includes the District of

Columbia and the Commonwealth of Puerto Rico" for "The term 'State'

includes Hawaii, and the District of Columbia", and "includes the

Virgin Islands and Guam" for "includes Puerto Rico, the Virgin

Islands, and Guam".

Pub. L. 86-624, Sec. 30(d)(1), struck out "Hawaii, and" before

"the District of Columbia".

Subsec. (a)(2). Pub. L. 86-778 substituted "means, except where

otherwise provided, the States, the District of Columbia, and the

Commonwealth of Puerto Rico" for "means the States, Hawaii, and the

District of Columbia".

Pub. L. 86-624, Sec. 30(d)(2), struck out ", Hawaii," before "and

the District of Columbia".

Subsec. (a)(8)(A). Pub. L. 86-624, Sec. 30(a)(1), (2),

substituted "per capita income of the United States" for "per

capita income of the continental United States (including Alaska)",

and struck out provisions which prescribed the Federal percentage

for Hawaii as 50 per centum.

Subsec. (a)(8)(B). Pub. L. 86-624, Sec. 30(a)(1), substituted

"United States" for "continental United States (including Alaska)".

Subsec. (a)(8)(C), (D). Pub. L. 86-624, Sec. 30(a)(3), added

subpars. (C) and (D).

1959 - Subsec. (a)(1). Pub. L. 86-70, Sec. 32(d)(1), substituted

"Hawaii and" for "Alaska, Hawaii, and".

Subsec. (a)(2). Pub. L. 86-70, Sec. 32(d)(2), struck out

"Alaska," before "Hawaii".

Subsec. (a)(8). Pub. L. 86-70, Sec. 32(a), substituted

"(including Alaska)" for "(excluding Alaska)" in two places, and

"50 per centum for Hawaii" for "50 per centum for Alaska and

Hawaii".

1958 - Subsec. (a)(1). Pub. L. 85-840, Sec. 506, included Guam

within definition of "State" when used in subchapters I, IV, V,

VII, X, and XIV of this chapter.

Subsec. (a)(8). Pub. L. 85-840, Sec. 505, added par. (8).

1956 - Subsec. (a)(1). Act Aug. 1, 1956, inserted reference to

subchapter VII of this chapter.

1950 - Subsec. (a)(1). Act Aug. 28, 1950, Sec. 403(a)(1),

redefined "State".

Subsec. (a)(6). Act Aug. 28, 1950, Sec. 403(a)(2), defined

"Administrator".

Subsec. (a)(7). Act Aug. 28, 1950, Sec. 403(b), added par. (7).

1948 - Subsec. (a)(6). Act June 14, 1948, provided for

application of usual common-law rules in determining whether a

person is an employee.

1946 - Subsec. (a)(1). Act Aug. 10, 1946, struck out exception of

section 45b of title 29 and inserted reference to Virgin Islands.

1939 - Subsec. (a)(1). Act Aug. 10, 1939, redefined "State".

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 1988 AMENDMENT

Section 601(d) of Pub. L. 100-485 provided that: "The amendments

made by this section [amending this section and sections 603, 1308,

and 1318 of this title] shall become effective on October 1, 1988."

EFFECTIVE DATE OF 1987 AMENDMENT

Amendment by Pub. L. 100-203 applicable with respect to fiscal

years beginning on or after Oct. 1, 1988, see section 9135(c) of

Pub. L. 100-203, set out as a note under section 621 of this title.

EFFECTIVE DATE OF 1986 AMENDMENTS

Amendment by section 1883(c)(1) of Pub. L. 99-514 effective Oct.

22, 1986, see section 1883(f) of Pub. L. 99-514, set out as a note

under section 402 of this title.

Amendment by section 1895(c)(6) of Pub. L. 99-514 effective,

except as otherwise provided, as if included in enactment of the

Consolidated Omnibus Budget Reconciliation Act of 1985, Pub. L.

99-272, see section 1895(e) of Pub. L. 99-514, set out as a note

under section 162 of Title 26, Internal Revenue Code.

Section 9528(b), (c) of Pub. L. 99-272, as amended by Pub. L.

99-509, title IX, Secs. 9102, 9421(a), Oct. 21, 1986, 100 Stat.

1972, 2065, provided that:

"(b) Effective Date. - The amendments made by this section

[amending this section] shall apply to the Federal percentage (and

Federal medical assistance percentage) for fiscal years 1987 and

thereafter. Such amendments shall apply without regard to the

requirement of section 1101(a)(8)(B) of the Social Security Act

[subsec. (a)(8)(B) of this section] relating to the promulgation of

the Federal percentage prior to November 30 of the year preceding

the year in which the new Federal percentage becomes applicable.

The Secretary of Health and Human Services shall promulgate such

new percentage for fiscal year 1987 as soon as practicable after

the date of the enactment of this Act [Apr. 7, 1986].

"(c) Hold Harmless Provision. - Notwithstanding subsection (b),

for calendar quarters occurring during fiscal year 1987 and only

for purposes of making payments to States under sections 403 and

1903 of the Social Security Act [sections 603 and 1396b of this

title], the amendments made by subsection (a) [amending this

section] shall not apply to a State with respect to either such

section if the effect of the [sic] applying the amendments would be

to reduce the amount of payment made to the State under that

section."

[Section 9102 of Pub. L. 99-509 provided that the amendment made

by that section [amending section 9528(c) of Pub. L. 99-272, set

out above] is effective as provided in section 9421(b) of Pub. L.

99-509. See below.]

[Section 9421(b) of Pub. L. 99-509 provided that: "The amendment

made by subsection (a) [enacting section 9528(c) of Pub. L. 99-272,

set out above] shall be effective as though it had been included in

the Consolidated Omnibus Budget Reconciliation Act of 1985 [Pub. L.

99-272] at the time of its enactment."]

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 OF 1982 AMENDMENT

Section 136(e) of Pub. L. 97-248 provided that: "The amendments

made by this section [amending this section and sections 1308,

1396a, and 1396d of this title] shall become effective on October

1, 1982."

Section 160(e) of Pub. L. 97-248 provided that: "The amendments

made by this section [amending this section and sections 671, 1308,

and 1397b of this title] shall be effective as of October 1, 1981."

EFFECTIVE DATE OF 1981 AMENDMENT

Amendment by section 2352(a) 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.

For effective date, savings, and transitional provisions relating

to amendment by section 2193(c)(2) of Pub. L. 97-35, see section

2194 of Pub. L. 97-35, set out as a note under section 701 of this

title.

EFFECTIVE DATE OF 1976 AMENDMENT

Amendment by Pub. L. 94-566 effective on the later of Oct. 1,

1976, or the day after the day on which the Secretary of Labor

approves under section 3304(a) of Title 26, Internal Revenue Code,

an unemployment compensation law submitted to him by the Virgin

Islands for approval, see section 116(f)(1) of Pub. L. 94-566, set

out as a note under section 3304 of Title 26.

EFFECTIVE DATE OF 1973 AMENDMENT

Section 18(z-2)(2) of Pub. L. 93-233 provided that: "The

amendments made by this subsection [amending this section and

sections 1315 and 1316 of this title] shall be effective on and

after January 1, 1974."

EFFECTIVE DATE OF 1972 AMENDMENT

Section 272(c) of Pub. L. 92-603 provided that: "The amendments

made by this section [amending this section and section 1308 of

this title] shall apply with respect to fiscal years beginning

after June 30, 1971."

EFFECTIVE DATE OF 1965 AMENDMENT

Section 121(c)(1) of Pub. L. 89-97 provided that the amendment

made by that section is effective Jan. 1, 1966.

EFFECTIVE DATE OF 1960 AMENDMENTS

Section 541 of Pub. L. 86-778 provided that the amendment made by

that section is effective on and after Jan. 1, 1961.

Amendment by section 30(d) of Pub. L. 86-624 effective Aug. 21,

1959, see section 47(f) of Pub. L. 86-624, set out as a note under

section 201 of this title.

Amendment by section 30(a)(1) of Pub. L. 86-624 applicable in the

case of promulgations or computations of Federal shares, allotment

percentages, allotment ratios, and Federal percentages, as the case

may be, made after Aug. 21, 1959, see section 47(a) of Pub. L.

86-624.

Section 47(b) of Pub. L. 86-624 provided that: "The amendments

made by paragraph (2) of section 30(a) [amending this section]

shall be effective with the beginning of the calendar quarter in

which this Act is enacted. The Secretary of Health, Education, and

Welfare shall, as soon as possible after enactment of this Act

[July 12, 1960], promulgate a Federal percentage for Hawaii

determined in accordance with the provisions of subparagraph (B) of

section 1101(a)(8) of the Social Security Act [subsec. (a)(8)(B) of

this section], such promulgation to be effective for the period

beginning with the beginning of the calendar quarter in which this

Act is enacted and ending with the close of June 30, 1961."

EFFECTIVE DATE OF 1959 AMENDMENT

Amendment by section 32(a) of Pub. L. 86-70 applicable in the

case of promulgations of Federal shares, allotment percentages,

allotment ratios, and Federal percentages, as the case may be, made

after satisfactory data are available from the Department of

Commerce for a full year on the per capita income of Alaska, and

amendment by section 32(d) of Pub. L. 86-70 effective Jan. 3, 1959,

see section 47(a), (d) of Pub. L. 86-70.

EFFECTIVE DATE OF 1958 AMENDMENT

For effective date of amendments 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 DATE OF 1950 AMENDMENT

Section 403(a)(3) of act Aug. 28, 1950, provided that: "The

amendment made by paragraph (1) of this subsection [amending this

section] shall take effect October 1, 1950, and the amendment made

by paragraph (2) of this subsection [amending this section],

insofar as it repeals the definition of 'employee', shall be

effective only with respect to services performed after 1950."

Section 403(b) of act Aug. 28, 1950, provided that the amendment

made by that section is effective Oct. 1, 1950.

EFFECTIVE DATE OF 1948 AMENDMENT

Section 2(b) of act June 14, 1948, provided that: "The amendment

made by subsection (a) [amending this section] shall have the same

effect as if included in the Social Security Act [this chapter] on

August 14, 1935, the date of its enactment, but shall not have the

effect of voiding any (1) wage credits reported to the Bureau of

Internal Revenue [now Internal Revenue Service] with respect to

services performed prior to the enactment of this Act [June 14,

1948] or (2) wage credits with respect to services performed prior

to the close of the first calendar quarter which begins after the

date of the enactment of this Act in the case of individuals who

have attained age sixty-five or who have died, prior to the close

of such quarter, and with respect to whom prior to the date of

enactment of this Act wage credits were established which would not

have been established had the amendment made by subsection (a) been

in effect on and after August 14, 1935."

EFFECTIVE DATE OF 1946 AMENDMENT

Section 401(a) of act Aug. 10, 1946, provided that the amendment

made by that section is effective Jan. 1, 1947.

EFFECTIVE DATE OF 1939 AMENDMENT

Section 801 of act Aug. 10, 1939, provided that the amendment

made by that section is effective Jan. 1, 1940.

REPEALS

The provisions of subsecs. (a)(1), (3), (6), (c) of this section

were incorporated into sections 1426(d) to (f), 1427, 1607(i) to

(k), and 1608 of former Title 26, Internal Revenue Code of 1939, by

act Feb. 10, 1939, ch. 2, 53 Stat. 1. Section 4 of the act of Feb.

10, 1939, provided that all laws and parts of laws codified into

the Internal Revenue Code of 1939, to the extent that they related

exclusively to internal revenue, were repealed. See enacting

sections preceding section 1 of former Title 26.

Provisions of the Internal Revenue Code of 1939 were generally

repealed by section 7851 of Title 26, Internal Revenue Code of 1954

(act Aug. 16, 1954, ch. 736, 68A Stat. 3). See, also, section 7807

of said Title 26, I.R.C. 1954, respecting rules in effect upon

enactment of I.R.C. 1954. The I.R.C. 1954 was redesignated I.R.C.

1986 by Pub. L. 99-514, Sec. 2, Oct. 22, 1986, 100 Stat. 2095. Said

repealed sections are covered by sections 3121, 3123, 3306, 3307,

7701 of Title 26.

-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.

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.

-MISC2-

PROVISIONS RELATING TO FEDERAL SECURITY ADMINISTRATOR

Section 2663(l) of Pub. L. 98-369 provided that: "Any reference

to the Federal Security Administrator which may remain in the

provisions of title II, IV, VII, or XI of the Social Security Act

[subchapter II, IV, VII, or XI of this chapter] (other than section

1101(a)(6) of such Act [subsec. (a)(6) of this section]) is amended

-

"(1) by substituting 'Secretary' or 'Secretary's' for the term

'Administrator' or 'Administrator's', where the reference is to

that term alone;

"(2) by substituting 'Secretary of Health, Education, and

Welfare' for the term 'Federal Security Administrator', where the

reference is to that term, if the provision containing such

reference is amended by paragraph (2) or (3) of subsection (j)

[Pub. L. 98-369, Sec. 2663(j)(2), (3), see Tables for

classification] (in which case the amendment of such provision

under this paragraph shall be deemed to have taken effect

immediately prior to the amendment of such provision under such

paragraph (2) or (3)); and

"(3) by substituting 'Secretary of Health and Human Services'

for the term 'Federal Security Administrator' in any other case

where the reference is to that term;

and any reference to the Federal Security Agency which may remain

in such provisions is amended by substituting 'Department of Health

and Human Services' for the term 'Federal Security Agency'; but

nothing in this subsection shall affect the exercise under section

402(a)(5) of such Act [section 602(a)(5) of this title] of the

functions, powers, and duties relating to the prescription of

personnel standards on a merit basis which were transferred from

the Secretary of Health, Education, and Welfare by section

208(a)(3)(D) of Public Law 91-648 [42 U.S.C. 4728(a)(3)(D)]."

-CROSS-

DEFINITION OF "SECRETARY"

Pub. L. 90-248, title IV, Sec. 404, Jan. 2, 1968, 81 Stat. 933,

as amended by Pub. L. 96-88, title V, Sec. 509(b), Oct. 17, 1979,

93 Stat. 695, provided that: "As used in the amendments made by

this Act [see Short Title of 1968 Amendment note set out under

section 1305 of this title] (unless the context otherwise

requires), the term 'Secretary' means the Secretary of Health and

Human Services."

Section 110 of Pub. L. 89-97, as amended by Pub. L. 96-88, title

V, Sec. 509(b), Oct. 17, 1979, 93 Stat. 695, provided that: "As

used in this Act, and in the provisions of the Social Security Act

amended by this Act [see Short Title of 1965 Amendment note set out

under section 1305 of this title], the term 'Secretary', unless the

context otherwise requires, means the Secretary of Health and Human

Services."

Section 6 of Pub. L. 88-156, as amended by Pub. L. 96-88, title

V, Sec. 509(b), Oct. 17, 1979, 93 Stat. 695, provided that: "As

used in the amendments to the Social Security Act made by this Act

[see Short Title of 1963 Amendment note set out under section 1305

of this title], the term 'Secretary' means the Secretary of Health

and Human Services."

Section 201 of Pub. L. 87-543, as amended by Pub. L. 96-88, title

V, Sec. 509(b), Oct. 17, 1979, 93 Stat. 695, provided that: "As

used in this Act and in the provisions of the Social Security Act

amended by this Act [see Short Title of 1962 Amendment note set out

under section 1305 of this title], the term 'Secretary', unless the

context otherwise requires, means the Secretary of Health and Human

Services."

Section 304 of title III of Pub. L. 87-64, as amended by Pub. L.

96-88, title V, Sec. 509(b), Oct. 17, 1979, 93 Stat. 695, provided

that: "As used in this title and title I, and in the provisions of

the Social Security Act amended thereby [see Short Title of 1961

Amendment note set out under section 1305 of this title], the term

'Secretary', unless the context otherwise requires, means the

Secretary of Health and Human Services."

Section 709 of Pub. L. 86-778, as amended by Pub. L. 96-88, title

V, Sec. 509(b), Oct. 17, 1979, 93 Stat. 695, provided that: "As

used in this Act and the provisions of the Social Security Act

amended by this Act [see Short Title of 1960 Amendment note set out

under section 1305 of this title] the term 'Secretary', unless the

context otherwise requires, means the Secretary of Health and Human

Services."

Section 702 of Pub. L. 85-840, as amended by Pub. L. 96-88, title

V, Sec. 509(b), Oct. 17, 1979, 93 Stat. 695, provided that: "As

used in the provisions of the Social Security Act amended by this

Act [see Short Title of 1958 Amendment note set out under section

1305 of this title], the term "Secretary", unless the context

otherwise requires, means the Secretary of Health and Human

Services."

Section 119 of act Aug. 1, 1956, ch. 836, as amended Oct. 17,

1979, Pub. L. 96-88, title V, Sec. 509(b), 93 Stat. 695, provided

that: "As used in this Act and in the provisions of the Social

Security Act set forth in this Act [see Short Title of 1956

Amendment note set out under section 1305 of this title], the term

'Secretary' means the Secretary of Health and Human Services."

Section 114 of title I of act Sept. 1, 1954, as amended Oct. 17,

1979, Pub. L. 96-88, title V, Sec. 509(b), 93 Stat. 695, provided

that: "As used in the provisions of the Social Security Act amended

by this title [sections 402, 403, 415, and 421 of this title], the

term 'Secretary' means the Secretary of Health and Human Services."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1012, 1395x, 1396d of

this title.

-End-

-CITE-

42 USC Sec. 1301-1 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 A - General Provisions

-HEAD-

Sec. 1301-1. Omitted

-COD-

CODIFICATION

Section, act Aug. 10, 1946, ch. 951, title II, Sec. 202, 60 Stat.

981, defined the term "Administrator" as used in certain sections

of this chapter. See section 1301 of this title.

-End-

-CITE-

42 USC Sec. 1301a 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. 1301a. Omitted

-COD-

CODIFICATION

Section, act June 26, 1940, ch. 428, title II, 54 Stat. 588,

provided for reimbursement for official travel performed by

employees of the Bureau of Old-Age Insurance, was from the Federal

Security Agency Appropriation Act, 1941, and was not repeated in

subsequent appropriations acts.

-End-

-CITE-

42 USC Sec. 1302 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. 1302. Rules and regulations; impact analyses of Medicare and

Medicaid rules and regulations on small rural hospitals

-STATUTE-

(a) The Secretary of the Treasury, the Secretary of Labor, and

the Secretary of Health and Human Services, respectively, shall

make and publish such rules and regulations, not inconsistent with

this chapter, as may be necessary to the efficient administration

of the functions with which each is charged under this chapter.

(b)(1) Whenever the Secretary publishes a general notice of

proposed rulemaking for any rule or regulation proposed under

subchapter XVIII of this chapter, subchapter XIX of this chapter,

or part B of this subchapter that may have a significant impact on

the operations of a substantial number of small rural hospitals,

the Secretary shall prepare and make available for public comment

an initial regulatory impact analysis. Such analysis shall describe

the impact of the proposed rule or regulation on such hospitals and

shall set forth, with respect to small rural hospitals, the matters

required under section 603 of title 5 to be set forth with respect

to small entities. The initial regulatory impact analysis (or a

summary) shall be published in the Federal Register at the time of

the publication of general notice of proposed rulemaking for the

rule or regulation.

(2) Whenever the Secretary promulgates a final version of a rule

or regulation with respect to which an initial regulatory impact

analysis is required by paragraph (1), the Secretary shall prepare

a final regulatory impact analysis with respect to the final

version of such rule or regulation. Such analysis shall set forth,

with respect to small rural hospitals, the matters required under

section 604 of title 5 to be set forth with respect to small

entities. The Secretary shall make copies of the final regulatory

impact analysis available to the public and shall publish, in the

Federal Register at the time of publication of the final version of

the rule or regulation, a statement describing how a member of the

public may obtain a copy of such analysis.

(3) If a regulatory flexibility analysis is required by chapter 6

of title 5 for a rule or regulation to which this subsection

applies, such analysis shall specifically address the impact of the

rule or regulation on small rural hospitals.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1102, 49 Stat. 647; Aug.

28, 1950, ch. 809, title IV, Sec. 403(c), 64 Stat. 559; Pub. L.

98-369, div. B, title VI, Sec. 2663(j)(2)(D)(i), (l)(2), July 18,

1984, 98 Stat. 1170, 1171; Pub. L. 100-203, title IV, Sec. 4402(a),

Dec. 22, 1987, 101 Stat. 1330-226.)

-REFTEXT-

REFERENCES IN TEXT

Part B of this subchapter, referred to in subsec. (b)(1), is

classified to section 1320c et seq. of this title.

-MISC1-

AMENDMENTS

1987 - Pub. L. 100-203 designated existing provision as subsec.

(a) and added subsec. (b).

1984 - Pub. L. 98-369, Sec. 2663(l)(2), substituted "Secretary of

Health, Education, and Welfare" for "Federal Security

Administrator" immediately prior to the substitution of "Health and

Human Services" for "Health, Education, and Welfare" by Pub. L.

98-369, Sec. 2663(j)(2)(D)(i).

1950 - Act Aug. 28, 1950, substituted "Federal Security

Administrator" for "Social Security Board".

EFFECTIVE DATE OF 1987 AMENDMENT

Section 4402(b) of Pub. L. 100-203 provided that: "The amendments

made by paragraph (1) [probably means subsec. (a), amending this

section] shall apply to regulations proposed more than 30 days

after the date of the enactment of this Act [Dec. 22, 1987]."

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.

REPEALS

The provisions of this section were incorporated into sections

1429 and 1609 of former Title 26, Internal Revenue Code of 1939, by

act Feb. 10, 1939, ch. 2, 53 Stat. 1. Section 4 of the act of Feb.

10, 1939, which enacted Title 26, I.R.C. 1939, provided that all

laws and parts of laws codified into the I.R.C. 1939, to the extent

that they related exclusively to internal revenue, were repealed.

Provisions of I.R.C. 1939 were generally repealed by section 7851

of Title 26, Internal Revenue Code of 1954. See also, section 7807

of said Title 26, I.R.C. 1954, respecting rules in effect upon

enactment of I.R.C. 1954. The I.R.C. 1954 was redesignated I.R.C.

1986 by Pub. L. 99-514, Sec. 2, Oct. 22, 1986, 100 Stat. 2095. The

repealed sections are covered by section 7805(a), (c) of Title 26.

ABORTION SERVICES; PROHIBITION ON CERTAIN POLICY CHANGES

Pub. L. 100-517, Sec. 9, Oct. 24, 1988, 102 Stat. 2583, provided

that: "With respect to abortion services, the Secretary of Health

and Human Services shall not promulgate or issue any regulations,

policy statements, or interpretations or develop any practices

concerning the performance of medically necessary procedures if

such regulations, policy statements, interpretations, or practices

would be inconsistent with regulations, policy statements,

interpretations, or practices in effect on the date of the

enactment of this Act [Oct. 24, 1988]."

NOTICE ON SOCIAL SECURITY CHECKS

Pub. L. 98-473, title II, Sec. 1212, Oct. 12, 1984, 98 Stat.

2165, provided that:

"(a) The Secretary of the Treasury shall take such steps as may

be necessary to provide that all checks issued for payment of

benefits under title II of the Social Security Act [subchapter II

of this chapter], and the envelopes in which such checks are

mailed, contain a printed notice that the commission of forgery in

conjunction with the cashing or attempted cashing of such checks

constitutes a violation of Federal law. Such notice shall also

state the maximum penalties for forgery under the applicable

provisions of title 18 of the United States Code.

"(b) Subsection (a) shall apply with respect to checks issued for

months after the ninth month after the date of the enactment of

this Act [Oct. 12, 1984]."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 912, 1395ff of this

title.

-End-

-CITE-

42 USC Sec. 1303 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. 1303. Separability

-STATUTE-

If any provision of this chapter, or the application thereof to

any person or circumstance, is held invalid, the remainder of the

chapter, and the application of such provision to other persons or

circumstances shall not be affected thereby.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1103, 49 Stat. 648.)

-MISC1-

SEPARABILITY

Pub. L. 98-460, Sec. 18, Oct. 9, 1984, 98 Stat. 1813, provided

that: "If any provision of this Act [amending sections 405, 408,

416, 421 to 423, 1382c, 1382d, 1382h, and 1383 to 1383b of this

title, enacting provisions set out as notes under sections 405, 421

to 423, 907, and 1305 of this title, and amending provisions set

out as a note under section 1382h of this title], or the

application thereof to any person or circumstance, is held invalid,

the remainder of this Act and the application of such provision to

other persons or circumstances shall not be affected thereby."

-End-

-CITE-

42 USC Sec. 1304 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. 1304. Reservation of right to amend or repeal

-STATUTE-

The right to alter, amend, or repeal any provision of this

chapter is hereby reserved to the Congress.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1104, 49 Stat. 648.)

-End-

-CITE-

42 USC Sec. 1305 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. 1305. Short title of chapter

-STATUTE-

This chapter may be cited as the "Social Security Act".

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1105, 49 Stat. 648.)

-MISC1-

SHORT TITLE OF 2002 AMENDMENTS

Pub. L. 107-133, Sec. 1, Jan. 17, 2002, 115 Stat. 2413, provided

that: "This Act [enacting sections 629f to 629i of this title,

amending sections 629, 629a, 629c, 629d, 629e, 674, and 677 of this

title, and enacting provisions set out as a note under section 677

of this title] may be cited as the 'Promoting Safe and Stable

Families Amendments of 2001'."

Pub. L. 107-121, Sec. 1, Jan. 15, 2002, 115 Stat. 2384, provided

that: "This Act [amending sections 1396a and 1396n of this title

and enacting provisions set out as a note under section 1396a of

this title] may be cited as the 'Native American Breast and

Cervical Cancer Treatment Technical Amendment Act of 2001'."

SHORT TITLE OF 2001 AMENDMENT

Pub. L. 107-105, Sec. 1, Dec. 27, 2001, 115 Stat. 1003, provided

that: "This Act [amending sections 1320d and 1395y of this title

and enacting provisions set out as notes under sections 1320d-4 and

1395y of this title] may be cited as the 'Administrative

Simplification Compliance Act'."

SHORT TITLE OF 2000 AMENDMENTS

Pub. L. 106-554, Sec. 1(a)(1) [title VI, Sec. 601], Dec. 21,

2000, 114 Stat. 2763, 2763A-74, provided that: "This title

[enacting and amending provisions set out as notes under section

604 of this title] may be cited as the 'Assets for Independence Act

Amendments of 2000'."

Pub. L. 106-554, Sec. 1(a)(6) [Sec. 1(a)], Dec. 21, 2000, 114

Stat. 2763, 2763A-463, provided that: "This Act [H.R. 5661, as

enacted by section 1(a)(6) of Pub. L. 106-554, see Tables for

classification] may be cited as the 'Medicare, Medicaid, and SCHIP

Benefits Improvement and Protection Act of 2000'."

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

2000, 114 Stat. 2762, 2762A-114, which provided that section

1(a)(2) [title VI, Sec. 635] of Pub. L. 106-553, enacting section

1320b-23 of this title, amending section 408 of this title, and

enacting provisions set out as notes under sections 408 and

1320b-23 of this title, could be cited as "Amy Boyer's Law", 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.

Pub. L. 106-354, Sec. 1, Oct. 24, 2000, 114 Stat. 1381, provided

that: "This Act [enacting section 1396r-1b of this title, amending

sections 1396a, 1396b, and 1396d of this title, and enacting

provisions set out as a note under section 1396a of this title] may

be cited as the 'Breast and Cervical Cancer Prevention and

Treatment Act of 2000'."

Pub. L. 106-182, Sec. 1, Apr. 7, 2000, 114 Stat. 198, provided

that: "This Act [amending sections 402 and 403 of this title and

enacting provisions set out as a note under section 402 of this

title] may be cited as the 'Senior Citizens' Freedom to Work Act of

2000'."

SHORT TITLE OF 1999 AMENDMENTS

Pub. L. 106-170, Sec. 1(a), Dec. 17, 1999, 113 Stat. 1860,

provided that: "This Act [see Tables for classification] may be

cited as the 'Ticket to Work and Work Incentives Improvement Act of

1999'."

Pub. L. 106-169, Sec. 1(a), Dec. 14, 1999, 113 Stat. 1822,

provided that: "This Act [enacting subchapter VIII of this chapter

and sections 1306b, 1320a-8a, 1320b-6, and 1320b-18 of this title,

amending sections 401, 402, 404, 405, 602, 604, 609, 613, 616,

629a, 652, 654, 655, 657, 659, 666, 671, 672, 673b, 674, 677, 903,

904, 909, 1320a-8, 1320b-7, 1320b-17, 1382, 1382a, 1382b, 1383,

1396a, and 1396d of this title and sections 3701 and 3716 of Title

31, Money and Finance, and enacting provisions set out as notes

under sections 402, 404, 602, 604, 657, 671, 677, 904, 1320a-8,

1320a-8a, 1320b-6, 1382, 1382a, 1382b, 1383, and 1396a of this

title and section 3701 of Title 31] may be cited as the 'Foster

Care Independence Act of 1999'."

Pub. L. 106-113, div. B, Sec. 1000(a)(6) [Sec. 1(a)], Nov. 29,

1999, 113 Stat. 1536, 1501A-321, provided that: "This Act [H.R.

3426, as enacted by section 1000(a)(6) of Pub. L. 106-113, see

Tables for classification] may be cited as the 'Medicare, Medicaid,

and SCHIP Balanced Budget Refinement Act of 1999'."

Pub. L. 106-4, Sec. 1, Mar. 25, 1999, 113 Stat. 7, provided that:

"This Act [amending section 1396r of this title and enacting

provisions set out as a note under section 1396r of this title] may

be cited as the 'Nursing Home Resident Protection Amendments of

1999'."

SHORT TITLE OF 1998 AMENDMENTS

Pub. L. 105-306, Sec. 1, Oct. 28, 1998, 112 Stat. 2926, provided

that: "This Act [enacting section 1320b-17 of this title, amending

sections 404, 603, 655, 1382a, 1382b, and 1383 of this title and

sections 1611 and 1621 of Title 8, Aliens and Nationality, enacting

provisions set out as notes under sections 404, 603, 652, 655, and

1382a of this title, and amending provisions set out as notes under

section 652 of this title and section 3306 of Title 26, Internal

Revenue Code] may be cited as the 'Noncitizen Benefit Clarification

and Other Technical Amendments Act of 1998'."

Pub. L. 105-200, Sec. 1, July 16, 1998, 112 Stat. 645, provided

that: "This Act [enacting section 658a of this title, amending

sections 603, 604, 609, 613, 622, 629b, 652, 653, 655, 658, 658a,

666, 669, 669a, 671, 673b, 674, and 1314a of this title and

sections 1021, 1144, and 1169 of Title 29, Labor, repealing section

658 of this title, enacting provisions set out as notes under

sections 608, 651 to 653, 655, 658a, 666, and 671 of this title,

sections 1021, 1144, and 1169 of Title 29, and section 5309 of

Title 49, Transportation, amending provisions set out as notes

under sections 608, 652, 658, and 658a of this title, and repealing

provisions set out as a note under section 658 of this title] may

be cited as the 'Child Support Performance and Incentive Act of

1998'."

SHORT TITLE OF 1997 AMENDMENT

Pub. L. 105-89, Sec. 1(a), Nov. 19, 1997, 111 Stat. 2115,

provided that: "This Act [enacting sections 673b, 678, and 679b of

this title, amending sections 603, 622, 629 to 629b, 653, 671 to

673, 674, 675, 677, and 1320a-9 of this title and sections 645 and

901 of Title 2, The Congress, enacting provisions set out as notes

under sections 613, 622, 629a, 671, 673, 675, 679b, 1320a-9, 5111,

and 5113 of this title, and amending provisions set out as a note

under section 670 of this title] may be cited as the 'Adoption and

Safe Families Act of 1997'."

SHORT TITLE OF 1996 AMENDMENTS

Pub. L. 104-193, Sec. 1, Aug. 22, 1996, 110 Stat. 2105, provided

that: "This Act [see Tables for classification] may be cited as the

'Personal Responsibility and Work Opportunity Reconciliation Act of

1996'."

Pub. L. 104-121, title I, Sec. 101, Mar. 29, 1996, 110 Stat. 847,

provided that: "This title [enacting sections 1320b-15 and 1383e of

this title, amending sections 401 to 403, 405, 422, 423, 425, 902,

903, 1382, 1382c, 1383, and 1383c of this title and sections 665e

and 901 of Title 2, The Congress, enacting provisions set out as

notes under sections 401 to 403, 405, 902, 1320b-15, and 1382 of

this title, and repealing provisions set out as a note under

section 425 of this title] may be cited as the 'Senior Citizens'

Right to Work Act of 1996'."

SHORT TITLE OF 1994 AMENDMENTS

Pub. L. 103-432, Sec. 1, Oct. 31, 1994, 108 Stat. 4398, provided

that: "This Act [see Tables for classification] may be cited as the

'Social Security Act Amendments of 1994'."

Pub. L. 103-382, title V, Sec. 551, Oct. 20, 1994, 108 Stat.

4056, provided that: "This subpart [subpart 1 (Secs. 551-554) of

part E of title V of Pub. L. 103-382 enacting section 5115a of this

title, amending section 622 of this title, and enacting provisions

set out as a note under section 622 of this title] may be cited as

the 'Howard M. Metzenbaum Multiethnic Placement Act of 1994'."

Pub. L. 103-296, Sec. 1(a), Aug. 15, 1994, 108 Stat. 1464,

provided that: "This Act [see Tables for classification] may be

cited as the 'Social Security Independence and Program Improvements

Act of 1994'."

SHORT TITLE OF 1991 AMENDMENT

Pub. L. 102-234, Sec. 1, Dec. 12, 1991, 105 Stat. 1793, provided

that: "This Act [amending sections 1396a, 1396b, and 1396r-4 of

this title and enacting provisions set out as notes under sections

1396a, 1396b, and 1396r-4 of this title] may be cited as the

'Medicaid Voluntary Contribution and Provider-Specific Tax

Amendments of 1991'."

SHORT TITLE OF 1989 AMENDMENTS

Pub. L. 101-239, title X, Sec. 10000, Dec. 19, 1989, 103 Stat.

2470, provided that: "This title [see Tables for classification]

may be cited as the 'Miscellaneous and Technical Social Security

Act Amendments of 1989'."

Pub. L. 101-234, Sec. 1, Dec. 13, 1989, 103 Stat. 1979, provided

that: "This Act [see Tables for classification] may be cited as the

'Medicare Catastrophic Coverage Repeal Act of 1989'."

SHORT TITLE OF 1988 AMENDMENTS

Pub. L. 100-485, Sec. 1(a), Oct. 13, 1988, 102 Stat. 2343,

provided that: "This Act [enacting sections 617, 668, 669, 681 to

687, and 1396r-6 of this title, amending sections 405, 426, 503,

504, 602, 603, 607, 652 to 655, 657, 658, 666, 667, 671, 704, 1301,

1308, 1315, 1318, 1320a-7, 1320a-7a, 1320b-10, 1320c-3, 1395i-2,

1395i-3, 1395l, 1395m, 1395r, 1395s, 1395t-1, 1395t-2, 1395u,

1395v, 1395w-2, 1395w-3, 1395x, 1395y, 1395aa to 1395dd, 1395mm,

1395tt, 1395ww, 1395aaa to 1395ccc, 1396a, 1396b, 1396d, 1396i,

1396n, 1396p, 1396r, 1396r-1, 1396r-4, 1396r-5, 1396s, 1397d, and

1397e of this title, section 5315 of Title 5, Government

Organization and Employees, and sections 21, 51, 62, 129, 6103,

6109, and 7213 of Title 26, Internal Revenue Code, repealing

sections 609, 614, 630 to 632, 633 to 645, and 1320a-2 of this

title, enacting provisions set out as notes under sections 405,

426, 602, 603, 607, 618, 652 to 655, 666, 667, 681, 704, 1308,

1315, 1320a-2, 1395k, 1396b, and 1396r-6 of this title and sections

21, 62, 6103, and 6109 of Title 26, and amending provisions set out

as notes under sections 603, 606, 1320c-5, 1395b, 1395d, 1395e,

1395i-3, 1395k, 1395u, 1395ll, 1395mm, 1395ss, 1395tt, 1395ww,

1396a, 1396d, and 1396r-5 of this title and sections 6402 of Title

26] may be cited as the 'Family Support Act of 1988'."

Pub. L. 100-364, Sec. 1, July 11, 1988, 102 Stat. 822, provided:

"That this Act [amending section 645 of this title] may be cited as

the 'WIN Demonstration Program Extension Act of 1988'."

Pub. L. 100-360, Sec. 1(a), July 1, 1988, 102 Stat. 683, provided

that: "This Act [enacting sections 1320b-10, 1395b-2, 1395i-1a,

1395t-1, 1395t-2, 1395w-3, 1396r-4, and 1396r-5 of this title and

section 59B of Title 26, Internal Revenue Code, amending sections

254o, 294f, 300aa-12, 300aa-15, 300aa-21, 401, 426, 704, 912,

1320a-7, 1320a-7a, 1320a-7b, 1320b-5, 1320b-7, 1320b-8, 1320c-3,

1320c-5, 1320c-9, 1382, 1382b, 1395c to 1395f, 1395h, 1395i,

1395i-2, 1395i-3, 1395k to 1395n, 1395r to 1395t, 1395u to 1395w-2,

1395x to 1395z, 1395aa to 1395dd, 1395gg, 1395mm, 1395ss, 1395tt,

1395ww, 1395aaa to 1395ccc, 1396a, 1396b, 1396d, 1396j, 1396n to

1396p, 1396r, 1396r-1, 1396r-3, 1396r-4, 1396s, and 1397d of this

title and section 6050F of Title 26, enacting provisions set out as

notes under this section and sections 294f, 1320b-7, 1320b-10,

1320c-3, 1395b, 1395b-1, 1395b-2, 1395d, 1395e, 1395h, 1395i-1a,

1395k, 1395l, 1395m, 1395r, 1395u, 1395v, 1395x, 1395y, 1395cc,

1395ll, 1395mm, 1395ss, 1395ww, 1396a, 1396b, 1396d, 1396r-1, and

1396r-5 of this title, section 106 of Title 1, General Provisions,

section 8902 of Title 5, Government Organization and Employees, and

section 59B of Title 26, amending provisions set out as notes under

sections 426, 1320a-7a, 1320c-2, 1320c-3, 1395b-1, 1395h, 1395i-3,

1395k, 1395l, 1395m, 1395n, 1395u, 1395w-1, 1395x, 1395y, 1395aa,

1395dd, 1395mm, 1395pp, 1395ss, 1395ww, 1395bbb, 1396a, 1396b, and

1396r of this title, and repealing provisions set out as a note

under section 1395l of this title] may be cited as the 'Medicare

Catastrophic Coverage Act of 1988'."

SHORT TITLE OF 1987 AMENDMENT

Pub. L. 100-93, Sec. 1(a), Aug. 18, 1987, 101 Stat. 680, provided

that: "This Act [enacting sections 1395aaa and 1396r-2 of this

title, amending sections 704, 1320a-3, 1320a-5, 1320a-7, 1320a-7a,

1320a-7b, 1320c-5, 1395u, 1395y, 1395cc, 1395ff, 1395nn, 1395rr,

1395ss, 1395ww, 1396a, 1396b, 1396h, 1396n, 1396s, and 1397d of

this title and section 824 of Title 21, Food and Drugs,

transferring section 1396h of this title to section 1320a-7b of

this title, repealing section 1395nn of this title, enacting

provisions set out as notes under sections 1320a-7 and 1320a-7b of

this title, and amending provisions set out as a note under section

1396a of this title] may be cited as the 'Medicare and Medicaid

Patient and Program Protection Act of 1987'."

SHORT TITLE OF 1986 AMENDMENTS

Pub. L. 99-643, Sec. 1, Nov. 10, 1986, 100 Stat. 3574, provided

that: "This Act [amending sections 1382, 1382c, 1382h, 1383, 1383c,

1396a, and 1396s of this title, enacting provisions set out as

notes under sections 1382, 1382h, 1383, 1383c, and 1396a of this

title, and amending provisions set out as a note under section

1382h of this title] may be cited as the 'Employment Opportunities

for Disabled Americans Act'."

Pub. L. 99-272, title IX, Sec. 9000, Apr. 7, 1986, 100 Stat. 151,

provided that: "This title [enacting sections 1320c-13, 1395w-1,

1395dd, 1396r, and 1396s of this title, amending sections 401, 701,

702, 704, 709, 1301, 1320a-2, 1320c-2, 1320c-3, 1395e, 1395f,

1395i, 1395i-2, 1395l, 1395p to 1395r, 1395t, 1395u, 1395x, 1395y,

1395cc, 1395mm, 1395ww, 1395yy, 1396a, 1396b, 1396d, 1396k, 1396n,

and 1396o of this title and sections 623, 631, and 1144 of Title

29, Labor, enacting provisions set out as notes under sections 401,

1301, 1320a-2, 1320c-2, 1320c-3, 1320c-13, 1395b, 1395b-1, 1395e,

1395h, 1395i-2, 1395l, 1395p, 1395r, 1395u, 1395x, 1395y, 1395cc,

1395dd, 1395mm, 1395rr, 1395ww, 1395yy, 1396a, 1396b, 1396d, 1396n,

and 1396r of this title and section 1144 of Title 29, and amending

provisions set out as notes under sections 1395c, 1395h, 1395y, and

1395ww of this title] may be cited as the 'Medicare and Medicaid

Budget Reconciliation Amendments of 1985'."

SHORT TITLE OF 1984 AMENDMENTS

Pub. L. 98-460, Sec. 1, Oct. 9, 1984, 98 Stat. 1794, provided

that: "This Act [amending sections 405, 408, 416, 421 to 423,

1382c, 1382d, 1382h, and 1383 to 1383b of this title, enacting

provisions set out as notes under sections 405, 421 to 423, 907,

and 1303 of this title, and amending provisions set out as a note

under section 1382h of this title] may be cited as the 'Social

Security Disability Benefits Reform Act of 1984'."

Pub. L. 98-378, Sec. 1, Aug. 16, 1984, 98 Stat. 1305, provided

that: "This Act [enacting sections 666 and 667 of this title,

amending sections 602, 603, 606, 651 to 658, 664, 671, 1315, and

1396a of this title and sections 6103, 6402, and 7213 of Title 26,

Internal Revenue Code, and enacting provisions set out as notes

under sections 602, 606, 652, 654, 657, 658, and 667 of this title

and section 6103 of Title 26] may be cited as the 'Child Support

Enforcement Amendments of 1984'."

Pub. L. 98-369, div. B, title III, Sec. 2300, July 18, 1984, 98

Stat. 1061, provided that: "This title [enacting sections 1317,

1395yy, 1395zz, and 1396q of this title, amending sections 291i,

300s-1a, 606, 701, 703, 706, 907a, 1308, 1310, 1316, 1320a-1,

1320a-7 to 1320a-8, 1320c-2, 1395b-1, 1395f, 1395h, 1395i, 1395i-2,

1395k, 1395l, 1395n, 1395p to 1395cc, 1395ff, 1395ii, 1395ll,

1395mm to 1395oo, 1395rr, 1395ww, 1396a, 1396b, 1396d, 1396k,

1396l, and 1396n of this title, section 5315 of Title 5, Government

Organization and Employees, section 162 of Title 26, Internal

Revenue Code, section 623 of Title 29, Labor, and section 231f of

Title 45, Railroads, repealing section 1395dd of this title,

enacting provisions set out as notes under sections 291i, 701,

907a, 1308, 1310, 1317, 1320a-1, 1320a-7, 1320c-2, 1395b-1, 1395f,

1395h, 1395i, 1395k, 1395l, 1395n, 1395p, 1395r, 1395u, 1395x,

1395y, 1395bb, 1395cc, 1395mm, 1395oo, 1395rr, 1395uu, 1395ww,

1395yy, 1396a, 1396b, 1396d, 1396l, and 1396q of this title and

section 623 of Title 29, and amending provisions set out as notes

under sections 1320c, 1395x, 1395mm, and 1395ww of this title] may

be cited as the 'Medicare and Medicaid Budget Reconciliation

Amendments of 1984'."

SHORT TITLE OF 1983 AMENDMENT

Pub. L. 98-21, Sec. 1, Apr. 20, 1983, 97 Stat. 65, provided in

part that Pub. L. 98-21 [enacting sections 910 and 911 of this

title and sections 86, 3510, and 6050F of Title 26, Internal

Revenue Code, amending sections 401, 402, 403, 405, 407, 409, 410,

411, 415, 416, 417, 418, 422, 423, 425, 426, 427, 428, 429, 430,

433, 503, 602, 659, 1320a-1, 1320c-2, 1322, 1382, 1382a, 1382f,

1382g, 1395f, 1395i, 1395i-2, 1395n, 1395r, 1395t, 1395v, 1395w,

1395x, 1395y, 1395cc, 1395mm, 1395oo, 1395rr, 1395ww, and 1395xx of

this title, section 3413 of Title 12, Banks and Banking, and

sections 37, 41, 43, 44A, 46, 53, 85, 86, 87, 105, 128, 164, 275,

401, 403, 406, 407, 415, 861, 871, 904, 1401, 1402, 1441, 3101,

3111, 3121, 3302, 3304, 3306, 6103, 6413, and 7871 of Title 26, and

enacting provisions set out as notes under sections 401, 402, 403,

405, 407, 410, 411, 414, 415, 416, 418, 426, 428, 429, 433, 602,

902, 911, 1382, 1395b-1, 1395i, 1395r, 1395x, 1395y, 1395cc, and

1395ww of this title, sections 37, 86, 406, 1401, 1402, 3101, 3121,

3302, 3303, 3304, 3306, and 3510 of Title 26, section 5123 of Title

38, Veterans' Benefits, and section 231n of Title 45, Railroads]

may be cited as the "Social Security Amendments of 1983".

SHORT TITLE OF 1982 AMENDMENT

Pub. L. 97-248, title I, Sec. 141, Sept. 3, 1982, 96 Stat. 381,

provided that: "This subtitle [subtitle C (Secs. 141-150) of Pub.

L. 97-248, enacting part B of this subchapter, 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 section 1320c of this title] may be cited as the 'Peer Review

Improvement Act of 1982'."

SHORT TITLE OF 1981 AMENDMENT

Pub. L. 97-35, title XXI, Sec. 2100, Aug. 13, 1981, 95 Stat. 783,

provided that: "Subtitles A [sections 2101-2114 of Pub. L. 97-35,

enacting sections 1320a-7a, 1395uu, and 1395vv of this title,

amending sections, 1320a-7, 1320c, 1320c-1, 1320c-3, 1320c-4,

1320c-7, 1320c-8, 1320c-9, 1320c-11, 1320c-17, 1320c-21, 1395l,

1395n, 1395q, 1395x, 1395y, 1396a, and 1396b of this title,

repealing sections 1320c-13 and 1320c-20 of this title, and

enacting provisions set out as notes under sections 1320c, 1320c-1,

1320c-3, 1395l, 1395x, 1395y, 1395uu, and 1396b of this title], B

[sections 2121-2156 of Pub. L. 97-35, amending sections 632a,

1320c-3, 1320c-4, 1320c-7, 1395d, 1395e, 1395f, 1395l, 1395n,

1395p, 1395q, 1395r, 1395u, 1395x, 1395y, 1395cc, and 1395rr of

this title and section 162 of Title 26, Internal Revenue Code,

enacting provisions set out as notes under sections 1320c-3, 1395e,

1395f, 1395l, 1395p, 1395x, 1395y and 1395rr of this title and

section 162 of Title 26, and repealing provisions set out as notes

under sections 1395b-1, 1395g, and 1395ll of this title], and C

[sections 2161-2184 of Pub. L. 97-35, enacting sections 1320b-5 and

1396n of this title, amending sections 301, 302, 303, 306, 603,

606, 1201, 1203, 1206, 1301, 1308, 1351, 1353, 1355, 1396a, 1396b,

1396d, and 1396n of this title, and enacting provisions set out as

notes under sections 603, 1308, 1381, 1382, 1383, 1385, 1396a,

1396b, 1396d, and 1396n of this title] of this title may be cited

as the 'Medicare and Medicaid Amendments of 1981'."

Pub. L. 97-35, title XXI, Sec. 2191, Aug. 13, 1981, 95 Stat. 818,

provided that: "This subtitle [subtitle D (sections 2191-2194) of

title XXI of Pub. L. 97-35, enacting sections 701 to 709 of this

title, amending sections 247a, 300a-27, 300b, 300b-3, 300b-6,

300c-11, 300c-21, 701, 1301, 1308, 1320a-1, 1320a-8, 1320b-2,

1320b-4, 1320c-21, 1382d, 1395b-1, 1395x, and 1396a of this title,

repealing sections 236, 247a, 300a-21 to 300a-28, 300a-41, 300b,

300b-5, 300c-11, and 300c-21 of this title, enacting provisions set

out as notes under sections 701, 706, and 1382d of this title, and

amending provisions set out as notes under sections 1320a-8 and

1395b-1 of this title] may be cited as the 'Maternal and Child

Health Services Block Grant Act'."

Pub. L. 97-35, title XXIII, Sec. 2351, Aug. 13, 1981, 95 Stat.

867, provided that: "This subtitle [subtitle C (Secs. 2351-2355) of

title XXIII of Pub. L. 97-35, enacting sections 1397 to 1397f of

this title, amending sections 303, 602, 603, 607, 671, 1203, 1301,

1308, 1315, 1316, 1320a-3, 1320a-5, 1320a-7, 1353, 1382e, 1382h,

and 1382i of this title, enacting provisions set out as notes under

sections 602, 603, 1381, 1383, and 1397 of this title, and

repealing a provision set out as a note under section 1397a of this

title] may be cited as the 'Social Services Block Grant Act'."

SHORT TITLE OF 1980 AMENDMENTS

Pub. L. 96-611, Sec. 6, Dec. 28, 1980, 94 Stat. 3568, provided

that: "Sections 6 to 10 of this Act [enacting section 663 of this

title, and section 1738A of Title 28, Judiciary and Judicial

Procedure, amending sections 654 and 655 of this title, and

enacting provisions set out as notes under section 1073 of Title

18, Crimes and Criminal Procedure, section 1738A of Title 28, and

section 663 of this title] may be cited as the 'Parental Kidnapping

Prevention Act of 1980'."

Pub. L. 96-499, title IX, Sec. 900, Dec. 5, 1980, 94 Stat. 2609,

provided that: "This title [enacting sections 632a, 1320a-7,

1320a-8, 1320b-4, 1395tt, 1396l, and 1396m of this title, amending

sections 426, 705, 1320a-2, 1320a-3, 1320c-1, 1320c-3, 1320c-4,

1320c-7, 1320c-11, 1320c-12, 1320c-22, 1395c, 1395d, 1395f, 1395h,

1395k, 1395l, 1395n, 1395p, 1395q, 1395r, 1395u, 1395v, 1395x,

1395y, 1395z, 1395aa, 1395cc, 1395gg, 1395nn, 1395oo, 1395pp,

1395rr, 1396a, 1396b, 1396d, 1396h, 1396i, and 1397b of this title,

and section 231f of Title 45, Railroads, repealing section 1395m of

this title, and enacting provisions set out as notes under sections

705, 1320a-8, 1320b-4, 1320c, 1320c-4, 1320c-7, 1320c-11, 1320c-12,

1320c-15, 1395b-1, 1395d, 1395f, 1395g, 1395k, 1395l, 1395n, 1395p,

1395u, 1395v, 1395x, 1395y, 1395gg, 1395ll, 1395pp, 1395tt, 1396a,

and 1396b of this title] may be cited as the 'Medicare and Medicaid

Amendments of 1980'."

Pub. L. 96-272, Sec. 1, June 17, 1980, 94 Stat. 500, provided

that: "This Act [enacting sections 612, 627, 628, 670 to 673a, 674

to 676, 1320b-2, and 1320b-3 of this title, amending sections 602,

608, 620-625, 652, 658, 672, 673, 675, 1308, 1318, 1382d, 1395y,

1395cc, 1396a, 1397, 1397a, 1397b, 1397c, and 1397d of this title

and section 50B of Title 26, Internal Revenue Code, repealing

section 608 of this title, enacting provisions set out as notes

under sections 602, 603, 608, 620, 622, 670, 672, 675, 1320b-2,

1320b-3, 1396a, and 1397a of this title and section 50B of Title

26, and amending provisions set out as notes under sections 655,

1397a, and 1397e-1 of this title] may be cited as the 'Adoption

Assistance and Child Welfare Act of 1980'."

Pub. L. 96-265, Sec. 1, June 9, 1980, 94 Stat. 441, provided:

"That this Act [enacting sections 613, 1320a-6, 1382h, 1382i,

1382j, and 1395ss of this title, amending sections 401, 402, 403,

404, 405, 415, 416, 418, 421, 422, 423, 425, 426, 503, 504, 602,

603, 652, 654, 655, 907a, 1310, 1382, 1382a, 1382c, 1382e, 1383,

1395c, 1395i, 1395p, and 1397b of this title, sections 6103 and

7213 of Title 26, Internal Revenue Code, and section 231f of Title

45, Railroads, and enacting provisions set out as notes under

sections 401, 402, 403, 405, 405a, 415, 418, 421, 423, 425, 426,

503, 602, 603, 613, 652, 655, 1310, 1320a-6, 1382, 1382a, 1382c,

1382h, 1382j, 1395ll, and 1395ss of this title and under section

6103 of Title 26] may be cited as the 'Social Security Disability

Amendments of 1980'."

SHORT TITLE OF 1977 AMENDMENTS

Pub. L. 95-216, Sec. 1, Dec. 20, 1977, 91 Stat. 1509, provided in

part that Pub. L. 95-216 [enacting sections 433, 611, 907a, and 909

of this title, amending sections 401, 402, 403, 405, 409, 410, 411

to 413, 415 to 418, 423, 424a, 426, 429, 430, 602, 603, 1315,

1395r, 1395u, and 1395x of this title, section 441i of Title 2, The

Congress, sections 1401, 1402, 3101, 3102, 3111, 3121, 3304, 3306,

and 6051 of Title 26, Internal Revenue Code, and section 231b of

Title 45, Railroads, and enacting provisions set out as notes under

sections 402, 403, 409, 411, 413, 418, 424a, 430, 602, 603, 902,

907, 909, 1383, and 1395x of this title, section 441i of Title 2,

sections 1401, 1402, 3102, 3111, and 3121 of Title 26, and section

231b of Title 45] may be cited as the "Social Security Amendments

of 1977".

Pub. L. 95-142, Sec. 1, Oct. 25, 1977, 91 Stat. 1175, provided

that: "This Act [enacting sections 1320a, 1320a-3 to 1320a-5,

1320c-20 to 1320c-22, and 1396k of this title, amending sections

254e, 1301, 1320c-1, 1320c-3, 1320c-4, 1320c-6, 1320c-7, 1320c-9,

1320c-12, 1320c-15 to 1320c-17, 1395b-1, 1395f, 1395g, 1395h,

1395l, 1395u, 1395x, 1395y, 1395cc, 1395nn, 1396a, 1396b, 1396h,

1397a, 1397b, and 3524 of this title, and enacting provisions set

out as notes under sections 254e, 1320a, 1320a-3, 1320a-5, 1320c-6,

1320c-7, 1395f, 1395g, 1395h, 1395l, 1395x, 1395cc, 1395ll, 1395nn,

1396a, and 1396b of this title] may be cited as the

'Medicare-Medicaid Anti-Fraud and Abuse Amendments'."

SHORT TITLE OF 1976 AMENDMENT

Pub. L. 94-202, Sec. 8(a), Jan. 2, 1976, 89 Stat. 1137, provided

that: "This section [enacting section 432 of this title, amending

sections 401, 403, 424a, and 430 of this title and section 6103 of

Title 26, Internal Revenue Code, and enacting provisions set out as

notes under sections 401, 418, and 432 of this title] may be cited

as the 'Combined Old-Age, Survivors, and Disability

Insurance-Income Tax Reporting Amendments of 1975'."

SHORT TITLE OF 1975 AMENDMENT

Pub. L. 93-647, Sec. 1, Jan. 4, 1975, 88 Stat. 2337, provided:

"That this Act [enacting subchapter XX of this chapter, sections

651 to 660 of this title, and section 6305 of Title 26, Internal

Revenue Code, amending sections 303, 602, 603, 604, 606, 622, 1203,

1306, 1308, 1315, 1316, 1353, and 1383 note of this title,

repealing sections 610, 801 to 805, and 1320b of this title, and

enacting provisions set out as notes under sections 602, 651,

1320b, 1397, and 1397a of this title] may be cited as the 'Social

Services Amendments of 1974'."

SHORT TITLE OF 1972 AMENDMENT

Pub. L. 92-603, Sec. 1, Oct. 30, 1972, 86 Stat. 1329, provided in

part that Pub. L. 92-603 [enacting sections 431, 801 to 805,

1320a-1, 1320a-2, 1320c to 1320c-19, 1381a, 1382a to 1382e, 1383a

to 1383c, 1395i-2, 1395mm, 1395nn, 1395oo, 1395pp, 1396h, 1396i,

and 3502a of this title, and section 228s-3 of Title 45, Railroads,

amending sections 302, 306, 401, 402, 403, 405, 408, 409, 410, 410

note, 411, 414, 415, 416, 418, 422, 423, 424a, 425, 426, 427, 429,

430, 602, 603, 620, 705, 706, 709, 1202, 1206, 1301, 1306, 1308,

1352, 1355, 1381, 1382, 1383, 1385, 1395b-1, 1395c, 1395f, 1395h,

1395i, 1395j, 1395k, 1395l, 1395n, 1395o, 1395p, 1395q, 1395r,

1395s, 1395t, 1395u, 1395w, 1395x, 1395y, 1395z, 1395aa, 1395bb,

1395cc, 1395dd, 1395ff, 1395gg, 1395ii, 1395kk, 1395ll, 1395mm,

1395nn, 1396a, 1396b, 1396b-1, 1396d, 1396g, 1396h, and 1396i of

this title, sections 5315 and 5316 of Title 5, Government

Organization and Employees, sections 1431, 2012, 2019, and 2023 of

Title 7, Agriculture, and sections 1401, 1402, 3101, 3111, 3121,

6051, and 6413 of Title 26, Internal Revenue Code, repealing

sections 301 to 306, 1201 to 1206, 1351, 1352, 1353, 1354, 1355,

and 1396e of this title and section 639 of Title 25, Indians, and

enacting provisions set out as notes under sections 301, 302, 401,

402, 403, 408, 409, 410, 411, 414, 415, 416, 418, 423, 424a, 426,

429, 602, 620, 705, 801, 1301, 1306, 1308, 1320a-1, 1320b, 1381,

1382e, 1395f, 1395l, 1395n, 1395p, 1395q, 1395s, 1395u, 1395w,

1395x, 1395aa, 1395cc, 1395ff, 1395gg, 1395mm, 1395nn, 1395oo,

1395pp, 1396a, 1396b, 2396d, and 1396e of this title, section 5315

of Title 5, sections 1431 and 2012 of Title 7, section 639 of Title

25, and sections 1401, 6051, and 6413 of Title 26,] may be cited as

the "Social Security Amendments of 1972".

SHORT TITLE OF 1969 AMENDMENT

Pub. L. 91-172, title X, Sec. 1001, Dec. 30, 1969, 83 Stat. 737,

provided that: "This title [amending sections 401 to 403, 415, 427,

and 428 of this title, and enacting provisions set out as notes

under sections 401 to 403, 415 and 427 of this title] may be cited

as the 'Social Security Amendments of 1969'."

SHORT TITLE OF 1968 AMENDMENT

Pub. L. 90-248, Sec. 1, Jan. 2, 1968, 81 Stat. 821, provided that

this Act [enacting sections 429, 610, 620 to 626, 630 to 644, 908,

1319-1320a, 1395b-1, and 1396e to 1396g of this title, amending

sections 302 to 304, 401 to 406, 409 to 411, 413, 415 to 418, 421

to 423, 424a, 425, 426, 426a, 427, 428, 601 to 604, 606 to 608,

622, 701 to 715, 729, 907, 1202 to 1204, 1306, 1308 to 1311, 1313

to 1318, 1352 to 1354, 1361, 1382, 1383, 1395d to 1395f, 1395i,

1395k, 1395l, 1395n, 1395p to 1395y, 1395aa, 1395cc, 1395dd,

1395gg, 1395ll, 1396a, 1396b, and 1396d of this title, sections

1401, 1402, 3101, 3111, 3121, 3122, 3125, 3306, 6051, and 6413 of

Title 26, Internal Revenue Code, and sections 228e and 228s-2 of

Title 45, Railroads, repealing sections 721 to 728, 1317, and

1395ee of this title, enacting provisions set out as notes under

sections 242b, 302, 303, 402 to 405, 409, 410, 413, 415, 416, 418,

423, 424a, 427, 601 to 603, 607, 609, 620, 622, 626, 633, 701, 705,

1301, 1308, 1319, 1395c to 1395f, 1395j to 1395l, 1395n, 1395p,

1395u, 1395x, 1395aa, 1395dd, 1396a, 1396b, 1396d, and 1396g of

this title, and amending provisions set out as notes under sections

603 and 608 of this title and sections 1401, 1402, 3121, and 6051

of Title 26] may be cited as the "Social Security Amendments of

1967."

Pub. L. 90-248, title III, Sec. 306, Jan. 2, 1968, 81 Stat. 930,

provided that: "This title [enacting subchapter V of this chapter,

amending sections 705, 729, 1396a, and 1396d of this title,

enacting provisions set out as notes under section 705 of this

title, and amending provisions set out as notes under section 242b

of this title] may be cited as the 'Child Health Act of 1967'."

SHORT TITLE OF 1965 AMENDMENT

Pub. L. 89-97, Sec. 1, July 30, 1965, 79 Stat. 286, provided that

this Act [enacting sections 424a, 426, 427, 716, 729-1, 907, 1316,

1317, 1318, 1395 to 1395dd, 1395ee, 1395gg to 1395ll and 1396 to

1396d of this title, section 6053 of Title 26, Internal Revenue

Code, and section 228s-2 of Title 45, Railroads; amending sections

302, 303, 306, 401 to 406, 409 to 411, 413, 415 to 418, 422, 423,

425, 602, 603, 606, 701, 703, 704, 711, 713, 714, 721 to 723, 1202,

1203, 1206, 1301, 1306, 1308, 1309, 1312, 1315, 1352, 1353, 1355,

1382, 1383, 1385, 1391, 1392, and 1395kk of this title, sections

72, 79, 213, 401, 451, 1401, 1402, 3101, 3102, 3111, 3121, 3122,

3125, 3201, 3211, 3221, 3401, 3402, 6051, 6205, 6413, 6652, and

6674 of Title 26, and sections 228a, 228e, and 228s-2 of title 45,

repealing section 727 of this title, enacting provisions set out as

notes under sections 242b, 302, 303, 306, 402, 403, 405, 410, 411,

415, 416, 418, 423, 424a, 426, 427, 602, 722, 729-1, 1202, 1301,

1308, 1309, 1315, 1316, 1352, 1382, 1395l, 1395o, 1395p, 1396b, and

2981 of this title, sections 213, 1401, 1402, 3121, 3201, and 6053

of Title 26, and section 228s-2 of Title 45, and amending

provisions set out as notes under sections 415 and 418 of this

title and section 3121 of Title 26] may be cited as the "Social

Security Amendments of 1965".

Pub. L. 89-97, title I, July 30, 1965, 79 Stat. 290, provided

that: "This title [enacting subchapter XVIII of this chapter,

sections 426, 907, and 1396 to 1396d of this title, and section

228s-2 of Title 45, Railroads, amending sections 303, 401, 401a,

402, 418, 603, 1203, 1301, 1306, 1309, 1315, 1353, 1383, and 1395kk

of this title, sections 72, 79, 213, 401, 405, 1401, 3101, 3111,

3201, 3211, 3221, and 6051 of Title 26, Internal Revenue Code, and

sections 228e and 228s-2 of Title 45, and enacting provisions set

out as notes under sections 426, 1301, 1309, 1315, 1395l, 1395o,

1395p, and 1396b of this title, sections 213 and 3201 of Title 26,

and section 228s-2 of Title 45] may be cited as the 'Health

Insurance for the Aged Act'."

Pub. L. 89-97, title III, July 30, 1965, 79 Stat. 361, provided

that: "This title [enacting sections 424a and 427 of this title and

section 6053 of Title 26, Internal Revenue Code, amending sections

401 to 406, 409 to 411, 413, 415 to 418, 422, 423, 425, and 1306 of

this title, sections 451, 1401, 1402, 3101, 3102, 3111, 3121, 3122,

3125, 3401, 3402, 6051, 6205, 6413, 6652, and 6674 of Title 26, and

sections 228a and 228e of Title 45, Railroads, enacting provisions

set out as notes under sections 402, 403, 405, 410, 411, 415, 416,

418, 424, 424a, and 427 of this title and sections 1401, 1402,

3121, and 6053 of Title 26, and amending provisions set out as

notes under sections 415 and 418 of this title and section 3121 of

Title 26] may be cited as the 'Old-Age, Survivors, and Disability

Insurance Amendments of 1965'."

SHORT TITLE OF 1963 AMENDMENT

Pub. L. 88-156, Sec. 1, Oct. 24, 1963, 77 Stat. 273, provided:

"That this Act [enacting subchapter XVII of this chapter and

sections 729 and 729a of this title, amending sections 701, 702,

711, and 712 of this title, and enacting provisions set out as a

note under section 1301 of this title] may be cited as the

'Maternal and Child Health and Mental Retardation Planning

Amendments of 1963'."

SHORT TITLE OF 1962 AMENDMENT

Pub. L. 87-543, Sec. 1, July 25, 1962, 76 Stat. 172, provided in

part that this Act [enacting sections 609, 727, 728, 1314, 1315,

and 1381 to 1385 of this title, amending sections 301 to 303, 306,

601 to 609, 721 to 723, 726, 906, 1201 to 1203, 1206, 1301, 1308,

1309, 1311, 1313, 1351 to 1353, and 1355 of this title, repealing

section 1202a of this title and provisions set out as notes under

sections 1202a and 1308 of this title, and enacting provisions set

out as notes under sections 302, 303, 306, 601, 603, 606, 608, 609,

722, 1202, 1301, 1308, and 1383 of this title], may be cited as the

"Public Welfare Amendments of 1962."

SHORT TITLE OF 1961 AMENDMENT

Pub. L. 87-64, Sec. 1, June 30, 1961, 75 Stat. 131, provided:

"That this Act [enacting section 1313 of this title, amending

sections 303, 402, 403, 409, 413, 414, 415, 416, 418, 423, 1203,

1308, and 1353 of this title, sections 1401, 1402, 3101 and 3111 of

Title 26, Internal Revenue Code, and section 228a of Title 45,

Railroads, and enacting provisions set out as notes under sections

303, 402, 403, 414, 415, 416, 1301, and 1308 of this title and

under sections 1401 and 1402 of Title 26] may be cited as the

'Social Security Amendments of 1961.' "

SHORT TITLE OF 1960 AMENDMENT

Pub. L. 86-778, Sec. 1, Sept. 13, 1960, 74 Stat. 924, provided

that this Act [enacting sections 726 and 1312 of this title and

sections 3125 and 3308 of Title 26, Internal Revenue Code, amending

sections 301 to 304, 306, 401, 401a, 402, 403, 405, 408 to 411, 413

to 416, 418, 422, 423, 501, 701, 702, 704, 711, 712, 714, 721, 722,

1101 to 1104, 1202, 1301, 1308, 1321 to 1324, 1361, 1363, 1364,

1367, 1371, and 1400c of this title, sections 1402, 1403, 3121,

3301, 3302, 3305, 3306, 6205, 6413, 7213, and 7701 of Title 26,

section 49d of Title 29, Labor, sections 228a, 228c, and 228e of

Title 45, Railroads, and section 1421h of Title 48, Territories and

Insular Possessions, repealing section 419 of this title, and

enacting provisions set out as notes under sections 301, 302, 401,

402, 403, 405, 410, 411, 413 to 418, 422, 423, 701, 1101, 1202,

1202a, 1301, 1321, 1362, 1363, and 1364 of this title, sections

1402, 3121, 3301, 3304, 3305, and 3306 of Title 26, and section 49d

of Title 29] may be cited as the "Social Security Amendments of

1960."

Pub. L. 86-778, title V, Sec. 501, Sept. 13, 1960, 74 Stat. 970,

provided that: "This title [enacting section 3308 of Title 26,

Internal Revenue Code, amending sections 501, 1101 to 1104, 1301,

1321 to 1324, 1361 to 1364, 1367, 1371, and 1400c of this title,

sections 3301, 3302, 3305, 3306, and 3309 of Title 26, and section

49d of Title 29, Labor, and enacting provisions set out as notes

under sections 1301, 1321, and 1362 to 1364 of this title, sections

3301, 3304, and 3305 of Title 26, and section 49d of Title 29] may

be cited as the 'Employment Security Act of 1960'."

SHORT TITLE OF 1958 AMENDMENT

Pub. L. 85-840, Sec. 1, Aug. 28, 1958, 72 Stat. 1013, provided

that this Act [enacting sections 722 to 725 and 1311 of this title,

amending sections 302, 303, 401, 402, 403, 406, 408, 409 to 411,

413 to 418, 422, 423, 425, 603, 701, 702, 711, 712, 1203, 1301,

1306, 1308, and 1353 of this title, sections 1401, 1402, 3101,

3111, 3121, 3122, 6334, and 6413 of Title 26, Internal Revenue

Code, and section 228a of Title 45, Railroads, repealing section

424 of this title, and enacting provisions set out as notes under

sections 303, 402, 403, 410, 411, 415, 416, 417, 418, 422, 721,

1202a, 1301 of this title and sections 1401, 1402, and 3121 of

Title 26] should be popularly known as the "Social Security

Amendments of 1958".

SHORT TITLE OF 1956 AMENDMENT

Act Aug. 1, 1956, ch. 836, Sec. 1, 70 Stat. 807, provided: "That

this Act [enacting sections 401a, 423, 424, 425, 906, and 1310 of

this title and section 3113 of Title 26, Internal Revenue Code,

amending sections 301 to 303, 401, 402, 403, 405, 409 to 411, 413

to 416, 418, 421, 422, 601 to 603, 606, 721, 1201 to 1203, 1301,

1308, and 1351 to 1353 of this title, sections 1401, 1402, 3101,

3102, 3111, and 3121 of Title 26, and sections 228 and 228e of

Title 45, Railroads, and amending provisions set out as a note

under section 3121 of Title 26] may be cited as the 'Social

Security Amendments of 1956'."

SHORT TITLE OF 1954 AMENDMENT

Act Aug. 5, 1954, ch. 657, Sec. 1, 68 Stat. 668, provided that:

"This Act [enacting sections 1101 to 1103, 1322, and 1323 of this

title and amending sections 503, 1104, and 1321 of this title and

sections 1601, 1603, and 1607 of former Title 26, Internal Revenue

Code of 1939] may be cited as the 'Employment Security

Administration Financing Act of 1954'."

SHORT TITLE OF 1952 AMENDMENT

Act July 18, 1952, ch. 945, Sec. 1, 66 Stat. 767, provided that:

"This Act [enacting sections 420, 421, and 1309 of this title,

amending sections 303, 403, 405, 413, 414, 415, 416, 417, 603,

1203, and 1353 of this title and sections 228a, 228e of Title 45,

Railroads, and enacting provisions set out as notes under sections

303, 402, 403, 413, 415, and 417 of this title] may be cited as the

'Social Security Act Amendments of 1952'."

SHORT TITLE OF 1950 AMENDMENT

Act Aug. 28, 1950, ch. 809, Sec. 1, 64 Stat. 477, provided in

part that act Aug. 28, 1950, may be cited as the "Social Security

Act Amendments of 1950". For complete classification of this Act to

the Code, see Tables.

-End-

-CITE-

42 USC Sec. 1306 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. 1306. Disclosure of information in possession of Social

Security Administration or Department of Health and Human

Services

-STATUTE-

(a) Disclosure prohibited; exceptions

(1) No disclosure of any return or portion of a return (including

information returns and other written statements) filed with the

Commissioner of Internal Revenue under title VIII of the Social

Security Act or under subchapter E of chapter 1 or subchapter A of

chapter 9 of the Internal Revenue Code [of 1939], or under

regulations made under authority thereof, which has been

transmitted to the head of the applicable agency by the

Commissioner of Internal Revenue, or of any file, record, report,

or other paper, or any information, obtained at any time by the

head of the applicable agency or by any officer or employee of the

applicable agency in the course of discharging the duties of the

head of the applicable agency under this chapter, and no disclosure

of any such file, record, report, or other paper, or information,

obtained at any time by any person from the head of the applicable

agency or from any officer or employee of the applicable agency,

shall be made except as the head of the applicable agency may by

regulations prescribe and except as otherwise provided by Federal

law. Any person who shall violate any provision of this section

shall be deemed guilty of a felony and, upon conviction thereof,

shall be punished by a fine not exceeding $10,000 for each

occurrence of a violation, or by imprisonment not exceeding 5

years, or both.

(2) For purposes of this subsection and subsection (b) of this

section, the term "applicable agency" means -

(A) the Social Security Administration, with respect to matter

transmitted to or obtained by such Administration or matter

disclosed by such Administration, or

(B) the Department of Health and Human Services, with respect

to matter transmitted to or obtained by such Department or matter

disclosed by such Department.

(b) Requests for information and services

Requests for information, disclosure of which is authorized by

regulations prescribed pursuant to subsection (a) of this section,

and requests for services, may, subject to such limitations as may

be prescribed by the head of the applicable agency to avoid undue

interference with his functions under this chapter, be complied

with if the agency, person, or organization making the request

agrees to pay for the information or services requested in such

amount, if any (not exceeding the cost of furnishing the

information or services), as may be determined by the head of the

applicable agency. Payments for information or services furnished

pursuant to this section shall be made in advance or by way of

reimbursement, as may be requested by the head of the applicable

agency, and shall be deposited in the Treasury as a special deposit

to be used to reimburse the appropriations (including

authorizations to make expenditures from the Federal Old-Age and

Survivors Insurance Trust Fund, the Federal Disability Insurance

Trust Fund, the Federal Hospital Insurance Trust Fund, and the

Federal Supplementary Medical Insurance Trust Fund) for the unit or

units of the applicable agency which furnished the information or

services. Notwithstanding the preceding provisions of this

subsection, requests for information made pursuant to the

provisions of part D of subchapter IV of this chapter for the

purpose of using Federal records for locating parents shall be

complied with and the cost incurred in providing such information

shall be paid for as provided in such part D of subchapter IV of

this chapter.

(c) Cost reimbursement

Notwithstanding sections 552 and 552a of title 5 or any other

provision of law, whenever the Commissioner of Social Security or

the Secretary determines that a request for information is made in

order to assist a party in interest (as defined in section 1002 of

title 29) with respect to the administration of an employee benefit

plan (as so defined), or is made for any other purpose not directly

related to the administration of the program or programs under this

chapter to which such information relates, such Commissioner or

Secretary may require the requester to pay the full cost, as

determined by such Commissioner or Secretary, of providing such

information.

(d) Compliance with requests

Notwithstanding any other provision of this section, in any case

in which -

(1) information regarding whether an individual is shown on the

records of the Commissioner of Social Security as being alive or

deceased is requested from the Commissioner for purposes of

epidemiological or similar research which the Commissioner in

consultation with the Secretary of Health and Human Services

finds may reasonably be expected to contribute to a national

health interest, and

(2) the requester agrees to reimburse the Commissioner for

providing such information and to comply with limitations on

safeguarding and rerelease or redisclosure of such information as

may be specified by the Commissioner,

the Commissioner shall comply with such request, except to the

extent that compliance with such request would constitute a

violation of the terms of any contract entered into under section

405(r) of this title.

(e) Public inspection

Notwithstanding any other provision of this section the Secretary

shall make available to each State agency operating a program under

subchapter XIX of this chapter and shall, subject to the

limitations contained in subsection (e) (!1) of this section, make

available for public inspection in readily accessible form and

fashion, the following official reports (not including, however,

references to any internal tolerance rules and practices that may

be contained therein, internal working papers or other informal

memoranda) dealing with the operation of the health programs

established by subchapters XVIII and XIX of this chapter -

(1) individual contractor performance reviews and other formal

evaluations of the performance of carriers, intermediaries, and

State agencies, including the reports of follow-up reviews;

(2) comparative evaluations of the performance of such

contractors, including comparisons of either overall performance

or of any particular aspect of contractor operation; and

(3) program validation survey reports and other formal

evaluations of the performance of providers of services,

including the reports of follow-up reviews, except that such

reports shall not identify individual patients, individual health

care practitioners, or other individuals.

(f) Opportunity for review

No report described in subsection (e) of this section shall be

made public by the Secretary or the State subchapter XIX agency

until the contractor or provider of services whose performance is

being evaluated has had a reasonable opportunity (not exceeding 60

days) to review such report and to offer comments pertinent parts

of which may be incorporated in the public report; nor shall the

Secretary be required to include in any such report information

with respect to any deficiency (or improper practice or procedures)

which is known by the Secretary to have been fully corrected,

within 60 days of the date such deficiency was first brought to the

attention of such contractor or provider of services, as the case

may be.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1106, as added Aug. 10,

1939, ch. 666, title VIII, Sec. 802, 53 Stat. 1398; amended Aug.

28, 1950, ch. 809, title IV, Sec. 403(d), 64 Stat. 559; Pub. L.

85-840, title VII, Sec. 701, Aug. 28, 1958, 72 Stat. 1055; Pub. L.

89-97, title I, Sec. 108(c), title III, Sec. 340, July 30, 1965, 79

Stat. 339, 411; Pub. L. 90-248, title I, Sec. 168, title II, Sec.

241(c)(1), Jan. 2, 1968, 81 Stat. 875, 917; Pub. L. 92-603, title

II, Sec. 249C(a), Oct. 30, 1972, 86 Stat. 1428; Pub. L. 93-647,

Sec. 101(d), Jan. 4, 1975, 88 Stat. 2360; Pub. L. 97-35, title

XXII, Sec. 2207, Aug. 13, 1981, 95 Stat. 838; Pub. L. 98-369, div.

B, title VI, Sec. 2663(j)(2)(D)(ii), (l), July 18, 1984, 98 Stat.

1170, 1171; Pub. L. 103-296, title I, Sec. 108(b)(2)-(5), title

III, Secs. 311(a), 313(a), Aug. 15, 1994, 108 Stat. 1481, 1482,

1525, 1530.)

-REFTEXT-

REFERENCES IN TEXT

Title VIII of the Social Security Act, referred to in subsec.

(a)(1), probably refers to former title VIII of the Act, which was

classified to subchapter VIII (Sec. 1001 et seq.) of this chapter

prior to its omission from the Code as superseded by the provisions

of the Internal Revenue Code of 1939 and the Internal Revenue Code

of 1986.

Subchapter E of chapter 1 and subchapter A of chapter 9 of the

Internal Revenue Code of 1939, referred to in subsec. (a), were

comprised of sections 480 to 482 and 1400 to 1432, respectively,

and were repealed (subject to certain exceptions) by section

7851(a)(1)(A), (3) of Title 26, Internal Revenue Code of 1954 (act

Aug. 16, 1954, ch. 736, 68A Stat. 3). The I.R.C. 1954 was

redesignated I.R.C. 1986 by Pub. L. 99-514, Sec. 2, Oct. 22, 1986,

100 Stat. 2095.

For provision deeming a reference in other laws to a provision of

the 1939 Code as a reference to the corresponding provisions of the

1986 Code, see section 7852(b) of the 1986 Code. For table of

comparisons of the 1939 Code to the 1986 Code, see table preceding

section 1 of Title 26, Internal Revenue Code. The Internal Revenue

Code of 1986 is classified generally to Title 26.

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

(b), is classified to section 651 et seq. of this title.

Subchapter XVIII of this chapter, referred to in subsec. (e), is

classified to section 1395 et seq. of this title.

Subchapter XIX of this chapter, referred to in subsecs. (e) and

(f), is classified to section 1396 et seq. of this title.

-MISC1-

AMENDMENTS

1994 - Subsec. (a). Pub. L. 103-296, Sec. 313(a), in par. (1),

substituted "felony" for "misdemeanor", "$10,000 for each

occurrence of a violation" for "$1,000", and "5 years" for "one

year".

Pub. L. 103-296, Sec. 108(b)(2), designated existing provisions

as par. (1), substituted "head of the applicable agency" for

"Secretary" wherever appearing and "employee of the applicable

agency" for "employee of the Department of Health and Human

Services" in two places, and added par. (2).

Subsec. (b). Pub. L. 103-296, Sec. 108(b)(3), substituted "head

of the applicable agency" for "Secretary" wherever appearing and

"applicable agency which" for "Department of Health and Human

Services which".

Subsec. (c). Pub. L. 103-296, Sec. 108(b)(4), substituted "the

Commissioner of Social Security or the Secretary" for "the

Secretary" where first appearing and "such Commissioner or

Secretary" for "the Secretary" where appearing subsequently in two

places.

Subsec. (d). Pub. L. 103-296, Sec. 311(a)(3), added subsec. (d).

Former subsec. (d) redesignated (e).

Pub. L. 103-296, Sec. 108(b)(5) in subsec. (d) as added by Pub.

L. 103-296, Sec. 311(a)(3), in par. (1) substituted "Commissioner

of Social Security" for "Secretary" after "records of the",

"Commissioner" for "Secretary" after "from the", "Commissioner in

consultation with the Secretary of Health and Human Services" for

"Secretary" after "which the", and in par. (2) and closing

provisions substituted "Commissioner" for "Secretary" wherever

appearing.

Subsec. (e). Pub. L. 103-296, Sec. 311(a)(1), redesignated

subsec. (d) as (e). Former subsec. (e) redesignated (f).

Subsec. (f). Pub. L. 103-296, Sec. 311(a)(1), (2), redesignated

subsec. (e) as (f) and substituted "subsection (e)" for "subsection

(d)".

1984 - Subsec. (a). Pub. L. 98-369, Sec. 2663(l), substituted

"Secretary" and "Department of Health and Human Services" for

"Administrator" and "Federal Security Agency", respectively,

wherever appearing.

Subsec. (b). Pub. L. 98-369, Sec. 2663(j)(2)(D)(ii), substituted

"Health and Human Services" for "Health, Education, and Welfare".

1981 - Subsec. (a). Pub. L. 97-35, Sec. 2207(1), substituted "as

otherwise provided by Federal law" for "as provided in part D of

subchapter IV of this chapter".

Subsec. (c). Pub. L. 97-35, Sec. 2207(2), added subsec. (c).

1975 - Subsec. (a). Pub. L. 93-647, Sec. 101(d)(1), inserted "and

except as provided in part D of subchapter IV of this chapter"

after "may by regulations prescribe".

Subsec. (b). Pub. L. 93-647, Sec. 101(d)(2), inserted provision

relating to compliance with requests for information made pursuant

to part D of subchapter IV of this chapter for purpose of using

Federal records to locate parents.

Subsec. (c). Pub. L. 93-647, Sec. 101(d)(3), repealed subsec. (c)

relating to requests by State or local agencies for most recent

address of any individual maintained pursuant to section 405 of

this title and requirements for release of such information.

1972 - Subsecs. (d), (e). Pub. L. 92-603 added subsecs. (d) and

(e).

1968 - Subsec. (c)(1). Pub. L. 90-248, Sec. 241(c)(1), struck out

"IV," after "I," and inserted "or part A of subchapter IV of this

chapter," after "XIX of this chapter,".

Subsec. (c)(1)(A), (B). Pub. L. 90-248, Sec. 168(a), designated

existing provisions as subpar. (A), redesignated former subpars.

(A) to (D) as cls. (i) to (iv) thereof, and added subpar. (B).

Subsec. (c)(2). Pub. L. 90-248, Sec. 168(b)(1), substituted

"(and, in the case of a request under paragraph (1)(A), shall be

accompanied by a certified copy of the order referred to in clauses

(i) and (iv) thereof)" for ", and shall be accompanied by a

certified copy of the order referred to in paragraph (1)(A) of this

subsection".

Subsec. (c)(3). Pub. L. 90-248, Sec. 168(b)(2), substituted

"authorized by subparagraph (A)(iv) or (B)" for "authorized by

subparagraph (D)".

1965 - Subsec. (b). Pub. L. 89-97, Sec. 108(c), provided for use

of special deposit in the Treasury (made up of payments for

information and services furnished) to reimburse authorizations to

make expenditures from the Federal Hospital Insurance Trust Fund

and the Supplementary Medical Insurance Trust Fund.

Subsec. (c). Pub. L. 89-97, Sec. 340, added subsec. (c).

1958 - Subsec. (b). Pub. L. 85-840 amended subsec. (b) generally,

authorizing compliance with requests for services if the agency,

person, or organization making the request agrees to pay for the

services.

1950 - Act Aug. 28, 1950, amended section generally, designating

existing provisions as subsec. (a), substituting "under subchapter

E of chapter 1 or subchapter A of chapter 9 of the Internal Revenue

Code of 1939" for "the Federal Insurance Contributions Act,"

reflecting the transfer of functions from the Social Security Board

to the Federal Security Administrator and the Federal Security

Agency, and adding subsec. (b).

EFFECTIVE DATE OF 1994 AMENDMENT

Amendment by section 108(b)(2)-(5) 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.

Amendment by section 311(a) of Pub. L. 103-296, applicable with

respect to requests for information made after Aug. 15, 1994, see

section 311(c) of Pub. L. 103-296, set out as a note under section

6103 of Title 26, Internal Revenue Code.

Section 313(c) of Pub. L. 103-296 provided that: "The amendments

made by this section [amending this section and section 1307 of

this title] shall apply to violations occurring on or after the

date of the enactment of this Act [Aug. 15, 1994]."

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 OF 1975 AMENDMENT

Amendment by Pub. L. 93-647 effective Aug. 1, 1975, see section

101(f) of Pub. L. 93-647, set out as an Effective Date note under

section 651 of this title.

EFFECTIVE DATE OF 1972 AMENDMENT

Section 249C(b) of Pub. L. 92-603 provided that: "The provisions

of subsection (a) [amending this section] shall apply with respect

to reports which are completed by the Secretary after the third

calendar month following the enactment of this Act [Oct. 30,

1972]."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1306b, 1382, 1395cc-2 of

this title; title 26 section 6103.

-FOOTNOTE-

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

-End-

-CITE-

42 USC Sec. 1306a 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. 1306a. Public access to State disbursement records

-STATUTE-

No State or any agency or political subdivision thereof shall be

deprived of any grant-in-aid or other payment to which it otherwise

is or has become entitled pursuant to subchapter I (other than

section 303(a)(3) thereof), IV, X, XIV, or XVI (other than section

1383(a)(3) thereof) of this chapter, by reason of the enactment or

enforcement by such State of any legislation prescribing any

conditions under which public access may be had to records of the

disbursement of any such funds or payments within such State, if

such legislation prohibits the use of any list or names obtained

through such access to such records for commercial or political

purposes.

-SOURCE-

(Oct. 20, 1951, ch. 521, title VI, Sec. 618, 65 Stat. 569; Pub. L.

86-778, title VI, Sec. 603(a), Sept. 13, 1960, 74 Stat. 992; Pub.

L. 87-543, title I, Sec. 141(e), July 25, 1962, 76 Stat. 205.)

-REFTEXT-

REFERENCES IN TEXT

Section 303(a)(3), referred to in text, was repealed by Pub. L.

97-35, title XXI, Sec. 2184(a)(4)(A), Aug. 13, 1981, 95 Stat. 816.

Section 1383(a)(3), referred to in text, was in the original a

reference to section 1603(a)(3) of the Social Security Act as added

July 25, 1962, Pub. L. 87-543, title I, Sec. 141(a), 76 Stat. 200,

and amended. That section was amended generally by Pub. L. 92-603,

Sec. 301, Oct. 30, 1972, 86 Stat. 1478. However, the amendment by

Pub. L. 92-603 was inapplicable to Puerto Rico, Guam, and the

Virgin Islands, so that the prior section (which is set out as a

note under section 1383 of this title) continues in effect for

Puerto Rico, Guam, and the Virgin Islands.

-COD-

CODIFICATION

Section was enacted as part of act Oct. 20, 1951, popularly known

as the Revenue Act of 1951, and not as part of the Social Security

Act which comprises this chapter.

-MISC1-

AMENDMENTS

1962 - Pub. L. 87-543 substituted "XIV, or XVI (other than

section 1383(a)(3) thereof)" for "or XIV".

1960 - Pub. L. 86-778 inserted "(other than section 303(a)(3)

thereof)" after "pursuant to subchapter I".

EFFECTIVE DATE OF 1960 AMENDMENT

Section 603(b) of Pub. L. 86-778 provided that: "The amendment

made by subsection (a) [amending this section] shall take effect

October 1, 1960."

-End-

-CITE-

42 USC Sec. 1306b 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. 1306b. State data exchanges

-STATUTE-

Whenever the Commissioner of Social Security requests information

from a State for the purpose of ascertaining an individual's

eligibility for benefits (or the correct amount of such benefits)

under subchapter II or XVI of this chapter, the standards of the

Commissioner promulgated pursuant to section 1306 of this title or

any other Federal law for the use, safeguarding, and disclosure of

information are deemed to meet any standards of the State that

would otherwise apply to the disclosure of information by the State

to the Commissioner.

-SOURCE-

(Pub. L. 106-169, title II, Sec. 209, Dec. 14, 1999, 113 Stat.

1842.)

-COD-

CODIFICATION

Section was enacted as part of the Foster Care Independence Act

of 1999, and not as part of the Social Security Act which comprises

this chapter.

-End-

-CITE-

42 USC Sec. 1307 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. 1307. Penalty for fraud

-STATUTE-

(a) Whoever, with the intent to defraud any person, shall make or

cause to be made any false representation concerning the

requirements of this chapter, of chapter 2, 21, or 23 of the

Internal Revenue Code of 1986, or of any provision of subtitle F of

such Code which corresponds (within the meaning of section 7852(b)

of such Code) to a provision contained in subchapter E of chapter 9

of the Internal Revenue Code of 1939, or of any rules or

regulations issued thereunder, knowing such representations to be

false, shall be deemed guilty of a misdemeanor, and, upon

conviction thereof, shall be punished by a fine not exceeding

$1,000, or by imprisonment not exceeding one year, or both.

(b) Whoever, with the intent to elicit information as to the

social security account number, date of birth, employment, wages,

or benefits of any individual (1) falsely represents to the

Commissioner of Social Security or the Secretary that he is such

individual, or the wife, husband, widow, widower, divorced wife,

divorced husband, surviving divorced wife, surviving divorced

husband, surviving divorced mother, surviving divorced father,

child, or parent of such individual, or the duly authorized agent

of such individual, or of the wife, husband, widow, widower,

divorced wife, divorced husband, surviving divorced wife, surviving

divorced husband, surviving divorced mother, surviving divorced

father, child, or parent of such individual, or (2) falsely

represents to any person that he is an employee or agent of the

United States, shall be deemed guilty of a felony, and, upon

conviction thereof, shall be punished by a fine not exceeding

$10,000 for each occurrence of a violation, or by imprisonment not

exceeding 5 years, or both.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1107, as added Aug. 10,

1939, ch. 666, title VIII, Sec. 802, 53 Stat. 1398; amended Aug.

28, 1950, ch. 809, title IV, Sec. 403(e), (f), 64 Stat. 560; Pub.

L. 98-369, div. B, title VI, Sec. 2663(e)(2)(A), (3),

(j)(2)(D)(iii), (l)(1), July 18, 1984, 98 Stat. 1168, 1170, 1171;

Pub. L. 99-514, Sec. 2, Oct. 22, 1986, 100 Stat. 2095; Pub. L.

103-296, title I, Sec. 108(b)(6), title III, Sec. 313(b), Aug. 15,

1994, 108 Stat. 1482, 1530.)

-REFTEXT-

REFERENCES IN TEXT

Subchapter E of chapter 9 of the Internal Revenue Code of 1939,

referred to in subsec. (a), was comprised of sections 1631 to 1636

of the 1939 Code, and was repealed (subject to certain exceptions)

by section 7851(a)(1)(A), (3) of Title 26, Internal Revenue Code of

1954 (act Aug. 16, 1954, ch. 736, 68A Stat. 3). The I.R.C. 1954 was

redesignated I.R.C. 1986 by Pub. L. 99-514, Sec. 2, Oct. 22, 1986,

100 Stat. 2095.

For provision deeming a reference in other laws to a provision of

the 1939 Code as a reference to the corresponding provisions of the

1986 Code, see section 7852(b) of the 1986 Code. For table of

comparisons of the 1939 Code to the 1986 Code, see table preceding

section 1 of Title 26, Internal Revenue Code. The Internal Revenue

Code of 1986 is classified generally to Title 26.

-MISC1-

AMENDMENTS

1994 - Subsec. (b). Pub. L. 103-296, Sec. 313(b), inserted

"social security account number," after "information as to the" and

substituted "felony" for "misdemeanor", "$10,000 for each

occurrence of a violation" for "$1,000", and "5 years" for "one

year".

Pub. L. 103-296, Sec. 108(b)(6), which directed that subsec. (b)

be amended by substituting "the Commissioner of Social Security or

the Secretary" for "the Secretary of Health and Human Services",

was executed by making the substitution for "the Secretary" to

reflect the probable intent of Congress.

1986 - Subsec. (a). Pub. L. 99-514 substituted "Internal Revenue

Code of 1986" for "Internal Revenue Code of 1954".

1984 - Subsec. (a). Pub. L. 98-369, Sec. 2663(e)(2)(A),

substituted "of chapter 2, 21, or 23 of the Internal Revenue Code

of 1954, or of any provision of subtitle F of such Code which

corresponds (within the meaning of section 7852(b) of such Code) to

a provision contained in subchapter E of chapter 9 of the Internal

Revenue Code of 1939," for "subchapter E of chapter 1 or subchapter

A, C, or E of chapter 9 of the Internal Revenue Code [of 1939]".

Subsec. (b). Pub. L. 98-369, Sec. 2663(l)(1), substituted

"Secretary" for "Administrator".

Pub. L. 98-369, Sec. 2663(j)(2)(D)(iii), which directed the

substitution of "Health and Human Services" for "Health, Education,

and Welfare" could not be executed because "Health, Education, and

Welfare" did not appear in text.

Pub. L. 98-369, Sec. 2663(e)(3), substituted "divorced wife,

divorced husband, surviving divorced wife, surviving divorced

husband, surviving divorced mother, surviving divorced father," for

"former wife divorced," in two places.

1950 - Subsec. (a). Act Aug. 28, 1950, Sec. 403(e), substituted

"subchapter E of chapter 1 or subchapter A, C, or E of chapter 9 of

the Internal Revenue Code of 1939," for "the Federal Insurance

Contributions Act, or the Federal Unemployment Tax Act,".

Subsec. (b). Act Aug. 28, 1950, Sec. 403(f), substituted

"Administrator" for "Board" and "wife, husband, widow, widower,

former wife divorced, child, or parent" for "wife, parent, or

child" wherever appearing.

EFFECTIVE DATE OF 1994 AMENDMENT

Amendment by section 108(b)(6) 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.

Amendment by section 313(b) of Pub. L. 103-296 applicable to

violations occurring on or after Aug. 15, 1994, see section 313(c)

of Pub. L. 103-296, set out as a note under section 1306 of this

title.

EFFECTIVE DATE OF 1984 AMENDMENT

Section Sec. 2663(e)(2)(B) of Pub. L. 98-369 provided that: "The

amendment made by subparagraph (A) [amending this section] shall

not apply to returns filed or representations made on or before the

date of the enactment of this Act [July 18, 1984]."

Amendment by section 2663(e)(3), (j)(2)(D)(iii), (l)(1) 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.

-End-

-CITE-

42 USC Sec. 1308 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. 1308. Additional grants to Puerto Rico, Virgin Islands, Guam,

and American Samoa; limitation on total payments

-STATUTE-

(a) Limitation on total payments to each territory

(1) In general

Notwithstanding any other provision of this chapter (except for

paragraph (2) of this subsection), the total amount certified by

the Secretary of Health and Human Services under subchapters I,

X, XIV, and XVI of this chapter, under parts A and E of

subchapter IV of this chapter, and under subsection (b) of this

section, for payment to any territory for a fiscal year shall not

exceed the ceiling amount for the territory for the fiscal year.

(2) Certain payments disregarded

Paragraph (1) of this subsection shall be applied without

regard to any payment made under section 603(a)(2), 603(a)(4),

603(a)(5), 606, or 613(f) of this title.

(b) Entitlement to matching grant

(1) In general

Each territory shall be entitled to receive from the Secretary

for each fiscal year a grant in an amount equal to 75 percent of

the amount (if any) by which -

(A) the total expenditures of the territory during the fiscal

year under the territory programs funded under parts A and E of

subchapter IV of this chapter, including any amount paid to the

State under part A of subchapter IV of this chapter that is

transferred in accordance with section 604(d) of this title and

expended under the program to which transferred; exceeds

(B) the sum of -

(i) the amount of the family assistance grant payable to

the territory without regard to section 609 of this title;

and

(ii) the total amount expended by the territory during

fiscal year 1995 pursuant to parts A and F of subchapter IV

of this chapter (as so in effect), other than for child care.

(2) Appropriation

Out of any money in the Treasury of the United States not

otherwise appropriated, there are appropriated for fiscal years

1997 through 2002, such sums as are necessary for grants under

this paragraph.

(c) Definitions

As used in this section:

(1) Territory

The term "territory" means Puerto Rico, the Virgin Islands,

Guam, and American Samoa.

(2) Ceiling amount

The term "ceiling amount" means, with respect to a territory

and a fiscal year, the mandatory ceiling amount with respect to

the territory, reduced for the fiscal year in accordance with

subsection (e) (!1) of this section, and reduced by the amount of

any penalty imposed on the territory under any provision of law

specified in subsection (a) of this section during the fiscal

year.

(3) Family assistance grant

The term "family assistance grant" has the meaning given such

term by section 603(a)(1)(B) of this title.

(4) Mandatory ceiling amount

The term "mandatory ceiling amount" means -

(A) $107,255,000 with respect to Puerto Rico;

(B) $4,686,000 with respect to Guam;

(C) $3,554,000 with respect to the Virgin Islands; and

(D) $1,000,000 with respect to American Samoa.

(5) Total amount expended by the territory

The term "total amount expended by the territory" -

(A) does not include expenditures during the fiscal year from

amounts made available by the Federal Government; and

(B) when used with respect to fiscal year 1995, also does not

include -

(i) expenditures during fiscal year 1995 under subsection

(g) or (i) of section 602 of this title (as in effect on

September 30, 1995); or

(ii) any expenditures during fiscal year 1995 for which the

territory (but for this section, as in effect on September

30, 1995) would have received reimbursement from the Federal

Government.

(d) Authority to transfer funds to certain programs

A territory to which an amount is paid under subsection (b) of

this section may use the amount in accordance with section 604(d)

of this title.

(e) Repealed. Pub. L. 105-33, title V, Sec. 5512(c), Aug. 5, 1997,

111 Stat. 619

(f) Total amount certified under subchapter XIX

Subject to subsection (g) of this section, the total amount

certified by the Secretary under subchapter XIX of this chapter

with respect to a fiscal year for payment to -

(1) Puerto Rico shall not exceed (A) $116,500,000 for fiscal

year 1994 and (B) for each succeeding fiscal year the amount

provided in this paragraph for the preceding fiscal year

increased by the percentage increase in the medical care

component of the consumer price index for all urban consumers (as

published by the Bureau of Labor Statistics) for the twelve-month

period ending in March preceding the beginning of the fiscal

year, rounded to the nearest $100,000;

(2) the Virgin Islands shall not exceed (A) $3,837,500 for

fiscal year 1994, and (B) for each succeeding fiscal year the

amount provided in this paragraph for the preceding fiscal year

increased by the percentage increase referred to in paragraph

(1)(B), rounded to the nearest $10,000;

(3) Guam shall not exceed (A) $3,685,000 for fiscal year 1994,

and (B) for each succeeding fiscal year the amount provided in

this paragraph for the preceding fiscal year increased by the

percentage increase referred to in paragraph (1)(B), rounded to

the nearest $10,000;

(4) Northern Mariana Islands shall not exceed (A) $1,110,000

for fiscal year 1994, and (B) for each succeeding fiscal year the

amount provided in this paragraph for the preceding fiscal year

increased by the percentage increase referred to in paragraph

(1)(B), rounded to the nearest $10,000; and

(5) American Samoa shall not exceed (A) $2,140,000 for fiscal

year 1994, and (B) for each succeeding fiscal year the amount

provided in this paragraph for the preceding fiscal year

increased by the percentage increase referred to in paragraph

(1)(B), rounded to the nearest $10,000.

(g) Medicaid payments to territories for fiscal year 1998 and

thereafter

(1) Fiscal year 1998

With respect to fiscal year 1998, the amounts otherwise

determined for Puerto Rico, the Virgin Islands, Guam, the

Northern Mariana Islands, and American Samoa under subsection (f)

of this section for such fiscal year shall be increased by the

following amounts:

(A) For Puerto Rico, $30,000,000.

(B) For the Virgin Islands, $750,000.

(C) For Guam, $750,000.

(D) For the Northern Mariana Islands, $500,000.

(E) For American Samoa, $500,000.

(2) Fiscal year 1999 and thereafter

Notwithstanding subsection (f) of this section, with respect to

fiscal year 1999 and any fiscal year thereafter, the total amount

certified by the Secretary under subchapter XIX of this chapter

for payment to -

(A) Puerto Rico shall not exceed the sum of the amount

provided in this subsection for the preceding fiscal year

increased by the percentage increase in the medical care

component of the Consumer Price Index for all urban consumers

(as published by the Bureau of Labor Statistics) for the

12-month period ending in March preceding the beginning of the

fiscal year, rounded to the nearest $100,000;

(B) the Virgin Islands shall not exceed the sum of the amount

provided in this subsection for the preceding fiscal year

increased by the percentage increase referred to in

subparagraph (A), rounded to the nearest $10,000;

(C) Guam shall not exceed the sum of the amount provided in

this subsection for the preceding fiscal year increased by the

percentage increase referred to in subparagraph (A), rounded to

the nearest $10,000;

(D) the Northern Mariana Islands shall not exceed the sum of

the amount provided in this subsection for the preceding fiscal

year increased by the percentage increase referred to in

subparagraph (A), rounded to the nearest $10,000; and

(E) American Samoa shall not exceed the sum of the amount

provided in this subsection for the preceding fiscal year

increased by the percentage increase referred to in

subparagraph (A), rounded to the nearest $10,000.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1108, as added Aug. 28,

1950, ch. 809, title III, pt. 6, Sec. 361(g), 64 Stat. 558; amended

Aug. 1, 1956, ch. 836, title III, Sec. 351(c), 70 Stat. 855; Pub.

L. 85-840, title V, Secs. 507, 508, Aug. 28, 1958, 72 Stat. 1051;

Pub. L. 86-778, title VI, Sec. 602, Sept. 13, 1960, 74 Stat. 992;

Pub. L. 87-31, Sec. 6(a)(1), (2), (b), May 8, 1961, 75 Stat. 78;

Pub. L. 87-64, title III, Sec. 303(d), June 30, 1961, 75 Stat. 143;

Pub. L. 87-543, title I, Sec. 151, July 25, 1962, 76 Stat. 206;

Pub. L. 89-97, title II, Sec. 208(a)(2), title IV, Sec. 408(a),

July 30, 1965, 79 Stat. 355, 422; Pub. L. 90-248, title II, Sec.

248(a)(1), Jan. 2, 1968, 81 Stat. 918; Pub. L. 92-603, title II,

Secs. 271(a), (b), 272(b), Oct. 30, 1972, 86 Stat. 1451; Pub. L.

93-647, Sec. 3(i), Jan. 4, 1975, 88 Stat. 2350; Pub. L. 95-600,

title VIII, Sec. 802(b), Nov. 6, 1978, 92 Stat. 2945; Pub. L.

96-272, title II, Sec. 207(c), title III, Secs. 305(a), (b), June

17, 1980, 94 Stat. 526, 529, 530; Pub. L. 97-35, title XXI, Secs.

2162(b)(1), 2193(c)(1), title XXIII, Sec. 2353(f), Aug. 13, 1981,

95 Stat. 806, 827, 872; Pub. L. 97-248, title I, Secs. 136(b),

160(a), Sept. 3, 1982, 96 Stat. 375, 400; Pub. L. 98-369, div. B,

title III, Sec. 2365(a), July 18, 1984, 98 Stat. 1108; Pub. L.

100-203, title IV, Sec. 4111(a), Dec. 22, 1987, 101 Stat. 1330-148;

Pub. L. 100-485, title II, Sec. 202(c)(2), (3), title VI, Secs.

601(b), (c)(2), 602(a), Oct. 13, 1988, 102 Stat. 2378, 2407, 2408;

Pub. L. 103-66, title XIII, Sec. 13641(a), Aug. 10, 1993, 107 Stat.

646; Pub. L. 104-193, title I, Sec. 103(b), Aug. 22, 1996, 110

Stat. 2160; Pub. L. 105-33, title IV, Sec. 4726, title V, Secs.

5001(b), 5512, Aug. 5, 1997, 111 Stat. 519, 589, 619.)

-REFTEXT-

REFERENCES IN TEXT

Parts A and E of subchapter IV of this chapter, referred to in

subsecs. (a) and (b)(1), are classified to sections 601 et seq. and

670 et seq., respectively, of this title.

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

(b)(1)(B)(ii), was classified to section 681 et seq. of this title,

prior to repeal by Pub. L. 104-193, title I, Sec. 108(e), Aug. 22,

1996, 110 Stat. 2167.

Subsection (e) of this section, referred to in subsec. (c)(2),

was repealed by Pub. L. 105-33, title V, Sec. 5512(c), Aug. 5,

1997, 111 Stat. 619.

-MISC1-

AMENDMENTS

1997 - Subsec. (a). Pub. L. 105-33, Sec. 5512(a), amended heading

and text of subsec. (a) generally. Prior to amendment, text read as

follows: "Notwithstanding any other provision of this chapter, the

total amount certified by the Secretary of Health and Human

Services under subchapters I, X, XIV, and XVI of this chapter,

under parts A and E of subchapter IV of this chapter, and under

subsection (b) of this section, for payment to any territory for a

fiscal year shall not exceed the ceiling amount for the territory

for the fiscal year."

Subsec. (a)(2). Pub. L. 105-33, Sec. 5001(b), inserted

"603(a)(5)," after "603(a)(4),".

Subsec. (b)(1)(A). Pub. L. 105-33, Sec. 5512(b), inserted ",

including any amount paid to the State under part A of subchapter

IV of this chapter that is transferred in accordance with section

604(d) of this title and expended under the program to which

transferred" before semicolon.

Subsec. (e). Pub. L. 105-33, Sec. 5512(c), struck out heading and

text of subsec. (e). Text read as follows: "The ceiling amount with

respect to a territory shall be reduced for a fiscal year by an

amount equal to the amount (if any) by which -

"(1) the total amount expended by the territory under all

programs of the territory operated pursuant to the provisions of

law specified in subsection (a) of this section (as such

provisions were in effect for fiscal year 1995) for fiscal year

1995; exceeds

"(2) the total amount expended by the territory under all

programs of the territory that are funded under the provisions of

law specified in subsection (a) of this section for the fiscal

year that immediately precedes the fiscal year referred to in the

matter preceding paragraph (1)."

Subsec. (f). Pub. L. 105-33, Sec. 4726(1), substituted "Subject

to subsection (g) of this section, the" for "The" in introductory

provisions.

Subsec. (g). Pub. L. 105-33, Sec. 4726(2), added subsec. (g).

1996 - Pub. L. 104-193, Sec. 103(b)(3), added section catchline

and struck out former catchline.

Subsecs. (a), (b). Pub. L. 104-193, Sec. 103(b)(3), added

subsecs. (a) and (b) and struck out former subsec. (a) which

limited total amount certified under subchapters I, X, XIV, XVI of

this chapter and parts A and E of subchapter IV of this chapter for

payment to Puerto Rico, the Virgin Islands, and Guam and former

subsec. (b) which limited total amount certified for family

planning services for Puerto Rico, the Virgin Islands, and Guam.

Subsec. (c). Pub. L. 104-193, Sec. 103(b)(3), added subsec. (c).

Former subsec. (c) redesignated (f).

Subsecs. (d), (e). Pub. L. 104-193, Sec. 103(b)(1), (3), added

subsecs. (d) and (e) and struck out former subsec. (d) which

limited payments to American Samoa and former subsec. (e) which

related to allotment of smaller amounts.

Subsec. (f). Pub. L. 104-193, Sec. 103(b)(2), redesignated

subsec. (c) as (f).

1993 - Subsec. (c)(1) to (5). Pub. L. 103-66 amended pars. (1) to

(5) generally. Prior to amendment, pars. (1) to (5) read as

follows:

"(1) Puerto Rico shall not exceed (A) $73,400,000 for fiscal year

1988, (B) $76,200,000 for fiscal year 1989, and (C) $79,000,000 for

fiscal year 1990 (and each succeeding fiscal year);

"(2) the Virgin Islands shall not exceed (A) $2,430,000 for

fiscal year 1988, (B) $2,515,000 for fiscal year 1989, and (C)

$2,600,000 for fiscal year 1990 (and each succeeding fiscal year);

"(3) Guam shall not exceed (A) $2,320,000 for fiscal year 1988,

(B) $2,410,000 for fiscal year 1989, and (C) $2,500,000 for fiscal

year 1990 (and each succeeding fiscal year);

"(4) the Northern Mariana Islands shall not exceed (A) $636,700

for fiscal year 1988, (B) $693,350 for fiscal year 1989, and (C)

$750,000 for fiscal year 1990 (and each succeeding fiscal year);

and

"(5) American Samoa shall not exceed (A) $1,330,000 for fiscal

year 1988, (B) $1,390,000 for fiscal year 1989, and (C) $1,450,000

for fiscal year 1990 (and each succeeding fiscal year)."

1988 - Pub. L. 100-485, Sec. 601(c)(2), amended section catchline

generally.

Subsec. (a). Pub. L. 100-485, Sec. 202(c)(2), inserted "or, in

the case of part A of subchapter IV of this chapter, section 603(k)

of this title" before "applies" in introductory provisions.

Subsec. (a)(1)(F), (G). Pub. L. 100-485, Sec. 602(a)(1), added

subpars. (F) and (G) and struck out former subpar. (F) which read

as follows: "$72,000,000 with respect to the fiscal year 1979 and

each fiscal year thereafter;".

Subsec. (a)(2)(F), (G). Pub. L. 100-485, Sec. 602(a)(2), added

subpars. (F) and (G) and struck out former subpar. (F) which read

as follows: "$2,400,000 with respect to the fiscal year 1979 and

each fiscal year thereafter;".

Subsec. (a)(3)(F), (G). Pub. L. 100-485, Sec. 602(a)(3), added

subpars. (F) and (G) and struck out former subpar. (F) which read

as follows: "$3,300,000 with respect to the fiscal year 1979 and

each fiscal year thereafter."

Subsec. (b). Pub. L. 100-485, Sec. 202(c)(3), struck out "and

services provided under section 602(a)(19) of this title" after

"family planning services" in introductory provisions.

Subsecs. (d), (e). Pub. L. 100-485, Sec. 601(b), added subsec.

(d) and redesignated former subsec. (d) as (e).

1987 - Subsec. (c). Pub. L. 100-203 amended subsec. (c)

generally. Prior to amendment, subsec. (c) read as follows: "The

total amount certified by the Secretary under subchapter XIX of

this chapter with respect to a fiscal year for payment to -

"(1) Puerto Rico shall not exceed $63,400,000;

"(2) the Virgin Islands shall not exceed $2,100,000;

"(3) Guam shall not exceed $2,000,000;

"(4) the Northern Mariana Islands shall not exceed $550,000;

and

"(5) American Samoa shall not exceed $1,150,000."

1984 - Subsec. (c). Pub. L. 98-369 substituted "$63,400,000" for

"$45,000,000" in par. (1), "$2,100,000" for "$1,500,000" in par.

(2), "$2,000,000" for "$1,400,000" in par. (3), "$550,000" for

"$350,000" in par. (4), and "$1,150,000" for "$750,000" in par.

(5).

1982 - Subsec. (a). Pub. L. 97-248, Sec. 160(a), inserted

provisions following par. (3)(F) that each jurisdiction specified

in this subsection may use in its program under subchapter XX of

this chapter any sums available to it under this subsection which

are not needed to carry out the programs specified in this

subsection.

Subsec. (c)(5). Pub. L. 97-248, Sec. 136(b), added par. (5).

1981 - Subsec. (a). Pub. L. 97-35, Sec. 2353(f), substituted in

provision preceding par. (1) "The total amount certified by the

Secretary of Health and Human Services" for "Except as provided in

section 1397a(a)(2)(C) of this title, the total amount certified by

the Secretary of Health, Education, and Welfare".

Subsec. (c). Pub. L. 97-35, Sec. 2162(b)(1), in par. (1)

increased the amount from not to exceed $2,000,000 to not to exceed

$45,000,000, in par. (2) increased the amount from not to exceed

$65,000 to not to exceed $1,500,000, in par. (3) increased the

amount from not to exceed $90,000 to not to exceed $1,400,000, and

added par. (4).

Subsec. (d). Pub. L. 97-35, Sec. 2193(c)(1), substituted "section

621 of this title" for "sections 702(a) and 712(a) of this title,

and the provisions of sections 621, 703(1), and 704(1) of this

title as amended by the Social Security Amendments of 1967".

1980 - Subsec. (a). Pub. L. 96-272 substituted "section

1397a(a)(2)(C) of this title" for "section 1397a(a)(2)(D) of this

title" and "under parts A and E" for "under part A" in provisions

preceding par. (1), substituted "with respect to each of the fiscal

years 1972 through 1978" for "with respect to the fiscal year 1972

and each fiscal year thereafter other than the fiscal year 1979" in

pars. (1)(E), (2)(E), and (3)(E), and substituted "with respect to

the fiscal year 1979 and each fiscal year thereafter" for "with

respect to the fiscal year 1979" in pars. (1)(F), (2)(F), and

(3)(F).

1978 - Subsec. (a)(1)(E). Pub. L. 95-600, Sec. 802(b)(1)(B),

inserted "other than the fiscal year 1979, or".

Subsec. (a)(1)(F). Pub. L. 95-600, Sec. 802(b)(1)(C), added

subpar. (F).

Subsec. (a)(2)(E). Pub. L. 95-600, Sec. 802(b)(2)(B), substituted

"other than the fiscal year 1979, or" for "; and".

Subsec. (a)(2)(F). Pub. L. 95-600, Sec. 802(b)(2)(C), added

subpar. (F).

Subsec. (a)(3)(E). Pub. L. 95-600, Sec. 802(b)(3)(B), inserted

"other than the fiscal year 1979, or".

Subsec. (a)(3)(F). Pub. L. 95-600, Sec. 802(b)(3)(C), added

subpar. (F).

1975 - Subsec. (a). Pub. L. 93-647 substituted "Except as

provided in section 1397a(a)(2)(D) of this title, the total amount"

for "The total amount".

1972 - Subsec. (c)(1). Pub. L. 92-603, Sec. 271(a), substituted

"$30,000,000" for "$20,000,000".

Subsec. (c)(2). Pub. L. 92-603, Sec. 271(b), substituted

"$1,000,000" for "$650,000".

Subsec. (d). Pub. L. 92-603, Sec. 272(b), inserted ", American

Samoa, and the Trust Territory of the Pacific Islands" after "allot

such smaller amounts to Guam".

1968 - Pub. L. 90-248 amended section generally and, among other

changes, raised the present $9.8 million limit for Federal

financial participation in the public assistance programs of Puerto

Rico to $12.5 million for fiscal 1968 with further increases in

succeeding fiscal years to a maximum of $24 million for fiscal 1972

and each fiscal year thereafter, increased the dollar maximums for

the Virgin Islands from $330,000 to $800,000 for fiscal 1972 and

thereafter and for Guam from $450,000 to $1.1 million for fiscal

1972 and thereafter, authorized payments for family planning

services and services referred to in section 602(a)(19) of this

title, with respect to any fiscal year, of not more than $2 million

for Puerto Rico, $65,000 for the Virgin Islands, and $90,000 for

Guam, imposed a maximum on Federal payments for the medical

assistance program under subchapter XIX of this chapter, with

respect to any fiscal year, of $20 million for Puerto Rico,

$650,000 for the Virgin Islands, and $900,000 for Guam, and

provided that notwithstanding sections 702(a) and 712(a) of this

title and sections 621, 703(1), and 704(1) of this title, as

amended by the Social Security Amendments of 1967, and until

Congress otherwise provides, the Secretary shall, in lieu of the

initial allotments specified in such sections, allot smaller

amounts to Guam as he deems appropriate.

1965 - Pub. L. 89-97 substituted "and 722(a)" for "722(a) and

727(a)" and struck out "(or, in the case of section 727(a) of this

title" after "in lieu of the initial", and removed the litigation

requiring that, with respect to any fiscal year, $625,000 of the

$9,800,000 certified for payments to Puerto Rico, $18,750 of the

$330,000 certified for payments to the Virgin Islands, and $25,000

of the $450,000 certified for payments to Guam, be used only for

payments with respect to section 303(a)(2)(B) or 1383(a)(2)(B) of

this title.

1962 - Pub. L. 87-543 substituted "$9,800,000", "$330,000",

"$450,000", and "initial (or, in the case of section 727(a) of this

title, the minimum) allotment" for "$9,500,000", "$320,000",

$430,000", and "$60,000, $60,000 $60,000, respectively," and

inserted references to subchapter "XVI (other than section

1383(a)(3) thereof)" of this chapter, section 1383(a)(2) in three

places and section 727(a) after section 722(a).

1961 - Pub. L. 87-64, substituted "$9,500,000", "$320,000", and

"$430,000" for "$9,425,000", "$318,750", and "$425,000",

respectively. See Repeals note below.

Pub. L. 87-31 increased the grant to Puerto Rico for fiscal year

ending June 30, 1961, from $9,000,000 to $9,075,000 and for fiscal

year ending June 30, 1962, to $9,425,000; the grants to Virgin

Islands and Guam from $315,000 and $420,000 to $318,750 and

$425,000, respectively; and payments under section 303(a)(2)(B) of

this title to Puerto Rico, Virgin Islands and Guam from $500,000,

$15,000 and $20,000 to $625,000, $18,750 and $25,000, respectively.

See also Limitation on Payments note below.

1960 - Pub. L. 86-778 substituted "$9,000,000, of which $500,000

may be used only for payments certified with respect to section

303(a)(2)(B) of this title" for "$8,500,000", "$315,000, of which

$15,000 may be used only for payments certified in respect to

section 303(a)(2)(B) of this title" for "$300,000", "$420,000, of

which $20,000 may be used only for payments certified in respect to

section 303(a)(2)(B) of this title" for "$400,000", and

"subchapters I (other than section 303(a)(3) thereof)" for

"subchapters I".

1958 - Pub. L. 85-840, Secs. 507, 508, amended section. Section

507(a) substituted "$8,500,000" for "$5,312,500" and "$300,000" for

"$200,000", and limited the total amount certified for payment to

Guam with respect to any fiscal year to not more than $400,000.

Section 507(b) amended catchline to include Guam. Section 508

inserted provisions requiring the Secretary, in lieu of the

allotments specified in sections 702(a)(2), 712(a)(2) and 722(a) of

this title, to allot such smaller amounts as he may deem

appropriate to Guam, notwithstanding provisions of such sections

and until such time as the Congress may by appropriation or other

law otherwise provide.

1956 - Act Aug. 1, 1956, substituted "$5,312,500" for

"$4,250,000", and "$200,000" for "$160,000".

EFFECTIVE DATE OF 1996 AMENDMENT

Amendment by Pub. L. 104-193 effective Oct. 1, 1996, see section

116(a)(3) of Pub. L. 104-193, set out as a note under section 601

of this title.

EFFECTIVE DATE OF 1993 AMENDMENT

Section 13641(b) of Pub. L. 103-66 provided that: "The amendment

made by subsection (a) [amending this section] shall apply

beginning with fiscal year 1994."

EFFECTIVE DATE OF 1988 AMENDMENT

Amendment by section 202(c)(2), (3) of Pub. L. 100-485 effective

Oct. 1, 1990, with provision for earlier effective dates in case of

States making certain changes in their State plans and formally

notifying the Secretary of Health and Human Services of their

desire to become subject to the amendments by title II of Pub. L.

100-485, at such earlier effective dates, see section 204 of Pub.

L. 100-485, set out as a note under section 671 of this title.

Amendment by section 601(b), (c)(2) of Pub. L. 100-485 effective

Oct. 1, 1988, see section 601(d) of Pub. L. 100-485, set out as an

Effective and Termination Dates of 1988 Amendment note under

section 1301 of this title.

Section 602(b) of Pub. L. 100-485 provided that: "The amendments

made by subsection (a) [amending this section] shall become

effective on October 1, 1988."

EFFECTIVE DATE OF 1987 AMENDMENT

Section 4111(b) of Pub. L. 100-203 provided that: "The amendment

made by subsection (a) [amending this section] shall apply to

payments for fiscal years beginning with fiscal year 1988."

EFFECTIVE DATE OF 1984 AMENDMENT

Section 2365(b) of Pub. L. 98-369 provided that: "The amendment

made by subsection (a) [amending this section] shall be effective

for fiscal years beginning on or after October 1, 1983."

EFFECTIVE DATE OF 1982 AMENDMENT

Amendment by section 136(b) of Pub. L. 97-248 effective Oct. 1,

1982, see section 136(e) of Pub. L. 97-248, set out as a note under

section 1301 of this title.

Amendment by section 160(a) of Pub. L. 97-248 effective Oct. 1,

1981, see section 160(e) of Pub. L. 97-248, set out as a note under

section 1301 of this title.

EFFECTIVE DATE OF 1981 AMENDMENT

Section 2162(b)(2) of Pub. L. 97-35 provided that: "The amendment

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

years beginning with fiscal year 1982."

For effective date, savings, and transitional provisions relating

to amendment by section 2193(c)(1) of Pub. L. 97-35, see section

2194 of Pub. L. 97-35, set out as a note under section 701 of this

title.

Amendment by section 2353(f) 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 Pub. L. 93-647 effective with respect to payments

under sections 603 and 803 of this title for quarters commencing

after Sept. 30, 1975, see section 7(b) of Pub. L. 93-647, set out

as a note under section 303 of this title.

EFFECTIVE DATE OF 1972 AMENDMENT

Section 271(c) of Pub. L. 92-603 provided that: "The amendments

made by subsections (a) and (b) [amending this section] shall apply

with respect to fiscal years beginning after June 30, 1971."

Amendment by section 272(b) of Pub. L. 92-603 applicable with

respect to fiscal years beginning after June 30, 1971, see section

272(c) of Pub. L. 92-603, set out as a note under section 1301 of

this title.

EFFECTIVE DATE OF 1968 AMENDMENT

Section 248(a)(2) of Pub. L. 90-248 provided that: "The amendment

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

respect to fiscal years beginning after June 30, 1967."

EFFECTIVE DATE OF 1965 AMENDMENT

Amendment by section 208(a)(2) Pub. L. 89-97 effective Jan. 1,

1966, see section 208(d) of Pub. L. 89-97.

Section 408(b) of Pub. L. 89-97 provided that: "The amendments

made by subsection (a) [amending this section] shall be effective

in the case of Puerto Rico, the Virgin Islands, or Guam with

respect to fiscal years beginning on or after the date on which its

plan under title XIX of the Social Security Act [section 1396 et

seq. of this title] is approved."

EFFECTIVE DATE OF 1962 AMENDMENT

Section 151 of Pub. L. 87-543 provided that the amendment made by

that section is effective for fiscal years ending after June 30,

1962.

EFFECTIVE AND TERMINATION DATES OF 1961 AMENDMENTS

Section 132(d) of Pub. L. 87-543 repealed section 303(d) of Pub.

L. 87-64, which had provided that the amendment by section 303(d)

of Pub. L. 87-64 shall be effective only for fiscal year ending

June 30, 1962, and section 6 of Pub. L. 87-31, which had provided

that the amendment by section 6(b) of Pub. L. 87-31 shall be

effective for fiscal years ending after June 30, 1961. Such repeal

applicable in the case of fiscal years beginning after June 30,

1962, see section 202(b) of Pub. L. 87-543, set out as an Effective

Date of 1962 Amendment note under section 906 of this title.

EFFECTIVE DATE OF 1960 AMENDMENT

Amendment by Pub. L. 86-778 effective with respect to fiscal

years ending after 1960, see section 604 of Pub. L. 86-778, set out

as a note under section 301 of this title.

EFFECTIVE DATE OF 1958 AMENDMENT

For effective date of amendments made by sections 507 and 508 of

Pub. L. 85-840, see section 512 of Pub. L. 85-840, set out as a

note under section 303 of this title.

EFFECTIVE DATE OF 1956 AMENDMENT

Section 351(d) of act Aug. 1, 1956, provided that: "The

amendments made by this section [amending this section and sections

603 and 606 of this title] shall be effective with respect to the

fiscal year ending June 30, 1957, and all succeeding fiscal years."

REPEALS: EFFECTIVE DATE

Section 132(d) of Pub. L. 87-543 repealed section 6 of Pub. L.

87-31, May 8, 1961, 75 Stat. 78, and section 303(d) of Pub. L.

87-64, title III, June 30, 1961, 75 Stat. 143, formerly cited as a

credit to this section. Such repeal applicable in the case of

fiscal years beginning after June 30, 1962, see section 202(b) of

Pub. L. 87-543, set out as an Effective Date of 1962 Amendment note

under section 906 of this title.

LIMITATION ON PAYMENTS: EFFECTIVE DATE

Section 132(d) of Pub. L. 87-543 repealed section 6(a) of Pub. L.

87-31, May 8, 1961, 75 Stat. 78, which had limited payments to

Puerto Rico not to exceed $9,075,000 for fiscal year ending June

30, 1961, $9,425,000 for fiscal year ending June 30, 1962; and

$9,125,000 for fiscal years ending after June 30, 1962. Such repeal

applicable in the case of fiscal years beginning after June 30,

1962, see section 202(b) of Pub. L. 87-543, set out as an Effective

Date of 1962 Amendment note under section 906 of this title.

-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.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 603, 1396a, 1396d of this

title.

-FOOTNOTE-

(!1) See References in Text note below.

-End-

-CITE-

42 USC Sec. 1309 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. 1309. Amounts disregarded not to be taken into account in

determining eligibility of other individuals

-STATUTE-

Any amount which is disregarded (or set aside for future needs)

in determining the eligibility of and amount of the aid or

assistance for any individual under a State plan approved under

subchapter I, X, XIV, XVI, or XIX of this chapter,(!1) shall not be

taken into consideration in determining the eligibility of and

amount of aid or assistance for any other individual under a State

plan approved under any other of such subchapters.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1109, as added July 18,

1952, ch. 945, Sec. 7, 66 Stat. 778; amended Pub. L. 87-543, title

I, Sec. 141(c), July 25, 1962, 76 Stat. 205; Pub. L. 89-97, title

I, Sec. 121(c)(2), July 30, 1965, 79 Stat. 352; Pub. L. 90-248,

title II, Sec. 241(c)(2), Jan. 2, 1968, 81 Stat. 917; Pub. L.

104-193, title I, Sec. 108(g)(1), Aug. 22, 1996, 110 Stat. 2168.)

-MISC1-

AMENDMENTS

1996 - Pub. L. 104-193 struck out "or part A of subchapter IV of

this chapter," after "subchapter I, X, XIV, XVI, or XIX of this

chapter,".

1968 - Pub. L. 90-248 struck out "IV," after "I," and inserted ",

or part A of subchapter IV of this chapter," after "XIX of this

chapter".

1965 - Pub. L. 89-97 substituted requirement that amounts

disregarded be not taken into account in determining eligibility of

other individuals, for former provisions which had provided that:

"Notwithstanding the provisions of sections 302(a)(10)(A),

602(a)(7), 1202(a)(8), 1352(a)(8), and 1382(a)(14) of this title, a

State plan approved under subchapter I, IV, X, XIV, or XVI of this

chapter may until June 30, 1954, and thereafter shall provide that

where earned income has been disregarded in determining the need of

an individual receiving aid to the blind under a State plan

approved under subchapter X of this chapter, the earned income so

disregarded (but not in excess of the amount specified in section

1202(a)(8) of this title) shall not be taken into consideration in

determining the need of any other individual for assistance under a

State plan approved under subchapter I, IV, X, XIV, or XVI of this

chapter".

1962 - Pub. L. 87-543 substituted reference to section

302(a)(10)(A) for 302(a)(7) and inserted references to section

1382(a)(14) and subchapter XVI.

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.

-FOOTNOTE-

(!1) So in original. The comma probably should not appear.

-End-

-CITE-

42 USC Sec. 1310 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. 1310. Cooperative research or demonstration projects

-STATUTE-

(a)(1) There are hereby authorized to be appropriated for the

fiscal year ending June 30, 1957, $5,000,000 and for each fiscal

year thereafter such sums as the Congress may determine for (A)

making grants to States and public and other organizations and

agencies for paying part of the cost of research or demonstration

projects such as those relating to the prevention and reduction of

dependency, or which will aid in effecting coordination of planning

between private and public welfare agencies or which will help

improve the administration and effectiveness of programs carried on

or assisted under this chapter and programs related thereto, and

(B) making contracts or jointly financed cooperative arrangements

with States and public and other organizations and agencies for the

conduct of research or demonstration projects relating to such

matters.

(2) No contract or jointly financed cooperative arrangement shall

be entered into, and no grant shall be made, under paragraph (1),

until the Secretary (or the Commissioner, with respect to any

jointly financed cooperative agreement or grant concerning

subchapters II or XVI of this chapter) obtains the advice and

recommendations of specialists who are competent to evaluate the

proposed projects as to soundness of their design, the

possibilities of securing productive results, the adequacy of

resources to conduct the proposed research or demonstrations, and

their relationship to other similar research or demonstrations

already completed or in process.

(3) Grants and payments under contracts or cooperative

arrangements under paragraph (1) may be made either in advance or

by way of reimbursement, as may be determined by the Secretary (or

the Commissioner, with respect to any jointly financed cooperative

agreement or grant concerning subchapter II or XVI of this

chapter); and shall be made in such installments and on such

conditions as the Secretary (or the Commissioner, as applicable)

finds necessary to carry out the purposes of this subsection.

(b)(1) The Commissioner is authorized to waive any of the

requirements, conditions, or limitations of subchapter XVI of this

chapter (or to waive them only for specified purposes, or to impose

additional requirements, conditions, or limitations) to such extent

and for such period as the Commissioner finds necessary to carry

out one or more experimental, pilot, or demonstration projects

which, in the Commissioner's judgment, are likely to assist in

promoting the objectives or facilitate the administration of such

subchapter. Any costs for benefits under or administration of any

such project (including planning for the project and the review and

evaluation of the project and its results), in excess of those that

would have been incurred without regard to the project, shall be

met by the Commissioner from amounts available to the Commissioner

for this purpose from appropriations made to carry out such

subchapter. The costs of any such project which is carried out in

coordination with one or more related projects under other

subchapters of this chapter shall be allocated among the

appropriations available for such projects and any Trust Funds

involved, in a manner determined by the Commissioner with respect

to the old-age, survivors, and disability insurance programs under

subchapter II of this chapter and the supplemental security income

program under subchapter XVI of this chapter, and by the Secretary

with respect to other subchapters of this chapter, taking into

consideration the programs (or types of benefit) to which the

project (or part of a project) is most closely related or which the

project (or part of a project) is intended to benefit. If, in order

to carry out a project under this subsection, the Commissioner

requests a State to make supplementary payments (or the

Commissioner makes them pursuant to an agreement under section

1382e of this title) to individuals who are not eligible therefor,

or in amounts or under circumstances in which the State does not

make such payments, the Commissioner shall reimburse such State for

the non-Federal share of such payments from amounts appropriated to

carry out subchapter XVI of this chapter. If, in order to carry out

a project under this subsection, the Secretary requests a State to

provide medical assistance under its plan approved under subchapter

XIX of this chapter to individuals who are not eligible therefor,

or in amounts or under circumstances in which the State does not

provide such medical assistance, the Secretary shall reimburse such

State for the non-Federal share of such assistance from amounts

appropriated to carry out subchapter XVI of this chapter, which

shall be provided by the Commissioner to the Secretary for this

purpose.

(2) With respect to the participation of recipients of

supplemental security income benefits in experimental, pilot, or

demonstration projects under this subsection -

(A) the Commissioner is not authorized to carry out any project

that would result in a substantial reduction in any individual's

total income and resources as a result of his or her

participation in the project;

(B) the Commissioner may not require any individual to

participate in a project; and the Commissioner shall assure (i)

that the voluntary participation of individuals in any project is

obtained through informed written consent which satisfies the

requirements for informed consent established by the Commissioner

for use in any experimental, pilot, or demonstration project in

which human subjects are at risk, and (ii) that any individual's

voluntary agreement to participate in any project may be revoked

by such individual at any time;

(C) the Commissioner shall, to the extent feasible and

appropriate, include recipients who are under age 18 as well as

adult recipients; and

(D) the Commissioner shall include in the projects carried out

under this section such experimental, pilot, or demonstration

projects as may be necessary to ascertain the feasibility of

treating alcoholics and drug addicts to prevent the onset of

irreversible medical conditions which may result in permanent

disability, including programs in residential care treatment

centers.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1110, as added Aug. 1,

1956, ch. 836, title III, Sec. 331, 70 Stat. 850; amended Pub. L.

90-248, title II, Sec. 246, Jan. 2, 1968, 81 Stat. 918; Pub. L.

96-265, title V, Sec. 505(b), June 9, 1980, 94 Stat. 474; Pub. L.

98-369, div. B, title III, Sec. 2331(a), July 18, 1984, 98 Stat.

1088; Pub. L. 99-272, title XII, Sec. 12101(d), Apr. 7, 1986, 100

Stat. 283; Pub. L. 103-296, title I, Sec. 108(b)(7), Aug. 15, 1994,

108 Stat. 1482; Pub. L. 105-33, title V, Sec. 5524, Aug. 5, 1997,

111 Stat. 623; Pub. L. 106-170, title IV, Sec. 404(a), Dec. 17,

1999, 113 Stat. 1910.)

-MISC1-

AMENDMENTS

1999 - Subsec. (a)(3). Pub. L. 106-170 substituted "subchapter II

or XVI" for "subchapter XVI".

1997 - Subsec. (a)(3). Pub. L. 105-33 inserted "(or the

Commissioner, with respect to any jointly financed cooperative

agreement or grant concerning subchapter XVI of this chapter)"

after "Secretary" the first place appearing and "(or the

Commissioner, as applicable)" after "Secretary" the second place

appearing.

1994 - Subsec. (a)(2). Pub. L. 103-296, Sec. 108(b)(7)(B),

inserted "(or the Commissioner, with respect to any jointly

financed cooperative agreement or grant concerning subchapters II

or XVI of this chapter)" after "Secretary".

Subsec. (b)(1). Pub. L. 103-296, Sec. 108(b)(7)(A), (C), in first

sentence substituted "The Commissioner" for "The Secretary", "as

the Commissioner" for "as he", and "in the Commissioner's judgment"

for "in his judgment", in second sentence substituted "by the

Commissioner" for "by the Secretary" and "available to the

Commissioner" for "available to him", in third sentence substituted

"determined by the Commissioner with respect to the old-age,

survivors, and disability insurance programs under subchapter II of

this chapter and the supplemental security income program under

subchapter XVI of this chapter, and by the Secretary with respect

to other subchapters of this chapter," for "determined by the

Secretary,", and substituted fourth and fifth sentences for former

fourth sentence which read as follows: "If, in order to carry out a

project under this subsection, the Secretary requests a State to

make supplementary payments (or makes them himself pursuant to an

agreement under section 1382e of this title), or to provide medical

assistance under its plan approved under subchapter XIX of this

chapter, to individuals who are not eligible therefor, or in

amounts or under circumstances in which the State does not make

such payments or provide such medical assistance, the Secretary

shall reimburse such State for the non-Federal share of such

payments or assistance from amounts appropriated to carry out

subchapter XVI of this chapter."

Subsec. (b)(2). Pub. L. 103-296, Sec. 108(b)(7)(A), (D),

substituted "the Commissioner" for "the Secretary" wherever

appearing and "the Commissioner shall" for "he shall" in subpar.

(B).

Subsec. (b)(3). Pub. L. 103-296, Sec. 108(b)(7)(E), struck out

par. (3) which read as follows: "All reports of the Secretary with

respect to projects carried out under this subsection shall be

incorporated into the Secretary's annual report to the Congress

required by section 904 of this title."

1986 - Subsec. (b)(3). Pub. L. 99-272 added par. (3).

1984 - Subsec. (a)(1)(A). Pub. L. 98-369 struck out "nonprofit"

before first reference to "organizations and agencies".

1980 - Pub. L. 96-265 redesignated provisions of subsec. (a) and

cls. (1) and (2) thereof as subsec. (a)(1) and cls. (A) and (B)

thereof, respectively, redesignated provisions of subsecs. (b) and

(c) as subsec. (a)(2) and (3), respectively, added subsec. (b), and

made conforming amendments to subsec. (a)(2) and (3) as

redesignated.

1968 - Subsec. (a). Pub. L. 90-248 struck out "nonprofit" before

"organizations" in cl. (2).

EFFECTIVE DATE OF 1999 AMENDMENT

Pub. L. 106-170, title IV, Sec. 404(b), Dec. 17, 1999, 113 Stat.

1910, provided that: "The amendment made by subsection (a)

[amending this section] shall take effect as if included in the

enactment of the Social Security Independence and Program

Improvements Act of 1994 (Public Law 103-296; 108 Stat. 1464)."

EFFECTIVE DATE OF 1997 AMENDMENT

Amendment by Pub. L. 105-33 effective as if included in the

enactment of the Social Security Independence and Program

Improvements Act of 1994, Pub. L. 103-296, see section 5528(b) of

Pub. L. 105-33, set out as a note under section 903 of this title.

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 1986 AMENDMENT

Amendment by Pub. L. 99-272 effective on first day of month

following April 1986, see section 12115 of Pub. L. 99-272, set out

as a note under section 415 of this title.

EFFECTIVE DATE OF 1984 AMENDMENT

Section 2331(c) of Pub. L. 98-369 provided that: "The amendments

made by this section [amending this section and section 1395b-1 of

this title] shall become effective on the date of the enactment of

this Act [July 18, 1984]."

VOCATIONAL REHABILITATION DEMONSTRATION PROJECTS

Pub. L. 101-508, title V, Sec. 5120(a)-(e), Nov. 5, 1990, 104

Stat. 1388-280, directed Secretary of Health and Human Services to

develop and carry out under this section demonstration projects in

each of not fewer than three States, with such demonstration

projects to be designed to assess the advantages and disadvantages

of permitting disabled beneficiaries to select from among both

public and private qualified vocational rehabilitation providers,

providers of vocational rehabilitation services directed at

enabling such beneficiaries to engage in substantial gainful

activities, with each such demonstration project to commence as

soon as practicable after Nov. 5, 1990, and to remain in operation

until the end of fiscal year 1993, and with a final written report

to be submitted to Congress not later than Apr. 1, 1994.

FINAL REPORT COVERING ALL EXPERIMENTS AND DEMONSTRATION PROJECTS

Section 505(c) of Pub. L. 96-265, as amended by Pub. L. 99-272,

title XII, Sec. 12101(c), Apr. 7, 1986, 100 Stat. 283; Pub. L.

101-239, title X, Sec. 10103(a)(3), Dec. 19, 1989, 103 Stat. 2472;

Pub. L. 101-508, title V, Sec. 5120(f), Nov. 5, 1990, 104 Stat.

1388-282; Pub. L. 103-296, title I, Sec. 108(m)(3), title III, Sec.

315(a)(3), Aug. 15, 1994, 108 Stat. 1489, 1531, which directed

Commissioner to submit to Congress final report with respect to all

experiments and demonstration projects carried out under section

505 of Pub. L. 96-265, which amended this section and section 401

of this title and enacted provisions formerly set out below (other

than demonstration projects conducted under section 5120 of the

Omnibus Budget Reconciliation of 1990, Pub. L. 101-508, set out

above) no later than Oct. 1, 1996, was repealed by Pub. L. 106-170,

title III, Sec. 301(b)(1)(A), Dec. 17, 1999, 113 Stat. 1902.

AUTHORITY FOR DEMONSTRATION PROJECTS; REPORT TO CONGRESS

Section 505(a)(1)-(4) of Pub. L. 96-265, as amended by Pub. L.

99-272, title XII, Sec. 12101(a), (b), Apr. 7, 1986, 100 Stat. 282;

Pub. L. 101-239, title X, Sec. 10103(a)(1), (2), Dec. 19, 1989, 103

Stat. 2472; Pub. L. 103-296, title I, Sec. 108(m), title III, Sec.

315(a)(1), (2), Aug. 15, 1994, 108 Stat. 1489, 1531, which

authorized Commissioner of Social Security to carry out

demonstration projects to determine advantages and disadvantages of

alternative methods of treating work activity of disabled

beneficiaries under the old age, survivors, and disability

insurance program and altering limitations and conditions

applicable to such disabled beneficiaries, and required report to

Congress on or before June 9, 1986, and in each succeeding year

through 1995, was repealed by Pub. L. 106-170, title III, Sec.

301(b)(1)(A), Dec. 17, 1999, 113 Stat. 1902.

Pub. L. 106-170, title III, Sec. 301(b)(2), Dec. 17, 1999, 113

Stat. 1902, provided that: "With respect to any experiment or

demonstration project being conducted under section 505(a) of the

Social Security Disability Amendments of 1980 [Pub. L. 96-265,

formerly set out above] (42 U.S.C. 1310 note) as of the date of the

enactment of this Act [Dec. 17, 1999], the authority to conduct

such experiment or demonstration project (including the terms and

conditions applicable to the experiment or demonstration project)

shall be treated as if that authority (and such terms and

conditions) had been established under section 234 of the Social

Security Act [section 434 of this title], as added by subsection

(a)."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1315 of this title.

-End-

-CITE-

42 USC Sec. 1311 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. 1311. Public assistance payments to legal representatives

-STATUTE-

For purposes of subchapters I, X, XIV, and XVI of this chapter,

and part A of subchapter IV of this chapter, payments on behalf of

an individual, made to another person who has been judicially

appointed, under the law of the State in which such individual

resides, as legal representative of such individual for the purpose

of receiving and managing such payments (whether or not he is such

individual's legal representative for other purposes), shall be

regarded as money payments to such individual.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1111, as added Pub. L.

85-840, title V, Sec. 511(a), Aug. 28, 1958, 72 Stat. 1051; amended

Pub. L. 87-543, title I, Sec. 141(d), July 25, 1962, 76 Stat. 205;

Pub. L. 90-248, title II, Sec. 241(c)(3), Jan. 2, 1968, 81 Stat.

917.)

-REFTEXT-

REFERENCES IN TEXT

Part A of subchapter IV of this chapter, referred to in text, is

classified to section 601 et seq. of this title.

-MISC1-

AMENDMENTS

1968 - Pub. L. 90-248 struck out "IV," after "I," and inserted

"and part A of subchapter IV of this chapter," after "XVI of this

chapter,".

1962 - Pub. L. 87-543 inserted reference to subchapter XVI.

EFFECTIVE DATE

Section 511(b) of Pub. L. 85-840 provided that: "The amendment

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

in the case of payments to legal representatives by any State made

after June 30, 1958; and to such payments by any State made after

December 31, 1955, and prior to July 1, 1958, if certifications for

payment to such State have been made by the Secretary of Health,

Education, and Welfare with respect thereto, or such State has

presented to the Secretary a claim (and such other data as the

Secretary may require) with respect thereto, prior to July 1,

1959."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 306, 1206, 1385 of this

title.

-End-

-CITE-

42 USC Sec. 1312 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. 1312. Medical care guides and reports for public assistance

and medical assistance

-STATUTE-

In order to assist the States to extend the scope and content,

and improve the quality, of medical care and medical services for

which payments are made to or on behalf of needy and low-income

individuals under this chapter and in order to promote better

public understanding about medical care and medical assistance for

needy and low-income individuals, the Secretary shall develop and

revise from time to time guides or recommended standards as to the

level, content, and quality of medical care and medical services

for the use of the States in evaluating and improving their public

assistance medical care programs and their programs of medical

assistance; shall secure periodic reports from the States on items

included in, and the quantity of, medical care and medical services

for which expenditures under such programs are made; and shall from

time to time publish data secured from these reports and other

information necessary to carry out the purposes of this section.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1112, as added Pub. L.

86-778, title VII, Sec. 705, Sept. 13, 1960, 74 Stat. 995; amended

Pub. L. 89-97, title IV, Sec. 408(c), July 30, 1965, 79 Stat. 422.)

-MISC1-

AMENDMENTS

1965 - Pub. L. 89-97 struck out "for the aged" after "medical

assistance".

-End-

-CITE-

42 USC Sec. 1313 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. 1313. Assistance for United States citizens returned from

foreign countries

-STATUTE-

(a) Authorization; reimbursement; utilization of facilities of

public or private agencies and organizations

(1) The Secretary is authorized to provide temporary assistance

to citizens of the United States and to dependents of citizens of

the United States, if they (A) are identified by the Department of

State as having returned, or been brought, from a foreign country

to the United States because of the destitution of the citizen of

the United States or the illness of such citizen or any of his

dependents or because of war, threat of war, invasion, or similar

crisis, and (B) are without available resources.

(2) Except in such cases or classes of cases as are set forth in

regulations of the Secretary, provision shall be made for

reimbursement to the United States by the recipients of the

temporary assistance to cover the cost thereof.

(3) The Secretary may provide assistance under paragraph (1)

directly or through utilization of the services and facilities of

appropriate public or private agencies and organizations, in

accordance with agreements providing for payment, in advance or by

way of reimbursement, as may be determined by the Secretary, of the

cost thereof. Such cost shall be determined by such statistical,

sampling, or other method as may be provided in the agreement.

(b) Plans and arrangements for assistance; consultations

The Secretary is authorized to develop plans and make

arrangements for provision of temporary assistance within the

United States to individuals specified in subsection (a)(1) of this

section. Such plans shall be developed and such arrangements shall

be made after consultation with the Secretary of State, the

Attorney General, and the Secretary of Defense. To the extent

feasible, assistance provided under subsection (a) of this section

shall be provided in accordance with the plans developed pursuant

to this subsection, as modified from time to time by the Secretary.

(c) "Temporary assistance" defined

For purposes of this section, the term "temporary assistance"

means money payments, medical care, temporary billeting,

transportation, and other goods and services necessary for the

health or welfare of individuals (including guidance, counseling,

and other welfare services) furnished to them within the United

States upon their arrival in the United States and for such period

after their arrival, not exceeding ninety days, as may be provided

in regulations of the Secretary; except that assistance under this

section may be furnished beyond such ninety-day period in the case

of any citizen or dependent upon a finding by the Secretary that

the circumstances involved necessitate or justify the furnishing of

assistance beyond such period in that particular case.

(d) Maximum total amount of temporary assistance

The total amount of temporary assistance provided under this

section shall not exceed $1,000,000 during any fiscal year

beginning after September 30, 1991.

(e) Authority of Secretary to accept gifts

(1) The Secretary may accept on behalf of the United States

gifts, in cash or in kind, for use in carrying out the program

established under this section. Gifts in the form of cash shall be

credited to the appropriation account from which this program is

funded, in addition to amounts otherwise appropriated, and shall

remain available until expended.

(2) Gifts accepted under paragraph (1) shall be available for

obligation or other use by the United States only to the extent and

in the amounts provided in appropriation Acts.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1113, as added Pub. L.

87-64, title III, Sec. 302, June 30, 1961, 75 Stat. 142; amended

Pub. L. 87-543, title I, Sec. 133, July 25, 1962, 76 Stat. 196;

Pub. L. 88-347, June 30, 1964, 78 Stat. 236; Pub. L. 90-36, Sec. 2,

June 29, 1967, 81 Stat. 94; Pub. L. 90-248, title V, Sec. 503, Jan.

2, 1968, 81 Stat. 934; Pub. L. 91-41, Sec. 4, July 9, 1969, 83

Stat. 45; Pub. L. 92-40, July 1, 1971, 85 Stat. 96; Pub. L. 94-44,

Secs. 1, 2, June 28, 1975, 89 Stat. 235; Pub. L. 101-382, title I,

Sec. 140, Aug. 20, 1990, 104 Stat. 654; Pub. L. 101-508, title V,

Sec. 5056(a), Nov. 5, 1990, 104 Stat. 1388-229.)

-MISC1-

AMENDMENTS

1990 - Subsec. (d). Pub. L. 101-508, Sec. 5056(a)(1), substituted

"after September 30, 1991" for "on or after October 1, 1989".

Pub. L. 101-382 amended subsec. (d) generally. Prior to

amendment, subsec. (d) read as follows: "The total amount of

temporary assistance provided under this section shall not exceed -

"(1) $8,000,000 during the fiscal years ending June 30, 1975,

and June 30, 1976, and the succeeding calendar quarter, or

"(2) $300,000 during any fiscal year beginning on or after

October 1, 1976."

Subsec. (e). Pub. L. 101-508, Sec. 5056(a)(2), added subsec. (e).

1975 - Subsec. (c). Pub. L. 94-44, Sec. 2, set a 90-day limit for

assistance following arrival in the United States with provision

for furnishing of assistance beyond the 90-day limit upon a finding

by the Secretary that the circumstances involved necessitate or

justify the furnishing of assistance in that particular case.

Subsec. (d). Pub. L. 94-44, Sec. 1, substituted provisions

setting the maximum total amount of temporary assistance provided

under this section for provisions prohibiting temporary assistance

after June 30, 1973.

1971 - Subsec. (d). Pub. L. 92-40 extended termination date from

June 30, 1971, to June 30, 1973.

1969 - Subsec. (d). Pub. L. 91-41 extended termination date from

June 30, 1969, to June 30, 1971.

1968 - Subsec. (d). Pub. L. 90-248 extended termination date from

June 30, 1968, to June 30, 1969.

1967 - Subsec. (d). Pub. L. 90-36 extended termination date from

June 30, 1967, to June 30, 1968.

1964 - Subsec. (d). Pub. L. 88-347 extended termination date from

June 30, 1964, to June 30, 1967.

1962 - Subsec. (d). Pub. L. 87-543 extended termination date from

June 30, 1962, to June 30, 1964.

EFFECTIVE DATE OF 1990 AMENDMENT

Section 5056(b) of Pub. L. 101-508 provided that: "The amendments

made by subsection (a) [amending this section] shall be effective

for fiscal years beginning after September 30, 1989."

-End-

-CITE-

42 USC Sec. 1314 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. 1314. Public advisory groups

-STATUTE-

(a) Advisory Council on Public Welfare; appointment and functions

of initial Council

The Secretary shall, during 1964, appoint an Advisory Council on

Public Welfare for the purpose of reviewing the administration of

the public assistance and child welfare services programs for which

funds are appropriated pursuant to this chapter and making

recommendations for improvement of such administration, and

reviewing the status of and making recommendations with respect to

the public assistance programs for which funds are so appropriated,

especially in relation to the old-age, survivors, and disability

insurance program, with respect to the fiscal capacities of the

States and the Federal Government, and with respect to any other

matters bearing on the amount and proportion of the Federal and

State shares in the public assistance and child welfare services

programs.

(b) Membership and representation of interests on initial Council

The Council shall be appointed by the Secretary without regard to

the provisions of title 5 governing appointments in the competitive

service and shall consist of twelve persons who shall, to the

extent possible, be representatives of employers and employees in

equal numbers, representatives of State or Federal agencies

concerned with the administration or financing of the public

assistance and child welfare services programs, representatives of

nonprofit private organizations concerned with social welfare

programs, other persons with special knowledge, experience, or

qualifications with respect to such programs, and members of the

public.

(c) Technical and other assistance for initial Council;

availability of data

The Council is authorized to engage such technical assistance as

may be required to carry out its functions, and the Secretary

shall, in addition, make available to the Council such secretarial,

clerical, and other assistance and such pertinent data prepared by

the Department of Health and Human Services as it may require to

carry out such functions.

(d) Termination of initial Council's existence on submission of

report

The Council shall make a report of its findings and

recommendations (including recommendations for changes in the

provisions of this chapter) to the Secretary, such report to be

submitted not later than July 1, 1966, after which date such

Council shall cease to exist.

(e) Succeeding Councils; appointment; functions; membership;

representation of interests; assistance and data; termination

The Secretary shall also from time to time thereafter appoint an

Advisory Council on Public Welfare, with the same functions and

constituted in the same manner as prescribed for the Advisory

Council in the preceding subsections of this section. Each Council

so appointed shall report its findings and recommendations, as

prescribed in subsection (d) of this section, not later than July 1

of the second year after the year in which it is appointed, after

which date such Council shall cease to exist.

(f) Advisory committees; functions; reports by Secretary

The Secretary may also appoint, without regard to the provisions

of title 5 governing appointments in the competitive service, such

advisory committees as he may deem advisable to advise and consult

with him in carrying out any of his functions under this chapter.

The Secretary shall report to the Congress annually on the number

of such committees and on the membership and activities of each

such committee.

(g) Compensation and travel expenses

Members of the Council or of any advisory committee appointed

under this section who are not regular full-time employees of the

United States shall, while serving on business of the Council or

any such committee, be entitled to receive compensation at rates

fixed by the Secretary, but not exceeding $75 per day, including

travel time; and while so serving away from their homes or regular

places of business, they may be allowed travel expenses, including

per diem in lieu of subsistence, as authorized by section 5703 of

title 5 for persons in Government service employed intermittently.

(h) Exemption from conflict of interest laws of members of Council

or advisory committees; exceptions

(1) Any member of the Council or any advisory committee appointed

under this chapter, who is not a regular full-time employee of the

United States, is hereby exempted, with respect to such

appointment, from the operation of sections 203, 205, and 209 of

title 18, except as otherwise specified in paragraph (2) of this

subsection.

(2) The exemption granted by paragraph (1) shall not extend -

(A) to the receipt or payment of salary in connection with the

appointee's Government service from any source other than the

employer of the appointee at the time of his appointment, or

(B) during the period of such appointment, to the prosecution

or participation in the prosecution, by any person so appointed,

of any claim against the Government involving any matter with

which such person, during such period, is or was directly

connected by reason of such appointment.

(i) Nonvoting members and experts

(1) Any advisory committee appointed under subsection (f) of this

section to advise the Secretary on matters relating to the

interpretation, application, or implementation of section

1395y(a)(1) of this title shall assure the full participation of a

nonvoting member in the deliberations of the advisory committee,

and shall provide such nonvoting member access to all information

and data made available to voting members of the advisory

committee, other than information that -

(A) is exempt from disclosure pursuant to subsection (a) of

section 552 of title 5 by reason of subsection (b)(4) of such

section (relating to trade secrets); or

(B) the Secretary determines would present a conflict of

interest relating to such nonvoting member.

(2) If an advisory committee described in paragraph (1) organizes

into panels of experts according to types of items or services

considered by the advisory committee, any such panel of experts may

report any recommendation with respect to such items or services

directly to the Secretary without the prior approval of the

advisory committee or an executive committee thereof.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1114, as added Pub. L.

87-543, title I, Sec. 121, July 25, 1962, 76 Stat. 190; amended

Pub. L. 90-248, title IV, Sec. 403(e), Jan. 2, 1968, 81 Stat. 932;

Pub. L. 98-369, div. B, title VI, Sec. 2663(e)(4), (j)(2)(D)(iv),

July 18, 1984, 98 Stat. 1168, 1170; Pub. L. 106-554, Sec. 1(a)(6)

[title V, Sec. 522(c)], Dec. 21, 2000, 114 Stat. 2763, 2763A-546.)

-REFTEXT-

REFERENCES IN TEXT

The provisions of title 5 governing appointments in the

competitive service, referred to in subsecs. (b) and (f), are

classified to section 3301 et seq. of Title 5, Government

Organization and Employees.

-MISC1-

AMENDMENTS

2000 - Subsec. (i). Pub. L. 106-554 added subsec. (i).

1984 - Subsec. (c). Pub. L. 98-369, Sec. 2663(j)(2)(D)(iv),

substituted "Health and Human Services" for "Health, Education, and

Welfare".

Subsec. (g). Pub. L. 98-369, Sec. 2663(e)(4)(A), made technical

correction of typographical error resulting in no change in text.

Subsec. (h)(1). Pub. L. 98-369, Sec. 2663(e)(4)(B), substituted

"sections 203, 205, and 209 of title 18" for "sections 281, 283,

and 1914 of title 18 and section 190 of the Revised Statutes (5

U.S.C. 99)".

1968 - Subsecs. (b), (f). Pub. L. 90-248, Sec. 403(e)(1), (2),

substituted "provisions of title 5, governing appointments in the

competitive service" for "civil-service laws".

Subsec. (g). Pub. L. 90-248, Sec. 403(e)(3), substituted "section

5703 of title 5" for "section 5 of the Administrative Expenses Act

of 1946 (5 U.S.C. 73b-2)".

EFFECTIVE DATE OF 2000 AMENDMENT

Pub. L. 106-554, Sec. 1(a)(6) [title V, Sec. 522(d)], Dec. 21,

2000, 114 Stat. 2763, 2763A-547, provided that: "The amendments

made by this section [amending this section and sections 1395y and

1395ff of this title] shall apply with respect to -

"(1) a review of any national or local coverage determination

filed,

"(2) a request to make such a determination made, and

"(3) a national coverage determination made,

on or after October 1, 2001."

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.

TERMINATION OF ADVISORY COMMITTEES

Advisory committees in existence on Jan. 5, 1973, to terminate

not later than the expiration of the 2-year period following Jan.

5, 1973, unless, in the case of a committee established by the

President or an officer of the Federal Government, such committee

is renewed by appropriate action prior to the expiration of such

2-year period, or in the case of a committee established by the

Congress, its duration is otherwise provided by law. Advisory

committees established after Jan. 5, 1973, to terminate not later

than the expiration of the 2-year period beginning on the date of

their establishment, unless, in the case of a committee established

by the President or an officer of the Federal Government, such

committee is renewed by appropriate action prior to the expiration

of such 2-year period, or in the case of a committee established by

the Congress, its duration is otherwise provided by law. See

section 14 of Pub. L. 92-463, Oct. 6, 1972, 86 Stat. 776, set out

in the Appendix to Title 5, Government Organization and Employees.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1395y of this title.

-End-

-CITE-

42 USC Sec. 1314a 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. 1314a. Measurement and reporting of welfare receipt

-STATUTE-

(a) Congressional policy

The Congress hereby declares that -

(1) it is the policy and responsibility of the Federal

Government to reduce the rate at which and the degree to which

families depend on income from welfare programs and the duration

of welfare receipt, consistent with other essential national

goals;

(2) it is the policy of the United States to strengthen

families, to ensure that children grow up in families that are

economically self-sufficient and that the life prospects of

children are improved, and to underscore the responsibility of

parents to support their children;

(3) the Federal Government should help welfare recipients as

well as individuals at risk of welfare receipt to improve their

education and job skills, to obtain child care and other

necessary support services, and to take such other steps as may

be necessary to assist them to become financially independent;

and

(4) it is the purpose of this section to provide the public

with generally accepted measures of welfare receipt so that it

can track such receipt over time and determine whether progress

is being made in reducing the rate at which and, to the extent

feasible, the degree to which, families depend on income from

welfare programs and the duration of welfare receipt.

(b) Development of welfare indicators and predictors

The Secretary of Health and Human Services (in this section

referred to as the "Secretary") in consultation with the Secretary

of Agriculture shall -

(1) develop -

(A) indicators of the rate at which and, to the extent

feasible, the degree to which, families depend on income from

welfare programs and the duration of welfare receipt; and

(B) predictors of welfare receipt;

(2) assess the data needed to report annually on the indicators

and predictors, including the ability of existing data collection

efforts to provide such data and any additional data collection

needs; and

(3) not later than 2 years after October 31, 1994, provide an

interim report containing conclusions resulting from the

development and assessment described in paragraphs (1) and (2),

to -

(A) the Committee on Ways and Means of the House of

Representatives;

(B) the Committee on Education and Labor of the House of

Representatives;

(C) the Committee on Agriculture of the House of

Representatives;

(D) the Committee on Commerce of the House of

Representatives;

(E) the Committee on Finance of the Senate;

(F) the Committee on Labor and Human Resources of the Senate;

and

(G) the Committee on Agriculture, Nutrition, and Forestry of

the Senate.

(c) Advisory Board on Welfare Indicators

(1) Establishment

There is established an Advisory Board on Welfare Indicators

(in this subsection referred to as the "Board").

(2) Composition

The Board shall be composed of 12 members with equal numbers to

be appointed by the House of Representatives, the Senate, and the

President. The Board shall be composed of experts in the fields

of welfare research and welfare statistical methodology,

representatives of State and local welfare agencies, and

organizations concerned with welfare issues.

(3) Vacancies

Any vacancy occurring in the membership of the Board shall be

filled in the same manner as the original appointment for the

position being vacated. The vacancy shall not affect the power of

the remaining members to execute the duties of the Board.

(4) Duties

Duties of the Board shall include -

(A) providing advice and recommendations to the Secretary on

the development of indicators of the rate at which and, to the

extent feasible, the degree to which, families depend on income

from welfare programs and the duration of welfare receipt; and

(B) providing advice on the development and presentation of

annual reports required under subsection (d) of this section.

(5) Travel expenses

Members of the Board shall not be compensated, but shall

receive travel expenses, including per diem in lieu of

subsistence, at rates authorized for employees of agencies under

subchapter I of chapter 57 of title 5 for each day the member is

engaged in the performance of duties away from the home or

regular place of business of the member.

(6) Detail of Federal employees

The Secretary shall detail, without reimbursement, any of the

personnel of the Department of Health and Human Services to the

Board to assist the Board in carrying out its duties. Any detail

shall not interrupt or otherwise affect the civil service status

or privileges of the Federal employee.

(7) Voluntary service

Notwithstanding section 1342 of title 31, the Board may accept

the voluntary services provided by a member of the Board.

(8) Termination of Board

The Board shall be terminated at such time as the Secretary

determines the duties described in paragraph (4) have been

completed, but in any case prior to the submission of the first

report required under subsection (d) of this section.

(d) Annual welfare indicators report

(1) Preparation

The Secretary shall prepare annual reports on welfare receipt

in the United States.

(2) Coverage

The report shall include analysis of families and individuals

receiving assistance under means-tested benefit programs,

including the program of aid to families with dependent children

under part A of subchapter IV of this chapter, the food stamp

program under the Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.),

and the Supplemental Security Income program under subchapter XVI

of this chapter, or as general assistance under programs

administered by State and local governments.

(3) Contents

Each report shall set forth for each of the means-tested

benefit programs described in paragraph (2) -

(A) indicators of -

(i) the rate at which and, to the extent feasible, the

degree to which, families depend on income from welfare

programs, and

(ii) the duration of welfare receipt;

(B) trends in indicators;

(C) predictors of welfare receipt;

(D) the causes of welfare receipt;

(E) patterns of multiple program receipt;

(F) such other information as the Secretary deems relevant;

and

(G) such recommendations for legislation, which shall not

include proposals to reduce eligibility levels or impose

barriers to program access, as the Secretary may determine to

be necessary or desirable to reduce -

(i) the rate at which and the degree to which families

depend on income from welfare programs, and

(ii) the duration of welfare receipt.

(4) Submission

The Secretary shall submit such a report not later than 3 years

after October 31, 1994, and annually thereafter, to the

committees specified in subsection (b)(3) of this section. Each

such report shall be transmitted during the first 60 days of each

regular session of Congress.

(e) Short title

This section may be cited as the "Welfare Indicators Act of

1994".

-SOURCE-

(Pub. L. 103-432, title II, Sec. 232, Oct. 31, 1994, 108 Stat.

4462; Pub. L. 105-200, title IV, Sec. 410(h), July 16, 1998, 112

Stat. 674.)

-REFTEXT-

REFERENCES IN TEXT

Part A of subchapter IV of this chapter and subchapter XVI of

this chapter, referred to in subsec. (d)(2), are classified to

section 601 et seq. and section 1381 et seq., respectively, of this

title.

The Food Stamp Act of 1977, referred to in subsec. (d)(2), is

Pub. L. 88-525, Aug. 31, 1964, 78 Stat. 703, as amended, which is

classified generally to chapter 51 (Sec. 2011 et seq.) of Title 7,

Agriculture. For complete classification of this Act to the Code,

see Short Title note set out under section 2011 of Title 7 and

Tables.

-COD-

CODIFICATION

Section was enacted as part of the Social Security Act Amendments

of 1994, and not as part of the Social Security Act which comprises

this chapter.

-MISC1-

AMENDMENTS

1998 - Subsec. (b)(3)(D). Pub. L. 105-200, Sec. 410(h)(1), struck

out "Energy and" before "Commerce".

Subsec. (d)(4). Pub. L. 105-200, Sec. 410(h)(2), substituted

"subsection (b)(3) of this section" for "subsection (b)(3)(C) of

this section".

-CHANGE-

CHANGE OF NAME

Committee on Education and Labor of House of Representatives

treated as referring to Committee on Economic and Educational

Opportunities of House of Representatives by section 1(a) of Pub.

L. 104-14, set out as a note preceding section 21 of Title 2, The

Congress. Committee on Economic and Educational Opportunities of

House of Representatives changed to Committee on Education and the

Workforce of House of Representatives by House Resolution No. 5,

One Hundred Fifth Congress, Jan. 7, 1997.

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. 1315 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. 1315. Demonstration projects

-STATUTE-

(a) Waiver of State plan requirements; costs regarded as State plan

expenditures; availability of appropriations

In the case of any experimental, pilot, or demonstration project

which, in the judgment of the Secretary, is likely to assist in

promoting the objectives of subchapter I, X, XIV, XVI, or XIX of

this chapter, or part A or D of subchapter IV of this chapter, in a

State or States -

(1) the Secretary may waive compliance with any of the

requirements of section 302, 602, 654, 1202, 1352, 1382, or 1396a

of this title, as the case may be, to the extent and for the

period he finds necessary to enable such State or States to carry

out such project, and

(2)(A) costs of such project which would not otherwise be

included as expenditures under section 303, 655, 1203, 1353,

1383, or 1396b of this title, as the case may be, and which are

not included as part of the costs of projects under section 1310

of this title, shall, to the extent and for the period prescribed

by the Secretary, be regarded as expenditures under the State

plan or plans approved under such subchapter, or for

administration of such State plan or plans, as may be

appropriate, and

(B) costs of such project which would not otherwise be a

permissible use of funds under part A of subchapter IV of this

chapter and which are not included as part of the costs of

projects under section 1310 of this title, shall to the extent

and for the period prescribed by the Secretary, be regarded as a

permissible use of funds under such part.

In addition, not to exceed $4,000,000 of the aggregate amount

appropriated for payments to States under such subchapters for any

fiscal year beginning after June 30, 1967, shall be available,

under such terms and conditions as the Secretary may establish, for

payments to States to cover so much of the cost of such projects as

is not covered by payments under such subchapters and is not

included as part of the cost of projects for purposes of section

1310 of this title.

(b) Child support enforcement programs

In the case of any experimental, pilot, or demonstration project

undertaken under subsection (a) of this section to assist in

promoting the objectives of part D of subchapter IV of this

chapter, the project -

(1) must be designed to improve the financial well-being of

children or otherwise improve the operation of the child support

program;

(2) may not permit modifications in the child support program

which would have the effect of disadvantaging children in need of

support; and

(3) must not result in increased cost to the Federal Government

under part A of such subchapter.

(c) Demonstration projects to test alternative definitions of

unemployment

(1)(A) The Secretary shall enter into agreements with up to 8

States submitting applications under this subsection for the

purpose of conducting demonstration projects in such States to test

and evaluate the use, with respect to individuals who received aid

under part A of subchapter IV of this chapter in the preceding

month (on the basis of the unemployment of the parent who is the

principal earner), of a number greater than 100 for the number of

hours per month that such individuals may work and still be

considered to be unemployed for purposes of section 607 of this

title. If any State submits an application under this subsection

for the purpose of conducting a demonstration project to test and

evaluate the total elimination of the 100-hour rule, the Secretary

shall approve at least one such application.

(B) If any State with an agreement under this subsection so

requests, the demonstration project conducted pursuant to such

agreement may test and evaluate the complete elimination of the

100-hour rule and of any other durational standard that might be

applied in defining unemployment for purposes of determining

eligibility under section 607 of this title.

(2) Notwithstanding section 602(a)(1) of this title, a

demonstration project conducted under this subsection may be

conducted in one or more political subdivisions of the State.

(3) An agreement under this subsection shall be entered into

between the Secretary and the State agency designated under section

602(a)(3) of this title. Such agreement shall provide for the

payment of aid under the applicable State plan under part A of

subchapter IV of this chapter as though section 607 of this title

had been modified to reflect the definition of unemployment used in

the demonstration project but shall also provide that such project

shall otherwise be carried out in accordance with all of the

requirements and conditions of section 607 of this title (and,

except as provided in paragraph (2), any related requirements and

conditions under part A of subchapter IV of this chapter).

(4) A demonstration project under this subsection may be

commenced any time after September 30, 1990, and shall be conducted

for such period of time as the agreement with the Secretary may

provide; except that, in no event may a demonstration project under

this section be conducted after September 30, 1995.

(5)(A) Any State with an agreement under this subsection shall

evaluate the comparative cost and employment effects of the use of

the definition of unemployment in its demonstration project under

this section by use of experimental and control groups comprised of

a random sample of individuals receiving aid under section 607 of

this title and shall furnish the Secretary with such information as

the Secretary determines to be necessary to evaluate the results of

the project conducted by the State.

(B) The Secretary shall report the results of the demonstration

projects conducted under this subsection to the Congress not later

than 6 months after all such projects are completed.

(e) (!1) Extensions of State-wide comprehensive demonstration

projects for which waivers granted

(1) The provisions of this subsection shall apply to the

extension of any State-wide comprehensive demonstration project (in

this subsection referred to as "waiver project") for which a waiver

of compliance with requirements of subchapter XIX of this chapter

is granted under subsection (a) of this section.

(2) During the 6-month period ending 1 year before the date the

waiver under subsection (a) of this section with respect to a

waiver project would otherwise expire, the chief executive officer

of the State which is operating the project may submit to the

Secretary a written request for an extension, of up to 3 years, of

the project.

(3) If the Secretary fails to respond to the request within 6

months after the date it is submitted, the request is deemed to

have been granted.

(4) If such a request is granted, the deadline for submittal of a

final report under the waiver project is deemed to have been

extended until the date that is 1 year after the date the waiver

project would otherwise have expired.

(5) The Secretary shall release an evaluation of each such

project not later than 1 year after the date of receipt of the

final report.

(6) Subject to paragraphs (4) and (7), the extension of a waiver

project under this subsection shall be on the same terms and

conditions (including applicable terms and conditions relating to

quality and access of services, budget neutrality, data and

reporting requirements, and special population protections) that

applied to the project before its extension under this subsection.

(7) If an original condition of approval of a waiver project was

that Federal expenditures under the project not exceed the Federal

expenditures that would otherwise have been made, the Secretary

shall take such steps as may be necessary to ensure that, in the

extension of the project under this subsection, such condition

continues to be met. In applying the previous sentence, the

Secretary shall take into account the Secretary's best estimate of

rates of change in expenditures at the time of the extension.

(f) Application for extension of waiver project; submission;

approval

An application by the chief executive officer of a State for an

extension of a waiver project the State is operating under an

extension under subsection (e) of this section (in this subsection

referred to as the "waiver project") shall be submitted and

approved or disapproved in accordance with the following:

(1) The application for an extension of the waiver project

shall be submitted to the Secretary at least 120 days prior to

the expiration of the current period of the waiver project.

(2) Not later than 45 days after the date such application is

received by the Secretary, the Secretary shall notify the State

if the Secretary intends to review the terms and conditions of

the waiver project. A failure to provide such notification shall

be deemed to be an approval of the application.

(3) Not later than 45 days after the date a notification is

made in accordance with paragraph (2), the Secretary shall inform

the State of proposed changes in the terms and conditions of the

waiver project. A failure to provide such information shall be

deemed to be an approval of the application.

(4) During the 30-day period that begins on the date

information described in paragraph (3) is provided to a State,

the Secretary shall negotiate revised terms and conditions of the

waiver project with the State.

(5)(A) Not later than 120 days after the date an application

for an extension of the waiver project is submitted to the

Secretary (or such later date agreed to by the chief executive

officer of the State), the Secretary shall -

(i) approve the application subject to such modifications in

the terms and conditions -

(I) as have been agreed to by the Secretary and the State;

or

(II) in the absence of such agreement, as are determined by

the Secretary to be reasonable, consistent with the overall

objectives of the waiver project, and not in violation of

applicable law; or

(ii) disapprove the application.

(B) A failure by the Secretary to approve or disapprove an

application submitted under this subsection in accordance with

the requirements of subparagraph (A) shall be deemed to be an

approval of the application subject to such modifications in the

terms and conditions as have been agreed to (if any) by the

Secretary and the State.

(6) An approval of an application for an extension of a waiver

project under this subsection shall be for a period not to exceed

3 years.

(7) An extension of a waiver project under this subsection

shall be subject to the final reporting and evaluation

requirements of paragraphs (4) and (5) of subsection (e) of this

section (taking into account the extension under this subsection

with respect to any timing requirements imposed under those

paragraphs).

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1115, as added Pub. L.

87-543, title I, Sec. 122, July 25, 1962, 76 Stat. 192; amended

Pub. L. 89-97, title I, Sec. 121(c)(3), July 30, 1965, 79 Stat.

352; Pub. L. 90-36, Sec. 2, June 29, 1967, 81 Stat. 94; Pub. L.

90-248, title II, Secs. 241(c)(4), 247, Jan. 2, 1968, 81 Stat. 917,

918; Pub. L. 93-233, Sec. 18(z-2)(1)(B), Dec. 31, 1973, 87 Stat.

973; Pub. L. 93-647, Sec. 3(c), Jan. 4, 1975, 88 Stat. 2349; Pub.

L. 95-216, title IV, Sec. 404, Dec. 20, 1977, 91 Stat. 1562; Pub.

L. 97-35, title XXIII, Sec. 2353(g), Aug. 13, 1981, 95 Stat. 872;

Pub. L. 98-369, div. B, title VI, Sec. 2663(e)(5), July 18, 1984,

98 Stat. 1168; Pub. L. 98-378, Sec. 10, Aug. 16, 1984, 98 Stat.

1317; Pub. L. 99-272, title XIV, Sec. 14001(b)(2), Apr. 7, 1986,

100 Stat. 328; Pub. L. 100-485, title V, Sec. 503, Oct. 13, 1988,

102 Stat. 2402; Pub. L. 104-193, title I, Sec. 108(g)(2), Aug. 22,

1996, 110 Stat. 2168; Pub. L. 105-33, title IV, Sec. 4757(a), Aug.

5, 1997, 111 Stat. 527; Pub. L. 106-554, Sec. 1(a)(6) [title VII,

Sec. 703(a)], Dec. 21, 2000, 114 Stat. 2763, 2763A-574.)

-REFTEXT-

REFERENCES IN TEXT

Parts A and D of subchapter IV of this chapter, referred to in

text, are classified to sections 601 et seq. and 651 et seq.,

respectively, of this title.

Sections 1382 and 1383 of this title, referred to in subsec.

(a)(1), (2), respectively, are references to sections 1382 and 1383

of this title as they existed prior to the general revision of this

subchapter by Pub. L. 92-603, title III, Sec. 301, Oct. 30, 1972,

86 Stat. 1465, eff. Jan. 1, 1974. The prior sections (which are set

out as notes under sections 1382 and 1383, respectively, of this

title) continue in effect for Puerto Rico, Guam, and the Virgin

Islands.

-MISC1-

AMENDMENTS

2000 - Subsec. (f). Pub. L. 106-554 added subsec. (f).

1997 - Subsec. (e). Pub. L. 105-33 added subsec. (e).

1996 - Subsec. (a)(2). Pub. L. 104-193, Sec. 108(g)(2)(A),

designated existing provisions as subpar. (A), struck out "603,"

before "655,", substituted ", and" for period at end, and added

subpar. (B).

Subsec. (b). Pub. L. 104-193, Sec. 108(g)(2)(C), redesignated

subsec. (c) as (b) and struck out former subsec. (b) which related

to purposes, criteria and procedures applicable to establishment,

participatory effect, duration and termination of demonstration

projects.

Subsec. (c). Pub. L. 104-193, Sec. 108(g)(2)(C), redesignated

subsec. (d) as (c). Former subsec. (c) redesignated (b).

Subsec. (c)(3). Pub. L. 104-193, Sec. 108(g)(2)(B), substituted

"part A of such subchapter" for "the program of aid to families

with dependent children".

Subsec. (d). Pub. L. 104-193, Sec. 108(g)(2)(C), redesignated

subsec. (d) as (c).

1988 - Subsec. (d). Pub. L. 100-485 added subsec. (d).

1986 - Subsec. (b)(2)(C). Pub. L. 99-272 struck out subpar. (C)

relating to use of funds as are appropriated for payments to States

under chapter 67 of title 31 to cover costs of salaries for

individuals in public service employment.

1984 - Subsec. (a). Pub. L. 98-378, Sec. 10(a)(1), substituted

"part A or D of subchapter IV" for "part A of subchapter IV" in

provisions preceding par. (1).

Pub. L. 98-369, Sec. 2663(e)(5), struck out "VI," after "I," in

provisions preceding par. (1).

Subsec. (a)(1). Pub. L. 98-378, Sec. 10(a)(2), inserted "654,".

Pub. L. 98-369, Sec. 2663(e)(5), struck out "802," after "602,".

Subsec. (a)(2). Pub. L. 98-378, Sec. 10(a)(3), inserted "655,".

Pub. L. 98-369, Sec. 2663(e)(5), struck out "803," after "603,".

Subsec. (c). Pub. L. 98-378, Sec. 10(b), added subsec. (c).

1981 - Subsec. (a). Pub. L. 97-35 substituted in provision

preceding par. (1) "or XIX of this chapter" for "XIX, or XX of this

chapter", in par. (1) "or 1396a of this title" for "1396a, 1397a,

1397b, or 1397c of this title", and in par. (2) "or 1396b of this

title" for "1396b, or 1397a of this title" and in par. (2) struck

out "or expenditures with respect to which payment shall be made

under section 1397a of this title," before "as may be appropriate".

1977 - Pub. L. 95-216 designated existing provisions as subsec.

(a) and existing pars. (a) and (b) thereof as pars. (1) and (2),

respectively, and added subsec. (b).

1975 - Pub. L. 93-647, Sec. 3(c)(1), substituted "XIX, or XX" for

"or XIX".

Subsec. (a). Pub. L. 93-647, Sec. 3(c)(2), inserted references to

sections 1397a, 1397b, and 1397c.

Subsec. (b). Pub. L. 93-647, Sec. 3(c)(3), (4), substituted

"1396b, or 1397a" for "1396b", and inserted "or expenditures with

respect to which payment shall be made under section 1397a of this

title" after "administration of such State plan or plans,".

1973 - Pub. L. 93-233 inserted references in text preceding

subsec. (a) to subchapter VI of this chapter, in subsec. (a) to

section 802 of this title, and in subsec. (b) to section 803 of

this title.

1968 - Pub. L. 90-248, Sec. 241(c)(4), in opening phrase struck

out "IV," after "I," and inserted ", or part A of subchapter IV of

this chapter," after "XIX of this chapter".

Pub. L. 90-248, Sec. 247, substituted in second sentence

"$4,000,000" for "$2,000,000" and "beginning after June 30, 1967"

for "ending prior to July 1, 1968".

1967 - Pub. L. 90-36 substituted "July 1, 1968" for "July 1,

1967".

1965 - Pub. L. 89-97 included in enumeration in opening phrase,

and cls. (a) and (b), subchapter XIX of this chapter, and sections

1396a and 1396b of this title, respectively.

EFFECTIVE DATE OF 2000 AMENDMENT

Pub. L. 106-554, Sec. 1(a)(6) [title VII, Sec. 703(b)], Dec. 21,

2000, 114 Stat. 2763, 2763A-575, provided that: "The amendment made

by subsection (a) [amending this section] shall apply to requests

for extensions of demonstration projects pending or submitted on or

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

EFFECTIVE DATE OF 1997 AMENDMENT

Section 4757(b) of Pub. L. 105-33 provided that: "The amendment

made by subsection (a) [amending this section] shall apply to

demonstration projects initially approved before, on, or after the

date of the enactment of this Act [Aug. 5, 1997]."

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 1986 AMENDMENT

Amendment by Pub. L. 99-272 effective Oct. 18, 1986, see section

14001(e) of Pub. L. 99-272.

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 OF 1981 AMENDMENT

Amendment by 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 Pub. L. 93-647 effective with respect to payments

under sections 603 and 803 of this title for quarters commencing

after Sept. 30, 1975, see section 7(b) of Pub. L. 93-647, set out

as a note under section 303 of this title.

EFFECTIVE DATE OF 1973 AMENDMENT

Amendment by Pub. L. 93-233 effective on and after Jan. 1, 1974,

see section 18(z-2)(2) of Pub. L. 93-233, set out as a note under

section 1301 of this title.

EFFECTIVE DATE OF 1965 AMENDMENT

Section 121(c)(3) of Pub. L. 89-97 provided that the amendment

made by that section is effective Jan. 1, 1966.

FAMILY SUPPORT DEMONSTRATION PROJECTS

Section 501 of Pub. L. 100-485, as amended by Pub. L. 103-432,

title II, Sec. 262, Oct. 31, 1994, 108 Stat. 4467, provided that:

"(a) Demonstration Projects To Test the Effect of Early Childhood

Development Programs. - (1) In order to test the effect of in-home

early childhood development programs and pre-school center-based

development programs (emphasizing the use of volunteers and

including academic credit for student volunteers) on families

receiving aid under State plans approved under section 402 of the

Social Security Act [section 602 of this title] and participating

in the job opportunities and basic skills training program under

part F of title IV of such Act [part F of subchapter IV of this

chapter], up to 10 States may undertake and carry out demonstration

projects utilizing such development programs to enhance the

cognitive skills and linguistic ability of children under the age

of 5, to improve the communications skills of such children, and to

develop their ability to read, write, and speak the English

language effectively. Such projects may include parents along with

their eligible children in family-centered education programs that

assist children directly in achieving the goals stated in the

preceding sentence and also help parents contribute to the proper

development and education of their young children. Demonstration

projects under this subsection shall meet such conditions and

requirements as the Secretary of Health and Human Services (in this

section referred to as the 'Secretary') shall prescribe, and no

such project shall be conducted for a period of more than 3 years.

"(2) The Secretary shall consider all applications received from

States desiring to conduct demonstration projects under this

subsection, shall approve up to 10 applications involving projects

which appear likely to contribute significantly to the achievement

of the purpose of this subsection, and shall make grants to the

States whose applications are approved to assist them in carrying

out such projects.

"(3) The Secretary shall submit to the Congress with respect to

each project undertaken by a State under this subsection, after

such project has been carried out for one year and again when such

project is completed, a detailed evaluation of the project and of

its contribution to the achievement of the purpose of this

subsection.

"(4) For grants to States to conduct demonstration projects under

this subsection, there are authorized to be appropriated not to

exceed $3,000,000 for each of the fiscal years 1995 through 1999.

"(b) State Demonstration Projects To Encourage Innovative

Education and Training Programs for Children. - In order to

encourage States to develop innovative education and training

programs for children receiving aid under State plans approved

under section 402 of the Social Security Act [section 602 of this

title], any State may establish and conduct one or more

demonstration projects, targeted to such children, designed to test

financial incentives and interdisciplinary approaches to reducing

school dropouts, encouraging skill development, and avoiding

welfare dependence; and the Secretary may make grants to States to

assist in financing such projects. Demonstration projects under

this subsection shall meet such conditions and requirements as the

Secretary shall prescribe, and no such project shall be conducted

for a period of less than one year or more than 5 years.

"(c) Demonstrations To Ensure Long Term Family Self-Sufficiency

Through Community-Based Services. - Any State, using funds made

available to it from appropriations made pursuant to subsection (d)

in conjunction with its other resources, may conduct demonstrations

to test more effective methods of providing coordination and

services to ensure long term family self-sufficiency through

community-based comprehensive family support services involving a

partnership between the State agency administering or supervising

the administrating of the State's plan under section 402 of the

Social Security Act [section 602 of this title] and community-based

organizations having experience and demonstrated effectiveness in

providing services.

"(d) Authorization of Appropriations. - For the purpose of making

grants to States to conduct demonstration projects under this

section, there is authorized to be appropriated not to exceed

$6,000,000 for each of the fiscal years 1990, 1991, and 1992."

DEMONSTRATION PROJECTS TO ENCOURAGE STATES TO EMPLOY PARENTS

RECEIVING AFDC AS PAID CHILD CARE PROVIDERS

Section 502 of Pub. L. 100-485 authorized Secretary of Health and

Human Services to permit up to 5 States to undertake and carry out

demonstration projects designed to test whether employment of

parents of dependent children receiving AFDC as providers of child

care for other children receiving AFDC would effectively facilitate

the conduct of the job opportunities and basic skills training

program under part F of title IV of this chapter by making

additional child care services available to meet the requirements

of section 602(g)(1)(A) of this title while affording significant

numbers of families receiving such aid a realistic opportunity to

avoid welfare dependence through employment as a child care

provider, and authorized to be appropriated not to exceed

$1,000,000 for each of the fiscal years 1990, 1991, and 1992 for

grants to States to carry out such demonstration projects.

DEMONSTRATION PROJECTS TO ADDRESS CHILD ACCESS PROBLEMS

Section 504 of Pub. L. 100-485 provided that any State could

establish and conduct one or more demonstration projects (in

accordance with such terms, conditions, and requirements prescribed

by the Secretary of Health and Human Services, except that no such

project could include the withholding of aid to families with

dependent children pending visitation) to develop, improve, or

expand activities designed to increase compliance with child access

provisions of court orders, specified activities that could be

funded by a grant under this section, authorized to be appropriated

not to exceed $4,000,000 for each of the fiscal years 1990 and

1991, and directed Secretary of Health and Human Services, not

later than July 1, 1992, to submit to Congress a report on the

effectiveness of the demonstration projects established under this

section.

DEMONSTRATION PROJECTS TO PROVIDE COUNSELING AND SERVICES TO

HIGH-RISK TEENAGERS

Section 506 of Pub. L. 100-485 provided that:

"(a) Findings and Purpose. - (1) The Congress finds that -

"(A) the incidences of teenage pregnancy, suicide, substance

abuse, and school dropout are increasing;

"(B) research to date has established a link between low

self-esteem, perceived limited life options and the risk of

teenage pregnancy, suicide, substance abuse, and school dropout;

"(C) little data currently exists on how to improve the

self-image of and expand the life options available to high-risk

teenagers; and

"(D) there currently is no Federal program in place to address

the unique and significant problems faced by today's teenagers.

"(2) It is the purpose of the demonstration projects conducted

under this section to provide programs in which a range of

non-academic services (sports, recreation, the arts) and self-image

counseling are provided to high-risk teenagers in order to reduce

the rates of pregnancy, suicide, substance abuse, and school

dropout among such teenagers.

"(b) In General. - The Secretary of Health and Human Services (in

this section referred to as the 'Secretary') shall enter into an

agreement with each of 4 States submitting applications under this

section for the purpose of conducting demonstration projects in

accordance with this section to provide counseling and services to

certain high-risk teenagers.

"(c) Nature of Project. - Under each demonstration project

conducted under this section -

"(1) The State shall establish a 'Teen Care Plan' that shall

consist of the following:

"(A) A clearing house where high-risk teenagers will be

referred to and encouraged to participate in non-academic

activities (arts, recreation, sports) which are already in

place in the community.

"(B) A survey of the area to be targeted by the project to

determine the need to fund and create new non-academic

activities in the area.

"(C) Counseling services utilizing qualified, locally

licensed psychologists, social psychologists, or other mental

health professionals or related experts to provide individual

and group counseling to participating high-risk teenagers.

"(D) A program to provide participants in the project (to the

extent practicable) with such transportation, child care, and

equipment as is necessary to carry out the purposes of the

project.

"(2) The State shall designate two geographical areas within

the State to be targeted by the project. One area will serve as

the 'home base' for the project, where services will be

concentrated and in which a local school system will be selected

to receive services and provide facilities for resource referral

and counseling. The second geographical area will serve as a

'peripheral' participant, receiving assistance and services from

the home base.

"(3) A high-risk teenager is any male or female who has reached

the age of 10 years and whose age does not exceed 20 years, and

who -

"(A) has a history of academic problems;

"(B) has a history of behavioral problems both in and out of

school;

"(C) comes from a one-parent household; or

"(D) is pregnant or is a mother of a child.

"(d) Applications; Selection Criteria. - (1) In selecting States

to conduct demonstration projects under this section, the Secretary

-

"(A) shall consult with the Consortium on Adolescent Pregnancy;

"(B) shall consider -

"(i) the rate of teenage pregnancy in each State,

"(ii) the teenage school dropout rate in each State,

"(iii) the incidence of teenage substance abuse in each

State, and

"(iv) the incidence of teenage suicide in each State; and

"(C) shall give priority to States whose applications -

"(i) demonstrate a current strong State commitment aimed at

reducing teenage pregnancy, suicide, drug abuse, and school

dropout;

"(ii) contain a 'State support agreement' signed by the

Governor, the State School Commissioner, the State Department

of Human Services, and the State Department of Education,

pledging their commitment to the project;

"(iii) describe facilities and services to be made available

by the State to assist in carrying out the project; and

"(iv) indicate a demonstrably high rate of alcoholism among

its residents.

"(2) Of the States selected to participate in the demonstration

projects conducted under this section -

"(A) one shall be a geographically small State with a

population of less than 1,250,000;

"(B) one shall be a State with a population of over 20,000,000;

and

"(C) two shall be States with populations of more than

1,000,000 but less than 20,000,000.

"(e) Evaluation and Report. - (1) Each State conducting a

demonstration project under this section shall submit to the

Secretary for his approval an evaluation plan that provides for

examining the effectiveness of the project in both the home base

and peripheral area of the State.

"(2) Not later than October 1, 1992, the Secretary shall submit

to the Congress a report containing a summary of the evaluations

conducted by States pursuant to the plans described in paragraph

(1).

"(f) Funding. - (1) Three-fifths of the total amount appropriated

pursuant to this section for any fiscal year for each State

conducting a demonstration project shall be expended by such State

for the provision of services and facilities within the State's

designated project home base, and 5 percent of such three-fifths

shall be set aside for the conduct of the State's evaluation as

provided for in subsection (e).

"(2) Two-fifths of the total amounts appropriated pursuant to

this section for any fiscal year for each State conducting a

demonstration project shall be expended by such State for the

provision of services and facilities within the State's designated

peripheral area, and 5 percent of such two-fifths shall be set

aside for the conduct of the State's evaluation as provided for in

subsection (e).

"(g) Duration. - A demonstration project conducted under this

section shall be commenced not later than September 30, 1989, and

shall be conducted for a 3-year period; except that the Secretary

may terminate a project before the end of such period if he

determines that the State conducting the project is not in

substantial compliance with the terms of the agreement entered into

with the Secretary under this section.

"(h) Authorization of Appropriations. - For the purpose of

funding in equal amounts each State demonstration project conducted

under this section, there is authorized to be appropriated not to

exceed $1,500,000 for each of the fiscal years 1990, 1991, and

1992."

CONTINUATION OF FEDERAL FINANCIAL PARTICIPATION IN EXPERIMENTAL,

PILOT, OR DEMONSTRATION PROJECTS APPROVED BEFORE OCTOBER 1, 1973,

FOR PERIOD ON-AND-AFTER DECEMBER 31, 1973, WITHOUT DENIAL OR

REDUCTION ON ACCOUNT OF SUBCHAPTER XVI PROVISIONS FOR SUPPLEMENTAL

SECURITY INCOME FOR THE AGED, BLIND AND DISABLED; WAIVER OF

SUBCHAPTER XVI RESTRICTIONS FOR INDIVIDUALS; FEDERAL PAYMENTS OF

NON-FEDERAL SHARE AS SUPPLEMENTARY PAYMENTS

Section 11 of Pub. L. 93-233 provided that:

"(a) If any State (other than the Commonwealth of Puerto Rico,

the Virgin Islands, or Guam) has any experimental, pilot, or

demonstration project (referred to in section 1115 of the Social

Security Act [this section]) -

"(1) which (prior to October 1, 1973) has been approved by the

Secretary of Health, Education, and Welfare [now Health and Human

Services] (hereinafter in this section referred to as the

'Secretary'), for a period which ends on or after December 31,

1973, as being a project with respect to which the authority

conferred upon him by subsection (a) or (b) of such section 1115

[subsec. (a) or (b) of this section] will be exercised, and

"(2) with respect to the costs of which Federal financial

participation would (except for the provisions of this section)

be denied or reduced on account of the enactment of section 301

of the Social Security Amendments of 1972 [enacting subchapter

XVI of this chapter],

then, for any period (after December 31, 1973) with respect to

which such project is approved by the Secretary, Federal financial

participation in the costs of such project shall be continued in

like manner as if -

"(3) such section 301 [enacting subchapter XVI of this chapter]

had not been enacted, and

"(4) such State (for the month of January 1974 and any month

thereafter) continued to have in effect the State plan (approved

under title XVI [subchapter XVI of this chapter]) which was in

effect for the month of October 1973, or the State plans

(approved under titles I, X, and XIV of the Social Security Act

[subchapters I, X, and XIV of this chapter]) which were in effect

for such month, as the case may be.

"(b) With respect to individuals -

"(1) who are participants in any project to which the

provisions of subsection (a) are applicable, and

"(2) with respect to whom supplemental security income benefits

are (or would, except for their participation in such project,

be) payable under title XVI of the Social Security Act, or who

meet the requirements for aid or assistance under a State plan

approved under title I, X, XIV, or XVI of the Social Security Act

of the State in which such project is conducted (as such State

plan was in effect for July 1973),

the Secretary may waive such requirements of title XVI of such Act

(as enacted by section 301 of the Social Security Amendments of

1972) to such extent as he determines to be necessary to the

successful operation of such project.

"(c) In the case of any State which has entered into an agreement

with the Secretary under section 1616 of the Social Security Act

[section 1382e of this title] (or which is deemed, under section

212(d) of Public Law 93-66 [set out as a note under section 1382 of

this title], to have entered into such an agreement), then, of the

costs of any project of such State with respect to which there is

(solely by reason of the provisions of subsection (a)) Federal

financial participation, the non-Federal share thereof shall -

"(1) be paid, from time to time, to such State by the

Secretary, and

"(2) shall, for purposes of section 1616(d) of the Social

Security Act [section 1382e(d) of this title] and section 401 of

the Social Security Amendments of 1972 [set out as a note under

section 1382e of this title] be treated in like manner as if such

non-Federal share were supplementary payments made by the

Secretary on behalf of such State pursuant to such agreement."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 613, 615, 652, 655,

1396a, 1396b, 1396d, 1396r-5, 1396r-6, 1396t, 1397gg of this title.

-FOOTNOTE-

(!1) So in original. No subsec. (d) has been enacted.

-End-

-CITE-

42 USC Sec. 1316 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. 1316. Administrative and judicial review of public assistance

determinations

-STATUTE-

(a) Determination of conformity with requirements for approval;

petition for reconsideration; hearing; time limitations; review

by court of appeals

(1) Whenever a State plan is submitted to the Secretary by a

State for approval under subchapter I, X, XIV, XVI, or XIX of this

chapter, he shall, not later than 90 days after the date the plan

is submitted to him, make a determination as to whether it conforms

to the requirements for approval under such subchapter. The 90-day

period provided herein may be extended by written agreement of the

Secretary and the affected State.

(2) Any State dissatisfied with a determination of the Secretary

under paragraph (1) of this subsection with respect to any plan

may, within 60 days after it has been notified of such

determination, file a petition with the Secretary for

reconsideration of the issue of whether such plan conforms to the

requirements for approval under such subchapter. Within 30 days

after receipt of such a petition, the Secretary shall notify the

State of the time and place at which a hearing will be held for the

purpose of reconsidering such issue. Such hearing shall be held not

less than 20 days nor more than 60 days after the date notice of

such hearing is furnished to such State, unless the Secretary and

such State agree in writing to holding the hearing at another time.

The Secretary shall affirm, modify, or reverse his original

determination within 60 days of the conclusion of the hearing.

(3) Any State which is dissatisfied with a final determination

made by the Secretary on such a reconsideration or a final

determination of the Secretary under section 304, 1204, 1354, 1384,

or 1396c of this title may, within 60 days after it has been

notified of such determination, file with the United States court

of appeals for the circuit in which such State is located a

petition for review of such determination. A copy of the petition

shall be forthwith transmitted by the clerk of the court to the

Secretary. The Secretary thereupon shall file in the court the

record of the proceedings on which he based his determination as

provided in section 2112 of title 28.

(4) The findings of fact by the Secretary, if supported by

substantial evidence, shall be conclusive; but the court, for good

cause shown, may remand the case to the Secretary to take further

evidence, and the Secretary may thereupon make new or modified

findings of fact and may modify his previous action, and shall

certify to the court the transcript and record of the further

proceedings. Such new or modified findings of fact shall likewise

be conclusive if supported by substantial evidence.

(5) The court shall have jurisdiction to affirm the action of the

Secretary or to set it aside, in whole or in part. The judgment of

the court shall be subject to review by the Supreme Court of the

United States upon certiorari or certification as provided in

section 1254 of title 28.

(b) Amendment of plans

For the purposes of subsection (a) of this section, any amendment

of a State plan approved under subchapter I, X, XIV, XVI, or XIX of

this chapter, may, at the option of the State, be treated as the

submission of a new State plan.

(c) Restitution when Secretary reverses his determination

Action pursuant to an initial determination of the Secretary

described in subsection (a) of this section shall not be stayed

pending reconsideration, but in the event that the Secretary

subsequently determines that his initial determination was

incorrect he shall certify restitution forthwith in a lump sum of

any funds incorrectly withheld or otherwise denied.

(d) Items covered under other subchapters; disallowance

Whenever the Secretary determines that any item or class of items

on account of which Federal financial participation is claimed

under subchapter I, X, XIV, XVI, or XIX of this chapter, shall be

disallowed for such participation, the State shall be entitled to

and upon request shall receive a reconsideration of the

disallowance.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1116, as added Pub. L.

89-97, title IV, Sec. 404(a), July 30, 1965, 79 Stat. 419; amended

Pub. L. 90-248, title II, Sec. 241(c)(5), Jan. 2, 1968, 81 Stat.

917; Pub. L. 93-233, Sec. 18(z-2)(1)(C), Dec. 31, 1973, 87 Stat.

974; Pub. L. 93-647, Sec. 3(d), Jan. 4, 1975, 88 Stat. 2349; Pub.

L. 97-35, title XXIII, Sec. 2353(h), Aug. 13, 1981, 95 Stat. 872;

Pub. L. 98-369, div. B, title III, Sec. 2354(c)(2), title VI, Sec.

2663(e)(6), July 18, 1984, 98 Stat. 1102, 1168; Pub. L. 104-193,

title I, Sec. 108(g)(3), Aug. 22, 1996, 110 Stat. 2168.)

-REFTEXT-

REFERENCES IN TEXT

Section 1384 of this title, referred to in subsec. (a)(3), is a

reference to section 1384 of this title as it existed prior to the

general revision of this subchapter by Pub. L. 92-603, title III,

Sec. 301, Oct. 30, 1972, 86 Stat. 1465, eff. Jan. 1, 1974. The

prior section (which is set out as a note under section 1384 of

this title) continues in effect for Puerto Rico, Guam, and the

Virgin Islands.

-MISC1-

AMENDMENTS

1996 - Subsec. (a)(1). Pub. L. 104-193, Sec. 108(g)(3)(A), struck

out "or part A of subchapter IV of this chapter," after "XIX of

this chapter,".

Subsec. (a)(3). Pub. L. 104-193, Sec. 108(g)(3)(B), struck out

"604," before "1204,".

Subsecs. (b), (d). Pub. L. 104-193, Sec. 108(g)(3)(A), struck out

"or part A of subchapter IV of this chapter," after "XIX of this

chapter,".

1984 - Subsec. (a)(1). Pub. L. 98-369, Sec. 2663(e)(6)(A), struck

out "VI," after "I,".

Pub. L. 98-369, Sec. 2354(c)(2), corrected typographical error in

directory language of Pub. L. 97-35, Sec. 2353(h)(1). See 1982

Amendment note below.

Subsec. (a)(3). Pub. L. 98-369, Sec. 2663(e)(6)(B), struck out

"804," after "604,".

Subsec. (b). Pub. L. 98-369, Sec. 2663(e)(6)(A), struck out "VI,"

after "I,".

Pub. L. 98-369, Sec. 2354(c)(2), corrected typographical error in

directory language of Pub. L. 97-35, Sec. 2353(h)(1). See 1982

Amendment note below.

Subsec. (d). Pub. L. 98-369, Sec. 2663(e)(6)(A), struck out "VI,"

after "I,".

Pub. L. 98-369, Sec. 2663(e)(6)(C), substituted "XVI, or XIX of

this chapter, or part A" for "XVI, or or XIX of this chapter, or

part A".

1981 - Subsec. (a)(1). Pub. L. 97-35, Sec. 2353(h)(1), as amended

by Pub. L. 98-369, Sec. 2354(c)(2), substituted "or XIX of this

chapter" for "XIX or XX of this chapter".

Subsec. (a)(3). Pub. L. 97-35, Sec. 2353(h)(2), substituted "or

1396c of this title" for "1396c, or 1397b of this title".

Subsec. (b). Pub. L. 97-35, Sec. 2353(h)(1), as amended by Pub.

L. 98-369, Sec. 2354(c)(2), substituted "or XIX of this chapter"

for "XIX or XX of this chapter".

Subsec. (d). Pub. L. 97-35, Sec. 2353(h)(3), substituted "or XIX

of this chapter" for "XIX, or XX of this chapter".

1975 - Subsec. (a)(1). Pub. L. 93-647, Sec. 3(d)(1), substituted

"XIX or XX" for "or XIX".

Subsec. (a)(3). Pub. L. 93-647, Sec. 3(d)(2), substituted "1396c,

or 1397b" for "or 1396c".

Subsec. (b). Pub. L. 93-647, Sec. 3(d)(1), substituted "XIX or

XX" for "or XIX".

Subsec. (d). Pub. L. 93-647, Sec. 3(d)(3), inserted "XX," after

"XIX,".

1973 - Subsec. (a). Pub. L. 93-233, Sec. 18(z-2)(1)(C)(i), (ii),

inserted references in par. (1) to subchapter VI of this chapter

and in par. (3) to section 804 of this title.

Subsecs. (b), (d). Pub. L. 93-233, Sec. 18(z-2)(1)(C)(iii), (iv),

inserted reference to subchapter VI of this chapter.

1968 - Subsec. (a)(1). Pub. L. 90-248, Sec. 241(c)(5)(A), struck

out "IV," after "I," and inserted "or part A of subchapter IV of

this chapter," after "XIX of this chapter,".

Subsecs. (b), (d). Pub. L. 90-248, Sec. 241(c)(5)(B), struck out

"IV," after "I," and inserted ", or part A of subchapter IV of this

chapter," after "XIX of this chapter".

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 section 2354(c)(2) of Pub. L. 98-369 effective as if

originally included in Pub. L. 97-35, see section 2354(e)(2) of

Pub. L. 98-369, set out as a note under section 1320a-1 of this

title.

Amendment by section 2663(e)(6) 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 1981 AMENDMENT

Amendment by 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 Pub. L. 93-647 effective with respect to payments

under sections 603 and 803 of this title for quarters commencing

after Sept. 30, 1975, see section 7(b) of Pub. L. 93-647, set out

as a note under section 303 of this title.

EFFECTIVE DATE OF 1973 AMENDMENT

Amendment by Pub. L. 93-233 effective on and after Jan. 1, 1974,

see section 18(z-2)(2) of Pub. L. 93-233, set out as a note under

section 1301 of this title.

EFFECTIVE DATE

Section 404(b) of Pub. L. 89-97 provided that: "The amendment

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

with respect to determinations made after December 31, 1965."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1396b, 1396n, 1396r,

1397gg of this title.

-End-

-CITE-

42 USC Sec. 1317 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. 1317. Appointment of Administrator and Chief Actuary of Health

Care Financing Administration

-STATUTE-

(a) The Administrator of the Health Care Financing Administration

shall be appointed by the President by and with the advice and

consent of the Senate.

(b)(1) There is established in the Health Care Financing

Administration the position of Chief Actuary. The Chief Actuary

shall be appointed by, and in direct line of authority to, the

Administrator of such Administration. The Chief Actuary shall be

appointed from among individuals who have demonstrated, by their

education and experience, superior expertise in the actuarial

sciences. The Chief Actuary shall exercise such duties as are

appropriate for the office of the Chief Actuary and in accordance

with professional standards of actuarial independence. The Chief

Actuary may be removed only for cause.

(2) The Chief Actuary shall be compensated at the highest rate of

basic pay for the Senior Executive Service under section 5382(b) of

title 5.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1117, as added Pub. L.

98-369, div. B, title III, Sec. 2332(a), July 18, 1984, 98 Stat.

1088; amended Pub. L. 105-33, title IV, Sec. 4643, Aug. 5, 1997,

111 Stat. 487.)

-MISC1-

PRIOR PROVISIONS

A prior section 1317, act Aug. 14, 1935, ch. 531, title XI, Sec.

1117, as added July 30, 1965, Pub. L. 89-97, title IV, Sec. 405, 79

Stat. 420; amended Jan. 2, 1968, Pub. L. 90-248, title II, Secs.

221(a)-(c), 241(c)(6), 81 Stat. 899, 917, related to maintenance of

State public assistance expenditures, prior to repeal by Pub. L.

90-248, title II, Sec. 221(d), Jan. 2, 1968, 81 Stat. 900, eff.

July 1, 1968.

AMENDMENTS

1997 - Pub. L. 105-33 amended section catchline, designated

existing provisions as subsec. (a), and added subsec. (b).

EFFECTIVE DATE

Section 2332(c) of Pub. L. 98-369 provided that: "The amendments

made by this section [enacting this section and amending section

5315 of Title 5, Government Organization and Employees] shall apply

to appointments made after the date of the enactment of this Act

[July 18, 1984]."

-End-

-CITE-

42 USC Sec. 1318 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. 1318. Alternative Federal payment with respect to public

assistance expenditures

-STATUTE-

In the case of any State which has in effect a plan approved

under subchapter XIX of this chapter for any calendar quarter, the

total of the payments to which such State is entitled for such

quarter, and for each succeeding quarter in the same fiscal year

(which for purposes of this section means the 4 calendar quarters

ending with September 30), under paragraphs (1) and (2) of sections

303(a),(!1) 1203(a),(!1) 1353(a),(!1) and 1383(a) (!1) of this

title shall, at the option of the State, be determined by

application of the Federal medical assistance percentage (as

defined in section 1396d of this title), instead of the percentages

provided under each such section, to the expenditures under its

State plans approved under subchapters I, X, XIV, and XVI of this

chapter, which would be included in determining the amounts of the

Federal payments to which such State is entitled under such

sections, but without regard to any maximum on the dollar amounts

per recipient which may be counted under such sections. For

purposes of the preceding sentence, the term "Federal medical

assistance percentage" shall, in the case of Puerto Rico, the

Virgin Islands, and Guam, mean 75 per centum.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1118, as added Pub. L.

89-97, title IV, Sec. 411, July 30, 1965, 79 Stat. 423; amended

Pub. L. 90-248, title II, Sec. 241(c)(7), Jan. 2, 1968, 81 Stat.

917; Pub. L. 94-273, Sec. 2(23), Apr. 21, 1976, 90 Stat. 376; Pub.

L. 95-600, title VIII, Sec. 802(a), Nov. 6, 1978, 92 Stat. 2945;

Pub. L. 96-272, title III, Sec. 305(c), June 17, 1980, 94 Stat.

530; Pub. L. 100-485, title VI, Sec. 601(c)(3), Oct. 13, 1988, 102

Stat. 2408; Pub. L. 104-193, title I, Sec. 108(g)(4), Aug. 22,

1996, 110 Stat. 2168.)

-REFTEXT-

REFERENCES IN TEXT

Paragraph (1) of sections 303(a), 1203(a), and 1353(a) of this

title, referred to in text, were repealed by Pub. L. 97-35, title

XXI, Sec. 2184(a)(4)(A), (c)(2)(A), Aug. 13, 1981, 95 Stat. 816,

817.

Section 1383(a) of this title, referred to in text, is a

reference to section 1383(a) of this title as it existed prior to

the general revision of this subchapter by Pub. L. 92-603, title

III, Sec. 301, Oct. 30, 1972, 86 Stat. 1465, eff. Jan. 1, 1974. The

prior section (which is set out as a note under section 1383 of

this title) continues in effect for Puerto Rico, Guam, and the

Virgin Islands.

-MISC1-

AMENDMENTS

1996 - Pub. L. 104-193 struck out "603(a)," before "1203(a),",

"and part A of subchapter IV of this chapter," after "XVI of this

chapter,", and ", and shall, in the case of American Samoa, mean 75

per centum with respect to part A of subchapter IV of this chapter"

after "the Virgin Islands, and Guam, mean 75 per centum".

1988 - Pub. L. 100-485 inserted before period at end ", and

shall, in the case of American Samoa, mean 75 per centum with

respect to part A of subchapter IV of this chapter".

1980 - Pub. L. 96-272 struck out "when applied to quarters in the

fiscal year ending September 30, 1979" after "means 75 per centum".

1978 - Pub. L. 95-600, inserted provision relating to definition

of "Federal medical assistance percentage" in the case of Puerto

Rico, the Virgin Islands, and Guam.

1976 - Pub. L. 94-273 substituted "September" for "June".

1968 - Pub. L. 90-248 struck out "IV," after "I," and inserted

"and part A of subchapter IV of this chapter," after "XVI of this

chapter".

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 1988 AMENDMENT

Amendment by Pub. L. 100-485 effective Oct. 1, 1988, see section

601(d) of Pub. L. 100-485, set out as an Effective and Termination

Dates of 1988 Amendment note under section 1301 of this title.

-FOOTNOTE-

(!1) See References in Text note below.

-End-

-CITE-

42 USC Sec. 1319 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. 1319. Federal participation in payments for repairs to home

owned by recipient of aid or assistance

-STATUTE-

In the case of an expenditure for repairing the home owned by an

individual who is receiving aid or assistance, other than medical

assistance to the aged, under a State plan approved under

subchapter I, X, XIV, or XVI of this chapter, if -

(1) the State agency or local agency administering the plan

approved under such subchapter has made a finding (prior to

making such expenditure) that (A) such home is so defective that

continued occupancy is unwarranted, (B) unless repairs are made

to such home, rental quarters will be necessary for such

individual, and (C) the cost of rental quarters to take care of

the needs of such individual (including his spouse living with

him in such home and any other individual whose needs were taken

into account in determining the need of such individual) would

exceed (over such time as the Secretary may specify) the cost of

repairs needed to make such home habitable together with other

costs attributable to continued occupancy of such home, and

(2) no such expenditures were made for repairing such home

pursuant to any prior finding under this section,

the amount paid to any such State for any quarter under section

303(a), 1203(a), 1353(a), or 1383(a) of this title shall be

increased by 50 per centum of such expenditures, except that the

excess above $500 expended with respect to any one home shall not

be included in determining such expenditures.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1119, as added Pub. L.

90-248, title II, Sec. 209(a), Jan. 2, 1968, 81 Stat. 894; amended

Pub. L. 104-193, title I, Sec. 108(g)(5), Aug. 22, 1996, 110 Stat.

2168.)

-REFTEXT-

REFERENCES IN TEXT

Section 1383(a) of this title, referred to in text, is a

reference to section 1383(a) of this title as it existed prior to

the general revision of this subchapter by Pub. L. 92-603, title

III, Sec. 301, Oct. 30, 1972, 86 Stat. 1465, eff. Jan. 1, 1974. The

prior section (which is set out as a note under section 1383 of

this title) continues in effect for Puerto Rico, Guam, and the

Virgin Islands.

-MISC1-

AMENDMENTS

1996 - Pub. L. 104-193 substituted "subchapter I, X, XIV, or XVI

of this chapter," for "subchapter I, X, XIV, or XVI, or part A of

subchapter IV of this chapter" in introductory provisions and

struck out "603(a)," before "1203(a)," in closing provisions.

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

Section 209(b) of Pub. L. 90-248 provided that: "The amendment

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

respect to expenditures made after December 31, 1967."

-End-

-CITE-

42 USC Sec. 1320 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. 1320. Approval of certain projects

-STATUTE-

No payment shall be made under this chapter with respect to any

experimental, pilot, demonstration, or other project all or any

part of which is wholly financed with Federal funds made available

under this chapter (without any State, local, or other non-Federal

financial participation) unless such project shall have been

personally approved by the Secretary or Deputy Secretary of Health

and Human Services.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1120, as added Pub. L.

90-248, title II, Sec. 249, Jan. 2, 1968, 81 Stat. 919; amended

Pub. L. 93-608, Sec. 2(5), Jan. 2, 1975, 88 Stat. 1971; Pub. L.

97-375, title I, Sec. 107(a), Dec. 21, 1982, 96 Stat. 1820; Pub. L.

98-369, div. B, title VI, Sec. 2663(j)(2)(D)(v), July 18, 1984, 98

Stat. 1170; Pub. L. 101-509, title V, Sec. 529 [title I, Sec.

112(c)], Nov. 5, 1990, 104 Stat. 1427, 1454.)

-MISC1-

AMENDMENTS

1990 - Pub. L. 101-509 substituted "Deputy Secretary of Health

and Human Services" for "Under Secretary of Health and Human

Services".

1984 - Pub. L. 98-369 substituted "Health and Human Services" for

"Health, Education, and Welfare".

1982 - Pub. L. 97-375 struck out subsec. (b) which directed the

Secretary to submit an annual report to Congress describing each

project approved under former subsec. (a) of this section during

the preceding year, including the purpose, probable cost, and

expected duration of each project, and struck out "(a)" before "No

payment".

1975 - Subsec. (b). Pub. L. 93-608 substituted provisions

relating to an annual submission of the required report to the

Congress by the Secretary for each approved project, for provisions

relating to submission of the report as soon as possible after

approval.

EFFECTIVE DATE OF 1990 AMENDMENT; CONTINUED SERVICE BY INCUMBENTS

Amendment by Pub. L. 101-509 effective on the first day of the

first pay period that begins on or after Nov. 5, 1990, with

continued service by incumbent Under Secretary of Health and Human

Services, see section 529 [title I, Sec. 112(e)] of Pub. L.

101-509, set out as a note under section 3404 of Title 20,

Education.

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.

-End-

-CITE-

42 USC Sec. 1320a 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. 1320a. Uniform reporting systems for health services

facilities and organizations

-STATUTE-

(a) Establishment; criteria for regulations; requirements for

hospitals

For the purposes of reporting the cost of services provided by,

of planning, and of measuring and comparing the efficiency of and

effective use of services in, hospitals, skilled nursing

facilities, intermediate care facilities, home health agencies,

health maintenance organizations, and other types of health

services facilities and organizations to which payment may be made

under this chapter, the Secretary shall establish by regulation,

for each such type of health services facility or organization, a

uniform system for the reporting by a facility or organization of

that type of the following information:

(1) The aggregate cost of operation and the aggregate volume of

services.

(2) The costs and volume of services for various functional

accounts and subaccounts.

(3) Rates, by category of patient and class of purchaser.

(4) Capital assets, as defined by the Secretary, including (as

appropriate) capital funds, debt service, lease agreements used

in lieu of capital funds, and the value of land, facilities, and

equipment.

(5) Discharge and bill data.

The uniform reporting system for a type of health services facility

or organization shall provide for appropriate variation in the

application of the system to different classes of facilities or

organizations within that type and shall be established, to the

extent practicable, consistent with the cooperative system for

producing comparable and uniform health information and statistics

described in section 242k(e)(1) of this title. In reporting under

such a system, hospitals shall employ such chart of accounts,

definitions, principles, and statistics as the Secretary may

prescribe in order to reach a uniform reconciliation of financial

and statistical data for specified uniform reports to be provided

to the Secretary.

(b) Monitoring, etc., of systems by Secretary

The Secretary shall -

(1) monitor the operation of the systems established under

subsection (a) of this section;

(2) assist with and support demonstrations and evaluations of

the effectiveness and cost of the operation of such systems and

encourage State adoption of such systems; and

(3) periodically revise such systems to improve their

effectiveness and diminish their cost.

(c) Availability of information to appropriate agencies and

organizations

The Secretary shall provide information obtained through use of

the uniform reporting systems described in subsection (a) of this

section in a useful manner and format to appropriate agencies and

organizations, including health systems agencies (designated under

section 300l-4 (!1) of this title) and State health planning and

development agencies (designated under section 300m (!1) of this

title), as may be necessary to carry out such agencies' and

organizations' functions.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1121, as added Pub. L.

95-142, Sec. 19(a), Oct. 25, 1977, 91 Stat. 1203.)

-REFTEXT-

REFERENCES IN TEXT

Section 300l-4 of this title, referred to in subsec. (c), was

repealed effective Jan. 1, 1987, by Pub. L. 99-660, title VII, Sec.

701(a), Nov. 14, 1986, 100 Stat. 3799.

Section 300m of this title, referred to in subsec. (c), was in

the original a reference to section 1521 of act July 1, 1944, which

was repealed effective Jan. 1, 1987, by Pub. L. 99-660, title VII,

Sec. 701(a), Nov. 14, 1986, 100 Stat. 3799. Pub. L. 101-354, Sec.

2, Aug. 10, 1990, 104 Stat. 410, enacted section 1503 of act July

1, 1944, which is classified to section 300m of this title.

-MISC1-

PRIOR PROVISIONS

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

1121, as added Jan. 2, 1968, Pub. L. 90-248, title II, Sec. 250(a),

81 Stat. 920, provided for assistance in the form of institutional

services in intermediate care facilities, the subsecs. providing as

follows: subsec. (a), modification of certain plans to include such

benefit; subsec. (b), eligible individuals; subsec. (c), payments

and Federal medical assistance percentage; subsec. (d), conditions,

limitations, rights, and obligations applicable to modified plans;

and subsec. (e), definition of "intermediate care facility", which

is covered in section 1396d(c) of this title, prior to repeal by

Pub. L. 92-223, Sec. 4(c), Dec. 28, 1971, 85 Stat. 810.

Section was additionally amended by Pub. L. 92-603, title II,

Sec. 278(a)(24), Oct. 30, 1972, 86 Stat. 1453, without reference to

the earlier repeal of this section by Pub. L. 92-223.

TIME PERIODS FOR ESTABLISHMENT OF UNIFORM REPORTING SYSTEMS;

CONSULTATIONS WITH INTERESTED PARTIES

Section 19(c)(1) of Pub. L. 95-142 directed Secretary of Health,

Education, and Welfare to establish the systems described in

subsec. (a) of this section only after consultation with interested

parties and for hospitals, skilled nursing facilities, and

intermediate care facilities, not later than the end of the one

year period beginning on Oct. 25, 1977, and for other types of

health services facilities and organizations, not later than the

end of the two-year period beginning on Oct. 25, 1977.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1395x, 1396a of this

title.

-FOOTNOTE-

(!1) See References in Text note below.

-End-

-CITE-

42 USC Sec. 1320a-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 A - General Provisions

-HEAD-

Sec. 1320a-1. Limitation on use of Federal funds for capital

expenditures

-STATUTE-

(a) Use of reimbursement for planning activities for health

services and facilities

The purpose of this section is to assure that Federal funds

appropriated under subchapters XVIII and XIX of this chapter are

not used to support unnecessary capital expenditures made by or on

behalf of health care facilities which are reimbursed under any of

such subchapters and that, to the extent possible, reimbursement

under such subchapters shall support planning activities with

respect to health services and facilities in the various States.

(b) Agreement between Secretary and State for submission of

proposed capital expenditures related to health care facilities

and procedures for appeal from recommendations

The Secretary, after consultation with the Governor (or other

chief executive officer) and with appropriate local public

officials, shall make an agreement with any State which is able and

willing to do so under which a designated planning agency (which

shall be an agency described in clause (ii) of subsection (d)(1)(B)

of this section that has a governing body or advisory board at

least half of whose members represent consumer interests) will -

(1) make, and submit to the Secretary together with such

supporting materials as he may find necessary, findings and

recommendations with respect to capital expenditures proposed by

or on behalf of any health care facility in such State within the

field of its responsibilities,

(2) receive from other agencies described in clause (ii) of

subsection (d)(1)(B) of this section, and submit to the Secretary

together with such supporting material as he may find necessary,

the findings and recommendations of such other agencies with

respect to capital expenditures proposed by or on behalf of

health care facilities in such State within the fields of their

respective responsibilities, and

(3) establish and maintain procedures pursuant to which a

person proposing any such capital expenditure may appeal a

recommendation by the designated agency and will be granted an

opportunity for a fair hearing by such agency or person other

than the designated agency as the Governor (or other chief

executive officer) may designate to hold such hearings,

whenever and to the extent that the findings of such designated

agency or any such other agency indicate that any such expenditure

is not consistent with the standards, criteria, or plans developed

pursuant to the Public Health Service Act [42 U.S.C. 201 et seq.]

to meet the need for adequate health care facilities in the area

covered by the plan or plans so developed.

(c) Manner of payment to States for carrying out agreement

The Secretary shall pay any such State from the general fund in

the Treasury, in advance or by way of reimbursement as may be

provided in the agreement with it (and may make adjustments in such

payments on account of overpayments or underpayments previously

made), for the reasonable cost of performing the functions

specified in subsection (b) of this section.

(d) Determination of amount of exclusions from Federal payments

(1) Except as provided in paragraph (2), if the Secretary

determines that -

(A) neither the planning agency designated in the agreement

described in subsection (b) of this section nor an agency

described in clause (ii) of subparagraph (B) of this paragraph

had been given notice of any proposed capital expenditure (in

accordance with such procedure or in such detail as may be

required by such agency) at least 60 days prior to obligation for

such expenditure; or

(B)(i) the planning agency so designated or an agency so

described had received such timely notice of the intention to

make such capital expenditure and had, within a reasonable period

after receiving such notice and prior to obligation for such

expenditure, notified the person proposing such expenditure that

the expenditure would not be in conformity with the standards,

criteria, or plans developed by such agency or any other agency

described in clause (ii) for adequate health care facilities in

such State or in the area for which such other agency has

responsibility, and

(ii) the planning agency so designated had, prior to submitting

to the Secretary the findings referred to in subsection (b) of

this section -

(I) consulted with, and taken into consideration the findings

and recommendations of, the State planning agencies established

pursuant to sections 314(a) and 604(a) of the Public Health

Service Act [42 U.S.C. 246(a), 291d(a)] (to the extent that

either such agency is not the agency so designated) as well as

the public or nonprofit private agency or organization

responsible for the comprehensive regional, metropolitan area,

or other local area plan or plans referred to in section 314(b)

of the Public Health Service Act [42 U.S.C. 246(b)] and

covering the area in which the health care facility proposing

such capital expenditure is located (where such agency is not

the agency designated in the agreement), or, if there is no

such agency, such other public or nonprofit private agency or

organization (if any) as performs, as determined in accordance

with criteria included in regulations, similar functions, and

(II) granted to the person proposing such capital expenditure

an opportunity for a fair hearing with respect to such

findings;

then, for such period as he finds necessary in any case to

effectuate the purpose of this section, he shall, in determining

the Federal payments to be made under subchapters XVIII and XIX of

this chapter with respect to services furnished in the health care

facility for which such capital expenditure is made, not include

any amount which is attributable to depreciation, interest on

borrowed funds, a return on equity capital (in the case of

proprietary facilities), or other expenses related to such capital

expenditure. With respect to any organization which is reimbursed

on a per capita or a fixed fee or negotiated rate basis, in

determining the Federal payments to be made under subchapters XVIII

and XIX of this chapter, the Secretary shall exclude an amount

which in his judgment is a reasonable equivalent to the amount

which would otherwise be excluded under this subsection if payment

were to be made on other than a per capita or a fixed fee or

negotiated rate basis.

(2) If the Secretary, after submitting the matters involved to

the advisory council established or designated under subsection (i)

of this section, determines that an exclusion of expenses related

to any capital expenditure of any health care facility would

discourage the operation or expansion of such facility which has

demonstrated to his satisfaction proof of capability to provide

comprehensive health care services (including institutional

services) efficiently, effectively, and economically, or would

otherwise be inconsistent with the effective organization and

delivery of health services or the effective administration of

subchapter XVIII or XIX of this chapter, he shall not exclude such

expenses pursuant to paragraph (1).

(e) Treatment of lease or comparable arrangement of any facility or

equipment for a facility in determining amount of exclusions from

Federal payments

Where a person obtains under lease or comparable arrangement any

facility or part thereof, or equipment for a facility, which would

have been subject to an exclusion under subsection (d) of this

section if the person had acquired it by purchase, the Secretary

shall (1) in computing such person's rental expense in determining

the Federal payments to be made under subchapters XVIII and XIX of

this chapter with respect to services furnished in such facility,

deduct the amount which in his judgment is a reasonable equivalent

of the amount that would have been excluded if the person had

acquired such facility or such equipment by purchase, and (2) in

computing such person's return on equity capital deduct any amount

deposited under the terms of the lease or comparable arrangement.

(f) Reconsideration by Secretary of determinations

Any person dissatisfied with a determination by the Secretary

under this section may within six months following notification of

such determination request the Secretary to reconsider such

determination. A determination by the Secretary under this section

shall not be subject to administrative or judicial review.

(g) "Capital expenditure" defined

For the purposes of this section, a "capital expenditure" is an

expenditure which, under generally accepted accounting principles,

is not properly chargeable as an expense of operation and

maintenance and which (1) exceeds $600,000 (or such lesser amount

as the State may establish), (2) changes the bed capacity of the

facility with respect to which such expenditure is made, or (3)

substantially changes the services of the facility with respect to

which such expenditure is made. For purposes of clause (1) of the

preceding sentence, the cost of the studies, surveys, designs,

plans, working drawings, specifications, and other activities

essential to the acquisition, improvement, expansion, or

replacement of the plant and equipment with respect to which such

expenditure is made shall be included in determining whether such

expenditure exceeds the dollar amount specified in clause (1).

(h) Applicability to Christian Science sanatoriums

The provisions of this section shall not apply to a religious

nonmedical health care institution (as defined in section

1395x(ss)(1) of this title).

(i) National advisory council; establishment or designation of

existing council; functions; consultations with other appropriate

national advisory councils; composition; compensation and travel

expenses

(1) The Secretary shall establish a national advisory council, or

designate an appropriate existing national advisory council, to

advise and assist him in the preparation of general regulations to

carry out the purposes of this section and on policy matters

arising in the administration of this section, including the

coordination of activities under this section with those under

other parts of this chapter or under other Federal or federally

assisted health programs.

(2) The Secretary shall make appropriate provision for

consultation between and coordination of the work of the advisory

council established or designated under paragraph (1) and the

Federal Hospital Council, the National Advisory Health Council, the

Health Insurance Benefits Advisory Council, and other appropriate

national advisory councils with respect to matters bearing on the

purposes and administration of this section and the coordination of

activities under this section with related Federal health programs.

(3) If an advisory council is established by the Secretary under

paragraph (1), it shall be composed of members who are not

otherwise in the regular full-time employ of the United States, and

who shall be appointed by the Secretary without regard to the civil

service laws from among leaders in the fields of the fundamental

sciences, the medical sciences, and the organization, delivery, and

financing of health care, and persons who are State or local

officials or are active in community affairs or public or civic

affairs or who are representative of minority groups. Members of

such advisory council, while attending meetings of the council or

otherwise serving on business of the council, shall be entitled to

receive compensation at rates fixed by the Secretary, but not

exceeding the maximum rate specified at the time of such service

for grade GS-18 in section 5332 of title 5, including traveltime,

and while away from their homes or regular places of business they

may also be allowed travel expenses, including per diem in lieu of

subsistence, as authorized by section 5703 of such title 5 for

persons in the Government service employed intermittently.

(j) Capital expenditure review exception for eligible organization

health care facilities

A capital expenditure made by or on behalf of a health care

facility shall not be subject to review pursuant to this section if

75 percent of the patients who can reasonably be expected to use

the service with respect to which the capital expenditure is made

will be individuals enrolled in an eligible organization as defined

in section 1395mm(b) of this title, and if the Secretary determines

that such capital expenditure is for services and facilities which

are needed by such organization in order to operate efficiently and

economically and which are not otherwise readily accessible to such

organization because -

(1) the facilities do not provide common services at the same

site (as usually provided by the organization),

(2) the facilities are not available under a contract of

reasonable duration,

(3) full and equal medical staff privileges in the facilities

are not available,

(4) arrangements with such facilities are not administratively

feasible, or

(5) the purchase of such services is more costly than if the

organization provided the services directly.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1122, as added Pub. L.

92-603, title II, Sec. 221(a), Oct. 30, 1972, 86 Stat. 1386;

amended Pub. L. 93-233, Sec. 18(z), (z-1), Dec. 31, 1973, 87 Stat.

973; Pub. L. 95-559, Sec. 14(b), Nov. 1, 1978, 92 Stat. 2141; Pub.

L. 96-32, Sec. 2(c), July 10, 1979, 93 Stat. 82; Pub. L. 97-35,

title XXI, Sec. 2193(c)(3), Aug. 13, 1981, 95 Stat. 827; Pub. L.

97-248, title I, Sec. 137(a)(5), Sept. 3, 1982, 96 Stat. 376; Pub.

L. 98-21, title VI, Sec. 607(a), (b)(1), (c), Apr. 20, 1983, 97

Stat. 171, 172; Pub. L. 98-369, div. B, title III, Sec. 2354(a)(1),

(2), July 18, 1984, 98 Stat. 1100; Pub. L. 105-33, title IV, Sec.

4454(c)(1), Aug. 5, 1997, 111 Stat. 431.)

-REFTEXT-

REFERENCES IN TEXT

The Public Health Service Act, referred to in subsec. (b), is act

July 1, 1944, ch. 373, 58 Stat. 682, as amended, which is

classified generally to chapter 6A (201 et seq.) of this title. For

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

note set out under section 201 of this title and Tables.

The civil service laws, referred to in subsec. (i)(3), are set

out in Title 5, Government Organization and Employees. See,

particularly, section 3301 et seq. of Title 5.

-MISC1-

AMENDMENTS

1997 - Subsec. (h). Pub. L. 105-33 substituted "a religious

nonmedical health care institution (as defined in section

1395x(ss)(1) of this title)." for "Christian Science sanatoriums

operated, or listed and certified, by the First Church of Christ,

Scientist, Boston, Massachusetts."

1984 - Subsec. (b). Pub. L. 98-369, Sec. 2354(a)(1), substituted

a comma for the period at end of par. (1), and struck out "(or the

Mental Retardation Facilities and Community Mental Health Centers

Construction Act of 1963)" before "to meet the need" in provisions

following par. (3).

Subsec. (i)(3). Pub. L. 98-369, Sec. 2354(a)(2), substituted

"5703" for "5703(b)".

1983 - Subsec. (c). Pub. L. 98-21, Sec. 607(a), substituted "the

general fund in the Treasury" for "the Federal Hospital Insurance

Trust Fund".

Subsec. (g). Pub. L. 98-21, Sec. 607(b)(1), substituted "$600,000

(or such lesser amount as the State may establish)" for "$100,000"

and Pub. L. 98-21, Sec. 607(b)(1)(B), substituted "the dollar

amount specified in clause (1)" for "$100,000" the second time it

appeared.

Subsec. (j). Pub. L. 98-21, Sec. 607(c), added subsec. (j).

1982 - Subsec. (d)(2). Pub. L. 97-248 amended directory language

of Pub. L. 97-35, Sec. 2193(c)(3)(B), to correct typographical

error, and did not involve any change in text. See 1981 Amendment

note below.

1981 - Subsec. (a). Pub. L. 97-35, Sec. 2193(c)(3)(A),

substituted "subchapters XVIII and XIX of this chapter" for

"subchapters V, XVIII, and XIX of this chapter".

Subsec. (d)(1). Pub. L. 97-35, Sec. 2193(c)(3)(A), substituted in

provision following subpar. (B)(ii)(II) "subchapters XVIII and XIX

of this chapter" for "subchapters V, XVIII, and XIX of this

chapter" in two places.

Subsec. (d)(2). Pub. L. 97-35, Sec. 2193(c)(3)(B), as amended by

Pub. L. 97-248, Sec. 137(a)(5), substituted "subchapter XVIII or

XIX of this chapter" for "subchapter V, XVIII, or XIX of this

chapter".

Subsec. (e). Pub. L. 97-35, Sec. 2193(c)(3)(A), substituted

"subchapters XVIII and XIX of this chapter" for "subchapters V,

XVIII, and XIX of this chapter".

1979 - Pub. L. 96-32 amended directory language of Pub. L. 95-559

and required no change in text of section. See 1978 Amendment notes

below.

1978 - Subsecs. (a), (b). Pub. L. 95-559, Sec. 14(b)(1), (2), as

amended by Pub. L. 96-32, struck out references to health

maintenance organizations wherever appearing.

Subsec. (d). Pub. L. 95-559, Sec. 14(b)(1), (3), as amended by

Pub. L. 96-32, struck out references to health maintenance

organizations wherever appearing and in par. (2) "or organization,

or of any facility of such organization," after "expansion of such

facility".

1973 - Subsec. (d)(1). Pub. L. 93-233, Sec. 18(z), inserted "or a

fixed fee or negotiated rate" after "per capita" wherever appearing

in last sentence.

Subsec. (d)(2). Pub. L. 93-233, Sec. 18(z-1), substituted

"exclude" for "include" where last appearing.

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.

EFFECTIVE DATE OF 1984 AMENDMENT

Section 2354(e) of Pub. L. 98-369 provided that:

"(1) Except as provided in paragraph (2), the amendments made by

this section [amending this section and sections 1316, 1320a-7a,

1320a-8, 1395f, 1395i, 1395i-2, 1395k, 1395l, 1395n, 1395p, 1395s

to 1395z, 1395aa, 1395cc, 1395ff, 1395ii, 1395ll, 1395mm, 1395oo,

1395rr, and 1395ww of this title and section 162 of Title 26,

Internal Revenue Code, and amending provisions set out as notes

under sections 1320c, 1395x, and 1395mm of this title] shall be

effective on the date of the enactment of this Act [July 18, 1984];

but none of such amendments shall be construed as changing or

affecting any right, liability, status, or interpretation which

existed (under the provisions of law involved) before that date.

"(2) The amendments made by paragraphs (1) [amending section

1395f of this title and provisions set out as a note under section

1395x of this title], (2) [amending section 1316 of this title],

and (3) [amending provisions set out as notes under sections 1320c

and 1395mm of this title] of subsection (c) shall be effective as

if they had been originally included in Public Laws 96-499, 97-35,

and 97-248, respectively."

EFFECTIVE DATE OF 1982 AMENDMENT

Amendment by Pub. L. 97-248 effective as if originally included

as part of this section as this section was amended by the Omnibus

Budget Reconciliation Act of 1981, Pub. L. 97-35, see section

137(d)(2) of Pub. L. 97-248, set out as a note under section 1396a

of this title.

EFFECTIVE DATE OF 1981 AMENDMENT, SAVINGS, AND TRANSITIONAL

PROVISIONS

For effective date, savings, and transitional provisions relating

to amendment by Pub. L. 97-35, see section 2194 of Pub. L. 97-35,

set out as a note under section 701 of this title.

EFFECTIVE DATE

Section 221(b) of Pub. L. 92-603 provided that: "The amendment

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

with respect to a capital expenditure the obligation for which is

incurred by or on behalf of a health care facility or health

maintenance organization subsequent to whichever of the following

is earlier: (A) December 31, 1972, or (B) with respect to any State

or any part thereof specified by such State, the last day of the

calendar quarter in which the State requests that the amendment

made by subsection (a) of this section [enacting this section]

apply in such State or such part thereof."

TERMINATION OF ADVISORY COUNCILS

Advisory councils in existence on Jan. 5, 1973, to terminate not

later than the expiration of the 2-year period following Jan. 5,

1973, unless, in the case of a council established by the President

or an officer of the Federal Government, such council is renewed by

appropriate action prior to the expiration of such 2-year period,

or in the case of a council established by the Congress, its

duration is otherwise provided by law. Advisory councils

established after Jan. 5, 1973, to terminate not later than the

expiration of the 2-year period beginning on the date of their

establishment, unless, in the case of a council established by the

President or an officer of the Federal Government, such council is

renewed by appropriate action prior to the expiration of such

2-year period, or in the case of a council established by the

Congress, its duration is otherwise provided by law. See sections

3(2) and 14 of Pub. L. 92-463, Oct. 6, 1972, 86 Stat. 770, 776, set

out in the Appendix to Title 5, Government Organization and

Employees.

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.

EXPENDITURES OR OBLIGATIONS OF HEALTH CARE FACILITIES PROVIDING

HEALTH CARE SERVICES PRIOR TO DECEMBER 18, 1970; LIMITATIONS ON

FEDERAL PARTICIPATION

Section 221(d) of Pub. L. 92-603 provided that: "In the case of a

health care facility providing health care services as of December

18, 1970, which on such date is committed to a formal plan of

expansion or replacement, the amendments made by the preceding

provisions of this section [enacting this section and amending

sections 705, 706, 709, 1395x, 1396a, and 1396b of this title]

shall not apply with respect to such expenditures as may be made or

obligations incurred for capital items included in such plan where

preliminary expenditures toward the plan of expansion or

replacement (including payments for studies, surveys, designs,

plans, working drawings, specifications, and site acquisition,

essential to the acquisition, improvement, expansion, or

replacement of the health care facility or equipment concerned) of

$100,000 or more, had been made during the three-year period ended

December 17, 1970."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1395x, 1396b, 6371d of

this title.

-End-

-CITE-

42 USC Sec. 1320a-1a 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. 1320a-1a. Transferred

-COD-

CODIFICATION

Section, act Aug. 14, 1935, ch. 531, title XI, Sec. 1123, as

added Oct. 31, 1994, Pub. L. 103-432, title II, Sec. 203(a), 108

Stat. 4454, which related to reviews of child and family services

programs, and of foster care and adoption assistance programs, for

conformity with State plan requirements, was renumbered section

1123A of act Aug. 14, 1935, by Pub. L. 104-193, title V, Sec. 504,

Aug. 22, 1996, 110 Stat. 2278, and was transferred to section

1320a-2a of this title.

-End-

-CITE-

42 USC Sec. 1320a-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 A - General Provisions

-HEAD-

Sec. 1320a-2. Effect of failure to carry out State plan

-STATUTE-

In an action brought to enforce a provision of this chapter, such

provision is not to be deemed unenforceable because of its

inclusion in a section of this chapter requiring a State plan or

specifying the required contents of a State plan. This section is

not intended to limit or expand the grounds for determining the

availability of private actions to enforce State plan requirements

other than by overturning any such grounds applied in Suter v.

Artist M., 112 S. Ct. 1360 (1992), but not applied in prior Supreme

Court decisions respecting such enforceability; provided, however,

that this section is not intended to alter the holding in Suter v.

Artist M. that section 671(a)(15) of this title is not enforceable

in a private right of action.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1123, as added Pub. L.

103-382, title V, Sec. 555(a), Oct. 20, 1994, 108 Stat. 4057.)

-MISC1-

PRIOR PROVISIONS

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

Sec. 1123, as added Oct. 30, 1972, Pub. L. 92-603, title II, Sec.

241, 86 Stat. 1418; amended Dec. 5, 1980, Pub. L. 96-499, title IX,

Sec. 911, 94 Stat. 2619; Sept. 3, 1982, Pub. L. 97-248, title I,

Sec. 126, 96 Stat. 366; Apr. 7, 1986, Pub. L. 99-272, title IX,

Sec. 9303(b)(4), 100 Stat. 189, related to qualifications for

health care personnel, prior to repeal by Pub. L. 100-360, title

IV, Sec. 430(a), as added Pub. L. 100-485, title VI, Sec. 608(b),

(g)(1), Oct. 13, 1988, 102 Stat. 2412, 2424, effective as if

included in the enactment of Pub. L. 100-360.

Another section 1123 of act Aug. 14, 1935, was renumbered section

1123A, and is classified to section 1320a-2a of this title.

EFFECTIVE DATE

Section 555(b) of Pub. L. 103-382 provided that: "The amendment

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

actions pending on the date of the enactment of this Act [Oct. 20,

1994] and to actions brought on or after such date of enactment."

-End-

-CITE-

42 USC Sec. 1320a-2a 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. 1320a-2a. Reviews of child and family services programs, and

of foster care and adoption assistance programs, for conformity

with State plan requirements

-STATUTE-

(a) In general

The Secretary, in consultation with the State agencies

administering the State programs under parts B and E of subchapter

IV of this chapter, shall promulgate regulations for the review of

such programs to determine whether such programs are in substantial

conformity with -

(1) State plan requirements under such parts B and E,

(2) implementing regulations promulgated by the Secretary, and

(3) the relevant approved State plans.

(b) Elements of review system

The regulations referred to in subsection (a) of this section

shall -

(1) specify the timetable for conformity reviews of State

programs, including -

(A) an initial review of each State program;

(B) a timely review of a State program following a review in

which such program was found not to be in substantial

conformity; and

(C) less frequent reviews of State programs which have been

found to be in substantial conformity, but such regulations

shall permit the Secretary to reinstate more frequent reviews

based on information which indicates that a State program may

not be in conformity;

(2) specify the requirements subject to review, and the

criteria to be used to measure conformity with such requirements

and to determine whether there is a substantial failure to so

conform;

(3) specify the method to be used to determine the amount of

any Federal matching funds to be withheld (subject to paragraph

(4)) due to the State program's failure to so conform, which

ensures that -

(A) such funds will not be withheld with respect to a

program, unless it is determined that the program fails

substantially to so conform;

(B) such funds will not be withheld for a failure to so

conform resulting from the State's reliance upon and correct

use of formal written statements of Federal law or policy

provided to the State by the Secretary; and

(C) the amount of such funds withheld is related to the

extent of the failure to so conform; and

(4) require the Secretary, with respect to any State program

found to have failed substantially to so conform -

(A) to afford the State an opportunity to adopt and implement

a corrective action plan, approved by the Secretary, designed

to end the failure to so conform;

(B) to make technical assistance available to the State to

the extent feasible to enable the State to develop and

implement such a corrective action plan;

(C) to suspend the withholding of any Federal matching funds

under this section while such a corrective action plan is in

effect; and

(D) to rescind any such withholding if the failure to so

conform is ended by successful completion of such a corrective

action plan.

(c) Provisions for administrative and judicial review

The regulations referred to in subsection (a) of this section

shall -

(1) require the Secretary, not later than 10 days after a final

determination that a program of the State is not in conformity,

to notify the State of -

(A) the basis for the determination; and

(B) the amount of the Federal matching funds (if any) to be

withheld from the State;

(2) afford the State an opportunity to appeal the determination

to the Departmental Appeals Board within 60 days after receipt of

the notice described in paragraph (1) (or, if later, after

failure to continue or to complete a corrective action plan); and

(3) afford the State an opportunity to obtain judicial review

of an adverse decision of the Board, within 60 days after the

State receives notice of the decision of the Board, by appeal to

the district court of the United States for the judicial district

in which the principal or headquarters office of the agency

responsible for administering the program is located.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1123A, formerly Sec. 1123,

as added Pub. L. 103-432, title II, Sec. 203(a), Oct. 31, 1994, 108

Stat. 4454; renumbered Sec. 1123A, Pub. L. 104-193, title V, Sec.

504, Aug. 22, 1996, 110 Stat. 2278.)

-REFTEXT-

REFERENCES IN TEXT

Parts B and E of subchapter IV of this chapter, referred to in

subsec. (a), are classified to sections 620 et seq. and 670 et

seq., respectively, of this title.

-COD-

CODIFICATION

Section was formerly classified to section 1320a-1a of this title

prior to renumbering by Pub. L. 104-193.

-MISC1-

EFFECTIVE DATE

Section 203(c)(1) of Pub. L. 103-432 provided that: "The

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

effect on the date of the enactment of this Act [Oct. 31, 1994]."

REGULATIONS

Section 203(c)(3) of Pub. L. 103-432 provided that: "The

Secretary shall promulgate the regulations referred to in section

1123(a) [now 1123A(a)] of the Social Security Act [subsec. (a) of

this section] (as added by this section) not later than July 1,

1995, to take effect on April 1, 1996."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 629h, 674 of this title.

-End-

-CITE-

42 USC Sec. 1320a-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 A - General Provisions

-HEAD-

Sec. 1320a-3. Disclosure of ownership and related information;

procedure; definitions; scope of requirements

-STATUTE-

(a)(1) The Secretary shall by regulation or by contract provision

provide that each disclosing entity (as defined in paragraph (2))

shall -

(A) as a condition of the disclosing entity's participation in,

or certification or recertification under, any of the programs

established by subchapters V, XVIII, and XIX of this chapter, or

(B) as a condition for the approval or renewal of a contract or

agreement between the disclosing entity and the Secretary or the

appropriate State agency under any of the programs established

under subchapters V, XVIII, and XIX of this chapter,

supply the Secretary or the appropriate State agency with full and

complete information as to the identity of each person with an

ownership or control interest (as defined in paragraph (3)) in the

entity or in any subcontractor (as defined by the Secretary in

regulations) in which the entity directly or indirectly has a 5 per

centum or more ownership interest and supply the Secretary with the

(!1) both the employer identification number (assigned pursuant to

section 6109 of the Internal Revenue Code of 1986) and social

security account number (assigned under section 405(c)(2)(B) of

this title) of the disclosing entity, each person with an ownership

or control interest (as defined in subsection (a)(3) of this

section), and any subcontractor in which the entity directly or

indirectly has a 5 percent or more ownership interest.

(2) As used in this section, the term "disclosing entity" means

an entity which is -

(A) a provider of services (as defined in section 1395x(u) of

this title, other than a fund), an independent clinical

laboratory, a renal disease facility, a managed care entity, as

defined in section 1396u-2(a)(1)(B) of this title, or a health

maintenance organization (as defined in section 300e(a) of this

title);

(B) an entity (other than an individual practitioner or group

of practitioners) that furnishes, or arranges for the furnishing

of, items or services with respect to which payment may be

claimed by the entity under any plan or program established

pursuant to subchapter V of this chapter or under a State plan

approved under subchapter XIX of this chapter; or

(C) a carrier or other agency or organization that is acting as

a fiscal intermediary or agent with respect to one or more

providers of services (for purposes of part A or part B of

subchapter XVIII of this chapter, or both, or for purposes of a

State plan approved under subchapter XIX of this chapter)

pursuant to (i) an agreement under section 1395h of this title,

(ii) a contract under section 1395u of this title, or (iii) an

agreement with a single State agency administering or supervising

the administration of a State plan approved under subchapter XIX

of this chapter.

(3) As used in this section, the term "person with an ownership

or control interest" means, with respect to an entity, a person who

-

(A)(i) has directly or indirectly (as determined by the

Secretary in regulations) an ownership interest of 5 per centum

or more in the entity; or

(ii) is the owner of a whole or part interest in any mortgage,

deed of trust, note, or other obligation secured (in whole or in

part) by the entity or any of the property or assets thereof,

which whole or part interest is equal to or exceeds 5 per centum

of the total property and assets of the entity; or

(B) is an officer or director of the entity, if the entity is

organized as a corporation; or

(C) is a partner in the entity, if the entity is organized as a

partnership.

(b) To the extent determined to be feasible under regulations of

the Secretary, a disclosing entity shall also include in the

information supplied under subsection (a)(1) of this section, with

respect to each person with an ownership or control interest in the

entity, the name of any other disclosing entity with respect to

which the person is a person with an ownership or control interest.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1124, as added Pub. L.

95-142, Sec. 3(a)(1), Oct. 25, 1977, 91 Stat. 1177; amended Pub. L.

96-499, title IX, Sec. 912(a), Dec. 5, 1980, 94 Stat. 2619; Pub. L.

97-35, title XXIII, Sec. 2353(i), Aug. 13, 1981, 95 Stat. 872; Pub.

L. 100-93, Sec. 11, Aug. 18, 1987, 101 Stat. 697; Pub. L. 105-33,

title IV, Secs. 4313(a), 4707(c), Aug. 5, 1997, 111 Stat. 388,

506.)

-REFTEXT-

REFERENCES IN TEXT

The Internal Revenue Code of 1986, referred to in subsec. (a)(1),

is classified generally to Title 26, Internal Revenue Code.

Parts A and B of subchapter XVIII of this chapter, referred to in

subsec. (a)(2)(C), are classified to sections 1395c et seq. and

1395j et seq. of this title.

-MISC1-

AMENDMENTS

1997 - Subsec. (a)(1). Pub. L. 105-33, Sec. 4313(a), inserted

before period at end of concluding provisions "and supply the

Secretary with the both the employer identification number

(assigned pursuant to section 6109 of the Internal Revenue Code of

1986) and social security account number (assigned under section

405(c)(2)(B) of this title) of the disclosing entity, each person

with an ownership or control interest (as defined in subsection

(a)(3) of this section), and any subcontractor in which the entity

directly or indirectly has a 5 percent or more ownership interest."

The substitution was made to reflect the probable intent of

Congress, in the absence of closing quotations designating the

provisions to be inserted.

Subsec. (a)(2)(A). Pub. L. 105-33, Sec. 4707(c), inserted "a

managed care entity, as defined in section 1396u-2(a)(1)(B) of this

title," after "renal disease facility,".

1987 - Subsec. (a)(3)(A)(ii). Pub. L. 100-93 struck out "$25,000

or" after "exceeds".

1981 - Subsec. (a)(1). Pub. L. 97-35, Sec. 2353(i)(1),

substituted in subpars. (A) and (B) "and XIX of this chapter" for

"XIX, and XX of this chapter".

Subsec. (a)(2)(D). Pub. L. 97-35, Sec. 2353(i)(2)(C), struck out

subpar. (D) which included within term "disclosing entity" an

entity, other than an individual practitioner or group of

practitioners, that furnishes, or arranges for the furnishing of,

health related services with respect to which payment may be

claimed by the entity under a State plan or program approved under

subchapter XX of this chapter.

1980 - Subsec. (a)(3)(A)(ii). Pub. L. 96-499 substituted "of a

whole or part interest" for "(in whole or in part) of an interest

of 5 per centum or more" and inserted ", which whole or part

interest is equal to or exceeds $25,000 or 5 per centum of the

total property and assets of the entity".

EFFECTIVE DATE OF 1997 AMENDMENT

Section 4313(e) of Pub. L. 105-33 provided that:

"(1) Disclosure requirements. - The amendment made by subsection

(a) [amending this section] shall apply to the application of

conditions of participation, and entering into and renewal of

contracts and agreements, occurring more than 90 days after the

date of submission of the report under subsection (d) [set out as a

note below].

"(2) Other providers. - The amendments made by subsection (b)

[amending section 1320a-3a of this title] shall apply to payment

for items and services furnished more than 90 days after the date

of submission of such report."

Amendment by section 4707(c) of Pub. L. 105-33 effective Aug. 5,

1997, and applicable to contracts entered into or renewed on or

after Oct. 1, 1997, see section 4710 of Pub. L. 105-33, set out as

a note under section 1396b of this title.

EFFECTIVE DATE OF 1987 AMENDMENT

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.

EFFECTIVE DATE OF 1981 AMENDMENT

Amendment by 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

Section 3(e) of Pub. L. 95-142 provided that: "The amendment made

by subsection (a)(1) [enacting this section] shall apply with

respect to certifications and recertifications made (and

participation in the programs established by titles V, XVIII, XIX,

and XX of the Social Security Act [subchapters V, XVIII, XIX, and

XX of this chapter] pursuant to certifications and recertifications

made), and fiscal intermediary or agent agreements or contracts

entered into or renewed, on and after the date of the enactment of

this Act [Oct. 25, 1977]. The remaining amendments made by this

section [amending sections 1395x and 1395cc of this title] shall

take effect on the date of the enactment of this Act [Oct. 25,

1977]; except that the amendments made by subsections (c) and (d)

[amending sections 1396a, 1396b, 1397a, and 1397b of this title]

shall become effective January 1, 1978."

REPORT ON CONFIDENTIALITY OF SOCIAL SECURITY ACCOUNT NUMBERS

Section 4313(d) of Pub. L. 105-33 provided that: "Before the

amendments made by this section [amending this section and section

1320a-3a of this title] may become effective, the Secretary of

Health and Human Services shall submit to Congress a report on

steps the Secretary has taken to assure the confidentiality of

social security account numbers that will be provided to the

Secretary under such amendments."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 300e-17, 1320a-3a,

1320a-7, 1395i-3, 1395m, 1395w-27, 1395bbb, 1396a, 1396b, 1396r,

1396t, 1397gg, 14902 of this title.

-FOOTNOTE-

(!1) So in original. The word "the" probably should not appear.

-End-

-CITE-

42 USC Sec. 1320a-3a 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. 1320a-3a. Disclosure requirements for other providers under

part B of Medicare

-STATUTE-

(a) Disclosure required to receive payment

No payment may be made under part B of subchapter XVIII of this

chapter for items or services furnished by any disclosing part B

provider unless such provider has provided the Secretary with full

and complete information -

(1) on the identity of each person with an ownership or control

interest in the provider or in any subcontractor (as defined by

the Secretary in regulations) in which the provider directly or

indirectly has a 5 percent or more ownership interest;

(2) with respect to any person identified under paragraph (1)

or any managing employee of the provider -

(A) on the identity of any other entities providing items or

services for which payment may be made under subchapter XVIII

of this chapter with respect to which such person or managing

employee is a person with an ownership or control interest at

the time such information is supplied or at any time during the

3-year period ending on the date such information is supplied,

and

(B) as to whether any penalties, assessments, or exclusions

have been assessed against such person or managing employee

under section 1320a-7, 1320a-7a, or 1320a-7b of this title; and

(3) including the employer identification number (assigned

pursuant to section 6109 of the Internal Revenue Code of 1986)

and social security account number (assigned under section

405(c)(2)(B) of this title) of the disclosing part B provider and

any person, managing employee, or other entity identified or

described under paragraph (1) or (2).

(b) Updates to information supplied

A disclosing part B provider shall notify the Secretary of any

changes or updates to the information supplied under subsection (a)

of this section not later than 180 days after such changes or

updates take effect.

(c) Verification

(1) Transmittal by HHS

The Secretary shall transmit -

(A) to the Commissioner of Social Security information

concerning each social security account number (assigned under

section 405(c)(2)(B) of this title), and

(B) to the Secretary of the Treasury information concerning

each employer identification number (assigned pursuant to

section 6109 of the Internal Revenue Code of 1986),

supplied to the Secretary pursuant to subsection (a)(3) of this

section or section 1320a-3(c) (!1) of this title to the extent

necessary for verification of such information in accordance with

paragraph (2).

(2) Verification

The Commissioner of Social Security and the Secretary of the

Treasury shall verify the accuracy of, or correct, the

information supplied by the Secretary to such official pursuant

to paragraph (1), and shall report such verifications or

corrections to the Secretary.

(3) Fees for verification

The Secretary shall reimburse the Commissioner and Secretary of

the Treasury, at a rate negotiated between the Secretary and such

official, for the costs incurred by such official in performing

the verification and correction services described in this

subsection.

(d) Definitions

For purposes of this section -

(1) the term "disclosing part B provider" means any entity

receiving payment on an assignment-related basis (or, for

purposes of subsection (a)(3) of this section, any entity

receiving payment) for furnishing items or services for which

payment may be made under part B of subchapter XVIII of this

chapter, except that such term does not include an entity

described in section 1320a-3(a)(2) of this title;

(2) the term "managing employee" means, with respect to a

provider, a person described in section 1320a-5(b) of this title;

and

(3) the term "person with an ownership or control interest"

means, with respect to a provider -

(A) a person described in section 1320a-3(a)(3) of this

title, or

(B) a person who has one of the 5 largest direct or indirect

ownership or control interests in the provider.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1124A, as added Pub. L.

101-508, title IV, Sec. 4164(b)(1), Nov. 5, 1990, 104 Stat.

1388-101; amended Pub. L. 103-432, title I, Sec. 147(f)(7)(A)(i),

Oct. 31, 1994, 108 Stat. 4432; Pub. L. 105-33, title IV, Sec.

4313(b), (c), Aug. 5, 1997, 111 Stat. 388.)

-REFTEXT-

REFERENCES IN TEXT

Part B of subchapter XVIII of this chapter, referred to in

subsecs. (a) and (d)(1), is classified to section 1395j et seq. of

this title.

The Internal Revenue Code of 1986, referred to in subsecs. (a)(3)

and (c)(1)(B), is classified generally to Title 26, Internal

Revenue Code.

Section 1320a-3 of this title, referred to in subsec. (c)(1),

does not contain a subsec. (c).

-MISC1-

AMENDMENTS

1997 - Subsec. (a)(3). Pub. L. 105-33, Sec. 4313(b)(1), added

par. (3).

Subsec. (c). Pub. L. 105-33, Sec. 4313(c)(2), added subsec. (c).

Former subsec. (c) redesignated (d).

Subsec. (c)(1). Pub. L. 105-33, Sec. 4313(b)(2), inserted "(or,

for purposes of subsection (a)(3) of this section, any entity

receiving payment)" after "on an assignment-related basis".

Subsec. (d). Pub. L. 105-33, Sec. 4313(c)(1), redesignated

subsec. (c) as (d).

1994 - Subsec. (a)(2)(A). Pub. L. 103-432 made technical

amendment to reference to subchapter XVIII of this chapter to

correct reference to corresponding provision of original act.

EFFECTIVE DATE OF 1997 AMENDMENT

Amendment by section 4313(b) of Pub. L. 105-33 applicable to

payment for items and services furnished more than 90 days after

date of submission of report under section 4313(d) of Pub. L.

105-33, set out as a note under section 1320a-3 of this title, see

section 4313(e) of Pub. L. 105-33, set out as a note under section

1320a-3 of this title.

EFFECTIVE DATE OF 1994 AMENDMENT

Section 147(g) of Pub. L. 103-432 provided that: "Except as

otherwise provided in this section [amending this section and

sections 1320b-5, 1395l, 1395p, 1395q, 1395x, 1395y, and 1395cc of

this title, enacting provisions set out as notes under sections

1395l, 1395p, and 1395y of this title, amending provisions set out

as notes under this section and sections 254b, 1395l, and 1395u of

this title, and repealing provisions set out as a note under

section 1395l of this title], the amendments made by this section

shall take effect as if included in the enactment of OBRA-1990 [Pub

L. 101-508]."

EFFECTIVE DATE

Section 4164(b)(4) of Pub. L. 101-508, as amended by Pub. L.

103-432, title I, Sec. 147(f)(7)(A)(ii), Oct. 31, 1994, 108 Stat.

4432, provided that: "The amendments made by paragraphs (1), (2),

and (3) [enacting this section and amending sections 1320a-7 and

1320a-7b of this title] shall apply with respect to items or

services furnished on or after -

"(A) January 1, 1993, in the case of items or services

furnished by a provider who, on or before the date of the

enactment of this Act [Nov. 5, 1990], has furnished items or

services for which payment may be made under part B of title

XVIII of the Social Security Act [part B of subchapter XVIII of

this chapter]; or

"(B) January 1, 1992, in the case of items or services

furnished by any other provider."

REPORT ON CONFIDENTIALITY OF SOCIAL SECURITY ACCOUNT NUMBERS

Before amendment by Pub. L. 105-33 may become effective,

Secretary of Health and Human Services is required to submit to

Congress a report on steps Secretary has taken to assure the

confidentiality of social security account numbers that will be

provided to Secretary, see section 4313(d) of Pub. L. 105-33, set

out as a note under section 1320a-3 of this title.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320a-7, 1320a-7b of this

title.

-FOOTNOTE-

(!1) See References in Text note below.

-End-

-CITE-

42 USC Sec. 1320a-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 A - General Provisions

-HEAD-

Sec. 1320a-4. Issuance of subpenas by Comptroller General

-STATUTE-

(a) Authorization; scope; service and proof of service

For the purpose of any audit, investigation, examination,

analysis, review, evaluation, or other function authorized by law

with respect to any program authorized under this chapter, the

Comptroller General of the United States shall have power to sign

and issue subpenas to any person requiring the production of any

pertinent books, records, documents, or other information. Subpenas

so issued by the Comptroller General shall be served by anyone

authorized by him (1) by delivering a copy thereof to the person

named therein, or (2) by registered mail or by certified mail

addressed to such person at his last dwelling place or principal

place of business. A verified return by the person so serving the

subpena setting forth the manner of service, or, in the case of

service by registered mail or by certified mail, the return post

office receipt therefor signed by the person so served, shall be

proof of service.

(b) Contumacy or refusal to obey subpena; contempt proceedings

In case of contumacy by, or refusal to obey a subpena issued

pursuant to subsection (a) of this section and duly served upon,

any person, any district court of the United States for the

judicial district in which such person charged with contumacy or

refusal to obey is found or resides or transacts business, upon

application by the Comptroller General, shall have jurisdiction to

issue an order requiring such person to produce the books, records,

documents, or other information sought by the subpena; and any

failure to obey such order of the court may be punished by the

court as a contempt thereof. In proceedings brought under this

subsection, the Comptroller General shall be represented by

attorneys employed in the General Accounting Office or by counsel

whom he may employ without regard to the provisions of title 5

governing appointments in the competitive service, and the

provisions of chapter 51 and subchapters III and VI of chapter 53

of such title, relating to classification and General Schedule pay

rates.

(c) Nondisclosure of personal medical records by General Accounting

Office

No personal medical record in the possession of the General

Accounting Office shall be subject to subpena or discovery

proceedings in a civil action.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1125, as added Pub. L.

95-142, Sec. 6, Oct. 25, 1977, 91 Stat. 1192.)

-REFTEXT-

REFERENCES IN TEXT

The provisions of title 5 governing appointments in the

competitive service, referred to in subsec. (b), are classified to

section 3301 et seq. of Title 5, Government Organization and

Employees.

-End-

-CITE-

42 USC Sec. 1320a-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 A - General Provisions

-HEAD-

Sec. 1320a-5. Disclosure by institutions, organizations, and

agencies of owners, officers, etc., convicted of offenses related

to programs; notification requirements; "managing employee"

defined

-STATUTE-

(a) As a condition of participation in or certification or

recertification under the programs established by subchapters

XVIII,(!1) and XIX of this chapter, any hospital, nursing facility,

or other entity (other than an individual practitioner or group of

practitioners) shall be required to disclose to the Secretary or to

the appropriate State agency the name of any person that is a

person described in subparagraphs (A) and (B) of section

1320a-7(b)(8) of this title. The Secretary or the appropriate State

agency shall promptly notify the Inspector General in the

Department of Health and Human Services of the receipt from any

entity of any application or request for such participation,

certification, or recertification which discloses the name of any

such person, and shall notify the Inspector General of the action

taken with respect to such application or request.

(b) For the purposes of this section, the term "managing

employee" means, with respect to an entity, an individual,

including a general manager, business manager, administrator, and

director, who exercises operational or managerial control over the

entity, or who directly or indirectly conducts the day-to-day

operations of the entity.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1126, as added Pub. L.

95-142, Sec. 8(a), Oct. 25, 1977, 91 Stat. 1194; amended Pub. L.

97-35, title XXIII, Sec. 2353(j), Aug. 13, 1981, 95 Stat. 873; Pub.

L. 98-369, div. B, title VI, Sec. 2663(j)(2)(D)(vi), July 18, 1984,

98 Stat. 1170; Pub. L. 100-93, Sec. 8(b), Aug. 18, 1987, 101 Stat.

692.)

-MISC1-

AMENDMENTS

1987 - Subsec. (a). Pub. L. 100-93, Sec. 8(b)(1), in first

sentence substituted "or other entity (other than an individual

practitioner or group of practitioners) shall be required to

disclose to the Secretary or to the appropriate State agency the

name of any person that is a person described in subparagraphs (A)

and (B) of section 1320a-7(b)(8) of this title." for "or other

institution, organization, or agency shall be required to disclose

to the Secretary or to the appropriate State agency the name of any

person who -

"(1) has a direct or indirect ownership or control interest of

5 percent or more in such institution, organization, or agency or

is an officer, director, agent, or managing employee (as defined

in subsection (b) of this section) of such institution,

organization, or agency, and

"(2) has been convicted (on or after October 25, 1977, or

within such period prior to that date as the Secretary shall

specify in regulations) of a criminal offense related to the

involvement of such person in any of such programs.",

and in second sentence substituted "entity" for "institution,

organization, or agency".

Subsec. (b). Pub. L. 100-93, Sec. 8(b)(2), substituted "entity"

for "institution, organization, or agency" in three places.

1984 - Subsec. (a). Pub. L. 98-369 substituted "Health and Human

Services" for "Health, Education, and Welfare" in provisions

following par. (2).

1981 - Subsec. (a). Pub. L. 97-35 substituted in provision

preceding par. (1) "and XIX of this chapter" for "XIX, and XX of

this chapter".

EFFECTIVE DATE OF 1987 AMENDMENT

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.

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 OF 1981 AMENDMENT

Amendment by 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

Section 8(e) of Pub. L. 95-142 provided that: "The amendments

made by this section [enacting this section and amending sections

1395cc, 1396b, and 1397a of this title] shall apply with respect to

contracts, agreements, and arrangements entered into and approvals

given pursuant to applications or requests made on and after the

first day of the fourth month beginning after the date of the

enactment of this Act [Oct. 25, 1977]."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320a-3a, 1320a-7,

1320a-7a, 1395i-3, 1395bbb, 1396r, 1396t, 1397gg, 15025 of this

title.

-FOOTNOTE-

(!1) So in original. The comma probably should not appear.

-End-

-CITE-

42 USC Sec. 1320a-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 A - General Provisions

-HEAD-

Sec. 1320a-6. Adjustments in SSI benefits on account of retroactive

benefits under subchapter II

-STATUTE-

(a) Reduction in benefits

Notwithstanding any other provision of this chapter, in any case

where an individual -

(1) is entitled to benefits under subchapter II of this chapter

that were not paid in the months in which they were regularly

due; and

(2) is an individual or eligible spouse eligible for

supplemental security income benefits for one or more months in

which the benefits referred to in clause (1) were regularly due,

then any benefits under subchapter II of this chapter that were

regularly due in such month or months, or supplemental security

income benefits for such month or months, which are due but have

not been paid to such individual or eligible spouse shall be

reduced by an amount equal to so much of the supplemental security

income benefits, whether or not paid retroactively, as would not

have been paid or would not be paid with respect to such individual

or spouse if he had received such benefits under subchapter II of

this chapter in the month or months in which they were regularly

due. A benefit under subchapter II of this chapter shall not be

reduced pursuant to the preceding sentence to the extent that any

amount of such benefit would not otherwise be available for payment

in full of the maximum fee which may be recovered from such benefit

by an attorney pursuant to subsection (a)(4) or (b) of section 406

of this title.

(b) "Supplemental security income benefits" defined

For purposes of this section, the term "supplemental security

income benefits" means benefits paid or payable by the Commissioner

of Social Security under subchapter XVI of this chapter, including

State supplementary payments under an agreement pursuant to section

1382e(a) of this title or an administration agreement under section

212(b) of Public Law 93-66.

(c) Reimbursement of the State

From the amount of the reduction made under subsection (a) of

this section, the Commissioner of Social Security shall reimburse

the State on behalf of which supplementary payments were made for

the amount (if any) by which such State's expenditures on account

of such supplementary payments for the month or months involved

exceeded the expenditures which the State would have made (for such

month or months) if the individual had received the benefits under

subchapter II of this chapter at the times they were regularly due.

An amount equal to the portion of such reduction remaining after

reimbursement of the State under the preceding sentence shall be

covered into the general fund of the Treasury.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1127, as added Pub. L.

96-265, title V, Sec. 501(a), June 9, 1980, 94 Stat. 469; amended

Pub. L. 98-369, div. B, title VI, Sec. 2615(a), July 18, 1984, 98

Stat. 1132; Pub. L. 101-508, title V, Sec. 5106(b), Nov. 5, 1990,

104 Stat. 1388-268; Pub. L. 103-296, title I, Sec. 108(b)(8), title

III, Sec. 321(f)(3)(B)(ii), Aug. 15, 1994, 108 Stat. 1483, 1542.)

-REFTEXT-

REFERENCES IN TEXT

Section 212(b) of Pub. L. 93-66, referred to in subsec. (b), is

set out as a note under section 1382 of this title.

-MISC1-

AMENDMENTS

1994 - Subsec. (a). Pub. L. 103-296, Sec. 321(f)(3)(B)(ii), in

last sentence substituted "subsection (a)(4) or (b) of section 406

of this title" for "section 406(a)(4) of this title".

Subsecs. (b), (c). Pub. L. 103-296, Sec. 108(b)(8), substituted

"Commissioner of Social Security" for "Secretary".

1990 - Subsec. (a). Pub. L. 101-508 inserted at end "A benefit

under subchapter II of this chapter shall not be reduced pursuant

to the preceding sentence to the extent that any amount of such

benefit would not otherwise be available for payment in full of the

maximum fee which may be recovered from such benefit by an attorney

pursuant to section 406(a)(4) of this title."

1984 - Pub. L. 98-369 substituted provisions relating to

adjustment in supplemental security income benefits on account of

retroactive benefits under subchapter II of this chapter for

provisions which related to adjustment of retroactive benefits

under subchapter II of this chapter on account of supplemental

security income benefits.

EFFECTIVE DATE OF 1994 AMENDMENT

Amendment by section 108(b)(8) 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.

Amendment by section 321(f)(3)(B)(ii) of Pub. L. 103-296

effective as if included in the provisions of the Omnibus

Reconciliation Act of 1990, Pub. L. 101-508, to which such

amendment relates, except that such amendment applicable with

respect to favorable judgments made after 180 days after Aug. 15,

1994, see section 321(f)(5) of Pub. L. 103-296, set out as a note

under section 405 of this title.

EFFECTIVE DATE OF 1990 AMENDMENT

Amendment by Pub. L. 101-508 applicable with respect to

determinations made on or after July 1, 1991, and to reimbursement

for travel expenses incurred on or after Apr. 1, 1991, see section

5106(d), of Pub. L. 101-508, set out as a note under section 401 of

this title.

EFFECTIVE DATE OF 1984 AMENDMENT

Section 2615(b) of Pub. L. 98-369 provided that: "The amendment

made by this section [amending this section] shall apply for

purposes of reducing retroactive benefits under title II of the

Social Security Act [subchapter II of this chapter] or retroactive

supplemental security income benefits payable beginning with the

seventh month following the month in which this Act is enacted

[July 1984]; except that in the case of retroactive title II

benefits other than those which result from a determination of

entitlement following an application for benefits under title II or

from a reinstatement of benefits under title II following a period

of suspension or termination of such benefits, it shall apply when

the Secretary of Health and Human Services determines that it is

administratively feasible."

EFFECTIVE DATE

Section 501(d) of Pub. L. 96-265 provided that: "The amendments

made by this section [enacting this section and amending sections

404 and 1383 of this title] shall be applicable in the case of

payments of monthly insurance benefits under title II of the Social

Security Act [subchapter II of this chapter] entitlement for which

is determined on or after the first day of the thirteenth month

which begins after the date of the enactment of this Act [June 9,

1980]."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 404, 406, 1383 of this

title.

-End-

-CITE-

42 USC Sec. 1320a-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 A - General Provisions

-HEAD-

Sec. 1320a-7. Exclusion of certain individuals and entities from

participation in Medicare and State health care programs

-STATUTE-

(a) Mandatory exclusion

The Secretary shall exclude the following individuals and

entities from participation in any Federal health care program (as

defined in section 1320a-7b(f) of this title):

(1) Conviction of program-related crimes

Any individual or entity that has been convicted of a criminal

offense related to the delivery of an item or service under

subchapter XVIII of this chapter or under any State health care

program.

(2) Conviction relating to patient abuse

Any individual or entity that has been convicted, under Federal

or State law, of a criminal offense relating to neglect or abuse

of patients in connection with the delivery of a health care item

or service.

(3) Felony conviction relating to health care fraud

Any individual or entity that has been convicted for an offense

which occurred after August 21, 1996, under Federal or State law,

in connection with the delivery of a health care item or service

or with respect to any act or omission in a health care program

(other than those specifically described in paragraph (1))

operated by or financed in whole or in part by any Federal,

State, or local government agency, of a criminal offense

consisting of a felony relating to fraud, theft, embezzlement,

breach of fiduciary responsibility, or other financial

misconduct.

(4) Felony conviction relating to controlled substance

Any individual or entity that has been convicted for an offense

which occurred after August 21, 1996, under Federal or State law,

of a criminal offense consisting of a felony relating to the

unlawful manufacture, distribution, prescription, or dispensing

of a controlled substance.

(b) Permissive exclusion

The Secretary may exclude the following individuals and entities

from participation in any Federal health care program (as defined

in section 1320a-7b(f) of this title):

(1) Conviction relating to fraud

Any individual or entity that has been convicted for an offense

which occurred after August 21, 1996, under Federal or State law

-

(A) of a criminal offense consisting of a misdemeanor

relating to fraud, theft, embezzlement, breach of fiduciary

responsibility, or other financial misconduct -

(i) in connection with the delivery of a health care item

or service, or

(ii) with respect to any act or omission in a health care

program (other than those specifically described in

subsection (a)(1) of this section) operated by or financed in

whole or in part by any Federal, State, or local government

agency; or

(B) of a criminal offense relating to fraud, theft,

embezzlement, breach of fiduciary responsibility, or other

financial misconduct with respect to any act or omission in a

program (other than a health care program) operated by or

financed in whole or in part by any Federal, State, or local

government agency.

(2) Conviction relating to obstruction of an investigation

Any individual or entity that has been convicted, under Federal

or State law, in connection with the interference with or

obstruction of any investigation into any criminal offense

described in paragraph (1) or in subsection (a) of this section.

(3) Misdemeanor conviction relating to controlled substance

Any individual or entity that has been convicted, under Federal

or State law, of a criminal offense consisting of a misdemeanor

relating to the unlawful manufacture, distribution, prescription,

or dispensing of a controlled substance.

(4) License revocation or suspension

Any individual or entity -

(A) whose license to provide health care has been revoked or

suspended by any State licensing authority, or who otherwise

lost such a license or the right to apply for or renew such a

license, for reasons bearing on the individual's or entity's

professional competence, professional performance, or financial

integrity, or

(B) who surrendered such a license while a formal

disciplinary proceeding was pending before such an authority

and the proceeding concerned the individual's or entity's

professional competence, professional performance, or financial

integrity.

(5) Exclusion or suspension under Federal or State health care

program

Any individual or entity which has been suspended or excluded

from participation, or otherwise sanctioned, under -

(A) any Federal program, including programs of the Department

of Defense or the Department of Veterans Affairs, involving the

provision of health care, or

(B) a State health care program,

for reasons bearing on the individual's or entity's professional

competence, professional performance, or financial integrity.

(6) Claims for excessive charges or unnecessary services and

failure of certain organizations to furnish medically necessary

services

Any individual or entity that the Secretary determines -

(A) has submitted or caused to be submitted bills or requests

for payment (where such bills or requests are based on charges

or cost) under subchapter XVIII of this chapter or a State

health care program containing charges (or, in applicable

cases, requests for payment of costs) for items or services

furnished substantially in excess of such individual's or

entity's usual charges (or, in applicable cases, substantially

in excess of such individual's or entity's costs) for such

items or services, unless the Secretary finds there is good

cause for such bills or requests containing such charges or

costs;

(B) has furnished or caused to be furnished items or services

to patients (whether or not eligible for benefits under

subchapter XVIII of this chapter or under a State health care

program) substantially in excess of the needs of such patients

or of a quality which fails to meet professionally recognized

standards of health care;

(C) is -

(i) a health maintenance organization (as defined in

section 1396b(m) of this title) providing items and services

under a State plan approved under subchapter XIX of this

chapter, or

(ii) an entity furnishing services under a waiver approved

under section 1396n(b)(1) of this title,

and has failed substantially to provide medically necessary

items and services that are required (under law or the contract

with the State under subchapter XIX of this chapter) to be

provided to individuals covered under that plan or waiver, if

the failure has adversely affected (or has a substantial

likelihood of adversely affecting) these individuals; or

(D) is an entity providing items and services as an eligible

organization under a risk-sharing contract under section 1395mm

of this title and has failed substantially to provide medically

necessary items and services that are required (under law or

such contract) to be provided to individuals covered under the

risk-sharing contract, if the failure has adversely affected

(or has a substantial likelihood of adversely affecting) these

individuals.

(7) Fraud, kickbacks, and other prohibited activities

Any individual or entity that the Secretary determines has

committed an act which is described in section 1320a-7a,

1320a-7b, or 1320a-8 of this title.

(8) Entities controlled by a sanctioned individual

Any entity with respect to which the Secretary determines that

a person -

(A)(i) who has a direct or indirect ownership or control

interest of 5 percent or more in the entity or with an

ownership or control interest (as defined in section

1320a-3(a)(3) of this title) in that entity,

(ii) who is an officer, director, agent, or managing employee

(as defined in section 1320a-5(b) of this title) of that

entity; or

(iii) who was described in clause (i) but is no longer so

described because of a transfer of ownership or control

interest, in anticipation of (or following) a conviction,

assessment, or exclusion described in subparagraph (B) against

the person, to an immediate family member (as defined in

subsection (j)(1) of this section) or a member of the household

of the person (as defined in subsection (j)(2) of this section)

who continues to maintain an interest described in such clause

-

is a person -

(B)(i) who has been convicted of any offense described in

subsection (a) of this section or in paragraph (1), (2), or (3)

of this subsection;

(ii) against whom a civil monetary penalty has been assessed

under section 1320a-7a or 1320a-8 of this title; or

(iii) who has been excluded from participation under a

program under subchapter XVIII of this chapter or under a State

health care program.

(9) Failure to disclose required information

Any entity that did not fully and accurately make any

disclosure required by section 1320a-3 of this title, section

1320a-3a of this title, or section 1320a-5 of this title.

(10) Failure to supply requested information on subcontractors

and suppliers

Any disclosing entity (as defined in section 1320a-3(a)(2) of

this title) that fails to supply (within such period as may be

specified by the Secretary in regulations) upon request

specifically addressed to the entity by the Secretary or by the

State agency administering or supervising the administration of a

State health care program -

(A) full and complete information as to the ownership of a

subcontractor (as defined by the Secretary in regulations) with

whom the entity has had, during the previous 12 months,

business transactions in an aggregate amount in excess of

$25,000, or

(B) full and complete information as to any significant

business transactions (as defined by the Secretary in

regulations), occurring during the five-year period ending on

the date of such request, between the entity and any wholly

owned supplier or between the entity and any subcontractor.

(11) Failure to supply payment information

Any individual or entity furnishing items or services for which

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

State health care program that fails to provide such information

as the Secretary or the appropriate State agency finds necessary

to determine whether such payments are or were due and the

amounts thereof, or has refused to permit such examination of its

records by or on behalf of the Secretary or that agency as may be

necessary to verify such information.

(12) Failure to grant immediate access

Any individual or entity that fails to grant immediate access,

upon reasonable request (as defined by the Secretary in

regulations) to any of the following:

(A) To the Secretary, or to the agency used by the Secretary,

for the purpose specified in the first sentence of section

1395aa(a) of this title (relating to compliance with conditions

of participation or payment).

(B) To the Secretary or the State agency, to perform the

reviews and surveys required under State plans under paragraphs

(26), (31), and (33) of section 1396a(a) of this title and

under section 1396b(g) of this title.

(C) To the Inspector General of the Department of Health and

Human Services, for the purpose of reviewing records,

documents, and other data necessary to the performance of the

statutory functions of the Inspector General.

(D) To a State medicaid fraud control unit (as defined in

section 1396b(q) of this title), for the purpose of conducting

activities described in that section.

(13) Failure to take corrective action

Any hospital that fails to comply substantially with a

corrective action required under section 1395ww(f)(2)(B) of this

title.

(14) Default on health education loan or scholarship obligations

Any individual who the Secretary determines is in default on

repayments of scholarship obligations or loans in connection with

health professions education made or secured, in whole or in

part, by the Secretary and with respect to whom the Secretary has

taken all reasonable steps available to the Secretary to secure

repayment of such obligations or loans, except that (A) the

Secretary shall not exclude pursuant to this paragraph a

physician who is the sole community physician or sole source of

essential specialized services in a community if a State requests

that the physician not be excluded, and (B) the Secretary shall

take into account, in determining whether to exclude any other

physician pursuant to this paragraph, access of beneficiaries to

physician services for which payment may be made under subchapter

XVIII or XIX of this chapter.

(15) Individuals controlling a sanctioned entity

(A) Any individual -

(i) who has a direct or indirect ownership or control

interest in a sanctioned entity and who knows or should know

(as defined in section 1320a-7a(i)(6) (!1) of this title) of

the action constituting the basis for the conviction or

exclusion described in subparagraph (B); or

(ii) who is an officer or managing employee (as defined in

section 1320a-5(b) of this title) of such an entity.

(B) For purposes of subparagraph (A), the term "sanctioned

entity" means an entity -

(i) that has been convicted of any offense described in

subsection (a) of this section or in paragraph (1), (2), or (3)

of this subsection; or

(ii) that has been excluded from participation under a

program under subchapter XVIII of this chapter or under a State

health care program.

(c) Notice, effective date, and period of exclusion

(1) An exclusion under this section or under section 1320a-7a of

this title shall be effective at such time and upon such reasonable

notice to the public and to the individual or entity excluded as

may be specified in regulations consistent with paragraph (2).

(2)(A) Except as provided in subparagraph (B), such an exclusion

shall be effective with respect to services furnished to an

individual on or after the effective date of the exclusion.

(B) Unless the Secretary determines that the health and safety of

individuals receiving services warrants the exclusion taking effect

earlier, an exclusion shall not apply to payments made under

subchapter XVIII of this chapter or under a State health care

program for -

(i) inpatient institutional services furnished to an individual

who was admitted to such institution before the date of the

exclusion, or

(ii) home health services and hospice care furnished to an

individual under a plan of care established before the date of

the exclusion,

until the passage of 30 days after the effective date of the

exclusion.

(3)(A) The Secretary shall specify, in the notice of exclusion

under paragraph (1) and the written notice under section 1320a-7a

of this title, the minimum period (or, in the case of an exclusion

of an individual under subsection (b)(12) of this section or in the

case described in subparagraph (G), the period) of the exclusion.

(B) Subject to subparagraph (G), in the case of an exclusion

under subsection (a) of this section, the minimum period of

exclusion shall be not less than five years, except that, upon the

request of a State, the Secretary may waive the exclusion under

subsection (a)(1) of this section in the case of an individual or

entity that is the sole community physician or sole source of

essential specialized services in a community. The Secretary's

decision whether to waive the exclusion shall not be reviewable.

(C) In the case of an exclusion of an individual under subsection

(b)(12) of this section, the period of the exclusion shall be equal

to the sum of -

(i) the length of the period in which the individual failed to

grant the immediate access described in that subsection, and

(ii) an additional period, not to exceed 90 days, set by the

Secretary.

(D) Subject to subparagraph (G), in the case of an exclusion of

an individual or entity under paragraph (1), (2), or (3) of

subsection (b) of this section, the period of the exclusion shall

be 3 years, unless the Secretary determines in accordance with

published regulations that a shorter period is appropriate because

of mitigating circumstances or that a longer period is appropriate

because of aggravating circumstances.

(E) In the case of an exclusion of an individual or entity under

subsection (b)(4) or (b)(5) of this section, the period of the

exclusion shall not be less than the period during which the

individual's or entity's license to provide health care is revoked,

suspended, or surrendered, or the individual or the entity is

excluded or suspended from a Federal or State health care program.

(F) In the case of an exclusion of an individual or entity under

subsection (b)(6)(B) of this section, the period of the exclusion

shall be not less than 1 year.

(G) In the case of an exclusion of an individual under subsection

(a) of this section based on a conviction occurring on or after

August 5, 1997, if the individual has (before, on, or after August

5, 1997) been convicted -

(i) on one previous occasion of one or more offenses for which

an exclusion may be effected under such subsection, the period of

the exclusion shall be not less than 10 years, or

(ii) on 2 or more previous occasions of one or more offenses

for which an exclusion may be effected under such subsection, the

period of the exclusion shall be permanent.

(d) Notice to State agencies and exclusion under State health care

programs

(1) Subject to paragraph (3), the Secretary shall exercise the

authority under this section and section 1320a-7a of this title in

a manner that results in an individual's or entity's exclusion from

all the programs under subchapter XVIII of this chapter and all the

State health care programs in which the individual or entity may

otherwise participate.

(2) The Secretary shall promptly notify each appropriate State

agency administering or supervising the administration of each

State health care program (and, in the case of an exclusion

effected pursuant to subsection (a) of this section and to which

section 824(a)(5) of title 21 may apply, the Attorney General) -

(A) of the fact and circumstances of each exclusion effected

against an individual or entity under this section or section

1320a-7a of this title, and

(B) of the period (described in paragraph (3)) for which the

State agency is directed to exclude the individual or entity from

participation in the State health care program.

(3)(A) Except as provided in subparagraph (B), the period of the

exclusion under a State health care program under paragraph (2)

shall be the same as any period of exclusion under subchapter XVIII

of this chapter.

(B)(i) The Secretary may waive an individual's or entity's

exclusion under a State health care program under paragraph (2) if

the Secretary receives and approves a request for the waiver with

respect to the individual or entity from the State agency

administering or supervising the administration of the program.

(ii) A State health care program may provide for a period of

exclusion which is longer than the period of exclusion under

subchapter XVIII of this chapter.

(e) Notice to State licensing agencies

The Secretary shall -

(1) promptly notify the appropriate State or local agency or

authority having responsibility for the licensing or

certification of an individual or entity excluded (or directed to

be excluded) from participation under this section or section

1320a-7a of this title, of the fact and circumstances of the

exclusion,

(2) request that appropriate investigations be made and

sanctions invoked in accordance with applicable State law and

policy, and

(3) request that the State or local agency or authority keep

the Secretary and the Inspector General of the Department of

Health and Human Services fully and currently informed with

respect to any actions taken in response to the request.

(f) Notice, hearing, and judicial review

(1) Subject to paragraph (2), any individual or entity that is

excluded (or directed to be excluded) from participation under this

section is 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, except that, in so applying such

sections and section 405(l) of this title, any reference therein to

the Commissioner of Social Security or the Social Security

Administration shall be considered a reference to the Secretary or

the Department of Health and Human Services, respectively.

(2) Unless the Secretary determines that the health or safety of

individuals receiving services warrants the exclusion taking effect

earlier, any individual or entity that is the subject of an adverse

determination under subsection (b)(7) of this section shall be

entitled to a hearing by an administrative law judge (as provided

under section 405(b) of this title) on the determination under

subsection (b)(7) of this section before any exclusion based upon

the determination takes effect.

(3) The provisions of section 405(h) of this title shall apply

with respect to this section and sections 1320a-7a, 1320a-8, and

1320c-5 of this title to the same extent as it is applicable with

respect to subchapter II of this chapter, except that, in so

applying such section and section 405(l) of this title, any

reference therein to the Commissioner of Social Security shall be

considered a reference to the Secretary.

(g) Application for termination of exclusion

(1) An individual or entity excluded (or directed to be excluded)

from participation under this section or section 1320a-7a of this

title may apply to the Secretary, in the manner specified by the

Secretary in regulations and at the end of the minimum period of

exclusion provided under subsection (c)(3) of this section and at

such other times as the Secretary may provide, for termination of

the exclusion effected under this section or section 1320a-7a of

this title.

(2) The Secretary may terminate the exclusion if the Secretary

determines, on the basis of the conduct of the applicant which

occurred after the date of the notice of exclusion or which was

unknown to the Secretary at the time of the exclusion, that -

(A) there is no basis under subsection (a) or (b) of this

section or section 1320a-7a(a) of this title for a continuation

of the exclusion, and

(B) there are reasonable assurances that the types of actions

which formed the basis for the original exclusion have not

recurred and will not recur.

(3) The Secretary shall promptly notify each appropriate State

agency administering or supervising the administration of each

State health care program (and, in the case of an exclusion

effected pursuant to subsection (a) of this section and to which

section 824(a)(5) of title 21 may apply, the Attorney General) of

the fact and circumstances of each termination of exclusion made

under this subsection.

(h) "State health care program" defined

For purposes of this section and sections 1320a-7a and 1320a-7b

of this title, the term "State health care program" means -

(1) a State plan approved under subchapter XIX of this chapter,

(2) any program receiving funds under subchapter V of this

chapter or from an allotment to a State under such subchapter,

(3) any program receiving funds under subchapter XX of this

chapter or from an allotment to a State under such subchapter, or

(4) a State child health plan approved under subchapter XXI of

this chapter.

(i) "Convicted" defined

For purposes of subsections (a) and (b) of this section, an

individual or entity is considered to have been "convicted" of a

criminal offense -

(1) when a judgment of conviction has been entered against the

individual or entity by a Federal, State, or local court,

regardless of whether there is an appeal pending or whether the

judgment of conviction or other record relating to criminal

conduct has been expunged;

(2) when there has been a finding of guilt against the

individual or entity by a Federal, State, or local court;

(3) when a plea of guilty or nolo contendere by the individual

or entity has been accepted by a Federal, State, or local court;

or

(4) when the individual or entity has entered into

participation in a first offender, deferred adjudication, or

other arrangement or program where judgment of conviction has

been withheld.

(j) Definition of immediate family member and member of household

For purposes of subsection (b)(8)(A)(iii) of this section:

(1) The term "immediate family member" means, with respect to a

person -

(A) the husband or wife of the person;

(B) the natural or adoptive parent, child, or sibling of the

person;

(C) the stepparent, stepchild, stepbrother, or stepsister of

the person;

(D) the father-, mother-, daughter-, son-, brother-, or

sister-in-law of the person;

(E) the grandparent or grandchild of the person; and

(F) the spouse of a grandparent or grandchild of the person.

(2) The term "member of the household" means, with respect to

any person, any individual sharing a common abode as part of a

single family unit with the person, including domestic employees

and others who live together as a family unit, but not including

a roomer or boarder.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1128, as added Pub. L.

96-499, title IX, Sec. 913(a), Dec. 5, 1980, 94 Stat. 2619; amended

Pub. L. 97-35, title XXI, Sec. 2105(b), title XXIII, Sec. 2353(k),

Aug. 13, 1981, 95 Stat. 791, 873; Pub. L. 98-369, div. B, title

III, Sec. 2333(a), (b), July 18, 1984, 98 Stat. 1089; Pub. L.

99-509, title IX, Sec. 9317(c), Oct. 21, 1986, 100 Stat. 2008; Pub.

L. 100-93, Sec. 2, Aug. 18, 1987, 101 Stat. 680; Pub. L. 100-203,

title IV, Sec. 4118(e)(2)-(5), Dec. 22, 1987, 101 Stat. 1330-155,

as amended Pub. L. 100-360, title IV, Sec. 411(k)(10)(D), July 1,

1988, 102 Stat. 795; Pub. L. 100-360, title IV, Sec. 411(k)(10)(C),

July 1, 1988, 102 Stat. 795; Pub. L. 101-239, title VI, Sec.

6411(d)(1), Dec. 19, 1989, 103 Stat. 2270; Pub. L. 101-508, title

IV, Sec. 4164(b)(3), Nov. 5, 1990, 104 Stat. 1388-102; Pub. L.

102-54, Sec. 13(q)(3)(A)(ii), June 13, 1991, 105 Stat. 279; Pub. L.

103-296, title I, Sec. 108(b)(9), title II, Sec. 206(b)(2), Aug.

15, 1994, 108 Stat. 1483, 1513; Pub. L. 104-191, title II, Secs.

211-213, Aug. 21, 1996, 110 Stat. 2003-2005; Pub. L. 105-33, title

IV, Secs. 4301, 4303(a), 4331(c), 4901(b)(2), Aug. 5, 1997, 111

Stat. 382, 396, 570.)

-MISC1-

AMENDMENTS

1997 - Subsec. (a). Pub. L. 105-33, Sec. 4331(c)(1), substituted

"any Federal health care program (as defined in section 1320a-7b(f)

of this title)" for "any program under subchapter XVIII of this

chapter and shall direct that the following individuals and

entities be excluded from participation in any State health care

program (as defined in subsection (h) of this section)" in

introductory provisions.

Subsec. (b). Pub. L. 105-33, Sec. 4331(c)(2), substituted "any

Federal health care program (as defined in section 1320a-7b(f) of

this title)" for "any program under subchapter XVIII of this

chapter and may direct that the following individuals and entities

be excluded from participation in any State health care program" in

introductory provisions.

Subsec. (b)(8)(A)(iii). Pub. L. 105-33, Sec. 4303(a)(1), added

cl. (iii).

Subsec. (c)(3)(A). Pub. L. 105-33, Sec. 4301(1), inserted "or in

the case described in subparagraph (G)" after "subsection (b)(12)

of this section".

Subsec. (c)(3)(B), (D). Pub. L. 105-33, Sec. 4301(2), substituted

"Subject to subparagraph (G), in the case" for "In the case".

Subsec. (c)(3)(G). Pub. L. 105-33, Sec. 4301(3), added subpar.

(G).

Subsec. (h)(4). Pub. L. 105-33, Sec. 4901(b)(2), added par. (4).

Subsec. (j). Pub. L. 105-33, Sec. 4303(a)(2), added subsec. (j).

1996 - Subsec. (a)(3). Pub. L. 104-191, Sec. 211(a)(1), added

par. (3).

Subsec. (a)(4). Pub. L. 104-191, Sec. 211(b)(1), added par. (4).

Subsec. (b)(1). Pub. L. 104-191, Sec. 211(a)(2), reenacted

heading without change and amended text generally. Prior to

amendment, text read as follows: "Any individual or entity that has

been convicted, under Federal or State law, in connection with the

delivery of a health care item or service or with respect to any

act or omission in a program operated by or financed in whole or in

part by any Federal, State, or local government agency, of a

criminal offense relating to fraud, theft, embezzlement, breach of

fiduciary responsibility, or other financial misconduct."

Subsec. (b)(3). Pub. L. 104-191, Sec. 211(b)(2), substituted

"Misdemeanor conviction" for "conviction" in heading and "criminal

offense consisting of a misdemeanor" for "criminal offense" in

text.

Subsec. (b)(15). Pub. L. 104-191, Sec. 213, added par. (15).

Subsec. (c)(3)(D) to (F). Pub. L. 104-191, Sec. 212, added

subpars. (D) to (F).

1994 - Subsec. (b)(7). Pub. L. 103-296, Sec. 206(b)(2)(A),

substituted "section 1320a-7a, 1320a-7b, or 1230a-8 of this title"

for "section 1320a-7a of this title or section 1320a-7b of this

title".

Subsec. (b)(8)(B)(ii). Pub. L. 103-296, Sec. 206(b)(2)(B),

inserted "or 1320a-8" after "section 1320a-7a".

Subsec. (f)(1). Pub. L. 103-296, Sec. 108(b)(9)(A), inserted

before period at end ", except that, in so applying such sections

and section 405(l) of this title, any reference therein to the

Commissioner of Social Security or the Social Security

Administration shall be considered a reference to the Secretary or

the Department of Health and Human Services, respectively".

Subsec. (f)(3). Pub. L. 103-296, Sec. 206(b)(2)(C), inserted ",

1320a-8," after "sections 1320a-7a".

Pub. L. 103-296, Sec. 108(b)(9)(B), inserted before period at end

", except that, in so applying such section and section 405(l) of

this title, any reference therein to the Commissioner of Social

Security shall be considered a reference to the Secretary".

1991 - Subsec. (b)(5)(A). Pub. L. 102-54 substituted "Department

of Veterans Affairs" for "Veterans' Administration".

1990 - Subsec. (b)(9). Pub. L. 101-508 substituted "section

1320a-3 of this title, section 1320a-3a of this title," for

"section 1320a-3 of this title".

1989 - Subsec. (b)(4)(A). Pub. L. 101-239 inserted "or the right

to apply for or renew such a license" after "lost such a license".

1988 - Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub. L.

100-203, Sec. 4118(e)(3)-(5), which amended subsec. (b)(8)(A)(i),

(d)(1), (3)(A), and (i). See 1987 Amendment notes below.

Subsec. (d)(3)(B)(ii). Pub. L. 100-360, Sec. 411(k)(10)(C),

struck out "under a program" after "longer than the period of

exclusion".

1987 - Pub. L. 100-93 amended section generally, substituting

subsecs. (a) to (i) for former subsecs. (a) to (f).

Subsec. (b)(8)(A)(i). Pub. L. 100-203, Sec. 4118(e)(3), as added

by Pub. L. 100-360, Sec. 411(k)(10)(D), inserted at beginning "who

has a direct or indirect ownership or control interest of 5 percent

or more in the entity or".

Subsec. (d)(1). Pub. L. 100-203, Sec. 4118(e)(4)(A), as added by

Pub. L. 100-360, Sec. 411(k)(10)(D), substituted "this section and

section 1320a-7a of this title" for "subsection (b) of this

section".

Subsec. (d)(3)(A). Pub. L. 100-203, Sec. 4118(e)(4)(B), as added

by Pub. L. 100-360, Sec. 411(k)(10)(D), struck out "under a

program" after "any period of exclusion".

Subsec. (d)(3)(B). Pub. L. 100-203, Sec. 4118(e)(2), designated

existing provisions as cl. (i) and added cl. (ii).

Subsec. (i). Pub. L. 100-203, Sec. 4118(e)(5)(A), as added by

Pub. L. 100-360, Sec. 411(k)(10)(D), substituted "an individual or

entity" for "a physician or other individual" in introductory

provisions.

Pub. L. 100-203, Sec. 4118(e)(5)(B), as added by Pub. L. 100-360,

Sec. 411(k)(10)(D), which directed amendment of pars. (1) to (4) by

substituting "individual or entity" for "physician or other

individual" each place it appears, was executed by substituting

"individual or entity" for "physician or individual" in pars. (1)

to (4) as the probable intent of Congress.

Subsec. (i)(4). Pub. L. 100-203, Sec. 4118(e)(5)(C), as added by

Pub. L. 100-360, Sec. 411(k)(10)(D), substituted "first offender,

deferred adjudication, or other arrangement or program" for "first

offender or other program".

1986 - Subsec. (f). Pub. L. 99-509 added subsec. (f).

1984 - Subsecs. (b) to (e). Pub. L. 98-369 added subsec. (b),

redesignated former subsecs. (b) to (d) as (c) to (e),

respectively, and in subsec. (e) substituted "Any person or entity"

for "Any person" and "(a), (b), or (c)" for "(a) or (b)".

1981 - Subsec. (a)(1). Pub. L. 97-35, Sec. 2105(b)(1), struck out

", for such period as he may deem appropriate," after "subchapter

XVIII of this chapter".

Subsec. (a)(2). Pub. L. 97-35, Sec. 2353(k), substituted in

subpar. (A) "subchapter XIX of this chapter" for "subchapter XIX or

subchapter XX of this chapter," and in subpar. (B) "subchapter XIX

of this chapter" for "subchapter XIX or subchapter XX of this

chapter".

Subsecs. (b) to (d). Pub. L. 97-35, Sec. 2105(b)(2)-(4), added

subsec. (b), redesignated former subsecs. (b) and (c) as (c) and

(d), respectively, and in subsec. (d) as so redesignated

substituted "subsection (a) or (b)" for "subsection (a)".

EFFECTIVE DATE OF 1997 AMENDMENT

Section 4303(b) of Pub. L. 105-33 provided that: "The amendments

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

the date that is 45 days after the date of the enactment of this

Act [Aug. 5, 1997]."

Amendments by section 4331(c) of Pub. L. 105-33 effective Aug. 5,

1997, see section 4331(f)(2) of Pub. L. 105-33, set out as a note

under section 1320a-7e of this title.

EFFECTIVE DATE OF 1996 AMENDMENT

Section 218 of Pub. L. 104-191 provided that: "Except as

otherwise provided, the amendments made by this subtitle [subtitle

B, Secs. 211-218, of title II of Pub. L. 104-191, amending this

section and sections 1320a-7b, 1320c-5, and 1395mm of this title]

shall take effect January 1, 1997."

EFFECTIVE DATE OF 1994 AMENDMENT

Amendment by section 108(b)(9) 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 206(b)(3) of Pub. L. 103-296 provided that: "The

amendments made by this subsection [enacting section 1320a-8 of

this title and amending this section] shall apply to conduct

occurring on or after October 1, 1994."

EFFECTIVE DATE OF 1990 AMENDMENT

Amendment by Pub. L. 101-508 applicable with respect to items or

services furnished on or after Jan. 1, 1993, in the case of items

or services furnished by a provider who, on or before Nov. 5, 1990,

has furnished items or services for which payment may be made under

part B of subchapter XVIII of this chapter, or Jan. 1, 1992, in the

case of items or services furnished by any other provider, see

section 4164(b)(4) of Pub. L. 101-508, set out as an Effective Date

note under section 1320a-3a of this title.

EFFECTIVE DATE OF 1989 AMENDMENT

Section 6411(d)(4)[(A)] of Pub. L. 101-239 provided that: "The

amendments made by paragraphs (1) and (2) [amending this section

and sections 1395y and 1396b of this title] shall take effect on

the date of the enactment of this Act [Dec. 19, 1989]."

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 AMENDMENT

Section 15 of Pub. L. 100-93 provided that:

"(a) In General. - Except as provided in subsections (b), (c),

(d), and (e), the amendments made by this Act [enacting sections

1395aaa and 1396r-2 of this title, amending this section, sections

704, 1320a-3, 1320a-5, 1320a-7a, 1320a-7b, 1320c-5, 1395u, 1395y,

1395cc, 1395ff, 1395nn, 1395rr, 1395ss, 1395ww, 1396a, 1396b,

1396h, 1396n, 1396s, and 1397d of this title, and section 824 of

Title 21, Food and Drugs, transferring section 1396h of this title

to section 1320a-7b of this title, repealing section 1395nn of this

title, enacting provisions set out as a note under section 1320a-7b

of this title, and amending provisions set out as a note under

section 1396a of this title] shall become effective at the end of

the fourteen-day period beginning on the date of the enactment of

this Act [Aug. 18, 1987] and shall not apply to administrative

proceedings commenced before the end of such period.

"(b) Mandatory Minimum Exclusions Apply Prospectively. - Section

1128(c)(3)(B) of the Social Security Act [subsec. (c)(3)(B) of this

section] (as amended by this Act), which requires an exclusion of

not less than five years in the case of certain exclusions, shall

not apply to exclusions based on convictions occurring before the

date of the enactment of this Act [Aug. 18, 1987].

"(c) Effective Date for Changes in Medicaid Law. - (1) The

amendments made by sections 5 and 8(f) [enacting section 1396r-2 of

this title and amending sections 1396a and 1396s of this title]

apply (except as provided under paragraph (2)) to payments under

title XIX of the Social Security Act [subchapter XIX of this

chapter] for calendar quarters beginning more than thirty days

after the date of the enactment of this Act [Aug. 18, 1987],

without regard to whether or not final regulations to carry out

such amendment have been published by such date.

"(2) In the case of a State plan for medical assistance under

title XIX of the Social Security Act which the Secretary of Health

and Human Services determines requires State legislation (other

than legislation appropriating funds) in order for the plan to meet

the additional requirements imposed by the amendments made by this

Act, the State plan shall not be regarded as failing to comply with

the requirements of such title solely on the basis of its failure

to meet these additional requirements before the first day of the

first calendar quarter beginning after the close of the first

regular session of the State legislature that begins after the date

of the enactment of this Act.

"(3) Subsection (j) of section 1128A of the Social Security Act

[section 1320a-7a(j) of this title] (as added by section 3(f) of

this Act) takes effect on the date of the enactment of this Act.

"(d) Physician Misrepresentations. - Clauses (ii) and (iii) of

section 1128A(a)(1)(C) of the Social Security Act [section

1320a-7a(a)(1)(C)(ii), (iii) of this title], as amended by section

3(a)(1) of this Act, apply to claims presented for services

performed on or after the effective date specified in subsection

(a), without regard to the date the misrepresentation of fact was

made.

"(e) Clarification of Medicaid Moratorium. - The amendments made

by section 9 of this Act [amending provisions set out as a note

under section 1396a of this title] shall apply as though they were

originally included in the enactment of section 2373(c) of the

Deficit Reduction Act of 1984 [set out as a note under section

1396a of this title].

"(f) Treatment of Certain Denials of Payment. - For purposes of

section 1128(b)(8)(B)(iii) of the Social Security Act [subsec.

(b)(8)(B)(iii) of this section] (as amended by section 2 of this

Act), a person shall be considered to have been excluded from

participation under a program under title XVIII [subchapter XVIII

of this chapter] if payment to the person has been denied under

section 1862(d) of the Social Security Act [section 1395y(d) of

this title], as in effect before the effective date specified in

subsection (a)."

EFFECTIVE DATE OF 1986 AMENDMENT

Section 9317(d)(3) of Pub. L. 99-509 provided that: "The

provisions -

"(A) of paragraphs (1), (2), and (3) of section 1128(f) of the

Social Security Act [subsec. (f)(1)-(3) of this section] (as

added by the amendment made by subsection (c)) shall apply to

judgments entered, findings made, and pleas entered, before, on,

or after the date of the enactment of this Act [Oct. 21, 1986],

and

"(B) of paragraph (4) of such section [subsec. (f)(4) of this

section] shall apply to participation in a program entered into

on or after the date of the enactment of this Act."

EFFECTIVE DATE OF 1984 AMENDMENT

Section 2333(c) of Pub. L. 98-369 provided that: "The amendments

made by this section [amending this section] become effective on

the date of the enactment of this Act [July 18, 1984] and shall

apply to convictions of persons occurring after such date."

EFFECTIVE DATE OF 1981 AMENDMENT

Amendment by section 2353(k) 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.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 704, 1320a-3a, 1320a-5,

1320a-7a, 1320a-7b, 1320a-7c, 1320a-7d, 1320a-7e, 1320a-8, 1320c-5,

1395a, 1395b-5, 1395l, 1395m, 1395u, 1395w-27, 1395y, 1395cc,

1395mm, 1395ww, 1395aaa, 1396a, 1396b, 1396r-2, 1396r-6, 1397d of

this title; title 21 section 824.

-FOOTNOTE-

(!1) So in original. Probably should be section "1320a-7a(i)(7)".

-End-

-CITE-

42 USC Sec. 1320a-7a 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. 1320a-7a. Civil monetary penalties

-STATUTE-

(a) Improperly filed claims

Any person (including an organization, agency, or other entity,

but excluding a beneficiary, as defined in subsection (i)(5) of

this section) that -

(1) knowingly presents or causes to be presented to an officer,

employee, or agent of the United States, or of any department or

agency thereof, or of any State agency (as defined in subsection

(i)(1) of this section), a claim (as defined in subsection (i)(2)

of this section) that the Secretary determines -

(A) is for a medical or other item or service that the person

knows or should know was not provided as claimed, including any

person who engages in a pattern or practice of presenting or

causing to be presented a claim for an item or service that is

based on a code that the person knows or should know will

result in a greater payment to the person than the code the

person knows or should know is applicable to the item or

service actually provided,

(B) is for a medical or other item or service and the person

knows or should know the claim is false or fraudulent,

(C) is presented for a physician's service (or an item or

service incident to a physician's service) by a person who

knows or should know that the individual who furnished (or

supervised the furnishing of) the service -

(i) was not licensed as a physician,

(ii) was licensed as a physician, but such license had been

obtained through a misrepresentation of material fact

(including cheating on an examination required for

licensing), or

(iii) represented to the patient at the time the service

was furnished that the physician was certified in a medical

specialty by a medical specialty board when the individual

was not so certified,

(D) is for a medical or other item or service furnished

during a period in which the person was excluded from the

program under which the claim was made pursuant to a

determination by the Secretary under this section or under

section 1320a-7, 1320c-5, 1320c-9(b) (as in effect on September

2, 1982), 1395y(d) (as in effect on August 18, 1987), or

1395cc(b) of this title or as a result of the application of

the provisions of section 1395u(j)(2) of this title, or

(E) is for a pattern of medical or other items or services

that a person knows or should know are not medically necessary;

(2) knowingly presents or causes to be presented to any person

a request for payment which is in violation of the terms of (A)

an assignment under section 1395u(b)(3)(B)(ii) of this title, or

(B) an agreement with a State agency (or other requirement of a

State plan under subchapter XIX of this chapter) not to charge a

person for an item or service in excess of the amount permitted

to be charged, or (C) an agreement to be a participating

physician or supplier under section 1395u(h)(1) of this title, or

(D) an agreement pursuant to section 1395cc(a)(1)(G) of this

title;

(3) knowingly gives or causes to be given to any person, with

respect to coverage under subchapter XVIII of this chapter of

inpatient hospital services subject to the provisions of section

1395ww of this title, information that he knows or should know is

false or misleading, and that could reasonably be expected to

influence the decision when to discharge such person or another

individual from the hospital;

(4) in the case of a person who is not an organization, agency,

or other entity, is excluded from participating in a program

under subchapter XVIII of this chapter or a State health care

program in accordance with this subsection or under section

1320a-7 of this title and who, at the time of a violation of this

subsection -

(A) retains a direct or indirect ownership or control

interest in an entity that is participating in a program under

subchapter XVIII of this chapter or a State health care

program, and who knows or should know of the action

constituting the basis for the exclusion; or

(B) is an officer or managing employee (as defined in section

1320a-5(b) of this title) of such an entity;

(5) offers to or transfers remuneration to any individual

eligible for benefits under subchapter XVIII of this chapter, or

under a State health care program (as defined in section

1320a-7(h) of this title) that such person knows or should know

is likely to influence such individual to order or receive from a

particular provider, practitioner, or supplier any item or

service for which payment may be made, in whole or in part, under

subchapter XVIII of this chapter, or a State health care program

(as so defined);

(6) arranges or contracts (by employment or otherwise) with an

individual or entity that the person knows or should know is

excluded from participation in a Federal health care program (as

defined in section 1320a-7b(f) of this title), for the provision

of items or services for which payment may be made under such a

program; or

(7) commits an act described in paragraph (1) or (2) of section

1320a-7b(b) of this title;

shall be subject, in addition to any other penalties that may be

prescribed by law, to a civil money penalty of not more than

$10,000 for each item or service (or, in cases under paragraph (3),

$15,000 for each individual with respect to whom false or

misleading information was given; in cases under paragraph (4),

$10,000 for each day the prohibited relationship occurs; or in

cases under paragraph (7), $50,000 for each such act). In addition,

such a person shall be subject to an assessment of not more than 3

times the amount claimed for each such item or service in lieu of

damages sustained by the United States or a State agency because of

such claim (or, in cases under paragraph (7), damages of not more

than 3 times the total amount of remuneration offered, paid,

solicited, or received, without regard to whether a portion of such

remuneration was offered, paid, solicited, or received for a lawful

purpose). In addition the Secretary may make a determination in the

same proceeding to exclude the person from participation in the

Federal health care programs (as defined in section 1320a-7b(f)(1)

of this title) and to direct the appropriate State agency to

exclude the person from participation in any State health care

program.

(b) Payments to induce reduction or limitation of services

(1) If a hospital or a critical access hospital knowingly makes a

payment, directly or indirectly, to a physician as an inducement to

reduce or limit services provided with respect to individuals who -

(A) are entitled to benefits under part A or part B of

subchapter XVIII of this chapter or to medical assistance under a

State plan approved under subchapter XIX of this chapter, and

(B) are under the direct care of the physician,

the hospital or a critical access hospital shall be subject, in

addition to any other penalties that may be prescribed by law, to a

civil money penalty of not more than $2,000 for each such

individual with respect to whom the payment is made.

(2) Any physician who knowingly accepts receipt of a payment

described in paragraph (1) shall be subject, in addition to any

other penalties that may be prescribed by law, to a civil money

penalty of not more than $2,000 for each individual described in

such paragraph with respect to whom the payment is made.

(3)(A) Any physician who executes a document described in

subparagraph (B) with respect to an individual knowing that all of

the requirements referred to in such subparagraph are not met with

respect to the individual shall be subject to a civil monetary

penalty of not more than the greater of -

(i) $5,000, or

(ii) three times the amount of the payments under subchapter

XVIII of this chapter for home health services which are made

pursuant to such certification.

(B) A document described in this subparagraph is any document

that certifies, for purposes of subchapter XVIII of this chapter,

that an individual meets the requirements of section 1395f(a)(2)(C)

or 1395n(a)(2)(A) of this title in the case of home health services

furnished to the individual.

(c) Initiation of proceeding; authorization by Attorney General,

notice, etc., estoppel, failure to comply with order or procedure

(1) The Secretary may initiate a proceeding to determine whether

to impose a civil money penalty, assessment, or exclusion under

subsection (a) or (b) of this section only as authorized by the

Attorney General pursuant to procedures agreed upon by them. The

Secretary may not initiate an action under this section with

respect to any claim, request for payment, or other occurrence

described in this section later than six years after the date the

claim was presented, the request for payment was made, or the

occurrence took place. The Secretary may initiate an action under

this section by serving notice of the action in any manner

authorized by Rule 4 of the Federal Rules of Civil Procedure.

(2) The Secretary shall not make a determination adverse to any

person under subsection (a) or (b) of this section until the person

has been given written notice and an opportunity for the

determination to be made on the record after a hearing at which the

person is entitled to be represented by counsel, to present

witnesses, and to cross-examine witnesses against the person.

(3) In a proceeding under subsection (a) or (b) of this section

which -

(A) is against a person who has been convicted (whether upon a

verdict after trial or upon a plea of guilty or nolo contendere)

of a Federal crime charging fraud or false statements, and

(B) involves the same transaction as in the criminal action,

the person is estopped from denying the essential elements of the

criminal offense.

(4) The official conducting a hearing under this section may

sanction a person, including any party or attorney, for failing to

comply with an order or procedure, failing to defend an action, or

other misconduct as would interfere with the speedy, orderly, or

fair conduct of the hearing. Such sanction shall reasonably relate

to the severity and nature of the failure or misconduct. Such

sanction may include -

(A) in the case of refusal to provide or permit discovery,

drawing negative factual inferences or treating such refusal as

an admission by deeming the matter, or certain facts, to be

established,

(B) prohibiting a party from introducing certain evidence or

otherwise supporting a particular claim or defense,

(C) striking pleadings, in whole or in part,

(D) staying the proceedings,

(E) dismissal of the action,

(F) entering a default judgment,

(G) ordering the party or attorney to pay attorneys' fees and

other costs caused by the failure or misconduct, and

(H) refusing to consider any motion or other action which is

not filed in a timely manner.

(d) Amount or scope of penalty, assessment, or exclusion

In determining the amount or scope of any penalty, assessment, or

exclusion imposed pursuant to subsection (a) or (b) of this

section, the Secretary shall take into account -

(1) the nature of claims and the circumstances under which they

were presented,

(2) the degree of culpability, history of prior offenses, and

financial condition of the person presenting the claims, and

(3) such other matters as justice may require.

(e) Review by courts of appeals

Any person adversely affected by a determination of the Secretary

under this section may obtain a review of such determination in the

United States Court of Appeals for the circuit in which the person

resides, or in which the claim was presented, by filing in such

court (within sixty days following the date the person is notified

of the Secretary's determination) a written petition requesting

that the determination be modified or set aside. A copy of the

petition shall be forthwith transmitted by the clerk of the court

to the Secretary, and thereupon the Secretary shall file in the

Court (!1) the record in the proceeding as provided in section 2112

of title 28. Upon such filing, the court shall have jurisdiction of

the proceeding and of the question determined therein, and shall

have the power to make and enter upon the pleadings, testimony, and

proceedings set forth in such record a decree affirming, modifying,

remanding for further consideration, or setting aside, in whole or

in part, the determination of the Secretary and enforcing the same

to the extent that such order is affirmed or modified. No objection

that has not been urged before the Secretary shall be considered by

the court, unless the failure or neglect to urge such objection

shall be excused because of extraordinary circumstances. The

findings of the Secretary with respect to questions of fact, if

supported by substantial evidence on the record considered as a

whole, shall be conclusive. If any party shall apply to the court

for leave to adduce additional evidence and shall show to the

satisfaction of the court that such additional evidence is material

and that there were reasonable grounds for the failure to adduce

such evidence in the hearing before the Secretary, the court may

order such additional evidence to be taken before the Secretary and

to be made a part of the record. The Secretary may modify his

findings as to the facts, or make new findings, by reason of

additional evidence so taken and filed, and he shall file with the

court such modified or new findings, which findings with respect to

questions of fact, if supported by substantial evidence on the

record considered as a whole, shall be conclusive, and his

recommendations, if any, for the modification or setting aside of

his original order. Upon the filing of the record with it, the

jurisdiction of the court shall be exclusive and its judgment and

decree shall be final, except that the same shall be subject to

review by the Supreme Court of the United States, as provided in

section 1254 of title 28.

(f) Compromise of penalties and assessments; recovery; use of funds

recovered

Civil money penalties and assessments imposed under this section

may be compromised by the Secretary and may be recovered in a civil

action in the name of the United States brought in United States

district court for the district where the claim was presented, or

where the claimant resides, as determined by the Secretary. Amounts

recovered under this section shall be paid to the Secretary and

disposed of as follows:

(1)(A) In the case of amounts recovered arising out of a claim

under subchapter XIX of this chapter, there shall be paid to the

State agency an amount bearing the same proportion to the total

amount recovered as the State's share of the amount paid by the

State agency for such claim bears to the total amount paid for

such claim.

(B) In the case of amounts recovered arising out of a claim

under an allotment to a State under subchapter V of this chapter,

there shall be paid to the State agency an amount equal to

three-sevenths of the amount recovered.

(2) Such portion of the amounts recovered as is determined to

have been paid out of the trust funds under sections 1395i and

1395t of this title shall be repaid to such trust funds.

(3) With respect to amounts recovered arising out of a claim

under a Federal health care program (as defined in section

1320a-7b(f) of this title), the portion of such amounts as is

determined to have been paid by the program shall be repaid to

the program, and the portion of such amounts attributable to the

amounts recovered under this section by reason of the amendments

made by the Health Insurance Portability and Accountability Act

of 1996 (as estimated by the Secretary) shall be deposited into

the Federal Hospital Insurance Trust Fund pursuant to section

1395i(k)(2)(C) of this title.

(4) The remainder of the amounts recovered shall be deposited

as miscellaneous receipts of the Treasury of the United States.

The amount of such penalty or assessment, when finally determined,

or the amount agreed upon in compromise, may be deducted from any

sum then or later owing by the United States or a State agency to

the person against whom the penalty or assessment has been

assessed.

(g) Finality of determination respecting penalty, assessment, or

exclusion

A determination by the Secretary to impose a penalty, assessment,

or exclusion under subsection (a) or (b) of this section shall be

final upon the expiration of the sixty-day period referred to in

subsection (e) of this section. Matters that were raised or that

could have been raised in a hearing before the Secretary or in an

appeal pursuant to subsection (e) of this section may not be raised

as a defense to a civil action by the United States to collect a

penalty, assessment, or exclusion assessed under this section.

(h) Notification of appropriate entities of finality of

determination

Whenever the Secretary's determination to impose a penalty,

assessment, or exclusion under subsection (a) or (b) of this

section becomes final, he shall notify the appropriate State or

local medical or professional organization, the appropriate State

agency or agencies administering or supervising the administration

of State health care programs (as defined in section 1320a-7(h) of

this title), and the appropriate utilization and quality control

peer review organization, and the appropriate State or local

licensing agency or organization (including the agency specified in

section 1395aa(a) and 1396a(a)(33) of this title) that such a

penalty, assessment, or exclusion has become final and the reasons

therefor.

(i) Definitions

For the purposes of this section:

(1) The term "State agency" means the agency established or

designated to administer or supervise the administration of the

State plan under subchapter XIX of this chapter or designated to

administer the State's program under subchapter V of this chapter

or subchapter XX of this chapter.

(2) The term "claim" means an application for payments for

items and services under a Federal health care program (as

defined in section 1320a-7b(f) of this title).

(3) The term "item or service" includes (A) any particular

item, device, medical supply, or service claimed to have been

provided to a patient and listed in an itemized claim for

payment, and (B) in the case of a claim based on costs, any entry

in the cost report, books of account or other documents

supporting such claim.

(4) The term "agency of the United States" includes any

contractor acting as a fiscal intermediary, carrier, or fiscal

agent or any other claims processing agent for a Federal health

care program (as so defined).

(5) The term "beneficiary" means an individual who is eligible

to receive items or services for which payment may be made under

a Federal health care program (as so defined) but does not

include a provider, supplier, or practitioner.

(6) The term "remuneration" includes the waiver of coinsurance

and deductible amounts (or any part thereof), and transfers of

items or services for free or for other than fair market value.

The term "remuneration" does not include -

(A) the waiver of coinsurance and deductible amounts by a

person, if -

(i) the waiver is not offered as part of any advertisement

or solicitation;

(ii) the person does not routinely waive coinsurance or

deductible amounts; and

(iii) the person -

(I) waives the coinsurance and deductible amounts after

determining in good faith that the individual is in

financial need; or

(II) fails to collect coinsurance or deductible amounts

after making reasonable collection efforts;

(B) subject to subsection (n) of this section, any

permissible practice described in any subparagraph of section

1320a-7b(b)(3) of this title or in regulations issued by the

Secretary;

(C) differentials in coinsurance and deductible amounts as

part of a benefit plan design as long as the differentials have

been disclosed in writing to all beneficiaries, third party

payers, and providers, to whom claims are presented and as long

as the differentials meet the standards as defined in

regulations promulgated by the Secretary not later than 180

days after August 21, 1996; or

(D) (!2) incentives given to individuals to promote the

delivery of preventive care as determined by the Secretary in

regulations so promulgated.

(D) (!2) a reduction in the copayment amount for covered OPD

services under section 1395l(t)(5)(B) (!3) of this title.

(7) The term "should know" means that a person, with respect to

information -

(A) acts in deliberate ignorance of the truth or falsity of

the information; or

(B) acts in reckless disregard of the truth or falsity of the

information,

and no proof of specific intent to defraud is required.

(j) Subpoenas

(1) The provisions of subsections (d) and (e) of section 405 of

this title shall apply with respect to this section to the same

extent as they are applicable with respect to subchapter II of this

chapter. The Secretary may delegate the authority granted by

section 405(d) of this title (as made applicable to this section)

to the Inspector General of the Department of Health and Human

Services for purposes of any investigation under this section.

(2) The Secretary may delegate authority granted under this

section and under section 1320a-7 of this title to the Inspector

General of the Department of Health and Human Services.

(k) Injunctions

Whenever the Secretary has reason to believe that any person has

engaged, is engaging, or is about to engage in any activity which

makes the person subject to a civil monetary penalty under this

section, the Secretary may bring an action in an appropriate

district court of the United States (or, if applicable, a United

States court of any territory) to enjoin such activity, or to

enjoin the person from concealing, removing, encumbering, or

disposing of assets which may be required in order to pay a civil

monetary penalty if any such penalty were to be imposed or to seek

other appropriate relief.

(l) Liability of principal for acts of agent

A principal is liable for penalties, assessments, and an

exclusion under this section for the actions of the principal's

agent acting within the scope of the agency.

(m) Claims within jurisdiction of other departments or agencies

(1) For purposes of this section, with respect to a Federal

health care program not contained in this chapter, references to

the Secretary in this section shall be deemed to be references to

the Secretary or Administrator of the department or agency with

jurisdiction over such program and references to the Inspector

General of the Department of Health and Human Services in this

section shall be deemed to be references to the Inspector General

of the applicable department or agency.

(2)(A) The Secretary and Administrator of the departments and

agencies referred to in paragraph (1) may include in any action

pursuant to this section, claims within the jurisdiction of other

Federal departments or agencies as long as the following conditions

are satisfied:

(i) The case involves primarily claims submitted to the Federal

health care programs of the department or agency initiating the

action.

(ii) The Secretary or Administrator of the department or agency

initiating the action gives notice and an opportunity to

participate in the investigation to the Inspector General of the

department or agency with primary jurisdiction over the Federal

health care programs to which the claims were submitted.

(B) If the conditions specified in subparagraph (A) are

fulfilled, the Inspector General of the department or agency

initiating the action is authorized to exercise all powers granted

under the Inspector General Act of 1978 (5 U.S.C. App.) with

respect to the claims submitted to the other departments or

agencies to the same manner and extent as provided in that Act with

respect to claims submitted to such departments or agencies.

(n) Safe harbor for payment of medigap premiums

(1) Subparagraph (B) of subsection (i)(6) of this section shall

not apply to a practice described in paragraph (2) unless -

(A) the Secretary, through the Inspector General of the

Department of Health and Human Services, promulgates a rule

authorizing such a practice as an exception to remuneration; and

(B) the remuneration is offered or transferred by a person

under such rule during the 2-year period beginning on the date

the rule is first promulgated.

(2) A practice described in this paragraph is a practice under

which a health care provider or facility pays, in whole or in part,

premiums for medicare supplemental policies for individuals

entitled to benefits under part A of subchapter XVIII of this

chapter pursuant to section 426-1 of this title.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1128A, as added Pub. L.

97-35, title XXI, Sec. 2105(a), Aug. 13, 1981, 95 Stat. 789;

amended Pub. L. 97-248, title I, Sec. 137(b)(26), Sept. 3, 1982, 96

Stat. 380; Pub. L. 98-369, div. B, title III, Secs. 2306(f)(1),

2354(a)(3), July 18, 1984, 98 Stat. 1073, 1100; Pub. L. 99-509,

title IX, Secs. 9313(c)(1), 9317(a), (b), Oct. 21, 1986, 100 Stat.

2003, 2008; Pub. L. 100-93, Sec. 3, Aug. 18, 1987, 101 Stat. 686;

Pub. L. 100-203, title IV, Secs. 4039(h)(1), 4118(e)(1), (6)-(10),

Dec. 22, 1987, 101 Stat. 1330-155, as amended Pub. L. 100-360,

title IV, Sec. 411(e)(3), (k)(10)(B)(ii), (D), July 1, 1988, 102

Stat. 775, 794, 795; Pub. L. 100-360, title II, Sec. 202(c)(2),

July 1, 1988, 102 Stat. 715; Pub. L. 100-485, title VI, Sec.

608(d)(26)(H)-(K)(i), Oct. 13, 1988, 102 Stat. 2422; Pub. L.

101-234, title II, Sec. 201(a), Dec. 13, 1989, 103 Stat. 1981; Pub.

L. 101-239, title VI, Sec. 6003(g)(3)(D)(i), Dec. 19, 1989, 103

Stat. 2153; Pub. L. 101-508, title IV, Secs. 4204(a)(3), 4207(h),

formerly 4027(h), 4731(b)(1), 4753, Nov. 5, 1990, 104 Stat.

1388-109, 1388-123, 1388-195, 1388-208, renumbered Sec. 4207(h),

Pub. L. 103-432, title I, Sec. 160(d)(4), Oct. 31, 1994, 108 Stat.

4444; Pub. L. 104-191, title II, Secs. 231(a)-(e), (h), 232(a),

Aug. 21, 1996, 110 Stat. 2012-2015; Pub. L. 105-33, title IV, Secs.

4201(c)(1), 4304(a), (b), 4331(e), 4523(c), Aug. 5, 1997, 111 Stat.

373, 383, 396, 449; Pub. L. 105-277, div. J, title V, Sec. 5201(a),

(b)(1), Oct. 21, 1998, 112 Stat. 2681-916.)

-REFTEXT-

REFERENCES IN TEXT

The Federal Rules of Civil Procedure, referred to in subsec.

(c)(1), are set out in the Appendix to Title 28, Judiciary and

Judicial Procedure.

The Health Insurance Portability and Accountability Act of 1996,

referred to in subsec. (f)(3), is Pub. L. 104-191, Aug. 21, 1996,

110 Stat. 1936. For complete classification of this Act to the

Code, see Short Title of 1996 Amendments note set out under section

201 of this title and Tables.

Section 1395l(t)(5)(B) of this title, referred to in subsec.

(i)(6)(D), was redesignated section 1395l(t)(8)(B) of this title by

Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Secs.

201(a)(1), 202(a)(2)], Nov. 29, 1999, 113 Stat. 1536, 1501A-336,

1501A-342.

The Inspector General Act of 1978, referred to in subsec.

(m)(2)(B), is Pub. L. 95-452, Oct. 12, 1978, 92 Stat. 1101, as

amended, which is set out in the Appendix to Title 5, Government

Organization and Employees.

-MISC1-

AMENDMENTS

1998 - Subsec. (i)(6)(B). Pub. L. 105-277, Sec. 5201(a), amended

subpar. (B) generally. Prior to amendment, subpar. (B) read as

follows: "any permissible waiver as specified in section

1320a-7b(b)(3) of this title or in regulations issued by the

Secretary;".

Subsec. (n). Pub. L. 105-277, Sec. 5201(b)(1), added subsec. (n).

1997 - Subsec. (a). Pub. L. 105-33, Sec. 4304(b)(2), in

concluding provisions, substituted "occurs; or in cases under

paragraph (7), $50,000 for each such act)." for "occurs)." and

inserted "(or, in cases under paragraph (7), damages of not more

than 3 times the total amount of remuneration offered, paid,

solicited, or received, without regard to whether a portion of such

remuneration was offered, paid, solicited, or received for a lawful

purpose)" after "of such claim".

Subsec. (a)(6). Pub. L. 105-33, Sec. 4304(a), added par. (6).

Subsec. (a)(7). Pub. L. 105-33, Sec. 4304(b)(1), added par. (7).

Subsec. (b)(1). Pub. L. 105-33, Sec. 4201(c)(1), substituted

"critical access" for "rural primary care" in introductory and

concluding provisions.

Subsec. (i)(6)(A)(iii). Pub. L. 105-33, Sec. 4331(e)(1), inserted

"or" at end of subcl. (I), struck out "or" at end of subcl. (II),

and struck out subcl. (III) which read as follows: "provides for

any permissible waiver as specified in section 1320a-7b(b)(3) of

this title or in regulations issued by the Secretary;".

Subsec. (i)(6)(B). Pub. L. 105-33, Sec. 4523(c)(1), which

directed amendment of par. (6) by striking "or" at end of subpar.

(B), could not be executed because the word "or" did not appear at

end of subpar. (B) subsequent to amendment by Pub. L. 105-33, Sec.

4331(e)(2), (3). See below.

Pub. L. 105-33, Sec. 4331(e)(3), added subpar. (B). Former

subpar. (B) redesignated (C).

Subsec. (i)(6)(C). Pub. L. 105-33, Sec. 4523(c)(2), which

directed amendment of par. (6) by substituting "; or" for the

period at end of subpar. (C), could not be executed because there

was not a period at the end of subpar. (C) subsequent to amendment

by Pub. L. 105-33, Sec. 4331(e)(2). See below.

Pub. L. 105-33, Sec. 4331(e)(2), redesignated subpar. (B) as (C).

Former subpar. (C) redesignated (D).

Subsec. (i)(6)(D). Pub. L. 105-33, Sec. 4523(c), added subpar.

(D) relating to a reduction in copayment amount for covered OPD

services.

Pub. L. 105-33, Sec. 4331(e)(2), redesignated subpar. (C),

relating to incentives given to individuals to promote delivery, as

(D).

1996 - Subsec. (a). Pub. L. 104-191, Sec. 231(c), in concluding

provisions, substituted "$10,000" for "$2,000", inserted "; in

cases under paragraph (4), $10,000 for each day the prohibited

relationship occurs" after "false or misleading information was

given", and substituted "3 times the amount" for "twice the

amount".

Pub. L. 104-191, Sec. 231(a)(1), in concluding provisions,

substituted "Federal health care programs (as defined in section

1320a-7b(f)(1) of this title)" for "programs under subchapter XVIII

of this chapter".

Subsec. (a)(1). Pub. L. 104-191, Sec. 231(d)(1)(A), inserted

"knowingly" before "presents" in introductory provisions.

Subsec. (a)(1)(A). Pub. L. 104-191, Sec. 231(e)(1), substituted

"claimed, including any person who engages in a pattern or practice

of presenting or causing to be presented a claim for an item or

service that is based on a code that the person knows or should

know will result in a greater payment to the person than the code

the person knows or should know is applicable to the item or

service actually provided," for "claimed,".

Subsec. (a)(1)(E). Pub. L. 104-191, Sec. 231(e)(2)-(4), added

subpar. (E).

Subsec. (a)(2). Pub. L. 104-191, Sec. 231(d)(1)(A), inserted

"knowingly" before "presents".

Subsec. (a)(3). Pub. L. 104-191, Sec. 231(d)(1)(B), substituted

"knowingly gives or causes to be given" for "gives".

Subsec. (a)(4). Pub. L. 104-191, Sec. 231(b), added par. (4).

Subsec. (a)(5). Pub. L. 104-191, Sec. 231(h)(1), added par. (5).

Subsec. (b)(3). Pub. L. 104-191, Sec. 232(a), added par. (3).

Subsec. (f)(3), (4). Pub. L. 104-191, Sec. 231(a)(2), added par.

(3) and redesignated former par. (3) as (4).

Subsec. (i)(2). Pub. L. 104-191, Sec. 231(a)(3)(A), substituted

"a Federal health care program (as defined in section 1320a-7b(f)

of this title)" for "subchapter V, XVIII, XIX, or XX of this

chapter".

Subsec. (i)(4). Pub. L. 104-191, Sec. 231(a)(3)(B), substituted

"a Federal health care program (as so defined)" for "a health

insurance or medical services program under subchapter XVIII or XIX

of this chapter".

Subsec. (i)(5). Pub. L. 104-191, Sec. 231(a)(3)(C), substituted

"a Federal health care program (as so defined)" for "subchapter V,

XVIII, XIX, or XX of this chapter".

Subsec. (i)(6). Pub. L. 104-191, Sec. 231(h)(2), added par. (6).

Subsec. (i)(7). Pub. L. 104-191, Sec. 231(d)(2), added par. (7).

Subsec. (m). Pub. L. 104-191, Sec. 231(a)(4), added subsec. (m).

1990 - Subsec. (b)(1). Pub. L. 101-508, Sec. 4731(b)(1), struck

out "or an entity with a contract under section 1396b(m) of this

title" before "knowingly makes a payment" in introductory

provisions.

Pub. L. 101-508, Sec. 4204(a)(3), struck out ", an eligible

organization with a risk-sharing contract under section 1395mm of

this title," after "primary care hospital" in introductory

provisions, struck out "or organization" after "primary care

hospital" in concluding provisions, redesignated subpar. (C) as

(B), and struck out former subpar. (B) which read as follows: "in

the case of an eligible organization or an entity, are enrolled

with the organization or entity, and".

Subsec. (j). Pub. L. 101-508, Sec. 4753, made an amendment to

subsec. (j) identically to that of Pub. L. 101-508, Sec. 4207(h).

See below.

Pub. L. 101-508, Sec. 4207(h), formerly Sec. 4027(h), as

renumbered by Pub. L. 103-432, designated existing provisions as

par. (1) and added par. (2).

1989 - Subsec. (a)(1)(D), (2)(C), (4). Pub. L. 101-234 repealed

Pub. L. 100-360, Sec. 202(c), 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.

Subsec. (b)(1). Pub. L. 101-239 substituted "hospital or a rural

primary care hospital" for "hospital" in introductory and

concluding provisions.

1988 - Subsec. (a). Pub. L. 100-360, Sec. 411(k)(10)(D), added

Pub. L. 100-203, Sec. 4118(e)(10)(A), see 1987 Amendment note

below.

Subsec. (a)(1). Pub. L. 100-360, Sec. 411(k)(10)(B)(ii)(I), (II),

as amended by Pub. L. 100-485, Sec. 608(d)(26)(H), amended

directory language of Pub. L. 100-203, Sec. 4118(e)(1), see 1987

Amendment note below.

Subsec. (a)(1)(D). Pub. L. 100-360, Sec. 411(k)(10)(D), as

amended by Pub. L. 100-485, Sec. 608(d)(26)(K)(i), added Pub. L.

100-203, Sec. 4118(e)(6), see 1987 Amendment note below.

Pub. L. 100-360, Sec. 202(c)(2)(A), struck out "or" after

semicolon.

Subsec. (a)(2)(C). Pub. L. 100-360, Sec. 202(c)(2)(B), inserted

"or to be a participating pharmacy under section 1395u(o) of this

title" after "section 1395u(h)(1) of this title".

Subsec. (a)(3). Pub. L. 100-360, Sec. 411(k)(10)(B)(ii)(I), (II),

as amended by Pub. L. 100-485, Sec. 608(d)(26)(H), made technical

amendment to directory language of Pub. L. 100-203, Sec.

4118(e)(1)(A), see 1987 Amendment note below.

Subsec. (a)(4). Pub. L. 100-360, Sec. 202(c)(2)(C)-(E), added

par. (4) relating to participating or nonparticipating pharmacies.

Subsec. (b)(1)(A). Pub. L. 100-360, Sec. 411(e)(3), added Pub. L.

100-203, Sec. 4039(h)(1)(A), see 1987 Amendment note below.

Subsec. (b)(2). Pub. L. 100-360, Sec. 411(e)(3), added Pub. L.

100-203, Sec. 4039(h)(1)(B), see 1987 Amendment note below.

Subsec. (c)(1). Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub.

L. 100-203, Sec. 4118(e)(7), see 1987 Amendment note below.

Subsec. (i). Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub. L.

100-203, Sec. 4118(e)(8), see 1987 Amendment note below.

Subsec. (i)(1). Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub.

L. 100-203, Sec. 4118(e)(9), see 1987 Amendment note below.

Subsec. (i)(2). Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub.

L. 100-203, Sec. 4118(e)(10)(B), see 1987 Amendment note below.

Subsec. (i)(5). Pub. L. 100-485, Sec. 608(d)(26)(J), amended

directory language of Pub. L. 100-203, Sec. 4118(e)(10)(C), see

1987 Amendment note below.

Pub. L. 100-360, Sec. 411(k)(10)(D), added Pub. L. 100-203, Sec.

4118(e)(10)(C), see 1987 Amendment note below.

Subsec. (l). Pub. L. 100-485, Sec. 608(d)(26)(I), inserted "for

penalties, assessments, and an exclusion" after "liable".

Pub. L. 100-360, Sec. 411(k)(10)(B)(ii)(III), added Pub. L.

100-203, Sec. 4118(e)(1)(B), see 1987 Amendment note below.

1987 - Subsec. (a). Pub. L. 100-203, Sec. 4118(e)(10)(A), as

added by Pub. L. 100-360, Sec. 411(k)(10)(D), inserted ", but

excluding a beneficiary, as defined in subsection (i)(5) of this

section" in introductory provisions.

Pub. L. 100-93, Sec. 3(a)(3)(B), in concluding provisions,

inserted "(or, in cases under paragraph (3), $15,000 for each

individual with respect to whom false or misleading information was

given)" before period at end of first sentence, and inserted at end

"In addition the Secretary may make a determination in the same

proceeding to exclude the person from participation in the programs

under subchapter XVIII of this chapter and to direct the

appropriate State agency to exclude the person from participation

in any State health care program."

Subsec. (a)(1). Pub. L. 100-203, Sec. 4118(e)(1)(A), formerly

Sec. 4118(e)(1), as amended by Pub. L. 100-360, Sec.

411(k)(10)(B)(ii)(I), (II), as amended by Pub. L. 100-485, Sec.

608(d)(26)(H), substituted "or should know" for "or has reason to

know" in subpars. (A) to (C).

Pub. L. 100-93, Sec. 3(a)(1), substituted "the Secretary

determines" for "the Secretary determines is for a medical or other

item or service" in introductory provisions and substituted

subpars. (A) to (D) for former subpars. (A) and (B) which read as

follows:

"(A) that the person knows or has reason to know was not provided

as claimed, or

"(B) payment for which may not be made under the program under

which such claim was made, pursuant to a determination by the

Secretary under section 1320a-7, 1320c-9(b), or 1395y(d) of this

title, or pursuant to a determination by the Secretary under

section 1395cc(b)(2) of this title with respect to which the

Secretary has initiated termination proceedings; or".

Subsec. (a)(1)(D). Pub. L. 100-203, Sec. 4118(e)(6), as added by

Pub. L. 100-360, Sec. 411(k)(10)(D), as amended by Pub. L. 100-485,

Sec. 608(d)(26)(K)(i), substituted "excluded from" for "excluded

under" and inserted "or as a result of the application of the

provisions of section 1395u(j)(2) of this title".

Subsec. (a)(2). Pub. L. 100-93, Sec. 3(a)(2), inserted "(or other

requirement of a State plan under subchapter XIX of this chapter)"

after "State agency" in subpar. (B) and added subpar. (D).

Subsec. (a)(3). Pub. L. 100-203, Sec. 4118(e)(1)(A), as amended

by Pub. L. 100-360, Sec. 411(k)(10)(B)(ii)(I), (II), as amended by

Pub. L. 100-485, Sec. 608(d)(26)(H), substituted "or should know"

for "or has reason to know".

Pub. L. 100-93, Sec. 3(a)(3)(A), added par. (3).

Subsec. (b)(1)(A). Pub. L. 100-203, Sec. 4039(h)(1)(A), as added

by Pub. L. 100-360, Sec. 411(e)(3), substituted "subchapter XVIII"

for "subchapter XVII".

Subsec. (b)(2). Pub. L. 100-203, Sec. 4039(h)(1)(B), as added by

Pub. L. 100-360, Sec. 411(e)(3), substituted "$2,000 for each" for

"$2,000 for".

Subsec. (c)(1). Pub. L. 100-203, Sec. 4118(e)(7), as added by

Pub. L. 100-360, Sec. 411(k)(10)(D), inserted ", request for

payment, or other occurrence described in this section" and ", the

request for payment was made, or the occurrence took place".

Pub. L. 100-93, Sec. 3(b), (c), substituted "penalty, assessment,

or exclusion" for "penalty or assessment" and inserted provision

that the Secretary not initiate an action under this section with

respect to a claim later than six years after the claim was

presented and that the Secretary initiate an action in the manner

authorized by Rule 4 of the Federal Rules of Civil Procedure.

Subsec. (d). Pub. L. 100-93, Sec. 3(c), substituted "penalty,

assessment, or exclusion" for "penalty or assessment" in

introductory provisions.

Subsec. (f)(1)(A). Pub. L. 100-93, Sec. 3(d), substituted

"bearing the same proportion to the total amount recovered as the

State's share of the amount paid by the State agency for such claim

bears to the total amount paid" for "equal to the State's share of

the amount paid by the State agency".

Subsec. (g). Pub. L. 100-93, Sec. 3(c), substituted "penalty,

assessment, or exclusion" for "penalty or assessment" in two

places.

Subsec. (h). Pub. L. 100-93, Sec. 3(c), (e), substituted

"penalty, assessment, or exclusion" for "penalty or assessment" in

two places and inserted "the appropriate State agency or agencies

administering or supervising the administration of State health

care programs (as defined in section 1320a-7(h) of this title),"

after "professional organization,".

Subsec. (i). Pub. L. 100-203, Sec. 4118(e)(8), as added by Pub.

L. 100-360, Sec. 411(k)(10)(D), substituted "this section" for

"this subsection" in introductory provisions.

Subsec. (i)(1). Pub. L. 100-203, Sec. 4118(e)(9), as added by

Pub. L. 100-360, Sec. 411(k)(10)(D), inserted "or subchapter XX of

this chapter".

Subsec. (i)(2). Pub. L. 100-203, Sec. 4118(e)(10)(B), as added by

Pub. L. 100-360, Sec. 411(k)(10)(D), substituted "for payments for

items and services under subchapter V, XVIII, XIX, or XX of this

chapter" for "submitted by -

"(A) a provider of services or other person, agency, or

organization that furnishes an item or service under subchapter

XVIII of this chapter, or

"(B) a person, agency, or organization that furnishes an item

or service for which medical assistance is provided under

subchapter XIX of this chapter, or

"(C) a person, agency, or organization that provides an item or

service for which payment is made under subchapter V of this

chapter or from an allotment to a State under such subchapter,

to the United States or a State agency, or agent thereof, for

payment for health care services under subchapter XVIII or XIX of

this chapter or for any item or service under subchapter V of this

chapter".

Subsec. (i)(5). Pub. L. 100-203, Sec. 4118(e)(10)(C), as added by

Pub. L. 100-360, Sec. 411(k)(10)(D), and amended by Pub. L.

100-485, Sec. 608(d)(26)(J), added par. (5).

Subsecs. (j), (k). Pub. L. 100-93, Sec. 3(f), added subsecs. (j)

and (k).

Subsec. (l). Pub. L. 100-203, Sec. 4118(e)(1)(B), as added by

Pub. L. 100-360, Sec. 411(k)(10)(B)(ii)(III), added subsec. (l).

1986 - Subsec. (a)(1). Pub. L. 99-509, Sec. 9313(c)(1)(B),

substituted "(i)(1)" and "(i)(2)" for "(h)(1)" and "(h)(2)",

respectively.

Subsec. (b). Pub. L. 99-509, Sec. 9313(c)(1)(D), (E), added

subsec. (b). Former subsec. (b) redesignated (c).

Subsec. (c). Pub. L. 99-509, Sec. 9313(c)(1)(A), (D),

redesignated subsec. (b) as (c) and substituted "subsection (a) or

(b)" for "subsection (a)" in pars. (1) and (2). Former subsec. (c)

redesignated (d).

Subsec. (c)(3). Pub. L. 99-509, Sec. 9317(a), added par. (3).

Subsec. (c)(4). Pub. L. 99-509, Sec. 9317(b), added par. (4).

Subsec. (d). Pub. L. 99-509, Sec. 9313(c)(1)(A), (D),

redesignated subsec. (c) as (d) and substituted "subsection (a) or

(b)" for "subsection (a)" in introductory provisions. Former

subsec. (d) redesignated (e).

Subsecs. (e), (f). Pub. L. 99-509, Sec. 9313(c)(1)(D),

redesignated subsecs. (d) and (e) as (e) and (f), respectively.

Former subsec. (f) redesignated (g).

Subsec. (g). Pub. L. 99-509, Sec. 9313(c)(1)(A), (C), (D),

redesignated subsec. (f) as (g) and substituted "subsection (a) or

(b)" for "subsection (a)" and "subsection (e)" for "subsection

(d)". Former subsec. (g) redesignated (h).

Subsec. (h). Pub. L. 99-509, Sec. 9313(c)(1)(A), (D),

redesignated subsec. (g) as (h) and substituted "subsection (a) or

(b)" for "subsection (a)". Former subsec. (h) redesignated (i).

Subsec. (i). Pub. L. 99-509, Sec. 9313(c)(1)(D), redesignated

subsec. (h) as (i).

1984 - Subsec. (a)(2)(C). Pub. L. 98-369, Sec. 2306(f)(1), added

cl. (C).

Subsec. (g). Pub. L. 98-369, Sec. 2354(a)(3), substituted

"utilization and quality control peer review organization" for

"Professional Standards Review Organization".

1982 - Subsec. (a). Pub. L. 97-248 redesignated as part of par.

(1) preceding subpar. (A) provisions formerly preceding par. (1),

in subpar. (B) substituted "or pursuant to a determination by the

Secretary under section 1395cc(b)(2) of this title with respect to

which the Secretary has initiated termination proceedings;" for "or

1395cc(b)(2) of this title,", and in par. (2) substituted "presents

or causes to be presented to any person a request for payment which

is in violation of the terms of (A) an assignment under section

1842(b)(3)(B)(ii), or (B) an agreement with a State agency not to

charge a person for an item or service in excess of the amount

permitted to be charged" for "is submitted in violation of an

agreement between the person and the United States or a State

agency".

EFFECTIVE DATE OF 1998 AMENDMENT

Pub. L. 105-277, div. J, title V, Sec. 5201(d), Oct. 21, 1998,

112 Stat. 2681-917, provided that: "The amendments made by this

section [amending this section and section 1320a-7d of this title]

shall take effect on the date of the enactment of this Act [Oct.

21, 1998]."

EFFECTIVE DATE OF 1997 AMENDMENT

Amendment by section 4201(c)(1) of Pub. L. 105-33 applicable to

services furnished on or after Oct. 1, 1997, see section 4201(d) of

Pub. L. 105-33, set out as a note under section 1395f of this

title.

Section 4304(c) of Pub. L. 105-33 provided that:

"(1) Contracts with excluded persons. - The amendments made by

subsection (a) [amending this section] shall apply to arrangements

and contracts entered into after the date of the enactment of this

Act [Aug. 5, 1997].

"(2) Kickbacks. - The amendments made by subsection (b) [amending

this section] shall apply to acts committed after the date of the

enactment of this Act."

Amendment by section 4331(e) of Pub. L. 105-33 effective as if

included in the enactment of the Health Insurance Portability and

Accountability Act of 1996, Pub. L. 104-191, see section 4331(f) of

Pub. L. 105-33, set out as a note under section 1320a-7e of this

title.

EFFECTIVE DATE OF 1996 AMENDMENT

Section 231(i) of Pub. L. 104-191 provided that: "The amendments

made by this section [amending this section and sections 1320c-5

and 1395mm of this title] shall apply to acts or omissions

occurring on or after January 1, 1997."

Section 232(b) of Pub. L. 104-191 provided that: "The amendment

made by subsection (a) [amending this section] shall apply to

certifications made on or after the date of the enactment of this

Act [Aug. 21, 1996]."

EFFECTIVE DATE OF 1989 AMENDMENT

Section 201(c) of Pub. L. 101-234 provided that: "The provisions

of this section [amending this section and sections 1320c-3, 1395h,

1395k, 1395l, 1395m, 1395n, 1395u, 1395w-2, 1395x, 1395y, 1395z,

1395aa, 1395bb, 1395cc, 1395mm, 1396a, 1396b, 1396d, and 1396n of

this title, repealing section 1395w-3 of this title, and amending

or repealing provisions set out as notes under sections 1320c-3,

1395b-1, 1395k, 1395m, 1395u, 1395x, 1395ll, and 1395ww of this

title] shall take effect January 1, 1990."

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.

Amendment by section 202(c)(2) of Pub. L. 100-360 applicable to

items dispensed on or after Jan. 1, 1990, see section 202(m)(1) of

Pub. L. 100-360, set out as a note under section 1395u of this

title.

Except as specifically provided in section 411 of Pub. L.

100-360, amendment by section 411(e)(3), (k)(10)(B)(ii), (D) 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 AMENDMENTS

Section 4118(e)(14), formerly section 4118(e)(3), of Pub. L.

100-203, as renumbered and amended by Pub. L. 100-360, title IV,

Sec. 411(k)(10)(B)(i), (D), July 1, 1988, 102 Stat. 794, 795,

provided that: "The amendments made by paragraph (1) [amending this

section] shall apply to activities occurring before, 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, except that

amendment by section 3(a)(1) of Pub. L. 100-93 applicable to claims

presented for services performed on or after date at end of

fourteen-day period beginning Aug. 18, 1987, without regard to the

date the physician's misrepresentation of fact was made, and

amendment by section 3(f) of Pub. L. 100-93 effective Aug. 18,

1987, see section 15(a), (c)(3), and (d) of Pub. L. 100-93, set out

as a note under section 1320a-7 of this title.

EFFECTIVE DATE OF 1986 AMENDMENT

Section 9313(c)(2) of Pub. L. 99-509, as amended by Pub. L.

100-203, title IV, Sec. 4016, Dec. 22, 1987, 101 Stat. 1330-64;

Pub. L. 101-239, title VI, Sec. 6207(a), Dec. 19, 1989, 103 Stat.

2245, provided that: "The amendments made by paragraph (1)

[amending this section] shall apply to -

"(A) payments by hospitals occurring more than 6 months after

the date of the enactment of this Act [Oct. 21, 1986], and

"(B) payments by eligible organizations or entities occurring

on or after April 1, 1991."

Section 9317(d)(1), (2) of Pub. L. 99-509 provided that:

"(1) The amendment made by subsection (a) [amending this section]

shall take effect on the date of the enactment of this Act [Oct.

21, 1986], without regard to when the criminal conviction was

obtained, but shall only apply to a conviction upon a plea of nolo

contendere tendered after the date of the enactment of this Act.

"(2) The amendment made by subsection (b) [amending this section]

shall apply to failures or misconduct occurring on or after the

date of the enactment of this Act."

EFFECTIVE DATE OF 1984 AMENDMENT

Amendment by section 2354(a)(3) 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

2354(e)(1) of Pub. L. 98-369, set out as a note under section

1320a-1 of this title.

EFFECTIVE DATE OF 1982 AMENDMENT

Amendment by Pub. L. 97-248 effective as if originally included

as part of this section as this section was amended by the Omnibus

Budget Reconciliation Act of 1981, Pub. L. 97-35, see section

137(d)(2) of Pub. L. 97-248, set out as a note under section 1396a

of this title.

REGULATIONS

Pub. L. 105-277, div. J, title V, Sec. 5201(e), Oct. 21, 1998,

112 Stat. 2681-917, provided that: "The Secretary of Health and

Human Services may promulgate regulations that take effect on an

interim basis, after notice and pending opportunity for public

comment, in order to implement the amendments made by this section

[amending this section and section 1320a-7d of this title] in a

timely manner."

GAO STUDY AND REPORT ON IMPACT OF SAFE HARBOR ON MEDIGAP POLICIES

Pub. L. 105-277, div. J, title V, Sec. 5201(b)(2), Oct. 21, 1998,

112 Stat. 2681-917, provided that: "If a permissible practice is

promulgated under section 1128A(n)(1)(A) of the Social Security Act

[subsec. (n)(1)(A) of this section] (as added by paragraph (1)),

the Comptroller General of the United States shall conduct a study

that compares any disproportionate impact on specific issuers of

medicare supplemental policies (including the impact on premiums

for non-ESRD medicare beneficiaries enrolled in such policies) due

to adverse selection in enrolling medicare ESRD beneficiaries

before the enactment of the Health Insurance Portability and

Accountability Act of 1996 [Pub. L. 104-191, Aug. 21, 1996] and 1

year after the date of promulgation of such permissible practice

under section 1128A(n)(1)(A) of the Social Security Act. Not later

than 18 months after the date of promulgation of such practice, the

Comptroller General shall submit a report to Congress on such study

and shall include in the report recommendations concerning whether

the time limitation imposed under section 1128A(n)(1)(B) of such

Act [subsec. (n)(1)(B) of this section] should be extended."

REPEAL OF 1988 EXPANSION OF MEDICARE PART B BENEFITS

Section 201(a) of Pub. L. 101-234 provided that:

"(1) General rule. - Except as provided in paragraph (2),

sections 201 through 208 of MCCA [sections 201 to 208 of Pub. L.

100-360, enacting section 1395w-3 of this title, amending this

section and sections 1320c-3, 1395h, 1395k, 1395l, 1395m, 1395n,

1395u, 1395w-2, 1395x, 1395y, 1395z, 1395aa, 1395bb, 1395cc,

1395mm, 1396a, 1396b, and 1396n of this title, and enacting

provisions set out as notes under sections 1320c-3, 1395b-1, 1395k,

1395m, 1395u, 1395x, 1395ll, and 1395ww of this title] are repealed

and the provisions of law amended or repealed by such sections are

restored or revived as if such sections had not been enacted.

"(2) Exception. - Paragraph (1) shall not apply to subsections

(g) and (m)(4) of section 202 of MCCA [amending section 1395u of

this title and enacting provisions set out as a note under section

1395u of this title.]"

STUDY AND REPORT ON INCENTIVE ARRANGEMENTS OFFERED TO PHYSICIANS

Section 9313(c)(3) of Pub. L. 99-509 directed Secretary of Health

and Human Services to report to Congress, not later than Jan. 1,

1988, concerning incentive arrangements offered by health

maintenance organizations and competitive medical plans to

physicians.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 262a, 299c-3, 704, 707,

1320a-3a, 1320a-7, 1320a-7c, 1320a-7d, 1320a-7e, 1320a-8, 1320b-10,

1320d-5, 1395b-5, 1395b-7, 1395i-3, 1395l, 1395m, 1395u, 1395w-2,

1395w-27, 1395y, 1395cc, 13955dd, 1395mm, 1395nn, 1395ss, 1395bbb,

1396a, 1396b, 1396r, 1396r-6, 1396r-8, 1396t, 1396u, 1397d, 1397gg,

11131, 11137 of this title; title 5 section 8904; title 10 section

1094.

-FOOTNOTE-

(!1) So in original. Probably should not be capitalized.

(!2) So in original. Two subpars. (D) have been enacted.

(!3) See References in Text note below.

-End-

-CITE-

42 USC Sec. 1320a-7b 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. 1320a-7b. Criminal penalties for acts involving Federal health

care programs

-STATUTE-

(a) Making or causing to be made false statements or

representations

Whoever -

(1) knowingly and willfully makes or causes to be made any

false statement or representation of a material fact in any

application for any benefit or payment under a Federal health

care program (as defined in subsection (f) of this section),

(2) at any time knowingly and willfully makes or causes to be

made any false statement or representation of a material fact for

use in determining rights to such benefit or payment,

(3) having knowledge of the occurrence of any event affecting

(A) his initial or continued right to any such benefit or

payment, or (B) the initial or continued right to any such

benefit or payment of any other individual in whose behalf he has

applied for or is receiving such benefit or payment, conceals or

fails to disclose such event with an intent fraudulently to

secure such benefit or payment either in a greater amount or

quantity than is due or when no such benefit or payment is

authorized,

(4) having made application to receive any such benefit or

payment for the use and benefit of another and having received

it, knowingly and willfully converts such benefit or payment or

any part thereof to a use other than for the use and benefit of

such other person,

(5) presents or causes to be presented a claim for a

physician's service for which payment may be made under a Federal

health care program and knows that the individual who furnished

the service was not licensed as a physician, or

(6) for a fee knowingly and willfully counsels or assists an

individual to dispose of assets (including by any transfer in

trust) in order for the individual to become eligible for medical

assistance under a State plan under subchapter XIX of this

chapter, if disposing of the assets results in the imposition of

a period of ineligibility for such assistance under section

1396p(c) of this title,

shall (i) in the case of such a statement, representation,

concealment, failure, or conversion by any person in connection

with the furnishing (by that person) of items or services for which

payment is or may be made under the program, be guilty of a felony

and upon conviction thereof fined not more than $25,000 or

imprisoned for not more than five years or both, or (ii) in the

case of such a statement, representation, concealment, failure,

conversion, or provision of counsel or assistance by any other

person, be guilty of a misdemeanor and upon conviction thereof

fined not more than $10,000 or imprisoned for not more than one

year, or both. In addition, in any case where an individual who is

otherwise eligible for assistance under a Federal health care

program is convicted of an offense under the preceding provisions

of this subsection, the administrator of such program may at its

option (notwithstanding any other provision of such program) limit,

restrict, or suspend the eligibility of that individual for such

period (not exceeding one year) as it deems appropriate; but the

imposition of a limitation, restriction, or suspension with respect

to the eligibility of any individual under this sentence shall not

affect the eligibility of any other person for assistance under the

plan, regardless of the relationship between that individual and

such other person.

(b) Illegal remunerations

(1) Whoever knowingly and willfully solicits or receives any

remuneration (including any kickback, bribe, or rebate) directly or

indirectly, overtly or covertly, in cash or in kind -

(A) in return for referring an individual to a person for the

furnishing or arranging for the furnishing of any item or service

for which payment may be made in whole or in part under a Federal

health care program, or

(B) in return for purchasing, leasing, ordering, or arranging

for or recommending purchasing, leasing, or ordering any good,

facility, service, or item for which payment may be made in whole

or in part under a Federal health care program,

shall be guilty of a felony and upon conviction thereof, shall be

fined not more than $25,000 or imprisoned for not more than five

years, or both.

(2) Whoever knowingly and willfully offers or pays any

remuneration (including any kickback, bribe, or rebate) directly or

indirectly, overtly or covertly, in cash or in kind to any person

to induce such person -

(A) to refer an individual to a person for the furnishing or

arranging for the furnishing of any item or service for which

payment may be made in whole or in part under a Federal health

care program, or

(B) to purchase, lease, order, or arrange for or recommend

purchasing, leasing, or ordering any good, facility, service, or

item for which payment may be made in whole or in part under a

Federal health care program,

shall be guilty of a felony and upon conviction thereof, shall be

fined not more than $25,000 or imprisoned for not more than five

years, or both.

(3) Paragraphs (1) and (2) shall not apply to -

(A) a discount or other reduction in price obtained by a

provider of services or other entity under a Federal health care

program if the reduction in price is properly disclosed and

appropriately reflected in the costs claimed or charges made by

the provider or entity under a Federal health care program;

(B) any amount paid by an employer to an employee (who has a

bona fide employment relationship with such employer) for

employment in the provision of covered items or services;

(C) any amount paid by a vendor of goods or services to a

person authorized to act as a purchasing agent for a group of

individuals or entities who are furnishing services reimbursed

under a Federal health care program if -

(i) the person has a written contract, with each such

individual or entity, which specifies the amount to be paid the

person, which amount may be a fixed amount or a fixed

percentage of the value of the purchases made by each such

individual or entity under the contract, and

(ii) in the case of an entity that is a provider of services

(as defined in section 1395x(u) of this title), the person

discloses (in such form and manner as the Secretary requires)

to the entity and, upon request, to the Secretary the amount

received from each such vendor with respect to purchases made

by or on behalf of the entity;

(D) a waiver of any coinsurance under part B of subchapter

XVIII of this chapter by a Federally qualified health care center

with respect to an individual who qualifies for subsidized

services under a provision of the Public Health Service Act [42

U.S.C. 201 et seq.];

(E) any payment practice specified by the Secretary in

regulations promulgated pursuant to section 14(a) of the Medicare

and Medicaid Patient and Program Protection Act of 1987; and

(F) any remuneration between an organization and an individual

or entity providing items or services, or a combination thereof,

pursuant to a written agreement between the organization and the

individual or entity if the organization is an eligible

organization under section 1395mm of this title or if the written

agreement, through a risk-sharing arrangement, places the

individual or entity at substantial financial risk for the cost

or utilization of the items or services, or a combination

thereof, which the individual or entity is obligated to provide.

(c) False statements or representations with respect to condition

or operation of institutions

Whoever knowingly and willfully makes or causes to be made, or

induces or seeks to induce the making of, any false statement or

representation of a material fact with respect to the conditions or

operation of any institution, facility, or entity in order that

such institution, facility, or entity may qualify (either upon

initial certification or upon recertification) as a hospital,

critical access hospital, skilled nursing facility, nursing

facility, intermediate care facility for the mentally retarded,

home health agency, or other entity (including an eligible

organization under section 1395mm(b) of this title) for which

certification is required under subchapter XVIII of this chapter or

a State health care program (as defined in section 1320a-7(h) of

this title), or with respect to information required to be provided

under section 1320a-3a of this title, shall be guilty of a felony

and upon conviction thereof shall be fined not more than $25,000 or

imprisoned for not more than five years, or both.

(d) Illegal patient admittance and retention practices

Whoever knowingly and willfully -

(1) charges, for any service provided to a patient under a

State plan approved under subchapter XIX of this chapter, money

or other consideration at a rate in excess of the rates

established by the State (or, in the case of services provided to

an individual enrolled with a medicaid managed care organization

under subchapter XIX of this chapter under a contract under

section 1396b(m) of this title or under a contractual, referral,

or other arrangement under such contract, at a rate in excess of

the rate permitted under such contract), or

(2) charges, solicits, accepts, or receives, in addition to any

amount otherwise required to be paid under a State plan approved

under subchapter XIX of this chapter, any gift, money, donation,

or other consideration (other than a charitable, religious, or

philanthropic contribution from an organization or from a person

unrelated to the patient) -

(A) as a precondition of admitting a patient to a hospital,

nursing facility, or intermediate care facility for the

mentally retarded, or

(B) as a requirement for the patient's continued stay in such

a facility,

when the cost of the services provided therein to the patient is

paid for (in whole or in part) under the State plan,

shall be guilty of a felony and upon conviction thereof shall be

fined not more than $25,000 or imprisoned for not more than five

years, or both.

(e) Violation of assignment terms

Whoever accepts assignments described in section

1395u(b)(3)(B)(ii) of this title or agrees to be a participating

physician or supplier under section 1395u(h)(1) of this title and

knowingly, willfully, and repeatedly violates the term of such

assignments or agreement, shall be guilty of a misdemeanor and upon

conviction thereof shall be fined not more than $2,000 or

imprisoned for not more than six months, or both.

(f) "Federal health care program" defined

For purposes of this section, the term "Federal health care

program" means -

(1) any plan or program that provides health benefits, whether

directly, through insurance, or otherwise, which is funded

directly, in whole or in part, by the United States Government

(other than the health insurance program under chapter 89 of

title 5); or

(2) any State health care program, as defined in section

1320a-7(h) of this title.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1128B, formerly title

XVIII, Sec. 1877(d), and title XIX, Sec. 1909, as added and amended

Pub. L. 92-603, title II, Secs. 242(c), 278(b)(9), Oct. 30, 1972,

86 Stat. 1419, 1454; Pub. L. 95-142, Sec. 4(a), (b), Oct. 25, 1977,

91 Stat. 1179, 1181; Pub. L. 96-499, title IX, Sec. 917, Dec. 5,

1980, 94 Stat. 2625; Pub. L. 98-369, div. B, title III, Sec.

2306(f)(2), July 18, 1984, 98 Stat. 1073; renumbered title XI, Sec.

1128B, and amended Pub. L. 100-93, Secs. 4(a)-(d), 14(b), Aug. 18,

1987, 101 Stat. 688, 689, 697; Pub. L. 100-203, title IV, Secs.

4039(a), 4211(h)(7), Dec. 22, 1987, 101 Stat. 1330-81, 1330-206;

Pub. L. 100-360, title IV, Sec. 411(a)(3)(A), (B)(i), July 1, 1988,

102 Stat. 768; Pub. L. 101-239, title VI, Sec. 6003(g)(3)(D)(ii),

Dec. 19, 1989, 103 Stat. 2153; Pub. L. 101-508, title IV, Secs.

4161(a)(4), 4164(b)(2), Nov. 5, 1990, 104 Stat. 1388-94, 1388-102;

Pub. L. 103-432, title I, Sec. 133(a)(2), Oct. 31, 1994, 108 Stat.

4421; Pub. L. 104-191, title II, Secs. 204(a), 216(a), 217, Aug.

21, 1996, 110 Stat. 1999, 2007, 2008; Pub. L. 105-33, title IV,

Secs. 4201(c)(1), 4704(b), 4734, Aug. 5, 1997, 111 Stat. 373, 498,

522.)

-REFTEXT-

REFERENCES IN TEXT

Part B of subchapter XVIII of this chapter, referred to in

subsec. (b)(3)(D), is classified to section 1395j et seq. of this

title.

The Public Health Service Act, referred to in subsec. (b)(3)(D),

is act July 1, 1944, ch. 373, 58 Stat. 682, as amended, which is

classified generally to chapter 6A (Sec. 201 et seq.) of this

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

Short Title note set out under section 201 of this title and

Tables.

Section 14(a) of the Medicare and Medicaid Patient and Program

Protection Act of 1987, referred to in subsec. (b)(3)(E), is

section 14(a) of Pub. L. 100-93, which is set out below.

-COD-

CODIFICATION

Prior to redesignation by Pub. L. 100-93, subsecs. (a) to (d) of

this section were subsecs. (a) to (d) of section 1909 of act Aug.

14, 1935, which was classified to section 1396h of this title, and

subsec. (e) of this section was subsec. (d) of section 1877 of act

Aug. 14, 1935, which was classified to section 1395nn of this

title.

-MISC1-

AMENDMENTS

1997 - Subsec. (a). Pub. L. 105-33, Sec. 4734(2), in cl. (ii) of

concluding provisions, substituted "failure, conversion, or

provision of counsel or assistance by any other person" for

"failure, or conversion by any other person".

Subsec. (a)(6). Pub. L. 105-33, Sec. 4734(1), added par. (6) and

struck out former par. (6) which read as follows: "knowingly and

willfully disposes of assets (including by any transfer in trust)

in order for an individual to become eligible for medical

assistance under a State plan under subchapter XIX of this chapter,

if disposing of the assets results in the imposition of a period of

ineligibility for such assistance under section 1396p(c) of this

title,".

Subsec. (c). Pub. L. 105-33, Sec. 4201(c)(1), substituted

"critical access" for "rural primary care".

Subsec. (d)(1). Pub. L. 105-33, Sec. 4704(b), inserted "(or, in

the case of services provided to an individual enrolled with a

medicaid managed care organization under subchapter XIX of this

chapter under a contract under section 1396b(m) of this title or

under a contractual, referral, or other arrangement under such

contract, at a rate in excess of the rate permitted under such

contract)" after "by the State".

1996 - Pub. L. 104-191, Sec. 204(a)(1), substituted "Federal" for

"Medicare or State" in section catchline.

Subsec. (a). Pub. L. 104-191, Sec. 204(a)(4), in concluding

provisions, substituted "a Federal health care program" for "a

State plan approved under subchapter XIX of this chapter" and "the

administrator of such program may at its option (notwithstanding

any other provision of such program)" for "the State may at its

option (notwithstanding any other provision of that subchapter or

of such plan)".

Subsec. (a)(1). Pub. L. 104-191, Sec. 204(a)(2), substituted "a

Federal health care program (as defined in subsection (f) of this

section)" for "a program under subchapter XVIII of this chapter or

a State health care program (as defined in section 1320a-7(h) of

this title)".

Subsec. (a)(5). Pub. L. 104-191, Sec. 204(a)(3), substituted "a

Federal" for "a program under subchapter XVIII of this chapter or a

State".

Subsec. (a)(6). Pub. L. 104-191, Sec. 217, added par. (6).

Subsec. (b). Pub. L. 104-191, Sec. 204(a)(5), substituted "a

Federal health care program" for "subchapter XVIII of this chapter

or a State health care program" wherever appearing.

Subsec. (b)(3)(F). Pub. L. 104-191, Sec. 216(a), added subpar.

(F).

Subsec. (c). Pub. L. 104-191, Sec. 204(a)(6), inserted "(as

defined in section 1320a-7(h) of this title)" after "a State health

care program".

Subsec. (f). Pub. L. 104-191, Sec. 204(a)(7), added subsec. (f).

1994 - Subsec. (b)(3)(B). Pub. L. 103-432, which directed

substitution of "1395m(j)(5)" for "1395m(j)(4)" in subpar. (B) as

amended by section 134(a) of Pub. L. 103-432, could not be executed

because "1395m(j)(4)" does not appear in subpar. (B) and section

134(a) of Pub. L. 103-432 did not amend this section.

1990 - Subsec. (b)(3)(D), (E). Pub. L. 101-508, Sec. 4161(a)(4),

added subpar. (D) and redesignated former subpar. (D) as (E).

Subsec. (c). Pub. L. 101-508, Sec. 4164(b)(2), substituted

"health care program, or with respect to information required to be

provided under section 1320a-3a of this title," for "health care

program".

1989 - Subsec. (c). Pub. L. 101-239 inserted "rural primary care

hospital," after "hospital,".

1988 - Subsec. (c). Pub. L. 100-360 made technical correction to

directory language of Pub. L. 100-203, Sec. 4039(a), see 1987

Amendment note below.

Pub. L. 100-203, Sec. 4211(h)(7)(A), substituted "nursing

facility, intermediate care facility for the mentally retarded" for

"intermediate care facility".

Subsec. (d)(2)(A). Pub. L. 100-203, Sec. 4211(h)(7)(B),

substituted "nursing facility, or intermediate care facility for

the mentally retarded" for "skilled nursing facility, or

intermediate care facility".

1987 - Pub. L. 100-93, Sec. 4(a)(1), substituted "Criminal

penalties for acts involving Medicare or State health care

programs" for "Offenses and penalties" in section catchline.

Subsec. (a). Pub. L. 100-93, Sec. 4(a)(3), (4), in concluding

provisions, substituted "made under the program" for "made under

this subchapter", "approved under subchapter XIX of this chapter"

for "approved under this subchapter", and "provision of that

subchapter" for "provision of this subchapter".

Subsec. (a)(1). Pub. L. 100-93, Sec. 4(a)(2), substituted "a

program under subchapter XVIII of this chapter or a State health

care program (as defined in section 1320a-7(h) of this title)" for

"a State plan approved under this subchapter".

Subsec. (a)(5). Pub. L. 100-93, Sec. 4(b), added par. (5).

Subsec. (b)(1)(A), (B), (2)(A), (B). Pub. L. 100-93, Sec.

4(a)(5), substituted "subchapter XVIII of this chapter or a State

health care program" for "this subchapter".

Subsec. (b)(3). Pub. L. 100-93, Secs. 4(a)(5), (6), 14(b),

substituted "subchapter XVIII of this chapter or a State health

care program" for "this subchapter" in two places in subpar. (A)

and added subpars. (C) and (D).

Subsec. (c). Pub. L. 100-203, Sec. 4039(a), as amended by Pub. L.

100-360, substituted "institution, facility, or entity" for

"institution or facility" wherever appearing and inserted

"(including an eligible organization under section 1395mm(b) of

this title)" after "other entity".

Pub. L. 100-93, Sec. 4(a)(7), substituted "home health agency, or

other entity for which certification is required under subchapter

XVIII of this chapter or a State health care program" for "or home

health agency (as those terms are employed in this subchapter)".

Subsec. (d)(1), (2). Pub. L. 100-93, Sec. 4(a)(8), substituted

"subchapter XIX of this chapter" for "this subchapter".

Subsec. (e). Pub. L. 100-93, Sec. 4(c), redesignated subsec. (d)

of section 1395nn of this title as subsec. (e) of this section.

1984 - Subsec. (e). Pub. L. 98-369 inserted "or agrees to be a

participating physician or supplier under section 1395u(h)(1) of

this title" after "section 1395u(b)(3)(B)(ii) of this title", and

substituted "or agreement" for "specified in subclause (I) of such

section".

1980 - Subsec. (b)(1), (2). Pub. L. 96-499 inserted "knowingly

and willfully" after "Whoever".

1977 - Subsec. (a). Pub. L. 95-142, Sec. 4(b), designated

existing provisions following par. (4) as cl. (ii) and, as so

designated, inserted provisions relating to activities of other

persons, and inserted provisions authorizing the State to limit,

restrict, or suspend, the eligibility of any convicted persons for

benefits, and added cl. (i). See Codification note above.

Subsec. (b). Pub. L. 95-142, Sec. 4(b), redesignated existing

provisions as par. (1), substituted provisions relating to

solicitation or receiving of any remuneration in return for

referring an individual to a person for the furnishing or arranging

the furnishing of any item or service, or in return for purchasing,

leasing, ordering, or arranging for or recommending purchasing,

etc., as constituting a felony punishable by a fine of not more

than $25,000 and/or imprisonment for not more than five years, for

provisions relating to furnishing items or services and soliciting,

offering or receiving any kickback, bribe, or rebate in connection

with furnishing, etc. items or services as constituting a

misdemeanor punishable by a fine of not more than $10,000 and/or

imprisonment for not more than one year, and added pars. (2) and

(3). See Codification note above.

Subsec. (c). Pub. L. 95-142, Sec. 4(b), substituted provisions

setting forth felony nature of criminal activities with a fine of

not more than $25,000, or imprisonment for not more than five

years, or both, for provisions setting forth misdemeanor nature of

criminal activities with a fine of not more than $2,000, or

imprisonment for not more than six months, or both. See

Codification note above.

Subsec. (d). Pub. L. 95-142, Sec. 4(b), added subsec. (d). See

Codification note above.

Subsec. (e). Pub. L. 95-142, Sec. 4(a), added subsec. (e). See

Codification note above.

1972 - Subsec. (c). Pub. L. 92-603, Sec. 278(b)(9), substituted

"skilled nursing facility" for "skilled nursing home".

EFFECTIVE DATE OF 1997 AMENDMENT

Amendment by section 4201(c)(1) of Pub. L. 105-33 applicable to

services furnished on or after Oct. 1, 1997, see section 4201(d) of

Pub. L. 105-33, set out as a note under section 1395f of this

title.

Amendment by section 4704(b) of Pub. L. 105-33 effective Aug. 5,

1997, and applicable to contracts entered into or renewed on or

after Oct. 1, 1997, see section 4710 of Pub. L. 105-33, set out as

a note under section 1396b of this title.

EFFECTIVE DATE OF 1996 AMENDMENT

Section 204(b) of Pub. L. 104-191 provided that: "The amendments

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

January 1, 1997."

Section 216(c) of Pub. L. 104-191 provided that: "The amendments

made by subsection (a) [amending this section] shall apply to

written agreements entered into on or after January 1, 1997,

without regard to whether regulations have been issued to implement

such amendments."

Amendment by section 217 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.

EFFECTIVE DATE OF 1994 AMENDMENT

Amendment by section 133(a)(2) of Pub. L. 103-432 applicable to

items or services furnished on or after Jan. 1, 1995, see section

133(c) of Pub. L. 103-432, set out as a note under section 1395m of

this title.

EFFECTIVE DATE OF 1990 AMENDMENT

Amendment by section 4161(a)(4) of Pub. L. 101-508 applicable to

services furnished on or after Oct. 1, 1991, see section 4161(a)(8)

of Pub. L. 101-508, set out as a note under section 1395k of this

title.

Amendment by section 4164(b)(2) of Pub. L. 101-508 applicable

with respect to items or services furnished on or after Jan. 1,

1993, in the case of items or services furnished by a provider who,

on or before Nov. 5, 1990, has furnished items or services for

which payment may be made under part B of subchapter XVIII of this

chapter or Jan. 1, 1992, in the case of items or services furnished

by any other provider, see section 4164(b)(4) of Pub. L. 101-508,

set out as an Effective Date note under section 1320a-3a of this

title.

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

Amendment by section 4211(h)(7) of Pub. L. 100-203 applicable to

nursing facility services furnished on or after Oct. 1, 1990,

without regard to whether regulations implementing such amendment

are promulgated by such date, except as otherwise specifically

provided in section 1396r of this title, with transitional rule,

see section 4214(a), (b)(2) of Pub. L. 100-203, as amended, set out

as an Effective Date note under section 1396r of this title.

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.

EFFECTIVE DATE OF 1977 AMENDMENT

Section 4(d) of Pub. L. 95-142 provided that: "The amendments

made by subsections (a) and (b) [amending this section] shall apply

with respect to acts occurring and statements or representations

made on or after the date of the enactment of this Act [Oct. 25,

1977]."

EFFECTIVE DATE

Section 242(d) of Pub. L. 92-603 provided that: "The provisions

of amendments made by this section [enacting this section and

section 1396h of this title and amending section 1395ii of this

title] shall not be applicable to any acts, statements, or

representations made or committed prior to the enactment of this

Act [Oct. 30, 1972]."

NEGOTIATED RULEMAKING FOR RISK-SHARING EXCEPTION

Section 216(b) of Pub. L. 104-191 provided that:

"(1) Establishment. -

"(A) In general. - The Secretary of Health and Human Services

(in this subsection referred to as the 'Secretary') shall

establish, on an expedited basis and using a negotiated

rulemaking process under subchapter 3 [III] of chapter 5 of title

5, United States Code, standards relating to the exception for

risk-sharing arrangements to the anti-kickback penalties

described in section 1128B(b)(3)(F) of the Social Security Act

[subsec. (b)(3)(F) of this section], as added by subsection (a).

"(B) Factors to consider. - In establishing standards relating

to the exception for risk-sharing arrangements to the

anti-kickback penalties under subparagraph (A), the Secretary -

"(i) shall consult with the Attorney General and

representatives of the hospital, physician, other health

practitioner, and health plan communities, and other interested

parties; and

"(ii) shall take into account -

"(I) the level of risk appropriate to the size and type of

arrangement;

"(II) the frequency of assessment and distribution of

incentives;

"(III) the level of capital contribution; and

"(IV) the extent to which the risk-sharing arrangement

provides incentives to control the cost and quality of health

care services.

"(2) Publication of notice. - In carrying out the rulemaking

process under this subsection, the Secretary shall publish the

notice provided for under section 564(a) of title 5, United States

Code, by not later than 45 days after the date of the enactment of

this Act [Aug. 21, 1996].

"(3) Target date for publication of rule. - As part of the notice

under paragraph (2), and for purposes of this subsection, the

'target date for publication' (referred to in section 564(a)(5) of

such title) shall be January 1, 1997.

"(4) Abbreviated period for submission of comments. - In applying

section 564(c) of such title under this subsection, '15 days' shall

be substituted for '30 days'.

"(5) Appointment of negotiated rulemaking committee and

facilitator. - The Secretary shall provide for -

"(A) the appointment of a negotiated rulemaking committee under

section 565(a) of such title by not later than 30 days after the

end of the comment period provided for under section 564(c) of

such title (as shortened under paragraph (4)), and

"(B) the nomination of a facilitator under section 566(c) of

such title by not later than 10 days after the date of

appointment of the committee.

"(6) Preliminary committee report. - The negotiated rulemaking

committee appointed under paragraph (5) shall report to the

Secretary, by not later than October 1, 1996, regarding the

committee's progress on achieving a consensus with regard to the

rulemaking proceeding and whether such consensus is likely to occur

before one month before the target date for publication of the

rule. If the committee reports that the committee has failed to

make significant progress toward such consensus or is unlikely to

reach such consensus by the target date, the Secretary may

terminate such process and provide for the publication of a rule

under this subsection through such other methods as the Secretary

may provide.

"(7) Final committee report. - If the committee is not terminated

under paragraph (6), the rulemaking committee shall submit a report

containing a proposed rule by not later than one month before the

target publication date.

"(8) Interim, final effect. - The Secretary shall publish a rule

under this subsection in the Federal Register by not later than the

target publication date. Such rule shall be effective and final

immediately on an interim basis, but is subject to change and

revision after public notice and opportunity for a period (of not

less than 60 days) for public comment. In connection with such

rule, the Secretary shall specify the process for the timely review

and approval of applications of entities to be certified as

provider-sponsored organizations pursuant to such rules and

consistent with this subsection.

"(9) Publication of rule after public comment. - The Secretary

shall provide for consideration of such comments and republication

of such rule by not later than 1 year after the target publication

date."

ANTI-KICKBACK REGULATIONS

Section 14(a) of Pub. L. 100-93 provided that: "The Secretary of

Health and Human Services, in consultation with the Attorney

General, not later than 1 year after the date of the enactment of

this Act [Aug. 18, 1987] shall publish proposed regulations, and

not later than 2 years after the date of the enactment of this Act

shall promulgate final regulations, specifying payment practices

that shall not be treated as a criminal offense under section

1128B(b) of the Social Security Act [subsec. (b) of this section]

and shall not serve as the basis for an exclusion under section

1128(b)(7) of such Act. Any practices specified in regulations

pursuant to the preceding sentence shall be in addition to the

practices described in subparagraphs (A) through (C) of section

1128B(b)(3)."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320a-3a, 1320a-7,

1320a-7a, 1320a-7c, 1320a-7d, 1320a-7e, 1395b-5, 1396b, 1396r-6,

1397gg of this title.

-End-

-CITE-

42 USC Sec. 1320a-7c 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. 1320a-7c. Fraud and abuse control program

-STATUTE-

(a) Establishment of program

(1) In general

Not later than January 1, 1997, the Secretary, acting through

the Office of the Inspector General of the Department of Health

and Human Services, and the Attorney General shall establish a

program -

(A) to coordinate Federal, State, and local law enforcement

programs to control fraud and abuse with respect to health

plans,

(B) to conduct investigations, audits, evaluations, and

inspections relating to the delivery of and payment for health

care in the United States,

(C) to facilitate the enforcement of the provisions of

sections 1320a-7, 1320a-7a, and 1320a-7b of this title and

other statutes applicable to health care fraud and abuse,

(D) to provide for the modification and establishment of safe

harbors and to issue advisory opinions and special fraud alerts

pursuant to section 1320a-7d of this title, and

(E) to provide for the reporting and disclosure of certain

final adverse actions against health care providers, suppliers,

or practitioners pursuant to the data collection system

established under section 1320a-7e of this title.

(2) Coordination with health plans

In carrying out the program established under paragraph (1),

the Secretary and the Attorney General shall consult with, and

arrange for the sharing of data with representatives of health

plans.

(3) Guidelines

(A) In general

The Secretary and the Attorney General shall issue guidelines

to carry out the program under paragraph (1). The provisions of

sections 553, 556, and 557 of title 5 shall not apply in the

issuance of such guidelines.

(B) Information guidelines

(i) In general

Such guidelines shall include guidelines relating to the

furnishing of information by health plans, providers, and

others to enable the Secretary and the Attorney General to

carry out the program (including coordination with health

plans under paragraph (2)).

(ii) Confidentiality

Such guidelines shall include procedures to assure that

such information is provided and utilized in a manner that

appropriately protects the confidentiality of the information

and the privacy of individuals receiving health care services

and items.

(iii) Qualified immunity for providing information

The provisions of section 1320c-6(a) of this title

(relating to limitation on liability) shall apply to a person

providing information to the Secretary or the Attorney

General in conjunction with their performance of duties under

this section.

(4) Ensuring access to documentation

The Inspector General of the Department of Health and Human

Services is authorized to exercise such authority described in

paragraphs (3) through (9) of section 6 of the Inspector General

Act of 1978 (5 U.S.C. App.) as necessary with respect to the

activities under the fraud and abuse control program established

under this subsection.

(5) Authority of Inspector General

Nothing in this chapter shall be construed to diminish the

authority of any Inspector General, including such authority as

provided in the Inspector General Act of 1978 (5 U.S.C. App.).

(b) Additional use of funds by Inspector General

(1) Reimbursements for investigations

The Inspector General of the Department of Health and Human

Services is authorized to receive and retain for current use

reimbursement for the costs of conducting investigations and

audits and for monitoring compliance plans when such costs are

ordered by a court, voluntarily agreed to by the payor, or

otherwise.

(2) Crediting

Funds received by the Inspector General under paragraph (1) as

reimbursement for costs of conducting investigations shall be

deposited to the credit of the appropriation from which initially

paid, or to appropriations for similar purposes currently

available at the time of deposit, and shall remain available for

obligation for 1 year from the date of the deposit of such funds.

(c) "Health plan" defined

For purposes of this section, the term "health plan" means a plan

or program that provides health benefits, whether directly, through

insurance, or otherwise, and includes -

(1) a policy of health insurance;

(2) a contract of a service benefit organization; and

(3) a membership agreement with a health maintenance

organization or other prepaid health plan.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1128C, as added Pub. L.

104-191, title II, Sec. 201(a), Aug. 21, 1996, 110 Stat. 1992.)

-REFTEXT-

REFERENCES IN TEXT

The Inspector General Act of 1978, referred to in subsec. (a)(4),

(5), is Pub. L. 95-452, Oct. 12, 1978, 92 Stat. 1101, as amended,

which is set out in the Appendix to Title 5, Government

Organization and Employees.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320a-7e, 1395i of this

title.

-End-

-CITE-

42 USC Sec. 1320a-7d 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. 1320a-7d. Guidance regarding application of health care fraud

and abuse sanctions

-STATUTE-

(a) Solicitation and publication of modifications to existing safe

harbors and new safe harbors

(1) In general

(A) Solicitation of proposals for safe harbors

Not later than January 1, 1997, and not less than annually

thereafter, the Secretary shall publish a notice in the Federal

Register soliciting proposals, which will be accepted during a

60-day period, for -

(i) modifications to existing safe harbors issued pursuant

to section 14(a) of the Medicare and Medicaid Patient and

Program Protection Act of 1987 (42 U.S.C. 1320a-7b note);

(ii) additional safe harbors specifying payment practices

that shall not be treated as a criminal offense under section

1320a-7b(b) of this title and shall not serve as the basis

for an exclusion under section 1320a-7(b)(7) of this title;

(iii) advisory opinions to be issued pursuant to subsection

(b) of this section; and

(iv) special fraud alerts to be issued pursuant to

subsection (c) of this section.

(B) Publication of proposed modifications and proposed

additional safe harbors

After considering the proposals described in clauses (i) and

(ii) of subparagraph (A), the Secretary, in consultation with

the Attorney General, shall publish in the Federal Register

proposed modifications to existing safe harbors and proposed

additional safe harbors, if appropriate, with a 60-day comment

period. After considering any public comments received during

this period, the Secretary shall issue final rules modifying

the existing safe harbors and establishing new safe harbors, as

appropriate.

(C) Report

The Inspector General of the Department of Health and Human

Services (in this section referred to as the "Inspector

General") shall, in an annual report to Congress or as part of

the year-end semiannual report required by section 5 of the

Inspector General Act of 1978 (5 U.S.C. App.), describe the

proposals received under clauses (i) and (ii) of subparagraph

(A) and explain which proposals were included in the

publication described in subparagraph (B), which proposals were

not included in that publication, and the reasons for the

rejection of the proposals that were not included.

(2) Criteria for modifying and establishing safe harbors

In modifying and establishing safe harbors under paragraph

(1)(B), the Secretary may consider the extent to which providing

a safe harbor for the specified payment practice may result in

any of the following:

(A) An increase or decrease in access to health care

services.

(B) An increase or decrease in the quality of health care

services.

(C) An increase or decrease in patient freedom of choice

among health care providers.

(D) An increase or decrease in competition among health care

providers.

(E) An increase or decrease in the ability of health care

facilities to provide services in medically underserved areas

or to medically underserved populations.

(F) An increase or decrease in the cost to Federal health

care programs (as defined in section 1320a-7b(f) of this

title).

(G) An increase or decrease in the potential overutilization

of health care services.

(H) The existence or nonexistence of any potential financial

benefit to a health care professional or provider which may

vary based on their decisions of -

(i) whether to order a health care item or service; or

(ii) whether to arrange for a referral of health care items

or services to a particular practitioner or provider.

(I) Any other factors the Secretary deems appropriate in the

interest of preventing fraud and abuse in Federal health care

programs (as so defined).

(b) Advisory opinions

(1) Issuance of advisory opinions

The Secretary, in consultation with the Attorney General, shall

issue written advisory opinions as provided in this subsection.

(2) Matters subject to advisory opinions

The Secretary shall issue advisory opinions as to the following

matters:

(A) What constitutes prohibited remuneration within the

meaning of section 1320a-7b(b) of this title or section

1320a-7a(i)(6) of this title.

(B) Whether an arrangement or proposed arrangement satisfies

the criteria set forth in section 1320a-7b(b)(3) of this title

for activities which do not result in prohibited remuneration.

(C) Whether an arrangement or proposed arrangement satisfies

the criteria which the Secretary has established, or shall

establish by regulation for activities which do not result in

prohibited remuneration.

(D) What constitutes an inducement to reduce or limit

services to individuals entitled to benefits under subchapter

XVIII of this chapter or subchapter XIX of this chapter within

the meaning of section 1320a-7a(b) of this title.

(E) Whether any activity or proposed activity constitutes

grounds for the imposition of a sanction under section 1320a-7,

1320a-7a, or 1320a-7b of this title.

(3) Matters not subject to advisory opinions

Such advisory opinions shall not address the following matters:

(A) Whether the fair market value shall be, or was paid or

received for any goods, services or property.

(B) Whether an individual is a bona fide employee within the

requirements of section 3121(d)(2) of the Internal Revenue Code

of 1986.

(4) Effect of advisory opinions

(A) Binding as to Secretary and parties involved

Each advisory opinion issued by the Secretary shall be

binding as to the Secretary and the party or parties requesting

the opinion.

(B) Failure to seek opinion

The failure of a party to seek an advisory opinion may not be

introduced into evidence to prove that the party intended to

violate the provisions of sections (!1) 1320a-7, 1320a-7a, or

1320a-7b of this title.

(5) Regulations

(A) In general

Not later than 180 days after August 21, 1996, the Secretary

shall issue regulations to carry out this section. Such

regulations shall provide for -

(i) the procedure to be followed by a party applying for an

advisory opinion;

(ii) the procedure to be followed by the Secretary in

responding to a request for an advisory opinion;

(iii) the interval in which the Secretary shall respond;

(iv) the reasonable fee to be charged to the party

requesting an advisory opinion; and

(v) the manner in which advisory opinions will be made

available to the public.

(B) Specific contents

Under the regulations promulgated pursuant to subparagraph

(A) -

(i) the Secretary shall be required to issue to a party

requesting an advisory opinion by not later than 60 days

after the request is received; and

(ii) the fee charged to the party requesting an advisory

opinion shall be equal to the costs incurred by the Secretary

in responding to the request.

(6) Application of subsection

This subsection shall apply to requests for advisory opinions

made on or after the date which is 6 months after August 21,

1996.

(c) Special fraud alerts

(1) In general

(A) Request for special fraud alerts

Any person may present, at any time, a request to the

Inspector General for a notice which informs the public of

practices which the Inspector General considers to be suspect

or of particular concern under the Medicare program under

subchapter XVIII of this chapter or a State health care

program, as defined in section 1320a-7(h) of this title (in

this subsection referred to as a "special fraud alert").

(B) Issuance and publication of special fraud alerts

Upon receipt of a request described in subparagraph (A), the

Inspector General shall investigate the subject matter of the

request to determine whether a special fraud alert should be

issued. If appropriate, the Inspector General shall issue a

special fraud alert in response to the request. All special

fraud alerts issued pursuant to this subparagraph shall be

published in the Federal Register.

(2) Criteria for special fraud alerts

In determining whether to issue a special fraud alert upon a

request described in paragraph (1), the Inspector General may

consider -

(A) whether and to what extent the practices that would be

identified in the special fraud alert may result in any of the

consequences described in subsection (a)(2) of this section;

and

(B) the volume and frequency of the conduct that would be

identified in the special fraud alert.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1128D, as added Pub. L.

104-191, title II, Sec. 205, Aug. 21, 1996, 110 Stat. 2000; amended

Pub. L. 105-33, title IV, Sec. 4331(a)(1), Aug. 5, 1997, 111 Stat.

395; Pub. L. 105-277, div. J, title V, Sec. 5201(c), Oct. 21, 1998,

112 Stat. 2681-917; Pub. L. 106-554, Sec. 1(a)(6) [title V, Sec.

543], Dec. 21, 2000, 114 Stat. 2763, 2763A-551.)

-REFTEXT-

REFERENCES IN TEXT

Section 14(a) of the Medicare and Medicaid Patient and Program

Protection Act of 1987, referred to in subsec. (a)(1)(A)(i), is

section 14(a) of Pub. L. 100-93, which is set out as a note under

section 1320a-7b of this title.

Section 5 of the Inspector General Act of 1978, referred to in

subsec. (a)(1)(C), is section 5 of Pub. L. 95-452, Oct. 12, 1978,

92 Stat. 1103, as amended, which is set out in the Appendix to

Title 5, Government Organization and Employees.

The Internal Revenue Code of 1986, referred to in subsec.

(b)(3)(B), is classified generally to Title 26, Internal Revenue

Code.

-MISC1-

AMENDMENTS

2000 - Subsec. (b)(6). Pub. L. 106-554 struck out ", and before

the date which is 4 years after August 21, 1996" before period at

end.

1998 - Subsec. (b)(2)(A). Pub. L. 105-277 inserted "or section

1320a-7a(i)(6) of this title" before period at end.

1997 - Subsec. (b)(2)(D). Pub. L. 105-33 substituted "section

1320a-7a(b)" for "section 1320a-7b(b)".

EFFECTIVE DATE OF 1997 AMENDMENT

Amendment by Pub. L. 105-33 effective as if included in the

enactment of the Health Insurance Portability and Accountability

Act of 1996, Pub. L. 104-191, see section 4331(f) of Pub. L.

105-33, set out as a note under section 1320a-7e of this title.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320a-7c, 1395nn of this

title.

-FOOTNOTE-

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

-End-

-CITE-

42 USC Sec. 1320a-7e 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. 1320a-7e. Health care fraud and abuse data collection program

-STATUTE-

(a) General purpose

Not later than January 1, 1997, the Secretary shall establish a

national health care fraud and abuse data collection program for

the reporting of final adverse actions (not including settlements

in which no findings of liability have been made) against health

care providers, suppliers, or practitioners as required by

subsection (b) of this section, with access as set forth in

subsection (c) of this section, and shall maintain a database of

the information collected under this section.

(b) Reporting of information

(1) In general

Each Government agency and health plan shall report any final

adverse action (not including settlements in which no findings of

liability have been made) taken against a health care provider,

supplier, or practitioner.

(2) Information to be reported

The information to be reported under paragraph (1) includes:

(A) The name and TIN (as defined in section 7701(a)(41) of

the Internal Revenue Code of 1986) of any health care provider,

supplier, or practitioner who is the subject of a final adverse

action.

(B) The name (if known) of any health care entity with which

a health care provider, supplier, or practitioner, who is the

subject of a final adverse action, is affiliated or associated.

(C) The nature of the final adverse action and whether such

action is on appeal.

(D) A description of the acts or omissions and injuries upon

which the final adverse action was based, and such other

information as the Secretary determines by regulation is

required for appropriate interpretation of information reported

under this section.

(3) Confidentiality

In determining what information is required, the Secretary

shall include procedures to assure that the privacy of

individuals receiving health care services is appropriately

protected.

(4) Timing and form of reporting

The information required to be reported under this subsection

shall be reported regularly (but not less often than monthly) and

in such form and manner as the Secretary prescribes. Such

information shall first be required to be reported on a date

specified by the Secretary.

(5) To whom reported

The information required to be reported under this subsection

shall be reported to the Secretary.

(6) Sanctions for failure to report

(A) Health plans

Any health plan that fails to report information on an

adverse action required to be reported under this subsection

shall be subject to a civil money penalty of not more than

$25,000 for each such adverse action not reported. Such penalty

shall be imposed and collected in the same manner as civil

money penalties under subsection (a) of section 1320a-7a of

this title are imposed and collected under that section.

(B) Governmental agencies

The Secretary shall provide for a publication of a public

report that identifies those Government agencies that have

failed to report information on adverse actions as required to

be reported under this subsection.

(c) Disclosure and correction of information

(1) Disclosure

With respect to the information about final adverse actions

(not including settlements in which no findings of liability have

been made) reported to the Secretary under this section with

respect to a health care provider, supplier, or practitioner, the

Secretary shall, by regulation, provide for -

(A) disclosure of the information, upon request, to the

health care provider, supplier, or licensed practitioner, and

(B) procedures in the case of disputed accuracy of the

information.

(2) Corrections

Each Government agency and health plan shall report corrections

of information already reported about any final adverse action

taken against a health care provider, supplier, or practitioner,

in such form and manner that the Secretary prescribes by

regulation.

(d) Access to reported information

(1) Availability

The information in the database maintained under this section

shall be available to Federal and State government agencies and

health plans pursuant to procedures that the Secretary shall

provide by regulation.

(2) Fees for disclosure

The Secretary may establish or approve reasonable fees for the

disclosure of information in such database (other than with

respect to requests by Federal agencies). The amount of such a

fee shall be sufficient to recover the full costs of operating

the database. Such fees shall be available to the Secretary or,

in the Secretary's discretion to the agency designated under this

section to cover such costs.

(e) Protection from liability for reporting

No person or entity, including the agency designated by the

Secretary in subsection (b)(5) of this section shall be held liable

in any civil action with respect to any report made as required by

this section, without knowledge of the falsity of the information

contained in the report.

(f) Coordination with National Practitioner Data Bank

The Secretary shall implement this section in such a manner as to

avoid duplication with the reporting requirements established for

the National Practitioner Data Bank under the Health Care Quality

Improvement Act of 1986 (42 U.S.C. 11101 et seq.).

(g) Definitions and special rules

For purposes of this section:

(1) Final adverse action

(A) In general

The term "final adverse action" includes:

(i) Civil judgments against a health care provider,

supplier, or practitioner in Federal or State court related

to the delivery of a health care item or service.

(ii) Federal or State criminal convictions related to the

delivery of a health care item or service.

(iii) Actions by Federal or State agencies responsible for

the licensing and certification of health care providers,

suppliers, and licensed health care practitioners, including

-

(I) formal or official actions, such as revocation or

suspension of a license (and the length of any such

suspension), reprimand, censure or probation,

(II) any other loss of license or the right to apply for,

or renew, a license of the provider, supplier, or

practitioner, whether by operation of law, voluntary

surrender, non-renewability, or otherwise, or

(III) any other negative action or finding by such

Federal or State agency that is publicly available

information.

(iv) Exclusion from participation in Federal or State

health care programs (as defined in sections 1320a-7b(f) and

1320a-7(h) of this title, respectively).

(v) Any other adjudicated actions or decisions that the

Secretary shall establish by regulation.

(B) Exception

The term does not include any action with respect to a

malpractice claim.

(2) Practitioner

The terms "licensed health care practitioner", "licensed

practitioner", and "practitioner" mean, with respect to a State,

an individual who is licensed or otherwise authorized by the

State to provide health care services (or any individual who,

without authority holds himself or herself out to be so licensed

or authorized).

(3) Government agency

The term "Government agency" shall include:

(A) The Department of Justice.

(B) The Department of Health and Human Services.

(C) Any other Federal agency that either administers or

provides payment for the delivery of health care services,

including, but not limited to the Department of Defense and the

Department of Veterans Affairs.

(D) State law enforcement agencies.

(E) State medicaid fraud control units.

(F) Federal or State agencies responsible for the licensing

and certification of health care providers and licensed health

care practitioners.

(4) Health plan

The term "health plan" has the meaning given such term by

section 1320a-7c(c) of this title.

(5) Determination of conviction

For purposes of paragraph (1), the existence of a conviction

shall be determined under paragraphs (1) through (4) of section

1320a-7(i) of this title.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1128E, as added Pub. L.

104-191, title II, Sec. 221(a), Aug. 21, 1996, 110 Stat. 2009;

amended Pub. L. 105-33, title IV, Sec. 4331(a)(2), (b), (d), Aug.

5, 1997, 111 Stat. 395, 396.)

-REFTEXT-

REFERENCES IN TEXT

The Internal Revenue Code of 1986, referred to in subsec.

(b)(2)(A), is classified generally to Title 26, Internal Revenue

Code.

The Health Care Quality Improvement Act of 1986, referred to in

subsec. (f), is title IV of Pub. L. 99-660, Nov. 14, 1986, 100

Stat. 3784, as amended, which is classified generally to chapter

117 (Sec. 11101 et seq.) of this title. For complete classification

of this Act to the Code, see Short Title note set out under section

11101 of this title and Tables.

-MISC1-

AMENDMENTS

1997 - Subsec. (b)(6). Pub. L. 105-33, Sec. 4331(d), added par.

(6).

Subsec. (g)(3)(C). Pub. L. 105-33, Sec. 4331(a)(2), substituted

"Department of Veterans Affairs" for "Veterans' Administration".

Subsec. (g)(5). Pub. L. 105-33, Sec. 4331(b), substituted

"paragraphs (1) through (4)" for "paragraph (4)".

EFFECTIVE DATE OF 1997 AMENDMENT

Section 4331(f) of Pub. L. 105-33 provided that:

"(1) In general. - Except as provided in this subsection, the

amendments made by this section [amending this section and sections

1320a-7, 1320a-7a, and 1320a-7d of this title] shall be effective

as if included in the enactment of the Health Insurance Portability

and Accountability Act of 1996 [Pub. L. 104-191].

"(2) Federal health program. - The amendments made by subsection

(c) [amending section 1320a-7 of this title] shall take effect on

the date of the enactment of this Act [Aug. 5, 1997].

"(3) Sanction for failure to report. - The amendment made by

subsection (d) [amending this section] shall apply to failures

occurring on or after the date of the enactment of this Act."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1320a-7c of this title.

-End-

-CITE-

42 USC Sec. 1320a-7f 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. 1320a-7f. Coordination of medicare and medicaid surety bond

provisions

-STATUTE-

In the case of a home health agency that is subject to a surety

bond requirement under subchapter XVIII of this chapter and

subchapter XIX of this chapter, the surety bond provided to satisfy

the requirement under one such subchapter shall satisfy the

requirement under the other such subchapter so long as the bond

applies to guarantee return of overpayments under both such

subchapters.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1128F, as added Pub. L.

106-113, div. B, Sec. 1000(a)(6) [title III, Sec. 304(b)], Nov. 29,

1999, 113 Stat. 1536, 1501A-361.)

-End-

-CITE-

42 USC Sec. 1320a-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 A - General Provisions

-HEAD-

Sec. 1320a-8. Civil monetary penalties and assessments for

subchapters II, VIII and XVI

-STATUTE-

(a) False statements or representations of material fact;

proceedings to exclude

(1) Any person (including an organization, agency, or other

entity) who makes, or causes to be made, a statement or

representation of a material fact for use in determining any

initial or continuing right to or the amount of -

(A) monthly insurance benefits under subchapter II of this

chapter,

(B) benefits or payments under subchapter VIII of this chapter,

or

(C) benefits or payments under subchapter XVI of this chapter,

that the person knows or should know is false or misleading or

knows or should know omits a material fact or makes such a

statement with knowing disregard for the truth shall be subject to,

in addition to any other penalties that may be prescribed by law, a

civil money penalty of not more than $5,000 for each such statement

or representation. Such person also shall be subject to an

assessment, in lieu of damages sustained by the United States

because of such statement or representation, of not more than twice

the amount of benefits or payments paid as a result of such a

statement or representation. In addition, the Commissioner of

Social Security may make a determination in the same proceeding to

recommend that the Secretary exclude, as provided in section

1320a-7 of this title, such a person who is a medical provider or

physician from participation in the programs under subchapter XVIII

of this chapter.

(2) For purposes of this section, a material fact is one which

the Commissioner of Social Security may consider in evaluating

whether an applicant is entitled to benefits under subchapter II of

this chapter or subchapter VIII of this chapter, or eligible for

benefits or payments under subchapter XVI of this chapter.

(b) Initiation of proceedings; hearing; sanctions

(1) The Commissioner of Social Security may initiate a proceeding

to determine whether to impose a civil money penalty or assessment,

or whether to recommend exclusion under subsection (a) of this

section only as authorized by the Attorney General pursuant to

procedures agreed upon by the Commissioner of Social Security and

the Attorney General. The Commissioner of Social Security may not

initiate an action under this section with respect to any violation

described in subsection (a) of this section later than 6 years

after the date the violation was committed. The Commissioner of

Social Security may initiate an action under this section by

serving notice of the action in any manner authorized by Rule 4 of

the Federal Rules of Civil Procedure.

(2) The Commissioner of Social Security shall not make a

determination adverse to any person under this section until the

person has been given written notice and an opportunity for the

determination to be made on the record after a hearing at which the

person is entitled to be represented by counsel, to present

witnesses, and to cross-examine witnesses against the person.

(3) In a proceeding under this section which -

(A) is against a person who has been convicted (whether upon a

verdict after trial or upon a plea of guilty or nolo contendere)

of a Federal or State crime charging fraud or false statements;

and

(B) involves the same transaction as in the criminal action;

the person is estopped from denying the essential elements of the

criminal offense.

(4) The official conducting a hearing under this section may

sanction a person, including any party or attorney, for failing to

comply with an order or procedure, for failing to defend an action,

or for such other misconduct as would interfere with the speedy,

orderly, or fair conduct of the hearing. Such sanction shall

reasonably relate to the severity and nature of the failure or

misconduct. Such sanction may include -

(A) in the case of refusal to provide or permit discovery,

drawing negative factual inference or treating such refusal as an

admission by deeming the matter, or certain facts, to be

established;

(B) prohibiting a party from introducing certain evidence or

otherwise supporting a particular claim or defense;

(C) striking pleadings, in whole or in part;

(D) staying the proceedings;

(E) dismissal of the action;

(F) entering a default judgment;

(G) ordering the party or attorney to pay attorneys' fees and

other costs caused by the failure or misconduct; and

(H) refusing to consider any motion or other action which is

not filed in a timely manner.

(c) Amount or scope of penalties, assessments, or exclusions

In determining pursuant to subsection (a) of this section the

amount or scope of any penalty or assessment, or whether to

recommend an exclusion, the Commissioner of Social Security shall

take into account -

(1) the nature of the statements and representations referred

to in subsection (a) of this section and the circumstances under

which they occurred;

(2) the degree of culpability, history of prior offenses, and

financial condition of the person committing the offense; and

(3) such other matters as justice may require.

(d) Judicial review

(1) Any person adversely affected by a determination of the

Commissioner of Social Security under this section may obtain a

review of such determination in the United States Court of Appeals

for the circuit in which the person resides, or in which the

statement or representation referred to in subsection (a) of this

section was made, by filing in such court (within 60 days following

the date the person is notified of the Commissioner's

determination) a written petition requesting that the determination

be modified or set aside. A copy of the petition shall be forthwith

transmitted by the clerk of the court to the Commissioner of Social

Security, and thereupon the Commissioner of Social Security shall

file in the court the record in the proceeding as provided in

section 2112 of title 28. Upon such filing, the court shall have

jurisdiction of the proceeding and of the question determined

therein, and shall have the power to make and enter upon the

pleadings, testimony, and proceedings set forth in such record a

decree affirming, modifying, remanding for further consideration,

or setting aside, in whole or in part, the determination of the

Commissioner of Social Security and enforcing the same to the

extent that such order is affirmed or modified. No objection that

has not been urged before the Commissioner of Social Security shall

be considered by the court, unless the failure or neglect to urge

such objection shall be excused because of extraordinary

circumstances.

(2) The findings of the Commissioner of Social Security with

respect to questions of fact, if supported by substantial evidence

on the record considered as a whole, shall be conclusive in the

review described in paragraph (1). If any party shall apply to the

court for leave to adduce additional evidence and shall show to the

satisfaction of the court that such additional evidence is material

and that there were reasonable grounds for the failure to adduce

such evidence in the hearing before the Commissioner of Social

Security, the court may order such additional evidence to be taken

before the Commissioner of Social Security and to be made a part of

the record. The Commissioner of Social Security may modify such

findings as to the facts, or make new findings, by reason of

additional evidence so taken and filed, and the Commissioner of

Social Security shall file with the court such modified or new

findings, which findings with respect to questions of fact, if

supported by substantial evidence on the record considered as a

whole shall be conclusive, and the Commissioner's recommendations,

if any, for the modification or setting aside of the Commissioner's

original order.

(3) Upon the filing of the record and the Commissioner's original

or modified order with the court, the jurisdiction of the court

shall be exclusive and its judgment and decree shall be final,

except that the same shall be subject to review by the Supreme

Court of the United States, as provided in section 1254 of title

28.

(e) Compromise of money penalties and assessments; recovery; use of

funds recovered

(1) Civil money penalties and assessments imposed under this

section may be compromised by the Commissioner of Social Security

and may be recovered -

(A) in a civil action in the name of the United States brought

in United States district court for the district where the

statement or representation referred to in subsection (a) of this

section was made, or where the person resides, as determined by

the Commissioner of Social Security;

(B) by means of reduction in tax refunds to which the person is

entitled, based on notice to the Secretary of the Treasury as

permitted under section 3720A of title 31;

(C)(i) by decrease of any payment of monthly insurance benefits

under subchapter II of this chapter, notwithstanding section 407

of this title,

(ii) by decrease of any payment under subchapter VIII of this

chapter to which the person is entitled, or

(iii) by decrease of any payment under subchapter XVI of this

chapter for which the person is eligible, notwithstanding section

407 of this title, as made applicable to subchapter XVI of this

chapter by reason of section 1383(d)(1) of this title;

(D) by authorities provided under the Debt Collection Act of

1982, as amended, to the extent applicable to debts arising under

this chapter;

(E) by deduction of the amount of such penalty or assessment,

when finally determined, or the amount agreed upon in compromise,

from any sum then or later owing by the United States to the

person against whom the penalty or assessment has been assessed;

or

(F) by any combination of the foregoing.

(2) Amounts recovered under this section shall be recovered by

the Commissioner of Social Security and shall be disposed of as

follows:

(A) In the case of amounts recovered arising out of a

determination relating to subchapter II of this chapter, the

amounts shall be transferred to the Managing Trustee of the

Federal Old-Age and Survivors Insurance Trust Fund or the Federal

Disability Insurance Trust Fund, as determined appropriate by the

Commissioner of Social Security, and such amounts shall be

deposited by the Managing Trustee into such Trust Fund.

(B) In the case of amounts recovered arising out of a

determination relating to subchapter VIII or XVI of this chapter,

the amounts shall be deposited by the Commissioner of Social

Security into the general fund of the Treasury as miscellaneous

receipts.

(f) Finality of determination respecting penalty, assessment, or

exclusion

A determination pursuant to subsection (a) of this section by the

Commissioner of Social Security to impose a penalty or assessment,

or to recommend an exclusion shall be final upon the expiration of

the 60-day period referred to in subsection (d) of this section.

Matters that were raised or that could have been raised in a

hearing before the Commissioner of Social Security or in an appeal

pursuant to subsection (d) of this section may not be raised as a

defense to a civil action by the United States to collect a penalty

or assessment imposed under this section.

(g) Notification of appropriate entities of finality of

determination

Whenever the Commissioner's determination to impose a penalty or

assessment under this section with respect to a medical provider or

physician becomes final, the Commissioner shall notify the

Secretary of the final determination and the reasons therefor, and

the Secretary shall then notify the entities described in section

1320a-7a(h) of this title of such final determination.

(h) Injunction

Whenever the Commissioner of Social Security has reason to

believe that any person has engaged, is engaging, or is about to

engage in any activity which makes the person subject to a civil

monetary penalty under this section, the Commissioner of Social

Security may bring an action in an appropriate district court of

the United States (or, if applicable, a United States court of any

territory) to enjoin such activity, or to enjoin the person from

concealing, removing, encumbering, or disposing of assets which may

be required in order to pay a civil monetary penalty and assessment

if any such penalty were to be imposed or to seek other appropriate

relief.

(i) Delegation of authority

(1) The provisions of subsections (d) and (e) of section 405 of

this title shall apply with respect to this section to the same

extent as they are applicable with respect to subchapter II of this

chapter. The Commissioner of Social Security may delegate the

authority granted by section 405(d) of this title (as made

applicable to this section) to the Inspector General for purposes

of any investigation under this section.

(2) The Commissioner of Social Security may delegate authority

granted under this section to the Inspector General.

(j) "State agency" defined

For purposes of this section, the term "State agency" shall have

the same meaning as in section 1320a-7a(i)(1) of this title.

(k) Liability of principal for acts of agents

A principal is liable for penalties and assessments under

subsection (a) of this section, and for an exclusion under section

1320a-7 of this title based on a recommendation under subsection

(a) of this section, for the actions of the principal's agent

acting within the scope of the agency.

(l) Protection of ongoing criminal investigations

As soon as the Inspector General, Social Security Administration,

has reason to believe that fraud was involved in the application of

an individual for monthly insurance benefits under subchapter II of

this chapter or for benefits under subchapter VIII or XVI of this

chapter, the Inspector General shall make available to the

Commissioner of Social Security information identifying the

individual, unless a United States attorney, or equivalent State

prosecutor, with jurisdiction over potential or actual related

criminal cases, certifies, in writing, that there is a substantial

risk that making the information so available in a particular

investigation or redetermining the eligibility of the individual

for such benefits would jeopardize the criminal prosecution of any

person who is a subject of the investigation from which the

information is derived.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1129, as added and amended

Pub. L. 103-296, title I, Sec. 108(b)(10)(A), title II, Sec.

206(b)(1), (e)(1), Aug. 15, 1994, 108 Stat. 1483, 1509, 1515; Pub.

L. 106-169, title II, Sec. 251(b)(6), Dec. 14, 1999, 113 Stat.

1855.)

-REFTEXT-

REFERENCES IN TEXT

Rule 4 of the Federal Rules of Civil Procedure, referred to in

subsec. (b)(1), is set out in the Appendix to Title 28, Judiciary

and Judicial Procedure.

The Debt Collection Act of 1982, referred to in subsec.

(e)(1)(D), is Pub. L. 97-365, Oct. 25, 1982, 96 Stat. 1749. For

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

1982 Amendment note set out under section 5514 of Title 5,

Government Employees and Organization, and Tables.

-MISC1-

PRIOR PROVISIONS

A prior section 1320a-8, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1129, as added Dec. 5, 1980, Pub. L. 96-499, title IX, Sec.

914(a), 94 Stat. 2621; amended Aug. 13, 1981, Pub. L. 97-35, title

XXI, Sec. 2193(c)(4), 95 Stat. 827; July 18, 1984, Pub. L. 98-369,

div. B, title III, Sec. 2354(a)(4), 98 Stat. 1100, related to

coordinated audits, prior to repeal by Pub. L. 100-203, title IV,

Sec. 4118(m)(1)(A), (2), Dec. 22, 1987, 101 Stat. 1330-157,

applicable to audits conducted after Dec. 22, 1987.

AMENDMENTS

1999 - Pub. L. 106-169, Sec. 251(b)(6)(A), substituted "II, VIII"

for "II" in section catchline.

Subsec. (a)(1)(B), (C). Pub. L. 106-169, Sec. 251(b)(6)(B), added

subpar. (B) and redesignated former subpar. (B) as (C).

Subsec. (a)(2). Pub. L. 106-169, Sec. 251(b)(6)(C), inserted "or

subchapter VIII of this chapter," after "subchapter II of this

chapter".

Subsec. (e)(1)(C)(ii), (iii). Pub. L. 106-169, Sec. 251(b)(6)(D),

added cl. (ii) and redesignated former cl. (ii) as (iii).

Subsec. (e)(2)(B). Pub. L. 106-169, Sec. 251(b)(6)(E),

substituted "subchapter VIII or XVI" for "subchapter XVI".

Subsec. (l). Pub. L. 106-169, Sec. 251(b)(6)(F), substituted

"subchapter VIII or XVI" for "subchapter XVI".

1994 - Subsec. (a)(1). Pub. L. 103-296, Sec. 108(b)(10)(A)(i),

(ii), in closing provisions substituted "Commissioner of Social

Security" for "Secretary", inserted "recommend that the Secretary"

before "exclude, as provided", and struck out before period at end

"and to direct the appropriate State agency to exclude the person

from participation in any State health care program permanently or

for such period as the Secretary determines".

Subsecs. (a)(2), (b)(1), (2), (c). Pub. L. 103-296, Sec.

108(b)(10)(A)(i), substituted "Commissioner of Social Security" for

"Secretary" wherever appearing.

Subsec. (d). Pub. L. 103-296, Sec. 108(b)(10)(A)(i), substituted

"Commissioner of Social Security" for "Secretary" wherever

appearing.

Pub. L. 103-296, Sec. 108(b)(10)(A)(i), which directed that this

section be amended by substituting "Commissioner of Social

Security" for "Secretary" wherever appearing, was also executed by

substituting "Commissioner's" for "Secretary's" wherever appearing

in subsec. (d), to reflect the probable intent of Congress, because

Pub. L. 103-296, Sec. 108(b)(10)(A)(i), (iii)(I), substituted

"Commissioner of Social Security" for "Secretary" throughout this

section and in subsec. (g) substituted "Commissioner's" for

"Secretary's".

Subsecs. (e), (f). Pub. L. 103-296, Sec. 108(b)(10)(A)(i), which

directed amendment of this section by substituting "Commissioner of

Social Security" for "Secretary" each place it appears, was

executed in subsecs. (e) and (f) by making the substitution

wherever appearing except where appearing before "of the Treasury"

in subsec. (e)(1)(B) to reflect the probable intent of Congress.

Subsec. (g). Pub. L. 103-296, Sec. 108(b)(10)(A)(iii),

substituted "Commissioner's" for "Secretary's" and "the

Commissioner shall notify the Secretary of the final determination

and the reasons therefor, and the Secretary shall then notify the

entities described in section 1320a-7a(h) of this title of such

final determination." for "the provisions of section 1320a-7a(h) of

this title shall apply."

Subsecs. (h), (i). Pub. L. 103-296, Sec. 108(b)(10)(A)(i),

substituted "Commissioner of Social Security" for "Secretary"

wherever appearing.

Subsec. (k). Pub. L. 103-296, Sec. 108(b)(10)(A)(iv), inserted

"based on a recommendation under subsection (a) of this section"

after "section 1320a-7 of this title".

Subsec. (l). Pub. L. 103-296, Sec. 206(e)(1), added subsec. (l).

Pub. L. 103-296, Sec. 108(b)(10)(A)(i), (v), in subsec. (l) as

added by Pub. L. 103-296, Sec. 206(e)(1), substituted "Social

Security Administration" for "Department of Health and Human

Services" and "Commissioner of Social Security" for "Secretary".

EFFECTIVE DATE OF 1994 AMENDMENT

Amendment by section 108(b)(10)(A) 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 206(e)(2) of Pub. L. 103-296 provided that: "The

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

effect on October 1, 1994."

EFFECTIVE DATE

Section applicable to conduct occurring on or after Oct. 1, 1994,

see section 206(b)(3) of Pub. L. 103-296, set out as an Effective

Date of 1994 Amendment note under section 1320a-7 of this title.

STUDY ON POSSIBLE MEASURES TO IMPROVE FRAUD PREVENTION AND

ADMINISTRATIVE PROCESSING

Pub. L. 106-169, title II, Sec. 210, Dec. 14, 1999, 113 Stat.

1842, provided that:

"(a) Study. - As soon as practicable after the date of the

enactment of this Act [Dec. 14, 1999], the Commissioner of Social

Security, in consultation with the Inspector General of the Social

Security Administration and the Attorney General, shall conduct a

study of possible measures to improve -

"(1) prevention of fraud on the part of individuals entitled to

disability benefits under section 223 of the Social Security Act

[section 423 of this title] or benefits under section 202 of such

Act [section 402 of this title] based on the beneficiary's

disability, individuals eligible for supplemental security income

benefits under title XVI of such Act [subchapter XVI of this

chapter], and applicants for any such benefits; and

"(2) timely processing of reported income changes by

individuals receiving such benefits.

"(b) Report. - Not later than 1 year after the date of the

enactment of this Act [Dec. 14, 1999], the Commissioner shall

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

Representatives and the Committee on Finance of the Senate a

written report that contains the results of the Commissioner's

study under subsection (a). The report shall contain such

recommendations for legislative and administrative changes as the

Commissioner considers appropriate."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1320a-7, 1320b-6 of this

title.

-End-

-CITE-

42 USC Sec. 1320a-8a 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. 1320a-8a. Administrative procedure for imposing penalties for

false or misleading statements

-STATUTE-

(a) In general

Any person who makes, or causes to be made, a statement or

representation of a material fact for use in determining any

initial or continuing right to or the amount of -

(1) monthly insurance benefits under subchapter II of this

chapter; or

(2) benefits or payments under subchapter XVI of this chapter,

that the person knows or should know is false or misleading or

knows or should know omits a material fact or who makes such a

statement with knowing disregard for the truth shall be subject to,

in addition to any other penalties that may be prescribed by law, a

penalty described in subsection (b) of this section to be imposed

by the Commissioner of Social Security.

(b) Penalty

The penalty described in this subsection is -

(1) nonpayment of benefits under subchapter II of this chapter

that would otherwise be payable to the person; and

(2) ineligibility for cash benefits under subchapter XVI of

this chapter,

for each month that begins during the applicable period described

in subsection (c) of this section.

(c) Duration of penalty

The duration of the applicable period, with respect to a

determination by the Commissioner under subsection (a) of this

section that a person has engaged in conduct described in

subsection (a) of this section, shall be -

(1) six consecutive months, in the case of the first such

determination with respect to the person;

(2) twelve consecutive months, in the case of the second such

determination with respect to the person; and

(3) twenty-four consecutive months, in the case of the third or

subsequent such determination with respect to the person.

(d) Effect on other assistance

A person subject to a period of nonpayment of benefits under

subchapter II of this chapter or ineligibility for subchapter XVI

of this chapter benefits by reason of this section nevertheless

shall be considered to be eligible for and receiving such benefits,

to the extent that the person would be receiving or eligible for

such benefits but for the imposition of the penalty, for purposes

of -

(1) determination of the eligibility of the person for benefits

under subchapters XVIII and XIX of this chapter; and

(2) determination of the eligibility or amount of benefits

payable under subchapter II or XVI of this chapter to another

person.

(e) Definition

In this section, the term "benefits under subchapter VIII or XVI

of this chapter" includes State supplementary payments made by the

Commissioner pursuant to an agreement under section 1010a or

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

the case may be.

(f) Consultations

The Commissioner of Social Security shall consult with the

Inspector General of the Social Security Administration regarding

initiating actions under this section.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1129A, as added Pub. L.

106-169, title II, Sec. 207(a), Dec. 14, 1999, 113 Stat. 1837;

amended Pub. L. 106-554, Sec. 1(a)(1) [title V, Sec. 518(b)(2)],

Dec. 21, 2000, 114 Stat. 2763, 2763A-74.)

-REFTEXT-

REFERENCES IN TEXT

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

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

Stat. 155, as amended, which is set out as a note under section

1382 of this title.

-MISC1-

AMENDMENTS

2000 - Subsec. (e). Pub. L. 106-554, Sec. 1(a)(1) [title V, Sec.

518(b)(2)(B), (D)], inserted "1010a or" after "agreement under

section" and ", as the case may be" before period at end.

Pub. L. 106-554, Sec. 1(a)(1) [title V, Sec. 518(b)(2)(C)], which

directed the amendment of subsec. (e) by inserting "1010A or"

before "1382(e)(a)", could not be executed because "1382(e)(a)"

does not appear in text.

Pub. L. 106-554, Sec. 1(a)(1) [title V, Sec. 518(b)(2)(A)], which

directed the amendment of subsec. (e) by inserting "VIII or" after

"benefits under", was executed by making the insertion after

"benefits under subchapter" to reflect the probable intent of

Congress.

EFFECTIVE DATE

Section applicable to statements and representations made on or

after Dec. 14, 1999, see section 207(e) of Pub. L. 106-169, set out

as an Effective Date of 1999 Amendment note under section 402 of

this title.

REGULATIONS

Pub. L. 106-169, title II, Sec. 207(d), Dec. 14, 1999, 113 Stat.

1838, provided that: "Within 6 months after the date of the

enactment of this Act [Dec. 14, 1999], the Commissioner of Social

Security shall develop regulations that prescribe the

administrative process for making determinations under section

1129A of the Social Security Act [this section] (including when the

applicable period in subsection (c) of such section shall

commence), and shall provide guidance on the exercise of discretion

as to whether the penalty should be imposed in particular cases."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 402 of this title.

-End-

-CITE-

42 USC Sec. 1320a-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 A - General Provisions

-HEAD-

Sec. 1320a-9. Demonstration projects

-STATUTE-

(a) Authority to approve demonstration projects

(1) In general

The Secretary may authorize States to conduct demonstration

projects pursuant to this section which the Secretary finds are

likely to promote the objectives of part B or E of subchapter IV

of this chapter.

(2) Limitation

The Secretary may authorize not more than 10 demonstration

projects under paragraph (1) in each of fiscal years 1998 through

2002.

(3) Certain types of proposals required to be considered

(A) If an appropriate application therefor is submitted, the

Secretary shall consider authorizing a demonstration project

which is designed to identify and address barriers that result in

delays to adoptive placements for children in foster care.

(B) If an appropriate application therefor is submitted, the

Secretary shall consider authorizing a demonstration project

which is designed to identify and address parental substance

abuse problems that endanger children and result in the placement

of children in foster care, including through the placement of

children with their parents in residential treatment facilities

(including residential treatment facilities for post-partum

depression) that are specifically designed to serve parents and

children together in order to promote family reunification and

that can ensure the health and safety of the children in such

placements.

(C) If an appropriate application therefor is submitted, the

Secretary shall consider authorizing a demonstration project

which is designed to address kinship care.

(4) Limitation on eligibility

The Secretary may not authorize a State to conduct a

demonstration project under this section if the State fails to

provide health insurance coverage to any child with special needs

(as determined under section 673(c) of this title) for whom there

is in effect an adoption assistance agreement between a State and

an adoptive parent or parents.

(5) Requirement to consider effect of project on terms and

conditions of certain court orders

In considering an application to conduct a demonstration

project under this section that has been submitted by a State in

which there is in effect a court order determining that the

State's child welfare program has failed to comply with the

provisions of part B or E of subchapter IV of this chapter, or

with the Constitution of the United States, the Secretary shall

take into consideration the effect of approving the proposed

project on the terms and conditions of the court order related to

the failure to comply.

(b) Waiver authority

The Secretary may waive compliance with any requirement of part B

or E of subchapter IV of this chapter which (if applied) would

prevent a State from carrying out a demonstration project under

this section or prevent the State from effectively achieving the

purpose of such a project, except that the Secretary may not waive

-

(1) any provision of section 627 of this title (as in effect

before April 1, 1996), section 622(b)(9) of this title (as in

effect after such date), or section 679 of this title; or

(2) any provision of such part E, to the extent that the waiver

would impair the entitlement of any qualified child or family to

benefits under a State plan approved under such part E.

(c) Treatment as program expenditures

For purposes of parts B and E of subchapter IV of this chapter,

the Secretary shall consider the expenditures of any State to

conduct a demonstration project under this section to be

expenditures under subpart 1 or 2 of such part B, or under such

part E, as the State may elect.

(d) Duration of demonstration

A demonstration project under this section may be conducted for

not more than 5 years, unless in the judgment of the Secretary, the

demonstration project should be allowed to continue.

(e) Application

Any State seeking to conduct a demonstration project under this

section shall submit to the Secretary an application, in such form

as the Secretary may require, which includes -

(1) a description of the proposed project, the geographic area

in which the proposed project would be conducted, the children or

families who would be served by the proposed project, and the

services which would be provided by the proposed project (which

shall provide, where appropriate, for random assignment of

children and families to groups served under the project and to

control groups);

(2) a statement of the period during which the proposed project

would be conducted;

(3) a discussion of the benefits that are expected from the

proposed project (compared to a continuation of activities under

the approved plan or plans of the State);

(4) an estimate of the costs or savings of the proposed

project;

(5) a statement of program requirements for which waivers would

be needed to permit the proposed project to be conducted;

(6) a description of the proposed evaluation design; and

(7) such additional information as the Secretary may require.

(f) Evaluations; report

Each State authorized to conduct a demonstration project under

this section shall -

(1) obtain an evaluation by an independent contractor of the

effectiveness of the project, using an evaluation design approved

by the Secretary which provides for -

(A) comparison of methods of service delivery under the

project, and such methods under a State plan or plans, with

respect to efficiency, economy, and any other appropriate

measures of program management;

(B) comparison of outcomes for children and families (and

groups of children and families) under the project, and such

outcomes under a State plan or plans, for purposes of assessing

the effectiveness of the project in achieving program goals;

and

(C) any other information that the Secretary may require; and

(2) provide interim and final evaluation reports to the

Secretary, at such times and in such manner as the Secretary may

require.

(g) Cost neutrality

The Secretary may not authorize a State to conduct a

demonstration project under this section unless the Secretary

determines that the total amount of Federal funds that will be

expended under (or by reason of) the project over its approved term

(or such portion thereof or other period as the Secretary may find

appropriate) will not exceed the amount of such funds that would be

expended by the State under the State plans approved under parts B

and E of subchapter IV of this chapter if the project were not

conducted.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1130, as added Pub. L.

103-432, title II, Sec. 208, Oct. 31, 1994, 108 Stat. 4457; amended

Pub. L. 105-89, title III, Sec. 301(a), (c), Nov. 19, 1997, 111

Stat. 2127, 2128.)

-REFTEXT-

REFERENCES IN TEXT

Parts B and E of subchapter IV of this chapter, referred to in

subsecs. (a) to (c) and (g), are classified to sections 620 et seq.

and 670 et seq., respectively, of this title.

Section 627 of this title, referred to in subsec. (b)(1), was

repealed by Pub. L. 103-432, title II, Sec. 202(c), Oct. 31, 1994,

108 Stat. 4454.

-MISC1-

PRIOR PROVISIONS

A prior section 1130 of act Aug. 14, 1935, was classified to

section 1320b of this title prior to repeal by Pub. L. 93-647, Sec.

3(e)(1), Jan. 4, 1975, 88 Stat. 2349.

AMENDMENTS

1997 - Subsec. (a). Pub. L. 105-89, Sec. 301(a), amended heading

and text of subsec. (a) generally. Prior to amendment, text read as

follows: "The Secretary may authorize not more than 10 States to

conduct demonstration projects pursuant to this section which the

Secretary finds are likely to promote the objectives of part B or E

of subchapter IV of this chapter."

Subsec. (d). Pub. L. 105-89, Sec. 301(c), inserted before period

at end ", unless in the judgment of the Secretary, the

demonstration project should be allowed to continue".

EFFECTIVE DATE OF 1997 AMENDMENT

Amendment by Pub. L. 105-89 effective Nov. 19, 1997, except as

otherwise provided, with delay permitted if State legislation is

required, see section 501 of Pub. L. 105-89, set out as a note

under section 622 of this title.

CONSTRUCTION OF 1997 AMENDMENT

Section 301(b) of Pub. L. 105-89 provided that: "Nothing in the

amendment made by subsection (a) [amending this section] shall be

construed as affecting the terms and conditions of any

demonstration project approved under section 1130 of the Social

Security Act (42 U.S.C. 1320a-9) before the date of the enactment

of this Act [Nov. 19, 1997]."

-End-

-CITE-

42 USC Sec. 1320a-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 A - General Provisions

-HEAD-

Sec. 1320a-10. Effect of failure to carry out State plan

-STATUTE-

In an action brought to enforce a provision of this chapter, such

provision is not to be deemed unenforceable because of its

inclusion in a section of this chapter requiring a State plan or

specifying the required contents of a State plan. This section is

not intended to limit or expand the grounds for determining the

availability of private actions to enforce State plan requirements

other than by overturning any such grounds applied in Suter v.

Artist M., 112 S. Ct. 1360 (1992), but not applied in prior Supreme

Court decisions respecting such enforceability: Provided, however,

That this section is not intended to alter the holding in Suter v.

Artist M. that section 671(a)(15) of this title is not enforceable

in a private right of action.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1130A, as added Pub. L.

103-432, title II, Sec. 211(a), Oct. 31, 1994, 108 Stat. 4460.)

-MISC1-

EFFECTIVE DATE

Section 211(b) of Pub. L. 103-432 provided that: "The amendment

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

actions pending on the date of the enactment of this Act [Oct. 31,

1994] and to actions brought on or after such date of enactment."

-End-

-CITE-

42 USC Sec. 1320b 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. Repealed. Pub. L. 93-647, Sec. 3(e)(1), Jan. 4, 1975,

88 Stat. 2349

-MISC1-

Section, act Aug. 14, 1935, ch. 531, title XI, Sec. 1130, as

added Oct. 20, 1972, Pub. L. 92-512, title III, Sec. 301(a), 86

Stat. 945; amended July 9, 1973, Pub. L. 93-66, title II, Sec. 221,

87 Stat. 159; Dec. 31, 1973, Pub. L. 93-233, Sec. 18(j), 87 Stat.

970, set out limitations on funds for certain social services.

EFFECTIVE DATE OF REPEAL

Repeal effective with respect to payments under sections 603 and

803 of this title for quarters commencing after Sept. 30, 1975, see

section 7(b) of Pub. L. 93-647, set out as an Effective Date of

1975 Amendment note under section 303 of this title.

SOCIAL SERVICES REGULATIONS POSTPONED

Pub. L. 93-233, Sec. 12, Dec. 31, 1973, 87 Stat. 959, as amended

by Pub. L. 93-647, Sec. 3(g), Jan. 4, 1975, 88 Stat. 2349, provided

that:

"(a) Subject to subsection (b), no regulation and no modification

of any regulation, promulgated by the Secretary of Health,

Education, and Welfare [now Health and Human Services] (hereinafter

referred to as the 'Secretary') after January 1, 1973, shall be

effective for any period which begins prior to October 1, 1975, if

(and insofar as) such regulation or modification of a regulation

pertains (directly or indirectly) to the provisions of law

contained in section 3(a)(4)(A), 402(a)(19)(G), 403(a)(3)(A),

603(a)(1)(A), 1003(a)(3)(A), 1403(a)(3)(A), or 1603(a)(4)(A) of the

Social Security Act [section 303(a)(4)(A), 602(a)(19)(G),

603(a)(3)(A), 803(a)(1)(A), 1203(a)(3)(A), 1353(a)(3)(A), or

1383(a)(4)(A) of this title].

"(b)(1) The provisions of subsection (a) shall not be applicable

to any regulation relating to 'scope of programs', if such

regulation is identical (except as provided in the succeeding

sentence) to the provisions of section 221.0 of the regulations

(relating to social services) proposed by the Secretary and

published in the Federal Register on May 1, 1973. There shall be

deleted from the first sentence of subsection (b) of such section

221.0 the phrase 'meets all the applicable requirements of this

part and'.

"(2) The provisions of subsection (a) shall not be applicable to

any regulation relating to 'limitations on total amount of Federal

funds payable to States for services', if such regulation is

identical (except as provided in the succeeding sentence) to the

provisions of section 221.55 of the regulations so proposed and

published on May 1, 1973. There shall be deleted from subsection

(d)(1) of such section 221.55 the phrase '(as defined under day

care services for children)'; and, in lieu of the sentence

contained in subsection (d)(5) of such section 221.55, there shall

be inserted the following: 'Services provided to a child who is

under foster care in a foster family home (as defined in section

408 of the Social Security Act [section 608 of this title]) or in a

childcare institution (as defined in such section [section 608 of

this title]), or while awaiting placement in such a home or

institution, but only if such services are needed by such child

because he is under foster care.'.

"(3) The provisions of subsection (a) shall not be applicable to

any regulation relating to 'rates and amounts of Federal financial

participation for Puerto Rico, the Virgin Islands, and Guam', if

such regulation is identical to the provisions of section 221.56 of

the regulations so proposed and published on May 1, 1973.

"(4) The provisions of subsection (a) shall not be construed to

preclude the Secretary from making any modification in any

regulation (described in subsection (a)) if such modification is

technically necessary to take account of the enactment of section

301 or 302 of the Social Security Amendments of 1972 [enacting

subchapters XVI and VI of this chapter].

"(c) Notwithstanding the provisions of section 553(d) of title 5,

United States Code, any regulation described in subsection (b) may

become effective upon the date of its publication in the Federal

Register."

Similar provisions were contained in the following prior act:

Pub. L. 93-66, title II, Sec. 220, July 9, 1973, 87 Stat. 158.

MODIFICATION OF SOCIAL SERVICES REGULATIONS

Section 3(g) of Pub. L. 93-647 provided in part that:

"Notwithstanding the provisions of section 12(a) of Public Law

93-233 [set out as a note above], the Secretary may make any

modification in any regulation described in that section if the

modification is necessary to implement the provisions of this

part."

ADJUSTMENT OF ALLOTMENT TO STATE FOR FISCAL YEAR ENDING JUNE 30,

1973

Pub. L. 92-603, title IV, Sec. 403, Oct. 30, 1972, 86 Stat. 1487,

provided for the computation of the allotment of each state for the

fiscal year ending June 30, 1973.

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-1. Notification of social security claimant with respect

to deferred vested benefits

-STATUTE-

(a) Whenever -

(1) the Commissioner of Social Security makes a finding of fact

and a decision as to -

(A) the entitlement of any individual to monthly benefits

under section 402, 423, or 428 of this title, or

(B) the entitlement of any individual to a lump-sum death

payment payable under section 402(i) of this title on account

of the death of any person to whom such individual is related

by blood, marriage, or adoption,

(2) the Secretary makes a finding of fact and a decision as to

the entitlement under section 426 of this title of any individual

to hospital insurance benefits under part A of subchapter XVIII

of this chapter, or

(3) the Commissioner of Social Security is requested to do so -

(A) by any individual with respect to whom the Commissioner

of Social Security holds information obtained under section

6057 of title 26, or

(B) in the case of the death of the individual referred to in

subparagraph (A), by the individual who would be entitled to

payment under section 404(d) of this title,

the Commissioner of Social Security shall transmit to the

individual referred to in paragraph (1) or (2) or the individual

making the request under paragraph (3) any information, as reported

by the employer, regarding any deferred vested benefit transmitted

to the Commissioner of Social Security pursuant to such section

6057 with respect to the individual referred to in paragraph (1),

(2), or (3)(A) or the person on whose wages and self-employment

income entitlement (or claim of entitlement) is based.

(b)(1) For purposes of section 401(g)(1) of this title, expenses

incurred in the administration of subsection (a) of this section

shall be deemed to be expenses incurred for the administration of

subchapter II of this chapter.

(2) There are hereby authorized to be appropriated to the Federal

Old-Age and Survivors Insurance Trust Fund for each fiscal year

(commencing with the fiscal year ending June 30, 1974) such sums as

the Commissioner of Social Security deems necessary on account of

additional administrative expenses resulting from the enactment of

the provisions of subsection (a) of this section.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1131, as added Pub. L.

93-406, title II, Sec. 1032, Sept. 2, 1974, 88 Stat. 947; amended

Pub. L. 98-369, div. B, title VI, Sec. 2663(e)(7), July 18, 1984,

98 Stat. 1168; Pub. L. 103-296, title I, Sec. 108(b)(11), Aug. 15,

1994, 108 Stat. 1484.)

-REFTEXT-

REFERENCES IN TEXT

Part A of subchapter XVIII of this chapter, referred to in

subsec. (a)(2), is classified to section 1395c et seq. of this

title.

-MISC1-

AMENDMENTS

1994 - Subsec. (a). Pub. L. 103-296, Sec. 108(b)(11)(A), (G), in

closing provisions substituted "the Commissioner of Social Security

shall transmit" for "he shall transmit", "paragraph (1) or (2)" for

"paragraph (1)", "paragraph (3)" for "paragraph (2)", "Commissioner

of Social Security pursuant to" for "Secretary pursuant to", and

"paragraph (1), (2), or (3)(A)" for "paragraph (1) or (2)(A)".

Subsec. (a)(1). Pub. L. 103-296, Sec. 108(b)(11)(A)-(D),

substituted "Commissioner of Social Security" for "Secretary" in

introductory provisions, inserted "or" at end of subpar. (A),

struck out "or" at end of subpar. (B), and struck out subpar. (C)

which read as follows: "the entitlement under section 426 of this

title of any individual to hospital insurance benefits under part A

of subchapter XVIII of this chapter, or".

Subsec. (a)(2). Pub. L. 103-296, Sec. 108(b)(11)(F), added par.

(2). Former par. (2) redesignated (3).

Subsec. (a)(3). Pub. L. 103-296, Sec. 108(b)(11)(A), (E),

redesignated par. (2) as (3) and substituted "Commissioner of

Social Security" for "Secretary" in introductory provisions and in

subpar. (A).

Subsec. (b)(2). Pub. L. 103-296, Sec. 108(b)(11)(A), substituted

"Commissioner of Social Security" for "Secretary".

1984 - Subsec. (a). Pub. L. 98-369, Sec. 2663(e)(7)(B), realigned

margin of provisions following par. (2)(B).

Subsec. (a)(2)(B). Pub. L. 98-369, Sec. 2663(e)(7)(A),

substituted a comma for the period after "section 404(d) of this

title".

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 effective Jan. 1, 1978, see section 1034 of Pub. L.

93-406, set out as a note under section 6057 of Title 26, Internal

Revenue Code.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in title 26 section 6103.

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-2. Period within which certain claims must be filed

-STATUTE-

(a) Claims

Notwithstanding any other provision of this chapter (but subject

to subsection (b) of this section), any claim by a State for

payment with respect to an expenditure made during any calendar

quarter by the State -

(1) in carrying out a State plan approved under subchapter I,

IV, X, XIV, XVI, XIX, or XX of this chapter, or

(2) under any other provision of this chapter which provides

(on an entitlement basis) for Federal financial participation in

expenditures made under State plans or programs,

shall be filed (in such form and manner as the Secretary shall by

regulations prescribe) within the two-year period which begins on

the first day of the calendar quarter immediately following such

calendar quarter; and payment shall not be made under this chapter

on account of any such expenditure if claim therefor is not made

within such two-year period; except that this subsection shall not

be applied so as to deny payment with respect to any expenditure

involving court-ordered retroactive payments or audit exceptions,

or adjustments to prior year costs.

(b) Waiver

The Secretary shall waive the requirement imposed under

subsection (a) of this section with respect to the filing of any

claim if he determines (in accordance with regulations) that there

was good cause for the failure by the State to file such claim

within the period prescribed under subsection (a) of this section.

Any such waiver shall be only for such additional period of time as

may be necessary to provide the State with a reasonable opportunity

to file such claim. A failure to file a claim within such time

period which is attributable to neglect or administrative

inadequacies shall be deemed not to be for good cause.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1132, as added Pub. L.

96-272, title III, Sec. 306(a), June 17, 1980, 94 Stat. 530;

amended Pub. L. 97-35, title XXI, Sec. 2193(c)(5), Aug. 13, 1981,

95 Stat. 827.)

-MISC1-

AMENDMENTS

1981 - Subsec. (a)(1). Pub. L. 97-35 substituted "subchapter I,

IV, X" for "subchapter I, IV, V, X".

EFFECTIVE DATE OF 1981 AMENDMENT, SAVINGS, AND TRANSITIONAL

PROVISIONS

For effective date, savings, and transitional provisions relating

to amendment by Pub. L. 97-35, see section 2194 of Pub. L. 97-35,

set out as a note under section 701 of this title.

EFFECTIVE DATE

Section 306(b), (c) of Pub. L. 96-272 provided that:

"(b)(1) The amendment made by subsection (a) [enacting this

section] shall be effective only in the case of claims filed on

account of expenditures made in calendar quarters commencing on or

after October 1, 1979.

"(2) In the case of claims filed prior to the date of enactment

of this Act [June 17, 1980] on account of expenditures described in

section 1132 of the Social Security Act [this section] made in

calendar quarters commencing prior to October 1, 1979, there shall

be no time limit for the payment of such claims.

"(3) In the case of such expenditures made in calendar quarters

commencing prior to October 1, 1979, for which no claim has been

filed on or before the date of enactment of this Act, payment shall

not be made under this Act on account of any such expenditure

unless claim therefor is filed (in such form and manner as the

Secretary shall by regulation prescribe) prior to January 1, 1981.

"(4) The provisions of this subsection shall not be applied so as

to deny payment with respect to any expenditure involving

adjustments to prior year costs or court-ordered retroactive

payments or audit exceptions. The Secretary may waive the

requirements of paragraph (3) in the same manner as under section

1132(b) of the Social Security Act [subsec. (b)(3) of this

section].

"(c) Notwithstanding any other provision of law, there shall be

no time limit for the filing or payment of such claims except as

provided in this section, unless such other provision of law, in

imposing such a time limitation, specifically exempts such filing

or payment from the provisions of this section."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1397gg of this title.

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-3. Applicants or recipients under public assistance

programs not to be required to make election respecting certain

veterans' benefits

-STATUTE-

(a) Supplemental Security Income program

Notwithstanding any other provision of law (but subject to

subsection (b) of this section), no individual who is an applicant

for or recipient of aid or assistance under a State plan approved

under subchapter I, X, XIV, or XVI of this chapter, or of benefits

under the Supplemental Security Income program established by

subchapter XVI of this chapter shall -

(1) be required, as a condition of eligibility for (or of

continuing to receive) such aid, assistance, or benefits, to make

an election under section 306 of the Veterans' and Survivors'

Pension Improvement Act of 1978 with respect to pension paid by

the Secretary of Veterans Affairs, or

(2) by reason of failure or refusal to make such an election,

be denied (or suffer a reduction in the amount of) such aid,

assistance, or benefits.

(b) Period of effectiveness

The provisions of subsection (a) of this section shall be

applicable only with respect to an individual, who is an applicant

for or recipient of aid, assistance, or benefits described in

subsection (a) of this section, during a period with respect to

which there is in effect -

(1) in case such individual is an applicant for or recipient of

aid or assistance under a State plan referred to in subsection

(a) of this section, in the State having such plan, or

(2) in case such individual is an applicant for or recipient of

benefits under the Supplemental Security Income program

established by subchapter XVI of this chapter, in the State in

which the individual applies for or receives such benefits,

a State plan for medical assistance, approved under subchapter XIX

of this chapter, under which medical assistance is available to

such individual only for periods for which such individual is a

recipient of aid, assistance, or benefits described in subsection

(a) of this section.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1133, as added Pub. L.

96-272, title III, Sec. 310(a)(1), June 17, 1980, 94 Stat. 532;

amended Pub. L. 102-54, Sec. 13(q)(3)(B)(iii), June 13, 1991, 105

Stat. 279; Pub. L. 104-193, title I, Sec. 108(g)(6), Aug. 22, 1996,

110 Stat. 2168.)

-REFTEXT-

REFERENCES IN TEXT

Section 306 of the Veterans' and Survivors' Pension Improvement

Act of 1978, referred to in subsec. (a)(1), is section 306 of Pub.

L. 95-588, title III, Nov. 4, 1978, 92 Stat. 2508, which is set out

as a note under section 1521 of Title 38, Veterans' Benefits.

-MISC1-

AMENDMENTS

1996 - Subsec. (a). Pub. L. 104-193 substituted "subchapter I, X,

XIV, or XVI of this chapter," for "subchapter I, X, XIV, or XVI, or

part A of subchapter IV of this chapter,".

1991 - Subsec. (a)(1). Pub. L. 102-54 substituted "Secretary of

Veterans Affairs" for "Veterans' Administration".

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

Section 310(a)(2) of Pub. L. 96-272 provided that: "The amendment

made by paragraph (1) [enacting this section] shall be effective on

and after January 1, 1979; except that nothing contained in such

amendment shall be construed to authorize or require any payment

(or increase in payment) of any aid or assistance or benefits

referred to in section 1133(a) of the Social Security Act [subsec.

(a) of this section] (as added by paragraph (1)) for any benefit

period which begins prior to the date of enactment of this Act

[June 17, 1980]."

CONTINUING MEDICAID ELIGIBILITY FOR CERTAIN RECIPIENTS OF VETERANS'

ADMINISTRATION PENSIONS

Section 310(b)(2) of Pub. L. 96-272 provided that:

"(A) The Administrator shall provide to each individual to whom

section 1133 of the Social Security Act (as added by subsection

(a)(1) of this section) [this section] applies and who is eligible

to make or has made an election under section 306 of the Veterans'

and Survivors' Pension Improvement Act of 1978 [Pub. L. 95-588, set

out as a note under section 1521 of Title 38, Veterans' Benefits],

a written notice, in clear and understandable language, which (i)

describes the consequences to such individual (and possibly to such

individual's family), in terms of a determination or possible

determination of ineligibility for medical assistance under a State

plan approved under title XIX of the Social Security Act

[subchapter XIX of this chapter], of making an election with

respect to pension under such section 306, (ii) describes the

provisions of subparagraph (B) of this paragraph and subsection (a)

of this section, (iii) sets forth other relevant information that

would be helpful to such individual in making an informed decision

concerning such an election or the disaffirmation thereof, and (iv)

in the case of any individual who has made such an election, is

accompanied by a form prepared for the purpose of enabling such

individual to file with the Administrator a written disaffirmation

of such an election.

"(B) Notwithstanding any other provision of law -

"(i) any individual to whom section 1133 of the Social Security

Act (as added by subsection (a)(1) of this section) [this

section] applies may, within the 90-day period beginning with the

day that there is mailed to such individual (at such individual's

last known mailing address) a notice referred to in subparagraph

(A), disaffirm an election previously made by such individual

under section 306 of the Veterans' and Survivors' Pension

Improvement Act of 1978 [Pub. L. 95-588, set out as a note under

section 1521 of Title 38] by completing and mailing to the

Administrator the form furnished such individual for such purpose

by the Administrator pursuant to subparagraph (A),

"(ii) whenever any such individual files such a disaffirmation

with the Administrator, the amount of pension payable to such

individual shall be adjusted, beginning with the first calendar

month which commences after the receipt by the Administrator of

such disaffirmation, to the amount that such pension would have

been if such an election by such individual had not been made,

"(iii) any individual who has filed a disaffirmation, pursuant

to this subparagraph, of an election made by such individual

under such section 306 may again make an election thereunder, but

such subsequent election may not be disaffirmed under this

subsection, and

"(iv) no indebtedness to the United States, as a result of the

disaffirmation by an individual, pursuant to this subparagraph,

of an election made by such individual under such section 306

shall be considered to arise from the payment of pension pursuant

to such an election.

"(C) The Administrator shall promptly advise the Secretary of

Health, Education, and Welfare [now Health and Human Services], and

provide identification of the individuals involved and other

pertinent information with respect to (i) disaffirmations of

elections made by individuals pursuant to subparagraph (B), (ii)

individuals who, by failing to disaffirm within the 90-day period

prescribed in subparagraph (B), are deemed to have reaffirmed

elections previously made, and (iii) individuals who, after having

disaffirmed an election under subparagraph (B), subsequently again

make an election under section 306 of the Veterans' and Survivors'

Pension Improvement Act of 1978 [Pub. L. 95-588, set out as a note

under section 1521 of Title 38]. The Secretary, upon receipt of any

such information with respect to an individual, shall promptly

notify the appropriate agencies administering State plans approved

under title I, X, XIV, XIX, and part A of title IV of the Social

Security Act [subchapters I, X, XIV, XIX, and part A of subchapter

IV of this chapter], and State agencies making supplemental

payments pursuant to section 1616 of such Act [section 1382e of

this title] or an agreement entered into pursuant to section 212(a)

of Public Law 93-66 [set out as a note under section 1382 of this

title]."

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-4. Nonprofit hospital or critical access hospital

philanthropy

-STATUTE-

For purposes of determining, under subchapters XVIII and XIX of

this chapter, the reasonable costs of services provided by

nonprofit hospitals or critical access hospitals, the following

items shall not be deducted from the operating costs of such

hospitals or critical access hospitals:

(1) A grant, gift, or endowment, or income therefrom, which is

to or for such a hospital and which has not been designated by

the donor for paying any specific operating costs.

(2) A grant or similar payment which is to such a hospital,

which was made by a governmental entity, and which is not

available under the terms of the grant or payment for use as

operating funds.

(3) Those types of donor designated grants and gifts (including

grants and similar payments which are made by a governmental

entity), and income therefrom, which the Secretary determines, in

the best interests of needed health care, should be encouraged.

(4) The proceeds from the sale or mortgage of any real estate

or other capital asset of such a hospital, which real estate or

asset the hospital acquired through gift or grant, if such

proceeds are not available for use as operating funds under the

terms of the gift or grant.

Paragraph (4) shall not apply to the recovery of the appropriate

share of depreciation when gains or losses are realized from the

disposal of depreciable assets.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1134, as added Pub. L.

96-499, title IX, Sec. 901(a), Dec. 5, 1980, 94 Stat. 2611; amended

Pub. L. 97-35, title XXI, Sec. 2193(c)(6), Aug. 13, 1981, 95 Stat.

827; Pub. L. 97-248, title I, Sec. 137(b)(5), Sept. 3, 1982, 96

Stat. 377; Pub. L. 101-239, title VI, Sec. 6003(g)(3)(D)(iii), Dec.

19, 1989, 103 Stat. 2153; Pub. L. 105-33, title IV, Sec.

4201(c)(1), Aug. 5, 1997, 111 Stat. 373.)

-MISC1-

AMENDMENTS

1997 - Pub. L. 105-33 substituted "critical access" for "rural

primary care" in two places in introductory provisions.

1989 - Pub. L. 101-239 substituted "hospitals or rural primary

care hospitals" for "hospitals" in two places in introductory

provisions.

1982 - Par. (4). Pub. L. 97-248 substituted "sale" for "scale".

1981 - Pub. L. 97-35 substituted "subchapters XVIII and" for

"subchapters V, XVIII, and" in provision preceding par. (1).

EFFECTIVE DATE OF 1997 AMENDMENT

Amendment by Pub. L. 105-33 applicable to services furnished on

or after Oct. 1, 1997, see section 4201(d) of Pub. L. 105-33, set

out as a note under section 1395f of this title.

EFFECTIVE DATE OF 1982 AMENDMENT

Amendment by Pub. L. 97-248 effective as if originally included

as part of this section as this section was amended by the Omnibus

Budget Reconciliation Act of 1981, Pub. L. 97-35, see section

137(d)(2) of Pub. L. 97-248, set out as a note under section 1396a

of this title.

EFFECTIVE DATE OF 1981 AMENDMENT, SAVINGS, AND TRANSITIONAL

PROVISIONS

For effective date, savings, and transitional provisions relating

to amendment by Pub. L. 97-35, see section 2194 of Pub. L. 97-35,

set out as a note under section 701 of this title.

EFFECTIVE DATE

Section 901(b) of Pub. L. 96-499 provided that: "The amendment

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

grants, gifts, and endowments, and income therefrom, made or

established after the date of the enactment of this Act [Dec. 5,

1980]."

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-5. Authority to waive requirements during national

emergencies

-STATUTE-

(a) Purpose

The purpose of this section is to enable the Secretary to ensure

to the maximum extent feasible, in any emergency area and during an

emergency period (as defined in subsection (g)(1) of this section)

-

(1) that sufficient health care items and services are

available to meet the needs of individuals in such area enrolled

in the programs under subchapters XVIII, XIX, and XXI of this

chapter; and

(2) that health care providers (as defined in subsection (g)(2)

of this section) that furnish such items and services in good

faith, but that are unable to comply with one or more

requirements described in subsection (b) of this section, may be

reimbursed for such items and services and exempted from

sanctions for such noncompliance, absent any determination of

fraud or abuse.

(b) Secretarial authority

To the extent necessary to accomplish the purpose specified in

subsection (a) of this section, the Secretary is authorized,

subject to the provisions of this section, to temporarily waive or

modify the application of, with respect to health care items and

services furnished by a health care provider (or classes of health

care providers) in any emergency area (or portion of such an area)

during any portion of an emergency period, the requirements of

subchapters XVIII, XIX, or XXI of this chapter, or any regulation

thereunder (and the requirements of this subchapter other than this

section, and regulations thereunder, insofar as they relate to such

subchapters), pertaining to -

(1)(A) conditions of participation or other certification

requirements for an individual health care provider or types of

providers,

(B) program participation and similar requirements for an

individual health care provider or types of providers, and

(C) pre-approval requirements;

(2) requirements that physicians and other health care

professionals be licensed in the State in which they provide such

services, if they have equivalent licensing in another State and

are not affirmatively excluded from practice in that State or in

any State a part of which is included in the emergency area;

(3) sanctions under section 1395dd of this title (relating to

examination and treatment for emergency medical conditions and

women in labor) for a transfer of an individual who has not been

stabilized in violation of subsection (c) of this section of such

section if the transfer arises out of the circumstances of the

emergency;

(4) sanctions under section 1395nn(g) of this title (relating

to limitations on physician referral);

(5) deadlines and timetables for performance of required

activities, except that such deadlines and timetables may only be

modified, not waived; and

(6) limitations on payments under section 1395w-21(i) of this

title for health care items and services furnished to individuals

enrolled in a Medicare+Choice plan by health care professionals

or facilities not included under such plan.

Insofar as the Secretary exercises authority under paragraph (6)

with respect to individuals enrolled in a Medicare+Choice plan, to

the extent possible given the circumstances, the Secretary shall

reconcile payments made on behalf of such enrollees to ensure that

the enrollees do not pay more than would be required had they

received services from providers within the network of the plan and

may reconcile payments to the organization offering the plan to

ensure that such organization pays for services for which payment

is included in the capitation payment it receives under part C of

subchapter XVIII of this chapter.

(c) Authority for retroactive waiver

A waiver or modification of requirements pursuant to this section

may, at the Secretary's discretion, be made retroactive to the

beginning of the emergency period or any subsequent date in such

period specified by the Secretary.

(d) Certification to Congress

The Secretary shall provide a certification and advance written

notice to the Congress at least two days before exercising the

authority under this section with respect to an emergency area.

Such a certification and notice shall include -

(1) a description of -

(A) the specific provisions that will be waived or modified;

(B) the health care providers to whom the waiver or

modification will apply;

(C) the geographic area in which the waiver or modification

will apply; and

(D) the period of time for which the waiver or modification

will be in effect; and

(2) a certification that the waiver or modification is

necessary to carry out the purpose specified in subsection (a) of

this section.

(e) Duration of waiver

(1) In general

A waiver or modification of requirements pursuant to this

section terminates upon -

(A) the termination of the applicable declaration of

emergency or disaster described in subsection (g)(1)(A) of this

section;

(B) the termination of the applicable declaration of public

health emergency described in subsection (g)(1)(B) of this

section; or

(C) subject to paragraph (2), the termination of a period of

60 days from the date the waiver or modification is first

published (or, if applicable, the date of extension of the

waiver or modification under paragraph (2)).

(2) Extension of 60-day periods

The Secretary may, by notice, provide for an extension of a

60-day period described in paragraph (1)(C) (or an additional

period provided under this paragraph) for additional period or

periods (not to exceed, except as subsequently provided under

this paragraph, 60 days each), but any such extension shall not

affect or prevent the termination of a waiver or modification

under subparagraph (A) or (B) of paragraph (1).

(f) Report to Congress

Within one year after the end of the emergency period in an

emergency area in which the Secretary exercised the authority

provided under this section, the Secretary shall report to the

Congress regarding the approaches used to accomplish the purposes

described in subsection (a) of this section, including an

evaluation of such approaches and recommendations for improved

approaches should the need for such emergency authority arise in

the future.

(g) Definitions

For purposes of this section:

(1) Emergency area; emergency period

An "emergency area" is a geographical area in which, and an

"emergency period" is the period during which, there exists -

(A) an emergency or disaster declared by the President

pursuant to the National Emergencies Act [50 U.S.C. 1601 et

seq.] or the Robert T. Stafford Disaster Relief and Emergency

Assistance Act [42 U.S.C. 5121 et seq.]; and

(B) a public health emergency declared by the Secretary

pursuant to section 247d of this title.

(2) Health care provider

The term "health care provider" means any entity that furnishes

health care items or services, and includes a hospital or other

provider of services, a physician or other health care

practitioner or professional, a health care facility, or a

supplier of health care items or services.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1135, as added Pub. L.

107-188, title I, Sec. 143(a), June 12, 2002, 116 Stat. 627.)

-REFTEXT-

REFERENCES IN TEXT

Part C of subchapter XVIII of this chapter, referred to in

subsec. (b), is classified to section 1395w-21 et seq. of this

title.

The National Emergencies Act, referred to in subsec. (g)(1)(A),

is Pub. L. 94-412, Sept. 14, 1976, 90 Stat. 1255, as amended, which

is classified principally to chapter 34 (Sec. 1601 et seq.) of

Title 50, War and National Defense. For complete classification of

this Act to the Code, see Short Title note set out under section

1601 of Title 50 and Tables.

The Robert T. Stafford Disaster Relief and Emergency Assistance

Act, referred to in subsec. (g)(1)(A), is Pub. L. 93-288, May 22,

1974, 88 Stat. 143, as amended, which is classified principally to

chapter 68 (Sec. 5121 et seq.) of this title. For complete

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

out under section 5121 of this title and Tables.

-MISC1-

PRIOR PROVISIONS

A prior section 1320b-5, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1135, as added Pub. L. 97-35, title XXI, Sec. 2173(c), Aug.

13, 1981, 95 Stat. 809; amended Pub. L. 97-248, title I, Sec.

101(b)(3), Sept. 3, 1982, 96 Stat. 335; Pub. L. 99-509, title IX,

Sec. 9343(f), Oct. 21, 1986, 100 Stat. 2041; Pub. L. 100-203, title

IV, Sec. 4068(b), Dec. 22, 1987, 101 Stat. 1330-114; Pub. L.

100-360, title IV, Sec. 411(g)(6), July 1, 1988, 102 Stat. 785;

Pub. L. 103-432, title I, Sec. 147(c)(2), Oct. 31, 1994, 108 Stat.

4429, related to development of model prospective rate methodology,

prior to repeal by Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title

III, Sec. 321(T3l)], Nov. 29, 1999, 113 Stat. 1536, 1501A-368,

effective Nov. 29, 1999.

EFFECTIVE DATE

Pub. L. 107-188, title I, Sec. 143(b), June 12, 2002, 116 Stat.

629, provided that: "The amendment made by subsection (a) [enacting

this section] shall be effective on and after September 11, 2001."

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-6. Exclusion of representatives and health care

providers convicted of violations from participation in social

security programs

-STATUTE-

(a) In general

The Commissioner of Social Security shall exclude from

participation in the social security programs any representative or

health care provider -

(1) who is convicted of a violation of section 408 or 1383a of

this title;

(2) who is convicted of any violation under title 18 relating

to an initial application for or continuing entitlement to, or

amount of, benefits under subchapter II of this chapter, or an

initial application for or continuing eligibility for, or amount

of, benefits under subchapter XVI of this chapter; or

(3) who the Commissioner determines has committed an offense

described in section 1320a-8(a)(1) of this title.

(b) Notice, effective date, and period of exclusion

(1) An exclusion under this section shall be effective at such

time, for such period, and upon such reasonable notice to the

public and to the individual excluded as may be specified in

regulations consistent with paragraph (2).

(2) Such an exclusion shall be effective with respect to services

furnished to any individual on or after the effective date of the

exclusion. Nothing in this section may be construed to preclude, in

determining disability under subchapter II of this chapter or

subchapter XVI of this chapter, consideration of any medical

evidence derived from services provided by a health care provider

before the effective date of the exclusion of the health care

provider under this section.

(3)(A) The Commissioner shall specify, in the notice of exclusion

under paragraph (1), the period of the exclusion.

(B) Subject to subparagraph (C), in the case of an exclusion

under subsection (a) of this section, the minimum period of

exclusion shall be 5 years, except that the Commissioner may waive

the exclusion in the case of an individual who is the sole source

of essential services in a community. The Commissioner's decision

whether to waive the exclusion shall not be reviewable.

(C) In the case of an exclusion of an individual under subsection

(a) of this section based on a conviction or a determination

described in subsection (a)(3) of this section occurring on or

after December 14, 1999, if the individual has (before, on, or

after December 14, 1999) been convicted, or if such a determination

has been made with respect to the individual -

(i) on one previous occasion of one or more offenses for which

an exclusion may be effected under such subsection, the period of

the exclusion shall be not less than 10 years; or

(ii) on two or more previous occasions of one or more offenses

for which an exclusion may be effected under such subsection, the

period of the exclusion shall be permanent.

(c) Notice to State agencies

The Commissioner shall promptly notify each appropriate State

agency employed for the purpose of making disability determinations

under section 421 or 1383b(a) of this title -

(1) of the fact and circumstances of each exclusion effected

against an individual under this section; and

(2) of the period (described in subsection (b)(3) of this

section) for which the State agency is directed to exclude the

individual from participation in the activities of the State

agency in the course of its employment.

(d) Notice to State licensing agencies

The Commissioner shall -

(1) promptly notify the appropriate State or local agency or

authority having responsibility for the licensing or

certification of an individual excluded from participation under

this section of the fact and circumstances of the exclusion;

(2) request that appropriate investigations be made and

sanctions invoked in accordance with applicable State law and

policy; and

(3) request that the State or local agency or authority keep

the Commissioner and the Inspector General of the Social Security

Administration fully and currently informed with respect to any

actions taken in response to the request.

(e) Notice, hearing, and judicial review

(1) Any individual who is excluded (or directed to be excluded)

from participation under this section is entitled to reasonable

notice and opportunity for a hearing thereon by the Commissioner to

the same extent as is provided in section 405(b) of this title, and

to judicial review of the Commissioner's final decision after such

hearing as is provided in section 405(g) of this title.

(2) The provisions of section 405(h) of this title shall apply

with respect to this section to the same extent as it is applicable

with respect to subchapter II of this chapter.

(f) Application for termination of exclusion

(1) An individual excluded from participation under this section

may apply to the Commissioner, in the manner specified by the

Commissioner in regulations and at the end of the minimum period of

exclusion provided under subsection (b)(3) of this section and at

such other times as the Commissioner may provide, for termination

of the exclusion effected under this section.

(2) The Commissioner may terminate the exclusion if the

Commissioner determines, on the basis of the conduct of the

applicant which occurred after the date of the notice of exclusion

or which was unknown to the Commissioner at the time of the

exclusion, that -

(A) there is no basis under subsection (a) of this section for

a continuation of the exclusion; and

(B) there are reasonable assurances that the types of actions

which formed the basis for the original exclusion have not

recurred and will not recur.

(3) The Commissioner shall promptly notify each State agency

employed for the purpose of making disability determinations under

section 421 or 1383b(a) of this title of the fact and circumstances

of each termination of exclusion made under this subsection.

(g) Availability of records of excluded representatives and health

care providers

Nothing in this section shall be construed to have the effect of

limiting access by any applicant or beneficiary under subchapter II

or XVI of this chapter, any State agency acting under section 421

or 1383b(a) of this title, or the Commissioner to records

maintained by any representative or health care provider in

connection with services provided to the applicant or beneficiary

prior to the exclusion of such representative or health care

provider under this section.

(h) Reporting requirement

Any representative or health care provider participating in, or

seeking to participate in, a social security program shall inform

the Commissioner, in such form and manner as the Commissioner shall

prescribe by regulation, whether such representative or health care

provider has been convicted of a violation described in subsection

(a) of this section.

(i) Delegation of authority

The Commissioner may delegate authority granted by this section

to the Inspector General.

(j) Definitions

For purposes of this section:

(1) Exclude

The term "exclude" from participation means -

(A) in connection with a representative, to prohibit from

engaging in representation of an applicant for, or recipient

of, benefits, as a representative payee under section 405(j) or

section 1383(a)(2)(A)(ii) of this title, or otherwise as a

representative, in any hearing or other proceeding relating to

entitlement to benefits; and

(B) in connection with a health care provider, to prohibit

from providing items or services to an applicant for, or

recipient of, benefits for the purpose of assisting such

applicant or recipient in demonstrating disability.

(2) Social security program

The term "social security programs" means the program providing

for monthly insurance benefits under subchapter II of this

chapter, and the program providing for monthly supplemental

security income benefits to individuals under subchapter XVI of

this chapter (including State supplementary payments made by the

Commissioner pursuant to an agreement under section 1382e(a) of

this title or section 212(b) of Public Law 93-66).

(3) Convicted

An individual is considered to have been "convicted" of a

violation -

(A) when a judgment of conviction has been entered against

the individual by a Federal, State, or local court, except if

the judgment of conviction has been set aside or expunged;

(B) when there has been a finding of guilt against the

individual by a Federal, State, or local court;

(C) when a plea of guilty or nolo contendere by the

individual has been accepted by a Federal, State, or local

court; or

(D) when the individual has entered into participation in a

first offender, deferred adjudication, or other arrangement or

program where judgment of conviction has been withheld.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1136, as added Pub. L.

106-169, title II, Sec. 208(a), Dec. 14, 1999, 113 Stat. 1839.)

-REFTEXT-

REFERENCES IN TEXT

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

(j)(2), is section 212(b) of Pub. L. 93-66, title II, July 9, 1973,

87 Stat. 155, as amended, which is set out as a note under section

1382 of this title.

-MISC1-

PRIOR PROVISIONS

A prior section 1320b-6, act Aug. 14, 1935, ch. 531, title XI,

Sec. 1136, as added Pub. L. 98-369, div. B, title VI, Sec. 2630,

July 18, 1984, 98 Stat. 1137; amended Pub. L. 99-514, title XVIII,

Sec. 1883(c)(2), Oct. 22, 1986, 100 Stat. 2918, related to pilot

projects to demonstrate use of integrated service delivery systems

for human services programs, prior to repeal by Pub. L. 104-193,

title I, Secs. 108(q)(7), 116, Aug. 22, 1996, 110 Stat. 2168, 2181,

effective July 1, 1997, with certain transition rules.

EFFECTIVE DATE

Pub. L. 106-169, title II, Sec. 208(b), Dec. 14, 1999, 113 Stat.

1842, provided that: "The amendment made by this section [enacting

this section] shall apply with respect to convictions of violations

described in paragraphs (1) and (2) of section 1136(a) of the

Social Security Act [subsec. (a) of this section] and

determinations described in paragraph (3) of such section occurring

on or after the date of the enactment of this Act [Dec. 14, 1999]."

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-7. Income and eligibility verification system

-STATUTE-

(a) Requirements of State eligibility systems

In order to meet the requirements of this section, a State must

have in effect an income and eligibility verification system which

meets the requirements of subsection (d) of this section and under

which -

(1) the State shall require, as a condition of eligibility for

benefits under any program listed in subsection (b) of this

section, that each applicant for or recipient of benefits under

that program furnish to the State his social security account

number (or numbers, if he has more than one such number), and the

State shall utilize such account numbers in the administration of

that program so as to enable the association of the records

pertaining to the applicant or recipient with his account number;

(2) wage information from agencies administering State

unemployment compensation laws available pursuant to section

3304(a)(16) of the Internal Revenue Code of 1986, wage

information reported pursuant to paragraph (3) of this

subsection, and wage, income, and other information from the

Social Security Administration and the Internal Revenue Service

available pursuant to section 6103(l)(7) of such Code, shall be

requested and utilized to the extent that such information may be

useful in verifying eligibility for, and the amount of, benefits

available under any program listed in subsection (b) of this

section, as determined by the Secretary of Health and Human

Services (or, in the case of the unemployment compensation

program, by the Secretary of Labor, or, in the case of the food

stamp program, by the Secretary of Agriculture);

(3) employers (as defined in section 653a(a)(2)(B) of this

title) (including State and local governmental entities and labor

organizations) in such State are required, effective September

30, 1988, to make quarterly wage reports to a State agency (which

may be the agency administering the State's unemployment

compensation law) except that the Secretary of Labor (in

consultation with the Secretary of Health and Human Services and

the Secretary of Agriculture) may waive the provisions of this

paragraph if he determines that the State has in effect an

alternative system which is as effective and timely for purposes

of providing employment related income and eligibility data for

the purposes described in paragraph (2), and except that no

report shall be filed with respect to an employee of a State or

local agency performing intelligence or counterintelligence

functions, if the head of such agency has determined that filing

such a report could endanger the safety of the employee or

compromise an ongoing investigation or intelligence mission, and

except that in the case of wage reports with respect to domestic

service employment, a State may permit employers (as so defined)

that make returns with respect to such employment on a calendar

year basis pursuant to section 3510 of the Internal Revenue Code

of 1986 to make such reports on an annual basis;

(4) the State agencies administering the programs listed in

subsection (b) of this section adhere to standardized formats and

procedures established by the Secretary of Health and Human

Services (in consultation with the Secretary of Agriculture)

under which -

(A) the agencies will exchange with each other information in

their possession which may be of use in establishing or

verifying eligibility or benefit amounts under any other such

program;

(B) such information shall be made available to assist in the

child support program under part D of subchapter IV of this

chapter, and to assist the Secretary of Health and Human

Services in establishing or verifying eligibility or benefit

amounts under subchapters II and XVI of this chapter, but

subject to the safeguards and restrictions established by the

Secretary of the Treasury with respect to information released

pursuant to section 6103(l) of the Internal Revenue Code of

1986; and

(C) the use of such information shall be targeted to those

uses which are most likely to be productive in identifying and

preventing ineligibility and incorrect payments, and no State

shall be required to use such information to verify the

eligibility of all recipients;

(5) adequate safeguards are in effect so as to assure that -

(A) the information exchanged by the State agencies is made

available only to the extent necessary to assist in the valid

administrative needs of the program receiving such information,

and the information released pursuant to section 6103(l) of the

Internal Revenue Code of 1986 is only exchanged with agencies

authorized to receive such information under such section

6103(l); and

(B) the information is adequately protected against

unauthorized disclosure for other purposes, as provided in

regulations established by the Secretary of Health and Human

Services, or, in the case of the unemployment compensation

program, the Secretary of Labor, or, in the case of the food

stamp program, the Secretary of Agriculture, or (!1) in the

case of information released pursuant to section 6103(l) of the

Internal Revenue Code of 1986, the Secretary of the Treasury;

(6) all applicants for and recipients of benefits under any

such program shall be notified at the time of application, and

periodically thereafter, that information available through the

system will be requested and utilized; and

(7) accounting systems are utilized which assure that programs

providing data receive appropriate reimbursement from the

programs utilizing the data for the costs incurred in providing

the data.

(b) Applicable programs

The programs which must participate in the income and eligibility

verification system are -

(1) any State program funded under part A of subchapter IV of

this chapter;

(2) the medicaid program under subchapter XIX of this chapter;

(3) the unemployment compensation program under section 3304 of

the Internal Revenue Code of 1986;

(4) the food stamp program under the Food Stamp Act of 1977 [7

U.S.C. 2011 et seq.]; and

(5) any State program under a plan approved under subchapter I,

X, XIV, or XVI of this chapter.

(c) Protection of applicants from improper use of information

(1) In order to protect applicants for and recipients of benefits

under the programs identified in subsection (b) of this section, or

under the supplemental security income program under subchapter XVI

of this chapter, from the improper use of information obtained from

the Secretary of the Treasury under section 6103(l)(7)(B) of the

Internal Revenue Code of 1986, no Federal, State, or local agency

receiving such information may terminate, deny, suspend, or reduce

any benefits of an individual until such agency has taken

appropriate steps to independently verify information relating to -

(A) the amount of the asset or income involved,

(B) whether such individual actually has (or had) access to

such asset or income for his own use, and

(C) the period or periods when the individual actually had such

asset or income.

(2) Such individual shall be informed by the agency of the

findings made by the agency on the basis of such verified

information, and shall be given an opportunity to contest such

findings, in the same manner as applies to other information and

findings relating to eligibility factors under the program.

(d) Citizenship or immigration status requirements; documentation;

verification by Immigration and Naturalization Service; denial of

benefits; hearing

The requirements of this subsection, with respect to an income

and eligibility verification system of a State, are as follows:

(1)(A) The State shall require, as a condition of an

individual's eligibility for benefits under a program listed in

subsection (b) of this section, a declaration in writing, under

penalty of perjury -

(i) by the individual,

(ii) in the case in which eligibility for program benefits is

determined on a family or household basis, by any adult member

of such individual's family or household (as applicable), or

(iii) in the case of an individual born into a family or

household receiving benefits under such program, by any adult

member of such family or household no later than the next

redetermination of eligibility of such family or household

following the birth of such individual,

stating whether the individual is a citizen or national of the

United States, and, if that individual is not a citizen or

national of the United States, that the individual is in a

satisfactory immigration status.

(B) In this subsection, in the case of the program described in

subsection (b)(4) of this section -

(i) any reference to the State shall be considered a

reference to the State agency, and

(ii) any reference to an individual's eligibility for

benefits under the program shall be considered a reference to

the individual's eligibility to participate in the program as a

member of a household, and

(iii) the term "satisfactory immigration status" means an

immigration status which does not make the individual

ineligible for benefits under the applicable program.

(2) If such an individual is not a citizen or national of the

United States, there must be presented either -

(A) alien registration documentation or other proof of

immigration registration from the Immigration and

Naturalization Service that contains the individual's alien

admission number or alien file number (or numbers if the

individual has more than one number), or

(B) such other documents as the State determines constitutes

reasonable evidence indicating a satisfactory immigration

status.

(3) If the documentation described in paragraph (2)(A) is

presented, the State shall utilize the individual's alien file or

alien admission number to verify with the Immigration and

Naturalization Service the individual's immigration status

through an automated or other system (designated by the Service

for use with States) that -

(A) utilizes the individual's name, file number, admission

number, or other means permitting efficient verification, and

(B) protects the individual's privacy to the maximum degree

possible.

(4) In the case of such an individual who is not a citizen or

national of the United States, if, at the time of application for

benefits, the statement described in paragraph (1) is submitted

but the documentation required under paragraph (2) is not

presented or if the documentation required under paragraph (2)(A)

is presented but such documentation is not verified under

paragraph (3) -

(A) the State -

(i) shall provide a reasonable opportunity to submit to the

State evidence indicating a satisfactory immigration status,

and

(ii) may not delay, deny, reduce, or terminate the

individual's eligibility for benefits under the program on

the basis of the individual's immigration status until such a

reasonable opportunity has been provided; and

(B) if there are submitted documents which the State

determines constitutes reasonable evidence indicating such

status -

(i) the State shall transmit to the Immigration and

Naturalization Service either photostatic or other similar

copies of such documents, or information from such documents,

as specified by the Immigration and Naturalization Service,

for official verification,

(ii) pending such verification, the State may not delay,

deny, reduce, or terminate the individual's eligibility for

benefits under the program on the basis of the individual's

immigration status, and

(iii) the State shall not be liable for the consequences of

any action, delay, or failure of the Service to conduct such

verification.

(5) If the State determines, after complying with the

requirements of paragraph (4), that such an individual is not in

a satisfactory immigration status under the applicable program -

(A) the State shall deny or terminate the individual's

eligibility for benefits under the program, and

(B) the applicable fair hearing process shall be made

available with respect to the individual.

(e) Erroneous State citizenship or immigration status

determinations; penalties not required

Each Federal agency responsible for administration of a program

described in subsection (b) of this section shall not take any

compliance, disallowance, penalty, or other regulatory action

against a State with respect to any error in the State's

determination to make an individual eligible for benefits based on

citizenship or immigration status -

(1) if the State has provided such eligibility based on a

verification of satisfactory immigration status by the

Immigration and Naturalization Service,

(2) because the State, under subsection (d)(4)(A)(ii) of this

section, was required to provide a reasonable opportunity to

submit documentation,

(3) because the State, under subsection (d)(4)(B)(ii) of this

section, was required to wait for the response of the Immigration

and Naturalization Service to the State's request for official

verification of the immigration status of the individual, or

(4) because of a fair hearing process described in subsection

(d)(5)(B) of this section.

(f) Medical assistance to aliens for treatment of emergency

conditions

Subsections (a)(1) and (d) of this section shall not apply with

respect to aliens seeking medical assistance for the treatment of

an emergency medical condition under section 1396b(v)(2) of this

title.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1137, as added Pub. L.

98-369, div. B, title VI, Sec. 2651(a), July 18, 1984, 98 Stat.

1147; amended Pub. L. 99-509, title IX, Sec. 9101, Oct. 21, 1986,

100 Stat. 1972; Pub. L. 99-514, Sec. 2, Oct. 22, 1986, 100 Stat.

2095; Pub. L. 99-603, title I, Sec. 121(a)(1), Nov. 6, 1986, 100

Stat. 3384; Pub. L. 100-360, title IV, Sec. 411(k)(15)(A), July 1,

1988, 102 Stat. 799; Pub. L. 103-432, title II, Sec. 231, Oct. 31,

1994, 108 Stat. 4462; Pub. L. 104-193, title I, Sec. 108(g)(8),

title III, Sec. 313(c), Aug. 22, 1996, 110 Stat. 2168, 2212; Pub.

L. 104-208, div. C, title V, Sec. 507(a), Sept. 30, 1996, 110 Stat.

3009-673; Pub. L. 106-169, title IV, Sec. 401(p), Dec. 14, 1999,

113 Stat. 1859; Pub. L. 106-170, title IV, Sec. 405(a), (b), Dec.

17, 1999, 113 Stat. 1911.)

-REFTEXT-

REFERENCES IN TEXT

Parts A and D of subchapter IV of this chapter, referred to in

subsecs. (a)(4)(B) and (b)(1), are classified to sections 601 et

seq. and 651 et seq., respectively, of this title.

The Internal Revenue Code of 1986, referred to in subsecs.

(a)(2), (3), (4)(B), (5), (b)(3), and (c)(1), is classified

generally to Title 26, Internal Revenue Code.

The Food Stamp Act of 1977, referred to in subsec. (b)(4), is

Pub. L. 88-525, Aug. 31, 1964, 78 Stat. 703, as amended, which is

classified generally to chapter 51 (Sec. 2011 et seq.) of Title 7,

Agriculture. For complete classification of this Act to the Code,

see Short Title note set out under section 2011 of Title 7 and

Tables.

-MISC1-

AMENDMENTS

1999 - Subsec. (a)(3). Pub. L. 106-170, Sec. 405(b)(2), inserted

"(as defined in section 653a(a)(2)(B) of this title)" after

"employers".

Pub. L. 106-170, Sec. 405(b)(1), which directed striking out "(as

defined in section 653a(a)(2)(B)(iii) of this title)" after "labor

organizations", was executed by striking "(as defined in section

653a(a)(2)(B)(ii) of this title)" to reflect the probable intent of

Congress and the amendment by Pub. L. 106-169.

Pub. L. 106-170, Sec. 405(a), inserted before semicolon at end:

", and except that in the case of wage reports with respect to

domestic service employment, a State may permit employers (as so

defined) that make returns with respect to such employment on a

calendar year basis pursuant to section 3510 of the Internal

Revenue Code of 1986 to make such reports on an annual basis".

Pub. L. 106-169, substituted "653a(a)(2)(B)(ii) of this title))"

for "653a(a)(2)(B)(iii) of this title)". See Effective Date of 1999

Amendment note below.

1996 - Subsec. (a)(3). Pub. L. 104-193, Sec. 313(c), inserted

"(including State and local governmental entities and labor

organizations (as defined in section 653a(a)(2)(B)(iii) of this

title)" after "employers" and ", and except that no report shall be

filed with respect to an employee of a State or local agency

performing intelligence or counterintelligence functions, if the

head of such agency has determined that filing such a report could

endanger the safety of the employee or compromise an ongoing

investigation or intelligence mission" before semicolon at end.

Subsec. (b)(1). Pub. L. 104-193, Sec. 108(g)(8)(A), added par.

(1) and struck out former par. (1) which read as follows: "the aid

to families with dependent children program under part A of

subchapter IV of this chapter;".

Subsec. (d)(1)(B). Pub. L. 104-193, Sec. 108(g)(8)(B),

substituted "In this subsection, in" for "In this subsection - ",

struck out "(ii) in" before "the case of the program described in

subsection (b)(4)", redesignated subcls. (I) to (III) as cls. (i)

to (iii), respectively, realigned margins, and struck out former

cl. (i) which read as follows: "in the case of the program

described in subsection (b)(1) of this section, any reference to an

individual's eligibility for benefits under the program shall be

considered a reference to the individual's being considered a

dependent child or to the individual's being treated as a caretaker

relative or other person whose needs are to be taken into account

in making the determination under section 602(a)(7) of this

title,".

Subsec. (d)(4)(B)(i). Pub. L. 104-208 amended cl. (i) generally.

Prior to amendment, cl. (i) read as follows: "the State shall

transmit to the Immigration and Naturalization Service photostatic

or other similar copies of such documents for official

verification,".

1994 - Subsec. (d)(1)(A). Pub. L. 103-432 amended subpar. (A)

generally. Prior to amendment, subpar. (A) read as follows: "The

State shall require, as a condition of an individual's eligibility

for benefits under any program listed in subsection (b) of this

section, a declaration in writing by the individual (or, in the

case of an individual who is a child, by another on the

individual's behalf), under penalty of perjury, stating whether or

not the individual is a citizen or national of the United States,

and, if that individual is not a citizen or national of the United

States, that the individual is in a satisfactory immigration

status."

1988 - Subsec. (f). Pub. L. 100-360 added subsec. (f).

1986 - Subsec. (a). Pub. L. 99-603, Sec. 121(a)(1)(A), inserted

"which meets the requirements of subsection (d) of this section

and" after "system" in introductory text.

Subsec. (a)(2), (4)(B). Pub. L. 99-514 substituted "Internal

Revenue Code of 1986" for "Internal Revenue Code of 1954".

Subsec. (a)(4)(C). Pub. L. 99-509 inserted before semicolon at

end ", and no State shall be required to use such information to

verify the eligibility of all recipients".

Subsec. (a)(5). Pub. L. 99-514 substituted "Internal Revenue Code

of 1986" for "Internal Revenue Code of 1954" wherever appearing.

Subsec. (b). Pub. L. 99-603, Sec. 121(a)(1)(B), substituted

"income and eligibility verification system" for "income

verification system" in introductory text.

Subsecs. (b)(3), (c)(1). Pub. L. 99-514 substituted "Internal

Revenue Code of 1986" for "Internal Revenue Code of 1954".

Subsecs. (d), (e). Pub. L. 99-603, Sec. 121(a)(1)(C), added

subsecs. (d) and (e).

EFFECTIVE DATE OF 1999 AMENDMENTS

Pub. L. 106-170, title IV, Sec. 405(c), Dec. 17, 1999, 113 Stat.

1911, provided that: "The amendments made by this section [amending

this section] shall apply to wage reports required to be submitted

on and after the date of the enactment of this Act [Dec. 17,

1999]."

Amendment by section 401(p) of Pub. L. 106-169 effective as if

included in the enactment of the Personal Responsibility and Work

Opportunity Reconciliation Act of 1996, Pub. L. 104-193, see

section 401(q) of Pub. L. 106-169, set out as a note under section

602 of this title.

EFFECTIVE DATE OF 1996 AMENDMENT

Amendment by section 108(g)(8) 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.

For effective date of amendment by section 313(c) of Pub. L.

104-193, see section 395(a)-(c) of Pub. L. 104-193, set out as a

note under section 654 of this title.

EFFECTIVE DATE OF 1988 AMENDMENT

Section 411(k)(15)(B) of Pub. L. 100-360 provided that: "The

amendment made by subparagraph (A) [amending this section] shall

apply as if it were included in the enactment of section 9406 of

the Omnibus Budget Reconciliation Act of 1986 [see section 9406(c)

of Pub. L. 99-509, set out as an Effective Date of 1986 Amendment

note under section 1396a of this title]."

EFFECTIVE DATE OF 1986 AMENDMENT; USE OF VERIFICATION SYSTEM

Section 121(c)(3), (4) of Pub. L. 99-603 provided that:

"(3) Use of verification system required in fiscal year 1989. -

Except as provided in paragraph (4), the amendments made by

subsection (a) [amending this section, section 1436a of this title,

and section 1091 of Title 20, Education] take effect on October 1,

1988. States have until that date to begin complying with the

requirements imposed by those amendments.

"(4) Use of verification system not required for a program in

certain cases. -

"(A) Report to respective congressional committees. - With

respect to each covered program (as defined in subparagraph

(D)(i)), each appropriate Secretary shall examine and report to

the appropriate Committees of the House of Representatives and of

the Senate, by not later than April 1, 1988, concerning whether

(and the extent to which) -

"(i) the application of the amendments made by subsection (a)

to the program is cost-effective and otherwise appropriate, and

"(ii) there should be a waiver of the application of such

amendments under subparagraph (B).

The amendments made by subsection (a) shall not apply with

respect to a covered program described in subclause (II), (V),

(VI), or (VII) of subparagraph (D)(i) until after the date of

receipt of such report with respect to the program.

"(B) Waiver in certain cases. - If, with respect to a covered

program, the appropriate Secretary determines, on the Secretary's

own initiative or upon an application by an administering entity

and based on such information as the Secretary deems persuasive

(which may include the results of the report required under

subsection (d)(1) [set out as a note below] and information

contained in such an application), that -

"(i) the appropriate Secretary or the administering entity

has in effect an alternative system of immigration status

verification which -

"(I) is as effective and timely as the system otherwise

required under the amendments made by subsection (a) with

respect to the program, and

"(II) provides for at least the hearing and appeals rights

for beneficiaries that would be provided under the amendments

made by subsection (a), or

"(ii) the costs of administration of the system otherwise

required under such amendments exceed the estimated savings,

such Secretary may waive the application of such amendments to

the covered program to the extent (by State or other geographic

area or otherwise) that such determinations apply.

"(C) Basis for determination. - A determination under

subparagraph (B)(ii) shall be based upon the appropriate

Secretary's estimate of -

"(i) the number of aliens claiming benefits under the covered

program in relation to the total number of claimants seeking

benefits under the program,

"(ii) any savings in benefit expenditures reasonably expected

to result from implementation of the verification program, and

"(iii) the labor and nonlabor costs of administration of the

verification system,

the degree to which the Immigration and Naturalization Service is

capable of providing timely and accurate information to the

administering entity in order to permit a reliable determination

of immigration status, and such other factors as such Secretary

deems relevant.

"(D) Definitions. - In this paragraph:

"(i) The term 'covered program' means each of the following

programs:

"(I) The aid to families with dependent children program

under part A of title IV of the Social Security Act [part A

of subchapter IV of this chapter].

"(II) The medicaid program under title XIX of the Social

Security Act [subchapter XIX of this chapter].

"(III) Any State program 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].

"(IV) The unemployment compensation program under section

3304 of the Internal Revenue Code of 1954 [now 1986; 26

U.S.C. 3304].

"(V) The food stamp program under the Food Stamp Act of

1977 [7 U.S.C. 2011 et seq.].

"(VI) The programs of financial assistance for housing

subject to section 214 of the Housing and Community

Development Act of 1980 [42 U.S.C. 1436a].

"(VII) The program of grants, loans, and work assistance

under title IV of the Higher Education Act of 1965 [20 U.S.C.

1070 et seq.; 42 U.S.C. 2751 et seq.].

"(ii) The term 'appropriate Secretary' means, with respect to

the covered program described in -

"(I) subclauses (I) through (III) of clause (i), the

Secretary of Health and Human Services;

"(II) clause (i)(IV), the Secretary of Labor;

"(III) clause (i)(V), the Secretary of Agriculture;

"(IV) clause (i)(VI), the Secretary of Housing and Urban

Development; and

"(V) clause (i)(VII), the Secretary of Education.

"(iii) The term 'administering entity' means, with respect to

the covered program described in -

"(I) subclause (I), (II), (III), (IV), or (V) of clause

(i), the State agency responsible for the administration of

the program in a State;

"(II) clause (i)(VI), the Secretary of Housing and Urban

Development, a public housing agency, or another entity that

determines the eligibility of an individual for financial

assistance; and

"(III) clause (i)(VII), an institution of higher education

involved."

EFFECTIVE DATE

Section 2651(l) of Pub. L. 98-369 provided that:

"(1) The amendments made by subsections (j) and (k) [amending

section 1383 of this title and section 6103 of Title 26, Internal

Revenue Code] shall become effective on the date of the enactment

of this Act [July 18, 1984].

"(2) Except as otherwise specifically provided, the amendments

made by subsections (a) through (i) [enacting this section,

amending sections 302, 503, 602, 1202, 1352, and 1396a of this

title and section 2020 of Title 7, Agriculture, repealing section

611 of this title, and amending provisions set out as a note under

section 1382 of this title] shall become effective on April 1,

1985. In the case of any State which submits a plan describing a

good faith effort by such State to come into compliance with the

requirements of such subsections, the Secretary of Health and Human

Services (or, in the case of the State unemployment compensation

program, the Secretary of Labor, or, in the case of the food stamp

program, the Secretary of Agriculture) may by waiver grant a delay

in the effective date of such subsections, except that no such

waiver may delay the effective date of section 1137(c) of the

Social Security Act [subsec. (c) of this section] (as added by

subsection (a) of this section), or delay the effective date of any

other provision of or added by this section beyond September 30,

1986."

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.

-TRANS-

ABOLITION OF IMMIGRATION AND NATURALIZATION SERVICE AND TRANSFER OF

FUNCTIONS

For abolition of Immigration and Naturalization Service, transfer

of functions, and treatment of related references, see note set out

under section 1551 of Title 8, Aliens and Nationality.

-MISC2-

IMMIGRATION AND NATURALIZATION SERVICE TO ESTABLISH VERIFICATION

SYSTEM BY OCTOBER 1, 1987

Section 121(c)(1) of Pub. L. 99-603 provided that: "The

Commissioner of Immigration and Naturalization shall implement a

system for the verification of immigration status under paragraphs

(3) and (4)(B)(i) of section 1137(d) of the Social Security Act

[subsec. (d)(3) and (4)(B)(i) of this section] (as amended by this

section) so that the system is available to all the States by not

later than October 1, 1987. Such system shall not be used by the

Immigration and Naturalization Service for administrative

(non-criminal) immigration enforcement purposes and shall be

implemented in a manner that provides for verification of

immigration status without regard to the sex, color, race,

religion, or nationality of the individual involved."

GENERAL ACCOUNTING OFFICE REPORTS

Section 121(d) of Pub. L. 99-603 directed Comptroller General to

examine current pilot projects relating to the System for Alien

Verification of Eligibility (SAVE) operated by, or through

cooperative agreements with, the Immigration and Naturalization

Service, and report, not later than Oct. 1, 1987, to Congress and

to Commissioner of Immigration and Naturalization Service

concerning the effectiveness of such projects and any problems with

the implementation of such projects, particularly as they may apply

to implementation of the system, with Comptroller General to

monitor and analyze the implementation of such system, report to

Congress and to the appropriate Secretaries, by not later than Apr.

1, 1989, on such implementation, and include in such report

recommendations for appropriate changes in the system.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 302, 502, 503, 609, 653a,

1202, 1352, 1383, 1396a, 1396b of this title; title 5 section 552a;

title 7 sections 2020, 2025; title 8 sections 1183a, 1642.

-FOOTNOTE-

(!1) So in original. Probably should be followed by a comma.

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-8. Hospital protocols for organ procurement and

standards for organ procurement agencies

-STATUTE-

(a)(1) The Secretary shall provide that a hospital or critical

access hospital meeting the requirements of subchapter XVIII or XIX

of this chapter may participate in the program established under

such subchapter only if -

(A) the hospital or critical access hospital establishes

written protocols for the identification of potential organ

donors that -

(i) assure that families of potential organ donors are made

aware of the option of organ or tissue donation and their

option to decline,

(ii) encourage discretion and sensitivity with respect to the

circumstances, views, and beliefs of such families, and

(iii) require that such hospital's designated organ

procurement agency (as defined in paragraph (3)(B)) is notified

of potential organ donors;

(B) in the case of a hospital in which organ transplants are

performed, the hospital is a member of, and abides by the rules

and requirements of, the Organ Procurement and Transplantation

Network established pursuant to section 274 of this title (in

this section referred to as the "Network"); and

(C) the hospital or critical access hospital has an agreement

(as defined in paragraph (3)(A)) only with such hospital's

designated organ procurement agency.

(2)(A) The Secretary shall grant a waiver of the requirements

under subparagraphs (A)(iii) and (C) of paragraph (1) to a hospital

or critical access hospital desiring to enter into an agreement

with an organ procurement agency other than such hospital's

designated organ procurement agency if the Secretary determines

that -

(i) the waiver is expected to increase organ donation; and

(ii) the waiver will assure equitable treatment of patients

referred for transplants within the service area served by such

hospital's designated organ procurement agency and within the

service area served by the organ procurement agency with which

the hospital seeks to enter into an agreement under the waiver.

(B) In making a determination under subparagraph (A), the

Secretary may consider factors that would include, but not be

limited to -

(i) cost effectiveness;

(ii) improvements in quality;

(iii) whether there has been any change in a hospital's

designated organ procurement agency due to a change made on or

after December 28, 1992, in the definitions for metropolitan

statistical areas (as established by the Office of Management and

Budget); and

(iv) the length and continuity of a hospital's relationship

with an organ procurement agency other than the hospital's

designated organ procurement agency;

except that nothing in this subparagraph shall be construed to

permit the Secretary to grant a waiver that does not meet the

requirements of subparagraph (A).

(C) Any hospital or critical access hospital seeking a waiver

under subparagraph (A) shall submit an application to the Secretary

containing such information as the Secretary determines

appropriate.

(D) The Secretary shall -

(i) publish a public notice of any waiver application received

from a hospital or critical access hospital under this paragraph

within 30 days of receiving such application; and

(ii) prior to making a final determination on such application

under subparagraph (A), offer interested parties the opportunity

to submit written comments to the Secretary during the 60-day

period beginning on the date such notice is published.

(3) For purposes of this subsection -

(A) the term "agreement" means an agreement described in

section 273(b)(3)(A) of this title;

(B) the term "designated organ procurement agency" means, with

respect to a hospital or critical access hospital, the organ

procurement agency designated pursuant to subsection (b) of this

section for the service area in which such hospital is located;

and

(C) the term "organ" means a human kidney, liver, heart, lung,

pancreas, and any other human organ or tissue specified by the

Secretary for purposes of this subsection.

(b)(1) The Secretary shall provide that payment may be made under

subchapter XVIII or XIX of this chapter with respect to organ

procurement costs attributable to payments made to an organ

procurement agency only if the agency -

(A)(i) is a qualified organ procurement organization (as

described in section 273(b) of this title) that is operating

under a grant made under section 273(a) of this title, or (ii)

has been certified or recertified by the Secretary within the

previous 2 years (4 years if the Secretary determines appropriate

for an organization on the basis of its past practices) as

meeting the standards to be a qualified organ procurement

organization (as so described);

(B) meets the requirements that are applicable under such

subchapter for organ procurement agencies;

(C) meets performance-related standards prescribed by the

Secretary;

(D) is a member of, and abides by the rules and requirements

of, the Network;

(E) allocates organs, within its service area and nationally,

in accordance with medical criteria and the policies of the

Network; and

(F) is designated by the Secretary as an organ procurement

organization payments to which may be treated as organ

procurement costs for purposes of reimbursement under such

subchapter.

(2) The Secretary may not designate more than one organ

procurement organization for each service area (described in

section 273(b)(1)(E) (!1) of this title) under paragraph (1)(F).

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1138, as added Pub. L.

99-509, title IX, Sec. 9318(a), Oct. 21, 1986, 100 Stat. 2009;

amended Pub. L. 100-203, title IV, Sec. 4039(h)(2), Dec. 22, 1987,

as added Pub. L. 100-360, title IV, Sec. 411(e)(3), July 1, 1988,

102 Stat. 775; amended Pub. L. 101-239, title VI, Sec.

6003(g)(3)(D)(iv), Dec. 19, 1989, 103 Stat. 2153; Pub. L. 103-432,

title I, Sec. 155(a)(1), Oct. 31, 1994, 108 Stat. 4438; Pub. L.

105-33, title IV, Secs. 4201(c)(1), 4642, Aug. 5, 1997, 111 Stat.

373, 487.)

-REFTEXT-

REFERENCES IN TEXT

Section 273(b)(1)(E) of this title, referred to in subsec.

(b)(2), was redesignated section 273(b)(1)(F) of this title by Pub.

L. 106-505, title VII, Sec. 701(c)(1), Nov. 13, 2000, 114 Stat.

2347 and Pub. L. 106-554, Sec. 1(a)(1) [title II, Sec. 219(b)(1)],

Dec. 21, 2000, 114 Stat. 2763, 2763A-29.

-MISC1-

AMENDMENTS

1997 - Subsec. (a). Pub. L. 105-33, Sec. 4201(c)(1), substituted

"critical access" for "rural primary care" wherever appearing.

Subsec. (b)(1)(A)(ii). Pub. L. 105-33, Sec. 4642, substituted "2

years (4 years if the Secretary determines appropriate for an

organization on the basis of its past practices)" for "two years".

1994 - Subsec. (a)(1)(A)(iii). Pub. L. 103-432, Sec.

155(a)(1)(A), amended cl. (iii) generally. Prior to amendment, cl.

(iii) read as follows: "require that an organ procurement agency

designated by the Secretary pursuant to subsection (b)(1)(F) of

this section be notified of potential organ donors; and".

Subsec. (a)(1)(C). Pub. L. 103-432, Sec. 155(a)(1)(B), added

subpar. (C).

Subsec. (a)(2). Pub. L. 103-432, Sec. 155(a)(1)(C)(ii), added

par. (2). Former par. (2) redesignated (3).

Subsec. (a)(3). Pub. L. 103-432, Sec. 155(a)(1)(D), amended par.

(3) generally. Prior to amendment, par. (3) read as follows: "For

purposes of this subsection, the term 'organ' means a human kidney,

liver, heart, lung, pancreas, and any other human organ or tissue

specified by the Secretary for purposes of this subsection."

Pub. L. 103-432, Sec. 155(a)(1)(C)(i), redesignated par. (2) as

(3).

1989 - Subsec. (a)(1). Pub. L. 101-239 substituted "hospital or

rural primary care hospital" for "hospital" in two places preceding

cl. (i) of subpar. (A).

1988 - Subsec. (a)(1)(B). Pub. L. 100-360 added Pub. L. 100-203,

Sec. 4039(h)(2), see 1987 Amendment note below.

1987 - Subsec. (a)(1)(B). Pub. L. 100-203, Sec. 4039(h)(2), as

added by Pub. L. 100-360, substituted "in" for "In" at beginning.

EFFECTIVE DATE OF 1997 AMENDMENT

Amendment by section 4201(c)(1) of Pub. L. 105-33 applicable to

services furnished on or after Oct. 1, 1997, see section 4201(d) of

Pub. L. 105-33, set out as a note under section 1395f of this

title.

EFFECTIVE DATE OF 1994 AMENDMENT

Section 155(a)(3) of Pub. L. 103-432 provided that: "The

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

apply to hospitals and rural primary care hospitals participating

in the programs under titles XVIII and XIX of the Social Security

Act [subchapters XVIII and XIX of this chapter] beginning January

1, 1996."

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

Section 9318(b) of Pub. L. 99-509, as amended by Pub. L. 100-119,

title I, Sec. 107(c), Sept. 29, 1987, 101 Stat. 784; Pub. L.

100-203, title IV, Sec. 4009(g)(1), Dec. 22, 1987, 101 Stat.

1330-58, provided that:

"(1) Section 1138(a) of the Social Security Act [subsec. (a) of

this section] shall apply to hospitals participating in the

programs under titles XVIII and XIX of such Act [subchapters XVIII

and XIX of this chapter] as of November 21, 1987."

"(2) Section 1138(b) of such Act [subsec. (b) of this section]

shall apply to costs of organs procured on or after March 31,

1988."

[Pub. L. 100-203, title IV, Sec. 4009(g)(2), Dec. 22, 1987, 101

Stat. 1330-58, provided that: "The amendment made by paragraph (1)

[amending this note] shall be effective as if included in the

enactment of the Omnibus Budget Reconciliation Act of 1986 [Pub. L.

99-509]."]

EXISTING AGREEMENTS WITH ORGAN PROCUREMENT AGENCIES

Section 155(a)(2) of Pub. L. 103-432 provided that: "Any hospital

or rural primary care hospital which has an agreement (as defined

in section 1138(a)(3)(A) of the Social Security Act [subsec.

(a)(3)(A) of this section]) with an organ procurement agency other

than such hospital's designated organ procurement agency (as

defined in section 1138(a)(3)(B) of such Act) on the date of the

enactment of this section [Oct. 31, 1994] shall, if such hospital

desires to continue such agreement on and after the effective date

of the amendments made by paragraph (1) [see Effective Date of 1994

Amendment note above], submit an application to the Secretary for a

waiver under section 1138(a)(2) of such Act not later than January

1, 1996, and such agreement may continue in effect pending the

Secretary's determination with respect to such application."

-FOOTNOTE-

(!1) See References in Text note below.

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-9. National Commission on Children

-STATUTE-

(a) Establishment

(1) (!1) There is hereby established a commission to be known as

the National Commission on Children (in this section referred to as

the "Commission").

(b) Membership

(1) The Commission shall consist of -

(A) 12 members to be appointed by the President,

(B) 12 members to be appointed by the Speaker of the House of

Representatives, and

(C) 12 members to be appointed by the President pro tempore of

the Senate.

(2) The President, the Speaker, and the President pro tempore

shall each appoint as members of the Commission -

(A) 4 individuals who -

(i) are representatives of organizations providing services

to children,

(ii) are involved in activities on behalf of children, or

(iii) have engaged in academic research with respect to the

problems and needs of children,

(B) 4 individuals who are elected or appointed public officials

(at the Federal, State, or local level) involved in issues and

programs relating to children, and

(C) 4 individuals who are parents or representatives of parents

or parents' organizations.

(3) The appointments made pursuant to subparagraphs (B) and (C)

of paragraph (1) shall be made in consultation with the chairmen of

committees of the House of Representatives and the Senate,

respectively, having jurisdiction over relevant Federal programs.

(c) Duties and functions of Commission; public hearings in

different geographical areas; broad spectrum of witnesses and

testimony

(1) It shall be the duty and function of the Commission to serve

as a forum on behalf of the children of the Nation and to conduct

the studies and issue the report required by subsection (d) of this

section.

(2) The Commission (and any committees that it may form) shall

conduct public hearings in different geographic areas of the

country, both urban and rural, in order to receive the views of a

broad spectrum of the public on the status of the Nation's children

and on ways to safeguard and enhance the physical, mental, and

emotional well-being of all of the children of the Nation,

including those with physical or mental disabilities, and others

whose circumstances deny them a full share of the opportunities

that parents of the Nation may rightfully expect for their

children.

(3) The Commission shall receive testimony from individuals, and

from representatives of public and private organizations and

institutions with an interest in the welfare of children, including

educators, health care professionals, religious leaders, providers

of social services, representatives of organizations with children

as members, elected and appointed public officials, and from

parents and children speaking in their own behalf.

(d) Interim and final report to President and Congress;

recommendations

The Commission shall submit to the President, and to the

Committees on Finance and Labor and Human Resources of the Senate

and the Committees on Ways and Means, Education and Labor, and

Energy and Commerce of the House of Representatives, an interim

report no later than March 31, 1990, and a final report no later

than March 31, 1991, setting forth recommendations with respect to

the following subjects:

(1) Questions relating to the health of children that the

Commission shall address include -

(A) how to reduce infant mortality,

(B) how to reduce the number of low-birth-weight babies,

(C) how to reduce the number of children with chronic

illnesses and disabilities,

(D) how to improve the nutrition of children,

(E) how to promote the physical fitness of children,

(F) how to ensure that pregnant women receive adequate

prenatal care,

(G) how to ensure that all children have access to both

preventive and acute care health services, and

(H) how to improve the quality and availability of health

care for children.

(2) Questions relating to social and support services for

children and their parents that the Commission shall address

include -

(A) how to prevent and treat child neglect and abuse,

(B) how to provide help to parents who seek assistance in

meeting the problems of their children,

(C) how to provide counseling services for children,

(D) how to strengthen the family unit,

(E) how children can be assured of adequate care while their

parents are working or participating in education or training

programs,

(F) how to improve foster care and adoption services,

(G) how to reduce drug and alcohol abuse by children and

youths, and

(H) how to reduce the incidence of teenage pregnancy.

(3) Questions relating to education that the Commission shall

address include -

(A) how to encourage academic excellence for all children at

all levels of education,

(B) how to use preschool experiences to enhance educational

achievement,

(C) how to improve the qualifications of teachers,

(D) how schools can better prepare the Nation's youth to

compete in the labor market,

(E) how parents and schools can work together to help

children achieve success at each step of the academic ladder,

(F) how to encourage teenagers to complete high school and

remain in school to fulfill their academic potential,

(G) how to address the problems of drug and alcohol abuse by

young people,

(H) how schools might lend support to efforts aimed at

reducing the incidence of teenage pregnancy, and

(I) how schools might better meet the special needs of

children who have physical or mental handicaps.

(4) Questions relating to income security that the Commission

shall address include -

(A) how to reduce poverty among children,

(B) how to ensure that parents support their children to the

fullest extent possible through improved child support

collection services, including services on behalf of children

whose parents are unmarried, and

(C) how to ensure that cash assistance to needy children is

adequate.

(5) Questions relating to tax policy that the Commission shall

address include -

(A) how to assure the equitable tax treatment of families

with children,

(B) the effect of existing tax provisions, including the

dependent care tax credit, the earned income tax credit, and

the targeted jobs tax credit, on children living in poverty,

(C) whether the dependent care tax credit should be

refundable and the effect of such a policy,

(D) whether the earned income tax credit should be adjusted

for family size and the effect of such a policy, and

(E) whether there are other tax-related policies which would

reduce poverty among children.

(6) In addition to addressing the questions specified in

paragraphs (1) through (5), the Commission shall -

(A) seek to identify ways in which public and private

organizations and institutions can work together at the

community level to identify deficiencies in existing services

for families and children and to develop recommendations to

ensure that the needs of families and children are met, using

all available resources, in a coordinated and comprehensive

manner, and

(B) assess the existing capacities of agencies to collect and

analyze data on the status of children and on relevant

programs, identify gaps in the data collection system, and

recommend ways to improve the collection of data and the

coordination among agencies in the collection and utilization

of data.

The reports required by this subsection shall be based upon the

testimony received in the hearings conducted pursuant to subsection

(c) of this section, and upon other data and findings developed by

the Commission.

(e) Time of appointment of members; vacancies; election of

Chairman; quorum; calling of meetings; number of meetings;

voting; compensation and expenses

(1)(A) Members of the Commission shall first be appointed not

later than 60 days after December 22, 1987, for terms ending on

March 31, 1991.

(B) A vacancy in the Commission shall not affect its powers, but

shall be filled in the same manner as the vacant position was first

filled.

(2) The Commission shall elect one of its members to serve as

Chairman of the Commission. The Chairman shall be a nonvoting

member of the Commission.

(3) A majority of the members of the Commission shall constitute

a quorum for the transaction of business.

(4)(A) The Commission shall meet at the call of the Chairman, or

at the call of a majority of the members of the Commission.

(B) The Commission shall meet not less than 4 times during the

period beginning with December 22, 1987, and ending with March 31,

1991.

(5) Decisions of the Commission shall be according to the vote of

a simple majority of those present and voting at a properly called

meeting.

(6) Members of the Commission shall serve without compensation,

but shall be reimbursed for travel, subsistence, and other

necessary expenses incurred in the performance of their duties as

members of the Commission.

(f) Executive Director and additional personnel; appointment and

compensation; consultants

(1) The Commission shall appoint an Executive Director of the

Commission. In addition to the Executive Director, the Commission

may appoint and fix the compensation of such personnel as it deems

advisable. Such appointments and compensation may be made without

regard to the provisions of title 5 that govern appointments in the

competitive services, and the provisions of chapter 51 and

subchapter III of chapter 53 of such title that relate to

classifications and the General Schedule pay rates.

(2) The Commission may procure such temporary and intermittent

services of consultants under section 3109(b) of title 5 as the

Commission determines to be necessary to carry out the duties of

the Commission.

(g) Time and place of hearings and nature of testimony authorized

In carrying out its duties, the Commission, or any duly organized

committee thereof, is authorized to hold such hearings, sit and act

at such times and places, and take such testimony, with respect to

matters for which it has a responsibility under this section, as

the Commission or committee may deem advisable.

(h) Data and information from other agencies and departments

(1) The Commission may secure directly from any department or

agency of the United States such data and information as may be

necessary to carry out its responsibilities.

(2) Upon request of the Commission, any such department or agency

shall furnish any such data or information.

(i) Support services by General Services Administration

The General Services Administration shall provide to the

Commission, on a reimbursable basis, such administrative support

services as the Commission may request.

(j) Authorization of appropriations

There are authorized to be appropriated through fiscal year 1991,

such sums as may be necessary to carry out this section for each of

fiscal years 1989 and 1990.

(k) Donations accepted and deposited in Treasury in separate fund;

expenditures; gift or bequest to or for use of United States

(1) The Commission is authorized to accept donations of money,

property, or personal services. Funds received from donations shall

be deposited in the Treasury in a separate fund created for this

purpose. Funds appropriated for the Commission and donated funds

may be expended for such purposes as official reception and

representation expenses, public surveys, public service

announcements, preparation of special papers, analyses, and

documentaries, and for such other purposes as determined by the

Commission to be in furtherance of its mission to review national

issues affecting children.

(2) For purposes of Federal income, estate, and gift taxation,

money and other property accepted under paragraph (1) of this

subsection shall be considered as a gift or bequest to or for the

use of the United States.

(3) Expenditure of appropriated and donated funds shall be

subject to such rules and regulations as may be adopted by the

Commission and shall not be subject to Federal procurement

requirements.

(l) Public surveys

The Commission is authorized to conduct such public surveys as it

deems necessary in support of its review of national issues

affecting children and, in conducting such surveys, the Commission

shall not be deemed to be an "agency" for the purpose of section

3502 of title 44.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1139, as added Pub. L.

100-203, title IX, Sec. 9136, Dec. 22, 1987, 101 Stat. 1330-316;

amended Pub. L. 100-647, title VIII, Sec. 8201, Nov. 10, 1988, 102

Stat. 3798; Pub. L. 101-45, title IV, Sec. 409, June 30, 1989, 103

Stat. 130; Pub. L. 101-239, title VI, Sec. 6221, Dec. 19, 1989, 103

Stat. 2255; Pub. L. 101-508, title IV, Sec. 4207(k)(6), formerly

Sec. 4027(k)(6), title V, Sec. 5057, Nov. 5, 1990, 104 Stat.

1388-125, 1388-230; Pub. L. 103-432, title I, Sec. 160(d)(4), title

II, Sec. 264(d), Oct. 31, 1994, 108 Stat. 4444, 4468.)

-REFTEXT-

REFERENCES IN TEXT

The provisions of title 5 that govern appointments in the

competitive services, referred to in subsec. (f)(1), are classified

generally to section 3301 et seq. of Title 5, Government

Organization and Employees.

-MISC1-

AMENDMENTS

1994 - Subsec. (d). Pub. L. 103-432, Sec. 264(d), repealed Pub.

L. 101-508, Sec. 5057. See 1990 Amendment note below.

1990 - Subsec. (d). Pub. L. 101-508, Sec. 5057, which directed

amendment of subsec. (d) by substituting "an interim report no

later than September 30, 1990, and a final report no later than

March 31, 1991" for "an interim report no later than March 31,

1991, and a final report no later than September 30, 1990", and

could not be executed, was repealed by Pub. L. 103-432, Sec.

264(d). See Construction of 1990 Amendment note below.

Pub. L. 101-508, Sec. 4207(k)(6), formerly Sec. 4027(k)(6), as

renumbered by Pub. L. 103-432, Sec. 160(d)(4), substituted "interim

report no later than March 31, 1990, and a final report no later

than March 31, 1991, setting forth" for "interim report no later

than March 31, 1991, and a final report no later than September 30,

1990, setting forth".

1989 - Subsec. (d). Pub. L. 101-239, Sec. 6221(1), which directed

the substitution of "March 31, 1990" for "September 30, 1988" and

"March 31, 1991" for "March 31, 1990 [1989]", could only be

executed in part by substituting "March 31, 1991" for "March 30,

1990" in view of amendment by Pub. L. 100-647. See 1990 Amendment

note above.

Subsec. (e)(1)(A), (4)(B). Pub. L. 101-239, Sec. 6221(2),

substituted "March 31, 1991" for "September 30, 1990".

Subsec. (f). Pub. L. 101-45 amended subsec. (f) generally. Prior

to amendment, subsec. (f) read as follows:

"(1) The Commission shall appoint an Executive Director of the

Commission who shall be compensated at a rate fixed by the

Commission, but which shall not exceed the rate established for

level V of the Executive Schedule under title 5.

"(2) In addition to the Executive Director, the Commission may

appoint and fix the compensation of such personnel as it deems

advisable, in accordance with the provisions of title 5 governing

appointments to the competitive service, and the provisions of

chapter 51 and subchapter III of chapter 53 of such title, relating

to classification and General Schedule pay rates."

Subsec. (j). Pub. L. 101-239, Sec. 6221(3), substituted "through

fiscal year 1991, such sums" for "such sums".

Subsecs. (k), (l). Pub. L. 101-239, Sec. 6221(4), added subsecs.

(k) and (l).

1988 - Subsec. (d). Pub. L. 100-647, Sec. 8201(1), (2),

substituted "March 31, 1990" for "September 30, 1988" and

"September 30, 1990" for "March 31, 1989" in introductory

provisions.

Subsec. (e)(1)(A), (4)(B). Pub. L. 100-647, Sec. 8201(3), (4),

substituted "September 30, 1990" for "March 31, 1989".

Subsec. (j). Pub. L. 100-647, Sec. 8201(5), inserted "for each of

fiscal years 1989 and 1990" before period at end.

-CHANGE-

CHANGE OF NAME

Committee on Education and Labor of House of Representatives

treated as referring to Committee on Economic and Educational

Opportunities of House of Representatives and Committee on Energy

and Commerce of House of Representatives treated as referring to

Committee on Commerce of House of Representatives by section 1(a)

of Pub. L. 104-14, set out as a note preceding section 21 of Title

2, The Congress. Committee on Economic and Educational

Opportunities of House of Representatives changed to Committee on

Education and the Workforce of House of Representatives by House

Resolution No. 5, One Hundred Fifth Congress, Jan. 7, 1997.

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.

-MISC2-

EFFECTIVE DATE OF 1994 AMENDMENT

Section 264(h) of Pub. L. 103-432 provided that: "Each amendment

made by this section [amending this section and sections 602,

1382a, and 1383 of this title] shall take effect as if included in

the provision of OBRA-1990 [Pub. L. 101-508] to which the amendment

relates at the time such provision became law."

CONSTRUCTION OF 1990 AMENDMENT

Section 264(d) of Pub. L. 103-432 provided that: "Section 5057 of

OBRA-1990 [Pub. L. 101-508, amending this section], and the

amendment made by such section, are hereby repealed, and section

1139(d) of the Social Security Act [subsec. (d) of this section]

shall be applied and administered as if such section 5057 had never

been enacted."

TERMINATION OF ADVISORY COMMISSIONS

Advisory commissions established after Jan. 5, 1973, to terminate

not later than the expiration of the 2-year period beginning on the

date of their establishment, unless, in the case of a commission

established by the President or an officer of the Federal

Government, such commission is renewed by appropriate action prior

to the expiration of such 2-year period, or in the case of a

commission established by the Congress, its duration is otherwise

provided for by law. See sections 3(2) and 14 of Pub. L. 92-463,

Oct. 6, 1972, 86 Stat. 770, 776, set out in the Appendix to Title

5, Government Organization and Employees.

-FOOTNOTE-

(!1) So in original. No par. (2) has been enacted.

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-10. Prohibition of misuse of symbols, emblems, or names

in reference to Social Security or Medicare

-STATUTE-

(a) Prohibited acts

(1) No person may use, in connection with any item constituting

an advertisement, solicitation, circular, book, pamphlet, or other

communication, or a play, motion picture, broadcast, telecast, or

other production, alone or with other words, letters, symbols, or

emblems -

(A) the words "Social Security", "Social Security Account",

"Social Security System", "Social Security Administration",

"Medicare", "Health Care Financing Administration", "Department

of Health and Human Services", "Health and Human Services",

"Supplemental Security Income Program", or "Medicaid", the

letters "SSA", "HCFA", "DHHS", "HHS", or "SSI", or any other

combination or variation of such words or letters, or

(B) a symbol or emblem of the Social Security Administration,

Health Care Financing Administration, or Department of Health and

Human Services (including the design of, or a reasonable

facsimile of the design of, the social security card issued

pursuant to section 405(c)(2)(F) of this title or the Medicare

card,,(!1) the check used for payment of benefits under

subchapter II of this chapter, or envelopes or other stationery

used by the Social Security Administration, Health Care Financing

Administration, or Department of Health and Human Services), or

any other combination or variation of such symbols or emblems,

in a manner which such person knows or should know would convey, or

in a manner which reasonably could be interpreted or construed as

conveying, the false impression that such item is approved,

endorsed, or authorized by the Social Security Administration, the

Health Care Financing Administration, or the Department of Health

and Human Services or that such person has some connection with, or

authorization from, the Social Security Administration, the Health

Care Financing Administration, or the Department of Health and

Human Services. The preceding provisions of this subsection shall

not apply with respect to the use by any agency or instrumentality

of a State or political subdivision of a State of any words or

letters which identify an agency or instrumentality of such State

or of a political subdivision of such State or the use by any such

agency or instrumentality of any symbol or emblem of an agency or

instrumentality of such State or a political subdivision of such

State.

(2)(A) No person may, for a fee, reproduce, reprint, or

distribute any item consisting of a form, application, or other

publication of the Social Security Administration unless such

person has obtained specific, written authorization for such

activity in accordance with regulations which the Commissioner of

Social Security shall prescribe.

(B) No person may, for a fee, reproduce, reprint, or distribute

any item consisting of a form, application, or other publication of

the Department of Health and Human Services unless such person has

obtained specific, written authorization for such activity in

accordance with regulations which the Secretary shall prescribe.

(3) Any determination of whether the use of one or more words,

letters, symbols, or emblems (or any combination or variation

thereof) in connection with an item described in paragraph (1) or

the reproduction, reprinting, or distribution of an item described

in paragraph (2) is a violation of this subsection shall be made

without regard to any inclusion in such item (or any so reproduced,

reprinted, or distributed copy thereof) of a disclaimer of

affiliation with the United States Government or any particular

agency or instrumentality thereof.

(b) Civil penalties

The Commissioner or the Secretary (as applicable) may, pursuant

to regulations, impose a civil money penalty not to exceed -

(1) except as provided in paragraph (2), $5,000, or

(2) in the case of a violation consisting of a broadcast or

telecast, $25,000,

against any person for each violation by such person of subsection

(a) of this section. In the case of any items referred to in

subsection (a)(1) of this section consisting of pieces of mail,

each such piece of mail which contains one or more words, letters,

symbols, or emblems in violation of subsection (a) of this section

shall represent a separate violation. In the case of any item

referred to in subsection (a)(2) of this section, the reproduction,

reprinting, or distribution of such item shall be treated as a

separate violation with respect to each copy thereof so reproduced,

reprinted, or distributed.

(c) Application of other law; compromise, recovery, and deposit

into Treasury of civil money penalties

(1) The provisions of section 1320a-7a of this title (other than

subsections (a), (b), (f), (h), and (i) and the first sentence of

subsection (c)) shall apply to civil money penalties under

subsection (b) of this section in the same manner as such

provisions apply to a penalty or proceeding under section

1320a-7a(a) of this title.

(2) Penalties imposed against a person under subsection (b) of

this section may be compromised by the Commissioner or the

Secretary (as applicable) and may be recovered in a civil action in

the name of the United States brought in the district court of the

United States for the district in which the violation occurred or

where the person resides, has its principal office, or may be

found, as determined by the Commissioner or the Secretary (as

applicable). Amounts recovered under this section shall be paid to

the Commissioner or the Secretary (as applicable) and shall be

deposited as miscellaneous receipts of the Treasury of the United

States, except that (A) to the extent that such amounts are

recovered under this section as penalties imposed for misuse of

words, letters, symbols, or emblems relating to the Social Security

Administration, such amounts shall be deposited into the Federal

Old-Age and Survivors Insurance Trust Fund, and (B) to the extent

that such amounts are recovered under this section as penalties

imposed for misuse of words, letters, symbols, or emblems relating

to the Department of Health and Human Services, such amounts shall

be deposited into the Federal Hospital Insurance Trust Fund or the

Federal Supplementary Medical Insurance Trust Fund, as appropriate.

The amount of such penalty when finally determined, or the amount

agreed upon in compromise, may be deducted from any sum then or

later owing by the United States to the person against whom the

penalty has been imposed.

(d) Enforcement

The preceding provisions of this section may be enforced through

the Office of the Inspector General of the Social Security

Administration or the Office of the Inspector General of the

Department of Health and Human Services (as appropriate).

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1140, as added Pub. L.

100-360, title IV, Sec. 428(a), July 1, 1988, 102 Stat. 815;

amended Pub. L. 100-485, title VI, Sec. 608(d)(30)(A), Oct. 13,

1988, 102 Stat. 2424; Pub. L. 103-296, title I, Sec. 108(b)(12),

title III, Secs. 304(b), 312(a)-(j), Aug. 15, 1994, 108 Stat. 1484,

1520, 1526, 1527.)

-MISC1-

AMENDMENTS

1994 - Subsec. (a). Pub. L. 103-296, Sec. 312(a), designated

existing provisions as par. (1), redesignated former pars. (1) and

(2) as subpars. (A) and (B), respectively, and added par. (2).

Subsec. (a)(1). Pub. L. 103-296, Sec. 312(c), (d), in closing

provisions substituted "convey, or in a manner which reasonably

could be interpreted or construed as conveying," for "convey" and

inserted at end "The preceding provisions of this subsection shall

not apply with respect to the use by any agency or instrumentality

of a State or political subdivision of a State of any words or

letters which identify an agency or instrumentality of such State

or of a political subdivision of such State or the use by any such

agency or instrumentality of any symbol or emblem of an agency or

instrumentality of such State or a political subdivision of such

State."

Subsec. (a)(1)(A). Pub. L. 103-296, Sec. 312(b)(1), substituted

"Administration', 'Department of Health and Human Services',

'Health and Human Services', 'Supplemental Security Income

Program', or 'Medicaid', the letters 'SSA', 'HCFA', 'DHHS', 'HHS',

or 'SSI'," for "Administration', the letters 'SSA' or 'HCFA',".

Subsec. (a)(1)(B). Pub. L. 103-296, Sec. 312(b)(2), substituted

"Social Security Administration, Health Care Financing

Administration, or Department of Health and Human Services" for

"Social Security Administration" in two places, struck out "or of

the Health Care Financing Administration" before ", or any other",

and inserted "or the Medicare card," after "section 405(c)(2)(F) of

this title".

Subsec. (a)(2). Pub. L. 103-296, Sec. 304(b), substituted

"405(c)(2)(F)" for "405(c)(2)(E)".

Subsec. (a)(2)(A), (B). Pub. L. 103-296, Sec. 108(b)(12)(A), in

par. (2) as added by Pub. L. 103-296, Sec. 312(a), designated

existing provisions as subpar. (A), struck out "or of the

Department of Health and Human Services" after "Social Security

Administration", substituted "Commissioner of Social Security" for

"Secretary", and added subpar. (B).

Subsec. (a)(3). Pub. L. 103-296, Sec. 312(e), added par. (3).

Subsec. (b). Pub. L. 103-296, Sec. 312(g), substituted "The" for

"(1) Subject to paragraph (2), the", redesignated subpars. (A) and

(B) as pars. (1) and (2), respectively, and in par. (1) substituted

"paragraph (2)" for "subparagraph (B)", and struck out former par.

(2) which read as follows: "The total amount of penalties which may

be imposed under paragraph (1) with respect to multiple violations

in any one year period consisting of substantially identical

communications or productions shall not exceed $100,000."

Subsec. (b)(1). Pub. L. 103-296, Sec. 312(f) inserted at end "In

the case of any items referred to in subsection (a)(1) of this

section consisting of pieces of mail, each such piece of mail which

contains one or more words, letters, symbols, or emblems in

violation of subsection (a) of this section shall represent a

separate violation. In the case of any item referred to in

subsection (a)(2) of this section, the reproduction, reprinting, or

distribution of such item shall be treated as a separate violation

with respect to each copy thereof so reproduced, reprinted, or

distributed."

Pub. L. 103-296, Sec. 108(b)(12)(B), substituted "the

Commissioner or the Secretary (as applicable)" for "the Secretary"

in introductory provisions.

Subsec. (c)(1). Pub. L. 103-296, Sec. 312(h), inserted "and the

first sentence of subsection (c)" after "and (i)".

Subsec. (c)(2). Pub. L. 103-296, Sec. 312(i), at end of second

sentence substituted comma for period and inserted "except that (A)

to the extent that such amounts are recovered under this section as

penalties imposed for misuse of words, letters, symbols, or emblems

relating to the Social Security Administration, such amounts shall

be deposited into the Federal Old-Age and Survivors Insurance Trust

Fund, and (B) to the extent that such amounts are recovered under

this section as penalties imposed for misuse of words, letters,

symbols, or emblems relating to the Department of Health and Human

Services, such amounts shall be deposited into the Federal Hospital

Insurance Trust Fund or the Federal Supplementary Medical Insurance

Trust Fund, as appropriate."

Pub. L. 103-296, Sec. 108(b)(12)(C), substituted "the

Commissioner or the Secretary (as applicable)" for "the Secretary"

wherever appearing.

Subsec. (d). Pub. L. 103-296, Sec. 312(j), added subsec. (d).

Pub. L. 103-296, Sec. 108(b)(12)(D), which in subsec. (d) as

added by Pub. L. 103-296, Sec. 312(j), directed the substitution of

"the Office of the Inspector General of the Social Security

Administration or the Office of the Inspector General of the

Department of Health and Human Services (as appropriate)" for "the

Office of Inspector General of the Department of Health and Human

Services", was executed by making the substitution for "the Office

of the Inspector General of the Department of Health and Human

Services" to reflect the probable intent of Congress.

1988 - Subsec. (c)(1). Pub. L. 100-485 amended par. (1)

generally. Prior to amendment, par. (1) read as follows:

"Subsections (c), (d), (e), (g), (j), and (k) of section 1320a-7a

of this title shall apply with respect to violations under

subsection (a) of this section and penalties imposed under

subsection (b) of this section in the same manner and to the same

extent as such subsections apply with respect to claims in

violation of section 1320a-7a of this title and penalties imposed

under section 1320a-7a(a) of this title."

EFFECTIVE DATE OF 1994 AMENDMENT

Amendment by section 108(b)(12) 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.

Amendment by section 312(a)-(j) of Pub. L. 103-296 applicable

with respect to violations occurring after Mar. 31, 1995, see

section 312(m)(1) of Pub. L. 103-296, set out as an Effective Date

note under section 333 of Title 31, Money and Finance.

EFFECTIVE DATE OF 1988 AMENDMENT

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.

EFFECTIVE DATE

Section 428(c) of Pub. L. 100-360 provided that: "The amendments

made by this section [enacting this section and amending section

1395ss of this title] shall take effect on the date of the

enactment of this Act [July 1, 1988] and shall apply only with

respect to violations occurring on or after such date."

REPORTS ON OPERATION OF THIS SECTION

Section 312(k) of Pub. L. 103-296 provided that:

"(1) In general. - The Secretary of Health and Human Services and

the Commissioner of Social Security shall each submit to the

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

Committee on Finance of the Senate 3 reports on the operation of

section 1140 of the Social Security Act [this section] with respect

to the Social Security Administration or the Department of Health

and Human Services during the period covered by the report, which

shall specify -

"(A) the number of complaints of violations of such section

received by the Social Security Administration or the Department

of Health and Human Services during the period,

"(B) the number of cases in which the Social Security

Administration or the Department, during the period, sent a

notice of violation of such section requesting that an individual

cease activities in violation of such section,

"(C) the number of cases in which the Social Security

Administration or the Department formally proposed a civil money

penalty in a demand letter during the period,

"(D) the total amount of civil money penalties assessed by the

Social Security Administration or the Department under this

section during the period,

"(E) the number of requests for hearings filed during the

period by the Social Security Administration or the Department

pursuant to sections 1140(c)(1) [subsec. (c)(1) of this section]

and 1128A(c)(2) [section 1320a-7a(c)(2) of this title] of the

Social Security Act,

"(F) the disposition during the period of hearings filed

pursuant to sections 1140(c)(1) and 1128A(c)(2) of the Social

Security Act, and

"(G) the total amount of civil money penalties collected under

this section and deposited into the Federal Old-Age and Survivors

Insurance Trust Fund or the Health Insurance and Supplementary

Medical Insurance Trust Funds, as applicable, during the period.

"(2) When due. - The reports required by paragraph (1) shall be

submitted not later than December 1, 1995, not later than December

1, 1997, and not later than December 1, 1999, respectively."

CONSULTATION BY UNITED STATES POSTAL SERVICE REGARDING PREVENTION

OF DECEPTIVE MAILINGS

United States Postal Service to consult and coordinate functions

of Secretary of Department of Health and Human Services in

administration of this section, see section 4 of Pub. L. 101-524,

set out as a Coordination of Functions With Department of Health

and Human Services note under section 3001 of Title 39, Postal

Service.

-FOOTNOTE-

(!1) So in original.

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-11. Blood donor locator service

-STATUTE-

(a) In general

The Commissioner of Social Security shall establish and conduct a

Blood Donor Locator Service, which shall be used to obtain and

transmit to any authorized person (as defined in subsection (h)(1)

of this section) the most recent mailing address of any blood donor

who, as indicated by the donated blood or products derived

therefrom or by the history of the subsequent use of such blood or

blood products, has or may have the virus for acquired immune

deficiency syndrome, in order to inform such donor of the possible

need for medical care and treatment.

(b) Provision of address information

Whenever the Commissioner of Social Security receives a request,

filed by an authorized person (as defined in subsection (h)(1) of

this section), for the mailing address of a donor described in

subsection (a) of this section and the Commissioner of Social

Security is reasonably satisfied that the requirements of this

section have been met with respect to such request, the

Commissioner of Social Security shall promptly undertake to provide

the requested address information from -

(1) the files and records maintained by the Social Security

Administration, and

(2) such files and records obtained pursuant to section

6103(m)(6) of the Internal Revenue Code of 1986 as the

Commissioner of Social Security considers necessary to comply

with such request.

(c) Manner and form of requests

A request for address information under this section shall be

filed in such manner and form as the Commissioner of Social

Security shall by regulation prescribe, shall include the blood

donor's social security account number, and shall be accompanied or

supported by such documents as the Commissioner of Social Security

may determine to be necessary.

(d) Procedures and safeguards

Any authorized person shall, as a condition for receiving address

information from the Blood Donor Locator Service -

(1) establish and maintain, to the satisfaction of the

Commissioner of Social Security, a system for standardizing

records with respect to any request, the reason for such request,

and the date of such request made by or of it and any disclosure

of address information made by or to it,

(2) establish and maintain, to the satisfaction of the

Commissioner of Social Security, a secure area or place in which

such address information and all related blood donor records

shall be stored,

(3) restrict, to the satisfaction of the Commissioner of Social

Security, access to the address information and related blood

donor records only to persons whose duties or responsibilities

require access and to whom disclosure may be made under the

provisions of this section,

(4) provide such other safeguards which the Commissioner of

Social Security determines (and which the Commissioner of Social

Security prescribes in regulations) to be necessary or

appropriate to protect the confidentiality of the address

information and related blood donor records,

(5) furnish a report to the Commissioner of Social Security, at

such time and containing such information as the Commissioner of

Social Security may prescribe, which describes the procedures

established and utilized by the authorized person for ensuring

the confidentiality of address information and related blood

donor records required under this subsection, and

(6) destroy such address information and related blood donor

records, upon completion of their use in providing the

notification for which the information was obtained, so as to

make such information and records undisclosable.

If the Commissioner of Social Security determines that any

authorized person has failed to, or does not, meet the requirements

of this subsection, the Commissioner of Social Security may, after

any proceedings for review established under subsection (f) of this

section, take such actions as are necessary to ensure such

requirements are met, including refusing to disclose address

information to such authorized person until the Commissioner of

Social Security determines that such requirements have been or will

be met. In the case of any authorized person who discloses any

address information received pursuant to this section or any

related blood donor records to any agent, this subsection shall

apply to such authorized person and each such agent (except that,

in the case of an agent, any report to the Commissioner of Social

Security or other action with respect to the Commissioner of Social

Security shall be made or taken through such authorized person).

The Commissioner of Social Security shall destroy all related blood

donor records in the possession of the Social Security

Administration upon completion of their use in transmitting mailing

addresses as required under subsection (a) of this section, so as

to make such records undisclosable.

(e) Arrangements with State agencies and authorized persons

The Commissioner of Social Security, in carrying out the

Commissioner's duties and functions under this section, shall enter

into arrangements -

(1) with State agencies to accept and to transmit to the

Commissioner of Social Security requests for address information

under this section and to accept and to transmit such information

to authorized persons, and

(2) with State agencies and authorized persons otherwise to

cooperate with the Commissioner of Social Security in carrying

out the purposes of this section.

(f) Procedures for administrative review

The Commissioner of Social Security shall by regulation prescribe

procedures which provide for administrative review of any

determination that any authorized person has failed to meet the

requirements of this section.

(g) Unauthorized disclosure of information

Paragraphs (1), (2), and (3) of section 7213(a) of the Internal

Revenue Code of 1986 shall apply with respect to the unauthorized

willful disclosure to any person of address information or related

blood donor records acquired or maintained by or under the

Commissioner of Social Security, or pursuant to this section by any

authorized person, or of information derived from any such address

information or related blood donor records, in the same manner and

to the same extent as such paragraphs apply with respect to

unauthorized disclosures of return and return information described

in such paragraphs. Paragraph (4) of section 7213(a) of such Code

shall apply with respect to the willful offer of any item of

material value in exchange for any such address information or

related blood donor record in the same manner and to the same

extent as such paragraph applies with respect to offers (in

exchange for any return or return information) described in such

paragraph.

(h) Definitions

For purposes of this section -

(1) Authorized person

The term "authorized person" means -

(A) any agency of a State (or of a political subdivision of a

State) which has duties or authority under State law relating

to the public health or otherwise has the duty or authority

under State law to regulate blood donations, and

(B) any entity engaged in the acceptance of blood donations

which is licensed or registered by the Food and Drug

Administration in connection with the acceptance of such blood

donations, and which, in accordance with such regulations as

may be prescribed by the Commissioner of Social Security,

provides for -

(i) the confidentiality of any address information received

pursuant to this section and related blood donor records,

(ii) blood donor notification procedures for individuals

with respect to whom such information is requested and a

finding has been made that they have or may have the virus

for acquired immune deficiency syndrome, and

(iii) counseling services for such individuals who have

been found to have such virus.

(2) Related blood donor record

The term "related blood donor record" means any record, list,

or compilation which indicates, directly or indirectly, the

identity of any individual with respect to whom a request for

address information has been made pursuant to this section.

(3) State

The term "State" includes the District of Columbia, the

Commonwealth of Puerto Rico, the Virgin Islands, Guam, the

Commonwealth of the Northern Marianas, and the Trust Territory of

the Pacific Islands.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1141, as added Pub. L.

100-647, title VIII, Sec. 8008(b)(1), Nov. 10, 1988, 102 Stat.

3784; amended Pub. L. 103-296, title I, Sec. 108(b)(13), Aug. 15,

1994, 108 Stat. 1484.)

-REFTEXT-

REFERENCES IN TEXT

The Internal Revenue Code of 1986, referred to in subsecs. (b)(2)

and (g), is classified generally to Title 26, Internal Revenue

Code.

-MISC1-

AMENDMENTS

1994 - Subsec. (a). Pub. L. 103-296, Sec. 108(b)(13)(A), (C),

substituted "The Commissioner of Social Security" for "The

Secretary" and struck out "under the direction of the Commissioner

of Social Security," before "which shall be used".

Subsec. (b), (c). Pub. L. 103-296, Sec. 108(b)(13)(A),

substituted "Commissioner of Social Security" for "Secretary"

wherever appearing.

Subsec. (d). Pub. L. 103-296, Sec. 108(b)(13)(D), which directed

amendment of par. (6) by substituting "Social Security

Administration" for "Department of Health Services", was executed

by substituting "Social Security Administration" for "Department of

Health and Human Services" in closing provisions to reflect the

probable intent of Congress.

Pub. L. 103-296, Sec. 108(b)(13)(A), substituted "Commissioner of

Social Security" for "Secretary" wherever appearing.

Subsec. (e). Pub. L. 103-296, Sec. 108(b)(13)(A), (B),

substituted "Commissioner of Social Security" for "Secretary"

wherever appearing and "Commissioner's" for "Secretary's" in

introductory provisions.

Subsecs. (f), (g), (h)(1)(B). Pub. L. 103-296, Sec.

108(b)(13)(A), substituted "Commissioner of Social Security" for

"Secretary".

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.

-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.

-MISC2-

TIME LIMIT FOR ESTABLISHMENT OF BLOOD DONOR LOCATOR SERVICE

Section 8008(b)(2) of Pub. L. 100-647 provided that: "The

Secretary of Health and Human Services shall establish the Blood

Donor Locator Service pursuant to section 1141 of the Social

Security Act [this section] not later than 180 days after the date

of the enactment of this Act [Nov. 10, 1988]."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 405 of this title; title

26 section 6103.

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-12. Research on outcomes of health care services and

procedures

-STATUTE-

(a) Establishment of program

(1) In general

The Secretary, acting through the Director of the Agency for

Healthcare Research and Quality, shall -

(A) conduct and support research with respect to the

outcomes, effectiveness, and appropriateness of health care

services and procedures in order to identify the manner in

which diseases, disorders, and other health conditions can most

effectively and appropriately be prevented, diagnosed, treated,

and managed clinically; and

(B) assure that the needs and priorities of the program under

subchapter XVIII of this chapter are appropriately reflected in

the development and periodic review and updating (through the

process set forth in section 299b-2 (!1) of this title) of

treatment-specific or condition-specific practice guidelines

for clinical treatments and conditions in forms appropriate for

use in clinical practice, for use in educational programs, and

for use in reviewing quality and appropriateness of medical

care.

(2) Evaluations of alternative services and procedures

In carrying out paragraph (1), the Secretary shall conduct or

support evaluations of the comparative effects, on health and

functional capacity, of alternative services and procedures

utilized in preventing, diagnosing, treating, and clinically

managing diseases, disorders, and other health conditions.

(3) Initial guidelines

(A) In carrying out paragraph (1)(B) of this subsection, and

section 299b-1(d) (!1) of this title, the Secretary shall, by not

later than January 1, 1991, assure the development of an initial

set of the guidelines specified in paragraph (1)(B) that shall

include not less than 3 clinical treatments or conditions that -

(i)(I) account for a significant portion of expenditures

under subchapter XVIII of this chapter; and

(II) have a significant variation in the frequency or the

type of treatment provided; or

(ii) otherwise meet the needs and priorities of the program

under subchapter XVIII of this chapter, as set forth under

subsection (b)(3) of this section.

(B)(i) The Secretary shall provide for the use of guidelines

developed under subparagrah (!2) (A) to improve the quality,

effectiveness, and appropriateness of care provided under

subchapter XVIII of this chapter. The Secretary shall determine

the impact of such use on the quality, appropriateness,

effectiveness, and cost of medical care provided under such

subchapter and shall report to the Congress on such determination

by not later than January 1, 1993.

(ii) For the purpose of carrying out clause (i), the Secretary

shall expend, from the amounts specified in clause (iii),

$1,000,000 for fiscal year 1990 and $1,500,000 for each of the

fiscal years 1991 and 1992.

(iii) For each fiscal year, for purposes of expenditures

required in clause (ii) -

(I) 60 percent of an amount equal to the expenditure involved

is appropriated from the Federal Hospital Insurance Trust Fund

(established under section 1395i of this title); and

(II) 40 percent of an amount equal to the expenditure

involved is appropriated from the Federal Supplementary Medical

Insurance Trust Fund (established under section 1395t of this

title).

(b) Priorities

(1) In general

The Secretary shall establish priorities with respect to the

diseases, disorders, and other health conditions for which

research and evaluations are to be conducted or supported under

subsection (a) of this section. In establishing such priorities,

the Secretary shall, with respect to a disease, disorder, or

other health condition, consider the extent to which -

(A) improved methods of prevention, diagnosis, treatment, and

clinical management can benefit a significant number of

individuals;

(B) there is significant variation among physicians in the

particular services and procedures utilized in making diagnoses

and providing treatments or there is significant variation in

the outcomes of health care services or procedures due to

different patterns of diagnosis or treatment;

(C) the services and procedures utilized for diagnosis and

treatment result in relatively substantial expenditures; and

(D) the data necessary for such evaluations are readily

available or can readily be developed.

(2) Preliminary assessments

For the purpose of establishing priorities under paragraph (1),

the Secretary may, with respect to services and procedures

utilized in preventing, diagnosing, treating, and clinically

managing diseases, disorders, and other health conditions,

conduct or support assessments of the extent to which -

(A) rates of utilization vary among similar populations for

particular diseases, disorders, and other health conditions;

(B) uncertainties exist on the effect of utilizing a

particular service or procedure; or

(C) inappropriate services and procedures are provided.

(3) Relationship with medicare program

In establishing priorities under paragraph (1) for research and

evaluation, and under section 299b-3(a) (!1) of this title for

the agenda under such section, the Secretary shall assure that

such priorities appropriately reflect the needs and priorities of

the program under subchapter XVIII of this chapter, as set forth

by the Administrator of the Health Care Financing Administration.

(c) Methodologies and criteria for evaluations

For the purpose of facilitating research under subsection (a) of

this section, the Secretary shall -

(1) conduct and support research with respect to the

improvement of methodologies and criteria utilized in conducting

research with respect to outcomes of health care services and

procedures;

(2) conduct and support reviews and evaluations of existing

research findings with respect to such treatment or conditions;

(3) conduct and support reviews and evaluations of the existing

methodologies that use large data bases in conducting such

research and shall develop new research methodologies, including

data-based methods of advancing knowledge and methodologies that

measure clinical and functional status of patients, with respect

to such research;

(4) provide grants and contracts to research centers, and

contracts to other entities, to conduct such research on such

treatment or conditions, including research on the appropriate

use of prescription drugs;

(5) conduct and support research and demonstrations on the use

of claims data and data on clinical and functional status of

patients in determining the outcomes, effectiveness, and

appropriateness of such treatment; and

(6) conduct and support supplementation of existing data bases,

including the collection of new information, to enhance data

bases for research purposes, and the design and development of

new data bases that would be used in outcomes and effectiveness

research.

(d) Standards for data bases

In carrying out this section, the Secretary shall develop -

(1) uniform definitions of data to be collected and used in

describing a patient's clinical and functional status;

(2) common reporting formats and linkages for such data; and

(3) standards to assure the security, confidentiality,

accuracy, and appropriate maintenance of such data.

(e) Dissemination of research findings and guidelines

(1) In general

The Secretary shall provide for the dissemination of the

findings of research and the guidelines described in subsection

(a) of this section, and for the education of providers and

others in the application of such research findings and

guidelines.

(2) Cooperative educational activities

In disseminating findings and guidelines under paragraph (1),

and in providing for education under such paragraph, the

Secretary shall work with professional associations, medical

specialty and subspecialty organizations, and other relevant

groups to identify and implement effective means to educate

physicians, other providers, consumers, and others in using such

findings and guidelines, including training for physician

managers within provider organizations.

(f) Evaluations

The Secretary shall conduct and support evaluations of the

activities carried out under this section to determine the extent

to which such activities have had an effect on the practices of

physicians in providing medical treatment, the delivery of health

care, and the outcomes of health care services and procedures.

(g) Research with respect to dissemination

The Secretary may conduct or support research with respect to

improving methods of disseminating information on the effectiveness

and appropriateness of health care services and procedures.

(h) Omitted

(i) Authorization of appropriations

(1) In general

There are authorized to be appropriated to carry out this

section -

(A) $50,000,000 for fiscal year 1990;

(B) $75,000,000 for fiscal year 1991;

(C) $110,000,000 for fiscal year 1992;

(D) $148,000,000 for fiscal year 1993; and

(E) $185,000,000 for fiscal year 1994.

(2) Specifications

For the purpose of carrying out this section, for each of the

fiscal years 1990 through 1992 an amount equal to two-thirds of

the amounts authorized to be appropriated under paragraph (1),

and for each of the fiscal years 1993 and 1994 an amount equal to

70 percent of such amounts, are to be appropriated in the

following proportions from the following trust funds:

(A) 60 percent from the Federal Hospital Insurance Trust Fund

(established under section 1395i of this title).

(B) 40 percent from the Federal Supplementary Medical

Insurance Trust Fund (established under section 1395t of this

title).

(3) Allocations

(A) For each fiscal year, of the amounts transferred or

otherwise appropriated to carry out this section, the Secretary

shall reserve appropriate amounts for each of the purposes

specified in clauses (i) through (iv) of subparagraph (B).

(B) The purposes referred to in subparagraph (A) are -

(i) the development of guidelines, standards, performance

measures, and review criteria;

(ii) research and evaluation;

(iii) data-base standards and development; and

(iv) education and information dissemination.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1142, as added Pub. L.

101-239, title VI, Sec. 6103(b)(1), Dec. 19, 1989, 103 Stat. 2195;

amended Pub. L. 106-129, Sec. 2(b)(2), Dec. 6, 1999, 113 Stat.

1670.)

-REFTEXT-

REFERENCES IN TEXT

Sections 299b-1 to 299b-3 of this title, referred to in subsecs.

(a) and (b), were in the original references to sections 912 to 914

of act July 1, 1944, which were omitted in the general amendment of

subchapter VII of chapter 6A of this title by Pub. L. 106-129, Sec.

2(a), Dec. 6, 1999, 113 Stat. 1653. Section 2(a) of Pub. L. 106-129

enacted new sections 912 to 914 of act July 1, 1944, which are

classified to sections 299b-1 to 299b-3, respectively, of this

title.

-COD-

CODIFICATION

Subsec. (h) of this section, which required the Secretary to

report biennially to Congress on the progress of the activities

under this section during the preceding 2 fiscal years, including

the impact of such activities on medical care (particularly medical

care for individuals receiving benefits under subchapter XVIII of

this chapter), terminated, effective May 15, 2000, pursuant to

section 3003 of Pub. L. 104-66, as amended, set out as a note under

section 1113 of Title 31, Money and Finance. See, also, item 10 on

page 94 of House Document No. 103-7.

Another section 1142 of act Aug. 14, 1935, was renumbered section

1143 by Pub. L. 101-508, title V, Sec. 5111(a)(1), Nov. 5, 1990,

104 Stat. 1388-272, and is classified to section 1320b-13 of this

title.

-MISC1-

AMENDMENTS

1999 - Subsec. (a)(1). Pub. L. 106-129 substituted "Director of

the Agency for Healthcare Research and Quality" for "Administrator

for Health Care Policy and Research" in introductory provisions.

AHCPR STUDY ON EFFECT OF CREDENTIALING OF TECHNOLOGISTS AND

SONOGRAPHERS ON QUALITY OF ULTRASOUND

Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title II, Sec. 229(b)],

Nov. 29, 1999, 113 Stat. 1536, 1501A-357, provided that:

"(1) Study. - The Administrator for Health Care Policy and

Research shall provide for a study that, with respect to the

provision of ultrasound under the medicare and medicaid programs

under titles XVIII and XIX of the Social Security Act [subchapters

XVIII and XIX of this chapter], compares differences in quality

between ultrasound furnished by individuals who are credentialed by

private entities or organizations and ultrasound furnished by those

who are not so credentialed. Such study shall examine and evaluate

differences in error rates, resulting complications, and patient

outcomes as a result of the differences in credentialing. In

designing the study, the Administrator shall consult with

organizations nationally recognized for their expertise in

ultrasound.

"(2) Report. - Not later than two years after the date of the

enactment of this Act [Nov. 29, 1999], the Administrator shall

submit a report to Congress on the study conducted under paragraph

(1)."

REPORT ON LINKAGE OF PUBLIC AND PRIVATE RESEARCH RELATED DATA

Section 6103(b)(2) of Pub. L. 101-239 provided that: "Not later

than 1 year after the date of the enactment of this Act [Dec. 19,

1989], the Secretary of Health and Human Services shall report to

the Congress on the feasibility of linking research-related data

described in section 1142(d) of the Social Security Act [subsec.

(d) of this section] (as added by paragraph (1) of this subsection)

with similar data collected or maintained by non-Federal entities

and by Federal agencies other than the Department of Health and

Human Services (including the Departments of Defense and Veterans

Affairs and the Office of Personnel Management)."

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 299a, 299c, 299c-2, 1395y

of this title.

-FOOTNOTE-

(!1) See References in Text note below.

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

-End-

-CITE-

42 USC Sec. 1320b-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 A - General Provisions

-HEAD-

Sec. 1320b-13. Social security account statements

-STATUTE-

(a) Provision upon request

(1) Beginning not later than October 1, 1990, the Secretary shall

provide upon the request of an eligible individual a social

security account statement (hereinafter referred to as the

"statement").

(2) Each statement shall contain -

(A) the amount of wages paid to and self-employment income

derived by the eligible individual as shown by the records of the

Secretary at the date of the request;

(B) an estimate of the aggregate of the employer, employee, and

self-employment contributions of the eligible individual for

old-age, survivors, and disability insurance as shown by the

records of the Secretary on the date of the request;

(C) a separate estimate of the aggregate of the employer,

employee, and self-employment contributions of the eligible

individual for hospital insurance as shown by the records of the

Secretary on the date of the request; and

(D) an estimate of the potential monthly retirement,

disability, survivor, and auxiliary benefits payable on the

eligible individual's account together with a description of the

benefits payable under the medicare program of subchapter XVIII

of this chapter.

(3) For purposes of this section, the term "eligible individual"

means an individual who -

(A) has a social security account number,

(B) has attained age 25 or over, and

(C) has wages or net earnings from self-employment.

(b) Notice to eligible individuals

The Secretary shall, to the maximum extent practicable, take such

steps as are necessary to assure that eligible individuals are

informed of the availability of the statement described in

subsection (a) of this section.

(c) Mandatory provision of statements

(1) By not later than September 30, 1995, the Secretary shall

provide a statement to each eligible individual who has attained

age 60 by October 1, 1994, and who is not receiving benefits under

subchapter II of this chapter and for whom a current mailing

address can be determined through such methods as the Secretary

determines to be appropriate. In fiscal years 1995 through 1999 the

Secretary shall provide a statement to each eligible individual who

attains age 60 in such fiscal years and who is not receiving

benefits under subchapter II of this chapter and for whom a current

mailing address can be determined through such methods as the

Secretary determines to be appropriate. The Secretary shall provide

with each statement to an eligible individual notice that such

statement is updated annually and is available upon request.

(2) Beginning not later than October 1, 1999, the Secretary shall

provide a statement on an annual basis to each eligible individual

who is not receiving benefits under subchapter II of this chapter

and for whom a mailing address can be determined through such

methods as the Secretary determines to be appropriate. With respect

to statements provided to eligible individuals who have not

attained age 50, such statements need not include estimates of

monthly retirement benefits. However, if such statements provided

to eligible individuals who have not attained age 50 do not include

estimates of retirement benefit amounts, such statements shall

include a description of the benefits (including auxiliary

benefits) that are available upon retirement.

-SOURCE-

(Aug. 14, 1935, ch. 531, title XI, Sec. 1143, formerly Sec. 1142,

as added Pub. L. 101-239, title X, Sec. 10308, Dec. 19, 1989, 103

Stat. 2485; renumbered Sec. 1143 and amended Pub. L. 101-508, title

V, Sec. 5111(a), Nov. 5, 1990, 104 Stat. 1388-272; Pub. L. 105-78,

title VI, Sec. 605, Nov. 13, 1997, 111 Stat. 1521.)