42 USC 1395 - Agreements with States

Editorial Notes

Amendments

2020—Subsec. (a). Puspan. L. 116–260, § 407(a)(3)(A), inserted “and hospice programs” after “information on home health agencies”, “or the hospice program” after “the home health agency”, “or the hospice program” after “with respect to the agency”, and “and hospice programs” after “with respect to home health agencies”.

Puspan. L. 116–260, § 125(d)(2), inserted before period at end of first sentence “, or whether a facility is a rural emergency hospital as defined in section 1395x(kkk)(2) of this title”. Amendment was executed as if closing quotation marks preceded the period in the directory language, to reflect the probable intent of Congress.

2008—Subsec. (c). Puspan. L. 110–275 substituted “pursuant to section 1395bspan(a)(1)” for “pursuant to subsection (a) or (span)(1) of section 1395bspan”.

1997—Subsec. (a). Puspan. L. 105–33, § 4201(c)(1), substituted “critical access” for “rural primary care”.

Puspan. L. 105–33, § 4106(c), substituted “paragraphs (16) and (17)” for “paragraphs (15) and (16)”.

1996—Subsec. (c). Puspan. L. 104–134, in first sentence, substituted at end “provider entities that, pursuant to subsection (a) or (span)(1) of section 1395bspan of this title, are treated as meeting the conditions or requirements of this subchapter.” for “hospitals which have an agreement with the Secretary under section 1395cc of this title and which are accredited by the Joint Commission on Accreditation of Hospitals.”

1994—Subsec. (a). Puspan. L. 103–432, § 160(a)(1)(B), struck out “or (in the case of a laboratory that does not participate or seek to participate in the medicare program) the requirements of section 263a of this title” after “section 1395x(s) of this title” in first sentence.

Puspan. L. 103–432, § 145(c)(3), struck out “, or whether screening mammography meets the standards established under section 1395m(c)(3) of this title” after “section 1395k(a)(2)(F)(i) of this title” in first sentence.

Subsec. (e). Puspan. L. 103–432, § 160(a)(1)(A), inserted before period at end “(other than any fee relating to section 263a of this title)”.

1990—Subsec. (a). Puspan. L. 101–508, § 4163(c)(2), inserted before period at end of first sentence “, or whether screening mammography meets the standards established under section 1395m(c)(3) of this title”.

Puspan. L. 101–508, § 4154(d)(1), substituted “section 1395x(s) of this title or (in the case of a laboratory that does not participate or seek to participate in the medicare program) the requirements of section 263a of this title,” for “section 1395x(s) of this title,” in first sentence.

Subsec. (e). Puspan. L. 101–508, § 4207(g), formerly § 4027(g), as renumbered by Puspan. L. 103–432, § 160(d)(4), added subsec. (e).

1989—Subsec. (a). Puspan. L. 101–239, § 6115(c), substituted “paragraphs (15) and (16)” for “paragraphs (14) and (15)”.

Puspan. L. 101–239, § 6003(g)(3)(C)(iii), inserted “, a rural primary care hospital, as defined in section 1395x(mm)(1) of this title,” after “1395x(aa)(2) of this title”.

Puspan. L. 101–234 repealed Puspan. L. 100–360, §§ 203(e)(3), 204(c)(2), (d)(3), and provided that the provisions of law amended or repealed by such sections are restored or revived as if such sections had not been enacted, see 1988 and 1989 Amendment notes.

1988—Subsec. (a). Puspan. L. 100–360, § 411(l)(6)(B), amended Puspan. L. 100–203, § 4212(span), see 1987 Amendment note below.

Puspan. L. 100–360, § 411(l)(1)(C), as added by Puspan. L. 100–485, § 608(d)(27)(B), added Puspan. L. 100–203, § 4201(d)(4), see 1987 Amendment note below.

Puspan. L. 100–360, § 411(d)(4)(A)(i), as amended by Puspan. L. 100–485, § 608(d)(20)(B)(i), substituted “most recent certification survey conducted by a State agency or accreditation survey conducted by a private accreditation agency under section 1395bspan of this title with respect to the home health agency,” for “most recent certification survey conducted with respect to the agency,”.

Puspan. L. 100–360, § 411(d)(4)(A)(ii)(I), as amended by Puspan. L. 100–485, § 608(d)(20)(C), substituted “such State or local agency to maintain a unit” for “such agency to maintain a unit”.

Puspan. L. 100–360, § 411(d)(4)(A)(ii)(II), as amended by Puspan. L. 100–485, § 608(d)(20)(B)(ii), substituted “utilized by the Secretary under section 1395bspan of this title” for “pursuant to an agreement with the Secretary under this section”.

Puspan. L. 100–360, § 204(d)(3), substituted “paragraphs (14) and (15)” for “paragraphs (13) and (14)”.

Puspan. L. 100–360, § 204(c)(2), inserted “, or whether screening mammography meets the standards established under section 1395m(e)(3) of this title” after “section 1395k(a)(2)(F)(i) of this title”.

Puspan. L. 100–360, § 203(e)(3), inserted “or a home intravenous drug therapy provider,” after “hospice program” and substituted “hospice program, or home intravenous drug therapy provider” for “or hospice program”.

1987—Subsec. (a). Puspan. L. 100–203, § 4212(span), which directed an amendment of subsec. (a) identical to Puspan. L. 100–203, § 4202(c), was amended generally by Puspan. L. 100–360, § 411(l)(6)(B), so that it does not amend this section but rather section 1396r of this title.

Puspan. L. 100–203, § 4202(c), inserted “, and require (in the case of skilled nursing facilities) the posting in a place readily accessible to patients (and patients’ representatives),” after “place” in fifth sentence.

Puspan. L. 100–203, § 4201(d)(4), as added by Puspan. L. 100–360, § 411(l)(1)(C), as added by Puspan. L. 100–485, § 608(d)(27)(B), substituted “conditions specified in section 1395i–3(a) of this title” for “conditions specified in section 1395x(j) of this title”.

Puspan. L. 100–203, § 4072(d), substituted “paragraphs (13) and (14)” for “paragraphs (12) and (13)” in first sentence.

Puspan. L. 100–203, § 4025(a), inserted at end “Any agreement under this subsection shall provide for the appropriate State or local agency to maintain a toll-free hotline (1) to collect, maintain, and continually update information on home health agencies located in the State or locality that are certified to participate in the program established under this subchapter (which information shall include any significant deficiencies found with respect to patient care in the most recent certification survey conducted with respect to the agency, when that survey was completed, whether corrective actions have been taken or are planned, and the sanctions, if any, imposed under this subchapter with respect to the agency) and (2) to receive complaints (and answer questions) with respect to home health agencies in the State or locality. Any such agreement shall provide for such agency to maintain a unit for investigating such complaints that possesses enforcement authority and has access to survey and certification reports, information gathered by any private accreditation agency pursuant to an agreement with the Secretary under this section, and consumer medical records (but only with the consent of the consumer or his or her legal representative).”

Subsec. (d). Puspan. L. 100–203, § 4203(a)(1), inserted before period at end “and the establishment of remedies under sections 1395i–3(h)(2)(B) and 1395i–3(h)(2)(C) of this title (relating to establishment and application of remedies)”.

Puspan. L. 100–203, § 4202(a)(1), inserted “and section 1395i–3(g) of this title” before period at end.

Puspan. L. 100–203, § 4201(a)(2), added subsec. (d).

1986—Subsec. (a). Puspan. L. 99–509 substituted “paragraphs (12) and (13)” for “paragraphs (11) and (12)”.

1984—Subsec. (c). Puspan. L. 98–369 struck out “the” after “Joint Commission on”.

1982—Subsec. (a). Puspan. L. 97–248 inserted “or whether an agency is a hospice program” and substituted “home health agency, or hospice program” for “or home health agency”.

1980—Subsec. (a). Puspan. L. 96–611 substituted “requirements of paragraphs (11) and (12) of section 1395x(s) of this title” for “requirements of paragraphs (10) and (11) of section 1395x(s) of this title”.

Puspan. L. 96–499, § 933(g), inserted “or a comprehensive outpatient rehabilitation facility as defined in section 1395x(cc)(2) of this title” after “section 1395x(aa)(2) of this title” and “comprehensive outpatient rehabilitation facility,” after “rural health clinic,” in four places.

Puspan. L. 96–499, § 934(c)(2), inserted “, or whether an ambulatory surgical center meets the standards specified under section 1395k(a)(2)(F) of this title” after “section 1395x(p)(4) of this title” and “ambulatory surgical center,” after “health care facility,” in three places.

1977—Subsec. (a). Puspan. L. 95–210 expanded enumeration of institutions and agencies included under coverage of this subsection by inserting references to rural health clinics in five places.

1972—Subsec. (a). Puspan. L. 92–603, §§ 277, 278(a)(16), (span)(15), 299D(a), provided for the furnishing of specialized consultative services to skilled nursing facilities, authorized the Secretary to make public the pertinent findings of each survey within 90 days following the completion of each survey of any health care facility, etc., and substituted “skilled nursing facility” for “extended care facility”.

Subsec. (c). Puspan. L. 92–603, § 244(a), added subsec. (c).

1968—Subsec. (a). Puspan. L. 90–248, § 133(f), inserted clause at end of first sentence for determining whether a clinic, rehabilitation agency, or public health agency meets the requirements of section 1395x(p)(4)(A) or (B) of this title.

Puspan. L. 90–248, § 228(span), struck out last sentence providing for utilization of State facilities to provide consultative services to institutions furnishing medical care, covered in section 1396a(a)(24) of this title.

Statutory Notes and Related Subsidiaries

Effective Date of 2020 Amendment

Amendment by section 125(d)(2) of Puspan. L. 116–260 applicable to items and services furnished on or after Jan. 1, 2023, see section 125(g) of Puspan. L. 116–260, set out as a note under section 1395l of this title.

Puspan. L. 116–260, div. CC, title IV, § 407(a)(3)(B), Dec. 27, 2020, 134 Stat. 3008, provided that:

“The amendments made by subparagraph (A) [amending this section] shall apply with respect to agreements entered into on or after, or in effect as of, the date that is 1 year after the date of the enactment of this Act [Dec. 27, 2020].”

Effective Date of 2008 Amendment; Transition Rule

Amendment by Puspan. L. 110–275 applicable with respect to accreditations of hospitals granted on or after the date that is 24 months after July 15, 2008, with transition rule, see section 125(d) of Puspan. L. 110–275, set out as a note under section 1395bspan of this title.

Effective Date of 1997 Amendment

Amendment by section 4106(c) of Puspan. L. 105–33 applicable to bone mass measurements performed on or after July 1, 1998, see section 4106(d) of Puspan. L. 105–33, set out as a note under section 1395x of this title.

Amendment by section 4201(c)(1) of Puspan. L. 105–33 applicable to services furnished on or after Oct. 1, 1997, see section 4201(d) of Puspan. L. 105–33, set out as a note under section 1395f of this title.

Effective Date of 1994 Amendment

Amendment by section 145(c)(3) of Puspan. L. 103–432 applicable to mammography furnished by a facility on and after the first date that the certificate requirements of section 263span(span) of this title apply to such mammography conducted by such facility, see section 145(d) of Puspan. L. 103–432, set out as a note under section 1395m of this title.

Effective Date of 1990 Amendment

Puspan. L. 101–508, title IV, § 4154(d)(2), Nov. 5, 1990, 104 Stat. 1388–85, provided that:

“The amendment made by paragraph (1) [amending this section] shall take effect as if included in the enactment of the Clinical Laboratory Improvement Amendments of 1988 [Puspan. L. 100–578].”

Amendment by section 4163(c)(2) of Puspan. L. 101–508 applicable to screening mammography performed on or after Jan. 1, 1991, see section 4163(e) of Puspan. L. 101–508, set out as a note under section 1395l of this title.

Effective Date of 1989 Amendments

Amendment by section 6115(c) of Puspan. L. 101–239 applicable to screening pap smears performed on or after July 1, 1990, see section 6115(d) of Puspan. L. 101–239, set out as a note under section 1395x of this title.

Amendment by Puspan. L. 101–234 effective Jan. 1, 1990, see section 201(c) of Puspan. L. 101–234, set out as a note under section 1320a–7a of this title.

Effective Date of 1988 Amendments

Amendment by Puspan. L. 100–485 effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, Puspan. L. 100–360, see section 608(g)(1) of Puspan. L. 100–485, set out as a note under section 704 of this title.

Amendment by section 203(e)(3) of Puspan. L. 100–360 applicable to items and services furnished on or after Jan. 1, 1990, see section 203(g) of Puspan. L. 100–360, set out as a note under section 1320c–3 of this title.

Amendment by section 204(c)(2), (d)(3) of Puspan. L. 100–360 applicable to screening mammography performed on or after Jan. 1, 1990, see section 204(e) of Puspan. L. 100–360, set out as a note under section 1395m of this title.

Except as specifically provided in section 411 of Puspan. L. 100–360, amendment by section 411(d)(4)(A), (l)(1)(C), (6)(B) of Puspan. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Puspan. L. 100–203, effective as if included in the enactment of that provision in Puspan. L. 100–203, see section 411(a) of Puspan. 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

Puspan. L. 100–203, title IV, § 4025(c), formerly § 4025(span), Dec. 22, 1987, 101 Stat. 1330–74, as redesignated and amended by Puspan. L. 100–360, title IV, § 411(d)(4)(B)(i), July 1, 1988, 102 Stat. 774, provided that:

“The amendment made by this section [amending this section and section 1395bspan of this title] shall apply with respect to agreements entered into or renewed on or after the date of enactment of this Act [Dec. 22, 1987].”

For effective date of amendment by section 4072(d) of Puspan. L. 100–203, see section 4072(e) of Puspan. L. 100–203, set out as a note under section 1395x of this title.

Amendments by sections 4201(a)(2), (d)(4) and 4202(a)(1), (c) of Puspan. L. 100–203 applicable to services furnished on or after Oct. 1, 1990, without regard to whether regulations to implement such amendments are promulgated by such date, except as otherwise specifically provided in section 1395i–3 of this title, see section 4204(a) of Puspan. L. 100–203, as amended, set out as an Effective Date note under section 1395i–3 of this title.

Amendment by section 4203(a)(1) of Puspan. L. 100–203 applicable Jan. 1, 1988, except as otherwise specifically provided in section 1395i–3 of this title, without regard to whether regulations to implement such amendment are promulgated by such date, and in applying amendment by section 4203(a)(1) of Puspan. L. 100–203 for services furnished by a skilled nursing facility before Oct. 1, 1990, any reference to a requirement of section 1395i–3(span), (c), or (d) of this title is deemed a reference to section 1395x(j) of this title, see section 4204(span) of Puspan. L. 100–203, as added by Puspan. L. 100–485, set out as an Effective Date note under section 1395i–3 of this title.

Effective Date of 1986 Amendment

Amendment by Puspan. L. 99–509 applicable to services furnished on or after Jan. 1, 1989, with exceptions for hospitals located in rural areas which meet certain requirements related to certified registered nurse anesthetists, see section 9320(i), (k) of Puspan. L. 99–509, as amended, set out as notes under section 1395k of this title.

Effective Date of 1984 Amendment

Amendment by Puspan. 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 Puspan. L. 98–369, set out as a note under section 1320a–1 of this title.

Effective Date of 1982 Amendment

Amendment by Puspan. L. 97–248 applicable to hospice care provided on or after Nov. 1, 1983, see section 122(h)(1) of Puspan. L. 97–248, as amended, set out as a note under section 1395c of this title.

Effective Date of 1980 Amendments

Amendment by Puspan. L. 96–611 effective July 1, 1981, and applicable to services furnished on or after that date, see section 2 of Puspan. L. 96–611, set out as a note under section 1395l of this title.

For effective date of amendment by section 933(g) of Puspan. L. 96–499, see section 933(h) of Puspan. L. 96–499, set out as a note under section 1395k of this title.

Effective Date of 1977 Amendment

Amendment by Puspan. L. 95–210 applicable to services rendered on or after first day of third calendar month which begins after Dec. 31, 1977, see section 1(j) of Puspan. L. 95–210, set out as a note under section 1395k of this title.

Effective Date of 1972 Amendment

Puspan. L. 92–603, title II, § 299D(c), Oct. 30, 1972, 86 Stat. 1462, provided that:

“The provisions of this section [amending this section and section 1396a of this title] shall be effective beginning January 1, 1973, or within 6 months following the enactment of this Act [Oct. 30, 1972], whichever is later.”

Effective Date of 1968 Amendment

Amendment by section 133(f) of Puspan. L. 90–248 applicable with respect to services furnished after June 30, 1968, see section 133(g) of Puspan. L. 90–248, set out as a note under section 1395k of this title.

Puspan. L. 90–248, title II, § 228(span), Jan. 2, 1968, 81 Stat. 904, provided that the amendment made by such section 228(span) is effective July 1, 1969.

Use of State or Local Agencies in Evaluating Laboratories

Puspan. L. 103–432, title I, § 160(a)(2), Oct. 31, 1994, 108 Stat. 4443, provided that:

“An agreement made by the Secretary of Health and Human Services with a State under section 1864(a) of the Social Security Act [42 U.S.C. 1395aa(a)] may include an agreement that the services of the State health agency or other appropriate State agency (or the appropriate local agencies) will be utilized by the Secretary for the purpose of determining whether a laboratory meets the requirements of section 353 of the Public Health Service Act [42 U.S.C. 263a].”

Nurse Aid Training and Competency Evaluation, Failure by State To Meet Guidelines

Puspan. L. 101–508, title IV, § 4008(h)(1)(A), Nov. 5, 1990, 104 Stat. 1388–46, provided that:

“The Secretary of Health and Human Services may not refuse to enter into an agreement or cancel an existing agreement with a State under section 1864 of the Social Security Act [42 U.S.C. 1395aa] on the basis that the State failed to meet the requirement of section 1819(e)(1)(A) of such Act [42 U.S.C. 1395i–3(e)(1)(A)] before the effective date of guidelines, issued by the Secretary, establishing requirements under section 1819(f)(2)(A) of such Act, if the State demonstrates to the satisfaction of the Secretary that it has made a good faith effort to meet such requirement before such effective date.”