US Code

Public Law 119-73 (01/23/2026)

42 U.S.C. § 1395d

Scope of benefits

(a)

Entitlement to payment for inpatient hospital services, post-hospital extended care services, home health services, and hospice care

section 1395f(d)(2) of this titleThe benefits provided to an individual by the insurance program under this part shall consist of entitlement to have payment made on his behalf or, in the case of payments referred to in to him (subject to the provisions of this part) for—
(1)
inpatient hospital services or inpatient critical access hospital services for up to 150 days during any spell of illness minus 1 day for each day of such services in excess of 90 received during any preceding spell of illness (if such individual was entitled to have payment for such services made under this part unless he specifies in accordance with regulations of the Secretary that he does not desire to have such payment made);
(2)
(A)
post-hospital extended care services for up to 100 days during any spell of illness, and (B) to the extent provided in subsection (f), extended care services that are not post-hospital extended care services;
(3)
in the case of individuals not enrolled in part B, home health services, and in the case of individuals so enrolled, post-institutional home health services furnished during a home health spell of illness for up to 100 visits during such spell of illness;
(4)
in lieu of certain other benefits, hospice care with respect to the individual during up to two periods of 90 days each and an unlimited number of subsequent periods of 60 days each with respect to which the individual makes an election under subsection (d)(1); and
(5)
section 1395x(r)(1) of this title for individuals who are terminally ill, have not made an election under subsection (d)(1), and have not previously received services under this paragraph, services that are furnished by a physician (as defined in ) who is either the medical director or an employee of a hospice program and that—
(A)
consist of—
(i)
an evaluation of the individual’s need for pain and symptom management, including the individual’s need for hospice care; and
(ii)
counseling the individual with respect to hospice care and other care options; and
(B)
may include advising the individual regarding advanced care planning.
(b)

Services not covered

Payment under this part for services furnished an individual during a spell of illness may not (subject to subsection (c)) be made for—
(1)
inpatient hospital services furnished to him during such spell after such services have been furnished to him for 150 days during such spell minus 1 day for each day of inpatient hospital services in excess of 90 received during any preceding spell of illness (if such individual was entitled to have payment for such services made under this part unless he specifies in accordance with regulations of the Secretary that he does not desire to have such payment made);
(2)
post-hospital extended care services furnished to him during such spell after such services have been furnished to him for 100 days during such spell; or
(3)
inpatient psychiatric hospital services furnished to him after such services have been furnished to him for a total of 190 days during his lifetime.
Payment under this part for post-institutional home health services furnished an individual during a home health spell of illness may not be made for such services beginning after such services have been furnished for a total of 100 visits during such spell.
(c)

Inpatients of psychiatric hospitals

If an individual is an inpatient of a psychiatric hospital on the first day of the first month for which he is entitled to benefits under this part, the days on which he was an inpatient of such a hospital in the 150-day period immediately before such first day shall be included in determining the number of days limit under subsection (b)(1) insofar as such limit applies to (1) inpatient psychiatric hospital services, or (2) inpatient hospital services for an individual who is an inpatient primarily for the diagnosis or treatment of mental illness (but shall not be included in determining such number of days limit insofar as it applies to other inpatient hospital services or in determining the 190-day limit under subsection (b)(3)).

(d)

Hospice care; election; waiver of rights; revocation; change of election

(1)
Payment under this part may be made for hospice care provided with respect to an individual only during two periods of 90 days each and an unlimited number of subsequent periods of 60 days each during the individual’s lifetime and only, with respect to each such period, if the individual makes an election under this paragraph to receive hospice care under this part provided by, or under arrangements made by, a particular hospice program instead of certain other benefits under this subchapter.
(2)
(A)
Except as provided in subparagraphs (B) and (C) and except in such exceptional and unusual circumstances as the Secretary may provide, if an individual makes such an election for a period with respect to a particular hospice program, the individual shall be deemed to have waived all rights to have payment made under this subchapter with respect to—
(i)
hospice care provided by another hospice program (other than under arrangements made by the particular hospice program) during the period, and
(ii)
services furnished during the period that are determined (in accordance with guidelines of the Secretary) to be—
(I)
related to the treatment of the individual’s condition with respect to which a diagnosis of terminal illness has been made or
(II)
equivalent to (or duplicative of) hospice care;
except that clause (ii) shall not apply to physicians’ services furnished by the individual’s attending physician (if not an employee of the hospice program) or to services provided by (or under arrangements made by) the hospice program.
(B)
After an individual makes such an election with respect to a 90-day period or a subsequent 60-day period, the individual may revoke the election during the period, in which case—
(i)
the revocation shall act as a waiver of the right to have payment made under this part for any hospice care benefits for the remaining time in such period and (for purposes of subsection (a)(4) and subparagraph (A)) the individual shall be deemed to have been provided such benefits during such entire period, and
(ii)
the individual may at any time after the revocation execute a new election for a subsequent period, if the individual otherwise is entitled to hospice care benefits with respect to such a period.
(C)
An individual may, once in each such period, change the hospice program with respect to which the election is made and such change shall not be considered a revocation of an election under subparagraph (B).
(D)
For purposes of this subchapter, an individual’s election with respect to a hospice program shall no longer be considered to be in effect with respect to that hospice program after the date the individual’s revocation or change of election with respect to that election takes effect.
(e)

Services taken into account

section 1395f(a) of this titleFor purposes of subsections (b) and (c), inpatient hospital services, inpatient psychiatric hospital services, and post-hospital extended care services shall be taken into account only if payment is or would be, except for this section or the failure to comply with the request and certification requirements of or under , made with respect to such services under this part.

(f)

Coverage of extended care services without regard to three-day prior hospitalization requirement

(1)
The Secretary shall provide for coverage, under clause (B) of subsection (a)(2), of extended care services which are not post-hospital extended care services at such time and for so long as the Secretary determines, and under such terms and conditions (described in paragraph (2)) as the Secretary finds appropriate, that the inclusion of such services will not result in any increase in the total of payments made under this subchapter and will not alter the acute care nature of the benefit described in subsection (a)(2).
(2)
The Secretary may provide—
(A)
for such limitations on the scope and extent of services described in subsection (a)(2)(B) and on the categories of individuals who may be eligible to receive such services, and
(B)
notwithstanding sections 1395f, 1395x(v), and 1395ww of this title, for such restrictions and alternatives on the amounts and methods of payment for services described in such subsection,
as may be necessary to carry out paragraph (1).
(g)

“Spell of illness” defined

section 1395x of this titleFor definitions of “spell of illness”, and for definitions of other terms used in this part, see .

Aug. 14, 1935, ch. 531Pub. L. 89–97, title I, § 102(a)79 Stat. 291Pub. L. 90–248, title I81 Stat. 847Pub. L. 96–499, title IX94 Stat. 2631Pub. L. 97–35, title XXI, § 2121(a)95 Stat. 796Pub. L. 97–248, title I96 Stat. 356Pub. L. 97–448, title III, § 309(b)(5)96 Stat. 2409Pub. L. 100–360, title I, § 101102 Stat. 684Pub. L. 101–234, title I, § 101(a)103 Stat. 1979Pub. L. 101–239, title VI, § 6003(g)(3)(B)(i)103 Stat. 2152Pub. L. 101–508, title IV, § 4006(a)104 Stat. 1388–43Pub. L. 103–432, title I, § 102(g)(1)108 Stat. 4404Pub. L. 105–33, title IV111 Stat. 373Pub. L. 106–113, div. B, § 1000(a)(6) [title III, § 321(k)(1)]113 Stat. 1536Pub. L. 108–173, title V, § 512(a)117 Stat. 2299(, title XVIII, § 1812, as added , , ; amended , §§ 129(c)(2), 137(a), 138(a), 143(b), 146(a), , , 853, 854, 857, 859; , §§ 930(b)–(d), 931(a), , , 2633; , , ; , §§ 122(b), 123, , , 364; , , ; , , ; , , ; , , ; , , ; , , ; , §§ 4201(c)(1), 4443(a), (b)(1), 4611(a), , , 423, 472; , , , 1501A–366; , title VII, § 736(c)(1), , , 2356.)

Editorial Notes

Amendments

Pub. L. 108–173, § 736(c)(1)2003—Subsec. (a)(3). , substituted “in the case of individuals not” for “for individuals not” and “in the case of individuals so” for “for individuals so”.

Pub. L. 108–173, § 512(a)Subsec. (a)(5). , added par. (5).

Pub. L. 106–1131999—Subsec. (b). inserted “during” after “100 visits” in concluding provisions.

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

Pub. L. 105–33, § 4611(a)(1)Subsec. (a)(3). , substituted “for individuals not enrolled in part B, home health services, and for individuals so enrolled, post-institutional home health services furnished during a home health spell of illness for up to 100 visits during such spell of illness” for “home health services”.

Pub. L. 105–33, § 4443(a)Subsec. (a)(4). , substituted “and an unlimited number of subsequent periods of 60 days each” for “, a subsequent period of 30 days, and a subsequent extension period”.

Pub. L. 105–33, § 4611(a)(2)Subsec. (b). , inserted closing provisions.

Pub. L. 105–33, § 4443(a)Subsec. (d)(1). , substituted “and an unlimited number of subsequent periods of 60 days each” for “, a subsequent period of 30 days, and a subsequent extension period”.

Pub. L. 105–33, § 4443(b)(1)Subsec. (d)(2)(B). , substituted “90-day period or a subsequent 60-day period” for “90- or 30-day period or a subsequent extension period”.

Pub. L. 103–4321994—Subsec. (a)(1). substituted “inpatient hospital services or inpatient rural primary care hospital services” for “inpatient hospital services” before “for up to 150 days” and “such services” for “inpatient hospital services” before “in excess of 90” and struck out “and inpatient rural primary care hospital services” after “such payment made)”.

Pub. L. 101–508, § 4006(a)(1)1990—Subsec. (a)(4). , substituted “90 days each, a subsequent period of 30 days, and a subsequent extension period” for “90 days each and one subsequent period of 30 days”.

Pub. L. 101–508, § 4006(a)(2)(A)Subsec. (d)(1). , substituted “90 days each, a subsequent period of 30 days, and a subsequent extension period during the individual’s lifetime” for “90 days each and one subsequent period of 30 days during the individual’s lifetime”.

Pub. L. 101–508, § 4006(a)(2)(B)Subsec. (d)(2)(B). , substituted “a 90- or 30-day period or a subsequent extension period” for “a 90- or 30-day period”.

Pub. L. 101–234Pub. L. 100–360, § 101(1)1989—Subsec. (a). repealed , 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.

Pub. L. 101–239Subsec. (a)(1). inserted “and inpatient rural primary care hospital services” before semicolon at end.

Pub. L. 101–234Pub. L. 100–360, § 101(2)Subsecs. (b) to (d)(1), (2)(B), (e) to (g). repealed –(6), 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 notes below.

Pub. L. 100–360, § 101(1)1988—Subsec. (a). , struck out former pars. (1) to (4) and added new pars. (1) to (4) which read as follows:

“(1) inpatient hospital services;

“(2) extended care services for up to 150 days during any calendar year;

“(3) home health services; and

“(4) in lieu of certain other benefits, hospice care with respect to the individual during up to two periods of 90 days each, a subsequent period of 30 days, and a subsequent extension period with respect to which the individual makes an election under subsection (d)(1) of this section.”

Pub. L. 100–360, § 101(2)Subsec. (b). , amended subsec. (b) generally, striking out par. (1) and renumbering and amending pars. (2) and (3) as (1) and (2), respectively.

Pub. L. 100–360, § 101(3)Subsec. (c). , amended subsec. (c) generally, substituting pars. (1) to (4) limiting periods for inpatients of psychiatric hospitals for former single paragraph.

Pub. L. 100–360, § 101(4)(A)Subsec. (d)(1). , substituted “, a subsequent period of 30 days, and a subsequent extension period” for “and one subsequent period of 30 days”.

Pub. L. 100–360, § 101(4)(B)Subsec. (d)(2)(B). , inserted “or a subsequent extension period” after “30-day period” in introductory provisions.

Pub. L. 100–360, § 101(5)Subsec. (e). , struck out “post-hospital” before “extended care services”.

Pub. L. 100–360, § 101(6)Subsec. (f). , struck out subsec. (f) which provided coverage of extended care services without regard to three-day prior hospitalization requirement.

Pub. L. 100–360, § 101(6)section 1395x of this titleSubsec. (g). , struck out subsec. (g) which cross-referenced for definitions of “spell of illness” and other terms used in this part.

Pub. L. 97–4481983—Subsec. (d)(2)(A). substituted “or to services” for “or to other than services” after “(if not an employee of the hospice program)”.

Pub. L. 97–248, § 123(a)1982—Subsec. (a)(2). , redesignated existing provisions as subpar. (A) and added subpar. (B).

Pub. L. 97–248, § 122(b)(1)Subsec. (a)(4). , added par. (4).

Pub. L. 97–248, § 122(b)(2)Subsec. (d). , added subsec. (d).

Pub. L. 97–248, § 123(b)Subsecs. (f), (g). , added subsec. (f) and redesignated former subsec. (f) as (g).

Pub. L. 97–351981—Subsec. (a). struck out par. (4) which related to alcohol detoxification facility services.

Pub. L. 96–499, § 930(b)section 1395x(n) of this title1980—Subsec. (a)(3). , substituted “home health services” for “post-hospital home health services for up to 100 visits (during the one-year period described in ) after the beginning of one spell of illness and before the beginning of the next”.

Pub. L. 96–499, § 931(a)Subsec. (a)(4). , added par. (4).

Pub. L. 96–499, § 930(c)section 1395x(n) of this titleSubsec. (d). , struck out subsec. (d) which authorized payment for post-hospital home health services furnished an individual only during the one year period described in following his most recent hospital discharge which met the requirements of such section and only for the first 100 visits in such period.

Pub. L. 96–499, § 930(d)Subsec. (e). , substituted “subsections (b) and (c)” for “subsections (b), (c), and (d)” and “and post-hospital extended care services” for “post-hospital extended care services, and post-hospital home health services”.

Pub. L. 90–248, § 143(b)section 1395f(d)(2) of this title1968—Subsec. (a). , inserted “or, in the case of payments referred to in to him” after “on his behalf” in text preceding par. (1).

Pub. L. 90–248, § 137(a)(1)Subsec. (a)(1). , increased the maximum duration of benefits from 90 to 150 days minus 1 day for each day of inpatient hospital services in excess of 90 received during any preceding spell of illness (if such individual was entitled to have payment for such services made under this part unless he specifies that he does not desire to have such payment made).

Pub. L. 90–248, § 129(c)(2)Subsec. (a)(4). , struck out par. (4) which provided for payment for outpatient hospital diagnostic services.

Pub. L. 90–248, § 137(a)(2)Subsec. (b)(1). , changed the limitation on payments from 90 to 150 days minus 1 day for each day of inpatient hospital services in excess of 90 received during any preceding spell of illness (if such individual was entitled to have payment for such services made under this part unless he specifies that he does not desire to have such payment made).

Pub. L. 90–248, § 138(a)Subsec. (c). , increased the limit from 90 to 150 days so that if an individual was an inpatient of a psychiatric or tuberculosis hospital on the first day of the first month for which he is entitled to benefits, the days he was an inpatient in the 150-day period immediately before such first day are included in determining the limit under subsec. (b)(1) insofar as such limit applies to (1) inpatient psychiatric hospital services and inpatient tuberculosis hospital services, or (2) inpatient hospital services for an individual who is an inpatient primarily for the diagnosis or treatment of mental illness or tuberculosis (but are not included in determining such limit as it applies to other inpatient hospital services or in determining the 190-day limit under subsec. (b)(3)).

Pub. L. 90–248, § 146(a), provided that the limitation of allowable days of inpatient hospital services will not apply to services provided to an inpatient of a tuberculosis hospital.

Statutory Notes and Related Subsidiaries

Effective Date of 2003 Amendment

Pub. L. 108–173, title V, § 512(d)117 Stat. 2300

“The amendments made by this section [amending this section and sections 1395f and 1395x of this title] shall apply to services provided by a hospice program on or after .”
, , , provided that:

Effective Date of 1999 Amendment

Pub. L. 106–113, div. B, § 1000(a)(6) [title III, § 321(m)]113 Stat. 1536

lsection 1320b–5 of this titlePub. L. 105–33“Except as otherwise provided, the amendments made by this section [amending this section and sections 1395i, 1395i–4, 1395, 1395m, 1395u, 1395w–3, 1395w–4, 1395w–21, 1395w–22, 1395w–24, 1395x, 1395y, 1395cc, 1395ss, 1395ww, 1395yy, and 1395fff of this title, repealing , and amending provisions set out as notes under sections 1395f and 1395ww of this title] shall take effect as if included in the enactment of BBA [Balanced Budget Act of 1997, ].”
, , , 1501A–368, provided that:

Effective Date of 1997 Amendment

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

Pub. L. 105–33, title IV, § 4449111 Stat. 424

Pub. L. 105–3342 U.S.C. 1395d(d)“Except as otherwise provided in this chapter [chapter 4 (§§ 4441–4449) of subtitle E of title IV of , amending this section and sections 1395f, 1395x, and 1395pp of this title and enacting provisions set out as notes under section 1395f and 1395x of this title], the amendments made by this chapter apply to benefits provided on or after the date of the enactment of this chapter [], regardless of whether or not an individual has made an election under section 1812(d) of the Social Security Act () before such date.”
, , , provided that:

Pub. L. 105–33, title IV, § 4611(f)111 Stat. 474

“The amendments made by this section [amending this section and sections 1395u, 1395x, and 1395ff of this title] apply to services furnished on or after . For purpose of applying such amendments, any home health spell of illness that began, but not [sic] did not end, before such date shall be considered to have begun as of such date.”
, , , provided that:

Effective Date of 1994 Amendment

Pub. L. 103–432, title I, § 102(i)108 Stat. 4404

“The amendments made by this section [amending this section and sections 1395e, 1395f, 1395i–4, 1395m, 1395x, and 1395ww of this title] shall take effect on the date of the enactment of this Act [].”
, , , provided that:

Effective Date of 1990 Amendment

Pub. L. 101–508, title IV, § 4006(c)104 Stat. 1388–43

section 1395f of this title“The amendments made by this section [amending this section and ] shall apply with respect to care and services furnished on or after .”
, , , provided that:

Effective Date of 1989 Amendment

Pub. L. 101–234section 101(d) of Pub. L. 101–234section 1395c of this titleAmendment by effective , see , set out as a note under .

Effective Date of 1988 Amendment

Pub. L. 100–360, title I, § 104(a)102 Stat. 687Pub. L. 100–485, title VI, § 608(d)(3)(A)102 Stat. 2413

“(1)

In general .—

Pub. L. 100–360Except as provided in paragraph (2) and subsection (b), the amendments made by this subtitle [subtitle A (§§ 101–104) of title I of , amending this section and sections 1395c, 1395e, 1395f, 1395i–2, 1395k, 1395x, 1395cc, and 1395tt of this title] shall take effect on , and shall apply—
“(A)
to the inpatient hospital deductible for 1989 and succeeding years,
“(B)
to care and services furnished on or after ,
“(C)
to premiums for January 1989 and succeeding months, and
“(D)
to blood or blood cells furnished on or after .
“(2)

Elimination of post-hospital requirement for extended care services .—

42 U.S.C. 1395d(a)(2)42 U.S.C. 1395The amendments made by this subtitle, insofar as they eliminate the requirement (under section 1812(a)(2) of the Social Security Act []) that extended care services are only covered under title XVIII of such Act [ et seq.] if they are post-hospital extended care services, shall only apply to extended care services furnished pursuant to an admission to a skilled nursing facility occurring on or after .”
, , , as amended by , , , provided that:

Effective Date of 1983 Amendment

Pub. L. 97–448Pub. L. 97–248section 309(c)(2) of Pub. L. 97–448section 426–1 of this titleAmendment by effective as if originally included as a part of this section as this section was amended by the Tax Equity and Fiscal Responsibility Act of 1982, , see , set out as a note under .

Effective Date of 1982 Amendment

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

Effective Date of 1981 Amendment

Pub. L. 97–35, title XXI, § 2121(i)95 Stat. 796

ll“The amendments made by this section [amending this section and sections 1320c–3, 1320c–4, 1320c–7, 1395f, and 1395x of this title] (other than by subsection (h) [repealing provisions set out as a note under section 1395 of this title]) shall apply to services furnished in detoxification facilities for inpatient stays beginning on or after the tenth day after the date of the enactment of this Act [].”
, , , provided that:

Effective Date of 1980 Amendment

Pub. L. 96–499section 930(s)(1) of Pub. L. 96–499section 1395x of this titleAmendment by section 930(b)–(d) of effective with respect to services furnished on or after , see , set out as a note under .

Pub. L. 96–499, title IX, § 931(e)94 Stat. 2634

“The amendments made by subsections (a) through (d) of this section [amending this section and sections 1395f and 1395x of this title] shall become effective on .”
, , , provided that:

Effective Date of 1968 Amendment

Pub. L. 90–248, title I, § 129(d)81 Stat. 849

lsection 228s–2 of Title 45section 1395f of this title“The amendments made by this section [amending this section and sections 426, 1395e, 1395f, 1395k, 1395, 1395n, 1395x, and 1395cc of this title and , Railroads] shall apply with respect to services furnished after , except that subsection (c)(5) of such section [amending ] shall become effective with respect to services furnished after the date of enactment of this Act [].”
, , , provided that:

Pub. L. 90–248, title I, § 137(c)81 Stat. 854

section 1395e of this title“The amendments made by subsections (a) and (b) [amending this section and ] shall apply with respect to services furnished after .”
, , , provided that:

Pub. L. 90–248, title I, § 138(b)81 Stat. 854

“The amendments made by subsection (a) [amending this section] shall apply with respect to payment for services furnished after .”
, , , provided that:

Pub. L. 90–248, title I, § 143(d)81 Stat. 858

section 1395x of this titlesection 1395f of this title“The provisions made by subsection (a) of this section [amending ] shall become effective as of , and the provisions made by subsections (b) and (c) of this section [amending this section and ] shall apply to services furnished with respect to admissions occurring after , and to outpatient hospital diagnostic services furnished after , and before .”
, , , provided that:

Pub. L. 90–248, title I, § 146(b)81 Stat. 859

“The amendment made by subsection (a) [amending this section] shall apply with respect to payment for services furnished after .”
, , , provided that:

Medicare Hospice Concurrent Care Demonstration Program

Pub. L. 111–148, title III, § 3140124 Stat. 440

“(a)

Establishment.—

“(1)

In general .—

42 U.S.C. 1395The Secretary of Health and Human Services (in this section referred to as the ‘Secretary’) shall establish a Medicare Hospice Concurrent Care demonstration program at participating hospice programs under which Medicare beneficiaries are furnished, during the same period, hospice care and any other items or services covered under title XVIII of the Social Security Act ( et seq.) from funds otherwise paid under such title to such hospice programs.
“(2)

Duration .—

The demonstration program under this section shall be conducted for a 3-year period.
“(3)

Sites .—

The Secretary shall select not more than 15 hospice programs at which the demonstration program under this section shall be conducted. Such hospice programs shall be located in urban and rural areas.
“(b)

Independent Evaluation and Reports.—

“(1)

Independent evaluation .—

The Secretary shall provide for the conduct of an independent evaluation of the demonstration program under this section. Such independent evaluation shall determine whether the demonstration program has improved patient care, quality of life, and cost-effectiveness for Medicare beneficiaries participating in the demonstration program.
“(2)

Reports .—

The Secretary shall submit to Congress a report containing the results of the evaluation conducted under paragraph (1), together with such recommendations as the Secretary determines appropriate.
“(c)

Budget Neutrality .—

42 U.S.C. 1395With respect to the 3-year period of the demonstration program under this section, the Secretary shall ensure that the aggregate expenditures under title XVIII [ et seq.] for such period shall not exceed the aggregate expenditures that would have been expended under such title if the demonstration program under this section had not been implemented.”
, , , provided that:

Protecting Home Health Benefits

Pub. L. 111–148, title III, § 3143124 Stat. 442

section 18001 of this title42 U.S.C. 1395“Nothing in the provisions of, or amendments made by, this Act [see Short Title note set out under ] shall result in the reduction of guaranteed home health benefits under title XVIII of the Social Security Act [ et seq.].”
, , , provided that:

Rural Hospice Demonstration Project

Pub. L. 108–173, title IV, § 409117 Stat. 2271

“(a)

In General .—

42 U.S.C. 1395x(dd)The Secretary [of Health and Human Services] shall conduct a demonstration project for the delivery of hospice care to medicare beneficiaries in rural areas. Under the project medicare beneficiaries who are unable to receive hospice care in the facility for lack of an appropriate caregiver are provided such care in a facility of 20 or fewer beds which offers, within its walls, the full range of services provided by hospice programs under section 1861(dd) of the Social Security Act ().
“(b)

Scope of Project .—

The Secretary shall conduct the project under this section with respect to no more than 3 hospice programs over a period of not longer than 5 years each.
“(c)

Compliance With Conditions .—

Under the demonstration project—
“(1)
42 U.S.C. 1395x(dd)(2)(A)(iii) the hospice program shall comply with otherwise applicable requirements, except that it shall not be required to offer services outside of the home or to meet the requirements of section 1861(dd)(2)(A)(iii) of the Social Security Act []; and
“(2)
42 U.S.C. 1395 payments for hospice care shall be made at the rates otherwise applicable to such care under title XVIII of such Act [ et seq.].
The Secretary may require the program to comply with such additional quality assurance standards for its provision of services in its facility as the Secretary deems appropriate.
“(d)

Report .—

Upon completion of the project, the Secretary shall submit a report to Congress on the project and shall include in the report recommendations regarding extension of such project to hospice programs serving rural areas.”
, , , provided that:

OIG Report on Notices Relating to Use of Hospital Lifetime Reserve Days

Pub. L. 108–173, title IX, § 953(d)117 Stat. 2428

“Not later than 1 year after the date of the enactment of this Act [], the Inspector General of the Department of Health and Human Services shall submit a report to Congress on—
“(1)
42 U.S.C. 1395d(a)(1) the extent to which hospitals provide notice to medicare beneficiaries in accordance with applicable requirements before they use the 60 lifetime reserve days described in section 1812(a)(1) of the Social Security Act (); and
“(2)
the appropriateness and feasibility of hospitals providing a notice to such beneficiaries before they completely exhaust such lifetime reserve days.”
, , , provided that:

MedPAC Report on Access to, and Use of, Hospice Benefit

Pub. L. 106–554, § 1(a)(6) [title III, § 323]114 Stat. 2763, , , 2763A–501, required a study on the factors affecting the use of hospice benefits under the medicare program and a report on the study no later than 18 months after .

Transition

Pub. L. 105–33, title IV, § 4611(e)111 Stat. 473

“(1)

In general .—

42 U.S.C. 139542 U.S.C. 1395cNotwithstanding any provision of title XVIII of the Social Security Act [ et seq.], the Secretary of Health and Human Services shall establish a transition for the aggregate amount of expenditures that are transferred from part A, to part B, of title XVIII of the Social Security Act [ et seq., 1395j et seq.], as a result of the amendments made by this section [amending this section and sections 1395u, 1395x, and 1395ff of this title], during each of the years during the period beginning with 1998 and ending with 2002 according to this subsection. Under the transition for each such year, the Secretary shall effect such transfer, between the trust funds under such parts, as will result in only the proportion (specified in paragraph (2)) of such aggregate expenditures for the year being transferred from such part A to such part B.
“(2)

Proportion specified .—

The proportion specified in this paragraph for—
“(A)
1998 is ⅙,
“(B)
1999 is ⅓,
“(C)
2000 is ½,
“(D)
2001 is ⅔, and
“(E)
2002 is ⅚.
“(3)

Application in establishing monthly premiums for 1998 through 2003.—

“(A)

In general .—

42 U.S.C. 1395rFor purposes only of computing the monthly premium under section 1839 of the Social Security Act (), the monthly actuarial rate for enrollees age 65 and over shall be computed as though any reference in paragraph (1) of this subsection to 2002 were a reference to 2003 and as if the following proportions were substituted for the proportions specified in paragraph (2):
“(i)
For 1998, ⅐.
“(ii)
27 For 1999, ⁄.
“(iii)
37 For 2000, ⁄.
“(iv)
47 For 2001, ⁄.
“(v)
57 For 2002, ⁄.
“(vi)
67 For 2003, ⁄.
“(B)

No impact on government contribution .—

42 U.S.C. 1395wSubparagraph (A) does not apply in determining the amount of the Government contribution under section 1844 of the Social Security Act ().”
, , , provided that:

Repeal of 1988 Expansion of Medicare Part A Benefits

section 101 of Pub. L. 100–360section 101 of Pub. L. 100–360Pub. L. 101–234section 1395e of this titleFor provisions repealing amendment by , restoring or reviving this section as if had not been enacted, and providing a transition period for medicare beneficiaries with respect to inpatient hospital services and extended care services provided on or after , and providing an exception to such restoration for certain hospice care, see section 101(a)–(b)(2) of , set out as a note under .