US Code

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

42 U.S.C. § 1395k

Scope of benefits; definitions

(a)

Scope of benefits

The benefits provided to an individual by the insurance program established by this part shall consist of—
(1)
section 1395u(b)(6) of this title entitlement to have payment made to him or on his behalf (subject to the provisions of this part) for medical and other health services, except those described in subparagraphs (B) and (D) of paragraph (2) and subparagraphs (E) and (F) of ; and
(2)
entitlement to have payment made on his behalf (subject to the provisions of this part) for—
(A)
home health services (other than items described in subparagraph (G) or subparagraph (I));
(B)
medical and other health services (other than items described in subparagraph (G) or subparagraph (I)) furnished by a provider of services or by others under arrangement with them made by a provider of services, excluding—
(i)
physician services except where furnished by—
(I)
a resident or intern of a hospital, or
(II)
section 1395x(b) of this title a physician to a patient in a hospital which has a teaching program approved as specified in paragraph (6) of (including services in conjunction with the teaching programs of such hospital whether or not such patient is an inpatient of such hospital) where the conditions specified in paragraph (7) of such section are met,
(ii)
section 1395n(b)(2) of this title services for which payment may be made pursuant to ,
(iii)
section 1395x(s)(2)(K)(i) of this title1
1 So in original. The semicolon probably should be a comma.
services described by , certified nurse-midwife services, qualified psychologist services, and services of a certified registered nurse anesthetist; 
(iv)
2
2 So in original. The word “and” probably should not appear.
services of a nurse practitioner or clinical nurse specialist but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services; and 
(C)
section 1395x(p) of this titlesection 1395x(g) of this titlesection 1395x(p) of this titlell outpatient physical therapy services (other than services to which the second sentence of applies), outpatient occupational therapy services (other than services to which such sentence applies through the operation of ), and outpatient speech-language pathology services (other than services to which the second sentence of applies through the application of section 1395x()(2) of this title);
(D)
(i)
rural health clinic services and (ii) Federally qualified health center services;
(E)
comprehensive outpatient rehabilitation facility services;
(F)
facility services furnished in connection with surgical procedures specified by the Secretary—
(i)
lllsection 1395u(b)(3)(B)(ii) of this titlel pursuant to section 1395(i)(1)(A) of this title and performed in an ambulatory surgical center (which meets health, safety, and other standards specified by the Secretary in regulations) if the center has an agreement in effect with the Secretary by which the center agrees to accept the standard overhead amount determined under section 1395(i)(2)(A) of this title as full payment for such services (including intraocular lens in cases described in section 1395(i)(2)(A)(iii) of this title) and to accept an assignment described in with respect to payment for all such services (including intraocular lens in cases described in section 1395(i)(2)(A)(iii) of this title) furnished by the center to individuals enrolled under this part, or
(ii)
lsection 1395x(r) of this title pursuant to section 1395(i)(1)(B) of this title and performed by a physician, described in paragraph (1), (2), or (3) of , in his office, if the Secretary has determined that—
(I)
a quality improvement organization (having a contract with the Secretary under part B of subchapter XI of this chapter) is willing, able, and has agreed to carry out a review (on a sample or other reasonable basis) of the physician’s performing such procedures in the physician’s office,
(II)
the particular physician involved has agreed to make available to such organization such records as the Secretary determines to be necessary to carry out the review, and
(III)
the physician is authorized to perform the procedure in a hospital located in the area in which the office is located,
lsection 1395x(s) of this title and if the physician agrees to accept the standard overhead amount determined under section 1395(i)(2)(B) of this title as full payment for such services and to accept payment on an assignment-related basis with respect to payment for all services (including all pre- and post-operative services) described in paragraphs (1) and (2)(A) of and furnished in connection with such surgical procedure to individuals enrolled under this part;
(G)
section 1395m(a)(13) of this title covered items (described in ) furnished by a provider of services or by others under arrangements with them made by a provider of services;
(H)
section 1395x(mm)(3) of this title outpatient critical access hospital services (as defined in );
(I)
section 1395m(h)(4) of this title prosthetic devices and orthotics and prosthetics (described in ) furnished by a provider of services or by others under arrangements with them made by a provider of services; and
(J)
section 1395x(ff)(2)(B) of this title partial hospitalization services and intensive outpatient services provided by a community mental health center (as described in ).
(b)

Definitions

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

Aug. 14, 1935, ch. 531Pub. L. 89–97, title I, § 102(a)79 Stat. 302Pub. L. 90–248, title I81 Stat. 848Pub. L. 92–603, title II86 Stat. 1406Pub. L. 95–210, § 1(a)91 Stat. 1485Pub. L. 96–499, title IX94 Stat. 2631Pub. L. 97–248, title I, § 148(c)96 Stat. 394Pub. L. 98–369, div. B, title III98 Stat. 1094Pub. L. 99–509, title IX100 Stat. 2013Pub. L. 100–203, title IV101 Stat. 1330–108Pub. L. 100–360, title IV, § 411(g)(2)(E)102 Stat. 783Pub. L. 100–360, title I, § 104(d)(3)102 Stat. 689Pub. L. 101–234, title I, § 101(a)103 Stat. 1979Pub. L. 101–239, title VI, § 6116(a)(2)103 Stat. 2219Pub. L. 101–508, title IV104 Stat. 1388–83Pub. L. 105–33, title IV111 Stat. 373Pub. L. 106–113, div. B, § 1000(a)(6) [title II, § 227(b)]113 Stat. 1536Pub. L. 106–554, § 1(a)(6) [title I, § 113(b)(1)]114 Stat. 2763Pub. L. 110–275, title I, § 143(b)(1)122 Stat. 2542Pub. L. 112–40, title II, § 261(a)(3)(B)125 Stat. 423Pub. L. 117–328, div. FF, title IV, § 4124(b)(1)(A)136 Stat. 5908(, title XVIII, § 1832, as added , , ; amended , §§ 129(c)(6)(B), 133(d), , , 851; , §§ 227(e)(1), 251(a)(4), , , 1445; , , ; , §§ 930(g), 933(a), 934(a), 948(a)(2), , , 2635, 2637, 2643; , , ; , §§ 2341(b), 2354(b)(6), , , 1100; , §§ 9320(d), 9337(a), 9343(e)(1), , , 2033, 2041; , §§ 4062(d)(2), 4063(e)(2), 4073(b)(1), 4077(b)(2), 4085(i)(22)(A), , , 1330–118, 1330–120, as amended , (h)(4)(A), (7)(B), (i)(4)(C)(vi), , , 786, 787, 789; , title II, §§ 203(a), 205(a), , , 721, 729, 783; , title II, § 201(a), , , 1981; , , ; , §§ 4153(a)(2)(A), 4155(b)(1), 4157(b), 4161(a)(3)(A), 4162(b)(1), , , 1388–86, 1388–89, 1388–93, 1388–96; , §§ 4201(c)(1), 4432(b)(5)(B), 4511(c), 4603(c)(2)(B)(ii), , , 421, 443, 471; , , , 1501A–354; , , , 2763A–473; , , ; , , ; , , .)

Editorial Notes

Amendments

Pub. L. 117–3282022—Subsec. (a)(2)(J). inserted “and intensive outpatient services” after “partial hospitalization services”.

Pub. L. 112–402011—Subsec. (a)(2)(F)(ii)(I). substituted “quality improvement” for “quality control and peer review”.

Pub. L. 110–275section 1395x(p) of this titlell2008—Subsec. (a)(2)(C). substituted “, outpatient” for “and outpatient” and inserted “, and outpatient speech-language pathology services (other than services to which the second sentence of applies through the application of section 1395x()(2) of this title)” before semicolon at end.

Pub. L. 106–554section 1395x(s)(2)(J)(v) of this title2000—Subsecs. (b), (c). redesignated subsec. (c) as (b) and struck out former subsec. (b), which related to extension of coverage of immunosuppressive drugs for individuals who would exhaust benefits under in a year during the 5-year period beginning with 2000, and set forth provisions relating to extension periods for each year.

Pub. L. 106–1131999—Subsecs. (b), (c). added subsec. (b) and redesignated former subsec. (b) as (c).

Pub. L. 105–33, § 4603(c)(2)(B)(ii)section 1395u(b)(6) of this titlesection 1395u(b)(6)(E) of this title1997—Subsec. (a)(1). , substituted “subparagraphs (E) and (F) of ;” for “;”.

Pub. L. 105–33, § 4432(b)(5)(B)section 1395u(b)(6)(E) of this title, substituted “(2) and ;” for “(2);”.

Pub. L. 105–33, § 4511(c)section 1395ww(d)(2)(D) of this titleSubsec. (a)(2)(B)(iv). , substituted “but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services” for “provided in a rural area (as defined in )”.

Pub. L. 105–33, § 4201(c)(1)Subsec. (a)(2)(H). , substituted “critical access” for “rural primary care”.

Pub. L. 101–508, § 4153(a)(2)(A)(i)1990—Subsec. (a)(2)(A), (B). , substituted “subparagraph (G) or subparagraph (I)” for “subparagraph (G)”.

Pub. L. 101–508, § 4157(b)Subsec. (a)(2)(B)(iii). , amended cl. (iii) generally. Prior to amendment, cl. (iii) related to services of a certified registered nurse anesthetist.

Pub. L. 101–508, § 4155(b)(1)Subsec. (a)(2)(B)(iv). , added cl. (iv).

Pub. L. 101–508, § 4161(a)(3)(A)Subsec. (a)(2)(D). , designated existing provisions as cl. (i) and added cl. (ii).

Pub. L. 101–508, § 4153(a)(2)(A)(ii)Subsec. (a)(2)(I). –(iv), added subpar. (I).

Pub. L. 101–508, § 4162(b)(1)Subsec. (a)(2)(J). , added subpar. (J).

Pub. L. 101–234, § 201(a)Pub. L. 100–3601989—Subsec. (a). , repealed , §§ 203(a), 205(a), 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 Amendment notes below.

Pub. L. 101–239Subsec. (a)(2)(H). added subpar. (H).

Pub. L. 101–234, § 101(a)Pub. L. 100–360, § 104(d)(3)Subsec. (b). , 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. 100–360, § 205(a)(2)1988—Subsec. (a). , inserted sentence at end relating to in-home care provided to a chronically dependent individual on any day.

Pub. L. 100–360, § 205(a)(1)Subsec. (a)(2)(A). , designated existing provisions as cl. (i) and added cl. (ii) relating to in-home care for a chronically dependent individual.

Pub. L. 100–360, § 203(a), inserted “and home intravenous drug therapy services” before semicolon at end.

Pub. L. 100–360, § 411(h)(7)(B)Pub. L. 100–203, § 4077(b)(2)Subsec. (a)(2)(B)(iv). , struck out , see 1987 Amendment note below.

Pub. L. 100–360, § 411(h)(4)(A)Pub. L. 100–203, § 4073(b)(1), struck out , see 1987 Amendment note below.

Pub. L. 100–360, § 411(g)(2)(E)Pub. L. 100–203, § 4063(e)(2)Subsec. (a)(2)(F)(i). , added , see 1987 Amendment note below.

Pub. L. 100–360, § 411(i)(4)Pub. L. 100–203, § 4085(i)(22)(A)Subsec. (a)(2)(F)(ii). (C)(vi), added , see 1987 Amendment note below.

Pub. L. 100–360, § 104(d)(3)Subsec. (b). , substituted “definitions of ‘medical and other health services’ and” for “definitions of ‘spell of illness’, ‘medical and other health services’, and”.

Pub. L. 100–203, § 4062(d)(2)(A)1987—Subsec. (a)(2)(A). , inserted “(other than items described in subparagraph (G))” after “services”.

Pub. L. 100–203, § 4062(d)(2)(B)Subsec. (a)(2)(B). , inserted “(other than items described in subparagraph (G))” after “health services”.

Pub. L. 100–203, § 4077(b)(2)Pub. L. 100–360, § 411(h)(7)(B)Subsec. (a)(2)(B)(iv). , which directed the addition of cl. (iv) relating to qualified psychologist services, was repealed by .

Pub. L. 100–203, § 4073(b)(1)Pub. L. 100–360, § 411(h)(4)(A), which directed the addition of cl. (iv) relating to certified nurse-midwife services, was repealed by .

Pub. L. 100–203, § 4063(e)(2)Pub. L. 100–360, § 411(g)(2)(E)lSubsec. (a)(2)(F)(i). , as added by , inserted “(including intraocular lens in cases described in section 1395(i)(2)(A)(iii) of this title)” after “services” in two places.

Pub. L. 100–203, § 4085(i)(22)(A)Pub. L. 100–360, § 411(i)(4)(C)(vi)section 1395u(b)(3)(B)(ii) of this titleSubsec. (a)(2)(F)(ii). , as added by , substituted “payment on an assignment-related basis” for “an assignment described in ” in concluding provisions.

Pub. L. 100–203, § 4062(d)(2)(C)Subsec. (a)(2)(G). , added subpar. (G).

Pub. L. 99–509, § 9320(d)1986—Subsec. (a)(2)(B)(iii). , added cl. (iii).

Pub. L. 99–509, § 9337(a)section 1395x(p) of this titleSubsec. (a)(2)(C). , amended subpar. (C) generally. Prior to amendment, subpar. (C) read as follows: “outpatient physical therapy services, other than services to which the next to last sentence of applies;”.

Pub. L. 99–509, § 9343(e)(1)Subsec. (a)(2)(F). , inserted “standard overhead” in cl. (i) and concluding provisions of cl. (ii).

Pub. L. 98–369, § 2341(b)section 1395x(r) of this titlesection 1395x(r)(1) of this title1984—Subsec. (a)(2)(F)(ii). , substituted “paragraph (1), (2), or (3) of ” for “”.

Pub. L. 98–369, § 2354(b)(6)Subsec. (a)(2)(F)(ii)(II). , substituted “organization” for “Organization”.

Pub. L. 97–2481982—Subsec. (a)(2)(F)(ii)(I). substituted “quality control and peer review organization (having a contract with the Secretary” for “Professional Standards Review Organization (designated, conditionally or otherwise,”.

Pub. L. 96–499, § 930(g)1980—Subsec. (a)(2)(A). , struck out restriction on home health services of 100 visits during a calendar year.

Pub. L. 96–499, § 948(a)(2)Subsec. (a)(2)(B)(i)(II). , substituted “where the conditions specified in paragraph (7) of such section are met” for “, unless either clause (A) or (B) of paragraph (7) of such section is met”.

Pub. L. 96–499, § 933(a)Subsec. (a)(2)(E). , added subpar. (E).

Pub. L. 96–499, § 934(a)Subsec. (a)(2)(F). , added subpar. (F).

Pub. L. 95–210, § 1(a)(1)1977—Subsec. (a)(1). , substituted “subparagraphs (B) and (D) of paragraph (2)” for “paragraph (2)(B)”.

Pub. L. 95–210, § 1(a)(2)Subsec. (a)(2)(D). , added subpar. (D).

Pub. L. 92–603, § 227(e)(1)1972—Subsec. (a)(2)(B). , inserted provisions relating to medical and other health services performed by a physician to a patient in a hospital which has an approved teaching program.

Pub. L. 92–603, § 251(a)(4)section 1395x(p) of this titleSubsec. (a)(2)(C). , inserted “, other than services to which the next to last sentence of applies”.

Pub. L. 90–248, § 129(c)(6)(B)section 1395n(b)(2) of this title1968—Subsec. (a)(2)(B). , inserted “and the services for which payment may be made pursuant to ” after “hospital”.

Pub. L. 90–248, § 133(d)Subsec. (a)(2)(C). , added subpar. (C).

Statutory Notes and Related Subsidiaries

Effective Date of 2022 Amendment

Pub. L. 117–328, div. FF, title IV, § 4124(d)136 Stat. 5910

l“The amendments made by this section [amending this section and sections 1395, 1395m, 1395x, and 1395cc of this title] shall apply with respect to items and services furnished on or after .”
, , , provided that:

Effective Date of 2011 Amendment

Pub. L. 112–40section 261(e) of Pub. L. 112–40section 1320c of this titleAmendment by applicable to contracts entered into or renewed on or after , see , set out as a note under .

Effective Date of 2008 Amendment

Pub. L. 110–275, title I, § 143(c)122 Stat. 2543

l“The amendments made by this section [amending this section and sections 1395, 1395n, 1395x, 1395y, 1395cc, and 1395nn of this title] shall apply to services furnished on or after .”
, , , 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 .

section 4432(b)(5)(B) of Pub. L. 105–33section 4432(d) of Pub. L. 105–33section 1395i–3 of this titleAmendment by applicable to items and services furnished on or after , see , set out as a note under .

Pub. L. 105–33, title IV, § 4511(e)111 Stat. 443

l“The amendments made by this section [amending this section and sections 1395, 1395x, 1395y, 1395cc, and 1395yy of this title] shall apply with respect to services furnished and supplies provided on and after .”
, , , provided that:

section 4603(c)(2)(B)(ii) of Pub. L. 105–33section 4603(d) of Pub. L. 105–33section 1395fff of this titleAmendment by applicable to cost reporting periods beginning on or after , except as otherwise provided, see , set out as an Effective Date note under .

Effective Date of 1990 Amendment

Pub. L. 101–508, title IV, § 4153(a)(3)104 Stat. 1388–83

l“The amendments made by paragraphs (1) and (2) [amending this section and sections 1395 and 1395m of this title] shall apply to items furnished on or after .”
, , , provided that:

Pub. L. 101–508, title IV, § 4155(e)104 Stat. 1388–88

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

Pub. L. 101–508, title IV, § 4157(d)104 Stat. 1388–89

“The amendments made by the preceding subsections [amending this section and sections 1395x, 1395y, and 1395cc of this title] apply to services furnished on or after .”
, , , provided that:

Pub. L. 101–508, title IV, § 4161(a)(8)104 Stat. 1388–95

“(A)
loo Subject to subparagraphs (B) and (C), the amendments made by this section [probably means this subsection, which amended this section and sections 1320a–7b, 1395, 1395x, 1395y, and 1395 of this title] shall apply to services furnished on or after .
“(B)
In the case of a Federally qualified health care center that has elected, as of , under part B of title XVIII of the Social Security Act [this part], to have the amount of payments for services under such part determined on a reasonable-charge basis, the amendment made by paragraph (3)(A) [amending this section] shall only apply on and after such date (not earlier than ) as the center may elect.
“(C)
oo The amendment made by paragraph (6) [amending section 1395 of this title] shall apply to cost reports for periods beginning on or after .”
, , , provided that:

Pub. L. 101–508, title IV, § 4162(c)104 Stat. 1388–96

“The amendments made by subsections (a) and (b) [amending this section and sections 1395x and 1395cc of this title] shall apply with respect to partial hospitalization services provided on or after .”
, , , provided that:

Effective Date of 1989 Amendment

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

section 201(a) of Pub. L. 101–234section 201(c) of Pub. L. 101–234section 1320a–7a of this titleAmendment by effective , see , set out as a note under .

Effective Date of 1988 Amendment

section 104(d)(3) of Pub. L. 100–360section 104(a) of Pub. L. 100–360section 1395d of this titleAmendment by effective , except as otherwise provided, and applicable to inpatient hospital deductible for 1989 and succeeding years, to care and services furnished on or after , to premiums for January 1989 and succeeding months, and to blood or blood cells furnished on or after , see , set out as a note under .

section 203(a) of Pub. L. 100–360section 203(g) of Pub. L. 100–360section 1320c–3 of this titleAmendment by applicable to items and services furnished on or after , see , set out as a note under .

Pub. L. 100–360, title II, § 205(f)102 Stat. 731section 205 of Pub. L. 100–360lPub. L. 101–234, title II, § 201(a)103 Stat. 1981, , , which provided that the amendments made by [amending this section and sections 1395, 1395n, 1395x, and 1395y of this title] were applicable to items and services furnished on or after , was repealed by , , .

section 411 of Pub. L. 100–360Pub. L. 100–360Pub. L. 100–203Pub. L. 100–203section 411(a) of Pub. L. 100–360section 106 of Title 1Except as specifically provided in , amendment by section 411(g)(2)(E), (h)(4)(A), (7)(B), (i)(4)(C)(vi) of , as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, , effective as if included in the enactment of that provision in , see , set out as a Reference to OBRA; Effective Date note under , General Provisions.

Effective Date of 1987 Amendment

section 4062(d)(2) of Pub. L. 100–203section 4062(e) of Pub. L. 100–203section 1395f of this titleAmendment by applicable to covered items (other than oxygen and oxygen equipment) furnished on or after , and to oxygen and oxygen equipment furnished on or after , see , as amended, set out as a note under .

Pub. L. 100–203, title IV, § 4073(e)101 Stat. 1330–119

l“The amendments made by this section [amending this section and sections 1395, 1395x, and 1396d of this title] shall be effective with respect to services performed on or after .”
, , , provided that:

Pub. L. 100–203, title IV, § 4077(b)(5)101 Stat. 1330–121Pub. L. 100–360, title IV, § 411(h)(7)(F)102 Stat. 787

l“The amendments made by this subsection [amending this section and sections 1395 and 1395x of this title] shall be effective with respect to services performed on or after .”
, formerly § 4077(b)(6), , , as renumbered by , , , provided that:

Effective Date of 1986 Amendment

Pub. L. 99–509, title IX, § 9320(i)100 Stat. 2016Pub. L. 100–485, title VI, § 608(c)(1)102 Stat. 2412

l“Except as provided in subsection (k) [set out below], the amendments made by this section (other than subsection (a)) [amending this section and sections 1395, 1395u, 1395x, 1395y, 1395aa, 1395bb, 1395cc, 1395ww, 1396a, and 1396n of this title] shall apply to services furnished on or after .”
, , , as amended by , , , provided that:

Pub. L. 99–509, title IX, § 9337(e)100 Stat. 2034

l“The amendments made by this section [amending this section and sections 1395, 1395n, 1395x, and 1395cc of this title] shall apply to expenses incurred for outpatient occupational therapy services furnished on or after .”
, , , provided that:

Effective Date of 1984 Amendment

Pub. L. 98–369, div. B, title III, § 2341(d)98 Stat. 1094

section 1395x of this title“The amendments made by this section [amending this section and ] apply to services furnished on or after the date of the enactment of this Act [].”
, , , provided that:

section 2354(b)(6) of Pub. L. 98–369section 2354(e)(1) of Pub. L. 98–369section 1320a–1 of this titleAmendment by effective , 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 , set out as a note under .

Effective Date of 1982 Amendment

Pub. L. 97–248section 149 of Pub. L. 97–248section 1320c of this titleAmendment by effective with respect to contracts entered into or renewed on or after , see , set out as an Effective Date note under .

Effective Date of 1980 Amendment

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

Pub. L. 96–499, title IX, § 933(h)94 Stat. 2637

“The amendments made by this section [amending this section and sections 1395n, 1395x, 1395z, and 1395aa of this title] shall become effective with respect to a comprehensive outpatient rehabilitation facility’s first accounting period which begins on or after .”
, , , provided that:

section 948(a)(2) of Pub. L. 96–499section 948(c)(1) of Pub. L. 96–499section 1395x of this titleAmendment by applicable with respect to cost accounting periods beginning on or after , see , set out as a note under .

Effective Date of 1977 Amendment

Pub. L. 95–210, § 1(j)91 Stat. 1488

ll“The amendments made by this section [amending this section and sections 1395, 1395x, 1395y, and 1395aa of this title and enacting provisions set out as notes under sections 1395 and 1395x of this title] shall apply to services rendered on or after the first day of the third calendar month which begins after the date of enactment of this Act [].”
, , , provided that:

Effective Date of 1972 Amendment

section 227(e)(1) of Pub. L. 92–603section 227(g) of Pub. L. 92–603section 1395x of this titleAmendment by applicable with respect to accounting periods beginning after , see , set out as a note under .

section 251(a)(4) of Pub. L. 92–603section 251(d)(1) of Pub. L. 92–603section 1395x of this titleAmendment by applicable with respect to services furnished on or after , see , set out as a note under .

Effective Date of 1968 Amendment

section 129(c)(6)(B) of Pub. L. 90–248section 129(d) of Pub. L. 90–248section 1395d of this titleAmendment by applicable with respect to services furnished after , see , set out as a note under .

Pub. L. 90–248, title I, § 133(g)81 Stat. 852

“The amendments made by the preceding subsections of this section [amending this section and sections 1395n, 1395x, 1395aa, and 1395cc of this title] shall apply to services furnished after .”
, , , provided that:

Construction of 2008 Amendment

Pub. L. 110–275, title I, § 143(d)122 Stat. 2543

l42 U.S.C. 1395j“Nothing in this section [amending this section and sections 1395, 1395n, 1395x, 1395y, 1395cc, and 1395nn of this title] shall be construed to affect existing regulations and policies of the Centers for Medicare & Medicaid Services that require physician oversight of care as a condition of payment for speech-language pathology services under part B of the Medicare program [ et seq.].”
, , , provided that:

Construction of 1986 Amendment

Pub. L. 99–509, title IX, § 9320(j)100 Stat. 2016

lsection 1395ww of this title“Nothing in this section or the amendments made by this section [amending this section and sections 1395, 1395u, 1395x, 1395y, 1395aa, 1395bb, 1395cc, 1395ww, 1396a, and 1396n of this title, enacting provisions set out as notes under this section, and amending provisions set out as a note under ] shall contravene provisions of State law relating to the practice of medicine or nursing or State law requirements or institutional requirements regarding the administration of anesthesia and its medical direction or supervision.”
, , , provided that:

Report on Immunosuppressive Drug Benefit

Pub. L. 106–113, div. B, § 1000(a)(6) [title II, § 227(d)]113 Stat. 1536Pub. L. 106–113section 1395x of this titlePub. L. 106–554, § 1(a)(6) [title I, § 113(b)(2)]114 Stat. 2763, , , 1501A–356, which required the Secretary of Health and Human Services to submit to Congress not later than , a report on the operation of section 1000(a)(6) [title II, § 227] of , amending this section and , including an analysis of impact and recommendations regarding an appropriate cost-effective method for providing coverage of immunosuppressive drugs under the medicare program on a permanent basis, was repealed by , , , 2763A–473.

Quality and Utilization of In-Home Care for Chronically Dependent Individuals

Pub. L. 100–360, title II, § 205(e)(2)102 Stat. 731section 205 of Pub. L. 100–360lPub. L. 101–234, title II, § 201(a)103 Stat. 1981, , , directed Secretary of Health and Human Services to take appropriate efforts to assure quality and provide for appropriate utilization of in-home care for chronically dependent individuals under the amendments made by [amending this section and sections 1395, 1395n, 1395x, and 1395y of this title], prior to repeal by , , .

Study of Alternative Out-of-Home Services

Pub. L. 100–360, title II, § 205(g)102 Stat. 731section 205 of Pub. L. 100–360lPub. L. 101–234, title II, § 201(a)103 Stat. 1981, , , which required Secretary of Health and Human Services to study, and report to Congress, not later than 18 months after , on advisability of providing, to chronically dependent individuals eligible for in-home care under amendments made by [amending this section and sections 1395, 1395n, 1395x, and 1395y of this title], out-of-home services as alternative services to in-home care, was repealed by , , .

Continuation of Cost Pass-Through for Certified Registered Nurse Anesthetists

Pub. L. 99–509, title IX, § 9320(k)Pub. L. 100–485, title VI, § 608(c)(2)102 Stat. 2412Pub. L. 101–239, title VI, § 6132(a)103 Stat. 2222

“(1)
lsection 1395ww of this title42 U.S.C. 1395ww(d) Subject to paragraph (2), the amendments made by this section [amending this section and sections 1395, 1395u, 1395x, 1395y, 1395aa, 1395bb, 1395cc, 1395ww, 1396a, and 1396n of this title and provisions set out as a note under ] shall not apply during a year (beginning with 1989) to a hospital located in a rural area (as defined for purposes of section 1886(d) of the Social Security Act []) if the hospital establishes, at any time before the year[,] to the satisfaction of the Secretary of Health and Human Services that—
“(A)
as of , the hospital employed or contracted with a certified registered nurse anesthetist (but not more than one full-time equivalent certified registered nurse anesthetist),
“(B)
in 1987 the hospital had a volume of surgical procedures (including inpatient and outpatient procedures) requiring anesthesia services that did not exceed 500 (or such higher number as the Secretary determines to be appropriate), and
“(C)
42 U.S.C. 1395j each certified registered nurse anesthetist employed by, or under contract with, the hospital has agreed not to bill under part B of title XVIII of such Act [ et seq.] for professional services furnished by the anesthetist at the hospital.
“(2)
Paragraph (1) shall not apply in a year (after 1989) to a hospital unless the hospital establishes, before the beginning of the year, that the hospital has had a volume of surgical procedures (including inpatient and outpatient procedures) requiring anesthesia services in the previous year that did not exceed 500 (or such higher number as the Secretary determines to be appropriate).”
, as added by , , , and amended by , , , provided that:

Pub. L. 101–239, title VI, § 6132(b)103 Stat. 2222

section 9320(k) of Pub. L. 99–509“The amendments made by this section [amending , set out above] shall apply to services furnished on or after .”
[, , , provided that: ]

Payment for Services of Physicians Rendered in a Teaching Hospital for Accounting Periods Beginning After , and Prior to ; Studies, Reports, etc.; Effective Dates

Pub. L. 93–233, § 15(a)(2)87 Stat. 96642 U.S.C. 1395x(b)(6)42 U.S.C. 1395x(b)(7), , , provided that for the cost accounting periods beginning after , and prior to , subsec. (a)(2)(B)(i) of this section will be administered as if subclause II of subsec. (a)(2)(B)(i) read as follows: “(II) a physician to a patient in a hospital which has a teaching program approved as specified in paragraph (6) of section 1861(b) [] (including services in conjunction with the teaching programs of such hospital whether or not such patient is an inpatient of such hospital), where the conditions specified in paragraph (7) of such section [] are met and”.