US Code

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

42 U.S.C. § 1395ll

Studies and recommendations

(a)

Health care of the aged and disabled

The Secretary shall carry on studies and develop recommendations to be submitted from time to time to the Congress relating to health care of the aged and the disabled, including studies and recommendations concerning (1) the adequacy of existing personnel and facilities for health care for purposes of the programs under parts A and B of this subchapter; (2) methods for encouraging the further development of efficient and economical forms of health care which are a constructive alternative to inpatient hospital care; and (3) the effects of the deductibles and coinsurance provisions upon beneficiaries, persons who provide health services, and the financing of the program.

(b)

Operation and administration of insurance programs

section 1395bb(a) of this title1

1 So in original. Probably should be followed by a comma.
42 U.S.C. 1395mm42 U.S.C. 1395b–142 U.S.C. 1395b–1The Secretary shall make a continuing study of the operation and administration of this subchapter (including a validation of the accreditation process of national accreditation bodies under   the operation and administration of health maintenance organizations authorized by section 226 of the Social Security Amendments of 1972 [], the experiments and demonstration projects authorized by section 402 of the Social Security Amendments of 1967 [] and the experiments and demonstration projects authorized by section 222(a) of the Social Security Amendments of 1972 [ note]), and shall transmit to the Congress annually a report concerning the operation of such programs.

Aug. 14, 1935, ch. 531Pub. L. 89–97, title I, § 102(a)79 Stat. 332Pub. L. 90–248, title IV, § 402(c)81 Stat. 931Pub. L. 92–603, title II86 Stat. 1373Pub. L. 98–369, div. B, title III, § 2354(b)(17)98 Stat. 1101Pub. L. 99–509, title IX, § 9316(a)100 Stat. 2006Pub. L. 100–203, title IV, § 4085(i)(20)101 Stat. 1330–133Pub. L. 100–647, title VIII, § 8413102 Stat. 3801Pub. L. 101–234, title III, § 301(b)(5)103 Stat. 1985Pub. L. 101–239, title VI, § 6103(b)(3)(A)103 Stat. 2199Pub. L. 108–173, title I, § 101(e)(7)117 Stat. 2152Pub. L. 110–275, title I, § 125(b)(4)122 Stat. 2519(, title XVIII, § 1875, as added , , ; amended , , ; , §§ 201(c)(7), 222(c), 226(d), 244(d), , , 1393, 1404, 1423; , , ; , , ; , , ; , , ; , (d)(2), , , 1986; , , ; , , ; , , .)

Editorial Notes

References in Text

section 226 of Pub. L. 92–603section 1395mm of this titlelSection 226 of the Social Security Amendments of 1972, referred to in subsec. (b), is , which enacted and provisions set out as notes under that section and amended this section and sections 1395f, 1395, and 1396b of this title.

section 402 of Pub. L. 90–248section 1395b–1 of this titleSection 402 of the Social Security Amendments of 1967, referred to in subsec. (b), is , which enacted and amended this section.

section 222(a) of Pub. L. 92–603section 1395b–1 of this titleSection 222(a) of the Social Security Amendments of 1972, referred to in subsec. (b), is , which enacted provisions set out as note under .

Amendments

Pub. L. 110–275section 1395bb(a) of this title2008—Subsec. (b). substituted “national accreditation bodies under ” for “the Joint Commission on Accreditation of Hospitals,”.

Pub. L. 108–1732003—Subsec. (b). substituted “this subchapter” for “the insurance programs under parts A and B of this subchapter”.

Pub. L. 101–2391989—Subsec. (c). struck out subsec. (c) which related to patient outcome assessment research program.

Pub. L. 101–234, § 301(b)(5)Subsec. (c)(7). , (d)(2), amended par. (7) identically, substituting “date of the enactment of this section” for “date of the enactment of this Act”.

Pub. L. 100–6471988—Subsec. (c)(3). amended par. (3) generally. Prior to amendment, par. (3) read as follows: “For purposes of carrying out the research program, there are authorized to be appropriated—

“(A) from the Federal Hospital Insurance Trust Fund $4,000,000 for fiscal year 1987 and $5,000,000 for each of fiscal years 1988 and 1989, and

“(B) from the Federal Supplementary Medical Insurance Trust Fund $2,000,000 for fiscal year 1987 and $2,500,000 for each of fiscal years 1988 and 1989.”

Pub. L. 100–2031987—Subsec. (c)(3)(B). substituted “fiscal year 1987” for “fiscal years 1987”.

Pub. L. 99–5091986—Subsec. (c). added subsec. (c).

Pub. L. 98–3691984—Subsec. (b). struck out “the” after “Joint Commission on”.

Pub. L. 92–603, § 201(c)(7)1972—Subsec. (a). , inserted “and the disabled” after “aged”.

Pub. L. 92–603Pub. L. 92–603, § 226(d)(2)Subsec. (b). , §§ 222(c), 226(d)(1), 244(d), substituted “(including a validation of the accreditation process of the Joint Commission on the Accreditation of Hospitals, the operation and administration of health maintenance organizations authorized by section 226 of the Social Security Amendments of 1972, the experiments and demonstration projects authorized by section 402 of the Social Security Amendments of 1967 and the experiments and demonstration projects authorized by section 222(a) of the Social Security Amendments of 1972)” for “(including the experimentation authorized by section 402 of the Social Security Amendments of 1967)”. , which directed the substitution of “1972” for “1971”, could not be executed because “1971” did not appear.

Pub. L. 90–2481968—Subsec. (b). inserted “(including the experimentation authorized by section 402 of the Social Security Amendments of 1967” after “under parts A and B of this subchapter”.

Statutory Notes and Related Subsidiaries

Effective Date of 2008 Amendment; Transition Rule

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

Effective Date of 1989 Amendment

Pub. L. 101–239, title VI, § 6103(b)(3)(A)103 Stat. 2199, , , provided that the amendment made by that section is effective for fiscal years beginning after fiscal year 1990.

Effective Date of 1984 Amendment

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 1972 Amendment

section 226(d) of Pub. L. 92–603section 226(f) of Pub. L. 92–603section 1395mm of this titleAmendment by effective with respect to services provided on or after , see , set out as an Effective Date note under .

Institute of Medicine Evaluation and Report on Health Care Performance Measures

Pub. L. 108–173, title II, § 238117 Stat. 2213

“(a)

Evaluation.—

“(1)

In general .—

42 U.S.C. 1395Not later than the date that is 2 months after the date of the enactment of this Act [], the Secretary [of Health and Human Services] shall enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences (in this section referred to as the ‘Institute’) shall conduct an evaluation of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the medicare program under title XVIII of the Social Security Act ( et seq.).
“(2)

Specific matters evaluated .—

In conducting the evaluation under paragraph (1), the Institute shall—
“(A)
catalogue, review, and evaluate the validity of leading health care performance measures;
“(B)
catalogue and evaluate the success and utility of alternative performance incentive programs in public or private sector settings; and
“(C)
identify and prioritize options to implement policies that align performance with payment under the medicare program that indicate—
“(i)
the performance measurement set to be used and how that measurement set will be updated;
“(ii)
the payment policy that will reward performance; and
“(iii)
the key implementation issues (such as data and information technology requirements) that must be addressed.
“(3)

Scope of health care performance measures .—

The health care performance measures described in paragraph (2)(A) shall encompass a variety of perspectives, including physicians, hospitals, other health care providers, health plans, purchasers, and patients.
“(4)

Consultation with medpac .—

42 U.S.C. 1395b–6In evaluating the matters described in paragraph (2)(C), the Institute shall consult with the Medicare Payment Advisory Commission established under section 1805 of the Social Security Act ().
“(b)

Report .—

42 U.S.C. 1395c42 U.S.C. 1395w–2142 U.S.C. 1395Not later than the date that is 18 months after the date of enactment of this Act [], the Institute shall submit to the Secretary and appropriate committees of jurisdiction of the Senate and House of Representatives a report on the evaluation conducted under subsection (a)(1) describing the findings of such evaluation and recommendations for an overall strategy and approach for aligning payment with performance, including options for updating performance measures, in the original medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act [ et seq., 1395j et seq.], the Medicare Advantage program under part C of such title [ et seq.], and any other programs under such title XVIII [ et seq.].
“(c)

Authorization of Appropriations .—

There are authorized to be appropriated such sums as may be necessary for purposes of conducting the evaluation and preparing the report required by this section.”
, , , provided that:

GAO Study on Access to Physicians’ Services

Pub. L. 108–173, title VI, § 604117 Stat. 2301

“(a)

Study .—

The Comptroller General of the United States shall conduct a study on access of medicare beneficiaries to physicians’ services under the medicare program. The study shall include—
“(1)
42 U.S.C. 1395j an assessment of the use by beneficiaries of such services through an analysis of claims submitted by physicians for such services under part B of the medicare program [ et seq.];
“(2)
an examination of changes in the use by beneficiaries of physicians’ services over time; and
“(3)
an examination of the extent to which physicians are not accepting new medicare beneficiaries as patients.
“(b)

Report .—

Not later than 18 months after the date of the enactment of this Act [], the Comptroller General shall submit to Congress a report on the study conducted under subsection (a). The report shall include a determination whether—
“(1)
42 U.S.C. 1395j data from claims submitted by physicians under part B of the medicare program [ et seq.] indicate potential access problems for medicare beneficiaries in certain geographic areas; and
“(2)
access by medicare beneficiaries to physicians’ services may have improved, remained constant, or deteriorated over time.”
, , , provided that:

Study on Enrollment Procedures for Groups That Retain Independent Contractor Physicians

Pub. L. 106–554, § 1(a)(6) [title IV, § 413]114 Stat. 2763

“(a)

In General .—

The Comptroller General of the United States shall conduct a study of the current medicare enrollment process for groups that retain independent contractor physicians with particular emphasis on hospital-based physicians, such as emergency department staffing groups. In conducting the evaluation, the Comptroller General shall consult with groups that retain independent contractor physicians and shall—
“(1)
review the issuance of individual medicare provider numbers and the possible medicare program integrity vulnerabilities of the current process;
“(2)
review direct and indirect costs associated with the current process incurred by the medicare program and groups that retain independent contractor physicians;
“(3)
assess the effect on program integrity by the enrollment of groups that retain independent contractor hospital-based physicians; and
“(4)
develop suggested procedures for the enrollment of these groups.
“(b)

Report .—

Not later than 1 year after the date of the enactment of this Act [], the Comptroller General shall submit to Congress a report on the study conducted under subsection (a).”
, , , 2763A–515, provided that:

GAO Studies and Reports on Medicare Payments

Pub. L. 106–554, § 1(a)(6) [title IV, § 437]114 Stat. 2763

“(a)

Study on HCFA Post-Payment Audit Process.— GAO

“(1)

Study .—

42 U.S.C. 1395The Comptroller General of the United States shall conduct a study on the post-payment audit process under the medicare program under title XVIII of the Social Security Act [ et seq.] as such process applies to physicians, including the proper level of resources that the Health Care Financing Administration should devote to educating physicians regarding—
“(A)
coding and billing;
“(B)
documentation requirements; and
“(C)
the calculation of overpayments.
“(2)

Report .—

Not later than 18 months after the date of the enactment of this Act [], the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1) together with specific recommendations for changes or improvements in the post-payment audit process described in such paragraph.
“(b)

Study on Administration and Oversight.— GAO

“(1)

Study .—

42 U.S.C. 1395The Comptroller General of the United States shall conduct a study on the aggregate effects of regulatory, audit, oversight, and paperwork burdens on physicians and other health care providers participating in the medicare program under title XVIII of the Social Security Act [ et seq.].
“(2)

Report .—

Not later than 18 months after the date of the enactment of this Act [], the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1) together with recommendations regarding any area in which—
“(A)
a reduction in paperwork, an ease of administration, or an appropriate change in oversight and review may be accomplished; or
“(B)
additional payments or education are needed to assist physicians and other health care providers in understanding and complying with any legal or regulatory requirements.”
, , , 2763A–527, provided that:

Study and Report Regarding Utilization of Physicians’ Services by Medicare Beneficiaries

Pub. L. 106–113, div. B, § 1000(a)(6) [title II, § 211(c)]113 Stat. 1536

“(1)

Study by secretary .—

The Secretary of Health and Human Services, acting through the Administrator of the Agency for Health Care Policy and Research, shall conduct a study of the issues specified in paragraph (2).
“(2)

Issues to be studied .—

The issues specified in this paragraph are the following:
“(A)
42 U.S.C. 139542 U.S.C. 1395c The various methods for accurately estimating the economic impact on expenditures for physicians’ services under the original medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act ( et seq.) [ et seq., 1395j et seq.] resulting from—
“(i)
improvements in medical capabilities;
“(ii)
advancements in scientific technology;
“(iii)
demographic changes in the types of medicare beneficiaries that receive benefits under such program; and
“(iv)
geographic changes in locations where medicare beneficiaries receive benefits under such program.
“(B)
42 U.S.C. 1395 The rate of usage of physicians’ services under the original medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act ( et seq.) among beneficiaries between ages 65 and 74, 75 and 84, 85 and over, and disabled beneficiaries under age 65.
“(C)
42 U.S.C. 1395 Other factors that may be reliable predictors of beneficiary utilization of physicians’ services under the original medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act ( et seq.).
“(3)

Report to congress .—

Not later than 3 years after the date of the enactment of this Act [], the Secretary of Health and Human Services shall submit a report to Congress setting forth the results of the study conducted pursuant to paragraph (1), together with any recommendations the Secretary determines are appropriate.
“(4)

Medpac report to congress .—

Not later than 180 days after the date of submission of the report under paragraph (3), the Medicare Payment Advisory Commission shall submit a report to Congress that includes—
“(A)
an analysis and evaluation of the report submitted under paragraph (3); and
“(B)
such recommendations as it determines are appropriate.”
, , , 1501A–349, provided that:

Study of Adult Day Care Services

Pub. L. 100–360, title II, § 208102 Stat. 732Pub. L. 100–485, title VI, § 608(d)(8)102 Stat. 2415Pub. L. 101–234, title II, § 201(a)103 Stat. 1981, , , as amended by , , , directed Secretary of Health and Human Services to conduct a survey of adult day care services in United States and to report to Congress, by not later than 1 year after , on the information collected in the survey, prior to repeal by , , .

Study To Develop a Strategy for Quality Review and Assurance

Pub. L. 99–509, title IX, § 9313(d)100 Stat. 2004Pub. L. 100–203, title IV, § 4085(i)(21)(A)101 Stat. 1330–133, , , as amended by , , , directed Secretary of Health and Human Services to arrange, with the National Academy of Sciences or other appropriate nonprofit private entity, for a study to design a strategy for reviewing and assuring the quality of care for which payment may be made under this subchapter, specified items to be included in the study, and directed Secretary to submit to Congress, not later than , a report on the study with recommendations with respect to strengthening quality assurances and review activities for services furnished under the medicare program.

Special Treatment of States Formerly Under Waiver

section 9202(j) of Pub. L. 99–272section 1395ww of this titleFor treatment of hospitals in States which have had a waiver approved under this section, upon termination of waiver, see , as amended, set out as a note under .

Drug Detoxification Medicare Coverage and Facility Incentives

Pub. L. 96–499, title IX, § 931(f)94 Stat. 2634Pub. L. 97–35, title XXI, § 2121(h)95 Stat. 796, , , which related to a study of medicare coverage of certain additional detoxification-related services, was repealed by , , .

Legislative Recommendations Regarding Reimbursement for Optometrists’ Services

Pub. L. 96–499, title IX, § 937(b)94 Stat. 264042 U.S.C. 1395, , , provided that the Secretary of Health and Human Services submit to the Congress by , legislative recommendations with respect to reimbursement under title XVIII of the Social Security Act [ et seq.] for services furnished by optometrists in connection with cataracts and such other services which they are legally authorized to perform.

Demonstration Projects, Studies, and Reports: Nutritional Therapy, Second Opinion Cost-Sharing, Services of Registered Dietitians, Services of Clinical Social Workers, Orthopedic Shoes, Respiratory Therapy Services, and Foot Conditions; Grants, Payments, and Expenditures

Pub. L. 96–499, title IX, § 95894 Stat. 2648section 1395i of this titlesection 1395t of this title, , , directed Secretary of Health and Human Services to carry out certain demonstration projects and conduct certain studies as follows: (a) a demonstration project to determine extent to which nutritional therapy in early renal failure could retard the disease with resultant substantive deferment of dialysis, and aspects of making such therapy available under this subchapter, report to Congress to be submitted within twenty-four months of ; (b) demonstration projects with respect to waiving the applicable cost sharing amounts which beneficiaries under this subchapter had to pay for obtaining a second opinion on having surgery, report to be submitted within one year after ; (c) a study of conditions under which services of registered dietitians could be covered as a home health benefit under this subchapter, report to be submitted within twenty-four months of ; (d) demonstration projects to determine aspects of making services of clinical social workers more generally available under this subchapter, report to be submitted within twenty-four months of ; (e) a study of methods for providing coverage under part B of this subchapter for orthopedic shoes for individuals with disabling or deforming conditions requiring special fitting considerations, or requiring special shoes in conjunction with the use of an orthosis or foot support, report to be submitted no later than ; (f) a study of conditions under which services with respect to respiratory therapy could be covered as a home health benefit under this subchapter, report to be submitted within twenty-four months of ; and (g) a study analyzing cost effects of alternative approaches to improving coverage under this subchapter for treatment of various types of foot conditions, report to be submitted within twenty-four months of . Payments and expenditures for such studies and projects were to be made in appropriate part from the Federal Hospital Insurance Trust Fund established by , and the Federal Supplementary Medical Insurance Trust Fund established by .

Demonstration Project Relating to the Terminally Ill

Pub. L. 96–265, title V, § 50694 Stat. 475, , , authorized Secretary of Health and Human Services to provide for participation, by Social Security Administration, in a demonstration project relating to the terminally ill then being conducted within the Department of Health and Human Services, the purpose of such participation to be to study impact on terminally ill of provisions of disability programs administered by Social Security Administration and to determine how best to provide services needed by persons who were terminally ill through programs over which the Social Security Administration had administrative responsibility, and authorized to be appropriated necessary sums not in excess of $2,000,000 for any fiscal year.

Report to Congress With Respect to Urban or Rural Comprehensive Mental Health Centers and Centers for Treatment of Alcoholism and Drug Abuse; Submission No Later Than

Pub. L. 95–210, § 491 Stat. 1490, , , directed Secretary of Health, Education, and Welfare to submit to Congress, no later than six months after , a report on the advantages and disadvantages of extending coverage under this subchapter to urban or rural comprehensive mental health centers and to centers for treatment of alcoholism and drug abuse.

Study and Review by Comptroller General of Administrative Structure for Processing Medicare Claims; Report to Congress

Pub. L. 95–142, § 1291 Stat. 1197, , , directed Comptroller General to conduct a comprehensive study and review of administrative structure established for processing of claims under this subchapter for purpose of determining whether and to what extent more efficient claims administration under this subchapter could be achieved and directed Comptroller General to submit to Congress no later than , a complete report with respect to such study and review.

Report by Secretary of Health, Education, and Welfare on Delivery of Home Health and Other In-Home Services; Contents; Consultation Requirements; Submission to Congress

Pub. L. 95–142, § 1891 Stat. 1202, , , directed Secretary of Health, Education, and Welfare, not later than one year after , to submit to appropriate committees of Congress a report analyzing, evaluating, and making recommendations with respect to all aspects of delivery of home health and other in-home services authorized to be provided under subchapters XVIII, XIX, and XX of this chapter.