TITLE XVIII—HEALTH INSURANCE FOR THE AGED AND DISABLED[1]
TABLE OF CONTENTS OF TITLE[2]
Sec. 1801. Prohibition against any Federal interference
Sec. 1802. Free choice by patient guaranteed
Sec. 1803. Option to individuals to obtain other health insurance protection
Sec. 1804. Notice of Medicare benefits: Medicare and Medigap information
Sec. 1805. Medicare payment advisory commission
Sec. 1806. Explanation of Medicare benefits
Sec. 1807. Chronic care improvement
Sec. 1808. Provisions relating to administration
Sec. 1809. Addressing health care disparities
Part A—Hospital Insurance Benefits for the Aged and Disabled
Sec. 1811. Description of program
Sec. 1813. Deductibles and coinsurance
Sec. 1814. Conditions of and limitations on payment for services
Sec. 1815. Payment to providers of services
Sec. 1816. Provisions relating to the administration of Part A
Sec. 1817. Federal hospital insurance trust fund
Sec. 1818. Hospital insurance benefits for uninsured elderly individuals not otherwise eligible
Sec. 1819. Requirements for, and assuring quality of care in, skilled nursing facilities
Sec. 1820. Medicare rural hospital flexibility program
Sec. 1821. Conditions for coverage of religious nonmedical health care institutional services
Part B—Supplementary Medical Insurance Benefits for the Aged and Disabled
Sec. 1831. Establishment of supplementary medical insurance program for the aged and the disabled
Sec. 1833. Payment of benefits
Sec. 1834. Special payment rules for particular items and services
Sec. 1834A. Improving policies for clinical diagnostic laboratory tests
Sec. 1835. Procedure for payment of claims of providers of services
Sec. 1836. Eligible individuals
Sec. 1839. Amounts of premiums
Sec. 1840. Payment of premiums
Sec. 1841. Federal supplementary medical insurance trust fund
Sec. 1842. Provisions relating to the administration of Part B
Sec. 1844. Appropriations to cover Government contributions and contingency reserve
Sec. 1846. Intermediate sanctions for providers or suppliers of clinical diagnostic laboratory tests
Sec. 1847. Competitive acquisition of certain items and services
Sec. 1847A. Use of average sales price payment methodology
Sec. 1847B. Competitive acquisition of outpatient drugs and biologicals
Sec. 1848. Payment for physicians’ services
Part C—Medicare+Choice Program
Sec. 1851. Eligibility, election, and enrollment
Sec. 1852. Benefits and beneficiary protections
Sec. 1853. Payments to Medicare+Choice organizations
Sec. 1854. Premiums and Premium Amounts
Sec. 1856. Establishment of standards
Sec. 1857. Contracts with Medicare+Choice organizations
Sec. 1858. Special Rules for MA Regional Plans
Sec. 1859. Definitions; miscellaneous provisions
Part D—Voluntary Prescription Drug Benefit Program
Subpart 1—Part D Eligible Individuals and Prescription Drug Benefits
Sec. 1860D-1. Eligibility, enrollment, and information
Sec. 1860D-2. Prescription drug benefits
Sec. 1860D-3. Access to a choice of qualified prescription drug coverage
Sec. 1860D-4. Beneficiary protections for qualified prescription drug coverage
Subpart 2—Prescription Drug Plans; PDP Sponsors; Financing
Sec. 1860D-11. PDP regions; submission of bids; plan approval
Sec. 1860D-12. Requirements for and contracts with prescription drug plan (PDP) sponsors
Sec. 1860D-13. Premiums; late enrollment penalty
Sec. 1860D-14. Premium and cost-sharing subsidies for low-income individuals
Sec. 1860D-14A. Medicare coverage gap discount program
Sec. 1860D-15. Subsidies for Part D eligible individuals for qualified prescription drug coverage
Subpart 3—Application to Medicare Advantage Program and Treatment of Employer-Sponsored Programs and Other Prescription Drug Plans
Sec. 1860D-21. Application to Medicare advantage program and related managed care programs
Sec. 1860D-22. Special rules for employer-sponsored programs
Sec. 1860D-23. State pharmaceutical assistance programs
Sec. 1860D-24. Coordination requirements for plans providing prescription drug coverage
Subpart 4—Medicare Prescription Drug Discount Card and Transitional Assistance Program
Sec. 1860D-31. Medicare prescription drug discount card and transitional assistance program
Subpart 5—Definitions and Miscellaneous Provisions
Sec. 1860D-41. Definitions; treatment of references to provisions in Part C
Sec. 1860D-42. Miscellaneous provisions
Sec. 1860D-43. Condition for coverage of drugs under this part
Part E—Miscellaneous Provisions
Sec. 1861. Definitions of services, institutions, etc.
Sec. 1862. Exclusions from coverage and Medicare as secondary payer
Sec. 1865. Effect of accreditation
Sec. 1866. Agreements with providers of services; enrollment processes
Sec. 1866A. Demonstration of application of physician volume increases to group practices
Sec. 1866B. Provisions for administration of demonstration program
Sec. 1866C. Health care quality demonstration program
Sec. 1866D. National pilot program on payment bundling
Sec. 1866E. Independence at home medical practice demonstration program
Sec. 1866F. Opioid use disorder treatment demonstration program
Sec. 1867. Examination and treatment for emergency medical conditions and women in labor
Sec. 1868. Practicing physicians advisory council; council for technology and innovation
Sec. 1869. Determinations; Appeals
Sec. 1872. Application of certain provisions of Title II
Sec. 1873. Designation of organization or publication by name
Sec. 1874A. Contracts with medicare administrative contractors
Sec. 1875. Studies and recommendations
Sec. 1876. Payments to health maintenance organizations and competitive medical plans
Sec. 1877. Limitation on certain physician referrals
Sec. 1878. Provider reimbursement review board
Sec. 1879. Limitation on liability of beneficiary where medicare claims are disallowed
Sec. 1880. Indian health service facilities
Sec. 1881. Medicare coverage for end stage renal disease patients
Sec. 1881A. Medicare coverage for individuals exposed to environmental health hazards
Sec. 1882. Certification of medicare supplemental health insurance policies
Sec. 1883. Hospital providers of extended care services
Sec. 1884. Payments to promote closing and conversion of underutilized hospital facilities
Sec. 1885. Withholding of payments for certain medicaid providers
Sec. 1886. Payment to hospitals for inpatient hospital services
Sec. 1887. Payment of provider–based physicians and payment under certain percentage arrangements
Sec. 1888. Payment to skilled nursing facilities for routine service costs
Sec. 1889. Provider education and technical assistance
Sec. 1890. Contract with a consensus-based entity regarding performance measurement
Sec. 1890A. Quality and efficiency measurement
Sec. 1891. Conditions of participation for home health agencies; Home health quality
Sec. 1893. Medicare integrity program
Sec. 1895. Prospective payment for home health services
Sec. 1896. Medicare subvention for military retirees
Sec. 1897. Health care infrastructure improvement program
Sec. 1898. medicare improvement fund
Sec. 1899. Shared savings program
Sec. 1899A. Independent Medicare Advisory Board.
[1] Title XVIII of the Social Security Act is administered by the Centers for Medicare and Medicaid Services. Title XVIII appears in the United States Code as §§1395-1395lll, subchapter XVIII, chapter 7, Title 42. Regulations of the Secretary of Health and Human Services relating to Title XVIII are contained in chapter IV, Title 42, and in subtitle A, Title 45, Code of Federal Regulations.
See Vol. II, 31 U.S.C. 3716(c)(3)(D), with respect to the application of administrative offset provisions to medicare provider or supplier payments; P.L. 78-410, §353(i)(3) and (n), with respect to clinical laboratories; P.L. 88-352, §601, for prohibition against discrimination in Federally assisted programs; P.L. 89-73, §§203 and 422(c), with respect to consultation with respect to programs and services for the aged; P.L. 93-288, §312(d), with respect to exclusion from income and resources of certain Federal major disaster and emergency assistance; P.L. 97-248, §119, with respect to private sector review initiative and restriction against recovery from beneficiaries; P.L. 98-369, §2355, with respect to waivers for social health maintenance organizations; P.L. 99-177, §257(b)(3) and (c)(3), with respect to the calculation of the baseline; P.L. 99-272, §9220, with respect to extension, terms, conditions, and period of approval of the extension of On Lok waiver; and §9215, with respect to the extension of certain medicare health services demonstration projects; P.L. 99-319, §105, with respect to systems requirements; P.L. 99-509, §9339(d) with respect to State standards for directors of clinical laboratories; §9342 with respect to Alzheimer’s disease demonstration projects; §9353(a)(4) with respect to a small-area analysis; and §9412 with respect to the waiver authority for chronically mentally ill and frail elderly; P.L. 99-660, Title IV, with respect to professional review activities; P.L. 100-203, §4008(d)(3), with respect to a report regarding hospital outlier payments; P.L. 100-204, §724(d), with respect to furnishing information to the United States Commission on Improving the Effectiveness of the United Nations; and §725(b), with respect to the detailing of Government personnel; P.L. 100-235, §§5–8, with respect to responsibilities of each Federal agency for computer systems security and privacy; P.L. 100-383, §§105(f)(2) and 206(d)(2), with respect to exclusions from income and resources of certain payments to certain individuals; P.L. 100-581, §§501, 502(b)(1), and 503, with respect to exclusion from income and resources of certain judgment funds; P.L. 100-647, §8411, with respect to treatment of certain nursing education programs; P.L. 100-690, §5301(a)(1)(C) and (d)(1)(B), with respect to benefits of drug traffickers and possessors; P.L. 100-713, §712, with respect to the provision of services in Montana; P.L. 101-121, with respect to the amounts collected by the Secretary of Health and Human Services under the authority of title IV of the Indian Health Care Improvement Act; P.L. 101-239, §6025, with respect to a dentist’s serving as hospital medical director; §6205(a)(1)(A) and (a)(2), with respect to recognition of costs of certain hospital-based nursing schools; P.L. 104-191, §261, with respect to purpose of administrative simplification; P.L. 106-554, §1(a)(6) [122], with respect to cancer prevention and treatment demonstrations for ethnic and racial minorities; and [128] with respect to a lifestyle modification program demonstration; P.L. 110-275, §186, with respect to a demonstration project to improve care to previously uninsured; P.L. 111-148, §1103, with respect to immediate information that allows consumers to identify affordable coverage options; §2602, with respect to providing Federal coverage and payment coordination for dual eligible beneficiaries; P.L. 111-240, §4241, with respect to the use of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse in the medicare fee-for-service program; P.L. 111-309, §206, with respect to funding for claims reprocessing; and P.L. 112-240, §609 (b), with respect to a strategy for providing data for performance improvement in a timely manner to applicable providers under the medicare program and §643, with respect to a commission on long-term care. See Vol. II, P.L. 114–10, §104, with respect to requirement on Secretary to make publicly available information about physicians and other eligible professionals on items and services furnished to medicare beneficiaries under this title; §106(b), with respect to requirements on Secretary to establish metric and mechanisms to promote electronic health records systems and interoperability; §106(d) for a rule of construction regarding health providers and malpractice and liability claims. See Vol. II, P.L. 114–255, §17003, with respect to required update to “Welcome to Medicare” package and information gathering by the Secretary of HHS. See Vol. II, P.L. 115–123, §50353, with respect to required HHS study on long-term, chronic condition cost drivers to the Medicare program. See Vol. II, P.L. 115–245, §§506, 507, for limitations on funds appropriated for the administration of Title XVIII programs. See Vol. II, P.L. 115–271, §6032, with respect to study and report to Congress regarding Medicare and Medicaid payment and coverage policies that may be viewed as potential obstacles to effective response to the opioid crisis; §6094, with respect to another technical expert study and report to Congress on reducing surgical setting opioid use and data collection on perioperative opioid use.
[2] This table of contents does not appear in the law.