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under section 300e-2, 300e-3, or 300e-4 of this title The period of operation of such health maintenance organizations which shall be evaluated under this subsection shall be not less than thirty-six months. The Comptroller General shall report to the Congress the results of the evaluation not later than ninety days after at least fifty of such health maintenance organizations have been in operation for at least thirty-six months. Such report shall contain findings

(1) with respect to the ability of the organizations evaluated to operate on a fiscally sound basis without continued Federal financial assistance,

(2) with respect to the ability of such organizations to meet the requirements of section 300e (c) of this title respecting their organization and operation.

(3) with respect to the ability of such organizations to provide basic and supplemental health services in the manner prescribed by section 300e (b) of this title,

(4) with respect to the ability of such organizations to include indigent and high-risk individuals in their membership, and

(5) with respect to the ability of such organizations to provide services to medically underserved populations.

(b) Study.

The Comptroller General shall also conduct a study of the economic effects on employers resulting from their compliance with the requirements of section 300e-9 of this title. The Comptroller General shall report to the Congress the results of such study not later than thirty-six months after December 29, 1973.

(c) Comparison of health maintenance organizations. The Comptroller General shall evaluate (1) the operations of distinct categories of health maintenance organizations in comparison with each other, (2) health maintenance organizations as a group in comparison with alternative forms of health care delivery, and (3) the impact that health maintenance organizations, individually, by category, and as a group, have on the health of the public. The Comptroller General shall report to the Congress the results of such evaluation not later than thirty-six months after December 29, 1973. (July 1, 1944, ch. 373, title XIII, § 1314, as added Dec. 29, 1973, Pub. L. 93-222, § 2, 87 Stat. 932.)

§ 300e-14. Annual report.

(a) The Secretary shall periodically review the programs of assistance authorized by this subchapter and make an annual report to the Congress of a summary of the activities under each program. The Secretary shall include in such summary

(1) a summary of each grant, contract, loan, or loan guarantee made under this subchapter in the period covered by the report and a list of the health maintenance organizations which during such period became qualified health maintenance organizations for purposes of section 300e-9 of this title;

(2) the statistics and other information reported in such period to the Secretary in accordance with section 300e (c) (11) of this title;

(3) findings with respect to the ability of the health maintenance organizations assisted under this subchapter

(A) to operate on a fiscally sound basis without continued Federal financial assistance,

(B) to meet the requirements of section 300e (c) of this title respecting their organization and operation,

(C) to provide basic and supplemental health services in the manner prescribed by section 300e (b) of this title,

(D) to include indigent and high-risk individuals in their membership, and

(E) to provide services to medically underserved populations; and

(4) findings with respect to

(A) the operation of distinct categories of health maintenance organizations in comparison with each other,

(B) health maintenance organizations as a group in comparison with alternative forms of health care delivery, and

(C) the impact that health maintenance organizations, individually, by category, and as a group, have on the health of the public.

(b) The Office of Management and Budget may review the Secretary's report under subsection (a) of this section before its submission to the Congress, but the Office may not revise the report or delay its submission, and it may submit to the Congress its comments (and those of other departments or agencies of the Government) respecting such report (July 1, 1944, ch. 373, title XIII, § 1315, as added Dec. 29, 1973, Pub. L. 93–222, § 2, 87 Stat. 933.)

§ 300e-14a. Health services for Indians and domestic agricultural migratory and seasonal workers.

The Secretary of Health, Education, and Welfare. in connection with existing authority (except section 242h of this title) for the provisions of health services to domestic agricultural migratory workers to persons who perform seasonal agricultural services similar to the services performed by such workers and to the families of such workers and persons, is authorized to arrange for the provision of health services to such workers and persons and their families through health maintenance organizations. In carrying out this section the Secretary may only use sums appropriated after December 29, 1973. (Pub. L. 93-222, § 6(b), Dec. 29, 1973, 87 Stat. 936.)

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803. Payments to States.

(a) Quarterly expenditures as basis for determination of amount.

(b) Estimation of amounts by Secretary; payment of amounts in installments; reduction or increases in amounts; appropriations available for payments to be deemed obligated subsequent to estimation.

(c) Availability and administration of benefits pursuant to State plan.

(d) Quarterly expenditures to exceed average of total expenditures for each quarter of fiscal year ending June 30, 1965; basis for determination of expenditures.

804. Operation of State plans.

805. Definition.

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expenditures [New].

(a) Use of reimbursement for planning activities for health services and facilities. (b) Agreement between Secretary and State for submission of proposed capital expenditures related to health care facilities or health maintenance organizations, and procedures for appeal from recommendations.

(c) Manner of payment to States for carrying out agreement.

(d) Determination of amount of exclusions from Federal payments.

(e) Treatment of lease or comparable arrangement of any facility or equipment for a facility in determining amount of exclusions from Federal payments.

(f) Reconsideration by Secretary of determinations.

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Sec. 1320a-2. Qualifications for health care personnel [New]. 1320b. Limitation on funds for certain social services [New].

(a) General limitation.

(b) State allotment; formula; promulgation
(c) State defined.

PART B.-PROFESSIONAL STANDARDS REVIEW [NEW]
1320c. Congressional declaration of purpose.
1320c-1. Professional Standards Review Organizations.
(a) Designation.

(b) Qualified organizations eligible for desig-
nation.

(c) Order of eligibility; renewal of agreements.
(d) Agreement expiration; prior termination.
(e) Waiver of those review, certification, and
similar activities now covered by Profes-
sional Standards Review Organizations.
(f) Agreement notice; objection by doctors;
poll.

1320c-2. Review pending designation of Professional Standards Review Organization.

1320c-3. Trial period for Professional Standards Review Organizations.

1320c-4. Duties and functions of Professional Standards Review Organizations.

(a) Responsibility for review of professional activities; case criteria; patient profiles; physician review of hospital care; involvement of reviewing physicians.

(b) Utilization of practitioners and specialists; examination of records; inspection of facilities.

(c) Utilization of services of unlicensed doctors of medicine or osteopathy.

(d) Familiarization of physicians with review functions of Professional Standards Review Organizations.

(e) Review committees of hospitals or other operating health care facilities or organizations.

(f) Agreement requirements.

(g) Review of health care services limited to health care services provided by or in institutions unless otherwise requested.

1320c-5. Norms of health care services.

(a) Development by Professional Standards Organizations.

(b) Requisite contents of norms.

(c) Data on regional norms; preparation; distribution, review, and revision; utilization of norms.

(d) Certification for further inpatient care. 1320c-6. Submission of reports by Professional Standards Review Organizations.

1320c-7. Review approval as condition of payment of claims.

1320c-8. Hearing and review by Secretary. 1320c-9. Obligations of health care practitioners and providers of health care services.

(a) Enumeration of obligations.

(b) Failure to comply with obligations; gross and flagrant violations; exclusion of practitioner or provider from eligibility; sanctions and penalties; hearing and review.

(c) Duty of Review Organizations and Statewide Review Councils to assure compliance with obligations.

1320c-10. Notice to practitioner or provider. 1320c-11. Statewide Professional Standards Review Councils.

(a) Establishment. (b) Membership.

(c) Duties.

(d) Payments.

(e) Advisory groups.

Sec.

1320c-12. National Professional Standards Review Council.

(a) Establishment; membership.

(b) Qualifications for membership.

(c) Consultants.

(d) Compensation of members.

(e) Duties.

(f) Reports.

1320c-13. Professional standards review requirements applicable to certain State programs.

1320c-14. Correlation of functions between Professional Standards Review Organizations and administrative instrumentalities.

1320c-15. Disclosure of information prohibited. 1320c-16. Limitation of liability.

(a) Persons providing information to Professional Standards Review Organizations. (b) Members and employees of Professional Standards Review Organizations.

(c) Health care practitioners and providers. 1320c-17. Authorization for use of funds to administer professional standards review program.

1320c-18. Technical assistance to organizations desiring to be designated as Professional Standards Review Organizations.

1320c-19. Exemptions of Christian Science sanatoriums. SUBCHAPTER XVI.-SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED [NEW] 1381. Statement of purpose; authorization of appropriation.

1381a. Basic entitlement to benefits.

PART A.-DETERMINATION OF BENEFITS

1382. Eligibility for benefits.

(a) Definition of eligible individual.
(b) Amount of benefits.

(c) Period for determination of benefits; re-
determination of eligibility and amount
of benefits; effective date of application.
(d) Limitation on amount of gross income
earned; definition of gross income.
(e) Limitation on eligibility of certain individ-
uals.

(f) Individuals outside the United States; deter-
mination of status.

(g) Individuals deemed to meet resources test. (h) Individuals deemed to meet income test. 1382a. Income; definition of earned and unearned income; exclusions from income.

1382b. Resources; exclusions from resources; disposition of resources.

1382c. Definitions.

1382d. Rehabilitation services for blind and disabled individuals.

(a) Referral by Secretary of eligible individuals to appropriate State agency; review by Secretary of individual's blindness or disability and need for services.

(b) Acceptance by referred individuals of services; payment by Secretary to State agency of costs of providing services to referred individuals.

(c) Refusal by referred individuals to accept services.

1382e. Supplementary assistance by State or subdivision to needy individuals.

(a) Exclusion of cash payments in determina

tion of income of individuals for purposes of eligibility for benefits; agreement by Secretary and State for Secretary to make supplementary payments on behalf of State or subdivision.

(b) Agreement between Secretary and State; contents.

(c) Residence requirement by State or subdivision for supplementary payments; disregarding of amounts of certain income by State or subdivision in determining eligibility for supplementary payments.

Sec.

1382e. Supplementary assistance by State or subdivision to needy individuals-Continued

1383.

(d) Payment to Secretary by State of amount equal to expenditures by Secretary as supplementary payments; time and manner of payment by State.

(e) Reduction of supplemental security income
payments to individuals provided institu-
tional medical or other remedial care, State
financed under Federal grants for medi-
cal assistance.

PART B.-PROCEDURAL AND GENERAL PROVISIONS
Procedure for payment of benefits.

(a) Time, manner, form, and duration of pay-
ments; promulgation of regulations.
(b) Overpayments and underpayments; adjust-
ment recovery, or payment of amounts by
Secretary.

(c) Hearing for eligible individual or eligible
spouse where eligibility or amount of
benefit is in question; time for request
for hearing; time for determinations pur-
suant to hearing; finality and conclusive-
ness of determinations of Secretary.

(d) Applicability of procedural requirements; prohibition on assignment of payments; appointment of hearing examiners; representation of claimants; maximum fees; violations; penalties.

(e) Administrative requirements prescribed by Secretary; criteria; reduction of benefits to individual for noncompliance with requirements.

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SUBCHAPTER XVIII.-HEALTH INSURANCE
FOR THE AGED

PART A.-HOSPITAL INSURANCE BENEFITS
FOR THE AGED

13951-2. Hospital insurance benefits for uninsured individuals not otherwise eligible [New].

(a) Individuals eligible to enroll.

(b) Time, manner, and form of enrollment. (c) Period of enrollment; scope of coverage. (d) Monthly premiums.

(e) Contract or other arrangement for pay-
ment of monthly premiums.

(f) Deposit of amounts into Treasury.
PART C.-MISCELLANEOUS PROVISIONS

1395mm. Payments to health maintenance organizations [New].

1395nn.

139500.

(a) Rates and adjustments.

(b) Definition.

(c) Benefits.

(d) Enrollment in local health maintenance organizations.

(e) Termination of enrollment.

(f) Hearings; judicial review.

(g) Limits on costs.

(h) Nonapplicability to certain organizations.

(1) Contract authority.

(1) Performance of contractual functions.

Offenses and penalties [New].

Provider Reimbursement Review Board [New]. (a) Establishment.

(b) Appeals by groups.

(c) Right to counsel; rules of evidence.

(d) Decisions of Board.

(e) Rules and regulations.

(1) Review of Board's decisions.
(g) Certain findings not reviewable.
(h) Composition and compensation.
(1) Technical and clerical assistance.

Sec.

1395pp. Limitations on liability where claims are disallowed [New].

(a) Conditions prerequisite to payment for
items and services notwithstanding de-
termination of disallowance.
(b) Knowledge of person or provider that
payment could not be made; indemnifi-
cation of individual.

(c) Knowledge of both provider and individ-
ual to whom items or services were fur-
nished that payment could not be made.
(d) Exercise of rights.

SUBCHAPTER XIX.-GRANTS TO STATES FOR
MEDICAL ASSISTANCE PROGRAMS

1396h. Offenses and penalties [New].

13961. Certification and approval of skilled nursing facilities [New].

CHAPTER REFERRED TO IN OTHER SECTIONS

This chapter is referred to in title 20 section 1070a; title 25 section 1407; title 26 section 162; title 45 sections 228a, 228c, 228s-3.

SUBCHAPTER I.-GRANTS TO STATES FOR OLD-AGE ASSISTANCE AND MEDICAL ASSISTANCE FOR THE AGED

REPEAL OF SUBCHAPTER I OF THIS CHAPTER EFFECTIVE JANUARY 1, 1974; INAPPLICABILITY OF REPEAL TO PUERTO RICO, GUAM, AND VIRGIN ISLANDS

Pub. L. 92-603, title III, § 303(a), (b), Oct. 30, 1972, 86 Stat. 1484, provided that this section is repealed effective January 1, 1974, except with respect to Puerto Rico, Guam, and the Virgin Islands.

SUBCHAPTER REFERRED TO IN OTHER SECTIONS

This subchapter is referred to in sections 802, 1306a, 1382, 1395z of this title; title 7 section 2012; title 29 section 981.

§ 301. Appropriation.

REPEAL OF SECTION EFFECTIVE JANUARY 1, 1974

Pub. L. 92-603, title III, § 303(a), (b), Oct. 30, 1972, 86 Stat. 1484, provided that this section is repealed effective January 1, 1974, except with respect to Puerto Rico, Guam, and the Virgin Islands.

PUERTO RICO, GUAM, AND THE VIRGIN ISLANDS Pub. L. 92-603, title III, § 303(b), Oct. 30, 1972, 86 Stat. 1484, provided that: "The amendments made by sections 301 [enacting sections 1381-1383b of this title] and 302 [enacting sections 801-805 of this title] and the repeals made by subsection (a) [repealing sections 301-306, 12011206 and 1351 of this title] shall not be applicable in the case of Puerto Rico, Guam, and the Virgin Islands."

§ 302. State old-age and medical assistance plans. (a) Contents.

A State plan for old-age assistance, or for medical assistance for the aged, or for old-age assistance and medical assistance for the aged must

(1) except to the extent permitted by the Secretary with respect to services, provide that it shall be in effect in all political subdivisions of the State, and, if administered by them, be mandatory upon them;

(4) provide (A) for granting an opportunity for a fair hearing before the State agency to any individual whose claim for assistance under the plan

is denied or is not acted upon with reasonable promptness, and (B) that if the State plan is administered in each of the political subdivisions of the State by a local agency and such local agency provides a hearing at which evidence may be presented prior to a hearing before the State agency, such local agency may put into effect immediately upon issuance its decision upon the matter considered at such hearing;

(7) provide safeguards which permit the use or disclosure of information concerning applicants or recipients only (A) to public officials who require such information in connection with their official duties, or (B) to other persons for purposes directly connected with the administration of the State plan;

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(10) If the State plan includes old-age assist

ance

(C) provide a description of the services (if any) which the State agency makes available (using whatever internal organizational arrangement it finds appropriate for this purpose) to applicants for and recipients of such assistance to help them attain self-care, including a description of the steps taken to assure, in the provision of such services, maximum utilization of other agencies providing similar or related services;

(b) Approval by Secretary.

The Secretary shall approve any plan which fulfills the conditions specified in subsection (a) of this section, except that he shall not approve any plan which imposes as a condition of eligibility for assistance under the plan

At the option of the State, the plan may provide that manuals and other policy issuances will be furnished to persons without charge for the reasonable cost of such materials, but such provision shall not be required by the Secretary as a condition for the approval of such plan under this subchapter.

(As amended Oct. 30, 1972, Pub. L. 92-603, title IV, §§ 405 (a), 406(a), 407(a), 410(a), 413(a), 86 Stat. 1488, 1489, 1491, 1492.)

REPEAL OF SECTION EFFECTIVE JANUARY 1, 1974

Pub. L. 92-603, title III, § 303(a), (b), Oct. 30, 1972, 86 Stat. 1484, provided that this section is repealed effective January 1, 1974, except with respect to Puerto Rico, Guam, and the Virgin Islands.

AMENDMENTS

1972 Subsec. (a) (1). Pub. L. 92-603, § 410(a), added "except to the extent permitted by the Secretary with respect to services" preceding "provide".

Subsec. (a) (4). Pub. L. 92-603, § 407(a), designated existing provisions as cl. (A) and added cl. (B).

Subsec. (a) (7). Pub. L. 92-603, § 413(a), substituted provisions permitting the use or disclosure of information concerning applicants or recipients to public officials requiring such information in connection with

their official duties and to other persons for purposes directly connected with the administration of the State plan, for provisions restricting the use or disclosure of such information to purposes directly connected with the administration of the State plan.

Subsec. (a) (10) (C). Pub. L. 92-603, § 405 (a), added provision relating to the use of whatever internal organizational arrangement found appropriate.

Subsec. (b). Pub. L. 92-603, § 406(a), added provision relating to the furnishing of manuals and other policy issuances to persons without charge and at the option of the State.

DISREGARDING OF INCOME OF OASDI RECIPIENTS IN DETERMINING NEED FOR PUBLIC ASSISTANCE Section 306 of Pub. L. 92-603 provided that: "In addition to the requirements imposed by law as a condition of approval of a State plan to provide aid or assistance in the form of money payments to individuals under title I, X, XIV, or XVI of the Social Security Act [subchapters I, X, XIV, or XVI of this chapter], there is hereby imposed the requirement (and the plan shall be deemed to require) that, in the case of any individual receiving aid or assistance for any month after October 1972, or, at the option of the State, September 1972, and before January 1974 who also receives in such month a monthly insurance benefit under title II of such Act [subchapter II of this chapter] which was increased as a result of the enactment of Public Law 92-336, the sum of the aid or assistance received by him for such month, plus the monthly insurance benefit received by him in such month (not including any part of such benefit which is disregarded under such plan), shall exceed the sum of the aid or assistance which would have been received by him for such month under such plan as in effect for October 1972, plus the monthly insurance benefit which would have been received by him in such month, by an amount equal to $4 or (if less) to such increase in his monthly insurance benefit under such title II (whether such excess is brought about by disregarding a portion of such monthly insurance benefit or otherwise)."

§ 303. Payments to States; computation of amounts; quarterly expenditures to exceed average of total expenditures for each quarter of fiscal year ending June 30, 1965.

(a) From the sums appropriated therefor, the Secretary of the Treasury shall (subject to section 1320b of this title) pay to each State which has a plan approved under this subchapter, for each quarter, beginning with the quarter commencing October 1, 1960

(4)

(E) under conditions which shall be prescribed by the Secretary, services which in the judgment of the State agency cannot be as economically or as effectively provided by the staff of such State or local agency and are not otherwise reasonably available to individuals in need of them, and which are provided, pursuant to agreement with the State agency, by the State health authority or the State agency or agencies administering or supervising the administration of the State plan for vocational rehabilitation services approved under the Vocational Rehabilitation Act or by any other State agency which the Secretary may determine to be appropriate (whether provided by its staff or by contract with public (local) or nonprofit private agencies);

(As amended Oct. 20, 1972, Pub. L. 92-512, title III, § 301(b), (d), 86 Stat. 946, 947.)

REPEAL OF SECTION EFFECTIVE JANUARY 1, 1974

Pub. L. 92-603, title III, § 303(a), (b), Oct. 30, 1972, 86 Stat. 1484, provided that this section is repealed effective January 1, 1974, except with respect to Puerto Rico, Guam, and the Virgin Islands.

REFERENCES IN TEXT

The Vocational Rehabilitation Act, referred to in subsec. (a) (4) (D), (E), which was classified to section 31 et seq. of title 29, was repealed by section 500 (a) of the Rehabilitation Act of 1973, Pub. L. 93-112, Sept. 26, 1973, 87 Stat. 357. Such section 500, classified to section 790 of title 29, provides in part that references to the Vocational Rehabilitation Act in any other provision of law shall be deemed to be references to the Rehabilitation Act of 1973, section 701 et seq. of title 29.

AMENDMENTS

1972 Subsec. (a). Pub. L. 92-512, § 301 (d), substituted "shall (subject to section 1320b of this title) pay" for "shall pay" in the text preceding par. (1).

Subsec. (a) (4) (E). Pub. L. 92-512, § 301 (b), substituted "under conditions which shall be" for "subject to limitations".

EFFECTIVE DATE OF 1972 AMENDMENT

Amendment of opening provisions of subsec. (a) by Pub. L. 92-512 effective July 1, 1972, and amendment of subsec. (a) (4) (E) by Pub. L. 92-512 effective Jan. 1, 1973, see section 301 (e) of Pub. L. 92-512, set out as a note under section 1320b of this title.

SECTION REFERRED TO IN OTHER SECTIONS This section is referred to in sections 1306a, 1320b of this title.

§§ 304, 305.

REPEAL OF SECTIONS EFFECTIVE JANUARY 1, 1974

Pub. L. 92-603, title III, § 303(a), (b), Oct. 30, 1972, 86 Stat. 1484, provided that these sections are repealed effective January 1, 1974, except with respect to Puerto Rico, Guam, and the Virgin Islands.

§ 306. Definitions.

(a) For the purposes of this subchapter, the term "old-age assistance" means money payments to, or (if provided in or after the third month before the month in which the recipient makes application for assistance) medical care in behalf of or any type of remedial care recognized under State law in behalf of, needy individuals who are 65 years of age or older, but does not include any such payments to or care in behalf of any individual who is an inmate of a public institution (except as a patient in a medical institution). Such term also includes payments which are not included within the meaning of such term under the preceding sentence, but which would be so included except that they are made on behalf of such a needy individual to another individual who (as determined in accordance with standards prescribed by the Secretary) is interested in or concerned with the welfare of such needy individual, but only with respect to a State whose State plan approved under section 302 of this title includes provision for

At the option of a State (if its plan approved under this subchapter so provides), such term (i) need

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