42 U.S.C. 1395n: Procedure for payment of claims of providers of services

2020

• Pub. L. 116–136, §3708(b)(5), in fourth sentence of concluding provisions, inserted "or no later than 6 months after March 27, 2020, for purposes of documentation for certification and recertification made under paragraph (2) by a nurse practitioner, clinical nurse specialist, or physi… (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (a)
• Pub. L. 116–136, §3708(b)(4), in third sentence of concluding provisions, inserted ", nurse practitioner, clinical nurse specialist, or physician assistant" after "physician". (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (a)
• Pub. L. 116–136, §3708(b)(3), in second sentence of concluding provisions, substituted "certification" for "physician certification" and "a physician, nurse practitioner, clinical nurse specialist, or physician assistant who" for "a physician who" and inserted "(or in the case of regulations to imp… (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (a)
• Pub. L. 116–136, §3708(b)(2), in first sentence of concluding provisions, inserted ", nurse practitioner, clinical nurse specialist, or physician assistant (as the case may be)" after "physician". (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (a)
• Pub. L. 116–136, §3708(b)(1)(A), in introductory provisions, inserted ", a nurse practitioner or clinical nurse specialist (as those terms are defined in section 1395x(aa)(5) of this title) who is working in accordance with State law, or a physician assistant (as defined in section … (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (a)
• Pub. L. 116–136, §3708(b)(1)(B)(i), inserted ", a nurse practitioner, a clinical nurse specialist, or a physician assistant (as the case may be)" after "physician". (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (a), (iii)
• Pub. L. 116–136, §3708(b)(1)(B)(ii), substituted "made by a physician after January 1, 2010, or by a nurse practitioner, clinical nurse specialist, or physician assistant (as the case may be) after a date specified by the Secretary (but in no case later than the date that is … (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (a)

2018

• Pub. L. 115–123 inserted "For purposes of documentation for physician certification and recertification made under paragraph (2) on or after January 1, 2019, and made with respect to home health services furnished by a home health agency, in addition to using documentation in the medic… (Bipartisan Budget Act of 2018) Law text · (a)

2010

• Pub. L. 111–148, §6404(a)(2)(B)(ii), inserted at end of concluding provisions "In applying paragraph (1), the Secretary may specify exceptions to the 1 calendar year period specified in such paragraph." (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §6404(a)(2)(B)(i), substituted "period ending 1 calendar year after the date of service;" for "period of 3 calendar years following the year in which such services are furnished (deeming any services furnished in the last 3 calendar months of any calendar year to ha… (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §6405(b)(2), as amended by Pub. L. 111–148, §10604, inserted ", or, in the case of services described in subparagraph (A), a physician enrolled under section 1395cc(j) of this title," after "a physician" in introductory provisions. (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §10605(b), inserted ", or a nurse practitioner or clinical nurse specialist (as those terms are defined in section 1395x(aa)(5) of this title) who is working in collaboration with the physician in accordance with State law, or a certified nurse-midwife (as de… (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §6407(a)(2), added cl. (iv). (Patient Protection and Affordable Care Act) Law text · (a)

2008

• Pub. L. 110–275, in second sentence, substituted "subsection (g) or (ll)(2) of section 1395x of this title" for "section 1395x(g) of this title" wherever appearing and inserted "or outpatient speech-language pathology services, respectively" before period at end. (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)

2003

• Pub. L. 108–173 substituted "leave home and" for "leave home," in fifth sentence of concluding provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)

2000

• Pub. L. 106–554, in concluding provisions, struck out ", and that absences of the individual from home are infrequent or of relatively short duration, or are attributable to the need to receive medical treatment" after "taxing effort by the individual" and inserted at end "Any absence … (Consolidated Appropriations Act, 2001) Law text · (a)

1997

• Pub. L. 105–33, §4615(a), inserted "(other than solely venipuncture for the purpose of obtaining a blood sample)" after "skilled nursing care". (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4201(c)(1), substituted "critical access" for "rural primary care" in two places. (Balanced Budget Act of 1997) Law text · (c)

1990

• Pub. L. 101–508 substituted "a hospital or a rural primary care hospital may" for "a hospital may" in first sentence, substituted "section 1395l(a)(2) of this title (or, in the case of a rural primary care hospital, in accordance with section 1395l(a)(6) of this title)" for "section 13… · (c)

1989

• Pub. L. 101–234 repealed Pub. L. 100–360, §§203(d)(1), 205(d), 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. · (a), (H)
• Pub. L. 101–239 inserted at end "A rural primary care hospital shall be considered a hospital for purposes of this subsection." · (c)

1988

• Pub. L. 100–360, §203(d)(1), added subpar. (G) relating to home intravenous drug therapy services. · (a)
• Pub. L. 100–360, §205(d), added subpar. (H) relating to in-home care provided to chronically dependent individuals. · (a)

1987

• Pub. L. 100–203, §4024(b), inserted two sentences at end clarifying "confined to his home" for purposes of par. (2)(A). · (a)
• Pub. L. 100–203, §4085(i)(4), struck out second comma at end. · (a)
• Pub. L. 100–203, §4070(b)(3), added subpar. (F). · (a)

1986

• Pub. L. 99–509, §9337(c)(2), inserted in second sentence "(or meets the requirements of such section through the operation of section 1395x(g) of this title)" in two places, and "or (through the operation of section 1395x(g) of this title) with respect to the furnishing of outpatient o… · (a)
• Pub. L. 99–509, §9337(c)(1), inserted "or outpatient occupational therapy services" in introductory provisions, "or occupational therapy services, respectively," in cl. (i), and "or qualified occupational therapist, respectively," in cl. (ii). · (a)

1984

• Pub. L. 98–369, §2354(b)(1), as amended by Pub. L. 98–617, §3(a)(3), in concluding provisions, substituted "contractual" for "contractural". · (a)
• Pub. L. 98–369, §2336(b), inserted before period at end of fourth sentence ", except that such prohibition shall not apply with respect to a home health agency which is a sole community home health agency (as determined by the Secretary)". · (a)
• Pub. L. 98–369, §2336(a), inserted sentence at end that for purposes of the preceding sentence, service by a physician as an uncompensated officer or director of a home health agency shall not constitute having a significant ownership interest in, or a significant financial or contractual relations… · (a)
• Pub. L. 98–369, §2354(b)(8)(A), struck out "and" at end. · (a), (C)
• Pub. L. 98–369, §2342(b), substituted "by a physician or by the qualified physical therapist providing such services and is periodically reviewed by a physician" for ", and is periodically reviewed, by a physician". · (a)
• Pub. L. 98–369, §2354(b)(8)(B), realigned margin of subpar. (D). · (a)
• Pub. L. 98–369, §2354(b)(9), designated concluding pars. (1) and (2) as (A) and (B), respectively, and in par. (B) inserted "(i)" after "written assurances that" and substituted "(ii) the individuals who" for "(B) the individuals who" and "return of" for "return for". · (e)

1983

• Pub. L. 98–21 inserted "(or would be if section 1395ww of this title did not apply)" after "section 1395(v)(1)(D) of this title". · (e)

1981

• Pub. L. 97–35, §2122(a)(1), substituted "needs or needed skilled nursing care on an intermittent basis or physical or speech therapy or, in the case of an individual who has been furnished home health services based on such a need and who no longer has such a need for such care o… · (a)
• Pub. L. 97–35, §2106(b)(1), inserted "and" after "physician;". · (a)
• Pub. L. 97–35, §2106(b)(1), substituted a period for "; and" at the end. · (a)

1980

• Pub. L. 96–499, §930(e), inserted sentence at end authorizing Secretary to prescribe regulations to prohibit significantly interested physicians from performing physician certification required by par. (2) for home health services. · (a)
• Pub. L. 96–499, §930(j), substituted "physical, occupational, or speech" for "physical or speech". · (a)
• Pub. L. 96–499, §944(a), inserted "by a physician or by the speech pathologist providing such services", after "has been established". · (a)
• Pub. L. 96–499, §933(b), added subpar. (E). · (a)

1976

• Pub. L. 94–437 substituted "Subject to section 1395qq of this title, no payment" for "No payment". · (d)

1972

• Pub. L. 92–603, §227(e)(2)(A), inserted reference to subsec. (e) of this section in introductory provisions. · (a)
• Pub. L. 92–603, §281(f), placed a 3-year time limitation on time within which a written request for payment is filed, with provision for reduction of limit to 1 year. · (a)
• Pub. L. 92–603, §251(b)(2), substituted "because the individual needed physical therapy services" for "because the individual needed physical therapy services on an outpatient basis". · (a)
• Pub. L. 92–603, §283(b), added subpar. (D). · (a)
• Pub. L. 92–603, §204(b), substituted "the applicable supplementary medical insurance deductible" for "$50". · (c)
• Pub. L. 92–603, §227(e)(2)(B), added subsec. (e). · (e)

1968

• Pub. L. 90–248, §§129(c)(9)(A), 130(a), inserted introductory exception phrase and included reference to subsec. (c). · (a)
• Pub. L. 90–248, §133(e)(5), inserted sentence at end defining "provider of services". · (a)
• Pub. L. 90–248, §§126(b), 133(e)(4), inserted "except services described in subparagraphs (B) and (C) of section 1395x(s)(2) of this title," after "health services," and inserted reference to subpar. (d). · (a)
• Pub. L. 90–248, §133(e)(1)–(3), added subpar. (C). · (a)
• Pub. L. 90–248, §129(c)(9)(B), added subsec. (b). Former subsec. (b) redesignated (c), in turn redesignated (d). · (b)
• Pub. L. 90–248, §130(b), added subsec. (c). Former subsec. (c), previously designated (b), redesignated (d). · (c)
• Pub. L. 90–248, §§129(c)(9)(B), 130(b), redesignated former subsec. (b) as (c), in turn as (d), respectively. · (d)