42 U.S.C. 1395w-22: Benefits and beneficiary protections

2022

• Pub. L. 117–169 added subcl. (VII) and redesignated former subcl. (VII) as (VIII). Law text · (a), (VIII)

2020

• Pub. L. 116–127, §6003(a)(1)(B), added subcls. (IV) and (V). Former subcl. (IV) redesignated (VI). (Families First Coronavirus Response Act) Law text · (a), (V)
• Pub. L. 116–136, §3713(c)(1)(B), added subcl. (VI). Former subcl. (VI) redesignated (VII). (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (a)
• Pub. L. 116–127, §6003(a)(1)(A), redesignated subcl. (IV) as (VI). (Families First Coronavirus Response Act) Law text · (a)
• Pub. L. 116–136, §3713(c)(1)(A), redesignated subcl. (VI) as (VII). (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (a)
• Pub. L. 116–136, §3713(c)(2), substituted "subclauses (IV), (V), and (VI)" for "subclauses (IV) and (V)". (Coronavirus Aid, Relief, and Economic Security Act" or the "CARES Act) Law text · (a)
• Pub. L. 116–127, §6003(a)(2), inserted ", other than subclauses (IV) and (V) of such clause," after "clause (iv)". (Families First Coronavirus Response Act) Law text · (a)
• Pub. L. 116–127, §6003(a)(3), added cl. (vi). (Families First Coronavirus Response Act) Law text · (a)

2018

• Pub. L. 115–123, §50323(a)(1), inserted ", subject to subsection (m)," after "means". (Bipartisan Budget Act of 2018) Law text · (a)
• Pub. L. 115–123, §50322(a)(1), substituted "Subject to subparagraph (D), each" for "Each". (Bipartisan Budget Act of 2018) Law text · (a)
• Pub. L. 115–123, §50322(a)(2), added subpar. (D). (Bipartisan Budget Act of 2018) Law text · (a)
• Pub. L. 115–123, §50323(a)(2), added subsec. (m). (Bipartisan Budget Act of 2018) Law text · (m)
• Pub. L. 115–271 added subsec. (n). (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act" or the "SUPPORT for Patients and Communities Act) Law text · (n)

2016

• Pub. L. 114–255, §17006(c)(1), inserted "or coverage for organ acquisitions for kidney transplants, including as covered under section 1395rr(d) of this title" after "hospice care". (21st Century Cures Act) Law text · (a)
• Pub. L. 114–255, §17006(a)(2)(A), struck out subpar. (A) designation and heading, substituted "A Medicare Advantage organization" for "A Medicare+Choice organization", and struck out subpar. (B). Prior to amendment, text of subpar. (B) read as follows: "Subparagraph (A) shall not be… (21st Century Cures Act) Law text · (b)

2010

• Pub. L. 111–148, §3202(a)(1)(A), inserted ", subject to clause (iii)," after "and B or". (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §3202(a)(1)(B), added cls. (iii) to (v). (Patient Protection and Affordable Care Act) Law text · (a), (b), (c), (d), (e), (f), (g), (h), (i), (j), (k), (l), (m), (n), (o), (p), (q), (r), (s), (t), (u), (v)

2008

• Pub. L. 110–275, §165(a), added par. (7). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §162(a)(1)(A), (2)(A), in introductory provisions, substituted "Subject to paragraphs (5) and (6), the Secretary" for "The Secretary" in second sentence. (Medicare Improvements for Patients and Providers Act of 2008) Law text · (d)
• Pub. L. 110–275, §162(a)(3)(A), substituted "a sufficient number and range of providers within such category to meet the access standards in subparagraphs (A) through (E) of paragraph (1)" for "a sufficient number and range of providers within such category to provide covered ser… (Medicare Improvements for Patients and Providers Act of 2008) Law text · (d)
• Pub. L. 110–275, §162(a)(1)(B), added par. (5). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (d)
• Pub. L. 110–275, §162(a)(2)(B), added par. (6). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (d)
• Pub. L. 110–275, §163(a), struck out "(other than an MA private fee-for-service plan or an MSA plan)" before period at end. (Medicare Improvements for Patients and Providers Act of 2008) Law text · (e)
• Pub. L. 110–275, §163(b)(1), inserted at end "With respect to MA private fee-for-service plans and MSA plans, the requirements under the preceding sentence may not exceed the requirements under this subparagraph with respect to MA local plans that are preferred provider organi… (Medicare Improvements for Patients and Providers Act of 2008) Law text · (e)
• Pub. L. 110–275, §§163(b)(2), 164(f)(1), added cl. (ii) and struck out former cl. (ii). Prior to amendment, text read as follows: "The Secretary shall establish as appropriate by regulation requirements for the collection, analysis, and reporting of data that permits the meas… (Medicare Improvements for Patients and Providers Act of 2008) Law text · (e)
• Pub. L. 110–275, §163(b)(3), inserted "local" after "to" and "and MA regional plans" after "organizations" in heading and "and to MA regional plans" after "organization plans" in text. (Medicare Improvements for Patients and Providers Act of 2008) Law text · (e)
• Pub. L. 110–275, §125(b)(6), substituted "section 1395bb(a)(2)" for "section 1395bb(b)(2)". (Medicare Improvements for Patients and Providers Act of 2008) Law text · (e)

2003

• Pub. L. 108–173, §222(a)(2), substituted "Requirement" for "In general" in par. heading, designated existing provisions as subpar. (A), inserted heading, substituted "chapter, benefits under the original medicare fee-for-service program option (and, for plan years before 2006, addit… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §221(d)(3)(A), inserted "and except as provided in paragraph (6) for MA regional plans" after "MSA plans" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §948(b)(2), substituted "determination" for "policy" wherever appearing in heading and text. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §222(a)(3), which directed insertion of "Such benefits may include reductions in cost-sharing below the actuarial value specified in section 1395w–24(e)(4)(B) of this title." at the end of par. (3), was executed by making the insertion at the end of the final sub… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §900(e)(1)(F), substituted "Centers for Medicare & Medicaid Services" for "Health Care Financing Administration" in concluding provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §221(d)(3)(B), added par. (6). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §222(l)(1), inserted at end "The Secretary shall not approve a plan of an organization if the Secretary determines that the design of the plan and its benefits are likely to substantially discourage enrollment by certain MA eligible individuals with the organizat… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §722(b), amended heading and text of subpar. (I) generally. Prior to amendment, text read as follows: "A description of the organization's quality assurance program under subsection (e) of this section, if required under such section." (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §233(a)(2)(A), inserted ", if required under such section" before period at end. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (c)
• Pub. L. 108–173, §211(j)(2), inserted before period at end of concluding provisions ", except that, if a plan entirely meets such requirement with respect to a category of health care professional or provider on the basis of subparagraph (B), it may provide for a higher beneficiary … (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (d)
• Pub. L. 108–173, §211(j)(1), inserted "(other than deemed contracts or agreements under subsection (j)(6))" after "the plan has contracts or agreements". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (d)
• Pub. L. 108–173, §722(a)(1), substituted "improvement" for "assurance" in heading. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (e)
• Pub. L. 108–173, §722(a)(2), reenacted heading without change and amended text generally. Prior to amendment, text read as follows: "Each Medicare+Choice organization must have arrangements, consistent with any regulation, for an ongoing quality assurance program for health care ser… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (e)
• Pub. L. 108–173, §233(a)(1), inserted "(other than MSA plans)" after "plans". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (e)
• Pub. L. 108–173, §722(a)(2), amended par. (2) generally, substituting provisions relating to chronic care improvement programs for provisions relating to elements of the quality assurance program of an organization with respect to a Medicare+Choice plan. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (e)
• Pub. L. 108–173, §233(a)(2)(B), struck out ", a non-network MSA plan," after "fee-for-service plan" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (e)
• Pub. L. 108–173, §233(a)(2)(C), struck out ", non-network MSA plans," after "fee-for-service plans" in heading and ", a non-network MSA plan," after "fee-for-service plan" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (e)
• Pub. L. 108–173, §722(a)(2), amended par. (3) generally, substituting provisions relating to collection, analysis, and reporting of data for provisions relating to external review by an independent quality review and improvement organization. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (e)
• Pub. L. 108–173, §722(a)(3)(A), amended cl. (i) generally. Prior to amendment, cl. (i) read as follows: "Paragraphs (1) and (2) of this subsection (relating to quality assurance programs)." (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (e)
• Pub. L. 108–173, §722(a)(3)(B), added cl. (vii). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (e)
• Pub. L. 108–173, §722(a)(4), struck out par. (5), which related to report to be submitted to Congress not later than 2 years after Dec. 21, 2000, and biennially thereafter, regarding how quality assurance programs focus on racial and ethnic minorities. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (e)
• Pub. L. 108–173, §940(b)(2)(A), inserted at end "The provisions of section 1395ff(b)(1)(E)(iii) of this title shall apply with respect to dollar amounts specified in the first 2 sentences of this paragraph in the same manner as they apply to the dollar amounts specified in section 1… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (g)
• Pub. L. 108–173, §222(h)(1), inserted "the organization provides assurances satisfactory to the Secretary that" after "unless" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (j)
• Pub. L. 108–173, §222(h)(2), substituted "the organization" for "the organization—", struck out subcl. (I) designation before "provides", substituted period for ", and" at end of subcl. (I), and struck out subcl. (II), which read as follows: "conducts periodic surveys of both… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (j)
• Pub. L. 108–173, §222(h)(3), struck out cl. (iii) which read as follows: "The organization provides the Secretary with descriptive information regarding the plan, sufficient to permit the Secretary to determine whether the plan is in compliance with the requirements of this … (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (j)
• Pub. L. 108–173, §102(b), added par. (7). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (j)
• Pub. L. 108–173, §233(c), inserted "or with an organization offering an MSA plan" after "section 1395w–21(a)(2)(A) of this title". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (k)

2000

• Pub. L. 106–554, §1(a)(6) [title VI, §615], added subpar. (C). (Consolidated Appropriations Act, 2001) Law text · (a)
• Pub. L. 106–554, §1(a)(6) [title VI, §611(b)(5)], inserted concluding provisions. (Consolidated Appropriations Act, 2001) Law text · (a)
• Pub. L. 106–554, §1(a)(6) [title VI, §611(b)(1), (2)], inserted "and legislative changes in benefits" after "National coverage determinations" in heading and inserted "or legislative change in benefits required to be provided under this part" after "there is a national coverage determination" in in… (Consolidated Appropriations Act, 2001) Law text · (a)
• Pub. L. 106–554, §1(a)(6) [title VI, §611(b)(3)], inserted "or legislative change in benefits" after "such determination". (Consolidated Appropriations Act, 2001) Law text · (a)
• Pub. L. 106–554, §1(a)(6) [title VI, §611(b)(4)], inserted "or legislative change" after "if such coverage determination". (Consolidated Appropriations Act, 2001) Law text · (a)
• Pub. L. 106–554, §1(a)(6) [title VI, §616(a)], inserted concluding provisions. (Consolidated Appropriations Act, 2001) Law text · (e), (B)
• Pub. L. 106–554, §1(a)(6) [title VI, §616(b)], added par. (5). (Consolidated Appropriations Act, 2001) Law text · (e)
• Pub. L. 106–554, §1(a)(6) [title V, §521(b)], inserted at end "The provisions of section 1395ff(c)(5) of this title shall apply to independent outside entities under contract with the Secretary under this paragraph." (Consolidated Appropriations Act, 2001) Law text · (g)
• Pub. L. 106–554, §1(a)(6) [title VI, §621(a)], added subsec. (l). (Consolidated Appropriations Act, 2001) Law text · (l)

1999

• Pub. L. 106–113, §1000(a)(6) [title III, §321(k)(6)(B)(i)], struck out comma after "MSA plan" and inserted comma after "the coverage)". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (a)
• Pub. L. 106–113, §1000(a)(6) [title V, §520(a)(1)], substituted ", a non-network MSA plan, or a preferred provider organization plan" for "or a non-network MSA plan" in introductory provisions. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (e)
• Pub. L. 106–113, §1000(a)(6) [title V, §520(a)(2)], substituted ", non-network MSA plans, and preferred provider organization plans" for "and non-network MSA plans" in heading and ", a non-network MSA plan, or a preferred provider organization plan" for "or a non-network MSA plan… (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (e)
• Pub. L. 106–113, §1000(a)(6) [title V, §520(a)(3)], added subpar. (D). (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (e)
• Pub. L. 106–113, §1000(a)(6) [title V, §518], amended heading and text of par. (4) generally. Prior to amendment, text read as follows: "The Secretary shall provide that a Medicare+Choice organization is deemed to meet requirements of paragraphs (1) and (2) of this subsection and su… (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (e)
• Pub. L. 106–113, §1000(a)(6) [title III, §321(k)(6)(B)(ii)(I)], inserted "or" after "in whole". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (g)
• Pub. L. 106–113, §1000(a)(6) [title III, §321(k)(6)(B)(ii)(II)], inserted period at end. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (g)
• Pub. L. 106–113, §1000(a)(6) [title III, §321(k)(6)(B)(iii)], substituted a semicolon for a comma before "and". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (h)
• Pub. L. 106–113, §1000(a)(6) [title III, §321(k)(6)(B)(iv)], substituted "balance" for "balancing" before "billing under subparagraph (A) could" in introductory provisions. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (k)