42 U.S.C. 1395y: Exclusions from coverage and medicare as secondary payer

2022

• Pub. L. 117–108 added cl. (iv). (Postal Service Reform Act of 2022) Law text · (b)

2021

• Pub. L. 117–2 designated existing provisions as par. (1) and added par. (2). (American Rescue Plan Act of 2021) Law text · (g)

2020

• Pub. L. 116–215 inserted clause (i) designation and heading and added clause (ii). (Further Continuing Appropriations Act, 2021, and Other Extensions Act) Law text · (b)

2018

• Pub. L. 115–271, §4002, amended cl. (i) generally. Prior to amendment, cl. (i) read as follows: "secure from the plan sponsor and plan participants such information as the Secretary shall specify for the purpose of identifying situations where the group health plan is or has b… (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 · (b)
• Pub. L. 115–271, §2008(c), inserted ", section 1395w–112(b)(7) of this section (including as applied pursuant to section 1395w–27(f)(3)(D) of this title)," after "this subsection". (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 · (o)
• Pub. L. 115–271, §2008(d), added par. (4). (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 · (o)

2016

• Pub. L. 114–255 added subpar. (D). (21st Century Cures Act) Law text · (l)

2015

• Pub. L. 114–10 added subpar. (E). (Medicare Access and CHIP Reauthorization Act of 2015) Law text · (b)

2014

• Pub. L. 113–188 substituted "for 2014, the Secretary shall" for "for a year, the Secretary shall". (Government Reports Elimination Act of 2014) Law text · (b)

2013

• Pub. L. 112–242, §202(a)(1), substituted "Subject to paragraph (9), a primary plan" for "A primary plan". (Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012) Law text · (b)
• Pub. L. 112–242, §205(a), inserted at end "An action may not be brought by the United States under this clause with respect to payment owed unless the complaint is filed not later than 3 years after the date of the receipt of notice of a settlement, judgment, award, or other… (Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012) Law text · (b)
• Pub. L. 112–242, §201, added cls. (vii) and (viii). (Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012) Law text · (b), (viii)
• Pub. L. 112–242, §204, inserted concluding provisions. (Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012) Law text · (b)
• Pub. L. 112–242, §203(1), substituted "may be subject to a civil money penalty of up to $1,000" for "shall be subject to a civil money penalty of $1,000". (Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012) Law text · (b)
• Pub. L. 112–242, §203(2), added subpar. (I). (Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012) Law text · (b)
• Pub. L. 112–242, §202(a)(2), added par. (9). (Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012) Law text · (b)

2011

• Pub. L. 112–40 substituted "quality improvement" for "utilization and quality control peer review". Law text · (a), (g)

2010

• Pub. L. 111–148, §4103(d)(1), added subpar. (P). (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §4103(d)(2), substituted "(K), or (P)" for "or (K)". (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §1104(d), added par. (25). (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §6402(g)(3), added subsec. (n). (Patient Protection and Affordable Care Act) Law text · (n)
• Pub. L. 111–148, §6402(h)(1), added subsec. (o). (Patient Protection and Affordable Care Act) Law text · (o)

2008

• Pub. L. 110–275, §101(a)(3), inserted "or additional preventive services (as described in section 1395x(ddd)(1) of this title)" after "succeeding subparagraph". (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §101(b)(3), (4), substituted "more" for "not later" and "1 year" for "6 months". (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §152(b)(1)(D), added subpar. (O). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §143(b)(7), substituted "outpatient physical therapy services, outpatient speech-language pathology services, or outpatient occupational therapy services" for "outpatient occupational therapy services or outpatient physical therapy services" and "subsection (g) or … (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §135(a)(2)(A), added par. (23). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
• Pub. L. 110–275, §153(b)(2), added par. (24). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)

2007

• Pub. L. 110–173 added pars. (7) and (8). (Medicare, Medicaid, and SCHIP Extension Act of 2007) Law text · (b), (8)

2006

• Pub. L. 109–171 added subpar. (N). (Deficit Reduction Act of 2005) Law text · (a)

2003

• Pub. L. 108–173, §948(a)(2)(A), struck out "established under section 1314(f) of this title" after "meetings of advisory committees" in concluding provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §731(a)(1)(A), inserted "consistent with subsection (l)" after "the Secretary shall ensure" in concluding provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §303(i)(3)(B), added subpar. (J). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §611(d)(1)(A), added subpar. (K). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §612(c), added subpar. (L). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §613(c), added subpar. (M). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §611(d)(1)(B), substituted "(H), or (K)" for "or (H)". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (a)
• Pub. L. 108–173, §301(c)(1), realigned margins. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §301(b)(1), inserted at end of concluding provisions "An entity that engages in a business, trade, or profession shall be deemed to have a self-insured plan if it carries its own risk (whether by a failure to obtain insurance, or otherwise) in whole or in part." (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §301(a)(1), struck out "promptly (as determined in accordance with regulations)" after "be expected to be made". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §301(a)(2)(B), added cl. (i). Former cl. (i) redesignated (ii). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §301(b)(2), substituted "A primary plan, and an entity that receives payment from a primary plan, shall reimburse the appropriate Trust Fund for any payment made by the Secretary under this subchapter with respect to an item or service if it is demonstrated t… (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §301(a)(2)(A), redesignated cl. (i) as (ii). Former cl. (ii) redesignated (iii). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §301(b)(3), substituted "In order to recover payment made under this subchapter for an item or service, the United States may bring an action against any or all entities that are or were required or responsible (directly, as an insurer or self-insurer, as a … (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §301(a)(2)(A), redesignated cl. (ii) as (iii). Former cl. (iii) redesignated (iv). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §301(a)(2)(A), redesignated cls. (iii) to (v) as (iv) to (vi), respectively. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §301(c)(2), struck out "such" before "paragraphs". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §900(e)(1)(J), substituted "Centers for Medicare & Medicaid Services" for "Health Care Financing Administration". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §944(a)(1), added subsec. (d). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (d)
• Pub. L. 108–173, §948(a)(1), transferred subsec. (i) of section 1314 of this title and redesignated it as subsec. (j) of this section. See Codification note above. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (j)
• Pub. L. 108–173, §948(a)(2)(B), in introductory provisions, struck out "under subsection (f)" after "appointed" and substituted "subsection (a)(1)" for "section 1395y(a)(1) of this title". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (j)
• Pub. L. 108–173, §950(a), added subsec. (k). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (k)
• Pub. L. 108–173, §731(a)(1)(B), added subsec. (l). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (l)
• Pub. L. 108–173, §731(b)(1), added subsec. (m). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (m)

2001

• Pub. L. 107–105, §3(a)(1), added par. (22). (Administrative Simplification Compliance Act) Law text · (a)
• Pub. L. 107–105, §3(a)(2), added subsec. (h). (Administrative Simplification Compliance Act) Law text · (h)

2000

• Pub. L. 106–554, §1(a)(6) [title V, §522(b)], inserted at end "In making a national coverage determination (as defined in paragraph (1)(B) of section 1395ff(f) of this title) the Secretary shall ensure that the public is afforded notice and opportunity to comment prior to implementatio… (Consolidated Appropriations Act, 2001) Law text · (a)
• Pub. L. 106–554, §1(a)(6) [title I, §102(c)], struck out "and," after "section 1395m(c)(1)(B) of this title," and inserted at end "and, in the case of screening for glaucoma, which is performed more frequently than is provided under section 1395x(uu) of this title,". (Consolidated Appropriations Act, 2001) Law text · (a)
• Pub. L. 106–554, §1(a)(6) [title IV, §432(b)(1)], struck out second comma after "section 1395x(aa)(1) of this title" and inserted "in the case of services for which payment may be made under section 1395qq(e) of this title," after "section 1395x(aa)(3) of this title,". (Consolidated Appropriations Act, 2001) Law text · (a)
• Pub. L. 106–554, §1(a)(6) [title III, §313(a)], substituted "during a period in which the resident is provided covered post-hospital extended care services (or, for services described in section 1395x(s)(2)(D) of this title, which are furnished to such an individual without regard … (Consolidated Appropriations Act, 2001) Law text · (a)

1999

• Pub. L. 106–113, §1000(a)(6) [title III, §321(k)(10)], substituted "subparagraph" for "subparagraphs". (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 III, §305(b)], inserted "(including medical supplies described in section 1395x(m)(5) of this title, but excluding durable medical equipment to the extent provided for in such section)" after "home health services". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (a)

1997

• Pub. L. 105–33, §4022(b)(1)(B), substituted "Medicare Payment Advisory Commission" for "Prospective Payment Assessment Commission". (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4102(c), inserted "and screening pelvic exam" after "screening pap smear". (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4103(c)(1), added subpar. (G). (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4104(c)(3)(A), added subpar. (H). (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4614(a), added subpar. (I). (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4104(c)(3)(B), substituted "(G), or (H)" for "or (G)". (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4103(c)(2), substituted "subparagraphs (B), (F), or (G) of paragraph (1)" for "paragraph (1)(B) or under paragraph (1)(F)". (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4511(a)(2)(C), substituted "section 1395x(s)(2)(K) of this title" for "section 1395x(s)(2)(K)(i) or 1395x(s)(2)(K)(iii) of this title". (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4201(c)(1), substituted "critical access" for "rural primary care" wherever appearing. (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–12 added par. (16). (Assisted Suicide Funding Restriction Act of 1997) Law text · (a)
• Pub. L. 105–33, §4319(b), added par. (17). (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4432(b)(1), added par. (18). (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4507(a)(2)(B), added par. (19). (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4541(b), added par. (20). (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4603(c)(2)(C), added par. (21). (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4631(a)(1)(A), substituted "in clause (iii))" for "in clause (iv))". (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4631(a)(1)(B), (C), redesignated cl. (iv) as (iii) and struck out heading and text of former cl. (iii). Text read as follows: "Clause (i) shall only apply to items and services furnished on or after January 1, 1987, and before October 1, 1998." (Balanced Budget Act of 1997) Law text · (b), (iv)
• Pub. L. 105–33, §4631(b), in concluding provisions, substituted "August 5, 1997" for "October 1, 1998" and inserted at end "Effective for items and services furnished on or after August 5, 1997, (with respect to periods beginning on or after the date that is 18 months prior to Au… (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4633(b), added subpar. (F). (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4633(a), substituted "(directly, as a third-party administrator, or otherwise) to make payment" for "under this subsection to pay" and inserted at end "The United States may not recover from a third-party administrator under this clause in cases where the thi… (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4632(a), added cl. (v). (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4631(c)(1), struck out heading and text of cl. (iii). Text read as follows: "Clause (ii) shall not apply to inquiries made after September 30, 1998." (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4022(b)(1)(B), substituted "Medicare Payment Advisory Commission" for "Prospective Payment Assessment Commission" in introductory provisions. (Balanced Budget Act of 1997) Law text · (i)

1996

• Pub. L. 104–226, §1(b)(1)(A), substituted "under subparagraph (A) for purposes of carrying out this subsection" for "under— Law text · (b)
• Pub. L. 104–226, §1(b)(1)(B), substituted "disclosed under subparagraph (B)" for "disclosed under subparagraph (B)(i)". Law text · (b)
• Pub. L. 104–224 struck out subsec. (h) which required Secretary to provide registry of all cardiac pacemaker devices and pacemaker leads for which payment was made under this chapter. Law text · (h)

1994

• Pub. L. 103–432, §145(c)(1), substituted "or which is not conducted by a facility described in section 1395m(c)(1)(B) of this title" for "or which does not meet the standards established under section 1395m(c)(3) of this title". · (a)
• Pub. L. 103–432, §156(a)(2)(D)(i), inserted "or" at end. · (a)
• Pub. L. 103–432, §147(e)(6), substituted "section 1395x(s)(2)(K)(i) or 1395x(s)(2)(K)(iii) of this title" for "section 1395x(s)(2)(K)(i) of this title". · (a)
• Pub. L. 103–432, §156(a)(2)(D)(ii), substituted period for "; or" at end. · (a)
• Pub. L. 103–432, §156(a)(2)(D)(iii), struck out par. (16) which read as follows: "furnished in connection with a surgical procedure for which a second opinion is required under section 1320c–13(c)(2) of this title and has not been obtained." · (a)
• Pub. L. 103–432, §151(c)(1)(A), substituted "older (and the spouse age 65 or older of any individual) who has current employment status with an employer" for "over (and the individual's spouse age 65 or older) who is covered under the plan by virtue of the individual's cur… · (b)
• Pub. L. 103–432, §151(c)(1)(B), substituted "employer that has 20 or more employees" for "employer or employee organization that has 20 or more individuals in current employment status". · (b)
• Pub. L. 103–432, §151(c)(9)(B), made technical amendment to directory language of Pub. L. 103–66, §13561(e)(1)(D). See 1993 Amendment note below. · (b)
• Pub. L. 103–432, §151(c)(5), substituted "paying benefits secondary to this subchapter when" for "taking into account that" in closing provisions. · (b)
• Pub. L. 103–432, §151(c)(4), substituted "this subparagraph" for "clauses (i) and (ii)" after "February 1, 1990)," in last sentence. · (b)
• Pub. L. 103–432, §151(b)(3)(A), (B), substituted "Repayment required" for "Primary plans" in heading and inserted at end "If reimbursement is not made to the appropriate Trust Fund before the expiration of the 60-day period that begins on the date such notice or other informat… · (b)
• Pub. L. 103–432, §151(a)(1)(C), added subpar. (C). · (b)
• Pub. L. 103–432, §157(b)(7), substituted "group health plan or a large group health plan" for "group health plan" in heading and text, struck out ", unless such incentive is also offered to all individuals who are eligible for coverage under the plan" after "(as defined in paragr… · (b)
• Pub. L. 103–432, §151(c)(6), substituted "section 6103(l)(12)(E)(iii) of such Code" for "section 6103(l)(12)(D)(iii) of such Code". · (b)
• Pub. L. 103–432, §151(a)(1)(A), added subpar. (D). · (b)
• Pub. L. 103–432, §151(a)(2)(A), added par. (6). · (b)

1993

• Pub. L. 103–66, §13561(e)(1)(A), amended subcls. (I) and (II) generally. Prior to amendment, subcls. (I) and (II) read as follows: · (b)
• Pub. L. 103–66, §13561(e)(1)(B), substituted "unless the plan is a plan of, or contributed to by, an employer or employee organization that has 20 or more individuals in current employment status" for "unless the plan is sponsored by or contributed to by an employer that has … · (b)
• Pub. L. 103–66, §13561(e)(1)(C), substituted "by virtue of current employment status with an employer that does not have 20 or more individuals in current employment status for each working day in each of 20 or more calendar weeks in the current calendar year and" for "by vi… · (b)
• Pub. L. 103–66, §13561(c)(2), substituted "Subparagraph (C) shall apply instead of clause (i)" for "Clause (i) shall not apply" and inserted "(without regard to entitlement under section 426 of this title)" after "individual is, or". · (b)
• Pub. L. 103–66, §13561(e)(1)(D), as amended by Pub. L. 103–432, §151(c)(9)(B), inserted before period at end ", without regard to section 5000(d) of such Code". · (b)
• Pub. L. 103–66, §13561(e)(1)(E), substituted "individuals" for "active individuals" in heading. · (b)
• Pub. L. 103–66, §13561(e)(1)(F), substituted "clause (iv)) may not take into account that an individual (or a member of the individual's family) who is covered under the plan by virtue of the individual's current employment status with an employer" for "clause (iv)(II)) may no… · (b)
• Pub. L. 103–66, §13561(c)(2), substituted "Subparagraph (C) shall apply instead of clause (i)" for "Clause (i) shall not apply" and inserted "(without regard to entitlement under section 426 of this title)" after "individual is, or". · (b)
• Pub. L. 103–66, §13561(b), substituted "1998" for "1995". · (b)
• Pub. L. 103–66, §13561(e)(1)(G), amended heading and text generally. Prior to amendment, text defined "active individual" and "large group health plan". · (b)
• Pub. L. 103–66, §13561(c)(1), (3), substituted "or eligible for benefits under this subchapter under" for "benefits under this subchapter solely by reason of" in cl. (i) and concluding provisions and substituted "before October 1, 1998" for "on or before January 1, 1996" in concl… · (b)
• Pub. L. 103–66, §13561(e)(1)(H), added cls. (ii) and (iii). · (b)
• Pub. L. 103–66, §13561(d)(1), added subpar. (E). · (b)
• Pub. L. 103–66, §13581(b)(1)(A), substituted "under—" for "under subparagraph (A) for the purposes of carrying out this subsection." and added cls. (i) and (ii) and concluding provisions. · (b)
• Pub. L. 103–66, §13581(b)(1)(B), substituted "subparagraph (B)(i)" for "subparagraph (B)". · (b)
• Pub. L. 103–66, §13561(a)(1), substituted "1998" for "1995". · (b)

1990

• Pub. L. 101–508, §4161(a)(3)(C)(iii), inserted at end "Paragraph (7) shall not apply to Federally qualified health center services described in section 1395x(aa)(3)(B) of this title." · (a)
• Pub. L. 101–508, §4163(d)(2)(A)(i), substituted "a succeeding subparagraph" for "subparagraph (B), (C), (D), or (E)". · (a)
• Pub. L. 101–508, §4163(d)(2)(A)(ii)–(iv), added subpar. (F). · (a)
• Pub. L. 101–508, §4161(a)(3)(C)(i), inserted before semicolon at end ", except in the case of Federally qualified health center services". · (a)
• Pub. L. 101–508, §4161(a)(3)(C)(ii), inserted ", in the case of Federally qualified health center services, as defined in section 1395x(aa)(3) of this title," after "section 1395x(aa)(1) of this title,". · (a)
• Pub. L. 101–508, §4163(d)(2)(B), inserted "or under paragraph (1)(F)" after "paragraph (1)(B)". · (a)
• Pub. L. 101–508, §4153(b)(2)(B), inserted "(other than eyewear described in section 1395x(s)(8) of this title)" after first reference to "eyeglasses". · (a)
• Pub. L. 101–508, §4157(c)(1), inserted ", services described by section 1395x(s)(2)(K)(i) of this title, certified nurse-midwife services, qualified psychologist services, and services of a certified registered nurse anesthetist," after "this paragraph)" and struck out before semic… · (a)
• Pub. L. 101–508, §4107(b), designated existing provisions as par. (A), substituted ", or" for "; or" at end, and added par. (B). · (a)
• Pub. L. 101–508, §4203(b), substituted "October 1, 1995" for "January 1, 1992". · (b)
• Pub. L. 101–508, §4203(c)(1)(B), inserted at end "Effective for items and services furnished on or after February 1, 1991, and on or before January 1, 1996, (with respect to periods beginning on or after February 1, 1990), clauses (i) and (ii) shall be applied by substituting '18… · (b)
• Pub. L. 101–508, §4203(c)(1)(A), substituted "during the 12-month period which begins with the first month in which the individual becomes entitled to benefits under part A under the provisions of section 426–1 of this title, or, if earlier, the first month in which the indivi… · (b)
• Pub. L. 101–508, §4204(g)(1), added subpar. (C). · (b)
• Pub. L. 101–508, §4203(a)(1), substituted "September 30, 1995" for "September 30, 1991". · (b)

1989

• Pub. L. 101–239, §6202(b)(1)(A), inserted "and medicare as secondary payer" in section catchline.
• Pub. L. 101–234 repealed Pub. L. 100–360, §204(d)(2)(A)(i), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, see 1988 Amendment note below. · (a)
• Pub. L. 101–239, §6103(b)(3)(B), substituted "section 1320b–12" for "section 1395ll(c)". · (a)
• Pub. L. 101–239, §6115(b), inserted before semicolon at end ", and, in the case of screening pap smear, which is performed more frequently than is provided under 1395x(nn) of this title". · (a)
• Pub. L. 101–234 repealed Pub. L. 100–360, §204(d)(2)(A)(ii)–(iv), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, see 1988 Amendment note below. · (a)
• Pub. L. 101–234 repealed Pub. L. 100–360, §§204(d)(2)(B), 205(e)(1), 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), (6), (7)
• Pub. L. 101–239, §6003(g)(3)(D)(xi), substituted "hospital or rural primary care hospital" for "hospital" in three places. · (a)
• Pub. L. 101–239, §6202(b)(1)(B), amended heading and text generally, substituting pars. (1) to (4) relating to medicare as secondary payer for former pars. (1) to (5) relating to items or services paid under workmen's compensation laws and end stage renal disease program. · (b)
• Pub. L. 101–239, §6202(e)(1), added subpar. (D). · (b)
• Pub. L. 101–239, §6202(a)(2)(A), added par. (5). · (b)
• Pub. L. 101–234 repealed Pub. L. 100–360, §202(d), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, see 1988 Amendment note below. · (c)
• Pub. L. 101–239, §6411(d)(2), inserted ", not including items or services furnished in an emergency room of a hospital" after "(other than an emergency item or service". · (e)

1988

• Pub. L. 100–360, §204(d)(2)(A)(i), substituted "a succeeding subparagraph" for "subparagraph (B), (C), (D), or (E)". · (a)
• Pub. L. 100–360, §204(d)(2)(A)(ii)–(iv), added subpar. (F) relating to screening mammography. · (a)
• Pub. L. 100–360, §205(e)(1)(A), as amended by Pub. L. 100–485, §608(d)(7), added subpar. (G) relating to in-home care for chronically dependent individuals. · (a)
• Pub. L. 100–360, §205(e)(1)(B), inserted "and except, in the case of in-home care, as is otherwise permitted under paragraph (1)(G)" after "paragraph (1)(C)". · (a)
• Pub. L. 100–360, §204(d)(2)(B), inserted "or under paragraph (1)(F)" after "(1)(B)". · (a)
• Pub. L. 100–360, §411(f)(4)(D)(i), inserted "(including subsequent insertion of an intraocular lens)" after "operation". · (a)
• Pub. L. 100–360, §202(d), designated existing provisions as par. (1), redesignated former par. (1) as subpar. (A), redesignated former subpars. (A) to (D) as cls. (i) to (iv), redesignated former par. (2) as subpar. (B), redesignated former subpar. (A) as cl. (i) and substituted "subpa… · (c)
• Pub. L. 100–360, §411(i)(4)(D)(i), as amended by Pub. L. 100–485, §608(d)(24)(C)(i), designated existing provisions of subsec. (e) as par. (1), redesignated former par. (1) as subpar. (A), substituted ", 1320a–7a, 1320c–5 or 1395u(j)(2)" for "or section 1320a–7a", and redesignated f… · (e)
• Pub. L. 100–360, §411(i)(4)(D)(ii), as amended by Pub. L. 100–485, §608(d)(24)(C)(ii), amended former section 1395aaa of this title by striking out the catchline "Limitation of liability of beneficiaries with respect to services furnished by excluded individuals and entities", subst… · (e)

1987

• Pub. L. 100–203, §4085(i)(15), substituted "(D), or (E)" for "or (D)". · (a)
• Pub. L. 100–203, §4072(c), inserted ", other than shoes furnished pursuant to section 1395x(s)(12) of this title" before semicolon. · (a)
• Pub. L. 100–203, §4085(i)(16), substituted "a patient" for "an patient". · (a)
• Pub. L. 100–203, §4009(j)(6)(C), made technical amendment to Pub. L. 99–509, §9320(h)(1). See 1986 Amendment note below. · (a)
• Pub. L. 100–203, §4036(a)(1), substituted "can reasonably be expected to be made under such a plan" for "the Secretary determines will be made under such a plan as promptly as would otherwise be the case if payment were made by the Secretary under this subchapter". · (b)
• Pub. L. 100–203, §4034(a), substituted "subsection (b) of section 5000 of the Internal Revenue Code of 1986 without regard to subsection (d) of such section" for "section 5000(b) of the Internal Revenue Code of 1986". · (b)
• Pub. L. 100–93, §8(c)(1)(A), struck out subsec. (d), which provided that no payment be made under this subchapter for any item or services to an individual by a person where Secretary determines such person knowingly and willfully made any false statement or representation of a materia… · (d)
• Pub. L. 100–93, §10, added par. (2). See 1988 Amendment note above. · (e)
• Pub. L. 100–93, §8(c)(1)(B), amended subsec. (e) generally. Prior to amendment, subsec. (e) read as follows: "No payment may be made under this subchapter with respect to any item or service furnished by a physician or other individual during the period when he is barred pursuant to section 1320a–7… · (e)
• Pub. L. 100–203, §4039(c)(1)(A), substituted "law (and any amount paid to a provider under any such warranty)," for "law,". · (h)
• Pub. L. 100–203, §4039(c)(1)(B), inserted "in determining the amount subject to repayment under paragraph (2)(C)," after "(3),". · (h)
• Pub. L. 100–203, §4039(c)(1)(C), added subpar. (C). · (h)
• Pub. L. 100–93, §8(c)(3), substituted "subsections (c), (f), and (g) of section 1320a–7 of this title" for "paragraphs (2) and (3) of subsection (d) of this section". · (h)
• Pub. L. 100–203, §4039(c)(1)(D), substituted ", has improperly" for "or has improperly" and inserted "or has failed to make repayment to the Secretary as required under paragraph (2)(C)," after "(2)(B),". · (h)

1986

• Pub. L. 99–509, §9316(b), added subpar. (E). · (a)
• Pub. L. 99–509, §9343(c)(1), substituted "patient" for "inpatient". · (a)
• Pub. L. 99–509, §9320(h)(1), as amended by Pub. L. 100–203, §4009(j)(6)(C), inserted "or are services of a certified registered nurse anesthetist" after "hospital" at end. · (a)
• Pub. L. 99–272, §9307(a), added par. (15). · (a)
• Pub. L. 99–272, §9401(c)(1), added par. (16). · (a)
• Pub. L. 99–514 substituted "Internal Revenue Code of 1986" for "Internal Revenue Code of 1954". · (b)
• Pub. L. 99–272, §9201(a)(1), substituted "(or to the spouse of such individual)" for "who is under 70 years of age during any part of such month (or to the spouse of such individual, if the spouse is under 70 years of age during any part of such month)". · (b)
• Pub. L. 99–272, §9201(a)(2), struck out "and ending with the month before the month in which such individual attains the age of 70" after "section 426(a) of this title". · (b)
• Pub. L. 99–514 substituted "Internal Revenue Code of 1986" for "Internal Revenue Code of 1954". · (b)
• Pub. L. 99–509, §9319(a), added par. (4). · (b)
• Pub. L. 99–509, §9319(b), added par. (5). · (b)

1984

• Pub. L. 98–369, §2354(b)(30), struck out second comma after "dental procedure". · (a)
• Pub. L. 98–369, §2344(a), substituted "to be made promptly" for "to be made" and "has been or could be made under such a law" for "has been made under such a law", and inserted "In order to recover payment made under this subchapter for an item or service, the United States may brin… · (b)
• Pub. L. 98–369, §2344(b), substituted "has been or could be made under a plan" for "has been made under a plan", and inserted "In order to recover payment made under this subchapter for an item or service, the United States may bring an action against any entity which would be re… · (b)
• Pub. L. 98–369, §2301(a), struck out "over 64 but" before "under 70 years" in two places. · (b)
• Pub. L. 98–369, §2344(c), substituted "has been or could be made under a group health plan" for "has been made under a group health plan", and inserted "In order to recover payment made under this subchapter for an item or service, the United States may bring an action agains… · (b)
• Pub. L. 98–369, §2354(b)(31), inserted "before the month" after "ending with the month". · (b)
• Pub. L. 98–369, §2304(c), added subsec. (h). · (h)
• Pub. L. 98–369, §2313(c), added subsec. (i). · (i)

1983

• Pub. L. 98–21, §601(f)(1), inserted reference to subpar. (D). · (a)
• Pub. L. 98–21, §601(f)(2)–(4), added subpar. (D). · (a)
• Pub. L. 98–21, §602(e), added par. (14). · (a)
• Pub. L. 97–448 inserted "in any month" after "service furnished", and "during any part of such month" after "70 years of age" wherever appearing. · (b)

1982

• Pub. L. 97–248, §122(f)(1), designated existing provisions as subpars. (A) and (B), in subpar. (A) as so designated inserted exception to provisions for items and services described in subpar. (B) or (C), substituted "and" for "or" as the connector between provisions, and added subp… · (a)
• Pub. L. 97–248, §122(f)(2), inserted "(except, in the case of hospice care, as is otherwise permitted under paragraph (1)(C))". · (a)
• Pub. L. 97–248, §122(f)(3), substituted "paragraph (1)(B)" for "paragraph (1)". · (a)
• Pub. L. 97–248, §122(f)(4), inserted "(except, in the case of hospice care, as is otherwise permitted under paragraph (1)(C))". · (a)
• Pub. L. 97–248, §128(a)(2), struck out "or plan" after "service has been made under such a law". · (b)
• Pub. L. 97–248, §128(a)(3), substituted "section 162(i)(2)" for "section 162(h)(2)". · (b)
• Pub. L. 97–248, §128(a)(4), inserted "furnished" before "to an individual". · (b)
• Pub. L. 97–248, §116(b), added par. (3). · (b)
• Pub. L. 97–248, §148(a), substituted "on the basis of information acquired by the Secretary in the administration of this subchapter" for ", on the basis of reports transmitted to him in accordance with section 1320c–6 of this title (or, in the absence of any such report, on the … · (d)
• Pub. L. 97–248, §122(g)(1), substituted "paragraph (1)(A)" for "paragraph (1)". · (f)
• Pub. L. 97–248, §142, added subsec. (g). · (g)

1981

• Pub. L. 97–35, §2146(a), designated existing provisions as par. (1) and added par. (2). · (b)
• Pub. L. 97–35, §2103(a)(1), added subsec. (c). · (c)
• Pub. L. 97–35, §2152(a), added subsec. (f). · (f)

1980

• Pub. L. 96–611, §1(a)(3)(A), inserted ", or, in the case of items and services described in section 1395x(s)(10) of this title, which are not reasonable and necessary for the prevention of illness" after "of a malformed body member". · (a)
• Pub. L. 96–611, §1(a)(3)(B), inserted "(except as otherwise allowed under section 1395x(s)(10) of this title and paragraph (1))" after "immunizations". · (a)
• Pub. L. 96–499, §936(c), inserted "or because of the severity of the dental procedure," after "and clinical status". · (a)
• Pub. L. 96–499, §939(a), struck out ", warts," after "corns". · (a)
• Pub. L. 96–499, §953, inserted "or under an automobile or liability insurance policy or plan (including a self-insured plan) or under no fault insurance" and ", policy, plan, or insurance" after "or a State" and ", policy, plan, or insurance" after "law or plan" and inserted provision … · (b)
• Pub. L. 96–272 added par. (4). · (d)
• Pub. L. 96–499, §913(b), substituted provisions barring payment under this subchapter with respect to items or services furnished by a physician or other individual during a period when such physician or other individual was barred pursuant to section 1320a–7 of this title from partici… · (e)

1977

• Pub. L. 95–210 substituted "except in the case of rural health clinic services, as defined in section 1395x(aa)(1) of this title, and in such other cases as the Secretary may specify" for "except in such cases as the Secretary may specify". · (a)
• Pub. L. 95–142, §13(b)(1), struck out requirement for concurrence of appropriate program review team for finding of Secretary under this paragraph. · (d)
• Pub. L. 95–142, §13(b)(2), substituted provisions relating to determinations by the Secretary on the basis of reports transmitted to him in accordance with section 1320c–6 of this title or other data acquired in the administration of this subchapter, for provisions relating to de… · (d)
• Pub. L. 95–142, §13(a), struck out par. (4) which set forth provisions relating to appointment and functions of program review teams. · (d)
• Pub. L. 95–142, §7(a), added subsec. (e). · (e)

1975

• Pub. L. 94–182 struck out subsec. (c) prohibiting payments to Federal employees under this subchapter unless a determination and certification by the Secretary of a modification of any health benefits plan under chapter 89 of Title 5 was made which would allow a Federal employee benefi… · (c)

1974

• Pub. L. 93–480 substituted "January 1, 1976" for "January 1, 1975". · (c)

1973

• Pub. L. 93–233 substituted "the provision of such dental services if the individual, because of his underlying medical condition and clinical status, requires hospitalization in connection with the provision of such services" for "a dental procedure where the individual suffers fro… · (a)

1972

• Pub. L. 92–603, §211(c)(1), inserted reference to physicians' services and ambulance services furnished an individual in conjunction with emergency inpatient hospital services. · (a)
• Pub. L. 92–603, §256(c), authorized payment under part A in the case of inpatient hospital services in connection with a dental procedure where the individual suffers from impairments of such severity as to require hospitalization. · (a)
• Pub. L. 92–603, §210, added subsec. (c). · (c)
• Pub. L. 92–603, §229(a), added subsec. (d). · (d)

1968

• Pub. L. 90–248, §128, prohibited payment for procedures performed (during the course of any eye examination) to determine the refractive state of the eyes. · (a)
• Pub. L. 90–248, §127(b), added par. (13). · (a)