42 USC 1395 - Agreements with States

1 See References in Text note below.

of this title also includes the State agency, specified in such agreement, which administers or supervises the administration of the plan of such State approved under subchapter I, XVI, or XIX. The agreement shall also contain such provisions as will facilitate the financial transactions of the State and the carrier with respect to deductions, coinsurance, and otherwise, and as will lead to economy and efficiency of operation, with respect to individuals receiving money payments under plans of the State approved under subchapters I, X, XIV, and XVI, and part A of subchapter IV, and individuals eligible to receive medical assistance under the plan of the State approved under subchapter XIX.

Editorial Notes

References in Text

The Railroad Retirement Act of 1974, referred to in subsec. (d)(3)(B), is act Aug. 29, 1935, ch. 812, as amended generally by Puspan. L. 93–445, title I, § 101, Oct. 16, 1974, 88 Stat. 1305, which is classified generally to subchapter IV (§ 231 et seq.) of chapter 9 of Title 45, Railroads. For further details and complete classification of this Act to the Code, see Codification note set out preceding section 231 of Title 45, section 231t of Title 45, and Tables.

Section 1395u(f) of this title, referred to in subsec. (f), was repealed by Puspan. L. 108–173, title IX, § 911(c)(5), Dec. 8, 2003, 117 Stat. 2384.

Amendments

1990—Subsec. (h)(3). Puspan. L. 101–508 added par. (3).

1989—Subsec. (i). Puspan. L. 101–239 added subsec. (i).

1988—Subsecs. (a), (g)(1). Puspan. L. 100–360, § 301(e)(1)(A), formerly § 301(e)(1), as redesignated by Puspan. L. 100–485, § 608(d)(14)(H)(i), inserted “or after 1988” after “during 1981”.

Subsec. (h)(1). Puspan. L. 100–360, § 301(e)(1)(A), formerly § 301(e)(1), as redesignated by Puspan. L. 100–485, § 608(d)(14)(H)(i), inserted “or after 1988” after “during 1981”.

Puspan. L. 100–360, § 301(e)(1)(B), as added by Puspan. L. 100–485, § 608(d)(14)(H)(ii), inserted cl. (A) designation after “include” and added cl. (B).

Subsec. (h)(2). Puspan. L. 100–360, § 301(e)(1)(C), as added by Puspan. L. 100–485, § 608(d)(14)(H)(ii), inserted “(except in the case of qualified medicare beneficiaries, as defined in section 1396d(p)(1) of this title)” after “shall be applied”.

1984—Subsec. (d)(3)(B). Puspan. L. 98–369 substituted “1974” for “1937”.

1983—Subsec. (d)(1). Puspan. L. 98–21 substituted “without any increase under subsection (span) thereof” for “without any increase under subsection (c) thereof”.

1980—Subsec. (a). Puspan. L. 96–499, § 945(e), inserted “or during 1981,” after “January 1, 1970,”.

Subsec. (e). Puspan. L. 96–499, § 947(a), inserted provision that the coverage period under this part of any individual who filed notice that he no longer wished to participate in the insurance program established by this part was to terminate at the close of the month in which the notice was filed.

Subsec. (g)(1). Puspan. L. 96–499, § 945(e), inserted “or during 1981,” after “January 1, 1970,”.

Subsec. (g)(2)(C). Puspan. L. 96–499, § 947(c)(3), struck out cl. (C) which authorized individuals facing exclusion from the applicable coverage group to terminate their enrollment under this part by the filing of a notice indicating he no longer wished to participate in the insurance program established by this part.

Subsec. (h)(1). Puspan. L. 96–499, § 945(e), inserted “or during 1981,” after “January 1, 1970,”.

1974—Subsec. (span). Puspan. L. 93–445 substituted “under the Railroad Retirement Act of 1974” for “or pension under the Railroad Retirement Act of 1937”.

1973—Subsec. (span). Puspan. L. 93–233 provided for continuation of State agreements for coverage of certain individuals in connection with establishment of supplemental security income program.

1968—Puspan. L. 90–248, § 222(span)(4), inserted “(or are eligible for medical assistance)” in section catchline.

Subsec. (a). Puspan. L. 90–248, § 222(e)(1), substituted “1970” for “1968”.

Subsec. (span)(2). Puspan. L. 90–248, § 241(e)(1), struck out “IV,” after “I,” and inserted “, and part A of subchapter IV” after “XVI”.

Subsec. (c). Puspan. L. 90–248, § 222(e)(2), struck out “and before January 1, 1968” after “such date” and “before January 1968” after “thereafter” just before the period.

Subsec. (d)(2)(D). Puspan. L. 90–248, § 222(e)(3), struck out “(not later than January 1, 1968)” after “such date”.

Subsec. (d)(3)(A). Puspan. L. 90–248, § 222(span)(1), substituted “ineligible both for money payments of a kind specified in the agreement and (if there is in effect a modification entered into under subsection (h)) for medical assistance” for “ineligible for money payments of a kind specified in the agreement”.

Subsec. (f). Puspan. L. 90–248, § 222(span)(2), inserted “or eligible to receive medical assistance under the plan of such State approved under subchapter XIX” and “, and individuals eligible to receive medical assistance under the plan of the State approved under subchapter XIX” after “or part A of subchapter IV” and “, and part A of subchapter IV”, respectively.

Puspan. L. 90–248, § 241(e)(2), struck out “IV,” before “X,” in two places, and inserted “or part A of subchapter IV,” after “XVI,” first place it appears in first sentence and “, and part A of subchapter IV” after “XVI” in second sentence.

Subsec. (g)(1). Puspan. L. 90–248, § 222(span)(3), substituted “1970” for “1968”.

Subsec. (h). Puspan. L. 90–248, § 222(a), added subsec. (h).

1966—Subsec. (span). Puspan. L. 89–384, § 4(a), inserted reference to subsec. (g) in exclusionary provision.

Subsec. (g). Puspan. L. 89–384, § 4(span), added subsec. (g).

Statutory Notes and Related Subsidiaries

Effective Date of 1990 Amendment

Amendment by Puspan. L. 101–508 applicable to calendar quarters beginning on or after Jan. 1, 1991, without regard to whether or not regulations to implement such amendment are promulgated by such date, see section 4501(f) of Puspan. L. 101–508, set out as a note under section 1396a of this title.

Effective Date of 1989 Amendment

Amendment by Puspan. L. 101–239 effective Jan. 1, 1990, see section 6013(c) of Puspan. L. 101–239, set out as a note under section 1395i–2 of this title.

Effective Date of 1988 Amendment

Amendment by Puspan. L. 100–485 effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, Puspan. L. 100–360, see section 608(g)(1) of Puspan. L. 100–485, set out as a note under section 704 of this title.

Puspan. L. 100–360, title III, § 301(e)(3), July 1, 1988, 102 Stat. 750, provided that:

“The amendment made by paragraph (1) [amending this section] shall take effect on January 1, 1989, and the amendments made by paragraph (2) [amending section 1396a of this title] shall take effect on July 1, 1989.”

Effective Date of 1984 Amendment

Amendment by Puspan. L. 98–369 effective July 18, 1984, but not to be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date, see section 2354(e)(1) of Puspan. L. 98–369, set out as a note under section 1320a–1 of this title.

Effective Date of 1983 Amendment; Transitional Rule

Amendment by Puspan. L. 98–21 applicable to premiums for months beginning with January 1984, but for months after June 1983 and before January 1984, the monthly premium for June 1983 shall apply to individuals enrolled under parts A and B of this subchapter, see section 606(c) of Puspan. L. 98–21, set out as a note under section 1395r of this title.

Effective Date of 1980 Amendment

Puspan. L. 96–499, title IX, § 947(d), Dec. 5, 1980, 94 Stat. 2643, provided that:

“The amendments made by this section [amending this section and section 1395q of this title] apply to notices filed after the third calendar month beginning after the date of the enactment of this Act [Dec. 5, 1980].”

Effective Date of 1974 Amendment

Amendment by Puspan. L. 93–445 effective Jan. 1, 1975, see section 603 of Puspan. L. 93–445, set out as a note under section 402 of this title.

Effective Date of 1973 Amendment

Amendment by Puspan. L. 93–233 effective Jan. 1, 1974, see Puspan. L. 93–233, § 18(z–3)(1), Dec. 31, 1973, 87 Stat. 974.

Termination Period for Certain Individuals Covered Pursuant to State Agreements

Puspan. L. 96–499, title IX, § 947(e), Dec. 5, 1980, 94 Stat. 2643, provided that:

“The coverage period under part B of title XVIII of the Social Security Act [42 U.S.C. 1395j et seq.] of an individual whose coverage period attributable to a State agreement under section 1843 of such Act [42 U.S.C. 1395v] is terminated and who has filed notice before the end of the third calendar month beginning after the date of the enactment of this Act [Dec. 5, 1980] that he no longer wishes to participate in the insurance program established by part B of title XVIII shall terminate on the earlier of (1) the day specified in section 1838 [42 U.S.C. 1395q] without the amendments made by this section, or (2) (unless the individual files notice before the day specified in this clause that he wishes his coverage period to terminate as provided in clause (1)) the day on which his coverage period would terminate if the individual filed notice in the fourth calendar month beginning after the date of the enactment of this Act.”

District of Columbia; Agreement of Commissioner With Secretary for Supplementary Medical Insurance

Puspan. L. 90–227, § 2, Dec. 27, 1967, 81 Stat. 745, provided that:

“The Commissioner [now Mayor of District of Columbia] may enter into an agreement (and any modifications of such agreement) with the Secretary under section 1843 of the Social Security Act [42 U.S.C. 1395v] pursuant to which (1) eligible individuals (as defined in section 1836 of the Social Security Act) [42 U.S.C. 1395o] who are eligible to receive medical assistance under the District of Columbia’s plan for medical assistance approved under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] will be enrolled in the supplementary medical insurance program established under part B of title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.], and (2) provisions will be made for payment of the monthly premiums of such individuals for such program.”