Subchapter XI: GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE SIMPLIFICATION
Part A: General Provisions
- Section 1301: Definitions
- Section 1301–1: Omitted
- Section 1301a: Omitted
- Section 1302: Rules and regulations; impact analyses of Medicare and Medicaid rules and regulations on small rural hospitals
- Section 1303: Separability
- Section 1304: Reservation of right to amend or repeal
- Section 1305: Short title of chapter
- Section 1306: Disclosure of information in possession of Social Security Administration or Department of Health and Human Services
- Section 1306a: Public access to State disbursement records
- Section 1306b: State data exchanges
- Section 1306c: Restriction on access to the Death Master File
- Section 1307: Penalty for fraud
- Section 1308: Additional grants to Puerto Rico, Virgin Islands, Guam, and American Samoa; limitation on total payments
- Section 1309: Amounts disregarded not to be taken into account in determining eligibility of other individuals
- Section 1310: Cooperative research or demonstration projects
- Section 1311: Public assistance payments to legal representatives
- Section 1312: Medical care guides and reports for public assistance and medical assistance
- Section 1313: Assistance for United States citizens returned from foreign countries
- Section 1314: Public advisory groups
- Section 1314a: Measurement and reporting of welfare receipt
- Section 1314b: National Advisory Committee on the Sex Trafficking of Children and Youth in the United States
- Section 1315: Demonstration projects
- Section 1315a: Center for Medicare and Medicaid Innovation
- Section 1315b: Providing Federal coverage and payment coordination for dual eligible beneficiaries
- Section 1316: Administrative and judicial review of public assistance determinations
- Section 1317: Appointment of the Administrator and Chief Actuary of the Centers for Medicare & Medicaid Services
- Section 1318: Alternative Federal payment with respect to public assistance expenditures
- Section 1319: Federal participation in payments for repairs to home owned by recipient of aid or assistance
- Section 1320: Approval of certain projects
- Section 1320a: Uniform reporting systems for health services facilities and organizations
- Section 1320a–1: Limitation on use of Federal funds for capital expenditures
- Section 1320a–1a: Transferred
- Section 1320a–2: Effect of failure to carry out State plan
- Section 1320a–2a: Reviews of child and family services programs, and of foster care and adoption assistance programs, for conformity with State plan requirements
- Section 1320a–3: Disclosure of ownership and related information; procedure; definitions; scope of requirements
- Section 1320a–3a: Disclosure requirements for other providers under part B of Medicare
- Section 1320a–4: Issuance of subpenas by Comptroller General
- Section 1320a–5: Disclosure by institutions, organizations, and agencies of owners, officers, etc., convicted of offenses related to programs; notification requirements; “managing employee” defined
- Section 1320a–6: Adjustments in SSI benefits on account of retroactive benefits under subchapter II
- Section 1320a–6a: Interagency coordination to improve program administration
- Section 1320a–7: Exclusion of certain individuals and entities from participation in Medicare and State health care programs
- Section 1320a–7a: Civil monetary penalties
- Section 1320a–7b: Criminal penalties for acts involving Federal health care programs
- Section 1320a–7c: Fraud and abuse control program
- Section 1320a–7d: Guidance regarding application of health care fraud and abuse sanctions
- Section 1320a–7e: Health care fraud and abuse data collection program
- Section 1320a–7f: Coordination of medicare and medicaid surety bond provisions
- Section 1320a–7g: Funds to reduce medicaid fraud and abuse
- Section 1320a–7h: Transparency reports and reporting of physician ownership or investment interests
- Section 1320a–7i: Reporting of information relating to drug samples
- Section 1320a–7j: Accountability requirements for facilities
- Section 1320a–7k: Medicare and Medicaid program integrity provisions
- Section 1320a–7l: Nationwide program for national and State background checks on direct patient access employees of long-term care facilities and providers
- Section 1320a–7m: Use of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse in the Medicare fee-for-service program
- Section 1320a–7n: Disclosure of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse
- Section 1320a–8: Civil monetary penalties and assessments for subchapters II, VIII and XVI
- Section 1320a–8a: Administrative procedure for imposing penalties for false or misleading statements
- Section 1320a–8b: Attempts to interfere with administration of this chapter
- Section 1320a–9: Demonstration projects
- Section 1320a–10: Effect of failure to carry out State plan
- Section 1320b: Repealed. Pub. L. 93–647, § 3(e)(1), Jan. 4, 1975, 88 Stat. 2349
- Section 1320b–1: Notification of Social Security claimant with respect to deferred vested benefits
- Section 1320b–2: Period within which certain claims must be filed
- Section 1320b–3: Applicants or recipients under public assistance programs not to be required to make election respecting certain veterans’ benefits
- Section 1320b–4: Nonprofit hospital or critical access hospital philanthropy
- Section 1320b–5: Authority to waive requirements during national emergencies
- Section 1320b–6: Exclusion of representatives and health care providers convicted of violations from participation in social security programs
- Section 1320b–7: Income and eligibility verification system
- Section 1320b–8: Hospital protocols for organ procurement and standards for organ procurement agencies
- Section 1320b–9: Improved access to, and delivery of, health care for Indians under subchapters XIX and XXI
- Section 1320b–9a: Child health quality measures
- Section 1320b–9b: Adult health quality measures
- Section 1320b–10: Prohibitions relating to references to Social Security or Medicare
- Section 1320b–11: Blood donor locator service
- Section 1320b–12: Research on outcomes of health care services and procedures
- Section 1320b–13: Social security account statements
- Section 1320b–14: Outreach efforts to increase awareness of the availability of medicare cost-sharing and subsidies for low-income individuals under subchapter XVIII
- Section 1320b–15: Protection of social security and medicare trust funds
- Section 1320b–16: Public disclosure of certain information on hospital financial interest and referral patterns
- Section 1320b–17: Cross-program recovery of overpayments from benefits
- Section 1320b–18: Repealed. Pub. L. 108–203, title II, § 210(b)(3), Mar. 2, 2004, 118 Stat. 517
- Section 1320b–19: The Ticket to Work and Self-Sufficiency Program
- Section 1320b–20: Work incentives outreach program
- Section 1320b–21: State grants for work incentives assistance to disabled beneficiaries
- Section 1320b–22: Grants to develop and establish State infrastructures to support working individuals with disabilities
- Section 1320b–23: Pharmacy benefit managers transparency requirements
- Section 1320b–24: Consultation with Tribal Technical Advisory Group
- Section 1320b–25: Reporting to law enforcement of crimes occurring in federally funded long-term care facilities
Part B: Peer Review of Utilization and Quality of Health Care Services
- Section 1320c: Purpose
- Section 1320c–1: Definition of quality improvement organization
- Section 1320c–2: Contracts with quality improvement organizations
- Section 1320c–3: Functions of quality improvement organizations
- Section 1320c–4: Right to hearing and judicial review
- Section 1320c–5: Obligations of health care practitioners and providers of health care services; sanctions and penalties; hearings and review
- Section 1320c–6: Limitation on liability
- Section 1320c–7: Application of this part to certain State programs receiving Federal financial assistance
- Section 1320c–8: Authorization for use of certain funds to administer provisions of this part
- Section 1320c–9: Prohibition against disclosure of information
- Section 1320c–10: Annual reports
- Section 1320c–11: Exemptions for religious nonmedical health care institutions
- Section 1320c–12: Medical officers in American Samoa, the Northern Mariana Islands, and the Trust Territory of the Pacific Islands to be included in the quality improvement program
- Section 1320c–13: Repealed. Pub. L. 103–432, title I, § 156(a)(1), Oct. 31, 1994, 108 Stat. 4440
- Section 1320c–14 to 1320c–19: Omitted
- Section 1320c–20: Repealed. Pub. L. 97–35, title XXI, § 2113(k), Aug. 13, 1981, 95 Stat. 795
- Section 1320c–21, 1320c–22: Omitted
Part C: Administrative Simplification
- Section 1320d: Definitions
- Section 1320d–1: General requirements for adoption of standards
- Section 1320d–2: Standards for information transactions and data elements
- Section 1320d–3: Timetables for adoption of standards
- Section 1320d–4: Requirements
- Section 1320d–5: General penalty for failure to comply with requirements and standards
- Section 1320d–6: Wrongful disclosure of individually identifiable health information
- Section 1320d–7: Effect on State law
- Section 1320d–8: Processing payment transactions by financial institutions
- Section 1320d–9: Application of HIPAA regulations to genetic information
Part D: Comparative Clinical Effectiveness Research
- Section 1320e: Comparative clinical effectiveness research
- Section 1320e–1: Limitations on certain uses of comparative clinical effectiveness research
- Section 1320e–2: Trust Fund transfers to Patient-Centered Outcomes Research Trust Fund
- Section 1320e–3: Information exchange with payroll data providers