42 U.S.C. § 1395w — Appropriations to cover Government contributions and contingency reserve

(a) In general

From time to time, Congress may appropriate money from Treasury funds that have not otherwise been appropriated to the Federal Supplementary Medical Insurance Trust Fund for the following government contributions and amounts:

(1)(A) For each month, a government contribution for enrollees age 65 or older. Start with the total premiums for that month that are payable for those enrollees and deposited in the Trust Fund. Multiply that total by this ratio:

(i) The numerator is twice the dollar amount of the actuarially adequate rate per enrollee age 65 or older for that month, as determined under section 1395r(a)(1) of this title, minus the dollar amount of the premium per enrollee for that month, as determined under section 1395r(a)(3) of this title.

(ii) The denominator is the dollar amount of the premium per enrollee for that month.

(B) For each month, a government contribution for enrollees under age 65. Start with the total premiums for that month that are payable for those enrollees and deposited in the Trust Fund. Multiply that total by this ratio:

(i) The numerator is twice the dollar amount of the actuarially adequate rate per enrollee under age 65 for that month, as determined under section 1395r(a)(4) of this title, minus the dollar amount of the premium per enrollee for that month, as determined under section 1395r(a)(3) of this title.

(ii) The denominator is the dollar amount of the premium per enrollee for that month.

(C) Subtract the total of additional premium payments attributable to applying section 1395r(i) of this title.

(2) The Secretary^* may also determine amounts needed to put the Trust Fund, at the end of any fiscal year after June 30, 1967, in the position it would have occupied at the end of that fiscal year if both of these assumptions had applied:

(A) The government contribution equal to the premiums deposited in the Trust Fund during the fiscal year ending June 30, 1967, minus the government contribution actually appropriated for that fiscal year had been appropriated on June 30, 1967.

(B) The government contribution for premiums deposited after June 30, 1967, had been appropriated when those premiums were deposited.

(3) A government contribution equal to the payment incentives payable under sections 1395w–4(o) and 1395w–23(l)(3) of this title.

(4) A government contribution equal to the estimated total reduction in premiums payable under part B that results from setting the premium at 15 percent of the actuarial rate under section 1395r(j) of this title, instead of 25 percent of that rate, for people enrolled only to receive coverage for immunosuppressive drugs under section 1395o(b) of this title. For this purpose, the actuarial rate is calculated under section 1395r(a)(1) as if “100 percent” appeared there instead of “one-half.”

When applying paragraph (1), amounts transferred under subsection (d)(1) for the enrollees described in subsection (d)(1)(A) and (B) are treated as premiums payable and deposited in the Trust Fund under paragraph (1)(A) and (B), respectively.

When applying paragraph (1), amounts transferred under subsection (e)(1) for the enrollees described in subsection (e)(1)(A) and (B) are treated in the same way: as premiums payable and deposited under paragraph (1)(A) and (B), respectively.

For purposes of paragraph (1)(A) and (B), the government contribution under paragraph (4) is treated as premiums payable and deposited for the enrollees covered by those subparagraphs.

This section does not define “actuarially adequate rate,” “premium,” “payment incentives,” “actuarial rate,” “immunosuppressive drugs,” or “fiscal year.”

(b) Contingency reserve

To ensure prompt payment of benefits and administrative expenses during the early months of the program under this part, and to provide a contingency reserve, Congress may also appropriate money from Treasury funds that have not otherwise been appropriated. The money remains available through the end of calendar year 1969 for repayable, interest-free advances to the Trust Fund. The authorized amount is $18 multiplied by the number of people the Secretary estimates could have been covered by the insurance program in July 1966 if they had already enrolled under this part.

(c) Election under section 1395w–24

When determining the government contribution under subsection (a)(1)(A) and (B), the Secretary must disregard all of the following:

• Any premium reduction resulting from an election under section 1395w–24(f)(1)(E) of this title.

• Any credits under section 1395w–24(b)(1)(C)(iv) of this title.

• Any premium adjustment under sections 1395r(h) and 1395w–29(f) of this title.

• Any premium adjustment under section 1395r(i) of this title.

(d) Transfer of certain General Fund amounts for 2016

(1) For 2016, an amount must be transferred from the General Fund to the Trust Fund. The amount is estimated by the Chief Actuary of the Centers for Medicare & Medicaid Services. It equals the reduction in total premiums payable under this part for a month in 2016, excluding changes in amounts collected under section 1395r(i) of this title, that results from applying section 1395r(a)(5)(A) of this title to:

(A) enrollees age 65 or older; and

(B) enrollees under age 65.

These amounts must be transferred from time to time as appropriate.

(2) When applying subsection (a), premium increases made under section 1395r(a)(6) of this title must not be counted.

(3) Amounts equal to the additional premiums payable because of section 1395r(a)(6) of this title must be transferred from the Trust Fund to the General Fund of the Treasury. The transfer excludes the total payments attributable to section 1395r(i)(3)(A)(ii)(II) of this title.

(e) Transfer of certain General Fund amounts for 2021

(1) For 2021, an amount must be transferred from the General Fund to the Trust Fund. The amount is estimated by the Chief Actuary of the Centers for Medicare & Medicaid Services. It equals the reduction in total premiums payable under this part for a month in 2021, excluding changes in amounts collected under section 1395r(i) of this title, that results from applying section 1395r(a)(7) of this title to:

(A) enrollees age 65 or older; and

(B) enrollees under age 65.

These amounts must be transferred from time to time as appropriate.

(2) When applying subsection (a), premium increases made under section 1395r(a)(6) of this title must not be counted.

(3) Amounts equal to the additional premiums payable because of section 1395r(a)(6) of this title must be transferred from the Trust Fund to the General Fund of the Treasury. The transfer excludes the total payments attributable to section 1395r(i)(3)(A)(ii)(II) of this title.

(f) Transfer of certain General Fund amounts for the COVID-19 public health emergency period

(1) An amount must be transferred from the General Fund of the Treasury to the Trust Fund. The amount is estimated by the Chief Actuary of the Centers for Medicare & Medicaid Services. It equals the amounts paid in advance for items and services under this part during the period that starts on the first day of the emergency period described in section 1320b–5(g)(1)(B) of this title and ends on October 1, 2020.

(2) Amounts equal to the following total must be transferred from the Trust Fund to the General Fund of the Treasury:

(A) Amounts by which claims have offset all or part of the advance payments described in paragraph (1).

(B) Advance payments described in paragraph (1) that have been repaid in whole or in part.

(3) Amounts described in paragraphs (1) and (2) must be transferred from time to time as appropriate.

This section does not define “General Fund,” “Trust Fund,” “Chief Actuary,” “emergency period,” “items and services,” “claims,” “premium reduction,” or “premium adjustment.”