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42 U.S.C. § 254gCharges for services by entities using Corps members

submitted 82 years ago by Pub. L. 107-251 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 484 words · no verdicts yet

in plain englishAI-generated · not legal advice

Entities with a Corps member cannot refuse care or discriminate against patients because they cannot pay, or because Medicare, Medicaid, or the Children's Health Insurance Program would cover them. These entities must set fee schedules based on local rates, and offer a sliding-scale discount based on a patient's ability to pay. For patients in federal programs, entities must accept Medicare assignment and sign Medicaid or CHIP agreements, and must reasonably try to collect all payments owed, including from third parties.

(a) Availability of services regardless of ability to pay or payment source. An entity to which a Corps member is assigned may not deny requested health care services, and may not discriminate in providing services to an individual, (1) because the individual cannot pay for the services, or (2) because payment would be made under (A) the Medicare program under title XVIII of the Social Security Act, (B) the Medicaid program under title XIX of that Act, or (C) the State children's health insurance program under title XXI of that Act. (b) Charges for services. These rules apply to charges for health care services given by an entity to which a Corps member is assigned: (1) In general. (A) Schedule of fees or payments. Except as (2) provides, the entity must prepare a schedule of fees or payments for its services, consistent with locally prevailing rates or charges and designed to cover the entity's reasonable cost of operation. (B) Schedule of discounts. Except as (2) provides, the entity must also prepare a corresponding schedule of discounts, including waivers in appropriate cases, adjusted based on a patient's ability to pay. (C) Use of schedules. The entity must make every reasonable effort to collect fees and payments from patients under these schedules, and fees or payments must be sufficiently discounted according to the (B) schedule. (2) Services to beneficiaries of Federal and federally assisted programs. For health care given to an individual who is a beneficiary of a program listed in (a)(2), the entity (A) must accept assignment under section 1842(b)(3)(B)(ii) of the Social Security Act for an individual who is a Medicare beneficiary; and (B) must enter into an appropriate agreement with (i) the State agency administering the Medicaid program, for an individual who is a Medicaid beneficiary, and (ii) the State agency administering the State children's health insurance program, for an individual who is a beneficiary of that program. (3) Collection of payments. The entity must take reasonable and appropriate steps to collect all payments due for the health care services it provides, including payments from any third party — including a Federal, State, or local government agency and any other third party — responsible for part or all of the charge for those services.
the actual law source: uscode.house.gov ↗public domain
(a) Availability of services regardless of ability to pay or payment source

An entity to which a Corps member is assigned shall not deny requested health care services, and shall not discriminate in the provision of services to an individual—

(1)

because the individual is unable to pay for the services; or

(2)

because payment for the services would be made under—

(A)

the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.);

(B)

the medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.); or

(C)

the State children’s health insurance program under title XXI of such Act (42 U.S.C. 1397aa et seq.).

(b) Charges for services

The following rules shall apply to charges for health care services provided by an entity to which a Corps member is assigned:

(1) In general
(A) Schedule of fees or payments

Except as provided in paragraph (2), the entity shall prepare a schedule of fees or payments for the entity’s services, consistent with locally prevailing rates or charges and designed to cover the entity’s reasonable cost of operation.

(B) Schedule of discounts

Except as provided in paragraph (2), the entity shall prepare a corresponding schedule of discounts (including, in appropriate cases, waivers) to be applied to the payment of such fees or payments. In preparing the schedule, the entity shall adjust the discounts on the basis of a patient’s ability to pay.

(C) Use of schedules

The entity shall make every reasonable effort to secure from patients fees and payments for services in accordance with such schedules, and fees or payments shall be sufficiently discounted in accordance with the schedule described in subparagraph (B).

(2) Services to beneficiaries of Federal and federally assisted programs

In the case of health care services furnished to an individual who is a beneficiary of a program listed in subsection (a)(2), the entity—

(A)

shall accept an assignment pursuant to section 1842(b)(3)(B)(ii) of the Social Security Act (42 U.S.C. 1395u(b)(3)(B)(ii)) with respect to an individual who is a beneficiary under the medicare program; and

(B)

shall enter into an appropriate agreement with—

(i)

the State agency administering the program under title XIX of such Act [42 U.S.C. 1396 et seq.] with respect to an individual who is a beneficiary under the medicaid program; and

(ii)

the State agency administering the program under title XXI of such Act [42 U.S.C. 1397aa et seq.] with respect to an individual who is a beneficiary under the State children’s health insurance program.

(3) Collection of payments

The entity shall take reasonable and appropriate steps to collect all payments due for health care services provided by the entity, including payments from any third party (including a Federal, State, or local government agency and any other third party) that is responsible for part or all of the charge for such services.

Source credit: (July 1, 1944, ch. 373, title III, § 334, as added Pub. L. 107–251, title III, § 305, Oct. 26, 2002, 116 Stat. 1647; amended Pub. L. 108–163, § 2(i), Dec. 6, 2003, 117 Stat. 2022.)

history & why it existsrecord from the source credit
  • 1944Enacted · Pub. L. 107-251 · 116 Stat. 1647
  • 2003Amended · Pub. L. 108-163 · 117 Stat. 2022

A history note hasn’t been published yet. The record shows enactment by Pub. L. 107-251 on 1944-07-01.

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