Any individual entitled to insurance benefits under this subchapter may obtain health services from any institution, agency, or person qualified to participate under this subchapter if such institution, agency, or person undertakes to provide him such services.
Subject to the provisions of this subsection, nothing in this subchapter shall prohibit a physician or practitioner from entering into a private contract with a medicare beneficiary for any item or service-
Paragraph (1) shall not apply to any contract unless-
Any contract to provide items and services to which paragraph (1) applies shall clearly indicate to the medicare beneficiary that by signing such contract the beneficiary-
Such contract shall also clearly indicate whether the physician or practitioner is excluded from participation under the medicare program under sectionof this title.
Paragraph (1) shall not apply to any contract entered into by a physician or practitioner unless an affidavit described in subparagraph (B) is in effect during the period any item or service is to be provided pursuant to the contract.
An affidavit is described in this subparagraph if-
If a physician or practitioner signing an affidavit under subparagraph (B) knowingly and willfully submits a claim under this subchapter for any item or service provided during the applicable 2-year period (or receives any reimbursement or amount described in paragraph (1)(B) for any such item or service) with respect to such affidavit-
In this subsection, the term "applicable 2-year period" means, with respect to an affidavit of a physician or practitioner under subparagraph (B), the 2-year period beginning on the date the affidavit is signed and includes each subsequent 2-year period unless the physician or practitioner involved provides notice to the Secretary (in a form and manner specified by the Secretary), not later than 30 days before the end of the previous 2-year period, that the physician or practitioner does not want to extend the application of the affidavit for such subsequent 2-year period.
Sectionof this title shall not apply with respect to any item or service provided to a medicare beneficiary under a contract described in paragraph (1).
Beginning not later than February 1, 2016, the Secretary shall make publicly available through an appropriate publicly accessible website of the Department of Health and Human Services information on the number and characteristics of opt-out physicians and practitioners and shall update such information on such website not less often than annually.
The information to be made available under subparagraph (A) shall include at least the following with respect to opt-out physicians and practitioners:
In this subsection:
The term "medicare beneficiary" means an individual who is entitled to benefits under part A or enrolled under part B.
The term "physician" has the meaning given such term by paragraphs (1), (2), (3), and (4) of sectionof this title.
The term "practitioner" has the meaning given such term by sectionof this title.
The term "opt-out physician or practitioner" means a physician or practitioner who has in effect an affidavit under paragraph (3)(B).
42 U.S.C. § 1395a
AMENDMENTS2015-Subsec. (b)(3)(B)(ii). Pub. L. 114-10, §106(a)(1)(A)(i), substituted "during the applicable 2-year period (as defined in subparagraph (D))" for "during the 2-year period beginning on the date the affidavit is signed". Subsec. (b)(3)(C). Pub. L. 114-10, §106(a)(1)(A)(ii), substituted "during the applicable 2-year period" for "during the 2-year period described in subparagraph (B)(ii)" in introductory provisions. Subsec. (b)(3)(D). Pub. L. 114-10, §106(a)(1)(A)(iii), added subpar. (D).Subsec. (b)(5). Pub. L. 114-10, §106(a)(2)(C), added par. (5). Former par. (5) redesignated (6).Subsec. (b)(5)(D). Pub. L. 114-10, §106(a)(2)(A), added subpar. (D). Subsec. (b)(6). Pub. L. 114-10, §106(a)(2)(B), redesignated par. (5) as (6).2003-Subsec. (b)(5)(B). Pub. L. 108-173 substituted "paragraphs (1), (2), (3), and (4) of section 1395x(r)" for "section 1395x(r)(1)". 1997- Pub. L. 105-33 designated existing provisions as subsec. (a), inserted heading, and added subsec. (b).
EFFECTIVE DATE OF 2015 AMENDMENT Pub. L. 114-10, title I, §106(a)(1)(B), Apr. 16, 2015, 129 Stat. 138, provided that: "The amendments made by subparagraph (A) [amending this section] shall apply to affidavits entered into on or after the date that is 60 days after the date of the enactment of this Act [Apr. 16, 2015]."
EFFECTIVE DATE OF 1997 AMENDMENT Pub. L. 105-33, title IV, §4507(c), Aug. 5, 1997, 111 Stat. 442, provided that: "The amendment made by subsection (a) [amending this section and sectionof this title] shall apply with respect to contracts entered into on and after January 1, 1998."
UPDATING THE WELCOME TO MEDICARE PACKAGE Pub. L. 114-255, div. C, title XVII, §170037003,, 130 Stat. 1331, provided that:"(a) IN GENERAL.-Not later than 12 months after the last day of the period for the request of information described in subsection (b), the Secretary of Health and Human Services shall, taking into consideration information collected pursuant to subsection (b), update the information included in the Welcome to Medicare package to include information, presented in a clear and simple manner, about options for receiving benefits under the Medicare program under title XVIII of the Social Security Act ( et seq.), including through the original medicare fee-for-service program under parts A and B of such title ( et seq., et seq.), Medicare Advantage plans under part C of such title ( et seq.), and prescription drug plans under part D of such title ( et seq.)). The Secretary shall make subsequent updates to the information included in the Welcome to Medicare package as appropriate."(b) REQUEST FOR INFORMATION.-Not later than 6 months after the date of the enactment of this Act [Dec. 13, 2016], the Secretary of Health and Human Services shall request information, including recommendations, from stakeholders (including patient advocates, issuers, and employers) on information included in the Welcome to Medicare package, including pertinent data and information regarding enrollment and coverage for Medicare eligible individuals."
REPORT TO CONGRESS ON EFFECT OF PRIVATE CONTRACTS Pub. L. 105-33, title IV, §4507(b), Aug. 5, 1997, 111 Stat. 441, required a report to be submitted to Congress no later than Oct. 1, 2001, on the effect on the program under title IV of Pub. L. 105-33 of certain private contracts.
- The term "Secretary" means the Secretary of Housing and Urban Development.1 See References in Text note below.
- The term "person" means an individual, a trust or estate, a partnership, or a corporation.