§ 1320d. Definitions
For purposes of this part:
(1) Code set
The term ‘‘code set’’ means any set of codes
used for encoding data elements, such as ta-
bles of terms, medical concepts, medical diag-
nostic codes, or medical procedure codes.
(2) Health care clearinghouse
The
term
‘‘health
care
clearinghouse’’
means a public or private entity that proc-
esses or facilitates the processing of non-
standard data elements of health information
into standard data elements.
(3) Health care provider
The term ‘‘health care provider’’ includes a
provider of services (as defined in section
1395x(u) of this title), a provider of medical or
other health services (as defined in section
1395x(s) of this title), and any other person fur-
nishing health care services or supplies.
(4) Health information
The term ‘‘health information’’ means any
information, whether oral or recorded in any
form or medium, that—
(A) is created or received by a health care
provider, health plan, public health author-
ity, employer, life insurer, school or univer-
sity, or health care clearinghouse; and
(B) relates to the past, present, or future
physical or mental health or condition of an
individual, the provision of health care to an
individual, or the past, present, or future
payment for the provision of health care to
an individual.
(5) Health plan
The term ‘‘health plan’’ means an individual
or group plan that provides, or pays the cost
of, medical care (as such term is defined in
section 300gg–91 of this title). Such term in-
cludes the following, and any combination
thereof:
(A) A group health plan (as defined in sec-
tion 300gg–91(a) of this title), but only if the
plan—
(i) has 50 or more participants (as de-
fined in section 1002(7) of title 29); or
(ii) is ad
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Authority boundary: historical or unconfirmed source not current law verified.
Stable record: federal_law:legal_authorities:uscode2024_a702f8fe39b9b9d216fed2e2 Source file: Laws/federal/codes/united-states-code-2024/title-42/section-1320d-definitions--80700dd4fa.md Pages: Not recorded – Not recorded Passage SHA-256: 86b3c457b1a0dfdde28c21c6dc1116c917c76f6433c67dd1c87969f5bc6288ed Retained source evidence SHA-256: 0c94a3605f58d2611075ed27ec3f40d58a8644a747e16b8b7c5eafb9591aba93
Page 2746
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1320c–20
1 So in original. Probably should be ‘‘Part’’.
tions between Professional Standards Review Organiza-
tions and administrative instrumentalities.
Section 1320c–15, act Aug. 14, 1935, ch. 531, title XI,
§ 1166, as added Oct. 30, 1972, Pub. L. 92–603, title II,
§ 249F(b), 86 Stat. 1443; amended Oct. 25, 1977, Pub. L.
95–142, § 5(h), 91 Stat. 1189, related to general prohibi-
tion against disclosure of data or information and ex-
ceptions to such prohibition. See section 1320c–9 of this
title.
Section 1320c–16, act Aug. 14, 1935, ch. 531, title XI,
§ 1167, as added Oct. 30, 1972, Pub. L. 92–603, title II,
§ 249F(b), 86 Stat. 1443; amended Oct. 25, 1977, Pub. L.
95–142, § 5(i), (n), 91 Stat. 1190, 1191, related to limitation
of liability of persons providing information to Profes-
sional Standards Review Organizations and Statewide
Professional Standards Review Councils. See section
1320c–6 of this title.
Section 1320c–17, act Aug. 14, 1935, ch. 531, title XI,
§ 1168, as added Oct. 30, 1972, Pub. L. 92–603, title II,
§ 249F(b), 86 Stat. 1444; amended Dec. 31, 1975, Pub. L.
94–182, title I, § 112(c), 89 Stat. 1055; Oct. 25, 1977, Pub. L.
95–142, § 5(j), 91 Stat. 1190; Aug. 13, 1981, Pub. L. 97–35,
title XXI, § 2113(j), 95 Stat. 795, related to authorization
for use of funds for administering professional review
program, transfer of moneys between funds, and pay-
ments for Professional Standards Review Organiza-
tions. See section 1320c–8 of this title.
Section 1320c–18, act Aug. 14, 1935, ch. 531, title XI,
§ 1169, as added Oct. 30, 1972, Pub. L. 92–603, title II,
§ 249F(b), 86 Stat. 1444, related to technical assistance
given to organizations desiring to be designated as Pro-
fessional Standards Review Organizations.
Section 1320c–19, act Aug. 14, 1935, ch. 531, title XI,
§ 1170, as added Oct. 30, 1972, Pub. L. 92–603, title II,
§ 249F(b), 86 Stat. 1445, related to exemptions of Chris-
tian Science sanatoriums. See section 1320c–11 of this
title.
§ 1320c–20. Repealed. Pub. L. 97–35, title XXI,
§ 2113(k), Aug. 13, 1981, 95 Stat. 795
Section, act Aug. 14, 1935, ch. 531, title XI, § 1171, as
added Oct. 25, 1977, Pub. L. 95–142, § 5(d)(2)(D), 91 Stat.
1186, set forth provisions respecting Federal-State rela-
tions regarding memorandum of understanding be-
tween Organization and State agency.
Statutory Notes and Related Subsidiaries
EFFECTIVE DATE OF REPEAL
Repeal applicable to agreements with Professional
Standards Review Organizations entered into on or
after Oct. 1, 1981, see section 2113(o) of Pub. L. 97–35, set
out as an Effective Date of 1981 Amendment note under
section 1396a of this title.
§§ 1320c–21, 1320c–22. Omitted
Editorial Notes
CODIFICATION
Sections 1320c–21 and 1320c–22 were omitted in the
general revision of this part by Pub. L. 97–248, title I,
§ 143, Sept. 3, 1982, 96 Stat. 382.
Section 1320c–21, act Aug. 14, 1935, ch. 531, title XI,
§ 1172, as added Oct. 25, 1977, Pub. L. 95–142, § 5(k), 91
Stat. 1190; amended Aug. 13, 1981, Pub. L. 97–35, title
XXI, §§ 2113(l), 2193(c)(7), 95 Stat. 795, 827, related to an-
nual reports submitted to Congress by Secretary. See
section 1320c–10 of this title.
Section 1320c–22, act Aug. 14, 1935, ch. 531, title XI,
§ 1173, as added Oct. 25, 1977, Pub. L. 95–142, § 5(l)(1), 91
Stat. 1191; amended Dec. 5, 1980, Pub. L. 96–499, title IX,
§ 923(e), 94 Stat. 2628, provided that medical officers in
American Samoa, the Northern Mariana Islands, and
the Trust Territory of the Pacific Islands were includ-
able in program under former Part B. See section
1320c–12 of this title.
PART C—ADMINISTRATIVE SIMPLIFICATION
§ 1320d. Definitions
For purposes of this part:
(1) Code set
The term ‘‘code set’’ means any set of codes
used for encoding data elements, such as ta-
bles of terms, medical concepts, medical diag-
nostic codes, or medical procedure codes.
(2) Health care clearinghouse
The
term
‘‘health
care
clearinghouse’’
means a public or private entity that proc-
esses or facilitates the processing of non-
standard data elements of health information
into standard data elements.
(3) Health care provider
The term ‘‘health care provider’’ includes a
provider of services (as defined in section
1395x(u) of this title), a provider of medical or
other health services (as defined in section
1395x(s) of this title), and any other person fur-
nishing health care services or supplies.
(4) Health information
The term ‘‘health information’’ means any
information, whether oral or recorded in any
form or medium, that—
(A) is created or received by a health care
provider, health plan, public health author-
ity, employer, life insurer, school or univer-
sity, or health care clearinghouse; and
(B) relates to the past, present, or future
physical or mental health or condition of an
individual, the provision of health care to an
individual, or the past, present, or future
payment for the provision of health care to
an individual.
(5) Health plan
The term ‘‘health plan’’ means an individual
or group plan that provides, or pays the cost
of, medical care (as such term is defined in
section 300gg–91 of this title). Such term in-
cludes the following, and any combination
thereof:
(A) A group health plan (as defined in sec-
tion 300gg–91(a) of this title), but only if the
plan—
(i) has 50 or more participants (as de-
fined in section 1002(7) of title 29); or
(ii) is administered by an entity other
than the employer who established and
maintains the plan.
(B) A health insurance issuer (as defined in
section 300gg–91(b) of this title).
(C) A health maintenance organization (as
defined in section 300gg–91(b) of this title).
(D) Parts 1 A, B, C, or D of the Medicare
program under subchapter XVIII.
(E) The medicaid program under sub-
chapter XIX.
(F) A Medicare supplemental policy (as de-
fined in section 1395ss(g)(1) of this title).
(G) A long-term care policy, including a
nursing home fixed indemnity policy (unless
the Secretary determines that such a policy
does not provide sufficiently comprehensive
Page 2747
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1320d–1
coverage of a benefit so that the policy
should be treated as a health plan).
(H) An employee welfare benefit plan or
any other arrangement which is established
or maintained for the purpose of offering or
providing health benefits to the employees
of 2 or more employers.
(I) The health care program for active
military personnel under title 10.
(J) The veterans health care program
under chapter 17 of title 38.
(K) The Civilian Health and Medical Pro-
gram
of
the
Uniformed
Services
(CHAMPUS), as defined in section 1072(4) of
title 10.
(L) The Indian health service program
under the Indian Health Care Improvement
Act (25 U.S.C. 1601 et seq.).
(M) The Federal Employees Health Benefit
Plan under chapter 89 of title 5.
(6) Individually identifiable health information
The term ‘‘individually identifiable health
information’’ means any information, includ-
ing demographic information collected from
an individual, that—
(A) is created or received by a health care
provider, health plan, employer, or health
care clearinghouse; and
(B) relates to the past, present, or future
physical or mental health or condition of an
individual, the provision of health care to an
individual, or the past, present, or future
payment for the provision of health care to
an individual, and—
(i) identifies the individual; or
(ii) with respect to which there is a rea-
sonable basis to believe that the informa-
tion can be used to identify the individual.
(7) Standard
The term ‘‘standard’’, when used with ref-
erence to a data element of health information
or
a
transaction
referred
to
in
section
1320d–2(a)(1) of this title, means any such data
element or transaction that meets each of the
standards and implementation specifications
adopted or established by the Secretary with
respect to the data element or transaction
under sections 1320d–1 through 1320d–3 of this
title.
(8) Standard setting organization
The term ‘‘standard setting organization’’
means a standard setting organization accred-
ited by the American National Standards In-
stitute, including the National Council for
Prescription Drug Programs, that develops
standards for information transactions, data
elements, or any other standard that is nec-
essary to, or will facilitate, the implementa-
tion of this part.
(9) Operating rules
The term ‘‘operating rules’’ means the nec-
essary business rules and guidelines for the
electronic exchange of information that are
not defined by a standard or its implementa-
tion specifications as adopted for purposes of
this part.
(Aug. 14, 1935, ch. 531, title XI, § 1171, as added
Pub. L. 104–191, title II, § 262(a), Aug. 21, 1996, 110
Stat. 2021; amended Pub. L. 107–105, § 4, Dec. 27,
2001, 115 Stat. 1007; Pub. L. 111–5, div. A, title
XIII, § 13102, Feb. 17, 2009, 123 Stat. 242; Pub. L.
111–148, title I, § 1104(b)(1), Mar. 23, 2010, 124 Stat.
146.)
Editorial Notes
REFERENCES IN TEXT
The Indian Health Care Improvement Act, referred to
in par. (5)(L), is Pub. L. 94–437, Sept. 30, 1976, 90 Stat.
1400, which is classified principally to chapter 18 (§ 1601
et seq.) of Title 25, Indians. For complete classification
of this Act to the Code, see Short Title note set out
under section 1601 of Title 25 and Tables.
PRIOR PROVISIONS
A prior section 1171 of act Aug. 14, 1935, was classified
to section 1320c–20 of this title prior to repeal by Pub.
L. 97–35.
AMENDMENTS
2010—Par. (9). Pub. L. 111–148 added par. (9).
2009—Par. (5)(D). Pub. L. 111–5 substituted ‘‘C, or D’’
for ‘‘or C’’.
2001—Par. (5)(D). Pub. L. 107–105 substituted ‘‘Parts A,
B, or C’’ for ‘‘Part A or part B’’.
Statutory Notes and Related Subsidiaries
EFFECTIVE DATE OF 2010 AMENDMENT
Pub. L. 111–148, title I, § 1105, Mar. 23, 2010, 124 Stat.
154,
provided
that:
‘‘This
subtitle
[subtitle
B
(§§ 1101–1105) of title I of Pub. L. 111–148, enacting sub-
chapter I of chapter 157 of this title, amending this sec-
tion and sections 1320d–2 and 1395y of this title, enact-
ing provisions set out as a note under section 1320d–2 of
this title, and amending provisions set out as a note
under this section] shall take effect on the date of en-
actment of this Act [Mar. 23, 2010].’’
PURPOSE
Pub. L. 104–191, title II, § 261, Aug. 21, 1996, 110 Stat.
2021, as amended by Pub. L. 111–148, title I, § 1104(a),
Mar. 23, 2010, 124 Stat. 146, provided that: ‘‘It is the pur-
pose of this subtitle [subtitle F (§§ 261–264) of title II of
Pub. L. 104–191, enacting this part, amending sections
242k and 1395cc of this title, and enacting provisions set
out as a note under section 1320d–2 of this title] to im-
prove the Medicare program under title XVIII of the
Social Security Act [42 U.S.C. 1395 et seq.], the med-
icaid program under title XIX of such Act [42 U.S.C.
1396 et seq.], and the efficiency and effectiveness of the
health care system, by encouraging the development of
a health information system through the establishment
of uniform standards and requirements for the elec-
tronic transmission of certain health information and
to reduce the clerical burden on patients, health care
providers, and health plans.’’
§ 1320d–1. General requirements for adoption of
standards
(a) Applicability
Any standard adopted under this part shall
apply, in whole or in part, to the following per-
sons:
(1) A health plan.
(2) A health care clearinghouse.
(3) A health care provider who transmits any
health information in electronic form in con-
nection with a transaction referred to in sec-
tion 1320d–2(a)(1) of this title.
(b) Reduction of costs
Any standard adopted under this part shall be
consistent with the objective of reducing the ad-
Cross-references
Connections may be documented source relationships, shared citations or nearby passages. Each explains its basis; a connection alone does not establish applicability to your situation.
Federal law — U.S. Code and appendices · legal_authorities
$10,000,000 shall remain available until expended, for the establishment of an Indian Catastrophic Health Emergency Fund (hereinafter referred to as the “Fund”). On and after October 18, 1986, the Fund is to cover the Indian Health Service portion of the medical expenses of catastrophic illness falling within the responsibility of the Service and shall be administered by the Secretary of Health and Human Services, acting through the central office of the Indian Health Service. No part of the Fund or its administration shall be subject to contract or grant under the Indian Self-Determination and Education Assistance Act (Public Law 93–638) [[25 U.S.C. 5301](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title25-section5301&num=0&edition=prelim) et seq.]. There shall be deposited into the Fund all amounts recovered under the authority of the Federal Medical Care Recovery Act ([42 U.S.C. 2651](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section2651&num=0&edition=prelim) et seq.), which shall become available for obligation upon receipt and which shall remain available for obligation until expended. The Fund shall not be used to pay for health services provided to eligible Indians to the extent that alternate Federal, State, local, or private insurance resources for payment: (1) are available and accessible to the beneficiary; or (2) would be available and accessible if the beneficiary were to apply for them; or (3) would be available and accessible to other citizens similarly situated under Federal, State, or local law or regulation or private insurance program notwithstanding Indian Health Service eligibility or residency on or off a Federal Indian reservation.
Stored review status: release_metadata_unconfirmed. The source passage cites 25 U.S.C. § 1601. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
§ 1601. Congressional findings
The Congress finds the following:
(1) Federal health services to maintain and
improve the health of the Indians are con-
sonant with and required by the Federal Gov-
ernment’s historical and unique legal relation-
ship with, and resulting responsibility to, the
American Indian people.
(2) A major national goal of the United
States is to provide the resources, processes,
and structure that will enable Indian tribes
and tribal members to obtain the quantity and
quality of health care services and opportuni-
ties that will eradicate the health disparities
between Indians and the general population of
the United States.
(3) A major national goal of the United
States is to provide the quantity and quality
of health services which will permit the health
status of Indians to be raised to the highest
possible level and to encourage the maximum
participation of Indians in the planning and
management of those services.
(4) Federal health services to Indians have
resulted in a reduction in the prevalence and
incidence of preventable illnesses among, and
unnecessary and premature deaths of, Indians.
(5) Despite such services, the unmet health
needs of the American Indian people are severe
Page 241
TITLE 25—INDIANS
§ 1601
and the health status of the Indians is far
below that of the general population of the
United States.
(Pub. L. 94–437, § 2, Sept. 30, 1976, 90 Stat. 1400;
Pub. L. 102–573, § 3(a), Oct. 29, 1992, 106 Stat. 4526;
Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010,
124 Stat. 935.)
Editorial Notes
CODIFICATION
Amendment by Pub. L. 111–148 is based on section 102
of title I of S. 1790, One Hundred Eleventh Congress, as
reported by the Committee on Indian Affairs of the
Senate in Dec. 2009, which was
Stored review status: historical_2024_not_currentness_verified. The source passage cites 25 U.S.C. § 1601. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
For purposes of this part:
(1) **Code set** — The term “code set” means any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes.
(2) **Health care clearinghouse** — The term “health care clearinghouse” means a public or private entity that processes or facilitates the processing of nonstandard data elements of health information into standard data elements.
(3) **Health care provider** — The term “health care provider” includes a provider of services (as defined in [section 1395x(u) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/u&num=0&edition=prelim)), a provider of medical or other health services (as defined in [section 1395x(s) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/s&num=0&edition=prelim)), and any other person furnishing health care services or supplies.
(4) **Health information** — The term “health information” means any information, whether oral or recorded in any form or medium, that—
(A) is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and
(B) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual.
(5) **Health plan** — The term “health plan” means an individual or group plan that provides, or pays the cost of, medical care (as such term is defined in [section 300gg–91 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-9
**(a) Conditions of participation; protection of individual rights; notification of State entities; use of home health aides; medical equipment; individual’s plan of care; compliance with Federal, State, and local laws and regulations** The conditions of participation that a home health agency is required to meet under this subsection are as follows:
(1) The agency protects and promotes the rights of each individual under its care, including each of the following rights:
(A) The right to be fully informed in advance about the care and treatment to be provided by the agency, to be fully informed in advance of any changes in the care or treatment to be provided by the agency that may affect the individual’s well-being, and (except with respect to an individual adjudged incompetent) to participate in planning care and treatment or changes in care or treatment.
(B) The right to voice grievances with respect to treatment or care that is (or fails to be) furnished without discrimination or reprisal for voicing grievances.
(C) The right to confidentiality of the clinical records described in section 1395x(o)(3) of this title.
(D) The right to have one’s property treated with respect.
(E) The right to be fully informed orally and in writing (in advance of coming under the care of the agency) of—
(i) all items and services furnished by (or under arrangements with) the agency for which payment may be made under this subchapter,
(ii) the coverage available for such items and services under this subchapter, subchapter XIX, and any other Federal program of which the agency is reasonably aware,
(iii) any charges for items and services not covered under this subchapter and any charges the individual may have to pay with respect to items and services furn
Stored review status: release_metadata_unconfirmed. The source passage cites 42 U.S.C. § 1395. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
§ 1395. Prohibition against any Federal inter-
ference
Nothing in this subchapter shall be construed
to authorize any Federal officer or employee to
exercise any supervision or control over the
practice of medicine or the manner in which
medical services are provided, or over the selec-
tion, tenure, or compensation of any officer or
employee of any institution, agency, or person
providing health services; or to exercise any su-
pervision or control over the administration or
operation of any such institution, agency, or
person.
(Aug. 14, 1935, ch. 531, title XVIII, § 1801, as added
Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79
Stat. 291.)
Statutory Notes and Related Subsidiaries
SHORT TITLE
For short title of title I of Pub. L. 89–97, which en-
acted this subchapter as the ‘‘Health Insurance for the
Aged Act’’, see section 100 of Pub. L. 89–97, set out as
a Short Title of 1965 Amendment note under section
1305 of this title.
PROTECTING AND IMPROVING GUARANTEED MEDICARE
BENEFITS
Pub. L. 111–148, title III, § 3601, Mar. 23, 2010, 124 Stat.
538, provided that:
‘‘(a) PROTECTING GUARANTEED MEDICARE BENEFITS.—
Nothing in the provisions of, or amendments made by,
this Act [see Short Title note set out under section
18001 of this title] shall result in a reduction of guaran-
teed benefits under title XVIII of the Social Security
Act [42 U.S.C. 1395 et seq.].
‘‘(b) ENSURING THAT MEDICARE SAVINGS BENEFIT THE
MEDICARE
PROGRAM
AND
MEDICARE
BENEFICIARIES.—
Savings generated for the Medicare program under title
XVIII of the Social Security Act under the provisions
of, and amendments made by, this Act shall extend the
solvency of the Medicare trust funds, reduce Medicare
premiums and other cost-sharing for beneficiaries, and
improve or expand gu
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 1395. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
**(a) Establishment** There is hereby established the Medicaid and CHIP Payment and Access Commission (in this section referred to as “MACPAC”).
**(b) Duties**
(1) **Review of access policies for all States and annual reports** — MACPAC shall—
(A) review policies of the Medicaid program established under this subchapter (in this section referred to as “Medicaid”) and the State Children’s Health Insurance Program established under subchapter XXI (in this section referred to as “CHIP”) affecting access to covered items and services, including topics described in paragraph (2);
(B) make recommendations to Congress, the Secretary, and States concerning such access policies;
(C) by not later than March 15 of each year (beginning with 2010), submit a report to Congress containing the results of such reviews and MACPAC’s recommendations concerning such policies; and
(D) by not later than June 15 of each year (beginning with 2010), submit a report to Congress containing an examination of issues affecting Medicaid and CHIP, including the implications of changes in health care delivery in the United States and in the market for health care services on such programs.
(2) **Specific topics to be reviewed** — Specifically, MACPAC shall review and assess the following:
(A) *Medicaid and CHIP payment policies* — Payment policies under Medicaid and CHIP, including—
(i) the factors affecting expenditures for the efficient provision of items and services in different sectors, including the process for updating payments to medical, dental, and health professionals, hospitals, residential and long-term care providers, providers of home and community based services, Federally-qualified health centers and rural health clinics, managed care entities, and providers of ot
Stored review status: release_metadata_unconfirmed. The source passage cites 42 U.S.C. § 1396. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
§ 1396. Medicaid and CHIP Payment and Access
Commission
(a) Establishment
There is hereby established the Medicaid and
CHIP Payment and Access Commission (in this
section referred to as ‘‘MACPAC’’).
(b) Duties
(1) Review of access policies for all States and
annual reports
MACPAC shall—
(A) review policies of the Medicaid pro-
gram established under this subchapter (in
this section referred to as ‘‘Medicaid’’) and
the State Children’s Health Insurance Pro-
gram established under subchapter XXI (in
this section referred to as ‘‘CHIP’’) affecting
access to covered items and services, includ-
ing topics described in paragraph (2);
(B) make recommendations to Congress,
the Secretary, and States concerning such
access policies;
(C) by not later than March 15 of each year
(beginning with 2010), submit a report to
Congress containing the results of such re-
views and MACPAC’s recommendations con-
cerning such policies; and
(D) by not later than June 15 of each year
(beginning with 2010), submit a report to
Congress
containing
an
examination
of
issues affecting Medicaid and CHIP, includ-
ing the implications of changes in health
care delivery in the United States and in the
market for health care services on such pro-
grams.
(2) Specific topics to be reviewed
Specifically, MACPAC shall review and as-
sess the following:
(A) Medicaid and CHIP payment policies
Payment policies under Medicaid and
CHIP, including—
(i) the factors affecting expenditures for
the efficient provision of items and serv-
ices in different sectors, including the
process for updating payments to medical,
dental, and health professionals, hospitals,
residential and long-term care providers,
providers of home and community based
services, Federally-qualified health ce
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 1396. This identifies an authority to review, not proof of applicability.