42 cfr part 405

42 cfr part 405 DEFAULT

§ Evidence, procedure, and certification for payments

(a) Rules and regulations; procedures

The Commissioner of Social Security shall have full power and authority to make rules and regulations and to establish procedures, not inconsistent with the provisions of this subchapter, which are necessary or appropriate to carry out such provisions, and shall adopt reasonable and proper rules and regulations to regulate and provide for the nature and extent of the proofs and evidence and the method of taking and furnishing the same in order to establish the right to benefits hereunder.

(b) Administrative determination of entitlement to benefits; findings of fact; hearings; investigations; evidentiary hearings in reconsiderations of disability benefit terminations; subsequent applications

(1) The Commissioner of Social Security is directed to make findings of fact, and decisions as to the rights of any individual applying for a payment under this subchapter. Any such decision by the Commissioner of Social Security which involves a determination of disability and which is in whole or in part unfavorable to such individual shall contain a statement of the case, in understandable language, setting forth a discussion of the evidence, and stating the Commissioner's determination and the reason or reasons upon which it is based. Upon request by any such individual or upon request by a wife, divorced wife, widow, surviving divorced wife, surviving divorced mother, surviving divorced father, husband, divorced husband, widower, surviving divorced husband, child, or parent who makes a showing in writing that his or her rights may be prejudiced by any decision the Commissioner of Social Security has rendered, the Commissioner shall give such applicant and such other individual reasonable notice and opportunity for a hearing with respect to such decision, and, if a hearing is held, shall, on the basis of evidence adduced at the hearing, affirm, modify, or reverse the Commissioner's findings of fact and such decision. Any such request with respect to such a decision must be filed within sixty days after notice of such decision is received by the individual making such request. The Commissioner of Social Security is further authorized, on the Commissioner's own motion, to hold such hearings and to conduct such investigations and other proceedings as the Commissioner may deem necessary or proper for the administration of this subchapter. In the course of any hearing, investigation, or other proceeding, the Commissioner may administer oaths and affirmations, examine witnesses, and receive evidence. Evidence may be received at any hearing before the Commissioner of Social Security even though inadmissible under rules of evidence applicable to court procedure.

(2) In any case where-

(A) an individual is a recipient of disability insurance benefits, or of child's, widow's, or widower's insurance benefits based on disability,

(B) the physical or mental impairment on the basis of which such benefits are payable is found to have ceased, not to have existed, or to no longer be disabling, and

(C) as a consequence of the finding described in subparagraph (B), such individual is determined by the Commissioner of Social Security not to be entitled to such benefits,


any reconsideration of the finding described in subparagraph (B), in connection with a reconsideration by the Commissioner of Social Security (before any hearing under paragraph (1) on the issue of such entitlement) of the Commissioner's determination described in subparagraph (C), shall be made only after opportunity for an evidentiary hearing, with regard to the finding described in subparagraph (B), which is reasonably accessible to such individual. Any reconsideration of a finding described in subparagraph (B) may be made either by the State agency or the Commissioner of Social Security where the finding was originally made by the State agency, and shall be made by the Commissioner of Social Security where the finding was originally made by the Commissioner of Social Security. In the case of a reconsideration by a State agency of a finding described in subparagraph (B) which was originally made by such State agency, the evidentiary hearing shall be held by an adjudicatory unit of the State agency other than the unit that made the finding described in subparagraph (B). In the case of a reconsideration by the Commissioner of Social Security of a finding described in subparagraph (B) which was originally made by the Commissioner of Social Security, the evidentiary hearing shall be held by a person other than the person or persons who made the finding described in subparagraph (B).

(3)(A) A failure to timely request review of an initial adverse determination with respect to an application for any benefit under this subchapter or an adverse determination on reconsideration of such an initial determination shall not serve as a basis for denial of a subsequent application for any benefit under this subchapter if the applicant demonstrates that the applicant, or any other individual referred to in paragraph (1), failed to so request such a review acting in good faith reliance upon incorrect, incomplete, or misleading information, relating to the consequences of reapplying for benefits in lieu of seeking review of an adverse determination, provided by any officer or employee of the Social Security Administration or any State agency acting under section of this title.

(B) In any notice of an adverse determination with respect to which a review may be requested under paragraph (1), the Commissioner of Social Security shall describe in clear and specific language the effect on possible entitlement to benefits under this subchapter of choosing to reapply in lieu of requesting review of the determination.

(c) Wage records

(1) For the purposes of this subsection-

(A) The term "year" means a calendar year when used with respect to wages and a taxable year when used with respect to self-employment income.

(B) The term "time limitation" means a period of three years, three months, and fifteen days.

(C) The term "survivor" means an individual's spouse, surviving divorced wife, surviving divorced husband, surviving divorced mother, surviving divorced father, child, or parent, who survives such individual.

(D) The term "period" when used with respect to self-employment income means a taxable year and when used with respect to wages means-

(i) a quarter if wages were reported or should have been reported on a quarterly basis on tax returns filed with the Secretary of the Treasury or his delegate under section of the Internal Revenue Code of or regulations thereunder (or on reports filed by a State under section (e) 1 of this title (as in effect prior to December 31, ) or regulations thereunder),

(ii) a year if wages were reported or should have been reported on a yearly basis on such tax returns or reports, or

(iii) the half year beginning January 1 or July 1 in the case of wages which were reported or should have been reported for calendar year


(2)(A) On the basis of information obtained by or submitted to the Commissioner of Social Security, and after such verification thereof as the Commissioner deems necessary, the Commissioner of Social Security shall establish and maintain records of the amounts of wages paid to, and the amounts of self-employment income derived by, each individual and of the periods in which such wages were paid and such income was derived and, upon request, shall inform any individual or his survivor, or the legal representative of such individual or his estate, of the amounts of wages and self-employment income of such individual and the periods during which such wages were paid and such income was derived, as shown by such records at the time of such request.

(B)(i) In carrying out the Commissioner's duties under subparagraph (A) and subparagraph (F), the Commissioner of Social Security shall take affirmative measures to assure that social security account numbers will, to the maximum extent practicable, be assigned to all members of appropriate groups or categories of individuals by assigning such numbers (or ascertaining that such numbers have already been assigned):

(I) to aliens at the time of their lawful admission to the United States either for permanent residence or under other authority of law permitting them to engage in employment in the United States and to other aliens at such time as their status is so changed as to make it lawful for them to engage in such employment;

(II) to any individual who is an applicant for or recipient of benefits under any program financed in whole or in part from Federal funds including any child on whose behalf such benefits are claimed by another person; and

(III) to any other individual when it appears that he could have been but was not assigned an account number under the provisions of subclauses (I) or (II) but only after such investigation as is necessary to establish to the satisfaction of the Commissioner of Social Security, the identity of such individual, the fact that an account number has not already been assigned to such individual, and the fact that such individual is a citizen or a noncitizen who is not, because of his alien status, prohibited from engaging in employment;


and, in carrying out such duties, the Commissioner of Social Security is authorized to take affirmative measures to assure the issuance of social security numbers:

(IV) to or on behalf of children who are below school age at the request of their parents or guardians; and

(V) to children of school age at the time of their first enrollment in school.


(ii) The Commissioner of Social Security shall require of applicants for social security account numbers such evidence as may be necessary to establish the age, citizenship, or alien status, and true identity of such applicants, and to determine which (if any) social security account number has previously been assigned to such individual. With respect to an application for a social security account number for an individual who has not attained the age of 18 before such application, such evidence shall include the information described in subparagraph (C)(ii).

(iii) In carrying out the requirements of this subparagraph, the Commissioner of Social Security shall enter into such agreements as may be necessary with the Attorney General and other officials and with State and local welfare agencies and school authorities (including nonpublic school authorities).

(C)(i) It is the policy of the United States that any State (or political subdivision thereof) may, in the administration of any tax, general public assistance, driver's license, or motor vehicle registration law within its jurisdiction, utilize the social security account numbers issued by the Commissioner of Social Security for the purpose of establishing the identification of individuals affected by such law, and may require any individual who is or appears to be so affected to furnish to such State (or political subdivision thereof) or any agency thereof having administrative responsibility for the law involved, the social security account number (or numbers, if he has more than one such number) issued to him by the Commissioner of Social Security.

(ii) In the administration of any law involving the issuance of a birth certificate, each State shall require each parent to furnish to such State (or political subdivision thereof) or any agency thereof having administrative responsibility for the law involved, the social security account number (or numbers, if the parent has more than one such number) issued to the parent unless the State (in accordance with regulations prescribed by the Commissioner of Social Security) finds good cause for not requiring the furnishing of such number. The State shall make numbers furnished under this subclause available to the Commissioner of Social Security and the agency administering the State's plan under part D of subchapter IV in accordance with Federal or State law and regulation. Such numbers shall not be recorded on the birth certificate. A State shall not use any social security account number, obtained with respect to the issuance by the State of a birth certificate, for any purpose other than for the enforcement of child support orders in effect in the State, unless section 7(a) of the Privacy Act of does not prohibit the State from requiring the disclosure of such number, by reason of the State having adopted, before January 1, , a statute or regulation requiring such disclosure.

(iii)(I) In the administration of section 9 of the Food and Nutrition Act of (7 U.S.C. ) involving the determination of the qualifications of applicants under such Act [7 U.S.C. et seq.], the Secretary of Agriculture may require each applicant retail store or wholesale food concern to furnish to the Secretary of Agriculture the social security account number of each individual who is an officer of the store or concern and, in the case of a privately owned applicant, furnish the social security account numbers of the owners of such applicant. No officer or employee of the Department of Agriculture shall have access to any such number for any purpose other than the establishment and maintenance of a list of the names and social security account numbers of such individuals for use in determining those applicants who have been previously sanctioned or convicted under section 12 or 15 of such Act (7 U.S.C. or ).

(II) The Secretary of Agriculture may share any information contained in any list referred to in subclause (I) with any other agency or instrumentality of the United States which otherwise has access to social security account numbers in accordance with this subsection or other applicable Federal law, except that the Secretary of Agriculture may share such information only to the extent that such Secretary determines such sharing would assist in verifying and matching such information against information maintained by such other agency or instrumentality. Any such information shared pursuant to this subclause may be used by such other agency or instrumentality only for the purpose of effective administration and enforcement of the Food and Nutrition Act of [7 U.S.C. et seq.] or for the purpose of investigation of violations of other Federal laws or enforcement of such laws.

(III) The Secretary of Agriculture, and the head of any other agency or instrumentality referred to in this subclause, shall restrict, to the satisfaction of the Commissioner of Social Security, access to social security account numbers obtained pursuant to this clause only to officers and employees of the United States whose duties or responsibilities require access for the purposes described in subclause (II).

(IV) The Secretary of Agriculture, and the head of any agency or instrumentality with which information is shared pursuant to clause 2 (II), shall provide such other safeguards as the Commissioner of Social Security determines to be necessary or appropriate to protect the confidentiality of the social security account numbers.

(iv) In the administration of section of the Federal Crop Insurance Act [7 U.S.C. ], the Federal Crop Insurance Corporation may require each policyholder and each reinsured company to furnish to the insurer or to the Corporation the social security account number of such policyholder, subject to the requirements of this clause. No officer or employee of the Federal Crop Insurance Corporation shall have access to any such number for any purpose other than the establishment of a system of records necessary for the effective administration of such Act [7 U.S.C. et seq.]. The Manager of the Corporation may require each policyholder to provide to the Manager, at such times and in such manner as prescribed by the Manager, the social security account number of each individual that holds or acquires a substantial beneficial interest in the policyholder. For purposes of this clause, the term "substantial beneficial interest" means not less than 5 percent of all beneficial interest in the policyholder. The Secretary of Agriculture shall restrict, to the satisfaction of the Commissioner of Social Security, access to social security account numbers obtained pursuant to this clause only to officers and employees of the United States or authorized persons whose duties or responsibilities require access for the administration of the Federal Crop Insurance Act. The Secretary of Agriculture shall provide such other safeguards as the Commissioner of Social Security determines to be necessary or appropriate to protect the confidentiality of such social security account numbers. For purposes of this clause the term "authorized person" means an officer or employee of an insurer whom the Manager of the Corporation designates by rule, subject to appropriate safeguards including a prohibition against the release of such social security account number (other than to the Corporation) by such person.

(v) If and to the extent that any provision of Federal law heretofore enacted is inconsistent with the policy set forth in clause (i), such provision shall, on and after October 4, , be null, void, and of no effect. If and to the extent that any such provision is inconsistent with the requirement set forth in clause (ii), such provision shall, on and after October 13, , be null, void, and of no effect.

(vi)(I) For purposes of clause (i) of this subparagraph, an agency of a State (or political subdivision thereof) charged with the administration of any general public assistance, driver's license, or motor vehicle registration law which did not use the social security account number for identification under a law or regulation adopted before January 1, , may require an individual to disclose his or her social security number to such agency solely for the purpose of administering the laws referred to in clause (i) above and for the purpose of responding to requests for information from an agency administering a program funded under part A of subchapter IV or an agency operating pursuant to the provisions of part D of such subchapter.

(II) Any State or political subdivision thereof (and any person acting as an agent of such an agency or instrumentality), in the administration of any driver's license or motor vehicle registration law within its jurisdiction, may not display a social security account number issued by the Commissioner of Social Security (or any derivative of such number) on any driver's license, motor vehicle registration, or personal identification card (as defined in section (a)(2) of the 9/11 Commission Implementation Act of ), or include, on any such license, registration, or personal identification card, a magnetic strip, bar code, or other means of communication which conveys such number (or derivative thereof).

(vii) For purposes of this subparagraph, the term "State" includes the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, the Commonwealth of the Northern Marianas, and the Trust Territory of the Pacific Islands.

(viii)(I) Social security account numbers and related records that are obtained or maintained by authorized persons pursuant to any provision of law enacted on or after October 1, , shall be confidential, and no authorized person shall disclose any such social security account number or related record.

(II) Paragraphs (1), (2), and (3) of section (a) of the Internal Revenue Code of shall apply with respect to the unauthorized willful disclosure to any person of social security account numbers and related records obtained or maintained by an authorized person pursuant to a provision of law enacted on or after October 1, , in the same manner and to the same extent as such paragraphs apply with respect to unauthorized disclosures of return and return information described in such paragraphs. Paragraph (4) of section (a) of such Code shall apply with respect to the willful offer of any item of material value in exchange for any such social security account number or related record in the same manner and to the same extent as such paragraph applies with respect to offers (in exchange for any return or return information) described in such paragraph.

(III) For purposes of this clause, the term "authorized person" means an officer or employee of the United States, an officer or employee of any State, political subdivision of a State, or agency of a State or political subdivision of a State, and any other person (or officer or employee thereof), who has or had access to social security account numbers or related records pursuant to any provision of law enacted on or after October 1, For purposes of this subclause, the term "officer or employee" includes a former officer or employee.

(IV) For purposes of this clause, the term "related record" means any record, list, or compilation that indicates, directly or indirectly, the identity of any individual with respect to whom a social security account number or a request for a social security account number is maintained pursuant to this clause.

(ix) In the administration of the provisions of chapter 81 of title 5 and the Longshore and Harbor Workers' Compensation Act (33 U.S.C. et seq.), the Secretary of Labor may require by regulation that any person filing a notice of injury or a claim for benefits under such provisions provide as part of such notice or claim such person's social security account number, subject to the requirements of this clause. No officer or employee of the Department of Labor shall have access to any such number for any purpose other than the establishment of a system of records necessary for the effective administration of such provisions. The Secretary of Labor shall restrict, to the satisfaction of the Commissioner of Social Security, access to social security account numbers obtained pursuant to this clause to officers and employees of the United States whose duties or responsibilities require access for the administration or enforcement of such provisions. The Secretary of Labor shall provide such other safeguards as the Commissioner of Social Security determines to be necessary or appropriate to protect the confidentiality of the social security account numbers.

(x) The Secretary of Health and Human Services, and the Exchanges established under section of the Patient Protection and Affordable Care Act [42 U.S.C. ], are authorized to collect and use the names and social security account numbers of individuals as required to administer the provisions of, and the amendments made by, the such Act.3

(xi) No Federal, State, or local agency may display the Social Security 4 account number of any individual, or any derivative of such number, on any check issued for any payment by the Federal, State, or local agency.

(xii) No Federal, State, or local agency may employ, or enter into a contract for the use or employment of, prisoners in any capacity that would allow such prisoners access to the Social Security 4 account numbers of other individuals. For purposes of this clause, the term "prisoner" means an individual confined in a jail, prison, or other penal institution or correctional facility pursuant to such individual's conviction of a criminal offense.

(xiii) The Secretary of Health and Human Services, in consultation with the Commissioner of Social Security, shall establish cost-effective procedures to ensure that a Social Security 4 account number (or derivative thereof) is not displayed, coded, or embedded on the Medicare card issued to an individual who is entitled to benefits under part A of subchapter XVIII or enrolled under part B of subchapter XVIII and that any other identifier displayed on such card is not identifiable as a Social Security 4 account number (or derivative thereof).

(D)(i) It is the policy of the United States that-

(I) any State (or any political subdivision of a State) and any authorized blood donation facility may utilize the social security account numbers issued by the Commissioner of Social Security for the purpose of identifying blood donors, and

(II) any State (or political subdivision of a State) may require any individual who donates blood within such State (or political subdivision) to furnish to such State (or political subdivision), to any agency thereof having related administrative responsibility, or to any authorized blood donation facility the social security account number (or numbers, if the donor has more than one such number) issued to the donor by the Commissioner of Social Security.


(ii) If and to the extent that any provision of Federal law enacted before November 10, , is inconsistent with the policy set forth in clause (i), such provision shall, on and after November 10, , be null, void, and of no effect.

(iii) For purposes of this subparagraph-

(I) the term "authorized blood donation facility" means an entity described in section b–11(h)(1)(B) of this title, and

(II) the term "State" includes the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, the Commonwealth of the Northern Marianas, and the Trust Territory of the Pacific Islands.


(E)(i) It is the policy of the United States that-

(I) any State (or any political subdivision of a State) may utilize the social security account numbers issued by the Commissioner of Social Security for the additional purposes described in clause (ii) if such numbers have been collected and are otherwise utilized by such State (or political subdivision) in accordance with applicable law, and

(II) any district court of the United States may use, for such additional purposes, any such social security account numbers which have been so collected and are so utilized by any State.


(ii) The additional purposes described in this clause are the following:

(I) Identifying duplicate names of individuals on master lists used for jury selection purposes.

(II) Identifying on such master lists those individuals who are ineligible to serve on a jury by reason of their conviction of a felony.


(iii) To the extent that any provision of Federal law enacted before August 15, , is inconsistent with the policy set forth in clause (i), such provision shall, on and after August 15, , be null, void, and of no effect.

(iv) For purposes of this subparagraph, the term "State" has the meaning such term has in subparagraph (D).

(F) The Commissioner of Social Security shall require, as a condition for receipt of benefits under this subchapter, that an individual furnish satisfactory proof of a social security account number assigned to such individual by the Commissioner of Social Security or, in the case of an individual to whom no such number has been assigned, that such individual make proper application for assignment of such a number.

(G) The Commissioner of Social Security shall issue a social security card to each individual at the time of the issuance of a social security account number to such individual. The social security card shall be made of banknote paper, and (to the maximum extent practicable) shall be a card which cannot be counterfeited.

(H) The Commissioner of Social Security shall share with the Secretary of the Treasury the information obtained by the Commissioner pursuant to the second sentence of subparagraph (B)(ii) and to subparagraph (C)(ii) for the purpose of administering those sections of the Internal Revenue Code of which grant tax benefits based on support or residence of children.

(3) The Commissioner's records shall be evidence for the purpose of proceedings before the Commissioner of Social Security or any court of the amounts of wages paid to, and self-employment income derived by, an individual and of the periods in which such wages were paid and such income was derived. The absence of an entry in such records as to wages alleged to have been paid to, or as to self-employment income alleged to have been derived by, an individual in any period shall be evidence that no such alleged wages were paid to, or that no such alleged income was derived by, such individual during such period.

(4) Prior to the expiration of the time limitation following any year the Commissioner of Social Security may, if it is brought to the Commissioner's attention that any entry of wages or self-employment income in the Commissioner's records for such year is erroneous or that any item of wages or self-employment income for such year has been omitted from such records, correct such entry or include such omitted item in the Commissioner's records, as the case may be. After the expiration of the time limitation following any year-

(A) the Commissioner's records (with changes, if any, made pursuant to paragraph (5) of this subsection) of the amounts of wages paid to, and self-employment income derived by, an individual during any period in such year shall be conclusive for the purposes of this subchapter;

(B) the absence of an entry in the Commissioner's records as to the wages alleged to have been paid by an employer to an individual during any period in such year shall be presumptive evidence for the purposes of this subchapter that no such alleged wages were paid to such individual in such period; and

(C) the absence of an entry in the Commissioner's records as to the self-employment income alleged to have been derived by an individual in such year shall be conclusive for the purposes of this subchapter that no such alleged self-employment income was derived by such individual in such year unless it is shown that he filed a tax return of his self-employment income for such year before the expiration of the time limitation following such year, in which case the Commissioner of Social Security shall include in the Commissioner's records the self-employment income of such individual for such year.


(5) After the expiration of the time limitation following any year in which wages were paid or alleged to have been paid to, or self-employment income was derived or alleged to have been derived by, an individual, the Commissioner of Social Security may change or delete any entry with respect to wages or self-employment income in the Commissioner's records of such year for such individual or include in the Commissioner's records of such year for such individual any omitted item of wages or self-employment income but only-

(A) if an application for monthly benefits or for a lump-sum death payment was filed within the time limitation following such year; except that no such change, deletion, or inclusion may be made pursuant to this subparagraph after a final decision upon the application for monthly benefits or lump-sum death payment;

(B) if within the time limitation following such year an individual or his survivor makes a request for a change or deletion, or for an inclusion of an omitted item, and alleges in writing that the Commissioner's records of the wages paid to, or the self-employment income derived by, such individual in such year are in one or more respects erroneous; except that no such change, deletion, or inclusion may be made pursuant to this subparagraph after a final decision upon such request. Written notice of the Commissioner's decision on any such request shall be given to the individual who made the request;

(C) to correct errors apparent on the face of such records;

(D) to transfer items to records of the Railroad Retirement Board if such items were credited under this subchapter when they should have been credited under the Railroad Retirement Act of or [45 U.S.C. a et seq., et seq.], or to enter items transferred by the Railroad Retirement Board which have been credited under the Railroad Retirement Act of or when they should have been credited under this subchapter;

(E) to delete or reduce the amount of any entry which is erroneous as a result of fraud;

(F) to conform the Commissioner's records to-

(i) tax returns or portions thereof (including information returns and other written statements) filed with the Commissioner of Internal Revenue under title VIII of the Social Security Act, under subchapter E of chapter 1 or subchapter A of chapter 9 of the Internal Revenue Code of , under chapter 2 or 21 of the Internal Revenue Code of or the Internal Revenue Code of , or under regulations made under authority of such title, subchapter, or chapter;

(ii) wage reports filed by a State pursuant to an agreement under section of this title or regulations of the Commissioner of Social Security thereunder; or

(iii) assessments of amounts due under an agreement pursuant to section of this title (as in effect prior to December 31, ), if such assessments are made within the period specified in subsection (q) 1 of such section (as so in effect), or allowances of credits or refunds of overpayments by a State under an agreement pursuant to such section;


except that no amount of self-employment income of an individual for any taxable year (if such return or statement was filed after the expiration of the time limitation following the taxable year) shall be included in the Commissioner's records pursuant to this subparagraph;

(G) to correct errors made in the allocation, to individuals or periods, of wages or self-employment income entered in the records of the Commissioner of Social Security;

(H) to include wages paid during any period in such year to an individual by an employer;

(I) to enter items which constitute remuneration for employment under subsection (o), such entries to be in accordance with certified reports of records made by the Railroad Retirement Board pursuant to section 5(k)(3) of the Railroad Retirement Act of [45 U.S.C. e(k)(3)] or section 7(b)(7) of the Railroad Retirement Act of [45 U.S.C. f(b)(7)]; or

(J) to include self-employment income for any taxable year, up to, but not in excess of, the amount of wages deleted by the Commissioner of Social Security as payments erroneously included in such records as wages paid to such individual, if such income (or net earnings from self-employment), not already included in such records as self-employment income, is included in a return or statement (referred to in subparagraph (F) of this subsection) filed before the expiration of the time limitation following the taxable year in which such deletion of wages is made.


(6) Written notice of any deletion or reduction under paragraph (4) or (5) of this subsection shall be given to the individual whose record is involved or to his survivor, except that (A) in the case of a deletion or reduction with respect to any entry of wages such notice shall be given to such individual only if he has previously been notified by the Commissioner of Social Security of the amount of his wages for the period involved, and (B) such notice shall be given to such survivor only if he or the individual whose record is involved has previously been notified by the Commissioner of Social Security of the amount of such individual's wages and self-employment income for the period involved.

(7) Upon request in writing (within such period, after any change or refusal of a request for a change of the Commissioner's records pursuant to this subsection, as the Commissioner of Social Security may prescribe), opportunity for hearing with respect to such change or refusal shall be afforded to any individual or his survivor. If a hearing is held pursuant to this paragraph the Commissioner of Social Security shall make findings of fact and a decision based upon the evidence adduced at such hearing and shall include any omitted items, or change or delete any entry, in the Commissioner's records as may be required by such findings and decision.

(8) A translation into English by a third party of a statement made in a foreign language by an applicant for or beneficiary of monthly insurance benefits under this subchapter shall not be regarded as reliable for any purpose under this subchapter unless the third party, under penalty of perjury-

(A) certifies that the translation is accurate; and

(B) discloses the nature and scope of the relationship between the third party and the applicant or recipient, as the case may be.


(9) Decisions of the Commissioner of Social Security under this subsection shall be reviewable by commencing a civil action in the United States district court as provided in subsection (g).

(d) Issuance of subpenas in administrative proceedings

For the purpose of any hearing, investigation, or other proceeding authorized or directed under this subchapter, or relative to any other matter within the Commissioner's jurisdiction hereunder, the Commissioner of Social Security shall have power to issue subpenas requiring the attendance and testimony of witnesses and the production of any evidence that relates to any matter under investigation or in question before the Commissioner of Social Security. Such attendance of witnesses and production of evidence at the designated place of such hearing, investigation, or other proceeding may be required from any place in the United States or in any Territory or possession thereof. Subpenas of the Commissioner of Social Security shall be served by anyone authorized by the Commissioner (1) by delivering a copy thereof to the individual named therein, or (2) by registered mail or by certified mail addressed to such individual at his last dwelling place or principal place of business. A verified return by the individual so serving the subpena setting forth the manner of service, or, in the case of service by registered mail or by certified mail, the return post-office receipt therefor signed by the individual so served, shall be proof of service. Witnesses so subpenaed shall be paid the same fees and mileage as are paid witnesses in the district courts of the United States.

(e) Judicial enforcement of subpenas; contempt

In case of contumacy by, or refusal to obey a subpena duly served upon, any person, any district court of the United States for the judicial district in which said person charged with contumacy or refusal to obey is found or resides or transacts business, upon application by the Commissioner of Social Security, shall have jurisdiction to issue an order requiring such person to appear and give testimony, or to appear and produce evidence, or both; any failure to obey such order of the court may be punished by said court as contempt thereof.

(f) Repealed. title II, §, Oct. 15, ,

(g) Judicial review

Any individual, after any final decision of the Commissioner of Social Security made after a hearing to which he was a party, irrespective of the amount in controversy, may obtain a review of such decision by a civil action commenced within sixty days after the mailing to him of notice of such decision or within such further time as the Commissioner of Social Security may allow. Such action shall be brought in the district court of the United States for the judicial district in which the plaintiff resides, or has his principal place of business, or, if he does not reside or have his principal place of business within any such judicial district, in the United States District Court for the District of Columbia. As part of the Commissioner's answer the Commissioner of Social Security shall file a certified copy of the transcript of the record including the evidence upon which the findings and decision complained of are based. The court shall have power to enter, upon the pleadings and transcript of the record, a judgment affirming, modifying, or reversing the decision of the Commissioner of Social Security, with or without remanding the cause for a rehearing. The findings of the Commissioner of Social Security as to any fact, if supported by substantial evidence, shall be conclusive, and where a claim has been denied by the Commissioner of Social Security or a decision is rendered under subsection (b) of this section which is adverse to an individual who was a party to the hearing before the Commissioner of Social Security, because of failure of the claimant or such individual to submit proof in conformity with any regulation prescribed under subsection (a) of this section, the court shall review only the question of conformity with such regulations and the validity of such regulations. Such additional or modified findings of fact and decision shall be reviewable only to the extent provided for review of the original findings of fact and decision. The judgment of the court shall be final except that it shall be subject to review in the same manner as a judgment in other civil actions. Any action instituted in accordance with this subsection shall survive notwithstanding any change in the person occupying the office of Commissioner of Social Security or any vacancy in such office.

(h) Finality of Commissioner's decision

The findings and decision of the Commissioner of Social Security after a hearing shall be binding upon all individuals who were parties to such hearing. No findings of fact or decision of the Commissioner of Social Security shall be reviewed by any person, tribunal, or governmental agency except as herein provided. No action against the United States, the Commissioner of Social Security, or any officer or employee thereof shall be brought under section or of title 28 to recover on any claim arising under this subchapter.

(i) Certification for payment

Upon final decision of the Commissioner of Social Security, or upon final judgment of any court of competent jurisdiction, that any person is entitled to any payment or payments under this subchapter, the Commissioner of Social Security shall certify to the Managing Trustee the name and address of the person so entitled to receive such payment or payments, the amount of such payment or payments, and the time at which such payment or payments should be made, and the Managing Trustee, through the Fiscal Service of the Department of the Treasury, and prior to any action thereon by the Government Accountability Office, shall make payment in accordance with the certification of the Commissioner of Social Security (except that in the case of (A) an individual who will have completed ten years of service (or five or more years of service, all of which accrues after December 31, ) creditable under the Railroad Retirement Act of [45 U.S.C. a et seq.] or the Railroad Retirement Act of [45 U.S.C. et seq.], (B) the wife or husband or divorced wife or divorced husband of such an individual, (C) any survivor of such an individual if such survivor is entitled, or could upon application become entitled, to an annuity under section 2 of the Railroad Retirement Act of [45 U.S.C. a], and (D) any other person entitled to benefits under section of this title on the basis of the wages and self-employment income of such an individual (except a survivor of such an individual where such individual did not have a current connection with the railroad industry, as defined in the Railroad Retirement Act of , at the time of his death), such certification shall be made to the Railroad Retirement Board which shall provide for such payment or payments to such person on behalf of the Managing Trustee in accordance with the provisions of the Railroad Retirement Act of ): Provided, That where a review of the Commissioner's decision is or may be sought under subsection (g) the Commissioner of Social Security may withhold certification of payment pending such review. The Managing Trustee shall not be held personally liable for any payment or payments made in accordance with a certification by the Commissioner of Social Security.

(j) Representative payees

(1)(A) If the Commissioner of Social Security determines that the interest of any individual under this subchapter would be served thereby, certification of payment of such individual's benefit under this subchapter may be made, regardless of the legal competency or incompetency of the individual, either for direct payment to the individual, or for his or her use and benefit, to another individual, or an organization, with respect to whom the requirements of paragraph (2) have been met (hereinafter in this subsection referred to as the individual's "representative payee"). If the Commissioner of Social Security or a court of competent jurisdiction determines that a representative payee has misused any individual's benefit paid to such representative payee pursuant to this subsection or section or (a)(2) of this title, the Commissioner of Social Security shall promptly revoke certification for payment of benefits to such representative payee pursuant to this subsection and certify payment to an alternative representative payee or, if the interest of the individual under this subchapter would be served thereby, to the individual.

(B) In the case of an individual entitled to benefits based on disability, the payment of such benefits shall be made to a representative payee if the Commissioner of Social Security determines that such payment would serve the interest of the individual because the individual also has an alcoholism or drug addiction condition (as determined by the Commissioner) and the individual is incapable of managing such benefits.

(C)(i) An individual who is entitled to or is an applicant for a benefit under this subchapter, subchapter VIII, or subchapter XVI, who has attained 18 years of age or is an emancipated minor, may, at any time, designate one or more other individuals to serve as a representative payee for such individual in the event that the Commissioner of Social Security determines under subparagraph (A) that the interest of such individual would be served by certification for payment of such benefits to which the individual is entitled to a representative payee. If the Commissioner of Social Security makes such a determination with respect to such individual at any time after such designation has been made, the Commissioner shall-

(I) certify payment of such benefits to the designated individual, subject to the requirements of paragraph (2); or

(II) if the Commissioner determines that certification for payment of such benefits to the designated individual would not satisfy the requirements of paragraph (2), that the designated individual is unwilling or unable to serve as representative payee, or that other good cause exists, certify payment of such benefits to another individual or organization, in accordance with paragraph (1).


(ii) An organization may not be designated to serve as a representative payee under this subparagraph.

(2)(A) Any certification made under paragraph (1) for payment of benefits to an individual's representative payee shall be made on the basis of-

(i) an investigation by the Commissioner of Social Security of the person to serve as representative payee, which shall be conducted in advance of such certification and shall, to the extent practicable, include a face-to-face interview with such person, and

(ii) adequate evidence that such certification is in the interest of such individual (as determined by the Commissioner of Social Security in regulations).


(B)(i) As part of the investigation referred to in subparagraph (A)(i), the Commissioner of Social Security shall-

(I) require the person being investigated to submit documented proof of the identity of such person, unless information establishing such identity has been submitted with an application for benefits under this subchapter, subchapter VIII, or subchapter XVI,

(II) verify such person's social security account number (or employer identification number),

(III) determine whether such person has been convicted of a violation of section , , or a of this title,

(IV) obtain information concerning whether such person has been convicted of any other offense under Federal or State law which resulted in imprisonment for more than 1 year,

(V) obtain information concerning whether such person is a person described in section (x)(1)(A)(iv) of this title,

(VI) determine whether certification of payment of benefits to such person has been revoked pursuant to this subsection, the designation of such person as a representative payee has been revoked pursuant to section (a) of this title, or payment of benefits to such person has been terminated pursuant to section (a)(2)(A)(iii) of this title by reason of misuse of funds paid as benefits under this subchapter, subchapter VIII, or subchapter XVI, and

(VII) determine whether such person has been convicted (and not subsequently exonerated), under Federal or State law, of a felony provided under clause (iv), or of an attempt or a conspiracy to commit such a felony.


(ii) The Commissioner of Social Security shall establish and maintain a centralized file, which shall be updated periodically and which shall be in a form which renders it readily retrievable by each servicing office of the Social Security Administration. Such file shall consist of-

(I) a list of the names and social security account numbers (or employer identification numbers) of all persons with respect to whom certification of payment of benefits has been revoked on or after January 1, , pursuant to this subsection, whose designation as a representative payee has been revoked pursuant to section (a) of this title, or with respect to whom payment of benefits has been terminated on or after such date pursuant to section (a)(2)(A)(iii) of this title, by reason of misuse of funds paid as benefits under this subchapter, subchapter VIII, or subchapter XVI, and

(II) a list of the names and social security account numbers (or employer identification numbers) of all persons who have been convicted of a violation of section , , or a of this title.


(iii) Notwithstanding the provisions of section a of title 5 or any other provision of Federal or State law (other than section of the Internal Revenue Code of and section (c) of this title), the Commissioner shall furnish any Federal, State, or local law enforcement officer, upon the written request of the officer, with the current address, social security account number, and photograph (if applicable) of any person investigated under this paragraph, if the officer furnishes the Commissioner with the name of such person and such other identifying information as may reasonably be required by the Commissioner to establish the unique identity of such person, and notifies the Commissioner that-

(I) such person is described in section (x)(1)(A)(iv) of this title,

(II) such person has information that is necessary for the officer to conduct the officer's official duties, and

(III) the location or apprehension of such person is within the officer's official duties.


(iv) The felony crimes provided under this clause, whether an offense under State or Federal law, are the following:

(I) Human trafficking, including as prohibited under sections and of title

(II) False imprisonment, including as prohibited under section of title

(III) Kidnapping, including as prohibited under section of title

(IV) Rape and sexual assault, including as prohibited under sections , , , and of title

(V) First-degree homicide, including as prohibited under section of title

(VI) Robbery, including as prohibited under section of title

(VII) Fraud to obtain access to government assistance, including as prohibited under sections , , and of title

(VIII) Fraud by scheme, including as prohibited under section of title

(IX) Theft of government funds or property, including as prohibited under section of title

(X) Abuse or neglect, including as prohibited under sections , , , , , or of title

(XI) Forgery, including as prohibited under section and chapter 25 (except section ) of title

(XII) Identity theft or identity fraud, including as prohibited under sections and A of title


The Commissioner of Social Security may promulgate regulations to provide for additional felony crimes under this clause.

(v)(I) For the purpose of carrying out the activities required under subparagraph (B)(i) as part of the investigation under subparagraph (A)(i), the Commissioner may conduct a background check of any individual seeking to serve as a representative payee under this subsection and may disqualify from service as a representative payee any such individual who fails to grant permission for the Commissioner to conduct such a background check.

(II) The Commissioner may revoke certification of payment of benefits under this subsection to any individual serving as a representative payee on or after January 1, who fails to grant permission for the Commissioner to conduct such a background check.

(C)(i) Benefits of an individual may not be certified for payment to any other person pursuant to this subsection if-

(I) such person has previously been convicted as described in subparagraph (B)(i)(III),

(II) except as provided in clause (ii), certification of payment of benefits to such person under this subsection has previously been revoked as described in subparagraph (B)(i)(VI) 5 the designation of such person as a representative payee has been revoked pursuant to section (a) of this title, or payment of benefits to such person pursuant to section (a)(2)(A)(ii) of this title has previously been terminated as described in section (a)(2)(B)(ii)(VI) of this title,

(III) except as provided in clause (iii), such person is a creditor of such individual who provides such individual with goods or services for consideration,

(IV) such person has previously been convicted as described in subparagraph (B)(i)(IV), unless the Commissioner determines that such certification would be appropriate notwithstanding such conviction,

(V) such person is a person described in section (x)(1)(A)(iv) of this title,

(VI) except as provided in clause (vi), such person has previously been convicted (and not subsequently exonerated) as described in subparagraph (B)(i)(VII), or

(VII) such person's benefits under this subchapter, subchapter VIII, or subchapter XVI are certified for payment to a representative payee during the period for which the individual's benefits would be certified for payment to another person.


(ii) The Commissioner of Social Security shall prescribe regulations under which the Commissioner of Social Security may grant exemptions to any person from the provisions of clause (i)(II) on a case-by-case basis if such exemption is in the best interest of the individual whose benefits would be paid to such person pursuant to this subsection.

(iii) Clause (i)(III) shall not apply with respect to any person who is a creditor referred to therein if such creditor is-

(I) a relative of such individual if such relative resides in the same household as such individual,

(II) a legal guardian or legal representative of such individual,

(III) a facility that is licensed or certified as a care facility under the law of a State or a political subdivision of a State,

(IV) a person who is an administrator, owner, or employee of a facility referred to in subclause (III) if such individual resides in such facility, and the certification of payment to such facility or such person is made only after good faith efforts have been made by the local servicing office of the Social Security Administration to locate an alternative representative payee to whom such certification of payment would serve the best interests of such individual, or

(V) an individual who is determined by the Commissioner of Social Security, on the basis of written findings and under procedures which the Commissioner of Social Security shall prescribe by regulation, to be acceptable to serve as a representative payee.


(iv) The procedures referred to in clause (iii)(V) shall require the individual who will serve as representative payee to establish, to the satisfaction of the Commissioner of Social Security, that-

(I) such individual poses no risk to the beneficiary,

(II) the financial relationship of such individual to the beneficiary poses no substantial conflict of interest, and

(III) no other more suitable representative payee can be found.


(v) In the case of an individual described in paragraph (1)(B), when selecting such individual's representative payee, preference shall be given to-

(I) a certified community-based nonprofit social service agency (as defined in paragraph (10)),

(II) a Federal, State, or local government agency whose mission is to carry out income maintenance, social service, or health care-related activities,

(III) a State or local government agency with fiduciary responsibilities, or

(IV) a designee of an agency (other than of a Federal agency) referred to in the preceding subclauses of this clause, if the Commissioner of Social Security deems it appropriate,


unless the Commissioner of Social Security determines that selection of a family member would be appropriate.

(vi)(I) With respect to any person described in subclause (II)-

(aa) subparagraph (B)(i)(VII) shall not apply; and

(bb) the Commissioner may grant an exemption from the provisions of clause (i)(VI) if the Commissioner determines that such exemption is in the best interest of the individual entitled to benefits.


(II) A person is described in this subclause if the person-

(aa) is the custodial parent of a minor child for whom the person applies to serve;

(bb) is the custodial spouse of the beneficiary for whom the person applies to serve;

(cc) is the custodial parent of a beneficiary who is under a disability (as defined in section (d) of this title) which began before the beneficiary attained the age of 22, for whom the person applies to serve;

(dd) is the custodial court appointed guardian of the beneficiary for whom the person applies to serve;

(ee) is the custodial grandparent of a minor grandchild for whom the person applies to serve;

(ff) is the parent who was previously representative payee for his or her minor child who has since turned 18 and continues to be eligible for such benefit; or

(gg) received a presidential or gubernatorial pardon for the relevant conviction.


(D)(i) Subject to clause (ii), if the Commissioner of Social Security makes a determination described in the first sentence of paragraph (1) with respect to any individual's benefit and determines that direct payment of the benefit to the individual would cause substantial harm to the individual, the Commissioner of Social Security may defer (in the case of initial entitlement) or suspend (in the case of existing entitlement) direct payment of such benefit to the individual, until such time as the selection of a representative payee is made pursuant to this subsection.

(ii)(I) Except as provided in subclause (II), any deferral or suspension of direct payment of a benefit pursuant to clause (i) shall be for a period of not more than 1 month.

(II) Subclause (I) shall not apply in any case in which the individual is, as of the date of the Commissioner's determination, legally incompetent, under the age of 15 years, or described in paragraph (1)(B).

(iii) Payment pursuant to this subsection of any benefits which are deferred or suspended pending the selection of a representative payee shall be made to the individual or the representative payee as a single sum or over such period of time as the Commissioner of Social Security determines is in the best interest of the individual entitled to such benefits.

(E)(i) Any individual who is dissatisfied with a determination by the Commissioner of Social Security to certify payment of such individual's benefit to a representative payee under paragraph (1) or with the designation of a particular person to serve as representative payee shall be entitled to a hearing by the Commissioner of Social Security to the same extent as is provided in subsection (b), and to judicial review of the Commissioner's final decision as is provided in subsection (g).

(ii) In advance of the certification of payment of an individual's benefit to a representative payee under paragraph (1), the Commissioner of Social Security shall provide written notice of the Commissioner's initial determination to certify such payment. Such notice shall be provided to such individual, except that, if such individual-

(I) is under the age of 15,

(II) is an unemancipated minor under the age of 18, or

(III) is legally incompetent,


then such notice shall be provided solely to the legal guardian or legal representative of such individual.

(iii) Any notice described in clause (ii) shall be clearly written in language that is easily understandable to the reader, shall identify the person to be designated as such individual's representative payee, and shall explain to the reader the right under clause (i) of such individual or of such individual's legal guardian or legal representative-

(I) to appeal a determination that a representative payee is necessary for such individual,

(II) to appeal the designation of a particular person to serve as the representative payee of such individual, and

(III) to review the evidence upon which such designation is based and submit additional evidence.


(3)(A) In any case where payment under this subchapter is made to a person other than the individual entitled to such payment, the Commissioner of Social Security shall establish a system of accountability monitoring whereby such person shall report not less often than annually with respect to the use of such payments. The Commissioner of Social Security shall establish and implement statistically valid procedures for reviewing such reports in order to identify instances in which such persons are not properly using such payments.

(B) Subparagraph (A) shall not apply in any case where the other person to whom such payment is made is a State institution. In such cases, the Commissioner of Social Security shall establish a system of accountability monitoring for institutions in each State.

(C) Subparagraph (A) shall not apply in any case where the individual entitled to such payment is a resident of a Federal institution and the other person to whom such payment is made is the institution.

(D)(i) Subparagraph (A) shall not apply in any case where the other person to whom such payment is made is-

(I) a parent, or other individual who is a legal guardian of, a minor child entitled to such payment who primarily resides in the same household;

(II) a parent of an individual entitled to such payment who is under a disability (as defined in section (d) of this title) who primarily resides in the same household; or

(III) the spouse of the individual entitled to such payment.


(ii) The Commissioner of Social Security shall establish and implement procedures as necessary for the Commissioner to determine the eligibility of such parties for the exemption provided in clause (i). The Commissioner shall prescribe such regulations as may be necessary to determine eligibility for such exemption.

(E) Notwithstanding subparagraphs (A), (B), (C), and (D), the Commissioner of Social Security may require a report at any time from any person receiving payments on behalf of another, if the Commissioner of Social Security has reason to believe that the person receiving such payments is misusing such payments.

(F) In any case in which the person described in subparagraph (A) or (E) receiving payments on behalf of another fails to submit a report required by the Commissioner of Social Security under subparagraph (A) or (E), the Commissioner may, after furnishing notice to such person and the individual entitled to such payment, require that such person appear in person at a field office of the Social Security Administration serving the area in which the individual resides in order to receive such payments.

(G) The Commissioner of Social Security shall maintain a centralized file, which shall be updated periodically and which shall be in a form which will be readily retrievable by each servicing office of the Social Security Administration, of-

(i) the address and the social security account number (or employer identification number) of each representative payee who is receiving benefit payments pursuant to this subsection, section of this title, or section (a)(2) of this title, and

(ii) the address and social security account number of each individual for whom each representative payee is reported to be providing services as representative payee pursuant to this subsection, section of this title, or section (a)(2) of this title.


(H) Each servicing office of the Administration shall maintain a list, which shall be updated periodically, of public agencies and certified community-based nonprofit social service agencies (as defined in paragraph (10)) which are qualified to serve as representative payees pursuant to this subsection or section or (a)(2) of this title and which are located in the area served by such servicing office.

Sours: https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-titlesection&num=0&edition=prelim

Title 42

SUBPART A
Subpart A [Reserved]SUBPART B
Subpart B - Medical Services Coverage Decisions That Relate to Health Care TechnologySECTION
    Scope of subpart and definitions.SECTION
    FDA categorization of investigational devices.SECTION
    Coverage of a Category B (Nonexperimental/investigational) device.SECTION
    Services related to a noncovered device.SECTION
    Payment for a Category B (Nonexperimental/investigational) device.SECTION
    Coverage of items and services in FDA-approved IDE studies.SECTION
    Medicare Coverage IDE study criteria.SECTION
    Re-evaluation of a device categorization.SECTION
    Confidential commercial and trade secret information.SUBPART C
Subpart C - Suspension of Payment, Recovery of Overpayments, and Repayment of Scholarships and LoansSUBJGRP 21
   General ProvisionsSECTION
    Scope of subpart.SUBJGRP 22
   Liability for Payments To Providers or Suppliers and Handling of Incorrect PaymentsSECTION
    Individual's liability for payments made to providers and other persons for items and services furnished the individual.SECTION
    Incorrect payments for which the individual is not liable.SECTION
    Adjustment of title XVIII incorrect payments.SECTION
    Certification of amount that will be adjusted against individual title II or railroad retirement benefits.SECTION
    Procedures for adjustment or recovery - title II beneficiary.SECTION
    Waiver of adjustment or recovery.SECTION
    Principles applied in waiver of adjustment or recovery.SECTION
    Notice of right to waiver consideration.SECTION
    When waiver of adjustment or recovery may be applied.SECTION
    Liability of certifying or disbursing officer.SUBJGRP 23
   Suspension and Recoupment of Payment to Providers and Suppliers and Collection and Compromise of OverpaymentsSECTION
    Definitions.SECTION
    Suspension, offset, and recoupment of Medicare payments to providers and suppliers of services.SECTION
    Proceeding for suspension of payment.SECTION
    Proceeding for offset or recoupment.SECTION
    Opportunity for rebuttal.SECTION
    Time limits for, and notification of, administrative determination after receipt of rebuttal statement.SECTION
    Suspension and termination of collection action and compromise of claims for overpayment.SECTION
    Withholding Medicare payments to recover Medicaid overpayments.SECTION
    Interest charges on overpayment and underpayments to providers, suppliers, and other entities.SECTION
    Limitation on recoupment of provider and supplier overpayments.SUBJGRP 24
   Repayment of Scholarships and LoansSECTION
    Collection of past-due amounts on scholarship and loan programs.SUBPART D
Subpart D - Private ContractsSECTION
    Definitions.SECTION
    General rules.SECTION
    Conditions for properly opting-out of Medicare.SECTION
    Requirements of the private contract.SECTION
    Requirements of the opt-out affidavit.SECTION
    Effects of opting-out of Medicare.SECTION
    Failure to properly opt-out.SECTION
    Failure to maintain opt-out.SECTION
    Emergency and urgent care services.SECTION
    Cancellation of opt-out and early termination of opt-out.SECTION
    Appeals.SECTION
    Application to Medicare Advantage contracts.SUBPART E
Subpart E - Criteria for Determining Reasonable ChargesSECTION
    Basis.SECTION
    Determination of reasonable charges.SECTION
    Criteria for determining reasonable charges.SECTION
    Determining customary charges.SECTION
    Determining prevailing charges.SECTION
    Determination of locality.SECTION
    Charges higher than customary or prevailing charges or lowest charge levels.SECTION
    Illustrations of the application of the criteria for determining reasonable charges.SECTION
    Determination of comparable circumstances; limitation.SECTION
    Determining the inflation-indexed charge.SECTION
    Reasonable charges for medical services, supplies, and equipment.SECTION
    Carriers' procedural terminology and coding systems.SECTION
    Reimbursement for clinical laboratory services billed by physicians.SECTION
    Payment for drugs and biologicals that are not paid on a cost or prospective payment basis.SECTION
    Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional services.SECTION
    Limitation on payment for screening mammography services.SECTION
    Special rule for nonparticipating physicians and suppliers furnishing screening mammography services before January 1, SUBPART F
Subpart F - XXXSUBPART G
Subpart G [Reserved]SUBPART H
Subpart H - Appeals Under the Medicare Part B ProgramSECTION
    Appeals of CMS or a CMS contractor.SECTION
    Appeals rights.SECTION
    Impact of reversal of contractor determinations on claims processing.SECTION
    Reinstatement of provider or supplier billing privileges following corrective action.SECTION
    Effective date for DMEPOS supplier's billing privileges.SECTION
    Submission of claims.SECTION
    Deadline for processing provider enrollment initial determinations.SUBPART I
Subpart I - Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B)SUBJGRP 25
   Initial DeterminationsSECTION
    Basis and scope.SECTION
    Definitions.SECTION
    Medicare initial determinations, redeterminations and appeals: General description.SECTION
    Parties to the initial determinations, redeterminations, reconsiderations, hearings, and reviews.SECTION
    Medicaid State agencies.SECTION
    Appointed representatives.SECTION
    Assignment of appeal rights.SECTION
    Initial determinations.SECTION
    Notice of initial determination.SECTION
    Time frame for processing initial determinations.SECTION
    Actions that are initial determinations.SECTION
    Decisions of utilization review committees.SECTION
    Actions that are not initial determinations.SECTION
    Initial determinations subject to the reopenings process.SECTION
    Effect of the initial determination.SUBJGRP 26
   RedeterminationsSECTION
    Right to a redetermination.SECTION
    Time frame for filing a request for a redetermination.SECTION
    Place and method of filing a request for a redetermination.SECTION
    Evidence to be submitted with the redetermination request.SECTION
    Notice to the beneficiary of applicable plan's request for a redetermination.SECTION
    Conduct of a redetermination.SECTION
    Time frame for making a redetermination.SECTION
    Withdrawal or dismissal of a request for a redetermination.SECTION
    Redetermination.SECTION
    Notice of a redetermination.SECTION
    Effect of a redetermination.SUBJGRP 27
   ReconsiderationSECTION
    Right to a reconsideration.SECTION
    Timeframe for filing a request for a reconsideration.SECTION
    Place and method of filing a request for a reconsideration.SECTION
    Evidence to be submitted with the reconsideration request.SECTION
    Conduct of a reconsideration.SECTION
    Timeframe for making a reconsideration following a contractor redetermination.SECTION
    Withdrawal or dismissal of a request for reconsideration or review of a contractor's dismissal of a request for redetermination.SECTION
    Reconsideration and review of a contractor's dismissal of a request for redetermination.SECTION
    Notice of a reconsideration.SECTION
    Effect of a reconsideration.SUBJGRP 28
   ReopeningsSECTION
    Reopening of initial determinations, redeterminations, reconsiderations, decisions, and reviews.SECTION
    Notice of a revised determination or decision.SECTION
    Effect of a revised determination or decision.SECTION
    Good cause for reopening.SUBJGRP 29
   Expedited Access to Judicial ReviewSECTION
    Expedited access to judicial review.SUBJGRP 30
   ALJ HearingsSECTION
    Hearing before an ALJ and decision by an ALJ or attorney adjudicator: General rule.SECTION
    Right to an ALJ hearing.SECTION
    Right to a review of QIC notice of dismissal.SECTION
    Amount in controversy required for an ALJ hearing and judicial review.SECTION
    Parties to the proceedings on a request for an ALJ hearing.SECTION
    When CMS or its contractors may participate in the proceedings on a request for an ALJ hearing.SECTION
    When CMS or its contractors may be a party to a hearing.SECTION
    Request for an ALJ hearing or a review of a QIC dismissal.SECTION
    Time frames for deciding an appeal of a QIC reconsideration or escalated request for a QIC reconsideration.SECTION
    Submitting evidence.SECTION
    Time and place for a hearing before an ALJ.SECTION
    Notice of a hearing before an ALJ.SECTION
    Objections to the issues.SECTION
    Disqualification of the ALJ or attorney adjudicator.SECTION
    Review of evidence submitted by parties.SECTION
    ALJ hearing procedures.SECTION
    Issues before an ALJ or attorney adjudicator.SECTION
    Requesting information from the QIC.SECTION
    Description of an ALJ hearing process.SECTION
    Discovery.SECTION
    Deciding a case without a hearing before an ALJ.SECTION
    Prehearing and posthearing conferences.SECTION
    The administrative record.SECTION
    Consolidated proceedings.SECTION
    Notice of an ALJ or attorney adjudicator decision.SECTION
    The effect of an ALJ's or attorney adjudicator's decision.SECTION
    Removal of a hearing request from OMHA to the Council.SECTION
    Dismissal of a request for a hearing before an ALJ or request for review of a QIC dismissal.SECTION
    Effect of dismissal of a request for a hearing or request for review of QIC dismissal.SECTION
    Remands of requests for hearing and requests for review.SECTION
    Effect of a remand.SUBJGRP 31
   Applicability of Medicare Coverage PoliciesSECTION
    Applicability of national coverage determinations (NCDs).SECTION
    Applicability of local coverage determinations and other policies not binding on the ALJ or attorney adjudicator and Council.SECTION
    Applicability of laws, regulations, CMS Rulings, and precedential decisions.SUBJGRP 32
   Medicare Appeals Council ReviewSECTION
    Medicare Appeals Council review: General.SECTION
    Request for Council review when ALJ or attorney adjudicator issues decision or dismissal.SECTION
    Where a request for review or escalation may be filed.SECTION
    Council actions when request for review or escalation is filed.SECTION
    Council reviews on its own motion.SECTION
    Content of request for review.SECTION
    Dismissal of request for review.SECTION
    Effect of dismissal of request for Council review or request for hearing.SECTION
    Obtaining evidence from the Council.SECTION
    Filing briefs with the Council.SECTION
    What evidence may be submitted to the Council.SECTION
    Oral argument.SECTION
    Case remanded by the Council.SECTION
    Action of the Council.SECTION
    Effect of the Council's decision.SECTION
    Request for escalation to Federal court.SECTION
    Extension of time to file action in Federal district court.SECTION
    Judicial review.SECTION
    Case remanded by a Federal district court.SECTION
    Council review of ALJ decision in a case remanded by a Federal district court.SUBPART J
Subpart J - Expedited Determinations and Reconsiderations of Provider Service Terminations, and Procedures for Inpatient Hospital DischargesSECTION
    Notifying beneficiaries of provider service terminations.SECTION
    Expedited determination procedures.SECTION
    Expedited reconsiderations.SECTION
    Notifying beneficiaries of hospital discharge appeal rights.SECTION
    Expedited determination procedures for inpatient hospital care.SECTION
    Hospital requests expedited QIO review.SUBPART K
Subparts K-Q [Reserved]SUBPART R
Subpart R - Provider Reimbursement Determinations and AppealsSECTION
    Introduction.SECTION
    Contractor determination and notice of amount of program reimbursement.SECTION
    Matters not subject to administrative and judicial review under prospective payment.SECTION
    Parties to contractor determination.SECTION
    Effect of contractor determination.SECTION
    Contractor hearing procedures.SECTION
    Right to contractor hearing; contents of, and adding issues to, hearing request.SECTION
    Good cause extension of time limit for requesting a contractor hearing.SECTION
    Contractor hearing officer jurisdiction.SECTION
    Parties to proceedings before the contractor hearing officer(s).SECTION
    Hearing officer or panel of hearing officers authorized to conduct contractor hearing; disqualification of officers.SECTION
    Conduct of contractor hearing.SECTION
    Prehearing discovery and other proceedings prior to the contractor hearing.SECTION
    Evidence at contractor hearing.SECTION
    Witnesses at contractor hearing.SECTION
    Record of proceedings before the contractor hearing officer(s).SECTION
    Scope of authority of contractor hearing officer(s).SECTION
    Contractor hearing decision.SECTION
    Contractor hearing officer review of compliance with the substantive reimbursement requirement of an appropriate cost report claim.SECTION
    Effect of contractor hearing decision.SECTION
    CMS reviewing official procedure.SECTION
    Right to Board hearing; contents of, and adding issues to, hearing request.SECTION
    Good cause extension of time limit for requesting a Board hearing.SECTION
    Group appeals.SECTION
    Amount in controversy.SECTION
    Board jurisdiction.SECTION
    Expedited judicial review.SECTION
    Parties to proceedings in a Board appeal.SECTION
    Composition of Board; hearings, decisions, and remands.SECTION
    Disqualification of Board members.SECTION
    Establishment of time and place of hearing by the Board.SECTION
    Conduct of Board hearing.SECTION
    Board proceedings prior to any hearing; discovery.SECTION
    Evidence at Board hearing.SECTION
    Subpoenas.SECTION
    Witnesses.SECTION
    Oral argument and written allegations.SECTION
    Administrative policy at issue.SECTION
    Record of administrative proceedings.SECTION
    Scope of Board's legal authority.SECTION
    Board actions in response to failure to follow Board rules.SECTION
    Scope of Board's authority in a hearing decision.SECTION
    Board hearing decision.SECTION
    Board review of compliance with the reimbursement requirement of an appropriate cost report claim.SECTION
    Administrator review.SECTION
    Judicial review.SECTION
    Appointment of representative.SECTION
    Authority of representative.SECTION
    Reopening a contractor determination or reviewing entity decision.SECTION
    Notice of reopening; effect of reopening.SECTION
    Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.SUBPART S
Subparts S-T [Reserved]SUBPART U
Subpart U - Conditions for Coverage of Suppliers of End-Stage Renal Disease (ESRD) ServicesSECTION
    [Reserved]SECTION
    Definitions.SECTION
    Designation of ESRD networks.SECTION
    [Reserved]SECTION
    ESRD network organizations.SECTION
    Medical review board.SECTION
    [Reserved]SECTION
    [Reserved]SUBPART V
Subparts V-W [Reserved]SUBPART X
Subpart X - Rural Health Clinic and Federally Qualified Health Center ServicesSUBJGRP 33
   Federally Qualified Health Center ServicesSECTION
    Basis.SECTION
    Scope and definitions.SECTION
    Rural health clinic basic requirements.SECTION
    Rural health clinic content and terms of the agreement with the Secretary.SECTION
    Termination of rural health clinic agreements.SECTION
    Application of Part B deductible and coinsurance.SECTION
    Scope of benefits.SECTION
    Physicians' services.SECTION
    Services and supplies incident to a physician's services.SECTION
    Nurse practitioner, physician assistant, and certified nurse midwife services.SECTION
    Incident to services and direct supervision.SECTION
    Visiting nurse services.SECTION
    Visiting nurse services: Determination of shortage of agencies.SECTION
    Basic requirements.SECTION
    Content and terms of the agreement.SECTION
    Termination of agreement.SECTION
    Conditions for reinstatement after termination by CMS.SECTION
    Notice to the public.SECTION
    Change of ownership.SECTION
    Scope of services.SECTION
    Preventive primary services.SECTION
    Preventive services.SECTION
    Clinical psychologist and clinical social worker services.SECTION
    Services and supplies incident to clinical psychologist and clinical social worker services.SUBJGRP 34
   Payment for Rural Health Clinic and Federally Qualified Health Center ServicesSECTION
    Applicability of general payment exclusions.SECTION
    Payment for RHC and FQHC services.SECTION
    What constitutes a visit.SECTION
    Payment rate.SECTION
    Annual reconciliation.SECTION
    Requirements of the FQHC PPS.SECTION
    Allowable costs.SECTION
    FQHC supplemental payments.SECTION
    Reports and maintenance of records.SECTION
    Beneficiary appeals.
Sours: https://ecfr.io/Title/Part
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United States of America > Social security (general standards)

Name:Federal Health Insurance for the Aged and Disabled Rule (42 CFR Part )Country:United States of AmericaSubject(s):Medical care and sickness benefit; Protection against particular hazardsType of legislation:Regulation, Decree, OrdinanceAdopted on:Entry into force:Published on:Federal Register,
ISN:USARLink:https://www.ilo.org/dyn/natlex/natlex4.detail?p_isn=&p_lang=Bibliography:Federal Register,
Abstract/Citation:Inter alia, amends para. and and inserts a new para. relating to interest charges on overpayments and underpayments to providers and supplierpara.Basic text(s):
Sours: http://www.ilo.org/dyn/natlex/natlex4.detail?p_lang=&p_isn=&p_classification=15

Social Security

Subpart G—Filing of Applications and Other Forms

Authority: Secs. (i), (j), (o), (p), and (r), (a), (i)(2), (b), (a), and (a)(5) of the Social Security Act (42 U.S.C. (i), (j), (o), (p), and (r), (a), (i)(2), (b), (a), and (a)(5)).

Source: 44 FR , June 26, , unless otherwise noted.

General Provisions

This subpart contains the Social Security Administration's rules for filing a claim for old-age, disability, dependents', and survivors' insurance benefits as described in subpart D of part It tells what an application is, who may sign it, where and when it must be signed and filed, the period of time it is in effect and how it may be withdrawn. This subpart also explains when a written statement, request, or notice will be considered filed. Since the application form and procedures for filing a claim under this subpart are the same as those used to establish entitlement to Medicare benefits under 42 CFR part , persons who wish to become entitled to Medicare benefits should refer to the provisions of this subpart. Requirements concerning applications for the black lung benefits program are contained in part Requirements concerning applications for the supplemental security income program are contained in part Part contains the requirements for applying for a social security number.

Sours: https://www.ssa.gov/OP_Home/cfr20//htm

Cfr 405 42 part

LoS: 42 CFR

Title Public Health

List of Subjects revised as of July 1,

42 CFR Part 1_Review of regulations.
Administrative practice and procedure
42 CFR Part 2_Confidentiality of substance use disorder patient records.
Alcohol abuse
Alcoholism
Drug abuse
Grant programs-health
Health records
Privacy
Reporting and recordkeeping requirements
42 CFR Part 2a_Protection of identity_research subjects.
Alcohol abuse
Alcoholism
Drug abuse
Drugs
Health records
Medical research
Mental health programs
Privacy
Reporting and recordkeeping requirements
42 CFR Part 3_Patient safety organizations and patient safety work product.
Administrative practice and procedure
Conflicts of interests
Courts
Freedom of information
Health care
Health facilities
Health insurance
Health professions
Health records
Hospitals
Investigations
Medical research
Organization and functions (Government agencies)
Privacy
Public health
Reporting and recordkeeping requirements
Safety
Technical assistance
42 CFR Part 4_National Library of Medicine.
Libraries
Medical research
Reporting and recordkeeping requirements
42 CFR Part 5_Designation of medically underserved populations and health professional shortage areas.
Health facilities
Health professions
Health statistics
Manpower
Mental health programs
Veterinarians
42 CFR Part 6_Federal Tort Claims Act coverage of certain grantees and individuals.
Claims
Penalties
42 CFR Part 7_Distribution of reference biological standards and biological preparations.
Biologics
42 CFR Part 8_Medication assisted treatment for opioid use disorders.
Drugs
Health professions
Reporting and recordkeeping requirements
42 CFR Part 9_Standards of care for chimpanzees held in the federally supported sanctuary system.
Animal welfare
42 CFR Part 10_B Drug Pricing Program.
Biologics
Business and industry
Diseases
Drugs
Health
Health care
Health facilities
Hospitals
42 CFR Part 11_Clinical trials registration and results information submission.
Biologics
Drugs
Human research subjects
Information
Laboratories
Medical devices
Medical research
Reporting and recordkeeping requirements
42 CFR Part 21_Commissioned officers.
Alimony
Child support
Government employees
Health professions
Reporting and recordkeeping requirements
Wages
42 CFR Part 22_Personnel other than commissioned officers.
Diseases
Government employees
Health professions
Wages
42 CFR Part 23_National Health Service Corps.
Government employees
Health professions
Loan programs-health
Manpower
Reporting and recordkeeping requirements
42 CFR Part 24_Senior Biomedical Research and Biomedical Product Assessment Service.
Administrative practice and procedure
Employment
Government employees
Health professions
Public health
Reporting and recordkeeping requirements
Research
Scientists
42 CFR Part 31_Medical care for certain personnel of the Coast Guard, National Ocean Survey, Public Health Service, and former Lighthouse Service.
Coast Guard
Government employees
Health care
National Oceanic and Atmospheric Administration
42 CFR Part 34_Medical examination of aliens.
Aliens
Health care
Passports and visas
Public health
42 CFR Part 35_Hospital and station management.
Health facilities
Public health
42 CFR Part 37_Specifications for medical examinations of coal miners.
Diseases
Health care
Medical research
Mine safety and health
Miners
X-rays
42 CFR Part 38_Disaster assistance for crisis counseling and training.
Disaster assistance
Government contracts
Grant programs-health
Mental health programs
42 CFR Part 50_Policies of general applicability.
Administrative practice and procedure
Conflicts of interests
Drugs
Family planning
Grant programs-health
Grant programs-science and technology
Health care
Reporting and recordkeeping requirements
Research
Science and technology
42 CFR Part 51_Requirements applicable to the protection and advocacy for individuals with mental illness program.
Administrative practice and procedure
Grant programs-health
Health facilities
Health records
Mental health programs
Privacy
Reporting and recordkeeping requirements
42 CFR Part 51a_Project grants for maternal and child health.
Diseases
Colleges and universities
Grant programs-health
Maternal and child health
Medical research
and recordkeeping requirements
42 CFR Part 51b_Project grants for preventive health services.
Diseases
Grant programs-health
Immunization
Maternal and child health
Reporting and recordkeeping requirements
Research
42 CFR Part 51c_Grants for community health services.
Grant programs-health
Health care
Health facilities
Reporting and recordkeeping requirements
42 CFR Part 51d_Mental health and substance abuse emergency response procedures.
Administrative practice and procedure
Disaster assistance
Drug abuse
Emergency medical services
Grant programs-health
Health facilities
Mental health programs
Privacy
Reporting and recordkeeping requirements
42 CFR Part 52_Grants for research projects.
Grant programs-health
Medical research
Reporting and recordkeeping requirements
42 CFR Part 52a_National Institutes of Health Center grants.
Diseases
Grant programs-health
Medical research
Reporting and recordkeeping requirements
42 CFR Part 52b_National Institutes of Health construction grants.
Grant programs-health
Health facilities
Medical research
Reporting and recordkeeping requirements
42 CFR Part 52c_Minority Biomedical Research Support Program.
Educational study programs
Grant programs-health
Medical research
Reporting and recordkeeping requirements
42 CFR Part 52d_National Cancer Institute Clinical Cancer Education Program.
Cancer
Educational study programs
Grant programs-health
Health professions
Reporting and recordkeeping requirements
42 CFR Part 52e_National Heart, Lung, and Blood Institute grants for prevention and control projects.
Diseases
Grant programs-health
Health care
Health professions
Medical research
Reporting and recordkeeping requirements
42 CFR Part 52h_Scientific peer review of research grant applications and research and development contract projects.
Government contracts
Grant programs-health
Medical research
42 CFR Part 52i_National Institute on Minority Health and Health Disparities Research Endowment Programs.
Grant programs-health
Medical research
42 CFR Part 53_Grants, loans and loan guarantees for construction and modernization of hospitals and medical facilities.
Grant programs-health
Health facilities
Hospitals
Loan programs-health
42 CFR Part 54_Charitable Choice regulations applicable to States receiving substance abuse prevention and treatment block grants and/or projects for assistance in transition from homelessness grants.
Drug abuse
Grant programs-social programs
42 CFR Part 54a_Charitable Choice regulations applicable to States, local governments and religious organizations receiving discretionary funding under Title V of the Public Health Service Act, 42 U.S.C. aa, et seq., for substance abuse prevention and treatment services.
Drug abuse
Grant programs-social programs
42 CFR Part 55a_Program grants for black lung clinics.
Black lung benefits
Grant programs-health
Health care
Health facilities
Miners
Reporting and recordkeeping requirements
42 CFR Part 56_Grants for migrant health services.
Grant programs-health
Health care
Health facilities
Migrant labor
Reporting and recordkeeping requirements
42 CFR Part 57_Grants for construction of teaching facilities, educational improvements, scholarships and student loans.
Aged
Education of disadvantaged
Educational facilities
Educational study programs
Grant programs-education
Grant programs-health
Health facilities
Health professions
Loan programs-health
Medical and dental schools
Reporting and recordkeeping requirements
Scholarships and fellowships
Student aid
42 CFR Part 58_Grants for training of public health and allied health personnel. [Reserved]
 
42 CFR Part 59_Grants for family planning services.
Family planning
Grant programs-health
Grant programs-social programs
Health
Health professions
Reporting and recordkeeping requirements
Youth
42 CFR Part 59a_National Library of Medicine grants.
Grant programs-health
Libraries
Medical research
Reporting and recordkeeping requirements
42 CFR Part 61_Fellowships.
Health professions
Medical research
Scholarships and fellowships
Student aid
42 CFR Part 62_National Health Service Corps scholarship and loan repayment programs.
Educational study programs
Grant programs-education
Grant programs-health
Health professions
Loan programs-education
Loan programs-health
Reporting and recordkeeping requirements
Scholarships and fellowships
42 CFR Part 63_Traineeships.
Grant programs-health
Health professions
Libraries
Manpower training programs
Student aid
42 CFR Part 63a_National Institutes of Health training grants.
Grant programs-health
Medical research
42 CFR Part 64_National Library of Medicine training grants.
Educational study programs
Grant programs-education
Grant programs-health
Health professions
Libraries
Manpower training programs
Reporting and recordkeeping requirements
42 CFR Part 64a_Obligated service for mental health traineeships.
Colleges and universities
Educational study programs
Grant programs-health
Health professions
Manpower training programs
Mental health programs
Student aid
42 CFR Part 65_National Institute of Environmental Health Sciences hazardous waste worker training.
Education
Grant programs-education
Grant programs-health
Hazardous waste
Nonprofit organizations
Occupational safety and health
Reporting and recordkeeping requirements
42 CFR Part 65a_National Institute of Environmental Health Sciences hazardous substances basic research and training grants.
Grant programs-health
Hazardous waste
Medical research
42 CFR Part 66_National Research Service awards.
Grant programs-health
Health professions
Medical research
42 CFR Part 67_Agency for Health Care Policy and Research grants and contracts.
Grant programs-health
Medical research
Reporting and recordkeeping requirements
42 CFR Part 68_National Institutes of Health (NIH) Loan Repayment Programs (LRPs).
Health professions
Loan programs-health
Medical research
Student aid
42 CFR Part 68b_National Institutes of Health (NIH) Undergraduate Scholarship Program Regarding Professions Needed by National Research Institutes (USGP).
Education of disadvantaged
Medical research
Loan programs-health
Medical research
42 CFR Part 70_Interstate quarantine.
Diseases
Public health
Quarantine
Reporting and recordkeeping requirements
Travel restrictions
42 CFR Part 71_Foreign quarantine.
Airports
Aliens
Animals
Cemeteries
Diseases
Harbors
Health care
Human remains
Imports
Pesticides and pests
Public health
Quarantine
Reporting and recordkeeping requirements
Travel restrictions
42 CFR Part 73_Select agents and toxins.
Biologics
Packaging and containers
Penalties
Reporting and recordkeeping requirements
Transportation
42 CFR Part 75_Standards for the accreditation of educational programs for and the credentialing of radiologic personnel.
Education
Health professions
Radiation protection
42 CFR Part 81_Guidelines for determining probability of causation under the Energy Employees Occupational Illness Compensation Program Act of
Cancer
Government employees
Nuclear materials
Occupational safety and health
Radiation protection
Radioactive materials
Workers' compensation
42 CFR Part 82_Methods for conducting dose reconstruction under the Energy Employees Occupational Illness Compensation Program Act of
Cancer
Government employees
Occupational safety and health
Radiation protection
Radioactive materials
Workers' compensation
42 CFR Part 83_Procedures for designating classes of employees as members of the special exposure cohort under the Energy Employees Occupational Illness Compensation Program Act of
Cancer
Government employees
Nuclear energy
Occupational safety and health
Radiation protection
Radioactive materials
Workers' compensation
42 CFR Part 84_Approval of respiratory protective devices.
Fees
Labeling
Laboratories
Mine safety and health
Occupational safety and health
42 CFR Part 85_Requests for health hazard evaluations.
Investigations
Mine safety and health
Occupational safety and health
Poison prevention
42 CFR Part 85a_Occupational safety and health investigations of places of employment.
Investigations
Mine safety and health
Occupational safety and health
42 CFR Part 86_Grants for education programs in occupational safety and health.
Educational study programs
Grant programs-health
Health professions
Reporting and recordkeeping requirements
42 CFR Part 87_National Institute for Occupational Safety and Health research and demonstration grants.
Grant programs-health
Medical research
Occupational safety and health
Reporting and recordkeeping requirements
42 CFR Part 88_World Trade Center Health Program.
Administrative practice and procedure
Diseases
Health care
Mental health programs
Public health
42 CFR Part 90_Administrative functions, practices, and procedures.
Administrative practice and procedure
Hazardous substances
Medical research
Privacy
Public health
Reporting and recordkeeping requirements
Superfund
42 CFR Part 93_Public health service policies on research misconduct.
Government contracts
Grant programs
Reporting and recordkeeping requirements
Research
Science and technology
42 CFR Part _Vaccine injury compensation.
Biologics
Health insurance
Immunization
42 CFR Part _Countermeasures injury compensation program.
Biologics
Immunization
Indemnity payments
42 CFR Part _Organ procurement and transplantation network.
Health care
Health facilities
Hospitals
Reporting and recordkeeping requirements
42 CFR Part _Medical facility construction and modernization.
Grant programs-health
Health facilities
Reporting and recordkeeping requirements
42 CFR Part _Indian health.
Employment
Government procurement
Health care
Health facilities
Indians
Infants and children
Maternal and child health
Penalties
Reporting and recordkeeping requirements
42 CFR Part a_Indian health.
Government procurement
Government programs-education
Grant programs-education
Grant programs-health
Grant programs-Indians
Health care
Health professions
Indians
Penalties
Reporting and recordkeeping requirements
Scholarships and fellowships
Student aid
42 CFR Part _Tribal self-governance.
Grant programs-Indians
Health care
Reporting and recordkeeping requirements
42 CFR Part _Introduction; definitions.
Grant programs-health
Health facilities
Health maintenance organizations (HMO)
Medicaid
Medicare
Reporting and recordkeeping requirements
42 CFR Part _General administrative requirements.
Claims
Freedom of information
Health facilities
Medicare
Privacy
42 CFR Part _Civil money penalties, assessments, and exclusions.
Administrative practice and procedure
Medicaid
Medicare
Penalties
42 CFR Part _Special programs and projects.
Grant programs-health
Health insurance
Hospitals
Intergovernmental relations
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Review of regulations.
Administrative practice and procedure
42 CFR Part _Federal health insurance for the aged and disabled.
Administrative practice and procedure
Diseases
Health facilities
Health insurance
Health professions
Medical devices
Medicare
Reporting and recordkeeping requirements
Rural areas
X-rays
42 CFR Part _Hospital insurance eligibility and entitlement.
Diseases
Health facilities
Medicare
42 CFR Part _Supplementary medical insurance (SMI) enrollment and entitlement.
Medicare
42 CFR Part _Premiums for supplementary medical insurance.
Medicare
42 CFR Part _Hospital insurance benefits.
Health facilities
Medicare
42 CFR Part _Supplementary medical insurance (SMI) benefits.
Diseases
Health facilities
Health professions
Laboratories
Medicare
Reporting and recordkeeping requirements
Rural areas
X-rays
42 CFR Part _Exclusions from Medicare and limitations on Medicare payment.
Diseases
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Prospective payment systems for inpatient hospital services.
Administrative practice and procedure
Health facilities
Medicare
Puerto Rico
Reporting and recordkeeping requirements
42 CFR Part _Principles of reasonable cost reimbursement; payment for end-stage renal disease services; optional prospectively determined payment rates for skilled nursing facilities; payment for acute kidney injury dialysis.
Diseases
Health facilities
Medicare
Puerto Rico
Reporting and recordkeeping requirements
42 CFR Part _Payment for Part B medical and other health services.
Administrative practice and procedure
Biologics
Diseases
Drugs
Health facilities
Health professions
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Services furnished by physicians in providers, supervising physicians in teaching settings, and residents in certain settings.
Health facilities
Health professions
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Ambulatory surgical services.
Health facilities
Health professions
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Health maintenance organizations, competitive medical plans, and health care prepayment plans.
Administrative practice and procedure
Grant programs-health
Health care
Health insurance
Health maintenance organizations (HMO)
Loan programs-health
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Hospice care.
Health facilities
Hospice care
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Prospective payment system for hospital outpatient department services.
Hospitals
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Program integrity: Medicare.
Fraud
Health facilities
Health professions
Medicare
42 CFR Part _Medicare contracting.
Administrative practice and procedure
Health facilities
Health professions
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Medicare Advantage program.
Administrative practice and procedure
Health facilities
Health maintenance organizations (HMO)
Medicare
Penalties
Privacy
Reporting and recordkeeping requirements
42 CFR Part _Voluntary Medicare prescription drug benefit.
Administrative practice and procedure
Emergency medical services
Health facilities
Health maintenance organizations (HMO)
Health professionals
Medicare
Penalties
Privacy
Reporting and recordkeeping requirements
42 CFR Part _Conditions for Medicare payment.
Emergency medical services
Health facilities
Health professions
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Medicare Shared Savings program.
Administrative practice and procedure
Health facilities
Health professions
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Review of national coverage determinations and local coverage determinations.
Administrative practice and procedure
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Grants to States for medical assistance programs.
Administrative practice and procedure
Grant programs-health
Medicaid
Reporting and recordkeeping requirements
42 CFR Part _State organization and general administration.
Grant programs-health
Health facilities
Medicaid
Privacy
Reporting and recordkeeping requirements
42 CFR Part _State personnel administration.
Grant programs-health
Medicaid
Reporting and recordkeeping requirements
Volunteers
42 CFR Part _State fiscal administration.
Administrative practice and procedure
Child support
Claims
Grant programs-health
Medicaid
Reporting and recordkeeping requirements
42 CFR Part _Contracts.
Grant programs-health
Health maintenance organizations (HMO)
Medicaid
Reporting and recordkeeping requirements
42 CFR Part _Eligibility in the States, District of Columbia, the Northern Mariana Islands, and American Samoa.
Aid to Families with Dependent Children
Grant programs-health
Medicaid
Reporting and recordkeeping requirements
Supplemental Security Income (SSI)
Wages
42 CFR Part _Eligibility in Guam, Puerto Rico, and the Virgin Islands.
Aid to Families with Dependent Children
Grant programs-health
Guam
Medicaid
Puerto Rico
Supplemental Security Income (SSI)
Virgin Islands
42 CFR Part _Managed care.
Citizenship and naturalization
Civil rights
Grant programs-health
Individuals with disabilities
Medicaid
Reporting and recordkeeping requirements
Sex discrimination
42 CFR Part _Services: General provisions.
Citizenship and naturalization
Civil rights
Grant programs-health
Individuals with disabilities
Medicaid
Sex discrimination
42 CFR Part _Services: Requirements and limits applicable to specific services.
Aged
Family planning
Grant programs-health
Infants and children
Medicaid
Penalties
Reporting and recordkeeping requirements
42 CFR Part _Standards for payment to nursing facilities and intermediate care facilities for individuals with intellectual disabilities.
Grant programs-health
Health facilities
Health professions
Medicaid
Nursing homes
Reporting and recordkeeping requirements
42 CFR Part _Payments for services.
Accounting
Administrative practice and procedure
Drugs
Grant programs-health
Health facilities
Health professions
Medicaid
Reporting and recordkeeping requirements
Rural areas
42 CFR Part _Program integrity: Medicaid.
Fraud
Grant programs-health
Health facilities
Health professions
Investigations
Medicaid
Reporting and recordkeeping requirements
42 CFR Part _Utilization control.
Administrative practice and procedure
Drugs
Grant programs-health
Health facilities
Medicaid
Reporting and recordkeeping requirements
42 CFR Part _Allotments and grants to States.
Administrative practice and procedure
Grant programs-health
Health insurance
Reporting and recordkeeping requirements
42 CFR Part _Programs of All-inclusive Care for the Elderly (PACE).
Aged
Citizenship and naturalization
Civil rights
Health
Health care
Health records
Incorporation by reference
Individuals with disabilities
Medicaid
Medicare
Religious discrimination
Reporting and recordkeeping requirements
Sex discrimination
42 CFR Part _Quality improvement organizations.
Grant programs-health
Health care
Health professions
Peer Review Organization (PRO)
Reporting and recordkeeping requirements
42 CFR Part _Quality improvement organization review.
Grant programs-health
Health care
Health facilities
Health professions
Health records
Peer Review Organization (PRO)
Penalties
Privacy
Reporting and recordkeeping requirements
42 CFR Part _Reconsiderations and appeals.
Administrative practice and procedure
Health care
Health professions
Peer Review Organization (PRO)
Reporting and recordkeeping requirements
42 CFR Part _Acquisition protection and disclosure of quality improvement organization information.
Health care
Health professions
Health records
Peer Review Organization (PRO)
Penalties
Privacy
Reporting and recordkeeping requirements
42 CFR Part _Conditions of participation for hospitals.
Grant programs-health
Hospitals
Medicaid
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Requirements for States and long term care facilities.
Grant programs-health
Health facilities
Health professions
Health records
Medicaid
Medicare
Nursing homes
Nutrition
Reporting and recordkeeping requirements
Safety
42 CFR Part _Home health services.
Administrative practice and procedure
Grant programs-health
Health facilities
Health professions
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Conditions of participation: specialized providers.
Grant programs-health
Health facilities
Medicaid
Privacy
Reporting and recordkeeping requirements
42 CFR Part _Conditions for coverage of specialized services furnished by suppliers.
Administrative practice and procedure
Grant programs-health
Health facilities
Medicare
Reporting and recordkeeping requirements
X-rays
42 CFR Part _Survey, certification and enforcement procedures.
Administrative practice and procedure
Health facilities
Health professions
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Provider agreements and supplier approval.
Health facilities
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Certification of certain health facilities.
Grant programs-health
Health facilities
Medicaid
Medicare
Reporting and recordkeeping requirements
Rural areas
42 CFR Part _Laboratory requirements.
Administrative practice and procedure
Grant programs-health
Health facilities
Laboratories
Medicaid
Medicare
Penalties
Reporting and recordkeeping requirements
42 CFR Part _Conditions for coverage for end-stage renal disease facilities.
Diseases
Health facilities
Incorporation by reference
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Standards for the Electronic Health Record Technology Incentive Program.
Administrative practice and procedure
Health facilities
Health maintenance organizations (HMO)
Health professions
Health records
Medicaid
Medicare
Penalties
Privacy
Reporting and recordkeeping requirements
42 CFR Part _Appeals procedures for determinations that affect participation in the Medicare program and for determinations that affect the participation of ICFs/IID and certain NFs in the Medicaid program.
Administrative practice and procedure
Health facilities
Health professions
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Establishment of the Health Care Infrastructure Improvement Program.
Administrative practice and procedure
Health facilities
Loan programs
Reporting and recordkeeping requirements
Rural areas
42 CFR Part _Comprehensive care for joint replacement model.
Administrative practice and procedure
Health facilities
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Radiation oncology model and end stage renal disease treatment choices model.
Administrative practice and procedure
Health facilities
Medicare
Reporting and recordkeeping requirements
42 CFR Part _Most Favored Nation (MFN) model.
Administrative practice and procedure
Health facilities
Medicare
Reporting and recordkeeping requirements
Waivers
42 CFR Part _Administration, eligibility, essential health benefits, performance standards, service delivery requirements, premium and cost sharing, allotments, and reconciliation.
Administrative practice and procedure
Health care
health insurance
Intergovernmental relations
Penalties
Reporting and recordkeeping requirements
42 CFR Part _Introduction: General definitions.
Administrative practice and procedure
Fraud
Grant programs-health
Health facilities
Health professions
Medicaid
Medicare
Social security
42 CFR Part _Program integrity_Medicare and State health care programs.
Administrative practice and procedure
Fraud
Grant programs-health
Health facilities
Health professions
Maternal and child health
Medicaid
Medicare
Social Security
42 CFR Part _Program integrity_State-initiated exclusions from Medicaid.
Fraud
Grant programs-health
Health facilities
Health professions
Medicaid
Reporting and recordkeeping requirements
42 CFR Part _Civil money penalties, assessments and exclusions.
Fraud
Grant programs-health
Health facilities
Health professions
Maternal and child health
Medicaid
Medicare
Penalties
Social Security
42 CFR Part _Imposition of sanctions on health care practitioners and providers of health care services by a quality improvement organization.
Administrative practice and procedure
Health facilities
Health professions
Medicare
Peer Review Organization (PRO)
Penalties
Reporting and recordkeeping requirements
42 CFR Part _Appeals of exclusions, civil money penalties and assessments.
Administrative practice and procedure
Fraud
Grant programs-health
Health facilities
Health professions
Maternal and child health
Medicaid
Medicare
Penalties
Social Security
42 CFR Part _Investigational inquiries.
Administrative practice and procedure
Fraud
Investigations
Penalties
42 CFR Part _State Medicaid fraud control units.
Administrative practice and procedure
Fraud
Grant programs-health
Medicaid
Reporting and recordkeeping requirements
42 CFR Part _Advisory opinions by the OIG.
Administrative practice and procedure
Medicaid
Medicare
Reporting and recordkeeping requirements

 

Sours: https://www.archives.gov/federal-register/cfr/subject-titlehtml
Master the CFR: Researching the Code of Federal Regulations

It's still in my ears. He held my head, not allowing me to move away. Sperm leaked from the corner of my mouth and dripped down my chin onto my chest. I mentally complimented myself on my foresight. When he let go, the second pushed me on the back of the head, putting me on all fours.

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Katya herself finished quietly, almost silently, as befits an office specialist, yet our "relationship" took place on a working day. Katka was a. Great lover, but with these sms she clearly crossed the line. Himself to blame. "Kitty", damn it.



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