§1395rr–1 Medicare coverage for individuals exposed to environmental health hazards

Summary

Some people who were exposed to certain environmental hazards can be treated as eligible for Medicare. If the government finds a person is an “environmental exposure affected individual” of the first kind, that person will be treated as meeting Medicare’s eligibility rules. The person will get Medicare Part A (hospital insurance) as of the date they are so treated, and they can sign up for Medicare Part B (medical insurance) starting the month they are treated as eligible. The Health and Human Services Secretary must run a pilot program to try new ways to give careful, coordinated, and cost‑effective care to these people. The Secretary may run separate pilots for each area that has a public health emergency (except the area tied to June 17, 2009). Pilots can pay for services not normally covered if the Secretary thinks those services help the pilot’s goals. The Secretary will set how providers are paid, may waive parts of Medicare law needed to run the pilots, must avoid paying when another public or private plan covers the same service, and may move money from the Medicare trust funds into the Centers for Medicare & Medicaid Services management account to run the pilots. Pilots do not have to be budget neutral. “Emergency declaration” — a public health emergency declared under section 9604(a) of this title. “Environmental exposure affected individual” — two types: (1) someone diagnosed with one or more listed asbestos‑related conditions who lived at least 6 months in the affected area that had an emergency declaration as of June 17, 2009, during a period ending at least 10 years before their diagnosis and before the cleanup steps listed in the Records of Decision for Operating Units 4 and 7, who files an application and is approved; and (2) someone not in the first type who has a medical condition the Secretary says was caused by the public health hazard in the emergency declaration, who lived at least 6 months in the affected area during a period the Secretary sets, who applies and is approved. The Commissioner of Social Security, with the Secretary’s help, decides who is an environmental exposure affected individual; the Secretary decides who may join the pilots.