§1395rr–1 Medicare Coverage for Individuals Exposed to Environmental Health Hazards

Summary

Gives Medicare to people who were harmed by environmental hazards if they meet certain rules. People the government finds to be “environmental exposure affected individuals” are treated as meeting Medicare’s basic eligibility rules. Those people get Part A benefits from the date they are deemed eligible. They can sign up for Part B starting the month they are deemed eligible. The Health Secretary can run pilot programs to try new ways to give coordinated and cheaper care. The Secretary can run separate pilots for each area with a federal public health emergency (except the June 17, 2009 declaration). Pilots can pay for services not usually covered if the Secretary says it helps. The Secretary must set ways to pay providers, may waive usual Medicare rules to run pilots, can move money from the Hospital Insurance and Supplementary Medical Insurance trust funds to the CMS Program Management Account, and does not have to make pilots budget neutral. No pilot payment is allowed when the person can get the same care from another public or private plan. The Social Security Commissioner, with the Secretary’s help and using the cost method in section 401(g), decides who is an “environmental exposure affected individual.” The Secretary decides who may join pilot programs. Two kinds of affected people are described. One kind are people linked to the area under the emergency declaration in effect on June 17, 2009. They must have certain asbestos-related conditions (like asbestosis, pleural disease, mesothelioma, or certain cancers) proven by the medical tests the Secretary requires, have lived a total of 6 months in that area during a period ending at least 10 years before diagnosis and before the remedial actions listed in the Record of Decision for Operating Unit 4 and the Record of Decision for Operating Unit 7, and must apply for benefits. The other kind are people with medical conditions the Secretary says were caused by exposure in an area with a public health emergency. They must meet the Secretary’s medical standards, have been present there for a total of 6 months in a period the Secretary sets, apply for benefits, and be found to meet the criteria.