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

Summary

Certain people who were exposed to environmental hazards must be treated as meeting Medicare’s normal eligibility rules. If the Social Security Commissioner, with the Health Secretary, finds someone is an “environmental exposure affected individual” with the listed asbestos-related illnesses, that person must be deemed eligible. The Health Secretary can also choose to deem other affected people eligible. People who are deemed eligible get Part A benefits starting the day they are deemed and can sign up for Part B starting that month. The Commissioner decides who is an affected person using a cost-allocation method, and the Secretary decides who may join any pilot programs. The law also creates a required pilot program for people living in or near the area of the June 17, 2009 public health emergency and allows optional pilots for other emergency areas (but not the June 17, 2009 declaration). To join a pilot, a person must enroll in Part B and apply. Pilots may pay for services not normally covered and try new ways to pay providers. They cannot pay for care that another public or private plan or legal agreement already covers. The Secretary can waive rules, transfer money from Medicare trust funds to run the pilots, and does not have to keep the pilots budget neutral. Definitions: “emergency declaration” = a declared public health emergency; “environmental exposure affected individual” = someone with certain exposure-linked medical conditions who meets the law’s time-in-area and application rules (including 6 months present in the area, and for certain asbestos-related cases a period ending at least 10 years before diagnosis and before remedial actions for Operating Unit 4 and Operating Unit 7).