PRIA, Government Policy, Made Personal

Summary

Organizations that have a Corps member must not refuse care or treat someone worse because they cannot pay or because their payment comes from Medicare, Medicaid, or the State Children’s Health Insurance Program (CHIP). Those organizations must set fees that match local rates and cover their costs. They must also create a matching discount or waiver plan based on a patient’s ability to pay, and try to collect fees according to those plans. For Medicare patients, the organization must accept Medicare assignment. For Medicaid and CHIP patients, it must make the proper agreement with the state agency that runs those programs. The organization must also try to collect payments from any third party responsible, including government agencies.

Title 42, §254g

The Public Health and Welfare, Source: USLM XML via OLRC

(a)Availability of services regardless of ability to pay or payment source

An entity to which a Corps member is assigned shall not deny requested health care services, and shall not discriminate in the provision of services to an individual—

(1)because the individual is unable to pay for the services; or

(2)because payment for the services would be made under—

(A)the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.);

(B)the medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.); or

(C)the State children’s health insurance program under title XXI of such Act (42 U.S.C. 1397aa et seq.).

(b)Charges for services

The following rules shall apply to charges for health care services provided by an entity to which a Corps member is assigned:

(1)In general

(A)Schedule of fees or payments

Except as provided in paragraph (2), the entity shall prepare a schedule of fees or payments for the entity’s services, consistent with locally prevailing rates or charges and designed to cover the entity’s reasonable cost of operation.

(B)Schedule of discounts

Except as provided in paragraph (2), the entity shall prepare a corresponding schedule of discounts (including, in appropriate cases, waivers) to be applied to the payment of such fees or payments. In preparing the schedule, the entity shall adjust the discounts on the basis of a patient’s ability to pay.

(C)Use of schedules

The entity shall make every reasonable effort to secure from patients fees and payments for services in accordance with such schedules, and fees or payments shall be sufficiently discounted in accordance with the schedule described in subparagraph (B).

(2)Services to beneficiaries of Federal and federally assisted programs

In the case of health care services furnished to an individual who is a beneficiary of a program listed in subsection (a)(2), the entity—

(A)shall accept an assignment pursuant to section 1842(b)(3)(B)(ii) of the Social Security Act (42 U.S.C. 1395u(b)(3)(B)(ii)) with respect to an individual who is a beneficiary under the medicare program; and

(B)shall enter into an appropriate agreement with—

(i)the State agency administering the program under title XIX of such Act [42 U.S.C. 1396 et seq.] with respect to an individual who is a beneficiary under the medicaid program; and

(ii)the State agency administering the program under title XXI of such Act [42 U.S.C. 1397aa et seq.] with respect to an individual who is a beneficiary under the State children’s health insurance program.

(3)Collection of payments

The entity shall take reasonable and appropriate steps to collect all payments due for health care services provided by the entity, including payments from any third party (including a Federal, State, or local government agency and any other third party) that is responsible for part or all of the charge for such services.

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Social Security Act, referred to in subsecs. (a)(2) and (b)(2)(B), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XVIII, XIX, and XXI of the Act are classified generally to subchapters XVIII (§ 1395 et seq.), XIX (§ 1396 et seq.), and XXI (§ 1397aa et seq.), respectively, of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.

Prior Provisions

A prior section 254g, act July 1, 1944, ch. 373, title III, § 334, as added Pub. L. 94–484, title IV, § 407(b)(3), Oct. 12, 1976, 90 Stat. 2274; amended Pub. L. 97–35, title XXVII, § 2704, Aug. 13, 1981, 95 Stat. 906; Pub. L. 98–194, § 3, Dec. 1, 1983, 97 Stat. 1345; Pub. L. 100–177, title II, § 202(c), Dec. 1, 1987, 101 Stat. 996; Pub. L. 101–597, title I, § 105, title IV, § 401(b)[(a)], Nov. 16, 1990, 104 Stat. 3018, 3035, related to shared responsibility for costs of Corps personnel providing health services in or to a health professional shortage area during the assignment period, prior to repeal by Pub. L. 107–251, title III, § 305, Oct. 26, 2002, 116 Stat. 1647.

Amendments

2003—Subsec. (b)(1)(B). Pub. L. 108–163 inserted “the payment of” after “applied to”.

Statutory Notes and Related Subsidiaries

Effective Date

of 2003 AmendmentAmendment by Pub. L. 108–163 deemed to have taken effect immediately after the enactment of Pub. L. 107–251, see section 3 of Pub. L. 108–163, set out as a note under section 233 of this title.

§254g Charges for Services by Entities Using Corps Members