Medicare definitions of services and benefits

What this document is

42 U.S.C. s. 1395x: Medicare definitions of services and benefits is a state statute published by U.S. Government Publishing Office (govinfo.gov). It is one of the documents that insurance license exam questions are written from, including life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• 42 U.S.C. § 1395x: subsection (dd) (Hospice Care)

  “The care and services described in subparagraphs (A) and (D) may be provided on a 24-hour, continuous basis only during periods of crisis (meeting criteria established by the Secretary) and only as necessary to maintain the terminally ill individual at home.”

• 42 U.S.C. § 1395x, subsection (b) (Inpatient Hospital Services)

  “The term "inpatient hospital services" means the following items and services furnished to an inpatient of a hospital and (except as provided in paragraph (3)) by the hospital - (1) bed and board; (2) such nursing services and other related services, such use of hospital facilities, and such...”

• 42 U.S.C. § 1395x: Subsection (dd) (Hospice Care)

  “(G) short-term inpatient care (including both respite care and procedures necessary for pain control and acute and chronic symptom management) in an inpatient facility meeting such conditions as the Secretary determines to be appropriate to provide such care, but such respite care may be provided...”

• 42 U.S.C. § 1395x: subsection (cc) (Comprehensive Outpatient Rehabilitation Facility Services)

  “(A) is primarily engaged in providing (by or under the supervision of physicians) diagnostic, therapeutic, and restorative services to outpatients for the rehabilitation of injured, disabled, or sick persons;”

• 42 U.S.C. § 1395x, subsection (jj) (Screening Mammography)

  “The term "screening mammography" means a radiologic procedure provided to a woman for the purpose of early detection of breast cancer and includes a physician's interpretation of the results of the procedure.”

• 42 U.S.C. § 1395x(dd)(1) (definition of hospice care)

  “The term "hospice care" means the following items and services provided to a terminally ill individual by, or by others under arrangements made by, a hospice program under a written plan (for providing such care to such individual) established and periodically reviewed by the individual's attending...”

• 42 U.S.C. § 1395x(a) - definition of spell of illness

  “The term "spell of illness" with respect to any individual means a period of consecutive days - (1) beginning with the first day (not included in a previous spell of illness) (A) on which such individual is furnished inpatient hospital services, inpatient critical access hospital services or...”

• 42 U.S.C. § 1395x(dd)(3)(A) (definition of a terminally ill individual)

  “An individual is considered to be "terminally ill" if the individual has a medical prognosis that the individual's life expectancy is 6 months or less.”

Practice this material

Questions about this source

More Federal sources sources

• Coverage for Pre-existing Conditions (Affordable Care Act) - HealthCare.govFederal guidance
• 20 C.F.R. § 404.1520 -- Evaluation of Disability in General (the five-step sequential evaluation process)Regulation
• Parts of Medicare (Medicare & You / medicare.gov)Federal guidance
• Continuation of Health Coverage (COBRA) - U.S. Department of LaborReference
• Portability of Health Coverage (HIPAA) - U.S. Department of LaborReference
• Fair Credit Reporting Act - 15 U.S.C. § 1681a (Definitions)State statute
• 15 U.S.C. s. 1681b: FCRA permissible purposes of consumer reportsState statute
• 15 U.S.C. s. 1681c: FCRA requirements relating to obsolete information in consumer reportsState statute