42 U.S.C. § 1395d

Scope of benefits

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(a) Entitlement to payment for inpatient hospital services, post-hospital extended care services, home health services, and hospice careThe benefits provided to an individual by the insurance program under this part shall consist of entitlement to have payment made on his behalf or, in the case of payments referred to in section 1395f(d)(2) of this title to him (subject to the provisions of this part) for—(1) inpatient hospital services or inpatient critical access hospital services for up to 150 days during any spell of illness minus 1 day for each day of such services in excess of 90 received during any preceding spell of illness (if such individual was entitled to have payment for such services made under this part unless he specifies in accordance with regulations of the Secretary that he does not desire to have such payment made);(2)(A) post-hospital extended care services for up to 100 days during any spell of illness, and (B) to the extent provided in subsection (f), extended care services that are not post-hospital extended care services;(3) in the case of individuals not enrolled in part B, home health services, and in the case of individuals so enrolled, post-institutional home health services furnished during a home health spell of illness for up to 100 visits during such spell of illness;(4) in lieu of certain other benefits, hospice care with respect to the individual during up to two periods of 90 days each and an unlimited number of subsequent periods of 60 days each with respect to which the individual makes an election under subsection (d)(1); and(5) for individuals who are terminally ill, have not made an election under subsection (d)(1), and have not previously received services under this paragraph, services that are furnished by a physician (as defined in section 1395x(r)(1) of this title) who is either the medical director or an employee of a hospice program and that—(A) consist of—(i) an evaluation of the individual’s need for pain and symptom management, including the individual’s need for hospice care; and(ii) counseling the individual with respect to hospice care and other care options; and(B) may include advising the individual regarding advanced care planning.(b) Services not coveredPayment under this part for services furnished an individual during a spell of illness may not (subject to subsection (c)) be made for—(1) inpatient hospital services furnished to him during such spell after such services have been furnished to him for 150 days during such spell minus 1 day for each day of inpatient hospital services in excess of 90 received during any preceding spell of illness (if such individual was entitled to have payment for such services made under this part unless he specifies in accordance with regulations of the Secretary that he does not desire to have such payment made);(2) post-hospital extended care services furnished to him during such spell after such services have been furnished to him for 100 days during such spell; or(3) inpatient psychiatric hospital services furnished to him after such services have been furnished to him for a total of 190 days during his lifetime.Payment under this part for post-institutional home health services furnished an individual during a home health spell of illness may not be made for such services beginning after such services have been furnished for a total of 100 visits during such spell.(c) Inpatients of psychiatric hospitals

If an individual is an inpatient of a psychiatric hospital on the first day of the first month for which he is entitled to benefits under this part, the days on which he was an inpatient of such a hospital in the 150-day period immediately before such first day shall be included in determining the number of days limit under subsection (b)(1) insofar as such limit applies to (1) inpatient psychiatric hospital services, or (2) inpatient hospital services for an individual who is an inpatient primarily for the diagnosis or treatment of mental illness (but shall not be included in determining such number of days limit insofar as it applies to other inpatient hospital services or in determining the 190-day limit under subsection (b)(3)).

(d) Hospice care; election; waiver of rights; revocation; change of election(1) Payment under this part may be made for hospice care provided with respect to an individual only during two periods of 90 days each and an unlimited number of subsequent periods of 60 days each during the individual’s lifetime and only, with respect to each such period, if the individual makes an election under this paragraph to receive hospice care under this part provided by, or under arrangements made by, a particular hospice program instead of certain other benefits under this subchapter.(2)(A) Except as provided in subparagraphs (B) and (C) and except in such exceptional and unusual circumstances as the Secretary may provide, if an individual makes such an election for a period with respect to a particular hospice program, the individual shall be deemed to have waived all rights to have payment made under this subchapter with respect to—(i) hospice care provided by another hospice program (other than under arrangements made by the particular hospice program) during the period, and(ii) services furnished during the period that are determined (in accordance with guidelines of the Secretary) to be—(I) related to the treatment of the individual’s condition with respect to which a diagnosis of terminal illness has been made or(II) equivalent to (or duplicative of) hospice care;except that clause (ii) shall not apply to physicians’ services furnished by the individual’s attending physician (if not an employee of the hospice program) or to services provided by (or under arrangements made by) the hospice program.(B) After an individual makes such an election with respect to a 90-day period or a subsequent 60-day period, the individual may revoke the election during the period, in which case—(i) the revocation shall act as a waiver of the right to have payment made under this part for any hospice care benefits for the remaining time in such period and (for purposes of subsection (a)(4) and subparagraph (A)) the individual shall be deemed to have been provided such benefits during such entire period, and(ii) the individual may at any time after the revocation execute a new election for a subsequent period, if the individual otherwise is entitled to hospice care benefits with respect to such a period.(C) An individual may, once in each such period, change the hospice program with respect to which the election is made and such change shall not be considered a revocation of an election under subparagraph (B).(D) For purposes of this subchapter, an individual’s election with respect to a hospice program shall no longer be considered to be in effect with respect to that hospice program after the date the individual’s revocation or change of election with respect to that election takes effect.(e) Services taken into account

For purposes of subsections (b) and (c), inpatient hospital services, inpatient psychiatric hospital services, and post-hospital extended care services shall be taken into account only if payment is or would be, except for this section or the failure to comply with the request and certification requirements of or under section 1395f(a) of this title, made with respect to such services under this part.

(f) Coverage of extended care services without regard to three-day prior hospitalization requirement(1) The Secretary shall provide for coverage, under clause (B) of subsection (a)(2), of extended care services which are not post-hospital extended care services at such time and for so long as the Secretary determines, and under such terms and conditions (described in paragraph (2)) as the Secretary finds appropriate, that the inclusion of such services will not result in any increase in the total of payments made under this subchapter and will not alter the acute care nature of the benefit described in subsection (a)(2).(2) The Secretary may provide—(A) for such limitations on the scope and extent of services described in subsection (a)(2)(B) and on the categories of individuals who may be eligible to receive such services, and(B) notwithstanding sections 1395f, 1395x(v), and 1395ww of this title, for such restrictions and alternatives on the amounts and methods of payment for services described in such subsection,as may be necessary to carry out paragraph (1).(g) “Spell of illness” defined

For definitions of “spell of illness”, and for definitions of other terms used in this part, see section 1395x of this title.

(Aug. 14, 1935, ch. 531, title XVIII, § 1812, as added Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79 Stat. 291; amended Pub. L. 90–248, title I, §§ 129(c)(2), 137(a), 138(a), 143(b), 146(a), Jan. 2, 1968, 81 Stat. 847, 853, 854, 857, 859; Pub. L. 96–499, title IX, §§ 930(b)–(d), 931(a), Dec. 5, 1980, 94 Stat. 2631, 2633; Pub. L. 97–35, title XXI, § 2121(a), Aug. 13, 1981, 95 Stat. 796; Pub. L. 97–248, title I, §§ 122(b), 123, Sept. 3, 1982, 96 Stat. 356, 364; Pub. L. 97–448, title III, § 309(b)(5), Jan. 12, 1983, 96 Stat. 2409; Pub. L. 100–360, title I, § 101, July 1, 1988, 102 Stat. 684; Pub. L. 101–234, title I, § 101(a), Dec. 13, 1989, 103 Stat. 1979; Pub. L. 101–239, title VI, § 6003(g)(3)(B)(i), Dec. 19, 1989, 103 Stat. 2152; Pub. L. 101–508, title IV, § 4006(a), Nov. 5, 1990, 104 Stat. 1388–43; Pub. L. 103–432, title I, § 102(g)(1), Oct. 31, 1994, 108 Stat. 4404; Pub. L. 105–33, title IV, §§ 4201(c)(1), 4443(a), (b)(1), 4611(a), Aug. 5, 1997, 111 Stat. 373, 423, 472; Pub. L. 106–113, div. B, § 1000(a)(6) [title III, § 321(k)(1)], Nov. 29, 1999, 113 Stat. 1536, 1501A–366; Pub. L. 108–173, title V, § 512(a), title VII, § 736(c)(1), Dec. 8, 2003, 117 Stat. 2299, 2356.)Editorial NotesAmendments

2003—Subsec. (a)(3). Pub. L. 108–173, § 736(c)(1), substituted “in the case of individuals not” for “for individuals not” and “in the case of individuals so” for “for individuals so”.

Subsec. (a)(5). Pub. L. 108–173, § 512(a), added par. (5).

1999—Subsec. (b). Pub. L. 106–113 inserted “during” after “100 visits” in concluding provisions.

1997—Subsec. (a)(1). Pub. L. 105–33, § 4201(c)(1), substituted “critical access” for “rural primary care”.

Subsec. (a)(3). Pub. L. 105–33, § 4611(a)(1), substituted “for individuals not enrolled in part B, home health services, and for individuals so enrolled, post-institutional home health services furnished during a home health spell of illness for up to 100 visits during such spell of illness” for “home health services”.

Subsec. (a)(4). Pub. L. 105–33, § 4443(a), substituted “and an unlimited number of subsequent periods of 60 days each” for “, a subsequent period of 30 days, and a subsequent extension period”.

Subsec. (b). Pub. L. 105–33, § 4611(a)(2), inserted closing provisions.

Subsec. (d)(1). Pub. L. 105–33, § 4443(a), substituted “and an unlimited number of subsequent periods of 60 days each” for “, a subsequent period of 30 days, and a subsequent extension period”.

Subsec. (d)(2)(B). Pub. L. 105–33, § 4443(b)(1), substituted “90-day period or a subsequent 60-day period” for “90- or 30-day period or a subsequent extension period”.

1994—Subsec. (a)(1). Pub. L. 103–432 substituted “inpatient hospital services or inpatient rural primary care hospital services” for “inpatient hospital services” before “for up to 150 days” and “such services” for “inpatient hospital services” before “in excess of 90” and struck out “and inpatient rural primary care hospital services” after “such payment made)”.

1990—Subsec. (a)(4). Pub. L. 101–508, § 4006(a)(1), substituted “90 days each, a subsequent period of 30 days, and a subsequent extension period” for “90 days each and one subsequent period of 30 days”.

Subsec. (d)(1). Pub. L. 101–508, § 4006(a)(2)(A), substituted “90 days each, a subsequent period of 30 days, and a subsequent extension period during the individual’s lifetime” for “90 days each and one subsequent period of 30 days during the individual’s lifetime”.

Subsec. (d)(2)(B). Pub. L. 101–508, § 4006(a)(2)(B), substituted “a 90- or 30-day period or a subsequent extension period” for “a 90- or 30-day period”.

1989—Subsec. (a). Pub. L. 101–234 repealed Pub. L. 100–360, § 101(1), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, see 1988 Amendment note below.

Subsec. (a)(1). Pub. L. 101–239 inserted “and inpatient rural primary care hospital services” before semicolon at end.

Subsecs. (b) to (d)(1), (2)(B), (e) to (g). Pub. L. 101–234 repealed Pub. L. 100–360, § 101(2)–(6), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, see 1988 Amendment notes below.

1988—Subsec. (a). Pub. L. 100–360, § 101(1), struck out former pars. (1) to (4) and added new pars. (1) to (4) which read as follows:

“(1) inpatient hospital services;

“(2) extended care services for up to 150 days during any calendar year;

“(3) home health services; and

“(4) in lieu of certain other benefits, hospice care with respect to the individual during up to two periods of 90 days each, a subsequent period of 30 days, and a subsequent extension period with respect to which the individual makes an election under subsection (d)(1) of this section.”

Subsec. (b). Pub. L. 100–360, § 101(2), amended subsec. (b) generally, striking out par. (1) and renumbering and amending pars. (2) and (3) as (1) and (2), respectively.

Subsec. (c). Pub. L. 100–360, § 101(3), amended subsec. (c) generally, substituting pars. (1) to (4) limiting periods for inpatients of psychiatric hospitals for former single paragraph.

Subsec. (d)(1). Pub. L. 100–360, § 101(4)(A), substituted “, a subsequent period of 30 days, and a subsequent extension period” for “and one subsequent period of 30 days”.

Subsec. (d)(2)(B). Pub. L. 100–360, § 101(4)(B), inserted “or a subsequent extension period” after “30-day period” in introductory provisions.

Subsec. (e). Pub. L. 100–360, § 101(5), struck out “post-hospital” before “extended care services”.

Subsec. (f). Pub. L. 100–360, § 101(6), struck out subsec. (f) which provided coverage of extended care services without regard to three-day prior hospitalization requirement.

Subsec. (g). Pub. L. 100–360, § 101(6), struck out subsec. (g) which cross-referenced section 1395x of this title for definitions of “spell of illness” and other terms used in this part.

1983—Subsec. (d)(2)(A). Pub. L. 97–448 substituted “or to services” for “or to other than services” after “(if not an employee of the hospice program)”.

1982—Subsec. (a)(2). Pub. L. 97–248, § 123(a), redesignated existing provisions as subpar. (A) and added subpar. (B).

Subsec. (a)(4). Pub. L. 97–248, § 122(b)(1), added par. (4).

Subsec. (d). Pub. L. 97–248, § 122(b)(2), added subsec. (d).

Subsecs. (f), (g). Pub. L. 97–248, § 123(b), added subsec. (f) and redesignated former subsec. (f) as (g).

1981—Subsec. (a). Pub. L. 97–35 struck out par. (4) which related to alcohol detoxification facility services.

1980—Subsec. (a)(3). Pub. L. 96–499, § 930(b), substituted “home health services” for “post-hospital home health services for up to 100 visits (during the one-year period described in section 1395x(n) of this title) after the beginning of one spell of illness and before the beginning of the next”.

Subsec. (a)(4). Pub. L. 96–499, § 931(a), added par. (4).

Subsec. (d). Pub. L. 96–499, § 930(c), struck out subsec. (d) which authorized payment for post-hospital home health services furnished an individual only during the one year period described in section 1395x(n) of this title following his most recent hospital discharge which met the requirements of such section and only for the first 100 visits in such period.

Subsec. (e). Pub. L. 96–499, § 930(d), substituted “subsections (b) and (c)” for “subsections (b), (c), and (d)” and “and post-hospital extended care services” for “post-hospital extended care services, and post-hospital home health services”.

1968—Subsec. (a). Pub. L. 90–248, § 143(b), inserted “or, in the case of payments referred to in section 1395f(d)(2) of this title to him” after “on his behalf” in text preceding par. (1).

Subsec. (a)(1). Pub. L. 90–248, § 137(a)(1), increased the maximum duration of benefits from 90 to 150 days minus 1 day for each day of inpatient hospital services in excess of 90 received during any preceding spell of illness (if such individual was entitled to have payment for such services made under this part unless he specifies that he does not desire to have such payment made).

Subsec. (a)(4). Pub. L. 90–248, § 129(c)(2), struck out par. (4) which provided for payment for outpatient hospital diagnostic services.

Subsec. (b)(1). Pub. L. 90–248, § 137(a)(2), changed the limitation on payments from 90 to 150 days minus 1 day for each day of inpatient hospital services in excess of 90 received during any preceding spell of illness (if such individual was entitled to have payment for such services made under this part unless he specifies that he does not desire to have such payment made).

Subsec. (c). Pub. L. 90–248, § 138(a), increased the limit from 90 to 150 days so that if an individual was an inpatient of a psychiatric or tuberculosis hospital on the first day of the first month for which he is entitled to benefits, the days he was an inpatient in the 150-day period immediately before such first day are included in determining the limit under subsec. (b)(1) insofar as such limit applies to (1) inpatient psychiatric hospital services and inpatient tuberculosis hospital services, or (2) inpatient hospital services for an individual who is an inpatient primarily for the diagnosis or treatment of mental illness or tuberculosis (but are not included in determining such limit as it applies to other inpatient hospital services or in determining the 190-day limit under subsec. (b)(3)).

Pub. L. 90–248, § 146(a), provided that the limitation of allowable days of inpatient hospital services will not apply to services provided to an inpatient of a tuberculosis hospital.

Statutory Notes and Related SubsidiariesEffective Date of 2003 Amendment

Pub. L. 108–173, title V, § 512(d), Dec. 8, 2003, 117 Stat. 2300, provided that: “The amendments made by this section [amending this section and sections 1395f and 1395x of this title] shall apply to services provided by a hospice program on or after January 1, 2005.”

Effective Date of 1999 Amendment

Pub. L. 106–113, div. B, § 1000(a)(6) [title III, § 321(m)], Nov. 29, 1999, 113 Stat. 1536, 1501A–368, provided that: “Except as otherwise provided, the amendments made by this section [amending this section and sections 1395i, 1395i–4, 1395l, 1395m, 1395u, 1395w–3, 1395w–4, 1395w–21, 1395w–22, 1395w–24, 1395x, 1395y, 1395cc, 1395ss, 1395ww, 1395yy, and 1395fff of this title, repealing section 1320b–5 of this title, and amending provisions set out as notes under sections 1395f and 1395ww of this title] shall take effect as if included in the enactment of BBA [Balanced Budget Act of 1997, Pub. L. 105–33].”

Effective Date of 1997 Amendment

Amendment by section 4201(c)(1) of Pub. L. 105–33 applicable to services furnished on or after Oct. 1, 1997, see section 4201(d) of Pub. L. 105–33, set out as a note under section 1395f of this title.

Pub. L. 105–33, title IV, § 4449, Aug. 5, 1997, 111 Stat. 424, provided that: “Except as otherwise provided in this chapter [chapter 4 (§§ 4441–4449) of subtitle E of title IV of Pub. L. 105–33, amending this section and sections 1395f, 1395x, and 1395pp of this title and enacting provisions set out as notes under section 1395f and 1395x of this title], the amendments made by this chapter apply to benefits provided on or after the date of the enactment of this chapter [Aug. 5, 1997], regardless of whether or not an individual has made an election under section 1812(d) of the Social Security Act (42 U.S.C. 1395d(d)) before such date.”

Pub. L. 105–33, title IV, § 4611(f), Aug. 5, 1997, 111 Stat. 474, provided that: “The amendments made by this section [amending this section and sections 1395u, 1395x, and 1395ff of this title] apply to services furnished on or after January 1, 1998. For purpose of applying such amendments, any home health spell of illness that began, but not [sic] did not end, before such date shall be considered to have begun as of such date.”

Effective Date of 1994 Amendment

Pub. L. 103–432, title I, § 102(i), Oct. 31, 1994, 108 Stat. 4404, provided that: “The amendments made by this section [amending this section and sections 1395e, 1395f, 1395i–4, 1395m, 1395x, and 1395ww of this title] shall take effect on the date of the enactment of this Act [Oct. 31, 1994].”

Effective Date of 1990 Amendment

Pub. L. 101–508, title IV, § 4006(c), Nov. 5, 1990, 104 Stat. 1388–43, provided that: “The amendments made by this section [amending this section and section 1395f of this title] shall apply with respect to care and services furnished on or after January 1, 1990.”

Effective Date of 1989 Amendment

Amendment by Pub. L. 101–234 effective Jan. 1, 1990, see section 101(d) of Pub. L. 101–234, set out as a note under section 1395c of this title.

Effective Date of 1988 Amendment

Pub. L. 100–360, title I, § 104(a), July 1, 1988, 102 Stat. 687, as amended by Pub. L. 100–485, title VI, § 608(d)(3)(A), Oct. 13, 1988, 102 Stat. 2413, provided that:“(1)In general.—Except as provided in paragraph (2) and subsection (b), the amendments made by this subtitle [subtitle A (§§ 101–104) of title I of Pub. L. 100–360, amending this section and sections 1395c, 1395e, 1395f, 1395i–2, 1395k, 1395x, 1395cc, and 1395tt of this title] shall take effect on January 1, 1989, and shall apply—“(A) to the inpatient hospital deductible for 1989 and succeeding years,“(B) to care and services furnished on or after January 1, 1989,“(C) to premiums for January 1989 and succeeding months, and“(D) to blood or blood cells furnished on or after January 1, 1989.“(2)Elimination of post-hospital requirement for extended care services.—The amendments made by this subtitle, insofar as they eliminate the requirement (under section 1812(a)(2) of the Social Security Act [42 U.S.C. 1395d(a)(2)]) that extended care services are only covered under title XVIII of such Act [42 U.S.C. 1395 et seq.] if they are post-hospital extended care services, shall only apply to extended care services furnished pursuant to an admission to a skilled nursing facility occurring on or after January 1, 1989.”

Effective Date of 1983 Amendment

Amendment by Pub. L. 97–448 effective as if originally included as a part of this section as this section was amended by the Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97–248, see section 309(c)(2) of Pub. L. 97–448, set out as a note under section 426–1 of this title.

Effective Date of 1982 Amendment

Amendment by section 122(b) of Pub. L. 97–248 applicable to hospice care provided on or after Nov. 1, 1983, see section 122(h)(1) of Pub. L. 97–248, as amended, set out as a note under section 1395c of this title.

Effective Date of 1981 Amendment

Pub. L. 97–35, title XXI, § 2121(i), Aug. 13, 1981, 95 Stat. 796, provided that: “The amendments made by this section [amending this section and sections 1320c–3, 1320c–4, 1320c–7, 1395f, and 1395x of this title] (other than by subsection (h) [repealing provisions set out as a note under section 1395ll of this title]) shall apply to services furnished in detoxification facilities for inpatient stays beginning on or after the tenth day after the date of the enactment of this Act [Aug. 13, 1981].”

Effective Date of 1980 Amendment

Amendment by section 930(b)–(d) of Pub. L. 96–499 effective with respect to services furnished on or after July 1, 1981, see section 930(s)(1) of Pub. L. 96–499, set out as a note under section 1395x of this title.

Pub. L. 96–499, title IX, § 931(e), Dec. 5, 1980, 94 Stat. 2634, provided that: “The amendments made by subsections (a) through (d) of this section [amending this section and sections 1395f and 1395x of this title] shall become effective on April 1, 1981.”

Effective Date of 1968 Amendment

Pub. L. 90–248, title I, § 129(d), Jan. 2, 1968, 81 Stat. 849, provided that: “The amendments made by this section [amending this section and sections 426, 1395e, 1395f, 1395k, 1395l, 1395n, 1395x, and 1395cc of this title and section 228s–2 of Title 45, Railroads] shall apply with respect to services furnished after March 31, 1968, except that subsection (c)(5) of such section [amending section 1395f of this title] shall become effective with respect to services furnished after the date of enactment of this Act [Jan. 2, 1968].”

Pub. L. 90–248, title I, § 137(c), Jan. 2, 1968, 81 Stat. 854, provided that: “The amendments made by subsections (a) and (b) [amending this section and section 1395e of this title] shall apply with respect to services furnished after December 31, 1967.”

Pub. L. 90–248, title I, § 138(b), Jan. 2, 1968, 81 Stat. 854, provided that: “The amendments made by subsection (a) [amending this section] shall apply with respect to payment for services furnished after December 31, 1967.”

Pub. L. 90–248, title I, § 143(d), Jan. 2, 1968, 81 Stat. 858, provided that: “The provisions made by subsection (a) of this section [amending section 1395x of this title] shall become effective as of July 1, 1966, and the provisions made by subsections (b) and (c) of this section [amending this section and section 1395f of this title] shall apply to services furnished with respect to admissions occurring after December 31, 1967, and to outpatient hospital diagnostic services furnished after December 31, 1967, and before April 1, 1968.”

Pub. L. 90–248, title I, § 146(b), Jan. 2, 1968, 81 Stat. 859, provided that: “The amendment made by subsection (a) [amending this section] shall apply with respect to payment for services furnished after December 31, 1967.”

Medicare Hospice Concurrent Care Demonstration Program

Pub. L. 111–148, title III, § 3140, Mar. 23, 2010, 124 Stat. 440, provided that:“(a)Establishment.—“(1)In general.—The Secretary of Health and Human Services (in this section referred to as the ‘Secretary’) shall establish a Medicare Hospice Concurrent Care demonstration program at participating hospice programs under which Medicare beneficiaries are furnished, during the same period, hospice care and any other items or services covered under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) from funds otherwise paid under such title to such hospice programs.“(2)Duration.—The demonstration program under this section shall be conducted for a 3-year period.“(3)Sites.—The Secretary shall select not more than 15 hospice programs at which the demonstration program under this section shall be conducted. Such hospice programs shall be located in urban and rural areas.“(b)Independent Evaluation and Reports.—“(1)Independent evaluation.—The Secretary shall provide for the conduct of an independent evaluation of the demonstration program under this section. Such independent evaluation shall determine whether the demonstration program has improved patient care, quality of life, and cost-effectiveness for Medicare beneficiaries participating in the demonstration program.“(2)Reports.—The Secretary shall submit to Congress a report containing the results of the evaluation conducted under paragraph (1), together with such recommendations as the Secretary determines appropriate.“(c)Budget Neutrality.—With respect to the 3-year period of the demonstration program under this section, the Secretary shall ensure that the aggregate expenditures under title XVIII [42 U.S.C. 1395 et seq.] for such period shall not exceed the aggregate expenditures that would have been expended under such title if the demonstration program under this section had not been implemented.”

Protecting Home Health Benefits

Pub. L. 111–148, title III, § 3143, Mar. 23, 2010, 124 Stat. 442, provided that: “Nothing in the provisions of, or amendments made by, this Act [see Short Title note set out under section 18001 of this title] shall result in the reduction of guaranteed home health benefits under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.].”

Rural Hospice Demonstration Project

Pub. L. 108–173, title IV, § 409, Dec. 8, 2003, 117 Stat. 2271, provided that:“(a)In General.—The Secretary [of Health and Human Services] shall conduct a demonstration project for the delivery of hospice care to medicare beneficiaries in rural areas. Under the project medicare beneficiaries who are unable to receive hospice care in the facility for lack of an appropriate caregiver are provided such care in a facility of 20 or fewer beds which offers, within its walls, the full range of services provided by hospice programs under section 1861(dd) of the Social Security Act (42 U.S.C. 1395x(dd)).“(b)Scope of Project.—The Secretary shall conduct the project under this section with respect to no more than 3 hospice programs over a period of not longer than 5 years each.“(c)Compliance With Conditions.—Under the demonstration project—“(1) the hospice program shall comply with otherwise applicable requirements, except that it shall not be required to offer services outside of the home or to meet the requirements of section 1861(dd)(2)(A)(iii) of the Social Security Act [42 U.S.C. 1395x(dd)(2)(A)(iii)]; and“(2) payments for hospice care shall be made at the rates otherwise applicable to such care under title XVIII of such Act [42 U.S.C. 1395 et seq.].The Secretary may require the program to comply with such additional quality assurance standards for its provision of services in its facility as the Secretary deems appropriate.“(d)Report.—Upon completion of the project, the Secretary shall submit a report to Congress on the project and shall include in the report recommendations regarding extension of such project to hospice programs serving rural areas.”

OIG Report on Notices Relating to Use of Hospital Lifetime Reserve Days

Pub. L. 108–173, title IX, § 953(d), Dec. 8, 2003, 117 Stat. 2428, provided that: “Not later than 1 year after the date of the enactment of this Act [Dec. 8, 2003], the Inspector General of the Department of Health and Human Services shall submit a report to Congress on—“(1) the extent to which hospitals provide notice to medicare beneficiaries in accordance with applicable requirements before they use the 60 lifetime reserve days described in section 1812(a)(1) of the Social Security Act (42 U.S.C. 1395d(a)(1)); and“(2) the appropriateness and feasibility of hospitals providing a notice to such beneficiaries before they completely exhaust such lifetime reserve days.”

MedPAC Report on Access to, and Use of, Hospice Benefit

Pub. L. 106–554, § 1(a)(6) [title III, § 323], Dec. 21, 2000, 114 Stat. 2763, 2763A–501, required a study on the factors affecting the use of hospice benefits under the medicare program and a report on the study no later than 18 months after Dec. 21, 2000.

Transition

Pub. L. 105–33, title IV, § 4611(e), Aug. 5, 1997, 111 Stat. 473, provided that:“(1)In general.—Notwithstanding any provision of title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.], the Secretary of Health and Human Services shall establish a transition for the aggregate amount of expenditures that are transferred from part A, to part B, of title XVIII of the Social Security Act [42 U.S.C. 1395c et seq., 1395j et seq.], as a result of the amendments made by this section [amending this section and sections 1395u, 1395x, and 1395ff of this title], during each of the years during the period beginning with 1998 and ending with 2002 according to this subsection. Under the transition for each such year, the Secretary shall effect such transfer, between the trust funds under such parts, as will result in only the proportion (specified in paragraph (2)) of such aggregate expenditures for the year being transferred from such part A to such part B.“(2)Proportion specified.—The proportion specified in this paragraph for—“(A) 1998 is ⅙,“(B) 1999 is ⅓,“(C) 2000 is ½,“(D) 2001 is ⅔, and“(E) 2002 is ⅚.“(3)Application in establishing monthly premiums for 1998 through 2003.—“(A)In general.—For purposes only of computing the monthly premium under section 1839 of the Social Security Act (42 U.S.C. 1395r), the monthly actuarial rate for enrollees age 65 and over shall be computed as though any reference in paragraph (1) of this subsection to 2002 were a reference to 2003 and as if the following proportions were substituted for the proportions specified in paragraph (2):“(i) For 1998, ⅐.“(ii) For 1999, ²⁄₇.“(iii) For 2000, ³⁄₇.“(iv) For 2001, ⁴⁄₇.“(v) For 2002, ⁵⁄₇.“(vi) For 2003, ⁶⁄₇.“(B)No impact on government contribution.—Subparagraph (A) does not apply in determining the amount of the Government contribution under section 1844 of the Social Security Act (42 U.S.C. 1395w).”

Repeal of 1988 Expansion of Medicare Part A Benefits

For provisions repealing amendment by section 101 of Pub. L. 100–360, restoring or reviving this section as if section 101 of Pub. L. 100–360 had not been enacted, and providing a transition period for medicare beneficiaries with respect to inpatient hospital services and extended care services provided on or after Jan. 1, 1990, and providing an exception to such restoration for certain hospice care, see section 101(a)–(b)(2) of Pub. L. 101–234, set out as a note under section 1395e of this title.

Notes of Decisions

Cited in 192 cases (16 in the last 5 years), 1970–2025 · leading case: Hospice of New Mexico, LLC v. Sebelius, 691 F. Supp. 2d 1275 (D.N.M. 2010).

Sort: Relevance Newest Treatment

Hospice of New Mexico, LLC v. Sebelius, 691 F. Supp. 2d 1275 (D.N.M. 2010). · cites it 7× “42 U.S.C. § 1395d(a)(4) and (d)(1). The only requirement is that each election be accompanied by a certification from the patient’s physician that he or she is suffering from a terminal illness.”

Heckler v. Ringer, 466 U.S. 602 (1984). · cites it 2× “See 42 U. S. C. §§ 1395d(a), 1395f(a); 42 CFR §§ 405.”

Est. of Landers Ex Rel. Landers v. Leavitt, 545 F.3d 98 (2d Cir. 2008). · cites it 3× “” 42 U.S.C. § 1395d(a)(2). Part A does not cover all extended care services that follow hospital stays, however.”

Metro. Hosp. v. United States Dep't of Health & Human Servs., 712 F.3d 248 (6th Cir. 2013). · cites it 4× “” Metro further argues that the following language from another Medicare statute, 42 U.S.C. § 1395d, confirms that “entitlement” to Medicare benefits is synonymous with the right to have payment made for such benefits: “The benefits provided to an individual by the insurance…”

Giesse v. Sec'y of the Dep't of Health & Human Servs., 522 F.3d 697 (6th Cir. 2008). · cites it 4× “This view is apparently based on the language of 42 U.S.C. § 1395d(a)(2)(A), which states: (a) Entitlement to payment for inpatient hospital services, post-hospital extended care services, home health services and hospice care.”

Mary Tataranowicz v. Louis W. Sullivan, M.D., in His Off. Capacity as Sec'y, Dep't of Health & Human Servs., 959 F.2d 268 (D.C. Cir. 1992). · cites it 4× “42 U.S.C. § 1395d (1988). The Repeal Act returned to the prior regime by reinstating both limitations.”

Froedtert Mem'l Lutheran Hosp., Inc. v. Nat'l STATES Ins. Co.., 2009 WI 33 (Wis. 2009). · cites it 4× “See 42 U.S.C. § 1395d(a). Medicare Part A provides coverage for 150 total days of inpatient care, 90 days of which are renewable for each "spell of *61 illness" 6 that results in subsequent hospitalization and 60 days of which are considered "lifetime reserve days" expendable…”

State of Florida v. Dep't of Health & Human Servs., 19 F.4th 1271 (11th Cir. 2021). · cites it 2× “” 42 U.S.C. § 1395d(a). Congress baked into the statutory definition of “hospital” that the USCA11 Case: 21-14098 Date Filed: 12/06/2021 Page: 30 of 94 30 Opinion of the Court 21-14098 institution must meet any “requirements that the Secretary finds necessary in the interest of…”

Victoria Druding v. Care Alternatives, 81 F.4th 361 (3rd Cir. 2023). · cites it 2× “See 42 U.S.C. § 1395d(d)(2)(A)(ii). For a patient to be eligible for Medicare hospice benefits, and for a hospice provider to be entitled to bill for such benefits, a patient must be certified as “terminally ill,” see 42 C.”

White v. Jubitz Corp., 219 P.3d 566 (Or. 2009). · cites it 2× “§ 1395 (y)(a)(2) (no payment by Medicare "may be made under part A or part B * * * for any expenses incurred for items or services * * * for which the individual furnished such items or services has no legal obligation to pay").”

Alabama Hosp. Ass'n v. United States, 228 Ct. Cl. 176 (Ct. Cl. 1981). · cites it 3× “In making Part A disbursements, the fiscal intermediaries must resolve two important and distinct questions: (1) whether the particular services provided to a beneficiary are covered under 42 U.S.C. § 1395d and not excluded by 42 U.”

Catholic Health Initiatives Iowa Corp. v. Sebelius, 718 F.3d 914 (D.C. Cir. 2013). · cites it 2× “61 (a); see also 42 U.S.C. § 1395d. Part E of Medicare sets out “Miscellaneous Provisions,” including a prospective payment system for reimbursing hospitals that provide inpatient hospital services covered under Part A.”

Victoria Druding v. Care Alternatives, 952 F.3d 89 (3rd Cir. 2020). “See 42 U.S.C. § 1395d(d)(2)(A) (2005); 42 C.F.”

Ne. Hosp. Corp. v. Sebelius, 699 F. Supp. 2d 81 (D.D.C. 2010). · cites it 2× “42 U.S.C. § 1395d(a). Both § 1395d and § 426 were adopted with the original Medicare bill.”

Empire Health Found. v. Alex Azar, II, 958 F.3d 873 (9th Cir. 2020). · cites it 2× “8 42 U.S.C. § 1395d; 42 C.F.R. § 409.61 (a)(1).”

United States v. Bourseau, 531 F.3d 1159 (9th Cir. 2008). “42 U.S.C. §§ 1395d(c), 1395k, 1395x(v)(1)(A); 42 C.”

United States v. Peter MacKby, 339 F.3d 1013 (9th Cir. 2003). “42 U.S.C. § 1395d; 42 C.F.R. § 406 . Medicare Part B is a voluntary insurance program that pays a portion of the costs of some services not covered by Part A.”

Los Angeles Haven Hospice, Inc. v. Sebelius, 638 F.3d 644 (9th Cir. 2011). “See 42 U.S.C. § 1395d(d)(l). To ensure that payments for hospice care for qualified beneficiaries would not exceed the cost of care in a conventional setting, Congress established a retrospective “cap” on the aggregate amount that Medicare would reimburse hospice providers each…”

George FRIEDMAN, Plaintiff-Appellant, v. Sec'y OF the Dep't OF HEALTH & HUMAN Servs., Defendant-Appellee, 819 F.2d 42 (2d Cir. 1987). · cites it 2× “Friedman contends, however, that the services received during this period are reimbursable under the provisions covering extended care services, 42 U.S.C. § 1395d(a)(2)(A), which provide for up to 100 days of post-hospital extended care services during any spell of illness.”

Eisman v. Mathews, 428 F. Supp. 877 (D. Maryland 1977). · cites it 4× “§ 1395d(a)(l), and will make payments for “post-hospital extended care services” for that same “spell of illness” for a maximum period of 100 days, 42 U.S.C. § 1395d(a)(2). If a Medicare beneficiary suffers successive “spells of illness,” a declining amount of coverage for…”

Bruce Anderson v. Michael Wilkening, 930 F.3d 1066 (9th Cir. 2019). “See 42 U.S.C. § 1395d(a). FNHRA also amended the Medicare Act with substantially identical provisions.”

Alfred H. Turecamo & Frances M. Turecamo v. Comm'r of Internal Revenue, 554 F.2d 564 (2d Cir. 1977). · cites it 2× “42 U.S.C. §§ 1395d and 1395e. These services are paid for from a separate and self-supporting trust fund, the Federal Hospital Insurance Trust Fund, 42 U.”

Barrows v. Burwell, 777 F.3d 106 (2d Cir. 2015). “42 U.S.C. § 1395d(a). 5 . Medicare Benefit Policy Manual, CMS Pub.”

Est. of Morris v. Shalala, 207 F.3d 744 (5th Cir. 2000). “1 See 42 U.S.C. §§ 1395d(a)(2)(A), 1395x(h); 42 C.”

Baystate Med. Ctr. v. Leavitt, 545 F. Supp. 2d 20 (D.D.C. 2008). “at 35-40; see also 42 U.S.C. § 1395d(b) (addressing scope of Medicare coverage for exhausted benefit days); id.”

Jewish Hosp., Inc. v. Sec'y of Health & Human Servs., 19 F.3d 270 (6th Cir. 1994). “Compare 42 U.S.C. § 1395d (Medicare benefits to person consist of “entitlement to have pay *279 ments made on his behalf’) and 42 C.”

Gartmann v. Sec'y of United States Dep't of Health & Human Servs., 633 F. Supp. 671 (E.D.N.Y 1986). · cites it 2× “42 U.S.C. § 1395d(a). Plaintiff in the case at bar seeks benefits for post-hospital extended care services.”

United States v. Garrison, 133 F.3d 831 (11th Cir. 1998). “” 42 U.S.C. § 1395d; 42 C.F.R. § 400.202 (1995).”

Marilynn K. Hammond, M.D. v. Northland Counseling Ctr., Inc. Greg Walker, 218 F.3d 886 (8th Cir. 2000). “See 42 U.S.C. §§ 1395d(a), 1395f. Administration of Medicare falls within the purview of the Health Care Financing Administration, a federal agency within the U.”

Cottage Health Sys. v. Sebelius, 631 F. Supp. 2d 80 (D.D.C. 2009). “42 U.S.C. § 1395d(a)(1). CMS itself is directly responsible for the costs of part A services.”

Pennsylvania Med. Soc'y v. Foster, 608 A.2d 633 (Pa. Commw. Ct. 1992). · cites it 2× “, American Society of Cataract and Refractive Surgery; 42 U.S.C. § 1395d, whereas Act 6 "attempts to regulate private medical benefits," i.”

Humana of South Carolina, Inc. v. Califano, 590 F.2d 1070 (D.C. Cir. 1978). “The Secretary has suggested that participation in the Medicare program enhances the financial position of providers.”

Lopez-Soto v. Hawayek, 175 F.3d 170 (1st Cir. 1999). “See 42 U.S.C. § 1395d(b)(l). As a practical matter, a hospital more often than not will discover the existence of an emergency medical condition by performing the screening required under subsection (a)—but nothing in EMTALA’s language or structure makes subsection (b) an…”

Dora Hultzman v. Caspar Weinberger, Sec'y of Health, Educ. & Welfare, 495 F.2d 1276 (3rd Cir. 1974). · cites it 3× “Hultzman after July 12, 1970, “were not ‘inpatient hospital services’ which are covered under [section 1395x(b) — definitional section] of the Social Security Act. Those services were not reasonable and necessary inpatient hospital services and are specifically excluded from…”

6 soc.sec.rep.ser. 142, Medicare&medicaid Gu 34,082 Rose Mayburg v. Sec'y of Health & Human Servs., 740 F.2d 100 (1st Cir. 1984). “” 42 U.S.C. § 1395d(a). The Act defines “spell of illness” as a period (1) beginning with the first day (not included in a previous spell of illness) (A) on which such individual is furnished in *102 patient hospital services or extended care services, and (B) which occurs in a…”

St. Anthony's Health Ctr. v. Leavitt, 579 F. Supp. 2d 115 (D.D.C. 2008). · cites it 2× “42 U.S.C. § 1395d(a)(2). The defendant is responsible for determining the amounts payable to SNFs for providing these services to Medicare patients.”

DaVita, Inc. v. Marietta Mem. Hosp., 978 F.3d 326 (6th Cir. 2020). “42 U.S.C. § 1395d(a); see Webster’s Third New International Dictionary of the English Language 204 (3d ed.”

Cal. Advocates for Nursing Home Reform v. Smith, 251 Cal. Rptr. 3d 636 (Cal. Ct. App. 5th 2019). “(42 U.S.C. § 1395d(a)(4).) Under Medicare, however, the patient must be notified of "the palliative rather than curative nature of hospice care, as it relates to the individual's terminal illness.”

US Ex Rel. Wall v. Vista Hospice Care, Inc., 778 F. Supp. 2d 709 (N.D. Tex. 2011). “42 U.S.C. § 1395d(a)(4). 9 . Id. § 1395f(a)(7).”

UNITED STATES of Am., Plaintiff-Appellee, v. BAYLOR Univ. Med. Ctr., Defendant-Appellant, 736 F.2d 1039 (5th Cir. 1984). “42 U.S.C. § 1395d(d)(2) (1983). The Medicaid program provides to state governments federal funds that the state, after establishing a federally approved plan, uses to pay for medical aid for the poor and disadvantaged.”

Sisters of Charity Hosp. v. Riley, 231 A.D.2d 272 (N.Y. App. Div. 1997). · cites it 2×

Nw. Hosp., Inc. v. Hosp. Serv. Corp., Blue Cross Ass'n, Patricia Harris, Sec'y of Health & Human Servs., 687 F.2d 985 (7th Cir. 1982).

Massachusetts v. Sebelius, 638 F.3d 24 (1st Cir. 2011).

Port Jefferson Health Care Facility v. Wing, 726 N.E.2d 449 (NY 1999).

Sowell v. Richardson, 319 F. Supp. 689 (D.S.C. 1970). · cites it 2×

St. John's Hickey Mem'l Hosp., Inc. v. Joseph A. Califano, Jr., Sec'y of Hew, 599 F.2d 803 (7th Cir. 1979).

Vencor Inc. v. Nat'l States Ins. Co., 303 F.3d 1024 (9th Cir. 2002).

Mayburg v. Heckler, 574 F. Supp. 922 (D. Mass. 1983). · cites it 3×

Popkin v. Burwell, 172 F. Supp. 3d 161 (D.D.C. 2016).

Silverado Hospice, Inc. v. Xavier Becerra, 42 F.4th 1112 (9th Cir. 2022). “42 U.S.C. § 1395d(d). A Medicare beneficiary is eligible for hospice benefits if he or she is terminally ill, meaning a life expectancy of six months or less.”

Metro. Hosp., Inc. v. United States Dep't of Health & Human Servs., 702 F. Supp. 2d 808 (W.D. Mich. 2010). · cites it 2× “¶ 14 (citing 42 U.S.C. § 1395d(b)). In addition to full payment for days 1-60 in hospital and partial payment for days 61-90 in hospital, each Medicare beneficiary is entitled to a lifetime reserve of 60 additional days to be used at their option.”

Henry Ford Health Sys. v. Donna E. Shalala, Sec'y, Dep't of Health & Human Servs., 233 F.3d 907 (6th Cir. 2000).

Bridgeport Hosp. v. Xavier Becerra, 108 F.4th 882 (D.C. Cir. 2024).

Monmouth Med. Ctr. v. Harris, 494 F. Supp. 590 (D.N.J. 1980). · cites it 3×

Reading v. Richardson, 339 F. Supp. 295 (E.D. Mo. 1972). · cites it 2×

Am. Med. Ass'n v. Mathews, 429 F. Supp. 1179 (N.D. Ill. 1977).

Black v. Am. Bankers Ins. Co., 478 S.W.2d 434 (Tex. 1972).

Abbott-Nw. Hosp., Inc. v. Richard S. Schweiker, Sec'y of Health & Human Servs., 698 F.2d 336 (8th Cir. 1983).

Colorado Dep't of Soc. Servs. v. Dep't of Health & Human Servs., 558 F. Supp. 337 (D. Colo. 1983).

Druding v. Care Alternatives, Inc., 346 F. Supp. 3d 669 (D.N.J. 2018). “See 42 U.S.C. § 1395d(2)(A). A Medicare beneficiary is eligible for the MHB if his or her attending physician and a hospice medical director certify that the individual is terminally ill.”

Brown v. Richardson, 395 F. Supp. 185 (W.D. Pa. 1975). · cites it 2×

David v. Heckler, 591 F. Supp. 1033 (E.D.N.Y 1984).

Friedberg v. Schweiker, 721 F.2d 445 (3rd Cir. 1983). “§ 1395x(a) which provides: *448 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 or…”

Cong. of California Seniors v. Catholic Healthcare West, 2001 Cal. Daily Op. Serv. 1713 (Cal. Ct. App. 2001).

Schupak v. Califano, 454 F. Supp. 105 (E.D.N.Y 1978).

Child.'s Healthcare is a Legal Duty, Inc. v. Min De Parle, 212 F.3d 1084 (8th Cir. 2000). · cites it 2×

Maximum Home Health Care, Inc. v. Donna E. Shalala, as Sec'y of the United States Dep't of Health & Human Servs., 272 F.3d 318 (6th Cir. 2001).

Catholic Health Initiatives Iowa Corp. v. Sebelius, 841 F. Supp. 2d 270 (D.D.C. 2012). “42 U.S.C. § 1395d(a)(l). Medicare Part A’s coverage for inpatient hospital services is limited to a certain number of days of care, after which such coverage is “exhausted.”

Bd. of Trs. of State Institutions of Higher Learning v. Sullivan, 763 F. Supp. 178 (S.D. Miss. 1991).

Willowood of Great Barrington, Inc. v. Sebelius, 638 F. Supp. 2d 98 (D. Mass. 2009).

United States ex rel. Martin v. Life Care Centers of Am., Inc., 114 F. Supp. 3d 549 (E.D. Tenn. 2014). “” 42 U.S.C. § 1395d(a)(2)(A). A physician, nurse practitioner, clinical nurse specialist, or a physician assistant must certify that: (1) services are required because the person needs skilled nursing care or other “skilled rehabilitation services” on a daily basis; (2) services…”

Home Comp Care, Inc. v. United States Dep't of Health & Human Servs. (In Re Home Comp Care, Inc.), 221 B.R. 202 (N.D. Ill. 1998).

Samuels v. Weinberger, 379 F. Supp. 120 (S.D. Ohio 1973). · cites it 2×

Fox v. Bowen, 656 F. Supp. 1236 (D. Conn. 1987). “” 42 U.S.C. §§ 1395d(a)(2), 1395y(a)(l). These services are covered under Part A of Medicare only if the patient receives “skilled nursing care .”

Matthews v. Leavitt, 452 F.3d 145 (2d Cir. 2006).

Himmler v. Califano, 611 F.2d 137 (6th Cir. 1979). · cites it 2×

Episcopal Hosp. v. Donna E. Shalala, Sec'y, Health & Human Servs., 994 F.2d 879 (D.C. Cir. 1993).

Duggan v. Bowen, 691 F. Supp. 1487 (D.D.C. 1988). “2599 , 2631 (1980) (amending 42 U.S.C. §§ 1395d(a)(3) and 1395k(a)(2)(A)).”

P.I.A. Michigan City Inc. v. Thompson, 292 F.3d 820 (D.C. Cir. 2002).

Univ. Med. Ctr., Inc. v. Sebelius, 856 F. Supp. 2d 66 (D.D.C. 2012). “42 U.S.C. § 1395d(a)(l). CMS itself is directly responsible for the costs of Part A services.”

Holmes v. California State Auto. Ass'n, 135 Cal. App. 3d 635 (Cal. Ct. App. 1982).

Rehab. Ass'n of Virginia, Inc. v. Kozlowski, 42 F.3d 1444 (4th Cir. 1994).

Gerstman v. Sec'y of Health, Educ. & Welfare, 432 F. Supp. 636 (W.D.N.Y. 1977). “F] 100-day benefits under 42 U.S.C. § 1395d(a)(2) expired, until December 12, 1969, plaintiff lived at the Carlton House Nursing Home at her own expense.”

Mount Sinai Hosp. of Greater Miami, Inc. v. Weinberger, 376 F. Supp. 1099 (S.D. Fla. 1974).

Montefiore Med. Ctr. v. Leavitt, 578 F. Supp. 2d 129 (D.D.C. 2008). · cites it 2×

Monmouth Med. Ctr. v. Harris, 646 F.2d 74 (3rd Cir. 1981). · cites it 2×

Cullman Reg'l Med. Ctr. v. Shalala, 945 F. Supp. 287 (D.D.C. 1996).

New York State Dep't of Soc. Servs. v. Bowen, 661 F. Supp. 1537 (S.D.N.Y. 1987).

Walsh v. Sec'y of United States Dep't of Health & Human Servs., 636 F. Supp. 358 (E.D.N.Y 1986). · cites it 2×

Howard Back v. Kathleen Sebelius, 684 F.3d 929 (9th Cir. 2012). “See 42 U.S.C. §§ 1395d(a)(4), 1395x(dd)(1). An individual who elects to receive these benefits waives his right to have Medicare payments made for treatment of his underlying terminal illness by someone other than the individual’s attending physician or the designated hospice…”

Lawrence & Mem'l Hosp. v. Sebelius, 986 F. Supp. 2d 124 (D. Conn. 2013).

LGH, LTD. v. Sullivan, 786 F. Supp. 1047 (D.D.C. 1992).

Mount Sinai Med. Ctr. of Greater Miami, Inc. v. Mathews, 425 F. Supp. 5 (S.D. Fla. 1976).

Stoner v. Califano, 458 F. Supp. 781 (E.D. Mich. 1978).

Town Court Nursing Ctr., Inc. v. Beal, 586 F.2d 266 (3rd Cir. 1978).

Torphy v. Weinberger, 384 F. Supp. 1117 (E.D. Wis. 1974).

Kraemer v. Heckler, 737 F.2d 214 (2d Cir. 1984).

Vencor, Inc. v. Physicians Mut. Ins., 39 F. Supp. 2d 1 (D.D.C. 1999).

Shepard v. Calfarm Life Ins., 92 Cal. Daily Op. Serv. 3627 (Cal. Ct. App. 1992).

Barys Ex Rel. United States v. Vitas Healthcare Corp., 298 F. App'x 893 (11th Cir. 2008). “42 U.S.C. § 1395d(a)(4). At the end of each period, the patient can be re-certified only if at that time they have less than six months to live if the illness runs its normal course.”

Exec. Dir. of the Off. of Vermont Health Access v. Sebelius, 698 F. Supp. 2d 436 (D. Vt. 2010). “See 42 U.S.C. § 1395d(a)(3). The Medicare program is administered through private contractors by the Centers for Medicare and Medicaid Services (“CMS”), which is part of the United States Department of Health and Human Services (“HHS”).”

Rapport v. Leavitt, 564 F. Supp. 2d 186 (W.D.N.Y. 2008).

Hosp. of the Univ. of Pennsylvania v. Sebelius, 847 F. Supp. 2d 125 (D.D.C. 2012).

Se. Arkansas Hospice, Inc. v. Sebelius, 1 F. Supp. 3d 915 (E.D. Ark. 2014). “See 42 U.S.C. § 1395d(d)(l). To ensure that hospice care payments do not exceed the costs of treatment in a *918 conventional setting, there is a “cap” on the total amount paid in reimbursements to hospice providers for all eligible patients in any given fiscal year.”

Rood v. New York State Teamsters Conf. Pension & Ret. Fund, 39 F. Supp. 3d 241 (N.D.N.Y. 2014).

Hull v. Burwell, 66 F. Supp. 3d 278 (D. Conn. 2014).

Landers v. Leavitt, 232 F.R.D. 42 (D. Conn. 2005).

McMahon v. Califano, 476 F. Supp. 978 (D. Mass. 1979).

Lodi Mem'l Hosp. v. Califano, 451 F. Supp. 651 (D.D.C. 1978).

Grijalva v. Shalala, 946 F. Supp. 747 (D. Ariz. 1996).

GranCare, Inc. v. Shalala, 93 F. Supp. 2d 24 (D.D.C. 2000).

Hurley v. Bowen, 674 F. Supp. 421 (E.D.N.Y 1987). · cites it 2×

Sokoloff v. Richardson, 383 F. Supp. 234 (E.D.N.Y 1973).

Himmler v. Weinberger, 422 F. Supp. 196 (E.D. Mich. 1976).

In Re Ahn Homecare, LLC, 222 B.R. 804 (Bankr. N.D. Tex. 1998).

Roth v. Sec'y of Health & Human Servs., 606 F. Supp. 636 (W.D.N.Y. 1985).

Anthony Guzzo v. Thomas G. Thompson, Sec'y of State of the United States Dep't of Health & Human Servs., 393 F.3d 652 (6th Cir. 2004).

Decatur Cnty. Gen. Hosp. v. Johnson, 602 F. Supp. 2d 176 (D.D.C. 2009).

John L. Doyne Hosp. v. Johnson, 603 F. Supp. 2d 172 (D.D.C. 2009).

House of Mercy, Inc. v. Centers for Medicare & Medicaid Servs. (In re House of Mercy, Inc.), 353 B.R. 867 (Bankr. W.D. La. 2006).

Fournier v. Sebelius, 839 F. Supp. 2d 1077 (D. Ariz. 2012).

Martinez v. Bowen, 655 F. Supp. 95 (D.N.M. 1986).

Hirsch v. Bowen, 655 F. Supp. 342 (S.D.N.Y. 1987).

Bergeron v. Shalala, 855 F. Supp. 665 (D. Vt. 1994). “See 42 U.S.C. § 1395d(a)(3). The remedial purpose of the Medicare program requires that the statute be broadly construed.”

Total Renal Labs., Inc. v. Shalala, 60 F. Supp. 2d 1323 (N.D. Ga. 1999).

Bartlett on Behalf of Neuman v. Heckler, 576 F. Supp. 830 (D.D.C. 1983).

Harris v. Richardson, 357 F. Supp. 242 (E.D. Va. 1973).

Stephenson v. Shalala, 87 F.3d 350 (9th Cir. 1996). · cites it 2×

Bryan v. United States Sec'y of Health & Human Servs., 758 F. Supp. 1092 (E.D.N.C. 1990). · cites it 2×

AHN Homecare, L.L.C. v. Home Health Reimbursement & Health Care Fin. Admin. (In re AHN Homecare, L.L.C.), 222 B.R. 804 (Bankr. N.D. Tex. 1998).

Chelsea Cmty. Hosp. v. Michigan Blue Cross Ass'n, 630 F.2d 1131 (6th Cir. 1980).

Levi v. Heckler, 736 F.2d 848 (2d Cir. 1984). · cites it 2× “” 42 U.S.C. § 1395d(a)(1) (1976). 1 Once this coverage is exhausted, a new “spell of illness” must commence in order for an individual to become again eligible for Medicare benefits.”

Pfalzgraf v. Shalala, 997 F. Supp. 360 (W.D.N.Y. 1998).

Smith on Behalf of McDonald v. Shalala, 855 F. Supp. 658 (D. Vt. 1994). “See 42 U.S.C. § 1395d(a)(3). The remedial purpose of the Medicare program requires that it be broadly construed.”

Chipman v. Shalala, 894 F. Supp. 392 (D. Kan. 1995).

Sacred Heart Hosp. v. Bowen, 652 F. Supp. 171 (E.D. Pa. 1986).

Eagle Healthcare, Inc. v. Shalala, 52 F. Supp. 2d 1 (D.D.C. 1999).

Born v. Sebelius, 968 F. Supp. 2d 1109 (D. Colo. 2013).

Westgard v. Weinberger, 391 F. Supp. 1011 (D.N.D. 1975).

Vencor, Inc. v. Stand. Life & Accident Ins., 317 F.3d 629 (6th Cir. 2003). · cites it 2×

Rine v. Weinberger, 401 F. Supp. 1134 (N.D.W. Va. 1975).

Mutzig v. Richardson, 348 F. Supp. 526 (W.D. Pa. 1972).

New York State Dep't of Soc. Servs. v. Bowen, 684 F. Supp. 775 (E.D.N.Y 1988).

Hinsdale Hosp. Corp. v. Shalala, 857 F. Supp. 621 (N.D. Ill. 1994).

Israel Ex Rel. Geyer v. Sec'y of Health & Human Servs., 669 F. Supp. 61 (W.D.N.Y. 1987).

Sellers v. United States, 3 Cl. Ct. 551 (Ct. Cl. 1983). “In connection with this determination, it may be mentioned that the Medicare legislation provides, in 42 U.S.C. § 1395d(b), that payment for services furnished an individual during a spell of illness may not be made for— (1) inpatient hospital services furnished to him during…”

Lena KAUFMAN, Plaintiff-Appellee, v. Patricia HARRIS, Sec'y of Health & Human Servs., Defendant-Appellant, 731 F.2d 370 (6th Cir. 1984).

New York State Dep't of Soc. Servs. v. Bowen, 846 F.2d 129 (2d Cir. 1988).

Connecticut Dep't of Soc. Servs. v. Leavitt, 428 F.3d 138 (2d Cir. 2005). “See 42 U.S.C. § 1395d(a)(3) (Medicare coverage of home health-care services), § 1396a(a)(10)(D) (Medicaid coverage of same).”

Hedgecock v. Vandiver, 477 P.2d 316 (N.M. Ct. App. 1970).

United States v. Rhode Island Insurers' Insolvency Fund, 892 F. Supp. 370 (D.R.I. 1995).

Fineberg v. Sec'y of Health, Educ. & Welfare, 363 F. Supp. 1382 (W.D.N.Y. 1973).

Russell v. Sebelius, 686 F. Supp. 2d 386 (D. Vt. 2010).

United Healthcare Ins. v. Sebelius, 774 F. Supp. 2d 1014 (D. Minnesota 2011).

Ridgely v. Sec'y of the Dep't of Health, Educ. & Welfare of the United States of Am., 475 F.2d 1222 (4th Cir. 1973).

Univ. Hosp., New York Univ. Med. Ctr., New York Univ. v. Bowen, 684 F. Supp. 1234 (S.D.N.Y. 1988).

Hurley ex rel. Hurley v. Bowen, 857 F.2d 907 (2d Cir. 1988). “See 42 U.S.C. § 1395d(a)(1) & (a)(2)(A) (1982).”

Stringfellow Mem'l Hosp. v. Price (D.D.C. 2018). · cites it 2×

State of Florida v. Dep't of Health & Human Servs. (11th Cir. 2021). · cites it 2×

Cooper Hosp. Univ. Med. Ctr. v. Selective Ins. Co. of Am. (085211) (Camden Cnty. & Statewide) (N.J. 2021). · cites it 2×

Aurora v. Sec'y Dep't of Health & Human Servs., 715 F. Supp. 466 (E.D.N.Y 1989).

Ne. Hosp. Corp. v. Johnson (D.D.C. 2010). · cites it 2×

Clarian Health West, LLC v. Burwell (D.D.C. 2016).

Cal. Advocates for Nursing Home Reform v. Smith (Cal. Ct. App. 2019).

Quishenberry v. UnitedHealthcare CA2/7 (Cal. Ct. App. 2021).

Cal. Advocates for Nursing Home Reform v. Smith, 250 Cal. Rptr. 3d 119 (Cal. Ct. App. 5th 2019).

Greenwald v. Price (D.D.C. 2022).

Quishenberry v. UnitedHealthcare, Inc. (Cal. 2023).

Horsley v. Comfort Care Home Health LLC (N.D. Ala. 2020).

Angel's Touch Inc. v. Cochran (D. Ariz. 2021).

Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (E.D. Mich. 2023).

Greenwald v. Price (D.D.C. 2024).

Capital Hospice v. Becerra (E.D. Va. 2025).

Baptist Healthcare of Oklahoma, LLC v. Becerra (D.D.C. 2025). “See 42 U.S.C. § 1395d(a)(1); Cath. Health Initiatives Iowa Corp.”

Gentry v. Encompass Health Rehab (5th Cir. 2025).

Becerra (D. Or. 2025). “42 U.S.C. § 1395d(2)(A). Plaintiff’s argument explicitly contemplates that Medicare Part B and Part D do not apply to its claims, and the Council was correct to reject Plaintiff’s argument that its overpayment should be adjusted by amounts not actually payable on Plaintiff’s…”

Vitality Rehab, Inc. v. Sebelius, 641 F. Supp. 2d 984 (C.D. Cal. 2009).

Univ. of Texas M.D. Anderson Cancer Ctr. v. Sebelius, 706 F. Supp. 2d 97 (D.D.C. 2010).

Univ. of Texas M.D. Anderson Cancer Ctr. v. Leavitt (D.D.C. 2010).

Cottage Health Sys. v. Leavitt (D.D.C. 2009).

John L. Doyne Hosp. v. Leavitt (D.D.C. 2009).

Decatur Cnty. Gen. Hosp. v. Leavitt (D.D.C. 2009).

The Chattanooga-Hamilton Cnty. Hosp. Auth. D/B/A Erlanger Health Sys. v. United Healthcare Plan of The River Valley, Inc. D/B/A Americhoice & Tennessee Attorney Gen. (Tenn. Ct. App. 2014).

Guzzo v. Thompson (6th Cir. 2004).

United States v. Bourseau (9th Cir. 2008). “42 U.S.C. §§ 1395d(c), 1395k, 1395x(v)(1)(A); 42 C.”

United Med. Healthcare, Inc. v. Dep't of Health & Human Servs., 889 F. Supp. 2d 832 (E.D. La. 2012).

United States v. Garrison, 133 F.3d 831 (11th Cir. 1998).

Oulton v. Bowen, 674 F. Supp. 429 (W.D.N.Y. 1988).

Maximum Home Health Care, Inc. v. Shalala, 136 F. Supp. 2d 814 (M.D. Tenn. 2000).

Marilyn K. Hammond v. Northland Counseling (8th Cir. 2000).

Univ. Hosp., Ny Univ. Med. Ctr. v. Bowen, 684 F. Supp. 1234 (S.D.N.Y. 1988).

— 42 U.S.C. § 1395d(2)(A) — 2 cases

— 42 U.S.C. § 1395d(a) — 45 cases

Heckler v. Ringer, 466 U.S. 602 (1984). “See 42 U. S. C. §§ 1395d(a), 1395f(a); 42 CFR §§ 405.”

State of Florida v. Dep't of Health & Human Servs., 19 F.4th 1271 (11th Cir. 2021). “” 42 U.S.C. § 1395d(a). Congress baked into the statutory definition of “hospital” that the USCA11 Case: 21-14098 Date Filed: 12/06/2021 Page: 30 of 94 30 Opinion of the Court 21-14098 institution must meet any “requirements that the Secretary finds necessary in the interest of…”

White v. Jubitz Corp., 219 P.3d 566 (Or. 2009). “§ 1395 (y)(a)(2) (no payment by Medicare "may be made under part A or part B * * * for any expenses incurred for items or services * * * for which the individual furnished such items or services has no legal obligation to pay").”

Metro. Hosp. v. United States Dep't of Health & Human Servs., 712 F.3d 248 (6th Cir. 2013). “” Metro further argues that the following language from another Medicare statute, 42 U.S.C. § 1395d, confirms that “entitlement” to Medicare benefits is synonymous with the right to have payment made for such benefits: “The benefits provided to an individual by the insurance…”

Ne. Hosp. Corp. v. Sebelius, 699 F. Supp. 2d 81 (D.D.C. 2010). “42 U.S.C. § 1395d(a). Both § 1395d and § 426 were adopted with the original Medicare bill.”

Bruce Anderson v. Michael Wilkening, 930 F.3d 1066 (9th Cir. 2019). “See 42 U.S.C. § 1395d(a). FNHRA also amended the Medicare Act with substantially identical provisions.”

Barrows v. Burwell, 777 F.3d 106 (2d Cir. 2015). “42 U.S.C. § 1395d(a). 5 . Medicare Benefit Policy Manual, CMS Pub.”

Catholic Health Initiatives Iowa Corp. v. Sebelius, 718 F.3d 914 (D.C. Cir. 2013). “61 (a); see also 42 U.S.C. § 1395d. Part E of Medicare sets out “Miscellaneous Provisions,” including a prospective payment system for reimbursing hospitals that provide inpatient hospital services covered under Part A.”

Mary Tataranowicz v. Louis W. Sullivan, M.D., in His Off. Capacity as Sec'y, Dep't of Health & Human Servs., 959 F.2d 268 (D.C. Cir. 1992). “42 U.S.C. § 1395d (1988). The Repeal Act returned to the prior regime by reinstating both limitations.”

DaVita, Inc. v. Marietta Mem. Hosp., 978 F.3d 326 (6th Cir. 2020). “42 U.S.C. § 1395d(a); see Webster’s Third New International Dictionary of the English Language 204 (3d ed.”

Froedtert Mem'l Lutheran Hosp., Inc. v. Nat'l STATES Ins. Co.., 2009 WI 33 (Wis. 2009). “See 42 U.S.C. § 1395d(a). Medicare Part A provides coverage for 150 total days of inpatient care, 90 days of which are renewable for each "spell of *61 illness" 6 that results in subsequent hospitalization and 60 days of which are considered "lifetime reserve days" expendable…”

Dora Hultzman v. Caspar Weinberger, Sec'y of Health, Educ. & Welfare, 495 F.2d 1276 (3rd Cir. 1974). “Hultzman after July 12, 1970, “were not ‘inpatient hospital services’ which are covered under [section 1395x(b) — definitional section] of the Social Security Act. Those services were not reasonable and necessary inpatient hospital services and are specifically excluded from…”

Bridgeport Hosp. v. Xavier Becerra, 108 F.4th 882 (D.C. Cir. 2024).

Gartmann v. Sec'y of United States Dep't of Health & Human Servs., 633 F. Supp. 671 (E.D.N.Y 1986). “42 U.S.C. § 1395d(a). Plaintiff in the case at bar seeks benefits for post-hospital extended care services.”

Child.'s Healthcare is a Legal Duty, Inc. v. Min De Parle, 212 F.3d 1084 (8th Cir. 2000).

Monmouth Med. Ctr. v. Harris, 494 F. Supp. 590 (D.N.J. 1980).

Willowood of Great Barrington, Inc. v. Sebelius, 638 F. Supp. 2d 98 (D. Mass. 2009).

Metro. Hosp., Inc. v. United States Dep't of Health & Human Servs., 702 F. Supp. 2d 808 (W.D. Mich. 2010). “¶ 14 (citing 42 U.S.C. § 1395d(b)). In addition to full payment for days 1-60 in hospital and partial payment for days 61-90 in hospital, each Medicare beneficiary is entitled to a lifetime reserve of 60 additional days to be used at their option.”

New York State Dep't of Soc. Servs. v. Bowen, 661 F. Supp. 1537 (S.D.N.Y. 1987).

Stoner v. Califano, 458 F. Supp. 781 (E.D. Mich. 1978).

Torphy v. Weinberger, 384 F. Supp. 1117 (E.D. Wis. 1974).

Kraemer v. Heckler, 737 F.2d 214 (2d Cir. 1984).

Rood v. New York State Teamsters Conf. Pension & Ret. Fund, 39 F. Supp. 3d 241 (N.D.N.Y. 2014).

Hull v. Burwell, 66 F. Supp. 3d 278 (D. Conn. 2014).

Landers v. Leavitt, 232 F.R.D. 42 (D. Conn. 2005).

Grijalva v. Shalala, 946 F. Supp. 747 (D. Ariz. 1996).

Samuels v. Weinberger, 379 F. Supp. 120 (S.D. Ohio 1973).

Himmler v. Califano, 611 F.2d 137 (6th Cir. 1979).

Fournier v. Sebelius, 839 F. Supp. 2d 1077 (D. Ariz. 2012).

Monmouth Med. Ctr. v. Harris, 646 F.2d 74 (3rd Cir. 1981).

Walsh v. Sec'y of United States Dep't of Health & Human Servs., 636 F. Supp. 358 (E.D.N.Y 1986).

Born v. Sebelius, 968 F. Supp. 2d 1109 (D. Colo. 2013).

Stephenson v. Shalala, 87 F.3d 350 (9th Cir. 1996).

Mutzig v. Richardson, 348 F. Supp. 526 (W.D. Pa. 1972).

Bryan v. United States Sec'y of Health & Human Servs., 758 F. Supp. 1092 (E.D.N.C. 1990).

New York State Dep't of Soc. Servs. v. Bowen, 846 F.2d 129 (2d Cir. 1988).

United States v. Rhode Island Insurers' Insolvency Fund, 892 F. Supp. 370 (D.R.I. 1995).

Ridgely v. Sec'y of the Dep't of Health, Educ. & Welfare of the United States of Am., 475 F.2d 1222 (4th Cir. 1973).

State of Florida v. Dep't of Health & Human Servs. (11th Cir. 2021).

Ne. Hosp. Corp. v. Johnson (D.D.C. 2010).

Cooper Hosp. Univ. Med. Ctr. v. Selective Ins. Co. of Am. (085211) (Camden Cnty. & Statewide) (N.J. 2021).

Gentry v. Encompass Health Rehab (5th Cir. 2025).

Marilyn K. Hammond v. Northland Counseling (8th Cir. 2000).

— 42 U.S.C. § 1395d(a)(1) — 9 cases

Cottage Health Sys. v. Sebelius, 631 F. Supp. 2d 80 (D.D.C. 2009). “42 U.S.C. § 1395d(a)(1). CMS itself is directly responsible for the costs of part A services.”

Levi v. Heckler, 736 F.2d 848 (2d Cir. 1984). “” 42 U.S.C. § 1395d(a)(1) (1976). 1 Once this coverage is exhausted, a new “spell of illness” must commence in order for an individual to become again eligible for Medicare benefits.”

Hurley ex rel. Hurley v. Bowen, 857 F.2d 907 (2d Cir. 1988). “See 42 U.S.C. § 1395d(a)(1) & (a)(2)(A) (1982).”

Cooper Hosp. Univ. Med. Ctr. v. Selective Ins. Co. of Am. (085211) (Camden Cnty. & Statewide) (N.J. 2021).

Baptist Healthcare of Oklahoma, LLC v. Becerra (D.D.C. 2025). “See 42 U.S.C. § 1395d(a)(1); Cath. Health Initiatives Iowa Corp.”

Univ. of Texas M.D. Anderson Cancer Ctr. v. Leavitt (D.D.C. 2010).

Cottage Health Sys. v. Leavitt (D.D.C. 2009).

Decatur Cnty. Gen. Hosp. v. Leavitt (D.D.C. 2009).

— 42 U.S.C. § 1395d(a)(2) — 16 cases

Est. of Landers Ex Rel. Landers v. Leavitt, 545 F.3d 98 (2d Cir. 2008). “” 42 U.S.C. § 1395d(a)(2). Part A does not cover all extended care services that follow hospital stays, however.”

St. Anthony's Health Ctr. v. Leavitt, 579 F. Supp. 2d 115 (D.D.C. 2008). “42 U.S.C. § 1395d(a)(2). The defendant is responsible for determining the amounts payable to SNFs for providing these services to Medicare patients.”

Eisman v. Mathews, 428 F. Supp. 877 (D. Maryland 1977). “§ 1395d(a)(l), and will make payments for “post-hospital extended care services” for that same “spell of illness” for a maximum period of 100 days, 42 U.S.C. § 1395d(a)(2). If a Medicare beneficiary suffers successive “spells of illness,” a declining amount of coverage for…”

Montefiore Med. Ctr. v. Leavitt, 578 F. Supp. 2d 129 (D.D.C. 2008).

Mayburg v. Heckler, 574 F. Supp. 922 (D. Mass. 1983).

McMahon v. Califano, 476 F. Supp. 978 (D. Mass. 1979).

Samuels v. Weinberger, 379 F. Supp. 120 (S.D. Ohio 1973).

Roth v. Sec'y of Health & Human Servs., 606 F. Supp. 636 (W.D.N.Y. 1985).

Hirsch v. Bowen, 655 F. Supp. 342 (S.D.N.Y. 1987).

Bartlett on Behalf of Neuman v. Heckler, 576 F. Supp. 830 (D.D.C. 1983).

Rine v. Weinberger, 401 F. Supp. 1134 (N.D.W. Va. 1975).

Israel Ex Rel. Geyer v. Sec'y of Health & Human Servs., 669 F. Supp. 61 (W.D.N.Y. 1987).

Vencor, Inc. v. Stand. Life & Accident Ins., 317 F.3d 629 (6th Cir. 2003).

— 42 U.S.C. § 1395d(a)(2)(A) — 16 cases

Giesse v. Sec'y of the Dep't of Health & Human Servs., 522 F.3d 697 (6th Cir. 2008). “This view is apparently based on the language of 42 U.S.C. § 1395d(a)(2)(A), which states: (a) Entitlement to payment for inpatient hospital services, post-hospital extended care services, home health services and hospice care.”

Est. of Morris v. Shalala, 207 F.3d 744 (5th Cir. 2000). “1 See 42 U.S.C. §§ 1395d(a)(2)(A), 1395x(h); 42 C.”

George FRIEDMAN, Plaintiff-Appellant, v. Sec'y OF the Dep't OF HEALTH & HUMAN Servs., Defendant-Appellee, 819 F.2d 42 (2d Cir. 1987). “Friedman contends, however, that the services received during this period are reimbursable under the provisions covering extended care services, 42 U.S.C. § 1395d(a)(2)(A), which provide for up to 100 days of post-hospital extended care services during any spell of illness.”

Matthews v. Leavitt, 452 F.3d 145 (2d Cir. 2006).

Mayburg v. Heckler, 574 F. Supp. 922 (D. Mass. 1983).

Rapport v. Leavitt, 564 F. Supp. 2d 186 (W.D.N.Y. 2008).

Walsh v. Sec'y of United States Dep't of Health & Human Servs., 636 F. Supp. 358 (E.D.N.Y 1986).

Pfalzgraf v. Shalala, 997 F. Supp. 360 (W.D.N.Y. 1998).

Hurley v. Bowen, 674 F. Supp. 421 (E.D.N.Y 1987).

New York State Dep't of Soc. Servs. v. Bowen, 684 F. Supp. 775 (E.D.N.Y 1988).

United Healthcare Ins. v. Sebelius, 774 F. Supp. 2d 1014 (D. Minnesota 2011).

Aurora v. Sec'y Dep't of Health & Human Servs., 715 F. Supp. 466 (E.D.N.Y 1989).

Quishenberry v. UnitedHealthcare CA2/7 (Cal. Ct. App. 2021).

Quishenberry v. UnitedHealthcare, Inc. (Cal. 2023).

— 42 U.S.C. § 1395d(a)(3) — 7 cases

Duggan v. Bowen, 691 F. Supp. 1487 (D.D.C. 1988). “2599 , 2631 (1980) (amending 42 U.S.C. §§ 1395d(a)(3) and 1395k(a)(2)(A)).”

Bergeron v. Shalala, 855 F. Supp. 665 (D. Vt. 1994). “See 42 U.S.C. § 1395d(a)(3). The remedial purpose of the Medicare program requires that the statute be broadly construed.”

Smith on Behalf of McDonald v. Shalala, 855 F. Supp. 658 (D. Vt. 1994). “See 42 U.S.C. § 1395d(a)(3). The remedial purpose of the Medicare program requires that it be broadly construed.”

Russell v. Sebelius, 686 F. Supp. 2d 386 (D. Vt. 2010).

Horsley v. Comfort Care Home Health LLC (N.D. Ala. 2020).

— 42 U.S.C. § 1395d(a)(4) — 9 cases

Hospice of New Mexico, LLC v. Sebelius, 691 F. Supp. 2d 1275 (D.N.M. 2010). “42 U.S.C. § 1395d(a)(4) and (d)(1). The only requirement is that each election be accompanied by a certification from the patient’s physician that he or she is suffering from a terminal illness.”

US Ex Rel. Wall v. Vista Hospice Care, Inc., 778 F. Supp. 2d 709 (N.D. Tex. 2011). “42 U.S.C. § 1395d(a)(4). 9 . Id. § 1395f(a)(7).”

Cal. Advocates for Nursing Home Reform v. Smith (Cal. Ct. App. 2019).

Cal. Advocates for Nursing Home Reform v. Smith, 250 Cal. Rptr. 3d 119 (Cal. Ct. App. 5th 2019).

Capital Hospice v. Becerra (E.D. Va. 2025).

— 42 U.S.C. § 1395d(a)(l) — 16 cases

Est. of Landers Ex Rel. Landers v. Leavitt, 545 F.3d 98 (2d Cir. 2008). “” 42 U.S.C. § 1395d(a)(2). Part A does not cover all extended care services that follow hospital stays, however.”

P.I.A. Michigan City Inc. v. Thompson, 292 F.3d 820 (D.C. Cir. 2002).

Univ. Med. Ctr., Inc. v. Sebelius, 856 F. Supp. 2d 66 (D.D.C. 2012). “42 U.S.C. § 1395d(a)(l). CMS itself is directly responsible for the costs of Part A services.”

Lawrence & Mem'l Hosp. v. Sebelius, 986 F. Supp. 2d 124 (D. Conn. 2013).

Brown v. Richardson, 395 F. Supp. 185 (W.D. Pa. 1975).

Mayburg v. Heckler, 574 F. Supp. 922 (D. Mass. 1983).

Hosp. of the Univ. of Pennsylvania v. Sebelius, 847 F. Supp. 2d 125 (D.D.C. 2012).

Monmouth Med. Ctr. v. Harris, 494 F. Supp. 590 (D.N.J. 1980).

Decatur Cnty. Gen. Hosp. v. Johnson, 602 F. Supp. 2d 176 (D.D.C. 2009).

Hurley v. Bowen, 674 F. Supp. 421 (E.D.N.Y 1987).

Vencor, Inc. v. Stand. Life & Accident Ins., 317 F.3d 629 (6th Cir. 2003).

Univ. of Texas M.D. Anderson Cancer Ctr. v. Sebelius, 706 F. Supp. 2d 97 (D.D.C. 2010).

— 42 U.S.C. § 1395d(b) — 3 cases

Baystate Med. Ctr. v. Leavitt, 545 F. Supp. 2d 20 (D.D.C. 2008). “at 35-40; see also 42 U.S.C. § 1395d(b) (addressing scope of Medicare coverage for exhausted benefit days); id.”

— 42 U.S.C. § 1395d(b)(2) — 1 case

— 42 U.S.C. § 1395d(b)(l) — 2 cases

— 42 U.S.C. § 1395d(c) — 2 cases

United States v. Bourseau, 531 F.3d 1159 (9th Cir. 2008). “42 U.S.C. §§ 1395d(c), 1395k, 1395x(v)(1)(A); 42 C.”

United States v. Bourseau (9th Cir. 2008). “42 U.S.C. §§ 1395d(c), 1395k, 1395x(v)(1)(A); 42 C.”

— 42 U.S.C. § 1395d(d) — 1 case

— 42 U.S.C. § 1395d(d)(2) — 1 case

— 42 U.S.C. § 1395d(d)(2)(A) — 2 cases

Victoria Druding v. Care Alternatives, 952 F.3d 89 (3rd Cir. 2020). “See 42 U.S.C. § 1395d(d)(2)(A) (2005); 42 C.F.”

— 42 U.S.C. § 1395d(d)(2)(A)(ii) — 1 case

Victoria Druding v. Care Alternatives, 81 F.4th 361 (3rd Cir. 2023). “See 42 U.S.C. § 1395d(d)(2)(A)(ii). For a patient to be eligible for Medicare hospice benefits, and for a hospice provider to be entitled to bill for such benefits, a patient must be certified as “terminally ill,” see 42 C.”

— 42 U.S.C. § 1395d(d)(l) — 3 cases

Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.