Source
(Pub. L. 89–554, Sept. 6, 1966, 80 Stat. 601; Pub. L. 93–246, § 3, Jan. 31, 1974, 88 Stat. 4; Pub. L. 93–363, § 1, July 30, 1974, 88 Stat. 398; Pub. L. 94–183, § 2(43), Dec. 31, 1975, 89 Stat. 1059; Pub. L. 94–460, title I, § 110(b), Oct. 8, 1976, 90 Stat. 1952; Pub. L. 95–368, § 1, Sept. 17, 1978, 92 Stat. 606; Pub. L. 95–454, title IX, § 906(a)(2), (3), Oct. 13, 1978, 92 Stat. 1224; Pub. L. 96–179, § 3, Jan. 2, 1980, 93 Stat. 1299; Pub. L. 98–615, § 3(2), Nov. 8, 1984, 98 Stat. 3203; Pub. L. 99–53, § 2(a), June 17, 1985, 99 Stat. 94; Pub. L. 99–251, title I, §§ 105(b),
106
(a)(3), Feb. 27, 1986, 100 Stat. 15, 16; Pub. L. 100–202, § 101(m) [title VI, § 626], Dec. 22, 1987, 101 Stat. 1329–390, 1329–430; Pub. L. 100–654, title II, §§ 201(b),
202
(a), Nov. 14, 1988, 102 Stat. 3845; Pub. L. 101–508, title VII, § 7002(a), Nov. 5, 1990, 104 Stat. 1388–329; Pub. L. 101–509, title IV, § 1, Nov. 5, 1990, 104 Stat. 1421; Pub. L. 102–393, title V, § 537(a), (b), Oct. 6, 1992, 106 Stat. 1765; Pub. L. 105–12, § 9(g), Apr. 30, 1997, 111 Stat. 27; Pub. L. 105–266, §§ 3(c),
8, Oct. 19, 1998, 112 Stat. 2366, 2370.)
Historical and Revision Notes
| Derivation |
U.S. Code |
Revised Statutes and Statutes at Large |
| | 5 U.S.C. 3005. | Sept. 28, 1959, Pub. L. 86–382, § 6, 73 Stat. 712. |
| | | Mar. 17, 1964, Pub. L. 88–284, § 1(7)–(9), 78 Stat. 165. |
Standard changes are made to conform with the definitions applicable and the style of this title as outlined in the preface to the report.
References in Text
Section 1310(d)(1) of title XIII of the Public Health Service Act (
42 U.S.C. 300c–9
(d)), referred to in subsec. (l), probably is intended as a reference to section
300e–9
(d) of Title
42, The Public Health and Welfare. Section
300e–9
(d) of Title
42 was redesignated section
300e–9
(c) of Title
42 by
Pub. L. 100–517, § 7(b), Oct. 24, 1988,
102 Stat. 2580.
The Assisted Suicide Funding Restriction Act of 1997, referred to in subsec. (o), is
Pub. L. 105–12, Apr. 30, 1997,
111 Stat. 23, which is classified principally to chapter 138 (§ 14401 et seq.) of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see Short Title note set out under section
14401 of Title
42 and Tables.
Codification
Another section 1 of title IV of
Pub. L. 101–509,
104 Stat. 1416, enacted sections
2701 to
2706 of Title
44, Public Printing and Documents, and provisions set out as a note under section
2102 of Title
44.
Amendments
1998—Subsec. (k)(2), (3).
Pub. L. 105–266, § 8, added par. (2) and redesignated former par. (2) as (3).
Subsec. (m)(1).
Pub. L. 105–266, § 3(c), added par. (1) and struck out former par. (1) which read as follows: “The provisions of any contract under this chapter which relate to the nature or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any State or local law, or any regulation issued thereunder, which relates to health insurance or plans to the extent that such law or regulation is inconsistent with such contractual provisions.”
1997—Subsec. (o).
Pub. L. 105–12 added subsec. (o).
1992—
Pub. L. 102–393 amended subsec. (k) generally. Prior to amendment, subsec. (k) read as follows:
“(1) When a contract under this chapter requires payment or reimbursement for services which may be performed by a clinical psychologist, optometrist, nurse midwife, or nurse practitioner/clinical specialist, licensed or certified as such under Federal or State law, as applicable, or by a qualified clinical social worker as defined in section
8901
(11), an employee, annuitant, family member, former spouse, or person having continued coverage under section
8905a of this title covered by the contract shall be free to select, and shall have direct access to, such a clinical psychologist, qualified clinical social worker, optometrist, nurse midwife, or nurse practitioner/nurse clinical specialist without supervision or referral by another health practitioner and shall be entitled under the contract to have payment or reimbursement made to him or on his behalf for the services performed.
“(2) The provisions of this subsection shall not apply to group practice prepayment plans.”
1990—Subsec. (k)(1).
Pub. L. 101–509 substituted “performed by a clinical psychologist, optometrist, nurse midwife, or nurse practitioner/clinical specialist” for “performed by a clinical psychologist or optometrist” and “qualified clinical social worker, optometrist, nurse midwife, or nurse practitioner/nurse clinical specialist” for “qualified clinical social worker or optometrist”.
Subsec. (n).
Pub. L. 101–508 added subsec. (n).
1988—Subsecs. (g), (j), (k)(1).
Pub. L. 100–654 substituted “former spouse, or person having continued coverage under section
8905a of this title” for “or former spouse” wherever appearing.
1987—Subsec. (k)(1).
Pub. L. 100–202, § 101(m) [title VI, § 626(1), (2)], inserted “or by a qualified clinical social worker as defined in section
8901
(11),” after “as applicable,”, and “, qualified clinical social worker” after “such a clinical psychologist”.
Subsec. (k)(2), (3).
Pub. L. 100–202, § 101(m) [title VI, § 626(3)], redesignated par. (3) as (2) and struck out former par. (2) which read as follows: “When a contract under this chapter requires payment or reimbursement for services which may be performed by a qualified clinical social worker, an employee, annuitant, family member, or former spouse covered by the contract shall be entitled under the contract to have payment or reimbursement made to him or on his behalf for the services performed. As a condition for the payment or reimbursement, the contract—
“(A) may require that the services be performed pursuant to a referral by a psychiatrist; but
“(B) may not require that the services be performed under the supervision of a psychiatrist or other health practitioner.”
Subsec. (m)(2)(A).
Pub. L. 100–202, § 101(m) [title VI, § 626(4)], struck out “This paragraph shall apply with respect to a qualified clinical social worker covered by subsection (k)(2) of this section without regard to whether such contract contains the requirement authorized by clause (i) of the second sentence of subparagraph (A) of such subsection (k)(2).”
1986—Subsec. (k).
Pub. L. 99–251, § 105(b), designated existing provisions as par. (1), struck out last sentence providing that the provisions of this subsection shall not apply to group practice prepayment plans, and added pars. (2) and (3).
Subsec. (m)(2)(A).
Pub. L. 99–251, § 106(a)(3), inserted last sentence relating to applicability of this paragraph with respect to a qualified clinical social worker covered by subsection (k)(2) of this section.
1985—Subsecs. (a), (e), (i).
Pub. L. 99–53 inserted reference to section
8903a of this title.
1984—Subsec. (g).
Pub. L. 98–615, § 3(2)(A), substituted “employee, annuitant, family member, or former spouse” for “employee or annuitant” in two places.
Subsecs. (j), (k).
Pub. L. 98–615, § 3(2)(B), substituted “family member, or former spouse” for “or family member”.
1980—Subsec. (m)(2)(A).
Pub. L. 96–179 substituted “in a State where 25 percent or more of the population is located in primary medical care manpower shortage areas designated pursuant to section 332 of the Public Health Service Act (
42 U.S.C.
254e)” for “who is a member of a medically underserved population (within the meaning of section 1302(7) of the Public Health Service Act (
42 U.S.C.
300e–17))”.
1978—Subsecs. (a), (c) to (e), (i), (j), (l).
Pub. L. 95–454 substituted “Office of Personnel Management” for “Civil Service Commission” and “Office” for “Commission” wherever appearing.
Subsec. (m).
Pub. L. 95–368 added subsec. (m).
1976—Subsec. (l).
Pub. L. 94–460 added subsec. (l).
1975—Subsecs. (j), (k).
Pub. L. 94–183 redesignated subsec. (j), added by
Pub. L. 93–363 and relating to services performed by a clinical psychologist or optometrist, as (k).
1974—Subsec. (j).
Pub. L. 93–363 added subsec. (j) covering services performed by a clinical psychologist or optometrist.
Pub. L. 93–246 added subsec. (j) requiring the carrier to pay for or provide a health service or supply in specified cases.
Effective Date of 1997 Amendment
Amendment by
Pub. L. 105–12 effective Apr. 30, 1997, and applicable to Federal payments made pursuant to obligations incurred after Apr. 30, 1997, for items and services provided on or after such date, subject to also being applicable with respect to contracts entered into, renewed, or extended after Apr. 30, 1997, as well as contracts entered into before Apr. 30, 1997, to the extent permitted under such contracts, see section 11 of
Pub. L. 105–12, set out as an Effective Date note under section
14401 of Title
42, The Public Health and Welfare.
Effective Date of 1992 Amendment
Section 537(c) of
Pub. L. 102–393 provided that: “The amendments made by this section [amending this section] shall be effective with respect to contract years beginning after the date of enactment of this Act [Oct. 6, 1992].”
Effective Date of 1990 Amendment
Section 7002(g) of
Pub. L. 101–508 provided that: “Except as provided in subsection (f) [set out as a note under section
8904 of this title], the amendments made by this section [amending this section, sections
8904,
8909, and
8910 of this title, and provisions set out as a note under section
8906 of this title] shall apply with respect to contract years beginning on or after January 1, 1991.”
Effective Date of 1988 Amendment
Section 203 of title II of
Pub. L. 100–654 provided that:
“(a) In General.—The amendments made by this title [enacting section
8905a of this title and amending this section and sections
8903,
8905, and
8909 of this title] shall apply with respect to—
“(1) any calendar year beginning, and contracts entered into or renewed for any calendar year beginning, after the end of the 9-month period beginning on the date of the enactment of this Act [Nov. 14, 1988]; and
“(2) any qualifying event occurring on or after the first day of the first calendar year beginning after the end of the 9-month period referred to in paragraph (1).
“(b) Definition.—For the purpose of this section, the term ‘qualifying event’ means any of the following events:
“(1) A separation from Government service.
“(2) A divorce, annulment, or legal separation.
“(3) Any change in circumstances which causes an individual to become ineligible to be considered an unmarried dependent child under chapter 89 of such title [section
8901 et seq. of this title].”
Effective Date of 1986 Amendment
Amendment by section 105(b) of
Pub. L. 99–251 effective with respect to contracts entered into or renewed for calendar years beginning after Dec. 31, 1986, see section 105(c) of
Pub. L. 99–251, set out as a note under section
8901 of this title.
Section 106(b) of
Pub. L. 99–251 provided that: “The amendments made by subsection (a) [amending this section and provisions set out as notes under this section] shall take effect with respect to services provided after December 31, 1984.”
Effective Date of 1984 Amendment
Amendment by
Pub. L. 98–615 effective May 7, 1985, with enumerated exceptions, and applicable to any individual who is married to an employee or annuitant on or after that date, see section 4(a)(2) of
Pub. L. 98–615, as amended, set out as a note under section
8341 of this title.
Effective Date of 1980 Amendment
Section 5(b) of
Pub. L. 96–179, as amended by
Pub. L. 99–251, title I, § 106(a)(2), Feb. 27, 1986,
100 Stat. 16, provided that: “The amendments made by section
3 [amending this section] shall apply to services provided after December 31, 1979, under any contract entered into or renewed after December 31, 1979.”
Effective Date of 1978 Amendments
Amendment by
Pub. L. 95–454 effective 90 days after Oct. 13, 1978, see section 907 of
Pub. L. 95–454, set out as a note under section
1101 of this title.
Section 3 of
Pub. L. 95–368, as amended by
Pub. L. 99–251, title I, § 106(a)(1), Feb. 27, 1986,
100 Stat. 16, provided that: “The provisions of section
8902
(m)(2) of title
5, United States Code, as added by the first section of this Act, shall apply to services provided under any contract entered into or renewed after December 31, 1979.”
Effective Date of 1976 Amendment
Amendment by
Pub. L. 94–460 effective Oct. 8, 1976, see section 118 of
Pub. L. 94–460, set out as a note under section
300e of Title
42, The Public Health and Welfare.
Effective Date of 1974 Amendments
Section 2 of
Pub. L. 93–363 provided that: “The amendment made by this Act [amending this section] shall become effective with respect to any contract entered into or renewed on or after the date of enactment of this Act [July 30, 1974].”
Section 4(c) of
Pub. L. 93–246 provided that: “Section
3 [amending this section] shall become effective with respect to any contract entered into or renewed on or after the date of enactment of this Act [Jan. 31, 1974].”
Full Disclosure in Health Plan Contracts
Pub. L. 105–266, § 5, Oct. 19, 1998,
112 Stat. 2368, provided that: “The Office of Personnel Management shall encourage carriers offering health benefits plans described by section
8903 or section
8903a of title
5, United States Code, with respect to contractual arrangements made by such carriers with any person for purposes of obtaining discounts from providers for health care services or supplies furnished to individuals enrolled in such plan, to seek assurance that the conditions for such discounts are fully disclosed to the providers who grant them.”
Rate Reduction for Medicare Eligible Federal Annuitants
Pub. L. 100–360, title IV, § 422, July 1, 1988,
102 Stat. 810, which directed the Office of Personnel Management to reduce the rates charged medicare eligible individuals participating in health benefit plans by a prorated amount, was repealed by
Pub. L. 101–234, title III, § 301(a), Dec. 13, 1989,
103 Stat. 1985.
Authority of Carrier To Contract for Comprehensive Medical Services From a Group Practice Unit or Organization
Pub. L. 91–515, title IV, § 401, Oct. 30, 1970,
84 Stat. 1309, authorized Secretary of Health, Education, and Welfare to permit any carrier which is a party to a contract entered into under this chapter or under the Retired Federal Employees Health Benefits Act, or which participates in carrying out of any such contract, to issue in any State contracts entitling any person as a beneficiary to receive comprehensive medical services from a group practice unit or organization with which such carrier has contracted or otherwise arranged for the provision of such services.