An Act to provide a hospital insurance program for the aged under the Social Security Act with a supplementary health benefits program and an expanded program of medical assistance, to increase benefits under the Old-Age, Survivors, and Disability Insurance System, to improve the Federal-State public assistance programs, and for other purposes
PL 89-97 (H.R.6675), enacted 07/30/1965

286 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
Public Law 89-97 
|H/R°66?f] 
^ 
AN ACT 
. 
To provide a hospital insurance program for the aged under the Social Security 
Act with a supplementary medical benefits program and an expanded program 
of medical assistance, to increase benefits under the Old-Age, Survivors, and 
Disability Insurance System, to improve the Federal-State public assistance 
programs, and for other purposes. 
Be it enacted hy the Senate and House of Representatives of the 
Am^ndments'^f*^ 
?7m^e<^ States of America in Congress assembled, That this Act, with 
1965. 
the following table of contents, may be cited as the "Social Security 
Amendments of 1965". 
TABLE OF CONTENTS 
TITLE I—HEALTH INSTJBANCE FOB THE AGED AND MEDICAL ASSISTANCE 
SEC. 100. Short title. 
PAET I—HEALTH INSURANCE BENEFITS FOR THE AGED 
SEC. 101. Entitlement to hospital insurance benefits. 
SEC. 102. Hospital insurance benefits and supplementary medical insurance 
benefits. 
TITLE XVIII—HEALTH INSURANCE FOR THE AGED 
SEC. 1801. Prohibition against any Federal interference. 
SEC. 1802. Free choice by patient guaranteed. 
SEC. 1803. Option to individuals to obtain other health insurance protec-
tion. 
PART A — H O S P I T A L INSURANCE BENEFITS FOB THE AGED 
SEC. 1811. Description of program. 
SEC. 1812. Scope of benefits. 
SEC. 1813. Deductibles and coinsurance. 
SEC. 1814. Conditions of and limitations on payment for services. 
(a) Requirement of requests and certifications. 
(b) Reasonable cost of services. 
(c) No payments to Federal providers of services. 
(d) Payments for emergency hospital services. 
(e) Payment for inpatient hospital services prior to notifi-
cation of noneligibility. 
(f) Payment for certain emergency hospital services furn-
ished outside the United States. 
SEC. 1815. Payment to providers of services 
SEC. 1816. Use of public agencies or private organizations to facilitate pay-
ment to providers of services. 
SEC. 1817. Federal hospital insurance trust fund. 
PART B — S U P P L E M E N T A B Y MEDICAL INSUBANCE BENEFITS FOB THE AGED 
SEC. 1831. Establishment of supplementary medical insurance program for 
the aged. 
SEC. 1832. Scope of benefits. 
SEC. 1833. Payment of benefits. 
SEC. 1834. Limitation on home health services. 
SEC. 1835. Procedure for payment of claims of providers of services. 
SEC. 1836. Eligible individuals. 
SEC. 1837. Enrollment periods. 
SEC. 1838. Coverage period. 
SEC. 1839. Amounts of premiums. 
SEC. 1840. Payment of premiums. 
SEC. 1841. Federal supplementary medical insurance trust fund. 
SEC. 1842. Use of carriers for administration of benefits. 
SEC. 1843. State agreements for coverage of eligible individuals who are 
receiving money payments under public assistance programs. 
SEC. 1844. Appropriations to cover Grovernment contributions and con-
tingency reserve. 
79 STAT. ] 
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287 
TABLE OF CONTENTS—Continued 
TITLE XVIII—HEALTH INSURANCE FOR THE AGED—Continued 
PART C—MISCELLANEOUS PROVISIONS 
j 
SEC. 1861. Definitions of services, institutions, etc. 
(a) Spell of illness. 
(b) Inpatient hospital services. 
I 
(c) Inpatient psychiatric hospital services. 
(d) Inpatient tuberculosis hospital services. 
(e) Hospital. 
(f) Psychiatric hospital. 
(g) Tuberculosis hospital, 
(h) Extended care services. 
(i) Post-hospital extended care services, 
(j) Extended care facility, 
(k) Utilization review. 
(1) Agreements for transfer between extended care facili-
ties and hospitals, 
(m) Home health services, 
(n) Post-hospital home health services, 
(o) Home health agency, 
(p) Outpatient hospital diagnostic services, 
(q) Physicians' services, 
(r) Physician. 
(s) Medical and other health services, 
(t) Drugs and biologicals. 
(u) Provider of services, 
(v) Reasonable cost, 
(w) Arrangements for certain services, 
(x) State and United States. 
(y) Post-hospital extended care in CJhristian Science ex-
tended care facilities. 
SEC. 1862. Exclusions from coverage. 
SEC 1863. Consultation with State agencies and other organizations to 
develop conditions of participation for providers of services. 
SEC 1864. Use of State agencies to determine compliance by providers of 
services with conditions of participation. 
SEC 1865. Effect of accreditation. 
SEC 1866. Agreements with providers of services. 
SEC 1867. Health insurance benefits advisory council. 
SEC 1868. National medical review committee. 
SEC 1869. Determinations; appeals. 
SEC 1870. Overpayments on behalf of individuals. 
SEC 1871. Regulations. 
SEC. 1872. Application of certain provisions of title II. 
SEC 1873. Designation of organization or publication by name. 
SEC 1874. Administration. 
SEC 1875. Studies and recommendations. 
SEC. 103. Transitional provision on eligibility of presently uninsured individuals 
for hospital insurance benefits. 
SEC. 104. Suspension in case of aliens; persons convicted of subversive 
activities. 
SEC 105. Railroad retirement amendments. 
SEC 106. Medical expense deduction. 
SEC 107. Receipts for employees must show taxes separately. 
SEC 108. Technical and administrative amendments relating to trust funds. 
SEC 109. Advisory council on social security. 
SEC 110. Meaning of term "Secretary". 
SEC 111. Role of the Railroad Retirement Board in the administration of hos-
pital insurance for the aged. 
288 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
TABLE OF CONTENTS—Continued 
TITLE XVIII—HEALTH INSURANCE FOR THE AGED—Continued 
PART 2—GRANTS' TO STATES FOR MEDICAL ASSISTANCE PROGRAMS 
SEC. 121. Establishment of programs. 
TiTi-E XIX—GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS 
SEC. 1901. Appropriation. 
SEC. 1902. State plans for medical assistance. 
SEC. 1903. Payment to States. 
SEC. 1904. Operation of State plans. 
SEC. 1905. Definitions. 
SEC. 122. Payment by States of premiums for supplementary medical insurance. 
TITLE II—OTHES AMENDMENTS RELATING TO HEALTH CARE 
PART 1—MATERNAL AND CHILD HEALTH AND CRIPPLED CHILDREN'S SERVICES 
SEC. 201. Increase in maternal and child health services. 
SEC. 202. Increase in crippled children's services. 
SEC. 203. Training of professional personnel for the care of crippled children. 
SEC 204. Payment for inpatient hospital services. 
SEC. 205. Special project grants for health of school and preschool children. 
SEC 206. Evaluation and report. 
SEC 207. Increase in child welfare services. 
SEC. 208. Day care services. 
PART 2—IMPLEMENTATION OF MENTAL RETARDATION PLANNING 
SEC. 211. Authorization of appropriations. 
PART 3—PUBLIC ASSISTANCE AMENDMENTS RELATING TO HEALTH CARE 
SEC. 22L Removal of limitations on Federal participation in assistance to 
individuals with tuberculosis or mental disease. 
SEC. 222. Amendment to definition of medical assistance for the aged. 
PART 4—MISCELLANEOUS AMENDMENTS RELATING TO HEALTH CARE 
SEC 231. Health study of resources relating to children's emotional illness. 
TITLE III—SOCIAL SECURITY AMENDMENTS 
SEC. 300. Short title. 
SEC. 301. Increase in old-age, survivors, and disability insurance benefits. 
SEC 302. Computation and recomputation of benefits. 
SEC. 303. Disability insurance benefits. 
SEC. 304. Payment of disability insurance benefits after entitlement to other 
monthly insurance benefits. 
SEC. 305. Disability insurance trust fund. 
SEC 306. Payment of child's insurance benefits after attainment of age 18 in 
case of child attending school. 
SEC 307. Reduced benefits for widows at age 60. 
SEC 308. Wife's and widow's benefits for divorced women. 
SEC 309. Transitional insured status. 
SEC 310. Increase in amount an individual is permitted to earn without suffer-
ing full deductions from benefits. 
SEC 311. Coverage for doctors of medicine. 
SEC 312. Gross income of farmers. 
SEC 313. Coverage of tips. 
SEC 314. Inclusion of Alaska among States permitted to divide their retirement 
systems. 
79 STAT. ] 
PUBLIC L
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289 
TABLE OF CONTENTS—Continued 
TITLE III—SOCIAL SECURITY AMENDMENTS—Continued 
SEC. 315. Additional period for electing coverage under divided retirement 
system. 
SEC. 316. Employees of nonprofit organizations. 
SEC. 317. Coverage of temporary employees of the District of Columbia. 
SEC. 318. Coverage for certain additional hospital employees in California. 
SEC. 319. Tax exemption for religious groups opposed to insurance. 
SEC. 320. Increase of earnings counted for benefit and tax purposes. 
SEC. 321. Changes in tax schedules. 
SEC. 322. Reimbursement of trust funds for cost of noncontributory military 
service credits. 
SEC. 323. Adoption of child by retired worker. 
SEC. 324. Extension of period for filing proof of support and applications for 
lump-sum death payment. 
SEC. 325. Treatment of certain royalties for retirement test purposes. 
SEC. 326. Amendments preserving relationship between railroad retirement and 
old-age, survivors, and disability insurance systems. 
SEC. 327. Technical amendment relating to meetings of board of trustees of the 
old-age, survivors, and disability insurance trust funds. 
SEC. 328. Applications for benefits. 
SEC. 329. Underpayments. 
SEC. 330. Payments to two or more individuals of the same family. 
SEC. 331. Validating certificates filed by ministers. 
SEC. 332. Determination of attorneys' fees in court proceedings under title II. 
SEC. 333. Continuation of widow's and widower's insurance benefits 
after 
remarriage. 
SEC. 334. Changes in definitions of wife, widow, husband, and widower. 
SEC. 335. Reduction of benefits on receipt of workmen's compensation. 
SEC. 336. Payment of costs of rehabilitation services from the trust funds. 
SEC. 337. Teachers in the State of Maine. 
SEC 338. Modification of agreement with North Dakota and Iowa with respect 
to certain students. 
SEC. 339. Qualification of children not qualified under State law. 
SEC. 340. Disclosure, under certain circumstances, to courts and interested 
welfare agencies of whereabouts of individuals. 
SEC. 341. Additional period for filing of ministers certificates. 
SEC 342. Rectifying error in interpreting law with respect to certain school 
employees in Alaska. 
SEC 343. Continuation of child's insurance benefits after adoption by brother or 
sister. 
SEC. 344. Disability insurance benefits for the blind; special provisions. 
TITLE IV—PUBLIC ASSISTANCE AMENDMENTS 
SEC. 401. Increased Federal payments under public assistance titles of the 
Social Security Act. 
SEC 402. Protective payments. 
SEC 403. Disregarding certain earnings in determining need under assistance 
programs for the aged, blind, and disabled. 
SEC 404. Administrative and judicial review of public assistance determina-
tions. 
SEC 405. Maintenance of State public assistance expenditures. 
SEC 406. Disregarding OASDI benefit increase, and child's insurance benefit 
payments beyond age 18, to the extent attributable to retroactive 
effective date. 
SEC 407. Extension of grace period for disregarding certain income for States 
where legislature has not met in regular session. 
SEC 408. Technical amendments relating to public assistance programs. 
SEC 409. Eligibility of children over age 18 attending school. 
SEC 410. Disregarding certain earnings in determining need of certain de-
pendent children. 
SEC 411. Federal share of public assistance expenditures. 
290 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
TITLE I—HEALTH INSURANCE FOR T H E AGED AND 
MEDICAL ASSISTANCE 
SHORT TITLE 
Health insur- 
gj,(,. iQO. This title mav be cited as the "Health Insurance for 
ance for the 
AT, 
A 
J 
A 
j.« 
Aged Act. 
the Aged Act". 
PART 1—HEALTH INSURANCE BENEFITS FOR THE AGED 
ENTITLEMENT TO HOSPITAL INSURANCE BENEFITS 
11 f.?'- 1362. 
SEC. 101. Title I I of the Social Security Act is amended by adding 
42 use 401-425. at the end thereof the following new section: 
a. 
ENTITLEMENT TO HOSPITAL INSURANCE BENEFITS 
"SEC. 226. (a) Every individual who— 
" (1) has attained the age of 65, and 
"(2) is entitled to monthly insurance benefits under section 
42 use 40 2. 
202 or is a qualified railroad retirement beneficiary, 
shall be entitled to hospital insurance benefits under part A of title 
Post, p. 291. 
X V I I I for each month for which he meets the condition specified in 
paragraph (2), beginning with the first month after June 1966 for 
which he meets the conditions specified in paragraphs (1) and (2). 
"(b) For purposes of subsection (a)— 
"(1) entitlement of an individual to hospital insurance bene-
fits for a month shall consist of entitlement to have payment 
made under, and subject to the limitations in, part A of title 
X V I I I on his behalf for inpatient hospital services, post-hospital 
extended care services, post-hospital home health services, and 
outpatient hospital diagnostic services (as such terms are defined 
in part C of title XVIII) furnished him in the United States (or 
outside the United States in the case of inpatient hospital serv-
ices furnished under the conditions described in section 1814(f)) 
during such month; except that (A) no such payment may be 
made for post-hospital extended care services furnished before 
January 1967, and (B) no such payment may be made for post-
hospital extended care services or post-hospital home health 
services unless the discharge from the hospital required to 
qualify such services for payment under pa-rt A of title X V I I I 
occurred after June 30, 1966, or on or after the first day of 
the month in which he attains age 65, whichever is later; and 
"(2) an individual shall be deemed entitled to monthly insur-
ance benefits under section 202, or to be a qualified railroad 
retirement beneficiary, for the month in which he died if he 
would have been entitled to such benefits, or would have been a 
qualified railroad retirement beneficiary, for such month had 
he died in the next month. 
"(c) For purposes of this section, the term 'qualified railroad 
retirement beneficiary' means an individual whose name has been 
certified to the Secretary by the Railroad Retirement Board under 
Post. pp. 335, 
section 21 of the Railroad Retirement Act of 1937. An individual 
shall cease to be a qualified railroad retirement beneficiary at the 
close of the month preceding the month which is certified by the 
340. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
291 
Kailroad Retirement Board as the month in which he ceased to meet 
the requirements of section 21 of the Railroad Retirement Act of 
1937. 
^ 
34^°^'' pp- "^' 
"(d) For entitlement to hospital insurance benefits in the case of 
certain uninsured individuals, see section 103 of the Social Security 
Amendments of 1965." 
HOSPITAL INSURANCE BENEFITS AND SUPPLEMENTARY MEDICAL 
INSURANCE BENEFITS 
SEC. 102. (a) The Social Security Act is amended by adding after 
title X V I I the following new title: 
4 2 use i sos. 
"TITLE XVIII—HEALTH INSURANCE FOR T H E AGED 
" P R O H I B I T I O N AGAINST ANY FEDERAL INTERFERENCE 
"SEC. 1801. Nothing in this title shall be construed to authorize any 
Federal officer or employee to exercise any supervision or control over 
the practice of medicine or the manner in which medical services are 
provided, or over the selection, tenure, or compensation of any officer 
or employee of any institution, agency, or person providing health 
services; or to exercise any supervision or control over the adminis-
tration or operation of any such institution, agency, or person. 
u 
FREE CHOICE BY PATIENT GUARANTEED 
"SEC. 1802. Any individual entitled to insurance benefits under this 
title may obtain health services from any institution, agency, or 
person qualified to participate under this title if such institution, 
agency, or person undertakes to provide him such services. 
" O P T I O N TO INDIVIDUAIiS TO OBTAIN OTHER HEALTH INSURANCE 
PROTECTION 
" S E C 1803. Nothing contained in this title shall be construed to 
preclude any State from providing, or any individual from pur-
chasing or otherwise securing, protection against the cost of any 
health services. 
"PART A—HOSPITAL INSURANCE BENEFITS FOR THE AGED 
"DESCRIPTION OF PROGRAM 
"SEC. 1811. The insurance program for which entitlement is estab-
lished by section 226 provides basic protection against the costs of hos- 
^"'*' P- 290. 
pital and related post-hospital services in accordance with this part 
for individuals who are age 65 or over and are entitled to retirement 
benefits under title I I of this Act or under the railroad retirement 
42 use 401-425. 
system. 
" S C O P E o r BENEFITS 
"SEC. 1812. (a) The benefits provided to an individual by the 
insurance program under this part shall consist of entitlement to have 
payment made on his behalf (subject to the provisions of this part) 
for— 
"(1) inpatient hospital services for up to 90 days during any 
spell of ilmess; 
292 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"(2) post-hospital extended care services for up to 100 days 
during any spell of illness; 
"(3) post-hospital home health services for up to 100 visits 
Post, p. 320. 
(during the one-year period described in section 1861 (n)) after 
the beginning of one spell of illness and before the beginning of 
the next; and 
" (4) outpatient hospital diagnostic services, 
"^b) Payment 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 90 days 
during such spell; 
"(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. 
"(c) If an individual is an inpatient of a psychiatric hospital or a 
tuberculosis 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 90-day period immediately before 
such first day shall be included in determining the 90-day limit under 
subsection (b) (1) (but not in determining the 190-day limit under 
subsection (b) (3)). 
"(d) Payment under this part may be made for post-hospital 
home health services furnished an individual only during the one-
year period described in section 1861 (n) following his most recent 
hospital discharge which meets the requirements of such section, 
and only for the first 100 visits in such period. 
The number of 
visits to be charged for purposes of the limitation in the preceding 
sentence, in connection with items or services described in section 
1861 (m), shall be determined in accordance with regulations. 
"(e) For purposes of subsections (b), (c), and (d), inpatient 
hospital services, inpatient psychiatric hospital services, post-hospital 
extended care services, and post-hospital home health 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 1814(a), made with respect to such 
services under this part. 
"(f) For definition of 'spell of illness', and for definitions of other 
terms used in this part, see section 1861. 
Post, 
p. 313. 
II 
DEDUCTIBLES AND COINSURANCE 
Inpatient hos. 
"SEC. 1813. (a)(1) The amount payable for inpatient hospital 
pitai services. 
sorvices fumished an individual during any spell of illness shall be 
reduced by a deduction equal to the inpatient hospital deductible or, 
if less, the charges imposed with respect to such individual for such 
services, except that, if the customary charges for such services are 
greater than the charges so imposed, such customary charges shall be 
considered to be the charges so imposed. 
Such amount shall be 
further reduced by a coinsurance amount equal to one-fourth of the 
79 
STAT.] 
PUBLIC LAW 89-97-JULY 30, 1965 
293 
Outpatient 
services. 
Ante, p. 290. 
inpatient hospital deductible for each day (before the 91st day) on 
which such individual is furnished such services during such spell of 
illness after such services have been furnished to him for 60 days 
during such spell. 
"(2) The amount payable for outpatient hospital diagnostic hospuai 
services furnished an individual during a diagnostic study shall be diagnost 
reduced by a deduction equal to the sum of (A) one-half of the 
inpatient hospital deductible which is applicable to spells of illness 
beginning in the same calendar year as such diagnostic study and (B) 
20 per centum of the remainder of such amount. 
For purposes of the 
preceding sentence, a diagnostic study for any individual consists of 
the outpatient hospital diagnostic services provided by (or under 
arrangements made by) the same hospital during the 20-day period 
beginning on the first day (not included in a previous diagnostic 
study) on which he is entitled to hospital insurance benefits under 
section 226 and on which outpatient hospital diagnostic services are 
furnished him. 
"(3) The amount payable to any provider of services under this 
part for services furnished an individual during any spell of illness 
shall be further reduced by an amount equal to the cost of the first 
three pints of whole blood furnished to him as part of such services 
during such spell of illness. 
"(4) The amount payable for post-hospital extended care services 
furnished an individual during any spell of illness shall be reduced by 
a coinsurance amount equal to one-eighth of the inpatient hospital 
deductible for each day (before the 101st day) on which he is fur-
nished such services after such services have been furnished to him 
for 20 days during such spell. 
"(b)(1) The inpatient hospital deductible which shall be appli-
cable for the purposes of subsection (a) shall be $40 in the case of any deduc'tibie. 
spell of illness or diagnostic study beginning before 1969. 
"(2) The Secretary shall, between July 1 and October 1 of 1968, 
and of each year thereafter, determine and promulgate the inpatient 
hospital deductible which shall be applicable for the purposes of 
subsection (a) in the case of any spell of illness or diagnostic study 
beginning during the succeeding calendar year. 
Such inpatient 
hospital deductible shall be equal to $40 multiplied by the ratio of 
(A) the current average per diem rate for inpatient hospital serv-
ices for the calendar year preceding the promulgation, to (B) the 
current average per diem rate for such services for 1966. 
Any 
amount determined under the preceding sentence which is not a 
multiple of $4 shall be rounded to the nearest multiple of $4 (or, 
if it is midway between two multiples of $4, to the next higher 
multiple of $4). The current average per diem rate for any year 
shall be determined by the Secretary on the basis of the best informa-
tion available to him (at the time the determination is made) as to 
the amounts paid under this part on account of inpatient hospital 
services furnished during such year, by hospitals which have agree-
ments in effect under section 1866, to individuals who are entitled 
to hospital insurance benefits under section 226, plus the amount 
which would have been so paid but for subsection (a) (1) of this 
section. 
Inpatient 
hospital 
Post, p. 327. 
294 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"CONDITIONS OF AND LIMITATIONS ON PAYMENT FOR SERVICES 
"Requirement of Requests and Certifications 
"SEC. 1814. (a) Except as provided in subsection (d), payment 
for services furnished an individual may be made only to providers 
Post, p. 327. 
Qf services which are eligible therefor under section 1866 and only 
"(1) written request, signed by such individual except in 
cases in which the Secretary finds it impracticable for the indi-
vidual to do so, is filed for such payment in such form, in such 
manner, within such time, and by such person or persons as 
the Secretary may by regulation prescribe; 
"(2) a physician certifies (and recertifies, where such services 
are furnished over a period of time, in such cases, with such 
frequency, and accompanied by such supporting material, appro-
priate to the case involved, as may be provided by regulations, 
except that the first of such recertifications shall be required in 
each case of inpatient hospital services not later than the 20th day 
of such period) that— 
"(A) in the case of inpatient hospital services (other than 
inj)atient psychiatric hospital services and inpatient tubercu-
losis hospital services), such services are or were required to be 
given on an inpatient basis for such individual's medical 
treatment, or that inpatient diagnostic study is or was 
medically required and such services are or were necessary 
for such purpose; 
"(B) in the case of inpatient psychiatric hospital services, 
such services are or were required to be given on an inpatient 
basis, by or under the supervision of a physician, for the 
psychiatric treatment of an individual; and (i) such treat-
ment can or could reasonably be expected to improve the 
condition for which such treatment is or was necessary or 
(ii) inpatient diagnostic study is or was medically required 
and such services are or were necessary for such purposes; 
"(C) in the case of inpatient tuberculosis hospital services, 
such services are or were required to be given on an inpatient 
basis, by or under the supervision of a physician, for the 
treatment of an individual for tuberculosis; and such treat-
ment can or could reasonably be expected to (i) improve the 
condition for which such treatment is or was necessary or 
(ii) render the condition noncommunicable; 
"(D) in the case of post-hospital extended care services, 
such services are or were required to be given on an inpatient 
basis because the individual needs or needed skilled nursing 
care on a continuing basis for any of the conditions with 
respect to which he was receiving inpatient hospital services 
(or, services whi-ch would constitute inpatient hospital serv-
ices if the institution met the requirements of paragraphs 
Post. p. 314. 
(6) and (8> of section 1861(e)) prior to transfer to the 
extended care facility or for a condition requiring such 
extended care services which arose after such transfer and 
while he was still in the facility for treatment of the con-
dition or conditions for which he was receiving such inpa-
tient hospital services; 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
295 
"(E) in the case of post-hospital home health services, 
such services are or were required because the individual 
is or was confined to his home (except when receiving 
items and services referred to in section 1861 (m) (7)) and 
^°«''P- 319. 
needed skilled nursing care on an intermittent basis, or 
physical or speech therapy, for any of the conditions with 
respect to which he was receiving inpatient hospital services 
(or services which would constitute inpatient hospital 
services if the institution met the requirements of para-
graphs (6) and (8) of section 1861(e)) or post-hospital 
extended care services; a plan for furnishing such services 
to such individual has been established and is periodically 
reviewed by a physician; and such services are or were 
furnished while the individual was under the care of a 
physician; or 
"(F) in the case of outpatient hospital diagnostic serv-
ices, such services are or were required for diagnostic study; 
"(3) in the case of inpatient psychiatric hospital services, 
the services are those which the records of the hospital indicate 
were furnished to the individual during periods when he was 
receiving (A) intensive treatment services, (B) admission and 
related services necessary for a diagnostic study, or (C) equiva-
lent services; 
"(4) in the case of inpatient tuberculosis hospital services, 
the services are those which the records of the hospital indicate 
were furnished to the individual during periods when he was 
receiving treatment which could reasonably be expected to (A) 
improve his condition or (B) render it noncommunicable; 
"(5) with respect to inpatient hospital services furnished 
such individual after the 20th day of a continuous period of such 
services and with respect to post-hospital extended care services 
furnished after such day of a continuous period of such services 
as may be prescribed in or pursuant to regulations, there was 
not in effect, at the time of admission of such individual to the 
hospital or extended care facility, as the case may be, a decision 
under section 1866(d) 
(based on a finding that utilization 
Post, p. in. 
review of long-stay cases is not being made in such hospital or 
facility); and 
"(6) with respect to inpatient hospital services or post-
hospital extended care services furnished such individual during 
a continuous period, a finding has not been made (by the physi-
cian members of the committee or group, as described in section 
1861 (k) (4)) pursuant to the system of utilization review that 
further inpatient hospital services or further 
post-hospital 
extended care services, as the case may be, are not medically 
necessary; except that, if such a finding has been made, payment 
may be made for such services furnished before the 4tli day 
after the day on which the hospital or extended care facility, 
as the case may be, received notice of such finding. 
To the extent provided by regulations, the certification and recertifica-
tion requirements of paragraph (2) shall be deemed satisfied where, 
at a later date, a physician makes certification of the kind provided 
in subparagraph (A), (B), (C), (D), (E), or (F) of paragraph (2) 
296 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
(whichever would have applied), but only where such certification is 
accompanied by such medical and other evidence as may be required 
by such regulations. 
"Eeasonable Cost of Services 
"(b) The amount paid to any provider of services with respect to 
services for which payment may be made under this part shall, subject 
Ante, p. 292. 
to the provisious of section 1813, be the reasonable cost of such services, 
as determined under section 1861 (v). 
Post, 
p. 322. 
"No Payments to Federal Providers of Services 
"(c) No payment may be made under this part (except under sub-
section (d)) to any Federal provider of services, except a provider of 
services which the Secretary determines is providing services to the 
public generally as a community institution or agency; and no such 
payment may be made to any provider of services for any item or 
service which such provider is obligated by a law of, or a contract 
with, the United States to render at public expense. 
"Payments for Emergency Hospital Services 
"(d) Payments shall also be made to any hospital for inpatient hos-
pital services or outpatient hospital diagnostic services furnished, by 
the hospital or under arrangements (as defined in section 1861 (w)) 
with it, to an individual entitled to hospital insurance benefits under 
Ante, p. 290. 
sectiou 226 even though such hospital does not have an agreement in 
effect under this title if (A) such services were emergency services and 
(B) the Secretary would be required to make such payment if the 
hospital had such an agreement in effect and otherwise met the condi-
tions of payment hereunder. 
Such payments shall be made only in 
the amounts provided under subsection (b) and then only if such hos-
pital agrees to complv, with respect to the emergency services pro-
vided, with the provisions of section 1866(a). 
"Payment for Inpatient Hospital Services Prior to Notification of 
Noneligibility 
"(e) Notwithstanding that an individual is not entitled to have 
payment made under this part for inpatient hospital services fur-
nished by any hospital, payment shall be made to such hospital (unless 
it elects not to receive such payment or, if payment has already been 
made by or on behalf of such individual, fails to refund such payment 
within the time specified by the Secretary) for such services which are 
furnished to the individual prior to notification to such hospital from 
the Secretary of his lack of entitlement, if such payments are pre-
Ante.p. 291. 
cluded ouly by reason of section 1812 and if such hospital complies 
with the requirements of and regulations under this title with respect 
to such payments, has acted in good faith and without knowledge of 
such lack of entitlement, and has acted reasonably in assuming entitle-
ment existed. Payment under the preceding sentence may not be 
made for services furnished an individual pursuant to any admission 
after the 6th elapsed day (not including as an elapsed day Saturday, 
Sunday, or a legal holiday) after the day on which such admission 
occurred. 
Post, 
p. 327. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
297 
"Payment for Certain Emergency Hospital Services Furnished 
Outside the United States 
"(f) The authority contained in subsection (d) shall be applicable 
to emergency inpatient hospital services furnished an individual by a 
hospital located outside the United States if— 
"(1) such individual was physically present in a place within 
the United States at the time the emergency which neces-
sitated such inpatient hospital services occurred; and 
"(2) such hospital was closer to, or substantially more acces-
sible from, such place than the nearest hospital within the United 
States which was adequately equipped to deal with, and was 
available for the treatment of, such individual's illness or injury. 
(( 
PAYMENT TO PROVTOERS OF SERVICES 
"SEC. 1815. The Secretary shall periodically determine the amount 
which should be paid under this part to each provider of services with 
respect to the services furnished by it, and the provider of services 
shall be paid, at such time or times as the Secretary believes appro-
priate (but not less often than monthly) and prior to audit or settle-
ment by the General Accounting Office, from the Federal Hospital 
Insurance Trust Fund, the amounts so determined, with necessary ^°^^' P- 299. 
adjustments on account of previously made overpayments or under-
payments; except that no such payments shall be made to any pro-
vider unless it has furnished such information as the Secretary may 
request in order to determine the amounts due such provider under 
this part for the period with respect to which the amounts are being 
paid or any prior period. 
" U S E 
O F P U B L I C AGENCIES OR PRIVATE ORGANIZATIONS TO FACILITATE 
PAYMENT TO PROVIDERS OF SERVICES 
"SEC. 1816. (a) If any group or association of providers of services 
wishes to have payments under this part to such providers made 
through a national. State, or other public or private agency or 
organization and nominates such agency or organization for this 
purpose, the Secretary is authorized to enter into an agreement with 
such agency or organization providing for the determination by 
such agency or organization (subject to such review by the Secretary 
as may be provided for by the agreement) of the amount of the pay-
ments required pursuant to this part to be made to such providers, 
and for the making of such payments by such agency or organization 
to such providers. Such agreement may also include provision for 
the agency or organization to do all or any part of the following: 
(1) to provide consultative services to institutions or agencies to 
enable them to establish and maintain fiscal records necessary for 
purposes of this part and otherwise to qualify as hospitals, extended 
care facilities, or home health agencies, and (2) with respect to the 
providers of services which are to receive payments through it (A) 
to serve as a center for, and communicate to providers, any informa-
tion or instructions furnished to it by the Secretary, and serve as 
a channel of communication from providers to the Secretary; (B) 
to make such audits of the records of providers as may be necessary 
to insure that proper payments are made under this part; and (C) 
to perform such other functions as are necessary to carry out this 
subsection. 
49-850 0-66—22 
298 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"(b) The Secretary shall not enter into an agreement with any 
agency or organization under this section unless (1) he finds (A) 
that to do so is consistent with the effective and efficient administra-
tion of this part, and (B) that such agency or organization is willing 
and able to assist the providers to which payments are made through 
it under this part in the application of safeguards against unneces-
sarv utilization of services furnished by them to individuals entitled 
Ante. p. 290, 
to hospital insuraucc benefits under section 226, and the agreement 
provides for such assistance, and (2) such agency or organization 
agrees to furnish to the Secretary such of the information acquired 
by it in carrying out its agreement under this section as the Secre-
tary may find necessary in performing his functions under this part. 
(c) An agreement with any agency or organization under this 
section may contain such terms and conditions as the Secretary finds 
necessary or appropriate, may provide for advances of funds to the 
agency or organization for the making of pavments by it under 
subsection (a), and shall provide for payment of so much of the cost 
of administration of the agency or organization as is determined by 
the Secretary to be necessary and proper for carrying out the func-
tions covered by the agreement. 
"(d) If the nomination of an agency or organization as provided 
in this section is made by a group or association of providers of 
services, it shall not be binding on members of the group or associa-
tion which notify the Secretary of their election to that effect. 
Any 
provider may, upon such notice as may be specified in the agreement 
under this section with an agency or organization, withdraw its 
nomination to receive payments through such agency or organization. 
Any provider which has withdrawn its nominatioUj and any provider 
which has not made a nomination, may elect to receive payments from 
any agency or organization which has entered into an agreement with 
the Secretary under this section if the Secretary and such agency 
or organization agree to it. 
"(e) An agreement with the Secretary under this section may be 
terminated— 
"(1) by the agency or organization which entered into such 
agreement at such time and upon such notice to the Secretary, 
to the public, and to the providers as may be provided in regu-
lations, or 
"(2) by the Secretary at such time and upon such notice to 
the agency or organization, to the providers which have nomi-
nated it for purposes of this section, and to the public, as may 
be provided in regulations, but only if he finds, after reasonable 
notice and opportunity for hearing to the agency or organiza-
tion, that (A) the agency or organization has failed substantially 
to carry out the agreement, or (B) the continuation of some or 
all of the functions provided for in the agreement with the 
agency or organization is disadvantageous or is inconsistent 
with the efficient administration of this part. 
"(f) An agreement with an agency or organization under this 
section may require any of its officers or employees certifying pay-
ments or disbursing funds pursuant to the agreement, or otherwise 
participating in carrying out the agreement, to give surety bond to 
the ITnited States in such amount as the Secretary may deem 
appropriate. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
299 
" (g) (1) ^ o individual designated pursuant to an agreement under 
this section as a certifying officer shall, in the absence of gross 
negligence or intent to defraud the United States, be liable with 
respect to any payments certified by him under this section. 
" (2) No disbursing officer shall, in the absence of gross negligence 
or intent to defraud the United States, be liable with respect to any 
payment by him under this section if it was based upon a voucher 
signed by a certifying officer designated as provided in paragraph 
(1) of this subsection, 
"(3) No such agency or organization shall be liable to the United 
States for any payments referred to in paragraph (1) or (2), 
"FEDERAL HOSPITAL INSURANCE TRUST FUND 
"SEC. 1817. (a) There is hereby created on the books of the 
Treasury of the United States a trust fund to be known as the 
'Federal Hospital Insurance Trust Fund' (hereinafter in this sec-
tion referred to as the 'Trust Fund'). 
The Trust Fund shall consist 
of such amounts as may be deposited in, or appropriated to, such fund 
as provided in this part. 
There are hereby appropriated to the Trust 
Fund for the fiscal year ending June 30,1966, and for each fiscal year 
thereafter, out of any moneys in the Treasury not otherwise appro-
priated, amounts equivalent to 100 per centum of— 
"(1) the taxes imposed by sections 3101(b) and 3111(b) of the 
Internal Eevenue Code of 1954 with respect to wages reported 
^°®*' PP* ^^^' ^^^• 
to the Secretary of the Treasury or his delegate pursuant to sub-
title F of such Code after December 31, 1965, as determined by J^^^^ ^''°^ "^ 
the Secretary of the Treasury by applying the applicable rates of 
tax under such sections to such wages, which wages shall be cer-
tified by the Secretary of Health, Education, and Welfare on the 
basis 01 records of wages established and maintained by the Sec-
retary of Health, Education, and Welfare in accordance with 
such reports; and 
"(2) the taxes imposed by section 1401(b) of the Internal 
Revenue Code of 1954 with respect to self-employment income 
^°®/' P* ^^'^^ 
reported to the Secretary of the Treasury or his delegate on tax 
returns under subtitle F of such Code, as determined by the 
Secretary of the Treasury by applying the applicable rate of 
tax under such section to such self-employment income, which 
self-employment income shall be certified by the Secretary of 
Health, Education, and Welfare on the basis of records of self-
employment established and maintained by the Secretary of 
Health, Education, and Welfare in accordance with such returns. 
The amounts appropriated by the preceding sentence shall be trans-
ferred from time to time from the general fund in the Treasury to 
the Trust Fund, such amounts to be determined on the basis of 
estimates by the Secretary of the Treasury of the taxes, specified in 
the preceding sentence, paid to or deposited into the Treasury; and 
proper adjustments shall be made in amounts subsequently trans-
ferred to the extent prior estimates were in excess of or were less 
than the taxes specified in such sent-ence. 
"(b) With respect to the Trust Fund, there is hereby created a Tm°stets^ 
body to be known as the Board of Trustees of the Trust Fund (here-
inafter in this section referred to as the 'Board of Trustees') com-
posed of the Secretary of the Treasury, the Secretary of Labor, and 
the Secretary of Health, Education, and Welfare, all ex officio. 
The 
Secretary of the Treasury shall be the Managing Trustee of the 
Board of Trustees (hereinafter in this section referred to as the 
300 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
'Managing Trustee'). 
The Commissioner of Social Security shall 
gresT'*'''° ^°"" serve as the Secretary of the Board of Trustees. 
The Board of 
Trustees shall meet not less frequently than once each calendar year. 
It shall be the duty of the Board of Trustees to— 
" (1) Hold the Trust Fund; 
"(2) Report to the Congress not later than the first day of 
March of each year on the operation and status of the Trust Fund 
during the preceding fiscal year and on its expected operation 
and status during the current fiscal year and the next 2 fiscal 
years; 
"(3) Report immediately to the Congress whenever the Board 
is of the opinion that the amount of the Trust Fund is unduly 
small; and 
"(4) Review the general policies followed in managing the 
Trust Fund, and recommend changes in such policies, including 
necessary changes in the provisions of law which govern the 
way in which the Trust Fund is to be managed. 
The report provided for in paragraph (2) shall include a statement 
of the assets of, and the disbursements made from, the Trust Fund 
during the preceding fiscal year, an estimate of the expected income 
to, and disbursements to be made from, the Trust Fund during the 
current fiscal year and each of the next 2 fiscal years, and a state-
ment of the actuarial status of the Trust Fund. Such report shall be 
printed as a House document of the session of the Congress to which 
the report is made. 
Fund"oniTs°^ 
"(c) It shall be the duty of the Managing Trustee to invest such 
portion of the Trust Fund as is not, in his judgment, required to meet 
current withdrawals. 
Such investments may be made only in 
interest-bearing obligations of the United States or in obligations 
guaranteed as to both principal and interest by the United States. 
For such purpose such obligations may be acquired (1) on original 
issue at the issue price, or (2) by purchase of outstanding obligations 
at the market price. The purposes for which obligations of the 
31 use 77^4.' 
United States may be issued under the Second Liberty Bond Act, as 
amended, are hereby extended to authorize the issuance at par of 
public-debt obligations for purchase by the Trust Fund. 
Such 
obligations issued for purchase by the Trust Fund shall have maturi-
ties fixed with due regard for the needs of the Trust Fund and shall 
bear interest at a rate equal to the average market yield (computed 
by the Managing Trustee on the basis of market quotations as of the 
end of the calendar month next preceding the date of such issue) on 
all marketable interest-bearing obligations of the United States then 
forming a part of the public debt which are not due or callable until 
after the expiration of 4 years from the end of such calendar month; 
except that where such average market yield is not a multiple of one-
eighth of 1 per centum, the rate of interest on such obligations shall 
be the multiple of one-eighth of 1 per centum nearest such market 
yield. 
The Managing Trustee may purchase other interest-bearing 
obligations of the United States or obligations guaranteed as to both 
principal and interest by the United States, on original issue or at the 
market price, only where he determines that the purchase of such 
other obligations is in the public interest. 
"(d) Any obligations acquired by the Trust Fund (except public-
debt obligations issued exclusively to the Trust Fund) may be sold by 
the Managing Trustee at the market price, and such public-debt 
obligations may be redeemed at par plus accrued interest. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
301 
"(e) The interest on, and the proceeds from the sale or redemption 
of, any obligations held in the Trust Fund shall be credited to and 
form a part of the Trust Fund. 
"(f)(1) The Managing Trustee is directed to pay from time to 
time from the Trust Fund into the Treasury the amount estimated 
by him as taxes imposed under section 3101(b) which are subject to 
^°®'' P- •^^^• 
refund under section 6413(c) of the Internal Eevenue Code of 1954 
^°«'' P- ^^3. 
with respect to wages paid after December 31, 1965. Such taxes shall 
be determined on the basis of the records of wages established and 
maintained by the Secretary of Health, Education, and Welfare in 
accordance with the wages reported to the Secretary of the Treasury 
or his delegate pursuant to subtitle F of the Internal Eevenue Code 
^6 use eoo i et 
of 1954, and the Secretary of Health, Education, and Welfare shall ^^'^' 
furnish the Managing Trustee such information as may be required 
by the Managing Trustee for such purpose. 
The payments by the 
Managing Trustee shall be covered into the Treasury as repayments 
to the account for refunding internal revenue collections. 
"(2) Repayments made under paragraph (1) shall not be available 
for expenditures but shall be carried to the surplus fund of the 
Treasury. If it subsequently appears that the estimates under such 
paragraph in any particular period were too hi^h or too low, appro-
priate adjustments shall be made by the Managing Trustee in future 
payments. 
"(g) There shall be transferred periodically (but not less often 
than once each fiscal year) to the Trust Fund from the Federal 
Old-Age and Survivors Insurance Trust Fund and from the Federal 
Disability Insurance Trust Fund amounts equivalent to the amounts 
not previously so transferred which the Secretary of Health, Educa-
tion, and Welfare shall have certified as overpayments (other than 
amounts so certified to the Railroad Retirement Board) pursuant 
to section 1870(b) of this Act. 
There shall be transferred periodi- 
Post, p. 331. 
cally (but not less often than once each fiscal year) to the Trust 
Fund from the Railroad Retirement Account amounts equivalent 
to the amounts not previously so transferred which the Secretary of 
Health, Education, and Welfare shall have certified as overpayments 
to the Railroad Retirement Board pursuant to section 1870(b) of 
this Act. 
"(h) The Managing Trustee shall also pay from time to time 
from the Trust Fund such amounts as the Secretary of Health, Edu-
cation, and Welfare certifies are necessary to make the payments 
provided for by this part, and the payments with respect to admin-
istrative expenses in accordance with section 201 (g) (1). 
^°^^' P« -'38. 
"PART B—SUPPLEMENTARY MEDICAL INSURANCE BENEFITS FOR THE 
AGED 
"ESTABLISHMENT OF SUPPLEMENTARY MEDICAL INSURANCE PROGRAM FOR 
THE AGED 
"SEC. 1831. There is hereby established a voluntary insurance pro-
gram to provide medical insurance benefits in accordance with the 
provisions of this part for individuals 65 years of age or over who 
elect to enroll under such program, to be financed from premium 
payments by enrollees together with contributions from funds ap-
propriated by the Federal Government. 
002 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"SCOPE OF BENEFITS 
"SEC. 1832. (a) The benefits provided to an individual by the in-
surance program established by this part shall consist of— 
"(1) entitlement to have payment made to him or on his 
behalf (subject to the provisions of this part) for medical and 
other health services, except those described in paragraph (2) 
(B);and 
"(2) entitlement to have payment made on his behalf (sub-
ject to the provisions of this part) for— 
"(A) home health services for up to 100 visits during a 
calendar year; and 
"(B) medical and other health services (other than physi-
cians' services unless furnished by a resident or intern of a 
hospital) furnished by a provider of services or by others 
under arrangements with them made by a provider of 
services. 
"(b) For definitions of 'spell of illness', 'medical and other health 
services', and other terms used in this part, see section 1861. 
Post, p. 313. 
il PAYMENT OF BENEFITS 
"SEC. 1833. (a) Subject to the succeeding provisions of this sec-
tion, there shall be paid from the Federal Supplementary Medical 
Post, p. 308. 
Insurance Trust Fund, in the case of each individual who is covered 
under the insurance program established by this part and incurs 
expenses for services with respect to which benefits are payable under 
this part, amounts equal to— 
"(1) in the case of services described in section 1832(a) (1)— 
80 percent of the reasonable cliarges for the services; except that 
an organization which provides medical and other health services 
(or arranges for their availability) on a prepayment basis may 
elect to be paid 80 percent of the reasonable cost of services for 
which payment may be made under this part on behalf of indi-
viduals enrolled in such organization in lieu of 80 percent of the 
reasonable charges for such services if the organization under-
takes to charge such individuals no more than 20 percent of such 
reasonable cost plus any amounts payable by them as a result of 
subsection (b); and 
"(2) in the case of services described in section 1832(a) (2)— 
80 percent of the reasonable cost of the services (as determined 
Post, p. 322. 
yjjder section 1861 (v)). 
Deductible pro- 
"(j^) Before applying subsection (a) with respect to expenses 
^*°"" 
incurred by an individual during any calendar year, the total amount 
of the expenses incurred by such individual during such year (which 
would, except for this subsection, constitute incurred expenses from 
which benefits payable under subsection (a) are determinable) shall 
be reduced by a deductible of $50; except that (1) the amount of the 
deductible for such calendar year as so determined shall first be reduced 
by the amount of any expenses incurred by such individual in the last 
three months of the preceding calendar year (or regarded under clause 
(2) as incurred in such preceding year with respect to services fur-
nished in such last three months) and applied toward such individual's 
deductible under this section for such preceding year, and (2) the 
Ante, p. 2
9 2. 
amount of any deduction imposed under section 1813(a) (2) (A) with 
Mental dis-
orders. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
303 
respect to outpatient hospital diagnostic services furnished in any 
calendar year shall be regarded as an incurred expense under this part 
for such year. 
"(c) Notwithstanding any other provision of this part, with respect 
to expenses incurred in any calendar year in connection with the treat-
ment of mental, psychoneurotic, and personality disorders of an indi-
vidual who is not an inpatient of a hospital at the time such expenses 
are incurred, there shall be considered as incurred expenses for pur-
poses of subsections (a) and (b) only whichever of the following 
amounts is the smaller: 
"(1) $312.50, or 
" (2) 621/^ percent of such expenses. 
"(d) No payment may be made under this part with respect to 
any services furnished an individual to the extent that such individual 
is entitled (or would be entitled except for section 1813 other than 
^"**' P- '
^
9 2. 
subsection (a)(2)(A) thereof) to have payment made with respect to 
such services under part A. 
"(e) No payment shall be made to any provider of services or other 
person under this part unless there has been furnished such informa-
tion as may be necessary in order to determine the amounts due such 
provider or other person under this part for the period with respect 
to which the amounts are being paid or for any prior period. 
a LIMITATION ON HOME H E A L T H SERVICES 
"SEC. 1834. (a) Payment under this part may be made for home 
health services furnished an individual during any calendar year only 
for 100 visits during such year. The number of visits to be charged for 
purposes of the limitation in the preceding sentence, in connection 
with items and services described in section 1861 (m), shall be deter- 
^°^^' P- 3^9. 
mined in accordance with regulations. 
"(b) For purposes of subsection (a), home health services shall 
be taken into account only if payment under this part is or would be, 
except for this section or the failure to comply with the request and 
certification requirements of or under section 1835(a), made with 
respect to such services. 
" P R O C E D U R E F O R PAYMENT OF CLAIMS OF PROVIDERS OF SERVICES 
"SEC. 1835. (a) Paym.ent for services described in section 1832(a) 
(2) furnished an individual may be made only to providers of services 
which are eligible therefor under section 1866(a), and only if— 
"(1) written request, signed b^ such individual except in cases 
in which the Secretary finds it impracticable for the individual 
to do so, is filed for such payment in such form, in such manner, 
within such time, and by such person or persons as the Secretary 
may by regulations prescribe; and 
"(2) a physician certifies (and recertifies, where such services 
are furnished over a period of time, in such cases, with such 
frequency, and accompanied by such supporting material, appro-
priate to the case involved, as may be provided by regulations) 
that— 
"(A) in the case of home health services (i) such services 
are or were required because the individual is or was con-
fined to his home (except when receiving items and services 
referred to in section 1861 (m) (7)) and needed skilled nursing 
care on an intermittent basis, or physical or speech therapy, 
Post, 
p. 327. 
304 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
(ii) a plan for furnishing such services to such individual has 
been established and is periodically reviewed by a physician, 
and (iii) such services are or were furnished while the indi-
vidual is or was under the care of a physician; and 
"(B) in the case of medical and other health services, such 
services are or were medically required. 
To the extent provided by regulations, the certification and recertifica-
tion requirements of paragraph (2) shall be deemed satisfied where, 
at a later date, a phvsician makes a certification of the kind provided 
in subparagraph (A) or (B) of paragraph (2) (whichever would 
have applied), but only w^here such certification is accompanied by 
such medical and other evidence as may be required by such 
regulations. 
"(b) No payment may be made under this part to any Federal 
provider of services or other Federal agency, except a provider of 
services which the Secretary determines is providing services to the 
public generally as a community institution or agency; and no such 
payment may be made to any provider of services or other person for 
any item or service which such provider or person is obligated by a 
law of, or a contract with, the United States to render at pufclic 
expense. 
"ELIGIBLE INDIVIDUALS 
"SEC. 1836. Every individual who— 
" (1) has attained the age of 65, and 
"(2) (A) is a resident of the United States, and is either (i) a 
citizen or (ii) an alien lawfully admitted for permanent residence 
who has resided in the United States continuously during the 5 
years immediately preceding the month in which he applies for 
enrollment under this part, or (B) is entitled to hospital insurance 
benefits under part A, 
is eligible to enroll in the insurance program established by this part. 
"ENROLLMENT PERIODS 
"SEC. 1837. (a) An individual may enroll in the insurance program 
established by this part only in such manner and form as may be 
prescribed by regulations, and only during an enrollment period pre-
scribed in or under this section. 
"(b) (1) No individual may enroll for the first time under this part 
more than 3 years after the close of the first enrollment period during 
which he could have enrolled under this part. 
" (2) An individual whose enrollment under this part has terminated 
may not enroll for the second time under this part unless he does so 
in a general enrollment period (as provided in subsection (e)) which 
begins within 3 years after the effective date of such termination. No 
individual may enroll under this part more than twice. 
"(c) In the case of individuals who first satisfy paragraphs (1) 
and (2) of section 1836 before January 1, 1966, the initial general 
enrollment period shall begin on the first day of the second month 
which begins after the date of enactment of this title and shall end on 
March 31, 1966. For purposes of this subsection and subsection (d), 
an individual who satisfies paragraph (2) of section 1836 solely by 
reason of subparagraph (B) thereof shall be treated as satisfying such 
paragraph (2) on the first day on which he is (or on filing applica-
tion would be) entitled to hospital insurance benefits under part A. 
"(d) In the case of an individual who first satisfies paragraphs (1) 
and (2) of section 1836 on or after January 1,1966, his initial enroll-
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
305 
ment period shall begin on the first day of the third month before the 
month in which he first satisfies such paragraphs and shall end seven 
months later. 
"(e) There shall be a general enrollment period, after the period 
described in subsection (c), during the period beginning on October 
1 and ending on December 31 of each odd-numbered year beginning 
with 1967. 
"COVERAGE PERIOD 
"SEC. 1838. (a) The period during which an individual is entitled to 
benefits under the insurance program established hj this part (herein-
after referred to as his 'coverage period') shall begin on whichever of 
the following is the latest: 
"(1) July 1,1966; or 
"(2) (A) in the case of an individual who enrolls pursuant to 
subsection (d) of section 1837 before the month in which he first 
satisfies paragraphs (1) and (2) of section 1836, the first day of 
such month, or 
"(B) in the case of an individual who enrolls pursuant to such 
subsection (d) in the month in which he first satisfies such para-
graphs, the first day of the month following the month in which 
he so enrolls, or 
"(C) in the case of an individual who enrolls pursuant to such 
subsection (d) in the month following the month in which he first 
satisfies such paragraphs, the first day of the second month follow-
ing the month in which he so enrolls, or 
"(D) in the case of an individual who enrolls pursuant to such 
subsection (d) more than one month following the month in which 
he satisfies such paragraphs, the first day of the third month fol-
lowing the month in which he so enrolls, or 
"(E) in the case of an individual who enrolls pursuant to sub-
section (e) of section 1837, the July 1 following the month in 
which he so enrolls. 
" (b) An individual's coverage period shall continue until his enroll-
ment has been terminated— 
"(1) by the filing of notice, during a general enrollment 
period described in section 1837(e), that the individual no longer 
wishes to participate in the insurance program estsiblished by this 
part, or 
"(2) for nonpayment of premiums. 
The termination of a coverage period under paragraph (1) shall 
take effect at the close of December 31 of the year in which the notice 
is filed. The termination of a coverage period under paragraph (2) 
shall take effect on a date determined under regulations, which may 
be determined so as to provide a grace period (not in excess of 90 
days) in which overdue premiums may be paid and coverage 
continued. 
"(c) No payments may be made under this part with respect to 
the expenses of an individual unless such expenses were incurred by 
such individual during a period which, with respect to him, is a cover-
age period. 
"AMOUNTS OF PREMIUMS 
"SEC. 1839. (a) The monthly premium of each individual enrolled 
imder this part for each month before 1968 shall be $3. 
"(b) (1) The monthly premium of each individual enrolled under 
this part for each month after 1967 shall be the amount determined 
under paragraph (2). 
Post, 
p. 308. 
306 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"(2) The Secretary shall, between July 1 and October 1 of 1967 
and of each odd-numbered year thereafter, determine and promulgate 
the dollar amount which shall be applicable for premiums for months 
occurring in either of the two succeeding calendar years. Such dollar 
amount snail be such amount as the Secretary estimates to be necessary 
so that the aggregate premiums for such two succeeding calendar years 
will equal one-half of the total of the benefits and admmistrative costs 
which he estimates will be payable from the Federal Supplementary 
Medical Insurance Trust Fund for such two succeeding calendar years. 
In estimating aggregate benefits payable for any period, the Secretary 
shall include an appropriate amount for a contingency margin. 
"(c) In the case of an individual whose coverage period began 
pursuant to an enrollment after his initial enrollment period (deter-
mined pursuant to subsection (c) or (d) of section 1837), the monthly 
premium determined under subsection (b) shall be increased by 10 
percent of the monthly premium so determined for each full 12 months 
m which he could have been but was not enrolled. For purposes of 
the preceding sentence, there shall be taken into account (1) the 
months which elapsed between the close of his initial enrollment 
period and the close of the enrollment period in which he enrolled, 
plus (in the case of an individual who enrolls for a second time) (2) 
the months which elapsed between the date of the termination of his 
first coverage period and the close of the enrollment period in which 
he enrolled for the second time. 
"(d) If any monthly premium determined under the foregoing 
provisions of this section is not a multiple of 10 cents, such premium 
shall be rounded to the nearest multiple of 10 cents. 
( ' T 
PAYMENT OF PREMIUMS 
"SEC. 1840. (a) (1) In the case of an individual who is entitled to 
42 u*sc 4
0
^
2 ^
* 
monthly benefits under section 202, his monthly premiums under 
this part shall (except as provided in subsection (d)) be collected by 
deducting the amount thereof from the amount of such monthly bene-
fits. 
Such deduction shall be made in such manner and at such times 
as the Secretary shall by regulation prescribe. 
" (2) The Secretary of the Treasury shall, from time to time, trans-
70 Stat. 819. 
fer from the Federal Old-Age and Survivors Insurance Trust Fund 
^^ 
"^ ' 
or the Federal Disability Insurance Trust Fund to the Federal Sup-
Post. p. 308. 
plementary Medical Insurance Trust Fund the aggregate amount 
deducted under paragraph (1) for the period to which such transfer 
relates from benefits under section 202 which are payable from such 
Trust Fund. 
Such transfer shall be made on the basis of a certification 
by the Secretary of Health, Education, and Welfare and shall be 
appropriately adjusted to the extent that prior transfers were too great 
or too small. 
milt^Acrl^u"'*' 
"(^) (1) I^ ^^^ ^^'^^ ^f ^^ individual who is entitled to receive for 
^n"s. "
" ^"""^" 
g
^ month an annuity or pension under the Railroad Retirement Act of 
P°^*' pp- 335. 
1937, his monthly premiums under this part shall (except as provided 
in subsection (d)) be collected by deducting the amount thereof from 
such annuity or pension. Such deduction shall be made in such man-
ner and at such times as the Secretary shall by regulations prescribe. 
Such regulations shall be prescribed only after consultation with the 
Railroad Retirement Board. 
"(2) The Secretary of the Treasury shall, from time to time, trans-
45 use 228o. 
|QJ. ffQjn the Railroad Retirement Account to the Federal Supple-
mentary Medical Insurance Trust Fund the aggregate amount 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
307 
deducted under paragraph (1) for the period to which such transfer 
relates. 
Such transfers shall be made on the basis of a certification 
by the Kailroad Eetirement Board and shall be appropriately ad-
justed to the extent that prior transfers were too great or too small. 
"(c) In the case of an individual who is entitled both to monthly 
benefits under section 202 and to an annuity or pension under the 
^2 use 402. 
Railroad Retirement Act of 1937 at the time he enrolls under this part, 34^°4QO^''' ^^^' 
subsection (a) shall apply so long as he continues to be entitled both 
to such benefits and such annuity or pension. 
In the case of an in-
dividual who becomes entitled both to such benefits and such an 
annuity or pension after he enrolls under this part, subsection (a) 
shall apply if the first month for which he was entitled to such benefits 
was the same as or earlier than the first month for which he was en-
titled to such annuity or pension, and otherwise subsection (b) shall 
"(d) If an individual to whom subsection (a) or (b) applies esti-
mates that the amount which will be available for deduction under 
such subsection for any premium payment period will be less than the 
amount of the monthly premiums for such period, he may (under 
regulations) pay to the Secretary such portion of the monthly pre 
miums for such period as he desires. 
" (e) (1) In the case of an individual receiving an annuity under the R^lfiJnenrAcT 
Civil Service Retirement Act, or other Act administered by the Civil annuitants. 
Service Commission providing retirement or survivorship protection, 
l^i^sc^l^i' 
to whom neither subsection (a) nor subsection (b) applies, his monthly note. 
premiums under this part (and the monthly premiums of the spouse 
of such individual under this part if neither subsection (a) nor sub-
section (b) applies to such spouse and if such individual agrees) shall, 
upon notice from the Secretary of Health, Education, and Welfare to 
the Civil Service Commission, be collected by deducting the amount 
thereof from each installment of such annuity. 
Such deduction shall 
be made in such manner and at such times as the Civil Service Com-
mission may determine. 
The Civil Service Commission shall furnish 
such information as the Secretary of Health, Education, and Welfare 
may reasonably request in order to carry out his functions under this 
part with respect to individuals to whom this subsection applies. 
"(2) The Secretary of the Treasury shall, from time to time, but 
not less often than quarterly, transfer from the Civil Service Retire-
ment and Disability Fund, or the account (if any) applicable in the 
case of such other Act administered by the Civil Service Commission, 
to the Federal Supplementary Medical Insurance Trust Fund the 
aggregate amount deducted under paragraph (1) for the period to 
which such transfer relates. 
Such transfer shall be made on the basis 
of a certification by the Civil Service Commission and shall be appro-
priately adjusted to the extent that prior transfers were too great or 
too small. 
"(f) In the case of an individual who participates in the insurance 
program established by this part but with respect to whom none of the 
preceding provisions of this section applies, or with respect to whom 
subsection (d) applies, the premiums shall be paid to the Secretary at 
such times, and m such manner, as the Secretary shall by regulations 
prescribe. 
"(g) Amounts paid to the Secretary under subsection (d) or (f) 
shall be deposited m the Treasury to the credit of the Federal Supple-
mentary Medical Insurance Trust Fund. 
308 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
Board of 
Trustees. 
Reports to Con-
gress, 
Investment of 
Fund monies. 
40 Stat. 288. 
31 u s e 774. 
"(h) In the case of an individual who participates in the insurance 
program established hj this part, premiums shall be payable for the 
period commencing with the first month of his coverage period and 
ending with the month in which he dies or, if earlier, in which his 
coverage under such program terminates. 
"rEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUND 
"SEC. 1841. (a) There is hereby created on the books of the Treas-
ury of the United States a trust fund to be known as the 'Federal Sup-
plementary Medical Insurance Trust Fund' (hereinafter in this sec-
tion referred to as the 'Trust Fund'). 
The Trust Fund shall consist 
of such amounts as may be deposited in, or appropriated to, such fund 
as provided in this part. 
" (b) With respect to the Trust Fund, there is hereby created a body 
to be known as the Board of Trustees of the Trust Fund (hereinafter 
in this section referred to as the 'Board of Trustees') composed of the 
Secretary of the Treasury the Secretary of Labor, and the Secretary 
of Health, Education, ana Welfare, all ex officio. 
The Secretary of 
the Treasury shall be the Managing Trustee of the Board of Trustees 
(hereinafter in this section referred to as the 'Managing Trustee'). 
The Commissioner of Social Security shall serve as the Secretary of 
the Board of Trustees. 
The Board of Trustees shall meet not less 
frequently than once each calendar year. 
It shall be the duty of the 
Board of Trustees to— 
" (1) Hold the Trust Fund; 
"(2) Report to the Congress not later than the first day of 
March of each year on the operation and status of the Trust Fund 
during the preceding fiscal year and on its expected operation and 
status during the current fiscal year and the next 2 fiscal years; 
"(3) Report immediately to the Congress whenever the Board 
is of the opinion that the amount of the Trust Fund is unduly 
small; and 
"(4) Review the general policies followed in managing the 
Trust Fund, and recommend changes in such policies, including 
necessary changes in the provisions of law which govern the way 
in which the Trust Fund is to be managed. 
The report provided for in paragraph (2) shall include a statement 
of the assets of, and the disbursements made from, the Trust Fund 
during the preceding fiscal year, an estimate of the expected income to, 
and disbursements to be made from, the Trust Fund during the current 
fiscal year and each of the next 2 fiscal years, and a statement of the 
actuarial status of the Trust Fund. 
Such report shall be printed as a 
House document of the session of the Congress to which the report is 
made. 
"(c) It shall be the duty of the Managing Trustee to invest such 
portion of the Trust Fund as is not, in his judgment, required to 
meet current withdrawals. 
Such investments may be made only in 
interest-bearing obligations of the United States or in obligations 
guaranteed as to both principal and interest by the United States. 
For such purpose such obligations may be acquired (1) on original 
issue at the issue price, or (2) by purchase of outstanding obligations 
at the market price. The purposes for which obligations of the 
United States may be issued under the Second Liberty Bond Act, 
as amended, are hereby extended to authorize the issuance at par of 
public-debt obligations for purchase by the Trust Fund. 
Such 
obligations issued for purchase by the Trust Fund shall have matu-
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
309 
rities fixed with due regard for the needs of the Trust Fund 
and shall bear interest at a rate equal to the average market yield 
(computed by the Managing Trustee on the basis of market quota-
tions as of the end of the calendar month next preceding the date 
of such issue) on all marketable interest-bearing obligations of the 
United States then forming a part of the public debt which are not 
due or callable until after the expiration of 4 years from the end 
of such calendar month; except that where such average market yield 
is not a multiple of one-eighth of 1 per centum, the rate of interest 
on such obligations shall be the multiple of one-eighth of 1 per cen-
tum nearest such market yield. 
The Managing Trustee may purchase 
other interest-bearing obligations of the United States or obliga-
tions guaranteed as to both principal and interest by the United States, 
on original issue or at the market price, only where he determines that 
the purchase of such other obligations is in the public interest. 
"(d) Any obligations acquired by the Trust Fund (except public-
debt obligations issued exclusively to the Trust Fund) may be sold 
by the Managing Trustee at the market price, and such public-debt 
obligations may be redeemed at par plus accrued interest. 
"(e) The interest on, and the proceeds from the sale or redemption 
of, any obligations held in the Trust Fund shall be credited to and form 
a part of the Trust Fund. 
"(f) There shall be transferred periodically (but not less often than 
once each fiscal year) to the Trust Fund from the Federal Old-Age 
and Survivors Insurance Trust Fund and from the Federal Disability 
Insurance Trust Fund amounts equivalent to the amounts not pre-
viously so transferred which the Secretary of Health, Education, and 
Welfare shall have certified as overpayments (other than amounts 
so certified to the Railroad Retirement Board) pursuant to section 
1870(b) of this Act. 
There shall be transferred periodically (but 
^°®'' P- •'3^-
not less often than once each fiscal year) to the Trust Fund from the 
Railroad Retirement Account amounts equivalent to the amounts not 
previously so transferred which the Secretary of Health, Education, 
and Welfare shall have certified as overpayments to the Railroad 
Retirement Board pursuant to section 1870(b) of this Act. 
"(g) The Managing Trustee shall pay from time to time from the 
Trust Fund such amounts as the Secretary of Health, Education, and 
Welfare certifies are necessary to make the payments provided for by 
this part, and the payments with respect to administrative expenses in 
accordance with section 201(g) (1). 
"(h) The Managing Trustee shall pay from time to time from the 
Trust Fund such amounts as the Secretary of Health, Education, and 
Welfare certifies are necessary to pay the costs incurred by the Civil 
Service Commission in making deductions pursuant to section 1840 (e). 
During each fiscal year, or after the close of such fiscal year, the Civil 
Service Commission shall certify to the Secretary the amount of the 
costs it incurred in making such deductions, and such certified amount 
shall be the basis for the amount of such costs certified by the Secretary 
to the Managing Trustee. 
"USE OF CARRIERS FOR ADMINISTRATION OF BENEFITS 
"SEC, 1842. (a) In order to provide for the administration of the 
benefits under this part with maximum efficiency and convenience for 
individuals entitled to benefits under this part and for providers of 
services and other persons furnishing services to such individuals, and 
with a view to furthering coordination of the administration of the 
Post, 
p. 338. 
310 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
Ante, p. 297. 
Post. p. 318. 
Contracts with 
carriers. 
41 u s e 5. 
Post, p. 322. 
benefits under part A and under this part, the Secretary is authorized 
to enter into contracts with carriers, including carriers with which 
agreements under section 1816 are in effect, which will perform some 
or all of the following functions (or, to the extent provided in such 
contracts, will secure performance thereof by other organizations); 
and, with respect to any of the following functions which involve pay-
ments for physicians' services, the Secretary shall to the extent possible 
enter into such contracts: 
" (1) (A) make determinations of the rates and amounts of pay-
ments required pursuant to this part to be made to providers of 
services and other persons on a reasonable cost or reasonable 
charge basis (as may oe applicable); 
"(B) receive, disburse, and account for funds in making such 
payments; and 
"(C) make such audits of the records of providers of services 
as may be necessary to assure that proper payments are made 
under this part; 
"(2) (A) determine compliance with the requirements of sec-
tion 1861 (k) as to utilization review; and 
"(B) assist providers of services and other persons who fur-
nish services for which payment may be made under this part in 
the development of procedures relating to utilization practices, 
make studies of the effectiveness of such procedures and methods 
for their improvement, assist in the application of safeguards 
against unnecessary utilization of services furnished by providers 
of services and other persons to individuals entitled to benefits 
under this part, and provide procedures for and assist in arrang-
ing, where necessary, the establishment of groups outside hos-
pitals (meeting the requirements of section 1861 (k) (2)) to make 
reviews of utilization; 
"(3) serve as a channel of communication of information re-
lating to the administration of this part; and 
" (4) otherwise assist, in such manner as the contract may pro-
vide, in discharging administrative duties necessary to carry out 
the purposes of this part. 
"(b) (1) Contracts with carriers under subsection (a) may be en-
tered into without regard to section 3709 of the Eevised Statutes or 
any other provision of law requiring competitive bidding. 
"(2) No such contract shall be entered into with any carrier unless 
the Secretary finds that such carrier will perform its obligations under 
the contract efficiently and effectively and will meet such requirements 
as to financial responsibility, legal authority, and other matters as he 
finds pertinent. 
"(3) Each such contract shall provide that the carrier— 
"(A) will take such action as may be necessary to assure that, 
where payment under this part for a service is on a cost basis, the 
cost is reasonable cost (as''determined under section 1861(v)); 
"(B) will take such action as may be necessary to assure that, 
where payment under this part for a service is on a charge basis, 
(i) such charge will be reasonable and not higher than the charge 
applicable, for a comparable service and under comparable cir-
cumstances, to the policyholders and subscribers of the carrier, and 
(ii) such payment will be made on the basis of a receipted bill, or 
on the basis of an assignment under the terms of which the reason-
able charge is the full charge for the service; 
"(C) will establish and maintain procedures pursuant to which 
an individual enrolled under this part will be granted an oppor-
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
311 
tunity for a fair hearing by the carrier when requests for pay-
ment under this part with respect to services furnished him are 
denied or are not acted upon with reasonable promptness or when 
the amount of such payment is in controversy; 
"(D) will furnish to the Secretary such timely information 
and reports as he may find necessary in performing his functions 
under this part; and 
"(E) will maintain such records and afford such access thereto 
as the Secretary finds necessary to assure the correctness and 
verification of the information and reports under subparagraph 
(D) and otherwise to carry out the purposes of this part; 
and shall contain such other terms and conditions not inconsistent 
with this section as the Secretary may find necessary or appropriate. 
In determining the reasonable charge for services for purposes of this 
paragraph, there shall be taken into consideration the customary 
charges for similar services generally made by the physician or other 
person furnishing such services, as well as the prevailing charges in 
the locality for similar services. 
"(4) Each contract under this section shall be for a term of at least 
one year, and may be made automatically renewable from term to term 
in the absence oi notice by either party of intention to terminate at 
the end of the current term; except that the Secretary may terminate 
any such contract at any time (after such reasonable notice and oppor-
tunity for hearing to the carrier involved as he may provide in regula-
tions) if he finds that the carrier has failed substantially to carry out 
the contract or is carrying out the contract in a manner inconsistent 
with the efficient and effective administration of the insurance program 
established by this part. 
"(c) Any contract entered into with a carrier under this section shall 
provide for advances of funds to the carrier for the making of pay-
ments by it under this part, and shall provide for payment of the cost 
of administration of the carrier, as determined by the Secretary to be 
necessary and proper for carrying out the functions covered by the 
contract. 
"(d) Any contract with a carrier under this section may require 
such carrier or any of its officers or employees certifying payments or 
disbursing funds pursuant to the contract, or otherwise participating 
in carrying out the contract, to give surety bond to the United States 
in such amount as the Secretary may deem appropriate. 
" (e) (1) No individual designated pursuant to a contract under this 
section as a certifying officer shall, in the absence of gross negligence 
or intent to defraud the United States, be liable with respect to any 
payments certified by him under this section. 
"(2) No disbursing officer shall, in the absence of gross negligence 
or intent to defraud the United States, be liable with respect to any 
payment by him under this section if it was based upon a voucher 
signed by a certifying officer designated as provided in paragraph (1) 
of this subsection. 
"(3) No such carrier shall be liable to the United States for any 
payments referred to in paragraph (1) or (2). 
"(f) For purposes of this part, the term 'carrier' means— 
"Carrier." 
"(1) with respect to providers of services and other persons, 
a voluntary association, corporation, partnership, or other non-
governmental organization which is lawfully engaged in provid-
ing, paying for, or reimbursing the cost of, health services under 
group insurance policies or contracts, medical or hospital service 
agreements, membership or subscription contracts, or similar 
312 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
group arrangements, in consideration of premiums or other 
periodic charges payable to the carrier, including a health benefits 
plan duly sponsored or underwritten by an employee organiza-
tion; and 
"(2) with respect to providers of services only, any agency or 
organization (not described in paragraph (1)) with which an 
Ante, p. 2
9 7. 
agreement is in effect under section 1816. 
(( 
42 use 401. 
STATE AGREEMENTS FOR COVERAGE OF ELIGIBLE INDIVIDUALS 
WHO 
ARE 
RECEIVING 
MONEY 
PAYMENTS 
UNDER 
PUBLIC 
ASSISTANCE 
PROGRAMS 
"SEC. 1843. (a) The Secretary shall, at the request of a State made 
before January 1,1968, enter into an agreement with such State pur-
suant to which all eligible individuals in either of the coverage groups 
described in subsection (b) (as specified in the agreement) will be 
enrolled under the program established by this part. 
"(b) An agreement entered into with any State pursuant to sub-
section (a) may be applicable to either oi the following coverage 
groups: 
"(1) individuals receiving money payments under the plan of 
such State approved under title I or title X V I ; or 
"(2) individuals receiving money payments under all of the 
plans of such State approved under titles I, IV, X, XIV, and 
42 use 30 1, 60 1, 
X V I • 
except that there shall be excluded from any coverage group any 
individual who is entitled to monthly insurance benefits under title I I 
or who is entitled to receive an annuity or pension under the Railroad 
340° 400^^* ^^^' 
I^tirement Act of 1937. 
"(c) For purposes of this section, an individual shall be treated 
as an eligible individual only if he is an eligible individual (within 
Ante, p. 304. 
^j^g meaning of section 1836) on the date an agreement covering him 
is entered into under subsection (a) or he becomes an eligible indi-
vidual (within the meaning of such section) at any time after such 
date and before January 1,1968; and he shall be treated as receiving 
money payments described in subsection (b) if he receives such pay-
ments for the month in which the agreement is entered into or any 
month thereafter before January 1968. 
"(d) In the case of any individual enrolled pursuant to this 
section— 
"(1) the monthly premium to be paid by the State shall be 
determined under section 1839 (without any increase under sub-
section (c) thereof); 
"(2) his coverage period shall begin on whichever of the fol-
lowing is the latest; 
"(A) July 1,1966; 
"(B) the firs " 
the first day of the third month following the month 
in which the State agreement is entered into; 
"(C) the first day of the first month in which he is both an 
eligible individual and a member^f a coverage group specified 
in the agreement under this section; or 
"(D) such date (not later than January 1,1968) as may be 
specified in the agreement; and 
" (3) his coverage period attributable to the agreement with the 
State under this section shall end on the last day of whichever of 
the following first occurs: 
"(A) the month in which he is determined by the State 
agency to have become ineligible for money payments of a 
kind specified in the agreement, or 
79 STAT. ] 
PUBLIC LAW 89-97- JULY 30, 1965 
313 
42 u s e 401. 
"(B) the month preceding the first month for which he 
becomes entitled to monthly benefits under title II or to an 
annuity or pension under the Railroad Retirement Act of 
]^937_ 
Post, pp. 335, 
"(e) Any individual whose coverage period attributable to the 
State agreement is terminated pursuant to subsection (d) (3) shall 
be deemed for purposes of this part (including the continuation of 
his coverage period under this part) to have enrolled under section 
1837 in the mitial general enrollment period provided by section 
^"^^' P- ^°'*-
1837(c). 
"(f) With respect to eligible individuals receiving money pay-
ments under the plan of a State approved under title I, IV, X, XIV, 
or XVI, if the agreement entered into under this section so provides, ^^^ ^^oi ^usi 
the term'carrier'as defined in section 1842(f) also includes the State iss'i. 
agency, specified in such agreement, which administers or supervises 
the administration of the plan of such State approved under title I, 
XVI, or XIX. 
The agreement shall also contain such provisions as 
will facilitate the financial transactions of the State and the carrier 
with respect to deductions, coinsurance, and otherwise, and as will lead 
to economy and efficiency of operation, with respect to individuals 
receiving money payments under plans of the State approved under 
titles I, IV, X, XIV, and XVI. 
"APPROPRIATIONS TO COVER GOVERNMENT CONTRIBUTIONS AND 
CONTINGENCY RESERVE 
"SEC. 1844. (a) There are authorized to be appropriated from time 
to time, out of any moneys in the Treasury not otherwise appropriated, 
to the Federal Supplementary Medical Insurance Trust Fund, a Gov-
ernment contribution equal to the aggregate premiums payable under 
this part. 
"(b) In order to assure prompt payment of benefits provided under 
this part and the administrative expenses thereunder during the early 
months of the program established by this part, and to provide a 
contingency reserve, there is also authorized to be appropriated, out 
of any moneys in the Treasury not otherwise appropriated, to remain 
available through the calendar year 1967 for repayable advances 
(without interest) to the Trust Fund, an amount equal to $18 multi-
plied by the number of individuals (as estimated by the Secretary) 
who could be covered in July 1966 by the insurance program estab-
lished by this part if they had theretofore enrolled under this part. 
"PART C—MISCELLANEOUS PROVISIONS 
"DEFINITIONS OF SERVICES, INSTITUTIONS, ETC. 
"SEC. 1861. For purposes of this title— 
"Spell of Illness 
"(a) 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 inpa-
tient hospital services or extended care services, and (B) which 
occurs in a month for which he is entitled to benefits under part 
A, and 
Ante. p. 291. 
49-850 0-66—23 
314 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"(2) ending with the close of the first period of 60 consecutive 
days thereafter on each of which he is neither an inpatient of a 
hospital nor an inpatient of an extended care facility. 
"Inpatient Hospital Services 
"(b) 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 medical social services as are 
ordinarily furnished by the hospital for the care and treatment of 
inpatients, and such drugs, biologicals, supplies, appliances, and 
equipment, for use in the hospital, as are ordinarily furnished by 
such hospital for the care and treatment of inpatients; and 
"(3) such other diagnostic or therapeutic items or services, 
furnished by the hospital or by others under arrangements with 
them made by the hospital, as are ordinarily furnished to 
inpatients either by such hospital or by others under such arrange-
ments; 
excluding, however— 
"(4) medical or surgical services provided by a physician, resi-
dent, or intern; and 
"(5) the services of a private-duty nurse or other private-duty 
attendant. 
Paragraph (4) shall not apply to services provided in the hospital by 
an intern or a resident-in-training under a teaching program approved 
by the Council on Medical Education of the American Medical Asso-
ciation or, in the case of an osteopathic hospital, approved by the 
Committee on Hospitals of the Bureau of Professional Education of 
the American Osteopathic Association, or, in the case of services in a 
hospital or osteopathic hospital by an intern or resident-in-training 
in the field of dentistry, approved by the Council on Dental Education 
of the American Dental Association. 
"Inpatient Psychiatric Hospital Services 
"(c) The term 'inpatient psychiatric hospital services' means 
inpatient hospital services furnished to an inpatient of a psychiatric 
hospital. 
"Inpatient Tuberculosis Hospital Services 
"(d) The term 'inpatient tuberculosis hospital services' means in-
patient hospital services fumisheid to an inpatient of a tuberculosis 
hospital. 
"Hospital 
Ante, p. 296. 
"(e) The term 'hospital' (except for purposes of section 1814^d), 
subsection (a) (2) of this section, paragraph (7) of this subsection, 
and subsections (i) and (n) of this section) means an institution 
which— 
" (1) is primarily engaged in providing, by or under the super-
vision of physicians, to inpatients (A) diagnostic services and 
therapeutic services for medical diagnosis, treatment, and care of 
injured, disabled, or sick persons, or (B) rehabilitation services 
for the rehabilitation of injured, disabled, or sick persons; 
" (2) maintains clinical records on all patients; 
Ante, 
p. 296. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
315 
" (3) has bylaws in effect with respect to its staff of physicians; 
"(4) has a requirement that every patient must be under the 
care of a physician; 
"(5) provides 24-hour nursing service rendered or supervised 
by a registered professional nurse, and has a licensed practical 
nurse or registered professional nurse on duty at all times; 
"(6) has in effect a hospital utilization review plan which 
meets the requirements of subsection (k); 
"(7) in the case of an institution in any State in which State 
or apjplicable local law provides for the licensing of hospitals, 
(A) is licensed pursuant to such law or (B) is approved, by the 
agency of such State or locality responsible for licensing hos-
pitals, as meeting the standards established for such licensing; 
and 
"(8) meets such other requirements as the Secretary finds 
necessary in the interest of the health and safety of individuals 
who are furnished services in the institution, except that such 
other requirements may not be higher than the comparable 
requirements prescribed for the accreditation of hospitals by the 
Joint Commission on Accreditation of Hospitals (subject to the 
second sentence of section 1863). 
^°^'' P* ^2^-
For purposes of subsection (a) (2), such term includes any institution 
which meets the rec[uirements of paragraph (1) of this subsection. 
For purposes of sections 1814(d) (including determination of whether 
an individual received inpatient hospital services for purposes of such 
section), and subsections (i) and (n) of this section, such term includes 
any institution which meets the requirements of paragraphs (1), (2), 
(3), (4), (5^, and (7) of this subsection. Notwithstanding the pre-
ceding provisions of this subsection, such term shall not, except for 
purposes of subsection (a) (2), include any institution which is pri-
marily for the care and treatment of mental diseases or tuberculosis 
unless it is a tuberculosis hospital (as defined in subsection (g)) or 
unless it is a psychiatric hospital (as defined in subsection (f)). 
The 
term 'hospital' also includes a Christian Science sanatorium operated, 
or listed and certified, by the First Church of Christ, Scientist, Boston, 
Massachusetts, but only with respect to items and services ordinarily 
furnished by such institution to inpatients, and payment may be made 
with respect to services provided by or in such an institution only to 
such extent and under such conditions, limitations, and requirements 
(in addition to or in lieu of the conditions, limitations, and require-
ments otherwise applicable) as may be provided in regulations. For 
provisions deeming certain requirements of this subsection to be met 
in the case of accredited institutions, see section 1865. 
"Psychiatric Hospital 
"(f) The term 'psychiatric hospital' means an institution which— 
"(1) is primarily engaged in providing, by or under tlie super-
vision of a physician, psychiatric services for the diagnosis and 
treatment of mentally ill persons; 
"(2) satisfies the requirements of paragraphs (3) through (8) 
of subsection (e); 
"(3) maintains clinical records on all patients and maintains 
such records as the Secretary finds to be necessary to determine 
the degree and intensity of the treatment provided to individuals 
entitled to hospital insurance benefits under part A; 
316 
PUBUC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"(4) meets such staffing requirements as the Secretary finds 
necessary for the institution to carry out an active program of 
treatment for individuals who are furnished services in the 
institution; and 
" (5) is accredited by the Joint Commission on Accreditation of 
Hospitals. 
In the case of an institution which satisfies paragraphs (1) and (2) of 
the preceding sentence and which contains a distinct part which also 
satisfies paragraphs (3) and (4) of such sentence, such distinct part 
shall be considered to be a 'psychiatric hospital' if the institution is 
accredited by the Joint Commission on Accreditation of Hospitals or 
if such distinct part meets requirements equivalent to such accredita-
tion requirements as determined by the Secretary. 
"Tuberculosis Hospital 
" (g) The term 'tuberculosis hospital' means an institution which— 
" (1) is primarily engaged in providing, by or under the super-
vision of a physician, medical services for the diagnosis and treat-
ment of tuoerculosis; 
"(2) satisfies the requirements of paragraphs (3) through (8) 
of .subsection (e); 
"(3) maintains clinical records on all patients and maintains 
such records as the Secretary finds to be necessary to determine the 
degree and intensity of the treatment provided to individuals 
covered by the insurance program established by part A; 
"(4) meets such staffing requirements as the Secretary finds 
necessary for the institution to carry out an active program of 
treatment for individuals who are furnished services in the insti-
tution; and 
" (5) is accredited by the Joint Commission on Accreditation of 
Hospitals. 
In the case of an institution which satisfies paragraphs (1) and (2) 
of the preceding sentence and which contains a distinct part which also 
satisfies paragraphs (3) and (4) of such sentence, such distinct part 
shall be considered to be a, 'tuberculosis hospital' if the institution is 
accredited by the Joint Commission on Accreditation of Hospitals or 
if such distinct part meets requirements equivalent to such accredita-
tion requirements as determined by the Secretary. 
"Extended Care Services 
"(h) The term 'extended care services' means the following items 
and services furnished to an inpatient of an extended care facility 
and (except as provided in paragraphs (3) and (6)) by such extended 
care facility— 
"(1) nursing care provided by or under the supervision of a 
registered professional nurse; 
"(2) bed and board in connection with the furnishing of such 
nursing care; 
"(3) physical, occupational, or speech therapy furnished by the 
extended care facility or by others under arrangements with them 
made by the f 
acility^; 
"(4) medical social services; 
"(5) such drugs, biologicals, supplies, appliances, and equip-
ment, furnished tor use in the extended care facility, as are ordi-
nariljj/^ furnished by such facility for the care and treatment of 
inpatients; 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
317 
" (6) medical services provided by an intern or resident-in-train-
ing of a hospital with which the facility has in effect a transfer 
agreement (meeting the requirements of subsection (1)), under a 
teaching program of such hospital approved as provided in the 
last sentence of subsection (b), and other diagnostic or therapeutic 
services provided by a hospital with which the facility has such an 
agreement in effect; and 
"(7) such other services necessary to the health of the patients 
as are generally provided by extended care facilities; 
excluding, however, any item or service if it would not be included 
under subsection (b) if furnished to an inpatient of a hospital. 
"Post-Hospital Extended Care Services 
"(i) The term 'post-hospital extended care services' means extended 
care services furnished an individual after transfer from a hospital 
ui which he was an inpatient for not less than 3 consecutive days before 
his discharge from the hospital in connection with such transfer. 
For 
purposes of the preceding sentence, items and services shall be deemed 
to have been furnished to an individual after transfer from a hospital, 
and he shall be deemed to have been an inpatient in the hospital 
immediately before transfer therefrom, if ne is admitted to the 
extended care facility within 14 days after discharge from such hos-
pital ; and an individual shall be deemed not to have been discharged 
from an extended care facility if, within 14 days after discharge there-
from, he is admitted to such facility or any other extended care facility. 
"Extended Care Facility 
"(j) The term 'extended care facility' means (except for purposes 
of subsection (a) (2)) an institution (or a distinct part of an institu-
tion) which has in effect a transfer agreement (meeting the require-
ments of subsection (1)) with one or more hospitals having agreements 
in effect under section 1866 and which— 
^°®'' P- ^'^'^• 
"(1) is primarily engaged in providing to inpatients (A) 
skilled nursing care and related services for patients who require 
medical or nursing care, or (B) rehabilitation services for the 
rehabilitation of injured, disabled, or sick persons; 
"(2) has policies, which are developed with the advice of (and 
with provision of review of such policies from time to time by) a 
group of professional personnel, including one or more physicians 
and one or more registered professional nurses, to govern the 
skilled nursing care and related medical or other services it 
provides; 
"(3) has a physician, a registered professional nurse, or a 
medical staff responsible for the execution of such policies; 
" (4) (A) has a requirement that the health care of every patient 
must be under the supervision of a phj^sician, and (B) provides 
for having a. physician available to furnish necessary medical c«,re 
in case of emergency; 
"(5) maintains clinical records on all patients; 
"(6) provides 24-hour nursing service which is sufficient to 
meet nursing needs in accordance with the policies developed as 
provided in paragraph (2), and has at least one registered pro-
fessional nurse employed full time; 
"(7) provides appropriate methods and procedures for the 
dispensing and administering of drugs and biologicals; 
318 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"(8) has in effect a utilization review plan which meets the 
reqjiirements of subsection (k); 
"(9) in the case of an institution in any State in which State 
or applicable local law provides for the licensing of institutions of 
this nature, (A) is licensed pursuant to such law, or (B) is 
approved, by the agency of such State or locality responsible for 
licensing institutions of this nature, as meeting the standards 
established for such licensing; and 
"(10) meets such other conditions relating to the health and 
safety of individuals who are furnished services in such institution 
or relating to the physical facilities thereof as the Secretary may 
find necessary (subject to the second sentence of section 1863); 
except that such term shall not (other than for purposes of subsection 
(a) (2)) include any institution which is primarily for the care and 
treatment of mental diseases or tuberculosis. For purposes of subsec-
tion (a)(2), such term includes any institution which meets the 
requirements of paragraph (1) of this subsection. The term 'extended 
care facility' also includes an institution described in paragraph (1) of 
subsection (y), to the extent and subject to the limitations provided 
in such subsection. 
"Utilization Review 
" (k) A utilization review plan of a hospital or extended care facility 
shall be considered sufficient if it is applicable to services furnished by 
the institution to individuals entitled to insurance benefits under this 
title and if it provides— 
"(1) for the review, on a sample or other basis, of admissions 
to the institution, the duration of stays therein, and the profes-
sional services (including drugs and biologicals) furnished, (A) 
with respect to the medical necessity of the services, and (B) for 
the purpose of promoting the most efficient use of available health 
facilities and services; 
" (2) for such review to be made by either (A) a staff committee 
of the institution composed of two or more physicians, with or 
without participation of other professional personnel, or (B) a 
group outside the institution which is similarly composed and (i) 
which is established by the local medical society and some or all of 
the hospitals and extended care facilities in the locality, or (ii) if 
(and for as long as) there has not been established such a group 
which serves such institution, which is established in such other 
manner as may be approved by the Secretary; 
" (3) for such review, in each case of inpatient hospital services 
or extended care services furnished to such an individual during a 
continuous period of extended duration, as of such days of such 
period (which may differ for different classes of cases) as may be 
specified in regulations, with such review to be made as promptly 
as possible, after each day so specified, and in no event later than 
one week following such day; and 
"(4) for prompt notification to the institution, the individual, 
and his attending physician of any finding (made after oppor-
tunity for consultation to such attending physician) by the physi-
cian members of such committee or group that any further stay 
in the institution is not medically necessary. 
The review committee must be composed as provided in clause (B) of 
paragraph (2) rather than as provided in clause (A) of such para,-
graph in the case of any hospital or extended care facility where, 
because of the small size of the institution, or (in the case of an 
Post, p. 326. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
319 
extended care facility) because of lack of an organized medical staff, 
or for such other reason or reasons as may be included in regulations, 
it is impracticable for the institution to have a properly functioning 
staff conmiittee for the purposes of this subsection. 
"Agreements for Transfer Between Extended Care Facilities and 
Hospitals 
"(1) A hospital and an extended care facility shall be considered 
to have a transfer agreement in effect if, by reason of a written agree-
ment between them or (in case the two institutions are under common 
control) by reason of a written undertaking by the person or body 
which controls them, there is reasonable assurance that— 
"(1) transfer of patients will be effected between the hospital 
and the extended care facility whenever such transfer is medically 
appropriate as determined by the attending physician; and 
"(2) there will be interchange of medical and other informa-
tion necessary or useful in the care and treatment of individuals 
transferred between the institutions, or in determining whether 
such individuals can be adequately cared for otherwise than in 
either of such institutions. 
Any extended care facility which does not have such an agreement in 
effect, but which is found by a State agency (of the State in which 
such facility is situated) with which an agreement under section 1864 
is in effect (or, in the case of a State in which no such agency has an 
agreement under section 1864, by the Secretary) to have attempted 
in good faith to enter into such an agreement with a hospital suffi-
ciently close to the facility to make feasible the transfer between them 
of patients and the information referred to in paragraph (2), shall be 
considered to have such an agreement in effect if and for so long as 
such agency (or the Secretary, as the case may be) finds that to do so 
is in the public interest and essential to assuring extended care services 
for persons in the community who are eligible for payments with 
respect to such services under this title. 
"Home Health Services 
"(m) The term 'home health services' means the following items 
and services furnished to an individual, who is under the care of a 
physician, by a home health agency or by others under arrangements 
with them made by such agency, under a plan (for furnishing such 
items and services to such individual) established and periodically 
reviewed by a physician, which items and services are, except as pro-
vided in paragraph (7), provided on a visiting basis in a place of 
residence used as such individual's home— 
"(1) part-time or intermittent nursing care provided by or 
under the supervision of a registered professional nurse; 
"(2) physical, occupational, or speech therapy; 
" (3) medical social services under the direction of a physician; 
"(4) to the extent permitted in regulations, part-time or inter-
mittent services of a home health aide; 
"(5) medical supplies (other than drugs and biologicals), and 
the use of medical appliances, while under such a plan; 
"(6) in the case of a home health agency which is affiliated 
or under common control with a hospital, medical services pro-
vided b j an intern or resident-in-training of such hospital, under 
a teachmg program of such hospital approved as provided in the 
last sentence of subsection (b) ; and 
320 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"(7) any of the foregoing items and services which are pro-
vided on an outpatient basis, under arrangements made by the 
home health agency, at a hospital or extended care facility, or at a 
rehabilitation center which meets such standards as may be pre-
scribed in regulations, and— 
"(A) the furnishing of which involves the use of equip-
ment of such a nature that the items and services cannot 
readily be made available to the individual in such place of 
residence, or 
"(B^ which are furnished at such facility while he is there 
to receive any such item or service described in clause (A), 
but not including transportation of the individual in connection 
with any such item or service; 
excluding, however, any item or service if it would not be included 
under subsection (b) if furnished to an inpatient of a hospital, 
"Post-Hospital Home Health Services 
"(n) The term 'post-hospital home health services' means home 
health services furnished an individual within one year after his most 
recent discharge from a hospital of which he was an inpatient for not 
less than 3 consecutive days or (if later) within one year after his most 
recent discharge from an extended care facility oi which he was an 
inpatient entitled to payment under part A for post-hospital extended 
care services, but only if the plan covering the home health services 
(as described in subsection (m)) is established within 14 days after 
his discharge from such hospital or extended care facility. 
"Home Health Agency 
"(o) The term 'home health agency' means a public agency or 
])rivate organization, or a subdivision of such an agency or orga-
nization, which— 
"(1) is primarily engaged in providing skilled nursing services 
and other therapeutic services; 
"(2) has policies, established by a group of professional per-
sonnel (associated with the agency or organization), including 
one or more physicians and one or more registered professional 
nurses, to govern the services (referred to in paragraph (1)) 
which it provides, and provides for supervision of such services by 
a physician or registered professional nurse; 
"(3) maintains clinical records on all patients; 
"(4) in the case of an agency or organization in any State in 
which State or applicable local law provides for the licensing of 
agencies or organizations of this nature, (A) is licensed pursuant 
to such law, or (B) is approved, by the agency of such State or 
locality responsible for licensing agencies or organizations of this 
nature, as meeting the standards established for such licensing; 
and 
• 
"(5) meets such other conditions of participation as the Secre-
tary may find necessary in the interest of the health and safety 
of individuals who are furnished services by such agency or or-
ganization; 
except that such term shall not include a private organization which 
is not a nonprofit organization exempt from Federal income taxation 
26ljscf*5o\^^' 
"nder section 501 of the Internal Revenue Code of 1954 (or a subdivi-
sion of such organization) unless it is licensed pursuant to State law 
and it meets such additional standards and requirements as may be 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
321 
prescribed in regulations; and except that for purposes of part A such 
term shall not include any agency or organization which is primarily 
for the care and treatment of mental diseases. 
"Outpatient Hospital Diagnostic Services 
"(p) The term 'outpatient hospital diagnostic services' means 
diagnostic services— 
"(1) which are furnished to an individual as an outpatient by a 
hospital or by others under arrangements with them made by a 
hospital; and 
"(2) which are ordinarily furnished by such hospital (or by 
others under such arrangements) to its outpatients for the pur-
pose of diagnostic study; 
excluding, however— 
"(3) any item or service if it would not be included under sub-
section (b) if furnished to an inpatient of a hospital; and 
" (4) any services furnished under such arrangements unless 
furnished in the hospital or in other facilities operated by or under 
the supervision of the hospital or its organized medical staff. 
"Physicians' Services 
" (q) The term 'physicians' services' means professional services per-
formed by physicians, including surgery, consultation, and home, office, 
and institutional calls (but not including services described in the last 
sentence of subsection (b)). 
"Physician 
"(r) The term 'physician', when used in connection with the per-
formance of any function or action, means (1) a doctor of medicine or 
osteopathy legally authorized to practice medicine and surgery by the 
State in which he performs such function or action (including a physi-
cian within the meaning of section 1101(a) (7)), or (2) a doctor of 
^4 st^t, 559. 
dentistry or of dental or oral surgery who is legally authorized to prac-
tice dentistry by the State in which he performs such function but 
only with respect to (A) surgery related to the jaw or any structure 
contiguous to the jaw or (B) the reduction of any fracture of the 
jaw or any facial bone. 
"Medical and Other Health Services 
"(s) The term 'medical and other health services' means any of the 
following items or services (unless they would otherwise constitute 
inpatient hospital services, extended care services, or home health 
services): 
"(1) physicians' services; 
"(2) services and supplies (including d r u ^ and biologicals 
which cannot, as determined in accordance with regulations, be 
self-administered) furnished as an incident to a physician's 
professional service, of kinds which are commonly furnished 
in physicians' offices and are commonly either rendered without 
charge or included in the physicans' bills, and hospital services 
(including drugs and biologicals which cannot, as determined in 
accordance with regulations, be self-administered) incident to 
physicians' services rendered to outpatients; 
42 u s e 1301. 
322 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"(3) diagnostic X-ray tests, diagnostic laboratory tests, and 
other diagnostic tests; 
"(4) X-ray, radium, and radioactive isotope therapy, including 
materials and services of technicians; 
"(5) surgical dressings, and splints, casts, and other devices 
used for reduction of fractures and dislocations; 
"(6) rental of durable medical equipment, including iron 
lungs, oxygen tents, hospital beds, and wheelchairs used in the 
patient's home (including an institution used as his home); 
"(7) ambulance service where the use of other methods of 
transportation is contraindicated by the individual's condition, 
but only to the extent provided in regulations; 
"(8) prosthetic devices (other than dental) which replace 
all (Or part of an internal body organ, including replacement of 
such devices; and 
"(9) leg, arm, back, and neck braces, and artificial legs, arms, 
and eyes, including replacements if required because of a change 
in the patient's physical condition. 
No diagnostic tests performed in any laboratory which is independent 
of a physician's office or a hospital shall be included within paragraph 
(3) unless such laboratory— 
" (10) if situated in any State in which State or applicable local 
law provides for licensing of establishments of this nature, (A) 
is licensed pursuant to such law, or (B) is approved, by the 
agency of such State or locality responsible for licensing estab-
lishments of this nature, as meeting the standards establi^ed for 
such licensing; and 
"(11) meets such other conditions relating to the health and 
safety of individuals with respect to whom such tests are per-
formed as the Secretary may find necessary. 
"Drugs and Biologicals 
"(t) The term 'drugs' and the term 'biologicals', except for pur-
poses of subsection (m) (5) of this section, include only such drugs 
and biologicals, respectively, as are included (or approved for inclu-
sion) in the United States Pharmacopoeia, the National Formulary, 
or the United States Homeopathic Pharmacopoeia, or in New Drugs 
or Accepted Dental Remedies (except for any drugs and biologicals 
unfavorably evaluated therein), or as are approved by the pharmacy 
and drug therapeutics committee (or equivalent committee) of the 
medical staff of the hospital furnishing such drugs and biologicals for 
use in such hospital. 
"Provider of Services 
"(u) The term 'provider of services' means a hospital, extended 
care facility, or home health agency. 
"Keasonable Cost 
" ( v ) ( l ) The reasonable cost of any services shall be determined 
in accordance with regulations establishing the method or methods to 
be used, and the items to be included, in determining such costs for 
various types or classes of institutions, agencies, and services; except 
that in any case to which paragraph (2) or (3) applies, the amount of 
the payment determined under such paragraph with respect to the 
services involved shall be considered the reasonable cost of such serv-
ices. In prescribing the regulations referred to in the preceding 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
323 
sentence, the Secretary shall consider, among other things, the prin-
ciples generally applied by national organizations or established pre-
payment organizations (which have developed such principles) in com-
puting the amount of payment, to be made by persons other than the 
recipients of services, to providers of services on account of services 
furnished to such recipients by such providers. 
Such regulations may 
provide for determination of the costs of services on a per diem, per 
unit, per capita, or other basis, may provide for using different meth-
ods in different circumstances, may provide for the use of estimates 
of costs of particular items or services, and may provide for the use 
of charges or a percentage of charges where this method reasonably 
reflects the costs. Such regulations shall (A) take into account both 
direct and indirect costs of providers of services in order that, under 
the methods of determining costs, the costs with respect to individuals 
covered by the insurance programs established by this title will not be 
borne by individuals not so covered, and the costs with respect to 
individuals not so covered will not be borne by such insurance pro-
grams, and (B) provide for the making of suitable retroactive cor-
rective adjustments where, for a provider of services for any fiscal 
period, the aggregate reimbursement produced by the methods of 
determining costs proves to be either inadequate or excessive. 
"(2) (A) If the bed and board furnished as part of inpatient 
hospital services (including inpatient tuberculosis hospital services 
and inpatient psychiatric hospital services) or post-hospital extended 
care services is in accommodations more expensive than semi-private 
accommodations, the amount taken into account for purposes of pay-
ment under this title with respect to such services may not exceed 
an amount equal to the reasonable cost of such services if furnished 
in such semi-private accommodations unless the more expensive ac-
commodations were recfuired for medical reasons. 
"(B) Where a provider of services which has an agreement in effect 
under this title furnishes to an individual items or services which are 
in excess of or more expensive than the items or services with respect 
to which payment may be made under part A or part B, as the case may 30"^"'*' ^^* ^^ ^' 
be, the Secretary shall take into account for purposes of payment to 
such provider of services only the equivalent of the reasonable cost 
of the items or services with respect to which such payment may be 
made. 
"(3) If the bed and board furnished as part of inpatient hospital 
services (including inpatient tuberculosis hospital services and inpa-
tient psychiatric hospital services) or post-nospital extended care 
services is in accommodations other than, but not more expensive than, 
semi-private accommodations and the use of such other accommoda-
tions rather than semi-private accommodations was neither at the 
request of the patient nor for a reason which the Secretary determines 
is consistent with the purposes of this title, the amount of the payment 
with respect to such bed and board under part A shall be the reasonable 
cost of such bed and board furnished in semi-private accommodations 
(determined pursuant to paragraph (1)) minus the difference between 
the charge customarily made by the hospital or extended care facility 
for bed and board in semi-private accommodations and the charge 
customarily made by it for bed and board in the accommodations 
furnished. 
" (4) For purposes of this subsection, the t«rm 'semi-private accom- accomwauont •
» 
modations' means two-bed, three-bed, or four-bed accommodations. 
324 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"Arrangements for Certain Services 
"(w) The term 'arrangements' is limited to arrangements under 
which receipt of payment by the hospital, extended care facility, or 
home health agency (whether in its own right or as agent), with respect 
to services for which an individual is entitled to have payment made 
under this title, discharges the liability of such individual or any 
other person to pay for the services. 
"State and United States 
" (x) The terms 'State' and 'United States' have the meaning given 
42 use 4fo^.' 
^^ them by subsections (h) and (i), respectively, of section 210. 
'Tost-Hospital Extended Care in Christian Science Extended Care 
Facilities 
"(y) (1) The term 'extended care facility' also includes a Christian 
Science sanatorium operated, or listed and certified, by the First 
Church of Christ, Scientist, Boston, Massachusetts, but only (except 
for purposes of subsection (a) (2)) with respect to items and services 
ordinarily furnished by such an institution to inpatients, and payment 
majr be made with respect to services provided hj or in such an insti-
tution only to such extent and under such conditions, limitations, and 
requirements (in addition to or in lieu of the conditions, limitations, 
and requirements otherwise applicable) as may be provided in regula-
tions. 
"(2) Notwithstanding any other provision of this title, payment 
under part A may not be made for services furnished an individual 
in an extended care facility to which paragraph (1) applies unless 
such individual elects, in accordance with regulations, for a spell of 
illness to have such services treated as post-hospital extended care 
services for purposes of such part; and payment under part A may not 
be made for post-hospital extended care services— 
"(A) furnished an individual during such spell of illness in an 
extended care facility to which paragraph (1) applies after— 
"(i) such services have been furnished to him in such a 
facility for 30 days during such spell, or 
"(ii) such services have been furnished to him during such 
spell in an extended care facility to which such paragraph 
does not apply; or 
"(B) furnished an individual during such spell of illness in an 
extended care facility to which paragraph (1) does not apply after 
such services have been furnished to him during such spell in an 
extended care facility to which such paragraph applies. 
"(3) The amount payable under part A for post-hospital extended 
care services furnished an individual during any spell of illness in an 
extended care facility to which paragraph (1) applies shall be reduced 
by a coinsurance amount equal to one-eighth of the inpatient hospital 
deductible for each day before the 31st day on which he is furnished 
such services in such a facility during such spell (and the reduction 
under this paragraph shall be in lieu of any reduction under section 
Ante. p. 292. 
1813(a)(4)). 
"(4) For purposes of subsection (i), the determination of whether 
services furnished hy or in an institution described in paragraph (1) 
constitute post-hospital extended care services shall be made in accord-
ance with and subject to such conditions, limitations, and requirements 
as may be provided in regulations. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
325 
'EXCLUSIONS FROM COVERAGE 
" T 
"SEC. 1862. (a) Notwithstanding any other provision of this title, no 
payment may be made under part A or part B for any expenses ^Q^"*''^^' '^^^' 
incurred for items or services— 
"(1) which are not reasonable and necessary for the diagnosis 
or treatment of illness or injury or to improve the functioning of 
a malformed body member; 
"(2) for which the individual furnished such items or services 
has no legal obligation to pay, and which no other person (by 
reason of such individual's membership in a prepayment plan or 
otherwise) has a legal obligation to provide or pay for; 
"(3) which are paid for directly or indirectly by a govern-
mental entity (other than under this Act and other than under 
a health benefits or insurance plan established for employees of 
such an entity), except in such cases as the Secretary may specify; 
"(4) which are not provided within the United States (except 
for emergency inpatient hospital services furnished outside the 
United States under the conditions described in section 1814 ( f ) ) ; 
Ante, p. 294. 
" (5) which are required as a result of war, or of an act of war, 
occurring after the effective date of such individual's current 
coverage im^der such part; 
"(6) which constitute personal comfort items; 
"(7) where such expenses are for routine physical checkups, 
eyeglasses or eye examinations for the purpose of prescribing, 
fitting, or changing eyeglasses, hearing aids or examinations there-
for, or immunizations; 
"(8) where such expenses are for orthopedic shoes or other 
supportive devices for the feet; 
"(9) where such expenses are for custodial care; 
"(10) where such expenses are for cosmetic surgery or are 
incurred in connection therewith, except as required for the 
prompt repair of accidental injury or for improvement of the 
functioning of a malformed body memiber; 
"(11) where such expenses constitute charges imposed by 
immediate relatives of such individual or members of his house-
hold; or 
"(12) where such expenses are for services in connection with 
the care, treatment, filling, removal, or replacement of teeth or 
structures directly supporting teeth. 
" (b) Payment under this title may not be made with respect to any 
item or service to the extent that payment has been made, or can 
reasonably be expected to be made (as determined in accordance with 
regulations), with respect to such item or service, under a workmen's 
compensation law or plan of the United States or a State. Any pay-
ment under this title with respect to any item or service shall be 
conditioned on reimbursement to the appropriate Trust Fund estab-
lished by this title when notice or other information is received that 
payment for such item or service has been made under such a law 
or plan. 
IC 
CONSULTATION 
W I T H 
STATE AGENCIES AND OTHER ORGANIZATIONS TO 
DEVELOP C O N D I T I O N S OF PARTICIPATION FOR PROVIDERS OF SERVICES 
"SEC. 1863. In carr;^ing out his functions, relating to determination 
of conditions of participation by providers of services, under sub-
sections (e) (8), (f) (4), (g) (4), (j) (10), and (o) (5) of section 1861, 
the Secretary shall consult with the Health Insurance Benefits Advis-
ory Coimcil established by section 1867, appropriate State agencies, 
326 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
and recognized national listing or accrediting bodies, and may consult 
with appropriate local agencies. Such conditions prescribed undeir 
any of such subsections may be varied for different areas or different 
classes of institutions or agencies and may, at the request of a State, 
provide higher requirements for such State than for other States; 
except that, in the case of any State or political subdivision of a State 
which imposes higher requirements on institutions as a condition to the 
purchase of services (or of certain specified services) in such institu-
42 use 301, 
tions under a State plan approved under title I, XVI, or X I X , the 
1381. Post. p. 343. gg(jj.gtary shall impose like requirements as a condition to the payment 
for services (or for the services specified by the State or subdivision) 
in such institutions in such State or subdivision. 
"USE OF STATE AGENCIES TO DETERMINE COMPLIANCE BY PROVIDERS OP 
SERVICES WITH CONDITIONS OF PARTICIPATION 
"SEC. 1864. (a) The Secretary shall make an agreement with any 
State which is able and willing to do so under which the services of 
the State health agency or other appropriate State agency (or the 
appropriate local agencies^ will be utilized by him for the purpose 
of determining whemer an institution therein is a hospital or extended 
care facility, or whether an agency therein is a home health agency, 
or whether a laboratory meets the requirements of paragraphs (10) 
Ante. p. 321. 
and (11) of sectiou 1861 (s). To the extent that the Secretary finds 
it appropriate, an institution or agency which such a State (or local) 
agency certifies is a hospital, extended care facility, or home health 
agency (as those terms are defined in section 1861) may be treated 
as such by the Secretary. The Secretary may also, pursuant to 
agreement, utilize the services of State health agencies and other 
appropriate State agencies (and the appropriate local agencies) to 
do any one or more of the following: (1) to provide consultative serv-
ices to institutions or agencies to assist them (A) to establish and 
maintain fiscal records necessary for purposes of this title, or other-
wise to qualify as hospitals, extended care facilities, or home health 
agencies, or (B) to provide information which may be necessary to 
permit determination under this title as to whether payments are 
due and the amounts thereof, and (2) to provide consultative serv-
ices to institutions, agencies, or organizations to assist in the establish-
ment of utilization review procedures meeting the requirements of 
section 1861 (k) and in evaluating their effectiveness. 
" (b) The Secretary shall pay any such State, in advance or by way 
of reimbursement, as may be provided in the agreement with it (and 
may make adjustments in such payments on account of overpayments 
or underpayments previously made), for the reasonable cost of per-
forming the functions specified in subsection (a), and for the Federal 
Ante. p. 299. 
Hospital Insurauce Trust Fund's fair share of the costs attributable 
to the planning and other efforts directed toward coordination of activ-
ities in carrying out its agreement and other activities related to the 
provision of services similar to those for which payment may be made 
under part A, or related to the facilities and personnel required for 
the provision of such services, or related to improving the quality of 
such services. 
" E F F E C T O F ACCREDITATION 
"SEC. 1865. Except as provided in the second sentence of section 
1863, an institution shall be deemed to meet the requirements of the 
numbered paragraphs of section 1861(e) (except paragraph (6) 
thereof) if such institution is accredited as a hospital by the Joint 
Commission on Accreditation of Hospitals. If such Commission, as 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
327 
a condition for accreditation of a hospital, requires a utilization review 
plan or imposes another requirement which serves substantially the 
same purpose, the Secretary is authorized to find that all institutions 
so accredited by the Commission comply also with section 1861(e) (6). 
In addition, if the Secretary finds that accreditation of an institution 
or agency by the American Osteopathic Association or any other 
national accreditation body provides reasonable assurance that any 
or all of the conditions of section 1861 (e), (j), or (o), as the case may 
be, are met, he may, to the extent he deems it appropriate, treat such 
institution or agency as meeting the condition or conditions with 
respect to which he made such finding. 
(( 
AGREEIMENTS WITH PROVIDERS OF SERVICES 
"SEC. 1866. (a) (1) Any provider of services shall be qualified to 
participate under this title and shall be eligible for payments under 
this title if it files with the Secretary an agreement— 
"(A) not to charge, except as provided in paragraph (2), any 
individual or any other person for items or services for which such 
individual is entitled to have payment made under this title (or 
for which he would be so entitled if such provider of services had 
complied with the procedural and other requirements under or 
pursuant to this title or for which such provider is paid pursuant 
to the provisions of section 1814(e)), and 
^ 
^^®' P- ^^^• 
"(B) to make adequate provision for return (or other disposi-
tion, in accordance with regulations) of any moneys incorrectly 
collected from such individual or other person. 
" (2) (A) A provider of services may charj^e such individual or other 
person (i) the amount of any deduction or coinsurance amount imposed 
pursuant to section 1813 (a) (1), (a) (2), or (a) (4), section 1833 (b), or 
section 1861 (y) (3) with respect to such items and services (not in 
excess of the amount customarily charged for such items and services 
by such provider), and (ii) an amount equal to 20 per centum of the 
reasonable charges for such items and services (not m excess of 20 per 
centum of the amount customarily charged for such items and services 
by such provider) for which payment is made under part B or, in the 
case of outpatient hospital diagnostic services, for which payment is 
made under part A. 
In the case of items and services described in 
section 1833(c), clause (ii) of the preceding sentence shall be applied 
by substituting for 20 percent the proportion which is appropriate 
under such section. 
"(B) Where a provider of services has furnished, at the request of 
such individual, items or services which are in excess of or more 
expensive than the items or services with respect to which payment 
may be made under this title, such provider of services may also charge 
such individual or other person for such more expensive items or 
services to the extent that the amount customarily charged by it for 
the items or services furnished at such request exceeds the amount 
customarily charged by it for the items or services with respect to 
which payment may be made under this title. 
"(C) A provider of services may also charge any such individual 
for any whole blood furnished him with respect to which a deductible 
is imposed under section 1813(a)(3), except that (i) any excess of 
such charge over the cost to such provider for the blood shall be 
deducted from any payment to such provider under this title, (ii) 
no such charge may be imposed for the cost of administration of such 
328 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
blood, and (iii) such charge may not be made to the extent such 
blood has been replaced on behalf of such individual or arrangements 
have been made for its replacement on his behalf. 
Termination o
f 
«ny\ ^j^ agreement with the Secretary under this section may be 
a g r e e m e n t s . 
j 
• 
, 
T 
termmated— 
"(1) by the provider of services at such time and upon such 
notice to the Secretary and the public as may be provided in 
regulations, except that notice of more than 6 months shall not 
be required, or 
"(2) by the Secretary at such time and upon such reasonable 
notice to the provider of services and the public as may be speci-
fied in regulations, but only after the Secretary has determmed 
(A) that such pjrovider of services is not complying substantially 
with the provisions of such agreement, or with the provisions of 
this title and regulations thereunder, or (B) that such provider 
of services no longer substantially meets the applicable provisions 
of section 1861, or (C) that such provider of services has failed 
to provide such information as the Secretary finds necessary to 
determine whether payments are or were due under this title and 
the amounts thereof, or has refused to permit such examination of 
its fiscal and other records by or on behalf of the Secretary as may 
be necessary to verify such information. 
Any termination shall be applicable— 
"(3) in the case of inpatient hospital services (including 
inpatient tuberculosis hospital services and inpatient psychiatric 
hospital services) or post-hospital extended care services, with 
respect to such services furnished to any individual who is admit-
ted to the hospital or extended care facility furnishing such 
services on or after the effective date of such termination, 
"(4) (A) with respect to home health services furnished to an 
individual under a plan therefor established on or after the effec-
tive date of such termination, or (B) if a plan is established before 
such effective date, with respect to such services furnished to such 
individual after the calendar year in which such termination is 
effective, and 
"(5) with respect to any other items and services furnished 
on or after the effective date of such termination. 
"(c) Where an agreement filed under this title by a provider of 
services has been terminated by the Secretary, such provider may not 
file another agreement under this title unless the Secretary finds that 
the reason for the termination has been removed and that there is 
reasonable assurance that it will not recur. 
"(d) If the Secretary finds that there is a substantial failure to make 
timely review in accordance with section 1861 (k) of long-stay cases in 
a hospital or extended care facility, he may, in lieu of terminating his 
agreement with such hospital or facility, decide that, with respect to 
any individual admitted to such hospital or facility after a subsequent 
date specified by him, no payment shall be made under this title for 
inpatient hospital services (including inpatient tuberculosis hospital 
services and inpatient psychiatric hospital services) after the 20th day 
of a continuous period of such services or for post-hospital extended 
care services after such day of a continuous period of such care as is 
prescribed in or pursuant to regulations, as the case may be. Such 
decision may be made effective only after such notice to the hospital, 
or (in the case of an extended care facility) to the facility and the 
hospital or hospitals with which it has a transfer agreement, and to 
the public, as may be prescribed by regulations, and its effectiveness 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
329 
shall terminate when the Secretary finds that tlie reason tlierefor has 
been removed and that there is reasonable assurance that it will not 
recur. 
The Secretary shall not make any such decision except after 
reasonable notice and opportunity for hearing to the institution or 
agency affected thereby. 
"HEALTH INSURANCE BENEFITS ADVISORY COUNCIL 
"SEC. 1867. For the purpose of advising the Secretary on matters of 
general policy in the administration of this title and in the formulation 
of regulations under this title, there is hereby created a Health Insur-
ance Benefits Advisory Council which shall consist of 16 persons, not 
otherwise in the employ of the United States, appointed by the Sec-
retary without regard to the civil service laws. The Secretary shall 
from time to time appoint one of the members to serve as Chairman. 
The members shall include persons who are outstanding in fields related 
to hospital, medical, and other health activities, and at least one person 
who is representative of the general public. Each member shall hold 
office for a term of 4 years, except that any member appointed to fill 
a vacancy occurring prior to the expiration of the term for which his 
predecessor was appointed shall be appointed for the remainder of 
such term, and except that the terms of office of the members first 
taking office shall expire, as designated by the Secretary at the time 
of appointment, four at the end of the first year, four at the end of 
the second year, four at the end of the third year, and four at the end 
of the fourth year after the date of appointment. 
A member shall not 
be eligible to serve continuously for more than 2 terms. The Secretary 
may, at the request of the Council or otherwise, appoint such special 
advisory professional or technical committees as may be useful in carry-
ing out this title. Members of the Advisory Council and members of 
any such advisory or technical committee, while attending meetings 
or conferences thereof or otherwise serving on business of the Advisory 
Council or of such committee, shall be entitled to receive compensation 
at rates fixed by the Secretary, but not exceeding $100 per day, includ-
ing travel time, and while so serving away from their homes or regular 
places of business they may be allowed travel expenses, including per 
diem in lieu of subsistence, as authorized by section 5 of the Adminis-
trative Expenses Act of 1946 (5 U.S.C. V3b-2) for persons in the 75^513^*339^' 
Government service employed intermittently. The Advisory Council 340. 
shall meet as frequently as the Secretary deems necessary. 
Upon 
request of 4 or more members, it shall be the duty of the Secretary to 
call a meeting of the Advisory Council. 
(( 
NATIONAL MEDICAL RE\IEW COMMITTEE 
"SEC. 1868. (a) There is hereby created a National Medical Review 
Committee (hereinafter in this section referred to as the 'Committee') 
which shall consist of nine persons, not otherwise in the employ of the 
United States, appointed by the Secretary without regard to the civil 
service laws. The Secretary shall from time to time appoint one of 
the members to serve as chairman. 
The members shall be selected 
from among individuals who are representative of organizations and 
associations of professional personnel in the field of medicine and other 
individuals who are outstanding in the field of medicine or in related 
fields; except that at least one member shall be representative of the 
general public, and at least a majority of the members shall be physi-
cians. Each member shall hold office for a term of three years, except 
49-850 0-66—24 
330 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
that any member appointed to fill a vacancy occurring prior to the 
expiration of the term for which his predecessor was appointed shall 
be appointed for the remainder of such term, and except that the terms 
of office of the members first taking office shall expire, as designated by 
the Secretary at the time of appointment, three at the end of the first 
year, three at the end of the second year, and three at the end of the 
third year after the date of appointment. 
A member shall not be 
eligible to serve continuously for more than two terms. 
"(b) Members of the Committee, while attending meetings or con-
ferences thereof or otherwise serving on business of the Committee, 
shall be entitled to receive compensation at rates fixed by the Secretary, 
but not exceeding $100 per day, including travel time, and while so 
serving away from their homes or regular places of business they 
may be allowed travel expenses, including per diem in lieu of sub-
sistence, as authorized by section 5 of the Administrative Expenses Act 
7 5^star*339°^' 
^^ ^^^^ C^ U.S.C. 73b-2) for persons in the Government service 
340. ^ * 
' 
employed intermittently. 
(c) It shall be the Junction of the Committee to study the utiliza-
tion of hospital and other medical care and services for which 
payment may be made under this title with a view to recommending 
any changes which may seem desirable in the way in which such care 
and services are utilized or in the administration of the programs 
Report to Con- 
establishcd by this title, or in the provisions of this title. The Com-
mittee shall make an annual report to the Secretary of the results of 
its study, including any recommendations it may have with respect 
thereto, and such report shall be transmitted promptly by the Secre-
tary to the Congress. 
(d) The Committee is authorized to engage such technical assist-
ance as may be required to carry out its functions, and the Secretary 
shall, in addition, make available to the Committee such secretarial, 
clerical, and other assistance and such pertinent data obtained and 
prepared by the Department of Health, Education, and Welfare as 
the Committee may require to carry out its functions. 
"DETERMINATIONS; APPEALS 
"SEC. 1869. (a) The determination of whether an individual is en-
t itled to benefits under part A or part B, and the determination of the 
amount of benefits under part A, shall be made by the Secretary in 
accordance with regulations prescribed by him. 
"(b) Any individual dissatisfied with any determination under 
subsection (a) as to entitlement under part A or part B, or as to 
amount of benefits under part A where the matter in controversy is 
$100 or more, shall be entitled to a hearing thereon by the Secretary 
42 use 405. 
^Q ^j^g same extent as is provided in section 205 (b), and, in the case of a 
determination as to entitlement or as to amount of benefits where the 
amount in controversy is $1,000 or more, to judicial review of the 
Secretary's final decision after such hearing as is provided in section 
205(g). 
"(c) Any institution or agency dissatisfied with any determination 
by the Secretary that it is not a provider of services, or with any 
determination described in section 1866(b) (2), shall be entitled to a 
hearing thereon by the Secretary (after reasonable notice and oppor-
tunity for hearing) to the same extent as is provided in section 205(b), 
and to judicial review of the Secretary's final decision after such 
hearing as is provided in section 205(g). 
79 STAT. ] 
PUBLIC L
A
W 89-97-JULY 30, 1965 
331 
"OVERPAYMENTS ON BEHALF OF INDIVIDTrALS 
"SEO. 18T0. (a) Any payment under this title to any provider of 
services or other person with respect to any items or services furnished 
any individual shall be regarded as a payment to such individual, 
^(b) Where— 
"(1) more than the correct amount is paid under this title to a 
provider of services or other person for items or services fur-
nished an individual and the Secretary determines that, within 
such period as he may specify, the excess over the correct amount 
cannot be recouped from such provider of services or other per-
son, or 
"(2) any payment has been made under section 1814(e) to a 
"*"'*' P- •
^
^
'
*
-
provider of services or other person for items or services fur-
nished an individual, 
proper adjustments shall be made, under regulations prescribed (after 
consultation with the Railroad Retirement Board) by the Secretary, 
by decreasing subsequent payments— 
"(3) to which such individual is entitled under title II of this 
Act or under the Railroad Retirement Act of 1937, as the case 
''^ use 4oi. 
r 
' 
Post, 
pp. 335, 
may be, or 
.
.
. 
. 
34o, 4oo. 
"(4) if such individual dies before such adjustment has been 
completed, to which any other individual is entitled under title 
II of this Act or under the Railroad Retirement Act of 1937, as 
the case may be, with respect to the wages and self-employment 
income or the compensation constituting the basis of the benefits 
of such deceased individual under title II of such Act. 
As soon as practicable after any adjustment under paragraph (3) or 
(4) is determined to be necessary, the Secretary, for purposes of this 
section, section 1817(g), and section 1841(f), shall certify (to the 
Railroad Retirement Board if the adjustment is to be made by decreas-
ing subsequent payments under the Railroad Retirement Act of 1937) 
the amount of the overpayment as to which the adjustment is to be 
made. 
"(c) There shall be no adjustment as provided in subsection (b) 
(nor shall there be recovery) in any case where the incorrect payment 
has been made (including payments under section 1814(e)) with 
respect to an individual who is without fault and where such adjust-
ment (or recovery) would defeat the purposes of title II or would be 
against equity and good conscience. 
"(d) No certifying or disbursing officer shall be held liable for any 
amount certified or paid by him to any provider of services or other 
person where the adjustment or recovery of such amount is waived 
under subsection (c) or where adjustment under subsection (b) is not 
completed prior to the death of all persons against whose benefits such 
adjustment is authorized. 
"REGULATIONS 
"SEC. 1871. The Secretary shall prescribe such regulations as may 
be necessarj^ to carry out the administration of the insurance programs 
under this title. "When used in this title, the term 'regulations' means, 
unless the context otherwise requires, regulations prescribed by the 
Secretary. 
332 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
42 u s e 401-425. 
"APPLICATION OF CERTAIN PROVISIONS OF TITLE II 
"SEC. 1872. The provisions of sections 206, 208, and 216 (j), and 
of subsections (a), (d), (e), (f), (h), (i), (j), (k), and (1) of sec-
tion 205, shall also apply with respect to this title to the same extent 
as they are applicable with respect to title II. 
" D E S I G N A T I O N o r ORGANIZATION OR PUBLICATION BT NAME 
"SEC. 1873. Designation in this title, by name, of any nongovern-
mental organization or publication shall not be affected by change 
of name of such organization or publication, and shall apply to any 
successor organization or publication which the Secretary finds serves 
the purpose for which such designation is made. 
"ADMINISTRATION 
"SEC. 1874. (a) Except as otherwise provided in this title, the 
insurance programs established by this title shall be administered 
by the Secretary. The Secretary may perform any of his functions 
under this title directly, or by contract providing for payment in 
advance or by way of reimbursement, and in such installments, as 
the Secretary may deem necessary. 
"(b) The Secretary may contract with any person, agency, or 
institution to secure on a reimbursable basis such special data, actuarial 
information, and other information as may be necessary in the carry-
ing out of his functions under this title. 
"STUDIES AND RECOMMENDATIONS 
"SEC. 1875. (a) The Secretary shall carry on studies and develop 
recommendations to be submitted from time to time to the Congress 
relating to health care of the aged, including studies and recommenda-
tions concerning (1) the adequacy of existing personnel and facilities 
Ante, pp. 291, 
for health care for purposes of the programs under parts A and B ; 
(2) methods for encouraging the further development of efficient and 
economical forms of health care which are a constructive alternative 
to inpatient hospital care; and (3) the effects of the deductibles and 
coinsurance provisions upon beneficiaries, persons who provide health 
services, and the financing of the program. 
Reports to Con- 
«(b) The Secretary shall make a continuing study of the operation 
and administration of the insurance programs under parts A and B, 
and shall transmit to the Congress annually a report concerning the 
operation of such programs." 
(b) I f - 
. . 
(1) an individual was eligible to enroll under section 1837(e) 
of the Social Security Act before April 1,1966, but failed to enroll 
before such date, and 
(2) it is shown to the satisfaction of the Secretary of Health, 
Education, and Welfare that there was good cause for such failure 
to enroll before April 1,1966, 
such individual may enroll pursuant to this subsection at any time 
before October 1, 1966. The determination of what constitutes good 
cause for purposes of the preceding sentence shall be made in accord-
ance with regulations of the Secretary. In the case of any individual 
who enrolls pursuant to this subsection, the coverage period (within 
the meaning of section 1838 of the Social Security Act) shall begin on 
the first day of the 6th month after the month in which he so enrolls. 
301. 
gress 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
333 
TRANSITIONAL 
PROVISION 
ON 
ELIGIBILITY 
OF 
PRESENTLY 
UNINSURED 
INDIVIDUALS FOR HOSPITAL INSURANCE 
BENEFITS 
SEC. 103. (a) Anyone who— 
(1) has attained the age of 65, 
(2) (A) attained such age before 1968, or (B) has not less 
than 3 quarters of coverage (as defined in title I I of the Social 
Security Act or section 6(1) of the Kailroad Retirement Act of 
^2 use 4oi. 
1937), whenever acquired, for each calendar year elapsing after 
^° ^*g^- '^^^^ 
1965 and before the year in which he attained such age, 
(3) is not, and upon filing application for monthly insurance 
benefits under section 202 of the Social Security Act would not 
^2 use 40 2. 
be, entitled to hospital insurance benefits under section 226 of 
^"'^' P- 29O. 
such Act, and is not certifiable as a qualified railroad retirement 
beneficiary under section 21 of the Railroad Retirement Act of 
1937 (as added by section 105 (a) of this Act), 
(4) is a resident of the United States (as defined in section 
210(i) of the Social Security Act), and is (A) a citizen of the 
74 stat. 937. 
United States or (B) an alien lawfully admitted for permanent 
residence who has resided in the United States (as so defined) 
continuously during the 5 years immediately preceding the month 
in which he files application under this section, and 
(5) has filed an application under this section in such manner 
and in accordance with such other requirements as may be pre-
scribed in regulations of the Secretary, 
shall (subject to the limitations in this section) be deemed, solely for 
purposes of section 226 of the Social Security Act, to be entitled to 
monthly insurance benefits under such section 202 for each month, 
beginning with the first month in which he meets the requirements of 
this subsection and ending with the month in which he dies, or, if 
earlier, the month before the month in which he becomes (or upon 
filing application for monthly insurance benefits under section 202 of 
such Act would become) entitled to hospital insurance benefits under 
section 226 or becomes certifiable as a qualified railroad retirement 
beneficiary. An individual who would have met the preceding require-
ments of this subsection in any month had he filed application under 
paragraph (5) hereof before the end of such month shall be deemed 
to have met such requirements in such month if he files such applica-
tion before the end of the twelfth month following such month. No 
application under this section which is filed by an individual more 
than 3 months before the first month in which he meets the require-
ments of paragraphs (1), (2), (3), and (4) shall be accepted as an 
application for purposes of this section. 
(b) The provisions of subsection (a) shall not apply to any indi-
vidual who— 
(1) is, at the beginning of the first month in which he meets the 
requirements of subsection (a), a member of any organization 
referred to in section 210 (a) (17) of the Social Security Act, 
^o stat. 839. 
(2) has, prior to the be^innin^ of such first month, been con-
victed of any offense listed m section 202 (u) of the Social Security 
Act, or 
Pose, p. 334. 
(3) (A) at the beginning of such first month is covered by an 
enrollment in a health benefits plan under the Federal Employees 
Health Benefits Act of 1959, 
s^ulc'sJo f' 
(B) was so covered on February 16,1965, or 
note. 
334 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
(C) oould have been so covered for such first month if he or 
some other person had availed himself of opportunities to enroll 
in a health benefits plan under such Act and to continue such 
enrollment (but this subparagraph shall not apply unless he or 
such other person, was a Federal employee at any time after 
February 15,1965). 
Paragraph (3) shall not apply in the case of any individual for the 
month (or any month thereafter) in which coverage under such a 
health benefits plan ceases (or would have ceased if he had had such 
coverage) by reason of his or some other person's separation from 
Federal service, if he or such other person was not (or would not have 
been) eligible to continue such coverage after such separation. 
(c) There are authorized to be appropriated to the Federal Hospital 
Insurance Trust Fund (esta;blished by section 1817 of the Social Secu-
rity Act) from time to time such sums as the Secretary deems necessary 
for any fiscal year, on account of— 
(1) payments made or to be made during such fiscal year from 
Ante, p. 291. 
gych Trust Futid under part A of title X V I I I of such Act with 
respect to individuals who are entitled to hospital insurance 
Ante, p. 290. 
benefits under section 226 of such Act solely by reason of this 
section, 
(2) the 
additional 
administrative 
expenses resulting 
or 
expected to result therefrom, and 
(3) any loss in interest to such Trust Fund resulting from the 
payment of such amounts, 
in order to place such Trust Fund in the same position at the end of 
such fiscal year in which it would have been if the preceding subsec-
tions of this section had not been enacted. 
SUSPENSION I N CASE OF A U E N S ; PERSONS CONVICTED Or SUBVERSIVE 
ACTTVITIES 
I?usc'4of* 
^^^- ^^^' (*)(!) Section 202(t) of the Social Security Act is 
amended by adding at the end thereof the following new paragraph: 
" (9) No payments shall be made under part A of title X V I I I with 
respect to items or services furnished to an individual in any month 
for which the prohibition in paragraph (1) against payment of bene-
fits to him is applicable (or would be if he were entitled to any such 
benefits)." 
(2) Section 202 (u) of such Act is amended by striking out "and" 
before the phrase "in determining the amount of any such benefit 
payable to such individual for any such month," and inserting after 
such phrase "and in determining whether such individual is entitled 
to insurance benefits under part A of title X V I I I for any such 
month,". 
(b) (1) No payments shall be made under part B of title X V I I I of 
Ante, p. 301. 
tlie Soclal Security Act with respect to expenses incurred by an 
individual during any month for which such individual may not be 
paid monthly benefits under title I I of such Act (or for which such 
monthly benefits would be suspended if he were otherwise entitled 
thereto) by reason of section 202(t) of such Act (relating to suspen-
sion of benefits of aliens who are outside the United States). 
(2) An individual who has been convicted of any offense under (A) 
chapter 37 (relating to espionage and censorship), chapter 105 
(relating to sabotage), or chapter 115 (relating to treason, sedition, 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
335 
and subversive activities) of title 18 of the United States Code, or (B) ^/g^i "fasT^' 
section 4,112, or 113 of the Internal Security Act of 1950, as amended, 
6
4 stat. 991, 
may not enroll under part B of title XVIII of the Social Security Act. 1029. ^^ 
RAILROAD RETIREMENT AMENDMENTS 
822, 823. 
SEC. 105. (a) (1) The Railroad Retirement Act of 1937 is amended 
so st^at. 3
o
^
7
^
_ 
by adding after section 20 the following new section: 
228S.1. 
'HOSPITAL I N S U R A N C E BENEFITS FOR THE AGED 
"SEC. 21. For the purposes of part A of title XVIII of the Social ^"''' P- ^^L 
Security Act, in order to provide hospital insurance benefits for annui-
tants, pensioners, and certain other aged individuals, the Board shall, 
upon request of the Secretary of Health, Education, and "Welfare, 
certify to the Secretary the name of any individual who has attained 
age 65 and who (1) is entitled to an annuity or pension under this 
Act, (2) would be entitled to such an annuity had he (i) ceased com-
pensated service and (in the case of a spouse) had such spouse's hus-
band or wife ceased compensated service and (ii) applied for such 
annuity, or (3) bears a relationship to an employee which, by reason of 
section 3(e) of this Act, has been, or would be, taken into account in 
calculating the amount of an annuity of such employee or his survivors. 
Such a certification shall include such additional information as may 
be necessary to carry out the provisions of part A of title XVIII of 
the Social Security Act, and shall become effective on the date of certi-
fication or on such earlier date not more than one year prior to the 
date of certification as the Board states that such individual first met 
the requirements for certification. The Board shall notify the Secre-
tary of the date on which such individual no longer meets the require-
ments of this section." 
(2) For purposes of section 21 of the Railroad Retirement Act of 
1937 (and sections 1840, 1843, and 1870 of the Social Security Act), 
entitlement to an annuity or pension under the Railroad Retirement 
Act of 1937 shall be deemed to include entitlement under the Railroad 
Retirement Act of 1935. 
^s use 215.228. 
(b) (1) Section 3201 of the Internal Revenue Code of 1954 (relating 
to rate of tax on employees under the Railroad Retirement Tax Act) 
^3 st^t. 28. 
is amended by striking out "the rate of the tax imposed with respect 
° ' 
to wages by section 3101 at such time exceeds the rate provided by 
paragraph (2) of such section 3101 as amended by the Social Security 
Amendments of 1956" and inserting in lieu thereof "the rate of the 
tax imposed with respect to wages by section 3101(a) at such time 
^°'''' P- ^SS, 
exceeds 2% percent (the rate provided by paragraph (2) of section 
3101 as amended by the Social Security Amendments of 1956)". 
7
o stat. 845. 
(2) Section 3211 of such Code (relating to the rate of tax on 
73 stat. 29. 
employee representatives under the Railroad Retirement Tax Act) 
^^ "^ ^^^^' 
is amended by striking out "the rate of the tax imposed with respect 
to wages by section 3101 at such time exceeds the rate provided by 
paragraph (2) of such section 3101 as amended by the Social Security 
Amendments of 1956" and inserting in lieu thereof "the rate of the tax 
imposed with respect to wa^s by section 3101(a) at such time exceeds 
2% percent (the rate provided by paragraph (2) of section 3101 as 
amended by the Social Security Amendments of 1956)". 
(3) Section 3221(b) of such Code (relating to the rate of tax on 
2
6 use 3221. 
employers under the Railroad Retirement Tax Act) is amended by 
striking out "the rate of the tax imposed with respect to wages by 
section 3111 at such time exceeds the rate provided by paragraph (2) 
336 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
Post, p. 396. 
70 Stat. 845, 
Post, p. 400. 
of such section 3111 as amended by the Social Security Amendments 
of 1956" and inserting in lieu thereof "the rate of the tax imposed with 
respect to wages by section 3111(a) at such time exceeds 2% percent 
(the rate provided by paragraph (2) of section 3111 as amended by 
the Social Security Amendments of 1956)". 
(4) The amendments made by this subsection shall be effective with 
respect to compensation paid for services rendered after December 31, 
1965. 
(c) For amendments preserving relationship between the railroad 
retirement and old-age, survivors, and disability insurance systems, see 
section 326 of this Act. 
74 Stat. 133. 
26 u s e 213. 
68A Stat. 43. 
26 u s e 152. 
Repeal. 
"Medical c a r e . " 
Ante, p. 301. 
MEDICAL EXPENSE DEDUCTION 
SEC. 106. (a) Subsection (a) of section 213 of the Internal Kevenue 
Code of 1954 (relating to allowance of deduction) is amended to read 
as follows: 
" (a) ALLOWANCE OF DEDUCTION.—There shall be allowed as a deduc-
tion the following amounts, ^ot compensated for by insurance or 
otherwise— 
"(1) the amount by which the amount of the expenses paid 
during the taxable year (reduced by any amount deductible under 
paragraph (2)) for medical care of the taxpayer, his spouse, and 
dependents (as defined in section 152) exceeds 3 percent of the 
adjusted gross income, and 
"(2) an amount (not in excess of $150) equal to one-half of 
the expenses paid during the taxable year for insurance which 
constitutes medical care for the taxpayer, his spouse, and 
dependents." 
(b) The second sentence of section 213(b) of such Code (relating 
to limitation with respect to medicine and drugs) is repealed. 
(c) Section 213 (e) of such Code (relating to definitions) is amended 
by renumbering paragraph (2) as paragraph (4), and by striking out 
paragraph (1) and inserting in lieu thereof the following: 
"(1) The term 'medical care' means amounts paid— 
"(A) for the diagnosis, cure, mitigation, treatment, or pre-
vention of disease, or for the purpose of affecting any struc-
ture or function of the body, 
"(B) for transportation primarily for and essential to 
medical care referred to in subparagraph (A), or 
"(C) for insurance (including amounts paid as premiums 
under part B of title X V I I I of the Social Security Act, re-
lating to supplementary medical insurance for the aged) 
covering medical care referred to in subparagraphs (A) and 
(B). 
" (2) In the case of an insurance contract under which amounts 
are payable for other than medical care referred to in subpara-
graphs (A) and (B) of paragraph (1)— 
"(A) no amount shall be treated as paid for insurance to 
which paragraph (1) (C) applies unless the charge for such 
insurance is either separately stated in the contract, or furn-
ished to the policyholder by the insurance company in a 
separate statement, 
"(B) the amount taken into account as the amount paid 
for such insurance sjiall not exceed such charge, and 
"(C) no amount shall be treated as paid for such insurance 
if the amount specified in the contract (or furnished to the 
76 Stat. 821. 
26 use 72. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
337 
policyholder by the insurance company in a separate state-
ment) as the charge for such insurance is unreasonably large 
in relation to the total charges under the contract. 
"(3) Subject to the limitations of paragraph (2), premiums 
paid during the taxable year by a taxpayer before he attains the 
age of 65 for insurance covering medical care (within the meaning 
of subparagraphs (A) and (B) of paragraph (1)) for the tax-
payer, his spouse, or a dependent after the taxpayer attains the 
age of 65 shall be treated as expenses paid during the taxable 
year for insurance which constitutes medical care if premiums for 
such insurance are payable (on a level payment basis) under the 
contract for a period of 10 years or more or until the year in which 
the taxpayer attains the age of 65 (but in no case for a period of 
less than 5 years)." 
(d) (1) Section 213 of such Code (relating to medical, dental, etc., 
^^ stat^. ^IM3. 
expenses) is amended by striking out subsections (c) and (g) of such 
section. 
(2) (A) Section 72(m) (5) (A) (i) of such Code (relating to special 
rules applicable to employment annuities and distributions under 
employee plans) is amended by striking out "section 213(g) (3)" and 
inserting in lieu thereof "paragraph (7) of this subsection". 
(B) Section 72 (m) of such Code is further amended by adding at 
the end thereof the following new paragraph: 
"(7) MEANING OF DISABLED.—For purposes of this section, an 
individual shall be considered to be disabled if he is unable to en-
gage in any substantial gainful activity by reason of any medically 
determinable physical or mental impairment which can be expected 
to result in death or to be of long-continued and indefinite dura-
tion. An individual shall not be considered to be disabled unless 
he furnishes proof of the existence thereof in such form and 
manner as the Secretary or his delegate may require." 
(C) Subparagraphs (A) (iii) and (B)(iii) of section 72(n)(l) 
of such Code (relating to treatment of certain distributions with 
respect to contributions by self-employed individuals) are each 
amended by striking out "section 213(g)(3)" and inserting in lieu 
thereof "subsection (m) (7)". 
(3) Section 79(b)(1) of such Code (relating to group-term life 
26 use ^^' 
insurance purchased for employees) is amended by striking out "para-
graph (3) of section 213(g), determined without regard to paragraph 
(4) thereof" and inserting in lieu thereof "section 72 (m) (7)". 
(4) Section 401(d)(4)(B) of such Code (relating to additional 
Hl'^^'^Si' 
requirements for qualification of trusts and plans benefiting owner-
employees) is amended by striking out "section 213 (g) (3)" and insert-
ing in lieu thereof "section 72(m) (7)". 
(5) Section 405(b) (1) (D) (ii) of such Code (relating to qualified 
26 use 405. 
bond purchase plans) is amended by striking out "section 213(g) (3)" 
and inserting in lieu thereof "section 72 (m) (7)". 
(e) The amendments made by this section shall apply to taxable 
years beginning after December 31,1966. 
RECEIPTS FOR EMPLOYEES MUST SHOW TAXES SEPARATELY 
SEC. 107. Section 6051(c) of the Internal Revenue Code of 1954 
^J^us^eosY 
(relating to additional requirements) is amended by adding at the 
end thereof the following new sentence: "The statements required 
under this section shall also show the proportion of the total amount 
338 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
Post, p. 395. 
withheld as tax under section 3101 which is for financing the cost of 
Ante, p. 291. 
hospital insurance benefits under part A of title X V I I I of the Social 
Security Act." 
TECHNICAL AND ADMINISTRATIVE AMENDMENTS RELATING TO TRUST FUNDS 
l2vic!oi' 
^^^- 1^^- (.^) (^). Section 201(a) (3) of the Social Security Act is 
amended by inserting "(other than sections 3101(b) and 3111(b))" 
after "chapter 21" each place it appears therein. 
(2) Section 201 (a) (4) of such Act is amended by inserting "(other 
than section 1401(b))" after "chapter 2" and after "such subchapter 
or chapter". 
(3) Section 201(g) (1) of such Act is amended to read as follows: 
"(1)(A) There are authorized to be made available for expendi-
ture, out of any or all of the Trust Funds (which for purposes of this 
paragraph shall include also the Federal Hospital Insurance Trust 
30^"'"' ^^" ^^^' 
Fund and the Federal Supplementary Medical Insurance Trust Fund 
established by title X V I I I ) , such amounts as the Congress may deem 
appropriate to pay the costs of the part of the administration of this 
title and title X V I I I for which the Secretary of Health, Education, 
and Welfare is responsible. During each fiscal year or after the close 
of such fiscal year (or at both times), the Secretary of Health, Educa-
tion, and Welfare shall analyze the costs of administration of this title 
and title XVIII during the aj)propriate part or all of such fiscal year 
in order to determine the portion of such costs which should be borne 
by each of the Trust Funds and shall certify to the Managing Trustee 
the amount, if any, which should be transferred among such Trust 
Funds in order to assure that each of the Trust Funds bears its proper 
share of the costs incurred during such fiscal year for the part of the 
administration of this title and title X V I I I lor which the Secretary 
of Health, Education, and Welfare is responsible. 
The Managing 
Trustee is authorized and directed to transfer any such amount (deter-
mined under the preceding sentence) among such Trust Funds in 
accordance with any certification so made. 
"(B) The Managing Trustee is directed to pay from the Trust 
Funds into the Treasury the amounts estimated by him which will be 
expended, out of moneys appropriated from the general funds in the 
Treasury, during each calendar quarter by the Treasury Department 
for the part of the administration of this title and title X V I I I for 
which the Treasury Department is responsible and for the administra-
^^68A Stat. 353, 
^'^^^ ^f chapters 2 and 21 of the Internal Revenue Code of 1954. Such 
26 use 1401- 
payments shall be covered into the Treasury as repayment to the 
1403,3101-3126. ftccount for reimbursement of expenses incurred in connection with 
such administration of this title and title X V I I I and chapters 2 and 21 
of the Internal Revenue Code of 1954." 
(4) Section 201(g) (2) of such Act is amended by inserting after 
"the amount estimated by him as taxes" the following: "imposed under 
section 3101(a)". 
(5) Section 201(h) of such Act is amended by inserting "(other 
than section 226)" after "this title". 
5° J*s^*-4^2^^; 
(b) Section 218(h)(1) of such Act is amended by striking out 
"Trust Funds in the ratio in which amounts are appropriated to such 
Funds pursuant to subsections (a) (3) and (b) (1) of section 201" and 
inserting in lieu thereof "Trust Funds and the Federal Hospital In-
surance Trust Fund in the ratio in which amounts are appropriated 
to such Funds pursuant to subsection (a) (3) of section 201, subsec-
Ante.p. 299. 
t-ioii (b)(1) of sucli scctlou, aiid subsection (a)(1) of section 1817, 
respectively". 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
339 
(c) Section 1106(b) of such Act is amended by striking out "and 
^2 st^^ wss. 
the Federal Disability Insurance Trust Fund" and inserting in lieu 
thereof ", the Federal Disability Insurance Trust Fund, the Federal 
Hospital Insurance Trust Fund, and the Federal Supplementary Med-
ical Insurance Trust Fimd". 
ADVISORY COUNCIL ON SOCIAL SECURITY 
SEC. 109. (a) Title VII of the Social Security Act is amended by 
jg stat^. eas.^^^ 
adding at the end thereof the following new section: 
"ADVISORY COUNCIL ON SOCIAL SECURITY 
"SEC. 706. (a) During 1968 and every fifth year thereafter, the 
Secretary shall appoint an Advisory Council on Social Security for 
the purpose of reviewing the status of the Federal Old-Age and 
Survivors Insurance Trust Fund, the Federal Disability Insurance 
Trust Fund, the Federal Hospital Insurance Trust Fund, and the 
42usc4oi. 
Federal Supplementary Medical Insurance Trust Fund in relation to 3„^"'*' ^P' ^^^' 
the long-term commitments of the old-age, survivors, and disability 
insurance program and the programs under parts A and B of title 
XVIII, and of reviewing the scope of coverage and the adequacy of 
^"'«' PP- 291, 
benefits under, and all other aspects of, these programs, including ^°^* 
their impact on the public assistance programs under this Act. 
"(b) Each such Council shall consist of the Commissioner of 
Social Security, as Chairman, and 12 other persons, appointed by the 
Secretary without regard to the civil service laws. The appointed 
members shall, to the extent possible, represent organizations of em-
ployers and employees in equal numbers, and represent self-employed 
persons and the public. 
"(c) (1) Any Council appointed hereunder is authorized to engage 
such technical assistance, including actuarial services, as may be re-
quired to carry out its functions, and the Secretary shall, in addition, 
make available to such Council such secretarial, clerical, and other 
assistance and such actuarial and other pertinent data prepared by the 
Department of Health, Education, and Welfare as it may require to 
carry out such functions. 
"(2) Appointed members of any such Council, while serving on 
business of the Council (inclusive of travel time), shall receive com-
pensation at rates fixed by the Secretary, but not exceeding $100 per day 
and, while so serving away from their homes or regular places of 
business, they may be allowed travel expenses, including per diem in 
lieu of subsistence, as authorized by section 5 of the Administrative 
Expenses Act of 1946 (5 U.S.C. 73b-2) for persons in the Government 
eo stat. sos; 
employed intermittently. 
^^ *
^
*
* ^^^' ^'*°' 
"(d) Each such Council shall submit reports of its findings and 
Reports to con-
recommendations to the Secretary not later than January 1 of the ^'^^^* 
second year after the year in which it is appointed, and such reports 
and recommendations shall thereupon be transmitted to the Congress 
and to the Board of Trustees of each of the Trust Funds. The reports 
required by this subsection shall include— 
"(1) a separate report with respect to the old-age, survivors, 
and disability insurance program under title I I and of the taxes 
42 use 401. 
imposed under sections 1401(a), 3101(a), and 3111(a) of the 
Internal Revenue Code of 1954, 
Poat, pp. 394-
"(2) a separate report with respect to the hospital insurance ^^^* 
program under part A of title X V I I I and of the taxes imposed by 
sections 1401(b), 3101(b), and 3111(b) of the Internal Revenue 
Code of 1954, and 
340 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
" (3) a separate report with respect to the supplementary medical 
Ante, p. 301. 
insurancc program established by part B of title X V I I I and of 
the financing thereof. 
After the date of the transmittal to the Congress of the reports required 
by this subsection, the Council shall cease to exist." 
^^p^^i- 
(b) Effective January 1, 1966, section 116(e) of the Social Security 
42 uS;' 40 u 
Amendments of 1956 is repealed. 
MEANING OF TERM "SECRETARY" 
SEC. 110. As used in this Act, and in the provisions of the Social 
Security Act amended by this Act, the term "Secretary", unless the 
context otherwise requires, means the Secretary of Health, Education, 
and Welfare. 
ROLE OF T H E RAILROAD RETIREMENT BOARD I N T H E ADMINISTRATION OF 
HOSPITAL INSURANCE FOR T H E AGED 
Ante, p. 332. 
SEC. 111. (a) The first sentence of section 1874(a) of the Social 
Security Act is amended to read as follows: "Except as otherwise pro-
p^sT^' ^400^^' 
vided in this title and in the Kailroad Retirement Act of 1937, the 
insurance programs established by this title shall be administered by 
the Secreta^v." 
(b) (1) Section 21 of the Railroad Retirement Act of 1937 (as added 
by section 105 of this Act) is amended to read as follows: 
u 
291, 313. 
HOSPITAL INSURANCE BENEFITS FOR T H E AGED 
"SEC. 21. (a) For the purposes of this section, the Board shall have 
the same authority to determine the rights of individuals described in 
subsection (b) of this section to have payments made on their behalf 
for hospital insurance benefits consisting of inpatient hospital services, 
post-hospital extended care services, post-hospital home health services, 
and outpatient hospital diagnostic services (all hereinafter referred to 
^^"f,«;,pp' 290, 
as 'services') under section 226, and parts A and C of title XVIII, of 
the Social Security Act as the Secretary of Health, Education, and 
Welfare has under such section and such parts with respect to indi-
viduals to whom such section and such parts apply. 
For purposes of 
45 use 228k. 
section 11, a determination with respect to the rights of an individual 
under this section shall, except in the case of a provider of services, be 
considered to be a decision with respect to an annuity. 
"(b) Except as otherwise provided in this section, every individual 
who— 
"(1) has attained age 65, and 
" (2) (A) is entitled to an annuity under this Act, or (B) would 
be entitled to such an annuity had he ceased compensated service 
and, in the case of a spouse, had such spouse's husband or wife 
ceased compensated service, or (C) had been awarded a pension 
45 use 228f. 
under section 6, or (D) bears a relationship to an employee which, 
45 use 228c. 
by reasou of section 3 (e), has been, or would be, taken into account 
in calculating the amount of an annuity of such employee or his 
survivors, 
shall be certified to the Secretary of Health, Education, and Welfare 
as a qualified railroad retirement beneficiary under section 226 of the 
Social Security Act. 
"(c) The Board and the Secretary of Health, Education, and Wel-
fare shall furnish each other with such information, records, and doc-
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
341 
uments as may be considered necessary to the administration of this 
section or section 226, and part A of title XVIII, of the Social Secu- ^g^"'^' ^^- ^^°' 
rity Act. 
"(d) For purposes of this section (and sections 1840,1843, and 1870 
of the Social Security Act), entitlement to an annuity or pension 
^IT'^SSI'^'^^^' 
under this Act shall be deemed to include entitlement under the Rail-
road Ketirement Act of 1935. 
45 use 215-228. 
"(e) The rights of individuals described in subsection (b) of this 
section to have payment made on their behalf for the services referred 
to in subsection (a) of this section but provided in Canada shall be 
the same as those of individuals to whom section 226 and part A of 
title X V I I I of the Social Security Act apply, and this subsection 
shall be administered by the Board as if the provisions of section 226 
and part A of title X V I I I of the Social Security Act were applicable, 
as if references to the Secretary of Health, Education, and Welfare 
were to the Board, as if references to the Federal Hospital Insurance 
Trust Fund were to the Railroad Retirement Account, as if refer-
ences to the United States or a State included Canada or a subdivision 
thereof, and as if the provisions of sections 1862(a) (4), 1863, 1864, 
1867, 1868, 1869, 1874(b), and 1875 of such title X V I I I were not 
included in such title. The payments for services herein provided 
for in Canada shall be made from the Railroad Retirement Account 
(in accordance with, and subject to, the conditions applicable under 
section 10(b) in making payment of other benefits) to the hospital, 
extended care facility, or home health agency providing such services 
in Canada to individuals to whom subsection (b) of this section applies, 
but only to the extent that the amount of payments for services other-
wise hereunder provided for an individual exceeds the amount pay-
able for like services provided pursuant to the law in effect in the 
place in Canada where such services are furnished. 
For the purposes 
of section 9 of this Act, any overpayment under this subsection shall 
"
^
^ "^^ ^^si. 
be treated as if it were an overpayment of an annuity." 
(2) Section 5(k) (2) of such Act is amended— 
^^ use 228e. 
(A) by striking out subparagraphs (A) and (B) and redesig-
nating subparagraphs (C), (D), and (E) as subparagraphs (A), 
(B^, and (C), respectively; 
(B) by striking out the second sentence and the last sentence of 
subdivision (i) of the subparagraph redesignated as subpara-
graph (A) by subparagraph (A) of this paragraph; and by 
striking out from such subdivision (i) "the Retirement Account" 
and inserting in lieu thereof "the Railroad Retirement Account 
(hereinafter termed 'Retirement Account')"; 
(C) by adding at the end of the subparagraph redesignated as 
subparagraph (A) by subparagraph (A) of this paragraph the 
following new subdivision: 
"(iii) At the close of the fiscal year ending June 30, 1966, and 
each fiscal year thereafter, the Board and the Secretary of Health, 
Education, and Welfare shall determine the amount, if any, 
which, if added to or subtracted from the Federal Hospital 
Insurance Trust Fund, would place such fund in the same position 
in which it would have been if service as an employee after Decem-
ber 31, 1936, had been included in the term 'employment' as 
defined in the Social Security Act and in the Federal Insurance 
Contributions Act. 
Such determination shall be made no later _^,°^'' PP- ^^S, 
than June 15 following the close of the fiscal year. 
If such 
amount is to be added to the Federal Hospital Insurance Trust 
Fund, the Board shall, within ten days after the determination, 
396. 
342 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
certify such amount to the Secretary of the Treasury for transfer 
from the Retirement Account to the Federal Hospital Insurance 
Trust Fund; and if such amount is to be subtracted from the 
Federal Hospital Insurance Trust Fund the Secretary of Health, 
Education, and "Welfare shall, within ten days after the deter-
mination, certify such amount to the Secretary of the Treasury 
for transfer from the Federal Hospital Insurance Trust Fund to 
the Retirement Account. 
The amount so certified shall further 
include interest (at the rate determined under subparagraph (B) 
for the fiscal year under consideration) payable from the close of 
such fiscal year until the date of certification."; 
(D) by striking out "subparagraph (D)" where it appears in 
the subparagraph redesignated as suoparagraph (A) by subpara-
graph (A) of this paragraph, and inserting in lieu thereof "sub-
paragraph (B)"; 
(E) by striking out "subparagraphs (B) and (C)" where it 
appears m the subparagraph redesignated as subparagraph (B) 
by subparagraph (A) of this paragraph and inserting in lieu 
thereof "subparagraph (A)"; and 
(F) by amending the subparagraph redesignated as subpara-
graph (C) by subparagraph (A) of this paragraph to read as 
follows: 
"(C) The Secretary of the Treasury is authorized and directed to 
transfer to the Federal Old-Age and Survivors Insurance Trust Fund, 
the Federal Disability Insurance Trust Fund, or the Federal Hospital 
Insurance Trust Fund from the Retirement Account or to the Retire-
ment Account from the Federal Old-Age and Survivors Insurance 
Trust Fund, the Federal Disability Insurance Trust Fund, or the 
Federal Hospital Insurance Trust Fund, as the case may be, such 
amounts as, from time to timej may be determined by the Board and the 
Secretary of Health, Education, and Welfare pursuant to the provi-
sions of subparagraph (A), and certified by the Board or the Secre-
tary of Health, Education, and Welfare for transfer from the Retire-
ment Account or from the Federal Old-Age and Survivors Insurance 
Trust Fund, the Federal Disability Insurance Trust Fund, or the 
Federal Hospital Insurance Trust Fund." 
Ante, p. 335. 
(c) (1) Section 3201 of the Internal Revenue Code of 1954 (relating 
to rate of tax on employees under the Railroad Retirement Tax Act) 
is amended by striking out "section 3101(a)" and inserting in lieu 
thereof "section 3101(a) plus the rate imposed by section 3101(b)". 
Ante, p. 335. 
(£) Sectjon 3211 of such Code (relating to the rate of tax on em-
ployee representatives under the Railroad Retirement Tax Act) is 
amended by striking out "section 3101(a)" and inserting in lieu 
thereof "section 3101(a) plus the rate imposed by section 3101(b)". 
Ante, p. 335. 
(3) Section 3221 (b) of such Code (relating to the rate of tax on em-
ployers under the Railroad Retirement Tax Act) is amended by strik-
mg out "section 3111(a)" and inserting in lieu thereof "section 3111 
(a) plus the rate imposed by section 3111(b)". 
(4) Section 1401 (b) (as amended by section 321 of this Act) of such 
Post, p. 394. 
Code (relating to the rate of tax under the Self-Employment Contri-
butions Act) is amended by striking out the last sentence. 
Post. p. 395. 
(5) Section 3101(b) of such Code (relating to the rate of tax on 
employees under the Federal Insurance Contributions Act) is amended 
by striking out ", but without regard to the provisions of paragraph 
(9) thereof insofar as it relates to employees". 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
343 
(6) Section 3111(b) of such Code (relating to the rate of tax on 
^°«'' P- 396. 
employers under the Federal Insurance Contributions Act) is amended 
by striking out ", but without regard to the provisions of paragraph 
(9) thereof insofar as it relates to employees". 
(d) There are authorized to be appropriated to the Federal Hospital 
Insurance Trust Fund (established by section 1817 of the Social 
Security Act) from time to time such sums as the Secretary deems '*"'^' P- ^^^• 
necessary for any fiscal year, on account of— 
(1) payments made or to be made during such fiscal year from 
siich Trust Fund under part A of title X V I I I of such Act with 
^"'^' P- ^'L 
respect to individuals who are qualified railroad retirement bene-
ficiaries (as defined in section 226(c) of such Act) and who are 
^"'^' P- ^^O. 
not, and upon filing application for monthly insurance benefits 
under section 202 of such Act would not be, entitled to such benefits 
'^^ "^^ '^^^' 
if service as an employee (as defined in the Railroad Retirement 
Act of 1937) after December 31, 1936, had been included in the g/^lf^JJ^' "^' 
term "employment" as defined in the Social Security Act, 
^'*°' °*'' ^' ^^°' 
(2) the 
additional 
administrative 
expenses 
resulting 
or 
expected to result therefrom, and 
(3) any loss of interest to such Trust Fund resulting from the 
payment of such amounts, 
in order to place such Trust Fund in the same position at the end of 
such fiscal year in which it would have been if the individuals 
described in paragraph (1) had not been entitled to benefits under 
part A of title X V I I I of the Social Security Act. 
(e) (1) The amendments made by the preceding provisions of this 
section shall apply to the calendar year 1966 or to any subsequent 
calendar year, but only if the requirement in paragraph (2) has been 
met with respect to such calendar year. 
(2) The requirement referred to in paragraph (1) shall be deemed 
to have been met with respect to any calendar year if, as of the October 1 
immediately preceding ^uch calendar year, the Railroad Retirement 
Tax Act provides that the maximum amount of monthly compensation 
^^ ^^^ ^2'^^-
taxable under such Act during all months of such calendar year will 
be an amount equal to one-twelfth of the maximum wages which the 
Federal Insurance Contributions Act provides may be counted for 30^°^*' ^^' ^^^' 
such calendar year. 
PART 2—GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS 
ESTABLISHMENT OF PROGRAMS 
SEC. 121. (a) The Social Security Act is amended by adding at the 
end thereof (after the new title X V I I I added by section 102) the 
^'*' P- 291. 
following new title: 
"TITLE XIX—GRANTS TO STATES FOR MEDICAL 
ASSISTANCE PROGRAMS 
"APPROPRIATION 
"SEC. 1901. For the purpose of enabling each State, as far as prac-
ticable under the conditions in such State, to furnish (1) medical 
assistance on behalf of families with dependent children and of aged, 
blind, or permanently and totally disabled individuals, whose income 
and resources are insufficient to meet the costs of necessary medical 
services, and (2) rehabilitation and other services to help such fam-
ilies and individuals attain or retain capability for independence or 
344 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
self-care, there is hereby authorized to be appropriated for each fiscal 
year a sum sufficient to carry out the purposes of this title. The sums 
made available under this section shall be used for making payments 
to States which have submitted, and had approved by the Secretary 
of Health, Education, and Welfare, State plans for medical assistance. 
306, 1381-1385. 
U 
STATE PLANS FOR MEDICAL ASSISTANCE 
"SEO. 1902. (a) A State plan for medical assistance must— 
"(1) provide that it shall be in effect in all political subdi-
visions of the State, and, if administered by them, be mandatory 
upon them; 
"(2) provide for financial participation by the State equal to 
not less than 40 per centum of uie non-Federal share of the expend-
itures under the plan with respect to which payments under sec-
tion 1903 are authorized by this title; and, effective July 1, 1970, 
provide for financial participation by the State equal to all of 
such non-Federal share or provide for distribution of funds from 
Federal or State sources, for carrying out the State plan, on an 
equalization or other basis which will assure that the lack of 
adequate funds from local sources will not result in lowering the 
amount, duration, scope, or quality of care and services available 
under the plan; 
"(3) provide for granting an opportunity for a fair hearing 
before the State agency to any individual whose claim for medical 
assistance under the plan is denied or is not acted upon with 
reasonable promptness; 
"(4) provide such methods of administration 
(including 
methods relating to the establishment and maintenance of per-
sonnel standards on a merit basis, except that the Secretary shall 
exercise no authority with respect to the selection, tenure or office, 
and compensation of any individual employed in accordance with 
such methods, and including provision for utilization of profes-
sional medical personnel in the administration and, where admin-
istered locally, supervision of administration of the plan) as are 
found by the Secretary to be necessary for the proper and efficient 
operation of the plan; 
"(5) either provide for the establishment or designation of a 
single State agency to administer the plan, or provide for the 
establishment or designation of a single State agency to supervise 
the administration of the plan, except that the determination of 
eligibility for medical assistance under the plan shall be made by 
the State or local agency administering the State plan approved 
n^ y,^^ f°a; 
under title I or XVI (insofar as it relates to the aged); 
"(6) provide that the State agency will make such reports, in 
such form and containing such information, as the Secretary may 
from time to time require, and comply with such provisions as 
the Secretary may from time to time find necessary to assure the 
correctness and verification of such reports; 
"(7) provide safe^ards which restrict the use or disclosure of 
information concerning applicants and recipients to purposes di-
rectly connected with the administration of the plan; 
"(8) provide that all individuals wishing to make application 
for medical assistance under the plan shall have opportunity to 
do so, and that such assistance shall be furnished with reasonable 
promptness to all eligible individuals; 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
345 
"(9) provide for the establishment or designation of a State 
authority or authorities which shall be responsible for establishing 
and maintaining standards for private or public institutions in 
which recipients of medical assistance under the plan may receive 
care or services; 
"(10) provide for making medical assistance available to all 
individuals receiving aid or assistance under State plans ap-
proved under titles I, IV, X, XIV, and X V I ; and— 
izolTs^'^'ist'' 
"(A) provide that the medical assistance made available 
to individuals receiving aid or assistance under any such 
State plan— 
"(i) shall not be less in amount, duration, or scope 
than the medical assistance made available to individ-
uals receiving aid or assistance under any other such 
State plan, and 
"(ii) shall not be less in amount, duratioUj or scope 
than the medical or remedial care and services made 
available to individuals not receiving aid or assistance 
under any such plan; and 
"(B) if medical or remedial care and services are included 
for any group of individuals who are not receiving aid or 
a;ssistance under any such State plan and who do not meet 
the income and resources requirements of the one of such 
State plans which is appropriate, as determined in accord-
ance with standards prescribed by the Secretary, provide— 
"(i) for making medical or remedial care and serv-
ices available to all individuals who would, if needy, be 
eligible for aid or assistance under any such State plan 
and who have insufficient (as determined in accordance 
with comparable standards) income and resources to 
meet the costs of necessary medical or remedial care and 
services, and 
"(ii) that the medical or remedial care and services 
made available to all individuals not receiving aid or 
assistance under any such State plan shall be equal in 
amount, duration, and scope; 
except that the making available of the services described in 
paragraph (4) or (14) of section 1905(a) to individuals meet- Post, p. ssi. 
m^ the age requirement prescribed therein shall not, by reason of 
this paragraph (10), require the making available of any such 
services, or the making available of such services of the same 
amount, duration, and scope, to individuals of any other ages; 
"(11) provide for entering into cooperative arrangements 
with the State agencies responsible for administering or super-
vising the administration of health services and vocational 
rehabilitation services in the State looking toward maximum 
utilization of such services in the provision of medical assistance 
under the plan; 
"(12) provide that, in determining whether an individual is 
blind, there shall be an examination by a physician skilled in 
the diseases of the eye or by an optometrist, whichever the 
individual may select; 
"(13) provide for inclusion of some institutional and some 
noninstitutional care and services, and, effective July 1, 1967, 
provide (A) for inclusion of at least the care and services listed 
m clauses (1) through (5) of section 1905(a), and (B) for 
49-850 0-66—25 
346 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
payment of the reasonable cost (as determined in accordance 
with standards approved by the Secretary and included in the 
plan) of inpatient hospital services provided under the plan; 
"(14) provide that (A) no deduction, cost sharing, or similar 
charge will be imposed under the plan on the individual with 
respect to inpatient hospital services furnished him under the 
plan, and (B) any deduction, cost sharing, or similar charge 
imposed under the plan with respect to any other medical 
assistance furnished him thereunder, and any enrollment fee, 
premium, or similar charge imposed under the plan, shall be 
reasonably related (as determined in accordance with standards 
approved by the Secretary and included in the plan) to the 
recipient's income or his income and resources; 
"(15) in the case of eligible individuals 65 years of age or 
older who are covered by either or both of the insurance programs 
Ante. p. 291. 
established by title XVIII, provide— 
" (A) for meeting the full cost of any deductible imposed 
with respect to any such individual under the insurance pro-
gram established by part A of such title; and 
"(B) where, under the plan, all of any deductible, cost 
sharing, or similar charge imposed with respect to any such 
individual under the insurance program established by part 
B of such title is not met, the portion thereof which is met 
shall be determined on a basis reasonably related (as deter-
mined in accordance with standards approved by the Secre-
tary and included in the plan) to such individual's income or 
his income and resources; 
"(16) provide for inclusion, to the extent required by regula-
tions prescribed by the Secretary, of provisions (conforming to 
such regulations) with respect to the furnishing of medical assist-
ance under the plan to individuals who are residents of the State 
but are absent therefrom; 
" (17) include reasonable standards (which shall be comparable 
for all groups) for determining eligibility for and the extent of 
medical assistance under the plan which (A) are consistent with 
the objectives of this title, (B) provide for taking into account 
only such income and resources as are, as determined in accord-
ance with standards prescribed by the Secretary, available to the 
applicant or recipient and (in the case of any applicant or recipi-
ent who would, if he met the requirements as to need, be eligible 
for aid or assistance in the form of money payments under a State 
12S Tsli^Vas? ^' 
P l ^ approved under title I, IV, X, XIV, or XVI) as would not 
be disregarded (or set aside for future needs) in determining his 
eligibility for and amount of such aid or assistance under such 
plan, (C) provide for reasonable evaluation of any such income 
or resources, and (D) do not take into account the financial respon-
sibility of any individual for any applicant or recipient of assist-
ance under the plan unless such applicant or recipient is such 
individual's spouse or such individual's child who is under age 21 
or is blind or permanently^ and totally disabled; and provide for 
flexibility in the application of such standards with respect to 
income by taking into account, except to the extent prescribed by 
the Secretary, the costs (whether in the form of insurance pre-
miums or otherwise) incurred for medical care or for any other 
type of remedial care recognized under State law; 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
347 
" (18) provide that no lien may be imposed against the property 
of any individual prior to his death on account of medical assist-
ance paid or to be paid on his behalf under the plan (except 
pursuant to the judgment of a court on account of benefits in-
correctly paid on behalf of such individual), and that there shall 
be no adjustment or recovery (except, in the case of an individual 
who was 65 years of age or older when he received such assistance, 
from his estate, and then only after the death of his surviving 
spouse, if any, and only at a time when he has no surviving child 
who is under age 21 or is blind or permanently and totally dis-
abled) of any medical assistance correctly paid on behalf or such 
individual under the plan; 
"(19) provide such safeguards as may be necessary to assure 
that eligibility for care and services under the plan will be deter-
mined, and such care and services will be provided, in a manner 
consistent with simplicity of administration and the best inter-
ests of the recipients; 
"(20) if the State plan includes medical assistance in behalf of 
individuals 65 years of age or older who are patients in institutions 
for mental diseases— 
" (A) provide for having in effect such agreements or other 
arrangements with State authorities concerned with mental 
diseases, and, where appropriate, with such institutions, as 
may be necessary for carrying out the State plan, including 
arrangements for joint planning and for development of 
alternate methods of care, arrangements providing assurance 
of immediate readmittance to institutions where needed for 
individuals under alternate plans of care, and arrangements 
providing for access to patients and facilities, for furnishing 
information, and for making reports; 
"(B) provide for an individual plan for each such patient 
to assure that the institutional care provided to him is in his 
best interests, including, to that end, assurances that there will 
be initial and periodic review of his medical and other needs, 
that he will be given appropriate medical treatment within 
the institution, and that there will be a periodical determi-
nation of his need for continued treatment in the institution; 
"(C) provide for the development of alternate plans of 
care, making maximum utilization of available resources, for 
recipients 65 years of age or older who would otherwise need 
care in such institutions, including appropriate medical treat-
ment and other aid or assistance; for services referred to in 
section 3 fa) (4) (A) (i) and (ii) or section 1603(a) (4) (A) 
(i) and (ii) which are appropriate for such recipients and 
^6 stat. 173, 
for such patients; and for methods of administration neces- 
42 use 303, 
sary to assure that the responsibilities of the State agency i383. 
under the State plan with respect to such recipients and such 
patients will be effectively carried out; and 
"(D) provide methods of determining the reasonable cost 
of institutional care for such patients; 
"(21) if the State plan includes medical assistance in behalf of 
individuals 65 years of age or older who are patients in public 
institutions for mental diseases, show that the State is making 
satisfactory progress toward developing and implementing a com-
prehensive mental health program, including provision for utiliza-
tion of community mental health centers, nursing homes, and 
other alternatives to care in public institutions for mental dis-
eases; and 
348 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
" (22) include descriptions of (A) the kinds and numbei-s of pro-
fessional medical personnel and supporting staff that will be used 
in the administration of the plan and of the responsibilities they 
will have, (B) the standards, for private or public institutions in 
which recipients of medical assistance under the plan may receive 
care or services, that will be utilized by the State authority or 
authorities responsible for establishing and maintaining such 
standards, (C) the coop|erative arrangements with State health 
agencies and State vocational rehabilitation agencies entered into 
with a view to maximum utilization of and coordination of the 
provision of medical assistance with the services administered or 
supervised by such agencies, and (D) other standards and methods 
that the State will use to assure that medical or remedial care and 
services provided to recipients of medical assistance are of high 
quality. 
Notwithstanding paragraph (5), if on January 1,1965, and on the date 
on which a State submits its plan for approval under this title, the 
State agency which administered or supervised the administration of 
1206 "fas/AVs's 
^^^ P^^^ ^^ ^^^^ State approved under title X (or title XVI, insofar as 
it relates to the blind) was different from the State agency which 
administered or supervised the administration of the State plan 
42 use 301-306. approvcd under title I (or title XVI, insofar as it relates to the aged), 
the State agency which administered or supervised the administration 
of such plan approved under title X (or title XVI, insofar as it relates 
to the blind) may be designated to administer or supervise the admin-
istration of the portion of the State plan for medical assistance which 
relates to blind individuals and a different State agency may be estab-
lished or designated to administer or supervise the administration of 
the rest of the State plan for medical assistance; and in such case the 
part, of the plan which each such agency administers, or the adminis-
tration of which each such agency supervises, shall be regarded as a 
separate plan for purposes of this title (except for purposes of 
parasfraph (10)). 
" (b) The Secretary shall approve any plan which fulfills the con-
ditions specified in subsection (a), except that he shall not approve 
any plan which imposes, as a condition of eligibility for medical 
assistance under the plan— 
"(1) an age requirement of more than 65 years; or 
"(2) effective July 1,1967, any age requirement which excludes 
any individual who has not attained the age of 21 and is or would, 
78 Stat. 1042. 
except for the provisions of section 406(a) (2), be a dependent 
I 2 S ? 6211609. 
child under title I V ; or 
. , . . . , 
"(3) any residence requirement which excludes any individual 
who resides in the State; or 
"(4) any citizenship requirement which excludes any citizen 
of the United States. 
"(c) Notwithstanding subsection (b), the Secretary shall not 
approve any State plan for medical assistance if he determines that 
the approval and operation of the plan will result in a reduction in aid 
or assistance (other than so much of the aid or assistance as is pro-
vided for under the plan of the State approved under this title) 
provided for eligible individuals under a plan of such State approved 
42 use 301 et 
^^^^^j, ^jtle I, IV, X, XIV, Or XVI. 
seq. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
349 
"PAYMENT TO STATES 
"SEC. 1903. (a) From the sums appropriated therefor, the Secre-
tary (except as otherwise provided m this section and section 1117) 
P°«'' P- ^^2O. 
shall pay to each State which has a plan approved under this title, 
for each quarter, beginning with the quarter commencing January 1, 
1966— 
"(1) an amount equal to the Federal medical assistance per-
centage (as defined in section 1905(b)) of the total amoiint 
expended during such quarter as medical assistance under the 
State plan (including expenditures for premiums under part B 
of title XVIII, for individuals who are recipients of money pay- ^"f^' P- ''oi. 
ments under a State plan approved under title I, IV, X, XlV, 
or XVI, and other insurance premiums for medical or any other 1
2
0
^
1 "f35f'VasV' 
type of remedial care or the cost thereof); plus 
" (2) an amount equal to 75 per centum of so much of the sums 
expended during such quarter (as found necessary by the Secre-
tary for the proper and efficient administration of the State plan) 
as are attributable to compensation or training of skilled profes-
sional medical personnel, and staff directly supporting such per-
sonnel, of the State agency (or of the local agency administering 
the State plan in the political subdivision); plus 
" (3) an amount equal to 50 per centum of the remainder of the 
amounts expended during such quarter as found necessary by the 
Secretary for the proper and efficient administration of the State 
plan. 
"(b) Notwithstanding the preceding provisions of this section, the 
amount determined under such provisions for any State for any quar-
ter which is attributable to expenditures with respect to individuals 
65 years of age or older who are patients in institutions for mental 
diseases shall be paid only to the extent that the State makes a showing 
satisfactory to the Secretary that total expenditures from Federal, 
State, and local sources for mental health services (including pay-
ments to or in behalf of individuals with mental health problems) 
under State and local public health and public welfare programs for 
such quarter exceed the average of the total expenditures from such 
sources for such services under such programs for each quarter of the 
fiscal year ending June 30, 1965. For purposes of this subsection, 
expenditures for such services for each quarter in the fiscal year ending 
June 30,1965, in the case of any State shall be determined on the basis 
of the latest data, satisfactory to the Secretary, available to him at the 
time of the first determination by him under this subsection for such 
State; and expenditures for such services for any quarter beginning 
after December 31,1965, in the case of any State shall be determined 
on the basis of the latest data, satisfactory to the Secretary, available 
to him at the time of the determination under this subsection for such 
State for such quarter; and determinations so made shall be conclusive 
for purposes of this subsection. 
"(c)(1) If the Secretary finds, on the basis of satisfactory informa-
tion furnished by a State, that the Federal medical assistance percent-
age for such State applicable to any quarter in the period beginning 
January 1, 1966, and ending with the close of June 30, 1969, is less 
than 105 per centum of the Federal share of medical expenditures 
by the State during the fiscal year ending June 30,1965 (as determined 
under paragraph (2)), then 105 per centum of such Federal share 
shall be the Federal medical assistance percentage (instead of the 
percentage determined under section 1905(b)) for such State for 
1203, 1353, 1383. 
350 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
such quarter and each quarter thereafter occurring in such period and 
prior to the first quarter with respect to which such a finding is not 
applicable. 
"(2) For purposes of paragraph (1), the Federal share of medical 
expenditures by a State during the fiscal year ending June 30, 1965, 
means the percentage which the excess of— 
"(A) the total of the amounts determined under sections 3, 
42 use 303,603, 
403, 1003, 1403, and 1603 with respect to expenditures by such 
State during such year as aid or assistance under its State plans 
approved under titles I, IV, X, XIV, and XVI, over 
"(B) the total of the amounts which would have been deter-
mined under such sections with respect to such expenditures dur-
ing such year if expenditures as aid or assistance in the form of 
medical or any other type of remedial care had not been counted, 
is of the total expenditures as aid or assistance in the form of medical 
or any other tjj^pe of remedial care under such plans during such year. 
" (d) (1) Prior to the beginning of each quarter, the Secretary shall 
estimate the amount to which a State will be entitled under subsections 
(a), (b), and (c) for such quarter, such estimates to be based on 
(A) a report filed by the State containing its estimate of the total 
sum to be expended in such quarter in accordance with the provisions 
of such subsections, and stating the amount appropriated or made 
available by the State and its political subdivisions for such expendi-
tures in such quarter, and if such amount is less than the State's 
proportionate share of the total sum of such estimated expenditures, 
the source or sources from which the difference is expected to be 
derived, and (B) such other investigation as the Secretary may find 
necessary. 
"(2) The Secretary shall then pay to the State, in such installments 
as he may determine, the amount so estimated, reduced or increased 
to the extent of any overpayment or underpayment which the Secre-
tary determines was made under this section to such State for any 
prior quarter and with respect to which adjustment has not already 
been made under this subsection. 
"(3) The pro rata share to which the United States is equitably 
entitled, as determined by the Secretary, of the net amount recovered 
during any quarter by the State or any political subdivision thereof 
with respect to medical assistance furnished under the State plan 
shall be considered an overpayment to be adjusted under this 
subsection. 
" (4) Upon the making of any estimate by the Secretary under this 
subsection, any appropriations available for payments under this 
section shall be deemed obligated. 
"(e) The Secretary shall not make payments under the preceding 
]Drovisions of this section to any State unless the State makes a satis-
factory showing that it is making efforts in the direction of broaden-
ing the scope of the care and services made available under the plan 
and in the direction of liberalizing the eligibility requirements for 
medical assistance, with a view toward furnishing by July 1,1975, com-
prehensive care and services to substantially all individuals who meet 
the plan's eligibility standards with respect to income and resources, 
including services to enable such individuals to attain or retain inde-
])eiidence or self-care. 
79 STAT. ] 
PUBLIC L
A
W 89-97-JULY 30,1965 
351 
"OPERATION OF STATE PLANS 
"SEC. 1904. If the Secretary, after reasonable notice and opportunity 
for hearing to the State agency administering or supervising the ad-
ministration of the State plan approved under this title, finds— 
"(1) that the plan has been so changed that it no longer com-
plies with the provisions of section 1902; or 
"(2) that in the administration of the plan there is a failure 
to comply substantially with any such provision; 
the Secretary shall notify such State agency that further payments 
will not be made to the State (or, in his discretion, that payments will 
be limited to categories under or parts of the State plan not affected 
by such failure), until the Secretary is satisfied that there will no 
longer be any such failure to comply. Until he is so satisfied he shall 
make no further payments to such State (or shall limit payments to 
categories under or parts of the State plan not affected by such 
failure). 
"DEFINITIONS 
"SEC. 1905. For purposes of this title— 
"(a) The term 'medical assistance' means payment of part or all 
of the cost of the following care and services (if provided m or after 
the third month before the month in which the recipient makes 
application for assistance) for individuals who are— 
" ri) under the age of 21, 
"(ii) relatives specified in section 406(b)(1) with whom a j^tttt^\^g^%o 
child is living if such child, except for section 406(a) (2), is (or 4
2 use eoe. 
would, if needy, be) a dependent child under title IV, 
„ 7
8 stat. 1042; 
U/"K ntf 
J 
1J3 
Post, p. 422, 
(ill) 65 years of age or older, 
4
2 use eo 1-609. 
"fiv) blind, or 
"(v) 18 years of age or older and permanently and totally 
disabled, 
but whose income and resources are insufficient to meet all of such 
cost— 
"(1) inpatient hospital services (other than services in an 
institution for tuberculosis or mental diseases); 
" ^2) outpatient hospital services; 
"(3) other laboratory and X-ray services; 
"(4) skilled nursing home services (other than services in an 
institution for tuberculosis or mental diseases) for individuals 
21 years of a ^ or older; 
"(6) physicians' services, whether furnished in the office, the 
patient's home, a hospital, or a skilled nursing home, or elsewhere; 
"(6) medical care, or any other tyjpe of remedial care recog-
nized under State law, furnished by licensed practitioners withm 
the scope of their practice as defined by State law; 
f7) home health care services; 
;8) private duty nursing services; 
19) clinic services; 
10) dental services; 
^11^ physical therapy and related services; 
12) prescribed drugs, dentures, and prosthetic devices; and 
eyeglasses prescribed by a physician skilled in diseases of the 
eye or by an optometrist, whichever the individual may select; 
" (13) other diagnostic, screening, preventive, and rehabilitative 
services; 
352 
PUBLIC L
A
W 89-97-JULY 30, 1965 
[79 STAT. 
"(14) inpatient hospital services and skilled nursing home serv-
ices for individuals 65 years of age or over in an institution for 
tuberculosis or mental diseases; and 
"(15) anj other medical care, and any other type of remedial 
care recognized under State law, specified by the Secretary; 
except that such term does not include— 
"(A) any such payments with respect to care or services for 
any individual who is an inmate of a public institution (except as 
a patient in a medical institution); or 
"(B) anv such payments with respect to care or services for 
any individual who has not attained 65 years of age and who is 
a patient in an institution for tuberculosis or mentafdiseases. 
"(b) The term 'Federal medical assistance percentage' for any State 
shall be 100 per centum less the State percentage; and the State per-
centage shall be that percentage which bears the same ratio to 45 per 
centum as the square of the ^er capita income of such State bears to 
the square of the per capita income of the continental United States 
(including Alaska) and Hawaii; except that (1) the Federal medical 
assistance percentage shall in no case be less than 50 per centum or 
more than 83 per centum, and (2) the Federal medical assistance per-^ 
centage for Puerto Rico, the Virgin Islands, and Guam shall be 55 per 
centum. The Federal medical assistance percentage for any State 
shall be determined and promulgated in accordance with the provisions 
4
2 u^c u ^1*' 
^^ subparagraph (B) of section 1101 (a) (8); except that the Secretary 
shall promulgate such percentage as soon as possible after the enact-
ment of this title, which promulgation shall be conclusive for each of 
the six quarters in the period beginning January 1, 1966, and ending 
with the close of June 30,1967." 
(b) No payment may be made to any State under title I, IV, X, 
4
2 use 301 et 
XIV, or XVI of the Social Security Act with respect to aid or assist-
^*'^' 
ance in the form of medical or any other type of remedial care for 
Ante, p. 343. 
any period for which such State receives payments under title XIX 
of such Act, or for any period after December 31, 1969. 
(c) (1) Effective January 1,1966, section 1101(a) (1) of the Social 
-rJL^l^^^^I^' 
Security Act is amended by striking out "and XVI" and inserting in 
76 Stat. 20|6. 
. . 
. J 
<
; «-V-TTT 
J 
- V T V ? ) 
4
2 use 1301. 
lieu thereof "XVI, and XIX". 
4
2 use 1
^
3
0
9 
(^) Section 1109 of such Act is amended to read as follows: 
"AMOUNTS DISREGARDED NOT TO BE TAKEN INTO ACCOUNT I N DETERMINING 
ELIGIBILITR OF OTHER INDIVIDUALS 
"SEC. 1109. Any amount which is disregarded (or set aside for 
future needs) in determining the eligibility of and amount of the aid 
or assistance for any individual under a State plan approved under 
title I, IV, X, XIV, XVI, or XIX shall not be taken mto considera-
tion in determining the eligibility of and amount of aid or assistance 
for any other individual under a State plan approved under any other 
of such titles." 
7
6 Stat. 192. 
(3) Effectivo JaixuaTy 1,1966, section 1115 of such Act is amended 
4
2 use 1315. 
^y striking out "or XVI", "or 1602", and "or 1603" and inserting in 
lieu thereof "XVI, or XIX", "1602, or 1902", and "1603, or 1903", 
respectively. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
353 
PAYMENT BY STATES OF PREMIUMS FOR SUPPLEMENTARY 
MEDICAL INSURANCE 
SEC. 122. Sections 3(a), 403(a), 1003(a), 1403(a), and 1603(a) of 
the Social Security Act are each amended by inserting "premiums 174^ fng^j^^'*' 
under part B of title X V I I I for individuals who are recipients of 
42 use 303', 603, 
money payments under such plan and other" after "expenditures for" 1203, 1353, isss. 
in the parenthetical phrase appearing in so much of paragraph (1) 
thereof as precedes clause (A), and in the parenthetical phrase 
appearing in paragraph (2) thereof. 
TITLE II—OTHER AMENDMENTS RELATING TO 
H E A L T H CARE 
PART 1—MATERNAL AND CHILD HEALTH AND CRIPPLED 
CHILDREN'S SERVICES 
I N C R E A S E I N MATERNAL AND CHILD HEALTH SERVICES 
SEC. 201. (a) The first sentence of section 501 of the Social Security 
Act is amended by striking out "$40,000,000" and all that follows and 
77 staj. 273. 
inserting in lieu thereof "$45,000,000 for the fiscal year ending June 
^^ 
^°^" 
30, 1966, $50,000,000 for the fiscal year ending June 30, 1967, 
$55,000,000 for the fiscal year ending June 30,1968, $55,000,000 for the 
fiscal year ending June 30, 1969, and $60,000,000 for the fiscal year 
ending JiHie 30,1970, and each fiscal year thereafter." 
(b) Section 504 of such Act is amended by adding at the end 
'•^ ^^^^- ^^°-
thereof the loilowmg new subsection: 
"(d) Notwithstanding the preceding provisions of this section, no 
payment shall be made to any State thereunder for any period after 
June 30,1966, unless it makes a satisfactory showing that the State is 
extending the provision of maternal and child health services in the 
State with a view to making such services available by July 1,1975, to 
children in all parts of the State." 
INCREASE IN CRIPPLED CHILDREN'S SERVICES 
42 use 704. 
SEC. 202. (a) The first sentence of section 511 of the Social Security 
Act is amended by striking out "$40,000,000" and all that follows and 
77 st^au 273. 
inserting in lieu thereof "$45,000,000 for the fiscal year ending June 
"^^ 
' ^^^' 
30, 1966, $50,000,000 for the fiscal year ending June 30, 1967, 
$55,000,000 for the fiscal year ending June 30,1968, $55,000,000 for the 
fiscal year ending June 30, 1969, and $60,000,000 for the fiscal year 
ending June 30,1970, and each fiscal year thereafter." 
(b) Section 514 of such Act is amended by adding at the end sg'^ltat^^Is"^' 
thereof the following new subsection: 
42 use 7
1
4
*
. 
"(d) Notwithstanding the preceding provisions of this subsection, 
no payment shall be made to any State thereunder for any period after 
June 30, 1966, unless it makes a satisfactory showing that the State 
is extending the provision of crippled children's services in the State 
with a view to making such services available by July 1, 1975, to 
children in all parts of the State." 
TRAINING OF PROFESSIONAL PERSONNEL FOR THE CARE OF CRIPPLED 
CHILDREN 
SEC. 203. (a) Part 2 of title V of the Social Security Act is amended 
^9 stau 63 u^ ^^ 
by adding at the end thereof the following new section: 
354 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
(' 
TRAINING OF PROFESSIONAL PERSONNEL 
"SEC. 516. There are authorized to be appropriated $5,000,000 for 
the fiscal year ending June 30, 1967, $10,000,000 for the fiscal year 
ending June 30, 1968, and $17,500,000 for each fiscal year thereafter, 
for grants hj the Secretary to public or other nonprofit institutions of 
higher learning for training professional personnel for health and 
related care of crippled children, particularly mentally retarded chil-
dren and children with multiple handicaps." 
42 u^c 7
\
^
4 ^
* 
(^) '^^^ second sentence of section 514(c) of such Act is amended 
by striking out "section 512(b)" and inserting in lieu thereof "section 
512(b) or 516". 
PAYMENT FOR I N P A T I E N T HOSPITAL SERVICES 
42 us^c 7?3* 
^^^' ^9^' (^) Section 503(a) of the Social Security Act is amended 
by striking out "and" before clause (7) and by inserting before the 
period at the end thereof the following new clause: "; and (8) effective 
July 1,1967, provide for payment of the reasonable cost (as determined 
in accordance with standards approved by the Secretary and included 
in the plan) of inpatient hospital services provided under the plan". 
42 use 713. 
^|3^ Section 513(a) of such Act is amended by striking out "and" 
before clause (6) and by inserting before the period at the end thereof 
the following new clause: "; and (7) effective July 1, 1967, provide 
for payment of the reasonable cost (as determined in accordance with 
standards approved by the Secretary and included in the plan) of 
inpatient hospital services provided under the plan". 
SPECIAL 
PROJECT 
GRANTS 
FOR 
H E A L T H 
OF 
SCHOOL 
AND 
PRESCHOOL 
CHILDREN 
42usc'729^729a. 
^^C- ^05. Part 4 of title V of the Social Security Act is amended 
(1) by revising the heading thereof to read as follows: "PART 4— 
GRANTS FOR SPECIAL MATERNITY AND INFANT CARE PROJECTS, FOR 
PROJECTS FOR HEALTH OF SCHOOL AND PRESCHOOL CHILDREN, AND FOR 
KESEARCH PROJECTS"; (2) by redesignating section 532 as section 
533; and (3) by inserting after section 531 the following new section: 
"SPECIAL PROJECT GRANTS FOR HEALTH OF SCHOOL AND PRESCHOOL 
CHILDREN 
"SEC. 532. (a) In order to promote the health of children and 
youth of school or preschool age, particularly in areas with concentra-
tions of low-income families, there are authorized to be appropriated 
$15,000,000 for the fiscal year ending June 30, 1966, $35,000,000 for 
the fiscal year ending June 30, 1967, $40,000,000 for the fiscal year 
ending June 30, 1968, $45,000,000 for the fiscal year ending June 30, 
1969, and $50,000,000 for the fiscal year ending June 30,1970, for grants 
as provided in this section. 
"(b) From the sums appropriated pursuant to subsection (a), the 
Secretary is authorized to make grants to the State health agency of 
any State and (with the consent of such agency) to the health agency 
of any political subdivision of the State, to the State agency of the 
State administering or supervising the administration of the State 
plan approved under section 513, to any school of medicine (with 
appropriate participation by a school of dentistry), and to any teach-
ing hospital affiliated with such a school, to pay not to exceed 75 per 
centum of the cost of projects of a comprehensive nature for health 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
355 
care and services for children and youth of school age or for preschool 
children (to help them prepare to start school). No projept shall be 
eligible for a grant under this section unless it provides (1) for the 
coordination of health care and services provided under it with, and 
utilization (to the extent feasible) of, other State or local health, 
welfare, and education programs for such children, (2) for payment 
of the reasonable cost (as determined in accordance with standards 
approved by the Secretary) of inpatient hospital services provided 
under the project, and (3) that any treatment, correction of defects, 
or aftercare provided under the project is available only to children 
who would not otherwise receive it because they are from low-income 
families or for other reasons beyond their control; and no such 
project for children and youth of school age shall be considered to be 
of a comprehensive nature for purposes of this section unless it includes 
(subject to the limitation in the preceding provisions of this sentence) 
at least such screening, diagnosis, preventive services, treatment, cor-
rection of defects, and aftercare, both medical and dental, as may be 
provided for in regulations of the Secretary. 
"(c) Payment of grants under this section may be made (after nec-
essary adjustment on account of previously made underpayments or 
overpayments) in advance or by way of reimbursement, and in such 
installments and on such conditions, as the Secretary may determine.-' 
EVALUATION AND REPORT 
SEC. 206. The Secretary shall submit to the President for transmis- ^^^^°^^ corress 
sion to the Congress before July 1,1969, a full report of the adminis- 
" ^" 
ongress. 
tration of the provisions of section 532 of the Social Security Act (as 
added by section 205 of this Act), together with an evaluation of the 
program established thereby and his recommendations as to continua-
tion of and modifications in that program. 
INCREASE I N CHILD WELFARE SERVICES 
SEC. 207. Section 621 of the Social Security Act is amended by strik- 
'^^ use 721. 
ing out "$40,000,000" and all that follows and inserting in lieu thereof 
"$40,000,000 for the fiscal year ending June 30, 1965, $45,000,000 for 
the fiscal year ending June 30,1966, $50,000,000 for the fiscal year end-
ing June 30,1967, $55,000,000 for the fiscal year ending June 30,1968, 
$55,000,000 for the fiscal year ending June 30, 1969, and $60,000,000 
for the fiscal year ending June 30,1970, and each fiscal year thereafter." 
DAT CARE SERVICES 
SEC. 208. (a)(1) Part 3 of title V of the Social Security Act is 
amended by striking out section 527. 
76 stat^. iss. 
(2) The second sentence of section 1108 of such Act is amended by 
striking out "522(a), and 527(a)" and inserting in lieu thereof "and 
522(a)" and by striking out "(or, in the case of section 527(a), the 
minimum)". 
(b) Section 522 of such Act is amended to read as follows: 
'^'^ ^^^ -'^s 
"ALLOTMENTS TO STATES 
"SEC. 522. The sum appropriated pursuant to section 521 for each 
fiscal year shall be allotted by the Secretary for use by cooperating 
State public welfare agencies which have plans developed jointly by 
the State agency and the Secretary, as follows: He shall allot $70,000 
42 u s e 727. 
42 u s e 1.308. 
356 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
to each State, and shall allot to each State an amount which bears the 
same ratio to the remainder of the smn so appropriated for such year 
as the product of (1) the population of such State under the age of 21 
and (2) the allotment percentage of such State (as determined under 
42 use 724. 
section 524) bears to the sum of the corresponding products of all the 
States." 
42 use 723. 
(c) Section 523(a) (1) (B) of such Act is amended by striking out 
"and" at the end of clause (lii) and by inserting after clause (iv) the 
following new clause: 
"(v) that day care j)rovided under the plan will be 
provided only in facilities (including private homes) 
which are licensed by the State, or approved (as meeting 
the standards established for such licensing) by the State 
agency responsible for licensing facilities of this type, 
and", 
(d) The amendments made by this section shall take effect on 
January 1,1966. 
Effective date. 
PART 2—IMPLEMENTATION OF MENTAL EETTARDATION PLANNING 
AUTHORIZATION OP APPROPRIATIONS 
42 us^c 1
^
3
9
1 
^^^' ?^^' (^) Section 1701 of the Social Security Act is amended 
bv adding at the end thereof the following new sentence: "There are 
also authorized to be appropriatedj for assisting such States in initiat-
ing the implementation and carrymg out of planning and other steps 
to combat mental retardation, $2,750,000 for the fiscal year ending 
June 30,1966, and $2,750,000 for the fiscal year ending June 30,1967.^' 
42 use 139 2. 
(b) xjie first sentence of section 1702 of such Act is amended by 
inserting "the first sentence of" before "section 1701" and by inserting 
the following before the period at the end thereof "; and the sums 
appropriated pursuant to the second sentence of such section for the 
fiscal year ending June 30, 1966, shall be available for such grants 
during such year and the next two fiscal years, and sums appropriated 
pursuant thereto for the fiscal year ending June 30, 1967, shall be 
available for such grants during such year and the succeeding fiscal 
year". 
PART 3—PUBLIC ASSISTANCE AMENDMENTS RELATING TO HEALTH 
CARE 
REMOVAL o r LIMITATIONS ON FEDERAL PARTICIPATION IN ASSISTANCE TO 
INDIVIDUALS WITH TUBERCULOSIS OR MENTAL DISEASE 
^ 64 s^tat^ M9; 
SEC. 221. (a)(1) Sectlon 6(a) of the Social Security Act is amended 
Post^p. 415. 
to read as follows: 
42 use 306. 
'<(a) For the purposes of this title, the term 'old-age assistance' 
means money payments to, or (if j)roviaed in or after the third month 
before the month in which the recipient makes application for assist-
ance) medical care in behalf of or any t^pe of remedial care recognized 
under State law in behalf of, needy individuals who are 65 years of age 
or older, but does not include any such payments to or care m behalf of 
any individual who is an inmate of a public institution (except as a 
patient in a medical institution)." 
(2) Section 6(b) of such Act is amended by striking out all that 
follows clause (12) and inserting in lieu thereof the following: 
"except that such term does not include any such payments with 
respect to care or services for any individual who is an inmate of a 
public institution (except as a patient in a medical institution)." 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
357 
(8) Section 2(a) of such Act is amended (A) by striking out "and" 
4
^
2 use 3^2' 
at the end of paragraph (10); (B) by striking out the period at the 
end of para^aph (11) and inserting in lieu thereof a semicolon; and 
(C) by adding after paragraph (11) the following new paragraphs: 
"(12) if the State plan includes assistance to or m bSialf of 
individuals who are patients in institutions for mental diseases— 
"(A) provide for having in effect such agreements or 
other arrangements with State authorities concerned with 
mental diseases, and, where appropriate, with such institu-
tions, as may be necessary for carrying out the State plan, 
including arrangements for joint planning and for develop-
ment of alternate methods of care, arrangements providing 
assurance of immediate readmittance to institutions where 
needed for individuals under alternate plans of care, and 
arrangements providing for access to patients and facilities, 
for furnishing information, and for making reports; 
"(B) provide for an individual plan for each such patient 
to assure that the institutional care provided to him is in 
his best interests, including, to that end, assurances that there 
will be initial and periodic review of his medical and other 
needs, that he will oe given appropriate medical treatment 
within the institution, and that there will be a periodic deter-
mination of his need for continued treatment in the 
institution; 
"(C) provide for the development of alternate plans of 
care, making maximum utilization of available resources^ for 
recipients vmo would otherwise need care in such institutions, 
including appropriate medical treatment and other assistance; 
for services referred to in section 3(a) (4) (A) (i) and (ii) 
''^ ^*sc 3^3^' 
which are appropriate for such recipients and for sucli 
patients; and for methods of administration necessary to 
assure that the responsibilities of the State agency under the 
State plan with respect to such recipients and such patients 
will be effectively carried out; and 
"(D) provide methods of determining the reasonable cost 
of institutional care for such patients; and 
"(13) if the State plan includes assistance to or in behalf of 
patients in public institutions for mental diseases, show that the 
State is making satisfactory progress toward developing and 
implementing a comprehensive mental health program, including 
l)rovision for utilization of community mental health centers, 
nursing homes, and other alternatives to care in public institu-
tions for mental diseases." 
(4) Section 3 of such Act is amended by adding at the end thereof yg^ltat^Y//^^' 
the following new subsection: 
42 use 3o'3. 
"(d) Notwithstanding the preceding provisions of this section, the 
amount determined under such provisions for any State for any quar-
ter which is attributable to expenditures with respect to patients in 
institutions for mental diseases shall be paid only to the extent that 
the State makes a showing satisfactoir to the Secretary that total 
expenditures in the State from Federal, State, and local sources for 
mental health services (including payments to or in behalf of individ-
uals with mental health problems) under State and local public 
health and public welfare programs for such quarter exceed the aver-
age of the total expenditures m the State from such sources for such 
services under such programs for each Quarter of the fiscal year ending 
June 30,1965. For purposes of this suosection, expenditures for such 
services for each quarter in the fiscal year ending June 30,1965, in the 
358 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
case of any State shall be determined on the basis of the latest data, 
satisfactor;^ to the Secretary, available to him at the time of the first 
determination by him under this subsection for such State; and 
expenditures for such services for any quarter beginning after Decem-
ber 31, 1965, in the case of any State shall be determined on the basis 
of the latest data, satisfactory to the Secretary, available to him at the 
time of the determination under this subsection for such State for such 
quarter; and determinations so made shall be conclusive for purposes 
of this subsection." 
Pott^T-^416^' 
i^) Section 1006 of such Act is amended by striking out clauses 
42'use 1206. 
(a) and (b) and inserting in lieu thereof the following: "who is a 
patient in an institution for tuberculosis or mental diseases". 
42 use'1355*. 
(^) Section 1405 of such Act is amended by striking out clauses 
(a) and (b) and inserting in lieu thereof the following: "who is a 
patient in an institution for tuberculosis or mental diseases". 
plltfIT416^' 
(d)(1) Section 1605 (a) of such Act is amended to read as follows: 
42 use 1385, 
"(a) For purposes of this title, the term 'aid to the aged, blind, or 
disabled' means money payments to, or (if provided in or after the 
third month before the month in which the recipient makes application 
for aid) medical care in behalf of or any type of remedial care recog-
nized under State law in behalf of, needy individuals who are 65 years 
of age or older, are blind, or are 18 years of age or over and perma-
nently and totally disabled, but such term does not include— 
"(1) any such payments to or care in behalf of any individual 
who is an inmate of a public institution (except as a patient in a 
medical institution); or 
"(2) any such payments to or care in behalf of any individual 
who has not attained 65 jedivs of age and who is a patient in an 
institution for tuberculosis or mentS diseases." 
(2) Section 1605 (b) of such Act is amended by striking out all that 
follows clause (12) and inserting in lieu thereof the following: 
"except that such term does not include any such payments with 
respect to care or services for any individual who is an inmate of a 
public institution (except as a patient in a medical institution)." 
(3) Section 1602(a) of such Act (as amended by section 403(e) of 
Post, p. 418. 
this Act) is amended (A) by striking out "and" at the end of para-
graph (14); (B) by striking out the period at the end of paragraph 
(15) and inserting in lieu thereof a semicolon; and (C) by adding 
after paragraph (15) the following new paragraphs: 
" (16) if the State plan includes aid or assistance to or in behalf 
of individuals 65 years of age or older who are patients in insti-
tutions for mental diseases— 
" (A) provide for having in effect such agreements or other 
arrangements with State authorities concerned with mental 
diseases, and, where appropriate, with such institutions, as 
may be necessary for carrying out the State plan, including 
arrangements for joint planning and for development of 
alternate methods of care, arrangements providing assurance 
of immediate readmittance to institutions where needed for 
individuals under alternate plans of care, and arrangements 
providing for access to patients and facilities, for furnishing 
information, and for making reports; 
"(B) provide for an individual plan for each such patient 
to assure that the instit-itional care provided to him is in his 
best interests, including, to that end, assurances that there 
will be initial and periodic review of his medical and other 
needs, that he will oe given appropriate medical treatment 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
359 
within the institution, and that there will be a periodic 
determination of his need for continued treatment in the 
institution; 
"(C) provide for the development of alternate plans of 
care, making maximum utilization of available resources, 
for recipients 65 years of age or older who would otherwise 
need care in such institutions, including appropriate medi-
cal treatment and other aid or assistance; for services 
referred to in section 1603(a)(4)(A) (i) and (ii) which 
76 stat. 200. 
are appropriate for such recipients and for such patients; 
'^^ 
^^^^' 
and for methods of administration necessary to assure that 
the responsibilities of the State agency under the State 
plan with respect to such recipients and such patients will 
be effectively carried out; and 
"(D) provide methods of determining the reasonable cost 
of institutional care for such patients; and 
"(17) if the State plan includes aid or assistance to or in 
behalf of individuals 65 years of a^e or older who are patients 
in public institutions for mental diseases, show that the State 
is making satisfactory progress toward developing and imple-
menting a comprehensive mental health program, including 
provision for utilization of community mental health centers, 
nursing homes, and other alternatives to care in public institu-
tions for mental diseases." 
(4) Section 1603 of such Act is amended by adding at the end 
thereof the following new subsection: 
"(d) Notwithstanding the preceding provisions of this section, the 
amount determined under such provisions for any State for any 
quarter which is attributable to expenditures with respect to in-
dividuals 65 years of age or older who are patients in institutions for 
mental diseases shall be paid only to the extent that the State makes a 
showing satisfactory to the Secretary that total expenditures in the 
State from Federal, State, and local sources for mental health services 
(including payments to or in behalf of individuals with mental health 
problems) under State and local public health and public welfare 
programs for such quarter exceed the average of the total expenditures 
in the State from such sources for such services under such programs 
for each quarter of the fiscal year ending June 30,1965. For purposes 
of this subsection, expenditures for such services for each quarter in 
the fiscal year ending June 30, 1965, in the case of any State shall be 
determined on the basis of the latest data, satisfactory to the Secretary, 
available to him at the time of the first determination by him under 
this subsection for such State; and expenditures for such services for 
any quarter beginning after December 31, 1965, in the case of any 
State shall be determined on the basis of the latest data, satisfactory 
to the Secretary, available to him at the time of the determination 
under this subsection for such State for such quarter; and determina-
tions so made shall be conclusive for purposes of this subsection.'' 
(e) The amendments made by this section shall apply in the case 
of expenditures made after D u m b e r 31, 1965, under a State plan 
approved under title I, X, XIV, or XVI of the Social Security Act. 
^2 use 301 et 
acq. 
360 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
74 Stat. 991. 
42 use 306. 
76 Stat, 204. 
42 use 1385. 
42 use 301, 
1385. 
AMENDMENT TO DEFINITION OF MEDICAL ASSISTANCE FOR THE AGED 
SEC. 222. (a^ Section 6(b) of the Social Security Act is amended by 
striking out "who are not recipients of old-age assistance" and in-
serting in lieu thereof "who are not recipients of old-age assist-
ance (except, for any month, for recipients of old-age assistance who 
are admitted to or discharged from a medical institution during such 
month)". 
(b) Section 1605(b) of such Act is amended by striking out "who 
are not recipients of aid to the a^d, blind, or disabled" and inserting 
in lieu thereof "who are not recipients of aid to the aged, blind, or 
disabled (except, for any month, for recipients of aid to the aged, blind, 
or disabled who are admitted to or discharged from a medical institu-
tion during such month)". 
(c) The amendments made by this section shall apply in the case 
of expenditures under a State plan approved under title I or XVI of 
the Social Security Act with respect to care and services provided 
under such plan after June 1965. 
PART 4—MISCELLANEOUS AMENDMENTS RELATING TO HEALTH CARE 
HEALTH STUDY OF RESOURCES RELATING TO CHILDREN'S EMOTIONAL 
ILLNESS 
Program grants. 
ggc. 231. (a) Tlio Secretary of Health, Education, and Welfare 
is authorized, upon the recommendation of the National Advisory 
Mental Health Council and after securing the advice of experts in 
pediatrics and child welfare, to make grants for carrying out a pro-
gram of research into and study of our resources, methods, and prac-
tices for diagnosing or preventing emotional illness in children and 
of treating, caring for, and rehabilitating children with emotional 
illnesses. 
(b) Such grants may be made to one or more organizations, but 
only on condition that the organization will undertake and conduct, 
or if more than one organization is to receive such grants, only on 
condition that such organizations have agreed among themselves to 
imdertake and conduct, a coordinated program of research into and 
study of all aspects of the resources, methods, and practices referred 
to in subsection (a). 
(c) As used m subsection (b), the term "organization" means a 
nongovernmental agency, or^nization, or commission, composed of 
representatives of leading national medical, welfare, educational, and 
other professional associations, organizations, or agencies active in the 
field of mental health of children. 
(d) There are authorized to be appropriated for the fiscal year 
ending June 30, 1966, the sum of $500,000 to be used for a grant or 
grants to help initiate the research and study provided for in this 
section; and the sum of $500,000 for the succeeding fiscal year for the 
making of such grants as may be needed to carry the research and 
study to completion. The terms of any such grant shall provide that 
the research and study shall be completed not later than two years 
from the date it is inaugurated; that the grantee shall file annual 
reports with the Congress, the Secretary, and the Governors of the 
several States, among others that the grantee may select; and that the 
final report shall be similarly filed. 
"Organization.'* 
Appropriation. 
Reports to eon-
gress. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
TITLE III—SOCIAL SECUEITY AMENDMENTS 
SHORT TITLE 
SEO. 300. This title may be cited as the "Old-Age, Survivors, and 
Disability Insurance Amendments of 1965". 
INCREASE I N OLD-AGE, SURVIVORS, AND DISABIUTT INSURANCE BENEFITS 
SEC. 301. (a) Section 215(a) of the Social Security Act is amended 
by striking out the table and inserting in lieu thereof the following: 
"TABLE FOB DETERMINING PRIMARY INSURANCE AMOUNT AND MAXIMUM 
FAMILY BENEFITS 
361 
"I 
(Primary Insurance benefit 
under 1939 Act, as modi-
fied) 
If an individual's primary 
insurance benefit (as de-
termined under subsec. 
(d))is-
At least— 
$13.49 
14.01 
14.49 
15.01 
16.61 
16.21 
16.86 
17.61 
18.41 
19.26 
20.01 
20.65 
21.29 
21.89 
22.29 
22.69 
23.09 
23.45 
23.77 
24.21 
24.61 
25.01 
26.49 
26.93 
26.41 
26.95 
27.47 
28.01 
28.69 
29.26 
29.69 
30.37 
30.93 
31.37 
32.01 
32.61 
33.21 
33.89 
34.61 
36.01 
35.81 
36.41 
37.09 
37.61 
38.21 
39.13 
39.69 
40.34 
41.13 
4L77 
42.46 
But not 
more than— 
$13.48 
14.00 
14.48 
16.00 
15.60 
16.20 
16.84 
17,60 
18.40 
19.24 
20.00 
20.64 
21.28 
21.88 
22.28 
22.68 
23.08 
23.44 
23.76 
24.20 
24.60 
25.00 
25.48 
25.92 
26.40 
26.94 
27.46 
28.00 
28.68 
29.26 
29.68 
30.36 
30.92 
31.36 
32.00 
32.60 
33.20 
33.88 
34.50 
35.00 
35.80 
36.40 
37.08 
37.60 
38.20 
39.12 
39.68 
40.33 
41.12 
41.76 
42.44 
43.20 
II 
(Primary 
insurance 
amount 
under 1958 
Act, as 
modified) 
Or his 
primary 
insurance 
amount 
(as deter-
mined 
under 
subsec. 
(c)) i s -
$40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 
51 
52 
53 
64 
66 
56 
57 
58 
59 
60 
61 
62 
63 
64 
66 
66 
67 
68 
69 
70 
71 
72 
73 
74 
76 
76 
77 
78 
79 
80 
81 
82 
83 
84 
86 
86 
87 
88 
89 
90 
91 
m 
(Average monthly wage) 
Or his average monthly 
wage 
(as 
determined 
under subsec. (b)) is— 
At least— 
$68 
70 
71 
73 
76 
77 
79 
81 
82 
84 
86 
88 
90 
91 
93 
95 
97 
98 
100 
102 
103 
105 
107 
108 
110 
114 
119 
123 
128 
133 
137 
142 
147 
151 
156 
161 
165 
170 
175 
179 
184 
189 
194 
193 
203 
208 
212 
217 
222 
226 
231 
But not 
more than— 
$67 
69 
70 
72 
74 
76 
78 
80 
81 
83 
85 
87 
89 
90 
92 
94 
96 
97 
99 
101 
102 
104 
106 
107 
109 
113 
118 
122 
127 
132 
136 
141 
146 
150 
155 
160 
164 
169 
174 
178 
183 
188 
193 
197 
202 
207 
211 
216 
221 
225 
230 
236 
IV 
(Primary 
insurance 
amount) 
The amount 
referred to in 
the preceding 
paragraphs of 
this subsection 
shall be— 
$44.00 
45.00 
46.00 
47.00 
48.00 
49.00 
50.00 
51.00 
52.00 
63.00 
54.00 
55.00 
56.00 
57.00 
58.00 
59.00 
60.00 
61.00 
62.10 
63.20 
64.20 
65.30 
66.40 
67.50 
68.50 
69.60 
70.70 
71.70 
72.80 
73.90 
74.90 
76.00 
77.10 
78.20 
79.20 
80.30 
81.40 
82.40 
83.60 
84.60 
85.60 
86.70 
87.80 
88.90 
89.90 
91.00 
92.10 
93.10 
94.20 
95.30 
9&30 
97.40 
V 
(Maximum 
family 
benefits) 
And the maxi-
mum amount 
of benefits 
payable (as 
provided in 
sec. 203(a)) on 
the basis of his 
wages and 
self-employ-
ment income 
shall be— 
$66.00 
67.50 
69.00 
70.60 
72.00 
73.60 
75.00 
76.50 
78.00 
79.50 
81.00 
82.60 
84.00 
85.60 
87.00 
88.50 
90.00 
91.60 
93.20 
9180 
96.30 
98.00 
99.60 
101.30 
102.80 
104.40 
106.10 
107.60 
109.20 
110.90 
112.40 
11400 
116.80 
120.00 
124.00 
128.00 
131.20 
135.20 
139.20 
142.40 
146.40 
160.40 
154.40 
157.60 
161.60 
165.60 
168.80 
172.80 
176.80 
180.00 
184.00 
188.00 
Old-Age, Sur-
vivors, ancJ Dis-
ability Insurance 
Amendments of 
1965. 
72 Stat. 1014. 
42 u s e 415. 
49-850 0-66—26 
362 
PUBLIC L
A
W 89-97-JULY 30, 1965 
[79 STAT. 
" T A B L E FOR D E T E R M I N I N G P R I M A R Y I N S U R A N C E A M O U N T A N D M A X I M U M 
F A M I L Y BENEFITS—Continued 
"I 
(Primary insurance benefit 
under 1939 Act, as modi-
fied) 
If an individual's primary 
Insurance benefit (as de-
termined under 
subsec. 
(d)) i s -
A t least— 
$43.21 
43.77 
44.45 
44.89 
But not 
more than— 
$43.76 
4144 
44.88 
45.60 
II 
(Primary 
Insurance 
amount 
under 1958 
Act, as 
modified) 
Or his 
primary 
insurance 
amount 
(as deter-
mined 
under 
subsec. 
(c)) i s -
$92 
93 
94 
95 
96 
97 
98 
99 
100 
101 
102 
103 
104 
106 
106 
107 
108 
109 
110 
111 
112 
113 
114 
116 
116 
117 
118 
119 
120 
121 
122 
123 
124 
125 
126 
127 
III 
(Average monthly wage) 
Or his average monthly 
wage 
(as 
determined 
under subsec. (b)) is— 
At least— 
$236 
240 
246 
250 
264 
269 
264 
268 
273 
278 
282 
287 
292 
296 
301 
306 
310 
316 
320 
324 
329 
334 
338 
343 
348 
352 
357 
362 
366 
371 
376 
380 
386 
390 
394 
399 
404 
408 
413 
418 
422 
427 
432 
437 
441 
446 
461 
456 
460 
465 
469 
474 
479 
483 
488 
493 
497 
602 
607 
511 
616 
621 
625 
630 
635 
639 
644 
649 
But not 
more than— 
$-239 
244 
249 
253 
268 
263 
267 
272 
277 
281 
286 
291 
295 
300 
306 
309 
314 
319 
323 
328 
333 
337 
342 
347 
351 
356 
361 
366 
370 
376 
379 
384 
389 
393 
398 
403 
407 
412 
417 
421 
426 
431 
436 
440 
446 
450 
454 
459 
464 
468 
473 
478 
482 
487 
492 
496 
501 
506 
510 
516 
620 
624 
529 
634 
538 
643 
648 
660 
IV 
(Primary 
insurance 
amount) 
The amount 
referred to in 
the preceding 
paragraphs of 
this subsection 
shall be— 
$98.50 
99.60 
100.60 
101.70 
102.80 
103.80 
104.90 
106.00 
107.00 
108.10 
109.20 
110.30 
111.30 
112.40 
113.50 
114.60 
115.60 
116.70 
117.70 
118.80 
119.90 
121.00 
122.00 
123.10 
124.20 
125.20 
126.30 
127.40 
128.40 
129.50 
130.60 
131.70 
132.70 
133.80 
134.90 
135.90 
137.00 
138.00 
139.00 
140.00 
141.00 
142.00 
143.00 
144.00 
146.00 
146.00 
147.00 
148.00 
149.00 
150.00 
151.00 
152.00 
163.00 
154.00 
156.00 
156.00 
167.00 
168.00 
159.00 
160.00 
161.00 
162.00 
163.00 
164.00 
166.00 
166.00 
167.00 
168.00 
V 
(Maximum 
family 
benefits) 
And the maxi-
mum amount 
of benefits 
payable (as 
provided in 
sec. 203(a)) on 
the basis of his 
wages and 
self-employ-
ment income 
shall be— 
$191.20 
195.20 
199.20 
202.40 
206.40 
210.40 
213.60 
217.60 
221.60 
224.80 
228.80 
232.80 
236.00 
240.00 
244.00 
247.20 
251.20 
255.20 
258.40 
262.40 
266.40 
269.60 
273.60 
277.60 
280.80 
284.80 
288.80 
292.00 
296.00 
298.00 
299.60 
301.60 
303.60 
305.20 
307.20 
309.20 
310.80 
312.80 
314.80 
316.40 
318.40 
320.40 
322.40 
324.00 
326.00 
328.00 
329.60 
331.60 
333.60 
335.20 
337.20 
339.20 
340.80 
342.80 
344.80 
346.40 
348.40 
350.40 
362.00 
364.00 
356.00 
367.60 
359.60 
361.60 
363.20 
366.20 
367.20 
368.00" 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
363 
(b) Section 215(c) of such Act is amended to read as follows: 
^ ^^^ ^
^
f
^
^
^
-
"Primary Insurance Amount Under 1958 Act, as Modified 
"(c) (1) For the purposes of column I I of the table appearing in 
subsection (a) of this section, an individual's primary insurance 
amount shall be computed as provided in, and subject to the limita-
tions specified in, (A) this section as in effect prior to the enactment 
of the Social Security Amendments of 1965, and (B) the applicable 
provisions of the Social Security Amendments of 1960. 
'^'* s*^*- 5'24. 
"(2) The provisions of this subsection shall be applicable only in note. 
the case of an individual who became entitled to benefits under section 
202(a) or section 223 before the date of enactment of the Social ^Q^staS^si?^' 
Security Amendments of 1965 or who died before such date." 
42 use 402,423. 
(c) Section 203(a) of such Act is amended by striking out para- pj|^^*^*' ^°^'^' 
graphs (2) and (3) and inserting in lieu thereof the following: 
°4Vusc 403. 
"(2) when two or more persons were entitled (without the ap-
plication of section 202(j)(l) and section 223(b)) to monthly 
benefits under section 202 or 223 for any month which begins 
after December 1964 and before the enactment of the Social 
Security Amendments of 1965, on the basis of the wages and self-
employment income of such insured individual, such total of 
benefits for any month occurring after December 1964 shall not 
be reduced to less than the larger of— 
"(A) the amount determined under this subsection with-
out regard to this paragraph, or 
"(B) (i) with respect to the month in which such Amend-
ments are enacted or any prior month, an amount equal 
to the sum of the amounts derived by multiplying the benefit 
amount determined under this title (including this subsec-
tion, but without the application of section 222(b), section 
202(q), and subsections (b), (c), and (d) of this section), ^H^^^^^l^'^' 
as in effect prior to the enactment of such Amendments, 
42 use 422,402. 
for each such person (other than a person who would not 
be entitled to such benefits for such month without the appli-
cation of the amendments made by section 306 of the Social 
Security Amendments of 1965), for such month, by 107 per-
cent and raising each such increased amount, if it is not a mul-
tiple of $0.10, to the next higher multiple of $0,10, and 
"(ii) with respect to any month after the month in which 
such Amendments are enacted, an amount equal to the sum 
of the amounts derived by multiplying the benefit amount 
determined under this title (including this subsection, but 
without the application of section 222(b), section 202 (q), 
and subsections (b), (c), and (d) of this section), as in effect 
prior to the enactment of such Amendments, for each such 
person (other than a person who would not be entitled to 
such benefits for such month without the application of the 
amendments made by section 306 of the Social Security 
Amendments of 1965) for the month of enactment, by 107 
percent and raising each such increased amount, if it is not 
a multiple of $0.10, to the next higher multiple of $0.10; 
but in any such case (I) paragraph (1) of this subsection shall 
not be applied to such total of benefits after the application of 
subparagraph (B) of this paragraph, and (II) if section 202(k) 
(2) (A) was applicable in the case of any of such benefits for any 
^^ ^^^ ^^^j-
such month b%inniiig before the enactment of the Social Secu-
364 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
rity Amendments of 1965, and ceases to apply after such month, 
the provisions of subparagraph (B) shall be applied, for and 
42 use 4
0 2. 
after the month in which such section 202(k) (2) (AJ ceases to 
apply, as though paragraph (1) had not been applicable to such 
total of benefits for such month beginning prior to such enact-
ment." 
(d) The amendments made by subsections (a),(b), and (c) of this 
section shall apply with respect to monthly benefits under title I I of 
42 use 401. 
^i^e Social Security Act for months after December 1964 and with 
respect to lump-sum death payments under such title in the case of 
deaths occurring in or after the month in which this Act is enacted. 
(e) If an individual is entitled to a disability insurance benefit under 
42 u'sc 423^' 
section 223 of the Social Security Act for December 1964 on the basis 
of an application filed after enactment of this Act and is entitled to 
42 use 402. 
old-age insurance benefits under section 202 (a) of such Act for January 
1965, then, for purposes of section 215(a) (4) of the Social Security 
^75 Stat. 135: 
\(.t (if applicable) the amount in column IV of the table appearing 
42 u^e 415. 
iu such section 215 (a) for such individual shall be the amount in such 
Ante, p. 361. 
columu ou the line on which in column I I appears his primary insur-
ance amount (as determined under section 215(c) of such Act) instead 
of the amount in column IV equal to his disability insurance benefit. 
COMPUTATION AND RECOMPUTATIGN OF BENEFITS 
SEC. 302. (a) (1) Subparagraph (C) of section 215 (b) (2) of the 
74 Stat. 960. 
Social Sccurity Act is amended to read as follows: 
"(C) For purposes of subparagraph (B),'computation base years' 
include only calendar years in the period after 1950 and prior to the 
earlier of the following years— 
"(i) the year in which occurred (whether by reason of section 
42 use 402* 
^02 (j) (1) or otherwise) the first month for which the individual 
was entitled to old-age insurance benefits, or 
"(ii) the year succeeding the year in which he died. 
Any calendar year all of which is included in a period of disability 
shall not be included as a computation base year." 
(2) Clauses (A), (B), and (C) of the first sentence of section 
75 Stat. 135. 
215(b) (3) of such Act are amended to read as follows: 
"(A) in the case of a woman, the year in which she died or, if 
it occurred earlier but after 1960, the year in which she attained 
age 62, 
"(B) in the case of a man who has died, the year in which he 
died or, if it occurred earlier but after 1960, the year in which he 
attained age 65, or 
"(C) in the case of a man who has not died, the year occurring 
after 1960 in which he attained (or would attain) age 65." 
74 Stat. 960. 
(3) Paragraphs (4) and (5) of section 215(b) of such Act are 
amended to read as follows: 
"(4) The provisions of this subsection shall be applicable only in 
the case of an individual— 
"(A) who becomes entitled, after December 1965, to benefits 
64 Stat. 482; 
uuder scctiou 202 (a) or section 223; or 
'4fus'c402,423. 
"(I^) ^ho dies after December 1965 without being entitled to 
benefits under section 202 (a) or section 223; or 
"(C) whose primary insurance amount is required to be recom-
puted under subsection (f) (2), as amended by the Social Security 
Amendments of 1965; 
except that it shall not apply to any such individual for purposes of 
monthly benefits for months before Januarv 1966. 
Post, p. 365. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
365 
"(5) For the purposes of column III of the table appearing in 
subsection (a) of this section, the provisions of this subsection, as in 
effect prior to the enactment of the Social Security Amendments of 
1965, shall apply— 
"(A) in the case of an individual to whom the provisions of 
this subsection are not made applicable by paragraph (4), but 
who, on or after the date of the enactment of the Social Security 
Amendments of 1965 and prior to 1966, met the requirements of 
this paragraph or paragraph (4), as in effect prior to such enact-
ment, and 
"(B) with respect to monthly benefits for months before Jan-
uary 1966, in the case of an individual to whom the provisions 
of this subsection are made applicable by paragraph (4)." 
(b)(1) Subparagraph (A) of section 215(d)(1) of such Act is 
42usc4.f5' 
amended by striking out "(2) (C) (i) and (3) (A) (i)" and inserting 
in lieu thereof "(2)(C) and (3)", by stnking out "December 31, 
1936," and inserting in lieu thereof "1936", and by striking out "De-
cember 31, 1950" and inserting in lieu thereof "1950". 
(2) Section 215(d)(3) of such Act is amended by striking out 
"1960" and inserting in lieu thereof "1965" and by stnking out "but 
without regard to whether such individual has six quarters of coverage 
after 1950'T 
(c) Section 215 (e) of such Act is amended by inserting "and" 
^"^ ^
*
^
*
- ^°^-
after the semicolon at the end of paragraph (1), by striking out 
"; and" at the end of paragraph (2) and inserting in lieu thereof a 
period, and by striking out paragraph (3). 
(d) (1) Paragraph (2) of section 215(f) of such Act is amended 
^^ ^'^'' i°^^-
to read as follows: 
" (2) With respect to each year— 
" (A) which begins after December 31,1964, and 
"(B) for any part of which an individual is entitled to old-age 
insurance benefits, 
the Secretary shall, at such time or times and within such period as he 
may by regulations prescribe, recompute the primary insurance amount 
of such individual. Such recomputation shall be made— 
"(C) as provided in subsection (a) (1) and (3) if such year 
is either the year in which he became entitled to such old-age in-
surance benefits or the year preceding such year, or 
"(D) as provided in subsection (a) (1) in any other case; 
and in all cases such recomputation shall be made as though the year 
with respect to which such recomputation is made is the last year of 
the period specified in paragraph (2) (C) of subsection (b). A re-
computation under this paragraph with respect to any year shall be 
effective— 
"(E) in the case of an indiddual who did not die in such year, 
for monthly benefits beginning with benefits for January of the 
following year; or 
"(F) in the case of an individual who died in such year (in-
cluding any individual whose increase in his primary insurance 
amount is attributable to compensation which, upon his death, 
is treated as remuneration for employment under section 205 (o)), 
^^ ^^^ ^^°' 
for monthly benefits beginning with benefits for the month in 
which he died." 
(2) Effective January 2, 1966, paragraphs (3), (4), and (7) of 
such section are repealed, and paragraphs (5) and (6] of sucli section 
are redesignated as paragraphs (3) and (4), respectively. 
366 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
pJ4^Stat. 964; 
(e)(1) The first sentence of section 223(a)(2) of such Act is 
V2 u^c 423. 
amended by inserting before the period at the end thereof "and was 
entitled to an old-a^e insurance benefit for each month for which 
(pursuant to subsection (b)) he was entitled to a disability insurance 
benefit". 
(2) The last sentence of section 223(a) (2) of such Act is amended 
by striking out "first year" and inserting in lieu thereof "year"; and 
by striking out the phrase "both was fully insured and had" both times 
it appears in such sentence. 
(f)(1)The amendments made by subsection (c) shall apply only 
to individuals who become entitled to old-age insurance benefits under 
It use 40 2
.
* 
section 202(a) of the Social Security Act after 1965. 
(2) Any individual who would, upon filing an application prior to 
January 2,1966, be entitled to a recomputation of his monthly benefit 
42 use 401. 
amount for purposes of title I I of the Social Security Act shall be 
deemed to have filed such application on the earliest date on which 
such application could have been filed, or on the day on which this 
Act is enacted, whichever is the later. 
(3) In the case of an individual who died after 1960 and prior to 
1966 and who was entitled to old-age insurance benefits under section 
202(a) of the Social Security Act at the time of his death, the provi-
es^staTioe"' 
^^^^^ ^* sections 215(f) (3) (B) and 215(f) (4) of such Act as in effect 
before the enactment of this Act shall apply. 
(4) In the case of a man who attains age 65 prior to 1966, or dies 
before such year, the provisions of section 215(f) (Y) of the Social 
Security Act as in effect before the enactment of this Act shall apply. 
(5) The amendments made by subsection (e) of this section shall 
apply in the case of individuals who become entitled to disability 
42 use 423' 
insurance benefits under section 223 of the Social Security Act after 
December 1965. 
74 Stat. 964. - 
(6) Section 303(g) (1) of the Social Security Amendments of 1960 
42USC415note. 
. 
^ ' 
j 
-, 
^'^^ ^ ' 
'
^ 
IS amended— 
(A) by striking out "notwithstanding the amendments made 
by the preceding subsections of this section," in the first sentence 
and inserting in lieu thereof "notwithstanding the amendments 
made by the preceding subsections of this section, or the amend-
ments made by section 302 of the Social Security Amendments 
of 1965,"; and 
(B) by striking out "Social Security Amendments of 1960," 
in the second sentence and inserting in lieu thereof "Social Secu-
rity Amendments of 1960, or (if such individual becomes entitled 
to old-age insurance benefits after 1965, or dies after 1965 without 
becoming so entitled) as amended by the Social Security Amend-
ments of 1965,". 
R^'p^^i- 
(7) Effective January 2, 1966, subparagraph 
(B) 
of section 
42usc*4i^5loU 
^02 (f) (2) of the Social Security Amendments of 1954 is repealed. 
DISABILrrT INSURANCE BENEFITS 
SEC. 303. (a) (1) Clause (A) of the first sentence of section 216(1) 
68 Stat. 1080. 
^j) Qf ^^Q Social Security Act is amended by striking out "or to be 
42 use 4 6. 
^£ long-continued and indefinite duration" and inserting in lieu thereof 
"or has lasted or can be expected to last for a continuous period of 
not less than 12 months". 
"Period of dis-
ability." 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
367 
(2) So much of section 223 (c) (2) of such Act as precedes the second pj°,^^^\il^' 
sentence thereof is amended to read as follows: 
42 use 423. 
"(2) The term'disability'means— 
"(A) inability to engage in any substantial gainful activity by 
reason of any medically determinable physical or mental impair-
ment which can be expected to result in death or which has lasted 
or can be expected to last for a continuous period of not less than 
12 months; or". 
(b)(1) Paragraph (2) of section 216(i) of such Act is amended 
^°usc4]i6°' 
to read as follows: 
"(2) (A) The term 'period of disability' means a continuous period 
(beginning and ending as hereinafter provided in this subsection) 
during which an individual was under a disability (as defined in 
paragraph (1)), but only if such period is of not less than 6 full 
calendar months' duration or such individual was entitled to benefits 
under section 223 for one or more months in such period. 
'^^ use 423, 
"(B) No period of disability shall begin as to any individual unless 
such individual files an application for a disability determination with 
respect to such period; and no such period shall oegin as to any indi-
vidual after such individual attains the age of 65. 
"(C) A period of disability shall begin— 
"(i) on the day the disability began, but only if the individual 
satisfies the requirements of paragraph (3) on such day; or 
'(ii) if such individual does not satisfy the requirements of 
paragraph (3) on such day, then on the first day of the first quar-
ter thereafter in w^hich he satisfies such requirements. 
"(D) A period of disability shall end with the close of whichever 
of the following months is the earlier: (i) the month preceding the 
month in which the individual attains age 65, or (ii) the second month 
following the month in which the disability ceases. 
"(E) No application for a disability determination which is filed 
more than 12 months after the month prescribed by subparagraph (D) 
as the month in which the period of disability ends (determined with-
out regard to subparagraph (B) and this subparagraph) shall be 
accepted as an application for purposes of this paragraph." 
(2) Section 216(i) (3) of such Act is amended by^ striking out 
p^^,^^^\^^^^ 
"clauses (A) and (B) of paragraph (2)" and inserting in lieu thereof 
' ^' 
"clauses (i) and (ii) of paragraph (2) (C)". 
(3) Subparagraph (D) of section 223 (a)(1) of such Act is amended 
p^^^^^ ^A^ 
by striking out "at the time such application is filed,". So much of 
' P- 
• 
such section 223(a) (1) as follows subparagraph (D) is amended by 
striking out "the first month for which he is entitled to old-age insur-
ance benefits,". 
(4) Section 223(c) (3) (A) of such Act is amended by striking out 
^2 stau ^1020 
"which continues until such application is filed". 
(c) Section 223(b) of such Act is amended by striking out the last 
sentence and inserting in lieu thereof the following: "An individual 
who would have been entitled to a disabilitv insurance benefit for any 
month had he filed application therefor before the end of such month 
shall be entitled to such benefit for such month if he files such applica-
tion before the end of the 12th month immediately succeeding such 
month." 
(d) The second sentence of section 202( j) (1) of such Act is amended 
^^ ^*|'!: '**,^-
by inserting "under this title" after "Any benefit". 
(e) So much of section 215(a)(4) of such Act as precedes "the pj^^^*^** ^^^' 
amount in column IV" is amended to read as follows: 
42 u^'c 415. 
" (4) In the case of an individual who was entitled to a disability 
insurance benefit for the month before the month in which he died, 
became entitled to old-age insurance benefits, or attained age 65,". 
368 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 SlA_T. 
Ante, p. 367. 
70 Stat. 815. 
42 u s e 423. 
S3 Stat. 1370. 
42 u s e 405. 
42 u s e 401. 
(f) (1) The amendments made by subsection (a), paragraphs (3) 
and (4) of subsection (b), and subsections (c) and (d), and the pro-
visions of subparagraphs (B) and (E) of section 216 (i) (2) of the 
Social Security Act (as amended by subsection (b) (1) of this sec-
tion), shall be effective with respect to applications for disability insur-
ance benefits under section 223, and for disability determinations under 
section 216 (i), of the Social Security Act filed— 
(A) in or after the month in which this Act is enacted, or 
(B) before the month in which this Act is enacted, if the appli-
cant has not died before such month and if— 
(i) notice of the final decision of the Secretary of Health, 
Education, and Welfare has not been given to the applicant 
before such month; or 
(ii) the notice referred to in subparagraph (i) has been so 
given before such month but a civil action with respect to 
such final decision is commenced under section 205(g) of the 
3cxiial Security Act (whether before, in, or after such month) 
and the decision in such civil action has not become final before 
such month; 
except that no monthly insurance benefits under title II of the Social 
Security Act shall be payable or increased by reason of the amend-
ments made bj subsections (a) and (b) for months before the second 
month following the month m which this Act is enacted. The preced-
ing sentence shall also be applicable in the case of applications for 
monthly insurance benefits under title II of the Social Security Act 
based on the wages and self-employment income of an applicant with 
respect to whose application for disability insurance benefits under 
section 223 of such Act such preceding sentence is applicable. 
(2) The amendment made by subsection (e) shall apply in the case 
of the primary insurance amounts of individuals who attain age 65 
after the date of enactment of this Act. 
64 Stat. 487. 
42 u s e 402. 
75 Stat. 131; 
Post, p. 374. 
PAYMENT OF DISABILITY INSURANCE BENEFFTS AFTER ENTITT^MENT TO 
OTHER MONTHLY INSURANCE BENEFITS 
SEC. 304. (a) Section 202(k) of the Social Security Act is amended 
by adding at the end thereof the following new paragraph: 
"(4) Any individual who, under this section and section 223, is 
entitled for any month to both an old-age insurance benefit and a 
disability insurance benefit under this title shall be entitled to only 
the larger of such benefits for such month, except that, if such individ-
ual so elects, he shall instead be entitled to only the smaller of such 
benefits for such month." 
(b) The heading of section 202 (q) of such Act is amended to read 
as follows: 
"Reduction of Old-Age, Disability, Wife's, Husband's, or Widow's 
Insurance Benefit Amounts" 
(c) Section 202 (q) of such Act is further amended by renumbering 
paragraphs (2), (3), (4), (5), (6), and (7) as paragraphs (3), (4), 
(6), (6), (7), and (8), respectively, by renumbering the cross ref-
erences in such section accordingly, and by inserting after paragraph 
(1) the following new paragraph: 
"(2) If an individual is entitled to a disability insurance benefit 
for a month after a month for which such individual was entitled 
to an old-age insurance benefit, such disability insurance benefit for 
each month shall be reduced by the amount such old-age insurance 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
369 
benefit would be reduced under paragraphs (1) and (4) for such 
month had such individual attained age 65 in the first month for 
which he most recently became entitled to a disability insurance 
benefit." 
(d) Subparagraph (B) of paragraph (3) (as redesignated by sub-
section (c) of this section) of section 202 (q) of such Act is amended 
by— 
(1) striking out "benefit," the first time it appears and insert-
ing in lieu thereof "benefit and is not entitled to a disability 
insurance benefit,"; . 
(2) striking out in clause (i) thereof "(1)," and inserting in 
lieu thereof "(1) for such month,"; and 
(3) striking out in clause (ii) thereof "(1)" and inserting in 
lieu thereof "(1) for such month". 
(e) Subparagraph (C) of paragraph (3) (as redesignated by sub-
section (c) of this section) of section 202 (q) of such Act is amended 
to read as follows: 
"(C) For any month for which such individual is entitled to a dis-
abil^,ty insurance benefit, such individual's wife's, husband's, or 
widow's insurance benefit shall be reduced by the sum of— 
"(i) the amount by which such disability insurance benefit is 
reduced under paragraph (2) for such month (if such paragraph 
applied to such benefit), and 
"(ii) the amount bv which such wife's, husband's, or-widow's 
insurance benefit would be reduced under paragraph (1) for such 
month if it were equal to the excess of such wife's, husband's, or 
widow's insurance benefit (before reduction under this subsec-
tion) over such disability insurance benefit (before reduction 
under this subsection)." 
(f) Paragraph (3) (as redesignated by subsection (c) of this sec-
tion) of section 202 (q) is further amended by adding alter subpara-
graph (E) (added by section 307(b) (4) of this Act) the following 
new subparagraphs: 
"(F) If the first month for which an individual is entitled to a dis-
ability insurance benefit (when such first month occurs with or after 
the month in which such individual attains the age of 62) is a month 
for which such individual is also (or would, but for subsection (e] (1), 
be) entitled to a widow's insurance benefit to which such individual 
was first entitled for a month before she attained retirement age, then 
such disability insurance benefit for each month shall be reduced by 
whichever of the following is larger: 
"(i) the amount by which (but for this subparagraph) such 
disability insurance benefit would have been reduced under para-
graph (2), or 
"(ii) the amount equal to the sum of the amount by which such 
widow's insurance benefit was reduced for the month in which such 
individual attained retirement age and the amount by which such 
disability insurance benefit would be reduced under paragraph 
(2) if it were equal to the excess of such disability insurance 
benefit (before reduction under this subsection) over such widow's 
insurance benefit (before reduction under this subsection). 
"(G) If the first month for which an individual is entitled to a 
disability insurance benefit (when such first month occurs before the 
month in which such individual attains the age of 62) is a month for 
which such individual is also (or would, but for subsection (e)(1), 
be) entitled to a widow's insurance benefit, then such disability insur-
ance benefit for each montli shall be reduced by the amount ^ch 
widow's insurance benefit would be reduced under paragraphs (1) and 
Post, p. 374. 
370 
PUBLIC L
A
W 89-97-JULY 30, 1965 
[79 STAT. 
(4) for such month had such individual attained age 62 in the first 
month for which he most recently became entitled to a disability insur-
ance benefit." 
(g) Paragraph (4) (as redesignated by subsection (c) of this sec-
tion) of section 202 (q) of such Act is amended by striking out in sub-
paragraph (A) thereof "under" and inserting in lieu thereof: "under 
paragraph (1) or (3) of". 
42 u s e 416. 
Ante, p. 367. 
74 Stat. 964; 
(h) Paragraph (7) (as redesignated by subsection (c) of this 
section and as amended by section 307(b) (7) of this Act) of section 
202 (q) of such Act is amended by adding after subparagraph (E) the 
followingnew subparagraph: 
"(F) in the case of old-age insurance benefits, any month for 
which such individual was entitled to a disability insurance 
benefit." 
(i) Paragraph (8) (as redesignated by subsection (c) of this sec-
tion) of section 202 (q) of such Act is amended by striking out "(1)'* 
and inserting in lieu thereof "(1), (2),". 
75 Stat. 133. 
(j) Scction 202(r) (2) of such Act is amended by inserting after 
inJe! p. ?68. 
"eligible" the following: " (but for section 202 (k) (4))". 
^
A ^^^^'oiy ^' 
(^) Section 215 (a) (4) of such Act is amended by striking out "such 
'42*'us"c 415. 
disability insurance benefit" and inserting in lieu thereof "the primary 
insurance amount upon which such disability insurance benefit is 
based". 
(1) Section 216 (i) (2) of such Act is amended by striking out 
" (subject to section 223(a) (3))". 
^^^ 
(m) Section 223(a) (2) of such Act is amended by striking out the 
42^'usc 423. 
word "Such" and inserting in lieu thereof "Except as provided in 
section 202(q), such". 
^n) Section 223(a) (3) of such Act is repealed. 
(o) The amendments made by this section shall apply with respect 
42 use 401. 
to monthly insurance benefits under title I I of the Social Security Act 
for and after the second month following the month in which this 
Act is enacted, but only on the basis of applications filed in or after 
the month in which this Act is enacted. 
DISABILITY INSURANCE TRUST F U N D 
70 Stat. 8
^
2
0
. 
SEC. 305, (a) Section 201(b)(1) of the Social Security Act is 
amended by inserting "and before January 1,1966," after "December 
31, 1956,", and by inserting after "1954," the following: "and 0.70 of 
1 per centum of the wages (as so defined) paid after December 31, 
1965, and so reported,". 
(b) Section 201(b) (2) of such Act is amended by inserting after 
"December 31,1956," the following: "and before January 1,1966, and 
0.525 of 1 per centum of the amount of self-employment income (as 
so defined) so reported for any taxable year beginning after Decem-
ber 31,1965,". 
PAYMENT OP C H I L D ' S INSURANCE BENEFITS AFTER ATTAINMENT OP AGE 1 8 
I N CASE OF CHILD ATTENDING SCHOOL 
II use ioT' 
^^^- ^^^' (^) Section 202(d) (1) (B) of the Social Security Act is 
amended to read as follows: 
"(B) at the time such application was filed was unmarried and 
(i) either had not attained the age of 18 or was a full-time student 
and had not attained the age of 22, or (ii) is under a disability (as 
Ant^'^^'VeV 
defined in section 223(c)) which began before he attained the 
age of 18, and". 
79 STAT. ] 
PUBLIC L
A
W 89-97-JULY 30, 1965 
371 
(b) (1) So much of the first sentence of section 202(d) (1) of such 
Act as follows subparagraph (C) is amended to read as follows: 
"shall be entitled to a child's insurance benefit for each month, begin-
ning with the first month after August 1950 in which such child 
becomes so entitled to such insurance benefits and ending with the 
month preceding whichever of the following first occurs— 
"(D) the month in which such child dies, marries, or is 
adopted (except for adoption by a stepparent, grandparent, aunt^ 
or uncle subsequent to the death of such fully or currently insured 
individual), 
"(E) the month in which such child attains the age of 18, but 
only if he (i) is not under a disability (as so defined) at the time 
he attains such age, and (ii) is not a luU-time student during any 
part of such month, 
"(F) if such child was not under a disability (as so defined) at 
the time he attained the age of 18, the earlier oi— 
"(i) the first month during no part of which he is a full-
time student, or 
"(ii) the month in which he attains the age of 22, or 
"(G) if such child was under a disability (as so defined) at the 
time he attained the age of 18, the third month followmg the 
month in which he ceases to be under such disability or (if later) 
the earlier of— 
"(i) the first month during no part of which he is a full-
time student, or 
"(ii) the mon^h in which he attains the age of 22." 
(2) The second sentence of section 202(d)(1) of such Act is 
repealed. 
(3) Section 202(d) of such Act is further amended by adding at 
the end thereof the fdllowing new paragraphs: 
"(7) A child whose entitlement to child's insurance benefits on the 
basis of the wages and self-employment income of an insured individ-
ual terminated with the month preceding the month in which such 
child attained the age of 18, or with a subsequent month, may again 
become entitled to such benefits (provided no event specified in para-
graph (1) (D) has occurred) beginning with the first month thereafter 
in which he is a full-time student and has not attained the age of 22 
if he has filed application for such reentitlement. Such reentitlement 
shall end with the month preceding whichever of the following first 
occurs: The first month during no part of which he is a full-time 
student, the month in which he attains the age of 22, or the first month 
in which an event specified in paragraph (1) (D) occurs. 
"(8) For the purposes of this subsection— 
"(A) A 'full-time student' is an individual who is in full-time 
attendance as a student at an educational institution, as deter-
mined by the Secretary (in accordance with regulations pre-
scribed by him) in the light of the standards and practices of the 
institutions involved, except that no individual shall be con-
sidered a 'full-time studenr if he is paid by his employer while 
attending an educational institution at the request, or pursuant 
to a requirement, of his employer. 
"(B) Except to the extent provided in such regulations, an indi-
vidual shall be deemed to be a full-time student during any period 
of nonattendance at an educational institution at which he has 
been in full-time attendance if (i) such period is 4 calendar 
months or less, and (ii) he shows to the satisfaction of the Secre-
tary that he intends to continue to be in full-time attendance at an 
educational institution immediately following such period. An 
72 Stat. 1022; 
Post, p. 397, 
42 u s e 402. 
"Full-time 
student." 
372 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
•'Educational 
institution." 
42 u s e 402. 
42 u s e 403, 
Ante, p. 367. 
42 u s e 423. 
74 Stat. 954, 
955;Post, p. 373. 
42 u s e 403. 
7 2 Stat. 10 26-
1028. 
42 u s e 416. 
72 Stat. 1026; 
Post, p. 405. 
42 u s e 402. 
individual who does not meet the requirement of clause (ii) with 
respect to such period of nonattendance shall be deemed to have 
met such requirement (as of the beginning of such period) if he 
is in full-time attendance at an educational institution immedi-
ately following such period. 
"(C) An 'educational institution' is (i) a school or college or 
university operated or directly supported by the United States, 
or by any State or local government or political subdivision 
thereof, or (ii) a school or college or university which has been 
approved by a State or accredited by a Stajte-reoo^ized or 
nationally-recognized accrediting agency or bodv, or (iii) a non-
accredited school or college or university whose credits are 
accepted, on transfer, by not less than three institutions which 
are so accredited, for credit on the same basis as if transferred 
from an institution so accredited." 
(c) (1) Section 202 of such Act is amended by inserting immedi-
ately after subsection (r) the following new subsection: 
"Child Aged 18 or Over Attending School 
"(s)(l) For the purposes of subsections (b)(1), (g)(1), (q)(5), 
and (q) (T) of this section and paragraphs (2), (3), and (4) of section 
203(c), a child who is entitled to child's insurance benefits under sub-
section (d) for any month, and who has attained the age of 18 but is 
not in such month under a disability (as defined in section 223(c)) 
which began before he attained such age, shall be deemed not entitled 
to such benefits for such month, unless he was under such a disability 
m the third month before such month. 
"(2) Subsection (f)(4), and so much of subsections (b)(3), (d) 
(6), (e) (3), (g) (3), and (h) (4) of this section as precedes the semi-
colon, shall not apply in the case of any child unless such child, at the 
time of the marriage referred to therein, was under a disability (as 
defined in section 223(c)) which be^an before such child attained the 
age of 18 or had been under such a disability in the third month before 
the month in which such marriage occurred. 
"(3) Subsections (c)(2)(B) and (f)(2)(B) of this section, so 
much of subsections (b) (3), (d) (6), (e) (3), (g) (3), and (h) (4) of 
this section as follows the semicolon, the last sentence of subsection 
(c) of section 203, subsection (f) (1) (C) of section 203, and subsec-
tions (b) (3) (B), (c) (6) (B), (f) (3) (B), and (g) (6) (B) of section 
216 shall not apply in the case of any child with respect to any month 
referred to therein unless in such month or the third month prior 
thereto such child was under a disability (as defined in section 223(c)) 
which began before such child attained the age of 18." 
(2) So much of subsection (c) (2] of such section 202 as precedes 
subparagraph (A) is amended by inserting "(subject to subsection 
(s))" after "shall". 
(3) So much of subsection (d) (6) of such section 202 as follows 
subparagraph (B) is amended by inserting "but subject to subsection 
(s)" after "notwithstanding the provisions of paragraph (1)". 
(4) So much of subsection (e)(3) of such section 202 as follows 
subparagraph (B) is amended by inserting "but subject to subsection 
(s)" after "notwithstanding the provisions of paragraph (1)". 
(5) So much of subsection (f) (2) of such section 202 as precedes 
subparagraph (A) is amended by inserting "(subject to subsection 
(s))"aft«r "shall". 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
373 
(6) So much of subsection (f) (4) of such section 202 as follows sub-
paragraph (B) is amended by inserting "but subject to subsection (s)" 
after "notwithstanding the provisions of para^aph (1)". 
(7) So much of the first sentence of subsection (g) (1) of such sec-
tion 202 as follows subparagraph (F) is amended by inserting "(sub- Postf^.^'arff' 
ject to subsection (s))" after "shall". 
42 use 402. 
(8) So much of subsection (g)(3) of such section 202 as follows 
subparagraph (B) is amended by inserting "but subject to subsection 
(s)" after "notwithstanding the provisions of paragraph (1)". 
(9) So much of subsection (h) (4) of such section 202 as follows 
^^ stat. 1032. 
subparagraph (B) is amended by inserting "but subject to subsection 
(s)" after "notwithstanding the provisions of parEigraph (1)". 
(10) The next to last sentence of subsection (c) of section 203 of 
^^ ^^^ ^''^• 
such Act is amended by striking out "for any month in which" and 
inserting in lieu thereof "for any month in which paragraph (1) of 
section 202 (s) applies or". 
(11) The last sentence of subsection (c) of such section 203 is 
amended by striking out "No" and inserting in lieu thereof "Subject 
to paragraph (3) of such section 202 (s), no". 
^"'^' ^- ^'^^' 
(12) The last sentence of subsection (f)(1) of such section 203 
is amended by inserting "but subject to section 202 (s)" after "Not-
withstanding the preceding provisions of this paragraph". 
(13) Subsections (b), (c), (f), and (g) of section 216 of such Act Js°^'' ""• ^°^' 
are each amended by inserting before the period at the end thereof 
42 use 416. 
"(subject, however, to section 202(s))". 
(14) Section 222(b) of such Act is amended by adding at the end 
^^ "^*^ ^22. 
thereof the following new paragraph : 
"(4) The provisions of paragraph (1) shall not apply to any child 
entitled to benefits under section 202(d), if he has attained the age of 3^^"'^' ^^' ^^°' 
18 but has not attained the age of 22, for any month during which he 
42 use 402. 
is a full-time student (as defined and determined under section 
202(d))." 
(16) Section 225 of such Act is amended by adding at the end 
42u*sc425' 
thereof the following new sentence: "The first sentence of this section 
shall not apply to any child entitled to benefits under section 202(d), 
if he has attained the age of 18 but has not attained the age of 22, for 
any month during which he is a full-time student (as defined and 
determined under section 202(d))." 
(d) The amendments made by this section shall apply with respect to 
monthly insurance benefits under section 202 of the Social Security 
Act for months after December 1964; except that— 
S'* stat. 482, 
(1) m the case of an individual who was not entitled to a 
child's insurance benefit under subsection (d) of such section for 
the month in which this Act is enacted, such amendments shall 
apply only on the basis of an application filed in or after the month 
in which this Act is enacted, and 
(2) no monthly insurance benefit shall be payable for any 
month before the second month following the month in which 
this Act is enacted by reason of section 202(d) (1) (B) (ii) of the 
Social Security Act as amended by this section. 
42 u s e 402. 
REDUCED BENEFITS FOR W m O W S AT AGE 60 
SEC. 307, (a)(1) Paragraph (1) (B) of section 202(e) of the Social 
Security Act (as amended by section 308(b) of this Act) is amended 
by striking out "age 62" and inserting in lieu thereof "age 60". 
(2) Paragraph (2) of such section (as so amended) is amended by 
striking out "Such" and inserting in lieu thereof "Except as provided 
in subsection (q), such". 
Ante, p. 370. 
Post, p . 376. 
374 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
42 use ^^^' 
(t>) (1) Paragraph (1) of section 202(q) of such Act is amended 
to read as follows: 
"(1) If the first month for which an individual is entitled to an 
old-age, wife's, husband's, or widow's insurance benefit is a month 
before the month in which such individual attains retirement age, the 
amount of such benefit for each month shall, subject to the succeeding 
paragraphs of this subsection, be reduced by— 
"(a) 5/9 of 1 percent of such amount if such benefit is an old-
age or widow's insurance benefit, or 25/36 of 1 percent of such 
amount if such benefit is a wife's or husband's insurance benefit, 
multiplied by 
" (B) (i) the number of months in the reduction period for such 
benefit (determined under paragraph (6)), if such benefit is for 
a month before the month in which such individual attains re-
tirement age, or 
"(ii) the number of months in the adjusted reduction period 
for such benefit (determined under paragraph (7)), if such benefit 
is for the month in which such individual attains retirement age 
or for any month thereafter." 
Ante, p. 368. 
(£) Paragraph (3) (A) (as renumbered by section 304(c) of this 
Act) of such section is amended— 
(A) by striking out "wife's or husband's insurance benefit'^* 
each place it appears and inserting in lieu thereof "wife's, hus-
band's, or widow's insurance benefit"; and 
(B) by striking out "age 62" and inserting in lieu thereof "age 
62 (in the case of a wife's or husband's insurance benefit) or age 60 
(in the case of a widow's insurance benefit)". 
(3) Paragraph (3)(D) (as so renumbered) of such section is 
amended by striking out "wife's or husband's" and inserting in lieu 
thereof "wife's, husband's, or widow's". 
(4) Paragraph (3) (as so renumbered) of such section is amended 
by adding at the end thereof the following new subparagraph: 
"(E) if the first month for which an mdividual is entitled to an 
old-age insurance benefit (whether such first month occurs before, 
with^ or after the month in which such individual attains the age of 
65) IS a month for which such individual is also (or would, but for 
subsection (e) (1), be) entitled to a widow's insurance benefit to Which 
such individual was first entitled for a month before she attained 
retirement age, then such old-age insurance benefit shall be reduced 
by whichever of the following is the larger: 
"(i) the amount by which (but for this subparagraph) such 
old-age insurance benefit would have been reduced under para-
graph (1), or 
" (ii) the amount equal to the sum of the amount by which such 
widow's insurance benefit was reduced for the month in which 
such individual attained retirement age and the amount by which 
such old-age insurance benefit would be reduced under para-
graph (1) if it were equal to the excess of such old-age insurance 
benefit (before reduction under this subsection) over such wid-
ow's insurance benefit (before reduction under this subsection)." 
(5) Paragraph (5) (as so renumbered) of such section is amended 
by adding at the end thereof the following new subj>aragraph: 
"(D) No widow's insurance benefit for a month in which she has 
in her care a child of her deceased husband (or deceased former hus-
band) entitled to child's insurance benefits shall be reduced under 
this subsection below the amount to which she would have been 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
375 
entitled had she been entitled for such month to mother's insurance 
benefits on the basis of her deceased husband's (or deceased former 
husband's) wages and self-employment income." 
(6) Paragraph (6) (as so renumbered) of such section is amended— 
(A) by striking out "wife's, or husband's" and inserting in lieu 
thereof "wife's, husband's, or widow's"; 
(B) by striking out "or husband's" in subparagraph (A) (i) 
and inserting in lieu thereof ", husband's, or widow's"; and 
(C) by striking out "age 65" in subparagraph (B) and insert-
ingin lieu thereof "retirement age". 
(7) Paragraph (7) (as so renumbered) of such section is amended— 
(A) by striking out "wife's, or husband's" and inserting in lieu 
thereof "wife's, husband's, or widow's"; and 
(B) by striking out "and" at the end of subparagraph (B), by 
striking out the period at the end of subparagraph (C) and insert-
ing in lieu thereof a comma, and by adding at the end thereof the 
following new subparagraphs: 
"(D) m the case of widow's insurance benefits, any month in 
which the reduction in the amount of such benefit was determined 
under paragraph (5) (D), 
"(E) in the case of widow's insurance benefits, any month 
before the month in which she attained retirement age for which 
she was not entitled to such benefit because of the occurrence of 
an event that terminated her entitlement to such benefits, and". 
(8) Section 202(q) of such Act (as amended by section 304(c) 
of this Act) is further amended by adding at the end thereof the 
^"'®' P- ^^S-
following new paragraph: 
"(9) For purposes of this subsection, the term 'retirement age' 
means age 65 with respect to an old-age, wife's, or husband's insurance 
benefit and age 62 with respect to a widow's insurance benefit." 
(c) The amendments made by this section shall apply with respect 
to monthly insurance benefits under section 202 of the Social Security 
Act for and after the second month following the month in which this 
^^ ^*|^- ^^j^^^-
Act is enacted, but only on the basis of applications filed in or after the 
month in which this Act is enacted. 
WIFE'S AND WIDOW'S BENEFITS FOR DIVORCED WOMEN 
SEC. 308. (a) Section 202(b) of the Social Security Act is amended 
to read as follows: 
"Wife's Insurance Benefits 
" (b) (1) The wife (as defined in section 216 (b)) and every divorced 
wife (as defined in section 216(d)) of an individual entitled to old-age 
f°tTco'/i«^' 
or disability insurance benefits, if such wife or such divorced wife— 
" (A) has filed application for wife's insurance benefits, 
"(B) has attained ag:e 62 or (in the case of a wife) has in her 
care (individually or jointly with such individual) at the time of 
filing such application a child entitled to a child's insurance benefit 
on the basis of the wages and self-employment income of such 
individual, 
"^C) in the case of a divorced wife, is not married, 
"(D) in the case of a divorced wife, was receiving at least one-
half of her support, as determined in accordance with regulations 
prescribed by the Secretary, from such individual, or was receiv-
ing substantial contributions from such individual (pursuant to 
a written agreement) or there was in effect a court order for 
substantial contributions to her support from such individual— 
42 u s e 416. 
376 
PUBLIC LAW 89-97~JULY 30, 1965 
[79 STAT. 
"(i) if he had a period of disability which did not end 
before the month in which he became entitled to old-age or 
disability insurance benefits, at the beginning of such period 
or at the time he became entitled to such benefits, or 
"(ii) if he did not have such a period of disability, at the 
time he became entitled to old-age msurance benefits, and 
"(E) is not entitled to old-age or disability insurance benefits, 
or is entitled to old-age or disability insurance benefits based on a 
primary insurance amount which is less than one-half of the 
primary insurance amount of such individual, 
shall (subject to subsection (s)) be entitled to a wife's insurance bene-
fit for each month, beginning with the first month in which she 
becomes so entitled to such insurance benefits and ending with the 
month preceding the first month in which any of the following 
occurs— 
"(F) she dies, 
"^G) such individual dies, 
"(H) in the case of a wife, they are divorced and either (i) she 
has not attained age 62, or (ii) she has attained age 62 but has not 
been married to such individual for a period of 20 years imme-
diately before the date the divorce became effective, 
"(I) in the case of a divorced wife, she marries a person other 
than such individual, 
" (J) in the case of a wife who has not attained age 62, no child 
of such individual is entitled to a child's insurance benefit, 
" (K) she becomes entitled to an old-age or disability insurance 
benefit based on a primary insurance amount which is equal to or 
exceeds one-half of the primary insurance amount of such indi-
vidual, or 
"(L) such individual is not entitled to disability insurance 
benefits and is not entitled to old-age insurance benefits. 
"(2) Except as provided in subsection (q), such wife's insurance 
benefit for each month shall be equal to one-half of the primary insur-
ance amount of her husband (or, in the case of a divorced wife, her 
former husband) for such month. 
"(3) In the case of any divorced wife who marries— 
"(A) an individual entitled to benefits under subsection (f) or 
(h) of this section, or 
"(B) an individual who has attained the age of 18 and is 
entitled to benefits under subsection (d), 
such divorced wife's entitlement to benefits under this subsection shall, 
notwithstanding the provisions of paragraph (1) (but subject to sub-
section (s)), not be terminated by reason of such marriage; except 
that, in the case of such a marriage to an individual entitled to benefits 
under subsection (d), the precedmg provisions of this paragraph shall 
not apply with respect to oienefits for months after the last month for 
which such individual is entitled to such benefits under subsection (d) 
unless he ceases to be so entitled by reason of his death." 
42 use 402. 
(b) (1) Paragraphs (1) and (2) of section 202(e) of such Act are 
amended to read as follows: 
"(1) The widow (as defined in section 216(c)) and every surviving 
Post, p. 377. 
divorced wife (as defined in section 216(d)) of an individual who died 
a fully insured individual, if such widow or such surviving divorced 
wife— 
"(A) is not married, 
"(B) has attained age 62, 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
377 
"(0) (i) has filed application for widow's insurance benefits, or 
was entitled, after attainment of age 62, to wife's insurance bene-
fits, on the basis of the wages and self-employment income of such 
individual, for the month preceding the month in which he died, or 
"(ii) was entitled, on the basis of such wages and self-employ-
ment income, to mother's insurance benefits for the month pre-
ceding the month in which she attained age 62, 
"(D) in the case of a surviving divorced wife who was not 
entitled to wife's insurance benefits on the basis of the wages and 
self-employment iilcome of such individual for the month pre-
ceding the month in which he died, was receiving at least one-half 
of her support, as determined in accordance with regulations pre-
scribed by the Secretary, from such individual, or was receiving 
substantial contributions from such individual (pursuant to a 
written agreement) or there was in effect a court order for sub-
stantial contributions to her support from such individual— 
"(i) at the time of his aeath (or, if such individual had a 
period of disability which did not end prior to the month in 
which he died, at the time such period began or at the time 
of his death), or 
"(ii) at the time he became entitled to old-age insurance 
benefite or disability insurance benefits (or, if such individual 
had a period of disability which did not end before the month 
in which he became entitled to such benefits, at the time such 
geriod began or at the time he became entitled to such bene-
ts),and 
"(E) is not entitled to old-age insurance benefits or is entitled 
to old-age insurance benefits each of which is less than 821/^ 
percent of the primary insurance amount of such deceased 
individual, 
shall be entitled to a widow's insurance benefit for each month, 
beginning with the first month in which she becomes so entitled to 
such insurance benefits and ending with the month preceding the 
first month in which any of the following occurs: she remarries, 
dies, or becomes entitled to an old-age insurance benefit equal to or 
exceeding 82i/^ percent of the primary insurance amount of such 
deceased individual. 
"(2) Such widow's insurance benefit for each month shall be 
equal to 8214 percent of the primary insurance amount of such 
deceased individual." 
(2) Paragraph (3) of section 202(e) of such Act is repealed. 
4
2 use 402. 
(3) Section 202(e) of such Act is amended by redesignating 
paragraph (4) as paragraph (3) and such paragraph is further 
amended by striking out "widow" and inserting in lieu thereof 
"widow or surviving divorced wife" and by striking out "widow's" 
and inserting in lieu thereof "widow's or surviving divorced wife's". 
(c) Section 216(d) of such Act is amended to read as follows: 
H ^^^ 4f6^^' 
"Divorced Wives; Divorce 
"(d) (1) The term 'divorced wife' means a woman divorced from 
an individual, but only if she had been married to such individual 
for a period of 20 years immediately before the date the divorce 
became effective. 
"(2) The term 'surviving divorced wife' means a woman divorced 
from an individual who has died, but only if she had been married 
to the individual for a period of 20 years immediately before the date 
the divorce became effective. 
49-850 0-66—27 
378 
PUBLIC LAW 89-97-JULY 30,1965 
{79 STAT. 
64 Stat. 483. 
42 u s e 402. 
72 Stat. 10 so-
lo 3 2. 
64 Stat. 510; 
72 Stat. 10 27. 
42 u s e 416. 
Ante, p. 373. 
42 u s e 402. 
Ante, p. 363. 
" (3) The term 'surviving divorc;ed mother' means a woman divorced 
from an individual who has died, but only if (A) she is the mother 
of his son or daughter, (B^ she legally adopted his son or daughter 
while she was married to nim and while such son or daughter was 
under the age of 18, (C) he legally adopted her son or daughter 
while she was married to him and while such son or daughter was 
under the age of 18, or (D) she was married to him at the time both 
of them legiQly adopted a child under the age of 18. 
" (4) The terms 'divorce' and 'divorced' refer to a divorce a vinculo 
matrimonii." 
(d) (1) Section 202(c) (1) of such Act is amended by striking out 
"divorced a vinculo matrunonii," and inserting in lieu thereof 
"divorced,". 
(2) (A) Subsections (d)(6)(A), (f)(4)(A), and (h) (4) (A) of 
section 202 of such Act are each amended by inserting " (b)," before 
"(e),". 
(B) Subsections (b) and (c) of section 216 of such Act are each 
amended by striking out " (e) or" and inserting in lieu thereof " (b), 
(e), or". 
(3) Subparagraph (A) of section 202(g) (1) of such Act is 
amended by striking out "has not remarried" and inserting in lieu 
thereof "is not married". 
(4) Subparagraph (F) of section 202 (g) (1) of such Act is amended 
to read as follows: 
"(F) in the case of a surviving divorced mother— 
"(i) at the time of such individual's death (or, if such 
individual had a period of disability which did not end before 
the month in which he died, at the time such period began or 
at the time of such death)— 
" (I) she was receiving at least one-half of her support, 
as determined in accordance with regulations prescribed 
by the Secretary, from such individual, or 
" (II) she was receiving substantial contributions from 
such individual (pursuant to a written agreement), or 
"(III) there was a court order for substential contri-
butions to her support from such individual, 
"(ii) the child referred to in subparagraph (E) is her son, 
daughter, or legally adopted child, and 
"(iii) the benefits referred to in such subparagraph are 
payable on the basis of such individual's wages and self-
employment income,". 
(5) Section 202(g) of such Act is further amended by striking out 
"former wife divorced" each place it appears and inserting in lieu 
thereof "surviving divorced mother". 
(6) Section 203(a) of such Act (as amended by section 301(c) of 
this Act) is amended bj striking out the period at the end of the first 
sentence and inserting m lieu thereof ", or" and by adding the follow-
ing new paragraph: 
"(3) when any of such individuals is entitled to monthly bene-
fits as a divorced wife under section 202(b) or as a surviving 
divorced wife imder section 202(e) for any month, the benefit 
to which she is entitled on the basis of the wages and self-
employment income of such insured individual for such month 
shall oe determined without regard to this subsection, and the 
benefits of all other individuals who are entitled for such month 
to monthly benefits under section 202 on the wages and self-
42 u s e 403. 
42 u s e 405. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
' 
379 
employment income of such insured individual shall be deter-
mined as if no such divorced wife or surviving divorced wife 
were entitled to benefits for such month." 
(7) Section 203(c) (4^ of such Act is amended by striking out 
"former wife divorced" and inserting in lieu thereof "surviving 
divorced mother". 
(8) Section 203(d)(1) of such Act is amended by striking out 
"wife," and inserting in lieu thereof "wife, divorced wife,". 
(9) The second sentence of section 205 (b^ of such Act is amended 
by striking out "wife, widow, former wife divorced," and inserting in 
lieu thereof "wife, divorced wife, widow, surviving divorced wife, sur-
viving divorced mother,". 
(10) Section 205(c) (1) (C) of such Act is amended by striking out 
"former wife divorced," and inserting in lieu thereof "surviving 
divorced wife, surviving divorced mother,". 
(11) Section 222(b)(3) of such Act is amended by inserting 
«use 422. 
"divorced wife," after "wife,". 
^ 
(12) Paragraph (3) of section 202(g) of such Act is repealed. 
42^^jsc 402. 
(13) Section 202 (g) of such Act is amended by redesignating para-
graph (4) as paragraph (3). 
(e) The amendments made by this section shall be applicable with 
respect to monthly insurance benefits under title II of the Social 
Security Act beginning with the second month following the month 
^^ "^^ '*°^-
in which this Act is enacted; but, in the case of an individual who was 
not entitled to a monthly insurance benefit under section 202 of such 
Act for the first month following the month in which this Act is 
enacted, only on the basis of an application filed in or after the month 
ill which this Act is enacted. 
TRANSITIONAL INSURED STATUS 
SEC. 309. (a) Title II of the Social Security Act is further amended 
by adding at the end thereof (after the new section 226 added by sec-
tion 101 of this Act) the following new section: 
"*"'"' P- ^^°-
^'TRANSITIONAL INSURED STATUS 
"SECL 227. (a) In the case of any individual who attains the 
age of 72 before 1969 but who does not meet the requirements of 
section 214(a), the 6 (quarters of coverage referred to in so much of 
H upc iu.' 
P
aragraph (1) of section 214(a) as follows clause (C) shall, instead, 
e 3 Quarters of coverage for purposes of determining entitlement 
of sucli individual to benefits under section 202(a), and of his wife ^'^ ^^^ '*°^* 
to benefits under section 202(b), but, in the case of such wife, only ^"*®' P- 375. 
if she attains the age of 72 before 1969 and only with respect to 
wife's insurance benefits under section 202(b) for and after the 
month in which she attains such age. For each month before the 
month in which any such individual meets the requirements oi section 
214(a), the amount of his old-age insurance benefit shall, notwith-
standing the provisions of section 2C^(a), be $35 and the amount 
of the wife's insurance benefit of his wife shall, notwithstanding the 
provisions of section 202 (b), be $17.50. 
"(b) In the case of any individual who has died, who does not 
meet the requirements of section 214(a), and whose widow attains 
age 72 before 1969, the 6 quarters of coverage referred to in para-
graph (3) of section 214(a) and in so much of paragraph (1) thereof 
as follows clause (C) shall, for purposes of determining her entitle-
42 use 402. 
380 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
^^^nte, pp. 376, 
meiit to wldow's insurance benefits under section 202(e), instead be— 
42 use 402. 
"(1) 3 quarters of coverage if such widow attains the age 
of 72 in or before 1966, 
" (2) 4 quarters of coverage if such widow attains the age of 
72 in 1967, or 
"(3) 5 quarters of coverage if such widow attains the age of 
72 in 1968. 
The amount of her widow's insurance benefit for each month shall, 
notwithstanding the provisions of section 202(e) (and section 202 
f,f4^<^r^' 
(m)),be$35. 
"(c) In the case of any individual who becjomes, or upon filing 
application therefor would become, entitled to benefits under section 
202(a) by reason of the application of subsection (a) of this section, 
who dies, and whose w i d ^ attains the age of 72 before 1969, such 
deceased individual shall be deemed to meet the requirements of sub-
Section (b) of this section for purposes of determining entitlement of 
such widow to widow's insurance benefits under section 202(e)." 
(b) The amendment made by subsection (a) shall apply in the 
case of monthly benefits under title II of the Social Security Act for 
and after the second month following the month in which this Act 
is enacted on the basis of applications filed in or after the month in 
which this Act is enacted. 
INCREASE IN AMOUNT AN INDIVIDUAL IS PERMITTED TO EARN WITHOUT 
SUFFERING FULL DEDUCTIONS FROM BENEFITS 
SEO. 310. (a)(1) Paragraphs (1), (3), and (4) (B) of subsection 
(f) of section 203 of the Social Security Act are each amended by strik-
ing out "$100" wherever it appears therein and inserting in lieu thereof 
"$125". 
(2) The first sentence of paragraph (3) of such subsection (f) is 
amended by striking out "^00" each place it appears therein and 
inserting in lieu thereof "$1,200". 
(3) Paragraph (1) (A) of subsection (h) of section 203 of such 
Act IS amended by striking out "$100" and inserting in lieu thereof 
"$125". 
(b) The amendments made by subsection (a) shall apply with 
• respect to taxable years ending after December 31,1965. 
COVERAGE FOR D0C1X>RS OF MEDICINE 
4
2 use 411. 
SEC. 3 U . (a) (1) Section 211(c) (5) of the Social Security Act is 
amended to read as follows: 
"(5) The performance of service by an individual in the 
exercise of his profession as a Christian Science practitioner." 
(2) Section 211 (c) of such Act is further amended by striking out 
the last two sentences and inserting in lieu thereof the following: 
"The provisions of paragraph (4) or (5) shall not apply to service 
(other than service performed by a member of a religious order who 
has taken a vow of poverty as a member of such order) performed 
by an individual during the period for which a certificate filed by 
Post, p. 381. 
jjjuj under section 1402(e) of the Internal Revenue Code of 1954 is 
in effect." 
(3) Section 210(a) (6) (C) (iv) of such Act is amended by insert-
ing before the semicolon at the end thereof the following: ", other 
than as a medical or dental intern or a medical or dental resident in 
training". 
42 use 403. 
68 Stat. 1053 
42 u s e 410. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
381 
(4) Section 210(a) (13) of such Act is amended by striking out all Jt^H^^Q^^' 
that follows the first semicolon. 
4
2 use 4io. 
(b) (1) Section 1402(c) (5) of the Internal Revenue Code of 1954 ^o stat. M^I. 
(relating to definition of trade or business) is amended to read as 
follows: 
"(5) the performance of service by an individual in the 
exercise of his profession as a Christian Science practitioner." 
(2) Section 1402(c) of such Code is further amended bv striking 
^^ ^
*
^
*
* ^''^^• 
out the last.two sentences and inserting in lieu thereof the following: 
"The provisions of paragraph (4) or (5) shall not apply to service 
(other than service performed by a member of a religious order who 
has taken a vow of poverty as a member of such order) performed by 
an individual during the period for which a certificate filed by him 
under subsection (e) is in effect." 
(3) (A) Section 1402(e)(1) of such Code (relating to filing of 
waiver certificate by ministers, members of religious orders, and 
Christian Science practitioners) is amended by striking out "extended 
to service" and all that follows and inserting in lieu thereof "extended 
to service described in subsection (c) (4) or (c) (5) performed bv 
him." 
(B) Clause (A) of section 1402(e) (2) of such Code (relating to 
time for filing waiver certificate) is amended to read as follows: 
"(A) the due date of the return (including any extension thereof) 
for his second taxable year ending after 1954 for which he has net 
earnings from self-employment (computed without regard to sub-
sections (c) (4) and (c) (5)) of $400 or more, any part of which was 
derived from the performance of service described in subsection (c) 
(4) or (c)(5); or". 
(4) Section 3121(b) (6) (C) (iv) of such Code (relating to defi- 
^s st^a^ 1092. 
nition of employment) is amended by inserting before the semicolon 
^'^^* 
at the end thereof the following: ", other than as a medical or dental 
intern or a medical or dental resident in training". 
(5) Section 3121(b) (13) of such Code is amended by striking out ^^^ttH-gf^^' 
all that follows the first semicolon. 
(c) The amendments made by paragraphs (1) and (2) of subsec-
tion (a), and by paragraphs (1), (2), and (3) of subsection (b), shall 
apply only with respect to taxable years ending on or after December 
31, 1965, The amendments made by paragraphs (3) and (4) of sub-
section (a), and by paragraphs (4) and (5) of subsection (b), shall 
apply only with respect to services performed after 1965. 
GROSS INCOME OF FARMERS 
SEC. 312. (a) The second sentence following paragraph (8) in 
section 211(a) of the Social Security Act is amended by striking out ^2 use 411. 
"$1,800" each place it appears and inserting in lieu thereof "$2,400", 
and by striking out "$1,200" each place it appears and inserting in 
lieu thereof "$1,600". 
(b) The second sentence following paragraph (9) in section 
1402(a) of the Internal Revenue Code of 1954 (relating to net earn-
ings from self-employment) is amended by striking out "$1,800" each 
place it appears and inserting in lieu thereof "$2,400", and by striking 
out "$1,200" each place it appears and inserting in lieu thereof 
'^$1,600". 
(c) The amendments made by this section shall apply only with 
respect to taxable years beginning after December 31, 1965. 
Post, p. 384. 
382 
PUBUC LAW 89-97-JULY 30, 1965 
[79 STAT. 
<X)VERAGE OF TIPS 
yg64^stat.^492; 
jgEo. 313, (ft) (1) SectioH 209 of the Social Security Act is amended 
42 use 409. 
by striking out "or" at the end of subsection (j), by striking out the 
period at the end of subsection (k) and inserting in lieu thereof "; or", 
and by adding immediately after subsection (k) the following new 
subsection: 
" Q) (1) Tips paid in any medium other than cash; 
"(2) Cash tips received by an employee in any calendar month in 
the course of his employment by an employer unless the amount of 
such cash tips is $20 or more." 
(2) Section 209 of such Act is-further amended by adding at the 
end thereof the following new paragraph: 
"For purposes of this title, tips received by an employee in the 
course of his employment snail be considered remuneration for 
employment. 
Such remuneratic«i shall be deemed to be paid at the 
time a written statement including such tips is furnished to the 
employer pursuant to section 6053(a) of the Internal Revenue Code 
of 1954 or (if no statement including such tips is so furnished) at the 
time received." 
26ljs? 45\"' 
(b) Section 451 of the Internal Revenue Code of 1954 (relating to 
general rule for taxable year of inclusion) is amended by adding at 
the end thereof the following new subsection: 
"(c) S P ^ I A L RULE FOR EMPLOYEE TIPS.—For purposes of sub-
section (a), tips included in a written statement furnished an employer 
by an employee pursuant to section 6053(a) shall be deemed to be 
received at the time the written statement including such tips is fur-
nished to the employer." 
26 use 3102. 
(c)(1) Section 3102 of such Code (relating to deduction of tax 
from wages) is amended by adding at the end thereof the following 
new subsection: 
"(c) 
SPECIAL RULE FOR TIPS.— 
"(1) In the case of tips which constitute wages, subsection (a) 
shall be applicable only to such tips as are included in a written 
statement furnished to the employer pursuant to section 6053(a), 
and only to the extent that collection can be made by the employer, 
at or after the time such statement is so furnished and before the 
close of the 10th day following the calendar month (or, if para-
graph (3) applies, the 30th day following the quarter) in which 
the tips were deemed paid, by deducting the amount of the tax 
from such wages of the employee (excluding tips, but including 
funds turned over by the employee to the employer pursuant to 
paragraph (2)) as are under control of the emj)loyer. 
Post, p. 3
9 5. 
«(2) If the tax imposed by section 3101, with respect to tips 
which are included in written statements furnished in any month 
to the employer pursuant to section 6053(a), exceeds the wages 
of the employee (excluding tips) from which the employer is 
required to collect the tax under paragraph (1), the employee may 
furnish to the employer on or before the 10th day of the following 
month (or, if paragraph (3) applies, on or before the 30th day of 
the following quarter) an amount of money equal to the amount 
of the excess. 
"(3) The Secretary or his delegate may, under regulations 
prescribed by him, authorize employers— 
"(A) to estimate the amount of tips that will be reported 
by the employee pursuant to section 6053 (a) in any quarter of 
the calendar year, 
Post, p. 384. 
26 use 3121. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30,1965 
383 
"(B) to detennine the amount to be deducted trpon each 
payment of wages (exclusive of tips) during such quarter as 
if the tips so estimated constituted the actual tips so reported, 
and 
"(G) to deduct upon any payment of wages (other than 
tips, but including funds turned over by the employee to the 
employer pursuant to paragraph (2)) to such employee dur-
ing such quarter (and within 30 days thereafter) such amount 
as may be necessary to adjust the amount actually deducted 
upon such wages of the employee during the quarter to the 
amount required to be deducted in respect of tips included in 
written statements furnished to the employer during the 
quarter. 
"(4) If the tax imposed by section 3101 with respect to tips 
^°^^' ^' '^^^• 
which constitute wages exceeds the portion of such tax which can 
be collected by the employer from the wages of the employee pur-
suant to paragraph (1) or paragraph (3), such excess shall be 
paid by the employee." 
(2) The second sentence of section 3102 (a) of such Code is amended 68^l4t!*io93.^^' 
by inserting before the period at the end thereof the following: "; and 
2
6 use 3102. 
an emploj^er who is furnished by an employee a written statement of 
tips (received in a calendar month) pursuant to section 6053(a) to 
which paragraph (12) (B) of section 3121(a) is applicable may deduct 
an amount equivalent to such tax with respect to such tips from any 
wages of the employee (exclusive of tips) under his control, even 
though at the time such statement is furnished the total amount of the 
tips included in statements furnished to the employer as having been 
received by the employee in such calendar month in the course of his 
employment by such employer is less than $20". 
(3) Section 3121(a) of such Code (relating to definition of wages 
under the Federal Insurance Contributions Actj is amended by striking 
out "or" at the end of paragraph (10), by striking out the period at 
the end of paragraph (11) and inserting in lieu thereof "; or ", and by 
adding after paragraph (11) the following new paragraph: 
"(12) (A) tips paid in any medium other than cash; 
"(B) cash tips received by an employee in any calendar month 
in the course of his employment by an employer unless the amount 
of such cash tips is $20 or more." 
(4) Section 3121 of such Code is further amended by adding at the 
end thereof the following new subsection: 
"(q) TIPS iNCiiUOED FOR EMPLOYEE TAXES.—^For purposes of this 
chapter other than for purposes of the taxes imposed by section 3111, ^°^^' P- 396. 
tips received by an employee in the course of his employment shall be 
considered remuneration for employment. Such remuneration shall 
be deemed to be paid at the time a written statement including such 
tips is furnished to the employer pursuant to section 6053(a) or (if 
no statement including such tips is so furnished) at the time received." 
(d) (1) Section 3401 of such Code (relating to definitions for pur- 26^scr34(u^* 
poses of collecting income tax at source on wages) is amended by 
adding^at the end thereof the following new subsection: 
"(f) TIPS.—For purposes of subsection (a), the term 'wages' 
"Wages." 
includes tips received by an employee in the course of his employment. 
Such wages shall be deemed to be paid at the time a written statement 
including such tips is furnished to the employer pursuant to section 
6053(a) or (if no statement including sudi tips is so furnished) at 
the time received." 
384 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
69 Stat. 616; 
7 5 Stat. 625; 
78 Stat. 36, 52. 
26 u s e 3401. 
68A Stat. 457; 
69 Stat. 605. 
26 u s e 3402. 
Intra. 
Ante, p. 382. 
Ante, p. 383. 
68A Stat. 747. 
26 u s e 6051. 
26 u s e 3121, 
3401. 
(2) Section 3401(a) of such Code (relating to definition of wa^es 
for purposes of collecting income tax at source) is amended by st,rikmg 
out ", or" at the end of paragraph (6) and inserting in lieuihereof 
" b y striking out the period at the end of paragraph (12) and 
or' 
inserting in lieu thereof "; or", by striking out the period at the end 
of paragraph (15) and inserting in lieu thereof "; or", and )by adding 
after paragraph (15) the followmgnew paragraph: 
"(16) (A) as tips in any medium other than cash; 
"(B) as cash tips to an employee in any calendar month in the 
course of his employment by an employer unless the amount of 
such cash tips is $20 or more." 
(3) Subsection (a) of section 3402 of such Code (relating to in-
come tax collected at source) is amended by striking out "subsection 
(j)" and inserting in lieu thereof "subsections {]) and (k)". 
(4) Section 3402(h) (3) of such Code (relating to income tax with-
holding on basis of average wages) is amended by inserting after 
"quarter" the first place it appears the following: "(and, in the case 
of tips referred to in subsection (k), within 30 days thereafter)". 
(5) Section 3402 of such Code is further amended by adding at the 
end thereof the follow^ing new subsection: 
"(k) TIPS.—In the case of tips which constitute wages, subsection 
(a) shall be applicable only to such tips as are included in a written 
statement furnished to the employer pursuant to section 6053(a), and 
only to the extent that the tax can be deducted and withheld by the 
employer, at or after the time such statement is so furnished and before 
the close of the calendar year in which such statement is furnished, 
from such wages of the employee (excluding tips, but including 
funds turned over by the employee to the employer for the purpose 
of such deduction and withholding) as are under the contr(M of 
the employer; and an employer who is furnished by an employee a 
written statement of tips (received in a calendar month) pursuant to 
section 6053(a) to which paragraph (16) (B) of section 3401(a) is 
applicable may deduct and withhold the tax with respect to such 
tips from any wages of the employee (excluding tips) under his con-
trol, even though at the time such statement is furnished the total 
amount of the tips included in statements furnished to the employer 
as having been received by the employee in such calendar month in 
the course of his employment by such employer is less than $20. Such 
tax shall not at any time be deducted and withheld in an amount which 
exceeds the aggregate of such wages and funds (including funds 
turned over under section 3102(c)(2)) minus any tax required by 
section 3102(a) to be collected from such wages and funds." 
(e) (1) Section 6051(a) of such Code (relating to receipts for em-
ployees) is amended by adding at the end thereof the following new 
sentence: "In the case of tips received by an employee in the course of 
his employment, the amounts required to be shown by paragraphs (3) 
and (5) shall include only sucn tips as are included in statements 
furnished to the employer pursuant to section 6053(a)." 
(2) (A) Subpart C of part I I I of subchapter A of chapter 61 of 
such Code (relating to information regarding wages paid employees) 
is amended by adding at the end thereof the following new section: 
*SEC. 6053. REPORTING OF TIPS. 
" (^) REPORTS BY EMPLOYEES.—Every employee who, in the course of 
his employment by an employer, receives in any calendar month tips 
which are wages (as defined in section 3121(a) or section 3401(a)) 
shall report all such tips in one or more written statements furnished 
to his employer on or before the 10th day following such month. 
Such 
Post, p. 39 5. 
26 u s e 3102. 
68A Stat. 8 28. 
26 u s e 6674. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
385 
statements shall be furnished by the employee under such regulations, 
at such other times before such lOth day, and in such form and manner, 
as may be prescribed by the Secretary or his delegate. 
"(b) STATEMENTS FURNISHED BY EMPLOYERS.—If the tax imposed 
by section 3101 with respect to tips reported by an employee pursuant 
to subsection (a) exceeds the tax which can be collected by the employer 
pursuant to section 3102, the employer shall furnish to the employee 
a written statement showing the amount of such excess. The statement 
required to be furnished pursuant to this subsection shall be furnished 
at such time, shall contain such other information, and shall be in such 
form as the Secretary or his delegate may by regulations prescribe. 
When required by such regulations, a duplicate of any such statement 
shall be filed with the Secretary or his delegate." 
(B) Section 6652(b) of such Code (relating to failure to file infor- 
H l"^^^ ^^l 
mation returns) is amended by inserting after "income tax withheld)," 
the following: "and in the case of each failure to furnish a statement 
required by section 6053(b) (relating to statements furnished by em- 
^"^'^* 
ployers with respect to tips),". 
(C) Section 6674 of such Code (relating to fraudulent statement or 
failure to furnish statement to emj>loyee] is amended by striking out 
"6051" each place it appears and inserting in lieu thereof "6051 or o^'^il^^^^nlV 
6053(b)". 
^ 
^^ 
^ 
26 use 6051. 
(D) The table of sections for such subpart G is amended by adding 
at the end thereof the following: 
"Sec. 6053. Reporting of tips." 
(3) Section 6652 of such Code (relating to failure to file certain 
information returns) is amended by redesignating subsection (c) as 
subsection (d) and by inserting after subsection (b) the following 
new subsection: 
"(c) FAILURE To EEPORT TIPS.—In the case of failure by an em-
ployee to report to his employer on the date and in the manner pre-
scribed therefor any amount of tips required to be so reported by sec-
tion 6053(a) which are wages (as defined in section 3121(a)), unless 
^6"usc*3m' 
it is shown that such failure is due to reasonable cause and not due to 
willful neglect, there shall be paid by the employee, in addition to the 
tax imposed by section 3101 with respect to the amount of tips which 
^°^'' P- ^^S. 
he so failed to report, an amount fequal to 50 percent of such tax." 
(f) The amendments made by this section shall apply only with 
respect to tips received by employees after 1965. 
INCLUSION OP ALASKA AMONG STATES PERMITTED TO DIVIDE THEIR RETIRE-
MENT SYSTEMS 
SEC. 314. The first sentence of section 218(d) (6) (C) of the Social 
Security Act is amended by inserting "Alaska," before "California". 
\l ^*|^- ^
^
^
g
^
^
-
ADDITIONAL PERIOD FOR ELECTING COVERAGE UNDER DIVIDED RETIREMENT 
SYSTEM 
SEC. 315. The first sentence of section 218(d) (6) (F) of the Social 
Security Act is amended by striking out "1963" and inserting in lieu ,Jof*f*'ii°^^' 
thereof "1967". 
42 use fis. 
386 
PUBLIC L
A
W 89-97-JULY 30, 1965 
[79 STAT. 
EMPLOYEES OF NONPROFIT ORGANIZATIONS 
72 Stat. 1044. 
26 u s e 3121. 
SEC. 316. (a) (1) Section 3121 (k) (1) (B) (iii) of the Internal Reve-
nue Code of 1954 (relating to effective date of exemption of religious, 
charitable, and certain other organizations) is amended to read as 
follows: 
"(iii) the first day of any calendar quarter preceding the 
calendar quarter in which the certificate is filed, except that 
such date may not be earlier than the first day of the twentieth 
calendar quarter preceding the quarter in which such certifi-
cate is filed." 
(2) The amendment made by paragraph (1) shall applv in the case 
of any certificate filed under section 3121 (k) (1) (A) oi such Code 
after the date of the enactment of this Act. 
(b) Section 3121 (k) (1) of such Code (relating to waiver of exemp-
tion by religious, charita;ble, and certain other organizations) is fur-
ther amended by adding at the end thereof the following new 
subparagraph: 
"(H) An organization which files a certificate under sub-
paragraph (A) before 1966 may amend such certificate dur-
ing 1965 or 1966 to make the certificate effective with the first 
day of any calendar quarter preceding the quarter for which 
such certificate originally became effective, except that such 
date may not be earlier than the first day of the twentieth 
calendar quarter preceding the quarter in which such certifi-
cate is so amended. If an organization amends its certifixjate 
pursuant to the preceding sentence, such amendment shall 
be effective with respect to the service of individuals who 
concurred in the filing of such certificate (initially or 
through the filing of a supplemental list) and who concur 
in the filing of such amendment. An amendment to a cer-
tificate filed pursuant to this subparagraph shall be filed with 
such official and in such form and manner as may be pre-
scribed by regulations made under this chapter. If an 
amendment is filed pursuant to this subparagraph— 
"(i) for purposes of computing interest and for pur-
6
8
A Stat. 821. 
poses of sectiou 6651 (relating to addition to tax for 
2
6 use 6651. 
failure to file tax return), the due date for the return 
and payment of the tax for any calendar quarter result-
ing from the filing of such an amendment shall be the 
last day of the calendar month following the calendar 
quarter in which the amendment is filed; and 
"(ii) the statutory period for the assessment of such 
tax shall not expire before the expiration of three years 
It use Im 
(c) (1) Section 105(b) of the Social Security Amendments of 1960 
'*°^*- 
is amended to read as follows: 
"(b)(1) I f - 
^ 
"(A) an individual performed service in the employ of an 
organization with respect to which remuneration was paid 
before the first day of the calendar quarter in which the 
organization filed a waiver certificate pursuant to section 
3121 (k) (1) of the Internal Revenue Code of 1954, and such 
service is excepted from employment under section 210(a) 
^2 usc*4\o!^* 
(8) (B) of the Social Security Act, 
"(B) such service would have constituted employment as 
defined In section 210 of such Act if the requirements of sec-
tion 3121 (k) (1) of such Code were satisfied, 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
387 
"(C) such organization paid, on or before the due date of 
the tax return for the calendar quarter before the calendar 
quarter in which the organization filed a certificate pursuant 
to section 3121 (k)(l) of such Code, any amount, as taxi^s 
oe u*sc 3
1
2
1
*
* 
imposed by sections 3101 and 3111 of such Code, with respect 
Post, pp. 395, 
to such remuneration paid by the organization to the individ- 396. 
ual for such service, 
"(D) such individual, or a fiduciary acting for such 
individual or his estate, or his survivor (within the meaning 
of section 205(c)(1)(C) of such Act), requests that such AnL^'p.^fgf' 
remuneration be deemed to constitute remuneration for 
employment for purposes of title I I of such Act, and 
"^^ "^^ '*°^' 
"(E) the request is made in such form and manner, 
and with such official, as may be prescribed by regulations 
made by the Secretary of Health, Education, and Welfare, 
then, subject to the conditions stated in paragraphs (2), (3), (4), 
and (5), the remuneration with respect to which the amount has 
been paid as taxes shall be deemed to constitute remuneration for 
employment for purposes of title I I of such Act. 
"(2) Paragraph (1) shall not apply with respect to an individual 
unless the organization referred to in paragraph (1)(A), on or 
before the date on which the request described in paragraph (1) is 
made, has filed a certificate pursuant to section 3121 (k) (1) of such 
Code. 
"(3) Paragraph (1) shall not apply with respect to an individual 
who is employed by the organization referred to in paragraph (2) 
on the date the certificate is filed. 
"(4) If credit or refund of any portion of the amount referred 
to in paragraph (1) (C) (other than a credit or refund which would 
be allowed if the service constituted employment for purposes of 
chapter 21 of such Code) has been obtained, paragraph (1) shall 
oe^uscTsiVi-' 
not apply with respect to the individual unless the amount credited 3126. 
or refunded (including any interest under section 6611 of such Code) 
^SA stat. 819. 
is repaid before January 1, 1968, or, if later, the first day of the 
^^^^^ ^*^^-
third year after the year in which the organization filed a certificate 
pursuant to section 3121 (k) (1) of such Code. 
"(5) Paragraph (1) shall not apply to any service performed for 
the organization in a period for which a certificate filed pursuant to 
section 3121 (k) (1) of such Code is not in effect." 
(2) The amendment made by paragraph (1) shall take effect on 
the date of the enactment of this Act. The provisions of section 
105(b) of the Social Security Amendments of 1960 which were in 
Itfj^n^t^; 
effect before the date of the enactment of this Act shall be applicable 
with respect to any request filed under section 105(b)(1) of such 
Amendments before such date. Nothing in the preceding sentence 
shall prevent the filing of a request under section 105(b) (1) of such 
Amendments as amended by this Act. 
(d) I f - 
. 
. . 
(1) an individual performed service with respect to which 
remuneration was paid before the date of enactment of this Act 
by an organization which, before such date, filed a waiver cer-
tificate pursuant to section 3121 (k) (1) of the Internal Revenue 
Code, 
(2) such service is excluded from employment under title I I 
of the Social Security Act but would not be excluded therefrom 
if the requirements 01 such section 3121 (k) (1) had been met with 
respect to such service, 
(3) such service was performed during the period such cer-
tificate was in effect, and 
26 use 3121 
note. 
388 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
(4) such individual was listed pursuant to such section 3121 
26 u*^c 3 °2f* 
(k) (1) ^t any time during such period and before the date of 
enactment of this Act as an employee who concurred in the filing 
of such certificate or such individual filed a request for coverage 
pursuant to section 105(b) of the Social Security Amendments of 
26 use 3m 
1960, as in effect prior to the enactment of this Act (but such list-
note, 
ing or request was not effective with respect to the service described 
above), 
then, subject to the conditions stated in subparagraphs (B), (C), (D), 
and (E) of paragraph (1), and paragraph (4), of section 105(b) of 
the Social Security Amendments of 1960, as amended by this section, 
the remuneration of such individual which was paid with respect to 
such excluded service shall be deemed to constitute remuneration for 
42 use 401. 
employment for purposes of such title I I ; except that, for purposes 
of this subsection, in applying subparagraph (C) of paragraph (1) of 
such section 105(b) the date of enactment of this Act shall be con-
sidered to be the date on which the organization filed its certificate 
under section 3121 (k) (1) and any reference, in paragraph (4) of such 
section, to such paragraph (1) shall be considered a reference to the 
preceding provisions of this subsection. 
COVERAGE OF TEMPORARY EMPLOYEES OF THE DISTRICT OF COLUMBIA 
74 Stat. 9 36. 
8^0. 317. (a) Scction 210(a)(7) of the Social Security Act is 
amended^— 
(1^ by striking out "or" at the end of subparagraph (B), 
(2) by striking out the semicolon at the end of subparagraph 
(C) (ii) and inserting in lieu thereof ", or", and 
(3) by adding after subparagraph (C) the following new sub-
paragraph : 
" (D) service performed in the employ of the District of Colum-
bia or any instrumentality which is wholly owned thereby, if such 
service is not covered by a retirement system established by a law 
of the United States; except that the provisions of this subpara-
graph shall not be applicable to service performed— 
" (i) in a hospital or penal institution by a patient or 
inmate thereof; 
"(ii) by any individual as an employee included under 
section 2 of the Act of August 4, 1947 (relating to certain 
interns, student nurses, and other student employees of hos-
pitals of the District of Columbia Government; 5 U.S.C. 
61 Stat. 727; 
1058), otheT thau as a medical or dental intern or as a 
63 Stat. 972. 
medical or dental resident in training; 
"(iii) by any individual as an employee serving on a tem-
porary basis in case of fire, storm, snow, earthquake, flood, or 
other similar emergency; or 
"(iv) by a member of a board, committee, or council of 
the District of Columbia, paid on a per diem, meeting, or 
other fee basis;". 
74 Stat. 938. 
(b) Section 3121 (b)(7) of the Internal Revenue Code of 1954 
(relating to certain services not included in definition of employ-
ment) is amended— 
(1^ by striking out "or" at the end of subparagraph (A), 
(2) by striking out the semicolon at the end of subparagraph 
(B) and inserting in lieu thereof ", or", and 
(3) by adding after subparagraph (B) the following new 
subparagraph: 
79 STAT. ] 
PUBLIC L
A
W 89-97-JULY 30, 1965 
389 
"(C) service j)erformed in the emi>loy of the District of 
Columbia or any instrumentality which is wholly owned thereby, 
if such service is not covered by a retirement system established 
by a law of the United States; except that the provisions of this 
subparagraj)h shall not be applicable to service performed— 
"(i) in a hospital or penal institution by a patient or 
inmate thereof; 
"(ii) by any individual as an employee included under 
section 2 of the Act of August 4, 1947 (relating to certain 
interns, student nurses, and other student employ^ of hos-
pitals of the District of Columbia Grovemment; 5 U.S.C. 
1052), other than as a medical or dental intern or as a medical ga^stat^ 9
7
^
2
^
^
' 
or dental resident in training; 
"(iii) by any individual as an employee serving on a 
temporary basis in case of fire, storm, snow, earthquake, flood 
or other similar emergency; or 
"(iv) by a member of a board, committee, or council of 
the District of Columbia, paid on a per diem, meeting, or 
other fee basis;". 
(c) (1) Section 3125 of such Code (relating to returns in the case ^
'
^ ^*^*' ^^^• 
of governmental employees in Guam and American Samoa) is amended 
^
^ ^^^ ^^^^• 
by adding at the end thereof the following new subsection: 
"(c) DISTRICT OF COLUMBIA.—In the case of the taxes imposed by 
this chapter with respect to service performed in the employ of the 
District of Columbia or in the employ of any instrumentality which 
is wholly owned thereby, the return and payment of the taxes may be 
made by the Commissioners of the District of Columbia or by such 
agents as they may designate. The person making such return may, 
for convenience of administration, make payments of the tax imposed 
by section 3111 with respect to such service without regard to the 
^°s<' ?• 396. 
$6,600 limitation in section 3121 (a) (1)." 
^°«'' P- ^sa-
(2) The heading of such section 3125 is amended by striking 
out "AND AMERICAN SAMOA" and inserting in lieu thereof ", AMER-
ICAN SAMOA, AND THE DISTRICT OF COLUMBIA". 
(3) The table of sections for subchapter C of chapter 21 of such 
Code (relating to general provisions for Federal Insurance Contri-
butions Act) IS amended by striking out 
"Sec. 3125. Returns in the case of governmental employees in 
Guam and American Samoa." 
and inserting in lieu thereof 
"Sec. 3125. Returns in the case of governmental employees in 
Guam, American Samoa, and the District of 
Columbia." 
(d) Section 6205(a) of such Code (relating to adjustment of tax) 7/^^^*940^^^' 
is amended by adding at the end thereof the following new paragraph: 2
6 use 6205. 
"(4) DISTRICT OF COLUMBIA AS EMPLOYER.—For purposes of this 
subsection, in the case of remuneration received during any calen-
dar year from the District of Columbia or any instrumentality 
which is wholly owned thereby, the Commissioners of the District 
of Columbia and each agent designated by them who makes a 
return pursuant to section 3126 shall be deemed a separate 
employer." 
(e) Seotion 6413(a) of such Code (relating to adjustment of certain y/litfgVo^^^' 
emj)loyment taxes) is amended by adding at the end thereof the fol- 
2
6 use 64i3. 
lowing paragraph: 
"(4) DISTRICT OF COLUMBIA AS EMPLOYER.—For purposes of this 
subsection, in the case of remuneration received durmg any cal-
endar year from the District of Columbia or any instrumentality 
390 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
'74 Stat. 939. 
26 u s e 3125. 
68A Stat. 797. 
26 u s e 6413. 
Ante, p. 389. 
42 u s e 401; 
Ante, p. 291. 
which is wholly owned thereby, the Commissioners of the District 
of Columbia and each agent designated by them who makes 
a return pursuant to section 3125 shall be deemed a separate em-
ployer." 
(f) (1) Section 6413(c) (2) of such Code (relating to applicability 
of special refunds to certain employment taxes) is amended by adding 
at the end thereof the following new subparagraph: 
"(F) 
GOVERNMENTAL EMPLOYEES IN THE DISTRICT OF CJOLUM-
BiA.—In the case of remuneration received from the District 
of Columbia or any instrumentality wholly owned thereby, 
during any calendar year, the Commissioners of the District 
of Columbia and each agent designated by them who makes 
a return pursuant to section 3125(c) shall, for purposes of 
this subsection, be deemed a separate employer." 
(2) The heading of such section 6413(c) (2) is amended by striking 
out "AND A
M
E
R
I
C
A
N SAMOA" and inserting in lieu thereof ", A3IERICAN 
SAMOA, AND THE DISTRICT OF COLUMBIA". 
(g) The amendments made by this section shall apply with respect 
to service performed after the calendar (quarter in which this section 
is enacted and after the calendar quarter m which the Secretary of the 
Treasury receives a certificaition from the Commissioners of the Dis-
trict of Columbia expressing their desire to have the insurance system 
established by title II (and part A of title XVIII) of the Social 
Security Act extended to the oflSicers and employees coming under the 
provisions of such amendments. 
74 Stat. 935. 
42 u s e 418 
note. 
Post, pp. 39 5, 
396. 
68A Stat. 415. 
26 u s e 3101-
3126. 
68A Stat. 353. 
26 u s e 1402. 
Post, p. 391. 
COVERAGE FOR CERTAIN ADDITIONAL HOSPITAL EMPLOYEES I N CALIFORNIA 
SEC. 318. Section 102 (k) of the Social Security Amendments of 
1960 is amended by inserting "(1)" immediately after "(k)", and by 
adding at the end thereof the following new paragraph: 
"(2) Such agreement, as modified pursuant to paragraph (1), may 
at the option of such State be further modified, at any time prior to 
the seventh month after the month in which this paragraph is enacted, 
so as to apply to services performed for any hospital affected by such 
earlier modification by any individual who after December 31, 1959, 
is or was employed by such State (or any political subdivision thereof) 
in any position described in paragraph (1). Such modification shall 
be effective with respect to (A) all services performed by such individ-
ual in any such position on or after January 1,1962, and (B) all such 
services, performed before such date, with respect to which amounts 
equivalent to the sum of the taxes which would have been imposed by 
sections 3101 and 3111 of the Internal Revenue Code of 1954 if such 
services had constituted employment for purposes of chapter 21 of 
such Code at the time they were performed have, prior to the date of 
the enactment of this paragraph, been paid." 
TAX EXEMPTION FOR RELIGIOUS GROUPS OPPOSED TO INSURANCE 
SEC. 319. (a) Subsection (c) of section 1402 of the Internal Revenue 
Code of 1954 is amended by striking out "or" at the end of paragraph 
(4), by striking out the period at the end of paragraph (5) and insert-
ing in lieu thereof "; or", and by adding after paragraph (5) the fol-
lowing new paragraph: 
"(6) the performance of service by an individual during the 
period for which an exemption under subsection (h) is effective 
with respect to him." 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
391 
(b) Subsection (c) of section 211 of the Social Security Act is 
4
2 ulc 411.' 
amended by striking out "or" at the end of paragraph (4), by striking 
out the period at the end of paragraph (5) and inserting in lieu thereof 
•'; or", and by adding after paragraph (5) the following new para-
graph: 
*'(6) The performance of service by an individual during the 
f
eriod for which an exemption under section 1402(h) of the 
nternal Revenue Code of 1954 is effective with respect to him." 
(c) Section 1402 of the Internal Revenue Code of 1954 is further 
aelisc MO"' 
amended by adding at the end thereof the following new subsection: 
"(h) 
MEMBERS or CERTAIN RELIGIOUS FAITHS.— 
"(1) EXEMPTION.—^Any individual may file an application (in 
such form and manner, and with such official, as may be prescribed 
by regulations under this chapter) for an exemption from the tax 
imposed by this chapter if he is a member of a recognized religious 
sect or division thereof and is an adherent of established tenets or 
teachings of such sect or division by reason of which he is con-
scientiously opposed to acceptance of the benefits of any private 
or public insurance which makes payments in the event of death, 
disability, old-age, or retirement or makes payments toward the 
cost of, or provides services for, medical care (including the bene-
fits of any insurance system established by the Social Security 
Act). 
Such exemption may be granted only if the application 
4
^
2 use ilo's. 
contains or is accompanied by— 
^'(A) such evidence of such individual's membership in, 
and adherence to the tenets or teachings of, the sect or division 
thereof as the Secretary or his delegate may require for pur-
poses of determining such individual's compliance with the 
preceding sentence, and 
"(B) his waiver of all benefits and other payments under 
titles II and XVIII of the Social Security Act on the basis 
J,l^l^^g\^' 
of his wages and self-employment income as well as all such 
benefits and other payments to him on the basis of the wages 
and self-employment income of any other person, 
and only if the Secretary of Health, Education, and Welfare finds 
that— 
"(C) such sect or division thereof has the established tenets 
or teachings referred to in the preceding sentence, 
"(D) it is the practice, and has been for a period of time 
which he deems to be substantial, for members of such sect 
or division thereof to make provision for their dependent 
members which in his judgment is reasonable in view of their 
general level of living, and 
"(E) such sect or division thereof has been in existence at 
all times since December 31,1950. 
An exemption may not be granted to any individual if any benefit 
or other payment referred to in subparagraph (B) became pay-
able (or, but for section 203 or 222(b) of the Social Security Act, ya^tarioa^a"' 
would have become payable) at or before the time of the filing of 
42 use 403, 
such waiver. 
422. 
" ^2) TIME FOR FILING APPLICATION.—For purposes of this sub-
section, an application must be filed— 
" (A) In the case of an individual who has self-employment 
income (determined without regard to this subsection and 
subsection (c) (6)) for any taxable year ending before 
"*"'*' ^' ^^°* 
December 31, 1965, on or before April 15, 1966, and 
392 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
64 Stat. 518. 
42 u s e 405. 
64 Stat. 482; 
70 Stat. 838. 
42 u s e 402. 
Ante, p. 391. 
Ante, p. 291. 
68A Stat. 353. 
26 u s e 1401-
1403. 
"(B^ In any other case, on or before the time prescribed 
for fihng the return (including any extension thereof) for 
the first taxable year ending on or after December 31, 1965, 
for which he has self-employment income (as so determined). 
"(3) 
PERIOD FOR WHICH EXEMPTION EFFECTIVE.—An exemption 
granted to any individual pursuant to this subsection shall apply 
with respect to all taxable years beginning after December 31, 
1950, except that such exemption shall not apply for any taxable 
year— 
"(A) beginning (i) before the taxable year in which such 
individual first met the requirements of the first sentence of 
paragraph (1), or (ii) before the time as of which the Secre-
tary of Health, Education, and Welfare finds that the sect or 
division thereof of which such individual is a member met 
the requirements of subparagraphs (C) and (D), or 
"(B) ending (i) after the time such individual ceases to 
meet tne requirements of the first sentence of paragraph (1), 
or (ii) after the time as of which the Secretary of Health, 
Education, and Welfare finds that the sect or division thereof 
of which he is a member ceases to meet the requirements of 
subparagraph (C) or (D). 
"(4) APPLICATION BY FIDUCIARIES OR suRvivoRS.-^In any case 
where an individual who has self-employment income dies before 
the expiration of the time prescribed by paragraph (2) for filing 
an application for exemption pursuant to this subsection, such 
an application may be filed with respect to such individual within 
such time by a fiduciary acting for such individual's estate or by 
such individual's survivor (within the meaning of section 205 
(c) (1) (C) of the Social Security Act)." 
(d) Section 202 of the Social Security Act is amended by adding 
at the end thereof the following new subsection: 
"Waiver of Benefits 
"(v) Notwithstanding any other provisions of this title, in the case 
of any individual who files a waiver pursuant to section 1402(h) of 
the Internal Revenue Code of 1954 and is granted a tax exemption 
thereunder, no benefits or other payments shall be payable under tbis 
title to him, no payments shall be made on his behalf under part A 
of title X y i l l , ?tnd no benefits or other payments under this title shall 
be payable on the basis of his wages and self-employment income to 
any other person, after the filing of such waiver; except that, if there-
after such individual's tax exemption under such section 1402(h) 
ceases to be effective, such waiver shall cease to be applicable in the 
case of benefits and other payments under this title and part A of title 
X V I I I to the eittent based on his self-employment income for and 
after the first taxable year for which such tax exemption ceases to be 
effective and on his wages for and after the calendar year (if any) 
which begins in or with the beginning of such taxable year." 
(e) The amendments made by this section shall apply with respect 
to taxable years beginning after December 31, 1950. For such pur-
pose, chapter 2 of the Internal Revenue Code of 1954 shall be treated 
as applying to all taxable years beginning after such date. 
(f) If refund or credit of any overpayment resulting from the 
enactment of this section is prevented on the date of the enactment of 
this Act or at any time on or before April 15, 1966, by the operation 
of any law or rule of law, refund or credit of such overpayment may, 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
393 
nevertheless, be made or allowed if claim therefor is filed on or before 
April 15,1966. 
No interest shall be allowed or paid on any overpay-
ment resulting from the enactment of this section. 
INCREASE OF EARNINGS COUNTED FOR BENEFIT AND TAX PURPOSES 
SEC. 320. (a) (1) (A) Section 209(a) (3) of the Social Security Act 
H stat. mg. 
is amended by inserting "and prior to 1966" after "1958". 
(B) Section 209(a) of such Act is further amended by adding at 
the end thereof the following new paragraph: 
"(4) That part of remuneration which, after remuneration 
(other than remuneration referred to in the succeeding sub-
sections of this section) equal to $6,600 with respect to employ-
ment has been paid to an individual during any calendar year 
after 1965, is paid to such individual during such calendar year;". 
(2) (A) Section 211 (b) (1) (C) of such Act is amended by inserting 
^^ use 4i i. 
"and prior to 1966" after "1958", and by striking out "; or" and 
inserting in lieu thereof "; and". 
(B) Section 211(b) (1) of such Act is further amended by adding 
at the end thereof the following new subparagraph: 
"(D) For any taxable year ending after 1965, (i) $6,600, minus 
(ii) the amount of the wages paid to such individual during the 
taxable year; or". 
(3) (A) Section 213(a) (2) (ii) of such Act is amended by striking ^/stfrsi"^^' 
out "after 1958" and inserting in lieu thereof "after 1958 and before 
42 use 413. 
1966, or $6,600 in the case of a calendar year after 1965". 
(B) Section 213(a) (2) (iii) of such Act is amended by striking out 
"after 1958" and insertmg in lieu thereof "after 1958 and before 1966, 
or $6,600 in the case of a taxable year ending after 1965". 
(4) Section 215(e) (1) of such Act is amended by striking out "and 
'^^ ^^^ '^^^^ 
the excess over $4,800 in the case of any calendar year after 1958" 
and inserting in lieu thereof "the excess over $4,800 in the case of any 
calendar year after 1958 and before 1966, and the excess over $6,600 
in the case of any calendar year after 1965". 
(b) (1) (A) Section 1402(b) (1) (C) of the Internal Revenue Code 
of 1954 (relating to definition of self-employment income) is amended 
by inserting "and before 1966" after "1958", and by striking out 
"; or" and inserting in lieu thereof "; and". 
(B) Section 1402(b) (1) of such Code is further amended by add-
ing at the end thereof the following new subparagraph: 
"(D) for any taxable year ending after 1965, (i) $6,600, 
minus (ii) the amount of the wages paid to such individual 
during the taxable year; or". 
(2) Section 3121(a)(1) of such Code (relating to definition of 
esA stat. 417; 
wages) is amended by striking out "$4,800" each place it appears and 
^\TvscVv2i 
inserting in lieu thereof "$6,600". 
(3) The second sentence of section 3122 of such Code (relating to 
2
6 use 3122. 
Federal service) is amended by striking out "$4,800" and inserting in 
lieu thereof "$6,600". 
(4) Section 3125 of such Code (relating to returns in the case of 
74 stat, 939. 
f
overnmental employees in Guam and American Samoa) is amended 
y striking out "$4,800" where it appears in subsections (a) and (b) 
and inserting in lieu thereof "$6,600 . 
(5) Section 6413(c)(1) of such Code (relating to special refunds 
U f}^X' }?^^-
m 
t 
, . 
\ 
. 
I T 
\ 
C 
i 
^f) UoC 6 4 1 3 . 
of employment taxes) is amended— 
(A) by inserting "and prior to the calendar year 1966" after 
"the calendar year 1958"; 
49-850 0-66—28 
26 u s e 1402. 
394 
PUBUC LAW 89-97-JULY 30, 1965 
[79 STAT. 
(B) by inserting after "exceed $4,800," the following: "or (C) 
during any calendar year after the calendar year 1965, the wages 
received by him during such year exceed $6,600". 
(C) by inserting before the period at the end thereof the fol-
lowing : "and before 1966, or which exceeds the tax with respect 
to the first $6,600 of such wages received in such calendar year 
after 1965". 
26 ?lc eJu.' 
(^) Section 6413(c) (2) (A) of such Code (relating to refunds of 
employment taxes in the case of Federal employees) is amended by 
striking out "or $4,800 for any calendar year after 1958" and inserting 
in lieu thereof "$4,800 for the calendar year 1959, 1960, 1961, 1962, 
1963,1964, or 1965, or $6,600 for anv calendar year after 1965". 
(c) The amendments made by subsections (a) (1) and (a) (3) (A), 
and the amendments made by subsection (b) (except paragraph (1) 
thereof), shall a p ^ y only with respect to remuneration paid after 
December 1965. The amendments made by subsections 
(a)(2), 
(a)(3)(B), and (b) (1) shall apply only with respect to taxable years 
ending after 1965. The amendment made by subsection (a) (4) shall 
apply only with respect to calendar years after 1965. 
CHANGES IN TAX SCHEDULES 
2
6 use uoi 
S^^: ^^^- (^) Section 1401 of the Internal Revenue Code of 1954 
(relating to rate of tax under the Self-Employment Contributions 
xVct) is amended to read as follows: 
"SEC. 1401. RATE OF TAX. 
"(a) OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE.—In addi-
tion to other taxes, there shall be imposed for each taxable year, on 
the self-employment income of every individual, a tax as follows: 
"(1) in the case of any taxable year beginning after December 
31, 1965, and before January 1, 1967, the tax shall be equal to 
5.8 percent of the amount of the self-employment income for such 
taxable year; 
"(2) in the case of any taxable year beginning after December 
31,1966, and before January 1,1969, the tax shall be equal to 5.9 
percent of the amount of the self-employment income for such 
taxable year; 
"(3) m the case of any taxable year beginning after December 
31,1968, and before January 1, 19T3, the tax shall be equal to 6.6 
percent of the amount of the self-employment income for such 
taxable year; and 
"(4) in the case of any taxable year beginning after December 
31, 19Y2, the tax shall be equal to 7.0 percent of the amount of the 
self-employment income for such taxable year. 
"(b) HOSPITAL INSURANCE.—In addition to the tax imposed by the 
preceding subsection, there shall be imposed for each taxable year, 
on the self-employment income of every individual, a tax as follows: 
"(1) in the case of any taxable year beginning after December 
31,1965, and before January 1,1967, the tax shall be equal to 0.35 
percent of the amount of the self-employment income for such 
taxable year; 
"(2) m the case of any taxable year beginning after Decem-
ber 31, 1966, and before January 1,1973, the tax shall be equal to 
0.50 percent of the amount of the self-employment income for 
such taxable year; 
^8A Stat. 3 55. 
26 u s e 1402. 
75 Stat. 141. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
395 
"(3) in the case of any taxable year beginning after Decem-
ber 31,1972, and before January 1,1976, the tax shall be equal to 
0.55 percent of the amount of the self-employment income for such 
taxable year; 
"(4) in the case of any taxable year beginning after Decem-
ber 31,1975, and before January 1,1980, the tax shall be equal to 
0.60 percent of the amount of the self-employment income for 
such taxable year; 
"(5) in the case of any taxable year begiiming after Decem-
ber 31,1979, and before January 1,1987, the tax shall be equal to 
0.70 percent of the amount of the self-employment income for 
such taxable year; and 
"(6) in the case of any taxable year beginning after Decem-
ber 31, 1986, the tax shall be equal to 0.80 percent of the amount 
of the self-employment income for such taxable year. 
For purposes of the tax imposed by this subsection, the exclusion of 
employee representatives by section 1402(c) (3) shall not apply." 
(b) Section 3101 of the Internal Kevenue Code of 1954 (relating to 
rate of tax on employees under the Federal Insurance Contributions 
^^ "^^ ^^°^-
Act) is amended to read as follows: 
'*SEC. 3101. RATE OF TAX. 
" (a) 
OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE.—In addition 
to other taxes, there is hereby imposed on the income of every indi-
vidual a tax equal to the following percentages of the wages (as 
defined in section 3121(a)) received by him with respect to employ- 
26^scf*3i2i' 
ment (as defined in section 3121 (b))— 
"(1) with respect to wages received during the calendar year 
1966, the rate shall be 3.85 percent; 
"(2) with respect to wages received during the calendar years 
1967 and 1968, the rate shall be 3.9 percent; 
"(3) with respect to wages received during the calendar years 
1969,1970,1971, and 1972, the rate shall be 4.4 percent; and 
"(4) with respect to wages received after December 31, 1972, 
the rate shall be 4.85 percent. 
" (b) HOSPITAL INSURANCE.—In addition to the tax imposed by the 
preceding subsection, there is hereby imposed on the income of every 
individual a tax equal to the following percentages of the wages (as 
defined in section 3121(a)) received by him with respect to employ-
ment (as defined in section 3121(b), but without regard to the pro-
visions of paragraph (9) thereof insofar as it relates to employees)— 
"(1) with respect to wages received during the calendar year 
1966, the rate shall be 0.35 percent; 
"(2) with respect to wages received during the calendar years 
1967,1968^ 1969,1970,1971, and 1972, the rate shall be 0.50 percent; 
"(3) with respect to wages received during the calendar years 
1973,1974j and 1975, the rate shall be 0.55 percent; 
"(4) with respect to wages received during the calendar years 
1976,1977j 1978, and 1979, the rate shall be 0.60 percent; 
"(5) with respect to wages received during the calendar years 
1980, 1981,1982,1983,1984,1985, and 1986, the rate shall be 0.70 
percent; and 
"(6) with respect to wages received after December 31, 1986, 
the rate shall be 0.80 percent." 
396 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
75 Stat. 141. 
26 u s e 3111. 
68A Stat. 417. 
26 u s e 3121. 
(c) Section 3111 of the Internal Revenue Code of 1954 (relating to 
rate of tax on employers under the Federal Insurance Contributions 
Act) is amended to read as follows: 
"SEC. 3lll. RATE OF TAX. 
"(a) OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE.—^In addi-
tion to other taxes, there is hereby imposed on every employer an 
excise tax, with respect to having individuals in his employ, equal to 
the following percentages of the wages (as denned in section 3121(a)) 
paid by him with respect to employment (as defined in section 
3121(b))— 
"(1) with respect to wages paid during the calendar year 1966, 
the rate shall be 3.85 percent; 
"(2) with respect to wages paid during the calendar years 
1967 and 1968, the rate shall be 3.9 percent; 
"(3) with respect to wages paid during the calendar years 
1969,1970, 1971, and 1972, the rate shall be 4.4 percent; and 
"(4) with respect to wages paid after December 31, 1972, the 
rate shall be 4.85 percent. 
"(b) HOSPITAL INSURANCE.—In addition to the tax imposed by the 
preceding subsection, there is hereby imposed on every employer an 
excise tax, with respect to having individuals in his employ, equal to 
the following percentages of the wages (as defined in section 3121 (a)) 
E
aid by him with respect to employment (as defined in section 3121 (b), 
ut without regard to the provisions of paragraph (9) thereof insofar 
as dt relates to employees)— 
"(1) with respect to wages paid during the calendar year 
1966, the rate shall be 0.35 percent; 
"(2) with respect to wages paid during the calendar years 
1967,1968,1969,1970,1971, and 1972, the rate shall be 0.50 percent; 
"(3) with respect to wages paid during the calendar years 
1973, 1974, and 1975, the rate shall be 0.55 percent; 
" (4) with respect to wages paid during the calendar years 1976, 
1977,1978, and 1979, the rate shall be 0.60 percent; 
"(5) with respect to wages paid during the calendar years 
1980,1981,1982,1983,1984,1985, and 1986, the rate shall be 0.70 
percent; 
"(6) with respect to wages paid after December 31, 1986, the 
rate shall be 0.80 percent." 
(d) The amendments made by subsection (a) shall apply only with 
respect to taxable years beginning after December 31, 1965. The 
amendments made by subsections (b) and (c) shall apply only with 
respect to remuneration paid after December 31,1965. 
REIMBURSEMENT OF TRUST-FUNDS FOR COST OF NONCONTRIBUTOR:Y MILI-
TARY SERVICE CREDITS 
42 use 4\7.* 
^^^- ^22- Section 217(g) of the Social Security Act is amended to 
read as follows: 
"(g)(1) In September 1965, and in every fifth September there-
after up to and including September 2010, the Secretary shall deter-
mine the amount which, if paid in equal installments at the beginning 
of each fiscal year in the period beginning— 
" (A) with July 1, 1965, in the case of the first such determina-
tion, and 
"(B) with the July 1 following the determination in the case 
of all other such determinations, 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
397 
and ending with the close of June 30, 2015, would accumulate, with 
interest compounded annually, to an amount equal to the amount 
needed to place each of the Trust Funds and the Federal Hospital 
Insurance Trust Fund in the same position at the close of June 30, 
2015, as he estimates they would otherwise be in at the close of that 
date if section 210 of this Act as in effect prior to the Social Security 
Act Amendments of 1950, and this section, had not been enacted. 
The rate of interest to be used in determining such amount shall be 
the rate determined under section 201(d) for public-debt obligations 
which were or could have been issued for purchase by the Trust Funds 
in the June preceding the September in which such determination is 
made. 
" (2) There are authorized to be appropriated to the Trust Funds 
and the Federal Hospital Insurance Trust Fund— 
" (A) for the fiscal year ending June 30,1966, an amount equal 
to the amount determined under paragraph (1) in September 
1965, and 
"(B) for each fiscal year in the period beginning with July 1, 
1966, and ending with the close of June 30, 2015, an amount equal 
to the annual mstallment for such fiscal year under the most 
recent determination under paragraph (1) which precedes such 
fiscal year. 
"(3) For the fiscal year ending June 30, 2016, there is authorized 
to be approOTiated to the Trust Funds and the Federal Hospital Insur-
ance Trust Fund such sums as the Secretary determines would place 
tiie Trust Funds and the Federal Hospital Insurance Trust Fund in 
the same position in which they would have been at the close of June 30, 
2015, if section 210 of this Act as in effect prior to the Social Security 
Act Amendments of 1950, and this section, had not been enacted. 
" (4) There are authorized to be appropriated to the Trust Funds 
and the Federal Hospital Insurance Trust Fund annually, as benefits 
under this title and part A of title X V I I I are paid after June 30, 
2015, such sums as the Secretary determines to be necessary to meet the 
additional costs, resulting from subsections (a), (b), and (e), of such 
benefits (including lump-sum death payments)." 
Ante, 
p. 299. 
42 u s e 410. 
64 Stat. 477. 
42 u s e 301 
note. 
70 Stat. 819. 
42 u s e 401. 
Ante, p. 291, 
ADOPTION OF CHILD BY RETIRED WORKER 
SEC. 323. (a) Section 202 (d) of the Social Security Act is amended— 
(1) by striking out the last sentence in paragraph (1), and 
(2) by adding at the end thereof (after the new paragraphs 
added by section 306 of this Act) the following new paragraphs: 
" (9) In the case of— 
"(A) an individual entitled to disability insurance benefits, or 
"(B) an individual entitled to old-age insurance benefits who 
was entitled to disability insurance benefits for the month preced-
ing the first month for which he was entitled to old-age insurance 
benefits, 
a child of such individual adopted after such individual became entitled 
to such disability insurance benefits shall be deemed not to meet the 
rec[uirements of clause (i) or (iii) of paragraph (1) (C) unless such 
child— 
" (C) is the natural child or stepchild of such individual (includ-
ing such a child who was legally adopted by such individual), or 
(D) was legally adopted by such individual before the end of 
the 24-month period beginning with the month after the month in 
which such individual most recently became entitled to disability 
insurance benefits, but only if— 
72 Stat. 1022. 
42 u s e 402. 
Ante, 
p. 370. 
398 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"(i) proceedings for such adoption of the child had been 
instituted by such individual in or before the month in which 
be^an the period of disability of such individual which still 
exists at the time of such adoption (or, if such child was 
adopted by such individual after such individual attained age 
65, the period of disability of such individual which existed 
in the month preceding the month in which he attained age 
65), or 
"(ii) such adopted child was living with such individual 
in such month. 
'*(10J If an individual entitled to old-age insurance benefits (but 
not an individual included under paragraph (9)) adopts a child after 
such individual becomes entitled to such oenefits, such child shall be 
deemed not to meet the requirements of clause (i) of paragraph (1) (C) 
unless such child— 
"(A) is the natural child or stepchild of such individual (in-
cluding such a child who was legally adopted by such individual), 
or 
"(B) was legally adopted by such individual before the end of 
the 24-month period beginning with the month after the month 
in which such individual became entitled to old-age insurance 
benefits, but only if— 
"(i) such child had been receiving at least one-half of his 
support from such individual for the year before such indi-
vidual filed his application for old-age insurance benefits or, 
if such individual had a period of disability which continued 
until he had become entitled to old-age insurance benefits, for 
the year before such period of disability began, and 
" (ii) either proceedm^ for such adoption of the child had 
been instituted by such mdividual in or before the month in 
which the individual filed his application for old-age insur-
ance benefits or such adopted child was living with such in-
dividual in such month." 
(b) The amendments made by subsection (a) of this section shall 
be applicable to persons who file applications, or on whose behalf ap-
plications are filed, for benefits under section 202(d) of the Social 
42 u*sc 4
o
°
2
^
^
' 
Security Act on or after the date this section is enacted. The time limit 
supta. 
' 
provided by section 202(d) (10) (B) of such Act as amended by this 
section for legally adopting a child shall not apply in the case of any 
child who is adopted before the end of the 12-month period following 
the month in which this section is enacted. 
EXTEXSION OF PERIOD FOR FILING PROOF OF SUPPORT AND APPLICATIONS 
FOR LUMP-SUM DEATH PAYMENT 
42 us^c 4
0
^
2 * 
^^^- ^^'*- ^^) Section 202 (p) of the Social Security Act is amended 
to read as follows: 
"Extension of Period for Filing Proof of Support and Applications 
for Lump-Sum Death Payment 
" (p) In any case in which there is a failure— 
"(1) to file proof of support under subparagraph (C) of sub-
section (c)Q), clause (i) or (ii) of subparagraph (D) of sub-
section (f)(1), or subparagraph (B) of subsection (h)(1). or 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
399 
64 Stat. 477. 
42 u s e 301 
42 u s e 40 2. 
tinder clause (B) of subsection (f) (1) of this section as in effect 
prior to the Social Security Act Amendments of 1950, within the 
period prescribed by such subparagraph or clause, or 
note 
"(2) to file, in the case of a death after 1946, application for a 
lump-sum death payment under subsection (i), or under sub-
section (g) of this section as in effect prior to the Social Security 
Act Amendments of 1950, within the period prescribed by such 
subsection, 
any such proof or application, as the case may be, which is filed 
after the expiration of such period shall be deemed to have been filed 
within such period if it is shown to the satisfaction of the Secretary 
that there was good cause for failure to file such proof or application 
within such period. The determination of what constitutes good 
cause for purposes of this subsection shall be made in accordance with 
regulations of the Secretary." 
(b) The amendments made by this section shall be effective with 
respect to (1) applications for lump-sum death payments filed in or 
after the month m which this Act is enacted, and (2) monthly benefits 
based on applications filed in or after such month. 
TREATMENT OF CERTAIN ROYALTIES FOR RETIREMENT TE8T PURPOSES 
SEC. 325. (a) (1) Subparagraph (B) of section 203 (f) (5) of the 
Social Security Act is amended to read as follows: 
42 use 4
0
^
3
^
.
" 
"(B) For purposes of this section— 
" (i) an individual's net earnings from self-employment for 
any taxable year shall be determined as provided in section 
211, except that paragraphs (1), (4), and (5) of section 
211(c) shall not apply and the gross income shall be com-
puted by excluding the amounts provided by subparagraph 
(D),and 
"(ii) an individual's net loss from self-employment for 
any taxable year is the excess of the deductions (plus his 
distributive share of loss described in section 702(a)(9) of 
the Internal Revenue Code of 1954) taken into account under 
clause (i) over the gross income (plus his distributive share 
of income so descrited) taken into account under clause (i)." 
(2) Such section 203(f) (5) is further amended by adding at the 
end thereof the following new subparagraph: 
"(D) In the case of an individual— 
"(i) who has attained the age of 65 on or before the last 
day of the taxable year, and 
"(ii) who shows to the satisfaction of the Secretary that 
he is receiving royalties attributable to a copyright or patent 
obtained before the taxable year in which he attained the age 
of 65 and that the property to which the copyright or patent 
relates was created oy his own personal efforts, 
there shall be excluded from gross mcome any such royalties." 
(b) The amendments made by subsection (a) shall apply with 
respect to the computation of net earnings from self-employment and 
the net loss from self-employment for taxable years beginning after 
1964. 
42 u s e 411. 
68A Stat. 239. 
26 u s e 702. 
400 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
AMENDMENTS 
PRESERVING 
RELATIONSHIP 
BETWEEN 
RAILROAD 
RETIRE-
M E N T 
AND 
OLD-AGE, 
SURVIVORS, 
AND 
DISABILITY 
INSURANCE 
SYSTEMS 
^/o^^tat.^307; 
SEC. 326. (a) Section l(q) of the Railroad Retirement Act of 1937 
45 use 228a. 
IS amended by striking out "1961" and inserting in lieu thereof "1965". 
73 Stat. 27. 
(b) Section 5(1) (9) of such Act is amended by striking out "after 
45 use 228e. 
jggg -^ j ^ ^ ^ ^^^^ $4,800" aud inserting in lieu thereof the following: 
"after 1958 and before 1966 is less than $4,800. or for any calendar 
year after 1965 is less than $6,600"; and by striking out "and $4,800 
for years after 1958", and inserting in lieu thereof the following: 
"$4,800 for years after 1958 and before 1966, and $6,600 for years after 
1965". 
T E C H N I C A L AMENDMENT RELATING TO MEETINGS OF BOARD OF TRU8TEIES 
OP 
T H E 
OLD-AGE, 
SURVIVORS, 
AND 
DISABILITY 
INSURANCE 
TRUST 
FUNDS 
II us^c 4o\^" 
^^'9' ^^'^- S^9<^ion 201(c) of the Social Security Act is amended by 
striking out "six months" in the fourth sentence and inserting in lieu 
thereof "calendar year". 
APPLICATIONS FOR BENEFITS 
«ulc4oJ.' 
S ^ - ^28. (a) Section 202(j) (2) of the Social Security Act is 
amended to read as follows: 
"(2) An application for any monthly benefits under this section 
filed before the first month in which the applicant satisfies the require-
ments for such benefits shall be deemed a valid application only if the 
applicant satisfies the requirements for such benefits before the Secre-
tary makes a final decision on the application. If upon final decision 
by the Secretary, or decision upon judicial review thereof, such appli-
cant is found to satisfy such requirements, the application shall be 
deemed to have been filed in such first month." 
(b) Section 216(i) (2) of such Act (as amended by subsection 
(b) (1) of section 303) is amended by inserting after subparagraph 
(E) the following: 
" ( F ) An application for a disability determination filed before the 
first day on which the applicant satisfies the requirements for a period 
of disability under this subsection shall be deemed a valid application 
only if the applicant satisfies the requirements for a period of dis-
ability before the Secretary makes a final decision on the application. 
If upon final decision by the Secretary, or decision upon judicial 
review thereof, such applicant is found to satisfy such requirements, 
the application shall be deemed to have been filed on such first day." 
42 use 423* 
(^) "^^^ ^ ^ sentence of section 223(b) of such Act is amended to 
read as follows: "An application for disability insurance benefits filed 
before the first month in which the applicant satisfies the requirements 
for such benefits (as prescribed in subsection (a) (1)) shall be deemed 
a valid application only if the applicant satisfies the requirements for 
such benefits before the Secretary makes a final decision on the appli-
cation. 
If, upon final decision by the Secretary, or decision upon 
judicial review thereof, such applicant is found to satisfy such re-
quirements, the application shall be deemed to have been filed in such 
first month." 
Ante, p. 367. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
401 
(d) The amendments made by this section shall apply with respect 
to (1) applications filed on or after the date of enactment of this 
Act^ (2) applications as to which the Secretary has not made a final 
decision before the date of enactment of this Act, and (3) if a civil 
action with respect to final decision by the Secretary has been com-
menced under section 205 (g^ of the Social Security Act before the 
^^ u^c 4^°' 
date of enactment of this Act, applications as to which there has 
been no final judicial decision before the date of enactment of this 
Act. 
UNDERPAYMENTS 
SEC. 329. Section 204 of the Social Security Act is amended by ^^ use 404. 
adding at the end thereof the following new subsection: 
"(d) Notwithstanding the provisions of subsection (a), if an indi-
vidual dies before any payment due him under this title is completed, 
and the total amount due at the time of his death does not exceed the 
amount of the monthly insurance benefit to which he was entitled for 
the month preceding the month in which he died, payment of the 
amount due shall be made— 
"(1) to the person, if any, determined by the Secretary to be 
the surviving spouse of the deceased individual and to have been 
living in the same ;household with the deceased at the time of his 
death, or 
"(2) if there is no such person, or if such person dies before 
receiving payment, to the legal representative of the estate of 
such deceased individual." 
PAYMENTS TO TWO OR MORE INDIVIDUALS OF THE SAME FAMILY 
SEC. 330. Section 205 (n) of the Social Security Act is amended to 
read as follows: 
"(n) The Secretary may, in his discretion, certify to the Managing 
Trustee any two or more individuals of the same family for joint pay-
ment of the total benefits payable to such individuals for any month, 
and if one of such individuals dies before a check representing such 
joint payment is negotiated, payment of the amount of such unnegoti-
ated check to the surviving individual or individuals may be authorized 
in accordance with regulations of the Secretary of the Treasury; 
except that appropriate adjustment or recovery shall be made under 
section 204(a) with respect to so much of the amount of such check as 
exceeds the amount to which such surviving individual or individuals 
are entitled under this title for such month." 
VALIDATING CERTIFICATES FILED BY MINISTERS 
SEC. 331. (a) Section 1402(e) of the Internal Revenue Code of 
1954 (relating to certificates to waive tax exemption on self-employ- 
^^ stat. loss. 
ment income m the case of ministers, members of religious orders, and 
Christian Science practitioners) is amended by striking out para-
graphs (5) and (6) and inserting in lieu thereof the following: 
"(5) 
OPTIONAL PROVISION FOR CERTAIN CERTIFICATES FILED ON OR 
BEFORE APRIL 15, 1967.—Notwithstanding any other provision of 
this section, in any case where an individual has derived earnings 
in any taxable year ending after 1954 from the performance of 
service described in subsection (c)(4), or in subsection (c)(5) 
insofar as it related to the performance of service by an individual 
402 
PUBLIC L
A
W 89-97-JULy 30, (1965 
[79 STAT. 
in the exercise of his profession as a Christian Science practitioner, 
and has reported such earnings as self-employment mcome on a 
return filed on or before the due date prescribed for filing such 
return (including any extension thereof)— 
"(A) a certificate filed by such individual on or before 
April 15,1966, which (but for this subparagraph) is ineffec-
tive for the first taxable year ending after 1954 for which 
such a return was filed shall be effective for such first taxable 
year and for all succeeding taxable years, provided a supple-
mental certificate is filed by such individual (or a fiduciary 
acting for such individual or his estate, or his survivor within 
the meaning of section 205(c) (1) (C) of the Social Security 
4
2 u*sc 405' 
-^^^^ after the date of enactment of the Social Security 
Amendments of 1965 and on or before April 15, 1967, and 
"(B) a certificate filed after the date oi enactment of the 
Social Security Amendments of 1965 and on or before April 
15,1967, by a survivor (within the meaning of section 205(c) 
(1) (C) of the Social Security Act) of such an individual 
who died on or before April 15,1966, may be effective, at the 
election of the person filing such a certificate, for the first 
taxable year ending after 1954 for which such a return was 
filed and for all succeeding years, 
but only if— 
Ante, p. 394. 
«(i) th© tax undcr section 1401 in respect to all such 
individual's self-employment income (except for underpay-
ments of tax attributable to errors made in good faith), for 
each such year described in subparagraphs (A) and (B) 
ending before January 1,1966, is paid on or before April 15, 
1967,. and 
"(ii) in any case where refund has been made of any such 
tax which (but for this paragraph) is an overpayment, the 
amount refunded (including any interest paid under section 
aeljsc 66u^" 
^^^-^J ^^ repaid on or before April 15,1967. 
2
6 use 640i! 
The provisions of section 6401 shall not apply to any payment or 
repayment described in this paragraph." 
(b) In the case of a certificate or supplemental certificate filed pur-
suant to section 1402(e) (5) of the Internal Jlevenue Code of 1954, as 
amended by subsection (a)— 
(1) for purposes of computing interest, the due date for the 
payment of the tax under section 1401 of such Code which is due 
for any taxable year ending before January 1, 1966, solely by 
reason of the filing of a certificate which is effective under such 
section 1402(e) (5) shall be April 15,1967; 
2
6 use 6501. 
(2) for purposes of section 6501 of such Code, the statutory 
period for the assessment of any tax for any taxable year for 
which tax is due solely hy reason of the filing of such certificate 
shall not expire before April 16,1970; and 
2
6 use 6651. 
(3) fpj. purposes of section 6651 of such Code (relating to addi-
tion to tax for failure to file tax return), the amount of tax 
required to be shown on the return shall not include tax under 
section 1401 of such Code "which is due for any taxable year 
ending before January 1,1966, solely by reason of the filing of a 
certificate which is effective under section 1402(e) (6). 
(c) Notwithstanding any provision of section 205(c) (5) (F) of the 
It fr^^ ?«^ 
Social Security Act, the Secretary of Health, Education, and Welfare 
may conform, before April 16,1970, his records to tax returns or state-
42 u s e 405. 
Ante, p. 401. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
403 
ments of earnings which constitute self-employment income solely by 
reason of the filing of a certificate which is effective under section 
1402(e)(5) of such Code. 
(d) The amendments made by this section shall be applicable 
(except as otherwise specifically provided therein) only to certificates 
with respect to which supplemental certificates are filed pursuant to 
section 1402(e) (5) (A) of such Code after the date of the enactment of 
this Act, and to certificates filed pursuant to section 1402(e) (5) (B) 
after such date; except that no monthly benefits under title II of the 
Social Securitv Act for the month in which this Act is enacted or any ^^ "^^ '*°^-
prior month snail be payable or increased by reason of such amend-
ments, and no lump-sum death payment under such title shall be pay-
able or increased by reason of such amendments in the case of any 
individual who died prior to the date of the enactment of this Act. 
The provisions of section 1402(e) (5) and (6) of the Internal Kevenue 
Code of 1954 which were in effect before the date of enactment of this 7
5
^ stat!*i4i!'' 
Act shall be applicable with respect to any certificate filed pursuant 
2
6 use 1402. 
thereto before such date if a supplemental certificate is not filed with 
respect to such certificate as provided in this section. 
DETERMINATION OF ATTORNEYS' FEES IN COURT PROCEEDINGS UNDER 
TITLE II 
SEC. 332. The heading of section 206 of the Social Security Act H l^^^ l^^-
is amended to read "REPRESENTATION OF CLAIMANTS". Such section 
is further amended by inserting "(a)" after "SEC. 206." and by adding 
at the end of such section the following new subsection: 
"(b)(1) Whenever a court renders a judgment favorable to a 
claimant under this title who was represented before the court by an 
attorney, the court may determine and allow as part of its judgment 
a reasonable fee for such representation, not in excess of 25 percent of 
the total of the past-due benefits to which the claimant is entitled by 
reason of such judgment, and the Secretary may, notwithstanding the 
provisions of section 205 (i), certify the amount of such fee for pay- ^"^ "^^ '*"^5-
ment to such attorney out of, and not in addition to, the amount of 
such past-due benefits. In case of any such judgment, no other fee 
may Ibe payable or certified for pajmient for such representation 
except as provided in this paragraph. 
"(2) Any attorney who charges, demands, receives, or collects for 
services rendered in connection with proceedings before a court to 
which paragraph (1) is applicable any amount in excess of that al-
lowed by the court thereunder shall be guilty of a misdemeanor and 
upon conviction thereof shall be subject to a fine of not more than 
$500, or imprisonment for not more than one year, or both." 
CONTINUATION oi' WIDOW's AND WIDOWER'S INSURANCE BENEFITS APIER 
REMARRIAGE 
Ante, p. 376. 
SEC. 333. (a) (1) Subsection (e) of section 202 of the Social Secu-
rity Act, as amended by section 308 of this Act, is amended by adding 
at the end thereof the following new paragraph: 
"(4) If a widow, after attaining the age of 60, marries an indi-
vidual (other than one described m subparagraph (A) or (B) of 
paragraph (3)), such marriage shall, for purposes of paragraph (1), 
be deemed not to have occurred; except that, notwithstanding the 
provisions of paragraph (2) and subsection (q), such widow's insur- 37^"'°' ^^' ^'^' 
Ante, 
p. 374. 
404 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
ance benefit for the month in which such marriage occurs and each 
month thereafter prior to the month in which the husband dies or 
such marriage is otherwise terminated, shall be equal to 50 per centum 
of the primary insurance amount of the deceased individual on whose 
wages and self-employment income such benefit is based." 
(2) Paragraph (2) of such subsection, as amended by section 307 
Ante, p. 373. 
of this Act, Is furthcr amended by inserting before the comma "and 
paragraph (4) of this subsection". 
4 2u*sc402^' 
(b)(1) Subsection (f) of such section is amended by adding at 
the end thereof the following new paragraph: 
"(5) If a widower, after attaining the age of 62, marries an 
individual (other than one described in subparagraph (A) or (B) of 
P
aragraph (4)), such marriage shall, for purposes of paragraph (1), 
e deemed not to have occurred; except that, notwithstandmg the 
provisions of paragraph (3) and subsection (q), such widower's 
insurance benefit for the month in which such marriage occurs and 
each month thereafter prior to the month in which the wife dies 
or such marriage is otherwise terminated, shall be equal to 50 per 
centum of the primary insurance amount of the deceased individual 
on whose wages and self-employment income such benefit is based." 
(2) Paragraph (3) of such subsection is amended by striking out 
"Such" and inserting in lieu thereof "Except as provided in para-
graph (5), such". 
(c)(1) Paragraph (2)(B) of subsection (k) of such section 202 
is amended by inserting "other than an individual to whom subsection 
Ante. p. 403. 
(g) (4) ^j. (f^ (5) applics)" after "Any individual" and by adding at 
the end thereof the following new sentence: "Any individual who is 
entitled for any month to more than one widow's or widower's insur-
ance benefit to which subsection (e)(4) or (f)(5) applies shall be 
entitled to only one such benefit for such month, such benefit to be the 
largest of such benefits.". 
(2) Paragraph (3) of such subsection is amended by inserting 
" (A)" after " (3)" and by adding at the end thereof the following new 
subparagraph: 
"(B) If an individual is entitled for any month to a widow's or 
widower's insurance benefit to which subsection (e)(4) or (f)(5) 
applies and to any other monthly insurance benefit under section 202 
(other than an old-age insurance benefit), such other insurance benefit 
for such month, after any reduction under subparagraph (A), any 
reduction under subsection (q), and any reduction under section 
42 u*sc 403V* 
203(a), shall be reduced, but not below zero, by an amount equal to 
such widow's or widower's insurance benefit after any reduction or 
reductions under such subparagraph (A) and such section 203(a)." 
(d) The amendments made by this section shall apply with respect, 
to monthly insurance benefits under section 202 of the Social Securitvi 
Act beginning with the second month following the month in which 
this Act is enacted; but, in the case of an individual who was not 
403"'sup^ra! ^^^' 
entitled to a monthly insurance benefit under section 202(e) or (f) 
of such Act for the first month following the month in which this Act 
ds enacted, only on the basis of an application filed in or after the 
month in which this Act is enacted. 
CHANGES I N DEFINITIONS OF W I F E , WIDOW, HUSBAND, AND WIDOWER 
SEC. 334. (a) Section 216 (b) of the Social Security Act, as amended 
Ante. p. 373. 
^jy gectiou 306 of this Act, is amended by striking out "or" at the end 
of clause (3) (A), and by inserting immediately before the period at 
the end thereof the following:", or (C) was entitled to, or upon appli-
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
405 
cation therefor and attainment of the required a ^ (if any) would 
have been entitled to, a widow's, child's (after attainment or age 18), 
or parent's insurance annuity under section 5 of the Railroad Retire-
ment Act of 193T, as amended". 
45u1c228;. 
(b) Section 216(c) of such Act, as amended by section 306 of this 
Act, is amended by striking out "or" at the end of clause (6) (A), and 
'^"^^' ^' ^'^^• 
by inserting immediately before the period at the end thereof the fol-
lowing: ", or (C) she was entitled to, or upon application therefor 
and attainment of the required age (if any) would have been entitled 
to, a widow's, child's (after attainment of age 18), or parent's insur-
ance annuity under section 5 of the Railroad Retirement Act of 1937, 
as amended". 
(c) Section 216(f) of such Act, as amended by section 306 of this 
Act, is amended by striking out "or" at the end oi clause (3) (A), and 
by inserting immediately before the period at the end thereof the fol-
lowing : ", or (C) he was entitled to, or upon application therefor and 
attainment of the required age (if any) he would have been entitled 
to, a widower's, child's (after attainment of age 18), or parent's 
insurance annuity under section 5 of the Railroad Retirement Act of 
1937, as amended". 
(d) Section 216(g) of such Act, as amended by section 306 of this 
Act, is amended by striking out "or" at the end of clause (6) (A), and 
by inserting immediately before the period at the end thereof the 
following: , or (C) he was entitled to, or on application therefor and 
attainment of the required age (if any) he would have been entitled 
to, a widower's, child's (after attainment of age 18), or parent's insur-
ance annuity under section 5 of the Railroad Retirement Act of 1937, 
as amended". 
(e) Section 202(c) (2) is amended by striking out "or" at the end AJtl,%^^37^2.^^'' 
of subparagraph (A), by striking out the period at the end of sub- 
42 use 402. 
paragraph (B) and inserting in lieu thereof "; or", and by adding 
after such subparagraph (B) the following new subparagraph: 
"(C) in the month prior to the month of his marriage to such 
individual he was entitled to, or on application therefor and 
attainment of the required age (if any) would have been entitled 
to, a widower's, child's (after attainment of age 18), or parent's 
insurance annuity under section 5 of the Railroad Retirement Act 
of 1937, as amended." 
(f) Section 202(f) (2) of such Act is amended by striking out 
"or" at the end of subparagraph (A), by striking out the period at 
the end of subparagraph (B) and inserting in lieu thereof "; or", and 
by adding after such subparagraph (B) the following new subpara-
graph : 
"(C) in the month prior to the month of his marriage to such 
individual he was entitled to, or on application therefor and 
attainment of the required age (if any), would have been entitled 
to, a widower's, child's (after attainment of age 18), or parent's 
insurance annuity under section 5 of the Railroad Retirement 
Act of 1937, as amended." 
(g) The amendments made by this section shall be applicable only 
with respect to monthly insurance benefits under title I I of the Social 
Security Act beginning with the second month following the month 
42 use 401. 
in which this Act is enacted, but only on the basis of applications filed 
in or after the month in which this Act is enacted. 
the total of his benefits under section 223 for such month and of an 
4
2 u*sc 402^' 
benefits under section 202 for such month based on his wages and sel 
406 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
REDUCTION OF BENEFITS ON RECEIPT OF WORKMEN'S COMPENSATION 
SEC. 335. Effective with respect to benefits under title II of the 
4
2 use 401. 
Social Security Act for months after December 1965 based on the 
wages and self-employment income of an individual who is entitled 
4
2 u'sc 4
2
3
^
.
' 
to benefits under section 223 of such Act and whose period of disability 
(as defined in such title) began after June 1, 1965, title II of such 
Act is amended by inserting after section 223 the following new 
section: 
"REDUCTION OF BENEFITS BASED ON DISABILITT ON ACCOUNT OF RECEIPT OF 
W O R K M E N ' S COMPENSATION 
"SEC 224. (a) If for any month prior to the month in which an 
individual attains the age of 62— 
"(1) such individual is entitled to benefits under section 223, 
and 
"(2) such individual is entitled for such month, under a work-
men's compensation law or plan of the United States or a State, 
to periodic benefits for a total or partial disability (whether or 
not permanent), and the Secretary has, in a prior month, received 
notice of such entitlement for such month, 
'_ ' ' t 
employment income shall be reduced (but not below zero) by the 
amount by which the sum of— 
"(3) such total of benefits under sections 223 and 202 for such 
month, and 
"(4) such periodic benefits payable (and actually paid) for 
such month to such individual under the workmen's compensation 
law or plan, 
exceeds the nigher of— 
"(5) 80 per centum of his 'average current earnings', or 
"(6) the total of such individuals disability insurance benefits 
under section 223 for such month and of any monthly insurance 
benefits under section 202 for such month based on his wa^es and 
self-employment income, prior to reduction under this section. 
In no case shall the reduction in the total of such benefits under sec-
tions 223 and 202 for a month (in a continuous period of months) 
reduce such total below the sum of— 
"(7) the total of the benefits under sections 223 and 202, after 
reduction under this section, with respect to all persons entitled 
to benefits on the basis of such individual's wages and self-employ-
ment income for such month which were determined for such 
individual and such persons for the first month for which reduc-
tion under this section was made (or which would have been so 
determined if all of them had been so entitled in such first month), 
and 
"(8) any increfise in such benefits with respect to such indi-
vidual and such persons, before reduction under this section, which 
is made effective for months after the first month for which reduc-
tion under this section is made. 
For purposes of clause (5), an individual's average current earnings 
means the larger of (A) the average monthly wage used for purposes 
of computing his benefits under section 223, or (B) one-sixtieth of the 
total of his wages and self-employment income for the five consecutive 
calendar years after 1950 for which such wages and self-employment 
income were highest. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
407 
"(b) If any periodic benefit under a workmen's compensation law 
or plan is payable on other than a monthly basis (excluding a benefit 
payable as a lump sum except to the extent that it is a commutation of, 
or a substitute for, periodic payments), the reduction under this sec-
tion shall be made at such time or times and in such amounts as the 
Secretary finds will approximate as nearly as practicable the reduction 
prescribed by subsection (a). 
"(c) Reduction of benefits under this section shall be made after 
any reduction under subsection (a) of section 203, but before deduc-
tions under such section and under section 222(b). 
"(d) The reduction of benefits reg^uired by this section shall not be 
made if the workmen's compensation law or plan under which a 
periodic benefit is payable provides for the reduction thereof when 
anyone is entitled to benefits under this title on the basis of the wages 
and self-employment income of an individual entitled to benefits under 
section 223. 
"(e) If it appears to the Secretary that an individual may be eligi-
ble for periodic benefits under a workmen's compensation law or plan 
which would give rise to reduction under this section, he may require, 
as a condition of certification for payment of any benefits under section 
223 to any individual for any month and of any benefits under section 
202 for such month based on such individual's wages and self-
employment income, that such individual certify (i) whether he has 
filed or intends to file any claim for such periodic benefits, and (ii) if 
he has so filed, whether there has been a decision on such claim. The 
Secretary may, in the absence of evidence to the contrary, rely upon 
such a certification by such individual that he has not filed and does 
not intend to file such a claim, or that he has so filed and no final 
decision thereon has been made, in certifying benefits for payment 
pursuant to section 205 (i). 
"(f) (1) In the second calendar year after the year in which reduc-
tion under this section in the total of an individual's benefits under 
section 223 and any benefits under section 202 based on his wages and 
self-employment income was first required (in a continuous period 
of months), and in each third year thereafter, the Secretary shall 
redetermine the amount of such benefits which are still subject to 
reduction under this section; but such redetermination shall not result 
in any decrease in the total amount of benefits payable under this title 
on the basis of such individual's wages and self-employment income. 
Such redetermined benefit shall be determined as of, and shall become 
effective with, the January following the year in which such redeter-
mination was made. 
"(2) In making the redetermination required by paragraph (1), 
the individual's average current earnings (as defined in subsection 
(a)) shall be deemed to be the product of his average current earnings 
as initially determined under subsection (a) and the ratio of (i) the 
average of the taxable wages of all persons for whom taxable wages 
were reported to the Secretary for the first calendar quarter of the 
calendar year in which such redetermination is made, to (ii) the 
average of the taxable wages of such persons reported to the Secretary 
for the first calendar quarter of the taxable year in which the reduction 
was first computed (but not counting any reduction made in benefits 
for a previous period of disability). Any amount determined under 
the preceding sentence which is not a multiple of $1 shall be reduced 
to the next lower multiple of $1. 
Ante, p. 363, 
378. 
70 Stat. 817. 
42 u s e 422. 
70 Stat. 815. 
42 u s e 423. 
64 Stat. 48 2. 
42 u s e 402. 
S3 Stat. 1371. 
42 use 405. 
408 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"(g) Whenever a reduction in the total of benefits for any monlh 
based on an individual's wages and self-employment income is made 
under this section, each benefit, except the disability insurance benefit, 
shall first be proportionately decreased, and any excess of such reduc-
tion over the sum of all such benefits other than the disability insurance 
benefit shall then be applied to such disability insurance benefit." 
PAYMENT OF COSTS OF REHABILITATION SERVICES FROM THE TRUST FUNDS 
42 use ^22.' 
^ ^ - ^^^- Section 222 of the Social Security Act is amended by 
adding at the end thereof the following new subsection: 
"COSTS O F REHABILITATION SERVICES FROM TRUST FUNDS 
"(d)(1) For the purpose of making vocational rehabilitation 
services more readily available to disabled individuals who are— 
"(A) entitled to disability insurance benefits under section 
70 Stat. 815. 
223. or 
64 Stat. 482. 
"(B) entitled to child's insurance benefits under section 202 
42 use 402. 
(d) after having attained age 18 (and are under a disability), 
to the end that savings will result to the Trust Funds as a result of 
rehabilitating the maximum number of such individuals into pro-
ductive activity, there are authorized to be transferred from the 
Trust Funds such sums as may be necessary to enable the Secretary 
to pay the costs of vocational rehabilitation services for such individ-
uals (including (i) services during their waiting periods, and (ii) 
so much of the expenditures for the administration of any State 
plan as is attributable to carrying out this subsection); except that 
the total amount so made available pursuant to this subsection in 
any fiscal year may not exceed 1 percent of the total of the benefits 
^^Ante. pp. 370, 
uuder section 202(d) for children who have attained age 18 and are 
under a disability, and the benefits under section 223, which were 
certified for payment in the preceding year. 
The selection of in-
dividuals (including the order in which they shall be selected) to 
receive such services shall be made in accordance with criteria formu-
lated by the Secretary which are based upon the effect the provision 
of such services would have upon the Trust Funds. 
"(2) In the case of each State which is willing to do so, such 
vocational rehabilitation services shall be furnished under a State 
plan for vocational rehabilitation services which— 
"(A) has been approved under section 5 of the Vocational 
68 Stat. 656. 
Eehabilitatlou Act, 
"(B) pr^ovides that, to the extent funds provided under this 
subsection are adequate for the purpose, such services will be 
furnished, to any individual in the State who meets the criteria 
prescribed by the Secretary pursuant to paragraph (1), with 
reasonable promptness and in accordance with the order of selec-
tion determmed under such criteria, and 
"(C) provides that such services will be furnished to any 
individual without regard to (i) his citizenship or place of resi-
dence, (ii) his need for financial assistance except as provided 
in reg^ulations of the Secretary in the case of maintenance during 
rehabilitation, or (iii) any order of selection which would other-
wise be followed under the State plan pursuant to section 5 (a) (4) 
of the Vocational Rehabilitation Act. 
" (3) In the case of any State which does not have a plan which meets 
the requirements of paragraph (2), the Secretary may provide such 
services by agreement or contract with other pulilio or private 
agencies, organizations, institutions, or individuals. 
29 u s e 35. 
68 Stat. 652. 
29 u s e 31 note. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
409 
" (4) Payments under this subsection may be made in installments, 
and in advance or by way of reimbursement, with necessary adjust-
ments on account of overpayments or underpayments. 
" (5) Money paid from the Trust Funds under this subsection to pay 
the costs of providing services to individuals who are entitled to bene-
fits under section 223 (including services during their waiting periods), 
^° ^*|^- ^^y-
or who are entitled to benefits under section 202(d) on the basis of the 
64 stat. 482; 
wages and self-employment income of such individuals shall be ^"'®' PP; •^^°' 3^^-
charged to the Federal Disability Insurance Trust Fund, and all other 
Ante, p. 370. 
money paid out from the Trust Funds under this subsection shall be 
charged to the Federal Old-Age and Survivors Insurance Trust Fund. 
The Secretary shall determine according to such methods and pro-
cedures as he may deem appropriate— 
" (A) the total cost or the services provided under this subsection, 
and 
"(B) subject to the provisions of the preceding sentence, the 
amount of such cost which should be charged to each of such Trust 
Funds. 
"(6) For the purposes of this subsection the term 'vocational reha-
bilitation services' shall have the meaning assigned to it in the Voca-
tional Rehabilitation Act, except that such services may be limited in 
type, scope, or amount in accordance with regulations of the Secretary 
designed to achieve the purposes of this subsection." 
TEACHERS I N T H E STATE OF M A I N E 
SEC. 337. (a) Section 316 of the Social Security Amendments of 1958 yJl^H^'^Ao'^'^'' 
is amended by striking out "July 1,1965" and inserting in lieu thereof 
42 use 418 
"July 1,1967". 
"°t«-
(b) The amendment made by this section shall be effective as of 
July 1,1965. 
MODIFICATION 
OF AGREEMENT W I T H 
NORTH DAKOTA AND IOWA 
W I T H 
RESPECT TO CERTAIN 
STUDENTS 
SEC. 338. Notwithstanding any provision of section 218 of the 
Social Security Act, the agreements with the States of North Dakota 
^^ ^*^^- ^
Y
g
"
^
-
and Iowa entered into pursuant to such section may, at the option of 
the State, be modified so as to exclude service performed in any calen-
dar quarter in the employ of a school, college, or university if such 
service is performed by a student who is enrolled and is regularly 
attending classes at such school, college, or university and if the remu-
neration for such service is less than $50. Any modification of either 
of such agreements pursuant to this Act shall be effective with respect 
to services performed after an effective date specified in such modifica-
tion, except that such date shall not be earlier than the date of enact-
ment of this Act. 
QUALIFICATION OF CHILDREN NOT QUALIFIED UNDER STATE LAW 
SEC. 339. (a) Section 216(h) of the Social Security Act is amended 7/statr\'o3o^' 
by adding at the end thereof the following new paragraph: 
42 use 416. 
" (3) An applicant who is the son or daughter of a fully or currently 
insured individual, but who is not (and is not deemed to be) the child 
of such insured individual under paragraph (2), shall nevertheless be 
deemed to be the child of such insured individual if: 
"(A) in the case of an insured individual entitled to old-age 
insurance benefits (who was not, in the month preceding such 
entitlement, entitled to disability insurance benefits)— 
49-850 0-66—29 
410 
PUBLIC LAW 89-97-JULY 30, 1965 
^79 STAT. 
"(i) such insured individual— 
"(I) has acknowledged in writing that the applicant 
is his son or daughter, 
"(II) has been decreed by a court to be the father of 
the applicant, or 
" (III) has been ordered by a court to contribute to the 
support of the applicant because the applicant is his son 
or daughter, 
and such acknowledgment, court decree, or court order was 
made not less than one year before such insured individual 
became entitled to old-age insurance benefits or attained age 
65, whichever is earlier; or 
"(ii) such insured individual is shown by evidence satis-
factory to the Secretary to be the father of the applicant and 
was living with or contributing to the support of the appli-
cant at the time such insured mdividual became entitled to 
benefits or attained age 65, whichever first occurred; 
"(B) in the case of an insured individual entitled to disability 
insurance benefits, or who was entitled to such benefits in the 
month preceding the first month for which he was entitled to old-
age insurance benefits— 
"(i) such insured individual—• 
"(I) has acknowledged in writing that the applicant 
is his son or daughter, 
"(II) has been decreed by a court to be the father of 
the applicant, or 
" (III) has been ordered by a court to contribute to the 
support of the applicant because the applicant is his son 
or daughter, 
and such acknowledgment, court decree, or court order was 
made before such insured individuaj's most recent period of 
disability began; or 
"(ii) such insured individual is shown by evidence satis-
factory to the Secretary to be the father of the applicant and 
was living with or contributing to the support of that appli-
cant at the time such period of disability began; 
"(C) in the case of a deceased individual— 
"(i) such insured individual— 
"(I) had acknowledged in writing that the applicant 
is his son or daughter, 
"(II) had been decreed by a court to be the father of 
the applicant, or 
"(III) had been ordered by a court to contribute to 
the support of the applicant because the applicant was 
his son or daughter, 
and such acknowledgment, court decree, or court order was 
made before the death of such insured individual, or 
"(ii) such insured individual is shown by evidence satis-
factory to the Secretary to have been the father of the appli-
cant, and such insured individual was living with or 
contributing to the support of the applicant at the time such 
insured individual died." 
74 Stat. 952. 
(b) Sectlou 202(d) of such Act is amended by inserting after 
42 use 402. 
«216(h) (2) (B)" the following: "or section 216(h) (3)". 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
411 
(c) The amendments made by subsections (a) and (b) shall be 
applicable with respect to monthly insurance benefits under title I I 
of the Social Security Act beginning with the second month following 
^2 use 401. 
the month in which this Act is enacted but only on the basis of an 
application filed in or after the month in which this Act is enacted. 
DISCLOSURE, UNDER CERTAIN CIRCUMSTANCES, TO COURTS AND INTERESTED 
WELFARE AGENCIES OF WHEREABOUTS OF INDIVIDUALS 
SEC. 340. Section 1106 of the Social Security Act is amended by 
^J Jta^ 5
^
5
9
^ 
adding at the end thereof the following new subsection: 
"(c) (1) Upon request (filed in accordance with paragraph (2) of 
this subsection) of any State or local agency participating in admin-
istration of the State plan approved under title I, IV, X, XIV, XVI, 
or XIX, or participating in the administration of any other State or 
42 use 301 et 
local public assistance program, for the most recent address of any ^*'^* 
individual included in the files of the Department of Health, Educa-
tion, and Welfare maintained pursuant to section 205, the Secretary 
^2^*|l* ^Q^^' 
shall furnish such address, or the address of the most recent employer, 
or both, if such agency certifies that— 
"(A) an order has been issued by a court of competent juris-
diction against such individual for the support and maintenance 
of his child or children who are under the age of 16 in destitute or 
necessitous circumstances, 
'^(B) such child or children are applicants for or recipients of 
assistance available under such a plan or program, 
"(C) such agency has attempted without success to secure such 
information from all other sources reasonably available to it, and 
"(D) such information is requested (for its own use, or on the 
request and for the use of the court which issued the order) for 
the purpose of obtaining such support and maintenance. 
"(2) A request under paragraph (l) shall be filed in such manner 
and form as the Secretary may prescribe, and shall be accompanied 
by a certified copy of the order referred to in paragraph (1) (A). 
"(3) The penalties provided in the second sentence of subsection 
(a) shall apply with respect to use of information provided under 
paragraph (1) of this subsection except for the purpose authorized 
by subparagraph (D) thereof. 
"(4) The Secretary, in such cases and to such extent as he may 
prescribe in accordance with regulations, may require payment for 
the cost of information provided under paragraph (1); and the pro-
visions of the second sentence of subsection (D) shall apply also with 
respect to payment under this paragraph." 
ADDITIONAL PERIOD FOR FILING MINISTERS CERTIFICATES 
SEC. 341. (a) Clause (B) of section 1402(e)(2) of the Internal 
Revenue Code of 1954 (relating to time for filing waiver certificate by 7g^stft^\*o76^' 
ministers, members of religious orders, and Christian Science practi- 
26 use 1402. 
tioners) is amended by striking out "his second taxable year ending 
after 1962" and inserting in lieu thereof "his second taxable year end-
ing after 1963". 
(b) Section 1402(e) (3) of such Code (relating to effective date of 
''l^H^^ ^"; 
certificate) is amended by adding at the end thereof the following ^^ 
new subparagraph: 
42 u s e 401. 
412 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"(D) Notwithstanding the first sentence of subparagraph 
(A), if an individual files a certificate after the date of the 
enactment of this subparagraph and on or before the due date 
of the return (including any extension thereof) for his sec-
ond taxable year ending after 1963, such certificate shall be 
effective for his first taxable year ending after 1962 and all 
succeeding years." 
(c) The amendments made by subsections (a) and (b) shall be ap-
plicable only with respect to certificates filed pursuant to section 1402 
26 use 1402 
(g^ of the Internal Revenue Code of 1954 after the date of the enact-
ment of this Act; except that no monthly benefits under title I I of the 
Social Security Act for the month in which this Act is enacted or any 
prior month shall be payable or increased by reason of such amend-
ments. 
RECTEFYING ERROR I N 
INTERPRETING 
LAW W I T H 
RESPECT TO 
CERTAIN 
SCHOOL EMPLOYEES I N 
ALASKA 
SEC. 342. For purposes of the agreement under section 218 of the 
4 2 use' 4\^8l' 
Social Security Act entered into by the State of Alaska, or its prede-
cessor the Territory of Alaska, where employees of an integral unit 
of a political subdivision of the State or Territory of Alaska have in 
good faith been included under the State or Territory's agreement as a 
coverage group on the basis that such integral unit of a political sub-
division was a political subdivision, then such unit of the political 
subdivision shall, for purposes of section 218(b) (2) of such Act, be 
deemed to be a political subdivision, and employees performing serv-
ices within such unit shall be deemed to be a coverage group, effective 
with the effective date specified in such agreement or modification of 
such agreement with respect to such coverage group and ending with 
the last day of the year in which this Act is enacted. 
CONTINUATION 
OF 
C H I L D ' S 
INSURANCE 
BENEFITS 
AFTER 
ADOPTION 
BY 
BROTHER OR SISTER 
Ante,, p. 371. 
SEC. 343. (a) Section 202(d) (1) (D) of the Social Security Act (as 
amended by section 306(b) of this Act) is further amended by strik-
ing out "or uncle" and inserting in lieu thereof "uncle, brother, or 
sister". 
(b) The amendment made by subsection (a) shall apply only with 
respect to monthly insurance benefits under title I I of the Social Secu-
rity Act for months after the month in which this Act is enacted; 
except that, in the case of an individual who was not entitled to child's 
/intt ^*^*'370' 
insurance benefits under section 202(d) of such Act for the month in 
397.' 
' 
' 
which this Act was enacted, such amendment shall apply only on the 
42 use 402. 
basis of an application filed in or after the month in which this Act 
is enacted. 
DISABILITY INSURANCE BENEFITS FOR T H E B L I N D ; 
SPECIAL 
PROVISIONS 
SEC. 344. (a) Section 216(i) (3) of the Social Security Act (as 
Ants, p. 367. 
amended by section 303 of this Act) is further amended by striking 
out subparagraph (B) and all that follows and inserting in lieu 
thereof the following: 
"(B) (i) he had not less than 20 quarters of coverage during 
the 40-quarter period which ends with such quarter, or 
"(ii) if such quarter ends before he attains (or would attain) 
age 31 and he is under a disability by reason of blindness (as 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
413 
defined in paragraph (1)), not less than one-half (and not less' 
than 6) of the quarters during the period ending with such 
quarter and beginning after he attained the age of 21 were 
quarters of coverage, or (if the number of quarters in such 
period is less than 12) not less than 6 of the quarters in the 12-
quarter period ending with such quarter were quarters of 
coverage; 
except that the provisions of subparagraph (A) of this paragraph 
shall not apply in the case of an individual with respect to whom a 
period of disability would, but for such subparagraph, begin before 
1951. For purposes of subparagraph (B) of this paragraph, when 
the number of quarters in any period is an odd number, such number 
shall be reduced by one, and a quarter shall not be counted as part 
of any period if any part of such quarter was included in a prior 
period of disability unless such quarter was a quarter of coverage." 
(b) Section 223(c) (1) of such Act is amended by striking out sub- 
^o sm. s^is. 
paragraph (B) and inserting in lieu thereof the following: 
"(B) (i) he had not less than 20 quarters of coverage during 
the 40-quarter period which ends with the quarter in which such 
month occurred, or 
"(ii) if such month ends before he attains (or would attain) 
age 31 and he is under a disability by reason of blindness (as 
defined in section 216(i)(l)), not less than one-half (and not 
es stat. loso. 
less than 6) of the quarters during the period ending with the 
'*^ usc4i6. 
quarter in which such month occurred and beginning after he 
attained the age of 21 were quarters of coverage, or (if the 
number of quarters in such period is less than 12) not less than 
6 of the quarters in the 12-quarter period ending with such 
quarter were quarters of coverage. 
For purposes of subparagraph (B) of this paragraph, when the 
number of quarters in any period is an odd number, such number 
shall be reduced by one, and a quarter shall not be counted as part 
of any period if any part of such quarter was included in a period 
of disability unless such quarter was a quarter of coverage." 
(c) Section 223(a)(1) of such Act (as amended by section 303 
of this Act) is further amended by adding the following sentence 
^"'*' P* 367. 
at the end thereof: "No payment under this paragraph may be made 
to an individual who would not meet the definition of disability in 
subsection (c) (2) except for subparagraph (B) thereof for any 
month in which he engages in substantial gainful activity, and no 
payment may be made for such month under subsection (b), (c), or 
(d) of section 202 to any person on the basis of the wages and self- 
^"'*' f
^
" ^7°' 
employment income of such individual." 
482! 
(d) The first sentence of section 223(c)(2) of such Act (as 
42 use 402. 
amended by section 303 of this Act) is further amended by adding 
a'fter subparagraph (A) the following new subparagraph: 
"(B) in the case of an individual who has attained the age 
of 55 and is blind (within the meaning of 'blindness' as defined 
in section 216(i)(l)), inability by reason of such blindness to 
engage in substantial gainful activity requiring skills or abilities 
comparable to those of any gainful activity in which he has 
previously engaged with some regularity and over a substantial 
period of time." 
(e) The amendments made by this section shall apply only with 
respect to monthly benefits under title I I of the Social Security Act 
'^^ use 401. 
for months after the first month following the month in which 
this Act is enacted, on the basis of applications for such benefits 
filled in or after the month in which this Act is enacted. 
414 
PUBLIC LAW 89-97-JULY 30, 1%5 
[79 STAT. 
TITLE IV—PUBLIC ASSISTANCE AMENDMENTS 
INCREASED 
FEDERAL 
PAYMENTS 
UNDER 
PUBLIC 
ASSISTANCE 
TITLES 
OF 
T H E SOCIAL SECURITY ACT 
76 Stat.^193. 
SEC. 401. (a) Sectioii 3 (ti) (1) of the Soclal Security Act is amended 
(1) by striking out, in so much thereof as precedes clause (A), "during 
such quarter" and inserting in lieu thereof "during each month of such 
quarter"; (2) by striking out, in clause (A), "29/35", "any month", 
and "$35" and inserting in lieu thereof "31/37", "such month", and 
"$37", respectively; and (3) by striking out clauses (B) and (C) and 
inserting in lieu thereof the following: 
" (B) the larger of the f 
ollowmg: 
"(i)(I) the Federal percentage (as defined in section 
72 Stat. loso. 
1101(a)(8)) of the amount by which such expenditures 
'^^ " ^ ^ * 
exceed the amount which may be counted under clause (A), 
not counting so much of such excess with respect to such 
month as exceeds the product of $38 multiplied by the total 
number of recipients of old-age assistance for such month, 
plus (II) 15 per centum of the total expended during such 
month as om-age assistance under the State plan m the 
form of medical or any other type of remedial care, not 
counting so much of such expenditure with respect to such 
month as exceeds the product of $15 multiplied oy the total 
number of recipients of old-age assistance for such month, or 
"(ii)(I) the Federal medical percentage (as defined in 
42us"c306* 
section 6(c)) of the amount by which such expenditures 
exceed the maximum which may be counted under clause (A), 
not counting so much of any expenditures with respect to such 
month as exceeds (a) the product of $52 multiplied by the 
total number of such recipients of old-age assistance for such 
month, or (b) if smaller, the total expended as old-age assist-
ance in the form of medical or any other type of remedial care 
with respect to such month plus the product of $37 multiplied 
by such total number of such recipients, plus (II) the Federal 
percentage of the amount by which the total expended during 
such month as old-age assistance under the State plan exceeds 
the amount which may be counted under clause (A) and the 
preceding provisions of this clause (B) (ii), not counting so 
much of such excess with respect to such month as exceeds 
the product of $38 multiplied by the total number of such 
recipients of old-age assistance for such month;". 
l\ usl; U83. 
(b) Section 1603(a) (1) of such Act is amended (1) by striking out, 
in so much thereof as precedes clause (A), "during such quarter" and 
inserting in lieu thereof "during each month of such quarter"; (2) by 
striking out, in clause (A), "29/35", "any month", and "$35" and 
mserting in lieu thereof "31/37", "such month", and "$37", respec-
tively; and (3) by striking out clauses (B) and (C) and inserting in 
lieu thereof the following: 
"(B) the larger of the following: 
"(i)(I) the Federal percentage (as defined in section 
1101(a)(8)) of the amount by which such expenditures 
exceed the amount which may be counted under clause (A), 
not counting so much of such excess with respect to such 
month as exceeds the product of $38 multiplied by the total 
number of recipients of aid to the aged, blind, or disabled 
for such month, plus (II) 15 per centum of the total expended 
during such month as aid to the aged, blind, or disabled under 
42 u s e 306. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
415 
the State plan in the form of medical or any other type of 
remedial care, not counting so much of such expenditure 
with respect to such month as exceeds the product of $15 
multiplied by the total number of recipients of aid to the 
aged, blind, or disabled for such month, or 
"(ii)(I) the Federal medical percentage (as defined in 
section 6(c)) of the amount by which such expenditures 
lofi^^n^nl' 
exceed the maximum which may be counted under clause (A), 
not counting so much of any expenditures with respect to 
such month as exceeds (a) the product of $52 multiplied by 
the total number of such recipients of aid to the aged, blind, 
or disabled for such month, or (b) if smaller, the total 
expended as aid to the aged, blind, or disabled in the form 
of medical or any other type of remedial care with respect 
to such month plus the product of $37 multiplied by such total 
number of such recipients, plus (II) the Federal percentage 
of the amount by which the total expended during such 
month as aid to the aged, blind, or disabled under the State 
plan exceeds the amount which may be counted under clause 
(A) and the preceding provisions of this clause (B)(ii), 
not counting so much of such excess with respect to such 
month as exceeds the product of $38 multiplied by the total 
number of such recipients of aid to the aged, olind, or disabled 
for such month;". 
(c) Section 403(a) (1) of such Act is amended (1) by striking out 
^6 stat. ^74. 
''fourteen-seventeenths" and "$17" in clause (A) and inserting in lieu 
"^ ""'" ""' 
thereof "five-sixths" and "$18", respectively; and (2) by striking out 
*'$30" in clause (B) and inserting in lieu thereof "$32". 
(d) Section 1003(a)(1) of such Act is amended (1) by striking 
out, in clause (A), "29/35" and "$35" and inserting in lieu thereof 
"31/37" and "$37", respectively; and (2) by striking out, in clause 
(B), "$70" and inserting in lieu thereof "$75". 
(e) Section 1403(a)(1) of such Act is amended (1) by striking 
42 use 1353. 
out, in clause (A), "29/35" and "$35" and inserting in lieu thereof 
"31/37" and "$37", respectively; and (2) by striking out, in clause 
(B), "$70" and inserting in lieu thereof "$75". 
(f) The amendments made by this section shall apply in the case of 
exiDenditures made after December 31, 1965, under a State plan ap-
proved under title I, IV, X, XIV, or XVI of the Social Security Act. 
^2 use 301. 
^ 
7 
5 
> 
? 
J 
gOi^ 1201, 1351, 
42 u s e 603. 
42 u s e 1203. 
1381. 
PROTECTIVE PAYMENTS 
SEC. 402. (a) Section 6(a) of the Social Security Act (as amended 
by section 221 of this Act) is amended by adding at the end thereof 
^"'*' P* '^^^' 
the following new sentence: "Such term also includes payments which 
are not included within the meaning of such term under the preceding 
sentence, but which would be go included except that they are made 
on behalf of such a needy individual to another individual who (as 
determined in accordance with standards prescribed by the Secretary) 
is interested in or concerned with the welfare of such needy individual, 
but only with respect to a State whose State plan approved under 
section 2 includes provision for— 
"
^
2 use 302. 
"(1) determination by the Stat© agency that such needy indi-
yidual has, by reason of his physical or mental condition, such 
inability to manage funds that making payments to him would 
be contrary to his welfare and, therefore, it is necessary to provide 
such assistance through payments described in this sentence; 
72 Stat. 10 52. 
• 42 u s e 1311. 
Ante, p. 358. 
416 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
"(2) making such payments only in cases in which such pay-
ments will, under the rules otherwise applicable under the State 
plan for determining need and the amount of old-age assistance to 
Be paid (and in conjunction with other income and resources), 
meet all the need of the individuals with respect to whom such 
payments are made; 
"(3) undertaking and continuing special efforts to protect the 
welfare of such individual and to improve, to the extent possible, 
his capacity for self-care and to manage funds; 
" (4) periodic review by such State agency of the determination 
under paragraph (1) to ascertain whether conditions justifying 
such determination still exist, with provision for termination of 
such payments if they do not and for seeking judicial appointment 
of a guardian or other legal representative, as described in sec-
tion 1111, if and when it appears that such action will best serve 
the interests of such needy individual; and 
"(5) opportunity for a fair hearing before the State agency on 
the determination referred to in paragraph (1) for any individual 
with respect to whom it is made." 
(b) Section 1605(a) of such Act (as amended by section 221 of this 
Act) is amended by adding at the end thereof (after and below para-
graph (2)) the following new sentence: 
"Such term also includes payments which are not included within 
the meaning of such term under the preceding sentence, but which 
would be so included except that they are made on behalf of such a 
needy individual to another individual who (as determined in accord-
ance with standards prescribed by the Secretary) is interested in or 
concerned with the welfare of such needy individual, but only with 
respect to a State whose State plan approved under section 1602 
includes provision for— 
"(A) determination by the State agency that such needy in-
dividual has, by reason of his physical or mental condition, such 
inability to manage funds that making payments to him would be 
contrary to his welfare and, therefore, it is necessary to provide 
such aid through payments described in this sentence; 
"(B) making such payments only in cases in which such pay-
ments will, under the rules otherwise'applicable under the otate 
plan for determining need and the amount of aid to the aged, 
blind, or disabled to be paid (and in conjunction with other income 
and resources), meet all the need of the individuals with respect to 
whom such payments are made; 
"(C) undertaking and continuing special efforts to protect the 
welfare of such individual and to improve, to the extent possible, 
his capacity for self-care and to manage funds; 
"(D) periodic review by such State agency of the determination 
under clause (A) to ascertain whether conditions justifying such 
determination still exist, with provision for termination of such 
payments if they do not and for seeking judicial appointment of a 
guardian or other legal representative, as described in section 
1111, if and when it appears that such action will best serve the 
interests of such needy individual; and 
"(E) opportunity for a fair hearing before the State agency on 
the determination referred to in clause (A) for any individual 
with respect to whom it is made." 
(c) Section 1006 of the Social Security Act (as amended by section 
221 of this Act) is amended by adding at the end thereof the following 
new sentence: "Such term also includes payments which are not in-
76 Stat. 198. 
42 u s e 138 2. 
Ante, p . 358. 
49 Stat. 645. 
42 u s e 120 2. 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
417 
eluded within the meaning of such term under the preceding sentence, 
but which would be so included except that they are made on behalf 
of such a needy individual to another individual who (as determined 
in accordance with standards prescribed by the Secretary) is interested 
in or concerned with the welfare of such needy individual, but only 
with respect to a State whose State plan approved under section 1002 
includes provision for— 
"(1) determination by the State agency that such needy indi-
vidual has, by reason of his physical or mental condition, such 
inability to manage funds that making payments to him would 
be contrary to his welfare and, therefore, it is necessary to provide 
such aid through payments described in this sentence; 
"(2) making such payments only in cases in which such pay-
ments will, under the rules otherwise applicable under the State 
plan for determining need and the amount of aid to the blind 
to be paid (and in conjunction with other income and resources), 
meet all the need of the individuals with respect to whom such 
payments are made; 
"(3) undertaking and continuing special efforts to protect the 
welfare of such individual and to improve, to the extent possible, 
his capacity for self-care and to manage funds; 
"(4) periodic review by such State agency of the determina-
tion under paragraph (1) to ascertain whether conditions justi-
fying such determination still exist, with provision for termina-
tion of such payments if they do not and for seeking judicial 
appointment of a guardian or other legal representative, as de-
scribed in section 1111, if and when it appears that such action 
^2 stat. 1052. 
will best serve the interests of such needy individual; and 
"
* 
"(5) opportunity for a fair hearing before the State agency on 
the determination referred to in paragraph (1) for any individual 
with respect to whom it is made." 
(d) Section 1405 of the Social Security Act (as amended by section 
221 of this Act) is amended by adding at the end thereof the follow- 
^"'*' P* ^^^' 
ing new sentence: "Such term also includes payments which are not 
included within the meaning of such term under the preceding sen-
tence, but which would be so included except that they are made on 
behalf of such a needy individual to another individual who (as de-
termined in accordance with standards prescribed by the Secretary) is 
interested in or concerned with the welfare of such needy individual, 
but only with respect to a State whose State plan approved under 
section 1402 includes provision for— 
J^ ^^^^' ^^^^^ 
"(1) determination by the State agency that such needy 
individual has, by reason of his physical or mental condition, such 
inability to manage funds that making payments to him would be 
contrary to his welfare and, therefore, it is necessary to provide 
such aid through payments described in this sentence; 
"(2) making such payments only in cases in which such pay-
ments will, under the rules otherwise applicable under the State 
plan for determining need and the amount of aid to the perma-
nently and totally disabled to be paid (and in conjunction with 
other income and resources), meet all the need of the individuals 
with respect to whom such payments are made; 
"(3) undertaking and continuing special efforts to protect the 
welfare of such individual and to improve, to the extent possible, 
his capacity for self-care and to manage funds; 
"(4) periodic review by such Staite agency of the determination 
nnder Daragraph (1) to ascertain whether conditions justifying 
418 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
such determination still exist, with provision for termination of 
such payments if they do not and for seeking judicial appointment 
72 Stat 1
0 52 
^^ ^ guardiau or other legal representative, as described in sec-
42 use 1311.* 
tion 1111, if and when it appears that such action will best serve 
the interests of such needy mdividual; and 
"(5) opportunity for a fair hearing before the State agency on 
the determination referred to in paragraph (1) for any individual 
with respect to whom it is made." 
(e) The amendments made by this section shall apply in the case 
of expenditures made after December 31, 1965, under a State plan 
i2ol"f35i^°i38i. approved under title I, X, XIV, or XVI of the Social Security Act. 
DISREGARDING CERTAIN EARNINGS I N DETERMINING NEED UNDER ASSIST-
ANCE PROGRAMS FOR T H E AGED, BLIND, AND DISABLED 
SEC, 403. (a) Effective October 1, 1965, section 2(a) (10) (A) of the 
42 us^c* 30^2' 
Social Security Act is amended by striking out "; except that, in mak-
ing such determination, of the first $50 per month of earned income 
the State agency may disregard, after December 31, 1962, not more 
than the first $10 thereof plus one-half of the remainder" and insert-
ing in lieu thereof the following: "; except that, in making such 
determination, (i) the State agency may disregard not more than 
$5 per month of any income and (li) of the first $80 per month of 
additional income which is earned the State agency may disregard not 
more than the first $20 thereof plus one-half of the remainder". 
(b) Effective October 1, 1965, section 402(a) (7) of the Social Se-
Post, p. 423. 
curity Act (as amended by section 410 of this Act) is further amended 
by inserting before the semicolon at the end thereof the following: 
", and (C) the State agency may, before disregarding the amounts 
referred to in clauses (A) and (B), disregard not more than $5 of any 
income". 
(c) Effective October 1, 1965, section 1002(a)(8) of the Social 
42 use n^l* 
Security Act is amended by inserting before the semicolon at the end 
thereof the following: ", and (C) may, before disregarding the 
amounts referred to in clauses (A) and (B), disregard not more than 
$5 of any income". 
64 Stat. 5|5. 
((J) Effcctive October 1, 1965, section 1402(a) (8) of such Act is 
amended by inserting after the semicolon at the end thereof the fol-
lowing: "except that, in making such determination, (A) the State 
agency may disregard not more than $5 of any income, (B) of the first 
$80 per month of additional income which is earned the State agency 
may disregard not more than the first $20 thereof plus one-half of the 
remainder, and (C) the State agency may, for a period not in excess 
of 36 months, disregard such additional amounts of other income and 
resources, in the case of an individual who has a plan for achieving 
self-support approved by the State agency, as may be necessary for 
the fulfillment of such plan, but only with respect to the part or parts 
of such period during substantially all of which he is actually under-
going vocational rehabilitation;". 
II I'ic'SI!: 
(e) Effective October 1, 1965, section 1602(a) (14) of such Act is 
amended to read as follows: 
" (14) provide that the State agency shall, in determining need 
for aid to the aged, blind, or disabled, take into consideration any 
other income and resources of an individual claiming such aid, as 
well as any expenses reasonably attributable to the earning of any 
such income; except that, in making such determination with 
respect to any individual— 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
419 
"(A) if such individual is blind, the State agency (i) 
shall disregard the first $85 per month of earned income plus 
one-half of earned income in excess of $85 per month, and 
(ii) shall, for a period not in excess of 12 months, and may, 
for a period not m excess of 36 months, disregard such addi-
tional amounts of other income and resources, in the case of 
any such individual who has a plan for achieving self-
support approved by the State agency, as may be necessary 
for the fulfillment of such plan, 
"(B) if such individual is not blind but is permanently 
and totally disabled, (i) of the first $80 per month of earned 
income, the State agency may disregard not more than the 
first $20 thereof plus one-half of the remainder, and (ii) the 
State agency may, for a period not in excess of 36 months, 
disregard such additional amounts of other income and 
resources, in the case of any such individual who has a plan 
for achieving self-support approved by the State agency, as 
may be necessary for the fulfillment of such plan, but only 
with respect to the part or parts of such period during sub-
stantially all of which he is actually undergoing vocational 
rehabilitation, 
"(C) if such individual has attained age 65 and is neither 
blind nor permanently and totally disabled, of the first $80 
per month of earned income the State agency may disregard 
not more than the first $20 thereof plus one-half of the 
remainder, and 
"(D) the State agency may, before disregarding the 
amounts referred to above in this paragraph (14), disregard 
not more than $5 of any income; and". 
ADMINISTRATIVE AND JUDICIAL REVIEW OF PUBLIC ASSISTANCE 
DETERMINATIONS 
SEC. 404. (a) Title X I of the Social Security Act is amended by 
^' "^^ *^^^-
adding at the end thereof the following new section: 
" A D M I N I S T R A T I V E AND JUDICIAL REVIEW OF CERTAIN ADMINISTRATIVE 
DETERMINATIONS 
"SEC. 1116. (a) (1) Whenever a State plan is submitted to the Sec-
retary by a State for approval under title I, IV, X, XIV, XVI, or 
X I X , he shall, not later than 90 days after the date the plan is sub- ^^^ "s^^^ soi, 
mitted to him, make a determination as to whether it conforms to the lasi. 
requirements for approval under such title. 
The 90-day period pro- 
^"^^' P- 343. 
vided herein may be extended by written agreement of the Secretary 
and the affected State. 
"(2) Any State dissatisfied with a determination of the Secretary 
under paragraph (1) with respect to any plan may, within 60 days 
after it has been notified of such determination, file a petition with 
the Secretary for reconsideration of the issue of whether such plan 
conforms to the requirements for approval under such title. 
Within 
30 days after receipt of such a petition, the Secretary shall notify the 
State of the time and place at which a hearing will be held for the 
purpose of reconsidering such issue. Such hearing shall be held not 
less than 20 days nor more than 60 days after the date notice of such 
hearing is furnished to such State, unless the Secretary and such 
420 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
State agree in writing to holding the hearing at another time. The^ 
Secretary shall affirm, modify, or reverse his original determination 
within 60 days of the conclusion of the hearing. 
" (3) Any State which is dissatisfied with a final determination made 
by the Secretary on such a reconsideration or a final determination of 
the Secretary under section 4,404,1004,1404,1604^ or 1904 may, within 
60 days after it has been notified of such determmation, file with the 
United States court of appeals for the circuit in which such State is 
located a petition for review of sudh determination. 
A copy of the 
petition shall be forthwith transmitted by the clerk of the court to the 
Secretary. 
The Secretary thereupon shall file in the court the record 
of the proceedings on w'hich he based his determination as provided in 
72 Stat. 941. 
scctiou 2112 of title 28, United States Code. 
"(4) The findings of fact by the Secretary, if supported by sub-
stantial evidence, shall be conclusive; but the court, for good cause 
shown, may remand the case to the Secretary to take further evidence, 
and the Secretary may thereupon make new or modified findings of 
fact and may modify his previous action, and shall certify to the court 
the transcript and record of the further proceedings. 
Such new or 
modified findings of fact shall likewise be conclusive if supported by 
substantial evidence. 
"(5) The court shall have jurisdiction to affirm the action of the 
Secretary or to set it aside, in whole or in part. The judgment of the 
court shall be subject to review by the Supreme Court of the United 
States upon certiorari or certification as provided in section 1254 of 
62 Stat. 9 28. 
title 28, United States Code. 
"(b) For the purposes of subsection (a), any amendment of a State 
601 S 
^?35i 
P^^? approved under title I, IV, X, XIV, XVI, or X I X may, at the 
1381. 
' 
' 
option of the State, be treated as the submission of a new State plan. 
Ante, p. 343. 
"(c) Actiou pursuaut to an initial determination of the Secretary 
described in subsection (a) shall not be stayed pending reconsidera-
tion, but in the event that the Secretary subsequently determines that 
his initial determination was incorrect he shall certify restitution 
forthwith in a lump sum of any funds incorrectly withheld or other-
wise denied. 
"(d) Whenever the Secretary determines that any item or class of 
items on account of which Federal financial participation is claimed 
under title I, IV, X, XIV, XVI, or X I X shall be disallowed for such 
participation, the State shall be entitled to and upon request shall 
receive a reconsideration of the disallowance." 
(b) The amendment made by subsection (a) shall apply only with 
respect to determinations made after December 31, 1965. 
MAINTENANCE OF STATE PUBLIC ASSISTANCE EXPENDITURES 
42 use 1301. 
gj,(3 405. Title X I of the Social Security Act is amended by adding 
at the end thereof (after the new section 1116 added by section 404 of 
Ante, p. 419. 
^hls Act) thc foUowlug new section: 
u 
MAINTENANCE OF STATE EFFORT 
"SEC. 1117. (a) The total of the amounts determined under sec-
tions 3, 403, 1003, 1403, 1603, and 1903 for any State for any quarter 
beginning after December 31, 1965, and ending before July 1, 1969, 
shall be reduced to the extent that— 
"(1) the excess of (A) the total of the amounts determined 
for the State under sections 3, 403, 1003, 1403, 1603, and 1903 for 
such quarter over (B) the total of the amounts determined for 
79 STAT. ] 
PUBLIC LAW 89-97-JULY 30, 1965 
421 
the State under sections 3, 403, 1003, 1403, and 1603 for the same 
quarter of the fiscal year ending June 30, 1965, is greater than 
"(2) the excess of (A) the total of the expenditures for such 
quarter (for which the determination is being made) under the 
plans of the State approved under titles I, IV, X, XIV, XVI, 
and X I X over (B) the total of the expenditures under the State 
^^^ ^^^^ ^"g'g^ 
plans of the State approved under titles I, IV, X, XIV, and XVI 
las'i. 
for the same quarter of the fiscal year ending June 30, 1965; 
^"'®' P- ^^S. 
except that, at the option of the State, any of the following may be 
substituted (with respect to the quarters of any fiscal year) for the 
amount determined as provided in paragraph (1)(B)— 
"(3) the total of the amounts determined for the State under 
sections 3, 403, 1003, 1403, and 1603 for the same quarter in the 
fiscal year ending June 30, 1964; or 
"(4) the average of the totals determined for the State under 
sections 3, 403, 1063, 1403, and 1603 for each quarter in the fiscal 
year ending June 30, 1964, or June 30, 1965. 
If the substitution of the total referred to in paragraph (3) is chosen 
by the State, there shall be substituted for the amount determined 
under clause (B) of paragraph (2) the total of the expenditures under 
the plans of the State approved under titles I, IV, X, XIV, and XVI 
for the quarter referred to in such paragraph (3), 
If the substitu-
tion of the average for either of the years referred to in paragraph 
(4) is chosen by the State, there shall be substituted for the amount 
determined under clause (B) of paragraph (2) the average of the 
total expenditures under the plans of the State approved under titles 
I, IV, X, XIV, and XVI for each quarter in the same fiscal year. 
" (b) For purposes of this section, expenditures under the plans of 
any State approved under titles I, IV, X, XIV, XVI, and X I X and 
the reduction determined with respect thereto under this section, shall 
be determined on the basis of data furnished by the State in the quar-
terly reports submitted by the State to the Secretary pursuant to and 
in accordance with the requirements of the Secretary under title I, 
IV, X, XIV, XVI, or X I X ; and determinations so made shall be 
conclusive for purposes of this section. 
"(c) If a reduction is required under the preceding provisions of 
this section in the total of the amounts determined for a State under 
sections 3,403,1003,1403,1603, and 1903 for any quarter, the Secretary 
shall determine which of such amounts shall be reduced and the extent 
thereof in such manner as in his judgment will best carry out the 
purpose of maintaining State effort under the Federal-State public 
assistance programs of the State, and with the total of such reductions 
to be equal to the reduction required under subsections (a) and (b) 
of this section." 
DISREGARDING OASDI BENEFIT INCREASE, AND C H I L D ' S INSURANCE BENEFIT 
PAYMENTS BEYOND AGE 1 8 , TO T H E EXTENT ATTRIBUTABLE TO RETROAC-
TIVE EFFECTIVE DATE 
SEC. 406. Notwithstanding the provisions of sections 2(a) (10) and 
(11) (D), 402(a)(7), 1002(a)(8), 1402(a)(8), and 1602(a) (13) 
and (14) of the Social Security Act, a State may disregard, in deter- ^74 stat. gss; 
mining need for aid or assistance under a State plan approved under stLt.'ioVs; 7
*
1 stat. 
title I, IV, X, XIV, or XVI of such Act, any amount paid to any 523; 76 st'at. 199. 
individual under title I I of such Act (or under the Kailroad Eetirement 
'^ ^ ^^^ '*° ^' 
422 
PUBLIC LAW 89-97-JULY 30, 1965 
[79 STAT. 
Ante, p. 400. 
^^t of 1937 by reason of section 326(a) of this Act), for any one or 
more months which occur after December 1964 and before the third 
month following the month in which this Act is enacted, to the extent 
that such payment is attributable— 
(1) to the increase in monthly insurance benefits under the old-
age, survivors, and disability insurance system resulting from the 
Ante, p. 361. 
euactmeut of section 301 of this Act, or 
(2) to the payment of child's insurance benefits under such sys-
tem after attainment of age 18, in the case of individuals attending 
Ante. p. 370. 
school, rcsultiug from the enactment of section 306 of this Act. 
EXTENSION 
OF GRACE PERIOD FOR DISREGARDING 
CERTAIN 
INCOME 
FOR 
STATES WHERE LEGISLATURE HAS NOT MET I N REGULAR SESSION 
SEC. 407. Notwithstanding the provisions of section 701 of the 
lo f
r
^
t
f
A
' o
Q
^
'
^
i 
Economic Opportunity Act of 1964, no funds to which a State is 
use 298 1. 
otj^erwise entitled under title I, IV, X, XIV, XVI, or X I X of the 
42 use 301, 
Social Security Act for any period before the first month beginning 
las'i. 
' 
' 
after the adjournment of a State's first regular legislative session 
Ante. p. 343. 
which adjoums after August 20, 1964 (the date of enactment pf the 
Economic Opportunity Act of 1964), shall be withheld by reason 
of any action taken pursuant to a State statute which prevents such 
State from complying with the requirements of subsection (a) of such 
section 701. 
TECHNICAL 
AMENDMENTS 
RELATING TO PUBLIC ASSISTANCE 
PROGRAMS 
76 Stat. 206. 
ggc. 408. (a) Section 1108 of the Social Security Act is amended— 
42 use 1308. 
^ j ^ ^y striking out "$9,800,000, of which $625,000 may be used 
42 use 303. 
only for payments certified with respect to section 3(a) (2) (B) 
42 use 1383. 
or 1603(a)(2)(B)" and inserting in lieu thereof "$9,800,000"; 
(2) by striking out "$330,000, of which $18,750 may be used 
only for payments certified with respect to section 3(a) (2) (B) 
or 1603(a)(2)(B)" and inserting m lieu thereof "$330,000"; 
and 
(3) by striking out "$450,000, of which $25,000 may be used 
only for payments certified with respect to section 3(a) (2) (B) 
or 1603(a) (2) (B)" and inserting in lieu thereof "$450,000". 
(b) The amendments made by subsection (a) shall be effective in 
the case of Puerto Rico, the Virgin Islands, or Guam with respect to 
fiscal years beginning on or after the date on which its plan under 
Ante, p. 343. 
^{^1^ X l X of Uie Soclal Security Act is approved. 
42 us^c ?3f2. 
(^) (-^) Section 1112 of such Act is amended by striking out "for 
the aged". 
(2) The heading of section 1112 of such Act is amended by striking 
out "FOR THE AGED". 
ELIGIBILITY OF CHILDREN OVER AGE 18 ATTENDING 
SCHOOL 
SEC. 409. Clause (2) (B) of section 406(a) of the Social Security 
42 us^'60^6^^* 
^^^ ^s amended by striking out "(as determined in accordance with 
standards prescribed by the Secretary) a student regularly attending 
a high school in pursuance of a course of study leading to a high school 
diploma or its equivalent," and inserting in lieu thereof "(as deter-
mined by the State in accordance with standards prescribed by 
the Secretary) a student regularly attending a school, college, or 
university,". 
79 STAT.] 
PUBLIC LAW 89-98-JULY 30, 1965 
423 
DISREGARDING CERTAIN EARNINGS IN DETERMINING NEED OF CERTAIN 
DEPENDENT CHILDREN 
SEC. 410. Effective July 1, 1965, so much, of clause (7) of section 
402(a) of the Social Security Act as follows the first semicolon is ^J^tfpf4 is^f' 
amended by inserting after "except that, in making such determina- 
42 use 602. 
tion," the following: "(A) the State agency may disregard not more 
than $50 per month of earned income of each dependent child under 
the age of 18 but not in excess of $150 per month of earned income of 
such dependent children in the same home, (B)". 
F E D E R A L S H A R E O F P U B L I C A S S I S T A N C E 
E X P E N D I T U R E S 
42 u s e 1301. 
SEC. 411. Title X I of the Social vSeeuiity Act is amended by adding 
at the end thereof (after section 1117, added by section 405 of this 
Act), the following new section: 
^"^®' P. 420. 
"ALTERNATIVE FEDERAL PAYMENT WITH RESPECT TO PUBLIC ASSISTANCE 
EXPENDITURES 
"SEC. 1118. In the case of any State which has in effect a plan 
approved under title X I X for any calendar quarter, the total of the 
^"'*' ^' ^'*^' 
payments to which such State is entitled for such quarter, and for each 
succeeding quarter in the same fiscal year (which for purposes of this 
section means the 4 calendar quarters ending with June 30), under 
paragraphs (1) and (2) of sections 3(a), 403(a), 1003(a), 1403(a), 
and 1603 (a) shall, at the option of the State, be determined by applica-
tion of the Federal medical assistance percentage (as defined in 
section 1905), instead of the percentages provided under each such 
Ante, p. 351. 
section, to tne expenditures under its State plans approved under 
titles I, IV, X, XIV, and XVI, which would be included in deter- 
42 use 301, 
mining the amounts of the Federal payments to which such State is 1381.^^°^' ^^^^' 
entitled under such sections, but without regard to any maximum on 
the dollar amounts per recipient which may be counted under such 
sections." 
Approved July 30, 1965, 5:19 p.m. 
Public Law 89-98 
AN ACT 
July 30, 1965 
To amend the Revised Organic Act of the Virgin Islands to provide for the 
[H. R. 8721] 
payment of legislative salaries and expenses by the government of the Virgin 
Islands. 
Be it enacted hy the Senate and House of Representatives 
of the 
United States of America in Congress assembled, That subsection ^e) 
Ll'"J^s"iat^orT'^^" 
of section 6 of the Eevised Organic Act of the Virgin Islands (68 sauael an"' 
Stat. 497, 499), as amended (73 Stat. 568; 48 U.S.C. 1572(e)), is expenses. 
further amended to read as follows: 
"(e) Each member of the legislature shall be paid such compen-
sation and shall receive such additional allowances or benefits as may 
be fixed under the laws of the Virgin Islands. Such compensation, 
allowances, or benefits, together with all other legislative expenses, 
shall be appropriated Iby, and paid out of funds of, the government 
of the Virgin Islands." 
Approved July 30, 1965.