---
kind: "section"
citation: "42 U.S.C. § 1395rr–1"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1395rr–1"
heading: "Medicare coverage for individuals exposed to environmental health hazards"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1395rr-1"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XVIII — Health Insurance for Aged and Disabled"
  - "Part E — Miscellaneous Provisions"
---

# §1395rr–1. Medicare coverage for individuals exposed to environmental health hazards

- (a) **Deeming of individuals as eligible for medicare benefits—**
  - (1) **In general—** For purposes of eligibility for benefits under this subchapter, an individual determined under [subsection (c)](#c) to be an environmental exposure affected individual described in [subsection (e)(2)](#e-2) shall be deemed to meet the conditions specified in [section 426(a) of this title](/usc/42/426.md?p=a).
  - (2) **Discretionary deeming—** For purposes of eligibility for benefits under this subchapter, the [Secretary](/usc/42/1301.md?p=a-6) may deem an individual determined under [subsection (c)](#c) to be an environmental exposure affected individual described in [subsection (e)(3)](#e-3) to meet the conditions specified in [section 426(a) of this title](/usc/42/426.md?p=a).
  - (3) **Effective date of coverage—** An Individual[^1] who is deemed eligible for benefits under this subchapter under paragraph [(1)](#a-1) or [(2)](#a-2) shall be—
    - (A) entitled to benefits under the program under Part[^1] A as of the date of such deeming; and
    - (B) eligible to enroll in the program under Part[^1] B beginning with the month in which such deeming occurs.
- (b) **Pilot program for care of certain individuals residing in emergency declaration areas—**
  - (1) **Program; purpose—**
    - (A) **Primary pilot program—** The [Secretary](/usc/42/1301.md?p=a-6) shall establish a pilot program in accordance with this subsection to provide innovative approaches to furnishing comprehensive, coordinated, and cost-effective care under this subchapter to individuals described in [paragraph (2)(A)](#b-2-A).
    - (B) **Optional pilot programs—** The [Secretary](/usc/42/1301.md?p=a-6) may establish a separate pilot program, in accordance with this subsection, with respect to each geographic area subject to an emergency declaration (other than the declaration of June 17, 2009), in order to furnish such comprehensive, coordinated and cost-effective care to individuals described in subparagraph (2)(B) who reside in each such area.
  - (2) **Individual described—** For purposes of [paragraph (1)](#b-1), an individual described in this paragraph is an individual who enrolls in part B, submits to the [Secretary](/usc/42/1301.md?p=a-6) an application to participate in the applicable pilot program under this subsection, and—
    - (A) is an environmental exposure affected individual described in [subsection (e)(2)](#e-2) who resides in or around the geographic area subject to an emergency declaration made as of June 17, 2009; or
    - (B) is an environmental exposure affected individual described in [subsection (e)(3)](#e-3) who—
      - (i) is deemed under [subsection (a)(2)](#a-2); and
      - (ii) meets such other criteria or conditions for participation in a pilot program under [paragraph (1)(B)](#b-1-B) as the [Secretary](/usc/42/1301.md?p=a-6) specifies.
  - (3) **Flexible benefits and services—** A pilot program under this subsection may provide for the furnishing of benefits, items, or services not otherwise covered or authorized under this subchapter, if the [Secretary](/usc/42/1301.md?p=a-6) determines that furnishing such benefits, items, or services will further the purposes of such pilot program (as described in [paragraph (1)](#b-1)).
  - (4) **Innovative reimbursement methodologies—** For purposes of the pilot program under this subsection, the [Secretary](/usc/42/1301.md?p=a-6)—
    - (A) shall develop and implement appropriate methodologies to reimburse providers for furnishing benefits, items, or services for which payment is not otherwise covered or authorized under this subchapter, if such benefits, items, or services are furnished pursuant to [paragraph (3)](#b-3); and
    - (B) may develop and implement innovative approaches to reimbursing providers for any benefits, items, or services furnished under this subsection.
  - (5) **Limitation—** Consistent with [section 1395y(b) of this title](/usc/42/1395y.md?p=b), no payment shall be made under the pilot program under this subsection with respect to benefits, items, or services furnished to an environmental exposure affected individual (as defined in [subsection (e)](#e)) to the extent that such individual is eligible to receive such benefits, items, or services through any other public or private benefits plan or legal agreement.
  - (6) **Waiver authority—** The [Secretary](/usc/42/1301.md?p=a-6) may waive such provisions of this subchapter and subchapter XI as are necessary to carry out pilot programs under this subsection.
  - (7) **Funding—** For purposes of carrying out pilot programs under this subsection, the [Secretary](/usc/42/1301.md?p=a-6) shall provide for the transfer, from the Federal [Hospital](/usc/42/1395x.md?p=e) Insurance Trust Fund under [section 1395i of this title](/usc/42/1395i.md) and the Federal Supplementary Medical Insurance Trust Fund under [section 1395t of this title](/usc/42/1395t.md), in such proportion as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate, of such sums as the [Secretary](/usc/42/1301.md?p=a-6) determines necessary, to the Centers for Medicare & Medicaid Services Program Management Account.
  - (8) **Waiver of budget neutrality—** The [Secretary](/usc/42/1301.md?p=a-6) shall not require that pilot programs under this subsection be budget neutral with respect to expenditures under this subchapter.
- (c) **Determinations—**
  - (1) **By the Commissioner of Social Security—** For purposes of this section, the Commissioner of [Social](/usc/42/1397j.md?p=20) Security, in consultation with the [Secretary](/usc/42/1301.md?p=a-6), and using the cost [allocation](/usc/42/2021b.md?p=2) method prescribed in [section 401(g) of this title](/usc/42/401.md?p=g), shall determine whether individuals are environmental exposure affected individuals.
  - (2) **By the Secretary—** The [Secretary](/usc/42/1301.md?p=a-6) shall determine eligibility for pilot programs under [subsection (b)](#b).
- (d) **Emergency declaration defined—** For purposes of this section, the term “emergency declaration” means a declaration of a public health emergency under [section 9604(a) of this title](/usc/42/9604.md?p=a).
- (e) **Environmental exposure affected individual defined—**
  - (1) **In general—** For purposes of this section, the term “environmental exposure affected individual” means—
    - (A) an individual described in [paragraph (2)](#e-2); and
    - (B) an individual described in [paragraph (3)](#e-3).
  - (2) **Individual described—**
    - (A) **In general—** An individual described in this paragraph is any individual who—
      - (i) is diagnosed with 1 or more conditions described in [subparagraph (B)](#e-2-B);
      - (ii) as demonstrated in such manner as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate, has been present for an aggregate total of 6 months in the geographic area subject to an emergency declaration specified in [subsection (b)(2)(A)](#b-2-A), during a period ending—
        - (I) not less than 10 years prior to such diagnosis; and
        - (II) prior to the implementation of all the remedial and removal actions specified in the Record of Decision for Operating Unit 4 and the Record of Decision for Operating Unit 7;
      - (iii) files an application for benefits under this subchapter (or has an application filed on behalf of the individual), [including](/usc/42/1301.md?p=b) pursuant to this section; and
      - (iv) is determined under this section to meet the criteria in this subparagraph.
    - (B) **Conditions described—** For purposes of [subparagraph (A)](#e-2-A), the following conditions are described in this subparagraph:
      - (i) Asbestosis, pleural thickening, or pleural plaques as established by—
        - (I) interpretation by a “B Reader” qualified [physician](/usc/42/1395x.md?p=r) of a plain chest x-ray or interpretation of a computed tomographic radiograph of the chest by a qualified [physician](/usc/42/1395x.md?p=r), as determined by the [Secretary](/usc/42/1301.md?p=a-6); or
        - (II) such other diagnostic [standards](/usc/42/1320d.md?p=7) as the [Secretary](/usc/42/1301.md?p=a-6) specifies,

      except that this clause shall not apply to pleural thickening or pleural plaques unless there are symptoms or conditions requiring medical [treatment](/usc/42/11851.md?p=11) as a result of these diagnoses.

      - (ii) Mesothelioma, or malignancies of the lung, colon, rectum, larynx, stomach, esophagus, pharynx, or ovary, as established by—
        - (I) pathologic examination of biopsy tissue;
        - (II) cytology from bronchioalveolar lavage; or
        - (III) such other diagnostic [standards](/usc/42/1320d.md?p=7) as the [Secretary](/usc/42/1301.md?p=a-6) specifies.
      - (iii) Any other diagnosis which the [Secretary](/usc/42/1301.md?p=a-6), in consultation with the Commissioner of [Social](/usc/42/1397j.md?p=20) Security, determines is an asbestos-related medical condition, as established by such diagnostic [standards](/usc/42/1320d.md?p=7) as the [Secretary](/usc/42/1301.md?p=a-6) specifies.
  - (3) **Other individual described—** An individual described in this paragraph is any individual who—
    - (A) is not an individual described in [paragraph (2)](#e-2);
    - (B) is diagnosed with a medical condition caused by the exposure of the individual to a public health hazard to which an emergency declaration applies, based on such medical conditions, diagnostic [standards](/usc/42/1320d.md?p=7), and other criteria as the [Secretary](/usc/42/1301.md?p=a-6) specifies;
    - (C) as demonstrated in such manner as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate, has been present for an aggregate total of 6 months in the geographic area subject to the emergency declaration involved, during a period determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6);
    - (D) files an application for benefits under this subchapter (or has an application filed on behalf of the individual), [including](/usc/42/1301.md?p=b) pursuant to this section; and
    - (E) is determined under this section to meet the criteria in this paragraph.

## Footnotes

[^1]: So in original. Probably should not be capitalized.

## Source credit

(Aug. 14, 1935, ch. 531, title XVIII, § 1881A, as added Pub. L. 111–148, title X, § 10323(a), Mar. 23, 2010, 124 Stat. 954.)

## Notes

### Editorial Notes

### References in Text

Parts A and B, referred to in subsecs. (a)(3) and (b)(2), are classified to sections 1395c et seq. and 1395j et seq., respectively, of this title.