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-CITE-
42 USC Sec. 1396d 01/22/02

 

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EXPCITE-
TITLE 42 - THE PUBLIC HEALTH AND WELFARE
CHAPTER 7 - SOCIAL SECURITY
SUBCHAPTER XIX - GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS

-HEAD-
Sec. 1396d. Definitions

-STATUTE-
For purposes of this subchapter -
(a) Medical assistance
The term ''medical assistance'' means payment of part or all of
the cost of the following care and services (if provided in or
after the third month before the month in which the recipient makes
application for assistance or, in the case of medicare cost-sharing
with respect to a qualified medicare beneficiary described in
subsection (p)(1) of this section, if provided after the month in
which the individual becomes such a beneficiary) for individuals,
and, with respect to physicians' or dentists' services, at the
option of the State, to individuals (other than individuals with
respect to whom there is being paid, or who are eligible, or would
be eligible if they were not in a medical institution, to have paid
with respect to them a State supplementary payment and are eligible
for medical assistance equal in amount, duration, and scope to the
medical assistance made available to individuals described in
section 1396a(a)(10)(A) of this title) not receiving aid or
assistance under any plan of the State approved under subchapter I,
X, XIV, or XVI of this chapter, or part A of subchapter IV of this
chapter, and with respect to whom supplemental security income
benefits are not being paid under subchapter XVI of this chapter,
who are -
(i) under the age of 21, or, at the option of the State, under
the age of 20, 19, or 18 as the State may choose,
(ii) relatives specified in section 606(b)(1) (FOOTNOTE 1) of
this title with whom a child is living if such child is (or
would, if needy, be) a dependent child under part A of subchapter
IV of this chapter,
(FOOTNOTE 1) See References in Text note below.
(iii) 65 years of age or older,
(iv) blind, with respect to States eligible to participate in
the State plan program established under subchapter XVI of this
chapter,
(v) 18 years of age or older and permanently and totally
disabled, with respect to States eligible to participate in the
State plan program established under subchapter XVI of this
chapter,
(vi) persons essential (as described in the second sentence of
this subsection) to individuals receiving aid or assistance under
State plans approved under subchapter I, X, XIV, or XVI of this
chapter,
(vii) blind or disabled as defined in section 1382c of this
title, with respect to States not eligible to participate in the
State plan program established under subchapter XVI of this
chapter,
(viii) pregnant women,
(ix) individuals provided extended benefits under section
1396r-6 of this title,
(x) individuals described in section 1396a(u)(1) of this title,
(xi) individuals described in section 1396a(z)(1) of this
title,
(xii) employed individuals with a medically improved disability
(as defined in subsection (v) of this section), or
(xiii) individuals described in section 1396a(aa) (FOOTNOTE 2)
of this title,
(FOOTNOTE 2) Probably means the subsec. (aa) of section 1396a
relating to certain breast or cervical cancer patients.
but whose income and resources are insufficient to meet all of such
cost -
(1) inpatient hospital services (other than services in an
institution for mental diseases);
(2)(A) outpatient hospital services, (B) consistent with State
law permitting such services, rural health clinic services (as
defined in subsection (l)(1) of this section) and any other
ambulatory services which are offered by a rural health clinic
(as defined in subsection (l)(1) of this section) and which are
otherwise included in the plan, and (C) Federally-qualified
health center services (as defined in subsection (l)(2) of this
section) and any other ambulatory services offered by a
Federally-qualified health center and which are otherwise
included in the plan;
(3) other laboratory and X-ray services;
(4)(A) nursing facility services (other than services in an
institution for mental diseases) for individuals 21 years of age
or older; (B) early and periodic screening, diagnostic, and
treatment services (as defined in subsection (r) of this section)
for individuals who are eligible under the plan and are under the
age of 21; and (C) family planning services and supplies
furnished (directly or under arrangements with others) to
individuals of child-bearing age (including minors who can be
considered to be sexually active) who are eligible under the
State plan and who desire such services and supplies;
(5)(A) physicians' services furnished by a physician (as
defined in section 1395x(r)(1) of this title), whether furnished
in the office, the patient's home, a hospital, or a nursing
facility, or elsewhere, and (B) medical and surgical services
furnished by a dentist (described in section 1395x(r)(2) of this
title) to the extent such services may be performed under State
law either by a doctor of medicine or by a doctor of dental
surgery or dental medicine and would be described in clause (A)
if furnished by a physician (as defined in section 1395x(r)(1) of
this title);
(6) medical care, or any other type of remedial care recognized
under State law, furnished by licensed practitioners within the
scope of their practice as defined by State law;
(7) home health care services;
(8) private duty nursing services;
(9) clinic services furnished by or under the direction of a
physician, without regard to whether the clinic itself is
administered by a physician, including such services furnished
outside the clinic by clinic personnel to an eligible individual
who does not reside in a permanent dwelling or does not have a
fixed home or mailing address;
(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, including any medical or remedial
services (provided in a facility, a home, or other setting)
recommended by a physician or other licensed practitioner of the
healing arts within the scope of their practice under State law,
for the maximum reduction of physical or mental disability and
restoration of an individual to the best possible functional
level;
(14) inpatient hospital services and nursing facility services
for individuals 65 years of age or over in an institution for
mental diseases;
(15) services in an intermediate care facility for the mentally
retarded (other than in an institution for mental diseases) for
individuals who are determined, in accordance with section
1396a(a)(31) of this title, to be in need of such care;
(16) effective January 1, 1973, inpatient psychiatric hospital
services for individuals under age 21, as defined in subsection
(h) of this section;
(17) services furnished by a nurse-midwife (as defined in
section 1395x(gg) of this title) which the nurse-midwife is
legally authorized to perform under State law (or the State
regulatory mechanism provided by State law), whether or not the
nurse-midwife is under the supervision of, or associated with, a
physician or other health care provider, and without regard to
whether or not the services are performed in the area of
management of the care of mothers and babies throughout the
maternity cycle;
(18) hospice care (as defined in subsection (o) of this
section);
(19) case management services (as defined in section
1396n(g)(2) of this title) and TB-related services described in
section 1396a(z)(2)(F) of this title;
(20) respiratory care services (as defined in section
1396a(e)(9)(C) of this title);
(21) services furnished by a certified pediatric nurse
practitioner or certified family nurse practitioner (as defined
by the Secretary) which the certified pediatric nurse
practitioner or certified family nurse practitioner is legally
authorized to perform under State law (or the State regulatory
mechanism provided by State law), whether or not the certified
pediatric nurse practitioner or certified family nurse
practitioner is under the supervision of, or associated with, a
physician or other health care provider;
(22) home and community care (to the extent allowed and as
defined in section 1396t of this title) for functionally disabled
elderly individuals;
(23) community supported living arrangements services (to the
extent allowed and as defined in section 1396u of this title);
(24) personal care services furnished to an individual who is
not an inpatient or resident of a hospital, nursing facility,
intermediate care facility for the mentally retarded, or
institution for mental disease that are (A) authorized for the
individual by a physician in accordance with a plan of treatment
or (at the option of the State) otherwise authorized for the
individual in accordance with a service plan approved by the
State, (B) provided by an individual who is qualified to provide
such services and who is not a member of the individual's family,
and (C) furnished in a home or other location;
(25) primary care case management services (as defined in
subsection (t) of this section);
(26) services furnished under a PACE program under section
1396u-4 of this title to PACE program eligible individuals
enrolled under the program under such section; and
(27) any other medical care, and any other type of remedial
care recognized under State law, specified by the Secretary,
except as otherwise provided in paragraph (16), 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) any 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 mental diseases.
For purposes of clause (vi) of the preceding sentence, a person
shall be considered essential to another individual if such person
is the spouse of and is living with such individual, the needs of
such person are taken into account in determining the amount of aid
or assistance furnished to such individual (under a State plan
approved under subchapter I, X, XIV, or XVI of this chapter), and
such person is determined, under such a State plan, to be essential
to the well-being of such individual. The payment described in the
first sentence may include expenditures for medicare cost-sharing
and for premiums under part B of subchapter XVIII of this chapter
for individuals who are eligible for medical assistance under the
plan and (A) are receiving aid or assistance under any plan of the
State approved under subchapter I, X, XIV, or XVI of this chapter,
or part A of subchapter IV of this chapter, or with respect to whom
supplemental security income benefits are being paid under
subchapter XVI of this chapter, or (B) with respect to whom there
is being paid a State supplementary payment and are eligible for
medical assistance equal in amount, duration, and scope to the
medical assistance made available to individuals described in
section 1396a(a)(10)(A) of this title, and, except in the case of
individuals 65 years of age or older and disabled individuals
entitled to health insurance benefits under subchapter XVIII of
this chapter who are not enrolled under part B of subchapter XVIII
of this chapter, other insurance premiums for medical or any other
type of remedial care or the cost thereof. No service (including
counseling) shall be excluded from the definition of ''medical
assistance'' solely because it is provided as a treatment service
for alcoholism or drug dependency.
(b) Federal medical assistance percentage; State percentage; Indian
health care percentage
Subject to section 1396u-3(d) of this title, the term ''Federal
medical assistance percentage'' for any State shall be 100 per
centum less the State percentage; and the State percentage shall be
that percentage which bears the same ratio to 45 per centum as the
square of the per 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, (2) the Federal medical assistance
percentage for Puerto Rico, the Virgin Islands, Guam, the Northern
Mariana Islands, and American Samoa shall be 50 per centum, (3) for
purposes of this subchapter and subchapter XXI of this chapter, the
Federal medical assistance percentage for the District of Columbia
shall be 70 percent, and (4) the Federal medical assistance
percentage shall be equal to the enhanced FMAP described in section
1397ee(b) of this title with respect to medical assistance provided
to individuals who are eligible for such assistance only on the
basis of section 1396a(a)(10)(A)(ii)(XVIII) of this title. The
Federal medical assistance percentage for any State shall be
determined and promulgated in accordance with the provisions of
section 1301(a)(8)(B) of this title. Notwithstanding the first
sentence of this section, the Federal medical assistance percentage
shall be 100 per centum with respect to amounts expended as medical
assistance for services which are received through an Indian Health
Service facility whether operated by the Indian Health Service or
by an Indian tribe or tribal organization (as defined in section
1603 of title 25). Notwithstanding the first sentence of this
subsection, in the case of a State plan that meets the condition
described in subsection (u)(1) of this section, with respect to
expenditures (other than expenditures under section 1396r-4 of this
title) described in subsection (u)(2)(A) of this section or
subsection (u)(3) of this section for the State for a fiscal year,
and that do not exceed the amount of the State's available
allotment under section 1397dd of this title, the Federal medical
assistance percentage is equal to the enhanced FMAP described in
section 1397ee(b) of this title.
(c) Nursing facility
For definition of the term ''nursing facility'', see section
1396r(a) of this title.
(d) Intermediate care facility for mentally retarded
The term ''intermediate care facility for the mentally retarded''
means an institution (or distinct part thereof) for the mentally
retarded or persons with related conditions if -
(1) the primary purpose of such institution (or distinct part
thereof) is to provide health or rehabilitative services for
mentally retarded individuals and the institution meets such
standards as may be prescribed by the Secretary;
(2) the mentally retarded individual with respect to whom a
request for payment is made under a plan approved under this
subchapter is receiving active treatment under such a program;
and
(3) in the case of a public institution, the State or political
subdivision responsible for the operation of such institution has
agreed that the non-Federal expenditures in any calendar quarter
prior to January 1, 1975, with respect to services furnished to
patients in such institution (or distinct part thereof) in the
State will not, because of payments made under this subchapter,
be reduced below the average amount expended for such services in
such institution in the four quarters immediately preceding the
quarter in which the State in which such institution is located
elected to make such services available under its plan approved
under this subchapter.
(e) Physicians' services
In the case of any State the State plan of which (as approved
under this subchapter) -
(1) does not provide for the payment of services (other than
services covered under section 1396a(a)(12) of this title)
provided by an optometrist; but
(2) at a prior period did provide for the payment of services
referred to in paragraph (1);
the term ''physicians' services'' (as used in subsection (a)(5) of
this section) shall include services of the type which an
optometrist is legally authorized to perform where the State plan
specifically provides that the term ''physicians' services'', as
employed in such plan, includes services of the type which an
optometrist is legally authorized to perform, and shall be
reimbursed whether furnished by a physician or an optometrist.
(f) Nursing facility services
For purposes of this subchapter, the term ''nursing facility
services'' means services which are or were required to be given an
individual who needs or needed on a daily basis nursing care
(provided directly by or requiring the supervision of nursing
personnel) or other rehabilitation services which as a practical
matter can only be provided in a nursing facility on an inpatient
basis.
(g) Chiropractors' services
If the State plan includes provision of chiropractors' services,
such services include only -
(1) services provided by a chiropractor (A) who is licensed as
such by the State and (B) who meets uniform minimum standards
promulgated by the Secretary under section 1395x(r)(5) of this
title; and
(2) services which consist of treatment by means of manual
manipulation of the spine which the chiropractor is legally
authorized to perform by the State.
(h) Inpatient psychiatric hospital services for individuals under
age 21
(1) For purposes of paragraph (16) of subsection (a) of this
section, the term ''inpatient psychiatric hospital services for
individuals under age 21'' includes only -
(A) inpatient services which are provided in an institution (or
distinct part thereof) which is a psychiatric hospital as defined
in section 1395x(f) of this title or in another inpatient setting
that the Secretary has specified in regulations;
(B) inpatient services which, in the case of any individual (i)
involve active treatment which meets such standards as may be
prescribed in regulations by the Secretary, and (ii) a team,
consisting of physicians and other personnel qualified to make
determinations with respect to mental health conditions and the
treatment thereof, has determined are necessary on an inpatient
basis and can reasonably be expected to improve the condition, by
reason of which such services are necessary, to the extent that
eventually such services will no longer be necessary; and
(C) inpatient services which, in the case of any individual,
are provided prior to (i) the date such individual attains age
21, or (ii) in the case of an individual who was receiving such
services in the period immediately preceding the date on which he
attained age 21, (I) the date such individual no longer requires
such services, or (II) if earlier, the date such individual
attains age 22;
(2) Such term does not include services provided during any
calendar quarter under the State plan of any State if the total
amount of the funds expended, during such quarter, by the State
(and the political subdivisions thereof) from non-Federal funds for
inpatient services included under paragraph (1), and for active
psychiatric care and treatment provided on an outpatient basis for
eligible mentally ill children, is less than the average quarterly
amount of the funds expended, during the 4-quarter period ending
December 31, 1971, by the State (and the political subdivisions
thereof) from non-Federal funds for such services.
(i) Institution for mental diseases
The term ''institution for mental diseases'' means a hospital,
nursing facility, or other institution of more than 16 beds, that
is primarily engaged in providing diagnosis, treatment, or care of
persons with mental diseases, including medical attention, nursing
care, and related services.
(j) State supplementary payment
The term ''State supplementary payment'' means any cash payment
made by a State on a regular basis to an individual who is
receiving supplemental security income benefits under subchapter
XVI of this chapter or who would but for his income be eligible to
receive such benefits, as assistance based on need in
supplementation of such benefits (as determined by the Commissioner
of Social Security), but only to the extent that such payments are
made with respect to an individual with respect to whom
supplemental security income benefits are payable under subchapter
XVI of this chapter, or would but for his income be payable under
that subchapter.
(k) Supplemental security income benefits
Increased supplemental security income benefits payable pursuant
to section 211 of Public Law 93-66 shall not be considered
supplemental security income benefits payable under subchapter XVI
of this chapter.
(l) Rural health clinics
(1) The terms ''rural health clinic services'' and ''rural health
clinic'' have the meanings given such terms in section 1395x(aa) of
this title, except that (A) clause (ii) of section 1395x(aa)(2) of
this title shall not apply to such terms, and (B) the physician
arrangement required under section 1395x(aa)(2)(B) of this title
shall only apply with respect to rural health clinic services and,
with respect to other ambulatory care services, the physician
arrangement required shall be only such as may be required under
the State plan for those services.
(2)(A) The term ''Federally-qualified health center services''
means services of the type described in subparagraphs (A) through
(C) of section 1395x(aa)(1) of this title when furnished to an
individual as an (FOOTNOTE 3) patient of a Federally-qualified
health center and, for this purpose, any reference to a rural
health clinic or a physician described in section 1395x(aa)(2)(B)
of this title is deemed a reference to a Federally-qualified health
center or a physician at the center, respectively.
(FOOTNOTE 3) So in original. Probably should be ''a''.
(B) The term ''Federally-qualified health center'' means an
entity which -
(i) is receiving a grant under section 254b of this title,
(ii)(I) is receiving funding from such a grant under a contract
with the recipient of such a grant, and
(II) meets the requirements to receive a grant under section
254b of this title,
(iii) based on the recommendation of the Health Resources and
Services Administration within the Public Health Service, is
determined by the Secretary to meet the requirements for
receiving such a grant, including requirements of the Secretary
that an entity may not be owned, controlled, or operated by
another entity, or
(iv) was treated by the Secretary, for purposes of part B of
subchapter XVIII of this chapter, as a comprehensive Federally
funded health center as of January 1, 1990;
and includes an outpatient health program or facility operated by a
tribe or tribal organization under the Indian Self-Determination
Act (Public Law 93-638) (25 U.S.C. 450f et seq.) or by an urban
Indian organization receiving funds under title V of the Indian
Health Care Improvement Act (25 U.S.C. 1651 et seq.) for the
provision of primary health services. In applying clause (ii),
(FOOTNOTE 4) the Secretary may waive any requirement referred to in
such clause for up to 2 years for good cause shown.
(FOOTNOTE 4) So in original. Probably should be clause
''(iii),''. See References in Text note below.
(m) Qualified family member
(1) Subject to paragraph (2), the term ''qualified family
member'' means an individual (other than a qualified pregnant woman
or child, as defined in subsection (n) of this section) who is a
member of a family that would be receiving aid under the State plan
under part A of subchapter IV of this chapter pursuant to section
607 (FOOTNOTE 5) of this title if the State had not exercised the
option under section 607(b)(2)(B)(i) (FOOTNOTE 5) of this title.
(FOOTNOTE 5) See References in Text note below.
(2) No individual shall be a qualified family member for any
period after September 30, 1998.
(n) ''Qualified pregnant woman or child'' defined
The term ''qualified pregnant woman or child'' means -
(1) a pregnant woman who -
(A) would be eligible for aid to families with dependent
children under part A of subchapter IV of this chapter (or
would be eligible for such aid if coverage under the State plan
under part A of subchapter IV of this chapter included aid to
families with dependent children of unemployed parents pursuant
to section 607 of this title) if her child had been born and
was living with her in the month such aid would be paid, and
such pregnancy has been medically verified;
(B) is a member of a family which would be eligible for aid
under the State plan under part A of subchapter IV of this
chapter pursuant to section 607 of this title if the plan
required the payment of aid pursuant to such section; or
(C) otherwise meets the income and resources requirements of
a State plan under part A of subchapter IV of this chapter; and
(2) a child who has not attained the age of 19, who was born
after September 30, 1983 (or such earlier date as the State may
designate), and who meets the income and resources requirements
of the State plan under part A of subchapter IV of this chapter.
(o) Optional hospice benefits
(1)(A) Subject to subparagraph (B), the term ''hospice care''
means the care described in section 1395x(dd)(1) of this title
furnished by a hospice program (as defined in section 1395x(dd)(2)
of this title) to a terminally ill individual who has voluntarily
elected (in accordance with paragraph (2)) to have payment made for
hospice care instead of having payment made for certain benefits
described in section 1395d(d)(2)(A) of this title and for which
payment may otherwise be made under subchapter XVIII of this
chapter and intermediate care facility services under the plan.
For purposes of such election, hospice care may be provided to an
individual while such individual is a resident of a skilled nursing
facility or intermediate care facility, but the only payment made
under the State plan shall be for the hospice care.
(B) For purposes of this subchapter, with respect to the
definition of hospice program under section 1395x(dd)(2) of this
title, the Secretary may allow an agency or organization to make
the assurance under subparagraph (A)(iii) of such section without
taking into account any individual who is afflicted with acquired
immune deficiency syndrome (AIDS).
(2) An individual's voluntary election under this subsection -
(A) shall be made in accordance with procedures that are
established by the State and that are consistent with the
procedures established under section 1395d(d)(2) of this title;
(B) shall be for such a period or periods (which need not be
the same periods described in section 1395d(d)(1) of this title)
as the State may establish; and
(C) may be revoked at any time without a showing of cause and
may be modified so as to change the hospice program with respect
to which a previous election was made.
(3) In the case of an individual -
(A) who is residing in a nursing facility or intermediate care
facility for the mentally retarded and is receiving medical
assistance for services in such facility under the plan,
(B) who is entitled to benefits under part A of subchapter
XVIII of this chapter and has elected, under section 1395d(d) of
this title, to receive hospice care under such part, and
(C) with respect to whom the hospice program under such
subchapter and the nursing facility or intermediate care facility
for the mentally retarded have entered into a written agreement
under which the program takes full responsibility for the
professional management of the individual's hospice care and the
facility agrees to provide room and board to the individual,
instead of any payment otherwise made under the plan with respect
to the facility's services, the State shall provide for payment to
the hospice program of an amount equal to the additional amount
determined in section 1396a(a)(13)(B) of this title and, if the
individual is an individual described in section 1396a(a)(10)(A) of
this title, shall provide for payment of any coinsurance amounts
imposed under section 1395e(a)(4) of this title.
(p) Qualified medicare beneficiary; medicare cost-sharing
(1) The term ''qualified medicare beneficiary'' means an
individual -
(A) who is entitled to hospital insurance benefits under part A
of subchapter XVIII of this chapter (including an individual
entitled to such benefits pursuant to an enrollment under section
1395i-2 of this title, but not including an individual entitled
to such benefits only pursuant to an enrollment under section
1395i-2a of this title),
(B) whose income (as determined under section 1382a of this
title for purposes of the supplemental security income program,
except as provided in paragraph (2)(D)) does not exceed an income
level established by the State consistent with paragraph (2), and
(C) whose resources (as determined under section 1382b of this
title for purposes of the supplemental security income program)
do not exceed twice the maximum amount of resources that an
individual may have and obtain benefits under that program.
(2)(A) The income level established under paragraph (1)(B) shall
be at least the percent provided under subparagraph (B) (but not
more than 100 percent) of the official poverty line (as defined by
the Office of Management and Budget, and revised annually in
accordance with section 9902(2) of this title) applicable to a
family of the size involved.
(B) Except as provided in subparagraph (C), the percent provided
under this clause, with respect to eligibility for medical
assistance on or after -
(i) January 1, 1989, is 85 percent,
(ii) January 1, 1990, is 90 percent, and
(iii) January 1, 1991, is 100 percent.
(C) In the case of a State which has elected treatment under
section 1396a(f) of this title and which, as of January 1, 1987,
used an income standard for individuals age 65 or older which was
more restrictive than the income standard established under the
supplemental security income program under subchapter XVI of this
chapter, the percent provided under subparagraph (B), with respect
to eligibility for medical assistance on or after -
(i) January 1, 1989, is 80 percent,
(ii) January 1, 1990, is 85 percent,
(iii) January 1, 1991, is 95 percent, and
(iv) January 1, 1992, is 100 percent.
(D)(i) In determining under this subsection the income of an
individual who is entitled to monthly insurance benefits under
subchapter II of this chapter for a transition month (as defined in
clause (ii)) in a year, such income shall not include any amounts
attributable to an increase in the level of monthly insurance
benefits payable under such subchapter which have occurred pursuant
to section 415(i) of this title for benefits payable for months
beginning with December of the previous year.
(ii) For purposes of clause (i), the term ''transition month''
means each month in a year through the month following the month in
which the annual revision of the official poverty line, referred to
in subparagraph (A), is published.
(3) The term ''medicare cost-sharing'' means (subject to section
1396a(n)(2) of this title) the following costs incurred with
respect to a qualified medicare beneficiary, without regard to
whether the costs incurred were for items and services for which
medical assistance is otherwise available under the plan:
(A)(i) premiums under section 1395i-2 or 1395i-2a of this
title, and
(ii) premiums under section 1395r of this title, (FOOTNOTE 6)
(FOOTNOTE 6) So in original. The comma probably should be a
period.
(B) Coinsurance under subchapter XVIII of this chapter
(including coinsurance described in section 1395e of this title).
(C) Deductibles established under subchapter XVIII of this
chapter (including those described in section 1395e of this title
and section 1395l(b) of this title).
(D) The difference between the amount that is paid under
section 1395l(a) of this title and the amount that would be paid
under such section if any reference to ''80 percent'' therein
were deemed a reference to ''100 percent''.
Such term also may include, at the option of a State, premiums for
enrollment of a qualified medicare beneficiary with an eligible
organization under section 1395mm of this title.
(4) Notwithstanding any other provision of this subchapter, in
the case of a State (other than the 50 States and the District of
Columbia) -
(A) the requirement stated in section 1396a(a)(10)(E) of this
title shall be optional, and
(B) for purposes of paragraph (2), the State may substitute for
the percent provided under subparagraph (B) (FOOTNOTE 7) or
(FOOTNOTE 8) 1396a(a)(10)(E)(iii) of this title of such paragraph
(FOOTNOTE 7) any percent.
(FOOTNOTE 7) So in original. The words ''of such paragraph''
probably should follow ''subparagraph (B)''.
(FOOTNOTE 8) So in original. Probably should be ''or section''.
In the case of any State which is providing medical assistance to
its residents under a waiver granted under section 1315 of this
title, the Secretary shall require the State to meet the
requirement of section 1396a(a)(10)(E) of this title in the same
manner as the State would be required to meet such requirement if
the State had in effect a plan approved under this subchapter.
(5)(A) The Secretary shall develop and distribute to States a
simplified application form for use by individuals (including both
qualified medicare beneficiaries and specified low-income medicare
beneficiaries) in applying for medical assistance for medicare
cost-sharing under this subchapter in the States which elect to use
such form. Such form shall be easily readable by applicants and
uniform nationally.
(B) In developing such form, the Secretary shall consult with
beneficiary groups and the States.
(6) For provisions relating to outreach efforts to increase
awareness of the availability of medicare cost-sharing, see section
1320b-14 of this title.
(q) Qualified severely impaired individual
The term ''qualified severely impaired individual'' means an
individual under age 65 -
(1) who for the month preceding the first month to which this
subsection applies to such individual -
(A) received (i) a payment of supplemental security income
benefits under section 1382(b) of this title on the basis of
blindness or disability, (ii) a supplementary payment under
section 1382e of this title or under section 212 of Public Law
93-66 on such basis, (iii) a payment of monthly benefits under
section 1382h(a) of this title, or (iv) a supplementary payment
under section 1382e(c)(3), and
(B) was eligible for medical assistance under the State plan
approved under this subchapter; and
(2) with respect to whom the Commissioner of Social Security
determines that -
(A) the individual continues to be blind or continues to have
the disabling physical or mental impairment on the basis of
which he was found to be under a disability and, except for his
earnings, continues to meet all non-disability-related
requirements for eligibility for benefits under subchapter XVI
of this chapter,
(B) the income of such individual would not, except for his
earnings, be equal to or in excess of the amount which would
cause him to be ineligible for payments under section 1382(b)
of this title (if he were otherwise eligible for such
payments),
(C) the lack of eligibility for benefits under this
subchapter would seriously inhibit his ability to continue or
obtain employment, and
(D) the individual's earnings are not sufficient to allow him
to provide for himself a reasonable equivalent of the benefits
under subchapter XVI of this chapter (including any federally
administered State supplementary payments), this subchapter,
and publicly funded attendant care services (including personal
care assistance) that would be available to him in the absence
of such earnings.
In the case of an individual who is eligible for medical assistance
pursuant to section 1382h(b) of this title in June, 1987, the
individual shall be a qualified severely impaired individual for so
long as such individual meets the requirements of paragraph (2).
(r) Early and periodic screening, diagnostic, and treatment
services
The term ''early and periodic screening, diagnostic, and
treatment services'' means the following items and services:
(1) Screening services -
(A) which are provided -
(i) at intervals which meet reasonable standards of medical
and dental practice, as determined by the State after
consultation with recognized medical and dental organizations
involved in child health care and, with respect to
immunizations under subparagraph (B)(iii), in accordance with
the schedule referred to in section 1396s(c)(2)(B)(i) of this
title for pediatric vaccines, and
(ii) at such other intervals, indicated as medically
necessary, to determine the existence of certain physical or
mental illnesses or conditions; and
(B) which shall at a minimum include -
(i) a comprehensive health and developmental history
(including assessment of both physical and mental health
development),
(ii) a comprehensive unclothed physical exam,
(iii) appropriate immunizations (according to the schedule
referred to in section 1396s(c)(2)(B)(i) of this title for
pediatric vaccines) according to age and health history,
(iv) laboratory tests (including lead blood level
assessment appropriate for age and risk factors), and
(v) health education (including anticipatory guidance).
(2) Vision services -
(A) which are provided -
(i) at intervals which meet reasonable standards of medical
practice, as determined by the State after consultation with
recognized medical organizations involved in child health
care, and
(ii) at such other intervals, indicated as medically
necessary, to determine the existence of a suspected illness
or condition; and
(B) which shall at a minimum include diagnosis and treatment
for defects in vision, including eyeglasses.
(3) Dental services -
(A) which are provided -
(i) at intervals which meet reasonable standards of dental
practice, as determined by the State after consultation with
recognized dental organizations involved in child health
care, and
(ii) at such other intervals, indicated as medically
necessary, to determine the existence of a suspected illness
or condition; and
(B) which shall at a minimum include relief of pain and
infections, restoration of teeth, and maintenance of dental
health.
(4) Hearing services -
(A) which are provided -
(i) at intervals which meet reasonable standards of medical
practice, as determined by the State after consultation with
recognized medical organizations involved in child health
care, and
(ii) at such other intervals, indicated as medically
necessary, to determine the existence of a suspected illness
or condition; and
(B) which shall at a minimum include diagnosis and treatment
for defects in hearing, including hearing aids.
(5) Such other necessary health care, diagnostic services,
treatment, and other measures described in subsection (a) of this
section to correct or ameliorate defects and physical and mental
illnesses and conditions discovered by the screening services,
whether or not such services are covered under the State plan.
Nothing in this subchapter shall be construed as limiting providers
of early and periodic screening, diagnostic, and treatment services
to providers who are qualified to provide all of the items and
services described in the previous sentence or as preventing a
provider that is qualified under the plan to furnish one or more
(but not all) of such items or services from being qualified to
provide such items and services as part of early and periodic
screening, diagnostic, and treatment services. The Secretary
shall, not later than July 1, 1990, and every 12 months thereafter,
develop and set annual participation goals for each State for
participation of individuals who are covered under the State plan
under this subchapter in early and periodic screening, diagnostic,
and treatment services.
(s) Qualified disabled and working individual
The term ''qualified disabled and working individual'' means an
individual -
(1) who is entitled to enroll for hospital insurance benefits
under part A of subchapter XVIII of this chapter under section
1395i-2a of this title;
(2) whose income (as determined under section 1382a of this
title for purposes of the supplemental security income program)
does not exceed 200 percent of the official poverty line (as
defined by the Office of Management and Budget and revised
annually in accordance with section 9902(2) of this title)
applicable to a family of the size involved;
(3) whose resources (as determined under section 1382b of this
title for purposes of the supplemental security income program)
do not exceed twice the maximum amount of resources that an
individual or a couple (in the case of an individual with a
spouse) may have and obtain benefits for supplemental security
income benefits under subchapter XVI of this chapter; and
(4) who is not otherwise eligible for medical assistance under
this subchapter.
(t) Primary care case management services; primary care case
manager; primary care case management contract; and primary
care
(1) The term ''primary care case management services'' means
case-management related services (including locating, coordinating,
and monitoring of health care services) provided by a primary care
case manager under a primary care case management contract.
(2) The term ''primary care case manager'' means any of the
following that provides services of the type described in paragraph
(1) under a contract referred to in such paragraph:
(A) A physician, a physician group practice, or an entity
employing or having other arrangements with physicians to provide
such services.
(B) At State option -
(i) a nurse practitioner (as described in subsection (a)(21)
of this section);
(ii) a certified nurse-midwife (as defined in section
1395x(gg) of this title); or
(iii) a physician assistant (as defined in section
1395x(aa)(5) of this title).
(3) The term ''primary care case management contract'' means a
contract between a primary care case manager and a State under
which the manager undertakes to locate, coordinate, and monitor
covered primary care (and such other covered services as may be
specified under the contract) to all individuals enrolled with the
manager, and which -
(A) provides for reasonable and adequate hours of operation,
including 24-hour availability of information, referral, and
treatment with respect to medical emergencies;
(B) restricts enrollment to individuals residing sufficiently
near a service delivery site of the manager to be able to reach
that site within a reasonable time using available and affordable
modes of transportation;
(C) provides for arrangements with, or referrals to, sufficient
numbers of physicians and other appropriate health care
professionals to ensure that services under the contract can be
furnished to enrollees promptly and without compromise to quality
of care;
(D) prohibits discrimination on the basis of health status or
requirements for health care services in enrollment,
disenrollment, or reenrollment of individuals eligible for
medical assistance under this subchapter;
(E) provides for a right for an enrollee to terminate
enrollment in accordance with section 1396u-2(a)(4) of this
title; and
(F) complies with the other applicable provisions of section
1396u-2 of this title.
(4) For purposes of this subsection, the term ''primary care''
includes all health care services customarily provided in
accordance with State licensure and certification laws and
regulations, and all laboratory services customarily provided by or
through, a general practitioner, family medicine physician,
internal medicine physician, obstetrician/gynecologist, or
pediatrician.
(u) Conditions for State plans
(1) The conditions described in this paragraph for a State plan
are as follows:
(A) The State is complying with the requirement of section
1397ee(d)(1) of this title.
(B) The plan provides for such reporting of information about
expenditures and payments attributable to the operation of this
subsection as the Secretary deems necessary in order to carry out
the fourth sentence of subsection (b) of this section.
(2)(A) For purposes of subsection (b) of this section, the
expenditures described in this subparagraph are expenditures for
medical assistance for optional targeted low-income children
described in subparagraph (B).
(B) For purposes of this paragraph, the term ''optional targeted
low-income child'' means a targeted low-income child as defined in
section 1397jj(b)(1) of this title (determined without regard to
that portion of subparagraph (C) of such section concerning
eligibility for medical assistance under this subchapter) who would
not qualify for medical assistance under the State plan under this
subchapter as in effect on March 31, 1997 (but taking into account
the expansion of age of eligibility effected through the operation
of section 1396a(l)(1)(D) of this title).
(3) For purposes of subsection (b) of this section, the
expenditures described in this paragraph are expenditures for
medical assistance for children who are born before October 1,
1983, and who would be described in section 1396a(l)(1)(D) of this
title if they had been born on or after such date, and who are not
eligible for such assistance under the State plan under this
subchapter based on such State plan as in effect as of March 31,
1997.
(4) The limitations on payment under subsections (f) and (g) of
section 1308 of this title shall not apply to Federal payments made
under section 1396b(a)(1) of this title based on an enhanced FMAP
described in section 1397ee(b) of this title.
(v) Employed individual with a medically improved disability
(1) The term ''employed individual with a medically improved
disability'' means an individual who -
(A) is at least 16, but less than 65, years of age;
(B) is employed (as defined in paragraph (2));
(C) ceases to be eligible for medical assistance under section
1396a(a)(10)(A)(ii)(XV) of this title because the individual, by
reason of medical improvement, is determined at the time of a
regularly scheduled continuing disability review to no longer be
eligible for benefits under section 423(d) or 1382c(a)(3) of this
title; and
(D) continues to have a severe medically determinable
impairment, as determined under regulations of the Secretary.
(2) For purposes of paragraph (1), an individual is considered to
be ''employed'' if the individual -
(A) is earning at least the applicable minimum wage requirement
under section 206 of title 29 and working at least 40 hours per
month; or
(B) is engaged in a work effort that meets substantial and
reasonable threshold criteria for hours of work, wages, or other
measures, as defined by the State and approved by the Secretary.
(w) Independent foster care adolescent
(1) For purposes of this subchapter, the term ''independent
foster care adolescent'' means an individual -
(A) who is under 21 years of age;
(B) who, on the individual's 18th birthday, was in foster care
under the responsibility of a State; and
(C) whose assets, resources, and income do not exceed such
levels (if any) as the State may establish consistent with
paragraph (2).
(2) The levels established by a State under paragraph (1)(C) may
not be less than the corresponding levels applied by the State
under section 1396u-1(b) of this title.
(3) A State may limit the eligibility of independent foster care
adolescents under section 1396a(a)(10)(A)(ii)(XVII) of this title
to those individuals with respect to whom foster care maintenance
payments or independent living services were furnished under a
program funded under part E of subchapter IV of this chapter before
the date the individuals attained 18 years of age.

-SOURCE-
(Aug. 14, 1935, ch. 531, title XIX, Sec. 1905, as added Pub. L.
89-97, title I, Sec. 121(a), July 30, 1965, 79 Stat. 351; amended
Pub. L. 90-248, title II, Sec. 230, 233, 241(f)(6), 248(e), title
III, Sec. 302(a), Jan. 2, 1968, 81 Stat. 905, 917, 919, 929; Pub.
L. 92-223, Sec. 4(a), Dec. 28, 1971, 85 Stat. 809; Pub. L. 92-603,
title II, Sec. 212(a), 247(b), 275(a), 278(a)(21)-(23), 280,
297(a), 299, 299B, 299E(b), 299L, Oct. 30, 1972, 86 Stat. 1384,
1425, 1452-1454, 1459-1462, 1464; Pub. L. 93-233, Sec.
13(a)(13)-(88), 18(w), (x)(7)-(10), (y)(2), Dec. 31, 1973, 87 Stat.
963, 964, 972, 973; Pub. L. 94-437, title IV, Sec. 402(e), Sept.
30, 1976, 90 Stat. 1410; Pub. L. 95-210, Sec. 2(a), (b), Dec. 13,
1977, 91 Stat. 1488; Pub. L. 95-292, Sec. 8(a), (b), June 13, 1978,
92 Stat. 316; Pub. L. 96-473, Sec. 6(k), Oct. 19, 1980, 94 Stat.
2266; Pub. L. 96-499, title IX, Sec. 965(a), Dec. 5, 1980, 94 Stat.
2651; Pub. L. 97-35, title XXI, Sec. 2162(a)(2), 2172(b), Aug. 13,
1981, 95 Stat. 806, 808; Pub. L. 97-248, title I, Sec. 136(c),
137(b)(17), (18), (f), Sept. 3, 1982, 96 Stat. 376, 379, 381; Pub.
L. 98-369, div. B, title III, Sec. 2335(f), 2340(b), 2361(b),
2371(a), 2373(b)(15)-(20), July 18, 1984, 98 Stat. 1091, 1093,
1104, 1110, 1112; Pub. L. 99-272, title IX, Sec. 9501(a), 9505(a),
9511(a), Apr. 7, 1986, 100 Stat. 201, 208, 212; Pub. L. 99-509,
title IX, Sec. 9403(b), (d), (g)(3), 9404(b), 9408(c)(1),
9435(b)(2), Oct. 21, 1986, 100 Stat. 2053, 2054, 2056, 2061, 2070;
Pub. L. 99-514, title XVIII, Sec. 1895(c)(3)(A), Oct. 22, 1986, 100
Stat. 2935; Pub. L. 100-203, title IV, Sec. 4073(d), 4101(c)(1),
4103(a), 4105(a), 4114, 4118(p)(8), 4211(e), (f), (h)(6), Dec. 22,
1987, 101 Stat. 1330-119, 1330-141, 1330-146, 1330-147, 1330-152,
1330-159, 1330-204 to 1330-206; Pub. L. 100-360, title III, Sec.
301(a)(2)-(d), (g)(2), title IV, Sec. 411(h)(4)(E), (k)(4), (8),
(14)(A), July 1, 1988, 102 Stat. 748-750, 787, 791, 794, 798; Pub.
L. 100-485, title III, Sec. 303(b)(2), title IV, Sec. 401(d)(2),
title VI, Sec. 608(d)(14)(A)-(G), (J), (f)(3), Oct. 13, 1988, 102
Stat. 2392, 2396, 2415, 2416, 2424; Pub. L. 100-647, title VIII,
Sec. 8434(a), (b)(3), (4), Nov. 10, 1988, 102 Stat. 3805; Pub. L.
101-234, title II, Sec. 201(b), Dec. 13, 1989, 103 Stat. 1981; Pub.
L. 101-239, title VI, Sec. 6402(c)(1), 6403(a), (c), (d)(2),
6404(a), (b), 6405(a), 6408(d)(2), (4)(A), (B), Dec. 19, 1989, 103
Stat. 2261-2265, 2268, 2269; Pub. L. 101-508, title IV, Sec.
4402(d)(2), 4501(a), (c), (e)(1), 4601(a)(2), 4704(c), (d), (e)(1),
4705(a), 4711(a), 4712(a), 4713(b), 4717, 4719(a), 4721(a), 4722,
4755(a)(1)(A), Nov. 5, 1990, 104 Stat. 1388-163 to 1388-166,
1388-172, 1388-174, 1388-187, 1388-191, 1388-193, 1388-194,
1388-209; Pub. L. 103-66, title XIII, Sec. 13601(a), 13603(e),
13605(a), 13606(a), 13631(f)(2), (g)(1), Aug. 10, 1993, 107 Stat.
612, 620, 621, 644, 645; Pub. L. 103-296, title I, Sec. 108(d)(2),
(3), Aug. 15, 1994, 108 Stat. 1486; Pub. L. 104-299, Sec. 4(b)(2),
Oct. 11, 1996, 110 Stat. 3645; Pub. L. 105-33, title IV, Sec.
4702(a), 4711(c)(1), 4712(d)(1), 4714(a)(2), 4725(b)(1), 4732(b),
4802(a)(1), 4911(a), Aug. 5, 1997, 111 Stat. 494, 508-510, 518,
520, 538, 570; Pub. L. 105-100, title I, Sec. 162(1), (2), Nov. 19,
1997, 111 Stat. 2188; Pub. L. 106-113, div. B, Sec. 1000(a)(6)
(title VI, Sec. 605(a), 608(l), (m), (aa)(3)), Nov. 29, 1999, 113
Stat. 1536, 1501A-396 to 1501A-398; Pub. L. 106-169, title I, Sec.
121(a)(2), (c)(5), Dec. 14, 1999, 113 Stat. 1829, 1830; Pub. L.
106-170, title II, Sec. 201(a)(2)(B), (C), Dec. 17, 1999, 113 Stat.
1892; Pub. L. 106-354, Sec. 2(a)(4), (c), Oct. 24, 2000, 114 Stat.
1382, 1384; Pub. L. 106-554, Sec. 1(a)(6) (title VII, Sec. 709(a),
title VIII, Sec. 802(d)(1), (2), title IX, Sec. 911(a)(2)), Dec.
21, 2000, 114 Stat. 2763, 2763A-578, 2763A-581, 2763A-584.)

-REFTEXT-
REFERENCES IN TEXT
Part A of subchapter IV of this chapter, referred to in subsecs.
(a), (m)(1), and (n), is classified to section 601 et seq. of this
title.
Parts A and B of subchapter XVIII of this chapter, referred to in
subsecs. (a), (l)(2)(B)(iv), (o)(3)(B), (p)(1)(A), and (s)(1), are
classified to sections 1395c et seq. and 1395j et seq.,
respectively, of this title.
Section 606 of this title, referred to in subsec. (a)(ii), was
repealed and a new section 606 enacted by Pub. L. 104-193, title I,
Sec. 103(a)(1), Aug. 22, 1996, 110 Stat. 2112, and, as so enacted,
no longer contains a subsec. (b)(1).
Section 211 of Pub. L. 93-66, referred to in subsec. (k), is
section 211 of Pub. L. 93-66, July 9, 1973, 87 Stat. 152, as
amended, which is set out as a note under section 1382 of this
title.
The Indian Self-Determination Act, referred to in subsec.
(l)(2)(B), is title I of Pub. L. 93-638, Jan. 4, 1975, 88 Stat.
2206, as amended, which is classified principally to part A (Sec.
450f et seq.) of subchapter II of chapter 14 of Title 25, Indians.
For complete classification of this Act to the Code, see Short
Title note set out under section 450 of Title 25 and Tables.
The Indian Health Care Improvement Act, referred to in subsec.
(l)(2)(B), is Pub. L. 94-437, Sept. 30, 1976, 90 Stat. 1400, as
amended. Title V of the Act is classified generally to subchapter
IV (Sec. 1651 et seq.) of chapter 18 of Title 25. For complete
classification of this Act to the Code, see Short Title note set
out under section 1601 of Title 25 and Tables.
Clause (ii), referred to in subsec. (l)(2)(B), was redesignated
as cl. (iii) by Pub. L. 101-508, title IV, Sec. 4704(c)(3), Nov. 5,
1990, 104 Stat. 1388-172.
Section 607 of this title, referred to in subsec. (m)(1), was
repealed and a new section 607 enacted by Pub. L. 104-193, title I,
Sec. 103(a)(1), Aug. 22, 1996, 110 Stat. 2112, and, as so enacted,
no longer contains a subsec. (b)(2)(B)(i).
Section 212 of Public Law 93-66, referred to in subsec.
(q)(1)(A), is section 212 of Pub. L. 93-66, title II, July 9, 1973,
87 Stat. 155, as amended, which is set out as a note under section
1382 of this title.

-MISC2-
AMENDMENTS
2000 - Subsec. (a)(xiii). Pub. L. 106-354, Sec. 2(a)(4), added
cl. (xiii).
Subsec. (b). Pub. L. 106-554, Sec. 1(a)(6) (title VIII, Sec.
802(d)(1)), in last sentence, substituted ''the State's available
allotment under section 1397dd of this title'' for ''the State's
allotment under section 1397dd of this title (not taking into
account reductions under section 1397dd(d)(2) of this title) for
the fiscal year reduced by the amount of any payments made under
section 1397ee of this title to the State from such allotment for
such fiscal year''.
Pub. L. 106-354, Sec. 2(c), in first sentence, struck out ''and''
before ''(3)'' and inserted before period at end '', and (4) the
Federal medical assistance percentage shall be equal to the
enhanced FMAP described in section 1397ee(b) of this title with
respect to medical assistance provided to individuals who are
eligible for such assistance only on the basis of section
1396a(a)(10)(A)(ii)(XVIII) of this title''.
Subsec. (p)(5). Pub. L. 106-554, Sec. 1(a)(6) (title VII, Sec.
709(a)), added par. (5).
Subsec. (p)(6). Pub. L. 106-554, Sec. 1(a)(6) (title IX, Sec.
911(a)(2)), added par. (6).
Subsec. (u)(1)(B). Pub. L. 106-554, Sec. 1(a)(6) (title VIII,
Sec. 802(d)(2)), struck out ''and section 1397dd(d) of this title''
before period at end.
1999 - Subsec. (a)(xii). Pub. L. 106-170, Sec. 201(a)(2)(C),
added cl. (xii).
Subsec. (a)(15). Pub. L. 106-113, Sec. 1000(a)(6) (title VI, Sec.
608(aa)(3)), substituted ''1396a(a)(31) of this title'' for
''1396a(a)(31)(A) of this title''.
Subsec. (b). Pub. L. 106-113, Sec. 1000(a)(6) (title VI, Sec.
605(a)), inserted ''(other than expenditures under section 1396r-4
of this title)'' after ''with respect to expenditures'' in last
sentence.
Subsec. (b)(1). Pub. L. 106-113, Sec. 1000(a)(6) (title VI, Sec.
608(l)), substituted ''83 per centum,'' for ''83 per centum,,''.
Subsec. (l)(2)(B). Pub. L. 106-113, Sec. 1000(a)(6) (title VI,
Sec. 608(m)), substituted ''an entity'' for ''a entity'' in
introductory provisions.
Subsec. (v). Pub. L. 106-169, Sec. 121(c)(5)(A), redesignated
subsec. (v), related to independent foster care adolescent, as (w).
Pub. L. 106-169, Sec. 121(a)(2), added subsec. (v), related to
independent foster care adolescent.
Pub. L. 106-170, Sec. 201(a)(2)(B), added subsec. (v).
Subsec. (w). Pub. L. 106-169, Sec. 121(c)(5), redesignated
subsec. (v) as (w) and substituted ''1396a(a)(10)(A)(ii)(XVII)''
for ''1396a(a)(10)(A)(ii)(XV)''.
1997 - Subsec. (a)(25). Pub. L. 105-33, Sec. 4702(a)(1), added
par. (25). Former par. (25) redesignated (26).
Subsec. (a)(26). Pub. L. 105-33, Sec. 4802(a)(1), added par.
(26). Former par. (26) redesignated (27).
Pub. L. 105-33, Sec. 4702(a)(1)(B), redesignated par. (25) as
(26) and substituted comma for period at end.
Subsec. (a)(27). Pub. L. 105-33, Sec. 4802(a)(1)(B), redesignated
par. (26) as (27).
Subsec. (b). Pub. L. 105-100, Sec. 162(1), inserted ''for the
State for a fiscal year, and that do not exceed the amount of the
State's allotment under section 1397dd of this title (not taking
into account reductions under section 1397dd(d)(2) of this title)
for the fiscal year reduced by the amount of any payments made
under section 1397ee of this title to the State from such allotment
for such fiscal year,'' after ''subsection (u)(3) of this
section''.
Pub. L. 105-33, Sec. 4911(a)(1), inserted at end
''Notwithstanding the first sentence of this subsection, in the
case of a State plan that meets the condition described in
subsection (u)(1) of this section, with respect to expenditures
described in subsection (u)(2)(A) of this section or subsection
(u)(3) of this section the Federal medical assistance percentage is
equal to the enhanced FMAP described in section 1397ee(b) of this
title.''
Pub. L. 105-33, Sec. 4732(b), substituted ''Subject to section
1396u-3(d) of this title, the term'' for ''The term''.
Pub. L. 105-33, Sec. 4725(b)(1), in first sentence, substituted
'', (2)'' for ''and (2)'' and inserted before period '', and (3)
for purposes of this subchapter and subchapter XXI of this chapter,
the Federal medical assistance percentage for the District of
Columbia shall be 70 percent''.
Subsec. (l)(2)(B)(iii). Pub. L. 105-33, Sec. 4712(d)(1), inserted
''including requirements of the Secretary that an entity may not be
owned, controlled, or operated by another entity,'' after ''such a
grant,''.
Subsec. (o)(3). Pub. L. 105-33, Sec. 4711(c)(1), substituted
''amount determined in section 1396a(a)(13)(B) of this title'' for
''amount described in section 1396a(a)(13)(D) of this title'' in
concluding provisions.
Subsec. (p)(3). Pub. L. 105-33, Sec. 4714(a)(2), inserted
''(subject to section 1396a(n)(2) of this title)'' after ''means''
in introductory provisions.
Subsec. (t). Pub. L. 105-33, Sec. 4702(a)(2), added subsec. (t).
Subsec. (u). Pub. L. 105-33, Sec. 4911(a)(2), added subsec. (u).
Subsec. (u)(1)(B). Pub. L. 105-100, Sec. 162(2)(A), substituted
''the fourth sentence of subsection (b) of this section'' for
''paragraph (2)''.
Subsec. (u)(2)(A). Pub. L. 105-100, Sec. 162(2)(B), substituted
''subparagraph (B)'' for ''subparagraph (C), but not in excess, for
a State for a fiscal year, of the amount described in subparagraph
(B) for the State and fiscal year''.
Subsec. (u)(2)(B), (C). Pub. L. 105-100, Sec. 162(2)(C), added
subpar. (B) and struck out former subpars. (B) and (C) which read
as follows:
''(B) The amount described in this subparagraph, for a State for
a fiscal year, is the amount of the State's allotment under section
1397dd of this title (not taking into account reductions under
section 1397dd(d)(2) of this title) for the fiscal year reduced by
the amount of any payments made under section 1397ee of this title
to the State from such allotment for such fiscal year.
''(C) For purposes of this paragraph, the term 'optional targeted
low-income child' means a targeted low-income child as defined in
section 1397jj(b)(1) of this title who would not qualify for
medical assistance under the State plan under this subchapter based
on such plan as in effect on April 15, 1997 (but taking into
account the expansion of age of eligibility effected through the
operation of section 1396a(l)(2)(D) of this title).''
Subsec. (u)(3). Pub. L. 105-100, Sec. 162(2)(D), substituted
''described in this paragraph'' for ''described in this
subparagraph'' and ''March 31, 1997'' for ''April 15, 1997''.
Subsec. (u)(4). Pub. L. 105-100, Sec. 162(2)(E), added par. (4).
1996 - Subsec. (l)(2)(B)(i), (ii)(II). Pub. L. 104-299
substituted ''section 254b of this title'' for ''section 254b,
254c, 256, or 256a of this title''.
1994 - Subsecs. (j), (q)(2). Pub. L. 103-296 substituted
''Commissioner of Social Security'' for ''Secretary''.
1993 - Subsec. (a)(xi). Pub. L. 103-66, Sec. 13603(e)(1)-(3),
added cl. (xi).
Subsec. (a)(7). Pub. L. 103-66, Sec. 13601(a)(1), struck out
''including personal care services (A) prescribed by a physician
for an individual in accordance with a plan of treatment, (B)
provided by an individual who is qualified to provide such services
and who is not a member of the individual's family, (C) supervised
by a registered nurse, and (D) furnished in a home or other
location; but not including such services furnished to an inpatient
or resident of a nursing facility'' after ''services''.
Subsec. (a)(17). Pub. L. 103-66, Sec. 13605(a), inserted before
semicolon at end '', and without regard to whether or not the
services are performed in the area of management of the care of
mothers and babies throughout the maternity cycle''.
Subsec. (a)(19). Pub. L. 103-66, Sec. 13603(e)(4), amended par.
(19) generally, inserting reference to TB-related services
described in section 1396a(z)(2)(F) of this title.
Subsec. (a)(21). Pub. L. 103-66, Sec. 13601(a)(2), struck out
''and'' at end.
Subsec. (a)(22). Pub. L. 103-66, Sec. 13601(a)(4), redesignated
par. (23) as (22). Former par. (22) redesignated (25).
Subsec. (a)(23). Pub. L. 103-66, Sec. 13601(a)(4), redesignated
par. (24) as (23). Former par. (23) redesignated (22).
Subsec. (a)(24). Pub. L. 103-66, Sec. 13601(a)(5), added par.
(24). Former par. (24) redesignated (23).
Pub. L. 103-66, Sec. 13601(a)(3), which directed amendment of
par. (24) by substituting semicolon for comma at end, was executed
by substituting semicolon for period at end to reflect the probable
intent of Congress.
Subsec. (a)(25). Pub. L. 103-66, Sec. 13601(a)(4), redesignated
par. (22) as (25), transferred such par. to appear after par. (23),
and substituted period for semicolon at end.
Subsec. (l)(2)(B). Pub. L. 103-66, Sec. 13631(f)(2)(B), in
concluding provisions, inserted ''or by an urban Indian
organization receiving funds under title V of the Indian Health
Care Improvement Act for the provision of primary health services''
before ''. In applying clause''.
Subsec. (l)(2)(B)(i). Pub. L. 103-66, Sec. 13631(f)(2)(A),
substituted ''256, or 256a'' for ''or 256''.
Pub. L. 103-66, Sec. 13606(a)(1), struck out ''or'' at end.
Subsec. (l)(2)(B)(ii). Pub. L. 103-66, Sec. 13631(f)(2)(A),
substituted ''256, or 256a'' for ''or 256'' in subcl. (II).
Pub. L. 103-66, Sec. 13606(a)(2), (3), realigned margin and
substituted a comma for semicolon at end.
Subsec. (l)(2)(B)(iv). Pub. L. 103-66, Sec. 13606(a)(4), (5),
added cl. (iv).
Subsec. (r)(1)(A)(i). Pub. L. 103-66, Sec. 13631(g)(1)(A),
inserted ''and, with respect to immunizations under subparagraph
(B)(iii), in accordance with the schedule referred to in section
1396s(c)(2)(B)(i) of this title for pediatric vaccines'' after
''child health care''.
Subsec. (r)(1)(B)(iii). Pub. L. 103-66, Sec. 13631(g)(1)(B),
inserted ''(according to the schedule referred to in section
1396s(c)(2)(B)(i) of this title for pediatric vaccines)'' after
''appropriate immunizations''.
1990 - Subsec. (a). Pub. L. 101-508, Sec. 4722, inserted at end
''No service (including counseling) shall be excluded from the
definition of 'medical assistance' solely because it is provided as
a treatment service for alcoholism or drug dependency.''
Pub. L. 101-508, Sec. 4402(d)(2), inserted at end ''The payment
described in the first sentence may include expenditures for
medicare cost-sharing and for premiums under part B of subchapter
XVIII of this chapter for individuals who are eligible for medical
assistance under the plan and (A) are receiving aid or assistance
under any plan of the State approved under subchapter I, X, XIV, or
XVI of this chapter, or part A of subchapter IV of this chapter, or
with respect to whom supplemental security income benefits are
being paid under subchapter XVI of this chapter, or (B) with
respect to whom there is being paid a State supplementary payment
and are eligible for medical assistance equal in amount, duration,
and scope to the medical assistance made available to individuals
described in section 1396a(a)(10)(A) of this title, and, except in
the case of individuals 65 years of age or older and disabled
individuals entitled to health insurance benefits under subchapter
XVIII of this chapter who are not enrolled under part B of
subchapter XVIII of this chapter, other insurance premiums for
medical or any other type of remedial care or the cost thereof.''
Subsec. (a)(x). Pub. L. 101-508, Sec. 4713(b), added cl. (x).
Subsec. (a)(2)(C). Pub. L. 101-508, Sec. 4704(e)(1), repealed
Pub. L. 101-239, Sec. 6402(c)(1). See 1989 Amendment note below.
Subsec. (a)(7). Pub. L. 101-508, Sec. 4721(a), substituted
''services including personal care services'' for ''services'' and
added subpars. (A) to (D).
Subsec. (a)(13). Pub. L. 101-508, Sec. 4719(a), inserted before
semicolon at end '', including any medical or remedial services
(provided in a facility, a home, or other setting) recommended by a
physician or other licensed practitioner of the healing arts within
the scope of their practice under State law, for the maximum
reduction of physical or mental disability and restoration of an
individual to the best possible functional level''.
Subsec. (a)(22). Pub. L. 101-508, Sec. 4711(a)(1), which directed
amendment of par. (22) by striking ''and'' at end, could not be
executed because the word did not appear.
Subsec. (a)(23). Pub. L. 101-508, Sec. 4712(a)(1), inserted
''and'' after semicolon at end.
Pub. L. 101-508, Sec. 4711(a)(2), (3), which directed amendment
of subsec. (a) by redesignating par. (23) as (24) and adding a new
par. (23), was executed by adding the new par. (23), there being no
former par. (23).
Subsec. (a)(24). Pub. L. 101-508, Sec. 4712(a)(2), (3), which
directed amendment of subsec. (a) by redesignating par. (24) as
(25) and adding a new par. (24), was executed by adding the new
par. (24), there being no former par. (24).
Subsec. (h)(1)(A). Pub. L. 101-508, Sec. 4755(a)(1)(A), inserted
''or in another inpatient setting that the Secretary has specified
in regulations'' after ''section 1395x(f) of this title''.
Subsec. (l)(2)(A). Pub. L. 101-508, Sec. 4704(c)(1), substituted
''patient'' for ''outpatient''.
Subsec. (l)(2)(B). Pub. L. 101-508, Sec. 4704(d)(2), which
directed amendment of subpar. (B) by inserting ''and includes an
outpatient health program or facility operated by a tribe or tribal
organization under the Indian Self-Determination Act (Public Law
93-638).'' after and below cl. (ii), was executed by inserting the
new language after cl. (iii) to reflect the probable intent of
Congress and the intervening redesignation of former cl. (ii) as
(iii) by Pub. L. 101-508, Sec. 4704(c)(3). See below.
Pub. L. 101-508, Sec. 4704(c)(2), substituted ''entity'' for
''facility'' in introductory provisions.
Subsec. (l)(2)(B)(ii), (iii). Pub. L. 101-508, Sec. 4704(c)(3),
(d)(1), added cl. (ii), redesignated former cl. (ii) as (iii), and
substituted comma for period at end of cl. (iii).
Subsec. (n)(2). Pub. L. 101-508, Sec. 4601(a)(2), substituted
''age of 19'' for ''age of 7 (or any age designated by the State
that exceeds 7 but does not exceed 8)''.
Subsec. (o)(1)(A). Pub. L. 101-508, Sec. 4717, inserted ''and for
which payment may otherwise be made under subchapter XVIII of this
chapter'' after ''section 1395d(d)(2)(A) of this title''.
Subsec. (o)(3). Pub. L. 101-508, Sec. 4705(a)(1), struck out ''a
State which elects not to provide medical assistance for hospice
care, but provides medical assistance for skilled nursing or
intermediate care facility services with respect to'' after ''In
the case of'' in introductory provisions.
Pub. L. 101-508, Sec. 4705(a)(3), (4), in concluding provisions,
substituted ''the additional amount described in section
1396a(a)(13)(D) of this title'' for ''the amounts allocated under
the plan for room and board in the facility, in accordance with the
rates established under section 1396a(a)(13) of this title,'' and
struck out at end ''For purposes of this paragraph and section
1396a(a)(13)(D) of this title, the term 'room and board' includes
performance of personal care services, including assistance in
activities of daily living, in socializing activities,
administration of medication, maintaining the cleanliness of a
resident's room, and supervising and assisting in the use of
durable medical equipment and prescribed therapies.''
Subsec. (o)(3)(A), (C). Pub. L. 101-508, Sec. 4705(a)(2),
substituted ''nursing facility or intermediate care facility for
the mentally retarded'' for ''skilled nursing or intermediate care
facility''.
Subsec. (p)(1)(B). Pub. L. 101-508, Sec. 4501(e)(1)(A), which
directed amendment of subpar. (B) by inserting '', except as
provided in paragraph (2)(D)'' after ''supplementary social
security income program'', was executed by inserting the new
language after ''supplemental security income program'' to reflect
the probable intent of Congress.
Subsec. (p)(2)(B). Pub. L. 101-508, Sec. 4501(a)(1), inserted
''and'' at end of cl. (ii), substituted ''100 percent.'' for ''95
percent, and'' in cl. (iii), and struck out cl. (iv) which read as
follows: ''January 1, 1992, is 100 percent.''
Subsec. (p)(2)(C). Pub. L. 101-508, Sec. 4501(a)(2), substituted
''95 percent, and'' for ''90 percent,'' in cl. (iii) and ''100
percent.'' for ''95 percent, and'' in cl. (iv) and struck out cl.
(v) which read as follows: ''January 1, 1993, is 100 percent.''
Subsec. (p)(2)(D). Pub. L. 101-508, Sec. 4501(e)(1)(B), added
subpar. (D).
Subsec. (p)(4). Pub. L. 101-508, Sec. 4501(c)(2), inserted at end
''In the case of any State which is providing medical assistance to
its residents under a waiver granted under section 1315 of this
title, the Secretary shall require the State to meet the
requirement of section 1396a(a)(10)(E) of this title in the same
manner as the State would be required to meet such requirement if
the State had in effect a plan approved under this subchapter.''
Subsec. (p)(4)(B). Pub. L. 101-508, Sec. 4501(c)(1), inserted
''or 1396a(a)(10)(E)(iii) of this title'' after ''subparagraph
(B)''.
1989 - Subsec. (a)(2)(B). Pub. L. 101-239, Sec. 6404(a)(2),
substituted ''subsection (l)(1)'' for ''subsection (l)'' in two
places.
Subsec. (a)(2)(C). Pub. L. 101-239, Sec. 6404(a)(3), added cl.
(C) relating to Federally-qualified health center services.
Pub. L. 101-239, Sec. 6402(c)(1), which directed addition of cl.
(C) relating to ambulatory services, was repealed by Pub. L.
101-508, Sec. 4704(e)(1).
Subsec. (a)(4)(B). Pub. L. 101-239, Sec. 6403(d)(2), amended cl.
(B) generally. Prior to amendment, cl. (B) read as follows:
''effective July 1, 1969, such early and periodic screening and
diagnosis of individuals who are eligible under the plan and are
under the age of 21 to ascertain their physical or mental defects,
and such health care, treatment, and other measures to correct or
ameliorate defects and chronic conditions discovered thereby, as
may be provided in regulations of the Secretary; and''.
Subsec. (a)(21), (22). Pub. L. 101-239, Sec. 6405(a), added par.
(21) and redesignated former par. (21) as (22).
Subsec. (l). Pub. L. 101-239, Sec. 6404(b), designated existing
provisions as par. (1), redesignated former cls. (1) and (2) as (A)
and (B), respectively, and added par. (2).
Subsec. (p)(1)(A). Pub. L. 101-239, Sec. 6408(d)(4)(B), inserted
'', but not including an individual entitled to such benefits only
pursuant to an enrollment under section 1395i-2a of this title''
after ''section 1395i-2 of this title''.
Subsec. (p)(3)(A). Pub. L. 101-239, Sec. 6408(d)(4)(A)(i),
amended subpar. (A) generally. Prior to amendment, subpar. (A)
read as follows: ''Premiums under subchapter XVIII of this chapter
(including under part B and, if applicable, under section 1395i-2
of this title).''
Subsec. (p)(3)(A)(i). Pub. L. 101-239, Sec. 6408(d)(4)(A)(ii),
substituted ''section 1395i-2 or 1395i-2a'' for ''section
1395i-2''.
Subsec. (p)(3)(C). Pub. L. 101-234, Sec. 201(b)(1), substituted
''Deductibles'' for ''Subject to paragraph (4), deductibles'' and
''section 1395e of this title and section 1395l(b) of this title)''
for ''section 1395e of this title, section 1395l(b) of this title,
and section 1395m(c)(1) of this title''.
Subsec. (p)(4), (5). Pub. L. 101-234, Sec. 201(b)(2),
redesignated par. (5) as (4) and struck out former par. (4) which
read as follows: ''In a State which provides medical assistance for
prescribed drugs under subsection (a)(12) of this section, instead
of providing to qualified medicare beneficiaries, under paragraph
(3)(C), medicare cost-sharing with respect to the annual deductible
for covered outpatient drugs under section 1395m(c)(1) of this
title, the State may provide to such beneficiaries, before charges
for covered outpatient drugs for a year reach such deductible
amount, benefits for prescribed drugs in the same amount, duration,
and scope as the benefits made available under the State plan for
individuals described in section 1396a(a)(10)(A)(i) of this
title.''
Subsec. (r). Pub. L. 101-239, Sec. 6403(c), inserted at end ''The
Secretary shall, not later than July 1, 1990, and every 12 months
thereafter, develop and set annual participation goals for each
State for participation of individuals who are covered under the
State plan under this subchapter in early and periodic screening,
diagnostic, and treatment services.''
Pub. L. 101-239, Sec. 6403(a), added subsec. (r).
Subsec. (s). Pub. L. 101-239, Sec. 6408(d)(2), added subsec. (s).
1988 - Subsec. (a). Pub. L. 100-647, Sec. 8434(b)(3), substituted
''in the case of medicare cost-sharing with respect to a qualified
medicare beneficiary'' for ''in the case of a qualified medicare
beneficiary'' in introductory provisions.
Subsec. (a)(ix). Pub. L. 100-485, Sec. 303(b)(2), added cl. (ix).
Subsec. (a)(5)(B). Pub. L. 100-360, Sec. 411(k)(4), substituted
''described in clause (A) if'' for ''described in subparagraph (A)
if''.
Subsec. (a)(17). Pub. L. 100-360, Sec. 411(h)(4)(E), amended Pub.
L. 100-203, Sec. 4073(d)(1), see 1987 Amendment note below.
Subsec. (i). Pub. L. 100-360, Sec. 411(k)(14)(A), added subsec.
(i).
Subsec. (m). Pub. L. 100-485, Sec. 401(d)(2), added subsec. (m).
Subsec. (o)(1). Pub. L. 100-360, Sec. 411(k)(8)(A), made
clarifying amendment to directory language of Pub. L. 100-203, Sec.
4114, see 1987 Amendment note below.
Subsec. (o)(1)(B). Pub. L. 100-360, Sec. 411(k)(8)(B), struck out
''only'' after ''For purposes of this subchapter'' and substituted
''immune deficiency syndrome (AIDS)'' for ''immunodeficiency
syndrome''.
Subsec. (o)(3). Pub. L. 100-485, Sec. 608(f)(3), realigned the
margin of par. (3).
Subsec. (p)(1). Pub. L. 100-647, Sec. 8434(a), redesignated
subpars. (C) and (D) as (B) and (C), respectively, and struck out
former subpar. (B) which read: ''who, but for section
1396a(a)(10)(E) of this title, is not eligible for medical
assistance under the plan,''.
Subsec. (p)(1)(B). Pub. L. 100-360, Sec. 301(a)(2), struck out
''and the election of the State'' after ''1396a(a)(10)(E) of this
title''.
Subsec. (p)(1)(C). Pub. L. 100-360, Sec. 301(c)(1), as amended by
Pub. L. 100-485, Sec. 608(d)(14)(E)(i), substituted ''paragraph
(2)'' for ''paragraph (2)(A)''.
Subsec. (p)(1)(D). Pub. L. 100-360, Sec. 301(c)(2), as amended by
Pub. L. 100-485, Sec. 608(d)(14)(E)(ii), substituted ''twice'' for
''(except as provided in paragraph (2)(B))''.
Subsec. (p)(2)(A). Pub. L. 100-647, Sec. 8434(b)(4), substituted
''paragraph (1)(B)'' for ''paragraph (1)(C)''.
Pub. L. 100-360, Sec. 301(b)(1), as amended by Pub. L. 100-485,
Sec. 608(d)(14)(A), substituted ''shall be at least the percent
provided under subparagraph (B) (but not more than 100 percent)''
for ''may not exceed a percentage (not more than 100 percent)''.
Pub. L. 100-360, Sec. 301(c)(3)(A), which directed amendment of
subpar. (A) by striking ''(2)(A)'' and inserting ''(2)'', was
repealed by Pub. L. 100-485, Sec. 608(d)(14)(E)(iii).
Pub. L. 100-360, Sec. 301(b)(2), which directed amendment of
subpar. (A) by inserting ''(i)'' after ''(2)(A)'', was repealed by
Pub. L. 100-485, Sec. 608(d)(14)(B).
Subsec. (p)(2)(B). Pub. L. 100-360, Sec. 301(b)(2), formerly Sec.
301(b)(3), as renumbered and amended by Pub. L. 100-485, Sec.
608(d)(14)(B)-(D)(ii), added subpar. (B) and struck out former
subpar. (B) which read as follows: ''In the case of a State that
provides medical assistance to individuals not described in section
1396a(a)(10)(A) of this title and at the State's option, the State
may use under paragraph (1)(D) such resource level (which is higher
than the level described in that paragraph) as may be applicable
with respect to individuals described in paragraph (1)(A) who are
not described in section 1396a(a)(10)(A) of this title.''
Pub. L. 100-360, Sec. 301(c)(3)(B), which directed amendment of
par. (2) by striking subpar. (B), was repealed by Pub. L. 100-485,
Sec. 608(d)(14)(E)(iii).
Subsec. (p)(2)(C). Pub. L. 100-360, Sec. 301(b)(2), formerly Sec.
301(b)(3), as renumbered and amended by Pub. L. 100-485, Sec.
608(d)(14)(B), (C), (D)(i), (iii), added subpar. (C).
Subsec. (p)(3). Pub. L. 100-360, Sec. 301(d)(1), as added by Pub.
L. 100-485, Sec. 608(d)(14)(G)(ii), inserted ''without regard to
whether the costs incurred were for items and services for which
medical assistance is otherwise available under the plan'' after
''qualified medicare beneficiary'' in introductory provisions.
Subsec. (p)(3)(A). Pub. L. 100-360, Sec. 301(d)(2), formerly Sec.
301(d)(1), as renumbered by Pub. L. 100-485, Sec. 608(d)(14)(G)(i),
substituted ''under subchapter XVIII of this chapter (including
under part B and, if applicable, under section 1395i-2 of this
title)'' for ''under part B and (if applicable) under section
1395i-2 of this title''.
Subsec. (p)(3)(B). Pub. L. 100-360, Sec. 301(d)(3), formerly Sec.
301(d)(2), as renumbered by Pub. L. 100-485, Sec. 608(d)(14)(G)(i),
amended subpar. (B) generally. Prior to amendment, subpar. (B)
read as follows: ''Deductibles and coinsurance described in section
1395e of this title.''
Subsec. (p)(3)(C). Pub. L. 100-360, Sec. 301(d)(3), formerly Sec.
301(d)(2), as renumbered and amended by Pub. L. 100-485, Sec.
608(d)(14)(F), (G)(i), amended subpar. (C) generally. Prior to
amendment, subpar. (C) read as follows: ''The annual deductible
described in section 1395l(b) of this title.''
Subsec. (p)(4). Pub. L. 100-360, Sec. 301(d)(4), formerly Sec.
301(d)(3), as renumbered by Pub. L. 100-485, Sec. 618(d)(14)(G)(i),
added par. (4).
Subsec. (p)(5). Pub. L. 100-360, Sec. 301(g)(2), as amended by
Pub. L. 100-485, Sec. 608(d)(14)(J), added par. (5).
1987 - Subsec. (a)(4)(A). Pub. L. 100-203, Sec. 4211(f), struck
out ''skilled'' before ''nursing''.
Subsec. (a)(5). Pub. L. 100-203, Sec. 4211(h)(6)(A), struck out
''skilled'' before ''nursing'' in cl. (A).
Pub. L. 100-203, Sec. 4103(a), designated existing provisions as
cl. (A) and added cl. (B).
Subsec. (a)(9). Pub. L. 100-203, Sec. 4105(a), inserted provision
including services furnished to an eligible individual who does not
reside in a permanent dwelling or have a fixed home or mailing
address.
Subsec. (a)(14). Pub. L. 100-203, Sec. 4211(h)(6)(B), substituted
''and nursing facility services'' for '', skilled nursing facility
services, and intermediate care facility services''.
Subsec. (a)(15). Pub. L. 100-203, Sec. 4211(h)(6)(C), substituted
''services in an intermediate care facility for the mentally
retarded (other than'' for ''intermediate care facility services
(other than such services''.
Subsec. (a)(17). Pub. L. 100-203, Sec. 4073(d)(1), as amended by
Pub. L. 100-360, Sec. 411(h)(4)(E), substituted ''(as defined in
section 1395x(gg) of this title)'' for ''(as defined in subsection
(m) of this section)''.
Subsec. (c). Pub. L. 100-203, Sec. 4211(e)(1), amended subsec.
(c) generally. Prior to amendment, subsec. (c) defined
''intermediate care facility''.
Subsec. (d). Pub. L. 100-203, Sec. 4211(e)(2), substituted
''intermediate care facility for the mentally retarded'' for
''intermediate care facility'' and ''means an'' for ''may include
services in a public'', and in par. (3) inserted ''in the case of a
public institution'' after ''(3)''.
Subsec. (f). Pub. L. 100-203, Sec. 4211(e)(3), struck out
''skilled'' before ''nursing'' in four places and before
''rehabilitation''.
Subsec. (i). Pub. L. 100-203, Sec. 4211(e)(4), struck out subsec.
(i) which provided that for purposes of this subchapter ''skilled
nursing facility'' also includes any institution which is located
in a State on an Indian reservation and is certified by the
Secretary as being a qualified skilled nursing facility by meeting
the requirements of section 1395x(j) of this title.
Subsec. (m). Pub. L. 100-203, Sec. 4073(d)(2), struck out subsec.
(m) which defined ''nurse-midwife''. See section 1395x(gg) of this
title.
Subsec. (n)(2). Pub. L. 100-203, Sec. 4101(c)(1), substituted
''has not attained the age of 7 (or any age designated by the State
that exceeds 7 but does not exceed 8)'' for ''is under 5 years of
age''.
Subsec. (o)(1). Pub. L. 100-203, Sec. 4114, as amended by Pub. L.
100-360, Sec. 411(k)(8)(A), designated existing provisions as
subpar. (A), substituted ''Subject to subparagraph (B), the'' for
''The'', and added subpar. (B).
Subsec. (p)(2)(A). Pub. L. 100-203, Sec. 4118(p)(8), struck out
''nonfarm'' before ''official''.
1986 - Subsec. (a). Pub. L. 99-509, Sec. 9403(g)(3), inserted
''or, in the case of a qualified medicare beneficiary described in
subsection (p)(1) of this section, if provided after the month in
which the individual becomes such a beneficiary'' after ''makes
application for assistance''.
Subsec. (a)(18). Pub. L. 99-272, Sec. 9505(a)(1), added par.
(18). Former par. (18) redesignated (19).
Subsec. (a)(19). Pub. L. 99-514, Sec. 1895(c)(3)(A), added par.
(19). Former par. (19) redesignated (20).
Pub. L. 99-272, Sec. 9505(a)(1)(B), redesignated former par. (18)
as (19).
Subsec. (a)(20). Pub. L. 99-509, Sec. 9408(c)(1), added par.
(20). Former par. (20) redesignated (21).
Pub. L. 99-514, Sec. 1895(c)(3)(A)(ii), redesignated former par.
(19) as (20).
Subsec. (a)(21). Pub. L. 99-509, Sec. 9408(c)(1)(B), redesignated
former par. (20) as (21).
Subsec. (n)(1)(C). Pub. L. 99-272, Sec. 9501(a), added subpar.
(C).
Subsec. (n)(2). Pub. L. 99-272, Sec. 9511(a), inserted ''(or such
earlier date as the State may designate)'' after ''September 30,
1983''.
Subsec. (o). Pub. L. 99-272, Sec. 9505(a)(2), added subsec. (o).
Subsec. (o)(3). Pub. L. 99-509, Sec. 9435(b)(2), added par. (3).
Subsec. (p). Pub. L. 99-509, Sec. 9403(b), (d), added subsec.
(p).
Subsec. (q). Pub. L. 99-509, Sec. 9404(b), added subsec. (q).
1984 - Subsec. (a). Pub. L. 98-369, Sec. 2335(f), substituted
''mental diseases'' for ''tuberculosis or mental diseases'' in
subd. (B) following par. (18).
Pub. L. 98-369, Sec. 2373(b)(17), substituted ''clause (vi)'' for
''clauses (vi)'' and ''well-being'' for ''well being'' in last
sentence.
Subsec. (a)(1). Pub. L. 98-369, Sec. 2335(f), substituted
''mental diseases'' for ''tuberculosis or mental diseases''.
Subsec. (a)(4). Pub. L. 98-369, Sec. 2335(f), substituted
''mental diseases'' for ''tuberculosis or mental diseases''.
Pub. L. 98-369, Sec. 2373(b)(15), inserted a semicolon before
''(B)''.
Subsec. (a)(9). Pub. L. 98-369, Sec. 2371(a), amended par. (9)
generally, inserting ''furnished by or under the direction of a
physician, without regard to whether the clinic itself is
administered by a physician''.
Subsec. (a)(14), (15). Pub. L. 98-369, Sec. 2335(f), substituted
''mental diseases'' for ''tuberculosis or mental diseases''.
Subsec. (a)(17). Pub. L. 98-369, Sec. 2373(b)(16), substituted
''the nurse-midwife'' for ''he'' in two places.
Subsec. (b). Pub. L. 98-369, Sec. 2373(b)(18), substituted
''section 1301(a)(8)(B) of this title'' for ''subparagraph (B) of
section 1301(a)(8) of this title''.
Subsec. (d)(1). Pub. L. 98-369, Sec. 2373(b)(19), substituted
''the institution meets'' for ''which meet''.
Subsec. (h)(1)(A). Pub. L. 98-369, Sec. 2340(b), amended subpar.
(A) generally. Prior to amendment, subpar. (A) read as follows:
''inpatient services which are provided in an institution which is
accredited as a psychiatric hospital by the Joint Commission on
Accreditation of Hospitals;''.
Subsec. (m). Pub. L. 98-369, Sec. 2373(b)(20), substituted ''the
nurse'' for ''he'' in two places.
Subsec. (n). Pub. L. 98-369, Sec. 2361(b), added subsec. (n).
1982 - Subsec. (a)(i). Pub. L. 97-248, Sec. 137(b)(17), struck
out ''or any reasonable category of such individuals,'' after ''as
the State may choose,''.
Subsec. (a)(viii). Pub. L. 97-248, Sec. 137(b)(18), added cl.
(viii).
Subsec. (b)(2). Pub. L. 97-248, Sec. 136(c), substituted ''the
Northern Mariana Islands, and American Samoa'' for ''and the
Northern Mariana Islands''.
Subsec. (h)(1)(C). Pub. L. 97-248, Sec. 137(f), redesignated cls.
(i) and (ii) as subcls. (I) and (II), respectively, and
redesignated cls. (A) and (B) as cls. (i) and (ii), respectively.
1981 - Subsec. (a). Pub. L. 97-35, Sec. 2172(b), in cl. (i),
inserted ''or, at the option of the State, under the age of 20, 19,
or 18 as the State may choose, or any reasonable category of such
individuals,'' and in cl. (ii), struck out reference to section
606(a)(2) of this title.
Subsec. (b). Pub. L. 97-35, Sec. 2162(a)(2), inserted reference
to Northern Mariana Islands.
1980 - Subsec. (a)(17), (18). Pub. L. 96-499, Sec. 965(a)(1)(B),
(C), added par. (17) and redesignated former par. (17) as (18).
Subsec. (c). Pub. L. 96-473 substituted ''clause (1)'' for
''clauses (1)''.
Subsec. (m). Pub. L. 96-499, Sec. 965(a)(2), added subsec. (m).
1978 - Subsec. (c). Pub. L. 95-292 added cl. (4) to first
sentence relating to a requirement that intermediate care
facilities meet section 1395x(j)(14) of this title with respect to
protection of patients' personal funds, and inserted reference to
that cl. (4) in provisions covering intermediate care facilities on
Indian reservations.
1977 - Subsec. (a)(2). Pub. L. 95-210, Sec. 2(a), designated
existing provisions as cl. (A) and added cl. (B).
Subsec. (l). Pub. L. 95-210, Sec. 2(b), added subsec. (l).
1976 - Subsec. (b). Pub. L. 94-437 inserted provision requiring
that the Federal medical assistance percentage be 100 per centum
for services received through an Indian Health Service facility.
1973 - Subsec. (a). Pub. L. 93-233, Sec. 13(a)(13), substituted
in introductory text ''individuals (other than individuals with
respect to whom there is being paid, or who are eligible or would
be eligible if they were not in a medical institution, to have paid
with respect to them a State supplementary payment and are eligible
for medical assistance equal in amount, duration, and scope to the
medical assistance made available to individuals described in
section 1396a(a)(10)(A) of this title) not receiving aid or
assistance under any plan of the State approved under subchapter I,
X, XIV, or XVI, or part A of subchapter IV of this chapter, and
with respect to whom supplemental security income benefits are not
being paid under subchapter XVI of this chapter'' for ''individuals
not receiving aid or assistance under the State's plan approved
under subchapter I, X, XIV, or XVI, or part A of subchapter IV of
this chapter''.
Subsec. (a)(iv). Pub. L. 93-233, Sec. 13(a)(14), inserted ''with
respect to States eligible to participate in the State plan program
established under subchapter XVI of this chapter,'' after
''blind,''.
Subsec. (a)(v). Pub. L. 93-233, Sec. 13(a)(15), substituted
''with respect to States eligible to participate in the State plan
program established under subchapter XVI of this chapter,'' for
''or''.
Subsec. (a)(vi). Pub. L. 93-233, Sec. 13(a)(16), inserted ''or''
at end of text.
Subsec. (a)(vii). Pub. L. 93-233, Sec. 13(a)(17), added cl.
(vii).
Subsec. (a)(16). Pub. L. 93-233, Sec. 18(x)(7), substituted
''under age 21, as defined in subsection (h) of this section; and''
for ''under 21, as defined in subsection (e) of this section;''.
Subsec. (b). Pub. L. 93-233, Sec. 18(y)(2), struck out ''; except
that the Secretary shall promulgate such percentage as soon as
possible after July 30, 1965, 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, 1966'' after
''section 1301(a)(8) of this title''.
Subsec. (c). Pub. L. 93-233, Sec. 18(x)(8), substituted ''skilled
nursing facility'' for ''skilled nursing home'' wherever appearing.
Subsec. (h)(1)(B). Pub. L. 93-233, Sec. 18(w), substituted ''(i)
involve active treatment'' for '', involves active treatment (i)'';
struck out ''pursuant to subchapter XVIII of this chapter'' after
''may be prescribed''; and substituted ''(ii)'' for ''(ii) which'',
respectively.
Subsec. (h)(2). Pub. L. 93-233, Sec. 18(x)(10), substituted
''paragraph (1)'' for ''paragraph (e)(1)''.
Subsec. (i). Pub. L. 93-233, Sec. 18(x)(9), redesignated subsec.
(h) as added by Pub. L. 92-603, Sec. 299L(b), as subsec. (i).
Subsecs. (j), (k). Pub. L. 93-233, Sec. 13(a)(18), added subsecs.
(j) and (k).
1972 - Subsec. (a). Pub. L. 92-603, Sec. 299B(c), in text
following redesignated subsec. (a)(17) substituted ''as otherwise
provided in paragraph (16),'' for ''that''.
Subsec. (a)(4). Pub. L. 92-603, Sec. 278(a)(21), 299E(b),
substituted ''skilled nursing facility'' for ''skilled nursing
home'' and added cl. (C).
Subsec. (a)(5). Pub. L. 92-603, Sec. 278(a)(22), 280, substituted
''skilled nursing facility'' for ''skilled nursing home'' and
inserted ''furnished by a physician (as defined in section
1395x(r)(1) of this title) after ''physicians' services''.
Subsec. (a)(14). Pub. L. 92-603, Sec. 278(a)(23), 297(a),
substituted ''skilled nursing facility'' for ''skilled nursing
home'' and inserted reference to intermediate care facility
services.
Subsec. (a)(15) to (17). Pub. L. 92-603, Sec. 299B(a), added par.
(16) and redesignated existing pars. (15) and (16) as (17) and
(15), respectively.
Subsec. (c). Pub. L. 92-603, Sec. 299L(a), inserted provision
defining ''intermediate care facility'' with respect to any
institution located in a State on an Indian reservation.
Subsec. (d)(3). Pub. L. 92-603, Sec. 299, inserted provisions
relating to reduction of non-Federal expenditures in any calendar
quarter prior to January 1, 1975.
Subsec. (e). Pub. L. 92-603, Sec. 212(a), added subsec. (e).
Subsec. (f). Pub. L. 92-603, Sec. 247(b), added subsec. (f).
Subsec. (g). Pub. L. 92-603, Sec. 275(a), added subsec. (g).
Subsec. (h). Pub. L. 92-603, Sec. 299B(b), added subsec. (h).
Subsec. (i). Pub. L. 92-603, Sec. 299L(b), added subsec. (i),
1971 - Subsec. (a)(16). Pub. L. 92-223, Sec. 4(a)(1)(C), added
cl. (16).
Subsecs. (c), (d). Pub. L. 92-223, Sec. 4(a)(2), added subsecs.
(c) and (d).
1968 - Subsec. (a). Pub. L. 90-248, Sec. 230, inserted '', and
with respect to physicians' or dentists' services, at the option of
the State, to individuals not receiving aid or assistance under the
State's plan approved under subchapter I, X, XIV, XVI of this
chapter, or part A of subchapter IV of this chapter'' after ''for
individuals'' in text preceding cl. (i).
Pub. L. 90-248, Sec. 233(b), inserted provision deeming, for
purposes of cl. (vi) of the preceding sentence, a person as
essential to another individual if such person is the spouse of and
is living with such individual, the needs of such person are taken
into account in determining the amount of aid or assistance
furnished to such individual (under a State plan approved under
subchapter I, X, XIV, or XV of this chapter, and such person is
determined, under such a State plan, to be essential to the well
being of such individual.
Subsec. (a)(ii). Pub. L. 90-248, Sec. 241(f)(6), inserted ''part
A of'' before ''subchapter IV''.
Subsec. (a)(vi). Pub. L. 90-248, Sec. 233(a), added cl. (vi).
Subsec. (a)(4). Pub. L. 90-248, Sec. 302(a), designated existing
provisions as cl. (A) and added cl. (B).
Subsec. (b). Pub. L. 90-248, Sec. 248(e), substituted in cl. (2)
of first sentence ''50'' for ''55''.
EFFECTIVE DATE OF 2000 AMENDMENTS
Pub. L. 106-554, Sec. 1(a)(6) (title VII, Sec. 709(b)), Dec. 21,
2000, 114 Stat. 2763, 2763A-578, provided that: ''The amendment
made by subsection (a) (amending this section) shall take effect 1
year after the date of the enactment of this Act (Dec. 21, 2000),
regardless of whether regulations have been promulgated to carry
out such amendment by such date. The Secretary of Health and Human
Services shall develop the uniform application form under such
amendment by not later than 9 months after the date of the
enactment of this Act.''
Pub. L. 106-554, Sec. 1(a)(6) (title VIII, Sec. 802(f)), Dec. 21,
2000, 114 Stat. 2763, 2763A-582, provided that: ''The amendments
made by this section (amending this section and sections 1397dd,
1397ee, and 1397jj of this title) shall be effective as if included
in the enactment of section 4901 of the BBA (Pub. L. 105-33) (111
Stat. 552).''
Amendment by section 1(a)(6) (title IX, Sec. 911(a)(2)) of Pub.
L. 106-554 effective one year after Dec. 21, 2000, see section
1(a)(6) (title IX, Sec. 911(c)) of Pub. L. 106-554, set out as an
Effective Date note under section 1320b-14 of this title.
Amendment by Pub. L. 106-354 applicable to medical assistance for
items and services furnished on or after Oct. 1, 2000, without
regard to whether final regulations to carry out such amendments
have been promulgated by such date, see section 2(d) of Pub. L.
106-354, set out as a note under section 1396a of this title.
EFFECTIVE DATE OF 1999 AMENDMENTS
Amendment by Pub. L. 106-170 applicable to medical assistance for
items and services furnished on or after Oct. 1, 2000, see section
201(d) of Pub. L. 106-170, set out as a note under section 1396a of
this title.
Amendment by section 121(a)(2) of Pub. L. 106-169 applicable to
medical assistance for items and services furnished on or after
Oct. 1, 1999, see section 121(b) of Pub. L. 106-169, set out as a
note under section 1396a of this title.
Pub. L. 106-113, div. B, Sec. 1000(a)(6) (title VI, Sec.
605(b)), Nov. 29, 1999, 113 Stat. 1536, 1501A-396, provided that:
''The amendment made by subsection (a) (amending this section)
takes effect on October 1, 1999, and applies to expenditures made
on or after such date.''
Pub. L. 106-113, div. B, Sec. 1000(a)(6) (title VI, Sec.
608(aa)), Nov. 29, 1999, 113 Stat. 1536, 1501A-398, provided that
the amendment made by section 1000(a)(6) (title VI, Sec.
608(aa)(3)) is effective as if included in the enactment of BBA
(the Balanced Budget Act of 1997, Pub. L. 105-33).
Amendment by section 1000(a)(6) (title VI, Sec. 608(l), (m)) of
Pub. L. 106-113 effective Nov. 29, 1999, see section 1000(a)(6)
(title VI, Sec. 608(bb)) of Pub. L. 106-113, set out as a note
under section 1396a of this title.
EFFECTIVE DATE OF 1997 AMENDMENTS
Section 162 of Pub. L. 105-100 provided that the amendment made
by that section is effective as if included in the enactment of
subtitle J (Sec. 4901-4923) of title IV of the Balanced Budget Act
of 1997, Pub. L. 105-33.
Amendment by section 4702(a) of Pub. L. 105-33 applicable to
primary care case management services furnished on or after Oct. 1,
1997, subject to provisions relating to extension of effective date
for State law amendments, and to nonapplication to waivers, see
section 4710(b)(1) of Pub. L. 105-33, set out as a note under
section 1396b of this title.
Amendment by section 4711(c)(1) of Pub. L. 105-33 effective Aug.
5, 1997, and applicable to payment for items and services furnished
on or after Oct. 1, 1997, see section 4711(d) of Pub. L. 105-33,
set out as a note under section 1396a of this title.
Section 4712(d)(2) of Pub. L. 105-33 provided that: ''The
amendment made by paragraph (1) (amending this section) shall apply
to services furnished on or after the date of the enactment of this
Act (Aug. 5, 1997).''
Amendment by section 4714(a)(2) of Pub. L. 105-33 applicable to
payment for (and with respect to provider agreements with respect
to) items and services furnished on or after Aug. 5, 1997, and to
payment by a State for items and services furnished before such
date if such payment is subject of lawsuit that is based on
subsection (p) of this section and section 1396a(n) of this title
and that is pending as of, or is initiated after Aug. 5, 1997, see
section 4714(c) of Pub. L. 105-33, set out as a note under section
1396a of this title.
Section 4725(b)(2) of Pub. L. 105-33 provided that: ''The
amendments made by paragraph (1) (amending this section) shall
apply to -
''(A) items and services furnished on or after October 1, 1997;
''(B) payments made on a capitation or other risk-basis for
coverage occurring on or after such date; and
''(C) payments attributable to DSH allotments for such States
determined under section 1923(f) of such Act (42 U.S.C.
1396r-4(f)) for fiscal years beginning with fiscal year 1998.''
Amendment by section 4911(a) of Pub. L. 105-33 applicable to
medical assistance for items and services furnished on or after
Oct. 1, 1997, see section 4911(c) of Pub. L. 105-33, set out as a
note under section 1396a of this title.
EFFECTIVE DATE OF 1996 AMENDMENT
Amendment by Pub. L. 104-299 effective Oct. 1, 1996, see section
5 of Pub. L. 104-299, as amended, set out as a note under section
233 of this title.
EFFECTIVE DATE OF 1994 AMENDMENT
Amendment by Pub. L. 103-296 effective Mar. 31, 1995, see section
110(a) of Pub. L. 103-296, set out as a note under section 401 of
this title.
EFFECTIVE DATE OF 1993 AMENDMENT
Amendment by section 13601(a) of Pub. L. 103-66 effective as if
included in enactment of section 4721(a) of the Omnibus Budget
Reconciliation Act of 1990, Pub. L. 101-508, see section 13601(c)
of Pub. L. 103-66, set out as a note under section 1396a of this
title.
Amendment by section 13603(e) of Pub. L. 103-66 applicable to
medical assistance furnished on or after Jan. 1, 1994, without
regard to whether or not final regulations to carry out the
amendments by section 13603 of Pub. L. 103-66 have been promulgated
by such date, see section 13603(f) of Pub. L. 103-66, set out as a
note under section 1396a of this title.
Section 13605(b) of Pub. L. 103-66 provided that: ''The amendment
made by subsection (a) (amending this section) shall apply to
services furnished on or after October 1, 1993.''
Section 13606(b) of Pub. L. 103-66 provided that: ''The
amendments made by subsection (a) (amending this section) shall
apply to calendar quarters beginning on or after July 1, 1993.''
Amendment by section 13631(f)(2) of Pub. L. 103-66 applicable,
except as otherwise provided, to calendar quarters beginning on or
after Oct. 1, 1993, without regard to whether or not final
regulations to carry out the amendments by section 13631(f) of Pub.
L. 103-66 have been promulgated by such date, see section
13631(f)(3) of Pub. L. 103-66, set out as a note under section
1396a of this title.
Section 13631(g)(2) of Pub. L. 103-66 provided that: ''The
amendments made by subparagraphs (A) and (B) of paragraph (1)
(amending this section) shall first apply 90 days after the date
the schedule referred to in subparagraphs (A)(i) and subparagraph
(B)(iii) of section 1905(r)(1) of the Social Security Act (subsec.
(r)(1)(B)(iii) of this section) (as amended by such respective
subparagraphs) is first established.''
EFFECTIVE DATE OF 1990 AMENDMENT
Amendment by section 4402(d)(2) of Pub. L. 101-508 applicable,
except as otherwise provided, to payments under this subchapter for
calendar quarters beginning on or after Jan. 1, 1991, without
regard to whether or not final regulations to carry out the
amendments by section 4402 of Pub. L. 101-508 have been promulgated
by such date, see section 4402(e) of Pub. L. 101-508, set out as a
note under section 1396a of this title.
Amendment by section 4501(a), (c), (e)(1) of Pub. L. 101-508
applicable to calendar quarters beginning on or after Jan. 1, 1991,
without regard to whether or not regulations to implement the
amendments by section 4501 of Pub. L. 101-508 are promulgated by
such date, except that amendment by section 4501(e)(1) of Pub. L.
101-508 is applicable to determinations of income for months
beginning with January 1991, see section 4501(f) of Pub. L.
101-508, set out as a note under section 1396a of this title.
Amendment by section 4601(a)(2) of Pub. L. 101-508 applicable,
except as otherwise provided, to payments under this subchapter for
calendar quarters beginning on or after July 1, 1991, without
regard to whether or not final regulations to carry out the
amendments by section 4601 of Pub. L. 101-508 have been promulgated
by such date, see section 4601(b) of Pub. L. 101-508, set out as a
note under section 1396a of this title.
Amendment by section 4704(c), (d), (e)(1) of Pub. L. 101-508
effective as if included in the enactment of the Omnibus Budget
Reconciliation Act of 1989, Pub. L. 101-239, see section 4704(f) of
Pub. L. 101-508, set out as a note under section 1396a of this
title.
Section 4705(b) of Pub. L. 101-508 provided that: ''The
amendments made by subsection (a) (amending this section) shall be
effective as if included in the amendments made by section
6408(c)(1) of the Omnibus Budget Reconciliation Act of 1989 (Pub.
L. 101-239, amending section 1396a of this title).''
Amendment by section 4711(a) of Pub. L. 101-508 applicable to
home and community care furnished on or after July 1, 1991, without
regard to whether or not final regulations to carry out the
amendments by section 4711 of Pub. L. 101-508 have been promulgated
by such date, see section 4711(e) of Pub. L. 101-508, set out as a
note under section 1396a of this title.
Amendment by section 4712(a) of Pub. L. 101-508 applicable to
community supported living arrangements services furnished on or
after the later of July 1, 1991, or 30 days after the publication
of regulations setting forth interim requirements under section
1396u(h) of this title without regard to whether or not final
regulations to carry out the amendments by section 4712 of Pub. L.
101-508 have been promulgated by such date, see section 4712(c) of
Pub. L. 101-508, set out as an Effective Date note under section
1396u of this title.
Amendment by section 4713(b) of Pub. L. 101-508 applicable to
medical assistance furnished on or after Jan. 1, 1991, see section
4713(c) of Pub. L. 101-508, set out as a note under section 1396a
of this title.
Section 4719(b) of Pub. L. 101-508 provided that: ''The amendment
made by subsection (a) (amending this section) shall take effect on
the date of the enactment of this Act (Nov. 5, 1990).''
Section 4721(b) of Pub. L. 101-508 provided that: ''The amendment
made by this section (amending this section) shall become effective
with respect to personal care services provided on or after October
1, 1994.''
Section 4755(a)(1)(B) of Pub. L. 101-508 provided that: ''The
amendment made by subparagraph (A) (amending this section) shall be
effective as if included in the enactment of the Deficit Reduction
Act of 1984 (Pub. L. 98-369).''
EFFECTIVE DATE OF 1989 AMENDMENTS
Amendment by section 6403(a), (c), (d)(2) of Pub. L. 101-239
effective Apr. 1, 1990, without regard to whether or not final
regulations to carry out the amendments by section 6403 of Pub. L.
101-239 have been promulgated by such date, see section 6403(e) of
Pub. L. 101-239, set out as a note under section 1396a of this
title.
Amendment by section 6404(a), (b) of Pub. L. 101-239 applicable,
except as otherwise provided, to payments under this subchapter for
calendar quarters beginning on or after Apr. 1, 1990, without
regard to whether or not final regulations to carry out the
amendments by section 6404 of Pub. L. 101-239 have been promulgated
by such date, see section 6404(d) of Pub. L. 101-239, set out as a
note under section 1396a of this title.
Amendment by section 6405(a) of Pub. L. 101-239 effective with
respect to services furnished by a certified pediatric nurse
practitioner or certified family nurse practitioner on or after
July 1, 1990, see section 6405(c) of Pub. L. 101-239, set out as a
note under section 1396a of this title.
Amendment by section 6408(d)(2), (4)(A), (B) of Pub. L. 101-239
applicable, except as otherwise provided, to payments under this
subchapter for calendar quarters beginning on or after July 1,
1990, without regard to whether or not final regulations to carry
out the amendments by section 6408(d) of Pub. L. 101-239 have been
promulgated by such date, see section 6408(d)(5) of Pub. L.
101-239, set out as a note under section 1396a of this title.
Amendment by Pub. L. 101-234 effective Jan. 1, 1990, see section
201(c) of Pub. L. 101-234, set out as a note under section 1320a-7a
of this title.
EFFECTIVE DATE OF 1988 AMENDMENTS
Amendment by Pub. L. 100-647 effective as if included in the
enactment of section 301 of the Medicare Catastrophic Coverage Act
of 1988, Pub. L. 100-360, see section 8434(c) of Pub. L. 100-647,
set out as a note under section 1396a of this title.
Amendment by section 303(b)(2) of Pub. L. 100-485 applicable to
payments under this subchapter for calendar quarters beginning on
or after Apr. 1, 1990 (or, in the case of the Commonwealth of
Kentucky, Oct. 1, 1990) (without regard to whether regulations to
implement such amendment are promulgated by such date), with
respect to families that cease to be eligible for aid under part A
of subchapter IV of this chapter on or after that date, see section
303(f)(1) of Pub. L. 100-485, set out as a note under section 1396a
of this title.
Amendment by section 401(d)(2) of Pub. L. 100-485 effective Oct.
1, 1990, except as provided in subsec. (m)(2) of this section and
not effective for Puerto Rico, Guam, American Samoa, and the Virgin
Islands, until the date of repeal of limitations contained in
section 1308(a) of this title on payments to such jurisdictions for
purposes of making maintenance payments under this part and part E
of this subchapter, see section 401(g) of Pub. L. 100-485, as
amended, set out as a note under section 1396a of this title.
Amendment by section 608(d)(14)(A)-(G), (J) of Pub. L. 100-485
effective as if included in the enactment of the Medicare
Catastrophic Coverage Act of 1988, Pub. L. 100-360, see section
608(g)(1) of Pub. L. 100-485, set out as a note under section 704
of this title.
Amendment by section 608(f)(3) of Pub. L. 100-485 effective Oct.
13, 1988, see section 608(g)(2) of Pub. L. 100-485, set out as a
note under section 704 of this title.
Amendment by section 301(a)(2)-(d) of Pub. L. 100-360 applicable,
except as otherwise provided, to payments under this subchapter for
calendar quarters beginning on or after Jan. 1, 1989, without
regard to whether or not final regulations to carry out such
amendment have been promulgated by that date, with respect to
medical assistance for monthly premiums under subchapter XVIII of
this chapter for months beginning with January 1989, and items and
services furnished on and after Jan. 1, 1989, see section 301(h) of
Pub. L. 100-360, set out as a note under section 1396a of this
title.
Except as specifically provided in section 411 of Pub. L.
100-360, amendment by section 411(h)(4)(E), (k)(4), (8) of Pub. L.
100-360, as it relates to a provision in the Omnibus Budget
Reconciliation Act of 1987, Pub. L. 100-203, effective as if
included in the enactment of that provision in Pub. L. 100-203, see
section 411(a) of Pub. L. 100-360, set out as a Reference to OBRA;
Effective Date note under section 106 of Title 1, General
Provisions.
Section 411(k)(14)(B) of Pub. L. 100-360 provided that: ''The
amendment made by subparagraph (A) (amending this section) shall
take effect on the date of the enactment of this Act (July 1,
1988).''
EFFECTIVE DATE OF 1987 AMENDMENT
Amendment by section 4073(d) of Pub. L. 100-203 effective with
respect to services performed on or after July 1, 1988, see section
4073(e) of Pub. L. 100-203, set out as a note under section 1395k
of this title.
Section 4101(c)(3) of Pub. L. 100-203 provided that:
''(A) The amendments made by this subsection (amending this
section and section 1396a of this title) shall apply to medical
assistance furnished on or after October 1, 1988.
''(B) For purposes of section 1905(n)(2) of the Social Security
Act (section 1396d(n)(2) of this title) (as amended by subsection
(a) (probably means ''subsection (c)'')) for medical assistance
furnished during fiscal year 1989, any reference to 'age of 7' is
deemed to be a reference to 'age of 6'.''
Section 4103(b) of Pub. L. 100-203 provided that:
''(1) The amendment made by subsection (a) (amending this
section) applies (except as provided under paragraph (2)) to
payments under title XIX of the Social Security Act (42 U.S.C. 1396
et seq.) for calendar quarters beginning on or after January 1,
1988, without regard to whether or not final regulations to carry
out such amendment have been promulgated by such date.
''(2) In the case of a State plan for medical assistance under
title XIX of the Social Security Act which the Secretary of Health
and Human Services determines requires State legislation (other
than legislation appropriating funds) in order for the plan to meet
the additional requirement imposed by the amendment made by
subsection (a), the State plan shall not be regarded as failing to
comply with the requirements of such title solely on the basis of
its failure to meet this additional requirement before the first
day of the first calendar quarter beginning after the close of the
first regular session of the State legislature that begins after
the date of enactment of this Act (Dec. 22, 1987).''
Section 4105(b) of Pub. L. 100-203 provided that: ''The amendment
made by subsection (a) (amending this section) shall apply to
services furnished on or after January 1, 1988, without regard to
whether regulations to implement such amendment are promulgated by
such date.''
Amendments by section 4211(e), (f), (h)(6) of Pub. L. 100-203
applicable to nursing facility services furnished on or after Oct.
1, 1990, without regard to whether regulations implementing such
amendments are promulgated by such date, except as otherwise
specifically provided in section 1396r of this title, with
transitional rule, see section 4214(a), (b)(2) of Pub. L. 100-203,
as amended, set out as an Effective Date note under section 1396r
of this title.
EFFECTIVE DATE OF 1986 AMENDMENTS
Amendment by Pub. L. 99-514 effective, except as otherwise
provided, as if included in enactment of the Consolidated Omnibus
Budget Reconciliation Act of 1985, Pub. L. 99-272, see section
1895(e) of Pub. L. 99-514, set out as a note under section 162 of
Title 26, Internal Revenue Code.
Amendment by section 9403(b), (d), (g)(3) of Pub. L. 99-509
applicable to payments under this subchapter for calendar quarters
beginning on or after July 1, 1987, without regard to whether or
not final regulations to carry out such amendments have been
promulgated by such date, see section 9403(h) of Pub. L. 99-509,
set out as a note under section 1396a of this title.
Amendment by section 9404(b) of Pub. L. 99-509 applicable, except
as otherwise provided, to payments under this subchapter for
calendar quarters beginning on or after July 1, 1987, without
regard to whether regulations to implement such amendments are
promulgated by such date, see section 9404(c) of Pub. L. 99-509,
set out as a note under section 1396a of this title.
Amendment by section 9408(c)(1) of Pub. L. 99-509 applicable to
services furnished on or after Oct. 21, 1986, see section 9408(d)
of Pub. L. 99-509, set out as a note under section 1396a of this
title.
Section 9501(d)(1) of Pub. L. 99-272 provided that:
''(A) The amendments made by subsection (a) (amending this
section) apply (except as provided under subparagraph (B)) to
payments under title XIX of the Social Security Act (this
subchapter) for calendar quarters beginning on or after the (sic)
July 1, 1986, without regard to whether or not final regulations to
carry out the amendments have been promulgated by that date.
''(B) In the case of a State plan for medical assistance under
title XIX of the Social Security Act which the Secretary of Health
and Human Services determines requires State legislation (other
than legislation appropriating funds) in order for the plan to meet
the additional requirement imposed by the amendments made by
subsection (a), the State plan shall not be regarded as failing to
comply with the requirements of such title solely on the basis of
its failure to meet this additional requirement before the first
day of the first calendar quarter beginning after the close of the
first regular session of the State legislature that begins after
the date of the enactment of this Act (Apr. 7, 1986).''
Amendment by section 9505(a) of Pub. L. 99-272 applicable to
medical assistance provided for hospice care furnished on or after
Apr. 7, 1986, see section 9505(e) of Pub. L. 99-272, set out as a
note under section 1396a of this title.
Section 9511(b) of Pub. L. 99-272, as amended by Pub. L. 99-509,
title IX, Sec. 9435(d)(2), Oct. 21, 1986, 100 Stat. 2070, provided
that: ''The amendment made by this section (amending this section)
shall apply to services furnished on or after April 1, 1986,
without regard to whether or not regulations to carry out the
amendment have been promulgated by that date.''
EFFECTIVE DATE OF 1984 AMENDMENT
Amendment by section 2335(f) of Pub. L. 98-369 effective July 18,
1984, see section 2335(g) of Pub. L. 98-369, set out as a note
under section 1395f of this title.
Amendment by section 2340(b) of Pub. L. 98-369 effective July 18,
1984, see section 2340(c) of Pub. L. 98-369, set out as a note
under section 1395x of this title.
Amendment by section 2361(b) of Pub. L. 98-369 applicable to
calendar quarters beginning on or after Oct. 1, 1984, without
regard to whether or not final regulations to carry out the
amendment have been promulgated by such date, except as otherwise
provided, see section 2361(d) of Pub. L. 98-369, set out as a note
under section 1396a of this title.
Section 2371(b) of Pub. L. 98-369 provided that: ''The amendment
made by subsection (a) (amending this section) shall apply to
services furnished on or after the date of the enactment of this
Act (July 18, 1984).''
EFFECTIVE DATE OF 1982 AMENDMENT
Amendment by section 136(c) of Pub. L. 97-248 effective Oct. 1,
1982, see section 136(e) of Pub. L. 97-248, set out as a note under
section 1301 of this title.
Amendment by section 137(b)(17), (18) of Pub. L. 97-248 effective
as if originally included as part of this section as this section
was amended by the Omnibus Budget Reconciliation Act of 1981, Pub.
L. 97-35, see section 137(d)(2) of Pub. L. 97-248, set out as a
note under section 1396a of this title.
EFFECTIVE DATE OF 1981 AMENDMENT
Amendment by section 2172(b) of Pub. L. 97-35 effective Aug. 13,
1981, see section 2172(c) of Pub. L. 97-35, set out as a note under
section 1396a of this title.
EFFECTIVE DATE OF 1980 AMENDMENT
For effective date of amendment by Pub. L. 96-499, see section
965(c) of Pub. L. 96-499, set out as a note under section 1396a of
this title.
EFFECTIVE DATE OF 1978 AMENDMENT
Section 8(d)(1) of Pub. L. 95-292 provided that: ''The amendments
made by subsections (a) and (b) (amending this section) shall
become effective on July 1, 1978.''
EFFECTIVE DATE OF 1977 AMENDMENT
Amendment by Pub. L. 95-210 applicable to medical assistance
provided, under a State plan approved under subchapter XIX of this
chapter, on and after the first day of the first calendar quarter
that begins more than six months after Dec. 13, 1977, with
exception for plans requiring State legislation, see section 2(f)
of Pub. L. 95-210, set out as a note under section 1395cc of this
title.
EFFECTIVE DATE OF 1973 AMENDMENT
Amendment by section 13(a)(13)-(18) of Pub. L. 93-233 effective
with respect to payments under section 1396b of this title for
calendar quarters commencing after Dec. 31, 1973, see section 13(d)
of Pub. L. 93-233, set out as a note under section 1396a of this
title.
EFFECTIVE DATE OF 1972 AMENDMENT
Section 212(b) of Pub. L. 92-603 provided that: ''The provisions
of subsection (e) of section 1905 of the Social Security Act
(subsec. (e) of this section) (as added by subsection (a) of this
section) shall be applicable in the case of services performed on
or after the date of enactment of this Act (Oct. 30, 1972).''
Amendment by section 247(b) of Pub. L. 92-603 effective with
respect to services furnished after Dec. 31, 1972, see section
247(c) of Pub. L. 92-603, set out as a note under section 1395f of
this title.
Section 275(b) of Pub. L. 92-603 provided that: ''The amendment
made by this section (amending this section) shall be effective
with respect to services furnished after June 30, 1973.''
Section 297(b) of Pub. L. 92-603 provided that: ''The amendment
made by this section (amending this section) shall apply with
respect to services furnished after December 31, 1972.''
EFFECTIVE DATE OF 1971 AMENDMENT
Amendment by Pub. L. 92-223 effective Jan. 1, 1972, see section
4(d) of Pub. L. 92-223, set out as a note under section 1396a of
this title.
EFFECTIVE DATE OF 1968 AMENDMENT
Section 248(e) of Pub. L. 90-248 provided that the amendment made
by that section is effective with respect to quarters after 1967.
CONSTRUCTION OF 1999 AMENDMENT
Amendment by Pub. L. 106-170 to be executed as if Pub. L. 106-169
had been enacted after the enactment of Pub. L. 106-170, see
section 121(c)(1) of Pub. L. 106-169, set out as a note under
section 1396a of this title.
ALASKA FMAPS
Pub. L. 106-554, Sec. 1(a)(6) (title VII, Sec. 706), Dec. 21,
2000, 114 Stat. 2763, 2763A-577, provided that: ''Notwithstanding
the first sentence of section 1905(b) of the Social Security Act
(42 U.S.C. 1396d(b)), only with respect to each of fiscal years
2001 through 2005, for purposes of titles XIX and XXI of the Social
Security Act (this subchapter and subchapter XXI of this chapter),
the State percentage used to determine the Federal medical
assistance percentage for Alaska shall be that percentage which
bears the same ratio to 45 percent as the square of the adjusted
per capita income of Alaska (determined by dividing the State's
3-year average per capita income by 1.05) bears to the square of
the per capita income of the 50 States.''
Section 4725(a) of Pub. L. 105-33 provided that:
''Notwithstanding the first sentence of section 1905(b) of the
Social Security Act (42 U.S.C. 1396d(b)), the Federal medical
assistance percentage determined under such sentence for Alaska
shall be 59.8 percent but only with respect to -
''(1) items and services furnished under a State plan under
title XIX (this subchapter) or under a State child health plan
under title XXI of such Act (subchapter XXI of this chapter)
during fiscal years 1998, 1999, and 2000;
''(2) payments made on a capitation or other risk-basis under
such titles for coverage occurring during such period; and
''(3) payments under title XIX of such Act attributable to DSH
allotments for such State determined under section 1923(f) of
such Act (42 U.S.C. 1396r-4(f)) for such fiscal years.''
EPSDT BENEFIT STUDY AND REPORT
Section 4744 of Pub. L. 105-33 provided that:
''(a) Study. -
''(1) In general. - The Secretary of Health and Human Services,
in consultation with Governors, directors of State medicaid
programs, the American Academy of Actuaries, and representatives
of appropriate provider and beneficiary organizations, shall
conduct a study of the provision of early and periodic screening,
diagnostic, and treatment services under the medicaid program
under title XIX of the Social Security Act (this subchapter) in
accordance with the requirements of section 1905(r) of such Act
(42 U.S.C. 1396d(r)).
''(2) Required contents. - The study conducted under paragraph
(1) shall include examination of the actuarial value of the
provision of such services under the medicaid program and an
examination of the portions of such actuarial value that are
attributable to paragraph (5) of section 1905(r) of such Act and
to the second sentence of such section.
''(b) Report. - Not later than 12 months after the date of the
enactment of this Act (Aug. 5, 1997), the Secretary of Health and
Human Services shall submit a report to Congress on the results of
the study conducted under subsection (a).''
REFERENCES TO PROVISIONS OF PART A OF SUBCHAPTER IV CONSIDERED
REFERENCES TO SUCH PROVISIONS AS IN EFFECT JULY 16, 1996
For provisions that certain references to provisions of part A
(Sec. 601 et seq.) of subchapter IV of this chapter be considered
references to such provisions of part A as in effect July 16, 1996,
see section 1396u-1(a) of this title.
LIMITATION ON DISALLOWANCES OR DEFERRAL OF FEDERAL FINANCIAL
PARTICIPATION FOR CERTAIN INPATIENT PSYCHIATRIC HOSPITAL SERVICES
FOR INDIVIDUALS UNDER AGE 21
Section 4706 of Pub. L. 101-508 provided that:
''(a) In General. - (1) If the Secretary of Health and Human
Services makes a determination that a psychiatric facility has
failed to comply with certification of need requirements for
inpatient psychiatric hospital services for individuals under age
21 pursuant to section 1905(h) of the Social Security Act (subsec.
(h) of this section), and such determination has not been subject
to a final judicial decision, any disallowance or deferral of
Federal financial participation under such Act (this chapter) based
on such determination shall only apply to the period of time
beginning with the first day of noncompliance and ending with the
date by which the psychiatric facility develops documentation
(using plan of care or utilization review procedures) of the need
for inpatient care with respect to such individuals.
''(2) Any disallowance of Federal financial participation under
title XIX of the Social Security Act (this subchapter) relating to
the failure of a psychiatric facility to comply with certification
of need requirements -
''(A) shall not exceed 25 percent of the amount of Federal
financial participation for the period described in paragraph
(1); and
''(B) shall not apply to any fiscal year before the fiscal year
that is 3 years before the fiscal year in which the determination
of noncompliance described in paragraph (1) is made.
''(b) Effective Date. - Subsection (a) shall apply to
disallowance actions and deferrals of Federal financial
participation with respect to services provided before the date of
enactment of this Act (Nov. 5, 1990).''
INTERMEDIATE CARE FACILITY; ACCESS AND VISITATION RIGHTS
Section 411(l)(3)(C)(i), formerly Sec. 411(l)(3)(C), of Pub. L.
100-360, as redesignated by Pub. L. 100-485, title VI, Sec.
608(d)(27)(E), Oct. 13, 1988, 102 Stat. 2423, provided that:
''Effective as of the date of the enactment of this Act (July 1,
1988) and until the effective date of section 1919(c) of such Act
(section 1396r(c) of this title, see Effective Date note set out
under section 1396r of this title), section 1905(c) of the Social
Security Act (subsec. (c) of this section) is deemed to include the
requirement described in section 1919(c)(3)(A) of such Act (as
inserted by section 4211(a)(3) of OBRA).''
REGULATIONS FOR INTERMEDIATE CARE FACILITIES FOR MENTALLY RETARDED
Section 9514 of Pub. L. 99-272 provided that: ''The Secretary of
Health and Human Services shall promulgate proposed regulations
revising standards for intermediate care facilities for the
mentally retarded under title XIX of the Social Security Act (this
subchapter) within 60 days after the date of the enactment of this
Act (Apr. 7, 1986).''
LIFE SAFETY CODE RECOGNITION
Section 9515 of Pub. L. 99-272 provided that: ''For purposes of
section 1905(c) of the Social Security Act (subsec. (c) of this
section), an intermediate care facility for the mentally retarded
(as defined in section 1905(d) of such Act) which meets the
requirements of the relevant sections of the 1985 edition of the
Life Safety Code of the National Fire Protection Association shall
be deemed to meet the fire safety requirements for intermediate
care facilities for the mentally retarded until such time as the
Secretary specifies a later edition of the Life Safety Code for
purposes of such section, or the Secretary determines that more
stringent standards are necessary to protect the safety of
residents of such facilities.''
STUDY OF FEDERAL MEDICAL ASSISTANCE PERCENTAGE FORMULA AND OF
ADJUSTMENTS OF TARGET AMOUNTS FOR FEDERAL MEDICAID EXPENDITURES;
REPORT TO CONGRESS
Section 2165 of Pub. L. 97-35 directed the Comptroller General,
in consultation with the Advisory Committee for Intergovernmental
Relations, to study the Federal medical assistance percentage
formula as applicable to distribution of Federal funds to States,
with a view to revising the medicaid matching formula so as to take
into account factors which might result in a more equitable
distribution of Federal funds to States under this chapter, and to
report to Congress on such study not later than Oct. 1, 1982.
COSTS CHARGED TO PERSONAL FUNDS OF PATIENTS IN INTERMEDIATE CARE
FACILITIES; COSTS INCLUDED IN CHARGES FOR SERVICES; REGULATIONS
Section 8(c), (d)(2) of Pub. L. 95-292 required the Secretary of
Health, Education, and Welfare to issue regulations, within 90 days
after enactment of Pub. L. 95-292 but not later than July 1, 1978,
defining those costs that may be charged to the personal funds of
patients in intermediate care facilities who are individuals
receiving medical assistance under a State plan approved under
title XIX of the Social Security Act, and those costs that are to
be included in the reasonable cost or reasonable charge for
intermediate care facility services. See section 1302 of this
title.

-SECREF-
SECTION REFERRED TO IN OTHER SECTIONS
This section is referred to in sections 256b, 280c-6, 290bb-1,
290jj, 300ff-52, 603, 618, 657, 674, 705, 1318, 1395i-2, 1395s,
1395v, 1395w-4, 1395w-21, 1395ss, 1396a, 1396b, 1396i, 1396n,
1396o, 1396p, 1396r, 1396r-1, 1396r-1b, 1396r-6, 1396r-8, 1396s,
1396t, 1396u-2, 1397ee, 1397jj, 11398 of this title; title 25
section 1645.

 

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