1 So in original. Probably should be “a quality improvement organization”.
or by an entity which meets the requirements of
2 So in original. There is no subpar. (G).
90 percent of the sums expended during the quarter as are attributable to the design, development, or installation of such mechanized verification and information retrieval systems as the Secretary determines are necessary to implement
3 So in original. The comma probably should be a semicolon.
and
4 See References in Text note below.
that are imposed on a hospital described in subsection (w)(3)(F) in that quarter.
5 So in original. The word “or” probably should precede “1396d(p)(1)”.
1396a(a)(10)(A)(ii)(XV), 1396a(a)(10)(A)(ii)(XVI), 1396a(a)(10)(A)(ii)(XVII), 1396a(a)(10)(A)(ii)(XVIII), 1396a(a)(10)(A)(ii)(XIX), 1396a(a)(10)(A)(ii)(XX), 1396a(a)(10)(A)(ii)(XXI), 1396a(a)(10)(A)(ii)(XXII), 1396d(p)(1) of this title or for any individual—
6 Probably means subclause (VIII) of subsection (a)(10)(A)(i) of section 1396a of this title.
other than medical assistance provided through benchmark coverage described in
7 So in original. Probably should be “waiver”.
under
8 So in original. Probably should be followed by a comma.
except with respect to clause (ix) of subparagraph (A), does not apply with respect to payments under this subchapter to a State with respect to expenditures incurred by it for payment for services provided by an entity which—
9 So in original. The word “section” probably should appear.
300jj(13) of this title) that is certified pursuant to
10 So in original. Probably should be preceded by “a”.
provider described in paragraph (2)(A)(ii), the dollar amounts specified in subparagraph (A) shall be ⅔ of the dollar amounts otherwise specified.
11 So in original. The word “or” probably should not appear.
for medical assistance provided to an individual described in subsection (a) of
12 So in original. Probably should be section “1396o–1(e)(4)(B)”.
of this title), or networks of such providers.
Editorial Notes
References in Text

Subsection (w)(3)(A), referred to in subsec. (span)(5), was in the original “section 1902(w)(3)(A)”, and was translated as reading “section 1903(w)(3)(A)”, meaning section 1903(w)(3)(A) of the Social Security Act, to reflect the probable intent of Congress, because section 1902(w)(3), which is classified to section 1396a(w)(3) of this title, does not contain a subpar. (A), and subsec. (w)(3)(A) of this section relates to health care related taxes.

The Individuals with Disabilities Education Act, referred to in subsec. (c), is title VI of Puspan. L. 91–230, Apr. 13, 1970, 84 Stat. 175. Parts B and C of the Act are classified generally to subchapters II (§ 1411 et seq.) and III (§ 1431 et seq.), respectively, of chapter 33 of Title 20, Education. For complete classification of this Act to the Code, see section 1400 of Title 20 and Tables.

The Internal Revenue Code of 1986, referred to in subsecs. (d)(3)(B)(i) and (w)(3)(F), is classified generally to Title 26, Internal Revenue Code.

Section 300e–9(d) of this title, referred to in subsecs. (g)(1) and (m)(1)(A), (4)(A), was redesignated section 300e–9(c) of this title by Puspan. L. 100–517, § 7(span), Oct. 24, 1988, 102 Stat. 2580.

The Assisted Suicide Funding Restriction Act of 1997, referred to in subsec. (i)(16), is Puspan. L. 105–12, Apr. 30, 1997, 111 Stat. 23, which is classified principally to chapter 138 (§ 14401 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 14401 of this title and Tables.

Sections 254span and 254c of this title, referred to in subsec. (m)(2)(B)(i)(I), (G), were in the original references to sections 329 and 330 of the Public Health Service Act, act July 1, 1944, which were omitted in the general amendment of subpart I (§ 254span et seq.) of part D of subchapter II of chapter 6A of this title by Puspan. L. 104–299, § 2, Oct. 11, 1996, 110 Stat. 3626. Sections 2 and 3(a) of Puspan. L. 104–299 enacted new sections 330 and 330A of act July 1, 1944, which are classified, respectively, to sections 254span and 254c of this title.

The Appalachian Regional Development Act of 1965, referred to in subsec. (m)(2)(B)(ii), (G), is Puspan. L. 89–4, Mar. 9, 1965, 79 Stat. 5, which was set out in the Appendix to former Title 40, Public Buildings, Property, and Works, and was repealed and reenacted as subtitle IV (§ 14101 et seq.) of Title 40, Public Buildings, Property, and Works, by Puspan. L. 107–217, §§ 1, 6(span), Aug. 21, 2002, 116 Stat. 1062, 1304.

Section 602 of this title, referred to in subsec. (u)(1)(D)(iv), was repealed and a new section 602 enacted by Puspan. L. 104–193, title I, § 103(a)(1), Aug. 22, 1996, 110 Stat. 2112, and, as so enacted, no longer contains a subsec. (a)(26)(C).

The Deficit Reduction Act of 2005, referred to in subsec. (x)(5), is Puspan. L. 109–171, Fespan. 8, 2006, 120 Stat. 4. Section 6036 of the Act amended this section and enacted provisions set out as notes under this section. For complete classification of this Act to the Code, see Short Title of 2006 Amendment note set out under section 1305 of this title and Tables.

Amendments

2020—Subsec. (a)(6). Puspan. L. 116–260, § 207(span), which directed amendment of concluding provisions by striking out “(as found necessary by the Secretary for the elimination of fraud in the provision and administration of medical assistance provided under the State plan (or waiver of such plan))”, was executed by striking out “(as found necessary by the Secretary for the elimination of fraud in the provision and administration of medical assistance provided under the State plan)” after “such quarter”, to reflect the probable intent of Congress.

Subsec. (i)(9). Puspan. L. 116–260, § 209(a)(3), added par. (9).

Subsec. (q)(4)(A)(ii). Puspan. L. 116–260, § 207(a), inserted “and of patients (who are receiving medical assistance under the State plan under this subchapter (or waiver of such plan)) in a noninstitutional or other setting” after “patients residing in board and care facilities”.

Subsec. (bspan). Puspan. L. 116–260, § 202, added subsec. (bspan).

2019—Subsec. (i)(10)(C) to (E). Puspan. L. 116–16, § 6(a)(2)(A), added subpar. (E) and realigned margins.

Subsec. (i)(12). Puspan. L. 116–16, § 8(a), added par. (12).

2018—Subsec. (l)(1). Puspan. L. 115–222, § 1(a)(1)(A), substituted “January 1, 2020” for “January 1, 2019” in introductory provisions.

Subsec. (l)(1)(A)(i). Puspan. L. 115–222, § 1(a)(1)(B), struck out “2019 and” before “2020”.

Subsec. (l)(4)(A)(i). Puspan. L. 115–222, § 1(a)(2), substituted “calendar quarters in 2020” for “calendar quarters in 2019”.

Subsec. (m)(7). Puspan. L. 115–271, § 1013, added par. (7).

Subsec. (m)(8). Puspan. L. 115–271, § 1016(a), added par. (8).

Subsec. (m)(9). Puspan. L. 115–271, § 4001, added par. (9).

Subsec. (aa). Puspan. L. 115–271, § 1003, added subsec. (aa).

2016—Subsec. (i)(2)(A). Puspan. L. 114–255, § 5005(a)(4)(A)(i), substituted semicolon for comma at end.

Subsec. (i)(2)(D). Puspan. L. 114–255, § 5005(a)(4)(A)(ii), (iii), added subpar. (D).

Subsec. (i)(2)(E). Puspan. L. 114–255, § 17004(span)(1)(A), added subpar. (E).

Subsec. (i)(21). Puspan. L. 114–255, § 5008(a), inserted “section 1396r–8(d)(2)(C) of this title (relating to drugs when used for cosmetic purposes or hair growth), except where medically necessary, and” after “drugs described in”.

Subsec. (i)(27). Puspan. L. 114–255, § 5002, substituted “January 1, 2018” for “January 1, 2019”.

Subsec. (l). Puspan. L. 114–255, § 12006(a), added subsec. (l).

Subsec. (m)(3). Puspan. L. 114–255, § 5005(a)(4)(B), added par. (3).

2015—Subsec. (i)(27). Puspan. L. 114–113 added par. (27).

2010—Subsec. (a)(3)(E). Puspan. L. 111–148, § 2102(a)(8)(A), amended Puspan. L. 111–3, § 211(a)(1)(B). See 2009 Amendment note below.

Subsec. (a)(3)(H). Puspan. L. 111–148, § 2102(a)(8)(B), amended Puspan. L. 111–3, § 211(a)(1)(B). See 2009 Amendment note below.

Subsec. (d)(2)(C). Puspan. L. 111–148, § 6506(a)(1)(A), substituted “1 year” for “60 days” in first sentence and “1-year period” for “60 days” in second sentence.

Subsec. (d)(2)(D). Puspan. L. 111–148, § 6506(a)(1)(B), designated existing provisions as cl. (i) and added cl. (ii).

Subsec. (f)(4). Puspan. L. 111–148, § 2402(d)(2)(A), inserted “1396a(a)(10)(A)(ii)(XXII),” after “1396a(a)(10)(A)(ii)(XXI),”.

Puspan. L. 111–148, § 2303(a)(4)(B), inserted “1396a(a)(10)(A)(ii)(XXI),” after “1396a(a)(10)(A)(ii)(XX),”.

Puspan. L. 111–148, § 2004(c)(1), inserted “1396a(a)(10)(A)(i)(IX),” after “1396a(a)(10)(A)(i)(VIII),”.

Puspan. L. 111–148, § 2001(e)(2)(B), inserted “1396a(a)(10)(A)(ii)(XX),” after “1396a(a)(10)(A)(ii)(XIX),”.

Puspan. L. 111–148, § 2001(a)(5)(D), inserted “1396a(a)(10)(A)(i)(VIII),” after “1396a(a)(10)(A)(i)(VII),”.

Subsec. (i)(2)(C). Puspan. L. 111–148, § 6402(h)(2), added subpar. (C).

Subsec. (i)(25). Puspan. L. 111–148, § 6402(c), added par. (25).

Subsec. (i)(26). Puspan. L. 111–148, § 2001(a)(2)(B), added par. (26).

Subsec. (m)(2)(A)(xi). Puspan. L. 111–148, § 6504(span)(1), inserted “and for the provision of such data to the State at a frequency and level of detail to be specified by the Secretary” after “patients”.

Subsec. (m)(2)(A)(xiii). Puspan. L. 111–148, § 2501(c)(1), added cl. (xiii).

Subsec. (r)(1)(B)(iv). Puspan. L. 111–148, § 6507(1), added cl. (iv).

Subsec. (r)(1)(F). Puspan. L. 111–148, § 6504(a), inserted “and including, for data submitted to the Secretary on or after January 1, 2010, data elements from the automated data system that the Secretary determines to be necessary for program integrity, program oversight, and administration, at such frequency as the Secretary shall determine” after “necessary”.

Subsec. (r)(4). Puspan. L. 111–148, § 6507(2), added par. (4).

Subsec. (t)(3)(D). Puspan. L. 111–157 substituted “inpatient or emergency room setting” for “setting (whether inpatient or outpatient)”.

Subsec. (t)(3)(E). Puspan. L. 111–309, § 205(e)(1), substituted “reduced by the average payment the Secretary estimates will be made to such Medicaid providers (determined on a percentage or other basis for such classes or types of providers as the Secretary may specify) from other sources (other than under this subsection, or by the Federal government or a State or local government)” for “reduced by any payment that is made to such Medicaid provider from any other source (other than under this subsection or by a State or local government)”.

Subsec. (t)(6)(B). Puspan. L. 111–309, § 205(e)(2), inserted “and shall be determined to have met such responsibility to the extent that the payment to the Medicaid provider is not in excess of 85 percent of the net average allowable cost” before period at end.

Subsec. (u)(1)(D)(v). Puspan. L. 111–148, § 2303(span)(2)(B), inserted “or for medical assistance provided to an individual described in subsection (a) of section 1396r–1c of this title during a presumptive eligibility period under such section,” after “section 1396r–1span of this title during a presumptive eligibility period under such section,”.

Puspan. L. 111–148, § 2202(span), substituted “section, for medical” for “section, or for medical” and inserted before period at end “, or for medical assistance provided to an individual during a presumptive eligibility period resulting from a determination of presumptive eligibility made by a hospital that elects under section 1396a(a)(47)(B) of this title to be a qualified entity for such purpose”.

2009—Subsec. (a)(2)(E). Puspan. L. 111–3, § 201(span)(2)(A), added subpar. (E).

Subsec. (a)(3)(A)(iii). Puspan. L. 111–3, § 401(span), added cl. (iii).

Subsec. (a)(3)(D). Puspan. L. 111–5, § 4201(a)(1)(A), struck out “and” at end.

Subsec. (a)(3)(E)(ii). Puspan. L. 111–5, § 4201(a)(1)(B), substituted “and” for “plus” at end.

Puspan. L. 111–3, § 211(a)(1)(B)(i), which directed substitution of “and” for “plus” at end and could not be executed, was struck out by Puspan. L. 111–148, § 2102(a)(8)(A).

Subsec. (a)(3)(F). Puspan. L. 111–5, § 4201(a)(1)(C), added subpar. (F).

Subsec. (a)(3)(H). Puspan. L. 111–3, § 211(a)(1)(B), as amended by Puspan. L. 111–148, § 2102(a)(8)(B), added subpar. (H).

Subsec. (i)(22). Puspan. L. 111–3, § 211(a)(3)(A), substituted “section 1396a(a)(46)(B) of this title” for “subsection (x)”.

Subsec. (t). Puspan. L. 111–5, § 4201(a)(2), added subsec. (t).

Subsec. (v)(1). Puspan. L. 111–3, § 214(a)(1), substituted “paragraphs (2) and (4)” for “paragraph (2)”.

Subsec. (v)(4). Puspan. L. 111–3, § 214(a)(2), added par. (4).

Subsec. (x)(1). Puspan. L. 111–3, § 211(a)(3)(B), substituted “section 1396a(a)(46)(B)(i) of this title” for “subsection (i)(22)”.

Subsec. (x)(2)(B), (C). Puspan. L. 111–3, § 211(span)(4), realigned margins.

Subsec. (x)(2)(D), (E). Puspan. L. 111–3, § 211(span)(3)(A)(i), added subpar. (D) and redesignated former subpar. (D) as (E).

Subsec. (x)(3)(B)(v), (vi). Puspan. L. 111–3, § 211(span)(1), added cl. (v) and redesignated former cl. (v) as (vi).

Subsec. (x)(4), (5). Puspan. L. 111–3, § 211(span)(2), (3)(A)(ii), added pars. (4) and (5).

2008—Subsec. (i)(24). Puspan. L. 110–252 added par. (24).

Subsec. (r)(1). Puspan. L. 110–379, § 3(a)(1), inserted “, in addition to meeting the requirements of paragraph (3),” after “a State must” in introductory provisions.

Subsec. (r)(3). Puspan. L. 110–379, § 3(a)(2), added par. (3).

2007—Subsec. (i)(23). Puspan. L. 110–28 added par. (23).

2006—Subsec. (f)(4). Puspan. L. 109–171, § 6062(c)(1), inserted “1396a(a)(10)(A)(ii)(XIX),” after “1396a(a)(10)(A)(ii)(XVIII),” in introductory provisions.

Subsec. (i)(10)(C). Puspan. L. 109–171, § 6002(span), added subpar. (C).

Subsec. (i)(10)(D). Puspan. L. 109–171, § 6033(a), added subpar. (D).

Subsec. (i)(22). Puspan. L. 109–171, § 6036(a)(1), added par. (22).

Subsec. (w)(4)(C). Puspan. L. 109–432, § 403, designated existing provisions as cl. (i) and added cl. (ii).

Subsec. (w)(7)(A)(viii). Puspan. L. 109–171, § 6051(a), amended cl. (viii) generally. Prior to amendment, cl. (viii) read as follows: “Services of a medicaid managed care organization with a contract under subsection (m) of this section.”

Subsec. (x). Puspan. L. 109–171, § 6036(a)(2), added subsec. (x).

Subsec. (x)(1). Puspan. L. 109–432, § 405(c)(1)(A)(i), substituted “(i)(22)” for “(i)(23)”.

Subsec. (x)(2). Puspan. L. 109–432, § 405(c)(1)(A)(ii)(I), substituted “individual declaring to be a citizen or national of the United States” for “alien” in introductory provisions.

Subsec. (x)(2)(B). Puspan. L. 109–432, § 405(c)(1)(A)(ii)(II), added subpar. (B) and struck out former subpar. (B) which read as follows: “on the basis of receiving supplemental security income benefits under subchapter XVI; or”.

Subsec. (x)(2)(C). Puspan. L. 109–432, § 405(c)(1)(A)(ii)(V), added subpar. (C). Former subpar. (C) redesignated (D).

Puspan. L. 109–432, § 405(c)(1)(A)(ii)(III), struck out “other” before “basis” and substituted “has” for “had”.

Subsec. (x)(2)(D). Puspan. L. 109–432, § 405(c)(1)(A)(ii)(IV), redesignated subpar. (C) as (D).

Subsec. (x)(3)(C)(iii). Puspan. L. 109–432, § 405(c)(1)(A)(iii), substituted “I–197” for “I–97”.

Subsec. (y). Puspan. L. 109–171, § 6043(span), added subsec. (y).

Subsec. (z). Puspan. L. 109–171, § 6081, added subsec. (z).

2005—Subsec. (i)(21). Puspan. L. 109–91 added par. (21).

2004—Subsec. (a)(3)(D). Puspan. L. 108–357, § 712(span)(1), substituted “and” for “plus”.

Subsec. (a)(3)(E). Puspan. L. 108–357, § 712(span)(2), added subpar. (E).

Subsec. (c). Puspan. L. 108–446 substituted “part C” for “part H”.

2000—Subsec. (f)(4). Puspan. L. 106–554, § 1(a)(6) [title VII, § 710(a)], inserted “1396a(a)(10)(A)(ii)(XVII), 1396a(a)(10)(A)(ii)(XVIII),” after “1396a(a)(10)(A)(ii)(XVI),”.

Subsec. (m)(2)(A)(ix). Puspan. L. 106–554, § 1(a)(6) [title VII, § 702(c)(1)], repealed Puspan. L. 105–33, § 4712(c)(2). See 1997 Amendment note below.

Subsec. (u)(1)(D)(v). Puspan. L. 106–354 substituted “, for items” for “or for items” and inserted before period at end “, or for medical assistance provided to an individual described in subsection (a) of section 1396r–1span of this title during a presumptive eligibility period under such section”.

1999—Subsec. (a)(3)(C)(i). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 604(a)(2)(B)], struck out “or quality review” after “medical and utilization review”.

Subsec. (span)(4). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(e)], inserted “of” after “for the use” in introductory provisions.

Subsec. (d)(3). Puspan. L. 106–31, § 3031(a), designated existing provisions as subpar. (A) and added subpar. (B).

Subsec. (d)(3)(B). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(f)], realigned margins.

Subsec. (f)(2). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(g)], struck out second period at end.

Subsec. (f)(4). Puspan. L. 106–170, § 201(span), inserted “1396a(a)(10)(A)(ii)(XV), 1396a(a)(10)(A)(ii)(XVI),” before “1396d(p)(1)” in introductory provisions.

Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(aa)(2)], substituted “1396a(a)(10)(A)(ii)(XIII), 1396a(a)(10)(A)(ii)(XIV), or 1396d(p)(1) of this title” for “1396d(p)(1), or 1396d(u) of this title” in introductory provisions.

Subsec. (i)(14). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(h)], inserted “or” after semicolon.

Subsec. (i)(19). Puspan. L. 106–31, § 3031(span), added par. (19).

Subsec. (i)(20). Puspan. L. 106–170, § 201(a)(4), added par. (20).

Subsec. (m)(2)(A)(vi). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(i)(1)], struck out semicolon after “section 1396u–2(a)(4) of this title”.

Subsec. (m)(2)(A)(xi), (xii). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(i)(2)], redesignated cl. (xi), relating to section 1396u–2, as (xii).

Subsec. (m)(6)(B)(ii). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 604(span)(2)(A)], inserted “and” at end.

Subsec. (m)(6)(B)(iii). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 604(span)(2)(B)], substituted a period for “; and” at end.

Subsec. (m)(6)(B)(iv). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 604(span)(2)(C)], struck out cl. (iv) which read as follows: “that the State agency will contract, for purposes of meeting the requirement under section 1396a(a)(30)(C) of this title, with an organization or entity that under section 1320c–3 of this title reviews services provided by an eligible organization pursuant to a contract under section 1395mm of this title for the purpose of determining whether the quality of services meets professionally recognized standards of health care.”

Subsec. (o). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(j)], struck out second closing parenthesis after “section 1167(1) of title 29”.

Subsec. (q)(3). Puspan. L. 106–170, § 407(a), inserted “(A)” after “in connection with” and added subpar. (B).

Subsec. (q)(4). Puspan. L. 106–170, § 407(c), amended par. (4) generally. Prior to amendment, par. (4) read as follows: “The entity has procedures for reviewing complaints of the abuse and neglect of patients of health care facilities which receive payments under the State plan under this subchapter, and, where appropriate, for acting upon such complaints under the criminal laws of the State or for referring them to other State agencies for action.”

Subsec. (q)(5). Puspan. L. 106–170, § 407(span), inserted “or under any Federal health care program (as so defined)” before “to health care facilities” and inserted at end “All funds collected in accordance with this paragraph shall be credited exclusively to, and available for expenditure under, the Federal health care program (including the State plan under this subchapter) that was subject to the activity that was the basis for the collection.”

Subsec. (w)(1)(B). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(k)(1)], substituted “purposes” for “puroses”.

Subsec. (w)(3)(B). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(k)(2)], inserted a comma after “(D)” in introductory provisions.

Subsec. (w)(7)(A)(viii). Puspan. L. 106–113, § 1000(a)(6) [title VI, § 608(k)(3)], realigned margins.

1997—Subsec. (a)(3)(C). Puspan. L. 105–33, § 4705(span), designated existing provisions as cl. (i) and added cl. (ii).

Subsec. (span)(4). Puspan. L. 105–33, § 4707(span), added par. (4).

Subsec. (span)(5). Puspan. L. 105–33, § 4722(span), added par. (5).

Subsec. (f)(4). Puspan. L. 105–100 substituted “1396d(p)(1), or 1396d(u) of this title” for “or 1396d(p)(1) of this title” in introductory provisions.

Subsec. (f)(4)(C). Puspan. L. 105–33, § 4802(span)(2), inserted “or who is a PACE program eligible individual enrolled in a PACE program under section 1396u–4 of this title,” after “section 1396a(a)(10)(A) of this title,”.

Subsec. (i). Puspan. L. 105–33, § 4708(d), inserted at end of closing provisions “Paragraphs (1), (2), (16), (17), and (18) shall apply with respect to items or services furnished and amounts expended by or through a managed care entity (as defined in section 1396u–2(a)(1)(B) of this title) in the same manner as such paragraphs apply to items or services furnished and amounts expended directly by the State.”

Subsec. (i)(2). Puspan. L. 105–33, § 4724(a)(1), substituted “; or” for the period at end.

Subsec. (i)(10)(B), (11). Puspan. L. 105–33, § 4724(a)(2), inserted “or” at end.

Subsec. (i)(12). Puspan. L. 105–33, § 4742(a), struck out par. (12) which related to restrictions on payments, on or after Jan. 1, 1992, for physicians’ services to children under 21 years of age and to pregnant women.

Subsec. (i)(13). Puspan. L. 105–33, § 4724(a)(2), inserted “or” at end.

Subsec. (i)(16). Puspan. L. 105–12 added par. (16).

Subsec. (i)(17). Puspan. L. 105–33, § 4724(a)(1), (3), added par. (17).

Subsec. (i)(18). Puspan. L. 105–33, § 4724(span)(1), added par. (18).

Subsec. (k). Puspan. L. 105–33, § 4701(span)(2)(A)(v), substituted “medicaid managed care organization” for “health maintenance organization”.

Subsec. (m)(1)(A). Puspan. L. 105–33, § 4701(span)(1), in introductory provisions, substituted “The term ‘medicaid managed care organization’ means a health maintenance organization, an eligible organization with a contract under section 1395mm of this title or a Medicare+Choice organization with a contract under part C of subchapter XVIII, a provider sponsored organization, or any other public or private organization, which meets the requirement of section 1396a(w) of this title and—” for “The term ‘health maintenance organization’ means a public or private organization, organized under the laws of any State, which meets the requirement of section 1396a(w) of this title is a qualified health maintenance organization (as defined in section 300e–9(d) of this title) or which meets the requirement of section 1396a(a) of this title and—” and inserted as closing provisions “An organization that is a qualified health maintenance organization (as defined in section 300e–9(d) of this title) is deemed to meet the requirements of clauses (i) and (ii).”

Subsec. (m)(1)(A)(ii). Puspan. L. 105–33, § 4706(1), inserted “, meets the requirements of subparagraph (C)(i) (if applicable),” after “provision is satisfactory to the State”.

Subsec. (m)(1)(B). Puspan. L. 105–33, § 4701(span)(2)(A)(vi), substituted “medicaid managed care organization” for “health maintenance organization”.

Subsec. (m)(1)(C). Puspan. L. 105–33, § 4706(2), added subpar. (C).

Subsec. (m)(2)(A)(i). Puspan. L. 105–33, § 4701(span)(2)(A)(vii), substituted “medicaid managed care organization” for “health maintenance organization”.

Subsec. (m)(2)(A)(ii). Puspan. L. 105–33, § 4703(a), struck out cl. (ii) which read as follows: “less than 75 percent of the membership of the entity which is enrolled on a prepaid basis consists of individuals who (I) are insured for benefits under part B of subchapter XVIII of this chapter or for benefits under both parts A and B of such subchapter, or (II) are eligible to receive benefits under this subchapter;”.

Subsec. (m)(2)(A)(iii). Puspan. L. 105–33, § 4708(a), substituted “$1,000,000 for 1998 and, for a subsequent year, the amount established udner this clause for the previous year increased by the percentage increase in the consumer price index for all urban consumers over the previous year” for “$100,000”.

Subsec. (m)(2)(A)(vi). Puspan. L. 105–33, § 4701(d)(2)(A), struck out “except as provided under subparagraph (F),” after “such contract (I)”, substituted “in accordance with section 1396u–2(a)(4) of this title;” for “without cause as of the beginning of the first calendar month following a full calendar month after the request is made for such termination”, and inserted “in accordance with such section” after “provides for notification”.

Subsec. (m)(2)(A)(ix). Puspan. L. 105–33, § 4712(c)(2), which directed the repeal of subsec. (m)(2)(A)(ix), was repealed by Puspan. L. 106–554, § 1(a)(6) [title VII, § 702(c)(1)]. See 2000 Amendment note above and Effective Date of 1997 Amendment note below.

Puspan. L. 105–33, § 4712(span)(2), amended cl. (ix) generally. Prior to amendment, cl. (ix) read as follows: “such contract provides, in the case of an entity that has entered into a contract for the provision of services of such center with a federally qualified health center, that (I) rates of prepayment from the State are adjusted to reflect fully the rates of payment specified in section 1396a(a)(13)(E) of this title, and (II) at the election of such center payments made by the entity to such a center for services described in 1396d(a)(2)(C) of this title are made at the rates of payment specified in section 1396a(a)(13)(E) of this title;”.

Subsec. (m)(2)(A)(xi). Puspan. L. 105–33, § 4701(c), added cl. (xi) relating to section 1396u–2.

Subsec. (m)(2)(C) to (E). Puspan. L. 105–33, § 4703(span)(1)(A), struck out subpars. (C) to (E) which read as follows:

“(C) Subparagraph (A)(ii) shall not apply with respect to payments under this subchapter to a State with respect to expenditures incurred by it for payment for services by an entity during the three-year period beginning on October 8, 1976, or beginning on the date the entity qualifies as a health maintenance organization (as determined by the Secretary), whichever occurs later, but only if the entity demonstrates to the satisfaction of the Secretary by the submission of plans for each year of such three-year period that it is making continuous efforts and progress toward achieving compliance with subparagraph (A)(ii).

“(D) In the case of a health maintenance organization that is a public entity, the Secretary may modify or waive the requirement described in subparagraph (A)(ii) but only if the Secretary determines that the organization has taken and is taking reasonable efforts to enroll individuals who are not entitled to benefits under the State plan approved under this subchapter or under subchapter XVIII of this chapter.

“(E) In the case of a health maintenance organization that—

“(i) is a nonprofit organization with at least 25,000 members,

“(ii) is and has been a qualified health maintenance organization (as defined in section 300e–9(d) of this title) for a period of at least four years,

“(iii) provides basic health services through members of the staff of the organization,

“(iv) is located in an area designated as medically underserved under section 300e–1(7) of this title, and

“(v) previously received a waiver of the requirement described in subparagraph (A)(ii) under section 1315 of this title,

the Secretary may modify or waive the requirement described in subparagraph (A)(ii) but only if the Secretary determines that special circumstances warrant such modification or waiver and that the organization has taken and is taking reasonable efforts to enroll individuals who are not entitled to benefits under the State plan approved under this subchapter or under subchapter XVIII of this chapter.”

Subsec. (m)(2)(F). Puspan. L. 105–33, § 4701(d)(2)(B), struck out subpar. (F) which read as follows: “In the case of—

“(i) a contract with an entity described in subparagraph (E) or (G), with a qualified health maintenance organization (as defined in section 300e–9(d) of this title) which meets the requirement of subparagraph (A)(ii), or or with an eligible organization with a contract under section 1395mm of this title which meets the requirement of subparagraph (A)(ii), or

“(ii) a program pursuant to an undertaking described in paragraph (6) in which at least 25 percent of the membership enrolled on a prepaid basis are individuals who (I) are not insured for benefits under part B of subchapter XVIII of this chapter or eligible for benefits under this subchapter, and (II) (in the case of such individuals whose prepayments are made in whole or in part by any government entity) had the opportunity at the time of enrollment in the program to elect other coverage of health care costs that would have been paid in whole or in part by any governmental entity,

a State plan may restrict the period in which requests for termination of enrollment without cause under subparagraph (A)(vi)(I) are permitted to the first month of each period of enrollment, each such period of enrollment not to exceed six months in duration, but only if the State provides notification, at least twice per year, to individuals enrolled with such entity or organization of the right to terminate such enrollment and the restriction on the exercise of this right. Such restriction shall not apply to requests for termination of enrollment for cause.”

Subsec. (m)(2)(G). Puspan. L. 105–33, § 4703(span)(1)(B), substituted “clause (i)” for “clauses (i) and (ii)”.

Subsec. (m)(2)(H). Puspan. L. 105–33, § 4702(span)(1)(B), in concluding provisions, inserted before period at end “or with the manager described in such clause if the manager continues to have a contract described in section 1396d(t)(3) of this title with the State”.

Puspan. L. 105–33, § 4701(span)(2)(B), struck out “health maintenance” before “organization described” in concluding provisions.

Subsec. (m)(2)(H)(i). Puspan. L. 105–33, § 4702(span)(1)(A), inserted “or with a primary care case manager with a contract described in section 1396d(t)(3) of this title” before comma at end.

Puspan. L. 105–33, § 4701(span)(2)(A)(vii), substituted “medicaid managed care organization” for “health maintenance organization”.

Subsec. (m)(4)(A). Puspan. L. 105–33, § 4701(span)(2)(A)(viii), substituted “Each medicaid managed care organization” for “Each health maintenance organization”.

Subsec. (r)(1). Puspan. L. 105–33, § 4753(a)(1), added par. (1) and struck out former par. (1) which read as follows:

“(1)(A) In order to receive payments under paragraphs (2)(A) and (7) of subsection (a) of this section without being subject to per centum reductions set forth in subparagraph (C) of this paragraph, a State must provide that mechanized claims processing and information retrieval systems of the type described in subsection (a)(3)(B) of this section and detailed in an advance planning document approved by the Secretary are operational on or before the deadline established under subparagraph (B).

“(B) The deadline for operation of such systems for a State is September 30, 1985.

“(C) If a State fails to meet the deadline established under subparagraph (B), the per centums specified in paragraphs (2)(A) and (7) of subsection (a) of this section with respect to that State shall each be reduced by 5 percentage points for the first two quarters beginning on or after such deadline, and shall be further reduced by an additional 5 percentage points after each period consisting of two quarters during which the Secretary determines the State fails to meet the requirements of subparagraph (A); except that—

“(i) neither such per centum may be reduced by more than 25 percentage points by reason of this paragraph; and

“(ii) no reduction shall be made under this paragraph for any quarter following the quarter during which such State meets the requirements of subparagraph (A).”

Subsec. (r)(2). Puspan. L. 105–33, § 4753(a)(1), (2)(B), (D), inserted introductory provisions, redesignated par. (5)(A)(i) to (iii) as par. (2)(A) to (C), and struck out former par. (2) which read as follows:

“(2)(A) In order to receive payments under paragraphs (2)(A) and (7) of subsection (a) of this section without being subject to the per centum reductions set forth in subparagraph (C) of this paragraph, a State must have its mechanized claims processing and information retrieval systems, of the type required to be operational under paragraph (1), initially approved by the Secretary in accordance with paragraph (5)(A) on or before the deadline established under subparagraph (B).

“(B) The deadline for approval of such systems for a State is the last day of the fourth quarter that begins after the date on which the Secretary determines that such systems became operational as required under paragraph (1).

“(C) If a State fails to meet the deadline established under subparagraph (B), the per centums specified in paragraphs (2)(A) and (7) of subsection (a) of this section with respect to that State shall each be reduced by 5 percentage points for the first two quarters beginning after such deadline, and shall be further reduced by an additional 5 percentage points at the end of each period consisting of two quarters during which the State fails to meet the requirements of subparagraph (A); except that—

“(i) neither such per centum may be reduced by more than 25 percentage points by reason of this paragraph, and

“(ii) no reduction shall be made under this paragraph for any quarter following the quarter during which such State’s systems are approved by the Secretary as provided in subparagraph (A).

“(D) Any State’s systems which are approved by the Secretary for purposes of subsection (a)(3)(B) of this section on or before October 7, 1980, shall be deemed to be initially approved for purposes of this subsection.”

Subsec. (r)(3), (4). Puspan. L. 105–33, § 4753(a)(1), struck out pars. (3) and (4) which related to Federal matching funds and Secretary’s periodic review of approved retrieval systems.

Subsec. (r)(5). Puspan. L. 105–33, § 4753(a)(2), struck out introductory provisions relating to requirements for Secretary’s initial approval of mechanized claims processing and information retrieval systems and struck out “under paragraph (6)” before period at end of subpar. (A)(iii), redesignated subpar. (A)(i) to (iii) as par. (2)(A) to (C), and struck out subpar. (B) which related to requirements for Secretary’s reapproval of mechanized claims processing and information retrieval systems.

Subsec. (r)(6) to (8). Puspan. L. 105–33, § 4753(a)(3), struck out pars. (6) to (8) which related to Secretary’s development of performance standards for approval of State mechanized processing claims and information retrieval systems, waiver of certain requirements for initial operation, and applicability of per centum reductions in certain situations.

Subsec. (u)(1)(D)(v). Puspan. L. 105–33, § 4912(span)(2), inserted before period at end “or for items and services described in subsection (a) of section 1396r–1a of this title provided to a child during a presumptive eligibility period under such section”.

Subsec. (w)(3)(B). Puspan. L. 105–33, § 4722(a)(1), substituted “(E), and (F)” for “and (E)” in introductory provisions.

Subsec. (w)(3)(F). Puspan. L. 105–33, § 4722(a)(2), added subpar. (F).

Subsec. (w)(7)(A)(viii). Puspan. L. 105–33, § 4701(span)(2)(C), amended cl. (viii) generally. Prior to amendment, cl. (viii) read as follows: “Services of health maintenance organizations (and other organizations with contracts under subsection (m) of this section).”

1996—Subsec. (i)(9). Puspan. L. 104–193 struck out par. (9) which read as follows: “with respect to any amount of medical assistance for pregnant women and children described in section 1396a(a)(10)(A)(ii)(IX) of this title, if the State has in effect, under its plan established under part A of subchapter IV of this chapter, payment levels that are less than the payment levels in effect under such plan on July 1, 1987;”.

Subsec. (i)(12)(A)(i). Puspan. L. 104–248, § 1(span)(1)(A), inserted “or is certified in family practice or pediatrics by the medical specialty board recognized by the American Osteopathic Association” before comma at end.

Subsec. (i)(12)(A)(vi). Puspan. L. 104–248, § 1(span)(1)(C)(i), (iii), (iv), added cl. (vi) and redesignated former cl. (vi) as (vii).

Puspan. L. 104–248, § 1(span)(1)(C)(ii), inserted “(or certified by the State in accordance with policies of the Secretary)” after “Secretary”.

Subsec. (i)(12)(A)(vii). Puspan. L. 104–248, § 1(span)(1)(C)(iii), redesignated cl. (vi) as (vii).

Subsec. (i)(12)(B)(i). Puspan. L. 104–248, § 1(span)(1)(B), inserted “or is certified in family practice or obstetrics by the medical specialty board recognized by the American Osteopathic Association” before comma at end.

Subsec. (i)(12)(B)(vi). Puspan. L. 104–248, § 1(span)(1)(C)(i), (iii), (iv), added cl. (vi) and redesignated former cl. (vi) as (vii).

Puspan. L. 104–248, § 1(span)(1)(C)(ii), inserted “(or certified by the State in accordance with policies of the Secretary)” after “Secretary”.

Subsec. (i)(12)(B)(vii). Puspan. L. 104–248, § 1(span)(1)(C)(iii), redesignated cl. (vi) as (vii).

1993—Subsec. (i)(10). Puspan. L. 103–66, § 13631(c)(1), which directed the amendment of par. (10) by striking all that follows “1396r–8(g) of this title” and inserting a semicolon, could not be executed because “1396r–8(g) of this title” did not appear subsequent to the general amendment of par. (10) by Puspan. L. 103–66, § 13602(span). See below.

Puspan. L. 103–66, § 13602(span), amended par. (10) generally. Prior to amendment, par. (10) read as follows: “with respect to covered outpatient drugs of a manufacturer dispensed in any State unless, (A) except as provided in section 1396r–8(a)(3) of this title, the manufacturer complies with the rebate requirements of section 1396r–8(a) of this title with respect to the drugs so dispensed in all States, and (B) effective January 1, 1993, the State provides for drug use review in accordance with section 1396r–8(g) of this title; or”.

Subsec. (i)(11). Puspan. L. 103–66, § 13631(c)(2), redesignated par. (12) as (11), transferred such par. to appear after par. (10), and substituted semicolon for period at end. Former par. (11) redesignated (13).

Subsec. (i)(12). Puspan. L. 103–66, § 13631(c)(3), redesignated par. (14) as (12), transferred such par. to appear after par. (11), as redesignated by Puspan. L. 103–66, § 13631(c)(2), and substituted semicolon for period at end. Former par. (12) redesignated (11).

Subsec. (i)(13). Puspan. L. 103–66, § 13631(c)(4), redesignated par. (11) as (13), transferred such par. to appear after par. (12), as redesignated by Puspan. L. 103–66, § 13631(c)(3), and directed substitution of “; or” for period at end.

Subsec. (i)(14). Puspan. L. 103–66, § 13631(c)(5), added par. (14).

Subsec. (i)(15). Puspan. L. 103–66, § 13631(h)(1), added par. (15).

Subsec. (o). Puspan. L. 103–66, § 13622(a)(2), substituted “regulation and including a group health plan (as defined in section 1167(1) of title 29)), a service benefit plan, and a health maintenance organization)” for “regulation)”.

Subsec. (s). Puspan. L. 103–66, § 13624(a), added subsec. (s).

Subsec. (v)(2)(C). Puspan. L. 103–66, § 13604(a), added subpar. (C).

1991—Subsec. (a)(1). Puspan. L. 102–234, § 3(span)(2)(B), inserted “and section 1396r–4(f) of this title” after “of this section”.

Subsec. (c). Puspan. L. 102–119 substituted “child with a disability” for “handicapped child”, “Individuals with Disabilities Education Act” for “Education of the Handicapped Act”, and “an infant or toddler with a disability” for “a handicapped infant or toddler”.

Subsec. (d)(6). Puspan. L. 102–234, § 4(a), added par. (6).

Subsec. (i)(10). Puspan. L. 102–234, § 2(span)(2), struck out par. (10) added by Puspan. L. 101–508, § 4701(span)(2)(B), which read as follows: “with respect to any amount expended for medical assistance for care or services furnished by a hospital, nursing facility, or intermediate care facility for the mentally retarded to reimburse the hospital or facility for the costs attributable to taxes imposed by the State soley [sic] with respect to hospitals or facilities.”

Subsec. (w). Puspan. L. 102–234, § 2(a), added subsec. (w).

1990—Subsec. (a)(1). Puspan. L. 101–508, § 4402(d)(3), struck out before semicolon “(including expenditures for medicare cost-sharing and including expenditures 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, or part A of subchapter IV, 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 sixty-five years of age or older and disabled individuals entitled to hospital 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)(2)(B). Puspan. L. 101–508, § 4801(a)(8), substituted “October 1, 1990” for “July 1, 1990”.

Subsec. (a)(3)(C), (D). Puspan. L. 101–508, § 4401(span)(1), substituted “and” for “plus” at end of subpar. (C) and added subpar. (D).

Subsec. (f)(2). Puspan. L. 101–508, § 4723(a), inserted “(A)” after “(2)” and added cl. (B).

Subsec. (f)(4). Puspan. L. 101–508, § 4601(a)(3)(A), substituted “1396a(a)(10)(A)(i)(III), 1396a(a)(10)(A)(i)(IV), 1396a(a)(10)(A)(i)(V), 1396a(a)(10)(A)(i)(VI), 1396a(a)(10)(A)(i)(VII)” for “1396a(a)(10)(A)(i)(IV), 1396a(a)(10)(A)(i)(VI)”.

Subsec. (i)(8). Puspan. L. 101–508, § 4711(c)(2), inserted “(A)” after “medical assistance” and added cl. (B).

Subsec. (i)(10). Puspan. L. 101–508, § 4701(span)(2), added par. (10) relating to any amount expended for medical assistance for care or services.

Puspan. L. 101–508, § 4401(a)(1), added par. (10) relating to covered outpatient drugs.

Subsec. (i)(11). Puspan. L. 101–508, § 4801(e)(16)(A), added par. (11).

Subsec. (i)(12). Puspan. L. 101–508, § 4752(a)(2), added par. (12).

Subsec. (i)(14). Puspan. L. 101–508, § 4752(e), added par. (14).

Subsec. (m)(1)(A). Puspan. L. 101–508, § 4751(span)(1), inserted “meets the requirement of section 1396a(w) of this title” after “State, which” and “meets the requirement of section 1396a(a) of this title and” after “or which”.

Subsec. (m)(2)(A)(i). Puspan. L. 101–508, § 4732(d)(1), struck out “(or the State as authorized by paragraph (3))” after “the Secretary”.

Subsec. (m)(2)(A)(ix). Puspan. L. 101–508, § 4704(span)(1), added cl. (ix).

Subsec. (m)(2)(A)(x). Puspan. L. 101–508, § 4731(a), added cl. (x).

Subsec. (m)(2)(A)(xi). Puspan. L. 101–508, § 4752(span)(1), added cl. (xi).

Subsec. (m)(2)(B). Puspan. L. 101–508, § 4704(span)(2), inserted “except with respect to clause (ix) of subparagraph (A),” after “Subparagraph (A)”.

Subsec. (m)(2)(D). Puspan. L. 101–508, § 4732(a), struck out “(i) special circumstances warrant such modification or waiver, and (ii)” after “the Secretary determines that”.

Subsec. (m)(2)(F)(i). Puspan. L. 101–508, § 4732(span)(2), substituted “(G),” for “(G) or” and inserted at end “or with an eligible organization with a contract under section 1395mm of this title which meets the requirement of subparagraph (A)(ii), or”.

Subsec. (m)(2)(H). Puspan. L. 101–508, § 4732(c), added subpar. (H).

Subsec. (m)(3). Puspan. L. 101–508, § 4732(d)(2), struck out par. (3) which read as follows: “A State may, in the case of an entity which has submitted an application to the Secretary for determination that it is a health maintenance organization within the meaning of paragraph (1) and for which no such determination has been made within 90 days of the submission of the application, make a provisional determination for the purposes of this subchapter that such entity is such a health maintenance organization. Such provisional determination shall remain in force until such time as the Secretary makes a determination regarding the entity’s qualification under paragraph (1).”

Subsec. (m)(5)(A)(v). Puspan. L. 101–508, § 4731(span)(2), added cl. (v).

Subsec. (u)(1)(D)(iv). Puspan. L. 101–508, § 4402(span), which directed amendment of subpar. (C)(iv) by inserting before period at end “or with respect to payments made in violation of section 1396e of this title”, was executed to subpar. (D)(iv) to reflect the probable intent of Congress because subpar. (C) does not have a cl. (iv).

1989—Subsec. (a)(2)(B). Puspan. L. 101–239, § 6901(span)(5)(A), inserted “(including the costs for nurse aides to complete such competency evaluation programs)” after “1396r(e)(1) of this title” and “(or, for calendar quarters beginning on or after July 1, 1988, and before July 1, 1990, the lesser of 90 percent or the Federal medical assistance percentage plus 25 percentage points)” after “50 percent”.

Subsec. (f)(4). Puspan. L. 101–239, § 6401(span), inserted “1396a(a)(10)(A)(i)(VI),” after “1396a(a)(10)(A) (i)(IV),”.

Subsec. (i)(2). Puspan. L. 101–239, § 6411(d)(2), inserted “, not including items or services furnished in an emergency room of a hospital” after “emergency item or service”.

Subsec. (i)(5). Puspan. L. 101–234 repealed Puspan. L. 100–360, § 202(h)(2), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, see 1988 Amendment note below.

1988—Subsec. (a)(1). Puspan. L. 100–360, § 301(f), amended Puspan. L. 99–509, § 9403(g)(2), see 1986 Amendment note below.

Subsec. (c). Puspan. L. 100–360, § 411(k)(13)(A), added subsec. (c).

Subsec. (f)(2). Puspan. L. 100–360, § 411(k)(10)(G)(ii), amended Puspan. L. 100–203, § 4118(h)(1), see 1987 Amendment note below.

Subsec. (f)(4). Puspan. L. 100–360, § 302(e)(4), inserted “1396a(a)(10)(A)(i)(IV),” before “1396a(a)(10)(A)(ii)(IX)” in introductory provisions.

Subsec. (i)(2)(A). Puspan. L. 100–360, § 411(k)(10)(D), as amended by Puspan. L. 100–485, § 608(d)(26)(K)(ii), added Puspan. L. 100–203, § 4118(e)(11)(A), see 1987 Amendment note below.

Subsec. (i)(2)(B). Puspan. L. 100–360, § 411(k)(10)(D), as amended by Puspan. L. 100–485, § 608(d)(26)(K)(ii), added Puspan. L. 100–203, § 4118(e)(11)(B), see 1987 Amendment note below.

Subsec. (i)(3). Puspan. L. 100–360, § 411(k)(6)(B)(x), added Puspan. L. 100–203, § 4112(span), see 1987 Amendment note below.

Subsec. (i)(5). Puspan. L. 100–360, § 202(h)(2), substituted “section 1395y(c)(1)” for “section 1395y(c)”.

Subsec. (i)(9). Puspan. L. 100–360, § 302(c)(3), added par. (9).

Subsec. (m)(2)(B)(i)(II). Puspan. L. 100–485, § 608(f)(4), substituted “1396a(a)(10)(D) of this title” for “1396a(a)(13)(A)(ii) of this title”.

Subsec. (m)(2)(F). Puspan. L. 100–360, § 411(k)(7)(D), repealed Puspan. L. 100–203, § 4113(d)(1), see 1987 Amendment note below.

Puspan. L. 100–360, § 411(a)(3)(A), (B)(iii), (k)(7)(A), amended Puspan. L. 100–203, § 4113(a)(1)(B), see 1987 Amendment note below.

Subsec. (m)(5). Puspan. L. 100–360, § 411(k)(12)(A), amended par. (5) generally. Prior to amendment, par. (5) read as follows:

“(A) Any entity with a contract under this subsection that fails substantially to provide medically necessary items and services that are required (under law or such contract) to be provided to individuals covered under such contract, if the failure has adversely affected (or has a substantial likelihood of adversely affecting) these individuals, is subject to a civil money penalty of not more than $10,000 for each such failure.

“(B) The provisions of section 1320a–7a of this title (other than subsection (a)) shall apply to a civil money penalty under subparagraph (A) in the same manner as they apply to a civil money penalty under that section.”

1987—Subsec. (a)(1). Puspan. L. 100–203, § 4211(g)(2), substituted “and (j)” for “, (h), and (j)”.

Subsec. (a)(2)(A) to (C). Puspan. L. 100–203, § 4211(d)(1), designated existing provisions as subpar. (A) and added subpars. (B) and (C).

Subsec. (a)(2)(D). Puspan. L. 100–203, § 4212(c)(1), added subpar. (D).

Subsec. (a)(3)(C). Puspan. L. 100–203, § 4113(span)(3), inserted “or by an entity which meets the requirements of section 1320c–1 of this title, as determined by the Secretary,” after “organization”.

Subsec. (a)(7). Puspan. L. 100–203, § 4212(e)(2), inserted “subject to section 1396r(g)(3)(B) of this title,” after “(7)”.

Subsec. (f)(2). Puspan. L. 100–203, § 4118(h)(1), as amended by Puspan. L. 100–360, § 411(k)(10)(G)(ii), substituted “(whether in the form of insurance premiums or otherwise and regardless of whether such costs are reimbursed under another public program of the State or political subdivision thereof)” for “(whether in the form of insurance premiums or otherwise)”.

Subsec. (f)(4). Puspan. L. 100–203, § 4118(p)(5), inserted “, 1396a(a)(10)(A)(ii)(X), or 1396d(p)(1)” after “1396a(a)(10)(A)(ii)(IX)”.

Subsec. (g)(1). Puspan. L. 100–203, § 4212(d)(1)(A), substituted “or services in an intermediate care facility for the mentally retarded” for first reference to “or intermediate care facility services”, struck out “, skilled nursing facility services for 30 days,” after first reference to “60 days”, substituted “or services in an intermediate care facility for the mentally retarded” for “, skilled nursing facility services, or intermediate care facility services”, and substituted “and intermediate care facilities for the mentally retarded” for “, skilled nursing facilities, and intermediate care facilities”.

Subsec. (g)(4)(B). Puspan. L. 100–203, § 4212(d)(1)(B), substituted “and intermediate care facilities for the mentally retarded” for “, skilled nursing facilities, and intermediate care facilities”.

Subsec. (g)(6)(B) to (D). Puspan. L. 100–203, § 4212(d)(1)(C), redesignated subpar. (C) as (B) and substituted “services in an intermediate care facility for the mentally retarded” for “intermediate care facility services”, redesignated subpar. (D) as (C), and struck out former subpar. (B) which read as follows: “Such recertifications in the case of skilled nursing facility services shall be conducted at least—

“(i) 30 days after the date of the initial certification,

“(ii) 60 days after the date of the initial certification,

“(iii) 90 days after the date of the initial certification, and

“(iv) every 60 days thereafter.”

Subsec. (g)(7). Puspan. L. 100–203, § 4212(d)(1)(D), struck out par. (7) which read as follows: “It is the duty and responsibility of the Secretary to assure that standards which govern the provision of care in skilled nursing facilities and intermediate care facilities under plans approved under this subchapter, and the enforcement of such standards, are adequate to protect the health and safety of residents and to promote the effective and efficient use of public moneys.”

Subsec. (h). Puspan. L. 100–203, § 4211(g)(1), struck out subsec. (h) which related to reduction by Secretary of amount otherwise considered as expenditures under State plan where reasonable cost differential between statewide average cost of skilled nursing facility services and statewide average cost of intermediate care facility services does not exist for any calendar quarter beginning after June 30, 1973.

Subsec. (i). Puspan. L. 100–203, § 4118(d)(1)(B), inserted sentence at end that nothing in par. (1) be construed as permitting a State to provide services under its plan under this subchapter that are not reasonable in amount, duration, and scope to achieve their purpose.

Subsec. (i)(1). Puspan. L. 100–203, § 4118(d)(1)(A), substituted “; or” for period at end.

Subsec. (i)(2). Puspan. L. 100–93, § 8(g), amended par. (2) generally. Prior to amendment, par. (2) read as follows: “with respect to any amount paid for services furnished under the plan after December 31, 1972, by a provider or other person during any period of time, if payment may not be made under subchapter XVIII of this chapter with respect to services furnished by such provider or person during such period of time solely by reason of a determination by the Secretary under section 1395y(d)(1) of this title or under clause (D), (E), or (F) of section 1395cc(span)(2) of this title, or by reason of noncompliance with a request made by the Secretary under clause (C)(ii) of such section 1395cc(span)(2) or under section 1396a(a)(38) of this title; or”.

Subsec. (i)(2)(A). Puspan. L. 100–203, § 4118(e)(11)(A), as added by Puspan. L. 100–360, § 411(k)(10)(D), as amended by Puspan. L. 100–485, § 608(d)(26)(K)(ii), substituted “under subchapter V, XVIII, or XX or under this subchapter pursuant to section 1320a–7, 1320a–7a, 1320c–5, or 1395u(j)(2) of this title” for “in the State plan under this subchapter pursuant to section 1320a–7 of this title or section 1320a–7a of this title”.

Subsec. (i)(2)(B). Puspan. L. 100–203, § 4118(e)(11)(B), as added by Puspan. L. 100–360, § 411(k)(10)(D), as amended by Puspan. L. 100–485, § 608(d)(26)(K)(ii), substituted “from participation under subchapter V, XVIII, or XX or under this subchapter pursuant to section 1320a–7, 1320a–7a, 1320c–5, or 1395u(j)(2) of this title” for “pursuant to section 1320a–7 of this title or section 1320a–7a of this title from participation in the program under this subchapter”.

Subsec. (i)(3). Puspan. L. 100–203, § 4112(span), as added by Puspan. L. 100–360, § 411(k)(6)(B)(x), inserted “(other than amounts attributable to the special situation of a hospital which serves a disproportionate number of low income patients with special needs)” before “to the extent”.

Subsec. (i)(4). Puspan. L. 100–203, § 4211(i), struck out “or skilled nursing facility” after “hospital” in three places.

Subsec. (i)(8). Puspan. L. 100–203, § 4213(span)(2), added par. (8).

Subsec. (m)(2)(F). Puspan. L. 100–203, § 4113(d)(1), which directed the substitution of “subparagraphs (E) or (G)” for “subparagraph (G)”, was repealed by Puspan. L. 100–360, § 411(k)(7)(D).

Puspan. L. 100–203, § 4113(a)(1)(B), as amended by Puspan. L. 100–360, § 411(a)(3)(A), (B)(iii), (k)(7)(A), substituted “(F) In the case of—” and cls. (i) and (ii) for “(F) In the case of a contract with an entity described in subparagraph (G) or with a qualified health maintenance organization (as defined in section 300e–9(d) of this title) which meets the requirement of subparagraph (A)(ii),”.

Subsec. (m)(6). Puspan. L. 100–203, § 4113(a)(1)(A), added par. (6).

Subsec. (n). Puspan. L. 100–93, § 8(h)(1), struck out subsec. (n) which related to State agency action upon disclosure or failure to disclose required information by institution, organization, etc.

Subsec. (r). Puspan. L. 100–203, § 4212(c)(2), substituted “paragraphs (2)(A)” for “paragraphs (2)” in pars. (1)(A), (C) and (2)(A), (C).

1986—Subsec. (a)(1). Puspan. L. 99–509, § 9403(g)(2), as amended by Puspan. L. 100–360, § 301(f), inserted “including expenditures for medicare cost-sharing and” before “including expenditures”.

Subsec. (a)(3)(C). Puspan. L. 99–509, § 9431(span)(2), inserted “or quality review” after “medical and utilization review”.

Subsec. (a)(4). Puspan. L. 99–603 added par. (4).

Subsec. (d)(2). Puspan. L. 99–272, § 9512(a), designated first sentence as subpar. (A), designated second sentence as subpar. (B), properly indented and aligned below subpar. (A), and added subpars. (C) and (D).

Subsec. (f)(4). Puspan. L. 99–509, § 9401(e)(2), inserted “for any individual described in section 1396a(a)(10)(A)(ii)(IX) of this title or” after “as medical assistance”.

Subsec. (i)(1). Puspan. L. 99–272, § 9507(a), added par. (1).

Subsec. (m)(2)(A). Puspan. L. 99–272, § 9517(a)(1), substituted “subparagraphs (B), (C), and (G)” for “subparagraphs (B) and (C)” in introductory text.

Puspan. L. 99–272, § 9517(c)(1), inserted “(including a health insuring organization)” after “any entity” and “(directly or through arrangements with providers of services)” after “responsible for the provision” in introductory text.

Subsec. (m)(2)(A)(iii). Puspan. L. 99–509, § 9434(a)(2), inserted before the semicolon “and under which the Secretary must provide prior approval for contracts providing for expenditures in excess of $100,000”.

Subsec. (m)(2)(A)(viii). Puspan. L. 99–509, § 9434(a)(1)(A), added cl. (viii).

Subsec. (m)(2)(F). Puspan. L. 99–514, § 1895(c)(2), substituted “In the case” for “in the case”.

Puspan. L. 99–272, § 9517(a)(2), struck out designation “(i)” at beginning of subpar. (F), substituted “in the case of a contract with an entity described in subparagraph (G) or with a qualified health maintenance organization (as defined in section 300e–9(d) of this title) which meets the requirement of subparagraph (A)(ii)” for “In the case of a contract with a health maintenance organization described in clause (ii)”, substituted “such entity or organization” for “such organization”, and struck out cl. (ii) which defined a health maintenance organization.

Subsec. (m)(2)(G). Puspan. L. 99–272, § 9517(a)(3), added subpar. (G).

Subsec. (m)(4). Puspan. L. 99–509, § 9434(a)(1)(B), added par. (4).

Subsec. (m)(5). Puspan. L. 99–509, § 9434(span), added par. (5).

Subsec. (r)(1)(B). Puspan. L. 99–272, § 9518(a), substituted “September 30, 1985” for “the earlier of (i) September 30, 1982, or (ii) the last day of the sixth month following the date specified for operation of such systems in the State’s most recently approved advance planning document submitted before October 7, 1980”.

Subsec. (r)(4)(A). Puspan. L. 99–272, § 9503(span)(2), substituted “once every three years” for “once each fiscal year” and inserted at end “Reviews may, at the Secretary’s discretion, constitute reviews of the entire system or of only those standards, systems requirements, and other conditions which have demonstrated weakness in previous reviews.”

Subsec. (r)(6)(J). Puspan. L. 99–272, § 9503(span)(1), amended subpar. (J) generally. Prior to amendment, subsec. (J) read as follows: “report on or before October 1, 1981, to the Congress on the extent to which States have developed and operated effective mechanized claims processing and information retrieval systems.”

Subsec. (u)(1)(D)(iv). Puspan. L. 99–272, § 9503(f), added cl. (iv).

Subsec. (u)(1)(D)(v). Puspan. L. 99–509, § 9407(c), added cl. (v).

Subsec. (v). Puspan. L. 99–509, § 9406(a), added subsec. (v).

1984—Subsec. (g)(1). Puspan. L. 98–369, § 2363(a)(2)(A), (B), in provision preceding subpar. (A), substituted “inpatient hospital services or intermediate care facility services for 60 days, skilled nursing facility services for 30 days, or inpatient mental hospital services for” for “care as an inpatient in a hospital (including an institution for tuberculosis), skilled nursing facility or intermediate care facility on 60 days, or in a hospital for mental diseases on”, and struck out “which for purposes of this section means the four calendar quarters ending with June 30,” before “the Federal medical assistance percentage”, and struck out “in the same fiscal year” before “shall be decreased by a per centum thereof”.

Puspan. L. 98–369, § 2363(a)(2)(C), substituted “, skilled nursing facility services, or intermediate care facility services furnished beyond 60 days (or inpatient mental hospital services furnished beyond 90 days), such State has an effective program of medical review of the care of patients in mental hospitals, skilled nursing facilities, and intermediate care facilities pursuant to paragraphs (26) and (31) of section 1396a(a) of this title whereby the professional management of each case is reviewed and evaluated at least annually by independent professional review teams” for “(including tuberculosis hospitals), skilled nursing facility services, or intermediate care facility services furnished beyond 60 days (or inpatient mental hospital services furnished beyond 90 days), there is in operation in the State an effective program of control over utilization of such services; such a showing must include evidence that—” and former subpars. (A) through (D) requirement for evidence concerning an effective program of utilization of certain medical services.

Subsec. (g)(4)(B). Puspan. L. 98–369, § 2373(span)(11), substituted “paragraphs (26)” for “paragraph (26)” and “diligence” for “deligence”.

Subsec. (g)(6). Puspan. L. 98–369, § 2363(a)(4), in amending par. (6) generally, substituted provisions relating to recertifications for provisions relating to reports to Congress concerning Secretary’s determination and review of showing respecting any decrease of Federal medical assistance percentage of amounts paid for services.

Subsec. (g)(7). Puspan. L. 98–369, § 2363(span), as amended by Puspan. L. 98–617, § 3(a)(6), added par. (7).

Subsec. (i)(7). Puspan. L. 98–369, § 2303(g)(2), added par. (7).

Subsec. (m)(2)(A)(vi). Puspan. L. 98–369, § 2364(1), inserted “except as provided under subparagraph (F),” after “(I)”.

Subsec. (m)(2)(B)(i)(I). Puspan. L. 98–369, § 2373(span)(12)(A), (C), struck out “(II)” before “for the period” and substituted “period” for “peroid”.

Subsec. (m)(2)(B)(i)(II). Puspan. L. 98–369, § 2373(span)(12)(B), substituted “of section 1396d(a) of this title” for “of such section”.

Subsec. (m)(2)(C). Puspan. L. 98–369, § 2373(span)(13), realigned margin of subpar. (C).

Subsec. (m)(2)(E), (F). Puspan. L. 98–369, § 2364(2), added subpars. (E) and (F).

Subsec. (s)(3)(B). Puspan. L. 98–369, § 2373(span)(14), substituted “non-Federal” for “nonfederal”.

1983—Subsec. (t)(3). Puspan. L. 97–448 substituted “purposes” for “purpose” and “the lower of the Federal medical assistance percentage for the State in effect for fiscal year 1981, or the Federal medical assistance percentage for the State in effect for fiscal year 1982” for “the Federal medical assistance percentage for States in effect for fiscal year 1981, disregarding any change in such percentage after fiscal year 1981”.

1982—Subsec. (a)(3)(C). Puspan. L. 97–248, § 146(span), substituted “utilization and quality control peer review organization” for “Professional Standards Review Organization”.

Subsec. (f)(3). Puspan. L. 97–248, § 137(g), struck out “(without regard to section 608 of this title)” after “consisting of one person if such plan”.

Subsec. (g)(1). Puspan. L. 97–248, § 137(span)(11), inserted “or which is a qualified health maintenance organization (as defined in section 300e–9(d) of this title)”.

Subsec. (g)(1)(A). Puspan. L. 97–248, § 137(span)(12), substituted “provided in an institution for the mentally retarded” for “described in section 1396d(d) of this title”.

Subsec. (k). Puspan. L. 97–248, § 137(span)(13), substituted “subsection (m) of this section” for “section 1395mm of this title”.

Subsec. (m)(2)(A). Puspan. L. 97–248, § 137(span)(14), substituted “or” for “and” before “(II)” in cl. (iv), and substituted “unforeseen” for “unforseen” in cl. (vii)(II).

Subsec. (s). Puspan. L. 97–248, § 137(a)(2), amended directory language of Puspan. L. 97–35, § 2161(c)(1), to correct an error, and did not involve any change in text. See 1981 Amendment note below.

Subsec. (s)(1)(A). Puspan. L. 97–248, § 137(span)(15)(A), (B), in provisions following cl. (iii), substituted “fiscal year 1982” for “fiscal year 1981”, and “subsections (a)(6) and (t) of this section, without regard to payments for claims relating to expenditures made for medical assistance for services received through a facility of the Indian Health Service,” for “subsection (t) of this section”.

Subsec. (s)(1)(C). Puspan. L. 97–248, § 137(span)(15)(C), inserted “a program in operation under”, before “a plan approved”.

Subsec. (s)(3)(D). Puspan. L. 97–248, § 137(span)(15)(D), substituted “must determine that” for “determines that”, “most recent year (which shall consist of a 12-month period determined by the Secretary for this purpose)” for “most recent calendar year”, and “2- or 3-year period” for “2 or 3 calendar year period”, and struck out “calendar” wherever appearing.

Subsec. (s)(4)(B). Puspan. L. 97–248, § 137(span)(15)(E), inserted “and paragraph (3)(D)”.

Subsec. (s)(5)(A)(i). Puspan. L. 97–248, § 137(span)(15)(F), inserted “(including amounts saved, to the extent such amounts can be documented to the satisfaction of the Secretary, by reason of the suspension or termination of a provider or other person for fraud or abuse, but only during the period of such suspension or termination or, if shorter, the 1-year period beginning on the date of such termination or suspension)” after “recovered or diverted”.

Subsec. (s)(5)(B). Puspan. L. 97–248, § 137(span)(27), inserted “or quarters” after “carried forward to the following quarter”.

Subsec. (t). Puspan. L. 97–248, § 137(a)(1), (2), amended directory language of Puspan. L. 97–35, § 2161(span), (c)(2), to correct an error, and did not involve any change in text. See 1981 Amendment note below.

Subsec. (t)(1)(A). Puspan. L. 97–248, § 137(span)(16)(A), substituted “payments under subsection (a)(6) of this section, interest paid under subsection (d)(5) of this section, and payments for claims relating to expenditures made for medical assistance for services received through a facility of the Indian Health Service” for “interest paid under subsection (d)(5) of this section”.

Subsec. (t)(1)(B). Puspan. L. 97–248, § 137(span)(16)(B), (D), substituted “Consumer Price Index for all urban consumers (U.S. city average) published by the Bureau of Labor Statistics” for “consumer price index for all urban consumers (published by the Bureau of Labor Statistics)” and “for the 12-month period ending on September 30, 1983” for “between September 1982 and September 1983”.

Subsec. (t)(1)(C). Puspan. L. 97–248, § 137(span)(16)(C), (D), substituted “Consumer Price Index for all urban consumers (U.S. city average) published by the Bureau of Labor Statistics” for “consumer price index for all urban consumers (published by the Bureau of Labor Statistics)” and “for the 24-month period ending on September 30, 1984” for “between September 1982 and September 1984”.

Subsec. (t)(2)(A). Puspan. L. 97–248, § 137(span)(16)(A), substituted “payments under subsection (a)(6) of this section, interest paid under subsection (d)(5) of this section, and payments for claims relating to expenditures made for medical assistance for services received through a facility of the Indian Health Service” for “interest paid under subsection (d)(5) of this section”.

Subsec. (t)(3). Puspan. L. 97–248, § 137(span)(16)(E), substituted “for fiscal years 1982, 1983, and 1984” for “for fiscal year 1984” wherever appearing, “years 1983, 1984, and 1985, respectively” for “year 1985”, “in effect for fiscal year 1981” for “in effect for fiscal year 1983”, and “after fiscal year 1981” for “between fiscal year 1983 and fiscal year 1984”.

Subsec. (u). Puspan. L. 97–248, § 133(a), added subsec. (u).

1981—Subsec. (a)(3)(B). Puspan. L. 97–35, § 2113(n), substituted “and” for “plus” at the end of subpar. (B) and added subpar. (C).

Subsec. (d)(5). Puspan. L. 97–35, § 2163, substituted “determination at a rate” for “determination (but not to exceed a period of twelve months with respect to disallowances made prior to October 1, 1981, or six months with respect to disallowances made thereafter) at a rate”.

Subsec. (e). Puspan. L. 97–35, § 2101(a)(2), added subsec. (e).

Subsec. (g)(1)(A). Puspan. L. 97–35, § 2183(a), inserted “and the physician, or a physician assistant or nurse practitioner under the supervision of a physician” and “or, in the case of services that are intermediate care facility services described in section 1396d(d) of this title, every year” in parenthetical text.

Subsec. (i)(1). Puspan. L. 97–35, § 2174(span), struck out par. (1) which provided that payments shall not be made with respect to any amount paid for items or services furnished under the plan after Dec. 31, 1972, to the extent that such amount exceeds the charge which would be determined to be reasonable for such items or services under fourth and fifth sentences of section 1395u(span)(3) of this title.

Subsec. (i)(5). Puspan. L. 97–35, § 2103(span)(1), added par. (5).

Subsec. (i)(6). Puspan. L. 97–35, § 2164(a), added par. (6).

Subsec. (m)(1)(A). Puspan. L. 97–35, § 2178(a)(1), redefined “Health Maintenance Organization” substantially, and substituted reference to public and private organizations making services to individuals eligible for benefits under this subchapter and which makes adequate provision against the risk of insolvency for reference to a legal entity which provides health services to individuals enrolled in such organization and providing services and benefits to individuals eligible for benefits under specified provisions of this subchapter.

Subsec. (m)(2)(A). Puspan. L. 97–35, § 2178(a)(2), in cl. (ii), substituted “75 percent of the membership of the entity which is enrolled on a prepaid basis” for “one-half of the membership of the entity”, and added cls. (iii) to (vii).

Subsec. (m)(2)(D). Puspan. L. 97–35, § 2178(a)(3), added subpar. (D).

Subsec. (n). Puspan. L. 97–35, § 2106(span)(3), struck out “of this section” after “section 1395cc of this title” thereby perfecting the amendment made by Puspan. L. 96–499, § 905(c)(2).

Subsec. (s). Puspan. L. 97–35, § 2161(c)(1), as amended by Puspan. L. 97–248, § 137(a)(2), repealed subsec. (s) which provided for reduction in medicaid payments to States, limitations on reductions, States included, and percentage reductions reduced under certain circumstances. See Effective Date of 1981 Amendment note below.

Puspan. L. 97–35, § 2161(a), added subsec. (s).

Subsec. (t). Puspan. L. 97–35, § 2161(c)(2), as amended by Puspan. L. 97–248, § 137(a)(2), repealed subsec. (t) which provided for offset for meeting Federal medicaid expenditure targets, and computation for meeting expenditure targets. See Effective Date of 1981 Amendment note below.

Puspan. L. 97–35, § 2161(span), as amended by Puspan. L. 97–248, § 137(a)(1), added subsec. (t).

1980—Subsec. (a)(1). Puspan. L. 96–499, § 905(span), inserted reference to subsection (j) of this section.

Subsec. (a)(6). Puspan. L. 96–499, § 963, substituted “such a quarter within the twelve-quarter period beginning with the first quarter in which a payment is made to the State pursuant to this paragraph, and (B) 75 per centum of the sums expended during each succeeding calendar quarter” for “each quarter beginning on or after October 1, 1977, and ending before October 1, 1980”.

Subsec. (d)(5). Puspan. L. 96–499, § 961(a), added par. (5).

Subsec. (g)(3)(B). Puspan. L. 96–499, § 964, substituted “January 1, 1978” for “October 1, 1977” and “any calendar quarter ending on or before December 31, 1978” for “the calendar quarter ending on December 31, 1977”.

Subsec. (j). Puspan. L. 96–499, § 905(c)(1), substituted provisions relating to the adjustment of amounts determined under subsec. (a)(1) of this section in accordance with section 1396m of this title for provisions relating to orders for suspension of payment.

Subsec. (n). Puspan. L. 96–499, § 905(c)(2), struck out “or is subject to a suspension of payment order issued under subsection (j)” after “section 1395cc of this title”.

Subsec. (r). Puspan. L. 96–398 added subsec. (r).

1979—Subsec. (m)(2)(C). Puspan. L. 96–79 substituted “the date the entity qualifies as a health maintenance organization (as determined by the Secretary)” for “the date the entity enters into a contract with the State under this subchapter for the provision of health services on a prepaid risk basis”.

1978—Subsec. (m)(1)(B). Puspan. L. 95–559 struck out “shall be administered through the Assistant Secretary for Health and in the Office of the Assistant Secretary for Health, and the administration of such duties and functions” after “subparagraph (A),”.

Subsec. (m)(2)(B)(i)(I). Puspan. L. 95–626 substituted “section 254span(d)(1)(A)” for “section 247d(d)(1)(A)”.

1977—Subsec. (a)(3)(B). Puspan. L. 95–142, § 10(a), inserted provisions relating to notice to individuals in a sample group and provisions exempting notice respecting confidential services from notice requirements.

Subsec. (a)(6), (7). Puspan. L. 95–142, § 17(a), added par. (6) and redesignated former par. (6) as (7).

Subsec. (span)(3). Puspan. L. 95–142, § 17(span), added par. (3).

Subsec. (g). Puspan. L. 95–142, § 20(a), in par. (1) substituted “Subject to paragraph (3), with respect to” for “With respect to” and “by a per centum thereof (determined under paragraph (5))” for “by 33⅓ per centum thereof”, in par. (2) inserted “timely” before “sample onsite surveys”, and added pars. (3) to (6).

Subsec. (i)(2). Puspan. L. 95–142, § 3(c)(2), inserted provisions relating to noncompliance under sections 1395cc(span)(2) and 1396a(a)(38) of this title.

Subsec. (m)(2)(A). Puspan. L. 95–83, § 105(a)(1), in revising text, incorporated former cl. (i) (I) and (II) provisions in introductory text relating to responsibility for providing inpatient hospital services and other described services, substituting “capitation basis” for “capitation risk basis” and inserting “unless”; redesignated as cl. (i) former cl. (ii), substituting “has determined that the entity is a health maintenance organization” for “has not determined to be a health maintenance organization”; and redesignated as cl. (ii) former cl. (iii), substituting “less than one-half of the membership of the entity consists of individuals who (I) are insured for benefits under part B of subchapter XVIII of this chapter or for benefits under both parts A and B of such subchapter, or (II) are eligible to receive benefits under this subchapter” for “more than one-half of the membership of which consists of individuals who are insured under parts A and B of subchapter XVIII of this chapter or recipients of benefits under this subchapter.”

Subsec. (m)(2)(C). Puspan. L. 95–83, § 105(a)(2), substituted reference to subpar. “(A)(ii)” for “(A)(iii)” wherever appearing.

Subsec. (n). Puspan. L. 95–142, § 8(c), added subsec. (n).

Subsecs. (o), (p). Puspan. L. 95–142, § 11(a), added subsecs. (o) and (p).

Subsec. (q). Puspan. L. 95–142, § 17(c), added subsec. (q).

1976—Subsec. (l). Puspan. L. 94–552 repealed subsec. (l) which provided for reduction of amount of payments to States found not to be in compliance with section 1396a(g) of this title.

Subsec. (m). Puspan. L. 94–460 added subsec. (m).

1975—Subsec. (g)(1)(C). Puspan. L. 94–182, § 110(a), inserted provisions specifying the method by which the size and composition of the sample of admissions subject to review is to be established.

Subsec. (l). Puspan. L. 94–182, § 111(span), added subsec. (l).

1973—Subsec. (a). Puspan. L. 93–233, § 18(x)(5), struck out reference to section 1317 of this title in introductory parenthetical phrase.

Subsec. (a)(1). Puspan. L. 93–233, §§ 13(a)(11), 18(r)(1), substituted “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 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” for “individuals who are recipients of money payments under a State plan approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV of this chapter” and inserted “and disabled individuals entitled to hospital insurance benefits under subchapter XVIII of this chapter,” after “individuals sixty-five years of age or older”.

Subsec. (a)(4). Puspan. L. 93–233, § 18(s), substituted “sums expended with respect to costs incurred” for “sums expended”.

Subsec. (a)(5). Puspan. L. 93–233, § 18(t), struck out “(as found necessary by the Secretary for the proper and efficient administration of the plan)” after “such quarter”.

Subsec. (span). Puspan. L. 93–233, §§ 18(r)(2), (u), (x)(6), inserted in par. (2) after “individuals sixty-five years of age or older” text reading “and disabled individuals entitled to hospital insurance benefits under subchapter XVIII” and end text reading “, other than amounts expended under provisions of the plan of such State required by section 1396a(a)(34) of this title,” and redesignated pars. (2) and (3) as (1) and (2), respectively.

Subsec. (c). Puspan. L. 93–233, § 18(y)(1)(A), struck out subsec. (c) which provided for Federal medical assistance percentage and Federal share of State medical expenses during fiscal year ending June 30, 1965.

Subsec. (d)(1). Puspan. L. 93–233, § 18(y)(1)(B), struck out reference to subsec. (c) of this section.

Subsec. (f)(4). Puspan. L. 93–233, § 13(a)(12), in subpar. (A), made payment limitations inapplicable to individual with respect to whom supplemental security income benefits are being paid under subchapter XVI of this chapter; in subpar. (B), made payment limitations inapplicable to individual with respect to whom such benefits are not being paid, and in cls. (i) and (ii) inserted “to have such benefits paid with respect to him”, and added subpar. (C).

Subsec. (g)(1)(C). Puspan. L. 93–233, § 18(v), substituted “directly responsible for the care of the patient or financially interested in any such institution or, except in the case of hospitals, employed by the institution” for “directly responsible for the care of the patient and who are not employed by or financially interested in any such institution”.

Subsec. (j). Puspan. L. 93–66 struck out provisions respecting skilled nursing facility services and intermediate care facility services.

1972—Subsec. (a)(1). Puspan. L. 92–603, § 207(a)(2), inserted reference to subsecs. (g) and (h) and of this section.

Subsec. (a)(3). Puspan. L. 92–603, § 235(a), added par. (3). Former par. (3) redesignated (4).

Subsec. (a)(4). Puspan. L. 92–603, § 249B, temporarily added par. (4) which provided for payments to States of 100 per centum of sums expended for costs incurred during a quarter attributable to compensation or training of personnel responsible for inspecting public or private institutions providing long-term care to recipients of medical assistance to determine compliance with health or safety standards. Former par. 4 redesignated (5). See Effective Date of 1972 Amendment note below.

Puspan. L. 92–603, § 235(a), redesignated former par. (3) as (4).

Subsec. (a)(5). Puspan. L. 92–603, § 299E(a), added par. (5). Former par. (5) redesignated (6).

Puspan. L. 92–603, § 249B, redesignated former par. (4) as (5).

Subsec. (a)(6). Puspan. L. 92–603, § 299E, redesignated former par. (5) as (6).

Subsec. (span)(1). Puspan. L. 92–603, § 295, struck out par. (1) which related to amount of quarterly expenditures exceeding average of total expenditures for each quarter of fiscal year ending June 30, 1965.

Subsec. (span)(3). Puspan. L. 92–603, § 221(c)(6), added par. (3).

Subsec. (e). Puspan. L. 92–603, § 230, repealed subsec. (e) which related to furnishing for comprehensive care and services by July 1, 1977.

Subsec. (g). Puspan. L. 92–603, §§ 207(a)(1), 278(span)(1), added subsec. (g) and substituted “skilled nursing facility” for “skilled nursing home” and “skilled nursing facilities” for “skilled nursing homes” wherever appearing.

Subsec. (h). Puspan. L. 92–603, §§ 207(a)(1), 278(span)(1)(5), added subsec. (h) and substituted “skilled nursing facility” for “skilled nursing home” wherever appearing.

Subsec. (i). Puspan. L. 92–603, §§ 224(c), 229(c), 233(c), 237(a)(1), 278(span)(7), added subsec. (i) and substituted “skilled nursing facility” for “skilled nursing home” wherever appearing.

Subsec. (j). Puspan. L. 92–603, § 290, added subsec. (j) relating to orders for suspension of payment.

Puspan. L. 92–603, §§ 225, 278(span)(16), added subsec. (j) relating to skilled nursing facilities services, and substituted “skilled nursing facility” for “skilled nursing home” wherever appearing.

Subsec. (k). Puspan. L. 92–603, § 226(e), added subsec. (k).

1969—Subsec. (e). Puspan. L. 91–56 extended from July 1, 1975, to July 1, 1977, the date by which comprehensive care and services for eligible individuals must be made available for a State to be eligible for payments.

1968—Subsec. (a)(1). Puspan. L. 90–248, § 222(d), substituted “and, except in the case of individuals sixty-five years of age or older who are not enrolled under part B of subchapter XVIII of this chapter, other insurance premiums” for “and other insurance premiums”.

Puspan. L. 90–248, § 241(f)(5), struck out “IV,” after “I,” and inserted “or part A of subchapter IV of this chapter,” after “XVI of this chapter,”.

Subsec. (a)(2). Puspan. L. 90–248, § 225(a), substituted “of the State agency or any other public agency” for “of the State agency (or of the local agency administering the State plan in the political subdivision)”.

Subsec. (span). Puspan. L. 90–248, § 222(c), designated existing provisions as par. (1) and added par. (2).

Subsec. (span)(2). Puspan. L. 90–364 substituted “1969” for “1967”.

Subsec. (d)(2). Puspan. L. 90–248, § 229(c), provided for treatment of expenditures for which payments were made to the State under subsec. (a) as an overpayment to the extent that the State or local agency administering the plan has been reimbursed for such expenditures by a third party pursuant to the provisions of its plan in compliance with section 1396a(a)(25) of this title.

Subsec. (f). Puspan. L. 90–248, § 220(a), added subsec. (f).

Statutory Notes and Related Subsidiaries
Change of Name

References to Medicare+Choice deemed to refer to Medicare Advantage or MA, subject to an appropriate transition provided by the Secretary of Health and Human Services in the use of those terms, see section 201 of Puspan. L. 108–173, set out as a note under section 1395w–21 of this title.

Effective Date of 2020 Amendment

Amendment by section 209(a)(3) of Puspan. L. 116–260 effective Dec. 27, 2020, and applicable to transportation furnished on or after such date, see section 209(a)(4) of Puspan. L. 116–260, set out as a note under section 1396a of this title.

Effective Date of 2019 Amendment

Amendment by section 6(a)(2)(A) of Puspan. L. 116–16 effective on Apr. 18, 2019, and applicable to covered outpatient drugs supplied by manufacturers under agreements under section 1396r–8 of this title on or after that date, see section 6(e) of Puspan. L. 116–16, set out as a note under section 1320a–7 of this title.

Puspan. L. 116–16, § 8(span), Apr. 18, 2019, 133 Stat. 864, provided that: “The amendment made by subsection (a) [amending this section] shall apply with respect to items and services furnished on or after January 1, 2020.”

Effective Date of 2018 Amendment

Puspan. L. 115–271, title I, § 1016(c), Oct. 24, 2018, 132 Stat. 3923, provided that: “The amendment made by subsection (a) [amending this section] shall take effect on the date of enactment of this Act [Oct. 24, 2018].”

Effective Date of 2016 Amendment

Puspan. L. 114–255, div. A, title V, § 5008(span), Dec. 13, 2016, 130 Stat. 1197, provided that: “The amendment made by subsection (a) [amending this section] shall apply with respect to calendar quarters beginning on or after the date of the enactment of this Act [Dec. 13, 2016].”

Effective Date of 2010 Amendment

Puspan. L. 111–309, title II, § 205(e), Dec. 15, 2010, 124 Stat. 3290, provided that the amendment made by section 205(e) is effective as if included in the enactment of section 4201(a)(2) of the American Recovery and Reinvestment Act of 2009 (Puspan. L. 111–5).

Amendment by Puspan. L. 111–157 effective as if included in the enactment of the HITECH Act (Puspan. L. 111–5, div. A, title XIII, div. B, title IV), see section 5(span) of Puspan. L. 111–157, set out as a note under section 1395w–4 of this title.

Amendment by section 2004(c)(1) of Puspan. L. 111–148 effective Jan. 1, 2014, see section 2004(d) of Puspan. L. 111–148, set out as an Effective and Termination Dates of 2010 Amendment note under section 1396a of this title.

Puspan. L. 111–148, title II, § 2102(a), Mar. 23, 2010, 124 Stat. 288, provided that the amendment made by section 2102(a)(8) of Puspan. L. 111–148 is effective as if included in the enactment of the Children’s Health Insurance Program Reauthorization Act of 2009 (Puspan. L. 111–3).

Amendment by section 2202(span) of Puspan. L. 111–148 effective Jan. 1, 2014, and applicable to services furnished on or after that date, see section 2202(c) of Puspan. L. 111–148, set out as an Effective and Termination Dates of 2010 Amendment note under section 1396a of this title.

Amendment by section 2303(a)(4)(B), (span)(2)(B) of Puspan. L. 111–148 effective Mar. 23, 2010, and applicable to items and services furnished on or after such date, see section 2303(d) of Puspan. L. 111–148, set out as an Effective and Termination Dates of 2010 Amendment note under section 1396a of this title.

Amendment by section 2402(d)(2)(A) of Puspan. L. 111–148 effective on the first day of the first fiscal year quarter that begins after Mar. 23, 2010, see section 2402(g) of Puspan. L. 111–148, set out as an Effective and Termination Dates of 2010 Amendment note under section 1396a of this title.

Puspan. L. 111–148, title VI, § 6504(span)(2), Mar. 23, 2010, 124 Stat. 777, provided that: “The amendment made by paragraph (1) [amending this section] shall apply with respect to contract years beginning on or after January 1, 2010.”

Puspan. L. 111–148, title VI, § 6506(a)(2), Mar. 23, 2010, 124 Stat. 777, provided that: “The amendments made by this subsection [amending this section] take effect on the date of enactment of this Act [Mar. 23, 2010] and apply to overpayments discovered on or after that date.”

Amendment by sections 6504(a) and 6507 of Puspan. L. 111–148 effective Jan. 1, 2011, without regard to whether final regulations to carry out such amendments and subtitle F (§§ 6501–6508) of title VI of Puspan. L. 111–148 have been promulgated by that date, see section 6508 of Puspan. L. 111–148, set out as an Effective and Termination Dates of 2010 Amendment note under section 1396a of this title.

Effective Date of 2009 Amendment

Amendment by sections 201(span)(2)(A), 214(a), and 401(span) of Puspan. L. 111–3 effective Apr. 1, 2009, and applicable to child health assistance and medical assistance provided on or after that date, with certain exceptions, see section 3 of Puspan. L. 111–3, set out as an Effective Date note under section 1396 of this title.

Amendment by section 211 of Puspan. L. 111–3 effective Jan. 1, 2010, except that amendment by section 211(span)(1)–(3)(A) of Puspan. L. 111–3 effective as if included in the enactment of section 6036 of Puspan. L. 109–171 and amendment by section 211(span)(4) of Puspan. L. 111–3 effective as if included in the enactment of section 405 of Puspan. L. 109–432, with restoration of eligibility and special transition rule for Indians, see section 211(d) of Puspan. L. 111–3, set out as a note under section 1396a of this title.

Effective Date of 2008 Amendment

Puspan. L. 110–379, § 3(span), Oct. 8, 2008, 122 Stat. 4075, provided that:

“(1)In general.—Except as provided in paragraph (2), the amendments made by subsection (a) [amending this section] take effect on October 1, 2009.
“(2)Extension of effective date for state law amendment.—In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet the additional requirements 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 these additional requirements 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 [Oct. 8, 2008]. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.”

Effective Date of 2007 Amendment

Puspan. L. 110–28, title VII, § 7002(span)(2), May 25, 2007, 121 Stat. 188, as amended by Puspan. L. 110–90, § 5, Sept. 29, 2007, 121 Stat. 985, provided that: “The amendments made by paragraph (1) [amending this section] shall apply to prescriptions executed after March 31, 2008.”

[Puspan. L. 110–90, § 5, Sept. 29, 2007, 121 Stat. 985, provided in part that the amendment by section 5 of Puspan. L. 110–90 to section 7002(span)(2) of Puspan. L. 110–28, set out above, is effective as if included in the enactment of section 7002(span) of Puspan. L. 110–28.]

Effective Date of 2006 Amendment

Puspan. L. 109–432, div. B, title IV, § 405(c)(1)(A), Dec. 20, 2006, 120 Stat. 2998, provided that the amendment made by section 405(c)(1)(A) is effective as if included in the amendment made by section 6036(a)(2) of the Deficit Reduction Act of 2005 [Puspan. L. 109–171].

Puspan. L. 109–171, title VI, § 6033(span), Fespan. 8, 2006, 120 Stat. 74, provided that: “The amendments made by subsection (a) [amending this section] take effect on the first day of the first fiscal year quarter that begins after the date of enactment of this Act [Fespan. 8, 2006].”

Puspan. L. 109–171, title VI, § 6036(span), Fespan. 8, 2006, 120 Stat. 81, as amended by Puspan. L. 109–432, div. B, title IV, § 405(c)(2)(A)(v)(I), Dec. 20, 2006, 120 Stat. 3000, provided that: “The amendments made by subsection (a) [amending this section] shall apply to determinations of initial eligibility for medical assistance made on or after July 1, 2006, and to redeterminations of eligibility made on or after such date in the case of individuals for whom the requirement of section 1903(x) of the Social Security Act [42 U.S.C. 1396span(x)], as added by such amendments, was not previously met.”

Puspan. L. 109–171, title VI, § 6043(c), Fespan. 8, 2006, 120 Stat. 88, provided that: “The amendments made by this section [amending this section and section 1396o–1 of this title] shall apply to non-emergency services furnished on or after January 1, 2007.”

Puspan. L. 109–171, title VI, § 6051(span), Fespan. 8, 2006, 120 Stat. 92, provided that:

“(1)In general.—Subject to paragraph (2), the amendment made by subsection (a) [amending this section] shall be effective as of the date of the enactment of this Act [Fespan. 8, 2006].
“(2)Delay in effective date.—
“(A)In general.—Subject to subparagraph (B), in the case of a State specified in subparagraph (B), the amendment made by subsection (a) shall be effective as of October 1, 2009.
“(B)Specified states.—For purposes of subparagraph (A), the States specified in this subparagraph are States that have enacted a law providing for a tax on the services of a Medicaid managed care organization with a contract under section 1903(m) of the Social Security Act [42 U.S.C. 1396span(m)] as of December 8, 2005.”

Amendment by section 6062(c)(1) of Puspan. L. 109–171 applicable to medical assistance for items and services furnished on or after Jan. 1, 2007, see section 6062(d) of Puspan. L. 109–171, set out as a note under section 1396a of this title.

Effective Date of 2005 Amendment

Puspan. L. 109–91, title I, § 104(d), Oct. 20, 2005, 119 Stat. 2093, provided that: “The amendments made by this section [amending this section and sections 1396r–8 and 1396u–5 of this title] shall apply to drugs dispensed on or after January 1, 2006.”

Effective Date of 2004 Amendment

Puspan. L. 108–357, title VII, § 712(d), Oct. 22, 2004, 118 Stat. 1561, provided that: “The amendments made by subsections (a) and (span) [amending this section and section 1396d of this title] take effect on the date of enactment of this Act [Oct. 22, 2004] and apply to medical assistance and services provided under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) on or after that date.”

Effective Date of 2000 Amendments

Amendment by section 702(c)(1) of Puspan. L. 106–554 effective Jan. 1, 2001, and applicable to services furnished on or after such date, see section 1(a)(6) [title VII, § 702(e)] of Puspan. L. 106–554, set out as a note under section 1396a of this title.

Puspan. L. 106–554, § 1(a)(6) [title VII, § 710(span)], Dec. 21, 2000, 114 Stat. 2763, 2763A–578, provided that:

“(1) The amendment made by subsection (a)(1) [amending this section] shall be effective as if included in the enactment of section 121 of the Foster Care Independence Act of 1999 (Public Law 106–169 [amending sections 1396a and 1396d of this title and enacting provisions set out as notes under section 1396a of this title]).
“(2) The amendment made by subsection (a)(2) [amending this section] shall be effective as if included in the enactment of the Breast and Cervical Cancer Prevention and Treatment Act of 2000 (Public Law 106–354).”

Amendment by Puspan. 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 Puspan. L. 106–354, set out as a note under section 1396a of this title.

Effective Date of 1999 Amendment

Amendment by section 201(a)(4), (span) of Puspan. L. 106–170 applicable to medical assistance for items and services furnished on or after Oct. 1, 2000, see section 201(d) of Puspan. L. 106–170, set out as a note under section 1396a of this title.

Puspan. L. 106–170, title IV, § 407(d), Dec. 17, 1999, 113 Stat. 1914, provided that: “The amendments made by this section [amending this section] take effect on the date of the enactment of this Act [Dec. 17, 1999].”

Amendment by section 1000(a)(6) [title VI, § 604(a)(2)(B), (span)(2)] of Puspan. L. 106–113 applicable as of such date as the Secretary of Health and Human Services certifies to Congress that the Secretary is fully implementing section 1396u–2(c)(2) of this title, see section 1000(a)(6) [title VI, § 604(c)(2)] of Puspan. L. 106–113, set out as a note under section 1396a of this title.

Puspan. L. 106–113, div. B, § 1000(a)(6) [title VI, § 608(aa)], Nov. 29, 1999, 113 Stat. 1536, 1501A–398, provided that the amendment made by section 1000(a)(6) [title VI, § 608(aa)(2)] is effective as if included in the enactment of BBA [the Balanced Budget Act of 1997, Puspan. L. 105–33].

Amendment by section 1000(a)(6) [title VI, § 608(e)–(k)] of Puspan. L. 106–113 effective Nov. 29, 1999, see section 1000(a)(6) [title VI, § 608(bspan)] of Puspan. L. 106–113, set out as a note under section 1396a of this title.

Puspan. L. 106–31, title III, § 3031(c), May 21, 1999, 113 Stat. 104, provided that: “This section [amending this section] and the amendments made by this section shall apply to amounts paid to a State prior to, on, or after the date of the enactment of this Act [May 21, 1999].”

Effective Date of 1997 Amendment

Puspan. L. 105–100, title I, § 162, Nov. 19, 1997, 111 Stat. 2188, provided that the amendment made by that section is effective as if included in the enactment of subtitle J (§§ 4901–4923) of title IV of the Balanced Budget Act of 1997, Puspan. L. 105–33.

Puspan. L. 105–33, title IV, § 4710, Aug. 5, 1997, 111 Stat. 506, provided that:

“(a)General Effective Date.—Except as otherwise provided in this chapter [chapter 1 (§§ 4701–4710) of subtitle H of title IV of Puspan. L. 105–33, enacting section 1396u–2 of this title, amending this section and sections 1320a–3, 1320a–7span, 1396a, 1396d, 1396o, 1396r–6, 1396r–8, 1396u–2, and 1396v of this title, and enacting provisions set out as a note under section 1396u–2 of this title] and section 4759 [enacting provisions set out as a note under section 1396a of this title], the amendments made by this chapter shall take effect on the date of the enactment of this Act [Aug. 5, 1997] and shall apply to contracts entered into or renewed on or after October 1, 1997.
“(span)Specific Effective Dates.—Subject to subsection (c) and section 4759—
“(1)PCCM option.—The amendments made by section 4702 [amending this section and sections 1396a and 1396d of this title] shall apply to primary care case management services furnished on or after October 1, 1997.
“(2) 75:25 rule.—The amendments made by section 4703 [amending this section and section 1396r–6 of this title] apply to contracts under section 1903(m) of the Social Security Act (42 U.S.C. 1396span(m)) on and after June 20, 1997.
“(3)Quality standards.—Section 1932(c)(1) of the Social Security Act [42 U.S.C. 1396u–2(c)(1)], as added by section 4705(a), shall take effect on January 1, 1999.
“(4)Solvency standards.—
“(A)In general.—The amendments made by section 4706 [amending this section] shall apply to contracts entered into or renewed on or after October 1, 1998.
“(B)Transition rule.—In the case of an organization that as of the date of the enactment of this Act [Aug. 5, 1997] has entered into a contract under section 1903(m) of the Social Security Act [42 U.S.C. 1396span(m)] with a State for the provision of medical assistance under title XIX of such Act [42 U.S.C. 1396 et seq.] under which the organization assumes full financial risk and is receiving capitation payments, the amendment made by section 4706 shall not apply to such organization until 3 years after the date of the enactment of this Act.
“(5)Sanctions for noncompliance.—Section 1932(e) of the Social Security Act [42 U.S.C. 1396u–2(e)], as added by section 4707(a), shall apply to contracts entered into or renewed on or after April 1, 1998.
“(6)Limitation on ffp for enrollment brokers.—The amendment made by section 4707(span) [amending this section] shall apply to amounts expended on or after October 1, 1997.
“(7) 6-month guaranteed eligibility.—The amendments made by section 4709 [amending section 1396a of this title] shall take effect on October 1, 1997.
“(c)Nonapplication to Waivers.—Nothing in this chapter (or the amendments made by this chapter) shall be construed as affecting the terms and conditions of any waiver, or the authority of the Secretary of Health and Human Services with respect to any such waiver, under section 1115 or 1915 of the Social Security Act (42 U.S.C. 1315, 1396n).”

Amendment by section 4712(span)(2) of Puspan. L. 105–33 applicable to services furnished on or after Oct. 1, 1997, see section 4712(span)(3) of Puspan. L. 105–33, set out as a note under section 1396a of this title.

Puspan. L. 105–33, title IV, § 4712(c), Aug. 5, 1997, 111 Stat. 509, as amended by Puspan. L. 106–113, div. B, § 1000(a)(6) [title VI, § 603(a)(2)], Nov. 29, 1999, 113 Stat. 1536, 1501A–394, which provided that the amendment made by section 4712(c) was effective for services furnished on or after Oct. 1, 2004, was repealed by Puspan. L. 106–554, § 1(a)(6) [title VII, § 702(c)(1), (e)], Dec. 21, 2000, 114 Stat. 2763, 2763A–574, effective Jan. 1, 2001, and applicable to services furnished on or after such date.

Puspan. L. 105–33, title IV, § 4722(d), Aug. 5, 1997, 111 Stat. 515, provided that: “The amendments made by subsection (a) [amending this section] shall apply to taxes imposed before, on, or after the date of the enactment of this Act [Aug. 5, 1997] and the amendment made by subsection (span) [amending this section] shall apply to taxes imposed on or after such date.”

Puspan. L. 105–33, title IV, § 4724(span)(2), Aug. 5, 1997, 111 Stat. 516, provided that: “The amendments made by paragraph (1) [amending this section] shall apply to home health care services furnished on or after January 1, 1998.”

Puspan. L. 105–33, title IV, § 4742(span), Aug. 5, 1997, 111 Stat. 523, 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 [Aug. 5, 1997].”

Amendment by section 4753(a) of Puspan. L. 105–33 effective Jan. 1, 1998, except as otherwise specifically provided, see section 4753(c) of Puspan. L. 105–33, set out as a note under section 1396a of this title.

Amendment by section 4912(span)(2) of Puspan. L. 105–33 effective Aug. 5, 1997, see section 4912(c) of Puspan. L. 105–33, set out as a note under section 1396a of this title.

Amendment by Puspan. L. 105–12 effective Apr. 30, 1997, and applicable to Federal payments made pursuant to obligations incurred after Apr. 30, 1997, for items and services provided on or after such date, subject to also being applicable with respect to contracts entered into, renewed, or extended after Apr. 30, 1997, as well as contracts entered into before Apr. 30, 1997, to the extent permitted under such contracts, see section 11 of Puspan. L. 105–12, set out as an Effective Date note under section 14401 of this title.

Effective Date of 1996 Amendment

Puspan. L. 104–248, § 1(span)(2), Oct. 9, 1996, 110 Stat. 3149, provided that: “The amendments made by paragraph (1) [amending this section] shall apply to physicians’ services furnished on or after January 1, 1992.”

Amendment by Puspan. L. 104–193 effective July 1, 1997, with transition rules relating to State options to accelerate such date, rules relating to claims, actions, and proceedings commenced before such date, rules relating to closing out of accounts for terminated or substantially modified programs and continuance in office of Assistant Secretary for Family Support, and provisions relating to termination of entitlement under AFDC program, see section 116 of Puspan. L. 104–193, as amended, set out as an Effective Date note under section 601 of this title.

Effective Date of 1993 Amendment

Amendment by section 13602(span) of Puspan. L. 103–66 effective as if included in enactment of the Omnibus Budget Reconciliation Act of 1990, Puspan. L. 101–508, see section 13602(d)(1) of Puspan. L. 103–66, set out as a note under section 1396r–8 of this title.

Puspan. L. 103–66, title XIII, § 13604(span), Aug. 10, 1993, 107 Stat. 621, provided that:

“(1) Subject to paragraph (2), the amendments made by subsection (a) [amending this section] shall apply as if included in the enactment of OBRA–1986 [Puspan. L. 99–509].
“(2) The Secretary of Health and Human Services shall not disallow expenditures made for the care and services described in section 1903(v)(2)(C) of the Social Security Act [42 U.S.C. 1396span(v)(2)(C)], as added by subsection (a), furnished before the date of the enactment of this Act [Aug. 10, 1993].”

Amendment by section 13622(a)(2) of Puspan. L. 103–66 applicable to items and services furnished on or after Oct. 1, 1993, see section 13622(d)(3) of Puspan. L. 103–66, set out as a note under section 1396a of this title.

Puspan. L. 103–66, title XIII, § 13624(span), Aug. 10, 1993, 107 Stat. 636, provided that: “The amendment made by subsection (a) [amending this section] shall apply to referrals made on or after December 31, 1994.”

Puspan. L. 103–66, title XIII, § 13631(h)(2), Aug. 10, 1993, 107 Stat. 645, provided that: “The amendments made by paragraph (1) [amending this section] shall apply to amounts expended for vaccines administered on or after October 1, 1993.”

Amendment by section 13631(c) of Puspan. L. 103–66 applicable to payments under State plans approved under this subchapter for calendar quarters beginning on or after Oct. 1, 1994, see section 13631(i) of Puspan. L. 103–66, set out as a note under section 1396a of this title.

Effective Date of 1991 Amendment

Amendments by section 2(a), (span)(2) of Puspan. L. 102–234 effective Jan. 1, 1992, without regard to whether or not regulations have been promulgated to carry out such amendments by such date, see section 2(c)(1) of Puspan. L. 102–234, set out as a note under section 1396a of this title.

Amendment by section 3(span)(2)(B) of Puspan. L. 102–234 effective Jan. 1, 1992, see section 3(e)(1) of Puspan. L. 102–234, set out as a note under section 1396a of this title.

Puspan. L. 102–234, § 4(span), Dec. 12, 1991, 105 Stat. 1804, provided that: “The amendment made by subsection (a) [amending this section] shall apply to fiscal years ending after the date of the enactment of this Act [Dec. 12, 1991].”

Effective Date of 1990 Amendments

Amendment by section 4402(span), (d)(3) of Puspan. 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 Puspan. L. 101–508 have been promulgated by such date, see section 4402(e) of Puspan. L. 101–508, set out as a note under section 1396a of this title.

Amendment by section 4601(a)(3)(A) of Puspan. 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 Puspan. L. 101–508 have been promulgated by such date, see section 4601(span) of Puspan. L. 101–508, set out as a note under section 1396a of this title.

Puspan. L. 101–508, title IV, § 4701(c), Nov. 5, 1990, 104 Stat. 1388–171, provided that: “The amendment made by subsection (span) [amending this section and section 1396a of this title] shall take effect on January 1, 1991.”

Amendment by section 4704(span)(1), (2) of Puspan. L. 101–508 effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989, Puspan. L. 101–239, see section 4704(f) of Puspan. L. 101–508, set out as a note under section 1396a of this title.

Amendment by section 4711(c)(2) of Puspan. L. 101–508 applicable to civil money penalties imposed after Nov. 5, 1990, see section 4711(e)(2)(B) of Puspan. L. 101–508, set out as a note under section 1396a of this title.

Puspan. L. 101–508, title IV, § 4731(c), Nov. 5, 1990, 104 Stat. 1388–195, provided that: “The amendments made by subsections (a) and (span)(2) [amending this section] shall apply with respect to contract years beginning on or after January 1, 1992, and the amendments made by subsection (span)(1) [amending section 1320a–7a of this title] shall take effect on the date of the enactment of this Act [Nov. 5, 1990].”

Amendment by section 4751(span)(1) of Puspan. L. 101–508 applicable with respect to services furnished on or after first day of first month beginning more than 1 year after Nov. 5, 1990, see section 4751(c) of Puspan. L. 101–508, set out as a note under section 1396a of this title.

Puspan. L. 101–508, title IV, § 4752(span)(2), Nov. 5, 1990, 104 Stat. 1388–206, provided that: “The amendments made by paragraph (1) [amending this section] shall apply to contract years beginning after the date of the establishment of the system described in section 1902(x) of the Social Security Act [42 U.S.C. 1396a(x)].”

Puspan. L. 101–508, title IV, § 4801(a)(9), Nov. 5, 1990, 104 Stat. 1388–212, provided that: “Except as provided in paragraph (6), the amendments made by this subsection [amending this section and section 1396r of this title] shall take effect as if they were included in the enactment of the Omnibus Budget Reconciliation Act of 1987 [Puspan. L. 100–203].”

Puspan. L. 101–508, title IV, § 4801(e)(16)(B), Nov. 5, 1990, 104 Stat. 1388–218, provided that: “The amendments made by subparagraph (A) [amending this section] shall apply with respect to actions initiated on or after the date of the enactment of this Act [Nov. 5, 1990].”

Effective Date of 1989 Amendment

Amendment by section 6401(span) of Puspan. L. 101–239 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after Apr. 1, 1990, with respect to eligibility for medical assistance on or after such date, without regard to whether or not final regulations to carry out the amendments by section 6401 of Puspan. L. 101–239 have been promulgated by such date, see section 6401(c) of Puspan. L. 101–239, set out as a note under section 1396a of this title.

Amendment by section 6901(span)(5)(A) of Puspan. L. 101–239 effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1987, Puspan. L. 100–203, see section 6901(span)(6) of Puspan. L. 101–239, set out as a note under section 1395i–3 of this title.

Amendment by Puspan. L. 101–234 effective Jan. 1, 1990, see section 201(c) of Puspan. L. 101–234, set out as a note under section 1320a–7a of this title.

Effective Date of 1988 Amendment

Amendment by section 608(d)(26)(K)(ii) of Puspan. L. 100–485 effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, Puspan. L. 100–360, see section 608(g)(1) of Puspan. L. 100–485, set out as a note under section 704 of this title.

Amendment by section 608(f)(4) of Puspan. L. 100–485 effective Oct. 13, 1988, see section 608(g)(2) of Puspan. L. 100–485, set out as a note under section 704 of this title.

Amendment by section 202(h)(2) of Puspan. L. 100–360 applicable to items dispensed on or after Jan. 1, 1990, see section 202(m)(1) of Puspan. L. 100–360, set out as a note under section 1395u of this title.

Puspan. L. 100–360, title III, § 301(f), July 1, 1988, 102 Stat. 750, provided that the amendment made by that section is effective as though included in the enactment of the Omnibus Budget Reconciliation Act of 1986, Puspan. L. 99–509.

Amendment by section 302(c)(3) of Puspan. L. 100–360 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after July 1, 1989, with respect to eligibility for medical assistance on or after that date, without regard to whether or not final regulations to carry out such amendment have been promulgated by such date, see section 302(f) of Puspan. L. 100–360, set out as a note under section 1396a of this title.

Except as specifically provided in section 411 of Puspan. L. 100–360, amendment by section 411(a)(3)(A), (B)(iii), (k)(6)(B)(x), (7)(A), (D), (10)(D), (G)(ii) of Puspan. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Puspan. L. 100–203, effective as if included in the enactment of that provision in Puspan. L. 100–203, see section 411(a) of Puspan. L. 100–360, set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions.

Puspan. L. 100–360, title IV, § 411(k)(12)(B), July 1, 1988, 102 Stat. 798, provided that: “The amendment made by subparagraph (A) [amending this section] shall apply to actions occurring on or after the date of the enactment of this Act [July 1, 1988].”

Puspan. L. 100–360, title IV, § 411(k)(13)(B), July 1, 1988, 102 Stat. 798, 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

Puspan. L. 100–203, title IV, § 4118(d)(2), Dec. 22, 1987, 101 Stat. 1330–155, provided that: “The amendments made by paragraph (1) [amending this section] shall be effective as if included in the enactment of section 9507 of the Consolidated Omnibus Budget Reconciliation Act of 1985 [Puspan. L. 99–272].”

Amendment by section 4118(h)(1) of Puspan. L. 100–203 applicable to costs incurred after Dec. 22, 1987, see section 4118(h)(3) of Puspan. L. 100–203, as amended, set out as a note under section 1396a of this title.

Amendments by sections 4211(d)(1), (g), (i), 4212(c)(1), (2), (d)(1), (e)(2) of Puspan. 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), (span)(2) of Puspan. L. 100–203, as amended, set out as an Effective Date note under section 1396r of this title.

Amendment by section 4212(d)(1) of Puspan. L. 100–203 not applicable until such date as of which the State has specified the resident assessment instrument under section 1396r(e)(5) of this title, and the State has begun conducting surveys under section 1396r(g)(2) of this title, see section 4212(d)(4) of Puspan. L. 100–203, set out as a note under section 1396a of this title.

Amendment by section 4213(span)(2) of Puspan. L. 100–203 applicable to payments under this subchapter for calendar quarters beginning on or after Dec. 22, 1987, without regard to whether regulations implementing such amendment are promulgated by such date, except as otherwise specifically provided in section 1396r of this title, see section 4214(span)(1) of Puspan. L. 100–203, as amended, set out as an Effective Date note under section 1396r of this title.

Amendment by Puspan. L. 100–93 effective at end of fourteen-day period beginning Aug. 18, 1987, and inapplicable to administrative proceedings commenced before end of such period, see section 15(a) of Puspan. L. 100–93, set out as a note under section 1320a–7 of this title.

Effective Date of 1986 Amendment

Amendment by Puspan. L. 99–603 effective Oct. 1, 1987, see section 121(c)(2) of Puspan. L. 99–603, set out as a note under section 502 of this title.

Amendment by Puspan. L. 99–514 effective, except as otherwise provided, as if included in enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985, Puspan. L. 99–272, see section 1895(e) of Puspan. L. 99–514, set out as a note under section 162 of Title 26, Internal Revenue Code.

Amendment by section 9401(e)(2) of Puspan. L. 99–509 applicable to medical assistance furnished in calendar quarters beginning on or after Apr. 1, 1987, without regard to whether of not final regulations to carry out such amendment have been promulgated by such date, see section 9401(f) of Puspan. L. 99–509, set out as a note under section 1396a of this title.

Amendment by section 9403(g)(2) of Puspan. 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 Puspan. L. 99–509, set out as a note under section 1396a of this title.

Amendment by section 9406(a) of Puspan. L. 99–509 applicable, except as otherwise provided, to medical assistance furnished to aliens on or after Jan. 1, 1987, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date, see section 9406(c) of Puspan. L. 99–509, set out as a note under section 1396a of this title.

Amendment by section 9407(c) of Puspan. L. 99–509 applicable to ambulatory prenatal care furnished in calendar quarters beginning on or after Apr. 1, 1987, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date, see section 9407(d) of Puspan. L. 99–509, set out as a note under section 1396a of this title.

Amendment by section 9431(span)(2) of Puspan. 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 9431(c) of Puspan. L. 99–509, set out as a note under section 1396a of this title.

Puspan. L. 99–509, title IX, § 9434(a)(3), Oct. 21, 1986, 100 Stat. 2069, provided that:

“(A) The amendments made by paragraph (1) [amending this section] shall take effect 6 months after the date of the enactment of this Act [Oct. 21, 1986].
“(B) The amendment made by paragraph (2) [amending this section] shall take effect on the date of the enactment of this Act and shall apply to contracts entered into, renewed, or extended after the end of the 30-day period beginning on the date of the enactment of this Act.”

Amendment by section 9503(span), (f) of Puspan. L. 99–272 applicable to calendar quarters beginning on or after Apr. 7, 1986, except as otherwise provided, see section 9503(g)(1), (2) of Puspan. L. 99–272, set out as a note under section 1396a of this title.

Puspan. L. 99–272, title IX, § 9507(span), Apr. 7, 1986, 100 Stat. 210, provided that: “The amendments made by subsection (a) [amending this section] shall apply to medical assistance furnished on or after January 1, 1987.”

Puspan. L. 99–272, title IX, § 9512(span), Apr. 7, 1986, 100 Stat. 213, provided that: “The amendments made by this section [amending this section] shall apply to overpayments identified for quarters beginning on or after October 1, 1985.”

Puspan. L. 99–272, title IX, § 9517(c)(2), (3), Apr. 7, 1986, 100 Stat. 216, as amended by Puspan. L. 99–509, title IX, § 9435(e), Oct. 21, 1986, 100 Stat. 2070; Puspan. L. 99–514, title XVIII, § 1895(c)(4), Oct. 22, 1986, 100 Stat. 2935; Puspan. L. 101–508, title IV, § 4734, Nov. 5, 1990, 104 Stat. 1388–196; Puspan. L. 104–240, § 1(a), Oct. 8, 1996, 110 Stat. 3140; Puspan. L. 106–554, § 1(a)(6) [title VII, § 704(a)], Dec. 21, 2000, 114 Stat. 2763, 2763A–575; Puspan. L. 110–275, title II, § 205(a), July 15, 2008, 122 Stat. 2593, provided that:

“(2)
(A) Except as provided in subparagraph (B) and in paragraph (3), the amendments made by paragraph (1) [amending this section] shall apply to expenditures incurred for health insuring organizations which first become operational on or after January 1, 1986. For purposes of this paragraph, a health insuring organization is not considered to be operational until the date on which it first enrolls patients.
“(B) In the case of a health insuring organization—
“(i) which first becomes operational on or after January 1, 1986, but
“(ii) for which the Secretary of Health and Human Services has waived, under section 1915(span) of the Social Security Act [42 U.S.C. 1396n(span)] and before such date, certain requirements of section 1902 of such Act [42 U.S.C. 1396a],
clauses (ii) and (vi) of section 1903(m)(2)(A) of such Act [42 U.S.C. 1396span(m)(2)(A)(ii), (vi)] shall not apply during the period for which such waiver is effective.
“(C) In the case of the Hartford Health Network, Inc., clauses (ii) and (vi) of section 1903(m)(2)(A) of the Social Security Act shall not apply during the period for which a waiver by the Secretary of Health and Human Services, under section 1915(span) of such Act, of certain requirements of section 1902 of such Act is in effect (pursuant to a request for a waiver under section 1915(span) of such Act submitted before January 1, 1986).
“(D) Nothing in section 1903(m)(1)(A) of the Social Security Act shall be construed as requiring a health-insuring organization to be organized under the health maintenance organization laws of a State.
“(3)
(A) Subject to subparagraph (C), in the case of up to 3 health insuring organizations which are described in subparagraph (B), in the case of any health insuring organization described in such subparagraph that is operated by a public entity established by Ventura County, and in the case of any health insuring organization described in such subparagraph that is operated by a public entity established by Merced County, which first become operational on or after January 1, 1986, and which are designated by the Governor, and approved by the Legislature, of California, the amendments made by paragraph (1) shall not apply.
“(B) A health insuring organization described in this subparagraph is one that—
“(i) is operated directly by a public entity established by a county government in the State of California under a State enabling statute;
“(ii) enrolls all medicaid beneficiaries residing in the county or counties in which it operates;
“(iii) meets the requirements for health maintenance organizations under the Knox-Keene Act (Cal. Health and Safety Code, section 1340 et seq.) and the Waxman-Duffy Act (Cal. Welfare and Institutions Code, section 14450 et seq.);
“(iv) assures a reasonable choice of providers, which includes providers that have historically served medicaid beneficiaries and which does not impose any restriction which substantially impairs access to covered services of adequate quality where medically necessary;
“(v) provides for a payment adjustment for a disproportionate share hospital (as defined under State law consistent with section 1923 of the Social Security Act [42 U.S.C. 1396r–4]) in a manner consistent with the requirements of such section; and
“(vi) provides for payment, in the case of childrens’ hospital services provided to medicaid beneficiaries who are under 21 years of age, who are children with special health care needs under title V of the Social Security Act [42 U.S.C. 701 et seq.], and who are receiving care coordination services under such title, at rates determined by the California Medical Assistance Commission.
“(C) Subparagraph (A) shall not apply with respect to any period for which the Secretary of Health and Human Services determines that the number of medicaid beneficiaries enrolled with health insuring organizations described in subparagraph (B) exceeds 16 percent of the number of such beneficiaries in the State of California.
“(D) In this paragraph, the term ‘medicaid beneficiary’ means an individual who is entitled to medical assistance under the State plan under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.], other than a qualified medicare beneficiary who is only entitled to such assistance because of section 1902(a)(10)(E) of such title [42 U.S.C. 1396a(a)(10)(E)].”

[Puspan. L. 110–275, title II, § 205(span), July 15, 2008, 122 Stat. 2594, provided that: “The amendments made by subsection (a) [amending section 9517(c)(3)(A), (C) of Puspan. L. 99–272, set out above] shall take effect on the date of the enactment of this Act [July 15, 2008].”]

[Puspan. L. 106–554, § 1(a)(6) [title VII, § 704(span)], Dec. 21, 2000, 114 Stat. 2763, 2763A–575, provided that: “The amendment made by subsection (a) [amending section 9517(c)(3)(C) of Puspan. L. 99–272, set out above] takes effect on the date of the enactment of this Act [Dec. 21, 2000].”]

[Puspan. L. 104–240, § 1(span), Oct. 8, 1996, 110 Stat. 3140, provided that: “The amendment made by subsection (a) [amending section 9517(c)(3)(B)(ii) of Puspan. L. 99–272, set out above] shall apply to quarters beginning on or after October 1, 1996.”]

Puspan. L. 99–272, title IX, § 9518(span), Apr. 7, 1986, 100 Stat. 216, provided that: “The amendment made by subsection (a) [amending this section] shall apply to payment under section 1903(a) of the Social Security Act [42 U.S.C. 1396span(a)] for calendar quarters beginning on or after October 1, 1982.”

Effective Date of 1984 Amendment

Amendment by Puspan. L. 98–617 effective as if originally included in the Deficit Reduction Act of 1984, Puspan. L. 98–369, see section 3(c) of Puspan. L. 98–617, set out as a note under section 1395f of this title.

Amendment by section 2303(g)(2) of Puspan. L. 98–369 applicable to payments for calendar quarters beginning on or after Oct. 1, 1984, but not applicable to clinical diagnostic laboratory tests furnished to inpatients of a provider operating under a waiver granted pursuant to section 602(k) of Puspan. L. 98–21, set out as a note under section 1395y of this title, see section 2303(j)(2) and (3) of Puspan. L. 98–369, set out as a note under section 1395l of this title.

Puspan. L. 98–369, div. B, title III, § 2363(c), July 18, 1984, 98 Stat. 1107, provided that: “The amendments made by subsection (a) [amending this section and section 1396a of this title] apply to calendar quarters beginning on or after the date of the enactment of this Act [July 18, 1984], except that, in the case of individuals admitted to skilled nursing facilities before such date, the amendments made by such subsection shall not require recertifications sooner or more frequently than were required under the law in effect before such date.”

Effective Date of 1983 Amendment

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

Effective Date of 1982 Amendment

Puspan. L. 97–248, title I, § 133(span), Sept. 3, 1982, 96 Stat. 374, provided that: “The amendment made by subsection (a) [amending this section] shall become effective on the date of the enactment of this Act [Sept. 3, 1982].”

Amendment by section 137(a)(1), (2) of Puspan. L. 97–248 effective as if originally included in the provision of the Omnibus Budget Reconciliation Act of 1981, Puspan. L. 97–35, to which such amendment relates, see section 137(d)(1) of Puspan. L. 97–248, set out as a note under section 1396a of this title.

Amendment by section 137(span)(11)–(16), (27) of Puspan. 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, Puspan. L. 97–35, see section 137(d)(2) of Puspan. L. 97–248, set out as a note under section 1396a of this title.

Puspan. L. 97–248, title I, § 137(g), Sept. 3, 1982, 96 Stat. 381, provided that the amendment made by that section is effective Oct. 1, 1982.

Amendment by section 146(span) of Puspan. L. 97–248 effective with respect to contracts entered into or renewed on or after Sept. 3, 1982, see section 149 of Puspan. L. 97–248, set out as an Effective Date note under section 1320c of this title.

Effective Date of 1981 Amendment

Amendment by section 2101(a)(2) of Puspan. L. 97–35 applicable only to services furnished by a hospital during any accounting year beginning on or after Oct. 1, 1981, see section 2101(c) of Puspan. L. 97–35, set out as an Effective Date note under section 1395uu of this title.

Puspan. L. 97–35, title XXI, § 2103(span)(2), Aug. 13, 1981, 95 Stat. 788, provided that: “The amendment made by paragraph (1) [amending this section] shall apply to amounts expended on or after October 1, 1981.”

Amendment by section 2113(n) of Puspan. L. 97–35 applicable to agreements with Professional Standards Review Organizations entered into on or after Oct. 1, 1981, see section 2113(o) of Puspan. L. 97–35, set out as a note under section 1396a of this title.

Puspan. L. 97–35, title XXI, § 2161(c)(1), Aug. 13, 1981, 95 Stat. 805, as amended by Puspan. L. 97–248, title I, § 137(a)(2), Sept. 3, 1982, 96 Stat. 376, provided that the amendment made by such section 2161(c)(1) is effective for calendar quarters beginning on or after Oct. 1, 1984.

Puspan. L. 97–35, title XXI, § 2161(c)(2), Aug. 13, 1981, 95 Stat. 805, as amended by Puspan. L. 97–248, title I, § 137(a)(2), Sept. 3, 1982, 96 Stat. 376, provided that the amendment made by such section 2161(c)(2) is effective after payments for the first quarter of fiscal year 1985.

Puspan. L. 97–35, title XXI, § 2164(span), Aug. 13, 1981, 95 Stat. 806, provided that: “The amendments made by subsection (a) [amending this section] shall apply to tests occurring on or after October 1, 1981.”

Amendment by section 2174(span) of Puspan. L. 97–35 applicable to services furnished on or after Oct. 1, 1981, see section 2174(c) of Puspan. L. 97–35, set out as a note under section 1396a of this title.

Amendment by section 2178(a) of Puspan. L. 97–35 applicable with respect to services furnished, under a State plan approved under this subchapter, on or before Oct. 1, 1981, except that such amendments not applicable with respect to services furnished by a health maintenance organization under a contract with a State entered into under this subchapter before Oct. 1, 1981, unless the organization requests that such amendments apply and the Secretary and the State agency agree to such request, see section 2178(c) of Puspan. L. 97–35, set out as a note under section 1396a of this title.

Puspan. L. 97–35, title XXI, § 2183(span), Aug. 13, 1981, 95 Stat. 816, provided that: “The amendments made by subsection (a) [amending this section] shall apply to payments made to States for calendar quarters beginning on or after October 1, 1981.”

Effective Date of 1980 Amendment

Puspan. L. 96–499, title IX, § 961(span), Dec. 5, 1980, 94 Stat. 2650, provided that: “The amendment made by subsection (a) [amending this section] shall be effective with respect to expenditures for services furnished on or after October 1, 1980.”

Effective Date of 1977 Amendment

Amendment by section 3(c)(2) of Puspan. L. 95–142 effective Jan. 1, 1978, see section 3(e) of Puspan. L. 95–142, set out as an Effective Date note under section 1320a–3 of this title.

Amendment by section 8(c) of Puspan. L. 95–142 effective with respect to contracts, agreements, etc., made on and after the first day of the fourth month beginning after Oct. 25, 1977, see section 8(e) of Puspan. L. 95–142, set out as an Effective Date note under section 1320a–5 of this title.

Puspan. L. 95–142, § 10(span), Oct. 25, 1977, 91 Stat. 1196, provided that: “The amendment made by subsection (a) [amending this section] shall apply with respect to calendar quarters beginning after the date of the enactment of this Act [Oct. 25, 1977].”

Puspan. L. 95–142, § 11(c), Oct. 25, 1977, 91 Stat. 1197, provided that: “The amendment made by subsection (a) [amending this section] shall apply with respect to medical assistance provided, under a State plan approved under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.], on and after January 1, 1978.”

Puspan. L. 95–142, § 17(e)(1), Oct. 25, 1977, 91 Stat. 1202, provided that: “The amendment made by subsection (a) [amending this section] shall apply with respect to calendar quarters beginning after September 30, 1977.”

Puspan. L. 95–142, § 20(c), Oct. 25, 1977, 91 Stat. 1207, as amended by Puspan. L. 95–292, § 8(e), June 13, 1978, 92 Stat. 316, provided that:

“(1) Except as provided in paragraph (2), the amendments made by this section [amending this section and section 1396a of this title] shall be effective on October 1, 1977, and the Secretary of Health, Education, and Welfare shall promptly adjust payments made to States under section 1903 of the Social Security Act [42 U.S.C. 1396span] to reflect the changes made by such amendments.
“(2) The amount of any reduction in the Federal medical assistance percentage of a State, otherwise required to be imposed under section 1903(g)(1) of the Social Security Act [42 U.S.C. 1396span(g)(1)] because of an unsatisfactory or invalid showing made by the State with respect to a calendar quarter beginning on or after January 1, 1977, shall be determined under such section as amended by this section. Subparagraph (B) of paragraph (4) of section 1903(g) of such Act [42 U.S.C. 1396span(g)(4)(B)], as added by this section, shall apply to any showing made by a State under such section with respect to a calendar quarter beginning on or after January 1, 1977.”

Puspan. L. 95–83, title I, § 105(a)(3), Aug. 1, 1977, 91 Stat. 384, provided that:

“The amendments made by paragraphs (1) and (2) [amending this section] shall apply with respect to payments under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] to States for services provided—
“(A) after October 8, 1976, under contracts under such title [42 U.S.C. 1396 et seq.] entered into or renegotiated after such date, or
“(B) after the expiration of the one-year period beginning on such date,
whichever occurs first.”

Effective Date of 1976 Amendment

Amendment by Puspan. L. 94–552 effective Jan. 1, 1976, see section 2 of Puspan. L. 94–552, set out as a note under section 1396a of this title.

Puspan. L. 94–460, title II, § 202(span), Oct. 8, 1976, 90 Stat. 1959, provided that:

“The amendment made by subsection (a) [amending this section] shall apply with respect to payments under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] to States for services provided—
“(1) after the date of enactment of subsection (a) [Oct. 8, 1976] under contracts under such title entered into or renegotiated after such date, or
“(2) after the expiration of the 1-year period beginning on such date of enactment,
whichever occurs first.”

Effective Date of 1975 Amendment

Puspan. L. 94–182, title I, § 110(span), Dec. 31, 1975, 89 Stat. 1054, provided that: “The amendment made by subsection (a) [amending this section] shall take effect on the first day of the first calendar month which begins not less than 90 days after the date of enactment of this Act [Dec. 31, 1975].”

Amendment by section 111(span) of Puspan. L. 94–182 effective January 1, 1976, except as otherwise provided therein, see section 111(c) of Puspan. L. 94–182, set out as a note under section 1396a of this title.

Effective Date of 1973 Amendment

Amendment by section 13(a)(11), (12) of Puspan. L. 93–233 effective with respect to payments under this section for calendar quarters commencing after Dec. 31, 1973, see section 13(d) of Puspan. L. 93–233, set out as a note under section 1396a of this title.

Amendment by section 18(u) of Puspan. L. 93–233 effective July 1, 1973, see section 18(z–3)(4) of Puspan. L. 93–233, set out as a note under section 1396a of this title.

Puspan. L. 93–66, title II, § 234(span), July 9, 1973, 87 Stat. 160, provided that: “The amendment made by subsection (a) [amending this section] shall be applicable in the case of expenditures for skilled nursing services and for intermediate care facility services furnished in calendar quarters which begin after December 31, 1972.”

Effective Date of 1972 Amendment

Puspan. L. 92–603, title II, § 207(span), Oct. 30, 1972, 86 Stat. 1380, provided that: “The amendments made by subsection (a) [amending this section] shall, except as otherwise provided therein, be effective July 1, 1973.”

Amendment by section 226(e) of Puspan. L. 92–603 effective with respect to services provided on or after July 1, 1973, see section 226(f) of Puspan. L. 92–603, set out as an Effective Date note under section 1395mm of this title.

Amendment by section 233(c) of Puspan. L. 92–603 applicable with respect to services furnished by hospitals in accounting periods beginning after Dec. 31, 1972, see section 233(f) of Puspan. L. 92–603, set out as a note under section 1395f of this title. See, also, section 16 of Puspan. L. 93–233, set out as an Effective Date note under section 1395f of this title.

Puspan. L. 92–603, title II, § 235(span), Oct. 30, 1972, 86 Stat. 1414, provided that: “The amendments made by subsection (a) [amending this section] shall apply with respect to expenditures under State plans approved under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.], made after June 30, 1971.”

Puspan. L. 92–603, title II, § 237(d)(1), Oct. 30, 1972, 86 Stat. 1416, provided that: “The amendments made by subsections (a)(1) and (span) [amending this section and section 706 of this title] shall apply with respect to services furnished in calendar quarters beginning after June 30, 1973.”

Puspan. L. 92–603, title II, § 249B, Oct. 30, 1972, 86 Stat. 1428, as amended by Puspan. L. 93–368, § 8, Aug. 7, 1974, 88 Stat. 422; Puspan. L. 95–83, title III, § 309(span), Aug. 1, 1977, 91 Stat. 396, provided that the amendment made by that section is effective for period beginning Oct. 1, 1972, and ending Sept. 30, 1980.

Effective Date of 1968 Amendment

Puspan. L. 90–248, title II, § 220(span), Jan. 2, 1968, 81 Stat. 899, provided that:

“(span)
(1) In the case of any State whose plan under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] is approved by the Secretary of Health, Education, and Welfare under section 1902 [42 U.S.C. 1396a] after July 25, 1967, the amendment made by subsection (a) [amending this section] shall apply with respect to calendar quarters beginning after the date of enactment of this Act [Jan. 2, 1968].
“(2) In the case of any State whose plan under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] was approved by the Secretary of Health, Education, and Welfare under section 1902 of the Social Security Act [42 U.S.C. 1396a] prior to July 26, 1967, amendments made by subsection (a) [amending this section] shall apply with respect to calendar quarters beginning after June 30, 1968, except that—
“(A) with respect to the third and fourth calendar quarters of 1968, such subsection shall be applied by substituting in subsection (f) of section 1903 of the Social Security Act [42 U.S.C. 1396span(f)] 150 percent for 133½ percent each time such latter figure appears in such subsection (f), and
“(B) with respect to all calendar quarters during 1969, such subsection shall be applied by substituting in subsection (f) of section 1903 of such Act [42 U.S.C. 1396span(f)] 140 percent for 133½ percent each time such latter figure appears in such subsection (f).”

Puspan. L. 90–248, title II, § 222(d), Jan. 2, 1968, 81 Stat. 901, as amended by Puspan. L. 90–364, title III, § 303(a)(2), June 29, 1968, 82 Stat. 274, provided that the amendment made by such section 222(d) is effective with respect to calendar quarters beginning after December 31, 1969.

Puspan. L. 90–248, title II, § 225(span), Jan. 2, 1968, 81 Stat. 902, provided that: “The amendment made by subsection (a) [amending this section] shall apply with respect to expenditures made after December 31, 1967.”

Puspan. L. 90–364, title III, § 303(span), June 29, 1968, 82 Stat. 274, provided that: “The amendments made by subsection (a) [amending this section] shall be effective with respect to calendar quarters beginning after December 31, 1967.”

Regulations

Puspan. L. 111–148, title VI, § 6506(span), Mar. 23, 2010, 124 Stat. 777, provided that: “The Secretary [of Health and Human Services] shall promulgate regulations that require States to correct Federally identified claims overpayments, of an ongoing or recurring nature, with new Medicaid Management Information System (MMIS) edits, audits, or other appropriate corrective action.”

Puspan. L. 102–234, § 5, Dec. 12, 1991, 105 Stat. 1804, provided that:

“(a)In General.—Subject to subsection (span), the Secretary of Health and Human Services shall issue such regulations (on an interim final or other basis) as may be necessary to implement this Act [see Short Title of 1991 Amendment note set out under section 1305 of this title] and the amendments made by this Act.
“(span)Regulations Changing Treatment of Intergovernmental Transfers.—The Secretary may not issue any interim final regulation that changes the treatment (specified in section 433.45(a) of title 42, Code of Federal Regulations) of public funds as a source of State share of financial participation under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.], except as may be necessary to permit the Secretary to deny Federal financial participation for public funds described in section 1903(w)(6)(A) of such Act [42 U.S.C. 1396span(w)(6)(A)] (as added by section 2(a) of this Act) that are derived from donations or taxes that would not otherwise be recognized as the non-Federal share under section 1903(w) of such Act.
“(c)Consultation With States.—The Secretary shall consult with the States before issuing any regulations under this Act.”

Secretary of Health and Human Services to promulgate final regulations necessary to carry out subsec. (r)(6)(j) of this section within 6 months after Apr. 7, 1986, see section 9503(c) of Puspan. L. 99–272, set out as a note under section 1396a of this title.

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 (§ 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.

Implementation of Subsections (i)(22) and (x) Requirements

Puspan. L. 109–171, title VI, § 6036(c), Fespan. 8, 2006, 120 Stat. 81, as amended by Puspan. L. 109–432, div. B, title IV, § 405(c)(2)(A)(v)(II), Dec. 20, 2006, 120 Stat. 3000, provided that: “As soon as practicable after the date of enactment of this Act [Fespan. 8, 2006], the Secretary of Health and Human Services shall establish an outreach program that is designed to educate individuals who are likely to be affected by the requirements of subsections (i)(22) and (x) of section 1903 of the Social Security Act [42 U.S.C. 1396span(i)(22), (x)] (as added by subsection (a)) about such requirements and how they may be satisfied.”

Construction of 2016 Amendment

Nothing in amendment by section 5005 of Puspan. L. 114–255 to be construed as changing or limiting the appeal rights of providers or the process for appeals of States under the Social Security Act, see section 5005(d) of Puspan. L. 114–255, set out as a note under section 1396a of this title.

Puspan. L. 114–255, div. B, title XII, § 12006(c), Dec. 13, 2016, 130 Stat. 1277, provided that:

“(1)No employer-employee relationship established.—Nothing in the amendment made by this section [amending this section] may be construed as establishing an employer-employee relationship between the agency or entity that provides for personal care services or home health care services and the individuals who, under a contract with such an agency or entity, furnish such services for purposes of part 552 of title 29, Code of Federal Regulations (or any successor regulations).
“(2)No particular or uniform electronic visit verification system required.—Nothing in the amendment made by this section shall be construed to require the use of a particular or uniform electronic visit verification system (as defined in subsection (l)(5) of section 1903 of the Social Security Act (42 U.S.C. 1396span), as inserted by subsection (a)) by all agencies or entities that provide personal care services or home health care under a State plan under title XIX of the Social Security Act (or under a waiver of the plan) (42 U.S.C. 1396 et seq.).
“(3)No limits on provision of care.—Nothing in the amendment made by this section may be construed to limit, with respect to personal care services or home health care services provided under a State plan under title XIX of the Social Security Act (or under a waiver of the plan) (42 U.S.C. 1396 et seq.), provider selection, constrain beneficiaries’ selection of a caregiver, or impede the manner in which care is delivered.
“(4)No prohibition on state quality measures requirements.—Nothing in the amendment made by this section shall be construed as prohibiting a State, in implementing an electronic visit verification system (as defined in subsection (l)(5) of section 1903 of the Social Security Act (42 U.S.C. 1396span), as inserted by subsection (a)), from establishing requirements related to quality measures for such system.”

Construction of 2015 Amendment

Puspan. L. 114–113, div. O, title V, § 503(a)(2), Dec. 18, 2015, 129 Stat. 3021, provided that: “Nothing in the amendments made by paragraph (1) [amending this section] shall be construed to prohibit a State Medicaid program from providing medical assistance for durable medical equipment for which payment is denied or not available under the Medicare program under title XVIII of such Act [act Aug. 14, 1935, ch. 531, 42 U.S.C. 1395 et seq.].”

Security and Privacy

Puspan. L. 115–271, title I, § 1016(span), Oct. 24, 2018, 132 Stat. 3923, provided that: “All applicable State and Federal security and privacy protections and laws shall apply to any State agency, individual, or entity accessing 1 or more prescription drug monitoring program databases or obtaining information in such databases in accordance with section 1903(m)(8) of the Social Security Act [42 U.S.C. 1396span(m)(8)] (as added by subsection (a)).”

Collection and Dissemination of Best Practices

Puspan. L. 114–255, div. B, title XII, § 12006(span), Dec. 13, 2016, 130 Stat. 1277, provided that: “Not later than January 1, 2018, the Secretary of Health and Human Services shall, with respect to electronic visit verification systems (as defined in subsection (l)(5) of section 1903 of the Social Security Act (42 U.S.C. 1396span), as inserted by subsection (a)), collect and disseminate best practices to State Medicaid Directors with respect to—

“(1) training individuals who furnish personal care services, home health care services, or both under the State plan under title XIX of such Act [42 U.S.C. 1396 et seq.] (or under a waiver of the plan) on such systems and the operation of such systems and the prevention of fraud with respect to the provision of personal care services or home health care services (as defined in such subsection (l)(5)); and
“(2) the provision of notice and educational materials to family caregivers and beneficiaries with respect to the use of such electronic visit verification systems and other means to prevent such fraud.”

Clarification Regarding Non-Regulation of Transfers

Puspan. L. 111–3, title VI, § 615, Fespan. 4, 2009, 123 Stat. 102, provided that:

“(a)In General.—Nothing in section 1903(w) of the Social Security Act (42 U.S.C. 1396span(w)) shall be construed by the Secretary of Health and Human Services as prohibiting a State’s use of funds as the non-Federal share of expenditures under title XIX of such Act [42 U.S.C. 1396 et seq.] where such funds are transferred from or certified by a publicly-owned regional medical center located in another State and described in subsection (span), so long as the Secretary determines that such use of funds is proper and in the interest of the program under title XIX.
“(span)Center Described.—A center described in this subsection is a publicly-owned regional medical center that—
“(1) provides level 1 trauma and burn care services;
“(2) provides level 3 neonatal care services;
“(3) is obligated to serve all patients, regardless of ability to pay;
“(4) is located within a Standard Metropolitan Statistical Area (SMSA) that includes at least 3 States;
“(5) provides services as a tertiary care provider for patients residing within a 125-mile radius; and
“(6) meets the criteria for a disproportionate share hospital under section 1923 of such Act (42 U.S.C. 1396r–4) in at least one State other than the State in which the center is located.”

Puspan. L. 108–173, title X, § 1001(e), Dec. 8, 2003, 117 Stat. 2431, provided that:

“(1)In general.—Nothing in section 1903(w) of the Social Security Act (42 U.S.C. 1396span(w)) shall be construed by the Secretary [of Health and Human Services] as prohibiting a State’s use of funds as the non-Federal share of expenditures under title XIX of such Act [42 U.S.C. 1396 et seq.] where such funds are transferred from or certified by a publicly-owned regional medical center located in another State and described in paragraph (2), so long as the Secretary determines that such use of funds is proper and in the interest of the program under title XIX.
“(2)Center described.—A center described in this paragraph is a publicly-owned regional medical center that—
“(A) provides level 1 trauma and burn care services;
“(B) provides level 3 neonatal care services;
“(C) is obligated to serve all patients, regardless of State of origin;
“(D) is located within a Standard Metropolitan Statistical Area (SMSA) that includes at least 3 States, including the States described in paragraph (1);
“(E) serves as a tertiary care provider for patients residing within a 125 mile radius; and
“(F) meets the criteria for a disproportionate share hospital under section 1923 of such Act [42 U.S.C. 1396r–4] in at least one State other than the one in which the center is located.
“(3)Effective period.—This subsection shall apply through December 31, 2005.”

Treatment of Donation or Tax Proceeds Prior to Effective Date of Subsection (w)

Puspan. L. 102–234, § 2(c)(2), Dec. 12, 1991, 105 Stat. 1799, provided that: “Except as specifically provided in section 1903(w) of the Social Security Act [42 U.S.C. 1396span(w)] and notwithstanding any other provision of such Act [42 U.S.C. 301 et seq.], the Secretary of Health and Human Services shall not, with respect to expenditures prior to the effective date specified in section 1903(w)(1)(F) of such Act, disallow any claim submitted by a State for, or otherwise withhold Federal financial participation with respect to, amounts expended for medical assistance under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] by reason of the fact that the source of the funds used to constitute the non-Federal share of such expenditures is a tax imposed on, or a donation received from, a health care provider, or on the ground that the amount of any donation or tax proceeds must be credited against the amount of the expenditure.”

Temporary Increase in Federal Match for Administrative Costs

Puspan. L. 101–508, title IV, § 4401(span)(2), Nov. 5, 1990, 104 Stat. 1388–159, provided that: “The per centum to be applied under section 1903(a)(7) of the Social Security Act [42 U.S.C. 1396span(a)(7)] for amounts expended during calendar quarters in fiscal year 1991 which are attributable to administrative activities necessary to carry out section 1927 (other than subsection (g)) of such Act [42 U.S.C. 1396r–8] shall be 75 percent, rather than 50 percent; after fiscal year 1991, the match shall revert back to 50 percent.”

Report on Errors in Eligibility Determinations; Error Rate Transition Rules

Puspan. L. 101–508, title IV, § 4607, Nov. 5, 1990, 104 Stat. 1388–170, directed Secretary of Health and Human Services to report to Congress, by not later than July 1, 1991, on error rates by States in determining eligibility of individuals described in subparagraph (A) or (B) of section 1396a(l)(1) of this title for medical assistance under plans approved under this subchapter, and directed that there should not be taken into account, for purposes of subsec. (u) of this section, payments and expenditures for medical assistance attributable to medical assistance for individuals described in such subparagraph (A) or (B), and made on or after July 1, 1989, and before the first calendar quarter that begins more than 12 months after the date of submission of the Secretary’s report.

   Medically Needy Income Levels for Certain        1-Member Families    

Puspan. L. 101–508, title IV, § 4718, Nov. 5, 1990, 104 Stat. 1388–193, provided that:

“(a)In General.—For purposes of section 1903(f)(1)(B) [probably means section 1903(f)(1)(B) of the Social Security Act, 42 U.S.C. 1396span(f)(1)(B)], for payments made before, on, or after the date of the enactment of this Act [Nov. 5, 1990], a State described in subparagraph (B) may use, in determining the ‘highest amount which would ordinarily be paid to a family of the same size’ (under the State’s plan approved under part A of title IV of such Act [probably means 42 U.S.C. 601 et seq.]) in the case of a family consisting only of one individual and without regard to whether or not such plan provides for aid to families consisting only of one individual, an amount reasonably related to the highest money payment which would ordinarily be made under such a plan to a family of two without income or resources.
“(span)States Covered.—Subsection (a) shall only apply to a State the State plan of which (under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.]) as of June 1, 1989, provided for the policy described in such paragraph. For purposes of the previous sentence, a State plan includes all the matter included in a State plan under section 2373(c)(5) of the Deficit Reduction Act of 1984 [Puspan. L. 98–369, set out as a note under section 1396a of this title] (as amended by section 9 of the Medicare and Medicaid Patient and Program Protection Act of 1987 [Puspan. L. 100–93]).”

Day Habilitation and Related Services

Puspan. L. 101–239, title VI, § 6411(g), Dec. 19, 1989, 103 Stat. 2272, provided that:

“(1)Prohibition of disallowance pending issuance of regulations.—Except as specifically permitted under paragraph (3), the Secretary of Health and Human Services may not—
“(A) withhold, suspend, disallow, or deny Federal financial participation under section 1903(a) of the Social Security Act [42 U.S.C. 1396span(a)] for day habilitation and related services under paragraph (9) or (13) of section 1905(a) of such Act [42 U.S.C. 1396d(a)(9), (13)] on behalf of persons with mental retardation or with related conditions pursuant to a provision of its State plan as approved on or before June 30, 1989, or
“(B) withdraw Federal approval of any such State plan provision.
“(2)Requirements for regulation.—A final regulation described in this paragraph is a regulation, promulgated after a notice of proposed rule-making and a period of at least 60 days for public comment, that—
“(A) specifies the types of day habilitation and related services that a State may cover under paragraph (9) or (13) of section 1905(a) of the Social Security Act on behalf of persons with mental retardation or with related conditions, and
“(B) any requirements respecting such coverage.
“(3)Prospective application of regulation.—If the Secretary promulgates a final regulation described in paragraph (2) and the Secretary determines that a State plan under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] does not comply with such regulation, the Secretary shall notify the State of the determination and its basis, and such determination shall not apply to day habilitation and related services furnished before the first day of the first calendar quarter beginning after the date of the notice to the State.”

Nurse Aide Training and Evaluation Programs; Allocation of Costs Before October 1, 1990

Puspan. L. 101–239, title VI, § 6901(span)(5)(B), Dec. 19, 1989, 103 Stat. 2299, provided that: “In making payments under section 1903(a)(2)(B) of the Social Security Act [42 U.S.C. 1396span(a)(2)(B)] for amounts expended for nurse aide training and competency evaluation programs, and competency evaluation programs, described in section 1919(e)(1) of such Act [42 U.S.C. 1396r(e)(1)], in the case of activities conducted before October 1, 1990, the Secretary of Health and Human Services shall not take into account, or allocate amounts on the basis of, the proportion of residents of nursing facilities that is entitled to benefits under title XVIII or XIX of such Act [42 U.S.C. 1395 et seq., 1396 et seq.].”

Clarification of Federal Matching Rate for Survey and Certification Activities

Puspan. L. 101–239, title VI, § 6901(d)(2), Dec. 19, 1989, 103 Stat. 2300, provided that: “During the period before October 1, 1990, the Federal percentage matching payment rate under section 1903(a) of the Social Security Act [42 U.S.C. 1396span(a)] for so much of the sums expended under a State plan under title XIX of such Act [42 U.S.C. 1396 et seq.] as are attributable to compensation or training of personnel responsible for inspecting public or private skilled nursing or intermediate care facilities to individuals receiving medical assistance to determine compliance with health or safety standards shall be 75 percent.”

Quality Control Transition Provisions

Puspan. L. 100–485, title VI, § 608(h), Oct. 13, 1988, 102 Stat. 2424, provided that: “There shall not be taken into account, for purposes of section 1903(u) of the Social Security Act [42 U.S.C. 1396span(u)], payments and expenditures for medical assistance which are made on or after January 1, 1989, and before July 1, 1989, and which are attributable to medicare-cost [sic] sharing for qualified medicare beneficiaries (as defined in section 1905(p) of such Act [42 U.S.C. 1396d(p)]).”

Delay Quality Control Sanctions for Medicaid

Puspan. L. 100–203, title IV, § 4117, Dec. 22, 1987, 101 Stat. 1330–154, provided that: “The Secretary of Health and Human Services shall not, prior to July 1, 1988, implement any reductions in payments to States pursuant to section 1903(u) of the Social Security Act [42 U.S.C. 1396span(u)] (or any provision of law described in subsection (c) of section 133 of the Tax Equity and Fiscal Responsibility Act of 1982 [section 133(c) of Puspan. L. 97–248, set out below]).”

Temporary Technical Error Definition

Puspan. L. 100–203, title IV, § 4118(n), Dec. 22, 1987, 101 Stat. 1330–157, provided that: “For purposes of section 1903(u)(1)(E)(ii) of the Social Security Act [42 U.S.C. 1396span(u)(1)(E)(ii)], effective for the period beginning on the date of enactment of this Act [Dec. 22, 1987] and ending December 31, 1988, a ‘technical error’ is an error in eligibility condition (such as assignment of social security numbers and assignment of rights to third-party benefits as a condition of eligibility) that, if corrected, would not result in a difference in the amount of medical assistance paid.”

Enhanced Funding for Nurse Aide Training

Puspan. L. 100–203, title IV, § 4211(d)(2), Dec. 22, 1987, 101 Stat. 1330–204, as amended by Puspan. L. 100–360, title IV, § 411(l)(3)(F), July 1, 1988, 102 Stat. 803, provided that: “For the 8 calendar quarters (beginning with the calendar quarter that begins on July 1, 1988), with respect to payment under section 1903(a)(2)(B) of the Social Security Act [42 U.S.C. 1396span(a)(2)(B)] to a State for additional amounts expended by the State under its plan approved under title XIX of such Act [42 U.S.C. 1396 et seq.] for nursing aide training and competency evaluation programs, and competency evaluation programs, described in section 1919(e)(1) of such title [42 U.S.C. 1396r(e)(1)], any reference to ‘50 percent’ is deemed a reference to the sum of the Federal medical assistance percentage (determined under section 1905(span) of such Act [42 U.S.C. 1396d(span)]) plus 25 percentage points, but not to exceed 90 percent.”

Expenses Incurred for Review of Care Provided to Residents of Nursing Facilities

Puspan. L. 100–203, title IV, § 4212(c)(3), Dec. 22, 1987, 101 Stat. 1330–212, provided that: “For purposes of section 1903(a) of the Social Security Act [42 U.S.C. 1396span(a)], proper expenses incurred by a State for medical review by independent professionals of the care provided to residents of nursing facilities who are entitled to medical assistance under title XIX of such Act [42 U.S.C. 1396 et seq.] shall be reimbursable as expenses necessary for the proper and efficient administration of the State plan under that title.”

Quality Control Studies and Penalty Moratorium

Puspan. L. 99–272, title XII, § 12301, Apr. 7, 1986, 100 Stat. 291, as amended by Puspan. L. 99–514, title XVII, § 1710, Oct. 22, 1986, 100 Stat. 2783; Puspan. L. 100–485, title VI, § 609(span), Oct. 13, 1988, 102 Stat. 2425, provided that:

“(a)Studies.—
(1) The Secretary of Health and Human Services (hereafter referred to in this section as the ‘Secretary’) shall conduct a study of quality control systems for the Aid to Families with Dependent Children Program under title IV–A of the Social Security Act [42 U.S.C. 601 et seq.] and for the Medicaid Program under title XIX of such Act [42 U.S.C. 1396 et seq.]. The study shall examine how best to operate such systems in order to obtain information which will allow program managers to improve the quality of administration, and provide reasonable data on the basis of which Federal funding may be withheld for States with excessive levels of erroneous payments.
“(2) The Secretary shall also contract with the National Academy of Sciences to conduct a concurrent independent study for the purpose described in paragraph (1). For purposes of such study, the Secretary shall provide to the National Academy of Sciences any relevant data available to the Secretary at the onset of the study and on an ongoing basis.
“(3) The Secretary and the National Academy of Sciences shall report the results of their respective studies to the Congress within one year after the date the Secretary and the National Academy of Sciences enter into the contract required under paragraph (2).
“(span)Moratorium on Penalties.—
(1) During the 24-month period beginning with the first calendar quarter which begins after the date of the enactment of this Act [Apr. 7, 1986] (hereafter in this section referred to as the ‘moratorium period’), the Secretary shall not impose any reductions in payments to States pursuant to section 403(i) of the Social Security Act [42 U.S.C. 603(i)] (or prior regulations), or pursuant to any comparable provision of law relating to the programs under title IV–A of such Act [42 U.S.C. 601 et seq.] in Puerto Rico, Guam, the Virgin Islands, American Samoa, or the Northern Mariana Islands.
“(2) During the moratorium period, the Secretary and the States shall continue to operate the quality control systems in effect under title IV–A of the Social Security Act, and to calculate the error rates under the provisions referred to in paragraph (1).
“(c)Restructured Quality Control Systems.—
(1) Not later than 6 months after the date on which the results of both studies required under subsection (a)(3) have been reported, the Secretary shall publish regulations which shall—
“(A) restructure the quality control systems under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] to the extent the Secretary determines to be appropriate, taking into account the studies conducted under subsection (a); and
“(B) establish, taking into account the studies conducted under subsection (a), criteria for adjusting the reductions which shall be made for quarters prior to the implementation of the restructured quality control systems so as to eliminate reductions for those quarters which would not be required if the restructured quality control systems had been in effect during those quarters.
“(2) Beginning with the first calendar quarter after the moratorium period, the Secretary shall implement the revised quality control systems under title XIX, and shall reduce payments to States—
“(A) for quarters after the moratorium period in accordance with the restructured quality control systems; and
“(B) for quarters in and before the moratorium period, as provided under the regulations described in paragraph (1)(B).
“(d)Effective Date.—This section shall become effective on the date of the enactment of this Act [Apr. 7, 1986].”

Effectiveness of Laws Limiting Federal Financial Participation With Respect to Erroneous Payments Made by States Under a State Plan Approved Under This Subchapter

Puspan. L. 97–248, title I, § 133(c), Sept. 3, 1982, 96 Stat. 374, provided that: “No provision of law limiting Federal financial participation with respect to erroneous payments made by States under a State plan approved under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] (including any provision contained in, or incorporated by reference into, any appropriation Act or resolution making continuing appropriations), other than the limitations contained in section 1903 of such Act [42 U.S.C. 1396span], shall be effective with respect to payments to States under such section 1903 for quarters beginning on or after October 1, 1982, unless such provision of law is enacted after the date of the date of the enactment of this Act [Sept. 3, 1982] and expressly provides that such limitation is in addition to or in lieu of the limitations contained in section 1903 of the Social Security Act.”

Medicaid Payments for Indian Health Service Facilities To Be Paid Entirely by Federal Funds; Exclusion of Payments to States in Computation of Target Amount of Federal Medicaid Expenditures

Puspan. L. 97–92, §§ 102, 118, Dec. 15, 1981, 95 Stat. 1193, 1197, as amended by Puspan. L. 97–161, Mar. 31, 1982, 96 Stat. 22, provided, for the period Dec. 15, 1981, to not later than Sept. 30, 1982, that: “Notwithstanding section 1903(s) of the Social Security Act [42 U.S.C. 1396span(s)], all medicaid payments to the States for Indian health service facilities as defined by section 1911 of the Social Security Act [42 U.S.C. 1396j] shall be paid entirely by Federal funds, and notwithstanding section 1903(t) of the Social Security Act [42 U.S.C. 1396span(t)], all medicaid payments to the States for Indian health service facilities shall not be included in the computation of the target amount of Federal medicaid expenditures.”

Promulgation of Regulations for Implementation of Amendments by Section 17 of Puspan. L. 95–142

Puspan. L. 95–142, § 17(e)(2), Oct. 25, 1977, 91 Stat. 1202, required Secretary of Health, Education, and Welfare to establish regulations, not later than 90 days after Oct. 25, 1977, to carry out amendments made by section 17 (amending sections 1395span–1 and 1396span of this title). See section 1302 of this title.

Deferral of Implementation of Decreases in Matching Funds

Puspan. L. 95–59, § 6, June 30, 1977, 91 Stat. 255, provided that: “Notwithstanding the provisions of subsection (g) of section 1903 of the Social Security Act [42 U.S.C. 1396span(g)], the amount payable to any State for the calendar quarters during the period commencing April 1, 1977, and ending September 30, 1977, on account of expenditures made under a State plan approved under title XIX of such Act [42 U.S.C. 1396 et seq.], shall not be decreased by reason of the application of the provisions of such subsection with respect to any period for which such State plan was in operation prior to April 1, 1977.”

Comprehensive Care and Services for Eligible Individuals by July 1, 1977; Requirement Inapplicable for Any Period Prior to July 1, 1971; Regulations; Advice to States

Puspan. L. 91–56, § 2(span), Aug. 9, 1969, 83 Stat. 99, which provided that subsection (e) of this section was inapplicable to the period prior to July 1, 1971, and which authorized the Secretary to issue regulations, was repealed by Puspan. L. 92–603, title II, § 230, Oct. 30, 1972, 86 Stat. 1410.

Exemption of Puerto Rico, the Virgin Islands, and Guam From Limitations on Federal Payments for Medical Assistance

Puspan. L. 90–248, title II, § 248(d), Jan. 2, 1968, 81 Stat. 919, provided that: “The amendment made by section 220(a) of this Act [amending this section] shall not apply in the case of Puerto Rico, the Virgin Islands, or Guam.”

Nonduplication of Payments to States; Limitation on Institutional Care

Puspan. L. 89–97, title I, § 121(span), July 30, 1965, 79 Stat. 352, as amended by Puspan. L. 92–603, title II, § 249D, Oct. 30, 1972, 86 Stat. 1429, provided that: “No payment may be made to any State under title I, IV, X, XIV, or XVI of the Social Security Act [42 U.S.C. 301 et seq., 601 et seq., 1201 et seq., 1351 et seq., 1381 et seq.] with respect to aid or assistance in the form of medical or any other type of remedial care for any period for which such State receives payments under title XIX of such Act [42 U.S.C. 1396 et seq.], or for any period after December 31, 1969. After the date of enactment of the Social Security Amendments of 1972 [Oct. 30, 1972], Federal matching shall not be available for any portion of any payment by any State under title I, X, XIV, or XVI, or part A of title IV, of the Social Security Act [42 U.S.C. 301 et seq., 1201 et seq., 1351 et seq., 1381 et seq., 601 et seq.] for or on account of any medical or any other type of remedial care provided by an institution to any individual as an inpatient thereof, in the case of any State which has a plan approved under title XIX of such Act [42 U.S.C. 1396 et seq.], if such care is (or could be) provided under a State plan approved under title XIX of such Act by an institution certified under such title XIX.”