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NOTES:
Source
(Aug. 14, 1935, ch. 531, title XIX, § 1902, as added , title I, § 121(a), July 30, 1965, ; amended , title II, §§ 210(a)(6),
,
, (c)(1),
,
,
,
,
,
,
,
,
,
–(4), title III, § 302(b), Jan. 2, 1968, , 901–906, 908, 911, 917, 929; , § 2(c), (d), Aug. 9, 1969, ; , § 4(b), Dec. 28, 1971, ; , title II, §§ 208(a),
, (b)(1),
,
,
,
,
,
239
(a), (b),
240,
,
,
,
,
,
–(20), (b)(14), 298, 299A, 299D(b), Oct. 30, 1972, , 1389, 1410, 1415–1418, 1424, 1426, 1446, 1450, 1452–1454, 1460, 1462; , §§ 13(a)(2)–(10), 18(o)–(q), (x)(1)–(4), Dec. 31, 1973, , 971, 972; , § 9(a), Aug. 7, 1974, ; , §§ 1,
, July 1, 1975, ; , title I, § 111(a), Dec. 31, 1975, ; , § 1, Oct. 18, 1976, ; , §§ 2(a)(3), (b)(1),
,
, (c),
,
,
, Oct. 25, 1977, , 1178, 1193, 1195, 1204, 1207; , § 2(c), Dec. 13, 1977, ; , § 14(a)(1), Nov. 1, 1978, ; , title III, § 308(c), June 17, 1980, ; , title IX, §§ 902(b),
,
,
,
, (d),
914
(b)(1),
916
(b)(1),
918
(b)(1),
962
(a),
965
(b), Dec. 5, 1980, , 2615, 2618–2621, 2624, 2626, 2650, 2652; , § 5(b), Dec. 28, 1980, ; , title XXI, §§ 2105(c),
,
2171
(a), (b),
2172
(a),
2173
(a), (b)(1),
2174
(a),
2175
(a), (d)(1),
2178
(b),
,
,
2193
(c)(9), Aug. 13, 1981, , 795, 807–809, 811, 814–816, 828; , title I, §§ 131(a), (c), formerly (b), 132(a), (c), 134(a), 136(d), 137(a)(3), (b)(7)–(10), (e), 146(a), Sept. 3, 1982, , 369, 370, 373, 375–378, 381, 394; , title III, § 309(a)(8), Jan. 12, 1983, ; , div. B, title III, §§ 2303(g)(1),
,
2335
(e),
,
,
,
2367
(a),
2368
(a), (b),
–(10), title VI, § 2651(c), July 18, 1984, , 1079, 1091, 1104, 1105, 1108, 1109, 1111, 1149; , § 20(c), Aug. 16, 1984, ; , § 3(a)(7), (b)(10), Nov. 8, 1984, , 3296; , title IX, §§ 9501(b), (c),
9503
(a),
9505
(b), (c)(1), (d),
9506
(a),
9509
(a),
9510
(a),
9517
(b),
9529
(a)(1), (b)(1), title XII, § 12305(b)(3), Apr. 7, 1986, , 202, 205, 208–212, 216, 220, 293; , title IX, §§ 9320(h)(3),
–(e)(1), 9402(a), (b), 9403(a), (c), (e)–(g)(1), (4)(A), 9404(a), 9405, 9406(b), 9407(a), 9408(a), (b), (c)(2), (3), 9431(a), (b)(1), 9433(a), 9435(b)(1), Oct. 21, 1986, , 2050–2058, 2060, 2061, 2066, 2068, 2069; , title XVIII, § 1895(c)(1), (3)(B), (C), (7), Oct. 22, 1986, , 2936; , title XI, § 11005(b), Oct. 27, 1986, ; , §§ 3(b),
, Nov. 10, 1986, , 3579; , §§ 5(a),
,
, Aug. 18, 1987, , 691, 694; , title IV, §§ 4072(d),
, (2), (b)(1)–(2)(B), (c)(2), (e)(1)–(5), 4102(b)(1), 4104, 4113(a)(2), (b)(1), (2), (c)(1), (2), (d)(2), 4116, 4118(c)(1), (h)(1), (2), (m)(1)(B), (p)(1)–(4), (6)–(8), 4211(b)(1), (h)(1)–(5), 4212(d)(2), (3), (e)(1), 4213(b)(1), 4218(a), title IX, §§ 9115(b),
, Dec. 22, 1987, , 1330–140 to 1330–143, 1330–146, 1330–147, 1330–151, 1330–152, 1330–154 to 1330–157, 1330–159, 1330–203, 1330–205, 1330–213, 1330–219, 1330–220, 1330–305, as amended , title IV, § 411(k)(5)(A), (7)(B)–(D), (10)(G)(ii), (iv), (l)(3)(H), (J), (8)(C), (n)(2), (4), formerly (3), July 1, 1988, , 794, 796, 803, 805, 807, as amended , title VI, § 608(d)(14)(I), (15)(A), (27)(F)–(H), (28), Oct. 13, 1988, , 2423; , title II, § 204(d)(3), title III, §§ 301(a)(1), (e)(2),
, (b)(1), (c)(1), (2), (d)–(e)(3), 303(d), (e), title IV, § 411(k)(5)(B), (17)(B), (l)(3)(E), (6)(C), (D), July 1, 1988, , 748–753, 762, 763, 792, 800, 803, 804; , title II, § 202(c)(4), title III, § 303(a)(2), (b)(1), (d), title IV, § 401(d)(1), title VI, § 608(d)(15)(B), (16)(C), Oct. 13, 1988, , 2391, 2392, 2396, 2416, 2418; , title VIII, § 8434(b)(1), (2), Nov. 10, 1988, ; , title II, § 201(a), Dec. 13, 1989, ; , title VI, §§ 6115(c),
,
6402
(a), (c)(2),
6403
(b), (d)(1),
6404
(c),
6405
(b),
6406
(a),
6408
(c)(1), (d)(1), (4)(C),
6411
(a)(1), (d)(3)(B), (e)(2), Dec. 19, 1989, , 2258, 2260, 2261, 2263–2265, 2268–2271; , title IV, §§ 4401(a)(2),
, (c), (d)(1),
, (e)(2),
,
,
,
, (b),
,
4704
(a), (e)(1),
4708
(a),
, (d),
,
4715
(a),
,
,
4732
(b)(1),
4751
(a),
4752
(a)(1)(A), (c)(1),
4754
(a),
4755
(a)(2), (c)(1),
, (11)(A), Nov. 5, 1990, , 1388–161, 1388–163 to 1388–173, 1388–186, 1388–187, 1388–190, 1388–192, 1388–194, 1388–195, 1388–204, 1388–206, 1388–208 to 1388–210, 1388–215, 1388–217; , §§ 2(b)(1),
, Dec. 12, 1991, ; , title XIII, § 13581(b)(2),
,
,
–(c), 13611(d)(1), 13622(a)(1), (b), (c), 13623(a), 13625(a), 13631(a), (e)(1), (f)(1), Aug. 10, 1993, , 613, 619, 620, 626, 632, 633, 636, 643, 644; , title I, § 108(d)(1), Aug. 15, 1994, ; , title II, § 204(w)(2)(E), Nov. 2, 1994, ; , title I, §§ 108(k),
–(d)(1), title IX, § 913, Aug. 22, 1996, , 2180, 2354; , § 1(b)(2), Oct. 2, 1996, ; , § 1(a)(1), Oct. 9, 1996, ; , § 9(b)(2), Apr. 30, 1997, ; , title IV, §§ 4106(c),
,
–(iv), (d)(1), 4702(b)(2), 4709, 4711(a), 4712(a), (b)(1), (c)(1), 4714(a)(1), 4715(a), 4724(c)(1), (d), (f), (g)(1), 4731(a), (b), 4732(a), 4733, 4741(a), 4751(a), (b), 4752(a), 4753(b), 4911(b), 4912(b)(1), 4913(a), Aug. 5, 1997, , 431, 493, 495, 506–510, 516, 517, 519, 520, 522–525, 571, 573; , div. B, § 1000(a)(6) [title VI, §§ 603(a)(1),
, (2)(A), (b)(1),
–(d), (y)(2), (aa)(1)], Nov. 29, 1999, , 1501A–394 to 1501A–398; , title I, § 121(a)(1), (c)(4), title II, §§ 205(c),
, Dec. 14, 1999, , 1830, 1834, 1837; , title II, § 201(a)(1), (2)(A), Dec. 17, 1999, , 1892; , § 2(a)(1)–(3), (b)(2)(A), Oct. 24, 2000, ; , § 1(a)(6) [title VII, §§ 702(a)–(c)(1), 707(b)], Dec. 21, 2000, , 2763A–572 to 2763A–574, 2763A–577; , § 2(a), (b)(1), (2), Jan. 15, 2002, .)
Repeal of Subsection (a)(29)
, title IV, § 4801(e)(11), Nov. 5, 1990, , provided that, effective on the date on which the Secretary promulgates standards regarding the qualifications of nursing facility administrators under section
of this title, subsection (a)(29) of this section is repealed.
References in Text
Parts A, D, and E of subchapter IV of this chapter, referred to in subsecs. (a), (c), (e)(1), (10), and (l)(3), are classified to sections
et seq., 651 et seq., and 670 et seq., respectively, of this title.
Parts A and B of subchapter XVIII of this chapter, referred to in subsec. (a)(10), (13)(B), are classified to sections
et seq. and 1395j et seq., respectively, of this title.
Section
of this title, referred to in subsecs. (a)(10)(A)(i)(I) and (e)(10), was repealed and a new section
enacted by , title I, § 103(a)(1), Aug. 22, 1996, , and, as so enacted, no longer contains subsec. (a)(37) or (a)(43).
Section
of this title, referred to in subsec. (a)(10)(A)(i)(I), was repealed and a new section
enacted by , title I, § 103(a)(1), Aug. 22, 1996, , and, as so enacted, no longer contains a subsec. (h).
Section
of this title, referred to in subsec. (a)(10)(A)(i)(I), was repealed by , title I, § 108(e), Aug. 22, 1996, .
The date of the enactment of section 211(a) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, referred to in subsec. (a)(10)(A)(i)(II), is the date of enactment of , which was approved Aug. 22, 1996. Section 211(a) of the Act amended section
of this title.
Section 4611 of the Balanced Budget Act of 1997, referred to in subsec. (a)(10)(E)(iv)(II), is section 4611 of , which amended sections
,
,
, and
of this title. Subsec. (e)(3) of section
4611 of the Act is set out as a note under section
of this title. For complete classification of section 4611 of the Act to the Code, see Tables.
Section
of this title, referred to in subsec. (a)(20)(C), was amended generally by , title XXIII, § 2353(a)(1)(A), Aug. 13, 1981, , and, as so amended, no longer contained cls. (i) and (ii). Section
was amended by , title XIII, § 13741(b), Aug. 10, 1993, , and, as so amended, no longer contains subparagraphs.
Section
and (ii) of this title, referred to in subsec. (a)(20)(C), is a reference to section
and (ii) existing prior to the general revision of subchapter XVI of this chapter by , title III, § 301, Oct. 30, 1972, , eff. Jan. 1, 1974. The prior section (which is set out as a note under section
of this title) continues in effect for Puerto Rico, Guam, and the Virgin Islands. Subsec. (a)(4) of the prior section was amended generally by , title XXIII, § 2353(m)(2)(B), Aug. 13, 1981, , and, as so amended, no longer contained clauses in subpar. (A). Subsec. (a)(4) of the prior section was also amended by , title XIII, § 13741(b), Aug. 10, 1993, , and, as so amended, no longer contains subparagraphs.
Part B of subchapter XI of this chapter, referred to in subsec. (d), is classified to section
et seq. of this title.
Public Law 92–336, referred to in provisions following subsec. (a)(52), is , July 1, 1972, , which amended sections
,
,
,
,
,
,
, and
of this title and sections
,
,
,
,
,
,
,
,
, and
of Title
, Internal Revenue Code, and enacted provisions set out as notes under sections
,
,
, and
of this title and sections
and
of Title
.
The Public Health Service Act, referred to in subsecs. (u)(3) and (aa)(3), is act July 1, 1944, ch. 373, , as amended. Titles XV and XXII of the Act are classified generally to subchapters XIII (§ 300k et seq.) and XX (§ 300bb–1 et seq.), respectively, of chapter
of this title. For complete classification of this Act to the Code, see Short Title note set out under section
of this title and Tables.
The Internal Revenue Code of 1986, referred to in subsec. (u)(3), is classified generally to Title 26.
The employee Retirement Income Security Act of 1974, referred to in subsec. (u)(3), is , Sept. 2, 1974, , as amended. Title VI of the Act probably means part 6 of subtitle B of title I of the Act which is classified generally to part 6 (§ 1161 et seq.) of subtitle
of subchapter
of chapter
of Title
, Labor, because the Act has no title VI. For complete classification of this Act to the Code, see Short Title note set out under section
of Title
and Tables.
Amendments
2002—Subsec. (a)(15). , § 2(b)(2), substituted “subsection (bb)” for “subsection (aa)”.
Subsec. (aa). , § 2(b)(1), redesignated subsec. (aa) relating to payment for services provided by federally-qualified health centers and rural health clinics as subsec. (bb).
Subsec. (aa)(4). , § 2(a), inserted “, but applied without regard to paragraph (1)(F) of such section” before period at end.
Subsec. (bb). , § 2(b)(1), redesignated subsec. (aa) relating to payment for services provided by federally-qualified health centers and rural health clinics as subsec. (bb).
2000—Subsec. (a)(10). , § 2(a)(3), in concluding provisions, substituted “(XIII)” for “and (XIII)” and inserted before semicolon at end “, and (XIV) the medical assistance made available to an individual described in subsection (aa) of this section who is eligible for medical assistance only because of subparagraph (A)(10)(ii)(XVIII) shall be limited to medical assistance provided during the period in which such an individual requires treatment for breast or cervical cancer”.
Subsec. (a)(10)(A)(ii)(XVIII). , § 2(a)(1), added subcl. (XVIII).
Subsec. (a)(13)(A)(iv). , § 1(a)(6) [title VII, § 702(a)(1)(A)], inserted “and” at end.
Subsec. (a)(13)(B). , § 1(a)(6) [title VII, § 702(a)(1)(B)], struck out “and” at end.
Subsec. (a)(13)(C). , § 1(a)(6) [title VII, § 702(c)(1)], repealed , § 4712(c)(1). See 1997 Amendment note below.
, § 1(a)(6) [title VII, § 702(a)(1)(C)], struck out subpar. (C) which read as follows: “(C)(i) for payment for services described in clause (B) or (C) of section
of this title under the plan of 100 percent (or 95 percent for services furnished during fiscal year 2000, fiscal year 2001, or fiscal year 2002, 90 percent for services furnished during fiscal year 2003, or 85 percent for services furnished during fiscal year 2004) of costs which are reasonable and related to the cost of furnishing such services or based on such other tests of reasonableness, as the Secretary prescribes in regulations under section
of this title, or, in the case of services to which those regulations do not apply, on the same methodology used under section
of this title and (ii) in carrying out clause (i) in the case of services furnished by a Federally-qualified health center or a rural health clinic pursuant to a contract between the center and an organization under section
of this title, for payment to the center or clinic at least quarterly by the State of a supplemental payment equal to the amount (if any) by which the amount determined under clause (i) exceeds the amount of the payments provided under such contract;”.
Subsec. (a)(15). , § 1(a)(6) [title VII, § 702(a)(2)], added par. (15).
Subsec. (a)(47). , § 2(b)(2)(A), inserted before semicolon at end “and provide for making medical assistance available to individuals described in subsection (a) of section
of this title during a presumptive eligibility period in accordance with such section”.
Subsec. (e)(1)(B). , § 1(a)(6) [title VII, § 707(b)], substituted “2002” for “2001”.
Subsec. (aa). , § 1(a)(6) [title VII, § 702(b)], added subsec. (aa) relating to payment for services provided by Federally-qualified health centers and rural health clinics.
, § 2(a)(2), added subsec. (aa) relating to certain breast or cervical cancer patients.
1999—Subsec. (a)(10)(A)(ii)(XIV). , § 1000(a)(6) [title VI, § 608(aa)(1)], substituted “1396d(u)(2)(B) of this title” for “1396d(u)(2)(C) of this title”.
Subsec. (a)(10)(A)(ii)(XV). , § 121(c)(4)(A), redesignated subcl. (XV), related to individuals who are independent foster care adolescents, as (XVII).
, § 121(a)(1)(C), added subcl. (XV), related to individuals who are independent foster care adolescents.
, § 121(a)(1)(A), which directed striking out of “or” at end of subcl. (XIII), was executed by amending subcl. (XV), related to individuals who would be considered to be receiving supplemental security income, etc. See Construction of 1999 Amendment note below.
, § 201(a)(1), added subcl. (XV), related to individuals who would be considered to be receiving supplemental security income, etc.
Subsec. (a)(10)(A)(ii)(XVI). , § 121(a)(1)(B), which directed insertion of “or” at end of subcl. (XIV), was executed to subcl. (XVI). See Construction of 1999 Amendment note below.
, § 201(a)(2)(A), added subcl. (XVI).
Subsec. (a)(10)(A)(ii)(XVII). , § 121(c)(4), redesignated subcl. (XV), related to individuals who are independent foster care adolescents, as (XVII) and substituted “section
” for “section
”.
Subsec. (a)(10)(G). , § 206(b), substituted “subsections (c) and (e) of section
” for “section
”.
, § 205(c), added subpar. (G).
Subsec. (a)(13)(C)(i). , § 1000(a)(6) [title VI, § 603(a)(1)], substituted “fiscal year 2001, or fiscal year 2002, 90 percent for services furnished during fiscal year 2003, or 85 percent for services furnished during fiscal year 2004” for “90 percent for services furnished during fiscal year 2001, 85 percent for services furnished during fiscal year 2002, or 70 percent for services furnished during fiscal year 2003”.
Subsec. (a)(30)(A). , § 1000(a)(6) [title VI, § 604(b)(1)(A)], inserted “and” at end.
Subsec. (a)(30)(B)(ii). , § 1000(a)(6) [title VI, § 604(b)(1)(B)], struck out “and” at end.
Subsec. (a)(30)(C). , § 1000(a)(6) [title VI, § 604(b)(1)(C)], struck out subpar. (C) which read as follows: “use a utilization and quality control peer review organization (under part B of subchapter XI of this chapter), an entity which meets the requirements of section
of this title, as determined by the Secretary, or a private accreditation body to conduct (on an annual basis) an independent, external review of the quality of services furnished under each contract under section
of this title, with the results of such review made available to the State and, upon request, to the Secretary, the Inspector General in the Department of Health and Human Services, and the Comptroller General;”.
Subsec. (a)(60). , § 1000(a)(6) [title VI, § 608(y)(2)], made technical amendment to reference in original act which appears in text as reference to section
-1 of this title.
Subsec. (a)(64). , § 1000(a)(6) [title VI, § 608(a)], inserted “and” at end.
Subsec. (d). , § 1000(a)(6) [title VI, § 604(a)(2)(A)], struck out “(including quality review functions described in subsection (a)(30)(C) of this section)” after “medical or utilization review functions”.
, § 1000(a)(6) [title VI, § 604(a)(1)], struck out “for the performance of the quality review functions described in subsection (a)(30)(C) of this section,” before “or a utilization and quality control peer review organization”.
Subsec. (j). , § 1000(a)(6) [title VI, § 608(b)], substituted “of” for “of of” after “numbered paragraph”.
Subsec. (l)(1)(C). , § 1000(a)(6) [title VI, § 608(c)(1)], substituted “children” for “children children”.
Subsec. (l)(3). , § 1000(a)(6) [title VI, § 608(c)(2)], struck out first comma after “(a)(10)(A)(i)(VII)” in introductory provisions.
Subsec. (l)(4)(B). , § 1000(a)(6) [title VI, § 608(c)(3)], inserted comma after “(a)(10)(A)(i)(IV)”.
Subsec. (v). , § 1000(a)(6) [title VI, § 608(d)], struck out par. (1) designation before “A State plan may provide”.
1997—Subsec. (a). , § 4454(b)(1), in second sentence of flush concluding provisions, substituted “to a religious nonmedical health care institution (as defined in section
of this title).” for “to a Christian Science sanatorium operated, or listed and certified, by The Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc..”
Subsec. (a)(4)(C), (D). , § 4724(c)(1), substituted “(C)” for “and (C)”, “local officer, employee, or independent contractor” for “local officer or employee”, and “such an officer, employee, or contractor” for “such an officer or employee” in two places and added subpar. (D).
Subsec. (a)(9)(C). , § 4106(c), substituted “paragraphs (16) and (17)” for “paragraphs (15) and (16)”.
Subsec. (a)(10)(A)(i)(II). , § 4913(a), inserted “(or were being paid as of the date of the enactment of section 211(a) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193)) and would continue to be paid but for the enactment of that section” after “subchapter XVI of this chapter”.
Subsec. (a)(10)(A)(ii)(XIII). , § 4733, added subcl. (XIII).
Subsec. (a)(10)(A)(ii)(XIV). , § 4911(b), added subcl. (XIV).
Subsec. (a)(10)(E)(iv). , § 4732(a), added cl. (iv).
Subsec. (a)(13)(A). , § 4711(a)(1), added subpar. (A) and struck out former subpar. (A) which related to payment of hospital services, nursing facility services, and services in intermediate care facilities for mentally retarded by use of rates which account for various specified costs.
Subsec. (a)(13)(B). , § 4711(a)(1)–(3), redesignated subpar. (D) as (B), inserted “and” at end, and struck out former subpar. (B) which read as follows: “that the State shall provide assurances satisfactory to the Secretary that the payment methodology utilized by the State for payments to hospitals can reasonably be expected not to increase such payments, solely as a result of a change of ownership, in excess of the increase which would result from the application of section
of this title;”.
Subsec. (a)(13)(C). , § 4712(c)(1), which directed the repeal of subsec. (a)(13)(C), was repealed by , § 1(a)(6) [title VII, § 702(c)(1)]. See 2000 Amendment note above and Effective Date of 1997 Amendment note below.
, § 4712(b)(1), designated existing provisions as cl. (i) and added cl. (ii).
, § 4712(a), inserted “(or 95 percent for services furnished during fiscal year 2000, 90 percent for services furnished during fiscal year 2001, 85 percent for services furnished during fiscal year 2002, or 70 percent for services furnished during fiscal year 2003)” after “100 percent”.
, § 4711(a)(1), (2), (4), redesignated subpar. (E) as (C), struck out “and” at end, and struck out former subpar. (C) which read as follows: “that the State shall provide assurances satisfactory to the Secretary that the valuation of capital assets, for purposes of determining payment rates for nursing facilities and for intermediate care facilities for the mentally retarded, will not be increased (as measured from the date of acquisition by the seller to the date of the change of ownership), solely as a result of a change of ownership, by more than the lesser of—
“(i) one-half of the percentage increase (as measured over the same period of time, or, if necessary, as extrapolated retrospectively by the Secretary) in the Dodge Construction Systems Costs for Nursing Homes, applied in the aggregate with respect to those facilities which have undergone a change of ownership during the fiscal year, or
“(ii) one-half of the percentage increase (as measured over the same period of time) in the Consumer Price Index for All Urban Consumers (United States city average);”.
Subsec. (a)(13)(D), (E). , § 4711(a)(2), redesignated subpars. (D) and (E) as (B) and (C), respectively.
Subsec. (a)(13)(F). , § 4711(a)(5), struck out subpar. (F) which read as follows: “for payment for home and community care (as defined in section
of this title and provided under such section) through rates which are reasonable and adequate to meet the costs of providing care, efficiently and economically, in conformity with applicable State and Federal laws, regulations, and quality and safety standards;”.
Subsec. (a)(23). , § 4724(d), struck out “except as provided in subsection (g) of this section and in section
and except in the case of Puerto Rico, the Virgin Islands, and Guam,” after “(23)” and inserted before semicolon at end “, except as provided in subsection (g) of this section and in section
of this title, except that this paragraph shall not apply in the case of Puerto Rico, the Virgin Islands, and Guam, and except that nothing in this paragraph shall be construed as requiring a State to provide medical assistance for such services furnished by a person or entity convicted of a felony under Federal or State law for an offense which the State agency determines is inconsistent with the best interests of beneficiaries under the State plan”.
Subsec. (a)(23)(B). , § 4701(d)(1), substituted “, in section
of this title, and in section
of this title” for “and in section
of this title”.
, § 4701(b)(2)(A)(i), substituted “medicaid managed care organization” for “health maintenance organization”.
Subsec. (a)(25)(A)(ii). , § 4753(b), substituted “be integrated with, and be monitored as a part of the Secretary’s review of, the State’s mechanized claims processing and information retrieval systems required under section
of this title;” for the dash that followed “which plan shall” and struck out subcls. (I) and (II) which read as follows:
“(I) be integrated with, and be monitored as a part of the Secretary’s review of, the State’s mechanized claims processing and information retrieval system under section
of this title, and
“(II) be subject to the provisions of section
of this title relating to reductions in Federal payments for failure to meet conditions of approval, but shall not be subject to any other financial penalty as a result of any other monitoring, quality control, or auditing requirements;”.
Subsec. (a)(25)(G) to (I). , § 4741(a), redesignated subpars. (H) and (I) as (G) and (H), respectively, and struck out former subpar. (G) which read as follows: “that the State plan shall meet the requirements of section
of this title (relating to enrollment of individuals under group health plans in certain cases);”.
Subsec. (a)(26). , § 4751(a), substituted “provide, with respect to each patient” for “provide—
“(A) with respect to each patient”
and struck out subpars. (B) and (C) which read as follows:
“(B) for periodic inspections to be made in all mental institutions within the State by one or more medical review teams (composed of physicians and other appropriate health and social service personnel) of the care being provided to each person receiving medical assistance, including (i) the adequacy of the services available to meet his current health needs and promote his maximum physical well-being, (ii) the necessity and desirability of his continued placement in the institution, and (iii) the feasibility of meeting his health care needs through alternative institutional or noninstitutional services; and
“(C) for full reports to the State agency by each medical review team of the findings of each inspection under subparagraph (B), together with any recommendations;”.
Subsec. (a)(31). , § 4751(b), substituted “provide, with respect to each patient” for “provide—
“(A) with respect to each patient”
and struck out subpars. (B) and (C) which read as follows:
“(B) with respect to each intermediate care facility for the mentally retarded within the State, for periodic onsite inspections of the care being provided to each person receiving medical assistance, by one or more independent professional review teams (composed of a physician or registered nurse and other appropriate health and social service personnel), including with respect to each such person (i) the adequacy of the services available to meet his current health needs and promote his maximum physical well-being, (ii) the necessity and desirability of his continued placement in the facility, and (iii) the feasibility of meeting his health care needs through alternative institutional or noninstitutional services; and
“(C) for full reports to the State agency by each independent professional review team of the findings of each inspection under subparagraph (B), together with any recommendations;”.
Subsec. (a)(47). , § 4912(b)(1), inserted before semicolon at end “and provide for making medical assistance for items and services described in subsection (a) of section
of this title available to children during a presumptive eligibility period in accordance with such section”.
Subsec. (a)(57). , § 4701(b)(2)(A)(ii), substituted “medicaid managed care organization” for “health maintenance organization”.
Subsec. (a)(63). , § 4724(g)(1)(A), struck out “and” at end.
Subsec. (a)(64). , § 4724(g)(1)(B), which directed the amendment of par. (64) by substituting “; and” for the period at end, could not be executed because there was no period at end.
, § 4724(f), added par. (64).
Subsec. (a)(65). , § 4724(g)(1)(C), added par. (65).
Subsec. (e)(2)(A). , § 4709(2), which directed the amendment of subsec. (e)(2) by inserting “or by or through the case manager” before period at end, was executed by making insertion before period at end of subpar. (A) to reflect the probable intent of Congress.
, § 4709(1), substituted “who is enrolled with a medicaid managed care organization (as defined in section
of this title), with a primary care case manager (as defined in section
of this title),” for “who is enrolled with a qualified health maintenance organization (as defined in title XIII of the Public Health Service Act) or with an entity described in paragraph (2)(B)(iii), (2)(E), (2)(G), or (6) of section
of this title under a contract described in section
of this title”.
Subsec. (e)(12). , § 4731(a), added par. (12).
Subsec. (i)(1)(B). , § 4752(a), substituted “establish alternative remedies if the State demonstrates to the Secretary’s satisfaction that the alternative remedies are effective in deterring noncompliance and correcting deficiencies, and may provide” for “provide”.
Subsec. (j). , § 4702(b)(2), substituted “a numbered paragraph of” for “paragraphs (1) through (25)”.
Subsec. (l)(1)(D). , § 4731(b), inserted “(or, at the option of a State, after any earlier date)” after “children born after September 30, 1983”.
Subsec. (n). , § 4714(a)(1), designated existing provisions as par. (1) and added pars. (2) and (3).
Subsec. (p)(2). , § 4701(b)(2)(A)(iii), substituted “medicaid managed care organization” for “health maintenance organization” in introductory provisions.
Subsec. (r)(1). , § 4715(a), designated existing provisions as subpar. (A), inserted “, the treatment described in subparagraph (B) shall apply,” after “under such a waiver”, substituted “, and” for “and,” after “Federal Republic of Germany”, and added subpar. (B).
Subsec. (w)(2)(E). , § 4701(b)(2)(A)(iv), substituted “medicaid managed care organization” for “health maintenance organization”.
Subsec. (w)(5). added par. (5).
1996—Subsec. (a). , § 913, which directed substitution of “The Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc.” for “The First Church of Christ, Scientist, Boston, Massachusetts” in third sentence, was executed by making the substitution for “the First Church of Christ, Scientist, Boston, Massachusetts” in first undesignated closing par. to reflect the probable intent of Congress.
Subsec. (a)(25)(A)(i). struck out “including the use of information collected by the Medicare and Medicaid Coverage Data Bank under section
of this title and any additional measures” before “as specified by the Secretary in regulations)”.
Subsec. (a)(59). substituted “subsection (x)” for “subsection (v)”.
Subsec. (a)(63). , § 114(b), added par. (63).
Subsec. (c). , § 114(d)(1), substituted “if the State requires individuals described in subsection (l)(1) of this section to apply for assistance under the State program funded under part A of subchapter IV of this chapter as a condition of applying for or receiving medical assistance under this subchapter.” for “if—
“(1) 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 May 1, 1988; or
“(2) the State requires individuals described in subsection (l)(1) of this section to apply for benefits under such part as a condition of applying for, or receiving, medical assistance under this subchapter.”
Subsec. (e)(1)(B). , § 114(c), substituted “2001” for “1998”.
Subsec. (j). , § 108(k), substituted “1308(f)” for “1308(c)”.
1994—Subsec. (a)(10)(A)(ii)(XI). substituted “Commissioner of Social Security” for “Secretary”.
Subsec. (a)(11)(C), (53)(A). substituted “special supplemental nutrition program” for “special supplemental food program”.
1993—Subsec. (a)(10). , § 13603(c), in concluding provisions, substituted “services, or hospitals, (XI)” for “services, or hospitals; and (XI)” and “other individuals, (XII)” for “other individuals, and (XI)”, and inserted “, and” and subdiv. (XIII) before semicolon at end.
Subsec. (a)(10)(A)(ii)(XII). , § 13603(a), added subcl. (XII).
Subsec. (a)(1)(C)(iv). , § 13601(b)(1), substituted “paragraphs numbered (1) through (24)” for “paragraphs numbered (1) through (21)”.
Subsec. (a)(11). , § 13631(f)(1)(A), (B), in subpar. (B), struck out “effective July 1, 1969,” after “(B)” and “and” before “(ii)” and substituted “to the individual under section
of this title, and (iii) providing for coordination of information and education on pediatric vaccinations and delivery of immunization services” for “to him under section
of this title”, and in subpar. (C), inserted “, including the provision of information and education on pediatric vaccinations and the delivery of immunization services,” after “operations under this subchapter”.
Subsec. (a)(18). , § 13611(d)(1)(A), substituted “, transfers of assets, and treatment of certain trusts” for “and transfers of assets”.
Subsec. (a)(25)(A). , § 13622(a), substituted “insurers, group health plans (as defined in section 607(1) of the employee Retirement Income Security Act of 1974), service benefit plans, and health maintenance organizations)” for “insurers)” in introductory provisions.
Subsec. (a)(25)(A)(i). , § 13581(b)(2), substituted “(including the use of information collected by the Medicare and Medicaid Coverage Data Bank under section
of this title and any additional measures as specified” for “(as specified”.
Subsec. (a)(25)(H). , § 13622(b), added subpar. (H).
Subsec. (a)(25)(I). , § 13622(c), added subpar. (I).
Subsec. (a)(32)(D). , § 13631(e)(1), added subpar. (D).
Subsec. (a)(43)(A). , § 13631(f)(1)(C), inserted before comma at end “and the need for age-appropriate immunizations against vaccine-preventable diseases”.
Subsec. (a)(51). , § 13611(d)(1)(B), struck out “(A)” before “meet the requirements” and “, and (B) meet the requirement of section
of this title (relating to transfer of assets)” after “community spouses)”.
Subsec. (a)(54). , § 13623(a)(1), which directed amendment of par. (54) by striking “and” at end, could not be executed because “and” did not appear at end subsequent to amendment by , § 13602(c). See below.
, § 13602(c), amended par. (54) generally. Prior to amendment, par. (54) read as follows:
“(A) provide that, any formulary or similar restriction (except as provided in section
of this title) on the coverage of covered outpatient drugs under the plan shall permit the coverage of covered outpatient drugs of any manufacturer which has entered into and complies with an agreement under section
of this title, which are prescribed for a medically accepted indication (as defined in subsection 1396r–8(k)(6) of this title), and
“(B) comply with the reporting requirements of section
of this title and the requirements of subsections (d) and (g) of section
of this title; and”.
Subsec. (a)(55). , § 13623(a)(3), redesignated par. (55) relating to providing for adjusted payments as (56).
, § 13623(a)(2), amended par. (55) relating to providing for receipt and initial processing of applications by substituting semicolon for period at end of subpar. (B).
Subsec. (a)(56). , § 13623(a)(3), redesignated par. (55) relating to providing for adjusted payments as (56), transferred such par. to appear after par. (55) relating to providing for receipt and initial processing of applications, and substituted semicolon for period at end.
Subsec. (a)(57). , § 13623(a)(4), transferred par. (57) to appear after par. (56) as redesignated by , § 13623(a)(3). See above.
Subsec. (a)(58). , § 13623(a)(6), redesignated par. (58) relating to maintaining a list as (59).
, § 13623(a)(5), amended par. (58) relating to providing that a State develop a written description of advance directive laws by substituting a semicolon for period at end.
, § 13623(a)(4), transferred par. (58) relating to providing that a State develop a written description of advance directive laws to follow par. (57) which was transferred by , § 13623(a)(4), to appear after par. (56), as redesignated by , § 13623(a)(3). See above.
Subsec. (a)(59). , § 13625(a)(1), struck out “and” at end.
, § 13623(a)(6), redesignated par. (58), relating to maintaining a list, as (59), transferred such par. to appear after par. (58) relating to providing that a State develop a written description of advance directive laws, and substituted “; and” for period at end.
Subsec. (a)(60). , § 13623(a)(7), added par. (60).
Subsec. (a)(61). , § 13625(a), added par. (61).
Subsec. (a)(62). , § 13631(a), added par. (62).
Subsec. (j). , § 13601(b)(2), substituted “paragraphs (1) through (25)” for “paragraphs (1) through (22)”.
Subsec. (k). , § 13611(d)(1)(C), struck out subsec. (k) which read as follows:
“(k)(1) In the case of a medicaid qualifying trust (described in paragraph (2)), the amounts from the trust deemed available to a grantor, for purposes of subsection (a)(17) of this section, is the maximum amount of payments that may be permitted under the terms of the trust to be distributed to the grantor, assuming the full exercise of discretion by the trustee or trustees for the distribution of the maximum amount to the grantor. For purposes of the previous sentence, the term ‘grantor’ means the individual referred to in paragraph (2).
“(2) For purposes of this subsection, a ‘medicaid qualifying trust’ is a trust, or similar legal device, established (other than by will) by an individual (or an individual’s spouse) under which the individual may be the beneficiary of all or part of the payments from the trust and the distribution of such payments is determined by one or more trustees who are permitted to exercise any discretion with respect to the distribution to the individual.
“(3) This subsection shall apply without regard to—
“(A) whether or not the medicaid qualifying trust is irrevocable or is established for purposes other than to enable a grantor to qualify for medical assistance under this subchapter; or
“(B) whether or not the discretion described in paragraph (2) is actually exercised.
“(4) The State may waive the application of this subsection with respect to an individual where the State determines that such application would work an undue hardship.”
Subsec. (z). , § 13603(b), added subsec. (z).
1991—Subsec. (h). , § 3(a), struck out “to limit the amount of payment adjustments that may be made under a plan under this subchapter with respect to hospitals that serve a disproportionate number of low-income patients with special needs or” after “Secretary”.
Subsec. (t). , § 2(b)(1), substituted “Nothing” for “Except as provided in section
of this title, nothing” and “taxes of general applicability” for “taxes (whether or not of general applicability)”.
1990—Subsec. (a)(10). , § 4713(a)(1)(D), which directed amendment of par. (10) by adding subdiv. (XI), relating to medical assistance available to an individual described in subsection (u)(1), in the matter following subparagraph (E), was executed in the matter following subpar. (F) to reflect the probable intent of Congress and the intervening amendment by , § 4713(a)(1)(A)–(C), which added subpar. (F). See below. Direction by section
to strike “and” before “(X)” could not be executed because “and” did not appear after amendment by , § 4402(d)(1). See below.
, § 4402(d)(1), in closing provisions, struck out “and” at end of subdiv. (IX), inserted “and” at end of subdiv. (X), and added subdiv. (XI) relating to medical assistance to cover costs of premiums, etc.
Subsec. (a)(10)(A)(i)(VII). , § 4601(a)(1)(A), added subcl. (VII).
Subsec. (a)(10)(A)(ii)(IX). , § 4601(a)(1)(B), substituted “, clause (i)(VI), or clause (i)(VII)” for “or clause (i)(VI)”.
Subsec. (a)(10)(C)(iv). , §§ 4711(d)(2),
4755
(c)(1)(A), amended cl. (iv) identically, substituting “through (21)” for “through (20)”.
Subsec. (a)(10)(E)(iii). , § 4501(b), added cl. (iii).
Subsec. (a)(10)(F). , § 4713(a)(1)(A)–(C), added subpar. (F).
Subsec. (a)(13)(A). , § 4801(e)(1)(A), inserted “(including the costs of services required to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident eligible for benefits under this subchapter)” after “take into account the costs”.
Subsec. (a)(13)(E). , § 4704(e)(1), repealed , § 6402(c)(2). See 1989 Amendment note below.
, § 4704(a), substituted “prescribes” for “may prescribe” and “on the same methodology used under section
of this title” for “on such tests of reasonableness as the Secretary may prescribe in regulations under this subparagraph”.
Subsec. (a)(13)(F). , § 4711(c)(1)(A), added subpar. (F).
Subsec. (a)(17). , § 4723(b), inserted “, payments made to the State under section
of this title,” after “insurance premiums”.
Subsec. (a)(25)(G). , § 4402(a)(1), added subpar. (G).
Subsec. (a)(32)(C). , § 4708(a), added subpar. (C).
Subsec. (a)(41). , § 4754(a), substituted “shall promptly notify the Secretary and, in the case of a physician and notwithstanding paragraph (7), the State medical licensing board” for “shall promptly notify the Secretary”.
Subsec. (a)(54). , § 4401(a)(2), added par. (54).
Subsec. (a)(55). , § 4604(b), added par. (55) relating to providing for adjusted payments.
, § 4602(a), added par. (55) relating to providing for receipt and initial processing of applications.
Subsec. (a)(57). , § 4751(a)(1), added par. (57).
Subsec. (a)(58). , § 4752(c), added par. (58) relating to maintaining a list.
, § 4751(a)(1), added par. (58) relating to providing that a State develop a written description of advance directive laws.
Subsec. (e)(2)(A). , § 4732(b)(1), inserted “or with an eligible organization with a contract under section
of this title” after “section
of this title”.
Subsec. (e)(4). , § 4603(a)(1), inserted “(or would remain if pregnant)” after “remains”.
Subsec. (e)(6). , § 4603(a)(2), substituted “In” for “At the option of a State, in”, substituted “the woman shall be deemed to continue to be” for “the State plan may nonetheless treat the woman as being”, and inserted at end “The preceding sentence shall not apply in the case of a woman who has been provided ambulatory prenatal care pursuant to section
of this title during a presumptive eligibility period and is then, in accordance with such section, determined to be ineligible for medical assistance under the State plan.”
Subsec. (e)(11). , § 4402(c), added par. (11).
Subsec. (h). , § 4711(c)(1)(B), inserted before period at end “or to limit the amount of payment that may be made under a plan under this subchapter for home and community care”.
Subsec. (j). , §§ 4711(d)(1),
4755
(c)(1)(B), amended subsec. (j) identically substituting “through (22)” for “through (21)”.
Subsec. (l)(1)(C). , § 4601(a)(1)(C)(i), inserted “children” after “(C)”.
Subsec. (l)(1)(D). , § 4601(a)(1)(C)(ii), added subpar. (D) and struck out former subpar. (D) which read as follows: “at the option of the State, children born after September 30, 1983, who have attained 6 years of age but have not attained 7 or 8 years of age (as selected by the State),”.
Subsec. (l)(2)(C). , § 4601(a)(1)(C)(iii), added subpar. (C) and struck out former subpar. (C) which read as follows: “If a State elects, under subsection (a)(10)(A)(ii)(IX) of this section, to cover individuals not described in subparagraph (A) or (B) of paragraph (1), for purposes of that paragraph and with respect to individuals not described in such subparagraphs the State shall establish an income level which is a percentage (not more than 100 percent) of the income official poverty line described in subparagraph (A).”
Subsec. (l)(3). , § 4601(a)(1)(C)(iv), inserted “, (a)(10)(A)(i)(VII),” after “(a)(10)(A)(i)(VI)”.
Subsec. (l)(4)(A). , § 4601(a)(1)(C)(v), inserted “or subsection (a)(10)(A)(i)(VII) of this section” after “(a)(10)(A)(i)(VI) of this section”.
Subsec. (l)(4)(B). , § 4601(a)(1)(C)(vi), substituted “(a)(10)(A)(i)(VI), or (a)(10)(A)(i)(VII)” for “or (a)(10)(A)(i)(VI)”.
Subsec. (m)(1)(B). , § 4501(e)(2)(A), inserted “, except as provided in paragraph (2)(C)” after “program”.
Subsec. (m)(2)(C). , § 4501(e)(2)(B), added subpar. (C).
Subsec. (r)(1). , § 4715(a), inserted “there shall be disregarded reparation payments made by the Federal Republic of Germany and” after “under such a waiver”.
Subsec. (r)(2)(A). , § 4601(a)(1)(D), inserted “(a)(10)(A)(i)(VII),” after “(a)(10)(A)(i)(VI),”.
Subsec. (s). , § 4604(a), added subsec. (s).
Subsec. (t). , § 4701(b)(1), added subsec. (t).
Subsec. (u). , § 4713(a)(2), added subsec. (u).
Subsec. (v). , § 4724(a), added subsec. (v).
Subsec. (w). , § 4751(a)(2), added subsec. (w).
Subsec. (x). , § 4752(a)(1)(A), added subsec. (x).
Subsec. (y). , § 4755(a)(2), added subsec. (y).
1989—Subsec. (a)(9)(C). , § 6115(c), substituted “paragraphs (15) and (16)” for “paragraphs (14) and (15)”.
repealed , § 204(d)(3), 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.
Subsec.(a)(10)(A). , § 6405(b), substituted “(1) through (5), (17) and (21)” for “(1) through (5) and (17)” in introductory provisions.
Subsec. (a)(10)(A)(i)(VI). , § 6401(a)(1), added subcl. (VI).
Subsec. (a)(10)(A)(ii)(IX). , § 6401(a)(2), inserted “or clause (i)(VI)” after “clause (i)(IV)”.
Subsec. (a)(10)(E). , § 6408(d)(1), designated existing provisions as cl. (i) and added cl. (ii).
Subsec. (a)(11)(C). , § 6406(a)(1), added subpar. (C).
Subsec. (a)(13)(D). , § 6408(c)(1), substituted “in amounts no lower than the amounts, using the same methodology, used” for “in the same amounts, and using the same methodology, as used”, “in the case of” for “a separate rate may be paid for”, and “there shall be paid an additional amount, to take into account the room and board furnished by the facility, equal to at least 95 percent of the rate that would have been paid by the State under the plan for facility services in that facility for that individual” for “to take into account the room and board furnished by such facility”.
Subsec. (a)(13)(E). , § 6404(c), substituted “clause (B) or (C) of section
of this title” for “section
of this title provided by a rural health clinic”.
, § 6402(c)(2), which directed insertion of “, and for payment for services described in section
of this title under the plan,” after “provided by a rural health clinic under the plan”, was repealed by , § 4704(e)(1).
Subsec. (a)(30)(A). , § 6402(a), inserted before semicolon at end “and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area”.
Subsec. (a)(43)(A). , § 6403(d)(1), substituted “section
” for “section
”.
Subsec. (a)(43)(D). , § 6403(b), added subpar. (D).
Subsec. (a)(53). , § 6406(a)(2)–(4), added par. (53).
Subsec. (e)(7). , § 6401(a)(8), substituted “, (C), or (D)” for “or (C)” in introductory provisions.
Subsec. (f). , § 6411(e)(2), inserted “and section
of this title” after “section
of this title”.
, § 6411(a)(1), inserted “and except with respect to qualified medicare beneficiaries, qualified severely impaired individuals, and individuals described in subsection (m)(1) of this subsection” before “, no State”.
, § 6408(d)(4)(C), inserted “, except with respect to qualified disabled and working individuals (described in section
of this title),” after “section
of this title”.
Subsec. (l)(1)(C), (D). , § 6401(a)(3), added subpars. (C) and (D) and struck out former subpar. (C) which read as follows: “at the option of the State, children born after September 30, 1983, who have attained one year of age but have not attained 2, 3, 4, 5, 6, 7, or 8 years of age (as selected by the State),”.
Subsec. (l)(2)(A)(ii)(II). , § 6401(a)(4)(A), amended subcl. (II) generally. Prior to amendment, subcl. (II) read as follows: “July 1, 1990, is 100 percent.”
Subsec. (l)(2)(A)(iv). , § 6401(a)(4)(B), added cl. (iv).
Subsec. (l)(2)(B), (C). , § 6401(a)(5), (6), added subpar. (B), struck out “, or, if less, the percentage established under subparagraph (A)” after “not more than 100 percent” in former subpar. (B), and redesignated former subpar. (B) as (C).
Subsec. (l)(3). , § 6401(a)(6)(A), inserted “, (a)(10)(A)(i)(VI),” after “(a)(10)(A)(i)(IV)” in introductory provisions.
Subsec. (l)(3)(C). , § 6401(a)(6)(B), substituted “(C), or (D)” for “or (C)”.
Subsec. (l)(4)(A). , § 6401(a)(7)(A), inserted “and for children described in subsection (a)(10)(A)(i)(VI) of this section” after “(a)(10)(A)(i)(IV) of this section”.
Subsec. (l)(4)(B). , § 6401(a)(7)(B), inserted “or (a)(10)(A)(i)(VI)” after “(a)(10)(A)(i)(IV)”.
Subsec. (p)(2)(C). , § 6411(d)(3)(B), added subpar. (C).
Subsec. (r)(2)(A). , § 6401(a)(9), inserted “(a)(10)(A)(i)(VI),” after “(a)(10)(A)(i)(IV),” in introductory provisions.
1988—Subsec. (a)(9)(C). , § 204(d)(3), substituted “paragraphs (14) and (15)” for “paragraphs (13) and (14)”.
Subsec. (a)(10). , § 8434(b)(1), inserted “who is only entitled to medical assistance because the individual is such a beneficiary” after “section
of this title” in subdiv. (VIII) of closing provisions.
, § 302(a)(1)(C), inserted “(A)(i)(IV) or” before “(A)(ii)(X)” in subdiv. (VII) of closing provisions.
, § 302(b)(1), added subdiv. (X) in closing provisions.
Subsec. (a)(10)(A)(i)(I). , § 202(c)(4), substituted “section
of this title” for “section
of this title”.
Subsec. (a)(10)(A)(i)(IV). , § 302(a)(1)(A), added subcl. (IV).
Subsec. (a)(10)(A)(i)(V). , § 401(d)(1), added subcl. (V).
Subsec. (a)(10)(A)(ii)(VI). , § 411(k)(17)(B), substituted “(c), (d), or (e)” for “(c) or (d)” in two places.
Subsec. (a)(10)(A)(ii)(IX). , § 302(a)(1)(B), amended subcl. (IX) generally. Prior to amendment, subcl. (IX) read as follows: “subject to subsection (l)(4) of this section, who are described in subsection (l)(1) of this section;”.
Subsec. (a)(10)(A)(ii)(X). , § 301(e)(2)(A), struck out “subject to subsection (m)(3) of this section,” before “who are described”.
Subsec. (a)(10)(A)(ii)(XI). , § 411(k)(5)(B), substituted “may be more restrictive” for “are more restrictive” and a semicolon for the period at end.
, § 411(k)(5)(A), amended , § 4104, see 1987 Amendment note below.
Subsec. (a)(10)(C)(i)(III). , § 303(e)(1), substituted “no more restrictive than the methodology” for “the same methodology” in two places.
Subsec. (a)(10)(E). , § 301(e)(2)(B), struck out “subject to subsection (m)(3) of this section,” before “for making medical”.
, § 301(a)(1), struck out “at the option of a State, but” after “(E)”.
Subsec. (a)(13)(A). , § 411(l)(3)(J), as added by , § 608(d)(27)(H), amended , § 4211(h)(2)(B), see 1987 Amendment note below.
Subsec. (a)(13)(C). , § 411(l)(3)(H)(i), as amended by , § 608(d)(27)(F), amended , § 4211(h)(2)(C), see 1987 Amendment note below.
Subsec. (a)(13)(D). , § 411(l)(3)(H)(ii), (iii), as amended by , § 608(d)(27)(G), amended , § 4211(h)(2)(D), see 1987 Amendment note below.
Subsec. (a)(15). , § 301(e)(2)(C), as added by , § 608(d)(14)(I)(iii), struck out par. (15) which read as follows: “in the case of eligible individuals 65 years of age or older who are not qualified medicare beneficiaries (as defined in section
of this title) but are covered by either or both of the insurance programs established by subchapter XVIII of this chapter, provide where, under the plan, all of any deductible, cost sharing, or similar charge imposed with respect to such individual under the insurance program established by such subchapter is not met, the portion thereof which is met shall be determined on a basis reasonably related (as determined in accordance with standards approved by the Secretary and included in the plan) to such individual’s income or his income and resources;”.
Subsec. (a)(17). , § 411(k)(10)(G)(ii), amended directory language of , § 4118(h)(1), see 1987 Amendment note below.
, § 301(e)(2)(D), formerly § 301(e)(2)(C), as redesignated and amended by , § 608(d)(14)(I)(i), substituted “(m)(3), and (m)(4)” for “(m)(4), and (m)(5)”.
Subsec. (a)(28)(D)(i). , § 411(l)(3)(E), substituted “section
of this title” for “section
of this title (relating to implementation of nursing facility requirements, including paragraph (6)(B), relating to specification of resident assessment instrument)”.
Subsec. (a)(33)(B). , § 411(l)(6)(C), substituted “section
of this title” for “section
of this title”.
Subsec. (a)(44)(A). , § 411(l)(6)(D), amended , § 4212(e)(1)(B), see 1987 Amendment note below.
Subsec. (a)(50). , § 411(n)(4), formerly § 411(n)(3), as redesignated by , § 608(d)(28), added , § 9119(d)(1)(A), see 1987 Amendment note below.
Subsec. (a)(51). , § 303(e)(2)–(4), added par. (51).
Subsec. (a)(52). , § 303(a)(2), added par. (52).
Subsec. (c). , § 302(c)(1), amended subsec. (c) generally. Prior to amendment, subsec. (c) read as follows: “Notwithstanding subsection (b) of this section, the Secretary shall not approve any State plan for medical assistance if he determines that the approval and operation of the plan will result in a reduction in aid or assistance in the form of money payments (other than so much, if any, of the aid or assistance in such form as was, immediately prior to the effective date of the State plan under this subchapter, attributable to medical needs) provided for eligible individuals under a plan of such State approved under subchapter I, X, XIV, or XVI of this chapter, or part A of subchapter IV of this chapter.”
Subsec. (d). , § 411(k)(7)(C), amended , § 4113(b)(2)(ii), see 1987 Amendment note below.
Subsec. (e)(1). , § 303(b)(1), designated existing provisions as subpar. (A), inserted “subject to subparagraph (B)” after “January 1, 1974,”, and added subpar. (B).
Subsec. (e)(2)(A). , § 411(k)(7)(D), repealed , § 4113(d)(2), see 1987 Amendment note below.
, § 411(k)(7)(B), amended , § 4113(a)(2), see 1987 Amendment note below.
Subsec. (e)(6). , § 302(e)(1), amended par. (6) generally. Prior to amendment, par. (6) read as follows: “At the option of a State, if a State plan provides medical assistance for individuals under subsection (a)(10)(A)(ii)(IX) of this section, the plan may provide that any woman described in such subsection and subsection (l)(1)(A) of this section shall continue to be treated as an individual described in subsection (a)(10)(A)(ii)(IX) of this section without regard to any change in income of the family of which she is a member until the end of the 60-day period beginning on the last day of her pregnancy.”
Subsec. (e)(7). , § 302(e)(2), in introductory provisions, substituted “In the case” for “If a State plan provides medical assistance for individuals under subsection (a)(10)(A)(ii)(IX) of this section, in the case” and inserted “or paragraph (2) of section
of this title”, and, in concluding provisions, substituted “such respective provision” for “subsection (a)(10)(A)(ii)(IX) of this section and subsection (l)(1) of this section”.
Subsec. (e)(10). , § 303(d), added par. (10).
Subsec. (f). , § 411(k)(10)(G)(iv), added , § 4118(h)(2), see 1987 Amendment note below.
Subsec. (i). , § 411(l)(8)(C), amended , § 4213(b)(1), see 1987 Amendment note below.
Subsec. (l)(1). , § 302(e)(3)(A), inserted “any of subclauses (I) through (III) of” after “described in” in concluding provisions.
Subsec. (l)(1)(C). , § 302(a)(2)(A), inserted “at the option of the State,” after “(C)” and struck out “and” after “1983,”.
Subsec. (l)(2)(A). , § 302(a)(2)(B), as amended by , § 608(d)(15)(A), designated existing provisions as cl. (i), substituted “(not less than the percentage provided under clause (ii) and not more than 185 percent)” for “(not more than 185 percent)”, and added cls. (ii) and (iii).
Subsec. (l)(2)(A)(ii). , § 608(d)(15)(B)(i), in introductory provisions, substituted “The” for “Subject to clause (iii), the”, and in subcl. (I), inserted “or, if greater, the percentage provided under clause (iii),”.
Subsec. (l)(2)(A)(iii). , § 608(d)(15)(B)(ii), substituted “clause (ii)(I)” for “clause (ii)” in introductory provisions and concluding provisions.
Subsec. (l)(3). , § 302(e)(3)(B), inserted “(a)(10)(A)(i)((IV) or” after “of subsection” in introductory provisions.
Subsec. (l)(4). , § 302(c)(2), (d), added par. (4) and struck out former par. (4) which read as follows:
“(A) A State plan may not elect the option of furnishing medical assistance to individuals described in subsection (a)(10)(A)(ii)(IX) of this section unless the State has in effect, under its plan established under part A of subchapter IV of this chapter, payment levels that are not less than the payment levels in effect under its plan on July 1, 1987.
“(B)(i) A State may not elect, under subsection (a)(10)(A)(ii)(IX) of this section, to cover only individuals described in paragraph (1)(A) or to cover only individuals described in paragraph (1)(B).
“(ii) A State may not elect, under subsection (a)(10)(A)(ii)(IX) of this section, to cover individuals described in subparagraph (C) of paragraph (1) unless the State has elected, under such subsection, to cover individuals described in the preceding subparagraphs of such paragraph.
“(C) A State plan may not provide, in its election of the option of furnishing medical assistance to individuals described in paragraph (1), that such individuals must apply for benefits under part A of subchapter IV of this chapter as a condition of applying for, or receiving, medical assistance under this subchapter.”
Subsec. (m)(3). , § 301(e)(2)(E), formerly § 301(e)(2)(D), as redesignated and amended by , § 608(d)(14)(I)(ii), redesignated par. (4) as (3) and struck out former par. (3) which read as follows: “A State plan may not provide coverage for individuals under subsection (a)(10)(A)(ii)(X) of this section or coverage under subsection (a)(10)(E) of this section, unless the plan provides coverage of some or all of the individuals described in subsection (l)(1) of this section.”
Subsec. (m)(4). , § 301(e)(2)(E), formerly § 301(e)(2)(D), as redesignated and amended by , § 608(d)(14)(I)(ii), redesignated par. (5) as (4). Former par. (4) redesignated (3).
Subsec. (m)(4)(A). , § 8434(b)(2), substituted “section
” for “section
”.
Subsec. (m)(5). , § 301(e)(2)(E), formerly § 301(e)(2)(D), as redesignated and amended by , § 608(d)(14)(I)(ii), redesignated par. (5) as (4).
Subsec. (o). , § 411(n)(2), made technical correction to directory language of , § 9115(b), see 1987 Amendment note below.
Subsec. (q). , § 411(n)(4), formerly § 411(n)(3), as redesignated by , § 608(d)(28), added , § 9119(d)(1)(B), see 1987 Amendment note below.
Subsec. (r). , § 303(e)(5), designated existing provisions as par. (1), redesignated subpars. (A) and (B) as cls. (i) and (ii), respectively, and added par. (2).
, § 303(d), added subsec. (r).
Subsec. (r)(2)(A). , § 608(d)(16)(C), substituted “, or (f) of this section or under section
of this title” for “of this section, or under subsection (f) of this section” in introductory provisions.
1987—Subsec. (a)(9)(C). , § 4072(d), substituted “paragraphs (13) and (14)” for “paragraphs (12) and (13)”.
Subsec. (a)(10). , § 4101(e)(1), substituted “postpartum, and family planning services” for “and postpartum services” in subdiv. (VII) of closing provisions.
Subsec. (a)(10)(A)(ii)(VI). , § 4211(h)(1)(A), substituted “nursing facility or intermediate care facility for the mentally retarded” for “skilled nursing facility or intermediate care facility”.
, § 4102(b)(1), substituted “subsection (c) or (d) of section
of this title” for “section
of this title” in two places.
Subsec. (a)(10)(A)(ii)(IX), (X). , § 4118(p)(1), (2), realigned margin of subcls. (IX) and (X).
Subsec. (a)(10)(A)(ii)(XI). , § 4104, as amended by , § 411(k)(5)(A), added subcl. (XI).
Subsec. (a)(10)(C)(iv). , § 4211(h)(1)(B), substituted “in an intermediate care facility” for “intermediate care facility services”.
Subsec. (a)(10)(D). , § 4211(h)(1)(C), struck out “skilled” before “nursing”.
Subsec. (a)(13)(A). , § 4211(h)(2)(B), as amended by , § 411(l)(3)(J), as added by , § 608(d)(27)(H), substituted “, nursing facility, and intermediate care facility for the mentally retarded and” for “, skilled nursing facility, and intermediate care facility and”.
, § 4211(h)(2)(A), substituted “services, nursing facility services, and services in an intermediate care facility for the mentally retarded” for “, skilled nursing facility, and intermediate care facility services”.
, § 4211(b)(1)(A), inserted “which, in the case of nursing facilities, take into account the costs of complying with subsections (b) (other than paragraph (3)(F) thereof), (c), and (d) of section
of this title and provide (in the case of a nursing facility with a waiver under section
of this title) for an appropriate reduction to take into account the lower costs (if any) of the facility for nursing care,” after second reference to “State”.
Subsec. (a)(13)(C). , § 4211(h)(2)(C), as amended by , § 411(l)(3)(H)(i), as amended by , § 608(d)(27)(F), substituted “nursing facilities and for intermediate care facilities for the mentally retarded” for “skilled nursing facilities and intermediate care facilities” in introductory provisions.
Subsec. (a)(13)(D). , § 4211(h)(2)(D), as amended by , § 411(l)(3)(H)(ii), (iii), as amended by , § 608(d)(27)(G), substituted “nursing facility or intermediate care facility for the mentally retarded” for “skilled nursing facility or intermediate care facility” and “nursing facility services or services in an intermediate care facility for the mentally retarded” for “skilled nursing facility services or intermediate care facility services”.
Subsec. (a)(17). , § 4118(p)(3), substituted “subsections (l)(3), (m)(4), and (m)(5) of this section” for “subsection (l)(3) of this section”.
, § 4118(h)(1), as amended by , § 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. (a)(23). , § 4113(c)(1), designated provision relating to the obtaining of medical assistance by an eligible individual as cl. (A) and added cl. (B).
, § 8(f)(1), inserted “subsection (g) of this section and in” after “as provided in”.
Subsec. (a)(28). , § 4211(b)(1)(B), amended par. (28) generally. Prior to amendment, par. (28) read as follows: “provide that any skilled nursing facility receiving payments under such plan must satisfy all of the requirements contained in section
of this title, except that the exclusion contained therein with respect to institutions which are primarily for the care and treatment of mental diseases shall not apply for purposes of this subchapter;”.
Subsec. (a)(30)(B)(i), (ii). , § 4211(h)(3), substituted “intermediate care facility for the mentally retarded” for “skilled nursing facility, intermediate care facility”.
Subsec. (a)(30)(C). , § 4118(p)(4), substituted “use” for “provide”.
, § 4113(b)(1), inserted “, an entity which meets the requirements of section
of this title, as determined by the Secretary,” before “or a private accreditation body”.
Subsec. (a)(31). , § 4212(d)(2), in introductory provision substituted “services in an intermediate care facility for the mentally retarded (where” for “skilled nursing facility services (and with respect to intermediate care facility services where” and in subpar. (B) substituted “intermediate care facility for the mentally retarded” for “skilled nursing or intermediate care facility”.
Subsec. (a)(33)(B). , § 4212(d)(3), inserted “, except as provided in section
of this title,” after “(B) that”.
Subsec. (a)(38). , § 8(f)(2), substituted “the information described in section
of this title” for “respectively, (A) full and complete information as to the ownership of a subcontractor (as defined by the Secretary in regulations) with whom such entity has had, during the previous twelve months, business transactions in an aggregate amount in excess of $25,000, and (B) full and complete information as to any significant business transactions (as defined by the Secretary in regulations), occurring during the five-year period ending on the date of such request, between such entity and any wholly owned supplier or between such entity and any subcontractor”.
Subsec. (a)(39). , § 8(f)(3), substituted “exclude” for “bar”, “individual or entity” for “person” in two places, and inserted reference to section
of this title.
Subsec. (a)(42). , § 4118(m)(1)(B), struck out “(A)” after “provide”, the comma after “under the plan”, and cls. (B) and (C) which read as follows: “(B) that such audits, for such entities also providing services under subchapter XVIII of this chapter, will be coordinated and conducted jointly (to such extent and in such manner as the Secretary shall prescribe) with audits conducted for purposes of such subchapter, and (C) for payment of such proportion of costs of each such common audit as is determined under methods specified by the Secretary under section
of this title”.
Subsec. (a)(44). , § 4212(e)(1)(A), substituted “services in an intermediate care facility for the mentally retarded” for “skilled nursing facility services, intermediate care facility services”.
Subsec. (a)(44)(A). , § 4218(a)(1), substituted “physician (or, in the case of skilled nursing facility services or intermediate care facility services, a physician, or a nurse practitioner or clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician) certifies” for “physician certifies” and “a physician, a physician assistant under the supervision of a physician, or, in the case of skilled nursing facility services or intermediate care facility services, a physician, or a nurse practitioner or clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician,” for “the physician, or a physician assistant or nurse practitioner under the supervision of a physician,”.
, § 4212(e)(1)(B), as amended by , § 411(l)(6)(D), substituted “that are services provided in an intermediate care facility for the mentally retarded” for “that are intermediate care facility services provided in an institution for the mentally retarded”.
Subsec. (a)(44)(B). , § 4218(a)(2), substituted “a physician, or, in the case of skilled nursing facility services or intermediate care facility services, a physician, or a nurse practitioner or clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician;” for “a physician;”.
Subsec. (a)(46). , § 5(a)(1), struck out “and” after “title;”.
Subsec. (a)(47). , § 5(a)(2), (3), substituted semicolon for period at end of par. (47), relating to ambulatory prenatal care and redesignated par. (47), relating to cards evidencing eligibility, as (48).
Subsec. (a)(48). , § 5(a)(3), redesignated par. (47), relating to cards evidencing eligibility for medical assistance, as (48), and substituted “address; and” for “address.”
Subsec. (a)(49). , § 5(a)(4), added par. (49).
Subsec. (a)(50). , § 9119(d)(1)(A), as added by , § 411(n)(4), formerly § 411(n)(3), as redesignated by , § 608(d)(28), added par. (50).
Subsec. (d). , § 4113(b)(2)(i), inserted “an entity which meets the requirements of section
of this title, as determined by the Secretary, for the performance of the quality review functions described in subsection (a)(30)(C) of this section, or” after “contracts with”.
, § 4113(b)(2)(ii), as amended by , § 411(k)(7)(C), substituted “an entity or organization” for “organization (or organizations)” in two places.
Subsec. (e)(2)(A). , § 4113(d)(2), which directed substitution of “subparagraph (B)(iii), (E), or (G) of section
of this title” for “section
of this title”, was repealed by , § 411(k)(7)(D).
, § 4113(a)(2), as amended by , § 411(k)(7)(B), substituted “paragraph (2)(B)(iii), (2)(E), (2)(G), or (6) of section
of this title” for “section
of this title”.
, § 4113(c)(2), substituted “but, except for benefits furnished under section
of this title, only” for “but only”.
Subsec. (e)(3)(B)(i). , § 4211(h)(4), substituted “nursing facility, or intermediate care facility for the mentally retarded” for “skilled nursing facility, or intermediate care facility”.
Subsec. (e)(3)(C). , § 4118(c)(1), substituted “for medical assistance under the State plan under this subchapter” for “to have a supplemental security income (or State supplemental) payment made with respect to him under subchapter XVI of this chapter”.
Subsec. (e)(4). , § 4101(a)(2), inserted sentence at end relating to child’s medical assistance eligibility identification number and submission and payment of claims under such number during period in which a child is eligible for assistance.
Subsec. (e)(5). , § 4101(e)(2), substituted “through the end of the month in which the 60-day period (beginning on the last day of her pregnancy) ends” for “until the end of the 60-day period beginning on the last day of her pregnancy”.
Subsec. (e)(7). , § 4101(b)(2)(B), substituted “subparagraph (B) or (C)” for “subparagraph (B), (C), (D), (E), or (F)”.
Subsec. (e)(9). , § 4118(p)(6), realigned margins of par. (9).
Subsec. (e)(9)(A)(iii). , § 4211(h)(5)(A), substituted “nursing facility, or intermediate care facility for the mentally retarded” for “skilled nursing facility, or intermediate care facility,”.
Subsec. (e)(9)(B). , § 4211(h)(5)(B), substituted “nursing facilities, or intermediate care facilities for the mentally retarded” for “skilled nursing facilities, or intermediate care facilities”.
Subsec. (f). , § 4118(h)(2), as added by , § 411(k)(10)(G)(iv), inserted “regardless of whether such expenses are reimbursed under another public program of the State or political subdivision thereof” after “State law” in first sentence.
Subsec. (i). , § 4213(b)(1), as amended by , § 411(l)(8)(C), in par. (1), substituted “intermediate care facility for the mentally retarded” for “skilled nursing facility or intermediate care facility” and “the requirements for such a facility under this subchapter” for “the provisions of section
of this title or section
of this title, respectively,”, and in pars. (2) and (3), substituted “the requirements for such a facility under this subchapter” for “the provisions of section
of this title or section
of this title (as the case may be)”.
Subsec. (j). , § 4116, inserted reference to Northern Mariana Islands in two places.
Subsec. (l). , § 7, redesignated subsec. (l), relating to disregarding certain benefits for purposes of determining post-eligibility contributions, as (o).
Subsec. (l)(1). , § 4118(p)(7), made technical corrections in introductory provisions and substituted “and whose” for “, whose” in closing provisions.
Subsec. (l)(1)(C). , § 4101(c)(2), substituted “5, 6, 7, or 8 years of age” for “or 5 years of age”.
, § 4101(b)(1), added subpar. (C). Former subpar. (C), which related to children who have attained one year of age but have not attained two years of age, was struck out.
Subsec. (l)(1)(D) to (F). , § 4101(b)(1)(B), struck out subpars. (D) to (F) which related to children who have attained two years of age but have not attained three years of age, children who have attained three years of age but have not attained four years of age, and children who have attained four years of age but have not attained five years of age, respectively.
Subsec. (l)(2). , § 4118(p)(8), struck out “nonfarm” after second reference to “income” in subpar. (A).
, § 4101(a)(1)(A), designated existing provisions as subpar. (A), inserted “with respect to individuals described in subparagraph (A) or (B) of that paragraph”, substituted “185 percent” for “100 percent”, and added subpar. (B).
Subsec. (l)(3)(C). , § 4101(b)(2)(A)(i), substituted “subparagraph (B) or (C)” for “subparagraph (B), (C), (D), (E), or (F)”.
Subsec. (l)(3)(D). , § 4101(a)(1)(B), inserted “appropriate” after “applied is the”.
Subsec. (l)(3)(E). , § 4101(e)(3), inserted “(except to the extent such methodology is inconsistent with clause (D) of subsection (a)(17) of this section)” after “subchapter IV of this chapter”.
Subsec. (l)(4)(A). , § 4101(e)(4), substituted “July 1, 1987” for “April 17, 1986”.
Subsec. (l)(4)(B)(ii). , § 4101(b)(2)(A)(ii), substituted “subparagraph (C)” for “subparagraph (C), (D), (E), or (F)”.
Subsec. (l)(4)(C). , § 4101(e)(5), added subpar. (C).
Subsec. (m)(2)(A). , § 4118(p)(8), struck out “nonfarm” before “official”.
Subsec. (o). , § 9115(b), as amended by , § 411(n)(2), substituted “subparagraph (E) or (G) of section
of this title” for “section
of this title”.
, § 7, redesignated subsec. (l), relating to disregarding certain benefits for purposes of determining post-eligibility contributions, as (o).
Subsec. (p). , § 7, added subsec. (p).
Subsec. (q). , § 9119(d)(1)(B), as added by , § 411(n)(4), formerly § 411(n)(3), as redesignated by , § 608(d)(28), added subsec. (q).
1986—Subsec. (a). , § 9406(b), inserted at end “Notwithstanding paragraph (10)(B) or any other provision of this subsection, a State plan shall provide medical assistance with respect to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law only in accordance with section
of this title.”
, § 9529(a)(1), inserted at end “For purposes of this subchapter, any child who meets the requirements of paragraph (1) or (2) of section
of this title shall be deemed to be a dependent child as defined in section
of this title and shall be deemed to be a recipient of aid to families with dependent children under part A of subchapter IV of this chapter in the State where such child resides.”
Subsec. (a)(9)(C). , § 9320(h)(3), substituted “paragraphs (12) and (13)” for “paragraphs (11) and (12)”.
Subsec. (a)(10). , § 9408(b), added cl. (IX) at end.
, § 9403(c), added cl. (VIII) at end.
, § 9401(c), added cl. (VII) at end.
, § 9505(b)(1), added cl. (VI) at end.
, § 9501(b), added cl. (V) at end.
Subsec. (a)(10)(A)(i)(I). , § 12305(b)(3), substituted “, 606(h), or 673(b) of this title” for “or 606(h) of this title”.
Subsec. (a)(10)(A)(i)(II). , § 9404(a), inserted “or who are qualified severely impaired individuals (as defined in section
of this title)” after “subchapter XVI of this chapter”.
Subsec. (a)(10)(A)(ii)(V). , § 9510(a), inserted “for a period of not less than 30 consecutive days (with eligibility by reason of this subclause beginning on the first day of such period)” after “are in a medical institution”.
Subsec. (a)(10)(A)(ii)(VII). , § 1895(c)(7)(A), realigned margin of subcl. (VII).
, § 9505(b)(2), added subcl. (VII).
Subsec. (a)(10)(A)(ii)(VIII). , § 1895(c)(7)(B), realigned margins of subcl. (VIII).
, § 9529(b)(1), added subcl. (VIII).
Subsec. (a)(10)(A)(ii)(IX). , § 9401(a), added subcl. (IX).
Subsec. (a)(10)(A)(ii)(X). , § 9402(a)(1), added subcl. (X).
Subsec. (a)(10)(C). , § 9403(g)(1), inserted “or (E)” after “subparagraph (A)” in introductory text.
Subsec. (a)(10)(C)(iv). , § 9408(c)(3), substituted “through (20)” for “through (19)”.
, § 1895(c)(3)(C), substituted “through (19)” for “through (18)”.
, § 9505(d)(2), substituted “through (18)” for “through (17)”.
Subsec. (a)(10)(E). , § 9403(a), added subpar. (E).
Subsec. (a)(13)(B). , § 9509(a)(1), substituted “hospitals” for “hospitals, skilled nursing facilities, and intermediate care facilities”.
Subsec. (a)(13)(C). , § 9509(a)(4), added subpar. (C). Former subpar. (C) redesignated (D).
, § 9505(c)(1), added subpar. (C). Former subpar. (C) redesignated (D).
Subsec. (a)(13)(D). , § 1895(c)(1), inserted “and” after “facility;”.
, § 9435(b)(1), inserted “and for payment of amounts under section
of this title” before first semicolon.
, § 9509(a)(2), (3), redesignated former subpar. (C) as (D), and struck out “and” at the end thereof. Former subpar. (D) redesignated (E).
, § 9505(c)(1)(B), redesignated former subpar. (C) as (D).
Subsec. (a)(13)(E). , § 9509(a)(3), redesignated former subpar. (D) as (E).
Subsec. (a)(15). , § 9403(g)(4)(A), inserted “are not qualified medicare beneficiaries (as defined in section
of this title) but” after “older who”.
Subsec. (a)(17). , § 9401(e)(1), inserted “except as provided in subsection (l)(3) of this section” after “(17)”.
Subsec. (a)(25). , § 9503(a)(1), amended par. (25) generally. Prior to amendment, par. (25) read as follows: “provide (A) that the State or local agency administering such plan will take all reasonable measures to ascertain the legal liability of third parties to pay for care and services (available under the plan) arising out of injury, disease, or disability, (B) that where the State or local agency knows that a third party has such a legal liability such agency will treat such legal liability as a resource of the individual on whose behalf the care and services are made available for purposes of paragraph (17)(B), and (C) that in any case where such a legal liability is found to exist after medical assistance has been made available on behalf of the individual and where the amount of reimbursement the State can reasonably expect to recover exceeds the costs of such recovery, the State or local agency will seek reimbursement for such assistance to the extent of such legal liability;”.
Subsec. (a)(30)(C). , § 9431(a), added subpar. (C).
Subsec. (a)(47). added par. (47) relating to cards evidencing eligibility for medical assistance.
, § 9407(a), added par. (47) relating to ambulatory prenatal care.
Subsec. (b)(2). , § 9405, inserted before semicolon “, regardless of whether or not the residence is maintained permanently or at a fixed address”.
Subsec. (d). , § 9431(b)(1), inserted “(including quality review functions described in subsection (a)(30)(C) of this section)” after “medical or utilization review functions”.
Subsec. (e)(2)(A). , § 9517(b)(1), inserted reference to an entity described in section
of this title, and substituted “such organization or entity” for “such organization”.
Subsec. (e)(2)(B). , § 9517(b)(2), substituted “an organization or entity” for “a health maintenance organization” and “the organization or entity” for “the organization”.
Subsec. (e)(5). , § 9501(c), added par. (5).
Subsec. (e)(6), (7). , § 9401(d), added pars. (6) and (7).
Subsec. (e)(8). , § 9403(f)(2), added par. (8).
Subsec. (e)(9). , § 9408(a), added par. (9).
Subsec. (f). , § 7(b), substituted “subsection (e) of this section and section
of this title” for “subsection (e) of this section”.
Subsec. (g). , § 9503(a)(2), added subsec. (g).
Subsec. (h). , § 9433(a), added subsec. (d) to section 2173 of in turn which added subsec. (h) of this section. See 1981 Amendment note below.
Subsec. (j). , § 9408(c)(2), substituted “(21)” for “(20)”.
, § 1895(c)(3)(B), substituted “(20)” for “(19)”.
, § 9505(d)(1), substituted “(19)” for “(18)”.
Subsec. (k). , § 9506(a), added subsec. (k).
Subsec. (l). , § 3(b), added subsec. (l) relating to disregarding of certain benefits for purposes of determining post-eligibility contributions.
, § 9401(b), added subsec. (l) relating to description of group.
Subsec. (m). , § 9402(a)(2), (b), added subsec. (m).
Subsec. (m)(3). , § 9403(f)(1)(A), which directed insertion of “or coverage under subsection (a)(10)(E) of this section” after “subsection (a)(10)(A)(ii)(IX) of this section”, was executed by making the insertion after “subsection (a)(10)(A)(ii)(X) of this section” as the probable intent of Congress.
Subsec. (m)(5). , § 9403(f)(1)(B), added par. (5).
Subsec. (n). , § 9403(e), added subsec. (n).
1984—Subsec. (a)(9)(C). , § 2373(b)(1), realigned margin of subpar. (C).
Subsec. (a)(10)(A). , § 2373(b)(2), realigned margins of subpar. (A).
Subsec. (a)(10)(A)(i). , § 2361(a), amended cl. (i) generally. Prior to the amendment cl. (i) read as follows: “all individuals receiving aid or assistance under any plan of the State approved under subchapter I, X, XIV, or XVI of this chapter, or part A or part E of subchapter IV of this chapter (including pregnant women deemed by the State to be receiving such aid as authorized in section
of this title and individuals considered by the State to be receiving such aid as authorized under section
of this title), or with respect to whom supplemental security income benefits are being paid under subchapter XVI of this chapter; and”.
Subsec. (a)(10(A)(i)(I). , § 20(c), substituted “section
or
of this title” for “section
of this title”.
Subsec. (a)(13)(A). , § 2373(b)(3), made clarifying amendment by striking out “(A)” and all that follows through “hospital” the first place it appears and inserting in lieu thereof “(A) for payment (except where the State agency is subject to an order under section
of this title) of the hospital”, resulting in no change in text.
Subsec. (a)(13)(B), (C). , § 2314(b), added subpar. (B) and redesignated former subpar. (B) as (C).
Subsec. (a)(20)(B). , § 2373(b)(4), substituted “periodic” for “periodical”.
Subsec. (a)(20)(C). , § 2373(b)(5), struck out reference to section
and (ii) of this title.
Subsec. (a)(26). , § 2368(b), in amending par. (26) generally, revised existing provisions to continue their application to review of inpatient mental hospital service programs, and to sever provisions relating to review of skilled nursing programs. See par. (31) of this section.
Subsec. (a)(26)(B)(ii). , § 3(a)(7), repealed the amendment made by , § 2373(b)(6). See below.
, § 2373(b)(6), provided that cl. (ii) is amended by substituting “facilities” for “homes”.
Subsec. (a)(26)(C). , § 3(b)(10), realigned margin of subpar. (C).
Subsec. (a)(28). , § 2335(e), struck out “and tuberculosis” after “mental diseases”.
Subsec. (a)(30). , § 2363(a)(1)(A), designated existing provisions as subpar. (A) and added subpar. (B).
Subsec. (a)(31). , § 2368(a), in amending par. (31) generally, revised existing provisions to cover review of skilled nursing facilities.
Subsec. (a)(33)(A). , § 2373(b)(7), substituted “second sentence” for “penultimate sentence”.
Subsec. (a)(42). , § 2373(b)(8), substituted “subchapter” for “part” after “audits conducted for purposes of such”.
Subsec. (a)(43). , § 2303(g)(1), redesignated par. (44) as (43), and struck out former par. (43) which provided that if the State plan makes provision for payment to a physician for laboratory services the performance of which such physician, or other physician with whom he shares his practice, did not personally perform or supervise, the plan include provision to insure that payment for such services not exceed the payment authorized by section
of this title.
Subsec. (a)(44). , § 2363(a)(1)(B), added par. (44).
, § 2303(g)(1)(C), redesignated former par. (44) as (43).
Subsec. (a)(45). , § 2367(a), added par. (45).
Subsec. (a)(46). , § 2651(c), added par. (46).
Subsec. (a), foll. par. (46). , § 2373(b)(9), substituted “The provisions of paragraph (9)(A), (31), and (33) and of section
of this title shall not apply to” for “For purposes of paragraph (9)(A), (26), (31), and (33), and of section
of this title, the term ‘skilled nursing facility’ and ‘nursing home’ do not include”.
Subsec. (e)(4). , § 2362(a), added par. (4).
Subsec. (f). , § 2373(b)(10), substituted “paragraph (10)(A)” and “paragraph (10)(C)” for “clause (10)(A)” and “clause (10)(C)”, respectively, wherever appearing.
1982—Subsec. (a)(10)(A). , § 137(b)(7), redesignated existing provisions as provisions preceding cl. (i) and cl. (i), and added cl. (ii).
Subsec. (a)(10)(C), (D). , § 137(a)(3), amended directory language of , § 2171(a)(3), to correct an error, and did not involve any change in text. See 1981 Amendment note below.
Subsec. (a)(10)(C)(i). , § 137(b)(8), substituted “, (II)” for “and (II)”, and added subcl. (III).
Subsec. (a)(10)(C)(ii)(I). , § 137(b)(9), substituted “under the age of 18 who (but for income and resources) would be eligible for medical assistance as an individual described in subparagraph (A)(i)” for “described in section
of this title”.
Subsec. (a)(10). , § 131(c), formerly § 131(b), as redesignated by , § 309(a)(8), in provisions following subpar. (D) added cl. (IV).
Subsec. (a)(14). , § 131(a), substituted provisions that a State plan for medical assistance must provide that enrollment fees, premiums, or similar charges, and deductions, cost sharing, or similar charges, may be imposed only as provided in section
of this title for provisions that such plan must provide that, with respect to individuals receiving assistance, no enrollment fee, premium, or similar charge, and no deduction, cost sharing, or similar charge with respect to the care and services listed in pars. (1) through (5), (7), and (17) of section
of this title, would be imposed under the plan, and any deduction, cost sharing, or similar charge imposed under the plan with respect to other care and services would be nominal in amount (as determined in accordance with standards approved by the Secretary and included in the plan), and with respect to individuals not receiving assistance, there could be imposed an enrollment fee, premium, or similar charge (as determined in accordance with standards prescribed by the Secretary) related to the individual’s income, and any deductible, cost-sharing, or similar charge imposed under the plan would be nominal.
Subsec. (a)(18). , § 132(a), substituted provisions that a State plan for medical assistance must comply with the provisions of section
of this title with respect to liens, adjustments and recoveries of medical assistance correctly paid, and transfers of assets for provisions that such plan must provide that no lien could be imposed against the property of any individual prior to his death on account of medical assistance paid or to be paid on his behalf under the plan (except pursuant to the judgment of a court on account of benefits incorrectly paid on behalf of such individual), and that there would be no adjustment or recovery (except, in the case of an individual who was 65 years of age or older when he received such assistance, from his estate, and then only after the death of his surviving spouse, if any, and only at a time when he had no surviving child who was under age 21 or (with respect to States eligible to participate in the State program established under subchapter XVI of this chapter), was blind or permanently and totally disabled, or was blind or disabled as defined in section
of this title with respect to States which were not eligible to participate in such program) of any medical assistance correctly paid on behalf of such individual under the plan.
Subsec. (a). , § 137(e), inserted “, (26)” after “(9)(A)” in provisions following par. (44).
Subsec. (b)(2) to (4). , § 137(b)(10), struck out par. (2) which provided that the Secretary would not approve any plan which imposed any age requirement which excluded any individual who had not attained the age of 19 and was a dependent child under part A of subchapter IV of this chapter, and redesignated pars. (3) and (4) as (2) and (3), respectively.
Subsec. (d). , § 146(a), substituted references to utilization and quality control peer review organizations having a contract with the Secretary, for references to conditionally or otherwise designated Professional Standards Review Organizations, wherever appearing.
Subsec. (e)(3). , § 134(a), added par. (3).
Subsec. (j). , §§ 132(c),
136
(d), struck out subsec. (j) which related to the denial of medical assistance under a State plan because of an individual’s disposal of resources for less than fair market value, the period of ineligibility, and the eligibility of certain individuals for medical assistance under a State plan who would otherwise be ineligible because of the provisions of section
of this title, and added a new subsec. (j) relating to waiver or modification of requirements with respect to American Samoa medical assistance program.
1981—Subsec. (a)(9)(C). , § 2175(d)(1)(C), added subpar. (C).
Subsec. (a)(10)(A). , § 2171(a)(1), substituted “including at least the care and services listed in paragraphs (1) through (5) and (17) of section
of this title, to all individuals receiving aid or assistance under any plan of the State approved under subchapter I, X, XIV, or XVI of this chapter, or part A or part E of subchapter IV of this chapter (including pregnant women deemed by the State to be receiving such aid as authorized by section
of this title and individuals considered by the State to be receiving such aid as authorized under section
of this title)” for “to all individuals receiving aid or assistance under any plan of the State approved under subchapters I, X, XIV, or XVI, or part A of subchapter IV of this chapter”.
Subsec. (a)(10)(B). , § 2171(a)(2), substituted reference to subparagraph for reference to clause in two places.
Subsec. (a)(10)(C). , § 2171(a)(3), as amended by , § 137(a)(3), substituted provisions relating to plans for medical assistance included for any group of individuals described in section
of this title who are not described in subpar. (A) for provisions relating to medical assistance for any group of individuals not described in subpar. (A) and who do not meet the income and resources requirements of the appropriate State plan, or the supplementary security income program under subchapter XVI of this chapter, as the case may be, as determined in accordance with standards prescribed by the Secretary.
Subsec. (a)(10)(D). , § 2171(a)(3), as amended by , § 137(a)(3), added subpar. (D).
Subsec. (a)(11). , § 2193(c)(9), substituted “under or through an allotment under) subchapter V of this chapter, (i) providing for utilizing such agency, institution, or organization in furnishing care and services which are available under such subchapter or allotment” for “for part or all of the cost of plans or projects under subchapter V of this chapter, (i) providing for utilizing such agency, institution, or organization in furnishing care and services which are available under such plan or project under subchapter V of this chapter”.
Subsec. (a)(13)(A). , §§ 2171(b),
2173
(a)(1)(B), (C), struck out subpar. (A) which provided that a State plan must provide for the inclusion of some institutional and some noninstitutional care and services and for the inclusion of home health services for any individual who is entitled to skilled nursing facility services, redesignated subpar. (E) as (A), and in subpar. (A), as so redesignated, made the subsection applicable to hospital facilities, inserted reference to rates which take into account the situation of hospitals which serve a disproportionate number of low income patients with special needs and provide, in the case of hospital patients receiving services at an inappropriate level of care under conditions similar to those described in section
of this title, for lower reimbursement rates reflecting the level of care actually received in a manner consistent with such section, and substituted “safety standards and to assure that individuals eligible for medical assistance have reasonable access (taking into account geographic location and reasonable travel time) to inpatient hospital services of adequate quality” for “safety standards”.
Subsec. (a)(13)(B). , §§ 2171(b),
2173
(a)(1)(C), struck out subpar. (B) which provided that a State plan must provide in the case of individuals receiving aid or assistance under any plan of the State approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV of this chapter, or with respect to whom supplemental security income benefits are being paid under subchapter XVI of this chapter, for the inclusion of at least the care and services listed in paragraphs (1) through (5) and (17) of section
of this title, and redesignated subpar. (F) as (B).
Subsec. (a)(13)(C). , § 2171(b), struck out subpar. (C) which provided for care and services of individuals not included in former subpar. (B).
Subsec. (a)(13)(D). , § 2173(a)(1)(A), struck out subpar. (D) which provided for payment of reasonable cost of inpatient hospital services provided under the plan with provisions for determination of such costs with certain maximum limitations and for payment of reasonable cost of inappropriate inpatient services described in subsec. (h)(1) of this section.
Subsec. (a)(13)(E), (F). , § 2173(a)(1)(C), redesignated subpars. (E) and (F) as (A) and (B), respectively.
Subsec. (a)(20)(D). , § 2173(a)(2), struck out subpar. (D) which required provision for methods of determining reasonable cost of institutional care of such patients.
Subsec. (a)(23). , § 2175(a), substituted “except as provided in section
and except in the case of” for “except in the case of”, and struck out provision that a State plan shall not be deemed to be out of compliance with the requirements of this paragraph or pars. (1) and (10) of this subsection solely by reason of the fact that the State or any political subdivision thereof has entered into a contract with an organization which has agreed to provide care and services in addition to those offered under the State plan to individuals eligible for medical assistance who reside in the geographic area served by such organization and who elect to obtain such care and services from such organization, or by reason of the fact that the plan provides for payment for rural health clinic services only if those services are provided by a rural health clinic.
Subsec. (a)(25)(C). , § 2182, substituted “of the individual and where the amount of reimbursement the State can reasonably expect to recover exceeds the costs of such recovery, the State” for “of the individual, the State”.
Subsec. (a)(30). , § 2174(a), substituted “that payments are consistent” for “that payments (including payments for any drugs provided under the plan) are not in excess of reasonable charges consistent”.
Subsec. (a)(39). , § 2105(c), substituted “person” for “individual” in two places.
Subsec. (a)(44). , § 2181(a)(2)(C), added par. (44).
Subsec. (b)(2). , § 2172(a), substituted “any age requirement which excludes any individual who has not attained the age of 19 and is a dependent child under part A of subchapter IV of this chapter;” for “effective July 1, 1967, any age requirement which excludes any individual who has not attained the age of 21 and is or would, except for the provisions of section
of this title, be a dependent child under part A of subchapter IV of this chapter; or”.
Subsec. (d). , § 2113(m), added subsec. (d).
Subsec. (e). , § 2178(b), designated existing provisions as par. (1) and added par. (2).
Subsec. (h). , § 2173(b)(1), (d), as amended by , § 9433(a), added a new subsec. (h) and repealed former subsec. (h) which related to skilled nursing and intermediate care facility services.
1980—Subsec. (a)(13)(B). , § 965(b)(1), substituted “paragraphs (1) through (5) and (17)” for “clauses (1) through (5)”.
Subsec. (a)(13)(C)(i). , § 965(b)(2), substituted “paragraphs (1) through (5) and (17)” for “clauses (1) through (5)”.
Subsec. (a)(13)(C)(ii). , § 965(b)(3), substituted “paragraphs numbered (1) through (17)” for “clauses numbered (1) through (16)”.
Subsec. (a)(13)(D). , § 902(b)(1), designated existing provisions as cl. (i) and added cl. (ii).
Subsec. (a)(13)(D)(i). , §§ 903(b),
, inserted “(except where the State agency is subject to an order under section
of this title)” after “payment” and “, except that in the case of hospitals reimbursed for services under part A of subchapter XVIII of this chapter in accordance with section
of this title, the plan must provide for payment of inpatient hospital services provided in such hospitals under the plan in accordance with the reimbursement system used under such section” after “subchapter XVIII of this chapter”.
Subsec. (a)(13)(E). , § 905(a), inserted “(except where the State agency is subject to an order under section
of this title)”.
, § 962(a), substituted provisions which required a State plan for medical assistance to provide for payment of skilled nursing facility and intermediate care facility services provided under such plan through the use of rates determined in accordance with methods and standards developed by the State rather than on a reasonable cost related basis, required the filing of uniform cost reports by each facility, and required periodic audits of such reports by the State.
Subsec. (a)(14)(A)(i). , § 965(b)(4), substituted “paragraphs (1) through (5), (7), and (17)” for “clauses (1) through (5) and (7)”.
Subsec. (a)(33)(B). , § 916(b)(1)(B), inserted exception authorizing the Secretary where there was cause to question the adequacy of participation determinations to make independent determinations concerning the extent to which individual institutions and agencies met the requirements for participation.
Subsec. (a)(35). , § 912(b), substituted “disclosing entity (as defined in section
of this title)” for “intermediate care facility”.
Subsec. (a)(39). , § 913(c), substituted provisions requiring that State plans for medical assistance authorize the State agency to bar specified individuals from participation in the program under the State plan when required by the Secretary to do so pursuant to section
of this title for provisions requiring that State plans for medical assistance provide for the suspension of physicians or other individuals from participation in the State plan upon notification by the Secretary that such physician or other individual had been suspended from participation in the plan under subchapter XVIII of this chapter.
Subsec. (a)(41). added par. (41).
Subsec. (a)(42). , § 914(b)(1), added par. (42).
Subsec. (a)(43). , § 918(b)(1)(C), added par. (43).
Subsec. (g). , § 913(d), struck out subsec. (g) which related to waiver of suspension of payments to physicians or practitioners suspended from participation in approved State plans.
Subsec. (h). , § 902(b)(2), added subsec. (h).
Subsec. (i). , § 916(b)(1)(A), added subsec. (i).
Subsec. (j). added subsec. (j).
1978—Subsec. (a)(4)(C). added cl. (C).
1977—Subsec. (a)(13)(F). , § 2(c)(1), added subpar. (F).
Subsec. (a)(23). , § 2(c)(2), inserted “, or by reason of the fact that the plan provides for payment for rural health clinic services only if those services are provided by a rural health clinic” after “who elect to obtain such care and services from such organization”.
Subsec. (a)(26). , § 20(b), inserted provision relating to staff of skilled nursing facilities.
Subsec. (a)(27)(B). , § 9, inserted “or the Secretary” after “State agency” wherever appearing.
Subsec. (a)(32). , § 2(a)(3), substituted provisions relating to terms, conditions, etc., for payments under an assignment or power of attorney, for provisions relating to terms, conditions, etc., for payments to anyone other than the individual receiving any care or service provided by a physician, dentist, or other individual practitioner, or such physician, dentist, or practitioner.
Subsec. (a)(35). , § 3(c)(1)(A), substituted provisions relating to requirements for intermediate care facilities to comply with section
of this title for provisions relating to disclosure requirements, effective Jan. 1, 1973, applicable to intermediate care facilities with respect to ownership, corporate, status, etc.
Subsec. (a)(37). , §§ 2(b)(1)(C),
,
, added subsec. (a)(37) and made and struck out minor changes in phraseology, necessitating no changes in text.
Subsec. (a)(38). , §§ 3(c)(1)(D),
,
, added par. (38) and made and struck out minor changes in phraseology necessitating no changes in text.
Subsec. (a)(39). , §§ 7(b)(3),
, added par. (39).
Subsec. (a)(40). , § 19(b)(2)(C), added par. (40).
Subsec. (a), foll. par. (40). , § 2(b)(1)(D), added paragraph relating to waiver of requirement of cl. (A) of par. (37).
Subsec. (g). , § 7(c), added subsec. (g).
1976—Subsec. (g). struck out provisions for consent to suit and waiver of immunity by State.
1975—Subsec. (a). , § 1, added undesignated paragraph at end of subsec. (a) relating to eligibility under this subchapter of any individual who was eligible for the month of August 1972, under a State plan approved under subchapters I, X, XIV, XVI, or part A of subchapter IV of this chapter if such individual would have been eligible for such month had the increase in monthly insurance benefits under subchapter II of this chapter resulting from enactment of not been applicable to such individual.
Subsec. (a)(23). , § 2, inserted “except in the case of Puerto Rico, the Virgin Islands, and Guam,”.
Subsec. (g). added subsec. (g).
1974—Subsec. (a)(14)(B)(i). substituted “may” for “shall”.
1973—Subsec. (a)(5). , § 13(a)(2)(A), (B), substituted “to administer or to supervise the administration of the plan” for “to administer the plan” and “to supervise the administration of the plan” in that order and inserted after the parenthetical phrase the conditional provision “if the State is eligible to participate in the State plan program established under subchapter XVI of this chapter, or by the agency or agencies administering the supplemental security income program established under subchapter XVI of this chapter or the State plan approved under part A of subchapter IV of this chapter if the State is not eligible to participate in the State plan program established under subchapter XVI of this chapter”.
Subsec. (a)(10). , § 13(a)(3), incorporated existing text in provisions designated as cl. (A), providing therein for medical assistance to individuals with respect to whom supplemental security income benefits are paid; incorporated existing par. (A) in provisions designated as cl. (B); incorporated existing par. (B) in provisions designated as cl. (C), providing therein for individuals not meeting income and resources requirements of the supplemental security income program; substituted in cls. (B)(ii), (C), (C)(i)(ii) and “medical assistance” for “medical or remedial care and services” appearing in predecessor provisions and in cl. (C)(i) “except for income and resources” for “if needy” appearing in predecessor provision; and in the exception provisions included reference to par. (16) of section
of this title in item (I), substituted “deductibles” for “the deductibles” in item (II), and added item (III).
Subsec. (a)(13)(B). , § 13(a)(4), substituted “any plan of the State approved” for “the State’s plan approved” and inserted after “part A of subchapter IV of this chapter” text reading “, or with respect to whom supplemental security income benefits are being paid under subchapter XVI of this chapter”.
Subsec. (a)(13)(C)(ii)(I). , § 18(x)(1), substituted reference to cl. “16” for “14”.
Subsec. (a)(14)(A). , § 13(a)(5), substituted “any plan of the State approved” for “a State plan approved” and “with respect to whom supplemental security income benefits are being paid under subchapter XVI of this chapter, or who meet the income and resources requirements of the appropriate State plan, or the supplemental security income program under subchapter XVI of this chapter, as the case may be, and individuals with respect to whom there is being paid, or who are eligible, or would be eligible if they were not in a medical institution, to have paid with respect to them, a State supplementary payment and are eligible for medical assistance equal in amount, duration, and scope to the medical assistance made available to individuals described in paragraph (10)(A)” for “who meet the income and resources requirements of the one of such State plans which is appropriate”.
Subsec. (a)(14)(B). , § 13(a)(6)(A)–(D), inserted after “with respect to individuals” the parenthetical provision “(other than individuals with respect to whom there is being paid, or who are eligible or would be eligible if they were not in a medical institution, to have paid with respect to them, a State supplementary payment and are eligible for medical assistance equal in amount, duration, and scope to the medical assistance made available to individuals described in paragraph (10)(A))”; inserted after “any such State plan” the clause “and with respect to whom supplemental security income benefits are not being paid under subchapter XVI of this chapter”; substituted “the appropriate State plan, or the supplemental security income program under subchapter XVI of this chapter, as the case may be,” for “the one of such State plans which is appropriate”; and struck out “or who, after December 31, 1973, are included under the State plan for medical assistance pursuant to subsection (a)(10)(B) of this section approved under this subchapter” preceding the hyphen and cl. (i), respectively.
Subsec. (a)(17). , § 13(a)(7)(A)–(D), (8), substituted: “any plan of the State approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV of this chapter, and with respect to whom supplemental security income benefits are not being paid under subchapter XVI of this chapter” for “the State’s plan approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV of this chapter”; “except for income and resources” for “if he met the requirements as to need”; “any plan of the State approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV of this chapter, or to have paid with respect to him supplemental security income benefits under subchapter XVI of this chapter” for “a State plan approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV of this chapter”; “such aid, assistance, or benefits” for “and amount of such aid or assistance under such plan”; and “(with respect to States eligible to participate in the State program established under subchapter XVI of this chapter), is blind or permanently and totally disabled, or is blind or disabled as defined in section
of this title (with respect to States which are not eligible to participate in such program)” for “is blind or permanently and totally disabled”.
Subsec. (a)(18). , § 13(a)(8), substituted “(with respect to States eligible to participate in the State program established under subchapter XVI of this chapter), is blind or permanently and totally disabled, or is blind or disabled as defined in section
of this title (with respect to States which are not eligible to participate in such program)” for “is blind or permanently and totally disabled”.
Subsec. (a)(20)(C). , § 13(a)(9), inserted reference to section
and (ii) of this title.
Subsec. (a)(21), (24). , § 18(x)(4), provided for substitution of “nursing facilities” for “nursing homes”.
Subsec. (a)(26)(B). , § 18(x)(4), provided for substitution of “nursing facility” and “nursing facilities” for “nursing home” and “nursing homes”, changes already executed under 1972 Amendment by , § 278(a)(19).
Subsec. (a)(33)(A). , § 18(x)(2), substituted “penultimate sentence” for “last sentence”.
Subsec. (a)(34). , § 18(o), inserted “(or application was made on his behalf in the case of a deceased individual)” after “he made application”.
Subsec. (a)(35)(A). , § 18(p), required the intermediate care facility to supply full and complete information respecting the person who is the owner (in whole or in part) of any mortgage, deed of trust, note, or other obligation secured (in whole or in part) by the intermediate care facility or any of the property or assets of the intermediate care facility.
Subsec. (a)(35) to (37). , § 18(x)(3)(A), (B), substituted “; and” for “.” at end of par. (35); and corrected numerical sequence of paragraphs, redesignating par. (37) as (36), the original subsec. (a) having been enacted without a par. (36).
Subsec. (e). , § 18(q), substituted “each family which was receiving aid pursuant to a plan of the State approved under part A” for “each family which was eligible for assistance pursuant to part A”, “for such aid because of increased hours of, or increased income from, employment” for “for such assistance because of increased income from employment”, and “remain eligible for assistance under the plan approved under this subchapter (as though the family was receiving aid under the plan approved under part A of subchapter IV of this chapter) for 4 calendar months beginning with the month in which such family became ineligible for aid under the plan approved under part A of subchapter IV of this chapter because of income and resources or hours of work limitations” for “remain eligible for such assistance for 4 calendar months following the month in which such family would otherwise be determined to be ineligible for such assistance because of the income and resources limitations”.
Subsec. (f). , § 13(a)(10)(A)–(D), substituted: “no State not eligible to participate in the State plan program established under subchapter XVI of this chapter” for “no State” and “any supplemental security income payment and State supplementary payment made with respect to such individual” for “such individual’s payment under subchapter XVI of this chapter” and “as recognized under State law” for “as defined in section
of Title
” in parenthetical text; and inserted two end sentences for consideration of certain individuals as eligible for medical assistance under cl. (10)(A) or (C) of subsec. (a) of this section or as eligible for such assistance under cl. (10)(A) in States not providing such assistance under cl. (10)(C), respectively.
1972—Subsec. (a). , §§ 268(a),
, inserted provisions exempting Christian Science sanatoriums from certain nursing facility and nursing home requirements.
Subsec. (a)(9). , § 239(a), inserted provisions to utilize State health agency for establishing and maintaining health standards for private or public institutions in which recipients of medical assistance under the plan may receive care or services.
Subsec. (a)(13)(A)(ii), (C). , § 278(a)(18), (b)(14), substituted “skilled nursing facility” for “skilled nursing home”.
Subsec. (a)(13)(D). , §§ 221(c)(5),
, inserted provisions that the reasonable cost of inpatient hospital services shall not exceed the amount determined under section
of this title and inserted reference to the consistency of methods and standards with section
of this title for determining the reasonable cost of inpatient hospital services.
Subsec. (a)(13)(E). , § 249(a), added subpar. (E).
Subsec. (a)(14). , § 208(a), substituted a nominal amount for an amount reasonably related to the recipient’s income as the amount of the deduction, cost sharing, or similar charge imposed under the plan and inserted provisions covering individuals who are not receiving aid or assistance under any state plan and who do not meet the income and resources requirements and covering individuals who are included under the state plan for medical assistance pursuant to subsec. (a)(10)(B) of this section approved under this subcha