
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC1395aa]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XVIII--HEALTH INSURANCE FOR AGED AND DISABLED
 
                    Part D--Miscellaneous Provisions
 
Sec. 1395aa. Agreements with States


(a) Use of State agencies to determine compliance by providers of 
        services with conditions of participation

    The Secretary shall make an agreement with any State which is able 
and willing to do so under which the services of the State health agency 
or other appropriate State agency (or the appropriate local agencies) 
will be utilized by him for the purpose of determining whether an 
institution therein is a hospital or skilled nursing facility, or 
whether an agency therein is a home health agency, or whether an agency 
is a hospice program or whether a facility therein is a rural health 
clinic as defined in section 1395x(aa)(2) of this title, a critical 
access hospital, as defined in section 1395x(mm)(1) of this title, or a 
comprehensive outpatient rehabilitation facility as defined in section 
1395x(cc)(2) of this title, or whether a laboratory meets the 
requirements of paragraphs (16) and (17) of section 1395x(s) of this 
title, or whether a clinic, rehabilitation agency or public health 
agency meets the requirements of subparagraph (A) or (B), as the case 
may be, of section 1395x(p)(4) of this title, or whether an ambulatory 
surgical center meets the standards specified under section 
1395k(a)(2)(F)(i) of this title. To the extent that the Secretary finds 
it appropriate, an institution or agency which such a State (or local) 
agency certifies is a hospital, skilled nursing facility, rural health 
clinic, comprehensive outpatient rehabilitation facility, home health 
agency, or hospice program (as those terms are defined in section 1395x 
of this title) may be treated as such by the Secretary. Any State agency 
which has such an agreement may (subject to approval of the Secretary) 
furnish to a skilled nursing facility, after proper request by such 
facility, such specialized consultative services (which such agency is 
able and willing to furnish in a manner satisfactory to the Secretary) 
as such facility may need to meet one or more of the conditions 
specified in section 1395i-3(a) of this title. Any such services 
furnished by a State agency shall be deemed to have been furnished 
pursuant to such agreement. Within 90 days following the completion of 
each survey of any health care facility, ambulatory surgical center, 
rural health clinic, comprehensive outpatient rehabilitation facility, 
laboratory, clinic, agency, or organization by the appropriate State or 
local agency described in the first sentence of this subsection, the 
Secretary shall make public in readily available form and place, and 
require (in the case of skilled nursing facilities) the posting in a 
place readily accessible to patients (and patients' representatives), 
the pertinent findings of each such survey relating to the compliance of 
each such health care facility, ambulatory surgical center, rural health 
clinic, comprehensive outpatient rehabilitation facility, laboratory, 
clinic, agency, or organization with (1) the statutory conditions of 
participation imposed under this subchapter and (2) the major additional 
conditions which the Secretary finds necessary in the interest of health 
and safety of individuals who are furnished care or services by any such 
health care facility, ambulatory surgical center, rural health clinic, 
comprehensive outpatient rehabilitation facility, laboratory, clinic, 
agency, or organization. Any agreement under this subsection shall 
provide for the appropriate State or local agency to maintain a toll-
free hotline (1) to collect, maintain, and continually update 
information on home health agencies located in the State or locality 
that are certified to participate in the program established under this 
subchapter (which information shall include any significant deficiencies 
found with respect to patient care in the most recent certification 
survey conducted by a State agency or accreditation survey conducted by 
a private accreditation agency under section 1395bb of this title with 
respect to the home health agency, when that survey was completed, 
whether corrective actions have been taken or are planned, and the 
sanctions, if any, imposed under this subchapter with respect to the 
agency) and (2) to receive complaints (and answer questions) with 
respect to home health agencies in the State or locality. Any such 
agreement shall provide for such State or local agency to maintain a 
unit for investigating such complaints that possesses enforcement 
authority and has access to survey and certification reports, 
information gathered by any private accreditation agency utilized by the 
Secretary under section 1395bb of this title, and consumer medical 
records (but only with the consent of the consumer or his or her legal 
representative).

(b) Payment in advance or by way of reimbursement to State for 
        performance of functions of subsection (a)

    The Secretary shall pay any such State, in advance or by way of 
reimbursement, as may be provided in the agreement with it (and may make 
adjustments in such payments on account of overpayments or underpayments 
previously made), for the reasonable cost of performing the functions 
specified in subsection (a) of this section, and for the Federal 
Hospital Insurance Trust Fund's fair share of the costs attributable to 
the planning and other efforts directed toward coordination of 
activities in carrying out its agreement and other activities related to 
the provision of services similar to those for which payment may be made 
under part A of this subchapter, or related to the facilities and 
personnel required for the provision of such services, or related to 
improving the quality of such services.

(c) Use of State or local agencies to survey hospitals

    The Secretary is authorized to enter into an agreement with any 
State under which the appropriate State or local agency which performs 
the certification function described in subsection (a) of this section 
will survey, on a selective sample basis (or where the Secretary finds 
that a survey is appropriate because of substantial allegations of the 
existence of a significant deficiency or deficiencies which would, if 
found to be present, adversely affect health and safety of patients), 
provider entities that, pursuant to subsection (a) or (b)(1) of section 
1395bb of this title, are treated as meeting the conditions or 
requirements of this subchapter. The Secretary shall pay for such 
services in the manner prescribed in subsection (b) of this section.

(d) Fulfillment of requirements by States

    The Secretary may not enter an agreement under this section with a 
State with respect to determining whether an institution therein is a 
skilled nursing facility unless the State meets the requirements 
specified in section 1395i-3(e) of this title and section 1395i-3(g) of 
this title and the establishment of remedies under sections 1395i-
3(h)(2)(B) and 1395i-3(h)(2)(C) of this title (relating to establishment 
and application of remedies).

(e) Prohibition of user fees for survey and certification

    Notwithstanding any other provision of law, the Secretary may not 
impose, or require a State to impose, any fee on any facility or entity 
subject to a determination under subsection (a) of this section, or any 
renal dialysis facility subject to the requirements of section 
1395rr(b)(1) of this title, for any such determination or any survey 
relating to determining the compliance of such facility or entity with 
any requirement of this subchapter (other than any fee relating to 
section 263a of this title).

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1864, as added Pub. L. 89-97, 
title I, Sec. 102(a), July 30, 1965, 79 Stat. 326; amended Pub. L. 90-
248, title I, Sec. 133(f), title II, Sec. 228(b), Jan. 2, 1968, 81 Stat. 
852, 904; Pub. L. 92-603, title II, Secs. 244(a), 277, 278(a)(16), 
(b)(15), 299D(a), Oct. 30, 1972, 86 Stat. 1422, 1452-1454, 1461; Pub. L. 
95-210, Sec. 1(i), Dec. 13, 1977, 91 Stat. 1488; Pub. L. 96-499, title 
IX, Secs. 933(g), 934(c)(2), Dec. 5, 1980, 94 Stat. 2639; Pub. L. 96-
611, Sec. 1(a)(2), Dec. 28, 1980, 94 Stat. 3566; Pub. L. 97-248, title 
I, Sec. 122(g)(3), Sept. 3, 1982, 96 Stat. 362; Pub. L. 98-369, div. B, 
title III, Sec. 2354(b)(17), July 18, 1984, 98 Stat. 1101; Pub. L. 99-
509, title IX, Sec. 9320(h)(3), Oct. 21, 1986, 100 Stat. 2016; Pub. L. 
100-203, title IV, Secs. 4025(a), 4072(d), 4201(a)(2), (d)(4), 
4202(a)(1), (c), 4203(a)(1), 4212(b), Dec. 22, 1987, 101 Stat. 1330-74, 
1330-117, 1330-160, 1330-174, 1330-179, 1330-212, as amended Pub. L. 
100-360, title IV, Sec. 411(l)(1)(C), (6)(B), July 1, 1988, 102 Stat. 
804, as amended Pub. L. 100-485, title VI, Sec. 608(d)(20)(B), (C), 
(27)(B), Oct. 13, 1988, 102 Stat. 2419, 2420, 2422; Pub. L. 100-360, 
title II, Secs. 203(e)(3), 204(c)(2), (d)(3), title IV, 
Sec. 411(d)(4)(A), July 1, 1988, 102 Stat. 725, 728, 729, 774; Pub. L. 
101-234, title II, Sec. 201(a), Dec. 13, 1989, 103 Stat. 1981; Pub. L. 
101-239, title VI, Secs. 6003(g)(3)(C)(iii), 6115(c), Dec. 19, 1989, 103 
Stat. 2152, 2219; Pub. L. 101-508, title IV, Secs. 4154(d)(1), 
4163(c)(2), 4207(g), formerly 4027(g), Nov. 5, 1990, 104 Stat. 1388-85, 
1388-100, 1388-123; Pub. L. 103-432, title I, Secs. 145(c)(3), 
160(a)(1), (d)(4), Oct. 31, 1994, 108 Stat. 4427, 4443, 4444; Pub. L. 
104-134, title I, Sec. 101(d) [title V, Sec. 516(c)(1)], Apr. 26, 1996, 
110 Stat. 1321-211, 1321-247; renumbered title I, Pub. L. 104-140, 
Sec. 1(a), May 2, 1996, 110 Stat. 1327; Pub. L. 105-33, title IV, 
Secs. 4106(c), 4201(c)(1), Aug. 5, 1997, 111 Stat. 368, 373.)

                       References in Text

    Part A of this subchapter, referred to in subsec. (b), is classified 
to section 1395c et seq. of this title.


                               Amendments

    1997--Subsec. (a). Pub. L. 105-33, Sec. 4201(c)(1), substituted 
``critical access'' for ``rural primary care''.
    Pub. L. 105-33, Sec. 4106(c), substituted ``paragraphs (16) and 
(17)'' for ``paragraphs (15) and (16)''.
    1996--Subsec. (c). Pub. L. 104-134, in first sentence, substituted 
at end ``provider entities that, pursuant to subsection (a) or (b)(1) of 
section 1395bb of this title, are treated as meeting the conditions or 
requirements of this subchapter.'' for ``hospitals which have an 
agreement with the Secretary under section 1395cc of this title and 
which are accredited by the Joint Commission on Accreditation of 
Hospitals.''
    1994--Subsec. (a). Pub. L. 103-432, Sec. 160(a)(1)(B), struck out 
``or (in the case of a laboratory that does not participate or seek to 
participate in the medicare program) the requirements of section 263a of 
this title'' after ``section 1395x(s) of this title'' in first sentence.
    Pub. L. 103-432, Sec. 145(c)(3), struck out ``, or whether screening 
mammography meets the standards established under section 1395m(c)(3) of 
this title'' after ``section 1395k(a)(2)(F)(i) of this title'' in first 
sentence.
    Subsec. (e). Pub. L. 103-432, Sec. 160(a)(1)(A), inserted before 
period at end ``(other than any fee relating to section 263a of this 
title)''.
    1990--Subsec. (a). Pub. L. 101-508, Sec. 4163(c)(2), inserted before 
period at end of first sentence ``, or whether screening mammography 
meets the standards established under section 1395m(c)(3) of this 
title''.
    Pub. L. 101-508, Sec. 4154(d)(1), substituted ``section 1395x(s) of 
this title or (in the case of a laboratory that does not participate or 
seek to participate in the medicare program) the requirements of section 
263a of this title,'' for ``section 1395x(s) of this title,'' in first 
sentence.
    Subsec. (e). Pub. L. 101-508, Sec. 4207(g), formerly Sec. 4027(g), 
as renumbered by Pub. L. 103-432, Sec. 160(d)(4), added subsec. (e).
    1989--Subsec. (a). Pub. L. 101-239, Sec. 6115(c), substituted 
``paragraphs (15) and (16)'' for ``paragraphs (14) and (15)''.
    Pub. L. 101-239, Sec. 6003(g)(3)(C)(iii), inserted ``, a rural 
primary care hospital, as defined in section 1395x(mm)(1) of this 
title,'' after ``1395x(aa)(2) of this title''.
    Pub. L. 101-234 repealed Pub. L. 100-360, Secs. 203(e)(3), 
204(c)(2), (d)(3), and provided that the provisions of law amended or 
repealed by such sections are restored or revived as if such sections 
had not been enacted, see 1988 and 1989 Amendment notes.
    1988--Subsec. (a). Pub. L. 100-360, Sec. 411(l)(6)(B), amended Pub. 
L. 100-203, Sec. 4212(b), see 1987 Amendment note below.
    Pub. L. 100-360, Sec. 411(l)(1)(C), as added by Pub. L. 100-485, 
Sec. 608(d)(27)(B), added Pub. L. 100-203, Sec. 4201(d)(4), see 1987 
Amendment note below.
    Pub. L. 100-360, Sec. 411(d)(4)(A)(i), as amended by Pub. L. 100-
485, Sec. 608(d)(20)(B)(i), substituted ``most recent certification 
survey conducted by a State agency or accreditation survey conducted by 
a private accreditation agency under section 1395bb of this title with 
respect to the home health agency,'' for ``most recent certification 
survey conducted with respect to the agency,''.
    Pub. L. 100-360, Sec. 411(d)(4)(A)(ii)(I), as amended by Pub. L. 
100-485, Sec. 608(d)(20)(C), substituted ``such State or local agency to 
maintain a unit'' for ``such agency to maintain a unit''.
    Pub. L. 100-360, Sec. 411(d)(4)(A)(ii)(II), as amended by Pub. L. 
100-485, Sec. 608(d)(20)(B)(ii), substituted ``utilized by the Secretary 
under section 1395bb of this title'' for ``pursuant to an agreement with 
the Secretary under this section''.
    Pub. L. 100-360, Sec. 204(d)(3), substituted ``paragraphs (14) and 
(15)'' for ``paragraphs (13) and (14)''.
    Pub. L. 100-360, Sec. 204(c)(2), inserted ``, or whether screening 
mammography meets the standards established under section 1395m(e)(3) of 
this title'' after ``section 1395k(a)(2)(F)(i) of this title''.
    Pub. L. 100-360, Sec. 203(e)(3), inserted ``or a home intravenous 
drug therapy provider,'' after ``hospice program'' and substituted 
``hospice program, or home intravenous drug therapy provider'' for ``or 
hospice program''.
    1987--Subsec. (a). Pub. L. 100-203, Sec. 4212(b), which directed an 
amendment of subsec. (a) identical to Pub. L. 100-203, Sec. 4202(c), was 
amended generally by Pub. L. 100-360, Sec. 411(l)(6)(B), so that it does 
not amend this section but rather section 1396r of this title.
    Pub. L. 100-203, Sec. 4202(c), inserted ``, and require (in the case 
of skilled nursing facilities) the posting in a place readily accessible 
to patients (and patients' representatives),'' after ``place'' in fifth 
sentence.
    Pub. L. 100-203, Sec. 4201(d)(4), as added by Pub. L. 100-360, 
Sec. 411(l)(1)(C), as added by Pub. L. 100-485, Sec. 608(d)(27)(B), 
substituted ``conditions specified in section 1395i-3(a) of this title'' 
for ``conditions specified in section 1395x(j) of this title''.
    Pub. L. 100-203, Sec. 4072(d), substituted ``paragraphs (13) and 
(14)'' for ``paragraphs (12) and (13)'' in first sentence.
    Pub. L. 100-203, Sec. 4025(a), inserted at end ``Any agreement under 
this subsection shall provide for the appropriate State or local agency 
to maintain a toll-free hotline (1) to collect, maintain, and 
continually update information on home health agencies located in the 
State or locality that are certified to participate in the program 
established under this subchapter (which information shall include any 
significant deficiencies found with respect to patient care in the most 
recent certification survey conducted with respect to the agency, when 
that survey was completed, whether corrective actions have been taken or 
are planned, and the sanctions, if any, imposed under this subchapter 
with respect to the agency) and (2) to receive complaints (and answer 
questions) with respect to home health agencies in the State or 
locality. Any such agreement shall provide for such agency to maintain a 
unit for investigating such complaints that possesses enforcement 
authority and has access to survey and certification reports, 
information gathered by any private accreditation agency pursuant to an 
agreement with the Secretary under this section, and consumer medical 
records (but only with the consent of the consumer or his or her legal 
representative).''
    Subsec. (d). Pub. L. 100-203, Sec. 4203(a)(1), inserted before 
period at end ``and the establishment of remedies under sections 1395i-
3(h)(2)(B) and 1395i-3(h)(2)(C) of this title (relating to establishment 
and application of remedies)''.
    Pub. L. 100-203, Sec. 4202(a)(1), inserted ``and section 1395i-3(g) 
of this title'' before period at end.
    Pub. L. 100-203, Sec. 4201(a)(2), added subsec. (d).
    1986--Subsec. (a). Pub. L. 99-509 substituted ``paragraphs (12) and 
(13)'' for ``paragraphs (11) and (12)''.
    1984--Subsec. (c). Pub. L. 98-369 struck out ``the'' after ``Joint 
Commission on''.
    1982--Subsec. (a). Pub. L. 97-248 inserted ``or whether an agency is 
a hospice program'' and substituted ``home health agency, or hospice 
program'' for ``or home health agency''.
    1980--Subsec. (a). Pub. L. 96-611 substituted ``requirements of 
paragraphs (11) and (12) of section 1395x(s) of this title'' for 
``requirements of paragraphs (10) and (11) of section 1395x(s) of this 
title''.
    Pub. L. 96-499, Sec. 933(g), inserted ``or a comprehensive 
outpatient rehabilitation facility as defined in section 1395x(cc)(2) of 
this title'' after ``section 1395x(aa)(2) of this title'' and 
``comprehensive outpatient rehabilitation facility,'' after ``rural 
health clinic'' in four places.
    Pub. L. 96-499, Sec. 934(c)(2), inserted ``, or whether an 
ambulatory surgical center meets the standards specified under section 
1395k(a)(2)(F) of this title'' after ``section 1395x(p)(4) of this 
title'' and ``ambulatory surgical center,'' after ``health care 
facility,'' in three places.
    1977--Subsec. (a). Pub. L. 95-210 expanded enumeration of 
institutions and agencies included under coverage of this subsection by 
inserting references to rural health clinics in five places.
    1972--Subsec. (a). Pub. L. 92-603, Secs. 277, 278(a)(16), (b)(15), 
299D(a), provided for the furnishing of specialized consultative 
services to skilled nursing facilities, authorized the Secretary to make 
public the pertinent findings of each survey within 90 days following 
the completion of each survey of any health care facility, etc., and 
substituted ``skilled nursing facility'' for ``extended care facility''.
    Subsec. (c). Pub. L. 92-603, Sec. 244(a), added subsec. (c).
    1968--Subsec. (a). Pub. L. 90-248, Sec. 133(f), inserted clause at 
end of first sentence for determining whether a clinic, rehabilitation 
agency, or public health agency meets the requirements of section 
1395x(p)(4)(A) or (B) of this title.
    Pub. L. 90-248, Sec. 228(b), struck out last sentence providing for 
utilization of State facilities to provide consultative services to 
institutions furnishing medical care, covered in section 1396a(a)(24) of 
this title.


                    Effective Date of 1997 Amendment

    Amendment by section 4106(c) of Pub. L. 105-33 applicable to bone 
mass measurements performed on or after July 1, 1998, see section 
4106(d) of Pub. L. 105-33, set out as a note under section 1395x of this 
title.
    Amendment by section 4201(c)(1) of Pub. L. 105-33 applicable to 
services furnished on or after Oct. 1, 1997, see section 4201(d) of Pub. 
L. 105-33, set out as a note under section 1395f of this title.


                    Effective Date of 1994 Amendment

    Amendment by section 145(c)(3) of Pub. L. 103-432 applicable to 
mammography furnished by a facility on and after the first date that the 
certificate requirements of section 263b(b) of this title apply to such 
mammography conducted by such facility, see section 145(d) of Pub. L. 
103-432, set out as a note under section 1395m of this title.


                    Effective Date of 1990 Amendment

    Section 4154(d)(2) of Pub. L. 101-508 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall take effect as if 
included in the enactment of the Clinical Laboratory Improvement 
Amendments of 1988 [Pub. L. 100-578].''
    Amendment by section 4163(c)(2) of Pub. L. 101-508 applicable to 
screening mammography performed on or after Jan. 1, 1991, see section 
4163(e) of Pub. L. 101-508, set out as a note under section 1395l of 
this title.


                    Effective Date of 1989 Amendments

    Amendment by section 6115(c) of Pub. L. 101-239 applicable to 
screening pap smears performed on or after July 1, 1990, see section 
6115(d) of Pub. L. 101-239, set out as a note under section 1395x of 
this title.
    Amendment by Pub. L. 101-234 effective Jan. 1, 1990, see section 
201(c) of Pub. L. 101-234, set out as a note under section 1320a-7a of 
this title.


                    Effective Date of 1988 Amendments

    Amendment by Pub. L. 100-485 effective as if included in the 
enactment of the Medicare Catastrophic Coverage Act of 1988, Pub. L. 
100-360, see section 608(g)(1) of Pub. L. 100-485, set out as a note 
under section 704 of this title.
    Amendment by section 203(e)(3) of Pub. L. 100-360 applicable to 
items and services furnished on or after Jan. 1, 1990, see section 
203(g) of Pub. L. 100-360, set out as a note under section 1320c-3 of 
this title.
    Amendment by section 204(c)(2), (d)(3) of Pub. L. 100-360 applicable 
to screening mammography performed on or after Jan. 1, 1990, see section 
204(e) of Pub. L. 100-360, set out as a note under section 1395m of this 
title.
    Except as specifically provided in section 411 of Pub. L. 100-360, 
amendment by section 411(d)(4)(A), (l)(1)(C), (6)(B) of Pub. L. 100-360, 
as it relates to a provision in the Omnibus Budget Reconciliation Act of 
1987, Pub. L. 100-203, effective as if included in the enactment of that 
provision in Pub. L. 100-203, see section 411(a) of Pub. L. 100-360, set 
out as a Reference to OBRA; Effective Date note under section 106 of 
Title 1, General Provisions.


                    Effective Date of 1987 Amendment

    Section 4025(c), formerly Sec. 4025(b), of Pub. L. 100-203, as 
redesignated and amended by Pub. L. 100-360, title IV, 
Sec. 411(d)(4)(B)(i), July 1, 1988, 102 Stat. 774, provided that: ``The 
amendment made by this section [amending this section and section 1395bb 
of this title] shall apply with respect to agreements entered into or 
renewed on or after the date of enactment of this Act [Dec. 22, 1987].''
    For effective date of amendment by section 4072(d) of Pub. L. 100-
203, see section 4072(e) of Pub. L. 100-203, set out as a note under 
section 1395x of this title.
    Amendments by sections 4201(a)(2), (d)(4) and 4202(a)(1), (c) of 
Pub. L. 100-203 applicable to services furnished on or after Oct. 1, 
1990, without regard to whether regulations to implement such amendments 
are promulgated by such date, except as otherwise specifically provided 
in section 1395i-3 of this title, see section 4204(a) of Pub. L. 100-
203, as amended, set out as an Effective Date note under section 1395i-3 
of this title.
    Amendment by section 4203(a)(1) of Pub. L. 100-203 applicable Jan. 
1, 1988, except as otherwise specifically provided in section 1395i-3 of 
this title, without regard to whether regulations to implement such 
amendment are promulgated by such date, and in applying amendment by 
section 4203(a)(1) of Pub. L. 100-203 for services furnished by a 
skilled nursing facility before Oct. 1, 1990, any reference to a 
requirement of section 1395i-3(b), (c), or (d) of this title is deemed a 
reference to section 1395x(j) of this title, see section 4204(b) of Pub. 
L. 100-203, as added by Pub. L. 100-485, set out as an Effective Date 
note under section 1395i-3 of this title.


                    Effective Date of 1986 Amendment

    Amendment by Pub. L. 99-509 applicable to services furnished on or 
after Jan. 1, 1989, with exceptions for hospitals located in rural areas 
which meet certain requirements related to certified registered nurse 
anesthetists, see section 9320(i), (k) of Pub. L. 99-509, as amended, 
set out as notes under section 1395k of this title.


                    Effective Date of 1984 Amendment

    Amendment by Pub. L. 98-369 effective July 18, 1984, but not to be 
construed as changing or affecting any right, liability, status, or 
interpretation which existed (under the provisions of law involved) 
before that date, see section 2354(e)(1) of Pub. L. 98-369, set out as a 
note under section 1320a-1 of this title.


                    Effective Date of 1982 Amendment

    Amendment by Pub. L. 97-248 applicable to hospice care provided on 
or after Nov. 1, 1983, see section 122(h)(1) of Pub. L. 97-248, as 
amended, set out as a note under section 1395c of this title.


                    Effective Date of 1980 Amendments

    Amendment by Pub. L. 96-611 effective July 1, 1981, and applicable 
to services furnished on or after that date, see section 2 of Pub. L. 
96-611, set out as a note under section 1395l of this title.
    For effective date of amendment by section 933(g) of Pub. L. 96-499, 
see section 933(h) of Pub. L. 96-499, set out as a note under section 
1395k of this title.


                    Effective Date of 1977 Amendment

    Amendment by Pub. L. 95-210 applicable to services rendered on or 
after first day of third calendar month which begins after Dec. 31, 
1977, see section 1(j) of Pub. L. 95-210, set out as a note under 
section 1395k of this title.


                    Effective Date of 1972 Amendment

    Section 299D(c) of Pub. L. 92-603 provided that: ``The provisions of 
this section [amending this section and section 1396a of this title] 
shall be effective beginning January 1, 1973, or within 6 months 
following the enactment of this Act [Oct. 30, 1972], whichever is 
later.''


                    Effective Date of 1968 Amendment

    Amendment by section 133(f) of Pub. L. 90-248 applicable with 
respect to services furnished after June 30, 1968, see section 133(g) of 
Pub. L. 90-248, set out as a note under section 1395k of this title.
    Section 228(b) of Pub. L. 90-248 provided that the amendment made by 
such section 228(b) is effective July 1, 1969.


        Use of State or Local Agencies in Evaluating Laboratories

    Section 160(a)(2) of Pub. L. 103-432 provided that: ``An agreement 
made by the Secretary of Health and Human Services with a State under 
section 1864(a) of the Social Security Act [subsec. (a) of this section] 
may include an agreement that the services of the State health agency or 
other appropriate State agency (or the appropriate local agencies) will 
be utilized by the Secretary for the purpose of determining whether a 
laboratory meets the requirements of section 353 of the Public Health 
Service Act [section 263a of this title].''


 Nurse Aid Training and Competency Evaluation, Failure by State To Meet 
                               Guidelines

    Section 4008(h)(1)(A) of Pub. L. 101-508 provided that: ``The 
Secretary of Health and Human Services may not refuse to enter into an 
agreement or cancel an existing agreement with a State under section 
1864 of the Social Security Act [this section] on the basis that the 
State failed to meet the requirement of section 1819(e)(1)(A) of such 
Act [section 1395i-3(e)(1)(A) of this title] before the effective date 
of guidelines, issued by the Secretary, establishing requirements under 
section 1819(f)(2)(A) of such Act, if the State demonstrates to the 
satisfaction of the Secretary that it has made a good faith effort to 
meet such requirement before such effective date.''

                  Section Referred to in Other Sections

    This section is referred to in sections 263a-2, 1320a-7, 1320a-7a, 
1395i-3, 1395x, 1395bb, 1395bbb, 1396a of this title; title 45 section 
231f.
