
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 23, 2000]
[Document affected by Public Law 106-354 Section 2(a)(1)-(3)]
[Document affected by Public Law 106-354 Section 2(a)(1)-(3)]
[Document affected by Public Law 106-354 Section 2(b)(2)(A)]
[Document affected by Public Law 106-554 Section 1(a)(6)]
[Document affected by Public Law 106-554 Section 1(a)(6)]
[Document affected by Public Law 106-554 Section 1(a)(6)]
[Document affected by Public Law 106-554 Section 1(a)(6)[707(b)]]
[Document affected by Public Law 107-121 Section 2(a)-(b)(2)]
[Document affected by Public Law 106-354 Section 2(d)]
[Document affected by Public Law 106-554 Section 1(a)(6)[125]]
[Document affected by Public Law 106-554 Section 1(a)(6)[702(d)]]
[Document affected by Public Law 106-554 Section 1(a)(6)[702(e)]]
[Document affected by Public Law 107-121 Section 2(c)]
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[CITE: 42USC1396a]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
    SUBCHAPTER XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
 
Sec. 1396a. State plans for medical assistance


(a) Contents

    A State plan for medical assistance must--
        (1) provide that it shall be in effect in all political 
    subdivisions of the State, and, if administered by them, be 
    mandatory upon them;
        (2) provide for financial participation by the State equal to 
    not less than 40 per centum of the non-Federal share of the 
    expenditures under the plan with respect to which payments under 
    section 1396b of this title are authorized by this subchapter; and, 
    effective July 1, 1969, provide for financial participation by the 
    State equal to all of such non-Federal share or provide for 
    distribution of funds from Federal or State sources, for carrying 
    out the State plan, on an equalization or other basis which will 
    assure that the lack of adequate funds from local sources will not 
    result in lowering the amount, duration, scope, or quality of care 
    and services available under the plan;
        (3) provide for granting an opportunity for a fair hearing 
    before the State agency to any individual whose claim for medical 
    assistance under the plan is denied or is not acted upon with 
    reasonable promptness;
        (4) provide (A) such methods of administration (including 
    methods relating to the establishment and maintenance of personnel 
    standards on a merit basis, except that the Secretary shall exercise 
    no authority with respect to the selection, tenure of office, and 
    compensation of any individual employed in accordance with such 
    methods, and including provision for utilization of professional 
    medical personnel in the administration and, where administered 
    locally, supervision of administration of the plan) as are found by 
    the Secretary to be necessary for the proper and efficient operation 
    of the plan, (B) for the training and effective use of paid 
    subprofessional staff, with particular emphasis on the full-time or 
    part-time employment of recipients and other persons of low income, 
    as community service aides, in the administration of the plan and 
    for the use of nonpaid or partially paid volunteers in a social 
    service volunteer program in providing services to applicants and 
    recipients and in assisting any advisory committees established by 
    the State agency, (C) that each State or local officer, employee, or 
    independent contractor who is responsible for the expenditure of 
    substantial amounts of funds under the State plan, each individual 
    who formerly was such an officer, employee, or contractor, and each 
    partner of such an officer, employee, or contractor shall be 
    prohibited from committing any act, in relation to any activity 
    under the plan, the commission of which, in connection with any 
    activity concerning the United States Government, by an officer or 
    employee of the United States Government, an individual who was such 
    an officer or employee, or a partner of such an officer or employee 
    is prohibited by section 207 or 208 of title 18, and (D) that each 
    State or local officer, employee, or independent contractor who is 
    responsible for selecting, awarding, or otherwise obtaining items 
    and services under the State plan shall be subject to safeguards 
    against conflicts of interest that are at least as stringent as the 
    safeguards that apply under section 423 of title 41 to persons 
    described in subsection (a)(2) of section 423 of title 41;
        (5) either provide for the establishment or designation of a 
    single State agency to administer or to supervise the administration 
    of the plan; or provide for the establishment or designation of a 
    single State agency to administer or to supervise the administration 
    of the plan, except that the determination of eligibility for 
    medical assistance under the plan shall be made by the State or 
    local agency administering the State plan approved under subchapter 
    I or XVI of this chapter (insofar as it relates to the aged) 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 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;
        (6) provide that the State agency will make such reports, in 
    such form and containing such information, as the Secretary may from 
    time to time require, and comply with such provisions as the 
    Secretary may from time to time find necessary to assure the 
    correctness and verification of such reports;
        (7) provide safeguards which restrict the use or disclosure of 
    information concerning applicants and recipients to purposes 
    directly connected with the administration of the plan;
        (8) provide that all individuals wishing to make application for 
    medical assistance under the plan shall have opportunity to do so, 
    and that such assistance shall be furnished with reasonable 
    promptness to all eligible individuals;
        (9) provide--
            (A) that the State health agency, or other appropriate State 
        medical agency (whichever is utilized by the Secretary for the 
        purpose specified in the first sentence of section 1395aa(a) of 
        this title), shall be responsible 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,
            (B) for the establishment or designation of a State 
        authority or authorities which shall be responsible for 
        establishing and maintaining standards, other than those 
        relating to health, for such institutions, and
            (C) that any laboratory services paid for under such plan 
        must be provided by a laboratory which meets the applicable 
        requirements of section 1395x(e)(9) of this title or paragraphs 
        (16) and (17) of section 1395x(s) of this title, or, in the case 
        of a laboratory which is in a rural health clinic, of section 
        1395x(aa)(2)(G) of this title;

        (10) provide--
            (A) for making medical assistance available, including at 
        least the care and services listed in paragraphs (1) through 
        (5), (17) and (21) of section 1396d(a) of this title, to--
                (i) all individuals--
                    (I) who are receiving aid or assistance under any 
                plan of the State approved under subchapter I, X, XIV, 
                or XVI of this chapter, or part A or part E of 
                subchapter IV of this chapter (including individuals 
                eligible under this subchapter by reason of section 
                602(a)(37),\1\ 606(h),\1\ or 673(b) of this title, or 
                considered by the State to be receiving such aid as 
                authorized under section 682(e)(6)\1\ of this title),
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    \1\ See References in Text note below.
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                    (II) with respect to whom supplemental security 
                income benefits are being paid under subchapter XVI of 
                this chapter (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 or who are 
                qualified severely impaired individuals (as defined in 
                section 1396d(q) of this title),
                    (III) who are qualified pregnant women or children 
                as defined in section 1396d(n) of this title,
                    (IV) who are described in subparagraph (A) or (B) of 
                subsection (l)(1) of this section and whose family 
                income does not exceed the minimum income level the 
                State is required to establish under subsection 
                (l)(2)(A) of this section for such a family; \2\
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    \2\ So in original. The semicolon probably should be a comma.
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                    (V) who are qualified family members as defined in 
                section 1396d(m)(1) of this title,
                    (VI) who are described in subparagraph (C) of 
                subsection (l)(1) of this section and whose family 
                income does not exceed the income level the State is 
                required to establish under subsection (l)(2)(B) of this 
                section for such a family, or
                    (VII) who are described in subparagraph (D) of 
                subsection (l)(1) of this section and whose family 
                income does not exceed the income level the State is 
                required to establish under subsection (l)(2)(C) of this 
                section for such a family; \3\
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    \3\ So in original. Probably should be followed by ``and''.

                (ii) at the option of the State, to \4\ any group or 
            groups of individuals described in section 1396d(a) of this 
            title (or, in the case of individuals described in section 
            1396d(a)(i) of this title, to \4\ any reasonable categories 
            of such individuals) who are not individuals described in 
            clause (i) of this subparagraph but--
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    \4\ So in original. The word ``to'' probably should not appear.
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                    (I) who meet the income and resources requirements 
                of the appropriate State plan described in clause (i) or 
                the supplemental security income program (as the case 
                may be),
                    (II) who would meet the income and resources 
                requirements of the appropriate State plan described in 
                clause (i) if their work-related child care costs were 
                paid from their earnings rather than by a State agency 
                as a service expenditure,
                    (III) who would be eligible to receive aid under the 
                appropriate State plan described in clause (i) if 
                coverage under such plan was as broad as allowed under 
                Federal law,
                    (IV) 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, aid or assistance under the appropriate State plan 
                described in clause (i), supplemental security income 
                benefits under subchapter XVI of this chapter, or a 
                State supplementary payment; \2\
                    (V) who are in a medical institution 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), who meet the resource requirements of the 
                appropriate State plan described in clause (i) or the 
                supplemental security income program, and whose income 
                does not exceed a separate income standard established 
                by the State which is consistent with the limit 
                established under section 1396b(f)(4)(C) of this title,
                    (VI) who would be eligible under the State plan 
                under this subchapter if they were in a medical 
                institution, with respect to whom there has been a 
                determination that but for the provision of home or 
                community-based services described in subsection (c), 
                (d), or (e) of section 1396n of this title they would 
                require the level of care provided in a hospital, 
                nursing facility or intermediate care facility for the 
                mentally retarded the cost of which could be reimbursed 
                under the State plan, and who will receive home or 
                community-based services pursuant to a waiver granted by 
                the Secretary under subsection (c), (d), or (e) of 
                section 1396n of this title,
                    (VII) who would be eligible under the State plan 
                under this subchapter if they were in a medical 
                institution, who are terminally ill, and who will 
                receive hospice care pursuant to a voluntary election 
                described in section 1396d(o) of this title; \5\
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    \5\ So in original. The semicolon probably should be a comma.
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                    (VIII) who is a child described in section 
                1396d(a)(i) of this title--
                        (aa) for whom there is in effect an adoption 
                    assistance agreement (other than an agreement under 
                    part E of subchapter IV of this chapter) between the 
                    State and an adoptive parent or parents,
                        (bb) who the State agency responsible for 
                    adoption assistance has determined cannot be placed 
                    with adoptive parents without medical assistance 
                    because such child has special needs for medical or 
                    rehabilitative care, and
                        (cc) who was eligible for medical assistance 
                    under the State plan prior to the adoption 
                    assistance agreement being entered into, or who 
                    would have been eligible for medical assistance at 
                    such time if the eligibility standards and 
                    methodologies of the State's foster care program 
                    under part E of subchapter IV of this chapter were 
                    applied rather than the eligibility standards and 
                    methodologies of the State's aid to families with 
                    dependent children program under part A of 
                    subchapter IV of this chapter; \5\

                    (IX) who are described in subsection (l)(1) of this 
                section and are not described in clause (i)(IV), clause 
                (i)(VI), or clause (i)(VII); \5\
                    (X) who are described in subsection (m)(1) of this 
                section; \5\
                    (XI) who receive only an optional State 
                supplementary payment based on need and paid on a 
                regular basis, equal to the difference between the 
                individual's countable income and the income standard 
                used to determine eligibility for such supplementary 
                payment (with countable income being the income 
                remaining after deductions as established by the State 
                pursuant to standards that may be more restrictive than 
                the standards for supplementary security income benefits 
                under subchapter XVI of this chapter), which are 
                available to all individuals in the State (but which may 
                be based on different income standards by political 
                subdivision according to cost of living differences), 
                and which are paid by a State that does not have an 
                agreement with the Commissioner of Social Security under 
                section 1382e or 1383c of this title; \5\
                    (XII) who are described in subsection (z)(1) of this 
                section (relating to certain TB-infected individuals); 
                \5\
                    (XIII) who are in families whose income is less than 
                250 percent of the income official poverty line (as 
                defined by the Office of Management and Budget, and 
                revised annually in accordance with section 9902(2) of 
                this title) applicable to a family of the size involved, 
                and who but for earnings in excess of the limit 
                established under section 1396d(q)(2)(B) of this title, 
                would be considered to be receiving supplemental 
                security income (subject, notwithstanding section 1396o 
                of this title, to payment of premiums or other cost-
                sharing charges (set on a sliding scale based on income) 
                that the State may determine); \5\
                    (XIV) who are optional targeted low-income children 
                described in section 1396d(u)(2)(B) of this title;
                    (XV) who, but for earnings in excess of the limit 
                established under section 1396d(q)(2)(B) of this title, 
                would be considered to be receiving supplemental 
                security income, who is at least 16, but less than 65, 
                years of age, and whose assets, resources, and earned or 
                unearned income (or both) do not exceed such limitations 
                (if any) as the State may establish;
                    (XVI) who are employed individuals with a medically 
                improved disability described in section 1396d(v)(1) of 
                this title and whose assets, resources, and earned or 
                unearned income (or both) do not exceed such limitations 
                (if any) as the State may establish, but only if the 
                State provides medical assistance to individuals 
                described in subclause (XV); or
                    (XVII) who are independent foster care adolescents 
                (as defined in section 1396d(w)(1) of this title), or 
                who are within any reasonable categories of such 
                adolescents specified by the State;

            (B) that the medical assistance made available to any 
        individual described in subparagraph (A)--
                (i) shall not be less in amount, duration, or scope than 
            the medical assistance made available to any other such 
            individual, and
                (ii) shall not be less in amount, duration, or scope 
            than the medical assistance made available to individuals 
            not described in subparagraph (A);

            (C) that if medical assistance is included for any group of 
        individuals described in section 1396d(a) of this title who are 
        not described in subparagraph (A) or (E), then--
                (i) the plan must include a description of (I) the 
            criteria for determining eligibility of individuals in the 
            group for such medical assistance, (II) the amount, 
            duration, and scope of medical assistance made available to 
            individuals in the group, and (III) the single standard to 
            be employed in determining income and resource eligibility 
            for all such groups, and the methodology to be employed in 
            determining such eligibility, which shall be no more 
            restrictive than the methodology which would be employed 
            under the supplemental security income program in the case 
            of groups consisting of aged, blind, or disabled individuals 
            in a State in which such program is in effect, and which 
            shall be no more restrictive than the methodology which 
            would be employed under the appropriate State plan 
            (described in subparagraph (A)(i)) to which such group is 
            most closely categorically related in the case of other 
            groups;
                (ii) the plan must make available medical assistance--
                    (I) to individuals 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), and
                    (II) to pregnant women, during the course of their 
                pregnancy, who (but for income and resources) would be 
                eligible for medical assistance as an individual 
                described in subparagraph (A);

                (iii) such medical assistance must include (I) with 
            respect to children under 18 and individuals entitled to 
            institutional services, ambulatory services, and (II) with 
            respect to pregnant women, prenatal care and delivery 
            services; and
                (iv) if such medical assistance includes services in 
            institutions for mental diseases or in an intermediate care 
            facility for the mentally retarded (or both) for any such 
            group, it also must include for all groups covered at least 
            the care and services listed in paragraphs (1) through (5) 
            and (17) of section 1396d(a) of this title or the care and 
            services listed in any 7 of the paragraphs numbered (1) 
            through (24) of such section;

            (D) for the inclusion of home health services for any 
        individual who, under the State plan, is entitled to nursing 
        facility services;
            (E)(i) for making medical assistance available for medicare 
        cost-sharing (as defined in section 1396d(p)(3) of this title) 
        for qualified medicare beneficiaries described in section 
        1396d(p)(1) of this title;
            (ii) for making medical assistance available for payment of 
        medicare cost-sharing described in section 1396d(p)(3)(A)(i) of 
        this title for qualified disabled and working individuals 
        described in section 1396d(s) of this title;
            (iii) for making medical assistance available for medicare 
        cost sharing described in section 1396d(p)(3)(A)(ii) of this 
        title subject to section 1396d(p)(4) of this title, for 
        individuals who would be qualified medicare beneficiaries 
        described in section 1396d(p)(1) of this title but for the fact 
        that their income exceeds the income level established by the 
        State under section 1396d(p)(2) of this title but is less than 
        110 percent in 1993 and 1994, and 120 percent in 1995 and years 
        thereafter of the official poverty line (referred to in such 
        section) for a family of the size involved; and
            (iv) subject to sections 1396u-3 and 1396d(p)(4) of this 
        title, for making medical assistance available (but only for 
        premiums payable with respect to months during the period 
        beginning with January 1998, and ending with December 2002)--
                (I) for medicare cost-sharing described in section 
            1396d(p)(3)(A)(ii) of this title for individuals who would 
            be qualified medicare beneficiaries described in section 
            1396d(p)(1) of this title but for the fact that their income 
            exceeds the income level established by the State under 
            section 1396d(p)(2) of this title and is at least 120 
            percent, but less than 135 percent, of the official poverty 
            line (referred to in such section) for a family of the size 
            involved and who are not otherwise eligible for medical 
            assistance under the State plan, and
                (II) for the portion of medicare cost-sharing described 
            in section 1396d(p)(3)(A)(ii) of this title that is 
            attributable to the operation of the amendments made by (and 
            subsection (e)(3) of) section 4611 of the Balanced Budget 
            Act of 1997 for individuals who would be described in 
            subclause (I) if ``135 percent'' and ``175 percent'' were 
            substituted for ``120 percent'' and ``135 percent'' 
            respectively;

            (F) at the option of a State, for making medical assistance 
        available for COBRA premiums (as defined in subsection (u)(2) of 
        this section) for qualified COBRA continuation beneficiaries 
        described in subsection (u)(1) of this section; and
            (G) that, in applying eligibility criteria of the 
        supplemental security income program under subchapter XVI of 
        this chapter for purposes of determining eligibility for medical 
        assistance under the State plan of an individual who is not 
        receiving supplemental security income, the State will disregard 
        the provisions of subsections (c) and (e) of section 1382b of 
        this title;

    except that (I) the making available of the services described in 
    paragraph (4), (14), or (16) of section 1396d(a) of this title to 
    individuals meeting the age requirements prescribed therein shall 
    not, by reason of this paragraph (10), require the making available 
    of any such services, or the making available of such services of 
    the same amount, duration, and scope, to individuals of any other 
    ages, (II) the making available of supplementary medical insurance 
    benefits under part B of subchapter XVIII of this chapter to 
    individuals eligible therefor (either pursuant to an agreement 
    entered into under section 1395v of this title or by reason of the 
    payment of premiums under such subchapter by the State agency on 
    behalf of such individuals), or provision for meeting part or all of 
    the cost of deductibles, cost sharing, or similar charges under part 
    B of subchapter XVIII of this chapter for individuals eligible for 
    benefits under such part, shall not, by reason of this paragraph 
    (10), require the making available of any such benefits, or the 
    making available of services of the same amount, duration, and 
    scope, to any other individuals, (III) the making available of 
    medical assistance equal in amount, duration, and scope to the 
    medical assistance made available to individuals described in clause 
    (A) to any classification of individuals approved by the Secretary 
    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 shall not, 
    by reason of this paragraph (10), require the making available of 
    any such assistance, or the making available of such assistance of 
    the same amount, duration, and scope, to any other individuals not 
    described in clause (A), (IV) the imposition of a deductible, cost 
    sharing, or similar charge for any item or service furnished to an 
    individual not eligible for the exemption under section 1396o(a)(2) 
    or (b)(2) of this title shall not require the imposition of a 
    deductible, cost sharing, or similar charge for the same item or 
    service furnished to an individual who is eligible for such 
    exemption, (V) the making available to pregnant women covered under 
    the plan of services relating to pregnancy (including prenatal, 
    delivery, and postpartum services) or to any other condition which 
    may complicate pregnancy shall not , by reason of this paragraph 
    (10), require the making available of such services, or the making 
    available of such services of the same amount, duration, and scope, 
    to any other individuals, provided such services are made available 
    (in the same amount, duration, and scope) to all pregnant women 
    covered under the State plan, (VI) with respect to the making 
    available of medical assistance for hospice care to terminally ill 
    individuals who have made a voluntary election described in section 
    1396d(o) of this title to receive hospice care instead of medical 
    assistance for certain other services, such assistance may not be 
    made available in an amount, duration, or scope less than that 
    provided under subchapter XVIII of this chapter, and the making 
    available of such assistance shall not, by reason of this paragraph 
    (10), require the making available of medical assistance for hospice 
    care to other individuals or the making available of medical 
    assistance for services waived by such terminally ill individuals, 
    (VII) the medical assistance made available to an individual 
    described in subsection (l)(1)(A) of this section who is eligible 
    for medical assistance only because of subparagraph (A)(i)(IV) or 
    (A)(ii)(IX) shall be limited to medical assistance for services 
    related to pregnancy (including prenatal, delivery, postpartum, and 
    family planning services) and to other conditions which may 
    complicate pregnancy, (VIII) the medical assistance made available 
    to a qualified medicare beneficiary described in section 1396d(p)(1) 
    of this title who is only entitled to medical assistance because the 
    individual is such a beneficiary shall be limited to medical 
    assistance for medicare cost-sharing (described in section 
    1396d(p)(3) of this title), subject to the provisions of subsection 
    (n) of this section and section 1396o(b) of this title, (IX) the 
    making available of respiratory care services in accordance with 
    subsection (e)(9) of this section shall not, by reason of this 
    paragraph (10), require the making available of such services, or 
    the making available of such services of the same amount, duration, 
    and scope, to any individuals not included under subsection 
    (e)(9)(A) of this section, provided such services are made available 
    (in the same amount, duration, and scope) to all individuals 
    described in such subsection, (X) if the plan provides for any fixed 
    durational limit on medical assistance for inpatient hospital 
    services (whether or not such a limit varies by medical condition or 
    diagnosis), the plan must establish exceptions to such a limit for 
    medically necessary inpatient hospital services furnished with 
    respect to individuals under one year of age in a hospital defined 
    under the State plan, pursuant to section 1396r-4(a)(1)(A) of this 
    title, as a disproportionate share hospital and subparagraph (B) 
    (relating to comparability) shall not be construed as requiring such 
    an exception for other individuals, services, or hospitals, (XI) the 
    making available of medical assistance to cover the costs of 
    premiums, deductibles, coinsurance, and other cost-sharing 
    obligations for certain individuals for private health coverage as 
    described in section 1396e of this title shall not, by reason of 
    paragraph (10), require the making available of any such benefits or 
    the making available of services of the same amount, duration, and 
    scope of such private coverage to any other individuals, (XII) the 
    medical assistance made available to an individual described in 
    subsection (u)(1) of this section who is eligible for medical 
    assistance only because of subparagraph (F) shall be limited to 
    medical assistance for COBRA continuation premiums (as defined in 
    subsection (u)(2) of this section), and (XIII) the medical 
    assistance made available to an individual described in subsection 
    (z)(1) of this section who is eligible for medical assistance only 
    because of subparagraph (A)(ii)(XII) shall be limited to medical 
    assistance for TB-related services (described in subsection (z)(2) 
    of this section);
        (11)(A) provide for entering into cooperative arrangements with 
    the State agencies responsible for administering or supervising the 
    administration of health services and vocational rehabilitation 
    services in the State looking toward maximum utilization of such 
    services in the provision of medical assistance under the plan, (B) 
    provide, to the extent prescribed by the Secretary, for entering 
    into agreements, with any agency, institution, or organization 
    receiving payments 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 and which are 
    included in the State plan approved under this section \6\ (ii) 
    making such provision as may be appropriate for reimbursing such 
    agency, institution, or organization for the cost of any such care 
    and services furnished any individual for which payment would 
    otherwise be made to the State with respect to the individual under 
    section 1396b of this title, and (iii) providing for coordination of 
    information and education on pediatric vaccinations and delivery of 
    immunization services, and (C) provide for coordination of the 
    operations under this subchapter, including the provision of 
    information and education on pediatric vaccinations and the delivery 
    of immunization services, with the State's operations under the 
    special supplemental nutrition program for women, infants, and 
    children under section 1786 of this title;
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    \6\ So in original. Probably should be followed by a comma.
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        (12) provide that, in determining whether an individual is 
    blind, there shall be an examination by a physician skilled in the 
    diseases of the eye or by an optometrist, whichever the individual 
    may select;
        (13) provide--
            (A) for a public process for determination of rates of 
        payment under the plan for hospital services, nursing facility 
        services, and services of intermediate care facilities for the 
        mentally retarded under which--
                (i) proposed rates, the methodologies underlying the 
            establishment of such rates, and justifications for the 
            proposed rates are published,
                (ii) providers, beneficiaries and their representatives, 
            and other concerned State residents are given a reasonable 
            opportunity for review and comment on the proposed rates, 
            methodologies, and justifications,
                (iii) final rates, the methodologies underlying the 
            establishment of such rates, and justifications for such 
            final rates are published, and
                (iv) in the case of hospitals, such rates take into 
            account (in a manner consistent with section 1396r-4 of this 
            title) the situation of hospitals which serve a 
            disproportionate number of low-income patients with special 
            needs;

            (B) for payment for hospice care in amounts no lower than 
        the amounts, using the same methodology, used under part A of 
        subchapter XVIII of this chapter and for payment of amounts 
        under section 1396d(o)(3) of this title; except that in the case 
        of hospice care which is furnished to an individual who is a 
        resident of a nursing facility or intermediate care facility for 
        the mentally retarded, and who would be eligible under the plan 
        for nursing facility services or services in an intermediate 
        care facility for the mentally retarded if he had not elected to 
        receive hospice care, 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; and
            (C)(i) for payment for services described in clause (B) or 
        (C) of section 1396d(a)(2) 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 1395l(a)(3) of this 
        title, or, in the case of services to which those regulations do 
        not apply, on the same methodology used under section 
        1395l(a)(3) 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 1396b(m) 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;

        (14) provide that enrollment fees, premiums, or similar charges, 
    and deductions, cost sharing, or similar charges, may be imposed 
    only as provided in section 1396o of this title;
        (15) Repealed. Pub. L. 100-360, title III, Sec. 301(e)(2)(C), as 
    added by Pub. L. 100-485, title VI, Sec. 608(d)(14)(I)(iii), Oct. 
    13, 1988, 102 Stat. 2416;
        (16) provide for inclusion, to the extent required by 
    regulations prescribed by the Secretary, of provisions (conforming 
    to such regulations) with respect to the furnishing of medical 
    assistance under the plan to individuals who are residents of the 
    State but are absent therefrom;
        (17) except as provided in subsections (l)(3), (m)(3), and 
    (m)(4) of this section, include reasonable standards (which shall be 
    comparable for all groups and may, in accordance with standards 
    prescribed by the Secretary, differ with respect to income levels, 
    but only in the case of applicants or recipients of assistance under 
    the plan who are not receiving aid or assistance under any plan of 
    the State approved under subchapter I, X, XIV, or XVI, or part A of 
    subchapter IV of this chapter, and with respect to whom supplemental 
    security income benefits are not being paid under subchapter XVI of 
    this chapter, based on the variations between shelter costs in urban 
    areas and in rural areas) for determining eligibility for and the 
    extent of medical assistance under the plan which (A) are consistent 
    with the objectives of this subchapter, (B) provide for taking into 
    account only such income and resources as are, as determined in 
    accordance with standards prescribed by the Secretary, available to 
    the applicant or recipient and (in the case of any applicant or 
    recipient who would, except for income and resources, be eligible 
    for aid or assistance in the form of money payments under any plan 
    of the State approved under subchapter I, X, XIV, or XVI, or part A 
    of subchapter IV, or to have paid with respect to him supplemental 
    security income benefits under subchapter XVI of this chapter) as 
    would not be disregarded (or set aside for future needs) in 
    determining his eligibility for such aid, assistance, or benefits, 
    (C) provide for reasonable evaluation of any such income or 
    resources, and (D) do not take into account the financial 
    responsibility of any individual for any applicant or recipient of 
    assistance under the plan unless such applicant or recipient is such 
    individual's spouse or such individual's child who is under age 21 
    or (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 1382c of this title (with respect to States which 
    are not eligible to participate in such program); and provide for 
    flexibility in the application of such standards with respect to 
    income by taking into account, except to the extent prescribed by 
    the Secretary, the costs (whether in the form of insurance premiums, 
    payments made to the State under section 1396b(f)(2)(B) of this 
    title, or otherwise and regardless of whether such costs are 
    reimbursed under another public program of the State or political 
    subdivision thereof) incurred for medical care or for any other type 
    of remedial care recognized under State law;
        (18) comply with the provisions of section 1396p of this title 
    with respect to liens, adjustments and recoveries of medical 
    assistance correctly paid,,\7\ transfers of assets, and treatment of 
    certain trusts;
---------------------------------------------------------------------------
    \7\ So in original.
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        (19) provide such safeguards as may be necessary to assure that 
    eligibility for care and services under the plan will be determined, 
    and such care and services will be provided, in a manner consistent 
    with simplicity of administration and the best interests of the 
    recipients;
        (20) if the State plan includes medical assistance in behalf of 
    individuals 65 years of age or older who are patients in 
    institutions for mental diseases--
            (A) provide for having in effect such agreements or other 
        arrangements with State authorities concerned with mental 
        diseases, and, where appropriate, with such institutions, as may 
        be necessary for carrying out the State plan, including 
        arrangements for joint planning and for development of alternate 
        methods of care, arrangements providing assurance of immediate 
        readmittance to institutions where needed for individuals under 
        alternate plans of care, and arrangements providing for access 
        to patients and facilities, for furnishing information, and for 
        making reports;
            (B) provide for an individual plan for each such patient to 
        assure that the institutional care provided to him is in his 
        best interests, including, to that end, assurances that there 
        will be initial and periodic review of his medical and other 
        needs, that he will be given appropriate medical treatment 
        within the institution, and that there will be a periodic 
        determination of his need for continued treatment in the 
        institution; and
            (C) provide for the development of alternate plans of care, 
        making maximum utilization of available resources, for 
        recipients 65 years of age or older who would otherwise need 
        care in such institutions, including appropriate medical 
        treatment and other aid or assistance; for services referred to 
        in section 303(a)(4)(A)(i) and (ii) \8\ or section 
        1383(a)(4)(A)(i) and (ii) \8\ of this title which are 
        appropriate for such recipients and for such patients; and for 
        methods of administration necessary to assure that the 
        responsibilities of the State agency under the State plan with 
        respect to such recipients and such patients will be effectively 
        carried out;
---------------------------------------------------------------------------
    \8\ See References in Text note below.

        (21) if the State plan includes medical assistance in behalf of 
    individuals 65 years of age or older who are patients in public 
    institutions for mental diseases, show that the State is making 
    satisfactory progress toward developing and implementing a 
    comprehensive mental health program, including provision for 
    utilization of community mental health centers, nursing facilities, 
    and other alternatives to care in public institutions for mental 
    diseases;
        (22) include descriptions of (A) the kinds and numbers of 
    professional medical personnel and supporting staff that will be 
    used in the administration of the plan and of the responsibilities 
    they will have, (B) the standards, for private or public 
    institutions in which recipients of medical assistance under the 
    plan may receive care or services, that will be utilized by the 
    State authority or authorities responsible for establishing and 
    maintaining such standards, (C) the cooperative arrangements with 
    State health agencies and State vocational rehabilitation agencies 
    entered into with a view to maximum utilization of and coordination 
    of the provision of medical assistance with the services 
    administered or supervised by such agencies, and (D) other standards 
    and methods that the State will use to assure that medical or 
    remedial care and services provided to recipients of medical 
    assistance are of high quality;
        (23) provide that (A) any individual eligible for medical 
    assistance (including drugs) may obtain such assistance from any 
    institution, agency, community pharmacy, or person, qualified to 
    perform the service or services required (including an organization 
    which provides such services, or arranges for their availability, on 
    a prepayment basis), who undertakes to provide him such services, 
    and (B) an enrollment of an individual eligible for medical 
    assistance in a primary care case-management system (described in 
    section 1396n(b)(1) of this title), a medicaid managed care 
    organization, or a similar entity shall not restrict the choice of 
    the qualified person from whom the individual may receive services 
    under section 1396d(a)(4)(C) of this title, except as provided in 
    subsection (g) of this section, in section 1396n of this title, and 
    in section 1396u-2(a) 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;
        (24) effective July 1, 1969, provide for consultative services 
    by health agencies and other appropriate agencies of the State to 
    hospitals, nursing facilities, home health agencies, clinics, 
    laboratories, and such other institutions as the Secretary may 
    specify in order to assist them (A) to qualify for payments under 
    this chapter, (B) to establish and maintain such fiscal records as 
    may be necessary for the proper and efficient administration of this 
    chapter, and (C) to provide information needed to determine payments 
    due under this chapter on account of care and services furnished to 
    individuals;
        (25) provide--
            (A) that the State or local agency administering such plan 
        will take all reasonable measures to ascertain the legal 
        liability of third parties (including health insurers, group 
        health plans (as defined in section 607(1) of the Employee 
        Retirement Income Security Act of 1974 [29 U.S.C. 1167(1)]), 
        service benefit plans, and health maintenance organizations) to 
        pay for care and services available under the plan, including--
                (i) the collection of sufficient information (as 
            specified by the Secretary in regulations) to enable the 
            State to pursue claims against such third parties, with such 
            information being collected at the time of any determination 
            or redetermination of eligibility for medical assistance, 
            and
                (ii) the submission to the Secretary of a plan (subject 
            to approval by the Secretary) for pursuing claims against 
            such third parties, which plan shall 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 1396b(r) of this 
            title;

            (B) 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;
            (C) that in the case of an individual who is entitled to 
        medical assistance under the State plan with respect to a 
        service for which a third party is liable for payment, the 
        person furnishing the service may not seek to collect from the 
        individual (or any financially responsible relative or 
        representative of that individual) payment of an amount for that 
        service (i) if the total of the amount of the liabilities of 
        third parties for that service is at least equal to the amount 
        payable for that service under the plan (disregarding section 
        1396o of this title), or (ii) in an amount which exceeds the 
        lesser of (I) the amount which may be collected under section 
        1396o of this title, or (II) the amount by which the amount 
        payable for that service under the plan (disregarding section 
        1396o of this title) exceeds the total of the amount of the 
        liabilities of third parties for that service;
            (D) that a person who furnishes services and is 
        participating under the plan may not refuse to furnish services 
        to an individual (who is entitled to have payment made under the 
        plan for the services the person furnishes) because of a third 
        party's potential liability for payment for the service;
            (E) that in the case of prenatal or preventive pediatric 
        care (including early and periodic screening and diagnosis 
        services under section 1396d(a)(4)(B) of this title) covered 
        under the State plan, the State shall--
                (i) make payment for such service in accordance with the 
            usual payment schedule under such plan for such services 
            without regard to the liability of a third party for payment 
            for such services; and
                (ii) seek reimbursement from such third party in 
            accordance with subparagraph (B);

            (F) that in the case of any services covered under such plan 
        which are provided to an individual on whose behalf child 
        support enforcement is being carried out by the State agency 
        under part D of subchapter IV of this chapter, the State shall--
                (i) make payment for such service in accordance with the 
            usual payment schedule under such plan for such services 
            without regard to any third-party liability for payment for 
            such services, if such third-party liability is derived 
            (through insurance or otherwise) from the parent whose 
            obligation to pay support is being enforced by such agency, 
            if payment has not been made by such third party within 30 
            days after such services are furnished; and
                (ii) seek reimbursement from such third party in 
            accordance with subparagraph (B);

            (G) that the State prohibits any health insurer (including a 
        group health plan, as defined in section 607(1) of the Employee 
        Retirement Income Security Act of 1974 [29 U.S.C. 1167(1)], a 
        service benefit plan, and a health maintenance organization), in 
        enrolling an individual or in making any payments for benefits 
        to the individual or on the individual's behalf, from taking 
        into account that the individual is eligible for or is provided 
        medical assistance under a plan under this subchapter for such 
        State, or any other State; and
            (H) that to the extent that payment has been made under the 
        State plan for medical assistance in any case where a third 
        party has a legal liability to make payment for such assistance, 
        the State has in effect laws under which, to the extent that 
        payment has been made under the State plan for medical 
        assistance for health care items or services furnished to an 
        individual, the State is considered to have acquired the rights 
        of such individual to payment by any other party for such health 
        care items or services;

        (26) if the State plan includes medical assistance for inpatient 
    mental hospital services, provide, with respect to each patient 
    receiving such services, for a regular program of medical review 
    (including medical evaluation) of his need for such services, and 
    for a written plan of care;
        (27) provide for agreements with every person or institution 
    providing services under the State plan under which such person or 
    institution agrees (A) to keep such records as are necessary fully 
    to disclose the extent of the services provided to individuals 
    receiving assistance under the State plan, and (B) to furnish the 
    State agency or the Secretary with such information, regarding any 
    payments claimed by such person or institution for providing 
    services under the State plan, as the State agency or the Secretary 
    may from time to time request;
        (28) provide--
            (A) that any nursing facility receiving payments under such 
        plan must satisfy all the requirements of subsections (b) 
        through (d) of section 1396r of this title as they apply to such 
        facilities;
            (B) for including in ``nursing facility services'' at least 
        the items and services specified (or deemed to be specified) by 
        the Secretary under section 1396r(f)(7) of this title and making 
        available upon request a description of the items and services 
        so included;
            (C) for procedures to make available to the public the data 
        and methodology used in establishing payment rates for nursing 
        facilities under this subchapter; and
            (D) for compliance (by the date specified in the respective 
        sections) with the requirements of--
                (i) section 1396r(e) of this title;
                (ii) section 1396r(g) of this title (relating to 
            responsibility for survey and certification of nursing 
            facilities); and
                (iii) sections 1396r(h)(2)(B) and 1396r(h)(2)(D) of this 
            title (relating to establishment and application of 
            remedies);

        (29) include a State program which meets the requirements set 
    forth in section 1396g of this title, for the licensing of 
    administrators of nursing homes;
        (30)(A) provide such methods and procedures relating to the 
    utilization of, and the payment for, care and services available 
    under the plan (including but not limited to utilization review 
    plans as provided for in section 1396b(i)(4) of this title) as may 
    be necessary to safeguard against unnecessary utilization of such 
    care and services and to assure that payments are consistent with 
    efficiency, economy, and quality of care 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; and
        (B) provide, under the program described in subparagraph (A), 
    that--
            (i) each admission to a hospital, intermediate care facility 
        for the mentally retarded, or hospital for mental diseases is 
        reviewed or screened in accordance with criteria established by 
        medical and other professional personnel who are not themselves 
        directly responsible for the care of the patient involved, and 
        who do not have a significant financial interest in any such 
        institution and are not, except in the case of a hospital, 
        employed by the institution providing the care involved, and
            (ii) the information developed from such review or 
        screening, along with the data obtained from prior reviews of 
        the necessity for admission and continued stay of patients by 
        such professional personnel, shall be used as the basis for 
        establishing the size and composition of the sample of 
        admissions to be subject to review and evaluation by such 
        personnel, and any such sample may be of any size up to 100 
        percent of all admissions and must be of sufficient size to 
        serve the purpose of (I) identifying the patterns of care being 
        provided and the changes occurring over time in such patterns so 
        that the need for modification may be ascertained, and (II) 
        subjecting admissions to early or more extensive review where 
        information indicates that such consideration is warranted to a 
        hospital, intermediate care facility for the mentally retarded, 
        or hospital for mental diseases;

        (31) with respect to services in an intermediate care facility 
    for the mentally retarded (where the State plan includes medical 
    assistance for such services) provide, with respect to each patient 
    receiving such services, for a written plan of care, prior to 
    admission to or authorization of benefits in such facility, in 
    accordance with regulations of the Secretary, and for a regular 
    program of independent professional review (including medical 
    evaluation) which shall periodically review his need for such 
    services;
        (32) provide that no payment under the plan for any care or 
    service provided to an individual shall be made to anyone other than 
    such individual or the person or institution providing such care or 
    service, under an assignment or power of attorney or otherwise; 
    except that--
            (A) in the case of any care or service provided by a 
        physician, dentist, or other individual practitioner, such 
        payment may be made (i) to the employer of such physician, 
        dentist, or other practitioner if such physician, dentist, or 
        practitioner is required as a condition of his employment to 
        turn over his fee for such care or service to his employer, or 
        (ii) (where the care or service was provided in a hospital, 
        clinic, or other facility) to the facility in which the care or 
        service was provided if there is a contractual arrangement 
        between such physician, dentist, or practitioner and such 
        facility under which such facility submits the bill for such 
        care or service;
            (B) nothing in this paragraph shall be construed (i) to 
        prevent the making of such a payment in accordance with an 
        assignment from the person or institution providing the care or 
        service involved if such assignment is made to a governmental 
        agency or entity or is established by or pursuant to the order 
        of a court of competent jurisdiction, or (ii) to preclude an 
        agent of such person or institution from receiving any such 
        payment if (but only if) such agent does so pursuant to an 
        agency agreement under which the compensation to be paid to the 
        agent for his services for or in connection with the billing or 
        collection of payments due such person or institution under the 
        plan is unrelated (directly or indirectly) to the amount of such 
        payments or the billings therefor, and is not dependent upon the 
        actual collection of any such payment;
            (C) in the case of services furnished (during a period that 
        does not exceed 14 continuous days in the case of an informal 
        reciprocal arrangement or 90 continuous days (or such longer 
        period as the Secretary may provide) in the case of an 
        arrangement involving per diem or other fee-for-time 
        compensation) by, or incident to the services of, one physician 
        to the patients of another physician who submits the claim for 
        such services, payment shall be made to the physician submitting 
        the claim (as if the services were furnished by, or incident to, 
        the physician's services), but only if the claim identifies (in 
        a manner specified by the Secretary) the physician who furnished 
        the services; and
            (D) in the case of payment for a childhood vaccine 
        administered before October 1, 1994, to individuals entitled to 
        medical assistance under the State plan, the State plan may make 
        payment directly to the manufacturer of the vaccine under a 
        voluntary replacement program agreed to by the State pursuant to 
        which the manufacturer (i) supplies doses of the vaccine to 
        providers administering the vaccine, (ii) periodically replaces 
        the supply of the vaccine, and (iii) charges the State the 
        manufacturer's price to the Centers for Disease Control and 
        Prevention for the vaccine so administered (which price includes 
        a reasonable amount to cover shipping and the handling of 
        returns);

        (33) provide--
            (A) that the State health agency, or other appropriate State 
        medical agency, shall be responsible for establishing a plan, 
        consistent with regulations prescribed by the Secretary, for the 
        review by appropriate professional health personnel of the 
        appropriateness and quality of care and services furnished to 
        recipients of medical assistance under the plan in order to 
        provide guidance with respect thereto in the administration of 
        the plan to the State agency established or designated pursuant 
        to paragraph (5) and, where applicable, to the State agency 
        described in the second sentence of this subsection; and
            (B) that, except as provided in section 1396r(g) of this 
        title, the State or local agency utilized by the Secretary for 
        the purpose specified in the first sentence of section 1395aa(a) 
        of this title, or, if such agency is not the State agency which 
        is responsible for licensing health institutions, the State 
        agency responsible for such licensing, will perform for the 
        State agency administering or supervising the administration of 
        the plan approved under this subchapter the function of 
        determining whether institutions and agencies meet the 
        requirements for participation in the program under such plan, 
        except that, if the Secretary has cause to question the adequacy 
        of such determinations, the Secretary is authorized to validate 
        State determinations and, on that basis, make independent and 
        binding determinations concerning the extent to which individual 
        institutions and agencies meet the requirements for 
        participation;

        (34) provide that in the case of any individual who has been 
    determined to be eligible for medical assistance under the plan, 
    such assistance will be made available to him for care and services 
    included under the plan and furnished in or after the third month 
    before the month in which he made application (or application was 
    made on his behalf in the case of a deceased individual) for such 
    assistance if such individual was (or upon application would have 
    been) eligible for such assistance at the time such care and 
    services were furnished;
        (35) provide that any disclosing entity (as defined in section 
    1320a-3(a)(2) of this title) receiving payments under such plan 
    complies with the requirements of section 1320a-3 of this title;
        (36) provide that within 90 days following the completion of 
    each survey of any health care facility, laboratory, agency, clinic, 
    or organization, by the appropriate State agency described in 
    paragraph (9), such agency shall (in accordance with regulations of 
    the Secretary) make public in readily available form and place the 
    pertinent findings of each such survey relating to the compliance of 
    each such health care facility, laboratory, clinic, agency, or 
    organization with (A) the statutory conditions of participation 
    imposed under this subchapter, and (B) 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 facility, laboratory, clinic, agency, or organization;
        (37) provide for claims payment procedures which (A) ensure that 
    90 per centum of claims for payment (for which no further written 
    information or substantiation is required in order to make payment) 
    made for services covered under the plan and furnished by health 
    care practitioners through individual or group practices or through 
    shared health facilities are paid within 30 days of the date of 
    receipt of such claims and that 99 per centum of such claims are 
    paid within 90 days of the date of receipt of such claims, and (B) 
    provide for procedures of prepayment and postpayment claims review, 
    including review of appropriate data with respect to the recipient 
    and provider of a service and the nature of the service for which 
    payment is claimed, to ensure the proper and efficient payment of 
    claims and management of the program;
        (38) require that an entity (other than an individual 
    practitioner or a group of practitioners) that furnishes, or 
    arranges for the furnishing of, items or services under the plan, 
    shall supply (within such period as may be specified in regulations 
    by the Secretary or by the single State agency which administers or 
    supervises the administration of the plan) upon request specifically 
    addressed to such entity by the Secretary or such State agency, the 
    information described in section 1320a-7(b)(9) of this title;
        (39) provide that the State agency shall exclude any specified 
    individual or entity from participation in the program under the 
    State plan for the period specified by the Secretary, when required 
    by him to do so pursuant to section 1320a-7 of this title or section 
    1320a-7a of this title, and provide that no payment may be made 
    under the plan with respect to any item or service furnished by such 
    individual or entity during such period;
        (40) require each health services facility or organization which 
    receives payments under the plan and of a type for which a uniform 
    reporting system has been established under section 1320a(a) of this 
    title to make reports to the Secretary of information described in 
    such section in accordance with the uniform reporting system 
    (established under such section) for that type of facility or 
    organization;
        (41) provide that whenever a provider of services or any other 
    person is terminated, suspended, or otherwise sanctioned or 
    prohibited from participating under the State plan, the State agency 
    shall promptly notify the Secretary and, in the case of a physician 
    and notwithstanding paragraph (7), the State medical licensing board 
    of such action;
        (42) provide that the records of any entity participating in the 
    plan and providing services reimbursable on a cost-related basis 
    will be audited as the Secretary determines to be necessary to 
    insure that proper payments are made under the plan;
        (43) provide for--
            (A) informing all persons in the State who are under the age 
        of 21 and who have been determined to be eligible for medical 
        assistance including services described in section 
        1396d(a)(4)(B) of this title, of the availability of early and 
        periodic screening, diagnostic, and treatment services as 
        described in section 1396d(r) of this title and the need for 
        age-appropriate immunizations against vaccine-preventable 
        diseases,
            (B) providing or arranging for the provision of such 
        screening services in all cases where they are requested,
            (C) arranging for (directly or through referral to 
        appropriate agencies, organizations, or individuals) corrective 
        treatment the need for which is disclosed by such child health 
        screening services, and
            (D) reporting to the Secretary (in a uniform form and manner 
        established by the Secretary, by age group and by basis of 
        eligibility for medical assistance, and by not later than April 
        1 after the end of each fiscal year, beginning with fiscal year 
        1990) the following information relating to early and periodic 
        screening, diagnostic, and treatment services provided under the 
        plan during each fiscal year:
                (i) the number of children provided child health 
            screening services,
                (ii) the number of children referred for corrective 
            treatment (the need for which is disclosed by such child 
            health screening services),
                (iii) the number of children receiving dental services, 
            and
                (iv) the State's results in attaining the participation 
            goals set for the State under section 1396d(r) of this 
            title;

        (44) in each case for which payment for inpatient hospital 
    services, services in an intermediate care facility for the mentally 
    retarded, or inpatient mental hospital services is made under the 
    State plan--
            (A) 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) certifies at the time of admission, or, if later, the 
        time the individual applies for medical assistance under the 
        State plan (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, recertifies, where such services 
        are furnished over a period of time, in such cases, at least as 
        often as required under section 1396b(g)(6) of this title (or, 
        in the case of services that are services provided in an 
        intermediate care facility for the mentally retarded, every 
        year), and accompanied by such supporting material, appropriate 
        to the case involved, as may be provided in regulations of the 
        Secretary), that such services are or were required to be given 
        on an inpatient basis because the individual needs or needed 
        such services, and
            (B) such services were furnished under a plan established 
        and periodically reviewed and evaluated by 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;

        (45) provide for mandatory assignment of rights of payment for 
    medical support and other medical care owed to recipients, in 
    accordance with section 1396k of this title;
        (46) provide that information is requested and exchanged for 
    purposes of income and eligibility verification in accordance with a 
    State system which meets the requirements of section 1320b-7 of this 
    title;
        (47) at the option of the State, provide for making ambulatory 
    prenatal care available to pregnant women during a presumptive 
    eligibility period in accordance with section 1396r-1 of this title 
    and provide for making medical assistance for items and services 
    described in subsection (a) of section 1396r-1a of this title 
    available to children during a presumptive eligibility period in 
    accordance with such section;
        (48) provide a method of making cards evidencing eligibility for 
    medical assistance available to an eligible individual who does not 
    reside in a permanent dwelling or does not have a fixed home or 
    mailing address;
        (49) provide that the State will provide information and access 
    to certain information respecting sanctions taken against health 
    care practitioners and providers by State licensing authorities in 
    accordance with section 1396r-2 of this title;
        (50) provide, in accordance with subsection (q) of this section, 
    for a monthly personal needs allowance for certain institutionalized 
    individuals and couples;
        (51) meet the requirements of section 1396r-5 of this title 
    (relating to protection of community spouses);
        (52) meet the requirements of section 1396r-6 of this title 
    (relating to extension of eligibility for medical assistance);
        (53) provide--
            (A) for notifying in a timely manner all individuals in the 
        State who are determined to be eligible for medical assistance 
        and who are pregnant women, breastfeeding or postpartum women 
        (as defined in section 1786 of this title), or children below 
        the age of 5, of the availability of benefits furnished by the 
        special supplemental nutrition program under such section, and
            (B) for referring any such individual to the State agency 
        responsible for administering such program;

        (54) in the case of a State plan that provides medical 
    assistance for covered outpatient drugs (as defined in section 
    1396r-8(k) of this title), comply with the applicable requirements 
    of section 1396r-8 of this title;
        (55) provide for receipt and initial processing of applications 
    of individuals for medical assistance under subsection 
    (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), or 
    (a)(10)(A)(ii)(IX) of this section--
            (A) at locations which are other than those used for the 
        receipt and processing of applications for aid under part A of 
        subchapter IV of this chapter and which include facilities 
        defined as disproportionate share hospitals under section 1396r-
        4(a)(1)(A) of this title and Federally-qualified health centers 
        described in section 1396d(1)(2)(B) \9\ of this title, and
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    \9\ So in original. Probably should be section ``1396d(l)(2)(B)''.
---------------------------------------------------------------------------
            (B) using applications which are other than those used for 
        applications for aid under such part;

        (56) provide, in accordance with subsection (s) of this section, 
    for adjusted payments for certain inpatient hospital services;
        (57) provide that each hospital, nursing facility, provider of 
    home health care or personal care services, hospice program, or 
    medicaid managed care organization (as defined in section 
    1396b(m)(1)(A) of this title) receiving funds under the plan shall 
    comply with the requirements of subsection (w) of this section;
        (58) provide that the State, acting through a State agency, 
    association, or other private nonprofit entity, develop a written 
    description of the law of the State (whether statutory or as 
    recognized by the courts of the State) concerning advance directives 
    that would be distributed by providers or organizations under the 
    requirements of subsection (w) of this section;
        (59) maintain a list (updated not less often than monthly, and 
    containing each physician's unique identifier provided under the 
    system established under subsection (x) of this section) of all 
    physicians who are certified to participate under the State plan;
        (60) provide that the State agency shall provide assurances 
    satisfactory to the Secretary that the State has in effect the laws 
    relating to medical child support required under section 1396g-1 of 
    this title;
        (61) provide that the State must demonstrate that it operates a 
    medicaid fraud and abuse control unit described in section 1396b(q) 
    of this title that effectively carries out the functions and 
    requirements described in such section, as determined in accordance 
    with standards established by the Secretary, unless the State 
    demonstrates to the satisfaction of the Secretary that the effective 
    operation of such a unit in the State would not be cost-effective 
    because minimal fraud exists in connection with the provision of 
    covered services to eligible individuals under the State plan, and 
    that beneficiaries under the plan will be protected from abuse and 
    neglect in connection with the provision of medical assistance under 
    the plan without the existence of such a unit;
        (62) provide for a program for the distribution of pediatric 
    vaccines to program-registered providers for the immunization of 
    vaccine-eligible children in accordance with section 1396s of this 
    title;
        (63) provide for administration and determinations of 
    eligibility with respect to individuals who are (or seek to be) 
    eligible for medical assistance based on the application of section 
    1396u-1 of this title;
        (64) provide, not later than 1 year after August 5, 1997, a 
    mechanism to receive reports from beneficiaries and others and 
    compile data concerning alleged instances of waste, fraud, and abuse 
    relating to the operation of this subchapter; and
        (65) provide that the State shall issue provider numbers for all 
    suppliers of medical assistance consisting of durable medical 
    equipment, as defined in section 1395x(n) of this title, and the 
    State shall not issue or renew such a supplier number for any such 
    supplier unless--
            (A)(i) full and complete information as to the identity of 
        each person with an ownership or control interest (as defined in 
        section 1320a-3(a)(3) of this title) in the supplier or in any 
        subcontractor (as defined by the Secretary in regulations) in 
        which the supplier directly or indirectly has a 5 percent or 
        more ownership interest; and
            (ii) to the extent determined to be feasible under 
        regulations of the Secretary, the name of any disclosing entity 
        (as defined in section 1320a-3(a)(2) of this title) with respect 
        to which a person with such an ownership or control interest in 
        the supplier is a person with such an ownership or control 
        interest in the disclosing entity; and
            (B) a surety bond in a form specified by the Secretary under 
        section 1395m(a)(16)(B) of this title and in an amount that is 
        not less than $50,000 or such comparable surety bond as the 
        Secretary may permit under the second sentence of such section.

Notwithstanding paragraph (5), if on January 1, 1965, and on the date on 
which a State submits its plan for approval under this subchapter, the 
State agency which administered or supervised the administration of the 
plan of such State approved under subchapter X of this chapter (or 
subchapter XVI of this chapter, insofar as it relates to the blind) was 
different from the State agency which administered or supervised the 
administration of the State plan approved under subchapter I of this 
chapter (or subchapter XVI of this chapter, insofar as it relates to the 
aged), the State agency which administered or supervised the 
administration of such plan approved under subchapter X of this chapter 
(or subchapter XVI of this chapter, insofar as it relates to the blind) 
may be designated to administer or supervise the administration of the 
portion of the State plan for medical assistance which relates to blind 
individuals and a different State agency may be established or 
designated to administer or supervise the administration of the rest of 
the State plan for medical assistance; and in such case the part of the 
plan which each such agency administers, or the administration of which 
each such agency supervises, shall be regarded as a separate plan for 
purposes of this subchapter (except for purposes of paragraph (10)). The 
provisions of paragraphs (9)(A), (31), and (33) and of section 
1396b(i)(4) of this title shall not apply to a religious nonmedical 
health care institution (as defined in section 1395x(ss)(1) of this 
title).
    For purposes of paragraph (10) any individual who, for the month of 
August 1972, was eligible for or receiving aid or assistance under a 
State plan approved under subchapter I, X, XIV, or XVI of this chapter, 
or part A of subchapter IV of this chapter and who for such month was 
entitled to monthly insurance benefits under subchapter II of this 
chapter shall for purposes of this subchapter only be deemed to be 
eligible for financial aid or assistance for any month thereafter if 
such individual would have been eligible for financial aid or assistance 
for such month had the increase in monthly insurance benefits under 
subchapter II of this chapter resulting from enactment of Public Law 92-
336 not been applicable to such individual.
    The requirement of clause (A) of paragraph (37) with respect to a 
State plan may be waived by the Secretary if he finds that the State has 
exercised good faith in trying to meet such requirement. For purposes of 
this subchapter, any child who meets the requirements of paragraph (1) 
or (2) of section 673(b) of this title shall be deemed to be a dependent 
child as defined in section 606 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. 
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 1396b(v) of this title.

(b) Approval by Secretary

    The Secretary shall approve any plan which fulfills the conditions 
specified in subsection (a) of this section, except that he shall not 
approve any plan which imposes, as a condition of eligibility for 
medical assistance under the plan--
        (1) an age requirement of more than 65 years; or
        (2) any residence requirement which excludes any individual who 
    resides in the State, regardless of whether or not the residence is 
    maintained permanently or at a fixed address; or
        (3) any citizenship requirement which excludes any citizen of 
    the United States.

(c) Lower payment levels or applying for benefits as condition of 
        applying for, or receiving, medical assistance

    Notwithstanding subsection (b) of this section, the Secretary shall 
not approve any State plan for medical assistance 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.

(d) Performance of medical or utilization review functions

    If a State contracts with an entity which meets the requirements of 
section 1320c-1 of this title, as determined by the Secretary, or a 
utilization and quality control peer review organization having a 
contract with the Secretary under part B of subchapter XI of this 
chapter for the performance of medical or utilization review functions 
required under this subchapter of a State plan with respect to specific 
services or providers (or services or providers in a geographic area of 
the State), such requirements shall be deemed to be met for those 
services or providers (or services or providers in that area) by 
delegation to such an entity or organization under the contract of the 
State's authority to conduct such review activities if the contract 
provides for the performance of activities not inconsistent with part B 
of subchapter XI of this chapter and provides for such assurances of 
satisfactory performance by such an entity or organization as the 
Secretary may prescribe.

(e) Continued eligibility of families determined ineligible because of 
        income and resources or hours of work limitations of plan; 
        individuals enrolled with health maintenance organizations; 
        persons deemed recipients of supplemental security income or 
        State supplemental payments; entitlement for certain newborns; 
        postpartum eligibility for pregnant women

    (1)(A) Notwithstanding any other provision of this subchapter, 
effective January 1, 1974, subject to subparagraph (B) each State plan 
approved under this subchapter must provide that each family which was 
receiving aid pursuant to a plan of the State approved under part A of 
subchapter IV of this chapter in at least 3 of the 6 months immediately 
preceding the month in which such family became ineligible for such aid 
because of increased hours of, or increased income from, employment, 
shall, while a member of such family is employed, 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 contained in such plan.
    (B) Subparagraph (A) shall not apply with respect to families that 
cease to be eligible for aid under part A of subchapter IV of this 
chapter during the period beginning on April 1, 1990, and ending on 
September 30, 2001. During such period, for provisions relating to 
extension of eligibility for medical assistance for certain families who 
have received aid pursuant to a State plan approved under part A of 
subchapter IV of this chapter and have earned income, see section 1396r-
6 of this title.
    (2)(A) In the case of an individual who is enrolled with a medicaid 
managed care organization (as defined in section 1396b(m)(1)(A) of this 
title), with a primary care case manager (as defined in section 1396d(t) 
of this title), or with an eligible organization with a contract under 
section 1395mm of this title and who would (but for this paragraph) lose 
eligibility for benefits under this subchapter before the end of the 
minimum enrollment period (defined in subparagraph (B)), the State plan 
may provide, notwithstanding any other provision of this subchapter, 
that the individual shall be deemed to continue to be eligible for such 
benefits until the end of such minimum period, but, except for benefits 
furnished under section 1396d(a)(4)(C) of this title, only with respect 
to such benefits provided to the individual as an enrollee of such 
organization or entity or by or through the case manager.
    (B) For purposes of subparagraph (A), the term ``minimum enrollment 
period'' means, with respect to an individual's enrollment with an 
organization or entity under a State plan, a period, established by the 
State, of not more than six months beginning on the date the 
individual's enrollment with the organization or entity becomes 
effective.
    (3) At the option of the State, any individual who--
        (A) is 18 years of age or younger and qualifies as a disabled 
    individual under section 1382c(a) of this title;
        (B) with respect to whom there has been a determination by the 
    State that--
            (i) the individual requires a level of care provided in a 
        hospital, nursing facility, or intermediate care facility for 
        the mentally retarded,
            (ii) it is appropriate to provide such care for the 
        individual outside such an institution, and
            (iii) the estimated amount which would be expended for 
        medical assistance for the individual for such care outside an 
        institution is not greater than the estimated amount which would 
        otherwise be expended for medical assistance for the individual 
        within an appropriate institution; and

        (C) if the individual were in a medical institution, would be 
    eligible for medical assistance under the State plan under this 
    subchapter,

shall be deemed, for purposes of this subchapter only, to be an 
individual with respect to whom a supplemental security income payment, 
or State supplemental payment, respectively, is being paid under 
subchapter XVI of this chapter.
    (4) A child born to a woman eligible for and receiving medical 
assistance under a State plan on the date of the child's birth shall be 
deemed to have applied for medical assistance and to have been found 
eligible for such assistance under such plan on the date of such birth 
and to remain eligible for such assistance for a period of one year so 
long as the child is a member of the woman's household and the woman 
remains (or would remain if pregnant) eligible for such assistance. 
During the period in which a child is deemed under the preceding 
sentence to be eligible for medical assistance, the medical assistance 
eligibility identification number of the mother shall also serve as the 
identification number of the child, and all claims shall be submitted 
and paid under such number (unless the State issues a separate 
identification number for the child before such period expires).
    (5) A woman who, while pregnant, is eligible for, has applied for, 
and has received medical assistance under the State plan, shall continue 
to be eligible under the plan, as though she were pregnant, for all 
pregnancy-related and postpartum medical assistance under the plan, 
through the end of the month in which the 60-day period (beginning on 
the last day of her pregnancy) ends.
    (6) In the case of a pregnant woman described in subsection (a)(10) 
of this section who, because of a change in income of the family of 
which she is a member, would not otherwise continue to be described in 
such subsection, the woman shall be deemed to continue to be an 
individual described in subsection (a)(10)(A)(i)(IV) of this section and 
subsection (l)(1)(A) of this section without regard to such change of 
income through the end of the month in which the 60-day period 
(beginning on the last day of her pregnancy) ends. The preceding 
sentence shall not apply in the case of a woman who has been provided 
ambulatory prenatal care pursuant to section 1396r-1 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.
    (7) In the case of an infant or child described in subparagraph (B), 
(C), or (D) of subsection (l)(1) of this section or paragraph (2) of 
section 1396d(n) of this title--
        (A) who is receiving inpatient services for which medical 
    assistance is provided on the date the infant or child attains the 
    maximum age with respect to which coverage is provided under the 
    State plan for such individuals, and
        (B) who, but for attaining such age, would remain eligible for 
    medical assistance under such subsection,

the infant or child shall continue to be treated as an individual 
described in such respective provision until the end of the stay for 
which the inpatient services are furnished.
    (8) If an individual is determined to be a qualified medicare 
beneficiary (as defined in section 1396d(p)(1) of this title), such 
determination shall apply to services furnished after the end of the 
month in which the determination first occurs. For purposes of payment 
to a State under section 1396b(a) of this title, such determination 
shall be considered to be valid for an individual for a period of 12 
months, except that a State may provide for such determinations more 
frequently, but not more frequently than once every 6 months for an 
individual.
    (9)(A) At the option of the State, the plan may include as medical 
assistance respiratory care services for any individual who--
        (i) is medically dependent on a ventilator for life support at 
    least six hours per day;
        (ii) has been so dependent for at least 30 consecutive days (or 
    the maximum number of days authorized under the State plan, 
    whichever is less) as an inpatient;
        (iii) but for the availability of respiratory care services, 
    would require respiratory care as an inpatient in a hospital, 
    nursing facility, or intermediate care facility for the mentally 
    retarded and would be eligible to have payment made for such 
    inpatient care under the State plan;
        (iv) has adequate social support services to be cared for at 
    home; and
        (v) wishes to be cared for at home.

    (B) The requirements of subparagraph (A)(ii) may be satisfied by a 
continuous stay in one or more hospitals, nursing facilities, or 
intermediate care facilities for the mentally retarded.
    (C) For purposes of this paragraph, respiratory care services means 
services provided on a part-time basis in the home of the individual by 
a respiratory therapist or other health care professional trained in 
respiratory therapy (as determined by the State), payment for which is 
not otherwise included within other items and services furnished to such 
individual as medical assistance under the plan.
    (10)(A) The fact that an individual, child, or pregnant woman may be 
denied aid under part A of subchapter IV of this chapter pursuant to 
section 602(a)(43) \10\ of this title shall not be construed as denying 
(or permitting a State to deny) medical assistance under this subchapter 
to such individual, child, or woman who is eligible for assistance under 
this subchapter on a basis other than the receipt of aid under such 
part.
---------------------------------------------------------------------------
    \10\ See References in Text note below.
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    (B) If an individual, child, or pregnant woman is receiving aid 
under part A of subchapter IV of this chapter and such aid is terminated 
pursuant to section 602(a)(43) \10\ of this title, the State may not 
discontinue medical assistance under this subchapter for the individual, 
child, or woman until the State has determined that the individual, 
child, or woman is not eligible for assistance under this subchapter on 
a basis other than the receipt of aid under such part.
    (11)(A) In the case of an individual who is enrolled with a group 
health plan under section 1396e of this title and who would (but for 
this paragraph) lose eligibility for benefits under this subchapter 
before the end of the minimum enrollment period (defined in subparagraph 
(B)), the State plan may provide, notwithstanding any other provision of 
this subchapter, that the individual shall be deemed to continue to be 
eligible for such benefits until the end of such minimum period, but 
only with respect to such benefits provided to the individual as an 
enrollee of such plan.
    (B) For purposes of subparagraph (A), the term ``minimum enrollment 
period'' means, with respect to an individual's enrollment with a group 
health plan, a period established by the State, of not more than 6 
months beginning on the date the individual's enrollment under the plan 
becomes effective.
    (12) At the option of the State, the plan may provide that an 
individual who is under an age specified by the State (not to exceed 19 
years of age) and who is determined to be eligible for benefits under a 
State plan approved under this subchapter under subsection (a)(10)(A) of 
this section shall remain eligible for those benefits until the earlier 
of--
        (A) the end of a period (not to exceed 12 months) following the 
    determination; or
        (B) the time that the individual exceeds that age.

(f) Effective date of State plan as determinative of duty of State to 
        provide medical assistance to aged, blind, or disabled 
        individuals

    Notwithstanding any other provision of this subchapter, except as 
provided in subsection (e) of this section and section 1382h(b)(3) of 
this title and section 1396r-5 of this title, except with respect to 
qualified disabled and working individuals (described in section 
1396d(s) of this title), and except with respect to qualified medicare 
beneficiaries, qualified severely impaired individuals, and individuals 
described in subsection (m)(1) of this subsection, no State not eligible 
to participate in the State plan program established under subchapter 
XVI of this chapter shall be required to provide medical assistance to 
any aged, blind, or disabled individual (within the meaning of 
subchapter XVI of this chapter) for any month unless such State would be 
(or would have been) required to provide medical assistance to such 
individual for such month had its plan for medical assistance approved 
under this subchapter and in effect on January 1, 1972, been in effect 
in such month, except that for this purpose any such individual shall be 
deemed eligible for medical assistance under such State plan if (in 
addition to meeting such other requirements as are or may be imposed 
under the State plan) the income of any such individual as determined in 
accordance with section 1396b(f) of this title (after deducting any 
supplemental security income payment and State supplementary payment 
made with respect to such individual, and incurred expenses for medical 
care as recognized under State law regardless of whether such expenses 
are reimbursed under another public program of the State or political 
subdivision thereof) is not in excess of the standard for medical 
assistance established under the State plan as in effect on January 1, 
1972. In States which provide medical assistance to individuals pursuant 
to paragraph (10)(C) of subsection (a) of this section, an individual 
who is eligible for medical assistance by reason of the requirements of 
this section concerning the deduction of incurred medical expenses from 
income shall be considered an individual eligible for medical assistance 
under paragraph (10)(A) of that subsection if that individual is, or is 
eligible to be (1) an individual with respect to whom there is payable a 
State supplementary payment on the basis of which similarly situated 
individuals are eligible to receive medical assistance equal in amount, 
duration, and scope to that provided to individuals eligible under 
paragraph (10)(A), or (2) an eligible individual or eligible spouse, as 
defined in subchapter XVI of this chapter, with respect to whom 
supplemental security income benefits are payable; otherwise that 
individual shall be considered to be an individual eligible for medical 
assistance under paragraph (10)(C) of that subsection. In States which 
do not provide medical assistance to individuals pursuant to paragraph 
(10)(C) of that subsection, an individual who is eligible for medical 
assistance by reason of the requirements of this section concerning the 
deduction of incurred medical expenses from income shall be considered 
an individual eligible for medical assistance under paragraph (10)(A) of 
that subsection.

(g) Reduction of aid or assistance to providers of services attempting 
        to collect from beneficiary in violation of third-party 
        provisions

    In addition to any other sanction available to a State, a State may 
provide for a reduction of any payment amount otherwise due with respect 
to a person who furnishes services under the plan in an amount equal to 
up to three times the amount of any payment sought to be collected by 
that person in violation of subsection (a)(25)(C) of this section.

(h) Payments for hospitals serving disproportionate number of low-income 
        patients and for home and community care

    Nothing in this subchapter (including subsections (a)(13) and 
(a)(30) of this section) shall be construed as authorizing the Secretary 
to limit the amount of payment that may be made under a plan under this 
subchapter for home and community care.

(i) Termination of certification for participation of and suspension of 
        State payments to intermediate care facilities for the mentally 
        retarded

    (1) In addition to any other authority under State law, where a 
State determines that a \11\ intermediate care facility for the mentally 
retarded which is certified for participation under its plan no longer 
substantially meets the requirements for such a facility under this 
subchapter and further determines that the facility's deficiencies--
---------------------------------------------------------------------------
    \11\ So in original. Probably should be ``an''.
---------------------------------------------------------------------------
        (A) immediately jeopardize the health and safety of its 
    patients, the State shall provide for the termination of the 
    facility's certification for participation under the plan and may 
    provide, or
        (B) do not immediately jeopardize the health and safety of its 
    patients, the State may, in lieu of providing for terminating the 
    facility's certification for participation under the plan, 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

that no payment will be made under the State plan with respect to any 
individual admitted to such facility after a date specified by the 
State.
    (2) The State shall not make such a decision with respect to a 
facility until the facility has had a reasonable opportunity, following 
the initial determination that it no longer substantially meets the 
requirements for such a facility under this subchapter, to correct its 
deficiencies, and, following this period, has been given reasonable 
notice and opportunity for a hearing.
    (3) The State's decision to deny payment may be made effective only 
after such notice to the public and to the facility as may be provided 
for by the State, and its effectiveness shall terminate (A) when the 
State finds that the facility is in substantial compliance (or is making 
good faith efforts to achieve substantial compliance) with the 
requirements for such a facility under this subchapter, or (B) in the 
case described in paragraph (1)(B), with the end of the eleventh month 
following the month such decision is made effective, whichever occurs 
first. If a facility to which clause (B) of the previous sentence 
applies still fails to substantially meet the provisions of the 
respective section on the date specified in such clause, the State shall 
terminate such facility's certification for participation under the plan 
effective with the first day of the first month following the month 
specified in such clause.

(j) Waiver or modification of subchapter requirements with respect to 
        medical assistance program in American Samoa

    Notwithstanding any other requirement of this subchapter, the 
Secretary may waive or modify any requirement of this subchapter with 
respect to the medical assistance program in American Samoa and the 
Northern Mariana Islands, other than a waiver of the Federal medical 
assistance percentage, the limitation in section 1308(f) of this title, 
or the requirement that payment may be made for medical assistance only 
with respect to amounts expended by American Samoa or the Northern 
Mariana Islands for care and services described in a numbered paragraph 
of section 1396d(a) of this title.

(k) Repealed. Pub. L. 103-66, title XIII, Sec. 13611(d)(1)(C), Aug. 10, 
        1993, 107 Stat. 627

(l) Description of group

    (1) Individuals described in this paragraph are--
        (A) women during pregnancy (and during the 60-day period 
    beginning on the last day of the pregnancy),
        (B) infants under one year of age,
        (C) children who have attained one year of age but have not 
    attained 6 years of age, and
        (D) children born after September 30, 1983 (or, at the option of 
    a State, after any earlier date), who have attained 6 years of age 
    but have not attained 19 years of age,

who are not described in any of subclauses (I) through (III) of 
subsection (a)(10)(A)(i) of this section and whose family income does 
not exceed the income level established by the State under paragraph (2) 
for a family size equal to the size of the family, including the woman, 
infant, or child.
    (2)(A)(i) For purposes of paragraph (1) with respect to individuals 
described in subparagraph (A) or (B) of that paragraph, the State shall 
establish an income level which is a percentage (not less than the 
percentage provided under clause (ii) and not more than 185 percent) of 
the income official poverty line (as defined by the Office of Management 
and Budget, and revised annually in accordance with section 9902(2) of 
this title) applicable to a family of the size involved.
    (ii) The percentage provided under this clause, with respect to 
eligibility for medical assistance on or after--
        (I) July 1, 1989, is 75 percent, or, if greater, the percentage 
    provided under clause (iii), and
        (II) April 1, 1990, 133 percent, or, if greater, the percentage 
    provided under clause (iv).

    (iii) In the case of a State which, as of July 1, 1988, has elected 
to provide, and provides, medical assistance to individuals described in 
this subsection or has enacted legislation authorizing, or appropriating 
funds, to provide such assistance to such individuals before July 1, 
1989, the percentage provided under clause (ii)(I) shall not be less 
than--
        (I) the percentage specified by the State in an amendment to its 
    State plan (whether approved or not) as of July 1, 1988, or
        (II) if no such percentage is specified as of July 1, 1988, the 
    percentage established under the State's authorizing legislation or 
    provided for under the State's appropriations;

but in no case shall this clause require the percentage provided under 
clause (ii)(I) to exceed 100 percent.
    (iv) In the case of a State which, as of December 19, 1989, has 
established under clause (i), or has enacted legislation authorizing, or 
appropriating funds, to provide for, a percentage (of the income 
official poverty line) that is greater than 133 percent, the percentage 
provided under clause (ii) for medical assistance on or after April 1, 
1990, shall not be less than--
        (I) the percentage specified by the State in an amendment to its 
    State plan (whether approved or not) as of December 19, 1989, or
        (II) if no such percentage is specified as of December 19, 1989, 
    the percentage established under the State's authorizing legislation 
    or provided for under the State's appropriations.

    (B) For purposes of paragraph (1) with respect to individuals 
described in subparagraph (C) of such paragraph, the State shall 
establish an income level which is equal to 133 percent of the income 
official poverty line described in subparagraph (A) applicable to a 
family of the size involved.
    (C) For purposes of paragraph (1) with respect to individuals 
described in subparagraph (D) of that paragraph, the State shall 
establish an income level which is equal to 100 percent of the income 
official poverty line described in subparagraph (A) applicable to a 
family of the size involved.
    (3) Notwithstanding subsection (a)(17) of this section, for 
individuals who are eligible for medical assistance because of 
subsection (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI), (a)(10) (A)(i)(VII), or 
(a)(10)(A)(ii)(IX) of this section--
        (A) application of a resource standard shall be at the option of 
    the State;
        (B) any resource standard or methodology that is applied with 
    respect to an individual described in subparagraph (A) of paragraph 
    (1) may not be more restrictive than the resource standard or 
    methodology that is applied under subchapter XVI of this chapter;
        (C) any resource standard or methodology that is applied with 
    respect to an individual described in subparagraph (B), (C), or (D) 
    of paragraph (1) may not be more restrictive than the corresponding 
    methodology that is applied under the State plan under part A of 
    subchapter IV of this chapter;
        (D) the income standard to be applied is the appropriate income 
    standard established under paragraph (2); and
        (E) family income shall be determined in accordance with the 
    methodology employed under the State plan under part A or E of 
    subchapter IV of this chapter (except to the extent such methodology 
    is inconsistent with clause (D) of subsection (a)(17) of this 
    section), and costs incurred for medical care or for any other type 
    of remedial care shall not be taken into account.

Any different treatment provided under this paragraph for such 
individuals shall not, because of subsection (a)(17) of this section, 
require or permit such treatment for other individuals.
    (4)(A) In the case of any State which is providing medical 
assistance to its residents under a waiver granted under section 1315 of 
this title, the Secretary shall require the State to provide medical 
assistance for pregnant women and infants under age 1 described in 
subsection (a)(10)(A)(i)(IV) of this section and for children described 
in subsection (a)(10)(A)(i)(VI) of this section or subsection 
(a)(10)(A)(i)(VII) of this section in the same manner as the State would 
be required to provide such assistance for such individuals if the State 
had in effect a plan approved under this subchapter.
    (B) In the case of a State which is not one of the 50 States or the 
District of Columbia, the State need not meet the requirement of 
subsection (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI), or (a)(10)(A)(i)(VII) 
of this section and, for purposes of paragraph (2)(A), the State may 
substitute for the percentage provided under clause (ii) of such 
paragraph any percentage.

(m) Description of individuals

    (1) Individuals described in this paragraph are individuals--
        (A) who are 65 years of age or older or are disabled individuals 
    (as determined under section 1382c(a)(3) of this title),
        (B) whose income (as determined under section 1382a of this 
    title for purposes of the supplemental security income program, 
    except as provided in paragraph (2)(C)) does not exceed an income 
    level established by the State consistent with paragraph (2)(A), and
        (C) whose resources (as determined under section 1382b of this 
    title for purposes of the supplemental security income program) do 
    not exceed (except as provided in paragraph (2)(B)) the maximum 
    amount of resources that an individual may have and obtain benefits 
    under that program.

    (2)(A) The income level established under paragraph (1)(B) may not 
exceed a percentage (not more than 100 percent) of the official poverty 
line (as defined by the Office of Management and Budget, and revised 
annually in accordance with section 9902(2) of this title) applicable to 
a family of the size involved.
    (B) In the case of a State that provides medical assistance to 
individuals not described in subsection (a)(10)(A) of this section and 
at the State's option, the State may use under paragraph (1)(C) such 
resource level (which is higher than the level described in that 
paragraph) as may be applicable with respect to individuals described in 
paragraph (1)(A) who are not described in subsection (a)(10)(A) of this 
section.
    (C) The provisions of section 1396d(p)(2)(D) of this title shall 
apply to determinations of income under this subsection in the same 
manner as they apply to determinations of income under section 1396d(p) 
of this title.
    (3) Notwithstanding subsection (a)(17) of this section, for 
individuals described in paragraph (1) who are covered under the State 
plan by virtue of subsection (a)(10)(A)(ii)(X) of this section--
        (A) the income standard to be applied is the income standard 
    described in paragraph (1)(B), and
        (B) except as provided in section 1382a(b)(4)(B)(ii) of this 
    title, costs incurred for medical care or for any other type of 
    remedial care shall not be taken into account in determining income.

Any different treatment provided under this paragraph for such 
individuals shall not, because of subsection (a)(17) of this section, 
require or permit such treatment for other individuals.
    (4) Notwithstanding subsection (a)(17) of this section, for 
qualified medicare beneficiaries described in section 1396d(p)(1) of 
this title--
        (A) the income standard to be applied is the income standard 
    described in section 1396d(p)(1)(B) of this title, and
        (B) except as provided in section 1382a(b)(4)(B)(ii) of this 
    title, costs incurred for medical care or for any other type of 
    remedial care shall not be taken into account in determining income.

Any different treatment provided under this paragraph for such 
individuals shall not, because of subsection (a)(17) of this section, 
require or permit such treatment for other individuals.

(n) Payment amounts

    (1) In the case of medical assistance furnished under this 
subchapter for medicare cost-sharing respecting the furnishing of a 
service or item to a qualified medicare beneficiary, the State plan may 
provide payment in an amount with respect to the service or item that 
results in the sum of such payment amount and any amount of payment made 
under subchapter XVIII of this chapter with respect to the service or 
item exceeding the amount that is otherwise payable under the State plan 
for the item or service for eligible individuals who are not qualified 
medicare beneficiaries.
    (2) In carrying out paragraph (1), a State is not required to 
provide any payment for any expenses incurred relating to payment for 
deductibles, coinsurance, or copayments for medicare cost-sharing to the 
extent that payment under subchapter XVIII of this chapter for the 
service would exceed the payment amount that otherwise would be made 
under the State plan under this subchapter for such service if provided 
to an eligible recipient other than a medicare beneficiary.
    (3) In the case in which a State's payment for medicare cost-sharing 
for a qualified medicare beneficiary with respect to an item or service 
is reduced or eliminated through the application of paragraph (2)--
        (A) for purposes of applying any limitation under subchapter 
    XVIII of this chapter on the amount that the beneficiary may be 
    billed or charged for the service, the amount of payment made under 
    subchapter XVIII of this chapter plus the amount of payment (if any) 
    under the State plan shall be considered to be payment in full for 
    the service;
        (B) the beneficiary shall not have any legal liability to make 
    payment to a provider or to an organization described in section 
    1396b(m)(1)(A) of this title for the service; and
        (C) any lawful sanction that may be imposed upon a provider or 
    such an organization for excess charges under this subchapter or 
    subchapter XVIII of this chapter shall apply to the imposition of 
    any charge imposed upon the individual in such case.

This paragraph shall not be construed as preventing payment of any 
medicare cost-sharing by a medicare supplemental policy or an employer 
retiree health plan on behalf of an individual.

(o) Certain benefits disregarded for purposes of determining post-
        eligibility contributions

    Notwithstanding any provision of subsection (a) of this section to 
the contrary, a State plan under this subchapter shall provide that any 
supplemental security income benefits paid by reason of subparagraph (E) 
or (G) of section 1382(e)(1) of this title to an individual who--
        (1) is eligible for medical assistance under the plan, and
        (2) is in a hospital, skilled nursing facility, or intermediate 
    care facility at the time such benefits are paid,

will be disregarded for purposes of determining the amount of any post-
eligibility contribution by the individual to the cost of the care and 
services provided by the hospital, skilled nursing facility, or 
intermediate care facility.

(p) Exclusion power of State; exclusion as prerequisite for medical 
        assistance payments; ``exclude'' defined

    (1) In addition to any other authority, a State may exclude any 
individual or entity for purposes of participating under the State plan 
under this subchapter for any reason for which the Secretary could 
exclude the individual or entity from participation in a program under 
subchapter XVIII of this chapter under section 1320a-7, 1320a-7a, or 
1395cc(b)(2) of this title.
    (2) In order for a State to receive payments for medical assistance 
under section 1396b(a) of this title, with respect to payments the State 
makes to a medicaid managed care organization (as defined in section 
1396b(m) of this title) or to an entity furnishing services under a 
waiver approved under section 1396n(b)(1) of this title, the State must 
provide that it will exclude from participation, as such an organization 
or entity, any organization or entity that--
        (A) could be excluded under section 1320a-7(b)(8) of this title 
    (relating to owners and managing employees who have been convicted 
    of certain crimes or received other sanctions),
        (B) has, directly or indirectly, a substantial contractual 
    relationship (as defined by the Secretary) with an individual or 
    entity that is described in section 1320a-7(b)(8)(B) of this title, 
    or
        (C) employs or contracts with any individual or entity that is 
    excluded from participation under this subchapter under section 
    1320a-7 or 1320a-7a of this title for the provision of health care, 
    utilization review, medical social work, or administrative services 
    or employs or contracts with any entity for the provision (directly 
    or indirectly) through such an excluded individual or entity of such 
    services.

    (3) As used in this subsection, the term ``exclude'' includes the 
refusal to enter into or renew a participation agreement or the 
termination of such an agreement.

(q) Minimum monthly personal needs allowance deduction; 
        ``institutionalized individual or couple'' defined

    (1)(A) In order to meet the requirement of subsection (a)(50) of 
this section, the State plan must provide that, in the case of an 
institutionalized individual or couple described in subparagraph (B), in 
determining the amount of the individual's or couple's income to be 
applied monthly to payment for the cost of care in an institution, there 
shall be deducted from the monthly income (in addition to other 
allowances otherwise provided under the State plan) a monthly personal 
needs allowance--
        (i) which is reasonable in amount for clothing and other 
    personal needs of the individual (or couple) while in an 
    institution, and
        (ii) which is not less (and may be greater) than the minimum 
    monthly personal needs allowance described in paragraph (2).

    (B) In this subsection, the term ``institutionalized individual or 
couple'' means an individual or married couple--
        (i) who is an inpatient (or who are inpatients) in a medical 
    institution or nursing facility for which payments are made under 
    this subchapter throughout a month, and
        (ii) who is or are determined to be eligible for medical 
    assistance under the State plan.

    (2) The minimum monthly personal needs allowance described in this 
paragraph \12\ is $30 for an institutionalized individual and $60 for an 
institutionalized couple (if both are aged, blind, or disabled, and 
their incomes are considered available to each other in determining 
eligibility).
---------------------------------------------------------------------------
    \12\ So in original. Probably should be ``this subsection''.
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(r) Disregarding payments for certain medical expenses by 
        institutionalized individuals

    (1)(A) For purposes of sections 1396a(a)(17) and 1396r-5(d)(1)(D) of 
this title and for purposes of a waiver under section 1396n of this 
title, with respect to the post-eligibility treatment of income of 
individuals who are institutionalized or receiving home or community-
based services under such a waiver, the treatment described in 
subparagraph (B) shall apply, there shall be disregarded reparation 
payments made by the Federal Republic of Germany, and there shall be 
taken into account amounts for incurred expenses for medical or remedial 
care that are not subject to payment by a third party, including--
        (i) medicare and other health insurance premiums, deductibles, 
    or coinsurance, and
        (ii) necessary medical or remedial care recognized under State 
    law but not covered under the State plan under this subchapter, 
    subject to reasonable limits the State may establish on the amount 
    of these expenses.

    (B)(i) In the case of a veteran who does not have a spouse or a 
child, if the veteran--
        (I) receives, after the veteran has been determined to be 
    eligible for medical assistance under the State plan under this 
    subchapter, a veteran's pension in excess of $90 per month, and
        (II) resides in a State veterans home with respect to which the 
    Secretary of Veterans Affairs makes per diem payments for nursing 
    home care pursuant to section 1741(a) of title 38,

any such pension payment, including any payment made due to the need for 
aid and attendance, or for unreimbursed medical expenses, that is in 
excess of $90 per month shall be counted as income only for the purpose 
of applying such excess payment to the State veterans home's cost of 
providing nursing home care to the veteran.
    (ii) The provisions of clause (i) shall apply with respect to a 
surviving spouse of a veteran who does not have a child in the same 
manner as they apply to a veteran described in such clause.
    (2)(A) The methodology to be employed in determining income and 
resource eligibility for individuals under subsection 
(a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI), (a)(10) 
(A)(i)(VII), (a)(10)(A)(ii), (a)(10)(C)(i)(III), or (f) of this section 
or under section 1396d(p) of this title may be less restrictive, and 
shall be no more restrictive, than the methodology--
        (i) in the case of groups consisting of aged, blind, or disabled 
    individuals, under the supplemental security income program under 
    subchapter XVI of this chapter, or
        (ii) in the case of other groups, under the State plan most 
    closely categorically related.

    (B) For purposes of this subsection and subsection (a)(10) of this 
section, methodology is considered to be ``no more restrictive'' if, 
using the methodology, additional individuals may be eligible for 
medical assistance and no individuals who are otherwise eligible are 
made ineligible for such assistance.

(s) Adjustment in payment for hospital services furnished to low-income 
        children under age of 6 years

    In order to meet the requirements of subsection (a)(55) \13\ of this 
section, the State plan must provide that payments to hospitals under 
the plan for inpatient hospital services furnished to infants who have 
not attained the age of 1 year, and to children who have not attained 
the age of 6 years and who receive such services in a disproportionate 
share hospital described in section 1396r-4(b)(1) of this title, shall--
---------------------------------------------------------------------------
    \13\ So in original. Probably should be subsection ``(a)(56)''.
---------------------------------------------------------------------------
        (1) if made on a prospective basis (whether per diem, per case, 
    or otherwise) provide for an outlier adjustment in payment amounts 
    for medically necessary inpatient hospital services involving 
    exceptionally high costs or exceptionally long lengths of stay,
        (2) not be limited by the imposition of day limits with respect 
    to the delivery of such services to such individuals, and
        (3) not be limited by the imposition of dollar limits (other 
    than such limits resulting from prospective payments as adjusted 
    pursuant to paragraph (1)) with respect to the delivery of such 
    services to any such individual who has not attained their first 
    birthday (or in the case of such an individual who is an inpatient 
    on his first birthday until such individual is discharged).

(t) Limitation on payments to States for expenditures attributable to 
        taxes

    Nothing in this subchapter (including sections 1396b(a) and 1396d(a) 
of this title) shall be construed as authorizing the Secretary to deny 
or limit payments to a State for expenditures, for medical assistance 
for items or services, attributable to taxes of general applicability 
imposed with respect to the provision of such items or services.

(u) Qualified COBRA continuation beneficiaries

    (1) Individuals described in this paragraph are individuals--
        (A) who are entitled to elect COBRA continuation coverage (as 
    defined in paragraph (3)),
        (B) whose income (as determined under section 1382a of this 
    title for purposes of the supplemental security income program) does 
    not exceed 100 percent of the official poverty line (as defined by 
    the Office of Management and Budget, and revised annually in 
    accordance with section 9902(2) of this title) applicable to a 
    family of the size involved,
        (C) whose resources (as determined under section 1382b of this 
    title for purposes of the supplemental security income program) do 
    not exceed twice the maximum amount of resources that an individual 
    may have and obtain benefits under that program, and
        (D) with respect to whose enrollment for COBRA continuation 
    coverage the State has determined that the savings in expenditures 
    under this subchapter resulting from such enrollment is likely to 
    exceed the amount of payments for COBRA premiums made.

    (2) For purposes of subsection (a)(10)(F) of this section and this 
subsection, the term ``COBRA premiums'' means the applicable premium 
imposed with respect to COBRA continuation coverage.
    (3) In this subsection, the term ``COBRA continuation coverage'' 
means coverage under a group health plan provided by an employer with 75 
or more employees provided pursuant to title XXII of the Public Health 
Service Act [42 U.S.C. 300bb-1 et seq.], section 4980B of the Internal 
Revenue Code of 1986, or title VI \14\ of the Employee Retirement Income 
Security Act of 1974.
---------------------------------------------------------------------------
    \14\ See References in Text note below.
---------------------------------------------------------------------------
    (4) Notwithstanding subsection (a)(17) of this section, for 
individuals described in paragraph (1) who are covered under the State 
plan by virtue of subsection (a)(10)(A)(ii)(XI) of this section--
        (A) the income standard to be applied is the income standard 
    described in paragraph (1)(B), and
        (B) except as provided in section 1382a(b)(4)(B)(ii) of this 
    title, costs incurred for medical care or for any other type of 
    remedial care shall not be taken into account in determining income.

Any different treatment provided under this paragraph for such 
individuals shall not, because of subsection (a)(10)(B) or (a)(17) of 
this section, require or permit such treatment for other individuals.

(v) State agency disability and blindness determinations for medical 
        assistance eligibility

    A State plan may provide for the making of determinations of 
disability or blindness for the purpose of determining eligibility for 
medical assistance under the State plan by the single State agency or 
its designee, and make medical assistance available to individuals whom 
it finds to be blind or disabled and who are determined otherwise 
eligible for such assistance during the period of time prior to which a 
final determination of disability or blindness is made by the Social 
Security Administration with respect to such an individual. In making 
such determinations, the State must apply the definitions of disability 
and blindness found in section 1382c(a) of this title.

(w) Maintenance of written policies and procedures respecting advance 
        directives

    (1) For purposes of subsection (a)(57) of this section and sections 
1396b(m)(1)(A) and 1396r(c)(2)(E) of this title, the requirement of this 
subsection is that a provider or organization (as the case may be) 
maintain written policies and procedures with respect to all adult 
individuals receiving medical care by or through the provider or 
organization--
        (A) to provide written information to each such individual 
    concerning--
            (i) an individual's rights under State law (whether 
        statutory or as recognized by the courts of the State) to make 
        decisions concerning such medical care, including the right to 
        accept or refuse medical or surgical treatment and the right to 
        formulate advance directives (as defined in paragraph (3)), and
            (ii) the provider's or organization's written policies 
        respecting the implementation of such rights;

        (B) to document in the individual's medical record whether or 
    not the individual has executed an advance directive;
        (C) not to condition the provision of care or otherwise 
    discriminate against an individual based on whether or not the 
    individual has executed an advance directive;
        (D) to ensure compliance with requirements of State law (whether 
    statutory or as recognized by the courts of the State) respecting 
    advance directives; and
        (E) to provide (individually or with others) for education for 
    staff and the community on issues concerning advance directives.

Subparagraph (C) shall not be construed as requiring the provision of 
care which conflicts with an advance directive.
    (2) The written information described in paragraph (1)(A) shall be 
provided to an adult individual--
        (A) in the case of a hospital, at the time of the individual's 
    admission as an inpatient,
        (B) in the case of a nursing facility, at the time of the 
    individual's admission as a resident,
        (C) in the case of a provider of home health care or personal 
    care services, in advance of the individual coming under the care of 
    the provider,
        (D) in the case of a hospice program, at the time of initial 
    receipt of hospice care by the individual from the program, and
        (E) in the case of a medicaid managed care organization, at the 
    time of enrollment of the individual with the organization.

    (3) Nothing in this section shall be construed to prohibit the 
application of a State law which allows for an objection on the basis of 
conscience for any health care provider or any agent of such provider 
which as a matter of conscience cannot implement an advance directive.
    (4) In this subsection, the term ``advance directive'' means a 
written instruction, such as a living will or durable power of attorney 
for health care, recognized under State law (whether statutory or as 
recognized by the courts of the State) and relating to the provision of 
such care when the individual is incapacitated.
    (5) For construction relating to this subsection, see section 14406 
of this title (relating to clarification respecting assisted suicide, 
euthanasia, and mercy killing).

(x) Physician identifier system; establishment

    The Secretary shall establish a system, for implementation by not 
later than July 1, 1991, which provides for a unique identifier for each 
physician who furnishes services for which payment may be made under a 
State plan approved under this subchapter.

(y) Intermediate sanctions for psychiatric hospitals

    (1) In addition to any other authority under State law, where a 
State determines that a psychiatric hospital which is certified for 
participation under its plan no longer meets the requirements for a 
psychiatric hospital (referred to in section 1396d(h) of this title) and 
further finds that the hospital's deficiencies--
        (A) immediately jeopardize the health and safety of its 
    patients, the State shall terminate the hospital's participation 
    under the State plan; or
        (B) do not immediately jeopardize the health and safety of its 
    patients, the State may terminate the hospital's participation under 
    the State plan, or provide that no payment will be made under the 
    State plan with respect to any individual admitted to such hospital 
    after the effective date of the finding, or both.

    (2) Except as provided in paragraph (3), if a psychiatric hospital 
described in paragraph (1)(B) has not complied with the requirements for 
a psychiatric hospital under this subchapter--
        (A) within 3 months after the date the hospital is found to be 
    out of compliance with such requirements, the State shall provide 
    that no payment will be made under the State plan with respect to 
    any individual admitted to such hospital after the end of such 3-
    month period, or
        (B) within 6 months after the date the hospital is found to be 
    out of compliance with such requirements, no Federal financial 
    participation shall be provided under section 1396b(a) of this title 
    with respect to further services provided in the hospital until the 
    State finds that the hospital is in compliance with the requirements 
    of this subchapter.

    (3) The Secretary may continue payments, over a period of not longer 
than 6 months from the date the hospital is found to be out of 
compliance with such requirements, if--
        (A) the State finds that it is more appropriate to take 
    alternative action to assure compliance of the hospital with the 
    requirements than to terminate the certification of the hospital,
        (B) the State has submitted a plan and timetable for corrective 
    action to the Secretary for approval and the Secretary approves the 
    plan of corrective action, and
        (C) the State agrees to repay to the Federal Government payments 
    received under this paragraph if the corrective action is not taken 
    in accordance with the approved plan and timetable.

(z) Optional coverage of TB-related services

    (1) Individuals described in this paragraph are individuals not 
described in subsection (a)(10)(A)(i) of this section--
        (A) who are infected with tuberculosis;
        (B) whose income (as determined under the State plan under this 
    subchapter with respect to disabled individuals) does not exceed the 
    maximum amount of income a disabled individual described in 
    subsection (a)(10)(A)(i) of this section may have and obtain medical 
    assistance under the plan; and
        (C) whose resources (as determined under the State plan under 
    this subchapter with respect to disabled individuals) do not exceed 
    the maximum amount of resources a disabled individual described in 
    subsection (a)(10)(A)(i) of this section may have and obtain medical 
    assistance under the plan.

    (2) For purposes of subsection (a)(10) of this section, the term 
``TB-related services'' means each of the following services relating to 
treatment of infection with tuberculosis:
        (A) Prescribed drugs.
        (B) Physicians' services and services described in section 
    1396d(a)(2) of this title.
        (C) Laboratory and X-ray services (including services to confirm 
    the presence of infection).
        (D) Clinic services and Federally-qualified health center 
    services.
        (E) Case management services (as defined in section 1396n(g)(2) 
    of this title).
        (F) Services (other than room and board) designed to encourage 
    completion of regimens of prescribed drugs by outpatients, including 
    services to observe directly the intake of prescribed drugs.

(Aug. 14, 1935, ch. 531, title XIX, Sec. 1902, as added Pub. L. 89-97, 
title I, Sec. 121(a), July 30, 1965, 79 Stat. 344; amended Pub. L. 90-
248, title II, Secs. 210(a)(6), 223(a), 224(a), (c)(1), 227(a), 228(a), 
229(a), 231, 234(a), 235(a), 236(a), 237, 238, 241(f)(1)-(4), title III, 
Sec. 302(b), Jan. 2, 1968, 81 Stat. 896, 901-906, 908, 911, 917, 929; 
Pub. L. 91-56, Sec. 2(c), (d), Aug. 9, 1969, 83 Stat. 99; Pub. L. 92-
223, Sec. 4(b), Dec. 28, 1971, 85 Stat. 809; Pub. L. 92-603, title II, 
Secs. 208(a), 209(a), (b)(1), 221(c)(5), 231, 232(a), 236(b), 237(a)(2), 
239(a), (b), 240, 246(a), 249(a), 255(a), 268(a), 274(a), 278(a)(18)-
(20), (b)(14), 298, 299A, 299D(b), Oct. 30, 1972, 86 Stat. 1381, 1389, 
1410, 1415-1418, 1424, 1426, 1446, 1450, 1452-1454, 1460, 1462; Pub. L. 
93-233, Secs. 13(a)(2)-(10), 18(o)-(q), (x)(1)-(4), Dec. 31, 1973, 87 
Stat. 960-962, 971, 972; Pub. L. 93-368, Sec. 9(a), Aug. 7, 1974, 88 
Stat. 422; Pub. L. 94-48, Secs. 1, 2, July 1, 1975, 89 Stat. 247; Pub. 
L. 94-182, title I, Sec. 111(a), Dec. 31, 1975, 89 Stat. 1054; Pub. L. 
94-552, Sec. 1, Oct. 18, 1976, 90 Stat. 2540; Pub. L. 95-142, 
Secs. 2(a)(3), (b)(1), 3(c)(1), 7(b), (c), 9, 19(b)(2), 20(b), Oct. 25, 
1977, 91 Stat. 1176, 1178, 1193, 1195, 1204, 1207; Pub. L. 95-210, 
Sec. 2(c), Dec. 13, 1977, 91 Stat. 1488; Pub. L. 95-559, Sec. 14(a)(1), 
Nov. 1, 1978, 92 Stat. 2140; Pub. L. 96-272, title III, Sec. 308(c), 
June 17, 1980, 94 Stat. 531; Pub. L. 96-499, title IX, Secs. 902(b), 
903(b), 905(a), 912(b), 913(c), (d), 914(b)(1), 916(b)(1), 918(b)(1), 
962(a), 965(b), Dec. 5, 1980, 94 Stat. 2613, 2615, 2618-2621, 2624, 
2626, 2650, 2652; Pub. L. 96-611, Sec. 5(b), Dec. 28, 1980, 94 Stat. 
3568; Pub. L. 97-35, title XXI, Secs. 2105(c), 2113(m), 2171(a), (b), 
2172(a), 2173(a), (b)(1), 2174(a), 2175(a), (d)(1), 2178(b), 2181(a)(2), 
2182, 2193(c)(9), Aug. 13, 1981, 95 Stat. 792, 795, 807-809, 811, 814-
816, 828; Pub. L. 97-248, title I, Secs. 131(a), (c), formerly (b), 
132(a), (c), 134(a), 136(d), 137(a)(3), (b)(7)-(10), (e), 146(a), Sept. 
3, 1982, 96 Stat. 367, 369, 370, 373, 375-378, 381, 394; Pub. L. 97-448, 
title III, Sec. 309(a)(8), Jan. 12, 1983, 96 Stat. 2408; Pub. L. 98-369, 
div. B, title III, Secs. 2303(g)(1), 2314(b), 2335(e), 2361(a), 2362(a), 
2363(a)(1), 2367(a), 2368(a), (b), 2373(b)(1)-(10), title VI, 
Sec. 2651(c), July 18, 1984, 98 Stat. 1066, 1079, 1091, 1104, 1105, 
1108, 1109, 1111, 1149; Pub. L. 98-378, Sec. 20(c), Aug. 16, 1984, 98 
Stat. 1322; Pub. L. 98-617, Sec. 3(a)(7), (b)(10), Nov. 8, 1984, 98 
Stat. 3295, 3296; Pub. L. 99-272, title IX, Secs. 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, Sec. 12305(b)(3), Apr. 7, 1986, 100 Stat. 201, 202, 
205, 208-212, 216, 220, 293; Pub. L. 99-509, title IX, Secs. 9320(h)(3), 
9401(a)-(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, 100 Stat. 2016, 2050-2058, 2060, 
2061, 2066, 2068, 2069; Pub. L. 99-514, title XVIII, Sec. 1895(c)(1), 
(3)(B), (C), (7), Oct. 22, 1986, 100 Stat. 2935, 2936; Pub. L. 99-570, 
title XI, Sec. 11005(b), Oct. 27, 1986, 100 Stat. 3207-169; Pub. L. 99-
643, Secs. 3(b), 7(b), Nov. 10, 1986, 100 Stat. 3575, 3579; Pub. L. 100-
93, Secs. 5(a), 7, 8(f), Aug. 18, 1987, 101 Stat. 689, 691, 694; Pub. L. 
100-203, title IV, Secs. 4072(d), 4101(a)(1), (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, Secs. 9115(b), 9119(d)(1), Dec. 22, 1987, 101 Stat. 
1330-117, 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 Pub. L. 100-360, title IV, 
Sec. 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, 102 Stat. 791, 794, 
796, 803, 805, 807, as amended Pub. L. 100-485, title VI, 
Sec. 608(d)(14)(I), (15)(A), (27)(F)-(H), (28), Oct. 13, 1988, 102 Stat. 
2416, 2423; Pub. L. 100-360, title II, Sec. 204(d)(3), title III, 
Secs. 301(a)(1), (e)(2), 302(a), (b)(1), (c)(1), (2), (d)-(e)(3), 
303(d), (e), title IV, Sec. 411(k)(5)(B), (17)(B), (l)(3)(E), (6)(C), 
(D), July 1, 1988, 102 Stat. 729, 748-753, 762, 763, 792, 800, 803, 804; 
Pub. L. 100-485, title II, Sec. 202(c)(4), title III, Sec. 303(a)(2), 
(b)(1), (d), title IV, Sec. 401(d)(1), title VI, Sec. 608(d)(15)(B), 
(16)(C), Oct. 13, 1988, 102 Stat. 2378, 2391, 2392, 2396, 2416, 2418; 
Pub. L. 100-647, title VIII, Sec. 8434(b)(1), (2), Nov. 10, 1988, 102 
Stat. 3805; Pub. L. 101-234, title II, Sec. 201(a), Dec. 13, 1989, 103 
Stat. 1981; Pub. L. 101-239, title VI, Secs. 6115(c), 6401(a), 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, 103 Stat. 2219, 
2258, 2260, 2261, 2263-2265, 2268-2271; Pub. L. 101-508, title IV, 
Secs. 4401(a)(2), 4402(a)(1), (c), (d)(1), 4501(b), (e)(2), 4601(a)(1), 
4602(a), 4603(a), 4604(a), (b), 4701(b)(1), 4704(a), (e)(1), 4708(a), 
4711(c)(1), (d), 4713(a), 4715(a), 4723(b), 4724(a), 4732(b)(1), 
4751(a), 4752(a)(1)(A), (c)(1), 4754(a), 4755(a)(2), (c)(1), 
4801(e)(1)(A), (11)(A), Nov. 5, 1990, 104 Stat. 1388-143, 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; 
Pub. L. 102-234, Secs. 2(b)(1), 3(a), Dec. 12, 1991, 105 Stat. 1799; 
Pub. L. 103-66, title XIII, Sec. 13581(b)(2), 13601(b), 13602(c), 
13603(a)-(c), 13611(d)(1), 13622(a)(1), (b), (c), 13623(a), 13625(a), 
13631(a), (e)(1), (f)(1), Aug. 10, 1993, 107 Stat. 611, 613, 619, 620, 
626, 632, 633, 636, 643, 644; Pub. L. 103-296, title I, Sec. 108(d)(1), 
Aug. 15, 1994, 108 Stat. 1486; Pub. L. 103-448, title II, 
Sec. 204(w)(2)(E), Nov. 2, 1994, 108 Stat. 4746; Pub. L. 104-193, title 
I, Secs. 108(k), 114(b)-(d)(1), title IX, Sec. 913, Aug. 22, 1996, 110 
Stat. 2169, 2180, 2354; Pub. L. 104-226, Sec. 1(b)(2), Oct. 2, 1996, 110 
Stat. 3033; Pub. L. 104-248, Sec. 1(a)(1), Oct. 9, 1996, 110 Stat. 3148; 
Pub. L. 105-12, Sec. 9(b)(2), Apr. 30, 1997, 111 Stat. 26; Pub. L. 105-
33, title IV, Secs. 4106(c), 4454(b)(1), 4701(b)(2)(A)(i)-(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, 111 Stat. 368, 431, 493, 495, 506-510, 516, 517, 519, 520, 522-
525, 571, 573; Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title VI, 
Secs. 603(a)(1), 604(a)(1), (2)(A), (b)(1), 608(a)-(d), (y)(2), 
(aa)(1)], Nov. 29, 1999, 113 Stat. 1536, 1501A-394 to 1501A-398; Pub. L. 
106-169, title I, Sec. 121(a)(1), (c)(4), title II, Secs. 205(c), 
206(b), Dec. 14, 1999, 113 Stat. 1829, 1830, 1834, 1837; Pub. L. 106-
170, title II, Sec. 201(a)(1), (2)(A), Dec. 17, 1999, 113 Stat. 1891, 
1892.)

                          Amendment of Section

        Pub. L. 105-33, title IV, Sec. 4712(c)(1), Aug. 5, 1997, 111 
    Stat. 509, provided that, effective for services furnished on or 
    after Oct. 1, 2004, subsection (a)(13)(C) of this section is 
    repealed.
        Pub. L. 101-508, title IV, Sec. 4801(e)(11), Nov. 5, 1990, 104 
    Stat. 1388-217, provided that, effective on the date on which the 
    Secretary promulgates standards regarding the qualifications of 
    nursing facility administrators under section 1396r(f)(4) 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 
601 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 1395c et seq. and 
1395j et seq., respectively, of this title.
    Section 602 of this title, referred to in subsecs. (a)(10)(A)(i)(I) 
and (e)(10), was repealed and a new section 602 enacted by Pub. L. 104-
193, title I, Sec. 103(a)(1), Aug. 22, 1996, 110 Stat. 2112, and, as so 
enacted, no longer contains subsec. (a)(37) or (a)(43).
    Section 606 of this title, referred to in subsec. (a)(10)(A)(i)(I), 
was repealed and a new section 606 enacted by Pub. L. 104-193, title I, 
Sec. 103(a)(1), Aug. 22, 1996, 110 Stat. 2112, and, as so enacted, no 
longer contains a subsec. (h).
    Section 682 of this title, referred to in subsec. (a)(10)(A)(i)(I), 
was repealed by Pub. L. 104-193, title I, Sec. 108(e), Aug. 22, 1996, 
110 Stat. 2167.
    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 Pub. L. 
104-193, which was approved Aug. 22, 1996. Section 211(a) of the Act 
amended section 1382c 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 Pub. L. 105-33, which 
amended sections 1395d, 1395u, 1395x, and 1395ff of this title. Subsec. 
(e)(3) of section 4611 of the Act is set out as a note under section 
1395d of this title. For complete classification of section 4611 of the 
Act to the Code, see Tables.
    Section 303(a)(4)(A) of this title, referred to in subsec. 
(a)(20)(C), was amended generally by Pub. L. 97-35, title XXIII, 
Sec. 2353(a)(1)(A), Aug. 13, 1981, 95 Stat. 871, and, as so amended, no 
longer contained cls. (i) and (ii). Section 303(a)(4) was amended by 
Pub. L. 103-66, title XIII, Sec. 13741(b), Aug. 10, 1993, 107 Stat. 663, 
and, as so amended, no longer contains subparagraphs.
    Section 1383(a)(4)(A)(i) and (ii) of this title, referred to in 
subsec. (a)(20)(C), is a reference to section 1383(a)(4)(A)(i) and (ii) 
existing prior to the general revision of subchapter XVI of this chapter 
by Pub. L. 92-603, title III, Sec. 301, Oct. 30, 1972, 86 Stat. 1465, 
eff. Jan. 1, 1974. The prior section (which is set out as a note under 
section 1383 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 Pub. L. 97-35, title XXIII, Sec. 2353(m)(2)(B), Aug. 13, 
1981, 95 Stat. 973, and, as so amended, no longer contained clauses in 
subpar. (A). Subsec. (a)(4) of the prior section was also amended by 
Pub. L. 103-66, title XIII, Sec. 13741(b), Aug. 10, 1993, 107 Stat. 663, 
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 1320c et seq. of this title.
    Public Law 92-336, referred to in provisions following subsec. 
(a)(52), is Pub. L. 92-336, July 1, 1972, 86 Stat. 406, which amended 
sections 401, 403, 409, 411, 415, 427, 428, and 430 of this title and 
sections 165, 1401, 1402, 3101, 3111, 3121, 3122, 3125, 6413, and 6654 
of Title 26, Internal Revenue Code, and enacted provisions set out as 
notes under sections 403, 409, 415, and 428 of this title and sections 
165 and 1401 of Title 26.
    The Public Health Service Act, referred to in subsec. (u)(3), is act 
July 1, 1944, ch. 373, 58 Stat. 682, as amended. Title XXII of the Act 
is classified generally to subchapter XX (Sec. 300bb-1 et seq.) of 
chapter 6A of this title. For complete classification of this Act to the 
Code, see Short Title note set out under section 201 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 Pub. L. 93-406, Sept. 2, 1974, 88 Stat. 829, 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 (Sec. 1161 et 
seq.) of subtitle B of subchapter I of chapter 18 of Title 29, 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 1001 of Title 29 
and Tables.


                               Amendments

    1999--Subsec. (a)(10)(A)(ii)(XIV). Pub. L. 106-113, Sec. 1000(a)(6) 
[title VI, Sec. 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). Pub. L. 106-169, Sec. 121(c)(4)(A), 
redesignated subcl. (XV), related to individuals who are independent 
foster care adolescents, as (XVII).
    Pub. L. 106-169, Sec. 121(a)(1)(C), added subcl. (XV), related to 
individuals who are independent foster care adolescents.
    Pub. L. 106-169, Sec. 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.
    Pub. L. 106-170, Sec. 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). Pub. L. 106-169, Sec. 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.
    Pub. L. 106-170, Sec. 201(a)(2)(A), added subcl. (XVI).
    Subsec. (a)(10)(A)(ii)(XVII). Pub. L. 106-169, Sec. 121(c)(4), 
redesignated subcl. (XV), related to individuals who are independent 
foster care adolescents, as (XVII) and substituted ``section 
1396d(w)(1)'' for ``section 1396d(v)(1)''.
    Subsec. (a)(10)(G). Pub. L. 106-169, Sec. 206(b), substituted 
``subsections (c) and (e) of section 1382b'' for ``section 1382b(e)''.
    Pub. L. 106-169, Sec. 205(c), added subpar. (G).
    Subsec. (a)(13)(C)(i). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 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). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 604(b)(1)(A)], inserted ``and'' at end.
    Subsec. (a)(30)(B)(ii). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 604(b)(1)(B)], struck out ``and'' at end.
    Subsec. (a)(30)(C). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 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 1320c-1 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 1396b(m) 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). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 608(y)(2)], made technical amendment to reference in original act 
which appears in text as reference to section 1396g-1 of this title.
    Subsec. (a)(64). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 608(a)], inserted ``and'' at end.
    Subsec. (d). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 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''.
    Pub. L. 106-113, Sec. 1000(a)(6) [title VI, Sec. 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). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 608(b)], substituted ``of'' for ``of of'' after ``numbered 
paragraph''.
    Subsec. (l)(1)(C). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 608(c)(1)], substituted ``children'' for ``children children''.
    Subsec. (l)(3). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 608(c)(2)], struck out first comma after ``(a)(10)(A)(i)(VII)'' in 
introductory provisions.
    Subsec. (l)(4)(B). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 608(c)(3)], inserted comma after ``(a)(10)(A)(i)(IV)''.
    Subsec. (v). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 608(d)], struck out par. (1) designation before ``A State plan may 
provide''.
    1997--Subsec. (a). Pub. L. 105-33, Sec. 4454(b)(1), in second 
sentence of flush concluding provisions, substituted ``to a religious 
nonmedical health care institution (as defined in section 1395x(ss)(1) 
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). Pub. L. 105-33, Sec. 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). Pub. L. 105-33, Sec. 4106(c), substituted 
``paragraphs (16) and (17)'' for ``paragraphs (15) and (16)''.
    Subsec. (a)(10)(A)(i)(II). Pub. L. 105-33, Sec. 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). Pub. L. 105-33, Sec. 4733, added 
subcl. (XIII).
    Subsec. (a)(10)(A)(ii)(XIV). Pub. L. 105-33, Sec. 4911(b), added 
subcl. (XIV).
    Subsec. (a)(10)(E)(iv). Pub. L. 105-33, Sec. 4732(a), added cl. 
(iv).
    Subsec. (a)(13)(A). Pub. L. 105-33, Sec. 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). Pub. L. 105-33, Sec. 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 1395x(v)(1)(O) of this title;''.
    Subsec. (a)(13)(C). Pub. L. 105-33, Sec. 4712(b)(1), designated 
existing provisions as cl. (i) and added cl. (ii).
    Pub. L. 105-33, Sec. 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''.
    Pub. L. 105-33, Sec. 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). Pub. L. 105-33, Sec. 4711(a)(2), 
redesignated subpars. (D) and (E) as (B) and (C), respectively.
    Subsec. (a)(13)(F). Pub. L. 105-33, Sec. 4711(a)(5), struck out 
subpar. (F) which read as follows: ``for payment for home and community 
care (as defined in section 1396t(a) 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). Pub. L. 105-33, Sec. 4724(d), struck out ``except 
as provided in subsection (g) of this section and in section 1396n 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 1396n 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). Pub. L. 105-33, Sec. 4701(d)(1), substituted ``, 
in section 1396n of this title, and in section 1396u-2(a) of this 
title'' for ``and in section 1396n of this title''.
    Pub. L. 105-33, Sec. 4701(b)(2)(A)(i), substituted ``medicaid 
managed care organization'' for ``health maintenance organization''.
    Subsec. (a)(25)(A)(ii). Pub. L. 105-33, Sec. 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 1396b(r) 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 1396b(r) of this title, and
    ``(II) be subject to the provisions of section 1396b(r)(4) 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). Pub. L. 105-33, Sec. 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 1396e of this title 
(relating to enrollment of individuals under group health plans in 
certain cases);''.
    Subsec. (a)(26). Pub. L. 105-33, Sec. 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). Pub. L. 105-33, Sec. 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). Pub. L. 105-33, Sec. 4912(b)(1), inserted before 
semicolon at end ``and provide for making medical assistance for items 
and services described in subsection (a) of section 1396r-1a of this 
title available to children during a presumptive eligibility period in 
accordance with such section''.
    Subsec. (a)(57). Pub. L. 105-33, Sec. 4701(b)(2)(A)(ii), substituted 
``medicaid managed care organization'' for ``health maintenance 
organization''.
    Subsec. (a)(63). Pub. L. 105-33, Sec. 4724(g)(1)(A), struck out 
``and'' at end.
    Subsec. (a)(64). Pub. L. 105-33, Sec. 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.
    Pub. L. 105-33, Sec. 4724(f), added par. (64).
    Subsec. (a)(65). Pub. L. 105-33, Sec. 4724(g)(1)(C), added par. 
(65).
    Subsec. (e)(2)(A). Pub. L. 105-33, Sec. 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.
    Pub. L. 105-33, Sec. 4709(1), substituted ``who is enrolled with a 
medicaid managed care organization (as defined in section 1396b(m)(1)(A) 
of this title), with a primary care case manager (as defined in section 
1396d(t) 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 1396b(m) of this title under a 
contract described in section 1396b(m)(2)(A) of this title''.
    Subsec. (e)(12). Pub. L. 105-33, Sec. 4731(a), added par. (12).
    Subsec. (i)(1)(B). Pub. L. 105-33, Sec. 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). Pub. L. 105-33, Sec. 4702(b)(2), substituted ``a 
numbered paragraph of'' for ``paragraphs (1) through (25)''.
    Subsec. (l)(1)(D). Pub. L. 105-33, Sec. 4731(b), inserted ``(or, at 
the option of a State, after any earlier date)'' after ``children born 
after September 30, 1983''.
    Subsec. (n). Pub. L. 105-33, Sec. 4714(a)(1), designated existing 
provisions as par. (1) and added pars. (2) and (3).
    Subsec. (p)(2). Pub. L. 105-33, Sec. 4701(b)(2)(A)(iii), substituted 
``medicaid managed care organization'' for ``health maintenance 
organization'' in introductory provisions.
    Subsec. (r)(1). Pub. L. 105-33, Sec. 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). Pub. L. 105-33, Sec. 4701(b)(2)(A)(iv), 
substituted ``medicaid managed care organization'' for ``health 
maintenance organization''.
    Subsec. (w)(5). Pub. L. 105-12 added par. (5).
    1996--Subsec. (a). Pub. L. 104-193, Sec. 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). Pub. L. 104-226 struck out ``including the 
use of information collected by the Medicare and Medicaid Coverage Data 
Bank under section 1320b-14 of this title and any additional measures'' 
before ``as specified by the Secretary in regulations)''.
    Subsec. (a)(59). Pub. L. 104-248 substituted ``subsection (x)'' for 
``subsection (v)''.
    Subsec. (a)(63). Pub. L. 104-193, Sec. 114(b), added par. (63).
    Subsec. (c). Pub. L. 104-193, Sec. 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). Pub. L. 104-193, Sec. 114(c), substituted 
``2001'' for ``1998''.
    Subsec. (j). Pub. L. 104-193, Sec. 108(k), substituted ``1308(f)'' 
for ``1308(c)''.
    1994--Subsec. (a)(10)(A)(ii)(XI). Pub. L. 103-296 substituted 
``Commissioner of Social Security'' for ``Secretary''.
    Subsec. (a)(11)(C), (53)(A). Pub. L. 103-448 substituted ``special 
supplemental nutrition program'' for ``special supplemental food 
program''.
    1993--Subsec. (a)(10). Pub. L. 103-66, Sec. 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). Pub. L. 103-66, Sec. 13603(a), added 
subcl. (XII).
    Subsec. (a)(1)(C)(iv). Pub. L. 103-66, Sec. 13601(b)(1), substituted 
``paragraphs numbered (1) through (24)'' for ``paragraphs numbered (1) 
through (21)''.
    Subsec. (a)(11). Pub. L. 103-66, Sec. 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 1396b 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 1396b 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). Pub. L. 103-66, Sec. 13611(d)(1)(A), substituted 
``, transfers of assets, and treatment of certain trusts'' for ``and 
transfers of assets''.
    Subsec. (a)(25)(A). Pub. L. 103-66, Sec. 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). Pub. L. 103-66, Sec. 13581(b)(2), substituted 
``(including the use of information collected by the Medicare and 
Medicaid Coverage Data Bank under section 1320b-14 of this title and any 
additional measures as specified'' for ``(as specified''.
    Subsec. (a)(25)(H). Pub. L. 103-66, Sec. 13622(b), added subpar. 
(H).
    Subsec. (a)(25)(I). Pub. L. 103-66, Sec. 13622(c), added subpar. 
(I).
    Subsec. (a)(32)(D). Pub. L. 103-66, Sec. 13631(e)(1), added subpar. 
(D).
    Subsec. (a)(43)(A). Pub. L. 103-66, Sec. 13631(f)(1)(C), inserted 
before comma at end ``and the need for age-appropriate immunizations 
against vaccine-preventable diseases''.
    Subsec. (a)(51). Pub. L. 103-66, Sec. 13611(d)(1)(B), struck out 
``(A)'' before ``meet the requirements'' and ``, and (B) meet the 
requirement of section 1396p(c) of this title (relating to transfer of 
assets)'' after ``community spouses)''.
    Subsec. (a)(54). Pub. L. 103-66, Sec. 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 Pub. L. 
103-66, Sec. 13602(c). See below.
    Pub. L. 103-66, Sec. 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 1396r-8(d) 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 1396r-8(a) 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 1396r-
8(b)(2)(A) of this title and the requirements of subsections (d) and (g) 
of section 1396r-8 of this title; and''.
    Subsec. (a)(55). Pub. L. 103-66, Sec. 13623(a)(3), redesignated par. 
(55) relating to providing for adjusted payments as (56).
    Pub. L. 103-66, Sec. 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). Pub. L. 103-66, Sec. 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). Pub. L. 103-66, Sec. 13623(a)(4), transferred par. 
(57) to appear after par. (56) as redesignated by Pub. L. 103-66, 
Sec. 13623(a)(3). See above.
    Subsec. (a)(58). Pub. L. 103-66, Sec. 13623(a)(6), redesignated par. 
(58) relating to maintaining a list as (59).
    Pub. L. 103-66, Sec. 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.
    Pub. L. 103-66, Sec. 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 Pub. L. 103-
66, Sec. 13623(a)(4), to appear after par. (56), as redesignated by Pub. 
L. 103-66, Sec. 13623(a)(3). See above.
    Subsec. (a)(59). Pub. L. 103-66, Sec. 13625(a)(1), struck out 
``and'' at end.
    Pub. L. 103-66, Sec. 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). Pub. L. 103-66, Sec. 13623(a)(7), added par. (60).
    Subsec. (a)(61). Pub. L. 103-66, Sec. 13625(a), added par. (61).
    Subsec. (a)(62). Pub. L. 103-66, Sec. 13631(a), added par. (62).
    Subsec. (j). Pub. L. 103-66, Sec. 13601(b)(2), substituted 
``paragraphs (1) through (25)'' for ``paragraphs (1) through (22)''.
    Subsec. (k). Pub. L. 103-66, Sec. 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). Pub. L. 103-66, Sec. 13603(b), added subsec. (z).
    1991--Subsec. (h). Pub. L. 102-234, Sec. 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). Pub. L. 102-234, Sec. 2(b)(1), substituted ``Nothing'' 
for ``Except as provided in section 1396b(i) of this title, nothing'' 
and ``taxes of general applicability'' for ``taxes (whether or not of 
general applicability)''.
    1990--Subsec. (a)(10). Pub. L. 101-508, Sec. 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 Pub. L. 101-508, Sec. 4713(a)(1)(A)-
(C), which added subpar. (F). See below. Direction by section 
4713(a)(1)(D) to strike ``and'' before ``(X)'' could not be executed 
because ``and'' did not appear after amendment by Pub. L. 101-508, 
Sec. 4402(d)(1). See below.
    Pub. L. 101-508, Sec. 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). Pub. L. 101-508, Sec. 4601(a)(1)(A), 
added subcl. (VII).
    Subsec. (a)(10)(A)(ii)(IX). Pub. L. 101-508, Sec. 4601(a)(1)(B), 
substituted ``, clause (i)(VI), or clause (i)(VII)'' for ``or clause 
(i)(VI)''.
    Subsec. (a)(10)(C)(iv). Pub. L. 101-508, Secs. 4711(d)(2), 
4755(c)(1)(A), amended cl. (iv) identically, substituting ``through 
(21)'' for ``through (20)''.
    Subsec. (a)(10)(E)(iii). Pub. L. 101-508, Sec. 4501(b), added cl. 
(iii).
    Subsec. (a)(10)(F). Pub. L. 101-508, Sec. 4713(a)(1)(A)-(C), added 
subpar. (F).
    Subsec. (a)(13)(A). Pub. L. 101-508, Sec. 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). Pub. L. 101-508, Sec. 4704(e)(1), repealed Pub. 
L. 101-239, Sec. 6402(c)(2). See 1989 Amendment note below.
    Pub. L. 101-508, Sec. 4704(a), substituted ``prescribes'' for ``may 
prescribe'' and ``on the same methodology used under section 1395l(a)(3) 
of this title'' for ``on such tests of reasonableness as the Secretary 
may prescribe in regulations under this subparagraph''.
    Subsec. (a)(13)(F). Pub. L. 101-508, Sec. 4711(c)(1)(A), added 
subpar. (F).
    Subsec. (a)(17). Pub. L. 101-508, Sec. 4723(b), inserted ``, 
payments made to the State under section 1396b(f)(2)(B) of this title,'' 
after ``insurance premiums''.
    Subsec. (a)(25)(G). Pub. L. 101-508, Sec. 4402(a)(1), added subpar. 
(G).
    Subsec. (a)(32)(C). Pub. L. 101-508, Sec. 4708(a), added subpar. 
(C).
    Subsec. (a)(41). Pub. L. 101-508, Sec. 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). Pub. L. 101-508, Sec. 4401(a)(2), added par. (54).
    Subsec. (a)(55). Pub. L. 101-508, Sec. 4604(b), added par. (55) 
relating to providing for adjusted payments.
    Pub. L. 101-508, Sec. 4602(a), added par. (55) relating to providing 
for receipt and initial processing of applications.
    Subsec. (a)(57). Pub. L. 101-508, Sec. 4751(a)(1), added par. (57).
    Subsec. (a)(58). Pub. L. 101-508, Sec. 4752(c), added par. (58) 
relating to maintaining a list.
    Pub. L. 101-508, Sec. 4751(a)(1), added par. (58) relating to 
providing that a State develop a written description of advance 
directive laws.
    Subsec. (e)(2)(A). Pub. L. 101-508, Sec. 4732(b)(1), inserted ``or 
with an eligible organization with a contract under section 1395mm of 
this title'' after ``section 1396b(m)(2)(A) of this title''.
    Subsec. (e)(4). Pub. L. 101-508, Sec. 4603(a)(1), inserted ``(or 
would remain if pregnant)'' after ``remains''.
    Subsec. (e)(6). Pub. L. 101-508, Sec. 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 1396r-1 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). Pub. L. 101-508, Sec. 4402(c), added par. (11).
    Subsec. (h). Pub. L. 101-508, Sec. 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). Pub. L. 101-508, Secs. 4711(d)(1), 4755(c)(1)(B), 
amended subsec. (j) identically substituting ``through (22)'' for 
``through (21)''.
    Subsec. (l)(1)(C). Pub. L. 101-508, Sec. 4601(a)(1)(C)(i), inserted 
``children'' after ``(C)''.
    Subsec. (l)(1)(D). Pub. L. 101-508, Sec. 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). Pub. L. 101-508, Sec. 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). Pub. L. 101-508, Sec. 4601(a)(1)(C)(iv), inserted 
``, (a)(10)(A)(i)(VII),'' after ``(a)(10)(A)(i)(VI)''.
    Subsec. (l)(4)(A). Pub. L. 101-508, Sec. 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). Pub. L. 101-508, Sec. 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). Pub. L. 101-508, Sec. 4501(e)(2)(A), inserted ``, 
except as provided in paragraph (2)(C)'' after ``program''.
    Subsec. (m)(2)(C). Pub. L. 101-508, Sec. 4501(e)(2)(B), added 
subpar. (C).
    Subsec. (r)(1). Pub. L. 101-508, Sec. 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). Pub. L. 101-508, Sec. 4601(a)(1)(D), inserted 
``(a)(10)(A)(i)(VII),'' after ``(a)(10)(A)(i)(VI),''.
    Subsec. (s). Pub. L. 101-508, Sec. 4604(a), added subsec. (s).
    Subsec. (t). Pub. L. 101-508, Sec. 4701(b)(1), added subsec. (t).
    Subsec. (u). Pub. L. 101-508, Sec. 4713(a)(2), added subsec. (u).
    Subsec. (v). Pub. L. 101-508, Sec. 4724(a), added subsec. (v).
    Subsec. (w). Pub. L. 101-508, Sec. 4751(a)(2), added subsec. (w).
    Subsec. (x). Pub. L. 101-508, Sec. 4752(a)(1)(A), added subsec. (x).
    Subsec. (y). Pub. L. 101-508, Sec. 4755(a)(2), added subsec. (y).
    1989--Subsec. (a)(9)(C). Pub. L. 101-239, Sec. 6115(c), substituted 
``paragraphs (15) and (16)'' for ``paragraphs (14) and (15)''.
    Pub. L. 101-234 repealed Pub. L. 100-360, Sec. 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). Pub. L. 101-239, Sec. 6405(b), substituted ``(1) 
through (5), (17) and (21)'' for ``(1) through (5) and (17)'' in 
introductory provisions.
    Subsec. (a)(10)(A)(i)(VI). Pub. L. 101-239, Sec. 6401(a)(1), added 
subcl. (VI).
    Subsec. (a)(10)(A)(ii)(IX). Pub. L. 101-239, Sec. 6401(a)(2), 
inserted ``or clause (i)(VI)'' after ``clause (i)(IV)''.
    Subsec. (a)(10)(E). Pub. L. 101-239, Sec. 6408(d)(1), designated 
existing provisions as cl. (i) and added cl. (ii).
    Subsec. (a)(11)(C). Pub. L. 101-239, Sec. 6406(a)(1), added subpar. 
(C).
    Subsec. (a)(13)(D). Pub. L. 101-239, Sec. 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). Pub. L. 101-239, Sec. 6404(c), substituted 
``clause (B) or (C) of section 1396d(a)(2) of this title'' for ``section 
1396d(a)(2)(B) of this title provided by a rural health clinic''.
    Pub. L. 101-239, Sec. 6402(c)(2), which directed insertion of ``, 
and for payment for services described in section 1396d(a)(2)(C) of this 
title under the plan,'' after ``provided by a rural health clinic under 
the plan'', was repealed by Pub. L. 101-508, Sec. 4704(e)(1).
    Subsec. (a)(30)(A). Pub. L. 101-239, Sec. 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). Pub. L. 101-239, Sec. 6403(d)(1), substituted 
``section 1396d(r)'' for ``section 1396d(a)(4)(B)''.
    Subsec. (a)(43)(D). Pub. L. 101-239, Sec. 6403(b), added subpar. 
(D).
    Subsec. (a)(53). Pub. L. 101-239, Sec. 6406(a)(2)-(4), added par. 
(53).
    Subsec. (e)(7). Pub. L. 101-239, Sec. 6401(a)(8), substituted ``, 
(C), or (D)'' for ``or (C)'' in introductory provisions.
    Subsec. (f). Pub. L. 101-239, Sec. 6411(e)(2), inserted ``and 
section 1396r-5 of this title'' after ``section 1382h(b)(3) of this 
title''.
    Pub. L. 101-239, Sec. 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''.
    Pub. L. 101-239, Sec. 6408(d)(4)(C), inserted ``, except with 
respect to qualified disabled and working individuals (described in 
section 1396d(s) of this title),'' after ``section 1382h(b)(3) of this 
title''.
    Subsec. (l)(1)(C), (D). Pub. L. 101-239, Sec. 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). Pub. L. 101-239, Sec. 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). Pub. L. 101-239, Sec. 6401(a)(4)(B), added 
cl. (iv).
    Subsec. (l)(2)(B), (C). Pub. L. 101-239, Sec. 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). Pub. L. 101-239, Sec. 6401(a)(6)(A), inserted ``, 
(a)(10)(A)(i)(VI),'' after ``(a)(10)(A)(i)(IV)'' in introductory 
provisions.
    Subsec. (l)(3)(C). Pub. L. 101-239, Sec. 6401(a)(6)(B), substituted 
``(C), or (D)'' for ``or (C)''.
    Subsec. (l)(4)(A). Pub. L. 101-239, Sec. 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). Pub. L. 101-239, Sec. 6401(a)(7)(B), inserted 
``or (a)(10)(A)(i)(VI)'' after ``(a)(10)(A)(i)(IV)''.
    Subsec. (p)(2)(C). Pub. L. 101-239, Sec. 6411(d)(3)(B), added 
subpar. (C).
    Subsec. (r)(2)(A). Pub. L. 101-239, Sec. 6401(a)(9), inserted 
``(a)(10)(A)(i)(VI),'' after ``(a)(10)(A)(i)(IV),'' in introductory 
provisions.
    1988--Subsec. (a)(9)(C). Pub. L. 100-360, Sec. 204(d)(3), 
substituted ``paragraphs (14) and (15)'' for ``paragraphs (13) and 
(14)''.
    Subsec. (a)(10). Pub. L. 100-647, Sec. 8434(b)(1), inserted ``who is 
only entitled to medical assistance because the individual is such a 
beneficiary'' after ``section 1396d(p)(1) of this title'' in subdiv. 
(VIII) of closing provisions.
    Pub. L. 100-360, Sec. 302(a)(1)(C), inserted ``(A)(i)(IV) or'' 
before ``(A)(ii)(X)'' in subdiv. (VII) of closing provisions.
    Pub. L. 100-360, Sec. 302(b)(1), added subdiv. (X) in closing 
provisions.
    Subsec. (a)(10)(A)(i)(I). Pub. L. 100-485, Sec. 202(c)(4), 
substituted ``section 682(e)(6) of this title'' for ``section 614(g) of 
this title''.
    Subsec. (a)(10)(A)(i)(IV). Pub. L. 100-360, Sec. 302(a)(1)(A), added 
subcl. (IV).
    Subsec. (a)(10)(A)(i)(V). Pub. L. 100-485, Sec. 401(d)(1), added 
subcl. (V).
    Subsec. (a)(10)(A)(ii)(VI). Pub. L. 100-360, Sec. 411(k)(17)(B), 
substituted ``(c), (d), or (e)'' for ``(c) or (d)'' in two places.
    Subsec. (a)(10)(A)(ii)(IX). Pub. L. 100-360, Sec. 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). Pub. L. 100-360, Sec. 301(e)(2)(A), 
struck out ``subject to subsection (m)(3) of this section,'' before 
``who are described''.
    Subsec. (a)(10)(A)(ii)(XI). Pub. L. 100-360, Sec. 411(k)(5)(B), 
substituted ``may be more restrictive'' for ``are more restrictive'' and 
a semicolon for the period at end.
    Pub. L. 100-360, Sec. 411(k)(5)(A), amended Pub. L. 100-203, 
Sec. 4104, see 1987 Amendment note below.
    Subsec. (a)(10)(C)(i)(III). Pub. L. 100-360, Sec. 303(e)(1), 
substituted ``no more restrictive than the methodology'' for ``the same 
methodology'' in two places.
    Subsec. (a)(10)(E). Pub. L. 100-360, Sec. 301(e)(2)(B), struck out 
``subject to subsection (m)(3) of this section,'' before ``for making 
medical''.
    Pub. L. 100-360, Sec. 301(a)(1), struck out ``at the option of a 
State, but'' after ``(E)''.
    Subsec. (a)(13)(A). Pub. L. 100-360, Sec. 411(l)(3)(J), as added by 
Pub. L. 100-485, Sec. 608(d)(27)(H), amended Pub. L. 100-203, 
Sec. 4211(h)(2)(B), see 1987 Amendment note below.
    Subsec. (a)(13)(C). Pub. L. 100-360, Sec. 411(l)(3)(H)(i), as 
amended by Pub. L. 100-485, Sec. 608(d)(27)(F), amended Pub. L. 100-203, 
Sec. 4211(h)(2)(C), see 1987 Amendment note below.
    Subsec. (a)(13)(D). Pub. L. 100-360, Sec. 411(l)(3)(H)(ii), (iii), 
as amended by Pub. L. 100-485, Sec. 608(d)(27)(G), amended Pub. L. 100-
203, Sec. 4211(h)(2)(D), see 1987 Amendment note below.
    Subsec. (a)(15). Pub. L. 100-360, Sec. 301(e)(2)(C), as added by 
Pub. L. 100-485, Sec. 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 1396d(p)(1) 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). Pub. L. 100-360, Sec. 411(k)(10)(G)(ii), amended 
directory language of Pub. L. 100-203, Sec. 4118(h)(1), see 1987 
Amendment note below.
    Pub. L. 100-360, Sec. 301(e)(2)(D), formerly Sec. 301(e)(2)(C), as 
redesignated and amended by Pub. L. 100-485, Sec. 608(d)(14)(I)(i), 
substituted ``(m)(3), and (m)(4)'' for ``(m)(4), and (m)(5)''.
    Subsec. (a)(28)(D)(i). Pub. L. 100-360, Sec. 411(l)(3)(E), 
substituted ``section 1396r(e) of this title'' for ``section 1396r(f) 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). Pub. L. 100-360, Sec. 411(l)(6)(C), substituted 
``section 1396r(g) of this title'' for ``section 1396r(d) of this 
title''.
    Subsec. (a)(44)(A). Pub. L. 100-360, Sec. 411(l)(6)(D), amended Pub. 
L. 100-203, Sec. 4212(e)(1)(B), see 1987 Amendment note below.
    Subsec. (a)(50). Pub. L. 100-360, Sec. 411(n)(4), formerly 
Sec. 411(n)(3), as redesignated by Pub. L. 100-485, Sec. 608(d)(28), 
added Pub. L. 100-203, Sec. 9119(d)(1)(A), see 1987 Amendment note 
below.
    Subsec. (a)(51). Pub. L. 100-360, Sec. 303(e)(2)-(4), added par. 
(51).
    Subsec. (a)(52). Pub. L. 100-485, Sec. 303(a)(2), added par. (52).
    Subsec. (c). Pub. L. 100-360, Sec. 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). Pub. L. 100-360, Sec. 411(k)(7)(C), amended Pub. L. 
100-203, Sec. 4113(b)(2)(ii), see 1987 Amendment note below.
    Subsec. (e)(1). Pub. L. 100-485, Sec. 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). Pub. L. 100-360, Sec. 411(k)(7)(D), repealed Pub. 
L. 100-203, Sec. 4113(d)(2), see 1987 Amendment note below.
    Pub. L. 100-360, Sec. 411(k)(7)(B), amended Pub. L. 100-203, 
Sec. 4113(a)(2), see 1987 Amendment note below.
    Subsec. (e)(6). Pub. L. 100-360, Sec. 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). Pub. L. 100-360, Sec. 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 1396d(n) 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). Pub. L. 100-485, Sec. 303(d), added par. (10).
    Subsec. (f). Pub. L. 100-360, Sec. 411(k)(10)(G)(iv), added Pub. L. 
100-203, Sec. 4118(h)(2), see 1987 Amendment note below.
    Subsec. (i). Pub. L. 100-360, Sec. 411(l)(8)(C), amended Pub. L. 
100-203, Sec. 4213(b)(1), see 1987 Amendment note below.
    Subsec. (l)(1). Pub. L. 100-360, Sec. 302(e)(3)(A), inserted ``any 
of subclauses (I) through (III) of'' after ``described in'' in 
concluding provisions.
    Subsec. (l)(1)(C). Pub. L. 100-360, Sec. 302(a)(2)(A), inserted ``at 
the option of the State,'' after ``(C)'' and struck out ``and'' after 
``1983,''.
    Subsec. (l)(2)(A). Pub. L. 100-360, Sec. 302(a)(2)(B), as amended by 
Pub. L. 100-485, Sec. 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). Pub. L. 100-485, Sec. 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). Pub. L. 100-485, Sec. 608(d)(15)(B)(ii), 
substituted ``clause (ii)(I)'' for ``clause (ii)'' in introductory 
provisions and concluding provisions.
    Subsec. (l)(3). Pub. L. 100-360, Sec. 302(e)(3)(B), inserted 
``(a)(10)(A)(i)((IV) or'' after ``of subsection'' in introductory 
provisions.
    Subsec. (l)(4). Pub. L. 100-360, Sec. 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). Pub. L. 100-360, Sec. 301(e)(2)(E), formerly 
Sec. 301(e)(2)(D), as redesignated and amended by Pub. L. 100-485, 
Sec. 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). Pub. L. 100-360, Sec. 301(e)(2)(E), formerly 
Sec. 301(e)(2)(D), as redesignated and amended by Pub. L. 100-485, 
Sec. 608(d)(14)(I)(ii), redesignated par. (5) as (4). Former par. (4) 
redesignated (3).
    Subsec. (m)(4)(A). Pub. L. 100-647, Sec. 8434(b)(2), substituted 
``section 1396d(p)(1)(B)'' for ``section 1396d(p)(1)(C)''.
    Subsec. (m)(5). Pub. L. 100-360, Sec. 301(e)(2)(E), formerly 
Sec. 301(e)(2)(D), as redesignated and amended by Pub. L. 100-485, 
Sec. 608(d)(14)(I)(ii), redesignated par. (5) as (4).
    Subsec. (o). Pub. L. 100-360, Sec. 411(n)(2), made technical 
correction to directory language of Pub. L. 100-203, Sec. 9115(b), see 
1987 Amendment note below.
    Subsec. (q). Pub. L. 100-360, Sec. 411(n)(4), formerly 
Sec. 411(n)(3), as redesignated by Pub. L. 100-485, Sec. 608(d)(28), 
added Pub. L. 100-203, Sec. 9119(d)(1)(B), see 1987 Amendment note 
below.
    Subsec. (r). Pub. L. 100-360, Sec. 303(e)(5), designated existing 
provisions as par. (1), redesignated subpars. (A) and (B) as cls. (i) 
and (ii), respectively, and added par. (2).
    Pub. L. 100-360, Sec. 303(d), added subsec. (r).
    Subsec. (r)(2)(A). Pub. L. 100-485, Sec. 608(d)(16)(C), substituted 
``, or (f) of this section or under section 1396d(p) of this title'' for 
``of this section, or under subsection (f) of this section'' in 
introductory provisions.
    1987--Subsec. (a)(9)(C). Pub. L. 100-203, Sec. 4072(d), substituted 
``paragraphs (13) and (14)'' for ``paragraphs (12) and (13)''.
    Subsec. (a)(10). Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 4211(h)(1)(A), 
substituted ``nursing facility or intermediate care facility for the 
mentally retarded'' for ``skilled nursing facility or intermediate care 
facility''.
    Pub. L. 100-203, Sec. 4102(b)(1), substituted ``subsection (c) or 
(d) of section 1396n of this title'' for ``section 1396n(c) of this 
title'' in two places.
    Subsec. (a)(10)(A)(ii)(IX), (X). Pub. L. 100-203, Sec. 4118(p)(1), 
(2), realigned margin of subcls. (IX) and (X).
    Subsec. (a)(10)(A)(ii)(XI). Pub. L. 100-203, Sec. 4104, as amended 
by Pub. L. 100-360, Sec. 411(k)(5)(A), added subcl. (XI).
    Subsec. (a)(10)(C)(iv). Pub. L. 100-203, Sec. 4211(h)(1)(B), 
substituted ``in an intermediate care facility'' for ``intermediate care 
facility services''.
    Subsec. (a)(10)(D). Pub. L. 100-203, Sec. 4211(h)(1)(C), struck out 
``skilled'' before ``nursing''.
    Subsec. (a)(13)(A). Pub. L. 100-203, Sec. 4211(h)(2)(B), as amended 
by Pub. L. 100-360, Sec. 411(l)(3)(J), as added by Pub. L. 100-485, 
Sec. 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''.
    Pub. L. 100-203, Sec. 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''.
    Pub. L. 100-203, Sec. 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 1396r of this title and provide (in the case of a nursing 
facility with a waiver under section 1396r(b)(4)(C)(ii) 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). Pub. L. 100-203, Sec. 4211(h)(2)(C), as amended 
by Pub. L. 100-360, Sec. 411(l)(3)(H)(i), as amended by Pub. L. 100-485, 
Sec. 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). Pub. L. 100-203, Sec. 4211(h)(2)(D), as amended 
by Pub. L. 100-360, Sec. 411(l)(3)(H)(ii), (iii), as amended by Pub. L. 
100-485, Sec. 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). Pub. L. 100-203, Sec. 4118(p)(3), substituted 
``subsections (l)(3), (m)(4), and (m)(5) of this section'' for 
``subsection (l)(3) of this section''.
    Pub. L. 100-203, Sec. 4118(h)(1), as amended by Pub. L. 100-360, 
Sec. 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). Pub. L. 100-203, Sec. 4113(c)(1), designated 
provision relating to the obtaining of medical assistance by an eligible 
individual as cl. (A) and added cl. (B).
    Pub. L. 100-93, Sec. 8(f)(1), inserted ``subsection (g) of this 
section and in'' after ``as provided in''.
    Subsec. (a)(28). Pub. L. 100-203, Sec. 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 1395x(j) 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). Pub. L. 100-203, Sec. 4211(h)(3), 
substituted ``intermediate care facility for the mentally retarded'' for 
``skilled nursing facility, intermediate care facility''.
    Subsec. (a)(30)(C). Pub. L. 100-203, Sec. 4118(p)(4), substituted 
``use'' for ``provide''.
    Pub. L. 100-203, Sec. 4113(b)(1), inserted ``, an entity which meets 
the requirements of section 1320c-1 of this title, as determined by the 
Secretary,'' before ``or a private accreditation body''.
    Subsec. (a)(31). Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 4212(d)(3), inserted ``, 
except as provided in section 1396r(d) of this title,'' after ``(B) 
that''.
    Subsec. (a)(38). Pub. L. 100-93, Sec. 8(f)(2), substituted ``the 
information described in section 1320a-7(b)(9) 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). Pub. L. 100-93, Sec. 8(f)(3), substituted 
``exclude'' for ``bar'', ``individual or entity'' for ``person'' in two 
places, and inserted reference to section 1320a-7a of this title.
    Subsec. (a)(42). Pub. L. 100-203, Sec. 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 1320a-8(a) of this title''.
    Subsec. (a)(44). Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 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,''.
    Pub. L. 100-203, Sec. 4212(e)(1)(B), as amended by Pub. L. 100-360, 
Sec. 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). Pub. L. 100-203, Sec. 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). Pub. L. 100-93, Sec. 5(a)(1), struck out ``and'' 
after ``title;''.
    Subsec. (a)(47). Pub. L. 100-93, Sec. 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). Pub. L. 100-93, Sec. 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). Pub. L. 100-93, Sec. 5(a)(4), added par. (49).
    Subsec. (a)(50). Pub. L. 100-203, Sec. 9119(d)(1)(A), as added by 
Pub. L. 100-360, Sec. 411(n)(4), formerly Sec. 411(n)(3), as 
redesignated by Pub. L. 100-485, Sec. 608(d)(28), added par. (50).
    Subsec. (d). Pub. L. 100-203, Sec. 4113(b)(2)(i), inserted ``an 
entity which meets the requirements of section 1320c-1 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''.
    Pub. L. 100-203, Sec. 4113(b)(2)(ii), as amended by Pub. L. 100-360, 
Sec. 411(k)(7)(C), substituted ``an entity or organization'' for 
``organization (or organizations)'' in two places.
    Subsec. (e)(2)(A). Pub. L. 100-203, Sec. 4113(d)(2), which directed 
substitution of ``subparagraph (B)(iii), (E), or (G) of section 
1396b(m)(2) of this title'' for ``section 1396a(m)(2)(G) of this 
title'', was repealed by Pub. L. 100-360, Sec. 411(k)(7)(D).
    Pub. L. 100-203, Sec. 4113(a)(2), as amended by Pub. L. 100-360, 
Sec. 411(k)(7)(B), substituted ``paragraph (2)(B)(iii), (2)(E), (2)(G), 
or (6) of section 1396b(m) of this title'' for ``section 1396b(m)(2)(G) 
of this title''.
    Pub. L. 100-203, Sec. 4113(c)(2), substituted ``but, except for 
benefits furnished under section 1396d(a)(4)(C) of this title, only'' 
for ``but only''.
    Subsec. (e)(3)(B)(i). Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 4101(b)(2)(B), substituted 
``subparagraph (B) or (C)'' for ``subparagraph (B), (C), (D), (E), or 
(F)''.
    Subsec. (e)(9). Pub. L. 100-203, Sec. 4118(p)(6), realigned margins 
of par. (9).
    Subsec. (e)(9)(A)(iii). Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 4118(h)(2), as added by Pub. L. 
100-360, Sec. 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). Pub. L. 100-203, Sec. 4213(b)(1), as amended by Pub. L. 
100-360, Sec. 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 1395x(j) of this 
title or section 1396d(c) 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 1395x(j) of this title 
or section 1396d(c) of this title (as the case may be)''.
    Subsec. (j). Pub. L. 100-203, Sec. 4116, inserted reference to 
Northern Mariana Islands in two places.
    Subsec. (l). Pub. L. 100-93, Sec. 7, redesignated subsec. (l), 
relating to disregarding certain benefits for purposes of determining 
post-eligibility contributions, as (o).
    Subsec. (l)(1). Pub. L. 100-203, Sec. 4118(p)(7), made technical 
corrections in introductory provisions and substituted ``and whose'' for 
``, whose'' in closing provisions.
    Subsec. (l)(1)(C). Pub. L. 100-203, Sec. 4101(c)(2), substituted 
``5, 6, 7, or 8 years of age'' for ``or 5 years of age''.
    Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 4118(p)(8), struck out 
``nonfarm'' after second reference to ``income'' in subpar. (A).
    Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 4101(b)(2)(A)(i), 
substituted ``subparagraph (B) or (C)'' for ``subparagraph (B), (C), 
(D), (E), or (F)''.
    Subsec. (l)(3)(D). Pub. L. 100-203, Sec. 4101(a)(1)(B), inserted 
``appropriate'' after ``applied is the''.
    Subsec. (l)(3)(E). Pub. L. 100-203, Sec. 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). Pub. L. 100-203, Sec. 4101(e)(4), substituted 
``July 1, 1987'' for ``April 17, 1986''.
    Subsec. (l)(4)(B)(ii). Pub. L. 100-203, Sec. 4101(b)(2)(A)(ii), 
substituted ``subparagraph (C)'' for ``subparagraph (C), (D), (E), or 
(F)''.
    Subsec. (l)(4)(C). Pub. L. 100-203, Sec. 4101(e)(5), added subpar. 
(C).
    Subsec. (m)(2)(A). Pub. L. 100-203, Sec. 4118(p)(8), struck out 
``nonfarm'' before ``official''.
    Subsec. (o). Pub. L. 100-203, Sec. 9115(b), as amended by Pub. L. 
100-360, Sec. 411(n)(2), substituted ``subparagraph (E) or (G) of 
section 1382(e)(1) of this title'' for ``section 1382(e)(1)(E) of this 
title''.
    Pub. L. 100-93, Sec. 7, redesignated subsec. (l), relating to 
disregarding certain benefits for purposes of determining post-
eligibility contributions, as (o).
    Subsec. (p). Pub. L. 100-93, Sec. 7, added subsec. (p).
    Subsec. (q). Pub. L. 100-203, Sec. 9119(d)(1)(B), as added by Pub. 
L. 100-360, Sec. 411(n)(4), formerly Sec. 411(n)(3), as redesignated by 
Pub. L. 100-485, Sec. 608(d)(28), added subsec. (q).
    1986--Subsec. (a). Pub. L. 99-509, Sec. 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 1396b(v) of this title.''
    Pub. L. 99-272, Sec. 9529(a)(1), inserted at end ``For purposes of 
this subchapter, any child who meets the requirements of paragraph (1) 
or (2) of section 673(b) of this title shall be deemed to be a dependent 
child as defined in section 606 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). Pub. L. 99-509, Sec. 9320(h)(3), substituted 
``paragraphs (12) and (13)'' for ``paragraphs (11) and (12)''.
    Subsec. (a)(10). Pub. L. 99-509, Sec. 9408(b), added cl. (IX) at 
end.
    Pub. L. 99-509, Sec. 9403(c), added cl. (VIII) at end.
    Pub. L. 99-509, Sec. 9401(c), added cl. (VII) at end.
    Pub. L. 99-272, Sec. 9505(b)(1), added cl. (VI) at end.
    Pub. L. 99-272, Sec. 9501(b), added cl. (V) at end.
    Subsec. (a)(10)(A)(i)(I). Pub. L. 99-272, Sec. 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). Pub. L. 99-509, Sec. 9404(a), inserted 
``or who are qualified severely impaired individuals (as defined in 
section 1396d(q) of this title)'' after ``subchapter XVI of this 
chapter''.
    Subsec. (a)(10)(A)(ii)(V). Pub. L. 99-272, Sec. 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). Pub. L. 99-514, Sec. 1895(c)(7)(A), 
realigned margin of subcl. (VII).
    Pub. L. 99-272, Sec. 9505(b)(2), added subcl. (VII).
    Subsec. (a)(10)(A)(ii)(VIII). Pub. L. 99-514, Sec. 1895(c)(7)(B), 
realigned margins of subcl. (VIII).
    Pub. L. 99-272, Sec. 9529(b)(1), added subcl. (VIII).
    Subsec. (a)(10)(A)(ii)(IX). Pub. L. 99-509, Sec. 9401(a), added 
subcl. (IX).
    Subsec. (a)(10)(A)(ii)(X). Pub. L. 99-509, Sec. 9402(a)(1), added 
subcl. (X).
    Subsec. (a)(10)(C). Pub. L. 99-509, Sec. 9403(g)(1), inserted ``or 
(E)'' after ``subparagraph (A)'' in introductory text.
    Subsec. (a)(10)(C)(iv). Pub. L. 99-509, Sec. 9408(c)(3), substituted 
``through (20)'' for ``through (19)''.
    Pub. L. 99-514, Sec. 1895(c)(3)(C), substituted ``through (19)'' for 
``through (18)''.
    Pub. L. 99-272, Sec. 9505(d)(2), substituted ``through (18)'' for 
``through (17)''.
    Subsec. (a)(10)(E). Pub. L. 99-509, Sec. 9403(a), added subpar. (E).
    Subsec. (a)(13)(B). Pub. L. 99-272, Sec. 9509(a)(1), substituted 
``hospitals'' for ``hospitals, skilled nursing facilities, and 
intermediate care facilities''.
    Subsec. (a)(13)(C). Pub. L. 99-272, Sec. 9509(a)(4), added subpar. 
(C). Former subpar. (C) redesignated (D).
    Pub. L. 99-272, Sec. 9505(c)(1), added subpar. (C). Former subpar. 
(C) redesignated (D).
    Subsec. (a)(13)(D). Pub. L. 99-514, Sec. 1895(c)(1), inserted 
``and'' after ``facility;''.
    Pub. L. 99-509, Sec. 9435(b)(1), inserted ``and for payment of 
amounts under section 1396d(o)(3) of this title'' before first 
semicolon.
    Pub. L. 99-272, Sec. 9509(a)(2), (3), redesignated former subpar. 
(C) as (D), and struck out ``and'' at the end thereof. Former subpar. 
(D) redesignated (E).
    Pub. L. 99-272, Sec. 9505(c)(1)(B), redesignated former subpar. (C) 
as (D).
    Subsec. (a)(13)(E). Pub. L. 99-272, Sec. 9509(a)(3), redesignated 
former subpar. (D) as (E).
    Subsec. (a)(15). Pub. L. 99-509, Sec. 9403(g)(4)(A), inserted ``are 
not qualified medicare beneficiaries (as defined in section 1396d(p)(1) 
of this title) but'' after ``older who''.
    Subsec. (a)(17). Pub. L. 99-509, Sec. 9401(e)(1), inserted ``except 
as provided in subsection (l)(3) of this section'' after ``(17)''.
    Subsec. (a)(25). Pub. L. 99-272, Sec. 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). Pub. L. 99-509, Sec. 9431(a), added subpar. (C).
    Subsec. (a)(47). Pub. L. 99-570 added par. (47) relating to cards 
evidencing eligibility for medical assistance.
    Pub. L. 99-509, Sec. 9407(a), added par. (47) relating to ambulatory 
prenatal care.
    Subsec. (b)(2). Pub. L. 99-509, Sec. 9405, inserted before semicolon 
``, regardless of whether or not the residence is maintained permanently 
or at a fixed address''.
    Subsec. (d). Pub. L. 99-509, Sec. 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). Pub. L. 99-272, Sec. 9517(b)(1), inserted 
reference to an entity described in section 1396b(m)(2)(G) of this 
title, and substituted ``such organization or entity'' for ``such 
organization''.
    Subsec. (e)(2)(B). Pub. L. 99-272, Sec. 9517(b)(2), substituted ``an 
organization or entity'' for ``a health maintenance organization'' and 
``the organization or entity'' for ``the organization''.
    Subsec. (e)(5). Pub. L. 99-272, Sec. 9501(c), added par. (5).
    Subsec. (e)(6), (7). Pub. L. 99-509, Sec. 9401(d), added pars. (6) 
and (7).
    Subsec. (e)(8). Pub. L. 99-509, Sec. 9403(f)(2), added par. (8).
    Subsec. (e)(9). Pub. L. 99-509, Sec. 9408(a), added par. (9).
    Subsec. (f). Pub. L. 99-643, Sec. 7(b), substituted ``subsection (e) 
of this section and section 1382h(b)(3) of this title'' for ``subsection 
(e) of this section''.
    Subsec. (g). Pub. L. 99-272, Sec. 9503(a)(2), added subsec. (g).
    Subsec. (h). Pub. L. 99-509, Sec. 9433(a), added subsec. (d) to 
section 2173 of Pub. L. 97-35 in turn which added subsec. (h) of this 
section. See 1981 Amendment note below.
    Subsec. (j). Pub. L. 99-509, Sec. 9408(c)(2), substituted ``(21)'' 
for ``(20)''.
    Pub. L. 99-514, Sec. 1895(c)(3)(B), substituted ``(20)'' for 
``(19)''.
    Pub. L. 99-272, Sec. 9505(d)(1), substituted ``(19)'' for ``(18)''.
    Subsec. (k). Pub. L. 99-272, Sec. 9506(a), added subsec. (k).
    Subsec. (l). Pub. L. 99-643, Sec. 3(b), added subsec. (l) relating 
to disregarding of certain benefits for purposes of determining post-
eligibility contributions.
    Pub. L. 99-509, Sec. 9401(b), added subsec. (l) relating to 
description of group.
    Subsec. (m). Pub. L. 99-509, Sec. 9402(a)(2), (b), added subsec. 
(m).
    Subsec. (m)(3). Pub. L. 99-509, Sec. 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). Pub. L. 99-509, Sec. 9403(f)(1)(B), added par. (5).
    Subsec. (n). Pub. L. 99-509, Sec. 9403(e), added subsec. (n).
    1984--Subsec. (a)(9)(C). Pub. L. 98-369, Sec. 2373(b)(1), realigned 
margin of subpar. (C).
    Subsec. (a)(10)(A). Pub. L. 98-369, Sec. 2373(b)(2), realigned 
margins of subpar. (A).
    Subsec. (a)(10)(A)(i). Pub. L. 98-369, Sec. 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 
606(g) of this title and individuals considered by the State to be 
receiving such aid as authorized under section 614(g) 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). Pub. L. 98-378, Sec. 20(c), substituted 
``section 602(a)(37) or 606(h) of this title'' for ``section 602(a)(37) 
of this title''.
    Subsec. (a)(13)(A). Pub. L. 98-369, Sec. 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 1396m of this title) of the hospital'', resulting in no 
change in text.
    Subsec. (a)(13)(B), (C). Pub. L. 98-369, Sec. 2314(b), added subpar. 
(B) and redesignated former subpar. (B) as (C).
    Subsec. (a)(20)(B). Pub. L. 98-369, Sec. 2373(b)(4), substituted 
``periodic'' for ``periodical''.
    Subsec. (a)(20)(C). Pub. L. 98-369, Sec. 2373(b)(5), struck out 
reference to section 803(a)(1)(A)(i) and (ii) of this title.
    Subsec. (a)(26). Pub. L. 98-369, Sec. 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). Pub. L. 98-617, Sec. 3(a)(7), repealed the 
amendment made by Pub. L. 98-369, Sec. 2373(b)(6). See below.
    Pub. L. 98-369, Sec. 2373(b)(6), provided that cl. (ii) is amended 
by substituting ``facilities'' for ``homes''.
    Subsec. (a)(26)(C). Pub. L. 98-617, Sec. 3(b)(10), realigned margin 
of subpar. (C).
    Subsec. (a)(28). Pub. L. 98-369, Sec. 2335(e), struck out ``and 
tuberculosis'' after ``mental diseases''.
    Subsec. (a)(30). Pub. L. 98-369, Sec. 2363(a)(1)(A), designated 
existing provisions as subpar. (A) and added subpar. (B).
    Subsec. (a)(31). Pub. L. 98-369, Sec. 2368(a), in amending par. (31) 
generally, revised existing provisions to cover review of skilled 
nursing facilities.
    Subsec. (a)(33)(A). Pub. L. 98-369, Sec. 2373(b)(7), substituted 
``second sentence'' for ``penultimate sentence''.
    Subsec. (a)(42). Pub. L. 98-369, Sec. 2373(b)(8), substituted 
``subchapter'' for ``part'' after ``audits conducted for purposes of 
such''.
    Subsec. (a)(43). Pub. L. 98-369, Sec. 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 1395u(h) of this 
title.
    Subsec. (a)(44). Pub. L. 98-369, Sec. 2363(a)(1)(B), added par. 
(44).
    Pub. L. 98-369, Sec. 2303(g)(1)(C), redesignated former par. (44) as 
(43).
    Subsec. (a)(45). Pub. L. 98-369, Sec. 2367(a), added par. (45).
    Subsec. (a)(46). Pub. L. 98-369, Sec. 2651(c), added par. (46).
    Subsec. (a), foll. par. (46). Pub. L. 98-369, Sec. 2373(b)(9), 
substituted ``The provisions of paragraph (9)(A), (31), and (33) and of 
section 1396b(i)(4) of this title shall not apply to'' for ``For 
purposes of paragraph (9)(A), (26), (31), and (33), and of section 
1396b(i)(4) of this title, the term `skilled nursing facility' and 
`nursing home' do not include''.
    Subsec. (e)(4). Pub. L. 98-369, Sec. 2362(a), added par. (4).
    Subsec. (f). Pub. L. 98-369, Sec. 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). Pub. L. 97-248, Sec. 137(b)(7), 
redesignated existing provisions as provisions preceding cl. (i) and cl. 
(i), and added cl. (ii).
    Subsec. (a)(10)(C), (D). Pub. L. 97-248, Sec. 137(a)(3), amended 
directory language of Pub. L. 97-35, Sec. 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). Pub. L. 97-248, Sec. 137(b)(8), substituted 
``, (II)'' for ``and (II)'', and added subcl. (III).
    Subsec. (a)(10)(C)(ii)(I). Pub. L. 97-248, Sec. 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 1396d(a)(i) of this 
title''.
    Subsec. (a)(10). Pub. L. 97-248, Sec. 131(c), formerly Sec. 131(b), 
as redesignated by Pub. L. 97-448, Sec. 309(a)(8), in provisions 
following subpar. (D) added cl. (IV).
    Subsec. (a)(14). Pub. L. 97-248, Sec. 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 1396o 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 1396d(a) 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). Pub. L. 97-248, Sec. 132(a), substituted provisions 
that a State plan for medical assistance must comply with the provisions 
of section 1396p 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 1382c 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). Pub. L. 97-248, Sec. 137(e), inserted ``, (26)'' after 
``(9)(A)'' in provisions following par. (44).
    Subsec. (b)(2) to (4). Pub. L. 97-248, Sec. 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). Pub. L. 97-248, Sec. 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). Pub. L. 97-248, Sec. 134(a), added par. (3).
    Subsec. (j). Pub. L. 97-248, Secs. 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 
1382b(c) 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). Pub. L. 97-35, Sec. 2175(d)(1)(C), added 
subpar. (C).
    Subsec. (a)(10)(A). Pub. L. 97-35, Sec. 2171(a)(1), substituted 
``including at least the care and services listed in paragraphs (1) 
through (5) and (17) of section 1396d(a) 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 
606(g) of this title and individuals considered by the State to be 
receiving such aid as authorized under section 614(g) 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). Pub. L. 97-35, Sec. 2171(a)(2), substituted 
reference to subparagraph for reference to clause in two places.
    Subsec. (a)(10)(C). Pub. L. 97-35, Sec. 2171(a)(3), as amended by 
Pub. L. 97-248, Sec. 137(a)(3), substituted provisions relating to plans 
for medical assistance included for any group of individuals described 
in section 1396d(a) 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). Pub. L. 97-35, Sec. 2171(a)(3), as amended by 
Pub. L. 97-248, Sec. 137(a)(3), added subpar. (D).
    Subsec. (a)(11). Pub. L. 97-35, Sec. 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). Pub. L. 97-35, Secs. 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 1395x(v)(1)(G) 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). Pub. L. 97-35, Secs. 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 1396d(a) of this title, 
and redesignated subpar. (F) as (B).
    Subsec. (a)(13)(C). Pub. L. 97-35, Sec. 2171(b), struck out subpar. 
(C) which provided for care and services of individuals not included in 
former subpar. (B).
    Subsec. (a)(13)(D). Pub. L. 97-35, Sec. 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). Pub. L. 97-35, Sec. 2173(a)(1)(C), 
redesignated subpars. (E) and (F) as (A) and (B), respectively.
    Subsec. (a)(20)(D). Pub. L. 97-35, Sec. 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). Pub. L. 97-35, Sec. 2175(a), substituted ``except 
as provided in section 1396n 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). Pub. L. 97-35, Sec. 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). Pub. L. 97-35, Sec. 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). Pub. L. 97-35, Sec. 2105(c), substituted ``person'' 
for ``individual'' in two places.
    Subsec. (a)(44). Pub. L. 97-35, Sec. 2181(a)(2)(C), added par. (44).
    Subsec. (b)(2). Pub. L. 97-35, Sec. 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 606(a)(2) of this title, be 
a dependent child under part A of subchapter IV of this chapter; or''.
    Subsec. (d). Pub. L. 97-35, Sec. 2113(m), added subsec. (d).
    Subsec. (e). Pub. L. 97-35, Sec. 2178(b), designated existing 
provisions as par. (1) and added par. (2).
    Subsec. (h). Pub. L. 97-35, Sec. 2173(b)(1), (d), as amended by Pub. 
L. 99-509, Sec. 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). Pub. L. 96-499, Sec. 965(b)(1), 
substituted ``paragraphs (1) through (5) and (17)'' for ``clauses (1) 
through (5)''.
    Subsec. (a)(13)(C)(i). Pub. L. 96-499, Sec. 965(b)(2), substituted 
``paragraphs (1) through (5) and (17)'' for ``clauses (1) through (5)''.
    Subsec. (a)(13)(C)(ii). Pub. L. 96-499, Sec. 965(b)(3), substituted 
``paragraphs numbered (1) through (17)'' for ``clauses numbered (1) 
through (16)''.
    Subsec. (a)(13)(D). Pub. L. 96-499, Sec. 902(b)(1), designated 
existing provisions as cl. (i) and added cl. (ii).
    Subsec. (a)(13)(D)(i). Pub. L. 96-499, Secs. 903(b), 905(a), 
inserted ``(except where the State agency is subject to an order under 
section 1396m 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 1395f(b)(3) 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). Pub. L. 96-499, Sec. 905(a), inserted ``(except 
where the State agency is subject to an order under section 1396m of 
this title)''.
    Pub. L. 96-499, Sec. 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). Pub. L. 96-499, Sec. 965(b)(4), substituted 
``paragraphs (1) through (5), (7), and (17)'' for ``clauses (1) through 
(5) and (7)''.
    Subsec. (a)(33)(B). Pub. L. 96-499, Sec. 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). Pub. L. 96-499, Sec. 912(b), substituted 
``disclosing entity (as defined in section 1320a-3(a)(2) of this 
title)'' for ``intermediate care facility''.
    Subsec. (a)(39). Pub. L. 96-499, Sec. 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 1320a-7 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). Pub. L. 96-272 added par. (41).
    Subsec. (a)(42). Pub. L. 96-499, Sec. 914(b)(1), added par. (42).
    Subsec. (a)(43). Pub. L. 96-499, Sec. 918(b)(1)(C), added par. (43).
    Subsec. (g). Pub. L. 96-499, Sec. 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). Pub. L. 96-499, Sec. 902(b)(2), added subsec. (h).
    Subsec. (i). Pub. L. 96-499, Sec. 916(b)(1)(A), added subsec. (i).
    Subsec. (j). Pub. L. 96-611 added subsec. (j).
    1978--Subsec. (a)(4)(C). Pub. L. 95-559 added cl. (C).
    1977--Subsec. (a)(13)(F). Pub. L. 95-210, Sec. 2(c)(1), added 
subpar. (F).
    Subsec. (a)(23). Pub. L. 95-210, Sec. 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). Pub. L. 95-142, Sec. 20(b), inserted provision 
relating to staff of skilled nursing facilities.
    Subsec. (a)(27)(B). Pub. L. 95-142, Sec. 9, inserted ``or the 
Secretary'' after ``State agency'' wherever appearing.
    Subsec. (a)(32). Pub. L. 95-142, Sec. 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). Pub. L. 95-142, Sec. 3(c)(1)(A), substituted 
provisions relating to requirements for intermediate care facilities to 
comply with section 1320a-3 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). Pub. L. 95-142, Secs. 2(b)(1)(C), 3(c)(1)(C), 
7(b)(1), added subsec. (a)(37) and made and struck out minor changes in 
phraseology, necessitating no changes in text.
    Subsec. (a)(38). Pub. L. 95-142, Secs. 3(c)(1)(D), 7(b)(2), 
19(b)(2)(A), added par. (38) and made and struck out minor changes in 
phraseology necessitating no changes in text.
    Subsec. (a)(39). Pub. L. 95-142, Secs. 7(b)(3), 19(b)(2)(B), added 
par. (39).
    Subsec. (a)(40). Pub. L. 95-142, Sec. 19(b)(2)(C), added par. (40).
    Subsec. (a), foll. par. (40). Pub. L. 95-142, Sec. 2(b)(1)(D), added 
paragraph relating to waiver of requirement of cl. (A) of par. (37).
    Subsec. (g). Pub. L. 95-142, Sec. 7(c), added subsec. (g).
    1976--Subsec. (g). Pub. L. 94-552 struck out provisions for consent 
to suit and waiver of immunity by State.
    1975--Subsec. (a). Pub. L. 94-48, Sec. 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 
Pub. L. 92-336 not been applicable to such individual.
    Subsec. (a)(23). Pub. L. 94-48, Sec. 2, inserted ``except in the 
case of Puerto Rico, the Virgin Islands, and Guam,''.
    Subsec. (g). Pub. L. 94-182 added subsec. (g).
    1974--Subsec. (a)(14)(B)(i). Pub. L. 93-368 substituted ``may'' for 
``shall''.
    1973--Subsec. (a)(5). Pub. L. 93-233, Sec. 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). Pub. L. 93-233, Sec. 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 1396(a) of this title in item (I), substituted 
``deductibles'' for ``the deductibles'' in item (II), and added item 
(III).
    Subsec. (a)(13)(B). Pub. L. 93-233, Sec. 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). Pub. L. 93-233, Sec. 18(x)(1), 
substituted reference to cl. ``16'' for ``14''.
    Subsec. (a)(14)(A). Pub. L. 93-233, Sec. 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). Pub. L. 93-233, Sec. 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). Pub. L. 93-233, Sec. 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 1382c 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). Pub. L. 93-233, Sec. 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 1382c 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). Pub. L. 93-233, Sec. 13(a)(9), inserted 
reference to section 803(a)(1)(A)(i) and (ii) of this title.
    Subsec. (a)(21), (24). Pub. L. 93-233, Sec. 18(x)(4), provided for 
substitution of ``nursing facilities'' for ``nursing homes''.
    Subsec. (a)(26)(B). Pub. L. 93-233, Sec. 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 Pub. L. 92-603, Sec. 278(a)(19).
    Subsec. (a)(33)(A). Pub. L. 93-233, Sec. 18(x)(2), substituted 
``penultimate sentence'' for ``last sentence''.
    Subsec. (a)(34). Pub. L. 93-233, Sec. 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). Pub. L. 93-233, Sec. 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). Pub. L. 93-233, Sec. 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). Pub. L. 93-233, Sec. 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). Pub. L. 93-233, Sec. 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 213 of Title 26'' 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). Pub. L. 92-603, Secs. 268(a), 278(b)(14), 
inserted provisions exempting Christian Science sanatoriums from certain 
nursing facility and nursing home requirements.
    Subsec. (a)(9). Pub. L. 92-603, Sec. 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). Pub. L. 92-603, Sec. 278(a)(18), 
(b)(14), substituted ``skilled nursing facility'' for ``skilled nursing 
home''.
    Subsec. (a)(13)(D). Pub. L. 92-603, Secs. 221(c)(5), 232(a), 
inserted provisions that the reasonable cost of inpatient hospital 
services shall not exceed the amount determined under section 1395x(v) 
of this title and inserted reference to the consistency of methods and 
standards with section 1320a-1 of this title for determining the 
reasonable cost of inpatient hospital services.
    Subsec. (a)(13)(E). Pub. L. 92-603, Sec. 249(a), added subpar. (E).
    Subsec. (a)(14). Pub. L. 92-603, Sec. 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 subchapter.
    Subsec. (a)(23). Pub. L. 92-603, Sec. 240, inserted provisions 
allowing States to adopt comprehensive health care programs while still 
complying with medicaid requirements.
    Subsec. (a)(26). Pub. L. 92-603, Secs. 274(a), 278(a)(19), (b)(14), 
substituted ``evaluation)'' for ``evaluation'' and ``care'' for 
``care)'' and substituted ``skilled nursing facility'' and ``skilled 
nursing facilities'' for ``skilled nursing home'' and ``skilled nursing 
homes''.
    Subsec. (a)(28). Pub. L. 92-603, Secs. 246(a), 278(a)(20), 
substituted ``skilled nursing facility'' for ``skilled nursing home'' 
and substituted a simple reference to the requirements contained in 
section 1395x(j) of this title with a specified exception for provisions 
spelling out in detail the requirements for skilled nursing homes 
receiving payments.
    Subsec. (a)(30). Pub. L. 92-603, Sec. 237(a)(2), substituted ``under 
the plan (including but not limited to utilization review plans as 
provided for in section 1396b(i)(4) of this title)'' for ``under the 
plan''.
    Subsec. (a)(31)(A). Pub. L. 92-603, Sec. 298, struck out ``which 
provides more than a minimum level of health care services'' after 
``intermediate care facility''.
    Subsec. (a)(32). Pub. L. 92-603, Sec. 236(b)(3), added par. (32).
    Subsec. (a)(33). Pub. L. 92-603, Sec. 239(b)(3), added par. (33).
    Subsec. (a)(34). Pub. L. 92-603, Sec. 255(a)(3), added par. (34).
    Subsec. (a)(35). Pub. L. 92-603, Sec. 299A(3), added par. (35).
    Subsec. (a)(37). Pub. L. 92-603, Sec. 299D(b)(3), added par. (37).
    Subsec. (d). Pub. L. 92-603, Sec. 231, repealed subsec. (d) which 
related to modification of state plans for medical assistance under 
certain circumstances.
    Subsec. (e). Pub. L. 92-603, Sec. 209(a), added subsec. (e).
    Subsec. (f). Pub. L. 92-603, Sec. 209(b)(1), added subsec. (f).
    1971--Subsec. (a)(31). Pub. L. 92-223 added par. (31).
    1969--Subsec. (c). Pub. L. 91-56, Sec. 2(c), substituted ``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)'' for ``aid or assistance (other than so much of the aid 
or assistance as is provided for under the plan of the State approved 
under this subchapter)''.
    Subsec. (d). Pub. L. 91-56, Sec. 2(d), added subsec. (d).
    1968--Subsec. (a)(2). Pub. L. 90-248, Sec. 231, changed the date on 
which State plans must meet certain financial participation requirements 
by substituting ``July 1, 1969'' for ``July 1, 1970''.
    Subsec. (a)(4). Pub. L. 90-248, Sec. 210(a)(6), designated existing 
provisions as subpar. (A) and added subpar. (B).
    Subsec. (a)(10). Pub. L. 90-248, Secs. 223(a), 241(f)(1), struck out 
``IV,'' after ``I,'' and inserted ``, and part A of subchapter IV of 
this chapter'' after ``XVI of this chapter'', and designated existing 
provisions as item I and added item II.
    Subsec. (a)(11). Pub. L. 90-248, Sec. 302(b), designated existing 
provisions as cl. (A) and added cl. (B).
    Subsec. (a)(13). Pub. L. 90-248, Sec. 224(a), designated existing 
provisions as subpar. (A), incorporated existing cl. (A) in provisions 
designated as subpars. (B) and (C)(i), making subpar. (B) and (C) 
applicable to individuals receiving aid or assistance under an approved 
State plan and to individuals not covered under subpar. (B), 
respectively, added cl. (ii) of subpar. (C), redesignated former cl. (B) 
as subpar. (D), and deleted effective date of July 1, 1967, for former 
cls. (A) and (B).
    Subsec. (a)(13)(A). Pub. L. 90-248, Sec. 224(c)(1), designated 
existing provisions as cl. (i) and added cl. (ii).
    Subsec. (a)(14)(A). Pub. L. 90-248, Sec. 235(a)(1), inserted ``in 
the case of individuals receiving aid or assistance under State plans 
approved under subchapters I, X, XIV, XVI, and part A of subchapter IV 
of this chapter,''.
    Subsec. (a)(14)(B). Pub. L. 90-248, Sec. 235(a)(2), inserted 
``inpatient hospital services or'' after ``respect to'' and substituted 
``to an individual'' for ``him''.
    Subsec. (a)(15). Pub. L. 90-248, Sec. 235(a)(3), struck out subpar. 
(B) provision for meeting the full cost of any deductible imposed with 
respect to any such individual under the insurance program established 
by part A of such subchapter, deleted subpar. (B) designation preceding 
``where, under the plan'', and substituted therein ``established by such 
subchapter'' for ``established by part B of such subchapter''.
    Subsec. (a)(17). Pub. L. 90-248, Sec. 238, inserted in parenthetical 
expression ``and may, in accordance with standards prescribed by the 
Secretary, differ with respect to income levels, but only in the case of 
applicants or recipients of assistance under the plan who are not 
receiving aid or assistance under the State's plan approved under 
subchapter I, X, XIV, or XVI of this chapter, or part A of subchapter IV 
of this chapter, based on the variations between shelter costs in urban 
areas and in rural areas'' after ``all groups''.
    Pub. L. 90-248, Sec. 241(f)(2), in cl. (B) struck out ``IV,'' after 
``I,'' and inserted ``, or part A of subchapter IV of this chapter'' 
after ``XVI of this chapter''.
    Subsec. (a)(23) to (30). Pub. L. 90-248, Secs. 227(a), 228(a), 
229(a), 234(a), 236(a), 237, added pars. (23), (24), (25), (26) to (28), 
(29), (30), respectively.
    Subsec. (b)(2). Pub. L. 90-248, Sec. 241(f)(3), inserted ``part A 
of'' before ``subchapter IV''.
    Subsec. (c). Pub. L. 90-248, Sec. 241(f)(4), struck out ``IV,'' 
after ``I,'' and inserted ``, or part A of subchapter IV of this 
chapter'' after ``XVI of this chapter''.


                    Effective Date of 1999 Amendments

    Pub. L. 106-170, title II, Sec. 201(d), Dec. 17, 1999, 113 Stat. 
1894, provided that: ``The amendments made by this section [amending 
this section and sections 1396b, 1396d, and 1396o of this title and 
enacting provisions set out as a note below] apply to medical assistance 
for items and services furnished on or after October 1, 2000.''
    Pub. L. 106-169, title II, Sec. 121(b), Dec. 14, 1999, 113 Stat. 
1830, provided that: ``The amendments made by subsection (a) [amending 
this section and section 1396d of this title] apply to medical 
assistance for items and services furnished on or after October 1, 
1999.''
    Amendment by section 205(c) of Pub. L. 106-169 effective Jan. 1, 
2000, and applicable to trusts established on or after such date, see 
section 205(d) of Pub. L. 106-169, set out as a note under section 1382a 
of this title.
    Amendment by section 206(b) of Pub. L. 106-169 effective with 
respect to disposals made on or after Dec. 14, 1999, see section 206(c) 
of Pub. L. 106-169, set out as a note under section 1382b of this title.
    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title VI, Sec. 603(a)(3)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-395, provided that: ``The 
amendments made by this subsection [amending this section and provisions 
set out as a note under this section] shall take effect as if included 
in the enactment of section 4712 of BBA (111 Stat. 508) [the Balanced 
Budget Act of 1997, Pub. L. 105-33].''
    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title VI, Sec. 604(c)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-395, provided that:
    ``(1) The amendment made by subsection (a)(1) [amending this 
section] applies to expenditures made on and after the date of the 
enactment of this Act [Nov. 29, 1999].
    ``(2) The amendments made by subsections (a)(2) and (b) [amending 
this section and section 1396b of this title] apply as of such date as 
the Secretary of Health and Human Services certifies to Congress that 
the Secretary is fully implementing section 1932(c)(2) of the Social 
Security Act (42 U.S.C. 1396u-2(c)(2)).''
    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title VI, Sec. 608(aa)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-398 provided that the amendment 
made by section 1000(a)(6) [title VI, Sec. 608(aa)(1)] is effective as 
if included in the enactment of BBA [the Balanced Budget Act of 1997, 
Pub. L. 105-33].
    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title VI, Sec. 608(bb)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-398, provided that: ``Except as 
otherwise provided, the amendments made by this section [amending this 
section and sections 1396b, 1396d, 1396g-1, 1396i, 1396n, 1396r, 1396r-
1, 1396r-1a, 1396r-4, 1396r-6, 1396r-8, 1396t, 1396u-2, and 1396u-3 of 
this title] shall take effect on the date of enactment of this Act [Nov. 
29, 1999].''


                    Effective Date of 1997 Amendments

    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 4454(b)(1) of Pub. L. 105-33 effective Aug. 5, 
1997, and applicable to items and services furnished on or after such 
date, with provision that Secretary of Health and Human Services issue 
regulations to carry out such amendment by not later than July 1, 1998, 
see section 4454(d) of Pub. L. 105-33, set out as an Effective Date note 
under section 1395i-5 of this title.
    Amendment by section 4701(b)(2)(A)(i)-(iv), (d)(1) of Pub. L. 105-33 
effective Aug. 5, 1997, and applicable to contracts entered into or 
renewed on Oct. 1, 1997, except as otherwise provided, see section 
4710(a) of Pub. L. 105-33, set out as a note under section 1396b of this 
title.
    Amendment by section 4702(b)(2) of Pub. L. 105-33 applicable to 
primary care case management services furnished on or after Oct. 1, 
1997, subject to provisions relating to extension of effective date for 
State law amendments, and to nonapplication to waivers, see section 
4710(b)(1) of Pub. L. 105-33, set out as a note under section 1396b of 
this title.
    Amendment by section 4709 of Pub. L. 105-33 effective Oct. 1, 1997, 
subject to provisions relating to extension of effective date for State 
law amendments, and to nonapplication to waivers, see section 4710(b)(7) 
of Pub. L. 105-33, set out as a note under section 1396b of this title.
    Section 4711(d) of Pub. L. 105-33 provided that: ``This section 
[amending this section and sections 1396d and 1396r-4 of this title] 
shall take effect on the date of the enactment of this Act [Aug. 5, 
1997] and the amendments made by subsections (a) and (c) [amending this 
section and sections 1396d and 1396r-4 of this title] shall apply to 
payment for items and services furnished on or after October 1, 1997.''
    Section 4712(b)(3) of Pub. L. 105-33 provided that: ``The amendments 
made by this subsection [amending this section and section 1396b of this 
title] shall apply to services furnished on or after October 1, 1997.''
    Pub. L. 105-33, title IV, Sec. 4712(c), Aug. 5, 1997, 111 Stat. 509, 
as amended by Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title VI, 
Sec. 603(a)(2)], Nov. 29, 1999, 113 Stat. 1536, 1501A-394, provided that 
the amendment made by section 4712(c) is effective for services 
furnished on or after Oct. 1, 2004.
    Section 4714(c) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section and sections 1395w-4, 
1395cc, 1396d of this title] shall apply to payment for (and with 
respect to provider agreements with respect to) items and services 
furnished on or after the date of the enactment of this Act [Aug. 5, 
1997]. The amendments made by subsection (a) [amending this section and 
section 1396d of this title] shall also apply to payment by a State for 
items and services furnished before such date if such payment is the 
subject of a law suit that is based on the provisions of sections 
1902(n) and 1905(p) of the Social Security Act [subsec. (n) of this 
section and section 1396d(p) of this title] and that is pending as of, 
or is initiated after, the date of the enactment of this Act.''
    Section 4715(b) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section] shall apply on and after 
October 1, 1997.''
    Section 4724(c)(2) of Pub. L. 105-33 provided that: ``The amendments 
made by paragraph (1) [amending this section] shall take effect on 
January 1, 1998.''
    Section 4724(g)(2) of Pub. L. 105-33 provided that: ``The amendments 
made by paragraph (1) [amending this section] shall apply to suppliers 
of medical assistance consisting of durable medical equipment furnished 
on or after January 1, 1998.''
    Section 4731(c) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section] shall apply to medical 
assistance for items and services furnished on or after October 1, 
1997.''
    Section 4741(c) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section and section 1396e of this 
title] shall take effect on the date of the enactment of this Act [Aug. 
5, 1997].''
    Section 4751(c) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section] take effect on the date of 
the enactment of this Act [Aug. 5, 1997].''
    Section 4752(b) of Pub. L. 105-33 provided that: ``The amendment 
made by subsection (a) [amending this section] takes effect on the date 
of the enactment of this Act [Aug. 5, 1997].''
    Section 4753(c) of Pub. L. 105-33 provided that: ``Except as 
otherwise specifically provided, the amendments made by this section 
[amending this section and section 1396b of this title] shall take 
effect on January 1, 1998.''
    Section 4911(c) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [amending this section and section 1396d of this 
title] shall apply to medical assistance for items and services 
furnished on or after October 1, 1997.''
    Section 4912(c) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [enacting section 1396r-1a and amending this 
section and section 1396b of this title] shall take effect on the date 
of the enactment of this Act [Aug. 5, 1997].''
    Section 4913(b) of Pub. L. 105-33 provided that: ``The amendment 
made by subsection (a) [amending this section] applies to medical 
assistance furnished on or after July 1, 1997.''
    Amendment by Pub. L. 105-12 effective Apr. 30, 1997, and applicable 
to Federal payments made pursuant to obligations incurred after Apr. 30, 
1997, for items and services provided on or after such date, subject to 
also being applicable with respect to contracts entered into, renewed, 
or extended after Apr. 30, 1997, as well as contracts entered into 
before Apr. 30, 1997, to the extent permitted under such contracts, see 
section 11 of Pub. L. 105-12, set out as an Effective Date note under 
section 14401 of this title.


                    Effective Date of 1996 Amendments

    Section 1(a)(2) of Pub. L. 104-248 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall be effective as if 
included in the enactment of the amendments made by section 4752(c)(1) 
of the Omnibus Budget Reconciliation Act of 1990 [Pub. L. 101-508].''
    Amendment by sections 108(k) and 114(b)-(d)(1), of Pub. L. 104-193 
effective July 1, 1997, with transition rules relating to State options 
to accelerate such date, rules relating to claims, actions, and 
proceedings commenced before such date, rules relating to closing out of 
accounts for terminated or substantially modified programs and 
continuance in office of Assistant Secretary for Family Support, and 
provisions relating to termination of entitlement under AFDC program, 
see section 116 of Pub. L. 104-193, as amended, set out as an Effective 
Date note under section 601 of this title.
    Section 913 of Pub. L. 104-193 provided that the amendment made by 
that section is effective Jan. 1, 1997.


                    Effective Date of 1994 Amendments

    Amendment by Pub. L. 103-448 effective Oct. 1, 1994, see section 401 
of Pub. L. 103-448, set out as a note under section 1755 of this title.
    Amendment by Pub. L. 103-296 effective Mar. 31, 1995, see section 
110(a) of Pub. L. 103-296, set out as a note under section 401 of this 
title.


                    Effective Date of 1993 Amendment

    Amendment by section 13581(b)(2) of Pub. L. 103-66 effective Jan. 1, 
1994, see section 13581(d) of Pub. L. 103-66, set out as a note under 
section 1395y of this title.
    Section 13601(c) of Pub. L. 103-66 provided that: ``The amendments 
made by subsections (a) and (b) [amending this section and section 1396d 
of this title] shall take effect as if included in the enactment of 
section 4721(a) of OBRA-1990 [Pub. L. 101-508].''
    Amendment by section 13602(c) of Pub. L. 103-66 applicable to 
calendar quarters beginning on or after Oct. 1, 1993, without regard to 
whether or not regulations to carry out the amendments by section 
13602(a)(1) and (c) of Pub. L. 103-66 have been promulgated by such 
date, see section 13602(d)(2) of Pub. L. 103-66, set out as a note under 
section 1396r-8 of this title.
    Section 13603(f) of Pub. L. 103-66 provided that: ``The amendments 
made by this section [amending this section and sections 1396d and 1396n 
of this title] shall apply to medical assistance furnished on or after 
January 1, 1994, without regard to whether or not final regulations to 
carry out such amendments have been promulgated by such date.''
    Amendment by section 13611(d)(1) of Pub. L. 103-66 applicable, 
except as otherwise provided, to payments under this subchapter for 
calendar quarters beginning on or after Oct. 1, 1993, without regard to 
whether or not final regulations to carry out the amendments by section 
13611 of Pub. L. 103-66 have been promulgated by such date, see section 
13611(e) of Pub. L. 103-66, set out as a note under section 1396p of 
this title.
    Section 13622(d) of Pub. L. 103-66 provided that:
    ``(1) Except as provided in paragraph (2), the amendments made by 
subsections (a)(1), (b), and (c) [amending this section] shall apply to 
calendar quarters beginning on or after October 1, 1993, without regard 
to whether or not final regulations to carry out such amendments have 
been promulgated by such date.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [this subchapter] which the Secretary of 
Health and Human Services determines requires State legislation (other 
than legislation appropriating funds) in order for the plan to meet the 
additional requirements imposed by the amendments made by subsections 
(a) and (b) [amending this section and section 1396b of this title], the 
State plan shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its failure to meet 
these additional requirements before the first day of the first calendar 
quarter beginning after the close of the first regular session of the 
State legislature that begins after the date of the enactment of this 
Act [Aug. 10, 1993]. For purposes of the preceding sentence, in the case 
of a State that has a 2-year legislative session, each year of such 
session shall be deemed to be a separate regular session of the State 
legislature.
    ``(3) The amendment made by subsection (a)(2) [amending section 
1396b of this title] shall apply to items and services furnished on or 
after October 1, 1993.''
    Amendment by section 13623(a) of Pub. L. 103-66 applicable, except 
as otherwise provided, to calendar quarters beginning on or after Apr. 
1, 1994, without regard to whether or not final regulations to carry out 
the amendments by section 13623 of Pub. L. 103-66 have been promulgated 
by such date, see section 13623(c) of Pub. L. 103-66, set out as an 
Effective Date note under section 1396g-1 of this title.
    Section 13625(b) of Pub. L. 103-66 provided that: ``Section 
1902(a)(61) of the Social Security Act [subsec. (a)(61) of this section] 
(as added by subsection (a)) shall take effect January 1, 1995, and the 
standards referred to in such section shall be established not later 
than March 31, 1994.''
    Section 13631(e)(2) of Pub. L. 103-66 provided that: ``The 
amendments made by paragraph (1) [amending this section] shall take 
effect on the date of the enactment of this Act [Aug. 10, 1993].''
    Section 13631(f)(3) of Pub. L. 103-66 provided that:
    ``(A) Except as provided in subparagraph (B), the amendments made by 
this subsection [amending this section and section 1396d of this title] 
shall apply to calendar quarters beginning on or after October 1, 1993, 
without regard to whether or not final regulations to carry out such 
amendments have been promulgated by such date.
    ``(B) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [this subchapter] which the Secretary of 
Health and Human Services determines requires State legislation (other 
than legislation appropriating funds) in order for the plan to meet the 
additional requirements imposed by the amendments made by this 
subsection, the State plan shall not be regarded as failing to comply 
with the requirements of such title solely on the basis of its failure 
to meet these additional requirements before the first day of the first 
calendar quarter beginning after the close of the first regular session 
of the State legislature that begins after the date of the enactment of 
this Act [Aug. 10, 1993]. For purposes of the previous sentence, in the 
case of a State that has a 2-year legislative session, each year of such 
session shall be deemed to be a separate regular session of the State 
legislature.''
    Section 13631(i) of Pub. L. 103-66 provided that: ``Except as 
otherwise provided in this section, the amendments made by this section 
[enacting section 1396s of this title, transferring former section 1396s 
of this title to section 1396v of this title, and amending this section 
and sections 1396b and 1396d of this title] shall apply to payments 
under State plans approved under title XIX of the Social Security Act 
[this subchapter] for calendar quarters beginning on or after October 1, 
1994.''


                    Effective Date of 1991 Amendment

    Section 2(c)(1) of Pub. L. 102-234 provided that: ``The amendments 
made by this section [amending this section and section 1396b of this 
title] shall take effect January 1, 1992, without regard to whether or 
not regulations have been promulgated to carry out such amendments by 
such date.''
    Section 3(e)(1) of Pub. L. 102-234 provided that: ``The amendments 
made by this section [amending this section and sections 1396b and 
1396r-4 of this title] shall take effect January 1, 1992.''


                    Effective Date of 1990 Amendment

    Section 4402(e) of Pub. L. 101-508 provided that:
    ``(1) The amendments made by this section [enacting section 1396e of 
this title and amending this section and sections 1396b and 1396d of 
this title] apply (except as provided under paragraph (2)) to payments 
under title XIX of the Social Security Act [this subchapter] for 
calendar quarters beginning on or after January 1, 1991, without regard 
to whether or not final regulations to carry out such amendments have 
been promulgated by such date.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
authorizing or appropriating funds) in order for the plan to meet the 
additional requirements imposed by the amendments made by subsection (a) 
[enacting section 1396e of this title and amending this section], the 
State plan shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its failure to meet 
this additional requirement before the first day of the first calendar 
quarter beginning after the close of the first regular session of the 
State legislature that begins after the date of the enactment of this 
Act [Nov. 5, 1990]. For purposes of the previous sentence, in the case 
of a State that has a 2-year legislative session, each year of such 
session shall be deemed to be a separate regular session of the State 
legislature.''
    Section 4501(f) of Pub. L. 101-508 provided that: ``The amendments 
made by this section [amending this section and sections 1395v and 1396d 
of this title] shall apply to calendar quarters beginning on or after 
January 1, 1991, without regard to whether or not regulations to 
implement such amendments are promulgated by such date; except that the 
amendments made by subsection (e) [amending this section and section 
1396d of this title] shall apply to determinations of income for months 
beginning with January 1991.''
    Section 4601(b) of Pub. L. 101-508 provided that:
    ``(1) The amendments made by this subsection [probably should be 
``section'', which amended this section and sections 1396b, 1396d, and 
1396r-6 of this title] apply (except as otherwise provided in this 
subsection) to payments under title XIX of the Social Security Act [this 
subchapter] for calendar quarters beginning on or after July 1, 1991, 
without regard to whether or not final regulations to carry out such 
amendments have been promulgated by such date.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
authorizing or appropriating funds) in order for the plan to meet the 
additional requirements imposed by the amendments made by this 
subsection [section], the State plan shall not be regarded as failing to 
comply with the requirements of such title solely on the basis of its 
failure to meet these additional requirements before the first day of 
the first calendar quarter beginning after the close of the first 
regular session of the State legislature that begins after the date of 
the enactment of this Act [Nov. 5, 1990]. For purposes of the previous 
sentence, in the case of a State that has a 2-year legislative session, 
each year of such session shall be deemed to be a separate regular 
session of the State legislature.''
    Section 4602(b) of Pub. L. 101-508 provided that: ``The amendments 
made by subsection (a) [amending this section] apply to payments under 
title XIX of the Social Security Act [this subchapter] for calenar [sic] 
quarters beginning on or after July 1, 1991, without regard to whether 
or not final regulations to carry out such amendments have been 
promulgated by such date.''
    Section 4603(b) of Pub. L. 101-508 provided that:
    ``(1) Infants.--The amendment made by subsection (a)(1) [amending 
this section] shall apply to individuals born on or after January 1, 
1991, without regard to whether or not final regulations to carry out 
such amendment have been promulgated by such date.
    ``(2) Pregnant women.--The amendments made by subsection (a)(2) 
[amending this section] shall apply with respect to determinations to 
terminate the eligibility of women, based on change of income, made on 
or after January 1, 1991, without regard to whether or not final 
regulations to carry out such amendments have been promulgated by such 
date.''
    Section 4604(d) of Pub. L. 101-508 provided that:
    ``(1) The amendments made by this subsection [probably should be 
``section'', which amended this section and section 1396n of this title] 
shall become effective with respect to payments under title XIX of the 
Social Security Act [this subchapter] for calendar quarters beginning on 
or after July 1, 1991, without regard to whether or not final 
regulations to carry out such amendments have been promulgated by such 
date.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
authorizing or appropriating funds) in order for the plan to meet the 
additional requirements imposed by the amendments made by this 
subsection [section], the State plan shall not be regarded as failing to 
comply with the requirements of such title solely on the basis of its 
failure to meet these additional requirements before the first day of 
the first calendar quarter beginning after the close of the first 
regular session of the State legislature that begins after the date of 
the enactment of this Act [Nov. 5, 1990]. For purposes of the previous 
sentence, in the case of a State that has a 2-year legislative session, 
each year of such session shall be deemed to be a separate regular 
session of the State legislature.''
    Amendment by section 4701(b)(1) of Pub. L. 101-508 effective Jan. 1, 
1991, see section 4701(c) of Pub. L. 101-508, set out as a note under 
section 1396b of this title.
    Section 4704(f) of Pub. L. 101-508 provided that: ``The amendments 
made by this section [amending this section and sections 1396b, 1396d, 
and 1396n of this title] shall be effective as if included in the 
enactment of the Omnibus Budget Reconciliation Act of 1989 [Pub. L. 101-
239].''
    Section 4708(b) of Pub. L. 101-508 provided that: ``The amendments 
made by this section [amending this section] shall apply to services 
furnished on or after the date of the enactment of this Act [Nov. 5, 
1990].''
    Section 4711(e) of Pub. L. 101-508 provided that:
    ``(1) Except as provided in this subsection, the amendments made by 
this section [enacting section 1396t of this title and amending this 
section and sections 1396b and 1396d of this title] shall apply to home 
and community care furnished on or after July 1, 1991, without regard to 
whether or not final regulations to carry out such amendments have been 
promulgated by such date.
    ``(2)(A) The amendments made by subsection (c)(1) [amending this 
section] shall apply to home and community care furnished on or after 
July 1, 1991, or, if later, 30 days after the date of publication of 
interim regulations under section 1929(k)(1) [section 1396t(k)(1) of 
this title].
    ``(B) The amendment made by subsection (c)(2) [amending section 
1396b of this title] shall apply to civil money penalties imposed after 
the date of the enactment of this Act [Nov. 5, 1990].''
    Section 4713(c) of Pub. L. 101-508 provided that: ``The amendments 
made by this section [amending this section and section 1396d of this 
title] shall apply to medical assistance furnished on or after January 
1, 1991.''
    Section 4715(b) of Pub. L. 101-508 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to treatment 
of income for months beginning more than 30 days after the date of the 
enactment of this Act [Nov. 5, 1990].''
    Section 4732(e) of Pub. L. 101-508 provided that: ``The amendments 
made by this section [amending this section and section 1396b of this 
title] shall take effect on the date of the enactment of this Act [Nov. 
5, 1990].''
    Section 4751(c) of Pub. L. 101-508 provided that: ``The amendments 
made by this section [amending this section and sections 1396b and 1396r 
of this title] shall apply with respect to services furnished on or 
after the first day of the first month beginning more than 1 year after 
the date of the enactment of this Act [Nov. 5, 1990].''
    Section 4752(c)(2) of Pub. L. 101-508 provided that: ``The 
amendments made by paragraph (1) [amending this section] shall apply to 
medical assistance for calendar quarters beginning more than 60 days 
after the date of establishment of the physician identifier system under 
section 1902(x) of the Social Security Act [subsec. (x) of this 
section].''
    Section 4754(b) of Pub. L. 101-508 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to sanctions 
effected more than 60 days after the date of the enactment of this Act 
[Nov. 5, 1990].''
    Section 4755(c)(1) of Pub. L. 101-508 provided that the amendment 
made by that section is effective July 1, 1990.
    Section 4801(e)(11) of Pub. L. 101-508 provided that the amendment 
made by that section is effective on the date on which the Secretary 
promulgates standards regarding the qualifications of nursing facility 
administrators under section 1396r(f)(4) of this title.
    Section 4801(e)(19) of Pub. L. 101-508 provided that: ``Except as 
provided in paragraphs (7), (11), and (16), the amendments made by this 
subsection [amending this section and sections 1396b and 1396r of this 
title, repealing section 1396g of this title, and amending provisions 
set out as a note under this section] shall take effect as if they were 
included in the enactment of the Omnibus Budget Reconciliation Act of 
1987 [Pub. L. 100-203].''


                    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.
    Section 6401(c) of Pub. L. 101-239 provided that:
    ``(1) Except as provided in paragraph (2), the amendments made by 
this section [amending this section and section 1396b of this title] 
shall apply to payments under title XIX of the Social Security Act [this 
subchapter] for calendar quarters beginning on or after April 1, 1990, 
with respect to eligibility for medical assistance on or after such 
date, without regard to whether or not final regulations to carry out 
such amendments have been promulgated by such date.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirements imposed by the amendments made by this section, the State 
plan shall not be regarded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet these additional 
requirements before the first day of the first calendar quarter 
beginning after the close of the first regular session of the State 
legislature that begins after the date of the enactment of this Act 
[Dec. 19, 1989]. For purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year of such session 
shall be deemed to be a separate regular session of the State 
legislature.''
    Section 6402(c), formerly Sec. 6402(d), of Pub. L. 101-239, as 
renumbered and amended by Pub. L. 101-508, title IV, Sec. 4704(e)(2), 
Nov. 5, 1990, 104 Stat. 1388-172, provided that: ``The amendments made 
by this section [enacting section 1396r-7 of this title and amending 
this section] (except as otherwise provided in such amendments) shall 
take effect on the date of the enactment of this Act [Dec. 19, 1989].''
    Section 6403(e) of Pub. L. 101-239 provided that: ``The amendments 
made by this section [amending this section and section 1396d of this 
title] shall take effect on April 1, 1990, without regard to whether or 
not final regulations to carry out such amendments have been promulgated 
by such date.''
    Section 6404(d) of Pub. L. 101-239 provided that:
    ``(1) The amendments made by this section [amending this section and 
section 1396d of this title] apply (except as provided under paragraph 
(2)) to payments under title XIX of the Social Security Act [this 
subchapter] for calendar quarters beginning on or after April 1, 1990, 
without regard to whether or not final regulations to carry out such 
amendments have been promulgated by such date.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirements imposed by the amendments made by this section, the State 
plan shall not be regarded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet these additional 
requirements before the first day of the first calendar quarter 
beginning after the close of the first regular session of the State 
legislature that begins after the date of the enactment of this Act 
[Dec. 19, 1989]. For purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year of such session 
shall be deemed to be a separate regular session of the State 
legislature.''
    Section 6405(c) of Pub. L. 101-239 provided that: ``The amendments 
made by this section [amending this section and section 1396d of this 
title] shall become effective with respect to services furnished by a 
certified pediatric nurse practitioner or certified family nurse 
practitioner on or after July 1, 1990.''
    Section 6406(b) of Pub. L. 101-239 provided that: ``The amendments 
made by subsection (a) [amending this section] shall take effect on July 
1, 1990, without regard to whether regulations to carry out such 
amendments have been promulgated by such date.''
    Section 6408(c)(2) of Pub. L. 101-239 provided that: ``The 
amendments made by paragraph (1) [amending this section] shall apply to 
services furnished on or after April 1, 1990, without regard to whether 
or not final regulations have been promulgated by such date to implement 
such amendments.''
    Section 6408(d)(5) of Pub. L. 101-239 provided that:
    ``(A) The amendments made by this subsection [amending this section 
and sections 1396d and 1396o of this title] apply (except as provided 
under subparagraph (B)) to payments under title XIX of the Social 
Security Act [this subchapter] for calendar quarters beginning on or 
after July 1, 1990, without regard to whether or not final regulations 
to carry out such amendments have been promulgated by such date.
    ``(B) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirements imposed by the amendments made by this subsection, the 
State plan shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its failure to meet 
these additional requirements before the first day of the first calendar 
quarter beginning after the close of the first regular session of the 
State legislature that begins after the date of the enactment of this 
Act [Dec. 19, 1989]. For purposes of the previous sentence, in the case 
of a State that has a 2-year legislative session, each year of such 
session shall be deemed to be a separate regular session of the State 
legislature.''
    Section 6411(a)(2) of Pub. L. 101-239 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall apply as if it had 
been included in the enactment of the Medicare Catastrophic Coverage Act 
of 1988 [Pub. L. 100-360].''
    Amendment by section 6411(d)(3)(B) of Pub. L. 101-239 applicable to 
employment and contracts as of 90 days after Dec. 19, 1989, see section 
6411(d)(4)(B) of Pub. L. 101-239, set out as a note under section 1395mm 
of this title.
    Section 6411(e)(4) of Pub. L. 101-239 provided that:
    ``(A) Spousal transfers.--The amendments made by paragraph (1) 
[amending section 1396p of this title] shall apply to transfers 
occurring after the date of the enactment of this Act [Dec. 19, 1989].
    ``(B) Other amendments.--Except as provided in subparagraph (A), the 
amendments made by this subsection [amending this section and sections 
1396p and 1396r-5 of this title] shall apply as if included in the 
enactment of section 303 of the Medicare Catastrophic Coverage Act of 
1988 [Pub. L. 100-360].''
    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

    Section 8434(c) of Pub. L. 100-647 provided that: ``The amendment 
made by this section [amending this section and section 1396d of this 
title] shall be effective as if included in the enactment of section 301 
of the Medicare Catastrophic Coverage Act of 1988 [Pub. L. 100-360].''
    Amendment by section 202(c)(4) of Pub. L. 100-485 effective Oct. 1, 
1990, with provision for earlier effective dates in case of States 
making certain changes in their State plans and formally notifying the 
Secretary of Health and Human Services of their desire to become subject 
to the amendments by title II of Pub. L. 100-485 at such earlier 
effective dates, see section 204(a), (b)(1)(A) of Pub. L. 100-485, set 
out as a note under section 671 of this title.
    Section 303(f) of Pub. L. 100-485, as amended by Pub. L. 101-239, 
title VI, Sec. 6411(i)(2), Dec. 19, 1989, 103 Stat. 2273; Pub. L. 104-
193, title I, Sec. 110(q), Aug. 22, 1996, 110 Stat. 2175, provided that:
    ``(1) The amendments made by this section [enacting section 1396r-6 
of this title, amending this section and section 1396d of this title] 
(other than subsections (b)(3), (d), and (e) [amending this section and 
section 602 of this title and provisions formerly set out as a note 
under section 606 of this title]) shall apply to payments under title 
XIX of the Social Security Act [this subchapter] for calendar quarters 
beginning on or after April 1, 1990 (or, in the case of the Commonwealth 
of Kentucky, October 1, 1990) (without regard to whether regulations to 
implement such amendments are promulgated by such date), with respect to 
families that cease to be eligible for aid under part A of title IV of 
the Social Security Act [part A of subchapter IV of this chapter] on or 
after such date.
    ``(2) The amendment made by subsection (b)(3) [amending section 602 
of this title] shall become effective on April 1, 1990, but such 
amendment shall not apply with respect to families that cease to be 
eligible for aid under part A of title IV of the Social Security Act 
before such date.
    ``(3) The amendment made by subsection (d) [amending this section] 
shall become effective on the effective date of section 402(a)(43) of 
the Social Security Act, as inserted by section 403(a) of this Act [the 
first day of the first calendar quarter to begin one year or more after 
Oct. 13, 1988, see section 403(b) of Pub. L. 100-485, 102 Stat. 2398].
    ``(4) The amendment made by subsection (e) [amending provisions 
formerly set out as a note under section 606 of this title] shall take 
effect on October 1, 1988.''
    Section 401(g) of Pub. L. 100-485, as amended by Pub. L. 103-432, 
title II, Sec. 234(a), Oct. 31, 1994, 108 Stat. 4466, provided that:
    ``(1) Except as provided in paragraph (2), and in section 1905(m)(2) 
of the Social Security Act [section 1396d(m)(2) of this title] (as added 
by subsection (d)(2) of this section), the amendments made by this 
section [amending this section and sections 602, 607, and 1396d of this 
title] shall become effective on October 1, 1990.
    ``(2) The amendments made by this section shall not become effective 
with respect to Puerto Rico, American Samoa, Guam, or the Virgin 
Islands, until the date of the repeal of the limitations contained in 
section 1108(a) of the Social Security Act [section 1308(a) of this 
title] on payments to such jurisdictions for purposes of making 
maintenance payments under parts A and E of title IV of such Act [parts 
A and E of subchapter IV of this chapter].''
    [Section 234(b) of Pub. L. 103-432 provided that: ``The amendment 
made by subsection (a) [amending section 401(g)(2) of Pub. L. 100-485, 
set out above] shall take effect as if included in the provision of the 
Family Support Act of 1988 [Pub. L. 100-485] to which the amendment 
relates at the time such provision became law.'']
    Amendment by section 608(d)(14)(I), (15)(A), (B), (16)(C), (27)(F)-
(H), (28) of Pub. L. 100-485 effective as if included in the enactment 
of the Medicare Catastrophic Coverage Act of 1988, Pub. L. 100-360, see 
section 608(g)(1) of Pub. L. 100-485, set out as a note under section 
704 of this title.
    Amendment by section 204(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.
    Amendment by section 301(e)(2) of Pub. L. 100-360 effective July 1, 
1989, see section 301(e)(3) of Pub. L. 100-360, set out as a note under 
section 1395v of this title.
    Section 301(h) of Pub. L. 100-360, as amended by Pub. L. 100-485, 
title VI, Sec. 608(d)(14)(K), Oct. 13, 1988, 102 Stat. 2416, provided 
that:
    ``(1) The amendments made by this section [amending this section and 
sections 1395v, 1396b, and 1396d of this title] apply (except as 
provided in subsections (e) and (f) [set out as notes under section 
1395v and 1396b of this title] and under paragraph (2)) to payments 
under title XIX of the Social Security Act [this subchapter] for 
calendar quarters beginning on or after January 1, 1989, without regard 
to whether or not final regulations to carry out such amendments have 
been promulgated by such date, with respect to medical assistance for--
        ``(A) monthly premiums under title XVIII of such Act [subchapter 
    XVIII of this chapter] for months beginning with January 1989, and
        ``(B) items and services furnished on and after January 1, 1989.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [this subchapter] which the Secretary of 
Health and Human Services determines requires State legislation (other 
than legislation appropriating funds) in order for the plan to meet the 
additional requirements imposed by the amendments made by this section, 
the State plan shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its failure to meet 
these additional requirements before the first day of the first calendar 
quarter beginning after the close of the first session of the State 
legislature that begins after the date of the enactment of this Act 
[July 1, 1988]. For purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year of such session 
shall be deemed to be a separate regular session of the State 
legislature.''
    Section 302(f) of Pub. L. 100-360 provided that:
    ``(1) In general.--The amendments made by this section [amending 
this section and sections 1396b and 1396r-4 of this title] apply (except 
as provided in this subsection) to payments under title XIX of the 
Social Security Act [this subchapter] for calendar quarters beginning on 
or after July 1, 1989, with respect to eligibility for medical 
assistance on or after such date, without regard to whether or not final 
regulations to carry out such amendments have been promulgated by such 
date.
    ``(2) Payment adjustment.--The amendments made by subsection (b)(2) 
[amending section 1396r-4 of this title] shall take effect on the date 
of the enactment of this Act [July 1, 1988].
    ``(3) Delay for state legislation.--In the case of a State plan for 
medical assistance under title XIX of the Social Security Act [this 
subchapter] which the Secretary of Health and Human Services determines 
requires State legislation (other than legislation appropriating funds) 
in order for the plan to meet the additional requirements imposed by the 
amendments made by this section (other than subsection (b)(2)), the 
State plan shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its failure to meet 
these additional requirements before the first day of the first calendar 
quarter beginning after the close of the first regular session of the 
State legislature that begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in the case of a State that 
has a regular legislative session of 2 years, each year of such session 
shall be deemed to be a separate regular session of the State 
legislature.''
    Amendment by section 303(d) of Pub. L. 100-360 effective on and 
after Apr. 8, 1988, with additional provision for supersedure of certain 
administrative regulations, see section 303(g)(4) of Pub. L. 100-360, 
set out as an Effective Date note under section 1396r-5 of this title.
    Amendment by section 303(e)(1), (5) of Pub. L. 100-360 applicable to 
medical assistance furnished on or after Oct. 1, 1982, see section 
303(g)(6) of Pub. L. 100-360, set out as an Effective Date note under 
section 1396r-5 of this title.
    Subsec. (a)(51)(A), as enacted by section 303(e)(2)-(4) of Pub. L. 
100-360, applicable to payments under this subchapter for calendar 
quarters beginning on or after Sept. 30, 1989, without regard to whether 
or not final regulations to carry out that paragraph have been 
promulgated by that date, see section 303(g)(1)(A) of Pub. L. 100-360, 
set out as an Effective Date note under section 1396r-5 of this title.
    Subsec. (a)(51)(B), as enacted by section 303(e)(2)-(4) of Pub. L. 
100-360, applicable to payments under this subchapter for calendar 
quarters beginning on or after July 1, 1988 (except in certain 
situations requiring State legislative action), without regard to 
whether or not final regulations to carry out that paragraph have been 
promulgated by that date, with an exception for resources disposed of 
before July 1, 1988, see section 303(g)(2)(A), (C), (5) of Pub. L. 100-
360, set out as an Effective Date note under section 1396r-5 of this 
title.
    Except as specifically provided in section 411 of Pub. L. 100-360, 
amendment by section 411(k)(5), (7)(B)-(D), (10)(G)(ii), (iv), (17)(B), 
(l)(3)(E), (H), (J), (6)(C), (D), (8)(C), and (n)(2), (4) 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 Amendments

    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.
    Section 4101(a)(3) of Pub. L. 100-203 provided that: ``The 
amendments made by this subsection [amending this section] shall apply 
to medical assistance furnished on or after July 1, 1988.''
    Section 4101(b)(3) of Pub. L. 100-203 provided that: ``The 
amendments made by this subsection [amending this section and provisions 
set out below] shall apply with respect to medical assistance furnished 
on or after July 1, 1988.''
    Amendment by section 4101(c)(2) of Pub. L. 100-203 applicable to 
medical assistance furnished on or after Oct. 1, 1988, see section 
4101(c)(3) of Pub. L. 100-203, set out as a note under section 1396d of 
this title.
    Section 4101(e)(6) of Pub. L. 100-203 provided that:
    ``(A) The amendment made by paragraph (1) [amending this section] 
shall become effective on the date of enactment of this Act [Dec. 22, 
1987].
    ``(B) The amendments made by paragraphs (2) and (3) [amending this 
section] shall be effective as if they had been included in the 
enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985 
[Pub. L. 99-272].
    ``(C) The amendment made by paragraph (4) [amending this section] 
shall apply to elections made on or after the enactment of this Act.
    ``(D) The amendment made by paragraph (5) [amending this section] 
shall apply as if included in the enactment of section 9401 of the 
Omnibus Budget Reconciliation Act of 1986 [Pub. L. 99-509].''
    Section 4113(c)(3) of Pub. L. 100-203 provided that: ``The 
amendments made by this subsection [amending this section] shall apply 
to services furnished on and after July 1, 1988.''
    Section 4118(c)(2) of Pub. L. 100-203 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall be effective as if 
it were included in section 134 of the Tax Equity and Fiscal 
Responsibility Act of 1982 [Pub. L. 97-248].''
    Section 4118(h)(3), formerly Sec. 4118(h)(2), of Pub. L. 100-203, as 
renumbered and amended by Pub. L. 100-360, title IV, 
Sec. 411(k)(10)(G)(iii), July 1, 1988, 102 Stat. 796, provided that: 
``The amendments made by this subsection [amending this section and 
section 1396b of this title] shall apply to costs incurred after the 
date of the enactment of this Act [Dec. 22, 1987].''
    Section 4118(m)(2) of Pub. L. 100-203 provided that: ``The 
amendments made by paragraph (1) [amending this section and repealing 
section 1320a-8 of this title] shall apply to audits conducted after the 
date of the enactment of this Act [Dec. 22, 1987].''
    Amendments by sections 4211(b)(1), (h)(1)-(5), 4212(d)(2), (3), 
(e)(1) of Pub. L. 100-203 applicable to nursing facility services 
furnished on or after Oct. 1, 1990, without regard to whether 
regulations implementing such amendments are promulgated by such date, 
except as otherwise specifically provided in section 1396r of this 
title, and except that subsec. (a)(28)(B) of this section as amended by 
section 4211(b) of Pub. L. 100-203 applicable to calendar quarters 
beginning more than 6 months after Dec. 22, 1987, with transitional 
rule, see section 4214(a), (b)(2) of Pub. L. 100-203, as amended, set 
out as an Effective Date note under section 1396r of this title.
    Section 4212(d)(4) of Pub. L. 100-203 provided that: ``The 
amendments made by this subsection [amending this section and section 
1396b of this title] shall not apply to a State until such date (not 
earlier than October 1, 1990) as of which the Secretary determines 
that--
        ``(A) the State has specified the resident assessment instrument 
    under section 1919(e)(5) of the Social Security Act [section 
    1396r(e)(5) of this title], and
        ``(B) the State has begun conducting surveys under section 
    1919(g)(2) of such Act.''
    Amendment by section 4213(b)(1) of Pub. L. 100-203 applicable to 
payments under this subchapter for calendar quarters beginning on or 
after Dec. 22, 1987, without regard to whether regulations implementing 
such amendments are promulgated by such date, except as otherwise 
specifically provided in section 1396r of this title, with transitional 
rule, see section 4214(b) of Pub. L. 100-203, as amended, set out as an 
Effective Date note under section 1396r of this title.
    Section 4218(b) of Pub. L. 100-203 provided that: ``The amendments 
made by subsection (a) [amending this section] shall apply with respect 
to certifications or recertifications during the period beginning on 
July 1, 1988, and ending on October 1, 1990.''
    Amendment by section 9115(b) of Pub. L. 100-203 effective July 1, 
1988, see section 9115(c) of Pub. L. 100-203, set out as a note under 
section 1382 of this title.
    Section 9119(d)(2) of Pub. L. 100-203, as added by Pub. L. 100-360, 
title IV, Sec. 411(n)(4), formerly Sec. 411(n)(3), July 1, 1988, 102 
Stat. 807, and renumbered by Pub. L. 100-485, title VI, Sec. 608(d)(28), 
Oct. 13, 1988, 102 Stat. 2423, provided that: ``The amendments made by 
paragraph (1) [amending this section] apply to payments under title XIX 
of the Social Security Act [this subchapter] for calendar quarters 
beginning on or after July 1, 1988, without regard to whether or not 
final regulations to carry out such amendments have been promulgated by 
such date.''
    Amendment by sections 5(a) and 8(f) of Pub. L. 100-93, applicable, 
with certain exception, to payments under subchapter XIX of this chapter 
for calendar quarters beginning more than thirty days after Aug. 18, 
1987, without regard to whether or not final regulations to carry out 
such amendments have been published by such date, see section 15(c) of 
Pub. L. 100-93, set out as a note under section 1320a-7 of this title.
    Amendment by section 7 of Pub. L. 100-93 effective at end of 
fourteen-day period beginning Aug. 18, 1987, and inapplicable to 
administrative proceedings commenced before end of such period, see 
section 15(a) of Pub. L. 100-93, set out as a note under section 1320a-7 
of this title.


                    Effective Date of 1986 Amendments

    Section 10(b) of Pub. L. 99-643 provided that:
    ``(1) Except as provided in paragraph (2), the amendments made by 
sections 3, 4, 5, 6, and 7 [amending this section and sections 1382, 
1382c, 1382h, 1383, and 1396s of this title] shall become effective on 
July 1, 1987.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [this subchapter] which the Secretary of 
Health and Human Services determines requires State legislation in order 
for the plan to meet the requirements imposed by the amendments made by 
section 3(b) [amending this section] and section 7 of this Act [amending 
this section and section 1382h of this title], the State plan shall not 
be regarded as failing to comply with the requirements of such title 
solely on the basis of its failure to meet such additional requirements 
until 60 days after the close of the first regular session of the State 
legislature that begins after the date of the enactment of this Act 
[Nov. 10, 1986].''
    Section 11005(c)(2) of Pub. L. 99-570 provided that: ``The 
amendments made by subsection (b) [amending this section] shall become 
effective on January 1, 1987, without regard to whether or not final 
regulations to carry out such amendments have been promulgated by such 
date.''
    Amendment by Pub. L. 99-514 effective, except as otherwise provided, 
as if included in enactment of the Consolidated Omnibus Budget 
Reconciliation Act of 1985, Pub. L. 99-272, see section 1895(e) of Pub. 
L. 99-514, set out as a note under section 162 of Title 26, Internal 
Revenue Code.
    Amendment by section 9320(h)(3) of 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.
    Section 9401(f) of Pub. L. 99-509, as amended by Pub. L. 100-203, 
title IV, Sec. 4101(b)(2)(C), Dec. 22, 1987, 101 Stat. 1330-141, 
provided that:
    ``(1) Except as provided in paragraph (2), the amendments made by 
this section [amending this section and section 1396b of this title] 
shall apply to medical assistance furnished in calendar quarters 
beginning on or after April 1, 1987.
    ``(2) Subparagraph (C) of section 1902(l)(1) of the Social Security 
Act [subsec. (l)(1)(C) of this section], as added by subsection (b) of 
this section, shall apply to medical assistance furnished in calendar 
quarters beginning on or after October 1, 1987.
    ``(3) An amendment made by this section shall become effective as 
provided in paragraph (1) or (2) without regard to whether or not final 
regulations to carry out such amendment have been promulgated by the 
applicable date.''
    Section 9402(c) of Pub. L. 99-509 provided that: ``The amendments 
made by this section [amending this section] shall apply to payments to 
States for calendar quarters beginning on or after July 1, 1987, without 
regard to whether or not final regulations to carry out such amendments 
have been promulgated by such date.''
    Section 9403(h) of Pub. L. 99-509 provided that: ``The amendments 
made by this section [amending this section and sections 1396b, 1396d, 
and 1396o of this title] apply to payments under title XIX of the Social 
Security Act [this subchapter] for calendar quarters beginning on or 
after July 1, 1987, without regard to whether or not final regulations 
to carry out such amendments have been promulgated by such date.''
    Section 9404(c) of Pub. L. 99-509 provided that:
    ``(1) The amendments made by this section [amending this section and 
section 1396d of this title] apply (except as provided under paragraph 
(2)) to payments under title XIX of the Social Security Act [this 
subchapter] for calendar quarters beginning on or after July 1, 1987, 
without regard to whether regulations to implement such amendments are 
promulgated by such date.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirements imposed by the amendments made by this section, the State 
plan shall not be regarded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet these additional 
requirements before the first day of the first calendar quarter 
beginning after the close of the first regular session of the State 
legislature that begins after the date of the enactment of this Act 
[Oct. 21, 1986].''
    Section 9406(c) of Pub. L. 99-509 provided that:
    ``(1) Except as provided in paragraph (2), the amendments made by 
this section [amending this section and section 1396b of this title] 
shall apply to medical assistance furnished to aliens on or after 
January 1, 1987, without regard to whether or not final regulations to 
carry out such amendments have been promulgated by such date.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [this subchapter] which the Secretary of 
Health and Human Services determines requires State legislation (other 
than legislation appropriating funds) in order for the plan to meet the 
additional requirement imposed by the amendment made in subsection (b) 
[amending this section], the State plan shall not be regarded as failing 
to comply with the requirements of such title solely on the basis of its 
failure to meet such additional requirement before the first day of the 
first calendar quarter beginning after the close of the first regular 
session of the State legislature that begins after the date of the 
enactment of this Act [Oct. 21, 1986].''
    Section 9407(d) of Pub. L. 99-509 provided that: ``The amendments 
made by this section [enacting section 1396r-1 of this title and 
amending this section and sections 1396b and 1396s of this title] shall 
apply to ambulatory prenatal care furnished in calendar quarters 
beginning on or after April 1, 1987, without regard to whether or not 
final regulations to carry out such amendments have been promulgated by 
such date.''
    Section 9408(d) of Pub. L. 99-509 provided that: ``The amendments 
made by this section [amending this section and section 1396d of this 
title] shall apply to services furnished on or after the date of the 
enactment of this Act [Oct. 21, 1986].''
    Section 9431(c) of Pub. L. 99-509 provided that: ``The amendments 
made by this section [amending this section and section 1396b of this 
title] apply to payments under title XIX of the Social Security Act 
[this subchapter] for calendar quarters beginning on or after July 1, 
1987, without regard to whether or not final regulations to carry out 
such amendments have been promulgated by such date.''
    Section 9433(b) of Pub. L. 99-509 provided that: ``The amendment 
made by subsection (a) [amending section 2173 of Pub. L. 97-35, which 
amended this section] shall apply as though it was included in the 
enactment of the Omnibus Budget Reconciliation Act of 1981 (Public Law 
97-35).''
    Section 9435(f) of Pub. L. 99-509 provided that: ``The amendments 
made by this section [amending this section and section 1396d of this 
title and provisions set out as notes under this section and sections 
1396d and 1396n of this title] shall be effective as if included in the 
enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985 
[Pub. L. 99-272].''
    Section 9501(d)(2), (3) of Pub. L. 99-272 provided that:
    ``(2) Optional services.--The amendments made by subsection (b) 
[amending this section] shall become effective on the date of the 
enactment of this Act [Apr. 7, 1986].
    ``(3) Continued coverage.--The amendment made by subsection (c) 
[amending this section] shall apply to medical assistance furnished to a 
woman on or after the date of the enactment of this Act.''
    Section 9503(g) of Pub. L. 99-272 provided that:
    ``(1) Except as otherwise provided, the amendments made by this 
section [amending this section and sections 1396b and 1396k of this 
title and section 1144 of Title 29, Labor, and enacting provisions set 
out as notes under this section and section 1144 of Title 29] shall 
apply to calendar quarters beginning on or after the date of the 
enactment of this Act [Apr. 7, 1986].
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [this subchapter] which the Secretary of 
Health and Human Services determines requires State legislation (other 
than legislation appropriating funds) in order for the plan to meet the 
additional requirements imposed by the amendments made by this section, 
the State plan shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its failure to meet 
these additional requirements before the first day of the first calendar 
quarter beginning after the close of the first regular session of the 
State legislature that begins after the date of the enactment of this 
Act.
    ``(3) No penalty may be applied against any State for a violation of 
section 1902(a)(25) of the Social Security Act [subsec. (a)(25) of this 
section] occurring prior to the effective date of the amendments made by 
this section.
    ``(4) The amendment made by subsection (c) [enacting provisions set 
out below] shall become effective on the date of the enactment of this 
Act [Apr. 7, 1986].''
    Section 9505(e) of Pub. L. 99-272, as amended by Pub. L. 99-509, 
title IX, Sec. 9435(d)(1), Oct. 21, 1986, 100 Stat. 2070, provided that: 
``The amendments made by this section [amending this section and 
sections 1396d and 1396o of this title] shall apply to medical 
assistance provided for hospice care furnished on or after the date of 
the enactment of this Act [Apr. 7, 1986], without regard to whether or 
not regulations to carry out the amendments have been promulgated by 
that date.''
    Section 9506(b), (c) of Pub. L. 99-272, as amended by Pub. L. 99-
509, title IX, Sec. 9435(c), Oct. 21, 1986, 100 Stat. 2070, provided 
that:
    ``(b) Effective Date.--The amendment made by subsection (a) 
[amending this section] shall apply to medical assistance furnished on 
or after the first day of the second month beginning after the date of 
the enactment of this Act [Apr. 7, 1986].
    ``(c) Exception.--The amendment made by subsection (a) [amending 
this section] shall not apply to any trust or initial trust decree 
established prior to April 7, 1986, solely for the benefit of a mentally 
retarded individual who resides in an intermediate care facility for the 
mentally retarded.''
    Section 9509(b) of Pub. L. 99-272 provided that:
    ``(1) Except as provided in paragraphs (2) and (3), the amendments 
made by this section [amending this section and enacting provisions set 
out below] shall apply to medical assistance furnished on or after 
October 1, 1985, but only with respect to changes of ownership occurring 
on or after such date.
    ``(2) The amendments made by this section shall not apply with 
respect to a change of ownership pursuant to an enforceable agreement 
entered into prior to October 1, 1985.
    ``(3) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [this subchapter] which the Secretary of 
Health and Human Services determines requires State legislation (other 
than legislation appropriating funds) in order for the plan to meet the 
requirements imposed by the amendments made by this section, the State 
plan shall not be regarded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet the requirements 
imposed by the amendments made by this section before the first day of 
the first calendar quarter beginning after the close of the first 
regular session of the State legislature that begins after the date of 
the enactment of this Act [Apr. 7, 1986].''
    Section 9510(b) of Pub. L. 99-272, as amended by Pub. L. 99-509, 
title IX, Sec. 9435(d)(2), Oct. 21, 1986, 100 Stat. 2070, provided that: 
``The amendment made by this section [amending this section] shall apply 
with respect to payment for services furnished on or after October 1, 
1985, without regard to whether or not regulations to carry out the 
amendment have been promulgated by that date.''
    Section 9529(a)(2) of Pub. L. 99-272 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall apply to medical 
assistance furnished on or after the first calendar quarter that begins 
more than 90 days after the date of the enactment of this Act [Apr. 7, 
1986].''
    Section 9529(b)(3) of Pub. L. 99-272 provided that: ``This 
subsection, and the amendments made by this subsection [amending this 
section and enacting provisions set out below], shall apply to adoption 
assistance agreements entered into before, on, or after the date of the 
enactment of this Act [Apr. 7, 1986].''
    Amendment by section 12305(b)(3) of Pub. L. 99-272 applicable to 
medical assistance furnished in or after first calendar quarter 
beginning more than 90 days after Apr. 7, 1986, see section 12305(c) of 
Pub. L. 99-272, set out as a note under section 673 of this title.


                    Effective Date of 1984 Amendments

    Amendment by Pub. L. 98-617 effective as if originally included in 
the Deficit Reduction Act of 1984, Pub. L. 98-369, see section 3(c) of 
Pub. L. 98-617, set out as a note under section 1395f of this title.
    Amendment by section 2303(g)(1) of Pub. L. 98-369 applicable to 
clinical diagnostic laboratory tests furnished on or after July 1, 1984, 
but not applicable to clinical diagnostic laboratory tests furnished to 
inpatients of a provider operating under a waiver granted pursuant to 
section 602(k) of Pub. L. 98-21, set out as a note under section 1395y 
of this title, see section 2303(j)(1) and (3) of Pub. L. 98-369, set out 
as a note under section 1395l of this title.
    Section 2314(c)(3) of Pub. L. 98-369 provided that:
    ``(A) Except as provided in subparagraph (B), the amendments made by 
subsection (b) [amending this section] shall apply to medical assistance 
furnished on or after October 1, 1984.
    ``(B) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [this subchapter] which the Secretary of 
Health and Human Services determines requires State legislation in order 
for the plan to meet the additional requirement imposed by the 
amendments made by this section [amending this section and section 1395x 
of this title and enacting provisions set out as a note under section 
1395x of this title], the State plan shall not be regarded as failing to 
comply with the requirements of such title solely on the basis of its 
failure to meet this additional requirement before the first day of the 
first calendar quarter beginning after the close of the first regular 
session of the State legislature that begins after the date of the 
enactment of this Act [July 18, 1984].''
    Amendment by section 2335(e) of Pub. L. 98-369 effective July 18, 
1984, see section 2335(g) of Pub. L. 98-369, set out as a note under 
section 1395f of this title.
    Section 2361(d) of Pub. L. 98-369 provided that:
    ``(1) Except as provided in paragraph (2), the amendments made by 
this section [amending this section and sections 606 and 1396d of this 
title] shall apply to calendar quarters beginning on or after October 1, 
1984, without regard to whether or not final regulations to carry out 
such amendments have been promulgated by such date.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [this subchapter] which the Secretary of 
Health and Human Services determines requires State legislation in order 
for the plan to meet the additional requirements imposed by the 
amendments made by this section, the State plan shall not be regarded as 
failing to comply with the requirements of such title solely on the 
basis of its failure to meet these additional requirements before the 
first day of the first calendar quarter beginning after the close of the 
first regular session of the State legislature that begins after the 
date of the enactment of this Act [July 18, 1984].''
    Section 2362(b) of Pub. L. 98-369 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to children 
born on or after October 1, 1984.''
    Amendment by section 2363(a)(1) of Pub. L. 98-369 applicable to 
calendar quarters beginning on or after July 18, 1984, except that, in 
the case of individuals admitted to skilled nursing facilities before 
that date, the amendment shall not require recertifications sooner or 
more frequently than were required under the law in effect before that 
date, see section 2363(c) of Pub. L. 98-369, set out as a note under 
section 1396b of this title.
    Section 2367(c) of Pub. L. 98-369 provided that:
    ``(1) Except as provided in paragraph (2), the amendments made by 
this section [amending this section and section 1396k of this title] 
shall become effective on October 1, 1984.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [this subchapter] which the Secretary of 
Health and Human Services determines requires State legislation in order 
for the plan to meet the additional requirement imposed by the 
amendments made by this section, the State plan shall not be regarded as 
failing to comply with the requirements of such title solely on the 
basis of its failure to meet this additional requirement before the 
first day of the first calendar quarter beginning after the close of the 
first regular session of the State legislature that begins after the 
date of the enactment of this Act [July 18, 1984].''
    Section 2368(c) of Pub. L. 98-369 provided that: ``The amendments 
made by this section [amending this section] shall become effective on 
the date of the enactment of this Act [July 18, 1984].''
    Amendment by section 2651(c) of Pub. L. 98-369 effective Apr. 1, 
1985, except as otherwise provided, see section 2651(l)(2) of Pub. L. 
98-369, set out as an Effective Date note under section 1320b-7 of this 
title.


                    Effective Date of 1982 Amendment

    Amendment by section 131(a), (c) of Pub. L. 97-248 effective Oct. 1, 
1982, see section 131(d) of Pub. L. 97-248, formerly Sec. 131(c), 
redesignated Pub. L. 97-448, title III, Sec. 309(a)(8), Jan. 12, 1983, 
96 Stat. 2408, set out as an Effective Date note under section 1396o of 
this title.
    Amendment by section 132(a), (c) of Pub. L. 97-248 effective Sept. 
3, 1982, see section 132(d) of Pub. L. 97-248, set out as an Effective 
Date note under section 1396p of this title.
    Section 134(b) of Pub. L. 97-248 provided that: ``The amendment made 
by subsection (a) [amending this section] shall become effective on 
October 1, 1982.''
    Amendment by section 136(d) of Pub. L. 97-248 effective Oct. 1, 
1982, see section 136(e) of Pub. L. 97-248, set out as a note under 
section 1301 of this title.
    Section 137(d) of Pub. L. 97-248 provided that:
    ``(1) Except as otherwise provided in this section, any amendment to 
the Omnibus Budget Reconciliation Act of 1981 [Pub. L. 97-35] made by 
this section [amending this section and sections 1320a-1 and 1396b of 
this title and provisions set out as a note under section 603 of this 
title] shall be effective as if it had been originally included in the 
provision of the Omnibus Budget Reconciliation Act of 1981 to which such 
amendment relates.
    ``(2) Except as otherwise provided in this section, any amendment to 
the Social Security Act [this chapter] made by the preceding provisions 
of this section [amending this section and sections 701, 705, 1320a-7a, 
1320b-4, 1396b, 1396d, and 1396n of this title] shall be effective as if 
it had been originally included as a part of that provision of the 
Social Security Act to which it relates, as such provision of the Social 
Security Act was amended by the Omnibus Budget Reconciliation Act of 
1981 [Pub. L. 97-35].''
    Amendment by section 146(a) of Pub. L. 97-248 effective with respect 
to contracts entered into or renewed on or after Sept. 3, 1982, see 
section 149 of Pub. L. 97-248, set out as an Effective Date note under 
section 1320c of this title.


                    Effective Date of 1981 Amendment

    Section 2113(o) of Pub. L. 97-35 provided that: ``The amendments 
made by this section [amending this section and sections 1320c, 1320c-1, 
1320c-3, 1320c-4, 1320c-7, 1320c-8, 1320c-9, 1320c-11, 1320c-17, 1320c-
21, and 1396b of this title and repealing sections 1320c-13 and 1320c-20 
of this title] apply to agreements with Professional Standards Review 
Organizations entered into on or after October 1, 1981.''
    Section 2171(c) of Pub. L. 97-35 provided that: ``The amendments 
made by this section [amending this section] shall become effective on 
the date of the enactment of this Act [Aug. 13, 1981].''
    Section 2172(c) of Pub. L. 97-35 provided that: ``The amendments 
made by this section [amending this section and section 1396d of this 
title] shall become effective on the date of the enactment of this Act 
[Aug. 13, 1981].''
    Section 2173(b)(2) of Pub. L. 97-35 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall not apply with 
respect to services furnished before the date the Secretary of Health 
and Human Services first promulgates and has in effect final regulations 
(on an interim or other basis) to carry out section 1902(a)(13)(A) of 
the Social Security Act [subsec. (a)(13)(A) of this section] (as amended 
by this subtitle).''
    Section 2174(c) of Pub. L. 97-35 provided that: ``The amendments 
made by this section [amending this section and section 1396b of this 
title] shall apply to services furnished on or after October 1, 1981.''
    Section 2175(d)(2) of Pub. L. 97-35 provided that:
    ``(A) The amendments made by paragraph (1) [amending this section] 
shall (except as provided under subparagraph (B)) be effective with 
respect to payments under title XIX of the Social Security Act [this 
subchapter] for calendar quarters beginning on or after October 1, 1981.
    ``(B) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [this subchapter] which the Secretary of 
Health and Human Services determines requires State legislation in order 
for the plan to meet the additional requirement imposed by the amendment 
made by paragraph (1)(C), the State plan shall not be regarded as 
failing to comply with the requirements of such title solely on the 
basis of its failure to meet this additional requirement before the 
first day of the first calendar year beginning after the close of the 
first regular session of the State legislature that begins after the 
date of the enactment of this Act [Aug. 13, 1981].''
    Section 2178(c) of Pub. L. 97-35 provided that: ``The amendments 
made by this section [amending this section and section 1396b of this 
title] shall apply with respect to services furnished, under a State 
plan approved under title XIX of the Social Security Act [this 
subchapter], on or after October 1, 1981; except that such amendments 
shall not apply with respect to services furnished by a health 
maintenance organization under a contract with a State entered into 
under such title before October 1, 1981 unless the organization requests 
that such amendments apply and the Secretary of Health and Human 
Services and the single State agency (administering or supervising the 
administration of the State plan under such title) agree to such 
request.''
    Section 2181(b) of Pub. L. 97-35, as amended by Pub. L. 97-248, 
title I, Sec. 137(a)(4), Sept. 3, 1982, 96 Stat. 376, provided that: 
``The amendment made by subsection (a)(1) [amending section 603 of this 
title] shall apply to reductions for calendar quarters beginning on or 
after June 30, 1974, and the amendments made by subsection (a)(2) 
[amending this section] shall take effect on October 1, 1981, except 
that, in the case of a State plan under title XIX of the Social Security 
Act [this subchapter] which the Secretary determines requires State 
legislation in order to incorporate the provisions required to be 
included by this section into such State plan, the State plan shall not 
be regarded as failing to comply with the requirements of such title 
solely on the basis of its failure to include the provisions required to 
be included in such State plan by subsection (a)(2) of this section 
before the first day of the first calendar quarter beginning after the 
close of the first regular session of the State legislature that begins 
after the date of enactment of this Act [Aug. 13, 1981], but the 
requirements previously set forth in paragraphs (1) through (3) of 
section 403(g) of the Social Security Act [section 603(g)(1)-(3) of this 
title] (prior to its repeal by this section) shall apply under title XIX 
of such Act to such State on and after October 1, 1981, whether or not 
the provisions required to be included by this section in the State plan 
under title XIX have been incorporated into such State plan.''
    For effective date, savings, and transitional provisions relating to 
amendment by section 2193(c)(9) of Pub. L. 97-35, see section 2194 of 
Pub. L. 97-35, set out as a note under section 701 of this title.


                    Effective Date of 1980 Amendment

    Amendment by section 902(b) of Pub. L. 96-499 effective on date on 
which final regulations to implement the amendment are first issued, see 
section 902(c) of Pub. L. 96-499, set out as a note under section 1395x 
of this title.
    Section 914(b)(2) of Pub. L. 96-499, as amended by Pub. L. 97-248, 
title I, Sec. 137(c)(1), Sept. 3, 1982, 96 Stat. 381, provided that:
    ``(A) The amendments made by paragraph (1) [amending this section] 
shall (except as provided under subparagraph (B)) apply to cost 
reporting periods, beginning on or after April 1, 1981, of an entity 
providing services under a State plan approved under title XIX of the 
Social Security Act [this subchapter].''
    ``(B) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary determines requires 
State legislation in order for the plan to meet the additional 
requirements imposed by the amendments made by paragraph (1), the State 
plan shall not be regarded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet these additional 
requirements before the first day of the first calendar quarter 
beginning after the close of the first regular session of the State 
legislature that begins after the date of the enactment of this Act.''
    Section 918(b)(2) of Pub. L. 96-499 provided that:
    ``(A) The amendments made by paragraph (1) [enacting this section] 
shall (except as otherwise provided in subparagraph (B)) apply to 
medical assistance provided, under a State plan approved under title XIX 
of the Social Security Act [this subchapter], on and after the first day 
of the first calendar quarter that begins more than six months after the 
date of the enactment of this Act [Dec. 5, 1980].
    ``(B) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation in order for the plan to 
meet the additional requirements imposed by the amendments made by 
paragraph (1), the State plan shall not be regarded as failing to comply 
with the requirements of such title solely on the basis of its failure 
to meet these additional requirements before the first day of the first 
calendar quarter beginning after the close of the first regular session 
of the State legislature that begins after the date of the enactment of 
this Act.''
    Section 962(b) of Pub. L. 96-499 provided that: ``The amendment made 
by subsection (a) [amending this section] shall become effective on 
October 1, 1980.''
    Section 965(c) of Pub. L. 96-499 provided that:
    ``(1) The amendments made by this section [amending this section and 
section 1396d of this title] shall (except as provided under paragraph 
(2)) be effective with respect to payments under title XIX of the Social 
Security Act [this subchapter] for calendar quarters beginning more than 
one hundred and twenty days after the date of the enactment of this Act 
[Dec. 5, 1980].
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation in order for the plan to 
meet the additional requirements imposed by the amendments made by this 
section, the State plan shall not be regarded as failing to comply with 
the requirements of such title solely on the basis of its failure to 
meet these additional requirements before the first day of the first 
calendar quarter beginning after the close of the first regular session 
of the State legislature that begins after the date of the enactment of 
this Act.''


                    Effective Date of 1978 Amendment

    Section 14(a)(2) of Pub. L. 95-559 provided that:
    ``(A) Except as provided in subparagraph (B), the amendments made by 
paragraph (1) [amending this section] shall take effect one hundred and 
eighty days after the date of the enactment of this Act [Nov. 1, 1978].
    ``(B) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act [this subchapter] which the Secretary 
determines requires State legislation in order for the plan to meet the 
requirement added by the amendments made by paragraph (1), such 
amendments shall not apply with respect to such State plan before ninety 
days after the close of the first regular session of the State 
legislature that begins after the date of the enactment of this Act.''


                    Effective Date of 1977 Amendments

    Amendment by Pub. L. 95-210 applicable to medical assistance 
provided, under a State plan approved under subchapter XIX of this 
chapter, on and after the first day of the first calendar quarter that 
begins more than six months after Dec. 13, 1977, with exception for 
plans requiring State legislation, see section 2(f) of Pub. L. 95-210, 
set out as a note under section 1395cc of this title.
    Amendment by section 2(a)(3) of Pub. L. 95-142 applicable with 
respect to care and services furnished on or after Oct. 25, 1977, see 
section 2(a)(4) of Pub. L. 95-142, set out as a note under section 1395g 
of this title.
    Section 2(b)(2) of Pub. L. 95-142 provided that: ``The amendments 
made by paragraph (1) [amending this section] shall apply to calendar 
quarters beginning on and after July 1, 1978, with respect to State 
plans approved under title XIX of the Social Security Act [this 
subchapter].''
    Amendment by section 3(c)(1) of Pub. L. 95-142 effective Jan. 1, 
1978, see section 3(e) of Pub. L. 95-142, set out as an Effective Date 
note under section 1320a-3 of this title.
    Section 7(e)(2) of Pub. L. 95-142 provided that: ``The amendment 
made by subsection (b) [amending this section] shall become effective on 
January 1, 1978.''
    Section 19(c)(2) of Pub. L. 95-142 provided that:
    ``(A) The amendments made by subsection (b) [amending this section 
and section 1395x of this title] shall apply with respect to operations 
of a hospital, skilled nursing facility, or intermediate care facility, 
on and after the first day of its first fiscal year which begins after 
the end of the six-month period beginning on the date a uniform 
reporting system is established (under section 1121(a) of the Social 
Security Act) [section 1320a(a) of this title] for that type of health 
services facility.
    ``(B) The amendments made by subsection (b) [amending this section 
and section 1395x of this title] shall apply, with respect to the 
operation of a health services facility or organization which is neither 
a hospital, a skilled nursing facility, nor an intermediate care 
facility, on and after the first day of its first fiscal year which 
begins after such date as the Secretary of Health, Education, and 
Welfare [now Health and Human Services] determines to be appropriate for 
the implementation of the reporting requirement for that type of 
facility or organization.
    ``(C) Except as provided in subparagraphs (A) and (B), the 
amendments made by subsection (b)(2) [amending this section] shall 
apply, with respect to State plans approved under title XIX of the 
Social Security Act [this subchapter], on and after October 1, 1977.''
    Amendment by section 20(b) of Pub. L. 95-142 effective Oct. 1, 1977, 
and the Secretary to adjust payments made to States under section 1396b 
of this title to reflect such amendment, see section 20(c) of Pub. L. 
95-142, set out as a note under section 1396b of this title.


                    Effective Date of 1976 Amendment

    Section 2 of Pub. L. 94-552 provided that: ``The amendments made by 
the first section [amending this section and section 1396b of this 
title] shall take effect as of January 1, 1976.''


                    Effective Date of 1975 Amendment

    Section 111(c) of Pub. L. 94-182 provided that: ``The amendments 
made by this section [amending this section and section 1396b of this 
title] shall (except as otherwise provided for therein) become effective 
January 1, 1976.''


                    Effective Date of 1974 Amendment

    Section 9(b) of Pub. L. 93-368 provided that: ``The amendment made 
by subsection (a) [amending this section] shall be effective January 1, 
1973.''


                    Effective Date of 1973 Amendment

    Section 13(d) of Pub. L. 93-233 provided that: ``The amendments made 
by subsection (a) [amending this section and sections 1396, 1396b, and 
1396d of this title] shall be effective with respect to payments under 
section 1903 of the Social Security Act [section 1396b of this title] 
for calendar quarters commencing after December 31, 1973.''
    Section 18(z-3)(4) of Pub. L. 93-233 provided that: ``The amendments 
made by subsections (o) and (u) [amending this section and section 1396b 
of this title] shall be effective July 1, 1973''.


                    Effective Date of 1972 Amendment

    Section 208(b) of Pub. L. 92-603 provided that: ``The amendment made 
by subsection (a) [amending this section] shall be effective January 1, 
1973 (or earlier if the State plan so provided).''
    Section 209(b)(2) of Pub. L. 92-603 provided that: ``The amendment 
made by this subsection [amending this section] shall become effective 
on January 1, 1974.''
    Section 232(c) of Pub. L. 92-603 provided that: ``The amendments 
made by this section [amending this section and section 705 of this 
title] shall be effective July 1, 1972 (or earlier if the State plan so 
provides).''
    Amendment by section 236(b) of Pub. L. 92-603 effective Jan. 1, 
1973, or earlier if the State plan so provides, see section 236(c) of 
Pub. L. 92-603, set out as a note under section 1395u of this title.
    Section 237(d)(2) of Pub. L. 92-603 provided that: ``The amendment 
made by subsection (a)(2) [amending this section] shall be effective 
July 1, 1973.''
    Section 239(d) of Pub. L. 92-603 provided that: ``The amendments 
made by this section [amending this section and section 705 of this 
title] shall be effective January 1, 1973 (or earlier if the State plan 
so provides).''
    Amendment by section 246(a) of Pub. L. 92-603 to be effective July 
1, 1973, see section 246(c) of Pub. L. 92-603, set out as a note under 
section 1395x of this title.
    Section 255(b) of Pub. L. 92-603 provided that: ``The amendments 
made by subsection (a) [amending this section] shall be effective July 
1, 1973.''
    Section 268(c) of Pub. L. 92-603 provided that: ``The amendments 
made by this section [amending this section and section 1396g of this 
title] shall be effective on the date of the enactment of this Act [Oct. 
30, 1972].''
    Amendment by section 299D(b) of Pub. L. 92-603 effective beginning 
Jan. 1, 1973, or within 6 months following Oct. 30, 1972, whichever is 
later, see section 299D(c) of Pub. L. 92-603, set out as a note under 
section 1395aa of this title.


                    Effective Date of 1971 Amendment

    Section 4(d) of Pub. L. 92-223, as amended by section 292 of Pub. L. 
92-603, provided that: ``The amendments made by this section [amending 
this section and section 1396d of this title and repealing section 1320a 
of this title] shall become effective January 1, 1972; except that the 
repeal made by subsection (c) [repealing section 1320a of this title], 
shall not become effective in the case of any State, which on January 1, 
1972 did not have in effect a State plan approved under title XIX of the 
Social Security Act [this subchapter], until the first day of the first 
month (occurring after such date) that such State does have in effect a 
State plan approved under such title [this subchapter].''


                    Effective Date of 1968 Amendment

    Amendment by section 210(a)(6) of Pub. L. 90-248 effective July 1, 
1969, or, if earlier (with respect to a State's plan approved under this 
subchapter) on the date as of which the modification of the State plan 
to comply with such amendment is approved, see section 210(b) of Pub. L. 
90-248, set out as a note under section 302 of this title.
    Section 223(b) of Pub. L. 90-248 provided that: ``The amendments 
made by subsection (a) [amending this section] shall apply with respect 
to calendar quarters beginning after June 30, 1967.''
    Section 224(b) of Pub. L. 90-248 provided that: ``The amendment made 
by subsection (a) [amending this section] shall apply with respect to 
calendar quarters beginning after December 31, 1967.''
    Section 224(c)(2) of Pub. L. 90-248 provided that: ``The amendment 
made by paragraph (1) of this subsection [amending this section] shall 
apply with respect to calendar quarters beginning after June 30, 1970.''
    Section 227(b) of Pub. L. 90-248, as amended by section 271A of Pub. 
L. 92-603, effective from and after July 1, 1972, provided that: ``The 
amendments made by this section [amending this section] shall apply with 
respect to calendar quarters beginning after June 30, 1969; except that 
such amendments shall apply in the case of Puerto Rico, the Virgin 
Islands, and Guam only with respect to calendar quarters beginning after 
June 30, 1975.''
    Section 229(b) of Pub. L. 90-248 provided that: ``The amendment made 
by subsection (a) [amending this section] shall apply with respect to 
legal liabilities of third parties arising after March 31, 1968.''
    Section 234(b) of Pub. L. 90-248 provided that: ``The amendments 
made by subsection (a) of this section [amending this section] (unless 
otherwise specified in the body of such amendments) shall take effect on 
January 1, 1969.''
    Section 235(b) of Pub. L. 90-248 provided that: ``The amendments 
made by subsection (a) [amending this section] shall be effective in the 
case of calendar quarters beginning after December 31, 1967.''
    Enactment by section 236(a) of Pub. L. 90-248 effective July 1, 
1970, except as otherwise specified in the text thereof, see section 
236(c) of Pub. L. 90-248, set out as an Effective Date note under 
section 1396g of this title.
    Section 237 of Pub. L. 90-248 provided that the amendment made by 
that section is effective Apr. 1, 1968.
    Section 238 of Pub. L. 90-248 provided that the amendment made by 
that section is effective July 1, 1969.


                     Construction of 1999 Amendment

    Pub. L. 106-169, title I, Sec. 121(c), Dec. 14, 1999, 113 Stat. 
1830, provided that: ``If the Ticket to Work and Work Incentives 
Improvement Act of 1999 [Pub. L. 106-170] is enacted (whether before, 
on, or after the date of the enactment of this Act)--
        ``(1) the amendments made by that Act [see Tables for 
    classification] shall be executed as if this Act [see Short Title of 
    1999 Amendment note under section 1305 of this title] had been 
    enacted after the enactment of such other Act;
        ``(2) with respect to subsection (a)(1)(A) of this section 
    [amending this section], any reference to subclause (XIII) is deemed 
    a reference to subclause (XV);
        ``(3) with respect to subsection (a)(1)(B) of this section 
    [amending this section], any reference to subclause (XIV) is deemed 
    a reference to subclause (XVI);
        ``(4) [Amended this section.]
        ``(5) [Amended section 1396d of this title.]''

                          Transfer of Functions

    Functions, powers, and duties of Secretary of Health and Human 
Services under subsec. (a)(4)(A) of this section, insofar as relates to 
the prescription of personnel standards on a merit basis, transferred to 
Office of Personnel Management, see section 4728(a)(3)(D) of this title.


                               GAO Reports

    Pub. L. 106-170, title II, Sec. 201(c), Dec. 17, 1999, 113 Stat. 
1893, provided that: ``Not later than 3 years after the date of the 
enactment of this Act [Dec. 17, 1999], the Comptroller General of the 
United States shall submit a report to the Congress regarding the 
amendments made by this section [amending this section and sections 
1396b, 1396d, and 1396o of this title] that examines--
        ``(1) the extent to which higher health care costs for 
    individuals with disabilities at higher income levels deter 
    employment or progress in employment;
        ``(2) whether such individuals have health insurance coverage or 
    could benefit from the State option established under such 
    amendments to provide a medicaid buy-in; and
        ``(3) how the States are exercising such option, including--
            ``(A) how such States are exercising the flexibility 
        afforded them with regard to income disregards;
            ``(B) what income and premium levels have been set;
            ``(C) the degree to which States are subsidizing premiums 
        above the dollar amount specified in section 1916(g)(2) of the 
        Social Security Act (42 U.S.C. 1396o(g)(2)); and
            ``(D) the extent to which there exists any crowd-out 
        effect.''
    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title VI, Sec. 603(b)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-395, provided that: ``Not later 
than 1 year after the date of the enactment of this Act [Nov. 29, 1999], 
the Comptroller General of the United States shall submit a report to 
Congress that evaluates the effect on Federally-qualified health centers 
and rural health clinics and on the populations served by such centers 
and clinics of the phase-out and elimination of the reasonable cost 
basis for payment for Federally-qualified health center services and 
rural health clinic services provided under section 1902(a)(13)(C)(i) of 
the Social Security Act (42 U.S.C. 1396a(a)(13)(C)(i)), as amended by 
section 4712 of BBA (111 Stat. 508) [the Balanced Budget Act of 1997, 
Pub. L. 105-33] and subsection (a) of this section. Such report shall 
include an analysis of the amount, method, and impact of payments made 
by States that have provided for payment under title XIX of such Act 
[this subchapter] for such services on a basis other than payment of 
costs which are reasonable and related to the cost of furnishing such 
services, together with any recommendations for legislation, including 
whether a new payment system is needed, that the Comptroller General 
determines to be appropriate as a result of the study.''


  Demonstration of Coverage Under the Medicaid Program of Workers With 
                     Potentially Severe Disabilities

    Pub. L. 106-170, title II, Sec. 204, Dec. 17, 1999, 113 Stat. 1897, 
provided that:
    ``(a) State Application.--A State may apply to the Secretary of 
Health and Human Services (in this section referred to as the 
`Secretary') for approval of a demonstration project (in this section 
referred to as a `demonstration project') under which up to a specified 
maximum number of individuals who are workers with a potentially severe 
disability (as defined in subsection (b)(1)) are provided medical 
assistance equal to--
        ``(1) that provided under section 1905(a) of the Social Security 
    Act (42 U.S.C. 1396d(a)) to individuals described in section 
    1902(a)(10)(A)(ii)(XIII) of that Act (42 U.S.C. 
    1396a(a)(10)(A)(ii)(XIII)); or
        ``(2) in the case of a State that has not elected to provide 
    medical assistance under that section to such individuals, such 
    medical assistance as the Secretary determines is an appropriate 
    equivalent to the medical assistance described in paragraph (1).
    ``(b) Worker With a Potentially Severe Disability Defined.--For 
purposes of this section--
        ``(1) In general.--The term `worker with a potentially severe 
    disability' means, with respect to a demonstration project, an 
    individual who--
            ``(A) is at least 16, but less than 65, years of age;
            ``(B) has a specific physical or mental impairment that, as 
        defined by the State under the demonstration project, is 
        reasonably expected, but for the receipt of items and services 
        described in section 1905(a) of the Social Security Act (42 
        U.S.C. 1396d(a)), to become blind or disabled (as defined under 
        section 1614(a) of the Social Security Act (42 U.S.C. 
        1382c(a))); and
            ``(C) is employed (as defined in paragraph (2)).
        ``(2) Definition of employed.--An individual is considered to be 
    `employed' if the individual--
            ``(A) is earning at least the applicable minimum wage 
        requirement under section 6 of the Fair Labor Standards Act (29 
        U.S.C. 206) and working at least 40 hours per month; or
            ``(B) is engaged in a work effort that meets substantial and 
        reasonable threshold criteria for hours of work, wages, or other 
        measures, as defined under the demonstration project and 
        approved by the Secretary.
    ``(c) Approval of Demonstration Projects.--
        ``(1) In general.--Subject to paragraph (3), the Secretary shall 
    approve applications under subsection (a) that meet the requirements 
    of paragraph (2) and such additional terms and conditions as the 
    Secretary may require. The Secretary may waive the requirement of 
    section 1902(a)(1) of the Social Security Act (42 U.S.C. 
    1396a(a)(1)) to allow for sub-State demonstrations.
        ``(2) Terms and conditions of demonstration projects.--The 
    Secretary may not approve a demonstration project under this section 
    unless the State provides assurances satisfactory to the Secretary 
    that the following conditions are or will be met:
            ``(A) Maintenance of state effort.--Federal funds paid to a 
        State pursuant to this section must be used to supplement, but 
        not supplant, the level of State funds expended for workers with 
        potentially severe disabilities under programs in effect for 
        such individuals at the time the demonstration project is 
        approved under this section.
            ``(B) Independent evaluation.--The State provides for an 
        independent evaluation of the project.
        ``(3) Limitations on federal funding.--
            ``(A) Appropriation.--
                ``(i) In general.--Out of any funds in the Treasury not 
            otherwise appropriated, there is appropriated to carry out 
            this section--
          ``(I) $42,000,000 for each of fiscal years 2001 through 2004; 
                and
          ``(II) $41,000,000 for each of fiscal years 2005 and 2006.
                ``(ii) Budget authority.--Clause (i) constitutes budget 
            authority in advance of appropriations Acts and represents 
            the obligation of the Federal Government to provide for the 
            payment of the amounts appropriated under clause (i).
            ``(B) Limitation on payments.--In no case may--
                ``(i) the aggregate amount of payments made by the 
            Secretary to States under this section exceed $250,000,000;
                ``(ii) the aggregate amount of payments made by the 
            Secretary to States for administrative expenses relating to 
            annual reports required under subsection (d) exceed 
            $2,000,000 of such $250,000,000; or
                ``(iii) payments be provided by the Secretary for a 
            fiscal year after fiscal year 2009.
            ``(C) Funds allocated to states.--The Secretary shall 
        allocate funds to States based on their applications and the 
        availability of funds. Funds allocated to a State under a grant 
        made under this section for a fiscal year shall remain available 
        until expended.
            ``(D) Funds not allocated to States.--Funds not allocated to 
        States in the fiscal year for which they are appropriated shall 
        remain available in succeeding fiscal years for allocation by 
        the Secretary using the allocation formula established under 
        this section.
            ``(E) Payments to States.--The Secretary shall pay to each 
        State with a demonstration project approved under this section, 
        from its allocation under subparagraph (C), an amount for each 
        quarter equal to the Federal medical assistance percentage (as 
        defined in section 1905(b) of the Social Security Act (42 U.S.C. 
        1395d(b) [42 U.S.C. 1396d(b)]) of expenditures in the quarter 
        for medical assistance provided to workers with a potentially 
        severe disability.
    ``(d) Annual Report.--A State with a demonstration project approved 
under this section shall submit an annual report to the Secretary on the 
use of funds provided under the grant. Each report shall include 
enrollment and financial statistics on--
        ``(1) the total population of workers with potentially severe 
    disabilities served by the demonstration project; and
        ``(2) each population of such workers with a specific physical 
    or mental impairment described in subsection (b)(1)(B) served by 
    such project.
    ``(e) Recommendation.--Not later than October 1, 2004, the Secretary 
shall submit a recommendation to the Committee on Commerce of the House 
of Representatives and the Committee on Finance of the Senate regarding 
whether the demonstration project established under this section should 
be continued after fiscal year 2006.
    ``(f) State Defined.--In this section, the term `State' has the 
meaning given such term for purposes of title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.).''


     Medical Assistance Payments for Eligible PACE Program Enrollees

    Pub. L. 105-277, div. A, Sec. 101(f) [title VII, Sec. 710], Oct. 21, 
1998, 112 Stat. 2681-337, 2681-391, provided that: ``For purposes of 
payments to States for medical assistance under title XIX of the Social 
Security Act [this subchapter] from amounts appropriated to carry out 
such title for fiscal year 1999 and for any subsequent fiscal year, 
individuals who are PACE program eligible individuals under section 1934 
of that Act [section 1396u-4 of this title] and who meet the income and 
resource eligibility requirements of individuals who are eligible for 
medical assistance under section 1902(a)(10)(A)(ii)(VI) of that Act 
[subsec. (a)(10)(A)(ii)(VI) of this section] shall be treated as 
individuals described in such section 1902(a)(10)(A)(ii)(VI) during the 
period of their enrollment in the PACE program.''


       Study and Report by Secretary of Health and Human Services

    Section 4711(b) of Pub. L. 105-33 provided that:
    ``(1) Study.--The Secretary of Health and Human Services shall study 
the effect on access to, and the quality of, services provided to 
beneficiaries of the rate-setting methods used by States pursuant to 
section 1902(a)(13)(A) of the Social Security Act (42 U.S.C. 
1396a(a)(13)(A)), as amended by subsection (a).
    ``(2) Report.--Not later than 4 years after the date of the 
enactment of this Act [Aug. 5, 1997], the Secretary of Health and Human 
Services shall submit a report to the appropriate committees of Congress 
on the conclusions of the study conducted under paragraph (1), together 
with any recommendations for legislation as a result of such 
conclusions.''


                   Dual Eligibles; Monitoring Payments

    Section 4724(e) of Pub. L. 105-33 provided that: ``The Administrator 
of the Health Care Financing Administration shall develop mechanisms to 
improve the monitoring of, and to prevent, inappropriate payments under 
the medicaid program under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) in the case of individuals who are dually eligible 
for benefits under such program and under the medicare program under 
title XVIII of such Act (42 U.S.C. 1395 et seq.).''


           Extension of Effective Date for State Law Amendment

    Section 4759 of title IV of Pub. L. 105-33 provided that: ``In the 
case of a State plan under title XIX of the Social Security Act [this 
subchapter] which the Secretary of Health and Human Services determines 
requires State legislation in order for the plan to meet the additional 
requirements imposed by the amendments made by a provision of this 
subtitle [subtitle H (Secs. 4701-4759) of title IV of Pub. L. 105-33, 
enacting sections 1396u-2 and 1396u-3 of this title, amending this 
section and sections 1308, 1315, 1320a-3, 1320a-7b, 1395i-3, 1395w-4, 
1395cc, 1396b, 1396d, 1396e, 1396n, 1396o, 1396r, 1396r-4, 1396r-6, 
1396r-8, 1396u-2, and 1396v of this title, and repealing section 1396r-7 
of this title], the State plan shall not be regarded as failing to 
comply with the requirements of such title solely on the basis of its 
failure to meet these additional requirements before the first day of 
the first calendar quarter beginning after the close of the first 
regular session of the State legislature that begins after the date of 
the enactment of this Act [Aug. 5, 1997]. For purposes of the previous 
sentence, in the case of a State that has a 2-year legislative session, 
each year of the session is considered to be a separate regular session 
of the State legislature.''


     References to Provisions of Part A of Subchapter IV Considered 
        References to Such Provisions as in Effect July 16, 1996

    For provisions that certain references to provisions of part A 
(Sec. 601 et seq.) of subchapter IV of this chapter be considered 
references to such provisions of part A as in effect July 16, 1996, see 
section 1396u-1(a) of this title.


  Demonstration Projects To Study Effect of Allowing States To Extend 
Medicaid Coverage to Certain Low-Income Families Not Otherwise Qualified 
                      To Receive Medicaid Benefits

    Section 4745 of Pub. L. 101-508, as amended by Pub. L. 103-66, title 
XIII, Sec. 13643(a), Aug. 10, 1993, 107 Stat. 647, provided that:
    ``(a) Demonstration Projects.--
        ``(1) In general.--(A) The Secretary of Health and Human 
    Services (hereafter in this section referred to as the `Secretary') 
    shall enter into agreements with 3 and no more than 4 States 
    submitting applications under this section for the purpose of 
    conducting demonstration projects to study the effect on access to, 
    and costs of, health care of eliminating the categorical eligibility 
    requirement for medicaid benefits for certain low-income 
    individuals.
        ``(B) In entering into agreements with States under this section 
    the Secretary shall provide that at least 1 and no more than 2 of 
    the projects are conducted on a substate basis.
        ``(2) Requirements.--(A) The Secretary may not enter into an 
    agreement with a State to conduct a project unless the Secretary 
    determines that--
            ``(i) the project can reasonably be expected to improve 
        access to health insurance coverage for the uninsured;
            ``(ii) with respect to projects for which the statewideness 
        requirement has not been waived, the State provides, under its 
        plan under title XIX of the Social Security Act [this 
        subchapter], for eligibility for medical assistance for all 
        individuals described in subparagraphs (A), (B), (C), and (D) of 
        paragraph (1) of section 1902(l) of such Act [subsec. (l)(1)(A), 
        (B), (C), (D) of this section] (based on the State's election of 
        certain eligibility options the highest income standards and, 
        based on the State's waiver of the application of any resource 
        standard);
            ``(iii) eligibility for benefits under the project is 
        limited to individuals in families with income below 150 percent 
        of the income official poverty line and who are not individuals 
        receiving benefits under title XIX of the Social Security Act;
            ``(iv) if the Secretary determines that it is cost-effective 
        for the project to utilize employer coverage (as described in 
        section 1925(b)(4)(D) of the Social Security Act [section 1396r-
        6(b)(4)(D) of this title]), the project must require an employer 
        contribution and benefits under the State plan under title XIX 
        of such Act will continue to be made available to the extent 
        they are not available under the employer coverage;
            ``(v) the project provides for coverage of benefits 
        consistent with subsection (b); and
            ``(vi) the project only imposes premiums, coinsurance, and 
        other cost-sharing consistent with subsection (c).
        ``(B) The Secretary may waive the requirements of clause (ii) of 
    this paragraph [probably means subparagraph (A)] with respect to 
    those projects described in subparagraph (B) of paragraph (1).
        ``(3) Permissible restrictions.--A project may limit eligibility 
    to individuals whose assets are valued below a level specified by 
    the State. For this purpose, any evaluation of such assets shall be 
    made in a manner consistent with the standards for valuation of 
    assets under the State plan under title XIX of the Social Security 
    Act for individuals entitled to assistance under part A of title IV 
    of such Act [part A of subchapter IV of this chapter]. Nothing in 
    this section shall be construed as requiring a State to provide for 
    eligibility for individuals for months before the month in which 
    such eligibility is first established.
        ``(4) Extension of eligibility.--A project may provide for 
    extension of eligibility for medical assistance for individuals 
    covered under the project in a manner similar to that provided under 
    section 1925 of the Social Security Act to certain families 
    receiving aid pursuant to a plan of the State approved under part A 
    of title IV of such Act.
        ``(5) Waiver of requirements.--
            ``(A) In general.--Subject to subparagraph (B), the 
        Secretary may waive such requirements of title XIX of the Social 
        Security Act (except section 1903(m) of the Social Security Act 
        [section 1396b(m) of this title]) as may be required to provide 
        for additional coverage of individuals under projects under this 
        section.
            ``(B) Nonwaivable provisions.--Except with respect to those 
        projects described in subparagraph (B) of paragraph (1), the 
        Secretary may not waive, under subparagraph (A), the 
        statewideness requirement of section 1902(a)(1) of the Social 
        Security Act [subsec. (a)(1) of this section] or the Federal 
        medical assistance percentage specified in section 1905(b) of 
        such Act [section 1396d(b) of this title].
    ``(b) Benefits.--
        ``(1) In general.--Except as provided in this subsection, the 
    amount, duration, and scope of medical assistance made available 
    under a project shall be the same as the amount, duration, and scope 
    of such assistance made available to individuals entitled to medical 
    assistance under the State plan under section 1902(a)(10)(A)(i) of 
    the Social Security Act [subsec. (a)(10)(A)(i) of this section].
        ``(2) Limits on benefits.--
            ``(A) Required.--Except with respect to those projects 
        described in subparagraph (B) of paragraph (1), no medical 
        assistance shall be made available under a project for nursing 
        facility services or community-based long-term care services (as 
        defined by the Secretary) or for pregnancy-related services. No 
        medical assistance shall be made available under a project to 
        individuals confined to a State correctional facility, county 
        jail, local or county detention center, or other State 
        institution.
            ``(B) Permissible.--A State, with the approval of the 
        Secretary, may limit or otherwise deny eligibility for medical 
        assistance under the project and may limit coverage of items and 
        services under the project, other than early and periodic 
        screening, diagnostic, and treatment services for children under 
        18 years of age.
        ``(3) Use of utilization controls.--Nothing in this subsection 
    shall be construed as limiting a State's authority to impose 
    controls over utilization of services, including preadmission 
    requirements, managed care provisions, use of preferred providers, 
    and use of second opinions before surgical procedures.
    ``(c) Premiums and Cost-Sharing.--
        ``(1) None for those with income below the poverty line.--Under 
    a project, there shall be no premiums, coinsurance, or other cost-
    sharing for individuals whose family income level does not exceed 
    100 percent of the income official poverty line (as defined in 
    subsection (g)(1)) applicable to a family of the size involved.
        ``(2) Limit for those with income above the poverty line.--Under 
    a project, for individuals whose family income level exceeds 100 
    percent, but is less than 150 percent, of the income official 
    poverty line applicable to a family of the size involved, the 
    monthly average amount of premiums, coinsurance, and other cost-
    sharing for covered items and services shall not exceed 3 percent of 
    the family's average gross monthly earnings.
        ``(3) Income determination.--Each project shall provide for 
    determinations of income in a manner consistent with the methodology 
    used for determinations of income under title XIX of the Social 
    Security Act [this subchapter] for individuals entitled to benefits 
    under part A of title IV of such Act [part A of subchapter IV of 
    this chapter].
    ``(d) Duration.--Each project under this section shall commence not 
later than July 1, 1991 and shall be conducted for a 3-year period; 
except that the Secretary may terminate such a project if the Secretary 
determines that the project is not in substantial compliance with the 
requirements of this section.
    ``(e) Limits on Expenditures and Funding.--
        ``(1) In general.--(A) The Secretary in conducting projects 
    shall limit the total amount of the Federal share of benefits paid 
    and expenses incurred under title XIX of the Social Security Act 
    [this subchapter] to no more than $40,000,000.
        ``(B) Of the amounts appropriated under subparagraph (A), the 
    Secretary shall provide that no more than one-third of such amounts 
    shall be used to carry out the projects described in paragraph 
    (1)(B) of subsection (a) (for which the statewideness requirement 
    has been waived).
        ``(2) No funding of current beneficiaries.--No funding shall be 
    available under a project with respect to medical assistance 
    provided to individuals who are otherwise eligible for medical 
    assistance under the plan without regard to the project.
        ``(3) No increase in federal medical assistance percentage.--
    Payments to a State under a project with respect to expenditures 
    made for medical assistance made available under the project may not 
    exceed the Federal medical assistance percentage (as defined in 
    section 1905(b) of the Social Security Act [section 1396d(b) of this 
    title]) of such expenditures.
    ``(f) Evaluation and Report.--
        ``(1) Evaluations.--For each project the Secretary shall provide 
    for an evaluation to determine the effect of the project with 
    respect to--
            ``(A) access to, and costs of, health care,
            ``(B) private health care insurance coverage, and
            ``(C) premiums and cost-sharing.
        ``(2) Reports.--The Secretary shall prepare and submit to 
    Congress an interim report on the status of the projects not later 
    than January 1, 1993, and a final report containing such summary 
    together with such further recommendations as the Secretary may 
    determine appropriate not later than one year after the termination 
    of the projects.
    ``(g) Definitions.--In this section:
        ``(1) The term `income official poverty line' means such line as 
    defined by the Office of Management and Budget and revised annually 
    in accordance with section 673(2) of the Omnibus Budget 
    Reconciliation Act of 1981 [section 9902(2) of this title].
        ``(2) The term `project' refers to a demonstration project under 
    subsection (a).''
    [Section 13643(a) of Pub. L. 103-66 provided in part that the 
amendment made by that section to section 4745 of Pub. L. 101-508, set 
out above, is effective as if included in enactment of Pub. L. 101-508.]


  Demonstration Project To Provide Medicaid Coverage for HIV-Positive 
                               Individuals

    Section 4747 of Pub. L. 101-508 provided that:
    ``(a) In General.--Not later than 3 months after the date of the 
enactment of this Act [Nov. 5, 1990], the Secretary of Health and Human 
Services (hereafter in this section referred to as the `Secretary') 
shall provide for 2 demonstration projects to be administered by States 
that submit an application under this section, through programs 
administered by the States under title XIX of the Social Security Act 
[this subchapter]. Such demonstration projects shall provide coverage 
for the services described in subsection (c) to individuals whose income 
and resources do not exceed the maximum allowable amount for eligibility 
for any individual in any category of disability under the State plan 
under section 1902 of the Social Security Act [this section], and who 
have tested positive for the presence of HIV virus (without regard to 
the presence of any symptoms of AIDS or opportunistic diseases related 
to AIDS).
    ``(b) Services Available Under a Demonstration Project.--(1) The 
medical assistance made available to individuals described in section 
1902(a)(10)(A) of the Social Security Act [subsec. (a)(10)(A) of this 
section] shall be made available to individuals described in subsection 
(a) who receive services under a demonstration project under such 
paragraph.
    ``(2) A demonstration project under subsection (a) shall provide 
services in addition to the services described in paragraph (1) which 
shall be limited only on the basis of medical necessity or the 
appropriateness of such services. To the extent not provided as 
described in paragraph (1), such additional services shall include--
        ``(A) general and preventative medical care services (including 
    inpatient, outpatient, residential care, physician visits, clinic 
    visits, and hospice care);
        ``(B) prescription drugs, including drugs for the purposes of 
    preventative health care services;
        ``(C) counseling and social services;
        ``(D) substance abuse treatment services (including services for 
    multiple substances abusers);
        ``(E) home care services (including assistance in carrying out 
    activities of daily living);
        ``(F) case management;
        ``(G) health education services;
        ``(H) respite care for caregivers;
        ``(I) dental services; and
        ``(J) diagnostic and laboratory services[.]
    ``(c) Agreements With States.--(1) Each State conducting a 
demonstration project under subsection (a) shall enter into an agreement 
with a hospital and at least one other nonprofit organization submitting 
applications to the State. The State shall require that such hospital 
and other entity have a demonstrated record of case management of 
patients who have tested positive for the presence of HIV virus and have 
access to a control group of such type of patients who are not receiving 
State or Federal payments for medical services (or other payments from 
private insurance coverage) before developing symptoms of AIDS. Under 
such agreement, the State shall agree to pay each such entity for the 
services provided under subsection (b) and not later than 12 months 
after the commencement of a demonstration project, institute a system of 
monthly payment to each such entity based on the average per capita cost 
of the services described in subsection (c) provided to individuals 
described in paragraphs (1) and (2) of subsection (a).
    ``(2) A demonstration project described in subsection (a) shall be 
limited to an enrollment of not more than 200 individuals.
    ``(3) A demonstration project conducted under subsection (a) shall 
commence not later than 9 months after the date of the enactment of this 
Act [Nov. 5, 1990] and shall terminate on the date that is 3 years after 
the date of commencement.
    ``(4)(A) The Secretary shall provide for an evaluation of the 
comparative costs of providing services to individuals who have tested 
positive for the presence of HIV virus at an early stage after detection 
of such virus and those that are treated at a later stage after such 
detection.
    ``(B) The Secretary shall report to Congress on the results of the 
evaluation conducted under subparagraph (A) no later than 6 months after 
the date of termination of the demonstration projects described in this 
section.
    ``(d) Federal Share of Costs.--The Federal share of the cost of 
services described in paragraph (3) furnished under a demonstration 
project conducted under paragraph (1) shall be determined by the 
otherwise applicable Federal matching assistance percentage pursuant to 
section 1905(b) of the Social Security Act [section 1396d(b) of this 
title].
    ``(e) Waiver of Requirements of the Social Security Act.--The 
Secretary may waive such requirements of the Social Security Act [this 
chapter] as the Secretary determines to be necessary to carry out the 
purposes of this section.
    ``(f) Limitation on Amount of Expenditures.--The amount of funds 
that may be expended as medical assistance to carry out the purposes of 
this section shall be $5,000,000 for fiscal year 1991, $12,000,000 for 
fiscal year 1992, and $13,000,000 for fiscal year 1993.''


                        Public Education Campaign

    Section 4751(d) of Pub. L. 101-508 provided that:
    ``(1) In general.--The Secretary, no later than 6 months after the 
date of enactment of this section [Nov. 5, 1990], shall develop and 
implement a national campaign to inform the public of the option to 
execute advance directives and of a patient's right to participate and 
direct health care decisions.
    ``(2) Development and distribution of information.--The Secretary 
shall develop or approve nationwide informational materials that would 
be distributed by providers under the requirements of this section 
[amending this section and sections 1396b and 1396r of this title and 
enacting provisions set out above], to inform the public and the medical 
and legal profession of each person's right to make decisions concerning 
medical care, including the right to accept or refuse medical or 
surgical treatment, and the existence of advance directives.
    ``(3) Providing assistance to states.--The Secretary shall assist 
appropriate State agencies, associations, or other private entities in 
developing the State-specific documents that would be distributed by 
providers under the requirements of this section. The Secretary shall 
further assist appropriate State agencies, associations, or other 
private entities in ensuring that providers are provided a copy of the 
documents that are to be distributed under the requirements of the 
section.
    ``(4) Duties of secretary.--The Secretary shall mail information to 
Social Security recipients, [and] add a page to the medicare handbook 
with respect to the provisions of this section.''


        Physician Identifier System; Deadline and Considerations

    Section 4752(a)(1)(B) of Pub. L. 101-508 provided that: ``The system 
established under the amendment made by subparagraph (A) [amending this 
section] may be the same as, or different from, the system established 
under section 9202(g) of the Consolidated Omnibus Budget Reconciliation 
Act of 1985 [Pub. L. 99-272, formerly set out in a note under section 
1395ww of this title].''


                 Foreign Medical Graduate Certification

    Section 4752(d) of Pub. L. 101-508 provided that:
    ``(1) Passage of fmgems examination in order to obtain identifier.--
The Secretary of Health and Human Service[s] shall provide, in the 
identifier system established under section 1902(x) of the Social 
Security Act [subsec. (x) of this section], that no foreign medical 
graduate (as defined in section 1886(h)(5)(D) of such Act [section 
1395ww(h)(5)(D) of this title]) shall be issued an identifier under such 
system unless the individual--
        ``(A) has passed the FMGEMS examination (as defined in section 
    1886(h)(5)(E) of such Act);
        ``(B) has previously received certification from, or has 
    previously passed the examination of, the Educational Commission for 
    Foreign Medical Graduates; or
        ``(C) has held a license from 1 or more States continuously 
    since 1958.
    ``(2) Effective date.--Paragraph (1) shall apply with respect to 
issuance of an identifier applicable to services furnished on or after 
January 1, 1992.''


     Exclusions in Determination of Income and Resources Under This 
                               Subchapter

    Section 11115(c) of Pub. L. 101-508 provided that: ``Pursuant to 
section 1902(a)(17) of the Social Security Act (42 U.S.C. 1396a(a)(17)), 
the Secretary of Health and Human Services shall promulgate regulations 
to exempt from any determination of income and resources (for the month 
of receipt and the following month) under title XIX of the Social 
Security Act [this subchapter] any refund of Federal income taxes made 
to an individual by reason of section 32 of the Internal Revenue Code of 
1986 [26 U.S.C. 32] (relating to earned income tax credit), and any 
payment made to an individual by an employer under section 3507 of such 
Code [26 U.S.C. 3507] (relating to advance payment of earned income 
credit).''


         Development of Model Applications for Medicaid Program

    Section 6506(b) of Pub. L. 101-239 provided that:
    ``(1) In general.--The Secretary of Health and Human Services shall, 
by not later than 1 year after the date of the enactment of this Act 
[Dec. 19, 1989], develop a model application form for use in applying 
for benefits under title XIX of the Social Security Act [this 
subchapter] for individuals who are not receiving cash assistance under 
part A of title IV of the Social Security Act [part A of subchapter IV 
of this chapter], and who are not institutionalized. In developing such 
model application form, the Secretary is not authorized to require that 
such form be adopted by States as part of their State medicaid plan.
    ``(2) Dissemination of model form.--The Secretary shall provide for 
publication in the Federal Register of the model application form 
developed under paragraph (1), and shall send a copy of such form to 
each State agency responsible for administering a State medicaid plan.''


  Clarification of Federal Financial Participation for Case-Management 
                                Services

    Section 8435 of Pub. L. 100-647 provided that: ``The Secretary of 
Health and Human Services may not fail or refuse to approve an amendment 
to a State plan under title XIX of the Social Security Act [this 
subchapter] that provides for coverage of case-management services 
described in section 1915(g)(2) of such Act [section 1396n(g)(2) of this 
title], or to deny payment to a State for such services under section 
1903(a)(1) of such Act [section 1396b(a)(1) of this title] on the basis 
that a State is required to provide such services under State law or on 
the basis that the State had paid or is paying for such services from 
non-Federal funds before or after April 7, 1986. Nothing in this section 
shall be construed as requiring the Secretary to make payment to a State 
under section 1903(a)(1) of such Act for such case-management services 
which are provided without charge to the users of such services.''


       Treatment of States Operating Under Demonstration Projects

    Section 301(g)(1) of Pub. L. 100-360 provided that: ``In the case of 
any State which is providing medical assistance to its residents under a 
waiver granted under section 1115(a) of the Social Security Act [section 
1315(a) of this title], the Secretary of Health and Human Services shall 
require the State to meet the requirement of section 1902(a)(10)(E) of 
the Social Security Act [subsec. (a)(10)(E) of this section] in the same 
manner as the State would be required to meet such requirement if the 
State had in effect a plan approved under title XIX of such Act [this 
subchapter].''


Adjustment in Medicaid Payment for Inpatient Hospital Services Furnished 
                   by Disproportionate Share Hospitals

    Pub. L. 100-203, title IV, Sec. 4112, Dec. 22, 1987, 101 Stat. 1330-
148, which related to adjustment in medicaid payment for inpatient 
hospital services furnished by disproportionate share hospitals was 
amended by Pub. L. 100-360, title IV, Sec. 411(k)(6)(A)-(B)(i), July 1, 
1988, 102 Stat. 792, 793, and so amended, Sec. 4112 enacts the 
provisions of former section 4112 as section 1396r-4 of this title and 
amends sections 1396b and 1396s of this title.


  Amendment to State Plan To Provide Adjustment for Services Furnished 
                         During Fiscal Year 1990

    Section 4211(b)(2) of Pub. L. 100-203, as amended by Pub. L. 101-
508, title IV, Sec. 4801(e)(1)(B), Nov. 5, 1990, 104 Stat. 1388-215, 
provided that: ``A plan of a State under title XIX of the Social 
Security Act [this subchapter] shall not be considered to have met the 
requirement of section 1902(a)(13)(A) of the Social Security Act 
[subsec. (a)(13)(A) of this section] (as amended by paragraph (1)(A) of 
this subsection), as of the first day of a Federal fiscal year 
(beginning on or after October 1, 1990), unless the State has submitted 
to the Secretary of Health and Human Services, as of April 1 before the 
fiscal year, an amendment to such State plan to provide for an 
appropriate adjustment in payment amounts for nursing facility services 
furnished during the Federal fiscal year. Each such amendment shall 
include a detailed description of the specific methodology to be used in 
determining the appropriate adjustment in payment amounts for nursing 
facility services. The Secretary shall, not later than September 30 
before the fiscal year concerned, review each such plan amendment for 
compliance with such requirement and by such date shall approve or 
disapprove each such amendment. If the Secretary disapproves such an 
amendment, the State shall immediately submit a revised amendment which 
meets such requirement. The absence of approval of such a plan amendment 
does not relieve the State or any nursing facility of any obligation or 
requirement under title XIX of the Social Security Act (as amended by 
this Act).''


 Technical Assistance With Respect to Facilities That Take Into Account 
                          Case Mix of Residents

    Section 4211(j) of Pub. L. 100-203 provided that: ``The Secretary of 
Health and Human Services shall, upon request by a State, furnish 
technical assistance with respect to the development and implementation 
of reimbursement methods for nursing facilities that take into account 
the case mix of residents in the different facilities.''


                    State Utilization Review Systems

    Section 9432 of Pub. L. 99-509, as amended by Pub. L. 100-203, title 
IV, Sec. 4118(p)(11), as added by Pub. L. 100-360, title IV, 
Sec. 411(k)(10)(M), July 1, 1988, 102 Stat. 797; Pub. L. 101-508, title 
IV, Sec. 4755(b), Nov. 5, 1990, 104 Stat. 1388-210, provided that:
    ``(a) In General.--(1) The Secretary of Health and Human Services 
(in this section referred to as the `Secretary') may not publish final 
or interim final regulations requiring a State plan approved under title 
XIX of the Social Security Act [this subchapter] to include a program 
requiring second surgical opinions or a program of inpatient hospital 
preadmission review.
    ``(2) The Secretary may not, during the period beginning on the date 
of the enactment of the Omnibus Budget Reconciliation Act of 1990 [Nov. 
5, 1990] and ending on the date that is 180 days after the date on which 
the report required by subsection (d) is submitted to the Congress, 
publish final or interim final regulations requiring a State plan 
approved under title XIX of the Social Security Act [this subchapter] to 
include a program for ambulatory surgery, preadmission testing, or same-
day surgery.
    ``(b) Report.--
        ``(1) The Secretary shall report to Congress, by not later than 
    October 1, 1988, for each State in a representative sample of 
    States--
            ``(A) the identity of those procedures which are high volume 
        or high cost procedures among patients who are covered under the 
        State medicaid plan,
            ``(B) the payment rates under those plans for such 
        procedures, and the aggregate annual payment amounts made under 
        such plans for such procedures (including the Federal share of 
        such payment amounts),
            ``(C) the rate at which each such procedure is performed on 
        medicaid patients and (to the extent that data are available) 
        comparisons to the rate at which such procedure is performed on 
        patients of comparable age who are not medicaid patients,
            ``(D) with respect to each such procedure--
                ``(i) the number of board certified or board eligible 
            physicians in the State who provide care and services to 
            medicaid patients and who perform the procedure, and
                ``(ii) in the case of a State with a mandatory second 
            surgical opinion program in operation, the number of 
            physicians described in clause (i) who provide second 
            opinions (of the type described in section 1164 of the 
            Social Security Act [section 1320c-13 of this title]) for 
            the procedure at prevailing payment rates under the State 
            medicaid plan, and
            ``(E) in the case of a State with a mandatory second 
        surgical opinion program or a program of inpatient hospital 
        preadmission review in operation, a description of--
                ``(i) the extent to which such program impedes access to 
            necessary care and services, and
                ``(ii) the measures that the State has taken to address 
            such impediments, particularly in rural areas.
        ``(2) Such report shall also include a list of those surgical 
    procedures which the Secretary believes meet the following criteria 
    and for which a mandatory second opinion program under medicaid 
    plans may be appropriate:
            ``(A) The procedure is one which generally can be postponed 
        without undue risk to the patient.
            ``(B) The procedure is a high volume procedure among 
        patients who are covered under State medicaid plans or is a high 
        cost procedure.
            ``(C) The procedure has a comparatively high rate of 
        nonconfirmation upon examination by another qualified physician, 
        there is substantial geographic variation in the rates of 
        performance of the procedure, or there are other reasons why 
        requiring second opinions for 100 percent of such procedures 
        would be cost effective.
        ``(3) The representative sample of States required to be 
    included in the report shall include States with mandatory second 
    surgical opinion programs in operation, States with programs of 
    inpatient hospital preadmission review in operation, and States with 
    neither such program in operation.
        ``(4) In this subsection and subsection (d), the term `medicaid 
    plan' means a State plan approved under title XIX of the Social 
    Security Act [this subchapter].
    ``(c) Study.--
        ``(1) The Secretary shall conduct a study of the utilization of 
    selected medical treatments and surgical procedures by medicaid 
    beneficiaries in order to assess the appropriateness, necessity, and 
    effectiveness of such treatments and procedures.
        ``(2) The study shall analyze the extent to which there is 
    significant variation in the rate of utilization by medicaid 
    beneficiaries of selected treatments and procedures for different 
    geographic areas within States and among States.
        ``(3) The study shall also identify underutilized, medically 
    necessary treatments and procedures for which--
            ``(A) a failure to furnish could have an adverse effect on 
        health status, and
            ``(B) the rate of utilization by medicaid beneficiaries is 
        significantly less than the rate for comparable, age-adjusted 
        populations.
        ``(4) The study shall be coordinated, to the extent practicable, 
    with the research program established pursuant to section 1875(c) of 
    the Social Security Act [section 1395ll(c) of this title], with 
    particular regard to the relationship of the variations described in 
    paragraph (2) to patient outcomes.
        ``(5) The Secretary shall submit an interim report on the 
    results of the study, including an analysis of the geographic 
    variations under paragraph (2), to the Congress not later than 
    January 1, 1990, and shall report the final results of the study to 
    the Congress not later than January 1, 1992.
    ``(d) Report.--The Secretary shall report to Congress, by not later 
than January 1, 1993, for each State in a representative sample of 
States--
        ``(1) an analysis of the procedures for which programs for 
    ambulatory surgery, preadmission testing, and same-day surgery are 
    appropriate for patients who are covered under the State medicaid 
    plan, and
        ``(2) the effects of such programs on access of such patients to 
    necessary care, quality of care, and costs of care.
In selecting such a sample of States, the Secretary shall include some 
States with medicaid plans that include such programs.''


                       Promulgation of Regulations

    Section 9503(c) of Pub. L. 99-272 provided that: ``The Secretary of 
Health and Human Services shall promulgate final regulations necessary 
to carry out sections 1902(a)(25) and 1903(r)(6)(J) of the Social 
Security Act [subsec. (a)(25) of this section and section 1396b(r)(6)(J) 
of this title] within 6 months after the date of the enactment of this 
Act [Apr. 7, 1986].''


   Study by Comptroller General of Effect of Amendment to Subsection 
                                 (a)(13)

    Section 9509(c) of Pub. L. 99-272 directed Comptroller General to 
conduct a study of effects of the amendments made by this section and 
report results of such study to Congress two years after Apr. 7, 1986.


               Task Force on Technology-Dependent Children

    Section 9520 of Pub. L. 99-272 directed Secretary of Health and 
Human Services, within six months after Apr. 7, 1986, to establish a 
task force concerning alternatives to institutional care for technology-
dependent children, such task force to (1) include representatives of 
Federal and State agencies with responsibilities relating to child 
health, health insurers, large employers (including those that self-
insure for health care costs), providers of health care to technology-
dependent children, and parents of technology-dependent children, (2) 
identify barriers that prevent the provision of appropriate care in a 
home or community setting to meet special needs of technology-dependent 
children, (3) recommend changes in the provision and financing of health 
care in private and public health care programs (including appropriate 
joint public-private initiatives) so as to provide home and community-
based alternatives to the institutionalization of technology-dependent 
children, and (4) make a final report to Secretary and to Congress on 
its activities not later than two years after Apr. 7, 1986.


  Medicaid Coverage Relating to Adoption Assistance Agreements Entered 
                        Into Before April 7, 1986

    Section 9529(b)(2) of Pub. L. 99-272 provided that: ``In the case of 
an adoption assistance agreement (other than an agreement under part E 
of title IV of the Social Security Act [part E of subchapter IV of this 
chapter]) entered into before the date of the enactment of this Act 
[Apr. 7, 1986]--
        ``(A) the requirements of subdivisions (aa) and (bb) of section 
    1902(a)(10)(A)(ii)(VIII) of the Social Security Act [subsec. 
    (a)(10)(A)(ii)(VIII)(aa), (bb) of this section] shall be deemed to 
    be met if the State agency responsible for adoption assistance 
    agreements determines that--
            ``(i) at the time of adoptive placement the child had 
        special needs for medical or rehabilitative care that made the 
        child difficult to place; and
            ``(ii) there is in effect with respect to such child an 
        adoption assistance agreement between the State and an adoptive 
        parent or parents; and
        ``(B) the requirement of subdivision (cc) of such section shall 
    be deemed to be met if the child was found by the State to be 
    eligible for medical assistance prior to such agreement being 
    entered into.''


                Payment for Psychiatric Hospital Services

    Section 2366 of Pub. L. 98-369 provided that: ``The provisions of 
section 1902(a)(13) of the Social Security Act [subsec. (a)(13) of this 
section], in so far as they require a reduction of the amount of payment 
otherwise to be made to a public psychiatric hospital due to the level 
of care received in such hospital, shall not apply to payments to 
hospitals before July 1, 1985, and such a reduction made for payments 
during the 12-month period ending June 30, 1986, and during the 12-month 
period ending June 30, 1987, shall be one-third and two-thirds, 
respectively, of the amount of the reduction which would have been made 
without regard to this section.''


              Moratorium on Regulatory Actions by Secretary

    Section 2373(c) of Pub. L. 98-369, as amended by Pub. L. 100-93, 
Sec. 9, Aug. 18, 1987, 101 Stat. 695, provided that:
    ``(1) The Secretary of Health and Human Services shall not take any 
compliance, disallowance, penalty, or other regulatory action against a 
State with respect to the moratorium period described in paragraph (2) 
by reason of such State's plan described in paragraph (5) under title 
XIX of the Social Security Act [this subchapter] (including any part of 
the plan operating pursuant to section 1902(f) of such Act [subsec. (f) 
of this section]), or the operation thereunder, being determined to be 
in violation of clause (IV), (V), or (VI) of section 1902(a)(10)(A)(ii) 
or section 1902(a)(10)(C)(i)(III) of such Act on account of such plan's 
(or its operation) having a standard or methodology which the Secretary 
interprets as being less restrictive than the standard or methodology 
required under such section, provided that such plan (or its operation) 
does not make ineligible any individual who would be eligible but for 
the provisions of this subsection.
    ``(2) The moratorium period is the period beginning on October 1, 
1981, and ending 18 months after the date on which the Secretary submits 
the report required under paragraph (3).
    ``(3) The Secretary shall report to the Congress within 12 months 
after the date of the enactment of this Act [July 18, 1984] with respect 
to the appropriateness, and impact on States and recipients of medical 
assistance, of applying standards and methodologies utilized in cash 
assistance programs to those recipients of medical assistance who do not 
receive cash assistance, and any recommendations for changes in such 
requirements.
    ``(4) No provision of law shall repeal or suspend the moratorium 
imposed by this subsection unless such provision specifically amends or 
repeals this subsection.
    ``(5) In this subsection, a State plan is considered to include--
        ``(A) any amendment or other change in the plan which is 
    submitted by a State, or
        ``(B) any policy or guideline delineated in the Medicaid 
    operation or program manuals of the State which are submitted by the 
    State to the Secretary,
whether before or after the date of enactment of this Act [July 18, 
1984] and whether or not the amendment or change, or the operating or 
program manual was approved, disapproved, acted upon, or not acted upon 
by the Secretary.
    ``(6) During the moratorium period, the Secretary shall implement 
(and shall not change by any administrative action) the policy in effect 
at the beginning of such moratorium period with respect to--
        ``(A) the point in time at which an institutionalized individual 
    must sell his home (in order that it not be counted as a resource); 
    and
        ``(B) the time period allowed for sale of a home of any such 
    individual,
who is an applicant for or recipient of medical assistance under the 
State plan as a medically needy individual (described in section 
1902(a)(10)(C) of the Social Security Act [subsec. (a)(10)(C) of this 
section]) or as an optional categorically needy individual (described in 
section 1902(a)(10)(A)(ii) of such Act).''
    [Amendment of section 2373(c) of Pub. L. 98-369, set out above, by 
section 9 of Pub. L. 100-93 applicable as though originally included in 
Pub. L. 98-369, Sec. 2373(c), see section 15(e) of Pub. L. 100-93, set 
out as an Effective Date of 1987 Amendment note under section 1320a-7 of 
this title.]


      Evaluation and Study of Reasons for Termination by Medicaid 
     Beneficiaries of Membership in Health Maintenance Organizations

    Section 2178(d) of Pub. L. 97-35 directed Secretary of Health and 
Human Services to conduct a study evaluating extent of, and reasons for, 
termination by medicaid beneficiaries of their memberships in health 
maintenance organizations, placing special emphasis on quantity and 
quality of medical care provided in health maintenance organizations and 
quality of such care when provided on a fee-for-service basis, with 
Secretary to submit an interim report to Congress, within two years 
after Aug. 13, 1981, and a final report within five years from such date 
containing, respectively, the interim and final findings and conclusions 
made as a result of such study.


  Continuing Medicaid Eligibility for Certain Recipients of Veterans' 
                         Administration Pensions

    Section 310(b)(1) of Pub. L. 96-272 provided that:
    ``(A) For purposes of section 1902(a)(10)(A) of the Social Security 
Act [subsec. (a)(10)(A) of this section], any individual who, prior to 
the date of enactment of this Act [June 17, 1980] and for the month of 
December 1978, was eligible for and received aid or assistance under a 
State plan approved under title I, X, XIV, or XVI, or part A of title IV 
of such Act [subchapter I, X, XIV, or XVI, or part A of subchapter IV of 
this chapter], or was eligible for and received supplemental security 
income benefits under title XVI of such Act [subchapter XVI of this 
chapter] (or a supplementary payment described in section 13(c) of 
Public Law 93-233) [set out as a note under this section], and was also 
in receipt of (or was a dependent, for purposes of chapter 15 of title 
38, United States Code, as in effect on December 31, 1978, of an 
individual in receipt of) pension from the Veterans' Administration for 
the month of December 1978 shall (subject to subparagraph (B)) be deemed 
to have been receiving such aid, assistance, supplemental security 
income, or supplementary payment, for each calendar month thereafter 
(prior to the month in which the provisions of this subparagraph cease 
to be effective with respect to him as determined under subparagraph 
(B)), if such individual would have been eligible therefor in December 
1978 and in the month in which the provisions of this subparagraph cease 
to be effective with respect to him as determined under subparagraph (B) 
had the increase in income of such individual (or of the family of which 
such individual is a member), attributable to an election (made by such 
individual or another member of such individual's family) under section 
306 of the Veterans' and Survivors' Pension Improvement Act of 1978 
[section 306 of Pub. L. 95-588, set out as a note under section 521 of 
Title 38, Veterans' Benefits], not occurred.
    ``(B)(i) The provisions of subparagraph (A) shall take effect on 
January 1, 1979, and shall cease to be effective, in the case of any 
individual, for and after the first calendar month beginning more than 
10 days after an `informed election' (as defined in subdivision (ii) of 
this subparagraph) has been made by such individual (or, if such 
individual is not eligible to make such an election, by a member of such 
individual's family who is eligible to make such an election which 
affects such individual's eligibility for aid, assistance, or benefits 
under a plan or program referred to in subparagraph (A)).
    ``(ii) The term `informed election' means an election made under 
section 306 of the Veterans' and Survivors' Pension Improvement Act of 
1978 [section 306 of Pub. L. 95-588, set out as a note under section 521 
of Title 38] (or a reaffirmation of such an election which previously 
was made under such section 306) after the date of compliance by the 
Administrator of Veterans' Affairs (hereinafter in this section referred 
to as the `Administrator') with the provisions of paragraph (2)(A) with 
respect to the individual concerned. An individual who fails, within the 
time limits prescribed in paragraph (2)(B), to disaffirm an election 
previously made by such individual under such section 306 shall be 
deemed, for purposes of this section and such section 306, to have 
reaffirmed such election.''


  Preservation of Medicaid Eligibility for Individuals Who Cease To Be 
 Eligible for Supplemental Security Income Benefits on Account of Cost-
             of-Living Increases in Social Security Benefits

    Pub. L. 94-566, title V, Sec. 503, Oct. 20, 1976, 90 Stat. 2685, 
provided that: ``In addition to other requirements imposed by law as a 
condition for the approval of any State plan under title XIX of the 
Social Security Act [this subchapter], there is hereby imposed the 
requirement (and each such State plan shall be deemed to require) that 
medical assistance under such plan shall be provided to any individual, 
for any month after June 1977 for which such individual is entitled to a 
monthly insurance benefit under title II of such Act [subchapter II of 
this chapter] but is not eligible for benefits under title XVI of such 
Act [subchapter XVI of this chapter], in like manner and subject to the 
same terms and conditions as are applicable under such State plan in the 
case of individuals who are eligible for and receiving benefits under 
such title XVI [subchapter XVI of this chapter] for such month, if for 
such month such individual would be (or could become) eligible for 
benefits under such title XVI [subchapter XVI of this chapter] except 
for amounts of income received by such individual and his spouse (if 
any) which are attributable to increases in the level of monthly 
insurance benefits payable under title II of such Act [subchapter II of 
this chapter] which have occurred pursuant to section 215(i) of such Act 
[section 415(i) of this title], in the case of such individual, since 
the last month after April 1977 for which such individual was both 
eligible for (and received) benefits under such title XVI [subchapter 
XVI of this chapter] and was entitled to a monthly insurance benefit 
under such title II [subchapter II of this chapter], and, in the case of 
such individual's spouse (if any), since the last such month for which 
such spouse was both eligible for (and received) benefits under such 
title XVI [subchapter XVI of this chapter] and was entitled to a monthly 
insurance benefit under such title II [subchapter II of this chapter]. 
Solely for purposes of this section, payments of the type described in 
section 1616(a) of the Social Security Act [section 1382e(a) of this 
title] or of the type described in section 212(a) of Public Law 93-66 
[set out as note under section 1382 of this title] shall be deemed to be 
benefits under title XVI of the Social Security Act [subchapter XVI of 
this chapter].''


     Medicaid Eligibility for Individuals Receiving Mandatory State 
                 Supplementary Payments; Effective Date

    Section 13(c) of Pub. L. 93-233 provided that: ``In addition to 
other requirements imposed by law as conditions for the approval of any 
State plan under title XIX of the Social Security Act [this subchapter], 
there is hereby imposed (effective January 1, 1974) the requirement (and 
each such State plan shall be deemed to require) that medical assistance 
under such plan shall be provided to any individual--
        ``(1) for any month for which there (A) is payable with respect 
    to such individual a supplementary payment pursuant to an agreement 
    entered into between the State and the Secretary of Health, 
    Education, and Welfare [now Health and Human Services] under section 
    212(a) of Public Law 93-66 [set out as note under section 1382 of 
    this title], and (B) would be payable with respect to such 
    individual such a supplementary payment, if the amount of the 
    supplementary payments payable pursuant to such agreement were 
    established without regard to paragraph (3)(A)(ii) of such section 
    212(a) [set out as note under section 1382 of this title], and
        ``(2) in like manner, and subject to the same terms and 
    conditions, as medical assistance is provided under such plan to 
    individuals with respect to whom benefits are payable for such month 
    under the supplementary security income program established by title 
    XVI of the Social Security Act [subchapter XVI of this chapter].
Federal matching under title XIX of the Social Security Act [this 
subchapter] shall be available for the medical assistance furnished to 
individuals who are eligible for such assistance under this 
subsection.''


              Coverage of Essential Persons Under Medicaid

    Section 230 of Pub. L. 93-66, title II, July 9, 1973, 87 Stat. 159, 
provided that: ``In the case of any State plan (approved under title XIX 
of the Social Security Act [this subchapter]) which for December 1973 
provided medical assistance to persons described in section 1905(a)(vi) 
of such Act [section 1396d(a)(vi) of this title], there is hereby 
imposed the requirement (and such State plan shall be deemed to require) 
that medical assistance under such plan be provided to each such person 
(who for December 1973 was eligible for medical assistance under such 
plan) for each month (after December 1973) that--
        ``(1) the individual (referred to in the last sentence of 
    section 1905(a) of such Act [section 1396d(a) of this title]) with 
    whom such person is living continues to meet the criteria (as in 
    effect for December 1973) for aid or assistance under a State plan 
    (referred to in such sentence), and
        ``(2) such person continues to have the relationship with such 
    individual described in such sentence and meets the other criteria 
    (referred to in such sentence) with respect to a State plan (so 
    referred to) as such plan was in effect for December 1973.
Federal matching under title XIX of the Social Security Act [this 
subchapter] shall be available for the medical assistance furnished to 
individuals eligible for such assistance under this section.''


                     Persons in Medical Institutions

    Section 231 of Pub. L. 93-66, title II, July 9, 1973, 87 Stat. 159, 
as amended by Pub. L. 93-233, Sec. 13(b)(1), Dec. 31, 1973, 87 Stat. 
964, provided that: ``For purposes of section 1902(a)(10) of the Social 
Security Act [subsec. (a)(10) of this section], any individual who, for 
all (or any part of) the month of December 1973--
        ``(1) was an inpatient in an institution qualified for 
    reimbursement under title XIX of the Social Security Act [this 
    subchapter], and
        ``(2)(A) received or would (except for his being an inpatient in 
    such institution) have been eligible to receive aid or assistance 
    under a State plan approved under title I, X, XIV, or XVI of such 
    Act [subchapter I, X, XIV, or XVI of this chapter], and
        ``(B), [sic] on the basis of his status as described in 
    subparagraph (A), was included as an individual eligible for medical 
    assistance under a State plan approved under title XIX of such Act 
    [this subchapter] (whether or not such individual actually received 
    aid or assistance under a State plan referred to in subparagraph 
    (A)),
shall be deemed to be receiving such aid or assistance for such month 
and for each succeeding month in a continuous period of months if, for 
each month in such period--
        ``(3) such individual continues to be (for all of such month) an 
    inpatient in such an institution and would (except for his being an 
    inpatient in such institution) continue to meet the conditions of 
    eligibility to receive aid or assistance under such plan (as such 
    plan was in effect for December 1973), and
        ``(4) such individual is determined (under the utilization 
    review and other professional audit procedures applicable to State 
    plans approved under title XIX of the Social Security Act [this 
    subchapter]) to be in need of care in such an institution.
Federal matching under title XIX of the Social Security Act [this 
subchapter] shall be available for the medical assistance furnished to 
individuals eligible for such assistance under this section.''


              Blind and Disabled Medically Indigent Persons

    Section 232 of Pub. L. 93-66, title II, July 9, 1973, 87 Stat. 160, 
as amended by Pub. L. 93-233, Sec. 13(b)(2), Dec. 31, 1973, 87 Stat. 
964, provided that: ``For purposes of section 1902(a)(10) of the Social 
Security Act [subsec. (a)(10) of this section], any individual who, for 
the month of December 1973 was eligible [subsec. (a)(10) of this 
section] for medical assistance by reason of his having been determined 
to meet the criteria for blindness or disability (established by a State 
plan approved under title I, X, XIV, or XVI of such Act [subchapter I, 
X, XIV, or XVI of this chapter]), shall be deemed for purposes of title 
XIX [this subchapter] to be an individual who is blind or disabled 
within the meaning of section 1614(a) of the Social Security Act 
[section 1382c(a) of this title] for each month in a continuous period 
of months (beginning with the month of January 1974), if, for each month 
in such period, such individual continues to meet the criteria for 
blindness or disability so established by such a State plan (as it was 
in effect for December 1973), and the other conditions of eligibility 
contained in the plan of the State approved under title XIX [this 
subchapter] (as it was in effect in December 1973). Federal matching 
under title XIX of the Social Security Act [this subchapter] shall be 
available for the medical assistance furnished to individuals eligible 
for such assistance under this section.''


 Impact of 1972 Social Security Benefits Increase Under Pub. L. 92-336 
          Upon Eligibility for Assistance Under This Subchapter

    Section 249E of Pub. L. 92-603, as amended by section 233 of Pub. L. 
93-66, title II, July 9, 1973, 87 Stat. 160, provided that: ``For 
purposes of section 1902(a)(10) of the Social Security Act [subsec. 
(a)(10) of this section] any individual who, for the month of August 
1972, was eligible for or receiving aid or assistance under a State plan 
approved under title I, X, XIV, or XVI, or part A of title IV of such 
Act [subchapter I, X, XIV, or XVI, or part A of subchapter IV of this 
chapter] and who for such month was entitled to monthly insurance 
benefits under title II of such Act [subchapter II of this chapter] 
shall be deemed to be eligible for such aid or assistance for any month 
thereafter prior to July 1975 if such individual would have been 
eligible for such aid or assistance for such month had the increase in 
monthly insurance benefits under title II of such Act [subchapter II of 
this chapter] resulting from enactment of Pub. L. 92-336 [see Tables] 
not been applicable to such individual.''


Nursing Homes Eligible for Matching Funds for Home Services When Meeting 
            State Licensure Requirements After June 30, 1968

    Section 234(c) of Pub. L. 90-248 provided that: ``Notwithstanding 
any other provision of law, after June 30, 1968, no Federal funds shall 
be paid to any State as Federal matching under title I, X, XIV, XVI, or 
XIX of the Social Security Act [subchapter I, X, XIV, XVI, or XIX of 
this chapter] for payments made to any nursing home for or on account of 
any nursing home services provided by such nursing home for any period 
during which such nursing home is determined not to meet fully all 
requirements of the State for licensure as a nursing home, except that 
the Secretary may prescribe a reasonable period or periods of time 
during which a nursing home which has formerly met such requirements 
will be eligible for payments which include Federal participation if 
during such period or periods such home promptly takes all necessary 
steps to again meet such requirements.''


            District of Columbia; Plan for Medical Assistance

    Pub. L. 90-227, Sec. 1, Dec. 27, 1967, 81 Stat. 744, provided: 
``That (a) the Commissioner of the District of Columbia [now Mayor] 
(hereafter in this Act [enacting this note and provisions set out as a 
note under section 1395v of this title] referred to as the 
`Commissioner') may submit under title XIX of the Social Security Act 
[this subchapter] to the Secretary of Health, Education, and Welfare 
[now Health and Human Services] (hereafter in this Act referred to as 
the `Secretary') a plan for medical assistance (and any modifications of 
such plan) to enable the District of Columbia to receive Federal 
financial assistance under such title for a medical assistance program 
established by the Commissioner under such plan.
    ``(b)(1) Notwithstanding any other provision of law, the 
Commissioner may take such action as may be necessary to submit such 
plan to the Secretary and to establish and carry out such medical 
assistance program, except that in prescribing the standards for 
determining eligibility for and the extent of medical assistance under 
the District of Columbia's plan for medical assistance, the Commissioner 
may not (except to the extent required by title XIX of the Social 
Security Act [this subchapter])--
        ``(A) prescribe maximum income levels for recipients of medical 
    assistance under such plan which exceed (i) the title XIX maximum 
    income levels if such levels are in effect, or (ii) the 
    Commissioner's maximum income levels for the local medical 
    assistance program if there are no title XIX maximum income levels 
    in effect; or
        ``(B) prescribe criteria which would permit an individual or 
    family to be eligible for such assistance if such individual or 
    family would be ineligible, solely by reason of his or its 
    resources, for medical assistance both under the plan of the State 
    of Maryland approved under title XIX of the Social Security Act 
    [this subchapter] and under the plan of the State of Virginia 
    approved under such title.
    ``(2) For purposes of subparagraph (A) of paragraph (1) of this 
subsection--
        ``(A) the term `title XIX maximum income levels' means any 
    maximum income levels which may be specified by title XIX of the 
    Social Security Act [this subchapter] for recipients of medical 
    assistance under State plans approved under that title;
        ``(B) the term `the Commissioner's maximum income levels for the 
    local medical assistance program' means the maximum income levels 
    prescribed for recipients of medical assistance under the District 
    of Columbia's medical assistance program in effect in the fiscal 
    year ending June 30, 1967; and
        ``(C) during any of the first four calendar quarters in which 
    medical assistance is provided under such plan there shall be deemed 
    to be no title XIX maximum income levels in effect if the title XIX 
    maximum income levels in effect during such quarter are higher than 
    the Commissioner's maximum income levels for the local medical 
    assistance program.''

                  Section Referred to in Other Sections

    This section is referred to in sections 256b, 300e-17, 608, 671, 
705, 1315, 1320a-7, 1320a-7a, 1320b-22, 1382c, 1382h, 1382i, 1395v, 
1395w-4, 1395w-21, 1395cc, 1396b, 1396c, 1396d, 1396e, 1396g, 1396g-1, 
1396i, 1396k, 1396l, 1396n, 1396o, 1396p, 1396r, 1396r-1, 1396r-1a, 
1396r-2, 1396r-4, 1396r-5, 1396r-6, 1396r-8, 1396s, 1396t, 1396u-1, 
1396u-2, 1396u-3, 1396u-4, 1397gg, 1397hh, 1397jj, 4728, 6006, 6022, 
6042, 14406 of this title; title 8 section 1255a; title 38 section 5503.
