
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)(4)]
[Document affected by Public Law 106-354 Section 2(c)]
[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)[709(a)]]
[Document affected by Public Law 106-554 Section 1(a)(6)[706]]
[Document affected by Public Law 106-554 Section 1(a)(6)[709(b)]]
[Document affected by Public Law 106-554 Section 1(a)(6)[802(f)]]
[CITE: 42USC1396d]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
    SUBCHAPTER XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
 
Sec. 1396d. Definitions

    For purposes of this subchapter--

(a) Medical assistance

    The term ``medical assistance'' means payment of part or all of the 
cost of the following care and services (if provided in or after the 
third month before the month in which the recipient makes application 
for assistance or, in the case of medicare cost-sharing with respect to 
a qualified medicare beneficiary described in subsection (p)(1) of this 
section, if provided after the month in which the individual becomes 
such a beneficiary) for individuals, and, with respect to physicians' or 
dentists' services, at the option of the State, to individuals (other 
than individuals with respect to whom there is being paid, or who are 
eligible, or would be eligible if they were not in a medical 
institution, to have paid with respect to them a State supplementary 
payment and are eligible for medical assistance equal in amount, 
duration, and scope to the medical assistance made available to 
individuals described in section 1396a(a)(10)(A) of this title) not 
receiving aid or assistance under any plan of the State approved under 
subchapter I, X, XIV, or XVI of this chapter, or part A of subchapter IV 
of this chapter, and with respect to whom supplemental security income 
benefits are not being paid under subchapter XVI of this chapter, who 
are--
        (i) under the age of 21, or, at the option of the State, under 
    the age of 20, 19, or 18 as the State may choose,
        (ii) relatives specified in section 606(b)(1) \1\ of this title 
    with whom a child is living if such child is (or would, if needy, 
    be) a dependent child under part A of subchapter IV of this chapter,
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    \1\ See References in Text note below.
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        (iii) 65 years of age or older,
        (iv) blind, with respect to States eligible to participate in 
    the State plan program established under subchapter XVI of this 
    chapter,
        (v) 18 years of age or older and permanently and totally 
    disabled, with respect to States eligible to participate in the 
    State plan program established under subchapter XVI of this chapter,
        (vi) persons essential (as described in the second sentence of 
    this subsection) to individuals receiving aid or assistance under 
    State plans approved under subchapter I, X, XIV, or XVI of this 
    chapter,
        (vii) blind or disabled as defined in section 1382c of this 
    title, with respect to States not eligible to participate in the 
    State plan program established under subchapter XVI of this chapter,
        (viii) pregnant women,
        (ix) individuals provided extended benefits under section 1396r-
    6 of this title,
        (x) individuals described in section 1396a(u)(1) of this title,
        (xi) individuals described in section 1396a(z)(1) of this title, 
    or
        (xii) employed individuals with a medically improved disability 
    (as defined in subsection (v) of this section),

but whose income and resources are insufficient to meet all of such 
cost--
        (1) inpatient hospital services (other than services in an 
    institution for mental diseases);
        (2)(A) outpatient hospital services, (B) consistent with State 
    law permitting such services, rural health clinic services (as 
    defined in subsection (l)(1) of this section) and any other 
    ambulatory services which are offered by a rural health clinic (as 
    defined in subsection (l)(1) of this section) and which are 
    otherwise included in the plan, and (C) Federally-qualified health 
    center services (as defined in subsection (l)(2) of this section) 
    and any other ambulatory services offered by a Federally-qualified 
    health center and which are otherwise included in the plan;
        (3) other laboratory and X-ray services;
        (4)(A) nursing facility services (other than services in an 
    institution for mental diseases) for individuals 21 years of age or 
    older; (B) early and periodic screening, diagnostic, and treatment 
    services (as defined in subsection (r) of this section) for 
    individuals who are eligible under the plan and are under the age of 
    21; and (C) family planning services and supplies furnished 
    (directly or under arrangements with others) to individuals of 
    child-bearing age (including minors who can be considered to be 
    sexually active) who are eligible under the State plan and who 
    desire such services and supplies;
        (5)(A) physicians' services furnished by a physician (as defined 
    in section 1395x(r)(1) of this title), whether furnished in the 
    office, the patient's home, a hospital, or a nursing facility, or 
    elsewhere, and (B) medical and surgical services furnished by a 
    dentist (described in section 1395x(r)(2) of this title) to the 
    extent such services may be performed under State law either by a 
    doctor of medicine or by a doctor of dental surgery or dental 
    medicine and would be described in clause (A) if furnished by a 
    physician (as defined in section 1395x(r)(1) of this title);
        (6) medical care, or any other type of remedial care recognized 
    under State law, furnished by licensed practitioners within the 
    scope of their practice as defined by State law;
        (7) home health care services;
        (8) private duty nursing services;
        (9) clinic services furnished by or under the direction of a 
    physician, without regard to whether the clinic itself is 
    administered by a physician, including such services furnished 
    outside the clinic by clinic personnel to an eligible individual who 
    does not reside in a permanent dwelling or does not have a fixed 
    home or mailing address;
        (10) dental services;
        (11) physical therapy and related services;
        (12) prescribed drugs, dentures, and prosthetic devices; and 
    eyeglasses prescribed by a physician skilled in diseases of the eye 
    or by an optometrist, whichever the individual may select;
        (13) other diagnostic, screening, preventive, and rehabilitative 
    services, including any medical or remedial services (provided in a 
    facility, a home, or other setting) recommended by a physician or 
    other licensed practitioner of the healing arts within the scope of 
    their practice under State law, for the maximum reduction of 
    physical or mental disability and restoration of an individual to 
    the best possible functional level;
        (14) inpatient hospital services and nursing facility services 
    for individuals 65 years of age or over in an institution for mental 
    diseases;
        (15) services in an intermediate care facility for the mentally 
    retarded (other than in an institution for mental diseases) for 
    individuals who are determined, in accordance with section 
    1396a(a)(31) of this title, to be in need of such care;
        (16) effective January 1, 1973, inpatient psychiatric hospital 
    services for individuals under age 21, as defined in subsection (h) 
    of this section;
        (17) services furnished by a nurse-midwife (as defined in 
    section 1395x(gg) of this title) which the nurse-midwife is legally 
    authorized to perform under State law (or the State regulatory 
    mechanism provided by State law), whether or not the nurse-midwife 
    is under the supervision of, or associated with, a physician or 
    other health care provider, and without regard to whether or not the 
    services are performed in the area of management of the care of 
    mothers and babies throughout the maternity cycle;
        (18) hospice care (as defined in subsection (o) of this 
    section);
        (19) case management services (as defined in section 1396n(g)(2) 
    of this title) and TB-related services described in section 
    1396a(z)(2)(F) of this title;
        (20) respiratory care services (as defined in section 
    1396a(e)(9)(C) of this title);
        (21) services furnished by a certified pediatric nurse 
    practitioner or certified family nurse practitioner (as defined by 
    the Secretary) which the certified pediatric nurse practitioner or 
    certified family nurse practitioner is legally authorized to perform 
    under State law (or the State regulatory mechanism provided by State 
    law), whether or not the certified pediatric nurse practitioner or 
    certified family nurse practitioner is under the supervision of, or 
    associated with, a physician or other health care provider;
        (22) home and community care (to the extent allowed and as 
    defined in section 1396t of this title) for functionally disabled 
    elderly individuals;
        (23) community supported living arrangements services (to the 
    extent allowed and as defined in section 1396u of this title);
        (24) personal care services furnished to an individual who is 
    not an inpatient or resident of a hospital, nursing facility, 
    intermediate care facility for the mentally retarded, or institution 
    for mental disease that are (A) authorized for the individual by a 
    physician in accordance with a plan of treatment or (at the option 
    of the State) otherwise authorized for the individual in accordance 
    with a service plan approved by the State, (B) provided by an 
    individual who is qualified to provide such services and who is not 
    a member of the individual's family, and (C) furnished in a home or 
    other location;
        (25) primary care case management services (as defined in 
    subsection (t) of this section);
        (26) services furnished under a PACE program under section 
    1396u-4 of this title to PACE program eligible individuals enrolled 
    under the program under such section; and
        (27) any other medical care, and any other type of remedial care 
    recognized under State law, specified by the Secretary,

except as otherwise provided in paragraph (16), such term does not 
include--
        (A) any such payments with respect to care or services for any 
    individual who is an inmate of a public institution (except as a 
    patient in a medical institution); or
        (B) any such payments with respect to care or services for any 
    individual who has not attained 65 years of age and who is a patient 
    in an institution for mental diseases.

For purposes of clause (vi) of the preceding sentence, a person shall be 
considered essential to another individual if such person is the spouse 
of and is living with such individual, the needs of such person are 
taken into account in determining the amount of aid or assistance 
furnished to such individual (under a State plan approved under 
subchapter I, X, XIV, or XVI of this chapter), and such person is 
determined, under such a State plan, to be essential to the well-being 
of such individual. The payment described in the first sentence may 
include expenditures for medicare cost-sharing and for premiums under 
part B of subchapter XVIII of this chapter for individuals who are 
eligible for medical assistance under the plan and (A) are receiving aid 
or assistance under any plan of the State approved under subchapter I, 
X, XIV, or XVI of this chapter, or part A of subchapter IV of this 
chapter, or with respect to whom supplemental security income benefits 
are being paid under subchapter XVI of this chapter, or (B) with respect 
to whom there is being paid a State supplementary payment and are 
eligible for medical assistance equal in amount, duration, and scope to 
the medical assistance made available to individuals described in 
section 1396a(a)(10)(A) of this title, and, except in the case of 
individuals 65 years of age or older and disabled individuals entitled 
to health insurance benefits under subchapter XVIII of this chapter who 
are not enrolled under part B of subchapter XVIII of this chapter, other 
insurance premiums for medical or any other type of remedial care or the 
cost thereof. No service (including counseling) shall be excluded from 
the definition of ``medical assistance'' solely because it is provided 
as a treatment service for alcoholism or drug dependency.

(b) Federal medical assistance percentage; State percentage; Indian 
        health care percentage

    Subject to section 1396u-3(d) of this title, the term ``Federal 
medical assistance percentage'' for any State shall be 100 per centum 
less the State percentage; and the State percentage shall be that 
percentage which bears the same ratio to 45 per centum as the square of 
the per capita income of such State bears to the square of the per 
capita income of the continental United States (including Alaska) and 
Hawaii; except that (1) the Federal medical assistance percentage shall 
in no case be less than 50 per centum or more than 83 per centum, (2) 
the Federal medical assistance percentage for Puerto Rico, the Virgin 
Islands, Guam, the Northern Mariana Islands, and American Samoa shall be 
50 per centum, and (3) for purposes of this subchapter and subchapter 
XXI of this chapter, the Federal medical assistance percentage for the 
District of Columbia shall be 70 percent. The Federal medical assistance 
percentage for any State shall be determined and promulgated in 
accordance with the provisions of section 1301(a)(8)(B) of this title. 
Notwithstanding the first sentence of this section, the Federal medical 
assistance percentage shall be 100 per centum with respect to amounts 
expended as medical assistance for services which are received through 
an Indian Health Service facility whether operated by the Indian Health 
Service or by an Indian tribe or tribal organization (as defined in 
section 1603 of title 25). Notwithstanding the first sentence of this 
subsection, in the case of a State plan that meets the condition 
described in subsection (u)(1) of this section, with respect to 
expenditures (other than expenditures under section 1396r-4 of this 
title) described in subsection (u)(2)(A) of this section or subsection 
(u)(3) of this section for the State for a fiscal year, and that do not 
exceed the amount of the State's allotment under section 1397dd of this 
title (not taking into account reductions under section 1397dd(d)(2) of 
this title) for the fiscal year reduced by the amount of any payments 
made under section 1397ee of this title to the State from such allotment 
for such fiscal year, the Federal medical assistance percentage is equal 
to the enhanced FMAP described in section 1397ee(b) of this title.

(c) Nursing facility

    For definition of the term ``nursing facility'', see section 
1396r(a) of this title.

(d) Intermediate care facility for mentally retarded

    The term ``intermediate care facility for the mentally retarded'' 
means an institution (or distinct part thereof) for the mentally 
retarded or persons with related conditions if--
        (1) the primary purpose of such institution (or distinct part 
    thereof) is to provide health or rehabilitative services for 
    mentally retarded individuals and the institution meets such 
    standards as may be prescribed by the Secretary;
        (2) the mentally retarded individual with respect to whom a 
    request for payment is made under a plan approved under this 
    subchapter is receiving active treatment under such a program; and
        (3) in the case of a public institution, the State or political 
    subdivision responsible for the operation of such institution has 
    agreed that the non-Federal expenditures in any calendar quarter 
    prior to January 1, 1975, with respect to services furnished to 
    patients in such institution (or distinct part thereof) in the State 
    will not, because of payments made under this subchapter, be reduced 
    below the average amount expended for such services in such 
    institution in the four quarters immediately preceding the quarter 
    in which the State in which such institution is located elected to 
    make such services available under its plan approved under this 
    subchapter.

(e) Physicians' services

    In the case of any State the State plan of which (as approved under 
this subchapter)--
        (1) does not provide for the payment of services (other than 
    services covered under section 1396a(a)(12) of this title) provided 
    by an optometrist; but
        (2) at a prior period did provide for the payment of services 
    referred to in paragraph (1);

the term ``physicians' services'' (as used in subsection (a)(5) of this 
section) shall include services of the type which an optometrist is 
legally authorized to perform where the State plan specifically provides 
that the term ``physicians' services'', as employed in such plan, 
includes services of the type which an optometrist is legally authorized 
to perform, and shall be reimbursed whether furnished by a physician or 
an optometrist.

(f) Nursing facility services

    For purposes of this subchapter, the term ``nursing facility 
services'' means services which are or were required to be given an 
individual who needs or needed on a daily basis nursing care (provided 
directly by or requiring the supervision of nursing personnel) or other 
rehabilitation services which as a practical matter can only be provided 
in a nursing facility on an inpatient basis.

(g) Chiropractors' services

    If the State plan includes provision of chiropractors' services, 
such services include only--
        (1) services provided by a chiropractor (A) who is licensed as 
    such by the State and (B) who meets uniform minimum standards 
    promulgated by the Secretary under section 1395x(r)(5) of this 
    title; and
        (2) services which consist of treatment by means of manual 
    manipulation of the spine which the chiropractor is legally 
    authorized to perform by the State.

(h) Inpatient psychiatric hospital services for individuals under age 21

    (1) For purposes of paragraph (16) of subsection (a) of this 
section, the term ``inpatient psychiatric hospital services for 
individuals under age 21'' includes only--
        (A) inpatient services which are provided in an institution (or 
    distinct part thereof) which is a psychiatric hospital as defined in 
    section 1395x(f) of this title or in another inpatient setting that 
    the Secretary has specified in regulations;
        (B) inpatient services which, in the case of any individual (i) 
    involve active treatment which meets such standards as may be 
    prescribed in regulations by the Secretary, and (ii) a team, 
    consisting of physicians and other personnel qualified to make 
    determinations with respect to mental health conditions and the 
    treatment thereof, has determined are necessary on an inpatient 
    basis and can reasonably be expected to improve the condition, by 
    reason of which such services are necessary, to the extent that 
    eventually such services will no longer be necessary; and
        (C) inpatient services which, in the case of any individual, are 
    provided prior to (i) the date such individual attains age 21, or 
    (ii) in the case of an individual who was receiving such services in 
    the period immediately preceding the date on which he attained age 
    21, (I) the date such individual no longer requires such services, 
    or (II) if earlier, the date such individual attains age 22;

    (2) Such term does not include services provided during any calendar 
quarter under the State plan of any State if the total amount of the 
funds expended, during such quarter, by the State (and the political 
subdivisions thereof) from non-Federal funds for inpatient services 
included under paragraph (1), and for active psychiatric care and 
treatment provided on an outpatient basis for eligible mentally ill 
children, is less than the average quarterly amount of the funds 
expended, during the 4-quarter period ending December 31, 1971, by the 
State (and the political subdivisions thereof) from non-Federal funds 
for such services.

(i) Institution for mental diseases

    The term ``institution for mental diseases'' means a hospital, 
nursing facility, or other institution of more than 16 beds, that is 
primarily engaged in providing diagnosis, treatment, or care of persons 
with mental diseases, including medical attention, nursing care, and 
related services.

(j) State supplementary payment

    The term ``State supplementary payment'' means any cash payment made 
by a State on a regular basis to an individual who is receiving 
supplemental security income benefits under subchapter XVI of this 
chapter or who would but for his income be eligible to receive such 
benefits, as assistance based on need in supplementation of such 
benefits (as determined by the Commissioner of Social Security), but 
only to the extent that such payments are made with respect to an 
individual with respect to whom supplemental security income benefits 
are payable under subchapter XVI of this chapter, or would but for his 
income be payable under that subchapter.

(k) Supplemental security income benefits

    Increased supplemental security income benefits payable pursuant to 
section 211 of Public Law 93-66 shall not be considered supplemental 
security income benefits payable under subchapter XVI of this chapter.

(l) Rural health clinics

    (1) The terms ``rural health clinic services'' and ``rural health 
clinic'' have the meanings given such terms in section 1395x(aa) of this 
title, except that (A) clause (ii) of section 1395x(aa)(2) of this title 
shall not apply to such terms, and (B) the physician arrangement 
required under section 1395x(aa)(2)(B) of this title shall only apply 
with respect to rural health clinic services and, with respect to other 
ambulatory care services, the physician arrangement required shall be 
only such as may be required under the State plan for those services.
    (2)(A) The term ``Federally-qualified health center services'' means 
services of the type described in subparagraphs (A) through (C) of 
section 1395x(aa)(1) of this title when furnished to an individual as an 
\2\ patient of a Federally-qualified health center and, for this 
purpose, any reference to a rural health clinic or a physician described 
in section 1395x(aa)(2)(B) of this title is deemed a reference to a 
Federally-qualified health center or a physician at the center, 
respectively.
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    \2\ So in original. Probably should be ``a''.
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    (B) The term ``Federally-qualified health center'' means an entity 
which--
        (i) is receiving a grant under section 254b of this title,
        (ii)(I) is receiving funding from such a grant under a contract 
    with the recipient of such a grant, and
        (II) meets the requirements to receive a grant under section 
    254b of this title,
        (iii) based on the recommendation of the Health Resources and 
    Services Administration within the Public Health Service, is 
    determined by the Secretary to meet the requirements for receiving 
    such a grant, including requirements of the Secretary that an entity 
    may not be owned, controlled, or operated by another entity, or
        (iv) was treated by the Secretary, for purposes of part B of 
    subchapter XVIII of this chapter, as a comprehensive Federally 
    funded health center as of January 1, 1990;

and includes an outpatient health program or facility operated by a 
tribe or tribal organization under the Indian Self-Determination Act 
(Public Law 93-638) [25 U.S.C. 450f et seq.] or by an urban Indian 
organization receiving funds under title V of the Indian Health Care 
Improvement Act [25 U.S.C. 1651 et seq.] for the provision of primary 
health services. In applying clause (ii),\3\ the Secretary may waive any 
requirement referred to in such clause for up to 2 years for good cause 
shown.
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    \3\ So in original. Probably should be clause ``(iii),''. See 
References in Text note below.
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(m) Qualified family member

    (1) Subject to paragraph (2), the term ``qualified family member'' 
means an individual (other than a qualified pregnant woman or child, as 
defined in subsection (n) of this section) who is a member of a family 
that would be receiving aid under the State plan under part A of 
subchapter IV of this chapter pursuant to section 607 \4\ of this title 
if the State had not exercised the option under section 607(b)(2)(B)(i) 
\4\ of this title.
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    \4\ See References in Text note below.
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    (2) No individual shall be a qualified family member for any period 
after September 30, 1998.

(n) ``Qualified pregnant woman or child'' defined

    The term ``qualified pregnant woman or child'' means--
        (1) a pregnant woman who--
            (A) would be eligible for aid to families with dependent 
        children under part A of subchapter IV of this chapter (or would 
        be eligible for such aid if coverage under the State plan under 
        part A of subchapter IV of this chapter included aid to families 
        with dependent children of unemployed parents pursuant to 
        section 607 of this title) if her child had been born and was 
        living with her in the month such aid would be paid, and such 
        pregnancy has been medically verified;
            (B) is a member of a family which would be eligible for aid 
        under the State plan under part A of subchapter IV of this 
        chapter pursuant to section 607 of this title if the plan 
        required the payment of aid pursuant to such section; or
            (C) otherwise meets the income and resources requirements of 
        a State plan under part A of subchapter IV of this chapter; and

        (2) a child who has not attained the age of 19, who was born 
    after September 30, 1983 (or such earlier date as the State may 
    designate), and who meets the income and resources requirements of 
    the State plan under part A of subchapter IV of this chapter.

(o) Optional hospice benefits

    (1)(A) Subject to subparagraph (B), the term ``hospice care'' means 
the care described in section 1395x(dd)(1) of this title furnished by a 
hospice program (as defined in section 1395x(dd)(2) of this title) to a 
terminally ill individual who has voluntarily elected (in accordance 
with paragraph (2)) to have payment made for hospice care instead of 
having payment made for certain benefits described in section 
1395d(d)(2)(A) of this title and for which payment may otherwise be made 
under subchapter XVIII of this chapter and intermediate care facility 
services under the plan. For purposes of such election, hospice care may 
be provided to an individual while such individual is a resident of a 
skilled nursing facility or intermediate care facility, but the only 
payment made under the State plan shall be for the hospice care.
    (B) For purposes of this subchapter, with respect to the definition 
of hospice program under section 1395x(dd)(2) of this title, the 
Secretary may allow an agency or organization to make the assurance 
under subparagraph (A)(iii) of such section without taking into account 
any individual who is afflicted with acquired immune deficiency syndrome 
(AIDS).
    (2) An individual's voluntary election under this subsection--
        (A) shall be made in accordance with procedures that are 
    established by the State and that are consistent with the procedures 
    established under section 1395d(d)(2) of this title;
        (B) shall be for such a period or periods (which need not be the 
    same periods described in section 1395d(d)(1) of this title) as the 
    State may establish; and
        (C) may be revoked at any time without a showing of cause and 
    may be modified so as to change the hospice program with respect to 
    which a previous election was made.

    (3) In the case of an individual--
        (A) who is residing in a nursing facility or intermediate care 
    facility for the mentally retarded and is receiving medical 
    assistance for services in such facility under the plan,
        (B) who is entitled to benefits under part A of subchapter XVIII 
    of this chapter and has elected, under section 1395d(d) of this 
    title, to receive hospice care under such part, and
        (C) with respect to whom the hospice program under such 
    subchapter and the nursing facility or intermediate care facility 
    for the mentally retarded have entered into a written agreement 
    under which the program takes full responsibility for the 
    professional management of the individual's hospice care and the 
    facility agrees to provide room and board to the individual,

instead of any payment otherwise made under the plan with respect to the 
facility's services, the State shall provide for payment to the hospice 
program of an amount equal to the additional amount determined in 
section 1396a(a)(13)(B) of this title and, if the individual is an 
individual described in section 1396a(a)(10)(A) of this title, shall 
provide for payment of any coinsurance amounts imposed under section 
1395e(a)(4) of this title.

(p) Qualified medicare beneficiary; medicare cost-sharing

    (1) The term ``qualified medicare beneficiary'' means an 
individual--
        (A) who is entitled to hospital insurance benefits under part A 
    of subchapter XVIII of this chapter (including an individual 
    entitled to such benefits pursuant to an enrollment under section 
    1395i-2 of this title, but not including an individual entitled to 
    such benefits only pursuant to an enrollment under section 1395i-2a 
    of this title),
        (B) whose income (as determined under section 1382a of this 
    title for purposes of the supplemental security income program, 
    except as provided in paragraph (2)(D)) does not exceed an income 
    level established by the State consistent with paragraph (2), and
        (C) whose resources (as determined under section 1382b of this 
    title for purposes of the supplemental security income program) do 
    not exceed twice the maximum amount of resources that an individual 
    may have and obtain benefits under that program.

    (2)(A) The income level established under paragraph (1)(B) shall be 
at least the percent provided under subparagraph (B) (but not more than 
100 percent) of the official poverty line (as defined by the Office of 
Management and Budget, and revised annually in accordance with section 
9902(2) of this title) applicable to a family of the size involved.
    (B) Except as provided in subparagraph (C), the percent provided 
under this clause, with respect to eligibility for medical assistance on 
or after--
        (i) January 1, 1989, is 85 percent,
        (ii) January 1, 1990, is 90 percent, and
        (iii) January 1, 1991, is 100 percent.

    (C) In the case of a State which has elected treatment under section 
1396a(f) of this title and which, as of January 1, 1987, used an income 
standard for individuals age 65 or older which was more restrictive than 
the income standard established under the supplemental security income 
program under subchapter XVI of this chapter, the percent provided under 
subparagraph (B), with respect to eligibility for medical assistance on 
or after--
        (i) January 1, 1989, is 80 percent,
        (ii) January 1, 1990, is 85 percent,
        (iii) January 1, 1991, is 95 percent, and
        (iv) January 1, 1992, is 100 percent.

    (D)(i) In determining under this subsection the income of an 
individual who is entitled to monthly insurance benefits under 
subchapter II of this chapter for a transition month (as defined in 
clause (ii)) in a year, such income shall not include any amounts 
attributable to an increase in the level of monthly insurance benefits 
payable under such subchapter which have occurred pursuant to section 
415(i) of this title for benefits payable for months beginning with 
December of the previous year.
    (ii) For purposes of clause (i), the term ``transition month'' means 
each month in a year through the month following the month in which the 
annual revision of the official poverty line, referred to in 
subparagraph (A), is published.
    (3) The term ``medicare cost-sharing'' means (subject to section 
1396a(n)(2) of this title) the following costs incurred with respect to 
a qualified medicare beneficiary, without regard to whether the costs 
incurred were for items and services for which medical assistance is 
otherwise available under the plan:
        (A)(i) premiums under section 1395i-2 or 1395i-2a of this title, 
    and
        (ii) premiums under section 1395r of this title,\5\
---------------------------------------------------------------------------
    \5\ So in original. The comma probably should be a period.
---------------------------------------------------------------------------
        (B) Coinsurance under subchapter XVIII of this chapter 
    (including coinsurance described in section 1395e of this title).
        (C) Deductibles established under subchapter XVIII of this 
    chapter (including those described in section 1395e of this title 
    and section 1395l(b) of this title).
        (D) The difference between the amount that is paid under section 
    1395l(a) of this title and the amount that would be paid under such 
    section if any reference to ``80 percent'' therein were deemed a 
    reference to ``100 percent''.

Such term also may include, at the option of a State, premiums for 
enrollment of a qualified medicare beneficiary with an eligible 
organization under section 1395mm of this title.
    (4) Notwithstanding any other provision of this subchapter, in the 
case of a State (other than the 50 States and the District of 
Columbia)--
        (A) the requirement stated in section 1396a(a)(10)(E) of this 
    title shall be optional, and
        (B) for purposes of paragraph (2), the State may substitute for 
    the percent provided under subparagraph (B) \6\ or \7\ 
    1396a(a)(10)(E)(iii) of this title of such paragraph \6\ any 
    percent.
---------------------------------------------------------------------------
    \6\ So in original. The words ``of such paragraph'' probably should 
follow ``subparagraph (B)''.
    \7\ So in original. Probably should be ``or section''.

In the case of any State which is providing medical assistance to its 
residents under a waiver granted under section 1315 of this title, the 
Secretary shall require the State to meet the requirement of section 
1396a(a)(10)(E) of this title in the same manner as the State would be 
required to meet such requirement if the State had in effect a plan 
approved under this subchapter.

(q) Qualified severely impaired individual

    The term ``qualified severely impaired individual'' means an 
individual under age 65--
        (1) who for the month preceding the first month to which this 
    subsection applies to such individual--
            (A) received (i) a payment of supplemental security income 
        benefits under section 1382(b) of this title on the basis of 
        blindness or disability, (ii) a supplementary payment under 
        section 1382e of this title or under section 212 of Public Law 
        93-66 on such basis, (iii) a payment of monthly benefits under 
        section 1382h(a) of this title, or (iv) a supplementary payment 
        under section 1382e(c)(3), and
            (B) was eligible for medical assistance under the State plan 
        approved under this subchapter; and

        (2) with respect to whom the Commissioner of Social Security 
    determines that--
            (A) the individual continues to be blind or continues to 
        have the disabling physical or mental impairment on the basis of 
        which he was found to be under a disability and, except for his 
        earnings, continues to meet all non-disability-related 
        requirements for eligibility for benefits under subchapter XVI 
        of this chapter,
            (B) the income of such individual would not, except for his 
        earnings, be equal to or in excess of the amount which would 
        cause him to be ineligible for payments under section 1382(b) of 
        this title (if he were otherwise eligible for such payments),
            (C) the lack of eligibility for benefits under this 
        subchapter would seriously inhibit his ability to continue or 
        obtain employment, and
            (D) the individual's earnings are not sufficient to allow 
        him to provide for himself a reasonable equivalent of the 
        benefits under subchapter XVI of this chapter (including any 
        federally administered State supplementary payments), this 
        subchapter, and publicly funded attendant care services 
        (including personal care assistance) that would be available to 
        him in the absence of such earnings.

In the case of an individual who is eligible for medical assistance 
pursuant to section 1382h(b) of this title in June, 1987, the individual 
shall be a qualified severely impaired individual for so long as such 
individual meets the requirements of paragraph (2).

(r) Early and periodic screening, diagnostic, and treatment services

    The term ``early and periodic screening, diagnostic, and treatment 
services'' means the following items and services:
        (1) Screening services--
            (A) which are provided--
                (i) at intervals which meet reasonable standards of 
            medical and dental practice, as determined by the State 
            after consultation with recognized medical and dental 
            organizations involved in child health care and, with 
            respect to immunizations under subparagraph (B)(iii), in 
            accordance with the schedule referred to in section 
            1396s(c)(2)(B)(i) of this title for pediatric vaccines, and
                (ii) at such other intervals, indicated as medically 
            necessary, to determine the existence of certain physical or 
            mental illnesses or conditions; and

            (B) which shall at a minimum include--
                (i) a comprehensive health and developmental history 
            (including assessment of both physical and mental health 
            development),
                (ii) a comprehensive unclothed physical exam,
                (iii) appropriate immunizations (according to the 
            schedule referred to in section 1396s(c)(2)(B)(i) of this 
            title for pediatric vaccines) according to age and health 
            history,
                (iv) laboratory tests (including lead blood level 
            assessment appropriate for age and risk factors), and
                (v) health education (including anticipatory guidance).

        (2) Vision services--
            (A) which are provided--
                (i) at intervals which meet reasonable standards of 
            medical practice, as determined by the State after 
            consultation with recognized medical organizations involved 
            in child health care, and
                (ii) at such other intervals, indicated as medically 
            necessary, to determine the existence of a suspected illness 
            or condition; and

            (B) which shall at a minimum include diagnosis and treatment 
        for defects in vision, including eyeglasses.

        (3) Dental services--
            (A) which are provided--
                (i) at intervals which meet reasonable standards of 
            dental practice, as determined by the State after 
            consultation with recognized dental organizations involved 
            in child health care, and
                (ii) at such other intervals, indicated as medically 
            necessary, to determine the existence of a suspected illness 
            or condition; and

            (B) which shall at a minimum include relief of pain and 
        infections, restoration of teeth, and maintenance of dental 
        health.

        (4) Hearing services--
            (A) which are provided--
                (i) at intervals which meet reasonable standards of 
            medical practice, as determined by the State after 
            consultation with recognized medical organizations involved 
            in child health care, and
                (ii) at such other intervals, indicated as medically 
            necessary, to determine the existence of a suspected illness 
            or condition; and

            (B) which shall at a minimum include diagnosis and treatment 
        for defects in hearing, including hearing aids.

        (5) Such other necessary health care, diagnostic services, 
    treatment, and other measures described in subsection (a) of this 
    section to correct or ameliorate defects and physical and mental 
    illnesses and conditions discovered by the screening services, 
    whether or not such services are covered under the State plan.

Nothing in this subchapter shall be construed as limiting providers of 
early and periodic screening, diagnostic, and treatment services to 
providers who are qualified to provide all of the items and services 
described in the previous sentence or as preventing a provider that is 
qualified under the plan to furnish one or more (but not all) of such 
items or services from being qualified to provide such items and 
services as part of early and periodic screening, diagnostic, and 
treatment services. The Secretary shall, not later than July 1, 1990, 
and every 12 months thereafter, develop and set annual participation 
goals for each State for participation of individuals who are covered 
under the State plan under this subchapter in early and periodic 
screening, diagnostic, and treatment services.

(s) Qualified disabled and working individual

    The term ``qualified disabled and working individual'' means an 
individual--
        (1) who is entitled to enroll for hospital insurance benefits 
    under part A of subchapter XVIII of this chapter under section 
    1395i-2a of this title;
        (2) whose income (as determined under section 1382a of this 
    title for purposes of the supplemental security income program) does 
    not exceed 200 percent of the official poverty line (as defined by 
    the Office of Management and Budget and revised annually in 
    accordance with section 9902(2) of this title) applicable to a 
    family of the size involved;
        (3) whose resources (as determined under section 1382b of this 
    title for purposes of the supplemental security income program) do 
    not exceed twice the maximum amount of resources that an individual 
    or a couple (in the case of an individual with a spouse) may have 
    and obtain benefits for supplemental security income benefits under 
    subchapter XVI of this chapter; and
        (4) who is not otherwise eligible for medical assistance under 
    this subchapter.

(t) Primary care case management services; primary care case manager; 
        primary care case management contract; and primary care

    (1) The term ``primary care case management services'' means case-
management related services (including locating, coordinating, and 
monitoring of health care services) provided by a primary care case 
manager under a primary care case management contract.
    (2) The term ``primary care case manager'' means any of the 
following that provides services of the type described in paragraph (1) 
under a contract referred to in such paragraph:
        (A) A physician, a physician group practice, or an entity 
    employing or having other arrangements with physicians to provide 
    such services.
        (B) At State option--
            (i) a nurse practitioner (as described in subsection (a)(21) 
        of this section);
            (ii) a certified nurse-midwife (as defined in section 
        1395x(gg) of this title); or
            (iii) a physician assistant (as defined in section 
        1395x(aa)(5) of this title).

    (3) The term ``primary care case management contract'' means a 
contract between a primary care case manager and a State under which the 
manager undertakes to locate, coordinate, and monitor covered primary 
care (and such other covered services as may be specified under the 
contract) to all individuals enrolled with the manager, and which--
        (A) provides for reasonable and adequate hours of operation, 
    including 24-hour availability of information, referral, and 
    treatment with respect to medical emergencies;
        (B) restricts enrollment to individuals residing sufficiently 
    near a service delivery site of the manager to be able to reach that 
    site within a reasonable time using available and affordable modes 
    of transportation;
        (C) provides for arrangements with, or referrals to, sufficient 
    numbers of physicians and other appropriate health care 
    professionals to ensure that services under the contract can be 
    furnished to enrollees promptly and without compromise to quality of 
    care;
        (D) prohibits discrimination on the basis of health status or 
    requirements for health care services in enrollment, disenrollment, 
    or reenrollment of individuals eligible for medical assistance under 
    this subchapter;
        (E) provides for a right for an enrollee to terminate enrollment 
    in accordance with section 1396u-2(a)(4) of this title; and
        (F) complies with the other applicable provisions of section 
    1396u-2 of this title.

    (4) For purposes of this subsection, the term ``primary care'' 
includes all health care services customarily provided in accordance 
with State licensure and certification laws and regulations, and all 
laboratory services customarily provided by or through, a general 
practitioner, family medicine physician, internal medicine physician, 
obstetrician/gynecologist, or pediatrician.

(u) Conditions for State plans

    (1) The conditions described in this paragraph for a State plan are 
as follows:
        (A) The State is complying with the requirement of section 
    1397ee(d)(1) of this title.
        (B) The plan provides for such reporting of information about 
    expenditures and payments attributable to the operation of this 
    subsection as the Secretary deems necessary in order to carry out 
    the fourth sentence of subsection (b) of this section and section 
    1397dd(d) of this title.

    (2)(A) For purposes of subsection (b) of this section, the 
expenditures described in this subparagraph are expenditures for medical 
assistance for optional targeted low-income children described in 
subparagraph (B).
    (B) For purposes of this paragraph, the term ``optional targeted 
low-income child'' means a targeted low-income child as defined in 
section 1397jj(b)(1) of this title (determined without regard to that 
portion of subparagraph (C) of such section concerning eligibility for 
medical assistance under this subchapter) who would not qualify for 
medical assistance under the State plan under this subchapter as in 
effect on March 31, 1997 (but taking into account the expansion of age 
of eligibility effected through the operation of section 1396a(l)(1)(D) 
of this title).
    (3) For purposes of subsection (b) of this section, the expenditures 
described in this paragraph are expenditures for medical assistance for 
children who are born before October 1, 1983, and who would be described 
in section 1396a(l)(1)(D) of this title if they had been born on or 
after such date, and who are not eligible for such assistance under the 
State plan under this subchapter based on such State plan as in effect 
as of March 31, 1997.
    (4) The limitations on payment under subsections (f) and (g) of 
section 1308 of this title shall not apply to Federal payments made 
under section 1396b(a)(1) of this title based on an enhanced FMAP 
described in section 1397ee(b) of this title.

(v) Employed individual with a medically improved disability

    (1) The term ``employed individual with a medically improved 
disability'' means an individual who--
        (A) is at least 16, but less than 65, years of age;
        (B) is employed (as defined in paragraph (2));
        (C) ceases to be eligible for medical assistance under section 
    1396a(a)(10)(A)(ii)(XV) of this title because the individual, by 
    reason of medical improvement, is determined at the time of a 
    regularly scheduled continuing disability review to no longer be 
    eligible for benefits under section 423(d) or 1382c(a)(3) of this 
    title; and
        (D) continues to have a severe medically determinable 
    impairment, as determined under regulations of the Secretary.

    (2) For purposes of paragraph (1), an individual is considered to be 
``employed'' if the individual--
        (A) is earning at least the applicable minimum wage requirement 
    under section 206 of title 29 and working at least 40 hours per 
    month; or
        (B) is engaged in a work effort that meets substantial and 
    reasonable threshold criteria for hours of work, wages, or other 
    measures, as defined by the State and approved by the Secretary.

(w) Independent foster care adolescent

    (1) For purposes of this subchapter, the term ``independent foster 
care adolescent'' means an individual--
        (A) who is under 21 years of age;
        (B) who, on the individual's 18th birthday, was in foster care 
    under the responsibility of a State; and
        (C) whose assets, resources, and income do not exceed such 
    levels (if any) as the State may establish consistent with paragraph 
    (2).

    (2) The levels established by a State under paragraph (1)(C) may not 
be less than the corresponding levels applied by the State under section 
1396u-1(b) of this title.
    (3) A State may limit the eligibility of independent foster care 
adolescents under section 1396a(a)(10)(A)(ii)(XVII) of this title to 
those individuals with respect to whom foster care maintenance payments 
or independent living services were furnished under a program funded 
under part E of subchapter IV of this chapter before the date the 
individuals attained 18 years of age.

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

                       References in Text

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


                               Amendments

    1999--Subsec. (a)(xii). Pub. L. 106-170, Sec. 201(a)(2)(C), added 
cl. (xii).
    Subsec. (a)(15). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 608(aa)(3)], substituted ``1396a(a)(31) of this title'' for 
``1396a(a)(31)(A) of this title''.
    Subsec. (b). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 605(a)], inserted ``(other than expenditures under section 1396r-4 
of this title)'' after ``with respect to expenditures'' in last 
sentence.
    Subsec. (b)(1). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 608(l)], substituted ``83 per centum,'' for ``83 per centum,,''.
    Subsec. (l)(2)(B). Pub. L. 106-113, Sec. 1000(a)(6) [title VI, 
Sec. 608(m)], substituted ``an entity'' for ``a entity'' in introductory 
provisions.
    Subsec. (v). Pub. L. 106-169, Sec. 121(c)(5)(A), redesignated 
subsec. (v), related to independent foster care adolescent, as (w).
    Pub. L. 106-169, Sec. 121(a)(2), added subsec. (v), related to 
independent foster care adolescent.
    Pub. L. 106-170, Sec. 201(a)(2)(B), added subsec. (v).
    Subsec. (w). Pub. L. 106-169, Sec. 121(c)(5), redesignated subsec. 
(v) as (w) and substituted ``1396a(a)(10)(A)(ii)(XVII)'' for 
``1396a(a)(10)(A)(ii)(XV)''.
    1997--Subsec. (a)(25). Pub. L. 105-33, Sec. 4702(a)(1), added par. 
(25). Former par. (25) redesignated (26).
    Subsec. (a)(26). Pub. L. 105-33, Sec. 4802(a)(1), added par. (26). 
Former par. (26) redesignated (27).
    Pub. L. 105-33, Sec. 4702(a)(1)(B), redesignated par. (25) as (26) 
and substituted comma for period at end.
    Subsec. (a)(27). Pub. L. 105-33, Sec. 4802(a)(1)(B), redesignated 
par. (26) as (27).
    Subsec. (b). Pub. L. 105-100, Sec. 162(1), inserted ``for the State 
for a fiscal year, and that do not exceed the amount of the State's 
allotment under section 1397dd of this title (not taking into account 
reductions under section 1397dd(d)(2) of this title) for the fiscal year 
reduced by the amount of any payments made under section 1397ee of this 
title to the State from such allotment for such fiscal year,'' after 
``subsection (u)(3) of this section''.
    Pub. L. 105-33, Sec. 4911(a)(1), inserted at end ``Notwithstanding 
the first sentence of this subsection, in the case of a State plan that 
meets the condition described in subsection (u)(1) of this section, with 
respect to expenditures described in subsection (u)(2)(A) of this 
section or subsection (u)(3) of this section the Federal medical 
assistance percentage is equal to the enhanced FMAP described in section 
1397ee(b) of this title.''
    Pub. L. 105-33, Sec. 4732(b), substituted ``Subject to section 
1396u-3(d) of this title, the term'' for ``The term''.
    Pub. L. 105-33, Sec. 4725(b)(1), in first sentence, substituted ``, 
(2)'' for ``and (2)'' and inserted before period ``, and (3) for 
purposes of this subchapter and subchapter XXI of this chapter, the 
Federal medical assistance percentage for the District of Columbia shall 
be 70 percent''.
    Subsec. (l)(2)(B)(iii). Pub. L. 105-33, Sec. 4712(d)(1), inserted 
``including requirements of the Secretary that an entity may not be 
owned, controlled, or operated by another entity,'' after ``such a 
grant,''.
    Subsec. (o)(3). Pub. L. 105-33, Sec. 4711(c)(1), substituted 
``amount determined in section 1396a(a)(13)(B) of this title'' for 
``amount described in section 1396a(a)(13)(D) of this title'' in 
concluding provisions.
    Subsec. (p)(3). Pub. L. 105-33, Sec. 4714(a)(2), inserted ``(subject 
to section 1396a(n)(2) of this title)'' after ``means'' in introductory 
provisions.
    Subsec. (t). Pub. L. 105-33, Sec. 4702(a)(2), added subsec. (t).
    Subsec. (u). Pub. L. 105-33, Sec. 4911(a)(2), added subsec. (u).
    Subsec. (u)(1)(B). Pub. L. 105-100, Sec. 162(2)(A), substituted 
``the fourth sentence of subsection (b) of this section'' for 
``paragraph (2)''.
    Subsec. (u)(2)(A). Pub. L. 105-100, Sec. 162(2)(B), substituted 
``subparagraph (B)'' for ``subparagraph (C), but not in excess, for a 
State for a fiscal year, of the amount described in subparagraph (B) for 
the State and fiscal year''.
    Subsec. (u)(2)(B), (C). Pub. L. 105-100, Sec. 162(2)(C), added 
subpar. (B) and struck out former subpars. (B) and (C) which read as 
follows:
    ``(B) The amount described in this subparagraph, for a State for a 
fiscal year, is the amount of the State's allotment under section 1397dd 
of this title (not taking into account reductions under section 
1397dd(d)(2) of this title) for the fiscal year reduced by the amount of 
any payments made under section 1397ee of this title to the State from 
such allotment for such fiscal year.
    ``(C) For purposes of this paragraph, the term `optional targeted 
low-income child' means a targeted low-income child as defined in 
section 1397jj(b)(1) of this title who would not qualify for medical 
assistance under the State plan under this subchapter based on such plan 
as in effect on April 15, 1997 (but taking into account the expansion of 
age of eligibility effected through the operation of section 
1396a(l)(2)(D) of this title).''
    Subsec. (u)(3). Pub. L. 105-100, Sec. 162(2)(D), substituted 
``described in this paragraph'' for ``described in this subparagraph'' 
and ``March 31, 1997'' for ``April 15, 1997''.
    Subsec. (u)(4). Pub. L. 105-100, Sec. 162(2)(E), added par. (4).
    1996--Subsec. (l)(2)(B)(i), (ii)(II). Pub. L. 104-299 substituted 
``section 254b of this title'' for ``section 254b, 254c, 256, or 256a of 
this title''.
    1994--Subsecs. (j), (q)(2). Pub. L. 103-296 substituted 
``Commissioner of Social Security'' for ``Secretary''.
    1993--Subsec. (a)(xi). Pub. L. 103-66, Sec. 13603(e)(1)-(3), added 
cl. (xi).
    Subsec. (a)(7). Pub. L. 103-66, Sec. 13601(a)(1), struck out 
``including personal care services (A) prescribed by a physician for an 
individual in accordance with a plan of treatment, (B) provided by an 
individual who is qualified to provide such services and who is not a 
member of the individual's family, (C) supervised by a registered nurse, 
and (D) furnished in a home or other location; but not including such 
services furnished to an inpatient or resident of a nursing facility'' 
after ``services''.
    Subsec. (a)(17). Pub. L. 103-66, Sec. 13605(a), inserted before 
semicolon at end ``, and without regard to whether or not the services 
are performed in the area of management of the care of mothers and 
babies throughout the maternity cycle''.
    Subsec. (a)(19). Pub. L. 103-66, Sec. 13603(e)(4), amended par. (19) 
generally, inserting reference to TB-related services described in 
section 1396a(z)(2)(F) of this title.
    Subsec. (a)(21). Pub. L. 103-66, Sec. 13601(a)(2), struck out 
``and'' at end.
    Subsec. (a)(22). Pub. L. 103-66, Sec. 13601(a)(4), redesignated par. 
(23) as (22). Former par. (22) redesignated (25).
    Subsec. (a)(23). Pub. L. 103-66, Sec. 13601(a)(4), redesignated par. 
(24) as (23). Former par. (23) redesignated (22).
    Subsec. (a)(24). Pub. L. 103-66, Sec. 13601(a)(5), added par. (24). 
Former par. (24) redesignated (23).
    Pub. L. 103-66, Sec. 13601(a)(3), which directed amendment of par. 
(24) by substituting semicolon for comma at end, was executed by 
substituting semicolon for period at end to reflect the probable intent 
of Congress.
    Subsec. (a)(25). Pub. L. 103-66, Sec. 13601(a)(4), redesignated par. 
(22) as (25), transferred such par. to appear after par. (23), and 
substituted period for semicolon at end.
    Subsec. (l)(2)(B). Pub. L. 103-66, Sec. 13631(f)(2)(B), in 
concluding provisions, inserted ``or by an urban Indian organization 
receiving funds under title V of the Indian Health Care Improvement Act 
for the provision of primary health services'' before ``. In applying 
clause''.
    Subsec. (l)(2)(B)(i). Pub. L. 103-66, Sec. 13631(f)(2)(A), 
substituted ``256, or 256a'' for ``or 256''.
    Pub. L. 103-66, Sec. 13606(a)(1), struck out ``or'' at end.
    Subsec. (l)(2)(B)(ii). Pub. L. 103-66, Sec. 13631(f)(2)(A), 
substituted ``256, or 256a'' for ``or 256'' in subcl. (II).
    Pub. L. 103-66, Sec. 13606(a)(2), (3), realigned margin and 
substituted a comma for semicolon at end.
    Subsec. (l)(2)(B)(iv). Pub. L. 103-66, Sec. 13606(a)(4), (5), added 
cl. (iv).
    Subsec. (r)(1)(A)(i). Pub. L. 103-66, Sec. 13631(g)(1)(A), inserted 
``and, with respect to immunizations under subparagraph (B)(iii), in 
accordance with the schedule referred to in section 1396s(c)(2)(B)(i) of 
this title for pediatric vaccines'' after ``child health care''.
    Subsec. (r)(1)(B)(iii). Pub. L. 103-66, Sec. 13631(g)(1)(B), 
inserted ``(according to the schedule referred to in section 
1396s(c)(2)(B)(i) of this title for pediatric vaccines)'' after 
``appropriate immunizations''.
    1990--Subsec. (a). Pub. L. 101-508, Sec. 4722, inserted at end ``No 
service (including counseling) shall be excluded from the definition of 
`medical assistance' solely because it is provided as a treatment 
service for alcoholism or drug dependency.''
    Pub. L. 101-508, Sec. 4402(d)(2), inserted at end ``The payment 
described in the first sentence may include expenditures for medicare 
cost-sharing and for premiums under part B of subchapter XVIII of this 
chapter for individuals who are eligible for medical assistance under 
the plan and (A) are receiving aid or assistance under any plan of the 
State approved under subchapter I, X, XIV, or XVI of this chapter, or 
part A of subchapter IV of this chapter, or with respect to whom 
supplemental security income benefits are being paid under subchapter 
XVI of this chapter, or (B) with respect to whom there is being paid a 
State supplementary payment and are eligible for medical assistance 
equal in amount, duration, and scope to the medical assistance made 
available to individuals described in section 1396a(a)(10)(A) of this 
title, and, except in the case of individuals 65 years of age or older 
and disabled individuals entitled to health insurance benefits under 
subchapter XVIII of this chapter who are not enrolled under part B of 
subchapter XVIII of this chapter, other insurance premiums for medical 
or any other type of remedial care or the cost thereof.''
    Subsec. (a)(x). Pub. L. 101-508, Sec. 4713(b), added cl. (x).
    Subsec. (a)(2)(C). Pub. L. 101-508, Sec. 4704(e)(1), repealed Pub. 
L. 101-239, Sec. 6402(c)(1). See 1989 Amendment note below.
    Subsec. (a)(7). Pub. L. 101-508, Sec. 4721(a), substituted 
``services including personal care services'' for ``services'' and added 
subpars. (A) to (D).
    Subsec. (a)(13). Pub. L. 101-508, Sec. 4719(a), inserted before 
semicolon at end ``, including any medical or remedial services 
(provided in a facility, a home, or other setting) recommended by a 
physician or other licensed practitioner of the healing arts within the 
scope of their practice under State law, for the maximum reduction of 
physical or mental disability and restoration of an individual to the 
best possible functional level''.
    Subsec. (a)(22). Pub. L. 101-508, Sec. 4711(a)(1), which directed 
amendment of par. (22) by striking ``and'' at end, could not be executed 
because the word did not appear.
    Subsec. (a)(23). Pub. L. 101-508, Sec. 4712(a)(1), inserted ``and'' 
after semicolon at end.
    Pub. L. 101-508, Sec. 4711(a)(2), (3), which directed amendment of 
subsec. (a) by redesignating par. (23) as (24) and adding a new par. 
(23), was executed by adding the new par. (23), there being no former 
par. (23).
    Subsec. (a)(24). Pub. L. 101-508, Sec. 4712(a)(2), (3), which 
directed amendment of subsec. (a) by redesignating par. (24) as (25) and 
adding a new par. (24), was executed by adding the new par. (24), there 
being no former par. (24).
    Subsec. (h)(1)(A). Pub. L. 101-508, Sec. 4755(a)(1)(A), inserted 
``or in another inpatient setting that the Secretary has specified in 
regulations'' after ``section 1395x(f) of this title''.
    Subsec. (l)(2)(A). Pub. L. 101-508, Sec. 4704(c)(1), substituted 
``patient'' for ``outpatient''.
    Subsec. (l)(2)(B). Pub. L. 101-508, Sec. 4704(d)(2), which directed 
amendment of subpar. (B) by inserting ``and includes an outpatient 
health program or facility operated by a tribe or tribal organization 
under the Indian Self-Determination Act (Public Law 93-638).'' after and 
below cl. (ii), was executed by inserting the new language after cl. 
(iii) to reflect the probable intent of Congress and the intervening 
redesignation of former cl. (ii) as (iii) by Pub. L. 101-508, 
Sec. 4704(c)(3). See below.
    Pub. L. 101-508, Sec. 4704(c)(2), substituted ``entity'' for 
``facility'' in introductory provisions.
    Subsec. (l)(2)(B)(ii), (iii). Pub. L. 101-508, Sec. 4704(c)(3), 
(d)(1), added cl. (ii), redesignated former cl. (ii) as (iii), and 
substituted comma for period at end of cl. (iii).
    Subsec. (n)(2). Pub. L. 101-508, Sec. 4601(a)(2), substituted ``age 
of 19'' for ``age of 7 (or any age designated by the State that exceeds 
7 but does not exceed 8)''.
    Subsec. (o)(1)(A). Pub. L. 101-508, Sec. 4717, inserted ``and for 
which payment may otherwise be made under subchapter XVIII of this 
chapter'' after ``section 1395d(d)(2)(A) of this title''.
    Subsec. (o)(3). Pub. L. 101-508, Sec. 4705(a)(1), struck out ``a 
State which elects not to provide medical assistance for hospice care, 
but provides medical assistance for skilled nursing or intermediate care 
facility services with respect to'' after ``In the case of'' in 
introductory provisions.
    Pub. L. 101-508, Sec. 4705(a)(3), (4), in concluding provisions, 
substituted ``the additional amount described in section 1396a(a)(13)(D) 
of this title'' for ``the amounts allocated under the plan for room and 
board in the facility, in accordance with the rates established under 
section 1396a(a)(13) of this title,'' and struck out at end ``For 
purposes of this paragraph and section 1396a(a)(13)(D) of this title, 
the term `room and board' includes performance of personal care 
services, including assistance in activities of daily living, in 
socializing activities, administration of medication, maintaining the 
cleanliness of a resident's room, and supervising and assisting in the 
use of durable medical equipment and prescribed therapies.''
    Subsec. (o)(3)(A), (C). Pub. L. 101-508, Sec. 4705(a)(2), 
substituted ``nursing facility or intermediate care facility for the 
mentally retarded'' for ``skilled nursing or intermediate care 
facility''.
    Subsec. (p)(1)(B). Pub. L. 101-508, Sec. 4501(e)(1)(A), which 
directed amendment of subpar. (B) by inserting ``, except as provided in 
paragraph (2)(D)'' after ``supplementary social security income 
program'', was executed by inserting the new language after 
``supplemental security income program'' to reflect the probable intent 
of Congress.
    Subsec. (p)(2)(B). Pub. L. 101-508, Sec. 4501(a)(1), inserted 
``and'' at end of cl. (ii), substituted ``100 percent.'' for ``95 
percent, and'' in cl. (iii), and struck out cl. (iv) which read as 
follows: ``January 1, 1992, is 100 percent.''
    Subsec. (p)(2)(C). Pub. L. 101-508, Sec. 4501(a)(2), substituted 
``95 percent, and'' for ``90 percent,'' in cl. (iii) and ``100 
percent.'' for ``95 percent, and'' in cl. (iv) and struck out cl. (v) 
which read as follows: ``January 1, 1993, is 100 percent.''
    Subsec. (p)(2)(D). Pub. L. 101-508, Sec. 4501(e)(1)(B), added 
subpar. (D).
    Subsec. (p)(4). Pub. L. 101-508, Sec. 4501(c)(2), inserted at end 
``In the case of any State which is providing medical assistance to its 
residents under a waiver granted under section 1315 of this title, the 
Secretary shall require the State to meet the requirement of section 
1396a(a)(10)(E) of this title in the same manner as the State would be 
required to meet such requirement if the State had in effect a plan 
approved under this subchapter.''
    Subsec. (p)(4)(B). Pub. L. 101-508, Sec. 4501(c)(1), inserted ``or 
1396a(a)(10)(E)(iii) of this title'' after ``subparagraph (B)''.
    1989--Subsec. (a)(2)(B). Pub. L. 101-239, Sec. 6404(a)(2), 
substituted ``subsection (l)(1)'' for ``subsection (l)'' in two places.
    Subsec. (a)(2)(C). Pub. L. 101-239, Sec. 6404(a)(3), added cl. (C) 
relating to Federally-qualified health center services.
    Pub. L. 101-239, Sec. 6402(c)(1), which directed addition of cl. (C) 
relating to ambulatory services, was repealed by Pub. L. 101-508, 
Sec. 4704(e)(1).
    Subsec. (a)(4)(B). Pub. L. 101-239, Sec. 6403(d)(2), amended cl. (B) 
generally. Prior to amendment, cl. (B) read as follows: ``effective July 
1, 1969, such early and periodic screening and diagnosis of individuals 
who are eligible under the plan and are under the age of 21 to ascertain 
their physical or mental defects, and such health care, treatment, and 
other measures to correct or ameliorate defects and chronic conditions 
discovered thereby, as may be provided in regulations of the Secretary; 
and''.
    Subsec. (a)(21), (22). Pub. L. 101-239, Sec. 6405(a), added par. 
(21) and redesignated former par. (21) as (22).
    Subsec. (l). Pub. L. 101-239, Sec. 6404(b), designated existing 
provisions as par. (1), redesignated former cls. (1) and (2) as (A) and 
(B), respectively, and added par. (2).
    Subsec. (p)(1)(A). Pub. L. 101-239, Sec. 6408(d)(4)(B), inserted ``, 
but not including an individual entitled to such benefits only pursuant 
to an enrollment under section 1395i-2a of this title'' after ``section 
1395i-2 of this title''.
    Subsec. (p)(3)(A). Pub. L. 101-239, Sec. 6408(d)(4)(A)(i), amended 
subpar. (A) generally. Prior to amendment, subpar. (A) read as follows: 
``Premiums under subchapter XVIII of this chapter (including under part 
B and, if applicable, under section 1395i-2 of this title).''
    Subsec. (p)(3)(A)(i). Pub. L. 101-239, Sec. 6408(d)(4)(A)(ii), 
substituted ``section 1395i-2 or 1395i-2a'' for ``section 1395i-2''.
    Subsec. (p)(3)(C). Pub. L. 101-234, Sec. 201(b)(1), substituted 
``Deductibles'' for ``Subject to paragraph (4), deductibles'' and 
``section 1395e of this title and section 1395l(b) of this title)'' for 
``section 1395e of this title, section 1395l(b) of this title, and 
section 1395m(c)(1) of this title''.
    Subsec. (p)(4), (5). Pub. L. 101-234, Sec. 201(b)(2), redesignated 
par. (5) as (4) and struck out former par. (4) which read as follows: 
``In a State which provides medical assistance for prescribed drugs 
under subsection (a)(12) of this section, instead of providing to 
qualified medicare beneficiaries, under paragraph (3)(C), medicare cost-
sharing with respect to the annual deductible for covered outpatient 
drugs under section 1395m(c)(1) of this title, the State may provide to 
such beneficiaries, before charges for covered outpatient drugs for a 
year reach such deductible amount, benefits for prescribed drugs in the 
same amount, duration, and scope as the benefits made available under 
the State plan for individuals described in section 1396a(a)(10)(A)(i) 
of this title.''
    Subsec. (r). Pub. L. 101-239, Sec. 6403(c), inserted at end ``The 
Secretary shall, not later than July 1, 1990, and every 12 months 
thereafter, develop and set annual participation goals for each State 
for participation of individuals who are covered under the State plan 
under this subchapter in early and periodic screening, diagnostic, and 
treatment services.''
    Pub. L. 101-239, Sec. 6403(a), added subsec. (r).
    Subsec. (s). Pub. L. 101-239, Sec. 6408(d)(2), added subsec. (s).
    1988--Subsec. (a). Pub. L. 100-647, Sec. 8434(b)(3), substituted 
``in the case of medicare cost-sharing with respect to a qualified 
medicare beneficiary'' for ``in the case of a qualified medicare 
beneficiary'' in introductory provisions.
    Subsec. (a)(ix). Pub. L. 100-485, Sec. 303(b)(2), added cl. (ix).
    Subsec. (a)(5)(B). Pub. L. 100-360, Sec. 411(k)(4), substituted 
``described in clause (A) if'' for ``described in subparagraph (A) if''.
    Subsec. (a)(17). Pub. L. 100-360, Sec. 411(h)(4)(E), amended Pub. L. 
100-203, Sec. 4073(d)(1), see 1987 Amendment note below.
    Subsec. (i). Pub. L. 100-360, Sec. 411(k)(14)(A), added subsec. (i).
    Subsec. (m). Pub. L. 100-485, Sec. 401(d)(2), added subsec. (m).
    Subsec. (o)(1). Pub. L. 100-360, Sec. 411(k)(8)(A), made clarifying 
amendment to directory language of Pub. L. 100-203, Sec. 4114, see 1987 
Amendment note below.
    Subsec. (o)(1)(B). Pub. L. 100-360, Sec. 411(k)(8)(B), struck out 
``only'' after ``For purposes of this subchapter'' and substituted 
``immune deficiency syndrome (AIDS)'' for ``immunodeficiency syndrome''.
    Subsec. (o)(3). Pub. L. 100-485, Sec. 608(f)(3), realigned the 
margin of par. (3).
    Subsec. (p)(1). Pub. L. 100-647, Sec. 8434(a), redesignated subpars. 
(C) and (D) as (B) and (C), respectively, and struck out former subpar. 
(B) which read: ``who, but for section 1396a(a)(10)(E) of this title, is 
not eligible for medical assistance under the plan,''.
    Subsec. (p)(1)(B). Pub. L. 100-360, Sec. 301(a)(2), struck out ``and 
the election of the State'' after ``1396a(a)(10)(E) of this title''.
    Subsec. (p)(1)(C). Pub. L. 100-360, Sec. 301(c)(1), as amended by 
Pub. L. 100-485, Sec. 608(d)(14)(E)(i), substituted ``paragraph (2)'' 
for ``paragraph (2)(A)''.
    Subsec. (p)(1)(D). Pub. L. 100-360, Sec. 301(c)(2), as amended by 
Pub. L. 100-485, Sec. 608(d)(14)(E)(ii), substituted ``twice'' for 
``(except as provided in paragraph (2)(B))''.
    Subsec. (p)(2)(A). Pub. L. 100-647, Sec. 8434(b)(4), substituted 
``paragraph (1)(B)'' for ``paragraph (1)(C)''.
    Pub. L. 100-360, Sec. 301(b)(1), as amended by Pub. L. 100-485, 
Sec. 608(d)(14)(A), substituted ``shall be at least the percent provided 
under subparagraph (B) (but not more than 100 percent)'' for ``may not 
exceed a percentage (not more than 100 percent)''.
    Pub. L. 100-360, Sec. 301(c)(3)(A), which directed amendment of 
subpar. (A) by striking ``(2)(A)'' and inserting ``(2)'', was repealed 
by Pub. L. 100-485, Sec. 608(d)(14)(E)(iii).
    Pub. L. 100-360, Sec. 301(b)(2), which directed amendment of subpar. 
(A) by inserting ``(i)'' after ``(2)(A)'', was repealed by Pub. L. 100-
485, Sec. 608(d)(14)(B).
    Subsec. (p)(2)(B). Pub. L. 100-360, Sec. 301(b)(2), formerly 
Sec. 301(b)(3), as renumbered and amended by Pub. L. 100-485, 
Sec. 608(d)(14)(B)-(D)(ii), added subpar. (B) and struck out former 
subpar. (B) which read as follows: ``In the case of a State that 
provides medical assistance to individuals not described in section 
1396a(a)(10)(A) of this title and at the State's option, the State may 
use under paragraph (1)(D) such resource level (which is higher than the 
level described in that paragraph) as may be applicable with respect to 
individuals described in paragraph (1)(A) who are not described in 
section 1396a(a)(10)(A) of this title.''
    Pub. L. 100-360, Sec. 301(c)(3)(B), which directed amendment of par. 
(2) by striking subpar. (B), was repealed by Pub. L. 100-485, 
Sec. 608(d)(14)(E)(iii).
    Subsec. (p)(2)(C). Pub. L. 100-360, Sec. 301(b)(2), formerly 
Sec. 301(b)(3), as renumbered and amended by Pub. L. 100-485, 
Sec. 608(d)(14)(B), (C), (D)(i), (iii), added subpar. (C).
    Subsec. (p)(3). Pub. L. 100-360, Sec. 301(d)(1), as added by Pub. L. 
100-485, Sec. 608(d)(14)(G)(ii), inserted ``without regard to whether 
the costs incurred were for items and services for which medical 
assistance is otherwise available under the plan'' after ``qualified 
medicare beneficiary'' in introductory provisions.
    Subsec. (p)(3)(A). Pub. L. 100-360, Sec. 301(d)(2), formerly 
Sec. 301(d)(1), as renumbered by Pub. L. 100-485, Sec. 608(d)(14)(G)(i), 
substituted ``under subchapter XVIII of this chapter (including under 
part B and, if applicable, under section 1395i-2 of this title)'' for 
``under part B and (if applicable) under section 1395i-2 of this 
title''.
    Subsec. (p)(3)(B). Pub. L. 100-360, Sec. 301(d)(3), formerly 
Sec. 301(d)(2), as renumbered by Pub. L. 100-485, Sec. 608(d)(14)(G)(i), 
amended subpar. (B) generally. Prior to amendment, subpar. (B) read as 
follows: ``Deductibles and coinsurance described in section 1395e of 
this title.''
    Subsec. (p)(3)(C). Pub. L. 100-360, Sec. 301(d)(3), formerly 
Sec. 301(d)(2), as renumbered and amended by Pub. L. 100-485, 
Sec. 608(d)(14)(F), (G)(i), amended subpar. (C) generally. Prior to 
amendment, subpar. (C) read as follows: ``The annual deductible 
described in section 1395l(b) of this title.''
    Subsec. (p)(4). Pub. L. 100-360, Sec. 301(d)(4), formerly 
Sec. 301(d)(3), as renumbered by Pub. L. 100-485, Sec. 618(d)(14)(G)(i), 
added par. (4).
    Subsec. (p)(5). Pub. L. 100-360, Sec. 301(g)(2), as amended by Pub. 
L. 100-485, Sec. 608(d)(14)(J), added par. (5).
    1987--Subsec. (a)(4)(A). Pub. L. 100-203, Sec. 4211(f), struck out 
``skilled'' before ``nursing''.
    Subsec. (a)(5). Pub. L. 100-203, Sec. 4211(h)(6)(A), struck out 
``skilled'' before ``nursing'' in cl. (A).
    Pub. L. 100-203, Sec. 4103(a), designated existing provisions as cl. 
(A) and added cl. (B).
    Subsec. (a)(9). Pub. L. 100-203, Sec. 4105(a), inserted provision 
including services furnished to an eligible individual who does not 
reside in a permanent dwelling or have a fixed home or mailing address.
    Subsec. (a)(14). Pub. L. 100-203, Sec. 4211(h)(6)(B), substituted 
``and nursing facility services'' for ``, skilled nursing facility 
services, and intermediate care facility services''.
    Subsec. (a)(15). Pub. L. 100-203, Sec. 4211(h)(6)(C), substituted 
``services in an intermediate care facility for the mentally retarded 
(other than'' for ``intermediate care facility services (other than such 
services''.
    Subsec. (a)(17). Pub. L. 100-203, Sec. 4073(d)(1), as amended by 
Pub. L. 100-360, Sec. 411(h)(4)(E), substituted ``(as defined in section 
1395x(gg) of this title)'' for ``(as defined in subsection (m) of this 
section)''.
    Subsec. (c). Pub. L. 100-203, Sec. 4211(e)(1), amended subsec. (c) 
generally. Prior to amendment, subsec. (c) defined ``intermediate care 
facility''.
    Subsec. (d). Pub. L. 100-203, Sec. 4211(e)(2), substituted 
``intermediate care facility for the mentally retarded'' for 
``intermediate care facility'' and ``means an'' for ``may include 
services in a public'', and in par. (3) inserted ``in the case of a 
public institution'' after ``(3)''.
    Subsec. (f). Pub. L. 100-203, Sec. 4211(e)(3), struck out 
``skilled'' before ``nursing'' in four places and before 
``rehabilitation''.
    Subsec. (i). Pub. L. 100-203, Sec. 4211(e)(4), struck out subsec. 
(i) which provided that for purposes of this subchapter ``skilled 
nursing facility'' also includes any institution which is located in a 
State on an Indian reservation and is certified by the Secretary as 
being a qualified skilled nursing facility by meeting the requirements 
of section 1395x(j) of this title.
    Subsec. (m). Pub. L. 100-203, Sec. 4073(d)(2), struck out subsec. 
(m) which defined ``nurse-midwife''. See section 1395x(gg) of this 
title.
    Subsec. (n)(2). Pub. L. 100-203, Sec. 4101(c)(1), substituted ``has 
not attained the age of 7 (or any age designated by the State that 
exceeds 7 but does not exceed 8)'' for ``is under 5 years of age''.
    Subsec. (o)(1). Pub. L. 100-203, Sec. 4114, as amended by Pub. L. 
100-360, Sec. 411(k)(8)(A), designated existing provisions as subpar. 
(A), substituted ``Subject to subparagraph (B), the'' for ``The'', and 
added subpar. (B).
    Subsec. (p)(2)(A). Pub. L. 100-203, Sec. 4118(p)(8), struck out 
``nonfarm'' before ``official''.
    1986--Subsec. (a). Pub. L. 99-509, Sec. 9403(g)(3), inserted ``or, 
in the case of a qualified medicare beneficiary described in subsection 
(p)(1) of this section, if provided after the month in which the 
individual becomes such a beneficiary'' after ``makes application for 
assistance''.
    Subsec. (a)(18). Pub. L. 99-272, Sec. 9505(a)(1), added par. (18). 
Former par. (18) redesignated (19).
    Subsec. (a)(19). Pub. L. 99-514, Sec. 1895(c)(3)(A), added par. 
(19). Former par. (19) redesignated (20).
    Pub. L. 99-272, Sec. 9505(a)(1)(B), redesignated former par. (18) as 
(19).
    Subsec. (a)(20). Pub. L. 99-509, Sec. 9408(c)(1), added par. (20). 
Former par. (20) redesignated (21).
    Pub. L. 99-514, Sec. 1895(c)(3)(A)(ii), redesignated former par. 
(19) as (20).
    Subsec. (a)(21). Pub. L. 99-509, Sec. 9408(c)(1)(B), redesignated 
former par. (20) as (21).
    Subsec. (n)(1)(C). Pub. L. 99-272, Sec. 9501(a), added subpar. (C).
    Subsec. (n)(2). Pub. L. 99-272, Sec. 9511(a), inserted ``(or such 
earlier date as the State may designate)'' after ``September 30, 1983''.
    Subsec. (o). Pub. L. 99-272, Sec. 9505(a)(2), added subsec. (o).
    Subsec. (o)(3). Pub. L. 99-509, Sec. 9435(b)(2), added par. (3).
    Subsec. (p). Pub. L. 99-509, Sec. 9403(b), (d), added subsec. (p).
    Subsec. (q). Pub. L. 99-509, Sec. 9404(b), added subsec. (q).
    1984--Subsec. (a). Pub. L. 98-369, Sec. 2335(f), substituted 
``mental diseases'' for ``tuberculosis or mental diseases'' in subd. (B) 
following par. (18).
    Pub. L. 98-369, Sec. 2373(b)(17), substituted ``clause (vi)'' for 
``clauses (vi)'' and ``well-being'' for ``well being'' in last sentence.
    Subsec. (a)(1). Pub. L. 98-369, Sec. 2335(f), substituted ``mental 
diseases'' for ``tuberculosis or mental diseases''.
    Subsec. (a)(4). Pub. L. 98-369, Sec. 2335(f), substituted ``mental 
diseases'' for ``tuberculosis or mental diseases''.
    Pub. L. 98-369, Sec. 2373(b)(15), inserted a semicolon before 
``(B)''.
    Subsec. (a)(9). Pub. L. 98-369, Sec. 2371(a), amended par. (9) 
generally, inserting ``furnished by or under the direction of a 
physician, without regard to whether the clinic itself is administered 
by a physician''.
    Subsec. (a)(14), (15). Pub. L. 98-369, Sec. 2335(f), substituted 
``mental diseases'' for ``tuberculosis or mental diseases''.
    Subsec. (a)(17). Pub. L. 98-369, Sec. 2373(b)(16), substituted ``the 
nurse-midwife'' for ``he'' in two places.
    Subsec. (b). Pub. L. 98-369, Sec. 2373(b)(18), substituted ``section 
1301(a)(8)(B) of this title'' for ``subparagraph (B) of section 
1301(a)(8) of this title''.
    Subsec. (d)(1). Pub. L. 98-369, Sec. 2373(b)(19), substituted ``the 
institution meets'' for ``which meet''.
    Subsec. (h)(1)(A). Pub. L. 98-369, Sec. 2340(b), amended subpar. (A) 
generally. Prior to amendment, subpar. (A) read as follows: ``inpatient 
services which are provided in an institution which is accredited as a 
psychiatric hospital by the Joint Commission on Accreditation of 
Hospitals;''.
    Subsec. (m). Pub. L. 98-369, Sec. 2373(b)(20), substituted ``the 
nurse'' for ``he'' in two places.
    Subsec. (n). Pub. L. 98-369, Sec. 2361(b), added subsec. (n).
    1982--Subsec. (a)(i). Pub. L. 97-248, Sec. 137(b)(17), struck out 
``or any reasonable category of such individuals,'' after ``as the State 
may choose,''.
    Subsec. (a)(viii). Pub. L. 97-248, Sec. 137(b)(18), added cl. 
(viii).
    Subsec. (b)(2). Pub. L. 97-248, Sec. 136(c), substituted ``the 
Northern Mariana Islands, and American Samoa'' for ``and the Northern 
Mariana Islands''.
    Subsec. (h)(1)(C). Pub. L. 97-248, Sec. 137(f), redesignated cls. 
(i) and (ii) as subcls. (I) and (II), respectively, and redesignated 
cls. (A) and (B) as cls. (i) and (ii), respectively.
    1981--Subsec. (a). Pub. L. 97-35, Sec. 2172(b), in cl. (i), inserted 
``or, at the option of the State, under the age of 20, 19, or 18 as the 
State may choose, or any reasonable category of such individuals,'' and 
in cl. (ii), struck out reference to section 606(a)(2) of this title.
    Subsec. (b). Pub. L. 97-35, Sec. 2162(a)(2), inserted reference to 
Northern Mariana Islands.
    1980--Subsec. (a)(17), (18). Pub. L. 96-499, Sec. 965(a)(1)(B), (C), 
added par. (17) and redesignated former par. (17) as (18).
    Subsec. (c). Pub. L. 96-473 substituted ``clause (1)'' for ``clauses 
(1)''.
    Subsec. (m). Pub. L. 96-499, Sec. 965(a)(2), added subsec. (m).
    1978--Subsec. (c). Pub. L. 95-292 added cl. (4) to first sentence 
relating to a requirement that intermediate care facilities meet section 
1395x(j)(14) of this title with respect to protection of patients' 
personal funds, and inserted reference to that cl. (4) in provisions 
covering intermediate care facilities on Indian reservations.
    1977--Subsec. (a)(2). Pub. L. 95-210, Sec. 2(a), designated existing 
provisions as cl. (A) and added cl. (B).
    Subsec. (l). Pub. L. 95-210, Sec. 2(b), added subsec. (l).
    1976--Subsec. (b). Pub. L. 94-437 inserted provision requiring that 
the Federal medical assistance percentage be 100 per centum for services 
received through an Indian Health Service facility.
    1973--Subsec. (a). Pub. L. 93-233, Sec. 13(a)(13), substituted in 
introductory text ``individuals (other than individuals with respect to 
whom there is being paid, or who are eligible or would be eligible if 
they were not in a medical institution, to have paid with respect to 
them a State supplementary payment and are eligible for medical 
assistance equal in amount, duration, and scope to the medical 
assistance made available to individuals described in section 
1396a(a)(10)(A) of this title) not receiving aid or assistance under any 
plan of the State approved under subchapter I, X, XIV, or XVI, or part A 
of subchapter IV of this chapter, and with respect to whom supplemental 
security income benefits are not being paid under subchapter XVI of this 
chapter'' for ``individuals not receiving aid or assistance under the 
State's plan approved under subchapter I, X, XIV, or XVI, or part A of 
subchapter IV of this chapter''.
    Subsec. (a)(iv). Pub. L. 93-233, Sec. 13(a)(14), inserted ``with 
respect to States eligible to participate in the State plan program 
established under subchapter XVI of this chapter,'' after ``blind,''.
    Subsec. (a)(v). Pub. L. 93-233, Sec. 13(a)(15), substituted ``with 
respect to States eligible to participate in the State plan program 
established under subchapter XVI of this chapter,'' for ``or''.
    Subsec. (a)(vi). Pub. L. 93-233, Sec. 13(a)(16), inserted ``or'' at 
end of text.
    Subsec. (a)(vii). Pub. L. 93-233, Sec. 13(a)(17), added cl. (vii).
    Subsec. (a)(16). Pub. L. 93-233, Sec. 18(x)(7), substituted ``under 
age 21, as defined in subsection (h) of this section; and'' for ``under 
21, as defined in subsection (e) of this section;''.
    Subsec. (b). Pub. L. 93-233, Sec. 18(y)(2), struck out ``; except 
that the Secretary shall promulgate such percentage as soon as possible 
after July 30, 1965, which promulgation shall be conclusive for each of 
the six quarters in the period beginning January 1, 1966, and ending 
with the close of June 30, 1966'' after ``section 1301(a)(8) of this 
title''.
    Subsec. (c). Pub. L. 93-233, Sec. 18(x)(8), substituted ``skilled 
nursing facility'' for ``skilled nursing home'' wherever appearing.
    Subsec. (h)(1)(B). Pub. L. 93-233, Sec. 18(w), substituted ``(i) 
involve active treatment'' for ``, involves active treatment (i)''; 
struck out ``pursuant to subchapter XVIII of this chapter'' after ``may 
be prescribed''; and substituted ``(ii)'' for ``(ii) which'', 
respectively.
    Subsec. (h)(2). Pub. L. 93-233, Sec. 18(x)(10), substituted 
``paragraph (1)'' for ``paragraph (e)(1)''.
    Subsec. (i). Pub. L. 93-233, Sec. 18(x)(9), redesignated subsec. (h) 
as added by Pub. L. 92-603, Sec. 299L(b), as subsec. (i).
    Subsecs. (j), (k). Pub. L. 93-233, Sec. 13(a)(18), added subsecs. 
(j) and (k).
    1972--Subsec. (a). Pub. L. 92-603, Sec. 299B(c), in text following 
redesignated subsec. (a)(17) substituted ``as otherwise provided in 
paragraph (16),'' for ``that''.
    Subsec. (a)(4). Pub. L. 92-603, Secs. 278(a)(21), 299E(b), 
substituted ``skilled nursing facility'' for ``skilled nursing home'' 
and added cl. (C).
    Subsec. (a)(5). Pub. L. 92-603, Secs. 278(a)(22), 280, substituted 
``skilled nursing facility'' for ``skilled nursing home'' and inserted 
``furnished by a physician (as defined in section 1395x(r)(1) of this 
title) after ``physicians' services''.
    Subsec. (a)(14). Pub. L. 92-603, Secs. 278(a)(23), 297(a), 
substituted ``skilled nursing facility'' for ``skilled nursing home'' 
and inserted reference to intermediate care facility services.
    Subsec. (a)(15) to (17). Pub. L. 92-603, Sec. 299B(a), added par. 
(16) and redesignated existing pars. (15) and (16) as (17) and (15), 
respectively.
    Subsec. (c). Pub. L. 92-603, Sec. 299L(a), inserted provision 
defining ``intermediate care facility'' with respect to any institution 
located in a State on an Indian reservation.
    Subsec. (d)(3). Pub. L. 92-603, Sec. 299, inserted provisions 
relating to reduction of non-Federal expenditures in any calendar 
quarter prior to January 1, 1975.
    Subsec. (e). Pub. L. 92-603, Sec. 212(a), added subsec. (e).
    Subsec. (f). Pub. L. 92-603, Sec. 247(b), added subsec. (f).
    Subsec. (g). Pub. L. 92-603, Sec. 275(a), added subsec. (g).
    Subsec. (h). Pub. L. 92-603, Sec. 299B(b), added subsec. (h).
    Subsec. (i). Pub. L. 92-603, Sec. 299L(b), added subsec. (i),
    1971--Subsec. (a)(16). Pub. L. 92-223, Sec. 4(a)(1)(C), added cl. 
(16).
    Subsecs. (c), (d). Pub. L. 92-223, Sec. 4(a)(2), added subsecs. (c) 
and (d).
    1968--Subsec. (a). Pub. L. 90-248, Sec. 230, inserted ``, and with 
respect to physicians' or dentists' services, at the option of the 
State, to individuals not receiving aid or assistance under the State's 
plan approved under subchapter I, X, XIV, XVI of this chapter, or part A 
of subchapter IV of this chapter'' after ``for individuals'' in text 
preceding cl. (i).
    Pub. L. 90-248, Sec. 233(b), inserted provision deeming, for 
purposes of cl. (vi) of the preceding sentence, a person as essential to 
another individual if such person is the spouse of and is living with 
such individual, the needs of such person are taken into account in 
determining the amount of aid or assistance furnished to such individual 
(under a State plan approved under subchapter I, X, XIV, or XV of this 
chapter, and such person is determined, under such a State plan, to be 
essential to the well being of such individual.
    Subsec. (a)(ii). Pub. L. 90-248, Sec. 241(f)(6), inserted ``part A 
of'' before ``subchapter IV''.
    Subsec. (a)(vi). Pub. L. 90-248, Sec. 233(a), added cl. (vi).
    Subsec. (a)(4). Pub. L. 90-248, Sec. 302(a), designated existing 
provisions as cl. (A) and added cl. (B).
    Subsec. (b). Pub. L. 90-248, Sec. 248(e), substituted in cl. (2) of 
first sentence ``50'' for ``55''.


                    Effective Date of 1999 Amendments

    Amendment by Pub. L. 106-170 applicable to medical assistance for 
items and services furnished on or after Oct. 1, 2000, see section 
201(d) of Pub. L. 106-170, set out as a note under section 1396a of this 
title.
    Amendment by section 121(a)(2) of Pub. L. 106-169 applicable to 
medical assistance for items and services furnished on or after Oct. 1, 
1999, see section 121(b) of Pub. L. 106-169, set out as a note under 
section 1396a of this title.
    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title VI, Sec. 605(b)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-396, provided that: ``The amendment 
made by subsection (a) [amending this section] takes effect on October 
1, 1999, and applies to expenditures made on or after such date.''
    Pub. L. 106-113, div. B, Sec. 1000(a)(6) [title VI, Sec. 608(aa)], 
Nov. 29, 1999, 113 Stat. 1536, 1501A-398, provided that the amendment 
made by section 1000(a)(6) [title VI, Sec. 608(aa)(3)] is effective as 
if included in the enactment of BBA [the Balanced Budget Act of 1997, 
Pub. L. 105-33].
    Amendment by section 1000(a)(6) [title VI, Sec. 608(l), (m)] of Pub. 
L. 106-113 effective Nov. 29, 1999, see section 1000(a)(6) [title VI, 
Sec. 608(bb)] of Pub. L. 106-113, set out as a note under section 1396a 
of this title.


                    Effective Date of 1997 Amendments

    Section 162 of Pub. L. 105-100 provided that the amendment made by 
that section is effective as if included in the enactment of subtitle J 
(Secs. 4901-4923) of title IV of the Balanced Budget Act of 1997, Pub. 
L. 105-33.
    Amendment by section 4702(a) of Pub. L. 105-33 applicable to primary 
care case management services furnished on or after Oct. 1, 1997, 
subject to provisions relating to extension of effective date for State 
law amendments, and to nonapplication to waivers, see section 4710(b)(1) 
of Pub. L. 105-33, set out as a note under section 1396b of this title.
    Amendment by section 4711(c)(1) of Pub. L. 105-33 effective Aug. 5, 
1997, and applicable to payment for items and services furnished on or 
after Oct. 1, 1997, see section 4711(d) of Pub. L. 105-33, set out as a 
note under section 1396a of this title.
    Section 4712(d)(2) of Pub. L. 105-33 provided that: ``The amendment 
made by paragraph (1) [amending this section] shall apply to services 
furnished on or after the date of the enactment of this Act [Aug. 5, 
1997].''
    Amendment by section 4714(a)(2) of Pub. L. 105-33 applicable to 
payment for (and with respect to provider agreements with respect to) 
items and services furnished on or after Aug. 5, 1997, and to payment by 
a State for items and services furnished before such date if such 
payment is subject of lawsuit that is based on subsection (p) of this 
section and section 1396a(n) of this title and that is pending as of, or 
is initiated after Aug. 5, 1997, see section 4714(c) of Pub. L. 105-33, 
set out as a note under section 1396a of this title.
    Section 4725(b)(2) of Pub. L. 105-33 provided that: ``The amendments 
made by paragraph (1) [amending this section] shall apply to--
        ``(A) items and services furnished on or after October 1, 1997;
        ``(B) payments made on a capitation or other risk-basis for 
    coverage occurring on or after such date; and
        ``(C) payments attributable to DSH allotments for such States 
    determined under section 1923(f) of such Act (42 U.S.C. 1396r-4(f)) 
    for fiscal years beginning with fiscal year 1998.''
    Amendment by section 4911(a) of Pub. L. 105-33 applicable to medical 
assistance for items and services furnished on or after Oct. 1, 1997, 
see section 4911(c) of Pub. L. 105-33, set out as a note under section 
1396a of this title.


                    Effective Date of 1996 Amendment

    Amendment by Pub. L. 104-299 effective Oct. 1, 1996, see section 5 
of Pub. L. 104-299, as amended, set out as a note under section 233 of 
this title.


                    Effective Date of 1994 Amendment

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


                    Effective Date of 1993 Amendment

    Amendment by section 13601(a) of Pub. L. 103-66 effective as if 
included in enactment of section 4721(a) of the Omnibus Budget 
Reconciliation Act of 1990, Pub. L. 101-508, see section 13601(c) of 
Pub. L. 103-66, set out as a note under section 1396a of this title.
    Amendment by section 13603(e) of Pub. L. 103-66 applicable to 
medical assistance furnished on or after Jan. 1, 1994, without regard to 
whether or not final regulations to carry out the amendments by section 
13603 of Pub. L. 103-66 have been promulgated by such date, see section 
13603(f) of Pub. L. 103-66, set out as a note under section 1396a of 
this title.
    Section 13605(b) of Pub. L. 103-66 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to services 
furnished on or after October 1, 1993.''
    Section 13606(b) of Pub. L. 103-66 provided that: ``The amendments 
made by subsection (a) [amending this section] shall apply to calendar 
quarters beginning on or after July 1, 1993.''
    Amendment by section 13631(f)(2) of Pub. L. 103-66 applicable, 
except as otherwise provided, to calendar quarters beginning on or after 
Oct. 1, 1993, without regard to whether or not final regulations to 
carry out the amendments by section 13631(f) of Pub. L. 103-66 have been 
promulgated by such date, see section 13631(f)(3) of Pub. L. 103-66, set 
out as a note under section 1396a of this title.
    Section 13631(g)(2) of Pub. L. 103-66 provided that: ``The 
amendments made by subparagraphs (A) and (B) of paragraph (1) [amending 
this section] shall first apply 90 days after the date the schedule 
referred to in subparagraphs (A)(i) and subparagraph (B)(iii) of section 
1905(r)(1) of the Social Security Act [subsec. (r)(1)(B)(iii) of this 
section] (as amended by such respective subparagraphs) is first 
established.''


                    Effective Date of 1990 Amendment

    Amendment by section 4402(d)(2) of Pub. L. 101-508 applicable, 
except as otherwise provided, to payments under this subchapter for 
calendar quarters beginning on or after Jan. 1, 1991, without regard to 
whether or not final regulations to carry out the amendments by section 
4402 of Pub. L. 101-508 have been promulgated by such date, see section 
4402(e) of Pub. L. 101-508, set out as a note under section 1396a of 
this title.
    Amendment by section 4501(a), (c), (e)(1) of Pub. L. 101-508 
applicable to calendar quarters beginning on or after Jan. 1, 1991, 
without regard to whether or not regulations to implement the amendments 
by section 4501 of Pub. L. 101-508 are promulgated by such date, except 
that amendment by section 4501(e)(1) of Pub. L. 101-508 is applicable to 
determinations of income for months beginning with January 1991, see 
section 4501(f) of Pub. L. 101-508, set out as a note under section 
1396a of this title.
    Amendment by section 4601(a)(2) of Pub. L. 101-508 applicable, 
except as otherwise provided, to payments under this subchapter for 
calendar quarters beginning on or after July 1, 1991, without regard to 
whether or not final regulations to carry out the amendments by section 
4601 of Pub. L. 101-508 have been promulgated by such date, see section 
4601(b) of Pub. L. 101-508, set out as a note under section 1396a of 
this title.
    Amendment by section 4704(c), (d), (e)(1) of Pub. L. 101-508 
effective as if included in the enactment of the Omnibus Budget 
Reconciliation Act of 1989, Pub. L. 101-239, see section 4704(f) of Pub. 
L. 101-508, set out as a note under section 1396a of this title.
    Section 4705(b) of Pub. L. 101-508 provided that: ``The amendments 
made by subsection (a) [amending this section] shall be effective as if 
included in the amendments made by section 6408(c)(1) of the Omnibus 
Budget Reconciliation Act of 1989 [Pub. L. 101-239, amending section 
1396a of this title].''
    Amendment by section 4711(a) of Pub. L. 101-508 applicable to home 
and community care furnished on or after July 1, 1991, without regard to 
whether or not final regulations to carry out the amendments by section 
4711 of Pub. L. 101-508 have been promulgated by such date, see section 
4711(e) of Pub. L. 101-508, set out as a note under section 1396a of 
this title.
    Amendment by section 4712(a) of Pub. L. 101-508 applicable to 
community supported living arrangements services furnished on or after 
the later of July 1, 1991, or 30 days after the publication of 
regulations setting forth interim requirements under section 1396u(h) of 
this title without regard to whether or not final regulations to carry 
out the amendments by section 4712 of Pub. L. 101-508 have been 
promulgated by such date, see section 4712(c) of Pub. L. 101-508, set 
out as an Effective Date note under section 1396u of this title.
    Amendment by section 4713(b) of Pub. L. 101-508 applicable to 
medical assistance furnished on or after Jan. 1, 1991, see section 
4713(c) of Pub. L. 101-508, set out as a note under section 1396a of 
this title.
    Section 4719(b) of Pub. L. 101-508 provided that: ``The amendment 
made by subsection (a) [amending this section] shall take effect on the 
date of the enactment of this Act [Nov. 5, 1990].''
    Section 4721(b) of Pub. L. 101-508 provided that: ``The amendment 
made by this section [amending this section] shall become effective with 
respect to personal care services provided on or after October 1, 
1994.''
    Section 4755(a)(1)(B) of Pub. L. 101-508 provided that: ``The 
amendment made by subparagraph (A) [amending this section] shall be 
effective as if included in the enactment of the Deficit Reduction Act 
of 1984 [Pub. L. 98-369].''


                    Effective Date of 1989 Amendments

    Amendment by section 6403(a), (c), (d)(2) of Pub. L. 101-239 
effective Apr. 1, 1990, without regard to whether or not final 
regulations to carry out the amendments by section 6403 of Pub. L. 101-
239 have been promulgated by such date, see section 6403(e) of Pub. L. 
101-239, set out as a note under section 1396a of this title.
    Amendment by section 6404(a), (b) of Pub. L. 101-239 applicable, 
except as otherwise provided, to payments under this subchapter for 
calendar quarters beginning on or after Apr. 1, 1990, without regard to 
whether or not final regulations to carry out the amendments by section 
6404 of Pub. L. 101-239 have been promulgated by such date, see section 
6404(d) of Pub. L. 101-239, set out as a note under section 1396a of 
this title.
    Amendment by section 6405(a) of Pub. L. 101-239 effective with 
respect to services furnished by a certified pediatric nurse 
practitioner or certified family nurse practitioner on or after July 1, 
1990, see section 6405(c) of Pub. L. 101-239, set out as a note under 
section 1396a of this title.
    Amendment by section 6408(d)(2), (4)(A), (B) of Pub. L. 101-239 
applicable, except as otherwise provided, to payments under this 
subchapter for calendar quarters beginning on or after July 1, 1990, 
without regard to whether or not final regulations to carry out the 
amendments by section 6408(d) of Pub. L. 101-239 have been promulgated 
by such date, see section 6408(d)(5) of Pub. L. 101-239, set out as a 
note under section 1396a of this title.
    Amendment by Pub. L. 101-234 effective Jan. 1, 1990, see section 
201(c) of Pub. L. 101-234, set out as a note under section 1320a-7a of 
this title.


                    Effective Date of 1988 Amendments

    Amendment by Pub. L. 100-647 effective as if included in the 
enactment of section 301 of the Medicare Catastrophic Coverage Act of 
1988, Pub. L. 100-360, see section 8434(c) of Pub. L. 100-647, set out 
as a note under section 1396a of this title.
    Amendment by section 303(b)(2) of Pub. L. 100-485 applicable to 
payments under this subchapter for calendar quarters beginning on or 
after Apr. 1, 1990 (or, in the case of the Commonwealth of Kentucky, 
Oct. 1, 1990) (without regard to whether regulations to implement such 
amendment are promulgated by such date), with respect to families that 
cease to be eligible for aid under part A of subchapter IV of this 
chapter on or after that date, see section 303(f)(1) of Pub. L. 100-485, 
set out as a note under section 1396a of this title.
    Amendment by section 401(d)(2) of Pub. L. 100-485 effective Oct. 1, 
1990, except as provided in subsec. (m)(2) of this section and not 
effective for Puerto Rico, Guam, American Samoa, and the Virgin Islands, 
until the date of repeal of limitations contained in section 1308(a) of 
this title on payments to such jurisdictions for purposes of making 
maintenance payments under this part and part E of this subchapter, see 
section 401(g) of Pub. L. 100-485, as amended, set out as a note under 
section 1396a of this title.
    Amendment by section 608(d)(14)(A)-(G), (J) of Pub. L. 100-485 
effective as if included in the enactment of the Medicare Catastrophic 
Coverage Act of 1988, Pub. L. 100-360, see section 608(g)(1) of Pub. L. 
100-485, set out as a note under section 704 of this title.
    Amendment by section 608(f)(3) of Pub. L. 100-485 effective Oct. 13, 
1988, see section 608(g)(2) of Pub. L. 100-485, set out as a note under 
section 704 of this title.
    Amendment by section 301(a)(2)-(d) of Pub. L. 100-360 applicable, 
except as otherwise provided, to payments under this subchapter for 
calendar quarters beginning on or after Jan. 1, 1989, without regard to 
whether or not final regulations to carry out such amendment have been 
promulgated by that date, with respect to medical assistance for monthly 
premiums under subchapter XVIII of this chapter for months beginning 
with January 1989, and items and services furnished on and after Jan. 1, 
1989, see section 301(h) of Pub. L. 100-360, set out as a note under 
section 1396a of this title.
    Except as specifically provided in section 411 of Pub. L. 100-360, 
amendment by section 411(h)(4)(E), (k)(4), (8) of Pub. L. 100-360, as it 
relates to a provision in the Omnibus Budget Reconciliation Act of 1987, 
Pub. L. 100-203, effective as if included in the enactment of that 
provision in Pub. L. 100-203, see section 411(a) of Pub. L. 100-360, set 
out as a Reference to OBRA; Effective Date note under section 106 of 
Title 1, General Provisions.
    Section 411(k)(14)(B) of Pub. L. 100-360 provided that: ``The 
amendment made by subparagraph (A) [amending this section] shall take 
effect on the date of the enactment of this Act [July 1, 1988].''


                    Effective Date of 1987 Amendment

    Amendment by section 4073(d) of Pub. L. 100-203 effective with 
respect to services performed on or after July 1, 1988, see section 
4073(e) of Pub. L. 100-203, set out as a note under section 1395k of 
this title.
    Section 4101(c)(3) of Pub. L. 100-203 provided that:
    ``(A) The amendments made by this subsection [amending this section 
and section 1396a of this title] shall apply to medical assistance 
furnished on or after October 1, 1988.
    ``(B) For purposes of section 1905(n)(2) of the Social Security Act 
[section 1396d(n)(2) of this title] (as amended by subsection (a) 
[probably means ``subsection (c)'']) for medical assistance furnished 
during fiscal year 1989, any reference to `age of 7' is deemed to be a 
reference to `age of 6'.''
    Section 4103(b) of Pub. L. 100-203 provided that:
    ``(1) The amendment made by subsection (a) [amending this section] 
applies (except as provided under paragraph (2)) to payments under title 
XIX of the Social Security Act [42 U.S.C. 1396 et seq.] for calendar 
quarters beginning on or after January 1, 1988, without regard to 
whether or not final regulations to carry out such amendment have been 
promulgated by such date.
    ``(2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirement imposed by the amendment made by subsection (a), the State 
plan shall not be regarded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet this additional 
requirement before the first day of the first calendar quarter beginning 
after the close of the first regular session of the State legislature 
that begins after the date of enactment of this Act [Dec. 22, 1987].''
    Section 4105(b) of Pub. L. 100-203 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to services 
furnished on or after January 1, 1988, without regard to whether 
regulations to implement such amendment are promulgated by such date.''
    Amendments by section 4211(e), (f), (h)(6) of Pub. L. 100-203 
applicable to nursing facility services furnished on or after Oct. 1, 
1990, without regard to whether regulations implementing such amendments 
are promulgated by such date, except as otherwise specifically provided 
in section 1396r of this title, with transitional rule, see section 
4214(a), (b)(2) of Pub. L. 100-203, as amended, set out as an Effective 
Date note under section 1396r of this title.


                    Effective Date of 1986 Amendments

    Amendment by Pub. L. 99-514 effective, except as otherwise provided, 
as if included in enactment of the Consolidated Omnibus Budget 
Reconciliation Act of 1985, Pub. L. 99-272, see section 1895(e) of Pub. 
L. 99-514, set out as a note under section 162 of Title 26, Internal 
Revenue Code.
    Amendment by section 9403(b), (d), (g)(3) of Pub. L. 99-509 
applicable to payments under this subchapter for calendar quarters 
beginning on or after July 1, 1987, without regard to whether or not 
final regulations to carry out such amendments have been promulgated by 
such date, see section 9403(h) of Pub. L. 99-509, set out as a note 
under section 1396a of this title.
    Amendment by section 9404(b) of Pub. L. 99-509 applicable, except as 
otherwise provided, to payments under this subchapter for calendar 
quarters beginning on or after July 1, 1987, without regard to whether 
regulations to implement such amendments are promulgated by such date, 
see section 9404(c) of Pub. L. 99-509, set out as a note under section 
1396a of this title.
    Amendment by section 9408(c)(1) of Pub. L. 99-509 applicable to 
services furnished on or after Oct. 21, 1986, see section 9408(d) of 
Pub. L. 99-509, set out as a note under section 1396a of this title.
    Section 9501(d)(1) of Pub. L. 99-272 provided that:
    ``(A) The amendments made by subsection (a) [amending this section] 
apply (except as provided under subparagraph (B)) to payments under 
title XIX of the Social Security Act [this subchapter] for calendar 
quarters beginning on or after the [sic] July 1, 1986, without regard to 
whether or not final regulations to carry out the amendments have been 
promulgated by that date.
    ``(B) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirement imposed by the amendments made by subsection (a), the State 
plan shall not be regarded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet this additional 
requirement before the first day of the first calendar quarter beginning 
after the close of the first regular session of the State legislature 
that begins after the date of the enactment of this Act [Apr. 7, 
1986].''
    Amendment by section 9505(a) of Pub. L. 99-272 applicable to medical 
assistance provided for hospice care furnished on or after Apr. 7, 1986, 
see section 9505(e) of Pub. L. 99-272, set out as a note under section 
1396a of this title.
    Section 9511(b) of Pub. L. 99-272, as amended by Pub. L. 99-509, 
title IX, Sec. 9435(d)(2), Oct. 21, 1986, 100 Stat. 2070, provided that: 
``The amendment made by this section [amending this section] shall apply 
to services furnished on or after April 1, 1986, without regard to 
whether or not regulations to carry out the amendment have been 
promulgated by that date.''


                    Effective Date of 1984 Amendment

    Amendment by section 2335(f) of Pub. L. 98-369 effective July 18, 
1984, see section 2335(g) of Pub. L. 98-369, set out as a note under 
section 1395f of this title.
    Amendment by section 2340(b) of Pub. L. 98-369 effective July 18, 
1984, see section 2340(c) of Pub. L. 98-369, set out as a note under 
section 1395x of this title.
    Amendment by section 2361(b) of Pub. L. 98-369 applicable to 
calendar quarters beginning on or after Oct. 1, 1984, without regard to 
whether or not final regulations to carry out the amendment have been 
promulgated by such date, except as otherwise provided, see section 
2361(d) of Pub. L. 98-369, set out as a note under section 1396a of this 
title.
    Section 2371(b) of Pub. L. 98-369 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply to services 
furnished on or after the date of the enactment of this Act [July 18, 
1984].''


                    Effective Date of 1982 Amendment

    Amendment by section 136(c) of Pub. L. 97-248 effective Oct. 1, 
1982, see section 136(e) of Pub. L. 97-248, set out as a note under 
section 1301 of this title.
    Amendment by section 137(b)(17), (18) of Pub. L. 97-248 effective as 
if originally included as part of this section as this section was 
amended by the Omnibus Budget Reconciliation Act of 1981, Pub. L. 97-35, 
see section 137(d)(2) of Pub. L. 97-248, set out as a note under section 
1396a of this title.


                    Effective Date of 1981 Amendment

    Amendment by section 2172(b) of Pub. L. 97-35 effective Aug. 13, 
1981, see section 2172(c) of Pub. L. 97-35, set out as a note under 
section 1396a of this title.


                    Effective Date of 1980 Amendment

    For effective date of amendment by Pub. L. 96-499, see section 
965(c) of Pub. L. 96-499, set out as a note under section 1396a of this 
title.


                    Effective Date of 1978 Amendment

    Section 8(d)(1) of Pub. L. 95-292 provided that: ``The amendments 
made by subsections (a) and (b) [amending this section] shall become 
effective on July 1, 1978.''


                    Effective Date of 1977 Amendment

    Amendment by Pub. L. 95-210 applicable to medical assistance 
provided, under a State plan approved under subchapter XIX of this 
chapter, on and after the first day of the first calender quarter that 
begins more than six months after Dec. 13, 1977, with exception for 
plans requiring State legislation, see section 2(f) of Pub. L. 95-210, 
set out as a note under section 1395cc of this title.


                    Effective Date of 1973 Amendment

    Amendment by section 13(a)(13)-(18) of Pub. L. 93-233 effective with 
respect to payments under section 1396b of this title for calendar 
quarters commencing after Dec. 31, 1973, see section 13(d) of Pub. L. 
93-233, set out as a note under section 1396a of this title.


                    Effective Date of 1972 Amendment

    Section 212(b) of Pub. L. 92-603 provided that: ``The provisions of 
subsection (e) of section 1905 of the Social Security Act [subsec. (e) 
of this section] (as added by subsection (a) of this section) shall be 
applicable in the case of services performed on or after the date of 
enactment of this Act [Oct. 30, 1972].''
    Amendment by section 247(b) of Pub. L. 92-603 effective with respect 
to services furnished after Dec. 31, 1972, see section 247(c) of Pub. L. 
92-603, set out as a note under section 1395f of this title.
    Section 275(b) of Pub. L. 92-603 provided that: ``The amendment made 
by this section [amending this section] shall be effective with respect 
to services furnished after June 30, 1973.''
    Section 297(b) of Pub. L. 92-603 provided that: ``The amendment made 
by this section [amending this section] shall apply with respect to 
services furnished after December 31, 1972.''


                    Effective Date of 1971 Amendment

    Amendment by Pub. L. 92-223 effective Jan. 1, 1972, see section 4(d) 
of Pub. L. 92-223, set out as a note under section 1396a of this title.


                    Effective Date of 1968 Amendment

    Section 248(e) of Pub. L. 90-248 provided that the amendment made by 
that section is effective with respect to quarters after 1967.


                     Construction of 1999 Amendment

    Amendment by Pub. L. 106-170 to be executed as if Pub. L. 106-169 
had been enacted after the enactment of Pub. L. 106-170, see section 
121(c)(1) of Pub. L. 106-169, set out as a note under section 1396a of 
this title.


                       Increased FMAPs for Alaska

    Section 4725(a) of Pub. L. 105-33 provided that: ``Notwithstanding 
the first sentence of section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)), the Federal medical assistance percentage determined 
under such sentence for Alaska shall be 59.8 percent but only with 
respect to--
        ``(1) items and services furnished under a State plan under 
    title XIX [this subchapter] or under a State child health plan under 
    title XXI of such Act [subchapter XXI of this chapter] during fiscal 
    years 1998, 1999, and 2000;
        ``(2) payments made on a capitation or other risk-basis under 
    such titles for coverage occurring during such period; and
        ``(3) payments under title XIX of such Act attributable to DSH 
    allotments for such State determined under section 1923(f) of such 
    Act (42 U.S.C. 1396r-4(f)) for such fiscal years.''


                     EPSDT Benefit Study and Report

    Section 4744 of Pub. L. 105-33 provided that:
    ``(a) Study.--
        ``(1) In general.--The Secretary of Health and Human Services, 
    in consultation with Governors, directors of State medicaid 
    programs, the American Academy of Actuaries, and representatives of 
    appropriate provider and beneficiary organizations, shall conduct a 
    study of the provision of early and periodic screening, diagnostic, 
    and treatment services under the medicaid program under title XIX of 
    the Social Security Act [this subchapter] in accordance with the 
    requirements of section 1905(r) of such Act (42 U.S.C. 1396d(r)).
        ``(2) Required contents.--The study conducted under paragraph 
    (1) shall include examination of the actuarial value of the 
    provision of such services under the medicaid program and an 
    examination of the portions of such actuarial value that are 
    attributable to paragraph (5) of section 1905(r) of such Act and to 
    the second sentence of such section.
    ``(b) Report.--Not later than 12 months after the date of the 
enactment of this Act [Aug. 5, 1997], the Secretary of Health and Human 
Services shall submit a report to Congress on the results of the study 
conducted under subsection (a).''


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

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


      Limitation on Disallowances or Deferral of Federal Financial 
 Participation for Certain Inpatient Psychiatric Hospital Services for 
                        Individuals Under Age 21

    Section 4706 of Pub. L. 101-508 provided that:
    ``(a) In General.--(1) If the Secretary of Health and Human Services 
makes a determination that a psychiatric facility has failed to comply 
with certification of need requirements for inpatient psychiatric 
hospital services for individuals under age 21 pursuant to section 
1905(h) of the Social Security Act [subsec. (h) of this section], and 
such determination has not been subject to a final judicial decision, 
any disallowance or deferral of Federal financial participation under 
such Act [this chapter] based on such determination shall only apply to 
the period of time beginning with the first day of noncompliance and 
ending with the date by which the psychiatric facility develops 
documentation (using plan of care or utilization review procedures) of 
the need for inpatient care with respect to such individuals.
    ``(2) Any disallowance of Federal financial participation under 
title XIX of the Social Security Act [this subchapter] relating to the 
failure of a psychiatric facility to comply with certification of need 
requirements--
        ``(A) shall not exceed 25 percent of the amount of Federal 
    financial participation for the period described in paragraph (1); 
    and
        ``(B) shall not apply to any fiscal year before the fiscal year 
    that is 3 years before the fiscal year in which the determination of 
    noncompliance described in paragraph (1) is made.
    ``(b) Effective Date.--Subsection (a) shall apply to disallowance 
actions and deferrals of Federal financial participation with respect to 
services provided before the date of enactment of this Act [Nov. 5, 
1990].''


        Intermediate Care Facility; Access and Visitation Rights

    Section 411(l)(3)(C)(i), formerly Sec. 411(l)(3)(C), of Pub. L. 100-
360, as redesignated by Pub. L. 100-485, title VI, Sec. 608(d)(27)(E), 
Oct. 13, 1988, 102 Stat. 2423, provided that: ``Effective as of the date 
of the enactment of this Act [July 1, 1988] and until the effective date 
of section 1919(c) of such Act [section 1396r(c) of this title, see 
Effective Date note set out under section 1396r of this title], section 
1905(c) of the Social Security Act [subsec. (c) of this section] is 
deemed to include the requirement described in section 1919(c)(3)(A) of 
such Act (as inserted by section 4211(a)(3) of OBRA).''


   Regulations for Intermediate Care Facilities for Mentally Retarded

    Section 9514 of Pub. L. 99-272 provided that: ``The Secretary of 
Health and Human Services shall promulgate proposed regulations revising 
standards for intermediate care facilities for the mentally retarded 
under title XIX of the Social Security Act [this subchapter] within 60 
days after the date of the enactment of this Act [Apr. 7, 1986].''


                      Life Safety Code Recognition

    Section 9515 of Pub. L. 99-272 provided that: ``For purposes of 
section 1905(c) of the Social Security Act [subsec. (c) of this 
section], an intermediate care facility for the mentally retarded (as 
defined in section 1905(d) of such Act) which meets the requirements of 
the relevant sections of the 1985 edition of the Life Safety Code of the 
National Fire Protection Association shall be deemed to meet the fire 
safety requirements for intermediate care facilities for the mentally 
retarded until such time as the Secretary specifies a later edition of 
the Life Safety Code for purposes of such section, or the Secretary 
determines that more stringent standards are necessary to protect the 
safety of residents of such facilities.''


     Study of Federal Medical Assistance Percentage Formula and of 
Adjustments of Target Amounts for Federal Medicaid Expenditures; Report 
                               to Congress

    Section 2165 of Pub. L. 97-35 directed the Comptroller General, in 
consultation with the Advisory Committee for Intergovernmental 
Relations, to study the Federal medical assistance percentage formula as 
applicable to distribution of Federal funds to States, with a view to 
revising the medicaid matching formula so as to take into account 
factors which might result in a more equitable distribution of Federal 
funds to States under this chapter, and to report to Congress on such 
study not later than Oct. 1, 1982.


    Costs Charged to Personal Funds of Patients in Intermediate Care 
     Facilities; Costs Included in Charges for Services; Regulations

    Section 8(c), (d)(2) of Pub. L. 95-292 required the Secretary of 
Health, Education, and Welfare to issue regulations, within 90 days 
after enactment of Pub. L. 95-292 but not later than July 1, 1978, 
defining those costs that may be charged to the personal funds of 
patients in intermediate care facilities who are individuals receiving 
medical assistance under a State plan approved under title XIX of the 
Social Security Act, and those costs that are to be included in the 
reasonable cost or reasonable charge for intermediate care facility 
services. See section 1302 of this title.

                  Section Referred to in Other Sections

    This section is referred to in sections 256b, 280c-6, 290bb-1, 
300ff-52, 603, 618, 657, 674, 705, 1318, 1395i-2, 1395v, 1395w-4, 1395w-
21, 1395ss, 1396a, 1396b, 1396i, 1396n, 1396o, 1396p, 1396r, 1396r-1, 
1396r-6, 1396r-8, 1396s, 1396t, 1396u-2, 1397dd, 1397ee, 1397jj, 3058k, 
11398 of this title.
