42 U.S.C. § 1396n
A State shall not be deemed to be out of compliance with the requirements of paragraphs (1), (10), or (23) of section 1396a(a) of this title solely by reason of the fact that the State (or any political subdivision thereof)-
The Secretary, to the extent he finds it to be cost-effective and efficient and not inconsistent with the purposes of this subchapter, may waive such requirements of section 1396a of this title (other than subsection (s)) (other than sections 1396a(a)(15), 1396a(bb), and 1396a(a)(10)(A) of this title insofar as it requires provision of the care and services described in section 1396d(a)(2)(C) of this title) as may be necessary for a State-
No waiver under this subsection may restrict the choice of the individual in receiving services under section 1396d(a)(4)(C) of this title. Subsection (h)(2) shall apply to a waiver under this subsection.
for an evaluation of the need for inpatient hospital services, nursing facility services, or services in an intermediate care facility for the mentally retarded;
Except as provided under paragraph (2)(D), the Secretary may not restrict the number of hours or days of respite care in any period which a State may provide under a waiver under this subsection.
the State will provide for an evaluation of the need for such skilled nursing facility or intermediate care facility services; and
Each State with a waiver under this subsection shall provide to the Secretary annually, consistent with a reasonable data collection plan designed by the Secretary, information on the impact of the waiver granted under this subsection on the type and amount of medical assistance provided under the State plan and on the health and welfare of recipients.
The Secretary shall develop (by not later than October 1, 1989) a method for projecting, on a State-specific basis, the percentage increase in the number of residents in each State who are over 65 years of age for any period. Effective on and after the date the Secretary promulgates the regulation under clause (iii), any reference in this subparagraph to the "lesser of 7 percent" shall be deemed to be a reference to the "greater of 7 percent".
and with respect to whom adoption or foster care assistance is (or will be) made available under part E of subchapter IV.
Subject to the succeeding provisions of this subsection, a State may provide through a State plan amendment for the provision of medical assistance for home and community-based services (within the scope of services described in paragraph (4)(B) of subsection (c) for which the Secretary has the authority to approve a waiver and not including room and board) for individuals eligible for medical assistance under the State plan whose income does not exceed 150 percent of the poverty line (as defined in section 1397jj(c)(5) of this title), without determining that but for the provision of such services the individuals would require the level of care provided in a hospital or a nursing facility or intermediate care facility for the mentally retarded, but only if the State meets the following requirements:
The State establishes needs-based criteria for determining an individual's eligibility under the State plan for medical assistance for such home and community-based services, and if the individual is eligible for such services, the specific home and community-based services that the individual will receive.
The State establishes needs-based criteria for determining whether an individual requires the level of care provided in a hospital, a nursing facility, or an intermediate care facility for the mentally retarded under the State plan or under any waiver of such plan that are more stringent than the needs-based criteria established under subparagraph (A) for determining eligibility for home and community-based services.
The State submits to the Secretary, in such form and manner, and upon such frequency as the Secretary shall specify, the projected number of individuals to be provided home and community-based services.
The criteria established by the State for purposes of subparagraphs (A) and (B) requires an assessment of an individual's support needs and capabilities, and may take into account the inability of the individual to perform 2 or more activities of daily living (as defined in section 7702B(c)(2)(B) of the Internal Revenue Code of 1986) or the need for significant assistance to perform such activities, and such other risk factors as the State determines to be appropriate.
The State plan amendment provides the State with the option to modify the criteria established under subparagraph (A) (without having to obtain prior approval from the Secretary) in the event that the enrollment of individuals eligible for home and community-based services exceeds the projected enrollment submitted for purposes of subparagraph (C), but only if-
The State uses an independent evaluation for making the determinations described in subparagraphs (A) and (B).
In the case of an individual who is determined to be eligible for home and community-based services, the State uses an independent assessment, based on the needs of the individual to-
The independent assessment required under subparagraph (E)(ii) shall include the following:
In the case of an individual who is determined to be eligible for home and community-based services, the State uses the independent assessment required under subparagraph (E)(ii) to establish a written individualized care plan for the individual.
The State ensures that the individualized care plan for an individual-
At the option of the State, the State may allow an individual or the individual's representative to elect to receive self-directed home and community-based services in a manner which gives them the most control over such services consistent with the individual's abilities and the requirements of subclauses (II) and (III).
The term "self-directed" means, with respect to the home and community-based services offered under the State plan amendment, such services for the individual which are planned and purchased under the direction and control of such individual or the individual's authorized representative, including the amount, duration, scope, provider, and location of such services, under the State plan consistent with the following requirements:
There is an assessment of the needs, capabilities, and preferences of the individual with respect to such services.
Based on such assessment, there is developed jointly with such individual or the individual's authorized representative a plan for such services for such individual that is approved by the State and that satisfies the requirements of subclause (III).
For purposes of subclause (II)(bb), the requirements of this subclause are that the plan-
With respect to individualized budgets described in subclause (III)(ff), the State plan amendment-
The State ensures that the provision of home and community-based services meets Federal and State guidelines for quality assurance.
The State establishes standards for the conduct of the independent evaluation and the independent assessment to safeguard against conflicts of interest.
The State allows for at least annual redeterminations of eligibility, and appeals in accordance with the frequency of, and manner in which, redeterminations and appeals of eligibility are made under the State plan.
The State, at its option, elects to provide for a period of presumptive eligibility (not to exceed a period of 60 days) only for those individuals that the State has reason to believe may be eligible for home and community-based services. Such presumptive eligibility shall be limited to medical assistance for carrying out the independent evaluation and assessment under subparagraph (E) to determine an individual's eligibility for such services and if the individual is so eligible, the specific home and community-based services that the individual will receive.
In this section, the term "individual's representative" means, with respect to an individual, a parent, a family member, or a guardian of the individual, an advocate for the individual, or any other individual who is authorized to represent the individual.
A State may elect in the State plan amendment approved under this section to not comply with the requirements of section 1396a(a)(10)(B) of this title (relating to comparability) and section 1396a(a)(10)(C)(i)(III) of this title (relating to income and resource rules applicable in the community), but only for purposes of provided home and community-based services in accordance with such amendment. Any such election shall not be construed to apply to the provision of services to an individual receiving medical assistance in an institutionalized setting as a result of a determination that the individual requires the level of care provided in a hospital or a nursing facility or intermediate care facility for the mentally retarded.
Nothing in this subsection shall be construed as affecting the option of a State to offer home and community-based services under a waiver under subsections (c) or (d) of this section or under section 1315 of this title.
Notwithstanding paragraph (1)(B), Federal financial participation shall continue to be available for an individual who is receiving medical assistance in an institutionalized setting, or home and community-based services provided under a waiver under this section or section 1315 of this title that is in effect as of the effective date of the State plan amendment submitted under this subsection, as a result of a determination that the individual requires the level of care provided in a hospital or a nursing facility or intermediate care facility for the mentally retarded, without regard to whether such individuals satisfy the more stringent eligibility criteria established under that paragraph, until such time as the individual is discharged from the institution or waiver program or no longer requires such level of care.
A State that provides home and community-based services in accordance with this subsection to individuals who satisfy the needs-based criteria for the receipt of such services established under paragraph (1)(A) may, in addition to continuing to provide such services to such individuals, elect to provide home and community-based services in accordance with the requirements of this paragraph to individuals who are eligible for home and community-based services under a waiver approved for the State under subsection (c), (d), or (e) or under section 1315 of this title to provide such services, but only for those individuals whose income does not exceed 300 percent of the supplemental security income benefit rate established by section 1382(b)(1) of this title.
Subject to subparagraph (C), a State shall provide home and community-based services to individuals under this paragraph in the same manner and subject to the same requirements as apply under the other paragraphs of this subsection to the provision of home and community-based services to individuals who satisfy the needs-based criteria established under paragraph (1)(A).
A State may offer home and community-based services to individuals under this paragraph that differ in type, amount, duration, or scope from the home and community-based services offered for individuals who satisfy the needs-based criteria established under paragraph (1)(A), so long as such services are within the scope of services described in paragraph (4)(B) of subsection (c) for which the Secretary has the authority to approve a waiver and do not include room or board.
A State may elect in a State plan amendment under this subsection to target the provision of home and community-based services under this subsection to specific populations and to differ the type, amount, duration, or scope of such services to such specific populations.
An election by a State under this paragraph shall be for a period of 5 years.
A State making an election under this paragraph may, during the first 5-year period for which the election is made, phase-in the enrollment of eligible individuals, or the provision of services to such individuals, or both, so long as all eligible individuals in the State for such services are enrolled, and all such services are provided, before the end of the initial 5-year period.
An election by a State under this paragraph may be renewed for additional 5-year terms if the Secretary determines, prior to beginning1 of each such renewal period, that the State has-
an evaluation of the need for personal care under the plan, or personal services under a waiver granted under subsection (c).
The participant (or in the case of a participant who is a minor child, the participant's parent or guardian, or in the case of an incapacitated adult, another individual recognized by State law to act on behalf of the participant) exercises choice and control over the budget, planning, and purchase of self-directed personal assistance services, including the amount, duration, scope, provider, and location of service provision.
There is an assessment of the needs, strengths, and preferences of the participants for such services.
A plan for such services (and supports for such services) for the participant has been developed and approved by the State based on such assessment through a person-centered process that-
A budget for such services and supports for the participant has been developed and approved by the State based on such assessment and plan and on a methodology that uses valid, reliable cost data, is open to public inspection, and includes a calculation of the expected cost of such services if those services were not self-directed. The budget may not restrict access to other medically necessary care and services furnished under the plan and approved by the State but not included in the budget.
There are appropriate quality assurance and risk management techniques used in establishing and implementing such plan and budget that recognize the roles and responsibilities in obtaining services in a self-directed manner and assure the appropriateness of such plan and budget based upon the participant's resources and capabilities.
Subject to the succeeding provisions of this subsection, beginning October 1, 2011, a State may provide through a State plan amendment for the provision of medical assistance for home and community-based attendant services and supports for individuals who are eligible for medical assistance under the State plan whose income does not exceed 150 percent of the poverty line (as defined in section 1397jj(c)(5) of this title) or, if greater, the income level applicable for an individual who has been determined to require an institutional level of care to be eligible for nursing facility services under the State plan and with respect to whom there has been a determination that, but for the provision of such services, the individuals would require the level of care provided in a hospital, a nursing facility, an intermediate care facility for the mentally retarded, or an institution for mental diseases, the cost of which could be reimbursed under the State plan, but only if the individual chooses to receive such home and community-based attendant services and supports, and only if the State meets the following requirements:
The State shall make available home and community-based attendant services and supports to eligible individuals, as needed, to assist in accomplishing activities of daily living, instrumental activities of daily living, and health-related tasks through hands-on assistance, supervision, or cueing-
In addition to assistance in accomplishing activities of daily living, instrumental activities of daily living, and health related tasks, the home and community-based attendant services and supports made available include-
Subject to subparagraph (D), the home and community-based attendant services and supports made available do not include-
The home and community-based attendant services and supports may include-
For purposes of payments to a State under section 1396b(a)(1) of this title, with respect to amounts expended by the State to provide medical assistance under the State plan for home and community-based attendant services and supports to eligible individuals in accordance with this subsection during a fiscal year quarter occurring during the period described in paragraph (1), the Federal medical assistance percentage applicable to the State (as determined under section 1396d(b) of this title) shall be increased by 6 percentage points.
In order for a State plan amendment to be approved under this subsection, the State shall-
A State shall ensure that, regardless of whether the State uses an agency-provider model or other models to provide home and community-based attendant services and supports under a State plan amendment under this subsection, such services and supports are provided in accordance with the requirements of the Fair Labor Standards Act of 1938 [29 U.S.C. 201 et seq.] and applicable Federal and State laws regarding-
The Secretary shall conduct an evaluation of the provision of home and community-based attendant services and supports under this subsection in order to determine the effectiveness of the provision of such services and supports in allowing the individuals receiving such services and supports to lead an independent life to the maximum extent possible; the impact on the physical and emotional health of the individuals who receive such services; and an2 comparative analysis of the costs of services provided under the State plan amendment under this subsection and those provided under institutional care in a nursing facility, institution for mental diseases, or an intermediate care facility for the mentally retarded.
The State shall provide the Secretary with the following information regarding the provision of home and community-based attendant services and supports under this subsection for each fiscal year for which such services and supports are provided:
Not later than-
In this subsection:
The term "activities of daily living" includes tasks such as eating, toileting, grooming, dressing, bathing, and transferring.
The term "consumer controlled" means a method of selecting and providing services and supports that allow the individual, or where appropriate, the individual's representative, maximum control of the home and community-based attendant services and supports, regardless of who acts as the employer of record.
The term "agency-provider model" means, with respect to the provision of home and community-based attendant services and supports for an individual, subject to paragraph (4), a method of providing consumer controlled services and supports under which entities contract for the provision of such services and supports.
The term "other models" means, subject to paragraph (4), methods, other than an agency-provider model, for the provision of consumer controlled services and supports. Such models may include the provision of vouchers, direct cash payments, or use of a fiscal agent to assist in obtaining services.
The term "health-related tasks" means specific tasks related to the needs of an individual, which can be delegated or assigned by licensed health-care professionals under State law to be performed by an attendant.
The term "individual's representative" means a parent, family member, guardian, advocate, or other authorized representative of an individual3
The term "instrumental activities of daily living" includes (but is not limited to) meal planning and preparation, managing finances, shopping for food, clothing, and other essential items, performing essential household chores, communicating by phone or other media, and traveling around and participating in the community.
With respect to calendar quarters beginning on or after October 1, 2019, a State may elect, through a State plan amendment, to provide medical assistance for items and services furnished to an eligible individual who is a patient in an eligible institution for mental diseases in accordance with the requirements of this subsection.
Subject to paragraphs (3) and (4), amounts expended under a State plan amendment under paragraph (1) for services described in such paragraph furnished, with respect to a 12-month period, to an eligible individual who is a patient in an eligible institution for mental diseases shall be treated as medical assistance for which payment is made under section 1396b(a) of this title but only to the extent that such services are furnished for not more than a period of 30 days (whether or not consecutive) during such 12-month period.
As a condition for a State receiving payments under section 1396b(a) of this title for medical assistance provided in accordance with this subsection, the State shall (during the period in which it so furnished such medical assistance through a State plan amendment under this subsection) maintain on an annual basis a level of funding expended by the State (and political subdivisions thereof) from non-Federal funds for items and services (including services described in subparagraph (B)) furnished to eligible individuals in outpatient and community-based settings that is not less than the level of such funding for such items and services for, at the option of the State-
For purposes of subparagraph (A), services described in this subparagraph are the following:
Prior to approval of a State plan amendment under this subsection, as a condition for a State receiving payments under section 1396b(a) of this title for medical assistance provided in accordance with this subsection, the State shall report to the Secretary, in accordance with the process established by the Secretary under clause (ii), the information deemed necessary by the Secretary under such clause.
Not later than the date that is 8 months after October 24, 2018, the Secretary shall establish a process for States to report to the Secretary, at such time and in such manner as the Secretary deems appropriate, such information as the Secretary deems necessary to verify a State's compliance with subparagraph (A).
In the case of a State with a State plan amendment in effect on September 30, 2023, for the 1-year period beginning on March 9, 2024, the provisions of subparagraph (A) shall be applied as if the amendments to such subparagraph made by the Consolidated Appropriations Act, 2024 had never been made.
As a condition for a State receiving payments under section 1396b(a) of this title for medical assistance provided in accordance with this subsection, the State shall carry out each of the requirements described in subparagraphs (B) through (F).
The State shall have in place evidence-based, substance use disorder-specific individual placement criteria and utilization management approaches to ensure placement of eligible individuals in an appropriate level of care, including criteria and approaches to ensure that eligible individuals receive appropriate evidence-based clinical screening prior to being furnished with items and services in an eligible institution for mental diseases, including initial and periodic assessments to determine the appropriate level of care, length of stay, and setting for such care for each individual. The State shall notify the Secretary at such time and in such form and manner as the Secretary shall require of such criteria and utilization management approaches.
The State shall, at a minimum, provide medical assistance for services that could otherwise be covered under the State plan, consistent with each of the following outpatient levels of care:
The State shall provide medical assistance for services that could otherwise be covered under the State plan, consistent with at least 2 of the following inpatient and residential levels of care:
In order to ensure an appropriate transition for an eligible individual from receiving care in an eligible institution for mental diseases to receiving care at a lower level of clinical intensity within the continuum of care (including outpatient services), the State shall ensure that-
The State shall, using nationally recognized substance use disorder-specific program standards, have in place a process to review the compliance of eligible institutions for mental diseases with such program standards specified by the State.
The State shall, not later than 12 months after the approval of a State plan amendment described in this subsection (or, in the case of a State that has such an amendment approved as of September 30, 2023, not later than 12 months after March 9, 2024), commence an assessment of-
The State shall complete an assessment described in clause (i) not later than 12 months after the date the State commences such assessment.
Payments for, and limitations to, medical assistance furnished in accordance with this subsection shall be in addition to and shall not be construed to limit or supersede the ability of States to make monthly capitation payments to managed care organizations for individuals receiving treatment in institutions for mental diseases in accordance with section 438.6(e) of title 42, Code of Federal Regulations (or any successor regulation).
The provision of medical assistance for items and services furnished to an eligible individual who is a patient in an eligible institution for mental diseases in accordance with the requirements of this subsection shall not prohibit Federal financial participation for medical assistance for items or services that are provided to such eligible individual in or away from the eligible institution for mental disease during any period in which the eligible individual is receiving items or services in accordance with this subsection.
In this subsection:
The term "eligible individual" means an individual who-
The term "eligible institution for mental diseases" means an institution for mental diseases that-
The term "institution for mental diseases" has the meaning given that term in section 1396d(i) of this title.
1So in original. Probably should be preceded by "the".
2So in original. Probably should be "a".
3So in original. Probably should be followed by a period.
42 U.S.C. § 1396n
Applicability of Amendment Amendment by section 204(c)(1)(A) of title I of div. G of Pub. L. 118-42 applicable with respect to States providing medical assistance for items and services pursuant to a State plan amendment under subsection (l) in calendar quarters beginning on or after Oct. 1, 2025. See 2024 Amendment notes below.
EDITORIAL NOTES
REFERENCES IN TEXTThe Public Health Service Act, referred to in subsec. (g)(5), is act July 1, 1944, ch. 373, 58 Stat. 682. Title XXVI of the Act is classified generally to subchapter XXIV (§300ff et seq.) of chapter 6A of this title. For complete classification of this Act to the Code, see Short Title note set out under section 201 of this title and Tables.Section 7702B(c)(2)(B) of the Internal Revenue Code of 1986, referred to in subsec. (i)(1)(D)(i), (F)(i), is classified to section 7702B(c)(2)(B) of Title 26, Internal Revenue Code.The Individuals with Disabilities Education Act, referred to in subsec. (k)(1)(C)(ii), is title VI of Pub. L. 91-230, Apr. 13, 1970, 84 Stat. 175, which is classified generally to chapter 33 (§1400 et seq.) of Title 20, Education. For complete classification of this Act to the Code, see section 1400 of Title 20 and Tables.The Rehabilitation Act of 1973, referred to in subsec. (k)(1)(C)(ii), is Pub. L. 93-112, Sept. 26, 1973, 87 Stat. 355, which is classified generally to chapter 16 (§701 et seq.) of Title 29, Labor. For complete classification of this Act to the Code, see Short Title note set out under section 701 of Title 29 and Tables. The Fair Labor Standards Act of 1938, referred to in subsec. (k)(4), is act June 25, 1938, ch. 676, 52 Stat. 1060, which is classified generally to chapter 8 (§201 et seq.) of Title 29, Labor. For complete classification of this Act to the Code, see section 201 of Title 29 and Tables. The Consolidated Appropriations Act, 2024, referred to in subsec. (l)(3)(D), is Pub. L. 118-42, 138 Stat. 5. For complete classification of this Act to the Code, see Tables.
AMENDMENTS2024-Subsec. (l)(1). Pub. L. 118-42, §204(a), substituted "With respect to calendar quarters beginning on or after October 1, 2019," for "With respect to calendar quarters beginning during the period beginning October 1, 2019, and ending September 30, 2023,".Subsec. (l)(3)(A). Pub. L. 118-42, §204(b)(1), substituted "from non-Federal funds for items and services (including services described in subparagraph (B))" for "other than under this subchapter from non-Federal funds for- "(i) items and services furnished to eligible individuals who are patients in eligible institutions for mental diseases that is not less than the level of such funding for such items and services for the most recently ended fiscal year as of October 24, 2018, or, if higher, for the most recently ended fiscal year as of the date the State submits a State plan amendment to the Secretary to provide such medical assistance in accordance with this subsection; and"(ii) items and services (including services described in subparagraph (B))"and "such items and services for, at the option of the State-" and cls. (i) and (ii) for "such items and services for the most recently ended fiscal year as of October 24, 2018, or, if higher, for the most recently ended fiscal year as of the date the State submits a State plan amendment to the Secretary to provide such medical assistance in accordance with this subsection."Subsec. (l)(3)(B). Pub. L. 118-42, §204(b)(2),substituted "subparagraph (A)" for "subparagraph (A)(ii)" in introductory provisions.Subsec. (l)(3)(D). Pub. L. 118-42, §204(b)(3), added subpar. (D). Subsec. (l)(4)(A). Pub. L. 118-42, §204(c)(1)(A)(i), substituted "through (F)" for "through (D)".Subsec. (l)(4)(B). Pub. L. 118-42, §204(c)(1)(A)(ii), substituted "The State shall have in place evidence-based, substance use disorder-specific individual placement criteria and utilization management approaches to ensure placement of eligible individuals in an appropriate level of care, including criteria and approaches to ensure" for "Prior to approval of a State plan amendment under this subsection, the State shall notify the Secretary of how the State will ensure" and inserted at end "The State shall notify the Secretary at such time and in such form and manner as the Secretary shall require of such criteria and utilization management approaches."Subsec. (l)(4)(C)(ii). Pub. L. 118-42, §204(c)(3)(A), which directed substitution of "conditions" for "problems in Dimensions 1, 2, or 3" each place it appears, was executed by making the substitution in subcl. (IV) and also making the substitution in subcl. (V) for "problems in Dimensions 1, 2 or 3", to reflect the probable intent of Congress.Subsec. (l)(4)(E). Pub. L. 118-42, §204(c)(1)(A)(iii), added subpar. (E).Subsec. (l)(4)(F). Pub. L. 118-42, §204(c)(2), added subpar. (F). Subsec. (l)(7). Pub. L. 118-42, §204(c)(3)(B), redesignated subpars. (B) to (D) as (A) to (C), respectively, and struck out former subpar. (A). Prior to amendment, text of subpar. (A) read as follows: "The term 'Dimensions 1, 2, or 3' has the meaning given that term for purposes of the publication of the American Society of Addiction Medicine entitled 'The ASAM Criteria: Treatment Criteria for Addictive Substance-Related, and Co-Occurring Conditions, 2013'." 2018-Subsec. (l). Pub. L. 115-271 added subsec. (l).2010-Subsec. (b). Pub. L. 111-148, §2601(b)(1)(A), inserted at end of concluding provisions "Subsection (h)(2) shall apply to a waiver under this subsection." Subsec. (c)(3). Pub. L. 111-148, §2601(b)(1)(B), inserted "(other than a waiver described in subsection (h)(2))" after "A waiver under this subsection".Subsec. (d)(3). Pub. L. 111-148, §2601(b)(1)(C), which directed insertion of "(other than a waiver described in subsection (h)(2))" after "A waiver under this subsection" in second sentence, was executed by making the insertion after "a waiver under this subsection", to reflect the probable intent of Congress. Subsec. (h). Pub. L. 111-148, §2601(a), designated existing provisions as par. (1), inserted ",or a waiver described in paragraph (2)" after "(c), (d), or (e)", and added par. (2).Subsec. (i)(1). Pub. L. 111-148, §2402(c), struck out "or such other services requested by the State as the Secretary may approve" after "room and board".Subsec. (i)(1)(C). Pub. L. 111-148, §2402(e)(1), added subpar. (C) and struck out former subpar. (C) which related to projection of number of individuals to be provided home and community-based services and State authority to limit number of eligible individuals. Subsec. (i)(1)(D)(ii)(II). Pub. L. 111-148, §2402(e)(2), substituted "to continue to be eligible for such services after the effective date of the modification and until such time as the individual no longer meets the standard for receipt of such services under such pre-modified criteria" for "to be eligible for such services for a period of at least 12 months beginning on the date the individual first received medical assistance for such services".Subsec. (i)(3). Pub. L. 111-148, §2402(f), substituted "1396a(a)(10)(B) of this title (relating to comparability)" for "1396a(a)(1) of this title (relating to statewideness)". Subsec. (i)(6), (7). Pub. L. 111-148, §2402(b), added pars. (6) and (7).Subsec. (k). Pub. L. 111-148, §2401, added subsec. (k).Subsec. (k)(1). Pub. L. 111-152 substituted "October 1, 2011" for "October 1, 2010" in introductory provisions. 2006-Subsec. (g)(2) to (5). Pub. L. 109-171, §6052(a), added pars. (2) to (5) and struck out former par. (2), which read as follows: "For purposes of this subsection, the term 'case management services' means services which will assist individuals eligible under the plan in gaining access to needed medical, social, educational, and other services." Subsec. (i). Pub. L. 109-171, §6086(a), added subsec. (i). Subsec. (j). Pub. L. 109-171, §6087(a), added subsec. (j). 2004-Subsec. (c)(5)(C)(i). Pub. L. 108-446 which directed the substitution of "(as such terms are defined in section 1401 of title 20)" for "as defined in section 1401(16) and (17) of title 20)", was executed by making the substitution for "(as defined in paragraphs (16) and (17) of section 1401(a) of title 20)" to reflect the probable intent of Congress and the amendment by Pub. L. 102-119. See 1991 Amendment note below.2002-Subsec. (b). Pub. L. 107-121 substituted "1396a(bb)" for "1396a(aa)". 2000-Subsec. (b). Pub. L. 106-554 substituted "1396a(a)(15), 1396a(aa)," for "1396a(a)(13)(C)" in introductory provisions.1999-Subsec. (b). Pub. L. 106-113, §1000(a)(6) [title VI, §608(z)], which directed, effective Oct. 1, 2004, substitution of "section" for "sections 1396a(a)(13)(C) and" in introductory provisions, could not be executed due to the amendment by Pub. L. 106-554. See 2000 Amendment note above. Pub. L. 106-113, §1000(a)(6) [title VI, §608(o)(1)], substituted "1396a(a)(13)(C)" for "1396a(a)(13)(E)" in introductory provisions.Subsec. (d)(5)(B)(iii). Pub. L. 106-113, §1000(a)(6) [title VI, §608(o)(2)], which directed substitution of "65" for "75" in last sentence of cl. (iii), was executed by making the substitution in the penultimate sentence to reflect the probable intent of Congress.Subsec. (h). Pub. L. 106-113, §1000(a)(6) [title VI, §608(o)(3)], substituted "90 days of such date" for "90 day of such date".1997-Subsec. (a)(1)(B)(ii)(I). Pub. L. 105-33, §4106(c), substituted "paragraphs (16) and (17)" for "paragraphs (15) and (16)".Subsec. (c)(5). Pub. L. 105-33, §4743(a), in introductory provisions, struck out ",with respect to individuals who receive such services after discharge from a nursing facility or intermediate care facility for the mentally retarded" after "'habilitation services'". 1993-Subsec. (g)(1). Pub. L. 103-66 inserted "or to individuals described in section 1396a(z)(1)(A) of this title" after "or with either,".1991-Subsec. (c)(5)(C)(i). Pub. L. 102-119 substituted "(as defined in paragraphs (16) and (17) of section 1401(a) of title 20)" for "(as defined in section 1401(16) and (17) of title 20)". The reference to section 1401 of title 20 includes the substitution of "Individuals with Disabilities Education Act" for "Education of the Handicapped Act" in the original. 1990-Subsec. (b). Pub. L. 101-508, §4704(b)(3), inserted "(other than sections 1396a(a)(13)(E) and 1396a(a)(10)(A) of this title insofar as it requires provision of the care and services described in section 1396d(a)(2)(C) of this title)" after "section 1396a of this title" in introductory provisions. Pub. L. 101-508, §4604(c), which directed amendment of subsec. (b) by inserting "(other than subsection (s))" after "Section 1396a of this title", was executed by inserting the new language after "section 1396a of this title" to reflect the probable intent of Congress.Subsec. (b)(4). Pub. L. 101-508, §4742(a), inserted before period at end "and if providers under such restriction are paid on a timely basis in the same manner as health care practitioners must be paid under section 1396a(a)(37)(A) of this title".Subsec. (c)(1). Pub. L. 101-508, §4741(a), inserted at end "For purposes of this subsection, the term 'room and board' shall not include an amount established under a method determined by the State to reflect the portion of costs of rent and food attributable to an unrelated personal caregiver who is residing in the same household with an individual who, but for the assistance of such caregiver, would require admission to a hospital, nursing facility, or intermediate care facility for the mentally retarded."Subsec. (c)(4). Pub. L. 101-508, §4742(d)(1), inserted at end "Except as provided under paragraph (2)(D), the Secretary may not restrict the number of hours or days of respite care in any period which a State may provide under a waiver under this subsection." Subsec. (c)(7)(C). Pub. L. 101-508, §4742(c)(1), added subpar. (C).Subsec. (d)(1). Pub. L. 101-508, §4741(a), inserted at end "For purposes of this subsection, the term 'room and board' shall not include an amount established under a method determined by the State to reflect the portion of costs of rent and food attributable to an unrelated personal caregiver who is residing in the same household with an individual who, but for the assistance of such caregiver, would require admission to a hospital, nursing facility, or intermediate care facility for the mentally retarded."Subsec. (d)(5)(B)(iv). Pub. L. 101-508, §4741(b), substituted "this subchapter whose provisions become effective on or after such date" for first reference to "this subchapter". 1989-Subsec. (a)(1)(B)(ii)(I). Pub. L. 101-239, §6115(c), substituted "paragraphs (15) and (16)" for "paragraphs (14) and (15)". Pub. L. 101-234 which repealed Pub. L. 100-360, §204(d)(3), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, was not executed in view of intervening amendments made to this section by Pub. L. 101-239, §6115(c), and to section 1395x(s) of this title by Pub. L. 101-239, §6115(a)(1)(C). See 1988 Amendment note below. Subsec. (b)(4). Pub. L. 101-239, §6411(c)(2), inserted "shall be consistent with the requirements of section 1396r-4 of this title and" after "which standards".1988-Subsec. (a)(1)(B)(ii)(I). Pub. L. 100-360, §204(d)(3), substituted "paragraphs (14) and (15)" for "paragraphs (13) and (14)".Subsec. (a)(2). Pub. L. 100-485, §608(f)(2), substituted "restricts" for "Restricts" in introductory provisions. Subsec. (c)(7). Pub. L. 100-360, §411(l)(3)(G), amended Pub. L. 100-203, §4211(h)(10)(G), see 1987 Amendment note below. Subsec. (c)(7)(A). Pub. L. 100-647, §8437(a), substituted "who are inpatients in, or who would require the level of care provided in, hospitals," for "who are inpatients in hospitals," and "who are inpatients in, or who would require the level of care provided in, those respective facilities" for "who are inpatients of those respective facilities".Subsec. (c)(7)(B). Pub. L. 100-360, §411(k)(10)(H), inserted ",without regard to the availability of beds for such inpatients" before period at end. Subsec. (c)(10). Pub. L. 100-360, §411(k)(10)(A), substituted "The Secretary shall not limit to fewer than 200" for "No waiver under this subsection shall limit by an amount less than 200" and "under a waiver under this subsection" for "under such waiver".Subsec. (d)(5)(B)(i), (ii). Pub. L. 100-647, §8432(b), in introductory provisions, substituted "the number of years (rounded to the nearest quarter of a year) beginning after the base year and ending at the end of the waiver year" for "the number of years beginning after the base year and ending before the waiver year", in subcls. (I) and (II), substituted "between the beginning of the base year and the beginning of the waiver year" for "between the base year and the waiver year", and in subcl. (III), inserted "(rounded to the nearest quarter of a year)" after "for each year" and substituted "at the end of the waiver year" for "before the waiver year".Subsec. (d)(5)(B)(iii). Pub. L. 100-360, §411(k)(3)(A)(ii), inserted before last sentence "The Secretary shall develop (by not later than October 1, 1989) a method for projecting, on a State-specific basis, the percentage increase in the number of residents in each State who are over 75 years of age for any period." Subsec. (d)(5)(B)(iii)(III). Pub. L. 100-360, §411(k)(3)(A)(i), substituted "65" for "75".Subsec. (d)(5)(B)(iv). Pub. L. 100-647, §8432(a), added cl. (iv).Subsec. (d)(5)(C)(i). Pub. L. 100-360, §411(k)(3)(B), substituted "paragraph (4), and personal care services" for "paragraph (4)(B), personal care services, and services furnished pursuant to a waiver under subsection (c) of this section". Subsec. (e). Pub. L. 100-360, §411(k)(17)(A)(ii), (iii), added subsec. (e), redesignated former subsec. (e)(1) as (f)(1), and struck out former subsec. (e)(2) which read as follows: "The Secretary shall report, not later than September 30, 1984, to Congress on waivers granted under this section."Subsec. (f)(1). Pub. L. 100-360, §411(k)(17)(A)(ii), redesignated former subsec. (e)(1) as (f)(1). Subsec. (f)(2). Pub. L. 100-360, §411(k)(17)(A)(i), redesignated former subsec. (f) as subsec. (f)(2).Subsec. (h). Pub. L. 100-360, §411(k)(10)(I), made technical amendment to directory language of Pub. L. 100-203, §4118(l)(1), see 1987 Amendment note below. Pub. L. 100-360, §411(k)(17)(A)(iv), as amended by Pub. L. 100-485, §608(d)(26)(M), substituted ",(d), or (e)" for "or (d)". 1987-Subsec. (a)(1)(B)(ii)(I). Pub. L. 100-203, §4072(d), substituted "paragraphs (13) and (14)" for "paragraphs (12) and (13)".Subsec. (a)(2). Pub. L. 100-93 amended par. (2) generally. Prior to amendment, par. (2) read as follows: "restricts- "(A) for a reasonable period of time the provider or providers from which an individual (eligible for medical assistance for items or services under the State plan) can receive such items or services, if the State has found, after notice and opportunity for a hearing (in accordance with procedures established by the State), that the individual has utilized such items or services at a frequency or amount not medically necessary (as determined in accordance with utilization guidelines established by the State), or"(B) (through suspension or otherwise) for a reasonable period of time the participation of a provider of items or services under the State plan, if the State has found, after notice and opportunity for a hearing (in accordance with procedures established by the State), that the provider has (in a significant number or proportion of cases) provided such items or services either (i) at a frequency or amount not medically necessary (as determined in accordance with utilization guidelines established by the State), or (ii) of a quality which does not meet professionally recognized standards of health care,if, under such restriction, individuals eligible for medical assistance for such services have reasonable access (taking into account geographic location and reasonable travel time) to such services of adequate quality."Subsec. (c)(1). Pub. L. 100-203, §4211(h)(10)(A), substituted "nursing facility or intermediate care facility for the mentally retarded" for "skilled nursing facility or intermediate care facility".Subsec. (c)(2)(B). Pub. L. 100-203, §4211(h)(10)(C), in closing provisions, substituted "need for inpatient hospital services, nursing facility services, or services in an intermediate care facility for the mentally retarded" for "need for such inpatient hospital, skilled nursing facility or intermediate care facility services". Pub. L. 100-203, §4118(p)(10), amended Pub. L. 99-509, §9411(a)(2). See 1986 Amendment note below. Subsec. (c)(2)(B)(i). Pub. L. 100-203, §4211(h)(10)(B), substituted "services, nursing facility services, or services in an intermediate care facility for the mentally retarded" for ",skilled nursing facility, or intermediate care facility services". Subsec. (c)(2)(C). Pub. L. 100-203, §4211(h)(10)(D), (E), substituted ",nursing facility, or intermediate care facility for the mentally retarded" for "or skilled nursing facility or intermediate care facility" and ",nursing facility services, or services in an intermediate care facility for the mentally retarded" for "or skilled nursing facility or intermediate care facility services".Subsec. (c)(3). Pub. L. 100-203, §4118(a)(1), substituted ",section 1396a(a)(10)(B) of this title (relating to comparability), and section 1396a(a)(10)(C)(i)(III) of this title (relating to income and resource rules applicable in the community)" for "and section 1396a(a)(10)(B) of this title (relating to comparability)". Subsec. (c)(5). Pub. L. 100-203, §4211(h)(10)(F), substituted "nursing facility or intermediate care facility for the mentally retarded" for "skilled nursing facility or intermediate care facility".Subsec. (c)(7). Pub. L. 100-203, §4211(h)(10)(G), as amended by Pub. L. 100-360, §411(l)(3)(G), substituted ",nursing facilities, or intermediate care facilities for the mentally retarded" for "or in skilled nursing or intermediate care facilities" in subpar. (A) and "nursing facility" for "skilled nursing facility or intermediate care facility" in subpar. (B). Pub. L. 100-203, §4118(k), designated existing provisions as subpar. (A) and added subpar. (B).Subsec. (c)(10). Pub. L. 100-203, §4118(b), added par. (10).Subsec. (d). Pub. L. 100-203, §4102(a)(1), added subsec. (d). Former subsec. (d) redesignated (h).Subsec. (g)(1). Pub. L. 100-203, §4118(i)(1), inserted at end "The State may limit the case managers available with respect to case management services for eligible individuals with developmental disabilities or with chronic mental illness in order to ensure that the case managers for such individuals are capable of ensuring that such individuals receive needed services."Subsec. (h). Pub. L. 100-203, §4118(l)(1), as amended by Pub. L. 100-360, §411(k)(10)(I), substituted ",within 90 days after the date of its submission to the Secretary, either denies such request in writing or informs the State agency in writing with respect to any additional information which is needed in order to make a final determination with respect to the request. After the date the Secretary receives such additional information, the request shall be deemed granted unless the Secretary, within 90 day of such date, denies such request." for "denies such request in writing within 90 days after the date of its submission to the Secretary." Pub. L. 100-203, §4102(b)(2), substituted "subsection (c) or (d)" for "subsection (c)". Pub. L. 100-203, §4102(a)(1)(A), redesignated former subsec. (d) as (h).1986-Subsec. (a)(1)(B)(ii)(I). Pub. L. 99-509, §9320(h)(3), substituted "paragraphs (12) and (13)" for "paragraphs (11) and (12)".Subsec. (b). Pub. L. 99-272, §9508(a)(2), inserted provision, following par. (4), that no waiver under this subsection may restrict the choice of the individual in receiving services under section 1396d(a)(4)(C) of this title. Subsec. (c)(1). Pub. L. 99-509, §9411(a)(1), inserted "a hospital or" after "level of care provided in", and struck out provision added by Pub. L. 99-272, §9502(b)(1). Pub. L. 99-272, §9502(b)(1), inserted provision relating to individuals with respect to whom there has been a determination that but for the provision of such services the individuals would continue to receive inpatient hospital services, skilled nursing facility services, or intermediate care facility services because they are dependent on ventilator support the cost of which is reimbursed under the State plan.Subsec. (c)(2)(B). Pub. L. 99-509, §9411(a)(2), as amended by Pub. L. 100-203, §4118(p)(10), substituted "inpatient hospital, skilled nursing facility, or" for "skilled nursing facility or" in cl. (i) and inserted "inpatient hospital," after "need for such" in concluding provision following cl. (iii). Subsec. (c)(2)(C). Pub. L. 99-272, §9502(b)(2), inserted "hospital or" after "provided in a", and "inpatient hospital services or" after "the provision of".Subsec. (c)(2)(D). Pub. L. 99-272, §9502(c)(1), inserted "100 percent of" after "does not exceed". Subsec. (c)(3). Pub. L. 99-509, §9411(c), substituted "and section 1396a(a)(10)(B) of this title (relating to comparability)" for "and section 1396a(a)(10) of this title". Pub. L. 99-272, §9502(g), substituted "additional five-year periods" for "additional three-year periods", and "previous waiver period" for "previous three-year period". Pub. L. 99-272, §9502(e), inserted at end "A waiver may provide, with respect to post-eligibility treatment of income of all individuals receiving services under that waiver, that the maximum amount of the individual's income which may be disregarded for any month for the maintenance needs of the individual may be an amount greater than the maximum allowed for that purpose under regulations in effect on July 1, 1985." Subsec. (c)(4)(B). Pub. L. 99-509, §9411(d), inserted before the period "and for day treatment or other partial hospitalization services, psychosocial rehabilitation services, and clinic services (whether or not furnished in a facility) for individuals with chronic mental illness". Subsec. (c)(5). Pub. L. 99-272, §9502(a), added par. (5). Subsec. (c)(6). Pub. L. 99-272, §9502(c)(2), added par. (6). Subsec. (c)(7). Pub. L. 99-509, §9411(a)(3), amended par. (7) generally. Prior to amendment, par. (7) read as follows: "In making estimates under paragraph (2)(D) in the case of a waiver which applies only to physically disabled individuals who are inpatients in skilled nursing or intermediate care facilities, the State may determine the average per capita expenditure which would have been made in a fiscal year for those individuals under the State plan separately from the expenditure for other individuals who are inpatients of those facilities." Pub. L. 99-272, §9502(d), added par. (7).Subsec. (c)(8). Pub. L. 99-272, §9502(h), added par. (8).Subsec. (c)(9). Pub. L. 99-272, §9502(i), added par. (9).Subsec. (g). Pub. L. 99-272, §9508(a)(1), added subsec. (g).Subsec. (g)(1). Pub. L. 99-509, §9411(b), inserted provision at end allowing a State to limit case management services to AIDS victims or to individuals with chronic mental illness. 1984-Subsec. (c)(1). Pub. L. 98-369 substituted "under this subchapter" for "under this part". 1983-Subsec. (c)(2)(B). Pub. L. 97-448 substituted "need for such skilled nursing facility or intermediate care facility services" for "need for such services" in provisions following cl. (iii). 1982-Subsec. (b). Pub. L. 97-248, §137(b)(19)(A), struck out "and section 1396b(m) of this title" after "section 1396a of this title".Subsec. (b)(1). Pub. L. 97-248, §137(b)(20), inserted "primary care" before "case-management system", and substituted "medical care services" for "primary care services".Subsec. (c)(1). Pub. L. 97-248, §137(b)(21), inserted "payment for part or all of the cost of" after "may include as 'medical assistance' under such plan". Subsec. (c)(2)(B). Pub. L. 97-248, §137(b)(22), redesignated existing provisions as cls. (i) and (ii) and added cl. (iii).Subsec. (c)(3). Pub. L. 97-248, §137(b)(23), substituted "section 1396a(a)(1) of this title" for "subsection (a)(1) of this section" and "section 1396a(a)(10) of this title" for "subsection (a)(10) of section 1396a of this title". Subsec. (c)(4). Pub. L. 97-248, §137(b)(24), substituted "this subsection" for "this section".Subsec. (f). Pub. L. 97-248, §137(b)(25), inserted "approval of" before "a proposed State plan". 1981-Subsecs. (c) to (e). Pub. L. 97-35, §2176, added subsec. (c), redesignated former subsec. (c) as (d) and inserted "(other than a waiver under subsection (c))", and redesignated former subsec. (d) as (e).Subsec. (f). Pub. L. 97-35, §2177(a), added subsec. (f).
STATUTORY NOTES AND RELATED SUBSIDIARIES
EFFECTIVE DATE OF 2024 AMENDMENT Pub. L. 118-42, div. G, title I, §204(c)(1)(B), Mar. 9, 2024, 138 Stat. 404, provided that: "The amendments made by subparagraph (A) [amending this section] shall apply with respect to States providing medical assistance for items and services pursuant to a State plan amendment under section 1915(l) of the Social Security Act (42 U.S.C. 1396n(l)) in calendar quarters beginning on or after October 1, 2025."
EFFECTIVE DATE OF 2010 AMENDMENT Amendment by section 2402(b), (c), (e), (f) of Pub. L. 111-148 effective on the first day of the first fiscal year quarter that begins after Mar. 23, 2010, see section 2402(g) of Pub. L. 111-148 set out as an Effective and Termination Dates of 2010 Amendment note under section 1396a of this title.
EFFECTIVE DATE OF 2006 AMENDMENT Pub. L. 109-171, title VI, §6052(c), Feb. 8, 2006, 120 Stat. 95, provided that: "The amendment made by subsection (a) [amending this section] shall take effect on January 1, 2006." Pub. L. 109-171, title VI, §6086(c), Feb. 8, 2006, 120 Stat. 127, provided that: "The amendments made by subsections (a) and (b) [amending this section] take effect on January 1, 2007, and apply to expenditures for medical assistance for home and community-based services provided in accordance with section 1915(i) of the Social Security Act [42 U.S.C. 1396n(i)] (as added by subsections (a) and (b) [probably means subsec. (a)]) on or after that date." Pub. L. 109-171, title VI, §6087(b), Feb. 8, 2006, 120 Stat. 130, provided that: "The amendment made by subsection (a) [amending this section] shall apply to services furnished on or after January 1, 2007."
EFFECTIVE DATE OF 2002 AMENDMENT Amendment by Pub. L. 107-121 effective as if included in the enactment of section 702 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 as enacted into law by section 1(a)(6) of Pub. L. 106-554 see section 2(c)(2) of Pub. L. 107-121 set out as a note under section 1396a of this title.
EFFECTIVE DATE OF 2000 AMENDMENT Amendment by Pub. L. 106-554 effective Jan. 1, 2001, and applicable to services furnished on or after such date, see section 1(a)(6) [title VII, §702(e)] of Pub. L. 106-554 set out as a note under section 1396a of this title.
EFFECTIVE DATE OF 1999 AMENDMENT Pub. L. 106-113, div. B, §1000(a)(6) [title VI, §608(z)], Nov. 29, 1999, 113 Stat. 1536, 1501A-398, provided that the amendment made by section 1000(a)(6) [title VI, §608(z)] is effective Oct. 1, 2004. Amendment by section 1000(a)(6) [title VI, §608o] of Pub. L. 106-113 effective Nov. 29, 1999, see section 1000(a)(6) [title VI, §608(bb)] of Pub. L. 106-113 set out as a note under section 1396a of this title.
EFFECTIVE DATE OF 1997 AMENDMENT Amendment by section 4106(c) of Pub. L. 105-33 applicable to bone mass measurements performed on or after July 1, 1998, see section 4106(d) of Pub. L. 105-33 set out as a note under section 1395x of this title. Pub. L. 105-33, title IV, §4743(b), Aug. 5, 1997, 111 Stat. 524, provided that: "The amendment made by subsection (a) [amending this section] apply to services furnished on or after October 1, 1997."
EFFECTIVE DATE OF 1993 AMENDMENT Amendment by 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.
EFFECTIVE DATE OF 1990 AMENDMENT Amendment by section 4604(c) of Pub. L. 101-508 effective with respect 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 4604 of Pub. L. 101-508 have been promulgated by such date, see section 4604(d) of Pub. L. 101-508 set out as a note under section 1396a of this title. Amendment by section 4704(b)(3) 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. Pub. L. 101-508, title IV, §4742(b), Nov. 5, 1990, 104 Stat. 1388-197, provided that: "The amendment made by subsection (a) [amending this section] shall take effect as of the first calendar quarter beginning more than 30 days after the date of the enactment of this Act [Nov. 5, 1990]." Pub. L. 101-508, title IV, §4742(c)(2), Nov. 5, 1990, 104 Stat. 1388-198, provided that: "The amendment made by paragraph (1) [amending this section] shall apply as if included in the enactment of the Omnibus Budget Reconciliation Act of 1981 [Pub. L. 97-35], but shall only apply to facilities the participation of which under a State plan under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] is terminated on or after the date of the enactment of this Act [Nov. 5, 1990]." Pub. L. 101-508, title IV, §4742(d)(2), Nov. 5, 1990, 104 Stat. 1388-198, provided that: "The amendment made by paragraph (1) [amending this section] shall apply as if included in the enactment of the Omnibus Budget Reconciliation Act of 1981 [Pub. L. 97-35]."
EFFECTIVE DATE OF 1989 AMENDMENT Amendment by section 6115(c) of Pub. L. 101-239 applicable to screening pap smears performed on or after July 1, 1990, see section 6115(d) of Pub. L. 101-239 set out as a note under section 1395x of this title. Pub. L. 101-239, title VI, §6411(c)(4), Dec. 19, 1989, 103 Stat. 2270, provided that: "The amendment made by paragraph (2) [amending this section] shall be effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1987 [Pub. L. 100-203]." 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 AMENDMENT Pub. L. 100-647, title VIII, §8432(c), Nov. 10, 1988, 102 Stat. 3804, provided that: "The amendments made by this section [amending this section] shall apply to waiver years beginning during or after fiscal year 1989." Pub. L. 100-647, title VIII, §8437(b), Nov. 10, 1988, 102 Stat. 3806, provided that: "The amendment made by subsection (a) [amending this section] shall apply with respect to waiver applications submitted before, on, or after the date of the enactment of this Act [Nov. 10, 1988]." Amendment by section 608(d)(26)(M) 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)(2) 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 204(d)(3) of Pub. L. 100-360 applicable to screening mammography performed on or after Jan. 1, 1990, see section 204(e) of Pub. L. 100-360 set out as a note under section 1395m of this title. Except as specifically provided in section 411 of Pub. L. 100-360 amendment by section 411(k)(3), (10)(A), (H), (I), (17)(A), (l)(3)(G) of Pub. L. 100-360 as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Pub. L. 100-203 effective as if included in the enactment of that provision in Pub. L. 100-203, see section 411(a) of Pub. L. 100-360 set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions.
EFFECTIVE DATE OF 1987 AMENDMENT For effective date of amendment by section 4072(d) of Pub. L. 100-203 see section 4072(e) of Pub. L. 100-203 set out as a note under section 1395x of this title. Pub. L. 100-203, title IV, §4102(a)(2), Dec. 22, 1987, 101 Stat. 1330-146, provided that: "The amendments made by paragraph (1) [amending this section] shall become effective on January 1, 1988." Pub. L. 100-203, title IV, §4118(a)(2), Dec. 22, 1987, 101 Stat. 1330-155, provided that: "The amendment made by paragraph (1) [amending this section] shall be effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1986 [Pub. L. 99-509]." Pub. L. 100-203, title IV, §4118(i)(2), Dec. 22, 1987, 101 Stat. 1330-156, provided that: "The amendment made by paragraph (1) [amending this section] shall take effect as though it were included in the enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985 [Pub. L. 99-272]." Pub. L. 100-203, title IV, §4118(l)(2), Dec. 22, 1987, 101 Stat. 1330-157, provided that: "The amendment made by paragraph (1) [amending this section] shall apply to requests for continuation of waivers received after the date of the enactment of this Act [Dec. 22, 1987]." Pub. L. 100-203, title IV, §4118(p) (10), Dec. 22, 1987, 101 Stat. 1330-160, provided that the amendment made by that section is effective as if included in the enactment of Pub. L. 99-509. Amendment by section 4211(h)(10) of Pub. L. 100-203 applicable to nursing facility services furnished on or after Oct. 1, 1990, without regard to whether regulations implementing such amendment 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. Amendment by Pub. L. 100-93 effective at end of fourteen-day period beginning Aug. 18, 1987, and inapplicable to administrative proceedings commenced before end of such period, see section 15(a) of Pub. L. 100-93 set out as a note under section 1320a-7 of this title.
EFFECTIVE DATE OF 1986 AMENDMENT Amendment by section 9320(h)(3) of Pub. L. 99-509 applicable to services furnished on or after Jan. 1, 1989, with exceptions for hospitals located in rural areas which meet certain requirements related to certified registered nurse anesthetists, see section 9320(i), (k) of Pub. L. 99-509 as amended, set out as notes under section 1395k of this title. Pub. L. 99-509, title IX, §9411(e), Oct. 21, 1986, 100 Stat. 2062, provided that: "The amendments made by this section [amending this section] shall apply to applications for waivers (or renewals thereof) approved on or after the date of the enactment of this Act [Oct. 21, 1986]." Pub. L. 99-272, title IX, §9502(j), Apr. 7, 1986, 100 Stat. 204, as amended by Pub. L. 99-509, title IX, §9435(a), Oct. 21, 1986, 100 Stat. 2069; Pub. L. 100-203, title IV, §4118(j), Dec. 22, 1987, 101 Stat. 1330-156, provided that:"(1) HABILITATION SERVICES.-The amendment made by subsection (a) [amending this section] shall be effective for services furnished on or after the date of the enactment of this Act [Apr. 7, 1986] to individuals eligible for services under a waiver granted under section 1915(c) of the Social Security Act [42 U.S.C. 1396n(c)], without regard to whether such individuals were receiving institutional services before their participation in the waiver."(2) HOSPITALIZED PATIENTS.-The amendments made by subsection (b) [amending this section] shall be effective for services furnished on or after October 1, 1985."(3) PROHIBITION OF REGULATORY LIMITS AND TREATMENT OF CERTAIN PHYSICALLY DISABLED INDIVIDUALS.-The amendments made by subsections (c) and (d) [amending this section] shall apply to applications for waivers (or renewals thereof) filed before, on, or after, the date of the enactment of this Act [Apr. 7, 1986] and for services furnished on or after August 13, 1981."(4) INCOME STANDARDS.-The amendment made by subsection (e) [amending this section] shall apply to waivers (or renewals thereof) approved before, on, or after the date of the enactment of this Act [Apr. 7, 1986]."(5) WAIVER EXTENSIONS.-Subsection (f) [enacting provisions set out below] shall apply to waivers expiring on or after September 30, 1985, and before September 30, 1986."(6) WAIVER RENEWALS.-The amendments made by subsection (g) [amending this section] shall become effective on September 30, 1986."(7) COORDINATED SERVICES AND SUBSTITUTION OF PARTICIPANTS.-The amendments made by subsections (h) and (i) [amending this section] shall become effective on the date of the enactment of this Act [Apr. 7, 1986]." Pub. L. 99-272, title IX, §9508(b), Apr. 7, 1986, 100 Stat. 211, as amended by Pub. L. 99-509, title IX, §9435(d)(1), Oct. 21, 1986, 100 Stat. 2070, provided that: "The amendments made by this section [amending this section] shall apply to services furnished on or after the date of the enactment of this Act [Apr. 7, 1986], without regard to whether or not regulations to carry out the amendments have been promulgated by that date."[Pub. L. 100-203, title IV, §4118(j), Dec. 22, 1987, 101 Stat. 1330-156, provided that the amendment made by that section to section 9502(j)(1) of Pub. L. 99-272 set out above, is effective as if included in the enactment of section 9502 of Pub. L. 99-272.]
EFFECTIVE DATE OF 1983 AMENDMENT Amendment by Pub. L. 97-448 effective as if originally included as a part of this section as this section was amended by the Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248, see section 309(c)(2) of Pub. L. 97-448 set out as a note under section 426-1 of this title.
EFFECTIVE DATE OF 1982 AMENDMENT Pub. L. 97-248, title I, §137(b) (19)(B), Sept. 3, 1982, 96 Stat. 380, provided that: "The amendment made by subparagraph (A) [amending this section] shall not apply with respect to any waiver if such waiver was granted, and the arrangement covered by the waiver was in place, prior to August 10, 1982." Amendment by section 137(b)(20)-(25) 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 Pub. L. 97-35, title XXI, §2177(b), Aug. 13, 1981, 95 Stat. 813, provided that: "The amendment made by this section [amending this section] shall become effective 90 days after the date of the enactment of this Act [Aug. 13, 1981]".
REGULATIONS Pub. L. 109-171, title VI, §6052(b), Feb. 8, 2006, 120 Stat. 95, provided that: "The Secretary shall promulgate regulations to carry out the amendment made by subsection (a) [amending this section] which may be effective and final immediately on an interim basis as of the date of publication of the interim final regulation. If the Secretary provides for an interim final regulation, the Secretary shall provide for a period of public comments on such regulation after the date of publication. The Secretary may change or revise such regulation after completion of the period of public comment."
CONSTRUCTION OF 2018 AMENDMENT Pub. L. 115-271, title V, §5052(b), Oct. 24, 2018, 132 Stat. 3976, provided that: "Nothing in the amendments made by subsection (a) [amending this section and section 1396d of this title] shall be construed as encouraging a State to place an individual in an inpatient or a residential care setting where a home or community-based care setting would be more appropriate for the individual, or as preventing a State from conducting or pursuing a demonstration project under section 1115 of the Social Security Act [42 U.S.C. 1315] to improve access to, and the quality of, substance use disorder treatment for eligible populations."
APPLICATION TO CERTAIN STATES Pub. L. 118-42, div. G, title I, §204(d), Mar. 9, 2024, 138 Stat. 405, provided that: "Notwithstanding section 430.20 of title 42, Code of Federal Regulations, the Secretary of Health and Human Services may approve a request to renew a State plan amendment under section 1915(l) of the Social Security Act (42 U.S.C. 1396n(l)) with an effective date of October 1, 2023, if the State making such request-"(1) had approval for a State plan amendment under such section as of September 30, 2023; and"(2) submits the request to renew such amendment not later than 60 days after the date of enactment of this Act [Mar. 9, 2024]."
OVERSIGHT AND ASSESSMENT OF THE ADMINISTRATION OF HOME AND COMMUNITY-BASED SERVICES Pub. L. 111-148, title II, §2402(a), Mar. 23, 2010, 124 Stat. 301, provided that: "The Secretary of Health and Human Services shall promulgate regulations to ensure that all States develop service systems that are designed to- "(1) allocate resources for services in a manner that is responsive to the changing needs and choices of beneficiaries receiving non-institutionally-based long-term services and supports (including such services and supports that are provided under programs other [than] the State Medicaid program), and that provides strategies for beneficiaries receiving such services to maximize their independence, including through the use of client-employed providers; "(2) provide the support and coordination needed for a beneficiary in need of such services (and their family caregivers or representative, if applicable) to design an individualized, self-directed, community-supported life; and "(3) improve coordination among, and the regulation of, all providers of such services under federally and State-funded programs in order to-"(A) achieve a more consistent administration of policies and procedures across programs in relation to the provision of such services; and"(B) oversee and monitor all service system functions to assure-"(i) coordination of, and effectiveness of, eligibility determinations and individual assessments; "(ii) development and service monitoring of a complaint system, a management system, a system to qualify and monitor providers, and systems for role-setting and individual budget determinations; and"(iii) an adequate number of qualified direct care workers to provide self-directed personal assistance services."
QUALITY OF CARE MEASURES Pub. L. 109-171, title VI, §6086(b), Feb. 8, 2006, 120 Stat. 127, provided that:"(1) IN GENERAL.-The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall consult with consumers, health and social service providers and other professionals knowledgeable about long-term care services and supports to develop program performance indicators, client function indicators, and measures of client satisfaction with respect to home and community-based services offered under State Medicaid programs."(2) BEST PRACTICES.-The Secretary shall-"(A) use the indicators and measures developed under paragraph (1) to assess such home and community-based services, the outcomes associated with the receipt of such services (particularly with respect to the health and welfare of the recipient of the services), and the overall system for providing home and community-based services under the Medicaid program under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.]; and"(B) make publicly available the best practices identified through such assessment and a comparative analyses of the system features of each State."(3) APPROPRIATION.-Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary of Health and Human Services, $1,000,000 for the period of fiscal years 2006 through 2010 to carry out this subsection."
PERMITTING ADJUSTMENT IN ESTIMATES TO TAKE INTO ACCOUNT PREADMISSION SCREENING REQUIREMENT Pub. L. 101-508, title IV, §4742(e), Nov. 5, 1990, 104 Stat. 1388-198, provided that: "In the case of a waiver under section 1915(c) of the Social Security Act [42 U.S.C. 1396n(c)] for individuals with mental retardation or a related condition in a State, the Secretary of Health and Human Services shall permit the State to adjust the estimate of average per capita expenditures submitted under paragraph (2)(D) of such section, with respect to such expenditures made on or after January 1, 1989, to take into account increases in expenditures for, or utilization of, intermediate care facilities for the mentally retarded resulting from implementation of section 1919(e)(7)(A) of such Act [42 U.S.C. 1396r(e)(7)(A)] ."
EXTENSIONS OF WAIVERS UNDER SUBSECTION (C) Pub. L. 100-203, title IV, §4102(c), Dec. 22, 1987, 101 Stat. 1330-146, provided that: "In the case of a State which, as of December 1, 1987, has a waiver approved with respect to elderly individuals under section 1915(c) of the Social Security Act [42 U.S.C. 1396n(c)], which waiver is scheduled to expire before July 1, 1988, if the State notifies the Secretary of Health and Human Services of the State's intention to file an application for a waiver under section 1915(d) of such Act (as amended by subsection (a) of this section), the Secretary shall extend approval of the State's waiver, under section 1915(c) of such Act, on the same terms and conditions through September 30, 1988." Pub. L. 99-272, title IX, §9502(f), Apr. 7, 1986, 100 Stat. 204, provided that: "The Secretary of Health and Human Services shall extend, upon request of the State, any waiver under section 1915(c) of the Social Security Act [42 U.S.C. 1396n(c)] which expires on or after September 30, 1985, and before September 30, 1986. Such extension shall be for a period of not less than one year nor more than five years, subject to section 1915(e)(1) of such Act."
- Secretary
- The term "Secretary" means the Secretary of Housing and Urban Development.1 See References in Text note below.
- person
- The term "person" means an individual, a trust or estate, a partnership, or a corporation.
- practices
- The term "practices" means design, financing, permitting, construction, commissioning, operation and maintenance, and other practices that contribute to achieving zero-net-energy buildings or facilities.
- project
- The terms "federally assisted housing" and "project" mean-(A) a public housing project (as such term is defined in section 3(b) of the United States Housing Act of 1937 [42 U.S.C. 1437a(b)] );(B) housing for which project-based assistance is provided under section 8 of the United States Housing Act of 1937 [42 U.S.C. 1437f] ;(C) housing that is assisted under section 1701q of title 12;(D) housing that is assisted under section 1701q of title 12, as such section existed before November 28, 1990;(E) housing financed by a loan or mortgage insured under section 1715l(d)(3) of title 12 that bears interest at a rate determined under the proviso of section 1715l(d)(5) of title 12;(F) housing insured, assisted, or held by the Secretary or a State or State agency under section 1715z-1 of title 12;(G) housing constructed or substantially rehabilitated pursuant to assistance provided under section 8(b)(2) of the United States Housing Act of 1937 [42 U.S.C. 1437f(b)(2)], as in effect before October 1, 1983, that is assisted under a contract for assistance under such section; and(H) housing that is assisted under section 8013 1 of this title.