42 U.S.C. 1396b: Payment to States

2024

• Pub. L. 118–42 struck out "(and before fiscal year 2024)" after "fiscal year 2020". (Consolidated Appropriations Act, 2024) Law text · (m)

2022

• Pub. L. 117–328, §1262(b)(8), redesignated cl. (iii) as (ii) and struck out former cl. (ii) which read as follows: "have in effect a registration or waiver under section 823(h) of title 21 for purposes of dispensing narcotic drugs to individuals for maintenance treatment or … (Consolidated Appropriations Act, 2023) Law text · (aa)
• Pub. L. 117–215 substituted "823(h)" for "823(g)" in two places. (Medical Marijuana and Cannabidiol Research Expansion Act) Law text · (aa)
• Pub. L. 117–328, §1262(b)(8)(C), redesignated cl. (iii) as (ii). (Consolidated Appropriations Act, 2023) Law text · (aa)

2020

• Pub. L. 116–260, §207(b), which directed amendment of concluding provisions by striking out "(as found necessary by the Secretary for the elimination of fraud in the provision and administration of medical assistance provided under the State plan (or waiver of such plan))", was exec… (Consolidated Appropriations Act, 2021) Law text · (a)
• Pub. L. 116–260, §209(a)(3), added par. (9). (Consolidated Appropriations Act, 2021) Law text · (i)
• Pub. L. 116–260, §207(a), inserted "and of patients (who are receiving medical assistance under the State plan under this subchapter (or waiver of such plan)) in a noninstitutional or other setting" after "patients residing in board and care facilities". (Consolidated Appropriations Act, 2021) Law text · (q)
• Pub. L. 116–260, §202, added subsec. (bb). (Consolidated Appropriations Act, 2021) Law text · (bb)

2019

• Pub. L. 116–16, §6(a)(2)(A), added subpar. (E) and realigned margins. (Medicaid Services Investment and Accountability Act of 2019) Law text · (i)
• Pub. L. 116–16, §8(a), added par. (12). (Medicaid Services Investment and Accountability Act of 2019) Law text · (i)

2018

• Pub. L. 115–222, §1(a)(1)(A), substituted "January 1, 2020" for "January 1, 2019" in introductory provisions. Law text · (l)
• Pub. L. 115–222, §1(a)(1)(B), struck out "2019 and" before "2020". Law text · (l)
• Pub. L. 115–222, §1(a)(2), substituted "calendar quarters in 2020" for "calendar quarters in 2019". Law text · (l)
• Pub. L. 115–271, §1013, added par. (7). (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act" or the "SUPPORT for Patients and Communities Act) Law text · (m)
• Pub. L. 115–271, §1016(a), added par. (8). (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act" or the "SUPPORT for Patients and Communities Act) Law text · (m)
• Pub. L. 115–271, §4001, added par. (9). (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act" or the "SUPPORT for Patients and Communities Act) Law text · (m)
• Pub. L. 115–271, §1003, added subsec. (aa). (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act" or the "SUPPORT for Patients and Communities Act) Law text · (aa)

2016

• Pub. L. 114–255, §5005(a)(4)(A)(i), substituted semicolon for comma at end. (21st Century Cures Act) Law text · (i)
• Pub. L. 114–255, §5005(a)(4)(A)(ii), (iii), added subpar. (D). (21st Century Cures Act) Law text · (i)
• Pub. L. 114–255, §17004(b)(1)(A), added subpar. (E). (21st Century Cures Act) Law text · (i)
• Pub. L. 114–255, §5008(a), inserted "section 1396r–8(d)(2)(C) of this title (relating to drugs when used for cosmetic purposes or hair growth), except where medically necessary, and" after "drugs described in". (21st Century Cures Act) Law text · (i)
• Pub. L. 114–255, §5002, substituted "January 1, 2018" for "January 1, 2019". (21st Century Cures Act) Law text · (i)
• Pub. L. 114–255, §12006(a), added subsec. (l). (21st Century Cures Act) Law text · (l)
• Pub. L. 114–255, §5005(a)(4)(B), added par. (3). (21st Century Cures Act) Law text · (m)

2015

• Pub. L. 114–113 added par. (27). (Consolidated Appropriations Act, 2016) Law text · (i)

2010

• Pub. L. 111–148, §2102(a)(8)(A), amended Pub. L. 111–3, §211(a)(1)(B). See 2009 Amendment note below. (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §2102(a)(8)(B), amended Pub. L. 111–3, §211(a)(1)(B). See 2009 Amendment note below. (Patient Protection and Affordable Care Act) Law text · (a)
• Pub. L. 111–148, §6506(a)(1)(A), substituted "1 year" for "60 days" in first sentence and "1-year period" for "60 days" in second sentence. (Patient Protection and Affordable Care Act) Law text · (d)
• Pub. L. 111–148, §6506(a)(1)(B), designated existing provisions as cl. (i) and added cl. (ii). (Patient Protection and Affordable Care Act) Law text · (d)
• Pub. L. 111–148, §2402(d)(2)(A), inserted "1396a(a)(10)(A)(ii)(XXII)," after "1396a(a)(10)(A)(ii)(XXI),". (Patient Protection and Affordable Care Act) Law text · (f)
• Pub. L. 111–148, §2303(a)(4)(B), inserted "1396a(a)(10)(A)(ii)(XXI)," after "1396a(a)(10)(A)(ii)(XX),". (Patient Protection and Affordable Care Act) Law text · (f)
• Pub. L. 111–148, §2004(c)(1), inserted "1396a(a)(10)(A)(i)(IX)," after "1396a(a)(10)(A)(i)(VIII),". (Patient Protection and Affordable Care Act) Law text · (f)
• Pub. L. 111–148, §2001(e)(2)(B), inserted "1396a(a)(10)(A)(ii)(XX)," after "1396a(a)(10)(A)(ii)(XIX),". (Patient Protection and Affordable Care Act) Law text · (f)
• Pub. L. 111–148, §2001(a)(5)(D), inserted "1396a(a)(10)(A)(i)(VIII)," after "1396a(a)(10)(A)(i)(VII),". (Patient Protection and Affordable Care Act) Law text · (f)
• Pub. L. 111–148, §6402(h)(2), added subpar. (C). (Patient Protection and Affordable Care Act) Law text · (i)
• Pub. L. 111–148, §6402(c), added par. (25). (Patient Protection and Affordable Care Act) Law text · (i)
• Pub. L. 111–148, §2001(a)(2)(B), added par. (26). (Patient Protection and Affordable Care Act) Law text · (i)
• Pub. L. 111–148, §6504(b)(1), inserted "and for the provision of such data to the State at a frequency and level of detail to be specified by the Secretary" after "patients". (Patient Protection and Affordable Care Act) Law text · (m)
• Pub. L. 111–148, §2501(c)(1), added cl. (xiii). (Patient Protection and Affordable Care Act) Law text · (m)
• Pub. L. 111–148, §6507(1), added cl. (iv). (Patient Protection and Affordable Care Act) Law text · (r)
• Pub. L. 111–148, §6504(a), inserted "and including, for data submitted to the Secretary on or after January 1, 2010, data elements from the automated data system that the Secretary determines to be necessary for program integrity, program oversight, and administration, at such fr… (Patient Protection and Affordable Care Act) Law text · (r)
• Pub. L. 111–148, §6507(2), added par. (4). (Patient Protection and Affordable Care Act) Law text · (r)
• Pub. L. 111–157 substituted "inpatient or emergency room setting" for "setting (whether inpatient or outpatient)". (Continuing Extension Act of 2010) Law text · (t)
• Pub. L. 111–309, §205(e)(1), substituted "reduced by the average payment the Secretary estimates will be made to such Medicaid providers (determined on a percentage or other basis for such classes or types of providers as the Secretary may specify) from other sources (other than … (Medicare and Medicaid Extenders Act of 2010) Law text · (t)
• Pub. L. 111–309, §205(e)(2), inserted "and shall be determined to have met such responsibility to the extent that the payment to the Medicaid provider is not in excess of 85 percent of the net average allowable cost" before period at end. (Medicare and Medicaid Extenders Act of 2010) Law text · (t)
• Pub. L. 111–148, §2303(b)(2)(B), inserted "or for medical assistance provided to an individual described in subsection (a) of section 1396r–1c of this title during a presumptive eligibility period under such section," after "section 1396r–1b of this title during a presumptive … (Patient Protection and Affordable Care Act) Law text · (u)
• Pub. L. 111–148, §2202(b), substituted "section, for medical" for "section, or for medical" and inserted before period at end ", or for medical assistance provided to an individual during a presumptive eligibility period resulting from a determination of presumptive eligibility made by a hospital t… (Patient Protection and Affordable Care Act) Law text · (u)

2009

• Pub. L. 111–3, §201(b)(2)(A), added subpar. (E). (Children's Health Insurance Program Reauthorization Act of 2009) Law text · (a)
• Pub. L. 111–3, §401(b), added cl. (iii). (Children's Health Insurance Program Reauthorization Act of 2009) Law text · (a)
• Pub. L. 111–5, §4201(a)(1)(A), struck out "and" at end. (American Recovery and Reinvestment Act of 2009) Law text · (a)
• Pub. L. 111–5, §4201(a)(1)(B), substituted "and" for "plus" at end. (American Recovery and Reinvestment Act of 2009) Law text · (a)
• Pub. L. 111–3, §211(a)(1)(B)(i), which directed substitution of "and" for "plus" at end and could not be executed, was struck out by Pub. L. 111–148, §2102(a)(8)(A). (Children's Health Insurance Program Reauthorization Act of 2009) Law text · (a)
• Pub. L. 111–5, §4201(a)(1)(C), added subpar. (F). (American Recovery and Reinvestment Act of 2009) Law text · (a)
• Pub. L. 111–3, §211(a)(1)(B), as amended by Pub. L. 111–148, §2102(a)(8)(B), added subpar. (H). (Children's Health Insurance Program Reauthorization Act of 2009) Law text · (a)
• Pub. L. 111–3, §211(a)(3)(A), substituted "section 1396a(a)(46)(B) of this title" for "subsection (x)". (Children's Health Insurance Program Reauthorization Act of 2009) Law text · (i)
• Pub. L. 111–5, §4201(a)(2), added subsec. (t). (American Recovery and Reinvestment Act of 2009) Law text · (t)
• Pub. L. 111–3, §214(a)(1), substituted "paragraphs (2) and (4)" for "paragraph (2)". (Children's Health Insurance Program Reauthorization Act of 2009) Law text · (v)
• Pub. L. 111–3, §214(a)(2), added par. (4). (Children's Health Insurance Program Reauthorization Act of 2009) Law text · (v)
• Pub. L. 111–3, §211(a)(3)(B), substituted "section 1396a(a)(46)(B)(i) of this title" for "subsection (i)(22)". (Children's Health Insurance Program Reauthorization Act of 2009) Law text · (x)
• Pub. L. 111–3, §211(b)(4), realigned margins. (Children's Health Insurance Program Reauthorization Act of 2009) Law text · (x), (C)
• Pub. L. 111–3, §211(b)(3)(A)(i), added subpar. (D) and redesignated former subpar. (D) as (E). (Children's Health Insurance Program Reauthorization Act of 2009) Law text · (x), (E)
• Pub. L. 111–3, §211(b)(1), added cl. (v) and redesignated former cl. (v) as (vi). (Children's Health Insurance Program Reauthorization Act of 2009) Law text · (x), (vi)
• Pub. L. 111–3, §211(b)(2), (3)(A)(ii), added pars. (4) and (5). (Children's Health Insurance Program Reauthorization Act of 2009) Law text · (x), (5)

2008

• Pub. L. 110–252 added par. (24). (Supplemental Appropriations Act, 2008) Law text · (i)
• Pub. L. 110–379, §3(a)(1), inserted ", in addition to meeting the requirements of paragraph (3)," after "a State must" in introductory provisions. (QI Program Supplemental Funding Act of 2008) Law text · (r)
• Pub. L. 110–379, §3(a)(2), added par. (3). (QI Program Supplemental Funding Act of 2008) Law text · (r)

2007

• Pub. L. 110–28 added par. (23). (U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act, 2007) Law text · (i)

2006

• Pub. L. 109–171, §6062(c)(1), inserted "1396a(a)(10)(A)(ii)(XIX)," after "1396a(a)(10)(A)(ii)(XVIII)," in introductory provisions. (Deficit Reduction Act of 2005) Law text · (f)
• Pub. L. 109–171, §6002(b), added subpar. (C). (Deficit Reduction Act of 2005) Law text · (i)
• Pub. L. 109–171, §6033(a), added subpar. (D). (Deficit Reduction Act of 2005) Law text · (i)
• Pub. L. 109–171, §6036(a)(1), added par. (22). (Deficit Reduction Act of 2005) Law text · (i)
• Pub. L. 109–432, §403, designated existing provisions as cl. (i) and added cl. (ii). (Tax Relief and Health Care Act of 2006) Law text · (w)
• Pub. L. 109–171, §6051(a), amended cl. (viii) generally. Prior to amendment, cl. (viii) read as follows: "Services of a medicaid managed care organization with a contract under subsection (m) of this section." (Deficit Reduction Act of 2005) Law text · (w)
• Pub. L. 109–171, §6036(a)(2), added subsec. (x). (Deficit Reduction Act of 2005) Law text · (x)
• Pub. L. 109–432, §405(c)(1)(A)(i), substituted "(i)(22)" for "(i)(23)". (Tax Relief and Health Care Act of 2006) Law text · (x)
• Pub. L. 109–432, §405(c)(1)(A)(ii)(I), substituted "individual declaring to be a citizen or national of the United States" for "alien" in introductory provisions. (Tax Relief and Health Care Act of 2006) Law text · (x)
• Pub. L. 109–432, §405(c)(1)(A)(ii)(II), added subpar. (B) and struck out former subpar. (B) which read as follows: "on the basis of receiving supplemental security income benefits under subchapter XVI; or". (Tax Relief and Health Care Act of 2006) Law text · (x)
• Pub. L. 109–432, §405(c)(1)(A)(ii)(V), added subpar. (C). Former subpar. (C) redesignated (D). (Tax Relief and Health Care Act of 2006) Law text · (x)
• Pub. L. 109–432, §405(c)(1)(A)(ii)(III), struck out "other" before "basis" and substituted "has" for "had". (Tax Relief and Health Care Act of 2006) Law text · (x)
• Pub. L. 109–432, §405(c)(1)(A)(ii)(IV), redesignated subpar. (C) as (D). (Tax Relief and Health Care Act of 2006) Law text · (x)
• Pub. L. 109–432, §405(c)(1)(A)(iii), substituted "I–197" for "I–97". (Tax Relief and Health Care Act of 2006) Law text · (x)
• Pub. L. 109–171, §6043(b), added subsec. (y). (Deficit Reduction Act of 2005) Law text · (y)
• Pub. L. 109–171, §6081, added subsec. (z). (Deficit Reduction Act of 2005) Law text · (z)

2005

• Pub. L. 109–91 added par. (21). (QI, TMA, and Abstinence Programs Extension and Hurricane Katrina Unemployment Relief Act of 2005) Law text · (i)

2004

• Pub. L. 108–357, §712(b)(1), substituted "and" for "plus". (American Jobs Creation Act of 2004) Law text · (a)
• Pub. L. 108–357, §712(b)(2), added subpar. (E). (American Jobs Creation Act of 2004) Law text · (a)
• Pub. L. 108–446 substituted "part C" for "part H". (Individuals with Disabilities Education Improvement Act of 2004) Law text · (c)

2000

• Pub. L. 106–554, §1(a)(6) [title VII, §710(a)], inserted "1396a(a)(10)(A)(ii)(XVII), 1396a(a)(10)(A)(ii)(XVIII)," after "1396a(a)(10)(A)(ii)(XVI),". (Consolidated Appropriations Act, 2001) Law text · (f)
• Pub. L. 106–554, §1(a)(6) [title VII, §702(c)(1)], repealed Pub. L. 105–33, §4712(c)(2). See 1997 Amendment note below. (Consolidated Appropriations Act, 2001) Law text · (m)
• Pub. L. 106–354 substituted ", for items" for "or for items" and inserted before period at end ", or for medical assistance provided to an individual described in subsection (a) of section 1396r–1b of this title during a presumptive eligibility period under such section". (Breast and Cervical Cancer Prevention and Treatment Act of 2000) Law text · (u)

1999

• Pub. L. 106–113, §1000(a)(6) [title VI, §604(a)(2)(B)], struck out "or quality review" after "medical and utilization review". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (a)
• Pub. L. 106–113, §1000(a)(6) [title VI, §608(e)], inserted "of" after "for the use" in introductory provisions. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (b)
• Pub. L. 106–31, §3031(a), designated existing provisions as subpar. (A) and added subpar. (B). (1999 Emergency Supplemental Appropriations Act) Law text · (d)
• Pub. L. 106–113, §1000(a)(6) [title VI, §608(f)], realigned margins. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (d)
• Pub. L. 106–113, §1000(a)(6) [title VI, §608(g)], struck out second period at end. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (f)
• Pub. L. 106–170, §201(b), inserted "1396a(a)(10)(A)(ii)(XV), 1396a(a)(10)(A)(ii)(XVI)," before "1396d(p)(1)" in introductory provisions. (Ticket to Work and Work Incentives Improvement Act of 1999) Law text · (f)
• Pub. L. 106–113, §1000(a)(6) [title VI, §608(aa)(2)], substituted "1396a(a)(10)(A)(ii)(XIII), 1396a(a)(10)(A)(ii)(XIV), or 1396d(p)(1) of this title" for "1396d(p)(1), or 1396d(u) of this title" in introductory provisions. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (f)
• Pub. L. 106–113, §1000(a)(6) [title VI, §608(h)], inserted "or" after semicolon. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (i)
• Pub. L. 106–31, §3031(b), added par. (19). (1999 Emergency Supplemental Appropriations Act) Law text · (i)
• Pub. L. 106–170, §201(a)(4), added par. (20). (Ticket to Work and Work Incentives Improvement Act of 1999) Law text · (i)
• Pub. L. 106–113, §1000(a)(6) [title VI, §608(i)(1)], struck out semicolon after "section 1396u–2(a)(4) of this title". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (m)
• Pub. L. 106–113, §1000(a)(6) [title VI, §608(i)(2)], redesignated cl. (xi), relating to section 1396u–2, as (xii). (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (m), (xii)
• Pub. L. 106–113, §1000(a)(6) [title VI, §604(b)(2)(A)], inserted "and" at end. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (m)
• Pub. L. 106–113, §1000(a)(6) [title VI, §604(b)(2)(B)], substituted a period for "; and" at end. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (m)
• Pub. L. 106–113, §1000(a)(6) [title VI, §604(b)(2)(C)], struck out cl. (iv) which read as follows: "that the State agency will contract, for purposes of meeting the requirement under section 1396a(a)(30)(C) of this title, with an organization or entity that under section 1320… (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (m)
• Pub. L. 106–113, §1000(a)(6) [title VI, §608(j)], struck out second closing parenthesis after "section 1167(1) of title 29". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (o)
• Pub. L. 106–170, §407(a), inserted "(A)" after "in connection with" and added subpar. (B). (Ticket to Work and Work Incentives Improvement Act of 1999) Law text · (q)
• Pub. L. 106–170, §407(c), amended par. (4) generally. Prior to amendment, par. (4) read as follows: "The entity has procedures for reviewing complaints of the abuse and neglect of patients of health care facilities which receive payments under the State plan under this subchapter, a… (Ticket to Work and Work Incentives Improvement Act of 1999) Law text · (q)
• Pub. L. 106–170, §407(b), inserted "or under any Federal health care program (as so defined)" before "to health care facilities" and inserted at end "All funds collected in accordance with this paragraph shall be credited exclusively to, and available for expenditure under, the Fede… (Ticket to Work and Work Incentives Improvement Act of 1999) Law text · (q)
• Pub. L. 106–113, §1000(a)(6) [title VI, §608(k)(1)], substituted "purposes" for "puroses". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (w)
• Pub. L. 106–113, §1000(a)(6) [title VI, §608(k)(2)], inserted a comma after "(D)" in introductory provisions. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (w)
• Pub. L. 106–113, §1000(a)(6) [title VI, §608(k)(3)], realigned margins. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (w)

1997

• Pub. L. 105–33, §4705(b), designated existing provisions as cl. (i) and added cl. (ii). (Balanced Budget Act of 1997) Law text · (a)
• Pub. L. 105–33, §4707(b), added par. (4). (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–33, §4722(b), added par. (5). (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–100 substituted "1396d(p)(1), or 1396d(u) of this title" for "or 1396d(p)(1) of this title" in introductory provisions. Law text · (f)
• Pub. L. 105–33, §4802(b)(2), inserted "or who is a PACE program eligible individual enrolled in a PACE program under section 1396u–4 of this title," after "section 1396a(a)(10)(A) of this title,". (Balanced Budget Act of 1997) Law text · (f)
• Pub. L. 105–33, §4708(d), inserted at end of closing provisions "Paragraphs (1), (2), (16), (17), and (18) shall apply with respect to items or services furnished and amounts expended by or through a managed care entity (as defined in section 1396u–2(a)(1)(B) of this title) in the same… (Balanced Budget Act of 1997) Law text · (i)
• Pub. L. 105–33, §4724(a)(1), substituted "; or" for the period at end. (Balanced Budget Act of 1997) Law text · (i)
• Pub. L. 105–33, §4724(a)(2), inserted "or" at end. (Balanced Budget Act of 1997) Law text · (i), (11)
• Pub. L. 105–33, §4742(a), struck out par. (12) which related to restrictions on payments, on or after Jan. 1, 1992, for physicians' services to children under 21 years of age and to pregnant women. (Balanced Budget Act of 1997) Law text · (i)
• Pub. L. 105–33, §4724(a)(2), inserted "or" at end. (Balanced Budget Act of 1997) Law text · (i)
• Pub. L. 105–12 added par. (16). (Assisted Suicide Funding Restriction Act of 1997) Law text · (i)
• Pub. L. 105–33, §4724(a)(1), (3), added par. (17). (Balanced Budget Act of 1997) Law text · (i)
• Pub. L. 105–33, §4724(b)(1), added par. (18). (Balanced Budget Act of 1997) Law text · (i)
• Pub. L. 105–33, §4701(b)(2)(A)(v), substituted "medicaid managed care organization" for "health maintenance organization". (Balanced Budget Act of 1997) Law text · (k)
• Pub. L. 105–33, §4701(b)(1), in introductory provisions, substituted "The term 'medicaid managed care organization' means a health maintenance organization, an eligible organization with a contract under section 1395mm of this title or a Medicare+Choice organization with a contra… (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4706(1), inserted ", meets the requirements of subparagraph (C)(i) (if applicable)," after "provision is satisfactory to the State". (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4701(b)(2)(A)(vi), substituted "medicaid managed care organization" for "health maintenance organization". (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4706(2), added subpar. (C). (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4701(b)(2)(A)(vii), substituted "medicaid managed care organization" for "health maintenance organization". (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4703(a), struck out cl. (ii) which read as follows: "less than 75 percent of the membership of the entity which is enrolled on a prepaid basis consists of individuals who (I) are insured for benefits under part B of subchapter XVIII of this chapter or for ben… (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4708(a), substituted "$1,000,000 for 1998 and, for a subsequent year, the amount established udner this clause for the previous year increased by the percentage increase in the consumer price index for all urban consumers over the previous year" for "$100,00… (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4701(d)(2)(A), struck out "except as provided under subparagraph (F)," after "such contract (I)", substituted "in accordance with section 1396u–2(a)(4) of this title;" for "without cause as of the beginning of the first calendar month following a full calenda… (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4712(c)(2), which directed the repeal of subsec. (m)(2)(A)(ix), was repealed by Pub. L. 106–554, §1(a)(6) [title VII, §702(c)(1)]. See 2000 Amendment note above and Effective Date of 1997 Amendment note below. (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4712(b)(2), amended cl. (ix) generally. Prior to amendment, cl. (ix) read as follows: "such contract provides, in the case of an entity that has entered into a contract for the provision of services of such center with a federally qualified health center, that (I) rates of prepayme… (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4701(c), added cl. (xi) relating to section 1396u–2. (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4703(b)(1)(A), struck out subpars. (C) to (E) which read as follows: (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4701(d)(2)(B), struck out subpar. (F) which read as follows: "In the case of— (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4703(b)(1)(B), substituted "clause (i)" for "clauses (i) and (ii)". (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4702(b)(1)(B), in concluding provisions, inserted before period at end "or with the manager described in such clause if the manager continues to have a contract described in section 1396d(t)(3) of this title with the State". (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4701(b)(2)(B), struck out "health maintenance" before "organization described" in concluding provisions. (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4702(b)(1)(A), inserted "or with a primary care case manager with a contract described in section 1396d(t)(3) of this title" before comma at end. (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4701(b)(2)(A)(vii), substituted "medicaid managed care organization" for "health maintenance organization". (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4701(b)(2)(A)(viii), substituted "Each medicaid managed care organization" for "Each health maintenance organization". (Balanced Budget Act of 1997) Law text · (m)
• Pub. L. 105–33, §4753(a)(1), added par. (1) and struck out former par. (1) which read as follows: (Balanced Budget Act of 1997) Law text · (r)
• Pub. L. 105–33, §4753(a)(1), (2)(B), (D), inserted introductory provisions, redesignated par. (5)(A)(i) to (iii) as par. (2)(A) to (C), and struck out former par. (2) which read as follows: (Balanced Budget Act of 1997) Law text · (r)
• Pub. L. 105–33, §4753(a)(1), struck out pars. (3) and (4) which related to Federal matching funds and Secretary's periodic review of approved retrieval systems. (Balanced Budget Act of 1997) Law text · (r), (4)
• Pub. L. 105–33, §4753(a)(2), struck out introductory provisions relating to requirements for Secretary's initial approval of mechanized claims processing and information retrieval systems and struck out "under paragraph (6)" before period at end of subpar. (A)(iii), redesignated sub… (Balanced Budget Act of 1997) Law text · (r)
• Pub. L. 105–33, §4753(a)(3), struck out pars. (6) to (8) which related to Secretary's development of performance standards for approval of State mechanized processing claims and information retrieval systems, waiver of certain requirements for initial operation, and applicabi… (Balanced Budget Act of 1997) Law text · (r)
• Pub. L. 105–33, §4912(b)(2), inserted before period at end "or for items and services described in subsection (a) of section 1396r–1a of this title provided to a child during a presumptive eligibility period under such section". (Balanced Budget Act of 1997) Law text · (u)
• Pub. L. 105–33, §4722(a)(1), substituted "(E), and (F)" for "and (E)" in introductory provisions. (Balanced Budget Act of 1997) Law text · (w)
• Pub. L. 105–33, §4722(a)(2), added subpar. (F). (Balanced Budget Act of 1997) Law text · (w)
• Pub. L. 105–33, §4701(b)(2)(C), amended cl. (viii) generally. Prior to amendment, cl. (viii) read as follows: "Services of health maintenance organizations (and other organizations with contracts under subsection (m) of this section)." (Balanced Budget Act of 1997) Law text · (w)

1996

• Pub. L. 104–193 struck out par. (9) which read as follows: "with respect to any amount of medical assistance for pregnant women and children described in section 1396a(a)(10)(A)(ii)(IX) of this title, if the State has in effect, under its plan established under part A of subchapter … (Personal Responsibility and Work Opportunity Reconciliation Act of 1996) Law text · (i)
• Pub. L. 104–248, §1(b)(1)(A), inserted "or is certified in family practice or pediatrics by the medical specialty board recognized by the American Osteopathic Association" before comma at end. Law text · (i)
• Pub. L. 104–248, §1(b)(1)(C)(i), (iii), (iv), added cl. (vi) and redesignated former cl. (vi) as (vii). Law text · (i)
• Pub. L. 104–248, §1(b)(1)(C)(ii), inserted "(or certified by the State in accordance with policies of the Secretary)" after "Secretary". Law text · (i)
• Pub. L. 104–248, §1(b)(1)(C)(iii), redesignated cl. (vi) as (vii). Law text · (i)
• Pub. L. 104–248, §1(b)(1)(B), inserted "or is certified in family practice or obstetrics by the medical specialty board recognized by the American Osteopathic Association" before comma at end. Law text · (i)
• Pub. L. 104–248, §1(b)(1)(C)(i), (iii), (iv), added cl. (vi) and redesignated former cl. (vi) as (vii). Law text · (i)
• Pub. L. 104–248, §1(b)(1)(C)(ii), inserted "(or certified by the State in accordance with policies of the Secretary)" after "Secretary". Law text · (i)
• Pub. L. 104–248, §1(b)(1)(C)(iii), redesignated cl. (vi) as (vii). Law text · (i)

1993

• Pub. L. 103–66, §13631(c)(1), which directed the amendment of par. (10) by striking all that follows "1396r–8(g) of this title" and inserting a semicolon, could not be executed because "1396r–8(g) of this title" did not appear subsequent to the general amendment of par. (10) by Pub… · (i)
• Pub. L. 103–66, §13602(b), amended par. (10) generally. Prior to amendment, par. (10) read as follows: "with respect to covered outpatient drugs of a manufacturer dispensed in any State unless, (A) except as provided in section 1396r–8(a)(3) of this title, the manufacturer complies with the rebate … · (i)
• Pub. L. 103–66, §13631(c)(2), redesignated par. (12) as (11), transferred such par. to appear after par. (10), and substituted semicolon for period at end. Former par. (11) redesignated (13). · (i)
• Pub. L. 103–66, §13631(c)(3), redesignated par. (14) as (12), transferred such par. to appear after par. (11), as redesignated by Pub. L. 103–66, §13631(c)(2), and substituted semicolon for period at end. Former par. (12) redesignated (11). · (i)
• Pub. L. 103–66, §13631(c)(4), redesignated par. (11) as (13), transferred such par. to appear after par. (12), as redesignated by Pub. L. 103–66, §13631(c)(3), and directed substitution of "; or" for period at end. · (i)
• Pub. L. 103–66, §13631(c)(5), added par. (14). · (i)
• Pub. L. 103–66, §13631(h)(1), added par. (15). · (i)
• Pub. L. 103–66, §13622(a)(2), substituted "regulation and including a group health plan (as defined in section 1167(1) of title 29)), a service benefit plan, and a health maintenance organization)" for "regulation)". · (o)
• Pub. L. 103–66, §13624(a), added subsec. (s). · (s)
• Pub. L. 103–66, §13604(a), added subpar. (C). · (v)

1991

• Pub. L. 102–234, §3(b)(2)(B), inserted "and section 1396r–4(f) of this title" after "of this section". · (a)
• Pub. L. 102–119 substituted "child with a disability" for "handicapped child", "Individuals with Disabilities Education Act" for "Education of the Handicapped Act", and "an infant or toddler with a disability" for "a handicapped infant or toddler". · (c)
• Pub. L. 102–234, §4(a), added par. (6). · (d)
• Pub. L. 102–234, §2(b)(2), struck out par. (10) added by Pub. L. 101–508, §4701(b)(2)(B), which read as follows: "with respect to any amount expended for medical assistance for care or services furnished by a hospital, nursing facility, or intermediate care facility for the mentall… · (i)
• Pub. L. 102–234, §2(a), added subsec. (w). · (w)

1990

• Pub. L. 101–508, §4402(d)(3), struck out before semicolon "(including expenditures for medicare cost-sharing and including expenditures 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 r… · (a)
• Pub. L. 101–508, §4801(a)(8), substituted "October 1, 1990" for "July 1, 1990". · (a)
• Pub. L. 101–508, §4401(b)(1), substituted "and" for "plus" at end of subpar. (C) and added subpar. (D). · (a), (D)
• Pub. L. 101–508, §4723(a), inserted "(A)" after "(2)" and added cl. (B). · (f)
• Pub. L. 101–508, §4601(a)(3)(A), substituted "1396a(a)(10)(A)(i)(III), 1396a(a)(10)(A)(i)(IV), 1396a(a)(10)(A)(i)(V), 1396a(a)(10)(A)(i)(VI), 1396a(a)(10)(A)(i)(VII)" for "1396a(a)(10)(A)(i)(IV), 1396a(a)(10)(A)(i)(VI)". · (f)
• Pub. L. 101–508, §4711(c)(2), inserted "(A)" after "medical assistance" and added cl. (B). · (i)
• Pub. L. 101–508, §4701(b)(2), added par. (10) relating to any amount expended for medical assistance for care or services. · (i)
• Pub. L. 101–508, §4401(a)(1), added par. (10) relating to covered outpatient drugs. · (i)
• Pub. L. 101–508, §4801(e)(16)(A), added par. (11). · (i)
• Pub. L. 101–508, §4752(a)(2), added par. (12). · (i)
• Pub. L. 101–508, §4752(e), added par. (14). · (i)
• Pub. L. 101–508, §4751(b)(1), inserted "meets the requirement of section 1396a(w) of this title" after "State, which" and "meets the requirement of section 1396a(a) of this title and" after "or which". · (m)
• Pub. L. 101–508, §4732(d)(1), struck out "(or the State as authorized by paragraph (3))" after "the Secretary". · (m)
• Pub. L. 101–508, §4704(b)(1), added cl. (ix). · (m)
• Pub. L. 101–508, §4731(a), added cl. (x). · (m)
• Pub. L. 101–508, §4752(b)(1), added cl. (xi). · (m)
• Pub. L. 101–508, §4704(b)(2), inserted "except with respect to clause (ix) of subparagraph (A)," after "Subparagraph (A)". · (m)
• Pub. L. 101–508, §4732(a), struck out "(i) special circumstances warrant such modification or waiver, and (ii)" after "the Secretary determines that". · (m)
• Pub. L. 101–508, §4732(b)(2), substituted "(G)," for "(G) or" and inserted at end "or with an eligible organization with a contract under section 1395mm of this title which meets the requirement of subparagraph (A)(ii), or". · (m)
• Pub. L. 101–508, §4732(c), added subpar. (H). · (m)
• Pub. L. 101–508, §4732(d)(2), struck out par. (3) which read as follows: "A State may, in the case of an entity which has submitted an application to the Secretary for determination that it is a health maintenance organization within the meaning of paragraph (1) and for which no suc… · (m)
• Pub. L. 101–508, §4731(b)(2), added cl. (v). · (m)
• Pub. L. 101–508, §4402(b), which directed amendment of subpar. (C)(iv) by inserting before period at end "or with respect to payments made in violation of section 1396e of this title", was executed to subpar. (D)(iv) to reflect the probable intent of Congress because subpar. … · (u)

1989

• Pub. L. 101–239, §6901(b)(5)(A), inserted "(including the costs for nurse aides to complete such competency evaluation programs)" after "1396r(e)(1) of this title" and "(or, for calendar quarters beginning on or after July 1, 1988, and before July 1, 1990, the lesser of 90 percen… · (a)
• Pub. L. 101–239, §6401(b), inserted "1396a(a)(10)(A)(i)(VI)," after "1396a(a)(10)(A) (i)(IV),". · (f)
• Pub. L. 101–239, §6411(d)(2), inserted ", not including items or services furnished in an emergency room of a hospital" after "emergency item or service". · (i)
• Pub. L. 101–234 repealed Pub. L. 100–360, §202(h)(2), and provided that the provisions of law amended or repealed by such section are restored or revived as if such section had not been enacted, see 1988 Amendment note below. · (i)

1988

• Pub. L. 100–360, §301(f), amended Pub. L. 99–509, §9403(g)(2), see 1986 Amendment note below. · (a)
• Pub. L. 100–360, §411(k)(13)(A), added subsec. (c). · (c)
• Pub. L. 100–360, §411(k)(10)(G)(ii), amended Pub. L. 100–203, §4118(h)(1), see 1987 Amendment note below. · (f)
• Pub. L. 100–360, §302(e)(4), inserted "1396a(a)(10)(A)(i)(IV)," before "1396a(a)(10)(A)(ii)(IX)" in introductory provisions. · (f)
• Pub. L. 100–360, §411(k)(10)(D), as amended by Pub. L. 100–485, §608(d)(26)(K)(ii), added Pub. L. 100–203, §4118(e)(11)(A), see 1987 Amendment note below. · (i)
• Pub. L. 100–360, §411(k)(10)(D), as amended by Pub. L. 100–485, §608(d)(26)(K)(ii), added Pub. L. 100–203, §4118(e)(11)(B), see 1987 Amendment note below. · (i)
• Pub. L. 100–360, §411(k)(6)(B)(x), added Pub. L. 100–203, §4112(b), see 1987 Amendment note below. · (i)
• Pub. L. 100–360, §202(h)(2), substituted "section 1395y(c)(1)" for "section 1395y(c)". · (i)
• Pub. L. 100–360, §302(c)(3), added par. (9). · (i)
• Pub. L. 100–485, §608(f)(4), substituted "1396a(a)(10)(D) of this title" for "1396a(a)(13)(A)(ii) of this title". · (m)
• Pub. L. 100–360, §411(k)(7)(D), repealed Pub. L. 100–203, §4113(d)(1), see 1987 Amendment note below. · (m)
• Pub. L. 100–360, §411(a)(3)(A), (B)(iii), (k)(7)(A), amended Pub. L. 100–203, §4113(a)(1)(B), see 1987 Amendment note below. · (m)
• Pub. L. 100–360, §411(k)(12)(A), amended par. (5) generally. Prior to amendment, par. (5) read as follows: · (m)

1987

• Pub. L. 100–203, §4211(g)(2), substituted "and (j)" for ", (h), and (j)". · (a)
• Pub. L. 100–203, §4211(d)(1), designated existing provisions as subpar. (A) and added subpars. (B) and (C). · (a)
• Pub. L. 100–203, §4212(c)(1), added subpar. (D). · (a)
• Pub. L. 100–203, §4113(b)(3), inserted "or by an entity which meets the requirements of section 1320c–1 of this title, as determined by the Secretary," after "organization". · (a)
• Pub. L. 100–203, §4212(e)(2), inserted "subject to section 1396r(g)(3)(B) of this title," after "(7)". · (a)
• Pub. L. 100–203, §4118(h)(1), as amended by Pub. L. 100–360, §411(k)(10)(G)(ii), substituted "(whether in the form of insurance premiums or otherwise and regardless of whether such costs are reimbursed under another public program of the State or political subdivision thereof)" for … · (f)
• Pub. L. 100–203, §4118(p)(5), inserted ", 1396a(a)(10)(A)(ii)(X), or 1396d(p)(1)" after "1396a(a)(10)(A)(ii)(IX)". · (f)
• Pub. L. 100–203, §4212(d)(1)(A), substituted "or services in an intermediate care facility for the mentally retarded" for first reference to "or intermediate care facility services", struck out ", skilled nursing facility services for 30 days," after first reference to "60 days", su… · (g)
• Pub. L. 100–203, §4212(d)(1)(B), substituted "and intermediate care facilities for the mentally retarded" for ", skilled nursing facilities, and intermediate care facilities". · (g)
• Pub. L. 100–203, §4212(d)(1)(C), redesignated subpar. (C) as (B) and substituted "services in an intermediate care facility for the mentally retarded" for "intermediate care facility services", redesignated subpar. (D) as (C), and struck out former subpar. (B) which read a… · (g)
• Pub. L. 100–203, §4212(d)(1)(D), struck out par. (7) which read as follows: "It is the duty and responsibility of the Secretary to assure that standards which govern the provision of care in skilled nursing facilities and intermediate care facilities under plans approved under this … · (g)
• Pub. L. 100–203, §4211(g)(1), struck out subsec. (h) which related to reduction by Secretary of amount otherwise considered as expenditures under State plan where reasonable cost differential between statewide average cost of skilled nursing facility services and statewide average cost… · (h)
• Pub. L. 100–203, §4118(d)(1)(B), inserted sentence at end that nothing in par. (1) be construed as permitting a State to provide services under its plan under this subchapter that are not reasonable in amount, duration, and scope to achieve their purpose. · (i)
• Pub. L. 100–203, §4118(d)(1)(A), substituted "; or" for period at end. · (i)
• Pub. L. 100–93, §8(g), amended par. (2) generally. Prior to amendment, par. (2) read as follows: "with respect to any amount paid for services furnished under the plan after December 31, 1972, by a provider or other person during any period of time, if payment may not be made under … · (i)
• Pub. L. 100–203, §4118(e)(11)(A), as added by Pub. L. 100–360, §411(k)(10)(D), as amended by Pub. L. 100–485, §608(d)(26)(K)(ii), substituted "under subchapter V, XVIII, or XX or under this subchapter pursuant to section 1320a–7, 1320a–7a, 1320c–5, or 1395u(j)(2) of this title" f… · (i)
• Pub. L. 100–203, §4118(e)(11)(B), as added by Pub. L. 100–360, §411(k)(10)(D), as amended by Pub. L. 100–485, §608(d)(26)(K)(ii), substituted "from participation under subchapter V, XVIII, or XX or under this subchapter pursuant to section 1320a–7, 1320a–7a, 1320c–5, or 1395u(j)(… · (i)
• Pub. L. 100–203, §4112(b), as added by Pub. L. 100–360, §411(k)(6)(B)(x), inserted "(other than amounts attributable to the special situation of a hospital which serves a disproportionate number of low income patients with special needs)" before "to the extent". · (i)
• Pub. L. 100–203, §4211(i), struck out "or skilled nursing facility" after "hospital" in three places. · (i)
• Pub. L. 100–203, §4213(b)(2), added par. (8). · (i)
• Pub. L. 100–203, §4113(d)(1), which directed the substitution of "subparagraphs (E) or (G)" for "subparagraph (G)", was repealed by Pub. L. 100–360, §411(k)(7)(D). · (m)
• Pub. L. 100–203, §4113(a)(1)(B), as amended by Pub. L. 100–360, §411(a)(3)(A), (B)(iii), (k)(7)(A), substituted "(F) In the case of—" and cls. (i) and (ii) for "(F) In the case of a contract with an entity described in subparagraph (G) or with a qualified health maintenance organization (as defined… · (m)
• Pub. L. 100–203, §4113(a)(1)(A), added par. (6). · (m)
• Pub. L. 100–93, §8(h)(1), struck out subsec. (n) which related to State agency action upon disclosure or failure to disclose required information by institution, organization, etc. · (n)
• Pub. L. 100–203, §4212(c)(2), substituted "paragraphs (2)(A)" for "paragraphs (2)" in pars. (1)(A), (C) and (2)(A), (C). · (r)

1986

• Pub. L. 99–509, §9403(g)(2), as amended by Pub. L. 100–360, §301(f), inserted "including expenditures for medicare cost-sharing and" before "including expenditures". · (a)
• Pub. L. 99–509, §9431(b)(2), inserted "or quality review" after "medical and utilization review". · (a)
• Pub. L. 99–603 added par. (4). · (a)
• Pub. L. 99–272, §9512(a), designated first sentence as subpar. (A), designated second sentence as subpar. (B), properly indented and aligned below subpar. (A), and added subpars. (C) and (D). · (d)
• Pub. L. 99–509, §9401(e)(2), inserted "for any individual described in section 1396a(a)(10)(A)(ii)(IX) of this title or" after "as medical assistance". · (f)
• Pub. L. 99–272, §9507(a), added par. (1). · (i)
• Pub. L. 99–272, §9517(a)(1), substituted "subparagraphs (B), (C), and (G)" for "subparagraphs (B) and (C)" in introductory text. · (m)
• Pub. L. 99–272, §9517(c)(1), inserted "(including a health insuring organization)" after "any entity" and "(directly or through arrangements with providers of services)" after "responsible for the provision" in introductory text. · (m)
• Pub. L. 99–509, §9434(a)(2), inserted before the semicolon "and under which the Secretary must provide prior approval for contracts providing for expenditures in excess of $100,000". · (m)
• Pub. L. 99–509, §9434(a)(1)(A), added cl. (viii). · (m)
• Pub. L. 99–514, §1895(c)(2), substituted "In the case" for "in the case". · (m)
• Pub. L. 99–272, §9517(a)(2), struck out designation "(i)" at beginning of subpar. (F), substituted "in the case of a contract with an entity described in subparagraph (G) or with a qualified health maintenance organization (as defined in section 300e–9(d) of this title) which meets the requirement … · (m)
• Pub. L. 99–272, §9517(a)(3), added subpar. (G). · (m)
• Pub. L. 99–509, §9434(a)(1)(B), added par. (4). · (m)
• Pub. L. 99–509, §9434(b), added par. (5). · (m)
• Pub. L. 99–272, §9518(a), substituted "September 30, 1985" for "the earlier of (i) September 30, 1982, or (ii) the last day of the sixth month following the date specified for operation of such systems in the State's most recently approved advance planning document submitted befo… · (r)
• Pub. L. 99–272, §9503(b)(2), substituted "once every three years" for "once each fiscal year" and inserted at end "Reviews may, at the Secretary's discretion, constitute reviews of the entire system or of only those standards, systems requirements, and other conditions which have… · (r)
• Pub. L. 99–272, §9503(b)(1), amended subpar. (J) generally. Prior to amendment, subsec. (J) read as follows: "report on or before October 1, 1981, to the Congress on the extent to which States have developed and operated effective mechanized claims processing and information retr… · (r)
• Pub. L. 99–272, §9503(f), added cl. (iv). · (u)
• Pub. L. 99–509, §9407(c), added cl. (v). · (u)
• Pub. L. 99–509, §9406(a), added subsec. (v). · (v)

1984

• Pub. L. 98–369, §2363(a)(2)(A), (B), in provision preceding subpar. (A), substituted "inpatient hospital services or intermediate care facility services for 60 days, skilled nursing facility services for 30 days, or inpatient mental hospital services for" for "care as an inpatient i… · (g)
• Pub. L. 98–369, §2363(a)(2)(C), substituted ", skilled nursing facility services, or intermediate care facility services furnished beyond 60 days (or inpatient mental hospital services furnished beyond 90 days), such State has an effective program of medical review of the care of patients in mental… · (g)
• Pub. L. 98–369, §2373(b)(11), substituted "paragraphs (26)" for "paragraph (26)" and "diligence" for "deligence". · (g)
• Pub. L. 98–369, §2363(a)(4), in amending par. (6) generally, substituted provisions relating to recertifications for provisions relating to reports to Congress concerning Secretary's determination and review of showing respecting any decrease of Federal medical assistance percentage… · (g)
• Pub. L. 98–369, §2363(b), as amended by Pub. L. 98–617, §3(a)(6), added par. (7). · (g)
• Pub. L. 98–369, §2303(g)(2), added par. (7). · (i)
• Pub. L. 98–369, §2364(1), inserted "except as provided under subparagraph (F)," after "(I)". · (m)
• Pub. L. 98–369, §2373(b)(12)(A), (C), struck out "(II)" before "for the period" and substituted "period" for "peroid". · (m)
• Pub. L. 98–369, §2373(b)(12)(B), substituted "of section 1396d(a) of this title" for "of such section". · (m)
• Pub. L. 98–369, §2373(b)(13), realigned margin of subpar. (C). · (m)
• Pub. L. 98–369, §2364(2), added subpars. (E) and (F). · (m), (F)
• Pub. L. 98–369, §2373(b)(14), substituted "non-Federal" for "nonfederal". · (s)

1983

• Pub. L. 97–448 substituted "purposes" for "purpose" and "the lower of the Federal medical assistance percentage for the State in effect for fiscal year 1981, or the Federal medical assistance percentage for the State in effect for fiscal year 1982" for "the Federal medical assistanc… · (t)

1982

• Pub. L. 97–248, §146(b), substituted "utilization and quality control peer review organization" for "Professional Standards Review Organization". · (a)
• Pub. L. 97–248, §137(g), struck out "(without regard to section 608 of this title)" after "consisting of one person if such plan". · (f)
• Pub. L. 97–248, §137(b)(11), inserted "or which is a qualified health maintenance organization (as defined in section 300e–9(d) of this title)". · (g)
• Pub. L. 97–248, §137(b)(12), substituted "provided in an institution for the mentally retarded" for "described in section 1396d(d) of this title". · (g)
• Pub. L. 97–248, §137(b)(13), substituted "subsection (m) of this section" for "section 1395mm of this title". · (k)
• Pub. L. 97–248, §137(b)(14), substituted "or" for "and" before "(II)" in cl. (iv), and substituted "unforeseen" for "unforseen" in cl. (vii)(II). · (m)
• Pub. L. 97–248, §137(a)(2), amended directory language of Pub. L. 97–35, §2161(c)(1), to correct an error, and did not involve any change in text. See 1981 Amendment note below. · (s)
• Pub. L. 97–248, §137(b)(15)(A), (B), in provisions following cl. (iii), substituted "fiscal year 1982" for "fiscal year 1981", and "subsections (a)(6) and (t) of this section, without regard to payments for claims relating to expenditures made for medical assistance for services … · (s)
• Pub. L. 97–248, §137(b)(15)(C), inserted "a program in operation under", before "a plan approved". · (s)
• Pub. L. 97–248, §137(b)(15)(D), substituted "must determine that" for "determines that", "most recent year (which shall consist of a 12-month period determined by the Secretary for this purpose)" for "most recent calendar year", and "2- or 3-year period" for "2 or 3 calendar year… · (s)
• Pub. L. 97–248, §137(b)(15)(E), inserted "and paragraph (3)(D)". · (s)
• Pub. L. 97–248, §137(b)(15)(F), inserted "(including amounts saved, to the extent such amounts can be documented to the satisfaction of the Secretary, by reason of the suspension or termination of a provider or other person for fraud or abuse, but only during the period of suc… · (s)
• Pub. L. 97–248, §137(b)(27), inserted "or quarters" after "carried forward to the following quarter". · (s)
• Pub. L. 97–248, §137(a)(1), (2), amended directory language of Pub. L. 97–35, §2161(b), (c)(2), to correct an error, and did not involve any change in text. See 1981 Amendment note below. · (t)
• Pub. L. 97–248, §137(b)(16)(A), substituted "payments under subsection (a)(6) of this section, interest paid under subsection (d)(5) of this section, and payments for claims relating to expenditures made for medical assistance for services received through a facility of the India… · (t)
• Pub. L. 97–248, §137(b)(16)(B), (D), substituted "Consumer Price Index for all urban consumers (U.S. city average) published by the Bureau of Labor Statistics" for "consumer price index for all urban consumers (published by the Bureau of Labor Statistics)" and "for the 12-month p… · (t)
• Pub. L. 97–248, §137(b)(16)(C), (D), substituted "Consumer Price Index for all urban consumers (U.S. city average) published by the Bureau of Labor Statistics" for "consumer price index for all urban consumers (published by the Bureau of Labor Statistics)" and "for the 24-month p… · (t)
• Pub. L. 97–248, §137(b)(16)(A), substituted "payments under subsection (a)(6) of this section, interest paid under subsection (d)(5) of this section, and payments for claims relating to expenditures made for medical assistance for services received through a facility of the India… · (t)
• Pub. L. 97–248, §137(b)(16)(E), substituted "for fiscal years 1982, 1983, and 1984" for "for fiscal year 1984" wherever appearing, "years 1983, 1984, and 1985, respectively" for "year 1985", "in effect for fiscal year 1981" for "in effect for fiscal year 1983", and "after fiscal yea… · (t)
• Pub. L. 97–248, §133(a), added subsec. (u). · (u)

1981

• Pub. L. 97–35, §2113(n), substituted "and" for "plus" at the end of subpar. (B) and added subpar. (C). · (a)
• Pub. L. 97–35, §2163, substituted "determination at a rate" for "determination (but not to exceed a period of twelve months with respect to disallowances made prior to October 1, 1981, or six months with respect to disallowances made thereafter) at a rate". · (d)
• Pub. L. 97–35, §2101(a)(2), added subsec. (e). · (e)
• Pub. L. 97–35, §2183(a), inserted "and the physician, or a physician assistant or nurse practitioner under the supervision of a physician" and "or, in the case of services that are intermediate care facility services described in section 1396d(d) of this title, every year" in par… · (g)
• Pub. L. 97–35, §2174(b), struck out par. (1) which provided that payments shall not be made with respect to any amount paid for items or services furnished under the plan after Dec. 31, 1972, to the extent that such amount exceeds the charge which would be determined to be reasonabl… · (i)
• Pub. L. 97–35, §2103(b)(1), added par. (5). · (i)
• Pub. L. 97–35, §2164(a), added par. (6). · (i)
• Pub. L. 97–35, §2178(a)(1), redefined "Health Maintenance Organization" substantially, and substituted reference to public and private organizations making services to individuals eligible for benefits under this subchapter and which makes adequate provision against the risk of i… · (m)
• Pub. L. 97–35, §2178(a)(2), in cl. (ii), substituted "75 percent of the membership of the entity which is enrolled on a prepaid basis" for "one-half of the membership of the entity", and added cls. (iii) to (vii). · (m)
• Pub. L. 97–35, §2178(a)(3), added subpar. (D). · (m)
• Pub. L. 97–35, §2106(b)(3), struck out "of this section" after "section 1395cc of this title" thereby perfecting the amendment made by Pub. L. 96–499, §905(c)(2). · (n)
• Pub. L. 97–35, §2161(c)(1), as amended by Pub. L. 97–248, §137(a)(2), repealed subsec. (s) which provided for reduction in medicaid payments to States, limitations on reductions, States included, and percentage reductions reduced under certain circumstances. See Effective Date of 1981 … · (s)
• Pub. L. 97–35, §2161(a), added subsec. (s). · (s)
• Pub. L. 97–35, §2161(c)(2), as amended by Pub. L. 97–248, §137(a)(2), repealed subsec. (t) which provided for offset for meeting Federal medicaid expenditure targets, and computation for meeting expenditure targets. See Effective Date of 1981 Amendment note below. · (t)
• Pub. L. 97–35, §2161(b), as amended by Pub. L. 97–248, §137(a)(1), added subsec. (t). · (t)

1980

• Pub. L. 96–499, §905(b), inserted reference to subsection (j) of this section. · (a)
• Pub. L. 96–499, §963, substituted "such a quarter within the twelve-quarter period beginning with the first quarter in which a payment is made to the State pursuant to this paragraph, and (B) 75 per centum of the sums expended during each succeeding calendar quarter" for "each quart… · (a)
• Pub. L. 96–499, §961(a), added par. (5). · (d)
• Pub. L. 96–499, §964, substituted "January 1, 1978" for "October 1, 1977" and "any calendar quarter ending on or before December 31, 1978" for "the calendar quarter ending on December 31, 1977". · (g)
• Pub. L. 96–499, §905(c)(1), substituted provisions relating to the adjustment of amounts determined under subsec. (a)(1) of this section in accordance with section 1396m of this title for provisions relating to orders for suspension of payment. · (j)
• Pub. L. 96–499, §905(c)(2), struck out "or is subject to a suspension of payment order issued under subsection (j)" after "section 1395cc of this title". · (n)
• Pub. L. 96–398 added subsec. (r). · (r)

1979

• Pub. L. 96–79 substituted "the date the entity qualifies as a health maintenance organization (as determined by the Secretary)" for "the date the entity enters into a contract with the State under this subchapter for the provision of health services on a prepaid risk basis". · (m)

1978

• Pub. L. 95–559 struck out "shall be administered through the Assistant Secretary for Health and in the Office of the Assistant Secretary for Health, and the administration of such duties and functions" after "subparagraph (A),". · (m)
• Pub. L. 95–626 substituted "section 254b(d)(1)(A)" for "section 247d(d)(1)(A)". · (m)

1977

• Pub. L. 95–142, §10(a), inserted provisions relating to notice to individuals in a sample group and provisions exempting notice respecting confidential services from notice requirements. · (a)
• Pub. L. 95–142, §17(a), added par. (6) and redesignated former par. (6) as (7). · (a), (7)
• Pub. L. 95–142, §17(b), added par. (3). · (b)
• Pub. L. 95–142, §20(a), in par. (1) substituted "Subject to paragraph (3), with respect to" for "With respect to" and "by a per centum thereof (determined under paragraph (5))" for "by 331/3 per centum thereof", in par. (2) inserted "timely" before "sample onsite surveys", and added pa… · (g)
• Pub. L. 95–142, §3(c)(2), inserted provisions relating to noncompliance under sections 1395cc(b)(2) and 1396a(a)(38) of this title. · (i)
• Pub. L. 95–83, §105(a)(1), in revising text, incorporated former cl. (i) (I) and (II) provisions in introductory text relating to responsibility for providing inpatient hospital services and other described services, substituting "capitation basis" for "capitation risk basis" and… · (m)
• Pub. L. 95–83, §105(a)(2), substituted reference to subpar. "(A)(ii)" for "(A)(iii)" wherever appearing. · (m)
• Pub. L. 95–142, §8(c), added subsec. (n). · (n)
• Pub. L. 95–142, §11(a), added subsecs. (o) and (p). · (o), (p)
• Pub. L. 95–142, §17(c), added subsec. (q). · (q)

1976

• Pub. L. 94–552 repealed subsec. (l) which provided for reduction of amount of payments to States found not to be in compliance with section 1396a(g) of this title. · (l)
• Pub. L. 94–460 added subsec. (m). · (m)

1975

• Pub. L. 94–182, §110(a), inserted provisions specifying the method by which the size and composition of the sample of admissions subject to review is to be established. · (g)
• Pub. L. 94–182, §111(b), added subsec. (l). · (l)

1973

• Pub. L. 93–233, §18(x)(5), struck out reference to section 1317 of this title in introductory parenthetical phrase. · (a)
• Pub. L. 93–233, §§13(a)(11), 18(r)(1), substituted "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 part A of subchapter IV of this chapter, or with respect… · (a)
• Pub. L. 93–233, §18(s), substituted "sums expended with respect to costs incurred" for "sums expended". · (a)
• Pub. L. 93–233, §18(t), struck out "(as found necessary by the Secretary for the proper and efficient administration of the plan)" after "such quarter". · (a)
• Pub. L. 93–233, §§18(r)(2), (u), (x)(6), inserted in par. (2) after "individuals sixty-five years of age or older" text reading "and disabled individuals entitled to hospital insurance benefits under subchapter XVIII" and end text reading ", other than amounts expended under provisions… · (b)
• Pub. L. 93–233, §18(y)(1)(A), struck out subsec. (c) which provided for Federal medical assistance percentage and Federal share of State medical expenses during fiscal year ending June 30, 1965. · (c)
• Pub. L. 93–233, §18(y)(1)(B), struck out reference to subsec. (c) of this section. · (d)
• Pub. L. 93–233, §13(a)(12), in subpar. (A), made payment limitations inapplicable to individual with respect to whom supplemental security income benefits are being paid under subchapter XVI of this chapter; in subpar. (B), made payment limitations inapplicable to individual with re… · (f)
• Pub. L. 93–233, §18(v), substituted "directly responsible for the care of the patient or financially interested in any such institution or, except in the case of hospitals, employed by the institution" for "directly responsible for the care of the patient and who are not employed… · (g)
• Pub. L. 93–66 struck out provisions respecting skilled nursing facility services and intermediate care facility services. · (j)

1972

• Pub. L. 92–603, §207(a)(2), inserted reference to subsecs. (g) and (h) and of this section. · (a)
• Pub. L. 92–603, §235(a), added par. (3). Former par. (3) redesignated (4). · (a)
• Pub. L. 92–603, §249B, temporarily added par. (4) which provided for payments to States of 100 per centum of sums expended for costs incurred during a quarter attributable to compensation or training of personnel responsible for inspecting public or private institutions providing lo… · (a)
• Pub. L. 92–603, §235(a), redesignated former par. (3) as (4). · (a)
• Pub. L. 92–603, §299E(a), added par. (5). Former par. (5) redesignated (6). · (a)
• Pub. L. 92–603, §249B, redesignated former par. (4) as (5). · (a)
• Pub. L. 92–603, §299E, redesignated former par. (5) as (6). · (a)
• Pub. L. 92–603, §295, struck out par. (1) which related to amount of quarterly expenditures exceeding average of total expenditures for each quarter of fiscal year ending June 30, 1965. · (b)
• Pub. L. 92–603, §221(c)(6), added par. (3). · (b)
• Pub. L. 92–603, §230, repealed subsec. (e) which related to furnishing for comprehensive care and services by July 1, 1977. · (e)
• Pub. L. 92–603, §§207(a)(1), 278(b)(1), added subsec. (g) and substituted "skilled nursing facility" for "skilled nursing home" and "skilled nursing facilities" for "skilled nursing homes" wherever appearing. · (g)
• Pub. L. 92–603, §§207(a)(1), 278(b)(1)(5), added subsec. (h) and substituted "skilled nursing facility" for "skilled nursing home" wherever appearing. · (h)
• Pub. L. 92–603, §§224(c), 229(c), 233(c), 237(a)(1), 278(b)(7), added subsec. (i) and substituted "skilled nursing facility" for "skilled nursing home" wherever appearing. · (i)
• Pub. L. 92–603, §290, added subsec. (j) relating to orders for suspension of payment. · (j)
• Pub. L. 92–603, §§225, 278(b)(16), added subsec. (j) relating to skilled nursing facilities services, and substituted "skilled nursing facility" for "skilled nursing home" wherever appearing. · (j)
• Pub. L. 92–603, §226(e), added subsec. (k). · (k)

1969

• Pub. L. 91–56 extended from July 1, 1975, to July 1, 1977, the date by which comprehensive care and services for eligible individuals must be made available for a State to be eligible for payments. · (e)

1968

• Pub. L. 90–248, §222(d), substituted "and, except in the case of individuals sixty-five years of age or older who are not enrolled under part B of subchapter XVIII of this chapter, other insurance premiums" for "and other insurance premiums". · (a)
• Pub. L. 90–248, §241(f)(5), struck out "IV," after "I," and inserted "or part A of subchapter IV of this chapter," after "XVI of this chapter,". · (a)
• Pub. L. 90–248, §225(a), substituted "of the State agency or any other public agency" for "of the State agency (or of the local agency administering the State plan in the political subdivision)". · (a)
• Pub. L. 90–248, §222(c), designated existing provisions as par. (1) and added par. (2). · (b)
• Pub. L. 90–364 substituted "1969" for "1967". · (b)
• Pub. L. 90–248, §229(c), provided for treatment of expenditures for which payments were made to the State under subsec. (a) as an overpayment to the extent that the State or local agency administering the plan has been reimbursed for such expenditures by a third party pursuant to th… · (d)
• Pub. L. 90–248, §220(a), added subsec. (f). · (f)