42 U.S.C. 1396n: Compliance with State plan and payment provisions

2024

• 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,". (Consolidated Appropriations Act, 2024) Law text · (l)
• 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— (Consolidated Appropriations Act, 2024) Law text · (l)
• Pub. L. 118–42, §204(b)(2), substituted "subparagraph (A)" for "subparagraph (A)(ii)" in introductory provisions. (Consolidated Appropriations Act, 2024) Law text · (l)
• Pub. L. 118–42, §204(b)(3), added subpar. (D). (Consolidated Appropriations Act, 2024) Law text · (l)
• Pub. L. 118–42, §204(c)(1)(A)(i), substituted "through (F)" for "through (D)". (Consolidated Appropriations Act, 2024) Law text · (l)
• 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… (Consolidated Appropriations Act, 2024) Law text · (l)
• 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 … (Consolidated Appropriations Act, 2024) Law text · (l)
• Pub. L. 118–42, §204(c)(1)(A)(iii), added subpar. (E). (Consolidated Appropriations Act, 2024) Law text · (l)
• Pub. L. 118–42, §204(c)(2), added subpar. (F). (Consolidated Appropriations Act, 2024) Law text · (l)
• 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 … (Consolidated Appropriations Act, 2024) Law text · (l)

2018

• Pub. L. 115–271 added subsec. (l). (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 · (l)

2010

• 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." (Patient Protection and Affordable Care Act) Law text · (b)
• Pub. L. 111–148, §2601(b)(1)(B), inserted "(other than a waiver described in subsection (h)(2))" after "A waiver under this subsection". (Patient Protection and Affordable Care Act) Law text · (c)
• 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 … (Patient Protection and Affordable Care Act) Law text · (d)
• 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). (Patient Protection and Affordable Care Act) Law text · (h)
• 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". (Patient Protection and Affordable Care Act) Law text · (i)
• 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. (Patient Protection and Affordable Care Act) Law text · (i)
• 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 b… (Patient Protection and Affordable Care Act) Law text · (i)
• 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)". (Patient Protection and Affordable Care Act) Law text · (i)
• Pub. L. 111–148, §2402(b), added pars. (6) and (7). (Patient Protection and Affordable Care Act) Law text · (i), (7)
• Pub. L. 111–148, §2401, added subsec. (k). (Patient Protection and Affordable Care Act) Law text · (k)
• Pub. L. 111–152 substituted "October 1, 2011" for "October 1, 2010" in introductory provisions. (Health Care and Education Reconciliation Act of 2010) Law text · (k)

2006

• 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 medi… (Deficit Reduction Act of 2005) Law text · (g)
• Pub. L. 109–171, §6086(a), added subsec. (i). (Deficit Reduction Act of 2005) Law text · (i)
• Pub. L. 109–171, §6087(a), added subsec. (j). (Deficit Reduction Act of 2005) Law text · (j)

2004

• 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 … (Individuals with Disabilities Education Improvement Act of 2004) Law text · (c)

2002

• Pub. L. 107–121 substituted "1396a(bb)" for "1396a(aa)". (Native American Breast and Cervical Cancer Treatment Technical Amendment Act of 2001) Law text · (b)

2000

• Pub. L. 106–554 substituted "1396a(a)(15), 1396a(aa)," for "1396a(a)(13)(C)" in introductory provisions. (Consolidated Appropriations Act, 2001) Law text · (b)

1999

• 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. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (b)
• 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. (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (b)
• 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. (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(o)(3)], substituted "90 days of such date" for "90 day of such date". (Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2000) Law text · (h)

1997

• Pub. L. 105–33, §4106(c), substituted "paragraphs (16) and (17)" for "paragraphs (15) and (16)". (Balanced Budget Act of 1997) Law text · (a)
• 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' ". (Balanced Budget Act of 1997) Law text · (c)

1993

• Pub. L. 103–66 inserted "or to individuals described in section 1396a(z)(1)(A) of this title" after "or with either,". · (g)

1991

• 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 Ac… · (c)

1990

• 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. · (b)
• 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. · (b)
• 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". · (b)
• 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 … · (c)
• 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." · (c)
• Pub. L. 101–508, §4742(c)(1), added subpar. (C). · (c)
• 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 … · (d)
• Pub. L. 101–508, §4741(b), substituted "this subchapter whose provisions become effective on or after such date" for first reference to "this subchapter". · (d)

1989

• Pub. L. 101–239, §6115(c), substituted "paragraphs (15) and (16)" for "paragraphs (14) and (15)". · (a)
• 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… · (a)
• 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". · (b)

1988

• Pub. L. 100–360, §204(d)(3), substituted "paragraphs (14) and (15)" for "paragraphs (13) and (14)". · (a)
• Pub. L. 100–485, §608(f)(2), substituted "restricts" for "Restricts" in introductory provisions. · (a)
• Pub. L. 100–360, §411(l)(3)(G), amended Pub. L. 100–203, §4211(h)(10)(G), see 1987 Amendment note below. · (c)
• 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 "… · (c)
• Pub. L. 100–360, §411(k)(10)(H), inserted ", without regard to the availability of beds for such inpatients" before period at end. · (c)
• 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". · (c)
• 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 be… · (d), (ii)
• 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 ag… · (d)
• Pub. L. 100–360, §411(k)(3)(A)(i), substituted "65" for "75". · (d)
• Pub. L. 100–647, §8432(a), added cl. (iv). · (d)
• 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". · (d)
• 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." · (e)
• Pub. L. 100–360, §411(k)(17)(A)(ii), redesignated former subsec. (e)(1) as (f)(1). · (f)
• Pub. L. 100–360, §411(k)(17)(A)(i), redesignated former subsec. (f) as subsec. (f)(2). · (f)
• 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. · (h)
• 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)". · (h)

1987

• Pub. L. 100–203, §4072(d), substituted "paragraphs (13) and (14)" for "paragraphs (12) and (13)". · (a)
• Pub. L. 100–93 amended par. (2) generally. Prior to amendment, par. (2) read as follows: "restricts— · (a)
• 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". · (c)
• 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 interm… · (c)
• Pub. L. 100–203, §4118(p)(10), amended Pub. L. 99–509, §9411(a)(2). See 1986 Amendment note below. · (c)
• 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". · (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 … · (c)
• 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 (rela… · (c)
• 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". · (c)
• 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 "skille… · (c)
• Pub. L. 100–203, §4118(k), designated existing provisions as subpar. (A) and added subpar. (B). · (c)
• Pub. L. 100–203, §4118(b), added par. (10). · (c)
• Pub. L. 100–203, §4102(a)(1), added subsec. (d). Former subsec. (d) redesignated (h). · (d)
• 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 individu… · (g)
• 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… · (h)
• Pub. L. 100–203, §4102(b)(2), substituted "subsection (c) or (d)" for "subsection (c)". · (h)
• Pub. L. 100–203, §4102(a)(1)(A), redesignated former subsec. (d) as (h). · (h)

1986

• Pub. L. 99–509, §9320(h)(3), substituted "paragraphs (12) and (13)" for "paragraphs (11) and (12)". · (a)
• 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. · (b)
• 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). · (c)
• 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 faci… · (c)
• 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. (ii… · (c)
• Pub. L. 99–272, §9502(b)(2), inserted "hospital or" after "provided in a", and "inpatient hospital services or" after "the provision of". · (c)
• Pub. L. 99–272, §9502(c)(1), inserted "100 percent of" after "does not exceed". · (c)
• 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". · (c)
• 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". · (c)
• 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 i… · (c)
• 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". · (c)
• Pub. L. 99–272, §9502(a), added par. (5). · (c)
• Pub. L. 99–272, §9502(c)(2), added par. (6). · (c)
• 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… · (c)
• Pub. L. 99–272, §9502(d), added par. (7). · (c)
• Pub. L. 99–272, §9502(h), added par. (8). · (c)
• Pub. L. 99–272, §9502(i), added par. (9). · (c)
• Pub. L. 99–272, §9508(a)(1), added subsec. (g). · (g)
• 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. · (g)

1984

• Pub. L. 98–369 substituted "under this subchapter" for "under this part". · (c)

1983

• 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). · (c)

1982

• Pub. L. 97–248, §137(b)(19)(A), struck out "and section 1396b(m) of this title" after "section 1396a of this title". · (b)
• Pub. L. 97–248, §137(b)(20), inserted "primary care" before "case-management system", and substituted "medical care services" for "primary care services". · (b)
• 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". · (c)
• Pub. L. 97–248, §137(b)(22), redesignated existing provisions as cls. (i) and (ii) and added cl. (iii). · (c)
• 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". · (c)
• Pub. L. 97–248, §137(b)(24), substituted "this subsection" for "this section". · (c)
• Pub. L. 97–248, §137(b)(25), inserted "approval of" before "a proposed State plan". · (f)

1981

• 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). · (c), (d), (e)
• Pub. L. 97–35, §2177(a), added subsec. (f). · (f)