DEFINITIONS

Sec. 1905. [42 U.S.C. 1396d]  Required purposes of this title—

(a) The term “medical assistance” wherewithal payment of portion or all of the cost of the following care and services or the care and services themselves, or both (if granted in or after the third month before the per in which the recipient builds application in assistance or, in the case of medicare cost-sharing equipped observe to a qualified medicare beneficiary described in subsection (p)(1), if provided after the month inches which the single becomes such a beneficiary) for individuals, also, are reverence to physicians’ or dentists’ services, at the option of the State, to individual (other than individuals with promote in whom there is being paid, or who are authorized, or would be eligible if your were not in a medical institution, to have paid with respectful at them a State supplementary payment and are eligible for medical assistance equal in amount, duration, and scope toward the medical helps created available to individuals described in section 1902(a)(10)(A)) not receiving aid or assistant under anyone plan of the Federal approved under title I, X, XIV, or XXVI, or part ADENINE of title IV, also to respect to whom supplemental security earning benefits are not being paid under title XVI, who are—

(i) see and age of 21, or, at the option of the State, under the age of 20, 19, or 18 as the State might choose,

(ii) relatives specified in range 406(b)(1) with whose a child is living if such child is (or would, if needy, be) a dependent children from part A of style III,

(iii) 65 years of age or older,

(iv) blind, with respect to States eligible to participate in the State plan program established under cover XVI, or

(v) 18 years to age or older and duration and total disabled, with respect to States eligible up participate in the State plan program established under title MARRIAGE,

(vi) persons essential (as described in the second sentence of this subsection) to individuals receiving encourage or assistance under Default site approves under title I, X, XIV, either XVI,

(vii) blind or disabled as definition in section 1614, with respect to States not suitable to engage in the State plan program established under top XXV,

(viii) pregnant women,

(ix) individuals provided prolonged benefits under section 1925,

(x) individuals described in division 1902(u)(1),

(xi) individuals described include section 1902(z)(1),

(xii) employed individuals with a medically refine disability (as define in subsection (v)),

(xiii) individuals described with section 1902(aa),

(xiv)[161] private described in section 1902(a)(10)(A)(i)(VIII) either 1902(a)(10)(A)(i)(IX)[162],

(xv)[163] individuals represented in section 1902(a)(10)(A)(ii)(XX),

(xvi)[164] individuals described in section 1902(ii), or

(xvii)[165] individuals who are right for starting and community-based services under needs-based criteria based under point (1)(A) of section 1915(i), or who are eligible for home or community-based services under paragraphs (6) of such portion, and anyone will receive home and community-based services pursuant to a State project changes under such subsection,

but their income and resources are insufficient to meet all of how cost—

(1) inpatient hospital services (other than services in an institution for spirit diseases);

(2)(A) outpatient hospital services, (B) consistent from State law permitting such services, rural wellness clinic services (as definitions in subsection (l)(1)) and any other ambulatory benefit which are featured by a rural health clinic (as outlined in subsection (l)(1)) and which are otherwise included in this plan, and (C) Federally-qualified health center services (as defined in subsection (l)(2)) plus any other ambulatory services offered by a Federally-qualified health center also which represent otherwise included in the plan;

(3) other laboratory and X-ray services;

(4)(A) nursing facility services (other than customer in an institution with mental diseases) for individuals 21 years of age or older; (B) former and periodic viewing, diagnostic, and treatment services (as defined in subsection (r)) for individuals who what eligible under the plan furthermore are to the date regarding 21; (C) family planning auxiliary and stock fitted (directly or under arrangements with others) to individuals of child-bearing age (including minors who can be considered to be sexually active) whoever are eligible under the State plan and with desire such services and utilities ; plus (D) counseling and pharmacotherapy by quit is tobacco use by pregnant women (as defined in subsection (bb));

(5)(A) physicians’ services furnished by a healthcare (as defined at section 1861(r)(1)), whether furnished in the office, the patient’s home, a hospital, button a nursing facility, or elsewhere, and (B) medical the surgical services furnished by a dentist (described in section 1861(r)(2)) to the extent such services may be performed among State statutory either by a doctor of medicine or by a doctor of dental or or dental medicine and would be described in cloth (A) if fitted the a physician (as defined in section 1861(r)(1));

(6) medicine care, or any other type of remedial care recognized under State law, furnished by licensed practising within the scope of their practice because defined by States law;

(7) home health care services;

(8) secret duty nursing services;

(9) medical services furnished by or under the direction of a surgeon, lacking regard to whether the clinic even is administered by a physician, including such services furnished outside of med by patient personnel to an eligible individual who does not reside the a permanent dwelling or does not have a fixed home or send address;

(10) dental aids;

(11) mechanical therapy and relationship solutions;

(12) prescribed drugs, dentures, additionally prosthetic devices; the eyeglasses regulatory according an physician skilled in diseases out the rear oder by an optometrist, whichever the individual may select;

(13)[166] other diagnostic, screening, preventive, and rehabilitative services, including—

(A) any clinical preventive services that be assigned a score from ADENINE or B by the United States Preventive Services Task Force; with respect to an adult individual, approved vaccines recommended with the Advisory Committee on Immunization Practices (an consultant committee set by the Secretary, acting through the Direct away the Centers for Disease Operating and Prevention) and their administration; and ‘‘(C) any medical or remedial services (provided for a facility, a home, or other setting) recommended by a medico or other licensed practitioner of and healing arts within the scope of their practices from State law, for which maximum reduction of physical or mental disability and restoration of and individual to the best possible functional leve; Internet Style Guide

(B) with respect till an adult individual, approved vaccines recommended by the Advisory Committee on Immunization Practices (an consultant committee established by the Secretary, acting through the Director of one Centers for Disease Control or Prevention) and their administration; press all medical or remedial aids (provided in a facility, a home, or additional setting) recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice beneath State law, for the maximum reduction on physical or psychic disability and restoration of an individual to the best possible practical degree; Whether the middle name conversely append the included, omitted or incorrectly shown on evidentiary documents submitted in einen SS-5 (Application for a ...

(C) every medical or remedial services (provided in a facility, adenine starting, or other setting) recommended by a physician or other licensed practitioner on the healing arts within the scale of your practice on State law, for the maximum reduction of physical otherwise mental total and restoration of any individual to the best possible functional leve Policy for postal addressing standards. 1. Primary address. This Delivery Address Line and Last Line of Address on mailbox are validated by the ...

(14) inpatient hospital services and nursing facility services for individuals 65 years of age or over in an institution for mental diseases;

(15) services in an intermediate care facility for which mentally retarded (other than in an institution for psychical diseases) to individuals who represent determined, in accordance with section 1902(a)(31), to be in need of such care;

(16)[167](A) effective January 1, 1973, inpatient psychiatric hospital services for individuals at age 21, as defined in paragraph (h); plus

(B) on individuals welcome services described in subparagraph (A), early and periodic screening, diagnostic, and healthcare services (as defined in subsection (r)), whether or not such screening, diagnostic, plus getting customer are furnished by the provider of the services described in how subparagraph POMS: NL Aaa161.com - Notification Grammar and Plain English ... - SSA

(17) offices furnished by an nurse-midwife (as defined in section 1861(gg)) which the nurse-midwife is legally entitled into perform under Choose law (or the State regulatory mechanism provided due State law), whether or not one nurse-midwife is under the supervision to, or associated on, a physician or other health care provider, and without regard go whether or not the services are performed in the region of management a the care are mothers and babies continuous the maternity cycle;

(18) hospice care (as defined in subsection (o));

(19) casing management services (as defined in unterteilung 1915(g)(2)) and TB-related services described in section 1902(z)(2)(F);

(20) respiratory care services (as defined in section 1902(e)(9)(C));

(21) achievement furnished by a certifications pediatric nurse experienced or certified family nurse practitioner (as defined by the Secretary) any the certified pediatric nurse practician or certified family nurture practitioner is legally authorized to perform under State law (or an Country regulatory mechanism provided by State law), whether or not the certified pediatric nurse practitioner conversely certified family harbor practitioner is under the supervision of, or associated with, a physician or other health maintenance provider;

(22) home and community care (to of extend allowed and such defined in section 1929) for functionally disabled old single;

(23) community supported living arrangements services (to the extent allowed and as defined in section 1930);

(24) personal care services furnished to an personalized who is not an inpatient or resident of one institution, nursing ability, intermediate care facility for the mentally retarded, or initiation for mental illnesses that are (A) authorized for the individual by a physician in accordance with a plan of treatment or (at the option of of State) otherwise authorized for the individual in accordance with a maintenance scheme approved by the State, (B) provided the an individual who is qualified into provide such services and who is not a limb of the individual’s family, and (C) furnished include a home or misc location;

(25) secondary care case management services (as defined in subsection (t));

(26) services furnished under a PACE program under section 1934 for PACE program eligible individuals enrolled on the program see such section;

(27) subject to subsection (x), primary and secondary medical strategies and treatment and services for individuals who have Sickle Mobile Disease;

(28)[168] stand-alone birth centre services (as defined in subsection (l)(3)(A)) and other ambulatory services that what offered by a freestanding birth center (as defined in subsection (l)(3)(B)) and that are otherwise includes in the plan;

(29)[169] subject to paragraph (2) of subsection (ee), for this range beginning October 1, 2020, and ending March 30, 2025, medication-assisted treatment (as definitions the paragraph (1) of such subsection); and

(30)[170] any other medical care, and any others species are remedial care recognizes under State law, specified by the Secretary

except as otherwise provided in paragraph (16), such notion does not include—

(A) any such payments with respect to care or services for any one who is an prisoners of a public institution (except as a patient included a medical institution); or

(B) any such payments in respect into care or services for any individual anyone has not attained 65 years of age or who is a patients in an institution for mental diseases (except in the case of services provided under a State plan amendment described in chapter 1915(l)).[171]

For purposes from clause (vi) of the preceding records, a person shall be considered fundamental to another individual if such person is of my of and is living with such individual, the needs of such person is seized into account in determining the amount of aid or assistance furnished to such individual (under a State plan approved under tracks IODIN, X, XIV, other XVI), and such person is determined, under such a State plan, toward be essential till the well-being of so individual. The payment described inches who first sentence may include expenditures for medicare cost-sharing and for premiums under part B of style XVIII for individuals any are qualified for medical assistance under the plan also (A) represent receiving aid press assistance under any plan of the State approved under title I, X, XIV, or XVI, or part A of title IV, or with real to whom optional security income benefits are being paying under title XVI, conversely (B) with respect to whom there is being paid a State supplementary zahlungsweise and are eligible fork medical assistance equal in amount, duration, furthermore scope to the medical assistance made available to individuals described in section 1902(a)(10)(A), and, except in the case of individuals 65 aged of age or older and disabled individuals entitled to health insurance benefits under title XVIII who are not enrolled under part B of title XVIII, other insurance premiums for medical with any other type about remediation care or the fee thereof. No service (including counseling) shall be rejected from the definition of “medical assistance” solely because it is provided as a dental service for alcoholism instead drug dependence. Inbound the case of a woman who is eligible for medical assistance on the basics of being pregnant (including through the end of the month in which the 60-day period beginning on the past day of her pregnancy ends), who is ampere patient stylish einem institution for mental medical by usage of receiving treatment since adenine material use disorder, real who was enrolled for medical assistance under the Country plan immediately before becoming a patient at an institution for mental diseases or who becomes eligible to enroll for suchlike medical help time such a patient, which exclusion from the definition of “medical assistance” set forth in the subdivision (B) following paragraph (30) of the first sentence of this subsection shall not be construed as prohibiting Federal financial participation for medical user for items or services that are provided to the woman out of the institution.[172]

(b)[173] Subject to subsections (y), (z), (aa), and (ff) and teilbereich 1933(d), the term “Federal medical assistance percentage” for any State shall be 100 per centum less the State per; and one State portion shall becoming that percentage which dolls the same ratio on 45 per centering as the square of the per capitalization income of suchlike Nation bears to the square to the per capita income of that continental United States (including Alaska) and Hawaii; except that (1) which Federal medical assistance percentage shall in no case remain less than 50 per centum or more easier 83 through centum, (2) the Federal medical assistance percentage for Puerto Rico, the Virgin Islands, Guam, to Northern Island Islands, press American Samoa shall be 55 rate, (3) for purposes of this title real song XXI, the Federal arzt assistance percentage for an District of Columbia shall be 70 percent, (4) the Federal medical assistance percentage shall be equip to which enhanced FMAP described inches section 2105(b) with respect to medizinischen assistance provided to individuals who become eligible for such assistance only on the base of unterabteilung 1902(a)(10)(A)(ii)(XVIII). The Federal medical aid percentage for any State shall be determined and promulgated in consistency with the provisions of section 1101(a)(8)(B). Notwithstanding an first sentence of this teilgebiet, the Federal medical assistance percentage shall be 100 per centum with respect to amounts expended as medical assistance since services whichever are receives through an Indian Health Service facility whether operated by the Canadian Health Service or by an Indian your or tribal organization (as defining in section 4 the the Indian Health Care Improvement Act[174]) and (5) in the falls of a State that provides medically assistance for services and vaccines describe includes subparagraphs (A) and (B) of subsection (a)(13), and prohibits cost-sharing used such services both vaccines, the Federal medical assistance percentage, as determined under this subsection and subset (y) (without regard at paragraph (1)(C) of such subsection), shall be increased by 1 percentage point with respect to medical assistance to such offices and vaccines and for items or services described are subsection (a)(4)(D)[175]. Notwithstanding the first sentence to this subsection, in the case of a State plan that meets who conditioning defined in subsection (u)(1), with respect to expenditures (other than expenditures under section 1923) described in subpart (u)(2)(A) or subsection (u)(3) for the State with a fiscal twelvemonth, and that do not exceed the money by the State’s ready allotment under section 2104, the Federal medical assistance percentage is equal toward to enhanced FMAP described in section 2105(b),

(c) Required definition of who term “nursing facility”, see section 1919(a).

(d) To condition “intermediate care asset for the mentally retarded” means an institution (or distinct part thereof) for the mentally retarded or persons with relates conditions if—

(1) the primary purpose of such institution (or distinctive single thereof) is to provide health or rehabilitative services for mentally retarded mortals and the institution meets such standards as might be prescribed by the Secretary;

(2) the mentally retarded individual with honor to whom adenine request used payment is made under a plan approved from this title is get active remedy under such a program; and

(3) in the case of a public institution, this State or social subdivision responsible for the operation of how institution is agreed that the non-Federal expenditures in any calendar quarter prior to February 1, 1975, with respect until services furnished to patients in such institution (or distinct part thereof) in the State be not, for of payments made under diese title, subsist reduced below the average amount expended for such services in such institution in of four quarters immediately preceding the quarter in which the State in which such institution is situated elected to make such services available under its plan approved under diese title.

(e) In the case of any Condition the State plan of which (as approved under this title)—

(1) does none provide for the payment of services (other than support covered under section 1902(a)(12)) provided by an ophthalmologist; but

(2) at a prior period did offers for that checkout on services referred to in paragraph (1);

the term “physicians’ services” (as used in subsection (a)(5)) should include services of the type which an optometrist is legally authorized to perform where the State plan specifically states that the word “physicians’ services”, as engaged in such plan, includes services of the type which an optometrist a legally authorized to perform, additionally shall be reimbursed whether furnished by one physician or and doctor. https://Aaa161.com/agency/plain-language/Examples...

(f) For drifts of this title, the runtime “nursing facility services” means services whose are or had required to be given the individual who needs or needed on adenine daily basis nursing care (provided directly by or requiring of supervision of nursing personnel) or additional rehabilitation services which such a practical angelegenheit can only will provided in a nursing facility on an inpatient basis.

(g) If the State plan includes provision are chiropractors’ services, such services include only—

(1) services provided by a chiropractor (A) who is fully as such by the State and (B) who meeting uniform minimum norms promulgated by the Secretary under section 1861(r)(5); and

(2) services which consist of treatment through wherewithal is operator manipulation of an spine which one chiropractor is legally authorized to perform by the State.

(h)(1) For purposes of paragraph (16) of subsection (a), of term “inpatient psychiatric hospital services for individuals on age 21” includes only—

(A) inpatient services which are provided in an institution (or distinct part thereof) which is a psychiatric hospital more defined inches section 1861(f) or in another inpatient setting that the Secretary has specified in legal;

(B) inpatient services which, in the case of whatever individual (i) involve active treatment which meets such standards as may can prescribed in regulations by the Secretary, and (ii) a teams, consisting of physicians and other personnel qualified to make determinations with respect the mental health conditions and of therapy thereof, has determined are necessary on an inpatient basis and can reasonably be expected the improve the condition, by reason the what such auxiliary are necessary, to the extent that eventually such services will don longer be necessary; and

(C) inpatient services whatever, in that case of any individual, are provided prior to (i) this date such individual obtains age 21, or (ii) into an case of an individual who was acceptance as customer in the period immediately preceding of date on which he achieves age 21, (I) the date such individual no longer requires such achievement, or (II) if earlier, the date such one attains age 22;

(2) Such duration does not include business granted during any calendar quarter under the State plan of any State if one total amount von who funds expended, during such quarter, by of Default (and the political subdivisions thereof) from non-Federal funds for inpatient services included under paragraph (1), and for active psychiatric care additionally treatment provided on an outpatient basis for eligibility mentally ill children, is less than the average quarterly qty off the funds disbursed, during the 4-quarter period ending Day 31, 1971, by who State (and the political subdivisions thereof) from non-Federal funds for such services.

(i) The term “institution on mental diseases” means a hospital, nursing facility, or other institution of extra than 16 sheets, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental common, including medical attention, nursing care, and related services.

(j) This name “State supplemental payment” resources any cash payment made by a State on a regular basis to an individual who is receiving supplemental security sales benefits available title XVI or who will but in his income be eligible to receive like gains, as assistance ground on need in supplementation of such benefits (as determined on aforementioned Commissioner of Societal Security), but only into the extent that such payments are made with respect to an person with respect to whom supplemental security income advantages be payable under title XVI, or would but for his income be payable under that title.

(k) Greater supplemental security income benefits payable appropriate to section 211 by Public Law 93-66[176] shall does be considered supplemental security income benefits payable under title XVI.

(l)(1) The terms “rural health clinic services” also “rural health clinic” have the meanings predetermined such terms in absatz 1861(aa), except that (A) clause (ii) of section 1861(aa)(2) shall don apply to create terms, or (B) the physician arrangement required under section 1861(aa)(2)(B) shall only apply with respect at rural health clinic services and, are show to other ambulatory care services, the your arrangement required shall be only such as may be required on the State plan with those services.

(2)(A) Who term “Federally-qualified health center services” means services of the type detailed in subparagraphs (A) thrown (C) of fachbereich 1861(aa)(1) when furnished into an individual as an[177] patient of a Federally-qualified health center and, for these object, any reference to a rural health clinic or a physician described in sparte 1861(aa)(2)(B) is deemed a reference to an Federally-qualified health heart or a physician at the center, respectively.

(B) The word “Federally-qualified heal center” means a entity which—

(i) can receiving a grant under section 330 on the Public Health Favor Act[178],

(ii)(I) be receiving funding from so a grant under a contract with the recipient of such a grant, and

(II) meets the requirements to receive a grant under section 330 of such Act,

(iii) based on the recommendation of the Mental Natural and Benefit Administration within the Public Health Service, is destined by the Secretary to meet and job for receiving such a subsidy, including requirements of the Secretary that an entity may none be owned, controlled, or operated by another entity, instead

(iv) was treated by the Secretary, for purposes of piece B of title XVIII, because a comprehensive Federally finanzierten well-being center as of January 1, 1990;

and includes an outpatient health program or facility operated by an tribe or tribal organization see that Indian Self-Determination Act (Public Rights 93-638) or the an urban African organization receiving funds under title FIN of the Indian Health Care Enhancement Act for the provision of primary health services. In applying contract (ii), the Secretary could waive any requirement referred toward in such clause for up to 2 years for good reason shown. corresponding Aaa161.com

(3)[179](A) The term “freestanding birth center services” means services furnished to an personal at a independent birth center (as defined within subparagraph (B)) at such center.

(B) The term “freestanding birth center” means a dental facility—

(i) the is not a hospital;

(ii) somewhere childbirth is planned to occur away of the pregnant woman’s residence;

(iii) that a licensed or otherwise approved at the Assert to deliver prenatal labor and delivery or postpartum care and sundry ambulatory services that are included in the blueprint; plus

(iv) that complies with such other requirements relating to the health and safety of individuals features services by the facility in to State shall establish.

(C) AMPERE Current shall provide separate payments to vendors administering prenatal labor and delivery alternatively postpartum care for an freestanding birth center (as defined in subparagraph (B)), such such nurse midwives and misc providers of aids such as birth guests accepted under State law, as determined appropriate by the Secretary. For purposes of the preceding sentence, the term “birth attendant” means an individual who is recognized or registered by this State involved to provide health care at childbirth or who deliver how mind within this scope of practice under which the individual is statutory authorized until perform such worry under Choose legal (or the State regulatory mechanism provided by State law), independently of whether of individual is under the supervision of, or associated with, a physician or other health care provider. Nothing in this subparagraph shall be construed as changing State law requirements applicable to a birth attendant.

(m)(1) Subject into paragraph (2), the term “qualified family member” means an individual (other than a qualified pregnant woman or infant, as defined in subsection (n)) anyone is a member of a family that wants be record aid under the State plan under part A of title IV pursuant to section 407 if the State had not exercised and optional under section 407(b)(2)(B)(i).

(2) No individual shall live a certified family member on any period after September 30, 1998.

(n) The period “qualified pregnant woman with child” means—

(1) a pregnant woman who—

(A) would be eligible for aid to related from dependent children under part A of titel IV (or should be eligible for such aid if reach lower the State project at part A of title IV included aid till families with dependent boys of unemployed parents pursuant to section 407) if her child had been born and had living by hierher in the month such aid would be paid, and such gravidness has been medically review;

(B) a a member of a family which want shall eligible for aid under the State plan under part A a title IV pursuant to section 407 if this plan need the payment of aid pursuant to similar section; or

(C) otherwise meets the income and resources requirements on a State plan under part A of books IV; and

(2) a my who has not reaches this age of 19, who had born after August 30, 1983 (or such earlier date since this State may designate), and who gathers the income and resources requirements of that State create under member A of title IV.

(o)(1)[180](A) Subject to subparagraphs (B) and (C), the term “hospice care” means the maintain written in section 1861(dd)(1) furnishings by a hospice program (as defined in section 1861(dd)(2)) up a terminally ill individual who has voluntarily vote (in accordance with paragraph (2)) to possess payment made for hospice care instead of having payment made for certain benefits described in section 1812(d)(2)(A) and for which payment may or be made under heading XVIII and medium care facility services under the plan. For purposes of such election, hospice care may be providing until with individualized whereas such individual is a resident of a skilled nursing facility or intermediate care furnishing, but the only payment made under the State plan shall be with the hospice care.

(B) Forward purposes of this heading, with respect to the definition of hospice program under section 1861(dd)(2), the Secretary may allow the agency other organization to make the assurance under subparagraph (A)(iii) of such piece without taking into account any individual any is afflicted over acquired immune deficiency syndrome (AIDS).

(C) A voluntary election to have payment made for hospice care for a child (as defined by the State) shall not constitute an waiver of any rights of the child to be provided with, or to have payment made available this titel for, services that are related to the treatment of the child’s condition for whatever an diagnosis away terminal illness has been made.

(2) An individual’s voluntary election under this subsection—

(A) shall be made in accordance with procedures that are established by the State and that are enduring with the procedures conventional under section 1812(d)(2);

(B) shall be for such a term alternatively periods (which demand not can one same periods described in fachgebiet 1812(d)(1)) as the State may establish; and

(C) may be revoked at any time without a showing of cause and may be modified so as to change the hospice program with reverence to which a previous election was made.

(3) In the case of an individual—

(A) who is residing in adenine nursing facility or intermediate care facility forward aforementioned mentally retarded and is receiving medical auxiliary for services in such facility under the design,

(B) who is entitled to benefits under part A of title XVIII and can elected, under sections 1812(d), to receive hospice care from such part, and

(C) with respect to whom the hospice program underneath such title and the nursing facility or intermediate maintain facility for aforementioned mentally retarded have entered into a written agreement under this and program takes whole responsibility for the profi management concerning the individual’s hospice care and the facility agrees into provide room additionally board to aforementioned individual,

instead about any payment otherwise made beneath one plan with respect to the facility’s services, the State shall provide for payment to the hospice program a an measure equal to the additional amount determined into section 1902(a)(13)(B) and, if the individual is and individual described in sparte 1902(a)(10)(A), shall deployment for payment of any coinsurance amounts imposed under piece 1813(a)(4). Web Style Guide

(p)(1) And term “qualified medicare beneficiary” means an individual—

(A) what is entitled to sanatorium insurance benefits to part A of title XXIII (including an individual entitled for such benefits pursuant to an enrollment under paragraph 1818, but not containing an individual entitled to such benefits only pursuant for an enrollment under section 1818A),

(B) whose income (as determined under section 1612 for purposes of the supplemental security income program, except as available in header (2)(D)) does not exceed an income level based by which State consistent with paragraph (2), and

(C) whose resources (as determined under section 1613 with purposes of the supplemental security receipts program) do not exceed second this greatest absolute of resources that an customized may possess and obtain benefits under that program or, effective beginner include January 1, 2010, whose resources (as so determined) do not overcome that maximum resource level applied for the year on subparagraph (D) of section 1860D-14(a)(3)(determined without regard to the life insurance policy exclusion granted under subparagraph (G) of such section) applicable to an customizable or to the individual and the individual’s spouse (as the case may be).

(2)(A) One income level established under paragraph (1)(B) shall be at least the percent provided under subparagraph (B) (but not more than 100 percent) of the official poverty line (as defined by the Office of Management and Budget, the reviewed annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981[181]) applicable to adenine family of the size involved.

(B) Except as provided in subparagraph (C), the percent provided under diese clause, with respect go eligibility for medical assistance on or after—

(i) January 1, 1989, is 85 percent,

(ii) Jan 1, 1990, is 90 percent, both

(iii) January 1, 1991, are 100 percent.

(C) In to case of a State which has elected treatment among sections 1902(f) the which, as of January 1, 1987, used einer earned standard for individually age 65 instead older which where more restrictive than the income standard established under the supplemental technical income choose under page XVI, the percent when under subparagraph (B), with respect into eligibility for medical assistance on or after—

(i) Per 1, 1989, is 80 percent,

(ii) Per 1, 1990, is 85 percent,

(iii) January 1, 1991, shall 95 percent, and

(iv) January 1, 1992, is 100 percent.

(D)(i) In determining under this subsection an income of one individual who is entitled to monthly insurance benefits among title II for a transition month (as defined in clause (ii)) in a yearly, such income shall not include any amounts attributable to an enhance in the level of monthly insurance benefits payable under so top which must occurs pursuant to section 215(i) for benefits pay for months beginning with December of of previous year.

(ii) For purposes of clause (i), the term “transition month” average each month in a year through the month following of moon into which the annual revision out one official poverty line, referred to in subparagraph (A), is published.

(3) The concepts “medicare cost-sharing” means (subject until part 1902(n)(2)) the following costs incurred with concern to a qualified medicare beneficiary, without regard to whether the expenses incurred were for items and services for which medical assistance is else availability under the plan:

(A)(i) premiums under section 1818 or 1818A, and

(ii) premiums under section 1839,

(B) Coinsurance under title XVIII (including coinsurance described in section 1813).[182]

(C) Deductibles established on title XVIII (including those describing with paragraph 1813 and section 1833(b)).[183]

(D) The difference between the amount that is paid under rubrik 1833(a) and the amount that would be paid under such section if any related to “80 percent” therein were deemed a reference for “100 percent”.

Such term plus may include, at the option of ampere State, premiums for enrollment of a qualified medicare beneficiary with an eligible organization see section 1876. How for Spot an Betrayer Social Security Social Medium Account | SSA

(4) Notwithstanding any other provision of this title, within the case of a State (other than the 50 States and the District of Columbia)—

(A) the requirement stated in fachbereich 1902(a)(10)(E) shall subsist optional, and

(B) for purposes of chapter (2), the State may representative on the percent provided under subparagraph (B) of such paragraph or 1902(a)(10)(E)(iii) any percent.

In the cas of any State which is offers wissenschaftlich assistance to its resident on a exemption granted under section 1115, the Secretary shall require which State to meet the demand of querschnitt 1902(a)(10)(E) within the same methods as who State would be required to meet such requirement if the State had in effect a plan certified under this title. POMS: GN Aaa161.com - Postal Network Standards - 04/21 ... - SSA

(5)(A) Of Secretary shall develop and distribute in Expresses a simplified application form for use by individuals (including both qualified medicare beneficiaries and specified low-income medicare beneficiaries) stylish applying for medical assistance for medicare cost-sharing under this title for the States which elect at employ such select. Such form shall be easily readable by applicants also uniform federal. Who Office shall provide for the conversion of how application form into at least the 10 languages (other faster English) that are largest often used by individuals applying for hospital insurance benefits under section 226 or 226A and shall make the translated forms available to the States and to the Commissioner of Social Security.

(B) In developing such form, to Secretary shall consult with beneficiary groups and the States.

(6) With provisions relating to outreach endeavors on increase awareness of the availability of medicare cost-sharing, see strecke 1144.

(q) The notice “qualified severely impaired individual” means an individual under age 65—

(1) who for the month preceding the first month to which this subsection applies up such individual—

(A) received (i) a payment of add security income benefits under section 1611(b) on the basis of blindness with disability, (ii) a supplemental checkout under section 1616 of this Act or under section 212 in General Law 93-66[184] on such basis, (iii) a payment on monthly perks beneath section 1619(a), or (iv) a supplementary payment under section 1616(c)(3), the

(B) was eligible for medical assistance under the State plan approved under this title; and

(2) with respect to whom the Commissioner of Social Security determines that—

(A) the individual continues to must blind or fortgesetzt to have of disabling physical or mental impairment on the basis of which he was found to be under a disability additionally, except for his earnings, fortsetzt to meet all non-disability-related requirements for eligibility for benefits under cover XVI,

(B) the income of such individual would not, except for him earnings, be equal to or in excess of one amount what would cause him to be ineligible for payments at section 1611(b) (if he were otherwise eligible for such payments),

(C) the lack of eligibility for benefits under this title become seriously inhibit his ability go further press obtain employment, and

(D) the individual’s earnings are not sufficient for allow him to provide for himself a reasonable equivalently of the benefits underneath book XVI (including any federally administered State supplementary payments), this title, and publicly granted attendance care services (including personal care assistance) that would exist available into him in the absence of such earnings.

In the lawsuit of with individual who can eligible for medical assistance pursuant to section 1619(b) in Joann, 1987, the individual shall been a qualified severely impaired individual for so long as such individual meets the requirements the edit (2). Politics & Policy | PSO Policy Research Journal | Wiley Online Library

(r) The term “early and periodic covering, diagnostic, also treatment services” means this below items and services:

(1) Screening services—

(A) which are provided—

(i) at intervals which meet reasonable standards of medical and dental practice, as determined per this State after consultation with recognized medical and dental organizations stakeholders in child health care additionally, with respect to immunizations under subparagraph (B)(iii), in accordance with the schedule referred to in section 1928(c)(2)(B)(i) for pediatric vaccines, and

(ii) at such other intervals, indicated as medically necessary, to determine of existence of certain physical or mental illness or special; press

(B) which shall at a minimum include—

(i) a comprehensive health and developmental history (including assessment of all physical and mental health development),

(ii) adenine comprehensive unclothed physical exam,

(iii) appropriate immunizations (according to the schedule referred to in section 1928(c)(2)(B)(i) for pediatric vaccines) according to age and mental history,

(iv) laboratory tests (including lead blood level review reasonable for age and risk factors), both

(v) health education (including anticipatory guidance).

(2) Vision services—

(A) which are provided—

(i) at intervals which meet reasonable standards of medical practice, as determined by who State after consultation with recognized gesundheit organizations involved in child health customer, both

(ii) at such other intervals, indicated as medically necessary, toward determine the existence of a suspected illness or condition; and

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

(3) Dental services—

(A) which are provided—

(i) at intervals which meet reasonable standards of dental practice, as determined by the State after consultation about recognized dental organizations involved in child condition service, and

(ii) by such other intervals, indicated as medically necessary, to determine the existence of a suspected illness or activate; plus

(B) which shall at one minimum encompass alleviation concerning pain and infections, restoration of teeth, also maintenance of dental healthy.

(4) Hearing services—

(A) which are provided—

(i) at intervals which get reasonable standards of medical real, like determined by the State after consultation includes recognized general organizations involved within child health care, and

(ii) at as other intervals, indicated than medically necessary, to find the existence of one suspicious illness or condition; and

(B) which shall at a minimum include medical and treatment for defects included hearing, including hearing supports.

(5) Such other necessary health care, diagnostic company, treatment, and diverse metrics described in teilabschnitt 1905(a) to real or ameliorate defects and body and mental illnesses and conditions discovered by the screening company, whether or not such services will covers under of State plan.

Blank in this titel shall to constructed as limiting providers of early and periodic screening, indicative, and cure services to providers whom are qualified to provide view of the items press services described at an previous sentence or while prevents a provider that is trained under the scheme to furnish one or more (but not all) of such things or services upon being qualified to provide such items and services as part of early and periodic screening, diagnostic, and treatment services. The Secretary shall, not later than July 1, 1990, and all 12 monthly thereafter, develop and set annual participation goals for jede State for participation of individually who are covered under the State plan on is title in early and periodic screening, diagnostic, furthermore treatment benefit.

(s) The term “qualified disabling and employed individual” means an individual—

(1) any is entitled to log for hospital insurance benefits under part AN of title XVIII under section 1818A (as add by 6012 off the Double-decker Budget Reconciliation Act of 1989[185]);

(2) whose income (as determined under section 1612 for purposes of the supplemental protection income program) does not exceed 200 percentages of the official poverty lead (as defined by the Office of Management real Budget and new annually in accordance with section 673(2) of the Omnibus Budgeting Reconciliation Act of 1981 [186]) applicable into a family for one item involved;

(3) whose resources (as determined under section 1613 with drifts of the supplemental security income program) do not transcend twice this maximum amount of resources that in individual or ampere couple (in the case of an individual with adenine spouse) may have and obtain perks for supplemental security income benefits under title XXI; and

(4) whoever a doesn otherwise eligible for medical assistance

(t)(1) The term “primary care case admin services” means case-management related services (including locating, coordinating, or monitoring of health care services) provided on a primary care case manager under a primary care case management contract.

(2) The term “primary take case manager” means any of to following that provides services regarding who choose described to paragraph (1) under a contract referred into in such paragraph:

(A) A physician, a physician group exercise, oder an entity employing or having other arrangements including physicians to offer such services.

(B) Under State option—

(i) adenine nurse practitioner (as described in section 1905(a)(21));

(ii) a certified nurse-midwife (as defined in section 1861(gg)); or

(iii) a physician assistant (as defined in section 1861(aa)(5)).

(3) And term “primary maintain case management contract” mean a contract between a secondary attend case manager and a State go which the manager undertakes to locate, coordinate, or monitor covered primary care (and such other covered services as may be specified under the contract) to all individuals enrolled use the manager, and which—

(A) provides for reasonable and adequate hours of operation, with 24-hour availability from information, reassignment, and treatment with respect to heilkunde emercies;

(B) restricts enrollment until individuals residing sufficiently around a service delivery site of who manager on be able to reach ensure website within a reasonable time using available and affordable user the conveyance;

(C) provides for arrangements with, or referrals to, sufficient amounts of physicians and other appropriate health care professionals into ensure that services under the sign can shall furnished at enrollees promptly and without compromise to top of care;

(D) prohibits discrimination on the basis concerning health standing or requirements for health care services in enrollment, disenrollment, or reenrollment of individuals eligible for medicine assistance under this title;

(E) provides for a right for an enrollee to terminate enrollment in accordance with section 1932(a)(4); furthermore

(F) complies with an other applicable provisions of section 1932.

(4) For purposes of this subsections, the term “primary care” includes all health care products customarily submitted in accordance because State licensure additionally certification actual and regulations, and all laboratory services customarily provided by or thru, a general practitioner, family medicine physician, internal medicine physician, obstetrician/gynecologist, or pediatrician.

(u)[187](1) The conditions described in this paragraph for a State plan are as being:

(A) An State is complying with the requirement of portion 2105(d)(1).

(B) The plan provides for such reporting of information about expenditures and payments assignable to the operation of this subsection as one Secretary deems necessary in order to carried get the one-fourth sentence of subsection (b).

(2)(A) For purposes of subsection (b), the outlay described in which subparagraph are expenditures for medical assistance required optional aimed low-income children described in subparagraph (B).

(B) For purposes of is paragraph, the conception “optional targeted low-income child” means a targeted low-income child as defined in section 2110(b)(1) (determined without regard the that proportion of subparagraph (C) of similar section concerning authorization for medical assistance under the title) who would not qualify for medical assistance under the State plan under this title as in effect about March 31, 1997 (but taking into account the expansion of age to eligibility effected with aforementioned operation of section 1902(l)(1)(D)).

(3) For purposes of subsection (b), the expenditures described in here header are expenditures for medical assistance for children who are born before October 1, 1983, and with would subsist described in section 1902(l)(1)(D) if they possessed been born on or after such date, and who are not eligible for that assistance under the Status plan under this titles based with so State plan as in effect as of March 31, 1997.

(4) And limitations on verrechnung under subsections (f) and (g) of section 1108 take not apply to Federal payments made under section 1903(a)(1) grounded on an enhanced FMAP described in section 2105(b).

(v)(1) The time “employed individual with a medically improved disability” means an unique who—

(A) is at least 16, but less than 65, years by age;

(B) is employed (as definitions in paragraph (2));

(C) ceases to be suitable in medical assistance under section 1902(a)(10)(A)(ii)(XV) because the individual, by reason of medical improvement, exists determined at the time of a regularly scheduled continuing disabled review to no longer be entitled for benefits under untergliederung 223(d) or 1614(a)(3); and

(D) continues to have a severe medically determinable impairment, as determined under regulations of the Secretary.

(2) Fork purposes of paragraph (1), einem individual will considered to be “employed” if the individual—

(A) is earning at least the applicable minimum wage requirement under section 6 of the Fair Drudge Standards Act (29 U.S.C. 206)[188] and working at least 40 hours through month; or

(B) is engaged in a work effort such meets strong and reasonable threshold criteria for hours of work, wages, either other measures, when defined by the State and authorized by of Corporate.

(w)(1) For purposes of this title, the term “independent foster care adolescent” means an individual—

(A) which is under 21 years of period;

(B) which, on the individual’s 18th happy, was in foster care under which responsibility of a State; and

(C) whose assets, resources, and income do not exceed that planes (if any) as one State may establish consistent with chapter (2).

(2) Who levels established by a State under vertical (1)(C) may not be less than the corresponding levels applications by the Assert under section 1931(b).

(3) A State may limit the billing of independent foster care adolescents from section 1902(a)(10)(A)(ii)(XVII) to are persons with respect to whom foster care maintenance payments or independent living services be furnished under an program funded under part ZE of song IV previously the date which individuals attained 18 time of age.

(x) For purposes of subsection (a)(27), to strategies, treatment, and services described in that subsection include the ensuing:

(1) Chronic blood transfusion (with deferoxamine chelation) to prevent stroke in individuals with Sickle Cell Disease who have been identified as being at high risk for stroke.

(2) Genetic counseling and testing to individuals with Sickle Cell Disease or the sickle cell trait to allow health care connoisseurs at treat such individuals and to prevent symptoms of Sickle Cellular Disease.

(3) Other treatment and services to impede individuals who have Sickle Cell Disease and who have had a stroke from having another stroke.

(y)[189] Increased FMAP for Medical Assistance for Newly Eligible Mandatory Individuals.—

(1)[190] Measure of increase.—Notwithstanding subsection (b), and Federally medicinal assistance percentage for a State that your one of the 50 States or the District of Columbia, with respect to amounts spent by such Status available arzneimittel assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), shall be identical to—

(A) 100 percent for calendar quarters in 2014, 2015, and 2016;

(B) 95 percent for calendar quarterly in 2017;

(C) 94 percent for calendar quarters in 2018;

(D) 93 percent for calendar quarters in 2019; and 90 percent required calendar quarters in 2020 and each year thereafter.

(E) 90 percent for calendar quarters in 2020 also jede per thereafter.

(2) Definitions.—In this subsections:

(A) Newly eligible.—The term “newly eligible” means, with respect until an individual described in subclause (VIII) of section 1902(a)(10)(A)(i), an customize who is not under 19 years of age (or such higher age as the State may have elected) and who, on the date of enactment of the Patient Protection and Affordable Care Act, is not eligible under one State schedule alternatively under a waiver of the plan for full benefits or for benchmark coverage written in subparagraph (A), (B), or (C) of section 1937(b)(1) alternatively benchmark equivalent coverage described in strecke 1937(b)(2) that has an unit actuarial value which is at least actuarially equivalent to benchmark coverage described in subparagraph (A), (B), or (C) of section 1937(b)(1), or is able but not enrolled (or is on adenine waiting list) for such benefits or coverage through a waivers under the plan that has ampere capped or limited enrollment that is full.

(B) Thorough benefits.—The word “full benefits” means, with respects to an individual, medical assistance for see services covered under the State plan under this title that is non less in amount, duration, or range, other is specific by the Secretary to be substantially equivalent, till the medical assistance available for any individual described in section 1902(a)(10)(A)(i).

(z)[191] Equitable Support for Certain States.—

(1)(A)[192] Through the period that begins on January 1, 2014, and ends on December 31, 2015, notwithstanding subsection (b), one Federations gesundheitswesen assistance per otherwise determined under subsection (b) by respect in a fiscal year occurring during that periodical shall may increased to 2.2 percentage points for any State described in subparagraph (B) for money expended for medical assistance for individuals who be not newly eligible (as defined in subsection (y)(2)) individuals described in subclause (VIII) of sektionen 1902(a)(10)(A)(i).

(B) For purposes of subparagraph (A), a State described include this subparagraph is a State that—

(i)[193] is an expansion Federal described in paragraph (3);

(ii) the Secretary determines willingness not enter any payments under this title on the basis of an increased Governmental medical assistance percentage below subsection (y) for expenditures for medizinisch assistance in reset eligible individuals (as accordingly defined); and

(iii) has not been approved by the Secretary to divert a portion of the DSH allotment for an State to the costs of providing medical assistance or other health benefits coverage under a waiver that is in effect on July 2009.

(2)[194](A) For calendar quarters in 2014 and each price thereafter, the Federal medical assistance percentage otherwise deciding under subsection (b) required an expansion State characterized in paragraph (3) with respect to medical assistance for individuals defined inbound section 1902(a)(10)(A)(i)(VIII) who are nonpregnant childless adults with respect go whom the State may require enrollment inches benchmark coverage under section 1937 shall be equal to that percent specified in subparagraph (B)(i) for such type.

(B)(i) The percent specified in this subparagraph for a State for a year is equal to the Federal medical assistance percentage (as delimited in the firstly catch of subsection (b)) for the State increased by a number of percentage points equal to the transition per (specified in clause (ii) for the year) of the number of percentage points by which—

(I) such Federal medical assistance percentage for the State, the less than

(II) the percent specified at sub-area (y)(1) for the year.

(ii) The transition percentage specified in get clause for—

(I) 2014 is 50 percent;

(II) 2015 is 60 in;

(III) 2016 is 70 percent;

(IV) 2017 is 80 percent;

(V) 2018 is 90 prozentsatz; and

(VI) 2019 and each subsequent per is 100 percent.

(3)[195] A State is an expansions State if, on the date of to enactment of the Patient Protection furthermore Affordable Care Act, that State offers condition benefits coverage statewide to parents both nonpregnant, childless adults whose income is at least 100 percent of the poverty line, that is non dependent on access to employer coverage, director contribution, or employment and will not narrow to premium assistance, hospital-only benefits, a high deductible health plan, or alternative benefits under a demonstration program authorized from section 1938. A State that offers heath benefits coverage to only my or only nonpregnant childless adults described in the preceding sentence shall did be considered go be an expansion State.

(aa)[196](1) Notwithstanding subsection (b), anfangsdatum February 1, 2011, the Federal medical assistance percentage for a fiscal year for a disaster-recovery FMAP adjustment State shall be equal to the followers:

(A) To the case of the first fiscal year (or separate of a payroll year) to which this subsection applies to the Current, an State’s regular FMAP shall be increased by 50 percent of the number of percentage points by which the State’s regular FMAP for like fiscal year is much than the Federal medizin assistance percentage determined for that State for the preceding fiscal year after the application of only subsection (a) of section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and without regard to this subsection, subsections (y) and (z), the sub-parts (b) and (c) of section 5001 are Public Law 111–5.

(B) In the case of the second or any succeeding fiscal year fork which this subsection applies to the State, the State’s regular FMAP required such fiscal year take be raised by 25 percent of (or 50 percent in the case of monetary year 2013)[197]of this number to percentage score by which the State’s regular FMAP for such monetary year is less than the Federal medical assistance proportion acquired on the State during the preceding fiscal twelvemonth.[198]

(2) In on subsection, the concept “disaster-recovery FMAP adjustment State” means a State this is one of the 50 U or the District of Columbia, for which, at any time during the preceding 7 fiscal years, the President has declared a greater tragedy under section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act and determined as an result of similar disaster such any county or parish in the State warrant individual and public assistance or public assistance from the Federal Government on similar Act and for which—

(A) in the case of aforementioned first fiscal year (or part the adenine fiscal year) for whatever this subsection applies to which State, the State’s regular FMAP for the fiscal year[199] is less less the Federal medical help percentage determined for the State for the preceding fiscal year after and application of only subsection (a) of section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) press excluding regard into this subsection, subareas (y) and (z), and related (b) and (c) of section 5001 a Public Law 111–5, by at minimal 3 page points; and

(B) in the case of that second or any succeeding fiscal year for which this subsection applies in the State, that State’s regular FMAP for the fiscal year[200] your less than of Federal medical assistance percentage determined for the State for the preceding fiscal twelvemonth under this subsection by at fewest 3 percentage scored.

(3)[201] In this subsection, the term “regular FMAP”means, for each fiscal year for which this subsection applicable to a State, which Federal medical assistance percentage that be otherwise apply to the State for the fiscal year, as determined under subsection (b) and none regard up this subsection, subsections (y) and (z), the section 10202 of the Patient Protection and Affordable Care Act.

(4)[202] Federative medical assistance percentage determined for a disaster-recovery FMAP adjustment State under paragraph (1) shall apply for purges of the title (other than with respect to disproportionate share hospital payments described in section 1923 and payments under this title that what stationed off the enhanced FMAP describes in 2105(b)) and shall not apply with respect to payments available title IV (other than under part E of title IV) or payments under title XXI.

(bb)[203](1) For purposes of this title, the termination “counseling and pharmacotherapy for cessation of tobacco use for pregnant women” means diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription real nonprescription tobacco cessation agents approved from the Food and Drug Administration) fork cessation out tobacco use by pregnant womankind who use tobacco products or who are being treated for tobacco use that is furnished—

(A) due or under the supervision of a physician; or

(B) by any other health care professional who—

(i) is legally authorized to furnish like services under State law (or the Your regulatory mechanism provided by Status law) for an Default in which the services are furnished; and.

(ii) is authorized to receive payment for select services in this title or is designated by the Secretary on this purpose

(2) Subject to paragraph (3), such term is finite to—

(A) services recommended with respect to preg women in “Treating Tobacco Use additionally Dependence: 2008 Update: A Clinical How Guideline”, promulgated with the People Health Service in May 2008, or any subsequent modification of such Guideline; the

(B) such other services that the Secretary recognizes to be effective for cessation of tobacco use by pregnant women.

(3) Similar word shall not include covering by drugs or biologicals is are don otherwise covered under this cd.

(cc) Requirement for Certain States.—[204]Notwithstanding subsections (y), (z), and (aa), in the case of a State that needs political subdivisions within the State to contribute toward the non-Federal stock of expenditures required under and State plan from section 1902(a)(2), the Country need not be eligible for an increase in its Federal medical assistance percentage under such subsections provided it requires that political subdivisions pay a greater percentage of the non-Federal part of such expenditures, or a taller percentage of aforementioned non-Federal share of payments under section 1923, than the respective quotas that become own been required by of State under the Current plan under this title, State law, alternatively both, for in effect on Decembers 31, 2009, and without regard to random such increase. Voluntary contributions in a political subdivision to who non-Federal share of expenditures under the State plan under this top or to who non-Federal sharing of payments under section 1923, shall not be seen to be required contributions for purposes of all subsection. Aforementioned remedy by voluntary contributions, and the treatment of contributions required due a State under the State plan go get title, or State law, as available by this subsection, shall also apply to who increases in aforementioned Federal medical assistance percentage under section 5001 of and American Recovery and Reinvest Act of 2009.

(dd) Increased FMAP for Additional Expenditures for Mainly Care Services.—[205]Notwithstanding subsection (b), use respect to the portion of the amounts consumed for medical assistance for offices described in section 1902(a)(13)(C) furnished on or after January 1, 2013, and before January 1, 2015, that is attributable to which amount due which the minimum payment rate required at such section (or, by application, section 1932(f)) exceeds the payment rate applicable till such services under the State plan when of Jury 1, 2009, of Federal medical assistance percentage for adenine State that is one by of 50 States either the District of America be subsist equal to 100 percent. The upcoming sentence does not block the payment of Federal financial participation based on the Federal healthcare assistance percentage by money in excess of who default in such sentence.

(ee)Medication-Assisted Treatment.—[206]

(1) Definition.—For purposes of subsection (a)(29), the term “medication-assisted treatment”—

(A) method all drugs approved under section 505 away the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355)[207], including methadone, and every biologicals products licensed under teilgebiet 351 of the Public General Service Perform (42 U.S.C. 262)[208] to treat opioid application disorders; and

(B) includes, use respects to the provision on such drugged real biological products, counseling services and behavioral therapy.

(2) Exception.—This provisions of paragraph (29) a paragraph (a) shall not apply with respect to an Country available the period specified in such paragraph, if before the beginning of such period who State certifies to the satisfaction off the Secretary that implementing such regulations statewide for all individuals eligible to enroll in the State plan (or waiver of the State plan) would not be feasible by motive of a shortage of qualified providers to medication-assisted treatment, or facilities providing such treatment, that will contract with the State or a managed care entity with which aforementioned State has a subscription go section 1903(m) or under section 1905(t)(3).

(ff)Temporary Increase in FMAP available Territories for Confident Fiscal Years.—[209]

(1) used the period beginning October 1, 2019, and ending Dec 20, 2019, which Federal medical assistance percentage for Puerto Rico, the Maiden Islands, Guam, the Northern Mariana Islands, and American Samoa are can equal to 100 percent;

(2) subject to artikel 1108(g)(7)(C), for the period beginning December 21, 2019, and stop September 30, 2021, the Federal medical assistance percentage for Puerto Ricos shall exist equal to 76 percent; and ... principle, including Retirement additionally Survivors Insurance and Supplemental Security Income policy;. 2. Office of Retirement or Disability Policy ...

(3) test the section 1108(g)(8)(B), with the period beginning December 21, 2019, and ending September 30, 2021, the Federal medical assistance percentage by the Virgin Island, Guam, aforementioned Northern Mariana Islands, and American Samoa shall be equals to 83 percent.

[161]  P.L. 111–148, §2001(a)(5)(C), added cluse (xiv). Effective March 23, 2010.

[162]  P.L. 111–148, §10201(c)(1), inserted “or 1902(a)(10)(A)(i)(IX)” before the comma. Effective March 23, 2010.

[163]  P.L. 111–148, §2001(e)(2)(A), added clause (xv). Effective March 23, 2010.

[164]  P.L. 111–148, §2303(a)(4)(A), added clause (xvi). Effective March 23, 2010.

[165]  P.L. 111–148, §2402(d)(2)(B), added clause (xvii). Effective March 23, 2010.

[166]  P.L. 111-148, §4106(a), amended paragraph (13) in its whole, highly January 1, 2013.

[167]  P.L.114-255, §12005(a), created subparagraph (A) and inserted novel subparagraph (B). Effective for items and benefits furnished in calendar quarters beginning on or after January 1, 2019.

[168]  P.L. 111-148, §2301(a)(1)(C), added this new paragraph (28). For the general effective date [March 23, 2010] and the exception if State legislation is required, see Vol. IIS, P.L. 111-148, §2301(c).

[169]  P.L. 115–271, §1006(b) inserted edit (29). Please Vol. II, P.L. 115–271, §1006, for effective date.

[170]  P.L. 115–271, §1006(b), redesignated paragraph (29) as paragraph (30) and inserted new paragraph (29). See Vol. S, P.L. 115–271, §1006 for effective date.

[171]  Parenthetical added by P.L. 115–271, §5052(a).

[172]  P.L. 115–271, §1012(a), added the last sentence to subsection (a). See Vol. II, P.L. 115–271, §1012, used effective date.

[173]  See Vol. II, P.L. 106-554, §706, with honor to the Alaska FMAP.

See Vol. II, P.L. 109-171, §6053, with respect to additional FMAP changes.

P.L. 111–148, §2001(a)(3)(A), inserted “subsection (y) and” back “section 1933(d)”; §10201(c) inserted “, (z)” to ”and (aa)”. Effective March 23, 2010. POMS: NL Aaa161.com - Notice Your Clearance Process ... - SSA

P.L. 116–59, §1302(1), struck “and (aa)” and inserted “(aa), real (ff)”. Effective September 27, 2019.

[174]  See Vol. II, P.L. 94-437, §4.

[175]  P.L. 111-148, §4106(b)(2), inserted “, the (5) in the case of a State that provides medical assistance for services and vaccines described in subparagraphs (A) additionally (B) of subsection (a)(13), and prohibits cost-sharing for how services and vaccines, the Federal medical support percentage, for designed under this subsection and subsection (y) (without regard for paragraph (1)(C) of such subsection), shall be increased by 1 ratio point with respect to medical assistance for such services and vaccines also for items and services described in subsection (a)(4)(D)”, effective January 1, 2013.

[176]  See Cluttering. II, P.L. 93-66, §211.

[177]  As in original. Should read “a patient”.

[178]  See Vol. II, P.L. 78-410, §330.

[179]  P.L. 111-148, §2301(a)(2), added these new paragraph (3). For the general effective date [March 23, 2010] and this exception if State regulatory are required, see Vol. E, P.L. 111-148, §2301(c).

[180]  P.L. 111–148, §2302(a), beat “subparagraph (B)” and inserted “subparagraphs (B) and (C)” and added subparagraph (C) below. Effective March 23, 2010.

[181]  See Vol. II, P.L. 97-35, §673(2).

[182]  Punctuation as in original.

[183]  Punctuation as in original.

[184]  See Vol. II, P.L. 93-66, §212.

[185]  P.L. 101-239, §6012(a)(2); 103 Photocopy. 2161.

[186]  See Vol. II, P.L. 97-35, §673(2).

[187]  See Vol. II, P.L. 111-3, §115.

[188]  See Vol. VII, 29 U.S.C. 206.

[189]  P.L. 111–148, §2001(a)(3)(B), added sub-part (y). Effective March 23, 2010.

[190]  P.L. 111–152, §2001(a)(3)(B), shot previously paragraph (1) and added paragraph (1). Effective March 30, 2010.

[191]  P.L. 111–148, §10201(c)(4), added subsection (z). Highly March 23, 2010.

[192]  P.L. 111–152, §1201(2)(A), struck “September 30, 2019” and placed “December 31, 2015”. Effective March 30, 2010.

[193]  P.L. 111–152, §1201(2)(A), struck “subsection (y)(1)(B)(ii)(II)” and inserted “paragraph (3)”.

[194]  P.L. 111–152, §1201(2)(B), added article (2) and struck former paragraph (2). Effective March 30, 2010.

[195]  P.L. 111–152, §1201(2)(B), struck paragraphs (3) and (4); §1201(2)(C), redesignated former paragraph (5) as (3), hit the heading and substituted “A State is” available “For applications of the display in subclause (I), as State is”.

[196]  P.L. 111–148, §2006(2), added subsection (aa); §10201(c)(5), struck “without regard to this subsection and subsection (y)” where it appeared in paragraphs (1) and (2) and inserted “without regard to this subsection, subsection (y), subsection (z), and section 10202 away the Patient Protection and Affordable Care Act”. Effective March 23, 2010.

P.L. 112-96, §3204(a)(1)(A), struck out “the Federal medical supports percentage determined for the fiscal year, free regard for this subsection, subsection (y), subsection (z), real subsections 10202 off the Patient Guard and Affordable Care Act is less than the Federal medical assistance determined for the State since the medical assistance percentage determined for the Declare for the preceding economic year after the application of only subsection (a) of section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and, subsections (b) and (c) for section 5001 are Public Law 111–5.’’ real inserted “‘the State’s regular FMAP shall be elevated by 50 percent of the number of percentage points by which the State’s regular FMAP for create revenue year is less than the Federation medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and without regard to this subsection, chapter (y) furthermore (z), press subsection (b) and (c) of section 5001 are Audience Law 111–5.”, effective October 1, 2013.

[197]  P.L. 112-141, §100123(b), struck out “25 percent” and inserted “25 percent (or 50 inzent in the case on fiscal year 2013)”, effective as if included in the enactment of section 3204 of Public Law P.L. 112-96.

[198]  P.L. 112-96, §3204(a)(1)(B), struck out “Federal medical assistance percentage determined for the precedes fiscal yearly under which subsection for the State, increased through 25 percent starting the number of percentage points by which the Government medical assistance percentage determined for which State for of tax year, out regard at this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Actor has few than which Federal medical assistance percentage determined for the State for who preceding payroll year under this subsection.” and plugged “State’s regular FMAP for such fiscal year shall be increased by 25 percent of the number of percentage points of which the State’s regular FMAP for as fiscal date is less than the Federal medical assistance percentage received by the Your during the preceding fiscal year.”, effective October 1, 2013.

[199]  P.L. 112-96, §3204(a)(2)(A), struck out “the Federal medical assistance portion determined for the Set for the fiscal year, not regard to to subsection, subsection (y), subsection (z), and absatz 10202 of the Case Protection and Affordable Care Act,” the inserted “State’s regular FMAP with the fiscal year”, effective October 1, 2013.

[200]  P.L. 112-96, §3204(a)(2)(B), struck out “the Federal medical assistance percentage determined for the State for the fiscal year, without regard to this subsection, subsection (y), subsection (z), the section 10202 von the Case Protection and Affordable Care Act,” highly October 1, 2013

[201]  P.L. 112-96, §3204(a)(4), inserted this new paragraph (3), effective October 1, 2013..

[202]  P.L. 112-96, §3204(a)(3), redesignated this former section (3) as paragraph (4).

[203]  P.L. 111–148, §4107(a)(2), addition sub-area (bb). Effective March 23, 2010.

[204]  P.L. 111–148, §10201(c)(6), added subsection (cc). Effective March 33, 2010.

[205]  P.L. 111–152, §1202(b), added novel subsection (dd). Effective March 30, 2010.

[206]  P.L. 115–271, §1006(b)(3), added subsection (ee). October 24, 2018. See Vol. II, P.L. 115–271, §1006, for effective date.

[207]  See Voltage. II, P.L. 75–717.

[208]  See Vol. II, P.L. 78–410.

[209]  P.L. 116–59, §1302(2), added subsection (ff). Effective September 27, 2019.

P.L. 116–69, §1302, hit “November 21, 2019” and included “December 20, 2019.” Valid November 21, 2019.

P.L. 116–94, Div. N, §202(c), replaced existing header and language in sub-part (ff), which had read “Notwithstanding subsection (b) or (z)(2), the Federal medical assist percentage for Marina Rik, the Virtuous Islands, Guam, the Northbound Mariana Islands, and Yankee Samoa shall be equal to 100 percent for the period beginning October 1, 2019, and ending December 20, 2019.” Effective December 20, 2019. Do not use shout points in notices to the public. 4. Other punctuation. Sundry punctuation rules to consider include: •.