TITLE XIX-GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS 1 'Title XIX of the Social Security Act is administered by the Health Care Financing Administration. Title XIX appears in the United States Code as §§1396-1396v, subchapter XIX, chapter 7, Title 42. Regulations relating to Title XIX are contained in chapter IV, Title 42, and subtitle A, Title 45, Code of Federal Regulations. See Vol. II, 31 U.S.Č. 6504-6505 with respect to intergovernmental cooperation. See Vol. II, 31 U.S.C. 7501-7507 with respect to uniform audit requirements for State and local governments receiving Federal financial assistance. See Vol. II, P.L. 78-410, §317A(a) and (d), with respect to coordination required in lead poisoning prevention; §353(i)(3) and (n), with respect to clinical laboratories; and §1301(c)(3), with respect to the requirement that health maintenance organizations enroll individuals entitled to medical assistance under Title XIX. See Vol. II, P.L. 79-396, §17(p), with respect to proprietary title XIX center. See Vol. II, P.L. 88-164, §124(b)(3), with respect to the membership of the State Planning Councils. See Vol. II, P.L. 88-352, §601, for prohibition against discrimination in federally assisted programs. See Vol. II, P.L. 89-73, §§203 and 422(c), with respect to consultation, and §306(c) with respect to agreements with other agencies. See Vol. II, P.L. 94-566, §503, with respect to preservation of medicaid eligibility for individuals who cease to be eligible for supplemental security income benefits on account of cost-ofliving increases in social security benefits. See Vol. II, P.L. 95-521, §102(i), with respect to reporting of benefits received under the Social Security Act. See Vol. II, P.L. 97-300, $106(e), with respect to performance standards; and §§501-505, with respect to the payment of a bonus for the successful job placement of certain employable dependent individuals. See Vol. II, P.L. 98-369, §2355, as amended by P.L. 101-508, §4207(b)(4)(B), with respect to waivers for social health maintenance organizations. See Vol. II, P.L. 99-319, §105, with respect to requirements for a system established regarding the rights of individuals with mental illness. See Vol. II, P.L. 100-203, §4211(j) with respect to technical assistance with respect to the development and implementation of reimbursement methods for nursing facilities. See Vol. II, P.L. 100-204, §724(d), with respect to furnishing information to the United States Commission on Improving the Effectiveness of the United Nations; and §725(b), with respect to the detailing of Government personnel. See Vol. II, P.L. 100-235, §§5-8, with respect to responsibilities of each Federal agency for computer systems security and privacy. See Vol. II, P.L. 100-690, §2306(c)(4), with respect to services covered in the plan of Hawaii; and $5301(a)(1)(C) and (d)(1)(B), with respect to benefits of drug traffickers and possessors. See Vol. II, P.L. 101-121, with respect to the amounts collected by the Secretary of Health and Human Services under the authority of title IV of the Indian Health Care Improvement Act. See Vol. II, P.L. 101-239, §6407, with respect to demonstration projects to study the effect of allowing States to extend medicaid to pregnant women and children not otherwise qualified to receive medicaid benefits; §6408(a), with respect to medicaid provisions; §6507, with respect to research on infant mortality and medicaid services; §6509, with respect to a maternal and child health handbook; $8015, with respect to demonstration of effectiveness of Minnesota family investment plan; and §10405, with respect to Agent Orange Settlement payments excluded from countable income and resources under Federal means-tested programs. See Vol. II, P.L. 101-508, §4401(c), with respect to demonstration projects; §4401(d), with respect to an annual report on drug pricing; §4745, with respect to demonstration projects to study the effect of allowing States to extend medicaid coverage to certain low-income families not otherwise qualified to receive medicaid benefits; §4801(b)(1), with respect to preadmission screening and annual resident review; §4801(e)(7)(B), with respect to a study and report on staffing requirements in nursing facilities; and §13302, with respect to protection of OASDI Trust Funds in the House of Representatives. See Vol. II, P.L. 103-432, §233, with respect to the New Hope Demonstration Project. See Vol. II. P.L. 105-33, §4724(e), with respect to monitoring payments for dual eligibles. See Vol. II, P.L. 105-277, $710, with respect to treatment of PACE program eligible individuals for purposes of payments to States for fiscal year 1999 on. Sec. 1901. Sec. 1906. Sec. 1907. Sec. 1908. Sec. 1911. Sec. 1915. Sec. 1916. Sec. 1917. Sec. 1920. Sec. 1922. Sec. 1924. Sec. 1925. Sec. 1928. Sec. 1930. Sec. 1933. Sec. 1934. TABLE OF CONTENTS OF TITLE 2 Appropriation State plans for medical assistance Operation of State plans Definitions ...... 1283 1323 1352 1352 Enrollment of individuals under group health plans 1366 Observance of religious beliefs 1368 State programs for licensing of administrators of nursing 1368 homes. Required laws relating to medical child support 1369 Redesignated as 1128B.] ......... 1371 Certification and approval of of rural health clinics and inter- 1371 mediate care facilities for the mentally retarded. 1372 1373 1374 Hospital providers of nursing facility services providers. ...... Provisions respecting inapplicability and waiver of certain re- 1376 quirements of this title. Page 1282 Use of enrollment fees, premiums, deductions, cost sharing, and 1385 similar charges. spouses. Extension of eligibility for medical assistance Liens, adjustments and recoveries, and transfers of assets ........................................... Presumptive eligibility for pregnant women 1432 Information concerning sanctions taken by State licensing au- 1434 thorities against health care practitioners and providers. Correction and reduction plans for intermediate care facilities 1436 for the mentally retarded. Adjustment in payment for inpatient hospital services fur- 1438 nished by disproportionate share hospitals. Treatment of income and resources for certain institutionalized 1446 2 This table of contents does not appear in the law. 1453 1461 Payment for covered outpatient drugs 1461 Program for distribution of pediatric vaccines 1480 Home and community care for functionally disabled elderly in- 1486 dividuals. 1499 Community supported living arrangements services 1501 Provisions relating to managed care 1504 State coverage of medicare cost-sharing for additional low- 1516 Program of all-inclusive care for the elderly (PACE) 1388 1396 1396 1431 1518 1528 APPROPRIATION SEC. 1901. [42 U.S.C. 1396] For the purpose of enabling each State, as far as practicable under the conditions in such State, to furnish (1) medical assistance on behalf of families with dependent children and of aged, blind, or disabled individuals, whose income and resources are insufficient to meet the costs of necessary medi cal services, and (2) rehabilitation and other services to help such families and individuals attain or retain capability for independence or self-care, there is hereby authorized to be appropriated for each fiscal year a sum sufficient to carry out the purposes of this title. The sums made available under this section shall be used for making payments to States which have submitted, and had approved by the Secretary, State plans for medical assistance. STATE PLANS FOR MEDICAL ASSISTANCE 3 SEC. 1902. [42 U.S.C. 1396a] (a) A State plan for medical assistance must (1) provide that it shall be in effect in all political subdivisions of the State, and, if administered by them, be mandatory upon them; (2) provide for financial participation by the State equal to not less than 40 per centum of the non-Federal share of the expenditures under the plan with respect to which payments under section 1903 are authorized by this title; and, effective July 1, 1969, provide for financial participation by the State equal to all of such non-Federal share or provide for distribution of funds from Federal or State sources, for carrying out the State plan, on an equalization or other basis which will assure that the lack of adequate funds from local sources will not result in lowering the amount, duration, scope, or quality of care and services available under the plan; (3) provide for granting an opportunity for a fair hearing before the State agency to any individual whose claim for medical assistance under the plan is denied or is not acted upon with reasonable promptness; (4) provide (A) such methods of administration (including methods relating to the establishment and maintenance of personnel standards on a merit basis, except that the Secretary shall exercise no authority with respect to the selection, tenure of office, and compensation of any individual employed in accordance with such methods, and including provision for utilization of professional medical personnel in the administration and, where administered locally, supervision of administration of the plan) as are found by the Secretary to be necessary for the proper and efficient operation of the plan, 4(B) for the training and effective use of paid subprofessional staff, with particular emphasis on the full-time or part-time employment of recipients and other persons of low income, as community service aides, in the administration of the plan and for the use of nonpaid or partially paid volunteers in a social service volunteer program in providing services to applicants and recipients and in assisting any advisory committees established by the 3 See Vol. II, P.L. 93-233, §13(c), with respect to medicaid eligibility for individuals receiving mandatory State supplementary payments. See Vol. II, P.L. 94-437, §402(c) and (d) with respect to a special fund for Indian Health Service facilities and §403 with respect to reports. See Vol. II, P.L. 105-33, §4759, with respect to an extension of the effective date if State legislation is required. 4P.L. 91-648, §208(a)(3)(D), transferred to the U.S. Civil Service Commission, effective March 6, 1971, all powers, functions, and duties of the Secretary under subparagraph (A). Functions of the Commission were transferred to the Director of the Office of Personnel Management under §102 of Reorganization Plan No. 2 of 1978 (5 U.S.C. 1101 note), effective January 1, 1979. State agency, (C)5 that each State or local officer, employee, or independent contractor who is responsible for the expenditure of substantial amounts of funds under the State plan, each individual who formerly was such an officer, employee, or contractor and each partner of such an officer or employee shall be prohibited from committing any act, in relation to any activity under the plan, the commission of which, in connection with any activity concerning the United States Government, by an officer or employee of the United States Government, an individual who was such an officer, employee, or contractor 8 or a partner of such an officer or employee is prohibited by section 207 or 208 of title 18, United States Code, and (D) that each State or local officer, employee, or independent contractor who is responsible for selecting, awarding, or otherwise obtaining items and services under the State plan shall be subject to safeguards against conflicts of interest that are at least as stringent as the safeguards that apply under section 27 of the Office of Federal Procurement Policy Act (41 U.S.C. 423) to persons described in subsection (a)(2) of such section of that Act 10; (5) either provide for the establishment or designation of a single State agency to administer or to supervise the administration of the plan; or provide for the establishment or designation of a single State agency to administer or to supervise the administration of the plan, except that the determination of eligibility for medical assistance under the plan shall be made by the State or local agency administering the State plan approved under title I or XVI (insofar as it relates to the aged) if the State is eligible to participate in the State plan program established under title XVI, or by the agency or agencies administering the supplemental security income program established under title XVI or the State plan approved under part A of title IV if the State is not eligible to participate in the State plan program established under title XVI; (6) provide that the State agency will make such reports, in such form and containing such information, as the Secretary may from time to time require, and comply with such provisions as the Secretary may from time to time find necessary to assure the correctness and verification of such reports; (7) provide safeguards which restrict the use or disclosure of information concerning applicants and recipients to purposes directly connected with the administration of the plan; (8) provide that all individuals wishing to make application for medical assistance under the plan shall have opportunity to SP.L. 105-33, §4724(c)(1)(A), struck out “and (C)" and substituted "(C)", effective January 1, 1998. "P.L. 105-33, §4724(c)(1)(B), struck out "local officer or employee" and substituted “local officer, employee, or independent contractor", effective January 1, 1998. P.L. 105-33, §4724(c)(1)(C), struck out "such an officer or employee" and substituted "such an officer, employee, or contractor", effective January 1, 1998. P.L. 105-33, §4724(c)(1)(C), struck out "such an officer or employee" and substituted "such an officer, employee, or contractor", effective January 1, 1998. "See Vol. II, Title 18. 10 P.L. 105-33, §4724(c)(1)(D), added “, and (D) that each State or local officer, employee, or independent contractor who is responsible for selecting, awarding, or otherwise obtaining items and services under the State plan shall be subject to safeguards against conflicts of interest that are at least as stringent as the safeguards that apply under section 27 of the Office of Federal Procurement Policy Act (41 U.S.C. 423) to persons described in subsection (a)(2) of such section of that Act", effective January 1, 1998. |