(iii) The interdisciplinary team approach to care management and service delivery.

(iv) Capitated, integrated financing that allows the provider to pool payments received from public and private programs and individuals.

(v) The assumption by the provider of full financial risk.

(3) APPLICATION OF CERTAIN ADDITIONAL BENEFICIARY AND PROGRAM PROTECTIONS.

(A) IN GENERAL.-In issuing such regulations and subject to subparagraph (B), the Secretary may apply with respect to PACE programs, providers, and agreements such requirements of part C of title XVIII (or, for periods before January 1, 1999, section 1876) and sections 1903(m) and 1932 relating to protection of beneficiaries and program integrity as would apply to Medicare+ Choice organizations under such part C (or for such periods eligible organizations under risk-sharing contracts under section 1876) and to medicaid managed care organizations under prepaid capitation agreements under section 1903(m).

(B) CONSIDERATIONS.-In issuing such regulations, the Secretary shall

(i) take into account the differences between populations served and benefits provided under this section and under part C of title XVIII (or, for periods before January 1, 1999, section 1876) and section 1903(m);

(ii) not include any requirement that conflicts with carrying out PACE programs under this section; and (iii) not include any requirement restricting the proportion of enrollees who are eligible for benefits under this title or title XVIII.

(4) CONSTRUCTION.-Nothing in this subsection shall be construed as preventing the Secretary from including in regulations provisions to ensure the health and safety of individuals enrolled in a PACE program under this section that are in addition to those otherwise provided under paragraphs (2) and (3).

(g) WAIVERS OF REQUIREMENTS.-With respect to carrying out a PACE program under this section, the following requirements of this title (and regulations relating to such requirements) shall not apply:

(1) Section 1902(a)(1), relating to any requirement that PACE programs or PACE program services be provided in all areas of a State.

(2) Section 1902(a)(10), insofar as such section relates to comparability of services among different population groups.

(3) Sections 1902(a)(23) and 1915(b)(4), relating to freedom of choice of providers under a PACE program.

(4) Section 1903(m)(2)(A), insofar as it restricts a PACE provider from receiving prepaid capitation payments.

(5) Such other provisions of this title that, as added or amended by the Balanced Budget Act of 1997, the Secretary determines are inapplicable to carrying out a PACE program under this section.

(h) DEMONSTRATION PROJECT FOR FOR-PROFIT ENTITIES.—

(1) IN GENERAL.-In order to demonstrate the operation of a PACE program by a private, for-profit entity, the Secretary (in close consultation with State administering agencies) shall grant waivers from the requirement under subsection (a)(3) that a PACE provider may not be a for-profit, private entity. (2) SIMILAR TERMS AND CONDITIONS.—

(A) IN GENERAL.-Except as provided under subparagraph (B), and paragraph (1), the terms and conditions for operation of a PACE program by a provider under this subsection shall be the same as those for PACE providers that are nonprofit, private organizations.

(B) NUMERICAL LIMITATION.-The number of programs for which waivers are granted under this subsection shall not exceed 10. Programs with waivers granted under this subsection shall not be counted against the numerical limitation specified in subsection (e)(1)(B).

(i) POST-ELIGIBILITY TREATMENT OF INCOME.-A State may provide for post-eligibility treatment of income for individuals enrolled in PACE programs under this section in the same manner as a State treats post-eligibility income for individuals receiving services under a waiver under section 1915(c).

(j) MISCELLANEOUS PROVISIONS.-Nothing in this section or section 1894 shall be construed as preventing a PACE provider from entering into contracts with other governmental or nongovernmental payers for the care of PACE program eligible individuals who are not eligible for benefits under part A, or enrolled under part B, of title XVIII or eligible for medical assistance under this title.

REFERENCES TO LAWS DIRECTLY AFFECTING MEDICAID PROGRAM 333

SEC. 1935. [42 U.S.C. 1396v] (a) AUTHORITY OR REQUIREMENTS TO COVER ADDITIONAL INDIVIDUALS.-For provisions of law which make additional individuals eligible for medical assistance under this title, see the following:

(1) AFDC.-(A) Section 402(a)(32) of this Act (relating to individuals who are deemed recipients of aid but for whom a payment is not made).

(B) Section 402(a)(37) of this Act (relating to individuals who lose AFDC eligibility due to increased earnings).

(C) Section 406(h) of this Act (relating to individuals who lose AFDC eligibility due to increased collection of child or spousal support).

(D) Section 482(e)(6) of this Act (relating to certain individuals participating in work supplementation programs). (2) SSI. (A) Section 1611(e) of this Act (relating to treatment of couples sharing an accommodation in a facility).

(B) Section 1619 of this Act (relating to benefits for individuals who perform substantial gainful activity despite severe medical impairment).

333 P.L. 104-193, §114(a)(1), redesignated the former §1931 as §1932.
P.L. 105-33, §4701(a), redesignated the former §1932 as §1933.

P.L. 105-33, §4732(c), redesignated the former §1933 as §1934.
P.L. 105-33, $4802(a)(2), redesignated the former §1934 as §1935.

See Vol. II, P.L. 105-33, §4759, with respect to an extension of the effective date if State legislation is required.

(C) Section 1634(b) of this Act (relating to preservation of benefit status for disabled widows and widowers who lost SSI benefits because of 1983 changes in actuarial reduction formula).

(D) Section 1634(c) of this Act (relating to individuals who lose eligibility for SSI benefits due to entitlement to child's insurance benefits under section 202(d) of this Act).

(E) Section 1634(d) of this Act (relating to individuals who lose eligibility for SSI benefits due to entitlement to early widow's or widower's insurance benefits under section 202(e) or (f) of this Act).

(3) FOSTER CARE AND ADOPTION ASSISTANCE.-Sections 472(h) and 473(b) of this Act (relating to medical assistance for children in foster care and for adopted children).

(4) REFUGEE ASSISTANCE.-Section 412(e)(5) of the Immigration and Nationality Act 334 (relating to medical assistance for certain refugees).

(5) 335 MISCELLANEOUS. (A) Section 230 of Public Law 93-66 (relating to deeming eligible for medical assistance certain essential persons).

(B) Section 231 of Public Law 93-66 (relating to deeming eligible for medical assistance certain persons in medical institutions).

(C) Section 232 of Public Law 93-66 (relating to deeming eligible for medical assistance certain blind and disabled medically indigent persons).

(D) Section 13(c) of Public Law 93-233 (relating to deeming eligible for medical assistance certain individuals receiving mandatory State supplementary payments).

(E) Section 503 of Public Law 94-566 (relating to deeming eligible for medical assistance certain individuals who would be eligible for supplemental security income benefits but for cost-of-living increases in social security benefits).

(F) Section 310(b)(1) of Public Law 96-272 (relating to continuing medicaid eligibility for certain recipients of Department of Veterans Affairs pensions).

(b) ADDITIONAL STATE PLAN REQUIREMENTS.-For other provisions of law that establish additional requirements for State plans to be approved under this title, see the following:

(1) Section 1618 of this Act (relating to requirement for operation of certain State supplementation programs).

(2) Section 212(a) of Public Law 93-66 336 (relating to requiring mandatory minimum State supplementation of SSI benefits program).

334 See Vol. II, P.L. 82-414.

335 See Vol. II, P.L. 93-66, P.L. 93-233, P.L. 94-566, and P.L. 96-272. 336 See Vol. II, P.L. 93-66, §212(a).

TITLE XX-BLOCK GRANTS TO STATES FOR
SOCIAL SERVICES1

PURPOSES OF TITLE; AUTHORIZATION OF APPROPRIATIONS

SEC. 2001. [42 U.S.C. 1397] For the purposes of consolidating Federal assistance to States for social services into a single grant, increasing State flexibility in using social service grants, and encouraging each State, as far as practicable under the conditions in that State, to furnish services directed at the goals of—

(1) achieving or maintaining economic self-support to prevent, reduce, or eliminate dependency;

(2) achieving or maintaining self-sufficiency, including reduction or prevention of dependency;

(3) preventing or remedying neglect, abuse, or exploitation of children and adults unable to protect their own interests, or preserving, rehabilitating or reuniting families;

(4) preventing or reducing inappropriate institutional care by providing for community-based care, home-based care, or other forms of less intensive care; and

Title XX of the Social Security Act is administered by the Office of Policy, Planning, and Legislation, Office of Human Development Services, Department of Health and Human Services. Title XX appears in the United States Code as §§1397-1397f, subchapter XX, chapter 7, Title

42.

Regulations of the Secretary of Health and Human Services relating to Title XX are contained in part 96, subtitle A, Title 45, Code of Federal Regulations.

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. 79-396, §17(p), with respect to proprietary title XX center and §17(q), with respect to demonstration projects.

See Vol. II, P.L. 88-352, §601, for prohibition against discrimination in federally assisted pro

grams.

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. 99-425, Title VI, with respect to grants for awarding scholarships to certain eligible individuals.

See Vol. II, P.L. 100-383, §§105(f)(2) and 206(d)(2), with respect to exclusion from income and resources of certain payments to certain individuals. See Vol. II, 31 U.S.C. 3803(c)(2)(C), with respect to benefits not affected by P.L. 100-383.

See Vol. II, P.L. 101-239, $10405, with respect to Agent Orange settlement payments excluded from countable income and resources under Federal means-tested programs.

2 This table of contents does not appear in the law.