42 U.S.C. § 1396 — Medicaid and CHIP Payment and Access

Page 4009 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396 of the enactment of this Act [Oct. 6, 2014], the Sec- retary shall develop and report to Congress on a stra- tegic plan for collecting or otherwise accessing data on race and ethnicity for purposes of specifying quality measures and resource use and other measures under subsections (c) and (d) of section 1899B of the Social Se- curity Act, as added by subsection (a), and, as the Sec- retary determines appropriate, other similar provisions of, including payment adjustments under, title XVIII of such Act (42 U.S.C. 1395 et seq.).’’ SUBCHAPTER XIX—GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS § 1396. Medicaid and CHIP Payment and Access Commission (a) Establishment There is hereby established the Medicaid and CHIP Payment and Access Commission (in this section referred to as ‘‘MACPAC’’). (b) Duties (1) Review of access policies for all States and annual reports MACPAC shall— (A) review policies of the Medicaid pro- gram established under this subchapter (in this section referred to as ‘‘Medicaid’’) and the State Children’s Health Insurance Pro- gram established under subchapter XXI (in this section referred to as ‘‘CHIP’’) affecting access to covered items and services, includ- ing topics described in paragraph (2); (B) make recommendations to Congress, the Secretary, and States concerning such access policies; (C) by not later than March 15 of each year (beginning with 2010), submit a report to Congress containing the results of such re- views and MACPAC’s recommendations con- cerning such policies; and (D) by not later than June 15 of each year (beginning with 2010), submit a report to Congress containing an examination of issues affecting Medicaid and CHIP, includ- ing the implications of changes in health care delivery in the United States and in the market for health care services on such pro- grams. (2) Specific topics to be reviewed Specifically, MACPAC shall review and as- sess the following: (A) Medicaid and CHIP payment policies Payment policies under Medicaid and CHIP, including— (i) the factors affecting expenditures for the efficient provision of items and serv- ices in different sectors, including the process for updating payments to medical, dental, and health professionals, hospitals, residential and long-term care providers, providers of home and community based services, Federally-qualified health cen- ters and rural health clinics, managed care entities, and providers of other covered items and services; (ii) payment methodologies; and (iii) the relationship of such factors and methodologies to access and quality of care for Medicaid and CHIP beneficiaries (including how such factors and meth- odologies enable such beneficiaries to ob- tain the services for which they are eligi- ble, affect provider supply, and affect pro- viders that serve a disproportionate share of low-income and other vulnerable popu- lations). (B) Eligibility policies Medicaid and CHIP eligibility policies, in- cluding a determination of the degree to which Federal and State policies provide health care coverage to needy populations. (C) Enrollment and retention processes Medicaid and CHIP enrollment and reten- tion processes, including a determination of the degree to which Federal and State poli- cies encourage the enrollment of individuals who are eligible for such programs and screen out individuals who are ineligible, while minimizing the share of program ex- penses devoted to such processes. (D) Coverage policies Medicaid and CHIP benefit and coverage policies, including a determination of the de- gree to which Federal and State policies pro- vide access to the services enrollees require to improve and maintain their health and functional status. (E) Quality of care Medicaid and CHIP policies as they relate to the quality of care provided under those programs, including a determination of the degree to which Federal and State policies achieve their stated goals and interact with similar goals established by other pur- chasers of health care services. (F) Interaction of Medicaid and CHIP pay- ment policies with health care delivery generally The effect of Medicaid and CHIP payment policies on access to items and services for children and other Medicaid and CHIP popu- lations other than under this subchapter or subchapter XXI and the implications of changes in health care delivery in the United States and in the general market for health care items and services on Medicaid and CHIP. (G) Interactions with Medicare and Medicaid Consistent with paragraph (11), the inter- action of policies under Medicaid and the Medicare program under subchapter XVIII, including with respect to how such inter- actions affect access to services, payments, and dual eligible individuals. (H) Other access policies The effect of other Medicaid and CHIP policies on access to covered items and serv- ices, including policies relating to transpor- tation and language barriers and preventive, acute, and long-term services and supports. (3) Recommendations and reports of State-spe- cific data MACPAC shall— (A) review national and State-specific Medicaid and CHIP data; and Page 4010 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396 (B) submit reports and recommendations to Congress, the Secretary, and States based on such reviews. (4) Creation of early-warning system MACPAC shall create an early-warning sys- tem to identify provider shortage areas, as well as other factors that adversely affect, or have the potential to adversely affect, access to care by, or the health care status of, Med- icaid and CHIP beneficiaries. MACPAC shall include in the annual report required under paragraph (1)(D) a description of all such areas or problems identified with respect to the pe- riod addressed in the report. (5) Comments on certain secretarial reports and regulations (A) Certain secretarial reports If the Secretary submits to Congress (or a committee of Congress) a report that is re- quired by law and that relates to access poli- cies, including with respect to payment poli- cies, under Medicaid or CHIP, the Secretary shall transmit a copy of the report to MACPAC. MACPAC shall review the report and, not later than 6 months after the date of submittal of the Secretary’s report to Congress, shall submit to the appropriate committees of Congress and the Secretary written comments on such report. Such com- ments may include such recommendations as MACPAC deems appropriate. (B) Regulations MACPAC shall review Medicaid and CHIP regulations and may comment through sub- mission of a report to the appropriate com- mittees of Congress and the Secretary, on any such regulations that affect access, quality, or efficiency of health care. (6) Agenda and additional reviews (A) In general MACPAC shall consult periodically with the chairmen and ranking minority mem- bers of the appropriate committees of Con- gress regarding MACPAC’s agenda and progress towards achieving the agenda. MACPAC may conduct additional reviews, and submit additional reports to the appro- priate committees of Congress, from time to time on such topics relating to the program under this subchapter or subchapter XXI as may be requested by such chairmen and members and as MACPAC deems appro- priate. (B) Review and reports regarding Medicaid DSH (i) In general MACPAC shall review and submit an an- nual report to Congress on dispropor- tionate share hospital payments under sec- tion 1396r–4 of this title. Each report shall include the information specified in clause (ii). (ii) Required report information Each report required under this subpara- graph shall include the following: (I) Data relating to changes in the number of uninsured individuals. (II) Data relating to the amount and sources of hospitals’ uncompensated care costs, including the amount of such costs that are the result of providing unreim- bursed or under-reimbursed services, charity care, or bad debt. (III) Data identifying hospitals with high levels of uncompensated care that also provide access to essential commu- nity services for low-income, uninsured, and vulnerable populations, such as graduate medical education, and the continuum of primary through quarternary care, including the provi- sion of trauma care and public health services. (IV) State-specific analyses regarding the relationship between the most recent State DSH allotment and the projected State DSH allotment for the succeeding year and the data reported under sub- clauses (I), (II), and (III) for the State. (iii) Data Notwithstanding any other provision of law, the Secretary regularly shall provide MACPAC with the most recent State re- ports and most recent independent cer- tified audits submitted under section 1396r–4(j) of this title, cost reports sub- mitted under subchapter XVIII, and such other data as MACPAC may request for purposes of conducting the reviews and preparing and submitting the annual re- ports required under this subparagraph. (iv) Submission deadlines The first report required under this sub- paragraph shall be submitted to Congress not later than February 1, 2016. Subse- quent reports shall be submitted as part of, or with, each annual report required under paragraph (1)(C) during the period of fiscal years 2017 through 2024. (7) Availability of reports MACPAC shall transmit to the Secretary a copy of each report submitted under this sub- section and shall make such reports available to the public. (8) Appropriate committee of Congress For purposes of this section, the term ‘‘ap- propriate committees of Congress’’ means the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate. (9) Voting and reporting requirements With respect to each recommendation con- tained in a report submitted under paragraph (1), each member of MACPAC shall vote on the recommendation, and MACPAC shall include, by member, the results of that vote in the re- port containing the recommendation. (10) Examination of budget consequences Before making any recommendations, MACPAC shall examine the budget con- sequences of such recommendations, directly or through consultation with appropriate ex- pert entities, and shall submit with any rec- ommendations, a report on the Federal and Page 4011 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396 1 See References in Text note below. State-specific budget consequences of the rec- ommendations. (11) Consultation and coordination with MEDPAC (A) In general MACPAC shall consult with the Medicare Payment Advisory Commission (in this paragraph referred to as ‘‘MedPAC’’) estab- lished under section 1395b–6 of this title in carrying out its duties under this section, as appropriate and particularly with respect to the issues specified in paragraph (2) as they relate to those Medicaid beneficiaries who are dually eligible for Medicaid and the Medicare program under subchapter XVIII, adult Medicaid beneficiaries (who are not dually eligible for Medicare), and bene- ficiaries under Medicare. Responsibility for analysis of and recommendations to change Medicare policy regarding Medicare bene- ficiaries, including Medicare beneficiaries who are dually eligible for Medicare and Medicaid, shall rest with MedPAC. (B) Information sharing MACPAC and MedPAC shall have access to deliberations and records of the other such entity, respectively, upon the request of the other such entity. (12) Consultation with States MACPAC shall regularly consult with States in carrying out its duties under this section, including with respect to developing processes for carrying out such duties, and shall ensure that input from States is taken into account and represented in MACPAC’s recommenda- tions and reports. (13) Coordinate and consult with the Federal Coordinated Health Care Office MACPAC shall coordinate and consult with the Federal Coordinated Health Care Office es- tablished under section 2081 1 of the Patient Protection and Affordable Care Act before making any recommendations regarding dual eligible individuals. (14) Programmatic oversight vested in the Sec- retary MACPAC’s authority to make recommenda- tions in accordance with this section shall not affect, or be considered to duplicate, the Sec- retary’s authority to carry out Federal re- sponsibilities with respect to Medicaid and CHIP. (c) Membership (1) Number and appointment MACPAC shall be composed of 17 members appointed by the Comptroller General of the United States. (2) Qualifications (A) In general The membership of MACPAC shall include individuals who have had direct experience as enrollees or parents or caregivers of en- rollees in Medicaid or CHIP and individuals with national recognition for their expertise in Federal safety net health programs, health finance and economics, actuarial science, health plans and integrated delivery systems, reimbursement for health care, health information technology, and other providers of health services, public health, and other related fields, who provide a mix of different professions, broad geographic representation, and a balance between urban and rural representation. (B) Inclusion The membership of MACPAC shall include (but not be limited to) physicians, dentists, and other health professionals, employers, third-party payers, and individuals with ex- pertise in the delivery of health services. Such membership shall also include rep- resentatives of children, pregnant women, the elderly, individuals with disabilities, caregivers, and dual eligible individuals, cur- rent or former representatives of State agen- cies responsible for administering Medicaid, and current or former representatives of State agencies responsible for administering CHIP. (C) Majority nonproviders Individuals who are directly involved in the provision, or management of the deliv- ery, of items and services covered under Medicaid or CHIP shall not constitute a ma- jority of the membership of MACPAC. (D) Ethical disclosure The Comptroller General of the United States shall establish a system for public disclosure by members of MACPAC of finan- cial and other potential conflicts of interest relating to such members. Members of MACPAC shall be treated as employees of Congress for purposes of applying subchapter I of chapter 131 of title 5. (3) Terms (A) In general The terms of members of MACPAC shall be for 3 years except that the Comptroller Gen- eral of the United States shall designate staggered terms for the members first ap- pointed. (B) Vacancies Any member appointed to fill a vacancy occurring before the expiration of the term for which the member’s predecessor was ap- pointed shall be appointed only for the re- mainder of that term. A member may serve after the expiration of that member’s term until a successor has taken office. A vacancy in MACPAC shall be filled in the manner in which the original appointment was made. (4) Compensation While serving on the business of MACPAC (including travel time), a member of MACPAC shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5; and while so serving away from home and the member’s regular place of busi- ness, a member may be allowed travel ex- Page 4012 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396 2 So in original. Probably should be followed by a comma. penses, as authorized by the Chairman of MACPAC. Physicians serving as personnel of MACPAC may be provided a physician com- parability allowance by MACPAC in the same manner as Government physicians may be pro- vided such an allowance by an agency under section 5948 of title 5, and for such purpose subsection (i) of such section shall apply to MACPAC in the same manner as it applies to the Tennessee Valley Authority. For purposes of pay (other than pay of members of MACPAC) and employment benefits, rights, and privileges, all personnel of MACPAC shall be treated as if they were employees of the United States Senate. (5) Chairman; Vice Chairman The Comptroller General of the United States shall designate a member of MACPAC, at the time of appointment of the member 2 as Chairman and a member as Vice Chairman for that term of appointment, except that in the case of vacancy of the Chairmanship or Vice Chairmanship, the Comptroller General of the United States may designate another member for the remainder of that member’s term. (6) Meetings MACPAC shall meet at the call of the Chair- man. (d) Director and staff; experts and consultants Subject to such review as the Comptroller General of the United States deems necessary to assure the efficient administration of MACPAC, MACPAC may— (1) employ and fix the compensation of an Executive Director (subject to the approval of the Comptroller General of the United States) and such other personnel as may be necessary to carry out its duties (without regard to the provisions of title 5 governing appointments in the competitive service); (2) seek such assistance and support as may be required in the performance of its duties from appropriate Federal and State depart- ments and agencies; (3) enter into contracts or make other ar- rangements, as may be necessary for the con- duct of the work of MACPAC (without regard to section 6101 of title 41); (4) make advance, progress, and other pay- ments which relate to the work of MACPAC; (5) provide transportation and subsistence for persons serving without compensation; and (6) prescribe such rules and regulations as it deems necessary with respect to the internal organization and operation of MACPAC. (e) Powers (1) Obtaining official data MACPAC may secure directly from any de- partment or agency of the United States and, as a condition for receiving payments under sections 1396b(a) and 1397ee(a) of this title, from any State agency responsible for admin- istering Medicaid or CHIP, information nec- essary to enable it to carry out this section. Upon request of the Chairman, the head of that department or agency shall furnish that information to MACPAC on an agreed upon schedule. (2) Data collection In order to carry out its functions, MACPAC shall— (A) utilize existing information, both pub- lished and unpublished, where possible, col- lected and assessed either by its own staff or under other arrangements made in accord- ance with this section; (B) carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate; and (C) adopt procedures allowing any inter- ested party to submit information for MACPAC’s use in making reports and rec- ommendations. (3) Access of GAO to information The Comptroller General of the United States shall have unrestricted access to all de- liberations, records, and nonproprietary data of MACPAC, immediately upon request. (4) Periodic audit MACPAC shall be subject to periodic audit by the Comptroller General of the United States. (f) Funding (1) Request for appropriations MACPAC shall submit requests for appro- priations (other than for fiscal year 2010) in the same manner as the Comptroller General of the United States submits requests for ap- propriations, but amounts appropriated for MACPAC shall be separate from amounts ap- propriated for the Comptroller General of the United States. (2) Authorization There are authorized to be appropriated such sums as may be necessary to carry out the provisions of this section. (3) Funding for fiscal year 2010 (A) In general Out of any funds in the Treasury not oth- erwise appropriated, there is appropriated to MACPAC to carry out the provisions of this section for fiscal year 2010, $9,000,000. (B) Transfer of funds Notwithstanding section 1397dd(a)(13) of this title, from the amounts appropriated in such section for fiscal year 2010, $2,000,000 is hereby transferred and made available in such fiscal year to MACPAC to carry out the provisions of this section. (4) Availability Amounts made available under paragraphs (2) and (3) to MACPAC to carry out the provi- sions of this section shall remain available until expended. (Aug. 14, 1935, ch. 531, title XIX, § 1900, as added Pub. L. 111–3, title V, § 506(a), Feb. 4, 2009, 123 Stat. 91; amended Pub. L. 111–148, title II, § 2801(a), Mar. 23, 2010, 124 Stat. 328; Pub. L. 113–93, title II, § 221(b), Apr. 1, 2014, 128 Stat. 1076; Pub. L. 117–286, § 4(c)(43), Dec. 27, 2022, 136 Stat. 4359.) Page 4013 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396 Editorial Notes REFERENCES IN TEXT Section 2081 of the Patient Protection and Affordable Care Act, referred to in subsec. (b)(13), probably means section 2602 of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 315, which is classified to section 1315b of this title. Section 2602 of Pub. L. 111–148 established the Federal Coordinated Health Care Office, and Pub. L. 111–148 does not contain a section 2081. CODIFICATION In subsec. (d)(3), ‘‘section 6101 of title 41’’ substituted for ‘‘section 3709 of the Revised Statutes (41 U.S.C. 5)’’ on authority of Pub. L. 111–350, § 6(c), Jan. 4, 2011, 124 Stat. 3854, which Act enacted Title 41, Public Con- tracts. PRIOR PROVISIONS A prior section 1396, act Aug. 14, 1935, ch. 531, title XIX, § 1901, as added Pub. L. 89–97, title I, § 121(a), July 30, 1965, 79 Stat. 343; amended Pub. L. 93–233, § 13(a)(1), Dec. 31, 1973, 87 Stat. 960; Pub. L. 98–369, div. B, title VI, § 2663(j)(3)(C), July 18, 1984, 98 Stat. 1171, which related to appropriations, was transferred to section 1396–1 of this title. AMENDMENTS 2022—Subsec. (c)(2)(D). Pub. L. 117–286 substituted ‘‘subchapter I of chapter 131 of title 5.’’ for ‘‘title I of the Ethics in Government Act of 1978 (Public Law 95–521).’’ 2014—Subsec. (b)(6). Pub. L. 113–93 designated existing provisions as subpar. (A), inserted heading, and added subpar. (B). 2010—Subsec. (b)(1). Pub. L. 111–148, § 2801(a)(1)(A)(i), inserted ‘‘for all States’’ before ‘‘and annual’’ in head- ing. Subsec. (b)(1)(A). Pub. L. 111–148, § 2801(a)(1)(A)(ii), struck out ‘‘children’s’’ before ‘‘access’’. Subsec. (b)(1)(B). Pub. L. 111–148, § 2801(a)(1)(A)(iii), inserted ‘‘, the Secretary, and States’’ after ‘‘Con- gress’’. Subsec. (b)(1)(C). Pub. L. 111–148, § 2801(a)(1)(A)(iv), substituted ‘‘March 15’’ for ‘‘March 1’’. Subsec. (b)(1)(D). Pub. L. 111–148, § 2801(a)(1)(A)(v), substituted ‘‘June 15’’ for ‘‘June 1’’. Subsec. (b)(2)(A)(i). Pub. L. 111–148, § 2801(a)(1)(B)(i)(I), inserted ‘‘the efficient provision of’’ after ‘‘expendi- tures for’’ and substituted ‘‘payments to medical, den- tal, and health professionals, hospitals, residential and long-term care providers, providers of home and com- munity based services, Federally-qualified health cen- ters and rural health clinics, managed care entities, and providers of other covered items and services’’ for ‘‘hospital, skilled nursing facility, physician, Feder- ally-qualified health center, rural health center, and other fees’’. Subsec. (b)(2)(A)(iii). Pub. L. 111–148, § 2801(a)(1)(B)(i)(II), inserted ‘‘(including how such fac- tors and methodologies enable such beneficiaries to ob- tain the services for which they are eligible, affect pro- vider supply, and affect providers that serve a dis- proportionate share of low-income and other vulnerable populations)’’ after ‘‘CHIP beneficiaries’’. Subsec. (b)(2)(B) to (H). Pub. L. 111–148, § 2801(a)(1)(B)(ii)–(v), added subpars. (B) to (E) and (G), redesignated former subpars. (B) and (C) as (F) and (H), respectively, and, in subpar. (H), inserted ‘‘and preven- tive, acute, and long-term services and supports’’ after ‘‘barriers’’. Subsec. (b)(3). Pub. L. 111–148, § 2801(a)(1)(D), added par. (3). Former par. (3) redesignated (4). Subsec. (b)(4). Pub. L. 111–148, § 2801(a)(1)(C), (E), re- designated par. (3) as (4) and substituted ‘‘, as well as other factors that adversely affect, or have the poten- tial to adversely affect, access to care by, or the health care status of, Medicaid and CHIP beneficiaries. MACPAC shall include in the annual report required under paragraph (1)(D) a description of all such areas or problems identified with respect to the period ad- dressed in the report.’’ for ‘‘or any other problems that threaten access to care or the health care status of Medicaid and CHIP beneficiaries.’’ Former par. (4) re- designated (5). Subsec. (b)(5). Pub. L. 111–148, § 2801(a)(1)(C), (F), re- designated par. (4) as (5), inserted ‘‘and regulations’’ after ‘‘reports’’ in heading, designated existing provi- sions as subpar. (A) and inserted heading, inserted ‘‘and the Secretary’’ after ‘‘appropriate committees of Con- gress’’ in subpar. (A), and added subpar. (B). Former par. (5) redesignated (6). Subsec. (b)(6) to (10). Pub. L. 111–148, § 2801(a)(1)(C), (G), redesignated pars. (5) to (9) as (6) to (10), respec- tively, and inserted ‘‘, and shall submit with any rec- ommendations, a report on the Federal and State-spe- cific budget consequences of the recommendations’’ in par. (10) before period at end. Subsec. (b)(11) to (14). Pub. L. 111–148, § 2801(a)(1)(H), added pars. (11) to (14). Subsec. (c)(2)(A), (B). Pub. L. 111–148, § 2801(a)(2)(A), added subpars. (A) and (B) and struck out former sub- pars. (A) and (B) which related to MACPAC member- ship qualifications. Subsec. (d)(2). Pub. L. 111–148, § 2801(a)(3), inserted ‘‘and State’’ after ‘‘Federal’’. Subsec. (e)(1). Pub. L. 111–148, § 2801(a)(4), inserted ‘‘and, as a condition for receiving payments under sec- tions 1396b(a) and 1397ee(a) of this title, from any State agency responsible for administering Medicaid or CHIP,’’ after ‘‘United States’’. Subsec. (f). Pub. L. 111–148, § 2801(a)(5), substituted ‘‘Funding’’ for ‘‘Authorization of appropriations’’ in heading, inserted ‘‘(other than for fiscal year 2010)’’ be- fore ‘‘in the same manner’’ in par. (1), and added pars. (3) and (4). Statutory Notes and Related Subsidiaries EFFECTIVE DATE Pub. L. 111–3, § 3, Feb. 4, 2009, 123 Stat. 10, provided that: ‘‘(a) GENERAL EFFECTIVE DATE.—Unless otherwise provided in this Act [enacting this section and sections 247d–9, 1320b–9a, 1396e–1, 1396w–2, and 1397kk to 1397mm of this title and section 657p of Title 15, Commerce and Trade, transferring former section 1396 of this title to section 1396–1 of this title, amending sections 300gg, 1308, 1320b–9, 1320b–9a, 1396a, 1396b, 1396r–1, 1396r–4, 1396u–7, 1397bb to 1397ee, and 1397gg to 1397jj of this title, section 1514 of Title 19, Customs Duties, sections 5701 to 5703, 5712, 5713, 5721 to 5723, 5741, 6103, and 9801 of Title 26, Internal Revenue Code, and sections 1022, 1132, and 1181 of Title 29, Labor, enacting provisions set out as notes under this section and sections 1305, 1396a, 1396b, 1396d, 1396u–7, 1396u–8, 1396w–2, 1397bb to 1397ee, 1397gg, and 1397hh of this title, section 1514 of Title 19, sections 5701 to 5703, 5711, 5712, 6103, and 6655 of Title 26, and section 1181 of Title 29, amending provisions set out as a note under section 1397gg of this title, and repeal- ing provisions set out as notes under sections 1397aa and 1397ee of this title], subject to subsections (b) through (d), this Act (and the amendments made by this Act) shall take effect on April 1, 2009, and shall apply to child health assistance and medical assistance provided on or after that date. ‘‘(b) EXCEPTION FOR STATE LEGISLATION.—In the case of a State plan under title XIX [42 U.S.C. 1396 et seq.] or State child health plan under [title] XXI [42 U.S.C. 1397aa et seq.] of the Social Security Act, which the Secretary of Health and Human Services determines re- quires State legislation in order for the respective plan to meet one or more additional requirements imposed by amendments made by this Act, the respective plan shall not be regarded as failing to comply with the re- quirements of such title solely on the basis of its fail- ure to meet such an additional requirement before the first day of the first calendar quarter beginning after Page 4014 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396 the close of the first regular session of the State legis- lature that begins after the date of enactment of this Act [Feb. 4, 2009]. For purposes of the previous sen- tence, in the case of a State that has a 2-year legisla- tive session, each year of the session shall be consid- ered to be a separate regular session of the State legis- lature. ‘‘(c) COORDINATION OF CHIP FUNDING FOR FISCAL YEAR 2009.—Notwithstanding any other provision of law, in- sofar as funds have been appropriated under section 2104(a)(11), 2104(k), or 2104(l) of the Social Security Act [42 U.S.C. 1397dd(a)(11), (k), (l)], as amended by section 201 of Public Law 110–173, to provide allotments to States under CHIP for fiscal year 2009— ‘‘(1) any amounts that are so appropriated that are not so allotted and obligated before April 1, 2009 are rescinded; and ‘‘(2) any amount provided for CHIP allotments to a State under this Act (and the amendments made by this Act) for such fiscal year shall be reduced by the amount of such appropriations so allotted and obli- gated before such date. ‘‘(d) RELIANCE ON LAW.—With respect to amendments made by this Act (other than title VII) [enacting this section and sections 1320b–9a, 1396e–1, 1396w–2, and 1397kk to 1397mm of this title, amending sections 300gg, 1308, 1320b–9, 1320b–9a, 1396a, 1396b, 1396r–1, 1396r–4, 1396u–7, 1397bb to 1397ee, and 1397gg to 1397jj of this title, section 9801 of Title 26, Internal Revenue Code, and sections 1022, 1132, and 1181 of Title 29, Labor, amending provisions set out as a note under section 1397gg of this title, and repealing provisions set out as notes under sections 1397aa and 1397ee of this title] that become effective as of a date— ‘‘(1) such amendments are effective as of such date whether or not regulations implementing such amendments have been issued; and ‘‘(2) Federal financial participation for medical as- sistance or child health assistance furnished under title XIX or XXI, respectively, of the Social Security Act [42 U.S.C. 1396 et seq., 1397aa et seq.] on or after such date by a State in good faith reliance on such amendments before the date of promulgation of final regulations, if any, to carry out such amendments (or before the date of guidance, if any, regarding the im- plementation of such amendments) shall not be de- nied on the basis of the State’s failure to comply with such regulations or guidance.’’ THINK DIFFERENTLY DATABASE Pub. L. 118–225, Jan. 4, 2025, 138 Stat. 2817, provided that: ‘‘SECTION 1. SHORT TITLE. ‘‘This Act may be cited as the ‘Think Differently Database Act’. ‘‘SEC. 2. PROMOTING AWARENESS OF AVAILABLE RESOURCES FOR INDIVIDUALS WITH DISABIL- ITIES. ‘‘(a) IN GENERAL.—Not later than 3 years after the date of the enactment of this Act [Jan. 4, 2025], the Sec- retary of Health and Human Services (in this section referred to as the ‘Secretary’) shall establish and up- date periodically a publicly available website to pro- vide information with respect to resources and infor- mation for people with a disability and the caregivers and families of such people. Such website shall in- clude— ‘‘(1) information on eligibility to receive medical assistance under a State plan under the Medicaid pro- gram under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan) based on a disability, including general information about eli- gibility under subclauses (XIII), (XV), (XVI), and (XIX) of section 1902(a)(10)(A)(ii) of the Social Secu- rity Act (42 U.S.C. 1396a(a)(10)(A)(ii)); ‘‘(2) which States offer eligibility under subclauses (XIII), (XV), (XVI), and (XIX) of section 1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)); ‘‘(3) each State’s specific eligibility requirements, if applicable, under subclauses (XIII), (XV), (XVI), and (XIX) of section 1902(a)(10)(A)(ii) of the Social Secu- rity Act (42 U.S.C. 1396a(a)(10)(A)(ii)); ‘‘(4) information about how to contact each State’s Medicaid office for information about Medicaid, in- cluding links and phone numbers for State contacts; ‘‘(5) general information on Medicaid-covered long- term services and supports that may be available to individuals eligible for medical assistance under a State plan under the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan); and ‘‘(6) where applicable, the average amount of time that individuals newly enrolled in a State’s waiver program for home and community-based services in the past 12 months were on the list of individuals waiting to enroll in such waiver program, in such a manner and process as described in section 441.311(d)(1)(iii) of title 42, Code of Federal Regula- tions. ‘‘(b) PROMOTION.—The Secretary shall, as applicable and appropriate, identify and disseminate promotional activities to improve, among people with a disability and the caretakers and families of such people, the awareness of the resources included in the website es- tablished under subsection (a), such as through collabo- ration with the Social Security Administration during its annual updates to the Red Book. ‘‘(c) MODEL.—In establishing the website under this section, the Secretary may use the website thinkdifferently.net as a model. ‘‘(d) NONAPPLICATION OF PAPERWORK REDUCTION ACT.—Chapter 35 of title 44, United States Code (com- monly referred to as the ‘Paperwork Reduction Act of 1995’), shall not apply to the implementation of this section.’’ PURPOSE Pub. L. 111–3, § 2, Feb. 4, 2009, 123 Stat. 10, provided that: ‘‘It is the purpose of this Act [see Effective Date note above] to provide dependable and stable funding for children’s health insurance under titles XXI and XIX of the Social Security Act [42 U.S.C. 1397aa et seq., 1396 et seq.] in order to enroll all six million uninsured children who are eligible, but not enrolled, for coverage today through such titles.’’ MODEL OF INTERSTATE COORDINATED ENROLLMENT AND COVERAGE PROCESS Pub. L. 111–3, title II, § 213, Feb. 4, 2009, 123 Stat. 56, provided that: ‘‘(a) IN GENERAL.—In order to assure continuity of coverage of low-income children under the Medicaid program and the State Children’s Health Insurance Program (CHIP), not later than 18 months after the date of the enactment of this Act [Feb. 4, 2009], the Sec- retary of Health and Human Services, in consultation with State Medicaid and CHIP directors and organiza- tions representing program beneficiaries, shall develop a model process for the coordination of the enrollment, retention, and coverage under such programs of chil- dren who, because of migration of families, emergency evacuations, natural or other disasters, public health emergencies, educational needs, or otherwise, fre- quently change their State of residency or otherwise are temporarily located outside of the State of their residency. ‘‘(b) REPORT TO CONGRESS.—After development of such model process, the Secretary of Health and Human Services shall submit to Congress a report de- scribing additional steps or authority needed to make further improvements to coordinate the enrollment, re- tention, and coverage under CHIP and Medicaid of chil- dren described in subsection (a).’’ IMPROVED ACCESSIBILITY OF DENTAL PROVIDER INFOR- MATION TO ENROLLEES UNDER MEDICAID AND CHIP Pub. L. 111–3, title V, § 501(f), Feb. 4, 2009, 123 Stat. 88, provided that: ‘‘The Secretary [of Health and Human Services] shall— Page 4015 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396a ‘‘(1) work with States, pediatric dentists, and other dental providers (including providers that are, or are affiliated with, a school of dentistry) to include, not later than 6 months after the date of the enactment of this Act [Feb. 4, 2009], on the Insure Kids Now website (http://www.insurekidsnow.gov/) and hotline (1–877–KIDS–NOW) (or on any successor websites or hotlines) a current and accurate list of all such den- tists and providers within each State that provide dental services to children enrolled in the State plan (or waiver) under Medicaid or the State child health plan (or waiver) under CHIP, and shall ensure that such list is updated at least quarterly; and ‘‘(2) work with States to include, not later than 6 months after the date of the enactment of this Act, a description of the dental services provided under each State plan (or waiver) under Medicaid and each State child health plan (or waiver) under CHIP on such Insure Kids Now website, and shall ensure that such list is updated at least annually.’’ DEADLINE FOR INITIAL APPOINTMENTS Pub. L. 111–3, title V, § 506(b), Feb. 4, 2009, 123 Stat. 95, provided that: ‘‘Not later than January 1, 2010, the Comptroller General of the United States shall appoint the initial members of the Medicaid and CHIP Payment and Access Commission established under section 1900 of the Social Security Act [42 U.S.C. 1396] (as added by subsection (a)).’’ ANNUAL REPORT Pub. L. 111–3, title V, § 506(c), Feb. 4, 2009, 123 Stat. 95, provided that: ‘‘Not later than January 1, 2010, and an- nually thereafter, the Secretary [of Health and Human Services], in consultation with the Secretary of the Treasury, the Secretary of Labor, and the States (as defined for purposes of Medicaid), shall submit an an- nual report to Congress on the financial status of, en- rollment in, and spending trends for, Medicaid for the fiscal year ending on September 30 of the preceding year.’’ NO FEDERAL FUNDING FOR ILLEGAL ALIENS; DISALLOWANCE FOR UNAUTHORIZED EXPENDITURES Pub. L. 111–3, title VI, § 605, Feb. 4, 2009, 123 Stat. 100, as amended by Pub. L. 111–148, title II, § 2102(a)(2), Mar. 23, 2010, 124 Stat. 288, provided that: ‘‘Nothing in this Act [see Effective Date note above] allows Federal pay- ment for individuals who are not lawfully residing in the United States. Titles XI, XIX, and XXI of the Social Security Act [42 U.S.C. 1301 et seq., 1396 et seq., 1397aa et seq.] provide for the disallowance of Federal finan- cial participation for erroneous expenditures under Medicaid and under CHIP, respectively.’’ DEFINITIONS Pub. L. 111–3, § 1(c), Feb. 4, 2009, 123 Stat. 8, provided that: ‘‘In this Act [see Effective Date note above]: ‘‘(1) CHIP.—The term ‘CHIP’ means the State Chil- dren’s Health Insurance Program established under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.). ‘‘(2) MEDICAID.—The term ‘Medicaid’ means the pro- gram for medical assistance established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.). ‘‘(3) SECRETARY.—The term ‘Secretary’ means the Secretary of Health and Human Services.’’ § 1396–1. Appropriations 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 medical services, and (2) rehabilita- tion and other services to help such families and individuals attain or retain capability for inde- pendence or self-care, there is hereby authorized to be appropriated for each fiscal year a sum sufficient to carry out the purposes of this sub- chapter. 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 assist- ance. (Aug. 14, 1935, ch. 531, title XIX, § 1901, as added Pub. L. 89–97, title I, § 121(a), July 30, 1965, 79 Stat. 343; amended Pub. L. 93–233, § 13(a)(1), Dec. 31, 1973, 87 Stat. 960; Pub. L. 98–369, div. B, title VI, § 2663(j)(3)(C), July 18, 1984, 98 Stat. 1171.) Editorial Notes CODIFICATION Section was formerly classified to section 1396 of this title. AMENDMENTS 1984—Pub. L. 98–369 struck out ‘‘of Health, Education, and Welfare’’ after ‘‘Secretary’’. 1973—Pub. L. 93–233 substituted ‘‘disabled individ- uals’’ for ‘‘permanently and totally disabled individ- uals’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1984 AMENDMENT Amendment by Pub. L. 98–369 effective July 18, 1984, but not to be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date, see section 2664(b) of Pub. L. 98–369, set out as a note under section 401 of this title. EFFECTIVE DATE OF 1973 AMENDMENT Amendment by Pub. L. 93–233 effective with respect to payments under section 1396b of this title for cal- endar quarters commencing after Dec. 31, 1973, see sec- tion 13(d) of Pub. L. 93–233, set out as a note under sec- tion 1396a of this title. § 1396a. State plans for medical assistance (a) Contents A State plan for medical assistance must— (1) provide that it shall be in effect in all po- litical subdivisions of the State, and, if admin- istered 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 pay- ments under section 1396b of this title are au- thorized by this subchapter; 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 low- ering 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 in- dividual whose claim for medical assistance under the plan is denied or is not acted upon with reasonable promptness; (4) provide (A) such methods of administra- tion (including methods relating to the estab-