42 U.S.C. § 1396g — State programs for licensing of adminis-

Page 4214 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396f because of Pub. L. 111–148, § 10203(b)(2)(B), set out as a note under this section. Subsec. (c). Pub. L. 111–148, § 2003(a)(2), struck out ‘‘under age 19’’ after ‘‘by the individual’’. Subsec. (d)(2). Pub. L. 111–148, § 2003(a)(3)(A), struck out ‘‘under age 19’’ after ‘‘to an individual’’ and sub- stituted ‘‘A State may not require, as a condition of an individual (or the individual’s parent) being or remain- ing eligible for medical assistance under this sub- chapter, that the individual (or the individual’s parent) apply for enrollment in qualified employer-sponsored coverage under this section.’’ for ‘‘State may not re- quire, as a condition of an individual under age 19 (or the individual’s parent) being or remaining eligible for medical assistance under this subchapter, apply for en- rollment in qualified employer-sponsored coverage under this section.’’ Subsec. (d)(3). Pub. L. 111–148, § 2003(a)(3)(B), sub- stituted ‘‘an individual (or the parent of an indi- vidual)’’ for ‘‘the parent of an individual under age 19’’. Subsec. (e). Pub. L. 111–148, § 2003(a)(4), struck out ‘‘under age 19’’ after ‘‘an individual’’ in two places. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2010 AMENDMENT Pub. L. 111–148, title II, § 2003(c), Mar. 23, 2010, 124 Stat. 283, provided that: ‘‘The amendments made by this section [amending this section] take effect on Jan- uary 1, 2014.’’ Pub. L. 111–148, title X, § 10203(b), Mar. 23, 2010, 124 Stat. 927, provided that the amendment made by sec- tion 10203(b)(2)(A) of Pub. L. 111–148 is effective as if in- cluded in the enactment of the Children’s Health Insur- ance Program Reauthorization Act of 2009 (Pub. L. 111–3). EFFECTIVE DATE Section effective Apr. 1, 2009, and applicable to child health assistance and medical assistance provided on or after that date, with certain exceptions, see section 3 of Pub. L. 111–3, set out as a note under section 1396 of this title. EFFECT OF CERTAIN AMENDMENT BY PUB. L. 111–148 Pub. L. 111–148, title X, § 10203(b)(2)(B), Mar. 23, 2010, 124 Stat. 927, provided that: ‘‘This Act shall be applied without regard to subparagraph (A) of section 2003(a)(1) of this Act [amending this section] and that subpara- graph and the amendment made by that subparagraph are hereby deemed null, void, and of no effect.’’ § 1396f. Observance of religious beliefs Nothing in this subchapter shall be construed to require any State which has a plan approved under this subchapter to compel any person to undergo any medical screening, examination, di- agnosis, or treatment or to accept any other health care or services provided under such plan for any purpose (other than for the purpose of discovering and preventing the spread of infec- tion or contagious disease or for the purpose of protecting environmental health), if such person objects (or, in case such person is a child, his parent or guardian objects) thereto on religious grounds. (Aug. 14, 1935, ch. 531, title XIX, § 1907, as added Pub. L. 90–248, title II, § 232, Jan. 2, 1968, 81 Stat. 905.) § 1396g. State programs for licensing of adminis- trators of nursing homes (a) Nature of State program For purposes of section 1396a(a)(29) of this title, a ‘‘State program for the licensing of ad- ministrators of nursing homes’’ is a program which provides that no nursing home within the State may operate except under the supervision of an administrator licensed in the manner pro- vided in this section. (b) Licensing by State agency or board rep- resentative of concerned professions and in- stitutions Licensing of nursing home administrators shall be carried out by the agency of the State responsible for licensing under the healing arts licensing act of the State, or, in the absence of such act or such an agency, a board representa- tive of the professions and institutions con- cerned with care of chronically ill and infirm aged patients and established to carry out the purposes of this section. (c) Functions and duties of State agency or board It shall be the function and duty of such agen- cy or board to— (1) develop, impose, and enforce standards which must be met by individuals in order to receive a license as a nursing home adminis- trator, which standards shall be designed to insure that nursing home administrators will be individuals who are of good character and are otherwise suitable, and who, by training or experience in the field of institutional admin- istration, are qualified to serve as nursing home administrators; (2) develop and apply appropriate tech- niques, including examinations and investiga- tions, for determining whether an individual meets such standards; (3) issue licenses to individuals determined, after the application of such techniques, to meet such standards, and revoke or suspend li- censes previously issued by the board in any case where the individual holding any such li- cense is determined substantially to have failed to conform to the requirements of such standards; (4) establish and carry out procedures de- signed to insure that individuals licensed as nursing home administrators will, during any period that they serve as such, comply with the requirements of such standards; (5) receive, investigate, and take appropriate action with respect to, any charge or com- plaint filed with the board to the effect that any individual licensed as a nursing home ad- ministrator has failed to comply with the re- quirements of such standards; and (6) conduct a continuing study and inves- tigation of nursing homes and administrators of nursing homes within the State with a view to the improvement of the standards imposed for the licensing of such administrators and of procedures and methods for the enforcement of such standards with respect to administra- tors of nursing homes who have been licensed as such. (d) Waiver of standards other than good char- acter or suitability standards No State shall be considered to have failed to comply with the provisions of section 1396a(a)(29) of this title because the agency or board of such State (established pursuant to Page 4215 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396g 1 So in original. The period probably should be ‘‘; and’’. subsection (b)) shall have granted any waiver, with respect to any individual who, during all of the three calendar years immediately preceding the calendar year in which the requirements prescribed in section 1396a(a)(29) of this title are first met by the State, has served as a nursing home administrator, of any of the standards de- veloped, imposed, and enforced by such agency or board pursuant to subsection (c). (e) ‘‘Nursing home’’ and ‘‘nursing home adminis- trator’’ defined As used in this section, the term— (1) ‘‘nursing home’’ means any institution or facility defined as such for licensing purposes under State law, or, if State law does not em- ploy the term nursing home, the equivalent term or terms as determined by the Secretary, but does not include a religious nonmedical health care institution (as defined in section 1395x(ss)(1) of this title).1 (2) ‘‘nursing home administrator’’ means any individual who is charged with the general ad- ministration of a nursing home whether or not such individual has an ownership interest in such home and whether or not his functions and duties are shared with one or more other individuals. (Aug. 14, 1935, ch. 531, title XIX, § 1908, as added Pub. L. 90–248, title II, § 236(b), Jan. 2, 1968, 81 Stat. 908; amended Pub. L. 92–603, title II, §§ 268(b), 269, 274(b), Oct. 30, 1972, 86 Stat. 1451, 1452; Pub. L. 93–233, § 18(y)(3), Dec. 31, 1973, 87 Stat. 973; Pub. L. 104–193, title IX, § 913, Aug. 22, 1996, 110 Stat. 2354; Pub. L. 105–33, title IV, § 4454(b)(2), Aug. 5, 1997, 111 Stat. 431.) REPEAL OF SECTION Pub. L. 101–508, title IV, § 4801(e)(11), Nov. 5, 1990, 104 Stat. 1388–217, provided that, effective on the date on which the Secretary promulgates standards regarding the qualifications of nurs- ing facility administrators under section 1396r(f)(4) of this title, this section is repealed. Editorial Notes CODIFICATION Another section 1908 of act Aug. 14, 1935, was renum- bered section 1908A and is classified to section 1396g–1 of this title. AMENDMENTS 1997—Subsec. (e)(1). Pub. L. 105–33 which directed sub- stitution of ‘‘a religious nonmedical health care insti- tution (as defined in section 1395x(ss)(1) of this title).’’ for ‘‘a Christian Science sanatorium operated, or listed and certified, by the First Church of Christ, Scientist, Boston, Massachusetts; and’’ in ‘‘Section 1908(e)(1) (42 U.S.C. 1396g–1(e)(1))’’ of the Social Security Act, was executed by making the substitution in subsec. (e)(1) of this section to reflect the probable intent of Congress, because section 1396g–1 of this title, which is also sec- tion 1908 of the Social Security Act, does not have a subsec. (e). 1996—Subsec. (e)(1). Pub. L. 104–193, which directed substitution of ‘‘The Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc.’’ for ‘‘The First Church of Christ, Scientist, Bos- ton, Massachusetts’’ in section 1908(e)(1) of the Social Security Act (42 U.S.C. 1396g–1(e)(1)) could not be exe- cuted to this section or section 1396g–1 of this title, both of which are section 1908. Section 1396g–1 does not have a subsec. (e) and subsec. (e)(1) of this section does not contain the quoted language with the word ‘‘the’’ capitalized. 1973—Subsec. (d). Pub. L. 93–233 struck out second sentence reading substantially the same as the first sentence but containing the following additional text reading ‘‘other than such standards as relate to good character or suitability if— ‘‘(1) such waiver is for a period which ends after being in effect for two years or on June 30, 1972, whichever is earlier, and ‘‘(2) there is provided in the State (during all of the period for which waiver is in effect), a program of training and instruction designed to enable all indi- viduals with respect to whom any such waiver is granted, to attain the qualifications necessary in order to meet such standards’’ and also ‘‘calendar year’’ instead of ‘‘three calendar years’’ and reference to ‘‘subsection (c)(1) of this section’’ instead of ‘‘sub- section (c) of this section’’. Subsec. (e). Pub. L. 93–233 redesignated subsec. (g) as (e), and repealed prior subsec. (e) relating to authoriza- tion of appropriations for fiscal years 1968 through 1972 and to limitation of grants. Subsec. (f). Pub. L. 93–233 repealed subsec. (f) pro- viding for creation of National Advisory Council on Nursing Home Administration and for its composition, appointment of members, the Chairman, representation of interests, functions and duties, compensation and travel expenses, technical assistance, availability of as- sistance and data, and termination date of Dec. 31, 1971. Subsec. (g). Pub. L. 93–233, redesignated subsec. (g) as (e). 1972—Subsec. (d). Pub. L. 92–603, §§ 269, 274(b), inserted references to the grant of waivers to individuals who, during all of the three calendar years immediately pre- ceding the calendar year in which the requirements prescribed in section 1396a(a)(29) of this title are first met by the State, have served as nursing home admin- istrators and substituted ‘‘subsection (c)(1)’’ for ‘‘sub- section (b)(1)’’. Subsec. (g)(1). Pub. L. 92–603, § 268(b), inserted ‘‘, but does not include a Christian Science sanatorium oper- ated, or listed and certified, by the First Church of Christ, Scientist, Boston, Massachusetts’’ after ‘‘Sec- retary’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1997 AMENDMENT Amendment by Pub. L. 105–33 effective Aug. 5, 1997, and applicable to items and services furnished on or after such date, with provision that Secretary of Health and Human Services issue regulations to carry out such amendment by not later than July 1, 1998, see section 4454(d) of Pub. L. 105–33, set out as an Effective Date note under section 1395i–5 of this title. EFFECTIVE DATE OF 1996 AMENDMENT Pub. L. 104–193, title IX, § 913, Aug. 22, 1996, 110 Stat. 2354, provided that the amendment made by that sec- tion is effective Jan. 1, 1997. EFFECTIVE DATE OF 1972 AMENDMENT Amendment by section 268(b) of Pub. L. 92–603 effec- tive Oct. 30, 1972, see section 268(c) of Pub. L. 92–603, set out as a note under section 1396a of this title. EFFECTIVE DATE Pub. L. 90–248, title II, § 236(c), Jan. 2, 1968, 81 Stat. 910, provided that: ‘‘Except as otherwise specified in the text thereof, the amendments made by this section [en- acting this section and amending section 1396a of this title] shall take effect on July 1, 1970.’’ Page 4216 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396g–1 § 1396g–1. Required laws relating to medical child support (a) In general The laws relating to medical child support, which a State is required to have in effect under section 1396a(a)(60) of this title, are as follows: (1) A law that prohibits an insurer from de- nying enrollment of a child under the health coverage of the child’s parent on the ground that— (A) the child was born out of wedlock, (B) the child is not claimed as a dependent on the parent’s Federal income tax return, or (C) the child does not reside with the par- ent or in the insurer’s service area. (2) In any case in which a parent is required by a court or administrative order to provide health coverage for a child and the parent is eligible for family health coverage through an insurer, a law that requires such insurer— (A) to permit such parent to enroll under such family coverage any such child who is otherwise eligible for such coverage (without regard to any enrollment season restric- tions); (B) if such a parent is enrolled but fails to make application to obtain coverage of such child, to enroll such child under such family coverage upon application by the child’s other parent or by the State agency admin- istering the program under this subchapter or part D of subchapter IV; and (C) not to disenroll (or eliminate coverage of) such a child unless the insurer is pro- vided satisfactory written evidence that— (i) such court or administrative order is no longer in effect, or (ii) the child is or will be enrolled in comparable health coverage through an- other insurer which will take effect not later than the effective date of such disenrollment. (3) In any case in which a parent is required by a court or administrative order to provide health coverage for a child and the parent is eligible for family health coverage through an employer doing business in the State, a law that requires such employer— (A) to permit such parent to enroll under such family coverage any such child who is otherwise eligible for such coverage (without regard to any enrollment season restric- tions); (B) if such a parent is enrolled but fails to make application to obtain coverage of such child, to enroll such child under such family coverage upon application by the child’s other parent or by the State agency admin- istering the program under this subchapter or part D of subchapter IV; and (C) not to disenroll (or eliminate coverage of) any such child unless— (i) the employer is provided satisfactory written evidence that— (I) such court or administrative order is no longer in effect, or (II) the child is or will be enrolled in comparable health coverage which will take effect not later than the effective date of such disenrollment, or (ii) the employer has eliminated family health coverage for all of its employees; and (D) to withhold from such employee’s com- pensation the employee’s share (if any) of premiums for health coverage (except that the amount so withheld may not exceed the maximum amount permitted to be withheld under section 1673(b) of title 15), and to pay such share of premiums to the insurer, ex- cept that the Secretary may provide by reg- ulation for appropriate circumstances under which an employer may withhold less than such employee’s share of such premiums. (4) A law that prohibits an insurer from im- posing requirements on a State agency, which has been assigned the rights of an individual eligible for medical assistance under this sub- chapter and covered for health benefits from the insurer, that are different from require- ments applicable to an agent or assignee of any other individual so covered. (5) A law that requires an insurer, in any case in which a child has health coverage through the insurer of a noncustodial parent— (A) to provide such information to the cus- todial parent as may be necessary for the child to obtain benefits through such cov- erage; (B) to permit the custodial parent (or pro- vider, with the custodial parent’s approval) to submit claims for covered services with- out the approval of the noncustodial parent; and (C) to make payment on claims submitted in accordance with subparagraph (B) di- rectly to such custodial parent, the provider, or the State agency. (6) A law that permits the State agency under this subchapter to garnish the wages, salary, or other employment income of, and requires withholding amounts from State tax refunds to, any person who— (A) is required by court or administrative order to provide coverage of the costs of health services to a child who is eligible for medical assistance under this subchapter, (B) has received payment from a third party for the costs of such services to such child, but (C) has not used such payments to reim- burse, as appropriate, either the other par- ent or guardian of such child or the provider of such services, to the extent necessary to reimburse the State agency for expenditures for such costs under its plan under this subchapter, but any claims for current or past-due child support shall take priority over any such claims for the costs of such services. (b) ‘‘Insurer’’ defined For purposes of this section, the term ‘‘in- surer’’ includes a group health plan, as defined in section 1167(1) of title 29, a health mainte- nance organization, and an entity offering a service benefit plan.