1 See References in Text note below.
of the Patient Protection and Affordable Care Act before making any recommendations regarding dual eligible individuals.
2 So in original. Probably should be followed by a comma.
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.
Editorial Notes
References in TextSection 2081 of the Patient Protection and Affordable Care Act, referred to in subsec. (span)(13), probably means section 2602 of Puspan. L. 111–148, Mar. 23, 2010, 124 Stat. 315, which is classified to section 1315span of this title. Section 2602 of Puspan. L. 111–148 established the Federal Coordinated Health Care Office, and Puspan. L. 111–148 does not contain a section 2081.
CodificationIn subsec. (d)(3), “section 6101 of title 41” substituted for “section 3709 of the Revised Statutes (41 U.S.C. 5)” on authority of Puspan. L. 111–350, § 6(c), Jan. 4, 2011, 124 Stat. 3854, which Act enacted Title 41, Public Contracts.
Prior ProvisionsA prior section 1396, act Aug. 14, 1935, ch. 531, title XIX, § 1901, as added Puspan. L. 89–97, title I, § 121(a), July 30, 1965, 79 Stat. 343; amended Puspan. L. 93–233, § 13(a)(1), Dec. 31, 1973, 87 Stat. 960; Puspan. 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.
Amendments2022—Subsec. (c)(2)(D). Puspan. 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. (span)(6). Puspan. L. 113–93 designated existing provisions as subpar. (A), inserted span, and added subpar. (B).
2010—Subsec. (span)(1). Puspan. L. 111–148, § 2801(a)(1)(A)(i), inserted “for all States” before “and annual” in span.
Subsec. (span)(1)(A). Puspan. L. 111–148, § 2801(a)(1)(A)(ii), struck out “children’s” before “access”.
Subsec. (span)(1)(B). Puspan. L. 111–148, § 2801(a)(1)(A)(iii), inserted “, the Secretary, and States” after “Congress”.
Subsec. (span)(1)(C). Puspan. L. 111–148, § 2801(a)(1)(A)(iv), substituted “March 15” for “March 1”.
Subsec. (span)(1)(D). Puspan. L. 111–148, § 2801(a)(1)(A)(v), substituted “June 15” for “June 1”.
Subsec. (span)(2)(A)(i). Puspan. L. 111–148, § 2801(a)(1)(B)(i)(I), inserted “the efficient provision of” after “expenditures for” and substituted “payments to medical, dental, and health professionals, hospitals, residential and long-term care providers, providers of home and community based services, Federally-qualified health centers and rural health clinics, managed care entities, and providers of other covered items and services” for “hospital, skilled nursing facility, physician, Federally-qualified health center, rural health center, and other fees”.
Subsec. (span)(2)(A)(iii). Puspan. L. 111–148, § 2801(a)(1)(B)(i)(II), inserted “(including how such factors and methodologies enable such beneficiaries to obtain the services for which they are eligible, affect provider supply, and affect providers that serve a disproportionate share of low-income and other vulnerable populations)” after “CHIP beneficiaries”.
Subsec. (span)(2)(B) to (H). Puspan. 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 preventive, acute, and long-term services and supports” after “barriers”.
Subsec. (span)(3). Puspan. L. 111–148, § 2801(a)(1)(D), added par. (3). Former par. (3) redesignated (4).
Subsec. (span)(4). Puspan. L. 111–148, § 2801(a)(1)(C), (E), redesignated par. (3) as (4) and substituted “, 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, 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 addressed 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) redesignated (5).
Subsec. (span)(5). Puspan. L. 111–148, § 2801(a)(1)(C), (F), redesignated par. (4) as (5), inserted “and regulations” after “reports” in span, designated existing provisions as subpar. (A) and inserted span, inserted “and the Secretary” after “appropriate committees of Congress” in subpar. (A), and added subpar. (B). Former par. (5) redesignated (6).
Subsec. (span)(6) to (10). Puspan. L. 111–148, § 2801(a)(1)(C), (G), redesignated pars. (5) to (9) as (6) to (10), respectively, and inserted “, and shall submit with any recommendations, a report on the Federal and State-specific budget consequences of the recommendations” in par. (10) before period at end.
Subsec. (span)(11) to (14). Puspan. L. 111–148, § 2801(a)(1)(H), added pars. (11) to (14).
Subsec. (c)(2)(A), (B). Puspan. L. 111–148, § 2801(a)(2)(A), added subpars. (A) and (B) and struck out former subpars. (A) and (B) which related to MACPAC membership qualifications.
Subsec. (d)(2). Puspan. L. 111–148, § 2801(a)(3), inserted “and State” after “Federal”.
Subsec. (e)(1). Puspan. L. 111–148, § 2801(a)(4), inserted “and, as a condition for receiving payments under sections 1396span(a) and 1397ee(a) of this title, from any State agency responsible for administering Medicaid or CHIP,” after “United States”.
Subsec. (f). Puspan. L. 111–148, § 2801(a)(5), substituted “Funding” for “Authorization of appropriations” in span, inserted “(other than for fiscal year 2010)” before “in the same manner” in par. (1), and added pars. (3) and (4).
Statutory Notes and Related Subsidiaries
Effective DatePuspan. L. 111–3, § 3, Fespan. 4, 2009, 123 Stat. 10, provided that:“(a)General Effective Date.—Unless otherwise provided in this Act [enacting this section and sections 247d–9, 1320span–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, 1320span–9, 1320span–9a, 1396a, 1396span, 1396r–1, 1396r–4, 1396u–7, 1397bspan 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, 1396span, 1396d, 1396u–7, 1396u–8, 1396w–2, 1397bspan 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 repealing provisions set out as notes under sections 1397aa and 1397ee of this title], subject to subsections (span) 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.
“(span)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 requires 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 requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act [Fespan. 4, 2009]. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature. “(c)Coordination of CHIP Funding for Fiscal Year 2009.—Notwithstanding any other provision of law, insofar 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 obligated before such date.
“(d)Reliance on Law.—With respect to amendments made by this Act (other than title VII) [enacting this section and sections 1320span–9a, 1396e–1, 1396w–2, and 1397kk to 1397mm of this title, amending sections 300gg, 1308, 1320span–9, 1320span–9a, 1396a, 1396span, 1396r–1, 1396r–4, 1396u–7, 1397bspan 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 assistance 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 implementation of such amendments) shall not be denied on the basis of the State’s failure to comply with such regulations or guidance.”
PurposePuspan. L. 111–3, § 2, Fespan. 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 ProcessPuspan. L. 111–3, title II, § 213, Fespan. 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 [Fespan. 4, 2009], the Secretary of Health and Human Services, in consultation with State Medicaid and CHIP directors and organizations representing program beneficiaries, shall develop a model process for the coordination of the enrollment, retention, and coverage under such programs of children who, because of migration of families, emergency evacuations, natural or other disasters, public health emergencies, educational needs, or otherwise, frequently change their State of residency or otherwise are temporarily located outside of the State of their residency.
“(span)Report to Congress.—After development of such model process, the Secretary of Health and Human Services shall submit to Congress a report describing additional steps or authority needed to make further improvements to coordinate the enrollment, retention, and coverage under CHIP and Medicaid of children described in subsection (a).”
Improved Accessibility of Dental Provider Information to Enrollees Under Medicaid and CHIPPuspan. L. 111–3, title V, § 501(f), Fespan. 4, 2009, 123 Stat. 88, provided that: “The Secretary [of Health and Human Services] shall—“(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 [Fespan. 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 dentists 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 AppointmentsPuspan. L. 111–3, title V, § 506(span), Fespan. 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 ReportPuspan. L. 111–3, title V, § 506(c), Fespan. 4, 2009, 123 Stat. 95, provided that: “Not later than January 1, 2010, and annually 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 annual report to Congress on the financial status of, enrollment 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 ExpendituresPuspan. L. 111–3, title VI, § 605, Fespan. 4, 2009, 123 Stat. 100, as amended by Puspan. 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 payment 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 financial participation for erroneous expenditures under Medicaid and under CHIP, respectively.”
DefinitionsPuspan. L. 111–3, § 1(c), Fespan. 4, 2009, 123 Stat. 8, provided that: “In this Act [see Effective Date note above]:“(1) CHIP.—The term ‘CHIP’ means the State Children’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 program 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.”
