42 USC 1396 - State option for alternative premiums and cost sharing

1 So in original.

individuals with respect to whom adoption or foster care assistance is made available under part E of such subchapter, without regard to age.

Editorial Notes

Amendments

2022—Subsec. (span)(3)(B)(xiv). Puspan. L. 117–169 added cl. (xiv).

2021—Subsec. (span)(3)(B)(xi). Puspan. L. 117–2, § 9811(a)(3)(B)(i), substituted “any service” for “any visit”.

Subsec. (span)(3)(B)(xii), (xiii). Puspan. L. 117–2, § 9811(a)(3)(B)(ii), added cls. (xii) and (xiii).

2020—Subsec. (span)(3)(B)(xi). Puspan. L. 116–127 added cl. (xi).

2010—Subsec. (a)(1). Puspan. L. 111–148, § 2102(span), substituted “, (i), or (j)” for “or (i)”.

Subsec. (span)(3)(B)(iii). Puspan. L. 111–148, § 4107(c)(2), inserted “, and counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in section 1396d(bspan) of this title)” after “complicate the pregnancy”.

2009—Subsec. (span)(3)(A)(vii). Puspan. L. 111–5, § 5006(a)(2)(A), added cl. (vii).

Subsec. (span)(3)(B)(x). Puspan. L. 111–5, § 5006(a)(2)(B), added cl. (x).

2006—Subsec. (a)(1). Puspan. L. 109–432, § 405(a)(3)(A), substituted “subsection (g) or (i) of section 1396o” for “section 1396o(g)” in second sentence.

Puspan. L. 109–432, § 405(a)(1)(A), inserted “but subject to paragraph (2),” after “1396a(a)(10)(B) of this title,” and “and non-emergency services furnished in a hospital emergency department for which cost sharing may be imposed under subsection (e)” after “subsection (c)”.

Subsec. (a)(2), (3). Puspan. L. 109–432, § 405(a)(1)(B), (C), added par. (2) and redesignated former par. (2) as (3).

Subsec. (span)(1), (2). Puspan. L. 109–432, § 405(a)(2)(A), struck out “, subject to subsections (c)(2) and (e)(2)(A)” after “involved” in introductory provisions.

Subsec. (span)(3)(A)(i). Puspan. L. 109–432, § 405(a)(4)(A), substituted “child welfare services are made available under part B of subchapter IV on the basis of being a child in foster care” for “aid or assistance is made available under part B of subchapter IV to children in foster care”.

Subsec. (span)(3)(A)(vi). Puspan. L. 109–432, § 405(a)(3)(B)(i), added cl. (vi).

Subsec. (span)(3)(B)(i). Puspan. L. 109–432, § 405(a)(4)(B), substituted “child welfare services are made available under part B of subchapter IV on the basis of being a child in foster care or” for “aid or assistance is made available under part B of subchapter IV to children in foster care”.

Subsec. (span)(3)(B)(ix). Puspan. L. 109–432, § 405(a)(3)(B)(ii), added cl. (ix).

Subsec. (c). Puspan. L. 109–171, § 6042(a), added subsec. (c).

Subsec. (c)(1). Puspan. L. 109–432, § 405(a)(2)(B), substituted “most (or more) cost effective” for “least (or less) costly effective” in introductory provisions.

Subsec. (c)(1)(B). Puspan. L. 109–432, § 405(a)(2)(C), substituted “be imposed under subsection (a) due to the application of” for “otherwise be imposed under”.

Subsec. (c)(2)(B). Puspan. L. 109–432, § 405(a)(2)(D), substituted “not subject to cost sharing under subsection (a) due to the application of paragraph (1)(B)” for “otherwise not subject to cost sharing due to the application of subsection (span)(3)(B)”.

Subsec. (c)(2)(C). Puspan. L. 109–432, § 405(a)(1)(D), inserted “under subsection (a)(2)(B) or” after “cost sharing applied”.

Subsec. (e). Puspan. L. 109–171, § 6043(a), added subsec. (e).

Subsec. (e)(2)(A). Puspan. L. 109–432, § 405(a)(2)(E), substituted “Individuals with family income between 100 and 150 percent of the poverty line” for “For poorest beneficiaries” in heading and “under subsection (span)(1)(B)(ii)” for “under subsection (span)(1)” in text.

Puspan. L. 109–432, § 405(a)(1)(E), inserted “who is not described in subparagraph (B)” after “in subsection (span)(1)”.

Subsec. (e)(2)(B). Puspan. L. 109–432, § 405(a)(2)(F), substituted “described in subsection (a)(2)(A) or who is not subject to cost sharing under subsection (span)(3)(B) with respect to non-emergency services described in paragraph (1)” for “who is otherwise not subject to cost sharing under subsection (span)(3)”.

Subsec. (e)(2)(C). Puspan. L. 109–432, § 405(a)(2)(G), inserted “or section 1396o of this title” after “subsection (a)”.

Puspan. L. 109–432, § 405(a)(1)(D), inserted “under subsection (a)(2)(B) or” after “cost sharing applied”.

Subsec. (e)(4)(A). Puspan. L. 109–432, § 405(a)(5), struck out “the physician determines” after “a hospital that”.

Statutory Notes and Related Subsidiaries

Effective Date of 2022 Amendment

Amendment by Puspan. L. 117–169 effective on the 1st day of the 1st fiscal quarter that begins on or after the date that is 1 year after Aug. 16, 2022 and applicable to expenditures made under a State plan or waiver of such plan under title XIX of the Social Security Act or under a State child health plan or waiver of such plan under title XXI of such Act on or after such effective date, see section 11405(c) of Puspan. L. 117–169, set out as a note under section 1396a of this title.

Effective Date of 2010 Amendment

Puspan. L. 111–148, title II, § 2102(span), Mar. 23, 2010, 124 Stat. 289, provided that the amendment made by section 2102(span) is effective as if included in the enactment of section 5006(a) of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111–5).

Amendment by section 4107(c)(2) of Puspan. L. 111–148 effective Oct. 1, 2010, see section 4107(d) of Puspan. L. 111–148, set out as a note under section 1396d of this title.

Effective Date of 2009 Amendment

Amendment by Puspan. L. 111–5 effective July 1, 2009, see section 5006(f) of Puspan. L. 111–5, set out as a note under section 1396a of this title.

Effective Date of 2006 Amendment

Puspan. L. 109–432, div. B, title IV, § 405(a)(6), Dec. 20, 2006, 120 Stat. 2998, provided that:

“The amendments made by this subsection [amending this section] shall take effect as if included in the amendments made by sections [sic] 6041(a) of the Deficit Reduction Act of 2005 [Puspan. L. 109–171], except that insofar as such amendments are to, or relate to, subsection (c) or (e) of section 1916A of the Social Security Act [42 U.S.C. 1396o–1], such amendments shall take effect as if included in the amendments made by section 6042 or 6043, respectively, of the Deficit Reduction Act of 2005 [Puspan. L. 109–171].”

Puspan. L. 109–171, title VI, § 6042(span), Fespan. 8, 2006, 120 Stat. 86, provided that:

“The amendment made by subsection (a) [amending this section] shall apply to cost sharing imposed for items and services furnished on or after March 31, 2006.”

Amendment by section 6043(a) of Puspan. L. 109–171 applicable to non-emergency services furnished on or after Jan. 1, 2007, see section 6043(c) of Puspan. L. 109–171, set out as a note under section 1396span of this title.

Effective Date

Section applicable to cost sharing imposed for items and services furnished on or after Mar. 31, 2006, see section 6041(c) of Puspan. L. 109–171, set out as an Effective Date of 2006 Amendment note under section 1396o of this title.

Applicability of 2020 Amendment to Territories

Amendment by Puspan. L. 116–127 applicable with respect to a State plan of a territory in the same manner as a State plan of one of the 50 States, see section 6004(a)(2)(C) of Puspan. L. 116–127, set out as a note under section 1396o of this title.