[House Report 114-462]
[From the U.S. Government Publishing Office]
114th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 114-462
_______________________________________________________________________
REDUCING DUPLICATIVE AND INEFFECTIVE FEDERAL FUNDING ACT
----------
R E P O R T
of the
COMMITTEE ON WAYS AND MEANS
HOUSE OF REPRESENTATIVES
To accompany
H.R. 4724
together with
DISSENTING VIEWS
[Including cost estimate of the Congressional Budget Office]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
March 23 2016.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
114th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 114-462
_______________________________________________________________________
REDUCING DUPLICATIVE AND INEFFECTIVE FEDERAL FUNDING ACT
__________
R E P O R T
of the
COMMITTEE ON WAYS AND MEANS
HOUSE OF REPRESENTATIVES
To accompany
H.R. 4724
together with
DISSENTING VIEWS
[Including cost estimate of the Congressional Budget Office]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
March 23 2016.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
______
U.S. GOVERNMENT PUBLISHING OFFICE
99-558 WASHINGTON : 2016
CONTENTS
Page
I. SUMMARY AND BACKGROUND...........................................3
A. Purpose and Summary................................. 3
B. Background and Need for Legislation................. 3
C. Legislative History................................. 9
II. EXPLANATION OF THE BILL..........................................9
Section 1: Short Title................................. 9
Section 2: Repeal of Funding for the Social Services
Block Grants Program............................... 10
II. VOTES OF THE COMMITTEE..........................................11
III. NEW BUDGET AUTHORITY AND TAX EXPENDITURES.......................12
IV. COST ESTIMATE PREPARED BY THE CONGRESSIONAL BUDGET OFFICE.......12
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE......14
A. Committee Oversight Findings and Recommendations.... 14
B. Statement of General Performance Goals and
Objectives......................................... 14
C. Applicability of House Rule XXI 5(b)................ 14
D. Congressional Earmarks, Limited Tax Benefits, and
Limited Tariff Benefits............................ 15
E. Duplication of Federal Programs..................... 15
F. Disclosure of Directed Rule Makings................. 15
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED...........15
A. Text of Existing Law Amended or Repealed by the
Bill, as Reported.................................. 15
B. Changes in Existing Law Proposed by the Bill, as
Reported........................................... 245
VII. DISSENTING VIEWS...............................................475
114th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 114-462
======================================================================
REDUCING DUPLICATIVE AND INEFFECTIVE FEDERAL FUNDING ACT
_______
March 23, 2016.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Brady of Texas, from the Committee on Ways and Means, submitted the
following
R E P O R T
together with
DISSENTING VIEWS
[To accompany H.R. 4724]
[Including cost estimate of the Congressional Budget Office]
The Committee on Ways and Means, to whom was referred the
bill (H.R. 4724) to repeal the program of block grants to
States for social services, having considered the same, report
favorably thereon with an amendment and recommend that the bill
as amended do pass.
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Reducing Duplicative and Ineffective
Federal Funding Act''.
SEC. 2. REPEAL OF THE PROGRAM OF BLOCK GRANTS TO STATES FOR SOCIAL
SERVICES.
(a) Repeals.--Sections 2001 through 2007 of the Social Security Act
(42 U.S.C. 1397-1397f) are repealed.
(b) Conforming Amendments.--
(1) Section 404(d) of the Social Security Act (42 U.S.C.
604(d)) is amended--
(A) in paragraph (1), by striking ``any or all of the
following provisions of law:'' and all that follows
through ``The'' and inserting ``the'';
(B) in paragraph (3)--
(i) by striking ``rules'' and all that
follows through ``any amount paid'' and
inserting ``rules.--Any amount paid'';
(ii) by striking ``a provision of law
specified in paragraph (1)'' and inserting
``the Child Care and Development Block Grant
Act of 1990''; and
(iii) by striking subparagraph (B); and
(C) by striking paragraph (2) and redesignating
paragraph (3) as paragraph (2).
(2) Section 422(b) of the Social Security Act (42 U.S.C.
622(b)) is amended--
(A) in paragraph (1)(A)--
(i) by striking ``administers or supervises''
and inserting ``administered or supervised'';
and
(ii) by striking ``subtitle 1 of title XX''
and inserting ``subtitle A of title XX (as in
effect before the repeal of such subtitle)'';
and
(B) in paragraph (2), by striking ``under subtitle 1
of title XX,''.
(3) Section 471(a) of the Social Security Act (42 U.S.C.
671(a)) is amended--
(A) in paragraph (4), by striking ``, under subtitle
1 of title XX of this Act,''; and
(B) in paragraph (8), by striking ``XIX, or XX'' and
inserting ``or XIX''.
(4) Section 472(h)(1) of the Social Security Act (42 U.S.C.
672(h)(1)) is amended by striking the 2nd sentence.
(5) Section 473(b) of the Social Security Act (42 U.S.C.
673(b)) is amended--
(A) in paragraph (1), by striking ``(3)'' and
inserting ``(2)'';
(B) in paragraph (4), by striking ``paragraphs (1)
and (2)'' and inserting ``paragraph (1)''; and
(C) by striking paragraph (2) and redesignating
paragraphs (3) and (4) as paragraphs (2) and (3),
respectively.
(6) Section 504(b)(6) of the Social Security Act (42 U.S.C.
704(b)(6)) is amended in each of subparagraphs (A) and (B) by
striking ``, XIX, or XX'' and inserting ``or XIX''.
(7) Section 1101(a)(1) of the Social Security Act (42 U.S.C.
1301(a)(1)) is amended by striking the penultimate sentence.
(8) Section 1128(h) of the Social Security Act (42 U.S.C.
1320a-7(h)) is amended--
(A) by adding ``or'' at the end of paragraph (2); and
(B) by striking paragraph (3) and redesignating
paragraph (4) as paragraph (3).
(9) Section 1128A(i)(1) of the Social Security Act (42 U.S.C.
1320a-7a(i)(1)) is amended by striking ``or subtitle 1 of title
XX''.
(10) Section 1132(a)(1) of the Social Security Act (42 U.S.C.
1320b-2(a)(1)) is amended by striking ``XIX, or XX'' and
inserting ``or XIX''.
(11) Section 1902(e)(13)(F)(iii) of the Social Security Act
(42 U.S.C. 1396a(e)(13)(F)(iii)) is amended--
(A) by striking ``Exclusions'' and inserting
``Exclusion''; and
(B) by striking ``an agency that determines
eligibility for a program established under the Social
Services Block Grant established under title XX or''.
(12) The heading for title XX of the Social Security Act is
amended by striking ``BLOCK GRANTS TO STATES FOR SOCIAL
SERVICES'' and inserting ``HEALTH PROFESSIONS DEMONSTRATIONS
AND ENVIRONMENTAL HEALTH CONDITION DETECTION''.
(13) The heading for subtitle A of title XX of the Social
Security Act is amended by striking ``Block Grants to States
for Social Services'' and inserting ``Health Professions
Demonstrations and Environmental Health Condition Detection''.
(14) Section 16(k)(5)(B)(i) of the Food and Nutrition Act of
2008 (7 U.S.C. 2025(k)(5)(B)(i)) is amended--
(A) by striking ``, or title XX,''; and
(B) by striking ``, 1397 et seq.''.
(15) Section 402(b)(3) of the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996 (8 U.S.C.
1612(b)(3)) is amended by striking subparagraph (B) and
redesignating subparagraph (C) as subparagraph (B).
(16) Section 245A(h)(4)(I) of the Immigration and Nationality
Act (8 U.S.C. 1255a(h)(4)(I)) is amended by striking ``, XVI,
and XX'' and inserting ``and XVI''.
(17) Section 17 of the Richard B. Russell National School
Lunch Act (42 U.S.C. 1766) is amended--
(A) in subsection (a)(2)--
(i) in subparagraph (B)--
(I) by striking ``--'' and all that
follows through ``(i)'';
(II) by striking ``or'' at the end of
clause (i); and
(III) by striking clause (ii); and
(ii) in subparagraph (D)(ii), by striking
``or title XX''; and
(B) in subsection (o)(2)(B)--
(i) by striking ``or title XX'' each place it
appears; and
(ii) by striking ``or XX''.
(18) Section 201(b) of the Indian Child Welfare Act of 1978
(25 U.S.C. 1931(b)) is amended by striking ``titles IV-B and
XX'' each place it appears and inserting ``part B of title
IV''.
(19) Section 3803(c)(2)(C) of title 31, United States Code,
is amended by striking clause (vi) and redesignating clauses
(vii) through (xvi) as clauses (vi) through (xv), respectively.
(20) Section 14502(d)(3) of title 40, United States Code, is
amended--
(A) by striking ``and title XX''; and
(B) by striking ``, 1397 et seq.''.
(21) Section 2006(a)(15) of the Public Health Service Act (42
U.S.C. 300z-5(a)(15)) is amended by striking ``and title XX''.
(22) Section 203(b)(3) of the Older Americans Act of 1965 (42
U.S.C. 3013(b)(3)) is amended by striking ``XIX, and XX'' and
inserting ``and XIX''.
(23) Section 213 of the Older Americans Act of 1965 (42
U.S.C. 3020d) is amended by striking ``or title XX''.
(24) Section 306(d) of the Older Americans Act of 1965 (42
U.S.C. 3026(d)) is amended in each of paragraphs (1) and (2) by
striking ``titles XIX and XX'' and inserting ``title XIX''.
(25) Section 2605 of the Low-Income Home Energy Assistance
Act of 1981 (42 U.S.C. 8624) is amended in each of subsections
(b)(4) and (j) by striking ``under title XX of the Social
Security Act,''.
(26) Section 602 of the Child Development Associate
Scholarship Assistance Act of 1985 (42 U.S.C. 10901) is
repealed.
(27) Section 3(d)(1) of the Assisted Suicide Funding
Restriction Act of 1997 (42 U.S.C. 14402(d)(1)) is amended by
striking subparagraph (C) and redesignating subparagraphs (D)
through (K) as subparagraphs (C) through (J), respectively.
(c) Effective Date.--The amendments made by this section shall take
effect on October 1, 2016.
I. SUMMARY AND BACKGROUND
A. Purpose and Summary
H.R. 4724 as amended, the Reducing Duplicative and
Ineffective Federal Funding Act, as ordered reported by the
Committee on Ways and Means on March 16, 2016, repeals sections
2001 through 2007 of title XX of the Social Security Act
effective on October 1, 2016, saving $1.3 billion in FY 2017,
$2.9 billion over the first two years, and $16.5 billion over
10 years.
B. Background and Need for Legislation
The predecessor to the current Social Services Block Grant
(SSBG) began in 1956 as a way to match targeted state spending
on specific services to help families leave welfare. Over the
ensuing decades, SSBG evolved in both structure and purpose,
and is now a 100 percent federal funding stream used to support
a wide range of services to individuals regardless of their
income. The Committee, after conducting an oversight hearing on
program duplication, reviewing related reports by the
nonpartisan Government Accountability Office (GAO), and
examining the range of federally-funded social services
programs designed to serve similar purposes, has determined
that the SSBG program has critical program flaws that argue for
its elimination, which will both minimize program duplication
and achieve significant savings for taxpayers. Accordingly, the
Committee legislation eliminates the SSBG effective on October
1, 2016 (that is, for FY 2017 and beyond), saving $1.3 billion
in FY 2017 and almost $17 billion over 10 years.
The Committee is not opposed to the specific services
funded by the SSBG, nor does the Committee believe that
individuals receiving these services are not in need of
assistance. Indeed, as is described in greater detail below, an
important argument for ending the SSBG is the fact that it
duplicates so many other programs, which generally provide far
greater support and greater accountability to the recipients
and taxpayers than SSBG currently offers for many of the same
services, such as child care, child welfare, and Meals on
Wheels. Further, the Committee is concerned with the design of
this program, which lacks measures of effectiveness.
In sum, the following key flaws in the SSBG program reflect
how it clearly does not serve taxpayers well:
1. No focus: SSBG spends $1.7 billion per year to support
29 different types of social services, including a category
called ``other.'' The current program has no federal
eligibility requirements for persons receiving social services
funded from the SSBG.
2. Duplicative: In the time since the SSBG was created in
the 1950s, more targeted welfare programs, which in fiscal year
2015 spent more than $500 billion, have been created. These
programs include Medicaid, Supplemental Security Income, Head
Start, the Earned Income Tax Credit, numerous foster care and
adoption programs, and other programs that are all much more
targeted in purpose than SSBG.
3. No state partnership: In contrast with other anti-
poverty programs under the Committee's jurisdiction, SSBG does
not require any state contribution to match federal dollars
spent through the program. As a result, SSBG is structured as a
permanent state aid program rather than a focused anti-poverty
program.
4. No accountability: SSBG includes no accountability for
results. State reporting on recipients is limited to a count of
the number of people receiving services funded with SSBG
dollars by general age categories, and there is no information
collected on the demographics of recipients, their earnings, or
their progress out of poverty and toward self-sufficiency. SSBG
has only one outcome measure, which is simply a measure of
state spending. This measure is calculated as the percentage
difference between what states planned on spending in each
category in a year, compared to what they ended up spending in
each category for that year.
History of the Social Services Block Grant
The SSBG began as many federal programs do--as a relatively
small program focused on helping a specific population achieve
specific goals. But in ensuing years it devolved into a simple
transfer from federal taxpayers to states for a broad array of
services with no accountability for real results.
Created in 1956, the precursor to the SSBG began as a 50/50
federal/state match program designed to provide services to
help families on welfare move off public assistance. When many
states declined to participate, in 1962 the federal match rate
was increased to 75 percent, allowable spending was expanded to
include child welfare, adult disability services, and elderly
services, and eligibility was broadened to include potential
welfare recipients.
In 1967, the program was again expanded to cover job
training and child care services, and the federal match rate
was raised yet again to 85 percent. As a result, spending
exploded from $282 million in FY 1967 to $1.7 billion in FY
1972, leading Congress to cap federal spending at $2.5 billion
per year. In 1974, program services were broadened yet again to
include an even wider range of social services, and eligibility
was expanded to include anyone below 85 percent of state median
income (which is about $43,000 in current terms).
This prior funding stream officially became the SSBG in
1981, when annual funding was set at $2.4 billion and all state
matching and eligibility requirements were eliminated. Since
1981, annual SSBG funding rose to $2.8 billion in 1991 through
1995 before falling in the late 1990s and finally settling at
$1.7 billion since 2001.
Duplication between the SSBG and other social service programs
On March 1, 2011, the Government Accountability Office
(GAO) released its first annual report identifying duplicative
and wasteful government programs, agencies, and offices. The
report highlighted billions of dollars spent on redundant
federal programs. In an April 5, 2011 hearing of the Ways and
Means Subcommittee on Human Resources on the GAO report on
program duplication, GAO provided testimony on fragmentation,
overlap, and duplication among programs under the
Subcommittee's jurisdiction, including SSBG.
Summarizing their work on human services programs, GAO
reported that:
``This array of programs plays a key role in
supporting those in need, but our work has shown it to
be too fragmented and overly complex--for clients to
navigate, for program operators to administer
efficiently, and for program managers and policymakers
to assess program performance.''\1\
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\1\U.S. Government Accountability Office. Human Services Programs:
Opportunities to Reduce Inefficiencies. April 5, 2011. Accessed March
23, 2016. Available online: http://www.gao.gov/assets/130/125910.pdf.
States report spending SSBG funds on 29 different types of
social services, including a catchall category called
``other.'' A significant portion of this State-reported SSBG
spending is for services funded under a variety of other
Federal programs, including a number under the jurisdiction of
the Committee, as described in detail below.
Child care
The largest category of SSBG spending reported by states is
day care for children. However, a 2014 GAO report cited the
SSBG as one of 45 different programs and five tax provisions,
administered by nine different federal agencies, that funds
education and care for children under the age of five.\2\ In FY
2012, states spent $66 million in SSBG funds on child care,
while other federal programs provided much more funding.\3\ For
example, Head Start spending has increased from $7.2 billion in
FY 2010 to $8.6 billion in FY 2015, a $1.4 billion per year
increase in just the most recent five years. In addition, child
care block grant spending has increased from $5.0 billion in FY
2010 to $5.4 billion in FY 2015, a $400 million per year
increase in just the most recent five years.
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\2\U.S. Government Accountability Office. Early Learning and Child
Care: Federal Funds Support Multiple Programs with Similar Goals.
February 5, 2014. Accessed March 23, 2016. Available online http://
www.gao.gov/assets/670/660685.pdf.
\3\U.S. Department of Health and Human Services. SSBG Annual Report
2012. January 21, 2015. Accessed March 23, 2016. Available online:
http://www.acf.hhs.gov/programs/ocs/
resource/ssbg-2012-annual-report.
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Child welfare
Child welfare is a shared responsibility between the states
and the federal government. Federal foster care and adoption
assistance programs match state spending on child welfare
services. In contrast, spending on child welfare under the SSBG
program includes no state matching requirement. Recent and
ongoing trends in child welfare funding suggest that, even
without SSBG funds, federal support for various child welfare
services and supports will only continue to grow in the years
ahead. SSBG duplicates eight other child welfare programs under
the jurisdiction of the Ways and Means Committee: Child Welfare
Services, Promoting Safe and Stable Families, Foster Care/
Adoption/Kinship Guardianship Assistance, Chafee Foster Care
Independence Program, Chafee Education and Training Vouchers,
Adoption and Legal Guardianship Incentives program, Temporary
Assistance for Needy Families, and the Adoption Tax Credit.
Other committees, such as the Committee on Education and the
Workforce and the Judiciary Committee, also oversee child
welfare programs. While SSBG has remained flat since 2001,
other federal child welfare programs have grown by more than $1
billion from FY 2013 through FY 2016. Due to changes enacted in
2008, States will continue to receive increased federal funding
to help support families for an increasing proportion of
adoptions in the years ahead. In fact, according to CBO,
federal funding for adoption alone is expected to rise by more
than $1 billion in the next eight years.\4\
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\4\Congressional Budget Office. Snapshot of Foster Care, Adoption
Assistance, and Guardianship Assistance. April 18, 2013. Accessed March
23, 2016. Available online: https://www.cbo.gov/publication/44082.
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States are also beginning to receive new Federal
entitlement funding to support children placed with relatives.
As the federal government begins paying for the cost of kinship
care (i.e., when a child is placed with a relative or close
family friend), CBO projects that federal reimbursement for
kinship care will rise from $217 million per year in FY 2013 to
$533 million per year by 2018, constituting a significant new
source of child welfare funding for states and families with
child welfare needs.\5\
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\5\Ibid.
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Disability services
In FY 2012, States reported spending 11 percent of their
SSBG funds on special services for the disabled.\6\ A GAO
report published in 2005 identified almost 200 programs in 20
agencies that provided over $120 billion in federal funds to
serve people with disabilities. In addition to these programs,
the GAO determined that Medicare and Medicaid spent $132
billion in 2002 on services for the disabled.\7\
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\6\U.S. Department of Health and Human Services. SSBG Annual Report
2012. January 21, 2015. Accessed March 23, 2016. Available online:
http://www.acf.hhs.gov/programs/ocs/
resource/ssbg-2012-annual-report.
\7\Government Accountability Office. Federal Disability Assistance:
Wide Array of Programs Needs to be Examined in Light of 21st Century
Challenges. June 2, 2005. Accessed March 23, 2016. Available online:
http://gao.gov/products/GAO-05-626.
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Meals on wheels
Seventeen States reported spending a small portion of their
SSBG funds on home-delivered meals. According to the annual
report on SSBG, ``home-delivered meals'' constituted just one
percent of SSBG expenditures in FY 2012. Other current
government programs provide far more support for meals on
wheels than SSBG, showing how it is duplicative.
Primary funding for what is commonly referred to as ``meals
on wheels'' is provided at the state and local level. Federal
funding is provided under the Elderly Nutrition Services
program authorized under Title III of the Older Americans Act.
This program, under the jurisdiction of the Committee on
Education and the Workforce, provides grants to state agencies
on aging to support congregate and home-delivered meals for
people aged 60 and older. According to CRS, Title III of the
Older Americans Act spent $214 million on meals on wheels
services in FY 2015. The share of Older Americans Act spending
on Meals on Wheels has been rising in recent years.\8\
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\8\Congressional Research Service. Older Americans Act: Funding
Formulas (Report RS22549). March 19, 2015.
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Significant funding for Meals on Wheels also comes from
private sources. For example, the Meals on Wheels Association
of America, reports that 95 percent of their funding comes from
sources other than government grants.\9\
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\9\Meals on Wheels Association of America. Financial Statements and
Independent Auditors' Report, December 31, 2014 and 2013. Accessed
March 23, 2016. Available online: http://www.mealsonwheelsamerica.org/
docs/default-source/financials/meals-on-wheels-america-audited-
financial-statement-2014.pdf?sfvrsn=2
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Adult Protective Services
States report that about seven percent of their SSBG
funding is for Adult Protective Services.\10\ However, a
separate federal program was created for this specific purpose
in 2010. Created as part of the Patient Protection and
Affordable Care Act (P.L. 111-148), Subtitle B of Title XX of
the Social Security Act titled ``Elder Justice'' established
(1) an Elder Justice Coordinating Council; (2) an Advisory
Board on Elder Abuse, Neglect, and Exploitation; (3) a new
grant program for forensic centers to help organizations
develop specialized expertise related to elder abuse, neglect,
and exploitation; and (4) a number of new grant programs to
promote elder justice. In addition to the Elder Justice
program, Medicaid funds are also used for this purpose. In a
March 2011 GAO report, GAO found that states received at least
$42 million in FY 2009 from Medicaid for Adult Protective
Services programs.\11\
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\10\U.S. Department of Health and Human Services. SSBG Annual
Report 2012. January 21, 2015. Accessed March 23, 2016. Available
online: http://www.acf.hhs.gov/programs/ocs/resource/ssbg-2012-annual-
report
\11\U.S. Government Accountability Office. Elder Justice: Stronger
Federal Leadership Could Enhance National Response to Elder Abuse.
March, 2011. Accessed March 23, 2016. Available online: http://
www.gao.gov/new.items/d11208.pdf
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Beyond federal funding provided for this purpose, states
should be--and are--a critical source of funding for Adult
Protective Services. In the same March 2011 GAO report and
survey, states reported that more than half of the budget for
Adult Protective Services came from state and local revenues.
In some states, the entire budget came from these sources.
Education and training
States reported spending $7 million in SSBG funds on
education and training services in FY 2012.\12\ A GAO report on
education and training programs revealed that in FY2009 the
federal government spent $18 billion on 47 different education
and training programs across nine federal agencies; and only
one in 10 of these programs had been evaluated for
effectiveness in the prior seven years.\13\
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\12\U.S. Department of Health and Human Services. SSBG Annual
Report 2012. January 21, 2015. Accessed March 23, 2016. Available
online: http://www.acf.hhs.gov/programs/ocs/resource/ssbg-2012-annual-
report
\13\Multiple Employment and Training Programs: Providing
Information on Colocating Services and Consolidating Administrative
Structures Could Promote Efficiencies. Accessed March 23, 2016.
Available online: http://www.gao.gov/products/GAO-11-92
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State partnership lacking in SSBG
Although the SSBG program is referred to as a block grant,
SSBG lacks many features commonly associated with block grants
and related federal funding streams. First, the program
contains no match requirement. Other block grant programs, such
as Temporary Assistance for Needy Families (TANF) and the Child
Care and Development Fund (CCDF) require states to maintain a
specified spending level in order to receive federal funding.
Although SSBG originally began as a program requiring states to
match federal spending, the match was eliminated over 30 years
ago and states are no longer required to invest state dollars
to receive funding.
SSBG has no accountability
Unlike other block grants, the SSBG is not targeted to a
specific population through federal eligibility requirements.
The program also lacks data on recipients or program services
that would reveal the impact and effectiveness of the program.
Due to the lack of eligibility requirements and metrics on
program performance, the program does not include financial
penalties for state failure to satisfy program purposes and
thus states cannot be held accountable for achieving any
specific outcomes such as reducing poverty, promoting work, or
ending dependence on government benefits.
These ongoing flaws have resulted in SSBG being repeatedly
cited in both Democrat and Republican budgets as a program
lacking accountability for results. For example, President
Clinton's FY 1999 budget proposed substantial reductions in
funding for the SSBG, stating that ``the budget targets funding
to programs that can better demonstrate positive performance.
The Social Services Block Grant supports a broad range of
social service programs, but without statutory performance
goals or measures of progress.''\14\
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\14\Budget of the United States Government. Fiscal Year 1999.
Accessed March 23, 2016. Available online: http://www.gpo.gov/fdsys/
pkg/BUDGET-1999-BUD/pdf/BUDGET-1999-BUD.pdf
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In proposing a reduction in funding for SSBG in President
Bush's FY 2007 budget, the administration stated that ``the
SSBG program was rated Results Not Demonstrated in the PART
process, was found to lack a national system of performance
measures against which program performance can be measured and
improvements sought, and was critiqued for an absence of
evaluations of sufficient scope of SSBG-funded activities and
programs. The program's flexibility and lack of state reporting
requirements pose a challenge in developing measures.''\15\ In
later proposing the elimination of funding for the program, the
Bush administration stated ``The program's minimal requirements
maximize state flexibility but, at the same time, do not ensure
that funded activities are effective. This is because SSBG is a
funding stream rather than a program with measurable
performance objectives.''\16\
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\15\U.S. Department of Health and Human Services. FY 2007 ACF
Congressional Justification: Social Services Block Grant. Accessed
March 23, 2016. Available online: http://www.acf.hhs.gov/programs/olab/
fy-2007-acf-congressional-justification
\16\House Document 110-123. A Request for Budget Amendment for
Fiscal Year 2009. Accessed March 23, 2016. Available online: http://
www.gpo.gov/fdsys/pkg/CDOC-110hdoc123/pdf/CDOC-110hdoc123.pdf
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C. Legislative History
Background
H.R. 4724, the Reducing Duplicative and Ineffective Federal
Funding Act, was introduced on March 10, 2016, by
Representative Kevin Brady, and was referred to the Committee
on Ways and Means.
Committee hearings
On November 3, 2015, the Human Resources Subcommittee held
a hearing on the need to better coordinate federal social
services programs to improve services for individuals in
need.\17\ At the hearing, the Subcommittee released a chart
highlighting the complexity of the current system, with more
than 80 federal anti-poverty programs designed to help those
with limited income--in many cases illustrating how these
programs are overlapping and duplicative. In prior years, the
Human Resources Subcommittee also held hearings on duplication
in social services programs and the lack of accountability in
many federally-funded social service programs.
---------------------------------------------------------------------------
\ 17\Human Resources Subcommittee Discusses Need to Better
Coordinate Dozens of Anti-Poverty Programs. November 3, 2015. Accessed
March 23, 2016. Available online: http://waysandmeans.house.gov/human-
resources-subcommittee-discusses-need-to-better-coordinate-dozens-of-
anti-poverty-programs/
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Committee action
The Committee on Ways and Means marked up H.R. 4724, the
Reducing Duplicative and Ineffective Federal Funding Act, on
March 16, 2016. The bill, H.R. 4724, was ordered favorably
reported to the House of Representatives as amended by a roll
call vote of 20 yeas to 16 nays (with a quorum being present).
II. EXPLANATION OF THE BILL
SECTION 1: SHORT TITLE
Present law
No provision.
Explanation of provision
This section contains the short title of the bill, the
``Reducing Duplicative and Ineffective Federal Funding Act.''
Reason for change
The Committee believes that the short title reflects the
policy actions included in the legislation.
Effective date
The provision is effective upon enactment.
SECTION 2: REPEAL OF FUNDING FOR THE SOCIAL SERVICES BLOCK GRANTS
PROGRAM
Present law
The SSBG is permanently authorized by Title XX, Subtitle A,
of the Social Security Act as a ``capped'' entitlement to
states. This means that states (and territories) are entitled
to their share of funds, as determined by formula, out of an
amount that is capped in statute at a specific level. Although
social services for certain welfare recipients have been
authorized under various titles of the Social Security Act
since 1956, the SSBG in its current form was created in 1981
(P.L. 97-35). Block grant funds are given to states to achieve
a wide range of social policy goals, which include promoting
self-sufficiency, preventing child abuse, and supporting
community-based care for the elderly and disabled.
The FY2016 appropriations law (P.L. 114-113) appropriated
$1.7 billion for the SSBG. However, this amount was reduced to
$1.584 billion due to budget sequestration. The FY2016
appropriations law also maintained a provision, included in
annual appropriations laws since FY2001, allowing states to
transfer up to 10% of their Temporary Assistance for Needy
Families (TANF) block grants to the SSBG. In addition to annual
appropriations, the SSBG occasionally receives supplemental
appropriations to assist states and territories in responding
to natural disasters, including in FY2006, FY2008, and FY2013.
Explanation of provision
Subsection (a) of this section repeals sections 2001
through 2007 of title XX of the Social Security Act, which now
provides authorization for the Social Services Block Grant
(SSBG). Subsection (b) of this section makes various conforming
amendments to the Social Security Act and other laws to remove
references to the SSBG given its repeal. Subsection (c) of this
section specifies the effective date of the repeal of the SSBG,
which is October 1, 2016.
Reason for change
The SSBG began as a focused program created to match state
spending on helping welfare recipients reduce their dependence
on government benefits. Over ensuing decades, the program
evolved to cover more services, at greater federal cost, for
more beneficiaries, and with less accountability and fewer
measurable results. Since its creation, dozens of other
programs have been created to fund similar services, most of
which contain focused objectives, include better oversight, and
can point to tangible results.
Congress has generally agreed to share the cost of social
services with states. For those services not funded by the
federal government, states support services with their own
state funds, local funds, or even private dollars. The role of
the federal government has never been to pay for the full cost
of all types of programs and services that states provide to
assist families in need, nor should it be. Ending the
duplicative and unaccountable SSBG program means that states
will have to make choices in prioritizing assistance and
services. However, to support them and individuals in need,
states will continue to receive significant and rising funding
from the federal government for a range of other social service
programs, most of which requires some state contribution--
unlike SSBG. The Committee believes this will provide for a
stronger partnership between the federal government and states
and in the long run provide better social services for those in
need.
The decision to end funding for this program is based on
the Committee's view of the federal government's proper role in
helping states administer social services, as well as on
serious flaws in the design of the SSBG program. The Committee
does not believe continued funding for SSBG represents a wise
and effective use of taxpayer dollars, especially as the
Congress continues to provide hundreds of billions of dollars
each year to states for a range of social services in programs
that are more focused and more accountable than the SSBG.
The federal government can not afford to award money to
states with no focus, no accountability, and no proven results.
President Obama said as much in his FY 2013 budget document, in
which he stated ``for far too long, many [g]overnment programs
have been allowed to continue or to grow even when their
objectives are no longer clear and they lack rigorous
assessment of whether the programs are achieving the desired
goals. The result has been the profusion of programs that are
duplicative, ineffective, or outdated--at a significant cost to
taxpayers.''\18\ When a program is known to fund the same
services that are provided in literally dozens of other federal
programs, as well as having been repeatedly cited as
ineffective, the Committee believes it is our responsibility to
say it should end.
---------------------------------------------------------------------------
\18\Fiscal Year 2013 Budget of the U.S. Government: Cutting Waste,
Reducing the Deficit, and Asking All to Pay Their Fare Share. Accessed
March 23, 2016. Available online: http://www.whitehouse.gov/sites/
default/files/omb/budget/fy2013/assets/cutting.pdf.
---------------------------------------------------------------------------
Effective date
The provision is effective on October 1, 2016.
II. VOTES OF THE COMMITTEE
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, the following statement is made
concerning the vote of the Committee on Ways and Means in its
consideration of H.R. 4724, the Reducing Duplicative and
Ineffective Federal Funding Act, on March 16, 2016.
The Committee on Ways and Means marked up H.R. 4724, the
Reducing Duplicative and Ineffective Federal Funding Act, on
March 16, 2016. The bill, H.R. 4724, was ordered favorably
reported to the House of Representatives as amended by a roll
call vote of 20 yeas to 16 nays (with a quorum being present).
The vote was as follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady........................ X Mr. Levin.......... X
Mr. Johnson...................... X Mr. Rangel......... X
Mr. Nunes........................ X Mr. McDermott...... X
Mr. Tiberi....................... X Mr. Lewis.......... X
Mr. Reichert..................... X Mr. Neal........... X
Mr. Boustany..................... X Mr. Becerra........ X
Mr. Roskam....................... X Mr. Doggett........ X
Mr. Price........................ ....... Mr. Thompson....... X
Mr. Buchanan..................... ....... Mr. Larson......... X
Mr. Smith (NE)................... X Mr. Blumenauer..... X
Ms. Jenkins...................... X Mr. Kind........... X
Mr. Paulsen...................... X Mr. Pascrell....... X
Mr. Marchant..................... X Mr. Crowley........ X
Ms. Black........................ X Mr. Davis.......... X
Mr. Reed......................... X Ms. Sanchez........ X
Mr. Young........................ X
Mr. Kelly........................ X
Mr. Renacci...................... X
Mr. Meehan....................... X
Ms. Noem......................... X
Mr. Holding...................... X
Mr. Smith (MO)................... .......
Mr. Dold......................... ....... X
Mr. Rice......................... X
----------------------------------------------------------------------------------------------------------------
III. NEW BUDGET AUTHORITY AND TAX EXPENDITURES
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee states that the
bill involves no new budget authority or tax expenditure budget
authority.
IV. COST ESTIMATE PREPARED BY THE CONGRESSIONAL BUDGET OFFICE
In compliance with clause 3(c)(3) of rule XIII of the Rules
of the House of Representatives, requiring a cost estimate
prepared by the CBO, the Committee sets forth the following
estimate and comparison prepared by the Director of the
Congressional Budget Office.
U.S. Congress,
Congressional Budget Office,
Washington, DC, March 21, 2016.
Hon. Kevin Brady,
Chairman Committee on Ways and Means,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 4724, the Reducing
Duplicative and Ineffective Federal Funding Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Susanne S.
Mehlman.
Sincerely,
Keith Hall.
Enclosure.
H.R. 4724--Reducing Duplicative and Ineffective Federal Funding Act
Summary: H.R. 4724 would amend title XX of the Social
Security Act to repeal the Social Services Block Grant (SSBG)
program, effective October 1, 2016. SSBG, which is administered
by the Department of Health and Human Services, supports a
variety of activities, including child welfare services, day
care for both children and adults, counseling services, home-
delivered meals, and special services for the disabled. This
program has a permanent authorization of $1.7 billion per year.
Although funding for the program is provided in annual
appropriation acts, spending for SSBG is classified as direct
spending. CBO estimates that enacting this legislation would
reduce direct spending by $16.5 billion over the 2016-2026
period.
Because enacting the legislation would affect direct
spending, pay-as-you-go procedures apply. Enacting H.R. 4724
would not affect revenues. CBO estimates that enacting H.R.
4724 would not increase net direct spending or on-budget
deficits in any of the four consecutive 10-year periods
beginning in 2027.
H.R. 4724 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the federal government: The estimated
budgetary effect of this legislation is shown in the following
table. The costs of this legislation fall within budget
function 500 (education, training, employment, and social
services).
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in billions of dollars--
------------------------------------------------------------------------------------------------------------
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2016-2021 2016-2026
--------------------------------------------------------------------------------------------------------------------------------------------------------
DECREASE IN DIRECT SPENDING
Estimated Budget Authority................. 0 -1.6 -1.7 -1.7 -1.7 -1.7 -1.7 -1.7 -1.7 -1.7 -1.7 -8.4 -16.9
Estimated Outlays.......................... 0 -1.3 -1.6 -1.7 -1.7 -1.7 -1.7 -1.7 -1.7 -1.7 -1.7 -8.0 -16.5
--------------------------------------------------------------------------------------------------------------------------------------------------------
Basis of estimate: For this estimate, CBO assumes that H.R.
4724 will be enacted by the start of 2017 and outlays will
follow historical patterns. Under the procedures established in
the Budget Control Act of 2011 for sequestration, the Office of
Management and Budget has announced that the amount
appropriated for SSBG in 2017 will be reduced by 6.9 percent.
Thus, although SSBG has an annual authorization of $1.7
billion, the savings in budget authority in 2017 would be $1.6
billion, which would lead to outlay savings of $1.3 billion
that year.
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. CB0 estimates that repealing SSBG would reduce direct
spending over the 2016-2026 period as shown in the following
table.
CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 4724 AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON WAYS AND MEANS ON MARCH 16, 2016
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in billions of dollars--
------------------------------------------------------------------------------------------------------------
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2016-2021 2016-2026
--------------------------------------------------------------------------------------------------------------------------------------------------------
NET DECREASE IN THE DEFICIT
Statutory Pay-As-You-Go Impact............. 0 -1.3 -1.6 -1.7 -1.7 -1.7 -1.7 -1.7 -1.7 -1.7 -1.7 -8.0 -16.5
--------------------------------------------------------------------------------------------------------------------------------------------------------
Increase in long-term direct spending and deficits: CBO
estimates that enacting the legislation would not increase net
direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2027.
Intergovernmental and private-sector impact: For large
entitlement programs like the SSBG program, UMRA defines a
reduction in funding as an intergovernmental mandate if the
affected governments lack authority to amend their financial or
programmatic responsibilities to continue providing required
services. The bill would repeal funding for the SSBG program
and all conditions of assistance associated with the program.
Because states would be under no obligation to continue
providing services funded by SSBG, the repeal would not impose
an intergovernmental mandate as defined in UMRA. However,
states would either have to eliminate services or use their own
funds to support current programs. CBO estimates that the
repeal would reduce federal aid to states by $1.3 billion in
2017 and by $16.5 billion over the 2017-2026 period.
The bill contains no private-sector mandates as defined in
UMRA.
Estimate prepared by: Federal Costs: Jennifer Gray and
Susanne S. Mehlman; Impact on State, Local, and Tribal
Governments: J'Nell Blanco Suchy; Impact on the Private Sector:
Paige Piper/Bach.
Estimate approved by: H. Samuel Papenfuss, Deputy Assistant
Director for Budget Analysis.
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE
A. Committee Oversight Findings and Recommendations
With respect to clause 3(c)(1) of rule XIII of the Rules of
the House of Representatives, the Committee advises that the
findings and recommendations of the Committee, based on
oversight activities under clause 2(b)(1) of Rule X of the
Rules of the House of Representatives, are incorporated in the
description portions of this report.
B. Statement of General Performance Goals and Objectives
With respect to the requirement of clause 3(c)(4) of rule
XIII of the Rules of the House of Representatives, the
performance goals and objectives of this legislation are to end
funding for the Social Services Block Grant, beginning October
1, 2016.
C. Applicability of House Rule XXI 5(b)
Rule XXI 5(b) of the Rules of the House of Representatives
provides, in part, that ``A bill or joint resolution,
amendment, or conference report carrying a Federal income tax
rate increase may not be considered as passed or agreed to
unless so determined by a vote of not less than three-fifths of
the Members voting, a quorum being present.'' The Committee has
carefully reviewed the bill, and states that the bill does not
involve any Federal income tax rate increases within the
meaning of the rule.
D. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff
Benefits
With respect to clause 9 of rule XXI of the Rules of the
House of Representatives, the Committee has carefully reviewed
the provisions of the bill, and states that the provisions of
the bill do not contain any congressional earmarks, limited tax
benefits, or limited tariff benefits within the meaning of the
rule.
E. Duplication of Federal Programs
In compliance with Sec. 3(g)(2) of H. Res. 5 (114th
Congress), the Committee states that no provision of the bill
establishes or reauthorizes: (1) a program of the Federal
Government known to be duplicative of another Federal program;
(2) a program included in any report from the Government
Accountability Office to Congress pursuant to section 21 of
Public Law 111-139; or (3) a program related to a program
identified in the most recent Catalog of Federal Domestic
Assistance, published pursuant to the Federal Program
Information Act (Pub. L. No. 95-220, as amended by Pub. L. No.
98-169).
F. Disclosure of Directed Rule Makings
In compliance with Sec. 3(i) of H. Res. 5 (114th Congress),
the following statement is made concerning directed rule
makings: The Committee estimates that the bill requires no
directed rule makings within the meaning of such section.
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
A. Text of Existing Law Amended or Repealed by the Bill, as Reported
In compliance with clause 3(e)(1)(A) of rule XIII of the
Rules of the House of Representatives, the text of each section
proposed to be amended or repealed by the bill, as reported, is
shown below:
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e)(1)(A) of rule XIII of the
Rules of the House of Representatives, the text of each section
proposed to be amended or repealed by the bill, as reported, is
shown below:
SOCIAL SECURITY ACT
* * * * * * *
TITLE IV--GRANTS TO STATES FOR AID AND SERVICES TO NEEDY FAMILIES WITH
CHILDREN AND FOR CHILD-WELFARE SERVICES
PART A--BLOCK GRANTS TO STATES FOR TEMPORARY ASSISTANCE FOR NEEDY
FAMILIES
* * * * * * *
SEC. 404. USE OF GRANTS.
(a) General Rules.--Subject to this part, a State to which a
grant is made under section 403 may use the grant--
(1) in any manner that is reasonably calculated to
accomplish the purpose of this part, including to
provide low income households with assistance in
meeting home heating and cooling costs; or
(2) in any manner that the State was authorized to
use amounts received under part A or F, as such parts
were in effect on September 30, 1995, or (at the option
of the State) August 21, 1996.
(b) Limitation on Use of Grant for Administrative Purposes.--
(1) Limitation.--A State to which a grant is made
under section 403 shall not expend more than 15 percent
of the grant for administrative purposes.
(2) Exception.--Paragraph (1) shall not apply to the
use of a grant for information technology and
computerization needed for tracking or monitoring
required by or under this part.
(c) Authority To Treat Interstate Immigrants Under Rules of
Former State.--A State operating a program funded under this
part may apply to a family the rules (including benefit
amounts) of the program funded under this part of another State
if the family has moved to the State from the other State and
has resided in the State for less than 12 months.
(d) Authority To Use Portion of Grant for Other Purposes.--
(1) In general.--Subject to paragraph (2), a State
may use not more than 30 percent of the amount of any
grant made to the State under section 403(a) for a
fiscal year to carry out a State program pursuant to
any or all of the following provisions of law:
(A) Subtitle A of title XX of this Act.
(B) The Child Care and Development Block
Grant Act of 1990.
(2) Limitation on amount transferable to subtitle 1
of title xx programs.--
(A) In general.--A State may use not more
than the applicable percent of the amount of
any grant made to the State under section
403(a) for a fiscal year to carry out State
programs pursuant to subtitle 1 of title XX.
(B) Applicable percent.--For purposes of
subparagraph (A), the applicable percent is
4.25 percent in the case of fiscal year 2001
and each succeeding fiscal year.
(3) Applicable rules.--
(A) In general.--Except as provided in
subparagraph (B) of this paragraph, any amount
paid to a State under this part that is used to
carry out a State program pursuant to a
provision of law specified in paragraph (1)
shall not be subject to the requirements of
this part, but shall be subject to the
requirements that apply to Federal funds
provided directly under the provision of law to
carry out the program, and the expenditure of
any amount so used shall not be considered to
be an expenditure under this part.
(B) Exception relating to subtitle 1 of title
xx programs.--All amounts paid to a State under
this part that are used to carry out State
programs pursuant to subtitle 1 of title XX
shall be used only for programs and services to
children or their families whose income is less
than 200 percent of the income official poverty
line (as defined by the Office of Management
and Budget, and revised annually in accordance
with section 673(2) of the Omnibus Budget
Reconciliation Act of 1981) applicable to a
family of the size involved.
(e) Authority to Carry Over Certain Amounts for Benefits or
Services or for Future Contingencies.--A State or tribe may use
a grant made to the State or tribe under this part for any
fiscal year to provide, without fiscal year limitation, any
benefit or service that may be provided under the State or
tribal program funded under this part.
(f) Authority to Operate Employment Placement Program.--A
State to which a grant is made under section 403 may use the
grant to make payments (or provide job placement vouchers) to
State-approved public and private job placement agencies that
provide employment placement services to individuals who
receive assistance under the State program funded under this
part.
(g) Implementation of Electronic Benefit Transfer System.--A
State to which a grant is made under section 403 is encouraged
to implement an electronic benefit transfer system for
providing assistance under the State program funded under this
part, and may use the grant for such purpose.
(h) Use of Funds for Individual Development Accounts.--
(1) In general.--A State to which a grant is made
under section 403 may use the grant to carry out a
program to fund individual development accounts (as
defined in paragraph (2)) established by individuals
eligible for assistance under the State program funded
under this part.
(2) Individual development accounts.--
(A) Establishment.--Under a State program
carried out under paragraph (1), an individual
development account may be established by or on
behalf of an individual eligible for assistance
under the State program operated under this
part for the purpose of enabling the individual
to accumulate funds for a qualified purpose
described in subparagraph (B).
(B) Qualified purpose.--A qualified purpose
described in this subparagraph is 1 or more of
the following, as provided by the qualified
entity providing assistance to the individual
under this subsection:
(i) Postsecondary educational
expenses.--Postsecondary educational
expenses paid from an individual
development account directly to an
eligible educational institution.
(ii) First home purchase.--Qualified
acquisition costs with respect to a
qualified principal residence for a
qualified first-time homebuyer, if paid
from an individual development account
directly to the persons to whom the
amounts are due.
(iii) Business capitalization.--
Amounts paid from an individual
development account directly to a
business capitalization account which
is established in a federally insured
financial institution and is restricted
to use solely for qualified business
capitalization expenses.
(C) Contributions to be from earned income.--
An individual may only contribute to an
individual development account such amounts as
are derived from earned income, as defined in
section 911(d)(2) of the Internal Revenue Code
of 1986.
(D) Withdrawal of funds.--The Secretary shall
establish such regulations as may be necessary
to ensure that funds held in an individual
development account are not withdrawn except
for 1 or more of the qualified purposes
described in subparagraph (B).
(3) Requirements.--
(A) In general.--An individual development
account established under this subsection shall
be a trust created or organized in the United
States and funded through periodic
contributions by the establishing individual
and matched by or through a qualified entity
for a qualified purpose (as described in
paragraph (2)(B)).
(B) Qualified entity.--As used in this
subsection, the term ``qualified entity''
means--
(i) a not-for-profit organization
described in section 501(c)(3) of the
Internal Revenue Code of 1986 and
exempt from taxation under section
501(a) of such Code; or
(ii) a State or local government
agency acting in cooperation with an
organization described in clause (i).
(4) No reduction in benefits.--Notwithstanding any
other provision of Federal law (other than the Internal
Revenue Code of 1986) that requires consideration of 1
or more financial circumstances of an individual, for
the purpose of determining eligibility to receive, or
the amount of, any assistance or benefit authorized by
such law to be provided to or for the benefit of such
individual, funds (including interest accruing) in an
individual development account under this subsection
shall be disregarded for such purpose with respect to
any period during which such individual maintains or
makes contributions into such an account.
(5) Definitions.--As used in this subsection--
(A) Eligible educational institution.--The
term ``eligible educational institution'' means
the following:
(i) An institution described in
section 481(a)(1) or 1201(a) of the
Higher Education Act of 1965 (20 U.S.C.
1088(a)(1) or 1141(a)), as such
sections are in effect on the date of
the enactment of this subsection.
(ii) An area vocational education
school (as defined in subparagraph (C)
or (D) of section 521(4) of the Carl D.
Perkins Vocational and Applied
Technology Education Act (20 U.S.C.
2471(4))) which is in any State (as
defined in section 521(33) of such
Act), as such sections are in effect on
the date of the enactment of this
subsection.
(B) Post-secondary educational expenses.--The
term ``post-secondary educational expenses''
means--
(i) tuition and fees required for the
enrollment or attendance of a student
at an eligible educational institution,
and
(ii) fees, books, supplies, and
equipment required for courses of
instruction at an eligible educational
institution.
(C) Qualified acquisition costs.--The term
``qualified acquisition costs'' means the costs
of acquiring, constructing, or reconstructing a
residence. The term includes any usual or
reasonable settlement, financing, or other
closing costs.
(D) Qualified business.--The term ``qualified
business'' means any business that does not
contravene any law or public policy (as
determined by the Secretary).
(E) Qualified business capitalization
expenses.--The term ``qualified business
capitalization expenses'' means qualified
expenditures for the capitalization of a
qualified business pursuant to a qualified
plan.
(F) Qualified expenditures.--The term
``qualified expenditures'' means expenditures
included in a qualified plan, including
capital, plant, equipment, working capital, and
inventory expenses.
(G) Qualified first-time homebuyer.--
(i) In general.--The term ``qualified
first-time homebuyer'' means a taxpayer
(and, if married, the taxpayer's
spouse) who has no present ownership
interest in a principal residence
during the 3-year period ending on the
date of acquisition of the principal
residence to which this subsection
applies.
(ii) Date of acquisition.--The term
``date of acquisition'' means the date
on which a binding contract to acquire,
construct, or reconstruct the principal
residence to which this subparagraph
applies is entered into.
(H) Qualified plan.--The term ``qualified
plan'' means a business plan which--
(i) is approved by a financial
institution, or by a nonprofit loan
fund having demonstrated fiduciary
integrity,
(ii) includes a description of
services or goods to be sold, a
marketing plan, and projected financial
statements, and
(iii) may require the eligible
individual to obtain the assistance of
an experienced entrepreneurial advisor.
(I) Qualified principal residence.--The term
``qualified principal residence'' means a
principal residence (within the meaning of
section 1034 of the Internal Revenue Code of
1986), the qualified acquisition costs of which
do not exceed 100 percent of the average area
purchase price applicable to such residence
(determined in accordance with paragraphs (2)
and (3) of section 143(e) of such Code).
(i) Sanction Welfare Recipients for Failing To Ensure That
Minor Dependent Children Attend School.--A State to which a
grant is made under section 403 shall not be prohibited from
sanctioning a family that includes an adult who has received
assistance under any State program funded under this part
attributable to funds provided by the Federal Government or
under the supplemental nutrition assistance program, as defined
in section 3(l) of the Food and Nutrition Act of 2008, if such
adult fails to ensure that the minor dependent children of such
adult attend school as required by the law of the State in
which the minor children reside.
(j) Requirement for High School Diploma or Equivalent.--A
State to which a grant is made under section 403 shall not be
prohibited from sanctioning a family that includes an adult who
is older than age 20 and younger than age 51 and who has
received assistance under any State program funded under this
part attributable to funds provided by the Federal Government
or under the supplemental nutrition assistance program, as
defined in section 3(l) of the Food and Nutrition Act of 2008,
if such adult does not have, or is not working toward
attaining, a secondary school diploma or its recognized
equivalent unless such adult has been determined in the
judgment of medical, psychiatric, or other appropriate
professionals to lack the requisite capacity to complete
successfully a course of study that would lead to a secondary
school diploma or its recognized equivalent.
(k) Limitations on Use of Grant for Matching Under Certain
Federal Transportation Program.--
(1) Use limitations.--A State to which a grant is
made under section 403 may not use any part of the
grant to match funds made available under section 3037
of the Transportation Equity Act for the 21st Century,
unless--
(A) the grant is used for new or expanded
transportation services (and not for
construction) that benefit individuals
described in subparagraph (C), and not to
subsidize current operating costs;
(B) the grant is used to supplement and not
supplant other State expenditures on
transportation;
(C) the preponderance of the benefits derived
from such use of the grant accrues to
individuals who are--
(i) recipients of assistance under
the State program funded under this
part;
(ii) former recipients of such
assistance;
(iii) noncustodial parents who are
described in section 403(a)(5)(C)(iii);
and
(iv) low-income individuals who are
at risk of qualifying for such
assistance; and
(D) the services provided through such use of
the grant promote the ability of such
recipients to engage in work activities (as
defined in section 407(d)).
(2) Amount limitation.--From a grant made to a State
under section 403(a), the amount that a State uses to
match funds described in paragraph (1) of this
subsection shall not exceed the amount (if any) by
which 30 percent of the total amount of the grant
exceeds the amount (if any) of the grant that is used
by the State to carry out any State program described
in subsection (d)(1) of this section.
(3) Rule of interpretation.--The provision by a State
of a transportation benefit under a program conducted
under section 3037 of the Transportation Equity Act for
the 21st Century, to an individual who is not otherwise
a recipient of assistance under the State program
funded under this part, using funds from a grant made
under section 403(a) of this Act, shall not be
considered to be the provision of assistance to the
individual under the State program funded under this
part.
* * * * * * *
PART B--CHILD AND FAMILY SERVICES
Subpart 1--Stephanie Tubbs Jones Child Welfare Services Program
* * * * * * *
STATE PLANS FOR CHILD WELFARE SERVICES
Sec. 422. (a) In order to be eligible for payment under this
subpart, a State must have a plan for child welfare services
which has been developed jointly by the Secretary and the State
agency designated pursuant to subsection (b)(1), and which
meets the requirements of subsection (b).
(b) Each plan for child welfare services under this subpart
shall--
(1) provide that (A) the individual or agency that
administers or supervises the administration of the
State's services program under subtitle 1 of title XX
will administer or supervise the administration of the
plan (except as otherwise provided in section 103(d) of
the Adoption Assistance and Child Welfare Act of 1980),
and (B) to the extent that child welfare services are
furnished by the staff of the State agency or local
agency administering the plan, a single organizational
unit in such State or local agency, as the case may be,
will be responsible for furnishing such child welfare
services;
(2) provide for coordination between the services
provided for children under the plan and the services
and assistance provided under subtitle 1 of title XX,
under the State program funded under part A, under the
State plan approved under subpart 2 of this part, under
the State plan approved under the State plan approved
under part E, and under other State programs having a
relationship to the program under this subpart, with a
view to provision of welfare and related services which
will best promote the welfare of such children and
their families;
(3) include a description of the services and
activities which the State will fund under the State
program carried out pursuant to this subpart, and how
the services and activities will achieve the purpose of
this subpart;
(4) contain a description of--
(A) the steps the State will take to provide
child welfare services statewide and to expand
and strengthen the range of existing services
and develop and implement services to improve
child outcomes; and
(B) the child welfare services staff
development and training plans of the State;
(5) provide, in the development of services for
children, for utilization of the facilities and
experience of voluntary agencies in accordance with
State and local programs and arrangements, as
authorized by the State;
(6) provide that the agency administering or
supervising the administration of the plan will furnish
such reports, containing such information, and
participate in such evaluations, as the Secretary may
require;
(7) provide for the diligent recruitment of potential
foster and adoptive families that reflect the ethnic
and racial diversity of children in the State for whom
foster and adoptive homes are needed;
(8) provide assurances that the State--
(A) is operating, to the satisfaction of the
Secretary--
(i) a statewide information system
from which can be readily determined
the status, demographic
characteristics, location, and goals
for the placement of every child who is
(or, within the immediately preceding
12 months, has been) in foster care;
(ii) a case review system (as defined
in section 475(5) and in accordance
with the requirements of section 475A)
for each child receiving foster care
under the supervision of the State;
(iii) a service program designed to
help children--
(I) where safe and
appropriate, return to families
from which they have been
removed; or
(II) be placed for adoption,
with a legal guardian, or if
adoption or legal guardianship
is determined not to be
appropriate for a child, in
some other planned, permanent
living arrangement, subject to
the requirements of sections
475(5)(C) and 475A(a), which
may include a residential
educational program; and
(iv) a preplacement preventive
services program designed to help
children at risk of foster care
placement remain safely with their
families; and
(B) has in effect policies and administrative
and judicial procedures for children abandoned
at or shortly after birth (including policies
and procedures providing for legal
representation of the children) which enable
permanent decisions to be made expeditiously
with respect to the placement of the children;
(9) contain a description, developed after
consultation with tribal organizations (as defined in
section 4 of the Indian Self-Determination and
Education Assistance Act) in the State, of the specific
measures taken by the State to comply with the Indian
Child Welfare Act;
(10) contain assurances that the State shall make
effective use of cross-jurisdictional resources
(including through contracts for the purchase of
services), and shall eliminate legal barriers, to
facilitate timely adoptive or permanent placements for
waiting children;
(11) contain a description of the activities that the
State has undertaken for children adopted from other
countries, including the provision of adoption and
post-adoption services;
(12) provide that the State shall collect and report
information on children who are adopted from other
countries and who enter into State custody as a result
of the disruption of a placement for adoption or the
dissolution of an adoption, including the number of
children, the agencies who handled the placement or
adoption, the plans for the child, and the reasons for
the disruption or dissolution;
(13) demonstrate substantial, ongoing, and meaningful
collaboration with State courts in the development and
implementation of the State plan under subpart 1, the
State plan approved under subpart 2, and the State plan
approved under part E, and in the development and
implementation of any program improvement plan required
under section 1123A;
(14) not later than October 1, 2007, include
assurances that not more than 10 percent of the
expenditures of the State with respect to activities
funded from amounts provided under this subpart will be
for administrative costs;
(15)(A) provides that the State will develop, in
coordination and collaboration with the State agency
referred to in paragraph (1) and the State agency
responsible for administering the State plan approved
under title XIX, and in consultation with
pediatricians, other experts in health care, and
experts in and recipients of child welfare services, a
plan for the ongoing oversight and coordination of
health care services for any child in a foster care
placement, which shall ensure a coordinated strategy to
identify and respond to the health care needs of
children in foster care placements, including mental
health and dental health needs, and shall include an
outline of--
(i) a schedule for initial and
follow-up health screenings that meet
reasonable standards of medical
practice;
(ii) how health needs identified
through screenings will be monitored
and treated, including emotional trauma
associated with a child's maltreatment
and removal from home;
(iii) how medical information for
children in care will be updated and
appropriately shared, which may include
the development and implementation of
an electronic health record;
(iv) steps to ensure continuity of
health care services, which may include
the establishment of a medical home for
every child in care;
(v) the oversight of prescription
medicines, including protocols for the
appropriate use and monitoring of
psychotropic medications;
(vi) how the State actively consults
with and involves physicians or other
appropriate medical or non-medical
professionals in assessing the health
and well-being of children in foster
care and in determining appropriate
medical treatment for the children; and
(vii) steps to ensure that the
components of the transition plan
development process required under
section 475(5)(H) that relate to the
health care needs of children aging out
of foster care, including the
requirements to include options for
health insurance, information about a
health care power of attorney, health
care proxy, or other similar document
recognized under State law, and to
provide the child with the option to
execute such a document, are met; and
(B) subparagraph (A) shall not be construed to reduce
or limit the responsibility of the State agency
responsible for administering the State plan approved
under title XIX to administer and provide care and
services for children with respect to whom services are
provided under the State plan developed pursuant to
this subpart;
(16) provide that, not later than 1 year after the
date of the enactment of this paragraph, the State
shall have in place procedures providing for how the
State programs assisted under this subpart, subpart 2
of this part, or part E would respond to a disaster, in
accordance with criteria established by the Secretary
which should include how a State would--
(A) identify, locate, and continue
availability of services for children under
State care or supervision who are displaced or
adversely affected by a disaster;
(B) respond, as appropriate, to new child
welfare cases in areas adversely affected by a
disaster, and provide services in those cases;
(C) remain in communication with caseworkers
and other essential child welfare personnel who
are displaced because of a disaster;
(D) preserve essential program records; and
(E) coordinate services and share information
with other States;
(17) not later than October 1, 2007, describe the
State standards for the content and frequency of
caseworker visits for children who are in foster care
under the responsibility of the State, which, at a
minimum, ensure that the children are visited on a
monthly basis and that the caseworker visits are well-
planned and focused on issues pertinent to case
planning and service delivery to ensure the safety,
permanency, and well-being of the children;
(18) include a description of the activities that the
State has undertaken to reduce the length of time
children who have not attained 5 years of age are
without a permanent family, and the activities the
State undertakes to address the developmental needs of
such children who receive benefits or services under
this part or part E; and
(19) contain a description of the sources used to
compile information on child maltreatment deaths
required by Federal law to be reported by the State
agency referred to in paragraph (1), and to the extent
that the compilation does not include information on
such deaths from the State vital statistics department,
child death review teams, law enforcement agencies, or
offices of medical examiners or coroners, the State
shall describe why the information is not so included
and how the State will include the information.
(c) Definitions.--In this subpart:
(1) Administrative costs.--The term ``administrative
costs'' means costs for the following, but only to the
extent incurred in administering the State plan
developed pursuant to this subpart: procurement,
payroll management, personnel functions (other than the
portion of the salaries of supervisors attributable to
time spent directly supervising the provision of
services by caseworkers), management, maintenance and
operation of space and property, data processing and
computer services, accounting, budgeting, auditing, and
travel expenses (except those related to the provision
of services by caseworkers or the oversight of programs
funded under this subpart).
(2) Other terms.--For definitions of other terms used
in this part, see section 475.
* * * * * * *
Part E--Federal Payments for Foster Care and Adoption Assistance
* * * * * * *
STATE PLAN FOR FOSTER CARE AND ADOPTION ASSISTANCE
Sec. 471. (a) In order for a State to be eligible for
payments under this part, it shall have a plan approved by the
Secretary which--
(1) provides for foster care maintenance payments in
accordance with section 472 and for adoption assistance
in accordance with section 473;
(2) provides that the State agency responsible for
administering the program authorized by subpart 1 of
part B of this title shall administer, or supervise the
administration of, the program authorized by this part;
(3) provides that the plan shall be in effect in all
political subdivisions of the State, and, if
administered by them, be mandatory upon them;
(4) provides that the State shall assure that the
programs at the local level assisted under this part
will be coordinated with the programs at the State or
local level assisted under parts A and B of this title,
under subtitle 1 of title XX of this Act, and under any
other appropriate provision of Federal law;
(5) provides that the State will, in the
administration of its programs under this part, use
such methods relating to the establishment and
maintenance of personnel standards on a merit basis as
are found by the Secretary to be necessary for the
proper and efficient operation of the programs, except
that the Secretary shall exercise no authority with
respect to the selection, tenure of office, or
compensation of any individual employed in accordance
with such methods;
(6) provides that the State agency referred to in
paragraph (2) (hereinafter in this part referred to as
the ``State agency'') will make such reports, in such
form and containing such information as the Secretary
may from time to time require, and comply with such
provisions as the Secretary may from time to time find
necessary to assure the correctness and verification of
such reports;
(7) provides that the State agency will monitor and
conduct periodic evaluations of activities carried out
under this part;
(8) subject to subsection (c), provides safeguards
which restrict the use of or disclosure of information
concerning individuals assisted under the State plan to
purposes directly connected with (A) the administration
of the plan of the State approved under this part, the
plan or program of the State under part A, B, or D of
this title or under title I, V, X, XIV, XVI (as in
effect in Puerto Rico, Guam, and the Virgin Islands),
XIX, or XX, or the supplemental security income program
established by title XVI, (B) any investigation,
prosecution, or criminal or civil proceeding, conducted
in connection with the administration of any such plan
or program, (C) the administration of any other Federal
or federally assisted program which provides
assistance, in cash or in kind, or services, directly
to individuals on the basis of need, (D) any audit or
similar activity conducted in connection with the
administration of any such plan or program by any
governmental agency which is authorized by law to
conduct such audit or activity, and (E) reporting and
providing information pursuant to paragraph (9) to
appropriate authorities with respect to known or
suspected child abuse or neglect; and the safeguards so
provided shall prohibit disclosure, to any committee or
legislative body (other than an agency referred to in
clause (D) with respect to an activity referred to in
such clause), of any information which identifies by
name or address any such applicant or recipient; except
that nothing contained herein shall preclude a State
from providing standards which restrict disclosures to
purposes more limited than those specified herein, or
which, in the case of adoptions, prevent disclosure
entirely;
(9) provides that the State agency will--
(A) report to an appropriate agency or
official, known or suspected instances of
physical or mental injury, sexual abuse or
exploitation, or negligent treatment or
maltreatment of a child receiving aid under
part B or this part under circumstances which
indicate that the child's health or welfare is
threatened thereby;
(B) provide such information with respect to
a situation described in subparagraph (A) as
the State agency may have; and
(C) not later than--
(i) 1 year after the date of
enactment of this subparagraph,
demonstrate to the Secretary that the
State agency has developed, in
consultation with State and local law
enforcement, juvenile justice systems,
health care providers, education
agencies, and organizations with
experience in dealing with at-risk
children and youth, policies and
procedures (including relevant training
for caseworkers) for identifying,
documenting in agency records, and
determining appropriate services with
respect to--
(I) any child or youth over
whom the State agency has
responsibility for placement,
care, or supervision and who
the State has reasonable cause
to believe is, or is at risk of
being, a sex trafficking victim
(including children for whom a
State child welfare agency has
an open case file but who have
not been removed from the home,
children who have run away from
foster care and who have not
attained 18 years of age or
such older age as the State has
elected under section 475(8) of
this Act, and youth who are not
in foster care but are
receiving services under
section 477 of this Act); and
(II) at the option of the
State, any individual who has
not attained 26 years of age,
without regard to whether the
individual is or was in foster
care under the responsibility
of the State; and
(ii) 2 years after such date of
enactment, demonstrate to the Secretary
that the State agency is implementing
the policies and procedures referred to
in clause (i).
(10) provides--
(A) for the establishment or designation of a
State authority or authorities that shall be
responsible for establishing and maintaining
standards for foster family homes and child
care institutions which are reasonably in
accord with recommended standards of national
organizations concerned with standards for the
institutions or homes, including standards
related to admission policies, safety,
sanitation, and protection of civil rights, and
which shall permit use of the reasonable and
prudent parenting standard;
(B) that the standards established pursuant
to subparagraph (A) shall be applied by the
State to any foster family home or child care
institution receiving funds under this part or
part B and shall require, as a condition of
each contract entered into by a child care
institution to provide foster care, the
presence on-site of at least 1 official who,
with respect to any child placed at the child
care institution, is designated to be the
caregiver who is authorized to apply the
reasonable and prudent parent standard to
decisions involving the participation of the
child in age or developmentally-appropriate
activities, and who is provided with training
in how to use and apply the reasonable and
prudent parent standard in the same manner as
prospective foster parents are provided the
training pursuant to paragraph (24);
(C) that the standards established pursuant
to subparagraph (A) shall include policies
related to the liability of foster parents and
private entities under contract by the State
involving the application of the reasonable and
prudent parent standard, to ensure appropriate
liability for caregivers when a child
participates in an approved activity and the
caregiver approving the activity acts in
accordance with the reasonable and prudent
parent standard; and
(D) that a waiver of any standards
established pursuant to subparagraph (A) may be
made only on a case-by-case basis for nonsafety
standards (as determined by the State) in
relative foster family homes for specific
children in care;
(11) provides for periodic review of the standards
referred to in the preceding paragraph and amounts paid
as foster care maintenance payments and adoption
assistance to assure their continuing appropriateness;
(12) provides for granting an opportunity for a fair
hearing before the State agency to any individual whose
claim for benefits available pursuant to this part is
denied or is not acted upon with reasonable promptness;
(13) provides that the State shall arrange for a
periodic and independently conducted audit of the
programs assisted under this part and part B of this
title, which shall be conducted no less frequently than
once every three years;
(14) provides (A) specific goals (which shall be
established by State law on or before October 1, 1982)
for each fiscal year (commencing with the fiscal year
which begins on October 1, 1983) as to the maximum
number of children (in absolute numbers or as a
percentage of all children in foster care with respect
to whom assistance under the plan is provided during
such year) who, at any time during such year, will
remain in foster care after having been in such care
for a period in excess of twenty-four months, and (B) a
description of the steps which will be taken by the
State to achieve such goals;
(15) provides that--
(A) in determining reasonable efforts to be
made with respect to a child, as described in
this paragraph, and in making such reasonable
efforts, the child's health and safety shall be
the paramount concern;
(B) except as provided in subparagraph (D),
reasonable efforts shall be made to preserve
and reunify
families--
(i) prior to the placement of a child
in foster care, to prevent or eliminate
the need for removing the child from
the child's home; and
(ii) to make it possible for a child
to safely return to the child's home;
(C) if continuation of reasonable efforts of
the type described in subparagraph (B) is
determined to be inconsistent with the
permanency plan for the child, reasonable
efforts shall be made to place the child in a
timely manner in accordance with the permanency
plan (including, if appropriate, through an
interstate placement), and to complete whatever
steps are necessary to finalize the permanent
placement of the child;
(D) reasonable efforts of the type described
in subparagraph (B) shall not be required to be
made with respect to a parent of a child if a
court of competent jurisdiction has determined
that--
(i) the parent has subjected the
child to aggravated circumstances (as
defined in State law, which definition
may include but need not be limited to
abandonment, torture, chronic abuse,
and sexual abuse);
(ii) the parent has--
(I) committed murder (which
would have been an offense
under section 1111(a) of title
18, United States Code, if the
offense had occurred in the
special maritime or territorial
jurisdiction of the United
States) of another child of the
parent;
(II) committed voluntary
manslaughter (which would have
been an offense under section
1112(a) of title 18, United
States Code, if the offense had
occurred in the special
maritime or territorial
jurisdiction of the United
States) of another child of the
parent;
(III) aided or abetted,
attempted, conspired, or
solicited to commit such a
murder or such a voluntary
manslaughter; or
(IV) committed a felony
assault that results in serious
bodily injury to the child or
another child of the parent; or
(iii) the parental rights of the
parent to a sibling have been
terminated involuntarily;
(E) if reasonable efforts of the type
described in subparagraph (B) are not made with
respect to a child as a result of a
determination made by a court of competent
jurisdiction in accordance with subparagraph
(D)--
(i) a permanency hearing (as
described in section 475(5)(C)), which
considers in-State and out-of-State
permanent placement options for the
child, shall be held for the child
within 30 days after the determination;
and
(ii) reasonable efforts shall be made
to place the child in a timely manner
in accordance with the permanency plan,
and to complete whatever steps are
necessary to finalize the permanent
placement of the child; and
(F) reasonable efforts to place a child for
adoption or with a legal guardian, including
identifying appropriate in-State and out-of-
State placements may be made concurrently with
reasonable efforts of the type described in
subparagraph (B);
(16) provides for the development of a case plan (as
defined in section 475(1) and in accordance with the
requirements of section 475A) for each child receiving
foster care maintenance payments under the State plan
and provides for a case review system which meets the
requirements described in sections 475(5) and 475A with
respect to each such child;
(17) provides that, where appropriate, all steps will
be taken, including cooperative efforts with the State
agencies administering the program funded under part A
and plan approved under part D, to secure an assignment
to the State of any rights to support on behalf of each
child receiving foster care maintenance payments under
this part;
(18) not later than January 1, 1997, provides that
neither the State nor any other entity in the State
that receives funds from the Federal Government and is
involved in adoption or foster care placements may--
(A) deny to any person the opportunity to
become an adoptive or a foster parent, on the
basis of the race, color, or national origin of
the person, or of the child, involved; or
(B) delay or deny the placement of a child
for adoption or into foster care, on the basis
of the race, color, or national origin of the
adoptive or foster parent, or the child,
involved;
(19) provides that the State shall consider giving
preference to an adult relative over a non-related
caregiver when determining a placement for a child,
provided that the relative caregiver meets all relevant
State child protection standards;
(20)(A) provides procedures for criminal records
checks, including fingerprint-based checks of national
crime information databases (as defined in section
534(e)(3)(A) of title 28, United States Code), for any
prospective foster or adoptive parent before the foster
or adoptive parent may be finally approved for
placement of a child regardless of whether foster care
maintenance payments or adoption assistance payments
are to be made on behalf of the child under the State
plan under this part, including procedures requiring
that--
(i) in any case involving a child on whose
behalf such payments are to be so made in which
a record check reveals a felony conviction for
child abuse or neglect, for spousal abuse, for
a crime against children (including child
pornography), or for a crime involving
violence, including rape, sexual assault, or
homicide, but not including other physical
assault or battery, if a State finds that a
court of competent jurisdiction has determined
that the felony was committed at any time, such
final approval shall not be granted; and
(ii) in any case involving a child on whose
behalf such payments are to be so made in which
a record check reveals a felony conviction for
physical assault, battery, or a drug-related
offense, if a State finds that a court of
competent jurisdiction has determined that the
felony was committed within the past 5 years,
such final approval shall not be granted; and
(B) provides that the State shall--
(i) check any child abuse and neglect
registry maintained by the State for
information on any prospective foster or
adoptive parent and on any other adult living
in the home of such a prospective parent, and
request any other State in which any such
prospective parent or other adult has resided
in the preceding 5 years, to enable the State
to check any child abuse and neglect registry
maintained by such other State for such
information, before the prospective foster or
adoptive parent may be finally approved for
placement of a child, regardless of whether
foster care maintenance payments or adoption
assistance payments are to be made on behalf of
the child under the State plan under this part;
(ii) comply with any request described in
clause (i) that is received from another State;
and
(iii) have in place safeguards to prevent the
unauthorized disclosure of information in any
child abuse and neglect registry maintained by
the State, and to prevent any such information
obtained pursuant to this subparagraph from
being used for a purpose other than the
conducting of background checks in foster or
adoptive placement cases; and
(C) provides procedures for criminal records checks,
including fingerprint-based checks of national crime
information databases (as defined in section
534(e)(3)(A) of title 28, United States Code), on any
relative guardian, and for checks described in
subparagraph (B) of this paragraph on any relative
guardian and any other adult living in the home of any
relative guardian, before the relative guardian may
receive kinship guardianship assistance payments on
behalf of the child under the State plan under this
part;
(21) provides for health insurance coverage
(including, at State option, through the program under
the State plan approved under title XIX) for any child
who has been determined to be a child with special
needs, for whom there is in effect an adoption
assistance agreement (other than an agreement under
this part) between the State and an adoptive parent or
parents, and who the State has determined cannot be
placed with an adoptive parent or parents without
medical assistance because such child has special needs
for medical, mental health, or rehabilitative care, and
that with respect to the provision of such health
insurance coverage--
(A) such coverage may be provided through 1
or more State medical assistance programs;
(B) the State, in providing such coverage,
shall ensure that the medical benefits,
including mental health benefits, provided are
of the same type and kind as those that would
be provided for children by the State under
title XIX;
(C) in the event that the State provides such
coverage through a State medical assistance
program other than the program under title XIX,
and the State exceeds its funding for services
under such other program, any such child shall
be deemed to be receiving aid or assistance
under the State plan under this part for
purposes of section 1902(a)(10)(A)(i)(I); and
(D) in determining cost-sharing requirements,
the State shall take into consideration the
circumstances of the adopting parent or parents
and the needs of the child being adopted
consistent, to the extent coverage is provided
through a State medical assistance program,
with the rules under such program;
(22) provides that, not later than January 1, 1999,
the State shall develop and implement standards to
ensure that children in foster care placements in
public or private agencies are provided quality
services that protect the safety and health of the
children;
(23) provides that the State shall not--
(A) deny or delay the placement of a child
for adoption when an approved family is
available outside of the jurisdiction with
responsibility for handling the case of the
child; or
(B) fail to grant an opportunity for a fair
hearing, as described in paragraph (12), to an
individual whose allegation of a violation of
subparagraph (A) of this paragraph is denied by
the State or not acted upon by the State with
reasonable promptness;
(24) includes a certification that, before a child in
foster care under the responsibility of the State is
placed with prospective foster parents, the prospective
foster parents will be prepared adequately with the
appropriate knowledge and skills to provide for the
needs of the child, that the preparation will be
continued, as necessary, after the placement of the
child, and that the preparation shall include knowledge
and skills relating to the reasonable and prudent
parent standard for the participation of the child in
age or developmentally-appropriate activities,
including knowledge and skills relating to the
developmental stages of the cognitive, emotional,
physical, and behavioral capacities of a child, and
knowledge and skills relating to applying the standard
to decisions such as whether to allow the child to
engage in social, extracurricular, enrichment,
cultural, and social activities, including sports,
field trips, and overnight activities lasting 1 or more
days, and to decisions involving the signing of
permission slips and arranging of transportation for
the child to and from extracurricular, enrichment, and
social activities;
(25) provide that the State shall have in effect
procedures for the orderly and timely interstate
placement of children; and procedures implemented in
accordance with an interstate compact, if incorporating
with the procedures prescribed by paragraph (26), shall
be considered to satisfy the requirement of this
paragraph;
(26) provides that--
(A)(i) within 60 days after the State
receives from another State a request to
conduct a study of a home environment for
purposes of assessing the safety and
suitability of placing a child in the home, the
State shall, directly or by contract--
(I) conduct and complete the study;
and
(II) return to the other State a
report on the results of the study,
which shall address the extent to which
placement in the home would meet the
needs of the child; and
(ii) in the case of a home study begun on or
before September 30, 2008, if the State fails
to comply with clause (i) within the 60-day
period as a result of circumstances beyond the
control of the State (such as a failure by a
Federal agency to provide the results of a
background check, or the failure by any entity
to provide completed medical forms, requested
by the State at least 45 days before the end of
the 60-day period), the State shall have 75
days to comply with clause (i) if the State
documents the circumstances involved and
certifies that completing the home study is in
the best interests of the child; except that
(iii) this subparagraph shall not be
construed to require the State to have
completed, within the applicable period, the
parts of the home study involving the education
and training of the prospective foster or
adoptive parents;
(B) the State shall treat any report
described in subparagraph (A) that is received
from another State or an Indian tribe (or from
a private agency under contract with another
State) as meeting any requirements imposed by
the State for the completion of a home study
before placing a child in the home, unless,
within 14 days after receipt of the report, the
State determines, based on grounds that are
specific to the content of the report, that
making a decision in reliance on the report
would be contrary to the welfare of the child;
and
(C) the State shall not impose any
restriction on the ability of a State agency
administering, or supervising the
administration of, a State program operated
under a State plan approved under this part to
contract with a private agency for the conduct
of a home study described in subparagraph (A);
(27) provides that, with respect to any child in
foster care under the responsibility of the State under
this part or part B and without regard to whether
foster care maintenance payments are made under section
472 on behalf of the child, the State has in effect
procedures for verifying the citizenship or immigration
status of the child;
(28) at the option of the State, provides for the
State to enter into kinship guardianship assistance
agreements to provide kinship guardianship assistance
payments on behalf of children to grandparents and
other relatives who have assumed legal guardianship of
the children for whom they have cared as foster parents
and for whom they have committed to care on a permanent
basis, as provided in section 473(d);
(29) provides that, within 30 days after the removal
of a child from the custody of the parent or parents of
the child, the State shall exercise due diligence to
identify and provide notice to the following relatives:
all adult grandparents, all parents of a sibling of the
child, where such parent has legal custody of such
sibling, and other adult relatives of the child
(including any other adult relatives suggested by the
parents), subject to exceptions due to family or
domestic violence, that--
(A) specifies that the child has been or is
being removed from the custody of the parent or
parents of the child;
(B) explains the options the relative has
under Federal, State, and local law to
participate in the care and placement of the
child, including any options that may be lost
by failing to respond to the notice;
(C) describes the requirements under
paragraph (10) of this subsection to become a
foster family home and the additional services
and supports that are available for children
placed in such a home; and
(D) if the State has elected the option to
make kinship guardianship assistance payments
under paragraph (28) of this subsection,
describes how the relative guardian of the
child may subsequently enter into an agreement
with the State under section 473(d) to receive
the payments;
(30) provides assurances that each child who has
attained the minimum age for compulsory school
attendance under State law and with respect to whom
there is eligibility for a payment under the State plan
is a full-time elementary or secondary school student
or has completed secondary school, and for purposes of
this paragraph, the term ``elementary or secondary
school student'' means, with respect to a child, that
the child is--
(A) enrolled (or in the process of enrolling)
in an institution which provides elementary or
secondary education, as determined under the
law of the State or other jurisdiction in which
the institution is located;
(B) instructed in elementary or secondary
education at home in accordance with a home
school law of the State or other jurisdiction
in which the home is located;
(C) in an independent study elementary or
secondary education program in accordance with
the law of the State or other jurisdiction in
which the program is located, which is
administered by the local school or school
district; or
(D) incapable of attending school on a full-
time basis due to the medical condition of the
child, which incapability is supported by
regularly updated information in the case plan
of the child;
(31) provides that reasonable efforts shall be made--
(A) to place siblings removed from their home
in the same foster care, kinship guardianship,
or adoptive placement, unless the State
documents that such a joint placement would be
contrary to the safety or well-being of any of
the siblings; and
(B) in the case of siblings removed from
their home who are not so jointly placed, to
provide for frequent visitation or other
ongoing interaction between the siblings,
unless that State documents that frequent
visitation or other ongoing interaction would
be contrary to the safety or well-being of any
of the siblings;
(32) provides that the State will negotiate in good
faith with any Indian tribe, tribal organization or
tribal consortium in the State that requests to develop
an agreement with the State to administer all or part
of the program under this part on behalf of Indian
children who are under the authority of the tribe,
organization, or consortium, including foster care
maintenance payments on behalf of children who are
placed in State or tribally licensed foster family
homes, adoption assistance payments, and, if the State
has elected to provide such payments, kinship
guardianship assistance payments under section 473(d),
and tribal access to resources for administration,
training, and data collection under this part;
(33) provides that the State will inform any
individual who is adopting, or whom the State is made
aware is considering adopting, a child who is in foster
care under the responsibility of the State of the
potential eligibility of the individual for a Federal
tax credit under section 23 of the Internal Revenue
Code of 1986;
(34) provides that, for each child or youth described
in paragraph (9)(C)(i)(I), the State agency shall--
(A) not later than 2 years after the date of
the enactment of this paragraph, report
immediately, and in no case later than 24 hours
after receiving information on children or
youth who have been identified as being a sex
trafficking victim, to the law enforcement
authorities; and
(B) not later than 3 years after such date of
enactment and annually thereafter, report to
the Secretary the total number of children and
youth who are sex trafficking victims; and
(35) provides that--
(A) not later than 1 year after the date of
the enactment of this paragraph, the State
shall develop and implement specific protocols
for--
(i) expeditiously locating any child
missing from foster care;
(ii) determining the primary factors
that contributed to the child's running
away or otherwise being absent from
care, and to the extent possible and
appropriate, responding to those
factors in current and subsequent
placements;
(iii) determining the child's
experiences while absent from care,
including screening the child to
determine if the child is a possible
sex trafficking victim (as defined in
section 475(9)(A)); and
(iv) reporting such related
information as required by the
Secretary; and
(B) not later than 2 years after such date of
enactment, for each child and youth described
in paragraph (9)(C)(i)(I) of this subsection,
the State agency shall report immediately, and
in no case later than 24 hours after receiving,
information on missing or abducted children or
youth to the law enforcement authorities for
entry into the National Crime Information
Center (NCIC) database of the Federal Bureau of
Investigation, established pursuant to section
534 of title 28, United States Code, and to the
National Center for Missing and Exploited
Children.
(b) The Secretary shall approve any plan which complies with
the provisions of subsection (a) of this section.
(c) Use of Child Welfare Records in State Court
Proceedings.--Subsection (a)(8) shall not be construed to limit
the flexibility of a State in determining State policies
relating to public access to court proceedings to determine
child abuse and neglect or other court hearings held pursuant
to part B or this part, except that such policies shall, at a
minimum, ensure the safety and well-being of the child,
parents, and family.
(d) Annual Reports by the Secretary on Number of Children and
Youth Reported by States To Be Sex Trafficking Victims.--Not
later than 4 years after the date of the enactment of this
subsection and annually thereafter, the Secretary shall report
to the Congress and make available to the public on the
Internet website of the Department of Health and Human Services
the number of children and youth reported in accordance with
subsection (a)(34)(B) of this section to be sex trafficking
victims (as defined in section 475(9)(A)).
FOSTER CARE MAINTENANCE PAYMENTS PROGRAM
Sec. 472. (a) In General.--
(1) Eligibility.--Each State with a plan approved
under this part shall make foster care maintenance
payments on behalf of each child who has been removed
from the home of a relative specified in section 406(a)
(as in effect on July 16, 1996) into foster care if--
(A) the removal and foster care placement
met, and the placement continues to meet, the
requirements of paragraph (2); and
(B) the child, while in the home, would have
met the AFDC eligibility requirement of
paragraph (3).
(2) Removal and foster care placement requirements.--
The removal and foster care placement of a child meet
the requirements of this paragraph if--
(A) the removal and foster care placement are
in accordance with--
(i) a voluntary placement agreement
entered into by a parent or legal
guardian of the child who is the
relative referred to in paragraph (1);
or
(ii) a judicial determination to the
effect that continuation in the home
from which removed would be contrary to
the welfare of the child and that
reasonable efforts of the type
described in section 471(a)(15) for a
child have been made;
(B) the child's placement and care are the
responsibility of--
(i) the State agency administering
the State plan approved under section
471;
(ii) any other public agency with
which the State agency administering or
supervising the administration of the
State plan has made an agreement which
is in effect; or
(iii) an Indian tribe or a tribal
organization (as defined in section
479B(a)) or a tribal consortium that
has a plan approved under section 471
in accordance with section 479B; and
(C) the child has been placed in a foster
family home or child-care institution.
(3) AFDC eligibility requirement.--
(A) In general.--A child in the home referred
to in paragraph (1) would have met the AFDC
eligibility requirement of this paragraph if
the child--
(i) would have received aid under the
State plan approved under section 402
(as in effect on July 16, 1996) in the
home, in or for the month in which the
agreement was entered into or court
proceedings leading to the
determination referred to in paragraph
(2)(A)(ii) of this subsection were
initiated; or
(ii)(I) would have received the aid
in the home, in or for the month
referred to in clause (i), if
application had been made therefor; or
(II) had been living in the home
within 6 months before the month in
which the agreement was entered into or
the proceedings were initiated, and
would have received the aid in or for
such month, if, in such month, the
child had been living in the home with
the relative referred to in paragraph
(1) and application for the aid had
been made.
(B) Resources determination.--For purposes of
subparagraph (A), in determining whether a
child would have received aid under a State
plan approved under section 402 (as in effect
on July 16, 1996), a child whose resources
(determined pursuant to section 402(a)(7)(B),
as so in effect) have a combined value of not
more than $10,000 shall be considered a child
whose resources have a combined value of not
more than $1,000 (or such lower amount as the
State may determine for purposes of section
402(a)(7)(B)).
(4) Eligibility of certain alien children.--Subject
to title IV of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996, if the child is
an alien disqualified under section 245A(h) or 210(f)
of the Immigration and Nationality Act from receiving
aid under the State plan approved under section 402 in
or for the month in which the agreement described in
paragraph (2)(A)(i) was entered into or court
proceedings leading to the determination described in
paragraph (2)(A)(ii) were initiated, the child shall be
considered to satisfy the requirements of paragraph
(3), with respect to the month, if the child would have
satisfied the requirements but for the
disqualification.
(b) Foster care maintenance payments may be made under this
part only on behalf of a child described in subsection (a) of
this section who is--
(1) in the foster family home of an individual,
whether the payments therefor are made to such
individual or to a public or private child-placement or
child-care agency, or
(2) in a child-care institution, whether the payments
therefor are made to such institution or to a public or
private child-placement or child-care agency, which
payments shall be limited so as to include in such
payments only those items which are included in the
term ``foster care maintenance payments'' (as defined
in section 475(4)).
(c) For the purposes of this part, (1) the term ``foster
family home'' means a foster family home for children which is
licensed by the State in which it is situated or has been
approved, by the agency of such State having responsibility for
licensing homes of this type, as meeting the standards
established for such licensing; and (2) the term ``child-care
institution'' means a private child-care institution, or a
public child-care institution which accommodates no more than
twenty-five children, which is licensed by the State in which
it is situated or has been approved, by the agency of such
State responsible for licensing or approval of institutions of
this type, as meeting the standards established for such
licensing, except, in the case of a child who has attained 18
years of age, the term shall include a supervised setting in
which the individual is living independently, in accordance
with such conditions as the Secretary shall establish in
regulations, but the term shall not include detention
facilities, forestry camps, training schools, or any other
facility operated primarily for the detention of children who
are determined to be delinquent.
(d) Notwithstanding any other provision of this title,
Federal payments may be made under this part with respect to
amounts expended by any State as foster care maintenance
payments under this section, in the case of children removed
from their homes pursuant to voluntary placement agreements as
described in subsection (a), only if (at the time such amounts
were expended) the State has fulfilled all of the requirements
of section 422(b)(8).
(e) No Federal payment may be made under this part with
respect to amounts expended by any State as foster care
maintenance payments under this section, in the case of any
child who was removed from his or her home pursuant to a
voluntary placement agreement as described in subsection (a)
and has remained in voluntary placement for a period in excess
of 180 days, unless there has been a judicial determination by
a court of competent jurisdiction (within the first 180 days of
such placement) to the effect that such placement is in the
best interests of the child.
(f) For the purposes of this part and part B of this title,
(1) the term ``voluntary placement'' means an out-of-home
placement of a minor, by or with participation of a State
agency, after the parents or guardians of the minor have
requested the assistance of the agency and signed a voluntary
placement agreement; and (2) the term ``voluntary placement
agreement'' means a written agreement, binding on the parties
to the agreement, between the State agency, any other agency
acting on its behalf, and the parents or guardians of a minor
child which specifies, at a minimum, the legal status of the
child and the rights and obligations of the parents or
guardians, the child, and the agency while the child is in
placement.
(g) In any case where--
(1) the placement of a minor child in foster care
occurred pursuant to a voluntary placement agreement
entered into by the parents or guardians of such child
as provided in subsection (a), and
(2) such parents or guardians request (in such manner
and form as the Secretary may prescribe) that the child
be returned to their home or to the home of a relative,
the voluntary placement agreement shall be deemed to be revoked
unless the State agency opposes such request and obtains a
judicial determination, by a court of competent jurisdiction,
that the return of the child to such home would be contrary to
the child's best interests.
(h)(1) For purposes of title XIX, any child with respect to
whom foster care maintenance payments are made under this
section is deemed to be a dependent child as defined in section
406 (as in effect as of July 16, 1996) and deemed to be a
recipient of aid to families with dependent children under part
A of this title (as so in effect). For purposes of subtitle 1
of title XX, any child with respect to whom foster care
maintenance payments are made under this section is deemed to
be a minor child in a needy family under a State program funded
under part A of this title and is deemed to be a recipient of
assistance under such part.
(2) For purposes of paragraph (1), a child whose costs in a
foster family home or child care institution are covered by the
foster care maintenance payments being made with respect to the
child's minor parent, as provided in section 475(4)(B), shall
be considered a child with respect to whom foster care
maintenance payments are made under this section.
(i) Administrative Costs Associated With Otherwise Eligible
Children Not in Licensed Foster Care Settings.--Expenditures by
a State that would be considered administrative expenditures
for purposes of section 474(a)(3) if made with respect to a
child who was residing in a foster family home or child-care
institution shall be so considered with respect to a child not
residing in such a home or institution--
(1) in the case of a child who has been removed in
accordance with subsection (a) of this section from the
home of a relative specified in section 406(a) (as in
effect on July 16, 1996), only for expenditures--
(A) with respect to a period of not more than
the lesser of 12 months or the average length
of time it takes for the State to license or
approve a home as a foster home, in which the
child is in the home of a relative and an
application is pending for licensing or
approval of the home as a foster family home;
or
(B) with respect to a period of not more than
1 calendar month when a child moves from a
facility not eligible for payments under this
part into a foster family home or child care
institution licensed or approved by the State;
and
(2) in the case of any other child who is potentially
eligible for benefits under a State plan approved under
this part and at imminent risk of removal from the
home, only if--
(A) reasonable efforts are being made in
accordance with section 471(a)(15) to prevent
the need for, or if necessary to pursue,
removal of the child from the home; and
(B) the State agency has made, not less often
than every 6 months, a determination (or
redetermination) as to whether the child
remains at imminent risk of removal from the
home.
ADOPTION AND GUARDIANSHIP ASSISTANCE PROGRAM
Sec. 473. (a)(1)(A) Each State having a plan approved under
this part shall enter into adoption assistance agreements (as
defined in section 475(3)) with the adoptive parents of
children with special needs.
(B) Under any adoption assistance agreement entered into by a
State with parents who adopt a child with special needs, the
State--
(i) shall make payments of nonrecurring adoption
expenses incurred by or on behalf of such parents in
connection with the adoption of such child, directly
through the State agency or through another public or
nonprofit private agency, in amounts determined under
paragraph (3), and
(ii) in any case where the child meets the
requirements of paragraph (2), may make adoption
assistance payments to such parents, directly through
the State agency or through another public or nonprofit
private agency, in amounts so determined.
(2)(A) For purposes of paragraph (1)(B)(ii), a child meets
the requirements of this paragraph if--
(i) in the case of a child who is not an applicable
child for the fiscal year (as defined in subsection
(e)), the child--
(I)(aa)(AA) was removed from the home of a
relative specified in section 406(a) (as in
effect on July 16, 1996) and placed in foster
care in accordance with a voluntary placement
agreement with respect to which Federal
payments are provided under section 474 (or
section 403, as such section was in effect on
July 16, 1996), or in accordance with a
judicial determination to the effect that
continuation in the home would be contrary to
the welfare of the child; and
(BB) met the requirements of section
472(a)(3) with respect to the home referred to
in subitem (AA) of this item;
(bb) meets all of the requirements of title
XVI with respect to eligibility for
supplemental security income benefits; or
(cc) is a child whose costs in a foster
family home or child-care institution are
covered by the foster care maintenance payments
being made with respect to the minor parent of
the child as provided in section 475(4)(B); and
(II) has been determined by the State,
pursuant to subsection (c)(1) of this section,
to be a child with special needs; or
(ii) in the case of a child who is an applicable
child for the fiscal year (as so defined), the child--
(I)(aa) at the time of initiation of adoption
proceedings was in the care of a public or
licensed private child placement agency or
Indian tribal organization pursuant to--
(AA) an involuntary removal of the
child from the home in accordance with
a judicial determination to the effect
that continuation in the home would be
contrary to the welfare of the child;
or
(BB) a voluntary placement agreement
or voluntary relinquishment;
(bb) meets all medical or disability
requirements of title XVI with respect to
eligibility for supplemental security income
benefits; or
(cc) was residing in a foster family home or
child care institution with the child's minor
parent, and the child's minor parent was in
such foster family home or child care
institution pursuant to--
(AA) an involuntary removal of the
child from the home in accordance with
a judicial determination to the effect
that continuation in the home would be
contrary to the welfare of the child;
or
(BB) a voluntary placement agreement
or voluntary relinquishment; and
(II) has been determined by the State,
pursuant to subsection (c)(2), to be a child
with special needs.
(B) Section 472(a)(4) shall apply for purposes of
subparagraph (A) of this paragraph, in any case in which the
child is an alien described in such section.
(C) A child shall be treated as meeting the requirements of
this paragraph for the purpose of paragraph (1)(B)(ii) if--
(i) in the case of a child who is not an applicable
child for the fiscal year (as defined in subsection
(e)), the child--
(I) meets the requirements of subparagraph
(A)(i)(II);
(II) was determined eligible for adoption
assistance payments under this part with
respect to a prior adoption;
(III) is available for adoption because--
(aa) the prior adoption has been
dissolved, and the parental rights of
the adoptive parents have been
terminated; or
(bb) the child's adoptive parents
have died; and
(IV) fails to meet the requirements of
subparagraph (A)(i) but would meet such
requirements if--
(aa) the child were treated as if the
child were in the same financial and
other circumstances the child was in
the last time the child was determined
eligible for adoption assistance
payments under this part; and
(bb) the prior adoption were treated
as never having occurred; or
(ii) in the case of a child who is an applicable
child for the fiscal year (as so defined), the child
meets the requirements of subparagraph (A)(ii)(II), is
determined eligible for adoption assistance payments
under this part with respect to a prior adoption (or
who would have been determined eligible for such
payments had the Adoption and Safe Families Act of 1997
been in effect at the time that such determination
would have been made), and is available for adoption
because the prior adoption has been dissolved and the
parental rights of the adoptive parents have been
terminated or because the child's adoptive parents have
died.
(D) In determining the eligibility for adoption
assistance payments of a child in a legal guardianship
arrangement described in section 471(a)(28), the
placement of the child with the relative guardian
involved and any kinship guardianship assistance
payments made on behalf of the child shall be
considered never to have been made.
(3) The amount of the payments to be made in any case under
clauses (i) and (ii) of paragraph (1)(B) shall be determined
through agreement between the adoptive parents and the State or
local agency administering the program under this section,
which shall take into consideration the circumstances of the
adopting parents and the needs of the child being adopted, and
may be readjusted periodically, with the concurrence of the
adopting parents (which may be specified in the adoption
assistance agreement), depending upon changes in such
circumstances. However, in no case may the amount of the
adoption assistance payment made under clause (ii) of paragraph
(1)(B) exceed the foster care maintenance payment which would
have been paid during the period if the child with respect to
whom the adoption assistance payment is made had been in a
foster family home.
(4)(A) Notwithstanding any other provision of this section, a
payment may not be made pursuant to this section to parents or
relative guardians with respect to a child--
(i) who has attained--
(I) 18 years of age, or such greater age as
the State may elect under section
475(8)(B)(iii); or
(II) 21 years of age, if the State determines
that the child has a mental or physical
handicap which warrants the continuation of
assistance;
(ii) who has not attained 18 years of age, if the
State determines that the parents or relative
guardians, as the case may be, are no longer legally
responsible for the support of the child; or
(iii) if the State determines that the child is no
longer receiving any support from the parents or
relative guardians, as the case may be.
(B) Parents or relative guardians who have been receiving
adoption assistance payments or kinship guardianship assistance
payments under this section shall keep the State or local
agency administering the program under this section informed of
circumstances which would, pursuant to this subsection, make
them ineligible for the payments, or eligible for the payments
in a different amount.
(5) For purposes of this part, individuals with whom a child
(who has been determined by the State, pursuant to subsection
(c), to be a child with special needs) is placed for adoption
in accordance with applicable State and local law shall be
eligible for such payments, during the period of the placement,
on the same terms and subject to the same conditions as if such
individuals had adopted such child.
(6)(A) For purposes of paragraph (1)(B)(i), the term
``nonrecurring adoption expenses'' means reasonable and
necessary adoption fees, court costs, attorney fees, and other
expenses which are directly related to the legal adoption of a
child with special needs and which are not incurred in
violation of State or Federal law.
(B) A State's payment of nonrecurring adoption expenses under
an adoption assistance agreement shall be treated as an
expenditure made for the proper and efficient administration of
the State plan for purposes of section 474(a)(3)(E).
(7)(A) Notwithstanding any other provision of this
subsection, no payment may be made to parents with respect to
any applicable child for a fiscal year that--
(i) would be considered a child with special needs
under subsection (c)(2);
(ii) is not a citizen or resident of the United
States; and
(iii) was adopted outside of the United States or was
brought into the United States for the purpose of being
adopted.
(B) Subparagraph (A) shall not be construed as prohibiting
payments under this part for an applicable child described in
subparagraph (A) that is placed in foster care subsequent to
the failure, as determined by the State, of the initial
adoption of the child by the parents described in subparagraph
(A).
(8)(A) A State shall calculate the savings (if any) resulting
from the application of paragraph (2)(A)(ii) to all applicable
children for a fiscal year, using a methodology specified by
the Secretary or an alternate methodology proposed by the State
and approved by the Secretary.
(B) A State shall annually report to the Secretary--
(i) the methodology used to make the calculation
described in subparagraph (A), without regard to
whether any savings are found;
(ii) the amount of any savings referred to in
subparagraph (A); and
(iii) how any such savings are spent, accounting for
and reporting the spending separately from any other
spending reported to the Secretary under part B or this
part.
(C) The Secretary shall make all information reported
pursuant to subparagraph (B) available on the website of the
Department of Health and Human Services in a location easily
accessible to the public.
(D)(i) A State shall spend an amount equal to the amount of
the savings (if any) in State expenditures under this part
resulting from the application of paragraph (2)(A)(ii) to all
applicable children for a fiscal year, to provide to children
of families any service that may be provided under part B or
this part. A State shall spend not less than 30 percent of any
such savings on post-adoption services, post-guardianship
services, and services to support and sustain positive
permanent outcomes for children who otherwise might enter into
foster care under the responsibility of the State, with at
least \2/3\ of the spending by the State to comply with such 30
percent requirement being spent on post-adoption and post-
guardianship services.
(ii) Any State spending required under clause (i) shall be
used to supplement, and not supplant, any Federal or non-
Federal funds used to provide any service under part B or this
part.
(b)(1) For purposes of title XIX, any child who is described
in paragraph (3) is deemed to be a dependent child as defined
in section 406 (as in effect as of July 16, 1996) and deemed to
be a recipient of aid to families with dependent children under
part A of this title (as so in effect) in the State where such
child resides.
(2) For purposes of subtitle 1 of title XX, any child who is
described in paragraph (3) is deemed to be a minor child in a
needy family under a State program funded under part A of this
title and deemed to be a recipient of assistance under such
part.
(3) A child described in this paragraph is any child--
(A)(i) who is a child described in subsection (a)(2),
and
(ii) with respect to whom an adoption assistance
agreement is in effect under this section (whether or
not adoption assistance payments are provided under the
agreement or are being made under this section),
including any such child who has been placed for
adoption in accordance with applicable State and local
law (whether or not an interlocutory or other judicial
decree of adoption has been issued),
(B) with respect to whom foster care maintenance
payments are being made under section 472, or
(C) with respect to whom kinship guardianship
assistance payments are being made pursuant to
subsection (d).
(4) For purposes of paragraphs (1) and (2), a child whose
costs in a foster family home or child-care institution are
covered by the foster care maintenance payments being made with
respect to the child's minor parent, as provided in section
475(4)(B), shall be considered a child with respect to whom
foster care maintenance payments are being made under section
472.
(c) For purposes of this section--
(1) in the case of a child who is not an applicable
child for a fiscal year, the child shall not be
considered a child with special needs unless--
(A) the State has determined that the child
cannot or should not be returned to the home of
his parents; and
(B) the State had first determined (A) that
there exists with respect to the child a
specific factor or condition (such as his
ethnic background, age, or membership in a
minority or sibling group, or the presence of
factors such as medical conditions or physical,
mental, or emotional handicaps) because of
which it is reasonable to conclude that such
child cannot be placed with adoptive parents
without providing adoption assistance under
this section or medical assistance under title
XIX, and (B) that, except where it would be
against the best interests of the child because
of such factors as the existence of significant
emotional ties with prospective adoptive
parents while in the care of such parents as a
foster child, a reasonable, but unsuccessful,
effort has been made to place the child with
appropriate adoptive parents without providing
adoption assistance under this section or
medical assistance under title XIX; or
(2) in the case of a child who is an applicable child
for a fiscal year, the child shall not be considered a
child with special needs unless--
(A) the State has determined, pursuant to a
criterion or criteria established by the State,
that the child cannot or should not be returned
to the home of his parents;
(B)(i) the State has determined that there
exists with respect to the child a specific
factor or condition (such as ethnic background,
age, or membership in a minority or sibling
group, or the presence of factors such as
medical conditions or physical, mental, or
emotional handicaps) because of which it is
reasonable to conclude that the child cannot be
placed with adoptive parents without providing
adoption assistance under this section and
medical assistance under title XIX; or
(ii) the child meets all medical or
disability requirements of title XVI with
respect to eligibility for supplemental
security income benefits; and
(C) the State has determined that, except
where it would be against the best interests of
the child because of such factors as the
existence of significant emotional ties with
prospective adoptive parents while in the care
of the parents as a foster child, a reasonable,
but unsuccessful, effort has been made to place
the child with appropriate adoptive parents
without providing adoption assistance under
this section or medical assistance under title
XIX.
(d) Kinship Guardianship Assistance Payments for Children.--
(1) Kinship guardianship assistance agreement.--
(A) In general.--In order to receive payments
under section 474(a)(5), a State shall--
(i) negotiate and enter into a
written, binding kinship guardianship
assistance agreement with the
prospective relative guardian of a
child who meets the requirements of
this paragraph; and
(ii) provide the prospective relative
guardian with a copy of the agreement.
(B) Minimum requirements.--The agreement
shall specify, at a minimum--
(i) the amount of, and manner in
which, each kinship guardianship
assistance payment will be provided
under the agreement, and the manner in
which the payment may be adjusted
periodically, in consultation with the
relative guardian, based on the
circumstances of the relative guardian
and the needs of the child;
(ii) the additional services and
assistance that the child and relative
guardian will be eligible for under the
agreement;
(iii) the procedure by which the
relative guardian may apply for
additional services as needed; and
(iv) subject to subparagraph (D),
that the State will pay the total cost
of nonrecurring expenses associated
with obtaining legal guardianship of
the child, to the extent the total cost
does not exceed $2,000.
(C) Interstate applicability.--The agreement
shall provide that the agreement shall remain
in effect without regard to the State residency
of the relative guardian.
(D) No effect on federal reimbursement.--
Nothing in subparagraph (B)(iv) shall be
construed as affecting the ability of the State
to obtain reimbursement from the Federal
Government for costs described in that
subparagraph.
(2) Limitations on amount of kinship guardianship
assistance payment.--A kinship guardianship assistance
payment on behalf of a child shall not exceed the
foster care maintenance payment which would have been
paid on behalf of the child if the child had remained
in a foster family home.
(3) Child's eligibility for a kinship guardianship
assistance payment.--
(A) In general.--A child is eligible for a
kinship guardianship assistance payment under
this subsection if the State agency determines
the following:
(i) The child has been--
(I) removed from his or her
home pursuant to a voluntary
placement agreement or as a
result of a judicial
determination to the effect
that continuation in the home
would be contrary to the
welfare of the child; and
(II) eligible for foster care
maintenance payments under
section 472 while residing for
at least 6 consecutive months
in the home of the prospective
relative guardian.
(ii) Being returned home or adopted
are not appropriate permanency options
for the child.
(iii) The child demonstrates a strong
attachment to the prospective relative
guardian and the relative guardian has
a strong commitment to caring
permanently for the child.
(iv) With respect to a child who has
attained 14 years of age, the child has
been consulted regarding the kinship
guardianship arrangement.
(B) Treatment of siblings.--With respect to a
child described in subparagraph (A) whose
sibling or siblings are not so described--
(i) the child and any sibling of the
child may be placed in the same kinship
guardianship arrangement, in accordance
with section 471(a)(31), if the State
agency and the relative agree on the
appropriateness of the arrangement for
the siblings; and
(ii) kinship guardianship assistance
payments may be paid on behalf of each
sibling so placed.
(C) Eligibility not affected by replacement
of guardian with a successor guardian.--In the
event of the death or incapacity of the
relative guardian, the eligibility of a child
for a kinship guardianship assistance payment
under this subsection shall not be affected by
reason of the replacement of the relative
guardian with a successor legal guardian named
in the kinship guardianship assistance
agreement referred to in paragraph (1)
(including in any amendment to the agreement),
notwithstanding subparagraph (A) of this
paragraph and section 471(a)(28).
(e) Applicable Child Defined.--
(1) On the basis of age.--
(A) In general.--Subject to paragraphs (2)
and (3), in this section, the term ``applicable
child'' means a child for whom an adoption
assistance agreement is entered into under this
section during any fiscal year described in
subparagraph (B) if the child attained the
applicable age for that fiscal year before the
end of that fiscal year.
(B) Applicable age.--For purposes of
subparagraph (A), the applicable age for a
fiscal year is as follows:
----------------------------------------------------------------------------------------------------------------
In the case of fiscal year: The applicable age is:
----------------------------------------------------------------------------------------------------------------
2010....................................................... 16
2011....................................................... 14
2012....................................................... 12
2013....................................................... 10
2014....................................................... 8
2015....................................................... 6
2016....................................................... 4
2017....................................................... 2
2018 or thereafter......................................... any age.
----------------------------------------------------------------------------------------------------------------
(2) Exception for duration in care.--Notwithstanding
paragraph (1) of this subsection, beginning with fiscal
year 2010, such term shall include a child of any age
on the date on which an adoption assistance agreement
is entered into on behalf of the child under this
section if the child--
(A) has been in foster care under the
responsibility of the State for at least 60
consecutive months; and
(B) meets the requirements of subsection
(a)(2)(A)(ii).
(3) Exception for member of a sibling group.--
Notwithstanding paragraphs (1) and (2) of this
subsection, beginning with fiscal year 2010, such term
shall include a child of any age on the date on which
an adoption assistance agreement is entered into on
behalf of the child under this section without regard
to whether the child is described in paragraph (2)(A)
of this subsection if the child--
(A) is a sibling of a child who is an
applicable child for the fiscal year under
paragraph (1) or (2) of this subsection;
(B) is to be placed in the same adoption
placement as an applicable child for the fiscal
year who is their sibling; and
(C) meets the requirements of subsection
(a)(2)(A)(ii).
* * * * * * *
TITLE V--MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT
* * * * * * *
use of allotment funds
Sec. 504. (a) Except as otherwise provided under this
section, a State may use amounts paid to it under section 503
for the provision of health services and related activities
(including planning, administration, education, and evaluation
and including payment of salaries and other related expenses of
National Health Service Corps personnel) consistent with its
application transmitted under section 505(a).
(b) Amounts described in subsection (a) may not be used for--
(1) inpatient services, other than inpatient services
provided to children with special health care needs or
to high-risk pregnant women and infants and such other
inpatient services as the Secretary may approve;
(2) cash payments to intended recipients of health
services;
(3) the purchase or improvement of land, the
purchase, construction, or permanent improvement (other
than minor remodeling) of any building or other
facility, or the purchase of major medical equipment;
(4) satisfying any requirement for the expenditure of
non-Federal funds as a condition for the receipt of
Federal funds;
(5) providing funds for research or training to any
entity other than a public or nonprofit private entity;
or
(6) payment for any item or service (other than an
emergency item or service) furnished--
(A) by an individual or entity during the
period when such individual or entity is
excluded under this title or title XVIII, XIX,
or XX pursuant to section 1128, 1128A, 1156, or
1842(j)(2), or
(B) at the medical direction or on the
prescription of a physician during the period
when the physician is excluded under this title
or title XVIII, XIX, or XX pursuant to section
1128, 1128A, 1156, or 1842(j)(2) and when the
person furnishing such item or service knew or
had reason to know of the exclusion (after a
reasonable time period after reasonable notice
has been furnished to the person).
The Secretary may waive the limitation contained in paragraph
(3) upon the request of a State if the Secretary finds that
there are extraordinary circumstances to justify the waiver and
that granting the waiver will assist in carrying out this
title.
(c) A State may use a portion of the amounts described in
subsection (a) for the purpose of purchasing technical
assistance from public or private entities if the State
determines that such assistance is required in developing,
implementing, and administering programs funded under this
title.
(d) Of the amounts paid to a State under section 503 from an
allotment for a fiscal year under section 502(c), not more than
10 percent may be used for administering the funds paid under
such section.
* * * * * * *
TITLE XI--GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE
SIMPLIFICATION
Part A--General Provisions
definitions
Sec. 1101. (a) When used in this Act--
(1) The term ``State'', except where otherwise
provided, includes the District of Columbia and the
Commonwealth of Puerto Rico, and when used in titles
IV, V, VII, XI, XIX, and XXI includes the Virgin
Islands and Guam. Such term when used in titles III,
IX, and XII also includes the Virgin Islands. Such term
when used in title V and in part B of this title also
includes American Samoa, the Northern Mariana Islands,
and the Trust Territory of the Pacific Islands. Such
term when used in titles XIX and XXI also includes the
Northern Mariana Islands and American Samoa. In the
case of Puerto Rico, the Virgin Islands, and Guam,
titles I, X, and XIV, and title XVI (as in effect
without regard to the amendment made by section 301 of
the Social Security Amendments of 1972) shall continue
to apply, and the term ``State'' when used in such
titles (but not in title XVI as in effect pursuant to
such amendment after December 31, 1973) includes Puerto
Rico, the Virgin Islands, and Guam. Such term when used
in title XX also includes the Virgin Islands, Guam,
American Samoa, and the Northern Mariana Islands. Such
term when used in title IV also includes American
Samoa.
(2) The term ``United States'' when used in a
geographical sense means, except where otherwise
provided, the States.
(3) The term ``person'' means an individual, a trust
or estate, a partnership, or a corporation.
(4) The term ``corporation'' includes associations,
joint-stock companies, and insurance companies.
(5) The term ``shareholder'' includes a member in an
association, joint-stock company, or insurance company.
(6) The term ``Secretary'', except when the context
otherwise requires, means the Secretary of Health and
Human Services.
(7) The terms ``physician'' and ``medical care'' and
``hospitalization'' include osteopathic practitioners
or the services of osteopathic practitioners and
hospitals within the scope of their practice as defined
by State law.
(8)(A) The ``Federal percentage'' for any State
(other than Puerto Rico, the Virgin Islands, and Guam)
shall be 100 per centum less the State percentage; and
the State percentage shall be that percentage which
bears the same ratio to 50 per centum as the square of
the per capita income of such State bears to the square
of the per capita income of the United States; except
that the Federal percentage shall in no case be less
than 50 per centum or more than 65 per centum.
(B) The Federal percentage for each State (other than
Puerto Rico, the Virgin Islands, and Guam) shall be
promulgated by the Secretary between October 1 and
November 30 of each year, on the basis of the average
per capita income of each State and of the United
States for the three most recent calendar years for
which satisfactory data are available from the
Department of Commerce. Such promulgation shall be
conclusive for each of the four quarters in the period
beginning October 1 next succeeding such promulgation:
Provided, That the Secretary shall promulgate such
percentages as soon as possible after the enactment of
the Social Security Amendments of 1958, which
promulgation shall be conclusive for each of the eleven
quarters in the period beginning October 1, 1958, and
ending with the close of June 30, 1961.
(C) The term ``United States'' means (but only for
purposes of subparagraphs (A) and (B) of this
paragraph) the fifty States and the District of
Columbia.
(D) Promulgations made before satisfactory data are
available from the Department of Commerce for a full
year on the per capita income of Alaska shall prescribe
a Federal percentage for Alaska of 50 per centum and,
for purposes of such promulgations, Alaska shall not be
included as part of the ``United States''.
Promulgations made thereafter but before per capita
income data for Alaska for a full three-year period are
available from the Department of Commerce shall be
based on satisfactory data available therefrom for
Alaska for such one full year or, when such data are
available for a two-year period, for such two years.
(9) The term ``shared health facility'' means any
arrangement whereby--
(A) two or more health care practitioners
practice their professions at a common physical
location;
(B) such practitioners share (i) common
waiting areas, examining rooms, treatment
rooms, or other space, (ii) the services of
supporting staff, or (iii) equipment;
(C) such practitioners have a person (who may
himself be a practitioner)--
(i) who is in charge of, controls,
manages, or supervises substantial
aspects of the arrangement or operation
for the delivery of health or medical
services at such common physical
location, other than the direct
furnishing of professional health care
services by the practitioners to their
patients; or
(ii) who makes available to such
practitioners the services of
supporting staff who are not employees
of such practitioners;
and who is compensated in whole or in part, for
the use of such common physical location or
support services pertaining thereto, on a basis
related to amounts charged or collected for the
services rendered or ordered at such location
or on any basis clearly unrelated to the value
of the services provided by the person; and
(D) at least one of such practitioners
received payments on a fee-for-service basis
under titles XVIII and XIX in an amount
exceeding $5,000 for any one month during the
preceding 12 months or in an aggregate amount
exceeding $40,000 during the preceding 12
months;
except that such term does not include a provider of
services (as defined in section 1861(u) of this Act), a
health maintenance organization (as defined in section
1301(a) of the Public Health Service Act), a hospital
cooperative shared services organization meeting the
requirements of section 501(e) of the Internal Revenue
Code of 1954, or any public entity.
(10) The term ``Administration'' means the Social
Security Administration, except where the context
requires otherwise.
(b) The terms ``includes'' and ``including'' when used in a
definition contained in this Act shall not be deemed to exclude
other things otherwise within the meaning of the term defined.
(c) Whenever under this Act or any Act of Congress, or under
the law of any State, an employer is required or permitted to
deduct any amount from the remuneration of an employee and to
pay the amount deducted to the United States, a State, or any
political subdivision thereof, then for the purposes of this
Act the amount so deducted shall be considered to have been
paid to the employee at the time of such deduction.
(d) Nothing in this Act shall be construed as authorizing any
Federal official, agent, or representative, in carrying out any
of the provisions of this Act, to take charge of any child over
the objection of either of the parents of such child, or of the
person standing in loco parentis to such child.
* * * * * * *
exclusion of certain individuals and entities from participation in
medicare and state health care programs
Sec. 1128. (a) Mandatory Exclusion.--The Secretary shall
exclude the following individuals and entities from
participation in any Federal health care program (as defined in
section 1128B(f)):
(1) Conviction of program-related crimes.--Any
individual or entity that has been convicted of a
criminal offense related to the delivery of an item or
service under title XVIII or under any State health
care program.
(2) Conviction relating to patient abuse.--Any
individual or entity that has been convicted, under
Federal or State law, of a criminal offense relating to
neglect or abuse of patients in connection with the
delivery of a health care item or service.
(3) Felony conviction relating to health care
fraud.--Any individual or entity that has been
convicted for an offense which occurred after the date
of the enactment of the Health Insurance Portability
and Accountability Act of 1996, under Federal or State
law, in connection with the delivery of a health care
item or service or with respect to any act or omission
in a health care program (other than those specifically
described in paragraph (1)) operated by or financed in
whole or in part by any Federal, State, or local
government agency, of a criminal offense consisting of
a felony relating to fraud, theft, embezzlement, breach
of fiduciary responsibility, or other financial
misconduct.
(4) Felony conviction relating to controlled
substance.--Any individual or entity that has been
convicted for an offense which occurred after the date
of the enactment of the Health Insurance Portability
and Accountability Act of 1996, under Federal or State
law, of a criminal offense consisting of a felony
relating to the unlawful manufacture, distribution,
prescription, or dispensing of a controlled substance.
(b) Permissive Exclusion.--The Secretary may exclude the
following individuals and entities from participation in any
Federal health care program (as defined in section 1128B(f)):
(1) Conviction relating to fraud.--Any individual or
entity that has been convicted for an offense which
occurred after the date of the enactment of the Health
Insurance Portability and Accountability Act of 1996,
under Federal or State law--
(A) of a criminal offense consisting of a
misdemeanor relating to fraud, theft,
embezzlement, breach of fiduciary
responsibility, or other financial misconduct--
(i) in connection with the delivery
of a health care item or service, or
(ii) with respect to any act or
omission in a health care program
(other than those specifically
described in subsection (a)(1))
operated by or financed in whole or in
part by any Federal, State, or local
government agency; or
(B) of a criminal offense relating to fraud,
theft, embezzlement, breach of fiduciary
responsibility, or other financial misconduct
with respect to any act or omission in a
program (other than a health care program)
operated by or financed in whole or in part by
any Federal, State, or local government agency.
(2) Conviction relating to obstruction of an
investigation or audit.--Any individual or entity that
has been convicted, under Federal or State law, in
connection with the interference with or obstruction of
any investigation or audit related to--
(i) any offense described in
paragraph (1) or in subsection (a); or
(ii) the use of funds received,
directly or indirectly, from any
Federal health care program (as defined
in section 1128B(f)).
(3) Misdemeanor conviction relating to controlled
substance.--Any individual or entity that has been
convicted, under Federal or State law, of a criminal
offense consisting of a misdemeanor relating to the
unlawful manufacture, distribution, prescription, or
dispensing of a controlled substance.
(4) License revocation or suspension.--Any individual
or entity--
(A) whose license to provide health care has
been revoked or suspended by any State
licensing authority, or who otherwise lost such
a license or the right to apply for or renew
such a license, for reasons bearing on the
individual's or entity's professional
competence, professional performance, or
financial integrity, or
(B) who surrendered such a license while a
formal disciplinary proceeding was pending
before such an authority and the proceeding
concerned the individual's or entity's
professional competence, professional
performance, or financial integrity.
(5) Exclusion or suspension under federal or state
health care program.--Any individual or entity which
has been suspended or excluded from participation, or
otherwise sanctioned, under--
(A) any Federal program, including programs
of the Department of Defense or the Department
of Veterans Affairs, involving the provision of
health care, or
(B) a State health care program,
for reasons bearing on the individual's or entity's
professional competence, professional performance, or
financial integrity.
(6) Claims for excessive charges or unnecessary
services and failure of certain organizations to
furnish medically necessary services.--Any individual
or entity that the Secretary determines--
(A) has submitted or caused to be submitted
bills or requests for payment (where such bills
or requests are based on charges or cost) under
title XVIII or a State health care program
containing charges (or, in applicable cases,
requests for payment of costs) for items or
services furnished substantially in excess of
such individual's or entity's usual charges
(or, in applicable cases, substantially in
excess of such individual's or entity's costs)
for such items or services, unless the
Secretary finds there is good cause for such
bills or requests containing such charges or
costs;
(B) has furnished or caused to be furnished
items or services to patients (whether or not
eligible for benefits under title XVIII or
under a State health care program)
substantially in excess of the needs of such
patients or of a quality which fails to meet
professionally recognized standards of health
care;
(C) is--
(i) a health maintenance organization
(as defined in section 1903(m))
providing items and services under a
State plan approved under title XIX, or
(ii) an entity furnishing services
under a waiver approved under section
1915(b)(1),
and has failed substantially to provide
medically necessary items and services that are
required (under law or the contract with the
State under title XIX) to be provided to
individuals covered under that plan or waiver,
if the failure has adversely affected (or has a
substantial likelihood of adversely affecting)
these individuals; or
(D) is an entity providing items and services
as an eligible organization under a risk-
sharing contract under section 1876 and has
failed substantially to provide medically
necessary items and services that are required
(under law or such contract) to be provided to
individuals covered under the risk-sharing
contract, if the failure has adversely affected
(or has a substantial likelihood of adversely
affecting) these individuals.
(7) Fraud, kickbacks, and other prohibited
activities.--Any individual or entity that the
Secretary determines has committed an act which is
described in section 1128A, 1128B, or 1129.
(8) Entities controlled by a sanctioned individual.--
Any entity with respect to which the Secretary
determines that a person--
(A)(i) who has a direct or indirect ownership
or control interest of 5 percent or more in the
entity or with an ownership or control interest
(as defined in section 1124(a)(3)) in that
entity,
(ii) who is an officer, director, agent, or
managing employee (as defined in section
1126(b)) of that entity; or
(iii) who was described in clause (i) but is
no longer so described because of a transfer of
ownership or control interest, in anticipation
of (or following) a conviction, assessment, or
exclusion described in subparagraph (B) against
the person, to an immediate family member (as
defined in subsection (j)(1)) or a member of
the household of the person (as defined in
subsection (j)(2)) who continues to maintain an
interest described in such clause--
is a person--
(B)(i) who has been convicted of any offense
described in subsection (a) or in paragraph
(1), (2), or (3) of this subsection;
(ii) against whom a civil monetary penalty
has been assessed under section 1128A or 1129;
or
(iii) who has been excluded from
participation under a program under title XVIII
or under a State health care program.
(9) Failure to disclose required information.--Any
entity that did not fully and accurately make any
disclosure required by section 1124, section 1124A, or
section 1126.
(10) Failure to supply requested information on
subcontractors and suppliers.--Any disclosing entity
(as defined in section 1124(a)(2)) that fails to supply
(within such period as may be specified by the
Secretary in regulations) upon request specifically
addressed to the entity by the Secretary or by the
State agency administering or supervising the
administration of a State health care program--
(A) full and complete information as to the
ownership of a subcontractor (as defined by the
Secretary in regulations) with whom the entity
has had, during the previous 12 months,
business transactions in an aggregate amount in
excess of $25,000, or
(B) full and complete information as to any
significant business transactions (as defined
by the Secretary in regulations), occurring
during the five-year period ending on the date
of such request, between the entity and any
wholly owned supplier or between the entity and
any subcontractor.
(11) Failure to supply payment information.--Any
individual or entity furnishing, ordering, referring
for furnishing, or certifying the need for items or
services for which payment may be made under title
XVIII or a State health care program that fails to
provide such information as the Secretary or the
appropriate State agency finds necessary to determine
whether such payments are or were due and the amounts
thereof, or has refused to permit such examination of
its records by or on behalf of the Secretary or that
agency as may be necessary to verify such information.
(12) Failure to grant immediate access.--Any
individual or entity that fails to grant immediate
access, upon reasonable request (as defined by the
Secretary in regulations) to any of the following:
(A) To the Secretary, or to the agency used
by the Secretary, for the purpose specified in
the first sentence of section 1864(a) (relating
to compliance with conditions of participation
or payment).
(B) To the Secretary or the State agency, to
perform the reviews and surveys required under
State plans under paragraphs (26), (31), and
(33) of section 1902(a) and under section
1903(g).
(C) To the Inspector General of the
Department of Health and Human Services, for
the purpose of reviewing records, documents,
and other data necessary to the performance of
the statutory functions of the Inspector
General.
(D) To a State medicaid fraud control unit
(as defined in section 1903(q)), for the
purpose of conducting activities described in
that section.
(13) Failure to take corrective action.--Any hospital
that fails to comply substantially with a corrective
action required under section 1886(f)(2)(B).
(14) Default on health education loan or scholarship
obligations.--Any individual who the Secretary
determines is in default on repayments of scholarship
obligations or loans in connection with health
professions education made or secured, in whole or in
part, by the Secretary and with respect to whom the
Secretary has taken all reasonable steps available to
the Secretary to secure repayment of such obligations
or loans, except that (A) the Secretary shall not
exclude pursuant to this paragraph a physician who is
the sole community physician or sole source of
essential specialized services in a community if a
State requests that the physician not be excluded, and
(B) the Secretary shall take into account, in
determining whether to exclude any other physician
pursuant to this paragraph, access of beneficiaries to
physician services for which payment may be made under
title XVIII or XIX.
(15) Individuals controlling a sanctioned entity.--
(A) Any individual--
(i) who has a direct or indirect ownership or
control interest in a sanctioned entity and who
knows or should know (as defined in section
1128A(i)(6)) of the action constituting the
basis for the conviction or exclusion described
in subparagraph (B); or
(ii) who is an officer or managing employee
(as defined in section 1126(b)) of such an
entity.
(B) For purposes of subparagraph (A), the term
``sanctioned entity'' means an entity--
(i) that has been convicted of any offense
described in subsection (a) or in paragraph
(1), (2), or (3) of this subsection; or
(ii) that has been excluded from
participation under a program under title XVIII
or under a State health care program.
(16) Making false statements or misrepresentation of
material facts.--Any individual or entity that
knowingly makes or causes to be made any false
statement, omission, or misrepresentation of a material
fact in any application, agreement, bid, or contract to
participate or enroll as a provider of services or
supplier under a Federal health care program (as
defined in section 1128B(f)), including Medicare
Advantage organizations under part C of title XVIII,
prescription drug plan sponsors under part D of title
XVIII, medicaid managed care organizations under title
XIX, and entities that apply to participate as
providers of services or suppliers in such managed care
organizations and such plans.
(c) Notice, Effective Date, and Period of Exclusion.--(1) An
exclusion under this section or under section 1128A shall be
effective at such time and upon such reasonable notice to the
public and to the individual or entity excluded as may be
specified in regulations consistent with paragraph (2).
(2)(A) Except as provided in subparagraph (B), such an
exclusion shall be effective with respect to services furnished
to an individual on or after the effective date of the
exclusion.
(B) Unless the Secretary determines that the health and
safety of individuals receiving services warrants the exclusion
taking effect earlier, an exclusion shall not apply to payments
made under title XVIII or under a State health care program
for--
(i) inpatient institutional services furnished to an
individual who was admitted to such institution before
the date of the exclusion, or
(ii) home health services and hospice care furnished
to an individual under a plan of care established
before the date of the exclusion,
until the passage of 30 days after the effective date of the
exclusion.
(3)(A) The Secretary shall specify, in the notice of
exclusion under paragraph (1) and the written notice under
section 1128A, the minimum period (or, in the case of an
exclusion of an individual under subsection (b)(12) or in the
case described in subparagraph (G), the period) of the
exclusion.
(B) Subject to subparagraph (G), in the case of an exclusion
under subsection (a), the minimum period of exclusion shall be
not less than five years, except that, upon the request of the
administrator of a Federal health care program (as defined in
section 1128B(f)) who determines that the exclusion would
impose a hardship on beneficiaries (as defined in section
1128A(i)(5)) of that program, the Secretary may, after
consulting with the Inspector General of the Department of
Health and Human Services, waive the exclusion under subsection
(a)(1), (a)(3), or (a)(4) with respect to that program in the
case of an individual or entity that is the sole community
physician or sole source of essential specialized services in a
community. The Secretary's decision whether to waive the
exclusion shall not be reviewable.
(C) In the case of an exclusion of an individual under
subsection (b)(12), the period of the exclusion shall be equal
to the sum of--
(i) the length of the period in which the individual
failed to grant the immediate access described in that
subsection, and
(ii) an additional period, not to exceed 90 days, set
by the Secretary.
(D) Subject to subparagraph (G), in the case of an exclusion
of an individual or entity under paragraph (1), (2), or (3) of
subsection (b), the period of the exclusion shall be 3 years,
unless the Secretary determines in accordance with published
regulations that a shorter period is appropriate because of
mitigating circumstances or that a longer period is appropriate
because of aggravating circumstances.
(E) In the case of an exclusion of an individual or entity
under subsection (b)(4) or (b)(5), the period of the exclusion
shall not be less than the period during which the individual's
or entity's license to provide health care is revoked,
suspended, or surrendered, or the individual or the entity is
excluded or suspended from a Federal or State health care
program.
(F) In the case of an exclusion of an individual or entity
under subsection (b)(6)(B), the period of the exclusion shall
be not less than 1 year.
(G) In the case of an exclusion of an individual under
subsection (a) based on a conviction occurring on or after the
date of the enactment of this subparagraph, if the individual
has (before, on, or after such date) been convicted--
(i) on one previous occasion of one or more offenses
for which an exclusion may be effected under such
subsection, the period of the exclusion shall be not
less than 10 years, or
(ii) on 2 or more previous occasions of one or more
offenses for which an exclusion may be effected under
such subsection, the period of the exclusion shall be
permanent.
(d) Notice to State Agencies and Exclusion Under State Health
Care Programs.--(1) Subject to paragraph (3), the Secretary
shall exercise the authority under this section and section
1128A in a manner that results in an individual's or entity's
exclusion from all the programs under title XVIII and all the
State health care programs in which the individual or entity
may otherwise participate.
(2) The Secretary shall promptly notify each appropriate
State agency administering or supervising the administration of
each State health care program (and, in the case of an
exclusion effected pursuant to subsection (a) and to which
section 304(a)(5) of the Controlled Substances Act may apply,
the Attorney General)--
(A) of the fact and circumstances of each exclusion
effected against an individual or entity under this
section or section 1128A, and
(B) of the period (described in paragraph (3)) for
which the State agency is directed to exclude the
individual or entity from participation in the State
health care program.
(3)(A) Except as provided in subparagraph (B), the period of
the exclusion under a State health care program under paragraph
(2) shall be the same as any period of exclusion under title
XVIII.
(B)(i) The Secretary may waive an individual's or entity's
exclusion under a State health care program under paragraph (2)
if the Secretary receives and approves a request for the waiver
with respect to the individual or entity from the State agency
administering or supervising the administration of the program.
(ii) A State health care program may provide for a period of
exclusion which is longer than the period of exclusion under
title XVIII.
(e) Notice to State Licensing Agencies.--The Secretary
shall--
(1) promptly notify the appropriate State or local
agency or authority having responsibility for the
licensing or certification of an individual or entity
excluded (or directed to be excluded) from
participation under this section or section 1128A, of
the fact and circumstances of the exclusion,
(2) request that appropriate investigations be made
and sanctions invoked in accordance with applicable
State law and policy, and
(3) request that the State or local agency or
authority keep the Secretary and the Inspector General
of the Department of Health and Human Services fully
and currently informed with respect to any actions
taken in response to the request.
(f) Notice, Hearing, and Judicial Review.--(1) Subject to
paragraph (2), any individual or entity that is excluded (or
directed to be excluded) from participation under this section
is entitled to reasonable notice and opportunity for a hearing
thereon by the Secretary to the same extent as is provided in
section 205(b), and to judicial review of the Secretary's final
decision after such hearing as is provided in section 205(g),
except that, in so applying such sections and section 205(l),
any reference therein to the Commissioner of Social Security or
the Social Security Administration shall be considered a
reference to the Secretary or the Department of Health and
Human Services, respectively.
(2) Unless the Secretary determines that the health or safety
of individuals receiving services warrants the exclusion taking
effect earlier, any individual or entity that is the subject of
an adverse determination under subsection (b)(7) shall be
entitled to a hearing by an administrative law judge (as
provided under section 205(b)) on the determination under
subsection (b)(7) before any exclusion based upon the
determination takes effect.
(3) The provisions of section 205(h) shall apply with respect
to this section and sections 1128A, 1129, and 1156 to the same
extent as it is applicable with respect to title II, except
that, in so applying such section and section 205(l), any
reference therein to the Commissioner of Social Security shall
be considered a reference to the Secretary.
(4) The provisions of subsections (d) and (e) of
section 205 shall apply with respect to this section to
the same extent as they are applicable with respect to
title II. The Secretary may delegate the authority
granted by section 205(d) (as made applicable to this
section) to the Inspector General of the Department of
Health and Human Services for purposes of any
investigation under this section.
(g) Application for Termination of Exclusion.--(1) An
individual or entity excluded (or directed to be excluded) from
participation under this section or section 1128A may apply to
the Secretary, in the manner specified by the Secretary in
regulations and at the end of the minimum period of exclusion
provided under subsection (c)(3) and at such other times as the
Secretary may provide, for termination of the exclusion
effected under this section or section 1128A.
(2) The Secretary may terminate the exclusion if the
Secretary determines, on the basis of the conduct of the
applicant which occurred after the date of the notice of
exclusion or which was unknown to the Secretary at the time of
the exclusion, that--
(A) there is no basis under subsection (a) or (b) or
section 1128A(a) for a continuation of the exclusion,
and
(B) there are reasonable assurances that the types of
actions which formed the basis for the original
exclusion have not recurred and will not recur.
(3) The Secretary shall promptly notify each appropriate
State agency administering or supervising the administration of
each State health care program (and, in the case of an
exclusion effected pursuant to subsection (a) and to which
section 304(a)(5) of the Controlled Substances Act may apply,
the Attorney General) of the fact and circumstances of each
termination of exclusion made under this subsection.
(h) Definition of State Health Care Program.--For purposes of
this section and sections 1128A and 1128B, the term ``State
health care program'' means--
(1) a State plan approved under title XIX,
(2) any program receiving funds under title V or from
an allotment to a State under such title,
(3) any program receiving funds under subtitle 1 of
title XX or from an allotment to a State under such
subtitle, or
(4) a State child health plan approved under title
XXI.
(i) Convicted Defined.--For purposes of subsections (a) and
(b), an individual or entity is considered to have been
``convicted'' of a criminal offense--
(1) when a judgment of conviction has been entered
against the individual or entity by a Federal, State,
or local court, regardless of whether there is an
appeal pending or whether the judgment of conviction or
other record relating to criminal conduct has been
expunged;
(2) when there has been a finding of guilt against
the individual or entity by a Federal, State, or local
court;
(3) when a plea of guilty or nolo contendere by the
individual or entity has been accepted by a Federal,
State, or local court; or
(4) when the individual or entity has entered into
participation in a first offender, deferred
adjudication, or other arrangement or program where
judgment of conviction has been withheld.
(j) Definition of Immediate Family Member and Member of
Household.--For purposes of subsection (b)(8)(A)(iii):
(1) The term ``immediate family member'' means, with
respect to a person--
(A) the husband or wife of the person;
(B) the natural or adoptive parent, child, or
sibling of the person;
(C) the stepparent, stepchild, stepbrother,
or stepsister of the person;
(D) the father-, mother-, daughter-, son-,
brother-, or sister-in-law of the person;
(E) the grandparent or grandchild of the
person; and
(F) the spouse of a grandparent or grandchild
of the person.
(2) The term ``member of the household'' means, with
respect to any person, any individual sharing a common
abode as part of a single family unit with the person,
including domestic employees and others who live
together as a family unit, but not including a roomer
or boarder.
civil monetary penalties
Sec. 1128A. (a) Any person (including an organization,
agency, or other entity, but excluding a beneficiary, as
defined in subsection (i)(5)) that--
(1) knowingly presents or causes to be presented to
an officer, employee, or agent of the United States, or
of any department or agency thereof, or of any State
agency (as defined in subsection (i)(1)), a claim (as
defined in subsection (i)(2)) that the Secretary
determines--
(A) is for a medical or other item or service
that the person knows or should know was not
provided as claimed, including any person who
engages in a pattern or practice of presenting
or causing to be presented a claim for an item
or service that is based on a code that the
person knows or should know will result in a
greater payment to the person than the code the
person knows or should know is applicable to
the item or service actually provided,
(B) is for a medical or other item or service
and the person knows or should know the claim
is false or fraudulent,
(C) is presented for a physician's service
(or an item or service incident to a
physician's service) by a person who knows or
should know that the individual who furnished
(or supervised the furnishing of) the service--
(i) was not licensed as a physician,
(ii) was licensed as a physician, but
such license had been obtained through
a misrepresentation of material fact
(including cheating on an examination
required for licensing), or
(iii) represented to the patient at
the time the service was furnished that
the physician was certified in a
medical specialty by a medical
specialty board when the individual was
not so certified,
(D) is for a medical or other item or service
furnished during a period in which the person
was excluded from the program under which the
claim was made pursuant to a determination by
the Secretary under this section or under
section 1128, 1156, 1160(b) (as in effect on
September 2, 1982), 1862(d) (as in effect on
the date of the enactment of the Medicare and
Medicaid Patient and Program Protection Act of
1987), or 1866(b) or as a result of the
application of the provisions of section
1842(j)(2), or
(E) is for a pattern of medical or other
items or services that a person knows or should
know are not medically necessary;
(2) knowingly presents or causes to be presented to
any person a request for payment which is in violation
of the terms of (A) an assignment under section
1842(b)(3)(B)(ii), or (B) an agreement with a State
agency (or other requirement of a State plan under
title XIX) not to charge a person for an item or
service in excess of the amount permitted to be
charged, or (C) an agreement to be a participating
physician or supplier under section 1842(h)(1), or (D)
an agreement pursuant to section 1866(a)(1)(G);
(3) knowingly gives or causes to be given to any
person, with respect to coverage under title XVIII of
inpatient hospital services subject to the provisions
of section 1886, information that he knows or should
know is false or misleading, and that could reasonably
be expected to influence the decision when to discharge
such person or another individual from the hospital;
(4) in the case of a person who is not an
organization, agency, or other entity, is excluded from
participating in a program under title XVIII or a State
health care program in accordance with this subsection
or under section 1128 and who, at the time of a
violation of this subsection--
(A) retains a direct or indirect ownership or
control interest in an entity that is
participating in a program under title XVIII or
a State health care program, and who knows or
should know of the action constituting the
basis for the exclusion; or
(B) is an officer or managing employee (as
defined in section 1126(b)) of such an entity;
(5) offers to or transfers remuneration to any
individual eligible for benefits under title XVIII of
this Act, or under a State health care program (as
defined in section 1128(h)) that such person knows or
should know is likely to influence such individual to
order or receive from a particular provider,
practitioner, or supplier any item or service for which
payment may be made, in whole or in part, under title
XVIII, or a State health care program (as so defined);
(6) arranges or contracts (by employment or
otherwise) with an individual or entity that the person
knows or should know is excluded from participation in
a Federal health care program (as defined in section
1128B(f)), for the provision of items or services for
which payment may be made under such a program;
(7) commits an act described in paragraph (1) or (2)
of section 1128B(b);
(8) knowingly makes, uses, or causes to be made or
used, a false record or statement material to a false
or fraudulent claim for payment for items and services
furnished under a Federal health care program; or
(9) fails to grant timely access, upon reasonable
request (as defined by the Secretary in regulations),
to the Inspector General of the Department of Health
and Human Services, for the purpose of audits,
investigations, evaluations, or other statutory
functions of the Inspector General of the Department of
Health and Human Services;
(8) orders or prescribes a medical or other item or
service during a period in which the person was
excluded from a Federal health care program (as so
defined), in the case where the person knows or should
know that a claim for such medical or other item or
service will be made under such a program;
(9) knowingly makes or causes to be made any false
statement, omission, or misrepresentation of a material
fact in any application, bid, or contract to
participate or enroll as a provider of services or a
supplier under a Federal health care program (as so
defined), including Medicare Advantage organizations
under part C of title XVIII, prescription drug plan
sponsors under part D of title XVIII, medicaid managed
care organizations under title XIX, and entities that
apply to participate as providers of services or
suppliers in such managed care organizations and such
plans;
(10) knows of an overpayment (as defined in paragraph
(4) of section 1128J(d)) and does not report and return
the overpayment in accordance with such section;
shall be subject, in addition to any other penalties that may
be prescribed by law, to a civil money penalty of not more than
$10,000 for each item or service (or, in cases under paragraph
(3), $15,000 for each individual with respect to whom false or
misleading information was given; in cases under paragraph (4),
$10,000 for each day the prohibited relationship occurs; in
cases under paragraph (7), $50,000 for each such act; or in
cases under paragraph (9), $50,000 for each false statement or
misrepresentation of a material fact). In addition, such a
person shall be subject to an assessment of not more than 3
times the amount claimed for each such item or service in lieu
of damages sustained by the United States or a State agency
because of such claim (or, in cases under paragraph (7),
damages of not more than 3 times the total amount of
remuneration offered, paid, solicited, or received, without
regard to whether a portion of such remuneration was offered,
paid, solicited, or received for a lawful purpose; or in cases
under paragraph (9), an assessment of not more than 3 times the
total amount claimed for each item or service for which payment
was made based upon the application containing the false
statement or misrepresentation of a material fact). In addition
the Secretary may make a determination in the same proceeding
to exclude the person from participation in the Federal health
care programs (as defined in section 1128B(f)(1)) and to direct
the appropriate State agency to exclude the person from
participation in any State health care program.
(b)(1) If a hospital or a critical access hospital knowingly
makes a payment, directly or indirectly, to a physician as an
inducement to reduce or limit medically necessary services
provided with respect to individuals who--
(A) are entitled to benefits under part A or part B
of title XVIII or to medical assistance under a State
plan approved under title XIX, and
(B) are under the direct care of the physician,
the hospital or a critical access hospital shall be subject, in
addition to any other penalties that may be prescribed by law,
to a civil money penalty of not more than $2,000 for each such
individual with respect to whom the payment is made.
(2) Any physician who knowingly accepts receipt of a payment
described in paragraph (1) shall be subject, in addition to any
other penalties that may be prescribed by law, to a civil money
penalty of not more than $2,000 for each individual described
in such paragraph with respect to whom the payment is made.
(3)(A) Any physician who executes a document described in
subparagraph (B) with respect to an individual knowing that all
of the requirements referred to in such subparagraph are not
met with respect to the individual shall be subject to a civil
monetary penalty of not more than the greater of--
(i) $5,000, or
(ii) three times the amount of the payments under
title XVIII for home health services which are made
pursuant to such certification.
(B) A document described in this subparagraph is any document
that certifies, for purposes of title XVIII, that an individual
meets the requirements of section 1814(a)(2)(C) or
1835(a)(2)(A) in the case of home health services furnished to
the individual.
(c)(1) The Secretary may initiate a proceeding to determine
whether to impose a civil money penalty, assessment, or
exclusion under subsection (a) or (b) only as authorized by the
Attorney General pursuant to procedures agreed upon by them.
The Secretary may not initiate an action under this section
with respect to any claim, request for payment, or other
occurrence described in this section later than six years after
the date the claim was presented, the request for payment was
made, or the occurrence took place. The Secretary may initiate
an action under this section by serving notice of the action in
any manner authorized by Rule 4 of the Federal Rules of Civil
Procedure.
(2) The Secretary shall not make a determination adverse to
any person under subsection (a) or (b) until the person has
been given written notice and an opportunity for the
determination to be made on the record after a hearing at which
the person is entitled to be represented by counsel, to present
witnesses, and to cross-examine witnesses against the person.
(3) In a proceeding under subsection (a) or (b) which--
(A) is against a person who has been convicted
(whether upon a verdict after trial or upon a plea of
guilty or nolo contendere) of a Federal crime charging
fraud or false statements, and
(B) involves the same transaction as in the criminal
action, the person is estopped from denying the
essential elements of the criminal offense.
(4) The official conducting a hearing under this section may
sanction a person, including any party or attorney, for failing
to comply with an order or procedure, failing to defend an
action, or other misconduct as would interfere with the speedy,
orderly, or fair conduct of the hearing. Such sanction shall
reasonably relate to the severity and nature of the failure or
misconduct. Such sanction may include--
(A) in the case of refusal to provide or permit
discovery, drawing negative factual inferences or
treating such refusal as an admission by deeming the
matter, or certain facts, to be established,
(B) prohibiting a party from introducing certain
evidence or otherwise supporting a particular claim or
defense,
(C) striking pleadings, in whole or in part,
(D) staying the proceedings,
(E) dismissal of the action,
(F) entering a default judgment,
(G) ordering the party or attorney to pay attorneys'
fees and other costs caused by the failure or
misconduct, and
(H) refusing to consider any motion or other action
which is not filed in a timely manner.
(d) In determining the amount or scope of any penalty,
assessment, or exclusion imposed pursuant to subsection (a) or
(b), the Secretary shall take into account--
(1) the nature of claims and the circumstances under
which they were presented,
(2) the degree of culpability, history of prior
offenses, and financial condition of the person
presenting the claims, and
(3) such other matters as justice may require.
(e) Any person adversely affected by a determination of the
Secretary under this section may obtain a review of such
determination in the United States Court of Appeals for the
circuit in which the person resides, or in which the claim was
presented, by filing in such court (within sixty days following
the date the person is notified of the Secretary's
determination) a written petition requesting that the
determination be modified or set aside. A copy of the petition
shall be forthwith transmitted by the clerk of the court to the
Secretary, and thereupon the Secretary shall file in the Court
the record in the proceeding as provided in section 2112 of
title 28, United States Code. Upon such filing, the court shall
have jurisdiction of the proceeding and of the question
determined therein, and shall have the power to make and enter
upon the pleadings, testimony, and proceedings set forth in
such record a decree affirming, modifying, remanding for
further consideration, or setting aside, in whole or in part,
the determination of the Secretary and enforcing the same to
the extent that such order is affirmed or modified. No
objection that has not been urged before the Secretary shall be
considered by the court, unless the failure or neglect to urge
such objection shall be excused because of extraordinary
circumstances. The findings of the Secretary with respect to
questions of fact, if supported by substantial evidence on the
record considered as a whole, shall be conclusive. If any party
shall apply to the court for leave to adduce additional
evidence and shall show to the satisfaction of the court that
such additional evidence is material and that there were
reasonable grounds for the failure to adduce such evidence in
the hearing before the Secretary, the court may order such
additional evidence to be taken before the Secretary and to be
made a part of the record. The Secretary may modify his
findings as to the facts, or make new findings, by reason of
additional evidence so taken and filed, and he shall file with
the court such modified or new findings, which findings with
respect to questions of fact, if supported by substantial
evidence on the record considered as a whole, shall be
conclusive, and his recommendations, if any, for the
modification or setting aside of his original order. Upon the
filing of the record with it, the jurisdiction of the court
shall be exclusive and its judgment and decree shall be final,
except that the same shall be subject to review by the Supreme
Court of the United States, as provided in section 1254 of
title 28, United States Code.
(f) Civil money penalties and assessments imposed under this
section may be compromised by the Secretary and may be
recovered in a civil action in the name of the United States
brought in United States district court for the district where
the claim was presented, or where the claimant resides, as
determined by the Secretary. Amounts recovered under this
section shall be paid to the Secretary and disposed of as
follows:
(1)(A) In the case of amounts recovered arising out
of a claim under title XIX, there shall be paid to the
State agency an amount bearing the same proportion to
the total amount recovered as the State's share of the
amount paid by the State agency for such claim bears to
the total amount paid for such claim.
(B) In the case of amounts recovered arising out of a
claim under an allotment to a State under title V,
there shall be paid to the State agency an amount equal
to three-sevenths of the amount recovered.
(2) Such portion of the amounts recovered as is
determined to have been paid out of the trust funds
under sections 1817 and 1841 shall be repaid to such
trust funds.
(3) With respect to amounts recovered arising out of
a claim under a Federal health care program (as defined
in section 1128B(f)), the portion of such amounts as is
determined to have been paid by the program shall be
repaid to the program, and the portion of such amounts
attributable to the amounts recovered under this
section by reason of the amendments made by the Health
Insurance Portability and Accountability Act of 1996
(as estimated by the Secretary) shall be deposited into
the Federal Hospital Insurance Trust Fund pursuant to
section 1817(k)(2)(C).
(4) The remainder of the amounts recovered shall be
deposited as miscellaneous receipts of the Treasury of
the United States.
The amount of such penalty or assessment, when finally
determined, or the amount agreed upon in compromise, may be
deducted from any sum then or later owing by the United States
or a State agency to the person against whom the penalty or
assessment has been assessed.
(g) A determination by the Secretary to impose a penalty,
assessment, or exclusion under subsection (a) or (b) shall be
final upon the expiration of the sixty-day period referred to
in subsection (e). Matters that were raised or that could have
been raised in a hearing before the Secretary or in an appeal
pursuant to subsection (e) may not be raised as a defense to a
civil action by the United States to collect a penalty,
assessment, or exclusion assessed under this section.
(h) Whenever the Secretary's determination to impose a
penalty, assessment, or exclusion under subsection (a) or (b)
becomes final, he shall notify the appropriate State or local
medical or professional organization, the appropriate State
agency or agencies administering or supervising the
administration of State health care programs (as defined in
section 1128(h)), and the appropriate utilization and quality
control peer review organization, and the appropriate State or
local licensing agency or organization (including the agency
specified in section 1864(a) and 1902(a)(33)) that such a
penalty, assessment, or exclusion has become final and the
reasons therefor.
(i) For the purposes of this section:
(1) The term ``State agency'' means the agency
established or designated to administer or supervise
the administration of the State plan under title XIX of
this Act or designated to administer the State's
program under title V or subtitle 1 of title XX of this
Act.
(2) The term ``claim'' means an application for
payments for items and services under a Federal health
care program (as defined in section 1128B(f)).
(3) The term ``item or service'' includes (A) any
particular item, device, medical supply, or service
claimed to have been provided to a patient and listed
in an itemized claim for payment, and (B) in the case
of a claim based on costs, any entry in the cost
report, books of account or other documents sup-
porting such claim.
(4) The term ``agency of the United States'' includes
any contractor acting as a fiscal intermediary,
carrier, or fiscal agent or any other claims processing
agent for a Federal health care program (as so
defined).
(5) The term ``beneficiary'' means an individual who
is eligible to receive items or services for which
payment may be made under a Federal health care program
(as so defined) but does not include a provider,
supplier, or practitioner.
(6) The term ``remuneration'' includes the waiver of
coinsurance and deductible amounts (or any part
thereof), and transfers of items or services for free
or for other than fair market value. The term
``remuneration'' does not include--
(A) the waiver of coinsurance and deductible
amounts by a person, if--
(i) the waiver is not offered as part
of any advertisement or solicitation;
(ii) the person does not routinely
waive coinsurance or deductible
amounts; and
(iii) the person--
(I) waives the coinsurance
and deductible amounts after
determining in good faith that
the individual is in financial
need; or
(II) fails to collect
coinsurance or deductible
amounts after making reasonable
collection efforts;
(B) subject to subsection (n), any
permissible practice described in any
subparagraph of section 1128B(b)(3) or in
regulations issued by the Secretary;
(C) differentials in coinsurance and
deductible amounts as part of a benefit plan
design as long as the differentials have been
disclosed in writing to all beneficiaries,
third party payers, and providers, to whom
claims are presented and as long as the
differentials meet the standards as defined in
regulations promulgated by the Secretary not
later than 180 days after the date of the
enactment of the Health Insurance Portability
and Accountability Act of 1996;
(D) incentives given to individuals to
promote the delivery of preventive care as
determined by the Secretary in regulations so
promulgated;
(E) a reduction in the copayment amount for
covered OPD services under section
1833(t)(5)(B);
(F) any other remuneration which promotes
access to care and poses a low risk of harm to
patients and Federal health care programs (as
defined in section 1128B(f) and designated by
the Secretary under regulations);
(G) the offer or transfer of items or
services for free or less than fair market
value by a person, if--
(i) the items or services consist of
coupons, rebates, or other rewards from
a retailer;
(ii) the items or services are
offered or transferred on equal terms
available to the general public,
regardless of health insurance status;
and
(iii) the offer or transfer of the
items or services is not tied to the
provision of other items or services
reimbursed in whole or in part by the
program under title XVIII or a State
health care program (as defined in
section 1128(h));
(H) the offer or transfer of items or
services for free or less than fair market
value by a person, if--
(i) the items or services are not
offered as part of any advertisement or
solicitation;
(ii) the items or services are not
tied to the provision of other services
reimbursed in whole or in part by the
program under title XVIII or a State
health care program (as so defined);
(iii) there is a reasonable
connection between the items or
services and the medical care of the
individual; and
(iv) the person provides the items or
services after determining in good
faith that the individual is in
financial need; or
(I) effective on a date specified by the
Secretary (but not earlier than January 1,
2011), the waiver by a PDP sponsor of a
prescription drug plan under part D of title
XVIII or an MA organization offering an MA-PD
plan under part C of such title of any
copayment for the first fill of a covered part
D drug (as defined in section 1860D-2(e)) that
is a generic drug for individuals enrolled in
the prescription drug plan or MA-PD plan,
respectively.
(7) The term ``should know'' means that a person,
with respect to information--
(A) acts in deliberate ignorance of the truth
or falsity of the information; or
(B) acts in reckless disregard of the truth
or falsity of the information,
and no proof of specific intent to defraud is required.
(j)(1) The provisions of subsections (d) and (e) of section
205 shall apply with respect to this section to the same extent
as they are applicable with respect to title II. The Secretary
may delegate the authority granted by section 205(d) (as made
applicable to this section) to the Inspector General of the
Department of Health and Human Services for purposes of any
investigation under this section.
(2) The Secretary may delegate authority granted under this
section and under section 1128 to the Inspector General of the
Department of Health and Human Services.
(k) Whenever the Secretary has reason to believe that any
person has engaged, is engaging, or is about to engage in any
activity which makes the person subject to a civil monetary
penalty under this section, the Secretary may bring an action
in an appropriate district court of the United States (or, if
applicable, a United States court of any territory) to enjoin
such activity, or to enjoin the person from concealing,
removing, encumbering, or disposing of assets which may be
required in order to pay a civil monetary penalty if any such
penalty were to be imposed or to seek other appropriate relief.
(l) A principal is liable for penalties, assessments, and an
exclusion under this section for the actions of the principal's
agent acting within the scope of the agency.
(m)(1) For purposes of this section, with respect to a
Federal health care program not contained in this Act,
references to the Secretary in this section shall be deemed to
be references to the Secretary or Administrator of the
department or agency with jurisdiction over such program and
references to the Inspector General of the Department of Health
and Human Services in this section shall be deemed to be
references to the Inspector General of the applicable
department or agency.
(2)(A) The Secretary and Administrator of the departments and
agencies referred to in paragraph (1) may include in any action
pursuant to this section, claims within the jurisdiction of
other Federal departments or agencies as long as the following
conditions are satisfied:
(i) The case involves primarily claims submitted to
the Federal health care programs of the department or
agency initiating the action.
(ii) The Secretary or Administrator of the department
or agency initiating the action gives notice and an
opportunity to participate in the investigation to the
Inspector General of the department or agency with
primary jurisdiction over the Federal health care
programs to which the claims were submitted.
(B) If the conditions specified in subparagraph (A) are
fulfilled, the Inspector General of the department or agency
initiating the action is authorized to exercise all powers
granted under the Inspector General Act of 1978 (5 U.S.C. App.)
with respect to the claims submitted to the other departments
or agencies to the same manner and extent as provided in that
Act with respect to claims submitted to such departments or
agencies.
(n)(1) Subparagraph (B) of subsection (i)(6) shall not apply
to a practice described in paragraph (2) unless--
(A) the Secretary, through the Inspector General of
the Department of Health and Human Services,
promulgates a rule authorizing such a practice as an
exception to remuneration; and
(B) the remuneration is offered or transferred by a
person under such rule during the 2-year period
beginning on the date the rule is first promulgated.
(2) A practice described in this paragraph is a practice
under which a health care provider or facility pays, in whole
or in part, premiums for medicare supplemental policies for
individuals entitled to benefits under part A of title XVIII
pursuant to section 226A.
* * * * * * *
period within which certain claims must be filed
Sec. 1132. (a) Notwithstanding any other provision of this
Act (but subject to subsection (b)), any claim by a State for
payment with respect to an expenditure made during any calendar
quarter by the State--
(1) in carrying out a State plan approved under title
I, IV, X, XIV, XVI, XIX, or XX of this Act, or
(2) under any other provision of this Act which
provides (on an entitlement basis) for Federal
financial participation in expenditures made under
State plans or programs,
shall be filed (in such form and manner as the Secretary shall
by regulations prescribe) within the two-year period which
begins on the first day of the calendar quarter immediately
following such calendar quarter; and payment shall not be made
under this Act on account of any such expenditure if claim
therefor is not made within such two-year period; except that
this subsection shall not be applied so as to deny payment with
respect to any expenditure involving court-ordered retroactive
payments or audit exceptions, or adjustments to prior year
costs.
(b) The Secretary shall waive the requirement imposed under
subsection (a) with respect to the filing of any claim if he
determines (in accordance with regulations) that there was good
cause for the failure by the State to file such claim within
the period prescribed under subsection (a). Any such waiver
shall be only for such additional period of time as may be
necessary to provide the State with a reasonable opportunity to
file such claim. A failure to file a claim within such time
period which is attributable to neglect or administrative
inadequacies shall be deemed not to be for good cause.
* * * * * * *
TITLE XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
* * * * * * *
STATE PLANS FOR MEDICAL ASSISTANCE
Sec. 1902. (a) A State plan for medical assistance must--
(1) provide that it shall be in effect in all
political subdivisions of the State, and, if
administered 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 payments under section 1903 are authorized by
this title; 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 lowering 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 individual whose
claim for medical assistance under the plan is denied
or is not acted upon with reasonable promptness;
(4) provide (A) such methods of administration
(including methods relating to the establishment and
maintenance of personnel standards on a merit basis,
except that the Secretary shall exercise no authority
with respect to the selection, tenure of office, and
compensation of any individual employed in accordance
with such methods, and including provision for
utilization of professional medical personnel in the
administration and, where administered locally,
supervision of administration of the plan) as are found
by the Secretary to be necessary for the proper and
efficient operation of the plan, (B) for the training
and effective use of paid subprofessional staff, with
particular emphasis on the full-time or part-time
employment of recipients and other persons of low
income, as community service aides, in the
administration of the plan and for the use of nonpaid
or partially paid volunteers in a social service
volunteer program in providing services to applicants
and recipients and in assisting any advisory committees
established by the State agency, (C) that each State or
local officer, employee, or independent contractor who
is responsible for the expenditure of substantial
amounts of funds under the State plan, each individual
who formerly was such an officer, employee, or
contractor, and each partner of such an officer,
employee, or contractor shall be prohibited from
committing any act, in relation to any activity under
the plan, the commission of which, in connection with
any activity concerning the United States Government,
by an officer or employee of the United States
Government, an individual who was such an officer or
employee, or a partner of such an officer or employee
is prohibited by section 207 or 208 of title 18, United
States Code, and (D) that each State or local officer,
employee, or independent contractor who is responsible
for selecting, awarding, or otherwise obtaining items
and services under the State plan shall be subject to
safeguards against conflicts of interest that are at
least as stringent as the safeguards that apply under
section 27 of the Office of Federal Procurement Policy
Act (41 U.S.C. 423) to persons described in subsection
(a)(2) of such section of that Act;
(5) either provide for the establishment or
designation of a single State agency to administer or
to supervise the administration of the plan; or provide
for the establishment or designation of a single State
agency to administer or to supervise the administration
of the plan, except that the determination of
eligibility for medical assistance under the plan shall
be made by the State or local agency administering the
State plan approved under title I or XVI (insofar as it
relates to the aged) if the State is eligible to
participate in the State plan program established under
title XVI, or by the agency or agencies administering
the supplemental security income program established
under title XVI or the State plan approved under part A
of title IV if the State is not eligible to participate
in the State plan program established under title XVI;
(6) provide that the State agency will make such
reports, in such form and containing such information,
as the Secretary may from time to time require, and
comply with such provisions as the Secretary may from
time to time find necessary to assure the correctness
and verification of such reports;
(7) provide--
(A) safeguards which restrict the use or
disclosure of information concerning applicants
and recipients to purposes directly connected
with--
(i) the administration of the plan;
and
(ii) the exchange of information
necessary to certify or verify the
certification of eligibility of
children for free or reduced price
breakfasts under the Child Nutrition
Act of 1966 and free or reduced price
lunches under the Richard B. Russell
National School Lunch Act, in
accordance with section 9(b) of that
Act, using data standards and formats
established by the State agency; and
(B) that, notwithstanding the Express Lane
option under subsection (e)(13), the State may
enter into an agreement with the State agency
administering the school lunch program
established under the Richard B. Russell
National School Lunch Act under which the State
shall establish procedures to ensure that--
(i) a child receiving medical
assistance under the State plan under
this title whose family income does not
exceed 133 percent of the poverty line
(as defined in section 673(2) of the
Community Services Block Grant Act,
including any revision required by such
section), as determined without regard
to any expense, block, or other income
disregard, applicable to a family of
the size involved, may be certified as
eligible for free lunches under the
Richard B. Russell National School
Lunch Act and free breakfasts under the
Child Nutrition Act of 1966 without
further application; and
(ii) the State agencies responsible
for administering the State plan under
this title, and for carrying out the
school lunch program established under
the Richard B. Russell National School
Lunch Act (42 U.S.C. 1751 et seq.) or
the school breakfast program
established by section 4 of the Child
Nutrition Act of 1966 (42 U.S.C. 1773),
cooperate in carrying out paragraphs
(3)(F) and (15) of section 9(b) of that
Act;
(8) provide that all individuals wishing to make
application for medical assistance under the plan shall
have opportunity to do so, and that such assistance
shall be furnished with reasonable promptness to all
eligible individuals;
(9) provide--
(A) that the State health agency, or other
appropriate State medical agency (whichever is
utilized by the Secretary for the purpose
specified in the first sentence of section
1864(a)), shall be responsible for establishing
and maintaining health standards for private or
public institutions in which recipients of
medical assistance under the plan may receive
care or services,
(B) for the establishment or designation of a
State authority or authorities which shall be
responsible for establishing and maintaining
standards, other than those relating to health,
for such institutions,
(C) that any laboratory services paid for
under such plan must be provided by a
laboratory which meets the applicable
requirements of section 1861(e)(9) or
paragraphs (16) and (17) of section 1861(s),
or, in the case of a laboratory which is in a
rural health clinic, of section 1861(aa)(2)(G),
and
(D) that the State maintain a consumer-
oriented website providing useful information
to consumers regarding all skilled nursing
facilities and all nursing facilities in the
State, including for each facility, Form 2567
State inspection reports (or a successor form),
complaint investigation reports, the facility's
plan of correction, and such other information
that the State or the Secretary considers
useful in assisting the public to assess the
quality of long term care options and the
quality of care provided by individual
facilities;
(10) provide--
(A) for making medical assistance available,
including at least the care and services listed
in paragraphs (1) through (5), (17), (21), and
(28) of section 1905(a), to--
(i) all individuals--
(I) who are receiving aid or
assistance under any plan of
the State approved under title
I, X, XIV, or XVI, or part A or
part E of title IV (including
individuals eligible under this
title by reason of section
402(a)(37), 406(h), or 473(b),
or considered by the State to
be receiving such aid as
authorized under section
482(e)(6)),
(II)(aa) with respect to whom
supplemental security income
benefits are being paid under
title XVI (or were being paid
as of the date of the enactment
of section 211(a) of the
Personal Responsibility and
Work Opportunity Reconciliation
Act of 1996 (P.L. 104-193) and
would continue to be paid but
for the enactment of that
section), (bb) who are
qualified severely impaired
individuals (as defined in
section 1905(q)), or (cc) who
are under 21 years of age and
with respect to whom
supplemental security income
benefits would be paid under
title XVI if subparagraphs (A)
and (B) of section 1611(c)(7)
were applied without regard to
the phrase ``the first day of
the month following'',
(III) who are qualified
pregnant women or children as
defined in section 1905(n),
(IV) who are described in
subparagraph (A) or (B) of
subsection (l)(1) and whose
family income does not exceed
the minimum income level the
State is required to establish
under subsection (l)(2)(A) for
such a family;
(V) who are qualified family
members as defined in section
1905(m)(1),
(VI) who are described in
subparagraph (C) of subsection
(l)(1) and whose family income
does not exceed the income
level the State is required to
establish under subsection
(l)(2)(B) for such a family,
(VII) who are described in
subparagraph (D) of subsection
(l)(1) and whose family income
does not exceed the income
level the State is required to
establish under subsection
(l)(2)(C) for such a family;
(VIII) beginning January 1,
2014, who are under 65 years of
age, not pregnant, not entitled
to, or enrolled for, benefits
under part A of title XVIII, or
enrolled for benefits under
part B of title XVIII, and are
not described in a previous
subclause of this clause, and
whose income (as determined
under subsection (e)(14)) does
not exceed 133 percent of the
poverty line (as defined in
section 2110(c)(5)) applicable
to a family of the size
involved, subject to subsection
(k); or
(IX) who--
(aa) are under 26
years of age;
(bb) are not
described in or
enrolled under any of
subclauses (I) through
(VII) of this clause or
are described in any of
such subclauses but
have income that
exceeds the level of
income applicable under
the State plan for
eligibility to enroll
for medical assistance
under such subclause;
(cc) were in foster
care under the
responsibility of the
State on the date of
attaining 18 years of
age or such higher age
as the State has
elected under section
475(8)(B)(iii); and
(dd) were enrolled in
the State plan under
this title or under a
waiver of the plan
while in such foster
care;
(ii) at the option of the State, to
any group or groups of individuals
described in section 1905(a) (or, in
the case of individuals described in
section 1905(a)(i), to any reasonable
categories of such individuals) who are
not individuals described in clause (i)
of this subparagraph but--
(I) who meet the income and
resources requirements of the
appropriate State plan
described in clause (i) or the
supplemental security income
program (as the case may be),
(II) who would meet the
income and resources
requirements of the appropriate
State plan described in clause
(i) if their work-related child
care costs were paid from their
earnings rather than by a State
agency as a service
expenditure,
(III) who would be eligible
to receive aid under the
appropriate State plan
described in clause (i) if
coverage under such plan was as
broad as allowed under Federal
law,
(IV) with respect to whom
there is being paid, or who are
eligible, or would be eligible
if they were not in a medical
institution, to have paid with
respect to them, aid or
assistance under the
appropriate State plan
described in clause (i),
supplemental security income
benefits under title XVI, or a
State supplementary payment;
(V) who are in a medical
institution for a period of not
less than 30 consecutive days
(with eligibility by reason of
this subclause beginning on the
first day of such period), who
meet the resource requirements
of the appropriate State plan
described in clause (i) or the
supplemental security income
program, and whose income does
not exceed a separate income
standard established by the
State which is consistent with
the limit established under
section 1903(f)(4)(C),
(VI) who would be eligible
under the State plan under this
title if they were in a medical
institution, with respect to
whom there has been a
determination that but for the
provision of home or community-
based services described in
subsection (c), (d), or (e) of
section 1915 they would require
the level of care provided in a
hospital, nursing facility or
intermediate care facility for
the mentally retarded the cost
of which could be reimbursed
under the State plan, and who
will receive home or community-
based services pursuant to a
waiver granted by the Secretary
under subsection (c), (d), or
(e) of section 1915,
(VII) who would be eligible
under the State plan under this
title if they were in a medical
institution, who are terminally
ill, and who will receive
hospice care pursuant to a
voluntary election described in
section 1905(o);
(VIII) who is a child
described in section
1905(a)(i)--
(aa) for whom there
is in effect an
adoption assistance
agreement (other than
an agreement under part
E of title IV) between
the State and an
adoptive parent or
parents,
(bb) who the State
agency responsible for
adoption assistance has
determined cannot be
placed with adoptive
parents without medical
assistance because such
child has special needs
for medical or
rehabilitative care,
and
(cc) who was eligible
for medical assistance
under the State plan
prior to the adoption
assistance agreement
being entered into, or
who would have been
eligible for medical
assistance at such time
if the eligibility
standards and
methodologies of the
State's foster care
program under part E of
title IV were applied
rather than the
eligibility standards
and methodologies of
the State's aid to
families with dependent
children program under
part A of title IV;
(IX) who are described in
subsection (l)(1) and are not
described in clause (i)(IV),
clause (i)(VI), or clause
(i)(VII);
(X) who are described in
subsection (m)(1);
(XI) who receive only an
optional State supplementary
payment based on need and paid
on a regular basis, equal to
the difference between the
individual's countable income
and the income standard used to
determine eligibility for such
supplementary payment (with
countable income being the
income remaining after
deductions as established by
the State pursuant to standards
that may be more restrictive
than the standards for
supplementary security income
benefits under title XVI),
which are available to all
individuals in the State (but
which may be based on different
income standards by political
subdivision according to cost
of living differences), and
which are paid by a State that
does not have an agreement with
the Commissioner of Social
Security under section 1616 or
1634;
(XII) who are described in
subsection (z)(1) (relating to
certain TB-infected
individuals);
(XIII) who are in families
whose income is less than 250
percent of the income official
poverty line (as defined by the
Office of Management and
Budget, and revised annually in
accordance with section 673(2)
of the Omnibus Budget
Reconciliation Act of 1981)
applicable to a family of the
size involved, and who but for
earnings in excess of the limit
established under section
1905(q)(2)(B), would be
considered to be receiving
supplemental security income
(subject, notwithstanding
section 1916, to payment of
premiums or other cost-sharing
charges (set on a sliding scale
based on income) that the State
may determine);
(XIV) who are optional
targeted low-income children
described in section
1905(u)(2)(B);
(XV) who, but for earnings in
excess of the limit established
under section 1905(q)(2)(B),
would be considered to be
receiving supplemental security
income, who is at least 16, but
less than 65, years of age, and
whose assets, resources, and
earned or unearned income (or
both) do not exceed such
limitations (if any) as the
State may establish;
(XVI) who are employed
individuals with a medically
improved disability described
in section 1905(v)(1) and whose
assets, resources, and earned
or unearned income (or both) do
not exceed such limitations (if
any) as the State may
establish, but only if the
State provides medical
assistance to individuals
described in subclause (XV);
(XVII) who are independent
foster care adolescents (as
defined in section 1905(w)(1)),
or who are within any
reasonable categories of such
adolescents specified by the
State;
(XVIII) who are described in
subsection (aa) (relating to
certain breast or cervical
cancer patients);
(XIX) who are disabled
children described in
subsection (cc)(1);
(XX) beginning January 1,
2014, who are under 65 years of
age and are not described in or
enrolled under a previous
subclause of this clause, and
whose income (as determined
under subsection (e)(14))
exceeds 133 percent of the
poverty line (as defined in
section 2110(c)(5)) applicable
to a family of the size
involved but does not exceed
the highest income eligibility
level established under the
State plan or under a waiver of
the plan, subject to subsection
(hh);
(XXI) who are described in
subsection (ii) (relating to
individuals who meet certain
income standards); or
(XXII) who are eligible for
home and community-based
services under needs-based
criteria established under
paragraph (1)(A) of section
1915(i), or who are eligible
for home and community-based
services under paragraph (6) of
such section, and who will
receive home and community-
based services pursuant to a
State plan amendment under such
subsection;
(B) that the medical assistance made
available to any individual described in
subparagraph (A)--
(i) shall not be less in amount,
duration, or scope than the medical
assistance made available to any other
such individual, and
(ii) shall not be less in amount,
duration, or scope than the medical
assistance made available to
individuals not described in
subparagraph (A);
(C) that if medical assistance is included
for any group of individuals described in
section 1905(a) who are not described in
subparagraph (A) or (E), then--
(i) the plan must include a
description of (I) the criteria for
determining eligibility of individuals
in the group for such medical
assistance, (II) the amount, duration,
and scope of medical assistance made
available to individuals in the group,
and (III) the single standard to be
employed in determining income and
resource eligibility for all such
groups, and the methodology to be
employed in determining such
eligibility, which shall be no more
restrictive than the methodology which
would be employed under the
supplemental security income program in
the case of groups consisting of aged,
blind, or disabled individuals in a
State in which such program is in
effect, and which shall be no more
restrictive than the methodology which
would be employed under the appropriate
State plan (described in subparagraph
(A)(i)) to which such group is most
closely categorically related in the
case of other groups;
(ii) the plan must make available
medical assistance--
(I) to individuals under the
age of 18 who (but for income
and resources) would be
eligible for medical assistance
as an individual described in
subparagraph (A)(i), and
(II) to pregnant women,
during the course of their
pregnancy, who (but for income
and resources) would be
eligible for medical assistance
as an individual described in
subparagraph (A);
(iii) such medical assistance must
include (I) with respect to children
under 18 and individuals entitled to
institutional services, ambulatory
services, and (II) with respect to
pregnant women, prenatal care and
delivery services; and
(iv) if such medical assistance
includes services in institutions for
mental diseases or in an intermediate
care facility for the mentally retarded
(or both) for any such group, it also
must include for all groups covered at
least the care and services listed in
paragraphs (1) through (5) and (17) of
section 1905(a) or the care and
services listed in any 7 of the
paragraphs numbered (1) through (24) of
such section;
(D) for the inclusion of home health services
for any individual who, under the State plan,
is entitled to nursing facility services;
(E)(i) for making medical assistance
available for medicare cost-sharing (as defined
in section 1905(p)(3)) for qualified medicare
beneficiaries described in section 1905(p)(1);
(ii) for making medical assistance available
for payment of medicare cost-sharing described
in section 1905(p)(3)(A)(i) for qualified
disabled and working individuals described in
section 1905(s);
(iii) for making medical assistance available
for medicare cost sharing described in section
1905(p)(3)(A)(ii) subject to section
1905(p)(4), for individuals who would be
qualified medicare beneficiaries described in
section 1905(p)(1) but for the fact that their
income exceeds the income level established by
the State under section 1905(p)(2) but is less
than 110 percent in 1993 and 1994, and 120
percent in 1995 and years thereafter of the
official poverty line (referred to in such
section) for a family of the size involved; and
(iv) subject to sections 1933 and 1905(p)(4),
for making medical assistance available for
medicare cost-sharing described in section
1905(p)(3)(A)(ii) for individuals who would be
qualified medicare beneficiaries described in
section 1905(p)(1) but for the fact that their
income exceeds the income level established by
the State under section 1905(p)(2) and is at
least 120 percent, but less than 135 percent,
of the official poverty line (referred to in
such section) for a family of the size involved
and who are not otherwise eligible for medical
assistance under the State plan;
(F) at the option of a State, for making
medical assistance available for COBRA premiums
(as defined in subsection (u)(2)) for qualified
COBRA continuation beneficiaries described in
section 1902(u)(1); and
(G) that, in applying eligibility criteria of
the supplemental security income program under
title XVI for purposes of determining
eligibility for medical assistance under the
State plan of an individual who is not
receiving supplemental security income, the
State will disregard the provisions of
subsections (c) and (e) of section 1613;
except that (I) the making available of the services
described in paragraph (4), (14), or (16) of section
1905(a) to individuals meeting the age requirements
prescribed therein shall not, by reason of this
paragraph (10), require the making available of any
such services, or the making available of such services
of the same amount, duration, and scope, to individuals
of any other ages, (II) the making available of
supplementary medical insurance benefits under part B
of title XVIII to individuals eligible therefor (either
pursuant to an agreement entered into under section
1843 or by reason of the payment of premiums under such
title by the State agency on behalf of such
individuals), or provision for meeting part or all of
the cost of deductibles, cost sharing, or similar
charges under part B of title XVIII for individuals
eligible for benefits under such part, shall not, by
reason of this paragraph (10), require the making
available of any such benefits, or the making available
of services of the same amount, duration, and scope, to
any other individuals, (III) the making available of
medical assistance equal in amount, duration, and scope
to the medical assistance made available to individuals
described in clause (A) to any classification of
individuals approved by the Secretary with respect to
whom there is being paid, or who are eligible, or would
be eligible if they were not in a medical institution,
to have paid with respect to them, a State
supplementary payment shall not, by reason of this
paragraph (10), require the making available of any
such assistance, or the making available of such
assistance of the same amount, duration, and scope, to
any other individuals not described in clause (A), (IV)
the imposition of a deductible, cost sharing, or
similar charge for any item or service furnished to an
individual not eligible for the exemption under section
1916(a)(2) or (b)(2) shall not require the imposition
of a deductible, cost sharing, or similar charge for
the same item or service furnished to an individual who
is eligible for such exemption, (V) the making
available to pregnant women covered under the plan of
services relating to pregnancy (including prenatal,
delivery, and postpartum services) or to any other
condition which may complicate pregnancy shall not, by
reason of this paragraph (10), require the making
available of such services, or the making available of
such services of the same amount, duration, and scope,
to any other individuals, provided such services are
made available (in the same amount, duration, and
scope) to all pregnant women covered under the State
plan, (VI) with respect to the making available of
medical assistance for hospice care to terminally ill
individuals who have made a voluntary election
described in section 1905(o) to receive hospice care
instead of medical assistance for certain other
services, such assistance may not be made available in
an amount, duration, or scope less than that provided
under title XVIII, and the making available of such
assistance shall not, by reason of this paragraph (10),
require the making available of medical assistance for
hospice care to other individuals or the making
available of medical assistance for services waived by
such terminally ill individuals, (VII) the medical
assistance made available to an individual described in
subsection (l)(1)(A) who is eligible for medical
assistance only because of subparagraph (A)(i)(IV) or
(A)(ii)(IX) shall be limited to medical assistance for
services related to pregnancy (including prenatal,
delivery, postpartum, and family planning services) and
to other conditions which may complicate pregnancy,
(VIII) the medical assistance made available to a
qualified medicare beneficiary described in section
1905(p)(1) who is only entitled to medical assistance
because the individual is such a beneficiary shall be
limited to medical assistance for medicare cost-sharing
(described in section 1905(p)(3)), subject to the
provisions of subsection (n) and section 1916(b), (IX)
the making available of respiratory care services in
accordance with subsection (e)(9) shall not, by reason
of this paragraph (10), require the making available of
such services, or the making available of such services
of the same amount, duration, and scope, to any
individuals not included under subsection (e)(9)(A),
provided such services are made available (in the same
amount, duration, and scope) to all individuals
described in such subsection, (X) if the plan provides
for any fixed durational limit on medical assistance
for inpatient hospital services (whether or not such a
limit varies by medical condition or diagnosis), the
plan must establish exceptions to such a limit for
medically necessary inpatient hospital services
furnished with respect to individuals under one year of
age in a hospital defined under the State plan,
pursuant to section 1923(a)(1)(A), as a
disproportionate share hospital and subparagraph (B)
(relating to comparability) shall not be construed as
requiring such an exception for other individuals,
services, or hospitals, (XI) the making available of
medical assistance to cover the costs of premiums,
deductibles, coinsurance, and other cost-sharing
obligations for certain individuals for private health
coverage as described in section 1906 shall not, by
reason of paragraph (10), require the making available
of any such benefits or the making available of
services of the same amount, duration, and scope of
such private coverage to any other individuals, (XII)
the medical assistance made available to an individual
described in subsection (u)(1) who is eligible for
medical assistance only because of subparagraph (F)
shall be limited to medical assistance for COBRA
continuation premiums (as defined in subsection
(u)(2)), (XIII) the medical assistance made available
to an individual described in subsection (z)(1) who is
eligible for medical assistance only because of
subparagraph (A)(ii)(XII) shall be limited to medical
assistance for TB-related services (described in
subsection (z)(2)), (XIV) the medical assistance made
available to an individual described in subsection (aa)
who is eligible for medical assistance only because of
subparagraph (A)(10)(ii)(XVIII) shall be limited to
medical assistance provided during the period in which
such an individual requires treatment for breast or
cervical cancer (XV) the medical assistance made
available to an individual described in subparagraph
(A)(i)(VIII) shall be limited to medical assistance
described in subsection (k)(1), (XVI) the medical
assistance made available to an individual described in
subsection (ii) shall be limited to family planning
services and supplies described in section
1905(a)(4)(C) including medical diagnosis and treatment
services that are provided pursuant to a family
planning service in a family planning setting and
(XVII) if an individual is described in subclause (IX)
of subparagraph (A)(i) and is also described in
subclause (VIII) of that subparagraph, the medical
assistance shall be made available to the individual
through subclause (IX) instead of through subclause
(VIII);
(11)(A) provide for entering into cooperative
arrangements with the State agencies responsible for
administering or supervising the administration of
health services and vocational rehabilitation services
in the State looking toward maximum utilization of such
services in the provision of medical assistance under
the plan, (B) provide, to the extent prescribed by the
Secretary, for entering into agreements, with any
agency, institution, or organization receiving payments
under (or through an allotment under) title V, (i)
providing for utilizing such agency, institution, or
organization in furnishing care and services which are
available under such title or allotment and which are
included in the State plan approved under this section
(ii) making such provision as may be appropriate for
reimbursing such agency, institution, or organization
for the cost of any such care and services furnished
any individual for which payment would otherwise be
made to the State with respect to the individual under
section 1903, and (iii) providing for coordination of
information and education on pediatric vaccinations and
delivery of immunization services, and (C) provide for
coordination of the operations under this title,
including the provision of information and education on
pediatric vaccinations and the delivery of immunization
services, with the State's operations under the special
supplemental nutrition program for women, infants, and
children under section 17 of the Child Nutrition Act of
1966;
(12) provide that, in determining whether an
individual is blind, there shall be an examination by a
physician skilled in the diseases of the eye or by an
optometrist, whichever the individual may select;
(13) provide--
(A) for a public process for determination of
rates of payment under the plan for hospital
services, nursing facility services, and
services of intermediate care facilities for
the mentally retarded under which--
(i) proposed rates, the methodologies
underlying the establishment of such
rates, and justifications for the
proposed rates are published,
(ii) providers, beneficiaries and
their representatives, and other
concerned State residents are given a
reasonable opportunity for review and
comment on the proposed rates,
methodologies, and justifications,
(iii) final rates, the methodologies
underlying the establishment of such
rates, and justifications for such
final rates are published, and
(iv) in the case of hospitals, such
rates take into account (in a manner
consistent with section 1923) the
situation of hospitals which serve a
disproportionate number of low-income
patients with special needs;
(B) for payment for hospice care in amounts
no lower than the amounts, using the same
methodology, used under part A of title XVIII
and for payment of amounts under section
1905(o)(3); except that in the case of hospice
care which is furnished to an individual who is
a resident of a nursing facility or
intermediate care facility for the mentally
retarded, and who would be eligible under the
plan for nursing facility services or services
in an intermediate care facility for the
mentally retarded if he had not elected to
receive hospice care, there shall be paid an
additional amount, to take into account the
room and board furnished by the facility, equal
to at least 95 percent of the rate that would
have been paid by the State under the plan for
facility services in that facility for that
individual; and
(C) payment for primary care services (as
defined in subsection (jj)) furnished in 2013
and 2014 by a physician with a primary
specialty designation of family medicine,
general internal medicine, or pediatric
medicine at a rate not less than 100 percent of
the payment rate that applies to such services
and physician under part B of title XVIII (or,
if greater, the payment rate that would be
applicable under such part if the conversion
factor under section 1848(d) for the year
involved were the conversion factor under such
section for 2009);
(14) provide that enrollment fees, premiums, or
similar charges, and deductions, cost sharing, or
similar charges, may be imposed only as provided in
section 1916;
(15) provide for payment for services described in
clause (B) or (C) of section 1905(a)(2) under the plan
in accordance with subsection (bb);
(16) provide for inclusion, to the extent required by
regulations prescribed by the Secretary, of provisions
(conforming to such regulations) with respect to the
furnishing of medical assistance under the plan to
individuals who are residents of the State but are
absent therefrom;
(17) except as provided in subsections (e)(14),
(e)(14), (l)(3), (m)(3), and (m)(4), include reasonable
standards (which shall be comparable for all groups and
may, in accordance with standards prescribed by the
Secretary, differ with respect to income levels, but
only in the case of applicants or recipients of
assistance under the plan who are not receiving aid or
assistance under any plan of the State approved under
title I, X, XIV, or XVI, or part A of title IV, and
with respect to whom supplemental security income
benefits are not being paid under title XVI, based on
the variations between shelter costs in urban areas and
in rural areas) for determining eligibility for and the
extent of medical assistance under the plan which (A)
are consistent with the objectives of this title, (B)
provide for taking into account only such income and
resources as are, as determined in accordance with
standards prescribed by the Secretary, available to the
applicant or recipient and (in the case of any
applicant or recipient who would, except for income and
resources, be eligible for aid or assistance in the
form of money payments under any plan of the State
approved under title I, X, XIV, or XVI, or part A of
title IV, or to have paid with respect to him
supplemental security income benefits under title XVI)
as would not be disregarded (or set aside for future
needs) in determining his eligibility for such aid,
assistance, or benefits, (C) provide for reasonable
evaluation of any such income or resources, and (D) do
not take into account the financial responsibility of
any individual for any applicant or recipient of
assistance under the plan unless such applicant or
recipient is such individual's spouse or such
individual's child who is under age 21 or (with respect
to States eligible to participate in the State program
established under title XVI), is blind or permanently
and totally disabled, or is blind or disabled as
defined in section 1614 (with respect to States which
are not eligible to participate in such program); and
provide for flexibility in the application of such
standards with respect to income by taking into
account, except to the extent prescribed by the
Secretary, the costs (whether in the form of insurance
premiums, payments made to the State under section
1903(f)(2)(B), or otherwise and regardless of whether
such costs are reimbursed under another public program
of the State or political subdivision thereof) incurred
for medical care or for any other type of remedial care
recognized under State law;
(18) comply with the provisions of section 1917 with
respect to liens, adjustments and recoveries of medical
assistance correctly paid, transfers of assets, and
treatment of certain trusts;
(19) provide such safeguards as may be necessary to
assure that eligibility for care and services under the
plan will be determined, and such care and services
will be provided, in a manner consistent with
simplicity of administration and the best interests of
the recipients;
(20) if the State plan includes medical assistance in
behalf of individuals 65 years of age or older who are
patients in institutions for mental diseases--
(A) provide for having in effect such
agreements or other arrangements with State
authorities concerned with mental diseases,
and, where appropriate, with such institutions,
as may be necessary for carrying out the State
plan, including arrangements for joint planning
and for development of alternate methods of
care, arrangements providing assurance of
immediate readmittance to institutions where
needed for individuals under alternate plans of
care, and arrangements providing for access to
patients and facilities, for furnishing
information, and for making reports;
(B) provide for an individual plan for each
such patient to assure that the institutional
care provided to him is in his best interests,
including, to that end, assurances that there
will be initial and periodic review of his
medical and other needs, that he will be given
appropriate medical treatment within the
institution, and that there will be a periodic
determination of his need for continued
treatment in the institution; and
(C) provide for the development of alternate
plans of care, making maximum utilization of
available resources, for recipients 65 years of
age or older who would otherwise need care in
such institutions, including appropriate
medical treatment and other aid or assistance;
for services referred to in section
3(a)(4)(A)(i) and (ii) or section
1603(a)(4)(A)(i) and (ii) which are appropriate
for such recipients and for such patients; and
for methods of administration necessary to
assure that the responsibilities of the State
agency under the State plan with respect to
such recipients and such patients will be
effectively carried out;
(21) if the State plan includes medical assistance in
behalf of individuals 65 years of age or older who are
patients in public institutions for mental diseases,
show that the State is making satisfactory progress
toward developing and implementing a comprehensive
mental health program, including provision for
utilization of community mental health centers, nursing
facilities, and other alternatives to care in public
institutions for mental diseases;
(22) include descriptions of (A) the kinds and
numbers of professional medical personnel and
supporting staff that will be used in the
administration of the plan and of the responsibilities
they will have, (B) the standards, for private or
public institutions in which recipients of medical
assistance under the plan may receive care or services,
that will be utilized by the State authority or
authorities responsible for establishing and
maintaining such standards, (C) the cooperative
arrangements with State health agencies and State
vocational rehabilitation agencies entered into with a
view to maximum utilization of and coordination of the
provision of medical assistance with the services
administered or supervised by such agencies, and (D)
other standards and methods that the State will use to
assure that medical or remedial care and services
provided to recipients of medical assistance are of
high quality;
(23) provide that (A) any individual eligible for
medical assistance (including drugs) may obtain such
assistance from any institution, agency, community
pharmacy, or person, qualified to perform the service
or services required (including an organization which
provides such services, or arranges for their
availability, on a prepayment basis), who undertakes to
provide him such services, and (B) an enrollment of an
individual eligible for medical assistance in a primary
care case-management system (described in section
1915(b)(1)), a medicaid managed care organization, or a
similar entity shall not restrict the choice of the
qualified person from whom the individual may receive
services under section 1905(a)(4)(C), except as
provided in subsection (g) and in section 1915, except
that this paragraph shall not apply in the case of
Puerto Rico, the Virgin Islands, and Guam, and except
that nothing in this paragraph shall be construed as
requiring a State to provide medical assistance for
such services furnished by a person or entity convicted
of a felony under Federal or State law for an offense
which the State agency determines is inconsistent with
the best interests of beneficiaries under the State
plan or by a provider or supplier to which a moratorium
under subsection (kk)(4) is applied during the period
of such moratorium';
(24) effective July 1, 1969, provide for consultative
services by health agencies and other appropriate
agencies of the State to hospitals, nursing facilities,
home health agencies, clinics, laboratories, and such
other institutions as the Secretary may specify in
order to assist them (A) to qualify for payments under
this Act, (B) to establish and maintain such fiscal
records as may be necessary for the proper and
efficient administration of this Act, and (C) to
provide information needed to determine payments due
under this Act on account of care and services
furnished to individuals;
(25) provide--
(A) that the State or local agency
administering such plan will take all
reasonable measures to ascertain the legal
liability of third parties (including health
insurers, self-insured plans, group health
plans (as defined in section 607(1) of the
Employee Retirement Income Security Act of
1974), service benefit plans, managed care
organizations, pharmacy benefit managers, or
other parties that are, by statute, contract,
or agreement, legally responsible for payment
of a claim for a health care item or service)
to pay for care and services available under
the plan, including--
(i) the collection of sufficient
information (as specified by the
Secretary in regulations) to enable the
State to pursue claims against such
third parties, with such information
being collected at the time of any
determination or redetermination of
eligibility for medical assistance, and
(ii) the submission to the Secretary
of a plan (subject to approval by the
Secretary) for pursuing claims against
such third parties, which plan shall be
integrated with, and be monitored as a
part of the Secretary's review of, the
State's mechanized claims processing
and information retrieval systems
required under section 1903(r);
(B) that in any case where such a legal
liability is found to exist after medical
assistance has been made available on behalf of
the individual and where the amount of
reimbursement the State can reasonably expect
to recover exceeds the costs of such recovery,
the State or local agency will seek
reimbursement for such assistance to the extent
of such legal liability;
(C) that in the case of an individual who is
entitled to medical assistance under the State
plan with respect to a service for which a
third party is liable for payment, the person
furnishing the service may not seek to collect
from the individual (or any financially
responsible relative or representative of that
individual) payment of an amount for that
service (i) if the total of the amount of the
liabilities of third parties for that service
is at least equal to the amount payable for
that service under the plan (disregarding
section 1916), or (ii) in an amount which
exceeds the lesser of (I) the amount which may
be collected under section 1916, or (II) the
amount by which the amount payable for that
service under the plan (disregarding section
1916) exceeds the total of the amount of the
liabilities of third parties for that service;
(D) that a person who furnishes services and
is participating under the plan may not refuse
to furnish services to an individual (who is
entitled to have payment made under the plan
for the services the person furnishes) because
of a third party's potential liability for
payment for the service;
(E) that in the case of prenatal or
preventive pediatric care (including early and
periodic screening and diagnosis services under
section 1905(a)(4)(B)) covered under the State
plan, the State shall--
(i) make payment for such service in
accordance with the usual payment
schedule under such plan for such
services without regard to the
liability of a third party for payment
for such services; and
(ii) seek reimbursement from such
third party in accordance with
subparagraph (B);
(F) that in the case of any services covered
under such plan which are provided to an
individual on whose behalf child support
enforcement is being carried out by the State
agency under part D of title IV of this Act,
the State shall--
(i) make payment for such service in
accordance with the usual payment
schedule under such plan for such
services without regard to any third-
party liability for payment for such
services, if such third-party liability
is derived (through insurance or
otherwise) from the parent whose
obligation to pay support is being
enforced by such agency, if payment has
not been made by such third party
within 30 days after such services are
furnished;
(ii) seek reimbursement from such
third party in accordance with
subparagraph (B);
(G) that the State prohibits any health
insurer (including a group health plan, as
defined in section 607(1) of the Employee
Retirement Income Security Act of 1974, a self-
insured plan, a service benefit plan, a managed
care organization, a pharmacy benefit manager,
or other party that is, by statute, contract,
or agreement, legally responsible for payment
of a claim for a health care item or service),
in enrolling an individual or in making any
payments for benefits to the individual or on
the individual's behalf, from taking into
account that the individual is eligible for or
is provided medical assistance under a plan
under this title for such State, or any other
State;
(H) that to the extent that payment has been
made under the State plan for medical
assistance in any case where a third party has
a legal liability to make payment for such
assistance, the State has in effect laws under
which, to the extent that payment has been made
under the State plan for medical assistance for
health care items or services furnished to an
individual, the State is considered to have
acquired the rights of such individual to
payment by any other party for such health care
items or services; and
(I) that the State shall provide assurances
satisfactory to the Secretary that the State
has in effect laws requiring health insurers,
including self-insured plans, group health
plans (as defined in section 607(1) of the
Employee Retirement Income Security Act of
1974), service benefit plans, managed care
organizations, pharmacy benefit managers, or
other parties that are, by statute, contract,
or agreement, legally responsible for payment
of a claim for a health care item or service,
as a condition of doing business in the State,
to--
(i) provide, with respect to
individuals who are eligible (and, at
State option, individuals who apply or
whose eligibility for medical
assistance is being evaluated in
accordance with section 1902(e)(13)(D))
for, or are provided, medical
assistance under the State plan under
this title (and, at State option, child
health assistance under title XXI),
upon the request of the State,
information to determine during what
period the individual or their spouses
or their dependents may be (or may have
been) covered by a health insurer and
the nature of the coverage that is or
was provided by the health insurer
(including the name, address, and
identifying number of the plan) in a
manner prescribed by the Secretary;
(ii) accept the State's right of
recovery and the assignment to the
State of any right of an individual or
other entity to payment from the party
for an item or service for which
payment has been made under the State
plan;
(iii) respond to any inquiry by the
State regarding a claim for payment for
any health care item or service that is
submitted not later than 3 years after
the date of the provision of such
health care item or service; and
(iv) agree not to deny a claim
submitted by the State solely on the
basis of the date of submission of the
claim, the type or format of the claim
form, or a failure to present proper
documentation at the point-of-sale that
is the basis of the claim, if--
(I) the claim is submitted by
the State within the 3-year
period beginning on the date on
which the item or service was
furnished; and
(II) any action by the State
to enforce its rights with
respect to such claim is
commenced within 6 years of the
State's submission of such
claim;
(26) if the State plan includes medical assistance
for inpatient mental hospital services, provide, with
respect to each patient receiving such services, for a
regular program of medical review (including medical
evaluation) of his need for such services, and for a
written plan of care;
(27) provide for agreements with every person or
institution providing services under the State plan
under which such person or institution agrees (A) to
keep such records as are necessary fully to disclose
the extent of the services provided to individuals
receiving assistance under the State plan, and (B) to
furnish the State agency or the Secretary with such
information, regarding any payments claimed by such
person or institution for providing services under the
State plan, as the State agency or the Secretary may
from time to time request;
(28) provide--
(A) that any nursing facility receiving
payments under such plan must satisfy all the
requirements of subsections (b) through (d) of
section 1919 as they apply to such facilities;
(B) for including in ``nursing facility
services'' at least the items and services
specified (or deemed to be specified) by the
Secretary under section 1919(f)(7) and making
available upon request a description of the
items and services so included;
(C) for procedures to make available to the
public the data and methodology used in
establishing payment rates for nursing
facilities under this title; and
(D) for compliance (by the date specified in
the respective sections) with the requirements
of--
(i) section 1919(e);
(ii) section 1919(g) (relating to
responsibility for survey and
certification of nursing facilities);
and
(iii) sections 1919(h)(2)(B) and
1919(h)(2)(D) (relating to
establishment and application of
remedies);
(29) include a State program which meets the
requirements set forth in section 1908, for the
licensing of administrators of nursing homes;
(30)(A) provide such methods and procedures relating
to the utilization of, and the payment for, care and
services available under the plan (including but not
limited to utilization review plans as provided for in
section 1903(i)(4)) as may be necessary to safeguard
against unnecessary utilization of such care and
services and to assure that payments are consistent
with efficiency, economy, and quality of care and are
sufficient to enlist enough providers so that care and
services are available under the plan at least to the
extent that such care and services are available to the
general population in the geographic area; and
(B) provide, under the program described in
subparagraph (A), that--
(i) each admission to a hospital,
intermediate care facility for the mentally
retarded, or hospital for mental diseases is
reviewed or screened in accordance with
criteria established by medical and other
professional personnel who are not themselves
directly responsible for the care of the
patient involved, and who do not have a
significant financial interest in any such
institution and are not, except in the case of
a hospital, employed by the institution
providing the care involved, and
(ii) the information developed from such
review or screening, along with the data
obtained from prior reviews of the necessity
for admission and continued stay of patients by
such professional personnel, shall be used as
the basis for establishing the size and
composition of the sample of admissions to be
subject to review and evaluation by such
personnel, and any such sample may be of any
size up to 100 percent of all admissions and
must be of sufficient size to serve the purpose
of (I) identifying the patterns of care being
provided and the changes occurring over time in
such patterns so that the need for modification
may be ascertained, and (II) subjecting
admissions to early or more extensive review
where information indicates that such
consideration is warranted to a hospital,
intermediate care facility for the mentally
retarded, or hospital for mental diseases;
(31) with respect to services in an intermediate care
facility for the mentally retarded (where the State
plan includes medical assistance for such services)
provide, with respect to each patient receiving such
services, for a written plan of care, prior to
admission to or authorization of benefits in such
facility, in accordance with regulations of the
Secretary, and for a regular program of independent
professional review (including medical evaluation)
which shall periodically review his need for such
services;
(32) provide that no payment under the plan for any
care or service provided to an individual shall be made
to anyone other than such individual or the person or
institution providing such care or service, under an
assignment or power of attorney or otherwise; except
that--
(A) in the case of any care or service
provided by a physician, dentist, or other
individual practitioner, such payment may be
made (i) to the employer of such physician,
dentist, or other practitioner if such
physician, dentist, or practitioner is required
as a condition of his employment to turn over
his fee for such care or service to his
employer, or (ii) (where the care or service
was provided in a hospital, clinic, or other
facility) to the facility in which the care or
service was provided if there is a contractual
arrangement between such physician, dentist, or
practitioner and such facility under which such
facility submits the bill for such care or
service;
(B) nothing in this paragraph shall be
construed (i) to prevent the making of such a
payment in accordance with an assignment from
the person or institution providing the care or
service involved if such assignment is made to
a governmental agency or entity or is
established by or pursuant to the order of a
court of competent jurisdiction, or (ii) to
preclude an agent of such person or institution
from receiving any such payment if (but only
if) such agent does so pursuant to an agency
agreement under which the compensation to be
paid to the agent for his services for or in
connection with the billing or collection of
payments due such person or institution under
the plan is unrelated (directly or indirectly)
to the amount of such payments or the billings
therefor, and is not dependent upon the actual
collection of any such payment;
(C) in the case of services furnished (during
a period that does not exceed 14 continuous
days in the case of an informal reciprocal
arrangement or 90 continuous days (or such
longer period as the Secretary may provide) in
the case of an arrangement involving per diem
or other fee-for-time compensation) by, or
incident to the services of, one physician to
the patients of another physician who submits
the claim for such services, payment shall be
made to the physician submitting the claim (as
if the services were furnished by, or incident
to, the physician's services), but only if the
claim identifies (in a manner specified by the
Secretary) the physician who furnished the
services; and
(D) in the case of payment for a childhood
vaccine administered before October 1, 1994, to
individuals entitled to medical assistance
under the State plan, the State plan may make
payment directly to the manufacturer of the
vaccine under a voluntary replacement program
agreed to by the State pursuant to which the
manufacturer (i) supplies doses of the vaccine
to providers administering the vaccine, (ii)
periodically replaces the supply of the
vaccine, and (iii) charges the State the
manufacturer's price to the Centers for Disease
Control and Prevention for the vaccine so
administered (which price includes a reasonable
amount to cover shipping and the handling of
returns);
(33) provide--
(A) that the State health agency, or other
appropriate State medical agency, shall be
responsible for establishing a plan, consistent
with regulations prescribed by the Secretary,
for the review by appropriate professional
health personnel of the appropriateness and
quality of care and services furnished to
recipients of medical assistance under the plan
in order to provide guidance with respect
thereto in the administration of the plan to
the State agency established or designated
pursuant to paragraph (5) and, where
applicable, to the State agency described in
the second sentence of this subsection; and
(B) that, except as provided in section
1919(g), the State or local agency utilized by
the Secretary for the purpose specified in the
first sentence of section 1864(a), or, if such
agency is not the State agency which is
responsible for licensing health institutions,
the State agency responsible for such
licensing, will perform for the State agency
administering or supervising the administration
of the plan approved under this title the
function of determining whether institutions
and agencies meet the requirements for
participation in the program under such plan,
except that, if the Secretary has cause to
question the adequacy of such determinations,
the Secretary is authorized to validate State
determinations and, on that basis, make
independent and binding determinations
concerning the extent to which individual
institutions and agencies meet the requirements
for participation;
(34) provide that in the case of any individual who
has been determined to be eligible for medical
assistance under the plan, such assistance will be made
available to him for care and services included under
the plan and furnished in or after the third month
before the month in which he made application (or
application was made on his behalf in the case of a
deceased individual) for such assistance if such
individual was (or upon application would have been)
eligible for such assistance at the time such care and
services were furnished;
(35) provide that any disclosing entity (as defined
in section 1124(a)(2)) receiving payments under such
plan complies with the requirements of section 1124;
(36) provide that within 90 days following the
completion of each survey of any health care facility,
laboratory, agency, clinic, or organization, by the
appropriate State agency described in paragraph (9),
such agency shall (in accordance with regulations of
the Secretary) make public in readily available form
and place the pertinent findings of each such survey
relating to the compliance of each such health care
facility, laboratory, clinic, agency, or organization
with (A) the statutory conditions of participation
imposed under this title, and (B) the major additional
conditions which the Secretary finds necessary in the
interest of health and safety of individuals who are
furnished care or services by any such facility,
laboratory, clinic, agency, or organization;
(37) provide for claims payment procedures which (A)
ensure that 90 per centum of claims for payment (for
which no further written information or substantiation
is required in order to make payment) made for services
covered under the plan and furnished by health care
practitioners through individual or group practices or
through shared health facilities are paid within 30
days of the date of receipt of such claims and that 99
per centum of such claims are paid within 90 days of
the date of receipt of such claims, and (B) provide for
procedures of prepayment and postpayment claims review,
including review of appropriate data with respect to
the recipient and provider of a service and the nature
of the service for which payment is claimed, to ensure
the proper and efficient payment of claims and
management of the program;
(38) require that an entity (other than an individual
practitioner or a group of practitioners) that
furnishes, or arranges for the furnishing of, items or
services under the plan, shall supply (within such
period as may be specified in regulations by the
Secretary or by the single State agency which
administers or supervises the administration of the
plan) upon request specifically addressed to such
entity by the Secretary or such State agency, the
information described in section 1128(b)(9);
(39) provide that the State agency shall exclude any
specified individual or entity from participation in
the program under the State plan for the period
specified by the Secretary, when required by him to do
so pursuant to section 1128 or section 1128A, terminate
the participation of any individual or entity in such
program if (subject to such exceptions as are permitted
with respect to exclusion under sections 1128(c)(3)(B)
and 1128(d)(3)(B)) participation of such individual or
entity is terminated under title XVIII or any other
State plan under this title, and provide that no
payment may be made under the plan with respect to any
item or service furnished by such individual or entity
during such period;
(40) require each health services facility or
organization which receives payments under the plan and
of a type for which a uniform reporting system has been
established under section 1121(a) to make reports to
the Secretary of information described in such section
in accordance with the uniform reporting system
(established under such section) for that type of
facility or organization;
(41) provide that whenever a provider of services or
any other person is terminated, suspended, or otherwise
sanctioned or prohibited from participating under the
State plan, the State agency shall promptly notify the
Secretary and, in the case of a physician and
notwithstanding paragraph (7), the State medical
licensing board of such action;
(42) provide that--
(A) the records of any entity participating
in the plan and providing services reimbursable
on a cost-related basis will be audited as the
Secretary determines to be necessary to insure
that proper payments are made under the plan;
and
(B) not later than December 31, 2010, the
State shall--
(i) establish a program under which
the State contracts (consistent with
State law and in the same manner as the
Secretary enters into contracts with
recovery audit contractors under
section 1893(h), subject to such
exceptions or requirements as the
Secretary may require for purposes of
this title or a particular State) with
1 or more recovery audit contractors
for the purpose of identifying
underpayments and overpayments and
recouping overpayments under the State
plan and under any waiver of the State
plan with respect to all services for
which payment is made to any entity
under such plan or waiver; and
(ii) provide assurances satisfactory
to the Secretary that--
(I) under such contracts,
payment shall be made to such a
contractor only from amounts
recovered;
(II) from such amounts
recovered, payment--
(aa) shall be made on
a contingent basis for
collecting
overpayments; and
(bb) may be made in
such amounts as the
State may specify for
identifying
underpayments;
(III) the State has an
adequate process for entities
to appeal any adverse
determination made by such
contractors; and
(IV) such program is carried
out in accordance with such
requirements as the Secretary
shall specify, including--
(aa) for purposes of
section 1903(a)(7),
that amounts expended
by the State to carry
out the program shall
be considered amounts
expended as necessary
for the proper and
efficient
administration of the
State plan or a waiver
of the plan;
(bb) that section
1903(d) shall apply to
amounts recovered under
the program; and
(cc) that the State
and any such
contractors under
contract with the State
shall coordinate such
recovery audit efforts
with other contractors
or entities performing
audits of entities
receiving payments
under the State plan or
waiver in the State,
including efforts with
Federal and State law
enforcement with
respect to the
Department of Justice,
including the Federal
Bureau of
Investigations, the
Inspector General of
the Department of
Health and Human
Services, and the State
medicaid fraud control
unit; and
(43) provide for--
(A) informing all persons in the State who
are under the age of 21 and who have been
determined to be eligible for medical
assistance including services described in
section 1905(a)(4)(B), of the availability of
early and periodic screening, diagnostic, and
treatment services as described in section
1905(r) and the need for age-appropriate
immunizations against vaccine-preventable
diseases,
(B) providing or arranging for the provision
of such screening services in all cases where
they are requested,
(C) arranging for (directly or through
referral to appropriate agencies,
organizations, or individuals) corrective
treatment the need for which is disclosed by
such child health screening services, and
(D) reporting to the Secretary (in a uniform
form and manner established by the Secretary,
by age group and by basis of eligibility for
medical assistance, and by not later than April
1 after the end of each fiscal year, beginning
with fiscal year 1990) the following
information relating to early and periodic
screening, diagnostic, and treatment services
provided under the plan during each fiscal
year:
(i) the number of children provided
child health screening services,
(ii) the number of children referred
for corrective treatment (the need for
which is disclosed by such child health
screening services),
(iii) the number of children
receiving dental services, and other
information relating to the provision
of dental services to such children
described in section 2108(e) and
(iv) the State's results in attaining
the participation goals set for the
State under section 1905(r);
(44) in each case for which payment for inpatient
hospital services, services in an intermediate care
facility for the mentally retarded, or inpatient mental
hospital services is made under the State plan--
(A) a physician (or, in the case of skilled
nursing facility services or intermediate care
facility services, a physician, or a nurse
practitioner or clinical nurse specialist who
is not an employee of the facility but is
working in collaboration with a physician)
certifies at the time of admission, or, if
later, the time the individual applies for
medical assistance under the State plan (and a
physician, a physician assistant under the
supervision of a physician, or, in the case of
skilled nursing facility services or
intermediate care facility services, a
physician, or a nurse practitioner or clinical
nurse specialist who is not an employee of the
facility but is working in collaboration with a
physician, recertifies, where such services are
furnished over a period of time, in such cases,
at least as often as required under section
1903(g)(6) (or, in the case of services that
are services provided in an intermediate care
facility for the mentally retarded, every
year), and accompanied by such supporting
material, appropriate to the case involved, as
may be provided in regulations of the
Secretary), that such services are or were
required to be given on an inpatient basis
because the individual needs or needed such
services, and
(B) such services were furnished under a plan
established and periodically reviewed and
evaluated by a physician, or, in the case of
skilled nursing facility services or
intermediate care facility services, a
physician, or a nurse practitioner or clinical
nurse specialist who is not an employee of the
facility but is working in collaboration with a
physician;
(45) provide for mandatory assignment of rights of
payment for medical support and other medical care owed
to recipients, in accordance with section 1912;
(46)(A) provide that information is requested and
exchanged for purposes of income and eligibility
verification in accordance with a State system which
meets the requirements of section 1137 of this Act; and
(B) provide, with respect to an individual declaring
to be a citizen or national of the United States for
purposes of establishing eligibility under this title,
that the State shall satisfy the requirements of--
(i) section 1903(x); or
(ii) subsection (ee);
(47) provide--
(A) at the option of the State, for making
ambulatory prenatal care available to pregnant
women during a presumptive eligibility period
in accordance with section 1920 and provide for
making medical assistance for items and
services described in subsection (a) of section
1920A available to children during a
presumptive eligibility period in accordance
with such section and provide for making
medical assistance available to individuals
described in subsection (a) of section 1920B
during a presumptive eligibility period in
accordance with such section and provide for
making medical assistance available to
individuals described in subsection (a) of
section 1920C during a presumptive eligibility
period in accordance with such section; and
(B) that any hospital that is a participating
provider under the State plan may elect to be a
qualified entity for purposes of determining,
on the basis of preliminary information,
whether any individual is eligible for medical
assistance under the State plan or under a
waiver of the plan for purposes of providing
the individual with medical assistance during a
presumptive eligibility period, in the same
manner, and subject to the same requirements,
as apply to the State options with respect to
populations described in section 1920, 1920A,
1920B, or 1920C (but without regard to whether
the State has elected to provide for a
presumptive eligibility period under any such
sections), subject to such guidance as the
Secretary shall establish;
(48) provide a method of making cards evidencing
eligibility for medical assistance available to an
eligible individual who does not reside in a permanent
dwelling or does not have a fixed home or mailing
address;
(49) provide that the State will provide information
and access to certain information respecting sanctions
taken against health care practitioners and providers
by State licensing authorities in accordance with
section 1921;
(50) provide, in accordance with subsection (q), for
a monthly personal needs allowance for certain
institutionalized individuals and couples;
(51) meet the requirements of section 1924 (relating
to protection of community spouses);
(52) meet the requirements of section 1925 (relating
to extension of eligibility for medical assistance);
(53) provide--
(A) for notifying in a timely manner all
individuals in the State who are determined to
be eligible for medical assistance and who are
pregnant women, breastfeeding or postpartum
women (as defined in section 17 of the Child
Nutrition Act of 1966), or children below the
age of 5, of the availability of benefits
furnished by the special supplemental nutrition
program under such section, and
(B) for referring any such individual to the
State agency responsible for administering such
program;
(54) in the case of a State plan that provides
medical assistance for covered outpatient drugs (as
defined in section 1927(k)), comply with the applicable
requirements of section 1927;
(55) provide for receipt and initial processing of
applications of individuals for medical assistance
under subsection (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI),
(a)(10)(A)(i)(VII), or (a)(10)(A)(ii)(IX)--
(A) at locations which are other than those
used for the receipt and processing of
applications for aid under part A of title IV
and which include facilities defined as
disproportionate share hospitals under section
1923(a)(1)(A) and Federally-qualified health
centers described in section 1905(1)(2)(B), and
(B) using applications which are other than
those used for applications for aid under such
part;
(56) provide, in accordance with subsection (s), for
adjusted payments for certain inpatient hospital
services;
(57) provide that each hospital, nursing facility,
provider of home health care or personal care services,
hospice program, or medicaid managed care organization
(as defined in section 1903(m)(1)(A)) receiving funds
under the plan shall comply with the requirements of
subsection (w);
(58) provide that the State, acting through a State
agency, association, or other private nonprofit entity,
develop a written description of the law of the State
(whether statutory or as recognized by the courts of
the State) concerning advance directives that would be
distributed by providers or organizations under the
requirements of subsection (w);
(59) maintain a list (updated not less often than
monthly, and containing each physician's unique
identifier provided under the system established under
subsection (x)) of all physicians who are certified to
participate under the State plan;
(60) provide that the State agency shall provide
assurances satisfactory to the Secretary that the State
has in effect the laws relating to medical child
support required under section 1908A;
(61) provide that the State must demonstrate that it
operates a medicaid fraud and abuse control unit
described in section 1903(q) that effectively carries
out the functions and requirements described in such
section, as determined in accordance with standards
established by the Secretary, unless the State
demonstrates to the satisfaction of the Secretary that
the effective operation of such a unit in the State
would not be cost-effective because minimal fraud
exists in connection with the provision of covered
services to eligible individuals under the State plan,
and that beneficiaries under the plan will be protected
from abuse and neglect in connection with the provision
of medical assistance under the plan without the
existence of such a unit;
(62) provide for a program for the distribution of
pediatric vaccines to program-registered providers for
the immunization of vaccine-eligible children in
accordance with section 1928;
(63) provide for administration and determinations of
eligibility with respect to individuals who are (or
seek to be) eligible for medical assistance based on
the application of section 1931;
(64) provide, not later than 1 year after the date of
the enactment of this paragraph, a mechanism to receive
reports from beneficiaries and others and compile data
concerning alleged instances of waste, fraud, and abuse
relating to the operation of this title;
(65) provide that the State shall issue provider
numbers for all suppliers of medical assistance
consisting of durable medical equipment, as defined in
section 1861(n), and the State shall not issue or renew
such a supplier number for any such supplier unless--
(A)(i) full and complete information as to
the identity of each person with an ownership
or control interest (as defined in section
1124(a)(3)) in the supplier or in any
subcontractor (as defined by the Secretary in
regulations) in which the supplier directly or
indirectly has a 5 percent or more ownership
interest; and
(ii) to the extent determined to be feasible
under regulations of the Secretary, the name of
any disclosing entity (as defined in section
1124(a)(2)) with respect to which a person with
such an ownership or control interest in the
supplier is a person with such an ownership or
control interest in the disclosing entity; and
(B) a surety bond in a form specified by the
Secretary under section 1834(a)(16)(B) and in
an amount that is not less than $50,000 or such
comparable surety bond as the Secretary may
permit under the second sentence of such
section;
(66) provide for making eligibility determinations
under section 1935(a);
(67) provide, with respect to services covered under
the State plan (but not under title XVIII) that are
furnished to a PACE program eligible individual
enrolled with a PACE provider by a provider
participating under the State plan that does not have a
contract or other agreement with the PACE provider that
establishes payment amounts for such services, that
such participating provider may not require the PACE
provider to pay the participating provider an amount
greater than the amount that would otherwise be payable
for the service to the participating provider under the
State plan for the State where the PACE provider is
located (in accordance with regulations issued by the
Secretary);
(68) provide that any entity that receives or makes
annual payments under the State plan of at least
$5,000,000, as a condition of receiving such payments,
shall--
(A) establish written policies for all
employees of the entity (including management),
and of any contractor or agent of the entity,
that provide detailed information about the
False Claims Act established under sections
3729 through 3733 of title 31, United States
Code, administrative remedies for false claims
and statements established under chapter 38 of
title 31, United States Code, any State laws
pertaining to civil or criminal penalties for
false claims and statements, and whistleblower
protections under such laws, with respect to
the role of such laws in preventing and
detecting fraud, waste, and abuse in Federal
health care programs (as defined in section
1128B(f));
(B) include as part of such written policies,
detailed provisions regarding the entity's
policies and procedures for detecting and
preventing fraud, waste, and abuse; and
(C) include in any employee handbook for the
entity, a specific discussion of the laws
described in subparagraph (A), the rights of
employees to be protected as whistleblowers,
and the entity's policies and procedures for
detecting and preventing fraud, waste, and
abuse;
(69) provide that the State must comply with any
requirements determined by the Secretary to be
necessary for carrying out the Medicaid Integrity
Program established under section 1936;
(70) at the option of the State and notwithstanding
paragraphs (1), (10)(B), and (23), provide for the
establishment of a non-emergency medical transportation
brokerage program in order to more cost-effectively
provide transportation for individuals eligible for
medical assistance under the State plan who need access
to medical care or services and have no other means of
transportation which--
(A) may include a wheelchair van, taxi,
stretcher car, bus passes and tickets, secured
transportation, and such other transportation
as the Secretary determines appropriate; and
(B) may be conducted under contract with a
broker who--
(i) is selected through a competitive
bidding process based on the State's
evaluation of the broker's experience,
performance, references, resources,
qualifications, and costs;
(ii) has oversight procedures to
monitor beneficiary access and
complaints and ensure that transport
personnel are licensed, qualified,
competent, and courteous;
(iii) is subject to regular auditing
and oversight by the State in order to
ensure the quality of the
transportation services provided and
the adequacy of beneficiary access to
medical care and services; and
(iv) complies with such requirements
related to prohibitions on referrals
and conflict of interest as the
Secretary shall establish (based on the
prohibitions on physician referrals
under section 1877 and such other
prohibitions and requirements as the
Secretary determines to be
appropriate);
(71) provide that the State will implement an asset
verification program as required under section 1940;
(72) provide that the State will not prevent a
Federally-qualified health center from entering into
contractual relationships with private practice dental
providers in the provision of Federally-qualified
health center services;
(73) in the case of any State in which 1 or more
Indian Health Programs or Urban Indian Organizations
furnishes health care services, provide for a process
under which the State seeks advice on a regular,
ongoing basis from designees of such Indian Health
Programs and Urban Indian Organizations on matters
relating to the application of this title that are
likely to have a direct effect on such Indian Health
Programs and Urban Indian Organizations and that--
(A) shall include solicitation of advice
prior to submission of any plan amendments,
waiver requests, and proposals for
demonstration projects likely to have a direct
effect on Indians, Indian Health Programs, or
Urban Indian Organizations; and
(B) may include appointment of an advisory
committee and of a designee of such Indian
Health Programs and Urban Indian Organizations
to the medical care advisory committee advising
the State on its State plan under this title;
(74) provide for maintenance of effort under the
State plan or under any waiver of the plan in
accordance with subsection (gg); and
(75) provide that, beginning January 2015, and
annually thereafter, the State shall submit a report to
the Secretary that contains--
(A) the total number of enrolled and newly
enrolled individuals in the State plan or under
a waiver of the plan for the fiscal year ending
on September 30 of the preceding calendar year,
disaggregated by population, including
children, parents, nonpregnant childless
adults, disabled individuals, elderly
individuals, and such other categories or sub-
categories of individuals eligible for medical
assistance under the State plan or under a
waiver of the plan as the Secretary may
require;
(B) a description, which may be specified by
population, of the outreach and enrollment
processes used by the State during such fiscal
year; and
(C) any other data reporting determined
necessary by the Secretary to monitor
enrollment and retention of individuals
eligible for medical assistance under the State
plan or under a waiver of the plan;
(76) provide that any data collected under the State
plan meets the requirements of section 3101 of the
Public Health Service Act;
(77) provide that the State shall comply with
provider and supplier screening, oversight, and
reporting requirements in accordance with subsection
(kk);
(79) provide that any agent, clearinghouse, or other
alternate payee (as defined by the Secretary) that
submits claims on behalf of a health care provider must
register with the State and the Secretary in a form and
manner specified by the Secretary;
(80) provide that the State shall not provide any
payments for items or services provided under the State
plan or under a waiver to any financial institution or
entity located outside of the United States; and
(81) provide for implementation of the payment models
specified by the Secretary under section 1115A(c) for
implementation on a nationwide basis unless the State
demonstrates to the satisfaction of the Secretary that
implementation would not be administratively feasible
or appropriate to the health care delivery system of
the State.
Notwithstanding paragraph (5), if on January 1, 1965, and on
the date on which a State submits its plan for approval under
this title, the State agency which administered or supervised
the administration of the plan of such State approved under
title X (or title XVI, insofar as it relates to the blind) was
different from the State agency which administered or
supervised the administration of the State plan approved under
title I (or title XVI, insofar as it relates to the aged), the
State agency which administered or supervised the
administration of such plan approved under title X (or title
XVI, insofar as it relates to the blind) may be designated to
administer or supervise the administration of the portion of
the State plan for medical assistance which relates to blind
individuals and a different State agency may be established or
designated to administer or supervise the administration of the
rest of the State plan for medical assistance; and in such case
the part of the plan which each such agency administers, or the
administration of which each such agency supervises, shall be
regarded as a separate plan for purposes of this title (except
for purposes of paragraph (10)). The provisions of paragraphs
(9)(A), (31), and (33) and of section 1903(i)(4) shall not
apply to a religious nonmedical health care institution (as
defined in section 1861(ss)(1)).
For purposes of paragraph (10) any individual who, for the
month of August 1972, was eligible for or receiving aid or
assistance under a State plan approved under title I, X, XIV,
or XVI, or part A of title IV and who for such month was
entitled to monthly insurance benefits under title II shall for
purposes of this title only be deemed to be eligible for
financial aid or assistance for any month thereafter if such
individual would have been eligible for financial aid or
assistance for such month had the increase in monthly insurance
benefits under title II resulting from enactment of Public Law
92-336 not been applicable to such individual.
The requirement of clause (A) of paragraph (37) with respect
to a State plan may be waived by the Secretary if he finds that
the State has exercised good faith in trying to meet such
requirement. For purposes of this title, any child who meets
the requirements of paragraph (1) or (2) of section 473(b)
shall be deemed to be a dependent child as defined in section
406 and shall be deemed to be a recipient of aid to families
with dependent children under part A of title IV in the State
where such child resides. Notwithstanding paragraph (10)(B) or
any other provision of this subsection, a State plan shall
provide medical assistance with respect to an alien who is not
lawfully admitted for permanent residence or otherwise
permanently residing in the United States under color of law
only in accordance with section 1903(v).
(b) The Secretary shall approve any plan which fulfills the
conditions specified in subsection (a) of this section, except
that he shall not approve any plan which imposes, as a
condition of eligibility for medical assistance under the
plan--
(1) an age requirement of more than 65 years; or
(2) any residence requirement which excludes any
individual who resides in the State, regardless of
whether or not the residence is maintained permanently
or at a fixed address; or
(3) any citizenship requirement which excludes any
citizen of the United States.
(c) Notwithstanding subsection (b), the Secretary shall not
approve any State plan for medical assistance if the State
requires individuals described in subsection (l)(1) to apply
for assistance under the State program funded under part A of
title IV as a condition of applying for or receiving medical
assistance under this title.
(d) If a State contracts with an entity which meets the
requirements of section 1152, as determined by the Secretary,
or a utilization and quality control peer review organization
having a contract with the Secretary under part B of title XI
for the performance of medical or utilization review functions
(including quality review functions described in subsection
(a)(30)(C)) required under this title of a State plan with
respect to specific services or providers (or services or
providers in a geographic area of the State), such requirements
shall be deemed to be met for those services or providers (or
services or providers in that area) by delegation to such an
entity or organization under the contract of the State's
authority to conduct such review activities if the contract
provides for the performance of activities not inconsistent
with part B of title XI and provides for such assurances of
satisfactory performance by such an entity or organization as
the Secretary may prescribe.
(e)(1) Beginning April 1, 1990, for provisions relating to
the extension of eligibility for medical assistance for certain
families who have received aid pursuant to a State plan
approved under part A of title IV and have earned income, see
section 1925.
(2)(A) In the case of an individual who is enrolled with a
medicaid managed care organization (as defined in section
1903(m)(1)(A)), with a primary care case manager (as defined in
section 1905(t)), or with an eligible organization with a
contract under section 1876 and who would (but for this
paragraph) lose eligibility for benefits under this title
before the end of the minimum enrollment period (defined in
subparagraph (B)), the State plan may provide, notwithstanding
any other provision of this title, that the individual shall be
deemed to continue to be eligible for such benefits until the
end of such minimum period, but, except for benefits furnished
under section 1905(a)(4)(C), only with respect to such benefits
provided to the individual as an enrollee of such organization
or entity or by or through the case manager.
(B) For purposes of subparagraph (A), the term ``minimum
enrollment period'' means, with respect to an individual's
enrollment with an organization or entity under a State plan, a
period, established by the State, of not more than six months
beginning on the date the individual's enrollment with the
organization or entity becomes effective.
(3) At the option of the State, any individual who--
(A) is 18 years of age or younger and qualifies as a
disabled individual under section 1614(a);
(B) with respect to whom there has been a
determination by the State that--
(i) the individual requires a level of care
provided in a hospital, nursing facility, or
intermediate care facility for the mentally
retarded,
(ii) it is appropriate to provide such care
for the individual outside such an institution,
and
(iii) the estimated amount which would be
expended for medical assistance for the
individual for such care outside an institution
is not greater than the estimated amount which
would otherwise be expended for medical
assistance for the individual within an
appropriate institution; and
(C) if the individual were in a medical institution,
would be eligible for medical assistance under the
State plan under this title,
shall be deemed, for purposes of this title only, to be
an individual with respect to whom a supplemental
security income payment, or State supplemental payment,
respectively, is being paid under title XVI.
(4) A child born to a woman eligible for and receiving
medical assistance under a State plan on the date of the
child's birth shall be deemed to have applied for medical
assistance and to have been found eligible for such assistance
under such plan on the date of such birth and to remain
eligible for such assistance for a period of one year. During
the period in which a child is deemed under the preceding
sentence to be eligible for medical assistance, the medical
assistance eligibility identification number of the mother
shall also serve as the identification number of the child, and
all claims shall be submitted and paid under such number
(unless the State issues a separate identification number for
the child before such period expires). Notwithstanding the
preceding sentence, in the case of a child who is born in the
United States to an alien mother for whom medical assistance
for the delivery of the child is made available pursuant to
section 1903(v), the State immediately shall issue a separate
identification number for the child upon notification by the
facility at which such delivery occurred of the child's birth.
(5) A woman who, while pregnant, is eligible for, has applied
for, and has received medical assistance under the State plan,
shall continue to be eligible under the plan, as though she
were pregnant, for all pregnancy-related and postpartum medical
assistance under the plan, through the end of the month in
which the 60-day period (beginning on the last day of her
pregnancy) ends.
(6) In the case of a pregnant woman described in subsection
(a)(10) who, because of a change in income of the family of
which she is a member, would not otherwise continue to be
described in such subsection, the woman shall be deemed to
continue to be an individual described in subsection
(a)(10)(A)(i)(IV) and subsection (l)(1)(A) without regard to
such change of income through the end of the month in which the
60-day period (beginning on the last day of her pregnancy)
ends. The preceding sentence shall not apply in the case of a
woman who has been provided ambulatory prenatal care pursuant
to section 1920 during a presumptive eligibility period and is
then, in accordance with such section, determined to be
ineligible for medical assistance under the State plan.
(7) In the case of an infant or child described in
subparagraph (B), (C), or (D) of subsection (l)(1) or paragraph
(2) of section 1905(n)--
(A) who is receiving inpatient services for which
medical assistance is provided on the date the infant
or child attains the maximum age with respect to which
coverage is provided under the State plan for such
individuals, and
(B) who, but for attaining such age, would remain
eligible for medical assistance under such subsection,
the infant or child shall continue to be treated as an
individual described in such respective provision until the end
of the stay for which the inpatient services are furnished.
(8) If an individual is determined to be a qualified medicare
beneficiary (as defined in section 1905(p)(1)), such
determination shall apply to services furnished after the end
of the month in which the determination first occurs. For
purposes of payment to a State under section 1903(a), such
determination shall be considered to be valid for an individual
for a period of 12 months, except that a State may provide for
such determinations more frequently, but not more frequently
than once every 6 months for an individual.
(9)(A) At the option of the State, the plan may include as
medical assistance respiratory care services for any individual
who--
(i) is medically dependent on a ventilator for life
support at least six hours per day;
(ii) has been so dependent for at least 30
consecutive days (or the maximum number of days
authorized under the State plan, whichever is less) as
an inpatient;
(iii) but for the availability of respiratory care
services, would require respiratory care as an
inpatient in a hospital, nursing facility, or
intermediate care facility for the mentally retarded
and would be eligible to have payment made for such
inpatient care under the State plan;
(iv) has adequate social support services to be cared
for at home; and
(v) wishes to be cared for at home.
(B) The requirements of subparagraph (A)(ii) may be satisfied
by a continuous stay in one or more hospitals, nursing
facilities, or intermediate care facilities for the mentally
retarded.
(C) For purposes of this paragraph, respiratory care services
means services provided on a part-time basis in the home of the
individual by a respiratory therapist or other health care
professional trained in respiratory therapy (as determined by
the State), payment for which is not otherwise included within
other items and services furnished to such individual as
medical assistance under the plan.
(10)(A) The fact that an individual, child, or pregnant woman
may be denied aid under part A of title IV pursuant to section
402(a)(43) shall not be construed as denying (or permitting a
State to deny) medical assistance under this title to such
individual, child, or woman who is eligible for assistance
under this title on a basis other than the receipt of aid under
such part.
(B) If an individual, child, or pregnant woman is receiving
aid under part A of title IV and such aid is terminated
pursuant to section 402(a)(43), the State may not discontinue
medical assistance under this title for the individual, child,
or woman until the State has determined that the individual,
child, or woman is not eligible for assistance under this title
on a basis other than the receipt of aid under such part.
(11)(A) In the case of an individual who is enrolled with a
group health plan under section 1906 and who would (but for
this paragraph) lose eligibility for benefits under this title
before the end of the minimum enrollment period (defined in
subparagraph (B)), the State plan may provide, notwithstanding
any other provision of this title, that the individual shall be
deemed to continue to be eligible for such benefits until the
end of such minimum period, but only with respect to such
benefits provided to the individual as an enrollee of such
plan.
(B) For purposes of subparagraph (A), the term ``minimum
enrollment period'' means, with respect to an individual's
enrollment with a group health plan, a period established by
the State, of not more than 6 months beginning on the date the
individual's enrollment under the plan becomes effective.
(12) At the option of the State, the plan may provide that an
individual who is under an age specified by the State (not to
exceed 19 years of age) and who is determined to be eligible
for benefits under a State plan approved under this title under
subsection (a)(10)(A) shall remain eligible for those benefits
until the earlier of--
(A) the end of a period (not to exceed 12 months)
following the determination; or
(B) the time that the individual exceeds that age.
(13) Express Lane Option.--
(A) In general.--
(i) Option to use a finding from an express
lane agency.--At the option of the State, the
State plan may provide that in determining
eligibility under this title for a child (as
defined in subparagraph (G)), the State may
rely on a finding made within a reasonable
period (as determined by the State) from an
Express Lane agency (as defined in subparagraph
(F)) when it determines whether a child
satisfies one or more components of eligibility
for medical assistance under this title. The
State may rely on a finding from an Express
Lane agency notwithstanding sections
1902(a)(46)(B) and 1137(d) or any differences
in budget unit, disregard, deeming or other
methodology, if the following requirements are
met:
(I) Prohibition on determining
children ineligible for coverage.--If a
finding from an Express Lane agency
would result in a determination that a
child does not satisfy an eligibility
requirement for medical assistance
under this title and for child health
assistance under title XXI, the State
shall determine eligibility for
assistance using its regular
procedures.
(II) Notice requirement.--For any
child who is found eligible for medical
assistance under the State plan under
this title or child health assistance
under title XXI and who is subject to
premiums based on an Express Lane
agency's finding of such child's income
level, the State shall provide notice
that the child may qualify for lower
premium payments if evaluated by the
State using its regular policies and of
the procedures for requesting such an
evaluation.
(III) Compliance with screen and
enroll requirement.--The State shall
satisfy the requirements under
subparagraphs (A) and (B) of section
2102(b)(3) (relating to screen and
enroll) before enrolling a child in
child health assistance under title
XXI. At its option, the State may
fulfill such requirements in accordance
with either option provided under
subparagraph (C) of this paragraph.
(IV) Verification of citizenship or
nationality status.--The State shall
satisfy the requirements of section
1902(a)(46)(B) or 2105(c)(9), as
applicable for verifications of
citizenship or nationality status.
(V) Coding.--The State meets the
requirements of subparagraph (E).
(ii) Option to apply to renewals and
redeterminations.--The State may apply the
provisions of this paragraph when conducting
initial determinations of eligibility,
redeterminations of eligibility, or both, as
described in the State plan.
(B) Rules of construction.--Nothing in this paragraph
shall be construed--
(i) to limit or prohibit a State from taking
any actions otherwise permitted under this
title or title XXI in determining eligibility
for or enrolling children into medical
assistance under this title or child health
assistance under title XXI; or
(ii) to modify the limitations in section
1902(a)(5) concerning the agencies that may
make a determination of eligibility for medical
assistance under this title.
(C) Options for satisfying the screen and enroll
requirement.--
(i) In general.--With respect to a child
whose eligibility for medical assistance under
this title or for child health assistance under
title XXI has been evaluated by a State agency
using an income finding from an Express Lane
agency, a State may carry out its duties under
subparagraphs (A) and (B) of section 2102(b)(3)
(relating to screen and enroll) in accordance
with either clause (ii) or clause (iii).
(ii) Establishing a screening threshold.--
(I) In general.--Under this clause,
the State establishes a screening
threshold set as a percentage of the
Federal poverty level that exceeds the
highest income threshold applicable
under this title to the child by a
minimum of 30 percentage points or, at
State option, a higher number of
percentage points that reflects the
value (as determined by the State and
described in the State plan) of any
differences between income
methodologies used by the program
administered by the Express Lane agency
and the methodologies used by the State
in determining eligibility for medical
assistance under this title.
(II) Children with income not above
threshold.--If the income of a child
does not exceed the screening
threshold, the child is deemed to
satisfy the income eligibility criteria
for medical assistance under this title
regardless of whether such child would
otherwise satisfy such criteria.
(III) Children with income above
threshold.--If the income of a child
exceeds the screening threshold, the
child shall be considered to have an
income above the Medicaid applicable
income level described in section
2110(b)(4) and to satisfy the
requirement under section 2110(b)(1)(C)
(relating to the requirement that CHIP
matching funds be used only for
children not eligible for Medicaid). If
such a child is enrolled in child
health assistance under title XXI, the
State shall provide the parent,
guardian, or custodial relative with
the following:
(aa) Notice that the child
may be eligible to receive
medical assistance under the
State plan under this title if
evaluated for such assistance
under the State's regular
procedures and notice of the
process through which a parent,
guardian, or custodial relative
can request that the State
evaluate the child's
eligibility for medical
assistance under this title
using such regular procedures.
(bb) A description of
differences between the medical
assistance provided under this
title and child health
assistance under title XXI,
including differences in cost-
sharing requirements and
covered benefits.
(iii) Temporary enrollment in chip pending
screen and enroll.--
(I) In general.--Under this clause, a
State enrolls a child in child health
assistance under title XXI for a
temporary period if the child appears
eligible for such assistance based on
an income finding by an Express Lane
agency.
(II) Determination of eligibility.--
During such temporary enrollment
period, the State shall determine the
child's eligibility for child health
assistance under title XXI or for
medical assistance under this title in
accordance with this clause.
(III) Prompt follow up.--In making
such a determination, the State shall
take prompt action to determine whether
the child should be enrolled in medical
assistance under this title or child
health assistance under title XXI
pursuant to subparagraphs (A) and (B)
of section 2102(b)(3) (relating to
screen and enroll).
(IV) Requirement for simplified
determination.--In making such a
determination, the State shall use
procedures that, to the maximum
feasible extent, reduce the burden
imposed on the individual of such
determination. Such procedures may not
require the child's parent, guardian,
or custodial relative to provide or
verify information that already has
been provided to the State agency by an
Express Lane agency or another source
of information unless the State agency
has reason to believe the information
is erroneous.
(V) Availability of chip matching
funds during temporary enrollment
period.--Medical assistance for items
and services that are provided to a
child enrolled in title XXI during a
temporary enrollment period under this
clause shall be treated as child health
assistance under such title.
(D) Option for automatic enrollment.--
(i) In general.--The State may initiate and
determine eligibility for medical assistance
under the State Medicaid plan or for child
health assistance under the State CHIP plan
without a program application from, or on
behalf of, the child based on data obtained
from sources other than the child (or the
child's family), but a child can only be
automatically enrolled in the State Medicaid
plan or the State CHIP plan if the child or the
family affirmatively consents to being enrolled
through affirmation in writing, by telephone,
orally, through electronic signature, or
through any other means specified by the
Secretary or by signature on an Express Lane
agency application, if the requirement of
clause (ii) is met.
(ii) Information requirement.--The
requirement of this clause is that the State
informs the parent, guardian, or custodial
relative of the child of the services that will
be covered, appropriate methods for using such
services, premium or other cost sharing charges
(if any) that apply, medical support
obligations (under section 1912(a)) created by
enrollment (if applicable), and the actions the
parent, guardian, or relative must take to
maintain enrollment and renew coverage.
(E) Coding; application to enrollment error rates.--
(i) In general.--For purposes of subparagraph
(A)(iv), the requirement of this subparagraph
for a State is that the State agrees to--
(I) assign such codes as the
Secretary shall require to the children
who are enrolled in the State Medicaid
plan or the State CHIP plan through
reliance on a finding made by an
Express Lane agency for the duration of
the State's election under this
paragraph;
(II) annually provide the Secretary
with a statistically valid sample (that
is approved by Secretary) of the
children enrolled in such plans through
reliance on such a finding by
conducting a full Medicaid eligibility
review of the children identified for
such sample for purposes of determining
an eligibility error rate (as described
in clause (iv)) with respect to the
enrollment of such children (and shall
not include such children in any data
or samples used for purposes of
complying with a Medicaid Eligibility
Quality Control (MEQC) review or a
payment error rate measurement (PERM)
requirement);
(III) submit the error rate
determined under subclause (II) to the
Secretary;
(IV) if such error rate exceeds 3
percent for either of the first 2
fiscal years in which the State elects
to apply this paragraph, demonstrate to
the satisfaction of the Secretary the
specific corrective actions implemented
by the State to improve upon such error
rate; and
(V) if such error rate exceeds 3
percent for any fiscal year in which
the State elects to apply this
paragraph, a reduction in the amount
otherwise payable to the State under
section 1903(a) for quarters for that
fiscal year, equal to the total amount
of erroneous excess payments determined
for the fiscal year only with respect
to the children included in the sample
for the fiscal year that are in excess
of a 3 percent error rate with respect
to such children.
(ii) No punitive action based on error
rate.--The Secretary shall not apply the error
rate derived from the sample under clause (i)
to the entire population of children enrolled
in the State Medicaid plan or the State CHIP
plan through reliance on a finding made by an
Express Lane agency, or to the population of
children enrolled in such plans on the basis of
the State's regular procedures for determining
eligibility, or penalize the State on the basis
of such error rate in any manner other than the
reduction of payments provided for under clause
(i)(V).
(iii) Rule of construction.--Nothing in this
paragraph shall be construed as relieving a
State that elects to apply this paragraph from
being subject to a penalty under section
1903(u), for payments made under the State
Medicaid plan with respect to ineligible
individuals and families that are determined to
exceed the error rate permitted under that
section (as determined without regard to the
error rate determined under clause (i)(II)).
(iv) Error rate defined.--In this
subparagraph, the term ``error rate'' means the
rate of erroneous excess payments for medical
assistance (as defined in section
1903(u)(1)(D)) for the period involved, except
that such payments shall be limited to
individuals for which eligibility
determinations are made under this paragraph
and except that in applying this paragraph
under title XXI, there shall be substituted for
references to provisions of this title
corresponding provisions within title XXI.
(F) Express lane agency.--
(i) In general.--In this paragraph, the term
``Express Lane agency'' means a public agency
that--
(I) is determined by the State
Medicaid agency or the State CHIP
agency (as applicable) to be capable of
making the determinations of one or
more eligibility requirements described
in subparagraph (A)(i);
(II) is identified in the State
Medicaid plan or the State CHIP plan;
and
(III) notifies the child's family--
(aa) of the information which
shall be disclosed in
accordance with this paragraph;
(bb) that the information
disclosed will be used solely
for purposes of determining
eligibility for medical
assistance under the State
Medicaid plan or for child
health assistance under the
State CHIP plan; and
(cc) that the family may
elect to not have the
information disclosed for such
purposes; and
(IV) enters into, or is subject to,
an interagency agreement to limit the
disclosure and use of the information
disclosed.
(ii) Inclusion of specific public agencies
and indian tribes and tribal organizations.--
Such term includes the following:
(I) A public agency that determines
eligibility for assistance under any of
the following:
(aa) The temporary assistance
for needy families program
funded under part A of title
IV.
(bb) A State program funded
under part D of title IV.
(cc) The State Medicaid plan.
(dd) The State CHIP plan.
(ee) The Food and Nutrition
Act of 2008 (7 U.S.C. 2011 et
seq.).
(ff) The Head Start Act (42
U.S.C. 9801 et seq.).
(gg) The Richard B. Russell
National School Lunch Act (42
U.S.C. 1751 et seq.).
(hh) The Child Nutrition Act
of 1966 (42 U.S.C. 1771 et
seq.).
(ii) The Child Care and
Development Block Grant Act of
1990 (42 U.S.C. 9858 et seq.).
(jj) The Stewart B. McKinney
Homeless Assistance Act (42
U.S.C. 11301 et seq.).
(kk) The United States
Housing Act of 1937 (42 U.S.C.
1437 et seq.).
(ll) The Native American
Housing Assistance and Self-
Determination Act of 1996 (25
U.S.C. 4101 et seq.).
(II) A State-specified governmental
agency that has fiscal liability or
legal responsibility for the accuracy
of the eligibility determination
findings relied on by the State.
(III) A public agency that is subject
to an interagency agreement limiting
the disclosure and use of the
information disclosed for purposes of
determining eligibility under the State
Medicaid plan or the State CHIP plan.
(IV) The Indian Health Service, an
Indian Tribe, Tribal Organization, or
Urban Indian Organization (as defined
in section 1139(c)).
(iii) Exclusions.--Such term does not
include an agency that determines eligibility
for a program established under the Social
Services Block Grant established under title XX
or a private, for-profit organization.
(iv) Rules of construction.--Nothing in this
paragraph shall be construed as--
(I) exempting a State Medicaid agency
from complying with the requirements of
section 1902(a)(4) relating to merit-
based personnel standards for employees
of the State Medicaid agency and
safeguards against conflicts of
interest); or
(II) authorizing a State Medicaid
agency that elects to use Express Lane
agencies under this subparagraph to use
the Express Lane option to avoid
complying with such requirements for
purposes of making eligibility
determinations under the State Medicaid
plan.
(v) Additional definitions.--In this
paragraph:
(I) State.--The term ``State'' means
1 of the 50 States or the District of
Columbia.
(II) State chip agency.--The term
``State CHIP agency'' means the State
agency responsible for administering
the State CHIP plan.
(III) State chip plan.--The term
``State CHIP plan'' means the State
child health plan established under
title XXI and includes any waiver of
such plan.
(IV) State medicaid agency.--The term
``State Medicaid agency'' means the
State agency responsible for
administering the State Medicaid plan.
(V) State medicaid plan.--The term
``State Medicaid plan'' means the State
plan established under title XIX and
includes any waiver of such plan.
(G) Child defined.--For purposes of this paragraph,
the term ``child'' means an individual under 19 years
of age, or, at the option of a State, such higher age,
not to exceed 21 years of age, as the State may elect.
(H) State option to rely on state income tax data or
return.--At the option of the State, a finding from an
Express Lane agency may include gross income or
adjusted gross income shown by State income tax records
or returns.
(I) Application.--This paragraph shall not apply with
respect to eligibility determinations made after
September 30, 2017.
(14) Income determined using modified adjusted gross
income.--
(A) In general.--Notwithstanding subsection
(r) or any other provision of this title,
except as provided in subparagraph (D), for
purposes of determining income eligibility for
medical assistance under the State plan or
under any waiver of such plan and for any other
purpose applicable under the plan or waiver for
which a determination of income is required,
including with respect to the imposition of
premiums and cost-sharing, a State shall use
the modified adjusted gross income of an
individual and, in the case of an individual in
a family greater than 1, the household income
of such family. A State shall establish income
eligibility thresholds for populations to be
eligible for medical assistance under the State
plan or a waiver of the plan using modified
adjusted gross income and household income that
are not less than the effective income
eligibility levels that applied under the State
plan or waiver on the date of enactment of the
Patient Protection and Affordable Care Act. For
purposes of complying with the maintenance of
effort requirements under subsection (gg)
during the transition to modified adjusted
gross income and household income, a State
shall, working with the Secretary, establish an
equivalent income test that ensures individuals
eligible for medical assistance under the State
plan or under a waiver of the plan on the date
of enactment of the Patient Protection and
Affordable Care Act, do not lose coverage under
the State plan or under a waiver of the plan.
The Secretary may waive such provisions of this
title and title XXI as are necessary to ensure
that States establish income and eligibility
determination systems that protect
beneficiaries.
(B) No income or expense disregards.--Subject
to subparagraph (I), no type of expense, block,
or other income disregard shall be applied by a
State to determine income eligibility for
medical assistance under the State plan or
under any waiver of such plan or for any other
purpose applicable under the plan or waiver for
which a determination of income is required.
(C) No assets test.--A State shall not apply
any assets or resources test for purposes of
determining eligibility for medical assistance
under the State plan or under a waiver of the
plan.
(D) Exceptions.--
(i) Individuals eligible because of
other aid or assistance, elderly
individuals, medically needy
individuals, and individuals eligible
for medicare cost-sharing.--
Subparagraphs (A), (B), and (C) shall
not apply to the determination of
eligibility under the State plan or
under a waiver for medical assistance
for the following:
(I) Individuals who are
eligible for medical assistance
under the State plan or under a
waiver of the plan on a basis
that does not require a
determination of income by the
State agency administering the
State plan or waiver, including
as a result of eligibility for,
or receipt of, other Federal or
State aid or assistance,
individuals who are eligible on
the basis of receiving (or
being treated as if receiving)
supplemental security income
benefits under title XVI, and
individuals who are eligible as
a result of being or being
deemed to be a child in foster
care under the responsibility
of the State.
(II) Individuals who have
attained age 65.
(III) Individuals who qualify
for medical assistance under
the State plan or under any
waiver of such plan on the
basis of being blind or
disabled (or being treated as
being blind or disabled)
without regard to whether the
individual is eligible for
supplemental security income
benefits under title XVI on the
basis of being blind or
disabled and including an
individual who is eligible for
medical assistance on the basis
of section 1902(e)(3).
(IV) Individuals described in
subsection (a)(10)(C).
(V) Individuals described in
any clause of subsection
(a)(10)(E).
(ii) Express lane agency findings.--
In the case of a State that elects the
Express Lane option under paragraph
(13), notwithstanding subparagraphs
(A), (B), and (C), the State may rely
on a finding made by an Express Lane
agency in accordance with that
paragraph relating to the income of an
individual for purposes of determining
the individual's eligibility for
medical assistance under the State plan
or under a waiver of the plan.
(iii) Medicare prescription drug
subsidies determinations.--
Subparagraphs (A), (B), and (C) shall
not apply to any determinations of
eligibility for premium and cost-
sharing subsidies under and in
accordance with section 1860D-14 made
by the State pursuant to section
1935(a)(2).
(iv) Long-term care.--Subparagraphs
(A), (B), and (C) shall not apply to
any determinations of eligibility of
individuals for purposes of medical
assistance for nursing facility
services, a level of care in any
institution equivalent to that of
nursing facility services, home or
community-based services furnished
under a waiver or State plan amendment
under section 1915 or a waiver under
section 1115, and services described in
section 1917(c)(1)(C)(ii).
(v) Grandfather of current enrollees
until date of next regular
redetermination.--An individual who, on
January 1, 2014, is enrolled in the
State plan or under a waiver of the
plan and who would be determined
ineligible for medical assistance
solely because of the application of
the modified adjusted gross income or
household income standard described in
subparagraph (A), shall remain eligible
for medical assistance under the State
plan or waiver (and subject to the same
premiums and cost-sharing as applied to
the individual on that date) through
March 31, 2014, or the date on which
the individual's next regularly
scheduled redetermination of
eligibility is to occur, whichever is
later.
(E) Transition planning and oversight.--Each
State shall submit to the Secretary for the
Secretary's approval the income eligibility
thresholds proposed to be established using
modified adjusted gross income and household
income, the methodologies and procedures to be
used to determine income eligibility using
modified adjusted gross income and household
income and, if applicable, a State plan
amendment establishing an optional eligibility
category under subsection (a)(10)(A)(ii)(XX).
To the extent practicable, the State shall use
the same methodologies and procedures for
purposes of making such determinations as the
State used on the date of enactment of the
Patient Protection and Affordable Care Act. The
Secretary shall ensure that the income
eligibility thresholds proposed to be
established using modified adjusted gross
income and household income, including under
the eligibility category established under
subsection (a)(10)(A)(ii)(XX), and the
methodologies and procedures proposed to be
used to determine income eligibility, will not
result in children who would have been eligible
for medical assistance under the State plan or
under a waiver of the plan on the date of
enactment of the Patient Protection and
Affordable Care Act no longer being eligible
for such assistance.
(F) Limitation on secretarial authority.--The
Secretary shall not waive compliance with the
requirements of this paragraph except to the
extent necessary to permit a State to
coordinate eligibility requirements for dual
eligible individuals (as defined in section
1915(h)(2)(B)) under the State plan or under a
waiver of the plan and under title XVIII and
individuals who require the level of care
provided in a hospital, a nursing facility, or
an intermediate care facility for the mentally
retarded.
(G) Definitions of modified adjusted gross
income and household income.--In this
paragraph, the terms ``modified adjusted gross
income'' and ``household income'' have the
meanings given such terms in section 36B(d)(2)
of the Internal Revenue Code of 1986.
(H) Continued application of medicaid rules
regarding point-in-time income and sources of
income.--The requirement under this paragraph
for States to use modified adjusted gross
income and household income to determine income
eligibility for medical assistance under the
State plan or under any waiver of such plan and
for any other purpose applicable under the plan
or waiver for which a determination of income
is required shall not be construed as affecting
or limiting the application of--
(i) the requirement under this title
and under the State plan or a waiver of
the plan to determine an individual's
income as of the point in time at which
an application for medical assistance
under the State plan or a waiver of the
plan is processed; or
(ii) any rules established under this
title or under the State plan or a
waiver of the plan regarding sources of
countable income.
(I) Treatment of portion of modified adjusted
gross income.--For purposes of determining the
income eligibility of an individual for medical
assistance whose eligibility is determined
based on the application of modified adjusted
gross income under subparagraph (A), the State
shall--
(i) determine the dollar equivalent
of the difference between the upper
income limit on eligibility for such an
individual (expressed as a percentage
of the poverty line) and such upper
income limit increased by 5 percentage
points; and
(ii) notwithstanding the requirement
in subparagraph (A) with respect to use
of modified adjusted gross income,
utilize as the applicable income of
such individual, in determining such
income eligibility, an amount equal to
the modified adjusted gross income
applicable to such individual reduced
by such dollar equivalent amount.
(14) Exclusion of compensation for participation in a
clinical trial for testing of treatments for a rare
disease or condition.--The first $2,000 received by an
individual (who has attained 19 years of age) as
compensation for participation in a clinical trial
meeting the requirements of section 1612(b)(26) shall
be disregarded for purposes of determining the income
eligibility of such individual for medical assistance
under the State plan or any waiver of such plan.
(f) Notwithstanding any other provision of this title, except
as provided in subsection (e) and section 1619(b)(3) and
section 1924, except with respect to qualified disabled and
working individuals (described in section 1905(s)), and except
with respect to qualified medicare beneficiaries, qualified
severely impaired individuals, and individuals described in
subsection (m)(1), no State not eligible to participate in the
State plan program established under title XVI shall be
required to provide medical assistance to any aged, blind, or
disabled individual (within the meaning of title XVI) for any
month unless such State would be (or would have been) required
to provide medical assistance to such individual for such month
had its plan for medical assistance approved under this title
and in effect on January 1, 1972, been in effect in such month,
except that for this purpose any such individual shall be
deemed eligible for medical assistance under such State plan if
(in addition to meeting such other requirements as are or may
be imposed under the State plan) the income of any such
individual as determined in accordance with section 1903(f)
(after deducting any supplemental security income payment and
State supplementary payment made with respect to such
individual, and incurred expenses for medical care as
recognized under State law regardless of whether such expenses
are reimbursed under another public program of the State or
political subdivision thereof) is not in excess of the standard
for medical assistance established under the State plan as in
effect on January 1, 1972. In States which provide medical
assistance to individuals pursuant to paragraph (10)(C) of
subsection (a) of this section, an individual who is eligible
for medical assistance by reason of the requirements of this
section concerning the deduction of incurred medical expenses
from income shall be considered an individual eligible for
medical assistance under paragraph (10)(A) of that subsection
if that individual is, or is eligible to be (1) an individual
with respect to whom there is payable a State supplementary
payment on the basis of which similarly situated individuals
are eligible to receive medical assistance equal in amount,
duration, and scope to that provided to individuals eligible
under paragraph (10)(A), or (2) an eligible individual or
eligible spouse, as defined in title XVI, with respect to whom
supplemental security income benefits are payable; otherwise
that individual shall be considered to be an individual
eligible for medical assistance under paragraph (10)(C) of that
subsection. In States which do not provide medical assistance
to individuals pursuant to paragraph (10)(C) of that
subsection, an individual who is eligible for medical
assistance by reason of the requirements of this section
concerning the deduction of incurred medical expenses from
income shall be considered an individual eligible for medical
assistance under paragraph (10)(A) of that subsection.
(g) In addition to any other sanction available to a State, a
State may provide for a reduction of any payment amount
otherwise due with respect to a person who furnishes services
under the plan in an amount equal to up to three times the
amount of any payment sought to be collected by that person in
violation of subsection (a)(25)(C).
(h) Nothing in this title (including subsections (a)(13) and
(a)(30) of this section) shall be construed as authorizing the
Secretary to limit the amount of payment that may be made under
a plan under this title for home and community care.
(i)(1) In addition to any other authority under State law,
where a State determines that a intermediate care facility for
the mentally retarded which is certified for participation
under its plan no longer substantially meets the requirements
for such a facility under this title and further determines
that the facility's deficiencies--
(A) immediately jeopardize the health and safety of
its patients, the State shall provide for the
termination of the facility's certification for
participation under the plan and may provide, or
(B) do not immediately jeopardize the health and
safety of its patients, the State may, in lieu of
providing for terminating the facility's certification
for participation under the plan, establish alternative
remedies if the State demonstrates to the Secretary's
satisfaction that the alternative remedies are
effective in deterring noncompliance and correcting
deficiencies, and may provide
that no payment will be made under the State plan with respect
to any individual admitted to such facility after a date
specified by the State.
(2) The State shall not make such a decision with respect to
a facility until the facility has had a reasonable opportunity,
following the initial determination that it no longer
substantially meets the requirements for such a facility under
this title, to correct its deficiencies, and, following this
period, has been given reasonable notice and opportunity for a
hearing.
(3) The State's decision to deny payment may be made
effective only after such notice to the public and to the
facility as may be provided for by the State, and its
effectiveness shall terminate (A) when the State finds that the
facility is in substantial compliance (or is making good faith
efforts to achieve substantial compliance) with the
requirements for such a facility under this title, or (B) in
the case described in paragraph (1)(B), with the end of the
eleventh month following the month such decision is made
effective, whichever occurs first. If a facility to which
clause (B) of the previous sentence applies still fails to
substantially meet the provisions of the respective section on
the date specified in such clause, the State shall terminate
such facility's certification for participation under the plan
effective with the first day of the first month following the
month specified in such clause.
(j) Notwithstanding any other requirement of this title, the
Secretary may waive or modify any requirement of this title
with respect to the medical assistance program in American
Samoa and the Northern Mariana Islands, other than a waiver of
the Federal medical assistance percentage, the limitation in
section 1108(f), or the requirement that payment may be made
for medical assistance only with respect to amounts expended by
American Samoa or the Northern Mariana Islands for care and
services described in a numbered paragraph of section 1905(a).
(k)(1) The medical assistance provided to an individual
described in subclause (VIII) of subsection (a)(10)(A)(i) shall
consist of benchmark coverage described in section 1937(b)(1)
or benchmark equivalent coverage described in section
1937(b)(2). Such medical assistance shall be provided subject
to the requirements of section 1937, without regard to whether
a State otherwise has elected the option to provide medical
assistance through coverage under that section, unless an
individual described in subclause (VIII) of subsection
(a)(10)(A)(i) is also an individual for whom, under
subparagraph (B) of section 1937(a)(2), the State may not
require enrollment in benchmark coverage described in
subsection (b)(1) of section 1937 or benchmark equivalent
coverage described in subsection (b)(2) of that section.
(2) Beginning with the first day of any fiscal year quarter
that begins on or after April 1, 2010, and before January 1,
2014, a State may elect through a State plan amendment to
provide medical assistance to individuals who would be
described in subclause (VIII) of subsection (a)(10)(A)(i) if
that subclause were effective before January 1, 2014. A State
may elect to phase-in the extension of eligibility for medical
assistance to such individuals based on income, so long as the
State does not extend such eligibility to individuals described
in such subclause with higher income before making individuals
described in such subclause with lower income eligible for
medical assistance.
(3) If an individual described in subclause (VIII) of
subsection (a)(10)(A)(i) is the parent of a child who is under
19 years of age (or such higher age as the State may have
elected) who is eligible for medical assistance under the State
plan or under a waiver of such plan (under that subclause or
under a State plan amendment under paragraph (2), the
individual may not be enrolled under the State plan unless the
individual's child is enrolled under the State plan or under a
waiver of the plan or is enrolled in other health insurance
coverage. For purposes of the preceding sentence, the term
``parent'' includes an individual treated as a caretaker
relative for purposes of carrying out section 1931.
(l)(1) Individuals described in this paragraph are--
(A) women during pregnancy (and during the 60-day
period beginning on the last day of the pregnancy),
(B) infants under one year of age,
(C) children who have attained one year of age but
have not attained 6 years of age, and
(D) children born after September 30, 1983 (or, at
the option of a State, after any earlier date), who
have attained 6 years of age but have not attained 19
years of age,
who are not described in any of subclauses (I) through (III) of
subsection (a)(10)(A)(i) and whose family income does not
exceed the income level established by the State under
paragraph (2) for a family size equal to the size of the
family, including the woman, infant, or child.
(2)(A)(i) For purposes of paragraph (1) with respect to
individuals described in subparagraph (A) or (B) of that
paragraph, the State shall establish an income level which is a
percentage (not less than the percentage provided under clause
(ii) and not more than 185 percent) of the income official
poverty line (as defined by the Office of Management and
Budget, and revised annually in accordance with section 673(2)
of the Omnibus Budget Reconciliation Act of 1981) applicable to
a family of the size involved.
(ii) The percentage provided under this clause, with respect
to eligibility for medical assistance on or after--
(I) July 1, 1989, is 75 percent, or, if greater, the
percentage provided under clause (iii), and
(II) April 1, 1990, 133 percent, or, if greater, the
percentage provided under clause (iv).
(iii) In the case of a State which, as of the date of the
enactment of this clause, has elected to provide, and provides,
medical assistance to individuals described in this subsection
or has enacted legislation authorizing, or appropriating funds,
to provide such assistance to such individuals before July 1,
1989, the percentage provided under clause (ii)(I) shall not be
less than--
(I) the percentage specified by the State in an
amendment to its State plan (whether approved or not)
as of the date of the enactment of this clause, or
(II) if no such percentage is specified as of the
date of the enactment of this clause, the percentage
established under the State's authorizing legislation
or provided for under the State's appropriations;
but in no case shall this clause require the percentage
provided under clause (ii)(I) to exceed 100 percent.
(iv) In the case of a State which, as of the date of the
enactment of this clause, has established under clause (i), or
has enacted legislation authorizing, or appropriating funds, to
provide for, a percentage (of the income official poverty line)
that is greater than 133 percent, the percentage provided under
clause (ii) for medical assistance on or after April 1, 1990,
shall not be less than--
(I) the percentage specified by the State in an
amendment to its State plan (whether approved or not)
as of the date of the enactment of this clause, or
(II) if no such percentage is specified as of the
date of the enactment of this clause, the percentage
established under the State's authorizing legislation
or provided for under the State's appropriations.
(B) For purposes of paragraph (1) with respect to individuals
described in subparagraph (C) of such paragraph, the State
shall establish an income level which is equal to 133 percent
of the income official poverty line described in subparagraph
(A) applicable to a family of the size involved.
(C) For purposes of paragraph (1) with respect to individuals
described in subparagraph (D) of that paragraph, the State
shall establish an income level which is equal to 100 percent
(or, beginning January 1, 2014, 133 percent) of the income
official poverty line described in subparagraph (A) applicable
to a family of the size involved.
(3) Notwithstanding subsection (a)(17), for individuals who
are eligible for medical assistance because of subsection
(a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), or
(a)(10)(A)(ii)(IX)--
(A) application of a resource standard shall be at
the option of the State;
(B) any resource standard or methodology that is
applied with respect to an individual described in
subparagraph (A) of paragraph (1) may not be more
restrictive than the resource standard or methodology
that is applied under title XVI;
(C) any resource standard or methodology that is
applied with respect to an individual described in
subparagraph (B), (C), or (D) of paragraph (1) may not
be more restrictive than the corresponding methodology
that is applied under the State plan under part A of
title IV;
(D) the income standard to be applied is the
appropriate income standard established under paragraph
(2); and
(E) family income shall be determined in accordance
with the methodology employed under the State plan
under part A or E of title IV (except to the extent
such methodology is inconsistent with clause (D) of
subsection (a)(17)), and costs incurred for medical
care or for any other type of remedial care shall not
be taken into account.
Any different treatment provided under this paragraph for such
individuals shall not, because of subsection (a)(17), require
or permit such treatment for other individuals.
(4)(A) In the case of any State which is providing medical
assistance to its residents under a waiver granted under
section 1115, the Secretary shall require the State to provide
medical assistance for pregnant women and infants under age 1
described in subsection (a)(10)(A)(i)(IV) and for children
described in subsection (a)(10)(A)(i)(VI) or subsection
(a)(10)(A)(i)(VII) in the same manner as the State would be
required to provide such assistance for such individuals if the
State had in effect a plan approved under this title.
(B) In the case of a State which is not one of the 50 States
or the District of Columbia, the State need not meet the
requirement of subsection (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI),
or (a)(10)(A)(i)(VII) and, for purposes of paragraph (2)(A),
the State may substitute for the percentage provided under
clause (ii) of such paragraph any percentage.
(m)(1) Individuals described in this paragraph are
individuals--
(A) who are 65 years of age or older or are disabled
individuals (as determined under section 1614(a)(3)),
(B) whose income (as determined under section 1612
for purposes of the supplemental security income
program, except as provided in paragraph (2)(C)) does
not exceed an income level established by the State
consistent with paragraph (2)(A), and
(C) whose resources (as determined under section 1613
for purposes of the supplemental security income
program) do not exceed (except as provided in paragraph
(2)(B)) the maximum amount of resources that an
individual may have and obtain benefits under that
program.
(2)(A) The income level established under paragraph (1)(B)
may not exceed a percentage (not more than 100 percent) of the
official poverty line (as defined by the Office of Management
and Budget, and revised annually in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of 1981)
applicable to a family of the size involved.
(B) In the case of a State that provides medical assistance
to individuals not described in subsection (a)(10)(A) and at
the State's option, the State may use under paragraph (1)(C)
such resource level (which is higher than the level described
in that paragraph) as may be applicable with respect to
individuals described in paragraph (1)(A) who are not described
in subsection (a)(10)(A).
(C) The provisions of section 1905(p)(2)(D) shall apply to
determinations of income under this subsection in the same
manner as they apply to determinations of income under section
1905(p).
(3) Notwithstanding subsection (a)(17), for individuals
described in paragraph (1) who are covered under the State plan
by virtue of subsection (a)(10)(A)(ii)(X)--
(A) the income standard to be applied is the income
standard described in paragraph (1)(B), and
(B) except as provided in section 1612(b)(4)(B)(ii),
costs incurred for medical care or for any other type
of remedial care shall not be taken into account in
determining income.
Any different treatment provided under this paragraph for such
individuals shall not, because of subsection (a)(17), require
or permit such treatment for other individuals.
(4) Notwithstanding subsection (a)(17), for qualified
medicare beneficiaries described in section 1905(p)(1)--
(A) the income standard to be applied is the income
standard described in section 1905(p)(1)(B), and
(B) except as provided in section 1612(b)(4)(B)(ii),
costs incurred for medical care or for any other type
of remedial care shall not be taken into account in
determining income.
Any different treatment provided under this paragraph for such
individuals shall not, because of subsection (a)(17), require
or permit such treatment for other individuals.
(n)(1) In the case of medical assistance furnished under this
title for medicare cost-sharing respecting the furnishing of a
service or item to a qualified medicare beneficiary, the State
plan may provide payment in an amount with respect to the
service or item that results in the sum of such payment amount
and any amount of payment made under title XVIII with respect
to the service or item exceeding the amount that is otherwise
payable under the State plan for the item or service for
eligible individuals who are not qualified medicare
beneficiaries.
(2) In carrying out paragraph (1), a State is not required to
provide any payment for any expenses incurred relating to
payment for deductibles, coinsurance, or copayments for
medicare cost-sharing to the extent that payment under title
XVIII for the service would exceed the payment amount that
otherwise would be made under the State plan under this title
for such service if provided to an eligible recipient other
than a medicare beneficiary.
(3) In the case in which a State's payment for medicare cost-
sharing for a qualified medicare beneficiary with respect to an
item or service is reduced or eliminated through the
application of paragraph (2)--
(A) for purposes of applying any limitation under
title XVIII on the amount that the beneficiary may be
billed or charged for the service, the amount of
payment made under title XVIII plus the amount of
payment (if any) under the State plan shall be
considered to be payment in full for the service;
(B) the beneficiary shall not have any legal
liability to make payment to a provider or to an
organization described in section 1903(m)(1)(A) for the
service; and
(C) any lawful sanction that may be imposed upon a
provider or such an organization for excess charges
under this title or title XVIII shall apply to the
imposition of any charge imposed upon the individual in
such case.
This paragraph shall not be construed as preventing payment of
any medicare cost-sharing by a medicare supplemental policy or
an employer retiree health plan on behalf of an individual.
(o) Notwithstanding any provision of subsection (a) to the
contrary, a State plan under this title shall provide that any
supplemental security income benefits paid by reason of
subparagraph (E) or (G) of section 1611(e)(1) to an individual
who--
(1) is eligible for medical assistance under the
plan, and
(2) is in a hospital, skilled nursing facility, or
intermediate care facility at the time such benefits
are paid,
will be disregarded for purposes of determining the amount of
any post-eligibility contribution by the individual to the cost
of the care and services provided by the hospital, skilled
nursing facility, or intermediate care facility.
(p)(1) In addition to any other authority, a State may
exclude any individual or entity for purposes of participating
under the State plan under this title for any reason for which
the Secretary could exclude the individual or entity from
participation in a program under title XVIII under section
1128, 1128A, or 1866(b)(2).
(2) In order for a State to receive payments for medical
assistance under section 1903(a), with respect to payments the
State makes to a medicaid managed care organization (as defined
in section 1903(m)) or to an entity furnishing services under a
waiver approved under section 1915(b)(1), the State must
provide that it will exclude from participation, as such an
organization or entity, any organization or entity that--
(A) could be excluded under section 1128(b)(8)
(relating to owners and managing employees who have
been convicted of certain crimes or received other
sanctions),
(B) has, directly or indirectly, a substantial
contractual relationship (as defined by the Secretary)
with an individual or entity that is described in
section 1128(b)(8)(B), or
(C) employs or contracts with any individual or
entity that is excluded from participation under this
title under section 1128 or 1128A for the provision of
health care, utilization review, medical social work,
or administrative services or employs or contracts with
any entity for the provision (directly or indirectly)
through such an excluded individual or entity of such
services.
(3) As used in this subsection, the term ``exclude'' includes
the refusal to enter into or renew a participation agreement or
the termination of such an agreement.
(q)(1)(A) In order to meet the requirement of subsection
(a)(50), the State plan must provide that, in the case of an
institutionalized individual or couple described in
subparagraph (B), in determining the amount of the individual's
or couple's income to be applied monthly to payment for the
cost of care in an institution, there shall be deducted from
the monthly income (in addition to other allowances otherwise
provided under the State plan) a monthly personal needs
allowance--
(i) which is reasonable in amount for clothing and
other personal needs of the individual (or couple)
while in an institution, and
(ii) which is not less (and may be greater) than the
minimum monthly personal needs allowance described in
paragraph (2).
(B) In this subsection, the term ``institutionalized
individual or couple'' means an individual or married couple--
(i) who is an inpatient (or who are inpatients) in a
medical institution or nursing facility for which
payments are made under this title throughout a month,
and
(ii) who is or are determined to be eligible for
medical assistance under the State plan.
(2) The minimum monthly personal needs allowance described in
this paragraph is $30 for an institutionalized individual and
$60 for an institutionalized couple (if both are aged, blind,
or disabled, and their incomes are considered available to each
other in determining eligibility).
(r)(1)(A) For purposes of sections 1902(a)(17) and
1924(d)(1)(D) and for purposes of a waiver under section 1915,
with respect to the post-eligibility treatment of income of
individuals who are institutionalized or receiving home or
community-based services under such a waiver, the treatment
described in subparagraph (B) shall apply, there shall be
disregarded reparation payments made by the Federal Republic of
Germany, and there shall be taken into account amounts for
incurred expenses for medical or remedial care that are not
subject to payment by a third party, including--
(i) medicare and other health insurance premiums,
deductibles, or coinsurance, and
(ii) necessary medical or remedial care recognized
under State law but not covered under the State plan
under this title, subject to reasonable limits the
State may establish on the amount of these expenses.
(B)(i) In the case of a veteran who does not have a spouse or
a child, if the veteran--
(I) receives, after the veteran has been determined
to be eligible for medical assistance under the State
plan under this title, a veteran's pension in excess of
$90 per month, and
(II) resides in a State veterans home with respect to
which the Secretary of Veterans Affairs makes per diem
payments for nursing home care pursuant to section
1741(a) of title 38, United States Code,
any such pension payment, including any payment made due to the
need for aid and attendance, or for unreimbursed medical
expenses, that is in excess of $90 per month shall be counted
as income only for the purpose of applying such excess payment
to the State veterans home's cost of providing nursing home
care to the veteran.
(ii) The provisions of clause (i) shall apply with respect to
a surviving spouse of a veteran who does not have a child in
the same manner as they apply to a veteran described in such
clause.
(2)(A) The methodology to be employed in determining income
and resource eligibility for individuals under subsection
(a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI),
(a)(10)(A)(i)(VII), (a)(10)(A)(ii), (a)(10)(C)(i)(III), or (f)
or under section 1905(p) may be less restrictive, and shall be
no more restrictive, than the methodology--
(i) in the case of groups consisting of aged, blind,
or disabled individuals, under the supplemental
security income program under title XVI, or
(ii) in the case of other groups, under the State
plan most closely categorically related.
(B) For purposes of this subsection and subsection (a)(10),
methodology is considered to be ``no more restrictive'' if,
using the methodology, additional individuals may be eligible
for medical assistance and no individuals who are otherwise
eligible are made ineligible for such assistance.
(s) In order to meet the requirements of subsection (a)(55),
the State plan must provide that payments to hospitals under
the plan for inpatient hospital services furnished to infants
who have not attained the age of 1 year, and to children who
have not attained the age of 6 years and who receive such
services in a disproportionate share hospital described in
section 1923(b)(1), shall--
(1) if made on a prospective basis (whether per diem,
per case, or otherwise) provide for an outlier
adjustment in payment amounts for medically necessary
inpatient hospital services involving exceptionally
high costs or exceptionally long lengths of stay,
(2) not be limited by the imposition of day limits
with respect to the delivery of such services to such
individuals, and
(3) not be limited by the imposition of dollar limits
(other than such limits resulting from prospective
payments as adjusted pursuant to paragraph (1)) with
respect to the delivery of such services to any such
individual who has not attained their first birthday
(or in the case of such an individual who is an
inpatient on his first birthday until such individual
is discharged).
(t) Nothing in this title (including sections 1903(a) and
1905(a)) shall be construed as authorizing the Secretary to
deny or limit payments to a State for expenditures, for medical
assistance for items or services, attributable to taxes of
general applicability imposed with respect to the provision of
such items or services.
(u)(1) Individuals described in this paragraph are
individuals--
(A) who are entitled to elect COBRA continuation
coverage (as defined in paragraph (3)),
(B) whose income (as determined under section 1612
for purposes of the supplemental security income
program) does not exceed 100 percent of the official
poverty line (as defined by the Office of Management
and Budget, and revised annually in accordance with
section 673(2) of the Omnibus Budget Reconciliation Act
of 1981) applicable to a family of the size involved,
(C) whose resources (as determined under section 1613
for purposes of the supplemental security income
program) do not exceed twice the maximum amount of
resources that an individual may have and obtain
benefits under that program, and
(D) with respect to whose enrollment for COBRA
continuation coverage the State has determined that the
savings in expenditures under this title resulting from
such enrollment is likely to exceed the amount of
payments for COBRA premiums made.
(2) For purposes of subsection (a)(10)(F) and this
subsection, the term ``COBRA premiums'' means the applicable
premium imposed with respect to COBRA continuation coverage.
(3) In this subsection, the term ``COBRA continuation
coverage'' means coverage under a group health plan provided by
an employer with 75 or more employees provided pursuant to
title XXII of the Public Health Service Act, section 4980B of
the Internal Revenue Code of 1986, or title VI of the Employee
Retirement Income Security Act of 1974.
(4) Notwithstanding subsection (a)(17), for individuals
described in paragraph (1) who are covered under the State plan
by virtue of subsection (a)(10)(A)(ii)(XI)--
(A) the income standard to be applied is the income
standard described in paragraph (1)(B), and
(B) except as provided in section 1612(b)(4)(B)(ii),
costs incurred for medical care or for any other type
of remedial care shall not be taken into account in
determining income.
Any different treatment provided under this paragraph for such
individuals shall not, because of subsection (a)(10)(B) or
(a)(17), require or permit such treatment for other
individuals.
(v) A State plan may provide for the making of determinations
of disability or blindness for the purpose of determining
eligibility for medical assistance under the State plan by the
single State agency or its designee, and make medical
assistance available to individuals whom it finds to be blind
or disabled and who are determined otherwise eligible for such
assistance during the period of time prior to which a final
determination of disability or blindness is made by the Social
Security Administration with respect to such an individual. In
making such determinations, the State must apply the
definitions of disability and blindness found in section
1614(a) of the Social Security Act.
(w)(1) For purposes of subsection (a)(57) and sections
1903(m)(1)(A) and 1919(c)(2)(E), the requirement of this
subsection is that a provider or organization (as the case may
be) maintain written policies and procedures with respect to
all adult individuals receiving medical care by or through the
provider or organization--
(A) to provide written information to each such
individual concerning--
(i) an individual's rights under State law
(whether statutory or as recognized by the
courts of the State) to make decisions
concerning such medical care, including the
right to accept or refuse medical or surgical
treatment and the right to formulate advance
directives (as defined in paragraph (3)), and
(ii) the provider's or organization's written
policies respecting the implementation of such
rights;
(B) to document in the individual's medical record
whether or not the individual has executed an advance
directive;
(C) not to condition the provision of care or
otherwise discriminate against an individual based on
whether or not the individual has executed an advance
directive;
(D) to ensure compliance with requirements of State
law (whether statutory or as recognized by the courts
of the State) respecting advance directives; and
(E) to provide (individually or with others) for
education for staff and the community on issues
concerning advance directives.
Subparagraph (C) shall not be construed as requiring the
provision of care which conflicts with an advance directive.
(2) The written information described in paragraph (1)(A)
shall be provided to an adult individual--
(A) in the case of a hospital, at the time of the
individual's admission as an inpatient,
(B) in the case of a nursing facility, at the time of
the individual's admission as a resident,
(C) in the case of a provider of home health care or
personal care services, in advance of the individual
coming under the care of the provider,
(D) in the case of a hospice program, at the time of
initial receipt of hospice care by the individual from
the program, and
(E) in the case of a medicaid managed care
organization, at the time of enrollment of the
individual with the organization.
(3) Nothing in this section shall be construed to prohibit
the application of a State law which allows for an objection on
the basis of conscience for any health care provider or any
agent of such provider which as a matter of conscience cannot
implement an advance directive.
(4) In this subsection, the term ``advance directive'' means
a written instruction, such as a living will or durable power
of attorney for health care, recognized under State law
(whether statutory or as recognized by the courts of the State)
and relating to the provision of such care when the individual
is incapacitated.
(5) For construction relating to this subsection, see section
7 of the Assisted Suicide Funding Restriction Act of 1997
(relating to clarification respecting assisted suicide,
euthanasia, and mercy killing).
(x) The Secretary shall establish a system, for
implementation by not later than July 1, 1991, which provides
for a unique identifier for each physician who furnishes
services for which payment may be made under a State plan
approved under this title.
(y)(1) In addition to any other authority under State law,
where a State determines that a psychiatric hospital which is
certified for participation under its plan no longer meets the
requirements for a psychiatric hospital (referred to in section
1905(h)) and further finds that the hospital's deficiencies--
(A) immediately jeopardize the health and safety of
its patients, the State shall terminate the hospital's
participation under the State plan; or
(B) do not immediately jeopardize the health and
safety of its patients, the State may terminate the
hospital's participation under the State plan, or
provide that no payment will be made under the State
plan with respect to any individual admitted to such
hospital after the effective date of the finding, or
both.
(2) Except as provided in paragraph (3), if a psychiatric
hospital described in paragraph (1)(B) has not complied with
the requirements for a psychiatric hospital under this title--
(A) within 3 months after the date the hospital is
found to be out of compliance with such requirements,
the State shall provide that no payment will be made
under the State plan with respect to any individual
admitted to such hospital after the end of such 3-month
period, or
(B) within 6 months after the date the hospital is
found to be out of compliance with such requirements,
no Federal financial participation shall be provided
under section 1903(a) with respect to further services
provided in the hospital until the State finds that the
hospital is in compliance with the requirements of this
title.
(3) The Secretary may continue payments, over a period of not
longer than 6 months from the date the hospital is found to be
out of compliance with such requirements, if--
(A) the State finds that it is more appropriate to
take alternative action to assure compliance of the
hospital with the requirements than to terminate the
certification of the hospital,
(B) the State has submitted a plan and timetable for
corrective action to the Secretary for approval and the
Secretary approves the plan of corrective action, and
(C) the State agrees to repay to the Federal
Government payments received under this paragraph if
the corrective action is not taken in accordance with
the approved plan and timetable.
(z)(1) Individuals described in this paragraph are
individuals not described in subsection (a)(10)(A)(i)--
(A) who are infected with tuberculosis;
(B) whose income (as determined under the State plan
under this title with respect to disabled individuals)
does not exceed the maximum amount of income a disabled
individual described in subsection (a)(10)(A)(i) may
have and obtain medical assistance under the plan; and
(C) whose resources (as determined under the State
plan under this title with respect to disabled
individuals) do not exceed the maximum amount of
resources a disabled individual described in subsection
(a)(10)(A)(i) may have and obtain medical assistance
under the plan.
(2) For purposes of subsection (a)(10), the term ``TB-related
services'' means each of the following services relating to
treatment of infection with tuberculosis:
(A) Prescribed drugs.
(B) Physicians' services and services described in
section 1905(a)(2).
(C) Laboratory and X-ray services (including services
to confirm the presence of infection).
(D) Clinic services and Federally-qualified health
center services.
(E) Case management services (as defined in section
1915(g)(2)).
(F) Services (other than room and board) designed to
encourage completion of regimens of prescribed drugs by
outpatients, including services to observe directly the
intake of prescribed drugs.
(aa) Individuals described in this subsection are individuals
who--
(1) are not described in subsection (a)(10)(A)(i);
(2) have not attained age 65;
(3) have been screened for breast and cervical cancer
under the Centers for Disease Control and Prevention
breast and cervical cancer early detection program
established under title XV of the Public Health Service
Act (42 U.S.C. 300k et seq.) in accordance with the
requirements of section 1504 of that Act (42 U.S.C.
300n) and need treatment for breast or cervical cancer;
and
(4) are not otherwise covered under creditable
coverage, as defined in section 2701(c) of the Public
Health Service Act (42 U.S.C. 300gg(c)), but applied
without regard to paragraph (1)(F) of such section.
(bb) Payment for Services Provided by Federally-Qualified
Health Centers and Rural Health Clinics.--
(1) In general.--Beginning with fiscal year 2001 with
respect to services furnished on or after January 1,
2001, and each succeeding fiscal year, the State plan
shall provide for payment for services described in
section 1905(a)(2)(C) furnished by a Federally-
qualified health center and services described in
section 1905(a)(2)(B) furnished by a rural health
clinic in accordance with the provisions of this
subsection.
(2) Fiscal year 2001.--Subject to paragraph (4), for
services furnished on and after January 1, 2001, during
fiscal year 2001, the State plan shall provide for
payment for such services in an amount (calculated on a
per visit basis) that is equal to 100 percent of the
average of the costs of the center or clinic of
furnishing such services during fiscal years 1999 and
2000 which are reasonable and related to the cost of
furnishing such services, or based on such other tests
of reasonableness as the Secretary prescribes in
regulations under section 1833(a)(3), or, in the case
of services to which such regulations do not apply, the
same methodology used under section 1833(a)(3),
adjusted to take into account any increase or decrease
in the scope of such services furnished by the center
or clinic during fiscal year 2001.
(3) Fiscal year 2002 and succeeding fiscal years.--
Subject to paragraph (4), for services furnished during
fiscal year 2002 or a succeeding fiscal year, the State
plan shall provide for payment for such services in an
amount (calculated on a per visit basis) that is equal
to the amount calculated for such services under this
subsection for the preceding fiscal year--
(A) increased by the percentage increase in
the MEI (as defined in section 1842(i)(3))
applicable to primary care services (as defined
in section 1842(i)(4)) for that fiscal year;
and
(B) adjusted to take into account any
increase or decrease in the scope of such
services furnished by the center or clinic
during that fiscal year.
(4) Establishment of initial year payment amount for
new centers or clinics.--In any case in which an entity
first qualifies as a Federally-qualified health center
or rural health clinic after fiscal year 2000, the
State plan shall provide for payment for services
described in section 1905(a)(2)(C) furnished by the
center or services described in section 1905(a)(2)(B)
furnished by the clinic in the first fiscal year in
which the center or clinic so qualifies in an amount
(calculated on a per visit basis) that is equal to 100
percent of the costs of furnishing such services during
such fiscal year based on the rates established under
this subsection for the fiscal year for other such
centers or clinics located in the same or adjacent area
with a similar case load or, in the absence of such a
center or clinic, in accordance with the regulations
and methodology referred to in paragraph (2) or based
on such other tests of reasonableness as the Secretary
may specify. For each fiscal year following the fiscal
year in which the entity first qualifies as a
Federally-qualified health center or rural health
clinic, the State plan shall provide for the payment
amount to be calculated in accordance with paragraph
(3).
(5) Administration in the case of managed care.--
(A) In general.--In the case of services
furnished by a Federally-qualified health
center or rural health clinic pursuant to a
contract between the center or clinic and a
managed care entity (as defined in section
1932(a)(1)(B)), the State plan shall provide
for payment to the center or clinic by the
State of a supplemental payment equal to the
amount (if any) by which the amount determined
under paragraphs (2), (3), and (4) of this
subsection exceeds the amount of the payments
provided under the contract.
(B) Payment schedule.--The supplemental
payment required under subparagraph (A) shall
be made pursuant to a payment schedule agreed
to by the State and the Federally-qualified
health center or rural health clinic, but in no
case less frequently than every 4 months.
(6) Alternative payment methodologies.--
Notwithstanding any other provision of this section,
the State plan may provide for payment in any fiscal
year to a Federally-qualified health center for
services described in section 1905(a)(2)(C) or to a
rural health clinic for services described in section
1905(a)(2)(B) in an amount which is determined under an
alternative payment methodology that--
(A) is agreed to by the State and the center
or clinic; and
(B) results in payment to the center or
clinic of an amount which is at least equal to
the amount otherwise required to be paid to the
center or clinic under this section.
(cc)(1) Individuals described in this paragraph are
individuals--
(A) who are children who have not attained 19 years
of age and are born--
(i) on or after January 1, 2001 (or, at the
option of a State, on or after an earlier
date), in the case of the second, third, and
fourth quarters of fiscal year 2007;
(ii) on or after October 1, 1995 (or, at the
option of a State, on or after an earlier
date), in the case of each quarter of fiscal
year 2008; and
(iii) after October 1, 1989, in the case of
each quarter of fiscal year 2009 and each
quarter of any fiscal year thereafter;
(B) who would be considered disabled under section
1614(a)(3)(C) (as determined under title XVI for
children but without regard to any income or asset
eligibility requirements that apply under such title
with respect to children); and
(C) whose family income does not exceed such income
level as the State establishes and does not exceed--
(i) 300 percent of the poverty line (as
defined in section 2110(c)(5)) applicable to a
family of the size involved; or
(ii) such higher percent of such poverty line
as a State may establish, except that--
(I) any medical assistance provided
to an individual whose family income
exceeds 300 percent of such poverty
line may only be provided with State
funds; and
(II) no Federal financial
participation shall be provided under
section 1903(a) for any medical
assistance provided to such an
individual.
(2)(A) If an employer of a parent of an individual described
in paragraph (1) offers family coverage under a group health
plan (as defined in section 2791(a) of the Public Health
Service Act), the State shall--
(i) notwithstanding section 1906, require such parent
to apply for, enroll in, and pay premiums for such
coverage as a condition of such parent's child being or
remaining eligible for medical assistance under
subsection (a)(10)(A)(ii)(XIX) if the parent is
determined eligible for such coverage and the employer
contributes at least 50 percent of the total cost of
annual premiums for such coverage; and
(ii) if such coverage is obtained--
(I) subject to paragraph (2) of section
1916(h), reduce the premium imposed by the
State under that section in an amount that
reasonably reflects the premium contribution
made by the parent for private coverage on
behalf of a child with a disability; and
(II) treat such coverage as a third party
liability under subsection (a)(25).
(B) In the case of a parent to which subparagraph (A)
applies, a State, notwithstanding section 1906 but subject to
paragraph (1)(C)(ii), may provide for payment of any portion of
the annual premium for such family coverage that the parent is
required to pay. Any payments made by the State under this
subparagraph shall be considered, for purposes of section
1903(a), to be payments for medical assistance.
(dd) Electronic Transmission of Information.--If the State
agency determining eligibility for medical assistance under
this title or child health assistance under title XXI verifies
an element of eligibility based on information from an Express
Lane Agency (as defined in subsection (e)(13)(F)), or from
another public agency, then the applicant's signature under
penalty of perjury shall not be required as to such element.
Any signature requirement for an application for medical
assistance may be satisfied through an electronic signature, as
defined in section 1710(1) of the Government Paperwork
Elimination Act (44 U.S.C. 3504 note). The requirements of
subparagraphs (A) and (B) of section 1137(d)(2) may be met
through evidence in digital or electronic form.
(ee)(1) For purposes of subsection (a)(46)(B)(ii), the
requirements of this subsection with respect to an individual
declaring to be a citizen or national of the United States for
purposes of establishing eligibility under this title, are, in
lieu of requiring the individual to present satisfactory
documentary evidence of citizenship or nationality under
section 1903(x) (if the individual is not described in
paragraph (2) of that section), as follows:
(A) The State submits the name and social security
number of the individual to the Commissioner of Social
Security as part of the program established under
paragraph (2).
(B) If the State receives notice from the
Commissioner of Social Security that the name or social
security number, or the declaration of citizenship or
nationality, of the individual is inconsistent with
information in the records maintained by the
Commissioner--
(i) the State makes a reasonable effort to
identify and address the causes of such
inconsistency, including through typographical
or other clerical errors, by contacting the
individual to confirm the accuracy of the name
or social security number submitted or
declaration of citizenship or nationality and
by taking such additional actions as the
Secretary, through regulation or other
guidance, or the State may identify, and
continues to provide the individual with
medical assistance while making such effort;
and
(ii) in the case such inconsistency is not
resolved under clause (i), the State--
(I) notifies the individual of such
fact;
(II) provides the individual with a
period of 90 days from the date on
which the notice required under
subclause (I) is received by the
individual to either present
satisfactory documentary evidence of
citizenship or nationality (as defined
in section 1903(x)(3)) or resolve the
inconsistency with the Commissioner of
Social Security (and continues to
provide the individual with medical
assistance during such 90-day period);
and
(III) disenrolls the individual from
the State plan under this title within
30 days after the end of such 90-day
period if no such documentary evidence
is presented or if such inconsistency
is not resolved.
(2)(A) Each State electing to satisfy the requirements of
this subsection for purposes of section 1902(a)(46)(B) shall
establish a program under which the State submits at least
monthly to the Commissioner of Social Security for comparison
of the name and social security number, of each individual
newly enrolled in the State plan under this title that month
who is not described in section 1903(x)(2) and who declares to
be a United States citizen or national, with information in
records maintained by the Commissioner.
(B) In establishing the State program under this paragraph,
the State may enter into an agreement with the Commissioner of
Social Security--
(i) to provide, through an on-line system or
otherwise, for the electronic submission of, and
response to, the information submitted under
subparagraph (A) for an individual enrolled in the
State plan under this title who declares to be citizen
or national on at least a monthly basis; or
(ii) to provide for a determination of the
consistency of the information submitted with the
information maintained in the records of the
Commissioner through such other method as agreed to by
the State and the Commissioner and approved by the
Secretary, provided that such method is no more
burdensome for individuals to comply with than any
burdens that may apply under a method described in
clause (i).
(C) The program established under this paragraph shall
provide that, in the case of any individual who is required to
submit a social security number to the State under subparagraph
(A) and who is unable to provide the State with such number,
shall be provided with at least the reasonable opportunity to
present satisfactory documentary evidence of citizenship or
nationality (as defined in section 1903(x)(3)) as is provided
under clauses (i) and (ii) of section 1137(d)(4)(A) to an
individual for the submittal to the State of evidence
indicating a satisfactory immigration status.
(3)(A) The State agency implementing the plan approved under
this title shall, at such times and in such form as the
Secretary may specify, provide information on the percentage
each month that the inconsistent submissions bears to the total
submissions made for comparison for such month. For purposes of
this subparagraph, a name, social security number, or
declaration of citizenship or nationality of an individual
shall be treated as inconsistent and included in the
determination of such percentage only if--
(i) the information submitted by the individual is
not consistent with information in records maintained
by the Commissioner of Social Security;
(ii) the inconsistency is not resolved by the State;
(iii) the individual was provided with a reasonable
period of time to resolve the inconsistency with the
Commissioner of Social Security or provide satisfactory
documentation of citizenship status and did not
successfully resolve such inconsistency; and
(iv) payment has been made for an item or service
furnished to the individual under this title.
(B) If, for any fiscal year, the average monthly percentage
determined under subparagraph (A) is greater than 3 percent--
(i) the State shall develop and adopt a corrective
plan to review its procedures for verifying the
identities of individuals seeking to enroll in the
State plan under this title and to identify and
implement changes in such procedures to improve their
accuracy; and
(ii) pay to the Secretary an amount equal to the
amount which bears the same ratio to the total payments
under the State plan for the fiscal year for providing
medical assistance to individuals who provided
inconsistent information as the number of individuals
with inconsistent information in excess of 3 percent of
such total submitted bears to the total number of
individuals with inconsistent information.
(C) The Secretary may waive, in certain limited cases, all or
part of the payment under subparagraph (B)(ii) if the State is
unable to reach the allowable error rate despite a good faith
effort by such State.
(D) Subparagraphs (A) and (B) shall not apply to a State for
a fiscal year if there is an agreement described in paragraph
(2)(B) in effect as of the close of the fiscal year that
provides for the submission on a real-time basis of the
information described in such paragraph.
(4) Nothing in this subsection shall affect the rights of any
individual under this title to appeal any disenrollment from a
State plan.
(ff) Notwithstanding any other requirement of this title or
any other provision of Federal or State law, a State shall
disregard the following property from resources for purposes of
determining the eligibility of an individual who is an Indian
for medical assistance under this title:
(1) Property, including real property and
improvements, that is held in trust, subject to Federal
restrictions, or otherwise under the supervision of the
Secretary of the Interior, located on a reservation,
including any federally recognized Indian Tribe's
reservation, pueblo, or colony, including former
reservations in Oklahoma, Alaska Native regions
established by the Alaska Native Claims Settlement Act,
and Indian allotments on or near a reservation as
designated and approved by the Bureau of Indian Affairs
of the Department of the Interior.
(2) For any federally recognized Tribe not described
in paragraph (1), property located within the most
recent boundaries of a prior Federal reservation.
(3) Ownership interests in rents, leases, royalties,
or usage rights related to natural resources (including
extraction of natural resources or harvesting of
timber, other plants and plant products, animals, fish,
and shellfish) resulting from the exercise of federally
protected rights.
(4) Ownership interests in or usage rights to items
not covered by paragraphs (1) through (3) that have
unique religious, spiritual, traditional, or cultural
significance or rights that support subsistence or a
traditional lifestyle according to applicable tribal
law or custom.
(gg) Maintenance of Effort.--
(1) General requirement to maintain eligibility
standards until state exchange is fully operational.--
Subject to the succeeding paragraphs of this
subsection, during the period that begins on the date
of enactment of the Patient Protection and Affordable
Care Act and ends on the date on which the Secretary
determines that an Exchange established by the State
under section 1311 of the Patient Protection and
Affordable Care Act is fully operational, as a
condition for receiving any Federal payments under
section 1903(a) for calendar quarters occurring during
such period, a State shall not have in effect
eligibility standards, methodologies, or procedures
under the State plan under this title or under any
waiver of such plan that is in effect during that
period, that are more restrictive than the eligibility
standards, methodologies, or procedures, respectively,
under the plan or waiver that are in effect on the date
of enactment of the Patient Protection and Affordable
Care Act.
(2) Continuation of eligibility standards for
children until october 1, 2019.--The requirement under
paragraph (1) shall continue to apply to a State
through September 30, 2019, with respect to the
eligibility standards, methodologies, and procedures
under the State plan under this title or under any
waiver of such plan that are applicable to determining
the eligibility for medical assistance of any child who
is under 19 years of age (or such higher age as the
State may have elected).
(3) Nonapplication.--During the period that begins on
January 1, 2011, and ends on December 31, 2013, the
requirement under paragraph (1) shall not apply to a
State with respect to nonpregnant, nondisabled adults
who are eligible for medical assistance under the State
plan or under a waiver of the plan at the option of the
State and whose income exceeds 133 percent of the
poverty line (as defined in section 2110(c)(5))
applicable to a family of the size involved if, on or
after December 31, 2010, the State certifies to the
Secretary that, with respect to the State fiscal year
during which the certification is made, the State has a
budget deficit, or with respect to the succeeding State
fiscal year, the State is projected to have a budget
deficit. Upon submission of such a certification to the
Secretary, the requirement under paragraph (1) shall
not apply to the State with respect to any remaining
portion of the period described in the preceding
sentence.
(4) Determination of compliance.--
(A) States shall apply modified adjusted
gross income.--A State's determination of
income in accordance with subsection (e)(14)
shall not be considered to be eligibility
standards, methodologies, or procedures that
are more restrictive than the standards,
methodologies, or procedures in effect under
the State plan or under a waiver of the plan on
the date of enactment of the Patient Protection
and Affordable Care Act for purposes of
determining compliance with the requirements of
paragraph (1), (2), or (3).
(B) States may expand eligibility or move
waivered populations into coverage under the
state plan.--With respect to any period
applicable under paragraph (1), (2), or (3), a
State that applies eligibility standards,
methodologies, or procedures under the State
plan under this title or under any waiver of
the plan that are less restrictive than the
eligibility standards, methodologies, or
procedures, applied under the State plan or
under a waiver of the plan on the date of
enactment of the Patient Protection and
Affordable Care Act, or that makes individuals
who, on such date of enactment, are eligible
for medical assistance under a waiver of the
State plan, after such date of enactment
eligible for medical assistance through a State
plan amendment with an income eligibility level
that is not less than the income eligibility
level that applied under the waiver, or as a
result of the application of subclause (VIII)
of section 1902(a)(10)(A)(i), shall not be
considered to have in effect eligibility
standards, methodologies, or procedures that
are more restrictive than the standards,
methodologies, or procedures in effect under
the State plan or under a waiver of the plan on
the date of enactment of the Patient Protection
and Affordable Care Act for purposes of
determining compliance with the requirements of
paragraph (1), (2), or (3).
(hh)(1) A State may elect to phase-in the extension of
eligibility for medical assistance to individuals described in
subclause (XX) of subsection (a)(10)(A)(ii) based on the
categorical group (including nonpregnant childless adults) or
income, so long as the State does not extend such eligibility
to individuals described in such subclause with higher income
before making individuals described in such subclause with
lower income eligible for medical assistance.
(2) If an individual described in subclause (XX) of
subsection (a)(10)(A)(ii) is the parent of a child who is under
19 years of age (or such higher age as the State may have
elected) who is eligible for medical assistance under the State
plan or under a waiver of such plan, the individual may not be
enrolled under the State plan unless the individual's child is
enrolled under the State plan or under a waiver of the plan or
is enrolled in other health insurance coverage. For purposes of
the preceding sentence, the term ``parent'' includes an
individual treated as a caretaker relative for purposes of
carrying out section 1931.
(ii)(1) Individuals described in this subsection are
individuals--
(A) whose income does not exceed an income
eligibility level established by the State that
does not exceed the highest income eligibility
level established under the State plan under
this title (or under its State child health
plan under title XXI) for pregnant women; and
(B) who are not pregnant.
(2) At the option of a State, individuals described
in this subsection may include individuals who, had
individuals applied on or before January 1, 2007, would
have been made eligible pursuant to the standards and
processes imposed by that State for benefits described
in clause (XVI) of the matter following subparagraph
(G) of section subsection (a)(10) pursuant to a waiver
granted under section 1115.
(3) At the option of a State, for purposes of
subsection (a)(17)(B), in determining eligibility for
services under this subsection, the State may consider
only the income of the applicant or recipient.
(jj) Primary Care Services Defined.--For purposes of
subsection (a)(13)(C), the term ``primary care services''
means--
(1) evaluation and management services that are
procedure codes (for services covered under title
XVIII) for services in the category designated
Evaluation and Management in the Healthcare Common
Procedure Coding System (established by the Secretary
under section 1848(c)(5) as of December 31, 2009, and
as subsequently modified); and
(2) services related to immunization administration
for vaccines and toxoids for which CPT codes 90465,
90466, 90467, 90468, 90471, 90472, 90473, or 90474 (as
subsequently modified) apply under such System.
(kk) Provider and Supplier Screening, Oversight, and
Reporting Requirements.--For purposes of subsection (a)(77),
the requirements of this subsection are the following:
(1) Screening.--The State complies with the process
for screening providers and suppliers under this title,
as established by the Secretary under section
1886(j)(2).
(2) Provisional period of enhanced oversight for new
providers and suppliers.--The State complies with
procedures to provide for a provisional period of
enhanced oversight for new providers and suppliers
under this title, as established by the Secretary under
section 1886(j)(3).
(3) Disclosure requirements.--The State requires
providers and suppliers under the State plan or under a
waiver of the plan to comply with the disclosure
requirements established by the Secretary under section
1886(j)(4).
(4) Temporary moratorium on enrollment of new
providers or suppliers.--
(A) Temporary moratorium imposed by the
secretary.--
(i) In general.--Subject to clause
(ii), the State complies with any
temporary moratorium on the enrollment
of new providers or suppliers imposed
by the Secretary under section
1886(j)(6).
(ii) Exception.--A State shall not be
required to comply with a temporary
moratorium described in clause (i) if
the State determines that the
imposition of such temporary moratorium
would adversely impact beneficiaries'
access to medical assistance.
(B) Moratorium on enrollment of providers and
suppliers.--At the option of the State, the
State imposes, for purposes of entering into
participation agreements with providers or
suppliers under the State plan or under a
waiver of the plan, periods of enrollment
moratoria, or numerical caps or other limits,
for providers or suppliers identified by the
Secretary as being at high-risk for fraud,
waste, or abuse as necessary to combat fraud,
waste, or abuse, but only if the State
determines that the imposition of any such
period, cap, or other limits would not
adversely impact beneficiaries' access to
medical assistance.
(5) Compliance programs.--The State requires
providers and suppliers under the State plan or under a
waiver of the plan to establish, in accordance with the
requirements of section 1866(j)(7), a compliance
program that contains the core elements established
under subparagraph (B) of that section 1866(j)(7) for
providers or suppliers within a particular industry or
category.
(6) Reporting of adverse provider actions.--The State
complies with the national system for reporting
criminal and civil convictions, sanctions, negative
licensure actions, and other adverse provider actions
to the Secretary, through the Administrator of the
Centers for Medicare & Medicaid Services, in accordance
with regulations of the Secretary.
(7) Enrollment and npi of ordering or referring
providers.--The State requires--
(A) all ordering or referring physicians or
other professionals to be enrolled under the
State plan or under a waiver of the plan as a
participating provider; and
(B) the national provider identifier of any
ordering or referring physician or other
professional to be specified on any claim for
payment that is based on an order or referral
of the physician or other professional.
(8) Other state oversight.--Nothing in this
subsection shall be interpreted to preclude or limit
the ability of a State to engage in provider and
supplier screening or enhanced provider and supplier
oversight activities beyond those required by the
Secretary.
* * * * * * *
TITLE XX--BLOCK GRANTS TO STATES FOR SOCIAL SERVICES AND ELDER JUSTICE
Subtitle A--Block Grants to States for Social Services
purposes of subtitle; authorization of appropriations
Sec. 2001. 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
(5) securing referral or admission for institutional
care when other forms of care are not appropriate, or
providing services to individuals in institution,
there are authorized to be appropriated for each fiscal year
such sums as may be necessary to carry out the purposes of this
title.
payments to states
Sec. 2002. (a)(1) Each State shall be entitled to payment
under this title for each fiscal year in an amount equal to its
allotment for such fiscal year, to be used by such State for
services directed at the goals set forth in section 2001,
subject to the requirements of this title.
(2) For purposes of paragraph (1)--
(A) services which are directed at the goals set
forth in section 2001 include, but are not limited to,
child care services, protective services for children
and adults, services for children and adults in foster
care, services related to the management and
maintenance of the home, day care services for adults,
transportation services, family planning services,
training and related services, employment services,
information, referral, and counseling services, the
preparation and delivery of meals, health support
services and appropriate combinations of services
designed to meet the special needs of children, the
aged, the mentally retarded, the blind, the emotionally
disturbed, the physically handicapped, and alcoholics
and drug addicts; and
(B) expenditures for such services may include
expenditures for--
(i) administration (including planning and
evaluation);
(ii) personnel training and retraining
directly related to the provision of those
services (including both short-and long-term
training at educational institutions through
grants to such institutions or by direct
financial assistance to students enrolled in
such institutions); and
(iii) conferences or workshops, and training
or retraining through grants to nonprofit
organizations within the meaning of section
501(c)(3) of the Internal Revenue Code of 1954
or to individuals with social services
expertise, or through financial assistance to
individuals participating in such conferences,
workshops, and training or retraining (and this
clause shall apply with respect to all persons
involved in the delivery of such services).
(b) The Secretary shall make payments in accordance with
section 6503 of title 31, United States Code, to each State
from its allotment for use under this title.
(c) Payments to a State from its allotment for any fiscal
year must be expended by the State in such fiscal year or in
the succeeding fiscal year.
(d) A State may transfer up to 10 percent of its allotment
under section 2003 for any fiscal year for its use for that
year under other provisions of Federal law providing block
grants for support of health services, health promotion and
disease prevention activities, or low-income home energy
assistance (or any combination of those activities). Amounts
allotted to a State under any provisions of Federal law
referred to in the preceding sentence and transferred by a
State for use in carrying out the purposes of this title shall
be treated as if they were paid to the State under this title
but shall not affect the computation of the State's allotment
under this title. The State shall inform the Secretary of any
such transfer of funds.
(e) A State may use a portion of the amounts described in
subsection (a) for the purpose of purchasing technical
assistance from public or private entities if the State
determines that such assistance is required in developing,
implementing, or administering programs funded under this
title.
(f) A State may use funds provided under this title to
provide vouchers, for services directed at the goals set forth
in section 2001, to families, including--
(1) families who have become ineligible for
assistance under a State program funded under part A of
title IV by reason of a durational limit on the
provision of such assistance; and
(2) families denied cash assistance under the State
program funded under part A of title IV for a child who
is born to a member of the family who is--
(A) a recipient of assistance under the
program; or
(B) a person who received such assistance at
any time during the 10-month period ending with
the birth of the child.
ALLOTMENTS
Sec. 2003. (a) The allotment for any fiscal year to each of
the jurisdictions of Puerto Rico, Guam, the Virgin Islands, and
the Northern Mariana Islands shall be an amount which bears the
same ratio to the amount specified in subsection (c) as the
amount which was specified for allocation to the particular
jurisdiction involved for the fiscal year 1981 under section
2002(a)(2)(C) of this Act (as in effect prior to the enactment
of this section) bore to $2,900,000,000. The allotment for
fiscal year 1989 and each succeeding fiscal year to American
Samoa shall be an amount which bears the same ratio to the
amount allotted to the Northern Mariana Islands for that fiscal
year as the population of American Samoa bears to the
population of the Northern Mariana Islands determined on the
basis of the most recent data available at the time such
allotment is determined.
(b) The allotment for any fiscal year for each State other
than the jurisdictions of Puerto Rico, Guam, the Virgin
Islands, American Samoa, and the Northern Mariana Islands shall
be an amount which bears the same ratio to--
(1) the amount specified in subsection (c), reduced
by
(2) the total amount allotted to those jurisdictions
for that fiscal year under subsection (a), as the
population of that State bears to the population of all
the States (other than Puerto Rico, Guam, the Virgin
Islands, American Samoa, and the Northern Mariana
Islands) as determined by the Secretary (on the basis
of the most recent data available from the Department
of Commerce) and promulgated prior to the first day of
the third month of the preceding fiscal year.
(c) The amount specified for purposes of subsections (a) and
(b) shall be--
(1) $2,400,000,000 for the fiscal year 1982;
(2) $2,450,000,000 for the fiscal year 1983;
(3) $2,700,000,000 for the fiscal years 1984, 1985,
1986, 1987, and 1989;
(4) $2,750,000,000 for the fiscal year 1988;
(5) $2,800,000,000 for each of the fiscal years 1990
through 1995;
(6) $2,381,000,000 for the fiscal year 1996;
(7) $2,380,000,000 for the fiscal year 1997;
(8) $2,299,000,000 for the fiscal year 1998;
(9) $2,380,000,000 for the fiscal year 1999;
(10) $2,380,000,000 for the fiscal year 2000; and
(11) $1,700,000,000 for the fiscal year 2001 and each
fiscal year thereafter.
state administration
Sec. 2004. Prior to expenditure by a State of payments made
to it under section 2002 for any fiscal year, the State shall
report on the intended use of the payments the State is to
receive under this title, including information on the types of
activities to be supported and the categories or
characteristics of individuals to be served. The report shall
be transmitted to the Secretary and made public within the
State in such manner as to facilitate comment by any person
(including any Federal or other public agency) during
development of the report and after its completion. The report
shall be revised throughout the year as may be necessary to
reflect substantial changes in the activities assisted under
this title, and any revision shall be subject to the
requirements of the previous sentence.
LIMITATIONS ON USE OF GRANTS
Sec. 2005. (a) Except as provided in subsection (b), grants
made under this title may not be used by the State, or by any
other person with which the State makes arrangements to carry
out the purposes of this title--
(1) for the purchase or improvement of land, or the
purchase, construction, or permanent improvement (other
than minor remodeling) of any building or other
facility;
(2) for the provision of cash payments for costs of
subsistence or for the provision of room and board
(other than costs of subsistence during rehabilitation,
room and board provided for a short term as an integral
but subordinate part of a social service, or temporary
emergency shelter provided as a protective service);
(3) for payment of the wages of any individual as a
social service (other than payment of the wages of
welfare recipients employed in the provision of child
day care services);
(4) for the provision of medical care (other than
family planning services, rehabilitation services, or
initial detoxification of an alcoholic or drug
dependent individual) unless it is an integral but
subordinate part of a social service for which grants
may be used under this title;
(5) for social services (except services to an
alcoholic or drug dependent individual or
rehabilitation services) provided in and by employees
of any hospital, skilled nursing facility, intermediate
care facility, or prison, to any individual living in
such institution;
(6) for the provision of any educational service
which the State makes generally available to its
residents without cost and without regard to their
income;
(7) for any child day care services unless such
services meet applicable standards of State and local
law;
(8) for the provision of cash payments as a service
(except as otherwise provided in this section);
(9) for payment for any item or service (other than
an emergency item or service) furnished--
(A) by an individual or entity during the
period when such individual or entity is
excluded under this title or title V, XVIII, or
XIX pursuant to section 1128, 1128A, 1156, or
1842(j)(2), or
(B) at the medical direction or on the
prescription of a physician during the period
when the physician is excluded under this title
or title V, XVIII, or XIX pursuant to section
1128, 1128A, 1156, or 1842(j)(2) and when the
person furnishing such item or service knew or
had reason to know of the exclusion (after a
reasonable time period after reasonable notice
has been furnished to the person); or
(10) in a manner inconsistent with the Assisted
Suicide Funding Restriction Act of 1997.
(b) The Secretary may waive the limitation contained in
subsection (a)(1) and (4) upon the State's request for such a
waiver if he finds that the request describes extraordinary
circumstances to justify the waiver and that permitting the
waiver will contribute to the State's ability to carry out the
purposes of this title.
reports and audits
Sec. 2006. (a) Each State shall prepare reports on its
activities carried out with funds made available (or
transferred for use) under this title. Reports shall be
prepared annually, covering the most recently completed fiscal
year, and shall be in such form and contain such information
(including but not limited to the information specified in
subsection (c)) as the State finds necessary to provide an
accurate description of such activities, to secure a complete
record of the purposes for which funds were spent, and to
determine the extent to which funds were spent in a manner
consistent with the reports required by section 2004. The State
shall make copies of the reports required by this section
available for public inspection within the State and shall
transmit a copy to the Secretary. Copies shall also be
provided, upon request, to any interested public agency, and
each such agency may provide its views on these reports to the
Congress.
(b) Each State shall, not less often than every two years,
audit its expenditures from amounts received (or transferred
for use) under this title. Such State audits shall be conducted
by an entity independent of any agency administering activities
funded under this title, in accordance with generally accepted
auditing principles. Within 30 days following the completion of
each audit, the State shall submit a copy of that audit to the
legislature of the State and to the Secretary. Each State shall
repay to the United States amounts ultimately found not to have
been expended in accordance with this title, or the Secretary
may offset such amounts against any other amount to which the
State is or may become entitled under this title.
(c) Each report prepared and transmitted by a State under
subsection (a) shall set forth (with respect to the fiscal year
covered by the report)--
(1) the number of individuals who received services
paid for in whole or in part with funds made available
under this title, showing separately the number of
children and the number of adults who received such
services, and broken down in each case to reflect the
types of services and circumstances involved;
(2) the amount spent in providing each such type of
service, showing separately for each type of service
the amount spent per child recipient and the amount
spent per adult recipient;
(3) the criteria applied in determining eligibility
for services (such as income eligibility guidelines,
sliding fee scales, the effect of public assistance
benefits, and any requirements for enrollment in school
or training programs); and
(4) the methods by which services were provided,
showing separately the services provided by public
agencies and those provided by private agencies, and
broken down in each case to reflect the types of
services and circumstances involved.
The Secretary shall establish uniform definitions of services
for use by the States in preparing the information required by
this subsection, and make such other provision as may be
necessary or appropriate to assure that compliance with the
requirements of this subsection will not be unduly burdensome
on the States.
(d) For other provisions requiring States to account for
Federal grants, see section 6503 of title 31, United States
Code.
SEC. 2007. ADDITIONAL GRANTS.
(a) Entitlement.--
(1) In general.--In addition to any payment under
section 2002, each State shall be entitled to--
(A) 2 grants under this section for each
qualified empowerment zone in the State; and
(B) 1 grant under this section for each
qualified enterprise community in the State.
(2) Amount of grants.--
(A) Empowerment grants.--The amount of each
grant to a State under this section for a
qualified empowerment zone shall be--
(i) if the zone is designated in an
urban area, $50,000,000, multiplied by
that proportion of the population of
the zone that resides in the State; or
(ii) if the zone is designated in a
rural area, $20,000,000, multiplied by
each proportion.
(B) Enterprise grants.--The amount of the
grant to a State under this section for a
qualified enterprise community shall be 1/95 of
$280,000,000, multiplied by that proportion of
the population of the community that resides in
the State.
(C) Population determinations.--The Secretary
shall make population determinations for
purposes of this paragraph based on the most
recent decennial census data available.
(3) Timing of grants.--
(A) Qualified empowerment zones.--With
respect to each qualified empowerment zone, the
Secretary shall make--
(i) 1 grant under this section to
each State in which the zone lies, on
the date of the designation of the zone
under part I of subchapter U of chapter
1 of the Internal Revenue Code of 1986;
and
(ii) 1 grant under this section to
each such State, on the 1st day of the
1st fiscal year that begins after the
date of the designation.
(B) Qualified enterprise communities.--With
respect to each qualified enterprise community,
the Secretary shall make 1 grant under this
section to each State in which the community
lies, on the date of the designation of the
community under part I of subchapter U of
chapter 1 of the Internal Revenue Code of 1986.
(4) Funding.--$1,000,000,000 shall be made available
to the Secretary for grants under this section.
(b) Program Options.--Notwithstanding section 2005(a):
(1) In order to prevent and remedy the neglect and
abuse of children, a State may use amounts paid under
this section to make grants to, or enter into contracts
with, entities to provide residential or nonresidential
drug and alcohol prevention and treatment programs that
offer comprehensive services for pregnant women and
mothers, and their children.
(2) In order to prevent to assist disadvantaged
adults and youths in achieving and maintaining self-
sufficiency, a State may use amounts paid under this
section to make grants to, or enter into contracts
with--
(A) organizations operated for profit or not
for profit, for the purpose of training and
employing disadvantaged adults and youths in
construction, rehabilitation, or improvement of
affordable housing, public infrastructure, and
community facilities; and
(B) nonprofit organizations and community or
junior colleges, for the purpose of enabling
such entities to provide short-term training
courses in entrepreneurism and self-employment,
and other training that will promote individual
self-sufficiency and the interests of the
community.
(3) A State may use amounts paid under this section
to make grants to, or enter into contracts with,
nonprofit community-based organizations to enable such
organizations to provide activities designed to promote
and protect the interests of children and families,
outside of school hours, including keeping schools open
during evenings and weekends for mentoring and study.
(4) In order to assist disadvantaged adults and
youths in achieving and maintain economic self-support,
a State may use amounts paid under this section to--
(A) fund services designed to promote
community and economic development in qualified
empowerment zones and qualified enterprise
communities, such as skills training, job
counseling, transportation services, housing
counseling, financial management, and business
counseling;
(B) assist in emergency and transitional
shelter for disadvantaged families and
individuals; or
(C) support programs that promote home
ownership, education, or other routes to
economic independence for low-income families
and individuals.
(c) Use of Grants.--
(1) In general.--Subject to subsection (d) of this
section, each State that receives a grant under this
section with respect to an area shall use the grant--
(A) for services directed only at the goals
set forth in paragraphs (1), (2), and (3) of
section 2001;
(B) in accordance with the strategic plan for
the area; and
(C) for activities that benefit residents of
the area for which the grant is made.
(2) Technical assistance.--A State may use a portion
of any grant made under this section in the manner
described in section 2002(e).
(d) Remittance of Certain Amounts.--
(1) Portion of grant upon termination of
designation.--Each State to which an amount is paid
under this subsection during a fiscal year with respect
to an area the designation of which under part I of
subchapter U of chapter 1 of the Internal Revenue Code
of 1986 ends before the end of the fiscal year shall
remit to the Secretary an amount equal to the total of
the amounts so paid with respect to the area,
multiplied by that proportion of the fiscal year
remaining after the designation ends.
(2) Amounts paid to the states and not obligated
within 2 years.--Each State shall remit to the
Secretary any amount paid to the State under this
section that is not obligated by the end of the 2-year
period that begins with the date of the payment.
(e) Reallocation of Remaining Funds.--
(1) Remitted amounts.--The amount specified in
section 2003(c) for any fiscal year is hereby increased
by the total of the amounts remitted during the fiscal
year pursuant to subsection (d) of this section.
(2) Amounts not paid to the states.--The amount
specified in section 2003(c) for fiscal year 1998 is
hereby increased by the amount made available for
grants under this section that has not been paid to any
State by the end of fiscal year 1997.
(f) Definitions.--As used in this section:
(1) Qualified empowerment zone.--The term ``qualified
empowerment zone'' means, with respect to a State, an
area--
(A) which has been designated (other than by
the Secretary of the Interior) as an
empowerment zone under part I of subchapter U
of chapter 1 of the Internal Revenue Code of
1986;
(B) with respect to which the designation is
in effect;
(C) the strategic plan for which is a
qualified plan; and
(D) part or all of which is in the State.
(2) Qualified enterprise community.--The term
``qualified enterprise community'' means, with respect
to a State, an area--
(A) which has been designated (other than by
the Secretary of the Interior) as an enterprise
community under part I of subchapter U of
chapter 1 of the Internal Revenue Code of 1986;
(B) with respect to which the designation is
in effect;
(C) the strategic plan for which is a
qualified plan; and
(D) part or all of which is in the State.
(3) Strategic plan.--The term ``strategic plan''
means, with respect to an area, the plan contained in
the application for designation of the area under part
I of subchapter U of chapter 1 of the Internal Revenue
Code of 1986.
(4) Qualified plan.--The term ``qualified plan''
means, with respect to an area, a plan that--
(A) includes a detailed description of the
activities proposed for the area that are to be
funded with amounts provided under this
section;
(B) contains a commitment that the amounts
provided under this section to any State for
the area will not be used to supplant Federal
or non-Federal funds for services and
activities which promote the purposes of this
section;
(C) was developed in cooperation with the
local government or governments with
jurisdiction over the area; and
(D) to the extent that any State will not use
the amounts provided under this section for the
area in the manner described in subsection (b),
explains the reasons why not.
(5) Rural area.--The term ``rural area'' has the
meaning given such term in section 1393(a)(2) of the
Internal Revenue Code of 1986.
(6) Urban area.--The term ``urban area'' has the
meaning given such term in section 1393(a)(3) of the
Internal Revenue Code of 1986.
* * * * * * *
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FOOD AND NUTRITION ACT OF 2008
* * * * * * *
ADMINISTRATIVE COST-SHARING AND QUALITY CONTROL
Sec. 16. (a) Subject to subsection (k), the Secretary is
authorized to pay to each State agency an amount equal to 50
per centum of all administrative costs involved in each State
agency's operation of the supplemental nutrition assistance
program, which costs shall include, but not be limited to, the
cost of (1) the certification of applicant households, (2) the
acceptance, storage, protection, control, and accounting of
benefits after their delivery to receiving points within the
State, (3) the issuance of benefits to all eligible households,
(4) informational activities relating to the supplemental
nutrition assistance program, including those undertaken under
section 11(e)(1)(A), but not including recruitment activities
designed to persuade an individual to apply forprogram benefits
or that promote the program through television,radio, or
billboard advertisements, (5) fair hearings, (6) automated data
processing and information retrieval systems subject to the
conditions set forth in subsection (g), (7) supplemental
nutrition assistance program investigations and prosecutions,
and (8) implementing and operating the immigration status
verification system established under section 1137(d) of the
Social Security Act (42 U.S.C. 1320b-7(d)): Provided, That the
Secretary is authorized at the Secretary's discretion to pay
any State agency administering the supplemental nutrition
assistance program on all or part of an Indian reservation
under section 11(d) of this Act or in a Native village within
the State of Alaska identified in section 11(b) of Public Law
92-203, such amounts for administrative costs as the Secretary
determines to be necessary for effective operation of the
supplemental nutrition assistance program, as well as to permit
each State to retain 35 percent of the value of all funds or
allotments recovered or collected pursuant to sections 6(b) and
13(c) and 20 percent of the value of any other funds or
allotments recovered or collected, except the value of funds or
allotments recovered or collected that arise from an error of a
State agency. The officials responsible for making
determinations of ineligibility under this Act shall not
receive or benefit from revenues retained by the State under
the provisions of this subsection.
(b) Work Supplementation or Support Program.--
(1) Definition of work supplementation or support
program.--In this subsection, the term ``work
supplementation or support program'' means a program
under which, as determined by the Secretary, public
assistance (including any benefits provided under a
program established by the State and the supplemental
nutrition assistance program) is provided to an
employer to be used for hiring and employing a public
assistance recipient who was not employed by the
employer at the time the public assistance recipient
entered the program.
(2) Program.--A State agency may elect to use an
amount equal to the allotment that would otherwise be
issued to a household under the supplemental nutrition
assistance program, but for the operation of this
subsection, for the purpose of subsidizing or
supporting a job under a work supplementation or
support program established by the State.
(3) Procedure.--If a State agency makes an election
under paragraph (2) and identifies each household that
participates in the supplemental nutrition assistance
program that contains an individual who is
participating in the work supplementation or support
program--
(A) the Secretary shall pay to the State
agency an amount equal to the value of the
allotment that the household would be eligible
to receive but for the operation of this
subsection;
(B) the State agency shall expend the amount
received under subparagraph (A) in accordance
with the work supplementation or support
program in lieu of providing the allotment that
the household would receive but for the
operation of this subsection;
(C) for purposes of--
(i) sections 5 and 8(a), the amount
received under this subsection shall be
excluded from household income and
resources; and
(ii) section 8(b), the amount
received under this subsection shall be
considered to be the value of an
allotment provided to the household;
and
(D) the household shall not receive an
allotment from the State agency for the period
during which the member continues to
participate in the work supplementation or
support program.
(4) Other work requirements.--No individual shall be
excused, by reason of the fact that a State has a work
supplementation or support program, from any work
requirement under section 6(d), except during the
periods in which the individual is employed under the
work supplementation or support program.
(5) Length of participation.--A State agency shall
provide a description of how the public assistance
recipients in the program shall, within a specific
period of time, be moved from supplemented or supported
employment to employment that is not supplemented or
supported.
(6) Displacement.--A work supplementation or support
program shall not displace the employment of
individuals who are not supplemented or supported.
(c) Quality Control System.--
(1) In general.--
(A) System.--
(i) In general.--In carrying out the
supplemental nutrition assistance
program, the Secretary shall carry out
a system that enhances payment accuracy
and improves administration by
establishing fiscal incentives that
require State agencies with high
payment error rates to share in the
cost of payment error.
(ii) Tolerance level for excluding
small errors.--The Secretary shall set
the tolerance level for excluding small
errors for the purposes of this
subsection--
(I) for fiscal year 2014, at
an amount not greater than $37;
and
(II) for each fiscal year
thereafter, the amount
specified in subclause (I)
adjusted by the percentage by
which the thrifty food plan is
adjusted under section 3(u)(4)
between June 30, 2013, and June
30 of the immediately preceding
fiscal year.
(B) Adjustment of federal share of
administrative costs for fiscal years before
fiscal year 2003.--
(i) In general.--Subject to clause
(ii), with respect to any fiscal year
before fiscal year 2003, the Secretary
shall adjust a State agency's federally
funded share of administrative costs
under subsection (a), other than the
costs already shared in excess of 50
percent under the proviso in the first
sentence of subsection (a) or under
subsection (g), by increasing that
share of all such administrative costs
by 1 percentage point to a maximum of
60 percent of all such administrative
costs for each full \1/10\ of a
percentage point by which the payment
error rate is less than 6 percent.
(ii) Limitation.--Only States with a
rate of invalid decisions in denying
eligibility that is less than a
nationwide percentage that the
Secretary determines to be reasonable
shall be entitled to the adjustment
under clause (i).
(C) Establishment of liability amount for
fiscal year 2003 and thereafter.--With respect
to fiscal year 2004 and any fiscal year
thereafter for which the Secretary determines
that, for the second or subsequent consecutive
fiscal year, a 95 percent statistical
probability exists that the payment error rate
of a State agency exceeds 105 percent of the
national performance measure for payment error
rates announced under paragraph (6), the
Secretary shall establish an amount for which
the State agency may be liable (referred to in
this paragraph as the ``liability amount'')
that is equal to the product obtained by
multiplying--
(i) the value of all allotments
issued by the State agency in the
fiscal year;
(ii) the difference between--
(I) the payment error rate of
the State agency; and
(II) 6 percent; and
(iii) 10 percent.
(D) Authority of secretary with respect to
liability amount.--With respect to the
liability amount established for a State agency
under subparagraph (C) for any fiscal year, the
Secretary shall--
(i)
(I) require that a portion, not to
exceed 50 percent, of the liability
amount established for the fiscal year
be used by the State agency for new
investment, approved by the Secretary,
to improve administration by the State
agency of the supplemental nutrition
assistance program (referred to in this
paragraph as the ``new investment
amount''), which new investment amount
shall not be matched by Federal funds;
(II) designate a portion, not to
exceed 50 percent, of the amount
established for the fiscal year for
payment to the Secretary in accordance
with subparagraph (E) (referred to in
this paragraph as the ``at-risk
amount''); or
(III) take any combination of the
actions described in subclauses (I) and
(II); or
(ii) make the determinations
described in clause (i) and enter into
a settlement with the State agency,
only with respect to any new investment
amount, before the end of the fiscal
year in which the liability amount is
determined under subparagraph (C).
(E) Payment of at-risk amount for certain
states.--
(i) In general.--A State agency shall
pay to the Secretary the at-risk amount
designated under subparagraph
(D)(i)(II) for any fiscal year in
accordance with clause (ii), if, with
respect to the immediately following
fiscal year, a liability amount has
been established for the State agency
under subparagraph (C).
(ii) Method of payment of at-risk
amount.--
(I) Remission to the
secretary.--In the case of a
State agency required to pay an
at-risk amount under clause
(i), as soon as practicable
after completion of all
administrative and judicial
reviews with respect to that
requirement to pay, the chief
executive officer of the State
shall remit to the Secretary
the at-risk amount required to
be paid.
(II) Alternative method of
collection.--
(aa) In general.--If
the chief executive
officer of the State
fails to make the
payment under subclause
(I) within a reasonable
period of time
determined by the
Secretary, the
Secretary may reduce
any amount due to the
State agency under any
other provision of this
section by the amount
required to be paid
under clause (i).
(bb) Accrual of
interest.--During any
period of time
determined by the
Secretary under item
(aa), interest on the
payment under subclause
(I) shall not accrue
under section 13(a)(2).
(F) Use of portion of liability amount for
new investment.--
(i) Reduction of other amounts due to
state agency.--In the case of a State
agency that fails to comply with a
requirement for new investment under
subparagraph (D)(i)(I) or clause
(iii)(I), the Secretary may reduce any
amount due to the State agency under
any other provision of this section by
the portion of the liability amount
that has not been used in accordance
with that requirement.
(ii) Effect of state agency's wholly
prevailing on appeal.--If a State
agency begins required new investment
under subparagraph (D)(i)(I), the State
agency appeals the liability amount of
the State agency, and the determination
by the Secretary of the liability
amount is reduced to $0 on
administrative or judicial review, the
Secretary shall pay to the State agency
an amount equal to 50 percent of the
new investment amount that was included
in the liability amount subject to the
appeal.
(iii) Effect of secretary's wholly
prevailing on appeal.--If a State
agency does not begin required new
investment under subparagraph
(D)(i)(I), the State agency appeals the
liability amount of the State agency,
and the determination by the Secretary
of the liability amount is wholly
upheld on administrative or judicial
review, the Secretary shall--
(I) require all or any
portion of the new investment
amount to be used by the State
agency for new investment,
approved by the Secretary, to
improve administration by the
State agency of the
supplemental nutrition
assistance program, which
amount shall not be matched by
Federal funds; and
(II) require payment of any
remaining portion of the new
investment amount in accordance
with subparagraph (E)(ii).
(iv) Effect of neither party's wholly
prevailing on appeal.--The Secretary
shall promulgate regulations regarding
obligations of the Secretary and the
State agency in a case in which the
State agency appeals the liability
amount of the State agency and neither
the Secretary nor the State agency
wholly prevails.
(G) Corrective action plans.--The Secretary
shall foster management improvements by the
States by requiring State agencies, other than
State agencies with payment error rates of less
than 6 percent, to develop and implement
corrective action plans to reduce payment
errors.
(2) As used in this section--
(A) the term ``payment error rate'' means the sum of
the point estimates of an overpayment error rate and an
underpayment error rate determined by the Secretary
from data collected in a probability sample of
participating households;
(B) the term ``overpayment error rate'' means the
percentage of the value of all allotments issued in a
fiscal year by a State agency that are either--
(i) issued to households that fail to meet
basic program eligibility requirements; or
(ii) overissued to eligible households; and
(C) the term ``underpayment error rate'' means the
ratio of the value of allotments underissued to
recipient households to the total value of allotments
issued in a fiscal year by a State agency.
(3) The following errors may be measured for management
purposes but shall not be included in the payment error rate:
(A) Any errors resulting in the application of new
regulations promulgated under this Act during the first
120 days from the required implementation date for such
regulations.
(B) Errors resulting from the use by a State agency
of correctly processed information concerning
households or individuals received from Federal
agencies or from actions based on policy information
approved or disseminated, in writing, by the Secretary
or the Secretary's designee.
(4) Reporting requirements.--The Secretary may
require a State agency to report any factors that the
Secretary considers necessary to determine a State
agency's payment error rate, liability amount or new
investment amount under paragraph (1), or performance
under the performance measures under subsection (d). If
a State agency fails to meet the reporting requirements
established by the Secretary, the Secretary shall base
the determination on all pertinent information
available to the Secretary.
(5) Procedures.--To facilitate the implementation of
this subsection, each State agency shall expeditiously
submit to the Secretary data concerning the operations
of the State agency in each fiscal year sufficient for
the Secretary to establish the State agency's payment
error rate, liability amount or new investment amount
under paragraph (1), or performance under the
performance measures under subsection (d). The
Secretary shall initiate efforts to collect the amount
owed by the State agency as a claim established under
paragraph (1) for a fiscal year, subject to the
conclusion of any formal or informal appeal procedure
and administrative or judicial review under section 14
(as provided for in paragraph (7)), before the end of
the fiscal year following such fiscal year.
(6) National performance measure for payment error
rates.--
(A) Announcement.--At the time the Secretary
makes the notification to State agencies of
their error rates, the Secretary shall also
announce a national performance measure that
shall be the sum of the products of each State
agency's error rate as developed for the
notifications under paragraph (8) times that
State agency's proportion of the total value of
national allotments issued for the fiscal year
using the most recent issuance data available
at the time of the notifications issued
pursuant to paragraph (8).
(B) Use of alternative measure of state
error.--Where a State fails to meet reporting
requirements pursuant to paragraph (4), the
Secretary may use another measure of a State's
error developed pursuant to paragraph (8), to
develop the national performance measure.
(C) Use of national performance measure.--The
announced national performance measure shall be
used in determining the liability amount of a
State under paragraph (1)(C) for the fiscal
year whose error rates are being announced
under paragraph (8).
(D) No administrative or judicial review.--
The national performance measure announced
under this paragraph shall not be subject to
administrative or judicial review.
(7) Administrative and judicial review.--
(A) In general.--Except as provided in
subparagraphs (B) and (C), if the Secretary
asserts a financial claim against or
establishes a liability amount with respect to
a State agency under paragraph (1), the State
may seek administrative and judicial review of
the action pursuant to section 14.
(B) Determination of payment error rate.--
With respect to any fiscal year, a
determination of the payment error rate of a
State agency or a determination whether the
payment error rate exceeds 105 percent of the
national performance measure for payment error
rates shall be subject to administrative or
judicial review only if the Secretary
establishes a liability amount with respect to
the fiscal year under paragraph (1)(C).
(C) Authority of secretary with respect to
liability amount.--An action by the Secretary
under subparagraph (D) or (F)(iii) of paragraph
(1) shall not be subject to administrative or
judicial review.
(8)(A) This paragraph applies to the determination of whether
a payment is due by a State agency for a fiscal year under
paragraph (1).
(B) Not later than the first May 31 after the end of the
fiscal year referred to in subparagraph (A), the case review
and all arbitrations of State-Federal difference cases shall be
completed.
(C) Not later than the first June 30 after the end of the
fiscal year referred to in subparagraph (A), the Secretary
shall--
(i) determine final error rates, the national average
payment error rate, and the amounts of payment claimed
against State agencies or liability amount established
with respect to State agencies;
(ii) notify State agencies of the payment claims or
liability amounts; and
(iii) provide a copy of the document providing
notification under clause (ii) to the chief executive
officer and the legislature of the State.
(D) A State agency desiring to appeal a payment claim or
liability amount determined under subparagraph (C) shall submit
to an administrative law judge--
(i) a notice of appeal, not later than 10 days after
receiving a notice of the claim or liability amount;
and
(ii) evidence in support of the appeal of the State
agency, not later than 60 days after receiving a notice
of the claim or liability amount.
(E) Not later than 60 days after a State agency submits
evidence in support of the appeal, the Secretary shall submit
responsive evidence to the administrative law judge to the
extent such evidence exists.
(F) Not later than 30 days after the Secretary submits
responsive evidence, the State agency shall submit rebuttal
evidence to the administrative law judge to the extent such
evidence exists.
(G) The administrative law judge, after an evidentiary
hearing, shall decide the appeal--
(i) not later than 60 days after receipt of rebuttal
evidence submitted by the State agency; or
(ii) if the State agency does not submit rebuttal
evidence, not later than 90 days after the State agency
submits the notice of appeal and evidence in support of
the appeal.
(H) In considering a claim or liability amount under this
paragraph, the administrative law judge shall consider all
grounds for denying the claim or liability amount, in whole or
in part, including the contention of a State agency that the
claim or liability amount should be waived, in whole or in
part, for good cause.
(I) The deadlines in subparagraphs (D), (E), (F), and (G)
shall be extended by the administrative law judge for cause
shown.
(9) As used in this subsection, the term ``good cause''
includes--
(A) a natural disaster or civil disorder that
adversely affects supplemental nutrition assistance
program operations;
(B) a strike by employees of a State agency who are
necessary for the determination of eligibility and
processing of case changes under the supplemental
nutrition assistance program;
(C) a significant growth in the caseload under the
supplemental nutrition assistance program in a State
prior to or during a fiscal year, such as a 15 percent
growth in caseload;
(D) a change in the supplemental nutrition assistance
program or other Federal or State program that has a
substantial adverse impact on the management of the
supplemental nutrition assistance program of a State;
and
(E) a significant circumstance beyond the control of
the State agency.
(d) Bonuses for States That Demonstrate High or Most Improved
Performance.--
(1) Fiscal years 2003 and 2004.--
(A) Guidance.--With respect to fiscal years
2003 and 2004, the Secretary shall establish,
in guidance issued to State agencies not later
than October 1, 2002--
(i) performance criteria relating
to--
(I) actions taken to correct
errors, reduce rates of error,
and improve eligibility
determinations; and
(II) other indicators of
effective administration
determined by the Secretary;
and
(ii) standards for high and most
improved performance to be used in
awarding performance bonus payments
under subparagraph (B)(ii).
(B) Performance bonus payments.--With respect
to each of fiscal years 2003 and 2004, the
Secretary shall--
(i) measure the performance of each
State agency with respect to the
criteria established under subparagraph
(A)(i); and
(ii) subject to paragraph (3), award
performance bonus payments in the
following fiscal year, in a total
amount of $48,000,000 for each fiscal
year, to State agencies that meet
standards for high or most improved
performance established by the
Secretary under subparagraph (A)(ii).
(2) Fiscal years 2005 and thereafter.--
(A) Regulations.--With respect to fiscal year
2005 and each fiscal year thereafter, the
Secretary shall--
(i) establish, by regulation,
performance criteria relating to--
(I) actions taken to correct
errors, reduce rates of error,
and improve eligibility
determinations; and
(II) other indicators of
effective administration
determined by the Secretary;
(ii) establish, by regulation,
standards for high and most improved
performance to be used in awarding
performance bonus payments under
subparagraph (B)(ii); and
(iii) before issuing proposed
regulations to carry out clauses (i)
and (ii), solicit ideas for performance
criteria and standards for high and
most improved performance from State
agencies and organizations that
represent State interests.
(B) Performance bonus payments.--With respect
to fiscal year 2005 and each fiscal year
thereafter, the Secretary shall--
(i) measure the performance of each
State agency with respect to the
criteria established under subparagraph
(A)(i); and
(ii) subject to paragraph (3), award
performance bonus payments in the
following fiscal year, in a total
amount of $48,000,000 for each fiscal
year, to State agencies that meet
standards for high or most improved
performance established by the
Secretary under subparagraph (A)(ii).
(3) Prohibition on receipt of performance bonus
payments.--A State agency shall not be eligible for a
performance bonus payment with respect to any fiscal
year for which the State agency has a liability amount
established under subsection (c)(1)(C).
(4) Payments not subject to judicial review.--A
determination by the Secretary whether, and in what
amount, to award a performance bonus payment under this
subsection shall not be subject to administrative or
judicial review.
(5) Use of performance bonus payments.--A State
agency may use a performance bonus payment received
under this subsection only to carry out the program
established under this Act, including investments in--
(A) technology;
(B) improvements in administration and
distribution; and
(C) actions to prevent fraud, waste, and
abuse.
(e) The Secretary and State agencies shall (1) require, as a
condition of eligibility for participation in the supplemental
nutrition assistance program, that each household member
furnish to the State agency their social security account
number (or numbers, if they have more than one number), and (2)
use such account numbers in the administration of the
supplemental nutrition assistance program. The Secretary and
State agencies shall have access to the information regarding
individual supplemental nutrition assistance program applicants
and participants who receive benefits under title XVI of the
Social Security Act that has been provided to the Commissioner
of Social Security, but only to the extent that the Secretary
and the Commissioner of Social Security determine necessary for
purposes of determining or auditing a household's eligibility
to receive assistance or the amount thereof under the
supplemental nutrition assistance program, or verifying
information related thereto.
(f) Notwithstanding any other provision of law, counsel may
be employed and counsel fees, court costs, bail, and other
expenses incidental to the defense of officers and employees of
the Department of Agriculture may be paid in judicial or
administrative proceedings to which such officers and employees
have been made parties and that arise directly out of their
performance of duties under this Act.
(g) Cost Sharing for Computerization.--
(1) In general.--Except as provided in paragraphs (2)
and (3), the Secretary is authorized to pay to each
State agency the amount provided under subsection
(a)(6) for the costs incurred by the State agency in
the planning, design, development, or installation of 1
or more automatic data processing and information
retrieval systems that the Secretary determines--
(A) would assist in meeting the requirements
of this Act;
(B) meet such conditions as the Secretary
prescribes;
(C) are likely to provide more efficient and
effective administration of the supplemental
nutrition assistance program;
(D) would be compatible with other systems
used in the administration of State programs,
including the program funded under part A of
title IV of the Social Security Act (42 U.S.C.
601 et seq.);
(E) would be tested adequately before and
after implementation, including through pilot
projects in limited areas for major systems
changes as determined under rules promulgated
by the Secretary, data from which shall be
thoroughly evaluated before the Secretary
approves the system to be implemented more
broadly; and
(F) would be operated in accordance with an
adequate plan for--
(i) continuous updating to reflect
changed policy and circumstances; and
(ii) testing the effect of the system
on access for eligible households and
on payment accuracy.
(2) Limitation.--The Secretary shall not make
payments to a State agency under paragraph (1) to the
extent that the State agency--
(A) is reimbursed for the costs under any
other Federal program; or
(B) uses the systems for purposes not
connected with the supplemental nutrition
assistance program.
(h) Funding of Employment and Training Programs.--
(1) In general.--
(A) Amounts.--To carry out employment and
training programs, the Secretary shall reserve
for allocation to State agencies, to remain
available for 24 months, from funds made
available for each fiscal year under section
18(a)(1), $90,000,000 for each fiscal year.
(B) Allocation.--Funds made available under
subparagraph (A) shall be made available to and
reallocated among State agencies under a
reasonable formula that--
(i) is determined and adjusted by the
Secretary; and
(ii) takes into account the number of
individuals who are not exempt from the
work requirement under section 6(o).
(C) Reallocation.--
(i) In general.--If a State agency
will not expend all of the funds
allocated to the State agency for a
fiscal year under subparagraph (B), the
Secretary shall reallocate the
unexpended funds to other States
(during the fiscal year or the
subsequent fiscal year) as the
Secretary considers appropriate and
equitable.
(ii) Timing.--The Secretary shall
collect such information as the
Secretary determines to be necessary
about the expenditures and anticipated
expenditures by the State agencies of
the funds initially allocated to the
State agencies under subparagraph (A)
to make reallocations of unexpended
funds under clause (i) within a
timeframe that allows each State agency
to which funds are reallocated at least
270 days to expend the reallocated
funds.
(iii) Opportunity.--The Secretary
shall ensure that all State agencies
have an opportunity to obtain
reallocated funds.
(D) Minimum allocation.--Notwithstanding
subparagraph (B), the Secretary shall ensure
that each State agency operating an employment
and training program shall receive not less
than $50,000 for each fiscal year.
(E) Additional allocations for states that
ensure availability of work opportunities.--
(i) In general.--In addition to the
allocations under subparagraph (A),
from funds made available under section
18(a)(1), the Secretary shall allocate
not more than $20,000,000 for each
fiscal year to reimburse a State agency
that is eligible under clause (ii) for
the costs incurred in serving members
of households receiving supplemental
nutrition assistance program benefits
who--
(I) are not eligible for an
exception under section
6(o)(3); and
(II) are placed in and comply
with a program described in
subparagraph (B) or (C) of
section 6(o)(2).
(ii) Eligibility.--To be eligible for
an additional allocation under clause
(i), a State agency shall make and
comply with a commitment to offer a
position in a program described in
subparagraph (B) or (C) of section
6(o)(2) to each applicant or recipient
who--
(I) is in the last month of
the 3-month period described in
section 6(o)(2);
(II) is not eligible for an
exception under section
6(o)(3);
(III) is not eligible for a
waiver under section 6(o)(4);
and
(IV) is not exempt under
section 6(o)(6).
(F) Pilot projects to reduce dependency and
increase work requirements and work effort
under supplemental nutrition assistance
program.--
(i) Pilot projects required.--
(I) In general.--The
Secretary shall carry out pilot
projects under which State
agencies shall enter into
cooperative agreements with the
Secretary to develop and test
methods, including operating
work programs with certain
features comparable to the
program of block grants to
States for temporary assistance
for needy families established
under part A of title IV of the
Social Security Act (42 U.S.C.
601 et seq.), for employment
and training programs and
services to raise the number of
work registrants under section
6(d) of this Act who obtain
unsubsidized employment,
increase the earned income of
the registrants, and reduce the
reliance of the registrants on
public assistance, so as to
reduce the need for
supplemental nutrition
assistance benefits.
(II) Requirements.--Pilot
projects shall--
(aa) meet such terms
and conditions as the
Secretary considers to
be appropriate; and
(bb) except as
otherwise provided in
this subparagraph, be
in accordance with the
requirements of
sections 6(d) and 20.
(ii) Selection criteria.--
(I) In general.--The
Secretary shall select pilot
projects under this
subparagraph in accordance with
the criteria established under
this clause and additional
criteria established by the
Secretary.
(II) Qualifying criteria.--To
be eligible to participate in a
pilot project, a State agency
shall--
(aa) agree to
participate in the
evaluation described in
clause (vii), including
providing evidence that
the State has a robust
data collection system
for program
administration and
cooperating to make
available State data on
the employment
activities and post-
participation
employment, earnings,
and public benefit
receipt of participants
to ensure proper and
timely evaluation;
(bb) commit to
collaborate with the
State workforce board
and other job training
programs in the State
and local area; and
(cc) commit to
maintain at least the
amount of State funding
for employment and
training programs and
services under
paragraphs (2) and (3)
and under section 20 as
the State expended for
fiscal year 2013.
(III) Selection criteria.--In
selecting pilot projects, the
Secretary shall--
(aa) consider the
degree to which the
pilot project would
enhance existing
employment and training
programs in the State;
(bb) consider the
degree to which the
pilot project would
enhance the employment
and earnings of program
participants;
(cc) consider whether
there is evidence that
the pilot project could
be replicated easily by
other States or
political subdivisions;
(dd) consider whether
the State agency has a
demonstrated capacity
to operate high quality
employment and training
programs; and
(ee) ensure the pilot
projects, when
considered as a group,
test a range of
strategies, including
strategies that--
(AA) target
individuals
with low skills
or limited work
experience,
individuals
subject to the
requirements
under section
6(o), and
individuals who
are working;
(BB) are
located in a
range of
geographic
areas and
States,
including rural
and urban
areas;
(CC)
emphasize
education and
training,
rehabilitative
services for
individuals
with barriers
to employment,
rapid
attachment to
employment, and
mixed
strategies; and
(DD) test
programs that
assign work
registrants to
mandatory and
voluntary
participation
in employment
and training
activities.
(iii) Accountability.--
(I) In general.--The
Secretary shall establish and
implement a process to
terminate a pilot project for
which the State has failed to
meet the criteria described in
clause (ii) or other criteria
established by the Secretary.
(II) Timing.--The process
shall include a reasonable time
period, not to exceed 180 days,
for State agencies found
noncompliant to correct the
noncompliance.
(iv) Employment and training
activities.--Allowable programs and
services carried out under this
subparagraph shall include those
programs and services authorized under
this Act and employment and training
activities authorized under the program
of block grants to States for temporary
assistance for needy families
established under part A of title IV of
the Social Security Act (42 U.S.C. 601
et seq.), including:
(I) Employment in the public
or private sector that is not
subsidized by any public
program.
(II) Employment in the
private sector for which the
employer receives a subsidy
from public funds to offset all
or a part of the wages and
costs of employing an adult.
(III) Employment in the
public sector for which the
employer receives a subsidy
from public funds to offset all
or a part of the wages and
costs of employing an adult.
(IV) A work activity that--
(aa) is performed in
return for public
benefits;
(bb) provides an
adult with an
opportunity to acquire
the general skills,
knowledge, and work
habits necessary to
obtain employment;
(cc) is designed to
improve the
employability of those
who cannot find
unsubsidized
employment; and
(dd) is supervised by
an employer, work site
sponsor, or other
responsible party on an
ongoing basis.
(V) Training in the public or
private sector that--
(aa) is given to a
paid employee while the
employee is engaged in
productive work; and
(bb) provides
knowledge and skills
essential to the full
and adequate
performance of the job.
(VI) Job search, obtaining
employment, or preparation to
seek or obtain employment,
including--
(aa) life skills
training;
(bb) substance abuse
treatment or mental
health treatment,
determined to be
necessary and
documented by a
qualified medical,
substance abuse, or
mental health
professional; and
(cc) rehabilitation
activities, supervised
by a public agency or
other responsible party
on an ongoing basis.
(VII) Structured programs and
embedded activities--
(aa) in which adults
perform work for the
direct benefit of the
community under the
auspices of public or
nonprofit
organizations;
(bb) that are limited
to projects that serve
useful community
purposes in fields such
as health, social
service, environmental
protection, education,
urban and rural
redevelopment, welfare,
recreation, public
facilities, public
safety, and child care;
(cc) that are
designed to improve the
employability of adults
not otherwise able to
obtain unsubsidized
employment;
(dd) that are
supervised on an
ongoing basis; and
(ee) with respect to
which a State agency
takes into account, to
the maximum extent
practicable, the prior
training, experience,
and skills of a
recipient in making
appropriate community
service assignments.
(VIII) Career and technical
training programs that are--
(aa) directly related
to the preparation of
adults for employment
in current or emerging
occupations; and
(bb) supervised on an
ongoing basis.
(IX) Training or education
for job skills that are--
(aa) required by an
employer to provide an
adult with the ability
to obtain employment or
to advance or adapt to
the changing demands of
the workplace; and
(bb) supervised on an
ongoing basis.
(X) Education that is--
(aa) related to a
specific occupation,
job, or job offer; and
(bb) supervised on an
ongoing basis.
(XI) In the case of an adult
who has not completed secondary
school or received a
certificate of general
equivalence, regular attendance
that is--
(aa) in accordance
with the requirements
of the secondary school
or course of study, at
a secondary school or
in a course of study
leading to a
certificate of general
equivalence; and
(bb) supervised on an
ongoing basis.
(XII) Providing child care to
enable another recipient of
public benefits to participate
in a community service program
that--
(aa) does not provide
compensation for the
community service;
(bb) is a structured
program designed to
improve the
employability of adults
who participate in the
program; and
(cc) is supervised on
an ongoing basis.
(v) Sanctions.--Subject to clause
(vi), no work registrant shall be
eligible to participate in the
supplemental nutrition assistance
program if the individual refuses
without good cause to participate in an
employment and training program under
this subparagraph, to the extent
required by the State agency.
(vi) Standards.--
(I) In general.--Employment
and training activities under
this subparagraph shall be
considered to be carried out
under section 6(d), including
for the purpose of satisfying
any conditions of participation
and duration of ineligibility.
(II) Standards for certain
employment activities.--The
Secretary shall establish
standards for employment
activities described in
subclauses (I), (II), and (III)
of clause (iv) that ensure that
failure to work for reasons
beyond the control of an
individual, such as involuntary
reduction in hours of
employment, shall not result in
ineligibility.
(III) Participation in other
programs.--Before assigning a
work registrant to mandatory
employment and training
activities, a State agency
shall--
(aa) assess whether
the work registrant is
participating in
substantial employment
and training activities
outside of the pilot
project that are
expected to result in
the work registrant
gaining increased
skills, training, work,
or experience
consistent with the
objectives of the pilot
project; and
(bb) if determined to
be acceptable, count
hours engaged in the
activities toward any
minimum participation
requirement.
(vii) Evaluation and reporting.--
(I) Independent evaluation.--
(aa) In general.--The
Secretary shall, under
such terms and
conditions as the
Secretary determines to
be appropriate, conduct
for each State agency
that enters into a
cooperative agreement
under clause (i) an
independent
longitudinal evaluation
of each pilot project
of the State agency
under this
subparagraph, with
results reported not
less frequently than in
consecutive 12-month
increments.
(bb) Purpose.--The
purpose of the
independent evaluation
shall be to measure the
impact of employment
and training programs
and services provided
by each State agency
under the pilot
projects on the ability
of adults in each pilot
project target
population to find and
retain employment that
leads to increased
household income and
reduced reliance on
public assistance, as
well as other measures
of household well-
being, compared to what
would have occurred in
the absence of the
pilot project.
(cc) Methodology.--
The independent
evaluation shall use
valid statistical
methods that can
determine, for each
pilot project, the
difference, if any,
between supplemental
nutrition assistance
and other public
benefit receipt
expenditures,
employment, earnings
and other impacts as
determined by the
Secretary--
(AA) as a
result of the
employment and
training
programs and
services
provided by the
State agency
under the pilot
project; as
compared to
(BB) a
control group
that is not
subject to the
employment and
training
programs and
services
provided by the
State agency
under the pilot
project.
(II) Reporting.--Not later
than December 31, 2015, and
each December 31 thereafter
until the completion of the
last evaluation under subclause
(I), the Secretary shall submit
to the Committee on Agriculture
of the House of Representatives
and the Committee on
Agriculture, Nutrition, and
Forestry of the Senate and
share broadly, including by
posting on the Internet website
of the Department of
Agriculture, a report that
includes a description of--
(aa) the status of
each pilot project
carried out under this
subparagraph;
(bb) the results of
the evaluation
completed during the
previous fiscal year;
(cc) to the maximum
extent practicable,
baseline information
relevant to the stated
goals and desired
outcomes of the pilot
project;
(dd) the employment
and training programs
and services each State
tested under the pilot,
including--
(AA) the
system of the
State for
assessing the
ability of work
registrants to
participate in
and meet the
requirements of
employment and
training
activities and
assigning work
registrants to
appropriate
activities; and
(BB) the
employment and
training
activities and
services
provided under
the pilot;
(ee) the impact of
the employment and
training programs and
services on appropriate
employment, income, and
public benefit receipt
as well as other
outcomes among
households
participating in the
pilot project, relative
to households not
participating; and
(ff) the steps and
funding necessary to
incorporate into State
employment and training
programs and services
the components of the
pilot projects that
demonstrate increased
employment and
earnings.
(viii) Funding.--
(I) In general.--Subject to
subclause (II), from amounts
made available under section
18(a)(1), the Secretary shall
use to carry out this
subparagraph--
(aa) for fiscal year
2014, $10,000,000; and
(bb) for fiscal year
2015, $190,000,000.
(II) Limitations.--
(aa) In general.--The
Secretary shall not
fund more than 10 pilot
projects under this
subparagraph.
(bb) Duration.--Each
pilot project shall be
in effect for not more
than 3 years.
(III) Availability of
funds.--Funds made available
under subclause (I) shall
remain available through
September 30, 2018.
(ix) Use of funds.--
(I) In general.--Funds made
available under this
subparagraph for pilot projects
shall be used only for--
(aa) pilot projects
that comply with this
Act;
(bb) the program and
administrative costs of
carrying out the pilot
projects;
(cc) the costs
incurred in developing
systems and providing
information and data
for the independent
evaluations under
clause (vii); and
(dd) the costs of the
evaluations under
clause (vii).
(II) Maintenance of effort.--
Funds made available under this
subparagraph shall be used only
to supplement, not to supplant,
non-Federal funds used for
existing employment and
training activities or
services.
(III) Other funds.--In
carrying out pilot projects,
States may contribute
additional funds obtained from
other sources, including
Federal, State, or private
funds, on the condition that
the use of the contributions is
permissible under Federal law.
(2) If, in carrying out such program during such fiscal year,
a State agency incurs costs that exceed the amount allocated to
the State agency under paragraph (1), the Secretary shall pay
such State agency an amount equal to 50 per centum of such
additional costs, subject to the first limitation in paragraph
(3), including the costs for case management and casework to
facilitate the transition from economic dependency to self-
sufficiency through work.
(3) The Secretary shall also reimburse each State agency in
an amount equal to 50 per centum of the total amount of
payments made or costs incurred by the State agency in
connection with transportation costs and other expenses
reasonably necessary and directly related to participation in
an employment and training program under section 6(d)(4) or a
pilot project under paragraph (1)(F), except that the amount of
the reimbursement for dependent care expenses shall not exceed
an amount equal to the payment made under section
6(d)(4)(I)(i)(II) but not more than the applicable local market
rate, and such reimbursement shall not be made out of funds
allocated under paragraph (1).
(4) Funds provided to a State agency under this subsection
may be used only for operating an employment and training
program under section 6(d)(4) or a pilot project under
paragraph (1)(F), and may not be used for carrying out other
provisions of this Act.
(5) Monitoring.--
(A) In general.--The Secretary shall monitor
the employment and training programs carried
out by State agencies under section 6(d)(4) and
assess the effectiveness of the programs in--
(i) preparing members of households
participating in the supplemental
nutrition assistance program for
employment, including the acquisition
of basic skills necessary for
employment; and
(ii) increasing the number of
household members who obtain and retain
employment subsequent to participation
in the employment and training
programs.
(B) Reporting measures.--
(i) In general.--The Secretary, in
consultation with the Secretary of
Labor, shall develop State reporting
measures that identify improvements in
the skills, training, education, or
work experience of members of
households participating in the
supplemental nutrition assistance
program.
(ii) Requirements.--Measures shall--
(I) be based on common
measures of performance for
Federal workforce training
programs; and
(II) include additional
indicators that reflect the
challenges facing the types of
members of households
participating in the
supplemental nutrition
assistance program who
participate in a specific
employment and training
component.
(iii) State requirements.--The
Secretary shall require that each State
employment and training plan submitted
under section 11(e)(19) identifies
appropriate reporting measures for each
proposed component that serves a
threshold number of participants
determined by the Secretary of at least
100 people a year.
(iv) Inclusions.--Reporting measures
described in clause (iii) may include--
(I) the percentage and number
of program participants who
received employment and
training services and are in
unsubsidized employment
subsequent to the receipt of
those services;
(II) the percentage and
number of program participants
who obtain a recognized
credential, including a
registered apprenticeship, or a
regular secondary school
diploma or its recognized
equivalent, while participating
in, or within 1 year after
receiving, employment and
training services;
(III) the percentage and
number of program participants
who are in an education or
training program that is
intended to lead to a
recognized credential,
including a registered
apprenticeship or on-the-job
training program, a regular
secondary school diploma or its
recognized equivalent, or
unsubsidized employment;
(IV) subject to terms and
conditions established by the
Secretary, measures developed
by each State agency to assess
the skills acquisition of
employment and training program
participants that reflect the
goals of the specific
employment and training program
components of the State agency,
which may include, at a
minimum--
(aa) the percentage
and number of program
participants who are
meeting program
requirements in each
component of the
education and training
program of the State
agency;
(bb) the percentage
and number of program
participants who are
gaining skills likely
to lead to employment
as measured through
testing, quantitative
or qualitative
assessment, or other
method; and
(cc) the percentage
and number of program
participants who do not
comply with employment
and training
requirements and who
are ineligible under
section 6(b); and
(V) other indicators approved
by the Secretary.
(C) Oversight of State employment and
training activities.--The Secretary shall
assess State employment and training programs
on a periodic basis to ensure--
(i) compliance with Federal
employment and training program rules
and regulations;
(ii) that program activities are
appropriate to meet the needs of the
individuals referred by the State
agency to an employment and training
program component;
(iii) that reporting measures are
appropriate to identify improvements in
skills, training, work and experience
for participants in an employment and
training program component; and
(iv) for States receiving additional
allocations under paragraph (1)(E), any
information the Secretary may require
to evaluate the compliance of the State
agency with paragraph (1), which may
include--
(I) a report for each fiscal
year of the number of
individuals in the State who
meet the conditions of
paragraph (1)(E)(ii), the
number of individuals the State
agency offers a position in a
program described in
subparagraph (B) or (C) of
section 6(o)(2), and the number
who participate in such a
program;
(II) a description of the
types of employment and
training programs the State
agency uses to comply with
paragraph (1)(E) and the
availability of those programs
throughout the State; and
(III) any additional
information the Secretary
determines to be appropriate.
(D) State report.--Each State agency shall
annually prepare and submit to the Secretary a
report on the State employment and training
program that includes, using measures
identified under subparagraph (B), the numbers
of supplemental nutrition assistance program
participants who have gained skills, training,
work, or experience that will increase the
ability of the participants to obtain regular
employment.
(E) Modifications to the State employment and
training plan.--Subject to terms and conditions
established by the Secretary, if the Secretary
determines that the performance of a State
agency with respect to employment and training
outcomes is inadequate, the Secretary may
require the State agency to make modifications
to the State employment and training plan to
improve the outcomes.
(F) Periodic evaluation.--Subject to terms
and conditions established by the Secretary,
not later than October 1, 2016, and not less
frequently than once every 5 years thereafter,
the Secretary shall conduct a study to review
existing practice and research to identify
employment and training program components and
practices that--
(i) effectively assist members of
households participating in the
supplemental nutrition assistance
program in gaining skills, training,
work, or experience that will increase
the ability of the participants to
obtain regular employment; and
(ii) are best integrated with
statewide workforce development
systems.
(i)(1) The Department of Agriculture may use quality control
information made available under this section to determine
which project areas have payment error rates (as defined in
subsection (d)(1)) that impair the integrity of the
supplemental nutrition assistance program.
(2) The Secretary may require a State agency to carry out new
or modified procedures for the certification of households in
areas identified under paragraph (1) if the Secretary
determines such procedures would improve the integrity of the
supplemental nutrition assistance program and be cost
effective.
(j) Not later than 180 days after the date of the enactment
of the Hunger Prevention Act of 1988, and annually thereafter,
the Secretary shall publish instructional materials
specifically designed to be used by the State agency to provide
intensive training to State agency personnel who undertake the
certification of households that include a member who engages
in farming.
(k) Reductions in Payments for Administrative Costs.--
(1) Definitions.--In this subsection:
(A) AFDC program.--The term ``AFDC program''
means the program of aid to families with
dependent children established under part A of
title IV of the Social Security Act (42 U.S.C.
601 et seq. (as in effect, with respect to a
State, during the base period for that State)).
(B) Base period.--The term ``base period''
means the period used to determine the amount
of the State family assistance grant for a
State under section 403 of the Social Security
Act (42 U.S.C. 603).
(C) Medicaid program.--The term ``medicaid
program'' means the program of medical
assistance under a State plan or under a waiver
of the plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(2) Determinations of amounts attributable to
benefiting programs.--Not later than 180 days after the
date of enactment of this subsection, the Secretary of
Health and Human Services, in consultation with the
Secretary of Agriculture and the States, shall, with
respect to the base period for each State, determine--
(A) the annualized amount the State received
under section 403(a)(3) of the Social Security
Act (42 U.S.C. 603(a)(3) (as in effect during
the base period)) for administrative costs
common to determining the eligibility of
individuals, families, and households eligible
or applying for the AFDC program and the
supplemental nutrition assistance program, the
AFDC program and the medicaid program, and the
AFDC program, the supplemental nutrition
assistance program, and the medicaid program
that were allocated to the AFDC program; and
(B) the annualized amount the State would
have received under section 403(a)(3) of the
Social Security Act (42 U.S.C. 603(a)(3) (as so
in effect)), section 1903(a)(7) of the Social
Security Act (42 U.S.C. 1396b(a)(7) (as so in
effect)), and subsection (a) of this section
(as so in effect), for administrative costs
common to determining the eligibility of
individuals, families, and households eligible
or applying for the AFDC program and the
supplemental nutrition assistance program, the
AFDC program and the medicaid program, and the
AFDC program, the supplemental nutrition
assistance program, and the medicaid program,
if those costs had been allocated equally among
such programs for which the individual, family,
or household was eligible or applied for.
(3) Reduction in payment.--
(A) In general.--Notwithstanding any other
provision of this section, the Secretary shall
reduce, for each fiscal year, the amount paid
under subsection (a) to each State by an amount
equal to the amount determined for the
supplemental nutrition assistance program under
paragraph (2)(B). The Secretary shall, to the
extent practicable, make the reductions
required by this paragraph on a quarterly
basis.
(B) Application.--If the Secretary of Health
and Human Services does not make the
determinations required by paragraph (2) by
September 30, 1999--
(i) during the fiscal year in which
the determinations are made, the
Secretary shall reduce the amount paid
under subsection (a) to each State by
an amount equal to the sum of the
amounts determined for the supplemental
nutrition assistance program under
paragraph (2)(B) for fiscal year 1999
through the fiscal year during which
the determinations are made; and
(ii) for each subsequent fiscal year,
subparagraph (A) applies.
(4) Appeal of determinations.--
(A) In general.--Not later than 5 days after
the date on which the Secretary of Health and
Human Services makes any determination required
by paragraph (2) with respect to a State, the
Secretary shall notify the chief executive
officer of the State of the determination.
(B) Review by administrative law judge.--
(i) In general.--Not later than 60
days after the date on which a State
receives notice under subparagraph (A)
of a determination, the State may
appeal the determination, in whole or
in part, to an administrative law judge
of the Department of Health and Human
Services by filing an appeal with the
administrative law judge.
(ii) Documentation.--The
administrative law judge shall consider
an appeal filed by a State under clause
(i) on the basis of such documentation
as the State may submit and as the
administrative law judge may require to
support the final decision of the
administrative law judge.
(iii) Review.--In deciding whether to
uphold a determination, in whole or in
part, the administrative law judge
shall conduct a thorough review of the
issues and take into account all
relevant evidence.
(iv) Deadline.--Not later than 60
days after the date on which the record
is closed, the administrative law judge
shall--
(I) make a final decision
with respect to an appeal filed
under clause (i); and
(II) notify the chief
executive officer of the State
of the decision.
(C) Review by departmental appeals board.--
(i) In general.--Not later than 30
days after the date on which a State
receives notice under subparagraph (B)
of a final decision, the State may
appeal the decision, in whole or in
part, to the Departmental Appeals Board
established in the Department of Health
and Human Services (referred to in this
paragraph as the ``Board'') by filing
an appeal with the Board.
(ii) Review.--The Board shall review
the decision on the record.
(iii) Deadline.--Not later than 60
days after the date on which the appeal
is filed, the Board shall--
(I) make a final decision
with respect to an appeal filed
under clause (i); and
(II) notify the chief
executive officer of the State
of the decision.
(D) Judicial review.--The determinations of
the Secretary of Health and Human Services
under paragraph (2), and a final decision of
the administrative law judge or Board under
subparagraphs (B) and (C), respectively, shall
not be subject to judicial review.
(E) Reduced payments pending appeal.--The
pendency of an appeal under this paragraph
shall not affect the requirement that the
Secretary reduce payments in accordance with
paragraph (3).
(5) Allocation of administrative costs.--
(A) In general.--No funds or expenditures
described in subparagraph (B) may be used to
pay for costs--
(i) eligible for reimbursement under
subsection (a) (or costs that would
have been eligible for reimbursement
but for this subsection); and
(ii) allocated for reimbursement to
the supplemental nutrition assistance
program under a plan submitted by a
State to the Secretary of Health and
Human Services to allocate
administrative costs for public
assistance programs.
(B) Funds and expenditures.--Subparagraph (A)
applies to--
(i) funds made available to carry out
part A of title IV, or title XX, of the
Social Security Act (42 U.S.C. 601 et
seq., 1397 et seq.);
(ii) expenditures made as qualified
State expenditures (as defined in
section 409(a)(7)(B) of that Act (42
U.S.C. 609(a)(7)(B)));
(iii) any other Federal funds (except
funds provided under subsection (a));
and
(iv) any other State funds that are--
(I) expended as a condition
of receiving Federal funds; or
(II) used to match Federal
funds under a Federal program
other than the supplemental
nutrition assistance program.
* * * * * * *
----------
PERSONAL RESPONSIBILITY AND WORK OPPORTUNITY RECONCILIATION ACT OF 1996
* * * * * * *
TITLE IV--RESTRICTING WELFARE AND PUBLIC BENEFITS FOR ALIENS
* * * * * * *
Subtitle A--Eligibility for Federal Benefits
* * * * * * *
SEC. 402. LIMITED ELIGIBILITY OF QUALIFIED ALIENS FOR CERTAIN FEDERAL
PROGRAMS.
(a) Limited Eligibility for Specified Federal Programs.--
(1) In general.--Notwithstanding any other provision
of law and except as provided in paragraph (2), an
alien who is a qualified alien (as defined in section
431) is not eligible for any specified Federal program
(as defined in paragraph (3)).
(2) Exceptions.--
(A) Time-limited exception for refugees and
asylees.--With respect to the specified Federal
programs described in paragraph (3), paragraph
(1) shall not apply to an alien until 7 years
after the date--
(i) an alien is admitted to the
United States as a refugee under
section 207 of the Immigration and
Nationality Act;
(ii) an alien is granted asylum under
section 208 of such Act;
(iii) an alien's deportation is
withheld under section 243(h) of such
Act (as in effect immediately before
the effective date of section 307 of
division C of Public Law 104-208) or
section 241(b)(3) of such Act (as
amended by section 305(a) of division C
of Public Law 104-208);
(iv) an alien is granted status as a
Cuban and Haitian entrant (as defined
in section 501(e) of the Refugee
Education Assistance Act of 1980); or
(v) an alien is admitted to the
United States as an Amerasian immigrant
pursuant to section 584 of the Foreign
Operations, Export Financing, and
Related Programs Appropriations Act,
1988 (as contained in section 101(e) of
Public Law 100-202 and amended by the
9th proviso under migration and refugee
assistance in title II of the Foreign
Operations, Export Financing, and
Related Programs Appropriations Act,
1989, Public Law 100-461, as amended).
(B) Certain permanent resident aliens.--
Paragraph (1) shall not apply to an alien who--
(i) is lawfully admitted to the
United States for permanent residence
under the Immigration and Nationality
Act; and
(ii)(I) has worked 40 qualifying
quarters of coverage as defined under
title II of the Social Security Act or
can be credited with such qualifying
quarters as provided under section 435,
and (II) in the case of any such
qualifying quarter creditable for any
period beginning after December 31,
1996, did not receive any Federal
means-tested public benefit (as
provided under section 403) during any
such period.
(C) Veteran and active duty exception.--
Paragraph (1) shall not apply to an alien who
is lawfully residing in any State and is--
(i) a veteran (as defined in section
101, 1101, or 1301, or as described in
section 107 of title 38, United States
Code) with a discharge characterized as
an honorable discharge and not on
account of alienage and who fulfills
the minimum active-duty service
requirements of section 5303A(d) of
title 38, United States Code,
(ii) on active duty (other than
active duty for
training) in the Armed Forces of the
United States, or
(iii) the spouse or unmarried
dependent child of an individual
described in clause (i) or (ii) or the
unremarried surviving spouse of an
individual described in clause (i) or
(ii) who is deceased if the marriage
fulfills the requirements of section
1304 of title 38, United States Code.
(D) Transition for aliens currently receiving
benefits.--
(i) SSI.--
(I) In general.--With respect
to the specified Federal
program described in paragraph
(3)(A), during the period
beginning on the date of the
enactment of this Act and
ending on September 30, 1998,
the Commissioner of Social
Security shall redetermine the
eligibility of any individual
who is receiving benefits under
such program as of the date of
the enactment of this Act and
whose eligibility for such
benefits may terminate by
reason of the provisions of
this subsection.
(II) Redetermination
criteria.--With respect to any
redetermination under subclause
(I), the Commissioner of Social
Security shall apply the
eligibility criteria for new
applicants for benefits under
such program.
(III) Grandfather
provision.--The provisions of
this subsection and the
redetermination under subclause
(I), shall only apply with
respect to the benefits of an
individual described in
subclause (I) for months
beginning on or after September
30, 1998.
(IV) Notice.--Not later than
March 31, 1997, the
Commissioner of Social Security
shall notify an individual
described in subclause (I) of
the provisions of this clause.
(ii) Food stamps.--
(I) In general.--With respect
to the specified Federal
program described in paragraph
(3)(B), ineligibility under
paragraph (1) shall not apply
until April 1, 1997, to an
alien who received benefits
under such program on the date
of enactment of this Act,
unless such alien is determined
to be ineligible to receive
such benefits under the Food
Stamp Act of 1977. The State
agency shall recertify the
eligibility of all such aliens
during the period beginning
April 1, 1997, and ending
August 22, 1997.
(II) Recertification
criteria.--With respect to any
recertification under subclause
(I), the State agency shall
apply the eligibility criteria
for applicants for benefits
under such program.
(III) Grandfather
provision.--The provisions of
this subsection and the
recertification under subclause
(I) shall only apply with
respect to the eligibility of
an alien for a program for
months beginning on or after
the date of recertification, if
on the date of enactment of
this Act the alien is lawfully
residing in any State and is
receiving benefits under such
program on such date of
enactment.
(E) Aliens receiving ssi on august 22,
1996.--With respect to eligibility for benefits
for the program defined in paragraph (3)(A)
(relating to the supplemental security income
program), paragraph (1) shall not apply to an
alien who is lawfully residing in the United
States and who was receiving such benefits on
August 22, 1996.
(F) Disabled aliens lawfully residing in the
united states on august 22, 1996.--With respect
to eligibility for benefits for the specified
Federal programs described in paragraph (3),
paragraph (1) shall not apply to an alien who--
(i) in the case of the specified
Federal program described in paragraph
(3)(A)--
(I) was lawfully residing in
the United States on August 22,
1996; and
(II) is blind or disabled (as
defined in paragraph (2) or (3)
of section 1614(a) of the
Social Security Act (42 U.S.C.
1382c(a))); and
(ii) in the case of the specified
Federal program described in paragraph
(3)(B), is receiving benefits or
assistance for blindness or disability
(within the meaning of section 3(j) of
the Food Stamp Act of 1977 (7 U.S.C.
2012(r))).
(G) Exception for certain indians.--With
respect to eligibility for benefits for the
specified Federal programs described in
paragraph (3), section 401(a) and paragraph (1)
shall not apply to any individual--
(i) who is an American Indian born in
Canada to whom the provisions of
section 289 of the Immigration and
Nationality Act (8 U.S.C. 1359) apply;
or
(ii) who is a member of an Indian
tribe (as defined in section 4(e) of
the Indian Self-Determination and
Education Assistance Act (25 U.S.C.
450b(e))).
(H) SSI exception for certain recipients on
the basis of very old applications.--With
respect to eligibility for benefits for the
program defined in paragraph (3)(A) (relating
to the supplemental security income program),
paragraph (1) shall not apply to any
individual--
(i) who is receiving benefits under
such program for months after July 1996
on the basis of an application filed
before January 1, 1979; and
(ii) with respect to whom the
Commissioner of Social Security lacks
clear and convincing evidence that such
individual is an alien ineligible for
such benefits as a result of the
application of this section.
(I) Food stamp exception for certain elderly
individuals.--With respect to eligibility for
benefits for the specified Federal program
described in paragraph (3)(B), paragraph (1)
shall not apply to any individual who on August
22, 1996--
(i) was lawfully residing in the
United States; and
(ii) was 65 years of age or older.
(J) Food stamp exception for certain
children.--With respect to eligibility for
benefits for the specified Federal program
described in paragraph (3)(B), paragraph (1)
shall not apply to any individual who is under
18 years of age.
(K) Food stamp exception for certain hmong
and highland laotians.--With respect to
eligibility for benefits for the specified
Federal program described in paragraph (3)(B),
paragraph (1) shall not apply to--
(i) any individual who--
(I) is lawfully residing in
the United States; and
(II) was a member of a Hmong
or Highland Laotian tribe at
the time that the tribe
rendered assistance to United
States personnel by taking part
in a military or rescue
operation during the Vietnam
era (as defined in section 101
of title 38, United States
Code);
(ii) the spouse, or an unmarried
dependent child, of such an individual;
or
(iii) the unremarried surviving
spouse of such an individual who is
deceased.
(L) Food stamp exception for certain
qualified aliens.--With respect to eligibility
for benefits for the specified Federal program
described in paragraph (3)(B), paragraph (1)
shall not apply to any qualified alien who has
resided in the United States with a status
within the meaning of the term ``qualified
alien'' for a period of 5 years or more
beginning on the date of the alien's entry into
the United States.
(M) SSI extensions through fiscal year
2011.--
(i) Two-year extension for certain
aliens and victims of trafficking.--
(I) In general.--Subject to
clause (ii), with respect to
eligibility for benefits under
subparagraph (A) for the
specified Federal program
described in paragraph (3)(A)
of qualified aliens (as defined
in section 431(b)) and victims
of trafficking in persons (as
defined in section 107(b)(1)(C)
of division A of the Victims of
Trafficking and Violence
Protection Act of 2000 (Public
Law 106-386) or as granted
status under section
101(a)(15)(T)(ii) of the
Immigration and Nationality
Act), the 7-year period
described in subparagraph (A)
shall be deemed to be a 9-year
period during fiscal years 2009
through 2011 in the case of
such a qualified alien or
victim of trafficking who
furnishes to the Commissioner
of Social Security the
declaration required under
subclause (IV) (if applicable)
and is described in subclause
(III).
(II) Aliens and victims whose
benefits ceased in prior fiscal
years.--Subject to clause (ii),
beginning on the date of the
enactment of the SSI Extension
for Elderly and Disabled
Refugees Act, any qualified
alien (as defined in section
431(b)) or victim of
trafficking in persons (as
defined in section 107(b)(1)(C)
of division A of the Victims of
Trafficking and Violence
Protection Act of 2000 (Public
Law 106-386) or as granted
status under section
101(a)(15)(T)(ii) of the
Immigration and Nationality
Act) rendered ineligible for
the specified Federal program
described in paragraph (3)(A)
during the period beginning on
August 22, 1996, and ending on
September 30, 2008, solely by
reason of the termination of
the 7-year period described in
subparagraph (A) shall be
eligible for such program for
an additional 2-year period in
accordance with this clause, if
such qualified alien or victim
of trafficking meets all other
eligibility factors under title
XVI of the Social Security Act,
furnishes to the Commissioner
of Social Security the
declaration required under
subclause (IV) (if applicable),
and is described in subclause
(III).
(III) Aliens and victims
described.--For purposes of
subclauses (I) and (II), a
qualified alien or victim of
trafficking described in this
subclause is an alien or victim
who--
(aa) has been a
lawful permanent
resident for less than
6 years and such status
has not been abandoned,
rescinded under section
246 of the Immigration
and Nationality Act, or
terminated through
removal proceedings
under section 240 of
the Immigration and
Nationality Act, and
the Commissioner of
Social Security has
verified such status,
through procedures
established in
consultation with the
Secretary of Homeland
Security;
(bb) has filed an
application, within 4
years from the date the
alien or victim began
receiving supplemental
security income
benefits, to become a
lawful permanent
resident with the
Secretary of Homeland
Security, and the
Commissioner of Social
Security has verified,
through procedures
established in
consultation with such
Secretary, that such
application is pending;
(cc) has been granted
the status of Cuban and
Haitian entrant, as
defined in section
501(e) of the Refugee
Education Assistance
Act of 1980 (Public Law
96-422), for purposes
of the specified
Federal program
described in paragraph
(3)(A);
(dd) has had his or
her deportation
withheld by the
Secretary of Homeland
Security under section
243(h) of the
Immigration and
Nationality Act (as in
effect immediately
before the effective
date of section 307 of
division C of Public
Law 104-208), or whose
removal is withheld
under section 241(b)(3)
of such Act;
(ee) has not attained
age 18; or
(ff) has attained age
70.
(IV) Declaration required.--
(aa) In general.--For
purposes of subclauses
(I) and (II), the
declaration required
under this subclause of
a qualified alien or
victim of trafficking
described in either
such subclause is a
declaration under
penalty of perjury
stating that the alien
or victim has made a
good faith effort to
pursue United States
citizenship, as
determined by the
Secretary of Homeland
Security. The
Commissioner of Social
Security shall develop
criteria as needed, in
consultation with the
Secretary of Homeland
Security, for
consideration of such
declarations.
(bb) Exception for
children.--A qualified
alien or victim of
trafficking described
in subclause (I) or
(II) who has not
attained age 18 shall
not be required to
furnish to the
Commissioner of Social
Security a declaration
described in item (aa)
as a condition of being
eligible for the
specified Federal
program described in
paragraph (3)(A) for an
additional 2-year
period in accordance
with this clause.
(V) Payment of benefits to
aliens whose benefits ceased in
prior fiscal years.--Benefits
paid to a qualified alien or
victim described in subclause
(II) shall be paid
prospectively over the duration
of the qualified alien's or
victim's renewed eligibility.
(ii) Special rule in case of pending
or approved naturalization
application.--With respect to
eligibility for benefits for the
specified program described in
paragraph (3)(A), paragraph (1) shall
not apply during fiscal years 2009
through 2011 to an alien described in
one of clauses (i) through (v) of
subparagraph (A) or a victim of
trafficking in persons (as defined in
section 107(b)(1)(C) of division A of
the Victims of Trafficking and Violence
Protection Act of 2000 (Public Law 106-
386) or as granted status under section
101(a)(15)(T)(ii) of the Immigration
and Nationality Act), if such alien or
victim (including any such alien or
victim rendered ineligible for the
specified Federal program described in
paragraph (3)(A) during the period
beginning on August 22, 1996, and
ending on September 30, 2008, solely by
reason of the termination of the 7-year
period described in subparagraph (A))
has filed an application for
naturalization that is pending before
the Secretary of Homeland Security or a
United States district court based on
section 336(b) of the Immigration and
Nationality Act, or has been approved
for naturalization but not yet sworn in
as a United States citizen, and the
Commissioner of Social Security has
verified, through procedures
established in consultation with the
Secretary of Homeland Security, that
such application is pending or has been
approved.
(3) Specified federal program defined.--For purposes
of this title, the term ``specified Federal program''
means any of the following:
(A) SSI.--The supplemental security income
program under title XVI of the Social Security
Act, including supplementary payments pursuant
to an agreement for Federal administration
under section 1616(a) of the Social Security
Act and payments pursuant to an agreement
entered into under section 212(b) of Public Law
93-66.
(B) Food stamps.--The food stamp program as
defined in section 3(l) of the Food Stamp Act
of 1977.
(b) Limited Eligibility for Designated Federal
Programs.--
(1) In general.--Notwithstanding any other provision
of law and except as provided in section 403 and
paragraph (2), a State is authorized to determine the
eligibility of an alien who is a qualified alien (as
defined in section 431) for any designated Federal
program (as defined in paragraph (3)).
(2) Exceptions.--Qualified aliens under this
paragraph shall be eligible for any designated Federal
program.
(A) Time-limited exception for refugees and
asylees.--
(i) Medicaid.--With respect to the
designated Federal program described in
paragraph (3)(C), paragraph (1) shall
not apply to an alien until 7 years
after the date--
(I) an alien is admitted to
the United States as a refugee
under section 207 of the
Immigration and Nationality
Act;
(II) an alien is granted
asylum under section 208 of
such Act;
(III) an alien's deportation
is withheld under section
243(h) of such Act (as in
effect immediately before the
effective date of section 307
of division C of Public Law
104-208) or section 241(b)(3)
of such Act (as amended by
section 305(a) of division C of
Public Law 104-208);
(IV) an alien is granted
status as a Cuban and Haitian
entrant (as defined in section
501(e) of the Refugee Education
Assistance Act of 1980); or
(V) an alien admitted to the United
States as an Amerasian immigrant as
described in subsection (a)(2)(A)(i)(V)
until 5 years after the date of such
alien's entry into the United States.
(ii) Other designated federal
programs.--With respect to the
designated Federal programs under
paragraph (3) (other than subparagraph
(C)), paragraph (1) shall not apply to
an alien until 5 years after the date--
(I) an alien is admitted to
the United States as a refugee
under section 207 of the
Immigration and Nationality
Act;
(II) an alien is granted
asylum under section 208 of
such Act;
(III) an alien's deportation
is withheld under section
243(h) of such Act;
(IV) an alien is granted
status as a Cuban and Haitian
entrant (as defined in section
501(e) of the Refugee Education
Assistance Act of 1980); or
(V) an alien admitted to the United
States as an Amerasian immigrant as
described in subsection (a)(2)(A)(i)(V)
until 5 years after the date of such
alien's entry into the United States.
(B) Certain permanent resident aliens.--An
alien who--
(i) is lawfully admitted to the
United States for permanent residence
under the Immigration and Nationality
Act; and
(ii)(I) has worked 40 qualifying
quarters of coverage as defined under
title II of the Social Security Act or
can be credited with such qualifying
quarters as provided under section 435,
and (II) in the case of any such
qualifying quarter creditable for any
period beginning after December 31,
1996, did not receive any Federal
means-tested public benefit (as
provided under section 403) during any
such period.
(C) Veteran and active duty exception.--An
alien who is lawfully residing in any State and
is--
(i) a veteran (as defined in section
101, 1101, or 1301, or as described in
section 107 of title 38, United States
Code) with a discharge characterized as
an honorable discharge and not on
account of alienage and who fulfills
the minimum active-duty service
requirements of section 5303A(d) of
title 38, United States Code,
(ii) on active duty (other than
active duty for
training) in the Armed Forces of the
United States, or
(iii) the spouse or unmarried
dependent child of an individual
described in clause (i) or (ii) or the
unremarried surviving spouse of an
individual described in clause (i) or
(ii) who is deceased if the marriage
fulfills the requirements of section
1304 of title 38, United States Code.
(D) Transition for those currently receiving
benefits.--An alien who on the date of the
enactment of this Act is lawfully residing in
any State and is receiving benefits under such
program on the date of the enactment of this
Act shall continue to be eligible to receive
such benefits until January 1, 1997.
(E) Medicaid exception for certain indians.--
With respect to eligibility for benefits for
the program defined in paragraph (3)(C)
(relating to the medicaid program), section
401(a) and paragraph (1) shall not apply to any
individual described in subsection (a)(2)(G).
(F) Medicaid exception for aliens receiving
ssi.--An alien who is receiving benefits under
the program defined in subsection (a)(3)(A)
(relating to the supplemental security income
program) shall be eligible for medical
assistance under a State plan under title XIX
of the Social Security Act (42 U.S.C. 1396 et
seq.) under the same terms and conditions that
apply to other recipients of benefits under the
program defined in such subsection.
(3) Designated federal program defined.--For purposes
of this title, the term ``designated Federal program''
means any of the following:
(A) Temporary assistance for needy
families.--The program of block grants to
States for temporary assistance for needy
families under part A of title IV of the Social
Security Act.
(B) Social services block grant.--The program
of block grants to States for social services
under title XX of the Social Security Act.
(C) Medicaid.--A State plan approved under
title XIX of the Social Security Act, other
than medical assistance described in section
401(b)(1)(A).
* * * * * * *
----------
SECTION 245A OF THE IMMIGRATION AND NATIONALITY ACT
ADJUSTMENT OF STATUS OF CERTAIN ENTRANTS BEFORE JANUARY 1, 1982, TO
THAT OF PERSON ADMITTED FOR LAWFUL RESIDENCE
Sec. 245A. (a) Temporary Resident Status.--The Attorney
General shall adjust the status of an alien to that of an alien
lawfully admitted for temporary residence if the alien meets
the following requirements:
(1) Timely application.--
(A) During application period.--Except as
provided in subparagraph (B), the alien must
apply for such adjustment during the 12-month
period beginning on a date (not later than 180
days after the date of enactment of this
section) designated by the Attorney General.
(B) Application within 30 days of show-cause
order.--An alien who, at any time during the
first 11 months of the 12-month period
described in subparagraph (A), is the subject
of an order to show cause issued under section
242 (as in effect before October 1, 1996), must
make application under this section not later
than the end of the 30-day period beginning
either on the first day of such 12-month period
or on the date of the issuance of such order,
whichever day is later.
(C) Information included in application.--
Each application under this subsection shall
contain such information as the Attorney
General may require, including information on
living relatives of the applicant with respect
to whom a petition for preference or other
status may be filed by the applicant at any
later date under section 204(a).
(2) Continuous unlawful residence since 1982.--
(A) In general.--The alien must establish
that he entered the United States before
January 1, 1982, and that he has resided
continuously in the United States in an
unlawful status since such date and through the
date the application is filed under this
subsection.
(B) Nonimmigrants.--In the case of an alien
who entered the United States as a nonimmigrant
before January 1, 1982, the alien must
establish that the alien's period of authorized
stay as a nonimmigrant expired before such date
through the passage of time or the alien's
unlawful status was known to the Government as
of such date.
(C) Exchange visitors.--If the alien was at
any time a nonimmigrant exchange alien (as
defined in section 101(a)(15)(J)), the alien
must establish that the alien was not subject
to the two-year foreign residence requirement
of section 212(e) or has fulfilled that
requirement or received a waiver thereof.
(3) Continuous physical presence since enactment.--
(A) In general.--The alien must establish
that the alien has been continuously physically
present in the United States since the date of
the enactment of this section.
(B) Treatment of brief, casual, and innocent
absences.--An alien shall not be considered to
have failed to maintained continuous physical
presence in the United States for purposes of
subparagraph (A) by virtue of brief, casual,
and innocent absences from the United States.
(C) Admissions.--Nothing in this section
shall be construed as authorizing an alien to
apply for admission to, or to be admitted to,
the United States in order to apply for
adjustment of status under this subsection.
(4) Admissible as immigrant.--The alien must
establish that he--
(A) is admissible to the United States as an
immigrant, except as otherwise provided under
subsection (d)(2),
(B) has not been convicted of any felony or
of three or more misdemeanors committed in the
United States,
(C) has not assisted in the persecution of
any person or persons on account of race,
religion, nationality, membership in a
particular social group, or political opinion,
and
(D) is registered or registering under the
Military Selective Service Act, if the alien is
required to be so registered under that Act.
For purposes of this subsection, an alien in the status
of a Cuban and Haitian entrant described in paragraph
(1) or (2)(A) of section 501(e) of Public Law 96-422
shall be considered to have entered the United States
and to be in an unlawful status in the United States.
(b) Subsequent Adjustment to Permanent Residence and Nature
of Temporary Resident Status.--
(1) Adjustment to permanent residence.--The Attorney
General shall adjust the status of any alien provided
lawful temporary resident status under subsection (a)
to that of an alien lawfully admitted for permanent
residence if the alien meets the following
requirements:
(A) Timely application after one year's
residence.--The alien must apply for such
adjustment during the 2-year period beginning
with the nineteenth month that begins after the
date the alien was granted such temporary
resident status.
(B) Continuous residence.--
(i) In general.--The alien must
establish that he has continuously
resided in the United States since the
date the alien was granted such
temporary resident status.
(ii) Treatment of certain absences.--
An alien shall not be considered to
have lost the continuous residence
referred to in clause (i) by reason of
an absence from the United States
permitted under paragraph (3)(A).
(C) Admissible as immigrant.--The alien must
establish that he--
(i) is admissible to the United
States as an immigrant, except as
otherwise provided under subsection
(d)(2), and
(ii) has not been convicted of any
felony or three or more misdemeanors
committed in the United States.
(D) Basic citizenship skills.--
(i) In general.--The alien must
demonstrate that he either--
(I) meets the requirements of
section 312(a) (relating to
minimal understanding of
ordinary English and a
knowledge and understanding of
the history and government of
the United States), or
(II) is satisfactorily
pursuing a course of study
(recognized by the Attorney
General) to achieve such an
understanding of English and
such a knowledge and
understanding of the history
and government of the United
States.
(ii) Exception for elderly or
developmentally disabled individuals.--
The Attorney General may, in his
discretion, waive all or part of the
requirements of clause (i) in the case
of an alien who is 65 years of age or
older or who is developmentally
disabled.
(iii) Relation to naturalization
examination.--In accordance with
regulations of the Attorney General, an
alien who has demonstrated under clause
(i)(I) that the alien meets the
requirements of section 312(a) may be
considered to have satisfied the
requirements of that section for
purposes of becoming naturalized as a
citizen of the United States under
title III.
(2) Termination of temporary residence.--The Attorney
General shall provide for termination of temporary
resident status granted an alien under subsection (a)--
(A) if it appears to the Attorney General
that the alien was in fact not eligible for
such status;
(B) if the alien commits an act that (i)
makes the alien inadmissible to the United
States as an immigrant, except as otherwise
provided under subsection (d)(2), or (ii) is
convicted of any felony or three or more
misdemeanors committed in the United States; or
(C) at the end of the 43rd month beginning
after the date the alien is granted such
status, unless the alien has filed an
application for adjustment of such status
pursuant to paragraph (1) and such application
has not been denied.
(3) Authorized travel and employment during temporary
residence.--During the period an alien is in lawful
temporary resident status granted under subsection
(a)--
(A) Authorization of travel abroad.--The
Attorney General shall, in accordance with
regulations, permit the alien to return to the
United States after such brief and casual trips
abroad as reflect an intention on the part of
the alien to adjust to lawful permanent
resident status under paragraph (1) and after
brief temporary trips abroad occasioned by a
family obligation involving an occurrence such
as the illness or death of a close relative or
other family need.
(B) Authorization of employment.--The
Attorney General shall grant the alien
authorization to engage in employment in the
United States and provide to that alien an
``employment authorized'' endorsement or other
appropriate work permit.
(c) Applications for Adjustment of Status.--
(1) To whom may be made.--The Attorney General shall
provide that applications for adjustment of status
under subsection (a) may be filed--
(A) with the Attorney General, or
(B) with a qualified designated entity, but
only if the applicant consents to the
forwarding of the application to the Attorney
General.
As used in this section, the term ``qualified
designated entity'' means an organization or person
designated under paragraph (2).
(2) Designation of qualified entities to receive
applications.--For purposes of assisting in the program
of legalization provided under this section, the
Attorney General--
(A) shall designate qualified voluntary
organizations and other qualified State, local,
and community organizations, and
(B) may designate such other persons as the
Attorney General determines are qualified and
have substantial experience, demonstrated
competence, and traditional long-term
involvement in the preparation and submittal of
applications for adjustment of status under
section 209 or 245, Public Law 89-732, or
Public Law 95-145.
(3) Treatment of applications by designated
entities.--Each qualified designated entity must agree
to forward to the Attorney General applications filed
with it in accordance with paragraph (1)(B) but not to
forward to the Attorney General applications filed with
it unless the applicant has consented to such
forwarding. No such entity may make a determination
required by this section to be made by the Attorney
General.
(4) Limitation on access to information.--Files and
records of qualified designated entities relating to an
alien's seeking assistance or information with respect
to filing an application under this section are
confidential and the Attorney General and the Service
shall not have access to such files or records relating
to an alien without the consent of the alien.
(5) Confidentiality of information.--
(A) In general.--Except as provided in this
paragraph, neither the Attorney General, nor
any other official or employee of the
Department of Justice, or bureau or agency
thereof, may--
(i) use the information furnished by
the applicant pursuant to an
application filed under this section
for any purpose other than to make a
determination on the application, for
enforcement of paragraph (6), or for
the preparation of reports to Congress
under section 404 of the Immigration
Reform and Control Act of 1986;
(ii) make any publication whereby the
information furnished by any particular
applicant can be identified; or
(iii) permit anyone other than the
sworn officers and employees of the
Department or bureau or agency or, with
respect to applications filed with a
designated entity, that designated
entity, to examine individual
applications.
(B) Required disclosures.--The Attorney
General shall provide the information furnished
under this section, and any other information
derived from such furnished information, to a
duly recognized law enforcement entity in
connection with a criminal investigation or
prosecution, when such information is requested
in writing by such entity, or to an official
coroner for purposes of affirmatively
identifying a deceased individual (whether or
not such individual is deceased as a result of
a crime).
(C) Authorized disclosures.--The Attorney
General may provide, in the Attorney General's
discretion, for the furnishing of information
furnished under this section in the same manner
and circumstances as census information may be
disclosed by the Secretary of Commerce under
section 8 of title 13, United States Code.
(D) Construction.--
(i) In general.--Nothing in this
paragraph shall be construed to limit
the use, or release, for immigration
enforcement purposes or law enforcement
purposes of information contained in
files or records of the Service
pertaining to an application filed
under this section, other than
information furnished by an applicant
pursuant to the application, or any
other information derived from the
application, that is not available from
any other source.
(ii) Criminal convictions.--
Information concerning whether the
applicant has at any time been
convicted of a crime may be used or
released for immigration enforcement or
law enforcement purposes.
(E) Crime.--Whoever knowingly uses,
publishes, or permits information to be
examined in violation of this paragraph shall
be fined not more than $10,000.
(6) Penalties for false statements in applications.--
Whoever files an application for adjustment of status
under this section and knowingly and willfully
falsifies, misrepresents, conceals, or covers up a
material fact or makes any false, fictitious, or
fraudulent statements or representations, or makes or
uses any false writing or document knowing the same to
contain any false, fictitious, or fraudulent statement
or entry, shall be fined in accordance with title 18,
United States Code, or imprisoned not more than five
years, or both.
(7) Application fees.--
(A) Fee Schedule.--The Attorney General shall
provide for a schedule of fees to be charged
for the filing of applications for adjustment
under subsection (a) or (b)(1). The Attorney
General shall provide for an additional fee for
filing an application for adjustment under
subsection (b)(1) after the end of the first
year of the 2-year period described in
subsection (b)(1)(A).
(B) Use of fees.--The Attorney General shall
deposit payments received under this paragraph
in a separate account and amounts in such
account shall be available, without fiscal year
limitation, to cover administrative and other
expenses incurred in connection with the review
of applications filed under this section.
(C) Immigration-related unfair employment
practices.--Not to exceed $3,000,000 of the
unobligated balances remaining in the account
established in subparagraph (B) shall be
available in fiscal year 1992 and each fiscal
year thereafter for grants, contracts, and
cooperative agreements to community-based
organizations for outreach programs, to be
administered by the Office of Special Counsel
for Immigration-Related Unfair Employment
Practices: Provided, That such amounts shall be
in addition to any funds appropriated to the
Office of Special Counsel for such purposes:
Provided further, That none of the funds made
available by this section shall be used by the
Office of Special Counsel to establish regional
offices.
(d) Waiver of Numerical Limitations and Certain Grounds for
Exclusion.--
Numerical limitations do not apply.--The numerical
limitations of sections 201 and 202 shall not apply to
the adjustment of aliens to lawful permanent resident
status under this section.
(2) Waiver of grounds for exclusion.--In the
determination of an alien's admissibility under
subsections (a)(4)(A), (b)(1)(C)(i), and (b)(2)(B)--
(A) Grounds of exclusion not applicable.--The
provisions of paragraphs (5) and (7)(A) of
section 212(a) shall not apply.
(B) Waiver of other grounds.--
(i) In general.--Except as provided
in clause (ii), the Attorney General
may waive any other provision of
section 212(a) in the case of
individual aliens for humanitarian
purposes, to assure family unity, or
when it is otherwise in the public
interest.
(ii) Grounds that may not be
waived.--The following provisions of
section 212(a) may not be waived by the
Attorney General under clause (i):
(I) Paragraphs (2)(A) and
(2)(B) (relating to criminals).
(II) Paragraph (2)(C)
(relating to drug offenses),
except for so much of such
paragraph as relates to a
single offense of simple
possession of 30 grams or less
of marihuana.
(III) Paragraph (3) (relating
to security and related
grounds).
(IV) Paragraph (4) (relating
to aliens likely to become
public charges) insofar as it
relates to an application for
adjustment to permanent
residence.
Subclause (IV) (prohibiting the waiver
of section 212(a)(4)) shall not apply
to an alien who is or was an aged,
blind, or disabled individual (as
defined in section 1614(a)(1) of the
Social Security Act).
(iii) Special rule for determination
of public charge.--An alien is not
ineligible for adjustment of status
under this section due to being
inadmissible under section 212(a)(4) if
the alien demonstrates a history of
employment in the United States
evidencing self-support without receipt
of public cash assistance.
(C) Medical examination.--The alien shall be
required, at the alien's expense, to undergo
such a medical examination (including a
determination of immunization status) as is
appropriate and conforms to generally accepted
professional standards of medical practice.
(e) Temporary Stay of Deportation and Work Authorization for
Certain Applicants.--
(1) Before application period.--The Attorney General
shall provide that in the case of an alien who is
apprehended before the beginning of the application
period described in subsection (a)(1)(A) and who can
establish a prima facie case of eligibility to have his
status adjusted under subsection (a) (but for the fact
that he may not apply for such adjustment until the
beginning of such period), until the alien has had the
opportunity during the first 30 days of the application
period to complete the filing of an application for
adjustment, the alien--
(A) may not be deported, and
(B) shall be granted authorization to engage
in employment in the United States and be
provided an ``employment authorized''
endorsement or other appropriate work permit.
(2) During application period.--The Attorney General
shall provide that in the case of an alien who presents
a prima facie application for adjustment of status
under subsection (a) during the application period, and
until a final determination on the application has been
made in accordance with this section, the alien--
(A) may not be deported, and
(B) shall be granted authorization to engage
in employment in the United States and be
provided an ``employment authorized''
endorsement or other appropriate work permit.
(f) Administrative and Judicial Review.--
(1) Administrative and judicial review.--There shall
be no administrative or judicial review of a
determination respecting an application for adjustment
of status under this section except in accordance with
this subsection.
(2) No review for late filings.--No denial of
adjustment of status under this section based on a late
filing of an application for such adjustment may be
reviewed by a court of the United States or of any
State or reviewed in any administrative proceeding of
the United States Government.
(3) Administrative review.--
(A) Single level of administrative appellate
review.--The Attorney General shall establish
an appellate authority to provide for a single
level of administrative appellate review of a
determination described in paragraph (1).
(B) Standard for review.--Such administrative
appellate review shall be based solely upon the
administrative record established at the time
of the determination on the application and
upon such additional or newly discovered
evidence as may not have been available at the
time of the determination.
(4) Judicial review.--
(A) Limitation to review of deportation.--
There shall be judicial review of such a denial
only in the judicial review of an order of
deportation under section 106 (as in effect
before October 1, 1996).
(B) Standard for judicial review.--Such
judicial review shall be based solely upon the
administrative record established at the time
of the review by the appellate authority and
the findings of fact and determinations
contained in such record shall be conclusive
unless the applicant can establish abuse of
discretion or that the findings are directly
contrary to clear and convincing facts
contained in the record considered as a whole.
(C) Jurisdiction of courts.--Notwithstanding
any other provision of law, no court shall have
jurisdiction of any cause of action or claim by
or on behalf of any person asserting an
interest under this section unless such person
in fact filed an application under this section
within the period specified by subsection
(a)(1), or attempted to file a complete
application and application fee with an
authorized legalization officer of the Service
but had the application and fee refused by that
officer.
(g) Implementation of Section.--
(1) Regulations.--The Attorney General, after
consultation with the Committees on the Judiciary of
the House of Representatives and of the Senate, shall
prescribe--
(A) regulations establishing a definition of
the term ``resided continuously'', as used in
this section, and the evidence needed to
establish that an alien has resided
continuously in the United States for purposes
of this section, and
(B) such other regulations as may be
necessary to carry out this section.
(2) Considerations.--In prescribing regulations
described in paragraph (1)(A)--
(A) Periods of continuous residence.--The
Attorney General shall specify individual
periods, and aggregate periods, of absence from
the United States which will be considered to
break a period of continuous residence in the
United States and shall take into account
absences due merely to brief and casual trips
abroad.
(B) Absences caused by deportation or
advanced parole.--The Attorney General shall
provide that--
(i) an alien shall not be considered
to have resided continuously in the
United States, if, during any period
for which continuous residence is
required, the alien was outside the
United States as a result of a
departure under an order of
deportation, and
(ii) any period of time during which
an alien is outside the United States
pursuant to the advance parole
procedures of the Service shall not be
considered as part of the period of
time during which an alien is outside
the United States for purposes of this
section.
(C) Waivers of certain absences.--The
Attorney General may provide for a waiver, in
the discretion of the Attorney General, of the
periods specified under subparagraph (A) in the
case of an absence from the United States due
merely to a brief temporary trip abroad
required by emergency or extenuating
circumstances outside the control of the alien.
(D) Use of certain documentation.--The
Attorney General shall require that--
(i) continuous residence and physical
presence in the United States must be
established through documents, together
with independent corroboration of the
information contained in such
documents, and
(ii) the documents provided under
clause (i) be employment-related if
employment-related documents with
respect to the alien are available to
the applicant.
(3) Interim final regulations.--Regulations
prescribed under this section may be prescribed to take
effect on an interim final basis if the Attorney
General determines that this is necessary in order to
implement this section in a timely manner.
(h) Temporary Disqualification of Newly Legalized Aliens from
Receiving Certain Public Welfare Assistance.--
(1) In general.--During the five-year period
beginning on the date an alien was granted lawful
temporary resident status under subsection (a), and
notwithstanding any other provision of law--
(A) except as provided in paragraphs (2) and
(3), the alien is not eligible for--
(i) any program of financial
assistance furnished under Federal law
(whether through grant, loan,
guarantee, or otherwise) on the basis
of financial need, as such programs are
identified by the Attorney General in
consultation with other appropriate
heads of the various departments and
agencies of Government (but in any
event including the State program of
assistance under part A of title IV of
the Social Security Act),
(ii) medical assistance under a State
plan approved under title XIX of the
Social Security Act, and
(iii) assistance under the Food and
Nutrition Act of 2008; and
(B) a State or political subdivision therein
may, to the extent consistent with subparagraph
(A) and paragraphs (2) and (3), provide that
the alien is not eligible for the programs of
financial assistance or for medical assistance
described in subparagraph (A)(ii) furnished
under the law of that State or political
subdivision.
Unless otherwise specifically provided by this section
or other law, an alien in temporary lawful residence
status granted under subsection (a) shall not be
considered (for purposes of any law of a State or
political subdivision providing for a program of
financial assistance) to be permanently residing in the
United States under color of law.
(2) Exceptions.--Paragraph (1) shall not apply--
(A) to a Cuban and Haitian entrant (as
defined in paragraph (1) or (2)(A) of section
501(e) of Public Law 96-422, as in effect on
April 1, 1983), or
(B) in the case of assistance (other than
assistance under a State program funded under
part A of title IV of the Social Security Act)
which is furnished to an alien who is an aged,
blind, or disabled individual (as defined in
section 1614(a)(1) of the Social Security Act).
(3) Restricted medicaid benefits.--
(A) Clarification of entitlement.--Subject to
the restrictions under subparagraph (B), for
the purpose of providing aliens with
eligibility to receive medical assistance--
(i) paragraph (1) shall not apply,
(ii) aliens who would be eligible for
medical assistance but for the
provisions of paragraph (1) shall be
deemed, for purposes of title XIX of
the Social Security Act, to be so
eligible, and
(iii) aliens lawfully admitted for
temporary residence under this section,
such status not having changed, shall
be considered to be permanently
residing in the United States under
color of law.
(B) Restriction of benefits.--
(i) Limitation to emergency services
and services for pregnant women.--
Notwithstanding any provision of title
XIX of the Social Security Act
(including subparagraphs (B) and (C) of
section 1902(a)(10) of such Act),
aliens who, but for subparagraph (A),
would be ineligible for medical
assistance under paragraph (1), are
only eligible for such assistance with
respect to--
(I) emergency services (as
defined for purposes of section
1916(a)(2)(D) of the Social
Security Act), and
(II) services described in
section 1916(a)(2)(B) of such
Act (relating to service for
pregnant women).
(ii) No restriction for exempt aliens
and children.--The restrictions of
clause (i) shall not apply to aliens
who are described in paragraph (2) or
who are under 18 years of age.
(C) Definition of medical assistance.--In
this paragraph, the term ``medical assistance''
refers to medical assistance under a State plan
approved under title XIX of the Social Security
Act.
(4) Treatment of certain programs.--Assistance
furnished under any of the following provisions of law
shall not be construed to be financial assistance
described in paragraph (1)(A)(i):
(A) The Richard B. Russell National School
Lunch Act.
(B) The Child Nutrition Act of 1966.
(C) The The Carl D. Perkins Career and
Technical Education Act of 2006.
(D) Title I of the Elementary and Secondary
Education Act of 1965.
(E) The Headstart-Follow Through Act.
(F) Title I of the Workforce Innovation and
Opportunity Act.
(G) Title IV of the Higher Education Act of
1965.
(H) The Public Health Service Act.
(I) Titles V, XVI, and XX, and parts B, D,
and E of title IV, of the Social Security Act
(and titles I, X, XIV, and XVI of such Act as
in effect without regard to the amendment made
by section 301 of the Social Security
Amendments of 1972).
(5) Adjustment not affecting fascell-stone
benefits.--For the purpose of section 501 of the
Refugee Education Assistance Act of 1980 (Public Law
96-122), assistance shall be continued under such
section with respect to an alien without regard to the
alien's adjustment of status under this section.
(i) Dissemination of Information on Legalization Program.--
Beginning not later than the date designated by the Attorney
General under subsection (a)(1)(A), the Attorney General, in
cooperation with qualified designated entities, shall broadly
disseminate information respecting the benefits which aliens
may receive under this section and the requirements to obtain
such benefits.
----------
RICHARD B. RUSSELL NATIONAL SCHOOL LUNCH ACT
* * * * * * *
SEC. 17. CHILD AND ADULT CARE FOOD PROGRAM.
(a) Program Purpose, Grant Authority and Institution
Eligibility.--
(1) In general.--
(A) Program purpose.--
(i) Findings.--Congress finds that--
(I) eating habits and other
wellness-related behavior
habits are established early in
life; and
(II) good nutrition and
wellness are important
contributors to the overall
health of young children and
essential to cognitive
development.
(ii) Purpose.--The purpose of the
program authorized by this section is
to provide aid to child and adult care
institutions and family or group day
care homes for the provision of
nutritious foods that contribute to the
wellness, healthy growth, and
development of young children, and the
health and wellness of older adults and
chronically impaired disabled persons.
(B) Grant authority.--The Secretary may carry
out a program to assist States through grants-
in-aid and other means to initiate and maintain
nonprofit food service programs for children in
institutions providing child care.
(2) Definition of institution.--In this section, the
term ``institution'' means--
(A) any public or private nonprofit
organization providing nonresidential child
care or day care outside school hours for
school children, including any child care
center, settlement house, recreational center,
Head Start center, and institution providing
child care facilities for children with
disabilities;
(B) any other private organization providing
nonresidential child care or day care outside
school hours for school children, if--
(i) at least 25 percent of the
children served by the organization
meet the income eligibility criteria
established under section 9(b) for free
or reduced price meals; or
(ii) the organization receives
compensation from amounts granted to
the States under title XX of the Social
Security Act (42 U.S.C. 1397 et seq.)
(but only if the organization receives
compensation under that title for at
least 25 percent of its enrolled
children or 25 percent of its licensed
capacity, whichever is less);
(C) any public or private nonprofit
organization acting as a sponsoring
organization for one or more of the
organizations described in subparagraph (A) or
(B) or for an adult day care center (as defined
in subsection (o)(2));
(D) any other private organization acting as
a sponsoring organization for, and that is part
of the same legal entity as, one or more
organizations that are--
(i) described in subparagraph (B); or
(ii) proprietary title XIX or title
XX centers (as defined in subsection
(o)(2));
(E) any public or private nonprofit
organization acting as a sponsoring
organization for one or more family or group
day care homes; and
(F) any emergency shelter (as defined in
subsection (t)).
(3) Age limit.--Except as provided in subsection (r),
reimbursement may be provided under this section only
for meals or supplements served to children not over 12
years of age (except that such age limitation shall not
be applicable for children of migrant workers if 15
years of age or less or for children with
disabilities).
(4) Additional guidelines.--The Secretary may
establish separate guidelines for institutions that
provide care to school children outside of school
hours.
(5) Licensing.--In order to be eligible, an
institution (except a school or family or group day
care home sponsoring organization) or family or group
day care home shall--
(A)(i) be licensed, or otherwise have
approval, by the appropriate Federal, State, or
local licensing authority; or
(ii) be in compliance with appropriate
procedures for renewing participation in the
program, as prescribed by the Secretary, and
not be the subject of information possessed by
the State indicating that the license of the
institution or home will not be renewed;
(B) if Federal, State, or local licensing or
approval is not available--
(i) meet any alternate approval
standards established by the
appropriate State or local governmental
agency; or
(ii) meet any alternate approval
standards established by the Secretary
after consultation with the Secretary
of Health and Human Services; or
(C) if the institution provides care to
school children outside of school hours and
Federal, State, or local licensing or approval
is not required for the institution, meet State
or local health and safety standards.
(6) Eligibility criteria.--No institution shall be
eligible to participate in the program unless it
satisfies the following criteria:
(A) accepts final administrative and
financial responsibility for management of an
effective food service;
(B) has not been seriously deficient in its
operation of the child and adult care food
program, or any other program under this Act or
the Child Nutrition Act of 1966, or has not
been determined to be ineligible to participate
in any other publicly funded program by reason
of violation of the requirements of the
program, for a period of time specified by the
Secretary;
(C)(i) will provide adequate supervisory and
operational personnel for overall monitoring
and management of the child care food program;
and
(ii) in the case of a sponsoring
organization, the organization shall employ an
appropriate number of monitoring personnel
based on the number and characteristics of
child care centers and family or group day care
homes sponsored by the organization, as
approved by the State (in accordance with
regulations promulgated by the Secretary), to
ensure effective oversight of the operations of
the child care centers and family or group day
care homes;
(D) in the case of a family or group day care
home sponsoring organization that employs more
than one employee, the organization does not
base payments to an employee of the
organization on the number of family or group
day care homes recruited;
(E) in the case of a sponsoring organization,
the organization has in effect a policy that
restricts other employment by employees that
interferes with the responsibilities and duties
of the employees of the organization with
respect to the program; and
(F) in the case of a sponsoring organization
that applies for initial participation in the
program on or after the date of the enactment
of this subparagraph and that operates in a
State that requires such institutions to be
bonded under State law, regulation, or policy,
the institution is bonded in accordance with
such law, regulation, or policy.
(b) For the fiscal year ending September 30, 1979, and for
each subsequent fiscal year, the Secretary shall provide cash
assistance to States for meals as provided in subsection (f) of
this section, except that, in any fiscal year, the aggregate
amount of assistance provided to a State by the Secretary under
this section shall not exceed the sum of (1) the Federal funds
provided by the State to participating institutions within the
State for that fiscal year and (2) any funds used by the State
under section 10 of the Child Nutrition Act of 1966.
(c)(1) For purposes of this section, except as provided in
subsection (f)(3), the national average payment rate for free
lunches and suppers, the national average payment rate for
reduced price lunches and suppers, and the national average
payment rate for paid lunches and suppers shall be the same as
the national average payment rates for free lunches, reduced
price lunches, and paid lunches, respectively, under sections 4
and 11 of this Act as appropriate (as adjusted pursuant to
section 11(a) of this Act).
(2) For purposes of this section, except as provided in
subsection (f)(3), the national average payment rate for free
breakfasts, the national average payment rate for reduced price
breakfasts, and the national average payment rate for paid
breakfasts shall be the same as the national average payment
rates for free breakfasts, reduced price breakfasts, and paid
breakfasts, respectively, under section 4(b) of the Child
Nutrition Act of 1966 (as adjusted pursuant to section 11(a) of
this Act).
(3) For purposes of this section, except as provided in
subsection (f)(3), the national average payment rate for free
supplements shall be 30 cents, the national average payment
rate for reduced price supplements shall be one-half the rate
for free supplements, and the national average payment rate for
paid supplements shall be 2.75 cents (as adjusted pursuant to
section 11(a) of this Act).
(4) Determinations with regard to eligibility for free and
reduced price meals and supplements shall be made in accordance
with the income eligibility guidelines for free lunches and
reduced price lunches, respectively, under section 9 of this
Act.
(5) A child shall be considered automatically eligible for
benefits under this section without further application or
eligibility determination, if the child is enrolled as a
participant in a Head Start program authorized under the Head
Start Act (42 U.S.C. 9831 et seq.), on the basis of a
determination that the child meets the eligibility criteria
prescribed under section 645(a)(1)(B) of the Head Start Act (42
U.S.C. 9840(a)(1)(B)).
(6) A child who has not yet entered kindergarten shall be
considered automatically eligible for benefits under this
section without further application or eligibility
determination if the child is enrolled as a participant in the
Even Start program under part B of chapter 1 of title I of the
Elementary and Secondary Education Act of 1965 (20 U.S.C. 2741
et seq.).
(d) Institution Approval and Applications.--
(1) Institution approval.--
(A) Administrative capability.--Subject to
subparagraph (B) and except as provided in
subparagraph (C), the State agency shall
approve an institution that meets the
requirements of this section for participation
in the child and adult care food program if the
State agency determines that the institution--
(i) is financially viable;
(ii) is administratively capable of
operating the program (including
whether the sponsoring organization has
business experience and management
plans appropriate to operate the
program) described in the application
of the institution; and
(iii) has internal controls in effect
to ensure program accountability.
(B) Approval of private institutions.--
(i) In general.--In addition to the
requirements established by
subparagraph (A) and subject to clause
(ii), the State agency shall approve a
private institution that meets the
requirements of this section for
participation in the child and adult
care food program only if--
(I) the State agency conducts
a satisfactory visit to the
institution before approving
the participation of the
institution in the program; and
(II) the institution--
(aa) has tax exempt
status under the
Internal Revenue Code
of 1986;
(bb) is operating a
Federal program
requiring nonprofit
status to participate
in the program; or
(cc) is described in
subsection (a)(2)(B).
(ii) Exception for family or group
day care homes.--Clause (i) shall not
apply to a family or group day care
home.
(C) Exception for certain sponsoring
organizations.--
(i) In general.--The State agency may
approve an eligible institution acting
as a sponsoring organization for one or
more family or group day care homes or
centers that, at the time of
application, is not participating in
the child and adult care food program
only if the State agency determines
that--
(I) the institution meets the
requirements established by
subparagraphs (A) and (B); and
(II) the participation of the
institution will help to ensure
the delivery of benefits to
otherwise unserved family or
group day care homes or centers
or to unserved children in an
area.
(ii) Criteria for selection.--The
State agency shall establish criteria
for approving an eligible institution
acting as a sponsoring organization for
one or more family or group day care
homes or centers that, at the time of
application, is not participating in
the child and adult care food program
for the purpose of determining if the
participation of the institution will
help ensure the delivery of benefits to
otherwise unserved family or group day
care homes or centers or to unserved
children in an area.
(D) Notification to applicants.--Not later
than 30 days after the date on which an
applicant institution files a completed
application with the State agency, the State
agency shall notify the applicant institution
whether the institution has been approved or
disapproved to participate in the child and
adult care food program.
(E) Permanent operating agreements.--
(i) In general.--Subject to clauses
(ii) and (iii), to participate in the
child and adult care food program, an
institution that meets the conditions
of eligibility described in this
subsection shall be required to enter
into a permanent agreement with the
applicable State agency.
(ii) Amendments.--A permanent
agreement described in clause (i) may
be amended as necessary to ensure that
the institution is in compliance with
all requirements established in this
section or by the Secretary.
(iii) Termination.--A permanent
agreement described in clause (i)--
(I) may be terminated for
convenience by the institution
or State agency that is a party
to the permanent agreement; and
(II) shall be terminated--
(aa) for cause by the
applicable State agency
in accordance with
paragraph (5); or
(bb) on termination
of participation of the
institution in the
child and adult care
food program.
(2) Program applications.--
(A) In general.--The Secretary shall develop
a policy under which each institution providing
child care that participates in the program
under this section shall--
(i) submit to the State agency an
initial application to participate in
the program that meets all requirements
established by the Secretary by
regulation;
(ii) annually confirm to the State
agency that the institution, and any
facilities of the institution in which
the program is operated by a sponsoring
organization, is in compliance with
subsection (a)(5); and
(iii) annually submit to the State
agency any additional information
necessary to confirm that the
institution is in compliance with all
other requirements to participate in
the program, as established in this Act
and by the Secretary by regulation.
(B) Required reviews of sponsored
facilities.--
(i) In general.--The Secretary shall
develop a policy under which each
sponsoring organization participating
in the program under this section shall
conduct--
(I) periodic unannounced site
visits at not less than 3-year
intervals to sponsored child
and adult care centers and
family or group day care homes
to identify and prevent
management deficiencies and
fraud and abuse under the
program; and
(II) at least 1 scheduled
site visit each year to
sponsored child and adult care
centers and family or group day
care homes to identify and
prevent management deficiencies
and fraud and abuse under the
program and to improve program
operations.
(ii) Varied timing.--Sponsoring
organizations shall vary the timing of
unannounced reviews under clause (i)(I)
in a manner that makes the reviews
unpredictable to sponsored facilities.
(C) Required reviews of institutions.--The
Secretary shall develop a policy under which
each State agency shall conduct--
(i) at least 1 scheduled site visit
at not less than 3-year intervals to
each institution under the State agency
participating in the program under this
section--
(I) to identify and prevent
management deficiencies and
fraud and abuse under the
program; and
(II) to improve program
operations; and
(ii) more frequent reviews of any
institution that--
(I) sponsors a significant
share of the facilities
participating in the program;
(II) conducts activities
other than the program
authorized under this section;
(III) has serious management
problems, as identified in a
prior review, or is at risk of
having serious management
problems; or
(IV) meets such other
criteria as are defined by the
Secretary.
(D) Detection and deterrence of erroneous
payments and false claims.--
(i) In general.--The Secretary may
develop a policy to detect and deter,
and recover erroneous payments to, and
false claims submitted by,
institutions, sponsored child and adult
care centers, and family or group day
care homes participating in the program
under this section.
(ii) Block claims.--
(I) Definition of block
claim.--In this clause, the
term ``block claim'' has the
meaning given the term in
section 226.2 of title 7, Code
of Federal Regulations (or
successor regulations).
(II) Program edit checks.--
The Secretary may not require
any State agency, sponsoring
organization, or other
institution to perform edit
checks or on-site reviews
relating to the detection of
block claims by any child care
facility.
(III) Allowance.--
Notwithstanding subclause (II),
the Secretary may require any
State agency, sponsoring
organization, or other
institution to collect, store,
and transmit to the appropriate
entity information necessary to
develop any other policy
developed under clause (i).
(3) Program information.--
(A) In general.--On enrollment of a child in
a sponsored child care center or family or
group day care home participating in the
program, the center or home (or its sponsoring
organization) shall provide to the child's
parents or guardians--
(i) information that describes the
program and its benefits; and
(ii) the name and telephone number of
the sponsoring organization of the
center or home and the State agency
involved in the operation of the
program.
(B) Form.--The information described in
subparagraph (A) shall be in a form and, to the
maximum extent practicable, language easily
understandable by the child's parents or
guardians.
(4) Allowable administrative expenses for sponsoring
organizations.--In consultation with State agencies and
sponsoring organizations, the Secretary shall develop,
and provide for the dissemination to State agencies and
sponsoring organizations of, a list of allowable
reimbursable administrative expenses for sponsoring
organizations under the program.
(5) Termination or suspension of participating
organizations.--
(A) In general.--The Secretary shall
establish procedures for the termination of
participation by institutions and family or
group day care homes under the program.
(B) Standards.--Procedures established
pursuant to subparagraph (A) shall include
standards for terminating the participation of
an institution or family or group day care home
that--
(i) engages in unlawful practices,
falsifies information provided to the
State agency, or conceals a criminal
background; or
(ii) substantially fails to fulfill
the terms of its agreement with the
State agency.
(C) Corrective action.--Procedures
established pursuant to subparagraph (A)--
(i) shall require an entity described
in subparagraph (B) to undertake
corrective action; and
(ii) may require the immediate
suspension of operation of the program
by an entity described in subparagraph
(B), without the opportunity for
corrective action, if the State agency
determines that there is imminent
threat to the health or safety of a
participant at the entity or the entity
engages in any activity that poses a
threat to public health or safety.
(D) Hearing.--
(i) In general.--Except as provided
in clause (ii), an institution or
family or group day care home shall be
provided a fair hearing in accordance
with subsection (e)(1) prior to any
determination to terminate
participation by the institution or
family or group day care home under the
program.
(ii) Exception for false or
fraudulent claims.--
(I) In general.--If a State
agency determines that an
institution has knowingly
submitted a false or fraudulent
claim for reimbursement, the
State agency may suspend the
participation of the
institution in the program in
accordance with this clause.
(II) Requirement for
review.--Prior to any
determination to suspend
participation of an institution
under subclause (I), the State
agency shall provide for an
independent review of the
proposed suspension in
accordance with subclause
(III).
(III) Review procedure.--The
review shall--
(aa) be conducted by
an independent and
impartial official
other than, and not
accountable to, any
person involved in the
determination to
suspend the
institution;
(bb) provide the
State agency and the
institution the right
to submit written
documentation relating
to the suspension,
including State agency
documentation of the
alleged false or
fraudulent claim for
reimbursement and the
response of the
institution to the
documentation;
(cc) require the
reviewing official to
determine, based on the
review, whether the
State agency has
established, based on a
preponderance of the
evidence, that the
institution has
knowingly submitted a
false or fraudulent
claim for
reimbursement;
(dd) require the
suspension to be in
effect for not more
than 120 calendar days
after the institution
has received
notification of a
determination of
suspension in
accordance with this
clause; and
(ee) require the
State agency during the
suspension to ensure
that payments continue
to be made to sponsored
centers and family and
group day care homes
meeting the
requirements of the
program.
(IV) Hearing.--A State agency
shall provide an institution
that has been suspended from
participation in the program
under this clause an
opportunity for a fair hearing
on the suspension conducted in
accordance with subsection
(e)(1).
(E) List of disqualified institutions and
individuals.--
(i) In general.--The Secretary shall
maintain a list of institutions,
sponsored family or group day care
homes, and individuals that have been
terminated or otherwise disqualified
from participation in the program.
(ii) Availability.--The Secretary
shall make the list available to State
agencies for use in approving or
renewing applications by institutions,
sponsored family or group day care
homes, and individuals for
participation in the program.
(e) Hearings.--
(1) In general.--Except as provided in paragraph (4),
each State agency shall provide, in accordance with
regulations promulgated by the Secretary, an
opportunity for a fair hearing and a prompt
determination to any institution aggrieved by any
action of the State agency that affects--
(A) the participation of the institution in
the program authorized by this section; or
(B) the claim of the institution for
reimbursement under this section.
(2) Reimbursement.--In accordance with paragraph (3),
a State agency that fails to meet timeframes for
providing an opportunity for a fair hearing and a
prompt determination to any institution under paragraph
(1) in accordance with regulations promulgated by the
Secretary, shall pay, from non-Federal sources, all
valid claims for reimbursement to the institution and
the facilities of the institution during the period
beginning on the day after the end of any regulatory
deadline for providing the opportunity and making the
determination and ending on the date on which a hearing
determination is made.
(3) Notice to state agency.--The Secretary shall
provide written notice to a State agency at least 30
days prior to imposing any liability for reimbursement
under paragraph (2).
(4) Federal audit determination.--A State is not
required to provide a hearing to an institution
concerning a State action taken on the basis of a
Federal audit determination.
(5) Secretarial hearing.--If a State does not provide
a hearing to an institution concerning a State action
taken on the basis of a Federal audit determination,
the Secretary, on request, shall afford a hearing to
the institution concerning the action.
(f) State Disbursements to Institutions.--
(1) In general.--
(A) Requirement.--Funds paid to any State
under this section shall be disbursed to
eligible institutions by the State under
agreements approved by the Secretary.
Disbursements to any institution shall be made
only for the purpose of assisting in providing
meals to children attending institutions, or in
family or group day care homes. Disbursement to
any institution shall not be dependent upon the
collection of moneys from participating
children. All valid claims from such
institutions shall be paid within forty-five
days of receipt by the State. The State shall
notify the institution within fifteen days of
receipt of a claim if the claim as submitted is
not valid because it is incomplete or
incorrect.
(B) Fraud or abuse.--
(i) In general.--The State may
recover funds disbursed under
subparagraph (A) to an institution if
the State determines that the
institution has engaged in fraud or
abuse with respect to the program or
has submitted an invalid claim for
reimbursement.
(ii) Payment.--Amounts recovered
under clause (i)--
(I) may be paid by the
institution to the State over a
period of one or more years;
and
(II) shall not be paid from
funds used to provide meals and
supplements.
(iii) Hearing.--An institution shall
be provided a fair hearing in
accordance with subsection (e)(1) prior
to any determination to recover funds
under this subparagraph.
(2)(A) Subject to subparagraph (B) of this paragraph, the
disbursement for any fiscal year to any State for disbursement
to institutions, other than family or group day care home
sponsoring organizations, for meals provided under this section
shall be equal to the sum of the products obtained by
multiplying the total number of each type of meal (breakfast,
lunch, or supper, or supplement) served in such institution in
that fiscal year by the applicable national average payment
rate for each such type of meal, as determined under subsection
(c).
(B) No reimbursement may be made to any institution under
this paragraph, or to family or group day care home sponsoring
organizations under paragraph (3) of this subsection, for more
than two meals and one supplement per day per child, or in the
case of an institution (but not in the case of a family or
group day care home sponsoring organization), 2 meals and 1
supplement per day per child, for children that are maintained
in a child care setting for eight or more hours per day.
(C) Limitation on administrative expenses for certain
sponsoring organizations.--
(i) In general.--Except as provided in clause
(ii), a sponsoring organization of a day care
center may reserve not more than 15 percent of
the funds provided under paragraph (1) for the
administrative expenses of the organization.
(ii) Waiver.--A State may waive the
requirement in clause (i) with respect to a
sponsoring organization if the organization
provides justification to the State that the
organization requires funds in excess of 15
percent of the funds provided under paragraph
(1) to pay the administrative expenses of the
organization.
(3) Reimbursement of family or group day care home
sponsoring organizations.--
(A) Reimbursement factor.--
(i) In general.--An institution that
participates in the program under this
section as a family or group day care
home sponsoring organization shall be
provided, for payment to a home
sponsored by the organization,
reimbursement factors in accordance
with this subparagraph for the cost of
obtaining and preparing food and
prescribed labor costs involved in
providing meals under this section.
(ii) Tier i family or group day care
homes.--
(I) Definition of tier i
family or group day care
home.--In this paragraph, the
term ``tier I family or group
day care home'' means--
(aa) a family or
group day care home
that is located in a
geographic area, as
defined by the
Secretary based on
census data, in which
at least 50 percent of
the children residing
in the area are members
of households whose
incomes meet the income
eligibility guidelines
for free or reduced
price meals under
section 9;
(bb) a family or
group day care home
that is located in an
area served by a school
enrolling students in
which at least 50
percent of the total
number of children
enrolled are certified
eligible to receive
free or reduced price
school meals under this
Act or the Child
Nutrition Act of 1966
(42 U.S.C. 1771 et
seq.); or
(cc) a family or
group day care home
that is operated by a
provider whose
household meets the
income eligibility
guidelines for free or
reduced price meals
under section 9 and
whose income is
verified by the
sponsoring organization
of the home under
regulations established
by the Secretary.
(II) Reimbursement.--Except
as provided in subclause (III),
a tier I family or group day
care home shall be provided
reimbursement factors under
this clause without a
requirement for documentation
of the costs described in
clause (i), except that
reimbursement shall not be
provided under this subclause
for meals or supplements served
to the children of a person
acting as a family or group day
care home provider unless the
children meet the income
eligibility guidelines for free
or reduced price meals under
section 9.
(III) Factors.--Except as
provided in subclause (IV), the
reimbursement factors applied
to a home referred to in
subclause (II) shall be the
factors in effect on July 1,
1996.
(IV) Adjustments.--The
reimbursement factors under
this subparagraph shall be
adjusted on July 1, 1997, and
each July 1 thereafter, to
reflect changes in the Consumer
Price Index for food at home
for the most recent 12-month
period for which the data are
available. The reimbursement
factors under this subparagraph
shall be rounded to the nearest
lower cent increment and based
on the unrounded adjustment in
effect on June 30 of the
preceding school year.
(iii) Tier ii family or group day
care homes.--
(I) In general.--
(aa) Factors.--Except
as provided in
subclause (II), with
respect to meals or
supplements served
under this clause by a
family or group day
care home that does not
meet the criteria set
forth in clause
(ii)(I), the
reimbursement factors
shall be 95 cents for
lunches and suppers, 27
cents for breakfasts,
and 13 cents for
supplements.
(bb) Adjustments.--
The factors shall be
adjusted on July 1,
1997, and each July 1
thereafter, to reflect
changes in the Consumer
Price Index for food at
home for the most
recent 12-month period
for which the data are
available. The
reimbursement factors
under this item shall
be rounded down to the
nearest lower cent
increment and based on
the unrounded
adjustment for the
preceding 12-month
period.
(cc) Reimbursement.--
A family or group day
care home shall be
provided reimbursement
factors under this
subclause without a
requirement for
documentation of the
costs described in
clause (i), except that
reimbursement shall not
be provided under this
subclause for meals or
supplements served to
the children of a
person acting as a
family or group day
care home provider
unless
the children meet the
income eligibility
guidelines for free or
reduced price meals
under section 9.
(II) Other factors.--A family
or group day care home that
does not meet the criteria set
forth in clause (ii)(I) may
elect to be provided
reimbursement factors
determined in accordance with
the following requirements:
(aa) Children
eligible for free or
reduced price meals.--
In the case of meals or
supplements served
under this subsection
to children who are
members of households
whose incomes meet the
income eligibility
guidelines for free or
reduced price meals
under section 9, the
family or group day
care home shall be
provided reimbursement
factors set by the
Secretary in accordance
with clause (ii)(III).
(bb) Ineligible
children.--In the case
of meals or supplements
served under this
subsection to children
who are members of
households whose
incomes do not meet the
income eligibility
guidelines, the family
or group day care home
shall be provided
reimbursement factors
in accordance with
subclause (I).
(III) Information and
determinations.--
(aa) In general.--If
a family or group day
care home elects to
claim the factors
described in subclause
(II), the family or
group day care home
sponsoring organization
serving the home shall
collect the necessary
income information, as
determined by the
Secretary, from any
parent or other
caretaker to make the
determinations
specified in subclause
(II) and shall make the
determinations in
accordance with rules
prescribed by the
Secretary.
(bb) Categorical
eligibility.--In making
a determination under
item (aa), a family or
group day care home
sponsoring organization
may consider a child
participating in or
subsidized under, or a
child with a parent
participating in or
subsidized under, a
federally or State
supported child care or
other benefit program
with an income
eligibility limit that
does not exceed the
eligibility standard
for free or reduced
price meals under
section 9 to be a child
who is a member of a
household whose income
meets the income
eligibility guidelines
under section 9.
(cc) Factors for
children only.--A
family or group day
care home may elect to
receive the
reimbursement factors
prescribed under clause
(ii)(III) solely for
the children
participating in a
program referred to in
item (bb) if the home
elects not to have
income statements
collected from parents
or other caretakers.
(dd) Transmission of
income information by
sponsored family or
group day care homes.--
If a family or group
day care home elects to
be provided
reimbursement factors
described in subclause
(II), the family or
group day care home may
assist in the
transmission of
necessary household
income information to
the family or group day
care home sponsoring
organization in
accordance with the
policy described in
item (ee).
(ee) Policy.--The
Secretary shall develop
a policy under which a
sponsored family or
group day care home
described in item (dd)
may, under terms and
conditions specified by
the Secretary and with
the written consent of
the parents or
guardians of a child in
a family or group day
care home participating
in the program, assist
in the transmission of
the income information
of the family to the
family or group day
care home sponsoring
organization.
(IV) Simplified meal counting
and reporting procedures.--The
Secretary shall prescribe
simplified meal counting and
reporting procedures for use by
a family or group day care home
that elects to claim the
factors under subclause (II)
and by a family or group day
care home sponsoring
organization that sponsors the
home. The procedures the
Secretary prescribes may
include 1 or more of the
following:
(aa) Setting an
annual percentage for
each home of the number
of meals served that
are to be reimbursed in
accordance with the
reimbursement factors
prescribed under clause
(ii)(III) and an annual
percentage of the
number of meals served
that are to be
reimbursed in
accordance with the
reimbursement factors
prescribed under
subclause (I), based on
the family income of
children enrolled in
the home in a specified
month or other period.
(bb) Placing a home
into 1 of 2 or more
reimbursement
categories annually
based on the percentage
of children in the home
whose households have
incomes that meet the
income eligibility
guidelines under
section 9, with each
such reimbursement
category carrying a set
of reimbursement
factors such as the
factors prescribed
under clause (ii)(III)
or subclause (I) or
factors established
within the range of
factors prescribed
under clause (ii)(III)
and subclause (I).
(cc) Such other
simplified procedures
as the Secretary may
prescribe.
(V) Minimum verification
requirements.--The Secretary
may establish any minimum
verification requirements that
are necessary to carry out this
clause.
(B) Administrative funds.--
(i) In general.--In addition to
reimbursement factors described in
subparagraph (A), a family or group day
care home sponsoring organization shall
receive reimbursement for the
administrative expenses of the
sponsoring organization in an amount
that is not less than the product
obtained each month by multiplying--
(I) the number of family and
group day care homes of the
sponsoring organization
submitting a claim for
reimbursement during the month;
by
(II) the appropriate
administrative rate determined
by the Secretary.
(ii) Annual adjustment.--The
administrative reimbursement levels
specified in clause (i) shall be
adjusted July 1 of each year to reflect
changes in the Consumer Price Index for
All Urban Consumers published by the
Bureau of Labor Statistics of the
Department of Labor for the most recent
12-month period for which such data are
available.
(iii) Carryover funds.--The Secretary
shall develop procedures under which
not more than 10 percent of the amount
made available to sponsoring
organizations under this section for
administrative expenses for a fiscal
year may remain available for
obligation or expenditure in the
succeeding fiscal year.
(C)(i) Reimbursement for administrative expenses shall also
include start-up funds to finance the administrative expenses
for such institutions to initiate successful operation under
the program and expansion funds to finance the administrative
expenses for such institutions to expand into low-income or
rural areas. Institutions that have received start-up funds may
also apply at a later date for expansion funds. Such start-up
funds and expansion funds shall be in addition to other
reimbursement to such institutions for administrative expenses.
Start-up funds and expansion funds shall be payable to enable
institutions satisfying the criteria of subsection (d) of this
section, and any other standards prescribed by the Secretary,
to develop an application for participation in the program as a
family or group day care home sponsoring organization or to
implement the program upon approval of the application. Such
start-up funds and expansion funds shall be payable in
accordance with the procedures prescribed by the Secretary. The
amount of start-up funds and expansion funds payable to an
institution shall be not less than the institution's
anticipated reimbursement for administrative expenses under the
program for one month and not more than the institution's
anticipated reimbursement for administrative expenses under the
program for two months.
(ii) Funds for administrative expenses may be used by family
or group day care home sponsoring organizations assist
unlicensed family or group day care homes in becoming licensed.
(D) Limitations on ability of family or group
day care homes to transfer sponsoring
organizations.--
(i) In general.--Subject to clause
(ii), a State agency shall limit the
ability of a family or group day care
home to transfer from a sponsoring
organization to another sponsoring
organization more frequently than once
a year.
(ii) Good cause.--The State agency
may permit or require a family or group
day care home to transfer from a
sponsoring organization to another
sponsoring organization more frequently
than once a year for good cause (as
determined by the State agency),
including circumstances in which the
sponsoring organization of the family
or group day care home ceases to
participate in the child and adult care
food program.
(E) Provision of data to family or group day
care home sponsoring organizations.--
(i) Census data.--The Secretary shall
provide to each State agency
administering a child and adult care
food program under this section data
from the most recent decennial census
survey or other appropriate census
survey for which the data are available
showing which areas in the State meet
the requirements of subparagraph
(A)(ii)(I)(aa). The State agency shall
provide the data to family or group day
care home sponsoring organizations
located in the State.
(ii) School data.--
(I) In general.--A State
agency administering the school
lunch program under this Act or
the school breakfast program
under the Child Nutrition Act
of 1966 (42 U.S.C. 1771 et
seq.) shall provide to approved
family or group day care home
sponsoring organizations a list
of schools serving elementary
school children in the State in
which not less than \1/2\ of
the children enrolled are
certified to receive free or
reduced price meals. The State
agency shall collect the data
necessary to create the list
annually and provide the list
on a timely basis to any
approved family or group day
care home sponsoring
organization that requests the
list.
(II) Use of data from
preceding school year.--In
determining for a fiscal year
or other annual period whether
a home qualifies as a tier I
family or group day care home
under subparagraph (A)(ii)(I),
the State agency administering
the program under this section,
and a family or group day care
home sponsoring organization,
shall use the most current
available data at the time of
the determination.
(iii) Duration of determination.--For
purposes of this section, a
determination that a family or group
day care home is located in an area
that qualifies the home as a tier I
family or group day care home (as the
term is defined in subparagraph
(A)(ii)(I)), shall be in effect for 5
years (unless the determination is made
on the basis of census data, in which
case the determination shall remain in
effect until more recent census data
are available) unless the State agency
determines that the area in which the
home is located no longer qualifies the
home as a tier I family or group day
care home.
(4) By the first day of each month of operation, the State
may provide advance payments for the month to each approved
institution in an amount that reflects the full level of valid
claims customarily received from such institution for one
month's operation. In the case of a newly participating
institution, the amount of the advance shall reflect the
State's best estimate of the level of valid claims such
institutions will submit. If the State has reason to believe
that an institution will not be able to submit a valid claim
covering the period for which such an advance has been made,
the subsequent month's advance payment shall be withheld until
the State receives a valid claim. Payments advanced to
institutions that are not subsequently deducted from a valid
claim for reimbursement shall be repaid upon demand by the
State. Any prior payment that is under dispute may be
subtracted from an advance payment.
(g) Nutritional Requirements for Meals and Snacks Served in
Institutions and Family or Group Day Care Homes.--
(1) Definition of dietary guidelines.--In this
subsection, the term ``Dietary Guidelines'' means the
Dietary Guidelines for Americans published under
section 301 of the National Nutrition Monitoring and
Related Research Act of 1990 (7 U.S.C. 5341).
(2) Nutritional requirements.--
(A) In general.--Except as provided in
subparagraph (C), reimbursable meals and snacks
served by institutions, family or group day
care homes, and sponsored centers participating
in the program under this section shall consist
of a combination of foods that meet minimum
nutritional requirements prescribed by the
Secretary on the basis of tested nutritional
research.
(B) Conformity with the dietary guidelines
and authoritative science.--
(i) In general.--Not less frequently
than once every 10 years, the Secretary
shall review and, as appropriate,
update requirements for meals served
under the program under this section to
ensure that the meals--
(I) are consistent with the
goals of the most recent
Dietary Guidelines; and
(II) promote the health of
the population served by the
program authorized under this
section, as indicated by the
most recent relevant nutrition
science and appropriate
authoritative scientific agency
and organization
recommendations.
(ii) Cost review.--The review
required under clause (i) shall include
a review of the cost to child care
centers and group or family day care
homes resulting from updated
requirements for meals and snacks
served under the program under this
section.
(iii) Regulations.--Not later than 18
months after the completion of the
review of the meal pattern under clause
(i), the Secretary shall promulgate
proposed regulations to update the meal
patterns for meals and snacks served
under the program under this section.
(C) Exceptions.--
(i) Special dietary needs.--The
minimum nutritional requirements
prescribed under subparagraph (A) shall
not prohibit institutions, family or
group day care homes, and sponsored
centers from substituting foods to
accommodate the medical or other
special dietary needs of individual
participants.
(ii) Exempt institutions.--The
Secretary may elect to waive all or
part of the requirements of this
subsection for emergency shelters
participating in the program under this
section.
(3) Meal service.--Institutions, family or group day
care homes, and sponsored centers shall ensure that
reimbursable meal service contributes to the
development and socialization of enrolled children by
providing that food is not used as a punishment or
reward.
(4) Fluid milk.--
(A) In general.--If an institution, family or
group day care home, or sponsored center
provides fluid milk as part of a reimbursable
meal or supplement, the institution, family or
group day care home, or sponsored center shall
provide the milk in accordance with the most
recent version of the Dietary Guidelines.
(B) Milk substitutes.--In the case of
children who cannot consume fluid milk due to
medical or other special dietary needs other
than a disability, an institution, family or
group day care home, or sponsored center may
substitute for the fluid milk required in meals
served, a nondairy beverage that--
(i) is nutritionally equivalent to
fluid milk; and
(ii) meets nutritional standards
established by the Secretary,
including, among other requirements
established by the Secretary,
fortification of calcium, protein,
vitamin A, and vitamin D to levels
found in cow's milk.
(C) Approval.--
(i) In general.--A substitution
authorized under subparagraph (B) may
be made--
(I) at the discretion of and
on approval by the
participating day care
institution; and
(II) if the substitution is
requested by written statement
of a medical authority, or by
the parent or legal guardian of
the child, that identifies the
medical or other special
dietary need that restricts the
diet of the child.
(ii) Exception.--An institution,
family or group day care home, or
sponsored center that elects to make a
substitution authorized under this
paragraph shall not be required to
provide beverages other than beverages
the State has identified as acceptable
substitutes.
(D) Excess expenses borne by institution.--A
participating institution, family or group day
care home, or sponsored center shall be
responsible for any expenses that--
(i) are incurred by the institution,
family or group day care home, or
sponsored center to provide
substitutions under this paragraph; and
(ii) are in excess of expenses
covered under reimbursements under this
Act.
(5) Nondiscrimination policy.--No physical
segregation or other discrimination against any person
shall be made because of the inability of the person to
pay, nor shall there be any overt identification of any
such person by special tokens or tickets, different
meals or meal service, announced or published lists of
names, or other means.
(6) Use of abundant and donated foods.--To the
maximum extent practicable, each institution shall use
in its food service foods that are--
(A) designated from time to time by the
Secretary as being in abundance, either
nationally or in the food service area; or
(B) donated by the Secretary.
(h)(1)(A) The Secretary shall donate agricultural commodities
produced in the United States for use in institutions
participating in the child care food program under this
section.
(B) The value of the commodities donated under subparagraph
(A) (or cash in lieu of commodities) to each State for each
school year shall be, at a minimum, the amount obtained by
multiplying the number of lunches and suppers served in
participating institutions in that State during the preceding
school year by the rate for commodities or cash in lieu of
commodities established under section 6(c) for the school year
concerned.
(C) After the end of each school year, the Secretary shall--
(i) reconcile the number of lunches and suppers
served in participating institutions in each State
during such school year with the number of lunches and
suppers served by participating institutions in each
State during the preceding school year; and
(ii) based on such reconciliation, increase or reduce
subsequent commodity assistance or cash in lieu of
commodities provided to each State.
(D) Any State receiving assistance under this section for
institutions participating in the child care food program may,
upon application to the Secretary, receive cash in lieu of some
or all of the commodities to which it would otherwise be
entitled under this subsection. In determining whether to
request cash in lieu of commodities, the State shall base its
decision on the preferences of individual participating
institutions within the State, unless this proves impracticable
due to the small number of institutions preferring donated
commodities.
(2) The Secretary is authorized to provide agricultural
commodities obtained by the Secretary under the provisions of
the Agricultural Act of 1949 (7 U.S.C. 1421 et seq.) and
donated under the provisions of section 416 of such Act, to the
Department of Defense for use by its institutions providing
child care services, when such commodities are in excess of the
quantities needed to meet the needs of all other child
nutrition programs, domestic and foreign food assistance and
export enhancement programs. The Secretary shall require
reimbursement from the Department of Defense for the costs, or
some portion thereof, of delivering such commodities to
overseas locations, unless the Secretary determines that it is
in the best interest of the program that the Department of
Agriculture shall assume such costs.
(i) Audits.--
(1) Disregards.--
(A) In general.--Subject to subparagraph (B),
in conducting management evaluations, reviews,
or audits under this section, the Secretary or
a State agency may disregard any overpayment to
an institution for a fiscal year if the total
overpayment to the institution for the fiscal
year does not exceed an amount that is
consistent with the disregards allowed in other
programs under this Act and recognizes the cost
of collecting small claims, as determined by
the Secretary.
(B) Criminal or fraud violations.--In
carrying out this paragraph, the Secretary and
a State agency shall not disregard any
overpayment for which there is evidence of a
violation of a criminal law or civil fraud law.
(2) Funding.--
(A) In general.--The Secretary shall make
available for each fiscal year to each State
agency administering the child and adult care
food program, for the purpose of conducting
audits of participating institutions, an amount
of up to 1.5 percent of the funds used by each
State in the program under this section, during
the second preceding fiscal year.
(B) Additional funding.--
(i) In general.--Subject to clause
(ii), for fiscal year 2016 and each
fiscal year thereafter, the Secretary
may increase the amount of funds made
available to any State agency under
subparagraph (A), if the State agency
demonstrates that the State agency can
effectively use the funds to improve
program management under criteria
established by the Secretary.
(ii) Limitation.--The total amount of
funds made available to any State
agency under this paragraph shall not
exceed 2 percent of the funds used by
each State agency in the program under
this section, during the second
preceding fiscal year.
(j) Agreements.--
(1) In general.--The Secretary shall issue
regulations directing States to develop and provide for
the use of a standard form of agreement between each
sponsoring organization and the family or group day
care homes or sponsored day care centers participating
in the program under such organization, for the purpose
of specifying the rights and responsibilities of each
party.
(2) Duration.--An agreement under paragraph (1) shall
remain in effect until terminated by either party to
the agreement.
(k) Training and Technical Assistance.--A State participating
in the program established under this section shall provide
sufficient training, technical assistance, and monitoring to
facilitate effective operation of the program. The Secretary
shall assist the State in developing plans to fulfill the
requirements of this subsection.
(l) Expenditures of funds from State and local sources for
the maintenance of food programs for children shall not be
diminished as a result of funds received under this section.
(m) States and institutions participating in the program
under this section shall keep such accounts and records as may
be necessary to enable the Secretary to determine whether there
has been compliance with the requirements of this section. Such
accounts and records shall be available at any reasonable time
for inspection and audit by representatives of the Secretary,
the Comptroller General of the United States, and appropriate
State representatives and shall be preserved for such period of
time, not in excess of five years, as the Secretary determines
necessary.
(n) There are hereby authorized to be appropriated for each
fiscal year such funds as are necessary to carry out the
purposes of this section.
(o)(1) For purposes of this section, adult day care centers
shall be considered eligible institutions for reimbursement for
meals or supplements served to persons 60 years of age or older
or to chronically impaired disabled persons, including victims
of Alzheimer's disease and related disorders with neurological
and organic brain dysfunction. Reimbursement provided to such
institutions for such purposes shall improve the quality of
meals or level of services provided or increase participation
in the program. Lunches served by each such institution for
which reimbursement is claimed under this section shall
provide, on the average, approximately \1/3\ of the daily
recommended dietary allowance established by the Food and
Nutrition Board of the National Research Council of the
National Academy of Sciences. Such institutions shall make
reasonable efforts to serve meals that meet the special dietary
requirements of participants, including efforts to serve foods
in forms palatable to participants.
(2) For purposes of this subsection--
(A) the term ``adult day care center'' means any
public agency or private nonprofit organization, or any
proprietary title XIX or title XX center, which--
(i) is licensed or approved by Federal,
State, or local authorities to provide adult
day care services to chronically impaired
disabled adults or persons 60 years of age or
older in a group setting outside their homes,
or a group living arrangement, on a less than
24-hour basis; and
(ii) provides for such care and services
directly or under arrangements made by the
agency or organization whereby the agency or
organization maintains professional management
responsibility for all such services; and
(B) the term ``proprietary title XIX or title XX
center'' means any private, for-profit center providing
adult day care services for which it receives
compensation from amounts granted to the States under
title XIX or XX of the Social Security Act and which
title XIX or title XX beneficiaries were not less than
25 percent of enrolled eligible participants in a
calendar month preceding initial application or annual
reapplication for program participation.
(3)(A) The Secretary, in consulation with the Assistant
Secretary for Aging, shall establish, within 6 months of
enactment, separate guidelines for reimbursement of
institutions described in this subsection. Such reimbursement
shall take into account the nutritional requirements of
eligible persons, as determined by the Secretary on the basis
of tested nutritional research, except that such reimbursement
shall not be less than would otherwise be required under this
section.
(B) The guidelines shall contain provisions designed to
assure that reimbursement under this subsection shall not
duplicate reimbursement under part C of title III of the Older
Americans Act of 1965, for the same meal served.
(4) For the purpose of establishing eligibility for free or
reduced price meals or supplements under this subsection,
income shall include only the income of an eligible person and,
if any, the spouse and dependents with whom the eligible person
resides.
(5) A person described in paragraph (1) shall be considered
automatically eligible for free meals or supplements under this
subsection, without further application or eligibility
determination, if the person is--
(A) a member of a household receiving assistance
under the Food and Nutrition Act of 2008 (7 U.S.C. 2011
et seq.); or
(B) a recipient of assistance under title XVI or XIX
of the Social Security Act (42 U.S.C. 1381 et seq.).
(6) The Governor of any State may designate to administer the
program under this subsection a State agency other than the
agency that administers the child care food program under this
section.
(q) Management Support.--
(1) Technical and training assistance.--In addition
to the training and technical assistance that is
provided to State agencies under other provisions of
this Act and the Child Nutrition Act of 1966 (42 U.S.C.
1771 et seq.), the Secretary shall provide training and
technical assistance in order to assist the State
agencies in improving their program management and
oversight under this section.
(2) Technical and training assistance for
identification and prevention of fraud and abuse.--As
part of training and technical assistance provided
under paragraph (1), the Secretary shall provide
training on a continuous basis to State agencies, and
shall ensure that such training is provided to
sponsoring organizations, for the identification and
prevention of fraud and abuse under the program and to
improve management of the program.
(r) Program for At-Risk School Children.--
(1) Definition of at-risk school child.--In this
subsection, the term ``at-risk school child'' means a
school child who--
(A) is not more than 18 years of age, except
that the age limitation provided by this
subparagraph shall not apply to a child
described in section 12(d)(1)(A); and
(B) participates in a program authorized
under this section operated at a site located
in a geographical area served by a school in
which at least 50 percent of the children
enrolled are certified as eligible to receive
free or reduced price school meals under this
Act or the Child Nutrition Act of 1966 (42
U.S.C. 1771 et seq.).
(2) Participation in child and adult care food
program.--An institution may participate in the program
authorized under this section only if the institution
provides meals or supplements under a program--
(A) organized primarily to provide care to
at-risk school children during after-school
hours, weekends, or holidays during the regular
school year; and
(B) with an educational or enrichment
purpose.
(3) Administration.--Except as otherwise provided in
this subsection, the other provisions of this section
apply to an institution described in paragraph (2).
(4) Meal and supplement reimbursement.--
(A) Limitations.--An institution may claim
reimbursement under this subsection only for
one meal per child per day and one supplement
per child per day served under a program
organized primarily to provide care to at-risk
school children during after-school hours,
weekends, or holidays during the regular school
year.
(B) Rates.--
(i) Meals.--A meal shall be
reimbursed under this subsection at the
rate established for free meals under
subsection (c).
(ii) Supplements.--A supplement shall
be reimbursed under this subsection at
the rate established for a free
supplement under subsection (c)(3).
(C) No charge.--A meal or supplement claimed
for reimbursement under this subsection shall
be served without charge.
(5) Limitation.--An institution participating in the
program under this subsection may not claim
reimbursement for meals and snacks that are served
under section 18(h) on the same day.
(6) Handbook.--
(A) In general.--Not later than 180 days
after the date of enactment of the Healthy,
Hunger-Free Kids Act of 2010, the Secretary
shall--
(i) issue guidelines for afterschool
meals for at-risk school children; and
(ii) publish a handbook reflecting
those guidelines.
(B) Review.--Each year after the issuance of
guidelines under subparagraph (A), the
Secretary shall--
(i) review the guidelines; and
(ii) issue a revised handbook
reflecting changes made to the
guidelines.
(s) Information Concerning the Special Supplemental Nutrition
Program for Women, Infants, and Children.--
(1) In general.--The Secretary shall provide each
State agency administering a child and adult care food
program under this section with information concerning
the special supplemental nutrition program for women,
infants, and children authorized under section 17 of
the Child Nutrition Act of 1966 (42 U.S.C. 1786).
(2) Requirements for state agencies.--Each State
agency shall ensure that each participating family and
group day care home and child care center (other than
an institution providing care to school children
outside school hours)--
(A) receives materials that include--
(i) a basic explanation of the
importance and benefits of the special
supplemental nutrition program for
women, infants, and children;
(ii) the maximum State income
eligibility standards, according to
family size, for the program; and
(iii) information concerning how
benefits under the program may be
obtained;
(B) receives periodic updates of the
information described in subparagraph (A); and
(C) provides the information described in
subparagraph (A) to parents of enrolled
children at enrollment.
(t) Participation by Emergency Shelters.--
(1) Definition of emergency shelter.--In this
subsection, the term ``emergency shelter'' means--
(A) an emergency shelter (as defined in
section 321 of the Stewart B. McKinney Homeless
Assistance Act (42 U.S.C. 11351)); or
(B) a site operated by the shelter.
(2) Administration.--Except as otherwise provided in
this subsection, an emergency shelter shall be eligible
to participate in the program authorized under this
section in accordance with the terms and conditions
applicable to eligible institutions described in
subsection (a).
(3) Licensing requirements.--The licensing
requirements contained in subsection (a)(5) shall not
apply to an emergency shelter.
(4) Health and safety standards.--To be eligible to
participate in the program authorized under this
section, an emergency shelter shall comply with
applicable State or local health and safety standards.
(5) Meal or supplement reimbursement.--
(A) Limitations.--An emergency shelter may
claim reimbursement under this subsection--
(i) only for a meal or supplement
served to children residing at an
emergency shelter, if the children
are--
(I) not more than 18 years of
age; or
(II) children with
disabilities; and
(ii) for not more than 3 meals, or 2
meals and a supplement, per child per
day.
(B) Rate.--A meal or supplement eligible for
reimbursement shall be reimbursed at the rate
at which free meals and supplements are
reimbursed under subsection (c).
(C) No charge.--A meal or supplement claimed
for reimbursement shall be served without
charge.
(u) Promoting Health and Wellness in Child Care.--
(1) Physical activity and electronic media use.--The
Secretary shall encourage participating child care
centers and family or group day care homes--
(A) to provide to all children under the
supervision of the participating child care
centers and family or group day care homes
daily opportunities for structured and
unstructured age-appropriate physical activity;
and
(B) to limit among children under the
supervision of the participating child care
centers and family or group day care homes the
use of electronic media to an appropriate
level.
(2) Water consumption.--Participating child care
centers and family or group day care homes shall make
available to children, as nutritionally appropriate,
potable water as an acceptable fluid for consumption
throughout the day, including at meal times.
(3) Technical assistance and guidance.--
(A) In general.--The Secretary shall provide
technical assistance to institutions
participating in the program under this section
to assist participating child care centers and
family or group day care homes in complying
with the nutritional requirements and wellness
recommendations prescribed by the Secretary in
accordance with this subsection and subsection
(g).
(B) Guidance.--Not later than January 1,
2012, the Secretary shall issue guidance to
States and institutions to encourage
participating child care centers and family or
group day care homes serving meals and snacks
under this section to--
(i) include foods that are
recommended for increased serving
consumption in amounts recommended by
the most recent Dietary Guidelines for
Americans published under section 301
of the National Nutrition Monitoring
and Related Research Act of 1990 (7
U.S.C. 5341), including fresh, canned,
dried, or frozen fruits and vegetables,
whole grain products, lean meat
products, and low-fat and non-fat dairy
products; and
(ii) reduce sedentary activities and
provide opportunities for regular
physical activity in quantities
recommended by the most recent Dietary
Guidelines for Americans described in
clause (i).
(C) Nutrition.--Technical assistance relating
to the nutritional requirements of this
subsection and subsection (g) shall include--
(i) nutrition education, including
education that emphasizes the
relationship between nutrition,
physical activity, and health;
(ii) menu planning;
(iii) interpretation of nutrition
labels; and
(iv) food preparation and purchasing
guidance to produce meals and snacks
that are--
(I) consistent with the goals
of the most recent Dietary
Guidelines; and
(II) promote the health of
the population served by the
program under this section, as
recommended by authoritative
scientific organizations.
(D) Physical activity.--Technical assistance
relating to the physical activity requirements
of this subsection shall include--
(i) education on the importance of
regular physical activity to overall
health and well being; and
(ii) sharing of best practices for
physical activity plans in child care
centers and homes as recommended by
authoritative scientific organizations.
(E) Electronic media use.--Technical
assistance relating to the electronic media use
requirements of this subsection shall include--
(i) education on the benefits of
limiting exposure to electronic media
by children; and
(ii) sharing of best practices for
the development of daily activity plans
that limit use of electronic media.
(F) Minimum assistance.--At a minimum, the
technical assistance required under this
paragraph shall include a handbook, developed
by the Secretary in coordination with the
Secretary for Health and Human Services, that
includes recommendations, guidelines, and best
practices for participating institutions and
family or group day care homes that are
consistent with the nutrition, physical
activity, and wellness requirements and
recommendations of this subsection.
(G) Additional assistance.--In addition to
the requirements of this paragraph, the
Secretary shall develop and provide such
appropriate training and education materials,
guidance, and technical assistance as the
Secretary considers to be necessary to comply
with the nutritional and wellness requirements
of this subsection and subsection (g).
(H) Funding.--
(i) In general.--On October 1, 2010,
out of any funds in the Treasury not
otherwise appropriated, the Secretary
of the Treasury shall transfer to the
Secretary to provide technical
assistance under this subsection
$10,000,000, to remain available until
expended.
(ii) Receipt and acceptance.--The
Secretary shall be entitled to receive,
shall accept, and shall use to carry
out this subsection the funds
transferred under clause (i), without
further appropriation.
* * * * * * *
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INDIAN CHILD WELFARE ACT OF 1978
* * * * * * *
TITLE II--INDIAN CHILD AND FAMILY PROGRAMS
Sec. 201. (a) The Secretary is authorized to make grants to
Indian tribes and organizations in the establishment and
operation of Indian child and family service programs on or
near reservations and in the preparation and implementation of
child welfare codes. The objective of every Indian child and
family service program shall be to prevent the breakup of
Indian families and, in particular, to insure that the
permanent removal of an Indian child from the custody of his
parent or Indian custodian shall be a last resort. Such child
and family service programs may include, but are not limited
to--
(1) a system for licensing or otherwise regulating
Indian foster and adoptive homes;
(2) the operation and maintenance of facilities for
the counseling and treatment of Indian families and for
the temporary custody of Indian children;
(3) family assistance, including homemaker and home
counselors, day care, afterschool care, and employment,
recreational activities, and respite care;
(4) home improvement programs;
(5) the employment of professional and other trained
personnel to assist the tribal court in the disposition
of domestic relations and child welfare matters;
(6) education and training of Indians, including
tribal court judges and staff, in skills relating to
child and family assistance and service programs;
(7) a subsidy program under which Indian adoptive
children may be provided support comparable to that for
which they would be eligible as foster children, taking
into account the appropriate State standards of support
for maintenance and medical needs; and
(8) guidance, legal representation, and advice to
Indian families involved in tribal, State, or Federal
child custody proceedings.
(b) Funds appropriated for use by the Secretary in accordance
with this section may be utilized as non-Federal matching share
in connection with funds provided under titles IV-B and XX of
the Social Security Act or under any other Federal financial
assistance programs which contribute to the purpose for which
such funds are authorized to be appropriated for use under this
Act. The provision or possibility of assistance under this Act
shall not be a basis for the denial or reduction of any
assistance otherwise authorized under titles IV-B and XX of the
Social Security Act or any other federally assisted program.
For purposes of qualifying for assistance under a federally
assisted program, licensing or approval of foster or adoptive
homes or institutions by an Indian tribe shall be deemed
equivalent to licensing or approval by a State.
* * * * * * *
----------
TITLE 31, UNITED STATES CODE
* * * * * * *
SUBTITLE III--FINANCIAL MANAGEMENT
* * * * * * *
CHAPTER 38--ADMINISTRATIVE REMEDIES FOR FALSE CLAIMS AND STATEMENTS
* * * * * * *
Sec. 3803. Hearing and determinations
(a)(1) The investigating official of an authority may
investigate allegations that a person is liable under section
3802 of this title and shall report the findings and
conclusions of such investigation to the reviewing official of
the authority. The preceding sentence does not modify any
responsibility of an investigating official to report
violations of criminal law to the Attorney General.
(2) If the reviewing official of an authority determines,
based upon the report of the investigating official under
paragraph (1) of this subsection, that there is adequate
evidence to believe that a person is liable under section 3802
of this title, the reviewing official shall transmit to the
Attorney General a written notice of the intention of such
official to refer the allegations of such liability to a
presiding officer of such authority. Such notice shall
include--
(A) a statement of the reasons of the reviewing
official for the referral of such allegations;
(B) a statement specifying the evidence which
supports such allegations;
(C) a description of the claims or statements for
which liability under section 3802 of this title is
alleged;
(D) an estimate of the amount of money or the value
of property or services requested or demanded in
violation of section 3802 of this title; and
(E) a statement of any exculpatory or mitigating
circumstances which may relate to such claims or
statements.
(b)(1) Within 90 days after receipt of a notice from a
reviewing official under paragraph (2) of subsection (a), the
Attorney General or an Assistant Attorney General designated by
the Attorney General shall transmit a written statement to the
reviewing official which specifies--
(A) that the Attorney General or such Assistant
Attorney General approves or disapproves the referral
to a presiding officer of the allegations of liability
stated in such notice;
(B) in any case in which the referral of allegations
is approved, that the initiation of a proceeding under
this section with respect to such allegations is
appropriate; and
(C) in any case in which the referral of allegations
is disapproved, the reasons for such disapproval.
(2) A reviewing official may refer allegations of liability
to a presiding officer only if the Attorney General or an
Assistant Attorney General designated by the Attorney General
approves the referral of such allegations in a written
statement described in paragraph (1) of this subsection.
(3) If the Attorney General or an Assistant Attorney General
designated by the Attorney General transmits to an authority
head a written finding that the continuation of any hearing
under this section with respect to a claim or statement may
adversely affect any pending or potential criminal or civil
action related to such claim or statement, such hearing shall
be immediately stayed and may be resumed only upon written
authorization of the Attorney General.
(c)(1) No allegations of liability under section 3802 of this
title with respect to any claim made, presented, or submitted
by any person shall be referred to a presiding officer under
paragraph (2) of subsection (b) if the reviewing official
determines that--
(A) an amount of money in excess of $150,000; or
(B) property or services with a value in excess of
$150,000,
is requested or demanded in violation of section 3802 of this
title in such claim or in a group of related claims which are
submitted at the time such claim is submitted.
(2)(A) Except as provided in subparagraph (B) of this
paragraph, no allegations of liability against an individual
under section 3802 of this title with respect to any claim or
statement made, presented, or submitted, or caused to be made,
presented, or submitted, by such individual relating to any
benefits received by such individual shall be referred to a
presiding officer under paragraph (2) of subsection (b).
(B) Allegations of liability against an individual under
section 3802 of this title with respect to any claim or
statement made, presented, or submitted, or caused to be made,
presented, or submitted, by such individual relating to any
benefits received by such individual may be referred to a
presiding officer under paragraph (2) of subsection (b) if--
(i) such claim or statement is made by such
individual in making application for such benefits;
(ii) such allegations relate to the eligibility of
such individual to receive such benefits; and
(iii) with respect to such claim or statement, the
individual--
(I) has actual knowledge that the claim or
statement is false, fictitious, or fraudulent;
(II) acts in deliberate ignorance of the
truth or falsity of the claim or statement; or
(III) acts in reckless disregard of the truth
or falsity of the claim or statement.
(C) For purposes of this subsection, the term ``benefits''
means--
(i) benefits under the supplemental security income
program under title XVI of the Social Security Act;
(ii) old age, survivors, and disability insurance
benefits under title II of the Social Security Act;
(iii) benefits under title XVIII of the Social
Security Act;
(iv) assistance under a State program funded under
part A of title IV of the Social Security Act;
(v) medical assistance under a State plan approved
under section 1902(a) of the Social Security Act;
(vi) benefits under title XX of the Social Security
Act;
(vii) benefits under the supplemental nutrition
assistance program (as defined in section 3 of the Food
and Nutrition Act of 2008);
(viii) benefits under chapters 11, 13, 15, 17, and 21
of title 38;
(ix) benefits under the Black Lung Benefits Act;
(x) benefits under the special supplemental nutrition
program for women, infants, and children established
under section 17 of the Child Nutrition Act of 1966;
(xi) benefits under section 336 of the Older
Americans Act;
(xii) any annuity or other benefit under the Railroad
Retirement Act of 1974;
(xiii) benefits under the Richard B. Russell National
School Lunch Act;
(xiv) benefits under any housing assistance program
for lower income families or elderly or handicapped
persons which is administered by the Secretary of
Housing and Urban Development or the Secretary of
Agriculture;
(xv) benefits under the Low-Income Home Energy
Assistance Act of 1981; and
(xvi) benefits under part A of the Energy
Conservation in Existing Buildings Act of 1976,
which are intended for the personal use of the individual who
receives the benefits or for a member of the individual's
family.
(d)(1) On or after the date on which a reviewing official is
permitted to refer allegations of liability to a presiding
officer under subsection (b) of this section, the reviewing
official shall mail, by registered or certified mail, or shall
deliver, a notice to the person alleged to be liable under
section 3802 of this title. Such notice shall specify the
allegations of liability against such person and shall state
the right of such person to request a hearing with respect to
such allegations.
(2) If, within 30 days after receiving a notice under
paragraph (1) of this subsection, the person receiving such
notice requests a hearing with respect to the allegations
contained in such notice--
(A) the reviewing official shall refer such
allegations to a presiding officer for the commencement
of such hearing; and
(B) the presiding officer shall commence such hearing
by mailing by registered or certified mail, or by
delivery of, a notice which complies with paragraphs
(2)(A) and (3)(B)(i) of subsection (g) to such person.
(e)(1)(A) Except as provided in subparagraph (B) of this
paragraph, at any time after receiving a notice under paragraph
(2)(B) of subsection (d), the person receiving such notice
shall be entitled to review, and upon payment of a reasonable
fee for duplication, shall be entitled to obtain a copy of, all
relevant and material documents, transcripts, records, and
other materials, which relate to such allegations and upon
which the findings and conclusions of the investigating
official under paragraph (1) of subsection (a) are based.
(B) A person is not entitled under subparagraph (A) to review
and obtain a copy of any document, transcript, record, or
material which is privileged under Federal law.
(2) At any time after receiving a notice under paragraph
(2)(B) of subsection (d), the person receiving such notice
shall be entitled to obtain all exculpatory information in the
possession of the investigating official or the reviewing
official relating to the allegations contained in such notice.
The provisions of subparagraph (B) of paragraph (1) do not
apply to any document, transcript, record, or other material,
or any portion thereof, in which such exculpatory information
is contained.
(f) Any hearing commenced under paragraph (2) of subsection
(d) shall be conducted by the presiding officer on the record
in order to determine--
(1) the liability of a person under section 3802 of
this title; and
(2) if a person is determined to be liable under such
section, the amount of any civil penalty or assessment
to be imposed on such person.
Any such determination shall be based on the preponderance of
the evidence.
(g)(1) Each hearing under subsection (f) of this section
shall be conducted--
(A) in the case of an authority to which the
provisions of subchapter II of chapter 5 of title 5
apply, in accordance with--
(i) the provisions of such subchapter to the
extent that such provisions are not
inconsistent with the provisions of this
chapter; and
(ii) procedures promulgated by the authority
head under paragraph (3) of this subsection; or
(B) in the case of an authority to which the
provisions of such subchapter do not apply, in
accordance with procedures promulgated by the authority
head under paragraphs (2) and (3) of this subsection.
(2) An authority head of an authority described in
subparagraph (B) of paragraph (1) shall by regulation
promulgate procedures for the conduct of hearings under this
chapter. Such procedures shall include:
(A) The provision of written notice of the hearing to
any person alleged to be liable under section 3802 of
this title, including written notice of--
(i) the time, place, and nature of the
hearing;
(ii) the legal authority and jurisdiction
under which the hearing is to be held; and
(iii) the matters of facts and law to be
asserted.
(B) The provision to any person alleged to be liable
under section 3802 of this title of opportunities for
the submission of facts, arguments, offers of
settlement, or proposals of adjustment.
(C) Procedures to ensure that the presiding officer
shall not, except to the extent required for the
disposition of ex parte matters as authorized by law--
(i) consult a person or party on a fact in
issue, unless on notice and opportunity for all
parties to the hearing to participate; or
(ii) be responsible to or subject to the
supervision or direction of the investigating
official or the reviewing official.
(D) Procedures to ensure that the investigating
official and the reviewing official do not participate
or advise in the decision required under subsection (h)
of this section or the review of the decision by the
authority head under subsection (i) of this section,
except as provided in subsection (j) of this section.
(E) The provision to any person alleged to be liable
under section 3802 of this title of opportunities to
present such person's case through oral or documentary
evidence, to submit rebuttal evidence, and to conduct
such cross-examination as may be required for a full
and true disclosure of the facts.
(F) Procedures to permit any person alleged to be
liable under section 3802 of this title to be
accompanied, represented, and advised by counsel or
such other qualified representative as the authority
head may specify in such regulations.
(G) Procedures to ensure that the hearing is
conducted in an impartial manner, including procedures
to--
(i) permit the presiding officer to at any
time disqualify himself; and
(ii) permit the filing, in good faith, of a
timely and sufficient affidavit alleging
personal bias or another reason for
disqualification of a presiding officer or a
reviewing official.
(3)(A) Each authority head shall promulgate by regulation
procedures described in subparagraph (B) of this paragraph for
the conduct of hearings under this chapter. Such procedures
shall be in addition to the procedures described in paragraph
(1) or paragraph (2) of this subsection, as the case may be.
(B) The procedures referred to in subparagraph (A) of this
paragraph are:
(i) Procedures for the inclusion, in any written
notice of a hearing under this section to any person
alleged to be liable under section 3802 of this title,
of a description of the procedures for the conduct of
the hearing.
(ii) Procedures to permit discovery by any person
alleged to be liable under section 3802 of this title
only to the extent that the presiding officer
determines that such discovery is necessary for the
expeditious, fair, and reasonable consideration of the
issues, except that such procedures shall not apply to
documents, transcripts, records, or other material
which a person is entitled to review under paragraph
(1) of subsection (e) or to information to which a
person is entitled under paragraph (2) of such
subsection. Procedures promulgated under this clause
shall prohibit the discovery of the notice required
under subsection (a)(2) of this section.
(4) Each hearing under subsection (f) of this section shall
be held--
(A) in the judicial district of the United States in
which the person alleged to be liable under section
3802 of this title resides or transacts business;
(B) in the judicial district of the United States in
which the claim or statement upon which the allegation
of liability under such section was made, presented, or
submitted; or
(C) in such other place as may be agreed upon by such
person and the presiding officer who will conduct such
hearing.
(h) The presiding officer shall issue a written decision,
including findings and determinations, after the conclusion of
the hearing. Such decision shall include the findings of fact
and conclusions of law which the presiding officer relied upon
in determining whether a person is liable under this chapter.
The presiding officer shall promptly send to each party to the
hearing a copy of such decision and a statement describing the
right of any person determined to be liable under section 3802
of this title to appeal the decision of the presiding officer
to the authority head under paragraph (2) of subsection (i).
(i)(1) Except as provided in paragraph (2) of this subsection
and section 3805 of this title, the decision, including the
findings and determinations, of the presiding officer issued
under subsection (h) of this section are final.
(2)(A)(i) Except as provided in clause (ii) of this
subparagraph, within 30 days after the presiding officer issues
a decision under subsection (h) of this section, any person
determined in such decision to be liable under section 3802 of
this title may appeal such decision to the authority head.
(ii) If, within the 30-day period described in clause (i) of
this subparagraph, a person determined to be liable under this
chapter requests the authority head for an extension of such
30-day period to file an appeal of a decision issued by the
presiding officer under subsection (h) of this section, the
authority head may extend such period if such person
demonstrates good cause for such extension.
(B) Any authority head reviewing under this section the
decision, findings, and determinations of a presiding officer
shall not consider any objection that was not raised in the
hearing conducted pursuant to subsection (f) of this section
unless a demonstration is made of extraordinary circumstances
causing the failure to raise the objection. If any party
demonstrates to the satisfaction of the authority head that
additional evidence not presented at such hearing is material
and that there were reasonable grounds for the failure to
present such evidence at such hearing, the authority head shall
remand the matter to the presiding officer for consideration of
such additional evidence.
(C) The authority head may affirm, reduce, reverse,
compromise, remand, or settle any penalty or assessment
determined by the presiding officer pursuant to this section.
The authority head shall promptly send to each party to the
appeal a copy of the decision of the authority head and a
statement describing the right of any person determined to be
liable under section 3802 of this title to judicial review
under section 3805 of this title.
(j) The reviewing official has the exclusive authority to
compromise or settle any allegations of liability under section
3802 of this title against a person without the consent of the
presiding officer at any time after the date on which the
reviewing official is permitted to refer allegations of
liability to a presiding officer under subsection (b) of this
section and prior to the date on which the presiding officer
issues a decision under subsection (h) of this section. Any
such compromise or settlement shall be in writing.
* * * * * * *
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TITLE 40, UNITED STATES CODE
* * * * * * *
SUBTITLE IV--APPALACHIAN REGIONAL DEVELOPMENT
* * * * * * *
CHAPTER 145--SPECIAL APPALACHIAN PROGRAMS
Subchapter I--PROGRAMS
* * * * * * *
Sec. 14502. Demonstration health projects
(a) Purpose.--To demonstrate the value of adequate health
facilities and services to the economic development of the
Appalachian region, the Secretary of Health and Human Services
may make grants for the planning, construction, equipment, and
operation of multi-county demonstration health, nutrition, and
child care projects, including hospitals, regional health
diagnostic and treatment centers, and other facilities and
services necessary for the purposes of this section.
(b) Planning Grants.--
(1) Authority to provide amounts and make grants.--
The Secretary may provide amounts to the Appalachian
Regional Commission for the support of its Health
Advisory Committee and may make grants for expenses of
planning necessary for the development and operation of
demonstration health projects for the region.
(2) Limitation on available amounts.--The amount of a
grant under this section for planning shall not be more
than 75 percent of expenses.
(3) Sources of assistance.--The federal contribution
may be provided entirely from amounts authorized under
this section or in combination with amounts provided
under other federal or federal grant programs.
(4) Federal share.--Notwithstanding any provision of
law limiting the federal share in those other programs,
amounts appropriated to carry out this section may be
used to increase the federal share to the maximum
percentage cost of a grant authorized by this
subsection.
(c) Construction and Equipment Grants.--
(1) Additional uses for construction grants.--Grants
under this section for construction may also be used
for--
(A) the acquisition of privately owned
facilities--
(i) not operated for profit; or
(ii) previously operated for profit
if the Commission finds that health
services would not otherwise be
provided in the area served by the
facility if the acquisition is not
made; and
(B) initial equipment.
(2) Standards for making grants.--Grants under this
section for construction shall be made in accordance
with section 14523 of this title and shall not be
incompatible with the applicable provisions of title VI
of the Public Health Service Act (42 U.S.C. 291 et
seq.), the Developmental Disabilities Assistance and
Bill of Rights Act of 2000 (42 U.S.C. 15001 et seq.),
and other laws authorizing grants for the construction
of health-related facilities, without regard to any
provisions in those laws relating to appropriation
authorization ceilings or to allotments among the
States.
(3) Limitation on available amounts.--A grant for the
construction or equipment of any component of a
demonstration health project shall not be more than 80
percent of the cost.
(4) Sources of assistance.--The federal contribution
may be provided entirely from amounts authorized under
this section or in combination with amounts provided
under other federal grant programs for the construction
or equipment of health-related facilities.
(5) Federal share.--Notwithstanding any provision of
law limiting the federal share in those other programs,
amounts authorized under this section may be used to
increase federal grants for component facilities of a
demonstration health project to a maximum of 80 percent
of the cost of the facilities.
(d) Operation Grants.--
(1) Standards for making grants.--A grant for the
operation of a demonstration health project shall not
be made--
(A) unless the facility is publicly owned, or
owned by a public or private nonprofit
organization, and is not operated for profit;
(B) after five years following the
commencement of the initial grant for operation
of the project, except that child development
demonstrations assisted under this section
during fiscal year 1979 may be approved under
section 14322 of this title for continued
support beyond that period, on request of the
State, if the Commission finds that no federal,
state, or local amounts are available to
continue the project; and
(C) unless the Secretary of Health and Human
Services is satisfied that the operation of the
project will be conducted under efficient
management practices designed to obviate
operating deficits.
(2) Limitation on available amounts.--Grants under
this section for the operation (including initial
operating amounts and operating deficits, which include
the cost of attracting, training, and retaining
qualified personnel) of a demonstration health project,
whether or not constructed with amounts authorized to
be appropriated by this section, may be made for up
to--
(A) 50 percent of the cost of that operation;
(B) in the case of a project to be carried
out in a county for which a distressed county
designation is in effect under section 14526,
80 percent of the cost of that operation; or
(C) in the case of a project to be carried
out for a county for which an at-risk county
designation is in effect under section 14526,
70 percent of the cost of that operation.
(3) Sources of assistance.--The federal contribution
may be provided entirely from amounts appropriated to
carry out this section or in combination with amounts
provided under other federal grant programs for the
operation of health related facilities and the
provision of health and child development services,
including parts A and B of title IV and title XX of the
Social Security Act (42 U.S.C. 601 et seq., 620 et
seq., 1397 et seq.).
(4) Federal share.--Notwithstanding any provision of
law limiting the federal share in those other programs,
amounts appropriated to carry out this section may be
used to increase federal grants for operating
components of a demonstration health project to the
maximum percentage cost of a grant authorized by this
subsection.
(5) State deemed to meet requirement of providing
assistance or services on statewide basis.--
Notwithstanding any provision of the Social Security
Act (42 U.S.C. 301 et seq.) requiring assistance or
services on a statewide basis, a State providing
assistance or services under a federal grant program
described in paragraph (2) in any area of the region
approved by the Commission is deemed to be meeting that
requirement.
(e) Grant Sources and Use of Grants in Computing
Allotments.--Grants under this section--
(1) shall be made only out of amounts specifically
appropriated for the purpose of carrying out this
subtitle; and
(2) shall not be taken into account in computing
allotments among the States under any other law.
(f) Maximum Commission Contribution.--
(1) In general.--Subject to paragraphs (2) and (3),
the Commission may contribute not more than 50 percent
of any project cost eligible for financial assistance
under this section from amounts appropriated to carry
out this subtitle.
(2) Distressed counties.--The maximum Commission
contribution for a project to be carried out in a
county for which a distressed county designation is in
effect under section 14526 of this title may be
increased to the lesser of--
(A) 80 percent; or
(B) the maximum federal contribution
percentage authorized by this section.
(3) At-risk counties.--The maximum Commission
contribution for a project to be carried out in a
county for which an at-risk county designation is in
effect under section 14526 may be increased to the
lesser of--
(A) 70 percent; or
(B) the maximum Federal contribution
percentage authorized by this section.
(g) Emphasis on Occupational Diseases From Coal Mining.--To
provide for the further development of the Appalachian region's
human resources, grants under this section shall give special
emphasis to programs and research for the early detection,
diagnosis, and treatment of occupational diseases arising from
coal mining, such as black lung.
* * * * * * *
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PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE XX--ADOLESCENT FAMILY LIFE DEMONSTRATION PROJECTS
* * * * * * *
requirements for applications
Sec. 2006. (a) An application for a grant for a demonstration
project for services under this title shall be in such form and
contain such information as the Secretary may require, and
shall include--
(1) an identification of the incidence of adolescent
pregnancy and related problems;
(2) a description of the economic conditions and
income levels in the geographic area to be served;
(3) a description of existing pregnancy prevention
services and programs of care for pregnant adolescents
and adolescent parents (including adoption services),
and including where, how, by whom, and to which
population groups such services are provided, and the
extent to which they are coordinated in the geographic
area to be served;
(4) a description of the major unmet needs for
services for adolescents at risk of initial or
recurrent pregnancies and an estimate of the number of
adolescents not being served in the area;
(5)(A) in the case of an applicant who will provide
care services, a description of how all core services
will be provided in the demonstration project using
funds under this title or will otherwise be provided by
the grantee in the area to be served, the population to
which such services will be provided, how such services
will be coordinated, integrated, and linked with other
related programs and services and the source or sources
of funding of such core services in the public and
private sectors; or
(B) in the case of an applicant who will provide
prevention services, a description of the necessary
services to be provided and how the applicant will
provide such services;
(6) a description of the manner in which adolescents
needing services other than the services provided
directly by the applicant will be identified and how
access and appropriate referral to such other services
(such as medicaid; licensed adoption agencies;
maternity home services; public assistance; employment
services; child care services for adolescent parents;
and other city, county, and State programs related to
adolescent pregnancy) will be provided, including a
description of a plan to coordinate such other services
with the services supported under this title;
(7) a description of the applicant's capacity to
continue services as Federal funds decrease and in the
absence of Federal assistance;
(8) a description of the results expected from the
provision of services, and the procedures to be used
for evaluating those results;
(9) a summary of the views of public agencies,
providers of services, and the general public in the
geographic area to be served, concerning the proposed
use of funds provided for a demonstration project for
services under this title and a description of
procedures used to obtain those views, and, in the case
of applicants who propose to coordinate services
administered by a State, the written comments of the
appropriate State officials responsible for such
services;
(10) assurances that the applicant will have an
ongoing quality assurance program;
(11) assurances that, where appropriate, the
applicant shall have a system for maintaining the
confidentiality of patient records in accordance with
regulations promulgated by the Secretary;
(12) assurances that the applicant will demonstrate
its financial responsibility by the use of such
accounting procedures and other requirements as may be
prescribed by the Secretary;
(13) assurances that the applicant (A) has or will
have a contractual or other arrangement with the agency
of the State (in which the applicant provides services)
that administers or supervises the administration of a
State plan approved under title XIX of the Social
Security Act for the payment of all or a part of the
applicant's costs in providing health services to
persons who are eligible for medical assistance under
such a State plan, or (B) has made or will make every
reasonable effort to enter into such an arrangement;
(14) assurances that the applicant has made or will
make and will continue to make every reasonable effort
to collect appropriate reimbursement for its costs in
providing health services to persons who are entitled
to benefits under title V of the Social Security Act,
to medical assistance under a State plan approved under
title XIX of such Act, or to assistance for medical
expenses under any other public assistance program or
private health insurance program;
(15) assurances that the applicant has or will make
and will continue to make every reasonable effort to
collect appropriate reimbursement for its costs in
providing services to persons entitled to services
under parts B and E of title IV and title XX of the
Social Security Act;
(16)(A) a description of--
(i) the schedule of fees to be used in the
provision of services, which shall comply with
section 2004(c) and which shall be designed to
cover all reasonable direct and indirect costs
incurred by the applicant in providing
services; and
(ii) a corresponding schedule of discounts to
be applied to the payment of such fees, which
shall comply with section 2004(c) and which
shall be adjusted on the basis of the ability
of the eligible person to pay;
(B) assurances that the applicant has made and will
continue to make every reasonable effort--
(i) to secure from eligible persons payment
for services in accordance with such schedules;
(ii) to collect reimbursement for health or
other services provided to persons who are
entitled to have payment made on their behalf
for such services under any Federal or other
government program or private insurance
program; and
(iii) to seek such reimbursement on the basis
of the full amount of fees for services without
application of any discount; and
(C) assurances that the applicant has submitted or
will submit to the Secretary such reports as the
Secretary may require to determine compliance with this
paragraph;
(17) assurances that the applicant will make maximum
use of funds available under title X of this Act;
(18) assurances that the acceptance by any individual
of family planning services or family planning
information (including educational materials) provided
through financial assistance under this title shall be
voluntary and shall not be a prerequisite to
eligibility for or receipt of any other service
furnished by the applicant;
(19) assurances that fees collected by the applicant
for services rendered in accordance with this title
shall be used by the applicant to further the purposes
of this title;
(20) assurances that the applicant, if providing both
prevention and care services will not exclude or
discriminate against any adolescent who receives
prevention services and subsequently requires care
services as a pregnant adolescent;
(21) a description of how the applicant will, as
appropriate in the provision of services--
(A) involve families of adolescents in a
manner which will maximize the role of the
family in the solution of problems relating to
the parenthood or pregnancy of the adolescent;
(B) involve religious and charitable
organizations, voluntary associations, and
other groups in the private sector as well as
services provided by publicly sponsored
initiatives;
(22)(A) assurances that--
(i) except as provided in subparagraph (B)
and subject to clause (ii), the applicant will
notify the parents or guardians of any
unemancipated minor requesting services from
the applicant and, except as provided in
subparagraph (C), will obtain the permission of
such parents or guardians with respect to the
provision of such services; and
(ii) in the case of a pregnant unemancipated
minor requesting services from the applicant,
the applicant will notify the parents or
guardians of such minor under clause (i) within
a reasonable period of time;
(B) assurances that the applicant will not notify or
request the permission of the parents or guardian of
any unemancipated minor without the consent of the
minor--
(i) who solely is requesting from the
applicant pregnancy testing or testing or
treatment for venereal disease;
(ii) who is the victim of incest involving a
parent; or
(iii) if an adult sibling of the minor or an
adult aunt, uncle, or grandparent who is
related to the minor by blood certifies to the
grantee that notification of the parents or
guardians of such minor would result in
physical injury to such minor; and
(C) assurances that the applicant will not require,
with respect to the provision of services, the
permission of the parents or guardians of any pregnant
unemancipated minor if such parents or guardians are
attempting to compel such minor to have an abortion;
(23) assurances that primary emphasis for services
supported under this title shall be given to
adolescents seventeen and under who are not able to
obtain needed assistance through other means;
(24) assurances that funds received under this title
shall supplement and not supplant funds received from
any other Federal, State, or local program or any
private sources of funds; and
(25) a plan for the conduct of, and assurances that
the applicant will conduct, evaluations of the
effectiveness of the services supported under this
title in accordance with subsection (b).
(b)(1) Each grantee which receives funds for a demonstration
project for services under this title shall expend at least 1
per centum but not in excess of 5 per centum of the amounts
received under this title for the conduct of evaluations of the
services supported under this title. The Secretary may, for a
particular grantee upon good cause shown, waive the provisions
of the preceding sentence with respect to the amounts to be
expended on evaluations, but may not waive the requirement that
such evaluations be conducted.
(2) Evaluations required by paragraph (1) shall be conducted
by an organization or entity which is independent of the
grantee providing services supported under this title. To
assist in conducting the evaluations required by paragraph (1),
each grantee shall develop a working relationship with a
college or university located in the grantee's State which will
provide or assist in providing monitoring and evaluation of
services supported under this title unless no college or
university in the grantee's State is willing or has the
capacity to provide or assist in providing such monitoring and
assistance.
(3) The Secretary may provide technical assistance with
respect to the conduct of evaluations required under this
subsection to any grantee which is unable to develop a working
relationship with a college or university in the applicant's
State for the reasons described in paragraph (2).
(c) Each grantee which receives funds for a demonstration
project for services under this title shall make such reports
concerning its use of Federal funds as the Secretary may
require. Reports shall include, at such times as are considered
appropriate by the Secretary, the results of the evaluations of
the services supported under this title.
(d)(1) A grantee shall periodically notify the Secretary of
the exact number of instances in which a grantee does not
notify the parents or guardians of a pregnant unemancipated
minor under subsection (a)(22)(B)(iii).
(2) For purposes of subsection (a)(22)(B)(iii), the term
``adult'' means an adult as defined by State law.
(e) Each applicant shall provide the Governor of the State in
which the applicant is located a copy of each application
submitted to the Secretary for a grant for a demonstration
project for services under this title. The Governor shall
submit to the applicant comments on any such application within
the period of sixty days beginning on the day when the Governor
receives such copy. The applicant shall include the comments of
the Governor with such application.
(f) No application submitted for a grant for a demonstration
project for care services under this title may be approved
unless the Secretary is satisfied that core services shall be
available through the applicant within a reasonable time after
such grant is received.
* * * * * * *
----------
OLDER AMERICANS ACT OF 1965
* * * * * * *
TITLE II--ADMINISTRATION ON AGING
* * * * * * *
federal agency consultation
Sec. 203. (a)(1) The Assistant Secretary, in carrying out the
objectives and provisions of this Act, shall coordinate,
advise, consult with, and cooperate with the head of each
department, agency, or instrumentality of the Federal
Government proposing or administering programs or services
substantially related to the objectives of this Act, with
respect to such programs or services. In particular, the
Assistant Secretary shall coordinate, advise, consult, and
cooperate with the Secretary of Labor in carrying out title V
and with the Corporation for National and Community Service in
carrying out this Act.
(2) The head of each department, agency, or instrumentality
of the Federal Government proposing to establish programs and
services substantially related to the objectives of this Act
shall consult with the Assistant Secretary prior to the
establishment of such programs and services. To achieve
appropriate coordination, the head of each department, agency,
or instrumentality of the Federal Government administering any
program substantially related to the objectives of this Act,
particularly administering any program referred to in
subsection (b), shall consult and cooperate with the Assistant
Secretary in carrying out such program. In particular, the
Secretary of Labor shall consult and cooperate with the
Assistant Secretary in carrying out title I of the Workforce
Innovation and Opportunity Act.
(3) The head of each department, agency, or instrumentality
of the Federal Government administering programs and services
substantially related to the objectives of this Act shall
collaborate with the Assistant Secretary in carrying out this
Act, and shall develop a written analysis, for review and
comment by the Assistant Secretary, of the impact of such
programs and services on--
(A) older individuals (with particular attention to
low-income older individuals, including low-income
minority older individuals, older individuals with
limited English proficiency, and older individuals
residing in rural areas) and eligible individuals (as
defined in section 518); and
(B) the functions and responsibilities of State
agencies and area agencies on aging.
(b) For the purposes of subsection (a), programs related to
the objectives of this Act shall include--
(1) title I of the Workforce Innovation and
Opportunity Act,
(2) title II of the Domestic Volunteer Service Act of
1973,
(3) titles XVI, XVIII, XIX, and XX of the Social
Security Act,
(4) sections 231 and 232 of the National Housing Act,
(5) the United States Housing Act of 1937,
(6) section 202 of the Housing Act of 1959,
(7) title I of the Housing and Community Development
Act of 1974,
(8) title I of the Higher Education Act of 1965 and
the Adult Education and Family Literacy Act,
(9) sections 3, 9, and 16 of the Urban Mass
Transportation Act of 1964,
(10) the Public Health Service Act, including block
grants under title XIX of such Act,
(11) the Low-Income Home Energy Assistance Act of
1981,
(12) part A of the Energy Conservation in Existing
Buildings Act of 1976, relating to weatherization
assistance for low income persons,
(13) the Community Services Block Grant Act,
(14) demographic statistics and analysis programs
conducted by the Bureau of the Census under title 13,
United States Code,
(15) parts II and III of title 38, United States
Code,
(16) the Rehabilitation Act of 1973,
(17) the Developmental Disabilities Assistance and
Bill of Rights Act of 2000,
(18) the Edward Byrne Memorial State and Local Law
Enforcement Assistance Programs, established under part
E of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (42 U.S.C. 3750-3766b)), and
(19) sections 4 and 5 of the Assistive Technology Act
of 1998 (29 U.S.C. 3003, 3004).
(c)(1) The Secretary, in collaboration with the Federal
officials specified in paragraph (2), shall establish an
Interagency Coordinating Committee on Aging (referred to in
this subsection as the ``Committee'') focusing on the
coordination of agencies with respect to aging issues.
(2) The officials referred to in paragraph (1) shall include
the Secretary of Labor and the Secretary of Housing and Urban
Development, and may include, at the direction of the
President, the Attorney General, the Secretary of
Transportation, the Secretary of the Treasury, the Secretary of
Agriculture, the Secretary of Homeland Security, the
Commissioner of Social Security, and such other Federal
officials as the President may direct. An official described in
this paragraph may appoint a designee to carry out the
official's duties under paragraph (1).
(3) The Secretary of Health and Human Services shall serve as
the first chairperson of the Committee, for 1 term, and the
Secretary of Housing and Urban Development shall serve as the
chairperson for the following term. After that following term,
the Committee shall select a chairperson from among the members
of the Committee, and any member may serve as the chairperson.
No member may serve as the chairperson for more than 1
consecutive term.
(4) For purposes of this subsection, a term shall be a period
of 2 calendar years.
(5) The Committee shall meet not less often than once each
year.
(6) The Committee shall--
(A) share information with and establish an ongoing
system to improve coordination among Federal agencies
with responsibility for programs and services for older
individuals and recommend improvements to such system
with an emphasis on--
(i) improving access to programs and services
for older individuals;
(ii) maximizing the impact of federally
funded programs and services for older
individuals by increasing the efficiency,
effectiveness, and delivery of such programs
and services;
(iii) planning and preparing for the impact
of demographic changes on programs and services
for older individuals; and
(iv) reducing or eliminating areas of overlap
and duplication by Federal agencies in the
provision and accessibility of such programs
and services;
(B) identify, promote, and implement (as
appropriate), best practices and evidence-based program
and service models to assist older individuals in
meeting their housing, health care, and other
supportive service needs, including--
(i) consumer-directed care models for home
and community-based care and supportive
services that link housing, health care, and
other supportive services and that facilitate
aging in place, enabling older individuals to
remain in their homes and communities as the
individuals age; and
(ii) innovations in technology applications
(including assistive technology devices and
assistive technology services) that give older
individuals access to information on available
services or that help in providing services to
older individuals;
(C) collect and disseminate information about older
individuals and the programs and services available to
the individuals to ensure that the individuals can
access comprehensive information;
(D) work with the Federal Interagency Forum on Aging-
Related Statistics, the Bureau of the Census, and
member agencies to ensure the continued collection of
data relating to the housing, health care, and other
supportive service needs of older individuals and to
support efforts to identify and address unmet data
needs;
(E) actively seek input from and consult with
nongovernmental experts and organizations, including
public health interest and research groups and
foundations about the activities described in
subparagraphs (A) through (F);
(F) identify any barriers and impediments, including
barriers and impediments in statutory and regulatory
law, to the access and use by older individuals of
federally funded programs and services; and
(G) work with States to better provide housing,
health care, and other supportive services to older
individuals by--
(i) holding meetings with State agencies;
(ii) providing ongoing technical assistance
to States about better meeting the needs of
older individuals; and
(iii) working with States to designate
liaisons, from the State agencies, to the
Committee.
(7) Not later than 90 days following the end of each term,
the Committee shall prepare and submit to the Committee on
Financial Services of the House of Representatives, the
Committee on Education and the Workforce of the House of
Representatives, the Committee on Energy and Commerce of the
House of Representatives, the Committee on Ways and Means of
the House of Representatives, the Committee on Banking,
Housing, and Urban Affairs of the Senate, the Committee on
Health, Education, Labor, and Pensions of the Senate, and the
Special Committee on Aging of the Senate, a report that--
(A) describes the activities and accomplishments of
the Committee in--
(i) enhancing the overall coordination of
federally funded programs and services for
older individuals; and
(ii) meeting the requirements of paragraph
(6);
(B) incorporates an analysis from the head of each
agency that is a member of the interagency coordinating
committee established under paragraph (1) that
describes the barriers and impediments, including
barriers and impediments in statutory and regulatory
law (as the chairperson of the Committee determines to
be appropriate), to the access and use by older
individuals of programs and services administered by
such agency; and
(C) makes such recommendations as the chairman
determines to be appropriate for actions to meet the
needs described in paragraph (6) and for coordinating
programs and services designed to meet those needs.
(8) On the request of the Committee, any Federal Government
employee may be detailed to the Committee without
reimbursement, and such detail shall be without interruption or
loss of civil service status or privilege.
* * * * * * *
surplus property eligibility
Sec. 213. Any State or local government agency, and any
nonprofit organization or institution, which receives funds
appropriated for programs for older individuals under this Act,
under title IV or title XX of the Social Security Act, or under
titles VIII and X of the Economic Opportunity Act of 1964 and
the Community Services Block Grant Act, shall be deemed
eligible to receive for such programs, property which is
declared surplus to the needs of the Federal Government in
accordance with laws applicable to surplus property.
* * * * * * *
TITLE III--GRANTS FOR STATE AND COMMUNITY PROGRAMS ON AGING
Part A--General Provisions
* * * * * * *
area plans
Sec. 306. (a) Each area agency on aging designated under
section 305(a)(2)(A) shall, in order to be approved by the
State agency, prepare and develop an area plan for a planning
and service area for a two-, three-, or four-year period
determined by the State agency, with such annual adjustments as
may be necessary. Each such plan shall be based upon a uniform
format for area plans within the State prepared in accordance
with section 307(a)(1). Each such plan shall--
(1) provide, through a comprehensive and coordinated
system, for supportive services, nutrition services,
and, where appropriate, for the establishment,
maintenance, or construction of multipurpose senior
centers, within the planning and service area covered
by the plan, including determining the extent of need
for supportive services, nutrition services, and
multipurpose senior centers in such area (taking into
consideration, among other things, the number of older
individuals with low incomes residing in such area, the
number of older individuals who have greatest economic
need (with particular attention to low-income older
individuals, including low-income minority older
individuals, older individuals with limited English
proficiency, and older individuals residing in rural
areas) residing in such area, the number of older
individuals who have greatest social need (with
particular attention to low-income older individuals,
including low-income minority older individuals, older
individuals with limited English proficiency, and older
individuals residing in rural areas) residing in such
area, and the number of older individuals who are
Indians residing in such area, and the efforts of
voluntary organizations in the community), evaluating
the effectiveness of the use of resources in meeting
such need, and entering into agreements with providers
of supportive services, nutrition services, or
multipurpose senior centers in such area, for the
provision of such services or centers to meet such
need;
(2) provide assurances that an adequate proportion,
as required under section 307(a)(2), of the amount
allotted for part B to the planning and service area
will be expended for the delivery of each of the
following categories of services--
(A) services associated with access to
services (transportation, health services
(including mental health services), outreach,
information and assistance (which may include
information and assistance to consumers on
availability of services under part B and how
to receive benefits under and participate in
publicly supported programs for which the
consumer may be eligible), and case management
services);
(B) in-home services, including supportive
services for families of older individuals who
are victims of Alzheimer's disease and related
disorders with neurological and organic brain
dysfunction; and
(C) legal assistance;
and assurances that the area agency on aging will
report annually to the State agency in detail the
amount of funds expended for each such category during
the fiscal year most recently concluded;
(3)(A) designate, where feasible, a focal point for
comprehensive service delivery in each community,
giving special consideration to designating
multipurpose senior centers (including multipurpose
senior centers operated by organizations referred to in
paragraph (6)(C)) as such focal point; and
(B) specify, in grants, contracts, and agreements
implementing the plan, the identity of each focal point
so designated;
(4)(A)(i)(I) provide assurances that the area agency
on aging will--
(aa) set specific objectives, consistent with
State policy, for providing services to older
individuals with greatest economic need, older
individuals with greatest social need, and
older individuals at risk for institutional
placement;
(bb) include specific objectives for
providing services to low-income minority older
individuals, older individuals with limited
English proficiency, and older individuals
residing in rural areas; and
(II) include proposed methods to achieve the
objectives described in items (aa) and (bb) of
subclause (I);
(ii) provide assurances that the area agency on aging
will include in each agreement made with a provider of
any service under this title, a requirement that such
provider will--
(I) specify how the provider intends to
satisfy the service needs of low-income
minority individuals, older individuals with
limited English proficiency, and older
individuals residing in rural areas in the area
served by the provider;
(II) to the maximum extent feasible, provide
services to low-income minority individuals,
older individuals with limited English
proficiency, and older individuals residing in
rural areas in accordance with their need for
such services; and
(III) meet specific objectives established by
the area agency on aging, for providing
services to low-income minority individuals,
older individuals with limited English
proficiency, and older individuals residing in
rural areas within the planning and service
area; and
(iii) with respect to the fiscal year preceding the
fiscal year for which such plan is prepared--
(I) identify the number of low-income
minority older individuals in the planning and
service area;
(II) describe the methods used to satisfy the
service needs of such minority older
individuals; and
(III) provide information on the extent to
which the area agency on aging met the
objectives described in clause (i);
(B) provide assurances that the area agency on aging
will use outreach efforts that will--
(i) identify individuals eligible for
assistance under this Act, with special
emphasis on--
(I) older individuals residing in
rural areas;
(II) older individuals with greatest
economic need (with particular
attention to low-income minority
individuals and older individuals
residing in rural areas);
(III) older individuals with greatest
social need (with particular attention
to low-income minority individuals and
older individuals residing in rural
areas);
(IV) older individuals with severe
disabilities;
(V) older individuals with limited
English proficiency;
(VI) older individuals with
Alzheimer's disease and related
disorders with neurological and organic
brain dysfunction (and the caretakers
of such individuals); and
(VII) older individuals at risk for
institutional placement; and
(ii) inform the older individuals referred to
in subclauses (I) through (VI) of clause (i),
and the caretakers of such individuals, of the
availability of such assistance; and
(C) contain an assurance that the area agency on
aging will ensure that each activity undertaken by the
agency, including planning, advocacy, and systems
development, will include a focus on the needs of low-
income minority older individuals and older individuals
residing in rural areas;
(5) provide assurances that the area agency on aging
will coordinate planning, identification, assessment of
needs, and provision of services for older individuals
with disabilities, with particular attention to
individuals with severe disabilities and individuals at
risk for institutional placement, with agencies that
develop or provide services for individuals with
disabilities;
(6) provide that the area agency on aging will--
(A) take into account in connection with
matters of general policy arising in the
development and administration of the area
plan, the views of recipients of services under
such plan;
(B) serve as the advocate and focal point for
older individuals within the community by (in
cooperation with agencies, organizations, and
individuals participating in activities under
the plan) monitoring, evaluating, and
commenting upon all policies, programs,
hearings, levies, and community actions which
will affect older individuals;
(C)(i) where possible, enter into
arrangements with organizations providing day
care services for children, assistance to older
individuals caring for relatives who are
children, and respite for families, so as to
provide opportunities for older individuals to
aid or assist on a voluntary basis in the
delivery of such services to children, adults,
and families;
(ii) if possible regarding the provision of
services under this title, enter into
arrangements and coordinate with organizations
that have a proven record of providing services
to older individuals, that--
(I) were officially designated as
community action agencies or community
action programs under section 210 of
the Economic Opportunity Act of 1964
(42 U.S.C. 2790) for fiscal year 1981,
and did not lose the designation as a
result of failure to comply with such
Act; or
(II) came into existence during
fiscal year 1982 as direct successors
in interest to such community action
agencies or community action programs;
and that meet the requirements under section
676B of the Community Services Block Grant Act;
and
(iii) make use of trained volunteers in
providing direct services delivered to older
individuals and individuals with disabilities
needing such services and, if possible, work in
coordination with organizations that have
experience in providing training, placement,
and stipends for volunteers or participants
(such as organizations carrying out Federal
service programs administered by the
Corporation for National and Community
Service), in community service settings;
(D) establish an advisory council consisting
of older individuals (including minority
individuals and older individuals residing in
rural areas) who are participants or who are
eligible to participate in programs assisted
under this Act, family caregivers of such
individuals, representatives of older
individuals, service providers, representatives
of the business community, local elected
officials, providers of veterans' health care
(if appropriate), and the general public, to
advise continuously the area agency on aging on
all matters relating to the development of the
area plan, the administration of the plan and
operations conducted under the plan;
(E) establish effective and efficient
procedures for coordination of--
(i) entities conducting programs that
receive assistance under this Act
within the planning and service area
served by the agency; and
(ii) entities conducting other
Federal programs for older individuals
at the local level, with particular
emphasis on entities conducting
programs described in section 203(b),
within the area;
(F) in coordination with the State agency and
with the State agency responsible for mental
health services, increase public awareness of
mental health disorders, remove barriers to
diagnosis and treatment, and coordinate mental
health services (including mental health
screenings) provided with funds expended by the
area agency on aging with mental health
services provided by community health centers
and by other public agencies and nonprofit
private organizations;
(G) if there is a significant population of
older individuals who are Indians in the
planning and service area of the area agency on
aging, the area agency on aging shall conduct
outreach activities to identify such
individuals in such area and shall inform such
individuals of the availability of assistance
under this Act;
(7) provide that the area agency on aging shall,
consistent with this section, facilitate the area-wide
development and implementation of a comprehensive,
coordinated system for providing long-term care in home
and community-based settings, in a manner responsive to
the needs and preferences of older individuals and
their family caregivers, by--
(A) collaborating, coordinating activities,
and consulting with other local public and
private agencies and organizations responsible
for administering programs, benefits, and
services related to providing long-term care;
(B) conducting analyses and making
recommendations with respect to strategies for
modifying the local system of long-term care to
better--
(i) respond to the needs and
preferences of older individuals and
family caregivers;
(ii) facilitate the provision, by
service providers, of long-term care in
home and community-based settings; and
(iii) target services to older
individuals at risk for institutional
placement, to permit such individuals
to remain in home and community-based
settings;
(C) implementing, through the agency or
service providers, evidence-based programs to
assist older individuals and their family
caregivers in learning about and making
behavioral changes intended to reduce the risk
of injury, disease, and disability among older
individuals; and
(D) providing for the availability and
distribution (through public education
campaigns, Aging and Disability Resource
Centers, the area agency on aging itself, and
other appropriate means) of information
relating to--
(i) the need to plan in advance for
long-term care; and
(ii) the full range of available
public and private long-term care
(including integrated long-term care)
programs, options, service providers,
and resources;
(8) provide that case management services provided
under this title through the area agency on aging
will--
(A) not duplicate case management services
provided through other Federal and State
programs;
(B) be coordinated with services described in
subparagraph (A); and
(C) be provided by a public agency or a
nonprofit private agency that--
(i) gives each older individual
seeking services under this title a
list of agencies that provide similar
services within the jurisdiction of the
area agency on aging;
(ii) gives each individual described
in clause (i) a statement specifying
that the individual has a right to make
an independent choice of service
providers and documents receipt by such
individual of such statement;
(iii) has case managers acting as
agents for the individuals receiving
the services and not as promoters for
the agency providing such services; or
(iv) is located in a rural area and
obtains a waiver of the requirements
described in clauses (i) through (iii);
(9) provide assurances that the area agency on aging,
in carrying out the State Long-Term Care Ombudsman
program under section 307(a)(9), will expend not less
than the total amount of funds appropriated under this
Act and expended by the agency in fiscal year 2000 in
carrying out such a program under this title;
(10) provide a grievance procedure for older
individuals who are dissatisfied with or denied
services under this title;
(11) provide information and assurances concerning
services to older individuals who are Native Americans
(referred to in this paragraph as ``older Native
Americans''), including--
(A) information concerning whether there is a
significant population of older Native
Americans in the planning and service area and
if so, an assurance that the area agency on
aging will pursue activities, including
outreach, to increase access of those older
Native Americans to programs and benefits
provided under this title;
(B) an assurance that the area agency on
aging will, to the maximum extent practicable,
coordinate the services the agency provides
under this title with services provided under
title VI; and
(C) an assurance that the area agency on
aging will make services under the area plan
available, to the same extent as such services
are available to older individuals within the
planning and service area, to older Native
Americans; and
(12) provide that the area agency on aging will
establish procedures for coordination of services with
entities conducting other Federal or federally assisted
programs for older individuals at the local level, with
particular emphasis on entities conducting programs
described in section 203(b) within the planning and
service area.
(13) provide assurances that the area agency on aging
will--
(A) maintain the integrity and public purpose
of services provided, and service providers,
under this title in all contractual and
commercial relationships;
(B) disclose to the Assistant Secretary and
the State agency--
(i) the identity of each
nongovernmental entity with which such
agency has a contract or commercial
relationship relating to providing any
service to older individuals; and
(ii) the nature of such contract or
such relationship;
(C) demonstrate that a loss or diminution in
the quantity or quality of the services
provided, or to be provided, under this title
by such agency has not resulted and will not
result from such contract or such relationship;
(D) demonstrate that the quantity or quality
of the services to be provided under this title
by such agency will be enhanced as a result of
such contract or such relationship; and
(E) on the request of the Assistant Secretary
or the State, for the purpose of monitoring
compliance with this Act (including conducting
an audit), disclose all sources and
expenditures of funds such agency receives or
expends to provide services to older
individuals;
(14) provide assurances that preference in receiving
services under this title will not be given by the area
agency on aging to particular older individuals as a
result of a contract or commercial relationship that is
not carried out to implement this title;
(15) provide assurances that funds received under
this title will be used--
(A) to provide benefits and services to older
individuals, giving priority to older
individuals identified in paragraph (4)(A)(i);
and
(B) in compliance with the assurances
specified in paragraph (13) and the limitations
specified in section 212;
(16) provide, to the extent feasible, for the
furnishing of services under this Act, consistent with
self-directed care; and
(17) include information detailing how the area
agency on aging will coordinate activities, and develop
long-range emergency preparedness plans, with local and
State emergency response agencies, relief
organizations, local and State governments, and any
other institutions that have responsibility for
disaster relief service delivery.
(b)(1) An area agency on aging may include in the area plan
an assessment of how prepared the area agency on aging and
service providers in the planning and service area are for any
anticipated change in the number of older individuals during
the 10-year period following the fiscal year for which the plan
is submitted.
(2) Such assessment may include--
(A) the projected change in the number of older
individuals in the planning and service area;
(B) an analysis of how such change may affect such
individuals, including individuals with low incomes,
individuals with greatest economic need, minority older
individuals, older individuals residing in rural areas,
and older individuals with limited English proficiency;
(C) an analysis of how the programs, policies, and
services provided by such area agency can be improved,
and how resource levels can be adjusted to meet the
needs of the changing population of older individuals
in the planning and service area; and
(D) an analysis of how the change in the number of
individuals age 85 and older in the planning and
service area is expected to affect the need for
supportive services.
(3) An area agency on aging, in cooperation with government
officials, State agencies, tribal organizations, or local
entities, may make recommendations to government officials in
the planning and service area and the State, on actions
determined by the area agency to build the capacity in the
planning and service area to meet the needs of older
individuals for--
(A) health and human services;
(B) land use;
(C) housing;
(D) transportation;
(E) public safety;
(F) workforce and economic development;
(G) recreation;
(H) education;
(I) civic engagement;
(J) emergency preparedness; and
(K) any other service as determined by such agency.
(c) Each State, in approving area agency on aging plans under
this section, shall waive the requirement described in
paragraph (2) of subsection (a) for any category of services
described in such paragraph if the area agency on aging
demonstrates to the State agency that services being furnished
for such category in the area are sufficient to meet the need
for such services in such area and had conducted a timely
public hearing upon request.
(d)(1) Subject to regulations prescribed by the Assistant
Secretary, an area agency on aging designated under section
305(a)(2)(A) or, in areas of a State where no such agency has
been designated, the State agency, may enter into agreement
with agencies administering programs under the Rehabilitation
Act of 1973, and titles XIX and XX of the Social Security Act
for the purpose of developing and implementing plans for
meeting the common need for transportation services of
individuals receiving benefits under such Acts and older
individuals participating in programs authorized by this title.
(2) In accordance with an agreement entered into under
paragraph (1), funds appropriated under this title may be used
to purchase transportation services for older individuals and
may be pooled with funds made available for the provision of
transportation services under the Rehabilitation Act of 1973,
and titles XIX and XX of the Social Security Act.
(e) An area agency on aging may not require any provider of
legal assistance under this title to reveal any information
that is protected by the attorney-client privilege.
(f)(1) If the head of a State agency finds that an area
agency on aging has failed to comply with Federal or State
laws, including the area plan requirements of this section,
regulations, or policies, the State may withhold a portion of
the funds to the area agency on aging available under this
title.
(2)(A) The head of a State agency shall not make a final
determination withholding funds under paragraph (1) without
first affording the area agency on aging due process in
accordance with procedures established by the State agency.
(B) At a minimum, such procedures shall include procedures
for--
(i) providing notice of an action to withhold funds;
(ii) providing documentation of the need for such
action; and
(iii) at the request of the area agency on aging,
conducting a public hearing concerning the action.
(3)(A) If a State agency withholds the funds, the State
agency may use the funds withheld to directly administer
programs under this title in the planning and service area
served by the area agency on aging for a period not to exceed
180 days, except as provided in subparagraph (B).
(B) If the State agency determines that the area agency on
aging has not taken corrective action, or if the State agency
does not approve the corrective action, during the 180-day
period described in subparagraph (A), the State agency may
extend the period for not more than 90 days.
* * * * * * *
----------
LOW-INCOME HOME ENERGY ASSISTANCE ACT OF 1981
* * * * * * *
TITLE XXVI--LOW-INCOME HOME ENERGY ASSISTANCE
* * * * * * *
applications and requirements
Sec. 2605. (a)(1) Each State desiring to receive an allotment
for any fiscal year under this title shall submit an
application to the Secretary. Each such application shall be in
such form as the Secretary shall require. Each such application
shall contain assurances by the chief executive officer of the
State that the State will meet the conditions enumerated in
subsection (b).
(2) After the expiration of the first fiscal year for which a
State receives funds under this title, no funds shall be
allotted to such State for any fiscal year under this title
unless such State conduct public hearings with respect to the
proposed use and distribution of funds to be provided under
this title for such fiscal year.
(b) As part of the annual application required by subsection
(a), the chief executive officer of each State shall certify
that the State agrees to--
(1) use the funds available under this title to--
(A) conduct outreach activities and provide
assistance to low income households in meeting
their home energy costs, particularly those
with the lowest incomes that pay a high
proportion of household income for home energy,
consistent with paragraph (5);
(B) intervene in energy crisis situations;
(C) provide low-cost residential
weatherization and other cost-effective energy-
related home repair; and
(D) plan, develop, and administer the State's
program under this title including leveraging
programs,
and the State agrees not to use such funds for any
purposes other than those specified in this title;
(2) make payments under this title only with respect
to--
(A) households in which 1 or more individuals
are receiving--
(i) assistance under the State
program funded under part A of title IV
of the Social Security Act;
(ii) supplemental security income
payments under title XVI of the Social
Security Act;
(iii) supplemental nutrition
assistance program benefits under the
Food and Nutrition Act of 2008; or
(iv) payments under section 415, 521,
541, or 542 of title 38, United States
Code, or under section 306 of the
Veterans' and Survivors' Pension
Improvement Act of 1978; or
(B) households with incomes which do not
exceed the greater of--
(i) an amount equal to 150 percent of
the poverty level for such State; or
(ii) an amount equal to 60 percent of
the State median income;
except that a State may not exclude a household
from eligibility in a fiscal year solely on the
basis of household income if such income is
less than 110 percent of the poverty level for
such State, but the State may give priority to
those households with the highest home energy
costs or needs in relation to household income;
(3) conduct outreach activities designed to assure
that eligible households, especially households with
elderly individuals or disabled individuals, or both,
and households with high home energy burdens, are made
aware of the assistance available under this title, and
any similar energy-related assistance available under
subtitle B of title VI (relating to community services
block grant program) or under any other provision of
law which carries out programs which were administered
under the Economic Opportunity Act of 1964 before the
date of the enactment of this Act;
(4) coordinate its activities under this title with
similar and related programs administered by the
Federal Government and such State, particularly low-
income energy-related programs under subtitle B of
title VI (relating to community services block grant
program), under the supplemental security income
program, under part A of title IV of the Social
Security Act, under title XX of the Social Security
Act, under the low-income weatherization assistance
program under title IV of the Energy Conservation and
Production Act, or under any other provision of law
which carries out programs which were administered
under the Economic Opportunity Act of 1964 before the
date of the enactment of this Act;
(5) provide, in a timely manner, that the highest
level of assistance will be furnished to those
households which have the lowest incomes and the
highest energy costs or needs in relation to income,
taking into account family size, except that the State
may not differentiate in implementing this section
between the households described in clauses (2)(A) and
(2)(B) of this subsection;
(6) to the extent it is necessary to designate local
administrative agencies in order to carry out the
purposes of this title, to give special consideration,
in the designation of such agencies, to any local
public or private nonprofit agency which was receiving
Federal funds under any low-income energy assistance
program or weatherization program under the Economic
Opportunity Act of 1964 or any other provision of law
on the day before the date of the enactment of this
Act, except that--
(A) the State shall, before giving such
special consideration, determine that the
agency involved meets program and fiscal
requirements established by the State; and
(B) if there is no such agency because of any
change in the assistance furnished to programs
for economically disadvantaged persons, then
the State shall give special consideration in
the designation of local administrative
agencies to any successor agency which is
operated in substantially the same manner as
the predecessor agency which did receive funds
for the fiscal year preceding the fiscal year
for which the determination is made;
(7) if the State chooses to pay home energy suppliers
directly, establish procedures to--
(A) notify each participating household of
the amount of assistance paid on its behalf;
(B) assure that the home energy supplier will
charge the eligible household, in the normal
billing process, the difference between the
actual cost of the home energy and the amount
of the payment made by the State under this
title;
(C) assure that the home energy supplier will
provide assurances that any agreement entered
into with a home energy supplier under this
paragraph will contain provisions to assure
that no household receiving assistance under
this title will be treated adversely because of
such assistance under applicable provisions of
State law or public regulatory requirements;
and
(D) ensure that the provision of vendored
payments remains at the option of the State in
consultation with local grantees and may be
contingent on unregulated vendors taking
appropriate measures to alleviate the energy
burdens of eligible households, including
providing for agreements between suppliers and
individuals eligible for benefits under this
Act that seek to reduce home energy costs,
minimize the risks of home energy crisis, and
encourage regular payments by individuals
receiving financial assistance for home energy
costs;
(8) provide assurances that (A) the State will not
exclude households described in clause (2)(B) of this
subsection from receiving home energy assistance
benefits under clause (2), and (B) the State will treat
owners and renters equitably under the program assisted
under this title;
(9) provide that--
(A) the State may use for planning and
administering the use of funds under this title
an amount not to exceed 10 percent of the funds
payable to such State under this title for a
fiscal year; and
(B) the State will pay from non-Federal
sources the remaining costs of planning and
administering the program assisted under this
title and will not use Federal funds for such
remaining costs (except for the costs of the
activities described in paragraph (16));
(10) provide that such fiscal control and fund
accounting procedures will be established as may be
necessary to assure the proper disbursal of and
accounting for Federal funds paid to the State under
this title, including procedures for monitoring the
assistance provided under this title, and provide that
the State will comply with the provisions of chapter 75
of title 31, United States Code (commonly known as the
``Single Audit Act'');
(11) permit and cooperate with Federal investigations
undertaken in accordance with section 2608;
(12) provide for timely and meaningful public
participation in the development of the plan described
in subsection (c);
(13) provide an opportunity for a fair administrative
hearing to individuals whose claims for assistance
under the plan described in subsection (c) are denied
or are not acted upon with reasonable promptness;
(14) cooperate with the Secretary with respect to
data collecting and reporting under section 2610;
(15) beginning in fiscal year 1992, provide, in
addition to such services as may be offered by State
Departments of Public Welfare at the local level,
outreach and intake functions for crisis situations and
heating and cooling assistance that is administered by
additional State and local governmental entities or
community-based organizations (such as community action
agencies, area agencies on aging, and not-for-profit
neighborhood-based organizations), and in States where
such organizations do not administer intake functions
as of September 30, 1991, preference in awarding grants
or contracts for intake services shall be provided to
those agencies that administer the low-income
weatherization or energy crisis intervention programs;
and
(16) use up to 5 percent of such funds, at its
option, to provide services that encourage and enable
households to reduce their home energy needs and
thereby the need for energy assistance, including needs
assessments, counseling, and assistance with energy
vendors, and report to the Secretary concerning the
impact of such activities on the number of households
served, the level of direct benefits provided to those
households, and the number of households that remain
unserved.
The Secretary may not prescribe the manner in which the States
will comply with the provisions of this subsection. The
Secretary shall issue regulations to prevent waste, fraud, and
abuse in the programs assisted by this title. Not later than 18
months after the date of the enactment of the Low-Income Home
Energy Assistance Amendments of 1994, the Secretary shall
develop model performance goals and measurements in
consultation with State, territorial, tribal, and local
grantees, that the States may use to assess the success of the
States in achieving the purposes of this title. The model
performance goals and measurements shall be made available to
States to be incorporated, at the option of the States, into
the plans for fiscal year 1997. The Secretary may request data
relevant to the development of model performance goals and
measurements.
(c)(1) As part of the annual application required in
subsection (a), the chief executive officer of each State shall
prepare and furnish to the Secretary, in such format as the
Secretary may require, a plan which--
(A) describes the eligibility requirements to be used
by the State for each type of assistance to be provided
under this title, including criteria for designating an
emergency under section 2604(c);
(B) describes the benefit levels to be used by the
State for each type of assistance including assistance
to be provided for emergency crisis intervention and
for weatherization and other energy-related home
repair;
(C) contains estimates of the amount of funds the
State will use for each of the programs under such plan
and describes the alternative use of funds reserved
under section 2604(c) in the event any portion of the
amount so reserved is not expended for emergencies;
(D) describes weatherization and other energy-related
home repair the State will provide under subsection
(k), including any steps the State will take to address
the weatherization and energy-related home repair needs
of households that have high home energy burdens, and
describes any rules promulgated by the Department of
Energy for administration of its Low Income
Weatherization Assistance Program which the State, to
the extent permitted by the Secretary to increase
consistency between federally assisted programs, will
follow regarding the use of funds provided under this
title by the State for such weatherization and energy-
related home repairs and improvements;
(E) describes any steps that will be taken (in
addition to those necessary to carry out the assurance
contained in paragraph (5) of subsection (b)) to target
assistance to households with high home energy burdens;
(F) describes how the State will carry out assurances
in clauses (3), (4), (5), (6), (7), (8), (10), (12),
(13), and (15) of subsection (b);
(G) states, with respect to the 12-month period
specified by the Secretary, the number and income
levels of households which apply and the number which
are assisted with funds provided under this title, and
the number of households so assisted with--
(i) one or more members who had attained 60
years of age;
(ii) one or more members who were disabled;
and
(iii) one or more young children; and
(H) contains any other information determined by the
Secretary to be appropriate for purposes of this title.
The chief executive officer may revise any plan prepared under
this paragraph and shall furnish the revised plan to the
Secretary.
(2) Each plan prepared under paragraph (1) and each
substantial revision thereof shall be made available for public
inspection within the State involved in such a manner as will
facilitate timely and meaningful review of, and comment upon,
such plan or substantial revision.
(3) Not later than April 1 of each fiscal year the Secretary
shall make available to the States a model State plan format
that may be used, at the option of each State, to prepare the
plan required under paragraph (1) for the next fiscal year.
(d) The State shall expend funds in accordance with the State
plan under this title or in accordance with revisions
applicable to such plan.
(e) Each State shall, in carrying out the requirements of
subsection (b)(10), obtain financial and compliance audits of
any funds which the State receives under this title. Such
audits shall be made public within the State on a timely basis.
The audits shall be conducted in accordance with chapter 75 of
title 31, United States Code.
(f)(1) Notwithstanding any other provision of law unless
enacted in express limitation of this paragraph, the amount of
any home energy assistance payments or allowances provided
directly to, or indirectly for the benefit of, an eligible
household under this title shall not be considered income or
resources of such household (or any member thereof) for any
purpose under any Federal or State law, including any law
relating to taxation, supplemental nutrition assistance program
benefits, public assistance, or welfare programs.
(2) For purposes of paragraph (1) of this subsection and for
purposes of determining any excess shelter expense deduction
under section 5(e) of the Food and Nutrition Act of 2008 (7
U.S.C. 2014(e))--
(A) the full amount of such payments or allowances
shall be deemed to be expended by such household for
heating or cooling expenses, without regard to whether
such payments or allowances are provided directly to,
or indirectly for the benefit of, such household,
except that, for purposes of the supplemental nutrition
assistance program established under the Food and
Nutrition Act of 2008 (7 U.S.C. 2011 et seq.), such
payments or allowances were greater than $20 annually,
consistent with section 5(e)(6)(C)(iv)(I) of that Act
(7 U.S.C. 2014(e)(6)(C)(iv)(I)), as determined by the
Secretary of Agriculture; and
(B) no distinction may be made among households on
the basis of whether such payments or allowances are
provided directly to, or indirectly for the benefit of,
any of such households.
(g) The State shall repay to the United States amounts found
not to have been expended in accordance with this title or the
Secretary may offset such amounts against any other amount to
which the State is or may become entitled under this title.
(h) The Comptroller General of the United States shall, from
time to time evaluate the expenditures by States of grants
under this title in order to assure that expenditures are
consistent with the provisions of this title and to determine
the effectiveness of the State in accomplishing the purposes of
this title.
(i) A household which is described in subsection (b)(2)(A)
solely by reason of clause (ii) thereof shall not be treated as
a household described in subsection (b)(2) if the eligibility
of the household is dependent upon--
(1) an individual whose annual supplemental security
income benefit rate is reduced pursuant to section
1611(e)(1) of the Social Security Act by reason of
being in an institution receiving payments under title
XIX of the Social Security Act with respect to such
individual;
(2) an individual to whom the reduction specified in
section 1612(a)(2)(A)(i) of the Social Security Act
applies; or
(3) a child described in section 1614(f)(2) of the
Social Security Act who is living together with a
parent, or the spouse of a parent, of the child.
(j) In verifying income eligibility for purposes of
subsection (b)(2)(B), the State may apply procedures and
policies consistent with procedures and policies used by the
State agency administering programs under part A of title IV of
the Social Security Act, under title XX of the Social Security
Act, under subtitle B of title VI of this Act (relating to
community services block grant program), under any other
provision of law which carries out programs which were
administered under the Economic Opportunity Act of 1964 before
the date of the enactment of this Act, or under other income
assistance or service programs (as determined by the State).
(k)(1) Except as provided in paragraph (2), not more than 15
percent of the greater of--
(A) the funds allotted to a State under this title
for any fiscal year; or
(B) the funds available to such State under this
title for such fiscal year;
may be used by the State for low-cost residential
weatherization or other energy-related home repair for low-
income households, particularly those low-income households
with the lowest incomes that pay a high proportion of household
income for home energy.
(2)(A) If a State receives a waiver granted under
subparagraph (B) for a fiscal year, the State may use not more
than the greater of 25 percent of--
(i) the funds allotted to a State under this title
for such fiscal year; or
(ii) the funds available to such State under this
title for such fiscal year;
for residential weatherization or other energy-related home
repair for low-income households, particularly those low-income
households with the lowest incomes that pay a high proportion
of household income for home energy.
(B) For purposes of subparagraph (A), the Secretary may grant
a waiver to a State for a fiscal year if the State submits a
written request to the Secretary after March 31 of such fiscal
year and if the Secretary determines, after reviewing such
request and any public comments, that--
(i)(I) the number of households in the State that
will receive benefits, other than weatherization and
energy-related home repair, under this title in such
fiscal year will not be fewer than the number of
households in the State that received benefits, other
than weatherization and energy-related home repair,
under this title in the preceding fiscal year;
(II) the aggregate amounts of benefits that will be
received under this title by all households in the
State in such fiscal year will not be less than the
aggregate amount of such benefits that were received
under this title by all households in the State in the
preceding fiscal year; and
(III) such weatherization activities have been
demonstrated to produce measurable savings in energy
expenditures by low-income households; or
(ii) in accordance with rules issued by the
Secretary, the State demonstrates good cause for
failing to satisfy the requirements specified in clause
(i).
(l)(1) Any State may use amounts provided under this title
for the purpose of providing credits against State tax to
energy suppliers who supply home energy at reduced rates to
low-income households.
(2) Any such credit provided by a State shall not exceed the
amount of the loss of revenue to such supplier on account of
such reduced rate.
(3) Any certification for such tax credits shall be made by
the State, but such State may use Federal data available to
such State with respect to recipients of supplemental security
income benefits if timely delivery of benefits to households
described in subsection (b) and suppliers will not be impeded
by the use of such data.
* * * * * * *
----------
CHILD DEVELOPMENT ASSOCIATE SCHOLARSHIP ASSISTANCE ACT OF 1985
TITLE VI--CHILD DEVELOPMENT ASSOCIATE SCHOLARSHIP ASSISTANCE PROGRAM
* * * * * * *
SEC. 602. GRANTS AUTHORIZED.
The Secretary is authorized to make a grant for any fiscal
year to any State receiving a grant under title XX of the
Social Security Act for such fiscal year to enable such State
to award scholarships to eligible individuals within the State
who are candidates for the Child Development Associate
credential.
* * * * * * *
----------
SECTION 3 OF THE ASSISTED SUICIDE FUNDING RESTRICTION ACT OF 1997
SEC. 3. RESTRICTION ON USE OF FEDERAL FUNDS UNDER HEALTH CARE PROGRAMS.
(a) Restriction on Federal Funding of Health Care Services.--
Subject to subsection (b), no funds appropriated by Congress
for the purpose of paying (directly or indirectly) for the
provision of health care services may be used--
(1) to provide any health care item or service
furnished for the purpose of causing, or for the
purpose of assisting in causing, the death of any
individual, such as by assisted suicide, euthanasia, or
mercy killing;
(2) to pay (directly, through payment of Federal
financial participation or other matching payment, or
otherwise) for such an item or service, including
payment of expenses relating to such an item or
service; or
(3) to pay (in whole or in part) for health benefit
coverage that includes any coverage of such an item or
service or of any expenses relating to such an item or
service.
(b) Construction and Treatment of Certain Services.--Nothing
in subsection (a), or in any other provision of this Act (or in
any amendment made by this Act), shall be construed to apply to
or to affect any limitation relating to--
(1) the withholding or withdrawing of medical
treatment or medical care;
(2) the withholding or withdrawing of nutrition or
hydration;
(3) abortion; or
(4) the use of an item, good, benefit, or service
furnished for the purpose of alleviating pain or
discomfort, even if such use may increase the risk of
death, so long as such item, good, benefit, or service
is not also furnished for the purpose of causing, or
the purpose of assisting in causing, death, for any
reason.
(c) Limitation on Federal Facilities and Employees.--Subject
to subsection (b), with respect to health care items and
services furnished--
(1) by or in a health care facility owned or operated
by the Federal government, or
(2) by any physician or other individual employed by
the Federal government to provide health care services
within the scope of the physician's or individual's
employment, no such item or service may be furnished
for the purpose of causing, or for the purpose of
assisting in causing, the death of any individual, such
as by assisted suicide, euthanasia, or mercy killing.
(d) List of Programs to Which Restrictions Apply.--
(1) Federal health care funding programs.--Subsection
(a) applies to funds appropriated under or to carry out
the following:
(A) Medicare program.--Title XVIII of the
Social Security Act.
(B) Medicaid program.--Title XIX of the
Social Security Act.
(C) Title xx social services block grant.--
Title XX of the Social Security Act.
(D) Maternal and child health block grant
program.--Title V of the Social Security Act.
(E) Public health service act.--The Public
Health Service Act.
(F) Indian health care improvement act.--The
Indian Health Care Improvement Act.
(G) Federal employees health benefits
program.--Chapter 89 of title 5, United States
Code.
(H) Military health care system (including
tricare and champus programs).--Chapter 55 of
title 10, United States Code.
(I) Veterans medical care.--Chapter 17 of
title 38, United States Code.
(J) Health services for peace corps
volunteers.--Section 5(e) of the Peace Corps
Act (22 U.S.C. 2504(e)).
(K) Medical services for federal prisoners
Section 4005(a) of title 18, United States
Code.
(2) Federal facilities and personnel.--The provisions
of subsection (c) apply to facilities and personnel of
the following:
(A) Military health care system.--The
Department of Defense operating under chapter
55 of title 10, United States Code.
(B) Veterans medical care.--The Veterans
Health Administration of the Department of
Veterans Affairs.
(C) Public health service.--The Public Health
Service.
(3) Nonexclusive list.--Nothing in this subsection
shall be construed as limiting the application of
subsection (a) to the programs specified in paragraph
(1) or the application of subsection (c) to the
facilities and personnel specified in paragraph (2).
B. Changes in Existing Law Proposed by the Bill, as Reported
In compliance with clause 3(e)(1)(B) of rule XIII of the
Rules of the House of Representatives, changes in existing law
proposed by the bill, as reported, are shown as follows
(existing law proposed to be omitted is enclosed in black
brackets, new matter is printed in italic, existing law in
which no change is proposed is shown in roman):
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e)(1)(B) of rule XIII of the
Rules of the House of Representatives, changes in existing law
made by the bill, as reported, are shown as follows (existing
law proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, and existing law in which no
change is proposed is shown in roman):
SOCIAL SECURITY ACT
* * * * * * *
TITLE IV--GRANTS TO STATES FOR AID AND SERVICES TO NEEDY FAMILIES WITH
CHILDREN AND FOR CHILD-WELFARE SERVICES
PART A--BLOCK GRANTS TO STATES FOR TEMPORARY ASSISTANCE FOR NEEDY
FAMILIES
* * * * * * *
SEC. 404. USE OF GRANTS.
(a) General Rules.--Subject to this part, a State to which a
grant is made under section 403 may use the grant--
(1) in any manner that is reasonably calculated to
accomplish the purpose of this part, including to
provide low income households with assistance in
meeting home heating and cooling costs; or
(2) in any manner that the State was authorized to
use amounts received under part A or F, as such parts
were in effect on September 30, 1995, or (at the option
of the State) August 21, 1996.
(b) Limitation on Use of Grant for Administrative Purposes.--
(1) Limitation.--A State to which a grant is made
under section 403 shall not expend more than 15 percent
of the grant for administrative purposes.
(2) Exception.--Paragraph (1) shall not apply to the
use of a grant for information technology and
computerization needed for tracking or monitoring
required by or under this part.
(c) Authority To Treat Interstate Immigrants Under Rules of
Former State.--A State operating a program funded under this
part may apply to a family the rules (including benefit
amounts) of the program funded under this part of another State
if the family has moved to the State from the other State and
has resided in the State for less than 12 months.
(d) Authority To Use Portion of Grant for Other Purposes.--
(1) In general.--Subject to paragraph (2), a State
may use not more than 30 percent of the amount of any
grant made to the State under section 403(a) for a
fiscal year to carry out a State program pursuant to
[any or all of the following provisions of law:]
[(A) Subtitle A of title XX of this Act.]
[(B) The] the Child Care and Development
Block Grant Act of 1990.
[(2) Limitation on amount transferable to subtitle 1
of title xx programs.--
[(A) In general.--A State may use not more
than the applicable percent of the amount of
any grant made to the State under section
403(a) for a fiscal year to carry out State
programs pursuant to subtitle 1 of title XX.
[(B) Applicable percent.--For purposes of
subparagraph (A), the applicable percent is
4.25 percent in the case of fiscal year 2001
and each succeeding fiscal year.]
[(3)] (2) Applicable rules.--
[(A) In general.--Except as provided in
subparagraph (B) of this paragraph, any amount
paid] Any amount paid to a State under this
part that is used to carry out a State program
pursuant to [a provision of law specified in
paragraph (1)] the Child Care and Development
Block Grant Act of 1990 shall not be subject to
the requirements of this part, but shall be
subject to the requirements that apply to
Federal funds provided directly under the
provision of law to carry out the program, and
the expenditure of any amount so used shall not
be considered to be an expenditure under this
part.
[(B) Exception relating to subtitle 1 of
title xx programs.--All amounts paid to a State
under this part that are used to carry out
State programs pursuant to subtitle 1 of title
XX shall be used only for programs and services
to children or their families whose income is
less than 200 percent of the income official
poverty line (as defined by the Office of
Management and Budget, and revised annually in
accordance with section 673(2) of the Omnibus
Budget Reconciliation Act of 1981) applicable
to a family of the size involved.]
(e) Authority to Carry Over Certain Amounts for Benefits or
Services or for Future Contingencies.--A State or tribe may use
a grant made to the State or tribe under this part for any
fiscal year to provide, without fiscal year limitation, any
benefit or service that may be provided under the State or
tribal program funded under this part.
(f) Authority to Operate Employment Placement Program.--A
State to which a grant is made under section 403 may use the
grant to make payments (or provide job placement vouchers) to
State-approved public and private job placement agencies that
provide employment placement services to individuals who
receive assistance under the State program funded under this
part.
(g) Implementation of Electronic Benefit Transfer System.--A
State to which a grant is made under section 403 is encouraged
to implement an electronic benefit transfer system for
providing assistance under the State program funded under this
part, and may use the grant for such purpose.
(h) Use of Funds for Individual Development Accounts.--
(1) In general.--A State to which a grant is made
under section 403 may use the grant to carry out a
program to fund individual development accounts (as
defined in paragraph (2)) established by individuals
eligible for assistance under the State program funded
under this part.
(2) Individual development accounts.--
(A) Establishment.--Under a State program
carried out under paragraph (1), an individual
development account may be established by or on
behalf of an individual eligible for assistance
under the State program operated under this
part for the purpose of enabling the individual
to accumulate funds for a qualified purpose
described in subparagraph (B).
(B) Qualified purpose.--A qualified purpose
described in this subparagraph is 1 or more of
the following, as provided by the qualified
entity providing assistance to the individual
under this subsection:
(i) Postsecondary educational
expenses.--Postsecondary educational
expenses paid from an individual
development account directly to an
eligible educational institution.
(ii) First home purchase.--Qualified
acquisition costs with respect to a
qualified principal residence for a
qualified first-time homebuyer, if paid
from an individual development account
directly to the persons to whom the
amounts are due.
(iii) Business capitalization.--
Amounts paid from an individual
development account directly to a
business capitalization account which
is established in a federally insured
financial institution and is restricted
to use solely for qualified business
capitalization expenses.
(C) Contributions to be from earned income.--
An individual may only contribute to an
individual development account such amounts as
are derived from earned income, as defined in
section 911(d)(2) of the Internal Revenue Code
of 1986.
(D) Withdrawal of funds.--The Secretary shall
establish such regulations as may be necessary
to ensure that funds held in an individual
development account are not withdrawn except
for 1 or more of the qualified purposes
described in subparagraph (B).
(3) Requirements.--
(A) In general.--An individual development
account established under this subsection shall
be a trust created or organized in the United
States and funded through periodic
contributions by the establishing individual
and matched by or through a qualified entity
for a qualified purpose (as described in
paragraph (2)(B)).
(B) Qualified entity.--As used in this
subsection, the term ``qualified entity''
means--
(i) a not-for-profit organization
described in section 501(c)(3) of the
Internal Revenue Code of 1986 and
exempt from taxation under section
501(a) of such Code; or
(ii) a State or local government
agency acting in cooperation with an
organization described in clause (i).
(4) No reduction in benefits.--Notwithstanding any
other provision of Federal law (other than the Internal
Revenue Code of 1986) that requires consideration of 1
or more financial circumstances of an individual, for
the purpose of determining eligibility to receive, or
the amount of, any assistance or benefit authorized by
such law to be provided to or for the benefit of such
individual, funds (including interest accruing) in an
individual development account under this subsection
shall be disregarded for such purpose with respect to
any period during which such individual maintains or
makes contributions into such an account.
(5) Definitions.--As used in this subsection--
(A) Eligible educational institution.--The
term ``eligible educational institution'' means
the following:
(i) An institution described in
section 481(a)(1) or 1201(a) of the
Higher Education Act of 1965 (20 U.S.C.
1088(a)(1) or 1141(a)), as such
sections are in effect on the date of
the enactment of this subsection.
(ii) An area vocational education
school (as defined in subparagraph (C)
or (D) of section 521(4) of the Carl D.
Perkins Vocational and Applied
Technology Education Act (20 U.S.C.
2471(4))) which is in any State (as
defined in section 521(33) of such
Act), as such sections are in effect on
the date of the enactment of this
subsection.
(B) Post-secondary educational expenses.--The
term ``post-secondary educational expenses''
means--
(i) tuition and fees required for the
enrollment or attendance of a student
at an eligible educational institution,
and
(ii) fees, books, supplies, and
equipment required for courses of
instruction at an eligible educational
institution.
(C) Qualified acquisition costs.--The term
``qualified acquisition costs'' means the costs
of acquiring, constructing, or reconstructing a
residence. The term includes any usual or
reasonable settlement, financing, or other
closing costs.
(D) Qualified business.--The term ``qualified
business'' means any business that does not
contravene any law or public policy (as
determined by the Secretary).
(E) Qualified business capitalization
expenses.--The term ``qualified business
capitalization expenses'' means qualified
expenditures for the capitalization of a
qualified business pursuant to a qualified
plan.
(F) Qualified expenditures.--The term
``qualified expenditures'' means expenditures
included in a qualified plan, including
capital, plant, equipment, working capital, and
inventory expenses.
(G) Qualified first-time homebuyer.--
(i) In general.--The term ``qualified
first-time homebuyer'' means a taxpayer
(and, if married, the taxpayer's
spouse) who has no present ownership
interest in a principal residence
during the 3-year period ending on the
date of acquisition of the principal
residence to which this subsection
applies.
(ii) Date of acquisition.--The term
``date of acquisition'' means the date
on which a binding contract to acquire,
construct, or reconstruct the principal
residence to which this subparagraph
applies is entered into.
(H) Qualified plan.--The term ``qualified
plan'' means a business plan which--
(i) is approved by a financial
institution, or by a nonprofit loan
fund having demonstrated fiduciary
integrity,
(ii) includes a description of
services or goods to be sold, a
marketing plan, and projected financial
statements, and
(iii) may require the eligible
individual to obtain the assistance of
an experienced entrepreneurial advisor.
(I) Qualified principal residence.--The term
``qualified principal residence'' means a
principal residence (within the meaning of
section 1034 of the Internal Revenue Code of
1986), the qualified acquisition costs of which
do not exceed 100 percent of the average area
purchase price applicable to such residence
(determined in accordance with paragraphs (2)
and (3) of section 143(e) of such Code).
(i) Sanction Welfare Recipients for Failing To Ensure That
Minor Dependent Children Attend School.--A State to which a
grant is made under section 403 shall not be prohibited from
sanctioning a family that includes an adult who has received
assistance under any State program funded under this part
attributable to funds provided by the Federal Government or
under the supplemental nutrition assistance program, as defined
in section 3(l) of the Food and Nutrition Act of 2008, if such
adult fails to ensure that the minor dependent children of such
adult attend school as required by the law of the State in
which the minor children reside.
(j) Requirement for High School Diploma or Equivalent.--A
State to which a grant is made under section 403 shall not be
prohibited from sanctioning a family that includes an adult who
is older than age 20 and younger than age 51 and who has
received assistance under any State program funded under this
part attributable to funds provided by the Federal Government
or under the supplemental nutrition assistance program, as
defined in section 3(l) of the Food and Nutrition Act of 2008,
if such adult does not have, or is not working toward
attaining, a secondary school diploma or its recognized
equivalent unless such adult has been determined in the
judgment of medical, psychiatric, or other appropriate
professionals to lack the requisite capacity to complete
successfully a course of study that would lead to a secondary
school diploma or its recognized equivalent.
(k) Limitations on Use of Grant for Matching Under Certain
Federal Transportation Program.--
(1) Use limitations.--A State to which a grant is
made under section 403 may not use any part of the
grant to match funds made available under section 3037
of the Transportation Equity Act for the 21st Century,
unless--
(A) the grant is used for new or expanded
transportation services (and not for
construction) that benefit individuals
described in subparagraph (C), and not to
subsidize current operating costs;
(B) the grant is used to supplement and not
supplant other State expenditures on
transportation;
(C) the preponderance of the benefits derived
from such use of the grant accrues to
individuals who are--
(i) recipients of assistance under
the State program funded under this
part;
(ii) former recipients of such
assistance;
(iii) noncustodial parents who are
described in section 403(a)(5)(C)(iii);
and
(iv) low-income individuals who are
at risk of qualifying for such
assistance; and
(D) the services provided through such use of
the grant promote the ability of such
recipients to engage in work activities (as
defined in section 407(d)).
(2) Amount limitation.--From a grant made to a State
under section 403(a), the amount that a State uses to
match funds described in paragraph (1) of this
subsection shall not exceed the amount (if any) by
which 30 percent of the total amount of the grant
exceeds the amount (if any) of the grant that is used
by the State to carry out any State program described
in subsection (d)(1) of this section.
(3) Rule of interpretation.--The provision by a State
of a transportation benefit under a program conducted
under section 3037 of the Transportation Equity Act for
the 21st Century, to an individual who is not otherwise
a recipient of assistance under the State program
funded under this part, using funds from a grant made
under section 403(a) of this Act, shall not be
considered to be the provision of assistance to the
individual under the State program funded under this
part.
* * * * * * *
PART B--CHILD AND FAMILY SERVICES
Subpart 1--Stephanie Tubbs Jones Child Welfare Services Program
* * * * * * *
STATE PLANS FOR CHILD WELFARE SERVICES
Sec. 422. (a) In order to be eligible for payment under this
subpart, a State must have a plan for child welfare services
which has been developed jointly by the Secretary and the State
agency designated pursuant to subsection (b)(1), and which
meets the requirements of subsection (b).
(b) Each plan for child welfare services under this subpart
shall--
(1) provide that (A) the individual or agency that
[administers or supervises] administered or supervised
the administration of the State's services program
under [subtitle 1 of title XX] subtitle A of title XX
(as in effect before the repeal of such subtitle) will
administer or supervise the administration of the plan
(except as otherwise provided in section 103(d) of the
Adoption Assistance and Child Welfare Act of 1980), and
(B) to the extent that child welfare services are
furnished by the staff of the State agency or local
agency administering the plan, a single organizational
unit in such State or local agency, as the case may be,
will be responsible for furnishing such child welfare
services;
(2) provide for coordination between the services
provided for children under the plan and the services
and assistance provided [under subtitle 1 of title XX,]
under the State program funded under part A, under the
State plan approved under subpart 2 of this part, under
the State plan approved under the State plan approved
under part E, and under other State programs having a
relationship to the program under this subpart, with a
view to provision of welfare and related services which
will best promote the welfare of such children and
their families;
(3) include a description of the services and
activities which the State will fund under the State
program carried out pursuant to this subpart, and how
the services and activities will achieve the purpose of
this subpart;
(4) contain a description of--
(A) the steps the State will take to provide
child welfare services statewide and to expand
and strengthen the range of existing services
and develop and implement services to improve
child outcomes; and
(B) the child welfare services staff
development and training plans of the State;
(5) provide, in the development of services for
children, for utilization of the facilities and
experience of voluntary agencies in accordance with
State and local programs and arrangements, as
authorized by the State;
(6) provide that the agency administering or
supervising the administration of the plan will furnish
such reports, containing such information, and
participate in such evaluations, as the Secretary may
require;
(7) provide for the diligent recruitment of potential
foster and adoptive families that reflect the ethnic
and racial diversity of children in the State for whom
foster and adoptive homes are needed;
(8) provide assurances that the State--
(A) is operating, to the satisfaction of the
Secretary--
(i) a statewide information system
from which can be readily determined
the status, demographic
characteristics, location, and goals
for the placement of every child who is
(or, within the immediately preceding
12 months, has been) in foster care;
(ii) a case review system (as defined
in section 475(5) and in accordance
with the requirements of section 475A)
for each child receiving foster care
under the supervision of the State;
(iii) a service program designed to
help children--
(I) where safe and
appropriate, return to families
from which they have been
removed; or
(II) be placed for adoption,
with a legal guardian, or if
adoption or legal guardianship
is determined not to be
appropriate for a child, in
some other planned, permanent
living arrangement, subject to
the requirements of sections
475(5)(C) and 475A(a), which
may include a residential
educational program; and
(iv) a preplacement preventive
services program designed to help
children at risk of foster care
placement remain safely with their
families; and
(B) has in effect policies and administrative
and judicial procedures for children abandoned
at or shortly after birth (including policies
and procedures providing for legal
representation of the children) which enable
permanent decisions to be made expeditiously
with respect to the placement of the children;
(9) contain a description, developed after
consultation with tribal organizations (as defined in
section 4 of the Indian Self-Determination and
Education Assistance Act) in the State, of the specific
measures taken by the State to comply with the Indian
Child Welfare Act;
(10) contain assurances that the State shall make
effective use of cross-jurisdictional resources
(including through contracts for the purchase of
services), and shall eliminate legal barriers, to
facilitate timely adoptive or permanent placements for
waiting children;
(11) contain a description of the activities that the
State has undertaken for children adopted from other
countries, including the provision of adoption and
post-adoption services;
(12) provide that the State shall collect and report
information on children who are adopted from other
countries and who enter into State custody as a result
of the disruption of a placement for adoption or the
dissolution of an adoption, including the number of
children, the agencies who handled the placement or
adoption, the plans for the child, and the reasons for
the disruption or dissolution;
(13) demonstrate substantial, ongoing, and meaningful
collaboration with State courts in the development and
implementation of the State plan under subpart 1, the
State plan approved under subpart 2, and the State plan
approved under part E, and in the development and
implementation of any program improvement plan required
under section 1123A;
(14) not later than October 1, 2007, include
assurances that not more than 10 percent of the
expenditures of the State with respect to activities
funded from amounts provided under this subpart will be
for administrative costs;
(15)(A) provides that the State will develop, in
coordination and collaboration with the State agency
referred to in paragraph (1) and the State agency
responsible for administering the State plan approved
under title XIX, and in consultation with
pediatricians, other experts in health care, and
experts in and recipients of child welfare services, a
plan for the ongoing oversight and coordination of
health care services for any child in a foster care
placement, which shall ensure a coordinated strategy to
identify and respond to the health care needs of
children in foster care placements, including mental
health and dental health needs, and shall include an
outline of--
(i) a schedule for initial and
follow-up health screenings that meet
reasonable standards of medical
practice;
(ii) how health needs identified
through screenings will be monitored
and treated, including emotional trauma
associated with a child's maltreatment
and removal from home;
(iii) how medical information for
children in care will be updated and
appropriately shared, which may include
the development and implementation of
an electronic health record;
(iv) steps to ensure continuity of
health care services, which may include
the establishment of a medical home for
every child in care;
(v) the oversight of prescription
medicines, including protocols for the
appropriate use and monitoring of
psychotropic medications;
(vi) how the State actively consults
with and involves physicians or other
appropriate medical or non-medical
professionals in assessing the health
and well-being of children in foster
care and in determining appropriate
medical treatment for the children; and
(vii) steps to ensure that the
components of the transition plan
development process required under
section 475(5)(H) that relate to the
health care needs of children aging out
of foster care, including the
requirements to include options for
health insurance, information about a
health care power of attorney, health
care proxy, or other similar document
recognized under State law, and to
provide the child with the option to
execute such a document, are met; and
(B) subparagraph (A) shall not be construed to reduce
or limit the responsibility of the State agency
responsible for administering the State plan approved
under title XIX to administer and provide care and
services for children with respect to whom services are
provided under the State plan developed pursuant to
this subpart;
(16) provide that, not later than 1 year after the
date of the enactment of this paragraph, the State
shall have in place procedures providing for how the
State programs assisted under this subpart, subpart 2
of this part, or part E would respond to a disaster, in
accordance with criteria established by the Secretary
which should include how a State would--
(A) identify, locate, and continue
availability of services for children under
State care or supervision who are displaced or
adversely affected by a disaster;
(B) respond, as appropriate, to new child
welfare cases in areas adversely affected by a
disaster, and provide services in those cases;
(C) remain in communication with caseworkers
and other essential child welfare personnel who
are displaced because of a disaster;
(D) preserve essential program records; and
(E) coordinate services and share information
with other States;
(17) not later than October 1, 2007, describe the
State standards for the content and frequency of
caseworker visits for children who are in foster care
under the responsibility of the State, which, at a
minimum, ensure that the children are visited on a
monthly basis and that the caseworker visits are well-
planned and focused on issues pertinent to case
planning and service delivery to ensure the safety,
permanency, and well-being of the children;
(18) include a description of the activities that the
State has undertaken to reduce the length of time
children who have not attained 5 years of age are
without a permanent family, and the activities the
State undertakes to address the developmental needs of
such children who receive benefits or services under
this part or part E; and
(19) contain a description of the sources used to
compile information on child maltreatment deaths
required by Federal law to be reported by the State
agency referred to in paragraph (1), and to the extent
that the compilation does not include information on
such deaths from the State vital statistics department,
child death review teams, law enforcement agencies, or
offices of medical examiners or coroners, the State
shall describe why the information is not so included
and how the State will include the information.
(c) Definitions.--In this subpart:
(1) Administrative costs.--The term ``administrative
costs'' means costs for the following, but only to the
extent incurred in administering the State plan
developed pursuant to this subpart: procurement,
payroll management, personnel functions (other than the
portion of the salaries of supervisors attributable to
time spent directly supervising the provision of
services by caseworkers), management, maintenance and
operation of space and property, data processing and
computer services, accounting, budgeting, auditing, and
travel expenses (except those related to the provision
of services by caseworkers or the oversight of programs
funded under this subpart).
(2) Other terms.--For definitions of other terms used
in this part, see section 475.
* * * * * * *
Part E--Federal Payments for Foster Care and Adoption Assistance
* * * * * * *
STATE PLAN FOR FOSTER CARE AND ADOPTION ASSISTANCE
Sec. 471. (a) In order for a State to be eligible for
payments under this part, it shall have a plan approved by the
Secretary which--
(1) provides for foster care maintenance payments in
accordance with section 472 and for adoption assistance
in accordance with section 473;
(2) provides that the State agency responsible for
administering the program authorized by subpart 1 of
part B of this title shall administer, or supervise the
administration of, the program authorized by this part;
(3) provides that the plan shall be in effect in all
political subdivisions of the State, and, if
administered by them, be mandatory upon them;
(4) provides that the State shall assure that the
programs at the local level assisted under this part
will be coordinated with the programs at the State or
local level assisted under parts A and B of this
title[, under subtitle 1 of title XX of this Act,] and
under any other appropriate provision of Federal law;
(5) provides that the State will, in the
administration of its programs under this part, use
such methods relating to the establishment and
maintenance of personnel standards on a merit basis as
are found by the Secretary to be necessary for the
proper and efficient operation of the programs, except
that the Secretary shall exercise no authority with
respect to the selection, tenure of office, or
compensation of any individual employed in accordance
with such methods;
(6) provides that the State agency referred to in
paragraph (2) (hereinafter in this part referred to as
the ``State agency'') will make such reports, in such
form and containing such information as the Secretary
may from time to time require, and comply with such
provisions as the Secretary may from time to time find
necessary to assure the correctness and verification of
such reports;
(7) provides that the State agency will monitor and
conduct periodic evaluations of activities carried out
under this part;
(8) subject to subsection (c), provides safeguards
which restrict the use of or disclosure of information
concerning individuals assisted under the State plan to
purposes directly connected with (A) the administration
of the plan of the State approved under this part, the
plan or program of the State under part A, B, or D of
this title or under title I, V, X, XIV, XVI (as in
effect in Puerto Rico, Guam, and the Virgin Islands),
[XIX, or XX] or XIX, or the supplemental security
income program established by title XVI, (B) any
investigation, prosecution, or criminal or civil
proceeding, conducted in connection with the
administration of any such plan or program, (C) the
administration of any other Federal or federally
assisted program which provides assistance, in cash or
in kind, or services, directly to individuals on the
basis of need, (D) any audit or similar activity
conducted in connection with the administration of any
such plan or program by any governmental agency which
is authorized by law to conduct such audit or activity,
and (E) reporting and providing information pursuant to
paragraph (9) to appropriate authorities with respect
to known or suspected child abuse or neglect; and the
safeguards so provided shall prohibit disclosure, to
any committee or legislative body (other than an agency
referred to in clause (D) with respect to an activity
referred to in such clause), of any information which
identifies by name or address any such applicant or
recipient; except that nothing contained herein shall
preclude a State from providing standards which
restrict disclosures to purposes more limited than
those specified herein, or which, in the case of
adoptions, prevent disclosure entirely;
(9) provides that the State agency will--
(A) report to an appropriate agency or
official, known or suspected instances of
physical or mental injury, sexual abuse or
exploitation, or negligent treatment or
maltreatment of a child receiving aid under
part B or this part under circumstances which
indicate that the child's health or welfare is
threatened thereby;
(B) provide such information with respect to
a situation described in subparagraph (A) as
the State agency may have; and
(C) not later than--
(i) 1 year after the date of
enactment of this subparagraph,
demonstrate to the Secretary that the
State agency has developed, in
consultation with State and local law
enforcement, juvenile justice systems,
health care providers, education
agencies, and organizations with
experience in dealing with at-risk
children and youth, policies and
procedures (including relevant training
for caseworkers) for identifying,
documenting in agency records, and
determining appropriate services with
respect to--
(I) any child or youth over
whom the State agency has
responsibility for placement,
care, or supervision and who
the State has reasonable cause
to believe is, or is at risk of
being, a sex trafficking victim
(including children for whom a
State child welfare agency has
an open case file but who have
not been removed from the home,
children who have run away from
foster care and who have not
attained 18 years of age or
such older age as the State has
elected under section 475(8) of
this Act, and youth who are not
in foster care but are
receiving services under
section 477 of this Act); and
(II) at the option of the
State, any individual who has
not attained 26 years of age,
without regard to whether the
individual is or was in foster
care under the responsibility
of the State; and
(ii) 2 years after such date of
enactment, demonstrate to the Secretary
that the State agency is implementing
the policies and procedures referred to
in clause (i).
(10) provides--
(A) for the establishment or designation of a
State authority or authorities that shall be
responsible for establishing and maintaining
standards for foster family homes and child
care institutions which are reasonably in
accord with recommended standards of national
organizations concerned with standards for the
institutions or homes, including standards
related to admission policies, safety,
sanitation, and protection of civil rights, and
which shall permit use of the reasonable and
prudent parenting standard;
(B) that the standards established pursuant
to subparagraph (A) shall be applied by the
State to any foster family home or child care
institution receiving funds under this part or
part B and shall require, as a condition of
each contract entered into by a child care
institution to provide foster care, the
presence on-site of at least 1 official who,
with respect to any child placed at the child
care institution, is designated to be the
caregiver who is authorized to apply the
reasonable and prudent parent standard to
decisions involving the participation of the
child in age or developmentally-appropriate
activities, and who is provided with training
in how to use and apply the reasonable and
prudent parent standard in the same manner as
prospective foster parents are provided the
training pursuant to paragraph (24);
(C) that the standards established pursuant
to subparagraph (A) shall include policies
related to the liability of foster parents and
private entities under contract by the State
involving the application of the reasonable and
prudent parent standard, to ensure appropriate
liability for caregivers when a child
participates in an approved activity and the
caregiver approving the activity acts in
accordance with the reasonable and prudent
parent standard; and
(D) that a waiver of any standards
established pursuant to subparagraph (A) may be
made only on a case-by-case basis for nonsafety
standards (as determined by the State) in
relative foster family homes for specific
children in care;
(11) provides for periodic review of the standards
referred to in the preceding paragraph and amounts paid
as foster care maintenance payments and adoption
assistance to assure their continuing appropriateness;
(12) provides for granting an opportunity for a fair
hearing before the State agency to any individual whose
claim for benefits available pursuant to this part is
denied or is not acted upon with reasonable promptness;
(13) provides that the State shall arrange for a
periodic and independently conducted audit of the
programs assisted under this part and part B of this
title, which shall be conducted no less frequently than
once every three years;
(14) provides (A) specific goals (which shall be
established by State law on or before October 1, 1982)
for each fiscal year (commencing with the fiscal year
which begins on October 1, 1983) as to the maximum
number of children (in absolute numbers or as a
percentage of all children in foster care with respect
to whom assistance under the plan is provided during
such year) who, at any time during such year, will
remain in foster care after having been in such care
for a period in excess of twenty-four months, and (B) a
description of the steps which will be taken by the
State to achieve such goals;
(15) provides that--
(A) in determining reasonable efforts to be
made with respect to a child, as described in
this paragraph, and in making such reasonable
efforts, the child's health and safety shall be
the paramount concern;
(B) except as provided in subparagraph (D),
reasonable efforts shall be made to preserve
and reunify families--
(i) prior to the placement of a child
in foster care, to prevent or eliminate
the need for removing the child from
the child's home; and
(ii) to make it possible for a child
to safely return to the child's home;
(C) if continuation of reasonable efforts of
the type described in subparagraph (B) is
determined to be inconsistent with the
permanency plan for the child, reasonable
efforts shall be made to place the child in a
timely manner in accordance with the permanency
plan (including, if appropriate, through an
interstate placement), and to complete whatever
steps are necessary to finalize the permanent
placement of the child;
(D) reasonable efforts of the type described
in subparagraph (B) shall not be required to be
made with respect to a parent of a child if a
court of competent jurisdiction has determined
that--
(i) the parent has subjected the
child to aggravated circumstances (as
defined in State law, which definition
may include but need not be limited to
abandonment, torture, chronic abuse,
and sexual abuse);
(ii) the parent has--
(I) committed murder (which
would have been an offense
under section 1111(a) of title
18, United States Code, if the
offense had occurred in the
special maritime or territorial
jurisdiction of the United
States) of another child of the
parent;
(II) committed voluntary
manslaughter (which would have
been an offense under section
1112(a) of title 18, United
States Code, if the offense had
occurred in the special
maritime or territorial
jurisdiction of the United
States) of another child of the
parent;
(III) aided or abetted,
attempted, conspired, or
solicited to commit such a
murder or such a voluntary
manslaughter; or
(IV) committed a felony
assault that results in serious
bodily injury to the child or
another child of the parent; or
(iii) the parental rights of the
parent to a sibling have been
terminated involuntarily;
(E) if reasonable efforts of the type
described in subparagraph (B) are not made with
respect to a child as a result of a
determination made by a court of competent
jurisdiction in accordance with subparagraph
(D)--
(i) a permanency hearing (as
described in section 475(5)(C)), which
considers in-State and out-of-State
permanent placement options for the
child, shall be held for the child
within 30 days after the determination;
and
(ii) reasonable efforts shall be made
to place the child in a timely manner
in accordance with the permanency plan,
and to complete whatever steps are
necessary to finalize the permanent
placement of the child; and
(F) reasonable efforts to place a child for
adoption or with a legal guardian, including
identifying appropriate in-State and out-of-
State placements may be made concurrently with
reasonable efforts of the type described in
subparagraph (B);
(16) provides for the development of a case plan (as
defined in section 475(1) and in accordance with the
requirements of section 475A) for each child receiving
foster care maintenance payments under the State plan
and provides for a case review system which meets the
requirements described in sections 475(5) and 475A with
respect to each such child;
(17) provides that, where appropriate, all steps will
be taken, including cooperative efforts with the State
agencies administering the program funded under part A
and plan approved under part D, to secure an assignment
to the State of any rights to support on behalf of each
child receiving foster care maintenance payments under
this part;
(18) not later than January 1, 1997, provides that
neither the State nor any other entity in the State
that receives funds from the Federal Government and is
involved in adoption or foster care placements may--
(A) deny to any person the opportunity to
become an adoptive or a foster parent, on the
basis of the race, color, or national origin of
the person, or of the child, involved; or
(B) delay or deny the placement of a child
for adoption or into foster care, on the basis
of the race, color, or national origin of the
adoptive or foster parent, or the child,
involved;
(19) provides that the State shall consider giving
preference to an adult relative over a non-related
caregiver when determining a placement for a child,
provided that the relative caregiver meets all relevant
State child protection standards;
(20)(A) provides procedures for criminal records
checks, including fingerprint-based checks of national
crime information databases (as defined in section
534(e)(3)(A) of title 28, United States Code), for any
prospective foster or adoptive parent before the foster
or adoptive parent may be finally approved for
placement of a child regardless of whether foster care
maintenance payments or adoption assistance payments
are to be made on behalf of the child under the State
plan under this part, including procedures requiring
that--
(i) in any case involving a child on whose
behalf such payments are to be so made in which
a record check reveals a felony conviction for
child abuse or neglect, for spousal abuse, for
a crime against children (including child
pornography), or for a crime involving
violence, including rape, sexual assault, or
homicide, but not including other physical
assault or battery, if a State finds that a
court of competent jurisdiction has determined
that the felony was committed at any time, such
final approval shall not be granted; and
(ii) in any case involving a child on whose
behalf such payments are to be so made in which
a record check reveals a felony conviction for
physical assault, battery, or a drug-related
offense, if a State finds that a court of
competent jurisdiction has determined that the
felony was committed within the past 5 years,
such final approval shall not be granted; and
(B) provides that the State shall--
(i) check any child abuse and neglect
registry maintained by the State for
information on any prospective foster or
adoptive parent and on any other adult living
in the home of such a prospective parent, and
request any other State in which any such
prospective parent or other adult has resided
in the preceding 5 years, to enable the State
to check any child abuse and neglect registry
maintained by such other State for such
information, before the prospective foster or
adoptive parent may be finally approved for
placement of a child, regardless of whether
foster care maintenance payments or adoption
assistance payments are to be made on behalf of
the child under the State plan under this part;
(ii) comply with any request described in
clause (i) that is received from another State;
and
(iii) have in place safeguards to prevent the
unauthorized disclosure of information in any
child abuse and neglect registry maintained by
the State, and to prevent any such information
obtained pursuant to this subparagraph from
being used for a purpose other than the
conducting of background checks in foster or
adoptive placement cases; and
(C) provides procedures for criminal records checks,
including fingerprint-based checks of national crime
information databases (as defined in section
534(e)(3)(A) of title 28, United States Code), on any
relative guardian, and for checks described in
subparagraph (B) of this paragraph on any relative
guardian and any other adult living in the home of any
relative guardian, before the relative guardian may
receive kinship guardianship assistance payments on
behalf of the child under the State plan under this
part;
(21) provides for health insurance coverage
(including, at State option, through the program under
the State plan approved under title XIX) for any child
who has been determined to be a child with special
needs, for whom there is in effect an adoption
assistance agreement (other than an agreement under
this part) between the State and an adoptive parent or
parents, and who the State has determined cannot be
placed with an adoptive parent or parents without
medical assistance because such child has special needs
for medical, mental health, or rehabilitative care, and
that with respect to the provision of such health
insurance coverage--
(A) such coverage may be provided through 1
or more State medical assistance programs;
(B) the State, in providing such coverage,
shall ensure that the medical benefits,
including mental health benefits, provided are
of the same type and kind as those that would
be provided for children by the State under
title XIX;
(C) in the event that the State provides such
coverage through a State medical assistance
program other than the program under title XIX,
and the State exceeds its funding for services
under such other program, any such child shall
be deemed to be receiving aid or assistance
under the State plan under this part for
purposes of section 1902(a)(10)(A)(i)(I); and
(D) in determining cost-sharing requirements,
the State shall take into consideration the
circumstances of the adopting parent or parents
and the needs of the child being adopted
consistent, to the extent coverage is provided
through a State medical assistance program,
with the rules under such program;
(22) provides that, not later than January 1, 1999,
the State shall develop and implement standards to
ensure that children in foster care placements in
public or private agencies are provided quality
services that protect the safety and health of the
children;
(23) provides that the State shall not--
(A) deny or delay the placement of a child
for adoption when an approved family is
available outside of the jurisdiction with
responsibility for handling the case of the
child; or
(B) fail to grant an opportunity for a fair
hearing, as described in paragraph (12), to an
individual whose allegation of a violation of
subparagraph (A) of this paragraph is denied by
the State or not acted upon by the State with
reasonable promptness;
(24) includes a certification that, before a child in
foster care under the responsibility of the State is
placed with prospective foster parents, the prospective
foster parents will be prepared adequately with the
appropriate knowledge and skills to provide for the
needs of the child, that the preparation will be
continued, as necessary, after the placement of the
child, and that the preparation shall include knowledge
and skills relating to the reasonable and prudent
parent standard for the participation of the child in
age or developmentally-appropriate activities,
including knowledge and skills relating to the
developmental stages of the cognitive, emotional,
physical, and behavioral capacities of a child, and
knowledge and skills relating to applying the standard
to decisions such as whether to allow the child to
engage in social, extracurricular, enrichment,
cultural, and social activities, including sports,
field trips, and overnight activities lasting 1 or more
days, and to decisions involving the signing of
permission slips and arranging of transportation for
the child to and from extracurricular, enrichment, and
social activities;
(25) provide that the State shall have in effect
procedures for the orderly and timely interstate
placement of children; and procedures implemented in
accordance with an interstate compact, if incorporating
with the procedures prescribed by paragraph (26), shall
be considered to satisfy the requirement of this
paragraph;
(26) provides that--
(A)(i) within 60 days after the State
receives from another State a request to
conduct a study of a home environment for
purposes of assessing the safety and
suitability of placing a child in the home, the
State shall, directly or by contract--
(I) conduct and complete the study;
and
(II) return to the other State a
report on the results of the study,
which shall address the extent to which
placement in the home would meet the
needs of the child; and
(ii) in the case of a home study begun on or
before September 30, 2008, if the State fails
to comply with clause (i) within the 60-day
period as a result of circumstances beyond the
control of the State (such as a failure by a
Federal agency to provide the results of a
background check, or the failure by any entity
to provide completed medical forms, requested
by the State at least 45 days before the end of
the 60-day period), the State shall have 75
days to comply with clause (i) if the State
documents the circumstances involved and
certifies that completing the home study is in
the best interests of the child; except that
(iii) this subparagraph shall not be
construed to require the State to have
completed, within the applicable period, the
parts of the home study involving the education
and training of the prospective foster or
adoptive parents;
(B) the State shall treat any report
described in subparagraph (A) that is received
from another State or an Indian tribe (or from
a private agency under contract with another
State) as meeting any requirements imposed by
the State for the completion of a home study
before placing a child in the home, unless,
within 14 days after receipt of the report, the
State determines, based on grounds that are
specific to the content of the report, that
making a decision in reliance on the report
would be contrary to the welfare of the child;
and
(C) the State shall not impose any
restriction on the ability of a State agency
administering, or supervising the
administration of, a State program operated
under a State plan approved under this part to
contract with a private agency for the conduct
of a home study described in subparagraph (A);
(27) provides that, with respect to any child in
foster care under the responsibility of the State under
this part or part B and without regard to whether
foster care maintenance payments are made under section
472 on behalf of the child, the State has in effect
procedures for verifying the citizenship or immigration
status of the child;
(28) at the option of the State, provides for the
State to enter into kinship guardianship assistance
agreements to provide kinship guardianship assistance
payments on behalf of children to grandparents and
other relatives who have assumed legal guardianship of
the children for whom they have cared as foster parents
and for whom they have committed to care on a permanent
basis, as provided in section 473(d);
(29) provides that, within 30 days after the removal
of a child from the custody of the parent or parents of
the child, the State shall exercise due diligence to
identify and provide notice to the following relatives:
all adult grandparents, all parents of a sibling of the
child, where such parent has legal custody of such
sibling, and other adult relatives of the child
(including any other adult relatives suggested by the
parents), subject to exceptions due to family or
domestic violence, that--
(A) specifies that the child has been or is
being removed from the custody of the parent or
parents of the child;
(B) explains the options the relative has
under Federal, State, and local law to
participate in the care and placement of the
child, including any options that may be lost
by failing to respond to the notice;
(C) describes the requirements under
paragraph (10) of this subsection to become a
foster family home and the additional services
and supports that are available for children
placed in such a home; and
(D) if the State has elected the option to
make kinship guardianship assistance payments
under paragraph (28) of this subsection,
describes how the relative guardian of the
child may subsequently enter into an agreement
with the State under section 473(d) to receive
the payments;
(30) provides assurances that each child who has
attained the minimum age for compulsory school
attendance under State law and with respect to whom
there is eligibility for a payment under the State plan
is a full-time elementary or secondary school student
or has completed secondary school, and for purposes of
this paragraph, the term ``elementary or secondary
school student'' means, with respect to a child, that
the child is--
(A) enrolled (or in the process of enrolling)
in an institution which provides elementary or
secondary education, as determined under the
law of the State or other jurisdiction in which
the institution is located;
(B) instructed in elementary or secondary
education at home in accordance with a home
school law of the State or other jurisdiction
in which the home is located;
(C) in an independent study elementary or
secondary education program in accordance with
the law of the State or other jurisdiction in
which the program is located, which is
administered by the local school or school
district; or
(D) incapable of attending school on a full-
time basis due to the medical condition of the
child, which incapability is supported by
regularly updated information in the case plan
of the child;
(31) provides that reasonable efforts shall be made--
(A) to place siblings removed from their home
in the same foster care, kinship guardianship,
or adoptive placement, unless the State
documents that such a joint placement would be
contrary to the safety or well-being of any of
the siblings; and
(B) in the case of siblings removed from
their home who are not so jointly placed, to
provide for frequent visitation or other
ongoing interaction between the siblings,
unless that State documents that frequent
visitation or other ongoing interaction would
be contrary to the safety or well-being of any
of the siblings;
(32) provides that the State will negotiate in good
faith with any Indian tribe, tribal organization or
tribal consortium in the State that requests to develop
an agreement with the State to administer all or part
of the program under this part on behalf of Indian
children who are under the authority of the tribe,
organization, or consortium, including foster care
maintenance payments on behalf of children who are
placed in State or tribally licensed foster family
homes, adoption assistance payments, and, if the State
has elected to provide such payments, kinship
guardianship assistance payments under section 473(d),
and tribal access to resources for administration,
training, and data collection under this part;
(33) provides that the State will inform any
individual who is adopting, or whom the State is made
aware is considering adopting, a child who is in foster
care under the responsibility of the State of the
potential eligibility of the individual for a Federal
tax credit under section 23 of the Internal Revenue
Code of 1986;
(34) provides that, for each child or youth described
in paragraph (9)(C)(i)(I), the State agency shall--
(A) not later than 2 years after the date of
the enactment of this paragraph, report
immediately, and in no case later than 24 hours
after receiving information on children or
youth who have been identified as being a sex
trafficking victim, to the law enforcement
authorities; and
(B) not later than 3 years after such date of
enactment and annually thereafter, report to
the Secretary the total number of children and
youth who are sex trafficking victims; and
(35) provides that--
(A) not later than 1 year after the date of
the enactment of this paragraph, the State
shall develop and implement specific protocols
for--
(i) expeditiously locating any child
missing from foster care;
(ii) determining the primary factors
that contributed to the child's running
away or otherwise being absent from
care, and to the extent possible and
appropriate, responding to those
factors in current and subsequent
placements;
(iii) determining the child's
experiences while absent from care,
including screening the child to
determine if the child is a possible
sex trafficking victim (as defined in
section 475(9)(A)); and
(iv) reporting such related
information as required by the
Secretary; and
(B) not later than 2 years after such date of
enactment, for each child and youth described
in paragraph (9)(C)(i)(I) of this subsection,
the State agency shall report immediately, and
in no case later than 24 hours after receiving,
information on missing or abducted children or
youth to the law enforcement authorities for
entry into the National Crime Information
Center (NCIC) database of the Federal Bureau of
Investigation, established pursuant to section
534 of title 28, United States Code, and to the
National Center for Missing and Exploited
Children.
(b) The Secretary shall approve any plan which complies with
the provisions of subsection (a) of this section.
(c) Use of Child Welfare Records in State Court
Proceedings.--Subsection (a)(8) shall not be construed to limit
the flexibility of a State in determining State policies
relating to public access to court proceedings to determine
child abuse and neglect or other court hearings held pursuant
to part B or this part, except that such policies shall, at a
minimum, ensure the safety and well-being of the child,
parents, and family.
(d) Annual Reports by the Secretary on Number of Children and
Youth Reported by States To Be Sex Trafficking Victims.--Not
later than 4 years after the date of the enactment of this
subsection and annually thereafter, the Secretary shall report
to the Congress and make available to the public on the
Internet website of the Department of Health and Human Services
the number of children and youth reported in accordance with
subsection (a)(34)(B) of this section to be sex trafficking
victims (as defined in section 475(9)(A)).
FOSTER CARE MAINTENANCE PAYMENTS PROGRAM
Sec. 472. (a) In General.--
(1) Eligibility.--Each State with a plan approved
under this part shall make foster care maintenance
payments on behalf of each child who has been removed
from the home of a relative specified in section 406(a)
(as in effect on July 16, 1996) into foster care if--
(A) the removal and foster care placement
met, and the placement continues to meet, the
requirements of paragraph (2); and
(B) the child, while in the home, would have
met the AFDC eligibility requirement of
paragraph (3).
(2) Removal and foster care placement requirements.--
The removal and foster care placement of a child meet
the requirements of this paragraph if--
(A) the removal and foster care placement are
in accordance with--
(i) a voluntary placement agreement
entered into by a parent or legal
guardian of the child who is the
relative referred to in paragraph (1);
or
(ii) a judicial determination to the
effect that continuation in the home
from which removed would be contrary to
the welfare of the child and that
reasonable efforts of the type
described in section 471(a)(15) for a
child have been made;
(B) the child's placement and care are the
responsibility of--
(i) the State agency administering
the State plan approved under section
471;
(ii) any other public agency with
which the State agency administering or
supervising the administration of the
State plan has made an agreement which
is in effect; or
(iii) an Indian tribe or a tribal
organization (as defined in section
479B(a)) or a tribal consortium that
has a plan approved under section 471
in accordance with section 479B; and
(C) the c