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42 U.S.C. § 1396r–1 — Presumptive eligibility for pregnant women
Federal law — U.S. Code and appendices · legal_authorities
**(a) Ambulatory prenatal care** A State plan approved under [section 1396a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396a&num=0&edition=prelim) may provide for making ambulatory prenatal care available to a pregnant woman during a presumptive eligibility period.
**(b) Definitions** For purposes of this section—
(1) the term “presumptive eligibility period” means, with respect to a pregnant woman, the period that—
(A) begins with the date on which a qualified provider determines, on the basis of preliminary information, that the family income of the woman does not exceed the applicable income level of eligibility under the State plan, and
(B) ends with (and includes) the earlier of—
(i) the day on which a determination is made with respect to the eligibility of the woman for medical assistance under the State plan, or
(ii) in the case of a woman who does not file an application by the last day of the month following the month during which the provider makes the determination referred to in subparagraph (A), such last day; and
(2) the term “qualified provider” means any provider that—
(A) is eligible for payments under a State plan approved under this subchapter,
(B) provides services of the type described in subparagraph (A) or (B) of [section 1396d(a)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396d/a/2&num=0&edition=prelim) or in [section 1396d(a)(9) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396d/a/9&num=0&edition=prelim),
(C) is determined by the State agency to be capable of making determinations of the type described in paragraph (1)(A), and
(D)
(i) receives funds under—
(I)
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Stable record: federal_law:legal_authorities:record_usc_7f01490822c02b415af2d143
Source file: Laws/federal/codes/united-states-code/title-42/section-1396r1-presumptive-eligibility-for-pregnant-women--bcdb039255.md
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Source location: Title 42, Chapter 7, § 1396r–1; chapter-007-social-security.md
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**(a) Ambulatory prenatal care** A State plan approved under [section 1396a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396a&num=0&edition=prelim) may provide for making ambulatory prenatal care available to a pregnant woman during a presumptive eligibility period.
**(b) Definitions** For purposes of this section—
(1) the term “presumptive eligibility period” means, with respect to a pregnant woman, the period that—
(A) begins with the date on which a qualified provider determines, on the basis of preliminary information, that the family income of the woman does not exceed the applicable income level of eligibility under the State plan, and
(B) ends with (and includes) the earlier of—
(i) the day on which a determination is made with respect to the eligibility of the woman for medical assistance under the State plan, or
(ii) in the case of a woman who does not file an application by the last day of the month following the month during which the provider makes the determination referred to in subparagraph (A), such last day; and
(2) the term “qualified provider” means any provider that—
(A) is eligible for payments under a State plan approved under this subchapter,
(B) provides services of the type described in subparagraph (A) or (B) of [section 1396d(a)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396d/a/2&num=0&edition=prelim) or in [section 1396d(a)(9) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396d/a/9&num=0&edition=prelim),
(C) is determined by the State agency to be capable of making determinations of the type described in paragraph (1)(A), and
(D)
(i) receives funds under—
(I) section 254b or 254c of this title,
(II) subchapter V of this chapter, or
(III) title V of the Indian Health Care Improvement Act [[25 U.S.C. 1651](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title25-section1651&num=0&edition=prelim) et seq.];
(ii) participates in a program established under—
(I) [section 1786 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1786&num=0&edition=prelim), or
(II) section 4(a) of the Agriculture and Consumer Protection Act of 1973;
(iii) participates in a State perinatal program; or
(iv) is the Indian Health Service or is a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act (Public Law 93–638) [[25 U.S.C. 5321](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title25-section5321&num=0&edition=prelim) et seq.].
The term “qualified provider” also includes a qualified entity, as defined in [section 1396r–1a(b)(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396r–1a/b/3&num=0&edition=prelim).
**(c) Duties of State agency, qualified providers, and presumptively eligible pregnant women**
(1) The State agency shall provide qualified providers with—
(A) such forms as are necessary for a pregnant woman to make application for medical assistance under the State plan, and
(B) information on how to assist such women in completing and filing such forms.
(2) A qualified provider that determines under subsection (b)(1)(A) that a pregnant woman is presumptively eligible for medical assistance under a State plan shall—
(A) notify the State agency of the determination within 5 working days after the date on which determination is made, and
(B) inform the woman at the time the determination is made that she is required to make application for medical assistance under the State plan by not later than the last day of the month following the month during which the determination is made.
(3) A pregnant woman who is determined by a qualified provider to be presumptively eligible for medical assistance under a State plan shall make application for medical assistance under such plan by not later than the last day of the month following the month during which the determination is made, which application may be the application used for the receipt of medical assistance by individuals described in section 1396a(l)(1)(A) of this title.
**(d) Ambulatory prenatal care as medical assistance** Notwithstanding any other provision of this subchapter, ambulatory prenatal care that—
(1) is furnished to a pregnant woman—
(A) during a presumptive eligibility period,
(B) by a provider that is eligible for payments under the State plan; and
(2) is included in the care and services covered by a State plan;
shall be treated as medical assistance provided by such plan for purposes of [section 1396b of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396b&num=0&edition=prelim).
**(e) Option to provide presumptive eligibility** If the State has elected the option to provide a presumptive eligibility period under this section or [section 1396r–1a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396r-1a&num=0&edition=prelim), the State may elect to provide a presumptive eligibility period (as defined in subsection (b)(1)) for individuals who are eligible for medical assistance under clause (i)(VIII), clause (i)(IX), or clause (ii)(XX) of subsection (a)(10)(A) 11 So in original. Probably means subsection (a)(10)(A) of [section 1396a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396a&num=0&edition=prelim). or [section 1396u–1 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396u-1&num=0&edition=prelim) in the same manner as the State provides for such a period under this section or [section 1396r–1a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396r-1a&num=0&edition=prelim), subject to such guidance as the Secretary shall establish.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Covered services** Except as otherwise provided under this section, a State may use amounts paid to it under [section 703 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section703&num=0&edition=prelim) 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 705(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section705/a&num=0&edition=prelim).
**(b) Restrictions** 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 subchapter or subchapter XVIII, XIX, or XX pursuant to section 1320a–7, 1320a–7a, 1320c–5, or 1395u(j)(2) of this title, or
(B) at the medical direct
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 704
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Findings respecting historical and special legal relationship, and resultant responsibilities** The Congress, after careful review of the Federal Government’s historical and special legal relationship with, and resulting responsibilities to, American Indian people, finds that—
(1) the prolonged Federal domination of Indian service programs has served to retard rather than enhance the progress of Indian people and their communities by depriving Indians of the full opportunity to develop leadership skills crucial to the realization of self-government, and has denied to the Indian people an effective voice in the planning and implementation of programs for the benefit of Indians which are responsive to the true needs of Indian communities; and
(2) the Indian people will never surrender their desire to control their relationships both among themselves and with non-Indian governments, organizations, and persons.
**(b) Further findings** The Congress further finds that—
(1) true self-determination in any society of people is dependent upon an educational process which will insure the development of qualified people to fulfill meaningful leadership roles;
(2) the Federal responsibility for and assistance to education of Indian children has not effected the desired level of educational achievement or created the diverse opportunities and personal satisfaction which education can and should provide; and
(3) parental and community control of the educational process is of crucial importance to the Indian people.
Source: Supplied U.S. Code snapshot — release unconfirmed · 25 U.S.C. § 5321
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Purpose** The purpose of this section is to provide grants for expanded delivery of health care services in rural areas, for the planning and implementation of integrated health care networks in rural areas, and for the planning and implementation of small health care provider quality improvement activities.
**(b) Definitions**
(1) **Director** — The term “Director” means the Director specified in subsection (d).
(2) **Federally qualified health center; rural health clinic** — The terms “Federally qualified health center” and “rural health clinic” have the meanings given the terms in [section 1395x(aa) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/aa&num=0&edition=prelim).
(3) **Health professional shortage area** — The term “health professional shortage area” means a health professional shortage area designated under [section 254e of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254e&num=0&edition=prelim).
(4) **Medically underserved community** — The term “medically underserved community” has the meaning given the term in [section 295p(6) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section295p/6&num=0&edition=prelim).
(5) **Medically underserved population** — The term “medically underserved population” has the meaning given the term in [section 254b(b)(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b/b/3&num=0&edition=prelim).
**(c) Program** The Secretary shall establish, under [section 241 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section241&num=0&edition=prelim), a small health care provider quality improvement grant program.
**(
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 254c
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Federal law — U.S. Code and appendices · legal_authorities
**(a) “Health center” defined**
(1) **In general** — For purposes of this section, the term “health center” means an entity that serves a population that is medically underserved, or a special medically underserved population comprised of migratory and seasonal agricultural workers, the homeless, and residents of public housing, by providing, either through the staff and supporting resources of the center or through contracts or cooperative arrangements—
(A) required primary health services (as defined in subsection (b)(1)); and
(B) as may be appropriate for particular centers, additional health services (as defined in subsection (b)(2)) necessary for the adequate support of the primary health services required under subparagraph (A);
for all residents of the area served by the center (hereafter referred to in this section as the “catchment area”).
(2) **Limitation** — The requirement in paragraph (1) to provide services for all residents within a catchment area shall not apply in the case of a health center receiving a grant only under subsection (g), (h), or (i).
**(b) Definitions** For purposes of this section:
(1) **Required primary health services**
(A) *In general* — The term “required primary health services” means—
(i) basic health services which, for purposes of this section, shall consist of—
(I) health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology that are furnished by physicians and where appropriate, physician assistants, nurse practitioners, and nurse midwives;
(II) diagnostic laboratory and radiologic services;
(III) preventive health services, including—
(aa) prenatal and perinatal services;
(bb) appropriate cancer screening;
(cc) well-chil
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 254b
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Mandatory application** All provisions of sections 5305(b), 5306, 5307, 5321(c) and (d), 5323, 5324(k) and (l), 5325(a) through (k), and 5332 of this title and section 314 of Public Law 101–512 (coverage under chapter 171 of title 28, commonly known as the “Federal Tort Claims Act”), to the extent not in conflict with this subchapter, shall apply to compacts and funding agreements authorized by this subchapter.
**(b) Discretionary application** At the request of a participating Indian tribe, any other provision of subchapter I of this chapter, to the extent such provision is not in conflict with this subchapter, shall be made a part of a funding agreement or compact entered into under this subchapter. The Secretary is obligated to include such provision at the option of the participating Indian tribe or tribes. If such provision is incorporated it shall have the same force and effect as if it were set out in full in this subchapter. In the event an Indian tribe requests such incorporation at the negotiation stage of a compact or funding agreement, such incorporation shall be deemed effective immediately and shall control the negotiation and resulting compact and funding agreement.
Source: Supplied U.S. Code snapshot — release unconfirmed · 25 U.S.C. § 5301
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Congressional findings and declaration of purpose** Congress finds that substantial numbers of pregnant, postpartum, and breastfeeding women, infants, and young children from families with inadequate income are at special risk with respect to their physical and mental health by reason of inadequate nutrition or health care, or both. It is, therefore, the purpose of the program authorized by this section to provide, up to the authorization levels set forth in subsection (g) of this section, supplemental foods and nutrition education, including breastfeeding promotion and support, through any eligible local agency that applies for participation in the program. The program shall serve as an adjunct to good health care, during critical times of growth and development, to prevent the occurrence of health problems, including drug abuse, and improve the health status of these persons.
**(b) Definitions** As used in this section—
(1) “Breastfeeding women” means women up to one year postpartum who are breastfeeding their infants.
(2) “Children” means persons who have had their first birthday but have not yet attained their fifth birthday.
(3) “Competent professional authority” means physicians, nutritionists, registered nurses, dietitians, or State or local medically trained health officials, or persons designated by physicians or State or local medically trained health officials, in accordance with standards prescribed by the Secretary, as being competent professionally to evaluate nutritional risk.
(4) “Costs of nutrition services and administration” or “nutrition services and administration” means costs that shall include, but not be limited to, costs for certification of eligibility of persons for participation in the program (including centrifuges, measuring boar
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1786
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Establishment** There is hereby established the Medicaid and CHIP Payment and Access Commission (in this section referred to as “MACPAC”).
**(b) Duties**
(1) **Review of access policies for all States and annual reports** — MACPAC shall—
(A) review policies of the Medicaid program established under this subchapter (in this section referred to as “Medicaid”) and the State Children’s Health Insurance Program established under subchapter XXI (in this section referred to as “CHIP”) affecting access to covered items and services, including topics described in paragraph (2);
(B) make recommendations to Congress, the Secretary, and States concerning such access policies;
(C) by not later than March 15 of each year (beginning with 2010), submit a report to Congress containing the results of such reviews and MACPAC’s recommendations concerning such policies; and
(D) by not later than June 15 of each year (beginning with 2010), submit a report to Congress containing an examination of issues affecting Medicaid and CHIP, including the implications of changes in health care delivery in the United States and in the market for health care services on such programs.
(2) **Specific topics to be reviewed** — Specifically, MACPAC shall review and assess the following:
(A) *Medicaid and CHIP payment policies* — Payment policies under Medicaid and CHIP, including—
(i) the factors affecting expenditures for the efficient provision of items and services in different sectors, including the process for updating payments to medical, dental, and health professionals, hospitals, residential and long-term care providers, providers of home and community based services, Federally-qualified health centers and rural health clinics, managed care entities, and providers of ot
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1396
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Federal law — U.S. Code and appendices · legal_authorities
$10,000,000 shall remain available until expended, for the establishment of an Indian Catastrophic Health Emergency Fund (hereinafter referred to as the “Fund”). On and after October 18, 1986, the Fund is to cover the Indian Health Service portion of the medical expenses of catastrophic illness falling within the responsibility of the Service and shall be administered by the Secretary of Health and Human Services, acting through the central office of the Indian Health Service. No part of the Fund or its administration shall be subject to contract or grant under the Indian Self-Determination and Education Assistance Act (Public Law 93–638) [[25 U.S.C. 5301](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title25-section5301&num=0&edition=prelim) et seq.]. There shall be deposited into the Fund all amounts recovered under the authority of the Federal Medical Care Recovery Act ([42 U.S.C. 2651](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section2651&num=0&edition=prelim) et seq.), which shall become available for obligation upon receipt and which shall remain available for obligation until expended. The Fund shall not be used to pay for health services provided to eligible Indians to the extent that alternate Federal, State, local, or private insurance resources for payment: (1) are available and accessible to the beneficiary; or (2) would be available and accessible if the beneficiary were to apply for them; or (3) would be available and accessible to other citizens similarly situated under Federal, State, or local law or regulation or private insurance program notwithstanding Indian Health Service eligibility or residency on or off a Federal Indian reservation.
Source: Supplied U.S. Code snapshot — release unconfirmed · 25 U.S.C. § 1601
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Federal law — U.S. Code and appendices · legal_authorities
Notwithstanding the provisions of title 5, Executive order, or administrative regulation, an Indian tribe or tribal organization carrying out programs under the Indian Self-Determination and Education Assistance Act ([25 U.S.C. 5301](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title25-section5301&num=0&edition=prelim) et seq.) or the Tribally Controlled Schools Act of 1988 ([25 U.S.C. 2501](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title25-section2501&num=0&edition=prelim) et seq.) or an urban Indian organization carrying out programs under subchapter IV of this chapter shall be entitled to purchase coverage, rights, and benefits for the employees of such Indian tribe or tribal organization, or urban Indian organization, under chapter 89 of title 5 and chapter 87 of such title if necessary employee deductions and agency contributions in payment for the coverage, rights, and benefits for the period of employment with such Indian tribe or tribal organization, or urban Indian organization, are currently deposited in the applicable Employee’s Fund under such title.
Source: Supplied U.S. Code snapshot — release unconfirmed · 25 U.S.C. § 1651
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Authority or requirements to cover additional individuals** For provisions of law which make additional individuals eligible for medical assistance under this subchapter, see the following:
(1) **AFDC**
(A) Section 602(a)(32) 11 See References in Text note below. of this title (relating to individuals who are deemed recipients of aid but for whom a payment is not made).
(B) Section 602(a)(37) 1 of this title (relating to individuals who lose AFDC eligibility due to increased earnings).
(C) Section 606(h) 1 of this title (relating to individuals who lose AFDC eligibility due to increased collection of child or spousal support).
(D) Section 682(e)(6) 1 of this title (relating to certain individuals participating in work supplementation programs).
(2) **SSI**
(A) [Section 1382(e) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1382/e&num=0&edition=prelim) (relating to treatment of couples sharing an accommodation in a facility).
(B) [Section 1382h of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1382h&num=0&edition=prelim) (relating to benefits for individuals who perform substantial gainful activity despite severe medical impairment).
(C) [Section 1383c(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1383c/b&num=0&edition=prelim) (relating to preservation of benefit status for disabled widows and widowers who lost SSI benefits because of 1983 changes in actuarial reduction formula).
(D) [Section 1383c(c) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1383c/c&num=0&edition=prelim) (relating to individuals who lose eligibility for SSI benefits due to entitlement to child
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1396v
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