42 U.S.C. § 1396i — Certification and approval of rural

Page 4217 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396i (Aug. 14, 1935, ch. 531, title XIX, § 1908A, formerly § 1908, as added Pub. L. 103–66, title XIII, § 13623(b), Aug. 10, 1993, 107 Stat. 633, renumbered § 1908A, Pub. L. 106–113, div. B, § 1000(a)(6) [title VI, § 608(y)(1)], Nov. 29, 1999, 113 Stat. 1536, 1501A–398.) Statutory Notes and Related Subsidiaries EFFECTIVE DATE Pub. L. 103–66, title XIII, § 13623(c), Aug. 10, 1993, 107 Stat. 635, provided that: ‘‘(1) Except as provided in paragraph (2), the amend- ments made by this section [enacting this section and amending section 1396a of this title] apply to calendar quarters beginning on or after April 1, 1994, without re- gard to whether or not final regulations to carry out such amendments have been promulgated by such date. ‘‘(2) In the case of a State plan under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] which the Secretary of Health and Human Services determines re- quires State legislation in order for the plan to meet the additional requirements imposed by the amend- ments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act [Aug. 10, 1993]. For purposes of the preceding sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a sepa- rate regular session of the State legislature.’’ § 1396h. State false claims act requirements for increased State share of recoveries (a) In general Notwithstanding section 1396d(b) of this title, if a State has in effect a law relating to false or fraudulent claims that meets the requirements of subsection (b), the Federal medical assistance percentage with respect to any amounts recov- ered under a State action brought under such law, shall be decreased by 10 percentage points. (b) Requirements For purposes of subsection (a), the require- ments of this subsection are that the Inspector General of the Department of Health and Human Services, in consultation with the Attorney General, determines that the State has in effect a law that meets the following requirements: (1) The law establishes liability to the State for false or fraudulent claims described in sec- tion 3729 of title 31 with respect to any expend- iture described in section 1396b(a) of this title. (2) The law contains provisions that are at least as effective in rewarding and facilitating qui tam actions for false or fraudulent claims as those described in sections 3730 through 3732 of title 31. (3) The law contains a requirement for filing an action under seal for 60 days with review by the State Attorney General. (4) The law contains a civil penalty that is not less than the amount of the civil penalty authorized under section 3729 of title 31. (c) Deemed compliance A State that, as of January 1, 2007, has a law in effect that meets the requirements of sub- section (b) shall be deemed to be in compliance with such requirements for so long as the law continues to meet such requirements. (d) No preclusion of broader laws Nothing in this section shall be construed as prohibiting a State that has in effect a law that establishes liability to the State for false or fraudulent claims described in section 3729 of title 31, with respect to programs in addition to the State program under this subchapter, or with respect to expenditures in addition to ex- penditures described in section 1396b(a) of this title, from being considered to be in compliance with the requirements of subsection (a) so long as the law meets such requirements. (Aug. 14, 1935, ch. 531, title XIX, § 1909, as added Pub. L. 109–171, title VI, § 6031(a), Feb. 8, 2006, 120 Stat. 72.) Editorial Notes PRIOR PROVISIONS A prior section 1396h, act Aug. 14, 1935, ch. 531, title XIX, § 1909, as added and amended Oct. 30, 1972, Pub. L. 92–603, title II, §§ 242(c), 278(b)(9), 86 Stat. 1419, 1454; Oct. 25, 1977, Pub. L. 95–142, § 4(b), 91 Stat. 1181; Dec. 5, 1980, Pub. L. 96–499, title IX, § 917, 94 Stat. 2625; Aug. 18, 1987, Pub. L. 100–93, § 4(a)–(c), 101 Stat. 688, 689, related to criminal penalties for acts involving Medicare and State health care programs, prior to being renumbered section 1128B of title XI of act Aug. 14, 1935, by section 4(d) of Pub. L. 100–93 and transferred to section 1320a–7b of this title. Statutory Notes and Related Subsidiaries EFFECTIVE DATE Pub. L. 109–171, title VI, § 6031(b), Feb. 8, 2006, 120 Stat. 73, as amended by Pub. L. 109–432, div. B, title IV, § 405(c)(2)(A)(iii), Dec. 20, 2006, 120 Stat. 3000, provided that: ‘‘Except as provided in section 6034(e) [set out as an Effective Date of 2006 Amendment note under sec- tion 1396a of this title], the amendments made by this section [enacting this section] take effect on January 1, 2007.’’ § 1396i. Certification and approval of rural health clinics and intermediate care facilities for mentally retarded (a)(1) Whenever the Secretary certifies a facil- ity in a State to be qualified as a rural health clinic under subchapter XVIII, such facility shall be deemed to meet the standards for cer- tification as a rural health clinic for purposes of providing rural health clinic services under this subchapter. (2) The Secretary shall notify the State agen- cy administering the medical assistance plan of his approval or disapproval of any facility in that State which has applied for certification by him as a qualified rural health clinic. (b)(1) The Secretary may cancel approval of any intermediate care facility for the mentally retarded at any time if he finds on the basis of a determination made by him as provided in sec- tion 1396a(a)(33)(B) of this title that a facility fails to meet the requirements contained in sec- tion 1396a(a)(31) of this title or section 1396d(d) of this title, or if he finds grounds for termi- nation of his agreement with the facility pursu- ant to section 1395cc(b) of this title. In that event the Secretary shall notify the State agen- cy and the intermediate care facility for the mentally retarded that approval of eligibility of the facility to participate in the programs es- Page 4218 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396i 1 So in original. Probably should be ‘‘an’’. tablished by this subchapter and subchapter XVIII shall be terminated at a time specified by the Secretary. The approval of eligibility of any such facility to participate in such programs may not be reinstated unless the Secretary finds that the reason for termination has been re- moved and there is reasonable assurance that it will not recur. (2) Any intermediate care facility for the men- tally retarded which is dissatisfied with a deter- mination by the Secretary that it no longer qualifies as a 1 intermediate care facility for the mentally retarded for purposes of this sub- chapter, shall be entitled to a hearing by the Secretary to the same extent as is provided in section 405(b) of this title and to judicial review of the Secretary’s final decision after such hear- ing as is provided in section 405(g) of this title, except that, in so applying such sections and in applying section 405(l) of this title thereto, 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 Serv- ices, respectively. Any agreement between such facility and the State agency shall remain in ef- fect until the period for filing a request for a hearing has expired or, if a request has been filed, until a decision has been made by the Sec- retary; except that the agreement shall not be extended if the Secretary makes a written deter- mination, specifying the reasons therefor, that the continuation of provider status constitutes an immediate and serious threat to the health and safety of patients, and the Secretary cer- tifies that the facility has been notified of its deficiencies and has failed to correct them. (Aug. 14, 1935, ch. 531, title XIX, § 1910, as added and amended Pub. L. 92–603, title II, §§ 249A(a), 278(b)(12), Oct. 30, 1972, 86 Stat. 1426, 1454; Pub. L. 95–210, § 2(d), Dec. 13, 1977, 91 Stat. 1489; Pub. L. 96–499, title IX, § 916(b)(2), Dec. 5, 1980, 94 Stat. 2624; Pub. L. 100–203, title IV, § 4212(e)(3), Dec. 22, 1987, 101 Stat. 1330–213; Pub. L. 100–360, title IV, § 411(l)(6)(F), July 1, 1988, as added Pub. L. 100–485, title VI, § 608(d)(27)(J), Oct. 13, 1988, 102 Stat. 2423; Pub. L. 101–239, title VI, § 6901(d)(5), Dec. 19, 1989, 103 Stat. 2301; Pub. L. 103–296, title I, § 108(d)(4), Aug. 15, 1994, 108 Stat. 1486; Pub. L. 106–113, div. B, § 1000(a)(6) [title VI, § 608(n)], Nov. 29, 1999, 113 Stat. 1536, 1501A–397.) Editorial Notes AMENDMENTS 1999—Pub. L. 106–113 struck out ‘‘of’’ after ‘‘approval of’’ in section catchline. 1994—Subsec. (b)(2). Pub. L. 103–296 inserted before pe- riod at end of first sentence ‘‘, except that, in so apply- ing such sections and in applying section 405(l) of this title thereto, any reference therein to the Commis- sioner of Social Security or the Social Security Admin- istration shall be considered a reference to the Sec- retary or the Department of Health and Human Serv- ices, respectively’’. 1989—Pub. L. 101–239, § 6901(d)(5)(A), substituted ‘‘rural health clinics and intermediate care facilities for the mentally retarded’’ for ‘‘rural health clinics’’ in section catchline. Subsec. (b)(1). Pub. L. 101–239, § 6901(d)(5)(B)–(D), sub- stituted ‘‘any intermediate care facility for the men- tally retarded’’ for ‘‘any skilled nursing or inter- mediate care facility’’, ‘‘section 1396a(a)(31) of this title or section 1396d(d) of this title’’ for ‘‘section 1396a(a)(28) of this title or section 1396r of this title or section 1396d(c) of this title’’, and ‘‘the intermediate care facil- ity for the mentally retarded’’ for ‘‘the skilled nursing facility or intermediate care facility’’. Subsec. (b)(2). Pub. L. 101–239, § 6901(d)(5)(D), sub- stituted ‘‘intermediate care facility for the mentally retarded’’ for ‘‘skilled nursing facility or intermediate care facility’’ in two places. 1988—Subsec. (b)(1). Pub. L. 100–360, § 411(l)(6)(F), as added by Pub. L. 100–485, § 608(d)(27)(J), inserted ‘‘or sec- tion 1396r of this title’’ after ‘‘1396a(a)(28) of this title’’. 1987—Pub. L. 100–203 struck out ‘‘skilled nursing fa- cilities and’’ before ‘‘of rural’’ in section catchline, re- designated subsecs. (b) and (c) as (a) and (b), respec- tively, and struck out former subsec. (a) which related to certification and approval of skilled nursing facili- ties. 1980—Subsec. (c). Pub. L. 96–499 added subsec. (c). 1977—Pub. L. 95–210 substituted ‘‘facilities and of rural health clinics’’ for ‘‘facilities’’ in section catch- line, redesignated existing subsecs. (a) and (b) as (a)(1) and (2), respectively, and added subsec. (b). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1994 AMENDMENT Amendment by Pub. L. 103–296 effective Mar. 31, 1995, see section 110(a) of Pub. L. 103–296, set out as a note under section 401 of this title. EFFECTIVE DATE OF 1989 AMENDMENT Amendment by Pub. L. 101–239 effective as if included in the enactment of the Omnibus Budget Reconcili- ation Act of 1987, Pub. L. 100–203, see section 6901(d)(6) of Pub. L. 101–239, set out as a note under section 1395i–3 of this title. EFFECTIVE DATE OF 1988 AMENDMENTS Amendment by Pub. L. 100–485 effective as if included in the enactment of the Medicare Catastrophic Cov- erage Act of 1988, Pub. L. 100–360, see section 608(g)(1) of Pub. L. 100–485, set out as a note under section 704 of this title. Except as specifically provided in section 411 of Pub. L. 100–360, amendment by Pub. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Pub. L. 100–203, effective as if included in the enactment of that provision in Pub. L. 100–203, see section 411(a) of Pub. L. 100–360, set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions. EFFECTIVE DATE OF 1987 AMENDMENT Amendment by Pub. L. 100–203 applicable to nursing facility services furnished on or after Oct. 1, 1990, with- out regard to whether regulations implementing such amendment are promulgated by such date, except as otherwise specifically provided in section 1396r of this title, with transitional rule, see section 4214(a), (b)(2) of Pub. L. 100–203, as amended, set out as an Effective Date note under section 1396r of this title. EFFECTIVE DATE OF 1977 AMENDMENT Amendment by Pub. L. 95–210 applicable to medical assistance provided, under a State plan approved under subchapter XIX of this chapter, on and after first day of first calendar quarter that begins more than six months after Dec. 13, 1977, with exception for plans re- quiring State legislation, see section 2(f) of Pub. L. 95–210, set out as a note under section 1395cc of this title. EFFECTIVE DATE Section effective with respect to agreements filed with Secretary under section 1395cc of this title by Page 4219 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1396j 1 See References in Text note below. skilled nursing facilities before, on, or after Oct. 30, 1972, but accepted by him on or after such date, see sec- tion 249A(e) of Pub. L. 92–603, set out as an Effective Date of 1972 Amendment note under section 1395cc of this title. § 1396j. Indian Health Service facilities (a) Eligibility for reimbursement for medical as- sistance A facility of the Indian Health Service (includ- ing a hospital, nursing facility, or any other type of facility which provides services of a type otherwise covered under the State plan), wheth- er operated by such Service or by an Indian tribe or tribal organization (as those terms are de- fined in section 1603 of title 25), shall be eligible for reimbursement for medical assistance pro- vided under a State plan if and for so long as it meets all of the conditions and requirements which are applicable generally to such facilities under this subchapter. (b) Facilities deemed to meet requirements upon submission of acceptable plan for achieving compliance Notwithstanding subsection (a), a facility of the Indian Health Service (including a hospital, nursing facility, or any other type of facility which provides services of a type otherwise cov- ered under the State plan) which does not meet all of the conditions and requirements of this subchapter which are applicable generally to such facility, but which submits to the Sec- retary within six months after September 30, 1976, an acceptable plan for achieving compli- ance with such conditions and requirements, shall be deemed to meet such conditions and re- quirements (and to be eligible for reimburse- ment under this subchapter), without regard to the extent of its actual compliance with such conditions and requirements, during the first twelve months after the month in which such plan is submitted. (c) Agreement to reimburse State agency for pro- viding care and services The Secretary is authorized to enter into agreements with the State agency for the pur- pose of reimbursing such agency for health care and services provided in Indian Health Service facilities to Indians who are eligible for medical assistance under the State plan. (d) Cross reference For provisions relating to the authority of cer- tain Indian tribes, tribal organizations, and Alaska Native health organizations to elect to directly bill for, and receive payment for, health care services provided by a hospital or clinic of such tribes or organizations and for which pay- ment may be made under this subchapter, see section 1645 of title 25.1 (Aug. 14, 1935, ch. 531, title XIX, § 1911, as added Pub. L. 94–437, title IV, § 402(a), Sept. 30, 1976, 90 Stat. 1409; amended Pub. L. 100–203, title IV, §§ 4118(f)(1), 4211(h)(8), Dec. 22, 1987, 101 Stat. 1330–155, 1330–206; Pub. L. 100–360, title IV, § 411(k)(10)(E), July 1, 1988, 102 Stat. 796; Pub. L. 106–417, § 3(b)(2), Nov. 1, 2000, 114 Stat. 1815.) Editorial Notes REFERENCES IN TEXT Section 1645 of title 25, referred to in subsec. (d), was amended generally by Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935, and, as so amended, no longer contains provisions relating to direct billing of medicare, medicaid, and other third party payors. AMENDMENTS 2000—Subsec. (d). Pub. L. 106–417 added subsec. (d). 1988—Subsecs. (a), (b). Pub. L. 100–360, § 411(k)(10)(E), made technical correction to directory language of Pub. L. 100–203, § 4118(f)(1)(A), see 1987 Amendment note below. 1987—Subsecs. (a), (b). Pub. L. 100–203, § 4118(f)(1)(A), as amended by Pub. L. 100–360, § 411(k)(10)(E), sub- stituted ‘‘, nursing facility, or any other type of facil- ity which provides services of a type otherwise covered under the State plan’’ for ‘‘or nursing facility’’. Pub. L. 100–203, § 4211(h)(8), substituted ‘‘or nursing fa- cility’’ for ‘‘, intermediate care facility, or skilled nursing facility’’ wherever appearing. Subsec. (c). Pub. L. 100–203, § 4118(f)(1)(B), added sub- sec. (c). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2000 AMENDMENT Amendment by Pub. L. 106–417 effective Oct. 1, 2000, see section 3(c) of Pub. L. 106–417, set out as a note under section 1645 of Title 25, Indians. EFFECTIVE DATE OF 1988 AMENDMENT Except as specifically provided in section 411 of Pub. L. 100–360, amendment by Pub. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Pub. L. 100–203, effective as if included in the enactment of that provision in Pub. L. 100–203, see section 411(a) of Pub. L. 100–360, set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions. EFFECTIVE DATE OF 1987 AMENDMENT Pub. L. 100–203, title IV, § 4118(f)(2), Dec. 22, 1987, 101 Stat. 1330–156, provided that: ‘‘The amendments made by paragraph (1) [amending this section] shall apply to health care services performed on or after the date of the enactment of this Act [Dec. 22, 1987].’’ Amendment by section 4211(h)(8) of Pub. L. 100–203 ap- plicable to nursing facility services furnished on or after Oct. 1, 1990, without regard to whether regulations implementing such amendment are promulgated by such date, except as otherwise specifically provided in section 1396r of this title, with transitional rule, see section 4214(a), (b)(2) of Pub. L. 100–203, as amended, set out as an Effective Date note under section 1396r of this title. AGREEMENTS TO REIMBURSE STATE AGENCY FOR HEALTH CARE AND SERVICES PROVIDED BY AGENCY TO INDIANS Pub. L. 94–437, title IV, § 402(b), Sept. 30, 1976, 90 Stat. 1409, which authorized Secretary to enter into agree- ments to reimburse State agencies for health care and services provided in Service facilities to Indians eligi- ble for medical assistance under this subchapter, was repealed by Pub. L. 100–713, title IV, § 401(b), Nov. 23, 1988, 102 Stat. 4818, applicable to services performed on or after the Nov. 23, 1988. PAYMENTS INTO SPECIAL FUND TO IMPROVE INDIAN HEALTH SERVICE FACILITIES TO ACHIEVE COMPLIANCE WITH CONDITIONS AND REQUIREMENTS Pub. L. 94–437, title IV, § 402(c), Sept. 30, 1976, 90 Stat. 1409, as amended by Pub. L. 100–713, title IV, § 401(a), Nov. 23, 1988, 102 Stat. 4818, provided that payments to which any Indian Health Service facility was entitled