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42 U.S.C. § 1396h — State false claims act requirements for
Federal law — U.S. Code and appendices · legal_authorities
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
Notwi
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1396h
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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-
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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
Stored review status: release_metadata_unconfirmed. The source passage cites 42 U.S.C. § 1396. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
Page 4009
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1396
of the enactment of this Act [Oct. 6, 2014], the Sec-
retary shall develop and report to Congress on a stra-
tegic plan for collecting or otherwise accessing data on
race and ethnicity for purposes of specifying quality
measures and resource use and other measures under
subsections (c) and (d) of section 1899B of the Social Se-
curity Act, as added by subsection (a), and, as the Sec-
retary determines appropriate, other similar provisions
of, including payment adjustments under, title XVIII of
such Act (42 U.S.C. 1395 et seq.).’’
SUBCHAPTER XIX—GRANTS TO STATES
FOR MEDICAL ASSISTANCE PROGRAMS
§ 1396. Medicaid and CHIP Payment and Access
Commission
(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 pro-
gram established under this subchapter (in
this section referred to as ‘‘Medicaid’’) and
the State Children’s Health Insurance Pro-
gram established under subchapter XXI (in
this section referred to as ‘‘CHIP’’) affecting
access to covered items and services, includ-
ing 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 re-
views and MACPAC’s recommendations con-
cerning 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, includ-
ing the impli
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1396
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 1396. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** Notwithstanding [section 1396d(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396d/b&num=0&edition=prelim), 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 recovered under a State action brought under such law, shall be decreased by 10 percentage points.
**(b) Requirements** For purposes of subsection (a), the requirements 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 [section 3729 of title 31](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title31-section3729&num=0&edition=prelim) with respect to any expenditure described in [section 1396b(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396b/a&num=0&edition=prelim).
(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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title31-section3729&num=0&edition=prelim).
**(c) Deemed compliance** A State that, as of January 1, 2007, has a
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1396h
Stored review status: release_metadata_unconfirmed. Same stored citation; legal effect and authority still require review.