H. R. 2015—252
‘‘(iii) may not renew or otherwise extend the dura-
tion of an existing agreement with the entity unless
the Secretary (in consultation with the Inspector Gen-
eral of the Department of Health and Human Services)
provides to the State and to Congress a written state-
ment describing compelling reasons that exist for
renewing or extending the agreement.
‘‘(C) PERSONS
DESCRIBED.—A person is described in
this subparagraph if such person—
‘‘(i) is debarred, suspended, or otherwise excluded
from participating in procurement activities under the
Federal Acquisition Regulation or from participating
in nonprocurement activities under regulations issued
pursuant to Executive Order No. 12549 or under guide-
lines implementing such order; or
‘‘(ii) is an affiliate (as defined in such Act) of a
person described in clause (i).
‘‘(2) RESTRICTIONS ON MARKETING.—
‘‘(A) DISTRIBUTION OF MATERIALS.—
‘‘(i) IN
GENERAL.—A managed care entity, with
respect to activities under this title, may not distribute
directly or through any agent or independent contractor
marketing materials within any State—
‘‘(I) without the prior approval of the State,
and
‘‘(II) that contain false or materially mislead-
ing information.
The requirement of subclause (I) shall not apply with
respect to a State until such date as the Secretary
specifies in consultation with such State.
‘‘(ii) CONSULTATION IN REVIEW OF MARKET MATE-
RIALS.—In the process of reviewing and approving such
materials, the State shall provide for consultation with
a medical care advisory committee.
‘‘(B) SERVICE MARKET.—A managed care entity shall
distribute marketing materials to the entire service area
of such entity covered under the contract under section
1903(m) or section 1903(t)(3).
‘‘(C) PROHIBITION OF TIE-INS.—A managed care entity,
or any agency of such entity, may not seek to influence
an individual’s enrollment with the entity in conjunction
with the sale of any other insurance.
‘‘(D) PROHIBITING MARKETING FRAUD.—Each managed
care entity shall comply with such procedures and condi-
tions as the Secretary prescribes in order to ensure that,
before an individual is enrolled with the entity, the individ-
ual is provided accurate oral and written information suffi-
cient to make an informed decision whether or not to
enroll.
‘‘(E) PROHIBITION
OF ‘COLD-CALL’ MARKETING.—Each
managed care entity shall not, directly or indirectly, con-
duct door-to-door, telephonic, or other ‘cold-call’ marketing
of enrollment under this title.
‘‘(3) STATE CONFLICT-OF-INTEREST SAFEGUARDS IN MEDICAID
RISK
CONTRACTING.—A medicaid managed care organization
may not enter into a contract with any State under section
H. R. 2015—253
1903(m) unless the State has in effect conflict-of-interest safe-
guards with respect to officers and employees of the State
with responsibilities relating to contracts with such organiza-
tions or to the default enrollment process described in sub-
section (a)(4)(C)(ii) that are at least as effective as the Federal
safeguards provided under section 27 of the Office of Federal
Procurement Policy Act (41 U.S.C. 423), against conflicts of
interest that apply with respect to Federal procurement officials
with comparable responsibilities with respect to such contracts.
‘‘(4) USE OF UNIQUE PHYSICIAN IDENTIFIER FOR PARTICIPAT-
ING
PHYSICIANS.—Each medicaid managed care organization
shall require each physician providing services to enrollees
eligible for medical assistance under the State plan under this
title to have a unique identifier in accordance with the system
established under section 1173(b).
‘‘(e) SANCTIONS FOR NONCOMPLIANCE.—
‘‘(1) USE OF INTERMEDIATE SANCTIONS BY THE STATE TO
ENFORCE REQUIREMENTS.—
‘‘(A) IN GENERAL.—A State may not enter into or renew
a contract under section 1903(m) unless the State has
established intermediate sanctions, which may include any
of the types described in paragraph (2), other than the
termination of a contract with a medicaid managed care
organization, which the State may impose against a medic-
aid managed care organization with such a contract, if
the organization—
‘‘(i) fails substantially to provide medically nec-
essary items and services that are required (under
law or under such organization’s contract with the
State) to be provided to an enrollee covered under
the contract;
‘‘(ii) imposes premiums or charges on enrollees
in excess of the premiums or charges permitted under
this title;
‘‘(iii) acts to discriminate among enrollees on the
basis of their health status or requirements for health
care services, including expulsion or refusal to reenroll
an individual, except as permitted by this title, or
engaging in any practice that would reasonably be
expected to have the effect of denying or discouraging
enrollment with the organization by eligible individuals
whose medical condition or history indicates a need
for substantial future medical services;
‘‘(iv) misrepresents or falsifies information that is
furnished—
‘‘(I) to the Secretary or the State under this
title; or
‘‘(II) to an enrollee, potential enrollee, or a
health care provider under such title; or
‘‘(v) fails to comply with the applicable require-
ments of section 1903(m)(2)(A)(x).
The State may also impose such intermediate sanction
against a managed care entity if the State determines
that the entity distributed directly or through any agent
or independent contractor marketing materials in violation
of subsection (d)(2)(A)(i)(II).
H. R. 2015—254
‘‘(B) RULE OF CONSTRUCTION.—Clause (i) of subpara-
graph (A) shall not apply to the provision of abortion serv-
ices, except that a State may impose a sanction on any
medicaid managed care organization that has a contract
to provide abortion services if the organization does not
provide such services as provided for under the contract.
‘‘(2) INTERMEDIATE SANCTIONS.—The sanctions described in
this paragraph are as follows:
‘‘(A) Civil money penalties as follows:
‘‘(i) Except as provided in clause (ii), (iii), or (iv),
not more than $25,000 for each determination under
paragraph (1)(A).
‘‘(ii) With respect to a determination under clause
(iii) or (iv)(I) of paragraph (1)(A), not more than
$100,000 for each such determination.
‘‘(iii) With respect to a determination under para-
graph (1)(A)(ii), double the excess amount charged in
violation of such subsection (and the excess amount
charged shall be deducted from the penalty and
returned to the individual concerned).
‘‘(iv) Subject to clause (ii), with respect to a deter-
mination under paragraph (1)(A)(iii), $15,000 for each
individual not enrolled as a result of a practice
described in such subsection.
‘‘(B) The appointment of temporary management—
‘‘(i) to oversee the operation of the medicaid man-
aged care organization upon a finding by the State
that there is continued egregious behavior by the
organization or there is a substantial risk to the health
of enrollees; or
‘‘(ii) to assure the health of the organization’s
enrollees, if there is a need for temporary management
while—
‘‘(I) there is an orderly termination or reorga-
nization of the organization; or
‘‘(II) improvements are made to remedy the
violations found under paragraph (1),
except 
that 
temporary 
management 
under 
this
subparagraph may not be terminated until the State
has determined that the medicaid managed care
organization has the capability to ensure that the viola-
tions shall not recur.
‘‘(C) Permitting individuals enrolled with the managed
care entity to terminate enrollment without cause, and
notifying such individuals of such right to terminate enroll-
ment.
‘‘(D) Suspension or default of all enrollment of individ-
uals under this title after the date the Secretary or the
State notifies the entity of a determination of a violation
of any requirement of section 1903(m) or this section.
‘‘(E) Suspension of payment to the entity under this
title for individuals enrolled after the date the Secretary
or State notifies the entity of such a determination and
until the Secretary or State is satisfied that the basis
for such determination has been corrected and is not likely
to recur.
H. R. 2015—255
‘‘(3) TREATMENT OF CHRONIC SUBSTANDARD ENTITIES.—In
the case of a medicaid managed care organization which has
repeatedly failed to meet the requirements of section 1903(m)
and this section, the State shall (regardless of what other
sanctions are provided) impose the sanctions described in sub-
paragraphs (B) and (C) of paragraph (2).
‘‘(4) AUTHORITY TO TERMINATE CONTRACT.—
‘‘(A) IN GENERAL.—In the case of a managed care entity
which has failed to meet the requirements of this part
or a contract under section 1903(m) or 1905(t)(3), the State
shall have the authority to terminate such contract with
the entity and to enroll such entity’s enrollees with other
managed care entities (or to permit such enrollees to receive
medical assistance under the State plan under this title
other than through a managed care entity).
‘‘(B) AVAILABILITY OF HEARING PRIOR TO TERMINATION
OF CONTRACT.—A State may not terminate a contract with
a managed care entity under subparagraph (A) unless the
entity is provided with a hearing prior to the termination.
‘‘(C) NOTICE
AND
RIGHT
TO
DISENROLL
IN
CASES
OF
TERMINATION HEARING.—A State may—
‘‘(i) notify individuals enrolled with a managed
care entity which is the subject of a hearing to termi-
nate the entity’s contract with the State of the hearing,
and
‘‘(ii) in the case of such an entity, permit such
enrollees to disenroll immediately with the entity with-
out cause.
‘‘(5) OTHER
PROTECTIONS
FOR
MANAGED
CARE
ENTITIES
AGAINST SANCTIONS IMPOSED BY STATE.—Before imposing any
sanction against a managed care entity other than termination
of the entity’s contract, the State shall provide the entity with
notice and such other due process protections as the State
may provide, except that a State may not provide a managed
care entity with a pre-termination hearing before imposing
the sanction described in paragraph (2)(B).’’.
(b) LIMITATION ON AVAILABILITY OF FFP FOR USE OF ENROLL-
MENT BROKERS.—Section 1903(b) (42 U.S.C. 1396b(b)) is amended
by adding at the end the following:
‘‘(4) Amounts expended by a State for the use an enrollment
broker in marketing medicaid managed care organizations and other
managed care entities to eligible individuals under this title shall
be considered, for purposes of subsection (a)(7), to be necessary
for the proper and efficient administration of the State plan but
only if the following conditions are met with respect to the broker:
‘‘(A) The broker is independent of any such entity and
of any health care providers (whether or not any such provider
participates in the State plan under this title) that provide
coverage of services in the same State in which the broker
is conducting enrollment activities.
‘‘(B) No person who is an owner, employee, consultant,
or has a contract with the broker either has any direct or
indirect financial interest with such an entity or health care
provider or has been excluded from participation in the program
under this title or title XVIII or debarred by any Federal
agency, or subject to a civil money penalty under this Act.’’.
H. R. 2015—256
(c) APPLICATION OF DISCLOSURE REQUIREMENTS TO MANAGED
CARE ENTITIES.—Section 1124(a)(2)(A) (42 U.S.C. 1320a–3(a)(2)(A))
is amended by inserting ‘‘a managed care entity, as defined in
section 1932(a)(1)(B),’’ after ‘‘renal disease facility,’’.
SEC. 4708. IMPROVED ADMINISTRATION.
(a) CHANGE IN THRESHOLD AMOUNT FOR CONTRACTS REQUIRING
SECRETARY’S
PRIOR
APPROVAL.—Section 
1903(m)(2)(A)(iii) 
(42
U.S.C. 1396b(m)(2)(A)(iii)) is amended by striking ‘‘$100,000’’ and
inserting ‘‘$1,000,000 for 1998 and, for a subsequent year, the
amount established under this clause for the previous year
increased by the percentage increase in the consumer price index
for all urban consumers over the previous year’’.
(b) PERMITTING SAME COPAYMENTS IN HEALTH MAINTENANCE
ORGANIZATIONS AS IN FEE-FOR-SERVICE.—Section 1916 (42 U.S.C.
1396o) is amended—
(1) in subsection (a)(2)(D), by striking ‘‘or services fur-
nished’’ and all that follows through ‘‘enrolled,’’; and
(2) in subsection (b)(2)(D), by striking ‘‘or (at the option’’
and all that follows through ‘‘enrolled,’’.
(c) ASSURING TIMELINESS
OF PROVIDER PAYMENTS.—Section
1932 is further amended by adding at the end the following:
‘‘(f) TIMELINESS OF PAYMENT.—A contract under section 1903(m)
with a medicaid managed care organization shall provide that the
organization shall make payment to health care providers for items
and services which are subject to the contract and that are furnished
to individuals eligible for medical assistance under the State plan
under this title who are enrolled with the organization on a timely
basis consistent with the claims payment procedures described in
section 1902(a)(37)(A), unless the health care provider and the
organization agree to an alternate payment schedule.’’.
(d) CLARIFICATION OF APPLICATION OF FFP DENIAL RULES TO
PAYMENTS MADE PURSUANT TO MANAGED CARE ENTITIES.—Section
1903(i) (42 U.S.C. 1396b(i)) is amended by adding at the end the
following new sentence: ‘‘Paragraphs (1), (2), (16), (17), and (18)
shall apply with respect to items or services furnished and amounts
expended by or through a managed care entity (as defined in
section 1932(a)(1)(B)) in the same manner as such paragraphs apply
to items or services furnished and amounts expended directly by
the State.’’.
SEC. 4709. 6-MONTH GUARANTEED ELIGIBILITY FOR ALL INDIVIDUALS
ENROLLED IN MANAGED CARE.
Section 1902(e)(2) (42 U.S.C. 1396a(e)(2)) is amended—
(1) by striking ‘‘who is enrolled’’ and all that follows through
‘‘section 1903(m)(2)(A)’’ and inserting ‘‘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)),’’; and
(2) by inserting before the period ‘‘or by or through the
case manager’’.
SEC. 4710. EFFECTIVE DATES.
(a) GENERAL EFFECTIVE DATE.—Except as otherwise provided
in this chapter and section 4759, the amendments made by this
chapter shall take effect on the date of the enactment of this
Act and shall apply to contracts entered into or renewed on or
after October 1, 1997.
H. R. 2015—257
(b) SPECIFIC EFFECTIVE DATES.—Subject to subsection (c) and
section 4759—
(1) PCCM OPTION.—The amendments made by section 4702
shall apply to primary care case management services furnished
on or after October 1, 1997.
(2) 75:25 RULE.—The amendments made by section 4703
apply to contracts under section 1903(m) of the Social Security
Act (42 U.S.C. 1396b(m)) on and after June 20, 1997.
(3) QUALITY STANDARDS.—Section 1932(c)(1) of the Social
Security Act, as added by section 4705(a), shall take effect
on January 1, 1999.
(4) SOLVENCY STANDARDS.—
(A) IN GENERAL.—The amendments made by section
4706 shall apply to contracts entered into or renewed on
or after October 1, 1998.
(B) TRANSITION RULE.—In the case of an organization
that as of the date of the enactment of this Act has entered
into a contract under section 1903(m) of the Social Security
Act with a State for the provision of medical assistance
under title XIX of such Act under which the organization
assumes full financial risk and is receiving capitation pay-
ments, the amendment made by section 4706 shall not
apply to such organization until 3 years after the date
of the enactment of this Act.
(5) SANCTIONS
FOR
NONCOMPLIANCE.—Section 1932(e) of
the Social Security Act, as added by section 4707(a), shall
apply to contracts entered into or renewed on or after April
1, 1998.
(6) LIMITATION ON FFP FOR ENROLLMENT BROKERS.—The
amendment made by section 4707(b) shall apply to amounts
expended on or after October 1, 1997.
(7) 6-MONTH GUARANTEED ELIGIBILITY.—The amendments
made by section 4709 shall take effect on October 1, 1997.
(c) NONAPPLICATION TO WAIVERS.—Nothing in this chapter (or
the amendments made by this chapter) shall be construed as affect-
ing the terms and conditions of any waiver, or the authority of
the Secretary of Health and Human Services with respect to any
such waiver, under section 1115 or 1915 of the Social Security
Act (42 U.S.C. 1315, 1396n).
CHAPTER 2—FLEXIBILITY IN PAYMENT OF PROVIDERS
SEC. 4711. FLEXIBILITY IN PAYMENT METHODS FOR HOSPITAL, NURS-
ING FACILITY, ICF/MR, AND HOME HEALTH SERVICES.
(a) REPEAL OF BOREN REQUIREMENTS.—Section 1902(a)(13) (42
U.S.C. 1396a(a)(13)) is amended—
(1) by striking all that precedes subparagraph (D) and
inserting the following:
‘‘(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,
H. R. 2015—258
‘‘(ii) providers, beneficiaries and their representa-
tives, 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 disproportion-
ate number of low-income patients with special needs;’’;
(2) by redesignating subparagraphs (D) and (E) as subpara-
graphs (B) and (C), respectively;
(3) in subparagraph (B), as so redesignated, by adding
‘‘and’’ at the end;
(4) in subparagraph (C), as so redesignated, by striking
‘‘and’’ at the end; and
(5) by striking subparagraph (F).
(b) STUDY AND REPORT.—
(1) STUDY.—The Secretary of Health and Human Services
shall study the effect on access to, and the quality of, services
provided to beneficiaries of the rate-setting methods used by
States pursuant to section 1902(a)(13)(A) of the Social Security
Act (42 U.S.C. 1396a(a)(13)(A)), as amended by subsection (a).
(2) REPORT.—Not later than 4 years after the date of the
enactment of this Act, the Secretary of Health and Human
Services shall submit a report to the appropriate committees
of Congress on the conclusions of the study conducted under
paragraph (1), together with any recommendations for legisla-
tion as a result of such conclusions.
(c) CONFORMING AMENDMENTS.—
(1) Section 1905(o)(3) (42 U.S.C. 1396d(o)(3)) is amended
by striking ‘‘amount described in section 1902(a)(13)(D)’’ and
inserting ‘‘amount determined in section 1902(a)(13)(B)’’.
(2) Section 1923 (42 U.S.C. 1396r–4) is amended, in sub-
sections (a)(1) and (e)(1), by striking ‘‘1902(a)(13)(A)’’ each place
it appears and inserting ‘‘1902(a)(13)(A)(iv)’’.
(d) EFFECTIVE DATE.—This section shall take effect on the
date of the enactment of this Act and the amendments made by
subsections (a) and (c) shall apply to payment for items and services
furnished on or after October 1, 1997.
SEC. 4712. PAYMENT FOR CENTER AND CLINIC SERVICES.
(a) PHASE-OUT OF PAYMENT BASED ON REASONABLE COSTS.—
Section 1902(a)(13)(C) (42 U.S.C. 1396a(a)(13)(C)), as redesignated
by section 4711(a)(2), is amended by inserting ‘‘(or 95 percent for
services furnished during fiscal year 2000, 90 percent for services
furnished during fiscal year 2001, 85 percent for services furnished
during fiscal year 2002, or 70 percent for services furnished during
fiscal year 2003)’’ after ‘‘100 percent’’.
(b) TRANSITIONAL SUPPLEMENTAL PAYMENT FOR SERVICES FUR-
NISHED UNDER CERTAIN MANAGED CARE CONTRACTS.—
(1) 
IN
GENERAL.—Section 
1902(a)(13)(C) 
(42 
U.S.C.
1396a(a)(13)(C)), as so redesignated, is further amended—
(A) by inserting ‘‘(i)’’ after ‘‘(C)’’, and
(B) by inserting before the semicolon at the end the
following: ‘‘and (ii) in carrying out clause (i) in the case
H. R. 2015—259
of services furnished by a Federally-qualified health center
or a rural health clinic pursuant to a contract between
the center and an organization under section 1903(m), for
payment to the center or clinic at least quarterly by the
State of a supplemental payment equal to the amount
(if any) by which the amount determined under clause
(i) exceeds the amount of the payments provided under
such contract’’.
(2) CONFORMING AMENDMENT TO MANAGED CARE CONTRACT
REQUIREMENT.—Clause (ix) of section 1903(m)(2)(A) (42 U.S.C.
1396b(m)(2)(A)) is amended to read as follows:
‘‘(ix) such contract provides, in the case of an entity that
has entered into a contract for the provision of services with
a Federally-qualified health center or a rural health clinic,
that the entity shall provide payment that is not less than
the level and amount of payment which the entity would make
for the services if the services were furnished by a provider
which is not a Federally-qualified health center or a rural
health clinic;’’.
(3) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply to services furnished on or after October
1, 1997.
(c) END OF TRANSITIONAL PAYMENT RULES.—Effective for serv-
ices furnished on or after October 1, 2003—
(1) subparagraph (C) of section 1902(a)(13) (42 U.S.C.
1396a(a)(13)), as so redesignated, is repealed, and
(2) clause (ix) of section 1903(m)(2)(A) (42 U.S.C.
1396b(m)(2)(A)) is repealed.
(d) FLEXIBILITY
IN COVERAGE
OF NON-FREESTANDING LOOK-
ALIKES.—
(1) IN
GENERAL.—Section 1905(l)(2)(B)(iii) (42 U.S.C.
1396d(l)(2)(B)(iii)) is amended by inserting ‘‘including require-
ments of the Secretary that an entity may not be owned,
controlled, or operated by another entity,’’ after ‘‘such a grant,’’.
(2) EFFECTIVE DATE.—The amendment made by paragraph
(1) shall apply to services furnished on or after the date of
the enactment of this Act.
SEC. 4713. ELIMINATION OF OBSTETRICAL AND PEDIATRIC PAYMENT
RATE REQUIREMENTS.
(a) IN GENERAL.—Section 1926 (42 U.S.C. 1396r–7) is repealed.
(b) EFFECTIVE DATE.—The repeal made by subsection (a) shall
apply to services furnished on or after October 1, 1997.
SEC. 4714. MEDICAID PAYMENT RATES FOR CERTAIN MEDICARE COST-
SHARING.
(a) CLARIFICATION REGARDING STATE LIABILITY FOR MEDICARE
COST-SHARING.—
(1) IN GENERAL.—Section 1902(n) (42 U.S.C. 1396a(n)) is
amended—
(A) by inserting ‘‘(1)’’ after ‘‘(n)’’, and
(B) by adding at the end the following:
‘‘(2) In carrying out paragraph (1), a State is not required
to provide any payment for any expenses incurred relating to pay-
ment 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
H. R. 2015—260
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.’’.
(2) CONFORMING
CLARIFICATION.—Section 1905(p)(3) (42
U.S.C. 1396d(p)(3)) is amended by inserting ‘‘(subject to section
1902(n)(2))’’ after ‘‘means’’.
(b) LIMITATION ON MEDICARE PROVIDERS.—
(1) PROVIDER
AGREEMENTS.—Section 1866(a)(1)(A) (42
U.S.C. 1395cc(a)(1)(A)) is amended—
(A) by inserting ‘‘(i)’’ after ‘‘(A)’’, and
(B) by inserting before the comma at the end the
following: ‘‘, and (ii) not to impose any charge that is
prohibited under section 1902(n)(3)’’.
(2) NONPARTICIPATING
PROVIDERS.—Section 1848(g)(3)(A)
(42 U.S.C. 1395w–4(g)(3)(A)) is amended by inserting before
the period at the end the following: ‘‘and the provisions of
section 1902(n)(3)(A) apply to further limit permissible charges
under this section’’.
(c) EFFECTIVE DATE.—The amendments made by this section
shall apply to payment for (and with respect to provider agreements
with respect to) items and services furnished on or after the date
of the enactment of this Act. The amendments made by subsection
(a) shall also apply to payment by a State for items and services
furnished before such date if such payment is the subject of a
law suit that is based on the provisions of sections 1902(n) and
1905(p) of the Social Security Act and that is pending as of, or
is initiated after, the date of the enactment of this Act.
SEC. 4715. TREATMENT OF VETERANS’ PENSIONS UNDER MEDICAID.
(a) POST-ELIGIBILITY TREATMENT.—Section 1902(r)(1) (42 U.S.C.
1396a(r)(1)) is amended—
(1) by inserting ‘‘(A)’’ after ‘‘(r)(1)’’,
(2) by inserting ‘‘, the treatment described in subparagraph
(B) shall apply,’’ after ‘‘under such a waiver’’;
(3) by striking ‘‘and,’’ and inserting ‘‘, and’’; and
(4) by adding at the end the following:
‘‘(B)(i) In the case of a veteran who does not have a spouse
or a child, if the veteran—