Source: https://www.law.cornell.edu/uscode/text/42/1396o?qt-us_code_tabs=2
Timestamp: 2015-03-01 17:19:14
Document Index: 589875382

Matched Legal Cases: ['§ 1916', '§ 131', '§ 309', '§ 9505', '§ 9403', '§ 4101', '§ 411', '§ 6408', '§ 4708', '§ 201', '§ 6041', '§ 5006', '§ 4107', '§ 5006', '§ 5006', '§ 6062', '§ 6041', '§ 6041', '§ 6062', '§ 201', '§ 201', '§ 4708', '§ 4708', '§ 6408', '§ 6408', '§ 4101', '§ 4211', '§ 4101', '§ 309', '§ 309', '§ 6041', '§ 4101', '§ 131', '§ 131', '§ 309']

no deduction, cost sharing, or similar charge will be imposed under the plan with respect to—
Imposition of monthly premium; persons affected; amount; prepayment; failure to pay; use of funds from other programs (1)
The State plan of a State may at the option of the State provide for imposing a monthly premium (in an amount that does not exceed the limit established under paragraph (2)) with respect to an individual described in subparagraph (A) or (B) of section 1396a
(l)(1) of this title who is receiving medical assistance on the basis of section 1396a
(a)(10)(A)(ii)(IX) of this title and whose family income (as determined in accordance with the methodology specified in section 1396a
(l)(3) of this title) equals or exceeds 150 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 9902
Premiums for qualified disabled and working individuals described in section 1396d(s) With respect to a qualified disabled and working individual described in section 1396d
(s) of this title whose income (as determined under paragraph (3) of that section) exceeds 150 percent of the official poverty line referred to in that paragraph, the State plan of a State may provide for the charging of a premium (expressed as a percentage of the medicare cost-sharing described in section 1396d
(p)(3)(A)(i) of this title provided with respect to the individual) according to a sliding scale under which such percentage increases from 0 percent to 100 percent, in reasonable increments (as determined by the Secretary), as the individual’s income increases from 150 percent of such poverty line to 200 percent of such poverty line.
Prohibition of denial of services on basis of individual’s inability to pay certain charges The State plan shall require that no provider participating under the State plan may deny care or services to an individual eligible for such care or services under the plan on account of such individual’s inability to pay a deduction, cost sharing, or similar charge. The requirements of this subsection shall not extinguish the liability of the individual to whom the care or services were furnished for payment of the deduction, cost sharing, or similar charge.
Charges imposed under waiver authority of Secretary No deduction, cost sharing, or similar charge may be imposed under any waiver authority of the Secretary, except as provided in subsections (a)(3) and (b)(3) of this section and section 1396o–1 of this title, unless such waiver is for a demonstration project which the Secretary finds after public notice and opportunity for comment—
Individuals provided medical assistance under section 1396a(a)(10)(A)(ii)(XV) or (XVI) With respect to individuals provided medical assistance only under subclause (XV) or (XVI) of section 1396a
(a)(10)(A)(ii) of this title—
a State may (in a uniform manner for individuals described in either such subclause)—
In the case of any calendar year beginning after 2000, the dollar amount specified in paragraph (2) shall be increased in accordance with the provisions of section 415
Indexing nominal cost sharing In applying this section and subsections (c) and (e) ofsection 1396o–1 of this title, with respect to cost sharing that is “nominal” in amount, the Secretary shall increase such “nominal” amounts for each year (beginning with 2006) by the annual percentage increase in the medical care component of the consumer price index for all urban consumers (U.S. city average) as rounded up in an appropriate manner.
State option to impose income-related premiums for families of disabled children (1)
With respect to disabled children provided medical assistance under section 1396a
(a)(10)(A)(ii)(XIX) of this title, subject to paragraph (2), a State may (in a uniform manner for such children) require the families of such children to pay monthly premiums set on a sliding scale based on family income.
A premium requirement imposed under paragraph (1) may only apply to the extent that—
in the case of a disabled child described in that paragraph whose family income—
does not exceed 200 percent of the poverty line, the aggregate amount of such premium and any premium that the parent is required to pay for family coverage under section 1396a
(cc)(2)(A)(i) of this title and other cost-sharing charges do not exceed 5 percent of the family’s income; and
exceeds 200, but does not exceed 300, percent of the poverty line, the aggregate amount of such premium and any premium that the parent is required to pay for family coverage under section 1396a
(cc)(2)(A)(i) of this title and other cost-sharing charges do not exceed 7.5 percent of the family’s income; and
the requirement is imposed consistent with section 1396a
(cc)(2)(A)(ii)(I) of this title.
A State shall not require prepayment of a premium imposed pursuant to paragraph (1) and shall not terminate eligibility of a child under section 1396a
(a)(10)(A)(ii)(XIX) of this title for medical assistance under this subchapter on the basis of failure to pay any such premium until such failure continues for a period of at least 60 days from the date on which the premium became past due. The State may waive payment of any such premium in any case where the State determines that requiring such payment would create an undue hardship.
No premiums or cost sharing for Indians furnished items or services directly by Indian health programs or through referral under contract health services (1)
No cost sharing for items or services furnished to Indians through Indian health programs (A)
In general No enrollment fee, premium, or similar charge, and no deduction, copayment, cost sharing, or similar charge shall be imposed against an Indian who is furnished an item or service directly by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization or through referral under contract health services for which payment may be made under this subchapter.
No reduction in amount of payment to Indian health providers Payment due under this subchapter to the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization, or a health care provider through referral under contract health services for the furnishing of an item or service to an Indian who is eligible for assistance under such subchapter, may not be reduced by the amount of any enrollment fee, premium, or similar charge, or any deduction, copayment, cost sharing, or similar charge that would be due from the Indian but for the operation of subparagraph (A).
Rule of construction Nothing in this subsection shall be construed as restricting the application of any other limitations on the imposition of premiums or cost sharing that may apply to an individual receiving medical assistance under this subchapter who is an Indian.
(Aug. 14, 1935, ch. 531, title XIX, § 1916, as added Pub. L. 97–248, title I, § 131(b),Sept. 3, 1982, 96 Stat. 367; amended Pub. L. 97–448, title III, § 309(b)(18)–(20), Jan. 12, 1983, 96 Stat. 2409, 2410; Pub. L. 99–272, title IX, § 9505(c)(2),Apr. 7, 1986, 100 Stat. 209; Pub. L. 99–509, title IX, § 9403(g)(4)(B),Oct. 21, 1986, 100 Stat. 2056; Pub. L. 100–203, title IV, §§ 4101(d)(1), 4211
(h)(11),Dec. 22, 1987, 101 Stat. 1330–142, 1330–207; Pub. L. 100–360, title IV, § 411(k)(2),July 1, 1988, 102 Stat. 791; Pub. L. 101–239, title VI, § 6408(d)(3),Dec. 19, 1989, 103 Stat. 2269; Pub. L. 105–33, title IV, § 4708(b),Aug. 5, 1997, 111 Stat. 506; Pub. L. 106–170, title II, § 201(a)(3),Dec. 17, 1999, 113 Stat. 1893; Pub. L. 109–171, title VI, §§ 6041(b), 6062
(b),Feb. 8, 2006, 120 Stat. 84, 98; Pub. L. 111–5, div. B, title V, § 5006(a)(1),Feb. 17, 2009, 123 Stat. 505; Pub. L. 111–148, title IV, § 4107(c)(1),Mar. 23, 2010, 124 Stat. 561.)
2010—Subsecs. (a)(2)(B), (b)(2)(B). Pub. L. 111–148inserted “, and counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in section 1396d
(bb)) of this title and covered outpatient drugs (as defined in subsection (k)(2) ofsection 1396r–8 of this title and including nonprescription drugs described in subsection (d)(2) of such section) that are prescribed for purposes of promoting, and when used to promote, tobacco cessation by pregnant women in accordance with the Guideline referred to in section 1396d
(bb)(2)(A) of this title” after “complicate the pregnancy”.
2009—Subsec. (a). Pub. L. 111–5, § 5006(a)(1)(A), substituted “, (i), and (j)” for “and (i)” in introductory provisions.
Subsec. (j). Pub. L. 111–5, § 5006(a)(1)(B), added subsec. (j).
2006—Subsec. (a). Pub. L. 109–171, § 6062(b)(1), substituted “subsections (g) and (i)” for “subsection (g)” in introductory provisions.
Subsec. (f). Pub. L. 109–171, § 6041(b)(1), inserted “and section 1396o–1 of this title” after “(b)(3) of this section”.
Subsec. (h). Pub. L. 109–171, § 6041(b)(2), added subsec. (h).
Subsec. (i). Pub. L. 109–171, § 6062(b)(2), added subsec. (i).
1999—Subsec. (a). Pub. L. 106–170, § 201(a)(3)(A), substituted “Subject to subsection (g) of this section, the State plan” for “The State plan” in introductory provisions.
Subsec. (g). Pub. L. 106–170, § 201(a)(3)(B), added subsec. (g).
1997—Subsec. (a)(2)(D). Pub. L. 105–33, § 4708(b)(1), struck out “or services furnished to such an individual by a health maintenance organization (as defined in section 1396b
(m) of this title) in which he is enrolled,” after “section 1396d
(a)(4)(C) of this title,”.
Subsec. (b)(2)(D). Pub. L. 105–33, § 4708(b)(2), struck out “or (at the option of the State) services furnished to such an individual by a health maintenance organization (as defined in section 1396b
1989—Subsec. (a). Pub. L. 101–239, § 6408(d)(3)(A), substituted “subparagraph (A) or (E)(i)” for “subparagraph (A) or (E)” in introductory provisions.
Subsecs. (d) to (f). Pub. L. 101–239, § 6408(d)(3)(B), (C), added subsec. (d) and redesignated former subsecs. (d) and (e) as (e) and (f), respectively.
1988—Subsec. (c)(1). Pub. L. 100–360struck out “nonfarm” after “150 percent of the”.
1987—Subsec. (a)(1). Pub. L. 100–203, § 4101(d)(1)(A), inserted “(except for a premium imposed under subsection (c) of this section)” after “plan”.
Subsecs. (a)(2)(C), (b)(2)(C). Pub. L. 100–203, § 4211(h)(11), substituted “nursing facility, intermediate care facility for the mentally retarded” for “skilled nursing facility, intermediate care facility”.
Subsecs. (c) to (e). Pub. L. 100–203, § 4101(d)(1)(B), (C), added subsec. (c) and redesignated former subsecs. (c) and (d) as (d) and (e), respectively.
1986—Subsec. (a). Pub. L. 99–509substituted “subparagraph (A) or (E) of section 1396a
(a)(10) of this title” for “section 1396a
(a)(10)(A) of this title”.
Subsec. (a)(2)(E). Pub. L. 99–272added subpar. (E).
Subsec. (b). Pub. L. 99–509substituted “subparagraph (A) or (E) of section 1396a
Subsec. (b)(2)(E). Pub. L. 99–272added subpar. (E).
1983—Subsec. (c). Pub. L. 97–448, § 309(b)(18), substituted “subsection” for “subparagraph”.
Subsec. (d). Pub. L. 97–448, § 309(b)(19), (20), substituted in introductory text “, except as provided in subsections (a)(3) and (b)(3) of this section” for “unless authorized under this section”, and in cl. (5) substituted “is voluntary, or makes provision” for “in which participation is voluntary, or in which provision is made”.
Amendment by Pub. L. 111–148effective Oct. 1, 2010, see section 4107(d) ofPub. L. 111–148, set out as a note under section 1396d of this title.
Pub. L. 109–171, title VI, § 6041(c),Feb. 8, 2006, 120 Stat. 85, provided that: “The amendments made by this section [enacting section 1396o–1 of this title and amending this section] shall apply to cost sharing imposed for items and services furnished on or after March 31, 2006.”
Amendment by section 6062(b) ofPub. L. 109–171applicable to medical assistance for items and services furnished on or after Jan. 1, 2007, see section 6062(d) ofPub. L. 109–171, set out as a note under section 1396a of this title.
Amendment by Pub. L. 106–170applicable to medical assistance for items and services furnished on or after Oct. 1, 2000, see section 201(d) ofPub. L. 106–170, set out as a note under section 1396a of this title.
Amendment by Pub. L. 101–239applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after July 1, 1990, without regard to whether or not final regulations have been promulgated by such date, see section 6408(d)(5) ofPub. L. 101–239, set out as a note under section 1396a of this title.
Pub. L. 100–203, title IV, § 4101(d)(2),Dec. 22, 1987, 101 Stat. 1330–142, provided that: “The amendments made by paragraph (1) [amending this section] shall become effective on July 1, 1988.”
Amendment by section 4211(h)(11) ofPub. L. 100–203applicable 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) ofPub. L. 100–203, as amended, set out as an Effective Date note under section 1396r of this title.
Amendment by Pub. L. 99–509applicable to payments under this subchapter for calendar quarters beginning on or after July 1, 1987, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date, see section 9403(h) ofPub. L. 99–509, set out as a note under section 1396a of this title.
Amendment by Pub. L. 99–272applicable to medical assistance provided for hospice care furnished on or after Apr. 7, 1986, see section 9505(e) ofPub. L. 99–272, set out as a note under section 1396a of this title.
Pub. L. 97–248, title I, § 131(d), formerly § 131(c),Sept. 3, 1982, 96 Stat. 370, redesignated by Pub. L. 97–448, title III, § 309(a)(8),Jan. 12, 1983, 96 Stat. 2408, provided that:
“(1) Except as provided in paragraph (2), the amendments made by this section [enacting this section and amending section 1396a of this title] shall become effective on October 1, 1982.
“(2) In the case of a State plan for medical assistance under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] which the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet the additional requirements imposed by the amendments 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 the enactment of this Act [Sept. 3, 1982].”