An Act to amend the Social Security Act to provide an increase in benefits under the old-age, survivors, and disability insurance system, to provide benefits for additional categories of Individuals, to improve the public assistance program and programs relating to the welfare and health of children, and for other purposes
PL 90-248 (H.R.12080), enacted 01/02/1968

81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
821 
Public Law 90-248 
AN A C T 
January 2, 1968 
To amend the Social Security Act to provide an increase in benefits under the 
[H. R. 12O8O] 
old-age, survivors, and disability insurance system, to provide benefits for 
additional categories of individuals, to improve the public assistance program 
and programs relating to the welfare and health of children, and for other 
purposes. 
Be it enacted hy the Senate and House of Representatives 
of the 
United States of America in Congress assembled. That this Act, with 
sociai security 
the following table of contents, may be cited as the "Social Security ^^^^_ ""^^ 
Amendments of 1967''. 
TABLE OF CONTEXTS 
TITLE I—OLD-AGE, SURVIVORS, DISABILITY, AND HEALTH 
INSURANCE 
PAKT 1—BENEFITS UNDER THE OLD-AGE, SUKVIVORS, AND DISABILITY 
INSURANCE PROGRAM 
Sec. 101. Increase in old-age, survivors, and disability Insurance benefits. 
Sec. 102. Increase in benefits for certain individuals age 72 and over. 
Sec. 103. Maximum amount of a wife's or husband's insurance benefit. 
Sec. 104. Benefits to disabled widows and widowers. 
Sec. 105. Insured status for younger disabled workers. 
Sec. 106. Benefits in case of members of the uniformed services. 
Sec. 107. Liberalization of earnings test. 
Sec. 108. Increase of earnings counted for benefit and tax purposes. 
Sec. 109. Changes in tax schedules. 
Sec. 110. Allocation to disability insurance trust fund. 
Sec. 111. Extension of time for filing application for disability freeze where 
failure to make timely application is due to incompetency. 
Sec. 112. Benefits for certain adojjted children. 
PART 2—COVERAGE UNDER THE OLD-AGE, SURVIVORS, AND DISABILITY 
INSURANCE PROGRAM 
Sec. 115. Coverage of ministers. 
Sec. 116. Coverage of State and local employees. 
Sec. 117. Inclusion of Illinois among States permitted to divide their retirement 
systems. 
Sec. 118. Taxation of certain earnings of retired partner. 
Sec. 119. Inclusion of Puerto Rico among States permitted to include 
firemen 
and policemen; validation of certain past coverage in the State of 
Nebraska. 
Sec. 120. Coverage of firemen's positions pursuant to a State agreement. 
Sec. 121. Validation of coverage erroneously reported. 
Sec. 122. Coverage of fees of State and local government employees as self-
employment income. 
Sec. 123. Family employment in a private home. 
Sec. 124. Termination of coverage of employees of the Massachusetts Turnpike 
Authority. 
PART 3—HEALTH INSURANCE BENEFITS 
Sec. 125. Method of payment to physicians under supplementary medical insur-
ance program. 
Sec. 126. Elimination of requirement of physician certification in case of certain 
hospital services. 
Sec. 127. Inclusion of podiatrists' services under supplementary medical insur-
ance program. 
Sec. 128. Exclusion of certain services. 
Sec. 129. Transfer of all outpatient hospital services to supplementary medical 
insurance program. 
Sec. 130. Billing by hospital for services furnished to outpatients. 
Sec. 131. Payment of reasonable charges for radiological or pathological services 
furnished by certain physicians to hospital inpatients. 
Sec. 132. Payment for purchase of durable medical equipment. 
Sec. 133. Payment for physical therapy services furnished to outpatients. 
Sec. 134. Payment for certain portable X-ray services. 
Sec. 135. Blood deductibles. 
822 
PUBLIC L
A
W 90-248-JAN. 2, 1968 
[81 STAT. 
TABLE OF CONTENTS—Continued 
TITLE I—OLD-AGE, SURVIVORS, DISABILITY, AND HEALTH 
INSURANCE—Continued 
I'AKT 3—HEALTH 
INSUKANCE BENEFITS—Continued 
Sec. 136. Enrollment under supplementary medical insurance program based on 
alleged date of attaining age 65. 
Sec. 137. Extension by 60 days during individual's lifetime of maximum dura-
tion of benefits for inpatient hospital services. 
Sec. 138. Limitation on special reduction in allov\-able days of inpatient hospital 
services. 
Sec. 13J), Transitional provision on eligibility of presently uninsured individuals 
for hospital insurance benefits. 
Sec. 1-iO. Advisory Council to study coverage of the disabled under title XVIII of 
the Social Security Act. 
Sec. 141. Study to determine feasibility of inclusion of certain additional serv-
ices under part B of title XVIII of the Social Security Act. 
Sec. 142. Provisions for benefits under part A of title XVIII of the Social Secu-
rity Act for services to patients admitted prior to 1968 to certain 
hospitals. 
Sec. 143. Payments for emergency hospital services. 
Sec. 144. Payment under supplementary medical insurance program for certain 
inpatient ancillary services. 
See. 145. General enrollment period under title XVIII. 
Sec. 146. Elimination of special reduction in allow^able days of inpatient hospital 
services for patients in tuberculosis hospitals. 
PART 4—MISCELLANEOUS AND TECHNICAL 
AMENDMENTS 
Sec. 150. Eligibility of adopted child for monthly benefits. 
Sec. 151. Criteria for determining child's dependency on mother. 
Sec. 152. Recovery of overpayments. 
Sec. 153. Benefits paid on basis of erroneous reports of death in military service. 
Sec. 154. Underpayments. 
Sec. 155. Simplification of computation of primary insurance amount and quar-
ters of coverage in case of 1937-1950 wages. 
Sec. 156. Definitions of vpidow, widov^^er, and stepchild. 
Sec. 157. Husband's and widower's insurance benefits without requirement of 
wife's currently insured status. 
Sec. 158. Definition of disability. 
Sec. 159. Disability benefits affected by receipt of workmen's compensation. 
Sec. 160. Extension of time for filing reports of earnings. 
Sec. 161. Penalties for failure to file timely reports of earnings and other events. 
Sec. 162. Limitation on payment of benefits to aliens outside the United States. 
Sec. 163. Benefits for certain children. 
Sec. 164. Transfer to Health Insurance Benefits Advisory Council of National 
Medical Review Committee functions; increase in Council's member-
ship. 
Sec. 165. Advisory Council on Social Security. 
Sec. 166. Reimbursement of civil service retirement annuitants for certain pre-
mium payments under supplementary medical insurance program. 
Sec. 167. Appropriations to supplementary medical insurance trust fund. 
Sec. 168. Disclosure to courts of whereabouts of certain individuals. 
Sec. 169. Reports of boards of trustees to Congress. 
Sec. 170. General saving provision. 
Sec. 171. Expedited benefit payments. 
Sec. 172. Definition of blindness. 
Sec. 173. Attorneys fees for claimants. 
TITLE II—PUBLIC WELFARE AMENDMENTS 
PAKT 1—PUBLIC ASSISTANCE AMENDMENTS 
Sec. 201. Programs of services furnished to families with dependent children. 
Sec. 202. Earnings exemption for recipients of aid to families with dependent 
children. 
Sec. 203. Dependent children of unemployed fathers. 
Sec. 204. Work incentive program for recipients of aid under part A of title IV. 
Sec. 205. Federal participation in payments for foster care of certain dependent 
children. 
Sec. 206. Emergency assistance for certain needy families with children. 
81 STAT. ] 
PUBLIC L
A
W 90-248-JAN. 2, 1968 
823 
TABLE OF CONTENTS—Continued 
TITLE II—PUBLIC WELFARE AMENDMENTS—Continued 
PART 1—PUBLIC ASSISTANCE AMENDMENTS—Continued 
Sec. 207. Protective payments and vendor payments with respect to dependent 
children. 
Sec. 208. Limitation on number of children with respect to whom Federal pay-
ments may be made. 
Sec. 209. Federal participation in payments for repairs to home owned by 
recipient of aid or assistance. 
Sec. 210. Use of subprofessional staff and volunteers in providing services to 
individuals applying for and receiving assistance. 
Sec. 211. Location of certain parents who desert or abandon dependent children. 
Sec. 212. Provision of services by others than a State. 
Sec. 213. Authority to disregard additional income of recipients of public 
assistance. 
PART 2—MEDICAL ASSISTANCE AMENDMENTS 
Sec. 220. Limitation on Federal participation in medical assistance. 
Sec. 221. Maintenance of State effort. 
Sec. 222. Coordination of title XIX and the supplementary medical insurance 
program. 
Sec. 223. Modification of comparability provisions. 
Sec. 224. Required services under State medical assistance plan. 
Sec. 225. Extent of Federal financial participation in certain administrative ex-
penses. 
Sec. 226. Advisory council on medical assistance. 
Sec. 227. Free choice by individuals eligible for medical assistance. 
Sec. 228. Utilization of State facilities to provide consultative services to institu-
tions furnishing medical care. 
Sec, 229. Payments for services and care by a third party. 
Sec. 230. Direct payments to certain recipients«of medical assistance. 
Sec. 231. Date on which State plans under title XIX must meet certain 
financial 
participation retiuirements. 
Sec. 232. Observance of religious beliefs. 
Sec. 233. Coverage under title XIX of certain spouses of individuals receiving 
cash welfare aid or assistance. 
Sec. 234. Standards for skilled nursing homes furnishing services under State 
plans approved under title XIX. 
Sec. 235. Cost sharing and similar charges with respect to inpatient hospital 
services furnished under title XIX. 
Sec. 236. State plan requirements regarding licensing of administrators of skilled 
nursing homes furnishing services under State plans approved under 
title XIX. 
Sec. 237. Utilization of care and services furnished under title XIX. 
Sec. 238. Differences in standards with respect to income eligibility under title 
XIX. 
PAKT 3—CHILD-WELFARE 
SERVICES AMENDMENTS 
Sec. 240. Inclusion of child-welfare services in title IV. 
Sec. 241. Conforming amendments. 
PART 4—MISCELLANEOUS AND TECHNICAL AMENDMENTS 
Sec. 245. Partial payments to States. 
Sec. 246. Contracts for cooperative research or demonstration projects. 
Sec. 247. Permanent authority to support demonstration projects. 
Sec. 248. Special provisions relating to Puerto Rico, the Virgin Islands, and Guam. 
Sec. 249. Approval of certain projects. 
Sec. 2.50. Assistance in the form of institutional services in intermediate care 
facilities. 
TITLE III—IMPROVEMENT OF CHILD HEALTH 
Sec. 301. Consolidation of separate programs under title V of the Social Security 
Act. 
Sec. 302. Conforming amendments. 
Sec. 303. 1968 authorization for maternity and infant care projects. 
Sec. 304. Use of subprofessional staff and volunteers. 
Sec. 305. Extension of due date for child mental health report. 
Sec. 306. Short title. 
824 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT . 
TABLE OF CONTENTS—Continued 
TITLE IV—GENERAL PROVISIONS 
8ec. 401. Social work manpower and training. 
Sec. 402. Incentives for economy while maintaining or improving quality in the 
provision of health services. 
Sec. 403. Changes to reflect codification of title 5, United States Code. 
Sec. 404. Meaning of Secretary. 
Sec. 405. Study of retirement test and of drug standards and coverage. 
TITLE V—MISCELLANEOUS PROVISIONS 
Sec. 501. Extension of period for filing application for exemption by members of 
religious groups opposed to insurance. 
Sec. 502. Refund of certain overpayments by employees of hospital insurance tax. 
Sec. 503. Extension of time to provide assistance for United States citizens re-
turned from foreign countries. 
Sec. 504. Exclusion from definition of wages of certain retirement, etc., payments 
under employer-established plans. 
TITLE I—OLD-AGE, SURVIVORS, DISABILITY, AND 
H E A L T H INSURANCE 
PART 1—BENEFITS UNDER THE OLD-AGE, SURVIVORS, AND DiSAiiiLiTv 
INSURANCE PROGRAM 
79 Stat. 361. 
42 u s e 415. 
INCREASE I N OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE 
BENEFITS 
SEC. 101. (a) Section 215(a) of the Social Security Act is amended 
by striking out the table and inserting in lieu thereof the following: 
"TABLE FOR DETERMINING PRIMARY INSURANCE AMOUNT AND MAXIMUM 
FAMILY BENEFITS 
"I 
(Primary insurance benefit 
under 1939 Act, as modi-
lied) 
If an individual's primary 
insurance benefit (as de-
termined under subsec. 
Id)) is— 
At least— 
$16.61 
16.21 
16.85 
17.61 
18.41 
19.25 
20.01 
20.65 
21.29 
21.89 
22.29 
22.69 
23.09 
23,45 
23.77 
24.21 
24.61 
25,01 
25.49 
25.93 
26.41 
26.95 
27.47 
28.01 
But not 
more than— 
$15.60 
16.20 
16.84 
17.60 
18.40 
19.24 
20.00 
20.64 
21.28 
21.88 
22.28 
22.68 
23.08 
23.44 
23.76 
24.20 
24.60 
25.00 
25.48 
25.92 
26.40 
26.94 
27.46 
28.00 
28.68 
II 
(Primary 
insurance 
amount 
under 1965 
Act) 
Or his 
primary 
insurance 
amount 
(as deter-
mined 
under 
subsec. 
(c)) i s -
$48.00 
or less 
49.00 
50.00 
51.00 
52.00 
53.00 
54.00 
55.00 
56.00 
57.00 
58.00 
59.00 
60.00 
61.00 
62.10 
63.20 
64.20 
65.30 
66.40 
67.50 
68.50 
69.60 
70.70 
71.70 
72.80 
III 
(Average monthly wage) 
Or his average monthly 
yfa/ge 
(as 
determined 
under subsec. (b)) is— 
At least— 
$75 
77 
79 
81 
82 
84 
86 
88 
90 
91 
93 
95 
97 
98 
100 
102 
103 
106 
107 
108 
110 
114 
119 
123 
But not 
more than— 
$74 
76 
78 
80 
81 
83 
85 
87 
89 
90 
92 
94 
96 
97 
99 
101 
102 
104 
106 
107 
109 
113 
118 
122 
127 
rv 
(Primary in-
surance 
amount) 
The amount 
referred to in 
the preceding 
paragraphs 
of this sub-
section shall 
be— 
$55.00 
55.40 
56.50 
57.70 
58.80 
59.90 
61.10 
62.20 
63.30 
64.50 
65.60 
66.70 
67.80 
69.00 
70.20 
71.50 
72.60 
73.80 
75.10 
76.30 
77.50 
78.70 
79.90 
81.10 
82.30 
V 
(Maximum family 
benefits) 
And the maximum 
amount of bene-
fits payable (as 
provided in sec. 
203(a)) on the 
basis of his wages 
and self-employ-
ment income 
shall be— 
$82.50 
83.10 
84.80 
86.60 
88.20 
89.90 
91.70 
93.30 
95.00 
96.80 
98.40 
100.10 
101.70 
103.50 
105.30 
107.30 
108.90 
110.70 
112.70 
114.50 
116.30 
118.10 
119.90 
121.70 
123.50 
81 STAT.] 
PUBLIC L
A
W 90-248-JAN. 2, 1968 
825 
" T A B L E FOK D E T E R M I N I N G P K I M A R Y I N S U R A N C E AJMOUNT A N D MAXIMUM 
FAMILY BENEFITS—Continued 
(Primary insurance benefit 
under 1939 Act, as modi-
fled) 
If an individual's primary 
insurance benefit (as de-
termined 
under 
subsec. 
(d)) I s -
II 
(Primary 
insurance 
amount 
under 1965 
Act) 
At least— 
$28. 69 
29.26 
29.69 
30.37 
30.93 
31.37 
32.01 
32.61 
33.21 
33.89 
34.51 
35.01 
.35.81 
36.41 
37.09 
37.61 
38.21 
39.13 
39.69 
40.34 
41.13 
41.77 
42.45 
43.21 
43.77 
44.45 
44.89 
But not 
more than-
$29.25 
29.68 
30.36 
30.92 
31.36 
32.00 
32.60 
33.20 
33.88 
34.50 
35.00 
35.80 
36.40 
37.08 
37.60 
38.20 
39.12 
39.68 
40.33 
41.12 
41.76 
42.44 
43.20 
43.76 
44.44 
44.88 
45.60 
Or his 
primary 
insurance 
amount 
(as deter-
mined 
under 
subsec. 
(c)) i s -
III 
(Average raontlily wage) 
IV 
(Primary in-
surance 
amount) 
$73.90 
74.90 
76.00 
77.10 
78.20 
79.20 
80.30 
8L40 
82.40 
83.50 
84.60 
85.60 
86.70 
87.80 
88.90 
89.90 
9L00 
92.10 
93.10 
94.20 
95.30 
96.30 
97.40 
98. .50 
99.60 
100.60 
101. 70 
102.80 
103.80 
104.90 
106.00 
107.00 
108.10 
109.20 
110.30 
111. 30 
112.40 
113.60 
114.50 
115.60 
116. 70 
117. 
70 
118.80 
119.90 
121.00 
122.00 
123.10 
124.20 
125. 
20 
126.30 
127.40 
128.40 
129.60 
130.60 
131. 70 
132. 70 
133.80 
134.90 
135.90 
137.00 
138.00 
139.00 
140.00 
141.00 
142.00 
143.00 
144.00 
146.00 
146.00 
147.00 
148.00 
149.00 
150.00 
151.00 
Or liis average montiily 
wage 
(as 
determined 
under subsec. (b)) is— 
At least-
$128 
133 
137 
142 
147 
151 
156 
161 
166 
170 
175 
179 
184 
189 
194 
198 
203 
208 
212 
217 
222 
226 
231 
236 
240 
245 
250 
2.54 
259 
264 
268 
273 
278 
282 
287 
292 
296 
301 
306 
310 
316 
320 
324 
329 
334 
338 
343 
348 
362 
367 
362 
366 
371 
376 
380 
385 
390 
394 
399 
404 
408 
413 
418 
422 
427 
432 
437 
441 
446 
451 
455 
460 
466 
469 
But not 
more than-
(Maximum family 
benefits) 
The amount 
referred to in 
the preceding 
paragraphs 
of this sub-
section shall 
b e -
$132 
1
3
6 
1
4
1 
1
4
6 
1
5
0 
1
5
5 
1
6
0 
1
6
4 
1
6
9 
1
7
4 
1
7
8 
1
8
3 
1
8
8 
1
9
3 
197 
202 
207 
2
1
1 
2
1
6 
2
2
1 
2
2
6 
230 
2
3
6 
239 
244 
2
4
9 
2
6
3 
2
6
8 
2
6
3 
267 
272 
277 
2
8
1 
2
8
6 
2
9
1 
2
9
5 
300 
3
0
6 
309 
314 
319 
323 
328 
333 
337 
342 
347 
3
6
1 
3
5
6 
3
6
1 
3
6
5 
370 
375 
379 
384 
389 
393 
398 
403 
407 
412 
417 
4
2
1 
4
2
6 
4
3
1 
4
3
6 
440 
445 
460 
464 
469 
464 
4
6
8 
473 
$83.60 
84.70 
85.90 
87.20 
88.40 
89.50 
90.80 
92.00 
93.20 
94.40 
95.60 
96.80 
98.00 
99.30 
100.50 
101.60 
102.90 
104.10 
106.20 
106.50 
107. 
70 
108.90 
110.10 
111.40 
112.60 
113. 
70 
115.00 
116.20 
117.30 
118.60 
119.80 
121.00 
122.20 
123.40 
124. 
70 
125.80 
127.10 
128.30 
129.40 
130.70 
131.90 
133.00 
134.30 
136.60 
136.80 
137.90 
139.10 
140.40 
141.50 
142.80 
144.00 
145.10 
146.40 
147.60 
148.90 
160.00 
151.20 
162.60 
153.60 
164.90 
156.00 
167.10 
168.20 
159.40 
160.60 
161.60 
162.80 
163.90 
166.00 
166.20 
167.30 
168.40 
169.60 
170. 
70 
And the maximum 
amount of bene-
fits payable (as 
provided in sec. 
203(a)) on the 
basis of his wages 
and self-employ-
ment income 
shall be— 
$126. 40 
127.10 
128.90 
130.80 
132.60 
134.30 
136.20 
138.00 
139.80 
141. 60 
143.40 
146.40 
150.40 
164.40 
157.60 
16L60 
165.60 
168.80 
172.80 
176.80 
180.00 
184.00 
188.00 
191.20 
195.20 
199.20 
202.40 
206.40 
210.40 
213.60 
217.60 
221.60 
224.80 
228.80 
232.80 
236.00 
240.00 
244.00 
247. 20 
26L20 
255.20 
268.40 
262.40 
266.40 
269.60 
273.60 
277.60 
280.80 
284.80 
288.80 
292.00 
296.00 
300.00 
303.20 
307.20 
311.20 
314.40 
318.40 
322.40 
326.60 
329.60 
333.60 
336.80 
340.80 
344.80 
348.80 
360.40 
362.40 
364.40 
356.00 
368.00 
360.00 
361.60 
363.60 
826 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
"TABLE FOR DETERMINING PRIMARY INSURANCE AMOUNT AND MAXIMUM 
FAMILY BENEFITS—Continued 
"I 
(Primary insurance benefit 
under 1939 Act, as modi-
fled) 
If an individual's primary 
insurance benefit (as de-
termined under subsec. 
(d)) i s -
At least— 
But not 
more than— 
II 
(Primary 
insurance 
amount 
under 1965 
Act) 
Or his 
primary 
insurance 
amount 
(as deter-
mined 
under 
subsec, 
(c)) i s -
$152.00 
153.00 
154.00 
155.00 
156.00 
157.00 
158.00 
159.00 
160.00 
161.00 
162.00 
163.00 
164.00 
165.00 
166.00 
167.00 
168.00 
III 
(Average monthly wage) 
Or his avers^e monthly 
wage 
(as 
determined 
under subsec. (b)) is— 
At least— 
$474 
479 
483 
488 
493 
497 
502 
507 
511 
516 
521 
525 
530 
535 
539 
544 
549 
554 
557 
561 
564 
568 
571 
575 
578 
582 
685 
589 
592 
596 
599 
603 
606 
610 
613 
617 
621 
624 
628 
631 
635 
638 
642 
645 
649 
But not 
more than— 
$478 
482 
487 
492 
496 
501 
506 
510 
515 
520 
524 
529 
534 
538 
543 
548 
553 
556 
560 
563 
567 
570 
574 
577 
581 
584 
588 
591 
595 
598 
602 
605 
609 
612 
616 
620 
623 
627 
630 
634 
637 
641 
644 
648 
650 
IV 
(Primary in-
surance 
amount) 
The amount 
referred to in 
the preceding 
paragraphs 
of this sub-
section shall 
be— 
$171.80 
172.90 
174.10 
175.20 
176.30 
177.50 
178.60 
179.70 
180.80 
182.00 
183.10 
184.20 
185.40 
186. 50 
187.60 
188.80 
189.90 
191.00 
192.00 
193.00 
194.00 
195.00 
196.00 
197.00 
198.00 
199.00 
200.00 
201.00 
202.00 
203.00 
204.00 
205.00 
•206.00 
207.00 
208.00 
209.00 
210.00 
211.00 
212.00 
213.00 
214.00 
215.00 
216.00 
217.00 
218.00 
V 
(Maximum family 
benefits) 
And the maximum 
amount of bene-
fits payable (as 
provided in sec. 
203(a)) on the 
basis of his wages 
and self-employ-
ment income 
shall be— 
$365.60 
367.20 
369.20 
371.20 
372.80 
374.80 
376.80 
378.40 
380.40 
382.40 
384.00 
386.00 
388.00 
389.60 
391.60 
393.60 
395.60 
396.80 
398.40 
399.60 
401.20 
402.40 
404.00 
405.20 
406.80 
408.00 
409.60 
410.80 
412.40 
413.60 
415.20 
416.40 
418.00 
419.20 
420.80 
422.40 
423.60 
425.20 
426.40 
428.00 
429.20 
430.80 
432.00 
433.60 
434.40". 
79 Stat. 363. 
42 u s e 403. 
42 use 402, 
423. 
42 use 422; 
Post, pp. 830-
832. 
(b) Section 203(a) of such Act is amended by striking out para-
graph (2) and inserting in lieu thereof the following: 
"(2) when two or more persons were entitled (without the ap-
plication of section 202(j)(l) and section 223(b)) to monthly 
benefits under section 202 or 223 for the month of February 1968 
on the basis of the wages and self-employment income of such in-
sured individual, such total of benefits for such month or any 
subsequent month shall not be reduced to less than the larger of— 
" (A) the amount determined under this subsection without 
regard to this paragraph, or 
"(B) an amount equal to the sum of the amounts derived 
by multiplying the benefit amount determined under this title 
(including this subsection, but without the application of 
section 222(b), section 202 (q), and subsections (b), (c), and 
(d) of this section), as in effect prior to February 1968, for 
each such person for February 1968, by 113 percent and 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
827 
raising each such increased amount, if it is not a multiple 
of $0.10, to the next higher multiple of $0.10; 
but in any such case (i) paragraph (1) of this subsection shall 
"
^
^ use 403. 
not be applied to such total of benefits after the application of 
subparagraph 
(B), and (ii) if section 202(k)(2)(A) was 
applicable in the case of any such benefits for the month of Feb-
ruary 1968, and ceases to apply after such month, the provisions 
of subparagraph (B) shall be applied, for and after the month 
in which section 202 (k) (2) (A) ceases to apply, as though para-
graph (1) had not been applicable to such total of benefits for 
February 1968, or". 
(c) (1) Section 215(b)(4) of such Act is amended to read as 
42 usl?;'4is^' 
follows: 
"(4) The provisions of this subsection shall be applicable only in 
the case of an individual — 
"(A) who becomes entitled, after January 1968, to benefits 
under section 202 (a) or section 223; or 
^23^ ^^^ '*°-^' 
"(B) who dies after January 1968 without being entitled to 
benefits under section 202 (a) or section 223; or 
"(C) whose primary insurance amount is required to be recom-
puted under subsection (f) (2)." 
^°«'' P- S^^-
(2) Section 215 (b)(5) of such Act is repealed. 
Repeal. 
(d) Section 215(c) of such Act is amended to read as follows: 
42 us^c 4
^
^
5
^
• 
"Primary Insurance Amount Under 1965 Act 
79 Stat. 363. 
"(c) (1) For the purposes of column I I of the table appearing in 
subsection (a) of this section, an individual's primary insurance 
^"'e- P- ^24. 
amount shall be computed on the basis of the law in effect prior to the 
enactment of the Social Security Amendments of 1967. 
"(2) The provisions of this subsection shall be applicable only in 
the case of an individual who became entitled to benefits under section 
202(a) or section 223 before the month of February 1968, or who died 
before such month." 
(e) The amendments made by this section shall apply with respect 
to monthly benefits under title I I of the Social Security Act for 42^^ PO^/°''333 
months after January 1968 and with respect to lump-sum death pay- 
• »«• P-
ments under such title in the case of deaths occurring after January 
1968. 
(f) If an individual was entitled to a disability insurance benefit 
under section 223 of the Social Security Act for the month of January 
1968 and became entitled to old-age insurance benefits under section 
202(a) of such Act for the month of February 1968, or who died in 
such month, then, for purposes of section 215(a) (4) of the Social 
Security Act (if applicable) the amount in column IV of the table 
appearing in such section 215(a) for such individual shall be the 
^"'®' P- ^^'^• 
amount in such column on the line on which in column I I appears 
his primary insurance amount (as determined under section 215(c) 
of such Act) instead of the amount in column IV equal to the primary supra. 
insurance amount on which his disability insurance benefit is based. 
INCREASE IN BENEFITS FOR CERTAIN INDIVIDUALS AGE 72 AND OVER 
SEC. 102. (a) (1) Section 227(a) of the Social Security Act is 
amended by striking out "$35" and inserting in lieu thereof "$40", 
and by striking out "'$17.50" and inserting in lieu thereof "$20". 
(2) Section 227(b) of such Act is amended by striking out in the 
second sentence "$35" and inserting in lieu thereof "$40". 
(b) (1) Section 228 (b) (1) of such Act is amended by striking out 
"$35" and inserting in lieu thereof "$40". 
79 Stat. 379. 
42 u s e 427. 
80 Stat. 67. 
42 u s e 428. 
828 
PUBLIC LAW 90-248-JAN. 2, 1968 
fel 
STAT. 
80 Stat. 68. 
42 u s e 428. 
(2) Section 228(b)(2) of such Act is amended by striking out 
"$35" and inserting in lieu thereof ''$40", and by striking out "$17.50" 
and inserting in lieu thereof "$20". 
(3) Section 228(c)(2) of such Act is amended by striking out 
"$17.50" and inserting in lieu thereof "$20", 
(4) Section 228(c) (3) (A) of such Act is amended by striking out 
"$35" and inserting in lieu thereof "$40". 
(5) Section 228(c) (3) (B) of such Act is amended by striking out 
"$17.50" and inserting in lieu thereof "$20". 
(c) The amendments made by subsections (a) and (b) shall apply 
with respect to monthly benefits under title I I of the Social Security 
4
2
^
*
8
^
; S,'*p.^833. -^^t for uiontlis after January 1968. 
79 Stat. 375. 
42 u s e 402. 
832 
79 Stat. 403. 
79 Stat. 404. 
79 Stat. 373 
376. 
Post, 
p. 868 
Post, 
p. 829 
MAXIMUM AMOUNT OF A W I F E ' S OR H U S B A N D ' S INSURANCE 
BENEFIT 
SEC. 103. (a) Section 202(b)(2) of the Social Security Act is 
amended to read as follows: 
Post, pp. 830- 
u^2) Except as provided in subsection (q), such wife's insurance 
benefit for each month shall be equal to whichever of the following is 
the smaller: (A) one-half of the primary insurance amount of her 
husband (or, in the case of a divorced wife, her former husband) for 
such month, or (B) $105." 
7 2^stat.^*io^26^' 
(^) Sectiou 202(c) (3) of such Act is amended to read as follows: 
"(3) Except as provided in subsection (q), such husband's insur-
ance benefit for each month shall be equal to whichever of the follow-
ing is the smaller: (A) one-half of the primary insurance amount of 
his wife for such month, or (B) $105." 
(c) Section 202(e) (4) of such Act is amended by striking out "50 
per centum of the primary insurance amount of the deceased indi-
vidual on whose wages and self-employment income such benefit is 
based" and inserting in lieu thereof "whichever of the following is the 
smaller: (A) one-half of the primary insurance amount of the 
deceased individual on whose wages and self-employment income such 
benefit is based, or (B) $105". 
(d) Section 202(f) (5) of such Act is amended by striking out "50 
per centum of the primary insurance amount of the deceased individ-
ual on whose wages and self-employment income such benefit is based" 
and inserting in lieu thereof "whichever of the following is the smaller: 
(A) one-half of the primary insurance amount of the deceased indi-
vidual on whose wages and self-employment income such benefit is 
based,or (B) $105". 
(e) The amendments made by subsections (a), (b), (c), and (d) 
shall apply with respect to monthly benefits under title I I of the Social 
Security Act for months after January 1968. 
B E N E F I T S 
T O 
D I S A P . L E D 
W I D O W S 
AND 
WIDOWERS 
SEC. 104. (a)(1) Subparagraph (B) of section 202(e)(1) of the 
Social Security Act is amended to read as follows: 
"(B) (i) has attahied age 60, or (ii) has attained age 50 but has 
not attained age 60 and is under a disability (as defined in sec-
tion 223(d)) which began before the end of the period specified in 
paragraph (5),". 
(2) So much of section 202(e) (1) of such Act as follows subpara-
graph (E) is amended to read as follows: 
"shall be entitled to a widow's insurance benefit for each month, 
beginning with— 
^"P''^- 
"(F) if she satisfies subparagraph (B) by reason of clause (i) 
thereof, the first month in which she becomes so entitled to such 
insurance benefits, or 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
829 
"(G) if she satisfies subparagraph (B) by reason of clause (ii) 
tliereof— 
" (i) the first month after her waiting period (as defined in 
paragraph (6)) in which she becomes so entitled to such 
insurance benefits, or 
"(ii) the first month during all of which she is under a dis-
ability and in which she becomes so entitled to such insurance 
benefits, but only if she was previously entitled to insurance 
benefits under this subsection on the basis of being under a 
disability and such first month occurs (I) in the period speci-
fied in paragraph (5) and (II) after the month in which a 
previous entitlement to such benefits on such basis terminated, 
and ending with the month preceding the first month in which any of 
the following occurs: she remarries, dies, becomes entitled to an old-age 
insurance benefit equal to or exceeding 821/^ percent of the primary 
insurance amount of such deceased individual, or, if she became en-
titled to such benefits before she attained age 60, the third month fol-
lowing the month in w^liich her disability ceases (unless she attains age 
02 on or before the last day of such third month)." 
(3) Section 202(e) of such Act is further amended by adding after 
paragraph (4) the following new paragraphs: 
"(5) The period referred to in paragraph (1) (B) (ii), in the case 
of any widow or surviving divorced wife, is tlie period beginning with 
Avhichever of the following is the latest: 
"(A) the month in which occurred the deatli of the fully in-
sured individual referred to in paragraph (1) on whose wages 
and self-employment income her benefits are or would be based, or 
"(B) the last month for which she was entitled to mother's 
insurance benefits on the basis of the wages and self-employment 
income of such individual, or 
"(C) the month in which a previous entitlement to widow's 
insurance benefits on the basis of such wages and self-employment 
income terminated because lier disability had ceased, 
and ending with the month before tlie month in which she attains age 
60, or, if earlier, with the close of the eighty-fourth month following 
the month with which such period began. 
"(6) The waiting period referred to in paragraph (1) (G), in the 
case of any widow or surviving divorced Avife, is the earliest period of 
six consecutive calendar months— 
"(A) throughout which she has been under a disability, and 
"(B) which begins not earlier than with whichever of the fol-
lowing is the later: (i) the first day of the eighteenth month be-
fore the month in which her application is filed, or (ii) the first 
day of the sixth month before the month in Avhich the period speci-
fied in paragraph (5) begins." 
(b)(1) Subparagraph (B) of section 202(f)(1) of such Act is 
amended to read as follows: 
"(B) (i) has attained age 62, or (ii) has attained age 50 but 
has not attained age 62 and is under a disability (as defined in 
section 223(d)) which began before the end of the period speci-
fied in paragrapli (6),". 
(2) So much of section 202(f) (1) of such Act as follows subpara-
graph (E) is amended to read as follows: 
"shall be entitled to a widower's insurance benefit for each month, 
beginning with— 
"(F) if he satisfies subparagraph (B) by reason of clause (i) 
thereof, the first month in which he becomes so entitled to such 
insurance benefits, or 
"(G) if he satisfies subparagraph (B) bv reason of clause (ii) 
thereof— 
Infra. 
79 Stat. 40 3. 
42 u s e 402. 
Ante, 
p. 828. 
Supra-
64 Stat. 485; 
75 Stat. 131. 
Post, 
p. 
Post, 
p. 
868. 
830. 
64 Stat. 485; 
71 Stat. 519. 
830 
PUBLIC LAW 90-248-JAN. 2. 1%8 
[81 STAT. 
Infra. 
Infra. 
75 Stat. 138; 
79 Stat. 404. 
42 u s e 402. 
79 Stat. 404. 
Ante, 
p. 829. 
Ante, 
p. 829. 
Supra. 
79 Stat. 368. 
79 Stat. 374. 
Post, 
p. 831. 
"(i) the first month after his waiting period (as defined in 
paragraph (7)) in which he becomes so entitled to such in-
surance benefits, or 
"(ii) the first month during all of which lie is under a dis-
ability and in which he becomes so entitled to such insurance 
benefits, but only if he was previously entitled to insurance 
benefits under this subsection on the basis of being under a 
disability and such first month occurs (I) in the period 
specified in paragraph (6) and (II) after the month in which 
a previous entitlement to such benefits on such basis termi-
nated, 
and ending with the month preceding the first month in which any of 
the following occurs: he remarries, dies, or becomes entitled to an old-
age insurance benefit equal to or exceeding 82y2 percent of the pri-
mary insurance amount of his deceased wife, or the third month fol-
lowing the month in which his disability ceases (unless he attains age 
62 on or before the last day of such third month)." 
(3) Section 202(f) (3) of such Act is amended by inserting "sub-
section (q) and" after "provided in". 
(4) Section 202(f) of such Act is further amended by adding after 
paragraph (5) the following new paragraphs: 
"(6) The period referred to in paragraph (1) (B) (ii), in the case 
of any widower, is the period beginning with whichever of the follow-
ing is the latest: 
"(A) the month in which occurred the death of the fully in-
sured individual referred to in paragraph (1) on whose wages 
and self-employment income his benefits are or would be based, or 
"(B) the month in which a previous entitlement to widower's 
insurance benefits on the basis of such wages and self-employ-
ment income terminated because his disability had ceased, 
and ending with the month before the month in which he attains age 
62, or, if earlier, with the close of the eighty-fourth month following 
the month with which such period began. 
"(7) The waiting j)eriod referred to in paragraph (1) (G), in the 
case of any widower, is the earliest period of six consecutive calendar 
months— 
" (A) throughout which he has been under a disability, and 
"(B) which begins not earlier than with whichever of the fol-
lowing is the later: (i) the first day of the eighteenth month be-
fore the month in which his application is filed, or (ii) the first 
day of the sixth month before the month in which the period 
specified in paragraph (6) begins." 
(c) (1) The heading of section 202 (q) of such Act is amended to 
read as follows: 
"Reduction of Benefit Amounts for Certain Beneficiaries" 
(2) So much of section 202(q)(l) of such Act as precedes sub-
paragraph (A) is amended by striking out "or widow's" and insert-
mg in lieu thereof "widow's, or widower's". 
(3) Subparagraph (A) of section 202 (q) (1) of such Act is amended 
by striking out "or widow's" and inserting in lieu thereof ", widow's, or 
widower's". 
(4) Section 202 (q) (1) of such Act is amended by adding at the end 
thereof the following: 
"A widow's or widower's insurance benefit reduced pursuant to the 
preceding sentence shall be further reduced by— 
"(C) ^%98 of 1 percent of the amount of such benefit, multi-
plied by 
"(D) (i) the number of months in the additional reduction pe-
riod for such benefit (determined under paragraph (6)), if such 
75 Stat. 132; 
79 Stat. 368, 37^ 
79 Stat. 374. 
81 STAT.] 
PUBLIC LAW 9(>.248-JAN. 2, 196» 
831 
benefit is for a month before the month in which such individual 
attains retirement age, or 
"(ii) the number of months in the additional adjusted reduc-
tion period for such benefit (determined under paragraph (7)), 
^°«'' P- ^'^2. 
if such benefit is for the month in which such individual attains 
retirement age or for any month thereafter." 
(5) Section 202 (q) (3) (A) of such Act is amended— 
75 stat. 132; 
(A) by striking out "or widow's" each place it appears and in- 
42 use 402. 
serting in lieu thereof "widow's, or widower's"; 
(B) by striking out "a widow's" and inserting in lieu thereof 
"a widow's or widower's"; and 
(C) by striking out "60" and inserting in lieu thereof "50". 
(6) Section 202(q) (3) (C) of such Act is amended by striking out 
^9 stat. 369. 
"or widow's" each time it appears and inserting in lieu thereof 
"widow's, or widower's". 
(7) Section 202^q) (3) (D) of such Act is amended by striking out 
"or widow's" and inserting in lieu thereof "widow's, or widower's". 
(8) Section 202((^) (3) (E) of such Act is amended— 
(A) by striking out "(or would, but for subsection (e)^!), 
be)" and inserting in lieu thereof "(or would, but for subsection 
(e) (1) in the case of a widow or surviving divorced wife or sub-
section (f) (1) in the case of a widower, be)"; 
(B) by striking out "widow's" each place it appears and insert-
ing in lieu thereof "widow's or widower's"; and 
(C) by striking out "she" and inserting in lieu thereof "she 
or he". 
(9) Section 202 (q) (3) (F) of such Act is amended— 
(A) by striking out" (or would, but for subsection (e) (1), be)" 
and inserting in lieu thereof " (or would, but for subsection (e) (1) 
in the case of a widow or surviving divorced wife or subsection 
(f) (1) in the case of a widower, be)"; 
(B) by striking out "widow's" each place it appears and insert-
ing in lieu thereof "widow's or widower's"; and 
(C) by striking out "she" and inserting in lieu thereof "she or 
he". 
(10) Section 202 (q) (3) (G) of such Act is amended— 
(A) by striking out "(or would, but for subsection (e)(1), 
be)" and inserting in lieu thereof " (or would, but for subsection 
(e) (|1) in the case of a widow or surviving divorced wife or sub-
section (f) (1) in the case of a widower, be) '; 
(B) by striking out "widow's" and inserting in lieu thereof 
"widow's or widower's"; and 
(C) by striking out "he" and inserting in lieu thereof "she or 
he". 
(11) Section 202(q) (6) of such Act is amended to read as follows: 
75 stat. las 
"(6) For the purposes of this subsection— 
^^ tat. 368. 
"(A) the 'reduction period' for an individual's old-age, wife's, 
"Reduction 
husband's, widow's, or widower's insurance benefit is the period— ^
^
*
^
^
° 
"(i) beginning— 
"(I) in the case of an old-age or husband's insurance 
benefit, with the first day of the first month for which 
such individual is entitled to such benefit, or 
"(II) in the case of a wife's insurance benefit, with 
the first day of the first month for which a certificate 
described in paragraph (5) (A) (i) is effective, or 
"(III) in the case of a widow's or widower's insur-
ance benefit, with the first day of the first month for 
which such individual is entitled to such benefit or the 
85-622 0-68—55 
"Additional re-
duction period." 
42 u s e 402. 
79 Stat. 375. 
832 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
first day of the month m which such individual attains 
age 60, whichever is the later, and 
"(ii) ending with the last day of the month before the 
month in which such individual attains retirement age; and 
"(B) the 'additional reduction period' for an individual's 
widow's or widower's insurance benefit is the period— 
"(i) beginning with the first day of the first month for 
which such individual is entitled to such benefit, but only if 
such individual has not attained age 60 in such first month, 
and 
"(ii) ending with the last day of the month before the 
month in which such individual attains age 60." 
75 Stat. 133; 
(12) Sectiou 202(q) (7) of such Act is amended— 
79 Stat. 368, 375. 
^^^ ^^ inserting "or 'additional adjusted reduction period'" 
after "the 'adjusted reduction period'"; 
(B) by striking out "or widow's" and inserting in lieu thereof 
"widow's, or widower's"; 
(C) by inserting "or additional reduction period (as the case 
may be)" after "the reduction period"; and 
(D) by striking out "widow's" in subparagraph (E) and ii^-
serting in lieu thereof "widow's or widower's", by striking out 
"she" each place it appears in such subparagraph and inserting 
in lieu thereof "she or he", and by striking out "her" in such 
subparagraph and inserting in lieu thereof "her or his". 
(13) Section 202 (q) (9) of such Act is amended by striking out 
"widow's" and inserting m lieu thereof "widow's or widower's". 
I2 use 403.' 
(d)(1)(A) The third sentence of section 203(c) of such Act is 
amended by striking out "or any subsequent month" and inserting in 
lieu thereof "or any subsequent month; nor shall any deduction be 
made under this subsection from any widow^'s insurance benefit for 
any month in which the widow or surviving divorced wife is entitled 
and has not attained age 62 (but only if she became so entitled prior 
to attaining age 60), or from any widower's insurance benefit for any 
month in which the widower is entitled and has not attained age 62". 
74 Stat. 955. 
(B) The third sentence of section 203(f) (1) of such Act is amended 
by striking out "or (D)" and inserting in lieu thereof the following: 
"(D) for which such individual is entitled to widow's insurance 
benefits and has not attained age 62 (but only if she became so entitled 
prior to attaining age 60) or widower's insurance benefits and has not 
attained age 62, or (E)". 
(C) Section 203(f)(2) of such Act is amended by striking out 
"and (D)" and inserting in lieu thereof " ( D ) , and (E) '\ 
(D) Section 203(f)(4) of such Act is amended by striking out 
" ( D ) " and inserting in lieu thereof " ( E ) " . 
JL^l^'-i^^^' 
(2) Section 216(i) (1) of such Act is amended by inserting "202(e), 
4?usc 416. 
202(f)," after "202(d),". 
4 2us^c42^2^" 
(^) (-^) Section 222(a) of such Act is amended by inserting 
"widow's insurance benefits, or widower's insurance benefits," after 
"benefits,". 
(B) Section 222(b)(1) of such Act is amended by striking out 
"child's insurance benefits or if" and inserting in lieu thereof "child's 
insurance benefits, a widow or surviving divorced wife who has not 
attained age 60, a widower who has not attained age 62, or". 
(4) (A) Section 222(d)(1) of such Act is amended by inserting 
"or" at the end of subparagraph (B), and by inserting after such 
subparagraph the following new subparagraphs: 
"(C) entitled to widow's insurance oenefits under section 
202(e) prior to attaining age 60, or 
70 Stat. 817; 
72 Stat. 1032. 
79 Stat. 408. 
42 u s e 402. 
70 Stat. 1317. 
42 u s e 425. 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
833 
"(D) entitled to widower's insurance benefits under section 
202(f) prior to attaining age 62,". 
42 use 402. 
(B) Section 222(d) (1) of such Act is further amended by striking 
79 stat. 408. 
out "who have attained age 18 and are under a disability," in the 
"^^ "^*^ '*^^-
first sentence and inserting in lieu thereof the following: "who have 
attained age 18 and are under a disability, the benefits under section 
202(e) for widows and surviving divorced wives who have not at-
tained age 60 and are under a disability, the benefits under section 
202(f) for widowers who have not attained age 62,". 
(5) (A) The first sentence of section 225 of such Act is amended 
by inserting after "under section 202(d)," the following: "or that 
a widow or surviving divorced wife who has not attained age 60 
and is entitled to benefits under section 202(e), or that a widower 
who has not attained age 62 and is entitled to benefits under section 
202(f),". 
(B) The first sentence of section 225 of such Act is further amended 
by striking out "223 or 202(d)" and inserting in lieu thereof "202(d), 
202(e), 202(f), or 223". 
(e) The amendments made by this section shall apply with respect 
to monthly benefits under title I I of the Social Security Act for 
and after the month of February 1968, but only on the basis of 
applications for such benefits filed in or after the month in which 
this Act is enacted. 
INSURED STATUS FOR YOUNGER DISABLED WORKERS 
SEC. 105. (a) Subparagraph (B) (ii) of section 216(i) (3) of the 
Social Security Act is amended by striking out "and he is under a 
^^ us^c 4
*
i
6 
disability by reason of blindness (as defined in paragraph (1))". 
(b) Subparagraph (B) (ii) of section 223(c)(1) of such Act is 
llf}^^ ^J;^-
amended by striking out "before he attains" and inserting in lieu 
thereof "before the quarter in which he attains", and by striking out 
"and he is under a disability by reason of blindness (as defined in 
section 216 ( i ) ( l ) ) " . 
(c) The amendment made by subsection (a) shall apply only with 
respect to applications for disability determinations filed under sec-
tion 216(i) of the Social Security Act in or after the month in which 
this Act is enacted. The amendments made by subsection (b) shall 
apply with respect to monthly benefits under title I I of such Act for 
months after January 1968, but only on the basis of applications for 
such benefits filed in or after the month in which tliis Act is enacted. 
BENEFITS I N CASE OF MEMBERS OF T H E UNIFORMED SERVICES 
42 u s e 423. 
SEC. 106. Title I I of the Social Security Act is amended by adding go^t^J^gy^^'"' 
at the end thereof the following new section: 
42 use 401-428. 
" B E N E F I T S I N 
C A S E O F MEMBERS OF T H E UNIFORMED SERVICES 
"SEC. 229. (a) For purposes of determining entitlement to and the 
amount of any monthly benefit for any month after December 1967, 
or entitlement to and the amount of any lump-sum death payment in 
case of a death after such month, payable under this title on the basis 
of the wages and self-employment income of any individual, and for 
purposes of section 216(i) (3), such individual shall be deemed to 
have been paid, in each calendar quarter occurring after 1967 in which 
he was paid wages for service as a member of a uniformed service (as 
defined in section 210(m)) which was included in the term 'employ-
ment' as defined in section 210(a) as a result of the provisions of sec-
834 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
tion 210(1), wages (in addition to the wages actually paid to him for 
such service) of— 
"(1) $100 if the wages actually paid to him in such quarter for 
such services were $100 or less, 
" (2) $200 if the wages actually paid to him in such quarter for 
such services were more than $100 but not more than $200, or 
" (3) $300 in anv other case. 
"(b) There are autnorized to be appropriated to the Federal Old-
Age and Survivors Insurance Trust Fund, the Federal Disability In-
surance Trust Fund, and the Federal Hospital Insurance Trust Fund 
se^^, ^uQslf-isVsi f'l^nually, as benefits under this title and part A of title XVIII are paid 
after December 1967, such sums as the Secretary determines to be 
necessary to meet (1) the additional costs, resulting from subsection 
(a), of such benefits (including lump-sum death payments), (2) the 
additional administrative expenses resulting therefrom, and (3) any 
loss in interest to such trust funds resulting from the payment of such 
amounts. Such additional costs shall be determined after any increases 
in such benefits arising from the application of section 217 have been 
made.'* 
LIBERALIZATION 
OF EARNINGS 
TEST 
SEC. 107. (a) (1) Paragraphs (1), (3), and (4) (B) of section 203(f) 
42 use 403 
^^ ^
^
^
® Social Security Act are each amended by striking out "$125" 
and inserting in lieu thereof "$140". 
(2) Paragraph (1) (A) of section 203(h) of such Act is amended 
by striking out "$125" and inserting in lieu thereof "$140". 
(b) The amendments made by subsection (a) shall apply with re-
spect to taxable years ending after December 1967. 
INCREASE OF EARNINGS COUNTED FOR BENEFIT AND TAX PURPOSES 
79 Stat. 393. 
42 u s e 409. 
SEC. 108. (a) (1) (A) Section 209 (a) (4) of the Social Security Act is 
amended by inserting "and prior to 1968" after "1965". 
68 staV. ToVs; 
(B) Section 209(a) of such Act is further amended by adding at 
79 Stat. 383. 
^j^g gj^^j tlicreof the following new paragraph: 
"(5) That part of remuneration which, after remuneration (other 
than remuneration referred to in the succeeding subsections of this 
section) equal to $7,800 with respect to employment has been paid to 
an individual during any calendar year after 1967, is paid to such 
individual during such calendar year;". 
(2) (A) Section 211 (b) (1) (D) of such Act is amended by inserting 
"and prior to 1968" after "1965", and by striking out"; or" and insert-
ing in lieu thereof "; and". 
(B) Section 211(b) (1) of such Act is further amended by adding 
at the end thereof the following new subparagraph: 
"(E) For any taxable year ending after 1967, (i) $7,800, 
minus (ii) the amount of the wages paid to such individual 
during the taxable year; or". 
(3) (A) Section 213(a) (2) (ii) of such Act is amended by striking 
out "after 1965" and inserting in lieu thereof "after 1965 and before 
1968, or $7,800 in the case of a calendar year after 1967". 
(B) Section 213(a) (2) (iii) of such Act is amended by striking out 
"after 1965" and inserting in lieu thereof "after 1965 and before 1968, 
or $7,800 in the case of a taxable year ending after 1967". 
42 us^c 4^^5^" 
(^) Section 215(e) (1) of such Act is amended by striking out "and 
the excess over $6,600 in the case of any calendar year after 1965" and 
inserting in lieu thereof "the excess over $6,600 in the case of n,nj cal-
endar year after 1965 and before 1968, and the excess over $7,800 m the 
case of any calendar year after 1967". 
79 Stat. 393. 
42 u s e 411. 
72 Stat. 10 19. 
79 Stat. 393. 
394. 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
835 
(b) (1) (A) Section 1402(b) (1) (D) of the Internal Revenue Code 
of 1954 (relating to definition of self-employment income) is amended 
^^ ^^^*- ^Qs. 
by inserting "and before 1968" after "1965", and by striking out"; or" 
and inserting in lieu thereof "; and". 
(B) Section 1402 (b) (1) of such Code is further amended by adding 
jg^tlu'^gT^'' 
at the end thereof the following new subparagraph: 
"(E) for any taxable year ending after 1967, (i) $7,800, 
minus (ii) the amount of the wages paid to such individual 
during the taxable year; or". 
(2) Section 3121(a)(1) of such Code (relating to definition of 
wages) is amended by striking out "$6,600" each place it appears and 
^^ ^*^^- ^^3. 
inserting in lieu thereof "$7,800". 
(3) The second sentence of section 3122 of such Code (relating to 
Federal service) is amended by striking out "$6,600" and inserting 
in lieu thereof "$7,800". 
(4) Section 3125 of such Code (relating to returns in the case of 
governmental employees in Guam, American Samoa, and the District 
of Columbia) is amended by striking out "$6,600" each place it appears 
and inserting in lieu thereof "$7,800". 
(5) Section 6413 (c) (1) of such Code (relating to special refunds 
of employment taxes) is amended— 
^J^ stat. 393, 
(A) by inserting "and prior to the calendar year 1968" after 
"the calendar year 1965"; 
(B) by inserting after "exceed $6,600," the following: "or (D) 
during any calendar year after the calendar year 1967, the wages 
received by him during such year exceed $7,800,"; and 
(C) by inserting before the period at the end thereof the fol-
lowing : "and before 1968, or which exceeds the tax with respect 
to the first $7,800 of such wages received in such calendar year 
after 1967". 
(6) Section 6413(c) (2) (A) of such Code (relating to refunds of 
employment taxes in the case of^ Federal employees) is amended by 
striking out "or $6,600 for any calendar year after 1965" and in-
serting in lieu thereof "$6,600 for the calendar year 1966 or 1967, or 
$7,800 for any calendar year after 1967". 
(c) The amendments made by subsections (a) (1) and (a) (3) (A), 
and the amendments made by subsection (b) (except paragraph (1) 
thereof), shall apply only with respect to remuneration paid after 
December 1967. The amendments made by subsections (a) (2), (a) (3) 
(B), and (b) (1) shall apply only with respect to taxable years end-
ing after 1967. The amendment made by subsection (a) (4) shall 
apply only with respect to calendar years after 1967. 
CHANGES I N TAX SCHEDULES 
SEC. 109. (a) (1) Section 1401(a) of the Internal Revenue Code of 
1954 (relating to rate of tax on self-employment income for purposes 
of old-age, survivors, and disability insurance) is amended by striking 
out paragraphs (1), (2), (3), and (4) and inserting in lieu thereof 
the following: 
"(1) in the case of any taxable year beginning after December 
31, 1967, and before January 1, 1969, the tax shall be equal to 
5.8 percent of the amount of the self-employment income for 
such taxable year; 
"(2) in the case of any taxable year beginning after December 
31, 1968, and before January 1, 1971, the tax shall be equal to 
6.3 percent of the amount of the self-employment income for such 
taxable year; 
"(3) in the case of any taxable year beginning after December 
31, 1970, and before January 1, 1973, the tax shall be equal to 
79 Stat. 394. 
836 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
6.9 percent of the amount of the self-employment income for such 
taxable year; and 
"(4) in the case of any taxable year beginning after December 
31, 1972, the tax shall be equal to 7.0 percent of the amount of the 
self-employment income for such taxable year." 
(2) Section 3101(a) of such Code (relating to rate of tax on em-
79 Stat. 39 5. 
ployccs for purposcs of old-age, survivors, and disability insurance) 
IS amended by striking out paragraphs (1), (2), (3), and (4) and 
inserting in lieu thereof the following: 
"(1) with respect to wages received during the calendar year 
1968, the rate shall be 3.8 percent; 
"(2) with respect to wages received during the calendar years 
1969 and 1970, the rate shall be 4.2 percent; 
"(3) with respect to wages received during the calendar years 
1971 and 1972, the rate shall be 4.6 percent; and 
"(4) with respect to wages received after December 31, 1972, 
the rate shall be 5.0 percent." 
(3) Section 3111(a) of such Code (relating to rate of tax on em-
79 Stat. 396. 
ploycrs for purposes of old-age, survivors, and disability insurance) 
is amended by striking out paragraphs (1), (2), (3), and (4) and 
inserting in lieu thereof the following: 
"(1) with respect to wages paid during the calendar year 1968, 
the rate shall be 3.8 percent; 
"(2) with respect to wages paid during the calendar years 1969 
and 1970, the rate shall be 4.2 percent; 
"(3) with respect to wages paid during the calendar years 1971 
and 1972, the rate shall be 4.6 percent; and 
"(4) with respect to wages paid after December 31, 1972, the 
rate shall be 5.0 percent." 
(b)(1) Section 1401(b) of such Code (relating to rate of tax on 
7
9 Stat. 394. 
self-cmploymeut income for purposes of hospital insurance) is amend-
ed by striking out paragraphs (1) through (6) and inserting in lieu 
thereof the following: 
"(1) in the case of any taxable year beginning after December 
31, 1967, and before January 1, 1973, the tax shall be equal to 
0.60 percent of the amount of the self-employment income for 
such taxable year; 
"(2) in the case of any taxable year beginning after December 
31, 1972, and before January 1, 1976, the tax shall be equal to 
0.65 percent of the amount of the self-employment income for 
such taxable year; 
"(3) in the case of any taxable year beginning after December 
31, 1975, and before January 1, 1980, the tax shall be equal to 
0.70 percent of the amount of the self-employment income for 
such taxable year; 
" (4) in the case of any taxable year beginning after December 
31, 19Y9, and before January 1,1987, the tax shall be equal to 0.80 
percent of the amount of the self-employment income for such 
taxable year; and 
"(5) in the case of any taxable year beginning after December 
31, 1986, the tax shall be equal to 0.90 percent of the amount of 
the self-employment income for such taxable year." 
(2) Section 3101(b) of such Code (relating to rate of tax on em-
79 Stat. 395. 
ployecs for purposes of hospital insurance) is amended by striking out 
paragraphs 
(1) through (6) and inserting in lieu thereof the 
following: 
"(1) with respect to wages received during the calendar years 
1968,1969,1970,1971, and 1972, the rate shall be 0.60 percent; 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
837 
"(2) with respect to wages received during the calendar years 
1973,1974, and 1975, the rate shall be 0.65 percent; 
"(3) with respect to wages received during the calendar years 
1976, 1977, 1978, and 1979, the rate shall be 0.70 percent; 
"(4) with respect to wages received during the calendar years 
1980, 1981, 1982, 1983, 1984, 1985, and 1986, the rate shall be 0.80 
percent; and 
"(5) with respect to wages received after December 31, 1986, 
the rate shall be 0.90 percent." 
(3) Section 3111(b) of such Code (relating to rate of tax on 
employers for purposes of hospital insurance) is amended by striking 
^^ stat. 396. 
out paragraphs (1) through (6) and inserting in lieu thereof the 
following: 
" (1) with respect to wages paid during the calendar years 1968, 
1969,1970,1971, and 1972, the rate shall be 0.60 percent; 
"(2) with respect to wages paid during the calendar years 
1973, 1974, and 1975, the rate shall be 0.65 percent; 
"(3) with respect to wages paid during the calendar years 
1976, 1977, 1978, and 1979, the rate shall be 0.70 percent; 
"(4) with respect to wages paid during the calendar years 
1980, 1981, 1982, 1983, 1984, 1985, and 1986, the rate shall be 
0.80 percent; and 
"(5) with respect to wages paid after December 31, 1986, the 
rate shall be 0.90 percent." 
(c) The amendments made by subsections (a) (1) and (b) (1) 
shall apply only with respect to taxable years beginning after Decem-
ber 31, 1967. The remaining amendments made by this section shall 
apply only with respect to remuneration paid after December 31,1967. 
ALLOCATION TO DISABILITY INSURANCE TRUST F U N D 
79 Stat. 370. 
42 u s e 401. 
SEC. 110. (a) Section 201(b)(1) of the Social Security Act is ,/°,^*^*-,V^ 
amended— 
(1) by inserting " ( A ) " after "(1)"; 
(2) by striking out "1954, and" and inserting in lieu thereof 
"1954, ( B ) " ; 
(3) by inserting "and before January 1, 1968," after "Decem-
ber 31,1965,"; and 
(4) by inserting after "so reported," the following: "and (C) 
0.95 of 1 per centum of the wages (as so defined) paid after Decem-
ber 31,1967, and so reported,". 
(b) Section 201 (b) (2) of such Act is amended— 
(1) by inserting "(A) "after "(2)"; 
(2) by striking out "1966, and" and inserting in lieu thereof 
"1966, (B)"; and 
(3) by inserting after "December 31,1965," the following: "and 
before January 1, 1968, and (C) 0.7125 of 1 per centum of the 
amount of self-employment income (as so defined) so reported for 
any taxable year beginning after December 31, 1967,". 
EXTENSION 
OF TIME 
FOR FILING APPLICATION 
FOR 'DISABILITY FREEZE 
WHERE FAILURE TO MAKE TIMELY APPLICATION IS DUE TO INCOMPETENCY 
SEC. 111. (a) Se^-tion 216(i)(2) of the Social Security Act is 
79 stat. 367, 
amended (1) by striking out "No" in subparagraph (E) and inserting '*°42 use 4 16. 
in lieu thereof "Except as is otherwise provided in subparagraph (F), 
no", (2) by redesignating subparagraph (F) as subparagraph (G), 
and (3) by adding after subparagraph (E) the following new sub-
paragraph : 
79 Stat. 367. 
42 u s e 416. 
Ante, 
p. 821. 
838 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
"(F) An application for a disability determination which is filed 
more than 12 months after the month prescribed by subparagraph 
(D) as the month in which the period of disability ends (determined 
without regard to subparagraphs (B) and (E)) shall be accepted as 
an application for purposes of this paragraph if— 
"(i) in the case of an application filed by or on behalf of an 
individual with respect to a disability which ends after the month 
in which the Social Security Amendments of 1967 is enacted, such 
application is filed not more than 36 months after the month in 
which such disability ended, such individual is alive at the time 
the application is filed, and the Secretary finds in accordance 
with regulations prescribed by him that the failure of such indi-
vidual to file an application for a disability determination within 
the time specified in subparagraph (E) was attributable to a 
physical or mental condition of such individual which rendered 
him incapable of executing such an application, and 
"(ii) in the case of an application filed by or on behalf of an 
individual with respect to a period of disability which ends in or 
before the month in which the Social Security Amendments of 
1967 is enacted, 
"(I) such application is filed not more than 12 months 
after the month in which the Social Security Amendments of 
1967 is enacted, 
" (II) a previous application for a disability determination 
has been filed by or on behalf of such individual (1) in or 
before the month in which the Social Security Amendments 
of 1967 is enacted, and (2) not more than 36 months after the 
month in which his disability ended, and 
"(III) the Secretary finds in accordance with regulations 
prescribed by him, that the failure of such individual to file 
an application within the then specified time period was at-
tributable to a physical or mental condition of such individ-
ual which rendered him incapable of executing such an 
application. 
In making a determination under this subsection, with respect to the 
disability or period of disability of any individual whose application 
for a determination thereof is accepted solely by reason of the provi-
sions of this subparagraph (F), the provisions of this subsection 
(other than the provisions of this subparagraph) shall be applied as 
such provisions are in effect at the time such determination is made." 
(b) No monthly insurance benefits under title I I of the Social Se-
curity Act shall be payable or increased for any month before the 
month in which this Act is enacted by reason of amendments made by 
subsection (a). 
42 u s e 401-
428; Ante, 
p. 833. 
BENEFITS FOR CERTAIN ADOPTED CHILDREN 
SEC. 112. (a) Section 202(d)(8) of the Social Security Act (as 
42 use 4
1
)
^
2
* 
redesignated by section 151(c) of this Act) is amended— 
(1) by striking out the period at the end of subparagraph (D), 
and inserting in lieu of such period "; or", and 
(2) by adding after and below subparagraph (D) the follow-
ing new subparagraph: 
"(E) was legally adopted by such individual— 
" (i) in an adoption which took place under the supervision 
of a public or private child-placement agency, 
" (li) in an adoption decreed by a court of competent juris-
diction within the United States, 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
839 
"(iii) on a date immediately preceding which such indi-
vidual had continuously resided for not less than one year 
within the United States; 
" (iv) at a time prior to the attainment of age 18 by such 
child." 
^ 
y 
(b) The amendments made by subsection (a) shall apply with 
respect to monthly benefits payable under title I I of the Social Se-
curity Act for months after January 1968, but only on the basis of ^^f, Tnfe'^^^sss 
applications filed after the date of enactment of this Act. 
- « e, p. 
PART 2—COVERAGE UNDER THE OLD-AGE, SURVIVORS, AND 
DISABILITY INSURANCE PROGRAM 
COVERAGE o r 
MINISTERS 
SEC. 115. (a) The last sentence of section 211 (c) of the Social Secu-
rity Act is amended to read as follows: "The provisions of paragraph 
^9 stat. jso. 
(4) or (5) shall not apply to service (other than service performed by 
a member of a religious order who has taken a vow of poverty as a 
member of such order) performed by an individual unless an exemp-
tion under section 1402(e) of the Internal Revenue Code of 1954 is 
^"''•^• 
effective with respect to him." 
(b) (1) The last sentence of section 1402(c) of the Internal Reve-
nue Code of 1954 (relating to definition of trade or business) is 
^9 stat. 381. 
amended to read as follows: 
"The provisions of paragraph (4) or (5) shall not apply to service 
(other than service performed by a member of a religious order who 
has taken a vow of poverty as a member of such order) performed by 
an individual unless an exemption under subsection (e) is effective 
with respect to him." 
(2) Section 1402(e) of such Code (relating to ministers, members 
of religious orders, and Christian Science practitioners) is amended to 
^^ s*^*- ^"^s. 
read as follows: 
"(e) 
MINISTERS, MEMBERS OF RPXIGIOUS ORDERS, AND CHRISTIAN 
SCIENCE PRACTITIONERS.— 
"(1) EXEMPTION.—Any individual who is (A) a duly ordained, 
commissioned, or licensed minister of a church or a member of a 
religious order (other than a member of a religious order who has 
taken a ¥ow of poverty as a member of such order) or (B) a 
Christian Science practitioner, upon filing an application (in such 
form and manner, and with such official, as may be prescribed by 
regulations made under this chapter) together with a statement 
26 use i4oi-
that either he is conscientiously opposed to. or because of religious 
principles he is opposed to, the acceptance (with respect to services 
performed by him as such minister, member, or practitioner) of 
any public insurance which makes payments in the event of 
death, disability, old age, or retirement or makes payments toward 
the cost of, or provides services for, medical care (including the 
benefits of any insurance system established by the Social Se-
curity Act), shall receive an exemption from the tax imposed by 
42 use 1305. 
this chapter with respect to services performed by him as such 
minister, member, or practitioner. Notwithstanding the preceding 
sentence, an exemption may not be granted to an individual under 
this subsection if he had filed an effective waiver certificate under 
this section as it was in effect before its amendment in 1967. 
"(2) TIME FOR FILING APPLICATION.—Any individual who de-
sires to file an application pursuant to paragraph (1) must file 
such application on or before whichever of the following dates 
is later: (A) the due date of the return (including any extension 
thereof) for the second taxable year for which he has net earn-
1403. 
840 
PUBLIC LAW 9U-248-.1AN. 2, 1968 
[81 STAT. 
ings from self-employment (computed without regard to sub-
sections (c) (4) and (c) (5)) of $400 or more, any part of which 
was derived from the performance of service described in sub-
section (c) (4) or (c) (5); or (B) the due date of the return 
(including any extension thereof) for his second taxable year 
ending after 1967. 
"(3) EFFECTIVE DATE OF EXEMPTION.—^An exemption received 
by an individual pursuant to this subsection shall be effective for 
the first taxable year for which he has net earnings from self-
employment (computed without regard to subsections (c) (4) 
and (c) (5)) of $400 or more, any part of which was derived 
from the performance of service described in subsection (c) (4) 
or (c)(5), and for all succeeding taxable years. An exemption 
received pursuant to this subsection shall be irrevocable." 
(c) The amendments made by subsections (a) and (b) shall apply 
only with respect to taxable years ending after 196Y. 
COVERAGE OF STATE AND LOCAL EMPLOYEES 
llviciii^' 
^^^' 11^- (^) Section 218(d)(6)(D) of the Social Security Act 
is amended by inserting "(i)" after "(D)", and by adding at the end 
thereof the following: 
"(ii) Notwithstanding clause (i), the State may, pursuant to sub-
section (c) (4) (B) and subject to the conditions of continuation or 
termination of coverage provided for in subsection (c)(7), modify 
its agreement under this section to include services performed by all 
individuals described in clause (i) other than those individuals to 
whose services the agreement already applies. Such individuals shall 
be deemed (on and after the effective date of the modification) to be 
in positions covered by the separate retirement system consisting of 
the positions of members of the division or part who desire coverage 
under the insurance system established under this title." 
08 Stat. 1057. 
(b) (1) (A) Section 218(c) (3) of such Act is amended by striking 
out subparagraph (A), and by redesignating subparagraphs (B) and 
(C) as subparagraphs (A) and (B), respectively. 
(B) Paragraphs (4) and (7) of section 218(c) of such Act, and 
paragraph (5) (B) of section 218(d) of such Act, are each amended 
by strikmg out "paragraph (3) (C)" wherever it appears and insert-
ing in lieu thereof "paragraph (3) (B)". 
(C) Paragraph (4) (C) of section 218(d) of such Act is amended 
by striking out "subsection (c) (3) (C>" and inserting in lieu thereof 
"subsection (c)(3)(B)". 
64 Stat. 515. 
(2) Section 218(c) (6) of such Act is amended— 
(A) by striking out "and" at the end of subparagraph (C); 
(B) by striking out the period at the end of subparagraph (D) 
and inserting in Heu thereof ", and"; and 
(C) 
by adding at the end thereof 
the following new 
subparagraph: 
"(E) service performed by an individual as an employee serv-
ing on a temporary basis in case of fire, storm, snow, earthquake, 
flood, or other similar emergency." 
(3) The amendments made by this subsection shall be effective with 
respect to services performed on or after January 1,1968. 
68 Stat. 1058. 
^Q^ Scctlon 218(c) of such Act is amended by adding at the end 
thereof the following new paragraph: 
"(8) Nothwithstanding any otner provision of this section, the 
agreement with any State entered into under this section may at the 
option of the State be modified on or after January 1,1968, to exclude 
service performed by election officials or election workers if the remun-
eration paid in a calendar quarter for such service is less than $50. 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
841 
Any modification of an agreement pursuant to this paragraph shall 
be effective with respect to services performed after an effective date, 
specified in such modification, which shall not be earlier than the last 
day of the calendar quarter in which the modification is mailed or 
delivered by other means to the Secretarv." 
(d) The first sentence of section 218(d) (6) (F) of the Social Secu-
rity Act is amended by striking out "1967" and inserting in lieu thereof 7/st^r385°^^' 
"1970". 
42 use 418. 
INCLUSION OF ILLINOIS AMONG STATES PERMITTED TO DIVIDE THEIR 
RETIREMENT SYSTEMS 
SEC. 117. Section 218(d)(6)(C) of the Social Security Act is 
amended by inserting "Illinois," after "Georgia,". 
TAXATION OF CERTAIN EARNINGS OF RETIRED PARTNER 
SEC. 118. (a) Section 1402(a) of the Internal Revenue Code of 1954 
(relating: to definition of net earnings from self-employment) is 
68 A stat. 353; 
^ 
1 y 
" 
^ 
"
^ 
'' 
68 Stat. 1087. 
amended— 
(1) by striking out "and" at the end of paragraph (8); 
(2) by striking out the period at the end of paragraph (9) and 
inserting in lieu thereof "; and"; and 
(3) by inserting after paragraph (9) the following new para-
graph : 
"(10) there shall be excluded amounts received by a partner 
pursuant to a written plan of the partnership, which meets such 
requirements as are prescribed by the Secretary or his delegate, 
and which provides for payments on account of retirement, on a 
periodic basis, to partners generally or to a class or classes of part-
ners, such payments to continue at least until such partner's death, 
if— 
" (A) such partner rendered no services with respect to any 
trade or business carried on by such partnership (or its suc-
cessors) during the taxable year of such partnership (or its 
successors), ending within or with his taxable year, m which 
such amounts were received, and 
"(B) no obligation exists (as of the close of the partner-
ship's taxable year referred to in subparagraph (A)) from 
the other partners to such partner except with respect to 
retirement payments under such plan, and 
"(C) such partner's share, if any, of the capital of the 
partnership has been paid to him in full before the close 
of the partnership's taxable year referred to in subpara-
graph (A)." 
(b) Section 211(a) of the Social Security Act is amended— 
^^ stat. 502; 
(1) by striking out "and" at the end of paragraph (7); 
42 use 4u'. 
(2) by striking out the period at the end of paragraph (8) and 
inserting in lieu thereof "; and"; and 
(3) by inserting after paragraph (8) the following new para-
graph : 
"(9) There shall be excluded amounts received by a partner 
pursuant to a written plan of the partnership, which meets such 
requirements as are prescribed by the Secretary of the Treasury 
or his delegate, and which provides for payments on account of 
retirement, on a periodic basis, to partners generally or to a class 
or classes of partners, such payments to continue at least until 
such partner's death, if— 
"(A) such partner rendered no services with respect to 
any trade or business carried on by such partnership (or its 
842 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
successors) during the taxable year of such partnership (or 
its successors), ending within or with his taxable year, in 
which such amounts were received, and 
"(B) no obligation exists (as of the close of the partner-
ship's taxable year referred to in subparagraph (A)) from 
the other partners to such partner except with respect to re-
tirement payments under such plan, and 
"(C) such partner's share, if any, of the capital of the 
partnership has been paid to him in full before the close of 
the partnership's taxable year referred to in subparagraph 
(c) The amendments made by this section shall apply only with 
respect to taxable years ending on or after December 31, 1967. 
INCLUSION OF PUERTO RICO AMONG STATES PERMITTED TO INCLUDE FIRE-
M E N AND POLICEMEN; VALIDATION OF CERTAIN PAST COVERAGE I N T H E 
STATE OF NEBRASKA 
70 Stat. 8 26. 
42 u s e 418. 
SEC. 119. (a) Section 218(p) of the Social Security Act is amended 
by inserting "Puerto Rico," after "Oregon,", 
(b) In any case in which— 
(1) an individual has performed services prior to the enactment 
of this Act in the employ of a political subdivision of the State 
of Nebraska in a fireman's position, and 
(2) amounts, equivalent to the sum of the taxes which would 
have been imposed by sections 3101 and 3111 of the Internal 
396^ ^*^*' ^^^' 
Revenue Code of 1954 had such services constituted employment 
for purposes of section 21 of such Code at the time they Avere per-
formed, were timely paid in good faith to the Secretary of the 
Treasury, and" 
(3) no refunds of such amounts paid in lieu of taxes have been 
obtained, 
the amount of the remuneration for such services with respect to 
which such amounts have been paid shall be deemed to constitute 
remuneration for employment as defined in section 209 of the Social 
42 use 409. 
Security Act. 
COVERAGE o r 
F I R E M E N ' S 
POSITIONS PURSUANT TO A STATE 
AGREEMENT 
SEC. 120. (a) Section 218 (p) of the Social Security Act is amended 
b y -
(1) inserting "(1)" after " ( p ) " ; and 
(2) adding the following paragraph: 
"(2) A State, not otherwise listed by name in paragraph (1), shall 
be deemed to be a State listed in such paragraph for the purpose of 
extending coverage under this title to service in firemen's positions 
covered by a retirement system, if the governor of the State, or an offi-
cial of the State designated by him for the purpose, certifies to the 
Secretary of Health, Education, and Welfare that the overall benefit 
protection of the employees in such positions would be improved by 
reason of the extension of such coverage to such employees. Notwith-
standing the provisions of the second sentence of such paragraph (1), 
such firemen's positions shall be deemed a separate retirement system 
and no other positions shall be included in such system." 
(b) Nothing in the amendments made by subsection (a) shall 
authorize the extension of the insurance system establshed by title 
42 use 401- 
j i of the Social Security Act under the provisions of section 218(d) 
428; An^e, p. 833. ^^^ ^^^ ^^ ^^^^j^ ^^^^ ^^ service in any fireman's position. 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
843 
(c) The amendment made by this section shall apply in the case of 
any State with respect to modifications of such State agreement under 
section 218 of the Social Security Act made after the date of enact-
ment of this Act. 
VALIDATION OF COVERAGE ERRONEOUSLY REPORTED 
SEC. 121. Section 218(f) of the Social Security Act is amended by 72^^sfat^*io^4o^' 
adding at the end thereof the following new paragraph: 
42 use 4 is. 
"(3) Notwithstanding the provisions of paragraph (2) of this sub-
sectlion, in the case of services performed by individuals as members 
of any coverage group to which an agreement under this section is 
made applicable, and with respect to which there were timely paid 
in good faith to the Secretary of the Treasury amounts equivalent to 
the sum of the taxes which would have been imposed by sections 3101 
and 3111 of the Internal Revenue Code of 1954 had such services ^^^ ^^^*- ^^^• 
constituted employment for purposes of chapter 21 of such Code at 
the time they were performed, and with respect to which refunds 
were not obtained, such individuals may, if so requested by the State, 
be deemed to be members of such coverage group on the date desig-
nated pursuant to paragraph (2)." 
COVERAGE OF FEES OF STATE AND LOCAL GOVERNMENT 
EMPLOYEES 
AS 
SELF-EMPLOYMENT INCOME 
SEC 122. (a) (1) Section 211(c) (1) of the Social Security Act is 
^/^ ulc TA' 
amended to read as follows: 
" (1) The performance of the functions of a public office, other 
than the functions of a public office of a State or a political sub-
division thereof with respect to fees received in any period in 
which the functions are performed in a position compensated 
solely on a fee basis and in which such functions are not covered 
under an agreement entered into by such State and the Secretary 
pursuant to section 218;". 
(2) Section 211(c) (2) of such Act is amended (A) by striking out 
^
"
^ ^^^^' ^'^^-
"and" at the end of subparagraph (C); (B) by striking out the semi-
colon at the end of subparagraph (D) and inserting in lieu thereof 
", and'-; and (C) by adding after such subparagraph the following new 
subparagraph: 
"(E) service performed by an individual as an employee of 
a State or a political subdivision thereof in a position com-
pensated solely on a fee basis with respect to fees received in 
any period in which such service is not covered under an 
agreement entered into by such State and the Secretary pur-
suant to section 218;". 
(b) (1) Section 1402(c) (1) of the Internal Revenue Code of 1954 
^SA stat. 355. 
is amended to read as follows: 
"(1) the performance of the functions of a public office, other 
than the functions of a public office of a State or a political sub-
division thereof with respect to fees received in any period in 
which the functions are performed in a position compensated 
solely on a fee basis and in which such functions are not covered 
under an agreement entered into by such State and the Secre-
tary of Health, Education, and Welfare pursuant to section 218 
of the Social Security Act;". 
(2) Section 1402(c) (2) of such Code is amended (A) by striking 
out "and" at the end of subparagraph (C); (B) by striking out the 
semicolon at the end of subparagraph (D) and inserting in lieu there-
of ", and"; and (C) by adding after such subparagraph the following 
new subparagraph: 
74 Stat. 545. 
844 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
"(E) service performed by an individual as an employee 
of a State or a political subdivision thereof in a position com-
pensated solely on a fee basis with respect to fees received 
in any period in which such service is not covered under an 
agreement entered into by such State and the Secretary of 
Health, Education, and Welfare pursuant to section 218 of 
the Social Security Act;". 
(c) (1) The amendments made by subsections (a) and (b) of this 
section shall apply with respect to fees received after 1967. 
(2) Notwithstanding the provisions of subsections (a) and (b) of 
this section, any individual who in 1968 is in a position to which the 
amendments made by such subsections apply may make an irrevocable 
election not to have such amendments apply to the fees he receives in 
1968 and every year thereafter, if on or before the due date of his in-
come tax return for 1968 (including any extensions thereof) he files 
with the Secretary of the Treasury or his delegate, in such manner as 
the Secretary of the Treasury or his delegate shall by regulations pre-
scribe, a certificate of election of exemption from such amendments. 
y/stat^aV^' 
(^) Section 218 of the Social Security Act is further amended 
42 use 418. 
by adding the follow^ing new subsection: 
"Positions Compensated Solely on a Fee Basis 
" ( u ) ( l ) Notwithstanding an^ other provision in this section, an 
agreement entered into under this section may be made applicable to 
service performed after 1967 in any class or classes of positions com-
pensated solely on a fee basis to which such agreement did not apply 
Erior to 1968 only if the State specifically requests that its agreement 
e made applicable to such service in such class or classes of positions. 
" (2) Notwithstanding any other provision in this section, an agree-
ment entered into under this section may be modified, at the option of 
the State, at any time after 1967, so as to exclude services performed 
in any class or classes of positions compensation for which is solely 
on a fee basis. 
"(3) Any modification made under this subsection shall be eft'ective 
with respect to services performed after the last day of the calendar 
year in which the modific^ition is agreed to by the Secretary and the 
State. 
"(4) If any class or classes of positions have been excluded from 
coverage under the State agreement by a modification agreed to under 
this subsection, the Secretary arid the State may not thereafter modify 
such agreement so as to again make the agreement applicable with 
respect to such class or classes of positions." 
FAMILY EMPLOYMENT I N A PRIVATE HOME 
li vie !to' 
^^^- 1^^- (^) Section 210(a) (3) (B) of the Social Security Act is 
amended by inserting after the semicolon the following: "except that 
the provisions of this subparagraph shall not be applicable to such 
domestic service if— 
"(i) the employer is a surviving spouse or a divorced individ-
ual and has not remarried, or has a spouse living in the home who 
has a mental or physical condition which results in such spouse's 
being incapable of caring for a son, daughter, stepson, or step-
daughter (referred to in clause (ii)) for at least 4 continuous 
weeks in the calendar quarter in which the service is rendered, and 
" (ii) a son, daughter, stepson, or stepdaughter of such employer 
is living in the home, and 
"(iii) the son, daughter, stepson, or stepdaughter (referred to 
in clause (ii)) has not attained age 18 or has a mental or physical 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
845 
condition which requires the personal care and supervision of an 
adult for at least 4 continuous weeks in the calendar quarter in 
which the service is rendered;" 
(b) Section 3121(b) (3) (B) of the Internal Revenue Code of 1954 
(relating to definition of employment) is amended by inserting after 
'''* ^
*
^
*
- ^'^^• 
the semicolon the following: "except that the provisions of this sub-
paragraph shall not be applicable to such domestic service if— 
"(i) the employer is a surviving spouse or a divorced individual 
and has not remarried, or has a spouse living in the home who has 
a mental or physical condition which results in such spouse's be-
ing incapable of caring for a son, daughter, stepson, or step-
daughter (referred to in clause (ii)) for at least 4 continuous 
weeks in the calendar quarter in which the service is rendered, 
and 
" (ii) a son, daughter, stepson, or stepdaughter of such employer 
is living in the home, and 
"(iii) the son, daughter, stepson, or stepdaughter (referred to 
in clause (ii)) has not attained age 18 or has a mental or physical 
condition which requires the personal care and supervision of an 
adult for at least 4 continuous weeks in the calendar quarter in 
which the service is rendered;" 
(c) The amendments made by this section shall apply with respect 
to services performed after December 31,1967. 
TERMINATION OF COVERAGE OF EMPLOYEES OF T H E MASSACHUSETTS 
T U R N P I K E AUTHORITY 
SEC. 124. (a) Notwithstanding the provisions of section 218(g) (1) 
of the Social Security Act the Secretary may, under such conditions as 
^^ ijsc Ait 
he deems appropriate, permit the State of Massachusetts to modify 
its agreement entered into under section 218 of such Act so as to ter-
minate the coverage of the employees of the Massachusetts Turnpike 
Authority effective at the end of any calendar quarter within the two 
years next following the date on which such agreement is so modified. 
(b) If the coverage of employees of the Massachusetts Turnpike 
Authority is terminated pursuant to subsection (a), coverage cannot 
later be extended to the employees of such Authority. 
PART 3—HEALTH INSURANCE BENEFITS 
METHOD OF PAYMENT TO PHYSICIANS UNDER SUPPLEMENTARY MEDICAI* 
INSURANCE PROGRAM 
S E C 125. (a) Section 1842(b) (3) (B) of the Social Security Act is 
amended— 
(1) by striking out" (i)" j ^^^ 
(2) by striking out "and (ii)" and all that follows and insert-
ing in lieu thereof the following: "and such payment will be 
made— 
" (i) on the basis of an itemized bill; or 
"(ii) on the basis of an assignment under the terms of 
which the reasonable charge is the full charge for the service; 
but (in the case of bills submitted, or requests for payment made, 
after March 1968) only if the bill is submitted, or a written re-
quest for payment is made in such other form as may be permitted 
under regulations, no later than the close of the calendar year 
following the year in which such service is furnished (deeming 
any service furnished in the last 3 months of any calendar year to 
have been furnished in the succeeding calendar year) ;". 
79 Stat. 310. 
42 u s e 1395U. 
846 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
(b) The amendments made by subsection (a) shall apply with re-
spect to claims on which a final determination has not been made on or 
before the date of enactment of this Act. 
ELIMINATION OF REQUIREMENT OF PHYSICIAN CERTIFICATION IN CASE OF 
CERTAIN HOSPITAL SERVICES 
SEC. 126. (a) Section 1814(a) of the Social Security Act (as 
Post. p. 848. 
amended by section 129 (c) (5) of this Act) is amended— 
(1) by striking out subparagraph (A) of paragraph (2) ; 
(2) by redesignating subparagraphs (B), (C), (D), and (E) 
of paragraph (2) as subparagraphs (A), (B), (C), and (D), 
respectively; 
(3) by redesignating paragraphs (3), (4), (5), and (6) as para-
graphs (4), (5), (6),and (7),respectively; 
(4) by inserting immediately after paragraph (2) the follow-
ing new paragraph: 
"(3) with respect to inpatient hospital services (other than 
inpatient psychiatric hospital services and inpatient 
tuber-
culosis hospital services) which are furnished over a period of 
time, a physician certifies that such services are required to be 
given on an inpatient basis for such individual's medical treat-
ment, or that inpatient diagnostic study is medically required and 
such services are necessary for such purpose, except that (A) 
such certification shall be furnished only in such cases, with such 
frequency, and accompanied by such supporting material, appro-
priate to the cases involved, as may be provided by regulations, 
and (B) the first such certification required in accordance with 
clause (A) shall be furnished no later than the 20th day of such 
period;"; and 
(5) by striking out "(D), or ( E ) " in the last sentence and in-
serting in lieu thereof "or (D)". 
42 use U95n. 
(^) Sectiou 1835(a) (2) (B) of such Act is amended by inserting 
after "medical and other health services," the following: "except serv-
ices described in subparagraphs (B) and (C) of section 1861 (s) (2),". 
(c) The amendments made by this section shall apply with respect 
to services furnished after the date of the enactment of this Act. 
INCLUSION OF PODIATRISTS' SERVICES UNDER SUPPLEMENTARY 
MEDICAL INSURANCE PROGRAM 
SEC 127. (a) Section 1861 (r) of the Social Security Act is 
amended—• 
(1) by striking out "or (2)" and inserting in lieu thereof " (2)"; 
and 
(2) by inserting before the period at the end thereof the fol-
lowing: ", or (3) except for the purposes of section 1814(a), 
section 1835, and subsections (j), (k), (m), and (o) of this sec-
tion, a doctor of podiatry or surgical chiropody, but (unless 
clause (1) of this subsection also applies to him) only with respect 
to functions which he is legally authorized to perform as such by 
the State in which he performs them". 
(b) Section 1862 (a) of such Act is amended— 
(1) by striking out "or" at the end of paragraph (11); 
(2) by striking out the period at the end of paragraph (12) 
and inserting in lieu thereof "; or"; and 
(3) by adding after paragraph 
(12) the following new 
paragraph: 
"(13) where such expenses are for— 
fost, p. 847. 
79 Stat. 321. 
42 u s e 1395x. 
42 u s e 1395y. 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
847 
" (A) the treatment of flat foot conditions and the prescrip-
tion of supportive devices therefor, 
"(B) the treatment of subluxations of the foot, or 
"(C) routine foot care (including the cutting or removal 
of corns, warts, or calluses, the trimming of nails, and other 
routine hygienic care)." 
(c) The amendments made by subsections (a) and (b) shall apply 
with respect to services furnished after December 31, 1967. 
EXCLUSION OF CERTAIN 
SERVICES 
79 Stat. 3:25. 
42 u s e 1395y. 
SEC. 128. Section 1862(a) (7) of the Social Security Act is amended 
by inserting after "changing eyeglasses," the following: "procedures 
performed (during the course of any eye examination) to determine 
the refractive state of the eyes,". 
TRANSFER OF ALL OUTPATIENT HOSPITAL SERVICES TO SUPPLEMENTARY 
MEDICAL INSURANCE PROGRAM 
SEC. 129. (a) Section 1861 (s) (2) of the Social Security Act is 
42 use UQSX. 
amended— 
(1) by inserting "(A) "after "(2)"; 
(2) by striking out "physicians' bills" and all that follows and 
inserting in lieu thereof the following: "physicians' bills; 
"(B) hospital services (including drugs and biologicals which 
cannot, as determined in accordance with regulations, be self-
administered) incident to physicians' services rendered to out-
patients; and 
"(C) diagnostic services which are— 
"(i) furnished to an individual as an outpatient by a 
hospital or by others under arrangements with them made 
by a hospital, and 
"(ii) ordinarily furnished by such hospital (or by others 
under such arrangements) to its outpatients for the purpose 
of diagnostic study;". 
(b) Section 1861 (s) of such Act is further amended by adding at 
the end thereof (after and below paragraph (11)) the following new 
sentence: 
"There shall be excluded from the diagnostic services specified in 
paragraph (2) (C) any item or service (except services referred to 
in paragraph (1)) which— 
"(12) would not be included under subsection (b) if it were 
furnished to an inpatient of a hospital; or 
"(13) is furnished under arrangements referred to in such para-
graph (2) (C) unless furnished in the hospital or in other facili-
ties operated by or under the supervision of the hospital or its 
organized medical staff." 
(c) (1) Section 226(b) (1) of such Act is amended by striking out 
J^ st^a^. 290. 
"post-hospital home health services, and outpatient hospital diagnos-
tic services" and inserting in lieu thereof "and post-hospital home 
health services". 
(2) Section 1812 (a) of such Act is amended— 
79 st^a^ 29^1.^ 
(A) by adding "and" at the end of paragraph (2) ; 
(B) by striking out "; and" at the end of paragraph (3) and 
inserting in lieu thereof a period; and 
(C) by striking out paragraph (4). 
(3) Section 1813(a) of such Act is amended by striking out para- 
^^ ^^^ lagse. 
graph (2), and by redesignating paragraphs (3) and (4) as para-
graphs (2) and (3), respectively. 
85-622 0-68—56 
848 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
79 Stat. 293. 
42 u s e 1395e. 
42 u s e 1395f 
Ante, 
p. 846. 
42 u s e 1395k. 
Infra. 
Post, p. 850. 
79 Stat. 303. 
42 u s e 1395L 
(4) (A) Section 1813(b) (1) of such Act is amended by striking out 
"or diagnostic study". 
(B) The first sentence of section 1813 (b) (2) of such Act is amended 
by striking out "or diagnostic study". 
(5) (A) Section 1814(a) (2) of such Act is amended— 
(i) by adding "or" at the end of subparagraph (D) ; 
(ii) by striking out "or" at the end of subparagraph ( E ) ; and 
(iii) by striking out subparagraph (F). 
(B) The last sentence of section 1814(a) of such Act is amended by 
striking out " ( E ) , or ( F ) " and inserting in lieu thereof "or (E)". 
(6) (A) Section 1814(d) of such Act is amended by strikmg out 
"or outpatient hospital diagnostic services". 
(B) Section 1832(a)(2)(B) of such Act is amended by striking 
out "hospital" and inserting in lieu thereof "hospital and the services 
for which payment may be made pursuant to section 1835(b) (2)". 
42usci395i. 
^7^ Section 1833(b) of such Act is amended— 
(A) by striking out "(or regarded under clause (2) as incurred 
in such preceding year with respect to services furnished in such 
last three months)"; and 
(B) by striking out ", and (2)" and all that follows and insert-
ing in lieu thereof a period. 
(8) Section 1833(d) of such Act is amended by striking out "other 
than subsection (a) (2) (A) thereof". 
42 use i395n. 
(9) (^) Sectlou 1835(a) of such Act is amended by striking out 
"Payment" and inserting m lieu thereof "Except as provided in sub-
section (b), payment". 
(B) Section 1835 of such Act is further amended by redesignating 
subsection (b) as subsection (c), and by inserting after subsection (a) 
the following new subsection: 
"(b) (1) Payment may also be made to any hospital for services 
^2 use 1395X. 
(described in section 1861 (s) furnished as an outpatient service by a 
hospital or by others under arrangements made by it to an individual 
entitled to benefits under this part even though such hospital does 
not have an agreement in effect under this title if (A) such services 
were emergency services, (B) the Secretary would be required to 
make such payment if the hospital had such an agreement in effect 
and otherwise met the conditions of payment hereunder, and (C) 
such hospital has made an election pursuant to section 1814(d) (1) (C) 
with respect to the calendar year in which such emergency services 
are provided. Such payments shall be made only in the amounts 
provided under section 1833(a)(2) and then only if such hospital 
agrees to comply, with respect to the emergency services provided, 
with the provisions of section 1866(a). 
"(2) Payment may also be made on the basis of an itemized bill 
to an individual for services described in paragraph (1) of this sub-
section if (A) payment cannot be made under such paragraph (1) 
solely because the hospital does not elect, in accordance with section 
1814(d)(1)(C), to claim such payments and (B) such individual 
files application (submitted within such time and in such form and 
manner, and containing and supported by such information as the 
Secretary shall by regulations prescribe) for reimbursement. The 
amounts payable under this paragraph shall, subject to the provisions 
of section 1833, be equal to 80 percent of the hospital's reasonable 
charges for such services." 
42 use 1395X. 
(C) Section 1861(e) of such Act is amended— 
(i) by striking out "except for purposes of section 1814(d)," 
and inserting in lieu thereof "except for purposes of sections 
1814(d) and 1835(b),"; and 
Ante, 
p. 847. 
P o s t p. 857. 
42 u s e 1395CC. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
849 
(ii) by striking out "(including determination of whether an 
individual received inpatient hospital services for purposes of 
such section)" and inserting in lieu thereof "and 1835(b) (in-
cluding determination of whether an individual received inpa-
tient hospital services or diagnostic services for purposes of such 
sections)". 
(10) Section 1861 (p) of such Act is repealed. 
(11) Section 1861 (y) (3) of such Act is amended by striking out 
"1813 (a) (4)" and inserting in lieu thereof "1813 (a) (3)". 
(12) (A) Section 1866(a) (2) (A) of such Act is amended— 
(i) by striking out ", (a) (2), or (a) (4)" and inserting in lieu 
thereof "or (a) (3)"; and 
(ii) by striking out "or, in the case of outpatient hospital diag-
nostic services, for which payment is made under part A". 
(B) Section 1866(a)(2)(C) of such Act is amended by striking 
out "1813(a) (3)" and inserting in lieu thereof "1813(a) (2)". 
(13) Section 21(a) of the Railroad Retirement Act of 1937 is 
amended by striking out "post-hospital home health services, and out-
patient hospital diagnostic services" and inserting in lieu thereof "and 
post-hospital home health services". 
(d) The amendments made by this section shall apply with respect 
to services furnished after March 31, 1968, except that subsection (c) 
(5) of such section shall become effective with respect to services fur-
nished after the date of enactment of this Act. 
Repeal. 
79 Stat. 321. 
42 USd 1395x. 
42 u s e 1395CC. 
79 Stat. 340. 
45 u s e 228 s-2. 
BILLING BY HOSPITAL FOR SERVICES FURNISHED TO OUTPATIENTS 
SEC. 130. (a) Section 1835(a) of the Social Security Act (as 
amended by section 129(c) (9) (A) of this Act) is further amended by 
striking out "Except as provided in subsection (b)," and inserting in 
lieu thereof "Except as provided in subsections (b) and (c),". 
(b) Section 1835 of such Act (as amended by section 129(c)(9) 
(B) of this Act) is amended by redesignating subsection (c) (as re-
designated) as subsection (d), and by inserting after subsection (b) 
the following new subsection: 
"(c) Notwithstanding the provisions of this section and sections 
1832, 1833, and 1866(a) (1) (A), a hospital may, subject to such limi-
tations as may be prescribed by regulations, collect from an individual 
the customary charges for services specified in section 1861 (s) and 
furnished to him by such hospital as an outpatient, but only if such 
charges for such services do not exceed $50, and such customary 
charges shall be regarded as expenses incurred by such individual with 
respect to which benefits are payable in accordance with section 1833 
(a) (1). Payments under this title to hospitals which have elected to 
make collections from individuals in accordance with the preceding 
sentence shall be adjusted periodically to place the hospital in the 
same position it would have been had it instead been reimbursed in 
accordance with section 1833 (a) (2)." 
(c) The amendments made by this section shall apply with respect 
to services furnished after March 31,1968. 
Ante, 
p. 848. 
42 u s e 1395k, 
1395Z, 1395CC. 
42 u s e 1395X. 
Ante, 
p. 847. 
Intra-
PAYMENT o r REASONABLE CHARGES FOR RADIOLOGICAL OR PATHOLOGICAL 
SERVICES FURNISHED BY CERTAIN PHYSICIANS TO HOSPITAL INPATIENTS 
SEO. 131. (a) Section 1833(a)(1) of the Social Security Act is 
H^^^^l 
amended— 
(1) by striking out "except that" and inserting in lieu thereof 
"except that (A)", and 
(2) by striking out "of subsection (b)" and inserting in lieu 
thereof "of subsection (b), and (B) with respect to expenses 
302. 
395 i. 
Ante, 
p. 848. 
850 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
incurred for radiological or pathological services for which pay-
ment may be made under this part, furnished to an inpatient of a 
hospital by a physician in the field of radiology or pathology, the 
amounts paid shall be equal to 100 percent of the reasonable 
charges for such services". 
(b) Section 1833(b) of such Act (as amended by section 129(c) (7) 
of this Act) is amended by inserting before the period at the end there-
of the following: ", and (2) such total amount shall not include 
expenses incurred for radiological or pathological services furnished 
to such individual as an inpatient of a hospital by a physician in the 
field of radiology or pathology". 
(c) The amendments made by this section shall apply with respect 
to services furnished after March 31,1968. 
PAYMENT FOR PURCHASE OF DURABLE MEDICAL 
E Q U I P M E N T 
r2usc?395x 
^^^' ^^^' (^) Section 1861 (s) (6) of the Social Security Act is 
amended by striking out "rental of", and by inserting before the semi-
colon at the end thereof the following: ", whether furnished on a 
rental basis or purchased". 
42 use 1395/. 
Qy-j Sectiou 1833 of such Act is amended by adding at the end 
thereof the following new subsection: 
"(f) In the case of the purchase of durable medical equipment in-
cluded under section 1861 (s) (6), by or on behalf of an individual, 
payment shall be made in such amounts as the Secretary determines 
to be equivalent to payments that would have been made under this 
part had such equipment been rented and over such period of time 
as the Secretary finds such equipment would be used for such individ-
ual's medical treatment, except that with respect to purchases of in-
expensive equipment (as determined by the Secretary) payment may 
be made in a lump sum if the Secretary finds that such method of 
payment is less costly or more practical than periodic payments." 
(c) The amendments made by this section shall apply only with 
respect to items purchased after December 31, 1967. 
PAYMENT FOR PHYSICAL THERAPY SERVICES FURNISHED TO OUTPATIENTS 
Ante, 
p. 847. 
Ante, 
p. 849. 
SEC. 133. (a) Section 1861 (s) (2) of the Social Security Act (as 
amended by section 129 (a) (2) of this Act) is amended by— 
(1) striking out "and" at the end of subparagraph (B); 
(2) inserting "and" at the end of subparagraph (C); and 
(3) adding at the end thereof the following: 
" (D) outpatient physical therapy services;" 
(b) Section 1861 of such Act is amended by inserting after subsec-
tion (o) the following new subsection (in lieu of subsection (p) re-
pealed by section 129 (c) (10) of this Act) : 
"Outpatient Physical Therapy Services 
" (p) The term 'outpatient physical therapy services' means physical 
therapy services furnished by a provider of services, a clinic, rehabili-
tation agency, or a public health agency, or by others under an ar-
rangement with, and under the supervision of, such provider, clinic, 
rehabilitation agency, or public health agency to an individual as an 
outpatient— 
"(1) who is under the care of a physician (as defined in section 
1861 ( r ) ( l ) ) , and 
" (2) with respect to whom a plan prescribing the type, amount, 
and duration of physical therapy services that are to be fur-
81 STAT. ] 
PUBLIC LAW 00-248-JAN. 2, 1968 
851 
nished such individual has been established, and is periodically 
reviewed, by a physician (as so defined); 
excluding, however— 
"(3) any item or service if it would not be included under sub-
section (b) if furnished to an inpatient of a hospital; and 
" (4) any such service— 
"(A) if furnished by a clinic or rehabilitation agency, 
or by others under arrangements with such clinic or agency, 
unless such clinic or rehabilitation agency— 
"(i) provides an adequate program of physical ther-
apy services for outpatients and has the facilities and 
personnel required for such program or required for the 
supervision of such a program, in accordance with such 
requirements as the Secretary may specify, 
"(ii) has policies, established by a group of profes-
sional personnel, including one or more physicians 
(associated with the clinic or rehabilitation agency) and 
one or more qualified physical therapists, to govern 
the services (referred to in clause (i)) it provides, 
"(iii) maintains clinical records on all patients, 
"(iv) if such clinic or agency is situated in a State in 
which State or applicable local law provides for the 
licensing of institutions of this nature, (I) is licensed 
pursuant to such law, or (II) is approved by the agency 
of such State or locality responsible for licensing insti-
tutions of this nature, as meeting the standards estab-
lished for such licensing; and 
" (v) meets such other conditions relating to the health 
and safety of individuals who are furnished services by 
such clinic or agency on an outpatient basis, as the Sec-
retary may find necessary, or 
"(B) if furnished by a public health agency, unless such 
agency meets such other conditions relating to health and 
safety of individuals who are furnished services by such 
agency on an outpatient basis, as the Secretary may find 
necessary." 
(c) Section 1866 of such Act is amended by adding at the end there-
of the following new subsection: 
"(e) For purposes of this section, the term 'provider of services' 
shall include a clinic, rehabilitation agency, or public health agency if, 
in the case of a clinic or rehabilitation agency, such clinic or agency 
meets the requirements of section 1861 (p) (4) (A), or if, in the case of 
a public health agency, such agency meets the requirements of section 
1861 (p) (4) (B), but only with respect to the furnishing of outpatient 
physical therapy services (as therein defined)." 
(d) Section 1832 (a) of such Act is amended by— 
(1) deleting "and" at the end of paragraph (2) (A) thereof; 
(2) striking out the period at the end and inserting in lieu 
thereof the following: "; and"; and 
(3) adding at the end thereof the following new subpara-
graph : 
"(C) outpatient physical therapy services." 
(e^ Section 1835(a) (2) of such Act (as amended by section 126(b^ 
of this Act) is amended by— 
(1) striking out "and" at the end of subparagraph ( A ) ; 
(2) striking out the period at the end and inserting in lieu 
thereof the following:"; and"; 
(3) adding at the end thereof the following new subparagraph: 
"(C) m the case of outpatient physical therapy services, 
(i) such services are or were required because the mdividual 
79 Stat. 327. 
42 u s e 1395CC. 
"Provider of 
services." 
Supra. 
79 Stat. 302. 
42 u s e 1395k. 
Ante, 
p. 846. 
services. 
852 
PUBLIC LAW 90-248-.1AN. 2, 1968 
[81 STAT. 
needed physical therapy services on an outpatient basis, (ii) 
a plan for furnishing such services has been established, and 
is periodically reviewed, by a physician, and (iii) such serv-
ices are or were furnished w^iile the individual is or was under 
the care of a physician."; 
(4) striking out "(B) and (C) of section 1861(s)(2)" and 
inserting in lieu thereof "(B), 
(C), and 
(D) 
of section 
Ante. p. 850. 
1861 (s) (2)"; aud 
^.''°^^^,t^ °^ 
(5) adding at the end thereof the following new sentence: "For 
purposes of this section, the term 'provider of services' shall in-
clude a clinic, rehabilitation agency, or public health agency if, 
in the case of a clinic or rehabilitation agency, such clinic or 
Ante. p. 851. 
ageucy meets the requirements of section 1861 (p) (4) (A), or if, 
in the case of a public health agency, such agency meets the re-
quirements of section 1861 (p) (4) (B), but only with respect to 
the furnishing of outpatient physical therapy services (as therein 
defined)." 
(f) The first sentence of section 1864(a) of such Act is amended by 
inserting before the period the following: ", or whether a clinic, re-
habilitation agency or public health agency meets the requirements of 
subparagraph (A) or (B), as the case may be, of section 1861 (p) (4)". 
(g) The amendments made by the preceding subsections of this sec-
tion shall apply to services furnished after June 30,1968. 
79 Stat. 326. 
42 use 1395aa. 
42 u s e 1395X. 
Ante, p. 847. 
Ante. p. 849. 
PAYMENT FOR CERTAIN PORTABLE X-RAY SERVICES 
SEC. 134, (a) Section 1861 (s) (3) of the Social Security Act is 
amended by striking out "diagnostic X-ray tests," and inserting in 
lieu thereof the following: "diagnostic X-ray tests (including tests 
under the supervision of a physician, furnished in a place of residence 
used as the patient's home, if the performance of such tests meets 
such conditions relating to health and safety as the Secretary may 
find necessary),". 
(b) The amendment made by subsection (a) shall apply with re-
spect to services furnished after December 31, 1967. 
BLOOD DEDUCTIBLES 
SEC. 135. (a) (1) Section 1813(a) (2) of the Social Security Act (as 
redesignated by section 129(c) (3) of this Act) is amended to read as 
follows: 
"(2) The amount payable to any provider of services under this 
part for services furnished an individual during any spell of illness 
shall be further reduced by a deduction equal to the cost of the first 
three pints of whole blood (or equivalent quantities of packed red 
blood cells, as defined under regulations) furnished to him as part of 
such services during such spell of illness." 
(b) Section 1866(a)(2)(C) of such Act (as amended by section 
129(c) (12) (B) of this Act) is amended— 
(1) by striking out "may also charge" and inserting in lieu 
thereof "may in accordance with its customary practice also 
appropriately charge"; 
(2) by inserting after "whole blood" the following: "(or 
equivalent quantities of packed red blood cells, as defined under 
regulations)"; 
(3) by inserting after "blood" where it appears in clauses (i), 
(ii), and (iii) the following: "(or equivalent quantities of packed 
red blood cells, as so defined)"; and 
(4) by adding at the end thereof the following new sentence: 
"For purposes of clause (iii) of the preceding sentence, whole 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
853 
blood (or equivalent quantities of packed red blood cells, as so 
defined) furnished an individual shall be deemed replaced when 
the provider of services is given one pint of blood for each pint 
of blood (or equivalent quantities of packed red blood cells, as so 
defined) furnished such individual with respect to which a deduc-
tion is imposed under section 1813 (a) (2)." 
^"'^' P- ^^2-
(c) Section 1833(b) of such Act (as amended by sections 129(c) (7) 
and 131(b) of this Act) is amended by adding at the end thereof the g^"^^- ^^' ^'*^' 
following new sentence: "The total amount of the expenses incurred 
by an individual as determined under the preceding sentence shall, 
after the reduction specified in such sentence, be further reduced by 
an amount equal to the expenses incurred for the first three pints 
of whole blood (or equivalent quantities of packed red blood cells, as 
defined under regulations) furnished to the mdividual during the cal-
endar year, except that such deductible for such blood shall in accord-
ance with regulations be appropriately reduced to the extent that there 
has been a replacement of such blood (or equivalent quantities of 
packed red blood cells, as so defined); and for such purposes blood 
(or equivalent quantities of packed red blood cells, as so defined) 
furnished such individual shall be deemed replaced when the institu-
tion or other person furnishing such blood (or such equivalent quan-
tities of packed red blood cells, as so defined) is given one pint of blood 
for each pint of blood (or equivalent quantities of packed red blood 
cells, as so defined) furnished such individual with respect to which a 
deduction is made under this sentence." 
(d) The amendments made by this section shall apply with respect 
to payment for blood (or packed red blood cells) furnished an indi-
vidual after December 31,1967. 
ENROLLMENT UNDER SUPPLEMENTARY MEDICAL INSURANCE 
PROGRAM 
BASED ON ALLEGED DATE OF ATTAINING AGE 
65 
SEC. 136. (a) Section 1837(d) of the Social Security Act is amended goltaJr^ioS'^' 
by adding at the end thereof the following new sentence: "Where the 
42 use 1395p. 
Secretary finds that an individual who has attained age 65 failed to 
enroll under this part during his initial enrollment period (based on 
a determination by the Secretary of the month in which such individual 
attained age 65), because such individual (relying on documentary 
evidence) was mistaken as to his correct date of birth, the Secretary 
shall establish for such individual an initial enrollment period based 
on his attaining age 65 at the time shown in such documentary evi-
dence (wuth a coverage period determined under section 1838 as though 
he had attained such age at that time)." 
(b) The amendment made by subsection (a) shall apply to indi-
viduals enrolling under part B of title X V I I I in months beginning 1395^^^ ^^^^' 
after the date of the enactment of this Act. 
EXTENSION 
BY 60 DAYS DURING INDIVIDUAL'S LIFETIME OF 
M A X I M U M 
DURATION OF BENEFITS FOR I N P A T I E N T HOSPITAL SERVICES 
SEC. 137. (a) (1) Section 1812(a) (1) of the Social Security Act is 
amended by striking out "up to 90 days during any spell of illness" 
and inserting in lieu thereof "up to 150 days during any spell of ill-
ness minus 1 day for each day of inpatient hospital services in excess 
of 90 received during any preceding spell of illness (if such individual 
was entitled to have payment for such services made under this part 
unless he specifies in accordance with regulations of the Secretary that 
he does not desire to have such payment made)". 
(2) Section 1812(b) (1) of such Act is amended by striking out "for 
90 days during such spell" and inserting in lieu thereof "for 150 days 
42 u s e 1395d. 
79 Stat. 29 2. 
42 u s e 1395e, 
854 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
during such spell minus 1 day for each day of inpatient hospital serv-
ices in excess of 90 received during any preceding spell of illness (if 
such individual was entitled to have payment for such services made 
under this part unless he specifies in accordance with regulations of 
the Secretary that he does not desire to have such payment made)". 
(b) The second sentence of section 1813(a) (1) of such Act is amend-
ed to read as follows: "Such amount shall be further reduced by a 
coinsurance amount equal to— 
"(A) one-fourth of the inpatient hospital deductible for each 
day (before the 91st day) on which such individual is furnished 
such services during such spell of illness after such services have 
been furnished to him for 60 days during such spell; and 
"(B) one-half of the inpatient hospital deductible for each day 
(before the day following the last day for which such individual 
is entitled under section 1812(a)(1) to have payment made on 
his behalf for inpatient hospital services during such spell of ill-
ness) on which such individual is furnished such services dur-
ing such spell of illness after such services have been furnished tc 
him for 90 days during such spell; 
except that the reduction under this sentence for any day shall not ex-
ceed the charges imposed for that day with respect to such individual 
for such services (and for this purpose, if the customary charges for 
such services are greater than the charges so imposed, such customary 
charges shall be considered to be the charges so imposed)." 
(c) The amendments made by subsections (a) and (b) shall apply 
with respect to services furnished after December 31, 1967. 
LIMITATION ON SPECIAL REDUCTION I N ALLOWABLE DAYS OF INPATIENT 
HOSPITAL SERVICES 
42 use i395d. 
g-Ec. 138. (a) Section 1812(c) of the Social Security Act is amended 
by striking out "in the 90-day period immediately before such first 
day shall be included in determining the 90-day limit under subsection 
(b)(1) (but not in determining the 190-day limit under subsection 
(b) (3))" and inserting in lieu thereof "in the 150-day period imme-
diately before such first day shall be included in determining the num-
ber of days limit under subsection (b) (1) insofar as such limit applies 
to (1) inpatient psychiatric hospital services and inpatient tuberculosis 
hospital services, or (2) inpatient hospital services for an individual 
who is an inpatient primarily for the diagnosis or treatment of mental 
illness or tuberculosis (but shall not be included in determining such 
number of days limit insofar as it applies to other inpatient hospital 
services or in determining the 190-day limit under subsection (b) 
(3))". 
(b) The amendment made by subsection (a) shall apply with respect 
to payment for services furnished after December 31,1967. 
TRANSITIONAL 
PROVISION 
ON ELIGIBILITY 
OF PRESENTLY 
UNINSURED 
INDIVIDUALS FOR HOSPITAL INSURANCE 
BENEFITS 
SEC. 139. Section 103(a) (2) of the Social Security Amendments of 
^o flin Ao^' 
1965 is amended bv striking out "1965" in clause (B) and inserting in 
42 u s e 4203. 
//^ „„««•« 
^ 
lieu thereof "1966". 
ADVISORY COUNCIL TO STUDY COVERAGE OF T H E 
DISABLED 
UNDER TITLE XVIII OF T H E 
SOCIAL SECURITY ACT 
SEC. 140. (a) The Secretary of Health, Education, and Welfare 
shall appoint an Advisory Council to study the need for coverage of 
the disabled under the health insurance program of title X V I I I of the 
42 use S s - 
Social Security Act. 
1395^. 
Ante, 
p. 853. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
855 
(b) The Council shall be appointed by the Secretary during 1968 
without regard to the provisions of title 5, United States Code, gov-
erning appointments in the competitive service and shall consist of 12 
persons who shall, to the extent possible, represent organizations of 
employers and employees in equal numbers, and represent self-em-
ployed persons and the public. 
(c) The Council is authorized to engage such technical assistance, 
including actuarial services, as may be required to carry out its func-
tions, and the Secretary shall, in addition, make available to such 
Council such secretarial, clerical, and other assistance and such actu-
arial and other pertinent data prepared by the Department of Health, 
Education, and Welfare as it may require to carry out such functions. 
(d) Members of the Council, while serving on the business of the 
Council (inclusive of travel time), shall receive compensation at rates 
fixed by the Secretary, but not exceeding $100 per day and, while so 
serving away from their homes or regular places of business, they may 
be allowed travel expenses, including per diem in lieu of subsistence, 
as authorized by section 5703 of title 5, United States Code, for per-
sons in the Government employed intermittently. 
(e) The Council shall make findings on the unmet need of the dis-
abled for health insurance, on the costs involved in providing the dis-
abled with insurance protection to cover the cost'of hospital and medi-
cal services, and on the ways of financing this insurance. The Council 
shall submit a report of its findings to the Secretary not later than 
January 1, 1969, together with recommendations on how such protec-
tion should be financed and, if such financing is to be accomplished 
through the trust funds established under title X V I I I of the Social 
Security Act, on the extent to which each of such trust funds should 
bear the cost of such financing. Such report shall thereupon be trans-
mitted to the Congress and to the Boards of Trustees created by sec-
tions 1817(b) and 1841(b) of the Social Security Act. After the date 
of transmittal to the Congress of the report, the Council shall cease to 
exist. 
80 Stat. 417. 
5 u s e 3301 et 
seq. 
Compensation, 
trdvel expenses. 
80 Stat. 499. 
79 Stat. 291. 
42 u s e 1395-
\395ll. 
Report to 
eongress. 
42 u s e 13951, 
1395t. 
Expiration date. 
STUDY TO DETERMINE FEASIBILITY OF INCLUSION OF CERTAIN ADDITIONAL 
SERVICES UNDER PART B OF TITLE XVIII OF T H E SOCIAL SECURITY ACT 
SEC. 141. The Secretary shall make a study relating to the inchision 
under the supplementary medical insurance program (j)art B of title 
XVIII of the Social Security Act) of services of additional types of 
licensed practitioners performing health services in independent prac-
tice. The Secretary shall make a report to the Congress prior to Jan-
uary 1, 1969, of his finding with respect to the need for covering, 
under the supplementary medical insurance program, any of the 
various types of services such practitioners perform and the costs to 
such program of covering such additional services, and shall make 
recommendations as to the priority and method for covering these 
services and the measures that should be adopted to protect the health 
and safety of the individuals to whom such services would be fur-
nished. 
42 u s e 139i5j-
1395w. 
Report to 
Congress. 
PROVISIONS FOR BENEFITS UNDER PART A OF TITLE XVIII OF T H E SOCIAL 
SECURITY ACT FOR SERVICES TO PATIENTS ADMITTED PRIOR TO 1 9 6 8 TO 
CERTAIN HOSPITALS 
SEC. 142. (a) Notwithstanding any provision of title X V I I I of the 
Social Security Act, an individual who is entitled to hospital insurance 
benefits under section 226 of such Act may, subject to subsections (b) 
and (c), receive, on the basis of an itemized bill, reimbursement for 
charges to him ior inpatient hospital services (as defined in section 
79 Stat. 290. 
42 u s e 426. 
856 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
79 Stat. 313. 
42 u s e 1395X. 
42 u s e 1395CC. 
42 u s e 1395c-
1395i. 
42 u s e 1395f. 
"Routine serv-
1861 of such Act, but without regard to subsection (e) of such sec-
tion) furnished by, or under arrangements (as defined in section 
1861 (w) of such Act) with, a hospital if— 
(1) the hospital did not have an agreement in effect under 
section 1866 of such Act but would have been eligible for payment 
under part A of title X V I I I of such Act with respect to such 
services if at the time such services were furnished the hospital 
had such an agreement in effect; 
(2) the hospital (A) meets the requirements of paragraphs (5) 
and (7) of section 1861(e) of such Act, (B) is not primarily 
engaged in providing the services described in section 1861(j) 
(1) (A) of such Act, and (C) is primarily engaged in providing, 
by or under the supervision of individuals referred to in para-
graph (1) of section 1861 (r) of such Act, to inpatients (i) 
diagnostic services and therapeutic services for medical diagnosis, 
treatment, and care of injured, disabled, or sick persons, or (ii) 
rehabilitation services for the rehabilitation of injured, disabled, 
or sick persons; 
(3) the hospital did not meet the requirements that must be 
met to permit payment to the hospital under part A of title 
X V I I I of such Act; and 
(4) an application is filed (submitted in such form and manner 
and by such person, and containing and supported by such infor-
mation, as the Secretary shall by regulations prescribe) for re-
imbursement before January 1,1969. 
(b) Payments under this section may not be made for inpatient 
hospital services (as described in subsection (a)) furnished to an 
individual— 
(1) prior to July 1,1966, 
(2) after December 31, 1967, unless furnished with respect to 
an admission to the hospital prior to January 1,1968, and 
(3) for more than— 
(A) 90 days in any spell of illness, but only if (i) prior to 
January 1,1969, the hospital furnishing such services entered 
into an agreement under section 1866 of the Social Security 
Act and (ii) the hospital's plan for utilization review, as pro-
vided for in section 1861 (k) of such Act, has, in accordance 
with section 1814 of such Act, been applied to the services 
furnished such individual, or 
(B) 20 days in any spell of illness, if the hospital did not 
meet the conditions of clauses (i) and (ii) of subparagraph 
(A)- 
. 
.
.
. 
(c) (1) The amounts payable in accordance with subsection (a) with 
respect to inpatient hospital services shall, subject to paragraph (2) 
of this subsection, be paid from the Federal Hospital Insurance Trust 
Fund in amounts equal to 60 percent of the hospital's reasonable 
charges for routine services furnished in the accommodations occupied 
by the individual or in semi-private accommodations (as defined in 
section 1861 (v) (4) of the Social Security Act) whichever is less, plus 
80 percent of the hospital's reasonable charges for ancillary services. 
If separate charges for routine and ancillary services are not made by 
the hospital, reimbursement may be based on two-thirds of the hos-
pital's reasonable charges for the services received but not to exceed 
the charges which would have been made if the patient had occupied 
semi-private accommodations (as so defined). For purposes of the pre-
ceding provisions of this paragraph, the term "routine services" shall 
mean the regular room, dietary, and nursing services, minor medical 
serv-
79 Stat. 29:;. 
42 u s e 1395e. 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
857 
and surgical supplies and the use of equipment and facilities for 
which a separate charge is not customarily made; the term "ancillary id's^"'''"^*"^ 
services" shall mean those special services for which charges are cus-
tomarily made in addition to routine services. 
(2) Before applying paragraph (1), payments made under this 
section shall be reduced to the extent provided for under section 1813 
of the Social Security Act in the case of benefits payable to providers 
^^ ^^^ ^^^^^ 
of services under part A of title X V I I I of such Act. 
42 use 13950-
(d) For the purposes of this section— 
13951. 
(1) the 90-day period, referred to in subsection (b)(3)(A), 
shall be reduced by the number of days of inpatient hospital 
services furnished to such individual during the spell of illness, 
referred to therein, and with respect to which he was entitled to 
have payment made under part A of title X V I I I of the Social 
Security Act ; 
(2) the 20-day period, referred to in subsection (b) (3) (B) 
shall be reduced by the number of days in excess of 70 days of 
inpatient hospital services furnished during the spell of illness, 
referred to therein, and with respect to which such individual 
was entitled to have payment made under such part A; 
(3) the term "spell of illness" shall have the meaning assigned 
"speii o
f in-
to it by subsection (a) of section 1861 of such Act except that the hospit"i'srr''v^-^'^"* 
term "inpatient hospital services" as it appears in such subsection ices." 
shall have the meaning assigned to it by subsection (a) of this 
'^^ ^^^ i395x. 
section. 
PAYMENTS FOR EMERGENCY HOSPITAL SERVICES 
SEC. 143. (a) The second sentence following paragraph (8) of sec-
tion 1861(e) of the Social Security Act is amended by striking out 
"which meets the requirement of paragraphs (1), (2), (3), (4), (5) 
and (7) of this subsection" and inserting in lieu thereof "which (i) 
meets the retjuirements of paragraphs (5) and (7) of this subsection, 
(ii) is not primarily engaged in providing the services described in sec-
tion 1861 (]) (1) (A) and (iii) is primarily engaged in providing, by or 
under the supervision of individuals referred to in paragraph (1) of 
section 1861 (r), to inpatients diagnostic services and therapeutic 
services for medical diagnosis, treatment, and care of injured, disabled, 
or sick persons, or rehabilitation services for the rehabilitation of in-
jured, disabled, or sick persons." 
(b) That portion of section 1812(a) of such Act that precedes para-
graph (1) thereof is amended by inserting "or, in the case of payments 
42 use i395d. 
referred to in section 1814(d) (2) to him" after "on his behalf". 
^°s'' p- sss. 
(c) Section 1814(d) of such Act is amended by— 
79 st^a^. 296^^ 
(1) striking out "Payments" and inserting in lieu thereof "(1) 
•
^
^ u c i395f. 
Payments"; 
(2) deleting "furnished" and inserting "furnished in a calendar 
year"; 
(3) deleting "and" at the end of clause (A) and inserting a 
comma in lieu thereof ; 
(4) inserting before the period at the end of the first sentence 
the following: ", and (C) such hospital has elected to claim pay-
ments for all such inpatient emergency services and for the emer-
gency outpatient services referred to in section 1835(b) furnished 
'^"'®' ^- *
•
*
*
• 
during such year"; and 
(5) adding at the end of such section 1814(d) the following 
new paragraphs: 
858 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT 
79 Stat. 290. 
42 u s e 426. 
42 u s e 1395e. 
42 use 1395X. 
"Routine serv-
"Ancillary 
services." 
"(2) Payment nuiy be made on the basis of an itemized bill to an in-
dividual entitled to hospital insurance benefits under section 226 for 
services described in paragraph (1) which are emergency services if 
(A) payment cannot be made under paragraph (1) solely beca.use the 
hospital does not elect to claim such payment, and (B) such individual 
files application (submitted within such time and in such form and 
manner and by such person, and containing and supported by such in-
formation as tlie Secretary shall by regulations prescribe) for reim-
bursement, 
"(3) The amounts payable under the preceding paragraph with 
respect to services described therein shall, subject to the provisions of 
section 1813, be equal to 60 percent of the hospital's reasonable charges 
for routine services furnished in the accommodations occupied by the 
individual or in semiprivate accommodations (as defined in section 
1861 (v) (4)), whichever is less, plus 80 percent of the hospital's rea-
sonable charges for ancillary services. If separate charges for routine 
and ancillary services are not made by the hospital, reimbursement 
may be based on two-thirds of the hospital's reasonable charges for the 
services received but not to exceed the charges which would have been 
made if the patient had occupied semiprivate accommodations. For 
purposes of the preceding provisions of this paragraph, the term 'rou-
tine services' shall mean the regular room, dietary, and nursing serv-
ices, minor medical and surgical supplies and the use of equipment and 
facilities for which a separate charge is not customarily made; the 
term 'ancillary services' shall mean those special services for which 
charges are customarily made in addition to routine services." 
(d) The provisions made by subsection (a) of this section shall be-
come eft'ective as of July 1, 1966, and the provisions made by subsec-
tions (b) and (c) of this section shall apply to services furnished with 
respect to admissions occurring after December 31, 1967, and to out-
patient hospital diagnostic services furnished after December 31,1967, 
and before April 1,1968. 
79 Stat. 321. 
42 u s e 1395x. 
Ante, p. 847. 
42 use 1395f. 
PAYMENT I NDER SUPPLEMENTARY MEDICAL INSURANCE PRO(iRAM FOR 
CERTAIN INPATIENT ANCILLARY SERVICES 
SEC. 144. (a) So much of section 1861 (s) of the Social Security Act 
which precedes paragraph (1) is amended by striking out "(unless 
they would otherwise constitute inpatient hospital services, extended 
care services, or home health services)". 
(b) The sentence immediately following paragraph (9) of section 
1861 (s) of such Act is amended by inserting after "hospital" the 
following: " (which, for purposes of this sentence, means an institution 
considered a hospital for purposes of section 1814(d))". 
(c) Section 1861 (s) of such Act is amended by adding at the end 
thereof (after and below paragraph (13) as added to such section by 
section 129(b) of this Act) the following new^ sentence: "None of the 
items and services referred to in the preceding paragraphs (other than 
paragraphs (1) and (2) (A)) of this subsection which are furnished 
to a patient of an institution which meets the definition of a hospital 
for purposes of section 1814(d) shall be included unless such other 
conditions are met as the Secretary may find necessary relating to 
health and safety of individuals with respect to whom such items 
and services are furnished." 
(d) Section 1861 (s) (6) of such Act is amended by striking out "as 
his home" and inserting in lieu thereof "as his home other than an 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
859 
institution that meets the requirements of subsection (e)(1) or (j)(l) 
of this section". 
(e) The amendments made by this section shall apply with respect 
to services furnished after March 31,1968. 
GENERAL ENROLLMENT PERIOD UNDER TITLE XVIII 
79 Stat. 304. 
42 u s e 1395p. 
SEC. 145. (a) Section 1837(b)(1) of the Social Security Act is 
amended to read as follows: 
"(1) No individual may enroll for the first time under this part 
unless he does so in a general enrollment period (as provided in sub-
section (e)) which begins within 3 years after the close of the first 
enrollment period during which he could have enrolled under this 
part." 
(b) Section 1837(e) of such Act is amended to read as follows: 
"(e) There shall be a general enrollment period, after the period 
described in subsection (c), during the period beginning on January 
1 and ending on March 31 of each year beginning with 1969." 
(c) Section 1838 (b) of such Act is amended by— 
^2 use i395q 
(1) striking out in paragraph (1) the following: ", during a 
general enrollment period described in section 1837(e),"; and 
(2) striking out "December 31 of the year" and inserting in lieu 
thereof "the calendar quarter following the calendar quarter". 
(d) Section 1839(b) (2) of such Act is amended to read as follows: 
^2 use i395r. 
"(2) The Secretary shall, during December 1968 and of each year 
thereafter, determine and promulgate the dollar amount (whether or 
not such dollar amount was applicable for premiums for any prior 
month) which shall be applicable for premiums for months occurring 
in the 12-month period commencing July 1 in each succeeding year. 
Such dollar amount shall be such amount as the Secretary estimates to 
be necessary so that the aggregate premiums for such 12-month period 
will equal one-half of the total of the benefits and administrative costs 
which he estimates will be payable from the Federal Supplementary 
Medical Insurance Trust Fund for such 12-month period. In estimat-
ing aggregate benefits payable for any period, the Secretary shall in-
clude an appropriate amount for a contingency margin. Whenever 
the Secretary, pursuant to the preceding sentence, promulgates the 
dollar amount which shall be applicable for premiums for any period, 
he shall, at the time such promulgation is announced, issue a public 
statement setting forth the actuarial assumptions and bases employed 
by him in arriving at the amount of premiums so promulgated." 
(e) The amendments made by subsections (a), (b), and (c) shall 
become effective April 1,1968. Notwithstanding the provisions of sec-
tion 2 of Public Law 90-97, the amendments made by subsection (d) 
^"'®' P- 249-
shall become eifective December 1, 1968. 
ELIMINATION OF SPECIAL REDUCTION I N ALLOWABLE DAYS OF I N P A T I E N T 
HOSPITAL SERVICES FOR PATIENTS I N TUBERCULOSIS HOSPITALS 
S E C 146. (a) Section 1812 (c) of the Social Security Act (as amended 
by section 138 of this Act) is further amended— 
'^"'°' P- ^54. 
(1) by striking out "a psychiatric hospital or a tuberculosis 
hospital" and inserting in lieu thereof "a psychiatric hospital", 
(2) by striking out "and inpatient tuberculosis hospital serv-
ices", and 
(3) by striking out "or tuberculosis". 
(b) The amendments made by subsection (a) shall apply with 
respect to payment for services furnished after December 31, 1967. 
860 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
PART 4—^MISCW.LANEOUS AND TECHNICAL AMENDMENT'S 
E L K i i B i L r n : O F A D O P ' T E D 
C H I L D F O R M O N T H L Y 
B E N E F I T S 
SEC. 150. (a) The second sentence of section 216(e) of the Social 
72 Stat. 1028. 
Secui'ity Act is amended by striking out "before the end of two years 
after the day on which such individual died or the date of enactment 
of this Act" and inserting in lieu thereof "only if (A) proceedings 
for the adoption of the child had been instituted by such individual 
before his death, or (B) such child was adopted by such individual's 
surviving spouse before the end of two years after (i) the day on 
which such individual died or (ii) the date of enactment of the Social 
Security Amendments of 1958''. 
(b) The amendment made by subsection (a) shall apply with re-
spect to monthly benefits payable under title I I of the Social Security 
'^L^^'^AV''^^^' -^^^ ^^^' i^oiiths after January 1968, but only on the basis of an 
application filed in or after the month in which this Act is enacted. 
42 u s e 30 2 
note. 
Ante, p. 833. 
CRITERIA FOR DETERMINING CHILD S DEPENDENCY ON MOTHER 
64 Stat. 484. 
42 u s e 40 2. 
74 Stat. 952. 
SEC. 151. (a) Section 202(d)(3) of the Social Security Act is 
amended— 
(1) by inserting "or his mother or adopting mother" after "his 
father or adopting father" in the first sentence; and 
(2) by striking out ", if such individual is the child's father,'' 
in the second sentence. 
(b) Section 202(d) (4) of such Act is amended by inserting "or 
stepmother'' after "stepfather" each place it appears. 
72^stat^'io3o^' 
^^^ Sectiou 202(d) of such Act is further amended by striking out 
79 Stat." 371,397. paragraph (5), and by redesignating paragraphs (6) through (10) 
as paragraphs (5) through (9), respectively. 
(d) (1) The paragraph of section 202(d) of such Act redesignated 
as paragraph (9) by subsection (c) of this section is amended by 
striking out "under paragraph (9)" and inserting in lieu thereof 
"under paragraph (8)''. 
79 Stat. 372. 
^2) Paragraphs (2) and (3) of section 202(s) of such Act are each 
amended by striking out "(d)(6)." and inserting in lieu thereof 
"(d)(5),". 
(8) Section (5) (1) (1) of the Railroad Retirement Act of 1937 is 
amended— 
(A) by striking out "(3), (4), or (5)" in the third sentence and 
inserting in lieu thereof " (3) or (4)"; and 
80 Stat. 1084. 
^g) jjy striking out "paragraph (8)" in the ninth sentence and 
inserting in lieu thereof "paragraph (7)". 
(e) The amendments made by this section shall apply with respect 
to monthly benefits payable under title I I of the Social Security Act 
45 us^c 2
^
2
8
^
3
- 
(si'Tid aiinuities accruing under the Railroad Retirement Act of 1937) 
228 s-2. 
for months after January 1968, but only on the basis of applications 
filed in or after the month in which this Act is enacted. 
R E C O V E R Y O F OVERPAYMENTS 
42 use io\^.^' 
SEC. 152. (a) Section 204(a) of the Social Security Act is amended 
to read as follows: 
" (a) Whenever the Secretary finds that more or less than the correct 
amount of payment has been made to any person under this title, proper 
adjustment or recovery shall be made, under regulations prescribed by 
the Secretary, as follows: 
65 Stat. 689. 
45 u s e 228e. 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
861 
"(1) With respect to payment to a person of more than the 
correct amount, the Secretarjr shall decrease any payment under 
this title to which such overpaid person is entitled, or shall require 
such overpaid person or his estate to refund the amount in excess 
of the correct amount, or shall decrease any payment under this 
title payable to his estate or to any other person on the basis of 
the wages and self-employment income which were the basis of the 
payments to such overpaid person, or shall apply any combina-
tion of the foregoing. 
"(2) With respect to payment to a person of less than the cor-
rect amount, the Secretary shall make payment of the balance of 
the amount due such underpaid person, or, if such person dies 
before payments are completed or before negotiating one or 
more checks representing correct payments, disposition of the 
amount due shall be made in accordance with subsection (d)." 
(b) Section 204(b) of such Act is amended to read as follows: 
^3 Jt^^^-^i^aes. 
"(b) In any case in which more than the correct amount of pay-
ment has been made, there shall be no adjustment of payments to, or 
recovery by the United States from, any person who is without fault 
if such adjustment or recovery would defeat the purpose of this title 
or would be against equity and good conscience." 
BENEFITS PAID OX BASIS OF ERRONEOUS REPORTS OP DEATH I N MILITARY 
SERVICE 
SEC. 153. (a) Section 204(a) (1) of the Social Security Act (as 
amended by section 152 of this Act) is further amended by adding at 
^^nte, p. seo. 
the end the following sentence: "A payment made under this title on 
the basis of an erroneous report of death by the Department of De-
fense of an individual in the line of duty while he is a member of the 
uniformed services (as defined in section 210(m)) on active duty (as 
defined in section 210(1)) shall not be considered an incorrect pay- 
42 use 410. 
ment for any month prior to the month such Department notifies the 
Secretary that such individual is alive." 
(b) The amendment made by this section shall apply with respect 
to benefits under title I I of the Social Security Act if the individual 
42 use 4oi-
to whom such benefits were paid would have been entitled to such •*28;>i"<e. p. .833. 
benefits in or after the month in which this Act was enacted if the 
report mentioned in the amendment made by subsection (a) of this 
section had been correct (but without regard to the provisions of sec-
tion 202 (j) (1) of such Act). 
42 use 402. 
UNDERPAYMENTS 
SEC. 154. (a) Section 204(d) of the Social Security Act is amended 
^ f'^'- I V 
read as follows: 
"(d) If an individual dies before any payment due him under this 
title is completed, payment of the amount due (including the amount 
of any unnegotiated checks) shall be made— 
"(1) to the person, if any, who is determined by the Secretary 
to be the surviving spouse of the deceased individual and who 
either (i) was living m the same household with the deceased at 
the time of his death or (ii) was, for the month in which the de-
ceased individual died, entitled to a monthly benefit on the basis 
of the same wages and self-employment income as Avas the de-
ceased individual; 
"(2) if there is no person who meets the requirements of para-
graph (1), or if the person who meets such requirements dies be-
fore the payment due him under this title is completed, to the 
child or children, if any, of the deceased individual who were, for 
862 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
the month in which the deceased individual died, entitled to 
monthly benefits on the basis of the same wages and self-employ-
ment income as was the deceased individual (and, in case there is 
more than one such child, in equal parts to each such child); 
"(3) if there is no person who meets the requirements of para-
graph (1) or (2), or if each person who meets such requirements 
dies before the payment due him under this title is completed, to 
the parent or parents, if any, of the deceased individual who were, 
for the month in which the deceased individual died, entitled to 
monthly benefits on the basis of the same wages and self-employ-
ment income as was the deceased individual (and, in case there is 
more than one such parent, in equal parts to each such parent); 
"(4) if there is no person who meets the requirements of para-
graph (1), (2), or (3), or if each person who meets such require-
ments dies before the payment due him under this title is com-
pleted, to the person, if any, determined by the Secretary to be 
the surviving spouse of the deceased individual; 
"(5) if there is no person who meets the requirements of para-
graph (1), (2), (3), or (4), or if each person who meets such 
requirements dies before the payment due him under this title is 
completed, to the person or persons, if any, determined by the Sec-
retary to be the child or children of the deceased individual (and, 
in case there is more than one such child, in equal parts to each 
such child); 
"(6) if there is no person who meets the requirements of para-
graph (1), (2), (3), (4), or (5), or if each person who meets 
such requirements dies before the payment due him under this 
title is completed, to the parent or parents, if any, of the deceased 
individual (and, in case there is more than one such parent, in 
equal parts to each such parent); or 
"(7) if there is no person who meets the requirements of para-
graph (1), (2), (3), (4), (5), or (6), or if each person who meets 
such requirements dies before the payment due him under this 
title is completed, to the legal representative of the estate of the 
deceased individual, if any." 
(b) The heading of section 1870 of such Act is amended by adding 
at the end thereof "AND SETTLEMENT OF CLAIMS FOR 
BENEFITS ON B E H A L F OF DECEASED INDIVIDUALS". 
(c) Section 1870 of such Act is amended by adding after subsection 
(d) the following new subsections: 
"(e) If an individual, who received services for which payment 
may be made to such individual under this title, dies, and payment for 
such services was made (other than under this title), and the indi-
vidual died before any payment due him under this title with respect 
to such services Avas completed, payment of the amount due (includ-
ing the amount of any unnegotiated checks) shall be made— 
"(1) if the payment for such services was made (before or 
after such individual's death) by a person other than the deceased 
individual, to the person or persons determined by the Secretary 
under regulations to have paid for such services, or if the pay-
ment for such services was made by the deceased individual be-
fore his death, to the legal representative of the estate of such 
deceased individual, if any; 
"(2) if there is no person who meets the requirements of 
paragraph (1), to the person, if any, who is determined by the 
Secretary to be the surviving spouse of the deceased individual 
and who was either living in the same household with the de-
ceased at the time of his death or was, for the month in which the 
deceased individual died, entitled to a monthly benefit on the 
79 Stat. 331. 
42 use 1395gg. 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
863 
basis of the same wages and self-employment income as was the 
deceased individual; 
"(3) if there is no person who meets the requirements of para-
graph (1) or (2), or if the person who meets such requirements 
dies before the payment due him under this title is completed, to 
the child or children, if any, of the deceased individual who were, 
for the month in which the deceased individual died, entitled to 
monthly benefits on the basis of the same wages and self-employ-
ment income as was the deceased individual (and, in case there 
is more than one such child, in equal parts to each such child); 
" (4) if there is no person who meets the requirements of para-
graph (1), (2), or (3), or if each person who meets such require-
ments dies before the payment due him under this title is com-
pleted, to the parent or parents, if any, of the deceased individual 
who were, for the month in which the deceased individual 
died, entitled to monthly benefits on the basis of the same w^ages 
and self-employment income as was the deceased individual (and, 
in case there is more than one such parent, in equal parts to each 
such parent); 
"(5) if there is no person who meets the requirements of para-
graph (1), (2), (3), or (4), or if each person who meets such 
requirements dies before the payment due him under this title is 
completed, to the person, if any, determined by the Secretary to 
be the surviving spouse of the deceased individual; 
" (6) if there is no person who meets the requirements of p)ara-
graph (1), (2), (3), (4), or (5), or if each person who meets such 
requirements dies before the payment due him under this title is 
completed, to the person or persons, if any, determined by the 
Secretary to be the child or children of the deceased individual 
(and, in case there is more than one such child, in equal parts to 
each such child) ; 
"(7) if there is no person who meets the requirements of para-
graph (1), (2), (3), (4), (5), or (6), or if each person w^ho meets 
such requirements dies before the payment due him under this 
title is completed, to the parent or parents, if any, of the deceased 
individual (and, in case there is more than one such parent, in 
equal parts to each such parent); or 
"(8) if there is no person who meets the requirements of para-
graph (1), (2), (3), (4), (5), (6), or (7), or if each person who 
meets such requirements dies before the payment due him under 
this title is completed, to the legal representatives of the estate of 
the deceased individual, if any. 
"(f) If an individual who received medical and other health serv-
ices for w^hich payment may be made under section 1832(a) (1) dies, 
^ ^^^^ ^^^;^ 
and— 
" (1) no assignment of the right to payments was made by such 
individual before his death, and 
" (2) payment for such services has not been made, 
payment for such services shall be made to the physician or other per-
son who provided such services, but payment shall be made under this 
subsection only in such amount and subject to such conditions as would 
have been applicable if the individual who received the services had 
not died, and only if the person or persons who provided the services 
agrees that the reasonable charge is the full charge for the services." 
(d) Section 1842(b)(3)(B) of such Act (as amended by section 
125(a) of this Act) is amended by striking out "and such payment 
will be made" and inserting in lieu thereof "and such payment will 
(except as otherwise provided in section 1870(f)) be made". 
85-622 0-68—57 
Ante, 
p. 845. 
Ante, 
p. 824. 
864 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT . 
SIMPLIFICATION OF COMPUTATION OF PRIMAKY INSURANCE AMOUNT AND 
QUARTERS OF COVERAGE I N CASE OF 1 9 3 7 - 1 0 5 0 WAGES 
72 Stat. 1016. 
SEC. 155. (a)(1) Section 215(d)(1) of the Social Security Act is 
amended to read as follows: 
"Primary Insurance Benefit Under 1939 Act 
" (d) (1) For purposes of column I of the table appearing in subsec-
tion (a) of this section, an individual's primary insurance benefit shall 
be computed as follows: 
"(A) The individuaFs average monthly wage shall be deter-
mined as provided in subsection (b) (but without regard to para-
graph (4) thereof) of this section, except that for purposes of 
paragraph (2) (C) and (3) of such subsection, 1936 shall be 
used instead of 1950. 
"(B) For purposes of subparagraphs (B) and (C) of subsec-
tion (b)(2), an individual whose total wages prior to 1951 (as 
defined in subparagraph (C) of this subsection) — 
"(i) do not exceed $27,000 shall be deemed to have been 
paid such wages in equal parts in nine calendar years after 
1936 and prior to 1951; 
"(ii) exceed $27,000 and are less than $42,000 shall be 
deemed to have been paid (I) $3,000 in each of such number 
of calendar years after 1936 and prior to 1951 as is equal to 
the integer derived by dividing such total wages by $3,000, 
and (II) the excess of such total wages over the product of 
$3,000 times such integer, in an additional calendar year in 
such period; or 
"(ill) are at least $42,000 shall be deemed to have been 
paid $3,000 in each of the fourteen calendar years after 1936 
and prior to 1951. 
"(C) For the purposes of subparagraph (B), 'total wages 
prior to 1951' with respect to an individual means the sum of (i) 
remuneration credited to such individual prior to 1951 on the 
records of the Secretary, (ii) wages deemed paid prior to 1951 to 
such individual under section 217, and (iii) compensation under 
the Railroad Retirement Act of 1937 prior to 1951 creditable to 
228"'s-2."" """" 
him pursuant to this title. 
"(D) The individual's primary insurance benefit shall be 45.6 
per centum of the first $50 of his average monthly wage as com-
puted under this subsection, plus 11.4 per centum of the next $200 
of such average monthly wage." 
(2) Section 215(d) (2) of such Act is amended to read as follows: 
"(2) The provisions of this subsection shall be applicable only in 
the case of an individual— 
" (A) with respect to whom at least one of the quarters elapsing 
prior to 1951 is a quarter of coverage; 
"(B) except as provided in paragraph (3), who attained age 
22 after 1950 and with respect to whom less than six of the quar-
ters elapsing after 1950 are quarters of coverage, or who attained 
such age before 1951; and 
"(C) (i) who becomes entitled to benefits under section 202(a) 
42 use 40 2, 
or 223 after the date of the enactment of the Social Security 
Amendments of 1967, or 
"(ii) who dies after such date without being entitled to benefits 
under section 202 (a) or 223, or 
"(iii) whose primary insurance amount is required to be re-
Post, p. 865. 
computed under section 215 (f) (2)." 
• T o t a l wages 
prior to 1951." 
42 u s e 417. 
50 Stat. 30 7. 
45 u s e 228 a-
81 STAT. ] 
PUBLIC LAW 90-248-JAIN. 2, 1968 
865 
(3) Section 215(d) (3) of such Act is amended to read as follows: 
^ 
vicTis: 
"(3) The provisions of this subsection as in effect prior to the en-
actment of the Social Security Amendments of 1967 shall be applicable 
in the case of an individual— 
"(A) who attained age 21 after 1936 and prior to 1951, or 
"(B) who had a period of disability which began prior to 1951, 
but only if the primary insurance amount resulting therefrom is 
higher than the primary insurance amount resulting from the 
application of this section (as amended by the Social Security 
Amendments of 1967) and section 220.". 
^^ use 42o. 
(4) So much of section 215(f) (2) of such Act as precedes subpara-
graph (E) is amended to read as follows: 
^^ s*^'- ^^'S. 
"(2) If an individual has wages or self-employment income for a 
year after 1965 for any part or which he is entitled to old-age in-
surance benefits, the Secretary shall, at such time or times and within 
such period as he may by regulations prescribe, recompute such in-
dividual's primary insurance amount with respect to each such year. 
Such recomputation shall be made as provided in subsection (a) (1) 
and (3) as though the year with respect to which such recomputation 
is made is the last year of the period specified in subsection (b) (2) 
(C). A recomputation under this paragraph with respect to any year 
shall be effective—" 
(5) Subparagraphs (E) and (F) of such section 215(f) (2) are re-
designated as subparagraphs (A) and (B), respectively. 
(6) Section 215(f) of such Act is further amended by adding at the y/stat^^aes"^' 
end thereof the following new paragraph: 
"(5) In the case of a man who became entitled to old-age insurance 
benefits and died before the month in which he attained age 65, the 
Secretary shall recompute his primary insurance amount as provided 
in subsection (a) as though he became entitled to old-age insurance 
benefits in the month in which he died; except that (i) his computa-
tion base years referred to in subsection (b) (2) shall include the year 
in which he died, and (ii) his elapsed years referred to in subsection 
(b) (3) shall not include the year in which he died or any year there-
after. Such recomputation of such primary insurance amount shall 
be effective for and after the month in which he died." 
(7) (A) The amendments made by paragraphs (4) and (5) shall 
apply with respect to recomputations made under section 215(f) (2) 
of the Social Security Act after the date of the enactment of this Act. 
(B) The amendment made by paragraph (6) shall apply with re-
spect to individuals who die after the date of enactment of this Act. 
(8) In any case in which— 
(A) any person became entitled to a monthly benefit under 
section 202 or 223 of the Social Security Act after the date of ^/g^ use 402, 
enactment of this Act and before February 1968, and 
(B) the primary insurance amount on which the amount of such 
benefit is based was determined by applying section 215(d) of 
the Social Security Act as amended by this Act, 
^"'^' P- ^^'^^ 
such primary insurance amount shall, for purposes of section 215(c) 
of the Social Security Act, as amended by this Act, be deemed to have 
been computed on the basis of the Social Security Act in effect prior 
to the enactment of this Act. 
(9) The amendment made by paragraphs (1) and (2) shall not 
apply with respect to monthly benefits for any month prior to January 
1967. 
(b) (1) Section 213 of the Social Security Act is amended by add- 
J^ us^c 4?^?" 
ing at the end thereof the following new subsection: 
Ante, p. 827. 
866 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
"Alternative Metliod for Determining Quarters of Coverage With 
Respect to Wages in the Period from 1937 to 1950 
75 Stat. 137. 
"(g) For purposcs of section 214(a), an individual shall be deemed 
4 2 use 414. 
^^ have one quarter of coverage for each $400 of his total wages prior 
Ante. p. 864. 
to 1951 (as defined in section 215(d) (1) (C)), except where— 
"(1) such individual is not a fully insured individual on the 
basis of the number of quarters of coverage so derived plus the 
number of quarters of coverage derived from the wages and self-
employment income credited to him for periods after 1950, or 
"(2) such individual's elapsed years (for purposes of section 
214 (a) (1)) are less than 7." 
(2) The amendment made by paragraph (1) shall apply only in 
the case of an individual who applies for benefits under section 202(a) 
of the Social Security Act after the date of the enactment of this Act, 
or who dies after such date without being entitled to benefits under 
^42 use 402, 
section 202(a) or 223 of the Social Security Act. 
74 Stat. 964; 
(c) SectioR 303(g) (1) of the Social Security Amendments of 1960 
79 Stat. 366. 
ig amended— 
^^42 use 415 
^-^^ ^y striking out "section 302 of" and by striking out 
"Amendments of 1965'' and inserting in lieu thereof "Amend-
ments of 1965 and 1967'' in the first sentence; and 
(2) by striking out "after 1965, or dies after 1965" and insert-
ing in lieu thereof "after the date of the enactment of the Social 
Security Amendments of 1967, or dies after such date", and by 
striking out "Amendments of 1965" and inserting in lieu thereof 
"Amendments of 1967", in the second sentence. 
DEFINITIONS 
OF WIDOW, WIDOWER, AND 
STEPCHILD 
42 us^c 416^^' 
^^^- ^^^- (^) Section 216 (c) of the Social Security Act is amended 
by striking out "not less than one year" in clause (5) and inserting in 
lieu thereof "not less than nine months". 
(b) The first sentence of section 216 (e) of such Act is amended by 
striking out "the day on which such individual died" and inserting 
in lieu thereof "not less than nine months immediately preceding the 
day on which such individual died". 
74^stat^99V°' 
^^^ SectioR 216 (g) of such Act is amended by striking out "not 
less than one year" in clause (5) and inserting in lieu thereof "not 
less than nine months". 
(d) Section 216 of such Act is further amended by adding at the 
end thereof the following new subsection: 
"Waiver of Nine-Month Requirement for Widow, Stepchild, or 
Widower in Case of Accidental Death or in Case of Serviceman 
Dying in Line of Duty 
"(k) The requirement in clause (5) of subsection (c) or clause (5) 
^"P'-^- 
of subsection (g) that the surviving spouse of an individual have 
been married to such individual for a period of not less than nine 
months immediately prior to the day on which such individual died in 
order to qualify as such individual's widow or widower, and the re-
quirement in subsection (e) that the stepchild of a deceased individual 
have been such stepchild for not less than nine months immediately 
preceding the day on which such individual died in order to qualify 
as such individual's child, shall be deemed to be satisfied, where such 
individual dies within the applicable nine-month period, if his 
death— 
"(1) is accidental, or 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
867 
" (2) occurs in line of duty while he is a member of a uniformed 
service serving on active duty (as defined in section 210(1) (2)), 
'*2 use 410. 
and he would satisfy such requirement if a three-month period were 
substituted for the nine-month period; except that this subsection 
shall not apply if the Secretary determines that at the time of the 
marriage involved the individual could not have reasonably been 
expected to live for nine months. For purposes of paragraph (1) of 
the preceding sentence, the death of an individual is accidental if 
he receives bodily injuries solely through violent, external, and acci-
dental means and, as a direct result of the bodily injuries and inde-
pendently of all other causes, loses his life not later than three months 
after the day on which he receives such bodily injuries." 
(e) The amendments made by this section shall apply with respect 
to monthly benefits under title I I of the Social Security Act for ^4^. ^^^^'^°„^' 
months after January 1968, but only on the basis of applications filed 
in or after the month in which this Act is enacted. 
428; Ante, 
p. 833. 
HUSBAND'S AND WIDOWER'S INSURANCE BENEFITS WITHOUT REQUIREMENT 
OF WIFE'S CURRENTLY INSURED STATUS 
SEC. 157. (a)(1) Section 202(c)(1) of the Social Security Act 
I'^^lTc}^^' 
is amended by striking out "a currently insured individual (as defined 
in section 214(b))" in the matter preceding subparagraph (A) and 
inserting in lieu thereof "an individual". 
(2) Section 202(c)(2) of such Act is amended by striking out 
^2 stat. 1026. 
""The requirement in paragraph (1) that the individual entitled to 
old-age or disability insurance benefits be a currently insured individ-
ual, and the provisions of subparagraph (C) of such paragraph," and 
inserting in lieu thereof "The provisions of subparagraph (C) of para-
graph (1)". 
(b) (1) Section 2q2(f) (1) of such Act is amended— 
^^ stat. 485. 
(A) by striking out "and currently" in the matter preceding 
subparagraph (A), and 
(B) bv striking out ". and she was a currently insured individ-
ual," in subparagraph (D) (ii). 
72 stat. 1023. 
(2) Section 202(f)(2) of such Act is amended by striking out 
"The requirement in paragraph (1) that the deceased fully insured 
individual also be a currently insured individual, and the provisions 
of subparagraph (D) of such paragraph," and inserting in lieu there-
of "The provisions of subparagraph (D) of paragraph (1)". 
(c) In the case of any husband who would not be entitled to 
husband's insurance benefits under section 202(c) of the Social 
Security Act or any widower w^ho would not be entitled to widower's 
insurance benefits under section 202(f) of such Act except for the 
enactment of this section, the requirement in section 202(c)(1)(C) 
or 202(f) (1) (D) of such Act relating to the time within which proof 
of support must be filed shall not apply if such proof of support is 
filed within two years after the month following the month in which 
this Act is enacted. 
(d) The amendments made by this section shall apply with respect 
to monthly benefits payable under title II of the Social Security Act 
for months after January 1968, but only on the basis of applications 
filed in or after the month in which this Act is enacted. 
DEFINITION OF DISABILITY 
SEC. 158. (a) Section 223(c) 
of the Social Security Act is 
lH'i'c 
HI 
amended— 
(1) by inserting "of Insured Status and Waiting Period" after 
"Definitions" in the heading; 
42 u s e 416. 
42 use 402. 
868 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT . 
7/stat.^367!^4i3. 
(2) b j Striking out paragraph (2) ; and 
42 use 423. 
(3) by redesignating paragraph (3) as paragraph (2). 
(b) Section 223 of such Act is further amended by adding at the 
end thereof the following new subsection: 
"Definition of Disability 
"(d) (1) The term 'disability' means— 
"(A) inability to engage in any substantial gainful activity 
by reason of any medically determinable physical or mental im-
pairment which can be expected to result in death or which has 
lasted or can be expected to last for a continuous period of not 
less than 12 months; or 
"(B) in the case of an individual who has attained the age of 
55 and is blind ^within the meaning of 'blindness' as defined 
in section 216(i)(l)), inability by reason of such blindness to 
engage in substantial gainful activity rec|uiring skills or abilities 
comparable to those of any gainful activity in which he has pre-
viously engaged with some regularity and over a substantial 
period of time. 
"(2) For purposes of paragraph (1) (A) — 
"(A) an individual (except a widow, surviving divorced wife, 
or widower for purposes of section 202 (e) or (f)) shall be deter-
mined to be under a disability only if his physical or mental im-
pairment or impairments are of such severity that he is not only 
unable to do his previous work but cannot, considering his age, 
education, and work experience, engage in any other kind of sub-
stantial gainful work which exists in the national economy, re-
gardless of whether such work exists in the immediate area in 
which he lives, or whether a specific job vacancy exists for him, 
or whether he would be hired if he applied for work. For purposes 
of the preceding sentence (with respect to any individual), 'work 
which exists in the national economy' means work which exists in 
significant numbers either in the region where such individual 
lives or in several regions of the country. 
"(B) A widow, surviving divorced wife, or widower shall not 
be determined to be under a disabilitjr (for purposes of section 
202 (e) or (f)) unless his or her physical or mental impairment 
or impairments are of a level of severity which under regulations 
prescribed by the Secretary is deemed to be sufficient to preclude 
,,p 
an individual from engaging in any gainful activity. 
mentai^imp^air"'^ 
" ( ^ ) F'or purposes of this subsectiou, a 'physical or mental impair-
ment." 
ment' is an impairment that results from anatomical, physiological, or 
psychological abnormalities which are demonstrable by medically ac-
ceptable clinical and laboratory diagnostic techniques. 
"(4) The Secretary shall by regulations prescribe the criteria for 
determining when services performed or earnings derived from serv-
ices demonstrate an individual's ability to engage in substantial gain-
ful activity. Notwithstanding the provisions of paragraph (2), an 
individual whose services or earnings meet such criteria shall, except 
for purposes of section 222(c), be found not to be disabled. 
"(5) An individual shall not be considered to be under a disability 
unless he furnishes such medical and other evidence of the existence 
thereof as the Secretary may require." 
(c) (1) Section 202(d) (1) (B) of such Act is amended by striking 
out "section 223(c)" and inserting in lieu thereof "section 223(d)". 
(2) Paragraphs (1), (2), and (3) of section 202(s) of such Act 
are each amended by striking out "section 223(c)" and inserting in 
lieu thereof "section 223 (d)". 
42 use 422. 
79 Stat. 370. 
42 use 402. 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
869 
70 Stat. 818. 
42 u s e 421. 
70 Stat. 817. 
42 u s e 425. 
68 Stat. 1080. 
42 u s e 416. 
Ante, 
p. 868. 
(3) Section 221(a) of such Act is amended by striking out "or 
223 (c)" and inserting in lieu thereof "or 223 (d)". 
(4) Section 221(c) of such Act is amended by striking out "or 
223 (c)" and inserting in lieu thereof "or 223 (d)". 
(5) Section 222(c) (4) (B) of such Act is amended by striking out 
42 JS'42^^' 
"section 223(c) (2)" and inserting in lieu thereof "section 223(d)". 
(6) Section 223(a) (1) (D) of such Act is amended by striking out 
^o st^a^. MS. 
"subsection (c)(2)" and inserting in lieu thereof "subsection (d)". 
(7) The first sentence of section 223(a) (1) of such Act is further 
amended by striking out "subsection (c)(3)" and inserting in lieu 
thereof "subsection (c) (2)". 
(8) The last sentence of section 223(a) (1) is amended by striking 
^^ us^c 42^^' 
out "subsection (c) (2) except for subparagraph (B) thereof" and 
inserting in lieu thereof "subsection (d) except for paragraph (1) (B) 
thereof". 
(9) Section 225 of such Act is amended by striking out "section 
223(c) (2)" and inserting in lieu thereof "section 223(d)". 
(d) Section 216 (i) (1) of such Act is amended by striking out the 
third sentence and inserting in lieu thereof the following: "The provi-
sions of paragraphs (2) (A), (3), (4), and (5) of section 223(d) shall 
be applied for purposes of determining whether an individual is under 
a disability within the meaning of the first sentence of this paragraph 
in the same manner as they are applied for purposes of paragraph (1) 
of such section." 
(e) The amendments made by this section shall be effective with 
respect to applications for disability insurance benefits under section 
223 of the Social Security Act, and for disability determinations under 
section 216 (i) of such Act, filed— 
(1) in or after the month in which this Act is enacted, or 
(2) before the month in which this Act is enacted if the appli-
cant has not died before such month and if— 
(A) notice of the final decision of the Secretary of Health, 
Education, and Welfare has not been given to the applicant 
before such month; or 
(B) the notice referred to in subparagraph (A) has been 
so given before such month but a civil action with respect to 
such final decision is commenced under section 205 (g) of the 
Social Security Act (whether before, in, or after such month) 
H ^^^^ ^Q'^^' 
and the decision in such civil action has not become final 
before such month. 
DISABILITY BENEFITS AFFECTED BY RECEIPT OF WORKMEN'S COMPENSATION 
SEC. 159. (a) (1) The last sentence of section 224(a) of the Social 
Security Act is amended by inserting after "his wages and self- 
^^ ^
*
^
*
- '^°^-
employment income" where it first appears in clause (B) the follow- 
"^^^^ '^24a. 
ing: " (computed without regard to the limitations specified in sections 
209(a) and 211(b) (1))". 
^^\2 use 409, 
(2) Section 224(a) of such Act is further amended by adding at 
the end thereof the following: "In any case where an individual's 
wages and self-employment income reported to the Secretary for a 
calendar year reach the limitations specified in sections 209(a) and 
211(b) (1), the Secretary under regulations shall estimate the total of 
such wages and self-employment income for purposes of clause (B) 
of the preceding sentence on the basis of such information as may 
be available to him indicating the extent (if any) by which such wages 
and self-employment income exceed such limitations." 
(b) (1) The amendments made by subsection (a) shall apply only 
with respect to monthly benefits under title I I of the Social Security 
Act for months after January 1968. 
42 use 4o 1-
'' 
428; Ante, 
p. 833. 
870 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
79 Stat. 407. 
42 u s e 424a. 
68 Stat. 1076; 
74 Stat. 955. 
(2) For purposes of any redetermination which is made mider sec-
tion 224(f) of the Social Security Act in the case of benefits subject 
to reduction under section 224 of such Act, where such reduction as 
first computed was effective with respect to benefits for the montli in 
whicli this Act is enacted or a prior month, the amendments made by 
subsection (a) of this section shall also be deemed to have applied 
in the initial determination of the "average current earnings" of the 
individual whose wages and self-employment income are involved. 
EXTENSION OF TIME FOR FILING REPORTS OF EARNINGS 
74ltar955°^^' 
SEC. 160. (a) Scctlou 203(h) (1) (A) of the Social Security Act is 
42 use 403. 
amended by adding at the end thereof the following new sentence: 
"The Secretary may grant a reasonable extension of time for making 
the report of earnings required in this paragraph if he finds that there 
is valid reason for a delay, but in no case may the period be extended 
more than three months." 
(b) Section 203(h)(2) of such Act is amended by striking out 
'within the time prescribed therein" and inserting in lieu thereof 
"within the time prescribed by or in accordance with such paragraph" 
PENALTIES FOR FAILURE TO FILE TIMELY REPORTS OF EARNINGS AND OTHER 
EVENTS 
SEC. 161. (a) Section 203(h) (2) (A) of the Social Security Act is 
amended by inserting before the semicolon at the end thereof the fol-
lowing: ", except that if the deduction imposed under subsection (b) 
by reason of his earnings for such year is less than the amount of his 
benefit (or benefits) for the last month of such year for which he was 
42 use 40 2. 
entitled to a benefit under section 202, the additional deduction shall 
be equal to the amount of the deduction imposed under subsection (b) 
but not less than $10". 
(b) Section 203(g) of such Act is amended by striking out all that 
follows "shall suffer" and inserting in lieu thereof the following: 
"deductions in addition to those imposed under subsection (c) as 
follows: 
"(1) if such failure is the first one with respect to which an 
additional deduction is imposed by this subsection, such additional 
deduction shall be equal to his benefit or benents for the first 
month of the period for which there is a failure to report even 
though such failure is with respect to more than one month; 
"(2) if such failure is the second one with respect to which an 
additional deduction is imposed by this subsection, such additional 
deduction shall be equal to two times his benefit or benefits for the 
first month of the period for which there is a failure to report even 
though such failure is with respect to more than two months; and 
"(3) if such failure is the third or a subsequent one for which 
an additional deduction is imposed under this subsection, such 
additional deduction shall be equal to three times his benefit or 
benefits for the first month of the period for which there is a 
failure to report even though the failure to report is with respect 
to more than three months; 
except that the number of additional deductions required by this sub-
section shall not exceed the number of months in the period for which 
"Period for 
there is a failure to report. As used in this subsection, the term 'period 
which there 16 a 
„ 
i • i 
1 
• 
e •^ 
• 
• i 
• 
-i- • -i 
failure to report." lor wliicli there IS a failure to report with respect to any individual 
means the period for which such individual received and accepted 
42 use 40 2. 
insurance benefits under section 202 without making a timely report 
and for which deductions are required under subsection (c)." 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
871 
(c) The amendnieiits made by this section shall apply with respect 
to any deductions imposed on or after the date of the enactment of this 
Act under snbsecti(ms (g) and (h) of section 203 of the Social Security 
Act on account of failure to make a report required thereby. 
'^^ '^^^ '*°^" 
IJIMITATION ON PAYMENT OF BENEFITS TO ALIENS OUTSIDE 
T H E UNITED STATES 
SEC. 162. (a)(1) Section 202(t)(l) of the Social Security Act is 
^°usc'402." 
amended by adding at the end thereof (after and below subparagraph 
(B)) the following new sentence: "For purposes of the preceding sen-
tence, after an individual has been outside the United States for any 
period of thirty consecutive days he shall be treated as remaining out-
side the LTnited States until he has been in the United States for a 
period of thirty consecutive days." 
(2) The amendment made by paragraph (1) shall apply only with 
respect to six-month periods (within the irieaning of section 202(t) 
(1) (A) of the Social Security Act) which begin after the date of the 
enactment of this Act. 
(b) (1) Section 202 (t) (4) of such Act is amended— 
ya^staS.^^iy^a!' 
(A) by striking out the period at the end of subparagraph (E) 
and inserting in lieu thereof a semicolon; and 
(B) by adding at the end thereof (after and below subpara-
graph (E)) the following: 
"except that subparagraphs (A) and (B) of this paragraph shall not 
apply in the case of any individual who is a citizen of a foreign coun-
try that has in eifect a social insurance or pension system which is of 
general application in such country and which satisfies subparagraph 
(A) but not subparagraph (B) of paragraph (2), or who is a citizen 
of a foreign country that has no social insurance or pension system 
of general application if at any time within five years prior to the 
month in which the Social Security Amendments of 1967 are enacted 
(or the first month thereafter for which his benefits are subject to sus-
pension under paragraph (1)) payments to individuals residing in 
such country were withheld by the Treasury Department under the 
first section of the Act of October 9,1940 (31 U.S.C. 123)." 
_ 
56^st!l^*io2°8'^' 
(2) The amendment made by paragraph (1) shall apply only with 
respect to monthly benefits under title I I of the Social Security Act ^^ti^^^tV'^^^'' 
for months beginning after June 30,1968. 
(c) (1) Section 202(t) of such Act is further amended by adding 
at the end thereof the following new paragraph: 
"(10) Notwithstanding any other provision of this title, no monthly 
benefits shall be paid under this Section or under section 223, for any 
month beginning after June 30, 1968, to an individual who is not a 
citizen or national of the United States and who resides during such 
month in a foreign country if payments for such month to individuals 
residing in such country are withheld by the Treasury Department 
under the first section of the Act of October 9, 1940 (31 U.S.C. 123)." 
(2) Section 202(t) (6) of such Act is amended by striking out "by 
reason of paragraph (1)" and inserting in lieu thereof "by reason of 
paragraph (1) or (10)". 
(3) Whenever benefits which an individual who is not a citizen or 
national of the United States was entitled to receive under title I I of 
the Social Security Act are, on June 30, 1968, being withheld by the 
Treasury Department under the first section of the Act of October 9, 
1940 (31 U.S.C. 123), any such benefits, payable to such individual 
70 Stat. 835; 
79 Stat. 334. 
872 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
for months after the month in which the determination by the Treas-
ury Department that the benefits should be so withheld was made, 
shall not be paid— 
(A) to any person other than such individual, or, if such in-
dividual dies before such benefits can be paid, to any person other 
than an individual who was entitled for the month in which the 
deceased individual died (with the application of section 202(j) 
(1) of the Social Security Act) to a monthly benefit under title 
428; Anfi.^p.^ 833. 
^ ^^ ^^^^1^ ^^t ou the basis of the same wages and self-employment 
income as such deceased individual, or 
(B) in excess of the equivalent of the last twelve months' bene-
fits that would have been payable to such individual. 
BENKriTS FOR CERTAIN CHILDREN 
SEC. 163. (a) (1) The last sentence of section 203(a) of the Social 
42 us^c 4
^
0 3
^
^ 
Security Act is amended to read as follows: "Whenever a reduction 
is made under this subsection in the total of monthly benefits to which 
individuals are entitled for any month on the basis of the wages and 
self-employment income of an insured individual, each such benefit 
other than the old-age or disability insurance benefit shall be propor-
tionately decreased; except that if such total of benefits for such month 
42 use 402. 
includes any benefit or benefits under section 202(d) which are payable 
42 use 416. 
solely by reason of section 216(h) (3), the reduction shall be first ap-
plied to reduce (proportionately where there is more than one benefit 
so payable) the benefits so payable (but not below zero)." 
(2) The amendment made by paragraph (1) shall apply only with 
respect to monthly benefits payable under title I I of the Social Security 
Act with respect to individuals who become entitled to benefits under 
section 202(d) of such Act solely by reason of section 216(h) (3) of 
such Act in or after January 1968 (but without regard to section 
202(j)(l) of such Act). The provisions of section 170 of this Act 
shall not apply with respect to any such individual, 
(b) Where— 
(1) one or more persons were entitled (without the applica-
tion of section 202(j) (1) of the Social Security Act) to monthly 
42 use 423. 
benefits under section 202 or 223 of such Act for January 1968 on 
the basis of the wages and self-employment income of an indi-
vidual, and 
(2) one or more persons became entitled to monthly benefits 
before January 1968 under section 202(d) of such Act by reason 
of section 216(h) (3) of such Act (but without regard to section 
202(j) (1)), on the basis of such wages and self-employment in-
come and are so entitled for January 1968, and 
(3) the total of benefits to which all persons are entitled under 
such section 202 or 223 of such Act on the basis of such wages and 
self-employment for January 1968 are reduced by reason of 
section 203(a) of such Act, as amended by this Act (or would, 
but for the penultimate sentence of such section 203(a), be so 
reduced), 
then the amount of the benefit to which each such person referred to 
in paragraph (1) above (but not including persons referred to in 
paragraph (2) above) is entitled for months aiter January 1968 shall 
be increased, after the application of such section 203 (a), to the amount 
it would have been if the person or persons referred to in paragraph 
(2) were not entitled to a benefit referred to in .such paragraph (2). 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
873 
TRANSFER TO HEALTH 
INSURANCE 
BENEFITS 
ADVISORY COUNCIL 
OF 
NATIONAL MEDICAL REVIEW COMMITTEE FUNCTIONS; INCREASE 
IN 
C O U N C I L ' S MEMBERSHIP 
SEC. 164. (a) Section 1867 of the Social Security Act is amended to 
read as follows: 
79 Stat. 329. 
42 use 1395dd. 
HEALTH I N S I ^ R A N C E BENEFITS ADVISORY COUNCIL 
"SEC. 1867. (a) There is hereby created a Health Insurance Benefits 
Advisory Council which shall consist of 19 persons, not otlierwise in 
the employ of the United States, appointed by the Secretary without 
regard to the provisions of title 5, ITnited States Code, governing ap-
pointments in the competitive service. The Secretary shall from time 
to time appoint one of the members to serve as Chairman, The mem-
bers shall include persons who are outstanding in fields related to hos-
pital, medical, and other health activities, persons who are representa-
tive of organizations and associations of professional personnel in the 
field of medicine, and at least one person who is representative of the 
general public. Each member shall hold office for a term of 4 years, 
except that any member appointed to fill a vacancy occurring prior to 
the expiration of the term for which his predecessor was appointed 
shall be appointed for the remainder of such term. A member shall not 
be eligible to serve continuously for more than 2 terms. The Secretary 
may, at the request of the Advisory Council or otherwise, appoint such 
special advisory professional or technical committees as may be useful 
in carrying out this title. Members of the Advisory Council and mem-
bers of any such advisory or technical committee, while attending 
meetings or conferences thereof or otherwise serving on business of the 
Advisory Council or of such committee, shall be entitled to receive 
compensation at rates fixed by the Secretary, but not exceeding $100 
per day, including travel time, and while so serving away from their 
homes or regular places of business they may be allowed travel ex-
penses, including per diem in lieu of subsistence, as authorized by 
section 5703 of title 5, United States Code, for persons in the Govern-
ment service employed intermittently. The Advisory Council shall 
meet as frequently as the Secretary deems necessary. ITpon request of 
5 or more members, it shall be the duty of the Secretary to call a meet-
ing of the Advisory Council. 
"(b) It shall be the function of the Advisory Council (1) to advise 
the Secretary on matters of general policy in the administration of this 
title and in the foririulation of regulations under this title, and (2) to 
study the utilization of hospital and other medical care and services 
for which payment may be made under this title with a view to recom-
mending any changes which may seem desirable in the way in which 
such care and services are utilized or in the administration of the 
programs established by this title, or in the provisions of this title. The 
Advisory Council shall make an annual report to the Secretary on the 
performance of its functions, including any recommendations it may 
have with respect thereto, and such report shall be transmitted 
promptly by the Secretary to the Congress. 
"(c) The Advisory Council is authorized to engage such technical 
assistance as may be required to carry out its functions, and the Secre-
tary shall, in addition, make available to the Advisory Council such 
secretarial, clerical, and other assistance and such pertinent data ob-
tained and prepared by the Department of Health, Education, and 
Welfare as the Advisory Council may require to carry out its 
functions." 
(b) The amendment made by subsection (a) shall not be construed 
as affecting the terms of office of the members of the Health Insurance 
Membership. 
80 Stat. 417. 
5 use 3301 et 
seq. 
Term of office. 
eompensation, 
travel expenses. 
80 Stat. 499. 
Duties. 
Report to 
eongress. 
874 
PUBLIC LAW 90-248-JAN. 2, 1968 
fel 
STAT. 
Benefits Advisory Council in office on the date of the enactment of 
this Act or their successors. The terms of office of the three additional 
members of the Health Insurance Benefits Advisory Council first ap-
pointed pursuant to the increase in the membership of such Council 
provided by such amendment shall expire, as designated by the Secre-
tary at the time of appointment, one at the end of the first year, one at 
the end of the second year, and one at the end of the third year after 
the date of appointment. 
79 s^tS; 329. 
(^) Section 1868 of the Social Security Act is repealed. 
42 u s e 1395ee. 
79 Stat. 339. 
42 u s e 907. 
ADVISORY COUNCIL ON SOCIAL SECURITY 
SEC. 165. (a)(1) Section 706(a) of the Social Security Act is 
amended by striking out "During 1968 and every fifth year thereafter" 
and inserting in lieu thereof "During 1969 (but not before Febru-
ary 1, 1969) and every fourth year thereafter (but not before Febru-
ary 1 of such fourth year)". 
(2) Section 706(d) such Act is amended by striking out "reports 
of its" and inserting in lieu thereof "reports (including any interim 
reports such Council may have issued) of its". 
(b) Section 706(b) of such Act is amended by striking out "shall 
consist of the Commissioner of Social Security, as Chairman, and 12 
other persons, appointed by the Secretary" and inserting in lieu 
thereof "shall consist of a Chairman and 12 other persons, appointed 
by the Secretary". 
REIMBURSEMENT OF CIVIL SERVICE RETIREMENT ANNUITANTS FOR CERTAIN 
P R E M I U M 
PAYMENTS 
UNDER 
SUPPLEMENTARY 
MEDICAL 
INSURANCE 
PROGRAM 
42 use 1395s. 
SEC. 166. Section 1840(e) (1) of the Social Security Act is amended 
by adding at the end thereof the following new sentence: "A plan 
80 Stat. 602. 
dcscHbed in section 8903 of title 5, United States Code, may reim-
burse each annuitant enrolled in such plan an amount equal to the 
premiums paid by him under this part if such reimbursement is paid 
entirely from funds of such plan which are derived from sources other 
than the contributions described in section 8906 of such title." 
APPROPRIAnONS TO SUPPLEMENTARY MEDICAL INSURANCE TOUST FUND 
lo fl^n f^o^ 
SEC. 167. (a) Section 1844 (a) of the Social Security Act is amended 
42 u s e 1395w. 
i
i
i
«
T
i 
' 
*' 
to read as follows: 
" (a) There are authorized to be appropriated from time to time, out 
of any moneys in the Treasury not otherwise appropriated, to the 
Federal Supplementary Medical Insurance Trust Fund— 
"(1) a Government contribution equal to the aggregate premi-
ums payable under this part and deposited in the Trust Fund, and 
"(2) such sums as the Secretary deems necessary to place the 
Trust Fund, at the end of any fiscal year occurring after June 30, 
1967, in the same position in which it would have been at the end 
of such fiscal year if (A) a Government contribution representing 
the excess of the premiums deposited in the Trust Fund during 
the fiscal year ending June 30, 1967, over the Government contri-
bution actually appropriated to the Trust Fund during such fiscal 
year had been appropriated to it on June 30, 1967, and (B) the 
Government contribution for premiums deposited in the Trust 
Fund after June 30, 1967, had been appropriated to it when such 
premiums were deposited." 
(b) Section 1844(b) of such Act is amended by striking out "1967" 
and inserting in lieu thereof "1969". 
42 u s e 1395t. 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
875 
79 Stat. 411. 
42 u s e 1306. 
DISCLOSURE TO COURTS OF WHEREABOUTS OF CERTAIN INDIVIDUALS 
SEC. 168. (a) Section 1106(c) (1) of the Social Security Act is 
amended by inserting " ( A ) " after "(c)(1)'', by redesignating sub-
paragraphs (A) through (D) as clauses (i) through (iv), respectively, 
and by adding at the end thereof the following new subparagraph: 
"(B) If a request for the most recent address of any individual so 
included is filed (in accordance with paragraph (2) of this subsection) 
by a court having jurisdiction to issue orders or entertain petitions 
against individuals for the support and maintenance of their children, 
the Secretary shall furnish such address, or the address of the indi-
vidual's most recent employer, or both, for the use of the court (and 
for no other purpose) in issuing or determining whether to issue such 
an order against such individual or in determining (in the event such 
individual is not within the jurisdiction of the court) the court to 
whicli a petition for support and maintenance against such individual 
should be forwarded under any reciprocal arrangements with other 
States to obtain or improve court orders for support, if the court cer-
tifies that the information is requested for such use." 
(b) (1) Section 1106(c) (2) of such Act is amended by striking out 
", and shall be accompanied" and all that follows and inserting in lieu 
thereof "(and, in the case of a request under paragraph (1) (A), shall 
be accompanied by a certified copy of the order referred to in clauses 
(i) and (iv) thereof)." 
(2) Section 1106(c)(3) of such Act is amended by striking out 
"authorized bv subparagraph (D) thereof" and inserting in lieu there-
of "authorized by subparagraph (A) (iv) or (R) thereof", 
REPORTS OF BOARDS OF TRUSTEES TO CONORESS 
SEC. 169. (a) Sections 201(c) (2), 1817(b) (2), and 1841 (b) (2) of 
the Social Security Act are each amended by striking out "March" 
and inserting in lieu thereof "April". 
42 use" 4oi 
(b) Section 201(c) of such Act is amended by inserting immedi- ^395i, i395t 
ately before the last sentence the following new sentence: "Such report 
shall also include an actuarial analysis of the benefit disbursements 
made from the Federal Old-Age and Survivors Insurance Trust Fund 
with respect to disabled beneficiaries." 
GENERAL SAVING PROVISION 
SEC. 170. Where— 
(1) one or more persons were entitled (without the applica-
tion of section 202(j) (1) of the Social Security Act) to monthly 
benefits under section 202 or 228 of such Act for January 1968 on 
^4 stat^. 487 
the basis of the wages and self-employment income of an indi- 
-"" ""^ """ 
vidual, and 
(2) one or more persons (not included in paragraph (1)) 
become entitled to monthly benefits under such section 202 for 
February 1968 on the basis of such wages and self-employment 
by reason of the amendments made to such Act by sections 104, 
112,150,151,156, and 157 of this Act, and 
(3) the total of benefits to which all persons are entitled under 
such section 202 or 223 on the basis of such wages and self-em-
ployment for February 1968 are reduced by reason of section 
203(a) of such Act, as amended by this Act (or would, but for 
the penultimate sentence of such section 203(a), be so reduced), 
then the amount of the benefit to which each such person referred to 
in paragraph (1) is entitled for months after January 1968 shall be 
increased, after the application of such section 203(a), to the amount 
70 Stat. 8 21; 
79 Stat. 300, 308. 
42 u s e 402. 
42 u s e 423. 
876 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
it would have been if the person or persons referred to in paragraph 
(2) were not entitled to a benefit referred to in such paragraph. 
42 use 405. 
42 u s e 428. 
EXPEDITED BENEFIT PAYMENTS 
SEC. 171. (a) Section 205 of the Social Security Act is amended 
by adding at the end thereof the following new subsection: 
"Expedited Benefit Payments 
" ( Q ) ( 1 ) The Secretary shall establish and put into effect pro-
cedures under which expedited payment of monthly insurance benefits 
under this title will, subject to paragraph (4) of this subsection, be 
made as set forth in paragraphs (2) and (3) of this subsection. 
" (2) In any case in which— 
"(A) an individual makes an allegation that a monthly benefit 
under this title was due him in a particular month but was not 
paid to him, and 
"(B) such individual submits a written request for the payment 
of such benefit— 
"(i) in the case of an individual who received a regular 
monthly benefit in the month preceding the month with re-
spect to which such allegation is made, not less than 30 days 
after the 15th day of the month with respect to which such 
allegation is made (and in the event that such req^uest is sub-
mitted prior to the expiration of such 30-day period, it shall 
be deemed to have been submitted upon the expiration of 
such period), and 
" (ii) in any other case, not less than 90 days after the later 
of (I) the date on which such benefit is alleged to have been 
due, or (II) the date on which such individual furnished 
the last information requested by the Secretary (and such 
written request will be deemed to be filed on the day on which 
it was filed, or the ninetieth day after the first day on which 
the Secretary has evidence that such allegation is true, which-
ever is later), 
the Secretary shall, if he finds that benefits are due, certify such bene-
fits for payment, and payment shall be made within 15 days immedi-
ately following the date on which the written request is deemed to 
have been filed. 
"(3) In any case in which the Secretary determines that there is 
evidence, although additional evidence might be required for a final 
decision, that an allegation described in paragraph (2) (A) is true, he 
may make a preliminary certification of such benefit for payment even 
though the 30-day or 90-day periods described in paragraph (2) (B) 
(i) and (B) (ii) have not elapsed. 
" (4) Any payment made pursuant to a certification under paragraph 
(3) of this subsection shall not be considered an incorrect payment for 
purposes of determining the liability of the certifying or disbursing 
officer. 
" (5) For purposes of this subsection, benefits payable under section 
228 shall be treated as monthly insurance benefits payable under this 
title. However, this subsection shall not apply with respect to any 
benefit for which a check has been negotiated, or with respect to any 
^Q^ use 423, 
benefit alleged to be due under either section 223, or section 202 to a 
wife, husband, or child of an individual entitled to or applying for 
benefits under section 223, or to a child who has attained age 18 and 
is under a disability, or to a widow or widower on the basis of being 
under a disability." 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
877 
(b) The amendment made by subsection (a) of this section shall be 
effective with respect to written requests filed under section 205 (q) 
of the Social Security Act after June 30,1968. 
DEFINITION" OF BLIXDNESS 
SEC. 172. (a) The first sentence of section 216(i) (1) of the Social 
Security Act is amended by striking out " ( B ) " and all that follows 
^2 use 4i6. 
and inserting in lieu thereof "(B) blindness; and the term 'blindness' 
means central visual acuity of 20/200 or less in the better eye with the 
use of a correcting lens." 
(b) The second sentence of section 216 (i) (1) of such Act is amended 
to read as follows: "An eye which is accompanied by a limitation in 
the fields of vision such that the widest diameter of the visual field 
subtends an angle no greater than 20 degrees shall be considered for 
purposes of this paragraph as having a central visual acuity of 
20/200 or less." 
(c) The amendments made by this section shall be effective with re-
spect to benefits under section 223 of the Social Security Act for 
^2 use 423. 
months after January 1968 based on applications filed after the date 
of enactment of this Act and with respect to disability determinations 
under section 216(i) of the Social Security Act based on applications 
fi^ed after the date of enactment of this Act. 
ATTORNEYS FEES FOR CLAIMANTS 
SEC. 173. Section 206(a) of the Social Security Act is amended by 
^2 use 406. 
inserting, immediately before the last sentence thereof, the following 
new sentences: "Whenever the Secretary, in any claim before him for 
benefits under this title, makes a determination favorable to the claim-
ant, he shall, if the claimant was represented by an attorney in con-
nection with such claim, fix (in accordance with the regulations pre-
scribed pursuant to the preceding sentence) a reasonable fee to com-
pensate such attorney for the services performed by him in connection 
w^ith such claim. If as a result of such determination, such claimant is 
entitled to past-due benefits under this title, the Secretary shall, not-
withstanding section 205(i), certify for payment (out of such past- 
42 use 405. 
due benefits) to such attorney an amount equal to whichever of the 
following is the smaller: (A) 25 per centum of the total amount of 
such past-due benefits, (B) the amount of the attorney's fee so fixed, 
or (C) the amount agreed upon between the claimant and such attor-
ney as the fee for such attorney's services." 
TITLE II—PUBLIC WELFARE AMENDMENTS 
PART 1—PUBLIC ASSISTANCE AMENDMENTS 
PROGRAMS OF SERVICES FURNISHED TO FAMILIES WITH DEPENDENT 
CHILDREN 
SEC, 201. (a)(1) Section 402(a) of the Social Security Act (as 
amended by section 202(a) of this Act) is amended by— 
^os<, p. ssi. 
(A) striking out "and" at the end of clause (13) ; 
(B) striking out clause (14), including the period at the end 
thereof, and inserting in lieu thereof the following: "(14) pro-
vide for the development and application of a program for such 
family services, as defined in section 406(d), and child-welfare 
^°«'' P- ^SO. 
services, as defined in section 425, for each child and relative who 
^osf, p. 914. 
receives aid to families with dependent children, and each ap-
propriate individual (living in the same home as a relative and 
878 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
child receiving such aid whose needs are taken into account in 
making the determination under clause (7)), as may be neces-
sary in the light of the particular home conditions and other 
needs of such child, relative, and individual, in order to assist 
such child, relative, and individual to attain or retain capability 
for self-support and care and in order to maintain and strengthen 
family life and to foster child development;"; and 
(C) adding after clause (14) the following new clauses: "(15) 
provide— 
"(A) for the development of a program for each appropriate 
relative and dependent child receiving aid under the plan, and 
each appropriate individual (living in the same home as a relative 
and child receiving such aid) whose needs are taken into account 
in making the determination under clause (7), with the objective 
of— 
"(i) assuring, to the maximum extent possible, that such 
relative, child, and individual will enter the labor force and 
accept employment so that they will become self-sufficient, 
and 
"(ii) preventing or reducing the incidence of births out of 
wedlock and otherwise strengthening family life, 
"(B) for the implementation of such programs by— 
"(i) assuring that such relative, child, or individual who 
is referred to the Secretary of Labor pursuant to clause (19) 
is furnished child-care services and that in all appropriate 
cases family planning services are offered them, and 
"(ii) in appropriate cases, providing aid to families with 
dependent children in the form of payments of the types de-
scribed in section 406(b) (2), and 
"(C) that the acceptance by such child, relative, or individual 
of family planning services provided under the plan shall be vol-
untary on the part of such child, relative, or individual and shall 
not be a prerequisite to eligibility for or the receipt of any other 
service or aid under the plan, 
"(D) for such review of each such program as may be necessary 
(as frequently as may be necessary, but at least once a year) to 
insure that it is being effectively implemented, 
"(E) for furnishing the Secretary with such reports as he 
may specify showing the results of such programs, and 
"(F) to the extent that such programs under this clause or 
clause (14) are developed and implemented by services furnished 
by the staff of the State agency or the local agency administering 
the State plan in each of the political subdivisions of the State, 
for the establishment of a single organizational unit in such State 
or local agency, as the case may be, responsible for the furnishing 
of such services; 
(16) provide that where the State agency has reason to believe that 
the home in which a relative and child receiving aid reside is unsuit-
able for the child because of the neglect, abuse, or exploitation of such 
child it shall bring such condition to the attention of the appropriate 
court or law enforcement agencies in the State, providing such data 
with respect to the situation it may have; (17) provide— 
"(A) for the development and implementation of a program 
under which the State agency will undertake— 
"(i) in the case of a child born out of wedlock who is re-
ceiving aid to families with dependent children, to establish 
the paternity of such child and secure support for him, and 
"(ii) in the case of any child receiving such aid who has 
been deserted or abandoned by his parent, to secure support 
Post, 
p. 893. 
Ante, 
p. 877. 
81 STAT. J 
PUBLIC LAW 90-248-JAN. 2, 1968 
879 
for such child from such parent (or from auy other person 
legally liable for such support), utilizing any reciprocal ar-
rangements adopted with other States to obtain or enforce 
court orders for support, and 
"(B) for the establishment of a single organizational unit in 
the State agency or local agency administering the State plan in 
each political subdivision which will be responsible for the ad-
ministration of the program referred to in clause (A); 
(18) provide for entering into cooperative arrangements with appro-
priate courts and law enforcement officials (A) to assist the State 
agency in administering the program referred to in clause (17) (A), 
including the entering into of financial arrangements with such courts 
and officials in order to assure optimum results under such program, 
and (B) with respect to any other matters of common concern to such 
courts or officials and the State agency or local agency administering 
the State plan." 
(2) Section 402(a) (13) of such Act (as redesignated by section 
202(a) of this Act) isamendedby striking out "(if any)*'. 
^°^'' P- ^^^• 
(b) Section 402 of such Act is amended by adding at the end there-
of the following new subsection: 
"(c) The Secretary shall, on the basis of his review of the reports 
received from the States under clause (15) of subsection (a), compile 
such data as he believes necessary and from time to time publish his 
findings as to the effectiveness of the programs developed and admin-
istered by the States under such clause. The Secretary shall annually 
Report to 
report to the Congress (with the first such report being made on or 
""s*"^^^-
before July 1, 1970) on the programs developed and administered by 
each State under such clause (15)." 
(c) Section 403(a) (3) of such Act is amended by striking out sub- 
^^ ^sc eot 
paragraphs (A) and (B) and inserting in lieu thereof the following: 
"(A) 75 per centum of so much of such expenditures as 
are for— 
"(i) any of the services described in clauses (14) and 
(15) of section 402(a) which are provided to any child 
^"'e- P- 877. 
or relative who is receiving aid under the plan, or to any 
other individual (living in the same home as such rela-
tive and child) whose needs are taken into account in 
making the determination under clause (7) of such 
section, 
"(ii) any of the services described in clauses (14) and 
(15) of section 402(a) which are provided to any child 
or relative who is applying for aid to families with 
dependent children or who, within such period or periods 
as the Secretary may prescribe, has been or is likely to 
become an applicant for or recipient of such aid, or 
"(iii) the training of personnel employed or prepar-
ing for employment by the State agency or by the local 
agency administering the plan in the political subdivi-
sion; plus". 
(d) Section 403(a) (3) of such Act is further amended— 
(1) (A) by redesignating subparagraphs (C), (I)),and (E) as 
subparagraphs (B), (C),and (D),respectively, 
(B) by striking out "subparagraph ( E ) " in subparagraph (C) 
(as so redesignated) and inserting in lieu thereof "subparagraph 
(D)", and 
(C) by striking out "subparagraph (D)" in the matter follow-
ing subparagraph (D) (as so redesignated) and inserting in lieu 
thereof "subparagraph (C)" ; 
85-622 0-68—58 
76 Stat. 176 
42 u s e 603 
42 u s e 608. 
49 Stat. 6 29; 
64 Stat. 551. 
ices 
880 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT . 
(2) by striking out "subparagraphs (A) and (B)" in the sen-
tence following subparagraph (B) (as redesignated by paragraph 
(1) of this subsection) and inserting in lieu thereof "subpara-
graph (A)"; 
(3) by inserting before the period at the end of the sentence 
following subparagraph (B) (as redesignated by paragraph (1) 
of this subsection) the following: "; and except that, to the extent 
specified by the Secretary, child-welfare services, family planning 
services, and family services may be provided from sources other 
than those referred to in subparagraphs (C) and (D)"; and 
(4) by striking out "subparagraphs (B) and (C) apply" in 
the last sentence and inserting in lieu thereof "subparagraph (B) 
applies". 
f!^„^^^: ... 
(e)(1) Section 403 (c) of such Act is repealed. 
(2) Section 403(a)(3) of such Act is amended by striking out 
"whose State plan approved under section 402 meets the requirements 
of subsection (c) (1)", and by striking out "; and" at the end and in-
serting in lieu thereof a period. 
^r*!!!!: 
(^) Section 403 (a) (4) of such Act is repealed. 
(4) Section 408(d) of such Act is amended by striking out "and 
(4)"- 
.
.
. 
. 
' 
(f) Section 406 of such Act is amended by adding at the end there-
42 use 606. 
of the following new subsection: 
^'Family serv- 
"(d) The term 'family services' means services to a family or any 
member thereof for the purpose of preserving, rehabilitating, reunit-
ing, or strengthening the family, and such other services as will assist 
members of a family to attain or retain capability for the maximum 
self-support and personal independence." 
{g)(l) 
The amendments made by subsections (a), (b), (d), (e), 
and (f) of this section shall be effective July 1, 1968 (or earlier if 
the State plan so provides); except that (A) if on the date of enact-
ment of this Act the agency of a State referred to in section 402(a) (3) 
of the Social Security Act is different from the agency of such State 
responsible for administering the plan for child-welfare services 
developed pursuant to part B of title IV of the Social Security Act, 
the provisions of section 402(a) (15) (F) of such Act (added thereto 
by subsection (a) of this section) shall not apply with respect to such 
agencies but only so long as such agencies of the State are different, 
and (B) if on such date the local agency administering the plan of a 
State under part A of title IV of such Act in a political subdivision 
is different from the local agency in such subdivision administering 
the State's plan for child-welfare services developed pursuant to part 
B of title IV of such Act, the provisions of such section 402(a) (15) (F) 
shall not apply with respect to such agencies but only so long as such 
local agencies are different. 
(2) The amendment made by subsection (c) shall apply with respect 
to services furnished after June 30, 1968, or furnished after such 
earlier date as the State plan may provide with respect to the amend-
ment made by paragraph (1) of this subsection. 
(h) Notwithstanding subparagraph (A) of section 403(a)(3) of 
the Social Security Act (as amended by subsection (c) of this section), 
the rate specified in such subparagraph in the case of any State shall 
be 85 per centum (rather than 75 per centum) with respect to expendi-
tures, for services furnished pursuant to clauses (14) and (15) of 
section 402(a) of such Act, made on or after the date of enactment 
of this Act, and prior to July 1, 1969. 
42 use 602. 
Post, p. 911. 
Ante, p. 877. 
81 STAT. ] 
PUBLIC LAW 90-248-JAN. 2, 1968 
^^^ 
EARNINGS EXEMPTION FOR RECIPIENTS OF AID TO FAMILIES W I T H 
DEPENDENT 
CHILDREN 
SEC. 202. (a) Clauses (8) through (13) of section 402(a) of the 
Social Security Act are redesignated as clauses (9) through (14), ^/It^J^^g"^^' 
respectively. 
42 use 602. 
(b) Effective July 1, 1969, section 402(a) of such Act is amended 
by striking out clause (7) and inserting in lieu thereof the following: 
"(7) except as may be otherwise provided in clause (8), provide that 
the State agency shall, in determining need, take into consideration 
any other income and resources of any child or relative claiming aid 
to families with dependent children, or of any other individual (living 
in the same home as such child and relative) whose needs the State 
determines should be considered in determining the need of the child 
or relative claiming such aid, as well as any expenses reasonably attrib-
utable to the earning of any such income; (8) provide that, in making 
the determination under clause (7), the State agency— 
"(A) shall with respect to any month disregard— 
"(i) all of the earned income of each dependent child 
receiving aid to families with dependent children who is 
(as determined by the State in accordance with standards 
prescribed by the Secretary) a full-time student or part-time 
student who is not a full-time employee attending a school, 
college, or university, or a course of vocational or technical 
training designed to fit him for gainful employment, and 
" (ii) in the case of earned income of a dependent child not 
included under clause (i), a relative receiving such aid, and 
any other individual (living in the same home as such relative 
and child) whose needs are taken into account in making such 
determination, the first $30 of the total of such earned income 
for such month plus one-third of the remainder of such 
income for such month; and 
"(B) (i) may, subject to the limitations prescribed by the 
Secretary, permit all or any portion of the earned or other income 
to be set aside for future identifiable needs of a dependent child, 
and (ii) may, before disregarding the amounts referred to in sub-
paragraph (A) and clause (i) of this subparagraph, disregard 
not more than $5 per month of any income; 
except that, with respect to any month, the State agency shall not 
disregard any earned income (other than income referred to in sub-
paragraph (B)) of—• 
"(C) any one of the persons specified in clause (ii) of sub-
paragraph (A) if such person— 
"(i) terminated his employment or reduced his earned in-
come without good cause within such period (of not less than 
30 days) preceding such month as may be prescribed by the 
Secretary; or 
"(ii) refused without good cause, within such period pre-
ceding such month as may be prescribed by the Secretary, 
to accept employment in which he is able to engage which is 
offered through the public employment offices of the State, 
or is otherwise offered by an employer if the offer of such em-
ployer is determined by the State or local agency administer-
ing the State plan, after notification by him, to be a bona 
fide offer of employment; or 
"(D) any of such persons specified in clause (ii) of subpara-
graph (A) if with respect to such month the income of the per-
sons so specified (within the meaning of clause (7)) was in excess 
of their need as determined by the State agency pursuant to 
882 
PUBLIC LAW 90-248-J 
AN. 2, 1968 
[81 STAT. 
clause (7) (without regard to clause (8)), unless, for any one 
of the four months preceding such month, the needs of such per-
sons were met by the furnishing of aid under the plan;'". 
42 use 602. 
(^^^ ^ State whose plan under section 402 of the Social Security Act 
has been approved by the Secretary shall not be deemed to have failed 
to comply substantially wdth the requirements of section 402(a) (T) 
of such Act (as in eifect prior to July 1, 1969) for any period begin-
ning after December 31, 1967, and ending prior to July 1, 1969, if 
for such period the State agency disregards earned income of the in-
dividuals involved in accordance with the requirements specified in 
Ante, p. 881. 
gcctiou 402(a) (7) and (8) of such Act as amended by this Act. 
(d) Effective with respect to quarters beginning after June 30, 
1968, in determining the need of individuals claiming aid under a 
State plan approved under part A of title IV of the Social Security 
Act, the State shall apply the provisions of such part notwithstand-
ing any provisions of law (other than such Act) requiring the State 
to disregard earned income of such individuals in determining need 
under such State plan. 
Post, 
p. 911. 
75 Stat. 75. 
42 u s e 607. 
DEPENDENT CHIIJ)REX OF UNEMPLOYED 
FATHERS 
SEC. 203. (a) Section 407 of the Social Security Act is amended to 
read as follows: 
a 
DEPENDENT CHILDREN OF UNEMPLOYED 
FATHERS 
chi'id^"^"'^^"' 
"SEC. 407. (a) The term 'dependent child' shall, notwithstanding 
'^ 42 use 606. 
section 406(a), include a needy child who meets the requirements of 
section 406(a)(2), who has been deprived of parental support or 
care by reason of the unemployment (as determined in accordance 
with standards prescribed by the Secretary) of his father, and who 
is living with any of the relatives specified in section 406(a) (1) in 
a place of residence maintained by one or more of such relatives as 
his (or their) own home. 
"(b) The provisions of subsection (a) shall be applicable to a State 
if the State's plan approved under section 402— 
"(1) requires the payment of aid to families with dependent 
children with respect to a dependent child as defined in subsection 
(a) when— 
"(A) such child's father has not been employed (as deter-
mined in accordance with standards prescribed by the Sec-
retary) for at least 30 days prior to the receipt of such aid, 
"(B) such father has not without good cause, within such 
period (of not less than 30 days) as may be prescribed by the 
Secretary, refused a bona fide offer of employment or training 
for employment, and 
"(C) (i) such father has 6 or more quarters of work (as 
defiiiea in subsection (d)(1)) in any 13-calendar-quarter 
period ending within one year prior to the application for 
such aid or (ii) he received unemployment compensation 
under an unemployment compensation law of a State or of 
the United States, or he was qualified (within the meaning of 
subsection (d) (3)) for unemj)loyment compensation under 
the unemployment compensation law of the State, within 
one year prior to the application for such aid; and 
"(2) provides— 
"(A) for such assurances as will satisfy the Secretary that 
fathers of dependent children as defined in subsection (a) 
will be referred to the Secretary of Labor as provided in sec-
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
883 
tion 402(a) (19) within thirty days after receipt of aid with 
^°^^' P- ^^O-
respect to such children; 
"(B) for entering into cooperative arrangements with the 
State agency responsible for administering or supervising the 
administration of vocational education in the State, designed 
to assure maximum utilization of available public vocational 
education services and facilities in the State in order to en-
courage the retraining of individuals capable of being re-
trained; and 
"(C) for the denial of aid to families with dependent chil-
dren to any child or relative specified in subsection (a) if, 
and for as long as, such child's father— 
"(i) is not currently registered with the public em-
ployment offices in the State, or 
"(ii) receives unemployment compensation under an 
unemployment compensation law of a State or of the 
United States, 
"(c) Xotwithstanding any other provisions of this section, expendi-
tures pursuant to this section shall be excluded from aid to families 
with dependent children (A) where such expenditures are made under 
the plan with respect to any dependent child as defined in subsection 
(a), (i) for any part of the 30-day period referred to in subparagraph 
(A) of subsection (b) (1), or (ii) for any period prior to the time 
Avhen the father satisfies subparagraph (B) of such subsection, and 
(B) if, and for as long as, no action is taken (after the 30-day period 
referred to in subparagraph (A) of subsection (b)(2)), under the 
program therein specified, to refer such father to the Secretary of 
Labor pursuant to section 402(a) (19). 
"(d) For purposes of this section— 
"(1) the term 'quarter of work' wdth respect to any individual 
"^"f'^'' "^ 
means a calendar quarter in which such individual received earned ^ 
income of not less than $50 (or which is a 'quarter of coverage' as 
defined in section 213(a) (2)), or in which such individual partici- 
'*^ ^^^ '*^^-
pated in a community work and training program under section 
409 or any other work and training program subject to the limita-
tions in section 409, or the work incentive program established 
42 us^ceo^g' 
under part C; 
Post, p. 884. 
"(2) the term 'calendar quarter' means a period of 3 consecu- 
"^^^^7'^^'' 
tive calendar months ending on March 31, June 30, September 30, 
or December 31; and 
"(3) an individual shall be deemed qualified for unemployment 
compensation under the State's unemployment compensation law 
if— 
" (A) he would have been eligible to receive such unemploy-
ment compensation upon filing application, or 
"(B) he performed work not covered under such law and 
such work, if it had been covered, would (together with any 
covered work he performed) have made him eligible to re-
ceive such unemployment compensation upon filmg appli-
cation," 
(b) In the case of an application for aid to families with dependent 
children under a State plan approved under section 402 of such Act 
Avith respect to a dependent child as defined in section 407(a) of such 
Act (as amended by this section) within 6 months after the effective 
date of the modification of such State plan which provides for pay-
ments in accordance with section 407 of such Act as so amended, the 
father of such child shall be deemed to meet the requirements of sub-
paragraph (C) of section 407(b) (1) of such Act (as so amended) if 
at any tmie after April 1961 and prior to the date of application such 
Ante, 
p. 88 2. 
Post, p. 911. 
884 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
father met the requirements of such subparagraph (C). For purposes 
of the preceding sentence, an individual receiving aid to families with 
dependent children (under section 407 of the Social Security Act as 
in effect before the enactment of this Act) for the last month ending 
before the effective date of the modification referred to in such sen-
tence shall be deemed to have filed application for such aid under such 
section 407 (as amended by this section) on the day after such effective 
date. 
(c) The amendment made by subsection (a) shall be efl'ective 
January 1, 1968; except that no State which had in operation a pro-
gram of aid with respect to children of unemployed parents under 
section 407 of the Social Security Act (as in effect prior to such amend-
ment) in the calendar quarter commencing October 1, 1967, shall 
be required to include any additional child or family under its State 
42 use 602. 
p2an approved under section 402 of such Act, by reason of the enact-
ment of such amendment, prior to July 1,1969. 
WORK INCENTIVE PROGRAM FOR RECIPIENTS OF AID UNDER PART A OF 
TITLE 
IV 
SEC. 201. (a) Title IV of the Social Security Act is amended by in-
serting after part B (hereinafter added to such title by section 240 
of this Act) the following material: 
"PART C—^^VORK INCENTIVE PROGRAM FOR RECIPIENTS OF AID UNDER 
STATE PLAN APPROVED UNDER PART 
A 
"PURPOSE 
"SEC. 430. The purpose of this part is to require the establishment of 
a program utilizing all available manpower services, including those 
authorized under other provisions of law, under which individuals re-
ceiving aid to families with dependent children will be furnished 
incentives, opportunities, and necessary services in order for (1) the 
employment of such individuals in the regular economy, (2) the train-
ing of such individuals for work in the regular economy, and (3) the 
participation of such individuals in special work projects, thus re-
storing the families of such individuals to independence and useful 
roles in their communities. It is expected that the individuals partici-
pating in the program established under this part will acquire a sense 
of dignity, self-worth, and confidence which will flow from being rec-
ognized as a wage-earning member of society and that the example of 
a working adult in these families will have beneficial effects on the 
children in such families. 
"APPROPRIATION 
"SEC. 431. There is hereby authorized to be appropriated to the 
Secretary of Health, Education, and Welfare for each fiscal year a sum 
sufficient to carry out the purposes of this part. The Secretary of 
Health, Education, and Welfare shall transfer to the Secretary of 
Labor from time to time sufficient amounts, out of the moneys appro-
priated pursuant to this section, to enable him to carry out such 
purposes. 
"ESTABLISHMENT OF PROGRAMS 
"SEC. 432. (a) The Secretary of Labor (hereinafter in this part 
referred to as the Secretary) shall, in accordance with the provisions of 
this part, establish work incentive programs (as provided for in sub-
section (b)) in each State and in each political subdivision of a State in 
which he determines there is a significant number of individuals Avho 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
885 
have attained age 16 and are receiving aid to families with dependent 
children. In o.ther political subdivisions, he shall use his best efforts 
to provide such programs either within such subdivisions or through 
the provision of transportation for such persons to political subdivi-
sions of the State in which such programs are established. 
"(b) Such programs shall include, but shall not be limited to, (1) 
a program placing as many individuals as is possible in employment, 
and utilizing on-the-job training positions for others, (2) a program 
of institutional and work experience training for those individuals 
for whom such training is likely to lead to regular employment, and 
(3) a program of special work projects for individuals for whom 
a job in the regular economy cannot be found. 
"(c) In carrying out the purposes of this part the Secretary may 
make grants to, or enter into agreements witli, public or private agen-
cies or organizations (including Indian tribes witli respect to Indians 
on a reservation), except that no such grant or agreement shall be 
made to or with a private employer for profit or with a private non-
profit employer not organized for a public purpose for purposes of the 
work experience program established by clause (2) of subsection (b). 
"(d) Using funds appropriated under this part, the Secretary, in 
order to carry out the purposes of this part, shall utilize his authority 
under the Manpower Development and Training Act of 1962, the Act 
of June 6, 1933, as amended (48 Stat. 113), and other Acts, to the note. 
extent such authority is not inconsistent with this Act. 
^9 use 49-49k. 
"(e) The Secretary shall take appropriate steps to assure that the 
present level of manpower services, available under the authority of 
other statutes to recipients of aid to families with dependent children 
is not reduced as a result of programs under this part. 
76 Stat. 23. 
42 u s e 2571 
a OPERATION o r 
PROGRAM 
"SEC. 433. (a) The Secretary shall provide a program of testing and 
counseling for all persons referred to him by a State, pursuant to sec-
tion 402, and shall select those persons whom he finds suitable for the 
programs established by clauses (1) and (2) of section 432(b). Those 
not so selected shall be deemed suitable for the program established by 
clause (3) of such section 432(b) unless the Secretary finds that there 
is good cause for an individual not to participate in such program. 
"(b) The Secretary shall develop an employability plan for each 
suitable person referred to him under section 402 which shall describe 
'^^ use 602. 
the education, training, work experience, and orientation which it is 
determined that each such person needs to complete in order to enable 
him to become self-supporting. 
"(c) The Secretary shall make maximum use of services available 
from other Federal and State agencies and, to the extent not other-
wise available on a nonreimbursable basis, he may reimburse such 
agencies for services rendered to persons under this part. 
"(d) To the extent practicable and where necessary, work incentive 
programs established by this part shall include, in addition to the 
regular counseling, testing, and referral available through the Fed-
eral-State Employment Service System, program orientation, basic 
education, training in communications and employability skills, work 
experience, institutional training, on-the-job training, job develop-
ment, and special job placement and foUowup services, required to 
assist participants in securing and retaining employment and securing 
possibilities for advancement. 
"(e) (1) In order to develop special work projects under the pro-
gram established by section 432(b) (3), the Secretary shall enter into 
agreements with (A) public agencies, (B) private nonprofit orga-
nizations established to serve a public purpose, and (C) Indian tribes 
886 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
with respect to Indians on a reservation, under Avliich individuals 
deemed suitable for participation in sncli a pro<rrani will be provided 
work whicli serves a useful public purpose and whicli would not other-
wise be performed by regular employees. 
" (2) Such agreements shall provide— 
"(A) for the payment by the Secretary to each employer a 
portion of the wages to be paid by the employer to the individuals 
for the work performed; 
''(B) the hourly wage rate and the number of hours per week 
;,», individuals will be scheduled to work on special work projects of 
such employer; 
"(C) that the Secretary will have such access to the premises 
of the employer as he finds necessary to determine whether such 
employer is carrying out his obligations under the agreement and 
this part; and 
"'(D) that the Secretary may terminate any agreement under 
this subsection at any time. 
"(3) The Secretary shall establish one or more accounts in each 
State with respect to the special work projects established and main-
tained pursuant to this subsection and place into such accounts the 
amounts paid to him by the State agency pursuant to section 402(a) 
Post, p. 890. 
(19) (E). The amounts in such accounts shall be available for the pay-
ments specified in subparagraph (A) of paragraph (2). At the end 
of each fiscal year and for such period of time as he may establish, 
rhe Secretary shall determine how much of the amounts paid to him 
by the State agency pursuant to section 402(a) (19) (E) were not 
expended as provided by the preceding sentence of this paragraph 
and shall return such unexpended amounts to the State, which 
amounts shall be regarded as overpayments for purposes of section 
403(b)(2). 
"(4) No wage rates provided under any agreement entered into 
under this subsection shall be lower than the applicable minimum 
wage for the particular work concerned. 
"(f) Before entering into a project under any of the programs 
established by this part, the Secretary shall have reasonable assurances 
that— 
"(1) appropriate standards for the health, safety, and other 
conditiions applicable to the performance of work and training on 
such project are established and will be maintained, 
"(2) such project will not result in the displacement of em-
ployed workers, 
"(3) with respect to such project the conditions of work, train-
ing, education, and employment are reasonable in the light of 
such factors as the type of work, geographical region, and pro-
ficiency of the participant, 
"(4) appropriate workmen's compensation protection is pro-
vided to all participants. 
"(g) Where an individual, referred to the Secretary of Labor pur-
suant to section 402 (a) (19) (A) (i) and (ii) refuses without good cause 
to accept employment or participate in a project under a program 
established by this part, the Secretary of Labor shall (after providing 
opportunity for fair hearing) notify the State agency which referred 
such individual and submit such other information as he may have 
with respect to such refusal. 
"(h) With respect to individuals who are participants in special 
work projects under the program established by section 432(b)(3), 
the Secretary shall periodically (but at least once every six months) 
review the employment record of each such individual while on such 
special work project and on the basis of such record and such other 
42 u s e 603. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
887 
information as he may acquire determine whether it would be feasible 
to place such individual in regular employment or on any of the proj-
ects under the programs established by section 432 (b) (1) and (2). 
"INCENTIVE PAYMENT 
"SEC. 434. The Secretary is authorized to pay to any participant 
under a program established by section 432(b) (2) an incentive pay-
ment of not more than $30 per month, payable in such amounts and at 
such times as the Secretary prescribes. 
"FEDERAL ASSISTANCE 
"SEC. 436. (a) Federal assistance under this part shall not exceed 80 
per centum of the costs of carrying out this part. Non-Federal con-
tributions may be cash or in kind, fairly evaluated, including but not 
limited to plant, equipment, and services. 
"(b) Costs of carrying out this part include costs of training, super-
vision, materials, administration, incentive payments, transportation, 
and other items as are authorized by the Secretary, but may not in-
clude any reimbursement for time spent by participants in work, train-
ing, or other participation in the program; except that with respect 
to special work projects under the program established by section 
432(b) (3), the costs of carrying out this part shall include only the 
costs of administration. 
"PERIOD or ENROLLMENT 
"SEC. 436. (a) The program established by section 432(b) (2) shall 
be designed by the Secretary so that the average period of enrollment 
under all projects under such program throughout any area of the 
United States will not exceed one year. 
" (b) Services provided under this part may continue to be provided 
to an individual for such period as the Secretary determines (in ac-
cordance with regulations prescribed by the Secretary after consulta-
tion with the Secretary of Health, Education, and Welfare) is neces-
sary to qualify him fully for employment even though his earnings 
disqualify him from aid under a State plan approved under section 
402. 
" 
42 use 602. 
"RELOCATION OF PARTICIPANTS 
"SEC. 437. The Secretary may assist participants to relocate their 
place of residence when he determines such relocation is necessary in 
order to enable them to become permanently employable and self-sup-
porting. Such assistance shall be given only to participants who con-
cur in their relocation and who will be employed at their place of 
relocation at wage rates which will meet at least their full need as 
determined by the State to which they will be relocated. Assistance 
under this section shall not exceed the reasonable costs of transporta-
tion for participants, their dependents, and their household belongings 
plus such relocation allowance as the Secretary determines to be 
leasonable. 
"PARTICIPANTS NOT FEDERAL EMPI^YEES 
"SEC. 438. Participants in projects under programs established by 
this part shall be deemed not to be Federal employees and shall not be 
subject to the provisions of laws relating to Federal employment, in-
cluding those relating to hours of work, rates of compensation, leave, 
unemployment compensation, and Federal employee benefits. 
888 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
"RULES AND KEGULATIONS 
"SEC. 439. The Secretary may issue such rules and regulations as he 
finds necessary to carry out the purposes of this part: Provided^ That 
in developing policies for programs established by this part the Secre-
tary shall consult with the Secretary of Health, Education, and Wel-
fare. 
"ANNUAL REPORT 
"SEC. 440. The Secretary shall annually report to the Congress 
(with the first such report being made on or before July 1, 1970) on 
the work incentive programs established by this part. 
a 
EVALUATION AND RESEARCH 
"SEC. 441. The Secretary shall (jointly with the Secretary of Health, 
Education, and Welfare) provide for the continuing evaluation of the 
work incentive programs established by this part, including their ef-
fectiveness in achieving stated goals and their impact on other related 
programs. He also may conduct research regarding ways to increase the 
effectiveness of such programs. He may, for this purpose, contract for 
independent evaluations of and research regarding such programs or 
individual projects under such programs. For purposes of sections 435 
and 443, the costs of carrying out tliis section shall not be regarded as 
costs of carrying out work incentive programs established by this 
part. 
"REVIEW or SPECIAL WORK PROJECTS BY A STATE PANEL 
"SEC. 442. (a) The Secretary shall make an agreement with any 
State which is able and willing to do so under which the Governor of 
the State will create oniB or more panels to review applications tenta-
tively approved by the Secretary for the special work projects in such 
State to be established by the Secretary under the program established 
by section 432(b) (3). 
"(b) Each such panel shall consist of not more than five and not 
less than three members, appointed by the Governor. The members 
shall include one representative of employers and one representative 
of employees; the remainder shall be representatives of the general 
public. No special work project under such program developed by 
the Secretary pursuant to an agreement under section 433(e) (1) shall, 
in any State which has an agreement under this section, be established 
or maintained under such program unless such project has first been 
approved by a panel created pursuant to this section. 
a COLLECTION OF STATE SHARE 
"SEC. 443. If a non-Federal contribution of 20 per centum of the 
costs of the w^ork incentive programs established by this part is not 
42 use 602. 
made in any State (as specified in section 402(a)), the Secretary of 
Health, Education, and Welfare may w^ithhold any action under sec-
42 use 604. 
tion 404 because of the State's failure to comply substantially with a 
provision required by section 402. If the Secretary of Health, Educa-
tion, and Welfare does withhold such action, he shall, after reasonable 
notice and opportunity for hearing to the appropriate State agency or 
agencies, withhold any payments to be made to the State under sec-
60? TiSz^u'sa 
^ions 3(a), 403(a), 1003(a), 1403(a), 1603(a), and 1903(a) until the 
1383, 1396b. ' 
amouut S
O withheld (including any amounts contributed by the State 
Post. p. 890. 
pursuant to the requirement in section 402(a) (19) (C)) equals 20 per 
centum of the costs of such work incentive programs. Such withhold-
ing shall remain in effect until such time as tlije Secretary has assur-
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
889 
ances from the State that such 20 per centum will be contributed as 
required by section 402. Amounts so withheld shall be deemed to have 
'•s use 602. 
been paid to the State under such sections and shall be paid by the 
Secretary of Health, Education, and Welfare to the Secretary. Sucli 
payment shall be considered a non-Federal contribution for purposes 
of section 435. 
"AGREEMENTS WITH OTHER AGENCIES PROVIDING ASSISTANCE TO 
FAMILIES OF UNEMPLOYED PARENTS 
"SEC. 444. (a) The Secretary is authorized to enter into an agree-
ment (in accordance wdth the succeeding provisions of this section) 
with any qualified State agency (as described in subsection (b)) under 
which the program established b^ the preceding sections of this part 
C will (except as otherwise provided in this section) be applicable to 
individuals referred by such State agency in the same manner, to the 
same extent, and under the same conditions as such program is ap-
plicable with respect to individuals referred to the Secretary by a 
State agency administering or supervising the administration of a 
State plan approved by the Secretary of Health, Education, and Wel-
fare under part A of this title. 
" (b) A qualified State agency referred to in subsection (a) is a State 
agency which is charged with the administration of a program— 
"(1) the purpose of which is to provide aid or assistance to 
the families of unemployed parents, 
"(2) which is not established pursuant to part A of title IV 
of the Social Security Act, 
Post, p. 911. 
"(3) which is financed entirely from funds appropriated by 
the Congress, and 
" (4) none of the financing of which is made available under any 
program established pursuant to title V of the Economic Op-
portunity Act. 
"(c) (1) Any agreement under this section with a qualified State 
agency shall provide that such agency will, with respect to all individ-
uals receiving aid or assistance under the program of aid or assistance 
to families of unemployed parents administered by such agency, com-
ply with the requirements imposed by section 402(a) (15) and section 
Ante, p. 87s. 
402(a) (19) (F) in the same manner and to the same extent as if (A) 
Post, p. 89o. 
such qualified agency were the agency in such State administering or 
supervising the administration of a State plan approved under part A 
of this title, and (B) individuals receiving aid or assistance under the 
program administered by such qualified agency were recipients of aid 
under a State plan which is so approved. 
"(2) Any agreement entered into under this section shall remain in 
effect for such period as may be specified in the agreement by the Sec-
retary and the qualified State agency, except that, whenever the Sec-
retary determines, after reasonable notice and opportunity for hearing 
to the qualified State agency, that such agency has failed substantially 
to comply with its obligations under such agreement, the Secretary 
may suspend operation of the agreement until such time as he is satis-
fied that the State agency will no longer fail substantially to comply 
with its obligations under such agreement. 
"(3) Any such agreement shall further provide that the agreement 
will be inoperative for any calendar quarter if, for the preceding calen-
dar quarter, the maximum amount of benefits payable under the pro-
gram of aid or assistance to families of unemployed parents adminis-
tered by the qualified State agency which is a party to such agreement 
is lower than the maximum amount of benefits payable under such 
program for the quarter which ended September 30,1967. 
Ante. p. 877. 
Ante, 
p. 884. 
890 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
"(d) The Secretary shall, at the request of any qualified State 
agency referred to in subsection (a) of this section and upon receipt 
from it of a list of the names of individuals rereferred to the Secre-
tary, furnish to such agency the names of each individual on such list 
Ante. p. 885. 
participating in a special work project under section 433(a) (3) whom 
the Secretary determines should continue to participate in such project. 
The Secretary shall not comply with any such request with respect 
to an individual on such list unless such individual has been referred 
Ante. p. 878. 
^^ ^^^ Secretary by such agency under such section 402(a) (15) for a 
period of at least six months." 
(b) Section 402(a) of such Act is amended by adding at the end 
thereof before the period the following: 
"; (19) provide— 
"(A) for the prompt referral to the Secretary of Labor 
or his representative for participation under a work incentive 
program established by part C of— 
"(i) each appropriate child and relative who has 
attained age sixteen and is receiving aid to families with 
dependent children, 
(ii) each appropriate individual (living in the same 
home as a relative and child receiving such aid) who has 
attained such age and whose needs are taken into 
account in making the determination under section 402 
(a)(T),and 
"(iii) any other person claiming aid under the plan 
(not included in clauses (i) and (ii)), who, after being 
informed of the work incentive programs established by 
part C, requests such referral unless the State agency 
determines that participation in any of such programs 
would be inimical to the welfare of such person or the 
family; 
except that the State agency shall not so refer a child, rela-
tive, or individual under clauses (i) and (ii) if such child, 
relative, or individual is— 
"(iv) a person with illness, incapacity, or advanced 
Ante, 
p. 887. 
"(v) so remote from any of the projects under the 
work incentive programs established by part C that he 
cannot effectively participate under any of such pro-
grams, 
" (vi) a child attending school full time, or 
"(vii) a person whose presence in the home on a sub-
stantially continuous basis is required because of the 
illness or incapacity of another member of the household; 
"(B) that aid under the plan will not be denied by reason 
of such referral or by reason of an individual's participation 
on a project under the program established by section 
432(b) (2) or (3) ; 
"(C) for arrangements to assure that there will be made a 
non-Federal contribution to the work incentive programs 
established by part C by appropriate agencies of the State 
or private organizations of 20 per centum of the cost of such 
programs, as specified in section 435(b) ; 
"(D) that (i) training incentives authorized under section 
434, and income derived from a special work project under 
the program established by section 432(b) (3) shall be dis-
regarded in determining the needs of an individual under 
Ante, p. 881. 
section 402(a) (7), and (ii) in determining such individual's 
needs the additional expenses attributable to his participa-
Ante, 
p. 882. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
891 
tion in a program established by section 432(b) (2) or (3) 
shall be taken into account; 
"(E) that, with respect to any individual referred pursu-
ant to subparagraph (A) who is participating in a special 
work project under the program established by section 
432(b)(3), (i) the State agency, after proper notification 
^"'^' P-«84. 
by the Secretary of Labor, will pay to such Secretary (at 
such times and in such manner as the Secretary of Health, 
Education, and Welfare prescribes) the money payments 
such State would otherwise make to or on behalf of such 
individual (including such money payments with respect to 
such individual's family), or 80 per centum of such individ-
ual's earnings under such program, whichever is lesser and 
(ii) the State agency will supplement any earnings received 
by such individual by payments to such individual (which 
payments shall be considered aid under the plan) to the 
extent that such payments when added to the individual's 
earnings from his participation in such special work project 
will be equal to the amount of the aid that would have been 
payable by the State agency with respect to such individual's 
family had he not participated in such special work project, 
plus 20 per centum of such individual's earnings from such 
special work project; and 
"(F) that if and for so long as any child, relative, or indi-
vidual (referred to the Secretary of Labor pursuant to sub-
paragraph (A) (i) and (ii) and section 407(b) (2)) has been 
found by the Secretary of Labor under section 433 (g) to have 
refused without good cause to participate under a work 
incentive program established by part C with respect to 
which the Secretary of Labor has determined his participa-
tion is consistent with the purposes of such part C, or to 
have refused without good cause to accept employment in 
which he is able to engage which is offered through the public 
employment offices of the State, or is otherwise offered by an 
employer if the offer of such employer is determined, after 
notification by him, to be a bona fide offer of employment— 
"(i) if the relative makes such refusal, such relative's 
needs shall not be taken into account in making the 
determination under clause (7), and aid for any depend-
ent child in the family in the form of payments of the 
type described in section 406(b)(2) (which in such a 
case shall be without regard to clauses (A) through (E) 
thereof) or section 408 will be made; 
'^^ use eos. 
"(ii) aid with respect to a dependent child will be 
denied if a child who is the only child receiving aid in 
the family makes such refusal; 
"(iii) if there is more than one child receiving aid in 
the family, aid for any such child will be denied (and 
his needs will not be taken into account in making the 
determination under clause (7)) if that child makes 
such refusal; and 
"(iv) if such individual makes such refusal, such in-
dividual's needs shall not be taken into account in making 
the determination under clause (7); 
except that the State agency shall, for a period of sixty days, 
make payments of the type described in section 406(b) (2) 
"
^
^ use eoe. 
(without regard to clauses (A) through (E) thereof) on 
behalf of the relative specified in clause (i), or continue aid 
in the case of a child specified in clause (ii) or (iii), or take 
892 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
the individual's needs into account in the case of an individual 
specified in clause (iv), but only if during such period such 
child, relative, or individual accepts counseling or other serv-
ices (which the State agency shall make available to such 
child, relative, or individual) aimed at persuading such rela-
tive, child, or individual, as the case may be, to participate 
in such program in accordance with the determination of the 
Secretary of Labor". 
(c) (1) The amendment made by subsection (b) shall in the case of 
any State be effective on July 1,1968, or if a statute of such State pre-
vents it from complying with the requirements of such amendment on 
such date, such amendment shall with respect to such State be effective 
on July 1, 1969; except such amendment shall be effective earlier (in 
the case of any State), but not before April 1, 1968, if a modification 
of the State plan to comply with such amendment is approved on an 
earlier date. 
42 use 609. 
(2) The provisions of section 409 of the Social Security Act shall 
not apply to any State with respect to any quarter beginning after 
June 30, 1968. 
(d) During the fiscal year ending June 30, 1969, the Secretary of 
Labor may, notwithstanding the provisions of section 433(e) (2) (A) 
Ante, p. 885. 
^f j-j^^ Social Security Act, pay all of the wages to be paid by the 
employer to the individuals for work performed for public agencies 
(including Indian tribes with respect to Indians on a reservation) 
under special work projects established under the program established 
by section 432(b) (3) of such Act and may transfer into accounts 
established pursuant to section 433(e) (3) of such Act such amounts 
as he finds necessary in addition to amounts paid into such accounts 
Ante. p. 890. 
pursuaut to section 402(a) (19) (E) of such Act. 
(e) Section 402(a) (8) of the Social Security Act (as amended by 
section 202(b) of this Act) is further amended by striking out 
"; and" at the end of subparagraph (A) and inserting in lieu thereof: 
"(except that the provisions of this clause (ii) shall not apply to 
earned income derived from participation on a project maintained 
under the programs established by section 432(b) (2) and (3)) ; and". 
FEDERAL 
PARTICIPATION 
I N 
PAYMENTS 
FOR FOSTER 
CARE 
OF 
CERTAIN 
DEPENDENT 
CHILDREN 
SEC. 205. (a) Section 402(a) of the Social Security Act (as amended 
Ante. p. 890. 
\)j f}^Q preceding provisions of this Act) is amended by inserting before 
the period at the end thereof the following new clause: "; (20) 
effective July 1, 1969, provide for aid to families wdth dependent 
42 use 608. 
children in the form of foster care in accordance with section 408". 
42 use 603. 
(b) Section 403(a) (1) (B) of such Act is amended by striking out 
"as exceeds" and all that follows and inserting in lieu thereof the fol-
lowing : "as exceeds (i) the product of $32 multiplied by the total num-
ber of recipients of aid to families with dependent children (other than 
such aid in the form of foster care) for such month, plus (ii) the prod-
uct of $100 multiplied by the total number of recipients of aid to 
families with dependent children in the form of foster care for such 
month; and". 
(c) Section 408(a) of such Act is amended by inserting " ( A ) " after 
"and (4) who", and by inserting before the semicolon at the end there-
of the following: ", or (B) (i) would have received such aid in or for 
such month if application had been made therefor, or (ii) in the case 
of a child who had been living with a relative specified in section 
406(a) within 6 months prior to the month in which such proceedings 
were initiated, w^ould have received such aid in or for such month if 
Ante. 
p. 881. 
81 STAT.] 
PUBLIC LAW 90-245-JAN. 2, 1968 
893 
in such month he had been living with (and removed from the home 
of) such a relative and application had been made therefor". 
(d) Sections 135 (e) and 155 (b) of the Public Welfare Amendments 
of 1962 are each amended by striking out ", and ending with the close 
of June 30,1968". 
(e) The amendments made by subsections (b) and (c) shall apply 
only with respect to foster care provided after December 1967. 
Ante, 
p. 94. 
Ante, 
p. 880. 
Ante, 
p. 880. 
'Emergency as-
sistance to needy 
EMERGENCY ASSISTANCE FOR CERTAIN NEEDY FAMILIES W I T H CHILDREN 
SEC. 206. (a) Section 403(a) of the Social Security Act 
(as 
amended by section 201 (e) of this Act) is amended by striking out the 
period at the end of paragraph (4) and inserting in lieu thereof "; 
and", and by inserting after paragraph (4) the following new 
paragraph: 
"(5) in the case of any State, an amount equal to the sum of— 
"(A) 50 per centum of the total amount expended under 
the State plan during such quarter as emergency assistance 
to needy families w^ith children in the form of payments or 
care specified in paragraph (1) of section 406(e), and 
"(B) 75 per centum of the total amount expended under 
the State plan during such quarter as emergency assistance 
to needy families with children in the form of services speci-
fied in paragraph (1) of section 40'6(e)." 
(b) Section 406 of such Act (as amended by section 201(f) of this 
Act) is amended by adding at the end thereof the following new 
subsection: 
"(e)(1) The term 'emergency assistance to needy families with 
children' means any of the following, furnished for a period not in families with 
excess of 30 days in any 12-month period, in the case of a needy child children." 
under the age of 21 who is (or, within such period as may be specified 
by the Secretary, has been) living with any of the relatives specified 
in subsection (a)(1) in a place of residence maintained by one or 
more of such relatives as his or their own home, but only where such 
child is without available resources, the payments, care, or services 
involved are necessary to avoid destitution of such child or to provide 
living arrangements in a home for such child, and such destitution 
or need for living arrangements did not arise because such child or 
relative refused without good cause to accept employment or training 
for emplovment— 
"(A) money payments, payments in kind, or such other pay-
ments as the State agency may specify with respect to, or medical 
care or any other type of remedial care recognized under State 
law on behalf of, such child or any other member of the house-
hold in which he is living, and 
"(B) such services as may be specified by the Secretary; 
but only wdth respect to a State whose State plan approved under 
section 402 includes provision for such assistance. 
"(2) Emergency assistance as authorized under paragraph (1) may 
be provided under the conditions specified in such paragraph to 
migrant workers with families in the State or in such part or parts 
thereof as the State shall designate." 
42 u s e 602. 
PROTECTIVE PAYMENTS AND VENDOR PAYMENTS W I T H RESPECT TO 
DEPENDENT 
CHILDREN 
S E C 207. (a) (1) Section 406(b) (2) of the Social Security Act is 
H 1^6 eS!'. 
amended bj^ striking out all that follows "(2)" and precedes "but 
only", and inserting in lieu thereof the following: "payments with 
respect to any dependent child (including payments to meet the needs of 
Ante, 
p. 881. 
894 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
the relath^e, and the reh\tive's spouse, with whom such child is livin*!, 
and the needs of any other individual living in the same liome if such 
needs are taken into account in making the determination under sec-
tion 402(a) (7)) which do not meet the preceding requirements of this 
subsection, but which would meet such requirements except that such 
payments are made to another individual who (as deteimined in ac-
cordance with standards prescribed by the Secretary) is interested in 
or concerned with the welfare of such child or relative, or are made on 
behalf of such child or relative directly to a person furnishing food, 
living accommodations, or other goods, services, or items to or for such 
child, relative, or other individual,". 
42 us^c 6?6" 
^^^ Section 406(b) (2) of such Act is further amended by striking 
out clause (B), and redesignating clauses (C) through (F) as clauses 
(B) through (E),respectively. 
Ante, p. 893. 
Q^^ Sectiou 408(a) of such Act (as amended by the preceding 
provisions of this Act) is amended by— 
(1) striking out "5"" in the sentence immediately following 
paragraph (5) and inserting in lieu thereof "10*'; 
(2) adding at the end thereof the following new sentence "In 
computing such 10 percent, there shall not be taken into account 
individuals with respect to whom such payments are made for 
Ante, p. 890. 
^j^j month lu accordauce with section 402(a) (19) (F).'' 
Ante. p. 94. 
((.) Sectlou 202(e) of the Public Welfare Amendments of 1962 is 
amended by striking out ", and ending with the close of June 30,1968". 
LIMITATION ON N t MBKR OF CHILDREN W I T H RESPECT TO W H O M 
FEDERAL PAYMENTS MAY BE MADE 
SEC. 208. (a) Section 403(a) of the Social Security Act is amended 
by striking out "shall pay" in the matter preceding paragraph (1) 
and inserting in lieu thereof the following: "shall (subject to sub-
section (d)) pay'". 
(b) Section 403 of such Act is further amended by adding at the 
end thereof the following new subsection: 
"(d) Notwithstanding any other provision of this Act, the average 
monthly number of dependent children under the age of 18 who have 
been deprived of parental support or care by reason of the continued 
absence from the home of a parent with respect to whom payments 
under this section may be made to a State for any calendar quarter 
after June 30,1968, shall not exceed the number which bears the same 
ratio to the total population of such State under the age of 18 on the 
first day of the year m which such quarter falls as the average monthly 
number of such dependent children under the age of 18 with respect 
to whom payments under this section were made to such State for the 
calendar quarter beginning January 1, 1968, bore to the total popula-
tion of such State under the age of 18 on that date." 
FEDERAL PARTICIPATION I N PAYMENTS FOR REPAIRS TO H O M E OW^NED KY 
RECIPIENT OF AID OR ASSISTANCE 
79^staS.^42^3'!^' 
SEO. 209. (a) Title X I of the Social Security Act is amended by 
4 2 use 1301 - 
adding at the end thereof the following new section: 
1318. 
" F E D E R A L PARTICIPATION I N PAYMENTS FOR REPAIRS TO HOME OWNED BY 
RECIPIENT OP AID OR ASSISTANCE 
"SEC. 1119. In the case of an expenditure for repairing the home 
owned by an individual who is receiving aid or assistance, other than 
medical assistance to the aged, under a State plan approved under 
uo'i^Ts f 
° 1381. title I, X, XIV, or XVI, or part A of title IV if— 
601.' 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
895 
"(1) the State agency or local agency administering the plan 
approved under such title has made a finding (prior to making 
such expenditure) that (A) such home is so defective that con-
tinued occupancy is uuAvarranted, (B) unless repairs are made 
to such home, rental quarters will be necessary for such indi-
vidual, and (C) the cost of rental quarters to take care of the 
needs of such individual (including his spouse living with him in 
such home and any other individual whose needs were taken into 
account in determining the need of such individual) would 
exceed (over such time as the Secretary may specify) the cost 
of repairs needed to make such home habitable together with 
other costs attributable to continued occupancy of such home, and 
"(2) no such expenditures were made for repairing such home 
pursuant to any prior finding under this section, 
the amount paid to any such State for any quarter under section 
3(a), 403(a), 1003(a), 1403(a), or 1603(a) shall be increased by 50 
_ 
per centum of such expenditures, except that the excess above $500 i383 
expended with respect to any one home shall not be included in deter-
mining such expenditures." 
(b) The amendment made by subsection (a) shall apply with 
respect to expenditures made after December 31, 1967. 
USE OF SUBPROFESSIONAL STAFF AND VOLUNTEERS I N PROVIDING SERVICES 
TO INDIVIDUALS APPLYING FOR AND RECEIVING ASSISTANCE 
42 u s e 303, 
603, 1203, 1353, 
74 Stat. 988. 
42 u s e 302. 
SEC. 210. (a)(1) Section 2(a)(5) of the Social Security Act is 
amended by— 
(A) striking out "provide" and inserting in lieu thereof "pro-
vide (A)";and 
(B) adding at the end thereof before the semicolon the follow-
ing: ", and (B) for the training and effective use of paid subpro-
fessional staff, with particular emphasis on the full-time or part-
time employment of recipients and other persons of low income, as 
community service aides, in the administration of the plan and for 
the use of nonpaid or partially paid volunteers in a social service 
volunteer program in providing services to applicants and recipi-
ents and in assisting any advisory committees established by the 
State agency". 
(2) Section 402 (a) (5) of such Act is amended by— 
53 ^^^^-^^^J^-
(A) striking out "provide" and inserting in lieu thereof "pro-
vide (A)";and 
(B) adding at the end thereof before the semicolon the follow-
ing: ", and (B) for the training and effective use of paid subpro-
fessional staff, with particular emphasis on the full-time or part-
time employment of recipients and other persons of low income, as 
community services aides, in the administration of the plan and for 
the use of nonpaid or partially paid volunteers in a social service 
volunteer program in providing services to applicants and recipi-
ents and in assisting any advisory committees established by the 
State agency". 
(3) Section 1002(a) (5) of such Act is amended by— 
^3 sta^ ^135,7. 
(A) striking out "provide" and inserting in lieu thereof "pro-
vide (A)";and 
(B) adding at the end thereof before the semicolon the follow-
ing: ", and (B) for the training and effective use of paid subpro-
fessional staff, with particular emphasis on the full-time or 
part-time employment of recipients and otlier persons of low-
mcome, as community service aides, in the administration of the 
plan and for the use of nonpaid or partially paid volunteers in a 
social service volunteer program in providing services to appli-
85-622 0-68—59 
79 Stat. 344. 
42 u s e 1396a. 
896 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
cants and recipients and in assisting any advisory committees 
established by the State agency'". 
42 us^c f352 
(^) Section 1402 (a) (5) of such Act is amended by— 
(A) striking out "provide" and inserting in lieu thereof "pro-
vide (A)";and 
(B) adding at the end thereof before the semicolon the follow-
ing : ", and (B) for the training and effective use of paid subpro-
fessional staff, with particular emphasis on the full-time or 
part-time employment of recipients and other persons of low 
income, as community service aides, in the administration of the 
plan and for the use of nonpaid or partially paid volunteers in a 
social service volunteer program in providing services to appli-
cants and recipients and in assisting any advisory committees 
established by the State agency". 
l\ use 1112. 
(•^) Section 1602 (a) (5) of such Act is amended by— 
(A) striking out "provide" and inserting in lieu thereof "pro-
Adde (A)"; and 
(B) adding at the end thereof before the semicolon the follow-
ing: ", and (B) for the training and effective use of paid subpro-
fessional staff, with particular emphasis on the full-time or part-
time employment of recipients and other persons of low income, as 
community service aides, in the administration of the plan and for 
the use of nonpaid or partially paid volunteers in a social service 
volunteer program in providing services to applicants and recipi-
ents and in assisting any advisory committees established by the 
State agency". 
(6) Section 1902(a) (4) of such Act is amended b^/^— 
(A) striking out "provide" and inserting in lieu thereof "pro-
vide (A)";and 
(B) adding at the end thereof before the semicolon the follow-
ing: ", and (B) for the training and effective use of paid subpro-
fessional staff, with particular emphasis on the full-time or part-
time employment of recipients and other persons of low income, as 
community service aides, in the administration of the plan and for 
the use of nonpaid or partially paid volunteers in a social service 
volunteer program in providing services to applicants and recipi-
ents and in assisting any advisory committees established by the 
State agency". 
(b) Each of the amendments made by subsection (a) shall become 
effective July 1, 1969, or, if earlier (with respect to a State's plan 
i2o'i ''f3''5f°lk8i 
''^PPi'ov^^ ui^d^r ^itle I, X, XIV, XVI, or XIX, or part A of title IV) 
1396! 601.' 
' on the date as of which the modification of the State plan to comply 
with such amendment is approved. 
LOCATION OF CERTAIN PARENTS W H O DESERT OR ABANDON 
DEPENDENT 
CHILDREN 
SEC. 211. (a) Effective January 1, 1969, section 402(a) of the 
Social Security Act (as amended by the preceding sections of this 
Act) is further amended by inserting before the period at the end 
thereof the following new clauses: 
; (21) provide that the State 
agency will report to the Secretary, at such times (not less often than 
once each calendar quarter) and in such manner as the Secretary may 
prescribe— 
"(A) the name, and social security account number, if known, 
of each parent of a dependent child or children with respect to 
whom aid is being provided under the State plan— 
"(i) against whom an order for the support and mainte-
nance of such child or children has been issued by a court of 
competent jurisdiction but who is not making payments in 
Ante, 
p. 892. 
42 u s e 405. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
897 
compliance or partial compliance with such order, or against 
whom a petition for such an order has been filed in a court 
having jurisdiction to receive such petition, and 
"(ii) whom it has been unable to locate after requesting 
and utilizing information included in the files of the 
Department of Health, Education, and Welfare maintained 
pursuant to section 205, 
^ 
^Af!^^'^'^^^' 
"(B) the last known address of such parent and any informa-
tion it has with respect to the date on which such parent could 
last be located at such address, and 
"(C) such other information as the Secretary may specify to 
assist in carrying out the provisions of section 410; 
^"f™. 
(22) provide that the State agency will, in accordance with stand-
ards prescribed by the Secretary, cooperate with the State agency 
administering or supervising the administration of the plan of another 
State under this part— 
"(A) in locating a parent residing in such State (whether or 
not permanently) against whom a petition has been filed in a 
court of competent jurisdiction of such other State for the support 
and maintenance of a child or children of such parent with respect 
to whom aid is being provided under the plan of such other State, 
and 
"(B) in securing compliance or good faith partial compliance 
by a parent residing in such State (whether or not permanently) 
with an order issued by a court of competent jurisdiction against 
such parent for the support and maintenance of a child or childi'en 
of such parent with respect to whom aid is being provided under 
the plan of such other State", 
(b) Title IV of such Act is amended by adding after section 409 the 
following new section: 
42 u s e 601-609. 
"ASSISTANCE BY INTERNAL REVENUE SERVICE I N LOCATING PARENTS 
"SEC. 410. (a) Upon receiving a report from a State agency made 
pursuant to section 402(a) (21), the Secretary shall furnish to the ^"'e, p. 896. 
Secretary of the Treasury or his delegate the names and social security 
account numbers of the parents contained in such report, and the name 
of the State agency which submitted such report. The Secretary of 
the Treasury or his delegate shall endeavor to ascertain the address 
of each such parent from the master files of the Internal Revenue 
Service, and shall furnish any address so ascertained to the State 
agency which submitted such report. 
"(b) There are hereby authorized to be appropriated such sums 
as may be necessary to carry out the provisions of subsection (a). The 
Secretary shall transfer to the Secretary of the Treasury from time to 
time sufficient amounts out of the monies appropriated pursuant to 
this subsection to enable him to perform his functions under sub-
section (a)." 
PROVISION o r SERVICES BY OTHERS T H A N A STATE 
76 Stat. 173. 
42 u s e 303. 
SEC. 212. (a) So much of section 3(a) (4) of the Social Security 
Act as follows subparagraph (C) and precedes subparagraph (D) 
is amended by inserting after "shall" the following: ", except to the 
extent specified by the Secretary,". 
(b) So much of section 1003(a)(3) of such Act as follows sub- 
^2 use 1203 
paragraph (C) and precedes subparagraph (D) is amended by insert-
ing after "shall" the following: ", except to the extent specified by the 
Secretary,". 
(c) So much of section 1403(a) (3) of such Act as follows sub- 
^2 use 1353 
paragraph (C) and precedes subparagraph (D) is amended by insert-
76 Stat. 200. 
42 u s e 1383. 
898 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
ing after "shall" the following: ", except to the extent specified by the 
Secretary,". 
(d) So much of section 1603(a)(4) of such Act as follows sub-
paragraph (C) and precedes subparagraph (D) is amended by insert-
ing after "shall" the follow^ing: ", except to the extent specified by the 
Secretary,". 
(e) The amendments made by the preceding subsections of this sec-
tion shall take effect January 1,1968. 
AUTHORITY TO DISREGARD ADDITIONAL INCOME OF RECIPIENTS OF PUBLIC 
ASSISTANCE 
79 Stat. 418. 
42 u s e 302. 
42 u s e 1352. 
79 Stat. 418. 
42 u s e 1382. 
SEC. 213. (a) (1) Section 2(a) (10) (A) (i) of the Social Security Act 
is amended by striking out "not more than $5" and inserting in lieu 
thereof "not more than $7.50". 
42 use 1202. 
(2) Section 1002(a) (8) (C) of such Act is amended by striking out 
"not more than $5" and inserting in lieu thereof "not more than $7.50". 
(3) Section 1402(a) (8) (A) of such Act is amended by striking out 
"not more than $5" and inserting in lieu thereof "not more than $7.50". 
(4) Section 1604(a) (14) (D) of such Act is amended by striking out 
"not more than $5" and inserting in lieu thereof "not more than $7.50". 
Ante, p. 896. 
^j^^ Scctiou 402(a) of sucli Act is amended by inserting before the 
period at the end thereof the following: "; and (23) provide that by 
July 1, 1969, the amounts used by the State to determine the needs of 
individuals will have been adjusted to reflect fully changes in living 
costs since such amounts were established, and any maximums that the 
State imposes on the amount of aid paid to families will have been pro-
portionately adjusted". 
PART 2—MEDICAL ASSISTANCE AMENDMENTS 
LIMITATION ON FEDERAL PARTICIPATION IN MEDICAL ASSISTANCE 
II usi;' ?396b 
SEC. 220. (a) Section 1903 of the Social Security Act is amended 
by adding at the end thereof the follow^ing new subsection: 
"(f) (1) (A) Except as provided in paragraph (4), payment under 
the preceding provisions of this section shall not be made with respect 
to any amount expended as medical assistance in a calendar quarter, 
in any State, for any member of a family the annual income of which 
exceeds the applicable income limitation determined under this para-
graph. 
" (B) (i) Except as provided in clause (ii) of this subparagraph, the 
applicable income limitation with respect to any family is the amount 
determined, in accordance with standards prescribed by the Secretary, 
to be equivalent to 133l^ percent of the highest amount which would 
ordinarily be paid to a family of the same size without any income or 
resources, in the form of money payments, under the plan of the State 
a pproved under part A of title IV of this Act. 
"(ii) If the Secretary finds that the operation of a uniform maxi-
mum limits payments to families of more than one size, he may adjust 
the amount otherwise determined under clause (i) to take account of 
families of different sizes. 
"(C) The total amount of any applicable income limitation deter-
mined under subparagraph (B) shall, if it is not a multiple of $100 
or such other amount as the Secretary may prescribe, be rounded to 
the next higher multiple of $100 or such other amount, as the case 
may be. 
"(2) In computing a family's income for purposes of paragraph 
(1), there shall be excluded any costs (whether in the form of insurance 
Post, 
p. 911. 
Post, p. 9 11. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
899 
premiums or otherwise) incurred by such family for medical care 
or for any other type of remedial care recognized under State law. 
"(3) For purposes of paragraph (1) (B), in the case of a family 
consisting of only one individual, the 'highest amount which would 
ordinarily be paid' to such family under the State's plan approved 
under part A of title IV of this Act shall be the amount determined by 
the State agency (on the basis of reasonable relationship to the 
amounts payable under such plan to families consisting of two or more 
persons) to be the amount of the aid which would ordinarily be payable 
under such plan to a family (without any income or resources) con-
sisting of one person if such plan (without regard to section 408) 
"^^ ^^^ ^°^-
provided for aid to such a family. 
"(4) The limitations on payment imposed by the preceding provi-
sions of this subsection shall not apply with respect to any amount 
expended by a State as medical assistance for any individual w^ho, at 
the time of the provision of the medical assistance giving rise to such 
expenditure— 
"(A) is a recipient of aid or assistance under a plan of such 
State w^hich is approved under title I, X, XIV, or XVI, or part A , „
^
2 use 301, 
i » i - j i - r x T 
* 201, 1351, .[ 38 1. 
01 title IV, or 
"(B) is not a recipient of aid or assistance under such a plan 
but (i) is eligible to receive such aid or assistance, or (ii) would 
be eligible to receive such aid or assistance if he were not in a 
medical institution." 
(b) (1) In the case of any State whose plan under title X I X of the 
Social Security Act is approved by the Secretary of Health, Education, ^^2^ "sc ^S'^^J 
and Welfare under section 1902 after July 25, 1967, the amendment 
made by subsection (a) shall apply with respect to calendar quarters 
beginning after the date of enactment of this Act. 
(2) In the case of any State whose plan under title X I X of the 
Social Security Act was approved by the Secretary of Health, 
Education, and Welfare under section 1902 of the Social Security Act 
prior to July 26, 1967, the amendments made by subsection (a) shall 
apply with respect to calendar quarters beginning after June 80, 1968, 
except that.— 
(A) with respect to the third and fourth calendar quarters of 
1968, such subsection shall be applied by substituting in subsection 
(f) of section 1903 of the Social Security Act 150 percent for 
^"^^' P- S'^S-
1331/^ percent each time such latter figure appears in such subsec-
tion (f), and 
(B) with respect to all calendar quarters during 1969, such 
subsection shall be applied by substituting in subsection (f) of 
section 1903 of such Act 140 percent for 1331/^ percent each time 
such latter figure appears in such subsection (f). 
MAINTENANCE OF STATE EFFORT 
SEC. 221. (a) Section 1117 (a) of the Social Security Act is amended 
H l'^^^ ^^f-
by adding at the end thereof the following new sentence: "For any 
fiscal year ending on or after June 30, 1967, and before July 1, 1968, 
in lieu of the substitution provided by paragraph (3) or (4), at the 
option of the State (i) paragraphs (1) and (2) of this subsection shall 
be applied on a fiscal year oasis (rather than on a quarterly basis), 
and (li) the base period fiscal year shall be either the fiscal year end-
ing June 30, 1965, or the fiscal year ending June 30, 1964 (whichever 
is chosen by the State). 
(b) Section 1117 of such Act is further amended by adding at the 
end thereof the following new subsection: 
"(d) (1) In the case of the c[uarters in any fiscal year ending before 
July 1, 1968, the reduction (if any) under this section shall, at the 
900 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
option of the State, be determined under paragraph (2), (3), or (4) 
of this subsection instead of under the preceding provisions of this 
section, 
"(2) If the reduction determination is made under this paragraph 
for a otate, then— 
"(A) subsection (a) shall be applied by taking into account 
only money payments under plans of the State approved under 
1
2
0
^
1 "iTs f las 1 
*^^?^® •^' -^' -^-'-^•' ^^^^ -^^^^^ ^^^ P^^^ A o^ ^i^^^ ^A"'. 
Post, p. 911. 
" ( ^ ) subsection (b) shall be applied by eliminating each ref-
42 use 1396. 
erence to title XIX, and 
90^?^'' ^^* ^°^' 
"(C) subsection (c) shall be applied by eliminating the ref-
erence to section 1903, and by substituting a reference to this 
paragraph for the reference to subsections (a) and (b). 
"(3) If the reduction determination is made under this paragraph 
for a State, then— 
"(A) subsection (a) shall be applied by taking into account 
72 Stat. 1053. 
payments under section 523 and section 422, 
p^os't, pp.'^i'u, 
"(B) subsection (b) shall be applied by adding a reference to 
9 15. 
section 523 aaid section 422 after each reference to title X I X , and 
"(C) subsection (c) shall be applied by adding a reference to 
section 523 and section 422 after the reference to section 1903, and 
by substituting a reference to this paragraph for the reference 
to subsections (a) and (b). 
"(4) If the reduction determination is made under this paragraph 
for a State, then— 
"(A) subsection (a) shall be applied by taking into account 
only (i) money payments under plans of the State approved imder 
titles I, X, XIV, and XVI, and part A of title IV, and (ii) pay-
ments under section 523 and section 422, 
"(B) subsection (b) shall be applied by eliminating each refer-
ence to title X I X and substituting a reference to section 523 and 
section 422, and 
"(C) subsection (c) shall be applied by eliminating the ref-
erence to section 1903 and substituting a reference to section 523 
and section 422, and by substituting a reference to this paragraph 
for the reference to subsections (a) and (b)." 
(c) Section 1117(a) of such Act is further amended by striking 
out "December 31,1965" and inserting in lieu thereof "June 30,1966" 
(d) Effective July 1, 1968, section 1117 of the Social Security Act 
is repealed. 
COORDINATION OF TITLE XIX AND T H E SUPPLEMENTARY 
MEDICAL, 
INSURANCE PROGRAM 
soltll.^^ios!^' 
^?^- 2^^- (^) Section 1843 of the Social Security Act is amended by 
42 use 1395V. adding at the end thereof the following new subsection: 
"(h) (1) The Secretary shall, at the request of a State made before 
January 1,1970, enter into a modification of an agreement entered into 
with such State pursuant to subsection (a) under which the coverage 
group described in subsection (b) and specified in such agreement is 
broadened to include individuals who are eligible to receive medical 
assistance under the plan of such State approved under title X I X . 
"(2) For purposes of this section, an individual shall be treated 
as eligible to receive medical assistance under the plan of the State 
approved under title X I X if, for the month in which the modification 
is entered into under this subsection or for any month thereafter, he 
has been determined to be eligible to receive medical assistance under 
such plan. In the case of any individual who would (but for this 
subsection) be excluded from the agreement, subsections (c) and 
(d) (2) shall be applied as if they referred to the modification under 
79 Stat. 420. 
42 u s e 1317. 
79 Stat. 312. 
42 u s e 1395V. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
901 
this subsection (in lieu of the agreement under subsection (a)), and 
subsection (d) (2) (C) shall be applied by substituting 'second month 
following the first month' for 'first month'." 
(b) (1) Section 1843(d) (3) (A) of such Act is amended by striking 
out "ineligible for money payments of a kind specified in the agree-
ment" and inserting in lieu thereof the following: "ineligible both for 
money payments of a kind specified in the agreement and (if there 
is in effect a modification entered into under subsection (h)) for 
medical assistance". 
(2) Section 1843 (f) of such Act is amended— 
(A) by inserting after "or part A of title IV," (as added by 
section 241(e)(2) of this Act) the following: "or eligible to 
^osf, p. 917. 
receive medical assistance under the plan of such State approved 
under title XIX,"; and 
(B) by inserting after ", and part A of title IV" (as added by 
section 241(e) (2) of this Act) the following: ", and individuals 
eligible to receive medical assistance under the plan of the State 
approved under title XIX". 
(3) Section 1843(g)(1) of such Act is amended by striking out 
so stat. 105. 
"1968" and inserting in lieu thereof "1970". 
(4) The heading of section 1843 of such Act is amended by adding 
^9 stat. 312. 
at the end thereof the following: "(OR ARE ELIGIBLE FOR MEDICAL 
ASSISTANCE)". 
(c) Section 1903 (b) of such Act is amended by inserting " (1)" after 
^^ stat. 349. 
"(b)", and by adding at the end thereof the following new paragraph: 
"(2) Notwithstanding the preceding provisions of this section, the 
amount determined under subsection (a) (1) for any State for any 
quarter beginning after December 31, 1967, shall not take into account 
any amounts expended as medical assistance with respect to individuals 
aged 65 or over which would not have been so expended if the indi-
viduals involved had been enrolled in the insurance program estab-
lished by part B of title XVIII." 
1395 w.^"" ^'^'^' 
(d) Effective with respect to calendar quarters beginning after 
December 31, 1967, section 1903(a)(1) of such Act is amended by 
striking out "and other insurance premiums" and inserting in lieu 
thereof "and, except in the case of individuals sixty-five years of age 
or older who are not enrolled under part B of title XVIII, other 
insurance premiums". 
(e)(1) Section 1843(a) of such Act is amended by striking out 
"1968" and inserting in lieu thereof "1970". 
(2) Section 1843(c) of such Act is amended— 
(A) by striking out "and before January 1, 1968"; and 
(B) hj striking out "thereafter before January 1968"; and 
inserting in lieu thereof "thereafter". 
(3) Section 1843(d) (2) (D) of such Act is amended by striking out 
"(not later than January 1, 1968)". 
MODIFICATION OF COMPARABILITY 
PROVISIONS 
SEC. 223. (a) Section 1902(a) (10) of the Social Security Act is 
amended— 
(1) by inserting " ( I ) " after "except that" in the matter follow-
ing subparagraph (B), and 
(2) by inserting before the semicolon at the end the following: 
", and (II) the making available of supplementary medical insur-
ance benefits under part B of title X V I I I to individuals eligible 
therefor (either pursuant to an agreement entered into under 
section 1843 or by reason of the payment of premiums under such 
title by the State agency on behalf of such individuals), or pro-
vision for meeting part or all of the cost of the deductibles, cost 
79 stat. 345. 
42 u s e 1396 a. 
902 
PUBLIC LAW 90.248-JAN. 2, 1968 
[81 STAT. 
i395w.^*^ ^^^^^ 
sharing, or similar charges under part B of title X V I I I for indi-
viduals eligible for benefits under such part, shall not, by reason 
of this paragraph (10), require the making available of any such 
benefits, or the making available of services of the same amount, 
duration, and scope, to any other individuals", 
(b) The amendments made by subsection (a) shall apply with 
respect to calendar quarters beginning after June 30,1967. 
REQUIRED SERVICES UNDER STATE MEDICAL ASSISTANCE 
P L A N 
Sir 
42 u s e 1396a. 
79 Stat. 345. 
g^c. 224. (a) Sectiou 1902(a) (13) of the Social Security Act is 
amended to read as follows; 
"(13) provide— 
" (A) for inclusion of some institutional and some noninsti-
tutional care and services, and 
"(B) in the case of individuals receiving aid or assistance 
under the State's plan approved under title I, X, XIV, or 
1
2
0
^
1 "f3^i^° 1381; 
XVI, or part A of title IV, for the inclusion of at least the 
Post', p. 911. 
' 
care and services listed in clauses (1) through (5) of section 
42 use i396d. 
1905(a), and 
"(C) in the case of individuals not included under sub-
paragraph (B) for the inclusion of at least— 
(i) the care and services listed in clauses (1) through 
(5) of section 1905(a) or 
(ii) (I) the care and services listed in any 7 of the 
' 
clauses numbered (1) through (14) of such section and 
(II) in the event the care and services provided linder 
the State plan include hospital or skilled nursing home 
services, physicians' services to an individual in a hos-
pital or skilled nursing home during any period he is 
receiving hospital services from such hospital or skilled 
nursing home services from such home, and 
"(D) for payment of the reasonable cost (as determined 
in accordance with standards approved by the Secretary and 
included in the plan) of inpatient hospital services provided 
under the plan;". 
(b) The amendment made by subsection (a) shall apply with 
respect to calendar quarters beginning after December 31, 1967. 
(c)(1) Section 1902(a) (13) (A) of the Social Security Act (as 
amended by subsection (a) of this section) is further amended to 
read as follows: 
"(A) (i) for the inclusion of some institutional and some 
non-institutional care and services, and 
"(ii) for the inclusion of home health services for any 
individual who, under the State plan, is entitled to skilled 
nursing home services, and". 
(2) The amendment made by paragraph (1) of this subsection shall 
apply with respect to calendar quarters beginning after June 30,1970. 
EXTENT o r FEDERAL EINANGIAL PARTICIPATION I N 
CERTAIN 
ADMINISTRATIVE 
EXPENSES 
42 use 1396b. 
gj;^. 225. (a) Section 1903(a)(2) of the Social Security Act is 
amended by striking out "of the State agency (or of the local agency 
administering the State plan in the political subdivision)" and insert-
ing in lieu thereof "of the State agency or any other public agency". 
(b) The amendment made by subsection (a) shall apply with respect 
to expenditures made after December 31, 1967. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
903 
ADVISORY COUNCIL ON MEDICAL ASSISTANCE 
SEC. 226. Title X I X of the Social Securitj Act is amended by 
H l'^^ 34^3. 
adding at the end thereof the following new section: 
1396 d. 
^ 
a 
ADVISORY COUNCIL ON MEDICAL ASSISTANCE 
"SEC. 1906. For the purpose of advising the Secretary on matters of 
general policy in the administration of this title (including the rela-
tionship of this title and title XVIII) and making recommendations 1395^"^^ ^''^^' 
for improvements in such administration, there is hereby created a 
Medical Assistance Advisory Council which shall consist of twenty-one 
E
ersons, not otherwise in the employ of the United States, appointed 
y the Secretary without regard to the provisions of title 5, United 
States Code, governing appointments in the competitive service. The 
Tx^ic^soi'et 
Secretary shall from time to time appoint one of the members to serve seq. 
as Chairman, The members shall include representatives of State and 
Membership. 
local agencies and nongovernmental organizations and groups con-
cerned with health, and of consumers of health services, and a major-
ity of the membership of the Advisory Council shall consist of 
representatives of consumers of health services. Each member shall 
^^^ °^ office-
hold office for a term of four years, except that any member appointed 
to fill a vacancy occurring prior to the expiration of the term for 
which his predecessor was appointed shall be appointed for the 
remainder of such term, and except that the terms of office of the 
members first taking office shall expire, as designated by the Secretary 
at the time of appointment, five at the end of the first year, five at tlie 
end of the second year, five at the end of the third year, and six at the 
end of the fourth year after the date of appointment. A member shall 
not be eligible to serve continuously for more than two terms. The 
Secretary may, at the request of the Council or otherwise, appoint 
such special advisory professional or technical committees as may be 
useful in carrying out this title. Members of the Advisory Council ^^^^°^i'^^^^l^°^' 
and members of any such advisory or technical committee, while 
attending meetings or conferences thereof or otherwise serving on 
business of the Advisory Council or of such committee, shall be 
entitled to receive compensation at rates fixed by the Secretary, but 
not exceeding $100 per day, including travel time, and while so serving 
away from their homes or regular places of business they may be 
allowed travel expenses, including per diem in lieu of subsistence, as 
authorized by section 5703 of title 5, United States Code, for persons 
in the Government service employed intermittently. The Advisory 
Council shall meet as frequently as the Secretary deems necessary. 
Upon request of five or more members, it shall be the duty of the 
Secretary to call a meeting of the Advisory Council." 
80 Stat. 499. 
FREE CHOICE BY INDIVIDUALS ELIGIBLE FOR MEDICAL ASSISTANCE 
SEC. 227. (a) Section 1902(a) of tlie Social Security Act is 
amended— 
(1) by striking out "and'' at the end of paragraph (21) ; 
(2) by striking out the period at the end of paragraph (22) 
and inserting in lieu thereof "; and "; and 
(3) by adding after paragraph (22) the following new para-
"(23) provide that any individual eligible for medical assist-
ance (including drugs) may obtain such assistance from any insti-
tution, agency, community pharmacy, or person, qualified to 
perform the service or services required (including an organization 
42 u s e 1396a. 
904 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT . 
which provides such services, or arranges for their availability, 
on a prepayment basis), who undertakes to provide him such 
services." 
(b) The amendments ma.de by this section shall apply with respect 
to calendar quarters beginning after June 30, 1969; except that such 
amendments shall apply in the case of Puerto Rico, the Virgin Islands, 
and Guam only with repect to calendar quarters beginning after 
June 30, 1972. 
UTILIZATION OF STATE FACILITIES TO PROVIDE CONSULTATIVE SERVICES TO 
INSTITUTIONS F U R N I S H I N G MEDICAL CARE 
SEC. 228. (a) Section 1902(a) of the Social Security Act (as 
Ante. p. 903. 
amended by section 227 of this Act) is amended— 
(1) by striking out "and" at the end of paragraph (22) ; 
(2) by striking out the period at the end of paragraph (23) and 
inserting in lieu thereof "; and"; and 
(3) by inserting after paragraph (23) the following new 
paragraph: 
"(24) effective July 1, 1969, provide for consultative services 
by health agencies and other appropriate agencies of the State to 
hospitals, nursing homes, home health agencies, clinics, labora-
tories, and such other institutions as the Secretary may specify 
in order to assist them (A) to qualify for payments under this Act, 
(B) to establish and maintain such fiscal records as may be neces-
sary for the proper and efficient administration of this Act, and 
(C) to provide mformation needed to determine payments due 
under this Act on account of care and services furnished to 
individuals." 
(b) Effective July 1, 1969, the last sentence of section 1864(a) of 
l\ use U95aa. ^uch Act is repealed. 
PAYMENTS FOR SERVICES AND CARE BY A THIRD PARTY 
SEC. 229. (a) Section 1902(a) of the Social Security Act (as 
amended by section 228 of this Act) is amended— 
(1) by striking out "and" at the end of paragraph (23); 
(2) by striking out the period at the end of paragraph (24) and 
inserting in lieu thereof ": and"; and 
(3) by inserting after paragraph (24) the following new 
paragraph: 
"(25) provide (A) that the State or local agency administering 
such plan will take all reasonable measures to ascertain the legal 
liability of third parties to pay for care and services (available 
under the plan) arising out of injury, disease, or disability, 
(B) that where the State or local agency knows that a third party 
has such a legal liability such agency will treat such legal liability 
as a resource of the individual on whose behalf the care and serv-
ices are made available for purposes of paragraph (17) (B), and 
(C) that in any case where such a legal liability is found to exist 
after medical assistance has been made available on behalf of the 
individual, the State or local agency will seek reimbursement for 
such assistance to the extent of such legal liability." 
(b) The amendment made by subsection (a) shall apply with 
respect to legal liabilities of third parties arising after March 31,1968. 
42 us^c f396b. 
(^) Section 1903(d) (2) of such Act is amended by adding at the 
end thereof the following new sentence: "Expenditures for which 
payments were made to the State under subsection (a) shall be treated 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
905 
as an overpayment to the extent that the State or local agency admin-
istering such plan has been reimbursed for such expenditures b;^ a 
third party pursuant to the provisions of its plan in compliance with 
section 1902(a) (25)." 
Ante, 
p. 904. 
DIRECT PAYMENTS TO CERTAIN RECIPIENTS OF MEDICAL ASSISTANCE 
SEC. 230. Section 1905(a) of the Social Security Act is amended 
by inserting after "for individuals" in the matter preceding clause 
(i) the following: ", and, with respect to physicians' or dentists' 
services, at the option of the State, to individuals not receiving aid or 
assistance under the State's plan approved under title I, X, XIV, or 
XVI, or part A of title IV,". 
DATE ON W H I C H STATE PLANS UNDER TITLE X I X MUST MEET CERTAIN 
FINANCIAL PARTICIPATION 
REQUIREMENTS 
SEC. 231. Section 1902(a) (2) of the Social Security Act is amended 
^2 use i396a. 
by striking out "July 1, 1970" and inserting in lieu thereof "July 1, 
1969". 
OBSERVANCE OF RELIGIOUS BELIEFS 
79 Stat. 351. 
42 u s e 1396d. 
42 u s e 301, 
1201, 1351, 1381; 
Post. 
p. 911. 
SEC. 232. Title X I X of the Social Security Act (as amended by sec-
tion 226 of this Act) is further amended by adding at the end thereof 
the following new section: 
"OBSERVANCE OF RELIGIOUS BELIEFS 
"SEC. 1907. Nothing in this title shall be construed to require any 
State which has a plan approved under this title to compel any 
person to undergo any medical screening, examination, diagnosis, or 
treatment or to accept any other health care or services provided under 
such plan for any purpose (other than for the purpose of discovering 
and preventing the spread of infection or contagious disease or for 
the purpose of protecting environmental health), if such person 
objects (or, in case such person is a child, his parent or guardian 
objects) thereto on religious grounds." 
C O V E R A G E UNDER TITLE XIX OF CERTAIN SPOUSES OF INDIVIDUALS RECEIVING 
CASH WELFARE AID OR ASSISTANCE 
SEC. 233. (a) Section 1905(a) of the Social Security Act is amended 
(1) by striking out "or" at the end of clause (iv), (2) by inserting "or" 
at the end of clause (v), and (3) by inserting immediately below clause 
(v) the following new clause: 
"(vi) persons essential (as described in the second sentence of 
this subsection) to individuals receiving aid or assistance under 
State plans approved under title I, X, XIV, or XVI,". 
(b) Section 1905(a) of such Act is further amended by adding at 
the end thereof the following new sentence: "For purposes of clauses 
(vi) of the preceding sentence, a person shall be considered essential to 
another individual if such person is the spouse of and is living with 
such individual, the needs of such person are taken into account in 
determining the amount of aid or assistance furnished to such indi-
vidual (under a State plan approved under title I, X, XIV, or XVI), 
and such person is determined, under such a State plan, to be essential 
to the well being of such individual." 
Ante, 
p. 903. 
904 
906 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
STANDARDS FOR SKILLED XURSING HOMES FURNISIIIKG SERVICES UNDER 
STATE PLANS APPROVED UNDER TITLE XIX 
SEC. 234. (a) Section 1902(a) of the Social Security Act (as 
Ante. pp. 903, 
amended by the preceding sections of this Act) is further amended 
(1) by striking out "and" at the end of paragraph (24), (2) by strik-
ing out the period at the end of paragraph (25) and inserting in lieu 
of such period a semicolon, and (3) by adding at the end thereof the 
following new paragraphs: 
"(26) effective July 1,1969, provide (A) for a regular program 
of medical review (including medical evaluation of each patient's 
need for skilled nursing home care) or (in the case of individuals 
who are eligible therefor under the State plan) need for care in a 
mental hospital, a written plan of care, and, where applicable, 
a plan of rehabilitation prior to admission to a skilled nursing 
home; (B) for periodic inspections to be made in all skilled nurs-
ing homes and mental institutions (if the State plan includes care 
in such institutions) within the State'by one or more medical 
review teams (composed of physicians and other appropriate 
health and social service personnel) of (i) the care being provided 
in such nursing homes (and mental institutions, if care therein is 
provided under the State plan) to persons receiving assistance 
under the State plan, (ii) with respect to each of the patients 
receiving such care, the adequacy of the services available in par-
ticular nursing homes (or institutions) to meet the current health 
needs and promote the maximum physical well-being of patients 
receiving care in such homes (or institutions), (iii) the necessity 
and desirability of the continued placement of such patients in 
such nursing homes (or institutions), and (iv) the feasibility of 
meeting their health care needs through alternative institutional 
or noninstitutional services; and (C) for the making by such team 
or teams of full and complete reports of the findings resulting 
from such inspections together with any recommendations to the 
State agency administering or supervising the administration of 
the State plan; 
"(27) provide for agreements with every person or institution 
providing services under the State plan under which such person 
or institution agrees (A) to keep such records as are necessary 
fully to disclose the ex:tent of the services provided to individuals 
receiving assistance under the State plan, and (B) to furnish the 
State agency with such information, regarding any payments 
claimed by such person or institution for providing services under 
the State plan, as the State agency may from time to time request; 
" (28) provide that any skilled nursing home receiving payments 
under such plan must— 
"(A) supply to the licensing agency of the State full and 
complete information as to the identity (i) of each person 
having (directly or indirectly) an ownership interest of 10 
per centum or more in such nursing home, (ii) in case a nurs-
ing home is organized as a corporation, of each officer and 
director of the corporation, and (iii) in case a nursing home 
is organized as a partnership, of each partner; and promptly 
report any changes which would affect the current accuracy 
of the information so required to be supplied; 
"(B) have and maintain an organized nursing service for 
its patients, which is under the direction of a professional 
registered nurse who is employed full-time by such nursing 
home, and which is composed of sufficient nursing and aux-
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
907 
iliary personnel to provide adequate and properly supervised 
nursing services for such patients during all hours of each 
day and all days of each week; 
"(C) make satisfactory arrangements for 
professional 
planning and supervision of menus and meal service for 
patients for whom special diets or dietary restrictions are 
medically prescribed; 
"(D) have satisfactory policies and procedures relating to 
the maintenance of medical records on each patient of the 
nursing home, dispensing and administering of 'drugs and 
biologicals, and assuring that each patient is under the care 
of a physician and that adequate provisions is made for medi-
cal attention to any patient during emergencies; 
"(E) have arrangements with one or more general hos-
pitals under which such hospital or hospitals will provide 
needed diagnostic and other services to patients of such nurs-
ing home, and under which such hospital or hospitals agree 
to timely acceptance, as patients thereof, of acutely ill patients 
of such nursing home who are in need of hospital care; except 
that the State agency may waive this requirement wholly or 
in part with respect to any nursing home meeting all the 
other requirements and which, by reason of remote location 
or other good and sufficient reason, is unable to effect such an 
arrangement with a hospital; and 
"(F) (i) meet (after December 31, 1969) such provisions 
of the Life Safety Code of the National Fire Protection 
Association (21st Edition, 1967) as are applicable to nursing 
homes; except that the State agency may waive in accord-
ance with regulations of the Secretary, for such periods as it 
deems appropriate, specific provisions of such code which, if 
rigidly applied, would result in unreasonable hardship upon 
a nursing home, but only if such agency makes a determina-
tion (and keeps a written record setting forth the basis of 
such determination) that such waiver will not advei*sely affect 
the health and safety of the patients of sucli skilled nursing 
home; and except that the requirements set forth in the pre-
ceding provisions of this subclause (i) shall not apply in any 
State if the Secretary finds that in such State there is in 
effect a fire and safety code, imposed by State law, which 
adequately protects patients in nursing homes; and (ii) meet 
conditions relating to environment and sanitation applicable 
to extended care facilities under title X V I I I ; except that 1395//^^ ^^^^" 
the State agency may waive in accordance with regulations 
of the Secretary, for such periods as it deems appropriate, 
any requirement imposed by the preceding provisions of this 
subclause (ii) if such agency finds that such requirement, 
if rigidly applied, would result in unreasonable hardship upon 
a nursing home, but only if such agency makes a determina-
tion (and keeps a written record setting forth the basis of 
such determination) that such waiver will not adversely 
affect the health and safety of the patients of such nursing-
home." 
(b) The amendments made by subsection (a) of this section (unless 
otherwise Specified in the body of such amendments) shall take effect 
on January 1,1969. 
(c) Notwithstanding any other provision of law, after June 30, 
1968, no Federal funds shall be paid to any State as Federal matching 
under title I, X, XIV, XVI, or X I X of the Social Security Act for is^o'^'iTsriasi 
payments made to any nursing home for or on account of any nursing 1396'; Post. pp. 
903-908. 
908 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
home services provided by such nursing home for any period during 
which such nursing home is determined not to meet fully all require-
ments of the State for licensure as a nursing home, except that the 
Secretary may prescribe a reasonable period or periods of time during 
which a nursing home which has formerly met such requirements 
will be eligible for payments which include Federal participation if 
during such period or periods such home promptly takes all necessary 
steps to again meet svich requirements. 
COST SHARING AND SIMILAR CHARGES W I T H RESPECT TO INPATIENT 
HOSPITAL SERVICES FURNISHED UNDER TITLE XIX 
SEC. 235. (a)(1) Section 1902(a) (14) (A) of the Social Security 
42 us^c u96a 
'^^^ ^^ amended by striking out "no"' and inserting in lieu thereof the 
following: "in the case of individuals receiving aid or assistance under 
State plans approved under titles I, X, XIV, XVI, and part A of title 
42 u s e 301, 
J Y 
J^QV 
Po°l: J.^QVI""^' . (2) Section 1902(a) (14) (B) of such Act is amended (A) by 
inserting "inpatient hospital services or' after "respect to", and (B) 
by striking out "him" and inserting in lieu thereof "to an individual". 
(8) Section 1902(a) (15) of the Social Security Act is amended to 
read as follows: 
"(15) in the case of eligible individuals 65 years of age or older 
who are covered by either or both of the insurance programs estab-
1395/V^^ ^^^^ 
lished by title XVIII, provide where, under the plan, all of any 
deductible, cost sharing, or similar charge imposed with respect to 
such individual under the insurance program established by such 
title is not met, the portion thereof which is met shall be deter-
mined on a basis reasonably related (as determined in accordance 
with standards approved by the Secretary and included in the 
plan) to such individual's income or his income and resources;", 
(b) The amendments made by subsection (a) shall be effective in 
the case of calendar quarters beginning after December 31, 1967. 
STATE PLAN REQUIREMENTS REGARDING LICENSING OF ADMINISTRATORS OF 
SKILLED NURSING HOMES F U R N I S H I N G SERVICES UNDER STATE PLANS 
APPROVED UNDER TITLE XIX 
SEC. 236. (a) Section 1902(a) of the Social Security Act (as 
sol^g^oe^^ ^°^' 
amended by the preceding sections of this Act) is fui-ther amended 
(1) by striking out the period at the end of paragraph (28) and insert-
ing in lieu thereof a semicolon and (2) by adding at the end of such 
section 1902 (a) the following new paragraph: 
"(29) include a State program which meets the requirements 
set forth in section 1908, for the licensing of administrators of 
nursing homes." 
(b) Title X I X of the Social Security Act (as amended by the 
Ante. pp. 903, 
jjrecediiig sections of this Act) is further amended by adding at the 
end thereof the followino-: 
a STATE PROGRAMS FOR LICENSING OF ADMINISTRATORS OF NURSING HOMES 
^"P"-^- 
" S E C 1908. (a) For purposes of section 1902(a) (29), a'State pro-
gram for the licensing of administrators of nursing homes' is a pro-
gram which provides that no nursing home within the State may 
operate except under the superA^sion of an administrator licensed in 
the manner provided in this section. 
"(b) Licensing of nursing home administrators shall be carried 
out by the agency of the State responsible for licensing under the 
healing arts licensing act of the State, or, in the absence of such act 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
909 
or siicli an agency, a board, representative of tlie professions and insti-
tutions concerned with care of chronically ill and infirm aged patients 
and established to cany out the purposes of this section. 
"(c) It shall be the function and duty of such agency or board to— 
"(1) develop, impose,-and enforce standards which must be 
met by individuals in order to receive a license as a nursing home 
administrator, Avhich standards shall be designed to insure that 
nursing home administrators will he individuals who are of good 
cliaracter and are otherwise suitable, and who, by training or 
experience in the field of institutional administration, are qualified 
to serve as nursing home administrators; 
"(2) develop and apply appropriate techniques, including 
examinations and investigations, for determining whether an 
individual meets such standards; 
"(3) issue licenses to individuals determined, after the appli-
cation of such techniques, to meet such standards, and revoke or 
suspend licenses previously issued by the board in any case where 
the individual holding any svich license is determined substantially 
to have failed to conform to the requirements of such standards; 
"(4) establish and carry out procedures designed to insure that 
individuals licensed as nursing home administrators will, during 
any period that they serve as such, comi)ly with the requirements 
of such standards; 
"(5) receive, investigate, and take appro])riate action with 
respect to, any charge or complaint filed with the board to the 
effect that any individual licensed as a nursing home administrator 
has failed to comply with the requirements of such standards; and 
"(6) conduct a continuing study and investigation of nursing 
homes and administrators of nursing homes within the State with 
a view to the improvement of the standards imposed for the 
licensing of such administrators and of procedures and methods 
for the enforcement of such standards with respect to administra-
tors of nursing homes who have been licensed as such. 
"(d) No State shall be considered to have failed to comply with the 
provisions of section 1902(a) (29) because the agency or board of such 
^"'^' P- ^°^-
State (established pursuant to subsection (b)) shall have granted any 
waiver, with respect to any individual who during all of the calendar 
year immediately preceding the calendar year in which the require-
ments prescribed in section 1902(a) (29) are first met by the State, has 
served as a nursing home administrator, of any of the standards de-
veloped, imposed, and enforced by such board pursuant to subsection 
(b) (1) other than such standards as relate to good character or suit-
ability if— 
" (1) such waiver is for a period which ends after being in effect 
for two years or on June 30,1972, whichever is earlier, and 
"(2) there is provided in the State (during all of the period 
for which waiver is in effect), a program of training and instruc-
tion designed to enable all individuals, with respect to whom any 
such waiver is granted, to attain the qualifications necessary in 
order to meet such standards. 
"(e) (1) There are hereby authorized to be appropriated for fiscal 
year 1968 and the four succeeding fiscal years such sums as may be 
necessary to enable the Secretary to make grants to States for the pur-
pose of assisting them in instituting and conducting programs of 
training and instruction of the type referred to in subsection (d) (2). 
"(2) No grant with resi)ect to any such program shall exceed 75 per 
centum of the reasonable and necessary cost, as determined by the 
Secretary, of instituting and conducting such program. 
910 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
National Ad-
visory Council on 
Nursing Home Ad-
ministration. 
80 Stat. 417. 
5 u s e 3301 et 
seq. 
Membership. 
Duties. 
Compensation, 
travel expenses. 
80 Stat. 499. 
Termination. 
"Nursing 
home." 
"Nursing home 
administrator." 
"(f) (1) For the purpose of advising the Secretary and the States 
in carrying out the provisions of this section, there is hereby created 
a National Advisory Council on Nursing Home Administration which 
shall consist of nine persons, not otherwise in the employ of the 
United States, appointed by the Secretary without regard to the 
provisions of title 5, United States Code, governing appointments in 
the competitive service. The Secretary shall from time to time appoint 
one of the members to serve as Chairman. The members shall include, 
but not be limited to, representatives of State health officers. State 
welfare directors, nursing home administrators, and university pro-
grams in public health or medical care administration. 
"(2) In addition to the function stated in paragraph (1) of this 
subsection, it shall be the function and duty of the Council (A) to 
study and identify the core of knowledge that should constitute 
minimally the training in the field of institutional administration 
which should qualify an individual to serve as a nursing home admin-
istrator; (B) to study and identify the experience in the field of 
institutional administration that a nursing home administrator should 
be required to possess; (C) to study and develop model techniques for 
determining whether an individual possesses sucli qualifications: (D) 
to study and develop model criteria for granting waivers under the 
provisions of subsection (d); (E) to study and develop suggested 
programs of training referred to in subsection (d); (F) to study, 
develop, and recommend programs of training and instruction for 
those desiring to pursue a career in nursing home administration; 
(G) to complete the functions in (A) through (E) above by July 1, 
1969, and submit a w^ritten report to the Secretary Avhich report shall 
be submitted to the States to assist tliem in carrying out the provisions 
of this section. 
"(3) Members of the Council, while attending meetings or confer-
ences thereof or otherwise serving on business of the Council shall be 
entitled to receive compensation at rates fixed by tlie Secretary, but 
not exceeding $100 per day, including travel time, and while so serving 
away from their homes or regular places of business they may be 
allowed travel expenses, including per diem in lieu of subsistence, as 
authorized by section 5703 of title 5, United States Code, for persons 
in the Government service employed intermittently. 
"(4) The Secretary may at the request of the Council engage such 
technical assistance as may be required to carry out its functions; and 
the Secretary shall, in addition, make available to the Council such 
secretarial, clerical, and other assistance and such pertinent data 
obtained and prepared by the Department of Health, Education, and 
Welfare as the Council may require to carry out its functions. 
"(5) The Council shall be appointed by the Secretary prior to July 
1,1968, and shall cease to exist as of December 31, 1971. 
" (g) As used in this section, the term— 
"(1) 'nursing home' means any institution or facility defined as 
such for licensing purposes under State law, or, if State law does 
not employ the term nursing home, the equivalent term or terms as 
determined by the Secretary; and 
"(2) 'nursing home administrator' means any individual who 
is charged with the general administration of a nursing home 
whether or not such individual has an ow^nership interest in such 
home and whether or not his functions and duties are shared with 
one or more other individuals." 
(c) Except as otherwise specified in the text thereof, the amend-
ments made by this section shall take effect on July 1, 1970. 
Ante, 
p. 90f 
42 u s e 1396a. 
42 u s e 301, 
1201, 1351, 1381; 
81 STAT.] 
PUBLIC LAW 9 0 - 2 4 8 - J A N . 2, 1968 
911 
UTILIZATION o r 
CARE AND SERVICES FURNISHED UNDER TITI.E XIX 
SEC. 237. Effective April 1,1968, section 1902(a) of the Social Secu-
rity Act (as amended by the preceding sections of this Act) is further 
amended by— 
(a) striking out the period at the end and inserting in Heu 
thereof the following "; and"; and 
(b) inserting after paragraph (29) (added to the Social Secu-
rity Act by section 236 of this Act) the following paragraph: 
" (30) provide such methods and procedures relating to the utili-
zation of, and the payment for, care and services available under 
the plan as may be necessary to safeguard against unnecessary 
utilization of such care and services and to assure that payments 
(including payments for any drugs provided under the plan) are 
not in excess of reasonable charges consistent with efficiency, econ-
omy, and quality of care." 
D I F E E R E N C E S I N STANDARDS W I T H RESPECT TO INCOME ELIGIBILITY UNDER 
TITLE 
XIX 
SEC. 238. Effective July 1, 1969, section 1902(a) (17) of the Social 
Security Act is amended by striking out "(which shall be comparable 
^^ f^^^- f-^^^ 
for all groups)" and inserting in lieu thereof the following: "(which 
shall be comparable for all groups and may, in accordance with stand-
ards prescribed by the Secretary, differ with respect to income levels, 
but only in the case of applicants or recipients of assistance under the 
plan who are not receiving aid or assistance under the State's plan 
approved under title I, X, XIV, or XVI, or part A of title IV, based 
on the variations between shelter costs in urban areas and in rural inil-a. 
areas)". 
PART 3—CHILD-WELFARE SERVICES AMENDMENTS 
INCLUSION OF C H I L D - W E L F A R E SERVICES I N TITLE IV 
SEC. 240. (a) The heading of title IV of the Social Security Act 
^^ f^ft. iss 
T -, J 
-, 
n T, 
~ 
"
^ 
42 u s e 601-609. 
IS amended to read as follows: 
"TITLE IV—GKANTS TO STATES FOR AID AND SERV-
ICES TO NEEDY FAMILIES W I T H CHILDREN AND FOR 
CHILD-WELFARE SERVICES" 
(b) Title IV of such Act is further amended by inserting imme-
diately after the heading of the title the following : 
"PART A—AID TO FAMILIES W I T H DEPENDENT CHILDREN" 
(c) Title IV of such Act is further amended by adding at the end yg'^gtat^^is"^' 
thereof the following new part: 
"PART B—CHILD-WELFARE SERVICES 
"APPROPRIATION 
"SEC. 420. For the purpose of enabling the United States, through 
the Secretary, to cooperate with State public welfare agencies m 
establishing, extending, and strengthening child-welfare services, the 
following sums are hereby authorized to be appropriated: $55,000,000 
for the fiscal year ending June 30,1968, $100,000,000 for the fiscal year 
ending June 30, 1969, and $110,000,000 for each fiscal year thereafter. 
85-622 0-68—60 
Post. p. 913. 
Post, p. 915. 
912 
PUBLIC LAW 90.248-JAN. 2, 1968 
[81 STAT. 
"ALLCyiMENTS TO STATES 
Ante. p. 911. 
"SEC. 421. TliB suni appropriated pursuant to section 420 for each 
fiscal year shall be allotted by the Secretary for use by cooperating 
State public welfare agencies which liave plans developed jointly by 
the State agency and the Secretary, as follows: He shall allot $70,000 
to each State, and shall allot to each State an amount which bears the 
same ratio to the remainder of the sum so appropriated for such year 
as the product of (1) the population of such State under the age of 
21 and (2) the allotment percentage of such State (as determined 
under section 423) bears to the sum of tlie corresponding products 
of all the States. 
"PAYMENT TO STATES 
"SEC. 422. (a) From the sums appropriated therefor and the allot-
ment available under this part, the Secretary shall from time to time 
pay to each State— 
"(1) that has a plan for child-welfare services which has been 
, 
developed as provided in this part and which— 
"(A) provides for coordination between the services pro-
vided under such plan and the services provided for depend-
42 use 601-609. 
gj^^ children under the State plan approved under part A of 
" ^' '^- 
• 
this title, with a view to provision of welfare and related 
services which will best promote the welfare of such children 
and their families, and 
"(B) provides, with respect to day care services (includ-
ing the provision of such care) provided under this title— 
"(i) for cooperative arrangements with the State 
health authority and the State agency primarily respon-
sible for State supervision of public schools to assure 
maximum utilization of such agencies in the provision of 
necessary health services and education for children 
receiving day care, 
"(ii) for an advisory committee, to advise tlie State 
public welfare agency on the general policy involved in 
the provision of day care services under the plan, which 
shall include among its members representatives of other 
State agencies concerned with day care or services related 
thereto and persons representative of professional or 
civic or other public or nonprofit private agencies, orga-
nizations, or groups concerned with the provision of 
day care, 
"(iii) for such safeguards as may be necessary to 
assure provision of day care under the plan only in cases 
in which it is in the best interest of the child and the 
mother and only in cases in which it is determined, under 
criteria establislied by the State, that a need for such 
care exists; and, in cases in which the family is able to 
pay part or all of the costs of such care, for payment of 
such fees as may be reasonable in the light of such ability, 
" (iv) for giving priority, in determining the existence 
of need for such day care, to members of low-income or 
other groups in the population, and to geographical areas, 
which have the greatest relative need for extension of 
such day care, and 
"(v) that day care provided under the plan will be 
provided only in facilities (including private homes) 
which are licensed by the State, or approved (as meeting 
the standards established for such licensing) by the 
State agency responsible for licensing facilities of this 
type, and 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
913 
"(vi) for the development and implementation of 
arrangements for the more effective involvement of the 
parent or j)arents in the appropriate care of the child 
and the improvement of the health and development of 
the child, and 
" (2) that makes a satisfactory showing that the State is extend-
ing the provision of child-welfare services in the State, with 
priority being given to communities with the greatest need for 
such services after giving consideration to their relative financial 
need, and with a view to making available by July 1, 1975, in 
all political subdivisions of the State, for all children in need 
thereof, child-welfare services provided by the staff (which shall 
to the extent feasible be composed of trained child-welfare per-
sonnel) of the State public welfare agency or of the local agency 
participating in the administration of the plan in the political 
subdivision, 
except that (effective July 1, 1969, or, if earlier, on the date as of 
which the modification of the State plan to comply with this require-
ment with respect to subprofessional staff is approved) such plan 
shall provide for the training and effective use of paid subprofessional 
staff with particular emphasis on the full-time or part-time employ-
ment of persons of low income, as community service aides, in the 
administration of the plan and for the use of nonpaid or partially 
paid volunteers in providing services and in assisting any advisory 
committees established by the State agency, an amount equal to the 
Federal share (as determined under section 423) of the total sum 
expended under such plan (including the cost of administration of 
the plan) in meeting the costs of State, district, county, or other local 
child-welfare services, in developing State services for the encourage-
ment and assistance of adequate methods of community child-welfare 
organization, in paying the costs of returning any runaway child who 
has not attained the age of eighteen to his own community in another 
State, and of maintaining such child until such return (for a period not 
exceeding fifteen days), m cases in which such costs cannot be met by 
the parents of such child or by any person, agency, or institution legally 
responsible for the support of such child. In developing such services 
for children, the facilities and experience of voluntary agencies shall 
be utilized in accordance with child-care programs and arrangements 
in the State and local communities as may be authorized by the State. 
"(b) The method of computing and paying such amounts shall be 
as follows: 
"(1)^ The Secretary shall, prior to the beginning of each period 
for which a payment is to be made, estimate the amount to be paid 
to the State for such period under the provisions of subsection (a). 
" (2) From the allotment available therefor, the Secretary shall 
pay the amount so estimated, reduced or increased, as the case may 
be, by any sum (not previously adjusted under this section) by 
which he finds that his estimate of the amount to be paid the State 
for any prior period under this section was greater or less than 
the amount which should have been paid to the State for such 
prior period under this section. 
"ALLOTMENT PERCENTAGE AND FEDERAL SHARE 
"SEC. 423. (a) The 'allotment percentage' for any State shall be 
100 per centum less the State percentage; and the State percentage 
shall be that percentage which bears the same ratio to 50 per centum as 
the per capita income of such State bears to the per capita income of 
914 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
tlie United States; except that (1) tlie allotment percentage shall in 
no case be less than 80 per centmn or more than T
O per centum, and 
(2) the allotment percentage shall be 70 per centnm in the case of 
Puerto Rico, the Virgin Islands, and Guam. 
"(b) The 'Federal share' for any State for any tiscal year shall be 
100 per centum less that percentage which bears the same ratio to 
50 per centnm as the per capita income of such State bears to the per 
capita income of the ITnited States, except that (1) in no case shall 
the Federal share be less than 331/^ per centum or more than 66% per 
centum, and (2) the Federal share shall be 66% per centum in the c^ise 
of Puerto Rico, the Virgm Islands, and Guam. 
" (c) The Federal share and the allotment percentage for each State 
shall be promulgated by the Secretary between July 1 and August 31 
of each even-numbered year, on the basis of the average per capita 
income of each State and of the United States for the three most recent 
calendar years for which satisfactory data are available from the 
Department of Commerce. Such promulgation shall be conclusive for 
each of the two fiscal years in the period beginning July 1 next succeed-
ing such promulgation: Provided^ That the Federal shares and allot-
ment percentages promulgated under section 524(c) of the Social 
42 use 7 24. 
Security Act in 1966 shall be effective for purposes of this section for 
the fiscal years ending June 30, 1968, and June 30, 1969. 
"United states." 
"(d) For purposes of this section, the term 'L'nited States' means 
the fiftv States and the District of Columbia. 
a 
KEALLOTMENT 
Ante, p. 912. 
"SEC. 42-1. The amount of any allotment to a State under section 421 
for any fiscal year which the State certifies to the Secretary will not 
be required for carrying out the State plan developed as provided in 
such section shall be available for reallotment from time to time, oai 
such dates as the Secretary may fix, to other States which the Secre-
tary determines (1) have need in carrying out their State plans so 
developed for sums in excess of those previously allotted to them under 
that section and (2) will be able to use such excess amounts during such 
fiscal year. Such reallotments shall be made on the basis of the State 
plans so developed, after taking into consideration the population 
under the age of twenty-one, and the per capita income of each such 
State as compared with the population under the age of twenty-one, 
and the per capita income of all such States with respect to which such 
a determination by the Secretary has been made. Any amount so real-
lotted to a State shall he. deemed part of its allotment under section 421. 
"DEFINITION 
"Child-welfare 
"SEC. 425. For purposes of this title, the term 'child-welfare serv-
ices' means public social services w^hich supplement, or substitute for, 
parental care and supervision for the purpose of (1) preventing or 
remedying, or assisting in the solution of problems which may result 
in, the neglect, abuse, exploitation, or delinquency of children, (2) 
protecting and caring for homeless, dependent, or neglected children, 
(3) protecting and promoting the welfare of children of working 
mothers, and (4) otherwise protecting and promoting the welfare of 
children, including the strengthening of their own homes where pos-
sible or, where needed, the provision of adequate care of children 
away from their homes in foster family homes or day-care or other 
child-care facilities. 
services. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
915 
"RESEARCH, TRAINING, OR DEMONSTRATION PROJECTS 
"SEC. 426. (a) There are hereby authorized to be appropriated for 
each fiscal year such sums as the Congress may determine— 
*' (1) for grants by the Secretary— 
"(A) to public or other nonprofit institutions of higher 
learning, and to public or other nonprofit agencies and 
organizations engaged in research or child-welfare activities, 
for special research or demonstration projects in the field of 
child welfare which are of regional or national significance 
and for special projects for the demonstration of new meth-
ods or facilities which show promise of substantial contribu-
tion to the adv^ancement of child welfare; 
"(B) to State or local public agencies responsible for 
administering, or supervising the administration of, the plan 
under this part, for projects for the demonstration of the 
utilization of research (including findings resulting there-
from) in the field of child welfare in order to encourage 
experimental and special types of welfare services; and 
"(C) to public or other nonprofit institutions of higher 
learning for special projects for training personnel for work 
in the field of child welfare, including traineeships with such 
stipends and allowances as may be permitted by the Secre-
tary; and 
" (2) for contracts or jointly financed cooperative arrangements 
with States and public and other organizations and agencies for 
the conduct of research, special projects, or demonstration projects 
relating to such matters. 
" (b) Payments of grants or under contracts or cooperative arrange-
ments under this section may be made in advance or by way of reim-
bursement, and in such installments, as the Secretary may determine; 
and shall be made on such conditions as the Secretary finds ne<;es-
sary to carry out the purposes of the grants, contracts, or other 
a r rangements." 
(d)(1) Subparagraphs (A) and (B) of section 422(a) (1) of the 
Social Security Act (as added by subsection (c) of this section) are 
^"^^' P- ^^2. 
redesignated as (B) and (C). 
(2) So much of paragraph (1) of section 422(a) of such Act (as 
added by subsection (c) of this section) as precedes subparagrajjli (B) 
(as redesignated) is amended to read as follows: 
"(1) that has a plan for child-welfare services which has been 
developed as provided in this part and which— 
"(A) 
provides that (i) the State agency designated 
pursuant to section 402(a) (3) to administer or supervise the 
^2 use 602. 
administration of the plan of the State ap])roved under part 
A of this title will administer or supervise the administration 
1LY^^^Q/"I^°^' 
of such plan for child-welfare services and (ii) to the extent 
that cliild-welfare services are furnished by the staff of the 
State agency or local agency administering such plan for 
child-welfare services, the organizational unit in such State 
or local agency established pursuant to section 402(a) (15) 
will 
be responsible 
for 
furnishing 
such 
child-welfare 
services,", 
(e) (1) Part 3 of title V of the Social Security Act is repealed on 
1
^
2
^
^
t
3
5
- ,05 
the date this Act is enacted, 
^ " 
^' 
(2) Part B of title IV of the Social Security Act (as added by 
subsection (c) of this section), and the amendments made by subsec-
tions (a) and (b) of this section, shall become effective on the date this 
Act is enacted. 
Ante, 
p. 91 1. 
Ante, 
p. 878. 
42USC721-728. 
42 use 723. 
916 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
(3) The amendineiits made b}^ paragraphs (1) and (2) of subsection 
{([) shall become effective July 1, 1969, except that (A) if on the date 
of enactment of this Act the agency of a State administering its plan 
for child-welfare services develoi)ed under part B of title lY of the 
Ante, p. 911. 
Social Security Act is diiferent from the agency of the State designated 
42 use 602. 
pursuant to section 402(a) (3) of such Act, so much of paragraph (1) 
of section 422(a) of such Act as precedes siibparagraph {'[^) (as added 
"^''' ^' 
• 
by paragraph (2) of such subsection (d)) shall not apply with respect 
to such agencies but only so long as such agencies of the State are 
different, and (B) if on such date the local agency administering the 
plan of a State for child-welfare services developed under part B of 
title IV of the Social Security Act is different from the local agency 
in such subdivision administering the plan of such State under part A 
IL^^p ^9n^°^ ^^ ^^^^^ -^^^ ^^ sxwh Act, so much of such paragraph (1) as precedes 
such subparagraph (B) shall not apply with respect to such local 
agencies but only so long as such local agencies are different. 
(f) In the case of any State which has a plan developed as provided 
in part 3 of title Y of the Social Security Act as in effect prior to the 
42 usc'721-7^28. enactment of this Act— 
(1) such plan shall be treated as a plan developed, as provided 
in part B of title IV of such Act, on the date this Act is enacted: 
(2) any sums appropriated, allotted, or reallotted pursuant to 
part 3 of title V for the fiscal year ending June 30, 1968, shall be 
deemed appropriated, allotted, or reallotted (as the case may be) 
under part B of title IV of such Act for such fiscal year; and 
(3) any overpayment or underpayment which the Secretary 
determines was made to the State under section 523 of the Social 
Security Act and with respect to which adjustment has not then 
already been made under subsection (b) of such section shall, for 
Ante, pp. 912, 
purposes of sectiou 422 of such Act, be considered an overpayment 
or underpayment (as the case may be) made under section 422 
of such Act. 
(g) Any sums appropriated or grants made pursuant to section 526 
of the Social Security Act (as in effect prior to the enactment of this 
Act) shall be deemed to have been appropriated or made (as the case 
may be) under section 426 of the Social Security Act (as added by sub-
section (c) of this section). 
(h) Each State plan approved under title IV of the Social Security 
Act as in effect on the day preceding the date of the enactment of this 
Act shall be deemed, without the necessity of any change in such 
plan, to have been conformed with the amendments made by sub-
sections (a) and (b) of this section. 
CONrORMlNG AMENDMENTS 
42 use 428. 
SJ,C. 241. (a) Section 228(d)(1) of the Social Security Act is 
amended by striking out "IV,", and by inserting after "XVI," the fol-
lowing : "or part A of title IV,". 
(b) (1) The first sentence of section 401 of the Social Security Act 
is amended by striking out "title" and inserting in lieu thereof "part". 
(2) The proviso in section 403(a) (3) (D) of such Act is amended 
by striking out "title" and inserting in lieu thereof "part". 
(3) The last sentence of section 403(c) (2) of such Act is amended 
by striking out "title" and inserting in lieu thereof "part". 
(4) Section 404(b) of such Act is amended by striking out "title" 
and inserting in lieu thereof "part". 
42 use 606. 
^5^ Section 406 of such Act is amended by striking out "title" in 
the matter preceding subsection (a) and inserting in lieu thereof 
"part". 
42 use 726. 
42 u s e 601-609. 
42 u s e 601. 
42 u s e 60 3. 
42 use 604. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
917 
(c) (1) Section 1106(c) (1) of such Act is amended by striking ont 
^2 use isoe. 
"IV,", and by inserting after "XIX," the foUoAving: "or part A of title 
IV,". 
(2) Section 1109 of such Act is amended by strikhig out "IV,", 
42 use 1309. 
and by inserting after " X I X " the following: ", or part A of title IV,". 
(3) Section 1111 of such Act is amended by striking out "IV,", and 
"
^
^ use 1311. 
by inserting after "XVI," the following: "and i)art A of title IV,". 
(4) Section 1115 of such Act is amended by striking out "IV,", and 
"
^
^ use 1315. 
by inserting after "XIX" the following: ", or part A of title IV,". 
(5) Section 1116 of such Act is amended— 
42 use 13 le. 
(A) by striking out "IV," in subsection (a) (1), and by insert-
ing after "XIX," in such subsection the following: "or part A 
of title IV,"; a,nd 
(B) by striking out "IV," in subsections (b) and (d), and by 
inserting after " X I X " in such subsections the following: ", or 
part A of title IV,". 
(6) Section 1117 of such Act is amended— 
42 use 1317. 
(A) by striking out "IV," in clause (A) of subsection (a) (2), 
and by inserting after "XIX" in such clause the following: ", and 
part A of title IV,"; 
(B) by striking out "IV," each place it appears in subsection 
(b); 
. 
. 
. 
. 
(C) by inserting after "and X I X " in subsection (b) the fol-
lowing : ", and part A of title IV,"; 
(D) by inserting after "or X I X " in subsection (b) the follow-
ing : ", or part A of title IV". 
(7) Section 1118 of such Act is amended by striking out "IV,", and 
"
^
^ ^^^ ^^ ^8-
bv inserting after "XVI," the following: "and part A of title IV,". 
" (d) Section 1602(a) (11) of such Act is amended by striking out 
42 use 1382. 
"title IV, X, or X I V " and inserting in lieu thereof "part A of title IV 
or under title X or XIV". 
(e) (1) Section 1843(b) (2) of such Act is amended by striking out 
^2 use oesv. 
"IV,", and by inserting after "XVI" the following: ", and part A of 
title IV". 
(2) Section 1843(f) of such Act is amended— 
(A) by striking out "IV," in the first sentence, and by inserting 
after "XVI," the first place it appears in such sentence the fol-
lowing : "or part A of title IV,", and 
(B) by striking out "IV," in the second sentence, and by insert-
ing after "XVI" in such sentence the following: ", and part A of 
title IV". 
(f) (1) Section 1902(a) (10) of such Act is amended by striking out 
^^ use 1396a. 
"IV,", and by inserting after "XVI" the following: ", and part A of 
title IV". 
(2) Section 1902(a) (17) of such Act is amended by striking out 
"IV,", and by inserting after "XVI" the folloAving: ", or part A of 
title IV". 
(3) Section 1902(b)(2) of such Act is amended by striking out 
"title IV" and inserting in lieu thereof "part A of title IV". 
(4) Section 1902(c) of such Act is amended by striking out "IV,", 
and by inserting after "XVI" the following: ", or part A of title IV". 
(5) Section 1903(a)(1) of such Act is amended by striking out 
42 use 1396b. 
"IV,", and by inserting after "XVI," the following: "or part A of 
title IV,". 
(6) Section 1905(a) (ii) of such Act is amended by striking out 
^2 use i396d. 
"title IV" and inserting in lieu thereof "part A of title IV". 
918 
PUBLIC LAW 90-248-JAN. 2, 1968 
fel 
STAT. 
PART 4—MISCELLANEOUS AND TECHNICAL AMENDMENTS 
PARTIAL 
P A Y M E N T S 
TO 
STATES 
SEC. 245.'Sections 4, 404(a), 1004, and 1404 of the Social Security 
628^ 6
4
6
*
^
- ^^^' 
^^^ ^^^ each amended— 
64 Stat. 557. 
(1) by Striking out "further payments will not be made to the 
42 use 304, 
State" and inserting in lieu thereof "further payments will not be 
made to the State (or, ni his discretion, that payments will be 
limited to categories under or parts of the State plan not affected 
by such failure)"; and 
(2) by striking out the last sentence and inserting in lieu 
thereof the following: "Until he is so satisfied he shall make no 
further payments to such State (or shall limit payments to cate-
gories under or parts of the State plan not affected by such 
failure)." 
604, 
1204, 1354. 
70 Stat. 851. 
42 u s e 1310. 
76 Stat. 192. 
42 u s e 1315. 
Ante, 
p. 94. 
76 Stat. 206. 
42 u s e 1308. 
CONTRACTS FOR COOPERATIVE RESEARCH OR DEMONSTRATION PROJECTS 
SEC. 246. Section 1110(a) (2) of the Social Security Act is amended 
by striking out "nonprofit". 
PERMANENT AUTHORITY IT) SUPPORT DEMONSTRATION 
PROJECTS 
SEC. 247. Section 1115 of the Social Security Act is amended— 
(1) by striking out "$2,000,000" and inserting in lieu thereof 
"$4,000,000" • and 
(2) by striking out "ending prior to July 1,1968" and inserting 
in lieu thereof "beginning after June 30, 1967". 
SPECIAL PROVISIONS RELATING TO PUERTO RICO, T H E VIRGIN ISLANDS, 
AND GUAM 
SEC 248. (a)(1) Section 1108 of the Social Security Act is amended 
to read as follows: 
" L I M I T A T I O N 
O N 
P A Y M E N T S TO PUERTO RICO, T H E VIRGIN ISLANDS, 
AND GUAM 
"SEC. 1108. (a) The total amount certified by the Secretary of 
Health, Education, and Welfare under title I, X, XIV, and XVI, and 
1
2
0
^
1 "fssf^ 1381- ^^^^6^ P^^t A of title IV (exclusive of any amounts on account of 
Ante. p. 911. 
' scTvlces aud itcms to whicli subsection (b) appHes)— 
" (1) for payment to Puerto Rico shall not exceed— 
" (A) $12,500,000 with respect to the fiscal year 1968, 
"(B) $15,000,000 with respect to the fiscal year 1969, 
"(C) $18,000,000 with respect to the fiscal year 1970, 
"(D) $21,000,000 with respect to the fiscal year 1971, or 
"(E) $24,000,000 with respect to the fiscal year 1972 and 
each fiscal year thereafter; 
"(2) for payment to the Virgin Islands shall not exceed— 
"(A) $425,000 with respect to the fiscal year 1968, 
"(B) $500,000 with respect to the fiscal year 1969, 
"(C) $600,000 with respect to the fiscal year 1970, 
"(D) $700,000 with respect to the fiscal year 1971, or 
"(E) $800,000 with respect to the fiscal year 1972 and each 
fiscal year thereafter; and 
"(3) for payment to Guam shall not exceed— 
"(A) $575,000 with respect to the fiscal year. 1968, 
42 u s e 60 1-609. 
Ante, 
p. 911. 
42 
712. 
An 
use 
te. 
Post, 
P-
P-
70 2, 
912. 
9 22. 
81 STAT.] 
PUBLIC LAW 9 0 - 2 4 8 - J A N . 2, 1968 
919 
"(B) $69(),()0() with respect to the fiscal year 1969, 
"(C) $825,000 Avith respect to the fiscal year 1970, 
"(I)) $960,000 with respect to the fiscaf year 1971, or 
"(p]) $1,100,000 with respect to the fiscal year 1972 and 
each fiscal year thereafter. 
"(b) The total amount ceilified by the Secretary under part A of 
title IV, on account of family planning services and services provided 
under section 402(a) (19) with respect to any fiscal year— 
Ante, p. 89o. 
"(1) for payment to Puerto Rico shall not exceed $2,000,000, 
"(2) for payment to the Virgin Islands shall not exceed 
$65,000, and 
"(3) for payment to Guam shall not exceed $90,000. 
"(c) The total amount certified by the Secretary under title X I X ^ggg"^*^ ^^'^^" 
with respect to any fiscal year— 
Ante, pp. QO3-
"(1) f«r payment to Puerto Rico shall not exceed $20,000,000, ^os. 
"(2) for payment to the Virgin Islands shall not exceed 
$650,000, and 
" (3) for payment to Guam shall not exceed $900,000. 
"(d) Notwithstanding the provisions of sections 502(a) and 512(a) 
of this Act, and the provisions of sections 421, 503(1), and 504(1) of 
this Act as amended by the Social Security Amendments of 1967, 
and until such time as the Congress may by appropriation or other 
law otherwise provide, the Secretary shall, in lieu of the initial allot-
ment specified in such sections, allot such smaller amounts to Guam 
as he may deem appropriate." 
(2) The amendment made by paragraph (1) shall apjjly with 
respect to fiscal years beginning after June 30,1967. 
(D) Notwithstanding subparagraphs (A) and (B) of section 403 
(a) (3) of such Act (as amended by this Act), the rate specified in 
^"'^' P- ^'^^• 
such subparagraphs in the case of Puerto Rico, the Virgin Islands, 
and Guam shall be 60 per centum (rather than 75 or 85 per centum). 
(c) Effective July 1, 1969, neither the provisions of clauses (A) 
through (C) of section 402(a) (7) of such Act as in effect before the 
enactment of this Act nor the provisions of section 402(a) (8) of such 
'^^ ^^^ ^°^'-
Act as amended by section 202(b) of this Act shall apply in the case of 
'*"^®' P- ^S^-
Puerto Rico, the Virgin Islands, or Guam. Effective no later than 
July 1, 1972, the State plans of Puerto Rico, the Virgin Islands, and 
Guam approved under section 402 of such Act shall provide for the 
disregarding of income in making the determination under section 
402(a) (7) of such Act in amounts (agreed to between the Secretary 
and the State agencies involved) sufficiently lower than the amounts 
specified in section 402(a) (8) of such Act to reflect appropriately the 
applicable differences in income levels. 
(d) The amendment made by section 220(a) of this Act shall not 
'^"'^' P- ^^^• 
apply in the case of Puerto Rico, the Virgin Islands, or Guam. 
(e) Effective with respect to quarters after 1967, section 1905(b) 
of such Act is amended by striking out "55 per centum" and inserting 
^^ stat. 352. 
in lieu thereof "50 per centum". 
APPROVAL OF CERTAIN 
PROJECTS 
SEC. 249. Title X I of the Social Security Act is amended by adding 
at the end thereof (after the new section added by section 209 of this 
Act) the following new section: 
^"'e, p. 894. 
<
c 
APPROVAL OF CERTAIN PROJECTS 
"SEC. 1120. (a) No payment shall be made under this Act with 
respect to any experimental, pilot, demonstration, or other project all 
or any part of which is wholly financed with Federal funds made avail-
able under this Act (without any State, local, or other non-Federal 
920 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
financial participation) unless such project shall have been personally 
approved by the Secretary or Under Secretary of Health, Education, 
and Welfare. 
"(b) As soon as possible after the approval of any project under 
subsection (a), the Secretary shall submit to the Congress a description 
of such project including a statement of its purpose, probable cost, and 
expected duration." 
ASSISTANCE I N THE FORM OF INSTITUTIONAL SERVICES I N INTERMEDIATE 
CARE FACILITIES 
SEC. 250. (a) Title X I of the Social Security Act (as amended by 
Ante. pp. 894, 
sectious 209 and 249 of this Act) is further amended by adding at the 
end thereof the following new section: 
" A S S I S T A N C E I N T H E F O R M O F INSTITUTIONAL SERVICES I N INTERMEDIATE 
CARE FACILITIES 
42 u s e 301. 
42 u s e 1201. 
42 u s e 1351. 
"SEC. 1121. (a) Any State which has in effect a plan for old-age 
assistance, approved under title I, a plan for aid to the blind, approved 
under title X, a plan for aid to the permanently and totally disabled, 
approved under title XrV, or a plan for aid to the aged, blind, or 
42 use 1381. 
disabled, approved under title XVI, may, on or after January 1,1968, 
modify such plan to include therein benefits in the form of institu-
tional services in intermediate care facilities for individuals who are 
entitled (or would, if not receiving institutional services in inter-
mediate care facilities, be entitled) to assistance, under such plan, in 
the form of money payments. 
"(b) Any modification pursuant to subsection (a) shall provide 
that benefits in the form of institutional services in intermediate care 
facilities will be provided only to individuals who— 
"(1) are entitled (or would, if not receiving institutional serv-
ices in intermediate care facilities, be entitled) to receive aid or 
assistance, under the State plan, in the form of money payments; 
"(2) because of their physical or mental condition (or both), 
require living accommodations and care which, as a practical 
matter, can be made available to them only through institutional 
facilities; and 
" (3) do not have sucli an illness, disease, injury, or other condi-
tion as to require the degree of care and treatment which a hos-
pital or skilled nursing home (as that term is employed in title 
X I X ) is designed to provide. 
908. 
"" 
"(c) Payments to any State which modifies its approved State plan 
(referred to in subsection (a)) to provide, to the recipients of aid or 
assistance thereunder, benefits in the form of institutional services in 
intermediate care facilities shall be made in the same manner and 
from the same appropriation as payments made with respect to expen-
ditures under the State plan so modified, except that, with respect to 
expenditures made by the State in paying the cost of benefits in the 
form of institutional services in intermediate care facilities for any 
quarter, the Secretary shall, if the State so elects, pay to each State 
an amount equal to the Federal medical assistance percentage (as de-
fined in section 1905 (b)). 
"(d) Except when inconsistent with the purposes of this section or 
contrary to any provision of this section, any modification, pursuant to 
this section, of an approved State plan shall be subject to the same 
conditions, limitations, rights, and obligations as obtain with respect 
to such approved State plan. 
42 u s e 1396. 
Ante, 
pp. 903-
42 u s e 1396d. 
Ante, 
p. 919. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
921 
" (e) For purposes of this section, the term 'intermediate care facil-
ity' means an institution or distinct part thereof which (1) is licensed, 
under State law, to provide the patients or residents thereof, on a 
regular basis, the range or level of care and services which is suitable 
to the needs of individuals described in subsection (b) (2) and (3), 
but which does not provide the degree of care required to be provided 
by a skilled nursing home furnishing services under a State plan 
approved under title X I X , and (2) meets such standards of safety 
and sanitation as are applicable to nursing homes under State 
law; except that in no case shall such term include an institution which 
does not regularly provide a level of care and service beyond room and 
board. The term 'intermediate care facility' also includes a Christian 
Science sanatorium operated, or listed and certified, by the First 
Church of Christ, Scientist, Boston, Massachusetts, but only with re-
spect to institutional services deemed appropriate by the State." 
"Intermediate 
care facility," 
42 u s e 1396-
1396d. 
Ante, 
pp. 90 3-
908. 
TITLE III—IMPKOVEMENT OF CHILD HEALTH 
COXSOLlDATION OF SEPARATE PROGRAMS UNDER TITLE V OF T H E 
SOCIAL SECURITY ACT 
SEC. 301. Effective with respect to fiscal years beginning after 
June 30,1968, title V of the Social Security Act (as otherwise amended 
by this Act) is amended to read as follows: 
"TITLE V—MATERNAL AND CHILD H E A L T H AND 
CRIPPLED CHILDREN'S SERVICES 
Child Health 
Act of 1967. 
49 Stat. 629. 
42 USC701-731. 
Ante, 
p. 9 15. 
Post, 
p. 929. 
''AUTHORIZATIOlSr OF APPROPRIATIONS 
"SEC. 501. For the purpose of enabling each State to extend 
and improve (especially in rural areas and in areas suffering from 
severe economic distress), as far as practicable under the conditions in 
such State, 
" (1) services for reducing infant mortality and otherwise pro-
moting the health of mothers and children; and 
"(2) services for locating, and for medical, surgical, corrective, 
and other services and care for and facilities for diagnosis, hos-
pitalization, and aftercare for, children who are crippled or who 
are suffering from conditions leading to crippling, 
there are authorized to be appropriated $250,000,000 for the fiscal year 
ending June 30, 1969, $275,000,000 for the fiscal year ending June 30, 
1970, $300,000,000 for the fiscal year ending June 30, 1971, $325,000,-
000 for the fiscal year ending June 30, 1972, and $350,000,000 for the 
fiscal year ending June 30, 1973, and each fiscal year thereafter. 
li P U R P O S E S F O R W H I C H FUNDS ARE AVAILABLE 
"SEC. 502. Appropriations pursuant to section 501 shall be available 
for the following purposes in the following proportions: 
" (1) In the case of the fiscal year ending June 30,1969, and each 
of the next 3 fiscal years, (A) 50 percent of the appropriation for 
such year shall be for allotments pursuant to sections 503 and 
.504; (B) 40 percent thereof shall be for grants pursuant to sec-
tions 508, 509. and 510; and (C) 10 percent thereof shall be for 
grants, contracts, or other arrangements pursuant to sections 
511 and 512. 
" (2) In the case of the fiscal year ending June 30,1973, and each 
fiscal year thereafter, (A) 90 percent of the appropriation for 
such years shall be for allotments pursuant to sections 503 and 
922 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
504; and (B) 10 percent thereof shall be for o-rants, contracts, or 
other arrangements pursnant to sections 511 and ol'2. 
Xot to exceed 5 percent of the appropriation for any fiscal 3-ear inider 
this section shall be transferred, at the reqnest of the Secretary, from 
one of the purposes specified in parap*aph (1) or (2) to another ]nir-
pose or purposes so specified. For each fiscal year, the Secretary shall 
determine the portion of the appropriation, AAithin the percentag:e 
determined above to be available for sections 508 and 504, which shall 
be available for allotment pursuant to section 503 and the poi-tion 
thereof which shall be available for allotment pursuant to section 504. 
Xotwithstandin^ the ])recedin^ provisions of this section, of the 
amount appropriated for any fiscal year pursuant to section 501, not 
less than 6 percent of the amount a])propriated shall be available for 
family planning services from allotments under section 503 and for 
family planning services under projects under sections 508 and 512. 
a 
ALLOTMEXTS TO STATES I'^OR :MATERXA1. A X D CHILD TIEAI/ril SERVICES 
"SEC. 503. The amount determined to be available pursuant to section 
502 for allotments under this section shall be allotted for })ayments for 
maternal and child health services as follows: 
"(1) One-half of such amount shall be allotted by allottino; to 
each State $70,000 plus such part of the remainder of such one-
half as he finds that the number of live births in such State bore 
to the total number of live births in the United States in the 
latest calendar year for which he has statistics. 
"(2) The remaining one-half of such amount shall (in addition 
to the allotments under paragraph (1)) be allotted to the States 
from time to time according to the financial need of each State 
for assistance in carrying out its State plan, as determined by the 
Secretary after taking into consideration the number of live births 
in such State; except that not more than 25 percent of such one-
half shall be available for grants to State agencies (administering 
or supervising the administration of a State plan approved under 
section 505), and to public or other nonprofit institutions of higher 
learning (situated in any State), for special projects of regional 
or national significance which may contribute to the advance-
ment of maternal and child health. 
" A L L O T M E N T S TO STATES FOR CRIPrLED C H I L D R E N ' S SERVICES 
"SEC. 504. The amount determined to be available pursuant to sec-
tion 502 for allotments under this section shall be allotted for payments 
for crippled children's services as follows: 
"(1) One-half of such amount shall be allotted by allotting to 
each State $70,000 and allotting the remainder of such one-half 
according to the need of each State as determined by him after 
taking into consideration the number of crippled children in such 
State in need of the services referred to in paragraph (2) of sec-
tion 501 and the cost of furnishing such services to them. 
"(2) The remaining one-half of such amount shall (in addi-
tion to the allotments under paragraph (1)) be allotted to the 
States from time to time according to the financial need of each 
State for assistance in carrying out its State plan, as determined 
by the Secretary after taking into consideration the number of 
crippled children in each State in need of the services referred 
to in paragraph (2) of section 501 and the cost of furnishing such 
services to them; except that not more than 25 percent of such 
one-half shall be available for grants to State agencies (adminis-
tering or supervising the administration of a State plan ap-
42 u s e 713. 
Post, p. 929. 
81 STAT,] 
PUBLIC LAW 90-248-JAN. 2, 1968 
923 
proved under section 505), and to public or otlier nonprofit insti-
tutions of higher learning (situated in any State), for special 
projects of regional or national significance which may contribute 
to the advancement of services for crippled children. 
"APPROVAL OF STATE PLANS 
"SEC. 505. (a) In order to be entitled to payments from allotments 
under section 502, a State must have a State plan for maternal and 
child health services and services for crippled children which— 
"(1) provides for financial participation by the State; 
"(2) provides for the administration of the plan by the State 
health agency or the supervision of the administration of the plan 
by the State health agency; except that in the case of those States 
w4iich on July 1, 1967, provided for administration (or super-
vision thereof) of the State plan approved under section 518 (as 
in eifect on such date) by a State agency other than the State 
health agency, the plan of such State may be approved under this 
section if it would meet the requirements of this subsection except 
for provision of administration (or supervision thereof) by such 
other agency for the portion of the plan relating to services for 
crippled children, and, in each such case, the portion of such plan 
which each such agency administers, or the administration of 
which each such agency supervises, shall be regarded as a separate 
plan for purposes of this title; 
"(3) provides such methods of administration (including meth-
ods relating to the establishment and maintenance of personnel 
standards on a merit basis, except that the Secretary shall exercise 
no authority with respect to the selection, tenure of office, and 
compensation of any individual employed in accordance with 
such methods) as are necessary for the proper and efficient opera-
tion of the plan; 
"(4) provides that the State agency wdll make such reports, in 
such form and containing such information, as the Secretary may 
from time to time require, and comply w^ith such provisions as he 
may from time to time find necessary to assure the correctness and 
verification of such reports; 
"(5) provides for cooperation with medical, health, nursing, 
educational, and w^elfare groups and organizations and, with re-
spect to the portion of the plan relating to services for crippled 
children, with any agency in such State charged with administer-
ing State laws providing for vocational rehabilitation of physi-
cally handicapped children; 
"(6) provides for payment of the reasonable cost (as deter-
mined in accordance with, standards approved by the Secretary 
and included in the plan) of inpatient hospital services provided 
under the plan; 
"(7) provides, with, respect to the portion of the plan relating 
to services for crippled children, for early identification of chil-
dren in need of health care and services, and for health care and 
treatment needed to correct or ameliorate defects or chronic con-
ditions discovered thereby, through provision of such periodic 
screening and diagnostic services, and such treatment, care and 
other measures to correct or ameliorate defects or chronic condi-
tions, as may be provided in regulations of the Secretary; 
"(8) effective July 1, 1972, provides a program (carried out 
directly or through grants or contracts) of projects described 
in section 508 which offers reasonable assurance, particularly in 
areas with concentrations of low-income families, of satisfactorily 
924 
PUBLIC LAW 90-248-JAN. 2, 1968 
[sl STAT. 
lielping to reduce the incidence of mental retardation and other 
handicapping conditions caused by complications associated with 
child bearing and of satisfactorily helping to reduce infant and 
maternal mortality; 
"(9) effective July 1, 1972, provides a program (carried out 
directly or through grants or contracts) of projects described in 
section 509 which offers reasonable assurance, particularly in areas 
with concentrations of low-income families, of satisfactorily 
promoting the health of children and youth of school or preschool 
age; 
"(10) effective July 1, 1972, provides a program (carried o\U 
directly or through grants or contracts) of projects described in 
section 510 which offers reasonable assurance, particularly in areas 
w^ith concentrations of low-income families, of satisfactorily 
promoting the dental health of children and youth of school or 
preschool age; 
"(11) provides for carrying out the purposes specified in sec-
tion 501; 
"(12) provides for the development of demonstration services 
(with special attention to dental care for children and family 
planning services for mothers) in needy areas and among groups 
in special need, 
"(18) provides that, where payment is authorized under the 
plan for services which an optometrist is licensed to perform, the 
individual for whom such payment is authorized may, to the ex-
tent practicable, obtain such services from an optometrist licensed 
to perform such services except where such services are rendered 
in a clinic, or another appropriate institution, which does not liave 
an arrangement with optometrists so licensed; and 
" (14) provides that acceptance of family planning services pro-
vided under the plan shall be voluntary on the part of the individ-
ual to wdiom such services are offered and shall not be a pre-
requisite to eligibility for or the receipt of any service under the 
plan. 
"(b) The Secretary shall approve anj' plan which meets the require-
ments of subsection (a). 
"PAYMENTS 
"SEC. 506. (a) From the sums appropriated therefor and the allot-
ments available under section 503(1) or 504(1), as the case may be, 
the Secretary shall pay to each State which has a ])lan approved under 
this title, for each quarter, beginning with the quarter commencing 
July 1, 1968, an amount, which shall be used exclusively for carrying 
out the State plan, equal to one-half of the total sum expended during 
such quarter for carrying out such plan with respect to maternal and 
child health services and services for crippled children, respectively. 
"(b) (1) Prior to the beginning of each quarter, the Secretary shall 
estimate the amount to which a State will be entitled under subsec-
tion (a) for such quarter, svich estimates to be based on (A) a report 
filed by the State containing its estimate of the total sum to be ex-
pended in such quarter in accordance with the provisions of such sub-
section, and stating the amount appropriated or made available by 
the State and its political subdivisions for such expenditures in such 
quarter, and if such amount is less than the State's proportionate share 
of the total sum of such estimated expenditures, the source or sources 
from which the difference is expected to be derived, and (B) such other 
investigation as the Secretary may find necessary. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
925 
"(2) The Secretary shall then pay to the State, in such mstallments 
as he may determine, the amount so estimated, reduced or increased 
to the extent of any overpayment or underpayment which the Secre-
tary determines was made under this section to such State for any prior 
quarter and with respect to which adjustment has not gtlready been 
made under this subsection. 
"(3) Upon the making of an estimate by the Secretary under this 
subsection, any appropriations available for payments under this sec-
tion shall be deemed obligated. 
"(c) The Secretary shall also from time to time make payments to 
the States from their respective allotments j)ursuant to section 503(2) 
or 604(2). Payments of grants under sections 503(2), 504(2), 508, 
509, 510, and 511, and of grants, contracts, or other arrangements 
under section 512, may be made in advance or by way of reimburse-
ment, and in such installments, as the Secretary may determine; and 
shall be made on such conditions as the Secretary finds necessary to 
carry out the purposes of the section involved. 
"(d) The total amount determined under subsections (a) and (b) 
and the first sentence of subsection (c) for any fiscal year ending after 
June 30, 1968, shall be reduced by the amount by which the sum ex-
pended (as determined by the Secretary) from non-Federal sources 
for maternal and child health services and services for crippled chil-
dren for such year is less than the sum expended from such sources for 
such services for the fiscal year ending June 30, 1968. In the case of 
any such reduction, the Secretary shall determine the portion thereof 
which shall be applied, and the manner of applying such reduction, to 
the amounts otherwise payable from allotments under section 503 or 
section 504. 
"(e) Notwithstanding the preceding provisions of this section, no 
payment shall be made to any State thereunder from the allotments 
under section 503 or section 504 for any period after June 30, 1968, 
unless the State makes a satisfactory showing that it is extending the 
provision of services, including services for dental care for children 
and family planning for mothers, to which such State's plan applies in 
the State with a view to making such services available by July 1, 
1975, to children and mothers in all parts of the State. 
"orERATIOX o r STATE PLANS 
"SEC. 507. If the Secretary, after reasonable notice and opportunity 
for hearing to the State agency administering or supervising the ad-
ministration of the State plan approved under this title, finds— 
"(1) that the plan has been so changed that it no longer com-
plies with the provisions of section 505; or 
"(2) that in the administration of the plan there is a failure 
to comply substantially with any such provision; 
the Secretary shall notify such State agency that further payments 
will not be made to the State (or, in his discretion, that payments will 
be limited to categories under or parts of the State plan not affected 
by such failure), until the Secretary is satisfied that there will no 
longer be any such failure to comply. Until he is so satisfied he shall 
make no further payments to such State (or shall limit payments to 
categories under or parts of the State plan not affected by such 
failure). 
926 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
ii SPECIAL PROJECT GRANTS FOR MATERNITY AND INFANT CARE 
"SEC. 508. (a) In order to help reduce the incidence of mental re-
tardation and other handicapping conditions caused by complications 
associated with childbearing and to help reduce infant and maternal 
mortality, the Secretary is authorized to make, from the sums available 
under clause (B) of paragraph (1) of section 502, grants to the State 
health agency of any State and, with the consent of such agency, to 
the health agency of any political subdivision of the State, and to any 
other public or nonprofit private agency, institution, or organization, 
to pay not to exceed 75 percent of the cost (exclusive of general agency 
overhead) of any project for the provision of— 
"(1) necessary health care to prospective mothers (including, 
after childbirth, health care to mothers and their infants) who 
have or are likely to have conditions associated with childbearing 
or are in circumstances which increase the hazards to the health of 
the mothers or their infants (including those which may cause 
physical or mental defects in the infants), or 
"(2) necessary health care to infants during their first year of 
life who have any condition or are in circumstances which increase 
the hazards to their health, or 
"(3) family planning services, 
but only if the State or local agency determines that the recipient will 
not otherwise receive such necessary health care or services because 
he is from a low-income family or for other reasons beyond his control. 
Acceptance of family planning services provided under a project un-
der this section (and section 512) shall be voluntary on the part of the 
individual to whom such services are offered and shall not be a pre-
requisite to the eligibility for or the receipt of any service under such 
project. 
"(b) No grant may be made under this section for any project for 
any period after June 30,1972. 
" S P E C I A L P R O J E C T GRANTS FOR HEALTH OF SCHOOL AND PRESCHOOL 
CHILDREN 
"SEC. 509, (a) In order to promote the health of children and 
youth of school or preschool age, particularly in areas with concen-
trations of low-income families, the Secretary is authorized to make, 
from the sums available under clause (B) of paragraph (1) of sec-
tion 502, grants to the State health agency of any State and (with 
the consent of such agency) to the health agency of any political 
subdivision of the State, to the State agency of the State administer-
ing or supervising the administration of the State plan approved 
under section 505, to any school of medicine (with appropriate par-
ticipation by a school of dentistry), and to any teaching hospital 
affiliated with such a school, to pay not to exceed 75 percent of the 
cost of projects of a comprehensive nature for health care and services 
for children and youth of school age or for preschool children (to 
help them prepare to start school). No project shall be eligible for 
a grant under this section unless it provides (1) for the coordination 
of health care and services provided under it with, and utilization 
(to the extent feasible) of, other State or local health, welfare, and 
education programs for such children, (2) for payment of the rea-
sonable cost (as determined in accordance with standards approved 
by the Secretary) of inpatient hospital services provided under the 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
927 
project, and (3) that any treatment, correction of defects, or aftercare 
provided under tlie project is available only to children who would 
not otherwise receive it because they are from low-income families 
or for other reasons beyond their control; and no such project for 
children and youth of school age shall be considered to be of a com-
prehensive nature for purposes of this section unless it includes 
(subject to the limitation in the preceding provisions of this sentence) 
at least such screening, diagnosis, preventive services, treatment,, 
correction of defects, and aftercare, both medical and dental, as may 
be provided for in regulations of the Secretary. 
"(b) No grant may be made under this section for any project 
for any period after June 30, 1972. 
"SPECIAL PROJECT GRANTS FOR DENTAL HEALTH OF CHILDREN 
"SEC. 510. (a) In order to promote the dental health of children 
and youtJi of school or preschool age, particularly in areas with con-
centrations of low-income families, the Secretary is authorized to 
make grants, from the sums available under clause (B) of paragraph 
(1) of section 502, to the State health agency of any State and (with 
the consent of such agency) to the health agency of any political 
subdivision of the State, and to any other public or nonprofit private 
agency, institution, or organization, to pay not to exceed 75 percent 
of the cost of projects of a comprehensive nature for dental care and 
services for children and youth of school age or for preschool children. 
No project sliall be eligible for a grant under this section unless it 
provides that any treatment, correction of defects, or aftercare pro-
vided under the project is available only to children who would not 
otherwise receive it because they are from low-income families or for 
other reasons beyond their control, and unless it includes (subject to 
the limitation of the foregoing provisions of this sentence) at least 
such preventive services, treatment, correction of defects, and after 
care, for such age groups, as may be provided in regulations of the 
Secretary. Such projects may also include research looking toward the 
development of new methods of diagnosis or treatment, or demon-
stration of the utilization of dental personnel with various levels of 
training. 
"(b) No grant may be made under this section for any project for 
any period after June 30, 1972. 
(
(
< 
TRAINING or 
PERSONNEL 
"SEC. 511. From the sums available under clause (C) of paragraph 
(1) or clause (B) of paragraph (2) of section 502, the Secretary is 
authorized to make grants to public or nonprofit private institutions 
of higher learning for training personnel for health care and related 
services for mothers and children, particularly mentally retarded 
children and children with multiple handicaps. In making such 
grants, the Secretary shall give special attention to programs pro-
viding training at the undergraduate level. 
"RESEARCH PROJECTS RELATING TO MATERNAL AND CHILD HEALTH SERVICES 
AND C R I P P L E D CHILDREN'S SERVICES 
"SEC. 512. From the sums available under clause (C) of paragraph 
(1) or clause (B) of paragraph (2) of section 502, the Secretary is 
authorized to make grants to or jointly financed cooperative arrange-
85-622 0-68—61 
928 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
ments with public or other nonprofit institutions of higher learning, 
and public or nonprofit private agencies and organizations engaged 
in research or in maternal and child health or crippled children's pro-
grams, and contracts with public or nonprofit private agencies and 
organizations engaged in research or in such programs, for research 
projects relating to maternal and child health services or crippled 
children's services which show promise of substantial contribution to 
the advancement thereof. Effective wnth respect to grants made and 
arrangements entered into after June 30, 1968, (1) special emphasis 
shall be accorded to projects which will help in studying the need 
for, and the feasibility, costs, and effectiveness of, comprehensive 
health care programs in which maximum use is made of health per-
sonnel with varying levels of training, and in studying methods of 
training for such programs, and (2) grants under this section may 
also include funds for the training of health personnel for work in 
such projects. 
"ADMINISTRATION 
''SEC. 513. (a) The Secretary of Health, Education, and Welfare 
shall make such studies and investigations as will promote the efficient 
administration of this title. 
"(b) Such portion of the appropriations for grants under section 
501 as the Secretary may determine, but not exceeding one-half of 
1 jjercent thereof, shall be available for evaluation by the Secretary 
(directly or by grants or contracts) of the programs for which such 
appropriations are made and, in the case of allotments from any such 
appropriation, the amount available for allotments shall be reduced 
accordingly. 
"(c) Any agency, institution, or organization shall, if and to the 
extent prescribed by the Secretary, as a condition to receipt of grants 
under this title, cooperate with the State agency administering or 
supervising the administration of the State plan approved under title 
^g'^2 use 1396- 
X I X in the provision of care and services, available under a plan or 
Ante. pp. 90 3- 
project uuder this title, for children eligible therefor under such plan 
^08- 
approved under title XIX. 
"DEFINITION 
"SEC. 514. For purposes of this title, a crippled child is an indi-
vidual under the age of 21 who has an organic disease, defect, or con-
dition which may hinder the achievement of normal grow^th and 
development. 
"OBSERVANCE OF RELIGIOUS BELIEFS 
"SEC. 515. Nothing in this title shall be construed to require any 
State which has any plan or program approved under, or receiving 
financial support under, this title to compel any person to undergo 
any medical screening, examination, diagnosis, or treatment or to ac-
cept any other health care or services provided under such plan or 
program for any purpose (other than for the purpose of discovering 
and preventing the spread of infection or contagious disease or for 
the purpose of protecting environmental health), if such person ob-
jects (or, in case such person is a child, his parent or guardian ob-
jects) thereto on religious grounds." 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
929 
CONFORMING 
AMENDMENTS 
79 Stat. 351. 
42 u s e 1396d. 
Ante, 
p. 9 21. 
SEC. 302. (a) Section 1905(a)(4) of the Social Security Act is 
amended by inserting " ( A ) " after "(4)", and by inserting before the 
semicolon at the end thereof the following: "(B) effective July 1, 
1969, such early and periodic screening and diagnosis of individuals 
who are eligible under the plan and are under the age of 21 to ascer-
tain their physical or mental defects, and such health care, treatment, 
and other measures to correct or ameliorate defects and chronic con-
ditions discovered thereby, as may be provided in regulations of the 
Secretary". 
(b) Section 1902(a) (11) of such Act is amended by inserting " (A)" 
^2 use 1396a 
after "(11)'', and by inserting before the semicolon at the end thereof 
the following: ", and (B) effective July 1,1969, provide, to the extent 
pre.scribed by the Secretary, for entering into agreements, with any 
agency, institution, or organization receiving payments for part or all 
of the cost of plans or projects under title V, (i) providing for uti-
lizing such agency, institution, or organization in furnishing care and 
services which are available under such plan or project under title V 
and which are included in the State plan approved under this section 
and (ii) making such provision as may be appropriate for reimburs-
ing such agency, institution, or organization for the cost of any such 
care and services furnished any individual for which payment would 
otherwise be made to the State with respect to him under section 
1 9 0 3 " . 
42 u s e 1396b 
1 9 6 8 AUTHORIZATION FOR MATERNITY AND I N F A N T CARE PROJECTS 
SEC. 303. Section 531(a) of the Social Security Act is amended by 
H ^^^^ ^l^-
striking out "and $30,000,000 for each of the next three fiscal years^' 
and inserting in lieu thereof "$30,000,000 for each of the next 2 fiscal 
years, and $35,000,000 for the fiscal year ending June 30. 1968". 
T J S E OF SUBPROFESSIONAL STAFF AND VOLUNTEERS 
SEC. 304. (a) Section 505(a)(3) of the Social Security Act (as 
added by section 301 of this Act) is amended by— 
(1) striking out "provides" and inserting in lieu thereof "pro-
vides (A)"; 
(2) adding at the end before the semicolon the following: "and 
(B) provides for the training and effective use of paid subprofes-
sional staff, w^ith particular emphasis on the full-time or part-time 
employment of persons of low income, as community service aides, 
in the administration of the plan and for the use of nonpaid or 
partially paid volunteers in providing services and in assisting any 
advisory committees established by the State agency". 
(b) The amendment made by this section shall become effective 
July 1, 1969, or, if earlier (with respect to a State) on the date as 
of which the modification of the State plan to comply with such amend-
ment is approved. 
E X T E N S I O N 
O F D U E DATE FOR CHILD MENTAL H E A L T H REPORT 
SEC. 305. Section 231 (d) of the Social Security Amendments of 1965 
(Public Law 89-97) is amended by striking out the word "two" and 
"^^ ^
*
^
*
- ^eo. 
inserting in lieu thereof "three". 
note. "^^ ^"^^^ 
930 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
SHORT 
TITLE 
Citation o
f title. 
^^^ gQg r^^iis title may be cited as the "Child Health Act of 1967". 
TITLE IV—GENERAL PROVISIONS 
49 Stat. 635; 
79 Stat. 339. 
42 u s e 901-907. 
"Graduate 
school of social 
work." 
"Accredited." 
"Nonprofit. 
SOCIAL WORK MANPOWER AND 
TRAINING 
SEC. 401. Title VII of the Social Security Act is amended by adding 
at the end thereof the following new section: 
" G R A N T S 
F O R 
E X P A N S I O N AND DEVELOPMENT OF UNDERGRADUATE 
AND GRADUATE 
PROGRAMS 
"SEC. 707. (a) There is authorized to be appropriated $5,000,000 
for the fiscal year ending June 30, 1969, and $5,000,000 for each of 
the three succeeding fiscal years, for grants by the Secretary to public 
or nonprofit private colleges and universities and to accredited grad-
uate schools of social work or an association of such schools to meet 
part of the costs of development, expansion, or improvement of 
(respectively) undergraduate programs in social work and programs 
for the graduate training of professional social work personnel, 
including the costs of compensation of additional faculty and admin-
istrative personnel and minor improvements of existing facilities. Not 
less than one-half of the sums appropriated for any fiscal year under 
the authority of this subsection shall be used by the Secretary for 
grants with respect to undergraduate programs. 
"(b) In considering applications for grants under this section, the 
Secretary shall take into account the relative need in the States for 
personnel trained in social work and the effect of the grants thereon. 
"(c) Payment of grants under this section may be made (after 
necessary adjustments on account of previously made overpayments 
or underpayments)-in advance or by way of reimbursement, and on 
such terms and conditions and in such installments, as the Secretary 
may determine. 
"(d) For purposes of this section— 
"(1) the term 'graduate school of social work' means a de-
partment, school, division, or other administrative unit, in a 
public or nonprofit private college or university, which provides, 
primarily or exclusively, a program of education in social work 
and allied subjects leading to a graduate degree in social work; 
"(2) the term 'accredited' as applied to a graduate school of 
social work refers to a school which is accredited by a body or 
bodies approved for the purpose by the Commissioner of Educa-
tion or with respect to which there is evidence satisfactory to the 
Secretary that it will be so accredited within a reasonable time; 
and 
"(3) the term 'nonprofit' as applied to any college or univer-
sity refers to a college or university which is a corporation or asso-
ciation, or is owned and operated by one or more corporations or 
associations, no part of the net earnings of which inures, or may 
lawfully inure, to the benefit of any private shareholder or 
individual." 
INCENTIVES FOR ECONOMY W H I L E MAINTAINING OR IMPROVING QUALITY 
I N T H E PROVISION OF H E A L T H 
SERVICES 
SEC. 402. (a) The Secretary of Health, Education, and Welfare 
is authorized to develop and engage in experiments under which 
physicians who would otherwise be entitled to receive payment on the 
basis of reasonable charge, and organizations and institutions which 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
931 
would otherwise be entitled to reimbursement or payment on the basis 
of reasonable cost, for services provided— 
(1) under title X V I I I of the Social Security Act, 
42 use 1395. 
(2) under a State plan approved under title X I X of such 
A c t , o r 
42 use 1396. 
(3) under a plan developed under title V of such Act, 
QOI"'^' ^^' ^^^' 
and which are selected by the Secretary in accordance with regulations 
Ante. p. 921. 
established by the Secretary, would be reimbursed or paid in any 
manner mutually agreed upon by the Secretary and the physician, 
organization, or institution. The method of payment (in the case of 
physicians) or reimbursement (in the case of an organization or in-
stitution) which may be applied in such experiments shall be such as 
the Secretary may select and may be based on charges or costs ad-
justed by incentive factors and may include specific incentive pay-
ments or reductions of payments for the performance of specific ac-
tions but in any case shall be such as he determines may, through ex-
geriment, be demonstrated to have the effect of increasing the ef-
ciency and economy of health services through the creation of addi-
tional incentives to these ends without adversely affecting the quality 
of such services. 
(b) In the case of any experiment under subsection (a), the Sec-
retary may waive compliance with the requirements of titles XVIII, 
X I X , and V of the Social Security Act insofar as such requirements 
relate to reimbursement or payment on the basis of reasonable cost, or 
(in the case of physicians) on the basis of reasonable charge; and 
costs incurred in such experiment in excess of the costs which would 
otherwise be reimbursed or paid under such titles may be reimbursed 
or paid to the extent that such waiver applies to them (with such ex-
cess being borne by the Secretary). No experiment shall be engaged 
in or developed under subsection ca) until the Secretary obtains the 
advice and recommendations of specialists who are competent to evalu-
ate the proposed experiment as to the soundness of its objectives, the 
possibilities of securing productive results, the adequacy of resources 
to conduct the proposed experiment, and its relationship to other simi-
lar experiments already completed or in process. 
(c) Section 1875(b) of the Social Security Act is amended by in- 79 stat. 332.^^ 
serting after "under parts A and B " the following: "(including the '^^ "^^ ^^^^ 
experimentation authorized by section 402 of the Social Security 
Amendments of 1967)". 
CHANGES TO REFLECT CODIFICATION OF TITLE 5 , UNITED STATES CODE 
42 u s e 410. 
SEC. 403. (a) (1) Section 210(a) (6) (C) (iv) of the Social Security 
Act is amended by striking out "under section 2 of the Act of A u ^ s t 4, 
1947" and inserting in lieu thereof "under section 5351(2) of title 5, 
United States Code", and by striking out "; 5 U.S.C, sec. 1052". 
(2) Section 210(a) (6) (C) (vi) of such Act is amended by striking 
out "the Civil Service Retirement Act" and inserting in lieu thereof 
"subchapter I I I of chapter 83 of title 5, United States Code,". 
(3) Section 210(a) (7) (D) (ii) of such Act is amended by striking 
out "under section 2 of the Act of August 4, 1947" and inserting in lieu 
thereof "under section 5351(2) of title 5, United States Code", and by 
striking out"; 6 ll.S.C. 1052". 
(b) Section 215(h) (1) of such Act is amended— 
'*2 use 4i5. 
(1) by striking out "of the C'ivil Service Retirement Act," and 
inserting in lieu thereof "of subchapter I I I of chapter 83 of title 
5, United States Code,"; and 
42 use 417. 
42 use 907. 
932 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
(2) by striking out "under the Civil Service Retirement Act" 
and inserting in lieu thereof "under subcliapter 111 of cliapter SH 
of title 5, United States Code,''. 
(c)(1) Section 217(f)(1) of such Act is amended— 
(A) by striking out "the Civil Service Retirement Act of May 
29, 1930, as amended," and inserting in lieu thereof "subchapter 
I I I of chapter 83 of title 5, United States Code,"; and 
(B) by striking out "such Act of May 29, 1930, as amended," 
and inserting in lieu thereof "such subchapter III". 
(2) Section 217(f) (2) of such Act is amended by striking out "the 
Civil Service Retirement Act of May 29, 1930, as amended," and in-
serting in lieu thereof "subchapter I I I of chapter 83 of title 5, United 
States Code,". 
(d) (1) Section 706(b) of such Act is amended by striking out "the 
civil service laws" and inserting in lieu thereof "the provisions of title 
5, United States Code, governing appointments in the competitive 
service". 
(2) Section 706(c) (2) of such Act is amended by striking out "sec-
tion 5 of the Administrative Expenses Act of 1946 (5 U.S.C. 73b-2)" 
and inserting in lieu thereof "section 5703 of title 5, United States 
Code,". 
42 use 1314. 
(e) (1) Section 1114(b) of such Act is amended by striking out "the 
civil-service laws" and inserting in lieu thereof "the provisions of title 
5, United States Code, governing appointments in the competitive 
service". 
(2) Section 1114(f) of such Act is amended by striking out "the 
civil-service laws" and inserting in lieu thereof "the provisions of title 
5, United States Code, governing appointments in the competitive 
service". 
(3) Section 1114(g) of such Act is amended by striking out "sec-
tion 5 of the Administrative Expenses Act of 1946 (5 U.S.C. 73b-2)" 
and inserting in lieu thereof "section 5703 of title 5, United States 
Code.". 
42 use 1361. 
(f) (1) Section 1501 (a) (6) of such Act is amended by striking out 
"the Civil Service Retirement Act of 1930" and inserting in lieu there-
of "subchapter III of chapter 83 of title 5, United States Code,". 
(2) Section 1501(a)(9) of such Act is amended by striking out 
"under section 2 of the Act of August 4, 1947" and inserting in lieu 
thereof "under section 5351(2) of title 5, United States Code", and 
by striking out"; 5 U.S.C, sec. 1052". 
42 use 1395s. 
(g) (1) Section 1840(e) (1) of such Act is amended by striking out 
"the Civil Service Retirement Act, or other Act" and inserting in lieu 
thereof "subchapter I I I of chapter 83 of title 5, United States Code, 
or any other law". 
(2) Section 1840(e)(2) of such Act is amended by striking out 
"such other Act" and inserting in lieu thereof "such other law". 
(h) Section 103(b) (3) of the Social Security Amendments of 1965 
is amended— 
(1) by striking out "the Federal Employees Health Benefits 
Act of 1959" in subparagraph (A) and inserting in lieu thereof 
"chapter 89 of title 5, United States Code"; and 
(2) by striking out "such Act" in subparagraph (C) and in-
serting in lieu thereof "such chapter". 
(i) (1) Section 3121(b) (6) (C) (iv) of the Internal Revenue Code 
of 1954 is amended by striking out "under section 2 of the Act of 
August 4, 1947" and inserting in lieu thereof "under section 5351(2) 
79 Stat. 333. 
42 use 426a. 
68 Stat. 109 2. 
70 Stat. 840. 
79 Stat. 389. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
933 
of title 5, United States Code", and by striking out "; 5 U.S.C., sec. 
1052". 
(2) Section 3121(b) (6) (C) (vi) of such Code is amended by strik-
ing out "the Civil Service Retirement Act" and inserting in lieu thereof 
"subchapter I I I of chapter 83 of title 5, LTnited States Code,". 
(3) Section 3121(b) (7) (C) (ii) of such Code is amended by strik-
ing out "under section 2 of the Act of August 4, 1947" and inserting 
in lieu thereof "under section 5351(2) of title 5, Ignited States Code", 
and by striking out"; 5 U.S.C. 1052". 
MEANING o r 
SECRETARY 
SEC. 404. As used in the amendments made by this Act (unless the 
"Secretary." 
context otherwise requires), the term "Secretary" means the Secretary 
of Health, Education, and Welfare. 
STUDY OF RETIREMENT TEST AND OF DRUG STANDARDS AND COVERAGE 
SEC. 405. (a) The Secretary of Health, Education, and Welfare is 
authorized and directed to study (1) the existing retirement test and 
proposals for the modification of such test (including proposals for an 
increase in old-age insurance benefit amounts on account of delayed 
retirement), (2) quality and cost standards for drugs for which pay-
ments are made under the Social Security Act, and (3) the coverage 
'^'^ "sc laos. 
of drugs under part B of title X V I I I of such Act. 
42 use i395j-
(b) On or before January 1, 1969, the Secretary shall transmit to ^^Re^^^t to Presi-
the President and the Congress a report which shall contain his find- dentandcongress. 
ings of fact and any conclusions or recommendations he may have. 
TITLE y—MISCELLANEOUS PROVISIONS 
E X T E N S I O N 
O F 
P E R I O D 
F O R 
F I L I N G APPLICATION FOR E X E M I T I O N 
BY 
MEMBERS OF RELIGIOUS GROUPS OPPOSED TO INSURANCE 
SEC. 501. (a) Section 1402(h) (2) of the Internal Revenue Code of 
1954 (relating to time for filing applications by members of certain 
religious faiths) is amended to read as follows: 
^9 stat. 391. 
"(2) TIME FOR FILING APPLICATION.—For purposes of this sub-
section, an application must be filed— 
"(A) In the case of an individual who has self-employ-
ment income (determined without regard to this .subsection 
and subsection (c) (6)) for any taxable year ending before 
^^ ^*^'- ^^°-
December 31, 1967, on or before December 31, 1968, and 
"(B) In any other case, on or before the time prescribed 
for filing the return (including any extension thereof) for 
the first taxable year ending on or after December 31, 1967, 
for which he has self-employment income (as so determined), 
except that an application filed after such date but on or 
before the last dav of the third calendar month following 
the calendar month in which the taxpayer is first notified in 
Avriting by the Secretary or his delegate that a timely appli-
cation for an exemption from the tax imposed by this chapter 
has not been filed by him shall be deemed to be filed timely." 
(b) The amendment made by subsection (a) shall apply with re-
spect to taxable years beginning after December 31, 1950. For such 
purpose, chapter 2 of the Internal Revenue Code of 1954 shall be yo^lfat^'fVs^^^' 
treated as applying to all taxable years beginning after such date. 
26 use 1401-
(c) If refund or credit of any overpayment resulting from the ^'^°^-
enactment of this section is prevented on the date of the enactment 
of this Act or at any time on or before December 31, 1968, by the 
68A Stat. 797. 
934 
PUBLIC LAW 90-248-JAN. 2, 1968 
[81 STAT. 
operation of any law or rule of law, refund or credit of such overpay-
ment may, nevertheless, be made or allowed if claim therefor is filed 
on or before December 31, 1968. No interest shall be allowed or paid 
on any overpayment resulting from the enactment of this section. 
REFUND OF CERTAIN OVERPAYMENTS BY EMPLOYEES OF HOSPITAL 
INSURANCE TAX 
SEC. 502. (a) Section 6413(c) of the Internal Kevenue Code of 1954 
(relating to special refunds of overpayments of certain employment 
taxes) is amended by adding at the end thereof the following new 
paragraph: 
" ( 3 ) 
APPLICABILITY W I T H RESPECT TO COMPENSATION or E M -
PLOYEES SUBJECT TO T H E RAILROAD RETIREMENT TAX ACT. 
I n the 
case of any individual who, during any calendar year after 1967, 
receives wages from one or more employers and also receives 
compensation which is subject to the tax imposed by section 3201 
73 Stat. 28,29. 
QJ. 3211, such compensatiou shall, solely for purposes of applying 
79 Stat. 395. 
paragraph (1) with respect to the tax imposed by section 3101 (b), 
be treated as wages received from an employer with respect to 
which the tax imposed by section 3101(b) was deducted." 
(b) (1) The second sentence of section 1402(b) of such Code (re-
68A Stat. 355. 
latiug to definition of self-employment income) is amended (A) by 
inserting " ( A ) " immediately after " 'wages' ", and (B) by inserting 
immediately before the period the following: ", and (B) includes, but 
solely with respect to the tax imposed by section 1401(b), compensa-
tion which is subject to the tax imposed by section 3201 or 3211". 
(2) The amendments made by paragraph (1) shall be effective only 
with respect to taxable years ending on or after December 31, 1968. 
(c) (1) Section 6051(a) of the Internal Revenue Code of 1954 (re-
68A Stat. 747. 
lating to requirement of receipts for employees) is amended— 
(A) by striking out "section 3101 or 3402" in the matter pre-
ceding paragraph (1) and inserting in lieu thereof "section 3101, 
3201, or 3402';; 
(B) by striking out "and" at the end of paragraph (5), and 
by striking out the period at the end of paragraph (6) and insert-
ing in lieu thereof ", and"; and 
(C) by inserting after paragraph (6) the following new para-
graphs : 
"(7) the total amount of compensation with respect to which 
the tax imposed by section 3201 was deducted, and 
"(8) the total amount deducted as tax under section 3201." 
79 Stat. 337. 
(2) Sectiou 6051(c) of such Code (relating to additional require-
ments) is amended by striking out "section 3101" in the second sen-
tence and inserting in lieu thereof "sections 3101 and 3201". 
(3) The amendments made by paragraphs (1) and (2) shall apply 
in respect of remuneration paid after December 31, 1967. 
EXTENSION OF TIME TO PROVIDE ASSISTANCE FOR UNITOD STATES CITIZENS 
RETURNED FROM FOREIGN COUNTRIES 
Ante, p. 94. 
ggc. 503. Sectlou 1113(d) of the Social Security Act is amended by 
striking out "1968" and inserting in lieu thereof "1969". 
EXCLUSION FROM DEFINITION OF WAGES OF CERTAIN RETIREMENT, ETC., 
PAYMENTS UNDER EMPLOYER-ESTABLISHED PLANS 
SEC. 504. (a) Section 3121(a) of the Internal Revenue Code of 1954 
79^sfat^*383^^'' 
(definition of wages) is amended by striking out "or" at the end of 
paragraph (11), by striking out the period at the end of paragraph 
68A Stat. 447; 
78 Stat. 1077. 
81 STAT.] 
PUBLIC LAW 90-248-JAN. 2, 1968 
935 
(12) and inserting in lieu thereof "; or", and by adding at the end 
thereof the following new paragraph: 
" (13) any payment or series of payments by an employer to an 
employee or any of his dependents which is paid— 
"(A) upon or after the termination of an employee's em-
ployment relationship because of (i) death, (ii) retirement 
for disability, or (iii) retirement after attaining an age spec-
ified in the plan referred to in subparagraph (B) or in a pen-
sion plan of the employer, and 
"(B) under a plan established by the employer which makes 
])rovision for his employees generally or a class or classes of 
his employees (or for such employees or class or classes of 
employees and tlieir dependents), 
other than any such payment or series of payments which would 
have been paid if the employee's employment relationship had 
not been so terminated." 
(b) Section 3306(b) of such Code (definition of wages) is amended 
by striking out "or" at the end of paragraph (8), by striking out the 
period at the end of paragraph (9) and inserting in lieu thereof "; 
or", and by adding at the end thereof the following new paragraph: 
"(10) any payment or series of payments by an employer to an 
employee or any of his dependents which is paid— 
"(A) upon or after the termination of an employee's 
employment relationship because of (i) death, (ii) retirement 
for disability, or (iii) retirement after attaining an age spec-
ified in the plan referred to in subparagraph (B) or m a 
pension plan of the employer, and 
"(B) under a plan established by the employer which 
makes provision for his emploj^^ees generally or a class or 
classes of his employees (or for such employees or class or 
classes of employees and their dependents), 
other than any such payment or series of payments which would 
have been paid if the employee's employment relationship had not 
been so terminated." 
(c) Section 209 of the Social Security Act (definition of wages) is 7/stat^*382?^' 
amended by striking out "or" at the end of subsection (k), by striking 
42 use 409. 
out the period at the end of subsection (1) and inserting in lieu thereof 
"; or", and by inserting after subsection (1) the following new sub-
section : 
"(m) Any payment or series of payments by an employer to an 
employee or any of his dependents which is paid— 
"(1) upon or after the termination of an employee's employ-
ment relationship because of (A) death, (B) retirement for 
disability, or (C) retirement after attaining an age specified in 
the plan referred to in paragraph (2) or in a pension plan of 
the employer, and 
"(2) under a plan established by the employer which makes 
provision for his employees generally or a class or classes of his 
employees (or for such employees or class or classes of employees 
and their dependents), 
other than any such payment or series of payments which would have 
been paid if the employee's employment relationship had not been 
so terminated." 
(d) The amendments made by this section shall apply with respect 
to remuneration paid after the date of the enactment of this Act. 
Approved January 2, 1968.