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Page:United States Statutes at Large Volume 96 Part 1.djvu/414

 96 STAT. 372

42 USC 1381. 42 USC 1382c.

PUBLIC LAW 97-248—SEPT. 3, 1982 "(2)(A) In any case where the uncompensated value of disposed of resources exceeds $12,000, the State plan may provide for a period of ineligibility which exceeds 24 months. If a State plan provides for a period of ineligibility exceeding 24 months, such plan shall provide for the period of ineligibility to bear a reasonable relationship to such uncompensated value. "(B)(i) In the case of any individual who is an inpatient in a skilled nursing facility, intermediate care facility, or other medical institution, if such individual is required, as a condition of receiving services in such institution under the State plan, to spend for costs of medical care all but a minimal amount of his income required for personal needs, and, who, at any time during or after the 24-month period immediately prior to application for medical assistance under the State plan, disposed of a home for less than fair market value, the State plan (subject to clause (iii)) may provide for a period of ineligibility for medical assistance in accordance with clause (ii). "(ii) If the State plan provides for a period of ineligibility under clause (i), such plan— "(I) shall provide that such individual shall be ineligible for all medical assistance for a period of 24 months after the date on which he disposed of such home, except that, in the case where the uncompensated value of the home is less than the average amount payable under the State plan as medical assistance for 24 months of care in a skilled nursing facility, the period of ineligibility shall be such shorter time as bears a reasonable relationship (based upon the average amount payable under the State plan as medical assistance for care in a skilled nursing facility) to the uncompensated value of the home, and "(II) may provide (at the option of the State) that, in the case where the uncompensated value of the home is more than the average amount payable under the State plan as medical assistance for 24 months of care in a skilled nursing facility, such individual shall be ineligible for all medical assistance for a period in excess of 24 months after the date on which he disposed of such home which bears a reasonable relationship (based upon the average amount payable under the State plan as medical assistance for care in a skilled nursing facility) to the uncompensated value of the home, "(iii) An individual shall not be ineligible for medical assistance by reason of clause (ii) if— "(I) a satisfactory showing is made to the State (in accordance with any regulations promulgated by the Secretary) that the individual cannot reasonably be expected to be discharged from the medical institution and to return to that home, "(II) title to such home was transferred to the individual's spouse or child who is under age 21, or (with respect to States eligible to participate in the State program established under title XVI) is blind or permanently and totally disabled, or (with respect to States which are not eligible to participate in such program) is blind or disabled as defined in section 1614, "(III) a satisfactory showing is made to the State (in accordance with any regulations promulgated by the Secretary) that the individual intended to dispose of the home either at fair market value, or for other valuable consideration, or "(IV) if the State determines that denial of eligibility would work an undue hardship.

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Page:United States Statutes at Large Volume 96 Part 1.djvu/415

 PUBLIC LAW 97-248—SEPT. 3, 1982 "(3) In any case where an individual is ineligible for medical assistance under the State plan solely because of the applicability to such individual of the provisions of section 1613(c), the State plan may provide for the eligibility of such individual for medical assistance under the plan if such individual would be so eligible if the State plan requirements with respect to disposal of resources applicable under paragraphs (1) and (2) of this subsection were applied in lieu of the provisions of section 1613(c).". (c) Section 1902 of such Act is amended by striking out subsection (j) thereof. (d) The amendments made by this section shall become effective on the date of the enactment of this Act, but the provisions of section 1917(c)(2)(B) of the Social Security Act shall not apply with respect to a transfer of assets which took place prior to such date of enactment.

96 STAT. 373

42 USC 1382b.

42 USC 1396a. Effective date. 42 USC 1396p note. Ante, p. 370.

LIMITATION OF FEDERAL FINANCIAL PARTICIPATION IN ERRONEOUS MEDICAL ASSISTANCE EXPENDITURES

SEC. 133. (a) Section 1903 of the Social Security Act is amended by 42 USC 1396b. adding at the end thereof the following new subsection: "(u)(l)(A) Notwithstanding subsection (a)(1), if the ratio of a State's erroneous excess payments for medical assistance (as defined in subparagraph (D)) to its total expenditures for medical assistance under the State plan approved under this title exceeds 0.03, for the period consisting of the third and fourth quarters of fiscal year 1983, or for any full fiscal year thereafter, then the Secretary shall make no payment for such period or fiscal year with respect to so much of such erroneous excess payments as exceeds such allowable error rate of 0.03. "(B) The Secretary may waive, in certain limited cases, all or part Waiver. of the reduction required under subparagraph (A) with respect to any State if such State is unable to reach the allowable error rate for a period or fiscal year despite a good faith effort by such State. "(C) In estimating the amount to be paid to a State under subsection (d), the Secretary shall take into consideration the limitation on Federal financial participation imposed by subparagraph (A) and shall reduce the estimate he makes under subsection (d)(1), for purposes of payment to the State under subsection (d)(3), in light of any expected erroneous excess payments for medical assistance (estimated in accordance with such criteria, including sampling procedures, as he may prescribe and subject to subsequent adjustment, if necessary, under subsection (d)(2)). "(D)(i) For purposes of this subsection, the term 'erroneous excess "Erroneous excess payments for medical assistance' means the total of— "(I) payments under the State plan with respect to ineligible payments for medical individuals and families, and assistance." "(II) overpayments on behalf of eligible individuals and families by reason of error in determining the amount of expenditures for medical care required of an individual or family as a condition of eligibility. "(ii) In determining the amount of erroneous excess payments for medical assistance to an ineligible individual or family under clause (i)(I), if such ineligibility is the result of an error in determining the amount of the resources of sueh individual or family, the amount of the erroneous excess payment shall be the smaller of (I) the amount of the payment with respect to such individual or family, or (II) the

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license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/


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Page:United States Statutes at Large Volume 96 Part 1.djvu/416

 96 STAT. 374

Effective date. 42 USC 1396b note. 42 USC 1396b note. 42 USC 1896. 42 USC 1396b.

PUBLIC LAW 97-248—SEPT. 3, 1982 difference between the actual amount of such resources and the allowable resource level established under the State plan. "(iii) In determining the amount of erroneous excess payments for medical assistance to an individual or family under clause (i)(II), the amount of the erroneous excess payment shall be the smaller of (I) the amount of the payment on behalf of the individual or family, or (II) the difference between the actual amount incurred for medical care by the individual or family and the amount which should have been incurred in order to establish eligibility for medical assistance. "(E) For purposes of subparagraph (D), there shall be excluded, in determining both erroneous excess payments for medical assistance and total expenditures for medical assistance— "(i) payments with respect to any individual whose eligibility therefor was determined exclusively by the Secretary under an agreement pursuant to section 1634 and such other classes of individuals as the Secretary may by regulation prescribe whose eligibility was determined in part under such an agreement; and "(ii) payments made as the result of a technical error. "(2) The State agency administering the plan approved under this title shall, at such times and in such form as the Secretary may specify, provide information on the rates of erroneous excess payments made (or expected, with respect to future periods specified by the Secretary) in connection with its administration of such plan, together with any other data he requests that are reasonably necessary for him to carry out the provisions of this subsection. "(3)(A) If a State fails to cooperate with the Secretary in providing information necessary to carry out this subsection, the Secretary, directly or through contractual or such other arrangements as he may find appropriate, shall establish the error rates for that State on the basis of the best data reasonably available to him and in accordance with such techniques for sampling and estimating as he finds appropriate. "(B) In any case in which it is necessary for the Secretary to exercise his authority under subparagraph (A) to determine a State's error rates for a fiscal year, the amount that would otherwise be payable to such State under this title for quarters in such year shall be reduced by the costs incurred by the Secretary in making (directly or otherwise) such determination. "(4) This subsection shall not apply with respect to Puerto Rico, Guam, the Virgin Islands, the Northern Mariana Islands, or American Samoa.". (b) The amendment made by subsection (a) shall become effective on the date of the enactment of this Act. (c) No provision of law limiting Federal financial participation with respect to erroneous payments made by States under a State plan approved under title XIX of the Social Security Act (including any provision contained in, or incorporated by reference into, any appropriation Act or resolution making continuing appropriations), other than the limitations contained in section 1903 of such Act, shall be effective with respect to payments to States under such section 1903 for quarters beginning on or after October 1, 1982, unless such provision of law is enacted after the date of the date of the enactment of this Act and expressly provides that such limitation is in addition to or in lieu of the limitations contained in section 1903 of the Social Security Act.

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Page:United States Statutes at Large Volume 96 Part 1.djvu/417

 PUBLIC LAW 97-248—SEPT. 3, 1982

96 STAT. 375

MEDICAID COVERAGE OF HOME CARE FOR CERTAIN DISABLED CHILDREN

SEC. 134. (a) Section 1902(e) of the Social Security Act is amended by adding at the end the following new paragraph: "(3) At the option of the State, any individual who— "(A) is 18 years of age or younger and qualifies as a disabled individual under section 1614(a); "(B) with respect to whom there has been a determination by the State that— "(i) the individual requires a level of care provided in a hospital, skilled nursing facility, or intermediate care facility, "(ii) it is appropriate to provide such care for the individual outside such an institution, and "(iii) the estimated amount which would be expended for medical assistance for the individual for such care outside an institution is not greater than the estimated amount which would otherwise be expended for medical assistance for the individual within an appropriate institution; and "(C) if the individual were in a medical institution, would be eligible to have a supplemental security income (or State supplemental) payment made with respect to him under title XVI, shall be deemed, for purposes of this title only, to be an individual with respect to whom a supplemental security income payment, or State supplemental payment, respectively, is being paid under title XVI.". (b) The amendment made by subsection (a) shall become effective on October 1, 1982.

42 USC 1396a.

42 USC 1382c.

42 USC 1381.

Effective date. 42 USC 1396a note.

SIX-MONTH MORATORIUM ON DEREGULATION OF SKILLED NURSING AND INTERMEDIATE CARE FACILITIES

SEC. 135. The Secretary of Health and Human Services may not promulgate any change in the regulations prescribed under— (1) subpart K of part 405 of subchapter B (relating to medicare conditions of participation of skilled nursing facilities), (2) so much of subpart S of part 405 of subchapter B (relating to certification procedure for providers) as relates to certification of skilled nursing facilities, and (3) subparts C, D, and E of part 442 of subchapter C (relating to medicaid certification and requirements for skilled nursing and intermediate care facilities), of chapter IV of title 42 of the Code of Federal Regulations until the first day of the seventh calendar month beginning after the date of the enactment of this Act unless ordered to do so by a court of competent jurisdiction. MEDICAID PROGRAM IN AMERICAN SAMOA

SEC. 136. (a) Section 1101(a)(1) of the Social Security Act is 42 USC 1301. amended by inserting "and American Samoa" after "Such term when used in title XIX also includes the Northern Mariana Islands". (b) Section 1108(c) of such Act is amended— 42 USC 1308. (1) by striking out "and" at the end of paragraph (3); (2) by striking out the period at the end of paragraph (4) and inserting in lieu thereof ", and"; and

97-200 O—84—pt, 1

14: QL3

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Page:United States Statutes at Large Volume 96 Part 1.djvu/418

 96 STAT. 376

42 USC 1396d.

42 USC 1396a.

42 USC 1308.

42 USC 1396d. Effective date. 42 USC 1301 note.

PUBLIC LAW 97-248—SEPT. 3, 1982 (3) by adding at the end thereof the following: "(5) American Samoa shall not exceed $750,000.". (c) Section 1905(b)(2) of such Act is amended by striking out "and the Northern Mariana Islands" and inserting in lieu thereof "the Northern Mariana Islands, and American Samoa". (d) Section 1902 of such Act (as amended by section 132(c) of this Act) is amended by adding at the end thereof the following new subsection: "(j) Notwithstanding any other requirement of this title, the Secretary may waive or modify any requirement of this title with respect to the medical assistance program in American Samoa, other than a waiver of the Federal medical assistance percentage, the limitation in section 1108(c), or the requirement that payment may be made for medical assistance only with respect to amounts expended by American Samoa for care and services described in paragraphs (1) through (18) of section 1905(a).". (e) The amendments made by this section shall become effective on October 1, 1982. TECHNICAL CORRECTIONS FROM OMNIBUS BUDGET RECONCILIATION ACT OF 1981

95 Stat. 803. 42 USC 1396b.

95 Stat. 807. 42 USC 1396a.

95 Stat. 815. 42 USC 603 note. 42 USC 1396.

42 USC 603.

95 Stat. 826. 42 USC 1320a-l. 95 Stat. 819. 42 USC 701.

SEC. 137. (a)(1) Section 2161(b) of the Ominbus Budget Reconciliation Act of 1981 is amended by striking out "Section 1902" and inserting in lieu thereof "Section 1903". (2) Paragraphs (1) and (2) of section 2161(c) of such Act are each amended by striking out "section 1902" and inserting in lieu thereof in each instance "section 1903". (3) Section 2171(a)(3) of such Act is amended by striking out "by striking out paragraph (C)" and inserting in lieu thereof "by striking out '(C) if medical assistance' and all that follows through the semicolon preceding 'except that' ". (4) Section 2181(b) of such Act is amended by inserting before the period at the end thereof the following: ", except that, in the case of a State plan under title XIX of the Social Security Act which the Secretary determines requires State legislation in order to incorporate the provisions required to be included by this section into such State plan, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to include the provisions required to be included in such State plan by subsection (a)(2) of this section before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act, but the requirements previously set forth in paragraphs (1) through (3) of section 403(g) of the Social Security Act (prior to its repeal by this section) shall apply under title XIX of such Act to such State on and after October 1, 1981, whether or not the provisions required to be included by this section in the State plan under title XIX have been incorporated into such State plan". (5) Section 2193(c)(3)(B) of such Act is amended by striking out "or X' " and inserting in lieu thereof "or XIX' ". (b)(1) Section 501(b)(1)(D) of the Social Security Act is amended by striking out "title IV" and inserting in lieu thereof "title VI'. (2) Section 501(b)(2) of such Act is amended by striking out "section 624 of the Economic Opportunity Act of 1964" and inserting in lieu thereof "section 673(2) of the Omnibus Budget Reconciliation Act of 1981".

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Page:United States Statutes at Large Volume 96 Part 1.djvu/419

 PUBLIC LAW 97-248—SEPT. 3, 1982 (3) Section 505(2)(B) of such Act is amended by striking out "502(b)(1)" and inserting in lieu thereof "501(b)(1)". (4) Section 505(2)(D) of such Act is amended by striking out "the State imposes any charges" and inserting in lieu thereof "any charges are imposed". (5) Section 1134(4) of such Act is amended by striking out "scale" and inserting in lieu thereof "sale". (6) The heading of title XVI of such Act as such title applies in the case of Puerto Rico, Guam, and the Virgin Islands is amended by striking out ", OR FOR SUCH AID FOR THE AGED". (7) Section 1902(a)(10)(A) of such Act is amended to read as follows: "(A) for making medical assistance available, including at least the care and services listed in paragraphs (1) through (5) and (17) of section 1905(a), to— "(i) all individuals receiving aid or assistance under any plan of the State approved under title I, X, XIV, or XVI, or part A or part E of title IV (including pregnant women deemed by the State to be receiving such aid as authorized in section 406(g) and individuals considered by the State to be receiving such aid as authorized under section 414(g)), or with respect to whom supplemental security income benefits are being paid under title XVI; and "(ii) at the option of the State, to any group or groups of individuals described in section 1905(a) (or, in the case of individuals described in section 1905(a)(i), to any reasonable categories of such individuals) who are not individuals described in clause (i) of this subparagraph but— "(I) who meet the income and resources requirements of the appropriate State plan described in clause (i) or the supplemental security income program (as the case may be), "(II) who would meet the income and resources requirements of the appropriate State plan described in clause (i) if their work-related child care costs were paid from their earnings rather than by a State agency as a service expenditure, "(III) who would be eligible to receive aid under the appropriate State plan described in clause (i) if coverage under such plan was as broad as allowed under Federal law, "(IV) with respect to whom there is being paid, or who are eligible, or would be eligible if they were not in a medical institution, to have paid with respect to them, aid or assistance under the appropriate State plan described in clause (i), supplemental security income benefits under title XVI, or a State supplementary payment; ' (V) who are in a medical institution, who meet the resource requirements of the appropriate State plan described in clause (i) or the supplemental security income program, and whose income does not exceed a separate income standard established by the State which is consistent with the limit established under section 1903(f)(4)(C), or "(VI) who would be eligible under the State plan under this title if they were in a medical institution, with respect to whom there has been a determination

96 STAT. 377 95 Stat. 822. 42 USC 705.

42 USC 1320b-4. 42 USC 1381. 95 Stat. 807. 42 USC 1396a. 42 USC 1396d.

42 USC 606.

42 USC 1396d.

42 USC 1396b.

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Page:United States Statutes at Large Volume 96 Part 1.djvu/420

 96 STAT. 378 95 Stat. 809. 42 USC 1396n.

95 Stat. 807. 42 USC 1396a.

95 Stat. 807. 42 USC 1396a.

42 USC 1396a.

42 USC 1396b.

95 Stat. 816. 42 USC 1396b.

95 Stat. 813. 42 USC 1396b.

95 Stat. 803. 42 USC 1396b.

PUBLIC LAW 97-248—SEPT. 3, 1982 that but for the provision of home or community-based services described in section 1915(c) they would require the level of care provided in a hospital, skilled nursing facility or intermediate care facility the cost of which could be reimbursed under the State plan, and who will receive home or community-based services pursuant to a waiver granted by the Secretary under section 1915(c)"". (8) Section 1902(a)(10)(C)(i) of such Act is amended— (A) by striking out "and (II)" and inserting in lieu thereof ", (II)"; and (B) by inserting before the semicolon at the end thereof ", and (III) the single standard to be employed in determining income and resource eligibility for all such groups, and the methodology to be employed in determining such eligibility, which shall be the same methodology which would be employed under the supplemental security income program in the case of groups consisting of aged, blind, or disabled individuals in a State in which such program is in effect, and which shall be the same methodology which would be employed under the appropriate State plan (described in subparagraph (A)(i)) to which such group is most closely categorically related in the case of other groups". (9) Section 1902(a)(10)(C)(ii)(I) of such Act is amended by striking out "described in section 1905(a)(i)" and inserting in lieu thereof "under the age of 18 who (but for income and resources) would be eligible for medical assistance as an individual described in subparagraph (A)(i)". (10) Section 1902(b) of such Act is amended by striking out paragraph (2) and redesignating paragraphs (3) and (4) as paragraphs (2) and (3), respectively. (11) Section 1903(g)(1) of such Act is amended by inserting "or which is a qualified health maintenance organization (as defined in section 131(d) of the Public Health Service Act)" after "as defined in section 1876". (12) Section 1903(g)(1)(A) of such Act is amended by striking out "intermediate care facility services described in section 1905(d)' and inserting in lieu thereof "intermediate care facility services provided in an institution for the mentally retarded". (13) Section 1903(k) of such Act is amended by striking out "section 1876" and inserting in lieu thereof "subsection (m) of this section". (14) Section 1903(m)(2)(A) of such Act is amended— (A) by striking out "and" before "(II)" in clause (iv) and inserting in lieu thereof "or"; and (B) by striking out "unforseen" in clause (vii) and inserting in lieu thereof "unforeseen". (15) Section 1903(s) of such Act is amended— (A) in paragraph (1)(A), by striking out "made before fiscal year 1981" and inserting in lieu thereof "made before fiscal year 1982"; (B) in paragraph (1)(A), by striking out "without regard to payments under subsection (t) and" and inserting in lieu thereof 'without regard to payments under subsections (a)(6) and (t), without regard to payments for claims relating to expenditures made for medical assistance for services received through a facility of the Indian Health Service, and";

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Page:United States Statutes at Large Volume 96 Part 1.djvu/421

 PUBLIC LAW 97-248—SEPT. 3, 1982 (C) in paragraph (1)(C), by inserting "a program in operation under" before "a plan approved under this title"; (D) in paragraph (3)(D)— (i) by striking out "determines that" and inserting in lieu thereof "must determine that"; (ii) by striking out "most recent calendar year" and inserting in lieu thereof "most recent year (which shall consist of a 12-month period determined by the Secretary for this purpose)"; (iii) by striking out "2 or 3 calendar year period" and inserting in lieu thereof "2- or 3-year period"; and (iv) by striking out "calendar" each place it appears; (E) in paragraph (4)(B), by inserting "and paragraph (3)(D)" after "subparagraph (A)"; and (F) in paragraph (5)(A)(i), by inserting "(including amounts saved, to the extent such amounts can be documented to the satisfaction of the Secretary, by reason of the suspension or termination of a provider or other person for fraud or abuse, but only during the period of such suspension or termination or, if shorter, the 1-year period beginning on the date of such termination or suspension)" after "recovered or diverted". (16) Section 1903(t) of such Act (as added by section 2161(b) of the Omnibus Budget Reconciliation Act of 1981 as amended by subsection (a) of this section) is amended— (A) in paragraphs (1)(A) and (2)(A), by striking out "other than interest paid under subsection (d)(5)" each place it appears and inserting in lieu thereof in each instance "other than payments under subsection (a)(6), interest paid under subsection (d)(5), and payments for claims relating to expenditures made for medical assistance for services received through a facility of the Indian Health Service"; (B) in paragraph (1)(B), by striking out "between September 1982 and September 1983" and inserting in lieu thereof "for the 12-month period ending on September 30, 1983"; (C) in paragraph (1)(C), by striking out "between September 1982 and September 1984" and inserting in lieu thereof "for the 24-month period ending on September 30, 1984"; (D) in subparagraphs (B) and (C) of paragraph (1), by striking out "consumer price index for all urban consumers (published by the Bureau of Labor Statistics)" each place it appears and inserting in lieu thereof in each instance "Consumer Price Index for all urban consumers (U.S. city average) published by the Bureau of Labor Statistics"; and (E) by amending paragraph (3) to read as follows: "(3) Only for the purpose of computing under this subsection the Federal share of expenditures for a State for fiscal years 1982, 1983, and 1984 (in the case of the payment which may be made for the first quarter of fiscal years 1983, 1984, and 1985, respectively), the Federal medical assistance percentage for fiscal years 1982, 1983, and 1984 shall be the Federal medical assistance percentage for States in effect for fiscal year 1981, disregarding any change in such percentage after fiscal year 1981.". (17) Section 1905(a)(i) of such Act is amended by striking out "or any reasonable category of such individuals,". (18) Section 1905(a) of such Act is amended by striking out "or" at the end of clause (vi), inserting "or" at the end of clause (vii), and inserting after clause (vii) the following:

96 STAT. 379

95 Stat. 803. 42 USC 1396b..

95 Stat. 808. 42 USC 1396d.

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Page:United States Statutes at Large Volume 96 Part 1.djvu/422

 96 STAT. 380 95 Stat. 809. 42 USC 1396n. 42 USC 1396n note.

95 Stat. 789. 42 USC 1320a-7a.

42 USC 1320a-7, 1820C-9, 1395y. 42 USC 1395CC.

42 USC 1395u.

PUBLIC LAW 97-248—SEPT. 3, 1982 "(viii) pregnant women,". (19)(A) Section 1915(b) of such Act is amended by striking out "and section 1903(m)". (B) The amendment made by subparagraph (A) shall not apply with respect to any waiver if such waiver was granted, and the arrangement covered by the waiver was in place, prior to August 10, 1982. (20) Section 1915(b)(1) of such Act is amended— (A) by inserting "primary care" before "case-management system"; and (B) by striking out "primary care services" and inserting in lieu thereof "medical care services". (21) Section 1915(c)(1) of such Act is amended by inserting "payment for part or all of the cost o f after "may include as 'medical assistance' under such plan". (22) Section 1915(c)(2)(B) of such Act is amended to read as follows: "(B) the State will provide, with respect to individuals who— "(i) are entitled to medical assistance for skilled nursing facility or intermediate care facility services under the State plan, "(ii) may require such services, and "(iii) may be eligible for such home or community-based care under such waiver, for an evaluation of the need for such services;". (23) Section 1915(c)(3) of such Act is amended— (A) by striking out "subsection (a)(1)" and inserting in lieu thereof "section 1902(a)(1)"; and (B) by striking out "subsection (a)(10) of section 1902" and inserting in lieu thereof "section 1902(a)(10)". (24) Section 1915(c)(4) of such Act is amended by striking out "this section" and inserting in lieu thereof "this subsection". (25) Section 1915(f) of such Act is amended by inserting "approval o f before "a proposed State plan". (26) Subsection (a) of section 1128A of such Act is amended by striking out all that precedes "shall be subject" and inserting in lieu thereof the following: "(a) Any person (including an organization, agency, or other entity) that— "(1) presents or causes to be presented to an officer, employee, or agent of the United States, or of any department or agency thereof, or of any State agency (as defined in subsection (h)(1)), a claim (as defined in subsection (h)(2)) that the Secretary determines is for a medical or other item or service— "(A) that the person knows or has reason to know was not provided as claimed, or "(B) payment for which may not be made under the program under which such claim was made, pursuant to a determination by the Secretary under section 1128, 1160(b), or 1862(d), or pursuant to a determination by the Secretary under section 1866(b)(2) with respect to which the Secretary has initiated termination proceedings; or "(2) presents or causes to be presented to any person a request for payment which is in violation of the terms of (A) an assignment under section 1842(b)(3)(B)(ii), or (B) an agreement with a State agency not to charge a person for an item or service in excess of the amount permitted to be charged,".

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Page:United States Statutes at Large Volume 96 Part 1.djvu/423

 PUBLIC LAW 97-248—SEPT. 3, 1982 (27) Section 1903(s)(5)(B) of such Act is amended by inserting "or quarters" after "carried forward to the following quarter". (c)(1) Section 914(b)(2)(A) of the Omnibus Reconciliation Act of 1980 is amended by striking out "medical assistance" and all that follows and inserting in lieu thereof "cost reporting periods, beginning on or after April 1, 1981, of an entity providing services under a State plan approved under title XIX of the Social Security Act.". (2) Section 914(c)(2) of the Omnibus Reconciliation Act of 1980 is amended by striking out "services provided" and all that follows and inserting in lieu thereof "cost reporting periods, beginning on or after April 1, 1981, of an entity providing services under a State plan approved under title V of the Social Security Act.". (d)(1) Except as otherwise provided in this section, any amendment to the Omnibus Budget Reconciliation Act of 1981 made by this section shall be effective as if it had been originally included in the provision of the Omnibus Budget Reconciliation Act of 1981 to which such amendment relates. (2) Except as otherwise provided in this section, any amendment to the Social Security Act made by the preceding provisions of this section shall be effective as if it had been originally included as a part of that provision of the Social Security Act to which it relates, as such provision of the Social Security Act was amended by the Omnibus Budget Reconciliation Act of 1981. (e) Section 1902(a) of the Social Security Act is amended in the matter following paragraph (44) by inserting ", (26)" after "(9)(A)". (f) Section 1905(h)(1)(C) of the Social Security Act is amended by redesignating clauses (i) and (ii) as subclauses (I) and (II) respectively, and by redesignating clauses (A) and (B) as clauses (i) and (ii) respectively. (g) Effective October 1, 1982, section 1903(f)(3) of the Social Security Act is amended by striking out "(without regard to section 408)".

Subtitle C—Utilization and Quality Control Peer Review

96 STAT. 381 95 Stat. 803. 42 USC 1396b. 42 USC 1896a note.

42 USC 1396. 42 USC 705 note.

42 USC 701. 42 USC 1396a note. 95 Stat. 357.

42 USC 1305.

95 Stat. 815. 42 USC 1396a. 42 USC 1396d.

42 USC 1396b.

Peer Review Improvement Act of 1982.

SHORT TITLE OF SUBTITLE

SEC. 141. This subtitle may be cited as the "Peer Review Improve- 42 USC 1305 ment Act of 1982". "°^^REQUIREMENT FOR SECRETARY TO ENTER INTO CONTRACTS

SEC. 142. Section 1862 of the Social Security Act is amended by 42 USC I395y. adding at the end thereof the following new subsection: "(g) The Secretary shall, in making the determinations under paragraphs (1) and (9) of subsection (a), and for the purposes of promoting the effective, efficient, and economical delivery of health care services, and of promoting the quality of services of the type for which payment may be made under this title, enter into contracts with utilization and quality control peer review organizations pursuant to part B of title XI of this Act.". 42 USC I320c.

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Page:United States Statutes at Large Volume 96 Part 1.djvu/424

 96 STAT. 382

PUBLIC LAW 97-248—SEPT. 3, 1982 ESTABLISHMENT OF UTILIZATION A N D QUALITY CONTROL PEER REVIEW PROGRAM

SEC. 143. Part B of title XI of the Social Security Act is amended to read as follows: "PART B—PEER REVIEW OF THE UTILIZATION AND QUALITY OF HEALTH CARE SERVICES "PURPOSE

42 USC 1320c. 42 USC I395y.

"SEC. 1151. The purpose of this part is to establish the contracting process which the Secretary must follow pursuant to the requirements of section 1862(g) of this Act, including the definition of the utilization and quality control peer review organizations with which the Secretary shall contract, the functions such peer review organizations are to perform, the confidentiality of medical records, and related administrative matters to facilitate the carrying out of the purposes of this part. "DEFINITION OF UTILIZATION AND QUALITY CONTROL PEER REVIEW ORGANIZATION

42 USC 1320C-1

"SEC. 1152. The term 'utilization and quality control peer review organization' means an entity which— "(1)(A) is composed of a substantial number of the licensed doctors of medicine and osteopathy engaged in the practice of medicine or surgery in the area and who are representative of the practicing physicians in the area, designated by the Secretary under section 1153, with respect to which the entity shall perform services under this part, or (B) has available to it, by arrangement or otherwise, the services of a sufficient number of licensed doctors of medicine or osteopathy engaged in the practice of medicine or surgery in such area to assure that adequate peer review of the services provided by the various medical specialties and subspecialties can be assured; and "(2) is able, in the judgment of the Secretary, to perform review functions required under section 1154 in a manner consistent with the efficient and effective administration of this part and to perform reviews of the pattern of quality of care in an area of medical practice where actual performance is measured against objective criteria which define acceptable and adequate practice. CONTRACTS WITH UTILIZATION A N D QUALITY CONTROL PEER REVIEW ORGANIZATIONS

42 USC 1320C-2.

"SEC. 1153. (a)(1) The Secretary shall establish throughout the United States geographic areas with respect to which contracts under this part will be made. In establishing such areas, the Secretary shall use the same areas as established under section 1152 of this Act as in effect immediately prior to the date of the enactment of the Peer Review Improvement Act of 1982, but subject to the provisions of paragraph (2). "(2) As soon as practicable after the date of the enactment of the Peer Review Improvement Act of 1982, the Secretary shall consoli-

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date such geographic areas, taking into account the following criteria: "(A) Each State shall generally be designated as a geographic area for purposes of paragraph (1). "(B) The Secretary shall establish local or regional areas rather than State areas only where the volume of review activity or other relevant factors (as determined by the Secretary) warrant such an establishment, and the Secretary determines that review activity can be carried out with equal or greater efficiency by establishing such local or regional areas. In applying this subparagraph the Secretary shall take into account the number of hospital admissions within each State for which payment may be made under title XVIII or a State plan 42 USC 1395. approved under title XIX, with any State having fewer than 42 USC 1396. 180,000 such admissions annually being established as a single statewide area, and no local or regional area being established which has fewer than 60,000 total hospital admissions (including public and private pay patients) under review annually, unless the Secretary determines that other relevant factors warrant otherwise. "(C) No local or regional area shall be designated which is not a self-contained medical service area, having a full spectrum of services, including medical specialists' services. "(b)(1) The Secretary shall enter into a contract with a utilization and quality control peer review organization for each area established under subsection (a) if a qualified organization is available in such area and such organization and the Secretary have negotiated a proposed contract which the Secretary determines will be carried out by such organization in a manner consistent with the efficient and effective administration of this part. If more than one such qualified organization meets the requirements of the preceding sentence, priority shall be given to any such organization which is described in section 1152(1)(A). "(2)(A) During the first twelve months in which the Secretary is entering into contracts under this section, the Secretary shall not enter into a contract under this part with any entity which is, or is affiliated with (through management, ownership, or common control), an entity which directly or indirectly makes payments to any practitioner or provider whose health care services are reviewed by such entity or would be reviewed by such entity if it entered into a contract with the Secretary under this part. "(B) If, after the expiration of the twelve-month period referred to in subparagraph (A), the Secretary determines that there is no other entity available for an area with which the Secretary can enter into a contract under this part, the Secretary may then enter into a contract under this part with an entity described in subparagraph (A) for such area if such entity otherwise meets the requirements of this part. "(3) The Secretary shall not enter into a contract under this part with any entity which is, or is affiliated with (through management, ownership, or common control), a health care facility, or association of such facilities, within the area served by such entity or which would be served by such entity if it entered into a contract with the Secretary under this part. "(c) Each contract with an organization under this section shall provide that—

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PUBLIC LAW 97-248—SEPT. 3, 1982 "(1) the organization shall perform the functions set forth in section 1154(a), or may subcontract for the performance of all or some of such functions (and for purposes of paragraphs (2) and (3) of subsection (b), a subcontract under this paragraph shall not constitute an affiliation with the subcontractor); "(2) the Secretary shall have the right to evaluate the quality and effectiveness of the organization in carrying out the functions specified in the contract; "(3) the contract shall be for an initial term of two years and shall be renewable on a biennial basis thereafter; "(4) if the Secretary intends not to renew a contract, he shall notify the organization of his decision at least 90 days prior to the expiration of the contract term, and shall provide the organization an opportunity to present data, interpretations of data, and other information pertinent to its performance under the contract, which shall be reviewed in a timely manner by the Secretary; "(5) the organization may terminate the contract upon 90 days notice to the Secretary; '(6) the Secretary may terminate the contract prior to the expiration of the contract term upon 90 days notice to the organization if the Secretary determines that— "(A) the organization does not substantially meet the requirements of section 1152; or "(B) the organization has failed substantially to carry out the contract or is carrying out the contract in a manner inconsistent with the efficient and effective administration of this part, but only after such organization has had an opportunity to submit data and have such data reviewed by the panel established under subsection (d); "(7) the Secretary shall include in the contract negotiated objectives against which the organization's performance will be judged, and negotiated specifications for use of regional norms, or modifications thereof based on national norms, for performing review functions under the contract; and "(8) reimbursement shall be made to the organization in accordance with the terms of the contract. "(d)(1) Prior to making any termination under subsection (c)(5)(B), the Secretary must provide the organization with an opportunity to provide data, interpretations of data, and other information pertinent to its performance under the contract. Such data and other information shall be reviewed in a timely manner by a panel appointed by the Secretary, and the panel shall submit a report of its findings to the Secretary in a timely manner. The Secretary shall make a copy of the report available to the organization. "(2) The Secretary may accept or not accept the findings of the panel. After the panel has submitted a report with respect to an organization, the Secretary may, with the concurrence of the organization, amend the contract to modify the scope of the functions to be carried out by the organization, or in any other manner. The Secretary may terminate a contract under the authority of subsection (c)(5)(C) upon 90 days notice after the panel has submitted a report, or earlier if the organization so agrees. "(3) A panel appointed by the Secretary under this subsection shall consist of not more than five individuals, each of whom shall be a member of a utilization and quality control peer review organization having a contract with the Secretary under this part. While

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serving on such panel individuals shall be paid at a per diem rate not to exceed the current per diem equivalent at the time that service on the panel is rendered for grade GS-18 under section 5332 of title 5, United States Code. Appointments shall be made without regard to title 5, United States Code. "(e) Contracting authority of the Secretary under this section may be carried out without regard to any provision of law relating to the making, performance, amendment, or modification of contracts of the United States as the Secretary may determine to be inconsistent with the purposes of this part. The Secretary may use different contracting methods with respect to different geographical areas. "(f) Any determination by the Secretary to terminate or not to renew a contract under this section shall not be subject to judicial review. "FUNCTIONS OF PEER REVIEW ORGANIZATIONS

"SEC. 1154. (a) Any utilization and quality control peer review 42 USC i320c-3. organization entering into a contract with the Secretary under this part must perform the following functions: "(1) The organization shall review some or all of the professional activities in the area, subject to the terms of the contract, of physicians and other health care practitioners and institutional and noninstitutional providers of health care services in the provision of health care services and items for which payment may be made (in whole or in part) under title XVIII for 42 USC 1395. the purpose of determining whether— "(A) such services and items are or were reasonable and medically necessary or otherwise allowable under section 1862(a)(1); "(B) the quality of such services meets professionally recognized standards of health care; and "(C) in case such services and items are proposed to be provided in a hospital or other health care facility on an inpatient basis, such services and items could, consistent with the provision of appropriate medical care, be effectively provided more economically on an outpatient basis or in an inpatient health care facility of a different type. "(2) The organization shall determine, on the basis of the review carried out under subparagraphs (A) and (C) of paragraph (1), whether payment shall be made for services under title XVIII. Such determination shall constitute the conclusive determination on those issues for purposes of payment under title XVIII, except that payment may be made if— "(A) such payment is allowed by reason of section 1879; "(B) in the case of inpatient hospital services or posthospital extended care services, the peer review organization determines that additional time is required in order to arrange for postdischarge care, but payment may be continued under this subparagraph for not more than two days, bui only in the case where the provider of such services did not know and could not reasonably have been expected to know (as determined under section 1879) that payment 42 USC I395pp. would not otherwise be made for such services under title XVIII prior to notification by the organization under paragraph (3);

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PUBLIC LAW 97-248—SEPT. 3, 1982 "(C) such determination is changed as the result of any hearing or review of the determination under section 1155; or "(D) such payment is authorized under section

42 USC 1395X.

1861(v)(l)(G).

"(3) Whenever the organization makes a determination that any health care services or items furnished or to be furnished to a patient by any practitioner or provider are disapproved, the organization shall promptly notify such practitioner or provider, such patient, and the agency or organization responsible for the payment of claims under title XVIII of this Act. In the case of practitioners and providers of services, the organization shall provide an opportunity for discussion and review of the determination. "(4) The organization shall, after consultation with the Secretary, determine the types and kinds of cases (whether by type of health care or diagnosis involved, or whether in terms of other relevant criteria relating to the provision of health care services) with respect to which such organization will, in order to most effectively carry out the purposes of this part, exercise review authority under the contract. The organization shall notify the Secretary periodically with respect to such determinations. "(5) The organization shall consult with nurses and other professional health care practitioners (other than physicians described in section 1861(r)(l)) and with representatives of institutional and noninstitutional providers of health care services, with respect to the organization's responsibility for the review under paragraph (1) of the professional activities of such practitioners and providers. "(6) The organization shall, consistent with the provisions of its contract under this part, apply professionally developed norms of care, diagnosis, and treatment based upon typical patterns of practice within the geographic area served by the organization as principal points of evaluation and review, taking into consideration national norms where appropriate. Such norms with respect to treatment for particular illnesses or health conditions shall include— "(A) the types and extent of the health care services which, taking into account differing, but acceptable, modes of treatment and methods of organizing and delivering care, are considered within the range of appropriate diagnosis and treatment of such illness or health condition, consistent with professionally recognized and accepted patterns of care; and "(B) the type of health care facility which is considered, consistent with such standards, to be the type in which health care services which are medically appropriate for such illness or condition can most economically be provided. "(7) The organization, to the extent necessary and appropriate to the performance of the contract, shall— "(A) make arrangements to utilize the services of persons who are practitioners of, or specialists in, the various areas of medicine (including dentistry), or other types of health care, which persons shall, to the maximum extent practicable, be individuals engaged in the practice of their profession within the area served by such organization;

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"(B) undertake such professional inquiries either before or after, or both before and after, the provision of services with respect to which such organization has a responsibility for review which in the judgment of such organization will facilitate its activities; "(C) examine the pertinent records of any practitioner or provider of health care services providing services with respect to which such organization has a responsibility for review under paragraph (1); and "(D) inspect the facilities in which care is rendered or services are provided (which are located in such area) of any practitioner or provider of health care services providing services with respect to which such organization has a responsibility for review under paragraph (1). "(8) The organization shall perform such duties and functions and assume such responsibilities and comply with such other requirements as may be required by this part or under regulations of the Secretary promulgated to carry out the provisions of this part. "(9) The organization shall collect such information relevant to its functions, and keep and maintain such records, in such form as the Secretary may require to carry out the purposes of this part, and shall permit access to and use of any such information and records as the Secretary may require for such purposes, subject to the provisions of section 1160. Post, p. 391. "(10) The organization shall coordinate activities, including information exchanges, which are consistent with economical and efficient operation of programs among appropriate public and private agencies or organizations including— "(A) agencies under contract pursuant to sections 1816 42 USC I395h, 1395u. and 1842 of this Act; "(B) other peer review organizations having contracts under this part; and "(C) other public or private review organizations as may be appropriate. "(11) The organization shall make available its facilities and resources for contracting with private and public entities paying for health care in its area for review, as feasible and appropriate, of services reimbursed by such entities. "(b)(1) No physician shall be permitted to review— "(A) health care services provided to a patient if he was directly responsible for providing such services; or "(B) health care services provided in or by an institution, organization, or agency, if he or any member of his family has, directly or indirectly, a significant financial interest in such institution, organization, or agency. "(2) For purposes of this subsection, a physician's family includes only his spouse (other than a spouse who is legally separated from him under a decree of divorce or separate maintenance), children (including legally adopted children), grandchildren, parents, and grandparents. "(c) No utilization and quality control peer review organization shall utilize the services of any individual who is not a duly licensed doctor of medicine, osteopathy, or dentistry to make final determinations of denial decisions in accordance with its duties and functions under this part with respect to the professional conduct of any other duly licensed doctor of medicine, osteopathy, or dentistry, or

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PUBLIC LAW 97-248—SEPT. 3, 1982 any act performed by any duly licensed doctor of medicine, osteopathy, or dentistry in the exercise of his profession. "RIGHT TO HEARING AND JUDICIAL REVIEW

42 USC 1320C-4. 42 USC 1395.

42 USC 405.

"SEC. 1155. Any beneficiary who is entitled to benefits under title XVIII, and any practitioner or provider, who is dissatisfied with a determination made by a contracting peer review organization in conducting its review responsibilities under this part, shall be entitled to a reconsideration of such determination by the reviewing organization. Where the reconsideration is adverse to the beneficiary and where the matter in controversy is $200 or more, such beneficiary shall be entitled to a hearing by the Secretary (to the same extent as is provided in section 205(b)), and, where the amount in controversy is $2,000 or more, to judicial review of the Secretary's final decision. OBLIGATIONS OF HEALTH CARE PRACTITIONERS AND PROVIDERS OF HEALTH CARE SERVICES; SANCTIONS AND PENALTIES; HEARINGS AND REVIEW

42 USC 1320C-5.

"SEC. 1156. (a) It shall be the obligation of any health care practitioner and any other person (including a hospital or other health care facility, organization, or agency) who provides health care services for which payment may be made (in whole or in part) under title XVIII, to assure, to the extent of his authority that services or items ordered or provided by such practitioner or person to beneficiaries and recipients under such title— "(1) will be provided economically and only when, and to the extent, medically necessary; "(2) will be of a quality which meets professionally recognized standards of health care; and "(3) will be supported by evidence of medical necessity and quality in such form and fashion and at such time as may reasonably be required by a reviewing peer review organization in the exercise of its duties and responsibilities. "(b)(1) If after reasonable notice and opportunity for discussion with the practitioner or person concerned, any organization having a contract with the Secretary under this part determines that such practitioner or person has— "(A) failed in a substantial number of cases substantially to comply with any obligation imposed on him under subsection (a), or "(B) grossly and flagrantly violated any such obligation in one or more instances, such organization shall submit a report and recommendations to the Secretary. If the Secretary agrees with such determination, and determines that such practitioner or person, in providing health care services over which such organization has review responsibility and for which payment (in whole or in part) may be made under title XVIII, has demonstrated an unwillingness or a lack of ability substantially to comply with such obligations, the Secretary (in addition to any other sanction provided under law) may exclude (permanently or for such period as the Secretary may prescribe) such practitioner or person from eligibility to provide such services on a reimbursable basis. If the Secretary fails to act upon the recommendations submitted to him by such organization within 120

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days after such submission, such practitioner or person shall be excluded from eligibility to provide services on a reimbursable basis until such time as the Secretary determines otherwise. "(2) A determination made by the Secretary under this subsection to exclude a practitioner or person shall be effective at such time and upon such reasonable notice to the public and to the practitioner or person furnishing the services involved as may be specified in regulations. Such determination shall be effective with respect to services furnished to an individual on or after the effective date of such determination (except that in the case of institutional health care services such determination shall be effective in the manner provided in title XVIII with respect to terminations of provider agreements), and shall remain in effect until the Secretary finds and gives reasonable notice to the public that the basis for such determination has been removed and that there is reasonable assurance that it will not recur. "(3) In lieu of the sanction authorized by paragraph (1), the Secretary may require that (as a condition to the continued eligibility of such practitioner or person to provide such health care services on a reimbursable basis) such practitioner or person pays to the United States, in case such acts or conduct involved the provision or ordering by such practitioner or person of health care services which were medically improper or unnecessary, an amount not in excess of the actual or estimated cost of the medically improper or unnecessary services so provided. Such amount may be deducted from any sums owing by the United States (or any instrumentality thereof) to the practitioner or person from whom such amount is claimed. "(4) Any practitioner or person furnishing services described in paragraph (1) who is dissatisfied with a determination made by the Secretary under this subsection shall be entitled to reasonable notice and opportunity for a hearing thereon by the Secretary to the same extent as is provided in section 205(b), and to judicial review of 42 USC 405. the Secretary's final decision after such hearing as is provided in section 205(g). "(c) It shall be the duty of each utilization and quality control peer review organization to use such authority or influence it may possess as a professional organization, and to enlist the support of any other professional or governmental organization having influence or authority over health care practitioners and any other person (including a hospital or other health care facility, organization, or agency) providing health care services in the area served by such review organization, in assuring that each practitioner or person (referred to in subsection (a)) providing health care services in such area shall comply with all obligations imposed on him under subsection (a). "LIMITATION ON LIABILITY

"SEC. 1157. (a) Notwithstanding any other provision of law, no 42 USC l320c-6. person providing information to any organization having a contract with the Secretary under this part shall be held, by reason of having provided such information, to have violated any criminal law, or to be civilly liable under any law of the United States or of any State (or political subdivision thereof) unless— "(1) such information is unrelated to the performance of the contract of such organization; or

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PUBLIC LAW 97-248—SEPT. 3, 1982 "(2) such information is false and the person providing it knew, or had reason to believe, that such information was false. "(b) No person who is employed by, or who has a fiduciary relationship with, any such organization or who furnishes professional services to such organization, shall be held by reason of the performance by him of any duty, function, or activity required or authorized pursuant to this part or to a valid contract entered into under this part, to have violated any criminal law, or to be civilly liable under any law of the United States or of any State (or political subdivision thereof) provided he has exercised due care. "(c) No doctor of medicine or osteopathy and no provider (including directors, trustees, employees, or officials thereof) of health care services shall be civilly liable to any person under any law of the United States or of any State (or political subdivision thereof) on account of any action taken by him in compliance with or reliance upon professionally developed norms of care and treatment applied by an organization under contract pursuant to section 1153 operating in the area where such doctor of medicine or osteopathy or provider took such action; but only if— "(1) he takes such action in the exercise of his profession as a doctor of medicine or osteopathy or in the exercise of his functions as a provider of health care services; and "(2) he exercised due care in all professional conduct taken or directed by him and reasonably related to, and resulting from, the actions taken in compliance with or reliance upon such professionally accepted norms of care and treatment. "(d) The Secretary shall make payment to an organization under contract with him pursuant to this part, or to any member or employee thereof, or to any person who furnishes legal counsel or services to such organization, in an amount equal to the reasonable amount of the expenses incurred, as determined by the Secretary, in connection with the defense of any suit, action, or proceeding brought against such organization, member, or employee related to the performance of any duty or function under such contract by such organization, member, or employee. APPLICATION OF THIS PART TO CERTAIN STATE PROGRAMS RECEIVING FEDERAL FINANCIAL ASSISTANCE

42 USC 1320C-7. 42 USC 1396.

42 USC 1395y.

42 USC 1396b.

"SEC. 1158. (a) A State plan approved under title XIX of this Act may provide that the functions specified in section 1154 may be performed in an area by contract with a utilization and quality control peer review organization that has entered into a contract with the Secretary in accordance with the provisions of section 1862(g). "(b) In the event a State enters into a contract in accordance with subsection (a), the Federal share of the expenditures made to the contracting organization for its costs in the performance of its functions under the State plan shall be 75 percent (as provided in section 1903(a)(3)(C)). AUTHORIZATION FOR USE OF CERTAIN FUNDS TO ADMINISTER THE PROVISIONS OF THIS PART

42 USC 1320C-8. 42 USC 1395y.

"SEC. 1159. Expenses incurred in the administration of the contracts described in section 1862(g) shall be payable from— "(1) funds in the Federal Hospital Insurance Trust Fund; and

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"(2) funds in the Federal Supplementary Medical Insurance Trust Fund, in such amounts from each of such Trust Funds as the Secretary shall deem to be fair and equitable after taking into consideration the expenses attributable to the administration of this part with respect to each of such programs. The Secretary shall make such transfers of moneys between such Trust Funds as may be appropriate to settle accounts between them in cases where expenses properly payable from one such Trust Fund have been paid from the other such Trust Fund. "PROHIBITION AGAINST DISCLOSURE OF INFORMATION

"SEC. 1160. (a) An organization, in carrying out its functions under 42 USC i320c-9. a contract entered into under this part, shall not be a Federal agency for purposes of the provisions of section 552 of title 5, United States Code (commonly referred to as the Freedom of Information Act). Any data or information acquired by any such organization in the exercise of its duties and functions shall be held in confidence and shall not be disclosed to any person except— "(1) to the extent that may be necessary to carry out the purposes of this part, "(2) in such cases and under such circumstances as the Secretary shall by regulations provide to assure adequate protection of the rights and interests of patients, health care practitioners, or providers of health care, or ' (3) in accordance with subsection (b). "(b) An organization having a contract with the Secretary under this part shall provide in accordance with procedures and safeguards established by the Secretary, data and information— "(1) which may identify specific providers or practitioners as may be necessary— "(A) to assist Federal and State agencies recognized by the Secretary as having responsibility for identifying and investigating cases or patterns of fraud or abuse, which data and information shall be provided by the peer review organization to any such agency at the request of such agency relating to a specific case or pattern; "(B) to assist appropriate Federal and State agencies recognized by the Secretary as having responsibility for identifying cases or patterns involving risks to the public health, which data and information shall be provided by the peer review organization to any such agency— "(i) at the discretion of the peer review organization, at the request of such agency relating to a specific case or pattern with respect to which such agency has made a finding, or has a reasonable belief, that there may be a substantial risk to the public health, or "(ii) upon a finding by, or the reasonable belief of, the peer review organization that there may be a substantial risk to the public health; and "(C) to assist appropriate State agencies recognized by the Secretary as having responsibility for licensing or certification of providers or practitioners, which data and information shall be provided by the peer review organization to any such agency at the request of such agency relating to a specific case, but only to the extent that such data and

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PUBLIC LAW 97-248—SEPT. 3, 1982 information is required by the agency in carrying out a function which is within the jurisdiction of such agency under State law; and "(2) to assist the Secretary, and such Federal and State agencies recognized by the Secretary as having health planning or related responsibilities under Federal or State law (including health systems agencies and State health planning and development agencies), in carrying out appropriate health care planning and related activities, which data and information shall be provided in such format and manner as may be prescribed by the Secretary or agreed upon by the responsible Federal and State agencies and such organization, and shall be in the form of aggregate statistical data (without explicitly identifying any individual) on a geographic, institutional, or other basis reflecting the volume and frequency of services furnished, as well as the demographic characteristics of the population subject to review by such organization. The penalty provided in subsection (c) shall not apply to the disclosure of any information received under this subsection, except that such penalty shall apply to the disclosure (by the agency receiving such information) of any such information described in paragraph (1) unless such disclosure is made in a judicial, administrative, or other formal legal proceeding resulting from an investigation conducted by the agency receiving the information. An organization may require payment of a reasonable fee for providing information under this subsection in response to a request for such information. "(c) It shall be unlawful for any person to disclose any such information described in subsection (a) other than for the purposes provided in subsections (a) and (b), and any person violating the provisions of this section shall, upon conviction, be fined not more than $1,000, and imprisoned for not more than 6 months, or both, and shall be required to pay the costs of prosecution. "(d) No patient record in the possession of an organization having a contract with the Secretary under this part shall be subject to subpena or discovery proceedings in a civil action. "ANNUAL REPORTS

42 USC 1320C-10.

"SEC. 1161. The Secretary shall submit to the Congress not later than April 1 of each year, a full and complete report on the administration, impact, and cost of the program under this part during the preceding fiscal year, including data and information on— "(1) the number, status, and service areas of all utilization and quality control peer review organizations participating in the program; "(2) the number of health care institutions and practitioners whose services are subject to review by such organizations, and the number of beneficiaries and recipients who received services subject to such review during such year; "(3) the various methods of reimbursement utilized in contracts under this part, and the relative efficiency of each such method of reimbursement; "(4) the imposition of penalties and sanctions under this title for violations of law and for failure to comply with the obligations imposed by this part;

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 PUBLIC LAW 97-248—SEPT. 3, 1982 "(5) the total costs incurred under titles XVIII and XIX of this Act in the implementation and operation of all procedures required by such titles for the review of services to determine their medical necessity, appropriateness of use, and quality; and "(6) descriptions of the criteria upon which decisions are made, and the selection and relative weights of such criteria.

96 STAT. 393 42 USC 1395, 1396.

EXEMPTIONS OF CHRISTIAN SCIENCE SANATORIUMS

"SEC. 1162. The provisions of this part shall not apply with respect 42 USC I320c-ll. to a Christian Science sanatorium operated, or listed and certified, by the First Church of Christ, Scientist, Boston, Massachusetts. " M E D I C A L OFFICERS I N AMERICAN SAMOA, THE NORTHERN MARIANA ISLANDS, A N D THE TRUST TERRITORY OF THE PACIFIC ISLANDS TO BE INCLUDED IN THE UTILIZATION A N D QUALITY CONTROL PEER REVIEW PROGRAM

"SEC. 1163. For purposes of applying this part to American Samoa, 42 USC I320c-12. the Northern Mariana Islands, and the Trust Territory of the Pacific Islands, individuals licensed to practice medicine in those places shall be considered to be physicians and doctors of medicine.". FACILITATION OF PRIVATE REVIEW

SEC. 144. Section 1866(a)(1) of the Social Security Act is amended— 42 USC 1395CC. (1) by striking out "and" at the end of subparagraphs (A), (B), and (C); (2) by striking out the period at the end of subparagraph (D) and inserting in lieu thereof ", and"; and (3) by inserting after subparagraph (D) the following new subparagraph: "(E) to release data with respect to patients of such provider upon request to an organization having a contract with the Secretary under part B of title XI as may be necessary (i) to 42 USC 1320c. allow such organization to carry out its functions under such contract, or (ii) to allow such organization to carry out similar review functions under any contract the organization may have with a private or public agency paying for health care in the same area with respect to patients who authorize release of such data for such purposes.". WAIVER OF LIABILITY PROVISION

SEC. 145. Section 1879(a) of the Social Security Act is amended by 42 USC 1395pp. adding at the end thereof the following new sentence: "Any provider or other person furnishing items or services for which payment may not be made by reason of section 1862(a)(1) or (9) shall be deemed to 42 USC I395y. have knowledge that payment cannot be made for such items or services if the claim relating to such items or services involves a case, provider or other person furnishing services, procedure, or test, with respect to which such provider or other person has been notified by the Secretary (including notification by a utilization and quality control peer review organization) that a pattern of inappropriate utilization has occurred in the past, and such provider or other person has been allowed a reasonable time to correct such inappropriate utilization.".

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PUBLIC LAW 97-248—SEPT. 3, 1982 MEDICAID PROVISIONS

95 Stat. 795. 42 USC 1396a.

95 Stat. 795. 42 USC 1396b.

SEC. 146. (a) Section 1902(d) of the Social Security Act is amended— (1) by striking out "a Professional Standards Review Organization designated, conditionally or otherwise," and inserting in lieu thereof "a utilization and quality control peer review organization having a contract with the Secretary"; and (2) by striking out "such Organization (or Organizations)" each place it appears and inserting in lieu thereof in each instance "such organization (or organizations)". (b) Section 1903(a)(3)(C) of such Act is amended by striking out "Professional Standards Review Organization" and inserting in lieu thereof "utilization and quality control peer review organization". DEMONSTRATION PROJECTS FOR COMPETITIVE BIDDING AND OTHER REIMBURSEMENT METHODS

42 USC I395b-l.

S E C 147. Section 402(a)(1) of the Social Security Amendments of 1967 (Public Law 90-248) is amended— (1) by striking out "and" at the end of subparagraph (I); (2) by striking out the period at the end of subparagraph (J) and inserting in lieu thereof "; and"; and (3) by inserting after subparagraph (J) the following new subparagraph: "(K) to determine whether the use of competitive bidding in the awarding of contracts, or the use of other methods of reimbursement, under part B of title XI would be efficient and effective methods of furthering the purposes of that part.". TECHNICAL AMENDMENTS

42 USC 1395y.

42 USC 1395g, 1395x.

42 USC 1395k.

42 USC 1395Z. 42 USC 1395pp.

SEC. 148. (a) Section 1862(d)(1)(C) of such Act is amended by striking out ", on the basis of reports transmitted to him in accordance with section 1157 of this Act (or, in the absence of any such report, on the basis of such data as he acquires in the administration of the program under this title)," and inserting in lieu thereof "on the basis of information acquired by the Secretary in the administration of this title". (b) Sections 1815(b), 1861(v)(l)(G), and 1861(w)(2) of such Act are each amended by striking out "Professional Standards Review Organization" and inserting in lieu thereof in each instance "quality control and peer review organization". (c) Section 1832(a)(2)(F)(ii) of such Act is amended by striking out "Professional Standards Review Organization (designated, conditionally or otherwise," and inserting in lieu thereof "quality control and peer review organization (having a contract with the Secretary". (d) Section 1833(i) of such Act is amended by striking out "the National Professional Standards Review Council and". (e) Section 1879(e) of such Act is amended by striking out "professional standards review organization" and inserting in lieu thereof "quality control and peer review organization".

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EFFECTIVE DATE

SEC. 149. The amendments made by this part shall, subject to section 150, be effective with respect to contracts entered into or renewed on or after the date of the enactment of this Act.

42 USC 1320c note.

MAINTENANCE OF CURRENT PSRO AGREEMENTS

SEC. 150. (a) The Secretary of Health and Human Services shall not terminate or fail to renew any agreement in effect with a professional standards review organization under part B of title XI of the Social Security Act on the earlier of the date of the enactment of this Act or September 30, 1982 until such time as he enters into a contract with a utilization and quality control peer review organization under such part, as amended by this subtitle, for the area served by such professional standards review organization. In complying with this subsection, the Secretary may renew any such contract with a professional standards review organization for a period of less than 12 months. (b) The provisions of part B of title XI of the Social Security Act as in effect prior to the amendments made by this subtitle shall remain in effect with respect to contracts with professional standards review organizations in effect on the earlier of the date of the enactment of this Act or September 30, 1982, until such time as such contract is terminated or is not renewed, in accordance with subsection (a). Any matters awaiting a determination by a Statewide Professional Standards Review Council on the date of the enactment of this Act shall be transferred to the Secretary of Health and Human Services for a determination unless such determination is made by such Council within 30 days after the date of the enactment of this Act. No payments shall be made under part B of title XI of the Social Security Act to Statewide Professional Standards Review Councils for services performed under section 1162 of such Act after the end of such 30-day period.

42 USC 1320c note. 42 USC 1301.

42 USC 1320c.

42 USC 1320c. 42 USC 1320C-11.

Subtitle D—Aid to Families with Dependent Children ROUNDING OF ELIGIBILITY AND BENEFIT AMOUNTS

SEC. 151. (a) Section 402(a) of the Social Security Act is amended— (1) by striking out "and" at the end of paragraph (32); (2) by striking out the period at the end of paragraph (33) and inserting in lieu thereof "; and"; and (3) by adding at the end thereof the following new paragraph: "(34) provide that both the standard of need applied to a family and the amount of aid determined to be payable, when not a whole dollar amount, shall be rounded to the next lower whole dollar amount.", (b) The amendment made by this section shall become effective on October 1, 1982.

95 Stat. 857. 42 USC 602.

Effective date. 42 USC 602 note.

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PUBLIC LAW 97-248—SEPT. 3, 1982 EFFECTIVE DATE OF APPLICATION; PRORATION OF F I R S T - M O N T H ' S A F D C BENEFIT

42 USC 602.

SEC. 152. (a) Section 402(a)(10) of the Social Security Act is amended— (1) by striking out "provide, effective July 1, 1951, that all individuals" and inserting in lieu thereof "(A) provide that all individuals"; (2) by adding "and" after the semicolon; and (3) by adding at the end thereof the following new subparagraph: "(B) provide that an application for aid under the plan will be effective no earlier than the date such application is filed with the State agency or local agency responsible for the administration of the State plan, and the amount payable for the month in which the application becomes effective, if such application becomes effective after the first day of such month, shall bear the same ratio to the amount which would be payable if the application had been effective on the first day of such month as the number of days in the month including and following the effective date of the application bears to the total number of days in such month;". 42 USC 602 note. (b) The amendments made by this section shall become effective on October 1, 1982. ABSENCE FROM HOME SOLELY BY REASON OF UNIFORMED SERVICE

42 USC 606.

SEC. 153. (a) Section 406(a)(1) of the Social Security Act is amended by inserting "(other than absence occasioned solely by reason of the performance of active duty in the uniformed services of the United States)" after "continued absence from the home". ^o^fr'i^iy nJ?/?*^\ (b) The amendment made by this section shall become effective on 42 USC 606 note. Qctober 1, 1982. JOB SEARCH

42 USC 602.

SEC. 154. (a) Section 402(a) of the Social Security Act (as amended by section 151(a) of this Act) is further amended— (1) by striking out "and" at the end of paragraph (33); (2) by striking out the period at the end of paragraph (34) and inserting in lieu thereof "; and"; and (3) by adding at the end thereof the following new paragraph: "(35) at the option of the State, provide— "(A) that as a condition of eligibility for aid under the State plan of any individual claiming such aid who is required to register pursuant to paragraph (19)(A) (or who would be required to register under paragraph (19)(A) but for clause (iii) thereof), including all such individuals or only such groups, types, or classes thereof as the State agency may designate for purposes of this paragraph, such individual will be required to participate in a program of employment search— "(i) beginning at the time he applies for such aid (or an application including his need is filed) and continuing for a period (prescribed by the State) of not more than eight weeks (but this requirement may not be used as a reason for any delay in making a determination of an individual's eligibility for aid or in issuing a

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payment to or in behalf of any individual who is otherwise eligible for such aid); and "(ii) at such time or times after the close of the period prescribed under clause (i) as the State agency may determine but not to exceed a total of 8 weeks in any 12 consecutive months; "(B) that any individual participating in a program of employment search under this paragraph will be furnished such transportation and other services, or paid (in advance or by way of reimbursement) such amounts to cover transportation costs and other expenses reasonably incurred in meeting requirements imposed on him under this paragraph, as may be necessary to enable such individual to participate in such program; and "(C) that, in the case of an individual who fails without good cause to comply with requirements imposed upon him under this paragraph, the sanctions imposed by paragraph (19)(F) shall be applied in the same manner as if the individual had made a refusal of the type which would cause the provisions of such paragraph (19)(F) to be applied (except that the State may at its option, for purposes of this paragraph, reduce the period for which such sanctions would otherwise be in effect).". (b)(1) Section 403(a)(3)(C) of such Act is amended by inserting 42 USC 603. immediately after "expenditures" the following: "(including as expenditures under this subparagraph the value of any services furnished, and the amount of any payments made (to cover expenses incurred by individuals under a program of employment search), under section 402(a)(35)(B))". (2) Section 403(a)(3) of such Act is further amended by striking out "other than services" in the matter immediately following subparagraph (C) and inserting in lieu thereof the following: "other than services furnished under section 402(a)(35)(B) (as described in the parenthetical phrase in subparagraph (C)), and other than services". (c) Section 409(b)(3) of such Act is amended— 95 Stat. 846. 42 USC 609. (1) in the first sentence— (A) by inserting ", any program of employment search under section 402(a)(35)," after "pursuant to this section", (B) by striking out "both such programs" and inserting in lieu thereof "more than one such program", and (C) by striking out "in the other" and inserting in lieu thereof "in another"; and (2) in the second sentence, by striking out "both such programs" and inserting in lieu thereof "more than one such program". (d) The amendments made by this section shall become effective Effective date. 42 " " ' ' " " " note. on October 1, 1982. ' " USC 602 PRORATION OF STANDARD AMOUNT FOR SHELTER AND UTILITIES

SEC. 155. (a) Section 412 of the Social Security Act is amended to 42 USC 612. read as follows:

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PUBLIC LAW 97-248—SEPT. 3, 1982 "PRORATING SHELTER ALLOWANCE OF AFDC FAMILY LIVING WITH ANOTHER HOUSEHOLD

42 USC 1382a. Effective date.

"SEC. 412. A State plan for aid and services to needy families with children may provide that, in determining the need of any dependent child or relative claiming aid who is living with other individuals (not claiming aid together with such child or relative) as a household (as defined, for purposes of this section, by the Secretary), the amount included in the standard of need, and the payment standard, applied to such child or relative for shelter, utilities, and similar needs may be prorated on a reasonable basis, in such manner and under such circumstances as the State may determine to be appropriate. For purposes of any method of proration used by a State under this section, there shall not be included as a member of a household an individual receiving benefits under title XVI in any month to whom the one-third reduction prescribed by section 1612(a)(2)(A)(i) is applied.". (b) The amendment made by this section shall become effective on

42 USC 612 note.

Q c to b e r 1, 1982.

42 USC 1381.

LIMITATION ON FEDERAL FINANCIAL PARTICIPATION IN ERRONEOUS ASSISTANCE EXPENDITURES

42 USC 603.

SEC. 156. (a) Section 403(i) of the Social Security Act is amended to read as follows: "(i)(l)(A) Notwithstanding subsection (a)(1), if the ratio of a State's erroneous excess payments (as defined in subparagraph (O) to its total payments under the State plan approved under this part exceeds— "(i) 0.04 for fiscal year 1983, or "(ii) 0.03 for any fiscal year thereafter, then the Secretary shall make no payment for such fiscal year with respect to so much of the erroneous excess payments (as so defined) as exceeds the allowable error rate for such fiscal year. "(B) The Secretary may waive, in certain limited cases, all or part of the reduction required under subparagraph (A) with respect to any State if such State is unable to reach the allowable error rate for a fiscal year despite a good faith effort by such State. "(C) For purposes of this subsection, the term 'erroneous excess payments' means the total of (i) payments to ineligible families, and (ii) overpayments to eligible families. "(2) The State agency administering the plan approved under this part shall, at such times and in such form as the Secretary may specify, provide information on the rates of erroneous excess payments made in connection with its administration of such plan, together with any other data he requests that are reasonably necessary for him to carry out the provisions of this subsection. "(3)(A) If a State fails to cooperate with the Secretary in providing information necessary to carry out this subsection, the Secretary, directly or through contractual or such other arrangements as he may find appropriate, shall establish the error rates for that State on the basis of the best data reasonably available to him and in accordance with such techniques for sampling and estimating as he finds appropriate. "(B) In any case in which it is necessary for the Secretary to exercise his authority under subparagraph (A) to determine a State's error rate for a fiscal year, the amount that would otherwise

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be payable to such State under this part for quarters in such year shall be reduced by the costs incurred by the Secretary in making (directly or otherwise) such determination. "(4) This subsection shall not apply with respect to Puerto Rico, Guam, or the Virgin Islands.". (b) Section 403(a) of such Act is amended by striking out "In the 42 USC 603. case of calendar quarters beginning after September 30, 1977, and prior to April 1, 1978, the amount to be paid to each State (as determined under the preceding provisions of this subsection or section 1118, as the case may be) shall be increased in accordance with the provisions of subsection (i) of this section.". (c) Section 4030') of such Act is amended by striking out "If the 42 USC 603. dollar error rate of aid furnished by a State" and inserting in lieu thereof "In the case of Puerto Rico, Guam, or the Virgin Islands, if the dollar error rate of aid furnished by such State". (d)(1) The amendments made by subsections (a) and (b) shall Effective date. 42 USC 603 note. become effective on October 1, 1982. (2) The inapplicability of section 403(j) of the Social Security Act to States other than Puerto Rico, Guam, and the Virgin Islands by reason of the amendment made by subsection (c) shall be effective with respect to six-month periods beginning after April 1983. (e) The regulations currently in effect for fiscal year 1982 with 42 USC 603 note. respect to erroneous payments made by States under a State plan approved under part A of title IV of the Social Security Act (45 CFR 42 USC 601. 205.42) shall remain in effect with respect to erroneous payments made by States until new regulations reflecting the changes made by subsection (a) are promulgated and placed in effect. EXCLUSION FROM INCOME OF CERTAIN STATE PAYMENTS

SEC. 157. (a) The last sentence of section 403(a) of the Social 42 USC 603. Security Act is amended by inserting before the period at the end thereof the following: ", but any such amount, if determined to have been paid by the State in recognition of the difference between the current or anticipated needs of a family for a month based upon actual income or other relevant circumstances for such month, and the needs of such family for such month based upon income and other relevant circumstances as retrospectively determined under section 402(a)(13)(A)(ii), shall not be considered income within the 42 USC 602. meaning of section 402(a)(13) for the purpose of determining the amount of aid in the succeeding months". (b) The amendment made by this section shall become effective on Effective date. 42 USC 603 note. October 1, 1982. EXTENSION OF TIME FOR STATES TO ESTABLISH A WORK INCENTIVE DEMONSTRATION PROGRAM

SEC. 158. (a) Section 445(b)(1) of the Social Security Act is amended by striking out "Not later than sixty days following the date of the enactment of this section" and inserting in lieu thereof "Not later than June 30, 1984". (b) Section 445(b)(1)(B) of such Act is amended by inserting before the semicolon at the end thereof the following: ", but subject to waiver of such criteria as provided under section 1115". (c) The amendments made by this section shall become effective on the date of the enactment of this Act.

95 Stat. 850. 42 USC 645.

42 USC 1315. Effective date. 42 USC 645 note.

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PUBLIC LAW 97-248—SEPT. 3, 1982 EXCLUSION FROM INCOME

42 USC 602 note.

42 USC 601.

SEC. 159. Notwithstanding any other provision of law, payments which are made, under a statutorily established State program, to meet certain needs of children receiving aid under the State's plan approved under part A of title IV of the Social Security Act, if— (1) the payments are made to such children by the State agency administering such plan, but are made without Federal financial participation (under section 403(a) of such Act or otherwise), and (2) the State program has been continuously in effect since before January 1, 1979, shall be excluded from the income of such children and their families for purposes of section 402(a)(17) of such Act, and for all the other purposes of such part A and of such plan, effective on the date of the enactment of this Act. TECHNICAL AMENDMENTS TO SOCIAL SERVICES AND FOSTER CARE PROVISIONS IN 1981 RECONCILIATION ACT

42 USC 1308.

95 Stat. 868. 42 USC 1397b.

95 Stat. 871. 42 USC 1301.

95 Stat. 871. 42 USC 671.

Effective date. 42 USC 1301 note.

SEC. 160. (a) Section 1108(a) of the Social Security Act is amended by adding at the end thereof (after and below paragraph (3)(F)) the following new sentence: "Each jurisdiction specified in this subsection may use in its program under title XX any sums available to it under this subsection which are not needed to carry out the programs specified in this subsection." (b) Section 2003(b) of such Act is amended in the matter following clause (2) by inserting "(other than Puerto Rico, Guam, the Virgin Islands, and the Northern Mariana Islands)" after "the population ofall the States". (c) The last sentence of section 1101(a)(1) of such Act is amended by striking out "American Samoa, the Northern Mariana Islands, and the Trust Territory of the Pacific Islands" and inserting in lieu thereof "Guam, and the Northern Mariana Islands". (d) Section 2353(r) of the Omnibus Budget Reconciliation Act of 1981 is amended to read as follows: "(r) Section 471(a)(10) of such Act is amended to read as follows: " '(10) provides for the establishment or designation of a State authority or authorities which shall be responsible for establishing and maintaining standards for foster family homes and child care institutions which are reasonably in accord with recommended standards of national organizations concerned with standards for such institutions or homes, including standards related to admission policies, safety, sanitation, and protection of civil rights, and provides that the standards so established shall be applied by the State to any foster family home or child care institution receiving funds under this part or part B of this title;'". (e) The amendments made by this section shall be effective as of October 1, 1981. D E L A Y E D EFFECTIVE D A T E IN C A S E S REQUIRING CONFORMING STATE

LEGISLATION 42 USC 602 note.

SEC. 161. In the case of a State with respect to which the Secretary of Health and Human Services has determined that State legislation

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 PUBLIC LAW 97-248—SEPT. 3, 1982 is required in order to conform the State plan approved under part A of title IV of the Social Security Act to the requirements imposed by any amendment made by this subtitle, the State plan shall not be regarded as failing to comply with the requirements of such part solely by reason of its failure to meet the requirements imposed by such amendment prior to the end of the first session of the State legislature which begins after October 1, 1982, or which began prior to October 1, 1982, and remained in session for at least twenty-five calendar days after such date. For purposes of the preceding sentence, the term "session" means a regular, special, budget, or other session of a State legislature.

96 STAT. 401 42 USC 601.

Subtitle E—Child Support Enforcement FEE FOR SERVICES TO NON-AFDC FAMILIES

SEC. 171. (a) Section 454(6) of the Social Security Act is amended— 95 Stat. 862. (1) in clause (A), by inserting "including, at the option of the 42 USC 654. State, support collection services for the spouse (or former spouse) with whom the absent parent's child is living (but only if a support obligation has been established with respect to such spouse)," after "with the State,"; (2) in clause (B), by striking out "services under the State plan (other than collection of support)" and inserting in lieu thereof "such services"; and (3) by amending clause (C) to read as follows: "(C) any costs in excess of the fee so imposed may be collected— "(i) from the parent who owes the child or spousal support obligation involved, or "(ii) at the option of the State, from the individual to whom such services are made available, but only if such State has in effect a procedure whereby all persons in such State having authority to order child or spousal support are informed that such costs are to be collected from the individual to whom such services were made available;". 95 Stat. 863. (b)(1) Section 454 of such Act is further amended— (A) by adding "and" after the semicolon at the end of paragraph (18); (B) by striking out paragraph (19); and (C) by redesignating paragraph (20) as paragraph (19). (2) Section 2333(c) of the Omnibus Budget Reconciliation Act of 95 Stat. 862. 1981 is amended by striking out "Section 453(a) of such Act is 42 USC 655. amended" and inserting in lieu thereof "Section 455(a) of such Act is amended". (3) Section 303(e)(2)(A)(iii)(II) of the Social Security Act is amended 42 USC 503 by striking out "454(20)(B)(i)" and inserting in lieu thereof "454(19)(B)(i)". (c) The amendments made by this section shall be effective on and Effective date. 42 USC 503 note. after August 13, 1981. ALLOTMENTS FROM PAY FOR CHILD AND SPOUSAL SUPPORT OWED BY MEMBERS OF THE UNIFORMED SERVICES ON ACTIVE DUTY

SEC. 172. (a) Part D of title IV of the Social Security Act is amended by adding at the end thereof the following new section:

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