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PUBLIC LAW 90-248-JAN. 2, 1968

[81 STAT.

which provides such services, or arranges for their availability, on a prepayment basis), who undertakes to provide him such services." (b) The amendments ma.de by this section shall apply with respect to calendar quarters beginning after June 30, 1969; except that such amendments shall apply in the case of Puerto Rico, the Virgin Islands, and Guam only with repect to calendar quarters beginning after June 30, 1972. U T I L I Z A T I O N OF STATE F A C I L I T I E S TO PROVIDE CONSULTATIVE SERVICES TO INSTITUTIONS F U R N I S H I N G MEDICAL CARE

SEC. 228. (a) Section 1902(a) of the Social Security Act (as Ante. p. 903. amended by section 227 of this Act) is amended— (1) by striking out "and" at the end of paragraph (22); (2) by striking out the period at the end of paragraph (23) and inserting in lieu thereof "; and"; and (3) by inserting after paragraph (23) the following new paragraph: "(24) effective July 1, 1969, provide for consultative services by health agencies and other appropriate agencies of the State to hospitals, nursing homes, home health agencies, clinics, laboratories, and such other institutions as the Secretary may specify in order to assist them (A) to qualify for payments under this Act, (B) to establish and maintain such fiscal records as may be necessary for the proper and efficient administration of this Act, and (C) to provide mformation needed to determine payments due under this Act on account of care and services furnished to individuals." (b) Effective July 1, 1969, the last sentence of section 1864(a) of l\ use U95aa. ^uch Act is repealed. P A Y M E N T S FOR SERVICES A N D CARE BY A T H I R D

42 us^c f396b.

PARTY

SEC. 229. (a) Section 1902(a) of the Social Security Act (as amended by section 228 of this Act) is amended— (1) by striking out "and" at the end of paragraph (23); (2) by striking out the period at the end of paragraph (24) and inserting in lieu thereof ": and"; and (3) by inserting after paragraph (24) the following new paragraph: "(25) provide (A) that the State or local agency administering such plan will take all reasonable measures to ascertain the legal liability of third parties to pay for care and services (available under the plan) arising out of injury, disease, or disability, (B) that where the State or local agency knows that a third party has such a legal liability such agency will treat such legal liability as a resource of the individual on whose behalf the care and services are made available for purposes of paragraph (17)(B), and (C) that in any case where such a legal liability is found to exist after medical assistance has been made available on behalf of the individual, the State or local agency will seek reimbursement for such assistance to the extent of such legal liability." (b) The amendment made by subsection (a) shall apply with respect to legal liabilities of third parties arising after March 31, 1968. (^) Section 1903(d)(2) of such Act is amended by adding at the end thereof the following new sentence: "Expenditures for which payments were made to the State under subsection (a) shall be treated

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PUBLIC LAW 90-248-JAN. 2, 1968

as an overpayment to the extent that the State or local agency administering such plan has been reimbursed for such expenditures b;^ a third party pursuant to the provisions of its plan in compliance with section 1902(a) (25)."

905

Ante,

p. 904.

DIRECT P A Y M E N T S TO CERTAIN R E C I P I E N T S OF MEDICAL ASSISTANCE

SEC. 230. Section 1905(a) of the Social Security Act is amended by inserting after "for individuals" in the matter preceding clause (i) the following: ", and, with respect to physicians' or dentists' services, at the option of the State, to individuals not receiving aid or assistance under the State's plan approved under title I, X, X IV, or X VI, or part A of title IV,".

79 Stat. 351. 42 USC 1396d.

42 USC 301, 1201, 1351, 1381; Post. p. 911.

DATE ON W H I C H STATE P L A N S U N D E R TITLE X IX M U S T M E E T CERTAIN FINANCIAL PARTICIPATION REQUIREMENTS

SEC. 231. Section 1902(a)(2) of the Social Security Act is amended by striking out "July 1, 1970" and inserting in lieu thereof "July 1, 1969".

^2 USC i396a.

OBSERVANCE OF RELIGIOUS B E L I E F S

SEC. 232. Title X IX of the Social Security Act (as amended by section 226 of this Act) is further amended by adding at the end thereof the following new section: "OBSERVANCE OF RELIGIOUS BELIEFS

"SEC. 1907. Nothing in this title shall be construed to require any State which has a plan approved under this title to compel any person to undergo any medical screening, examination, diagnosis, or treatment or to accept any other health care or services provided under such plan for any purpose (other than for the purpose of discovering and preventing the spread of infection or contagious disease or for the purpose of protecting environmental health), if such person objects (or, in case such person is a child, his parent or guardian objects) thereto on religious grounds." C O V E R A G E U N D E R TITLE XIX OF CERTAIN SPOUSES OF INDIVIDUALS RECEIVING CASH W E L F A R E AID OR ASSISTANCE

SEC. 233. (a) Section 1905(a) of the Social Security Act is amended (1) by striking out "or" at the end of clause (iv), (2) by inserting "or" at the end of clause (v), and (3) by inserting immediately below clause (v) the following new clause: "(vi) persons essential (as described in the second sentence of this subsection) to individuals receiving aid or assistance under State plans approved under title I, X, X IV, or XVI,". (b) Section 1905(a) of such Act is further amended by adding at the end thereof the following new sentence: " For purposes of clauses (vi) of the preceding sentence, a person shall be considered essential to another individual if such person is the spouse of and is living with such individual, the needs of such person are taken into account in determining the amount of aid or assistance furnished to such individual (under a State plan approved under title I, X, X IV, or X VI), and such person is determined, under such a State plan, to be essential to the well being of such individual."

Ante,

p. 903.

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Page:United States Statutes at Large Volume 81.djvu/940

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PUBLIC LAW 90-248-JAN. 2, 1968

[81 STAT.

STANDARDS FOR SKILLED X U R S I N G H O M E S F U R N I S III K G SERVICES U N D E R STATE P L A N S APPROVED U N D E R TITLE XIX

SEC. 234. (a) Section 1902(a) of the Social Security Act (as Ante. pp. 903, amended by the preceding sections of this Act) is further amended 904 (1) by striking out "and" at the end of paragraph (24), (2) by striking out the period at the end of paragraph (25) and inserting in lieu of such period a semicolon, and (3) by adding at the end thereof the following new paragraphs: "(26) effective July 1, 1969, provide (A) for a regular program of medical review (including medical evaluation of each patient's need for skilled nursing home care) or (in the case of individuals who are eligible therefor under the State plan) need for care in a mental hospital, a written plan of care, and, where applicable, a plan of rehabilitation prior to admission to a skilled nursing home; (B) for periodic inspections to be made in all skilled nursing homes and mental institutions (if the State plan includes care in such institutions) within the State'by one or more medical review teams (composed of physicians and other appropriate health and social service personnel) of (i) the care being provided in such nursing homes (and mental institutions, if care therein is provided under the State plan) to persons receiving assistance under the State plan, (ii) with respect to each of the patients receiving such care, the adequacy of the services available in particular nursing homes (or institutions) to meet the current health needs and promote the maximum physical well-being of patients receiving care in such homes (or institutions), (iii) the necessity and desirability of the continued placement of such patients in such nursing homes (or institutions), and (iv) the feasibility of meeting their health care needs through alternative institutional or noninstitutional services; and (C) for the making by such team or teams of full and complete reports of the findings resulting from such inspections together with any recommendations to the State agency administering or supervising the administration of the State plan; "(27) provide for agreements with every person or institution providing services under the State plan under which such person or institution agrees (A) to keep such records as are necessary fully to disclose the ex:tent of the services provided to individuals receiving assistance under the State plan, and (B) to furnish the State agency with such information, regarding any payments claimed by such person or institution for providing services under the State plan, as the State agency may from time to time request; " (28) provide that any skilled nursing home receiving payments under such plan must— " (A) supply to the licensing agency of the State full and complete information as to the identity (i) of each person having (directly or indirectly) an ownership interest of 10 per centum or more in such nursing home, (ii) in case a nursing home is organized as a corporation, of each officer and director of the corporation, and (iii) in case a nursing home is organized as a partnership, of each partner; and promptly report any changes which would affect the current accuracy of the information so required to be supplied; " (B) have and maintain an organized nursing service for its patients, which is under the direction of a professional registered nurse who is employed full-time by such nursing home, and which is composed of sufficient nursing and aux-

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907

iliary personnel to provide adequate and properly supervised nursing services for such patients during all hours of each day and all days of each week; " (C) make satisfactory arrangements for professional planning and supervision of menus and meal service for patients for whom special diets or dietary restrictions are medically prescribed; " (D) have satisfactory policies and procedures relating to the maintenance of medical records on each patient of the nursing home, dispensing and administering of 'drugs and biologicals, and assuring that each patient is under the care of a physician and that adequate provisions is made for medical attention to any patient during emergencies; " (E) have arrangements with one or more general hospitals under which such hospital or hospitals will provide needed diagnostic and other services to patients of such nursing home, and under which such hospital or hospitals agree to timely acceptance, as patients thereof, of acutely ill patients of such nursing home who are in need of hospital care; except that the State agency may waive this requirement wholly or in part with respect to any nursing home meeting all the other requirements and which, by reason of remote location or other good and sufficient reason, is unable to effect such an arrangement with a hospital; and " (F)(i) meet (after December 31, 1969) such provisions of the Life Safety Code of the National Fire Protection Association (21st Edition, 1967) as are applicable to nursing homes; except that the State agency may waive in accordance with regulations of the Secretary, for such periods as it deems appropriate, specific provisions of such code which, if rigidly applied, would result in unreasonable hardship upon a nursing home, but only if such agency makes a determination (and keeps a written record setting forth the basis of such determination) that such waiver will not adversely affect the health and safety of the patients of such skilled nursing home; and except that the requirements set forth in the preceding provisions of this subclause (i) shall not apply in any State if the Secretary finds that in such State there is in effect a fire and safety code, imposed by State law, which adequately protects patients in nursing homes; and (ii) meet conditions relating to environment and sanitation applicable to extended care facilities under title X VIII; except that 1395//^^ ^^^^" the State agency may waive in accordance with regulations of the Secretary, for such periods as it deems appropriate, any requirement imposed by the preceding provisions of this subclause (ii) if such agency finds that such requirement, if rigidly applied, would result in unreasonable hardship upon a nursing home, but only if such agency makes a determination (and keeps a written record setting forth the basis of such determination) that such waiver will not adversely affect the health and safety of the patients of such nursinghome." (b) The amendments made by subsection (a) of this section (unless otherwise Specified in the body of such amendments) shall take effect on January 1, 1969. (c) Notwithstanding any other provision of law, after June 30, 1968, no Federal funds shall be paid to any State as Federal matching under title I, X, X IV, X VI, or X IX of the Social Security Act for is^o'^'iTsriasi payments made to any nursing home for or on account of any nursing 1396'; Post. pp. 903-908.

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[81 STAT.

home services provided by such nursing home for any period during which such nursing home is determined not to meet fully all requirements of the State for licensure as a nursing home, except that the Secretary may prescribe a reasonable period or periods of time during which a nursing home which has formerly met such requirements will be eligible for payments which include Federal participation if during such period or periods such home promptly takes all necessary steps to again meet svich requirements. COST S H A R I N G A N D S I M I L A R CHARGES W I T H RESPECT TO I N P A T I E N T H O S P I T A L SERVICES F U R N I S H E D U N D E R TITLE XIX

42 us^c u96a 42 USC 301,

Po°l:

J.^QVI""^'

1395/V^^ ^^^^

SEC. 235. (a)(1) Section 1902(a) (14)(A) of the Social Security '^^^ ^^ amended by striking out "no"' and inserting in lieu thereof the following: "in the case of individuals receiving aid or assistance under State plans approved under titles I, X, X IV, X VI, and part A of title JY

J^QV

. (2) Section 1902(a) (14)(B) of such Act is amended (A) by inserting "inpatient hospital services o r ' after "respect to", and (B) by striking out "him" and inserting in lieu thereof "to an individual". (8) Section 1902(a) (15) of the Social Security Act is amended to read as follows: "(15) in the case of eligible individuals 65 years of age or older who are covered by either or both of the insurance programs established by title X VIII, provide where, under the plan, all of any deductible, cost sharing, or similar charge imposed with respect to such individual under the insurance program established by such title is not met, the portion thereof which is met shall be determined on a basis reasonably related (as determined in accordance with standards approved by the Secretary and included in the plan) to such individual's income or his income and resources;", (b) The amendments made by subsection (a) shall be effective in the case of calendar quarters beginning after December 31, 1967. STATE P L A N REQUIREMENTS REGARDING L I C E N S I N G OF ADMINISTRATORS OF S K I L L E D N U R S I N G H O M E S F U R N I S H I N G SERVICES U N D E R STATE P L A N S APPROVED U N D E R TITLE XIX

sol^g^oe^^ ^°^'

Ante. pp. 903,

SEC. 236. (a) Section 1902(a) of the Social Security Act (as amended by the preceding sections of this Act) is further amended (1) by striking out the period at the end of paragraph (28) and inserting in lieu thereof a semicolon and (2) by adding at the end of such section 1902(a) the following new paragraph: "(29) include a State program which meets the requirements set forth in section 1908, for the licensing of administrators of nursing homes." (b) Title X IX of the Social Security Act (as amended by the jjreceding sections of this Act) is further amended by adding at the end thereof the followino-: a STATE PROGRAMS FOR L I C E N S I N G OF ADMINISTRATORS OF N U R S I N G H O M E S

^"P"-^-

" S E C 1908. (a) For purposes of section 1902(a) (29), a ' State program for the licensing of administrators of nursing homes' is a program which provides that no nursing home within the State may operate except under the superA^sion of an administrator licensed in the manner provided in this section. "(b) Licensing of nursing home administrators shall be carried out by the agency of the State responsible for licensing under the healing arts licensing act of the State, or, in the absence of such act

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or such an agency, a board, representative of the professions and institutions concerned with care of chronically ill and infirm aged patients and established to c any out the purposes of this section. "(c) I t shall be the function and duty of such agency or board to— "(1) develop, impose,-and enforce standards which must be met by individuals in order to receive a license as a nursing home administrator, which standards shall be designed to insure that nursing home administrators will he individuals who are of good character and are otherwise suitable, and who, by training or experience in the field of institutional administration, are qualified to serve as nursing home administrators; "(2) develop and apply appropriate techniques, including examinations and investigations, for determining whether an individual meets such standards; "(3) issue licenses to individuals determined, after the application of such techniques, to meet such standards, and revoke or suspend licenses previously issued by the board in any case where the individual holding any svich license is determined substantially to have failed to conform to the requirements of such standards; "(4) establish and carry out procedures designed to insure that individuals licensed as nursing home administrators will, during any period that they serve as such, comply with the requirements of such standards; "(5) receive, investigate, and take appropriate action with respect to, any charge or complaint filed with the board to the effect that any individual licensed as a nursing home administrator has failed to comply with the requirements of such standards; and "(6) conduct a continuing study and investigation of nursing homes and administrators of nursing homes within the State with a view to the improvement of the standards imposed for the licensing of such administrators and of procedures and methods for the enforcement of such standards with respect to administrators of nursing homes who have been licensed as such. " (d) No State shall be considered to have failed to comply with the provisions of section 1902(a) (29) because the agency or board of such State (established pursuant to subsection (b)) shall have granted any waiver, with respect to any individual who during all of the calendar year immediately preceding the calendar year in which the requirements prescribed in section 1902(a) (29) are first met by the State, has served as a nursing home administrator, of any of the standards developed, imposed, and enforced by such board pursuant to subsection (b)(1) other than such standards as relate to good character or suitability if— " (1) such waiver is for a period which ends after being in effect for two years or on June 30, 1972, whichever is earlier, and "(2) there is provided in the State (during all of the period for which waiver is in effect), a program of training and instruction designed to enable all individuals, with respect to whom any such waiver is granted, to attain the qualifications necessary in order to meet such standards. "(e)(1) There are hereby authorized to be appropriated for fiscal year 1968 and the four succeeding fiscal years such sums as may be necessary to enable the Secretary to make grants to States for the purpose of assisting them in instituting and conducting programs of training and instruction of the type referred to in subsection (d)(2). "(2) No grant with respect to any such program shall exceed 75 per centum of the reasonable and necessary cost, as determined by the Secretary, of instituting and conducting such program.

909

^"'^' P- ^°^-

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text:
Page:United States Statutes at Large Volume 81.djvu/944

 910 National Advisory Council on Nursing Home Administration.

80 Stat. 417. 5 USC 3301 et seq. Membership.

Duties.

Compensation, travel e x p e n s e s.

80 Stat. 499.

Termination.

"Nursing home."

" N u r s i n g home administrator."

PUBLIC LAW 90-248-JAN. 2, 1968

[81 STAT.

"(f)(1) For the purpose of advising the Secretary and the States in carrying out the provisions of this section, there is hereby created a National Advisory Council on Nursing Home Administration which shall consist of nine persons, not otherwise in the employ of the United States, appointed by the Secretary without regard to the provisions of title 5, United States Code, governing appointments in the competitive service. The Secretary shall from time to time appoint one of the members to serve as Chairman. The members shall include, but not be limited to, representatives of State health officers. State welfare directors, nursing home administrators, and university programs in public health or medical care administration. "(2) I n addition to the function stated in paragraph (1) of this subsection, it shall be the function and duty of the Council (A) to study and identify the core of knowledge that should constitute minimally the training in the field of institutional administration which should qualify an individual to serve as a nursing home administrator; (B) to study and identify the experience in the field of institutional administration that a nursing home administrator should be required to possess; (C) to study and develop model techniques for determining whether an individual possesses such qualifications: (D) to study and develop model criteria for granting waivers under the provisions of subsection (d); (E) to study and develop suggested programs of training referred to in subsection (d); (F) to study, develop, and recommend programs of training and instruction for those desiring to pursue a career in nursing home administration; (G) to complete the functions in (A) through (E) above by July 1, 1969, and submit a written report to the Secretary which report shall be submitted to the States to assist them in carrying out the provisions of this section. "(3) Members of the Council, while attending meetings or conferences thereof or otherwise serving on business of the Council shall be entitled to receive compensation at rates fixed by the Secretary, but not exceeding $100 per day, including travel time, and while so serving away from their homes or regular places of business they may be allowed travel expenses, including per diem in lieu of subsistence, as authorized by section 5703 of title 5, United States Code, for persons in the Government service employed intermittently. "(4) The Secretary may at the request of the Council engage such technical assistance as may be required to carry out its functions; and the Secretary shall, in addition, make available to the Council such secretarial, clerical, and other assistance and such pertinent data obtained and prepared by the Department of Health, Education, and Welfare as the Council may require to carry out its functions. "(5) The Council shall be appointed by the Secretary prior to July 1, 1968, and shall cease to exist as of December 31, 1971. " (g) As used in this section, the term— "(1) 'nursing home' means any institution or facility defined as such for licensing purposes under State law, or, if State law does not employ the term nursing home, the equivalent term or terms as determined by the Secretary; and "(2) 'nursing home administrator' means any individual who is charged with the general administration of a nursing home whether or not such individual has an ownership interest in such home and whether or not his functions and duties are shared with one or more other individuals." (c) Except as otherwise specified in the text thereof, the amendments made by this section shall take effect on July 1, 1970.

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Page:United States Statutes at Large Volume 81.djvu/945

 81 STAT.]

PUBLIC LAW 9 0 - 2 4 8 - J A N. 2, 1968

UTILIZATION o r

CARE A N D

911

SERVICES F U R N I S H E D U N D E R T I T I. E XIX

SEC. 237. Effective April 1, 1968, section 1902(a) of the Social Security Act (as amended by the preceding sections of this Act) is further amended by— (a) striking out the period at the end and inserting in Heu thereof the following "; and"; and (b) inserting after paragraph (29) (added to the Social Security Act by section 236 of this Act) the following paragraph: " (30) provide such methods and procedures relating to the utilization of, and the payment for, care and services available under the plan as may be necessary to safeguard against unnecessary utilization of such care and services and to assure that payments (including payments for any drugs provided under the plan) are not in excess of reasonable charges consistent with efficiency, economy, and quality of care."

Ante,

p. 90f

D I F E E R E N C E S I N STANDARDS W I T H RESPECT TO I N C O M E E L I G I B I L I T Y U N D E R TITLE

XIX

SEC. 238. Effective July 1, 1969, section 1902(a) (17) of the Social Security Act is amended by striking out "(which shall be comparable ^^ f^^^- f-^^^ for all groups)" and inserting in lieu thereof the following: "(which 42 USC 1396a. shall be comparable for all groups and may, in accordance with standards prescribed by the Secretary, differ with respect to income levels, but only in the case of applicants or recipients of assistance under the plan who are not receiving aid or assistance under the State's plan 42 e 301, approved under title I, X, X IV, or X VI, or part A of title IV, based 1201,u s1351, 1381; on the variations between shelter costs in urban areas and in rural inil-a. areas)". PART 3—CHILD-WELFARE SERVICES AMENDMENTS I N C L U S I O N OF C H I L D - W E L F A R E SERVICES I N TITLE IV

SEC. 240. (a) The heading of title IV of the Social Security Act T

-, J

-,

n T,

~

"^

^^ f^ft. iss 42 USC 601-609.

IS amended to read as follows: " TITLE IV—GKANTS TO STATES FOR A I D AND SERVICES TO N E E D Y F A M I L I E S W I T H CHILDREN AND FOR CHILD-WELFARE SERVICES" (b) Title IV of such Act is further amended by inserting immediately after the heading of the title the following: " P A R T A — A I D TO FAMILIES W I T H DEPENDENT CHILDREN"

(c) Title IV of such Act is further amended by adding at the end yg'^gtat^^is"^' thereof the following new part: " P A R T B — C H I L D - W E L F A R E SERVICES "APPROPRIATION

"SEC. 420. For the purpose of enabling the United States, through the Secretary, to cooperate with State public welfare agencies m establishing, extending, and strengthening child-welfare services, the following sums are hereby authorized to be appropriated: $55,000,000 for the fiscal year ending June 30, 1968, $100,000,000 for the fiscal year ending June 30, 1969, and $110,000,000 for each fiscal year thereafter. 85-622 0-68—60

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Page:United States Statutes at Large Volume 81.djvu/946

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PUBLIC LAW 90.248-JAN. 2, 1968

[81 STAT.

"ALLCyiMENTS TO STATES

Ante. p. 911.

Post.

p. 9 1 3.

"SEC. 421. TliB suni appropriated pursuant to section 420 for each fiscal year shall be allotted by the Secretary for use by cooperating State public welfare agencies which have plans developed jointly by the State agency and the Secretary, as follows: H e shall allot $70,000 to each State, and shall allot to each State an amount which bears the same ratio to the remainder of the sum so appropriated for such year as the product of (1) the population of such State under the age of 21 and (2) the allotment percentage of such State (as determined under section 423) bears to the sum of the corresponding products of all the States. "PAYMENT TO STATES

"SEC. 422. (a) From the sums appropriated therefor and the allotment available under this part, the Secretary shall from time to time pay to each State— Post, p. 915. "(1) that has a plan for child-welfare services which has been , developed as provided in this part and which— " (A) provides for coordination between the services provided under such plan and the services provided for depend42 USC 601-609. gj^^ children under the State plan approved under part A of " ^' '^- • this title, with a view to provision of welfare and related services which will best promote the welfare of such children and their families, and " (B) provides, with respect to day care services (including the provision of such care) provided under this title— " (i) for cooperative arrangements with the State health authority and the State agency primarily responsible for State supervision of public schools to assure maximum utilization of such agencies in the provision of necessary health services and education for children receiving day care, "(ii) for an advisory committee, to advise the State public welfare agency on the general policy involved in the provision of day care services under the plan, which shall include among its members representatives of other State agencies concerned with day care or services related thereto and persons representative of professional or civic or other public or nonprofit private agencies, organizations, or groups concerned with the provision of day care, "(iii) for such safeguards as may be necessary to assure provision of day care under the plan only in cases in which it is in the best interest of the child and the mother and only in cases in which it is determined, under criteria establislied by the State, that a need for such care exists; and, in cases in which the family is able to pay part or all of the costs of such care, for payment of such fees as may be reasonable in the light of such ability, " (iv) for giving priority, in determining the existence of need for such day care, to members of low-income or other groups in the population, and to geographical areas, which have the greatest relative need for extension of such day care, and " (v) that day care provided under the plan will be provided only in facilities (including private homes) which are licensed by the State, or approved (as meeting the standards established for such licensing) by the State agency responsible for licensing facilities of this type, and

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PUBLIC LAW 90-248-JAN. 2, 1968

"(vi) for the development and implementation of arrangements for the more effective involvement of the parent or parents in the appropriate care of the child and the improvement of the health and development of the child, and " (2) that makes a satisfactory showing that the State is extending the provision of child-welfare services in the State, with priority being given to communities with the greatest need for such services after giving consideration to their relative financial need, and with a view to making available by July 1, 1975, in all political subdivisions of the State, for all children in need thereof, child-welfare services provided by the staff (which shall to the extent feasible be composed of trained child-welfare personnel) of the State public welfare agency or of the local agency participating in the administration of the plan in the political subdivision, except that (effective July 1, 1969, or, if earlier, on the date as of which the modification of the State plan to comply with this requirement with respect to subprofessional staff is approved) such plan shall provide for the training and effective use of paid subprofessional staff with particular emphasis on the full-time or part-time employment of persons of low income, as community service aides, in the administration of the plan and for the use of nonpaid or partially paid volunteers in providing services and in assisting any advisory committees established by the State agency, an amount equal to the Federal share (as determined under section 423) of the total sum expended under such plan (including the cost of administration of the plan) in meeting the costs of State, district, county, or other local child-welfare services, in developing State services for the encouragement and assistance of adequate methods of community child-welfare organization, in paying the costs of returning any runaway child who has not attained the age of eighteen to his own community in another State, and of maintaining such child until such return (for a period not exceeding fifteen days), m cases in which such costs cannot be met by the parents of such child or by any person, agency, or institution legally responsible for the support of such child. I n developing such services for children, the facilities and experience of voluntary agencies shall be utilized in accordance with child-care programs and arrangements in the State and local communities as may be authorized by the State. " (b) The method of computing and paying such amounts shall be as follows: "(1)^ The Secretary shall, prior to the beginning of each period for which a payment is to be made, estimate the amount to be paid to the State for such period under the provisions of subsection (a). " (2) From the allotment available therefor, the Secretary shall pay the amount so estimated, reduced or increased, as the case may be, by any sum (not previously adjusted under this section) by which he finds that his estimate of the amount to be paid the State for any prior period under this section was greater or less than the amount which should have been paid to the State for such prior period under this section. " ALLOTMENT PERCENTAGE A N D FEDERAL S H A R E

"SEC. 423. (a) The 'allotment percentage' for any State shall be 100 per centum less the State percentage; and the State percentage shall be that percentage which bears the same ratio to 50 per centum as the per capita income of such State bears to the per capita income of

913

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PUBLIC LAW 90-248-JAN. 2, 1968

[81 STAT.

the United States; except that (1) the allotment percentage shall in no case be less than 80 per centmn or more than TO per centum, and (2) the allotment percentage shall be 70 per centnm in the case of Puerto Rico, the Virgin Islands, and Guam. "(b) The 'Federal share' for any State for any tiscal year shall be 100 per centum less that percentage which bears the same ratio to 50 per centnm as the per capita income of such State bears to the per capita income of the United States, except that (1) in no case shall the Federal share be less than 331/^ per centum or more than 66% per centum, and (2) the Federal share shall be 66% per centum in the c^ise of Puerto Rico, the Virgm Islands, and Guam. " (c) The Federal share and the allotment percentage for each State shall be promulgated by the Secretary between July 1 and August 31 of each even-numbered year, on the basis of the average per capita income of each State and of the United States for the three most recent calendar years for which satisfactory data are available from the Department of Commerce. Such promulgation shall be conclusive for each of the two fiscal years in the period beginning July 1 next succeeding such promulgation: Provided, That the Federal shares and allotment percentages promulgated under section 524(c) of the Social 42 USC 7 24. Security Act in 1966 shall be effective for purposes of this section for the fiscal years ending June 30, 1968, and June 30, 1969. "United states." " (d) For purposes of this section, the term 'United States' means the fifty States and the District of Columbia. aKEALLOTMENT

Ante, p. 912.

"SEC. 42-1. The amount of any allotment to a State under section 421 for any fiscal year which the State certifies to the Secretary will not be required for carrying out the State plan developed as provided in such section shall be available for reallotment from time to time, oai such dates as the Secretary may fix, to other States which the Secretary determines (1) have need in carrying out their State plans so developed for sums in excess of those previously allotted to them under that section and (2) will be able to use such excess amounts during such fiscal year. Such reallotments shall be made on the basis of the State plans so developed, after taking into consideration the population under the age of twenty-one, and the per capita income of each such State as compared with the population under the age of twenty-one, and the per capita income of all such States with respect to which such a determination by the Secretary has been made. Any amount so reallotted to a State shall he. deemed part of its allotment under section 421. "DEFINITION

"Child-welfare services.

"SEC. 425. For purposes of this title, the term 'child-welfare services' means public social services which supplement, or substitute for, parental care and supervision for the purpose of (1) preventing or remedying, or assisting in the solution of problems which may result in, the neglect, abuse, exploitation, or delinquency of children, (2) protecting and caring for homeless, dependent, or neglected children, (3) protecting and promoting the welfare of children of working mothers, and (4) otherwise protecting and promoting the welfare of children, including the strengthening of their own homes where possible or, where needed, the provision of adequate care of children away from their homes in foster family homes or day-care or other child-care facilities.

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915

"RESEARCH, TRAINING, OR DEMONSTRATION PROJECTS

"SEC. 426. (a) There are hereby authorized to be appropriated for each fiscal year such sums as the Congress may determine— " (A) to public or other nonprofit institutions of higher learning, and to public or other nonprofit agencies and organizations engaged in research or child-welfare activities, for special research or demonstration projects in the field of child welfare which are of regional or national significance and for special projects for the demonstration of new methods or facilities which show promise of substantial contribution to the adv^ancement of child welfare; " (B) to State or local public agencies responsible for administering, or supervising the administration of, the plan under this part, for projects for the demonstration of the utilization of research (including findings resulting therefrom) in the field of child welfare in order to encourage experimental and special types of welfare services; and " (C) to public or other nonprofit institutions of higher learning for special projects for training personnel for work in the field of child welfare, including traineeships with such stipends and allowances as may be permitted by the Secretary; and " (2) for contracts or jointly financed cooperative arrangements with States and public and other organizations and agencies for the conduct of research, special projects, or demonstration projects relating to such matters. " (b) Payments of grants or under contracts or cooperative arrangements under this section may be made in advance or by way of reimbursement, and in such installments, as the Secretary may determine; and shall be made on such conditions as the Secretary finds ne<;essary to carry out the purposes of the grants, contracts, or other a r rangements." (d)(1) Subparagraphs (A) and (B) of section 422(a)(1) of the Social Security Act (as added by subsection (c) of this section) are redesignated as (B) and (C). (2) So much of paragraph (1) of section 422(a) of such Act (as added by subsection (c) of this section) as precedes subparagrajjli (B) (as redesignated) is amended to read as follows: "(1) that has a plan for child-welfare services which has been developed as provided in this part and which— " (A) provides that (i) the State agency designated pursuant to section 402(a)(3) to administer or supervise the administration of the plan of the State approved under part A of this title will administer or supervise the administration of such plan for child-welfare services and (ii) to the extent that child-welfare services are furnished by the staff of the State agency or local agency administering such plan for child-welfare services, the organizational unit in such State or local agency established pursuant to section 402(a) (15) will be responsible for furnishing such child-welfare services,", (e)(1) Part 3 of title V of the Social Security Act is repealed on the date this Act is enacted, (2) Part B of title IV of the Social Security Act (as added by subsection (c) of this section), and the amendments made by subsections (a) and (b) of this section, shall become effective on the date this Act is enacted.
 * ' (1) for grants by the Secretary—

^"^^' P- ^^2.

^2 USC 602. 1LY^^^Q/"I^°^'

Ante,

p. 91 1.

Ante,

p. 878.

1^2^^t35- ,05 ^ " ^' 42 USC 721-728.

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[81 STAT.

(3) The amendineiits made b}^ paragraphs (1) and (2) of subsection {([) shall become effective July 1, 1969, except that (A) if on the date of enactment of this Act the agency of a State administering its plan for child-welfare services developed under part B of title l Y of the Ante, p. 911. Social Security Act is diiferent from the agency of the State designated 42 USC 602. pursuant to section 402(a)(3) of such Act, so much of paragraph (1) of section 422(a) of such Act as precedes siibparagraph {'[^) (as added "^''' ^' • by paragraph (2) of such subsection (d)) shall not apply with respect to such agencies but only so long as such agencies of the State are different, and (B) if on such date the local agency administering the plan of a State for child-welfare services developed under part B of title IV of the Social Security Act is different from the local agency in such subdivision administering the plan of such State under part A IL^^p ^9n^°^ ^^ ^^^^^ -^^^ ^^ sxwh Act, so much of such paragraph (1) as precedes such subparagraph (B) shall not apply with respect to such local agencies but only so long as such local agencies are different. (f) I n the case of any State which has a plan developed as provided in part 3 of title Y of the Social Security Act as in effect prior to the 42 USC'721-7^28. enactment of this Act— (1) such plan shall be treated as a plan developed, as provided in part B of title IV of such Act, on the date this Act is enacted: (2) any sums appropriated, allotted, or reallotted pursuant to part 3 of title V for the fiscal year ending June 30, 1968, shall be deemed appropriated, allotted, or reallotted (as the case may be) under part B of title IV of such Act for such fiscal year; and (3) any overpayment or underpayment which the Secretary determines was made to the State under section 523 of the Social 42 USC 723. Security Act and with respect to which adjustment has not then already been made under subsection (b) of such section shall, for Ante, pp. 912, purposes of section 422 of such Act, be considered an overpayment or underpayment (as the case may be) made under section 422 of such Act. (g) Any sums appropriated or grants made pursuant to section 526 of the Social Security Act (as in effect prior to the enactment of this 42 USC 726. Act) shall be deemed to have been appropriated or made (as the case may be) under section 426 of the Social Security Act (as added by subsection (c) of this section). (h) Each State plan approved under title IV of the Social Security Act as in effect on the day preceding the date of the enactment of this 42 USC 601-609. Act shall be deemed, without the necessity of any change in such plan, to have been conformed with the amendments made by subsections (a) and (b) of this section. CONrORMlNG AMENDMENTS

42 USC 428. 42 USC 601. 42 USC 60 3.

42 USC 604.

42 USC 606.

SJ,C. 241. (a) Section 228(d)(1) of the Social Security Act is amended by striking out "IV,", and by inserting after " X VI, " the following: "or part A of title IV,". (b)(1) The first sentence of section 401 of the Social Security Act is amended by striking out "title" and inserting in lieu thereof "part". (2) The proviso in section 403(a)(3)(D) of such Act is amended by striking out "title" and inserting in lieu thereof "part". (3) The last sentence of section 403(c)(2) of such Act is amended by striking out "title" and inserting in lieu thereof "part". (4) Section 404(b) of such Act is amended by striking out "title" and inserting in lieu thereof "part". ^5^ Section 406 of such Act is amended by striking out "title" in the matter preceding subsection (a) and inserting in lieu thereof "part".

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(c)(1) Section 1106(c)(1) of such Act is amended by striking ont "IV,", and by inserting after "XIX," the following: "or part A of title IV,". (2) Section 1109 of such Act is amended by strikhig out "IV,", and by inserting after " X IX " the following: ", or part A of title IV,". (3) Section 1111 of such Act is amended by striking out "IV,", and by inserting after " X VI, " the following: "and part A of title IV,". (4) Section 1115 of such Act is amended by striking out "IV,", and by inserting after " X IX " the following: ", or part A of title IV,". (5) Section 1116 of such Act is amended— (A) by striking out "IV," in subsection (a)(1), and by inserting after " X IX, " in such subsection the following: "or part A of title IV, "; and (B) by striking out "IV," in subsections (b) and (d), and by inserting after " X IX " in such subsections the following: ", or part A of title IV,". (6) Section 1117 of such Act is amended— (A) by striking out "IV," in clause (A) of subsection (a)(2), and by inserting after " X IX " in such clause the following: ", and part A of title IV, "; (B) by striking out "IV," each place it appears in subsection (b); . . . . (C) by inserting after "and X IX " in subsection (b) the following: ", and part A of title IV, "; (D) by inserting after "or X IX " in subsection (b) the following: ", or part A of title IV". (7) Section 1118 of such Act is amended by striking out "IV,", and by inserting after " X VI, " the following: "and part A of title IV,". " (d) Section 1602(a) (11) of such Act is amended by striking out "title IV, X, or X IV " and inserting in lieu thereof "part A of title IV or under title X or X IV ". (e)(1) Section 1843(b)(2) of such Act is amended by striking out "IV,", and by inserting after " X VI " the following: ", and part A of title IV". (2) Section 1843(f) of such Act is amended— (A) by striking out "IV," in the first sentence, and by inserting after " X VI, " the first place it appears in such sentence the following: "or part A of title IV,", and (B) by striking out " IV, " in the second sentence, and by inserting after " X VI " in such sentence the following: ", and part A of title IV". (f)(1) Section 1902(a) (10) of such Act is amended by striking out "IV,", and by inserting after " X VI " the following: ", and part A of title IV". (2) Section 1902(a) (17) of such Act is amended by striking out "IV,", and by inserting after " X VI " the following: ", or part A of title IV". (3) Section 1902(b)(2) of such Act is amended by striking out "title IV " and inserting in lieu thereof "part A of title IV". (4) Section 1902(c) of such Act is amended by striking out "IV,", and by inserting after " X VI " the following: ", or part A of title IV". (5) Section 1903(a)(1) of such Act is amended by striking out "IV,", and by inserting after " X VI, " the following: "or part A of title IV,". (6) Section 1905(a) (ii) of such Act is amended by striking out "title IV " and inserting in lieu thereof "part A of title IV".

917 ^2 USC isoe. 42 USC 1309. "^^ use 1311. " ^ use 1315. ^ 42 USC 13 le.

42 USC 1317.

" ^ ^^^ ^^ ^8^ 42 USC 1382. ^2 USC oesv.

^^ use 1396a.

42 USC 1396b. ^2 USC i396d.

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fel

STAT.

PART 4—MISCELLANEOUS AND TECHNICAL AMENDMENTS PARTIAL P A Y M E N T S

628^ 6 6 ^ ^^^' 4 *64 Stat. 557. 42 1204, 1354. 604, use 304,

TO

STATES

SEC. 245.'Sections 4, 404(a), 1004, and 1404 of the Social Security ^ ^ ^ ^^^ each amended— (1) by Striking out "further payments will not be made to the State" and inserting in lieu thereof "further payments will not be made to the State (or, ni his discretion, that payments will be limited to categories under or parts of the State plan not affected by such failure)"; and (2) by striking out the last sentence and inserting in lieu thereof the following: "Until he is so satisfied he shall make no further payments to such State (or shall limit payments to categories under or parts of the State plan not affected by such failure)." CONTRACTS FOR COOPERATIVE RESEARCH OR DEMONSTRATION P R O J E C T S

70 Stat. 8 5 1. 42 USC 1310.

SEC. 246. Section 1110(a)(2) of the Social Security Act is amended by striking out "nonprofit". P E R M A N E N T AUTHORITY IT) SUPPORT DEMONSTRATION

76 Stat. 192. 42 USC 1315.

Ante,

p. 94.

PROJECTS

SEC. 247. Section 1115 of the Social Security Act is amended— (1) by striking out "$2,000,000" and inserting in lieu thereof "$4,000,000" • and (2) by striking out "ending prior to July 1, 1968" and inserting in lieu thereof "beginning after June 30, 1967". SPECIAL PROVISIONS RELATING TO PUERTO RICO, THE VIRGIN I S L A N D S, AND GUAM

76 Stat. 206. 42 USC 1308.

S E C 248. (a)(1) Section 1108 of the Social Security Act is amended to read as follows: "LIMITATION

ON PAYMENTS

TO PUERTO RICO, THE VIRGIN I S L A N D S, AND GUAM

"SEC. 1108. (a) The total amount certified by the Secretary of Health, Education, and Welfare under title I, X, X IV, and X VI, and 120^1 "fssf^ 1381- ^^^^6^ P^^t A of title IV (exclusive of any amounts on account of Ante. p. 911. ' scTvlces aud items to which subsection (b) appHes)— " (1) for payment to Puerto Rico shall not exceed— " (A) $12,500,000 with respect to the fiscal year 1968, " (B) $15,000,000 with respect to the fiscal year 1969, " (C) $18,000,000 with respect to the fiscal year 1970, " (D) $21,000,000 with respect to the fiscal year 1971, or " (E) $24,000,000 with respect to the fiscal year 1972 and each fiscal year thereafter; "(2) for payment to the Virgin Islands shall not exceed— " (A) $425,000 with respect to the fiscal year 1968, " (B) $500,000 with respect to the fiscal year 1969, " (C) $600,000 with respect to the fiscal year 1970, " (D) $700,000 with respect to the fiscal year 1971, or " (E) $800,000 with respect to the fiscal year 1972 and each fiscal year thereafter; and "(3) for payment to Guam shall not exceed— " (A) $575,000 with respect to the fiscal year. 1968,

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 81 STAT.]

PUBLIC LAW 9 0 - 2 4 8 - J A N. 2, 1968

919

" (B) $69,0 with respect to the fiscal year 1969, " (C) $825,000 with respect to the fiscal year 1970, " (I)) $960,000 with respect to the fiscaf year 1971, or "(p]) $1,100,000 with respect to the fiscal year 1972 and each fiscal year thereafter. " (b) The total amount ceilified by the Secretary under part A of 42 u 1-609. title IV, on account of family planning services and services provided Ante, s ep.60 1 1. 9 under section 402(a) (19) with respect to any fiscal year— Ante, p. 89o. "(1) for payment to Puerto Rico shall not exceed $2,000,000, "(2) for payment to the Virgin Islands shall not exceed $65,000, and "(3) for payment to Guam shall not exceed $90,000. "(c) The total amount certified by the Secretary under title X IX ^ggg"^*^ ^^'^^" with respect to any fiscal year— Ante, pp. QO3"(1) f«r payment to Puerto Rico shall not exceed $20,000,000, ^os. "(2) for payment to the Virgin Islands shall not exceed $650,000, and " (3) for payment to Guam shall not exceed $900,000. "(d) Notwithstanding the provisions of sections 502(a) and 512(a) 42 of this Act, and the provisions of sections 421, 503(1), and 504(1) of 712. use 70 2, this Act as amended by the Social Security Amendments of 1967, Ante. P- 912. and until such time as the Congress may by appropriation or other Post, P- 9 22. law otherwise provide, the Secretary shall, in lieu of the initial allotment specified in such sections, allot such smaller amounts to Guam as he may deem appropriate." (2) The amendment made by paragraph (1) shall apjjly with respect to fiscal years beginning after June 30, 1967. (D) Notwithstanding subparagraphs (A) and (B) of section 403 (a)(3) of such Act (as amended by this Act), the rate specified in ^"'^' P- ^'^^• such subparagraphs in the case of Puerto Rico, the Virgin Islands, and Guam shall be 60 per centum (rather than 75 or 85 per centum). (c) Effective July 1, 1969, neither the provisions of clauses (A) through (C) of section 402(a)(7) of such Act as in effect before the enactment of this Act nor the provisions of section 402(a)(8) of such '^^ ^^^ ^°^'Act as amended by section 202(b) of this Act shall apply in the case of '*"^®' P- ^SPuerto Rico, the Virgin Islands, or Guam. Effective no later than July 1, 1972, the State plans of Puerto Rico, the Virgin Islands, and Guam approved under section 402 of such Act shall provide for the disregarding of income in making the determination under section 402(a)(7) of such Act in amounts (agreed to between the Secretary and the State agencies involved) sufficiently lower than the amounts specified in section 402(a)(8) of such Act to reflect appropriately the applicable differences in income levels. (d) The amendment made by section 220(a) of this Act shall not '^"'^' P- ^^^• apply in the case of Puerto Rico, the Virgin Islands, or Guam. (e) Effective with respect to quarters after 1967, section 1905(b) of such Act is amended by striking out "55 per centum" and inserting ^^ Stat. 352. in lieu thereof "50 per centum". APPROVAL OF CERTAIN

PROJECTS

SEC. 249. Title X I of the Social Security Act is amended by adding at the end thereof (after the new section added by section 209 of this Act) the following new section: < APPROVAL OF CERTAIN PROJECTS c

"SEC. 1120. (a) No payment shall be made under this Act with respect to any experimental, pilot, demonstration, or other project all or any part of which is wholly financed with Federal funds made available under this Act (without any State, local, or other non-Federal

^"'e, p. 894.

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[81 STAT.

financial participation) unless such project shall have been personally approved by the Secretary or Under Secretary of Health, Education, and Welfare. " (b) As soon as possible after the approval of any project under subsection (a), the Secretary shall submit to the Congress a description of such project including a statement of its purpose, probable cost, and expected duration." ASSISTANCE I N THE FORM OF INSTITUTIONAL SERVICES I N INTERMEDIATE CARE FACILITIES

Ante. pp. 894,

SEC. 250. (a) Title X I of the Social Security Act (as amended by sectious 209 and 249 of this Act) is further amended by adding at the end thereof the following new section: " A S S I S T A N C E I N THE FOR M O F INSTITUTIONAL SERVICES I N INTERMEDIATE CARE FACILITIES

42 USC 301. 42 USC 1201. 42 USC 1351.

42 USC 1381.

42 USC 1396. Ante, pp. 903-

908.

""

42 USC 1396d. Ante, p. 919.

"SEC. 1121. (a) Any State which has in effect a plan for old-age assistance, approved under title I, a plan for aid to the blind, approved under title X, a plan for aid to the permanently and totally disabled, approved under title X r V, or a plan for aid to the aged, blind, or disabled, approved under title X VI, may, on or after January 1, 1968, modify such plan to include therein benefits in the form of institutional services in intermediate care facilities for individuals who are entitled (or would, if not receiving institutional services in intermediate care facilities, be entitled) to assistance, under such plan, in the form of money payments. " (b) Any modification pursuant to subsection (a) shall provide that benefits in the form of institutional services in intermediate care facilities will be provided only to individuals who— "(1) are entitled (or would, if not receiving institutional services in intermediate care facilities, be entitled) to receive aid or assistance, under the State plan, in the form of money payments; "(2) because of their physical or mental condition (or both), require living accommodations and care which, as a practical matter, can be made available to them only through institutional facilities; and " (3) do not have such an illness, disease, injury, or other condition as to require the degree of care and treatment which a hospital or skilled nursing home (as that term is employed in title X IX) is designed to provide. "(c) Payments to any State which modifies its approved State plan (referred to in subsection (a)) to provide, to the recipients of aid or assistance thereunder, benefits in the form of institutional services in intermediate care facilities shall be made in the same manner and from the same appropriation as payments made with respect to expenditures under the State plan so modified, except that, with respect to expenditures made by the State in paying the cost of benefits in the form of institutional services in intermediate care facilities for any quarter, the Secretary shall, if the State so elects, pay to each State an amount equal to the Federal medical assistance percentage (as defined in section 1905(b)). " (d) Except when inconsistent with the purposes of this section or contrary to any provision of this section, any modification, pursuant to this section, of an approved State plan shall be subject to the same conditions, limitations, rights, and obligations as obtain with respect to such approved State plan.

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81 STAT.]

" (e) For purposes of this section, the term 'intermediate care facility' means an institution or distinct part thereof which (1) is licensed, under State law, to provide the patients or residents thereof, on a regular basis, the range or level of care and services which is suitable to the needs of individuals described in subsection (b)(2) and (3), but which does not provide the degree of care required to be provided by a skilled nursing home furnishing services under a State plan approved under title X IX, and (2) meets such standards of safety and sanitation as are applicable to nursing homes under State law; except that in no case shall such term include an institution which does not regularly provide a level of care and service beyond room and board. The term 'intermediate care facility' also includes a Christian Science sanatorium operated, or listed and certified, by the First Church of Christ, Scientist, Boston, Massachusetts, but only with respect to institutional services deemed appropriate by the State." TITLE III—IMPROVEMENT OF CHILD HEALTH

"Intermediate care f a c i l i t y, "

42 USC 13961396d. Ante, pp. 90 3908.

Child Health Act of 1967.

COXSOLlDATION OF SEPARATE PROGRAMS U N D E R TITLE V OF THE SOCIAL SECURITY ACT

SEC. 301. Effective with respect to fiscal years beginning after June 30, 1968, title V of the Social Security Act (as otherwise amended by this Act) is amended to read as follows: " TITLE V — M A T E R N A L A N D C H I L D H E A L T H AND CRIPPLED CHILDREN'S SERVICES ''AUTHORIZATIOlSr OF APPROPRIATIONS

"SEC. 501. For the purpose of enabling each State to extend and improve (especially in rural areas and in areas suffering from severe economic distress), as far as practicable under the conditions in such State, " (1) services for reducing infant mortality and otherwise promoting the health of mothers and children; and "(2) services for locating, and for medical, surgical, corrective, and other services and care for and facilities for diagnosis, hospitalization, and aftercare for, children who are crippled or who are suffering from conditions leading to crippling, there are authorized to be appropriated $250,000,000 for the fiscal year ending June 30, 1969, $275,000,000 for the fiscal year ending June 30, 1970, $300,000,000 for the fiscal year ending June 30, 1971, $325,000,000 for the fiscal year ending June 30, 1972, and $350,000,000 for the fiscal year ending June 30, 1973, and each fiscal year thereafter. li

P U R P O S E S FOR W H I C H F U N D S ARE AVAILABLE

"SEC. 502. Appropriations pursuant to section 501 shall be available for the following purposes in the following proportions: " (1) I n the case of the fiscal year ending June 30, 1969, and each of the next 3 fiscal years, (A) 50 percent of the appropriation for such year shall be for allotments pursuant to sections 503 and .504; (B) 40 percent thereof shall be for grants pursuant to sections 508, 509. and 510; and (C) 10 percent thereof shall be for grants, contracts, or other arrangements pursuant to sections 511 and 512. " (2) I n the case of the fiscal year ending June 30, 1973, and each fiscal year thereafter, (A) 90 percent of the appropriation for such years shall be for allotments pursuant to sections 503 and

49 Stat. 629. 42 USC 701-731. Ante, p. 9 15. Post, p. 929.

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PUBLIC LAW 90-248-JAN. 2, 1968

[81 STAT.

504; and (B) 10 percent thereof shall be for o-rants, contracts, or other arrangements pursuant to sections 511 and ol'2. Xot to exceed 5 percent of the appropriation for any fiscal 3-ear inider this section shall be transferred, at the reqnest of the Secretary, from one of the purposes specified in parap*aph (1) or (2) to another ]nirpose or purposes so specified. For each fiscal year, the Secretary shall determine the portion of the appropriation, AAithin the percentag:e determined above to be available for sections 508 and 504, which shall be available for allotment pursuant to section 503 and the portion thereof which shall be available for allotment pursuant to section 504. Xotwithstandin^ the precedin^ provisions of this section, of the amount appropriated for any fiscal year pursuant to section 501, not less than 6 percent of the amount appropriated shall be available for family planning services from allotments under section 503 and for family planning services under projects under sections 508 and 512. a ALLOTMENTS TO STATES I'^OR: M A T E R X A 1. A X D CHILD TIEAI/ril SERVICES

"SEC. 503. The amount determined to be available pursuant to section 502 for allotments under this section shall be allotted for payments for maternal and child health services as follows: "(1) One-half of such amount shall be allotted by allottino; to each State $70,000 plus such part of the remainder of such onehalf as he finds that the number of live births in such State bore to the total number of live births in the United States in the latest calendar year for which he has statistics. "(2) The remaining one-half of such amount shall (in addition to the allotments under paragraph (1)) be allotted to the States from time to time according to the financial need of each State for assistance in carrying out its State plan, as determined by the Secretary after taking into consideration the number of live births in such State; except that not more than 25 percent of such onehalf shall be available for grants to State agencies (administering or supervising the administration of a State plan approved under section 505), and to public or other nonprofit institutions of higher learning (situated in any State), for special projects of regional or national significance which may contribute to the advancement of maternal and child health. " ALLOTMENTS TO STATES FOR CRIPrLED C H I L D R E N ' S SERVICES

"SEC. 504. The amount determined to be available pursuant to section 502 for allotments under this section shall be allotted for payments for crippled children'services as follows: "(1) One-half of such amount shall be allotted by allotting to each State $70,000 and allotting the remainder of such one-half according to the need of each State as determined by him after taking into consideration the number of crippled children in such State in need of the services referred to in paragraph (2) of section 501 and the cost of furnishing such services to them. "(2) The remaining one-half of such amount shall (in addition to the allotments under paragraph (1)) be allotted to the States from time to time according to the financial need of each State for assistance in carrying out its State plan, as determined by the Secretary after taking into consideration the number of crippled children in each State in need of the services referred to in paragraph (2) of section 501 and the cost of furnishing such services to them; except that not more than 25 percent of such one-half shall be available for grants to State agencies (administering or supervising the administration of a State plan ap-

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STAT,]

PUBLIC LAW 90-248-JAN. 2, 1968

923

proved under section 505), and to public or other nonprofit institutions of higher learning (situated in any State), for special projects of regional or national significance which may contribute to the advancement of services for crippled children. "APPROVAL OF STATE PLANS

"SEC. 505. (a) In order to be entitled to payments from allotments under section 502, a State must have a State plan for maternal and child health services and services for crippled children which— "(1) provides for financial participation by the State; "(2) provides for the administration of the plan by the State health agency or the supervision of the administration of the plan by the State health agency; except that in the case of those States w4iich on July 1, 1967, provided for administration (or supervision thereof) of the State plan approved under section 518 (as in eifect on such date) by a State agency other than the State health agency, the plan of such State may be approved under this section if it would meet the requirements of this subsection except for provision of administration (or supervision thereof) by such other agency for the portion of the plan relating to services for crippled children, and, in each such case, the portion of such plan which each such agency administers, or the administration of which each such agency supervises, shall be regarded as a separate plan for purposes of this title; "(3) provides such methods of administration (including methods relating to the establishment and maintenance of personnel standards on a merit basis, except that the Secretary shall exercise no authority with respect to the selection, tenure of office, and compensation of any individual employed in accordance with such methods) as are necessary for the proper and efficient operation of the plan; "(4) provides that the State agency wdll make such reports, in such form and containing such information, as the Secretary may from time to time require, and comply with such provisions as he may from time to time find necessary to assure the correctness and verification of such reports; "(5) provides for cooperation with medical, health, nursing, educational, and welfare groups and organizations and, with respect to the portion of the plan relating to services for crippled children, with any agency in such State charged with administering State laws providing for vocational rehabilitation of physically handicapped children; "(6) provides for payment of the reasonable cost (as determined in accordance with, standards approved by the Secretary and included in the plan) of inpatient hospital services provided under the plan; "(7) provides, with, respect to the portion of the plan relating to services for crippled children, for early identification of children in need of health care and services, and for health care and treatment needed to correct or ameliorate defects or chronic conditions discovered thereby, through provision of such periodic screening and diagnostic services, and such treatment, care and other measures to correct or ameliorate defects or chronic conditions, as may be provided in regulations of the Secretary; "(8) effective July 1, 1972, provides a program (carried out directly or through grants or contracts) of projects described in section 508 which offers reasonable assurance, particularly in areas with concentrations of low-income families, of satisfactorily

42 USC 713.

Post, p. 929.

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PUBLIC LAW 90-248-JAN. 2, 1968

[sl STAT.

helping to reduce the incidence of mental retardation and other handicapping conditions caused by complications associated with child bearing and of satisfactorily helping to reduce infant and maternal mortality; "(9) effective July 1, 1972, provides a program (carried out directly or through grants or contracts) of projects described in section 509 which offers reasonable assurance, particularly in areas with concentrations of low-income families, of satisfactorily promoting the health of children and youth of school or preschool age; "(10) effective July 1, 1972, provides a program (carried o\U directly or through grants or contracts) of projects described in section 510 which offers reasonable assurance, particularly in areas with concentrations of low-income families, of satisfactorily promoting the dental health of children and youth of school or preschool age; "(11) provides for carrying out the purposes specified in section 501; "(12) provides for the development of demonstration services (with special attention to dental care for children and family planning services for mothers) in needy areas and among groups in special need, "(18) provides that, where payment is authorized under the plan for services which an optometrist is licensed to perform, the individual for whom such payment is authorized may, to the extent practicable, obtain such services from an optometrist licensed to perform such services except where such services are rendered in a clinic, or another appropriate institution, which does not have an arrangement with optometrists so licensed; and " (14) provides that acceptance of family planning services provided under the plan shall be voluntary on the part of the individual to wdiom such services are offered and shall not be a prerequisite to eligibility for or the receipt of any service under the plan. "(b) The Secretary shall approve anj' plan which meets the requirements of subsection (a). "PAYMENTS

"SEC. 506. (a) From the sums appropriated therefor and the allotments available under section 503(1) or 504(1), as the case may be, the Secretary shall pay to each State which has a plan approved under this title, for each quarter, beginning with the quarter commencing July 1, 1968, an amount, which shall be used exclusively for carrying out the State plan, equal to one-half of the total sum expended during such quarter for carrying out such plan with respect to maternal and child health services and services for crippled children, respectively. "(b)(1) Prior to the beginning of each quarter, the Secretary shall estimate the amount to which a State will be entitled under subsection (a) for such quarter, svich estimates to be based on (A) a report filed by the State containing its estimate of the total sum to be expended in such quarter in accordance with the provisions of such subsection, and stating the amount appropriated or made available by the State and its political subdivisions for such expenditures in such quarter, and if such amount is less than the State's proportionate share of the total sum of such estimated expenditures, the source or sources from which the difference is expected to be derived, and (B) such other investigation as the Secretary may find necessary.

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PUBLIC LAW 90-248-JAN. 2, 1968

"(2) The Secretary shall then pay to the State, in such installments as he may determine, the amount so estimated, reduced or increased to the extent of any overpayment or underpayment which the Secretary determines was made under this section to such State for any prior quarter and with respect to which adjustment has not gtlready been made under this subsection. "(3) Upon the making of an estimate by the Secretary under this subsection, any appropriations available for payments under this section shall be deemed obligated. "(c) The Secretary shall also from time to time make payments to the States from their respective allotments pursuant to section 503(2) or 604(2). Payments of grants under sections 503(2), 504(2), 508, 509, 510, and 511, and of grants, contracts, or other arrangements under section 512, may be made in advance or by way of reimbursement, and in such installments, as the Secretary may determine; and shall be made on such conditions as the Secretary finds necessary to carry out the purposes of the section involved. " (d) The total amount determined under subsections (a) and (b) and the first sentence of subsection (c) for any fiscal year ending after June 30, 1968, shall be reduced by the amount by which the sum expended (as determined by the Secretary) from non-Federal sources for maternal and child health services and services for crippled children for such year is less than the sum expended from such sources for such services for the fiscal year ending June 30, 1968. I n the case of any such reduction, the Secretary shall determine the portion thereof which shall be applied, and the manner of applying such reduction, to the amounts otherwise payable from allotments under section 503 or section 504. "(e) Notwithstanding the preceding provisions of this section, no payment shall be made to any State thereunder from the allotments under section 503 or section 504 for any period after June 30, 1968, unless the State makes a satisfactory showing that it is extending the provision of services, including services for dental care for children and family planning for mothers, to which such State's plan applies in the State with a view to making such services available by July 1, 1975, to children and mothers in all parts of the State. "orERATIOX o r STATE PLANS

"SEC. 507. If the Secretary, after reasonable notice and opportunity for hearing to the State agency administering or supervising the administration of the State plan approved under this title, finds— "(1) that the plan has been so changed that it no longer complies with the provisions of section 505; or "(2) that in the administration of the plan there is a failure to comply substantially with any such provision; the Secretary shall notify such State agency that further payments will not be made to the State (or, in his discretion, that payments will be limited to categories under or parts of the State plan not affected by such failure), until the Secretary is satisfied that there will no longer be any such failure to comply. Until he is so satisfied he shall make no further payments to such State (or shall limit payments to categories under or parts of the State plan not affected by such failure).

925

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PUBLIC LAW 90-248-JAN. 2, 1968 ii

[81 STAT.

SPECIAL PROJECT GRANTS FOR MATERNITY AND INFANT CARE

"SEC. 508. (a) I n order to help reduce the incidence of mental retardation and other handicapping conditions caused by complications associated with childbearing and to help reduce infant and maternal mortality, the Secretary is authorized to make, from the sums available under clause (B) of paragraph (1) of section 502, grants to the State health agency of any State and, with the consent of such agency, to the health agency of any political subdivision of the State, and to any other public or nonprofit private agency, institution, or organization, to pay not to exceed 75 percent of the cost (exclusive of general agency overhead) of any project for the provision of— "(1) necessary health care to prospective mothers (including, after childbirth, health care to mothers and their infants) who have or are likely to have conditions associated with childbearing or are in circumstances which increase the hazards to the health of the mothers or their infants (including those which may cause physical or mental defects in the infants), or "(2) necessary health care to infants during their first year of life who have any condition or are in circumstances which increase the hazards to their health, or "(3) family planning services, but only if the State or local agency determines that the recipient will not otherwise receive such necessary health care or services because he is from a low-income family or for other reasons beyond his control. Acceptance of family planning services provided under a project under this section (and section 512) shall be voluntary on the part of the individual to whom such services are offered and shall not be a prerequisite to the eligibility for or the receipt of any service under such project. "(b) No grant may be made under this section for any project for any period after June 30, 1972. " S P E C I A L P R O J E C T GRANTS FOR HEALTH OF SCHOOL AND PRESCHOOL CHILDREN

"SEC. 509, (a) In order to promote the health of children and youth of school or preschool age, particularly in areas with concentrations of low-income families, the Secretary is authorized to make, from the sums available under clause (B) of paragraph (1) of section 502, grants to the State health agency of any State and (with the consent of such agency) to the health agency of any political subdivision of the State, to the State agency of the State administering or supervising the administration of the State plan approved under section 505, to any school of medicine (with appropriate participation by a school of dentistry), and to any teaching hospital affiliated with such a school, to pay not to exceed 75 percent of the cost of projects of a comprehensive nature for health care and services for children and youth of school age or for preschool children (to help them prepare to start school). No project shall be eligible for a grant under this section unless it provides (1) for the coordination of health care and services provided under it with, and utilization (to the extent feasible) of, other State or local health, welfare, and education programs for such children, (2) for payment of the reasonable cost (as determined in accordance with standards approved by the Secretary) of inpatient hospital services provided under the

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PUBLIC LAW 90-248-JAN. 2, 1968

project, and (3) that any treatment, correction of defects, or aftercare provided under the project is available only to children who would not otherwise receive it because they are from low-income families or for other reasons beyond their control; and no such project for children and youth of school age shall be considered to be of a comprehensive nature for purposes of this section unless it includes (subject to the limitation in the preceding provisions of this sentence) at least such screening, diagnosis, preventive services, treatment,, correction of defects, and aftercare, both medical and dental, as may be provided for in regulations of the Secretary. " (b) No grant may be made under this section for any project for any period after June 30, 1972. "SPECIAL PROJECT GRANTS FOR DENTAL HEALTH OF CHILDREN

"SEC. 510. (a) I n order to promote the dental health of children and youth of school or preschool age, particularly in areas with concentrations of low-income families, the Secretary is authorized to make grants, from the sums available under clause (B) of paragraph (1) of section 502, to the State health agency of any State and (with the consent of such agency) to the health agency of any political subdivision of the State, and to any other public or nonprofit private agency, institution, or organization, to pay not to exceed 75 percent of the cost of projects of a comprehensive nature for dental care and services for children and youth of school age or for preschool children. No project shall be eligible for a grant under this section unless it provides that any treatment, correction of defects, or aftercare provided under the project is available only to children who would not otherwise receive it because they are from low-income families or for other reasons beyond their control, and unless it includes (subject to the limitation of the foregoing provisions of this sentence) at least such preventive services, treatment, correction of defects, and after care, for such age groups, as may be provided in regulations of the Secretary. Such projects may also include research looking toward the development of new methods of diagnosis or treatment, or demonstration of the utilization of dental personnel with various levels of training. "(b) No grant may be made under this section for any project for any period after June 30, 1972. (< ( TRAINING

or

PERSONNEL

"SEC. 511. From the sums available under clause (C) of paragraph (1) or clause (B) of paragraph (2) of section 502, the Secretary is authorized to make grants to public or nonprofit private institutions of higher learning for training personnel for health care and related services for mothers and children, particularly mentally retarded children and children with multiple handicaps. I n making such grants, the Secretary shall give special attention to programs providing training at the undergraduate level. "RESEARCH PROJECTS RELATING TO MATERNAL AND CHILD HEALTH SERVICES AND C R I P P L E D CHILDREN'S SERVICES

"SEC. 512. From the sums available under clause (C) of paragraph (1) or clause (B) of paragraph (2) of section 502, the Secretary is authorized to make grants to or jointly financed cooperative arrange85-622 0-68—61

927

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PUBLIC LAW 90-248-JAN. 2, 1968

[81 STAT.

ments with public or other nonprofit institutions of higher learning, and public or nonprofit private agencies and organizations engaged in research or in maternal and child health or crippled children's programs, and contracts with public or nonprofit private agencies and organizations engaged in research or in such programs, for research projects relating to maternal and child health services or crippled children'services which show promise of substantial contribution to the advancement thereof. Effective wnth respect to grants made and arrangements entered into after June 30, 1968, (1) special emphasis shall be accorded to projects which will help in studying the need for, and the feasibility, costs, and effectiveness of, comprehensive health care programs in which maximum use is made of health personnel with varying levels of training, and in studying methods of training for such programs, and (2) grants under this section may also include funds for the training of health personnel for work in such projects. "ADMINISTRATION

513. (a) The Secretary of Health, Education, and Welfare shall make such studies and investigations as will promote the efficient administration of this title. " (b) Such portion of the appropriations for grants under section 501 as the Secretary may determine, but not exceeding one-half of 1 jjercent thereof, shall be available for evaluation by the Secretary (directly or by grants or contracts) of the programs for which such appropriations are made and, in the case of allotments from any such appropriation, the amount available for allotments shall be reduced accordingly. "(c) Any agency, institution, or organization shall, if and to the extent prescribed by the Secretary, as a condition to receipt of grants under this title, cooperate with the State agency administering or supervising the administration of the State plan approved under title ^g'^2 USC 1396X IX in the provision of care and services, available under a plan or Ante. pp. 90 3- project under this title, for children eligible therefor under such plan ^08approved under title X IX. ''SEC.

"DEFINITION

"SEC. 514. For purposes of this title, a crippled child is an individual under the age of 21 who has an organic disease, defect, or condition which may hinder the achievement of normal growth and development. "OBSERVANCE OF RELIGIOUS BELIEFS

"SEC. 515. Nothing in this title shall be construed to require any State which has any plan or program approved under, or receiving financial support under, this title to compel any person to undergo any medical screening, examination, diagnosis, or treatment or to accept any other health care or services provided under such plan or program for any purpose (other than for the purpose of discovering and preventing the spread of infection or contagious disease or for the purpose of protecting environmental health), if such person objects (or, in case such person is a child, his parent or guardian objects) thereto on religious grounds."

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PUBLIC LAW 90-248-JAN. 2, 1968 CONFORMING

929

AMENDMENTS

SEC. 302. (a) Section 1905(a)(4) of the Social Security Act is amended by inserting " (A) " after " (4) ", and by inserting before the semicolon at the end thereof the following: " (B) effective July 1, 1969, such early and periodic screening and diagnosis of individuals who are eligible under the plan and are under the age of 21 to ascertain their physical or mental defects, and such health care, treatment, and other measures to correct or ameliorate defects and chronic conditions discovered thereby, as may be provided in regulations of the Secretary". (b) Section 1902(a) (11) of such Act is amended by inserting " (A) " after "(11)'', and by inserting before the semicolon at the end thereof the following: ", and (B) effective July 1, 1969, provide, to the extent pre.scribed by the Secretary, for entering into agreements, with any agency, institution, or organization receiving payments for part or all of the cost of plans or projects under title V, (i) providing for utilizing such agency, institution, or organization in furnishing care and services which are available under such plan or project under title V and which are included in the State plan approved under this section and (ii) making such provision as may be appropriate for reimbursing such agency, institution, or organization for the cost of any such care and services furnished any individual for which payment would otherwise be made to the State with respect to him under section 1903".

79 Stat. 351. 42 USC 1396d.

^2 USC 1396a

Ante,

p. 9 21.

42 USC 1396b

1968 AUTHORIZATION FOR M A T E R N I T Y A N D I N F A N T CARE P R O J E C T S

SEC. 303. Section 531(a) of the Social Security Act is amended by striking out "and $30,000,000 for each of the next three fiscal years^' and inserting in lieu thereof "$30,000,000 for each of the next 2 fiscal years, and $35,000,000 for the fiscal year ending June 30. 1968".

H ^^^^ ^l^-

T J S E OF SUBPROFESSIONAL S T A F F A N D VOLUNTEERS

SEC. 304. (a) Section 505(a)(3) of the Social Security Act (as added by section 301 of this Act) is amended by— (1) striking out "provides" and inserting in lieu thereof "provides (A) "; (2) adding at the end before the semicolon the following: "and (B) provides for the training and effective use of paid subprofessional staff, with particular emphasis on the full-time or part-time employment of persons of low income, as community service aides, in the administration of the plan and for the use of nonpaid or partially paid volunteers in providing services and in assisting any advisory committees established by the State agency". (b) The amendment made by this section shall become effective July 1, 1969, or, if earlier (with respect to a State) on the date as of which the modification of the State plan to comply with such amendment is approved. E X T E N S I O N OF D U E DATE FOR C H I L D M E N T A L H E A L T H

REPORT

SEC. 305. Section 231(d) of the Social Security Amendments of 1965 (Public Law 89-97) is amended by striking out the word "two" and "^^ ^*^*- ^eo. inserting in lieu thereof "three". note. "^^ ^"^^^

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PUBLIC LAW 90-248-JAN. 2, 1968 SHORT

Citation of title.

[81 STAT.

TITLE

^^^ gQg r^^iis title may be cited as the "Child Health Act of 1967". TITLE IV—GENERAL PROVISIONS SOCIAL W O R K M A N P O W E R A N D

49 Stat. 635; 79 Stat. 339. 42 USC 901-907.

TRAINING

SEC. 401. Title VII of the Social Security Act is amended by adding at the end thereof the following new section: " G R A N T S FOR E X P A N S I O N AND DEVELOPMENT OF UNDERGRADUATE A N D GRADUATE PROGRAMS

"Graduate school of s o c i a l work."

"Accredited."

"Nonprofit.

"SEC. 707. (a) There is authorized to be appropriated $5,000,000 for the fiscal year ending June 30, 1969, and $5,000,000 for each of the three succeeding fiscal years, for grants by the Secretary to public or nonprofit private colleges and universities and to accredited graduate schools of social work or an association of such schools to meet part of the costs of development, expansion, or improvement of (respectively) undergraduate programs in social work and programs for the graduate training of professional social work personnel, including the costs of compensation of additional faculty and administrative personnel and minor improvements of existing facilities. Not less than one-half of the sums appropriated for any fiscal year under the authority of this subsection shall be used by the Secretary for grants with respect to undergraduate programs. " (b) In considering applications for grants under this section, the Secretary shall take into account the relative need in the States for personnel trained in social work and the effect of the grants thereon. "(c) Payment of grants under this section may be made (after necessary adjustments on account of previously made overpayments or underpayments)-in advance or by way of reimbursement, and on such terms and conditions and in such installments, as the Secretary may determine. " (d) For purposes of this section— "(1) the term 'graduate school of social work' means a department, school, division, or other administrative unit, in a public or nonprofit private college or university, which provides, primarily or exclusively, a program of education in social work and allied subjects leading to a graduate degree in social work; " (2) the term 'accredited' as applied to a graduate school of social work refers to a school which is accredited by a body or bodies approved for the purpose by the Commissioner of Education or with respect to which there is evidence satisfactory to the Secretary that it will be so accredited within a reasonable time; and "(3) the term 'nonprofit' as applied to any college or university refers to a college or university which is a corporation or association, or is owned and operated by one or more corporations or associations, no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual." I N C E N T IV E S FOR E C O N O M Y W H I L E M A I N T A I N I N G OR I M P R O VI N G Q U A L I T Y I N THE PROVISION OF H E A L T H SERVICES

SEC. 402. (a) The Secretary of Health, Education, and Welfare is authorized to develop and engage in experiments under which physicians who would otherwise be entitled to receive payment on the basis of reasonable charge, and organizations and institutions which

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would otherwise be entitled to reimbursement or payment on the basis of reasonable cost, for services provided— (1) under title X VIII of the Social Security Act, (2) under a State plan approved under title X IX of such Act, or

931

42 USC 1395. 42 USC 1396.

(3) under a plan developed under title V of such Act, QOI"'^' ^^' ^^^' and which are selected by the Secretary in accordance with regulations Ante. p. 921. established by the Secretary, would be reimbursed or paid in any manner mutually agreed upon by the Secretary and the physician, organization, or institution. The method of payment (in the case of physicians) or reimbursement (in the case of an organization or institution) which may be applied in such experiments shall be such as the Secretary may select and may be based on charges or costs adjusted by incentive factors and may include specific incentive payments or reductions of payments for the performance of specific actions but in any case shall be such as he determines may, through exgeriment, be demonstrated to have the effect of increasing the efciency and economy of health services through the creation of additional incentives to these ends without adversely affecting the quality of such services. (b) I n the case of any experiment under subsection (a), the Secretary may waive compliance with the requirements of titles X VIII, X IX, and V of the Social Security Act insofar as such requirements relate to reimbursement or payment on the basis of reasonable cost, or (in the case of physicians) on the basis of reasonable charge; and costs incurred in such experiment in excess of the costs which would otherwise be reimbursed or paid under such titles may be reimbursed or paid to the extent that such waiver applies to them (with such excess being borne by the Secretary). No experiment shall be engaged in or developed under subsection ca) until the Secretary obtains the advice and recommendations of specialists who are competent to evaluate the proposed experiment as to the soundness of its objectives, the possibilities of securing productive results, the adequacy of resources to conduct the proposed experiment, and its relationship to other similar experiments already completed or in process. (c) Section 1875(b) of the Social Security Act is amended by in- 79 Stat. 332.^^ serting after "under parts A and B " the following: "(including the '^^ "^^ ^^^^ experimentation authorized by section 402 of the Social Security Amendments of 1967)". C H A N G E S TO REFLECT CODIFICATION OF TITLE 5, UNITED STATES CODE

SEC. 403. (a)(1) Section 210(a)(6)(C) (iv) of the Social Security Act is amended by striking out "under section 2 of the Act of A u ^ s t 4, 1947" and inserting in lieu thereof "under section 5351(2) of title 5, United States Code", and by striking out "; 5 U.S.C. sec. 1052". (2) Section 210(a)(6)(C) (vi) of such Act is amended by striking out "the Civil Service Retirement Act" and inserting in lieu thereof "subchapter III of chapter 83 of title 5, United States Code,". (3) Section 210(a)(7)(D) (ii) of such Act is amended by striking out "under section 2 of the Act of August 4, 1947" and inserting in lieu thereof "under section 5351(2) of title 5, United States Code", and by striking o u t "; 6 ll.S.C. 1052". (b) Section 215(h)(1) of such Act is amended— (1) by striking out "of the C'ivil Service Retirement Act," and inserting in lieu thereof "of subchapter III of chapter 83 of title 5, United States Code,"; and

42 USC 410.

'*2 USC 4i5.

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42 USC 417.

42 USC 907.

42 USC 1314.

42 USC 1361.

42 USC 1395s.

79 Stat. 333. 42 USC 426a.

68 Stat. 109 2.

PUBLIC LAW 90-248-JAN. 2, 1968

[81 STAT.

(2) by striking out "under the Civil Service Retirement Act" and inserting in lieu thereof "under subchapter 111 of chapter SH of title 5, United States Code,''. (c)(1) Section 217(f)(1) of such Act is amended— (A) by striking out "the Civil Service Retirement Act of May 29, 1930, as amended," and inserting in lieu thereof "subchapter III of chapter 83 of title 5, United States Code,"; and (B) by striking out "such Act of May 29, 1930, as amended," and inserting in lieu thereof "such subchapter III". (2) Section 217(f)(2) of such Act is amended by striking out "the Civil Service Retirement Act of May 29, 1930, as amended," and inserting in lieu thereof "subchapter III of chapter 83 of title 5, United States Code,". (d)(1) Section 706(b) of such Act is amended by striking out "the civil service laws" and inserting in lieu thereof "the provisions of title 5, United States Code, governing appointments in the competitive service". (2) Section 706(c)(2) of such Act is amended by striking out "section 5 of the Administrative Expenses Act of 1946 (5 U.S.C. 73b-2)" and inserting in lieu thereof "section 5703 of title 5, United States Code,". (e)(1) Section 1114(b) of such Act is amended by striking out "the civil-service laws" and inserting in lieu thereof "the provisions of title 5, United States Code, governing appointments in the competitive service". (2) Section 1114(f) of such Act is amended by striking out "the civil-service laws" and inserting in lieu thereof "the provisions of title 5, United States Code, governing appointments in the competitive service". (3) Section 1114(g) of such Act is amended by striking out "section 5 of the Administrative Expenses Act of 1946 (5 U.S.C. 73b-2)" and inserting in lieu thereof "section 5703 of title 5, United States Code.". (f)(1) Section 1501(a)(6) of such Act is amended by striking out "the Civil Service Retirement Act of 1930" and inserting in lieu thereof "subchapter III of chapter 83 of title 5, United States Code,". (2) Section 1501(a)(9) of such Act is amended by striking out "under section 2 of the Act of August 4, 1947" and inserting in lieu thereof "under section 5351(2) of title 5, United States Code", and by striking o u t "; 5 U.S.C. sec. 1052". (g)(1) Section 1840(e)(1) of such Act is amended by striking out "the Civil Service Retirement Act, or other Act" and inserting in lieu thereof "subchapter III of chapter 83 of title 5, United States Code, or any other law". (2) Section 1840(e)(2) of such Act is amended by striking out "such other Act" and inserting in lieu thereof "such other law". (h) Section 103(b)(3) of the Social Security Amendments of 1965 is amended— (1) by striking out "the Federal Employees Health Benefits Act of 1959" in subparagraph (A) and inserting in lieu thereof "chapter 89 of title 5, United States Code"; and (2) by striking out "such Act" in subparagraph (C) and inserting in lieu thereof "such chapter". (i)(1) Section 3121(b)(6)(C) (iv) of the Internal Revenue Code of 1954 is amended by striking out "under section 2 of the Act of August 4, 1947" and inserting in lieu thereof "under section 5351(2)

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