A State plan approved under section
1396a of this title may provide for making medical assistance available to an individual described in section
1396a(aa) of this title (relating to certain breast or cervical cancer patients) during a presumptive eligibility period.
For purposes of this section:
(1) Presumptive eligibility period
The term “presumptive eligibility period” means, with respect to an individual described in subsection (a) of this section, the period that—
(A)begins with the date on which a qualified entity determines, on the basis of preliminary information, that the individual is described in section
1396a(aa) of this title; and
(B)ends with (and includes) the earlier of—
(i)the day on which a determination is made with respect to the eligibility of such individual for services under the State plan; or
(ii)in the case of such an individual who does not file an application by the last day of the month following the month during which the entity makes the determination referred to in subparagraph (A), such last day.
(2) Qualified entity
(A) In general
Subject to subparagraph (B), the term “qualified entity” means any entity that—
(i)is eligible for payments under a State plan approved under this subchapter; and
(ii)is determined by the State agency to be capable of making determinations of the type described in paragraph (1)(A).
The Secretary may issue regulations further limiting those entities that may become qualified entities in order to prevent fraud and abuse and for other reasons.
(C) Rule of construction
Nothing in this paragraph shall be construed as preventing a State from limiting the classes of entities that may become qualified entities, consistent with any limitations imposed under subparagraph (B).
(1) In general
The State agency shall provide qualified entities with—
(A)such forms as are necessary for an application to be made by an individual described in subsection (a) of this section for medical assistance under the State plan; and
(B)information on how to assist such individuals in completing and filing such forms.
(2) Notification requirements
A qualified entity that determines under subsection (b)(1)(A) of this section that an individual described in subsection (a) of this section is presumptively eligible for medical assistance under a State plan shall—
(A)notify the State agency of the determination within 5 working days after the date on which determination is made; and
(B)inform such individual at the time the determination is made that an application for medical assistance under the State plan is required to be made by not later than the last day of the month following the month during which the determination is made.
(3) Application for medical assistance
In the case of an individual described in subsection (a) of this section who is determined by a qualified entity to be presumptively eligible for medical assistance under a State plan, the individual shall apply for medical assistance under such plan by not later than the last day of the month following the month during which the determination is made.
Notwithstanding any other provision of this subchapter, medical assistance that—
(1)is furnished to an individual described in subsection (a) of this section—
(A)during a presumptive eligibility period;
(B)by a  entity that is eligible for payments under the State plan; and
(2)is included in the care and services covered by the State plan,
shall be treated as medical assistance provided by such plan for purposes of clause (4) of the first sentence of section
1396d(b) of this title.
Section applicable to medical assistance for items and services furnished on or after Oct. 1, 2000, without regard to whether final regulations to carry out such amendments have been promulgated by such date, see section 2(d) ofPub. L. 106–354, set out as an Effective Date of 2000 Amendment note under section
1396a of this title.
The table below lists the classification updates, since Jan. 3, 2012, for this section. Updates to a broader range of sections may be found at the update page for containing chapter, title, etc.
The most recent Classification Table update that we have noticed was Tuesday, August 13, 2013
An empty table indicates that we see no relevant changes listed in the classification tables. If you suspect that our system may be missing something, please double-check with the Office of the Law Revision Counsel.
Description of Change
Statutes at Large
LII has no control over and does not endorse any external Internet site that contains links to or references LII.