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us/statute/42/1396r–1 — Presumptive eligibility for pregnant women · Axiom

(b)Definitions#

For purposes of this section—

(1) the term “presumptive eligibility period” means, with respect to a pregnant woman, the period that— (A) begins with the date on which a qualified provider determines, on the basis of preliminary information, that the family income of the woman does not exceed the applicable income level of eligibility under the State plan, and (B) ends with (and includes) the earlier of— (i) the day on which a determination is made with respect to the eligibility of the woman for medical assistance under the State plan, or (ii) in the case of a woman who does not file an application by the last day of the month following the month during which the provider makes the determination referred to in subparagraph (A), such last day; and

(2) the term “qualified provider” means any provider that— (A) is eligible for payments under a State plan approved under this subchapter, (B) provides services of the type described in subparagraph (A) or (B) of section 1396d(a)(2) of this title or in section 1396d(a)(9) of this title , (C) is determined by the State agency to be capable of making determinations of the type described in paragraph (1)(A), and (D) (i) receives funds under— (I) section 254b or 254c of this title, (II) subchapter V of this chapter, or (III) title V of the Indian Health Care Improvement Act [ 25 U.S.C. 1651 et seq.]; (ii) participates in a program established under— (I) section 1786 of this title , or (II) section 4(a) of the Agriculture and Consumer Protection Act of 1973; (iii) participates in a State perinatal program; or (iv) is the Indian Health Service or is a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act ( Public Law 93–638 ) [ 25 U.S.C. 5321 et seq.].

The term “qualified provider” also includes a qualified entity, as defined in section 1396r–1a(b)(3) of this title .

(b)(1)#

the term “presumptive eligibility period” means, with respect to a pregnant woman, the period that—

(A) begins with the date on which a qualified provider determines, on the basis of preliminary information, that the family income of the woman does not exceed the applicable income level of eligibility under the State plan, and

(B) ends with (and includes) the earlier of— (i) the day on which a determination is made with respect to the eligibility of the woman for medical assistance under the State plan, or (ii) in the case of a woman who does not file an application by the last day of the month following the month during which the provider makes the determination referred to in subparagraph (A), such last day; and

(b)(1)(A)#

begins with the date on which a qualified provider determines, on the basis of preliminary information, that the family income of the woman does not exceed the applicable income level of eligibility under the State plan, and

(b)(1)(B)#

ends with (and includes) the earlier of—

(i) the day on which a determination is made with respect to the eligibility of the woman for medical assistance under the State plan, or

(ii) in the case of a woman who does not file an application by the last day of the month following the month during which the provider makes the determination referred to in subparagraph (A), such last day; and

(b)(1)(B)(i)#

the day on which a determination is made with respect to the eligibility of the woman for medical assistance under the State plan, or

(b)(1)(B)(ii)#

in the case of a woman who does not file an application by the last day of the month following the month during which the provider makes the determination referred to in subparagraph (A), such last day; and

(b)(2)#

the term “qualified provider” means any provider that—

(A) is eligible for payments under a State plan approved under this subchapter,

(B) provides services of the type described in subparagraph (A) or (B) of section 1396d(a)(2) of this title or in section 1396d(a)(9) of this title ,

(C) is determined by the State agency to be capable of making determinations of the type described in paragraph (1)(A), and

(D) (i) receives funds under— (I) section 254b or 254c of this title, (II) subchapter V of this chapter, or (III) title V of the Indian Health Care Improvement Act [ 25 U.S.C. 1651 et seq.]; (ii) participates in a program established under— (I) section 1786 of this title , or (II) section 4(a) of the Agriculture and Consumer Protection Act of 1973; (iii) participates in a State perinatal program; or (iv) is the Indian Health Service or is a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act ( Public Law 93–638 ) [ 25 U.S.C. 5321 et seq.].

(b)(2)(A)#

is eligible for payments under a State plan approved under this subchapter,

(b)(2)(B)#

provides services of the type described in subparagraph (A) or (B) of section 1396d(a)(2) of this title or in section 1396d(a)(9) of this title ,

(b)(2)(C)#

is determined by the State agency to be capable of making determinations of the type described in paragraph (1)(A), and

(b)(2)(D)#

(i) receives funds under— (I) section 254b or 254c of this title, (II) subchapter V of this chapter, or (III) title V of the Indian Health Care Improvement Act [ 25 U.S.C. 1651 et seq.];

(ii) participates in a program established under— (I) section 1786 of this title , or (II) section 4(a) of the Agriculture and Consumer Protection Act of 1973;

(iii) participates in a State perinatal program; or

(iv) is the Indian Health Service or is a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act ( Public Law 93–638 ) [ 25 U.S.C. 5321 et seq.].

(b)(2)(D)(i)#

receives funds under—

(I) section 254b or 254c of this title,

(II) subchapter V of this chapter, or

(III) title V of the Indian Health Care Improvement Act [ 25 U.S.C. 1651 et seq.];

(b)(2)(D)(i)(I)#

section 254b or 254c of this title,

(b)(2)(D)(i)(II)#

subchapter V of this chapter, or

(b)(2)(D)(i)(III)#

title V of the Indian Health Care Improvement Act [ 25 U.S.C. 1651 et seq.];

(b)(2)(D)(ii)#

participates in a program established under—

(I) section 1786 of this title , or

(II) section 4(a) of the Agriculture and Consumer Protection Act of 1973;

(b)(2)(D)(ii)(I)#

section 1786 of this title , or

(b)(2)(D)(ii)(II)#

section 4(a) of the Agriculture and Consumer Protection Act of 1973;

(b)(2)(D)(iii)#

participates in a State perinatal program; or

(b)(2)(D)(iv)#

is the Indian Health Service or is a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act ( Public Law 93–638 ) [ 25 U.S.C. 5321 et seq.].

(c)Duties of State agency, qualified providers, and presumptively eligible pregnant women#

(1) The State agency shall provide qualified providers with— (A) such forms as are necessary for a pregnant woman to make application for medical assistance under the State plan, and (B) information on how to assist such women in completing and filing such forms.

(2) A qualified provider that determines under subsection (b)(1)(A) that a pregnant woman 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 the woman at the time the determination is made that she is required to make application for medical assistance under the State plan by not later than the last day of the month following the month during which the determination is made.

(3) A pregnant woman who is determined by a qualified provider to be presumptively eligible for medical assistance under a State plan shall make application 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, which application may be the application used for the receipt of medical assistance by individuals described in section 1396a( l )(1)(A) of this title.

(c)(1)#

The State agency shall provide qualified providers with—

(A) such forms as are necessary for a pregnant woman to make application for medical assistance under the State plan, and

(B) information on how to assist such women in completing and filing such forms.

(c)(1)(A)#

such forms as are necessary for a pregnant woman to make application for medical assistance under the State plan, and

(c)(1)(B)#

information on how to assist such women in completing and filing such forms.

(c)(2)#

A qualified provider that determines under subsection (b)(1)(A) that a pregnant woman 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 the woman at the time the determination is made that she is required to make application for medical assistance under the State plan by not later than the last day of the month following the month during which the determination is made.

(c)(2)(A)#

notify the State agency of the determination within 5 working days after the date on which determination is made, and

(c)(2)(B)#

inform the woman at the time the determination is made that she is required to make application for medical assistance under the State plan by not later than the last day of the month following the month during which the determination is made.

(c)(3)#

A pregnant woman who is determined by a qualified provider to be presumptively eligible for medical assistance under a State plan shall make application 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, which application may be the application used for the receipt of medical assistance by individuals described in section 1396a( l )(1)(A) of this title.

Presumptive eligibility for pregnant women