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107 STAT. 628 PUBLIC LAW 103-66—AUG. 10, 1993 **(CXi) In the case of an individual who has received (or is entitled to receive) benefits under a long-term care insurance policy in connection wi^ which assets or resources are dis- regarded in the manner described in clause (ii), except as provided in such clause, the State shall seek a4justment or recovery from the individual's estate on account of medical assistance paid on behalf of the individual for nursing facility and other long-term care services. "(ii) Clause (i) shall not apply in the case of an individual who received medical assistance under a State plan of a State which had a State plan amendment approved as of May 14, 1993, wluch provided for the disregard of any assets or resources— "(I) to the extent that payments are made under a long-term care insurance policy; or "(ID because an individual has received (or is entitled to receive) benefits under a long-term care insurance Dolicy.". (b) HARDSHIP WAIVER.—Section 1917(b) (42 U.S.C. 1396p(b)) is amended by adding at the end the following new paragraph: "(3) The State agency shall establish procedures (in accordance with standards specified by the Secretary) under which the agencr^r shall waive the application of this subsection (other than paragraph (IXC)) if such application would work an imdue hardship as deter- mined on the basis of criteria established by the Secretary.". (c) DEFINITION OF ESTATE.—Section 1917(b) (42 U.S.C. 1396p(b)), as amended by subsection (b), is amended by adding at the end the following new paragraph: "(4) For purposes of tms subsection, the term 'estate', with respect to a deceased individual— "(A) shall include all real and personal property and other assets included within the individual's estate, as defined for purposes of State probate law; and "(B) may include, at the option of the State (and shall include, in the case of an individual to whom paragraph (IXCXi) applies), any other real and personal property and other assets in which the individual had any legal title or interest at the time of death (to the extent of such interest), including such assets conveyed to a survivor, heir, or assign of the deceased individual tlurough joint tenancy, tenancy in common, survivor- ship, life estate, Bving trust, or other arrangement.". 42 use I396p (d) EFFECTIVE DATES.—(IXA) Except as provided in subpara- note. graph (B), the amendments made b^ this section shall apply to pajrments under title XIX of the Social Security Act for calendar quarters beginning on or after October 1, 1993, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date. (B) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires Stete legislation (other than legislation appropriating fimds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, tne Stete plan shall not be regarded as failing to comply with the requirements imposed by such amendmente solely on the basis of its failure to meet these additional require- mente before the first day of the first calendar quarter beginning after the close of the first regular session of the Stete legislature