P.L. 115–123, Approved February 9, 2018 (132 Stat. 64)
Bipartisan Budget Act of 2018
An Act to amend title 4, United States Code, to provide for the flying of the flag at half-staff in the event of the death of a first responder in the line of duty.
Approved February 9, 2018.
DIVISION B—SUPPLEMENTAL APPROPRIATIONS, TAX RELIEF, AND MEDICAID CHANGES RELATING TO CERTAIN DISASTERS AND FURTHER EXTENSION OF CONTINUING APPROPRIATIONS
Subdivision 1–Further Additional Supplemental Appropriations For Disaster Relief Requirements Act, 2018***TITLE VIII***GENERAL PROVISIONS—DEPARTMENT OF LABORDEFERRAL OF INTEREST PAYMENT FOR VIRGIN ISLANDS
SEC. 20801. Notwithstanding any other provision of law, the interest payment of the Virgin Islands that was due under section 1202(b)(1) of the Social Security Act on September 29, 2017, shall not be due until September 28, 2018, and no interest shall accrue on such amount through September 28, 2018: Provided, That such amount is designated by the Congress as being for an emergency requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control Act of 1985.[477]
* * * * * * *
SUBDIVISION 2–TAX RELIEF AND MEDICAID CHANGES RELATING TO CERTAIN DISASTERS***TITLE III—HURRICANE MARIA RELIEF FOR PUERTO RICO AND THE VIRGIN ISLANDS MEDICAID PROGRAMS
* * * * * * *
SEC. 20301. HURRICANE MARIA RELIEF FOR PUERTO RICO AND THE VIRGIN ISLANDS MEDICAID PROGRAMS.
* * * * * * *
(c) Report to Congress.—Not later than July 1, 2018, the Secretary of Health and Human Services shall submit a report to the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate that—
(1) describes the steps taken by Puerto Rico and the Virgin Islands to meet the conditions for certification specified in clauses (i) and (ii), respectively, of section 1108(g)(5)(D) of the Social Security Act (42 U.S.C. 1308(g)(5)(D)) (as amended by subsection (a) of this section); and
(2) specifies timelines for each such territory to, as a condition of eligibility for any additional increases in the amounts determined for Puerto Rico or the Virgin Islands, respectively, under subsection (g) of section 1108 of such Act (42 U.S.C. 1308) for purposes of payments under title XIX of such Act for fiscal year 2019, complete—
(A) implementation of methods, satisfactory to the Secretary, for the collection and reporting of reliable data to the Transformed Medicaid Statistical Information System (T–MSIS) (or a successor system); and
(B) the establishment of a State medicaid fraud control unit described in section 1903(q) of the Social Security Act (42 U.S.C. 1396d(q)).
* * * * * * *
DIVISION C—BUDGETARY AND OTHER MATTERS***TITLE II—OFFSETS
* * * * * * *
SEC. 30206. REEMPLOYMENT SERVICES AND ELIGIBILITY ASSESSMENTS.
* * * * * * *
(b) Report.—Not later than 3 years after the date of enactment of this Act, the Secretary of Labor shall submit to Congress a report to describe promising interventions used by States to provide reemployment assistance.
* * * * * * *
DIVISION E—HEALTH AND HUMAN SERVICES EXTENDERS
* * * * * * *
TITLE I—CHIP
* * * * * * *
SEC. 50101. FUNDING EXTENSION OF THE CHILDREN’S HEALTH INSURANCE PROGRAM THROUGH FISCAL YEAR 2027.
* * *
(b) Allotments.—* * *
(2) One-time appropriation for fiscal year 2027.—There is appropriated to the Secretary of Health and Human Services, out of any money in the Treasury not otherwise appropriated, such sums as are necessary to fund allotments to States under subsections (c) and (m) of section 2104 of the Social Security Act (42 U.S.C. 1397dd) for fiscal year 2027, taking into account the full year amounts calculated for States under paragraph (11)(C) of subsection (m) of such section (as added by paragraph (1)) and the amounts appropriated under subparagraphs (A) and (B) of subsection (a)(28) of such section (as added by subsection (a)). Such amount shall accompany the allotment made for the period beginning on October 1, 2026, and ending on March 31, 2027, under paragraph (28)(A) of section 2104(a) of such Act (42 U.S.C. 1397dd(a)), to remain available until expended. Such amount shall be used to provide allotments to States under paragraph (11) of section 2104(m) of such Act for the first 6 months of fiscal year 2027 in the same manner as allotments are provided under subsection (a)(28)(A) of such section 2104 and subject to the same terms and conditions as apply to the allotments provided from such subsection (a)(28)(A).
* * * * * * *
TITLE II—MEDICARE EXTENDERS
* * * * * * *
SEC. 50204. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT ADJUSTMENT FOR CERTAIN LOW-VOLUME HOSPITALS.
* * *
(b) MedPAC Report on Extension of Increased Inpatient Hospital Payment Adjustment for Certain Low-volume Hospitals.—
(1) In general.—Not later than March 15, 2022, the Medicare Payment Advisory Commission shall submit to Congress a report on the extension of the increased inpatient hospital payment adjustment for certain low-volume hospitals under section 1886(d)(12) of the Social Security Act (42 U.S.C. 1395ww(d)(12)) under the provisions of, and amendments made by, this section.
(2) Contents.—The report under paragraph (1) shall include an evaluation of the effects of such extension on the following:
(A) Beneficiary utilization of inpatient hospital services under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
(B) The financial status of hospitals with a low volume of Medicare or total inpatient admissions.
(C) Program spending under such title XVIII.
(D) Other matters relevant to evaluating the effects of such extension.
* * * * * * *
SEC. 50207. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR LOW-INCOME PROGRAMS; STATE HEALTH INSURANCE ASSISTANCE PROGRAM REPORTING REQUIREMENTS.
* * *
(b) [42 U.S.C. 1395b-3 note] State Health Insurance Assistance Program Reporting Requirements.—Beginning not later than April 1, 2019, and biennially thereafter, the Agency for Community Living shall electronically post on its website the following information, with respect to grants to States for State health insurance assistance programs, (such information to be presented by State and by entity receiving funds from the State to carry out such a program funded by such grant):
(1) The amount of Federal funding provided to each such State for such program for the period involved and the amount of Federal funding provided by each such State for such program to each such entity for the period involved.
(2) Information as the Secretary may specify, with respect to such programs carried out through such grants, consistent with the terms and conditions for receipt of such grants.
* * * * * * *
SEC. 50208. EXTENSION OF HOME HEALTH RURAL ADD-ON.
* * *
(b) HHS OIG Analysis.—Not later than January 1, 2023, the Inspector General of the Department of Health and Human Services shall submit to Congress—
(1) an analysis of the home health claims and utilization of home health services by county (or equivalent area) under the Medicare program; and
(2) recommendations the Inspector General determines appropriate based on such analysis.
* * * * * * *
TITLE III—CREATING HIGH-QUALITY RESULTS AND OUTCOMES NECESSARY TO IMPROVE CHRONIC (CHRONIC) CARE
Subtitle B—Advancing Team-Based Care
* * * * * * *
SEC. 50311. PROVIDING CONTINUED ACCESS TO MEDICARE ADVANTAGE SPECIAL NEEDS PLANS FOR VULNERABLE POPULATIONS.
* * * * * * *
(e) GAO Study and Report on State-Level Integration Between Dual SNPs and Medicaid.—
(1) Study.—The Comptroller General of the United States (in this subsection referred to as the ‘‘Comptroller General’’) shall conduct a study on State-level integration between specialized MA plans for special needs individuals described in subsection (b)(6) (B)(ii) of section 1859 of the Social Security Act (42 U.S.C. 1395w–28) and the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.). Such study shall include an analysis of the following:
(A) The characteristics of States in which the State agency responsible for administering the State plan under such title XIX has a contract with such a specialized MA plan and that delivers long-term services and supports under the State plan under such title XIX through a managed care program, including the requirements under such State plan with respect to long-term services and supports.
(B) The types of such specialized MA plans, which may include the following:
(i) A plan described in section 1853(a)(1)(B)(iv)(II) of such Act (42 U.S.C. 1395w–23(a)(1)(B)(iv)(II)).
(ii) A plan that meets the requirements described in subsection (f)(3)(D) of such section 1859.
(iii) A plan described in clause (ii) that also meets additional requirements established by the State.
(C) The characteristics of individuals enrolled in such specialized MA plans.
(D) As practicable, the following with respect to State programs for the delivery of long-term services and supports under such title XIX through a managed care program:
(i) Which populations of individuals are eligible to receive such services and supports.
(ii) Whether all such services and supports are provided on a capitated basis or if any of such services and supports are carved out and provided through fee-for service.
(E) As practicable, how the availability and variation of integration arrangements of such specialized MA plans offered in States affects spending, service delivery options, access to community-based care, and utilization of care.
(F) The efforts of State Medicaid programs to transition dually-eligible beneficiaries receiving long-term services and supports (LTSS) from institutional settings to home and community-based settings and related financial impacts of such transitions.
(G) Barriers and opportunities for making further progress on dual integration, as well as recommendations for legislation or administrative action to expedite or refine pathways toward fully integrated care.
(2) Report.—Not later than 2 years after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.
Subtitle C—Expanding Innovation and Technology
* * * * * * *
SEC. 50322. EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE NEEDS OF CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES.
* * *
(b) GAO Study and Report.—
(1) Study.—The Comptroller General of the United States (in this subsection referred to as the ‘‘Comptroller General’’) shall conduct a study on supplemental benefits provided to enrollees in Medicare Advantage plans under part C of title XVIII of the Social Security Act, including specialized MA plans for special needs individuals (as defined in section 1859(b)(6) of such Act (42 U.S.C. 1395w–28(b)(6))). To the extend data are available, such study shall include an analysis of the following:
(A) The type of supplemental benefits provided to such enrollees, the total number of enrollees receiving each supplemental benefit, and whether the supplemental benefit is covered by the standard benchmark cost of the benefit or with an additional premium.
(B) The frequency in which supplemental benefits are utilized by such enrollees.
(C) The impact supplemental benefits have on—
(i) indicators of the quality of care received by such enrollees, including overall health and function of the enrollees;
(ii) the utilization of items and services for which benefits are available under the original Medicare feefor- service program option under parts A and B of such title XVIII by such enrollees; and
(iii) the amount of the bids submitted by Medicare Advantage Organizations for Medicare Advantage plans under such part C.
(2) Consultation.—In conducting the study under paragraph (1), the Comptroller General shall, as necessary, consult with the Centers for Medicare & Medicaid Services and Medicare Advantage organizations offering Medicare Advantage plans.
(3) Report.—Not later than 5 years after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.
SEC. 50324. PROVIDING ACCOUNTABLE CARE ORGANIZATION THE ABILITY TO EXPAND THE USE OF TELEHEALTH.
* * *
(b) [42 U.S.C. 1395jjj note] Study and Report.—
(1) Study.—
(A) In general.—The Secretary of Health and Human Services (in this subsection referred to as the “Secretary”) shall conduct a study on the implementation of section 1899(l) of the Social Security Act, as added by subsection (a). Such study shall include an analysis of the utilization of, and expenditures for, telehealth services under such section.
(B) Collection of data.—The Secretary may collect such data as the Secretary determines necessary to carry out the study under this paragraph.
(2) Report.—Not later than January 1, 2026, the Secretary shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.
* * * * * * *
Subtitle E—Empowering Individuals and Caregivers in Care Delivery
SEC. 50341. ELIMINATING BARRIERS TO CARE COORDINATION UNDER ACCOUNTABLE CARE ORGANIZATIONS.
* * *
(c) Evaluation and Report.—
(1) Evaluation.—The Secretary of Health and Human Services (in this subsection referred to as the “Secretary”) shall conduct an evaluation of the ACO Beneficiary Incentive Program established under subsections (b)(2)(I) and (m) of section 1899 of the Social Security Act (42 U.S.C. 1395jjj), as added by subsection (a). The evaluation shall include an analysis of the impact of the implementation of the Program on expenditures and beneficiary health outcomes under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
(2) Report.—Not later than October 1, 2023, the Secretary shall submit to Congress a report containing the results of the evaluation under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.
* * * * * * *
SEC. 50353. HHS STUDY AND REPORT ON LONG-TERM RISK FACTORS FOR CHRONIC CONDITIONS AMONG MEDICARE BENEFICIARIES.
(a) Study.—The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall conduct a study on long-term cost drivers to the Medicare program, including obesity, tobacco use, mental health conditions, and other factors that may contribute to the deterioration of health conditions among individuals with chronic conditions in the Medicare population. The study shall include an analysis of any barriers to collecting and analyzing such information and how to remove any such barriers (including through legislation and administrative actions).
(b) Not later than 18 months after the date of the enactment of this Act, the Secretary shall submit to Congress a report containing the results of the study under subsection (a), together with recommendations for such legislation and administrative action as the Secretary determines appropriate. The Secretary shall also post such report on the Internet website of the Department of Health and Human Services.
TITLE IV—PART B IMPROVEMENT ACT AND OTHER PART B ENHANCEMENTS
Subtitle A—Medicare Part B Improvement Act
* * * * * * *
SEC. 50403. INDEPENDENT ACCREDITATION FOR DIALYSIS FACILITIES AND ASSURANCE OF HIGH QUALITY SURVEYS
(a) Accreditation and Surveys.—* * *
(2) Timing for acceptance of requests from accreditation organizations.—Not later than 90 days after the date of enactment of this Act, the Secretary of Health and Human Services shall begin accepting requests from national accreditation bodies for a finding described in section 1865(a)(3)(A) of the Social Security Act (42 U.S.C. 1395bb(a)(3)(A)) for purposes of accrediting provider entities that are required to meet the conditions and requirements under section 1881(b) of such Act (42 U.S.C. 1395rr(b)).
* * * * * * *
TITLE VII—FAMILY FIRST PREVENTION SERVICES ACT
Subtitle A—Investing in Prevention and Supporting Families
* * * * * * *
PART III—MISCELLANEOUS
SEC. 50731. REVIEWING AND IMPROVING LICENSING STANDARDS FOR PLACEMENT IN A RELATIVE FOSTER FAMILY HOME.
(a) Identification of Reputable Model Licensing Standards.—Not later than October 1, 2018, the Secretary of Health and Human Services shall identify reputable model licensing standards with respect to the licensing of foster family homes (as defined in section 472(c)(1) of the Social Security Act).
* * * * * * *
SEC. 50734. EFFECTIVE DATES.
* * *
(b) Transition Rule.—
(1) In general.—In the case of a State plan under part B or E of title IV of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by parts I through III of this subtitle, the State plan shall not be regarded as failing to comply with the requirements of such part solely on the basis of the failure of the plan to meet such additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be deemed to be a separate regular session of the State legislature.
(2) Application to programs operated by indian tribal organizations.—In the case of an Indian tribe, tribal organization, or tribal consortium which the Secretary of Health and Human Services determines requires time to take action necessary to comply with the additional requirements imposed by the amendments made by parts I through III of this subtitle (whether the tribe, organization, or tribal consortium has a plan under section 479B of the Social Security Act or a cooperative agreement or contract entered into with a State), the Secretary shall provide the tribe, organization, or tribal consortium with such additional time as the Secretary determines is necessary for the tribe, organization, or tribal consortium to take the action to comply with the additional requirements before being regarded as failing to comply with the requirements.
* * * * * * *
PART VII—TECHNICAL CORRECTIONS
SEC. 50771. TECHNICAL CORRECTIONS TO DATA EXCHANGE STANDARDS TO IMPROVE PROGRAM COORDINATION.
* * *
(b) Effective Date.—Not later than the date that is 24 months after the date of the enactment of this section, the Secretary of Health and Human Services shall issue a proposed rule that—
(1) identifies federally required data exchanges, include specification and timing of exchanges to be standardized, and address the factors used in determining whether and when to standardize data exchanges; and
(2) specifies State implementation options and describes future milestones.
TITLE X—MISCELLANEOUS HEALTH CARE POLICIES
SEC. 51001. HOME HEALTH PAYMENT REFORM.
* * *
(b) Technical expert panel.—
(1) In general.—During the period beginning on January 1, 2018, and ending on December 31, 2018, the Secretary of Health and Human Services shall hold at least one session of a technical expert panel, the participants of which shall include home health providers, patient representatives, and other relevant stakeholders. The technical expert panel shall identify and prioritize recommendations with respect to the prospective payment system for home health services under section 1895(b) of the Social Security Act (42 U.S.C. 1395fff(b)), on the following:
(A) The Home Health Groupings Model, as described in the proposed rule “Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and Proposed CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements” (82 Fed. Reg. 35294 through 35332 (July 28, 2017)).
(B) Alternative case-mix models to the Home Health Groupings Model that were submitted during 2017 as comments in response to proposed rule making, including patient-focused factors that consider the risks of hospitalization and readmission to a hospital, improvement or maintenance of functionality of individuals to increase the capacity for self-care, quality of care, and resource utilization.
(2) Inapplicability of faca.—The provisions of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the technical expert panel under paragraph (1).
(3) Report.—Not later than April 1, 2019, the Secretary of Health and Human Services shall submit to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report on the recommendations of such panel described in such paragraph.
(4) Notice and comment rulemaking.—Not later than December 31, 2019, the Secretary of Health and Human Services shall pursue notice and comment rulemaking on a casemix system with respect to the prospective payment system for home health services under section 1895(b) of the Social Security Act (42 U.S.C. 1395fff(b)).
(c) Reports.—
(1) Interim report.—Not later than March 15, 2022, the Medicare Payment Advisory Commission shall submit to Congress an interim report on the application of a 30-day unit of service as the unit of service applied under section 1895(b)(2) of the Social Security Act (42 U.S.C. 1395fff(b)(2)), as amended by subsection (a), including an analysis of the level of payments provided to home health agencies as compared to the cost of delivering home health services, and any unintended consequences, including with respect to behavioral changes and quality.
(2) Final report.—Not later than March 15, 2026, such Commission shall submit to Congress a final report on such application and any such consequences.
* * * * * * *
TITLE XII—OFFSETS
* * * * * * *
SEC. 53102. THIRD PARTY LIABILITY IN MEDICAID AND CHIP.
* * *
(b) Delay in Effective Date and Repeal of Certain Bipartisan Budget Act of 2013 Amendments..—
(1) Repeal.—Effective as of September 30, 2017, subsection (b) of section 202 of the Bipartisan Budget Act of 2013 (Public Law 113–67; 127 Stat. 1177; 42 U.S.C. 1396a note) (including any amendments made by such subsection) is repealed and the provisions amended by such subsection shall be applied and administered as if such amendments had never been enacted.
(2) Delay in effective date.—Subsection (c) of section 202 of the Bipartisan Budget Act of 2013 (Public Law 113– 67; 127 Stat. 1177; 42 U.S.C. 1396a note) is amended to read as follows:“(c) Effective Date.—The amendments made by subsection (a) shall take effect on October 1, 2019.”
(3) Effective date; treatment.—The repeal and amendment made by this subsection shall take effect as if enacted on September 30, 2017, and shall apply with respect to any open claims, including claims pending, generated, or filed, after such date. The amendments made by subsections (a) and (b) of section 202 of the Bipartisan Budget Act of 2013 (Public Law 113–67; 127 Stat. 1177; 42 U.S.C. 1396a note) that took effect on October 1, 2017, are null and void and section 1902(a)(25) of the Social Security Act (42 U.S.C. 1396a(a)(25)) shall be applied and administered as if such amendments had not taken effect on such date.
(c) GAO Study and Report.—Not later than 18 months after the date of enactment of this Act, the Comptroller General of the United States shall submit a report to the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate on the impacts of the amendments made by subsections (a)(1) and (b)(2), including—
(1) the impact, or potential effect, of such amendments on access to prenatal and preventive pediatric care (including early and periodic screening, diagnostic, and treatment services) covered under State plans under such title (or waivers of such plans);
(2) the impact, or potential effect, of such amendments on access to services covered under such plans or waivers for individuals on whose behalf child support enforcement is being carried out by a State agency under part D of title IV of such Act; and
(3) the impact, or potential effect, on providers of services under such plans or waivers of delays in payment or related issues that result from such amendments.
* * * * * * *
SEC. 53103. TREATMENT OF LOTTERY WINNINGS AND OTHER LUMP-SUM INCOME FOR PURPOSES OF INCOME ELIGIBILITY UNDER MEDICAID.
* * *
(b) [42 U.S.C. 1396a note] Rules of Construction.—
(1) Interception of lottery winnings allowed.—Nothing in the amendment made by subsection (a)(2) shall be construed as preventing a State from intercepting the State lottery winnings awarded to an individual in the State to recover amounts paid by the State under the State Medicaid plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) for medical assistance furnished to the individual.
(2) Applicability limited to eligibility of recipient of lottery winnings or lump sum income.—Nothing in the amendment made by subsection (a)(2) shall be construed, with respect to a determination of household income for purposes of a determination of eligibility for medical assistance under the State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan) made by applying modified adjusted gross income under subparagraph (A) of section 1902(e)(14) of such Act (42 U.S.C. 1396a(e)(14)), as limiting the eligibility for such medical assistance of any individual that is a member of the household other than the individual who received qualified lottery winnings or qualified lump-sum income (as defined in subparagraph (K) of such section 1902(e)(14), as added by subsection (a)(2) of this section).
* * * * * * *
SEC. 53109. HOSPITAL TRANSFER POLICY FOR EARLY DISCHARGES TO HOSPICE CARE.
* * *
(b) MedPAC Evaluation and Report.—
(1) Evaluation.—The Medicare Payment Advisory Commission (in this subsection referred to as the ‘‘Commission’’) shall conduct an evaluation of the effects of the amendments made by subsection (a), including the effects on—
(A) the numbers of discharges of patients from an inpatient hospital setting to a hospice program;
(B) the lengths of stays of patients in an inpatient hospital setting who are discharged to a hospice program;
(C) spending under the Medicare program under title XVIII of the Social Security Act; and
(D) other areas determined appropriate by the Commission.
(2) Consideration.—In conducting the evaluation under paragraph (1), the Commission shall consider factors such as whether the timely access to hospice care by patients admitted to a hospital has been affected through changes to hospital policies or behaviors made as a result of such amendments.
(3) Preliminary results.—Not later than March 15, 2020, the Commission shall provide Congress with preliminary results on the evaluation being conducted under paragraph (1).
(4) Report.—Not later than March 15, 2021, the Commission shall submit to Congress a report on the evaluation conducted under paragraph (1).
* * * * * * *
SEC. 53117. MODERNIZING CHILD SUPPORT ENFORCEMENT FEES.
* * *
(b) Effective Date.—
(1) In general.—The amendments made by subsection (a) shall take effect on the 1st day of the 1st fiscal year that begins on or after the date of the enactment of this Act, and shall apply to payments under part D of title IV of the Social Security Act (42 U.S.C. 651 et seq.) for calendar quarters beginning on or after such 1st day.
(2) Delay permitted if state legislation required.—If the Secretary of Health and Human Services determines that State legislation (other than legislation appropriating funds) is required in order for a State plan developed pursuant to part D of title IV of the Social Security Act (42 U.S.C. 651 et seq.) to meet the requirements imposed by the amendment made by subsection (a), the plan shall not be regarded as failing to meet such requirements before the 1st day of the 1st calendar quarter beginning after the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the preceding sentence, if the State has a 2-year legislative session, each year of the session is deemed to be a separate regular session of the State legislature.
* * * * * * *
[Internal References.—SSAct §1201(b)(1) footnote refers to P.L. 115–123, Div. B, §20801. SSAct §1108(g)(5) footnote refers to §20301(c). SSAct §306 heading footnote refers to §30206(b). SSAct §2104 header footnote refers to §50101(b)(2). SSAct §1886(d)(12) footnote refers to §50204(b). P.L. 110–275, §119(b), refers to §50207(b). SSAct §1895(c) refers to §50208(b). SSAct §1852(a)(3) footnote refers to §50322(b). Footnotes for SSAct §§1899(b)(2)(I) and (m) refer to §50341(c). Footnote in header for SSAct Title XVIII refers to §50353. Footnote for SSAct §1865(a)(3)(A) refers to §50403(a)(2). Footnote for SSAct §472(c)(1) refers to §50731(a). Footnote in header for SSAct §440 refers to §50771(b). Footnote for §1895(b)(4)(B)(ii) refers to §51001(b). Footnote for SSAct §1902(a)(25) refers to §53102(b). Footnote for SSAct §1902(e)(14)(K) refers to §53103(b). Footnotes in SSAct §1886(d)(5)(J) refer to §53109(b). Footnote for SSAct §454(6)(B)(ii) refers to §53117(b).]
[477] P.L. 99–177.