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U.S. Code as of:
01/19/04
Section 1396r-1. Presumptive eligibility for pregnant women
(a) Ambulatory prenatal care
A State plan approved under section 1396a of this title may
provide for making ambulatory prenatal care available to a pregnant
woman during a presumptive eligibility period.
(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.
450f 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) of this section 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.
(d) Ambulatory prenatal care as medical assistance
Notwithstanding any other provision of this subchapter,
ambulatory prenatal care that -
(1) is furnished to a pregnant woman -
(A) during a presumptive eligibility period,
(B) by a provider that is eligible for payments under the
State plan; and
(2) is included in the care and services covered by a State
plan;
shall be treated as medical assistance provided by such plan for
purposes of section 1396b of this title.
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