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U.S. Code as of:
01/19/04
Section 1396r-1b. Presumptive eligibility for certain breast or cervical cancer patients
(a) State option
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.
(b) Definitions
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).
(B) Regulations
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).
(c) Administration
(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.
(d) Payment
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 )1(! 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.
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