us/statute/42/1396a/e/8

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If an individual is determined to be a qualified medicare beneficiary (as defined in section 1396d(p)(1) of this title ), such determination shall apply to services furnished after the end of the month in which the determination first occurs. For purposes of payment to a State under section 1396b(a) of this title , such determination shall be considered to be valid for an individual for a period of 12 months, except that a State may provide for such determinations more frequently, but not more frequently than once every 6 months for an individual.

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statutes/42/1396a/e.yaml

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Rules

managed_care_minimum_enrollment_period_max_months

Parameter

source: 42 USC 1396a(e)(2)(B)

- name: managed_care_minimum_enrollment_period_max_months
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(2)(B)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: not more than six months
  versions:
    - effective_from: '1990-04-01'
      formula: '6'

disabled_child_deeming_age_ceiling_years

Parameter

source: 42 USC 1396a(e)(3)(A)

- name: disabled_child_deeming_age_ceiling_years
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(3)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: is 18 years of age or younger
  versions:
    - effective_from: '1990-04-01'
      formula: '18'

newborn_deemed_eligibility_period_years

Parameter

source: 42 USC 1396a(e)(4)

- name: newborn_deemed_eligibility_period_years
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(4)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: remain eligible for such assistance for a period of one year
  versions:
    - effective_from: '1990-04-01'
      formula: '1'

qualified_medicare_beneficiary_determination_validity_months

Parameter

source: 42 USC 1396a(e)(8)

- name: qualified_medicare_beneficiary_determination_validity_months
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(8)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: valid for an individual for a period of 12 months
  versions:
    - effective_from: '1990-04-01'
      formula: '12'

qualified_medicare_beneficiary_redetermination_min_interval_months

Parameter

source: 42 USC 1396a(e)(8)

- name: qualified_medicare_beneficiary_redetermination_min_interval_months
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(8)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: not more frequently than once every 6 months
  versions:
    - effective_from: '1990-04-01'
      formula: '6'

ventilator_dependency_daily_hours_threshold

Parameter

source: 42 USC 1396a(e)(9)(A)(i)

- name: ventilator_dependency_daily_hours_threshold
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(9)(A)(i)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: at least six hours per day
  versions:
    - effective_from: '1990-04-01'
      formula: '6'

ventilator_dependency_consecutive_inpatient_days_threshold

Parameter

source: 42 USC 1396a(e)(9)(A)(ii)

- name: ventilator_dependency_consecutive_inpatient_days_threshold
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(9)(A)(ii)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: for at least 30 consecutive days
  versions:
    - effective_from: '1990-04-01'
      formula: '30'

group_health_plan_minimum_enrollment_period_max_months

Parameter

source: 42 USC 1396a(e)(11)(B)

- name: group_health_plan_minimum_enrollment_period_max_months
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(11)(B)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: not more than 6 months
  versions:
    - effective_from: '1990-04-01'
      formula: '6'

child_continuous_eligibility_period_months

Parameter

source: 42 USC 1396a(e)(12)(A)

- name: child_continuous_eligibility_period_months
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(12)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: the end of the 12-month period
  versions:
    - effective_from: '2024-01-01'
      formula: '12'

child_continuous_eligibility_age_ceiling_years

Parameter

source: 42 USC 1396a(e)(12)

- name: child_continuous_eligibility_age_ceiling_years
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(12)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: under the age of 19
  versions:
    - effective_from: '2024-01-01'
      formula: '19'

express_lane_screening_threshold_minimum_percentage_point_excess

Parameter

source: 42 USC 1396a(e)(13)(C)(ii)(I)

- name: express_lane_screening_threshold_minimum_percentage_point_excess
  kind: parameter
  dtype: Rate
  source: 42 USC 1396a(e)(13)(C)(ii)(I)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: exceeds the highest income threshold ... by a minimum of 30 percentage points
  versions:
    - effective_from: '2009-01-01'
      formula: '0.30'

express_lane_error_rate_reduction_threshold

Parameter

source: 42 USC 1396a(e)(13)(E)(i)(IV), (V)

- name: express_lane_error_rate_reduction_threshold
  kind: parameter
  dtype: Rate
  source: 42 USC 1396a(e)(13)(E)(i)(IV), (V)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: error rate exceeds 3 percent
  versions:
    - effective_from: '2009-01-01'
      formula: '0.03'

express_lane_child_default_age_ceiling_years

Parameter

source: 42 USC 1396a(e)(13)(G)

- name: express_lane_child_default_age_ceiling_years
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(13)(G)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: child means an individual under 19 years of age
  versions:
    - effective_from: '2009-01-01'
      formula: '19'

express_lane_child_state_option_max_age_years

Parameter

source: 42 USC 1396a(e)(13)(G)

- name: express_lane_child_state_option_max_age_years
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(13)(G)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: not to exceed 21 years of age
  versions:
    - effective_from: '2009-01-01'
      formula: '21'

clinical_trial_compensation_age_threshold_years

Parameter

source: 42 USC 1396a(e)(15)

- name: clinical_trial_compensation_age_threshold_years
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(15)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: who has attained 19 years of age
  versions:
    - effective_from: '2021-01-01'
      formula: '19'

clinical_trial_compensation_disregard_cap

Parameter

source: 42 USC 1396a(e)(15)

- name: clinical_trial_compensation_disregard_cap
  kind: parameter
  dtype: Money
  unit: USD
  source: 42 USC 1396a(e)(15)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: amount
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: The first $2,000 received
  versions:
    - effective_from: '2021-01-01'
      formula: '2000'

clinical_trial_compensation_disregarded_for_income_eligibility

Derived

source: 42 USC 1396a(e)(15)

- name: clinical_trial_compensation_disregarded_for_income_eligibility
  kind: derived
  entity: Person
  dtype: Money
  period: Month
  unit: USD
  source: 42 USC 1396a(e)(15)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: >-
              The first $2,000 received by an individual (who has attained 19 years of age) as
              compensation for participation in a clinical trial ... shall be disregarded
  versions:
    - effective_from: '2021-01-01'
      formula: >-
        if individual_age_years >= clinical_trial_compensation_age_threshold_years and
        compensation_received_for_qualifying_rare_disease_clinical_trial:
        min(clinical_trial_compensation_amount, clinical_trial_compensation_disregard_cap) else: 0

extended_postpartum_coverage_period_months

Parameter

source: 42 USC 1396a(e)(16)(A), (B)

- name: extended_postpartum_coverage_period_months
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(16)(A), (B)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: during the 12-month period that begins on the last day of the individual’s pregnancy
  versions:
    - effective_from: '2021-01-01'
      formula: '12'

▸citations (2)

References

This rule cites 2 other rules.

42 USC § 1396d (p)(1)inferredUS Federal › Statutes › Title 42 › § 1396d › (p)(1)
42 USC § 1396b (a)inferredUS Federal › Statutes › Title 42 › § 1396b › (a)

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us/statute/42/1396a/e/8 · Axiom

Official source

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▸rulespec code

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statutes/42/1396a/e.yaml

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This encoding covers the parent provision us/statute/42/1396a/e; no dedicated encoding exists for this exact provision yet.

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Rules

managed_care_minimum_enrollment_period_max_months

Parameter

source: 42 USC 1396a(e)(2)(B)

- name: managed_care_minimum_enrollment_period_max_months
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(2)(B)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: not more than six months
  versions:
    - effective_from: '1990-04-01'
      formula: '6'

disabled_child_deeming_age_ceiling_years

Parameter

source: 42 USC 1396a(e)(3)(A)

- name: disabled_child_deeming_age_ceiling_years
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(3)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: is 18 years of age or younger
  versions:
    - effective_from: '1990-04-01'
      formula: '18'

newborn_deemed_eligibility_period_years

Parameter

source: 42 USC 1396a(e)(4)

- name: newborn_deemed_eligibility_period_years
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(4)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: remain eligible for such assistance for a period of one year
  versions:
    - effective_from: '1990-04-01'
      formula: '1'

qualified_medicare_beneficiary_determination_validity_months

Parameter

source: 42 USC 1396a(e)(8)

- name: qualified_medicare_beneficiary_determination_validity_months
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(8)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: valid for an individual for a period of 12 months
  versions:
    - effective_from: '1990-04-01'
      formula: '12'

qualified_medicare_beneficiary_redetermination_min_interval_months

Parameter

source: 42 USC 1396a(e)(8)

- name: qualified_medicare_beneficiary_redetermination_min_interval_months
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(8)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: not more frequently than once every 6 months
  versions:
    - effective_from: '1990-04-01'
      formula: '6'

ventilator_dependency_daily_hours_threshold

Parameter

source: 42 USC 1396a(e)(9)(A)(i)

- name: ventilator_dependency_daily_hours_threshold
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(9)(A)(i)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: at least six hours per day
  versions:
    - effective_from: '1990-04-01'
      formula: '6'

ventilator_dependency_consecutive_inpatient_days_threshold

Parameter

source: 42 USC 1396a(e)(9)(A)(ii)

- name: ventilator_dependency_consecutive_inpatient_days_threshold
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(9)(A)(ii)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: for at least 30 consecutive days
  versions:
    - effective_from: '1990-04-01'
      formula: '30'

group_health_plan_minimum_enrollment_period_max_months

Parameter

source: 42 USC 1396a(e)(11)(B)

- name: group_health_plan_minimum_enrollment_period_max_months
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(11)(B)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: not more than 6 months
  versions:
    - effective_from: '1990-04-01'
      formula: '6'

child_continuous_eligibility_period_months

Parameter

source: 42 USC 1396a(e)(12)(A)

- name: child_continuous_eligibility_period_months
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(12)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: the end of the 12-month period
  versions:
    - effective_from: '2024-01-01'
      formula: '12'

child_continuous_eligibility_age_ceiling_years

Parameter

source: 42 USC 1396a(e)(12)

- name: child_continuous_eligibility_age_ceiling_years
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(12)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: under the age of 19
  versions:
    - effective_from: '2024-01-01'
      formula: '19'

express_lane_screening_threshold_minimum_percentage_point_excess

Parameter

source: 42 USC 1396a(e)(13)(C)(ii)(I)

- name: express_lane_screening_threshold_minimum_percentage_point_excess
  kind: parameter
  dtype: Rate
  source: 42 USC 1396a(e)(13)(C)(ii)(I)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: exceeds the highest income threshold ... by a minimum of 30 percentage points
  versions:
    - effective_from: '2009-01-01'
      formula: '0.30'

express_lane_error_rate_reduction_threshold

Parameter

source: 42 USC 1396a(e)(13)(E)(i)(IV), (V)

- name: express_lane_error_rate_reduction_threshold
  kind: parameter
  dtype: Rate
  source: 42 USC 1396a(e)(13)(E)(i)(IV), (V)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: error rate exceeds 3 percent
  versions:
    - effective_from: '2009-01-01'
      formula: '0.03'

express_lane_child_default_age_ceiling_years

Parameter

source: 42 USC 1396a(e)(13)(G)

- name: express_lane_child_default_age_ceiling_years
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(13)(G)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: child means an individual under 19 years of age
  versions:
    - effective_from: '2009-01-01'
      formula: '19'

express_lane_child_state_option_max_age_years

Parameter

source: 42 USC 1396a(e)(13)(G)

- name: express_lane_child_state_option_max_age_years
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(13)(G)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: not to exceed 21 years of age
  versions:
    - effective_from: '2009-01-01'
      formula: '21'

clinical_trial_compensation_age_threshold_years

Parameter

source: 42 USC 1396a(e)(15)

- name: clinical_trial_compensation_age_threshold_years
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(15)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: who has attained 19 years of age
  versions:
    - effective_from: '2021-01-01'
      formula: '19'

clinical_trial_compensation_disregard_cap

Parameter

source: 42 USC 1396a(e)(15)

- name: clinical_trial_compensation_disregard_cap
  kind: parameter
  dtype: Money
  unit: USD
  source: 42 USC 1396a(e)(15)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: amount
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: The first $2,000 received
  versions:
    - effective_from: '2021-01-01'
      formula: '2000'

clinical_trial_compensation_disregarded_for_income_eligibility

Derived

source: 42 USC 1396a(e)(15)

- name: clinical_trial_compensation_disregarded_for_income_eligibility
  kind: derived
  entity: Person
  dtype: Money
  period: Month
  unit: USD
  source: 42 USC 1396a(e)(15)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: >-
              The first $2,000 received by an individual (who has attained 19 years of age) as
              compensation for participation in a clinical trial ... shall be disregarded
  versions:
    - effective_from: '2021-01-01'
      formula: >-
        if individual_age_years >= clinical_trial_compensation_age_threshold_years and
        compensation_received_for_qualifying_rare_disease_clinical_trial:
        min(clinical_trial_compensation_amount, clinical_trial_compensation_disregard_cap) else: 0

extended_postpartum_coverage_period_months

Parameter

source: 42 USC 1396a(e)(16)(A), (B)

- name: extended_postpartum_coverage_period_months
  kind: parameter
  dtype: Count
  source: 42 USC 1396a(e)(16)(A), (B)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/e
            excerpt: during the 12-month period that begins on the last day of the individual’s pregnancy
  versions:
    - effective_from: '2021-01-01'
      formula: '12'

▸citations (2)

References

This rule cites 2 other rules.

42 USC § 1396d (p)(1)inferredUS Federal › Statutes › Title 42 › § 1396d › (p)(1)
42 USC § 1396b (a)inferredUS Federal › Statutes › Title 42 › § 1396b › (a)