42 USC 1396w - Asset verification through access to information held by financial institutions

U.S Code last checked for updates: Oct 16, 2024

§ 1396w.

Asset verification through access to information held by financial institutions

(a)

Implementation

(1)

In general

(2)

Plan submittal

In order to meet the requirement of paragraph (1), each State shall—

(A)

submit not later than a deadline specified by the Secretary consistent with paragraph (3), a State plan amendment under this subchapter that describes how the State intends to implement the asset verification program; and

(B)

provide for implementation of such program for eligibility determinations and redeterminations made on or after 6 months after the deadline established for submittal of such plan amendment.

(3)

Phase-in

(A)

In general

(i)

Implementation in current asset verification demo States

(ii)

Implementation in other States

The Secretary shall require other States to submit and implement an asset verification program under this subsection in such manner as is designed to result in the application of such programs, in the aggregate for all such other States, to enrollment of approximately, but not less than, the following percentage of enrollees, in the aggregate for all such other States, by the end of the fiscal year involved:

(I)

12.5 percent by the end of fiscal year 2009.

(II)

25 percent by the end of fiscal year 2010.

(III)

50 percent by the end of fiscal year 2011.

(IV)

75 percent by the end of fiscal year 2012.

(V)

100 percent by the end of fiscal year 2013.

(iii)

Implementation in Puerto Rico

(B)

Consideration

(C)

States specified

(D)

Construction

(4)

Exemption of certain territories

(b)

Asset verification program

(1)

In general

For purposes of this section, an asset verification program means a program described in paragraph (2) under which a State—

(A)

requires each applicant for, or recipient of, medical assistance under the State plan under this subchapter on the basis of being aged, blind, or disabled to provide authorization by such applicant or recipient (and any other person whose resources are required by law to be disclosed to determine the eligibility of the applicant or recipient for such assistance) for the State to obtain (subject to the cost reimbursement requirements of section 1115(a) of the Right to Financial Privacy Act 1

 See References in Text note below.

[12 U.S.C. 3415] but at no cost to the applicant or recipient) from any financial institution (within the meaning of section 1101(1) of such Act [12 U.S.C. 3401(1)]) any financial record (within the meaning of section 1101(2) of such Act) held by the institution with respect to the applicant or recipient (and such other person, as applicable), whenever the State determines the record is needed in connection with a determination with respect to such eligibility for (or the amount or extent of) such medical assistance; and

(B)

uses the authorization provided under subparagraph (A) to verify the financial resources of such applicant or recipient (and such other person, as applicable), in order to determine or redetermine the eligibility of such applicant or recipient for medical assistance under the State plan.

(2)

Program described

(c)

Duration of authorization

Notwithstanding section 1104(a)(1) of the Right to Financial Privacy Act ¹ [12 U.S.C. 3404(a)(1)], an authorization provided to a State under subsection (b)(1) shall remain effective until the earliest of—

(1)

the rendering of a final adverse decision on the applicant’s application for medical assistance under the State’s plan under this subchapter;

(2)

the cessation of the recipient’s eligibility for such medical assistance; or

(3)

the express revocation by the applicant or recipient (or such other person described in subsection (b)(1), as applicable) of the authorization, in a written notification to the State.

(d)

Treatment of Right to Financial Privacy Act requirements

(1)

An authorization obtained by the State under subsection (b)(1) shall be considered to meet the requirements of the Right to Financial Privacy Act ¹ for purposes of section 1103(a) of such Act [12 U.S.C. 3403(a)], and need not be furnished to the financial institution, notwithstanding section 1104(a) of such Act [12 U.S.C. 3404(a)].

(2)

The certification requirements of section 1103(b) of the Right to Financial Privacy Act ¹ [12 U.S.C. 3403(b)] shall not apply to requests by the State pursuant to an authorization provided under subsection (b)(1).

(3)

A request by the State pursuant to an authorization provided under subsection (b)(1) is deemed to meet the requirements of section 1104(a)(3) of the Right to Financial Privacy Act ¹ [12 U.S.C. 3404(a)(3)] and of section 1102 of such Act [12 U.S.C. 3402], relating to a reasonable description of financial records.

(e)

Required disclosure

(f)

Refusal or revocation of authorization

(g)

Use of contractor

(h)

Technical assistance

(i)

Reports

(j)

Treatment of program expenses

(k)

Reduction in FMAP after 2020 for non-compliant States

(1)

In general

With respect to a calendar quarter, the Federal medical assistance percentage otherwise determined under section 1396d(b) of this title for—

(A)

a non-compliant State that is one of the 50 States or the District of Columbia shall be reduced—

(i)

for calendar quarters in 2021 and 2022, by 0.12 percentage points;

(ii)

for calendar quarters in 2023, by 0.25 percentage points;

(iii)

for calendar quarters in 2024, by 0.35 percentage points; and

(iv)

for calendar quarters in 2025 and each year thereafter, by 0.5 percentage points; and

(B)

a non-compliant State that is Puerto Rico shall be reduced—

(i)

for calendar quarters in fiscal year 2026 beginning on or after January 1, 2026, by 0.12 percentage points;

(ii)

for calendar quarters in fiscal year 2027, by 0.25 percentage points;

(iii)

for calendar quarters in fiscal year 2028, by 0.35 percentage points; and

(iv)

for calendar quarters in fiscal year 2029 and each fiscal year thereafter, by 0.5 percentage points.

(2)

Non-compliant State defined

For purposes of this subsection, the term “non-compliant State” means a State—

(A)

that is one of the 50 States, the District of Columbia, or Puerto Rico;

(B)

with respect to which the Secretary has not approved a State plan amendment submitted under subsection (a)(2); and

(C)

that is not operating, on an ongoing basis, an asset verification program in accordance with this section.

(Aug. 14, 1935, ch. 531, title XIX, § 1940, as added Pub. L. 110–252, title VII, § 7001(d)(1), June 30, 2008, 122 Stat. 2391; amended Pub. L. 116–3, § 4, Jan. 24, 2019, 133 Stat. 7; Pub. L. 117–328, div. FF, title V, § 5101(c), Dec. 29, 2022, 136 Stat. 5935.)

cite as: 42 USC 1396w