§1316 — Title 42 The Public Health and Welfare | U.S. Code

Summary

Requires the federal Secretary to decide within 90 days whether a State’s plan for certain public benefit programs meets the rules. The State and Secretary can agree in writing to extend that 90-day time. If the State disagrees, it has 60 days after getting the decision to ask for reconsideration. The Secretary must tell the State within 30 days when a hearing will happen. The hearing must be held 20 to 60 days after that notice unless both agree otherwise. The Secretary must issue a new decision within 60 days after the hearing. If still unhappy, the State has 60 days to ask the U.S. court of appeals for review. The court mostly accepts the Secretary’s facts if supported by strong evidence, but it can return the case for more fact-finding or set the decision aside. A State may treat an approved plan change as a new plan if it wants. The Secretary’s initial action is not put on hold while reconsideration happens, but if the Secretary later admits a mistake, he must promptly pay back any money wrongly withheld in one lump sum. If the Secretary disallows federal payments for items, the State can get a reconsideration. For disallowances under subchapter XIX, the State must request reconsideration within 60 days and may appeal to the Departmental Appeals Board within 60 days of notice. The Board’s decision is final for the Secretary but can be re-opened by a motion within 60 days or taken to federal district court under the timing rules in the law.

Title 42, §1316

The Public Health and Welfare — Source: USLM XML via OLRC

(a)(1)Whenever a State plan is submitted to the Secretary by a State for approval under subchapter I, X, XIV, XVI, or XIX, he shall, not later than 90 days after the date the plan is submitted to him, make a determination as to whether it conforms to the requirements for approval under such subchapter. The 90-day period provided herein may be extended by written agreement of the Secretary and the affected State.

(2)Any State dissatisfied with a determination of the Secretary under paragraph (1) of this subsection with respect to any plan may, within 60 days after it has been notified of such determination, file a petition with the Secretary for reconsideration of the issue of whether such plan conforms to the requirements for approval under such subchapter. Within 30 days after receipt of such a petition, the Secretary shall notify the State of the time and place at which a hearing will be held for the purpose of reconsidering such issue. Such hearing shall be held not less than 20 days nor more than 60 days after the date notice of such hearing is furnished to such State, unless the Secretary and such State agree in writing to holding the hearing at another time. The Secretary shall affirm, modify, or reverse his original determination within 60 days of the conclusion of the hearing.

(3)Any State which is dissatisfied with a final determination made by the Secretary on such a reconsideration or a final determination of the Secretary under section 304, 1204, 1354, 1384, or 1396c of this title may, within 60 days after it has been notified of such determination, file with the United States court of appeals for the circuit in which such State is located a petition for review of such determination. A copy of the petition shall be forthwith transmitted by the clerk of the court to the Secretary. The Secretary thereupon shall file in the court the record of the proceedings on which he based his determination as provided in section 2112 of title 28.

(4)The findings of fact by the Secretary, if supported by substantial evidence, shall be conclusive; but the court, for good cause shown, may remand the case to the Secretary to take further evidence, and the Secretary may thereupon make new or modified findings of fact and may modify his previous action, and shall certify to the court the transcript and record of the further proceedings. Such new or modified findings of fact shall likewise be conclusive if supported by substantial evidence.

(5)The court shall have jurisdiction to affirm the action of the Secretary or to set it aside, in whole or in part. The judgment of the court shall be subject to review by the Supreme Court of the United States upon certiorari or certification as provided in section 1254 of title 28.

(b)For the purposes of subsection (a), any amendment of a State plan approved under subchapter I, X, XIV, XVI, or XIX, may, at the option of the State, be treated as the submission of a new State plan.

(c)Action pursuant to an initial determination of the Secretary described in subsection (a) shall not be stayed pending reconsideration, but in the event that the Secretary subsequently determines that his initial determination was incorrect he shall certify restitution forthwith in a lump sum of any funds incorrectly withheld or otherwise denied.

(d)Whenever the Secretary determines that any item or class of items on account of which Federal financial participation is claimed under subchapter I, X, XIV,11 So in original. Probably should be followed by “or”. XVI, shall be disallowed for such participation, the State shall be entitled to and upon request shall receive a reconsideration of the disallowance.

(e)(1)Whenever the Secretary determines that any item or class of items on account of which Federal financial participation is claimed under subchapter XIX shall be disallowed for such participation, the State shall be entitled to and upon request shall receive a reconsideration of the disallowance, provided that such request is made during the 60-day period that begins on the date the State receives notice of the disallowance.

(2)(A)A State may appeal a disallowance of a claim for federal 22 So in original. Probably should be capitalized. financial participation under subchapter XIX by the Secretary, or an unfavorable reconsideration of a disallowance, during the 60-day period that begins on the date the State receives notice of the disallowance or of the unfavorable reconsideration, in whole or in part, to the Departmental Appeals Board, established in the Department of Health and Human Services (in this paragraph referred to as the “Board”), by filing a notice of appeal with the Board.

(B)The Board shall consider a State’s appeal of a disallowance of such a claim (or of an unfavorable reconsideration of a disallowance) on the basis of such documentation as the State may submit and as the Board may require to support the final decision of the Board. In deciding whether to uphold a disallowance of such a claim or any portion thereof, the Board shall be bound by all applicable laws and regulations and shall conduct a thorough review of the issues, taking into account all relevant evidence. The Board’s decision of an appeal under subparagraph (A) shall be the final decision of the Secretary and shall be subject to reconsideration by the Board only upon motion of either party filed during the 60-day period that begins on the date of the Board’s decision or to judicial review in accordance with subparagraph (C).

(C)A State may obtain judicial review of a decision of the Board by filing an action in any United States District Court located within the appealing State (or, if several States jointly appeal the disallowance of claims for Federal financial participation under section 1396b of this title, in any United States District Court that is located within any State that is a party to the appeal) or the United States District Court for the District of Columbia. Such an action may only be filed—

(i)if no motion for reconsideration was filed within the 60-day period specified in subparagraph (B), during such 60-day period; or

(ii)if such a motion was filed within such period, during the 60-day period that begins on the date of the Board’s decision on such motion.

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 1384 of this title, referred to in subsec. (a)(3), is a reference to section 1384 of this title as it existed prior to the general revision of this subchapter by Pub. L. 92–603, title III, § 301, Oct. 30, 1972, 86 Stat. 1465, eff. Jan. 1, 1974. The prior section (which is set out as a note under section 1384 of this title) continues in effect for Puerto Rico, Guam, and the Virgin Islands.

Amendments

2008—Subsec. (d). Pub. L. 110–275, § 204(b), struck out “or XIX,” after “XVI,”. Subsec. (e). Pub. L. 110–275, § 204(a), added subsec. (e). 1996—Subsec. (a)(1). Pub. L. 104–193, § 108(g)(3)(A), struck out “or part A of subchapter IV,” after “XIX,”. Subsec. (a)(3). Pub. L. 104–193, § 108(g)(3)(B), struck out “604,” before “1204,”. Subsecs. (b), (d). Pub. L. 104–193, § 108(g)(3)(A), struck out “or part A of subchapter IV,” after “XIX,”. 1984—Subsec. (a)(1). Pub. L. 98–369, § 2663(e)(6)(A), struck out “VI,” after “I,”. Pub. L. 98–369, § 2354(c)(2), corrected typographical error in directory language of Pub. L. 97–35, § 2353(h)(1). See 1981 Amendment note below. Subsec. (a)(3). Pub. L. 98–369, § 2663(e)(6)(B), struck out “804,” after “604,”. Subsec. (b). Pub. L. 98–369, § 2663(e)(6)(A), struck out “VI,” after “I,”. Pub. L. 98–369, § 2354(c)(2), corrected typographical error in directory language of Pub. L. 97–35, § 2353(h)(1). See 1981 Amendment note below. Subsec. (d). Pub. L. 98–369, § 2663(e)(6)(C), substituted “XVI, or XIX, or part A” for “XVI, or or XIX, or part A”. Pub. L. 98–369, § 2663(e)(6)(A), struck out “VI,” after “I,”. 1981—Subsec. (a)(1). Pub. L. 97–35, § 2353(h)(1), as amended by Pub. L. 98–369, § 2354(c)(2), substituted “or XIX” for “XIX or XX”. Subsec. (a)(3). Pub. L. 97–35, § 2353(h)(2), substituted “or 1396c of this title” for “1396c, or 1397b of this title”. Subsec. (b). Pub. L. 97–35, § 2353(h)(1), as amended by Pub. L. 98–369, § 2354(c)(2), substituted “or XIX” for “XIX or XX”. Subsec. (d). Pub. L. 97–35, § 2353(h)(3), substituted “or XIX” for “XIX, or XX”. 1975—Subsec. (a)(1). Pub. L. 93–647, § 3(d)(1), substituted “XIX or XX” for “or XIX”. Subsec. (a)(3). Pub. L. 93–647, § 3(d)(2), substituted “1396c, or 1397b” for “or 1396c”. Subsec. (b). Pub. L. 93–647, § 3(d)(1), substituted “XIX or XX” for “or XIX”. Subsec. (d). Pub. L. 93–647, § 3(d)(3), inserted “XX,” after “XIX,”. 1973—Subsec. (a). Pub. L. 93–233, § 18(z–2)(1)(C)(i), (ii), inserted references in par. (1) to subchapter VI of this chapter and in par. (3) to section 804 of this title. Subsecs. (b), (d). Pub. L. 93–233, § 18(z–2)(1)(C)(iii), (iv), inserted reference to subchapter VI of this chapter. 1968—Subsec. (a)(1). Pub. L. 90–248, § 241(c)(5)(A), struck out “IV,” after “I,” and inserted “or part A of subchapter IV,” after “XIX,”. Subsecs. (b), (d). Pub. L. 90–248, § 241(c)(5)(B), struck out “IV,” after “I,” and inserted “, or part A of subchapter IV,” after “XIX”.

Statutory Notes and Related Subsidiaries

Effective Date

of 2008 Amendment Pub. L. 110–275, title II, § 204(c), July 15, 2008, 122 Stat. 2593, provided that: “The

Amendments

made by this section [amending this section] take effect on the date of the enactment of this Act [July 15, 2008] and apply to any disallowance of a claim for Federal financial participation under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) made on or after such date or during the 60-day period prior to such date.”

Effective Date

of 1996 AmendmentAmendment by Pub. L. 104–193 effective July 1, 1997, with transition rules relating to State options to accelerate such date, rules relating to claims, actions, and proceedings commenced before such date, rules relating to closing out of accounts for terminated or substantially modified programs and continuance in office of Assistant Secretary for Family Support, and provisions relating to termination of entitlement under AFDC program, see section 116 of Pub. L. 104–193, as amended, set out as an

Effective Date

note under section 601 of this title.

Effective Date

of 1984 AmendmentAmendment by section 2354(c)(2) of Pub. L. 98–369 effective as if originally included in Pub. L. 97–35, see section 2354(e)(2) of Pub. L. 98–369, set out as a note under section 1320a–1 of this title. Amendment by section 2663(e)(6) of Pub. L. 98–369 effective July 18, 1984, but not to be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date, see section 2664(b) of Pub. L. 98–369, set out as a note under section 401 of this title.

Effective Date

of 1981 AmendmentAmendment by Pub. L. 97–35 effective Oct. 1, 1981, except as otherwise explicitly provided, see section 2354 of Pub. L. 97–35, set out as an

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note under section 1397 of this title.

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of 1975 AmendmentAmendment by Pub. L. 93–647 effective with respect to payments under section 603 and 803 of this title for quarters commencing after Sept. 30, 1975, see section 7(b) of Pub. L. 93–647, set out as a note under section 303 of this title.

Effective Date

of 1973 AmendmentAmendment by Pub. L. 93–233 effective on and after Jan. 1, 1974, see section 18(z–2)(2) of Pub. L. 93–233, set out as a note under section 1301 of this title.

Effective Date

Pub. L. 89–97, title IV, § 404(b),

July 30, 1965, 79 Stat. 420, provided that: “The amendment made by subsection (a) [enacting this section] shall apply only with respect to determinations made after

December 31, 1965.”

§1316 Administrative and judicial review of public assistance determinations

Summary

Title 42, §1316

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