---
kind: "section"
citation: "42 U.S.C. § 1396b–1"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1396b–1"
heading: "Payment adjustment for health care-acquired conditions"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1396b-1"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XIX — Grants to States for Medical Assistance Programs"
---

# §1396b–1. Payment adjustment for health care-acquired conditions

- (a) **In general—** The [Secretary](/usc/42/1301.md?p=a-6) of Health and Human Services (in this subsection referred to as the “[Secretary](/usc/42/1301.md?p=a-6)”) shall identify current [State](/usc/42/619.md?p=5) [practices](/usc/42/17061.md?p=19) that prohibit payment for health care-acquired conditions and shall incorporate the [practices](/usc/42/17061.md?p=19) identified, or elements of such [practices](/usc/42/17061.md?p=19), which the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate for application to the Medicaid program in regulations. Such regulations shall be effective as of July 1, 2011, and shall prohibit payments to [States](/usc/42/619.md?p=5) under section 1903 of the [Social](/usc/42/1397j.md?p=20) Security Act [[42 U.S.C. 1396b](/usc/42/1396b.md)] for any amounts expended for providing [medical assistance](/usc/42/1396d.md?p=a) for health care-acquired conditions specified in the regulations. The regulations shall ensure that the prohibition on payment for health care-acquired conditions shall not result in a loss of access to care or services for Medicaid beneficiaries.
- (b) **Health care-acquired condition—** In this section.[^1] the term “health care-acquired condition” means a medical condition for which an individual was diagnosed that could be identified by a secondary diagnostic code described in section 1886(d)(4)(D)(iv) of the [Social](/usc/42/1397j.md?p=20) Security Act ([42 U.S.C. 1395ww(d)(4)(D)(iv)](/usc/42/1395ww.md?p=d-4-D-iv)).
- (c) **Medicare provisions—** In carrying out this section, the [Secretary](/usc/42/1301.md?p=a-6) shall apply to [State](/usc/42/619.md?p=5) plans (or waivers) under title XIX of the [Social](/usc/42/1397j.md?p=20) Security Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.] the regulations promulgated pursuant to [section 1886(d)(4)(D)](/usc/42/1886.md) of such Act ([42 U.S.C. 1395ww(d)(4)(D)](/usc/42/1395ww.md?p=d-4-D)) relating to the prohibition of payments based on the presence of a secondary diagnosis code specified by the [Secretary](/usc/42/1301.md?p=a-6) in such regulations, as appropriate for the Medicaid program. The [Secretary](/usc/42/1301.md?p=a-6) may exclude certain conditions identified under title XVIII of the [Social](/usc/42/1397j.md?p=20) Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq.] for non-payment under title XIX of such Act when the [Secretary](/usc/42/1301.md?p=a-6) finds the inclusion of such conditions to be inapplicable to beneficiaries under title XIX.

## Footnotes

[^1]: So in original. The period probably should be a comma.

## Source credit

(Pub. L. 111–148, title II, § 2702, Mar. 23, 2010, 124 Stat. 318.)

## Notes

### Editorial Notes

### References in Text

The Social Security Act, referred to in subsec. (c), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XIX of the Act is classified generally to this subchapter. Title XVIII of the Act is classified generally to subchapter XVIII (§ 1395 et seq.) of this chapter. For complete classification of this Act to the Code, see section 1305 of this title and Tables.

### Codification

Section was enacted as part of the Patient Protection and Affordable Care Act, and not as part of the Social Security Act which comprises this chapter.