note. 104 STAT. 1388-194 PUBLIC LAW 101-508 —NOV. 5, 1990 (1) personal care services furnished before such date pursuant to regulations in effect as of July 1, 1989; and (2) such services furnished before October 1, 1994. SEC. 4721. MEDICAID COVERAGE OF PERSONAL CARE SERVICES OUTSIDE THE HOME. (a) IN GENERAL. — Section 1905(a)(7) (42 U.S.C. 1396d(a)(7)) is amended by striking "services" and inserting "services including personal care services (A) prescribed by a physician for an individual in accordance with a plan of treatment, (B) provided by an individual who is qualified to provide such services and who is not a member of the individual's family, (C) supervised by a registered nurse, and (D) furnished in a home or other location; but not including such services furnished to an inpatient or resident of a nursing facility", fLY^ ^^^^ (b) EFFECTIVE DATE.—The amendment made by this section shall become effective with respect to personal care services provided on or after October 1, 1994. SEC. 4722. MEDICAID COVERAGE OF ALCOHOLISM AND DRUG DEPEND- ENCY TREATMENT SERVICES. Section 1905(a) of the Social Security Act is amended by adding at the end the following new sentence: No service (including counseling) shall be excluded from the definition of 'medical assistance' solely because it is provided as a treatment service for alcoholism or drug dependency. ". SEC. 4723. MEDICAID SPENDDOWN OPTION. (a) IN GENERAL.— Section 1903(f)(2) (42 U.S.C. 1396b(f)(2)) is amended by— (1) inserting "(A)" after "(2)"; and (2) by adding before the period at the end the following: "or, (B) notwithstanding section 1916 at State option, an amount paid by such family, at the family's option, to the State, provided that the amount, when combined with costs incurred in prior months, is sufficient when excluded from the family's income to reduce such family's income below the applicable income limitation described in paragraph (1). The amount of State expenditures for which medical assistance is available under subsection (a)(1) will be reduced by amounts paid to the State pursuant to this subparagraph." 0)) CONFORMING AMENDMENT. —Section 1902(a)(17) (42 U.S.C. 1396a(a)(17)) is amended by inserting after "insurance premiums" ", payments made to the State under section 1903(f)(2)(B),". SEC, 4724. OPTIONAL STATE MEDICAID DISABILITY DETERMINATIONS INDEPENDENT OF THE SOCIAL SECURITY ADMINISTRATION. (a) IN GENERAL.— Section 1902 (42 U.S.C. 1396a) as amended by this title, is further amended by adding at the end the following new subsection: "(v)(l) A State plan may provide for the making of determinations of disability or blindness for the purpose of determining eligibility for medical assistance under the State plan by the single State agency or its designee, and make medical assistance available to individuals whom it finds to be blind or disabled and who are determined otherwise eligible for such assistance during the period of time prior to which a final determination of disability or blind-
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