104 STAT. 1388-212 PUBLIC LAW 101-508—NOV. 5, 1990 program on a prorata basis during the period in which the nurse aide is so employed.". (6) MODIFICATION OF NURSING FACILITY DEFICIENCY STAND- ARDS.— (A) IN GENERAL.— Section 1919(f)(2)(B)(iii)(I) (42 U.S.C. 1396r(f)(2)(B)(iii)(I)) is amended to read as follows: "(I) offered by or in a nursing facility which, within the previous 2 years— "(a) has operated under a waiver under subsection (b)(4)(C)(ii) that was granted on the basis of a demonstration that the facility is unable to provide the nursing care required under subsection (b)(4)(C)(i) for a period in excess of 48 hours during a week; "(b) has been subject to an extended (or partial extended) survey under section 1819(g)(2)(B)(i) or subsection (g)(2)(B)(i); or "(c) has been assessed a civil money penalty described in section 1819(h)(2)(B)(ii) or subsection (h)(2)(A)(ii) of not less than $5,000, or has been subject to a remedy described in subsection (h)(l)(B)(i), clauses (i), (iii), or (iv) of subsection (h)(2)(A), clauses (i) or (iii) of section 1819(h)(2)(B), or section 1819(h)(4), or". 42 USC 1396r (B) EFFECTIVE DATE. — T Tie amendments made by subpara- ^ote. graph (A) shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1987, except that a State may not approve a training and competency evaluation program or a competency evaluation program offered by or in a nursing facility which, pursuant to any Federal or State law within the 2-year period beginning on October 1, 1988— (i) had its participation terminated under title XVIII of the Social Security Act or under the State plan under title XIX of such Act; (ii) was subject to a denial of payment under either such title; (iii) was assessed a civil money penalty not less than $5,000 for deficiencies in nursing facility standards; (iv) operated under a temporary management appointed to oversee the operation of the facility and to ensure the health and safety of the facility's residents; or (v) pursuant to State action, was closed or had its residents transferred. (7) CLARIFICATION OF STATE RESPONSIBILITY TO DETERMINE COM- PETENCY. — Section 1919(f)(2)(B) (42 U.S.C. 1396r(f)(2)(B)) is amended in the second sentence by inserting "(through subcontract or otherwise)" after "may not delegate '. (8) EXTENSION OF ENHANCED MATCH RATE UNTIL OCTOBER i, 1990.— Section 1903(a)(2)(B) (42 U.S.C. 1396b(a)(2)(B)) is amended by striking "July 1, 1990" and inserting "October 1, 1990". 42 USC 1396b (9) EFFECTIVE DATE.—Except as provided in paragraph (6), the note. amendments made by this subsection shall take effect as if they were included in the enactment of the Omnibus Budget Reconciliation Act of 1987.
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