42 U.S.C. § 1397ee — Payments to States

(a) Payments

(1) In general. Subject to the rest of this section, the Secretary^* must pay each State^* with an approved plan^*, from the State’s allotment under section 1397dd, for each quarter an amount equal to the enhanced FMAP applied to that quarter’s covered expenditures. For translation or interpretation services under (D)(iv), the rate is the higher of 75 percent or the enhanced FMAP plus 5 percentage points. The covered expenditures are:

(A) Medical assistance under the plan for targeted low-income children when payment is made using the enhanced FMAP under the fourth sentence of section 1396d(b).

(B) The supplied text contains no substantive text for this subparagraph.

(C) Health-benefits coverage under the plan for targeted low-income children that meets section 1397cc.

(D) To the extent subsection (c) permits it:

(i) Other child health assistance^* for targeted low-income children.

(ii) Health-services initiatives under the plan that improve children’s health, including the health of targeted low-income children and other low-income children.

(iii) Outreach activities under section 1397bb(c)(1).

(iv) Translation or interpretation services needed for people whose primary language is not English to enroll in, stay enrolled in, or use services under this subchapter, when the Secretary finds them necessary for proper and efficient administration^* of the State plan.

(v) Other reasonable costs the State incurs to administer the plan.

(2) Order of payments. The State’s allotment must be used in this order: first, paragraph (1)(A) expenditures; second, paragraph (1)(B) expenditures; third, paragraph (1)(C) expenditures; and fourth, paragraph (1)(D) expenditures.

(3) Performance bonus payment to offset additional Medicaid and CHIP child^*-enrollment costs resulting from enrollment and retention efforts.

(A) In general. For each fiscal year from 2009 through 2013, in addition to paragraph (1) payments, the Secretary must pay a State that meets paragraph (4) an amount calculated under (B), using amounts available under (E). The Secretary must make the payment as one payment no later than the last day of the first calendar quarter of the next fiscal year.

(B) Amount for above-baseline Medicaid child-enrollment costs. The amount is the sum of:

(i) The number of first-tier above-baseline child enrollees under subchapter XIX, determined under (C)(i), multiplied by 15 percent of the State’s projected per-capita Medicaid expenditures, determined under (D).

(ii) The number of second-tier above-baseline child enrollees under subchapter XIX, determined under (C)(ii), multiplied by 62.5 percent of those projected per-capita State Medicaid expenditures.

(C) Number of first- and second-tier above-baseline child enrollees; baseline number.

(i) First tier. The number is the monthly average unduplicated number of qualifying children enrolled during the fiscal year under the State’s subchapter XIX plan, minus the baseline number in (iii), if positive, but it cannot exceed 10 percent of that baseline.

(ii) Second tier. The number is the monthly average unduplicated number of those qualifying children minus the baseline number plus the maximum first-tier number, if positive.

(iii) Baseline. Subject to (H), the baseline is calculated as follows. For 2009, start with the monthly average unduplicated number of qualifying children enrolled in 2007, add the Census Bureau’s estimated child-population growth from 2007 to 2008 plus 4 percentage points, and then add the growth from 2008 to 2009 plus 4 percentage points. For 2010, 2011, and 2012, use the prior year’s baseline and add the estimated child-population growth from the calendar year in which the fiscal year begins to the next calendar year, plus 3.5 percentage points. For 2013, 2014, and 2015, use the prior baseline and add that growth plus 3 percentage points. For any later fiscal year, use the prior baseline and add that growth plus 2 percentage points.

(D) Projected per-capita State Medicaid expenditures. Start with the average per-capita expenditures, including State and Federal shares, for children under the State’s subchapter XIX plan and waivers, excluding children eligible because they receive subchapter XVI benefits. Use the most recent fiscal year with actual data, as the Secretary determines. Increase that amount for each later fiscal year through the fiscal year involved by the annual percentage increase in per-capita National Health Expenditures estimated by the Secretary for the calendar year in which that later fiscal year ends. Then multiply by the State matching percentage: 100 percent minus the Federal medical assistance percentage for the fiscal year involved.

(E) Amounts available.

(i) Initial appropriation. The Treasury appropriates $3,225,000,000 for fiscal year 2009, available until spent, for these payments.

(ii) Transfers. Without a fiscal-year limit, the following are also available:

(I) Unobligated national allotment. For fiscal years 2009 through 2012, as of December 31 of each year, this includes any part of that year’s subsection (a) appropriation that has not been obligated for State allotments under subsection (m) or set aside under section 1397kk(a)(3) or (b)(2). For the first half of fiscal year 2013, as of December 31, it includes any unobligated part of the appropriations under subsection (a)(16)(A) and section 108 of the Children’s Health Insurance Reauthorization Act of 2009 for October 1, 2012, through March 31, 2013, that was not allotted or set aside under section 1397kk(b)(2). For the second half of 2013, as of June 30, it includes any unobligated part of subsection (a)(16)(B) funds for April 1 through September 30, 2013, that was not allotted or set aside under section 1397kk(b)(2).

(II) Unexpended allotments not used for redistribution. As of November 15 in 2010 through 2013, this includes State allotments for the second preceding fiscal year that were not spent or redistributed under section 1397dd(f) during their obligation period. For fiscal-year 2006, 2007, and 2008 allotments, use the third preceding fiscal year.

(III) Excess contingency funds. As of October 1 in 2010 through 2013, this includes any amount above the Child Enrollment Contingency Fund’s aggregate cap under section 1397dd(n).

(iii) Proportional reduction. If the amount otherwise payable for a fiscal year is greater than the amount available, each State’s payment must be reduced proportionally.

(F) Qualifying children.

(i) Generally, this means children meeting the income, categorical-eligibility, age, immigration-status, and other eligibility criteria in effect on July 1, 2008, for enrollment under subchapter XIX, including criteria applied under a section 1315 waiver.

(ii) A child receiving medical assistance during presumptive eligibility counts only if the child is later found eligible for subchapter XIX assistance.

(iii) The term excludes children for whom the State elected to provide assistance under section 1396b(v)(4), and children enrolled on or after October 1, 2013.

(G) The rule in section 1397dd(n)(3)(G) for commonwealths and territories applies to payments under this paragraph in the same way it applies to payments under that section.

(H) For a State providing coverage under section 115 of the Children’s Health Insurance Program Reauthorization Act of 2009 after fiscal year 2008, children enrolled through that election are ignored when calculating the monthly average during the first three fiscal years of the election. After those three years, the baseline for the State uses the monthly average of qualifying children enrolled during the third year.

(4) Enrollment and retention provisions for children. A State satisfies the condition for a fiscal year if it implements at least five of the following provisions, with each letter counting separately, throughout the entire fiscal year:

(A) Continuous eligibility. The State provides 12 months of continuous eligibility to all children under 19 described in section 1396a(e)(12) under subchapter XIX and applies the same policy under its State child health plan^*.

(B) More flexible asset rules. The State either (i) uses no asset or resource test for children under subchapter XIX or this subchapter, or (ii) lets a parent or caretaker relative declare and sign, under penalty of perjury, family-asset information and verifies assets by means other than demanding documents, except for discrepancies or other justified cases.

(C) No required in-person^* application or interview. The State does not require an in-person application or face-to-face interview for an initial or renewal application, unless discrepancies or individual circumstances justify one.

(D) One Medicaid/CHIP application. The application, any supplemental forms, and the information-verification process are the same for establishing and renewing eligibility under subchapter XIX and this subchapter.

(E) Automatic renewal. (i) For renewal, the State sends a preprinted form based on its information and tells the parent or caretaker relative that eligibility will continue on that information unless the State receives different information. The State may verify the information electronically or by other means. (ii) The State also satisfies this requirement if it renews eligibility without an in-person interview unless it lacks enough information and cannot obtain it from other sources, including other State agencies, without the applicant or the applicant’s parent or caretaker relative.

(F) Presumptive eligibility. The State implements section 1396r-1a under subchapter XIX and, under section 1397gg(e)(1), under this subchapter.

(G) Express Lane. The State implements section 1396a(e)(13) under subchapter XIX and, under section 1397gg(e)(1), under this subchapter.

(H) Premium-assistance subsidies. The State implements the option under subsection (c)(10) or section 1396e-1.

(b) Enhanced FMAP. For a State and fiscal year, the enhanced FMAP starts with the State’s Federal medical assistance percentage under the first sentence of section 1396d(b). Add 30 percent of the percentage-point difference between that percentage and 100 percent. The result cannot exceed 85 percent. From October 1, 2015, through September 30, 2019, add 23 percentage points to the enhanced FMAP; from October 1, 2019, through September 30, 2020, add 11.5 percentage points. During those periods the result cannot exceed 100 percent. The increases just described do not apply when determining payments for (a)(1)(D)(iv), (c)(8), (c)(9), (c)(11), or clause (4) of the first sentence of section 1396d(b).

(c) Limitation on certain payments for certain expenditures.

(1) General limitations. State funds under this subchapter may be used only for this subchapter’s purposes, as described in section 1397aa, or for the rural health transformation program in subsection (h). Except for subsection (h) funds, they may not cover a nonpregnant childless adult. Coverage may include abortion only when necessary to save the mother’s life or when the pregnancy resulted from rape or incest. A caretaker relative, as defined for section 1396u-1, is not treated as a childless adult.

(2) Non-Medicaid or non-health-insurance expenditures.

(A) Generally, paragraph (1)(D) expenditures may not receive more than 10 percent of the total amount spent under (a)(1)(A), (C), and (D).

(B) The Secretary may waive that limit if the State shows that the coverage meets section 1397cc, costs no more per child on average than the coverage that section would otherwise provide, and is delivered through a community-based system, such as contracts with section 254b health centers or hospitals receiving specified disproportionate-share adjustments.

(C) The limit does not apply to: (i) outreach and enrollment of Indian children for this subchapter or subchapter XIX, including activities under section 1320b-9(a); (ii) expenditures needed to meet (9)(A); (iii) outreach for premium-assistance subsidies to families and likely employers, limited to 1.25 percent of the maximum otherwise permitted under (A); or (iv) expenses for administering payment-error-rate measurement (PERM) requirements under the cited federal statutes, regulations, or successor guidance.

(3) Family-coverage purchase. Payment for family coverage that includes targeted low-income children is allowed only if the State shows to the Secretary that it is cost-effective compared with the State child health plan’s comparable coverage costs, including administration, for the child or family, or for all such children or families, and that the coverage will not substitute for coverage the plan would otherwise provide to those children.

(4) Non-Federal matching funds. Federal money, or services significantly assisted or subsidized by Federal money, cannot count toward the non-Federal contribution required under subsection (a).

(5) Premium and cost-sharing^* receipts. The plan’s expenditures for subsection (a) purposes must be reduced by premiums and other cost-sharing the State receives.

(6) No duplicate payments.

(A) Other health plans. No payment is made for assistance that a private insurer would have had to provide, but for a contract term limiting or excluding that duty because the person is eligible for or receives plan assistance. “Private insurer” is defined by Secretary regulation and includes a group health plan^*, service-benefit plan, and health maintenance organization.

(B) Other Federal programs. Except for the provisions referenced in (a)(1)(A) and (B), or another law, no payment is made when payment has been made or can reasonably be expected promptly under another federally operated or financed health-insurance program identified by the Secretary, except an Indian Health Service program. Rules like section 1396b(d)(2) overpayment rules apply.

(7) Abortion.

(A) No payment may cover an abortion or help buy coverage that includes abortion.

(B) The prohibition does not apply when the abortion is necessary to save the mother’s life or the pregnancy resulted from rape or incest.

(C) This section does not affect a State, locality, private person, or private entity spending State, local, or private funds outside the State plan for abortion or coverage that includes abortion.

(8) Children above 300 percent of poverty.

(A) For fiscal years beginning in 2009, use the ordinary FMAP under section 1396d(b), without its clause (4), instead of the enhanced FMAP for assistance or coverage for a targeted low-income child^* whose effective family income would exceed 300 percent of poverty but for a general exclusion of a block of income not based on expense or income type.

(B) This substitution does not apply to a State that on February 4, 2009, had an approved plan amendment or waiver for that coverage, or had enacted a law to submit such an amendment.

(9) Citizenship documents.

(A) No payment is made for a person who declared United States^* citizenship or nationality to establish eligibility unless the State meets section 1396a(a)(46)(B)’s requirements for that person.

(B) Despite (b), the enhanced FMAP for expenses under section 1396b(a)(3)(G)(i) or (ii) needed to meet (A) cannot be below 90 percent or 75 percent, respectively.

(10) State premium-assistance option.

(A) A State may offer a premium-assistance subsidy to all eligible targeted low-income children who can access qualified employer^*-sponsored coverage if the subsidy is cost-effective under paragraph (3)(A). The child or parent must choose it voluntarily; the State cannot require that choice as a condition of child health assistance.

(B) Qualified employer-sponsored coverage. Subject to (ii), this means an employer group plan or health insurance that (I) is creditable group-plan coverage under section 2701(c)(1) of the Public Health Service Act; (II) has an employer contribution of at least 40 percent of any premium; and (III) is offered to all people under a nondiscriminatory eligibility classification under Internal Revenue Code section 105(h)(3)(A)(ii), without applying that provision’s clause (i). (ii) It excludes health flexible-spending-arrangement benefits and a high-deductible health plan^*, whether or not bought with a health savings account.

(C) Premium-assistance subsidy. (i) For a child, it is the employee contribution for employee-and-child enrollment minus the employee-only contribution, less applicable State-plan premium cost-sharing. The total employee-and-child contribution must count toward the annual aggregate cost-sharing limit in section 1397cc(e). (ii) The State may reimburse the employee or pay the employer directly. (iii) An employer may opt out of direct payment. Then it withholds the full employee-and-child contribution and the State pays the subsidy to the employee. (iv) These subsidy expenses are child health assistance under (a)(1)(C).

(D) The State is the secondary payer for items and services covered by the employer plan for which the State plan provides assistance.

(E) Supplemental coverage. (i) Despite section 1397jj(b)(1)(C), the State must provide each child enrolled in the employer coverage with supplemental coverage for items or services not covered or only partly covered by that coverage, plus cost-sharing protection consistent with section 1397cc(e). (ii) The State may directly pay the employer-plan cost-sharing and may collect all, part, or none of it from the parent.

(F) Any State-plan waiting period applies equally before the subsidy begins.

(G) The State must let a parent disenroll the child from employer coverage and enroll the child in the State plan starting the first day of any month when the child is eligible, while maintaining continuity of coverage.

(H) If the State covers parents under section 1397kk(b), it may offer a subsidy to an eligible parent in the same way. The subsidy may be increased for the parent’s enrollment, or, if cost-effective, the family’s enrollment. References to a child then include the parent or family as applicable.

(I) Employer-family pool. (i) A State may create a purchasing pool for employers with fewer than 250 employees that have at least one employee who is a pregnant woman eligible under the State plan, including through section 1397ll(f), or a family member with at least one targeted low-income child^*. The State may provide subsidies for coverage through the pool. (ii) A State choosing this option must identify and offer at least two private health plans equivalent to the benefits in a section 1397cc(b) benchmark package or compliant benchmark-equivalent coverage. (iii) This does not authorize payment for pool establishment or operation unless otherwise allowed under this subchapter.

(J) This paragraph does not limit premium assistance under sections 1396e or 1396e-1, the waivers referenced in (2)(B) or (3), a section 1315 waiver, or authority in effect before February 4, 2009.

(K) Notice. A State offering subsidies must put notice of their availability on child-assistance applications and enrollment forms, explain the subsidies and how to choose them during application and enrollment, and establish procedures to make parents fully aware of State-plan and subsidy choices.

(L) For employer coverage certified by an actuary as equivalent to a section 1397cc(b) benchmark package or compliant benchmark-equivalent coverage, the State may provide subsidies in the same way without providing the supplemental benefits and cost-sharing protection required by (E).

(M) For a child receiving assistance through a subchapter XIX State plan who voluntarily chooses a subsidy, section 1396e-1 applies and overrides inconsistent provisions here.

(11) PERM. Despite (b), the enhanced FMAP for administering PERM requirements cannot be below 90 percent.

(12) COVID-19 vaccines. During the period in section 1396d(hh)(2), the enhanced FMAP is 100 percent for State-plan or waiver expenditures for a vaccine described in section 1396d(a)(4)(E), including its administration.

(d) Maintenance of effort.

(1) Medicaid eligibility standards. No payment is made if the State adopts income or resource standards or methods for children’s Medicaid eligibility that are more restrictive than those in effect June 1, 1997, except as section 1396a(e)(14) requires.

(2) State-funded children’s health insurance spending.

(A) Beginning in fiscal year 1999, reduce the State’s allotment by the amount, if any, by which its preceding-year children’s health insurance expenditures were below its fiscal-year-1996 expenditures.

(B) Those expenditures are: (i) the State share under this subchapter; (ii) the State share under subchapter XIX attributable to the enhanced FMAP under section 1396d(b)’s fourth sentence; and (iii) State spending for coverage under an existing comprehensive State program described in section 1397cc(d).

(3) Eligibility standards through September 30, 2029.

(A) From March 23, 2010, through September 30, 2029, as a condition of Medicaid payments under section 1396b(a), a State may not use child eligibility standards, methods, or procedures under its plan or waiver that are more restrictive than those in effect March 23, 2010. From October 1, 2019, through September 30, 2029, this protection applies only to children in families at or below 300 percent of the poverty line^* under section 1397jj(c)(5). The rule does not stop a State from using less restrictive rules; after September 30, 2015, enrolling eligible targeted low-income children in a Secretary-certified qualified health plan^*; or imposing a section 1397ll(b)(7) limit to keep plan spending within available Federal participation.

(B) If section 1397dd allotments cannot cover all eligible targeted low-income children, the State must screen them for Medicaid or waiver eligibility and enroll those found eligible. For those not eligible for Medicaid or its waiver, the State must ensure enrollment in a Secretary-certified qualified health plan offered through a State Exchange under section 18031. For premium-assistance eligibility under Internal Revenue Code section 36B and reduced cost-sharing under section 18071, those children are treated as ineligible for the State child health plan.

(C) By April 1, 2015, the Secretary must review each State’s Exchange qualified health plans for children’s benefits and cost-sharing and certify plans whose benefits and protections are at least comparable to the State child health plan.

(e) Advance payment; later adjustment. The Secretary may pay each quarter using the State’s advance expenditure estimates and any investigation the Secretary finds necessary. The Secretary may increase or reduce later payments to correct overpayments or underpayments for earlier quarters.

(f) Flexible claims. This section and section 1397dd(e) and (f) do not prevent a State from claiming in one quarter expenditures incurred in an earlier quarter.

(g) Qualifying States may use certain funds for Medicaid.

(1) State option.

(A) A qualifying State may elect to use up to 20 percent of an allotment for fiscal years 1998, 1999, 2000, 2001, 2004, 2005, 2006, 2007, or 2008, to the extent available under section 1397dd(e) and (g), for subchapter XIX payments instead of this subchapter’s expenditures. Paragraph (4) also applies.

(B) For a qualifying State making that election, the Secretary must pay each quarter, subject to available funds, the additional amount the State would have received under subchapter XIX for the expenditures in (ii) if the enhanced FMAP had replaced the ordinary FMAP. The expenditures are medical assistance after August 15, 2003, during the fund-availability period, for people under 19 whose family income exceeds 150 percent of poverty. If the State uses the payment for waiver expenditures, waiver budget-neutrality calculations ignore that payment.

(2) Qualifying State. This means a State that, on and after April 15, 1997, has an income-eligibility standard of at least 184 percent of poverty for one or more child categories other than infants eligible under section 1396a(a)(10)(A); or a specified State with a statewide section 1315 waiver first implemented August 1, 1994, July 1, 1995, January 1, 1994, or October 1, 1993, meeting the listed 185-percent standards. For the October 1, 1993, waiver, the State must also, on and after July 1, 1998, have at least a 185-percent standard under section 1396a(a)(10)(A) or such a waiver.

(3) Nothing in (1) or (2) changes requirements for State child health plans.

(4) For 2009 through 2029, a qualifying State may elect enhanced-rate payments from its allotment for expenditures after February 4, 2009, while funds remain available. The expenditures must provide Medicaid assistance to State residents under 19, or under 20 or 21 if the State elected that age, who qualify under a subchapter XIX plan or waiver and whose family income is at least 133 percent but no more than the Medicaid applicable income level^*. The payment equals the additional subchapter XIX amount that would result from substituting the enhanced FMAP for the ordinary FMAP.

(h) Rural health transformation program.

(1) Appropriation.

(A) The Treasury appropriates $10,000,000,000 for each fiscal year 2026, 2027, 2028, 2029, and 2030 to the CMS Administrator^* for State allotments for paragraph (6) activities.

(B) (i) Any amount still unspent or unobligated on October 1, 2032, must return to the Treasury. (ii) By March 31, 2028, and each year through March 31, 2032, the Administrator must identify prior-year funds that are unspent or unobligated, available under (A), and will not remain available to a State under (iii). (iii)(I) A State may spend an allotment through the end of the fiscal year after the allotment year. (II) Redistributed funds have the same period, except funds redistributed in 2032 are available only through September 30, 2032. (iv) If a State is not using funds consistently with its approved application, the Administrator may withhold or reduce payments or recover earlier payments. Withheld, reduced-remaining, or recovered amounts return to the Treasury.

(2) Application.

(A) To qualify, a State must apply during a period set by the Administrator ending no later than December 31, 2025. The application must include a detailed rural-health transformation plan to: (I) improve rural residents’ access to hospitals, providers, items, and services; (II) improve rural health outcomes; (III) prioritize emerging technology for prevention and chronic-disease management; (IV) build local and regional partnerships between rural hospitals and other providers for measurable quality improvement, financial stability, economies of scale, and shared best practices^*; (V) improve recruitment and training of clinicians; (VI) prioritize data- and technology-driven care as close to home as possible; (VII) address long-term financial solvency and rural-hospital operating models; and (VIII) identify causes of the increasing risk that standalone rural hospitals will close, convert, or reduce services. The application must also certify that these funds will not pay an expenditure attributable to an intergovernmental transfer, certified public expenditure, or other expenditure used to finance a required non-Federal share under any law, including this subchapter, subchapter XIX, or a waiver. It must include other information the Administrator requires.

(B) The Administrator must approve or deny every application by December 31, 2025.

(C) Approval is a one-time application. An approved State is eligible for allotments in every year 2026 through 2030, subject to (1)(B)(iv).

(D) Only the 50 States qualify. References to a State in this subsection mean only those 50 States.

(3) Allotments.

(A) For each year 2026 through 2030, the Administrator must determine each approved State’s allotment under (B).

(B) Of that year’s appropriation, 50 percent is divided equally among approved States. The other 50 percent is divided as the Administrator determines under (C).

(C) For the second half, the Administrator must ensure that at least one-quarter of approved States receive funds and must consider: (I) the percentage of the State’s population in a rural census tract of a metropolitan statistical area under the most recent Goldsmith Modification; (II) the State’s share of nationwide rural health facilities; (III) the State hospital situation described in section 1396a(a)(13)(A)(iv); and (IV) other appropriate factors.

(D) A “rural health facility” means: (i) a subsection (d) hospital that is in a rural area, treated as rural under section 1395ww(d)(8)(E), or in a rural census tract of a metropolitan statistical area under the Goldsmith Modification; (ii) a critical access hospital; (iii) a sole community hospital; (iv) a Medicare-dependent small rural hospital; (v) a low-volume hospital; (vi) a rural emergency hospital; (vii) a rural health clinic; (viii) a federally qualified health center; (ix) a community mental health center; (x) a health center receiving a section 254b grant; (xi) an opioid treatment^* program in a rural census tract of a metropolitan statistical area; or (xii) a certified community behavioral health clinic in such a tract. Each term has the definition in the cited provision.

(4) No matching payment. An approved State need not provide matching funds to receive an allotment.

(5) Terms and conditions. The Administrator may set appropriate terms, including: (A) requiring each State, at the specified time and in the specified form, to submit a plan using its allotment for at least three paragraph (6) activities and annual reports with additional required information; and (B) limiting administrative expenses to 10 percent of the State’s yearly allotment.

(6) Use of funds. A State must use its allotment for at least three of these activities: (A) measurable, evidence-based prevention and chronic-disease interventions; (B) provider payments for items or services the Administrator specifies; (C) consumer-facing technology for prevention and chronic-disease management; (D) training and technical help for technology-enabled rural-hospital care, including remote monitoring, robotics, artificial intelligence, and other advanced technology; (E) recruiting and keeping clinicians in rural areas with commitments to serve at least five years; (F) technical help, software, and hardware for major information-technology improvements, cybersecurity, efficiency, and patient outcomes; (G) helping communities right-size delivery systems by identifying needed preventive, ambulatory, pre-hospital, emergency, acute inpatient, outpatient, and post-acute services; (H) access to opioid-use-disorder, other substance-use-disorder, and mental-health services; (I) innovative care models, including value-based and alternative payment arrangements when appropriate; and (J) other uses the Administrator determines will promote sustainable access to high-quality rural health care.

(7) Paragraphs (2), (3), (5), (6), (8), (10), (11), and (12) of subsection (c) do not apply to payments under this subsection.

(8) No administrative or judicial review is available under section 1316 or otherwise for allotments or redistributions, withheld or reduced payments, or recovered payments under this subsection.

(9) For this subsection, “health care provider” means a provider or supplier enrolled under this subchapter, subchapter XVIII, or subchapter XIX.