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U.S. Code as of:
01/19/04
Section 1397bb. General contents of State child health plan; eligibility; outreach
(a) General background and description
A State child health plan shall include a description, consistent
with the requirements of this subchapter, of -
(1) the extent to which, and manner in which, children in the
State, including targeted low-income children and other classes
of children classified by income and other relevant factors,
currently have creditable health coverage (as defined in section
1397jj(c)(2) of this title);
(2) current State efforts to provide or obtain creditable
health coverage for uncovered children, including the steps the
State is taking to identify and enroll all uncovered children who
are eligible to participate in public health insurance programs
and health insurance programs that involve public-private
partnerships;
(3) how the plan is designed to be coordinated with such
efforts to increase coverage of children under creditable health
coverage;
(4) the child health assistance provided under the plan for
targeted low-income children, including the proposed methods of
delivery, and utilization control systems;
(5) eligibility standards consistent with subsection (b) of
this section;
(6) outreach activities consistent with subsection (c) of this
section; and
(7) methods (including monitoring) used -
(A) to assure the quality and appropriateness of care,
particularly with respect to well-baby care, well-child care,
and immunizations provided under the plan, and
(B) to assure access to covered services, including emergency
services.
(b) General description of eligibility standards and methodology
(1) Eligibility standards
(A) In general
The plan shall include a description of the standards used to
determine the eligibility of targeted low-income children for
child health assistance under the plan. Such standards may
include (to the extent consistent with this subchapter) those
relating to the geographic areas to be served by the plan, age,
income and resources (including any standards relating to
spenddowns and disposition of resources), residency, disability
status (so long as any standard relating to such status does
not restrict eligibility), access to or coverage under other
health coverage, and duration of eligibility. Such standards
may not discriminate on the basis of diagnosis.
(B) Limitations on eligibility standards
Such eligibility standards -
(i) shall, within any defined group of covered targeted
low-income children, not cover such children with higher
family income without covering children with a lower family
income, and
(ii) may not deny eligibility based on a child having a
preexisting medical condition.
(2) Methodology
The plan shall include a description of methods of establishing
and continuing eligibility and enrollment.
(3) Eligibility screening; coordination with other health
coverage programs
The plan shall include a description of procedures to be used
to ensure -
(A) through both intake and followup screening, that only
targeted low-income children are furnished child health
assistance under the State child health plan;
(B) that children found through the screening to be eligible
for medical assistance under the State medicaid plan under
subchapter XIX of this chapter are enrolled for such assistance
under such plan;
(C) that the insurance provided under the State child health
plan does not substitute for coverage under group health plans;
(D) the provision of child health assistance to targeted
low-income children in the State who are Indians (as defined in
section 1603(c) of title 25); and
(E) coordination with other public and private programs
providing creditable coverage for low-income children.
(4) Nonentitlement
Nothing in this subchapter shall be construed as providing an
individual with an entitlement to child health assistance under a
State child health plan.
(c) Outreach and coordination
A State child health plan shall include a description of the
procedures to be used by the State to accomplish the following:
(1) Outreach
Outreach to families of children likely to be eligible for
child health assistance under the plan or under other public or
private health coverage programs to inform these families of the
availability of, and to assist them in enrolling their children
in, such a program.
(2) Coordination with other health insurance programs
Coordination of the administration of the State program under
this subchapter with other public and private health insurance
programs.
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