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U.S. Code as of:
01/19/04
Section 1397hh. Annual reports; evaluations
(a) Annual report
The State shall -
(1) assess the operation of the State plan under this
subchapter in each fiscal year, including the progress made in
reducing the number of uncovered low-income children; and
(2) report to the Secretary, by January 1 following the end of
the fiscal year, on the result of the assessment.
(b) State evaluations
(1) In general
By March 31, 2000, each State that has a State child health
plan shall submit to the Secretary an evaluation that includes
each of the following:
(A) An assessment of the effectiveness of the State plan in
increasing the number of children with creditable health
coverage.
(B) A description and analysis of the effectiveness of
elements of the State plan, including -
(i) the characteristics of the children and families
assisted under the State plan including age of the children,
family income, and the assisted child's access to or coverage
by other health insurance prior to the State plan and after
eligibility for the State plan ends,
(ii) the quality of health coverage provided including the
types of benefits provided,
(iii) the amount and level (including payment of part or
all of any premium) of assistance provided by the State,
(iv) the service area of the State plan,
(v) the time limits for coverage of a child under the State
plan,
(vi) the State's choice of health benefits coverage and
other methods used for providing child health assistance, and
(vii) the sources of non-Federal funding used in the State
plan.
(C) An assessment of the effectiveness of other public and
private programs in the State in increasing the availability of
affordable quality individual and family health insurance for
children.
(D) A review and assessment of State activities to coordinate
the plan under this subchapter with other public and private
programs providing health care and health care financing,
including medicaid and maternal and child health services.
(E) An analysis of changes and trends in the State that
affect the provision of accessible, affordable, quality health
insurance and health care to children.
(F) A description of any plans the State has for improving
the availability of health insurance and health care for
children.
(G) Recommendations for improving the program under this
subchapter.
(H) Any other matters the State and the Secretary consider
appropriate.
(2) Report of the Secretary
The Secretary shall submit to Congress and make available to
the public by December 31, 2001, a report based on the
evaluations submitted by States under paragraph (1), containing
any conclusions and recommendations the Secretary considers
appropriate.
(c) Federal evaluation
(1) In general
The Secretary, directly or through contracts or interagency
agreements, shall conduct an independent evaluation of 10 States
with approved child health plans.
(2) Selection of States
In selecting States for the evaluation conducted under this
subsection, the Secretary shall choose 10 States that utilize
diverse approaches to providing child health assistance,
represent various geographic areas (including a mix of rural and
urban areas), and contain a significant portion of uncovered
children.
(3) Matters included
In addition to the elements described in subsection (b)(1) of
this section, the evaluation conducted under this subsection
shall include each of the following:
(A) Surveys of the target population (enrollees,
disenrollees, and individuals eligible for but not enrolled in
the program under this subchapter).
(B) Evaluation of effective and ineffective outreach and
enrollment practices with respect to children (for both the
program under this subchapter and the medicaid program under
subchapter XIX of this chapter), and identification of
enrollment barriers and key elements of effective outreach and
enrollment practices, including practices that have
successfully enrolled hard-to-reach populations such as
children who are eligible for medical assistance under
subchapter XIX of this chapter but have not been enrolled
previously in the medicaid program under that subchapter.
(C) Evaluation of the extent to which State medicaid
eligibility practices and procedures under the medicaid program
under subchapter XIX of this chapter are a barrier to the
enrollment of children under that program, and the extent to
which coordination (or lack of coordination) between that
program and the program under this subchapter affects the
enrollment of children under both programs.
(D) An assessment of the effect of cost-sharing on
utilization, enrollment, and coverage retention.
(E) Evaluation of disenrollment or other retention issues,
such as switching to private coverage, failure to pay premiums,
or barriers in the recertification process.
(4) Submission to Congress
Not later than December 31, 2001, the Secretary shall submit to
Congress the results of the evaluation conducted under this
subsection.
(5) Funding
Out of any money in the Treasury of the United States not
otherwise appropriated, there are appropriated $10,000,000 for
fiscal year 2000 for the purpose of conducting the evaluation
authorized under this subsection. Amounts appropriated under this
paragraph shall remain available for expenditure through fiscal
year 2002.
(d) Inspector General audit and GAO report
(1) Audit
Beginning with fiscal year 2000, and every third fiscal year
thereafter, the Secretary, through the Inspector General of the
Department of Health and Human Services, shall audit a sample
from among the States described in paragraph (2) in order to -
(A) determine the number, if any, of enrollees under the plan
under this subchapter who are eligible for medical assistance
under subchapter XIX of this chapter (other than as optional
targeted low-income children under section
1396a(a)(10)(A)(ii)(XIV) of this title); and
(B) assess the progress made in reducing the number of
uncovered low-income children, including the progress made to
achieve the strategic objectives and performance goals included
in the State child health plan under section 1397gg(a) of this
title.
(2) State described
A State described in this paragraph is a State with an approved
State child health plan under this subchapter that does not, as
part of such plan, provide health benefits coverage under the
State's medicaid program under subchapter XIX of this chapter.
(3) Monitoring and report from GAO
The Comptroller General of the United States shall monitor the
audits conducted under this subsection and, not later than March
1 of each fiscal year after a fiscal year in which an audit is
conducted under this subsection, shall submit a report to
Congress on the results of the audit conducted during the prior
fiscal year.
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