
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC1397bb]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XXI--STATE CHILDREN'S HEALTH INSURANCE PROGRAM
 
Sec. 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.

(Aug. 14, 1935, ch. 531, title XXI, Sec. 2102, as added Pub. L. 105-33, 
title IV, Sec. 4901(a), Aug. 5, 1997, 111 Stat. 552.)

                  Section Referred to in Other Sections

    This section is referred to in section 1397ee of this title.
