
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document affected by Public Law 106-554 Section 1(a)(6)]
[CITE: 42USC1397jj]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XXI--STATE CHILDREN'S HEALTH INSURANCE PROGRAM
 
Sec. 1397jj. Definitions


(a) Child health assistance

    For purposes of this subchapter, the term ``child health 
assistance'' means payment for part or all of the cost of health 
benefits coverage for targeted low-income children that includes any of 
the following (and includes, in the case described in section 
1397ee(a)(2)(A) of this title, payment for part or all of the cost of 
providing any of the following), as specified under the State plan:
        (1) Inpatient hospital services.
        (2) Outpatient hospital services.
        (3) Physician services.
        (4) Surgical services.
        (5) Clinic services (including health center services) and other 
    ambulatory health care services.
        (6) Prescription drugs and biologicals and the administration of 
    such drugs and biologicals, only if such drugs and biologicals are 
    not furnished for the purpose of causing, or assisting in causing, 
    the death, suicide, euthanasia, or mercy killing of a person.
        (7) Over-the-counter medications.
        (8) Laboratory and radiological services.
        (9) Prenatal care and prepregnancy family planning services and 
    supplies.
        (10) Inpatient mental health services, other than services 
    described in paragraph (18) but including services furnished in a 
    State-operated mental hospital and including residential or other 
    24-hour therapeutically planned structured services.
        (11) Outpatient mental health services, other than services 
    described in paragraph (19) but including services furnished in a 
    State-operated mental hospital and including community-based 
    services.
        (12) Durable medical equipment and other medically-related or 
    remedial devices (such as prosthetic devices, implants, eyeglasses, 
    hearing aids, dental devices, and adaptive devices).
        (13) Disposable medical supplies.
        (14) Home and community-based health care services and related 
    supportive services (such as home health nursing services, home 
    health aide services, personal care, assistance with activities of 
    daily living, chore services, day care services, respite care 
    services, training for family members, and minor modifications to 
    the home).
        (15) Nursing care services (such as nurse practitioner services, 
    nurse midwife services, advanced practice nurse services, private 
    duty nursing care, pediatric nurse services, and respiratory care 
    services) in a home, school, or other setting.
        (16) Abortion only if necessary to save the life of the mother 
    or if the pregnancy is the result of an act of rape or incest.
        (17) Dental services.
        (18) Inpatient substance abuse treatment services and 
    residential substance abuse treatment services.
        (19) Outpatient substance abuse treatment services.
        (20) Case management services.
        (21) Care coordination services.
        (22) Physical therapy, occupational therapy, and services for 
    individuals with speech, hearing, and language disorders.
        (23) Hospice care.
        (24) Any other medical, diagnostic, screening, preventive, 
    restorative, remedial, therapeutic, or rehabilitative services 
    (whether in a facility, home, school, or other setting) if 
    recognized by State law and only if the service is--
            (A) prescribed by or furnished by a physician or other 
        licensed or registered practitioner within the scope of practice 
        as defined by State law,
            (B) performed under the general supervision or at the 
        direction of a physician, or
            (C) furnished by a health care facility that is operated by 
        a State or local government or is licensed under State law and 
        operating within the scope of the license.

        (25) Premiums for private health care insurance coverage.
        (26) Medical transportation.
        (27) Enabling services (such as transportation, translation, and 
    outreach services) only if designed to increase the accessibility of 
    primary and preventive health care services for eligible low-income 
    individuals.
        (28) Any other health care services or items specified by the 
    Secretary and not excluded under this section.

(b) ``Targeted low-income child'' defined

    For purposes of this subchapter--

                           (1) In general

        Subject to paragraph (2), the term ``targeted low-income child'' 
    means a child--
            (A) who has been determined eligible by the State for child 
        health assistance under the State plan;
            (B)(i) who is a low-income child, or
            (ii) is a child--
                (I) whose family income (as determined under the State 
            child health plan) exceeds the medicaid applicable income 
            level (as defined in paragraph (4)), but does not exceed 50 
            percentage points above the medicaid applicable income 
            level;
                (II) whose family income (as so determined) does not 
            exceed the medicaid applicable income level (as defined in 
            paragraph (4) but determined as if ``June 1, 1997'' were 
            substituted for ``March 31, 1997''); or
                (III) who resides in a State that does not have a 
            medicaid applicable income level (as defined in paragraph 
            (4)); and

            (C) who is not found to be eligible for medical assistance 
        under subchapter XIX of this chapter or covered under a group 
        health plan or under health insurance coverage (as such terms 
        are defined in section 300gg-91 of this title).

                        (2) Children excluded

        Such term does not include--
            (A) a child who is an inmate of a public institution or a 
        patient in an institution for mental diseases; or
            (B) a child who is a member of a family that is eligible for 
        health benefits coverage under a State health benefits plan on 
        the basis of a family member's employment with a public agency 
        in the State.

                          (3) Special rule

        A child shall not be considered to be described in paragraph 
    (1)(C) notwithstanding that the child is covered under a health 
    insurance coverage program that has been in operation since before 
    July 1, 1997, and that is offered by a State which receives no 
    Federal funds for the program's operation.

                (4) Medicaid applicable income level

        The term ``medicaid applicable income level'' means, with 
    respect to a child, the effective income level (expressed as a 
    percent of the poverty line) that has been specified under the State 
    plan under subchapter XIX of this chapter (including under a waiver 
    authorized by the Secretary or under section 1396a(r)(2) of this 
    title), as of March 31, 1997, for the child to be eligible for 
    medical assistance under section 1396a(l)(2) or 1396d(n)(2) of this 
    title (as selected by a State) for the age of such child.

(c) Additional definitions

    For purposes of this subchapter:

                              (1) Child

        The term ``child'' means an individual under 19 years of age.

                   (2) Creditable health coverage

        The term ``creditable health coverage'' has the meaning given 
    the term ``creditable coverage'' under section 300gg(c) of this 
    title and includes coverage that meets the requirements of section 
    1397cc of this title provided to a targeted low-income child under 
    this subchapter or under a waiver approved under section 
    1397ee(c)(2)(B) of this title (relating to a direct service waiver).

       (3) Group health plan; health insurance coverage; etc.

        The terms ``group health plan'', ``group health insurance 
    coverage'', and ``health insurance coverage'' have the meanings 
    given such terms in section 300gg-91 of this title.

                        (4) Low-income child

        The term ``low-income child'' means a child whose family income 
    is at or below 200 percent of the poverty line for a family of the 
    size involved.

                      (5) Poverty line defined

        The term ``poverty line'' has the meaning given such term in 
    section 9902(2) of this title, including any revision required by 
    such section.

                 (6) Preexisting condition exclusion

        The term ``preexisting condition exclusion'' has the meaning 
    given such term in section 300gg(b)(1)(A) of this title.

                  (7) State child health plan; plan

        Unless the context otherwise requires, the terms ``State child 
    health plan'' and ``plan'' mean a State child health plan approved 
    under section 1397ff of this title.

                         (8) Uncovered child

        The term ``uncovered child'' means a child that does not have 
    creditable health coverage.

(Aug. 14, 1935, ch. 531, title XXI, Sec. 2110, as added Pub. L. 105-33, 
title IV, Sec. 4901(a), Aug. 5, 1997, 111 Stat. 567; amended Pub. L. 
105-100, title I, Sec. 162(3), (9), Nov. 19, 1997, 111 Stat. 2189, 
2190.)


                               Amendments

    1997--Subsec. (b)(1)(B)(ii). Pub. L. 105-100, Sec. 162(3)(A), 
amended cl. (ii) generally. Prior to amendment, cl. (ii) read as 
follows: ``is a child whose family income (as determined under the State 
child health plan) exceeds the medicaid applicable income level (as 
defined in paragraph (4)), but does not exceed 50 percentage points 
above the medicaid applicable income level; and''.
    Subsec. (b)(4). Pub. L. 105-100, Sec. 162(3)(B), substituted ``March 
31, 1997'' for ``June 1, 1997'' and ``1396a(l)(2) or 1396d(n)(2) of this 
title (as selected by a State)'' for ``1396a(l)(2) of this title''.
    Subsec. (c)(3). Pub. L. 105-100, Sec. 162(9), made technical 
amendment to reference in original act which appears in text as 
reference to section 300gg-91 of this title.


                    Effective Date of 1997 Amendment

    Section 162 of Pub. L. 105-100 provided in part that the amendment 
made by that section is effective as if included in the enactment of 
subtitle J (Secs. 4901-4923) of title IV of the Balanced Budget Act of 
1997, Pub. L. 105-33.

                  Section Referred to in Other Sections

    This section is referred to in sections 1396d, 1397bb of this title.
