STRATEGIC OBJECTIVES AND PERFORMANCE GOALS; PLAN ADMINISTRATION

Sec. 2107. [42 U.S.C. 1397gg] (a) Strategic Objectives and Performance Goals.—

(1) Description.—A State child health plan shall include a description of—

(A) the strategic objectives,

(B) the performance goals, and

(C) the performance measures, the State has established for providing child health assistance to targeted low-income children under the plan and otherwise for maximizing health benefits coverage for other low-income children and children generally in the State.

(2) Strategic objectives.—Such plan shall identify specific strategic objectives relating to increasing the extent of creditable health coverage among targeted low-income children and other low-income children.

(3) Performance goals.—Such plan shall specify one or more performance goals for each such strategic objective so identified.

(4) Performance measures.—Such plan shall describe how performance under the plan will be—

(A) measured through objective, independently verifiable means, and

(B) compared against performance goals, in order to determine the State’s performance under this title.

(b) Records, Reports, Audits, and Evaluation.—

(1) Data collection, records, and reports.—A State child health plan shall include an assurance that the State will collect the data, maintain the records, and furnish the reports to the Secretary, at the times and in the standardized format the Secretary may require in order to enable the Secretary to monitor State program administration and compliance and to evaluate and compare the effectiveness of State plans under this title.

(2) State assessment and study.—A State child health plan shall include a description of the State’s plan for the annual assessments and reports under section 2108(a)and the evaluation required by section 2108(b).

(3) Audits.—A State child health plan shall include an assurance that the State will afford the Secretary access to any records or information relating to the plan for the purposes of review or audit.

(c) Program Development Process.—A State child health plan shall include a description of the process used to involve the public in the design and implementation of the plan and the method for ensuring ongoing public involvement.

(d) Program Budget.—A State child health plan shall include a description of the budget for the plan. The description shall be updated periodically as necessary and shall include details on the planned use of funds and the sources of the non-Federal share of plan expenditures, including any requirements for cost-sharing by beneficiaries.

(e) Application of Certain General Provisions.—The following sections of this Act shall apply to States under this title in the same manner as they apply to a State under title XIX:

(1)[57] Title xix provisions.—

(A) Section 1902(a)(4)(C) (relating to conflict of interest standards).

(B)[58] Section 1902(a)(25) (relating to third party liability).

(D) Section 1902(a)(78) (relating to enrollment of providers participating in State plans providing medical assistance on a fee-for-service basis).”;

(E) Section 1902(a)(72) (relating to limiting FQHC contracting for provision of dental services).

(F) Section 1902(a)(73) (relating to requiring certain States to seek advice from designees of Indian Health Programs and Urban Indian Organizations).

(G) Subsections (a)(77) and (kk) of section 1902 (relating to provider and supplier screening, oversight, and reporting requirements).

(H) Section 1902(e)(13) (relating to the State option to rely on findings from an Express Lane agency to help evaluate a child’s eligibility for medical assistance).

(I) Section 1902(e)(14) (relating to income determined using modified adjusted gross income and household income).

(J)[59] Section 1902(bb) (relating to payment for services provided by Federally-qualified health centers and rural health clinics).

(K) Section 1902(ff) (relating to disregard of certain property for purposes of making eligibility of determinations).

(L) Paragraphs (2), (16), and (17) of section 1903(i) (relating to limitations on payment).

(M) Section 1903(m)(3) (relating to limitation on payment with respect to managed care).”; and

(N) Paragraph (4) of section 1903(v) (relating to optional coverage of categories of lawfully residing immigrant children or pregnant women), but only if the State has elected to apply such paragraph with respect to such category of children or pregnant women under title XIX.

(O) Section 1903(w) (relating to limitations on provider taxes and donations).

(P) Section 1920A (relating to presumptive eligibility for children).

(Q) Subsections (a)(2)(C) (relating to Indian enrollment), (d)(5) (relating to contract requirement for managed care entities), (d)(6) (relating to enrollment of providers participating with a managed care entity), and (h) (relating to special rules with respect to Indian enrollees, Indian health care providers, and Indian managed care entities) of section 1932.

(R) Section 1942 (relating to authorization to receive data directly relevant to eligibility determinations).

(S)[60] Section 1943(b) (relating to coordination with State Exchanges and the State Medicaid agency).

(2) Title xi provisions.—

(A) Section 1115 (relating to waiver authority).

(B) Section 1116 (relating to administrative and judicial review), but only insofar as consistent with this title.

(D) Section 1126 (relating to disclosure of information about certain convicted individuals).

(E) Section 1128A (relating to civil monetary penalties).

(F) Section 1128B(d) (relating to criminal penalties for certain additional charges).

(G) Section 1132 (relating to periods within which claims must be filed).

(f) Limitation Of Waiver Authority.—Notwithstanding subsection (e)(2)(A) and section 1115(a):

(1) The Secretary may not approve a waiver, experimental, pilot, or demonstration project that would allow funds made available under this title to be used to provide child health assistance or other health benefits coverage to a nonpregnant childless adult or a parent (as defined in section 2111(c)(2)(A)), who is not pregnant, of a targeted low-income child.

(2) The Secretary may not approve, extend, renew, or amend a waiver, experimental, pilot, or demonstration project with respect to a State after the date of enactment of the Children’s Health Insurance Program Reauthorization Act of 2009^[61] that would waive or modify the requirements of section 2111.

(g)Use of Blended Risk Pools.—

(1) In general.—Nothing in this title (or any other provision of Federal law) shall be construed as preventing a State from considering children enrolled in a qualified CHIP look-alike program and children enrolled in a State child health plan under this title (or a waiver of such plan) as members of a single risk pool.

(2) Qualified chip look-alike program.—In this subsection, the term “qualified CHIP look-alike program” means a State program—

(A) under which children who are under the age of 19 and are not eligible to receive medical assistance under title XIX or child health assistance under this title may purchase coverage through the State that provides benefits that are at least identical to the benefits provided under the State child health plan under this title (or a waiver of such plan); and

(B) that is funded exclusively through non-Federal funds, including funds received by the State in the form of premiums for the purchase of such coverage.^[62]

^[57] P.L. 111–148, §2101(d)(2), redesignated subparagraphs (E) through (L) as subparagraphs (F) through (M), respectively, and inserted new subparagraph (E), which read “(E) Section 1902(e)(14) (relating to income determined using modified gross income and household income).”.

P.L.114-255, in §5005(c)(1), (A) redesignated subparagraphs (B), (C), (D), (E), (F), (G), (H), (I), (J), (K), (L), (M), (N), and (O) as subparagraphs (D), (E), (F), (G), (H), (I), (J), (K), (M), (N), (O), (P), (Q), and (R), respectively; (B) inserted new subparagraphs (B) and (C); inserted new subparagraph (L); (D) in subparagraph (P) struck “(a)(2)(C) and (h)” and inserted “(a)(2)(C) (relating to Indian enrollment), (d)(5) (relating to contract requirement for managed care entities), (d)(6) (relating to enrollment of providers participating with a managed care entity), and (h) (relating to special rules with respect to Indian enrollees, Indian health care providers, and Indian managed care entities)”. Effective December 13, 2016.

^[58] P.L. 115–123, §53102(d)(1), redesignated subparagraphs (B) through (R) as subparagraphs (C) through (S); inserted new subparagraph (B). Effective February 9, 2018.

^[59] See Vol. II, P.L. 111-3, §503(b), with respect to certain transition grants.

^[60] P.L. 111–148, §2101(e), inserted subparagraph (S) as subparagraph (N) originally. Effective March 23, 2010.

^[61] February 4, 2009 [P.L. 111-3; 123 Stat. 8].

^[62] P.L. 115–120, §3002(g)(1)(2)(A—B) Added subsection g. Effective January 22, 2018.

Compilation of the Social Security Laws

STRATEGIC OBJECTIVES AND PERFORMANCE GOALS; PLAN ADMINISTRATION