H. R. 2015—313
the purchase, in whole or in part, of health benefit coverage
that includes coverage of abortion.
‘‘(B) EXCEPTION.—Subparagraph (A) shall not apply
to an 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.
‘‘(C) RULE OF CONSTRUCTION.—Nothing in this section
shall be construed as affecting the expenditure by a State,
locality, or private person or entity of State, local, or private
funds (other than funds expended under the State plan)
for any abortion or for health benefits coverage that
includes coverage of abortion.
‘‘(d) MAINTENANCE OF EFFORT.—
‘‘(1) IN MEDICAID ELIGIBILITY STANDARDS.—No payment may
be made under subsection (a) with respect to child health
assistance provided under a State child health plan if the
State adopts income and resource standards and methodologies
for purposes of determining a child’s eligibility for medical
assistance under the State plan under title XIX that are more
restrictive than those applied as of June 1, 1997.
‘‘(2) IN
AMOUNTS
OF
PAYMENT
EXPENDED
FOR
CERTAIN
STATE-FUNDED HEALTH INSURANCE PROGRAMS FOR CHILDREN.—
‘‘(A) IN GENERAL.—The amount of the allotment for
a State in a fiscal year (beginning with fiscal year 1999)
shall be reduced by the amount by which—
‘‘(i) the total of the State children’s health insur-
ance expenditures in the preceding fiscal year, is less
than
‘‘(ii) the total of such expenditures in fiscal year
1996.
‘‘(B) STATE CHILDREN’S HEALTH INSURANCE EXPENDI-
TURES.—The term ‘State children’s health insurance
expenditures’ means the following:
‘‘(i) The State share of expenditures under this
title.
‘‘(ii) The State share of expenditures under title
XIX that are attributable to an enhanced FMAP under
section 1905(u).
‘‘(iii) State expenditures under health benefits cov-
erage under an existing comprehensive State-based
program, described section 2103(d).
‘‘(e) ADVANCE PAYMENT; RETROSPECTIVE ADJUSTMENT.—The
Secretary may make payments under this section for each quarter
on the basis of advance estimates of expenditures submitted by
the State and such other investigation as the Secretary may find
necessary, and may reduce or increase the payments as necessary
to adjust for any overpayment or underpayment for prior quarters.
‘‘SEC. 2106. PROCESS FOR SUBMISSION, APPROVAL, AND AMENDMENT
OF STATE CHILD HEALTH PLANS.
‘‘(a) INITIAL PLAN.—
‘‘(1) IN
GENERAL.—As a condition of receiving payment
under section 2105, a State shall submit to the Secretary a
State child health plan that meets the applicable requirements
of this title.
‘‘(2) APPROVAL.—Except as the Secretary may provide under
subsection (e), a State plan submitted under paragraph (1)—
H. R. 2015—314
‘‘(A) shall be approved for purposes of this title, and
‘‘(B) shall be effective beginning with a calendar quar-
ter that is specified in the plan, but in no case earlier
than October 1, 1997.
‘‘(b) PLAN AMENDMENTS.—
‘‘(1) IN
GENERAL.—A State may amend, in whole or in
part, its State child health plan at any time through transmittal
of a plan amendment.
‘‘(2) APPROVAL.—Except as the Secretary may provide under
subsection (e), an amendment to a State plan submitted under
paragraph (1)—
‘‘(A) shall be approved for purposes of this title, and
‘‘(B) shall be effective as provided in paragraph (3).
‘‘(3) EFFECTIVE DATES FOR AMENDMENTS.—
‘‘(A) IN GENERAL.—Subject to the succeeding provisions
of this paragraph, an amendment to a State plan shall
take effect on one or more effective dates specified in the
amendment.
‘‘(B) AMENDMENTS RELATING TO ELIGIBILITY OR BENE-
FITS.—
‘‘(i) NOTICE REQUIREMENT.—Any plan amendment
that eliminates or restricts eligibility or benefits under
the plan may not take effect unless the State certifies
that it has provided prior public notice of the change,
in a form and manner provided under applicable State
law.
‘‘(ii) TIMELY TRANSMITTAL.—Any plan amendment
that eliminates or restricts eligibility or benefits under
the plan shall not be effective for longer than a 60-
day period unless the amendment has been transmitted
to the Secretary before the end of such period.
‘‘(C) OTHER AMENDMENTS.—Any plan amendment that
is not described in subparagraph (B) and that becomes
effective in a State fiscal year may not remain in effect
after the end of such fiscal year (or, if later, the end
of the 90-day period on which it becomes effective) unless
the amendment has been transmitted to the Secretary.
‘‘(c) DISAPPROVAL OF PLANS AND PLAN AMENDMENTS.—
‘‘(1) PROMPT REVIEW OF PLAN SUBMITTALS.—The Secretary
shall promptly review State plans and plan amendments
submitted under this section to determine if they substantially
comply with the requirements of this title.
‘‘(2) 90-DAY APPROVAL DEADLINES.—A State plan or plan
amendment is considered approved unless the Secretary notifies
the State in writing, within 90 days after receipt of the plan
or amendment, that the plan or amendment is disapproved
(and the reasons for disapproval) or that specified additional
information is needed.
‘‘(3) CORRECTION.—In the case of a disapproval of a plan
or plan amendment, the Secretary shall provide a State with
a reasonable opportunity for correction before taking financial
sanctions against the State on the basis of such disapproval.
‘‘(d) PROGRAM OPERATION.—
‘‘(1) IN GENERAL.—The State shall conduct the program
in accordance with the plan (and any amendments) approved
under subsection (c) and with the requirements of this title.
H. R. 2015—315
‘‘(2) VIOLATIONS.—The Secretary shall establish a process
for enforcing requirements under this title. Such process shall
provide for the withholding of funds in the case of substantial
noncompliance with such requirements. In the case of an
enforcement action against a State under this paragraph, the
Secretary shall provide a State with a reasonable opportunity
for correction before taking financial sanctions against the State
on the basis of such an action.
‘‘(e) CONTINUED APPROVAL.—An approved State child health
plan shall continue in effect unless and until the State amends
the plan under subsection (b) or the Secretary finds, under sub-
section (d), substantial noncompliance of the plan with the require-
ments of this title.
‘‘SEC. 2107. STRATEGIC OBJECTIVES AND PERFORMANCE GOALS; PLAN
ADMINISTRATION.
‘‘(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 spe-
cific 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 verifi-
able 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 Sec-
retary 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.
H. R. 2015—316
‘‘(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 fol-
lowing 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) TITLE XIX PROVISIONS.—
‘‘(A) Section 1902(a)(4)(C) (relating to conflict of
interest standards).
‘‘(B) Paragraphs (2), (16), and (17) of section 1903(i)
(relating to limitations on payment).
‘‘(C) Section 1903(w) (relating to limitations on provider
taxes and donations).
‘‘(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.
‘‘(C) Section 1124 (relating to disclosure of ownership
and related information).
‘‘(D) Section 1126 (relating to disclosure of information
about certain convicted individuals).
‘‘(E) Section 1128A (relating to civil monetary pen-
alties).
‘‘(F) Section 1128B(d) (relating to criminal penalties
for certain additional charges).
‘‘(G) Section 1132 (relating to periods within which
claims must be filed).
‘‘SEC. 2108. ANNUAL REPORTS; EVALUATIONS.
‘‘(a) ANNUAL REPORT.—The State shall—
‘‘(1) assess the operation of the State plan under this title
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,