These are comments on the final regulations implementing Title XXI of the Social Security Act. Title XXI authorizes a new State Children's Health Insurance Program (SCHIP).
The proposed rules were published on November 8, 1999 at 64 Fed. Reg. 60882 and the final rules were published on January 11, 2001 at 66 Fed. Reg. 2490. Interim final rules were published on June 25, 2001 at 66 Fed. Reg. 33810. In this memoranda, we comment on changes to the proposed rules that were made by the final rule, and changes to the final rule that were made by the interim final rule.
Part 431 – State Organization and General Administration
The final version of this part adds a new Section 431.636. This section, entitled "Coordination of the Medicaid with the State Children's Health Insurance Program (SCHIP)," provides the statutory basis for the section and describes the obligations of the State Medicaid agency (SMA). It requires the SMA to facilitate the Medicaid application process and enrollment of children. The SMA must ensure that applicants are not required to submit duplicate documentation to the SMA if it has already been submitted as part of a SCHIP application. It must also ensure that eligibility is determined in a timely manner. The SMA is required to promptly notify the agency responsible for determining eligibility under the SCHIP program when a child is determined eligible or ineligible for Medicaid and must adopt a process that facilitates enrollment in the SCHIP program when a child is determined ineligible for Medicaid.
Section 431.865 describes disallowance of Federal financial participation for erroneous State payments for annual assessment periods ending after July 1, 1990. The proposed rule excludes payments made for care and services covered under the state plan and furnished to children during a presumptive eligibility period. The final version contains no substantive changes and sets forth the entire rule including the addition included in the proposed rule.
Part 433 – State Fiscal Administration
The Proposed Rule amended the currently published version of Section 433.10 and added a new Section 433.11.
Section 433.10 deals with rates of FFP for program services. The proposed rule added a new subsection (c)(4) clarifying the special provisions for calculating FMAP described in the new Section 433.11. The final version of the rule is identical to the proposed rule.
Section 433.11 describes the enhanced FMAP rate for children. The final version is essentially the same as the proposed version of the rule.
Part 435 – Eligibility in the States, District of Columbia, The Northern Mariana Islands and American Samoa
Section 435.4 – Definitions and use of terms
This section contains definitions and use of terms. The final version of this section includes a definition of optional targeted low income children. The definition itself is extensive, defining children in terms of age, income level, lack of insurance coverage. The substance of this definition is essentially the same as the definition contained in proposed Section 457.310.
Section 435.229 – Optional targeted low-income children
The proposed version of the rule had added a new section 435.229 that briefly defined optional targeted low income children. The final version includes this section, which now simply provides that Medicaid may be provided to optional targeted low income children under age 19, or to reasonable categories of those children.
Section 435.910 – Use of social security number
Proposed section 435.910 had added a subsection (h) containing an exception that allowed the state to use a Medicaid identification number to a person who refused to obtain a Social Security Number because of "well-established religious objections." The final version has not been changed substantively, but has been reworded slightly, presumably for greater clarity.
Section 435.1001 – FFP for administration
This section contains provisions regarding FFP for administration and the final version is identical to the proposed version.
Section 435.1002 – FFP for service
This section contains provisions regarding FFP for services and the final version is identical to the proposed version.
Section 435.1007
This section contains an amendment adding an additional statutory reference to the rule, and the final version is identical to the proposed version.
Subpart L – Option for Coverage of Special Groups
Section 435.1100
This section provides the basis and scope for coverage for special groups and the final version is identical to the proposed version.
Section 435.1101 – Definitions related to presumptive eligibility for children
This section contains the definitions related to presumptive eligibility for children. A number of changes have been made in the final version of the rule. First, the proposed version contained a definition of the term "Applicable Income Level." This term has been replaced with "Presumptive Income Standard" in the final version. The definition itself is unchanged. Second, in the proposed version, the definition of "Application Form" set a minimum standard for a form, requiring that it at least have the characteristics of the application form used for the poverty-level related eligibility groups. The final version is similar, but specifies that the minimum-level form may also be a joint form for children to apply for the SCHIP program. Finally, the final version adds to the definition of "Qualified Entity." A qualified entity is one that is determined by the SMA to be capable of making presumptive eligibility determinations. The final version specifies that a qualified entity may, in addition to the four types of entities contained in the proposed version, also be: (1) an elementary or secondary school; (2) a state or tribal child support enforcement agency; (3) an organization providing emergency food and shelter under the Stewart B. McKinney Homeless Assistance Act; (4) a state or tribal office or entity involved in enrollment in Temporary Assistance to Needy Families, the Medicaid program or the SCHIP program; (5) an entity that determined eligibility for public or assisted housing receiving federal funds; or (6) any other entity the state chooses, as approved by HHS. Some of these additional types of entities are listed in the Medicaid Act definition of "qualified entity." See 42 U.S.C. § 1396r-1a(b)(3).
The June 25 revisions add more to the definition of "Qualified Entity," providing that a entity authorized to determine eligibility of a child Medicaid or SCHIP may also be a qualified entity. Interim final section 457.1101. This entity is also listed in the Medicaid Act definition of "qualified entity." 42 U.S.C. § 1396r-1a(b)(3).
Section 435.1102 – General Rules
This section contains the general rules for presumptive eligibility. Some changes have been made in the final version. First, the section has been reorganized into more subsections and is easier to read. Substantively, the final version now requires that the notification to parents and caretakers of determinations related to presumptive eligibility must be made not only in writing, but also orally "if appropriate," presumably, if the parent does not read. Section 435.1102(b)(2)(i), (iv). The proposed version only required that they be informed that they must apply for regular Medicaid because the period of presumptive eligibility would end. The final version of Section 435.1102(b)(2)(ii) adds a requirement that parents must actually be given a regular Medicaid application form. Finally, the final version of Section 435.1102(c) requires that the SMA adopt reasonable standards regarding the number of periods of presumptive eligibility that will be authorized for a child in a given time frame. The proposed version had only provided that the SMA was allowed to set such reasonable methods.
Part 436 – Eligibility in Guam, Puerto Rico and the Virgin Islands
The final version makes a number of amendments to this section.
A definition of "Targeted Low Income Child" is added to section 436.3. The definition is identical to the one for children living in the states that is found at 435.4, which is discussed above.
A new section 436.229 is added in the final version. This section specifies that the SMA may provides Medicaid to all individuals under 19 who are optional targeted low income children or reasonable categories of those children. This section is identical to the provision regarding children living in the states that is found at 435.229, which is discussed above.
Final section 436.1001 describes the FFP for administration and final section 436.1002 describes the FFP for services. Both are identical to the provisions regarding payments for children in the states that are found at 435.1001 and 435.1002, discussed above.
Subpart L – Option for Coverage of Special Groups
Section 436.1100 – Basis and Scope
The final version of section 436.1100 provides the statutory basis and scope for the option for coverage of special groups describes the requirements for providing medical assistance to special groups that are neither categorically eligible nor medically needy under Medicaid.
Sections 436.1101 and 436.1102 – Definitions and General Rules
The final version of 436.1101 provides definitions related to presumptive eligibility for children and 436.1102 provides the general rules applicable to the programs. These sections are identical to final version 435.1101 and 435.1102, which contain the definitions and rules applicable to children living in the states.
The interim final revisions add more to the definition of "Qualified Entity," providing that a qualified entity is one that is authorized to determine eligibility of a child for Medicaid or SCHIP. Interim final section 457.1101.
Part 457 – Allotments and Grants to States
Subpart A – Introduction; State plans for Child Health Insurance Programs and Outreach Strategies
The final versions of Section 457.1 (Program Description); 457.2 (Basis and Scope of Subchapter D) are unchanged from the proposed versions.
Section 457.10, which includes the definitions and use of terms, has been re-organized significantly in the final version. A number of substantive changes have been made as well.
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