Sec. 402. Easing administrative barriers to State cooperation with employer-sponsored insurance coverage
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Section 2102(a) of the Social Security Act ( 42 U.S.C. 1397b(a) ), as amended by section 401(a), is amended— in paragraph (7), by striking and at the end; in paragraph (8), by striking the period at the end and inserting ; and ; and by adding at the end the following new paragraph: effective for plan years beginning on or after October 1, 2014, how the plan will provide for child health assistance with respect to targeted low-income children covered under a group health plan. .
Section 2105 of the Social Security Act ( 42 U.S.C. 1397d ) is amended— in subsection (a)(1)(C), by inserting before the semicolon at the end the following: and, subject to paragraph (3)(C), in the form of payment of the premiums for coverage under a group health plan that includes coverage of targeted low-income children and benefits supplemental to such coverage ; and by amending paragraph
(3)of subsection
(c)to read as follows: Payment may be made to a State under subsection (a)(1)(C), subject to the provisions of this paragraph, for the purchase of family coverage under a group health plan that includes coverage of targeted low-income children unless such coverage would otherwise substitute for coverage that would be provided to such children but for the purchase of family coverage. With respect to coverage described in subparagraph (A)— notwithstanding section 2102, no minimum benefits requirement (other than those otherwise applicable with respect to services referred to in section 2102(a)(7)) under this title shall apply; and no limitation on beneficiary cost-sharing otherwise applicable under this title or title XIX shall apply. If the coverage described in subparagraph
(A)does not provide coverage for the services referred to in section 2102(a)(7), the State child health plan shall provide coverage of such services as supplemental benefits. The amount of the payment under paragraph (1)(C) for coverage described in subparagraph
(A)(and supplemental benefits under subparagraph
(C)for individuals so covered) during a fiscal year may not exceed the product of— the national per capita expenditure under this title (taking into account both Federal and State expenditures) for the previous fiscal year (as determined by the Secretary using the best available data); the enhanced FMAP for the State and fiscal year involved; and the number of targeted low-income children for whom such coverage is provided. A State child health plan— may not require a targeted low-income child to enroll in coverage described in subparagraph
(A)in order to obtain child health assistance under this title; before providing such child health assistance for such coverage of a child, shall make available (which may be through an Internet Web site or other means including the State transparency plan portal established under section 901 of the Empowering Patients First Act of 2013 ) to the parent or guardian of the child information on the coverage available under this title, including benefits and cost-sharing; and shall provide at least one opportunity per fiscal year for beneficiaries to switch coverage under this title from coverage described in subparagraph
(A)to the coverage that is otherwise made available under this title. A State child health plan shall— describe how the State will notify potential beneficiaries of coverage described in subparagraph (A); provide such notification in writing at least during the initial application for enrollment under this title and during redeterminations of eligibility if the individual was enrolled before October 1, 2014; and post a description of these coverage options on any official Web site that may be established by the State in connection with the plan, including the State transparency plan portal established under section 901 of the Empowering Patients First Act of 2013 . If coverage described in subparagraph
(A)is provided under a group health plan with respect to a targeted low-income child, the State child health plan shall provide for the collection, at least once every six months, of proof from the plan that the child is enrolled in such coverage. Nothing in this section is to be construed to prohibit a State from— offering wrap around benefits in order for a group health plan to meet any State-established minimum benefit requirements; establishing a cost-effectiveness test to qualify for coverage under such a plan; establishing limits on beneficiary cost-sharing under such a plan; paying all or part of a beneficiary’s cost-sharing requirements under such a plan; paying less than the full cost of the employee’s share of the premium under such a plan, including prorating the cost of the premium to pay for only what the State determines is the portion of the premium that covers targeted low-income children; using State funds to pay for benefits above the Federal upper limit established under subparagraph (C); allowing beneficiaries enrolled in group health plans from changing plans to another coverage option available under this title at any time; or providing any guidance or information it deems appropriate in order to help beneficiaries make an informed decision regarding the option to enroll in coverage described in subparagraph (A). In this paragraph, the term group health plan has the meaning given such term in section 2791(a)(1) of the Public Health Service Act ( 42 U.S.C. 300gg–91(a)(1) ). . The Secretary of Health and Human Services shall provide for the application of the amendments made by subsections
(a)and
(b)under the Medicaid program under title XIX of the Social Security Act in the same manner as such amendments apply to SCHIP under title XXI of such Act.
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- 42 USC 300gg–91(a)(1)
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Sec. 402
Easing administrative barriers to State cooperation with employer-sponsored insurance coverage
Cite42 USC 300gg–91(a)(1)
Cites 3Cited by 0 across 0 sources