Sec. 71103. Reducing duplicate enrollment under the Medicaid and CHIP programs

1,031 words·~5 min read·/bill/119/hr/1/eas/section-71103

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) is amended— in subsection (a)— in paragraph (86), by striking and at the end; in paragraph (87), by striking the period and inserting ; and ; and by inserting after paragraph

(87)the following new paragraph: provide— beginning not later than January 1, 2027, in the case of 1 of the 50 States and the District of Columbia, for a process to regularly obtain address information for individuals enrolled under such plan (or a waiver of such plan) in accordance with subsection (vv); and beginning not later than October 1, 2029— for the State to submit to the system established by the Secretary under subsection (uu), with respect to an individual enrolled or seeking to enroll under such plan, not less frequently than once each month and during each determination or redetermination of the eligibility of such individual for medical assistance under such plan (or waiver of such plan)— the social security number of such individual, if such individual has a social security number and is required to provide such number to enroll under such plan (or waiver); and such other information with respect to such individual as determined necessary by the Secretary for purposes of preventing individuals from simultaneously being enrolled under State plans (or waivers of such plans) of multiple States; for the use of such system to prevent such simultaneous enrollment; and in the case that such system indicates that an individual enrolled or seeking to enroll under such plan (or waiver of such plan) is enrolled under a State plan (or waiver of such a plan) of another State, for the taking of appropriate action (as determined by the Secretary) to identify whether such an individual resides in the State and disenroll an individual from the State plan of such State if such individual does not reside in such State (unless such individual meets such an exception as the Secretary may specify). ; and by adding at the end the following new subsections: Not later than October 1, 2029, the Secretary shall establish a system to be utilized by the Secretary and States to prevent an individual from being simultaneously enrolled under the State plans (or waivers of such plans) of multiple States. Such system shall— provide for the receipt of information submitted by a State under subsection (a)(88)(B)(i); and not less than once each month, transmit information to a State (or allow the Secretary to transmit information to a State) regarding whether an individual enrolled or seeking to enroll under the State plan of such State (or waiver of such plan) is enrolled under the State plan (or waiver of such plan) of another State. The Secretary shall establish such standards as determined necessary by the Secretary to limit and protect information submitted under such system and ensure the privacy of such information, consistent with subsection (a)(7). There are appropriated to the Administrator of the Centers for Medicare & Medicaid Services, out of amounts in the Treasury not otherwise appropriated, in addition to amounts otherwise available— for fiscal year 2026, $10,000,000 for purposes of establishing the system and standards required under this subsection, to remain available until expended; and for fiscal year 2029, $20,000,000 for purposes of maintaining such system, to remain available until expended. For purposes of subsection (a)(88)(A), a process to regularly obtain address information for individuals enrolled under a State plan (or a waiver of such plan) shall obtain address information from reliable data sources described in paragraph

(2)and take such actions as the Secretary shall specify with respect to any changes to such address based on such information. For purposes of paragraph

(1), the reliable data sources described in this paragraph are the following: Mail returned to the State by the United States Postal Service with a forwarding address. The National Change of Address Database maintained by the United States Postal Service. A managed care entity (as defined in section 1932(a)(1)(B)) or prepaid inpatient health plan or prepaid ambulatory health plan (as such terms are defined in section 1903(m)(9)(D)) that has a contract under the State plan if the address information is provided to such entity or plan directly from, or verified by such entity or plan directly with, such individual. Other data sources as identified by the State and approved by the Secretary. . Section 1903(r)(3) of the Social Security Act ( 42 U.S.C. 1396b(r)(3) ) is amended— by striking In order and inserting In order ; by striking through the Public and inserting through— the Public ; by striking the period at the end and inserting ; and beginning October 1, 2029, the system established by the Secretary under section 1902(uu). ; and by adding at the end the following new subparagraph: Beginning October 1, 2029, the Secretary may determine that a State is not required to have in operation an eligibility determination system which provides for data matching (for purposes of address verification under section 1902(vv)) through the system described in subparagraph (A)(i) to meet the requirements of this paragraph. . Section 1932 of the Social Security Act ( 42 U.S.C. 1396u–2 ) is amended by adding at the end the following new subsection: Beginning January 1, 2027, each contract under a State plan with a managed care entity (as defined in section 1932(a)(1)(B)) or with a prepaid inpatient health plan or prepaid ambulatory health plan (as such terms are defined in section 1903(m)(9)(D)), shall provide that such entity or plan shall promptly transmit to the State any address information for an individual enrolled with such entity or plan that is provided to such entity or plan directly from, or verified by such entity or plan directly with, such individual. . Section 2107(e)(1) of the Social Security Act ( 42 U.S.C. 1397gg(e)(1) ) is amended— by redesignating subparagraphs

(H)through

(U)as subparagraphs

(I)through (V), respectively; and by inserting after subparagraph

(G)the following new subparagraph: Section 1902(a)(88) (relating to address information for enrollees and prevention of simultaneous enrollments). . Section 2103(f)(3) of the Social Security Act ( 42 U.S.C. 1397cc(f)(3) ) is amended by striking and

(e)and inserting (e), and

(j).

Connectionstraces to 4

Traces to 4 documents

U.S. Code

1 reference not yet in our index