§ 1397gg. Strategic objectives and performance goals; plan administration
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/usc/title-42/section-1397ggA research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(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 subchapter.
(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 subchapter.
(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 1397hh(a) of this title and the evaluation required by section 1397hh(b) of this title.
(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 chapter shall apply to States under this subchapter in the same manner as they apply to a State under subchapter XIX:
(1)Subchapter XIX provisions
(A)Section 1396a(a)(4)(C) of this title (relating to conflict of interest standards).
(B)Section 1396a(a)(25) of this title (relating to third party liability).
(C)Section 1396a(a)(39) of this title (relating to termination of participation of certain providers).
(D)Section 1396a(a)(78) of this title (relating to enrollment of providers participating in State plans providing medical assistance on a fee-for-service basis).
(E)Section 1396a(a)(72) of this title (relating to limiting FQHC contracting for provision of dental services).
(F)Section 1396a(a)(73) of this title (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 1396a of this title (relating to provider and supplier screening, oversight, and reporting requirements) and subsection (a)(83) of section 1396a of this title (relating to searchable directories of the providers described in subsection
(mm)of such section).
(H)Section 1396a(a)(88) of this title (relating to address information for enrollees and prevention of simultaneous enrollments).
(I)Section 1396a(e)(13) of this title (relating to the State option to rely on findings from an Express Lane agency to help evaluate a child’s eligibility for medical assistance).
(J)Section 1396a(e)(14) of this title (relating to income determined using modified adjusted gross income and household income).
(K)Paragraphs
(5)and
(16)of section 1396a(e) of this title (relating to the State option to provide medical assistance consisting of full benefits during pregnancy and throughout the 12-month postpartum period under subchapter XIX),1 if the State provides child health assistance for targeted low-income children who are pregnant or to targeted low-income pregnant women and the State has elected to apply such paragraph
(16)with respect to pregnant women under subchapter XIX, the provision of assistance under the State child health plan or waiver for targeted low-income children or targeted low-income pregnant women during pregnancy and the 12-month postpartum period shall be required and not at the option of the State and shall include coverage of all items or services provided to a targeted low-income child or targeted low-income pregnant woman (as applicable) under the State child health plan or waiver).1
(L)Section 1396a(e)(12) of this title (relating to 1 year of continuous eligibility for children), except that a targeted low-income child enrolled under the State child health plan or waiver may be transferred to the Medicaid program under subchapter XIX for the remaining duration of the 12-month continuous eligibility period, if the child becomes eligible for full benefits under subchapter XIX during such period.
(M)Section 1396a(bb) of this title (relating to payment for services provided by Federally-qualified health centers and rural health clinics).
(N)Section 1396a(ff) of this title (relating to disregard of certain property for purposes of making eligibility determinations).
(O)Paragraphs (2), (16), and
(17)of section 1396b(i) of this title (relating to limitations on payment).
(P)Section 1396b(m)(3) of this title (relating to limitation on payment with respect to managed care).
(Q)Paragraph
(4)of section 1396b(v) of this title (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 subchapter XIX.
(R)Section 1396b(v)(5) of this title (relating to payments for medical assistance furnished to aliens), except in relation to payments for services provided under section 1397ee(a)(1)(D)(ii) of this title.
(S)Section 1396b(w) of this title (relating to limitations on provider taxes and donations).
(T)Section 1396r–1a of this title (relating to presumptive eligibility for children).
(U)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 1396u–2 of this title.
(V)Section 1396w–2 of this title (relating to authorization to receive data directly relevant to eligibility determinations).
(W)Section 1396w–3(b) of this title (relating to coordination with State Exchanges and the State Medicaid agency).
(2)Subchapter XI provisions
(A)Section 1315 of this title (relating to waiver authority).
(B)Section 1316 of this title (relating to administrative and judicial review), but only insofar as consistent with this subchapter.
(C)Section 1320a–3 of this title (relating to disclosure of ownership and related information).
(D)Section 1320a–5 of this title (relating to disclosure of information about certain convicted individuals).
(E)Section 1320a–7a of this title (relating to civil monetary penalties).
(F)Section 1320a–7b(d) of this title (relating to criminal penalties for certain additional charges).
(G)Section 1320b–2 of this title (relating to periods within which claims must be filed).
(f)Limitation of waiver authority Notwithstanding subsection (e)(2)(A) and section 1315(a) of this title:
(1)The Secretary may not approve a waiver, experimental, pilot, or demonstration project that would allow funds made available under this subchapter 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 1397kk(c)(2)(A) of this title), 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 February 4, 2009, that would waive or modify the requirements of section 1397kk of this title.
(g)Use of blended risk pools
(1)In general Nothing in this subchapter (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 subchapter (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 subchapter XIX or child health assistance under this subchapter 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 subchapter (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.
(Aug. 14, 1935, ch. 531, title XXI, § 2107, as added Pub. L. 105–33, title IV, § 4901(a), Aug. 5, 1997, 111 Stat. 565; amended Pub. L. 106–554, § 1(a)(6) [title VIII, § 803], Dec. 21, 2000, 114 Stat. 2763, 2763A–582; Pub. L. 109–171, title VI, § 6102(a), Feb. 8, 2006, 120 Stat. 131; Pub. L. 111–3, title I, § 112(a)(2)(A), title II, §§ 203(a)(2), (d)(2), 214(b), title V, §§ 501(d)(2), 503(a)(1), Feb. 4, 2009, 123 Stat. 33, 46, 49, 57, 87, 89; Pub. L. 111–5, div. B, title V, § 5006(b)(2), (d)(2), (e)(2)(B), Feb. 17, 2009, 123 Stat. 506, 510;
Pub. L. 111–148, title II, § 2101(d)(2), (e), title VI, § 6401(c), Mar. 23, 2010, 124 Stat. 287, 753; Pub. L. 111–152, title I, § 1004(b)(2)(B), Mar. 30, 2010, 124 Stat. 1034; Pub. L. 111–309, title II, § 205(f)(2), Dec. 15, 2010, 124 Stat. 3291; Pub. L. 114–255, div. A, title V, § 5005(c)(1), Dec. 13, 2016, 130 Stat. 1194; Pub. L. 115–120, div. C, § 3002(g)(1), Jan. 22, 2018, 132 Stat. 35; Pub. L. 115–123, div. E, title XII, § 53102(d)(1), Feb. 9, 2018, 132 Stat. 299; Pub. L. 117–2, title IX, § 9822(a)(1), Mar. 11, 2021, 135 Stat. 220;
Pub. L. 117–328, div. FF, title V, §§ 5112(b), 5123(c), Dec. 29, 2022, 136 Stat. 5940, 5946; Pub. L. 119–21, title VII, §§ 71103(b)(1), 71109(b), July 4, 2025, 139 Stat. 293, 297; Pub. L. 119–75, div. J, title I, § 6101(b)(3), Feb. 3, 2026, 140 Stat. 638.)
Amendment of Subsection (e)(1)(G)
Pub. L. 119–75, div. J, title I, § 6101(b)(3), (c), Feb. 3, 2026, 140 Stat. 638, provided that, effective on the date that is 3 years after Feb. 3, 2026, subsection (e)(1)(G) of this section is amended by inserting “enrollment,” after “screening,”. See 2026 Amendment note below.
Connections304 cite this · traces to 21
Cited by 304 sections · top 60
U.S. Code
- § 1396Medicaid and CHIP Payment and Access Commission
- § 1396aState plans for medical assistance
- § 1305Short title of chapter
- § 1397eePayments to States
- § 1397llOptional coverage of targeted low-income pregnant women through a State plan amendment
- § 5000ARequirement to maintain minimum essential coverage
- § 1397kkPhase-out of coverage for nonpregnant childless adults; conditions for coverage of parents
public-private-law
- Public Law 117-328Consolidated Appropriations Act, 2023
- Public Law 117-2American Rescue Plan Act of 2021
- Public Law 114-25521st Century Cures Act
- Public Law 115-123Bipartisan Budget Act of 2018
- Public Law 119-21To provide for reconciliation pursuant to title II of H
- Public Law 115-120Federal Register Printing Savings Act of 2017
statutes-at-large
- Public Law 106–554Making consolidated appropriations for the fiscal year ending September 30, 2001, and for other purposes
- Public Law 115–123To amend title 4, United States Code, to provide for the flying of the flag at half-staff in the event of the death of a first responder in the line of duty
- Public Law 111–5Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for the fiscal year ending September 30, 2009, and for other purposes
- Public Law 111–3To amend title XXI of the Social Security Act to extend and improve the Children’s Health Insurance Program, and for other purposes
- Public Law 117–2To provide for reconciliation pursuant to title II of S
- Public Law 114–255To accelerate the discovery, development, and delivery of 21st century cures, and for other purposes
- Public Law 105–32Waiving certain enrollment requirements with respect to two specified bills of the One Hundred Fifth Congress
- Public Law 115–120Making further continuing appropriations for the fiscal year ending September 30, 2018, and for other purposes
- Public Law 111–148Entitled The Patient Protection and Affordable Care Act
- Public Law 111–309To extend certain expiring provisions of the Medicare and Medicaid programs, and for other purposes
- Public Law 109–171To provide for reconciliation pursuant to section 202(a) of the concurrent resolution on the budget for fiscal year 2006 (H
- Public Law 117–328Making consolidated appropriations for the fiscal year ending September 30, 2023, and for providing emergency assistance for the situation in Ukraine, and for other purposes
statute-compilations
- Sec. 3002SIX-YEAR FUNDING EXTENSION OF THE CHILDREN’S HEALTH INSURANCE PROGRAM
- Sec. 2107STRATEGIC OBJECTIVES AND PERFORMANCE GOALS; PLAN ADMINISTRATION
- Sec. 1004INCOME DEFINITIONS
- Sec. 2101ADDITIONAL FEDERAL FINANCIAL PARTICIPATION FOR CHIP
- Sec. 9822MODIFICATIONS TO CERTAIN COVERAGE UNDER CHIP FOR PREGNANT AND POSTPARTUM WOMEN
- Sec. 5005INCREASING OVERSIGHT OF TERMINATION OF MEDICAID PROVIDERS
- Sec. 2107STRATEGIC OBJECTIVES AND PERFORMANCE GOALS; PLAN ADMINISTRATION
- Sec. 6401PROVIDER SCREENING AND OTHER ENROLLMENT REQUIREMENTS UNDER MEDICARE, MEDICAID, AND CHIP
- Sec. 53102THIRD PARTY LIABILITY IN MEDICAID AND CHIP
register
bill
- Sec. 203Improving claims processing and detection of fraud within the Medicaid and CHIP programs
- Sec. 8Improving claims processing and detection of fraud within the Medicaid and CHIP programs
- Sec. 203Improving claims processing and detection of fraud within the Medicaid and CHIP programs
- Sec. 212Transitional Medical Assistance
- Sec. 3Removing barriers to health coverage for lawfully present individuals
- Sec. 3Establishment of Medicaid and CHIP Care Coordination program for children with medically complex conditions as Medicaid State option
- Sec. 205Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs
- Sec. 502Removing barriers to health care and nutrition assistance for children, pregnant women, and lawfully present individuals
- Sec. 212Transitional Medical Assistance
- Sec. 212Transitional Medical Assistance
- Sec. 212Transitional Medical Assistance
- Sec. 211Automatic enrollment for newborns under CHIP
- Sec. 131Portability of advance directives
- Sec. 3Removing barriers to health coverage for lawfully present individuals
- Sec. 2Increasing oversight of termination of Medicaid providers
- Sec. 3Establishment of Medicaid and CHIP Care Coordination program for children with medically complex conditions as Medicaid State option
- Sec. 203Improving claims processing and detection of fraud within the Medicaid and CHIP programs
- Sec. 3Establishment of Medicaid and Chip Care Coordination program for children with medically complex conditions as Medicaid State option
- Sec. 312-month continuous enrollment
- Sec. 203Improving claims processing and detection of fraud within the Medicaid and CHIP programs
- Sec. 203Improving claims processing and detection of fraud within the Medicaid and CHIP programs
- Sec. 5005Increasing oversight of termination of Medicaid providers
Traces to 21 documents
U.S. Code
- Annual reports; evaluations§ 1397hh
- State plans for medical assistance§ 1396a
- Payment to States§ 1396b
- Payments to States§ 1397ee
- Requirements for nursing facilities§ 1396r
- Community supported living arrangements services§ 1396u
- Asset verification through access to information held by financial institutions§ 1396w
- Demonstration projects§ 1315
- Administrative and judicial review of public assistance determinations§ 1316
- Uniform reporting systems for health services facilities and organizations§ 1320a
- Repealed. Pub. L. 93–647, § 3(e)(1), Jan. 4, 1975, 88 Stat. 2349§ 1320b
- Phase-out of coverage for nonpregnant childless adults; conditions for coverage of parents§ 1397kk
- Medicaid and CHIP Payment and Access Commission§ 1396
- Definitions§ 1301
- Purpose; State child health plans§ 1397aa
public-private-law
- 21st Century Cures ActPublic Law 114-255
- Federal Register Printing Savings Act of 2017Public Law 115-120
- Bipartisan Budget Act of 2018Public Law 115-123
- American Rescue Plan Act of 2021Public Law 117-2
- Consolidated Appropriations Act, 2023Public Law 117-328
- To provide for reconciliation pursuant to title II of HPublic Law 119-21
69 references not yet in our index
- 1
- Aug. 14, 1935, ch. 531
- Pub. L. 105–33, title IV, § 4901(a)
- 111 Stat. 565
- Pub. L. 106–554, § 1(a)(6) [title VIII, § 803]
- 114 Stat. 2763
- Pub. L. 109–171, title VI, § 6102(a)
- 120 Stat. 131
- Pub. L. 111–3, title I, § 112(a)(2)(A)
- 123 Stat. 33
- Pub. L. 111–5, div. B, title V, § 5006(b)(2)
- 123 Stat. 506
- Pub. L. 111–148, title II, § 2101(d)(2)
- 124 Stat. 287
- Pub. L. 111–152, title I, § 1004(b)(2)(B)
- 124 Stat. 1034
- Pub. L. 111–309, title II, § 205(f)(2)
- 124 Stat. 3291
- 130 Stat. 1194
- 132 Stat. 35
- 132 Stat. 299
- 135 Stat. 220
- 136 Stat. 5940
- 139 Stat. 293
- Pub. L. 119–75, div. J, title I, § 6101(b)(3)
- 140 Stat. 638
- section 501(d)(2) of Pub. L. 111–3
- section 214(b) of Pub. L. 111–3
- section 501(d)(3) of Pub. L. 111–3
- Pub. L. 119–75
- Pub. L. 111–309, § 205(f)(2)(A)
- Pub. L. 111–148, § 6401(c)(2)
- Pub. L. 111–148, § 6401(c)(1)
- Pub. L. 111–148, § 2101(d)(2)(B)
- Pub. L. 111–152
- section 2101(d)(2) of Pub. L. 111–148
- Pub. L. 111–148, § 2101(d)(2)(A)
- Pub. L. 111–309
- Pub. L. 111–148, § 2101(e)
- Pub. L. 111–5, § 5006(e)(2)(B)(ii)
+ 29 more
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§ 1397gg
Strategic objectives and performance goals; plan administration
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Fed. Reg.×4
Cite1
ActAug. 14, 1935, ch. 531
Pub. L.Pub. L. 105–33, title IV, § 4901(a)
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