Page:United States Statutes at Large Volume 111 Part 1.djvu/577

 PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 553 "(1) the extent to which, and manner in which, children iii the State, including targeted low-income children and other classes of children classified by income and other relevant factors, currently have creditable health coverage (as defined in section 2110(c)(2)); "(2) current State efforts to provide or obtain creditable health coverage for uncovered children, including the steps the State is talking to identify and enroll all uncovered children who are eligible to participate in public health insurance programs and health insurance programs that involve public-private partnerships; "(3) how the plan is designed to be coordinated with such efforts to increase coverage of children under creditable health coverage; "(4) the child health assistance provided under the plan for targeted low-income children, including the proposed methods of delivery, and utilization control systems; "(5) eligibility standsirds consistent with subsection (b); "(6) outreach activities consistent with subsection (c); and "(7) methods (including monitoring) used— "(A) to assure the quality and appropriateness of care, particularly with respect to well-baby care, well-child care, and immunizations provided under the plan, and "(B) to assure access to covered services, including emergency services. "(b) GENERAL DESCRIPTION OF ELIGIBILITY STANDARDS AND METHODOLOGY.— " (1) ELIGIBILITY STANDARDS. — "(A) IN GENERAL.— The plan shall include a description of the standards used to determine the eligibility of targeted low-income children for child health assistance under the plan. Such standards may include (to the extent consistent with this title) those relating to the geographic areas to be served by the plan, age, income and resources (including any standards relating to spenddowns and disposition of resources), residency, disability status (so long as any standard relating to such status does not restrict eligibility), access to or coverage under other health coverage, and duration of eligibility. Such standards may not discriminate on the basis of diagnosis. " (B) LIMITATIONS ON ELIGIBILITY STANDARDS.—Such eligibility standards— "(i) shall, within any defined group of covered targeted low-income children, not cover such children with higher family income without covering children with a lower family income, and "(ii) may not deny eligibility based on a child having a preexisting medical condition. "(2) METHODOLOGY. —The plan shall include a description of methods of establishing and continuing eligibility and enrollment. " (3) ELIGIBILITY SCREENING; COORDINATION WITH OTHER HEALTH COVERAGE PROGRAMS. —The plan shall include a description of procedures to be used to ensure— "(A) through both intake and followup screening, that only targeted low-income children are furnished child health assistance under the State child health plan; 39-194O-97-19:QL3Part1

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