Page:United States Statutes at Large Volume 111 Part 1.djvu/580

 Ill STAT. 556 PUBLIC LAW 105-33—AUG. 5, 1997 "(A) by an individual who is a member of the American Academy of Actuaries; "(B) using generally accepted actuarial principles and methodologies; "(C) using a standardized set of utilization and price factors; "(D) using a standardized population that is representative of privately insured children of the age of children who are expected to be covered under the State child health plan; "(E) applying the same principles and factors in comparing the value of different coverage (or categories of services); "(F) without taking into account any differences in coverage based on the method of delivery or means of cost control or utilization used; and "(G) taking into account the ability of a State to reduce benefits by taking into account the increase in actuarial VEilue of benefits coverage offered under the State child health plan that results from the limitations on cost sharing under such coverage. The actuary preparing the opinion shall select and specify in the memorandum the standardized set and population to be used under subparagraphs (C) and (D). "(5) CONSTRUCTION ON PROHIBITED COVERAGE.— Nothing in this section shall be construed as requiring any health benefits coverage offered under the plan to provide coverage for items or services for which payment is prohibited under this title, notwithstanding that any benchmark benefit package includes coverage for such an item or service. " (d) DESCRIPTION OF EXISTING COMPREHENSIVE STATE-BASED COVERAGE.— "(1) IN GENERAL.—^A program described in this paragraph is a child health coverage program that— "(A) includes coverage of a range of benefits; "(B) is administered or overseen by the State and receives funds from the State; "(C) is offered in New York, Florida, or Pennsylvania; and "(D) was offered as of the date of the enactment of this title. " (2) MODIFICATIONS.— A State may modify a program described in paragraph (1) from time to time so long as it continues to meet the requirement of subparagraph (A) and does not reduce the actuarial value of the coverage under the program below the lower of— "(A) the actuarial value of the coverage under the program as of the date of the enactment of this title, or "(B) the actuarial value described in subsection (a)(2)(B), evaluated as of the time of the modification. "(e) COST-SHARING.— " (1) DESCRIPTION; GENERAL CONDITIONS.— " (A) DESCRIPTION.— ^A State child health plan shall include a description, consistent with this subsection, of the amount (if any) of premiums, deductibles, coinsurance.

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