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PA Bulletin, Doc. No. 09-1125



Children's Health Insurance Program State Plan Amendment

[39 Pa.B. 3145]
[Saturday, June 20, 2009]

   The Insurance Department (Department) has drafted a Children's Health Insurance Program (CHIP) State Plan Amendment to address new mandates and to implement other options in the Federal law authorizing the Federal share of the funding of the CHIP program. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA or Pub. L. No. 111-3) reauthorized the CHIP. CHIPRA included new mandates, verification of CHIP enrollee's citizenship, and new options, using an interface to the Social Security Administration to verify citizenship. The Commonwealth intends to meet the requirements in the Federal law and to implement several of the options permitted in the new law. Prior to implementing these changes, the State must submit a State Plan Amendment to the Centers for Medicare and Medicaid Services to address how the State intends to implement these CHIPRA mandates and options.

   CHIPRA mandated changes:

   *  Verify citizenship of applicants--requires the Social Security Number of applicant children to be included on the application

   *  Increase the premium payment grace period from 10 days to 30 days

   *  Provide notice during the 30 day grace period that coverage will terminate at the end of the grace period if payment is not received

   *  Automatic enrollment of a newborn child for 1 year if the child is born to a targeted low-income woman who was receiving pregnancy-related assistance through CHIP on the date of the child's birth

   *  Provide mental health parity--places limit on physical health outpatient visits to match the outpatient limits for mental health at 50 visits per year. This requirement will exclude well-baby and well-child visits

   CHIPRA options to be pursued by the State:

   *  Implement a match with the Social Security Administration for verification of citizenship status. This reduces the burden on applicants to provide original documentation

   *  Add low-income pregnant women to the targeted population (requires legislative authority and additional state matching funds)

   *  Implement Express Lane Eligibility to enroll children

   *  Implement administrative renewals to reduce the amount of enrollee verifications required at renewal

   Other amendments:

   *  Modify some benefits by eliminating the lifetime maximums and adding hospice care to the benefit package

   *  Simplify the applicant and enrollee protection process

   *  Add verification of immigrant status through the Systematic Alien Verification for Entitlements program

   *  Add an exception to the 12-month continuous eligibility

   A summary of CHIP State Plan Amendment will be presented at the Medical Assistance Advisory Committee meeting on June 25, 2009, at 10 a.m., to be held at Lecture Hall 246/248, Temple University Harrisburg, 234 Strawberry Square, Harrisburg, PA. The complete proposed CHIP State Plan Amendment is also available through the Department's web site at

   Comments on the State Plan Amendment will be accepted through June 27 and should be directed To Peter J. Adams, Deputy Commissioner for CHIP and adultBasic, Insurance Department, Office of CHIP and adultBasic, 333 Market Street, Lobby, Harrisburg, PA 17120,

Insurance Commissioner

[Pa.B. Doc. No. 09-1125. Filed for public inspection June 19, 2009, 9:00 a.m.]

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