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PA Bulletin, Doc. No. 10-2381



Children's Health Insurance Program; Benefit Changes and State Plan Amendment; Notice

[40 Pa.B. 7165]
[Saturday, December 11, 2010]

 The Insurance Department (Department) has or will implement several benefit changes and other changes on December 1, 2010, the beginning of its next plan year, or on the effective date indicated. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Pub. L. No. 111-3), which reauthorized the Children's Health Insurance Program (CHIP), requires several of these changes and, along with the Patient Protection and Affordable Care Act of 2010 (ACA), provides other options for states to include in their State Plan. Consistent with Federal law, the mandated benefit and administrative changes are included in a State Plan Amendment being submitted to the Centers for Medicare and Medicaid Services (CMS) on or before December 31, 2010. The State Plan Amendment also includes other changes planned by the Commonwealth's CHIP, some of which are permitted by CHIPRA and some of which are not addressed in CHIPRA.

 CHIPRA mandated changes:

 • Expand covered dental services (effective January 1, 2011)

 • Provide a copy of the dental benefit as required annually

 • Provide concurrence to meet the dental reporting requirement

 • Update the projected budget for CHIP

 CHIPRA optional changes:

 • Even though it does not result in a change to eligibility, incorporate the required template language into Section 4 of the State Plan. The template was provided by the CMS to standardize the way states elect to cover eligible children who are lawfully residing in the United States.

 • Provide a more comprehensive explanation of exclusions and limitations of benefits

 ACA optional changes:

 • Open CHIP coverage to children of employees of public agencies within this Commonwealth if they meet the Hardship Exception included in the ACA (effective July 1, 2010)

 • Simplify the application process through the elimination of the requirement for proof of income in those instances that verification can be obtained through various data exchanges (for example, Income and Eligibility Verification System—IEVS) (effective July 1, 2010)

 The complete proposed CHIP State Plan Amendment will be available through the CHIP's web site at

Acting Insurance Commissioner

[Pa.B. Doc. No. 10-2381. Filed for public inspection December 10, 2010, 9:00 a.m.]

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