| CHIP state plan (current version) |
2018 (newest version) |
Type of Change |
Reason for Change |
Burden Change |
| Introduction |
Updates introduction and guidance for states regarding the revisions and additions to Section 3 |
Rev |
Providing further clarification |
No |
| Section 3 - Provides states the option of selecting whether it uses Title XXI funds only for expanded eligibility under Medicaid- Provides states the opportunity to select and describe the benefit package(s) provided to individuals covered under the CHIP state plan. |
Updates guidance regarding states need to complete the remaining sections within Section 3, when applicable to the state |
Rev |
Providing further clarification |
No |
| Section 3.1 - Provides states the opportunity to describe the financing and delivery method used for CHIP service delivery |
Adds options to clearly select the delivery mechanism (including managed care or Fee-For-Service) and if managed care, the types of managed care entities utilized by the state to deliver care |
Rev |
To increase clarity in relation to the SPA review process |
No |
| Section 3.2 - Provides states the opportunity to describe the utlization controls utilized by the state so that enrollees receive health care services that are appropriate and medically necessary |
Adds assurances related to the state's compliance with the general contracting requirments for use of managed care entities by the state at §§457.940, 457.1207 and 457.1210, 457.1220 and 457.1250 |
Rev |
New regulations effective 5/6/16 with a compliance date for contracts in effect on the first day of the state fiscal year that begins on or after 7/1/18 |
May slightly increase burden on states to provide additional detail. |
| Section 3.3 |
Adds assurances related to the state's compliance with rate making and medical loss ratio requirements at §457.1203 |
Add |
New regulations effective 5/6/16 with a compliance date for contracts in effect on the first day of the state fiscal year that begins on or after 7/1/18 |
May slightly increase burden on states to provide additional detail. |
| Section 3.4 |
Adds assurances related to the state's compliance with enrollee disenrollment rights and procedures at §§457.1201, 457.1207, 457.1210, 457.1212 |
Add |
New regulations effective 5/6/16 with a compliance date for contracts in effect on the first day of the state fiscal year that begins on or after 7/1/18 |
May slightly increase burden on states to provide additional detail. |
| Section 3.5 |
Adds assurances related to the state's compliance with potential enrollee, enrollee and marketing informational requirements for the state and managed care entities at §457.1207 |
Add |
New regulations effective 5/6/16 with a compliance date for contracts in effect on the first day of the state fiscal year that begins on or after 7/1/18 |
May slightly increase burden on states to provide additional detail. |
| Section 3.6 |
Adds assurances related to the state's compliance with benefit and service requirements that must be available for beneficiares enrolled in managed care entities at §§457.1209, 457.1201, 457.1218, and 457.1230 |
Add |
New regulations effective 5/6/16 with a compliance date for contracts in effect on the first day of the state fiscal year that begins on or after 7/1/18 |
May slightly increase burden on states to provide additional detail. |
| Section 3.7 |
Adds assurances related to the state's compliance with operational requirements for managed care entities contracted to operate in the state's CHIP at §§457.1208 and 457.1233 |
Add |
New regulations effective 5/6/16 with a compliance date for contracts in effect on the first day of the state fiscal year that begins on or after 7/1/18 |
May slightly increase burden on states to provide additional detail. |
| Section 3.8 |
Adds assurances related to the state's compliance with beneficiary protection requirements for beneficiaries enrolled in managed care at §§457.1201, 457.1220, and 457.1226 |
Add |
New regulations effective 5/6/16 with a compliance date for contracts in effect on the first day of the state fiscal year that begins on or after 7/1/18 |
May slightly increase burden on states to provide additional detail. |
| Section 3.9 |
Adds assurances related to the state's compliance with grievance and appeal requirements for beneficiaries enrolled in managed care at §457.1260 |
Add |
New regulations effective 5/6/16 with a compliance date for contracts in effect on the first day of the state fiscal year that begins on or after 7/1/18 |
May slightly increase burden on states to provide additional detail. |
| Section 3.10 |
Adds assurances related to the state's compliance with program integrity requirements for managed care entities contracted to operate in the state's CHIP at §§457.1214, 457.1280, 457.1285 |
Add |
New regulations effective 5/6/16 with a compliance date for contracts in effect on the first day of the state fiscal year that begins on or after 7/1/18 |
May slightly increase burden on states to provide additional detail. |
| Section 3.11 |
Adds assurances related to the state's compliance with sanctions of managed care entities contracted to operate in the state's CHIP at §457.1270 |
Add |
New regulations effective 5/6/16 with a compliance date for contracts in effect on the first day of the state fiscal year that begins on or after 7/1/18 |
May slightly increase burden on states to provide additional detail. |
| Section 3.12 |
Adds assurances related to the state's compliance with quality measurement and improvement and external quality review requirements at §§457.1240 and 457.1250 |
Add |
New regulations effective 5/6/16 with a compliance date for contracts in effect on the first day of the state fiscal year that begins on or after 7/1/18 |
May slightly increase burden on states to provide additional detail. |