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United States Code (Last Updated: May 24, 2014) |
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Title 42. THE PUBLIC HEALTH AND WELFARE |
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Chapter 7. SOCIAL SECURITY |
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SubChapter XXI. STATE CHILDREN’S HEALTH INSURANCE PROGRAM |
§ 1397jj. Definitions
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(a) Child health assistance For purposes of this subchapter, the term “child health assistance” means payment for part or all of the cost of health benefits coverage for targeted low-income children that includes any of the following (and includes, in the case described in section 1397ee(a)(1)(D)(i) of this title, payment for part or all of the cost of providing any of the following), as specified under the State plan: (1) Inpatient hospital services. (2) Outpatient hospital services. (3) Physician services. (4) Surgical services. (5) Clinic services (including health center services) and other ambulatory health care services. (6) Prescription drugs and biologicals and the administration of such drugs and biologicals, only if such drugs and biologicals are not furnished for the purpose of causing, or assisting in causing, the death, suicide, euthanasia, or mercy killing of a person. (7) Over-the-counter medications. (8) Laboratory and radiological services. (9) Prenatal care and prepregnancy family planning services and supplies. (10) Inpatient mental health services, other than services described in paragraph (18) but including services furnished in a State-operated mental hospital and including residential or other 24-hour therapeutically planned structured services. (11) Outpatient mental health services, other than services described in paragraph (19) but including services furnished in a State-operated mental hospital and including community-based services. (12) Durable medical equipment and other medically-related or remedial devices (such as prosthetic devices, implants, eyeglasses, hearing aids, dental devices, and adaptive devices). (13) Disposable medical supplies. (14) Home and community-based health care services and related supportive services (such as home health nursing services, home health aide services, personal care, assistance with activities of daily living, chore services, day care services, respite care services, training for family members, and minor modifications to the home). (15) Nursing care services (such as nurse practitioner services, nurse midwife services, advanced practice nurse services, private duty nursing care, pediatric nurse services, and respiratory care services) in a home, school, or other setting. (16) Abortion only if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest. (17) Dental services. (18) Inpatient substance abuse treatment services and residential substance abuse treatment services. (19) Outpatient substance abuse treatment services. (20) Case management services. (21) Care coordination services. (22) Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders. (23) Hospice care (concurrent, in the case of an individual who is a child, with care related to the treatment of the child’s condition with respect to which a diagnosis of terminal illness has been made. of the Public Health Service Act (42 U.S.C. 300gg(c)) and includes coverage that meets the requirements of section 1397cc of this title provided to a targeted low-income child under this subchapter or under a waiver approved under section 1397ee(c)(2)(B) of this title (relating to a direct service waiver). (3) Group health plan; health insurance coverage; etc. The terms “group health plan”, “group health insurance coverage”, and “health insurance coverage” have the meanings given such terms in section 300gg–91 of this title.
(4) Low-income child The term “low-income child” means a child whose family income is at or below 200 percent of the poverty line for a family of the size involved.
(5) Poverty line defined The term “poverty line” has the meaning given such term in section 9902(2) of this title, including any revision required by such section.
(6) Preexisting condition exclusion The term “preexisting condition exclusion” has the meaning given such term in section 2701(b)(1)(A) 2 of the Public Health Service Act (42 U.S.C. 300gg(b)(1)(A)).
(7) State child health plan; plan Unless the context otherwise requires, the terms “State child health plan” and “plan” mean a State child health plan approved under section 1397ff of this title.
(8) Uncovered child The term “uncovered child” means a child that does not have creditable health coverage.
(9) School-based health center (A) In general The term “school-based health center” means a health clinic that— (i) is located in or near a school facility of a school district or board or of an Indian tribe or tribal organization; (ii) is organized through school, community, and health provider relationships; (iii) is administered by a sponsoring facility; (iv) provides through health professionals primary health services to children in accordance with State and local law, including laws relating to licensure and certification; and (v) satisfies such other requirements as a State may establish for the operation of such a clinic. (B) Sponsoring facility For purposes of subparagraph (A)(iii), the term “sponsoring facility” includes any of the following: (i) A hospital. (ii) A public health department. (iii) A community health center. (iv) A nonprofit health care agency. (v) A local educational agency (as defined under section 7801 of title 20.1 (vi) A program administered by the Indian Health Service or the Bureau of Indian Affairs or operated by an Indian tribe or a tribal organization.
References In Text
Section 2701 of the Public Health Service Act, referred to in subsec. (c)(2), (6), is section 2701 of act
Amendments
2010—Subsec. (a)(23). Pub. L. 111–148, § 2302(b), which directed insertion of “(concurrent, in the case of an individual who is a child, with care related to the treatment of the child’s condition with respect to which a diagnosis of terminal illness has been made” after “hospice care”, was executed by making the insertion after “Hospice care”, to reflect the probable intent of Congress.
Subsec. (b)(2)(B). Pub. L. 111–148, § 10203(d)(2)(D)(i), inserted “except as provided in paragraph (6),” before “a child”.
Subsec. (b)(6). Pub. L. 111–148, § 10203(d)(2)(D)(ii), added par. (6).
Subsec. (b)(6)(B). Pub. L. 111–309, § 205(d)(1), struck out “per person” before “agency contribution” in heading and substituted “employees” for “each employee”.
Subsec. (b)(6)(C). Pub. L. 111–309, § 205(d)(2), struck out “, on a case-by-case basis,” after “determines”.
Subsec. (c)(9)(B)(v). Pub. L. 111–148, § 2102(a)(7), substituted “local educational agency (as defined under section 7801 of title 20” for “school or school system”.
2009—Subsec. (b)(1)(C). Pub. L. 111–3, § 501(b)(1)(A), inserted “, subject to paragraph (5),” after “subchapter XIX of this chapter or”.
Subsec. (b)(5). Pub. L. 111–3, § 501(b)(1)(B), added par. (5).
Subsec. (c)(9). Pub. L. 111–3, § 505(b), added par. (9).
2000—Subsec. (a). Pub. L. 106–554 substituted “section 1397ee(a)(1)(D)(i)” for “section 1397ee(a)(2)(A)” in introductory provisions.
1997—Subsec. (b)(1)(B)(ii). Pub. L. 105–100, § 162(3)(A), amended cl. (ii) generally. Prior to amendment, cl. (ii) read as follows: “is a child whose family income (as determined under the State child health plan) exceeds the medicaid applicable income level (as defined in paragraph (4)), but does not exceed 50 percentage points above the medicaid applicable income level; and”.
Subsec. (b)(4). Pub. L. 105–100, § 162(3)(B), substituted “
Subsec. (c)(3). Pub. L. 105–100, § 162(9), made technical amendment to reference in original act which appears in text as reference to section 300gg–91 of this title.
Effective Date Of Amendment
Pub. L. 111–148, title II, § 2102(a),
Amendment by Pub. L. 111–3 effective
Amendment by Pub. L. 106–554 effective as if included in the enactment of section 4901 of Pub. L. 105–33, see section 1(a)(6) [title VIII, § 802(f)] of Pub. L. 106–554, set out as a note under section 1396d of this title.
Pub. L. 105–100, title I, § 162,
Miscellaneous
Pub. L. 111–148, title II, § 2101(f),