CHIP Administration & Eligibility

Template CA4 – CHIP State Plan Administration - Assurances

Statute: Title XXI of the Social Security Act

Regulation: 42 CFR 457

INTRODUCTION

Template CA4 must be completed by all States with a CHIP program.

In this template, the State provides assurances as to various administrative functions and compliance with certain regulatory requirements.

BACKGROUND

States must indicate that they comply with certain statutory or regulatory provisions by providing assurances to that effect in their State plans. Assurances required in this section include:

• That expenditures for child health assistance will not be claimed prior to the time that the State has legislative authority to operate the State plan or plan amendment as approved by CMS consistent with the requirements in 42 CFR 457.40(d).

• That the State collects data, maintains records, and will furnish reports to the Secretary, at the times and in the standardized format the Secretary may require to enable the Secretary to monitor State program administration and compliance and to evaluate and compare the effectiveness of State plans under Title XXI of the Act consistent with the requirements in 42 CFR 457.720.

• That eligibility standards, in the State’s plan do not discriminate on the basis of diagnosis; that within a defined covered group, do not cover individuals of higher income families without covering individuals with a lower family income and do not deny eligibility based on an individual having a pre-existing medical condition consistent with the requirements in 42 CFR 320(b)(1), (2) and (3).

• That the State will comply with all applicable Federal laws and regulations, including but not limited to Federal grant requirements and Federal reporting requirements consistent with the requirements in 42 CFR 457.204.

• That the State provides child health assistance to targeted low-income children in the State who are Indians consistent with the requirements in 42 CFR 457.125(a) (Section 2102(b)(3)(D)).

TECHNICAL GUIDANCE

In template CA4 the State is being asked to provide the assurances listed above.

The State provides these affirmative assurances by checking the boxes next to the assurance statements. If the State does not check this box, the system will not accept this template for review and approval.