CROSSWALK: Title XXI State Plan Template

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Title XXI CHIP State Plan Template Crosswalk
May 2026
Section

Old Version

New Version

Type of
Change

Reason for Change

Burden of Change
(Yes or No)

Section 3

N/A

Assurance language with check off box:

Addition

To reflect a statutory
requirement effective
January 1, 2027, that
creates state plan
requirements related to
address verification for
states.

Yes

Modify

To reflect a regulatory
requirement effective
January 1, 2026, unless a
state is granted an
extension, the CMS
Interoperability and Prior
Authorization Final Rule
(CMS-0057-F) amended 42
CFR 457.495(d) to require
state CHIP fee-for-service
programs to complete prior
authorization decisions
within 7 calendar days for
standard requests and 72
hours for expedited
requests. Additionally,
states must notify the
enrollee of the prior
authorization decision and
provide review rights.

Yes

3.10 Program
Integrity –

The State assures that each managed care
entity (as defined in 42 CFR 457.10) or plan
(MCO, PIHP, PAHP, PCCM, and PCCM entity)
that the State contracts with under the State
plan promptly transmits to the State any
enrollee address information. This includes
address information received directly from
the enrollee or information the entity verifies
directly with the enrollee. This is required in
section 2103(f)(3) of the Act, which crossreferences to section 1932(j) of the Act.

3.10.17

Section 7
Quality and
Appropriateness
of Care –
7.2.4

State provides
description of
methods used to
ensure compliance
with federal policy:
Decisions related to
the prior
authorization of
health services are
completed in
accordance with
State law or, in
accordance with the
medical needs of the
patient, within 14
days after the receipt
of a request for
services. (Section
2102(a)(7)) (42CFR
457.495(d)) Exigent
medical
circumstances may

State provides description of methods used
to ensure compliance with federal policy:
Decisions related to the prior authorization
of health services are completed within 7
calendar days for a standard request or
within 72 hours for an expedited request. An
extension of up to 14 days may be permitted
if an enrollee, physician, or health plan
requests the extension to obtain additional
information. Enrollees must be provided
notice of the state’s prior authorization
decision, decision information, and
information about enrollee review rights.
States may establish prior authorization
decision timeframes of a shorter duration in
accordance with State law.
An emergency medical circumstance may
require more rapid response according to
the medical needs of the enrollee.

Section 7
Quality and
Appropriateness
of Care –

require more rapid
response according
to the medical needs
of the patient.
N/A

N/A

Assurance language with check off box:

Addition

N/A

The state assures that it has a process to
regularly obtain address information for
individuals enrolled as specified at section
2107(e)(1)(H) of the Act, which crossreferences to section 1902(a)(88)(A) of the
Act as follows
Assurance language with check off box:

Addition

11.3

Section 11
Program
Integrity –
11.3.1

Addition

The Sate annually posts on its website the
prior authorization metrics described in 42
CFR 457.732(c). The State must make the
previous calendar year metrics publicly
accessible by March 31.

7.2.4.1

Section 11
Program
Integrity –

Assurance language with check off box:

The agency has a process to regularly obtain
updated address information from:
a. Mail returned to the State by the United
States Postal Service (USPS) with a
forwarding address.
b. The National Change of Address Database
(NCOA) maintained by USPS.
c. A managed care entity (as defined in 42
CFR 457.10) managed care organization
(MCO), primary care case manager (PCCM),
PCCM entity, prepaid inpatient health plan
(PIHP), or prepaid ambulatory health plan
(PAHP) that has a contract under the State
plan if the address information is provided
directly from, or verified with, the applicant

To reflect a regulatory
requirement effective
March 31, 2026, the CMS
Interoperability and Prior
Authorization Final Rule
(CMS-0057-F) amended 42
CFR 457.732(c) to require
state CHIP fee-for-service
programs to post prior
authorization metrics
annually to their website for
the previous calendar year
by March 31.
To reflect a statutory
requirement effective
January 1, 2027, that
creates state plan
requirements related to
address verification for
states.

Yes

To reflect a statutory
requirement effective
January 1, 2027, that
creates state plan
requirements related to
address verification for
states.

Yes

Yes

or beneficiary (or someone acting on their
behalf).
Section 11
Program
Integrity –

N/A

State provides description of data sources
used, if applicable:

Additon

To reflect a statutory
requirement effective
January 1, 2027, that
creates state plan
requirements related to
address verification for
states.

Yes

Technical
addition

To give this section a title.

No

Technical
modification

Made a variety of technical
changes to align the chart
with how CMCS operates
(states work with CHIP POs
versus MCOG now) and to
make certain information
more evergreen.

No

The agency obtains updated address
information from other data sources:

11.3.2

If selected, please describe the following:
Name of the data source(s):

Section 13 –
Appendix
Section 13 –
Appendix

No title in old version

Description of data source(s), including
safeguards to ensure accuracy of address
information returned:
Adding title: Section 13 – Appendix

Table titled: CMS
Regional Offices

Updated table: CMS Regional Points of
Contact

Columns titled:
• CMS
Regional
Offices
• States
• Associate
Regional
Administrator
• Regional
Office
Address

Update column titles:
• CMS Regions
• CHIP Project Officer (PO)
Reordered states to be in alphabetical order
Remove column Regional Office Address
Included the updated contact information
for CHIP POs