42 CFR 457.348 - Determinations of Children's Health Insurance Program eligibility by other insurance affordability programs.

§ 457.348 Determinations of Children's Health Insurance Program eligibility by other insurance affordability programs.
(a) Agreements with other insurance affordability programs. The State must enter into and, upon request, provide to the Secretary one or more agreements with the Exchange and the agencies administering other insurance affordability programs as are necessary to fulfill the requirements of this section, including a clear delineation of the responsibilities of each program to—
(1) Minimize burden on individuals;
(2) Ensure compliance with paragraph (c) of this section, § 457.350, and if applicable, paragraph (b) of this section;
(3) Ensure prompt determination of eligibility and enrollment in the appropriate program without undue delay, consistent with the timeliness standards established under § 457.340(d), based on the date the application is submitted to any insurance affordability program.
(b) Provision of CHIP for individuals found eligible for CHIP by another insurance affordability program. If a State accepts final determinations of CHIP eligibility made by another insurance affordability program, for each individual determined so eligible by the other insurance affordability program, the State must—
(1) Establish procedures to receive, via secure electronic interface, the electronic account containing the determination of CHIP eligibility; and
(2) Comply with the provisions of § 457.340 of this subpart to the same extent as if the application had been submitted to the State.
(3) Maintain proper oversight of the eligibility determinations made by the other program.
(c) Transfer from other insurance affordability programs to CHIP. For individuals for whom another insurance affordability program has not made a determination of CHIP eligibility, but who have been screened as potentially CHIP eligible, the State must—
(1) Accept, via secure electronic interface, the electronic account for the individual.
(2) Not request information or documentation from the individual already provided to the other insurance affordability program and included in the individual's electronic account or other transmission from the other program;
(3) Promptly and without undue delay, consistent with the timeliness standards established under § 457.340(d) of this subpart, determine the CHIP eligibility of the individual, in accordance with § 457.340 of this subpart, without requiring submission of another application;
(4) Accept any finding relating to a criterion of eligibility made by such program, without further verification, if such finding was made in accordance with policies and procedures which are the same as those applied by the State in accordance with § 457.380 of this subpart or approved by it in the agreement described in paragraph (a) of this section;
(5) Notify such program of the receipt of the electronic account.
(d) Certification of eligibility criteria. The State must certify for the Exchange and other insurance affordability programs the criteria applied in determining CHIP eligibility.
[77 FR 17215, Mar. 23, 2012]
Effective Date Note:
At 77 FR 17215, Mar. 23, 2012, § 457.348 was added, effective Jan. 1, 2014.

Title 42 published on 2013-10-01

no entries appear in the Federal Register after this date.

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