§ 1397jj. Definitions
(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:
(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.
(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).
(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.
(18)
Inpatient substance abuse treatment services and residential substance abuse treatment services.
(22)
Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders.
(24)
Any other medical, diagnostic, screening, preventive, restorative, remedial, therapeutic, or rehabilitative services (whether in a facility, home, school, or other setting) if recognized by State law and only if the service is—
(b)
“Targeted low-income child” defined
For purposes of this subchapter—
(1)
In general
Subject to paragraph (2), the term “targeted low-income child” means a child—
(B)
(ii)
is a child—
(I)
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;
(C)
who is not found to be eligible for medical assistance under subchapter XIX of this chapter or, subject to paragraph (5), covered under a group health plan or under health insurance coverage (as such terms are defined in section
300gg–91 of this title).
(2)
Children excluded
Such term does not include—
(3)
Special rule
A child shall not be considered to be described in paragraph (1)(C) notwithstanding that the child is covered under a health insurance coverage program that has been in operation since before July 1, 1997, and that is offered by a State which receives no Federal funds for the program’s operation.
(4)
Medicaid applicable income level
The term “medicaid applicable income level” means, with respect to a child, the effective income level (expressed as a percent of the poverty line) that has been specified under the State plan under subchapter XIX of this chapter (including under a waiver authorized by the Secretary or under section
1396a
(r)(2) of this title), as of March 31, 1997, for the child to be eligible for medical assistance under section
1396a
(l)(2) or
1396d
(n)(2) of this title (as selected by a State) for the age of such child.
(5)
Option for States with a separate CHIP program to provide dental-only supplemental coverage
(A)
In general
Subject to subparagraphs (B) and (C), in the case of any child who is enrolled in a group health plan or health insurance coverage offered through an employer who would, but for the application of paragraph (1)(C), satisfy the requirements for being a targeted low-income child under a State child health plan that is implemented under this subchapter, a State may waive the application of such paragraph to the child in order to provide—
(i)
dental coverage consistent with the requirements of subsection (c)(5) of section
1397cc of this title; or
(B)
Limitation
A State may limit the application of a waiver of paragraph (1)(C) to children whose family income does not exceed a level specified by the State, so long as the level so specified does not exceed the maximum income level otherwise established for other children under the State child health plan.
(C)
Conditions
A State may not offer dental-only supplemental coverage under this paragraph unless the State satisfies the following conditions:
(i)
Income eligibility
The State child health plan under this subchapter—
(I)
has the highest income eligibility standard permitted under this subchapter (or a waiver) as of January 1, 2009;
(ii)
No more favorable treatment
The State child health plan may not provide more favorable dental coverage or cost-sharing protection for dental coverage to children provided dental-only supplemental coverage under this paragraph than the dental coverage and cost-sharing protection for dental coverage provided to targeted low-income children who are eligible for the full range of child health assistance provided under the State child health plan.
(c)
Additional definitions
For purposes of this subchapter:
(2)
Creditable health coverage
The term “creditable health coverage” has the meaning given the term “creditable coverage” under section
300gg
(c) of this title 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.
(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;