50-29 Children's Health Insurance Program

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CHAPTER 50-29CHILDREN'S HEALTH INSURANCE PROGRAM50-29-01. Definitions. As used in this chapter:1.&quot;Children's health insurance program&quot; means a program to provide health<br>assistance to low-income children funded through title XXI of the federal Social<br>Security Act [42 U.S.C. 1397aa et seq.].2.&quot;County agency&quot; means the county social service board.3.&quot;Department&quot; means the department of human services.4.&quot;Plan&quot; means the children's health insurance program state plan.5.&quot;Poverty line&quot; means the official income poverty line as defined by the United States<br>office of management and budget and revised annually in accordance with 42<br>U.S.C. 9902(2), applicable to a family of the size involved.50-29-02. Duties of the department. The department shall:1.Prepare, submit, and implement the plan that includes eligibility determinations for<br>self-employed applicants, when adjusted gross income or loss means the adjusted<br>gross income or loss as computed for an individual for federal income tax purposes<br>under the Internal Revenue Code, based on the lower of either:a.The previous one year of adjusted gross income or loss from the business, or if<br>the previous year's federal income tax return has not been filed, from the year<br>prior to that year, less any earned or unearned income on the tax return, plus<br>any current earned or unearned income; orb.The average of the previous three years of adjusted gross income or loss from<br>the business, or if the previous year's federal income tax return has not been<br>filed or the business has been in existence for fewer than three years, from the<br>federal income tax returns from the previous three years that have been filed<br>for the business, less the average of earned or unearned income for each of<br>the years for which federal income tax returns have been filed, plus any current<br>earned or unearned income.If the most recently available federal income tax return does not accurately predict<br>income because the business has been recently established, has been terminated,<br>has been subjected to a severe change such as an uninsured loss or a decrease or<br>increase in the size of the operation, income statements or any other reliable<br>information may be used to compute self-employment income;2.Supervise the administration of the children's health insurance program throughout<br>this state;3.Take action, give directions, and adopt rules as may be necessary or desirable to<br>carry out the provisions of this chapter;4.After federal approval of the plan, apply for a federal waiver allowing plan coverage<br>for a family through an employer-based insurance policy if an employer-based family<br>insurance policy is more cost-effective than the traditional plan coverage for the<br>children;5.Report annually to the legislative council and describe enrollment statistics and costs<br>associated with the plan;Page No. 16.Reimburse counties for expenses incurred in the administration of the children's<br>health insurance program at rates based upon all counties' total administrative costs;<br>and7.Administer all funds appropriated or made available to the department for the<br>purpose of carrying out the provisions of this chapter.50-29-03.Duties of county agency.In the administration of the plan, unless thedepartment otherwise establishes eligibility, the county agency shall:1.Administer the plan under the direction and supervision of the department; and2.Make an investigation and record the circumstances of each applicant, obtaining<br>information as may be required by the department.50-29-04. Plan requirements. The plan:1.Must be provided through private contracts with insurance carriers;2.Must allow conversion to another health insurance policy;3.Must be based on an actuarial equivalent of a benchmark plan;4.Must incorporate every state-required waiver approved by the federal government;5.Must include community-based eligibility outreach services; and6.Must provide:a.A net income eligibility limit of one hundred sixty percent of the poverty line;b.A copayment requirement for each pharmaceutical prescription and for each<br>emergency room visit;c.A deductible for each inpatient hospital visit;d.Coverage for:(1)Inpatient hospital, medical, and surgical services;(2)Outpatient hospital and medical services;(3)Psychiatric and substance abuse services;(4)Prescription medications;(5)Preventive screening services;(6)Preventive dental and vision services; and(7)Prenatal services; ande.A coverage effective date that is the first day of the month, following the date of<br>application and determination of eligibility.50-29-05. Limitations of chapter. Health assistance provided under this chapter is notan entitlement. A person does not have a property interest in any health assistance sought or<br>provided under this chapter. If the department estimates that available funds are insufficient to<br>allow participation by additional applicants, the department may take any action appropriate toPage No. 2avoid commitment of funds in excess of available funds, including denying applications and<br>establishing waiting lists, that is not forbidden by title XXI of the federal Social Security Act [42<br>U.S.C. 1397aa et seq.] or regulations adopted thereunder. If federal children's health insurance<br>program funding decreases, the department may decrease the income eligibility limit to<br>accommodate the decrease in federal funding, notwithstanding any other provisions of this<br>chapter.50-29-06. Grants - Gifts - Donations - Continuing appropriation. The departmentmay accept any gift, grant, or donation, whether conditional or unconditional, for the purpose of<br>providing funds for the children's health insurance program. The department may contract with<br>public or private entities and may expend any moneys available to the department to obtain<br>matching funds for the purposes of this chapter. The department shall seek grants from the<br>academy for health research and health policy state coverage initiative and from any other entity<br>that may award such grants. All moneys received as a gift, grant, or donation under this section<br>are appropriated as a standing and continuing appropriation to the department for the purpose of<br>providing funds for the children's health insurance program.Page No. 3Document Outlinechapter 50-29 children's health insurance program