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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: 53 9.8. The state assures, to the extent they apply, that the following provisions of the Social Security Act will apply under Title XXI, to the same extent they apply to a state under Title XIX: (Section 2107(e)) (42CFR 457.135)

9.8.1.

Section 1902(a)(4)(C) (relating to conflict of interest standards) 9.8.2.

Paragraphs (2), (16) and (17) of Section 1903(i) (relating to limitations on payment) 9.8.3.

Section 1903(w) (relating to limitations on provider donations and taxes) 9.8.4.

Section 1132 (relating to periods within which claims must be filed)

9.9. Describe the process used by the state to accomplish involvement of the public in the design and implementation of the plan and the method for insuring ongoing public involvement. (Section 2107(c)) (42CFR 457.120(a) and (b))

A Task Force was appointed by the Secretary of the North Carolina Department of Health and Human Services to develop recommendations for implementation of the Title XXI Children's Health Plan. Membership of the Task Force included state government officials, local government officials, health care providers from the private sector, recipient advocates, insurance company representatives, Health Maintenance Organization representatives, and various other interested parties. The Task Force worked closely with local advisory groups comprised of representation from county level departments of Social Services, local health departments, area Mental Health agencies (now referred to as Local Management Entities), etc. A copy of the Task Force report can be found at http://www.dhhs.state.nc.us/dma/CHIP/task.htm. In addition, some 10 public meetings were held across the state before the General Assembly met to consider the Title XXI plan. The General Assembly met for six weeks in special session to consider only the Title XXI plan. The session was the subject of intense public scrutiny and input.

The General Assembly established the Governor’s Commission on Children with Special Health Care Needs to assure that the needs of this population are being met. The entire Title XXI program is also subject to monitoring by the Joint Legislative Health Care Oversight Committee.

In addition, an Outreach Advisory Panel was appointed with the ongoing responsibility of assuring public involvement in the program. The Outreach Advisory Panel (as described in Section 5) is designed to maximize public involvement from provider groups, local programs, and an inclusive cadre of racial and ethnic groups. Subsets of each racial and ethnic group have