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sharing, and moved administration of the program to the Pennsylvania Insurance Department.

• The second amendment, approved on March 7, 2000, expanded the income eligibility by allowing a work expense deduction and day-care expenses to be subtracted from gross earnings.

• The third amendment, also approved on March 7, 2000, expanded the benefit package by including outpatient mental health services, disposable medical supplies, inpatient and outpatient substance abuse services, and rehabilitation services.

• The fourth amendment, submitted on September 22, 2000, expanded the benefit package to include prenatal care and pre-pregnancy family services and supplies.

• Pennsylvania submitted its fifth amendment on June 28, 2002. This amendment updated and amended the CHIP state plan to indicate the State's compliance with the final CHIP regulations.

• The sixth amendment was submitted on December 19, 2003. This amendment increased the work income disregard from $90 per month to $120 per month to be consistent with the State’s Medicaid Program.

• The seventh amendment was submitted on November 20, 2006. This amendment made the following changes to the State plan:

• Expanded health insurance coverage to children from 200 percent of the Federal poverty level (FPL) to 300 percent of the FPL.

• Added monthly premiums to children above 200 percent and at or below 300 percent of the FPL.

• Added co-payments for physician visits (other than preventive and diagnostic dental services, vision services, well-baby-well-child, immunizations, or emergency care that results in admissions) for children above 200 percent of the FPL as follows:

o $5 for non-well primary care visits, o $10 for specialists, o $25 for emergency care, o $6 for generic prescriptions, and o $9 for brand name prescriptions.

SPA #7 made the following modifications to benefits:

• Added counseling, education and related services to prevent and address the consequences of at-risk behavior related to sexually transmitted diseases and pregnancy; • Clarified that inpatient services limits of 90 days per year includes both physical and mental health; • Clarified that inpatient substance abuse detoxification is limited to seven days per incident and 4 incidents per lifetime;