42 C.F.R. Subpart G—Strategic Planning, Reporting, and Evaluation
Title 42 - Public Health
Source: 66 FR 2683, Jan. 11, 2001, unless otherwise noted.
(a) Statutory basis. This subpart implements— (1) Sections 2107(a), (b) and (d) of the Act, which set forth requirements for strategic planning, reports, and program budgets; and (2) Section 2108 of the Act, which sets forth provisions regarding annual reports and evaluation. (b) Scope. This subpart sets forth requirements for strategic planning, monitoring, reporting and evaluation under title XXI. (c) Applicability. The requirements of this subpart apply to separate child health programs and Medicaid expansion programs. (a) Plan description. A State plan must include a description of— (1) The strategic objectives as described in paragraph (b) of this section; (2) The performance goals as described in paragraph (c) of this section; and (3) The performance measurements, as described in paragraph (d) of this section, that the State has established for providing child health assistance to targeted low-income children under the plan and otherwise for maximizing health benefits coverage for other low-income children and children generally in the State. (b) Strategic objectives. The State plan must identify specific strategic objectives relating to increasing the extent of creditable health coverage among targeted low-income children and other low-income children. (c) Performance goals. The State plan must specify one or more performance goals for each strategic objective identified. (d) Performance measurements. The State plan must describe how performance under the plan is— (1) Measured through objective, independently verifiable means; and (2) Compared against performance goals. (e) Core elements. The State's strategic objectives, performance goals and performance measures must include a common core of national performance goals and measures consistent with the data collection, standard methodology, and verification requirements, as developed by the Secretary. A State plan must include an assurance that the State collects data, maintains records, and furnishes reports to the Secretary, at the times and in the standardized format the Secretary may require to enable the Secretary to monitor State program administration and compliance and to evaluate and compare the effectiveness of State plans under title XXI. This includes collection of data and reporting as required under §431.970 of this chapter. [70 FR 58276, Oct. 5, 2005] (a) Required quarterly reports. A State must submit reports to CMS that contain quarterly program expenditures and statistical data no later than 30 days after the end of each quarter of the Federal fiscal year. A State must collect required data beginning on the date of implementation of the approved State plan. Territories are exempt from the definition of “State” for purposes of the required quarterly reporting under this section. The quarterly reports must include data on— (1) Program expenditures; (2) The number of children enrolled in the title XIX Medicaid program, the separate child health program, and the Medicaid expansion program, as applicable, as of the last day of each quarter of the Federal fiscal year; and (3) The number of children under 19 years of age who are enrolled in the title XIX Medicaid program, the separate child health program, and in the Medicaid expansion program, as appropriate, by the following categories: (i) Age (under 1 year of age, 1 through 5 years of age, 6 through 12 years of age, and 13 through 18 years of age). (ii) Gender, race, and ethnicity. (iii) Service delivery system (managed care, fee-for-service, and primary care case management). (iv) Family income as a percentage of the Federal poverty level as described in paragraph (b) of this section. (b) Reportable family income categories. (1) A State that does not impose cost sharing or a State that imposes cost sharing based on a fixed percentage of income must report by two family income categories: (i) At or below 150 percent of FPL. (ii) Over 150 percent of FPL. (2) A State that imposes a different level or percentage of cost sharing at different poverty levels must report by poverty level categories that match the poverty level categories used for purposes of cost sharing. (c) Required unduplicated counts. Thirty days after the end of the Federal fiscal year, the State must submit an unduplicated count for the Federal fiscal year of children who were enrolled in the Medicaid program, the separate child health program, and the Medicaid expansion program, as appropriate, by age, gender, race, ethnicity, service delivery system, and poverty level categories described in paragraphs (a) and (b) of this section. (a) Report required for each Federal fiscal year. A State must report to CMS by January 1 following the end of each Federal fiscal year, on the results of the State's assessment of the operation of the State plan. (b) Contents of annual report. In the annual report required under paragraph (a) of this section, a State must— (1) Describe the State's progress in reducing the number of uncovered, low-income children and; in meeting other strategic objectives and performance goals identified in the State plan; and provide information related to a core set of national performance goals and measures as developed by the Secretary; (2) Report on the effectiveness of the State's policies for discouraging the substitution of public coverage for private coverage; (3) Identify successes and barriers in State plan design and implementation, and the approaches the State is considering to overcome these barriers; (4) Describe the State's progress in addressing any specific issues (such as outreach) that the State plan proposed to periodically monitor and assess; (5) Provide an updated budget for a 3-year period that describes those elements required in §457.140, including any changes in the sources of the non-Federal share of State plan expenditures; (6) Identify the total State expenditures for family coverage and total number of children and adults, respectively, covered by family coverage during the preceding Federal fiscal year; (7) Describe the State's current income standards and methodologies for its Medicaid expansion program, separate child health program, and title XIX Medicaid program, as appropriate. (c) Methodology for estimate of number of uninsured, low-income children. (1) To report on the progress made in reducing the number of uninsured, low-income children as required in paragraph (b) of this section, a State must choose a methodology to establish an initial baseline estimate of the number of low-income children who are uninsured in the State. (i) A State may base the estimate on data from— (A) The March supplement to the Current Population Survey (CPS); (B) A State-specific survey; (C) A statistically adjusted CPS; or (D) Another appropriate source. (ii) If the State does not base the estimate on data from the March supplement to the CPS, the State must submit a description of the methodology used to develop the initial baseline estimate and the rationale for its use. (2) The State must provide an annual estimate of changes in the number of uninsured in the State using— (i) The same methodology used in establishing the initial baseline; or (ii) Another methodology based on new information that enables the State to establish a new baseline. (3) If a new methodology is used, the State must also provide annual estimates based on either the March supplement to the CPS or the methodology used to develop the initial baseline. [66 FR 2683, Jan. 11, 2001, as amended at 66 FR 33824, June 25, 2001]
Title 42: Public Health
PART 457—ALLOTMENTS AND GRANTS TO STATES
Subpart G—Strategic Planning, Reporting, and Evaluation
§ 457.700 Basis, scope, and applicability.
§ 457.710 State plan requirements: Strategic objectives and performance goals.
§ 457.720 State plan requirement: State assurance regarding data collection, records, and report.
§ 457.740 State expenditures and statistical reports.
§ 457.750 Annual report.
