80 FR 22654 - Eligibility in the States, District of Columbia, the Northern Mariana Islands, and American Samoa

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services

Federal Register Volume 80, Issue 78 (April 23, 2015)

[Federal Register Volume 80, Number 78 (Thursday, April 23, 2015)]
[Rules and Regulations]
[Pages 22654-22655]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-09487]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 435


Eligibility in the States, District of Columbia, the Northern 
Mariana Islands, and American Samoa

CFR Correction

    In Title 42 of the Code of Federal Regulations, Parts 430 to 481, 
revised as of October 1, 2014, on page 198, in Sec.  435.912, revise 
paragraphs (a) and (b); redesignate paragraphs (c), (d), and (e) as 
paragraphs (e), (f), and (g), respectively; and add new paragraphs (c) 
and (d) to read as follows:


Sec.  435.912   Timely determination of eligibility. [Corrected]

    (a) For purposes of this section--
    (1) ``Timeliness standards'' refer to the maximum period of time in 
which every applicant is entitled to a determination

[[Page 22655]]

of eligibility, subject to the exceptions in paragraph (e) of this 
section.
    (2) ``Performance standards'' are overall standards for determining 
eligibility in an efficient and timely manner across a pool of 
applicants, and include standards for accuracy and consumer 
satisfaction, but do not include standards for an individual 
applicant's determination of eligibility.
    (b) Consistent with guidance issued by the Secretary, the agency 
must establish in its State plan timeliness and performance standards 
for, promptly and without undue delay--
    (1) Determining eligibility for Medicaid for individuals who submit 
applications to the single State agency or its designee.
    (2) Determining potential eligibility for, and transferring 
individuals' electronic accounts to, other insurance affordability 
programs pursuant to Sec.  435.1200(e) of this part.
    (3) Determining eligibility for Medicaid for individuals whose 
accounts are transferred from other insurance affordability programs, 
including at initial application as well as at a regularly-scheduled 
renewal or due to a change in circumstances.
    (c)(1) The timeliness and performance standards adopted by the 
agency under paragraph (b) of this section must cover the period from 
the date of application or transfer from another insurance 
affordability program to the date the agency notifies the applicant of 
its decision or the date the agency transfers the individual to another 
insurance affordability program in accordance with Sec.  435.1200(e) of 
this part, and must comply with the requirements of paragraph (c)(2) of 
this section, subject to additional guidance issued by the Secretary to 
promote accountability and consistency of high quality consumer 
experience among States and between insurance affordability programs.
    (2) Timeliness and performance standards included in the State plan 
must account for--
    (i) The capabilities and cost of generally available systems and 
technologies;
    (ii) The general availability of electronic data matching and ease 
of connections to electronic sources of authoritative information to 
determine and verify eligibility;
    (iii) The demonstrated performance and timeliness experience of 
State Medicaid, CHIP and other insurance affordability programs, as 
reflected in data reported to the Secretary or otherwise available; and
    (iv) The needs of applicants, including applicant preferences for 
mode of application (such as through an internet Web site, telephone, 
mail, in-person, or other commonly available electronic means), as well 
as the relative complexity of adjudicating the eligibility 
determination based on household, income or other relevant information.
    (3) Except as provided in paragraph (e) of this section, the 
determination of eligibility for any applicant may not exceed--
    (i) Ninety days for applicants who apply for Medicaid on the basis 
of disability; and
    (ii) Forty-five days for all other applicants.
    (d) The agency must inform applicants of the timeliness standards 
adopted in accordance with this section.
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[FR Doc. 2015-09487 Filed 4-22-15; 8:45 am]
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