[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR457.340]



[Page 394]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 457_ALLOTMENTS AND GRANTS TO STATES--Table of Contents

 

Subpart C_State Plan Requirements: Eligibility, Screening, Applications, 

                             and Enrollment

 

Sec.  457.340  Application for and enrollment in a separate child 



health program.



    (a) Application assistance. A State must afford families an 

opportunity to apply for child health assistance without delay, provided 

that the State has not reached an approved enrollment cap, and offer 

assistance to families in understanding and completing applications and 

in obtaining any required documentation.

    (b) Use of social security number. A State may require a social 

security number for each individual requesting services consistent with 

the requirements at Sec.  435.910(b), (e), (f), and (g) of this chapter.

    (c) Notice of rights and responsibilities. A State must inform 

applicants at the time of application, in writing and orally if 

appropriate, about the application and eligibility requirements, the 

time frame for determining eligibility, and the right to review of 

eligibility determinations as described in Sec.  457.1130.

    (d) Timely determinations of eligibility. (1) The agency must 

promptly determine eligibility and issue a notice of decision within the 

time standards established, except in circumstances that are beyond the 

agency's control.

    (2) A State must establish time standards for determining 

eligibility. These standards may not exceed forty-five calendar days 

(excluding days during which the application has been suspended, 

pursuant to Sec.  457.350(f)(1)).

    (3) In applying the time standards, the State must define ``date of 

application'' and must count each calendar day from the date of 

application to the day the agency mails or otherwise provides notice of 

its eligibility decision.

    (e) Notice of decision concerning eligibility. A State must provide 

each applicant or enrollee a written notice of any decision on the 

application or other determination concerning eligibility.

    (1) If eligibility is approved, the notice must include information 

on the enrollee's rights and responsibilities under the program, 

including the opportunity for review of matters described in Sec.  

457.1130.

    (2) If eligibility is denied, suspended or terminated, the State 

must provide notice in accordance with Sec.  457.1180. In the case of a 

suspension or termination of eligibility, the State must provide 

sufficient notice to enable the child's parent or caretaker to take any 

appropriate actions that may be required to allow coverage to continue 

without interruption.

    (f) Effective date of eligibility. A State must specify a method for 

determining the effective date of eligibility for its separate child 

health program, which can be determined based on the date of application 

or through any other reasonable method.



[66 FR 2675, Jan. 11, 2001, as amended at 66 FR 33823, June 25, 2001]