42 U.S.C. § 1397ff — Process for submission, approval, and amendment of State child health plans

(a) Initial plan. (1) In general. To receive payment under section 1397ee(a) or (g), a State must submit to the Secretary a State child health plan meeting this subchapter’s applicable requirements. (2) Approval. Unless the Secretary provides otherwise under (e), the submitted plan is approved for this subchapter and begins in the calendar quarter specified in the plan, but never before October 1, 1997. (b) Plan amendments. (1) In general. A State may amend all or part of its plan at any time by sending a plan amendment. (2) Approval. Unless the Secretary provides otherwise under (e), the amendment is approved for this subchapter and takes effect under (3). (3) Effective dates. (A) Generally, an amendment takes effect on the date or dates stated in it, subject to the rest of this paragraph. (B) Eligibility or benefits. (i) An amendment eliminating or restricting eligibility or benefits cannot take effect unless the State certifies that it gave prior public notice in the form and manner required by State law. (ii) It cannot remain effective for more than 60 days unless the State sent it to the Secretary before that period ends. (C) Other amendments. An amendment not covered by (B) that takes effect in a State fiscal year cannot remain effective after that fiscal year, or after the later end of its first 90 days, unless the State sent it to the Secretary. (c) Disapproval. (1) The Secretary must promptly review submitted plans and amendments for substantial compliance with this subchapter. (2) A plan or amendment is considered approved unless, within 90 days after receiving it, the Secretary gives the State written notice that it is disapproved and why, or that specified additional information is needed. (3) If the Secretary disapproves a plan or amendment, the Secretary must give the State a reasonable chance to correct it before imposing financial sanctions based on the disapproval. (d) Program operation. (1) The State must run the program according to the plan and approved amendments and this subchapter. (2) The Secretary must establish an enforcement process, including withholding funds for substantial noncompliance. Before imposing financial sanctions in an enforcement action, the Secretary must give the State a reasonable chance to correct the problem. (e) Continued approval. An approved plan stays in effect until the State amends it under (b) or the Secretary finds under (d) that it substantially fails to comply with this subchapter.