61956 Federal Register / Vol

61956 Federal Register / Vol. 67, No. 191 / Wednesday, October 2, 2002 / Rules and Regulations DEPARTMENT OF HEALTH AND I. Background income child, and her child would HUMAN SERVICES Section 4901 of the Balanced Budget benefit from needed prenatal care and Act, (Pub. L. 105–33), as amended by delivery services by virtue of the Centers for Medicare and Medicaid Public Law 105–100, added title XXI to mother’s eligibility status, a pregnant Services the Act. Title XXI authorizes the State woman over age 19 could not be eligible Children’s Health Insurance Program as a targeted low-income child. 42 CFR Part 457 We stated that the proposed definition (SCHIP) to assist State efforts to initiate would provide States with the option to and expand the provision of child consider an unborn child to be a [CMS–2127–F] health assistance to uninsured, low- targeted low-income child and therefore income children. Under title XXI, States eligible for SCHIP if other applicable RIN 0938–AL37 may provide child health assistance State eligibility requirements are met. primarily for obtaining health benefits This would permit States to ensure that State Children’s Health Insurance coverage through (1) a separate child Program; Eligibility for Prenatal Care needed services are available to benefit health program that meets the unborn children independent of the and Other Health Services for Unborn requirements specified under section Children mother’s eligibility status. We also 2103 of the Act; (2) expanding eligibility discussed in detail the Department’s AGENCY: Centers for Medicare & for benefits under the State’s Medicaid 1999 report, Trends in the Well-Being of Medicaid Services (CMS), HHS. plan under title XIX of the Act; or (3) America’s Children and Youth, which a combination of the two approaches. ACTION: Final rule. describes the benefits of prenatal care To be eligible for funds under this for the mother and the child. We stated SUMMARY: In order to provide prenatal program, States must submit a State that our proposed revisions were care and other health services, this final child health plan (State plan), that intended to benefit both the unborn rule revises the definition of ‘‘child’’ meets the applicable requirements of children and their mothers by under the State Children’s Health title XXI and is approved by the promoting continuity of important Insurance Program (SCHIP) to clarify Secretary. medical care. that an unborn child may be considered Benefits under SCHIP are jointly In order to protect against the a ‘‘targeted low-income child’’ by the financed by the Federal and State substitution of title XXI enhanced State and therefore eligible for SCHIP if governments and are administered by payments for Medicaid payments, we other applicable State eligibility the States. Within broad Federal proposed to add a new paragraph (a)(3) requirements are met. Under this guidelines, each State determines the to § 457.626(a), Prevention of duplicate definition, the State may elect to extend design of its program, eligibility groups, payments, to clarify that payment is not eligibility to unborn children for health benefit packages, payment levels for available under title XXI when payment benefits coverage, including prenatal coverage, and administrative and may be reasonably expected to be made care and delivery, consistent with operating procedures. Under section under Medicaid on the basis of the SCHIP requirements. 2102(b) of the Act, States have Medicaid eligibility or enrollment of the discretion to adopt eligibility standards EFFECTIVE DATE: These regulations are pregnant woman. that are related to age, and thus may effective on November 1, 2002. With regard to maintenance of effort extend SCHIP eligibility only to certain requirements, we proposed that if a FOR FURTHER INFORMATION CONTACT: age groups of targeted low-income State elects to include unborn children Kathleen Farrell, (410) 786–1236. children (who must be under age 19). in the SCHIP definition of children, the SUPPLEMENTARY INFORMATION: Copies: To SCHIP provides a capped amount of State must also apply that same order copies of the Federal Register funds to States on a matching basis for interpretation in assessing compliance containing this document, send your Federal fiscal years (FY) 1998 through with the Medicaid maintenance of effort request to: New Orders, Superintendent 2007. Regulations implementing SCHIP provision of section 2105(d)(1) of the of Documents, PO Box 371954, are set forth at 42 CFR 457. Act. Specifically, we proposed to revise Pittsburgh, PA 15250–7954. Specify the § 457.622, Rate of Federal Financial II. Provisions of the Proposed date of the issue requested and enclose Participation (FFP) for State Regulations a check or money order payable to the expenditures, to provide that the State Superintendent of Documents, or On March 5, 2002, we published a does not adopt eligibility standards and enclose your Visa or Master Card proposed rule in the Federal Register methodologies for purposes of number and expiration date. Credit card that proposed to revise the definition of determining a child’s eligibility under orders can also be placed by calling the ‘‘child’’ under the SCHIP program (67 the Medicaid State plan that were more order desk at (202) 512–1800 or by FR 9936). In the interest of providing restrictive than those applied under faxing to (202) 512–2250. The cost for necessary prenatal care and other health policies of the State plan in effect on each copy is $9. As an alternative, you services to children, we proposed to June 1, 1997. This limitation applies can view and photocopy the Federal clarify and expand the definition of the also to more restrictive standards and Register document at most libraries term ‘‘child’’ so that a State may elect methodologies for determining designated as Federal Depository to make individuals in the period eligibility for services for a child based Libraries and at many other public and between conception and birth eligible on the eligibility of a pregnant woman. academic libraries throughout the for coverage under the State plan. We also stated that, a State that country that receive the Federal Specifically, we proposed to revise the defines children under SCHIP to Register. definition at § 457.10 to clarify that include unborn children would need to This Federal Register document is ‘‘child’’ means an individual under the apply the same definition in the screen- also available from the Federal Register age of 19 and may include any period and-enroll process described in SCHIP online database through GPO access, a of time from conception to birth up to regulations at § 457.350, Eligibility service of the U.S. Government Printing age 19. In this rule, we explained that screening and facilitation of Medicaid Office. The Web site address is http:// while a pregnant woman under age 19 enrollment. We proposed to add a new www.access.gpo.gov/nara/index.html. could be eligible as a targeted low- § 457.350(b)(2) to clarify that screening VerDate Sep<04>2002 18:39 Oct 01, 2002 Jkt 200001 PO 00000 Frm 00002 Fmt 4701 Sfmt 4700 E:\FR\FM\02OCR2.SGM 02OCR2 Federal Register / Vol. 67, No. 191 / Wednesday, October 2, 2002 / Rules and Regulations 61957 procedures must identify any applicant appropriate legal protection, before as expands them by offering important or enrollee who would be potentially well as after birth. Other commenters health care that may not otherwise be eligible for Medicaid services based on viewed the proposed rule as available to her. the eligibility of his or her mother under empowering lower-income women to In general, patient education literature one of the poverty level groups choose life for their children and affirms that prenatal care benefits both described in section 1902(l) of the Act, enhance their ability to raise their the mother and the unborn child. For section 1931 of the Act, or a Medicaid families with dignity. example, the Web site of the American demonstration project approved under Many commenters expressed College of Obstetricians and section 1115 of the Act. opposing views on this issue, saying Gynecologists (ACOG) provides excerpts We noted that under our proposed that this is an anti-choice proposal from its patient education material. regulation, States would continue to disguised as a health care proposal. ACOG Education Pamphlet AP098— have the authority to set eligibility Commenters considered the proposal as Special Tests for Monitoring Fetal requirements under their State plans, the Administration’s attempt to create Health explains that, ‘‘[e]arly prenatal including age limits so long as the age legal precedent for viewing unborn care gives your doctor a chance to check limit is under 19 years of age. Hence, children as separate physical and legal on your health and the progress of your States would not be required to extend entities, which they believe devalues pregnancy. Based on the results of coverage to this population. States that women as persons and is routine prenatal care, your doctor may opt to extend eligibility to unborn counterproductive to the health and suggest tests to check the health of the children must submit a State plan well being of both women and children. baby. Most of the time, these tests help amendment in accordance with Commenters stated that the underlying assure you and your doctor that all is § 457.60. States can use the preprinted purpose of the proposed rule is to going well. Monitoring helps you and application template for the State advance fetal personhood and deny the your doctor during your pregnancy by Children’s Health Insurance Program, right of every woman to determine the telling more about the well being of the sections 4.1.2 and 4.4, and the direction of her own life.

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