--- kind: "section" citation: "42 U.S.C. § 1397ff" title: "42" title_heading: "The Public Health and Welfare" number: "1397ff" heading: "Process for submission, approval, and amendment of State child health plans" release: "119-102" url: "https://uscodex.org/usc/42/1397ff" units: - "Chapter 7 — Social Security" - "Subchapter XXI — State Children’s Health Insurance Program" --- # §1397ff. Process for submission, approval, and amendment of State child health plans - (a) **Initial plan—** - (1) **In general—** As a condition of receiving payment under subsection (a) or (g) of [section 1397ee of this title](/usc/42/1397ee.md), a [State](/usc/42/1397n–12.md?p=6) shall submit to the [Secretary](/usc/42/1301.md?p=a-6) a [State child health plan](/usc/42/1397jj.md?p=c-7) that meets the applicable requirements of this subchapter. - (2) **Approval—** Except as the [Secretary](/usc/42/1301.md?p=a-6) may provide under [subsection (e)](#e), a [State](/usc/42/1397n–12.md?p=6) plan submitted under [paragraph (1)](#a-1)— - (A) shall be approved for purposes of this subchapter, and - (B) shall be effective beginning with a calendar quarter that is specified in the plan, but in no case earlier than October 1, 1997. - (b) **Plan amendments—** - (1) **In general—** A [State](/usc/42/1397n–12.md?p=6) may amend, in whole or in part, its [State child health plan](/usc/42/1397jj.md?p=c-7) at any time through transmittal of a plan amendment. - (2) **Approval—** Except as the [Secretary](/usc/42/1301.md?p=a-6) may provide under [subsection (e)](#e), an amendment to a [State](/usc/42/1397n–12.md?p=6) plan submitted under [paragraph (1)](#b-1)— - (A) shall be approved for purposes of this subchapter, and - (B) shall be effective as provided in [paragraph (3)](#b-3). - (3) **Effective dates for amendments—** - (A) **In general—** Subject to the succeeding provisions of this paragraph, an amendment to a [State](/usc/42/1397n–12.md?p=6) plan shall take effect on one or more effective dates specified in the amendment. - (B) **Amendments relating to eligibility or benefits—** - (i) **Notice requirement—** Any plan amendment that eliminates or restricts eligibility or benefits under the plan may not take effect unless the [State](/usc/42/1397n–12.md?p=6) certifies that it has provided prior public notice of the change, in a form and manner provided under applicable [State](/usc/42/1397n–12.md?p=6) law. - (ii) **Timely transmittal—** Any plan amendment that eliminates or restricts eligibility or benefits under the plan shall not be effective for longer than a 60-day period unless the amendment has been transmitted to the [Secretary](/usc/42/1301.md?p=a-6) before the end of such period. - (C) **Other amendments—** Any plan amendment that is not described in [subparagraph (B)](#b-3-B) and that becomes effective in a [State](/usc/42/1397n–12.md?p=6) fiscal year may not remain in effect after the end of such fiscal year (or, if later, the end of the 90-day period on which it becomes effective) unless the amendment has been transmitted to the [Secretary](/usc/42/1301.md?p=a-6). - (c) **Disapproval of plans and plan amendments—** - (1) **Prompt review of plan submittals—** The [Secretary](/usc/42/1301.md?p=a-6) shall promptly review [State](/usc/42/1397n–12.md?p=6) plans and plan amendments submitted under this section to determine if they substantially comply with the requirements of this subchapter. - (2) **90-day approval deadlines—** A [State](/usc/42/1397n–12.md?p=6) plan or plan amendment is considered approved unless the [Secretary](/usc/42/1301.md?p=a-6) notifies the [State](/usc/42/1397n–12.md?p=6) in writing, within 90 days after receipt of the plan or amendment, that the plan or amendment is disapproved (and the reasons for disapproval) or that specified additional information is needed. - (3) **Correction—** In the case of a disapproval of a plan or plan amendment, the [Secretary](/usc/42/1301.md?p=a-6) shall provide a [State](/usc/42/1397n–12.md?p=6) with a reasonable opportunity for correction before taking financial sanctions against the [State](/usc/42/1397n–12.md?p=6) on the basis of such disapproval. - (d) **Program operation—** - (1) **In general—** The [State](/usc/42/1397n–12.md?p=6) shall conduct the [program](/usc/42/274l–1.md?p=4) in accordance with the plan (and any amendments) approved under [subsection (c)](#c) and with the requirements of this subchapter. - (2) **Violations—** The [Secretary](/usc/42/1301.md?p=a-6) shall establish a process for enforcing requirements under this subchapter. Such process shall provide for the withholding of [funds](/usc/42/12854.md?p=3) in the case of substantial noncompliance with such requirements. In the case of an [enforcement action](/usc/42/247d–6d.md?p=c-5-B-i) against a [State](/usc/42/1397n–12.md?p=6) under this paragraph, the [Secretary](/usc/42/1301.md?p=a-6) shall provide a [State](/usc/42/1397n–12.md?p=6) with a reasonable opportunity for correction before taking financial sanctions against the [State](/usc/42/1397n–12.md?p=6) on the basis of such an action. - (e) **Continued approval—** An approved [State child health plan](/usc/42/1397jj.md?p=c-7) shall continue in effect unless and until the [State](/usc/42/1397n–12.md?p=6) amends the plan under [subsection (b)](#b) or the [Secretary](/usc/42/1301.md?p=a-6) finds, under [subsection (d)](#d), substantial noncompliance of the plan with the requirements of this subchapter. ## Source credit (Aug. 14, 1935, ch. 531, title XXI, § 2106, as added Pub. L. 105–33, title IV, § 4901(a), Aug. 5, 1997, 111 Stat. 563; amended Pub. L. 119–21, title VII, § 71401(b)(3), July 4, 2025, 139 Stat. 332.) ## Notes ### Editorial Notes ### Amendments 2025—Subsec. (a)(1). Pub. L. 119–21 inserted “subsection (a) or (g) of” before “section 1397ee of this title”.