42 U.S.C. § 1397gg — Strategic objectives and performance

Page 4494 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397gg 1 So in original. There are two closing parentheses for the opening parenthesis preceding ‘‘relating’’. (Aug. 14, 1935, ch. 531, title XXI, § 2106, as added Pub. L. 105–33, title IV, § 4901(a), Aug. 5, 1997, 111 Stat. 563.) § 1397gg. Strategic objectives and performance goals; plan administration (a) Strategic objectives and performance goals (1) Description A State child health plan shall include a de- scription of— (A) the strategic objectives, (B) the performance goals, and (C) the performance measures, the State has established for providing child health assistance to targeted low-income chil- dren under the plan and otherwise for maxi- mizing health benefits coverage for other low- income children and children generally in the State. (2) Strategic objectives Such plan shall identify specific strategic objectives relating to increasing the extent of creditable health coverage among targeted low-income children and other low-income children. (3) Performance goals Such plan shall specify one or more perform- ance goals for each such strategic objective so identified. (4) Performance measures Such plan shall describe how performance under the plan will be— (A) measured through objective, independ- ently verifiable means, and (B) compared against performance goals, in order to determine the State’s perform- ance under this subchapter. (b) Records, reports, audits, and evaluation (1) Data collection, records, and reports A State child health plan shall include an assurance that the State will collect the data, maintain the records, and furnish the reports to the Secretary, at the times and in the standardized format the Secretary may re- quire in order to enable the Secretary to mon- itor State program administration and com- pliance and to evaluate and compare the effec- tiveness of State plans under this subchapter. (2) State assessment and study A State child health plan shall include a de- scription of the State’s plan for the annual as- sessments and reports under section 1397hh(a) of this title and the evaluation required by section 1397hh(b) of this title. (3) Audits A State child health plan shall include an assurance that the State will afford the Sec- retary access to any records or information re- lating to the plan for the purposes of review or audit. (c) Program development process A State child health plan shall include a de- scription of the process used to involve the pub- lic in the design and implementation of the plan and the method for ensuring ongoing public in- volvement. (d) Program budget A State child health plan shall include a de- scription of the budget for the plan. The descrip- tion shall be updated periodically as necessary and shall include details on the planned use of funds and the sources of the non-Federal share of plan expenditures, including any require- ments for cost-sharing by beneficiaries. (e) Application of certain general provisions The following sections of this chapter shall apply to States under this subchapter in the same manner as they apply to a State under subchapter XIX: (1) Subchapter XIX provisions (A) Section 1396a(a)(4)(C) of this title (relat- ing to conflict of interest standards). (B) Section 1396a(a)(25) of this title (relating to third party liability). (C) Section 1396a(a)(39) of this title (relating to termination of participation of certain pro- viders). (D) Section 1396a(a)(78) of this title (relating to enrollment of providers participating in State plans providing medical assistance on a fee-for-service basis). (E) Section 1396a(a)(72) of this title (relating to limiting FQHC contracting for provision of dental services). (F) Section 1396a(a)(73) of this title (relating to requiring certain States to seek advice from designees of Indian Health Programs and Urban Indian Organizations). (G) Subsections (a)(77) and (kk) of section 1396a of this title (relating to provider and supplier screening, oversight, and reporting requirements). (H) Section 1396a(e)(13) of this title (relating to the State option to rely on findings from an Express Lane agency to help evaluate a child’s eligibility for medical assistance). (I) Section 1396a(e)(14) of this title (relating to income determined using modified adjusted gross income and household income). (J) Paragraphs (5) and (16) of section 1396a(e) of this title (relating to the State option to provide medical assistance consisting of full benefits during pregnancy and throughout the 12-month postpartum period under subchapter XIX),1 if the State provides child health assist- ance for targeted low-income children who are pregnant or to targeted low-income pregnant women and the State has elected to apply such paragraph (16) with respect to pregnant women under subchapter XIX, the provision of assist- ance under the State child health plan or waiver for targeted low-income children or targeted low-income pregnant women during pregnancy and the 12-month postpartum pe- riod shall be required and not at the option of the State and shall include coverage of all items or services provided to a targeted low- income child or targeted low-income pregnant woman (as applicable) under the State child health plan or waiver).1 (K) Section 1396a(e)(12) of this title (relating to 1 year of continuous eligibility for chil- Page 4495 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397gg dren), except that a targeted low-income child enrolled under the State child health plan or waiver may be transferred to the Medicaid program under subchapter XIX for the remain- ing duration of the 12-month continuous eligi- bility period, if the child becomes eligible for full benefits under subchapter XIX during such period. (L) Section 1396a(bb) of this title (relating to payment for services provided by Federally- qualified health centers and rural health clin- ics). (M) Section 1396a(ff) of this title (relating to disregard of certain property for purposes of making eligibility determinations). (N) Paragraphs (2), (16), and (17) of section 1396b(i) of this title (relating to limitations on payment). (O) Section 1396b(m)(3) of this title (relating to limitation on payment with respect to man- aged care). (P) Paragraph (4) of section 1396b(v) of this title (relating to optional coverage of cat- egories of lawfully residing immigrant chil- dren or pregnant women), but only if the State has elected to apply such paragraph with re- spect to such category of children or pregnant women under subchapter XIX. (Q) Section 1396b(w) of this title (relating to limitations on provider taxes and donations). (R) Section 1396r–1a of this title (relating to presumptive eligibility for children). (S) Subsections (a)(2)(C) (relating to Indian enrollment), (d)(5) (relating to contract re- quirement for managed care entities), (d)(6) (relating to enrollment of providers partici- pating with a managed care entity), and (h) (relating to special rules with respect to In- dian enrollees, Indian health care providers, and Indian managed care entities) of section 1396u–2 of this title. (T) Section 1396w–2 of this title (relating to authorization to receive data directly relevant to eligibility determinations). (U) Section 1396w–3(b) of this title (relating to coordination with State Exchanges and the State Medicaid agency). (2) Subchapter XI provisions (A) Section 1315 of this title (relating to waiver authority). (B) Section 1316 of this title (relating to ad- ministrative and judicial review), but only in- sofar as consistent with this subchapter. (C) Section 1320a–3 of this title (relating to disclosure of ownership and related informa- tion). (D) Section 1320a–5 of this title (relating to disclosure of information about certain con- victed individuals). (E) Section 1320a–7a of this title (relating to civil monetary penalties). (F) Section 1320a–7b(d) of this title (relating to criminal penalties for certain additional charges). (G) Section 1320b–2 of this title (relating to periods within which claims must be filed). (f) Limitation of waiver authority Notwithstanding subsection (e)(2)(A) and sec- tion 1315(a) of this title: (1) The Secretary may not approve a waiver, experimental, pilot, or demonstration project that would allow funds made available under this subchapter to be used to provide child health assistance or other health benefits cov- erage to a nonpregnant childless adult or a parent (as defined in section 1397kk(c)(2)(A) of this title), who is not pregnant, of a targeted low-income child. (2) The Secretary may not approve, extend, renew, or amend a waiver, experimental, pilot, or demonstration project with respect to a State after February 4, 2009, that would waive or modify the requirements of section 1397kk of this title. (g) Use of blended risk pools (1) In general Nothing in this subchapter (or any other provision of Federal law) shall be construed as preventing a State from considering children enrolled in a qualified CHIP look-alike pro- gram and children enrolled in a State child health plan under this subchapter (or a waiver of such plan) as members of a single risk pool. (2) Qualified CHIP look-alike program In this subsection, the term ‘‘qualified CHIP look-alike program’’ means a State program— (A) under which children who are under the age of 19 and are not eligible to receive medical assistance under subchapter XIX or child health assistance under this sub- chapter may purchase coverage through the State that provides benefits that are at least identical to the benefits provided under the State child health plan under this sub- chapter (or a waiver of such plan); and (B) that is funded exclusively through non- Federal funds, including funds received by the State in the form of premiums for the purchase of such coverage. (Aug. 14, 1935, ch. 531, title XXI, § 2107, as added Pub. L. 105–33, title IV, § 4901(a), Aug. 5, 1997, 111 Stat. 565; amended Pub. L. 106–554, § 1(a)(6) [title VIII, § 803], Dec. 21, 2000, 114 Stat. 2763, 2763A–582; Pub. L. 109–171, title VI, § 6102(a), Feb. 8, 2006, 120 Stat. 131; Pub. L. 111–3, title I, § 112(a)(2)(A), title II, §§ 203(a)(2), (d)(2), 214(b), title V, §§ 501(d)(2), 503(a)(1), Feb. 4, 2009, 123 Stat. 33, 46, 49, 57, 87, 89; Pub. L. 111–5, div. B, title V, § 5006(b)(2), (d)(2), (e)(2)(B), Feb. 17, 2009, 123 Stat. 506, 510; Pub. L. 111–148, title II, § 2101(d)(2), (e), title VI, § 6401(c), Mar. 23, 2010, 124 Stat. 287, 753; Pub. L. 111–152, title I, § 1004(b)(2)(B), Mar. 30, 2010, 124 Stat. 1034; Pub. L. 111–309, title II, § 205(f)(2), Dec. 15, 2010, 124 Stat. 3291; Pub. L. 114–255, div. A, title V, § 5005(c)(1), Dec. 13, 2016, 130 Stat. 1194; Pub. L. 115–120, div. C, § 3002(g)(1), Jan. 22, 2018, 132 Stat. 35; Pub. L. 115–123, div. E, title XII, § 53102(d)(1), Feb. 9, 2018, 132 Stat. 299; Pub. L. 117–2, title IX, § 9822(a)(1), Mar. 11, 2021, 135 Stat. 220; Pub. L. 117–328, div. FF, title V, §§ 5112(b), 5123(c), Dec. 29, 2022, 136 Stat. 5940, 5946.) AMENDMENT OF SUBSECTION (e)(1)(G) Pub. L. 117–328, div. FF, title V, § 5123(c), (d), Dec. 29, 2022, 136 Stat. 5946, provided that, ef- fective July 1, 2025, subsection (e)(1)(G) of this section is amended by inserting ‘‘and subsection (a)(83) of section 1396a of this title (relating to searchable directories of the providers described in subsection (mm) of such section)’’ before the period at end. See 2022 Amendment note below. Page 4496 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397gg Editorial Notes CODIFICATION Amendment by section 501(d)(2) of Pub. L. 111–3 exe- cuted after amendment by section 214(b) of Pub. L. 111–3 to reflect the probable intent of Congress, not- withstanding section 501(d)(3) of Pub. L. 111–3, set out as an Effective Date of 2009 Amendment note under sec- tion 1396a of this title. AMENDMENTS 2022—Subsec. (e)(1)(G). Pub. L. 117–328, § 5123(c), in- serted ‘‘and subsection (a)(83) of section 1396a of this title (relating to searchable directories of the providers described in subsection (mm) of such section)’’ before period at end. Subsec. (e)(1)(K) to (U). Pub. L. 117–328, § 5112(b), added subpar. (K) and redesignated former subpars. (K) to (T) as (L) to (U), respectively. 2021—Subsec. (e)(1)(J) to (T). Pub. L. 117–2 added sub- par. (J) and redesignated former subpars. (J) to (S) as (K) to (T), respectively. 2018—Subsec. (e)(1)(B) to (S). Pub. L. 115–123 added subpar. (B) and redesignated former subpars. (B) to (R) as (C) to (S), respectively. Subsec. (g). Pub. L. 115–120 added subsec. (g). 2016—Subsec. (e)(1)(B) to (R). Pub. L. 114–255 added subpars. (B), (C), and (L), redesignated former subpars. (B) to (I) as (D) to (K) and (J) to (O) as (M) to (R), re- spectively, and in subpar. (P), as so redesignated, sub- stituted ‘‘(a)(2)(C) (relating to Indian enrollment), (d)(5) (relating to contract requirement for managed care en- tities), (d)(6) (relating to enrollment of providers par- ticipating with a managed care entity), and (h) (relat- ing to special rules with respect to Indian enrollees, In- dian health care providers, and Indian managed care entities)’’ for ‘‘(a)(2)(C) and (h)’’. 2010—Subsec. (e)(1)(D). Pub. L. 111–309, § 205(f)(2)(A), substituted ‘‘(kk)’’ for ‘‘(ii)’’. Pub. L. 111–148, § 6401(c)(2), added subpar. (D). Former subpar. (D) redesignated (E). Subsec. (e)(1)(E). Pub. L. 111–148, § 6401(c)(1), redesig- nated subpar. (D) as (E). Former subpar. (E) redesig- nated (F). Pub. L. 111–148, § 2101(d)(2)(B), added subpar. (E). Former subpar. (E) redesignated (F). Subsec. (e)(1)(F). Pub. L. 111–152, which directed the substitution of ‘‘modified adjusted gross income’’ for ‘‘modified gross income’’ in subpar. (E), as added by section 2101(d)(2) of Pub. L. 111–148, was executed to subpar. (F) to reflect the probable intent of Congress and the redesignation of subpar. (E) as (F) by Pub. L. 111–148, § 6401(c)(1). See below. Pub. L. 111–148, § 6401(c)(1), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). Pub. L. 111–148, § 2101(d)(2)(A), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). Subsec. (e)(1)(G) to (M). Pub. L. 111–148, § 6401(c)(1), re- designated subpars. (F) to (L) as (G) to (M), respec- tively. Former subpar. (M) redesignated (N). Pub. L. 111–148, § 2101(d)(2)(A), redesignated subpars. (F) to (L) as (G) to (M), respectively. Subsec. (e)(1)(N). Pub. L. 111–309 redesignated subpar. (N) relating to section 1396w–3 of this title as (O). Pub. L. 111–148, § 6401(c)(1), redesignated subpar. (M), relating to section 1396w–2 of this title, as (N). Pub. L. 111–148, § 2101(e), added subpar. (N) relating to section 1396w–3(b) of this title. Subsec. (e)(1)(O). Pub. L. 111–309 redesignated subpar. (N) relating to section 1396w–3 of this title as (O). 2009—Subsec. (e)(1). Pub. L. 111–5, § 5006(e)(2)(B)(ii), re- arranged subpars. into alphabetical order. Subsec. (e)(1)(B). Pub. L. 111–5, § 5006(e)(2)(B)(i), redes- ignated subpar. (D) as (B). Former subpar. (B) redesig- nated (D). Pub. L. 111–3, § 203(a)(2), added subpar. (B). Former subpar. (B) redesignated (C). Subsec. (e)(1)(C). Pub. L. 111–5, § 5006(e)(2)(B)(iii), added subpar. (C). Former subpar. (C) redesignated (F). Pub. L. 111–5, § 5006(b)(2)(B), added subpar. (C). Former subpar. (C) redesignated (D). Pub. L. 111–3, § 501(d)(2), added subpar. (C). Former subpar. (C) redesignated (D). Pub. L. 111–3, § 203(a)(2), redesignated subpar. (B) as (C). Former subpar. (C) redesignated (D). Subsec. (e)(1)(D). Pub. L. 111–5, § 5006(e)(2)(B)(i), redes- ignated subpar. (B) as (D). Former subpar. (D) redesig- nated (B). Pub. L. 111–5, § 5006(b)(2)(A), redesignated subpar. (C) as (D). Former subpar. (D) redesignated (E). Pub. L. 111–3, § 503(a)(1), added subpar. (D). Former subpar. (D) redesignated (E). Pub. L. 111–3, § 501(d)(2), redesignated subpar. (C) as (D). Former subpar. (D) redesignated (E). Pub. L. 111–3, § 203(a)(2), redesignated subpar. (C) as (D). Former subpar. (D) redesignated (E). Subsec. (e)(1)(E). Pub. L. 111–5, § 5006(b)(2)(A), redesig- nated subpar. (D) as (E). Former subpar. (E) redesig- nated (F). Pub. L. 111–3, § 503(a)(1), redesignated subpar. (D) as (E). Former subpar. (E) redesignated (F). Pub. L. 111–3, § 501(d)(2), redesignated subpar. (D) as (E). Former subpar. (E) redesignated (F). Pub. L. 111–3, § 214(b), added subpar. (E). Former sub- par. (E) redesignated (F). Pub. L. 111–3, § 203(a)(2), redesignated subpar. (D) as (E). Subsec. (e)(1)(F). Pub. L. 111–5, § 5006(e)(2)(B)(i), redes- ignated subpar. (C) as (F). Former subpar. (F) redesig- nated (G). Pub. L. 111–5, § 5006(b)(2)(A), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). Pub. L. 111–3, § 503(a)(1), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). Pub. L. 111–3, § 501(d)(2), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). Pub. L. 111–3, § 214(b), redesignated subpar. (E) as (F). Former subpar. (F) redesignated (G). Pub. L. 111–3, § 203(d)(2), added subpar. (F). Subsec. (e)(1)(G). Pub. L. 111–5, § 5006(e)(2)(B)(i), redes- ignated subpar. (F) as (G). Former subpar. (G) redesig- nated (I). Pub. L. 111–5, § 5006(b)(2)(A), redesignated subpar. (F) as (G). Former subpar. (G) redesignated (H). Pub. L. 111–3, § 503(a)(1), redesignated subpar. (F) as (G). Former subpar. (G) redesignated (H). Pub. L. 111–3, § 501(d)(2), redesignated subpar. (F) as (G). Former subpar. (G) redesignated (H). Pub. L. 111–3, § 214(b), redesignated subpar. (F) as (G). Subsec. (e)(1)(H). Pub. L. 111–5, § 5006(b)(2)(A), redesig- nated subpar. (G) as (H). Former subpar. (H) redesig- nated (I). Pub. L. 111–3, § 503(a)(1), redesignated subpar. (G) as (H). Former subpar. (H) redesignated (I). Pub. L. 111–3, § 501(d)(2), redesignated subpar. (G) as (H). Subsec. (e)(1)(I). Pub. L. 111–5, § 5006(e)(2)(B)(i), redes- ignated subpar. (G) as (I). Former subpar. (I) redesig- nated (J). Pub. L. 111–5, § 5006(b)(2)(A), redesignated subpar. (H) as (I). Former subpar. (I) redesignated (J). Pub. L. 111–3, § 503(a)(1), redesignated subpar. (H) as (I). Subsec. (e)(1)(J). Pub. L. 111–5, § 5006(e)(2)(B)(i), redes- ignated subpar. (I) as (J). Former subpar. (J) redesig- nated (K). Pub. L. 111–5, § 5006(d)(2)(B), added subpar. (J). Pub. L. 111–5, § 5006(b)(2)(A), redesignated subpar. (I) as (J). Subsec. (e)(1)(K). Pub. L. 111–5, § 5006(e)(2)(B)(i), redes- ignated subpar. (J) as (K). Former subpar. (K) redesig- nated (L). Pub. L. 111–5, § 5006(d)(2)(A), redesignated subpar. (J) as (K). Subsec. (e)(1)(L). Pub. L. 111–5, § 5006(e)(2)(B)(i), redes- ignated subpar. (K) as (L). Subsec. (f). Pub. L. 111–3, § 112(a)(2)(A)(i), substituted ‘‘section 1315(a) of this title:’’ for ‘‘section 1315(a) of this title, the Secretary’’ and inserted par. (1) designa- Page 4497 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1397hh tion and ‘‘The Secretary’’ before ‘‘may not approve a waiver,’’. Subsec. (f)(1). Pub. L. 111–3, § 112(a)(2)(A)(ii), (iii), in- serted ‘‘or a parent (as defined in section 1397kk(c)(2)(A) of this title), who is not pregnant, of a targeted low-income child’’ after ‘‘nonpregnant child- less adult’’ and struck out last sentence which read as follows: ‘‘For purposes of the preceding sentence, a caretaker relative (as such term is defined for purposes of carrying out section 1396u–1 of this title) shall not be considered a childless adult.’’ Subsec. (f)(2). Pub. L. 111–3, § 112(a)(2)(A)(iv), added par. (2). 2006—Subsec. (f). Pub. L. 109–171 added subsec. (f). 2000—Subsec. (e)(1)(D). Pub. L. 106–554 added subpar. (D). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2022 AMENDMENT Amendment by section 5112(b) of Pub. L. 117–328 effec- tive on the first day of the first fiscal quarter that be- gins on or after the date that is 1 year after Dec. 29, 2022, see section 5112(c) of Pub. L. 117–328, set out as a note under section 1396a of this title. Amendment by section 5123(c) of Pub. L. 117–328 effec- tive July 1, 2025, see section 5123(d) of Pub. L. 117–328, set out as a note under section 1396a of this title. EFFECTIVE DATE OF 2021 AMENDMENT Pub. L. 117–2, title IX, § 9822(b), Mar. 11, 2021, 135 Stat. 221, as amended by Pub. L. 117–328, div. FF, title V, § 5113, Dec. 29, 2022, 136 Stat. 5940, provided that: ‘‘The amendments made by subsection (a) [amending this section], shall apply with respect to State elections made under paragraph (16) of section 1902(e) of the So- cial Security Act (42 U.S.C. 1396a(e)), as added by sec- tion 9812(a) of subtitle J of this title [subtitle J (§§ 9811–9819) of title IX of Pub. L. 117–2], beginning on the 1st day of the 1st fiscal year quarter that begins one year after the date of the enactment of this Act [Mar. 11, 2021].’’ [Pub. L. 117–328, div. FF, title V, § 5113, Dec. 29, 2022, 136 Stat. 5940, provided in part that the amendment made by section 5113 to section 9822(b) of Pub. L. 117–2, set out above, is effective as if included in the enact- ment of Pub. L. 117–2.] EFFECTIVE DATE OF 2009 AMENDMENT Amendment by Pub. L. 111–5 effective July 1, 2009, see section 5006(f) of Pub. L. 111–5, set out as a note under section 1396a of this title. Except as otherwise provided, amendment by Pub. L. 111–3 effective Apr. 1, 2009, and applicable to child health assistance and medical assistance provided on or after that date, see section 3 of Pub. L. 111–3, set out as a note under section 1396 of this title. Amendment by section 203(a)(2), (d)(2) of Pub. L. 111–3 effective Feb. 4, 2009, see section 203(f) of Pub. L. 111–3, set out as a note under section 1396a of this title. Amendment by section 501(d)(2) of Pub. L. 111–3 effec- tive Jan. 1, 2009, see section 501(d)(3) of Pub. L. 111–3, set out as a note under section 1396a of this title. Pub. L. 111–3, title V, § 503(a)(2), Feb. 4, 2009, 123 Stat. 89, provided that: ‘‘The amendment made by paragraph (1) [amending this section] shall apply to services pro- vided on or after October 1, 2009.’’ EFFECTIVE DATE OF 2006 AMENDMENT Pub. L. 109–171, title VI, § 6102(d), Feb. 8, 2006, 120 Stat. 132, provided that: ‘‘This section [amending this section and section 1397ee of this title and enacting provisions set out as a note below] and the amendments made by this section shall take effect as if enacted on October 1, 2005, and shall apply to any waiver, experimental, pilot, or demonstration project that is approved on or after that date.’’ CONSTRUCTION OF 2016 AMENDMENT Nothing in amendment by Pub. L. 114–255 to be con- strued as changing or limiting the appeal rights of pro- viders or the process for appeals of States under the So- cial Security Act, see section 5005(d) of Pub. L. 114–255, set out as a note under section 1396a of this title. CONSTRUCTION OF 2006 AMENDMENT Pub. L. 109–171, title VI, § 6102(c), Feb. 8, 2006, 120 Stat. 131, as amended by Pub. L. 111–3, title I, § 112(a)(2)(B), Feb. 4, 2009, 123 Stat. 33, provided that: ‘‘Subject to sec- tion 2111 of the Social Security Act [42 U.S.C. 1397kk], as added by section 112 of the Children’s Health Insur- ance Program Reauthorization Act of 2009 [Pub. L. 111–3], nothing in this section [amending this section and section 1397ee of this title and enacting provisions set out as a note above] or the amendments made by this section shall be construed to— ‘‘(1) authorize the waiver of any provision of title XIX or XXI of the Social Security Act (42 U.S.C. 1396 et seq., 1397aa et seq.) that is not otherwise author- ized to be waived under such titles or under title XI of such Act (42 U.S.C. 1301 et seq.) as of the date of en- actment of this Act [Feb. 8, 2006]; ‘‘(2) imply congressional approval of any waiver, ex- perimental, pilot, or demonstration project affecting funds made available under the State children’s health insurance program under title XXI of the So- cial Security Act (42 U.S.C. 1397aa et. seq.) or any amendment to such a waiver or project that has been approved as of such date of enactment; or ‘‘(3) apply to any waiver, experimental, pilot, or demonstration project that would allow funds made available under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) to be used to provide child health assistance or other health benefits coverage to a nonpregnant childless adult that is approved before the date of enactment of this Act or to any extension, renewal, or amendment of such a waiver or project that is approved on or after such date of enactment.’’ § 1397hh. Annual reports; evaluations (a) Annual report Subject to subsection (e), the State shall— (1) assess the operation of the State plan under this subchapter in each fiscal year, in- cluding the progress made in reducing the number of uncovered low-income children; and (2) report to the Secretary, by January 1 fol- lowing the end of the fiscal year, on the result of the assessment. (b) State evaluations (1) In general By March 31, 2000, each State that has a State child health plan shall submit to the Secretary an evaluation that includes each of the following: (A) An assessment of the effectiveness of the State plan in increasing the number of children with creditable health coverage. (B) A description and analysis of the effec- tiveness of elements of the State plan, in- cluding— (i) the characteristics of the children and families assisted under the State plan in- cluding age of the children, family income, and the assisted child’s access to or cov- erage by other health insurance prior to the State plan and after eligibility for the State plan ends, (ii) the quality of health coverage pro- vided including the types of benefits pro- vided, (iii) the amount and level (including pay- ment of part or all of any premium) of as- sistance provided by the State,