---
kind: "section"
citation: "42 U.S.C. § 1397hh"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1397hh"
heading: "Annual reports; evaluations"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1397hh"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XXI — State Children’s Health Insurance Program"
---

# §1397hh. Annual reports; evaluations

- (a) **Annual report—** Subject to [subsection (e)](#e), the [State](/usc/42/619.md?p=5) shall—
  - (1) assess the operation of the [State](/usc/42/619.md?p=5) plan under this subchapter in each [fiscal year](/usc/42/619.md?p=3), [including](/usc/42/1301.md?p=b) the progress made in reducing the number of uncovered low-income children; and
  - (2) report to the [Secretary](/usc/42/1301.md?p=a-6), by January 1 following the end of the [fiscal year](/usc/42/619.md?p=3), on the result of the assessment.
- (b) **State evaluations—**
  - (1) **In general—** By March 31, 2000, each [State](/usc/42/619.md?p=5) that has a [State child health plan](/usc/42/1397jj.md?p=c-7) shall submit to the [Secretary](/usc/42/1301.md?p=a-6) an evaluation that [includes](/usc/42/1301.md?p=b) each of the following:
    - (A) An assessment of the effectiveness of the [State](/usc/42/619.md?p=5) plan in increasing the number of children with [creditable health coverage](/usc/42/1397jj.md?p=c-2).
    - (B) A description and analysis of the effectiveness of elements of the [State](/usc/42/619.md?p=5) plan, [including](/usc/42/1301.md?p=b)—
      - (i) the characteristics of the children and families assisted under the [State](/usc/42/619.md?p=5) plan [including](/usc/42/1301.md?p=b) age of the children, family income, and the assisted [child](/usc/42/1382c.md?p=c)’s access to or coverage by other health insurance prior to the [State](/usc/42/619.md?p=5) plan and after eligibility for the [State](/usc/42/619.md?p=5) plan ends,
      - (ii) the quality of health coverage provided [including](/usc/42/1301.md?p=b) the types of benefits provided,
      - (iii) the amount and level ([including](/usc/42/1301.md?p=b) payment of part or all of any premium) of assistance provided by the [State](/usc/42/619.md?p=5),
      - (iv) the service area of the [State](/usc/42/619.md?p=5) plan,
      - (v) the time limits for coverage of a [child](/usc/42/1382c.md?p=c) under the [State](/usc/42/619.md?p=5) plan,
      - (vi) the [State](/usc/42/619.md?p=5)’s choice of health benefits coverage and other methods used for providing [child health assistance](/usc/42/1397jj.md?p=a), and
      - (vii) the sources of non-Federal funding used in the [State](/usc/42/619.md?p=5) plan.
    - (C) An assessment of the effectiveness of other public and private programs in the [State](/usc/42/619.md?p=5) in increasing the availability of affordable quality individual and family health insurance for children.
    - (D) A review and assessment of [State](/usc/42/619.md?p=5) activities to coordinate the plan under this subchapter with other public and private programs providing health care and health care financing, [including](/usc/42/1301.md?p=b) medicaid and maternal and [child](/usc/42/1382c.md?p=c) health services.
    - (E) An analysis of changes and trends in the [State](/usc/42/619.md?p=5) that affect the provision of accessible, affordable, quality health insurance and health care to children.
    - (F) A description of any plans the [State](/usc/42/619.md?p=5) has for improving the availability of health insurance and health care for children.
    - (G) Recommendations for improving the program under this subchapter.
    - (H) Any other matters the [State](/usc/42/619.md?p=5) and the [Secretary](/usc/42/1301.md?p=a-6) consider appropriate.
  - (2) **Report of the Secretary—** The [Secretary](/usc/42/1301.md?p=a-6) shall submit to Congress and make available to the public by December 31, 2001, a report based on the evaluations submitted by [States](/usc/42/619.md?p=5) under [paragraph (1)](#b-1), containing any conclusions and recommendations the [Secretary](/usc/42/1301.md?p=a-6) considers appropriate.
- (c) **Federal evaluation—**
  - (1) **In general—** The [Secretary](/usc/42/1301.md?p=a-6), directly or through contracts or interagency agreements, shall conduct an independent evaluation of 10 [States](/usc/42/619.md?p=5) with approved [child](/usc/42/1382c.md?p=c) [health plans](/usc/42/1320d.md?p=5).
  - (2) **Selection of States—** In selecting [States](/usc/42/619.md?p=5) for the evaluation conducted under this subsection, the [Secretary](/usc/42/1301.md?p=a-6) shall choose 10 [States](/usc/42/619.md?p=5) that utilize diverse approaches to providing [child health assistance](/usc/42/1397jj.md?p=a), represent various geographic areas ([including](/usc/42/1301.md?p=b) a mix of rural and urban areas), and contain a significant portion of uncovered children.
  - (3) **Matters included—** In addition to the elements described in [subsection (b)(1)](#b-1), the evaluation conducted under this subsection shall include each of the following:
    - (A) Surveys of the target population (enrollees, disenrollees, and individuals eligible for but not enrolled in the program under this subchapter).
    - (B) Evaluation of effective and ineffective outreach and enrollment [practices](/usc/42/17061.md?p=19) with respect to children (for both the program under this subchapter and the medicaid program under subchapter XIX), and identification of enrollment barriers and key elements of effective outreach and enrollment [practices](/usc/42/17061.md?p=19), [including](/usc/42/1301.md?p=b) [practices](/usc/42/17061.md?p=19) (such as through community health workers and others) that have successfully enrolled hard-to-reach populations such as children who are eligible for medical assistance under subchapter XIX but have not been enrolled previously in the medicaid program under that subchapter.
    - (C) Evaluation of the extent to which [State](/usc/42/619.md?p=5) medicaid eligibility [practices](/usc/42/17061.md?p=19) and procedures under the medicaid program under subchapter XIX are a barrier to the enrollment of children under that program, and the extent to which coordination (or lack of coordination) between that program and the program under this subchapter affects the enrollment of children under both programs.
    - (D) An assessment of the effect of cost-sharing on utilization, enrollment, and coverage retention.
    - (E) Evaluation of disenrollment or other retention issues, such as switching to private coverage, failure to pay premiums, or barriers in the recertification process.
  - (4) **Submission to Congress—** Not later than December 31, 2001, the [Secretary](/usc/42/1301.md?p=a-6) shall submit to Congress the results of the evaluation conducted under this subsection.
  - (5) **Subsequent evaluation using updated information—**
    - (A) **In general—** The [Secretary](/usc/42/1301.md?p=a-6), directly or through contracts or interagency agreements, shall conduct an independent subsequent evaluation of 10 [States](/usc/42/619.md?p=5) with approved [child](/usc/42/1382c.md?p=c) [health plans](/usc/42/1320d.md?p=5).
    - (B) **Selection of States and matters included—** Paragraphs [(2)](#c-2) and [(3)](#c-3) shall apply to such subsequent evaluation in the same manner as such provisions apply to the evaluation conducted under [paragraph (1)](#c-1).
    - (C) **Submission to Congress—** Not later than December 31, 2011, the [Secretary](/usc/42/1301.md?p=a-6) shall submit to Congress the results of the evaluation conducted under this paragraph.
    - (D) **Funding—** Out of any money in the Treasury of the [United States](/usc/42/1301.md?p=a-2) not otherwise appropriated, there are appropriated $10,000,000 for [fiscal year](/usc/42/619.md?p=3) 2010 for the purpose of conducting the evaluation authorized under this paragraph. Amounts appropriated under this subparagraph shall remain available for expenditure through [fiscal year](/usc/42/619.md?p=3) 2012.
- (d) **Access to records for IG and GAO audits and evaluations—** For the purpose of evaluating and auditing the program established under this subchapter, or subchapter XIX, the [Secretary](/usc/42/1301.md?p=a-6), the Office of Inspector General, and the Comptroller General shall have access to any books, accounts, records, correspondence, and other documents that are related to the expenditure of Federal funds under this subchapter and that are in the possession, custody, or control of [States](/usc/42/619.md?p=5) receiving Federal funds under this subchapter or political subdivisions thereof, or any grantee or contractor of such [States](/usc/42/619.md?p=5) or political subdivisions.
- (e) **1 Information required for inclusion in State annual report—** The [State](/usc/42/619.md?p=5) shall include the following information in the annual report required under [subsection (a)](#a):
  - (1) Eligibility criteria, enrollment, and retention data ([including](/usc/42/1301.md?p=b) data with respect to continuity of coverage or duration of benefits).
  - (2) Data regarding the extent to which the [State](/usc/42/619.md?p=5) uses process measures with respect to determining the eligibility of children under the [State child health plan](/usc/42/1397jj.md?p=c-7), [including](/usc/42/1301.md?p=b) measures such as 12-month continuous eligibility, self-declaration of income for applications or renewals, or presumptive eligibility.
  - (3) Data regarding denials of eligibility and redeterminations of eligibility.
  - (4) Data regarding access to primary and specialty services, access to networks of care, and care coordination provided under the [State child health plan](/usc/42/1397jj.md?p=c-7), using quality care and consumer satisfaction measures included in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
  - (5) If the [State](/usc/42/619.md?p=5) provides [child health assistance](/usc/42/1397jj.md?p=a) in the form of premium assistance for the purchase of coverage under a [group health plan](/usc/42/1397jj.md?p=c-3), data regarding the provision of such assistance, [including](/usc/42/1301.md?p=b) the extent to which employer-sponsored [health insurance coverage](/usc/42/1397jj.md?p=c-3) is available for children eligible for [child health assistance](/usc/42/1397jj.md?p=a) under the [State child health plan](/usc/42/1397jj.md?p=c-7), the range of the monthly amount of such assistance provided on behalf of a [child](/usc/42/1382c.md?p=c) or family, the number of children or families provided such assistance on a monthly basis, the income of the children or families provided such assistance, the benefits and cost-sharing protection provided under the [State child health plan](/usc/42/1397jj.md?p=c-7) to supplement the coverage purchased with such premium assistance, the effective strategies the [State](/usc/42/619.md?p=5) engages in to reduce any administrative barriers to the provision of such assistance, and,[^2] the effects, if any, of the provision of such assistance on preventing the coverage provided under the [State child health plan](/usc/42/1397jj.md?p=c-7) from substituting for coverage provided under employer-sponsored health insurance offered in the [State](/usc/42/619.md?p=5).
  - (6) To the extent applicable, a description of any [State](/usc/42/619.md?p=5) activities that are designed to reduce the number of uncovered children in the [State](/usc/42/619.md?p=5), [including](/usc/42/1301.md?p=b) through a [State](/usc/42/619.md?p=5) health insurance connector program or support for innovative private health coverage initiatives.
  - (7) Data collected and reported in accordance with [section 300kk of this title](/usc/42/300kk.md), with respect to individuals enrolled in the [State child health plan](/usc/42/1397jj.md?p=c-7) (and, in the case of enrollees under 19 years of age, their parents or legal guardians), [including](/usc/42/1301.md?p=b) data regarding the primary language of such individuals, parents, and legal guardians.
- (e) **1 Information on dental care for children—**
  - (1) **In general—** Each annual report under [subsection (a)](#a) shall include the following information with respect to care and services described in [section 1396d(r)(3) of this title](/usc/42/1396d.md?p=r-3) provided to targeted low-income children enrolled in the [State child health plan](/usc/42/1397jj.md?p=c-7) under this subchapter at any time during the year involved:
    - (A) The number of enrolled children by age grouping used for reporting purposes under [section 1396a(a)(43) of this title](/usc/42/1396a.md?p=a-43).
    - (B) For children within each such age grouping, information of the type contained in questions 12(a)–(c) of CMS Form 416 (that consists of the number of enrolled targeted [low income](/usc/42/701.md?p=b-2) children who receive any,[^2] preventive, or restorative dental care under the [State](/usc/42/619.md?p=5) plan).
    - (C) For the age grouping that [includes](/usc/42/1301.md?p=b) children 8 years of age, the number of such children who have received a protective sealant on at least one permanent molar tooth.
  - (2) **Inclusion of information on enrollees in managed care plans—** The information under [paragraph (1)](#e-1) shall include information on children who are enrolled in managed care plans and other private [health plans](/usc/42/1320d.md?p=5) and contracts with such plans under this subchapter shall provide for the reporting of such information by such plans to the [State](/usc/42/619.md?p=5).

## Footnotes

[^1]: So in original. Two subsecs. (e) have been enacted.
[^2]: So in original. The comma probably should not appear.

## Source credit

(Aug. 14, 1935, ch. 531, title XXI, § 2108, as added Pub. L. 105–33, title IV, § 4901(a), Aug. 5, 1997, 111 Stat. 566; amended Pub. L. 106–113, div. B, § 1000(a)(6) [title VII, § 703(b), (c)], Nov. 29, 1999, 113 Stat. 1536, 1501A–401; Pub. L. 111–3, title II, § 201(b)(2)(B)(ii), title IV, § 402(a), title V, § 501(e)(2), title VI, §§ 603, 604, Feb. 4, 2009, 123 Stat. 39, 82, 87, 99; Pub. L. 111–8, div. G, title I, § 1301(e), Mar. 11, 2009, 123 Stat. 829; Pub. L. 111–148, title IV, § 4302(b)(1)(B), Mar. 23, 2010, 124 Stat. 581.)

## Notes

### Editorial Notes

### Amendments

2010—Subsec. (e)(7). Pub. L. 111–148, which directed amendment of subsec. (e) by adding par. (7) at end, was executed to the subsec. (e) added by Pub. L. 111–3, § 402(a)(2), relating to information required for inclusion in State annual report, to reflect the probable intent of Congress.

2009—Subsec. (a). Pub. L. 111–3, § 402(a)(1), substituted “Subject to subsection (e), the State” for “The State” in introductory provisions.

Subsec. (c)(3)(B). Pub. L. 111–3, § 201(b)(2)(B)(ii), inserted “(such as through community health workers and others)” after “including practices”.

Subsec. (c)(5). Pub. L. 111–3, § 603, added par. (5) and struck out former par. (5). Prior to amendment, text read as follows: “Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated $10,000,000 for fiscal year 2000 for the purpose of conducting the evaluation authorized under this subsection. Amounts appropriated under this paragraph shall remain available for expenditure through fiscal year 2002.”

Subsec. (d). Pub. L. 111–8 struck out “and GAO report” after “Inspector General audit” in heading and struck out par. (3) which related to duty of Comptroller General to monitor Inspector General audits and report to Congress on audit results.

Pub. L. 111–3, § 604, amended subsec. (d) generally. Prior to amendment, subsec. related to Inspector General audits of certain States.

Subsec. (e). Pub. L. 111–3, § 501(e)(2), added subsec. (e) relating to information on dental care for children.

Pub. L. 111–3, § 402(a)(2), added subsec. (e) relating to information required for inclusion in State annual report.

1999—Subsecs. (c), (d). Pub. L. 106–113 added subsecs. (c) and (d).

### Statutory Notes and Related Subsidiaries

### Effective Date of 2009 Amendment

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 an Effective Date note under section 1396 of this title.

Amendment by section 501(e)(2) of Pub. L. 111–3 effective for annual reports submitted for years beginning after Feb. 4, 2009, see section 501(e)(3) of Pub. L. 111–3, set out as a note under section 1396a of this title.

### Standardized Reporting Format

Pub. L. 111–3, title IV, § 402(b), Feb. 4, 2009, 123 Stat. 83, provided that: In general.—Not later than 1 year after the date of enactment of this Act [Feb. 4, 2009], the Secretary [of Health and Human Services] shall specify a standardized format for States to use for reporting the information required under section 2108(e) of the Social Security Act [42 U.S.C. 1397hh(e)], as added by subsection (a)(2). Transition period for states.—Each State that is required to submit a report under subsection (a) of section 2108 of the Social Security Act [42 U.S.C. 1397hh(a)] that includes the information required under subsection (e) of such section may use up to 3 reporting periods to transition to the reporting of such information in accordance with the standardized format specified by the Secretary under paragraph (1).”