(a) Content. (1) The State that is operating a BHP must submit an annual report that includes any evidence of fraud, waste, or abuse on the part of participating providers, plans, or the State BHP agency known to the State, and a detailed data-driven review of compliance with the following:
(i) Eligibility verification requirements for program participation as specified in § 600.345.
(ii) Limitations on the use of Federal funds received by the BHP as specified in § 600.705.
(iii) Requirements to collect quality and performance measures from all participating standard health plans focusing on quality of care and improved health outcomes as specified in sections 1311(c)(3) and (4) of the Affordable Care Act and as further described in § 600.415.
(iv) Requirements specified by the Secretary at least 120 days prior to the date of the annual report as requiring further study to assess continued State compliance with Federal law, regulations and the terms of the State's certified Blueprint, based on a Federal review of the BHP pursuant to § 600.200, and/or a list of any outstanding recommendations from any audit or evaluation conducted by the HHS Office of Inspector General that have not been fully implemented, including a statement describing the status of implementation and why implementation is not complete.
(2) A State that has suspended its BHP under § 600.140(b) of this part must submit an annual report that includes the following:
(i) The balance of the BHP trust fund and any interest accrued on that balance;
(ii) An assurance that the coverage provided to individuals who would be eligible for a BHP under § 600.305 of this part continues to meet the standards described in § 600.140(b)(1)(i), (ii), and (iii) of this part; and
(iii) Any additional information specified by the Secretary at least 120 days prior to the date of the annual report.
(b) Timing. The annual reports, in the format specified by the Secretary, are due 60 days after the end of each operational year. Information that may be required to secure the release of funding for the subsequent year may be requested in advance.
[79 FR 14140, Mar. 12, 2014, as amended at 88 FR 79555, Nov. 16, 2023]
authority: Section 1331 of the Patient Protection and Affordable Care Act of 2010 (Pub. L. 111-148, 124 Stat. 119), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152, 124 Stat 1029)
source: 79 FR 14140, Mar. 12, 2014, unless otherwise noted.
cite as: 42 CFR 600.170