                                 CODE OF VIRGINIA

FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN ESTABLISHED (§ 32.1-351)

A. The Department of Medical Assistance Services shall amend the Virginia
Children&#8217;s Medical Security Insurance Plan to be renamed the Family Access
to Medical Insurance Security (FAMIS) Plan. The Department of Medical Assistance
Services shall provide coverage under the Family Access to Medical Insurance
Security Plan for individuals under the age of 19 when such individuals (i) have
family incomes at or below 200 percent of the federal poverty level or were
enrolled on the date of federal approval of Virginia&#8217;s FAMIS Plan in the
Children&#8217;s Medical Security Insurance Plan (CMSIP); such individuals shall
continue to be enrolled in FAMIS for so long as they continue to meet the
eligibility requirements of CMSIP; (ii) are not eligible for medical assistance
services pursuant to Title XIX of the Social Security Act, as amended; (iii) are
not covered under a group health plan or under health insurance coverage, as
defined in &#xA7; 2791 of the Public Health Service Act (42 U.S.C. &#xA7;
300gg-91 (a) and (b)(1)); and (iv) meet both the requirements of Title XXI of
the Social Security Act, as amended, and the Family Access to Medical Insurance
Security Plan. Eligible children, residing in Virginia, whose family income does
not exceed 200 percent of the federal poverty level during the enrollment period
shall receive 12 continuous months of coverage as permitted by Title XXI of the
Social Security Act.

B. The Department of Medical Assistance Services shall also provide coverage for
children and pregnant women who meet the criteria set forth in clauses (i)
through (iv) of subsection A during the first five years of lawful residence in
the United States, pursuant to &#xA7; 214 of the Children&#8217;s Health
Insurance Program Reauthorization Act of 2009 (P.L. 111-3).

C. Family Access to Medical Insurance Security Plan participants shall
participate in cost-sharing to the extent allowed under Title XXI of the Social
Security Act, as amended, and as set forth in the Virginia Plan for Title XXI of
the Social Security Act. The annual aggregate cost-sharing for all eligible
children in a family above 150 percent of the federal poverty level shall not
exceed five percent of the family&#8217;s gross income or as allowed by federal
law and regulations. The annual aggregate cost-sharing for all eligible children
in a family at or below 150 percent of the federal poverty level shall not
exceed 2.5 percent of the family&#8217;s gross income. The nominal copayments
for all eligible children in a family shall not be less than those in effect on
January 1, 2003. Cost-sharing shall not be required for well-child and
preventive services including age-appropriate child immunizations.

D. The Family Access to Medical Insurance Security Plan shall provide
comprehensive health care benefits to program participants, including well-child
and preventive services, to the extent required to comply with federal
requirements of Title XXI of the Social Security Act. These benefits shall
include comprehensive medical, dental, vision, mental health, and substance
abuse services, and physical therapy, occupational therapy, speech-language
pathology, and skilled nursing services for special education students. The
medical services required to be provided herein shall include dispensing or
furnishing of up to a 12-month supply of hormonal contraceptives at one time, in
accordance with subdivision A 27 of &#xA7; 32.1-325. The mental health services
required herein shall include intensive in-home services, case management
services, day treatment, and 24-hour emergency response. The services shall be
provided in the same manner and with the same coverage and service limitations
as they are provided to children under the State Plan for Medical Assistance
Services.

E. The Virginia Plan for Title XXI of the Social Security Act shall include a
provision that participants in the Family Access to Medical Insurance Security
Plan who have access to employer-sponsored health insurance coverage, as defined
in &#xA7; 32.1-351.1, may, but shall not be required to, enroll in an
employer&#8217;s health plan, and the Department of Medical Assistance Services
or its designee shall make premium payments to such employer&#8217;s plan on
behalf of eligible participants if the Department of Medical Assistance Services
or its designee determines that such enrollment is cost-effective, as defined in
&#xA7; 32.1-351.1.

F. The Family Access to Medical Insurance Security Plan shall ensure that
coverage under this program does not substitute for private health insurance
coverage.

G. The health care benefits provided under the Family Access to Medical
Insurance Security Plan shall be through existing Department of Medical
Assistance Services&#8217; contracts with health maintenance organizations and
other providers, or through new contracts with health maintenance organizations,
health insurance plans, other similarly licensed entities, or other entities as
deemed appropriate by the Department of Medical Assistance Services, or through
employer-sponsored health insurance. All eligible individuals, insofar as
feasible, shall be enrolled in health maintenance organizations.

H. The Department of Medical Assistance Services may establish a centralized
processing site for the administration of the program to include responding to
inquiries, distributing applications and program information, and receiving and
processing applications. The Family Access to Medical Insurance Security Plan
shall include a provision allowing a child&#8217;s application to be filed by a
parent, legal guardian, authorized representative or any other adult caretaker
relative with whom the child lives. The Department of Medical Assistance
Services may contract with third-party administrators to provide any additional
administrative services. Duties of the third-party administrators may include,
but shall not be limited to, enrollment, outreach, eligibility determination,
data collection, premium payment and collection, financial oversight and
reporting, and such other services necessary for the administration of the
Family Access to Medical Insurance Security Plan. Any centralized processing
site shall determine a child&#8217;s eligibility for either Title XIX or Title
XXI and shall enroll eligible children in Title XIX or Title XXI. A single
application form shall be used to determine eligibility for Title XIX or Title
XXI of the Social Security Act, as amended, and outreach, enrollment,
re-enrollment and services delivery shall be coordinated with the FAMIS Plus
program pursuant to &#xA7; 32.1-325. In the event that an application is denied,
the applicant shall be notified of any services available in his locality that
can be accessed by contacting the local department of social services.

I. The Virginia Plan for Title XXI of the Social Security Act, as amended, shall
include a provision that, in addition to any centralized processing site, local
social services agencies shall provide and accept applications for the Family
Access to Medical Insurance Security Plan and shall assist families in the
completion of applications. Contracting health plans, providers, and others may
also provide applications for the Family Access to Medical Insurance Security
Plan and may assist families in completion of the applications.

J. The Department of Medical Assistance Services shall develop and submit to the
federal Secretary of Health and Human Services an amended Title XXI plan for the
Family Access to Medical Insurance Security Plan and may revise such plan as may
be necessary. Such plan and any subsequent revisions shall comply with the
requirements of federal law, this chapter, and any conditions set forth in the
appropriation act. In addition, the plan shall provide for coordinated
implementation of publicity, enrollment, and service delivery with existing
local programs throughout the Commonwealth that provide health care services,
educational services, and case management services to children. In developing
and revising the plan, the Department of Medical Assistance Services shall
advise and consult with the Joint Commission on Health Care.

K. Funding for the Family Access to Medical Insurance Security Plan shall be
provided through state and federal appropriations and shall include
appropriations of any funds that may be generated through the Virginia Family
Access to Medical Insurance Security Plan Trust Fund.

L. The Board of Medical Assistance Services, or the Director, as the case may
be, shall adopt, promulgate, and enforce such regulations pursuant to the
Administrative Process Act (&#xA7; 2.2-4000 et seq.) as may be necessary for the
implementation and administration of the Family Access to Medical Insurance
Security Plan.

M. Children enrolled in the Virginia Plan for Title XXI of the Social Security
Act prior to implementation of these amendments shall continue their eligibility
under the Family Access to Medical Insurance Security Plan and shall be given
reasonable notice of any changes in their benefit packages. Continuing
eligibility in the Family Access to Medical Insurance Security Plan for children
enrolled in the Virginia Plan for Title XXI of the Social Security Act prior to
implementation of these amendments shall be determined in accordance with their
regularly scheduled review dates or pursuant to changes in income status.
Families may select among the options available pursuant to subsections D and F
of this section.

N. The provisions of Chapter 9 (&#xA7; 32.1-310 et seq.) of this title relating
to the regulation of medical assistance shall apply, mutatis mutandis, to the
Family Access to Medical Insurance Security Plan.

O. In addition, in any case in which any provision set forth in Title 38.2
excludes, exempts or does not apply to the Virginia plan for medical assistance
services established pursuant to Title XIX of the Social Security Act, 42 U.S.C.
&#xA7; 1396 et seq. (Medicaid), such exclusion, exemption or carve out of
application to Title XIX of the Social Security Act (Medicaid) shall be deemed
to subsume and thus to include the Family Access to Medical Insurance Security
(FAMIS) Plan, established pursuant to Title XXI of the Social Security Act, upon
approval of FAMIS by the federal Centers for Medicare &amp; Medicaid Services as
Virginia&#8217;s State Children&#8217;s Health Insurance Program.

HISTORY: 1997, c. 679; 1999, c. 1034; 2000, cc. 824, 848; 2001, cc. 238, 735,
756; 2002, c. 640; 2003, cc. 66, 71, 521; 2005, c. 584; 2006, c. 428; 2007, c.
407; 2012, cc. 646, 689; 2014, cc. 9, 183; 2021, Sp. Sess. I, c. 245.