102 STAT. 2390
PUBLIC LAW 100-485—OCT. 13, 1988 ment option that the State might offer under subparagraph (A)(i) with respect to receiving services through a health maintenance organization in accordance with section 1903(m). If a State elects to offer an option to enroll a family under this subparagraph, the State shall pay any premiums and other costs for such enrollment imposed on the family and may pay deductibles and coinsurance imposed on the family. A State's payment of premiums for the enrollment of families under this subparagraph (not including any premiums otherwise payable by an employer and less the amount of premiums collected from such families under paragraph (5)) and payment of any deductibles and coinsurance shall be considered, for purposes of section 1903(a)(l)) to be payments for medical assistance. "(E) PROHIBITION ON OOST-SHABING FOR MATERNITY AND PREVENTIVE PEDIATRIC CARE.—
"(i) IN GENERAL.—If a State offers any alternative option under subparagraph (D) for families, under each such option the State must assure that care described in clause (ii) is available without charge to the families th]:x>ugh— "(1) payment of any deductibles, coinsurance, and other cost-sharing respecting such care, or "(ID providing coverage under the State plan for such care without any cost-sharing, or any combination of such mechanisms. "(ii) CARE DESCRIBED.—The care described in this clause consists of— " D services related to pr^nancy (including preO natal, delivery, and post partum services), and "(H) ambulatory preventive pediatric care (including ambulatory early and periodic screening, diagnosis, and treatment services under section 1905(a)(4)(B)) for each child who meets the age and date of birtib requirements to be a qualified child under section 1905(n)(2). "(5) PREIiaUM.—
"(A) PERMITTED.—Notwithstanding any other provision of this title (including section 1916), a State may impose a premium for a family for additional extended coverage under this subsection for a premiimi payment period (as defined in subparagraph (D)(i)), but only if the family's average gross monthly earnings (less the average monthly costs for such child care as is necessary for the employment of the caretaker relative) for the premium base period exceed 100 percent of the official poverty line (as defined by the CNEfice of Management and Bucket, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved. "(B) LEVEL MAY VARY BY OPTION OFFERED.—The level of such premium may vary, for the same family, for each option offered by a State under paragraph (4)(D). "(Q LIMIT ON PREBAIUM.—In no case may the amount of any premium under this paragraph for a family for a month in either of the premiimi payment periods described
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