124 STAT. 235 PUBLIC LAW 111–148—MAR. 23, 2010 (3) DETERMINATION OF ELIGIBILITY.— (A) IN GENERAL.—Each applicable State health subsidy program shall, to the maximum extent practicable— (i) establish, verify, and update eligibility for participation in the program using the data matching arrangement under paragraph (2); and (ii) determine such eligibility on the basis of reli- able, third party data, including information described in sections 1137, 453(i), and 1942(a) of the Social Secu- rity Act, obtained through such arrangement. (B) EXCEPTION.—This paragraph shall not apply in circumstances with respect to which the Secretary deter- mines that the administrative and other costs of use of the data matching arrangement under paragraph (2) out- weigh its expected gains in accuracy, efficiency, and pro- gram participation. (4) SECRETARIAL STANDARDS.—The Secretary shall, after consultation with persons in possession of the data to be matched and representatives of applicable State health subsidy programs, promulgate standards governing the timing, con- tents, and procedures for data matching described in this sub- section. Such standards shall take into account administrative and other costs and the value of data matching to the establish- ment, verification, and updating of eligibility for applicable State health subsidy programs. (d) ADMINISTRATIVE AUTHORITY.— (1) AGREEMENTS.—Subject to section 1411 and section 6103(l)(21) of the Internal Revenue Code of 1986 and any other requirement providing safeguards of privacy and data integrity, the Secretary may establish model agreements, and enter into agreements, for the sharing of data under this sec- tion. (2) AUTHORITY OF EXCHANGE TO CONTRACT OUT.—Nothing in this section shall be construed to— (A) prohibit contractual arrangements through which a State medicaid agency determines eligibility for all applicable State health subsidy programs, but only if such agency complies with the Secretary’s requirements ensuring reduced administrative costs, eligibility errors, and disruptions in coverage; or (B) change any requirement under title XIX that eligi- bility for participation in a State’s medicaid program must be determined by a public agency. (e) APPLICABLE STATE HEALTH SUBSIDY PROGRAM.—In this sec- tion, the term ‘‘applicable State health subsidy program’’ means— (1) the program under this title for the enrollment in qualified health plans offered through an Exchange, including the premium tax credits under section 36B of the Internal Revenue Code of 1986 and cost-sharing reductions under section 1402; (2) a State medicaid program under title XIX of the Social Security Act; (3) a State children’s health insurance program (CHIP) under title XXI of such Act; and (4) a State program under section 1331 establishing quali- fied basic health plans.
