123STA T .68PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9(C)WORKING GRO UPT O DEV E L OP M ODEL C OVER A GE COORDINATION DI S CLOSURE F ORM .— ( i ) M EDICAID , C H IP, AND EMPLO Y ER - SPONSORED COVERAGE COORDINATION W ORKING GROUP.— ( I ) IN GENERAL.— Notla t er t h a n60d a ys a f ter the date of ena c t m ent of this A ct, the S ecretary of H ealth and H u man Ser v ices and the Secretary of L a b or shall j ointly establish a Medicaid, CHI P , and E m p loyer-Sponsored Covera g e Coordination Wor k ing G roup (in this subparagraph referred to as the ‘ ‘Working Group ’ ’). T he purpose of the Working Group shall be to develop the model cov- erage coordination disclosure form described in subclause (II) and to identify the impediments to the effective coordination of coverage available to families that include employees of employers that maintain group health plans and members w ho are eligible for medical assistance under title X IX of the Social Security Act or child health assistance or other health benefits coverage under title XXI of such Act. (II) MODEL COVERAGE COORDINATION DISCLO- SURE FORM DESCRI B ED.—The model form described in this subclause is a form for plan administrators of group health plans to complete for purposes of permitting a State to determine the availability and cost-effectiveness of the coverage available under such plans to employees who have family members who are eligible for premium assistance offered under a State plan under title XIX or XXI of such Act and to allow for coordination of cov- erage for enrollees of such plans. Such form shall provide the following information in addition to such other information as the Working Group determines appropriate
(aa) A determination of whether the employee is eligible for coverage under the group health plan. (bb) The name and contract information of the plan administrator of the group health plan. (cc) The benefits offered under the plan. (dd) The premiums and cost-sharing re q uired under the plan. (ee) Any other information relevant to cov- erage under the plan. (ii) MEMBERSHIP.—The Working Group shall con- sist of not more than 3 0 members and shall be com- posed of representatives of— (I) the D epartment of Labor
(II) the Department of Health and Human Services; (III) State directors of the Medicaid program under title XIX of the Social Security Act; (I V ) State directors of the State Children’s Health Insurance Program under title XXI of the Social Security Act; Deadlin e .Est a b lis hm ent. 29USC1 1 8 1 n o te.
