113 HR 567 IH: State Health Flexibility Act of 2013
U.S. House of Representatives
2013-02-06
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents
(a)This Act may be cited
as the State Health Flexibility Act of
2013
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Health grants to the States for health care services to
indigent individuals.
Title XXII—BLOCK GRANTS TO STATES FOR HEALTH CARE SERVICES TO
INDIGENT INDIVIDUALS
Sec. 2201. Purpose.
Sec. 2202. Grants to States.
Sec. 2203. Administrative and fiscal
accountability.
Sec. 2204. Nondiscrimination provisions.
Sec. 2205. Emergency assistance.
Sec. 2206. Definitions.
Sec. 3. Repeal of PPACA, HCERA, and the Federal requirements of
Medicaid and CHIP.
Sec. 4. Severability.
Sec. 5. Effective date.
2.Health grants to
the States for health care services to indigent individuals
(a)Health care
block grant to StatesThe Social Security Act is amended by
adding at the end the following new title:
<enum>XXII</enum><header>BLOCK GRANTS TO
STATES FOR HEALTH CARE SERVICES TO INDIGENT INDIVIDUALS</header>
<section id="H75E28C705CDB4DFEAC7FC5909A898B67"><enum>2201.</enum><header>Purpose</header><text display-inline="no-display-inline">The purpose of this title is to provide
Federal financial assistance to the States, in the form of a single grant, to
allow the States maximum flexibility in providing, and financing the provision
of, health-care-related items and services to indigent individuals.</text>
</section><section id="H8517F10C4CBA4C0A93D04CCF942A3B6D"><enum>2202.</enum><header>Grants to
States</header>
<subsection id="HE3EC789A8BCC4C19BC1C20C1D1C25F7A"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to the
requirements of this title, each State is entitled to receive from the
Secretary of the Treasury a grant for each quarter of fiscal years 2014, 2015,
2016, 2017, 2018, 2019, 2020, 2021, 2022, and 2023, in an amount that is equal
to 25 percent of the total amount received by a State under title XIX and title
XXI for fiscal year 2012.</text>
</subsection><subsection id="HFF0D830B0AC14FED9A68395506817F89"><enum>(b)</enum><header>Appropriation</header><text display-inline="yes-display-inline">Out of any money in the Treasury of the
United States not otherwise appropriated, there are appropriated for fiscal
years 2014, 2015, 2016, 2017, 2018, 2019, 2020, 2021, 2022, and 2023 such sums
as are necessary for grants under this section.</text>
</subsection><subsection id="H5D394BE8402740E4A202E1B6787F113E"><enum>(c)</enum><header>Requirements
relating to intergovernmental financing</header><text>The Secretary of the
Treasury shall make the transfer of funds under grants under
<internal-xref idref="HE3EC789A8BCC4C19BC1C20C1D1C25F7A" legis-path="2202.(a)">subsection (a)</internal-xref> directly to each State in
accordance with the requirements of <external-xref legal-doc="usc" parsable-cite="usc/31/6503">section 6503</external-xref> of title 31, United States
Code.</text>
</subsection><subsection id="HAA834688CDB34FDC8E43DC57B9B31BF7"><enum>(d)</enum><header>Expenditure of
funds</header>
<paragraph id="H4BAF736CC16A46F28CF03D847C379190"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Except as provided in
paragraph (2), amounts received by a State under this title for any fiscal year
shall be expended by the State in such fiscal year or in the succeeding fiscal
year.</text>
</paragraph><paragraph id="H674FC3E67E024ED8B21BD8602DEF1F44"><enum>(2)</enum><header>Use of rainy day
fund permitted</header><text>Of the amounts received by a State under this
title, the State may set aside, in a separate account, such amounts as the
State deems necessary to provide, without fiscal limitation,
health-care-related items and services for indigent individuals during—</text>
<subparagraph id="H8914CE84920847F8A08CA35ABD24DCFE"><enum>(A)</enum><text>periods of
unexpectedly high rates of unemployment; or</text>
</subparagraph><subparagraph id="HFECF4C8552614195A3393825AD4D4D73"><enum>(B)</enum><text>periods related to
circumstances that are not described in subparagraph (A) and that cause
unexpected increases in the need for such items and services for such
individuals.</text>
</subparagraph></paragraph><paragraph commented="no" id="H2E2EE0CF71FE449C98D09AEC00D1E38A"><enum>(3)</enum><header>Funds remaining
after fiscal year 2022</header><text>If, after fiscal year 2023, a State has
funds in the account under paragraph (2), the State may only expend such funds
if such funds are used in a manner that is permitted under subsection (e), as
such subsection is in effect on September 30, 2023.</text>
</paragraph></subsection><subsection id="H4109019F8AFE42DA91918D9FACD18C13"><enum>(e)</enum><header>Use of
funds</header><text>A State may only use the amounts received under subsection
(a) as follows:</text>
<paragraph id="HC74341EE1C984677960C3BD5CCE4A093"><enum>(1)</enum><header>General
purpose</header><text display-inline="yes-display-inline">For the purpose under
section 2201, including the provision of health-care-related items and services
as required under section 2205. Nothing in this title shall be construed as
limiting the flexibility of a State to determine which providers of such items
and services qualify to receive payment from a grant made to the State under
this title.</text>
</paragraph><paragraph id="HDFA192C1DB1247F3BCE17EDC0AF22389"><enum>(2)</enum><header>Funding for risk
adjustment mechanisms</header><text display-inline="yes-display-inline">To fund
qualified high risk pools, reinsurance pools, or other risk-adjustment
mechanisms used for the purpose of subsidizing the purchase of private health
insurance for the high-risk population.</text>
</paragraph><paragraph id="H76954DDDE71B41CA8AA3DAB40EF62AEA"><enum>(3)</enum><header>Authority to use
portion of Federal assistance for other welfare-related programs</header>
<subparagraph id="H21745FBD37A4492392FAC861ED7B83FD"><enum>(A)</enum><header>In
general</header><text>Subject to the limit under subparagraph (B), to carry out
a State program pursuant to any or all of the following provisions of
law:</text>
<clause id="H5061BCFD4E40485E8E517AB617DDC967"><enum>(i)</enum><text>Part A of title IV
of this Act.</text>
</clause><clause id="HA710577B06254B37B4AEDEE452B5F059"><enum>(ii)</enum><text>Section 1616 of
this Act.</text>
</clause><clause id="HF13760C1FD3D461EA454FDA01EFF0666"><enum>(iii)</enum><text>The Food and
Nutrition Act of 2008.</text>
</clause></subparagraph><subparagraph id="HF4EA6EE359874EA4B16F8DBBD48F496B"><enum>(B)</enum><header>Limitation</header><text display-inline="yes-display-inline">A State may not use more than 30 percent of
the amount received under subsection (a) for a fiscal year to carry out a State
program, or programs, under subparagraph (A).</text>
</subparagraph><subparagraph id="H5C809811270749E2B1299A7B2BCBECE1"><enum>(C)</enum><header>Requirements on
funds</header><text>Any amounts that are used under subparagraph (A)—</text>
<clause id="HEE743FF806FC4609BD3EE71269DE7053"><enum>(i)</enum><text>shall not be
subject to any of the requirements of subsection (d), subsection (f), section
2204, or section 2205; and</text>
</clause><clause id="H46222A8E19894DFE8D85FE485F2ADFF4"><enum>(ii)</enum><text>shall be subject
to—</text>
<subclause id="H79DBB5D73777479FBBA14DBE247E0CEA"><enum>(I)</enum><text>the audit
requirements under section 2203; and</text>
</subclause><subclause id="H239460EF264345E38ACB3AEF937DCC2F"><enum>(II)</enum><text>any requirements
that apply to Federal funds provided directly for such State program.</text>
</subclause></clause></subparagraph></paragraph></subsection><subsection id="H994E458F0E304101941F3000BED221D2"><enum>(f)</enum><header>Maintenance of
current law restrictions on use of federal funds</header>
<paragraph id="HADAF57CCE25145949891C1773BEBE61C"><enum>(1)</enum><header>In
general</header>
<subparagraph id="H4CDB0FC5013B44D599A155649275CA6C"><enum>(A)</enum><header>No funding for
abortions</header><text display-inline="yes-display-inline">None of the funds
appropriated in this title shall be expended for any abortion.</text>
</subparagraph><subparagraph id="HC8369B6FCEC9401B880B14DA1F6F5DC2"><enum>(B)</enum><header>No funds for
coverage of abortion</header><text display-inline="yes-display-inline">None of
the funds appropriated in this title shall be expended for health benefits
coverage that includes coverage of abortion.</text>
</subparagraph><subparagraph id="H08EBDB8D9192475B8B4B00BBC2B1721A"><enum>(C)</enum><header>Health benefits
coverage defined</header><text>For purposes of this subsection, the term
<term>health benefits coverage</term> means the package of services covered by
a managed care provider or organization pursuant to a contract or other
arrangement.</text>
</subparagraph></paragraph><paragraph id="H92EEB4B9D0A8495B94F75C36D00B43B4"><enum>(2)</enum><header>Exceptions</header><text>The
limitations established in
<internal-xref idref="H4CDB0FC5013B44D599A155649275CA6C" legis-path="2202.(e)(1)">paragraph (1)</internal-xref> shall not apply to an
abortion—</text>
<subparagraph id="HF236F2D7C12140309E3A94BA52DB8469"><enum>(A)</enum><text>if the pregnancy
is the result of an act of rape or incest; or</text>
</subparagraph><subparagraph id="H8A758581255D460794DE248465E7AB7F"><enum>(B)</enum><text display-inline="yes-display-inline">in the case where a woman suffers from a
physical disorder, physical injury, or physical illness that would, as
certified by a physician, place the woman in danger of death unless an abortion
is performed, including a life-endangering physical condition caused by or
arising from the pregnancy itself.</text>
</subparagraph></paragraph><paragraph commented="no" id="HBDA6E0A641F74DD58898B6BE0283BF0C"><enum>(3)</enum><header>State funds used
in conjunction with Federal funds</header><text display-inline="yes-display-inline">The limitations established in paragraph
(1) shall apply to any State funds used in conjunction with Federal funds
appropriated under this title to provide, or finance the provision of,
health-care-related items and services to indigent individuals pursuant to
section 2201 or subsections (d)(2), (e)(1), or (e)(2) of this section.</text>
</paragraph><paragraph id="HB255D56871FA4AD89F5333D127CF411E"><enum>(4)</enum><header>Option to
purchase separate coverage or plan</header><text>Nothing in this subsection
shall be construed as prohibiting a State from purchasing separate coverage for
abortions for which funding is prohibited under this subsection, or a health
plan that includes such abortions, so long as such coverage or plan is paid for
entirely using funds not provided by this title.</text>
</paragraph><paragraph id="HBF9E8B8151F649B0926D075DB2866D65"><enum>(5)</enum><header>Option to offer
coverage or plan</header><text display-inline="yes-display-inline">Nothing in
this subsection shall restrict any health insurance issuer from offering
separate coverage for abortions for which funding is prohibited under this
subsection, or a health plan that includes such abortions, so long as—</text>
<subparagraph id="HC337C6E36E9A488980DEBFA4E393DB7E"><enum>(A)</enum><text>premiums for such
separate coverage or plan are paid entirely with funds not provided by this
title; and</text>
</subparagraph><subparagraph id="H0B85CDC61A534A22B83736FE44FDE7AF"><enum>(B)</enum><text>administrative
costs and all services offered through such separate coverage or plan are paid
for using only premiums collected for such coverage or plan.</text>
</subparagraph></paragraph><paragraph id="H675183F8F23B49AA85045B47A28404F1"><enum>(6)</enum><header>Conscience
protections</header>
<subparagraph id="H8E31C8BC091F4673A45E2DF10EE94749"><enum>(A)</enum><text>None of the funds
appropriated in this Act may be made available to a Federal agency or program,
or to a State or local government, if such agency, program, or government
subjects any institutional or individual health care entity to discrimination
on the basis that the health care entity does not provide, pay for, provide
coverage of, or refer for abortions.</text>
</subparagraph><subparagraph id="H694FFA4F83A74FDB9C2F286C6A17E5F2"><enum>(B)</enum><text>In this paragraph,
the term <term>health care entity</term> includes an individual physician or
other health care professional, a hospital, a provider-sponsored organization,
a health maintenance organization, a health insurance plan, or any other kind
of health care facility, organization, or plan.</text>
</subparagraph></paragraph></subsection><subsection display-inline="no-display-inline" id="H6099EBA7ACEE4D88B9625F9772982CDF"><enum>(g)</enum><header>No funding for
illegal aliens</header><text display-inline="yes-display-inline">Except as
provided under this section and section 2205, no funds appropriated in this
title may be used to provide health-care-related items and services to an alien
who is not lawfully admitted for permanent residence or otherwise permanently
residing in the United States under color of law.</text>
</subsection><subsection id="HCE3D4334C0C949CB802E63AB55E0C611"><enum>(h)</enum><header>Nonentitlement</header><text>Nothing
in this title shall be construed as providing an individual with an entitlement
to health-care-related items and services under this title.</text>
</subsection></section><section id="H0842E638190A42228CB61EE6B31F88AE"><enum>2203.</enum><header>Administrative
and fiscal accountability</header>
<subsection id="HE4FDB38954FC431A901030932911FECA"><enum>(a)</enum><header>Audits</header>
<paragraph id="H7A21A235234C4608838473F189D24241"><enum>(1)</enum><header>Contract with
approved auditing entity</header><text display-inline="yes-display-inline">Not
later than October 1, 2014, and annually thereafter, a State shall contract
with an approved auditing entity (as defined under paragraph (3)(B)) for
purposes of conducting an audit under
<internal-xref idref="H4B6F0E6DAF0E4E8B901925D9E0D1F47E" legis-path="2203.(a)(2)">paragraph (2) </internal-xref>(with respect to the
fiscal year ending September 30 of such year).</text>
</paragraph><paragraph id="H4B6F0E6DAF0E4E8B901925D9E0D1F47E"><enum>(2)</enum><header>Audit
requirement</header><text>Under a contract under paragraph (1), an approved
auditing entity shall conduct an audit of the expenditures or transfers made by
a State from amounts received under a grant under this title, or from State
funds described in section 2202(f)(3), with respect to the fiscal year which
such audit covers, to determine the extent to which such expenditures and
transfers were expended in accordance with this title.</text>
</paragraph><paragraph id="H8FD4393578B64E538219FA3E6C2CB7B6"><enum>(3)</enum><header>Entity
conducting audit</header>
<subparagraph id="HE23CD1FB37C649A0B07FE20D47A3AD80"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">With respect to a
State, the audit under paragraph (2) shall be conducted by an approved auditing
entity in accordance with generally accepted auditing principles.</text>
</subparagraph><subparagraph id="H019E5E80A8DA415E843943B093BF64A8"><enum>(B)</enum><header>Approved
auditing entity</header><text>For purposes of this section, the term
<term>approved auditing entity</term> means, with respect to a State, an entity
that is—</text>
<clause id="H802C74CEE3C342C18B41219B92A9C7C2"><enum>(i)</enum><text>approved by the
Secretary of the Treasury;</text>
</clause><clause id="H54079B6A0289474781B7291214E0B3ED"><enum>(ii)</enum><text>approved by the
chief executive officer of the State; and</text>
</clause><clause id="H89DA0BC512FE496CA092D2BF05BEB08C"><enum>(iii)</enum><text>independent of
any Federal, State, or local agency.</text>
</clause></subparagraph></paragraph><paragraph id="H47F5D3BA4891417E8A5FBFB66EC96A37"><enum>(4)</enum><header>Submission of
audit</header><text>Not later than December 31, 2014, and annually thereafter,
a State shall submit the results of the audit under paragraph (2) (with respect
to the fiscal year ending on September 30 of such year) to the State
legislature and to the Secretary of the Treasury.</text>
</paragraph><paragraph id="HA4253667A1414BC9BE0732372ECDEBD3"><enum>(5)</enum><header>Additional
accounting requirements</header><text>The provisions of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/31/75">chapter 75</external-xref> of title 31,
United States Code, shall apply to the audit requirements of this
section.</text>
</paragraph></subsection><subsection id="HC1A358E2425E4148806534297BEE3A7C"><enum>(b)</enum><header>Reimbursement
and penalty</header>
<paragraph id="H87338E45017948DEA84D5266CFBA5ABA"><enum>(1)</enum><header>In
general</header><text>If, through an audit conducted under subsection (a), an
approved auditing entity finds that any amounts paid to a State under a grant
under this title were not expended in accordance with this title—</text>
<subparagraph id="H583D491B83554D778F7F4179CA7EB3D5"><enum>(A)</enum><text>the State shall
pay to the Treasury of the United States any such amount, plus 10 percent of
such amount as a penalty; or</text>
</subparagraph><subparagraph id="HDFBB4127C9F84CFFB78C968924FD4BC0"><enum>(B)</enum><text>the Secretary of
the Treasury shall offset such amount plus the 10 percent penalty against any
other amount in any other fiscal year that the State may be entitled to receive
under a grant under this title.</text>
</subparagraph></paragraph><paragraph commented="no" id="H3F54934415B3425EB475E234D807AAC7"><enum>(2)</enum><header>Misuse of State
funds</header><text display-inline="yes-display-inline">If, through an audit
conducted under subsection (a), an approved auditing entity finds that a State
violated the requirements of section 2202(f)(3), the State shall pay to the
Treasury of the United States 100 percent of the amount of State funds that
were used in violation of section 2202(f)(3) as a penalty. Insofar as a State
fails to pay any such penalty, the Secretary of the Treasury shall offset the
amount not so paid against the amount of any grant otherwise payable to the
State under this title.</text>
</paragraph></subsection><subsection id="HB3A07779D5B345FF91E53E44F2E1DE5D"><enum>(c)</enum><header>Annual reporting
requirements</header>
<paragraph id="HAA09C076492A4B3DB31BFC7F7CCA8389"><enum>(1)</enum><header>In
general</header><text>Not later than January 31, 2015, and annually thereafter,
each State shall submit to the Secretary of the Treasury and the State
legislature a report on the activities carried out by the State during the most
recently completed fiscal year with funds received by the State under a grant
under this title for such fiscal year.</text>
</paragraph><paragraph id="H5A7E656A150B4278980479AB92F31842"><enum>(2)</enum><header>Content</header><text>A
report under paragraph (1) shall, with respect to a fiscal year—</text>
<subparagraph id="H6C561EBDC00A4A5690C4AF65B5BC0249"><enum>(A)</enum><text>contain the
results of the audit conducted by an approved auditing entity for a State for
such fiscal year, in accordance with the requirements of subsection (a) of this
section;</text>
</subparagraph><subparagraph id="H1043E831D4594A47854F2246D8B3981E"><enum>(B)</enum><text display-inline="yes-display-inline">specify the amount of the grant made to the
State under this title that is used to carry out a program under section
2202(e)(3); and</text>
</subparagraph><subparagraph id="HB98624ED29CC4D4A9D9E7DB63F13B99C"><enum>(C)</enum><text>be in such form
and contain such other information as the State determines is necessary to
provide—</text>
<clause id="H0D2410E36D0547BD9178F6CA0243E043"><enum>(i)</enum><text display-inline="yes-display-inline">an accurate description of the activities
conducted by the State for the purpose described under section 2201 and any
other use of funds permitted under subsections (d) and (e) of section 2202;
and</text>
</clause><clause id="HE82DEB21AA394B6E9F9F28A84EDC39FF"><enum>(ii)</enum><text>a
complete record of the purposes for which amounts were expended in accordance
with this title.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="HF62F6DA4A1F04DA3A0CD0BE32D228B8B"><enum>(3)</enum><header>Conformity with
accounting principals</header><text>Any financial information in the report
under paragraph (1) shall be prepared and reported in accordance with generally
accepted accounting principles, including the provisions of chapter 75 of title
31, United States Code.</text>
</paragraph><paragraph id="H1AD149E10FA64305A4FCB9A5033AF5D3"><enum>(4)</enum><header>Public
availability</header><text>A State shall make copies of the reports required
under this section available on a public Web site and shall make copies
available in other formats upon request.</text>
</paragraph></subsection><subsection id="H936F194083CE4A1DBB0BE9546BCB530B"><enum>(d)</enum><header>Failure To
comply with requirements</header><text>The Secretary of the Treasury shall not
make any payment to a State under a grant authorized by section 2202(a)—</text>
<paragraph id="H3759558D9B534AD1ADF6BF85A3B72C7A"><enum>(1)</enum><text>if an audit for a
State is not submitted as required under subsection (a), during the period
between the date such audit is due and the date on which such audit is
submitted;</text>
</paragraph><paragraph id="HDE7FA4D1A9604AA4A4BAEF49000FB483"><enum>(2)</enum><text display-inline="yes-display-inline">if a State fails to submit a report as
required under subsection (c), during the period between the date such report
is due and the date on which such report is submitted; or</text>
</paragraph><paragraph id="H057FC8E57C294DE5A23138525A2E8098"><enum>(3)</enum><text>if a State
violates a requirement of section 2202(f), during the period beginning on the
date the Secretary becomes aware of such violation and the date on which such
violation is corrected by the State.</text>
</paragraph></subsection><subsection id="H3D7DB33A24354C679069FE6ABC34B950"><enum>(e)</enum><header>Administrative
supervision and oversight</header>
<paragraph id="H2CBC84F0962C4530BBA56E8CFAB01704"><enum>(1)</enum><header>Limited role for
Secretary of Treasury and the Attorney general</header>
<subparagraph id="H3D7A5219E98D4E5FB20F1660E9F66C63"><enum>(A)</enum><header>Treasury</header><text>The
authority of the Secretary of the Treasury under this title is limited
to—</text>
<clause id="HD72F7B98EB964D86ACEE22070DE768AE"><enum>(i)</enum><text>promulgating
regulations, issuing rules, or publishing guidance documents to the extent
necessary for purposes of implementing subsection (a)(3)(B), subsection (b),
and subsection (d);</text>
</clause><clause id="H570AA122C65843D9AE405ACA63F2F2E6"><enum>(ii)</enum><text>making quarterly
payments to the States under grants under this title in accordance with section
2202(a);</text>
</clause><clause id="HD1AEC994026547C7B056D68ACF993514"><enum>(iii)</enum><text>approving
entities under subsection (a)(3)(B) for purposes of the audits required under
subsection (a);</text>
</clause><clause commented="no" id="H71D7B3AD8BD14255A0B88A5E26E5FC95"><enum>(iv)</enum><text>withholding
payment to a State of a grant under subsection (d) or offsetting a payment of
such a grant to a State under subsection (b); and</text>
</clause><clause commented="no" id="H1440D36350A746A8A1C04D5045DD469A"><enum>(v)</enum><text>exercising the
authority relating to nondiscrimination that is specified in section
2204(b).</text>
</clause></subparagraph><subparagraph id="H71FB12E45DEE41BC9F29145C1DB11010"><enum>(B)</enum><header>Attorney
general</header><text>The authority of the Attorney General to supervise the
amounts received by a State under this title is limited to the authority under
section 2204(c).</text>
</subparagraph></paragraph><paragraph id="H1AEB65A6D12F47FCA5ADDA4B9F6E8157"><enum>(2)</enum><header>Federal
supervision</header>
<subparagraph id="HEB29E66F618A48909C12D8E433FF790D"><enum>(A)</enum><header>In
general</header><text>Except as provided under paragraph (1), an administrative
officer, employee, department, or agency of the United States (including the
Secretary of Health and Human Services) may not—</text>
<clause display-inline="no-display-inline" id="HA8A2D837B25B44F0AC5E8DA3FDF9FF27"><enum>(i)</enum><text>supervise—</text>
<subclause id="H6FC24D70849A4C47981CC973DCFF32BB"><enum>(I)</enum><text>the amounts
received by the States under this title; or</text>
</subclause><subclause id="H52754DFDF5EB4ABDB0B463C4C6386C47"><enum>(II)</enum><text>the use of such
amounts by the States; or</text>
</subclause></clause><clause id="HCC81EC64B6E14B17A490A6E2B306C9A8"><enum>(ii)</enum><text>promulgate
regulations or issue rules in accordance with this title.</text>
</clause></subparagraph><subparagraph id="H095A0CBFFC5F4BB4B05152E182FBF2AE"><enum>(B)</enum><header>Limitation on
Secretary of Health and Human Services</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services
shall have no authority over any provision of this title.</text>
</subparagraph></paragraph></subsection><subsection id="HA97CD9BE82284E17BC1C8C5D57554875"><enum>(f)</enum><header>Reservation of
State powers</header><text display-inline="yes-display-inline">Nothing in this
section shall be construed to limit the power of a State, including the power
of a State to pursue civil and criminal penalties under State law against any
individual or entity that misuses, or engages in fraud or abuse related to, the
funds provided to a State under this title.</text>
</subsection></section><section id="HA86CEFAE126B42CB9EA5FEA324A7F550"><enum>2204.</enum><header>Nondiscrimination
provisions</header>
<subsection display-inline="no-display-inline" id="HCA932A2E86C5490DB085107B17B3ACD5"><enum>(a)</enum><header>No
discrimination against individuals</header><text>No individual shall be
excluded from participation in, denied the benefits of, or subjected to
discrimination under, any program or activity funded in whole or in part with
amounts paid to a State under this title on the basis of such
individual’s—</text>
<paragraph id="H470633C472C04D2697E9BEED0634F117"><enum>(1)</enum><text>disability under
section 504 of the Rehabilitation Act of 1973 (<external-xref legal-doc="usc" parsable-cite="usc/29/794">29 U.S.C. 794</external-xref>);</text>
</paragraph><paragraph id="HCABBD6B768654767B2C12487D45BF288"><enum>(2)</enum><text>sex under title IX
of the Education Amendments of 1972 (<external-xref legal-doc="usc" parsable-cite="usc/20/1681">20 U.S.C. 1681 et seq.</external-xref>); or</text>
</paragraph><paragraph id="HE828B810F63144CDA2532286A0BB8669"><enum>(3)</enum><text>race, color, or
national origin under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d
et seq.).</text>
</paragraph></subsection><subsection id="H5CCB5245443B43AFBEA8D406C9E7FE39"><enum>(b)</enum><header>Compliance</header>
<paragraph id="HD547A6C61B874B51ACCDCF3F45C6A3BA"><enum>(1)</enum><text>If the Secretary
of the Treasury determines that a State or an entity that has received funds
from amounts paid to a State under a grant under this title has failed to
comply with a provision of law referred to in subsection (a), the Secretary of
the Treasury shall notify the chief executive officer of the State of such
failure to comply and shall request that such chief executive officer secure
such compliance.</text>
</paragraph><paragraph id="H70B22AA957B544E5AC4B4312D4C3386D"><enum>(2)</enum><text>If, not later than
60 days after receiving notification under paragraph (1), the chief executive
officer of a State fails or refuses to secure compliance with the provision of
law referred to in such notification, the Secretary of the Treasury may—</text>
<subparagraph id="HADC268B2C0D349BB9ECF248259BDE1D2"><enum>(A)</enum><text>refer the matter
to the Attorney General with a recommendation that an appropriate civil action
be instituted; or</text>
</subparagraph><subparagraph id="HA0FB83B0F12B44BF95FB2DB5F4E4FF17"><enum>(B)</enum><text>exercise the
powers and functions provided under section 505 of the Rehabilitation Act of
1973 (<external-xref legal-doc="usc" parsable-cite="usc/29/794a">29 U.S.C. 794a</external-xref>), title IX of the Education Amendments of 1972 (20 U.S.C.
1681 et seq.), or title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et
seq.) (as applicable).</text>
</subparagraph></paragraph></subsection><subsection id="HB94EEBEB0BA441CD93815CC0C01AC0F3"><enum>(c)</enum><header>Civil
actions</header><text>If a matter is referred to the Attorney General under
subsection (b)(2)(A), or the Attorney General has reason to believe that a
State or entity has failed to comply with a provision of law referred to in
subsection (a), the Attorney General may bring a civil action in an appropriate
district court of the United States for such relief as may be appropriate,
including injunctive relief.</text>
</subsection></section><section id="HDB9675DD27104B25AC0F8E3E104047CE"><enum>2205.</enum><header>Emergency
assistance</header>
<subsection display-inline="no-display-inline" id="H00C93EFDAC444041B4C784C5000E8DDD"><enum>(a)</enum><header>In
general</header><text>A State that receives a grant under this title for a
fiscal year shall provide payment for health-care-related items and services
provided to a citizen, legal resident, or an alien who is not lawfully admitted
for permanent residence or otherwise permanently residing in the United States
under color of law, consistent with the requirements of section 1867,
if—</text>
<paragraph id="H0C914AB39EB74832B86042A46674D0D9"><enum>(1)</enum><text>such
health-care-related items and services are—</text>
<subparagraph id="HAD4A7918497B46DBB5460F8831906F1C"><enum>(A)</enum><text>necessary for the
treatment of an emergency medical condition; and</text>
</subparagraph><subparagraph id="H896A70AE13E7442BB10B30EDC4D22187"><enum>(B)</enum><text>health-care-related
items and services that such State would provide payment for under this title,
if provided to an indigent individual;</text>
</subparagraph></paragraph><paragraph id="H3BB3CBA275A1423CA9EABF99891048BF"><enum>(2)</enum><text display-inline="yes-display-inline">the individual meets all necessary
eligibility requirements for health-care-related items and services under the
State program funded under this title, except for any requirement related to
immigration status; and</text>
</paragraph><paragraph id="HCB99522AC0EE4020822EADBB62110605"><enum>(3)</enum><text>such items and
services are not related to an organ transplant procedure.</text>
</paragraph></subsection><subsection id="HB1FD361C5E8341369C115BCA8B77193C"><enum>(b)</enum><header>Emergency
medical condition</header><text>For purposes of this section, the term
<term>emergency medical condition</term> means a medical condition (including
emergency labor and delivery) manifesting itself by acute symptoms of
sufficient severity (including severe pain) such that the absence of immediate
medical attention could reasonably be expected to result in—</text>
<paragraph id="HB099C3D91C61476A935491502E229AF5"><enum>(1)</enum><text>placing the
patient’s health in serious jeopardy;</text>
</paragraph><paragraph id="H019BA5AF66B94E938ED5FA77DDB2A3D6"><enum>(2)</enum><text>serious impairment
to bodily functions; or</text>
</paragraph><paragraph id="HEEEE26BE33CF4358A698E683CE371235"><enum>(3)</enum><text>serious
dysfunction of any bodily organ or part.</text>
</paragraph></subsection></section><section commented="no" id="H3BC293A391AE441EBE14A3E82CF4EA6C"><enum>2206.</enum><header>Definitions</header><text display-inline="no-display-inline">For purposes of this title:</text>
<paragraph id="HFB653E61CAC640DF91BB438C7A3E101B"><enum>(1)</enum><header>Health-care-related
items and services</header><text display-inline="yes-display-inline">The term
<term>health-care-related items and services</term> shall be defined by a State
with respect to use of such term for purposes of the application of this title
to the State.</text>
</paragraph><paragraph commented="no" id="H533CBC21D81E444BBECB0DAF1596EF91"><enum>(2)</enum><header>High-Risk
Population</header><text>The term <term>high-risk population</term> means
individuals who are described in one of the following subparagraphs:</text>
<subparagraph commented="no" id="H8C96B5803C304CA5A8C3E546EB238F57"><enum>(A)</enum><text>Individuals who,
by reason of the existence or history of a medical condition, are able to
acquire health coverage only at rates which are at least 150 percent of the
standard risk rates for such coverage.</text>
</subparagraph><subparagraph commented="no" id="HD49B19E34BAB44EEABC0E7CF7E7974DB"><enum>(B)</enum><text>Individuals who
are provided health coverage by a qualified high risk pool.</text>
</subparagraph></paragraph><paragraph id="H401F0046B7A74C4FA6B3850D7F4D6EC5"><enum>(3)</enum><header>Indigent
individual</header><text>The term <term>indigent individual</term> shall be
defined by a State with respect to use of such term for purposes of the
application of this title to the State.</text>
</paragraph><paragraph commented="no" id="H88FD17CDF1DF42308CBE3B4BACA87435"><enum>(4)</enum><header>Qualified high
risk pool</header><text display-inline="yes-display-inline">The term
<term>qualified high risk pool</term> has the meaning given such term in
section 2745(g)(1)(A) of the Public Health Service Act.</text>
</paragraph><paragraph commented="no" id="H82AEAC7E8D03456D8207C4305DFE06C5"><enum>(5)</enum><header>Risk-Adjustment
Mechanism Defined</header><text>For purposes of this section, the term
<term>risk-adjustment mechanism</term> means any risk-spreading mechanism to
subsidize the purchase of private health insurance for the high-risk
population, including a qualified high risk
pool.</text>
</paragraph></section>.
(b)Report on
reduction of Federal administrative expendituresBeginning not later than October 31, 2014,
and annually thereafter until October 31, 2023, the Secretary of Health and
Human Services, in consultation with the Secretary of the Treasury, shall
submit a report to the Committee on Energy and Commerce in the House of
Representatives and the Finance Committee in the Senate containing a
description of the total reduction in Federal expenditures required to
administer and provide oversight for the programs to provide
health-care-related items and services to indigent individuals under this Act,
compared to the expenditures required to administer and provide oversight for
the programs under titles XIX and XXI of the Social Security Act, as in effect
on September 30, 2012.
(c)Section 1101(a)(1) of
the Social Security Act (42 U.S.C. 1301(a)(1)) is amended—
(1)in the first
sentence, by striking and XXI
and inserting XXI, and
XXII
; and
(2)in the fourth
sentence, by striking and XXI
and inserting , XXI, and
XXII
.
3.Repeal of PPACA,
HCERA, and the Federal requirements of Medicaid and CHIP
(a)The Patient Protection and Affordable Care
Act (Public Law 111–148) is repealed, and the provisions of law amended or
repealed by such Act are restored or revived as if such Act had not been
enacted.
(b)Title
I and subtitle B of title II of the Health Care and Education Reconciliation
Act of 2010 (Public Law 111–152) are repealed, and the provisions of law
amended or repealed by such title or subtitle, respectively, are restored or
revived as if such title and subtitle had not been enacted.
(c)Titles XIX and XXI of the Social Security Act are
repealed.
4.If any provision of this Act, or the
application of such provision to any person or circumstance, is found to be
unconstitutional, the remainder of this Act, or the application of that
provision to other persons or circumstances, shall not be affected.
5.This Act and the
amendments made by this Act shall take effect with respect to items and
services furnished on or after October 1, 2013.