[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5218 Introduced in House (IH)]







108th CONGRESS
  2d Session
                                H. R. 5218

To increase health insurance coverage in America by requiring employers 
 to offer health insurance coverage with greater government assistance 
 and by expanding current safety net programs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 5, 2004

 Mr. Gephardt introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
  Ways and Means and Education and the Workforce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
To increase health insurance coverage in America by requiring employers 
 to offer health insurance coverage with greater government assistance 
 and by expanding current safety net programs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Matt's Health 
Insurance Plan Act of 2004''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
TITLE I--REQUIREMENT FOR EMPLOYERS TO PROVIDE HEALTH INSURANCE COVERAGE

Sec. 101. Requirement for employers to provide health insurance 
                            coverage.
Sec. 102. Tax credits for employers to provide health insurance 
                            coverage.
Sec. 103. Health care costs of nontaxpayer employers.
            TITLE II--EXPANSION OF EXISTING PUBLIC PROGRAMS

Subtitle A--Access to Medicare Benefits for Individuals 55-to-65 Years 
                                 of Age

Sec. 201. Access to medicare benefits for individuals 55-to-65 years of 
                            age.
 Subtitle B--Refundable Tax Credit for Employee Costs of COBRA Coverage

Sec. 211. Refundable tax credit for employee costs of COBRA coverage.
                         Subtitle C--FamilyCare

Sec. 221. Renaming of title XXI program.
Sec. 222. Familycare coverage of parents and pregnant women under the 
                            medicaid program and title XXI.
Sec. 223. Automatic enrollment of children born to title XXI parents.
Sec. 224. Allowing States to simplify rules for families.
Sec. 225. Revision and simplification of the transitional medical 
                            assistance program (TMA).
Sec. 226. Limitations on conflicts of interest.
Sec. 227. Increase in chip allotment for each of fiscal years 2002 
                            through 2004.
Sec. 228. Demonstration programs to improve medicaid and chip outreach 
                            to homeless individuals and families.
Sec. 229. Additional chip revisions.
Sec. 230. Increased Federal reimbursement for language services under 
                            the medicaid program and title XXI.
   TITLE III--NATIONAL CENTER FOR EVIDENCE-BASED HEALTHCARE PRACTICES

Sec. 301. Establishment of center.

TITLE I--REQUIREMENT FOR EMPLOYERS TO PROVIDE HEALTH INSURANCE COVERAGE

SEC. 101. REQUIREMENT FOR EMPLOYERS TO PROVIDE HEALTH INSURANCE 
              COVERAGE.

    (a) In General.--Each employers must offer health insurance 
coverage constituting qualified health care to employees and former 
employees of such employer and to their families.
    (b) Incorporation of Terms.--For purposes of subsection (a), the 
terms ``employer'', ``qualified health care'', ``employee'', ``former 
employee'', and ``family'' have the meanings given such terms for 
purposes of chapter 101 of the Internal Revenue Code of 1986, as added 
by section 102(a).

SEC. 102. TAX CREDITS FOR EMPLOYERS TO PROVIDE HEALTH INSURANCE 
              COVERAGE.

    (a) In General.--The Internal Revenue Code of 1986 is amended by 
adding at the end the following new subtitle:

      ``Subtitle L--Employment-Based Health Insurance Tax Credits

      ``Chapter 101--EMPLOYMENT-BASED HEALTH INSURANCE TAX CREDITS

      ``CHAPTER 101--EMPLOYMENT-BASED HEALTH INSURANCE TAX CREDITS

                              ``Sec. 9901. Health care costs of 
                                        employers.
                              ``Sec. 9902. Health insurance costs of 
                                        the self-employed.
                              ``Sec. 9903. Health insurance costs of 
                                        certain low wage workers.
                              ``Sec. 9904. Special rules.

``SEC. 9901. HEALTH CARE COSTS OF EMPLOYERS.

    ``(a) Credit for Employers Providing Insurance Pre-Effective 
Date.--
            ``(1) In general.--In the case of a specified employer, 
        there shall be allowed as a credit against the tax imposed by 
        subtitle A an amount equal to 60 percent of the amount paid or 
        incurred by the employer during the taxable year to provide 
        qualified health care (directly or otherwise) to the employees 
        and former employees of such employer and to their families.
            ``(2) Specified employer.--For purposes of this 
        subsection--
                    ``(A) In general.--The term `specified employer' 
                means any employer who provided health care (directly 
                or otherwise) to any employee or former employee of 
                such employer under a group health plan (as defined in 
                section 5000(b)) during the 1-year period ending on 
                January 1, 2005.
                    ``(B) Successor employers.--Except as provided in 
                regulations, any entity and any predecessor or 
                successor entities of such entity shall be treated as 1 
                entity.
    (b) Credit for Other Employers.--
            (1) In general.--In the case of any employer (other than an 
        employer to which subsection (a) applies), there shall be 
        allowed as a credit against the tax imposed by subtitle A an 
        amount equal to the lesser of--
                    ``(A) 100 percent of the amount paid or incurred by 
                the employer during the taxable year to provide 
                qualified health care (directly or otherwise) to the 
                employees and former employees of such employer and to 
                their families, or
                    ``(B) 60 percent of the total amounts paid or 
                incurred (including any amounts paid or incurred by 
                employees or former employees of the employer as 
                premiums or other cost-sharing) during the taxable year 
                to provide qualified health care (directly or 
                otherwise) to the employees and former employees of 
                such employer and to their families.
    ``(c) Qualified Health Care.--For purposes of this section, the 
term `qualified health care' means health care for which the employer 
bears 60 percent or more of the cost.
    ``(d) Certain Employment Not Taken Into Account.--For purposes this 
section, except as provided in regulations by the Secretary, an 
individual shall be treated as an employee only with respect to 
employment described in section 3121(b) (determined without regard to 
paragraph (7) thereof).

``SEC. 9902. HEALTH INSURANCE COSTS OF THE SELF-EMPLOYED.

    ``(a) In General.--In the case of an individual who is an employee 
within the meaning of section 401(c)(1), there shall be allowed as a 
credit against the tax imposed by subtitle A an amount equal to 60 
percent of the amount paid by the taxpayer during the taxable year for 
insurance which constitutes medical care for the taxpayer, his spouse, 
and dependents.
    ``(b) Limitations.--
            ``(1) Dollar amount.--No credit shall be allowed under 
        subsection (a) to the extent that the amount of such credit 
        exceeds the taxpayer's earned income (within the meaning of 
        section 401(c)) derived by the taxpayer from the trade or 
        business with respect to which the plan providing the medical 
        care coverage is established.
            ``(2) Other coverage.--Subsection (a) shall not apply to 
        any taxpayer for any calendar month for which the taxpayer is 
        eligible to participate in any subsidized health plan 
        maintained by any employer of the taxpayer or of the spouse of 
        the taxpayer. The preceding sentence shall be applied 
        separately with respect to--
                    ``(A) plans which include coverage for qualified 
                long-term care services (as defined in section 
                7702B(c)) or are qualified long-term care insurance 
                contracts (as defined in section 7702B(b)), and
                    ``(B) plans which do not include such coverage and 
                are not such contracts.
            ``(3) Long-term care premiums.--In the case of a qualified 
        long-term care insurance contract (as defined in section 
        7702B(b)), only eligible long-term care premiums (as defined in 
        section 213(d)(10) shall be taken into account under paragraph 
        (1).

``SEC. 9903. HEALTH INSURANCE COSTS OF CERTAIN LOW WAGE WORKERS.

    ``(a) In General.--In the case of an individual, there shall be 
allowed as a credit against the tax imposed by subtitle A an amount 
equal to 25 percent of the amount paid by the taxpayer for coverage of 
the taxpayer, his spouse, and dependents under any subsidized health 
plan maintained by any employer of the taxpayer or of the spouse of the 
taxpayer.
    ``(b) Limitation.--
            ``(1) In general.--The amount of the credit allowed under 
        subsection (a) shall be reduced (but not below zero) by an 
        amount which bears the same ratio to the amount so determined 
        as--
                    ``(A) the amount (if any) by which the taxpayer's 
                adjusted gross income for the taxable year exceeds the 
                threshold amount, bears to
                    ``(B) the threshold amount.
            ``(2) Threshold amount.--For purposes of this subsection, 
        the term `threshold amount' means the poverty line (as defined 
        in section 673(2) of the Community Services Block Grant Act, 
        including any revision required by such section) for a family 
        of the size involved, as in effect at the close of the taxable 
        year.
    ``(c) Special Rules.--
            ``(1) Coordination with savings accounts.--Amounts 
        distributed from an Archer MSA (as defined in section 220(d)) 
        or a health savings account (as defined in section 223(d)) 
        shall not be taken into account under subsection (a).
            ``(2) Denial of credit to dependents.--No credit shall be 
        allowed under this section to any individual with respect to 
        whom a deduction under section 151 is allowable to another 
        taxpayer for a taxable year beginning in the calendar year in 
        which such individual's taxable year begins.
            ``(3) Married couples must file joint return.--If the 
        taxpayer is married at the close of the taxable year, the 
        credit shall be allowed under subsection (a) only if the 
        taxpayer and his spouse file a joint return for the taxable 
        year. Rules similar to the rules of paragraphs (3) and (4) of 
        section 21(e) shall apply for purposes of this paragraph.

``SEC. 9904. SPECIAL RULES.

    ``(a) Credits Treated as Refundable.--For purposes of this title, 
the credits allowed under this chapter shall be treated as allowed 
under subpart C of part IV of subchapter A of chapter 1.
    ``(b) Coordination With Deductions.--Any amount which is taken into 
account under section 9901(a)(1), 9901(b)(1) (determined without regard 
to section 9901(b)(1)(B)), 9902(a), or 9903(a) shall not be taken into 
account in determining any deduction under subtitle A.
    ``(c) Regulations.--The Secretary may prescribe such regulations 
and other guidance as may be necessary or appropriate to carry out this 
chapter.''.
    (b) Conforming Amendments.--
            (1) Section 162 of the Internal Revenue Code of 1986 is 
        amended by striking subsection (l).
            (2) Paragraph (2) of section 1324(b) of title 31, United 
        States Code, is amended by inserting ``or chapter 101'' after 
        ``section 35''.
            (3) The table of subtitles of the Internal Revenue Code of 
        1986 is amended by adding at the end the following new item:

``Subtitle L--Employment-based health insurance tax credits.''.
    (c) Effective Date.--The amendments made by this subsection shall 
apply to taxable years beginning after December 31, 2004.

SEC. 103. HEALTH CARE COSTS OF NONTAXPAYER EMPLOYERS.

    (a) Payments by Secretary of the Treasury.--The Secretary of the 
Treasury shall establish a program under which the Secretary shall make 
payments to qualified nontaxpayer employers in amounts equal to the 
credits that such employers would have been allowed under section 9901 
of the Internal Revenue Code of 1986 if such employers were subject to, 
and not exempt from, taxation under subtitle A of such Code.
    (b) Qualified Nontaxpayer Employers.--For purposes of this section, 
the term ``qualified nontaxpayer employer'' means any employer which 
is--
                    (A) a State, political subdivision of a State, or 
                any agency or instrumentality of a State or political 
                subdivision of a State,
                    (B) any Indian tribal government (as defined in 
                section 7701(a)(40) of the Internal Revenue Code of 
                1986), subdivision of an Indian tribal government 
                (determined in accordance with section 7871(d) of such 
                Code), or an agency or instrumentality of an Indian 
                tribal government or subdivision thereof, or
                    (C) any other organization (other than a 
                governmental or tribal unit) exempt from tax under 
                subtitle A of the Internal Revenue Code of 1986.

            TITLE II--EXPANSION OF EXISTING PUBLIC PROGRAMS

Subtitle A--Access to Medicare Benefits for Individuals 55-to-65 Years 
                                 of Age

SEC. 201. ACCESS TO MEDICARE BENEFITS FOR INDIVIDUALS 55-TO-65 YEARS OF 
              AGE.

    (a) In General.--Title XVIII of the Social Security Act, as amended 
by section 101(a) of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108-173), is amended--
            (1) by redesignating part E as part F; and
            (2) by inserting after part D the following new part:

``PART E--PURCHASE OF MEDICARE BENEFITS BY CERTAIN INDIVIDUALS 55-TO-65 
                              YEARS OF AGE

``SEC. 1860E-1. PROGRAM BENEFITS; ELIGIBILITY.

    ``(a) Entitlement to Medicare Benefits for Enrolled Individuals.--
            ``(1) In general.--An individual enrolled under this part 
        is entitled to the same benefits under this title as an 
        individual entitled to benefits or enrolled under any part of 
        this title.
            ``(2) Definitions.--For purposes of this part:
                    ``(A) Federal or state COBRA continuation 
                provision.--The term `Federal or State COBRA 
                continuation provision' has the meaning given the term 
                `COBRA continuation provision' in section 2791(d)(4) of 
                the Public Health Service Act and includes a comparable 
                State program, as determined by the Secretary.
                    ``(B) Federal health insurance program defined.--
                The term `Federal health insurance program' means any 
                of the following:
                            ``(i) Medicare.--Any part of this title 
                        (other than by reason of this part).
                            ``(ii) Medicaid.--A State plan under title 
                        XIX.
                            ``(iii) FEHBP.--The Federal employees 
                        health benefit program under chapter 89 of 
                        title 5, United States Code.
                            ``(iv) TRICARE.--The TRICARE program (as 
                        defined in section 1072(7) of title 10, United 
                        States Code).
                            ``(v) Active duty military.--Health 
                        benefits under title 10, United States Code, to 
                        an individual as a member of the uniformed 
                        services of the United States.
                    ``(C) Group health plan.--The term `group health 
                plan' has the meaning given such term in section 
                2791(a)(1) of the Public Health Service Act.
    ``(b) Eligibility of Individuals Age 55-to-65 Years of Age.--
            ``(1) In general.--Subject to paragraph (2), an individual 
        who meets the following requirements with respect to a month is 
        eligible to enroll under this part with respect to such month:
                    ``(A) Age.--As of the last day of the month, the 
                individual has attained 55 years of age, but has not 
                attained 65 years of age.
                    ``(B) Medicare eligibility (but for age).--The 
                individual would be eligible for benefits under part A 
                or part B for the month if the individual were 65 years 
                of age.
                    ``(C) Not eligible for coverage under group health 
                plans or federal health insurance programs.--The 
                individual is not eligible for benefits or coverage 
                under a Federal health insurance program (as defined in 
                subsection (a)(2)(B)) or under a group health plan 
                (other than such eligibility merely through a Federal 
                or State COBRA continuation provision) as of the last 
                day of the month involved.
            ``(2) Limitation on eligibility if terminated enrollment.--
        If an individual described in paragraph (1) enrolls under this 
        part and coverage of the individual is terminated under section 
        1860E-2(d) (other than because of age), the individual is not 
        again eligible to enroll under this subsection unless the 
        following requirements are met:
                    ``(A) New coverage under group health plan or 
                federal health insurance program.--After the date of 
                termination of coverage under such section, the 
                individual obtains coverage under a group health plan 
                or under a Federal health insurance program.
                    ``(B) Subsequent loss of new coverage.--The 
                individual subsequently loses eligibility for the 
                coverage described in subparagraph (A) without regard 
                to whether the individual has exhausted any eligibility 
                the individual may subsequently have for coverage under 
                a Federal or State COBRA continuation provision.
            ``(3) Change in health plan eligibility does not affect 
        coverage.--In the case of an individual who is eligible for and 
        enrolls under this part under this subsection, the individual's 
        continued entitlement to benefits under this part shall not be 
        affected by the individual's subsequent eligibility for 
        benefits or coverage described in paragraph (1)(C), or 
        entitlement to such benefits or coverage.

``SEC. 1860E-2. ENROLLMENT PROCESS; COVERAGE.

    ``(a) In General.--An individual may enroll in the program 
established under this part only in such manner and form as may be 
prescribed by regulations, and only during an enrollment period 
prescribed by the Secretary consistent with the provisions of this 
section. Such regulations shall provide a process under which 
individuals eligible to enroll as of a month are permitted to pre-
enroll during a prior month within an enrollment period described in 
subsection (b).
    ``(b) Enrollment Periods.--
            ``(1) Individuals 55-to-65 years of age.--In the case of 
        individuals eligible to enroll under this part under section 
        1860E-1(b)--
                    ``(A) Initial enrollment period.--If the individual 
                is eligible to enroll under such section for January 
                2005, the enrollment period shall begin on November 1, 
                2004, and shall end on February 28, 2005. Any such 
                enrollment before January 1, 2005, is conditioned upon 
                compliance with the conditions of eligibility for 
                January 2005.
                    ``(B) Subsequent periods.--If the individual is 
                eligible to enroll under such section for a month after 
                January 2005, the enrollment period shall begin on the 
                first day of the second month before the month in which 
                the individual first is eligible to so enroll and shall 
                end four months later. Any such enrollment before the 
                first day of the third month of such enrollment period 
                is conditioned upon compliance with the conditions of 
                eligibility for such third month.
            ``(2) Authority to correct for government errors.--The 
        provisions of section 1837(h) apply with respect to enrollment 
        under this part in the same manner as they apply to enrollment 
        under part B.
    ``(c) Date Coverage Begins.--
            ``(1) In general.--The period during which an individual is 
        entitled to benefits under this part shall begin as follows, 
        but in no case earlier than January 1, 2005:
                    ``(A) In the case of an individual who enrolls 
                (including pre-enrolls) before the month in which the 
                individual satisfies eligibility for enrollment under 
                section 1860E-1, the first day of such month of 
                eligibility.
                    ``(B) In the case of an individual who enrolls 
                during or after the month in which the individual first 
                satisfies eligibility for enrollment under such 
                section, the first day of the following month.
            ``(2) Authority to provide for partial months of 
        coverage.--Under regulations, the Secretary may, in the 
        Secretary's discretion, provide for coverage periods that 
        include portions of a month in order to avoid lapses of 
        coverage.
            ``(3) Limitation on payments.--No payments may be made 
        under this title with respect to the expenses of an individual 
        enrolled under this part unless such expenses were incurred by 
        such individual during a period which, with respect to the 
        individual, is a coverage period under this section.
    ``(d) Termination of Coverage.--
            ``(1) In general.--An individual's coverage period under 
        this part shall continue until the individual's enrollment has 
        been terminated at the earliest of the following:
                    ``(A) General provisions.--
                            ``(i) Notice.--The individual files notice 
                        (in a form and manner prescribed by the 
                        Secretary) that the individual no longer wishes 
                        to participate in the insurance program under 
                        this part.
                            ``(ii) Nonpayment of premiums.--The 
                        individual fails to make payment of premiums 
                        required for enrollment under this part.
                            ``(iii) Medicare eligibility.--The 
                        individual becomes entitled to benefits or 
                        enrolled under any other part of this title 
                        (other than by reason of this part).
                    ``(B) Termination based on age.--The individual 
                attains 65 years of age.
            ``(2) Effective date of termination.--
                    ``(A) Notice.--The termination of a coverage period 
                under paragraph (1)(A)(i) shall take effect at the 
                close of the month following for which the notice is 
                filed.
                    ``(B) Nonpayment of premium.--The termination of a 
                coverage period under paragraph (1)(A)(ii) shall take 
                effect on a date determined under regulations, which 
                may be determined so as to provide a grace period in 
                which overdue premiums may be paid and coverage 
                continued. The grace period determined under the 
                preceding sentence shall not exceed 60 days; except 
                that it may be extended for an additional 30 days in 
                any case where the Secretary determines that there was 
                good cause for failure to pay the overdue premiums 
                within such 60-day period.
                    ``(C) Age or medicare eligibility.--The termination 
                of a coverage period under paragraph (1)(A)(iii) or 
                (1)(B) shall take effect as of the first day of the 
                month in which the individual attains 65 years of age 
                or becomes entitled to benefits or enrolled in any 
                other part of this title (other than by reason of this 
                part).

``SEC. 1860E-3. PREMIUMS.

    ``(a) Amount of Monthly Premiums.--The Secretary shall, during 
September of each year (beginning with 2004), determine a monthly 
premium for individuals 55 years of age or older, equal to \1/12\ of 
the annual premium computed under subsection (b)(2), which shall apply 
with respect to coverage provided under this title for any month in the 
succeeding year.
    ``(b) Annual Premium.--
            ``(1) National, per capita average.--The Secretary shall 
        estimate the average, annual per capita amount that would be 
        payable under this title with respect to individuals residing 
        in the United States who meet the requirement of section 1860E-
        1(b)(1)(A) as if all such individuals were eligible for (and 
        enrolled) under this title during the entire year (and assuming 
        that section 1862(b)(2)(A)(i) did not apply).
            ``(2) Annual premium.--The annual premium under this 
        subsection for months in a year is equal to the average, annual 
        per capita amount estimated under paragraph (1) for the year.

``SEC. 1860E-4. PAYMENT OF PREMIUMS.

    ``(a) Payment of Monthly Premium.--
            ``(1) In general.--The Secretary shall provide for payment 
        and collection of the monthly premium, determined under section 
        1860E-3(a) for the age of the individual involved, in the same 
        manner as for payment of monthly premiums under section 1840, 
        except that, for purposes of applying this section, any 
        reference in such section to the Federal Supplementary Medical 
        Insurance Trust Fund is deemed a reference to the Trust Fund 
        established under section 1860E-6.
            ``(2) Period of payment.--In the case of an individual who 
        participates in the program established by this title, the 
        monthly premium shall be payable for the period commencing with 
        the first month of the individual's coverage period and ending 
        with the month in which the individual's coverage under this 
        title terminates.
    ``(b) Application of Certain Provisions.--The provisions of section 
1840 (other than subsection (h)) shall apply to premiums collected 
under this section in the same manner as they apply to premiums 
collected under part B, except that any reference in such section to 
the Federal Supplementary Medical Insurance Trust Fund is deemed a 
reference to the Trust Fund established under section 1860E-6.

``SEC. 1860E-5. PROVISIONS RELATING TO EMPLOYMENT-BASED RETIREE HEALTH 
              COVERAGE.

    ``(a) In General.--In the case of an individual who would be 
eligible to enroll under this part but for the provision of employment-
based retiree health coverage by an employer to the individual, 
notwithstanding the limitation under section 1860E-1(b)(1)(C), the 
individual is eligible to enroll under this part.
    ``(b) Maintenance of Effort.--In the case of an employer that 
offers employment-based retiree health coverage to an individual who 
enrolls under this part, upon enrollment of the individual under this 
part, the employer may modify such coverage to provide for the 
following benefits:
            ``(1) Payment is made by the employer under such coverage 
        for items and services for which payment may not be made under 
        this title.
            ``(2) Payment is made by the employer sponsoring such 
        coverage of 25 percent of the monthly premium under section 
        1860E-3 applicable to the individual after enrollment under 
        this part.
    ``(c) Employment-Based Retiree Health Coverage.--The term 
`employment-based retiree health coverage' has the meaning given that 
term in section 1860D-22(c)(1), except that, fur purposes of this part, 
any reference in such section to `part D' is deemed to be a reference 
to `part E'.

``SEC. 1860E-6. MEDICARE EARLY ACCESS TRUST FUND.

    ``(a) Establishment of Trust Fund.--
            ``(1) In general.--There is hereby created on the books of 
        the Treasury of the United States a trust fund to be known as 
        the `Medicare Early Access Trust Fund' (in this section 
        referred to as the `Trust Fund'). The Trust Fund shall consist 
        of such gifts and bequests as may be made as provided in 
        section 201(i)(1) and such amounts as may be deposited in, or 
        appropriated to, such fund as provided in this title.
            ``(2) Premiums.--Premiums collected under section 1860E-3 
        and payable under section 1860E-5(a)(2) shall be transferred to 
        the Trust Fund.
    ``(b) Incorporation of Provisions.--
            ``(1) In general.--Subject to paragraph (2), subsections 
        (b) through (i) of section 1841 shall apply with respect to the 
        Trust Fund and this title in the same manner as they apply with 
        respect to the Federal Supplementary Medical Insurance Trust 
        Fund and part B, respectively.
            ``(2) Miscellaneous references.--In applying provisions of 
        section 1841 under paragraph (1)--
                    ``(A) any reference in such section to `this part' 
                is construed to refer to this part E;
                    ``(B) any reference in section 1841(h) to section 
                1840(d) and in section 1841(i) to sections 1840(b)(1) 
                and 1842(g) are deemed references to comparable 
                authority exercised under this part; and
                    ``(C) payments may be made under section 1841(g) to 
                the Trust Funds under sections 1817 and 1841 as 
                reimbursement to such funds for payments they made for 
                benefits provided under this part.

``SEC. 1860E-7. OVERSIGHT AND ACCOUNTABILITY.

    ``(a) Through Annual Reports of Trustees.--The Board of Trustees of 
the Medicare Early Access Trust Fund under section 1860E-6(b)(1) shall 
report on an annual basis to Congress concerning the status of the 
Trust Fund and the need for adjustments in the program under this part 
to maintain financial solvency of the program under this part.
    ``(b) Periodic GAO Reports.--The Comptroller General of the United 
States shall periodically submit to Congress reports on the adequacy of 
the financing of coverage provided under this part. The Comptroller 
General shall include in such report such recommendations for 
adjustments in such financing and coverage as the Comptroller General 
deems appropriate in order to maintain financial solvency of the 
program under this part.

``SEC. 1860E-8. ADMINISTRATION AND MISCELLANEOUS.

    ``(a) Treatment for Purposes of Title.--Except as otherwise 
provided in this part--
            ``(1) individuals enrolled under this part shall be treated 
        for purposes of this title as though the individual were 
        entitled to benefits and enrolled under any part of this title; 
        and
            ``(2) benefits described in section 1860E-1 shall be 
        payable under this title to such individuals in the same manner 
        as if such individuals were so entitled and enrolled.
    ``(b) Not Treated as Medicare Program for Purposes of Medicaid 
Program.--For purposes of applying title XIX (including the provision 
of medicare cost-sharing assistance under such title), an individual 
who is enrolled under this part shall not be treated as being entitled 
to benefits under this title.
    ``(c) Not Treated as Medicare Program for Purposes of COBRA 
Continuation Provisions.--In applying a COBRA continuation provision 
(as defined in section 2791(d)(4) of the Public Health Service Act), 
any reference to an entitlement to benefits under this title shall not 
be construed to include entitlement to benefits under this title 
pursuant to the operation of this part.''.
    (b) Conforming Amendments to Social Security Act.--(1) Section 
201(i)(1) of the Social Security Act (42 U.S.C. 401(i)(1)) is amended 
by striking ``or the Federal Supplementary Medical Insurance Trust 
Fund'' and inserting ``the Federal Supplementary Medical Insurance 
Trust Fund, and the Medicare Early Access Trust Fund''.
    (2) Section 201(g)(1)(A) of such Act (42 U.S.C. 401(g)(1)(A)) is 
amended by striking ``and the Federal Supplementary Medical Insurance 
Trust Fund established by title XVIII'' and inserting ``, the Federal 
Supplementary Medical Insurance Trust Fund, and the Medicare Early 
Access Trust Fund established by title XVIII''.
    (3) Section 1820(i) of such Act (42 U.S.C. 1395i-4(i)) is amended 
by striking ``part D'' and inserting ``part F''.
            (4) Section 1853 of such Act (42 U.S.C. 1395w-23), as 
        amended by section 222(d) of the Medicare Prescription Drug, 
        Improvement, and Modernization Act of 2003 (Public Law 108-
        173), is amended by adding at the end the following new 
        subsection:
    ``(k) Adjustment for Early Access.--In applying this section with 
respect to individuals entitled to benefits under part E, the Secretary 
shall provide for an appropriate adjustment in, for 2005, the 
Medicare+Choice capitation rate, and for years beginning with 2006, the 
payment amount determined under this section or section 1858, as may be 
appropriate to reflect differences between the population served under 
such part and the population under parts A and B.''.
            (5) Section 1860D-15(c)(1) of such Act, as added by section 
        101(a) of the Medicare Prescription Drug, Improvement, and 
        Modernization Act of 2003 (Public Law 108-173), is amended by 
        adding at the end the following new subparagraph:
                    ``(E) Adjustment for early access.--In applying 
                this section with respect to individuals entitled to 
                benefits under part E, the Secretary shall provide for 
                an appropriate adjustment in the payment amount 
                determined under this section as may be appropriate to 
                reflect differences between the population served under 
                such part and the population under parts A and B.''.
    (c) Other Conforming.--(1) Section 602(2)(D)(ii) of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1162(2)) is amended 
by inserting ``(not including an individual who is so entitled pursuant 
to enrollment under section 1860E-1)'' after ``Social Security Act''.
    (2) Section 2202(2)(D)(ii) of the Public Health Service Act (42 
U.S.C. 300bb-2(2)(D)(ii)) is amended by inserting ``(not including an 
individual who is so entitled pursuant to enrollment under section 
1860E-1)'' after ``Social Security Act''.
    (3) Section 4980B(f)(2)(B)(i)(V) of the Internal Revenue Code of 
1986 is amended by inserting ``(not including an individual who is so 
entitled pursuant to enrollment under section 1860E-1)'' after ``Social 
Security Act''.

 Subtitle B--Refundable Tax Credit for Employee Costs of COBRA Coverage

SEC. 211. REFUNDABLE TAX CREDIT FOR EMPLOYEE COSTS OF COBRA COVERAGE.

    (a) In General.--Chapter 101 of the Internal Revenue Code of 1986, 
as added by section 102, is amended by redesignating section 9905 as 
section 9906 and by inserting after section 9904 the following new 
section:

``SEC. 9905. EMPLOYEE COSTS OF COBRA COVERAGE.

    ``(a) In General.--In the case of an individual, there shall be 
allowed against the tax imposed by subtitle A an amount equal to 65 
percent of the amount paid by the taxpayer for coverage of the 
taxpayer, his spouse, and dependents under a COBRA continuation 
provision (as defined in section 9832(d)(1)).
    ``(b) Special Rules.--Rules similar to the rules of section 9904(c) 
shall apply for purposes of this section.''.
    (b) Conforming Amendments.--
            (1) Subsection (b) of section 9906 of such Code (as added 
        by section 102 and redesignated by subsection (a)) is further 
        amended by striking ``or 9904(a)'' and inserting ``9904(a), or 
        9905(a)''.
            (2) The table of sections for chapter 101 of such Code is 
        amended by striking the item relating to section 9905 and 
        inserting the following new items:

                              ``Sec. 9905. Employee costs of COBRA 
                                        coverage.
                              ``Sec. 9906. Special rules.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2004.

                  Subtitle C--FamilyCare <plus-minus>

SEC. 221. RENAMING OF TITLE XXI PROGRAM.

    (a) In General.--The heading of title XXI of the Social Security 
Act (42 U.S.C. 1397aa et seq.) is amended to read as follows:

                   ``TITLE XXI--FAMILYCARE PROGRAM''.

    (b) Program References.--Any reference in any provision of Federal 
law or regulation to ``SCHIP'' or ``State children's health insurance 
program'' under title XXI of the Social Security Act shall be deemed a 
reference to the FamilyCare program under such title.

SEC. 222. FAMILYCARE COVERAGE OF PARENTS AND PREGNANT WOMEN UNDER THE 
              MEDICAID PROGRAM AND TITLE XXI.

    (a) Incentives To Implement FamilyCare Coverage.--
            (1) Under medicaid.--
                    (A) Establishment of new optional eligibility 
                category.--Section 1902(a)(10)(A)(ii) of the Social 
                Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is 
                amended--
                            (i) by striking ``or'' at the end of 
                        subclause (XVII);
                            (ii) by adding ``or'' at the end of 
                        subclause (XVIII); and
                            (iii) by adding at the end the following:
                                    ``(XIX) who are individuals 
                                described in subsection (k)(1) 
                                (relating to parents of categorically 
                                eligible children);''.
                    (B) Parents described.--Section 1902 of the Social 
                Security Act is further amended by inserting after 
                subsection (j) the following:
    ``(k)(1)(A) Individuals described in this paragraph are 
individuals--
            ``(i) who are the parents of an individual who is under 19 
        years of age (or such higher age as the State may have elected 
        under section 1902(l)(1)(D)) and who is eligible for medical 
        assistance under subsection (a)(10)(A);
            ``(ii) who are not otherwise eligible for medical 
        assistance under such subsection or under a waiver approved 
        under section 1115 or otherwise (except under section 1931 or 
        under subsection (a)(10)(A)(ii)(XIX)); and
            ``(iii) whose family income or resources exceeds the 
        effective income level or resource level applicable under the 
        State plan under part A of title IV as in effect as of July 16, 
        1996, but does not exceed the highest effective income or 
        resource level (if any) applicable to a child in the family 
        under this title.
    ``(B) In establishing an income eligibility level for individuals 
described in this paragraph, a State may vary such level consistent 
with the various income levels established under subsection (l)(2) in 
order to ensure, to the maximum extent possible, that such individuals 
shall be enrolled in the same program as their children.
    ``(C) An individual may not be treated as being described in this 
paragraph unless, at the time of the individual's enrollment under this 
title, the child referred to in subparagraph (A)(i) of the individual 
is also enrolled under this title or otherwise insured.
    ``(D) In this subsection, the term `parent' includes an individual 
treated as a caretaker for purposes of carrying out section 1931.
    ``(E) In this subsection, the term `effective income level' means 
the income level expressed as a percent of the poverty line and 
considering applicable income disregards.
    ``(2) The State shall provide for coverage of a parent described in 
paragraph (1) or section 2111 of a child who is covered under this 
title or title XXI under the same title as the title as such child is 
covered. In the case of a parent described in paragraph (1) who is also 
the parent of a child who is eligible for child health assistance under 
title XXI, the State may elect (on a uniform basis) to cover all such 
parents under section 2111 or under this title.''.
                    (C) Enhanced matching funds available if certain 
                conditions met.--Section 1905 of the Social Security 
                Act (42 U.S.C. 1396d) is amended--
                            (i) in the fourth sentence of subsection 
                        (b), by striking ``or subsection (u)(3)'' and 
                        inserting ``, (u)(3), or (u)(4)(A)''; and
                            (ii) in subsection (u)--
                                    (I) by redesignating paragraph (4) 
                                as paragraph (6), and
                                    (II) by inserting after paragraph 
                                (3) the following:
    ``(4) For purposes of subsection (b) and section 2105(a)(1):
            ``(A) FamilyCare parents.--The expenditures described in 
        this subparagraph are the expenditures described in the 
        following clauses (i) and (ii):
                    ``(i) Parents.--If the conditions described in 
                clauses (iii) and (iv) are met, expenditures for 
                medical assistance for parents described in section 
                1902(k)(1) and for parents who would be described in 
                such section but for the fact that they are eligible 
                for medical assistance under section 1931 or under a 
                waiver approved under section 1115.
                    ``(ii) Certain pregnant women.--If the conditions 
                described in clause (v) are met, expenditures for 
                medical assistance for pregnant women described in 
                subsection (n) or under section 1902(l)(1)(A) in a 
                family the income of which exceeds the effective income 
                level applicable under subsection (a)(10)(A)(i)(III) or 
                (l)(2)(A) of section 1902 to a family of the size 
                involved as of January 1, 2005.
                    ``(iii) Conditions relating to ensuring children's 
                coverage for enhanced match for parents.--The 
                conditions described in this clause are the following:
                            ``(I) The State has a State child health 
                        plan under title XXI which (whether implemented 
                        under such title or under this title) has an 
                        effective income level for children that is at 
                        least 200 percent of the poverty line.
                            ``(II) Such State child health plan does 
                        not limit the acceptance of applications, does 
                        not use a waiting list for children who meet 
                        eligibility standards to qualify for 
                        assistance, and provides benefits to all 
                        children in the State who apply for and meet 
                        eligibility standards.
                            ``(III) Effective for determinations of 
                        eligibility made on or after the date that is 1 
                        year after the date of the enactment of this 
                        clause, the application and renewal procedures 
                        for individuals under 19 years of age (or such 
                        higher age as the State has elected under 
                        section 1902(l)(1)(D)) for medical assistance 
                        under section 1902(a)(10)(A) are not be more 
                        restrictive or burdensome than such procedures 
                        used for children with higher income under the 
                        State child health plan under title XXI.
                    ``(iv) Conditions relating to minimum coverage for 
                parents for enhanced match for parents.--The conditions 
                described in this clause are the following:
                            ``(I) The State does not apply an income 
                        level for parents that is lower than the 
                        effective income level (expressed as a percent 
                        of the poverty line) that has been specified 
                        under the State plan under title XIX (including 
                        under a waiver authorized by the Secretary or 
                        under section 1902(r)(2)), as of January 1, 
                        2005, to be eligible for medical assistance as 
                        a parent under this title.
                            ``(II) The State plans under this title and 
                        title XXI do not provide coverage for parents 
                        with higher family income without covering 
                        parents with a lower family income.
                    ``(v) Conditions for enhanced match for certain 
                pregnant women.--The conditions described in this 
                clause are the following:
                            ``(I) The State has established an 
                        effective income eligibility level for pregnant 
                        women under subsection (a)(10)(A)(i)(III) or 
                        (l)(2)(A) of section 1902 that is at least 185 
                        percent of the poverty line.
                            ``(II) The State plans under this title and 
                        title XXI do not provide coverage for pregnant 
                        women described in subparagraph (A)(ii) with 
                        higher family income without covering such 
                        pregnant women with a lower family income.
                            ``(III) The State does not apply an income 
                        level for pregnant women that is lower than the 
                        effective income level that has been specified 
                        under the State plan under subsection 
                        (a)(10)(A)(i)(III) or (l)(2)(A) of section 
                        1902, as of January 1, 2005, to be eligible for 
                        medical assistance as a pregnant woman.
                            ``(IV) The State satisfies the conditions 
                        described in subclauses (I) and (II) of clause 
                        (iii).
                    ``(vi) Definitions.--For purposes of this 
                subsection:
                            ``(I) The term `parent' has the meaning 
                        given such term for purposes of section 
                        1902(k)(1).
                            ``(II) The term `poverty line' has the 
                        meaning given such term in section 
                        2110(c)(5).''.
                    (D) Appropriation from title xxi allotment for 
                certain medicaid expansion costs.--Section 2105(a) of 
                the Social Security Act (42 U.S.C. 1397ee(a)) is 
                amended--
                            (i) in paragraph (1), by redesignating 
                        subparagraphs (B) through (D) as subparagraphs 
                        (C) through (E), respectively, and by inserting 
                        after subparagraph (A) the following new 
                        subparagraph:
                    ``(B) for medical assistance that is attributable 
                to expenditures described in section 1905(u)(4)(A);''; 
                and
                            (ii) in paragraph (2), by adding at the end 
                        the following new subparagraph:
                    ``(E) Fifth, for expenditures for items described 
                in paragraph (1)(E).''.
                    (E) Increasing enhanced fmap to 100 percent for 
                fiscal years 2005 and 2006 for coverage of parents.--
                Section 2105(b) of such Act (42 U.S.C. 1397ee(b)) is 
                amended by adding at the end the following new 
                sentence: ``Notwithstanding the previous sentence, the 
                `enhanced FMAP' shall be 100 percent with respect to 
                medical assistance under title XIX for expenditures 
                described in section 1905(u)(4)(A)(i), but only for 
                such assistance furnished during fiscal year 2005 and 
                fiscal year 2006.''.
            (2) Under title xxi.--
                    (A) FamilyCare coverage.--Title XXI of the Social 
                Security Act (42 U.S.C. 1397aa et seq.) is amended by 
                adding at the end the following:

``SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PARENTS OF TARGETED LOW-
              INCOME CHILDREN.

    ``(a) Optional Coverage.--Notwithstanding any other provision of 
this title, a State may provide for coverage, through an amendment to 
its State child health plan under section 2102, of parent health 
assistance for targeted low-income parents, health care assistance for 
targeted low-income pregnant women, or both, in accordance with this 
section, but only if--
            ``(1) with respect to the provision of parent health 
        assistance, the State meets the conditions described in clause 
        (iii) of section 1905(u)(4)(A);
            ``(2) with respect to the provision of health care 
        assistance for pregnant women, the State meets the conditions 
        described in clause (iv) of section 1905(u)(4)(A); and
            ``(3) in the case of parent health assistance for targeted 
        low-income parents, the State elects to provide medical 
        assistance under section 1902(a)(10)(A)(ii)(XIX), under section 
        1931, or under a waiver under section 1115 to individuals 
        described in section 1902(k)(1)(A)(i) and elects an effective 
        income level that, consistent with paragraphs (1)(B) and (2) of 
        section 1902(k), ensures to the maximum extent possible, that 
        such individuals shall be enrolled in the same program as their 
        children if their children are eligible for coverage under 
        title XIX (including under a waiver authorized by the Secretary 
        or under section 1902(r)(2)).
    ``(b) Definitions.--For purposes of this title:
            ``(1) Parent health assistance.--The term `parent health 
        assistance' has the meaning given the term child health 
        assistance in section 2110(a) as if any reference to targeted 
        low-income children were a reference to targeted low-income 
        parents.
            ``(2) Parent.--The term `parent' has the meaning given the 
        term `caretaker relative' for purposes of carrying out section 
        1931.
            ``(3) Health care assistance for pregnant women.--The term 
        `health care assistance for pregnant women' has the meaning 
        given the term child health assistance in section 2110(a) as if 
        any reference to targeted low-income children were a reference 
        to targeted low-income pregnant women.
            ``(4) Targeted low-income parent.--The term `targeted low-
        income parent' has the meaning given the term targeted low-
        income child in section 2110(b) as if the reference to a child 
        were deemed a reference to a parent (as defined in paragraph 
        (3)) of the child; except that in applying such section--
                    ``(A) there shall be substituted for the income 
                level described in paragraph (1)(B)(ii)(I) the 
                applicable income level in effect for a targeted low-
                income child;
                    ``(B) in paragraph (3), January 1, 2005, shall be 
                substituted for July 1, 1997; and
                    ``(C) in paragraph (4), January 1, 2005, shall be 
                substituted for March 31, 1997.
            ``(5) Targeted low-income pregnant woman.--The term 
        `targeted low-income pregnant woman' has the meaning given the 
        term targeted low-income child in section 2110(b) as if any 
        reference to a child were a reference to a woman during 
        pregnancy and through the end of the month in which the 60-day 
        period beginning on the last day of her pregnancy ends; except 
        that in applying such section--
                    ``(A) there shall be substituted for the income 
                level described in paragraph (1)(B)(ii)(I) the 
                applicable income level in effect for a targeted low-
                income child;
                    ``(B) in paragraph (3), January 1, 2005, shall be 
                substituted for July 1, 1997; and
                    ``(C) in paragraph (4), January 1, 2005, shall be 
                substituted for March 31, 1997.
    ``(c) References to Terms and Special Rules.--In the case of, and 
with respect to, a State providing for coverage of parent health 
assistance to targeted low-income parents or health care assistance to 
targeted low-income pregnant women under subsection (a), the following 
special rules apply:
            ``(1) Any reference in this title (other than in subsection 
        (b)) to a targeted low-income child is deemed to include a 
        reference to a targeted low-income parent or a targeted low-
        income pregnant woman (as applicable).
            ``(2) Any such reference to child health assistance--
                    ``(A) with respect to such parents is deemed a 
                reference to parent health assistance; and
                    ``(B) with respect to such pregnant women, is 
                deemed a reference to health care assistance for 
                pregnant women.
            ``(3) In applying section 2103(e)(3)(B) in the case of a 
        family (consisting of a parent and one or more children) 
        provided coverage under this section or a pregnant woman 
        provided coverage under this section without covering other 
        family members, the limitation on total annual aggregate cost-
        sharing shall be applied to such entire family or such pregnant 
        woman, respectively.
            ``(4) In applying section 2110(b)(4), any reference to 
        `section 1902(l)(2) or 1905(n)(2) (as selected by a State)' is 
        deemed a reference to the effective income level applicable to 
        parents under section 1931 or under a waiver approved under 
        section 1115, or, in the case of a pregnant woman, the income 
        level established under section 1902(l)(2)(A).
            ``(5) In applying section 2102(b)(3)(B), any reference to 
        children found through screening to be eligible for medical 
        assistance under the State medicaid plan under title XIX is 
        deemed a reference to parents and pregnant women.''.
                    (B) Additional allotment for states providing 
                familycare.--
                            (i) In general.--Section 2104 of the Social 
                        Security Act (42 U.S.C. 1397dd) is amended by 
                        inserting after subsection (c) the following:
    ``(d) Additional Allotments for State Providing FamilyCare.--
            ``(1) Appropriation; total allotment.--For the purpose of 
        providing additional allotments to States to provide FamilyCare 
        coverage under section 2111, there is appropriated, out of any 
        money in the Treasury not otherwise appropriated--
                    ``(A) for fiscal year 2005, $7,000,000,000;
                    ``(B) for fiscal year 2006, $7,000,000,000;
                    ``(C) for fiscal year 2007, $3,000,000,000;
                    ``(D) for fiscal year 2008, $3,000,000,000;
                    ``(E) for fiscal year 2009, $6,000,000,000;
                    ``(F) for fiscal year 2010, $7,000,000,000;
                    ``(G) for fiscal year 2011, $8,000,000,000;
                    ``(H) for fiscal year 2012, $9,000,000,000; and
                    ``(I) for fiscal year 2013 and each fiscal year 
                thereafter, the amount of the allotment provided under 
                this paragraph for the preceding fiscal year increased 
                by the percentage increase (if any) in the medical care 
                expenditure category of the Consumer Price Index for 
                All Urban Consumers (United States city average).
            ``(2) State and territorial allotments.--
                    ``(A) In general.--In addition to the allotments 
                provided under subsections (b) and (c), subject to 
                paragraphs (3) and (4), of the amount available for the 
                additional allotments under paragraph (1) for a fiscal 
                year, the Secretary shall allot to each State with a 
                State child health plan approved under this title--
                            ``(i) in the case of such a State other 
                        than a commonwealth or territory described in 
                        clause (ii), the same proportion as the 
                        proportion of the State's allotment under 
                        subsection (b) (determined without regard to 
                        subsection (f)) to 98.95 percent of the total 
                        amount of the allotments under such section for 
                        such States eligible for an allotment under 
                        this subparagraph for such fiscal year; and
                            ``(ii) in the case of a commonwealth or 
                        territory described in subsection (c)(3), the 
                        same proportion as the proportion of the 
                        commonwealth's or territory's allotment under 
                        subsection (c) (determined without regard to 
                        subsection (f)) to 1.05 percent of the total 
                        amount of the allotments under such section for 
                        commonwealths and territories eligible for an 
                        allotment under this subparagraph for such 
                        fiscal year.
                    ``(B) Availability and redistribution of unused 
                allotments.--In applying subsections (e) and (f) with 
                respect to additional allotments made available under 
                this subsection, the procedures established under such 
                subsections shall ensure such additional allotments are 
                only made available to States which have elected to 
                provide coverage under section 2111.
            ``(3) Use of additional allotment.--Additional allotments 
        provided under this subsection are not available for amounts 
        expended before October 1, 2004. Such amounts are available for 
        amounts expended on or after such date for child health 
        assistance for targeted low-income children, as well as for 
        parent health assistance for targeted low-income parents, and 
        health care assistance for targeted low-income pregnant women.
            ``(4) Requiring election to provide coverage.--No payments 
        may be made to a State under this title from an allotment 
        provided under this subsection unless the State has made an 
        election to provide parent health assistance for targeted low-
        income parents, or health care assistance for targeted low-
        income pregnant women.''.
                            (ii) Conforming amendments.--Section 2104 
                        of the Social Security Act (42 U.S.C. 1397dd) 
                        is amended--
                                    (I) in subsection (a), by inserting 
                                ``subject to subsection (d),'' after 
                                ``under this section,'';
                                    (II) in subsection (b)(1), by 
                                inserting ``and subsection (d)'' after 
                                ``Subject to paragraph (4)''; and
                                    (III) in subsection (c)(1), by 
                                inserting ``subject to subsection 
                                (d),'' after ``for a fiscal year,''.
                    (C) No cost-sharing for pregnancy-related 
                benefits.--Section 2103(e)(2) of the Social Security 
                Act (42 U.S.C. 1397cc(e)(2)) is amended--
                            (i) in the heading, by inserting ``and 
                        pregnancy-related services'' after ``preventive 
                        services''; and
                            (ii) by inserting before the period at the 
                        end the following: ``and for pregnancy-related 
                        services''.
            (3) Effective date.--The amendments made by this subsection 
        apply to items and services furnished on or after October 1, 
        2004, whether or not regulations implementing such amendments 
        have been issued.
    (b) Rules for Implementation Beginning With Fiscal Year 2006.--
            (1) Expansion of availability of enhanced match under 
        medicaid for pre-chip expansions.--Paragraph (4) of section 
        1905(u) of the Social Security Act (42 U.S.C. 1396d(u)), as 
        inserted by subsection (a)(1)(C), is amended--
                    (A) by amending clause (ii) of subparagraph (A) to 
                read as follows:
                    ``(ii) Certain pregnant women.--Expenditures for 
                medical assistance for pregnant women under section 
                1902(l)(1)(A) in a family the income of which exceeds 
                the 133 percent of the income official poverty line, 
                but only if the income level established under section 
                1902(l)(2) (or under a Statewide waiver under section 
                1115) for pregnant women is 185 percent of the income 
                official poverty line.''; and
                    (B) by adding at the end the following:
            ``(B) Children in families with income above medicaid 
        mandatory level not previously described.--The expenditures 
        described in this subparagraph are expenditures (other than 
        expenditures described in paragraph (2) or (3)) for medical 
        assistance made available to any child who is eligible for 
        assistance under section 1902(a)(10)(A) (other than under 
        clause (i)) and the income of whose family exceeds the minimum 
        income level required under subsection 1902(l)(2) (or, if 
        higher, the minimum level required under section 1931 for that 
        State) for a child of the age involved (treating any child who 
        is 19 or 20 years of age as being 18 years of age).''.
            (2) Offset of additional expenditures for enhanced match 
        for pre-chip expansion.--Section 1905 of the Social Security 
        Act (42 U.S.C. 1396d) is amended--
                    (A) in the fourth sentence of subsection (b), by 
                inserting ``(except in the case of expenditures 
                described in subsection (u)(5))'' after ``do not 
                exceed'';
                    (B) in subsection (u), by inserting after paragraph 
                (4) (as inserted by subparagraph (C)), the following:
    ``(5) For purposes of the fourth sentence of subsection (b) and 
section 2105(a), the following payments under this title do not count 
against a State's allotment under section 2104:
            ``(A) Regular fmap for expenditures for pregnant women with 
        income above 133 percent of poverty.--The portion of the 
        payments made for expenditures described in paragraph 
        (4)(A)(ii) that represents the amount that would have been paid 
        if the enhanced FMAP had not been substituted for the Federal 
        medical assistance percentage.
            ``(B) FamilyCare parents.--Payments for expenditures 
        described in paragraph (4)(A)(i).
            ``(C) Regular fmap for expenditures for certain children in 
        families with income above medicaid mandatory level.--The 
        portion of the payments made for expenditures described in 
        paragraph (4)(B) that represents the amount that would have 
        been paid if the enhanced FMAP had not been substituted for the 
        Federal medical assistance percentage.''.
                    (B) Conforming amendments.--Subparagraph (B) of 
                section 2105(a)(1) of the Social Security Act, as 
                amended by subsection (a)(1)(D), is amended to read as 
                follows:
                    ``(B) Certain familycare parents and others.--
                Expenditures for medical assistance that is 
                attributable to expenditures described in section 
                1905(u)(4), except as provided in section 
                1905(u)(5).''.
            (3) Effective date.--The amendments made by this subsection 
        apply as of October 1, 2005, to fiscal years beginning on or 
        after such date and to expenditures under the State plan on and 
        after such date, whether or not regulations implementing such 
        amendments have been issued.
    (c) Making Title XXI Base Allotments Permanent.--Section 2104(a) of 
the Social Security Act (42 U.S.C. 1397dd(a)) is amended--
            (1) by striking ``and'' at the end of paragraph (9);
            (2) by striking the period at the end of paragraph (10) and 
        inserting ``; and''; and
            (3) by adding at the end the following:
            ``(11) for fiscal year 2008 and each fiscal year 
        thereafter, the amount of the allotment provided under this 
        subsection for the preceding fiscal year increased by the 
        percentage increase (if any) in the medical care expenditure 
        category of the Consumer Price Index for All Urban Consumers 
        (United States city average).''.
    (d) GAO Study.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct a study regarding funding under title XXI of the 
        Social Security Act that examines--
                    (A) the adequacy of overall funding under such 
                title;
                    (B) the formula for determining allotments and for 
                redistribution of unspent funds under such title; and
                    (C) the effect of waiting lists and caps on 
                enrollment under such title.
            (2) Report.--Not later than July 1, 2006, the Comptroller 
        General shall submit a report on the study conducted under 
        paragraph (1). Such report shall include recommendations 
        regarding a better mechanism for determining State allotments 
        and redistribution of unspent funds under such title in order 
        to ensure all eligible families in need can access coverage 
        through such title.
    (e) Conforming Amendments.--
            (1) Eligibility categories.--Section 1905(a) of the Social 
        Security Act (42 U.S.C. 1396d(a)) is amended, in the matter 
        before paragraph (1)--
                    (A) by striking ``or'' at the end of clause (xii);
                    (B) by inserting ``or'' at the end of clause 
                (xiii); and
                    (C) by inserting after clause (xiii) the following:
            ``(xiv) who are parents described (or treated as if 
        described) in section 1902(k)(1),''.
            (2) Income limitations.--Section 1903(f)(4) of the Social 
        Security Act (42 U.S.C. 1396b(f)(4)) is amended--
                    (A) effective October 1, 2005, by inserting 
                ``1902(a)(10)(A)(i)(VIII),'' after 
                ``1902(a)(10)(A)(i)(VII),''; and
                    (B) by inserting ``1902(a)(10)(A)(ii)(XIX),'' after 
                ``1902(a)(10)(A)(ii)(XVIII),''.
            (3) Conforming amendment relating to no waiting period for 
        pregnant women.--Section 2102(b)(1)(B) of the Social Security 
        Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--
                    (A) by striking ``, and'' at the end of clause (i) 
                and inserting a semicolon;
                    (B) by striking the period at the end of clause 
                (ii) and inserting ``; and''; and
                    (C) by adding at the end the following:
                            ``(iii) may not apply a waiting period 
                        (including a waiting period to carry out 
                        paragraph (3)(C)) in the case of a targeted 
                        low-income parent who is pregnant.''.

SEC. 223. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO TITLE XXI PARENTS.

    Section 2102(b)(1) of the Social Security Act (42 U.S.C. 
1397bb(b)(1)) is amended by adding at the end the following:
                    ``(C) Automatic eligibility of children born to a 
                parent being provided familycare.--Such eligibility 
                standards shall provide for automatic coverage of a 
                child born to an individual who is provided assistance 
                under this title in the same manner as medical 
                assistance would be provided under section 1902(e)(4) 
                to a child described in such section.''.

SEC. 224. ALLOWING STATES TO SIMPLIFY RULES FOR FAMILIES.

    (a) Presumptive Eligibility.--
            (1) Application to presumptive eligibility for pregnant 
        women under medicaid.--Section 1920(b) of the Social Security 
        Act (42 U.S.C. 1396r-1(b)) is amended by adding at the end 
        after and below paragraph (2) the following flush sentence:
``The term `qualified provider' includes a qualified entity as defined 
in section 1920A(b)(3).''.
            (2) Optional application of presumptive eligibility 
        provisions to parents.--Section 1920A of the Social Security 
        Act (42 U.S.C. 1396r-1a) is amended by adding at the end the 
        following:
    ``(e) A State may elect to apply the previous provisions of this 
section to provide for a period of presumptive eligibility for medical 
assistance for a parent of a child with respect to whom such a period 
is provided under this section.''.
            (3) Application under title xxi.--Section 2107(e)(1)(D) of 
        the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended to 
        read as follows:
                    ``(D) Sections 1920 and 1920A (relating to 
                presumptive eligibility).''.
    (b) 12-Months Continuous Eligibility.--
            (1) Medicaid.--Section 1902(e)(12) of the Social Security 
        Act (42 U.S.C. 1396a(e)(12)) is amended--
                    (A) by striking ``At the option of the State, the 
                plan may'' and inserting ``The plan shall'';
                    (B) by striking ``an age specified by the State 
                (not to exceed 19 years of age)'' and inserting ``19 
                years of age (or such higher age as the State has 
                elected under subsection (l)(1)(D)) or, at the option 
                of the State, who is eligible for medical assistance as 
                the parent of such a child''; and
                    (C) in subparagraph (A), by striking ``a period 
                (not to exceed 12 months) '' and inserting ``the 12-
                month period beginning on the date''.
            (2) Title XXI.--Section 2102(b)(2) of such Act (42 U.S.C. 
        1397bb(b)(2)) is amended by adding at the end the following: 
        ``Such methods shall provide continuous eligibility for 
        children under this title in a manner that is no less generous 
        than the 12-months continuous eligibility provided under 
        section 1902(e)(12) for children described in such section 
        under title XIX. If a State has elected to apply section 
        1902(e)(12) to parents, such methods may provide continuous 
        eligibility for parents under this title in a manner that is no 
        less generous than the 12-months continuous eligibility 
        provided under such section for parents described in such 
        section under title XIX.''.
            (3) Effective date.--The amendments made by this subsection 
        shall take effect on July 1, 2005, whether or not regulations 
        implementing such amendments have been issued.
    (c) Provision of Medicaid and CHIP Applications and Information 
Under the School Lunch Program.--Section 9(b)(2)(B) of the Richard B. 
Russell National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is 
amended--
            (1) by striking ``(B) Applications'' and inserting ``(B)(i) 
        Applications''; and
            (2) by adding at the end the following:
    ``(ii)(I) Applications for free and reduced price lunches that are 
distributed pursuant to clause (i) to parents or guardians of children 
in attendance at schools participating in the school lunch program 
under this Act shall also contain information on the availability of 
medical assistance under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) and of child health and FamilyCare assistance 
under title XXI of such Act, including information on how to obtain an 
application for assistance under such programs.
    ``(II) Information on the programs referred to in subclause (I) 
shall be provided on a form separate from the application form for free 
and reduced price lunches under clause (i).''.

SEC. 225. REVISION AND SIMPLIFICATION OF THE TRANSITIONAL MEDICAL 
              ASSISTANCE PROGRAM (TMA).

    (a) Making Reporting Requirements Optional; Option of Extended 
Eligibility.--
            (1) Option for making reporting requirements optional.--
        Section 1925(b) of the Social Security Act (42 U.S.C. 1396r-
        6(b)) is amended--
                    (A) in paragraph (1), by inserting ``, at the 
                option of a State,'' after ``and which'';
                    (B) in paragraph (2)(A), by inserting ``Subject to 
                subparagraph (C)--'' after ``(A) Notices.--'';
                    (C) in paragraph (2)(B), by inserting ``Subject to 
                subparagraph (C)--'' after ``(B) Reporting 
                requirements.--'';
                    (D) by adding at the end the following new 
                subparagraph:
                    ``(C) State option to waive notice and reporting 
                requirements.--A State may waive some or all of the 
                reporting requirements under clauses (i) and (ii) of 
                subparagraph (B). Insofar as it waives such a reporting 
                requirement, the State need not provide for a notice 
                under subparagraph (A) relating to such requirement.''; 
                and
                    (E) in paragraph (3)(A)(iii), by inserting ``the 
                State has not waived under paragraph (2)(C) the 
                reporting requirement with respect to such month under 
                paragraph (2)(B) and if'' after ``6-month period if''.
            (2) State option to extend eligibility for low-income 
        individuals for up to 12 additional months.--Section 1925 of 
        such Act (42 U.S.C. 1396r-6) is further amended--
                    (A) by redesignating subsections (c) through (f) as 
                subsections (d) through (g); and
                    (B) by inserting after subsection (b) the following 
                new subsection:
    ``(c) State Option of Up to 12 Months of Additional Eligibility.--
            ``(1) In general.--Notwithstanding any other provision of 
        this title, each State plan approved under this title may 
        provide, at the option of the State, that the State shall offer 
        to each family which received assistance during the entire 6-
        month period under subsection (b) and which meets the 
        applicable requirement of paragraph (2), in the last month of 
        the period the option of extending coverage under this 
        subsection for the succeeding period not to exceed 12 months.
            ``(2) Income restriction.--The option under paragraph (1) 
        shall not be made available to a family for a succeeding period 
        unless the State determines that the family's average gross 
        monthly earnings (less such costs for such child care as is 
        necessary for the employment of the caretaker relative) as of 
        the end of the 6-month period under subsection (b) does not 
        exceed 185 percent of the official poverty line (as defined by 
        the Office of Management and Budget, 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.
            ``(3) Application of extension rules.--The provisions of 
        paragraphs (2), (3), (4), and (5) of subsection (b) shall apply 
        to the extension provided under this subsection in the same 
        manner as they apply to the extension provided under subsection 
        (b)(1), except that for purposes of this subsection--
                    ``(A) any reference to a 6-month period under 
                subsection (b)(1) is deemed a reference to the 
                extension period provided under paragraph (1) and any 
                deadlines for any notices or reporting and the premium 
                payment periods shall be modified to correspond to the 
                appropriate calendar quarters of coverage provided 
                under this subsection; and
                    ``(B) any reference to a provision of subsection 
                (a) or (b) is deemed a reference to the corresponding 
                provision of subsection (b) or of this subsection, 
                respectively.''.
    (b) State Option To Waive Receipt of Medicaid for 3 of Previous 6 
Months To Qualify for TMA.--Section 1925(a)(1) of such Act (42 U.S.C. 
1396r-6(a)(1)) is amended by adding at the end the following: ``A State 
may, at its option, also apply the previous sentence in the case of a 
family that was receiving such aid for fewer than 3 months, or that had 
applied for and was eligible for such aid for fewer than 3 months, 
during the 6 immediately preceding months described in such 
sentence.''.
    (c) Elimination of Sunset for TMA.--
            (1) Subsection (g) of section 1925 of such Act (42 U.S.C. 
        1396r-6), as redesignated under subsection (a)(2), is repealed.
            (2) Section 1902(e)(1) of such Act (42 U.S.C. 1396a(e)(1)) 
        is amended by striking ``(A) Nothwithstanding'' and all that 
        follows through ``During such period, for'' in subparagraph (B) 
        and inserting ``For''.
    (d) CMS Report on Enrollment and Participation Rates Under TMA.--
Section 1925 of such Act, as amended by subsections (a)(2) and (c)(1), 
is amended by adding at the end the following new subsection:
    ``(g) Additional Provisions.--
            ``(1) Collection and reporting of participation 
        information.--Each State shall--
                    ``(A) collect and submit to the Secretary, in a 
                format specified by the Secretary, information on 
                average monthly enrollment and average monthly 
                participation rates for adults and children under this 
                section; and
                    ``(B) make such information publicly available.
        Such information shall be submitted under subparagraph (A) at 
        the same time and frequency in which other enrollment 
        information under this title is submitted to the Secretary. 
        Using such information, the Secretary shall submit to Congress 
        annual reports concerning such rates.''.
    (e) Coordination of Work.--Section 1925(g) of such Act, as added by 
subsection (d), is amended by adding at the end the following new 
paragraph:
            ``(2) Coordination with administration for children and 
        families.--The Administrator of the Centers for Medicare & 
        Medicaid Services, in carrying out this section, shall work 
        with the Assistant Secretary for the Administration for 
        Children and Families to develop guidance or other technical 
        assistance for States regarding best practices in guaranteeing 
        access to transitional medical assistance under this 
        section.''.
    (f) Elimination of TMA Requirement for States that Extend Coverage 
to Children and Parents Through 185 Percent of Poverty.--
            (1) In general.--Section 1925 of such Act is further 
        amended by adding at the end the following new subsection:
    ``(h) Provisions Optional for States That Extend Coverage to 
Children and Parents Through 185 Percent of Poverty.--A State may (but 
is not required to) meet the requirements of subsections (a) and (b) if 
it provides for medical assistance under section 1931 to families 
(including both children and caretaker relatives) the average gross 
monthly earning of which (less such costs for such child care as is 
necessary for the employment of a caretaker relative) is at or below a 
level that is at least 185 percent of the official poverty line (as 
defined by the Office of Management and Budget, 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.''.
            (2) Conforming amendments.--Such section is further 
        amended, in subsections (a)(1) and (b)(1), by inserting ``, but 
        subject to subsection (h),'' after ``Notwithstanding any other 
        provision of this title,'' each place it appears.
    (g) Extending Use of Outstationed Workers to Accept Applications 
for Transitional Medical Assistance.--Section 1902(a)(55) of such Act 
(42 U.S.C. 1396a(a)(55)) is amended by inserting ``and under section 
1931'' after ``(a)(10)(A)(ii)(IX)''.
    (h) Effective Dates.--(1) Except as provided in this subsection, 
the amendments made by this section shall apply to calendar quarters 
beginning on or after the date of the enactment of this Act, without 
regard to whether or not final regulations to carry out such amendments 
have been promulgated by such date.
    (2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirements imposed by the amendments made by this section, the State 
plan shall not be regarded as failing to comply with the requirements 
of such title solely on the basis of its failure to meet these 
additional requirements before the first day of the first calendar 
quarter beginning after the close of the first regular session of the 
State legislature that begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in the case of a State that 
has a 2-year legislative session, each year of such session shall be 
deemed to be a separate regular session of the State legislature.

SEC. 226. LIMITATIONS ON CONFLICTS OF INTEREST.

    (a) Limitation on Conflicts of Interest in Marketing Activities.--
            (1) Title xxi.--Section 2105(c) of the Social Security Act 
        (42 U.S.C. 300aa-5(c)) is amended by adding at the end the 
        following:
            ``(8) Limitation on expenditures for marketing 
        activities.--Amounts expended by a State for the use of an 
        administrative vendor in marketing health benefits coverage to 
        low-income children under this title shall not be considered, 
        for purposes of subsection (a)(2)(D), to be reasonable costs to 
        administer the plan unless the following conditions are met 
        with respect to the vendor:
                    ``(A) The vendor is independent of any entity 
                offering the coverage in the same area of the State in 
                which the vendor is conducting marketing activities.
                    ``(B) No person who is an owner, employee, 
                consultant, or has a contract with the vendor either 
                has any direct or indirect financial interest with such 
                an entity or has been excluded from participation in 
                the program under this title or title XVIII or XIX or 
                debarred by any Federal agency, or subject to a civil 
                money penalty under this Act.''.
    (b) Prohibition of Affiliation With Debarred Individuals.--
            (1) Medicaid.--Section 1903(i) of the Social Security Act 
        (42 U.S.C. 1396b(i))is amended--
                    (A) by striking the period at the end of paragraph 
                (20) and inserting ``; or''; and
                    (B) by inserting after paragraph (20) the 
                following:
            ``(21) with respect to any amounts expended for an entity 
        that receives payments under the plan unless--
                    ``(A) no person with an ownership or control 
                interest (as defined in section 1124(a)(3)) in the 
                entity is a person that is debarred, suspended, or 
                otherwise excluded from participating in procurement or 
                non-procurement activities under the Federal 
                Acquisition Regulation; and
                    ``(B) such entity has not entered into an 
                employment, consulting, or other agreement for the 
                provision of items or services that are material to 
                such entity's obligations under the plan with a person 
                described in subparagraph (A).''.
            (2) Title xxi.--Section 2107(e)(1) of the Social Security 
        Act (42 U.S.C. 1397gg(e)(1)) is amended
                    (A) in subparagraph (B), by striking ``and (17)'' 
                and inserting ``(17), and (21)''; and
                    (B) by adding at the end the following:
                    ``(E) Section 1902(a)(67) (relating to prohibition 
                of affiliation with debarred individuals).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to expenditures made on or after July 1, 2005, whether or not 
regulations implementing such amendments have been issued.

SEC. 227. INCREASE IN CHIP ALLOTMENT FOR EACH OF FISCAL YEARS 2002 
              THROUGH 2004.

    Effective as if included in the enactment of the Balanced Budget 
Act of 1997, paragraphs (5), (6), and (7) of section 2104(a) of the 
Social Security Act (42 U.S.C. 1397dd(a)) are amended by striking 
``$3,150,000,000'' each place it appears and inserting 
``$4,150,000,000''.

SEC. 228. DEMONSTRATION PROGRAMS TO IMPROVE MEDICAID AND CHIP OUTREACH 
              TO HOMELESS INDIVIDUALS AND FAMILIES.

    (a) Authority.--The Secretary of Health and Human Services may 
award demonstration grants to not more than 7 States (or other 
qualified entities) to conduct innovative programs that are designed to 
improve outreach to homeless individuals and families under the 
programs described in subsection (b) with respect to enrollment of such 
individuals and families under such programs and the provision of 
services (and coordinating the provision of such services) under such 
programs.
    (b) Programs for Homeless Described.--The programs described in 
this subsection are as follows:
            (1) Medicaid.--The program under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.).
            (2) CHIP.--The program under title XXI of the Social 
        Security Act (42 U.S.C. 1397aa et seq.).
            (3) TANF.--The program under part of A of title IV of the 
        Social Security Act (42 U.S.C. 601 et seq.).
            (4) SAMHSA block grants.--The program of grants under part 
        B of title XIX of the Public Health Service Act (42 U.S.C. 
        300x-1 et seq.).
            (5) Food stamp program.--The program under the Food Stamp 
        Act of 1977 (7 U.S.C. 2011 et seq.).
            (6) Workforce investment act.--The program under the 
        Workforce Investment Act of 1999 (29 U.S.C. 2801 et seq.).
            (7) Welfare-to-work.--The welfare-to-work program under 
        section 403(a)(5) of the Social Security Act (42 U.S.C. 
        603(a)(5)).
            (8) Other programs.--Other public and private benefit 
        programs that serve low-income individuals.
    (c) Appropriations.--For the purposes of carrying out this section, 
there is appropriated for fiscal year 2005, out of any funds in the 
Treasury not otherwise appropriated, $10,000,000, to remain available 
until expended.

SEC. 229. ADDITIONAL CHIP REVISIONS.

    (a) Limiting Cost-Sharing to 2.5 Percent for Families With Income 
Below 150 Percent of Poverty.--Section 2103(e)(3)(A) of the Social 
Security Act (42 U.S.C. 1397cc(e)(3)(A)) is amended--
            (1) by striking ``and'' at the end of clause (i);
            (2) by striking the period at the end of clause (ii) and 
        inserting ``; and''; and
            (3) by adding at the end the following new clause:
                            ``(iii) total annual aggregate cost-sharing 
                        described in clauses (i) and (ii) with respect 
                        to all such targeted low-income children in a 
                        family under this title that exceeds 2.5 
                        percent of such family's income for the year 
                        involved.''.
    (b) Employer Coverage Waiver Changes.--Section 2105(c)(3) of such 
Act (42 U.S.C. 1397ee(c)(3)) is amended--
            (1) by redesignating subparagraphs (A) and (B) as clauses 
        (i) and (ii) and indenting appropriately;
            (2) by designating the matter beginning with ``Payment may 
        be made'' as a subparagraph (A) with the heading ``In general'' 
        and indenting appropriately; and
            (3) by adding at the end the following new subparagraph:
                    ``(B) Application of requirements.--In carrying out 
                subparagraph (A)--
                            ``(i) in determining cost-effectiveness, 
                        the Secretary shall measure against family 
                        coverage costs to the extent that a State has 
                        expanded coverage to parents pursuant to 
                        section 2111;
                            ``(ii) subject to clause (iii), the State 
                        shall provide satisfactory assurances that the 
                        minimum benefits and cost-sharing protections 
                        established under this title are provided, 
                        either through the coverage under subparagraph 
                        (A) or as a supplement to such coverage; and
                            ``(iii) coverage under such subparagraph 
                        shall not be considered to violate clause (ii) 
                        because it does not comply with requirements 
                        relating to reviews of health service decisions 
                        if the enrollee involved is provided the option 
                        of being provided benefits directly under this 
                        title.''.
    (c) Effective Date.--The amendments made by this section apply as 
of January 1, 2005, whether or not regulations implementing such 
amendments have been issued.

SEC. 230. INCREASED FEDERAL REIMBURSEMENT FOR LANGUAGE SERVICES UNDER 
              THE MEDICAID PROGRAM AND TITLE XXI.

    (a) Medicaid.--Section 1903(a)(3) of the Social Security Act (42 
U.S.C. 1396b(a)(3)) is amended--
            (1) in subparagraph (D), by striking ``plus'' at the end 
        and inserting ``and''; and
            (2) by adding at the end the following:
                    ``(E) 90 percent of the sums expended with respect 
                to costs incurred during such quarter as are 
                attributable to the provision of language services, 
                including oral interpretation, translations of written 
                materials, and other language services, for individuals 
                with limited English proficiency who apply for, or 
                receive, medical assistance under the State plan; 
                plus''.
    (b) SCHIP.--Section 2105(a)(1) of the Social Security Act (42 
U.S.C.1397ee(a)) is amended--
            (1) in the matter preceding subparagraph (A), by inserting 
        ``or, in the case of expenditures described in subparagraph 
        (D)(iv), 90 percent'' after ``enhanced FMAP''; and
            (2) in subparagraph (D)--
                    (A) in clause (iii), by striking ``and'' at the 
                end;
                    (B) be redesignating clause (iv) as clause (v); and
                    (C) by inserting after clause (iii) the following:
                            ``(iv) for expenditures attributable to the 
                        provision of language services, including oral 
                        interpretation, translations of written 
                        materials, and other language services, for 
                        individuals with limited English proficiency 
                        who apply for, or receive, child health 
                        assistance under the plan; and''.
    (c) Effective Date.--The amendments made by this section take 
effect on January 1, 2005.

   TITLE III--NATIONAL CENTER FOR EVIDENCE-BASED HEALTHCARE PRACTICES

SEC. 301. ESTABLISHMENT OF CENTER.

    Part E of title IV of the Public Health Service Act (42 U.S.C. 287 
et seq.) is amended by adding at the end the following subpart:

  ``Subpart 7--National Center for Evidence-Based Healthcare Practices

``SEC. 485J. PURPOSE OF CENTER.

    ``(a) In General.--The general purpose of the National Center for 
Evidence-Based Healthcare Practices (in this subpart referred to as the 
`Center') is the establishment of national standards for healthcare 
practices that are based on scientific evidence developed through the 
conduct of research and the collection of data (in this subpart 
referred to as `evidence-based practices').
    ``(b) Certain Duties.-- With respect to evidence-based practices 
established under subsection (a), the Director of the Center--
            ``(1) shall disseminate the practices and provide general 
        information on the practices to the public and health 
        professionals;
            ``(2) may conduct and support programs for training health 
        professionals with respect to the practices; and
            ``(3) may provide to healthcare entities technical 
        assistance regarding the practices.
    ``(c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2005 through 2009.''
                                 <all>