109 HR 3561 IH: Minority Health and Genomics Act of 2005 U.S. House of Representatives 2005-07-28 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I 109th CONGRESS 1st Session H. R. 3561 IN THE HOUSE OF REPRESENTATIVES July 28, 2005 Mr. Honda (for himself, Mrs. Napolitano, Mr. Watt, Mr. Kildee, Ms. Bordallo, Ms. Solis, Mrs. Christensen, Mr. Pallone, Ms. Pelosi, Mr. Menendez, Mr. Hoyer, and Mr. Clyburn) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, Resources, Judiciary, Ways and Means, and Agriculture, 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 improve the health of minority individuals.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Healthcare Equality and Accountability Act. (b)

Table of contents

The table of contents of this Act is as follows: Sec. 1. Short title; table of contents Sec. 2. Findings and purpose Title I—Coverage of the uninsured Subtitle A—FamilyCare Sec. 101. Short title Sec. 102. Renaming of title XXI Program Title XXI—FamilyCare Program Sec. 103. FamilyCare coverage of parents under the Medicaid Program and title XXI Sec. 2111. Optional FamilyCare coverage of parents of targeted low-income children Sec. 104. Automatic enrollment of children born to title XXI parents Sec. 105. Optional coverage of children through age 20 under the Medicaid Program and title XXI Sec. 106. Allowing States to simplify rules for families Sec. 107. Demonstration programs to improve Medicaid and CHIP outreach to homeless individuals and families Sec. 108. Additional CHIP revisions Sec. 109. Coordination of title XXI with the maternal and child Health Program Subtitle B—State Option to Provide Coverage for All Residents With Income at or Below the Poverty Line Sec. 121. State option to provide coverage for all residents with income at or below the poverty line Subtitle C—Optional Coverage of Legal Immigrants Under the Medicaid Program and Title XXI, and to Extend Eligibility to Certain Legal Residents Sec. 131. Equal access to Health coverage for legal immigrants Sec. 132. Exception for citizens of freely associated States Subtitle D—Indian Healthcare Funding Chapter 1—Guaranteed Funding Sec. 141. Guaranteed adequate funding for Indian Healthcare Sec. 825. Funding Chapter 2—Indian Healthcare Programs Sec. 145. Programs operated by Indian Tribes and Tribal organizations Sec. 146. Licensing Sec. 147. Authorization for emergency contract Health services Sec. 148. Prompt action on Payment of claims Sec. 149. Liability for Payment Sec. 150. Health services for ineligible persons Sec. 151. Definitions Sec. 152. Authorization of appropriations Subtitle E—Territories Sec. 161. Funding for territories Subtitle F—Migrant Workers and Farmworkers Health Sec. 171. Demonstration project regarding continuity of coverage of migrant workers and farmworkers under Medicaid and CHIP Subtitle G—Expanded Access to Health Care Sec. 181. National Commission for Expanded Access to Health Care Sec. 182. Institute of Medicine evaluation and report on Health care performance measures Subtitle H—FMAP Reimbursement for Native Hawaiians Sec. 191. 100 percent FMAP for medical assistance provided to a Native Hawaiian through a federally-qualified Health Center or a Native Hawaiian Health care system under the Medicaid Program Title II—Culturally and linguistically appropriate Healthcare Sec. 201. Amendment to the Public Health Service Act Title XXIX—Culturally and linguistically appropriate Healthcare Sec. 2900. Definitions Sec. 2901. Improving access to services for individuals with Limited English proficiency Sec. 2902. National Standards for culturally and linguistically appropriate services in Healthcare Sec. 2903. Robert T. Matsui Center for Cultural and Linguistic Competence in Healthcare Sec. 2904. Innovations in language access grants Sec. 2905. Research on language access Sec. 2906. Information about Federal Health programs for Limited English proficient populations Sec. 202. Standards for language access services Sec. 203. Federal reimbursement for culturally and linguistically appropriate services under the medicare, Medicaid and State Children’s Health Insurance Program Sec. 204. Increasing understanding of Health literacy Sec. 205. Report on Federal efforts to provide culturally and linguistically appropriate Healthcare services Sec. 206. General Accounting Office report on impact of language access services Sec. 207. Definitions Title III—Health workforce Diversity Sec. 301. Amendment to the Public Health Service Act Subtitle A—Diversifying the Healthcare Workplace Sec. 2911. Report on workforce Diversity Sec. 2912. National Working Group on Workforce Diversity Sec. 2913. Technical Clearinghouse for Health workforce Diversity Sec. 2914. Evaluation of workforce Diversity initiatives Sec. 2915. Data collection and reporting by Health professional schools Sec. 2916. Support for Institutions committed to workforce Diversity Sec. 2917. Career development for scientists and researchers Sec. 2918. Career support for non-research Health professionals Sec. 2919. Research on the effect of workforce Diversity on quality Sec. 2920. Health disparities education Program Sec. 2920A. Cultural competence training for Healthcare professionals Sec. 302. Health Careers Opportunity Program Sec. 303. Program of excellence in Health professions education for underrepresented minorities Sec. 304. Hispanic-Serving Health Professions Schools Sec. 742. Hispanic-Serving Health Professions Schools Sec. 305. Health professions student loan fund; authorizations of appropriations regarding students from disadvantaged backgrounds Sec. 306. National Health Service Corps; recruitment and fellowships for individuals from disadvantaged backgrounds Sec. 307. Loan repayment Program of Centers for Disease Control and Prevention Sec. 308. Cooperative agreements for online degree programs at schools of Public Health and schools of allied Health Sec. 743. Cooperative agreements for online degree programs Sec. 309. Mid-career Health professions scholarship Program Sec. 744. Mid-career Health professions scholarship Program Sec. 310. Strengthening and expanding rural Health provider networks Sec. 311. National report on the preparedness of Health professionals to care for diverse populations Sec. 312. Scholarship and fellowship programs Sec. 2920B. David Satcher Public Health and Health Services Corps Sec. 2920C. Louis Stokes Public Health Scholars Program Sec. 2920D. Patsy Mink Health and Gender Research Fellowship Program Sec. 2920E. Paul David Wellstone International Health Fellowship Program Sec. 2920F. Edward R. Roybal Healthcare Scholar Program Sec. 313. Advisory Committee on Health Professions Training for Diversity Sec. 314. Mcnair postbaccalaureate achievement Program Title IV—Reducing disease and disease-related complications Subtitle A—Education and Outreach Sec. 401. Preventive Health services block grants; use of allotments Sec. 402. Indigenous, racial and ethnic approaches to community Health Sec. 403. Grants to promote positive Health behaviors in women Sec. 399O. Grants to promote positive Health behaviors in women Sec. 404. Provisions regarding National Asthma Education and Prevention Program of national heart, lung, and Blood Institute Sec. 405. Asthma-related activities of Centers for Disease Control and Prevention Sec. 406. Grants for community outreach regarding asthma information, education, and services Sec. 407. Action plans of local educational agencies regarding asthma Sec. 408. Programs of Centers for Disease Control and Prevention Sec. 317H. Diabetes in children and youth Sec. 409. Research with respect to uterine fibroids Sec. 410. Information and education with respect to uterine fibroids Subtitle B—Research and Training Sec. 431. Innovative chronic disease management programs Sec. 432. Research funding for autoimmune disease in minority populations Sec. 490E–1. Research funding for autoimmune disease in minority populations Sec. 433. Research on effective messages for combatting stigma Subtitle C—Innovative Treatment Modalities and Services Delivery Models Sec. 441. Guidelines for disease screening for minority patients Sec. 442. Cancer reduction Subtitle B—Reducing Disease and Disease-Related Complications Sec. 2921. Cancer prevention and treatment for underserved minority or other populations Sec. 443. Monitoring the quality of and disparities in diabetes care Sec. 904. Areas of special emphasis Sec. 444. Diabetes prevention, treatment, and control Sec. 445. Genetics of diabetes Sec. 430A. Genetics of diabetes Sec. 446. Research and training on diabetes in underserved and minority populations Sec. 434B. Research on diabetes in underserved and minority populations Sec. 447. Authorization of appropriations Sec. 434C. Authorization of appropriations Sec. 448. Prevention and control of sexually transmitted diseases Sec. 449. Model community diabetes and chronic disease care and prevention among Pacific Islanders and Native Hawaiians Sec. 399P. Model community diabetes and chronic disease care and prevention among Pacific Islanders and Native Hawaiians Sec. 450. Grants to improve the provision of dental services under Medicaid and SCHIP Sec. 511. Grants to improve the provision of dental services under Medicaid and SCHIP Sec. 451. State option to provide wrap-around SCHIP coverage to children who have other Health coverage Sec. 452. Grants to improve the provision of dental Health services through community Health Centers and public Health departments Sec. 329. Grant Program to expand the availability of services Sec. 453. Priority substance abuse treatment needs of regional and national significance Sec. 454. Fetal Alcohol Syndrome Sec. 2922. Fetal Alcohol Syndrome Sec. 455. HIV/AIDS reduction Sec. 2923. HIV/AIDS reduction in the minority community Sec. 456. Systems for heart disease and stroke Sec. 2924. Heart disease Sec. 2925. Stroke education campaign Subtitle D—Studies, Reports, and Plans Sec. 461. IOM study request Sec. 462. Strategic plan Sec. 463. Advisory Council for the Elimination of Tuberculosis Sec. 464. National Program for tuberculosis elimination Sec. 465. Inclusion of inpatient hospital services for the treatment of tb-infected individuals Subtitle E—Miscellaneous Provisions Sec. 471. Health empowerment zones Sec. 472. Overweight and obesity prevention and treatment Sec. 473. Border Health grants Sec. 474. United States-Mexico Border Health Commission Act amendments Sec. 9. Authorization of appropriations Sec. 475. Prevention and control of injuries Title V—Data collection and reporting Sec. 501. Amendment to the Public Health Service Act Subtitle C—Strengthening Data Collection, Improving Data Analysis, and Expanding Data Reporting Sec. 2931. Data on race, ethnicity, and primary language Sec. 2932. Provisions relating to Native Americans Sec. 502. Collection of race and ethnicity data by the Social Security Administration Sec. 1150A. Collection of race and ethnicity data by the Social Security Administration Sec. 503. Revision of HIPAA claims Standards Sec. 504. National Center for Health Statistics Sec. 505. Geo-access study Title VI—Accountability Subtitle A—General Provisions Sec. 601. Report on workforce Diversity Sec. 602. Federal Agency plan to eliminate disparities and improve the Health of minority populations Sec. 603. Accountability within the Department of Health and Human Services Subtitle D—Strengthening Accountability Sec. 2941. Elevation of the Office of Civil Rights Sec. 2942. Establishment of Health Program offices for Civil Rights within Federal Health and human services agencies Sec. 604. Office of Minority Health Sec. 605. Establishment of the Indian Health Service as an Agency of the public Health Service Sec. 606. Establishment of individual offices of Minority Health within agencies of public Health Service Sec. 1707A. Individual offices of Minority Health within public Health Service Sec. 607. Office of Minority Health at the Centers for Medicare and Medicaid Services Sec. 608. Office of Minority Affairs at the Food and Drug Administration Sec. 908. Office of Minority Affairs Sec. 609. Safety and effectiveness of drugs with respect to racial and ethnic background Sec. 505C. Safety and effectiveness of drugs with respect to racial and ethnic background Sec. 610. United States Commission on Civil Rights Sec. 610A. Sense of Congress concerning full funding of activities to eliminate racial and ethnic Health disparities Subtitle B—Minority Health and Genomics Commission Sec. 611. Short title Sec. 612. Minority Health and Genomics Commission Sec. 613. Report Sec. 614. Membership Sec. 615. Powers of Commission Sec. 616. Termination Subtitle C—Improving Environmental Justice Sec. 621. Definitions Sec. 622. Environmental justice responsibilities of Federal agencies Sec. 623. Interagency environmental justice Working Group Sec. 624. Federal Agency strategies Sec. 625. Federal Environmental Justice Advisory Committee Sec. 626. Human Health and environmental research, data collection and analysis Title VII—Strengthening Health Institutions that provide Healthcare to minority populations Subtitle A—General Provisions Sec. 701. Amendment to the Public Health Service Act Subtitle E—Strengthening Health Institutions that provide Healthcare to minority populations Chapter 1—General Programs Sec. 2951. Grant support for quality improvement initiatives Sec. 2951A. Centers of excellence Sec. 2951B. Consultation, construction and renovation of American Indian and Alaska Native facilities; reports Sec. 2951C. Reconstruction and improvement grants for Public Health care facilities serving Pacific Islanders and the insular areas Chapter 2—National Health Safety Net Infrastructure Subchapter A—General provisions Sec. 2952. Payments to Healthcare facilities Sec. 2952A. Application for assistance Sec. 2952B. Public Service responsibilities Sec. 2952C. Health Safety Net Infrastructure Trust Fund Sec. 2952D. Administration Subchapter B—Loan guarantees Sec. 2953. Provision of loan guarantees to safety net Healthcare facilities Sec. 2953A. Eligible loans Sec. 2953B. Guarantee allotments Sec. 2953C. Terms and conditions of loan guarantees Sec. 2953D. Premiums for loan guarantees Sec. 2953E. Procedures in the event of loan default Subchapter C—Grants for urgent capital needs Sec. 2956. Provision of grants Sec. 2956A. Eligible projects Sec. 702. Establishment of Alejandro Garcia National Center for Social Work Research Part J—Alejandro Garcia National Center for Social Work Research Sec. 597. Purpose of Center Sec. 597A. Specific authorities Sec. 597B. Advisory Council Sec. 597C. Biennial report Sec. 597D. Quarterly report Sec. 597E. Authorization of appropriations Sec. 703. Annie Dodge Wauneka and Susan Laflesche-Picotte Native American Health and Wellness Foundation Title VIII—Annie Dodge Wauneka and Susan Laflesche-Picotte Native American Health and Wellness Foundation Sec. 801. Definitions Sec. 802. Annie Dodge Wauneka and Susan Laflesche-Picotte Native American Health and Wellness Foundation Sec. 803. Administrative services and support Subtitle B—Rural and Underserved Urban America Telehealth Programs Sec. 711. Increasing types of originating telehealth sites and facilitating the provision of telehealth services across State lines Sec. 712. Strengthening telehealth services in rural and underserved urban America Sec. 330M. Integrative eldercare telehealth demonstration project Sec. 330N. American Indian and Alaska Native telehealth demonstration project Sec. 330O. Oral Health telehealth demonstration project Sec. 713. Joint Working Group on Telehealth Title VIII—Miscellaneous provisions Sec. 801. Definitions Sec. 802. Davis-Bacon Act

2.

Findings and purpose

(a)

Findings

Congress makes the following findings: (1)Despite significant advances in public health and health care, the health status of racial and ethnic minority populations continues to lag behind that of the white population. (2)The United States is becoming increasingly diverse. According to the 2000 United States Census, African Americans, American Indians and Alaska Natives, Asians, Hispanics, and Native Hawaiians and other Pacific Islanders comprise 30 percent of the United States population. Racial and ethnic minorities are expected to comprise 40 percent of the United States population by 2030. (3)To improve the health care of racial and ethnic minorities and to reduce and eliminate disparities in health care and health outcomes, the following issues must be addressed: (A)

Need for insurance coverage

(i)Disparities in health status can be attributed largely to underlying differences in socioeconomic status and insurance coverage. Minorities are at a greater risk of being uninsured than their white counterparts. Lack of health insurance has consistently been associated with worse health outcomes. (ii)Even after adjusting for differences in socioeconomic and insurance status, however, racial and ethnic health and health care disparities remain. (iii)Through treaties and Federal statutes, the Federal Government has established a trust responsibility to provide health care to American Indians and Alaska Natives. In the Indian Health Amendments of 1992, Congress specifically pledged to assure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy. Despite those commitments, the unmet health needs of American Indians and Alaska Natives remain alarmingly severe and their health status is far below the health status of the general population of the United States. The critical shortfall of funding for the Indian Health Service is a major source of this problem. (iv)At least 26,000,000 children in the United States lack dental coverage. These children include many from working poor families who cannot access SCHIP because they have some medical coverage. White children are 1.7 times more likely to have private dental coverage than non-white children. (v)As few as 7 States continue to provide reasonably comprehensive dental care to poor adults through Medicaid. About half the States provide no dental coverage or provide emergency services only. (B)

Need for culturally and linguistically appropriate care

(i)Limited English proficiency adversely affects the care of many racial and ethnic minority patients. The lack of available interpretation and translation services or bilingual providers contributes to racial and ethnic disparities in health and health care. The Federal Government provides and funds an array of services that should be made accessible to eligible persons who are not proficient in the English language. (ii)Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) prohibits discrimination on the basis of race, color, and national origin in programs and activities receiving Federal financial assistance. Discrimination on the basis of primary language has consistently been interpreted as discrimination on the basis of national origin. (iii)The provision of effective language services has been shown to improve care for limited English proficient (referred to in this section as LEP) patients by increasing patient satisfaction, access to care, compliance with recommended medical advice, and appropriate utilization. (iv)A 2002 study by the Office of Management and Budget found that language assistance services can substantially improve the health and quality of life of LEP individuals and their families, increase the efficiency of distribution of government services to LEP individuals, and measurably increase the effectiveness of public health and safety programs. (v)The same study estimated that language translation services would only increase the cost of the average health care visit by less than one percent. (vi)Increasing racial and ethnic diversity among health professionals is vitally important because evidence indicates that diversity is associated with improved access to care for racial and ethnic minority patients, greater patient satisfaction, and better educational experiences for health profession students, among many other benefits. (C)

Need for Health workforce Diversity

(i)Research has demonstrated that minority health professionals dramatically increase access to care for minority patients and improve the quality of care that they receive. African Americans, American Indians and Alaska Natives, Hispanics, Native Hawaiians and other Pacific Islanders, and Southeast Asians are significantly underrepresented in the health professions, exacerbating health disparities. (ii)Minority physicians are more likely than white physicians to serve minority populations. Nearly 40 percent of all minority medical school graduates will practice medicine in underserved areas, compared to 10 percent of their white colleagues. (iii)Minorities often report experiences with discrimination when seeking health care. (iv)There is substantial evidence to demonstrate that race concordance between physicians and patients increases patient satisfaction and participation in health decisionmaking. (v)Minority health care providers can bridge linguistic, cultural, and other barriers that hamper access to care. (vi)African Americans, Hispanics, and American Indians remain severely underrepresented in health professions schools. African Americans and Hispanics constitute 20 percent and 16 percent, respectively, of the students in public health and baccalaureate nursing programs, and less than 15 percent of students in all other health professions. (vi)The number of minorities enrolling in health professional schools has remained stagnant. For example, in 1994, 1,307 African American and 1,090 Hispanic students enrolled in American medical colleges. In 2000, the figures were essentially unchanged at 1,307 African American and 1,033 Hispanic students. (vii)While the need for a racially and ethnically diverse workforce is clear, the practitioners, faculty, and students of the fields of nursing, medicine, dentistry, psychology, social work, behavioral science, and health education have yet to reflect the diversity of the Nation. (viii)In 2003, only 2 percent of practicing dentists and 3 percent of dental hygienists were African-American, and only 4 percent of practicing dentists and 1 percent of hygienists were Hispanic. (ix)Underrepresented minority recruitment into dental education is a serious problem. In 2003, the first-year enrollment of underrepresented minority students in dental school was only 11.6 percent of the total first year enrollment. In 1990, the percentage of underrepresented minority students in the first year class was 13.8 percent of the total first year enrollment. (x)Given the fact that the patients of Black dentists are 61.8 percent black and the patients of Hispanic dentists are 45.4 percent Hispanic, increasing minority enrollment is an immediate and practical approach to addressing the problem. Only 10.5 percent of Black patients are seen by white dentists. (D)

Need for reduction of disease occurrence and disease-related complications among minorities

(i)Despite notable progress in the overall health of the Nation, there are continuing disparities in the burden of illness and death experienced by minorities compared to the United States population as a whole. Minority populations are disproportionately impacted by acute and chronic diseases. (ii)In 2000, 6 of the 10 leading causes of death for all age groups in this country were behaviorally based. In addition, many modifiable behavioral factors are now known to increase an individual’s risk for disease and physical disability, representing the largest amount of preventable healthcare expenses. (iii)Despite suffering a greater burden of acute and chronic disease, minorities are less likely to receive needed health care. Numerous studies have documented that minorities receive less preventive care, medical therapy, and surgical interventions. (iv)Culturally appropriate, community-driven programs are essential to eliminating health disparities. To be successful, these programs need to be based on sound prevention research and supported by new and innovative partnerships among governments, businesses, faith-based organizations, and communities. (v)Parents reported seeking care for relief of their child’s pain for 10 percent of white children, 16 percent of Black children, and 17 percent of Hispanic children. Parents of American Indian and Alaska Native schoolchildren report that one third miss school because of dental pain each year. They also report that 1 in 4 avoid laughing or smiling and 1 in 5 avoid meeting other people because of the way their teeth look. (vi)Five-year survival statistics for Blacks are poorer at 33 percent versus 55 percent for whites. (vii)Hispanic adults are twice as likely, Black adults 3 times as likely, and Asian adults 4 times as likely as whites to report missed work or missed school because of a dental problem. (E)

Need for Minority Health data collection and reporting

(i)Efforts to study disparities in health and health care for minorities have been hampered by the lack of available data on race, ethnicity, and primary language. (ii)Data collection, analysis, and reporting by race, ethnicity, and primary language is permissible under the law and necessary to assure equity and nondiscrimination in the quality of health care services. Collection, analysis, and reporting of such data is authorized under Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.). Such collection, analysis, and reporting should be conducted with appropriate privacy protections in place. (F)

Need for greater accountability in government Institutions

A number of studies have shown that differences in health care quality contribute to health disparities among minority populations. These differences may result from bias, stereotyping, and discrimination. Government institutions must be held accountable for the quality of health care delivered to all patient populations and resultant health outcomes. (G)

Need for equitable socioeconomic policies

Literature suggests that equitable socioeconomic policies are needed to improve the health status of racial and ethnic minorities and economically disadvantaged populations. (H)

Need for strengthening Health Institutions that provide care to minority populations

(i)A small segment of health care institutions provide a disproportionate amount of health care to minority populations. (ii)Safety net institutions, including public hospitals, community health centers and community clinics, provide a disproportionate share of health care to minority and underserved populations. (iii)Financial stress, negative operating margins, and the overall burden of caring for the uninsured and delivering high-cost specialty care to the entire community place undue pressure on core safety net providers. These providers are increasingly challenged in their ability to meet the day-to-day needs of their patients. (b)

Purposes

It is the purpose of this Act to improve the health and healthcare of minority populations and to eliminate racial and ethnic disparities in health and healthcare by— (1)increasing access to health care for all populations; (2)expanding culturally and linguistically appropriate health services for all populations; (3)promoting health workforce diversity; (4)supporting and expanding programs and activities that will improve the prevention, diagnosis, and management of disease in minority populations; (5)enhancing racial, ethnic, and primary language health data collection at the local, State, and Federal level; (6)ensuring accountability for the quality of health care and health outcomes for minority populations; and (7)strengthening the technical and financial resources of the safety net institutions of the United States.

. (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.

103.

FamilyCare coverage of parents 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); 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, 2006. (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, 2006, 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, 2006, 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).. (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:

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, 2006, shall be substituted for July 1, 1997; and (C)in paragraph (4), January 1, 2006, 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, 2006, shall be substituted for July 1, 1997; and (C)in paragraph (4), January 1, 2006, 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 2006, $2,000,000,000; (B)for fiscal year 2007, $2,000,000,000; (C)for fiscal year 2008, $3,000,000,000; and (D)for fiscal year 2009, $3,000,000,000. (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, 2007. 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, 2007, whether or not regulations implementing such amendments have been issued. (b)

Rules for implementation beginning with fiscal year 2007

(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.. (3)

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).. (4)

Effective date

The amendments made by this subsection apply as of October 1, 2006, 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)

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, 2007, 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. (d)

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 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..

104.

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..

105.

Optional coverage of children through age 20 under the Medicaid Program and title XXI

(a)

Medicaid

(1)

In general

Section 1902(l)(1)(D) of the Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is amended by inserting (or, at the election of a State, 20 or 21 years of age) after 19 years of age. (2)

Conforming amendments

(A)Section 1902(e)(3)(A) of the Social Security Act (42 U.S.C. 1396a(e)(3)(A)) is amended by inserting (or 1 year less than the age the State has elected under subsection (l)(1)(D)) after 18 years of age. (B)Section 1902(e)(12) of the Social Security Act (42 U.S.C. 1396a(e)(12)) is amended by inserting or such higher age as the State has elected under subsection (l)(1)(D) after 19 years of age. (C)Section 1920A(b)(1) of the Social Security Act (42 U.S.C. 1396r–1a(b)(1)) is amended by inserting or such higher age as the State has elected under section 1902(l)(1)(D) after 19 years of age. (D)Section 1928(h)(1) of the Social Security Act (42 U.S.C. 1396s(h)(1)) is amended by inserting or 1 year less than the age the State has elected under section 1902(l)(1)(D) before the period at the end. (E)Section 1932(a)(2)(A) of the Social Security Act (42 U.S.C. 1396u–2(a)(2)(A)) is amended by inserting (or such higher age as the State has elected under section 1902(l)(1)(D)) after 19 years of age. (b)

Title XXI

Section 2110(c)(1) of the Social Security Act (42 U.S.C. 1397jj(c)(1)) is amended by inserting (or such higher age as the State has elected under section 1902(l)(1)(D)). (c)

Effective date

The amendments made by this section take effect on January 1, 2006, and apply to medical assistance and child health assistance provided on or after such date, whether or not regulations implementing such amendments have been issued.

106.

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, 2006 (or, if later, 60 days after the date of the enactment of this Act), 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)..

107.

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 2006, out of any funds in the Treasury not otherwise appropriated, $10,000,000, to remain available until expended.

108.

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, 2006, whether or not regulations implementing such amendments have been issued.

109.

Coordination of title XXI with the maternal and child Health Program

(a)

In general

Section 2102(b)(3) of the Social Security Act (42 U.S.C. 1397bb(b)(3)) is amended— (1)in subparagraph (D), by striking and at the end; (2)in subparagraph (E), by striking the period and inserting ; and; and (3)by adding at the end the following new subparagraph: (F)that operations and activities under this title are developed and implemented in consultation and coordination with the program operated by the State under title V in areas including outreach and enrollment, benefits and services, service delivery standards, public health and social service agency relationships, and quality assurance and data reporting.. (b)

Conforming Medicaid amendment

Section 1902(a)(11) of such Act (42 U.S.C. 1396a(a)(11)) is amended— (1)by striking and before (C); and (2)by inserting before the semicolon at the end the following: , and (D) provide that operations and activities under this title are developed and implemented in consultation and coordination with the program operated by the State under title V in areas including outreach and enrollment, benefits and services, service delivery standards, public health and social service agency relationships, and quality assurance and data reporting. (c)

Effective date

The amendments made by this section take effect on January 1, 2006.

B

State option to provide coverage for all residents with income at or below the poverty line

121.

State option to provide coverage for all residents with income at or below the poverty line

(a)

In general

Section 1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended— (1)by striking or at the end of subclause (XVII); (2)by adding or at the end of subclause (XVIII); and (3)by adding at the end the following new subclause: (XIX)any individual whose family income does not exceed 100 percent of the income 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 and who is not otherwise eligible for medical assistance under this title;. (b)

Conforming amendments

(1)Section 1905(a) of such 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 adding or at the end of clause (xiii); and (C)by inserting after clause (xiii) the following new clause: (xii)individuals described in section 1902(a)(10)(A)(ii)(XIX),. (2)Section 1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4)) is amended by inserting 1902(a)(10)(A)(ii)(XIX), after 1902(a)(10)(A)(ii)(XVIII),. (c)

Effective date

The amendments made by this section shall take effect on October 1, 2006.

C

Optional coverage of legal immigrants under the Medicaid Program and title XXI, and to extend eligibility to certain legal residents

131.

Equal access to Health coverage for legal immigrants

(a)

In general

Section 401(b)(1) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1611(b)(1)) is amended— (1)by striking subparagraph (A) and inserting the following: (A)Medical assistance under title XIX of the Social Security Act.; and (2)by adding at the end the following: (F)Child health assistance under title XXI of the Social Security Act.. (b)

Conforming amendments

(1)Section 402(b) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(b)) is amended— (A)in paragraph (2)— (i)in subparagraph (A)— (I)by striking clause (i); (II)by redesignating clause (ii) as subparagraph (A) and realigning the margins accordingly; and (III)by redesignating subclauses (I) through (V) of subparagraph (A), as so redesignated, as clauses (i) through (v), respectively and realigning the margins accordingly; and (ii)by striking subparagraphs (E) and (F); and (B)in paragraph (3), by striking subparagraph (C). (2)Section 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1613)) is amended— (A)in subsection (c), by adding at the end the following: (M)Child health assistance provided under title XXI of the Social Security Act.; and (B)in subsection (d)(1), by striking programs specified in subsections (a)(3) and (b)(3)(C) and inserting program specified in subsection (a)(3). (3)Section 421 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1631)) is amended by adding at the end the following: (g)

Exceptions

This section shall not apply to— (1)medical assistance provided under a State plan approved under title XIX of the Social Security Act; and (2)child health assistance provided under title XXI of the Social Security Act.. (4)Section 423(d) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 is amended by adding at the end the following: (12)Child health assistance provided under title XXI of the Social Security Act.. (c)

Effective date

(1)

In general

Except as provided in paragraph (2), the amendments made by this section take effect on the date of enactment of this Act and apply to medical assistance provided under title XIX of the Social Security Act and child health assistance provided under title XXI of the Social Security Act on or after that date. (2)

Requirements for sponsor’s affidavit of support

Section 423(d) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 shall be applied as if the amendments made by this Act were enacted on December 1, 2002.

132.

Exception for citizens of freely associated States

(a)

In General

Section 402(a)(2) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(a)(2)) is amended by adding at the end the following: (M)

Exception for citizens of freely associated states

With respect to eligibility for benefits for the specified Federal programs described in paragraph (3), paragraph (1) shall not apply to any individual who lawfully resides in the United States (including territories and possessions of the United States) in accordance with— (i)section 141 of the Compact of Free Association between the Government of the United States and the Government of the Federated States of Micronesia, approved by Congress in the Compact of Free Association Amendments Act of 2003; (ii)section 141 of the Compact of Free Association between the Government of the United States and the Government of the Republic of the Marshall Islands, approved by Congress in the Compact of Free Association Amendments Act of 2003; or (iii)section 141 of the Compact of Free Association between the Government of the United States and the Government of Palau, approved by Congress in Public Law 99–658 (100 Stat. 3672).. (b)

Medicaid Exception

Section 402(b)(2) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at the end the following: (G)

Medicaid exceptions for citizens of freely associated states

With respect to eligibility for benefits for the programs defined in subparagraphs (A) and (C) of paragraph (3) (relating to medicaid), paragraph (1) shall not apply to any individual who lawfully resides in the United States (including territories and possessions of the United States) in accordance with a Compact of Free Association referred to in subsection (a)(2)(M).. (c)

Qualified Alien

Section 431(b) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1641(b)) is amended— (1)in paragraph (6), by striking or at the end; (2)in paragraph (7), by striking the period at the end and inserting ; or; and (3)by adding at the end the following: (8)an individual who lawfully resides in the United States (including territories and possessions of the United States) in accordance with a Compact of Free Association referred to in section 402(a)(2)(M).. (d)

Financial Treatment Under Medicaid

Section 1108 of the Social Security Act (42 U.S.C. 1308) is amended— (1)in subsection (f), by striking subsection (g) and inserting subsections (g) and (h); and (2)by adding at the end the following new subsection: (h)The limitations of subsections (f) and (g) shall not apply with respect to medical assistance provided to an individual described in section 431(b)(8) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996..

D

Indian Healthcare funding

1

Guaranteed funding

141.

Guaranteed adequate funding for Indian Healthcare

Section 825 of the Indian Health Care Improvement Act (25 U.S.C. 1680o) is amended to read as follows:

825.

Funding

(a)

In general

Notwithstanding any other provision of law, not later than 30 days after the date of enactment of this section, on October 1, 2007, and on each October 1 thereafter, out of any funds in the Treasury not otherwise appropriated, the Secretary of the Treasury shall transfer to the Secretary to carry out this title the amount determined under subsection (d). (b)

Use and availability

(1)

In general

An amount transferred under subsection (a)— (A)shall remain available until expended; and (B)shall be used to carry out any programs, functions, and activities relating to clinical services (as defined in paragraph (2)) of the Service and Service units. (2)

Clinical services defined

For purposes of paragraph (1)(B), the term clinical services includes all programs of the Indian Health Service which are funded directly or under the authority of the Indian Self-Determination and Education Assistance Act, for the purposes of— (A)clinical care, including inpatient care, outpatient care (including audiology, clinical eye and vision care), primary care, secondary and tertiary care, and long term care; (B)preventive health, including mammography and other cancer screening; (C)dental care; (D)mental and behavioral health, including community mental and behavioral health services, inpatient mental and behavioral health services, dormitory mental and behavioral health services, therapeutic and residential treatment centers; (E)emergency medical services; (F)treatment and control of, and rehabilitative care related to, alcoholism and drug abuse (including fetal alcohol syndrome) among Indians; (G)accident prevention programs; (H)home healthcare; (I)community health representatives; (J)maintenance and repair; and (K)traditional healthcare practices and training of traditional healthcare practitioners. (c)

Receipt and acceptance

The Secretary shall be entitled to receive, shall accept, and shall use to carry out this title the funds transferred under subsection (a), without further appropriation. (d)

Amount

The amount referred to in subsection (a) is— (1)for fiscal year 2006, the amount equal to 390 percent of the amount obligated by the Service during fiscal year 2002 for the purposes described in subsection (b)(2); and (2)for fiscal year 2007 and each fiscal year thereafter, the amount equal to the product obtained by multiplying— (A)the number of Indians served by the Service as of September 30 of the preceding the fiscal year; and (B)the per capita baseline amount, as determined under subsection (e). (e)

Per capita baseline amount

(1)

In general

For the purpose of subsection (d)(2)(B), the per capita baseline amount shall be equal to the sum of— (A)the quotient obtained by dividing— (i)the amount specified in subsection (d)(1); by (ii)the number of Indians served by the Service as of September 30, 2002; and (B)any applicable increase under paragraph (2). (2)

Increase

For each fiscal year, the Secretary shall provide a percentage increase (rounded to the nearest dollar) in the per capita baseline amount equal to the percentage by which— (A)the Consumer Price Index for all Urban Consumers published by the Department of Labor (relating to the United States city average for medical care and not seasonally adjusted) for the 1-year period ending on the June 30 of the fiscal year preceding the fiscal year for which the increase is made; exceeds (B)that Consumer Price Index for the 1-year period preceding the 1-year period described in subparagraph (A).

.

2

Indian Healthcare programs

145.

Programs operated by Indian Tribes and Tribal organizations

The Service shall provide funds for healthcare programs and facilities operated by Indian tribes and tribal organizations under funding agreements with the Service entered into under the Indian Self-Determination and Education Assistance Act on the same basis as such funds are provided to programs and facilities operated directly by the Service.

146.

Licensing

Healthcare professionals employed by Indian tribes and tribal organizations to carry out agreements under the Indian Self-Determination and Education Assistance Act, shall, if licensed in any State, be exempt from the licensing requirements of the State in which the agreement is performed.

147.

Authorization for emergency contract Health services

With respect to an elderly Indian or an Indian with a disability receiving emergency medical care or services from a non-Service provider or in a non-Service facility under the authority of the Indian Health Care Improvement Act, the time limitation (as a condition of payment) for notifying the Service of such treatment or admission shall be 30 days.

148.

Prompt action on Payment of claims

(a)

Requirement

The Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification. (b)

Failure to respond

If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service. (c)

Payment

The Service shall pay a valid contract care service claim within 30 days after the completion of the claim.

149.

Liability for Payment

(a)

No liability

A patient who receives contract healthcare services that are authorized by the Service shall not be liable for the payment of any charges or costs associated with the provision of such services. (b)

Notification

The Secretary shall notify a contract care provider and any patient who receives contract healthcare services authorized by the Service that such patient is not liable for the payment of any charges or costs associated with the provision of such services. (c)

Limitation

Following receipt of the notice provided under subsection (b), or, if a claim has been deemed accepted under section 154(b), the provider shall have no further recourse against the patient who received the services involved.

150.

Health services for ineligible persons

(a)

Ineligible persons

(1)

In general

Any individual who— (A)has not attained 19 years of age; (B)is the natural or adopted child, step-child, foster-child, legal ward, or orphan of an eligible Indian; and (C)is not otherwise eligible for the health services provided by the Service, shall be eligible for all health services provided by the Service on the same basis and subject to the same rules that apply to eligible Indians until such individual attains 19 years of age. The existing and potential health needs of all such individuals shall be taken into consideration by the Service in determining the need for, or the allocation of, the health resources of the Service. If such an individual has been determined to be legally incompetent prior to attaining 19 years of age, such individual shall remain eligible for such services until one year after the date such disability has been removed. (2)

Spouses

Any spouse of an eligible Indian who is not an Indian, or who is of Indian descent but not otherwise eligible for the health services provided by the Service, shall be eligible for such health services if all of such spouses or spouses who are married to members of the Indian tribe being served are made eligible, as a class, by an appropriate resolution of the governing body of the Indian tribe or tribal organization providing such services. The health needs of persons made eligible under this paragraph shall not be taken into consideration by the Service in determining the need for, or allocation of, its health resources. (b)

Programs and services

(1)

Programs

(A)

In general

The Secretary may provide health services under this subsection through health programs operated directly by the Service to individuals who reside within the service area of a service unit and who are not eligible for such health services under any other subsection of this section or under any other provision of law if— (i)the Indian tribe (or, in the case of a multi-tribal service area, all the Indian tribes) served by such service unit requests such provision of health services to such individuals; and (ii)the Secretary and the Indian tribe or tribes have jointly determined that— (I)the provision of such health services will not result in a denial or diminution of health services to eligible Indians; and (II)there is no reasonable alternative health program or services, within or without the service area of such service unit, available to meet the health needs of such individuals. (B)

Funding agreements

In the case of health programs operated under a funding agreement entered into under the Indian Self-Determination and Educational Assistance Act, the governing body of the Indian tribe or tribal organization providing health services under such funding agreement is authorized to determine whether health services should be provided under such funding agreement to individuals who are not eligible for such health services under any other subsection of this section or under any other provision of law. In making such determinations, the governing body of the Indian tribe or tribal organization shall take into account the considerations described in subparagraph (A)(ii). (2)

Liability for Payment

(A)

In general

Persons receiving health services provided by the Service by reason of this subsection shall be liable for payment of such health services under a schedule of charges prescribed by the Secretary which, in the judgment of the Secretary, results in reimbursement in an amount not less than the actual cost of providing the health services. Notwithstanding section 1880 of the Social Security Act or any other provision of law, amounts collected under this subsection, including medicare or medicaid reimbursements under titles XVIII and XIX of the Social Security Act, shall be credited to the account of the program providing the service and shall be used solely for the provision of health services within that program. Amounts collected under this subsection shall be available for expenditure within such program for not to exceed 1 fiscal year after the fiscal year in which collected. (B)

Services for indigent persons

Health services may be provided by the Secretary through the Service under this subsection to an indigent person who would not be eligible for such health services but for the provisions of paragraph (1) only if an agreement has been entered into with a State or local government under which the State or local government agrees to reimburse the Service for the expenses incurred by the Service in providing such health services to such indigent person. (3)

Service areas

(A)

Service to only one tribe

In the case of a service area which serves only one Indian tribe, the authority of the Secretary to provide health services under paragraph (1)(A) shall terminate at the end of the fiscal year succeeding the fiscal year in which the governing body of the Indian tribe revokes its concurrence to the provision of such health services. (B)

Multi-tribal areas

In the case of a multi-tribal service area, the authority of the Secretary to provide health services under paragraph (1)(A) shall terminate at the end of the fiscal year succeeding the fiscal year in which at least 51 percent of the number of Indian tribes in the service area revoke their concurrence to the provision of such health services. (c)

Purpose for providing services

The Service may provide health services under this subsection to individuals who are not eligible for health services provided by the Service under any other subsection of this section or under any other provision of law in order to— (1)achieve stability in a medical emergency; (2)prevent the spread of a communicable disease or otherwise deal with a public health hazard; (3)provide care to non-Indian women pregnant with an eligible Indian’s child for the duration of the pregnancy through post partum; or (4)provide care to immediate family members of an eligible person if such care is directly related to the treatment of the eligible person. (d)

Hospital privileges

Hospital privileges in health facilities operated and maintained by the Service or operated under a contract entered into under the Indian Self-Determination Education Assistance Act may be extended to non-Service healthcare practitioners who provide services to persons described in subsection (a) or (b). Such non-Service healthcare practitioners may be regarded as employees of the Federal Government for purposes of section 1346(b) and chapter 171 of title 28, United States Code (relating to Federal tort claims) only with respect to acts or omissions which occur in the course of providing services to eligible persons as a part of the conditions under which such hospital privileges are extended. (e)

Definition

In this section, the term eligible Indian means any Indian who is eligible for health services provided by the Service without regard to the provisions of this section.

151.

Definitions

For purposes of this chapter, the definitions contained in section 4 of the Indian Health Care Improvement Act shall apply.

152.

Authorization of appropriations

There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2015 to carry out this chapter.

E

Territories

161.

Funding for territories

(a)

Temporary elimination of spending cap

Section 1108 of the Social Security Act (42 U.S.C. 1308) is amended— (1)in subsection (f), by striking subsection (g) and inserting subsections (g) and (h); and (2)by adding at the end the following: (h)

Temporary elimination of caps

With respect to each of fiscal years 2006 through 2009, the Secretary shall make payments under title XIX to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa without regard to the limitations on the amount of such payments imposed under subsections (f) and (g).. (b)

Temporary increase in FMAP

The first sentence of section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is amended by inserting (except that, only with respect to fiscal years 2006 through 2009 and only for purposes of expenditures under this title, such percentage shall be 77 percent) after 50 per centum.

F

Migrant workers and farmworkers Health

171.

Demonstration project regarding continuity of coverage of migrant workers and farmworkers under Medicaid and CHIP

(a)

Authority to conduct demonstration project

(1)

In general

The Secretary of Health and Human Services shall conduct a demonstration project for the purpose of evaluating methods for strengthening the health coverage of, and continuity of coverage of, migrant workers and farmworkers under the medicaid and State children’s health insurance programs (42 U.S.C. 1396 et seq., 1397aa et seq.). (2)

Waiver authority

The Secretary of Health and Human Services shall waive compliance with the requirements of titles XI, XIX, and XXI of the Social Security Act (42 U.S.C. 1301 et seq, 1396 et seq., 1397aa et seq.) to such extent and for such period as the Secretary determines is necessary to conduct the demonstration project under this section. (b)

Requirements

The demonstration project conducted under this section shall provide for— (1)uniform eligibility criteria under the medicaid and State children’s health insurance programs with respect to migrant workers and farmworkers; and (2)the portability of coverage of such workers under those programs between participating States. (c)

Report

Not later than March 31, 2007, the Secretary of Health and Human Services shall submit a report to Congress on the demonstration project conducted under this section that contains such recommendations for legislative action as the Secretary determines is appropriate.

G

Expanded Access to Health Care

181.

National Commission for Expanded Access to Health Care

(a)

Establishment

There is established a commission to be known as the National Commission for Expanded Access to Health Care (referred to in this section as the Commission). (b)

Appointment of members

(1)

In general

Not later than 45 days after the date of enactment of this Act— (A)the majority and minority leaders of the Senate and the Speaker and minority leader of the House of Representatives shall each appoint 7 members of the Commission; and (B)the Secretary of Health and Human Services (in this section referred to as the Secretary) shall appoint 1 member of the Commission. (2)

Criteria

Members of the Commission shall include representatives of the following: (A)Consumers of health insurance. (B)Health care professionals. (C)State and territorial officials. (D)Health economists. (E)Health care providers. (F)Experts on health insurance. (G)Experts on expanding health care to individuals who are uninsured. (H)Experts on the elimination of racial and ethnic health disparities. (I)Experts on health care in the United States territories. (3)

Chairperson

At the first meeting of the Commission, the Commission shall select a Chairperson from among its members. (c)

Meetings

(1)

In general

After the initial meeting of the Commission, which shall be called by the Secretary, the Commission shall meet at the call of the Chairperson. (2)

Quorum

A majority of the members of the Commission shall constitute a quorum, but a lesser number of members may hold hearings. (3)

Supermajority voting requirement

To approve a report required under paragraph (1), (2), or (3) of subsection (e), at least 60 percent of the membership of the Commission must vote in favor of such a report. (d)

Duties

The Commission shall— (1)assess the effectiveness of programs designed to expand health care coverage or make health care coverage affordable to uninsured individuals by identifying the accomplishments and needed improvements of each program; (2)make recommendations regarding the benefits and cost-sharing that should be included in health care coverage for various groups, taking into account— (A)the special health care needs of children and individuals with disabilities; (B)the different ability of various populations to pay out-of-pocket costs for services; (C)incentives for efficiency and cost-containment; (D)racial and ethnic disparities in health status and health care; (E)incremental changes to the United States health care delivery system and changes to achieve fundamental restructuring of the system; (F)populations who are traditionally more difficult to cover, including immigrants and homeless persons; (G)preventive care, diagnostic services, disease management services, and other factors; (H)quality improvement initiatives among health institutions serving disadvantaged patient populations; and (I)the feasibility of and barriers to the development of a comprehensive system of health care; (3)recommend mechanisms to expand health care coverage to uninsured individuals; (4)recommend automatic enrollment and retention procedures and other measures to increase health care coverage among those eligible for assistance; and (5)analyze the size, effectiveness, and efficiency of current tax and other subsidies for health care coverage and recommend improvements. (e)

Reports

(1)

Annual reports

The Commission shall submit annual reports to the President and the appropriate committees of Congress addressing the matters identified in subsection (d). (2)

Biennial report

The Commission shall submit biennial reports to the President and the appropriate committees of Congress containing— (A)recommendations concerning essential benefits and maximum out-of-pocket cost-sharing for— (i)the general population; and (ii)individuals with limited ability to pay; and (B)proposed legislative language to implement such recommendations. (3)

Commission report

Not later than January 15, 2007, the Commission shall submit a report to the President and the appropriate committees of Congress, which shall include— (A)recommendations on policies to provide health care coverage to uninsured individuals; (B)recommendations on changes to policies enacted under this Act; and (C)proposed legislative language to implement such recommendations. (f)

Administration

(1)

Powers

(A)

Hearings

The Commission may hold such hearings, sit and act at such times and places, take such testimony, and receive such evidence as the Commission considers advisable to carry out this section. (B)

Information from Federal agencies

The Commission may secure directly from any Federal department or agency such information as the Commission considers necessary to carry out this section. Upon request of the Chairperson of the Commission, the head of such department or agency shall furnish such information to the Commission. (C)

Postal services

The Commission may use the United States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government. (D)

Gifts

The Commission may accept, use, and dispose of donations of services or property. (2)

Compensation

(A)

In general

Each member of the Commission who is not an officer or employee of the Federal Government shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code, for each day (including travel time) during which such member is engaged in the performance of duties of the Commission. All members of the Commission who are officers or employees of the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States. (B)

Travel expenses

The members of the Commission shall be allowed travel expenses, as authorized by the Chairperson of the Commission, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Commission. (3)

Staff

(A)

In general

The Chairperson of the Commission may appoint an executive director such other staff as may be necessary to enable the Commission to perform its duties. The employment of an executive director shall be subject to confirmation by the Commission. (B)

Staff compensation

The Chairperson of the Commission may fix the compensation of personnel without regard to chapter 51 and subchapter III of chapter 53 of title 5, United States Code, relating to classification of positions and General Schedule pay rates, except that the rate of pay for personnel may not exceed the rate payable for level V of the Executive Schedule under section 5316 of such title. (C)

Detail of government employees

Any Federal Government employee may be detailed to the Commission without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege. (D)

Procurement of temporary and intermittent services

The Chairperson of the Commission may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title. (g)

Termination

Except with respect to activities in connection with the ongoing biennial report required under subsection (e)(2), the Commission shall terminate 90 days after the date on which the Commission submits the report required under subsection (e)(3). (h)

Authorization of appropriations

There is authorized to be appropriated to carry out this section, such sums as may be necessary for fiscal year 2007 and each subsequent fiscal year.

182.

Institute of Medicine evaluation and report on Health care performance measures

(a)

Evaluation

(1)

In general

Not later than the date that is 2 months after the date of the enactment of this Act, the Secretary shall enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences (in this section referred to as the Institute) shall conduct an evaluation of the Federal poverty line for purposes of access to health care services under any applicable Federal health care program. (2)

Poverty line defined

For purposes of paragraph (1), the term poverty line has the meaning given that term in section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)), including any revision required by such section. (b)

Report

Not later than the date that is 18 months after the date of enactment of this Act, the Institute shall submit to the Secretary and appropriate committees of jurisdiction of the House of Representatives and Senate a report on the evaluation conducted under subsection (a)(1) describing the findings of such evaluation and recommendations for any adjustment of the Federal poverty line for appropriate access of individuals to such Federal health care programs. (c)

Authorization of appropriations

There are authorized to be appropriated such sums as may be necessary for purposes of conducting the evaluation and preparing the report required by this section.

H

FMAP reimbursement for Native Hawaiians

191.

100 percent FMAP for medical assistance provided to a Native Hawaiian through a federally-qualified Health Center or a Native Hawaiian Health care system under the Medicaid Program

(a)

Medicaid

The third sentence of section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is amended by inserting , and with respect to medical assistance provided to a Native Hawaiian (as defined in section 12 of the Native Hawaiian Health Care Improvement Act) through a federally-qualified health center or a Native Hawaiian health care system (as so defined) whether directly, by referral, or under contract or other arrangement between a federally-qualified health center or a Native Hawaiian health care system and another health care provider before the period. (b)

Effective date

The amendment made by this section applies to medical assistance provided on or after the date of enactment of this Act.

.

202.

Standards for language access services

Not later than 120 days after the date of enactment of this Act, the head of each Federal agency that carries out health care-related activities shall develop and adopt a guidance on language services for those with limited English proficiency who attempt to have access to or participate in such activities that provides at the minimum the factors and principles set forth in the Department of Justice guidance published on June 12, 2002.

203.

Federal reimbursement for culturally and linguistically appropriate services under the medicare, Medicaid and State Children’s Health Insurance Program

(a)

Demonstration project promoting access for medicare beneficiaries with Limited English proficiency

(1)

In general

The Secretary shall conduct a demonstration project (in this section referred to as the project) to demonstrate the impact on costs and health outcomes of providing reimbursement for interpreter services to certain medicare beneficiaries who are limited English proficient in urban and rural areas. (2)

Scope

The Secretary shall carry out the project in not less than 30 States through contracts with— (A)health plans (under part C of title XVIII of the Social Security Act); (B)small providers; (C)hospitals; and (D)community-based clinics. (3)

Duration

Each contract entered into under the project shall extend over a period of not longer than 2 years. (4)

Report

Upon completion of the project, the Secretary shall submit a report to Congress on the project which shall include recommendations regarding the extension of such project to the entire medicare program. (5)

Evaluation

The Director of the Agency for Healthcare Research and Quality shall award grants to public and private nonprofit entities for the evaluation of the project. Such evaluations shall focus on access, utilization, efficiency, cost-effectiveness, patient satisfaction, and select health outcomes. (b)

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 culturally and linguistically appropriate services, including oral interpretation, translations of written materials, and other cultural and linguistic services for individuals with limited English proficiency and disabilities who apply for, or receive, medical assistance under the State plan (including any waiver granted to the State plan); plus. (c)

SCHIP

Section 2105(a)(1) of the Social Security Act (42 U.S.C.1397ee(a)), as amended by section 515, 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)by redesignating clause (iv) as clause (v); and (C)by inserting after clause (iii) the following: (iv)for expenditures attributable to the provision of culturally and linguistically appropriate services, including oral interpretation, translations of written materials, and other language services for individuals with limited English proficiency and disabilities who apply for, or receive, child health assistance under the plan; and. (d)

Effective date

The amendments made by this section take effect on October 1, 2006.

204.

Increasing understanding of Health literacy

(a)

In general

The Secretary, acting through the Director of the Agency for Healthcare Research and Quality and the Administrator of the Health Resources and Services Administration, shall award grants to eligible entities to improve healthcare for patient populations that have low functional health literacy. (b)

Eligibility

To be eligible to receive a grant under subsection (a), an entity shall— (1)be a hospital, health center or clinic, health plan, or other health entity; and (2)prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require. (c)

Use of funds

(1)

Agency for Healthcare Research and Quality

Grants awarded under subsection (a) through the Agency for Healthcare Research and Quality shall be used— (A)to define and increase the understanding of health literacy; (B)to investigate the correlation between low health literacy and health and healthcare; (C)to clarify which aspects of health literacy have an effect on health outcomes; and (D)for any other activity determined appropriate by the Director of the Agency. (2)

Health Resources and Services Administration

Grants awarded under subsection (a) through the Health Resources and Services Administration shall be used to conduct demonstration projects for interventions for patients with low health literacy that may include— (A)the development of new disease management programs for patients with low health literacy; (B)the tailoring of existing disease management programs addressing mental and physical health conditions for patients with low health literacy; (C)the translation of written health materials for patients with low health literacy; (D)the identification, implementation, and testing of low health literacy screening tools; (E)the conduct of educational campaigns for patients and providers about low health literacy; and (F)other activities determined appropriate by the Administrator of the Health Resources and Services Administration. (d)

Definitions

In this section, the term low health literacy means the inability of an individual to obtain, process, and understand basic health information and services needed to make appropriate health decisions. (e)

Authorization of appropriations

There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2006 through 2011.

205.

Report on Federal efforts to provide culturally and linguistically appropriate Healthcare services

Not later than 1 year after the date of enactment of this Act and annually thereafter, the Secretary of Health and Human Services shall enter into a contract with the Institute of Medicine for the preparation and publication of a report that describes federal efforts to ensure that all individuals have meaningful access to culturally and linguistically appropriate healthcare services. Such report shall include— (1)a description and evaluation of the activities carried out under this Act; and (2)a description of best practices, model programs, guidelines, and other effective strategies for providing access to culturally and linguistically appropriate healthcare services.

206.

General Accounting Office report on impact of language access services

Not later than 3 years after the date of enactment of this Act, the Comptroller General of the United States shall examine, and prepare and publish a report on, the impact of language access services on the health and healthcare of limited English proficient populations. Such report shall include— (1)recommendations on the development and implementation of policies and practices by healthcare organizations and providers for limited English proficient patient populations; (2)a description of the effect of providing language access services on quality of healthcare and access to care and reduced medical error; and (3)a description of the costs associated with or savings related to provision of language access services.

207.

Definitions

In this title: (1)

Incorporated definitions

The definitions contained in section 2900 of the Public Health Service Act, as added by section 201, shall apply. (2)

Secretary

The term Secretary means the Secretary of Health and Human Services.

B

Medicare and Medicaid Programs Requirements

211.

Treatment of the medicare part b program under title vi of Civil Rights Act of 1964

A payment provider of services or physician or other supplier under part B of title XVIII of the Social Security Act shall be deemed a grant, and not a contract of insurance or guaranty, for the purposes of title VI of the Civil Rights Act of 1964.

. (b)

Technical amendments

The Indian Self-Determination and Education Assistance Act is amended— (1)by redesignating title V (as added by section 1302 of the American Indian Education Foundation Act of 2000) (25 U.S.C. 458bbb et seq.)) as title VII; (2)by redesignating sections 501, 502, and 503 (as added by section 1302 of the American Indian Education Foundation Act of 2000) as sections 701, 702, and 703, respectively; and (3)in subsection (a)(2) of section 702 and paragraph (2) of section 703 (as redesignated by paragraph (2)), by striking section 501 and inserting section 701. B

Rural and underserved urban America telehealth programs

711.

Increasing types of originating telehealth sites and facilitating the provision of telehealth services across State lines

(a)

Increasing types of originating sites

Section 1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the end the following: (VI)A skilled nursing facility (as defined in section 1819(a)). (VII)An assisted-living facility (as defined by the Secretary). (VIII)A board-and-care home (as defined by the Secretary). (IX)A county or community health clinic (as defined by the Secretary). (X)A community mental health center (as described in section 1861(ff)(2)(B)). (XI)A facility operated by the Indian Health Service or by an Indian tribe, tribal organization, or an urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) directly, or under contract or other arrangement. (XII)A site in a State in which the respective State medical board has adopted a formal policy regarding licensing or certification requirements for providers at distant sites who do not have a license to practice medicine at the originating site.. (b)

Expanding eligibility for reimbursement

Section 1834(m)(4)(C)(i)(I) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)(i)(I)) is amended by striking rural.

712.

Strengthening telehealth services in rural and underserved urban America

Subpart I of part D of title III of the Public Health Service Act (42 U.S.C. 254b et seq.) is amended— (1)in section 330L— (A)by redesignating subsection (b) as subsection (c); and (B)by inserting after subsection (a) the following: (b)

Conference

Within 1 year of the date of enactment of the Telehealth Improvement Act of 2004, the Secretary shall convene a conference of State licensing boards, local telehealth projects, health care practitioners, and patient advocates to promote interstate licensure for telehealth projects.; and (2)by adding at the end the following:

330M.

Integrative eldercare telehealth demonstration project

(a)

Purposes

The purposes of this section are to encourage the creation of programs to— (1)evaluate the use of telehealth services in an integrative eldercare setting; (2)eliminate fragmented service delivery while promoting enhanced continuity of care and more simplified access to services; (3)develop community-based options that promote patient independence and leverage telehealth services and equipment to enable the use of the most cost-effective, least restrictive care settings; and (4)promote access for elderly patients in rural and underserved urban areas to improvements in medical technology and training across an integrated spectrum of care; and to make health care services more flexible and responsive to the diverse and changing needs of elderly patients in rural areas. (b)

Grants authorized

(1)

In general

The Director may award grants to eligible providers for projects to demonstrate how telehealth technologies can be used through telehealth networks in rural areas, frontier communities, and medically underserved areas, and for medically underserved populations, to— (A)expand access to, coordinate, and improve the quality of health care services; (B)improve and expand the training of health care providers; and (C)expand and improve the quality of health information available to health care providers, and patients and their families, for decisionmaking. (2)

Grant period

The Director shall award grants under this subsection for a period of up to 4 years. (3)

Number of grants

Not to exceed 20 grants shall be awarded under this subsection, of which at least 1/2 shall be dedicated to providing services in rural communities. (c)

Use of funds

Grants awarded pursuant to subsection (b) may be used for activities including— (1)improving access to coordinated health care services at the lowest intensity and resource level of care consistent with quality health care services and optimal patient outcomes, improving the quality of such care, increasing patient satisfaction with such care, and reducing the cost of such care through advanced telecommunication technologies; (2)developing effective care management practices and educational curricula to train health care professionals, paraprofessionals, and caregivers, including family members, and to increase the general level of competency of such individuals through such training; and (3)developing curricula to train health care professionals, paraprofessionals, and caregivers, including family members, serving integrative eldercare patients in the use of telecommunications. (d)

Applications

To be eligible to receive a grant under subsection (b), an eligible provider, in consultation with the appropriate State office of rural health or another appropriate State entity, shall prepare and submit to the Director an application, at such time, in such manner, and containing such information as the Director may require, including— (1)a description of the project that the eligible entity will carry out using the funds provided under the grant; (2)a description of the manner in which the project funded under the grant will meet the health care needs of rural or other populations to be served through the project, or improve the access to services of, and the quality of the services received by, those populations; (3)evidence of local support for the project, and a description of how the areas, communities, or populations to be served will be involved in the development and ongoing operations of the project; (4)a plan for sustaining the project after Federal support for the project has ended; (5)information on the source and amount of non-Federal funds that the entity will provide for the project; (6)information demonstrating the long-term viability of the project, and other evidence of institutional commitment of the entity to the project; (7)in the case of an application for a project involving a telehealth network, information demonstrating how the project will promote the integration of telehealth technologies into the operations of health care providers, to avoid redundancy, and improve access to and the quality of care; and (8)other such information as the Director determines to be appropriate. (e)

Report

(1)

Final report

Not later than 9 months after the date of termination of the last grant to be awarded under this section, the Director shall submit to Congress a final report— (A)describing the results of the programs funded by grants awarded pursuant to this section; and (B)evaluating the impact of the use of telehealth services in an integrative eldercare setting on— (i)access to care for patients served by integrative eldercare programs; and (ii)the quality of, patient satisfaction with, and the cost of, such care. (2)

Ensuring access to quality care

In conducting the evaluation under paragraph (1)(B), the Director shall— (A)give special consideration to the impact of programs funded under this section on face-to-face access to medical providers; and (B)develop specific measures to evaluate the quality of care provided to those participating in such programs to ensure that telehealth augments the plan of care. (f)

Eligible provider

The term eligible provider means a consortia of home and facility-based care providers that includes providers from no less than 2 of the following: (1)An adult congregate care facility. (2)A continuing care retirement community. (3)An assisted living facility. (4)An Alzheimer’s facility. (5)An institutional hospice facility. (6)A residential care facility. (7)An adult foster home. (8)A State-licensed nursing home, including a skilled nursing facility, an intermediate care facility, licensed home health provider or other health care provider that the Director deems appropriate and consistent with the purposes of this section. (g)

Definitions

In this section: (1)

Director; Office

The terms Director and Office mean the Director of the Office for the Advancement of Telehealth and the Office for the Advancement of Telehealth. (2)

Integrative eldercare

The term integrative eldercare includes case management and coordination of care for elderly patients recovering from acute illness or coping with chronic disease at the lowest intensity and resource level of care consistent with quality health care services and optimal patient outcomes. (3)

Telehealth services

The term telehealth services means services provided through telehealth technologies. (4)

Telehealth technologies

The term telehealth technologies means technologies relating to the use of electronic information, and telecommunications technologies, to support and promote, at a distance, health care, patient and professional health-related education, health administration, and public health. (h)

Authorization of appropriations

There are authorized to be appropriated to the Office for the Advancement of Telehealth to carry out this section $30,000,000 for fiscal year 2006 and such sums as may be necessary for each of fiscal years 2007 through 2009.

330N.

American Indian and Alaska Native telehealth demonstration project

(a)

Purpose

The purpose of this section is to evaluate the use of telehealth services in areas under the jurisdiction of Indian tribes or tribal organizations, including efforts to develop more effective case management for chronic and acute disease and preventive health care programs. (b)

Grants authorized

(1)

In general

The Director may award grants to eligible providers, individually or as part of a network of eligible providers, for the provision of telehealth services to improve patient care, prevent health care complications, improve patient outcomes, and achieve efficiencies in the delivery of care to patients who reside in areas under the jurisdiction of Indian tribes or tribal organizations. (2)

Grant period

The Director shall award grants under this section for a period of up to 4 years. (3)

Number of grants

Not to exceed 20 grants shall be awarded under this section, of which at least 1/2 shall be dedicated to providing services in rural communities. (c)

Use of funds

Grants awarded under this section may be used for activities including— (1)improving access to care for home care patients served by eligible providers, improving the quality of such care, increasing patient satisfaction with such care, and reducing the cost of such care through advanced telecommunication technologies; (2)developing effective telehealth management practices and educational curricula to train health professionals and paraprofessionals and increase their general level of competency through such training; and (3)developing curricula to train health care professionals and paraprofessionals serving patients of eligible providers in the use of telecommunications. (d)

Collaboration

The Director shall ensure that eligible providers receiving grants under this section collaborate to enable comparisons across programs and to share relevant, de-identified information to better facilitate program performance evaluation. (e)

Applications

To be eligible to receive a grant under subsection (b), an eligible entity, in consultation with the appropriate State office of rural health or another appropriate State entity, shall prepare and submit to the Director an application, at such time, in such manner, and containing such information as the Director may require, including— (1)a description of the project that the eligible entity will carry out using the funds provided under the grant; (2)a description of the manner in which the project funded under the grant will meet the health care needs of rural or other populations to be served through the project, or improve the access to services of, and the quality of the services received by, those populations; (3)evidence of local support for the project, and a description of how the areas, communities, or populations to be served will be involved in the development and ongoing operations of the project; (4)a plan for sustaining the project after Federal support for the project has ended; (5)information on the source and amount of non-Federal funds that the entity will provide for the project; (6)information demonstrating the long-term viability of the project, and other evidence of institutional commitment of the entity to the project; (7)in the case of an application for a project involving a telehealth network, information demonstrating how the project will promote the integration of telehealth technologies into the operations of health care providers, to avoid redundancy, and improve access to and the quality of care; and (8)other such information as the Director determines to be appropriate. (f)

Report

(1)

Final report

Not later than 9 months after the date of termination of the last grant to be awarded under this section, the Director shall submit to Congress a final report— (A)describing the results of the programs funded by grants awarded pursuant to this section; and (B)evaluating the impact of telehealth services in an institutional long-term care setting on— (i)access to care for patients of eligible providers; and (ii)the quality of, patient satisfaction with, and the cost of, such care. (2)

Ensuring access to quality care

In conducting the evaluation under paragraph (1)(B), the Director shall— (A)give special consideration to the impact of programs funded under this section on face-to-face access to medical providers; and (B)develop specific measures to evaluate the quality of care provided to those participating in such programs to ensure that telemedicine augments the plan of care. (g)

Definitions

In this section: (1)

Director; Office

The terms Director and Office mean the Director of the Office for the Advancement of Telehealth and the Office for the Advancement of Telehealth. (2)

Eligible provider

The term eligible provider includes any public or private nonprofit health care provider a majority of whose patient practice is Native American or any Indian tribe or tribal organization that provides health care services for its members. (3)

Indian tribe

The term Indian tribe has the meaning given such term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b). (4)

Native American

The term Native American means a member of an Indian tribe, a Native Hawaiian (as defined in section 338K(c)), or a Native American Pacific Islander. (5)

Native American Pacific Islander

The term Native American Pacific Islander means an individual who is indigenous to a United States territory or possession located in the Pacific Ocean. (6)

Tribal organization

The term tribal organization has the meaning given such term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b). (h)

Authorization of appropriations

There are authorized to be appropriated to carry out this section $30,000,000 for fiscal year 2006 and such sums as may be necessary for each of fiscal years 2007 through 2009.

330O.

Oral Health telehealth demonstration project

(a)

Purpose

The purpose of this section is to evaluate the use of telehealth services to expand access to oral health services and improve oral health outcomes among rural and underserved urban patients. (b)

Grants authorized

(1)

In general

The Director is authorized to award competitive grants to eligible providers, individually or as part of a network of eligible providers, for the provision of oral health services to improve patient care, prevent health care complications, improve patient outcomes, and achieve efficiencies in the delivery of oral health care to patients who reside in rural areas. (2)

Grant period

The Director shall award grants under this section for a period of up to 4 years. (3)

Number of grants

The number of grants awarded under this section shall not exceed 10 grants. (c)

Use of funds

Grants awarded pursuant to subsection (b) may be used for activities including— (1)improving access to care for rural and underserved urban patients served by eligible providers, improving the quality of that care, increasing patient satisfaction with that care, and reducing the cost of that care through advanced telecommunication technologies; (2)developing effective oral telehealth care management practices and educational curricula to train oral health professionals and paraprofessionals and increase their general level of competency through that training; and (3)developing curricula to train health care professionals and paraprofessionals, serving rural and underserved urban patients in the use of telecommunications. (d)

Applications

To be eligible to receive a grant under subsection (b), an eligible entity, in consultation with the appropriate State office of rural health or another appropriate State entity, shall prepare and submit to the Director an application, at such time, in such manner, and containing such information as the Director may require, including— (1)a description of the project that the eligible entity will carry out using the funds provided under the grant; (2)a description of the manner in which the project funded under the grant will meet the health care needs of rural or other populations to be served through the project, or improve the access to services of, and the quality of the services received by, those populations; (3)evidence of local support for the project, and a description of how the areas, communities, or populations to be served will be involved in the development and ongoing operations of the project; (4)a plan for sustaining the project after Federal support for the project has ended; (5)information on the source and amount of non-Federal funds that the entity will provide for the project; (6)information demonstrating the long-term viability of the project, and other evidence of institutional commitment of the entity to the project; (7)in the case of an application for a project involving a telehealth network, information demonstrating how the project will promote the integration of telehealth technologies into the operations of health care providers, to avoid redundancy, and improve access to and the quality of care; and (8)other such information as the Director determines to be appropriate. (e)

Report

(1)

Final report

Not later than 9 months after the date of termination of the last grant to be awarded under this section, the Director shall submit to Congress a final report— (A)describing the results of the programs funded by grants awarded pursuant to this section; and (B)including an evaluation of the impact of the use of oral telehealth services on— (i)access to oral health care for rural patients; and (ii)the quality of, patient satisfaction with, and the cost of, that care. (2)

Ensuring access to quality care

In conducting the evaluation under paragraph (1)(B), the Director shall— (A)give special consideration to the impact of programs funded under this section on face-to-face access to medical providers; and (B)develop specific measures to evaluate the quality of care provided to those participating in such programs to ensure that telemedicine augments the plan of care. (f)

Definition of eligible provider

In this section the term eligible provider includes dentists, periodontists, orthodontists, dental and oral health clinics, and schools of dentistry and oral health, where a majority of the patient population resides in a rural area, and may include other rural oral health providers that the Director deems appropriate. (g)

Authorization of appropriations

There are authorized to be appropriated to carry out this section $30,000,000 for fiscal year 2006 and such sums as may be necessary for each of fiscal years 2007 through 2009.

.

713.

Joint Working Group on Telehealth

(a)

In general

(1)

Representation of rural areas

The Secretary of Health and Human Services shall establish, within the Health Resources and Services Administration Office for the Advancement of Telehealth, and under the leadership of the Director of the Office for the Advancement of Telehealth, a Joint Working Group on Telehealth. In establishing such Group, the Secretary shall ensure that all relevant Federal agencies are represented and that input from relevant industry groups, including representatives of rural areas and medically underserved areas, is fully considered. (2)

Mission

The mission of the Joint Working Group on Telehealth is— (A)to identify, monitor, and coordinate Federal telehealth projects, data sets, and programs; (B)to analyze— (i)how telehealth systems are expanding access to health care services, education, and information; (ii)the clinical, educational, or administrative efficacy and cost-effectiveness of telehealth applications; and (iii)the quality of the telehealth services delivered; and (C)to make further recommendations for coordinating Federal and State efforts to increase access to health services, education, and information in rural and medically underserved areas. (3)

Annual reports

Not later than 2 years after the date of enactment of this Act, and each January 1 thereafter, the Joint Working Group on Telehealth shall submit to Congress a report on the status of the Group’s mission and the state of the telehealth field generally. (b)

Report specifics

The annual report required under subsection (a)(3) shall provide— (1)an analysis of— (A)the matters described in subsection (a)(2)(B); (B)Federal activities with respect to telehealth; and (C)the process of the Joint Working Group on Telehealth’s efforts to coordinate Federal telehealth programs; and (2)recommendations for a coordinated Federal strategy to increase health care access through telehealth. (c)

Authorization of appropriations

There are authorized to be appropriated such sums as may be necessary to enable the Joint Working Group on Telehealth to carry out this section.