[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5864 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 5864

To provide for innovation in health care through State initiatives that 
                      expand coverage and access.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 24, 2006

 Ms. Baldwin (for herself, Mr. Price of Georgia, Mr. Tierney, and Mr. 
  Beauprez) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
 Rules, 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 provide for innovation in health care through State initiatives that 
                      expand coverage and access.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Partnership Through Creative 
Federalism Act''.

SEC. 2. STATE HEALTH REFORM PROJECTS.

    (a) Purposes; Establishment of State Health Care Expansion and 
Improvement Program.--
            (1) Purposes.--The purposes of the programs approved under 
        this section shall include, but not be limited to--
                    (A) achieving the goals of increased health 
                coverage and access; and
                    (B) testing alternative reforms, such as building 
                on the public or private health systems, or creating 
                new systems, to achieve the objectives of this Act.
            (2) Intent of congress.--It is the intent of Congress 
        that--
                    (A) the programs approved under this Act each 
                comprise significant coverage expansions;
                    (B) taken as a whole, such programs should be 
                diverse and balanced in their approaches to covering 
                the uninsured; and
                    (C) each such program should be rigorously and 
                objectively evaluated, so that the State programs 
                developed pursuant to this Act may guide the 
                development of future State and national policy.
    (b) Applications by States and Local Governments.--
            (1) Entities that may apply.--
                    (A) In general.--A State may apply for a State 
                health care expansion and improvement program for the 
                entire State (or for regions of the State) under 
                paragraph (2).
                    (B) Regional and sub-state groups.--A regional 
                entity consisting of more than one State or one or more 
                local governments within a State may apply for a multi-
                State or a sub-state health care expansion and 
                improvement program for the region or area involved.
                    (C) Definition.--In this Act, the term ``State'' 
                means the 50 States, the District of Columbia, and the 
                Commonwealth of Puerto Rico. Such term shall include a 
                regional entity described in subparagraph (B).
            (2) Submission of application.--In accordance with this 
        section, each State or regional entity desiring to implement a 
        State health care expansion and improvement program may submit 
        an application to the State Health Coverage Innovation 
        Commission under subsection (c) (referred to in this section as 
        the ``Commission'') for approval.
            (3) Local government applications.--Where a State fails to 
        submit an application under this section, a unit of local 
        government of such State, or a consortium of such units of 
        local governments, may submit an application directly to the 
        Commission for programs or projects under this subsection. Such 
        an application shall be subject to the requirements of this 
        section.
    (c) State Health Coverage Innovation Commission.--
            (1) In general.--Within 90 days after the date of the 
        enactment of this Act, the Secretary of Health and Human 
        Services (in this section referred to as the ``Secretary'') 
        shall establish a State Health Coverage Innovation Commission 
        that--
                    (A) shall be comprised of--
                            (i) the Secretary;
                            (ii) four State governors to be appointed 
                        by the National Governors Association on a 
                        bipartisan basis;
                            (iii) two members of a State legislature to 
                        be appointed, on a joint and bipartisan basis, 
                        by the National Conference of State Legislators 
                        and the American Legislative Exchange Council;
                            (iv) two county officials to be appointed 
                        by the National Association of Counties on a 
                        bipartisan basis;
                            (v) two mayors to be appointed, on a joint 
                        and bipartisan basis, by the National League of 
                        Cities and by the United States Conference of 
                        Mayors;
                            (vi) two individuals to be appointed by the 
                        Speaker of the House of Representatives;
                            (vii) two individuals to be appointed by 
                        the Minority Leader of the House of 
                        Representatives;
                            (viii) two individuals to be appointed by 
                        the Majority Leader of the Senate; and
                            (ix) two individuals to be appointed by the 
                        Minority Leader of the Senate;
                    (B) shall request States to submit proposals, which 
                may include a variety of reform options such as tax 
                credit approaches, expansions of public programs such 
                as Medicaid and the State Children's Health Insurance 
                Program, the creation of purchasing pooling 
                arrangements similar to the Federal Employees Health 
                Benefits Program, individual market purchasing options, 
                single risk pool or single payer systems, health 
                savings accounts, a combination of the options 
                described in this subparagraph, or other alternatives 
                determined appropriate by the Commission, including 
                options suggested by States or the public, and nothing 
                in this subparagraph shall be construed to prevent the 
                Commission from approving a reform proposal not 
                included in this subparagraph;
                    (C) shall conduct a thorough review of the grant 
                application from a State and carry on a dialogue with 
                all State applicants concerning possible modifications 
                and adjustments;
                    (D) shall submit the recommendations and 
                legislative proposal described in subsection (d)(4)(C);
                    (E) shall be responsible for receiving information 
                to determine the status and progress achieved under 
                program or projects granted under this section;
                    (F) shall report to the public concerning progress 
                made by States with respect to the performance measures 
                and goals established under this Act, the periodic 
                progress of the State relative to its State performance 
                measures and goals, and the State program application 
                procedures, by region and State jurisdiction;
                    (G) shall promote information exchange between 
                States and the Federal Government;
                    (H) shall be responsible for making recommendations 
                to the Secretary and the Congress, using equivalency or 
                minimum standards, for minimizing the negative effect 
                of State program on national employer groups, provider 
                organizations, and insurers because of differing State 
                requirements under the programs; and
                    (I) may require States to submit additional 
                information or reports concerning the status and 
                progress achieved under health care expansion and 
                improvement programs granted under this section, as 
                needed.
            (2) Period of appointment; representation requirements; 
        vacancies.--Members shall be appointed for a term of 5 years. 
        In appointing such members under paragraph (1)(A), the 
        designated appointing individuals shall ensure the 
        representation of urban and rural areas and an appropriate 
        geographic distribution of such members. Any vacancy in the 
        Commission shall not affect its powers, but shall be filled in 
        the same manner as the original appointment.
            (3) Chairperson, meetings.--
                    (A) Chairperson.--The Commission shall select a 
                Chairperson from among its members.
                    (B) Quorum.--Two-thirds of the members of the 
                Commission shall constitute a quorum, but a lesser 
                number of members may hold hearings.
                    (C) Meetings.--Not later than 30 days after the 
                date on which all members of the Commission have been 
                appointed, the Commission shall hold its first meeting. 
                The Commission shall meet at the call of the 
                Chairperson.
            (4) Powers of the commission.--
                    (A) Negotiations with states.--The Commission may 
                conduct detailed discussions and negotiations with 
                States submitting applications under this section, 
                either individually or in groups, to facilitate a final 
                set of recommendations for purposes of subsection 
                (d)(4)(C).
                    (B) 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 the 
                purposes of this subsection.
                    (C) Meetings.--In addition to other meetings the 
                Commission may hold, the Commission shall hold an 
                annual meeting with the participating States under this 
                section for the purpose of having States report 
                progress toward the purposes in subsection (a) and for 
                an exchange of information.
                    (D) Information.--The Commission may secure 
                directly from any Federal department or agency such 
                information as the Commission considers necessary to 
                carry out the provisions of this subsection. Upon 
                request of the Chairperson of the Commission, the head 
                of such department or agency shall furnish such 
                information to the Commission if the head of the 
                department or agency involved determines it 
                appropriate.
                    (E) 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.
            (5) Personnel matters.--
                    (A) Compensation.--Each member of the Commission 
                who is not an officer or employee of the Federal 
                Government or of a State or local 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 the 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, 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.
                    (C) Staff.--The Chairperson of the Commission may, 
                without regard to the civil service laws and 
                regulations, appoint and terminate an executive 
                director and such other additional personnel 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.
                    (D) 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.
                    (E) 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.
            (6) Funding.--For the purpose of carrying out this 
        subsection, there are authorized to be appropriated $3,000,000 
        for fiscal year 2007 and each fiscal year thereafter.
    (d) Requirements for Programs.--
            (1) State plan.--A State that seeks to operate a program 
        under this section shall prepare and submit to the Commission, 
        as part of the application under subsection (b), a State health 
        care plan that shall have as its goal increased coverage, and 
        in service of that goal such additional goals as improvements 
        in quality, efficiency, cost-effectiveness, and the appropriate 
        use of information technology. To achieve such goal, the State 
        plan shall comply with the following:
                    (A) Coverage.--
                            (i) In general.--With respect to coverage, 
                        the State plan shall--
                                    (I) provide and describe the manner 
                                in which the State will ensure that an 
                                increased number of individuals 
                                residing within the State will have 
                                expanded access to health care coverage 
                                with a specific 5-year target for 
                                reduction in the number or proportion 
                                of uninsured individuals through either 
                                private or public program expansion, or 
                                both, in accordance with or in addition 
                                to the options established by the 
                                Commission;
                                    (II) describe the number and 
                                percentage of current uninsured 
                                individuals who will achieve coverage 
                                under a State health program;
                                    (III) describe the coverage that 
                                will be provided to beneficiaries under 
                                a State health program;
                                    (IV) identify Federal, State, or 
                                local and private programs that 
                                currently provide health care services 
                                in the State and describe how such 
                                programs could be coordinated with a 
                                State health program, to the extent 
                                practicable; and
                                    (V) provide for improvements in the 
                                availability of appropriate health care 
                                coverage that will increase access to 
                                care in urban, suburban, rural, and 
                                frontier areas of the State with 
                                medically underserved populations or 
                                where there may be an inadequate supply 
                                of health care providers.
                            (ii) Coverage options.--The coverage under 
                        the State plan may be--
                                    (I) health insurance coverage that 
                                meets the aggregate actuarial value 
                                requirement of section 2103(a)(2)(B) of 
                                the Social Security Act (42 U.S.C. 
                                1397cc(a)(2)(B));
                                    (II) a combination of health 
                                insurance coverage and a consumer-
                                directed health care spending account, 
                                if the actuarial value of such coverage 
                                plus the amount of annual deposits into 
                                such account from sources other than 
                                the beneficiary is not less than the 
                                actuarial value amount described in 
                                subclause (I); or
                                    (III) health care access not less 
                                on average than that provided through 
                                coverage described in subclause (I).
                            (iii) Construction.--Nothing in this clause 
                        shall be construed to limit in any way the 
                        authority of the Secretary of Health and Human 
                        Services to issue waivers under section 1115 of 
                        the Social Security Act.
                    (B) Quality.--With respect to quality, the State 
                plan may describe efforts to improve health care 
                quality in the State, including an explanation of how 
                such efforts would change (if at all) under the State 
                plan.
                    (C) Costs.--With respect to costs, the State plan 
                shall--
                            (i) describe such steps as the State may 
                        undertake to improve the efficiency of health 
                        care;
                            (ii) describe the public and private sector 
                        financing to be provided for the State health 
                        program;
                            (iii) estimate the amount of Federal, 
                        State, and local expenditures, as well as, the 
                        costs to business and individuals under the 
                        State health program; and
                            (iv) describe how the State plan will 
                        ensure the financial solvency of the State 
                        health program.
                    (D) Health information technology.--With respect to 
                health information technology, the State plan may 
                describe efforts to improve the appropriate use of 
                health information technology, including an explanation 
                of how such efforts would change (if at all) under the 
                State plan.
                    (E) Exceptions to federal policies.--The State plan 
                shall describe the exceptions to otherwise applicable 
                Federal statutes, regulations, and policies that would 
                apply within the geographic area and time period 
                governed by the plan.
            (2) Technical assistance.--The Secretary shall, if 
        requested, provide technical assistance to States to assist 
        such States in developing applications and plans under this 
        section, including technical assistance by private sector 
        entities if determined appropriate by the Commission.
            (3) Initial review.--With respect to a State application 
        under subsection (b), the Secretary and the Commission shall 
        complete an initial review of such State application within 60 
        days of the receipt of such application, analyze the scope of 
        the proposal, and determine whether additional information is 
        needed from the State. The Commission shall advise the State 
        within such period of the need to submit additional 
        information.
            (4) Final determination.--
                    (A) In general.--In a timely manner consistent with 
                subparagraph (C), the Commission shall determine 
                whether to submit a State proposal to Congress for 
                approval.
                    (B) Voting.--
                            (i) In general.--The determination to 
                        submit a State proposal to Congress under 
                        subparagraph (A) shall be approved by \2/3\ of 
                        the members of the Commission who are present 
                        and eligible to vote and a majority of the 
                        entire Commission.
                            (ii) Eligibility.--A member of the 
                        Commission shall not participate in a 
                        determination under subparagraph (A) if--
                                    (I) in the case of a member who is 
                                a Governor, such determination relates 
                                to the State of which the member is the 
                                Governor; or
                                    (II) in the case of member not 
                                described in subclause (I), such 
                                determination relates to the geographic 
                                area of a State of which such member 
                                serves as a State or local official or 
                                as a Member of Congress.
                    (C) Submission.--Not later than 90 days prior to 
                October 1 of each fiscal year, the Commission may 
                submit to Congress a list, in the form of a legislative 
                proposal, of the State applications that the Commission 
                recommends for approval under this section.
            (5) Program or project period.--A State program or project 
        may be approved for a period of 5 years and may be extended for 
        a subsequent period of time upon approval by the Commission, 
        based upon achievement of targets.
    (e) Expedited Congressional Consideration.--
            (1) Introduction and expedited consideration in the house 
        of representatives.--
                    (A) Introduction in house of representatives.--The 
                legislative proposal submitted pursuant to subsection 
                (d)(4)(C) shall be in the form of a joint resolution 
                (in this subsection referred to as the ``resolution''). 
                Such resolution shall be introduced in the House of 
                Representatives by the Speaker immediately upon receipt 
                of the language and shall be referred non-sequentially 
                to the appropriate committee (or committees) of House 
                of Representatives. If the resolution is not introduced 
                in accordance with the preceding sentence, the 
                resolution may be introduced by any member of the House 
                of Representatives.
                    (B) Committee consideration.--Not later than 15 
                calendar days after the introduction of the resolution 
                described in subparagraph (A), each committee of House 
                of Representatives to which the resolution was referred 
                shall report the resolution. The report may include, at 
                the committee's discretion, a recommendation for action 
                by the House. If a committee has not reported such 
                resolution (or an identical resolution) at the end of 
                15 calendar days after its introduction or at the end 
                of the first day after there has been reported to the 
                House a resolution, whichever is earlier, such 
                committee shall be deemed to be discharged from further 
                consideration of such resolution and such resolution 
                shall be placed on the appropriate calendar of the 
                House of Representatives.
                    (C) Expedited procedure in house.--Not later than 5 
                legislative days after the date on which all committees 
                have been discharged from consideration of a 
                resolution, the Speaker of the House of 
                Representatives, or the Speaker's designee, shall move 
                to proceed to the consideration of the resolution. It 
                shall also be in order for any member of the House of 
                Representatives to move to proceed to the consideration 
                of the resolution at any time after the conclusion of 
                such 5-day period. All points of order against the 
                resolution (and against consideration of the 
                resolution) are waived. A motion to proceed to the 
                consideration of the resolution is highly privileged in 
                the House of Representatives and is not debatable. The 
                motion is not subject to amendment, to a motion to 
                postpone consideration of the resolution, or to a 
                motion to proceed to the consideration of other 
                business. A motion to reconsider the vote by which the 
                motion to proceed is agreed to or not agreed to shall 
                not be in order. If the motion to proceed is agreed to, 
                the House of Representatives shall immediately proceed 
                to consideration of the resolution without intervening 
                motion, order, or other business, and the resolution 
                shall remain the unfinished business of the House of 
                Representatives until disposed of. A motion to recommit 
                the resolution shall not be in order. Upon its passage 
                in the House, the clerk of the House shall provide for 
                its immediate transmittal to the Senate.
            (2) Expedited consideration in the senate.--
                    (A) Referral to committee.--If the resolution is 
                agreed to by the House of Representatives, upon its 
                receipt in the Senate the Majority Leader of the 
                Senate, or the Leader's designee, the resolution shall 
                be referred to the appropriate committee of Senate.
                    (B) Committee consideration.--Not later than 15 
                calendar days after the referral of the resolution 
                under subparagraph (A), the committee of the Senate to 
                which the resolution was referred shall report the 
                resolution. The report may include, at the committee's 
                discretion, a recommendation for action by the Senate. 
                If a committee has not reported such resolution (or an 
                identical resolution) at the end of 15 calendar days 
                after its referral or at the end of the first day after 
                there has been reported to the Senate a resolution, 
                whichever is earlier, such committee shall be deemed to 
                be discharged from further consideration of such 
                resolution and such resolution shall be placed on the 
                appropriate calendar of the Senate.
                    (C) Expedited floor consideration.--Not later than 
                5 legislative days after the date on which all 
                committees have been discharged from consideration of a 
                resolution, the Majority Leader of the Senate, or the 
                Majority Leader's designee, shall move to proceed to 
                the consideration of the resolution. It shall also be 
                in order for any member of the Senate to move to 
                proceed to the consideration of the resolution at any 
                time after the conclusion of such 5-day period. All 
                points of order against the resolution (and against 
                consideration of the resolution) are waived. A motion 
                to proceed to the consideration of the resolution in 
                the Senate is privileged and is not debatable. The 
                motion is not subject to amendment, to a motion to 
                postpone consideration of the resolution, or to a 
                motion to proceed to the consideration of other 
                business. A motion to reconsider the vote by which the 
                motion to proceed is agreed to or not agreed to shall 
                not be in order. If the motion to proceed is agreed to, 
                the Senate shall immediately proceed to consideration 
                of the resolution without intervening motion, order, or 
                other business, and the resolution shall remain the 
                unfinished business of the Senate until disposed of.
            (3) Rules of the senate and house of representatives.--This 
        subsection is enacted by Congress--
                    (A) as an exercise of the rulemaking power of the 
                Senate and House of Representatives, respectively, and 
                is deemed to be part of the rules of each House, 
                respectively, but applicable only with respect to the 
                procedure to be followed in that House in the case of a 
                resolution under this subsection, and it supersedes 
                other rules only to the extent that it is inconsistent 
                with such rules; and
                    (B) with full recognition of the constitutional 
                right of either House to change the rules (so far as 
                they relate to the procedure of that House) at any 
                time, in the same manner, and to the same extent as in 
                the case of any other rule of that House.
            (4) Federal budget neutrality.--Except insofar as it allots 
        appropriations made pursuant to subsection (k), the legislative 
        proposal submitted pursuant to subsection (d)(4)(C) may not 
        increase the cumulative, net Federal budget deficit during the 
        multi-year operation of all the State applications contained 
        therein, taking into account such applications' impact on 
        Federal mandatory and discretionary spending, Federal revenue, 
        and Federal tax expenditures.
    (f) Funding.--
            (1) In general.--The Secretary shall provide a grant to a 
        State that has an application approved under subsection (e) to 
        enable such State to carry out an innovative State health 
        program in the State, to the extent that such a grant is 
        included in the recommendation of the Commission.
            (2) Amount of grant.--The amount of a grant provided to a 
        State under paragraph (1) shall be determined based upon the 
        recommendations of the Commission, subject to the amount 
        appropriated under subsection (k).
            (3) Performance-based funding allocation.--In awarding 
        grants under paragraph (1), the Commission shall direct the 
        Secretary to--
                    (A) fund a balanced diversity of approaches as 
                provided for by the Commission in subsection (c)(1)(B); 
                and
                    (B) link allocations to the State to the meeting of 
                the goals and performance measures relating to health 
                care coverage and health care costs established under 
                this Act through the State project application process.
            (4) Report.--One year prior to the end of the 5-year period 
        beginning on the date on which the first State begins to 
        implement a plan approved under subsection (e), the Commission 
        shall prepare and submit to the appropriate committees of 
        Congress, a report on the progress made by States in meeting 
        the goals of expanded coverage and cost containment through 
        performance measures established during the 5-year period of 
        the State plan. Such report may contain the recommendation of 
        the Commission concerning any future action that Congress 
        should take concerning health care reform, including whether or 
        not to extend the program established under this subsection.
    (g) Monitoring and Evaluation.--
            (1) Annual reports and participation by states.--Each State 
        that has received a program approval shall--
                    (A) submit to the Commission an annual report based 
                on the period representing the respective State's 
                fiscal year, detailing compliance with the requirements 
                established by the Commission and the Secretary in the 
                approval and in this section; and
                    (B) participate in the annual meeting under 
                subsection (c)(4)(C).
            (2) Evaluations by commission.--The Commission shall 
        prepare and submit to the Congress annual reports that shall 
        contain--
                    (A) a description of the effects of the reforms 
                undertaken in States receiving approvals under this 
                section;
                    (B) a description of the recommendations of the 
                Commission and actions taken based on these 
                recommendations;
                    (C) an independent evaluation of the effectiveness 
                of such reforms in--
                            (i) expanding health care coverage for 
                        State residents; and
                            (ii) reducing or containing health care 
                        costs in the States,
                as well as other relevant or significant findings;
                    (D) recommendations regarding the advisability of 
                increasing Federal financial assistance for State 
                ongoing or future health program initiatives, including 
                the amount and source of such assistance; and
                    (E) as required by the Commission or the Secretary 
                under this section, a periodic, independent evaluation 
                of the program.
    (h) Noncompliance.--
            (1) Corrective action plans.--If a State is not in 
        compliance with a requirement of this section, the Commission, 
        on recommendation of the Secretary, shall develop a corrective 
        action plan for such State.
            (2) Termination.--The Commission, on recommendation of the 
        Secretary, may revoke any program granted under this section. 
        Such decisions shall be subject to a petition for 
        reconsideration and appeal pursuant to regulations established 
        by the Secretary.
    (i) Relationship to Federal Programs.--
            (1) In general.--Nothing in this Act, or in section 1115 of 
        the Social Security Act (42 U.S.C. 1315) shall be construed as 
        authorizing the Secretary, the Commission, a State, or any 
        other person or entity to alter or affect in any way the 
        provisions of title XIX of such Act (42 U.S.C. 1396 et seq.) or 
        the regulations implementing such title.
            (2) Maintenance of effort.--No payment may be made under 
        subsection (f)(1) if the State adopts criteria for benefits or 
        criteria for standards and methodologies for purposes of 
        determining an individual's eligibility for medical assistance 
        under the State plan under title XIX that are more restrictive 
        than those required under Federal law and applied as of the 
        date of enactment of this Act.
    (j) Miscellaneous Provisions.--
            (1) Application of certain requirements.--
                    (A) Restriction on application of preexisting 
                condition exclusions.--
                            (i) In general.--Subject to subparagraph 
                        (B), a State shall not permit the imposition of 
                        any preexisting condition exclusion for covered 
                        benefits under a program or project under this 
                        section.
                            (ii) Group health plans and group health 
                        insurance coverage.--If the State program or 
                        project provides for benefits through payment 
                        for, or a contract with, a group health plan or 
                        group health insurance coverage, the program or 
                        project may permit the imposition of a 
                        preexisting condition exclusion but only 
                        insofar and to the extent that such exclusion 
                        is permitted under the applicable provisions of 
                        part 7 of subtitle B of title I of the Employee 
                        Retirement Income Security Act of 1974 and 
                        title XXVII of the Public Health Service Act.
                    (B) Compliance with other requirements.--Coverage 
                offered under the program or project shall comply with 
                the requirements of subpart 2 of part A of title XXVII 
                of the Public Health Service Act insofar as such 
                requirements apply with respect to a health insurance 
                issuer that offers group health insurance coverage.
            (2) Prevention of duplicative payments.--
                    (A) Other health plans.--No payment shall be made 
                to a State under subsection (f)(1) for expenditures for 
                health assistance provided for an individual to the 
                extent that a private insurer (as defined by the 
                Secretary by regulation and including a group health 
                plan (as defined in section 607(1) of the Employee 
                Retirement Income Security Act of 1974), a service 
                benefit plan, and a health maintenance organization) 
                would have been obligated to provide such assistance 
                but for a provision of its insurance contract which has 
                the effect of limiting or excluding such obligation 
                because the individual is eligible for or is provided 
                health assistance under the plan.
                    (B) Other federal governmental programs.--Except as 
                provided in any other provision of law, no payment 
                shall be made to a State under subsection (f)(1) for 
                expenditures for health assistance provided for an 
                individual to the extent that payment has been made or 
                can reasonably be expected to be made promptly (as 
                determined in accordance with regulations) under any 
                other federally operated or financed health care 
                insurance program. For purposes of this paragraph, 
                rules similar to the rules for overpayments under 
                section 1903(d)(2) of the Social Security Act shall 
                apply.
            (3) Application of certain general provisions.--The 
        following provisions of the Social Security Act shall apply to 
        States under subsection (f)(1) in the same manner as they apply 
        to a State under such title XIX:
                    (A) Title xix provisions.--
                            (i) Section 1902(a)(4)(C) (relating to 
                        conflict of interest standards).
                            (ii) Paragraphs (2), (16), and (17) of 
                        section 1903(i) (relating to limitations on 
                        payment).
                            (iii) Section 1903(w) (relating to 
                        limitations on provider taxes and donations).
                            (iv) Section 1920A (relating to presumptive 
                        eligibility for children).
                    (B) Title xi provisions.--
                            (i) Section 1116 (relating to 
                        administrative and judicial review), but only 
                        insofar as consistent with this title.
                            (ii) Section 1124 (relating to disclosure 
                        of ownership and related information).
                            (iii) Section 1126 (relating to disclosure 
                        of information about certain convicted 
                        individuals).
                            (iv) Section 1128A (relating to civil 
                        monetary penalties).
                            (v) Section 1128B(d) (relating to criminal 
                        penalties for certain additional charges).
                            (vi) Section 1132 (relating to periods 
                        within which claims must be filed).
            (4) Relation to hipaa.--Health benefits coverage provided 
        under a State program or project under this section shall be 
        treated as creditable coverage for purposes of part 7 of 
        subtitle B of title I of the Employee Retirement Income 
        Security Act of 1974, title XXVII of the Public Health Service 
        Act, and subtitle K of the Internal Revenue Code of 1986.
    (k) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
in each fiscal year. Amounts appropriated for a fiscal year under this 
subsection and not expended may be used in subsequent fiscal years to 
carry out this section.
                                 <all>