[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2772 Introduced in Senate (IS)]


109th CONGRESS
  2d Session
                                S. 2772

To provide for innovation in health care through State initiatives that 
 expand coverage and access and improve quality and efficiency in the 
                          health care system.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 9, 2006

 Mr. Voinovich (for himself, Mr. Bingaman, Mr. DeWine, and Mr. Akaka) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To provide for innovation in health care through State initiatives that 
 expand coverage and access and improve quality and efficiency in the 
                          health care system.

    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 Act''.

SEC. 2. STATE HEALTH REFORM PROJECTS.

    (a) Purpose; Establishment of State Health Care Expansion and 
Improvement Program.--The purposes of the programs approved under this 
section shall include, but not be limited to--
            (1) achieving the goals of increased health coverage and 
        access;
            (2) ensuring that patients receive high-quality, 
        appropriate health care;
            (3) improving the efficiency of health care spending; and
            (4) testing alternative reforms, such as building on the 
        public or private health systems, or creating new systems, to 
        achieve the objectives of this Act.
    (b) Applications by States, Local Governments, and Tribes.--
            (1) Entities that may apply.--
                    (A) In general.--A State, in consultation with 
                local governments, Indian tribes, and Indian 
                organizations involved in the provision of health care, 
                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 groups.--A regional entity consisting 
                of more than one State may apply for a multi State 
                health care expansion and improvement program for the 
                entire region involved under paragraph (2).
                    (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 desiring to implement a State health care 
        expansion and improvement program may submit an application to 
        the State Health Innovation Commission under subsection (c) 
        (referred to in this section as the ``Commission'') for 
        approval.
            (3) Local government applications.--
                    (A) In general.--Where a State declines 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.
                    (B) Other applications.--Subject to such additional 
                guidelines as the Secretary may prescribe, a unit of 
                local government, Indian tribe, or Indian health 
                organization may submit an application under this 
                section, whether or not the State submits such an 
                application, if such unit of local government can 
                demonstrate unique demographic needs or a significant 
                population size that warrants a substate program under 
                this subsection.
    (c) State Health Innovation Commission.--
            (1) In general.--Within 90 days after the date of the 
        enactment of this Act, the Secretary shall establish a State 
        Health Innovation Commission that shall--
                    (A) 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 by the National Conference of 
                        State Legislators on a bipartisan basis;
                            (iv) two county officials to be appointed 
                        by the National Association of Counties on a 
                        bipartisan basis;
                            (v) two mayors to be appointed by the 
                        United States Conference of Mayors on a 
                        bipartisan basis;
                            (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;
                            (ix) two individuals to be appointed by the 
                        Minority Leader of the Senate; and
                            (x) two individuals who are members of 
                        federally-recognized Indian tribes to be 
                        appointed on a bipartisan basis by the National 
                        Congress of American Indians;
                    (B) upon approval of \2/3\ of the members of the 
                Commission, provide the States with a variety of reform 
                options for their applications, 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 clause, or other alternatives 
                determined appropriate by the Commission, including 
                options suggested by States, Indian tribes, or the 
                public;
                    (C) establish, in collaboration with a qualified 
                and independent organization such as the Institute of 
                Medicine, minimum performance measures and goals with 
                respect to coverage, quality, and cost of State 
                programs, as described under subsection (d)(1);
                    (D) 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;
                    (E) submit the recommendations and legislative 
                proposal described in subsection (d)(4)(B);
                    (F) be responsible for monitoring the status and 
                progress achieved under program or projects granted 
                under this section;
                    (G) 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;
                    (H) promote information exchange between States and 
                the Federal Government; and
                    (I) 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.
            (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.--A majority 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)(B). Such negotiations shall include 
                consultations with Indian tribes, and be conducted in a 
                public forum.
                    (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)(1) 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 2006 and each fiscal year thereafter.
    (d) Requirements for Programs.--
            (1) State plan.--A State that seeks to receive a grant 
        under subsection (f) 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 improvements in coverage, quality and 
        costs. To achieve such goal, the State plan shall comply with 
        the following:
                    (A) Coverage.--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 of uninsured 
                        individuals through either private or public 
                        program expansion, or both, in accordance with 
                        the options established by the Commission;
                            (ii) describe the number and percentage of 
                        current uninsured individuals who will achieve 
                        coverage under the State health program;
                            (iii) describe the minimum benefits package 
                        that will be provided to all classes of 
                        beneficiaries under the 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 the 
                        State health program, to the extent 
                        practicable; and
                            (v) provide for improvements in the 
                        availability of appropriate health care 
                        services that will increase access to care in 
                        urban, rural, and frontier areas of the State 
                        with medically underserved populations or where 
                        there is an inadequate supply of health care 
                        providers.
                    (B) Quality.--With respect to quality, the State 
                plan shall--
                            (i) provide a plan to improve health care 
                        quality in the State, including increasing 
                        effectiveness, efficiency, timeliness, patient 
                        focused, equity while reducing health 
                        disparities, and medical errors; and
                            (ii) contain appropriate results-based 
                        quality indicators established by the 
                        Commission that will be addressed by the State 
                        as well as State-specific quality indicators.
                    (C) Costs.--With respect to costs, the State plan 
                shall--
                            (i) provide that the State will develop and 
                        implement systems to improve the efficiency of 
                        health care, including a specific 5-year target 
                        for reducing administrative costs (including 
                        paperwork burdens);
                            (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;
                            (iv) describe how the State plan will 
                        ensure the financial solvency of the State 
                        health program; and
                            (v) provide that the State will prepare and 
                        submit to the Secretary and the Commission such 
                        reports as the Secretary or Commission may 
                        require to carry out program evaluations.
                    (D) Health information technology.--With respect to 
                health information technology, the State plan shall 
                provide methodology for the appropriate use of health 
                information technology to improve infrastructure, such 
                as improving the availability of evidence-based medical 
                and outcomes data to providers and patients, as well as 
                other health information (such as electronic health 
                records, electronic billing, and electronic 
                prescribing).
            (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 
        for a grant 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.--Not later than 90 days after 
                completion of the initial review under paragraph (3), 
                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 eligible 
                        to participate in such determination subject to 
                        clause (ii).
                            (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.
                    (C) Submission.--Not later than 90 days prior to 
                October 1 of each fiscal year, the Commission shall 
                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.
                    (D) Approval.--With respect to a fiscal year, a 
                State proposal that has been recommended under 
                subparagraph (B) shall be deemed to be approved, and 
                subject to the availability of appropriations, Federal 
                funds shall be provided to such program, unless a joint 
                resolution has been enacted disapproving such proposal 
                as provided for in subsection (e). Nothing in the 
                preceding sentence shall be construed to include the 
                approval of State proposals that involve waivers or 
                modifications in applicable Federal law.
            (5) Program or project period.--A State program or project 
        may be approved for a period of 5 years and may be extended for 
        subsequent 5-year periods upon approval by the Commission and 
        the Secretary, based upon achievement of targets, except that a 
        shorter period may be requested by a State and granted by the 
        Secretary.
    (e) Expedited Congressional Consideration.--
            (1) Introduction and committee consideration.--
                    (A) Introduction.--The legislative proposal 
                submitted pursuant to subsection (d)(4)(B) 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, and in the Senate, by the Majority Leader, 
                immediately upon receipt of the language and shall be 
                referred to the appropriate committee of Congress. If 
                the resolution is not introduced in accordance with the 
                preceding sentence, the resolution may be introduced in 
                either House of Congress by any member thereof.
                    (B) Committee consideration.--A resolution 
                introduced in the House of Representatives shall be 
                referred to the Committee on Ways and Means of the 
                House of Representatives. A resolution introduced in 
                the Senate shall be referred to the Committee on 
                Finance of the Senate. Not later than 15 calendar days 
                after the introduction of the resolution, the committee 
                of Congress to which the resolution was referred shall 
                report the resolution or a committee amendment thereto. 
                If the 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 involved a 
                resolution, whichever is earlier, such committee shall 
                be deemed to be discharged from further consideration 
                of such reform bill and such reform bill shall be 
                placed on the appropriate calendar of the House 
                involved.
            (2) Expedited procedure.--
                    (A) Consideration.--Not later than 5 days after the 
                date on which a committee has been discharged from 
                consideration of a resolution, the Speaker of the House 
                of Representatives, or the Speaker's designee, or the 
                Majority Leader of the Senate, or the Leader's 
                designee, shall move to proceed to the consideration of 
                the committee amendment to the resolution, and if there 
                is no such amendment, to the resolution. It shall also 
                be in order for any member of the House of 
                Representatives or the Senate, respectively, 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 privileged in the Senate 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 or the Senate, as the case 
                may be, 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 or 
                the Senate, as the case may be, until disposed of.
                    (B) Consideration by other house.--If, before the 
                passage by one House of the resolution that was 
                introduced in such House, such House receives from the 
                other House a resolution as passed by such other 
                House--
                            (i) the resolution of the other House shall 
                        not be referred to a committee and may only be 
                        considered for final passage in the House that 
                        receives it under clause (iii);
                            (ii) the procedure in the House in receipt 
                        of the resolution of the other House, with 
                        respect to the resolution that was introduced 
                        in the House in receipt of the resolution of 
                        the other House, shall be the same as if no 
                        resolution had been received from the other 
                        House; and
                            (iii) notwithstanding clause (ii), the vote 
                        on final passage shall be on the reform bill of 
                        the other House.
                Upon disposition of a resolution that is received by 
                one House from the other House, it shall no longer be 
                in order to consider the resolution bill that was 
                introduced in the receiving House.
                    (C) Consideration in conference.--Immediately upon 
                a final passage of the resolution that results in a 
                disagreement between the two Houses of Congress with 
                respect to the resolution, conferees shall be appointed 
                and a conference convened. Not later than 10 days after 
                the date on which conferees are appointed, the 
                conferees shall file a report with the House of 
                Representatives and the Senate resolving the 
                differences between the Houses on the resolution. 
                Notwithstanding any other rule of the House of 
                Representatives or the Senate, it shall be in order to 
                immediately consider a report of a committee of 
                conference on the resolution filed in accordance with 
                this subclause. Debate in the House of Representatives 
                and the Senate on the conference report shall be 
                limited to 10 hours, equally divided and controlled by 
                the Speaker of the House of Representatives and the 
                Minority Leader of the House of Representatives or 
                their designees and the Majority and Minority Leaders 
                of the Senate or their designees. A vote on final 
                passage of the conference report shall occur 
                immediately at the conclusion or yielding back of all 
                time for debate on the conference report.
            (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, 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) Limitation.--The amount of Federal funds provided with 
        respect to any State proposal that is deemed approved under 
        subsection (d)(3) shall not exceed the cost provided for such 
        proposals within the concurrent resolution on the budget as 
        enacted by Congress for the fiscal year involved.
    (f) Funding.--
            (1) In general.--The Secretary shall provide a grant to a 
        State that has an application approved under subsection (b) to 
        enable such State to carry out an innovative State health 
        program in the State.
            (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 and 
        prioritization.--In awarding grants under paragraph (1), the 
        Secretary shall--
                    (A) fund a diversity of approaches as provided for 
                by the Commission in subsection (c)(1)(B);
                    (B) give priority to those State programs that the 
                Commission determines have the greatest opportunity to 
                succeed in providing expanded health insurance coverage 
                and in providing children, youth, and other vulnerable 
                populations with improved access to health care items 
                and services; and
                    (C) link allocations to the State to the meeting of 
                the goals and performance measures relating to health 
                care coverage, quality, and health care costs 
                established under this Act through the State project 
                application process.
            (4) Maintenance of effort.--A State, in utilizing the 
        proceeds of a grant received under paragraph (1), shall 
        maintain the expenditures of the State for health care coverage 
        purposes for the support of direct health care delivery at a 
        level equal to not less than the level of such expenditures 
        maintained by the State for the fiscal year preceding the 
        fiscal year for which the grant is received.
            (5) Report.--At the end of the 5-year period beginning on 
        the date on which the Secretary awards the first grant under 
        paragraph (1), the State Health Innovation Advisory Commission 
        established under subsection (c) shall prepare and submit to 
        the appropriate committees of Congress, a report on the 
        progress made by States receiving grants under paragraph (1) in 
        meeting the goals of expanded coverage, improved quality, and 
        cost containment through performance measures established 
        during the 5-year period of the grant. Such report shall 
        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)(B).
            (2) Evaluations by commission.--The Commission, in 
        consultation with a qualified and independent organization such 
        as the Institute of Medicine, shall prepare and submit to the 
        Committee on Finance and the Committee on Health, Education, 
        Labor, and Pensions of the Senate and the Committee on Energy 
        and Commerce, the Committee on Education and the Workforce, and 
        the Committee on Ways and Means of the House of Representatives 
        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 evaluation of the effectiveness of such 
                reforms in--
                            (i) expanding health care coverage for 
                        State residents;
                            (ii) improving the quality of health care 
                        provided in the States; and
                            (iii) reducing or containing health care 
                        costs in the States;
                    (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 subsection (f)(5), a periodic, independent 
                evaluation of the program.
    (h) Noncompliance.--
            (1) Corrective action plans.--If a State is not in 
        compliance with a requirements of this section, the Secretary 
        shall develop a corrective action plan for such State.
            (2) Termination.--For good cause and in consultation with 
        the Commission, 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 
        this section if the State adopts criteria for benefits, income, 
        and resource 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 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 this section 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 this section 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, other than an insurance program 
                operated or financed by the Indian Health Service, as 
                identified by the Secretary. 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 sections of the Social Security Act shall apply to 
        States under this section 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 other laws.--
                    (A) 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.
                    (B) ERISA.--Nothing in this section shall be 
                construed as affecting or modifying section 514 of the 
                Employee Retirement Income Security Act of 1974 (29 
                U.S.C. 1144) with respect to a group health plan (as 
                defined in section 2791(a)(1) of the Public Health 
                Service Act (42 U.S.C. 300gg-91(a)(1))).
    (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>