[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3171 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 3171

 To amend titles XIX and XXI of the Social Security Act to provide for 
     an express lane for simplified Medicaid and SCHIP eligibility 
                      determinations for children.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 25, 2007

  Mr. Kagen introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend titles XIX and XXI of the Social Security Act to provide for 
     an express lane for simplified Medicaid and SCHIP eligibility 
                      determinations for children.

    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 ``Fast Track for Healthy Children Act 
of 2007''.

SEC. 2. STATE OPTION TO RELY ON FINDINGS FROM AN EXPRESS LANE AGENCY TO 
              CONDUCT SIMPLIFIED ELIGIBILITY DETERMINATIONS.

    (a) Medicaid.--Section 1902(e) of the Social Security Act (42 
U.S.C. 1396a(e)) is amended by adding at the end the following:
    ``(13) Express Lane Option.--
            ``(A) In general.--
                    ``(i) Option to use a finding from an express lane 
                agency.--At the option of the State, the State plan may 
                provide that in determining eligibility under this 
                title for a child (as defined in subparagraph (F)), the 
                State may rely on a finding made within a reasonable 
                period (as determined by the State) from an Express 
                Lane agency (as defined in subparagraph (E)) when it 
                determines whether a child satisfies one or more 
                components of eligibility for medical assistance under 
                this title. The State may rely on a finding from an 
                Express Lane agency notwithstanding sections 
                1902(a)(46)(B), 1903(x), and 1137(d) and any 
                differences in budget unit, disregard, deeming or other 
                methodology, if the following requirements are met:
                            ``(I) Prohibition on determining children 
                        ineligible for coverage.--If a finding from an 
                        Express Lane agency would result in a 
                        determination that a child does not satisfy an 
                        eligibility requirement for medical assistance 
                        under this title and for child health 
                        assistance under title XXI, the State shall 
                        determine eligibility for assistance using its 
                        regular procedures.
                            ``(II) Notice requirement.--For any child 
                        who is found eligible for medical assistance 
                        under the State plan under this title or child 
                        health assistance under title XXI and who is 
                        subject to premiums based on an Express Lane 
                        agency's finding of such child's income level, 
                        the State shall provide notice that the child 
                        may qualify for lower premium payments if 
                        evaluated by the State using its regular 
                        policies and of the procedures for requesting 
                        such an evaluation.
                            ``(III) Compliance with screen and enroll 
                        requirement.--The State shall satisfy the 
                        requirements under (A) and (B) of section 
                        2102(b)(3) (relating to screen and enroll) 
                        before enrolling a child in child health 
                        assistance under title XXI. At its option, the 
                        State may fulfill such requirements in 
                        accordance with either option provided under 
                        subparagraph (C) of this paragraph.
                    ``(ii) Option to apply to renewals and 
                redeterminations.--The State may apply the provisions 
                of this paragraph when conducting initial 
                determinations of eligibility, redeterminations of 
                eligibility, or both, as described in the State plan.
            ``(B) Rules of construction.--Nothing in this paragraph 
        shall be construed--
                    ``(i) to limit or prohibit a State from taking any 
                actions otherwise permitted under this title or title 
                XXI in determining eligibility for or enrolling 
                children into medical assistance under this title or 
                child health assistance under title XXI; or
                    ``(ii) to modify the limitations in section 
                1902(a)(5) concerning the agencies that may make a 
                determination of eligibility for medical assistance 
                under this title.
            ``(C) Options for satisfying the screen and enroll 
        requirement.--
                    ``(i) In general.--With respect to a child whose 
                eligibility for medical assistance under this title or 
                for child health assistance under title XXI has been 
                evaluated by a State agency using an income finding 
                from an Express Lane agency, a State may carry out its 
                duties under subparagraphs (A) and (B) of section 
                2102(b)(3) (relating to screen and enroll) in 
                accordance with either clause (ii) or clause (iii).
                    ``(ii) Establishing a screening threshold.--
                            ``(I) In general.--Under this clause, the 
                        State establishes a screening threshold set as 
                        a percentage of the Federal poverty level that 
                        exceeds the highest income threshold applicable 
                        under this title to the child by a minimum of 
                        30 percentage points or, at State option, a 
                        higher number of percentage points that 
                        reflects the value (as determined by the State 
                        and described in the State plan) of any 
                        differences between income methodologies used 
                        by the program administered by the Express Lane 
                        agency and the methodologies used by the State 
                        in determining eligibility for medical 
                        assistance under this title.
                            ``(II) Children with income not above 
                        threshold.--If the income of a child does not 
                        exceed the screening threshold, the child is 
                        deemed to satisfy the income eligibility 
                        criteria for medical assistance under this 
                        title regardless of whether such child would 
                        otherwise satisfy such criteria.
                            ``(III) Children with income above 
                        threshold.--If the income of a child exceeds 
                        the screening threshold, the child shall be 
                        considered to have an income above the Medicaid 
                        applicable income level described in section 
                        2110(b)(4) and to satisfy the requirement under 
                        section 2110(b)(1)(C) (relating to the 
                        requirement that SCHIP matching funds be used 
                        only for children not eligible for Medicaid). 
                        If such a child is enrolled in child health 
                        assistance under title XXI, the State shall 
                        provide the parent, guardian, or custodial 
                        relative with the following:
                                    ``(aa) Notice that the child may be 
                                eligible to receive medical assistance 
                                under the State plan under this title 
                                if evaluated for such assistance under 
                                the State's regular procedures and 
                                notice of the process through which a 
                                parent, guardian, or custodial relative 
                                can request that the State evaluate the 
                                child's eligibility for medical 
                                assistance under this title using such 
                                regular procedures.
                                    ``(bb) A description of differences 
                                between the medical assistance provided 
                                under this title and child health 
                                assistance under title XXI, including 
                                differences in cost-sharing 
                                requirements and covered benefits.
                    ``(iii) Temporary enrollment in schip pending 
                screen and enroll.--
                            ``(I) In general.--Under this clause, a 
                        State enrolls a child in child health 
                        assistance under title XXI for a temporary 
                        period if the child appears eligible for such 
                        assistance based on an income finding by an 
                        Express Lane agency.
                            ``(II) Determination of eligibility.--
                        During such temporary enrollment period, the 
                        State shall determine the child's eligibility 
                        for child health assistance under title XXI or 
                        for medical assistance under this title in 
                        accordance with this clause.
                            ``(III) Prompt follow up.--In making such a 
                        determination, the State shall take prompt 
                        action to determine whether the child should be 
                        enrolled in medical assistance under this title 
                        or child health assistance under title XXI 
                        pursuant to subparagraphs (A) and (B) of 
                        section 2102(b)(3) (relating to screen and 
                        enroll).
                            ``(IV) Requirement for simplified 
                        determination.--In making such a determination, 
                        the State shall use procedures that, to the 
                        maximum feasible extent, reduce the burden 
                        imposed on the individual of such 
                        determination. Such procedures may not require 
                        the child's parent, guardian, or custodial 
                        relative to provide or verify information that 
                        already has been provided to the State agency 
                        by an Express Lane agency or another source of 
                        information unless the State agency has reason 
                        to believe the information is erroneous.
                            ``(V) Availability of schip matching funds 
                        during temporary enrollment period.--Medical 
                        assistance for items and services that are 
                        provided to a child enrolled in title XXI 
                        during a temporary enrollment period under this 
                        clause shall be treated as child health 
                        assistance under such title.
            ``(D) Option for automatic enrollment.--
                    ``(i) In general.--At its option, a State may 
                initiate an evaluation of an individual's eligibility 
                for medical assistance under this title without an 
                application and determine the individual's eligibility 
                for such assistance using findings from one or more 
                Express Lane agencies and information from sources 
                other than a child, if the requirements of clauses (ii) 
                and (iii) are met.
                    ``(ii) Individual choice requirement.--The 
                requirement of this clause is that the child is 
                enrolled in medical assistance under this title or 
                child health assistance under title XXI only if the 
                child (or a parent, caretaker relative, or guardian on 
                the behalf of the child) has affirmatively assented to 
                such enrollment.
                    ``(iii) Information requirement.--The requirement 
                of this clause is that the State informs the parent, 
                guardian, or custodial relative of the child of the 
                services that will be covered, appropriate methods for 
                using such services, premium or other cost sharing 
                charges (if any) that apply, medical support 
                obligations (under section 1912(a)) created by 
                enrollment (if applicable), and the actions the parent, 
                guardian, or relative must take to maintain enrollment 
                and renew coverage.
            ``(E) Express lane agency defined.--In this paragraph, the 
        term `express lane agency' means an agency that meets the 
        following requirements:
                    ``(i) The agency determines eligibility for 
                assistance under the Food Stamp Act of 1977, the 
                Richard B. Russell National School Lunch Act, the Child 
                Nutrition Act of 1966, or the Child Care and 
                Development Block Grant Act of 1990.
                    ``(ii) The agency notifies the child (or a parent, 
                caretaker relative, or guardian on the behalf of the 
                child)--
                            ``(I) of the information which shall be 
                        disclosed;
                            ``(II) that the information will be used by 
                        the State solely for purposes of determining 
                        eligibility for and for providing medical 
                        assistance under this title or child health 
                        assistance under title XXI; and
                            ``(III) that the child, or parent, 
                        caretaker relative, or guardian, may elect to 
                        not have the information disclosed for such 
                        purposes.
                    ``(iii) The agency and the State agency are subject 
                to an interagency agreement limiting the disclosure and 
                use of such information to such purposes.
                    ``(iv) The agency is determined by the State agency 
                to be capable of making the determinations described in 
                this paragraph and is identified in the State plan 
                under this title or title XXI.
        For purposes of this subparagraph, the term `State agency' 
        refers to the agency determining eligibility for medical 
        assistance under this title or child health assistance under 
        title XXI.
            ``(F) Child defined.--For purposes of this paragraph, the 
        term `child' means an individual under 19 years of age, or, at 
        the option of a State, such higher age, not to exceed 21 years 
        of age, as the State may elect.''.
    (b) SCHIP.--Section 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)) 
is amended by redesignating subparagraph (B) and succeeding 
subparagraphs as subparagraph (C) and succeeding subparagraphs and by 
inserting after subparagraph (A) the following new subparagraph:
                    ``(B) Section 1902(e)(13) (relating to the State 
                option to rely on findings from an Express Lane agency 
                to help evaluate a child's eligibility for medical 
                assistance).''.
    (c) Electronic Transmission of Information.--Section 1902 of such 
Act (42 U.S.C. 1396a) is amended by adding at the end the following new 
subsection:
    ``(dd) Electronic Transmission of Information.--If the State agency 
determining eligibility for medical assistance under this title or 
child health assistance under title XXI verifies an element of 
eligibility based on information from an Express Lane Agency (as 
defined in subsection (e)(13)(F)), or from another public agency, then 
the applicant's signature under penalty of perjury shall not be 
required as to such element. Any signature requirement for an 
application for medical assistance may be satisfied through an 
electronic signature, as defined in section 1710(1) of the Government 
Paperwork Elimination Act (44 U.S.C. 3504 note). The requirements of 
subparagraphs (A) and (B) of section 1137(d)(2) may be met through 
evidence in digital or electronic form.''.
    (d) Authorization of Information Disclosure.--
            (1) In general.--Title XIX of the Social Security Act is 
        amended--
                    (A) by redesignating section 1939 as section 1940; 
                and
                    (B) by inserting after section 1938 the following 
                new section:

``SEC. 1939. AUTHORIZATION TO RECEIVE PERTINENT INFORMATION.

    ``(a) In General.--Notwithstanding any other provision of law, a 
Federal or State agency or private entity in possession of the sources 
of data potentially pertinent to eligibility determinations under this 
title (including eligibility files maintained by Express Lane agencies 
described in section 1902(e)(13)(F), information described in paragraph 
(2) or (3) of section 1137(a), vital records information about births 
in any State, and information described in sections 453(i) and 
1902(a)(25)(I)) is authorized to convey such data or information to the 
State agency administering the State plan under this title, to the 
extent such conveyance meets the requirements of subsection (b).
    ``(b) Requirements for Conveyance.--Data or information may be 
conveyed pursuant to subsection (a) only if the following requirements 
are met:
            ``(1) The individual whose circumstances are described in 
        the data or information (or such individual's parent, guardian, 
        caretaker relative, or authorized representative) has either 
        provided advance consent to disclosure or has not objected to 
        disclosure after receiving advance notice of disclosure and a 
        reasonable opportunity to object.
            ``(2) Such data or information are used solely for the 
        purposes of--
                    ``(A) identifying individuals who are eligible or 
                potentially eligible for medical assistance under this 
                title and enrolling or attempting to enroll such 
                individuals in the State plan; and
                    ``(B) verifying the eligibility of individuals for 
                medical assistance under the State plan.
            ``(3) An interagency or other agreement, consistent with 
        standards developed by the Secretary--
                    ``(A) prevents the unauthorized use, disclosure, or 
                modification of such data and otherwise meets 
                applicable Federal requirements safeguarding privacy 
                and data security; and
                    ``(B) requires the State agency administering the 
                State plan to use the data and information obtained 
                under this section to seek to enroll individuals in the 
                plan.
    ``(c) Criminal Penalty.--A private entity described in the 
subsection (a) that publishes, discloses, or makes known in any manner, 
or to any extent not authorized by Federal law, any information 
obtained under this section shall be fined not more than $1,000 or 
imprisoned not more than 1 year, or both, for each such unauthorized 
publication or disclosure.
    ``(d) Rule of Construction.--The limitations and requirements that 
apply to disclosure pursuant to this section shall not be construed to 
prohibit the conveyance or disclosure of data or information otherwise 
permitted under Federal law (without regard to this section).''.
            (2) Conforming amendment to title xxi.--Section 2107(e)(1) 
        of such Act (42 U.S.C. 1397gg(e)(1)), as amended by subsection 
        (b), is amended by adding at the end the following new 
        subparagraph:
                    ``(F) Section 1939 (relating to authorization to 
                receive data potentially pertinent to eligibility 
                determinations).''.
            (3) Conforming amendment to provide access to data about 
        enrollment in insurance for purposes of evaluating applications 
        and for schip.--Section 1902(a)(25)(I)(i) of such Act (42 
        U.S.C. 1396a(a)(25)(I)(i)) is amended--
                    (A) by inserting ``(and, at State option, 
                individuals who are potentially eligible or who 
                apply)'' after ``with respect to individuals who are 
                eligible''; and
                    (B) by inserting ``under this title (and, at State 
                option, child health assistance under title XXI)'' 
                after ``the State plan''.
    (e) Effective Date.--The amendments made by this section are 
effective on January 1, 2008.
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