1.Short title; table of
contents; findings
(a)This Act may be cited as the MediKids Health Insurance Act of
2007
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents; findings.
Sec. 2. Benefits for all children born after
2008.
Title XXII—MediKids Program
Sec. 2201. Eligibility.
Sec. 2202. Benefits.
Sec. 2203. Premiums.
Sec. 2204. MediKids Trust Fund.
Sec. 2205. Oversight and accountability.
Sec. 2206. Inclusion of care coordination services.
Sec. 2207. Administration and
miscellaneous.
Sec. 3. MediKids premium.
Sec. 4. Refundable credit for certain cost-sharing expenses
under MediKids program.
Sec. 5. Report on long-term revenues.
(c)Congress
finds the following:
(1)More than 9
million American children are uninsured.
(2)Children who are
uninsured receive less medical care and less preventive care and have a poorer
level of health, which result in lifetime costs to themselves and to the entire
American economy.
(3)Although SCHIP and
Medicaid are successfully extending a health coverage safety net to a growing
portion of the vulnerable low-income population of uninsured children, they
alone cannot achieve 100 percent health insurance coverage for our nation’s
children due to inevitable gaps during outreach and enrollment, fluctuations in
eligibility, variations in access to private insurance at all income levels,
and variations in States’ ability to provide required matching funds.
(4)As all segments of
society continue to become more transient, with many changes in employment over
the working lifetime of parents, the need for a reliable safety net of health
insurance which follows children across State lines, already a major problem
for the children of migrant and seasonal farmworkers, will become a major
concern for all families in the United States.
(5)The medicare
program has successfully evolved over the years to provide a stable, universal
source of health insurance for the nation’s disabled and those over age 65, and
provides a tested model for designing a program to reach out to America’s
children.
(6)The problem of
insuring 100 percent of all American children could be gradually solved by
automatically enrolling all children born after December 31, 2008, in a program
modeled after Medicare (and to be known as MediKids
), and
allowing those children to be transferred into other equivalent or better
insurance programs, including either private insurance, SCHIP, or Medicaid, if
they are eligible to do so, but maintaining the child’s default enrollment in
MediKids for any times when the child’s access to other sources of insurance is
lost.
(7)A
family’s freedom of choice to use other insurers to cover children would not be
interfered with in any way, and children eligible for SCHIP and Medicaid would
continue to be enrolled in those programs, but the underlying safety net of
MediKids would always be available to cover any gaps in insurance due to
changes in medical condition, employment, income, or marital status, or other
changes affecting a child’s access to alternate forms of insurance.
(8)The MediKids
program can be administered without impacting the finances or status of the
existing Medicare program.
(9)The MediKids
benefit package can be tailored to the special needs of children and updated
over time.
(10)The financing of
the program can be administered without difficulty by a yearly payment of
affordable premiums through a family’s tax filing (or adjustment of a family’s
earned income tax credit).
(11)The cost of the
program will gradually rise as the number of children using MediKids as the
insurer of last resort increases, and a future Congress always can accelerate
or slow down the enrollment process as desired, while the societal costs for
emergency room usage, lost productivity and work days, and poor health status
for the next generation of Americans will decline.
(12)Over time 100
percent of American children will always have basic health insurance, and we
can therefore expect a healthier, more equitable, and more productive
society.
2.Benefits for all
children born after 2008
(a)The Social Security
Act is amended by adding at the end the following new title:
<enum>XXII</enum><header>MediKids
Program</header>
<section id="HC894DE548E764C79BC471C172712529C"><enum>2201.</enum><header>Eligibility</header>
<subsection id="HB326A8698F7E45ED906D3EFE12C0811B"><enum>(a)</enum><header>Eligibility of
individuals born after December 31, 2008; all children under 23 years of age in
fifth year</header><text>An individual who meets the following requirements
with respect to a month is eligible to enroll under this title with respect to
such month:</text>
<paragraph id="H7372828D118E4B42BE90CB53B91EFE91"><enum>(1)</enum><header>Age</header>
<subparagraph id="H767DAB06C91E407F95BBF2D2B9FDC40"><enum>(A)</enum><header>First
year</header><text>As of the first day of the first year in which this title is
effective, the individual has not attained 6 years of age.</text>
</subparagraph><subparagraph id="H266C528974224D4D9FECF4800373AAD"><enum>(B)</enum><header>Second
year</header><text display-inline="yes-display-inline">As of the first day of
the second year in which this title is effective, the individual has not
attained 11 years of age.</text>
</subparagraph><subparagraph id="HAF44B5B0AB7341A9979DD409AED44611"><enum>(C)</enum><header>Third
year</header><text display-inline="yes-display-inline">As of the first day of
the third year in which this title is effective, the individual has not
attained 16 years of age.</text>
</subparagraph><subparagraph id="H4172FD8BAAD946B08CA9A300ECE04E00"><enum>(D)</enum><header>Fourth
year</header><text display-inline="yes-display-inline">As of the first day of
the fourth year in which this title is effective, the individual has not
attained 21 years of age.</text>
</subparagraph><subparagraph id="H59CA3E36D5764D16A1DAA5079056F5BD"><enum>(E)</enum><header>Fifth and
subsequent years</header><text display-inline="yes-display-inline">As of the
first day of the fifth year in which this title is effective and each
subsequent year, the individual has not attained 23 years of age.</text>
</subparagraph></paragraph><paragraph id="H96860F260E29430985D164E6F19C006E"><enum>(2)</enum><header>Citizenship</header><text>The
individual is a citizen or national of the United States or is permanently
residing in the United States under color of law.</text>
</paragraph></subsection><subsection id="HE558108BF49B4B3D97A49345FA30DB87"><enum>(b)</enum><header>Enrollment
process</header><text>An individual may enroll in the program established under
this title only in such manner and form as may be prescribed by regulations,
and only during an enrollment period prescribed by the Secretary consistent
with the provisions of this section. Such regulations shall provide a process
under which—</text>
<paragraph id="H7F24C9E8879C4C1C8CD2EDA1A51F56CD"><enum>(1)</enum><text>individuals who
are born in the United States after December 31, 2008, are deemed to be
enrolled at the time of birth and a parent or guardian of such an individual is
permitted to pre-enroll in the month prior to the expected month of
birth;</text>
</paragraph><paragraph id="H3C9CB30C33944B5C8F7B101BAA2B0887"><enum>(2)</enum><text>individuals who
are born outside the United States after such date and who become eligible to
enroll by virtue of immigration into (or an adjustment of immigration status
in) the United States are deemed enrolled at the time of entry or adjustment of
status;</text>
</paragraph><paragraph id="H053748C59D2E472D9310F8EAB5A2F2AE"><enum>(3)</enum><text>eligible
individuals may otherwise be enrolled at such other times and manner as the
Secretary shall specify, including the use of outstationed eligibility sites as
described in section 1902(a)(55)(A) and the use of presumptive eligibility
provisions like those described in section 1920A; and</text>
</paragraph><paragraph id="HE87A0B2FADA64D06000003015972FE53"><enum>(4)</enum><text>at the time of
automatic enrollment of a child, the Secretary provides for issuance to a
parent or custodian of the individual a card evidencing coverage under this
title and for a description of such coverage.</text>
</paragraph><continuation-text continuation-text-level="subsection">The
provisions of section 1837(h) apply with respect to enrollment under this title
in the same manner as they apply to enrollment under part B of title XVIII. An
individual who is enrolled under this title is not eligible to be enrolled
under an MA or MA–PD plan under part C of title XVIII.</continuation-text></subsection><subsection id="HC76C4E149AE54A40BD02E3FFC601E7A0"><enum>(c)</enum><header>Date coverage
begins</header>
<paragraph id="H458F8B3A34054A4B8820E31B3CDC7CCA"><enum>(1)</enum><header>In
general</header><text>The period during which an individual is entitled to
benefits under this title shall begin as follows, but in no case earlier than
January 1, 2009:</text>
<subparagraph id="HABEB403EDFF244908BC94FB6BA9EA00"><enum>(A)</enum><text>In the case of an
individual who is enrolled under paragraph (1) or (2) of subsection (b), the
date of birth or date of obtaining appropriate citizenship or immigration
status, as the case may be.</text>
</subparagraph><subparagraph id="HD1EB6694339A447B8D8FE16BAADB732"><enum>(B)</enum><text>In the case of
another individual who enrolls (including pre-enrolls) before the month in
which the individual satisfies eligibility for enrollment under subsection (a),
the first day of such month of eligibility.</text>
</subparagraph><subparagraph id="HA790AD72102C49ECAFEC059800D4C0E7"><enum>(C)</enum><text>In the case of
another individual who enrolls during or after the month in which the
individual first satisfies eligibility for enrollment under such subsection,
the first day of the following month.</text>
</subparagraph></paragraph><paragraph id="H0565FB3FD7D241BDA752174B97E1BADF"><enum>(2)</enum><header>Authority to
provide for partial months of coverage</header><text>Under regulations, the
Secretary may, in the Secretary’s discretion, provide for coverage periods that
include portions of a month in order to avoid lapses of coverage.</text>
</paragraph><paragraph id="H84C6B0A521FF4FF28C5BADD1003EE500"><enum>(3)</enum><header>Limitation on
payments</header><text>No payments may be made under this title with respect to
the expenses of an individual enrolled under this title unless such expenses
were incurred by such individual during a period which, with respect to the
individual, is a coverage period under this section.</text>
</paragraph></subsection><subsection id="HE64541C8182242ABBFF5111219C5D450"><enum>(d)</enum><header>Expiration of
eligibility</header><text>An individual’s coverage period under this section
shall continue until the individual’s enrollment has been terminated because
the individual no longer meets the requirements of subsection (a) (whether
because of age or change in immigration status).</text>
</subsection><subsection id="H36F02CB377C34A4D96845300E34BB500"><enum>(e)</enum><header>Entitlement to
MediKids benefits for enrolled individuals</header><text>An individual enrolled
under this title is entitled to the benefits described in section 2202.</text>
</subsection><subsection id="H69936491B29B40F3AF679207C050DF43"><enum>(f)</enum><header>Low-income
information</header>
<paragraph id="HF28FAC31436E4EDBBD6594DA32DEBF18"><enum>(1)</enum><header>Inquiry of
income</header><text display-inline="yes-display-inline">At the time of
enrollment of a child under this title, the Secretary shall make an inquiry as
to whether the family income (as determined for purposes of section 1905(p)) of
the family that includes the child is within any of the following income
ranges:</text>
<subparagraph id="H936E5427F5AA4562A9CAAAA9F0D11599"><enum>(A)</enum><header>Up to 150
percent of poverty</header><text>The income of the family does not exceed 150
percent of the poverty line for a family of the size involved.</text>
</subparagraph><subparagraph id="HA516463299CB43F2BB8BC000B8329B00"><enum>(B)</enum><header>Between 150 and
200 percent of poverty</header><text>The income of the family exceeds 150
percent, but does not exceed 200 percent, of such poverty line.</text>
</subparagraph><subparagraph id="HC35447BFD0C3411AA839DB8E45AA02FD"><enum>(C)</enum><header>Between 200 and
300 percent of poverty</header><text>The income of the family exceeds 200
percent, but does not exceed 300 percent, of such poverty line.</text>
</subparagraph></paragraph><paragraph id="H0A44D00E90614F8CA275CEDA90BCE4CB"><enum>(2)</enum><header>Coding</header><text>If
the family income is within a range described in paragraph (1), the Secretary
shall encode in the identification card issued in connection with eligibility
under this title a code indicating the range applicable to the family of the
child involved.</text>
</paragraph><paragraph id="HD0263520E5724D7A92EA495484005BF9"><enum>(3)</enum><header>Provider
verification through electronic system</header><text display-inline="yes-display-inline">The Secretary also shall provide for an
electronic system through which providers may verify which income range
described in paragraph (1), if any, is applicable to the family of the child
involved.</text>
</paragraph></subsection><subsection id="H5125AC0FE0B44FFCADB408FC2FE90026"><enum>(g)</enum><header>Construction</header><text>Nothing
in this title shall be construed as requiring (or preventing) an individual who
is enrolled under this title from seeking medical assistance under a State
medicaid plan under title XIX or child health assistance under a State child
health plan under title XXI.</text>
</subsection></section><section id="HE127B98B7D394863B3658D2CDA392845"><enum>2202.</enum><header>Benefits</header>
<subsection id="HE8C6A13F50334D1B93CC7160CB21E6CE"><enum>(a)</enum><header>Secretarial
specification of benefit package</header>
<paragraph id="H4EC833178FFD4D38B6C6B996EABD4BBE"><enum>(1)</enum><header>In
general</header><text>The Secretary shall specify the benefits to be made
available under this title consistent with the provisions of this section and
in a manner designed to meet the health needs of enrollees.</text>
</paragraph><paragraph id="HD5015A6EE9FB43DF99131B7ED86D36A1"><enum>(2)</enum><header>Updating</header><text>The
Secretary shall update the specification of benefits over time to ensure the
inclusion of age-appropriate benefits to reflect the enrollee
population.</text>
</paragraph><paragraph id="HEED8E77ADED549FF00AAF57F31DEE8E"><enum>(3)</enum><header>Annual
updating</header><text>The Secretary shall establish procedures for the annual
review and updating of such benefits to account for changes in medical
practice, new information from medical research, and other relevant
developments in health science.</text>
</paragraph><paragraph id="H19DCB849FC174DA9804D7E8DD880522F"><enum>(4)</enum><header>Input</header><text>The
Secretary shall seek the input of the pediatric community in specifying and
updating such benefits.</text>
</paragraph><paragraph id="H9A34AC8BBF434DB0953D67C5D250310"><enum>(5)</enum><header>Limitation on
updating</header><text>In no case shall updating of benefits under this
subsection result in a failure to provide benefits required under subsection
(b).</text>
</paragraph></subsection><subsection id="H54F49EA945E349088BDE508E93F6DD6"><enum>(b)</enum><header>Inclusion of
certain benefits</header>
<paragraph id="HF922492E267C41EB9DE2BDF2A8C874B3"><enum>(1)</enum><header>Medicare core
benefits</header><text>Such benefits shall include (to the extent consistent
with other provisions of this section) at least the same benefits (including
coverage, access, availability, duration, and beneficiary rights) that are
available under parts A and B of title XVIII.</text>
</paragraph><paragraph id="H95E993C1028C4968B0FAF041B183AE30"><enum>(2)</enum><header>All required
Medicaid benefits</header><text>Such benefits shall also include all items and
services for which medical assistance is required to be provided under section
1902(a)(10)(A) to individuals described in such section, including early and
periodic screening, diagnostic services, and treatment services.</text>
</paragraph><paragraph id="H1CBAAF089793479CA0D88FE402C4E4D"><enum>(3)</enum><header>Inclusion of
prescription drugs</header><text>Such benefits also shall include (as specified
by the Secretary) benefits for prescription drugs and biologicals which are not
less than the benefits for such drugs and biologicals under the standard option
for the service benefit plan described in
<external-xref legal-doc="usc" parsable-cite="usc/5/8903">section
8903(1)</external-xref> of title 5, United States Code, offered during
2007.</text>
</paragraph><paragraph id="HB93EA8A9696E42CDB0CCE5ABD6877FF4"><enum>(4)</enum><header>Cost-sharing</header>
<subparagraph id="H24D5ED0490304DFBA6154D1934244140"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to
subparagraph (B), such benefits also shall include the cost-sharing (in the
form of deductibles, coinsurance, and copayments) which is substantially
similar to such cost-sharing under the health benefits coverage in any of the
four largest health benefits plans (determined by enrollment) offered under
<external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/89">chapter
89</external-xref> of title 5, United States Code, and including an
out-of-pocket limit for catastrophic expenditures for covered benefits, except
that no cost-sharing shall be imposed with respect to early and periodic
screening and diagnostic services included under paragraph (2).</text>
</subparagraph><subparagraph id="H39206DAC9EAB49F0924B00AC5CC4CB60"><enum>(B)</enum><header>Reduced
cost-sharing for low income children</header><text>Such benefits shall provide
that—</text>
<clause id="HE5E44BCBF8364F298600C3151E2603C1"><enum>(i)</enum><text>there shall be no
cost-sharing for children in families the income of which is within the range
described in section 2201(f)(1)(A);</text>
</clause><clause id="H803CAD9875644C2AAB8750A0D734D69"><enum>(ii)</enum><text display-inline="yes-display-inline">the cost-sharing otherwise applicable shall
be reduced by 75 percent for children in families the income of which is within
the range described in section 2201(f)(1)(B); or</text>
</clause><clause id="HFBDF987B60D54147A8F93B7FB9649EBA"><enum>(iii)</enum><text display-inline="yes-display-inline">the cost-sharing otherwise applicable shall
be reduced by 50 percent for children in families the income of which is within
the range described in section 2201(f)(1)(C).</text>
</clause></subparagraph><subparagraph id="H8FA526B5715649868161D8C93B4E396"><enum>(C)</enum><header>Catastrophic
limit on cost-sharing</header><text>For a refundable credit for cost-sharing in
the case of cost-sharing in excess of a percentage of the individual’s adjusted
gross income, see <external-xref legal-doc="usc" parsable-cite="usc/26/36">section 36</external-xref> of the Internal Revenue
Code of 1986.</text>
</subparagraph></paragraph></subsection><subsection id="H84C6D7B5E67F41C299F71314F8CCA64F"><enum>(c)</enum><header>Payment
schedule</header><text>The Secretary, with the assistance of the Medicare
Payment Advisory Commission, shall develop and implement a payment schedule for
benefits covered under this title. To the extent feasible, such payment
schedule shall be consistent with comparable payment schedules and
reimbursement methodologies applied under parts A and B of title XVIII.</text>
</subsection><subsection id="HF5530230129D4830AA0080FF07F2F41"><enum>(d)</enum><header>Input</header><text>The
Secretary shall specify such benefits and payment schedules only after
obtaining input from appropriate child health providers and experts.</text>
</subsection><subsection id="H53281A8EB3B44CF1A0D16CC4E7186FB8"><enum>(e)</enum><header>Enrollment in
health plans</header><text>The Secretary shall provide for the offering of
benefits under this title through enrollment in a health benefit plan that
meets the same (or similar) requirements as the requirements that apply to
Medicare Advantage plans under part C of title XVIII (other than any such
requirements that relate to part D of such title). In the case of individuals
enrolled under this title in such a plan, the payment rate shall be based on
payment rates provided for under section 1853(c) in effect before the date of
the enactment of the Medicare Prescription Drug, Modernization, and Improvement
Act of 2003 (<external-xref legal-doc="public-law" parsable-cite="pl/108/173">Public Law 108–173</external-xref>), except that
such payment rates shall be adjusted in an appropriate manner to reflect
differences between the population served under this title and the population
under title XVIII.</text>
</subsection></section><section id="HA2384035A28F4619875FBF77C8F3608E"><enum>2203.</enum><header>Premiums</header>
<subsection id="HE03959BD739844B68C90804BF40364C4"><enum>(a)</enum><header>Amount of
monthly premiums</header>
<paragraph id="HE61E0921C1094338857B8066048893DA"><enum>(1)</enum><header>In
general</header><text>The Secretary shall, during September of each year
(beginning with 2008), establish a monthly MediKids premium for the following
year. Subject to paragraph (2), the monthly MediKids premium for a year is
equal to <fraction>1/12</fraction> of the annual premium rate computed under
subsection (b).</text>
</paragraph><paragraph id="HA1634E3A62A8404893EC26F61FB46DE"><enum>(2)</enum><header>Elimination of
monthly premium for demonstration of equivalent coverage (including coverage
under low-income programs)</header><text>The amount of the monthly premium
imposed under this section for an individual for a month shall be zero in the
case of an individual who demonstrates to the satisfaction of the Secretary
that the individual has basic health insurance coverage for that month. For
purposes of the previous sentence enrollment in a medicaid plan under title
XIX, a State child health insurance plan under title XXI, or under the medicare
program under title XVIII is deemed to constitute basic health insurance
coverage described in such sentence.</text>
</paragraph></subsection><subsection id="H943E6397FAB8449EABA050B0FD17E10"><enum>(b)</enum><header>Annual
premium</header>
<paragraph id="H25FDB20B1B9342BAADA5E1B1349E2C48"><enum>(1)</enum><header>National per
capita average</header><text>The Secretary shall estimate the average, annual
per capita amount that would be payable under this title with respect to
individuals residing in the United States who meet the requirement of section
2201(a)(1) as if all such individuals were eligible for (and enrolled) under
this title during the entire year (and assuming that section 1862(b)(2)(A)(i)
did not apply).</text>
</paragraph><paragraph id="H503B85D78C9C4EA79835B500E97EEC76"><enum>(2)</enum><header>Annual
premium</header><text>Subject to subsection (d), the annual premium under this
subsection for months in a year is equal to 25 percent of the average, annual
per capita amount estimated under paragraph (1) for the year.</text>
</paragraph></subsection><subsection id="H3646320802D949719203D516C4692DC9"><enum>(c)</enum><header>Payment of
monthly premium</header>
<paragraph id="H4FF55D22A41C48D4ABFA11A2E316D9FD"><enum>(1)</enum><header>Period of
payment</header><text>In the case of an individual who participates in the
program established by this title, subject to subsection (d), the monthly
premium shall be payable for the period commencing with the first month of the
individual’s coverage period and ending with the month in which the
individual’s coverage under this title terminates.</text>
</paragraph><paragraph id="H507B823350014807B6865826CBEF1E38"><enum>(2)</enum><header>Collection
through tax return</header><text>For provisions providing for the payment of
monthly premiums under this subsection, see section 59B of the Internal Revenue
Code of 1986.</text>
</paragraph><paragraph id="H63859979AB314E128452B29E077B4E3D"><enum>(3)</enum><header>Protections
against fraud and abuse</header><text>The Secretary shall develop, in
coordination with States and other health insurance issuers, administrative
systems to ensure that claims which are submitted to more than one payor are
coordinated and duplicate payments are not made.</text>
</paragraph></subsection><subsection id="H2EA77683819F45998415E8C6E06E4636"><enum>(d)</enum><header>Reduction in
premium for certain low-income families</header><text>For provisions reducing
the premium under this section for certain low-income families, see section
59B(d) of the Internal Revenue Code of 1986.</text>
</subsection></section><section id="HDCD1BD1B3C5E4624BD2D3E74CF2184"><enum>2204.</enum><header>MediKids Trust
Fund</header>
<subsection id="H27E4E81175C6418BA752623876ACEE7C"><enum>(a)</enum><header>Establishment of
Trust Fund</header>
<paragraph id="H16163FEABABE4FF39CEA83692F4D313B"><enum>(1)</enum><header>In
general</header><text>There is hereby created on the books of the Treasury of
the United States a trust fund to be known as the <quote>MediKids Trust
Fund</quote> (in this section referred to as the <quote>Trust Fund</quote>).
The Trust Fund shall consist of such gifts and bequests as may be made as
provided in section 201(i)(1) and such amounts as may be deposited in, or
appropriated to, such fund as provided in this title.</text>
</paragraph><paragraph id="H3392CDDC29E84703AB21B7B94F11A9F"><enum>(2)</enum><header>Premiums</header><text>Premiums
collected under <external-xref legal-doc="usc" parsable-cite="usc/26/59B">section 59B</external-xref> of the Internal Revenue
Code of 1986 shall be periodically transferred to the Trust Fund.</text>
</paragraph><paragraph id="HB8DD452AECC946658F65E977998BC6E3"><enum>(3)</enum><header>Transitional
funding before receipt of premiums</header><text>In order to provide for funds
in the Trust Fund to cover expenditures from the fund in advance of receipt of
premiums under section 2203, there are transferred to the Trust Fund from the
general fund of the United States Treasury such amounts as may be
necessary.</text>
</paragraph></subsection><subsection id="H300C356D39894832AD09E9E8DF4E36C3"><enum>(b)</enum><header>Incorporation of
provisions</header>
<paragraph id="HB2F13F77D1C540ABA8DC3BC2CE39101F"><enum>(1)</enum><header>In
general</header><text>Subject to paragraph (2), subsection (b) (other than the
last sentence) and subsections (c) through (i) of section 1841 shall apply with
respect to the Trust Fund and this title in the same manner as they apply with
respect to the Federal Supplementary Medical Insurance Trust Fund and part B,
respectively.</text>
</paragraph><paragraph id="H43038D4673AE4DE5A6DBBFCCC27F5B9C"><enum>(2)</enum><header>Miscellaneous
references</header><text>In applying provisions of section 1841 under paragraph
(1)—</text>
<subparagraph id="HD5F5F3908EB94B32A8D4D800E56600A5"><enum>(A)</enum><text>any reference in
such section to <quote>this part</quote> is construed to refer to title
XXII;</text>
</subparagraph><subparagraph id="H76F165D18E8D48A193E2758502C816D5"><enum>(B)</enum><text>any reference in
section 1841(h) to section 1840(d) and in section 1841(i) to sections
1840(b)(1) and 1842(g) are deemed references to comparable authority exercised
under this title;</text>
</subparagraph><subparagraph id="HDC45FD89C08348F0B3C2BB6957CB5FF"><enum>(C)</enum><text>payments may be
made under section 1841(g) to the Trust Funds under sections 1817 and 1841 as
reimbursement to such funds for payments they made for benefits provided under
this title; and</text>
</subparagraph><subparagraph id="H895919802C474EDF8F1C665DC422184D"><enum>(D)</enum><text>the Board of
Trustees of the MediKids Trust Fund shall be the same as the Board of Trustees
of the Federal Supplementary Medical Insurance Trust Fund.</text>
</subparagraph></paragraph></subsection></section><section id="H59684B9F5AE144F18EF827FB506BE272"><enum>2205.</enum><header>Oversight and
accountability</header>
<subsection id="HDEB1A0ACA19046F49FFF3F79C8F4B34D"><enum>(a)</enum><header>Periodic GAO
reports</header><text>The Comptroller General of the United States shall
periodically submit to Congress reports on the operation of the program under
this title, including on the financing of coverage provided under this
title.</text>
</subsection><subsection id="H36E11878978944A993A816978D7EE1BB"><enum>(b)</enum><header>Periodic MedPAC
reports</header><text>The Medicare Payment Advisory Commission shall
periodically report to Congress concerning the program under this title.</text>
</subsection></section><section id="HC9B0E6D050254217ABB8400D8674BFF"><enum>2206.</enum><header>Inclusion of
care coordination services</header>
<subsection id="H739501A49D254D539C9F8E6209B0330"><enum>(a)</enum><header>In
general</header>
<paragraph id="H2200E4B22F1D46B9B61FA71E3C35D44B"><enum>(1)</enum><header>Program
authority</header><text>The Secretary, beginning in 2009, may implement a care
coordination services program in accordance with the provisions of this section
under which, in appropriate circumstances, eligible individuals under section
2201 may elect to have health care services covered under this title managed
and coordinated by a designated care coordinator.</text>
</paragraph><paragraph id="H8821F910858C404EB1ABCC0DA99986C"><enum>(2)</enum><header>Administration by
contract</header><text>The Secretary may administer the program under this
section through a contract with an appropriate program administrator.</text>
</paragraph><paragraph id="H95910ACCDF654544B2F00484E16E303"><enum>(3)</enum><header>Coverage</header><text>Care
coordination services furnished in accordance with this section shall be
treated under this title as if they were included in the definition of medical
and other health services under section 1861(s) and benefits shall be available
under this title with respect to such services without the application of any
deductible or coinsurance.</text>
</paragraph></subsection><subsection id="H739CA7AB3B4B4F0E8C01FBE70758524"><enum>(b)</enum><header>Eligibility
criteria; identification and notification of eligible individuals</header>
<paragraph id="HFFF399FE9BEC45D1B4D36ED9E8B386E3"><enum>(1)</enum><header>Individual
eligibility criteria</header><text>The Secretary shall specify criteria to be
used in making a determination as to whether an individual may appropriately be
enrolled in the care coordination services program under this section, which
shall include at least a finding by the Secretary that for cohorts of
individuals with characteristics identified by the Secretary, professional
management and coordination of care can reasonably be expected to improve
processes or outcomes of health care and to reduce aggregate costs to the
programs under this title.</text>
</paragraph><paragraph id="HBA11AB1639BC4C0F9C9B60B2EE8997B0"><enum>(2)</enum><header>Procedures to
facilitate enrollment</header><text>The Secretary shall develop and implement
procedures designed to facilitate enrollment of eligible individuals in the
program under this section.</text>
</paragraph></subsection><subsection id="HD996B32EE21D47F880E3B8CDF617A23F"><enum>(c)</enum><header>Enrollment of
individuals</header>
<paragraph id="HB6F0FFE08D96416EBFCF87425D68034F"><enum>(1)</enum><header>Secretary’s
determination of eligibility</header><text>The Secretary shall determine the
eligibility for services under this section of individuals who are enrolled in
the program under this section and who make application for such services in
such form and manner as the Secretary may prescribe.</text>
</paragraph><paragraph id="H6ED6FCD7A03C44D1AFF9B921EA89E674"><enum>(2)</enum><header>Enrollment
period</header>
<subparagraph id="H184F8BA890D8415400FB77B12E36489F"><enum>(A)</enum><header>Effective date
and duration</header><text>Enrollment of an individual in the program under
this section shall be effective as of the first day of the month following the
month in which the Secretary approves the individual’s application under
paragraph (1), shall remain in effect for one month (or such longer period as
the Secretary may specify), and shall be automatically renewed for additional
periods, unless terminated in accordance with such procedures as the Secretary
shall establish by regulation. Such procedures shall permit an individual to
disenroll for cause at any time and without cause at re-enrollment
intervals.</text>
</subparagraph><subparagraph id="HD8773988DFFA4A7BA64FE3968177800"><enum>(B)</enum><header>Limitation on
reenrollment</header><text>The Secretary may establish limits on an
individual’s eligibility to reenroll in the program under this section if the
individual has disenrolled from the program more than once during a specified
time period.</text>
</subparagraph></paragraph></subsection><subsection id="HCA476AAA16704D72BDD0A52BA4A8BCFE"><enum>(d)</enum><header>Program</header><text>The
care coordination services program under this section shall include the
following elements:</text>
<paragraph id="HB30E4731793A413FBF53EEA6625000CC"><enum>(1)</enum><header>Basic care
coordination services</header>
<subparagraph id="H6C77BB7528ED453200A57071C5E6D87F"><enum>(A)</enum><header>In
general</header><text>Subject to the cost-effectiveness criteria specified in
subsection (b)(1), except as otherwise provided in this section, enrolled
individuals shall receive services described in section 1905(t)(1) and may
receive additional items and services as described in subparagraph (B).</text>
</subparagraph><subparagraph id="HADA8584E48804A81AFBD33A59E6CB548"><enum>(B)</enum><header>Additional
benefits</header><text>The Secretary may specify additional benefits for which
payment would not otherwise be made under this title that may be available to
individuals enrolled in the program under this section (subject to an
assessment by the care coordinator of an individual’s circumstance and need for
such benefits) in order to encourage enrollment in, or to improve the
effectiveness of, such program.</text>
</subparagraph></paragraph><paragraph id="HE27FF6CC4D164F188383373C8C54CAE4"><enum>(2)</enum><header>Care
coordination requirement</header><text>Notwithstanding any other provision of
this title, the Secretary may provide that an individual enrolled in the
program under this section may be entitled to payment under this title for any
specified health care items or services only if the items or services have been
furnished by the care coordinator, or coordinated through the care coordination
services program. Under such provision, the Secretary shall prescribe
exceptions for emergency medical services as described in section 1852(d)(3),
and other exceptions determined by the Secretary for the delivery of timely and
needed care.</text>
</paragraph></subsection><subsection id="H94AEBD9D562B42CCA58DD8C516F68D94"><enum>(e)</enum><header>Care
coordinators</header>
<paragraph id="HFB8E7F703F7043EFAD25B9B0A24E9418"><enum>(1)</enum><header>Conditions of
participation</header><text>In order to be qualified to furnish care
coordination services under this section, an individual or entity shall—</text>
<subparagraph id="H33FC3EB3A1AD4DEE9DD7296E2DD8D2E8"><enum>(A)</enum><text>be a health care
professional or entity (which may include physicians, physician group
practices, or other health care professionals or entities the Secretary may
find appropriate) meeting such conditions as the Secretary may specify;</text>
</subparagraph><subparagraph id="H46330B07B2A741B1A4F771F1B98741A2"><enum>(B)</enum><text>have entered into
a care coordination agreement; and</text>
</subparagraph><subparagraph id="HF23B681A222741DBA448F23DD25695C"><enum>(C)</enum><text>meet such criteria
as the Secretary may establish (which may include experience in the provision
of care coordination or primary care physician’s services).</text>
</subparagraph></paragraph><paragraph id="HBC30A03D2F2D40FD839D3789F2CEDC4B"><enum>(2)</enum><header>Agreement term;
payment</header>
<subparagraph id="H621F0AC95D484BFB9F08B186E767EC2D"><enum>(A)</enum><header>Duration and
renewal</header><text>A care coordination agreement under this subsection shall
be for one year and may be renewed if the Secretary is satisfied that the care
coordinator continues to meet the conditions of participation specified in
paragraph (1).</text>
</subparagraph><subparagraph id="HCD3F340DE93B4D6DBF57E2303896156"><enum>(B)</enum><header>Payment for
services</header><text>The Secretary may negotiate or otherwise establish
payment terms and rates for services described in subsection (d)(1).</text>
</subparagraph><subparagraph id="H95EF17B1E122462DA25902FA23CCE987"><enum>(C)</enum><header>Liability</header><text>Care
coordinators shall be subject to liability for actual health damages which may
be suffered by recipients as a result of the care coordinator’s decisions,
failure or delay in making decisions, or other actions as a care
coordinator.</text>
</subparagraph><subparagraph id="H5AF5B7E36A7B4E229FAE251C5B1925D"><enum>(D)</enum><header>Terms</header><text>In
addition to such other terms as the Secretary may require, an agreement under
this section shall include the terms specified in subparagraphs (A) through (C)
of section 1905(t)(3).</text>
</subparagraph></paragraph></subsection></section><section id="HBFD30AC062484A4C9900B11D394B54C0"><enum>2207.</enum><header>Administration
and miscellaneous</header>
<subsection id="HFB39EC6678CF404A8BC5115D9F95ABC8"><enum>(a)</enum><header>In
general</header><text>Except as otherwise provided in this title—</text>
<paragraph id="HF5FE173195DE4064A7AFA4FFF67FB844"><enum>(1)</enum><text>the Secretary
shall enter into appropriate contracts with providers of services, other health
care providers, carriers, and fiscal intermediaries, taking into account the
types of contracts used under title XVIII with respect to such entities, to
administer the program under this title;</text>
</paragraph><paragraph id="H5FB4516999664117957F6C7BA4705C49"><enum>(2)</enum><text>beneficiary
protections for individuals enrolled under this title shall not be less than
the beneficiary protections (including limits on balance billing) provided
medicare beneficiaries under title XVIII;</text>
</paragraph><paragraph id="HECF3ABC7584340DB8FFD8CCE95A527C"><enum>(3)</enum><text>benefits described
in section 2202 that are payable under this title to such individuals shall be
paid in a manner specified by the Secretary (taking into account, and based to
the greatest extent practicable upon, the manner in which they are provided
under title XVIII); and</text>
</paragraph><paragraph id="HFDE24442847546638DB79E8B2700C7B7"><enum>(4)</enum><text>provider
participation agreements under title XVIII shall apply to enrollees and
benefits under this title in the same manner as they apply to enrollees and
benefits under title XVIII.</text>
</paragraph></subsection><subsection id="H03C38EB8DD434AB2A544B6FFB6B94500"><enum>(b)</enum><header>Coordination
with Medicaid and SCHIP</header><text>Notwithstanding any other provision of
law, individuals entitled to benefits for items and services under this title
who also qualify for benefits under title XIX or XXI or any other Federally
funded health care program that provides basic health insurance coverage
described in section 2203(a)(2) may continue to qualify and obtain benefits
under such other title or program, and in such case such an individual shall
elect either—</text>
<paragraph id="H0793A899E7F04C35808C8CC9B0CD005D"><enum>(1)</enum><text>such other title
or program to be primary payor to benefits under this title, in which case no
benefits shall be payable under this title and the monthly premium under
section 2203 shall be zero; or</text>
</paragraph><paragraph id="HC361441615124FB200C671E657962D1E"><enum>(2)</enum><text display-inline="yes-display-inline">benefits under this title shall be primary
payor to benefits provided under such title or program, in which case the
Secretary shall enter into agreements with States as may be appropriate to
provide that, in the case of such individuals, the benefits under titles XIX
and XXI or such other program (including reduction of cost-sharing) are
provided on a <quote>wrap-around</quote> basis to the benefits under this
title.</text>
</paragraph></subsection></section>.
(b)Conforming
amendments to Social Security Act
provisions
(1)Section 201(i)(1)
of the Social Security Act (42 U.S.C.
401(i)(1)) is amended by striking or the Federal Supplementary Medical
Insurance Trust Fund
and inserting the Federal Supplementary
Medical Insurance Trust Fund, and the MediKids Trust Fund
.
(2)Section
201(g)(1)(A) of such Act (42 U.S.C. 401(g)(1)(A)) is amended
by striking and the Federal Supplementary Medical Insurance Trust Fund
established by title XVIII
and inserting , the Federal
Supplementary Medical Insurance Trust Fund, and the MediKids Trust Fund
established by title XVIII
.
(c)Maintenance of
Medicaid eligibility and benefits for children
(1)In order for a State to continue to be eligible for
payments under section 1903(a) of the Social
Security Act (42 U.S.C. 1396b(a))—
(A)the State may not
reduce standards of eligibility, or benefits, provided under its State medicaid
plan under title XIX of the Social Security
Act or under its State child health plan under title XXI of such Act
for individuals under 23 years of age below such standards of eligibility, and
benefits, in effect on the date of the enactment of this Act; and
(B)the State shall
demonstrate to the satisfaction of the Secretary of Health and Human Services
that any savings in State expenditures under title XIX or XXI of the
Social Security Act that results from
children enrolling under title XXII of such Act shall be used in a manner that
improves services to beneficiaries under title XIX of such Act, such as through
expansion of eligibility, improved nurse and nurse aide staffing and improved
inspections of nursing facilities, and coverage of additional services.
(2)MediKids as
primary payorIn applying title XIX of the
Social Security Act, the MediKids
program under title XXII of such Act shall be treated as a primary payor in
cases in which the election described in section 2207(b)(2) of such Act, as
added by subsection (a), has been made.
(d)Expansion of
medpac membership to 19
(1)Section 1805(c) of the Social Security Act (42 U.S.C.
1395b–6(c)) is amended—
(A)in paragraph (1),
by striking 17
and inserting 19
; and
(B)in paragraph
(2)(B), by inserting experts in children’s health,
after
other health professionals,
.
(2)Initial terms of
additional members
(A)For purposes of staggering the initial terms of members
of the Medicare Payment Advisory Commission under section 1805(c)(3) of the
Social Security Act (42 U.S.C.
1395b–6(c)(3)), the initial terms of the 2 additional members of the Commission
provided for by the amendment under subsection (a)(1) are as follows:
(i)One
member shall be appointed for 1 year.
(ii)One
member shall be appointed for 2 years.
(B)Such terms shall begin on January 1, 2008.
(3)Section
1805(b)(1)(A) of such Act (42 U.S.C. 1395b–6(b)(1)(A)) is
amended by inserting before the semicolon at the end the following: and
payment policies under title XXII
.
3.
(a)Subchapter A of chapter 1 of the Internal Revenue Code of
1986 (relating to determination of tax liability) is amended by adding at the
end the following new part:
VIII
Sec. 59B. MediKids premium.
59B.
(a)In the case of a taxpayer to whom this section applies, there
is hereby imposed (in addition to any other tax imposed by this subtitle) a
MediKids premium for the taxable year.
(b)Individuals
Subject to premium
(1)This section shall apply to a taxpayer if a MediKid is a
dependent of the taxpayer for the taxable year.
(2)For
purposes of this section, the term MediKid means any individual
enrolled in the MediKids program under title XXII of the Social Security
Act.
(c)For purposes of this section, the MediKids premium for a
taxable year is the sum of the monthly premiums (for months in the taxable
year) determined under section 2203 of the Social
Security Act with respect to each MediKid who is a dependent of the
taxpayer for the taxable year.
(d)Exceptions based
on adjusted gross income
(1)Exemption for
very low-income taxpayers
(A)No premium shall be imposed by this section on any
taxpayer having an adjusted gross income not in excess of the exemption
amount.
(B)For purposes of this paragraph, the exemption amount
is—
(i)$20,535 in the
case of a taxpayer having 1 MediKid,
(ii)$25,755 in the
case of a taxpayer having 2 MediKids,
(iii)$30,975 in the
case of a taxpayer having 3 MediKids, and
(iv)$35,195 in the
case of a taxpayer having 4 or more MediKids.
(C)In the case of a taxpayer having an adjusted gross
income which exceeds the exemption amount but does not exceed twice the
exemption amount, the premium shall be the amount which bears the same ratio to
the premium which would (but for this subparagraph) apply to the taxpayer as
such excess bears to the exemption amount.
(D)Inflation
adjustment of exemption amountsIn the case of any taxable year
beginning in a calendar year after 2009, each dollar amount contained in
subparagraph (C) shall be increased by an amount equal to the product
of—
(i)such dollar
amount, and
(ii)the
cost-of-living adjustment determined under section 1(f)(3) for the calendar
year in which the taxable year begins, determined by substituting
calendar year 2008
for calendar year 1992
in
subparagraph (B) thereof.
If any
increase determined under the preceding sentence is not a multiple of $50, such
increase shall be rounded to the nearest multiple of $50.(2)Premium limited
to 5 percent of adjusted gross incomeIn no event shall any
taxpayer be required to pay a premium under this section in excess of an amount
equal to 5 percent of the taxpayer’s adjusted gross income.
(e)Coordination
with other provisions
(1)Not treated as
medical expenseFor purposes of this chapter, any premium paid
under this section shall not be treated as expense for medical care.
(2)Not treated as
tax for certain purposesThe premium paid under this section
shall not be treated as a tax imposed by this chapter for purposes of
determining—
(A)the amount of any
credit allowable under this chapter, or
(B)the amount of the
minimum tax imposed by section 55.
(3)Treatment under
subtitle fFor purposes of subtitle F, the premium paid under
this section shall be treated as if it were a tax imposed by section
1.
.
(b)
(1)Subsection (a) of
section 6012 of such Code is amended by inserting after paragraph (9) the
following new paragraph:
(10)Every individual
liable for a premium under section
59B.
.
(2)The table of parts
for subchapter A of chapter 1 of such Code is amended by adding at the end the
following new item:
Part VIII. MediKids
premium
.
(c)The amendments made by this section shall apply to months
beginning after December 2008, in taxable years ending after such date.
4.Refundable credit
for certain cost-sharing expenses under MediKids program
(a)Subpart C of part IV of subchapter A of chapter 1 of the
Internal Revenue Code of 1986 (relating to refundable credits) is amended by
redesignating section 36 as section 37 and by inserting after section 35 the
following new section:
36.Catastrophic
limit on cost-sharing expenses under MediKids program
(a)In the case of a
taxpayer who has a MediKid (as defined in section 59B) at any time during the
taxable year, there shall be allowed as a credit against the tax imposed by
this subtitle an amount equal to the excess of—
(1)the amount paid by
the taxpayer during the taxable year as cost-sharing under section 2202(b)(4)
of the Social Security Act,
over
(2)5 percent of the
taxpayer’s adjusted gross income for the taxable
year.
.
(b)Coordination
with other provisionsThe
excess described in subsection (a) shall not be taken into account in computing
the amount allowable to the taxpayer as a deduction under section 162(l) or
213(a).
(c)
(1)The table of
sections for subpart C of part IV of subchapter A of chapter 1 of such Code is
amended by redesignating the item relating to section 36 as an item relating to
section 37 and by inserting before such item the following new item:
Sec. 36. Catastrophic limit on cost-sharing expenses under
MediKids
program.
.
(2)Paragraph (2) of
section
1324(b) of title 31, United States Code, is amended by
inserting , 36,
after section 35
.
(d)The amendments made by this section shall apply to taxable
years beginning after December 31, 2008.
5.Report on
long-term revenuesWithin one
year after the date of the enactment of this Act, the Secretary of the Treasury
shall propose a gradual schedule of progressive tax changes to fund the program
under title XXII of the Social Security
Act, as the number of enrollees grows in the out-years.