[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2 Engrossed Amendment Senate (EAS)]
In the Senate of the United States,
January 29, 2009.
Resolved, That the bill from the House of Representatives (H.R. 2)
entitled ``An Act to amend title XXI of the Social Security Act to
extend and improve the Children's Health Insurance Program, and for
other purposes.'', do pass with the following
AMENDMENT:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES;
TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Children's Health
Insurance Program Reauthorization Act of 2009''.
(b) Amendments to Social Security Act.--Except as otherwise
specifically provided, whenever in this Act an amendment is expressed
in terms of an amendment to or repeal of a section or other provision,
the reference shall be considered to be made to that section or other
provision of the Social Security Act.
(c) References to CHIP; Medicaid; Secretary.--In this Act:
(1) CHIP.--The term ``CHIP'' means the State Children's
Health Insurance Program established under title XXI of the
Social Security Act (42 U.S.C. 1397aa et seq.).
(2) Medicaid.--The term ``Medicaid'' means the program for
medical assistance established under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(d) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; amendments to Social Security Act; references;
table of contents.
Sec. 2. Purpose.
Sec. 3. General effective date; exception for State legislation;
contingent effective date; reliance on law.
TITLE I--FINANCING
Subtitle A--Funding
Sec. 101. Extension of CHIP.
Sec. 102. Allotments for States and territories for fiscal years 2009
through 2013.
Sec. 103. Child Enrollment Contingency Fund.
Sec. 104. CHIP performance bonus payment to offset additional
enrollment costs resulting from enrollment
and retention efforts.
Sec. 105. Two-year initial availability of CHIP allotments.
Sec. 106. Redistribution of unused allotments.
Sec. 107. Option for qualifying States to receive the enhanced portion
of the CHIP matching rate for Medicaid
coverage of certain children.
Sec. 108. One-time appropriation.
Sec. 109. Improving funding for the territories under CHIP and
Medicaid.
Subtitle B--Focus on Low-Income Children and Pregnant Women
Sec. 111. State option to cover low-income pregnant women under CHIP
through a State plan amendment.
Sec. 112. Phase-out of coverage for nonpregnant childless adults under
CHIP; conditions for coverage of parents.
Sec. 113. Elimination of counting Medicaid child presumptive
eligibility costs against title XXI
allotment.
Sec. 114. Limitation on matching rate for States that propose to cover
children with effective family income that
exceeds 300 percent of the poverty line.
Sec. 115. State authority under Medicaid.
TITLE II--OUTREACH AND ENROLLMENT
Subtitle A--Outreach and Enrollment Activities
Sec. 201. Grants and enhanced administrative funding for outreach and
enrollment.
Sec. 202. Increased outreach and enrollment of Indians.
Sec. 203. State option to rely on findings from an Express Lane agency
to conduct simplified eligibility
determinations.
Subtitle B--Reducing Barriers to Enrollment
Sec. 211. Verification of declaration of citizenship or nationality for
purposes of eligibility for Medicaid and
CHIP.
Sec. 212. Reducing administrative barriers to enrollment.
Sec. 213. Model of Interstate coordinated enrollment and coverage
process.
Sec. 214. Permitting States to ensure coverage without a 5-year delay
of certain children and pregnant women
under the Medicaid program and CHIP.
TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE
Subtitle A--Additional State Option for Providing Premium Assistance
Sec. 301. Additional State option for providing premium assistance.
Sec. 302. Outreach, education, and enrollment assistance.
Subtitle B--Coordinating Premium Assistance With Private Coverage
Sec. 311. Special enrollment period under group health plans in case of
termination of Medicaid or CHIP coverage or
eligibility for assistance in purchase of
employment-based coverage; coordination of
coverage.
TITLE IV--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES
Sec. 401. Child health quality improvement activities for children
enrolled in Medicaid or CHIP.
Sec. 402. Improved availability of public information regarding
enrollment of children in CHIP and
Medicaid.
Sec. 403. Application of certain managed care quality safeguards to
CHIP.
TITLE V--IMPROVING ACCESS TO BENEFITS
Sec. 501. Dental benefits.
Sec. 502. Mental health parity in CHIP plans.
Sec. 503. Application of prospective payment system for services
provided by Federally-qualified health
centers and rural health clinics.
Sec. 504. Premium grace period.
Sec. 505. Clarification of coverage of services provided through
school-based health centers.
Sec. 506. Medicaid and CHIP Payment and Access Commission.
TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS
Subtitle A--Program Integrity and Data Collection
Sec. 601. Payment error rate measurement (``PERM'').
Sec. 602. Improving data collection.
Sec. 603. Updated Federal evaluation of CHIP.
Sec. 604. Access to records for IG and GAO audits and evaluations.
Sec. 605. No Federal funding for illegal aliens; disallowance for
unauthorized expenditures.
Subtitle B--Miscellaneous Health Provisions
Sec. 611. Deficit Reduction Act technical corrections.
Sec. 612. References to title XXI.
Sec. 613. Prohibiting initiation of new health opportunity account
demonstration programs.
Sec. 614. Adjustment in computation of Medicaid FMAP to disregard an
extraordinary employer pension
contribution.
Sec. 615. Clarification treatment of regional medical center.
Sec. 616. Extension of Medicaid DSH allotments for Tennessee and
Hawaii.
Sec. 617. GAO report on Medicaid managed care payment rates.
Subtitle C--Other Provisions
Sec. 621. Outreach regarding health insurance options available to
children.
Sec. 622. Sense of the Senate regarding access to affordable and
meaningful health insurance coverage.
TITLE VII--REVENUE PROVISIONS
Sec. 701. Increase in excise tax rate on tobacco products.
Sec. 702. Administrative improvements.
Sec. 703. Treasury study concerning magnitude of tobacco smuggling in
the United States.
Sec. 704. Time for payment of corporate estimated taxes.
SEC. 2. PURPOSE.
It is the purpose of this Act to provide dependable and stable
funding for children's health insurance under titles XXI and XIX of the
Social Security Act in order to enroll all six million uninsured
children who are eligible, but not enrolled, for coverage today through
such titles.
SEC. 3. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE LEGISLATION;
CONTINGENT EFFECTIVE DATE; RELIANCE ON LAW.
(a) General Effective Date.--Unless otherwise provided in this Act,
subject to subsections (b) through (d), this Act (and the amendments
made by this Act) shall take effect on April 1, 2009, and shall apply
to child health assistance and medical assistance provided on or after
that date.
(b) Exception for State Legislation.--In the case of a State plan
under title XIX or State child health plan under XXI of the Social
Security Act, which the Secretary of Health and Human Services
determines requires State legislation in order for the respective plan
to meet one or more additional requirements imposed by amendments made
by this Act, the respective plan shall not be regarded as failing to
comply with the requirements of such title solely on the basis of its
failure to meet such an additional requirement before the first day of
the first calendar quarter beginning after the close of the first
regular session of the State legislature that begins after the date of
enactment of this Act. For purposes of the previous sentence, in the
case of a State that has a 2-year legislative session, each year of the
session shall be considered to be a separate regular session of the
State legislature.
(c) Coordination of CHIP Funding for Fiscal Year 2009.--
Notwithstanding any other provision of law, insofar as funds have been
appropriated under section 2104(a)(11), 2104(k), or 2104(l) of the
Social Security Act, as amended by section 201 of Public Law 110-173,
to provide allotments to States under CHIP for fiscal year 2009--
(1) any amounts that are so appropriated that are not so
allotted and obligated before April 1, 2009 are rescinded; and
(2) any amount provided for CHIP allotments to a State
under this Act (and the amendments made by this Act) for such
fiscal year shall be reduced by the amount of such
appropriations so allotted and obligated before such date.
(d) Reliance on Law.--With respect to amendments made by this Act
(other than title VII) that become effective as of a date--
(1) such amendments are effective as of such date whether
or not regulations implementing such amendments have been
issued; and
(2) Federal financial participation for medical assistance
or child health assistance furnished under title XIX or XXI,
respectively, of the Social Security Act on or after such date
by a State in good faith reliance on such amendments before the
date of promulgation of final regulations, if any, to carry out
such amendments (or before the date of guidance, if any,
regarding the implementation of such amendments) shall not be
denied on the basis of the State's failure to comply with such
regulations or guidance.
TITLE I--FINANCING
Subtitle A--Funding
SEC. 101. EXTENSION OF CHIP.
Section 2104(a) (42 U.S.C. 1397dd(a)) is amended--
(1) in paragraph (10), by striking ``and'' at the end;
(2) by amending paragraph (11), by striking ``each of
fiscal years 2008 and 2009'' and inserting ``fiscal year
2008''; and
(3) by adding at the end the following new paragraphs:
``(12) for fiscal year 2009, $10,562,000,000;
``(13) for fiscal year 2010, $12,520,000,000;
``(14) for fiscal year 2011, $13,459,000,000;
``(15) for fiscal year 2012, $14,982,000,000; and
``(16) for fiscal year 2013, for purposes of making 2 semi-
annual allotments--
``(A) $2,850,000,000 for the period beginning on
October 1, 2012, and ending on March 31, 2013, and
``(B) $2,850,000,000 for the period beginning on
April 1, 2013, and ending on September 30, 2013.''.
SEC. 102. ALLOTMENTS FOR STATES AND TERRITORIES FOR FISCAL YEARS 2009
THROUGH 2013.
Section 2104 (42 U.S.C. 1397dd) is amended--
(1) in subsection (b)(1), by striking ``subsection (d)''
and inserting ``subsections (d) and (m)'';
(2) in subsection (c)(1), by striking ``subsection (d)''
and inserting ``subsections (d) and (m)(4)''; and
(3) by adding at the end the following new subsection:
``(m) Allotments for Fiscal Years 2009 Through 2013.--
``(1) For fiscal year 2009.--
``(A) For the 50 states and the district of
columbia.--Subject to the succeeding provisions of this
paragraph and paragraph (4), the Secretary shall allot
for fiscal year 2009 from the amount made available
under subsection (a)(12), to each of the 50 States and
the District of Columbia 110 percent of the highest of
the following amounts for such State or District:
``(i) The total Federal payments to the
State under this title for fiscal year 2008,
multiplied by the allotment increase factor
determined under paragraph (5) for fiscal year
2009.
``(ii) The amount allotted to the State for
fiscal year 2008 under subsection (b),
multiplied by the allotment increase factor
determined under paragraph (5) for fiscal year
2009.
``(iii) The projected total Federal
payments to the State under this title for
fiscal year 2009, as determined on the basis of
the February 2009 projections certified by the
State to the Secretary by not later than March
31, 2009.
``(B) For the commonwealths and territories.--
Subject to the succeeding provisions of this paragraph
and paragraph (4), the Secretary shall allot for fiscal
year 2009 from the amount made available under
subsection (a)(12) to each of the commonwealths and
territories described in subsection (c)(3) an amount
equal to the highest amount of Federal payments to the
commonwealth or territory under this title for any
fiscal year occurring during the period of fiscal years
1999 through 2008, multiplied by the allotment increase
factor determined under paragraph (5) for fiscal year
2009, except that subparagraph (B) thereof shall be
applied by substituting `the United States' for `the
State'.
``(C) Adjustment for qualifying states.--In the
case of a qualifying State described in paragraph (2)
of section 2105(g), the Secretary shall permit the
State to submit a revised projection described in
subparagraph (A)(iii) in order to take into account
changes in such projections attributable to the
application of paragraph (4) of such section.
``(2) For fiscal years 2010 through 2012.--
``(A) In general.--Subject to paragraphs (4) and
(6), from the amount made available under paragraphs
(13) through (15) of subsection (a) for each of fiscal
years 2010 through 2012, respectively, the Secretary
shall compute a State allotment for each State
(including the District of Columbia and each
commonwealth and territory) for each such fiscal year
as follows:
``(i) Growth factor update for fiscal year
2010.--For fiscal year 2010, the allotment of
the State is equal to the sum of--
``(I) the amount of the State
allotment under paragraph (1) for
fiscal year 2009; and
``(II) the amount of any payments
made to the State under subsection (k),
(l), or (n) for fiscal year 2009,
multiplied by the allotment increase factor
under paragraph (5) for fiscal year 2010.
``(ii) Rebasing in fiscal year 2011.--For
fiscal year 2011, the allotment of the State is
equal to the Federal payments to the State that
are attributable to (and countable towards) the
total amount of allotments available under this
section to the State in fiscal year 2010
(including payments made to the State under
subsection (n) for fiscal year 2010 as well as
amounts redistributed to the State in fiscal
year 2010), multiplied by the allotment
increase factor under paragraph (5) for fiscal
year 2011.
``(iii) Growth factor update for fiscal
year 2012.--For fiscal year 2012, the allotment
of the State is equal to the sum of--
``(I) the amount of the State
allotment under clause (ii) for fiscal
year 2011; and
``(II) the amount of any payments
made to the State under subsection (n)
for fiscal year 2011,
multiplied by the allotment increase factor
under paragraph (5) for fiscal year 2012.
``(3) For fiscal year 2013.--
``(A) First half.--Subject to paragraphs (4) and
(6), from the amount made available under subparagraph
(A) of paragraph (16) of subsection (a) for the semi-
annual period described in such paragraph, increased by
the amount of the appropriation for such period under
section 108 of the Children's Health Insurance Program
Reauthorization Act of 2009, the Secretary shall
compute a State allotment for each State (including the
District of Columbia and each commonwealth and
territory) for such semi-annual period in an amount
equal to the first half ratio (described in
subparagraph (D)) of the amount described in
subparagraph (C).
``(B) Second half.--Subject to paragraphs (4) and
(6), from the amount made available under subparagraph
(B) of paragraph (16) of subsection (a) for the semi-
annual period described in such paragraph, the
Secretary shall compute a State allotment for each
State (including the District of Columbia and each
commonwealth and territory) for such semi-annual period
in an amount equal to the amount made available under
such subparagraph, multiplied by the ratio of--
``(i) the amount of the allotment to such
State under subparagraph (A); to
``(ii) the total of the amount of all of
the allotments made available under such
subparagraph.
``(C) Full year amount based on rebased amount.--
The amount described in this subparagraph for a State
is equal to the Federal payments to the State that are
attributable to (and countable towards) the total
amount of allotments available under this section to
the State in fiscal year 2012 (including payments made
to the State under subsection (n) for fiscal year 2012
as well as amounts redistributed to the State in fiscal
year 2012), multiplied by the allotment increase factor
under paragraph (5) for fiscal year 2013.
``(D) First half ratio.--The first half ratio
described in this subparagraph is the ratio of--
``(i) the sum of--
``(I) the amount made available
under subsection (a)(16)(A); and
``(II) the amount of the
appropriation for such period under
section 108 of the Children's Health
Insurance Program Reauthorization Act
of 2009; to
``(ii) the sum of the--
``(I) amount described in clause
(i); and
``(II) the amount made available
under subsection (a)(16)(B).
``(4) Proration rule.--If, after the application of this
subsection without regard to this paragraph, the sum of the
allotments determined under paragraph (1), (2), or (3) for a
fiscal year (or, in the case of fiscal year 2013, for a semi-
annual period in such fiscal year) exceeds the amount available
under subsection (a) for such fiscal year or period, the
Secretary shall reduce each allotment for any State under such
paragraph for such fiscal year or period on a proportional
basis.
``(5) Allotment increase factor.--The allotment increase
factor under this paragraph for a fiscal year is equal to the
product of the following:
``(A) Per capita health care growth factor.--1 plus
the percentage increase in the projected per capita
amount of National Health Expenditures from the
calendar year in which the previous fiscal year ends to
the calendar year in which the fiscal year involved
ends, as most recently published by the Secretary
before the beginning of the fiscal year.
``(B) Child population growth factor.--1 plus the
percentage increase (if any) in the population of
children in the State from July 1 in the previous
fiscal year to July 1 in the fiscal year involved, as
determined by the Secretary based on the most recent
published estimates of the Bureau of the Census before
the beginning of the fiscal year involved, plus 1
percentage point.
``(6) Increase in allotment to account for approved program
expansions.--In the case of one of the 50 States or the
District of Columbia that--
``(A) has submitted to the Secretary, and has
approved by the Secretary, a State plan amendment or
waiver request relating to an expansion of eligibility
for children or benefits under this title that becomes
effective for a fiscal year (beginning with fiscal year
2010 and ending with fiscal year 2013); and
``(B) has submitted to the Secretary, before the
August 31 preceding the beginning of the fiscal year, a
request for an expansion allotment adjustment under
this paragraph for such fiscal year that specifies--
``(i) the additional expenditures that are
attributable to the eligibility or benefit
expansion provided under the amendment or
waiver described in subparagraph (A), as
certified by the State and submitted to the
Secretary by not later than August 31 preceding
the beginning of the fiscal year; and
``(ii) the extent to which such additional
expenditures are projected to exceed the
allotment of the State or District for the
year,
subject to paragraph (4), the amount of the allotment of the
State or District under this subsection for such fiscal year
shall be increased by the excess amount described in
subparagraph (B)(i). A State or District may only obtain an
increase under this paragraph for an allotment for fiscal year
2010 or fiscal year 2012.
``(7) Availability of amounts for semi-annual periods in
fiscal year 2013.--Each semi-annual allotment made under
paragraph (3) for a period in fiscal year 2013 shall remain
available for expenditure under this title for periods after
the end of such fiscal year in the same manner as if the
allotment had been made available for the entire fiscal
year.''.
SEC. 103. CHILD ENROLLMENT CONTINGENCY FUND.
Section 2104 (42 U.S.C. 1397dd), as amended by section 102, is
amended by adding at the end the following new subsection:
``(n) Child Enrollment Contingency Fund.--
``(1) Establishment.--There is hereby established in the
Treasury of the United States a fund which shall be known as
the `Child Enrollment Contingency Fund' (in this subsection
referred to as the `Fund'). Amounts in the Fund shall be
available without further appropriations for payments under
this subsection.
``(2) Deposits into fund.--
``(A) Initial and subsequent appropriations.--
Subject to subparagraphs (B) and (D), out of any money
in the Treasury of the United States not otherwise
appropriated, there are appropriated to the Fund--
``(i) for fiscal year 2009, an amount equal
to 20 percent of the amount made available
under paragraph (12) of subsection (a) for the
fiscal year; and
``(ii) for each of fiscal years 2010
through 2012 (and for each of the semi-annual
allotment periods for fiscal year 2013), such
sums as are necessary for making payments to
eligible States for such fiscal year or period,
but not in excess of the aggregate cap
described in subparagraph (B).
``(B) Aggregate cap.--The total amount available
for payment from the Fund for each of fiscal years 2010
through 2012 (and for each of the semi-annual allotment
periods for fiscal year 2013), taking into account
deposits made under subparagraph (C), shall not exceed
20 percent of the amount made available under
subsection (a) for the fiscal year or period.
``(C) Investment of fund.--The Secretary of the
Treasury shall invest, in interest bearing securities
of the United States, such currently available portions
of the Fund as are not immediately required for
payments from the Fund. The income derived from these
investments constitutes a part of the Fund.
``(D) Availability of excess funds for performance
bonuses.--Any amounts in excess of the aggregate cap
described in subparagraph (B) for a fiscal year or
period shall be made available for purposes of carrying
out section 2105(a)(3) for any succeeding fiscal year
and the Secretary of the Treasury shall reduce the
amount in the Fund by the amount so made available.
``(3) Child enrollment contingency fund payments.--
``(A) In general.--If a State's expenditures under
this title in fiscal year 2009, fiscal year 2010,
fiscal year 2011, fiscal year 2012, or a semi-annual
allotment period for fiscal year 2013, exceed the total
amount of allotments available under this section to
the State in the fiscal year or period (determined
without regard to any redistribution it receives under
subsection (f) that is available for expenditure during
such fiscal year or period, but including any carryover
from a previous fiscal year) and if the average monthly
unduplicated number of children enrolled under the
State plan under this title (including children
receiving health care coverage through funds under this
title pursuant to a waiver under section 1115) during
such fiscal year or period exceeds its target average
number of such enrollees (as determined under
subparagraph (B)) for that fiscal year or period,
subject to subparagraph (D), the Secretary shall pay to
the State from the Fund an amount equal to the product
of--
``(i) the amount by which such average
monthly caseload exceeds such target number of
enrollees; and
``(ii) the projected per capita
expenditures under the State child health plan
(as determined under subparagraph (C) for the
fiscal year), multiplied by the enhanced FMAP
(as defined in section 2105(b)) for the State
and fiscal year involved (or in which the
period occurs).
``(B) Target average number of child enrollees.--In
this paragraph, the target average number of child
enrollees for a State--
``(i) for fiscal year 2009 is equal to the
monthly average unduplicated number of children
enrolled in the State child health plan under
this title (including such children receiving
health care coverage through funds under this
title pursuant to a waiver under section 1115)
during fiscal year 2008 increased by the
population growth for children in that State
for the year ending on June 30, 2007 (as
estimated by the Bureau of the Census) plus 1
percentage point; or
``(ii) for a subsequent fiscal year (or
semi-annual period occurring in a fiscal year)
is equal to the target average number of child
enrollees for the State for the previous fiscal
year increased by the child population growth
factor described in subsection (m)(5)(B) for
the State for the prior fiscal year.
``(C) Projected per capita expenditures.--For
purposes of subparagraph (A)(ii), the projected per
capita expenditures under a State child health plan--
``(i) for fiscal year 2009 is equal to the
average per capita expenditures (including both
State and Federal financial participation)
under such plan for the targeted low-income
children counted in the average monthly
caseload for purposes of this paragraph during
fiscal year 2008, increased by the annual
percentage increase in the projected per capita
amount of National Health Expenditures (as
estimated by the Secretary) for 2009; or
``(ii) for a subsequent fiscal year (or
semi-annual period occurring in a fiscal year)
is equal to the projected per capita
expenditures under such plan for the previous
fiscal year (as determined under clause (i) or
this clause) increased by the annual percentage
increase in the projected per capita amount of
National Health Expenditures (as estimated by
the Secretary) for the year in which such
subsequent fiscal year ends.
``(D) Proration rule.--If the amounts available for
payment from the Fund for a fiscal year or period are
less than the total amount of payments determined under
subparagraph (A) for the fiscal year or period, the
amount to be paid under such subparagraph to each
eligible State shall be reduced proportionally.
``(E) Timely payment; reconciliation.--Payment
under this paragraph for a fiscal year or period shall
be made before the end of the fiscal year or period
based upon the most recent data for expenditures and
enrollment and the provisions of subsection (e) of
section 2105 shall apply to payments under this
subsection in the same manner as they apply to payments
under such section.
``(F) Continued reporting.--For purposes of this
paragraph and subsection (f), the State shall submit to
the Secretary the State's projected Federal
expenditures, even if the amount of such expenditures
exceeds the total amount of allotments available to the
State in such fiscal year or period.
``(G) Application to commonwealths and
territories.--No payment shall be made under this
paragraph to a commonwealth or territory described in
subsection (c)(3) until such time as the Secretary
determines that there are in effect methods,
satisfactory to the Secretary, for the collection and
reporting of reliable data regarding the enrollment of
children described in subparagraphs (A) and (B) in
order to accurately determine the commonwealth's or
territory's eligibility for, and amount of payment,
under this paragraph.''.
SEC. 104. CHIP PERFORMANCE BONUS PAYMENT TO OFFSET ADDITIONAL
ENROLLMENT COSTS RESULTING FROM ENROLLMENT AND RETENTION
EFFORTS.
Section 2105(a) (42 U.S.C. 1397ee(a)) is amended by adding at the
end the following new paragraphs:
``(3) Performance bonus payment to offset additional
medicaid and chip child enrollment costs resulting from
enrollment and retention efforts.--
``(A) In general.--In addition to the payments made
under paragraph (1), for each fiscal year (beginning
with fiscal year 2009 and ending with fiscal year
2013), the Secretary shall pay from amounts made
available under subparagraph (E), to each State that
meets the condition under paragraph (4) for the fiscal
year, an amount equal to the amount described in
subparagraph (B) for the State and fiscal year. The
payment under this paragraph shall be made, to a State
for a fiscal year, as a single payment not later than
the last day of the first calendar quarter of the
following fiscal year.
``(B) Amount for above baseline medicaid child
enrollment costs.--Subject to subparagraph (E), the
amount described in this subparagraph for a State for a
fiscal year is equal to the sum of the following
amounts:
``(i) First tier above baseline medicaid
enrollees.--An amount equal to the number of
first tier above baseline child enrollees (as
determined under subparagraph (C)(i)) under
title XIX for the State and fiscal year,
multiplied by 15 percent of the projected per
capita State Medicaid expenditures (as
determined under subparagraph (D)) for the
State and fiscal year under title XIX.
``(ii) Second tier above baseline medicaid
enrollees.--An amount equal to the number of
second tier above baseline child enrollees (as
determined under subparagraph (C)(ii)) under
title XIX for the State and fiscal year,
multiplied by 62.5 percent of the projected per
capita State Medicaid expenditures (as
determined under subparagraph (D)) for the
State and fiscal year under title XIX.
``(C) Number of first and second tier above
baseline child enrollees; baseline number of child
enrollees.--For purposes of this paragraph:
``(i) First tier above baseline child
enrollees.--The number of first tier above
baseline child enrollees for a State for a
fiscal year under title XIX is equal to the
number (if any, as determined by the Secretary)
by which--
``(I) the monthly average
unduplicated number of qualifying
children (as defined in subparagraph
(F)) enrolled during the fiscal year
under the State plan under title XIX,
respectively; exceeds
``(II) the baseline number of
enrollees described in clause (iii) for
the State and fiscal year under title
XIX, respectively;
but not to exceed 10 percent of the baseline
number of enrollees described in subclause
(II).
``(ii) Second tier above baseline child
enrollees.--The number of second tier above
baseline child enrollees for a State for a
fiscal year under title XIX is equal to the
number (if any, as determined by the Secretary)
by which--
``(I) the monthly average
unduplicated number of qualifying
children (as defined in subparagraph
(F)) enrolled during the fiscal year
under title XIX as described in clause
(i)(I); exceeds
``(II) the sum of the baseline
number of child enrollees described in
clause (iii) for the State and fiscal
year under title XIX, as described in
clause (i)(II), and the maximum number
of first tier above baseline child
enrollees for the State and fiscal year
under title XIX, as determined under
clause (i).
``(iii) Baseline number of child
enrollees.--Subject to subparagraph (H), the
baseline number of child enrollees for a State
under title XIX--
``(I) for fiscal year 2009 is equal
to the monthly average unduplicated
number of qualifying children enrolled
in the State plan under title XIX
during fiscal year 2007 increased by
the population growth for children in
that State from 2007 to 2008 (as
estimated by the Bureau of the Census)
plus 4 percentage points, and further
increased by the population growth for
children in that State from 2008 to
2009 (as estimated by the Bureau of the
Census) plus 4 percentage points;
``(II) for each of fiscal years
2010, 2011, and 2012, is equal to the
baseline number of child enrollees for
the State for the previous fiscal year
under title XIX, increased by the
population growth for children in that
State from the calendar year in which
the respective fiscal year begins to
the succeeding calendar year (as
estimated by the Bureau of the Census)
plus 3.5 percentage points;
``(III) for each of fiscal years
2013, 2014, and 2015, is equal to the
baseline number of child enrollees for
the State for the previous fiscal year
under title XIX, increased by the
population growth for children in that
State from the calendar year in which
the respective fiscal year begins to
the succeeding calendar year (as
estimated by the Bureau of the Census)
plus 3 percentage points; and
``(IV) for a subsequent fiscal year
is equal to the baseline number of
child enrollees for the State for the
previous fiscal year under title XIX,
increased by the population growth for
children in that State from the
calendar year in which the fiscal year
involved begins to the succeeding
calendar year (as estimated by the
Bureau of the Census) plus 2 percentage
points.
``(D) Projected per capita state medicaid
expenditures.--For purposes of subparagraph (B), the
projected per capita State Medicaid expenditures for a
State and fiscal year under title XIX is equal to the
average per capita expenditures (including both State
and Federal financial participation) for children under
the State plan under such title, including under
waivers but not including such children eligible for
assistance by virtue of the receipt of benefits under
title XVI, for the most recent fiscal year for which
actual data are available (as determined by the
Secretary), increased (for each subsequent fiscal year
up to and including the fiscal year involved) by the
annual percentage increase in per capita amount of
National Health Expenditures (as estimated by the
Secretary) for the calendar year in which the
respective subsequent fiscal year ends and multiplied
by a State matching percentage equal to 100 percent
minus the Federal medical assistance percentage (as
defined in section 1905(b)) for the fiscal year
involved.
``(E) Amounts available for payments.--
``(i) Initial appropriation.--Out of any
money in the Treasury not otherwise
appropriated, there are appropriated
$3,225,000,000 for fiscal year 2009 for making
payments under this paragraph, to be available
until expended.
``(ii) Transfers.--Notwithstanding any
other provision of this title, the following
amounts shall also be available, without fiscal
year limitation, for making payments under this
paragraph:
``(I) Unobligated national
allotment.--
``(aa) Fiscal years 2009
through 2012.--As of December
31 of fiscal year 2009, and as
of December 31 of each
succeeding fiscal year through
fiscal year 2012, the portion,
if any, of the amount
appropriated under subsection
(a) for such fiscal year that
is unobligated for allotment to
a State under subsection (m)
for such fiscal year or set
aside under subsection (a)(3)
or (b)(2) of section 2111 for
such fiscal year.
``(bb) First half of fiscal
year 2013.--As of December 31
of fiscal year 2013, the
portion, if any, of the sum of
the amounts appropriated under
subsection (a)(16)(A) and under
section 108 of the Children's
Health Insurance
Reauthorization Act of 2009 for
the period beginning on October
1, 2012, and ending on March
31, 2013, that is unobligated
for allotment to a State under
subsection (m) for such fiscal
year or set aside under
subsection (b)(2) of section
2111 for such fiscal year.
``(cc) Second half of
fiscal year 2013.--As of June
30 of fiscal year 2013, the
portion, if any, of the amount
appropriated under subsection
(a)(16)(B) for the period
beginning on April 1, 2013, and
ending on September 30, 2013,
that is unobligated for
allotment to a State under
subsection (m) for such fiscal
year or set aside under
subsection (b)(2) of section
2111 for such fiscal year.
``(II) Unexpended allotments not
used for redistribution.--As of
November 15 of each of fiscal years
2010 through 2013, the total amount of
allotments made to States under section
2104 for the second preceding fiscal
year (third preceding fiscal year in
the case of the fiscal year 2006, 2007,
and 2008 allotments) that is not
expended or redistributed under section
2104(f) during the period in which such
allotments are available for
obligation.
``(III) Excess child enrollment
contingency funds.--As of October 1 of
each of fiscal years 2010 through 2013,
any amount in excess of the aggregate
cap applicable to the Child Enrollment
Contingency Fund for the fiscal year
under section 2104(n).
``(IV) Unexpended transitional
coverage block grant for nonpregnant
childless adults.--As of October 1,
2011, any amounts set aside under
section 2111(a)(3) that are not
expended by September 30, 2011.
``(iii) Proportional reduction.--If the sum
of the amounts otherwise payable under this
paragraph for a fiscal year exceeds the amount
available for the fiscal year under this
subparagraph, the amount to be paid under this
paragraph to each State shall be reduced
proportionally.
``(F) Qualifying children defined.--
``(i) In general.--For purposes of this
subsection, subject to clauses (ii) and (iii),
the term `qualifying children' means children
who meet the eligibility criteria (including
income, categorical eligibility, age, and
immigration status criteria) in effect as of
July 1, 2008, for enrollment under title XIX,
taking into account criteria applied as of such
date under title XIX pursuant to a waiver under
section 1115.
``(ii) Limitation.--A child described in
clause (i) who is provided medical assistance
during a presumptive eligibility period under
section 1920A shall be considered to be a
`qualifying child' only if the child is
determined to be eligible for medical
assistance under title XIX.
``(iii) Exclusion.--Such term does not
include any children for whom the State has
made an election to provide medical assistance
under paragraph (4) of section 1903(v).
``(G) Application to commonwealths and
territories.--The provisions of subparagraph (G) of
section 2104(n)(3) shall apply with respect to payment
under this paragraph in the same manner as such
provisions apply to payment under such section.
``(H) Application to states that implement a
Medicaid expansion for children after fiscal year
2008.--In the case of a State that provides coverage
under section 115 of the Children's Health Insurance
Program Reauthorization Act of 2009 for any fiscal year
after fiscal year 2008--
``(i) any child enrolled in the State plan
under title XIX through the application of such
an election shall be disregarded from the
determination for the State of the monthly
average unduplicated number of qualifying
children enrolled in such plan during the first
3 fiscal years in which such an election is in
effect; and
``(ii) in determining the baseline number
of child enrollees for the State for any fiscal
year subsequent to such first 3 fiscal years,
the baseline number of child enrollees for the
State under title XIX for the third of such
fiscal years shall be the monthly average
unduplicated number of qualifying children
enrolled in the State plan under title XIX for
such third fiscal year.
``(4) Enrollment and retention provisions for children.--
For purposes of paragraph (3)(A), a State meets the condition
of this paragraph for a fiscal year if it is implementing at
least 5 of the following enrollment and retention provisions
(treating each subparagraph as a separate enrollment and
retention provision) throughout the entire fiscal year:
``(A) Continuous eligibility.--The State has
elected the option of continuous eligibility for a full
12 months for all children described in section
1902(e)(12) under title XIX under 19 years of age, as
well as applying such policy under its State child
health plan under this title.
``(B) Liberalization of asset requirements.--The
State meets the requirement specified in either of the
following clauses:
``(i) Elimination of asset test.--The State
does not apply any asset or resource test for
eligibility for children under title XIX or
this title.
``(ii) Administrative verification of
assets.--The State--
``(I) permits a parent or caretaker
relative who is applying on behalf of a
child for medical assistance under
title XIX or child health assistance
under this title to declare and certify
by signature under penalty of perjury
information relating to family assets
for purposes of determining and
redetermining financial eligibility;
and
``(II) takes steps to verify assets
through means other than by requiring
documentation from parents and
applicants except in individual cases
of discrepancies or where otherwise
justified.
``(C) Elimination of in-person interview
requirement.--The State does not require an application
of a child for medical assistance under title XIX (or
for child health assistance under this title),
including an application for renewal of such
assistance, to be made in person nor does the State
require a face-to-face interview, unless there are
discrepancies or individual circumstances justifying an
in-person application or face-to-face interview.
``(D) Use of joint application for medicaid and
chip.--The application form and supplemental forms (if
any) and information verification process is the same
for purposes of establishing and renewing eligibility
for children for medical assistance under title XIX and
child health assistance under this title.
``(E) Automatic renewal (use of administrative
renewal).--
``(i) In general.--The State provides, in
the case of renewal of a child's eligibility
for medical assistance under title XIX or child
health assistance under this title, a pre-
printed form completed by the State based on
the information available to the State and
notice to the parent or caretaker relative of
the child that eligibility of the child will be
renewed and continued based on such information
unless the State is provided other information.
Nothing in this clause shall be construed as
preventing a State from verifying, through
electronic and other means, the information so
provided.
``(ii) Satisfaction through demonstrated
use of ex parte process.--A State shall be
treated as satisfying the requirement of clause
(i) if renewal of eligibility of children under
title XIX or this title is determined without
any requirement for an in-person interview,
unless sufficient information is not in the
State's possession and cannot be acquired from
other sources (including other State agencies)
without the participation of the applicant or
the applicant's parent or caretaker relative.
``(F) Presumptive eligibility for children.--The
State is implementing section 1920A under title XIX as
well as, pursuant to section 2107(e)(1), under this
title.
``(G) Express lane.--The State is implementing the
option described in section 1902(e)(13) under title XIX
as well as, pursuant to section 2107(e)(1), under this
title.
``(H) Premium assistance subsidies.--The State is
implementing the option of providing premium assistance
subsidies under section 2105(c)(10) or section
1906A.''.
SEC. 105. TWO-YEAR INITIAL AVAILABILITY OF CHIP ALLOTMENTS.
Section 2104(e) (42 U.S.C. 1397dd(e)) is amended to read as
follows:
``(e) Availability of Amounts Allotted.--
``(1) In general.--Except as provided in paragraph (2),
amounts allotted to a State pursuant to this section--
``(A) for each of fiscal years 1998 through 2008,
shall remain available for expenditure by the State
through the end of the second succeeding fiscal year;
and
``(B) for fiscal year 2009 and each fiscal year
thereafter, shall remain available for expenditure by
the State through the end of the succeeding fiscal
year.
``(2) Availability of amounts redistributed.--Amounts
redistributed to a State under subsection (f) shall be
available for expenditure by the State through the end of the
fiscal year in which they are redistributed.''.
SEC. 106. REDISTRIBUTION OF UNUSED ALLOTMENTS.
(a) Beginning With Fiscal Year 2007.--
(1) In general.--Section 2104(f) (42 U.S.C. 1397dd(f)) is
amended--
(A) by striking ``The Secretary'' and inserting the
following:
``(1) In general.--The Secretary'';
(B) by striking ``States that have fully expended
the amount of their allotments under this section.''
and inserting ``States that the Secretary determines
with respect to the fiscal year for which unused
allotments are available for redistribution under this
subsection, are shortfall States described in paragraph
(2) for such fiscal year, but not to exceed the amount
of the shortfall described in paragraph (2)(A) for each
such State (as may be adjusted under paragraph
(2)(C)).''; and
(C) by adding at the end the following new
paragraph:
``(2) Shortfall states described.--
``(A) In general.--For purposes of paragraph (1),
with respect to a fiscal year, a shortfall State
described in this subparagraph is a State with a State
child health plan approved under this title for which
the Secretary estimates on the basis of the most recent
data available to the Secretary, that the projected
expenditures under such plan for the State for the
fiscal year will exceed the sum of--
``(i) the amount of the State's allotments
for any preceding fiscal years that remains
available for expenditure and that will not be
expended by the end of the immediately
preceding fiscal year;
``(ii) the amount (if any) of the child
enrollment contingency fund payment under
subsection (n); and
``(iii) the amount of the State's allotment
for the fiscal year.
``(B) Proration rule.--If the amounts available for
redistribution under paragraph (1) for a fiscal year
are less than the total amounts of the estimated
shortfalls determined for the year under subparagraph
(A), the amount to be redistributed under such
paragraph for each shortfall State shall be reduced
proportionally.
``(C) Retrospective adjustment.--The Secretary may
adjust the estimates and determinations made under
paragraph (1) and this paragraph with respect to a
fiscal year as necessary on the basis of the amounts
reported by States not later than November 30 of the
succeeding fiscal year, as approved by the
Secretary.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to redistribution of allotments made for fiscal
year 2007 and subsequent fiscal years.
(b) Redistribution of Unused Allotments for Fiscal Year 2006.--
Section 2104(k) (42 U.S.C. 1397dd(k)) is amended--
(1) in the subsection heading, by striking ``the First 2
Quarters of'';
(2) in paragraph (1), by striking ``the first 2 quarters
of''; and
(3) in paragraph (6)--
(A) by striking ``the first 2 quarters of''; and
(B) by striking ``March 31'' and inserting
``September 30''.
SEC. 107. OPTION FOR QUALIFYING STATES TO RECEIVE THE ENHANCED PORTION
OF THE CHIP MATCHING RATE FOR MEDICAID COVERAGE OF
CERTAIN CHILDREN.
(a) In General.--Section 2105(g) (42 U.S.C. 1397ee(g)) is amended--
(1) in paragraph (1)(A), as amended by section 201(b)(1) of
Public Law 110-173--
(A) by inserting ``subject to paragraph (4),''
after ``Notwithstanding any other provision of law,'';
and
(B) by striking ``2008, or 2009'' and inserting
``or 2008''; and
(2) by adding at the end the following new paragraph:
``(4) Option for allotments for fiscal years 2009 through
2013.--
``(A) Payment of enhanced portion of matching rate
for certain expenditures.--In the case of expenditures
described in subparagraph (B), a qualifying State (as
defined in paragraph (2)) may elect to be paid from the
State's allotment made under section 2104 for any of
fiscal years 2009 through 2013 (insofar as the
allotment is available to the State under subsections
(e) and (m) of such section) an amount each quarter
equal to the additional amount that would have been
paid to the State under title XIX with respect to such
expenditures if the enhanced FMAP (as determined under
subsection (b)) had been substituted for the Federal
medical assistance percentage (as defined in section
1905(b)).
``(B) Expenditures described.--For purposes of
subparagraph (A), the expenditures described in this
subparagraph are expenditures made after the date of
the enactment of this paragraph and during the period
in which funds are available to the qualifying State
for use under subparagraph (A), for the provision of
medical assistance to individuals residing in the State
who are eligible for medical assistance under the State
plan under title XIX or under a waiver of such plan and
who have not attained age 19 (or, if a State has so
elected under the State plan under title XIX, age 20 or
21), and whose family income equals or exceeds 133
percent of the poverty line but does not exceed the
Medicaid applicable income level.''.
(b) Repeal of Limitation on Availability of Fiscal Year 2009
Allotments.--Paragraph (2) of section 201(b) of the Medicare, Medicaid,
and SCHIP Extension Act of 2007 (Public Law 110-173) is repealed.
SEC. 108. ONE-TIME APPROPRIATION.
There is appropriated to the Secretary, out of any money in the
Treasury not otherwise appropriated, $11,706,000,000 to accompany the
allotment made for the period beginning on October 1, 2012, and ending
on March 31, 2013, under section 2104(a)(16)(A) of the Social Security
Act (42 U.S.C. 1397dd(a)(16)(A)) (as added by section 101), to remain
available until expended. Such amount shall be used to provide
allotments to States under paragraph (3) of section 2104(m) of the
Social Security Act (42 U.S.C. 1397dd(i)), as added by section 102, for
the first 6 months of fiscal year 2013 in the same manner as allotments
are provided under subsection (a)(16)(A) of such section 2104 and
subject to the same terms and conditions as apply to the allotments
provided from such subsection (a)(16)(A).
SEC. 109. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP AND
MEDICAID.
Section 1108(g) (42 U.S.C. 1308(g)) is amended by adding at the end
the following new paragraph:
``(4) Exclusion of certain expenditures from payment
limits.--With respect to fiscal years beginning with fiscal
year 2009, if Puerto Rico, the Virgin Islands, Guam, the
Northern Mariana Islands, or American Samoa qualify for a
payment under subparagraph (A)(i), (B), or (F) of section
1903(a)(3) for a calendar quarter of such fiscal year, the
payment shall not be taken into account in applying subsection
(f) (as increased in accordance with paragraphs (1), (2), and
(3) of this subsection) to such commonwealth or territory for
such fiscal year.''.
Subtitle B--Focus on Low-Income Children and Pregnant Women
SEC. 111. STATE OPTION TO COVER LOW-INCOME PREGNANT WOMEN UNDER CHIP
THROUGH A STATE PLAN AMENDMENT.
(a) In General.--Title XXI (42 U.S.C. 1397aa et seq.), as amended
by section 112(a), is amended by adding at the end the following new
section:
``SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-INCOME PREGNANT WOMEN
THROUGH A STATE PLAN AMENDMENT.
``(a) In General.--Subject to the succeeding provisions of this
section, a State may elect through an amendment to its State child
health plan under section 2102 to provide pregnancy-related assistance
under such plan for targeted low-income pregnant women.
``(b) Conditions.--A State may only elect the option under
subsection (a) if the following conditions are satisfied:
``(1) Minimum income eligibility levels for pregnant women
and children.--The State has established an income eligibility
level--
``(A) for pregnant women under subsection
(a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of
section 1902 that is at least 185 percent (or such
higher percent as the State has in effect with regard
to pregnant women under this title) of the poverty line
applicable to a family of the size involved, but in no
case lower than the percent in effect under any such
subsection as of July 1, 2008; and
``(B) for children under 19 years of age under this
title (or title XIX) that is at least 200 percent of
the poverty line applicable to a family of the size
involved.
``(2) No chip income eligibility level for pregnant women
lower than the state's medicaid level.--The State does not
apply an effective income level for pregnant women under the
State plan amendment that is lower than the effective income
level (expressed as a percent of the poverty line and
considering applicable income disregards) specified under
subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A)
of section 1902, on the date of enactment of this paragraph to
be eligible for medical assistance as a pregnant woman.
``(3) No coverage for higher income pregnant women without
covering lower income pregnant women.--The State does not
provide coverage for pregnant women with higher family income
without covering pregnant women with a lower family income.
``(4) Application of requirements for coverage of targeted
low-income children.--The State provides pregnancy-related
assistance for targeted low-income pregnant women in the same
manner, and subject to the same requirements, as the State
provides child health assistance for targeted low-income
children under the State child health plan, and in addition to
providing child health assistance for such women.
``(5) No preexisting condition exclusion or waiting
period.--The State does not apply any exclusion of benefits for
pregnancy-related assistance based on any preexisting condition
or any waiting period (including any waiting period imposed to
carry out section 2102(b)(3)(C)) for receipt of such
assistance.
``(6) Application of cost-sharing protection.--The State
provides pregnancy-related assistance to a targeted low-income
woman consistent with the cost-sharing protections under
section 2103(e) and applies the limitation on total annual
aggregate cost sharing imposed under paragraph (3)(B) of such
section to the family of such a woman.
``(7) No waiting list for children.--The State does not
impose, with respect to the enrollment under the State child
health plan of targeted low-income children during the quarter,
any enrollment cap or other numerical limitation on enrollment,
any waiting list, any procedures designed to delay the
consideration of applications for enrollment, or similar
limitation with respect to enrollment.
``(c) Option To Provide Presumptive Eligibility.--A State that
elects the option under subsection (a) and satisfies the conditions
described in subsection (b) may elect to apply section 1920 (relating
to presumptive eligibility for pregnant women) to the State child
health plan in the same manner as such section applies to the State
plan under title XIX.
``(d) Definitions.--For purposes of this section:
``(1) Pregnancy-related assistance.--The term `pregnancy-
related assistance' has the meaning given the term `child
health assistance' in section 2110(a) with respect to an
individual during the period described in paragraph (2)(A).
``(2) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' means an individual--
``(A) during pregnancy and through the end of the
month in which the 60-day period (beginning on the last
day of her pregnancy) ends;
``(B) whose family income exceeds 185 percent (or,
if higher, the percent applied under subsection
(b)(1)(A)) of the poverty line applicable to a family
of the size involved, but does not exceed the income
eligibility level established under the State child
health plan under this title for a targeted low-income
child; and
``(C) who satisfies the requirements of paragraphs
(1)(A), (1)(C), (2), and (3) of section 2110(b) in the
same manner as a child applying for child health
assistance would have to satisfy such requirements.
``(e) Automatic Enrollment for Children Born to Women Receiving
Pregnancy-Related Assistance.--If a child is born to a targeted low-
income pregnant woman who was receiving pregnancy-related assistance
under this section on the date of the child's birth, the child shall be
deemed to have applied for child health assistance under the State
child health plan and to have been found eligible for such assistance
under such plan or to have applied for medical assistance under title
XIX and to have been found eligible for such assistance under such
title, as appropriate, on the date of such birth and to remain eligible
for such assistance until the child attains 1 year of age. During the
period in which a child is deemed under the preceding sentence to be
eligible for child health or medical assistance, the child health or
medical assistance eligibility identification number of the mother
shall also serve as the identification number of the child, and all
claims shall be submitted and paid under such number (unless the State
issues a separate identification number for the child before such
period expires).
``(f) States Providing Assistance Through Other Options.--
``(1) Continuation of other options for providing
assistance.--The option to provide assistance in accordance
with the preceding subsections of this section shall not limit
any other option for a State to provide--
``(A) child health assistance through the
application of sections 457.10, 457.350(b)(2),
457.622(c)(5), and 457.626(a)(3) of title 42, Code of
Federal Regulations (as in effect after the final rule
adopted by the Secretary and set forth at 67 Fed. Reg.
61956-61974 (October 2, 2002)), or
``(B) pregnancy-related services through the
application of any waiver authority (as in effect on
June 1, 2008).
``(2) Clarification of authority to provide postpartum
services.--Any State that provides child health assistance
under any authority described in paragraph (1) may continue to
provide such assistance, as well as postpartum services,
through the end of the month in which the 60-day period
(beginning on the last day of the pregnancy) ends, in the same
manner as such assistance and postpartum services would be
provided if provided under the State plan under title XIX, but
only if the mother would otherwise satisfy the eligibility
requirements that apply under the State child health plan
(other than with respect to age) during such period.
``(3) No inference.--Nothing in this subsection shall be
construed--
``(A) to infer congressional intent regarding the
legality or illegality of the content of the sections
specified in paragraph (1)(A); or
``(B) to modify the authority to provide pregnancy-
related services under a waiver specified in paragraph
(1)(B).''.
(b) Additional Conforming Amendments.--
(1) No cost sharing for pregnancy-related benefits.--
Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended--
(A) in the heading, by inserting ``or pregnancy-
related assistance'' after ``preventive services''; and
(B) by inserting before the period at the end the
following: ``or for pregnancy-related assistance''.
(2) No waiting period.--Section 2102(b)(1)(B) (42 U.S.C.
1397bb(b)(1)(B)) is amended--
(A) in clause (i), by striking ``, and'' at the end
and inserting a semicolon;
(B) in clause (ii), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income pregnant woman provided pregnancy-
related assistance under section 2112.''.
SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS UNDER
CHIP; CONDITIONS FOR COVERAGE OF PARENTS.
(a) Phase-Out Rules.--
(1) In general.--Title XXI (42 U.S.C. 1397aa et seq.) is
amended by adding at the end the following new section:
``SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS;
CONDITIONS FOR COVERAGE OF PARENTS.
``(a) Termination of Coverage for Nonpregnant Childless Adults.--
``(1) No new chip waivers; automatic extensions at state
option through 2009.--Notwithstanding section 1115 or any other
provision of this title, except as provided in this
subsection--
``(A) the Secretary shall not on or after the date
of the enactment of the Children's Health Insurance
Program Reauthorization Act of 2009, approve or renew a
waiver, experimental, pilot, or demonstration project
that would allow funds made available under this title
to be used to provide child health assistance or other
health benefits coverage to a nonpregnant childless
adult; and
``(B) notwithstanding the terms and conditions of
an applicable existing waiver, the provisions of
paragraph (2) shall apply for purposes of any period
beginning on or after January 1, 2010, in determining
the period to which the waiver applies, the individuals
eligible to be covered by the waiver, and the amount of
the Federal payment under this title.
``(2) Termination of chip coverage under applicable
existing waivers at the end of 2009.--
``(A) In general.--No funds shall be available
under this title for child health assistance or other
health benefits coverage that is provided to a
nonpregnant childless adult under an applicable
existing waiver after December 31, 2009.
``(B) Extension upon state request.--If an
applicable existing waiver described in subparagraph
(A) would otherwise expire before January 1, 2010,
notwithstanding the requirements of subsections (e) and
(f) of section 1115, a State may submit, not later than
September 30, 2009, a request to the Secretary for an
extension of the waiver. The Secretary shall approve a
request for an extension of an applicable existing
waiver submitted pursuant to this subparagraph, but
only through December 31, 2009.
``(C) Application of enhanced fmap.--The enhanced
FMAP determined under section 2105(b) shall apply to
expenditures under an applicable existing waiver for
the provision of child health assistance or other
health benefits coverage to a nonpregnant childless
adult during the period beginning on the date of the
enactment of this subsection and ending on December 31,
2009.
``(3) State option to apply for medicaid waiver to continue
coverage for nonpregnant childless adults.--
``(A) In general.--Each State for which coverage
under an applicable existing waiver is terminated under
paragraph (2)(A) may submit, not later than September
30, 2009, an application to the Secretary for a waiver
under section 1115 of the State plan under title XIX to
provide medical assistance to a nonpregnant childless
adult whose coverage is so terminated (in this
subsection referred to as a `Medicaid nonpregnant
childless adults waiver').
``(B) Deadline for approval.--The Secretary shall
make a decision to approve or deny an application for a
Medicaid nonpregnant childless adults waiver submitted
under subparagraph (A) within 90 days of the date of
the submission of the application. If no decision has
been made by the Secretary as of December 31, 2009, on
the application of a State for a Medicaid nonpregnant
childless adults waiver that was submitted to the
Secretary by September 30, 2009, the application shall
be deemed approved.
``(C) Standard for budget neutrality.--The budget
neutrality requirement applicable with respect to
expenditures for medical assistance under a Medicaid
nonpregnant childless adults waiver shall--
``(i) in the case of fiscal year 2010,
allow expenditures for medical assistance under
title XIX for all such adults to not exceed the
total amount of payments made to the State
under paragraph (2)(B) for fiscal year 2009,
increased by the percentage increase (if any)
in the projected nominal per capita amount of
National Health Expenditures for 2010 over
2009, as most recently published by the
Secretary; and
``(ii) in the case of any succeeding fiscal
year, allow such expenditures to not exceed the
amount in effect under this subparagraph for
the preceding fiscal year, increased by the
percentage increase (if any) in the projected
nominal per capita amount of National Health
Expenditures for the calendar year that begins
during the year involved over the preceding
calendar year, as most recently published by
the Secretary.
``(b) Rules and Conditions for Coverage of Parents of Targeted Low-
Income Children.--
``(1) Two-year period; automatic extension at state option
through fiscal year 2011.--
``(A) No new chip waivers.--Notwithstanding section
1115 or any other provision of this title, except as
provided in this subsection--
``(i) the Secretary shall not on or after
the date of the enactment of the Children's
Health Insurance Program Reauthorization Act of
2009 approve or renew a waiver, experimental,
pilot, or demonstration project that would
allow funds made available under this title to
be used to provide child health assistance or
other health benefits coverage to a parent of a
targeted low-income child; and
``(ii) notwithstanding the terms and
conditions of an applicable existing waiver,
the provisions of paragraphs (2) and (3) shall
apply for purposes of any fiscal year beginning
on or after October 1, 2011, in determining the
period to which the waiver applies, the
individuals eligible to be covered by the
waiver, and the amount of the Federal payment
under this title.
``(B) Extension upon state request.--If an
applicable existing waiver described in subparagraph
(A) would otherwise expire before October 1, 2011, and
the State requests an extension of such waiver, the
Secretary shall grant such an extension, but only,
subject to paragraph (2)(A), through September 30,
2011.
``(C) Application of enhanced fmap.--The enhanced
FMAP determined under section 2105(b) shall apply to
expenditures under an applicable existing waiver for
the provision of child health assistance or other
health benefits coverage to a parent of a targeted low-
income child during the third and fourth quarters of
fiscal year 2009 and during fiscal years 2010 and 2011.
``(2) Rules for fiscal years 2012 through 2013.--
``(A) Payments for coverage limited to block grant
funded from state allotment.--Any State that provides
child health assistance or health benefits coverage
under an applicable existing waiver for a parent of a
targeted low-income child may elect to continue to
provide such assistance or coverage through fiscal year
2012 or 2013, subject to the same terms and conditions
that applied under the applicable existing waiver,
unless otherwise modified in subparagraph (B).
``(B) Terms and conditions.--
``(i) Block grant set aside from state
allotment.--If the State makes an election
under subparagraph (A), the Secretary shall set
aside for the State for each such fiscal year
an amount equal to the Federal share of 110
percent of the State's projected expenditures
under the applicable existing waiver for
providing child health assistance or health
benefits coverage to all parents of targeted
low-income children enrolled under such waiver
for the fiscal year (as certified by the State
and submitted to the Secretary by not later
than August 31 of the preceding fiscal year).
In the case of fiscal year 2013, the set aside
for any State shall be computed separately for
each period described in subparagraphs (A) and
(B) of section 2104(a)(16) and any reduction in
the allotment for either such period under
section 2104(m)(4) shall be allocated on a pro
rata basis to such set aside.
``(ii) Payments from block grant.--The
Secretary shall pay the State from the amount
set aside under clause (i) for the fiscal year,
an amount for each quarter of such fiscal year
equal to the applicable percentage determined
under clause (iii) or (iv) for expenditures in
the quarter for providing child health
assistance or other health benefits coverage to
a parent of a targeted low-income child.
``(iii) Enhanced fmap only in fiscal year
2012 for states with significant child outreach
or that achieve child coverage benchmarks; fmap
for any other states.--For purposes of clause
(ii), the applicable percentage for any quarter
of fiscal year 2012 is equal to--
``(I) the enhanced FMAP determined
under section 2105(b) in the case of a
State that meets the outreach or
coverage benchmarks described in any of
subparagraph (A), (B), or (C) of
paragraph (3) for fiscal year 2011; or
``(II) the Federal medical
assistance percentage (as determined
under section 1905(b) without regard to
clause (4) of such section) in the case
of any other State.
``(iv) Amount of federal matching payment
in 2013.--For purposes of clause (ii), the
applicable percentage for any quarter of fiscal
year 2013 is equal to--
``(I) the REMAP percentage if--
``(aa) the applicable
percentage for the State under
clause (iii) was the enhanced
FMAP for fiscal year 2012; and
``(bb) the State met either
of the coverage benchmarks
described in subparagraph (B)
or (C) of paragraph (3) for
fiscal year 2012; or
``(II) the Federal medical
assistance percentage (as so
determined) in the case of any State to
which subclause (I) does not apply.
For purposes of subclause (I), the REMAP
percentage is the percentage which is the sum
of such Federal medical assistance percentage
and a number of percentage points equal to one-
half of the difference between such Federal
medical assistance percentage and such enhanced
FMAP.
``(v) No federal payments other than from
block grant set aside.--No payments shall be
made to a State for expenditures described in
clause (ii) after the total amount set aside
under clause (i) for a fiscal year has been
paid to the State.
``(vi) No increase in income eligibility
level for parents.--No payments shall be made
to a State from the amount set aside under
clause (i) for a fiscal year for expenditures
for providing child health assistance or health
benefits coverage to a parent of a targeted
low-income child whose family income exceeds
the income eligibility level applied under the
applicable existing waiver to parents of
targeted low-income children on the date of
enactment of the Children's Health Insurance
Program Reauthorization Act of 2009.
``(3) Outreach or coverage benchmarks.--For purposes of
paragraph (2), the outreach or coverage benchmarks described in
this paragraph are as follows:
``(A) Significant child outreach campaign.--The
State--
``(i) was awarded a grant under section
2113 for fiscal year 2011;
``(ii) implemented 1 or more of the
enrollment and retention provisions described
in section 2105(a)(4) for such fiscal year; or
``(iii) has submitted a specific plan for
outreach for such fiscal year.
``(B) High-performing state.--The State, on the
basis of the most timely and accurate published
estimates of the Bureau of the Census, ranks in the
lowest \1/3\ of States in terms of the State's
percentage of low-income children without health
insurance.
``(C) State increasing enrollment of low-income
children.--The State qualified for a performance bonus
payment under section 2105(a)(3)(B) for the most recent
fiscal year applicable under such section.
``(4) Rules of construction.--Nothing in this subsection
shall be construed as prohibiting a State from submitting an
application to the Secretary for a waiver under section 1115 of
the State plan under title XIX to provide medical assistance to
a parent of a targeted low-income child that was provided child
health assistance or health benefits coverage under an
applicable existing waiver.
``(c) Applicable Existing Waiver.--For purposes of this section--
``(1) In general.--The term `applicable existing waiver'
means a waiver, experimental, pilot, or demonstration project
under section 1115, grandfathered under section 6102(c)(3) of
the Deficit Reduction Act of 2005, or otherwise conducted under
authority that--
``(A) would allow funds made available under this
title to be used to provide child health assistance or
other health benefits coverage to--
``(i) a parent of a targeted low-income
child;
``(ii) a nonpregnant childless adult; or
``(iii) individuals described in both
clauses (i) and (ii); and
``(B) was in effect during fiscal year 2009.
``(2) Definitions.--
``(A) Parent.--The term `parent' includes a
caretaker relative (as such term is used in carrying
out section 1931) and a legal guardian.
``(B) Nonpregnant childless adult.--The term
`nonpregnant childless adult' has the meaning given
such term by section 2107(f).''.
(2) Conforming amendments.--
(A) Section 2107(f) (42 U.S.C. 1397gg(f)) is
amended--
(i) by striking ``, the Secretary'' and
inserting ``:
``(1) The Secretary'';
(ii) in the first sentence, by inserting
``or a parent (as defined in section
2111(c)(2)(A)), who is not pregnant, of a
targeted low-income child'' before the period;
(iii) by striking the second sentence; and
(iv) by adding at the end the following new
paragraph:
``(2) The Secretary may not approve, extend, renew, or
amend a waiver, experimental, pilot, or demonstration project
with respect to a State after the date of enactment of the
Children's Health Insurance Program Reauthorization Act of 2009
that would waive or modify the requirements of section 2111.''.
(B) Section 6102(c) of the Deficit Reduction Act of
2005 (Public Law 109-171; 120 Stat. 131) is amended by
striking ``Nothing'' and inserting ``Subject to section
2111 of the Social Security Act, as added by section
112 of the Children's Health Insurance Program
Reauthorization Act of 2009, nothing''.
(b) GAO Study and Report.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of whether--
(A) the coverage of a parent, a caretaker relative
(as such term is used in carrying out section 1931), or
a legal guardian of a targeted low-income child under a
State health plan under title XXI of the Social
Security Act increases the enrollment of, or the
quality of care for, children, and
(B) such parents, relatives, and legal guardians
who enroll in such a plan are more likely to enroll
their children in such a plan or in a State plan under
title XIX of such Act.
(2) Report.--Not later than 2 years after the date of the
enactment of this Act, the Comptroller General shall report the
results of the study to the Committee on Finance of the Senate
and the Committee on Energy and Commerce of the House of
Representatives, including recommendations (if any) for changes
in legislation.
SEC. 113. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE
ELIGIBILITY COSTS AGAINST TITLE XXI ALLOTMENT.
(a) In General.--Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)) is
amended--
(1) in the matter preceding subparagraph (A), by striking
``(or, in the case of expenditures described in subparagraph
(B), the Federal medical assistance percentage (as defined in
the first sentence of section 1905(b)))''; and
(2) by striking subparagraph (B) and inserting the
following new subparagraph:
``(B) [reserved]''.
(b) Amendments to Medicaid.--
(1) Eligibility of a newborn.--Section 1902(e)(4) (42
U.S.C. 1396a(e)(4)) is amended in the first sentence by
striking ``so long as the child is a member of the woman's
household and the woman remains (or would remain if pregnant)
eligible for such assistance''.
(2) Application of qualified entities to presumptive
eligibility for pregnant women under medicaid.--Section 1920(b)
(42 U.S.C. 1396r-1(b)) is amended by adding after paragraph (2)
the following flush sentence:
``The term `qualified provider' also includes a qualified entity, as
defined in section 1920A(b)(3).''.
SEC. 114. LIMITATION ON MATCHING RATE FOR STATES THAT PROPOSE TO COVER
CHILDREN WITH EFFECTIVE FAMILY INCOME THAT EXCEEDS 300
PERCENT OF THE POVERTY LINE.
(a) FMAP Applied to Expenditures.--Section 2105(c) (42 U.S.C.
1397ee(c)) is amended by adding at the end the following new paragraph:
``(8) Limitation on matching rate for expenditures for
child health assistance provided to children whose effective
family income exceeds 300 percent of the poverty line.--
``(A) FMAP applied to expenditures.--Except as
provided in subparagraph (B), for fiscal years
beginning with fiscal year 2009, the Federal medical
assistance percentage (as determined under section
1905(b) without regard to clause (4) of such section)
shall be substituted for the enhanced FMAP under
subsection (a)(1) with respect to any expenditures for
providing child health assistance or health benefits
coverage for a targeted low-income child whose
effective family income would exceed 300 percent of the
poverty line but for the application of a general
exclusion of a block of income that is not determined
by type of expense or type of income.
``(B) Exception.--Subparagraph (A) shall not apply
to any State that, on the date of enactment of the
Children's Health Insurance Program Reauthorization Act
of 2009, has an approved State plan amendment or waiver
to provide, or has enacted a State law to submit a
State plan amendment to provide, expenditures described
in such subparagraph under the State child health
plan.''.
(b) Rule of Construction.--Nothing in the amendments made by this
section shall be construed as--
(1) changing any income eligibility level for children
under title XXI of the Social Security Act; or
(2) changing the flexibility provided States under such
title to establish the income eligibility level for targeted
low-income children under a State child health plan and the
methodologies used by the State to determine income or assets
under such plan.
SEC. 115. STATE AUTHORITY UNDER MEDICAID.
Notwithstanding any other provision of law, including the fourth
sentence of subsection (b) of section 1905 of the Social Security Act
(42 U.S.C. 1396d) or subsection (u) of such section, at State option,
the Secretary shall provide the State with the Federal medical
assistance percentage determined for the State for Medicaid with
respect to expenditures described in section 1905(u)(2)(A) of such Act
or otherwise made to provide medical assistance under Medicaid to a
child who could be covered by the State under CHIP.
TITLE II--OUTREACH AND ENROLLMENT
Subtitle A--Outreach and Enrollment Activities
SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUNDING FOR OUTREACH AND
ENROLLMENT.
(a) Grants.--Title XXI (42 U.S.C. 1397aa et seq.), as amended by
section 111, is amended by adding at the end the following:
``SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT.
``(a) Outreach and Enrollment Grants; National Campaign.--
``(1) In general.--From the amounts appropriated under
subsection (g), subject to paragraph (2), the Secretary shall
award grants to eligible entities during the period of fiscal
years 2009 through 2013 to conduct outreach and enrollment
efforts that are designed to increase the enrollment and
participation of eligible children under this title and title
XIX.
``(2) Ten percent set aside for national enrollment
campaign.--An amount equal to 10 percent of such amounts shall
be used by the Secretary for expenditures during such period to
carry out a national enrollment campaign in accordance with
subsection (h).
``(b) Priority for Award of Grants.--
``(1) In general.--In awarding grants under subsection (a),
the Secretary shall give priority to eligible entities that--
``(A) propose to target geographic areas with high
rates of--
``(i) eligible but unenrolled children,
including such children who reside in rural
areas; or
``(ii) racial and ethnic minorities and
health disparity populations, including those
proposals that address cultural and linguistic
barriers to enrollment; and
``(B) submit the most demonstrable evidence
required under paragraphs (1) and (2) of subsection
(c).
``(2) Ten percent set aside for outreach to indian
children.--An amount equal to 10 percent of the funds
appropriated under subsection (g) shall be used by the
Secretary to award grants to Indian Health Service providers
and urban Indian organizations receiving funds under title V of
the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.)
for outreach to, and enrollment of, children who are Indians.
``(c) Application.--An eligible entity that desires to receive a
grant under subsection (a) shall submit an application to the Secretary
in such form and manner, and containing such information, as the
Secretary may decide. Such application shall include--
``(1) evidence demonstrating that the entity includes
members who have access to, and credibility with, ethnic or
low-income populations in the communities in which activities
funded under the grant are to be conducted;
``(2) evidence demonstrating that the entity has the
ability to address barriers to enrollment, such as lack of
awareness of eligibility, stigma concerns and punitive fears
associated with receipt of benefits, and other cultural
barriers to applying for and receiving child health assistance
or medical assistance;
``(3) specific quality or outcomes performance measures to
evaluate the effectiveness of activities funded by a grant
awarded under this section; and
``(4) an assurance that the eligible entity shall--
``(A) conduct an assessment of the effectiveness of
such activities against the performance measures;
``(B) cooperate with the collection and reporting
of enrollment data and other information in order for
the Secretary to conduct such assessments; and
``(C) in the case of an eligible entity that is not
the State, provide the State with enrollment data and
other information as necessary for the State to make
necessary projections of eligible children and pregnant
women.
``(d) Dissemination of Enrollment Data and Information Determined
From Effectiveness Assessments; Annual Report.--The Secretary shall--
``(1) make publicly available the enrollment data and
information collected and reported in accordance with
subsection (c)(4)(B); and
``(2) submit an annual report to Congress on the outreach
and enrollment activities conducted with funds appropriated
under this section.
``(e) Maintenance of Effort for States Awarded Grants; No Match
Required for Any Eligible Entity Awarded a Grant.--
``(1) State maintenance of effort.--In the case of a State
that is awarded a grant under this section, the State share of
funds expended for outreach and enrollment activities under the
State child health plan shall not be less than the State share
of such funds expended in the fiscal year preceding the first
fiscal year for which the grant is awarded.
``(2) No matching requirement.--No eligible entity awarded
a grant under subsection (a) shall be required to provide any
matching funds as a condition for receiving the grant.
``(f) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means
any of the following:
``(A) A State with an approved child health plan
under this title.
``(B) A local government.
``(C) An Indian tribe or tribal consortium, a
tribal organization, an urban Indian organization
receiving funds under title V of the Indian Health Care
Improvement Act (25 U.S.C. 1651 et seq.), or an Indian
Health Service provider.
``(D) A Federal health safety net organization.
``(E) A national, State, local, or community-based
public or nonprofit private organization, including
organizations that use community health workers or
community-based doula programs.
``(F) A faith-based organization or consortia, to
the extent that a grant awarded to such an entity is
consistent with the requirements of section 1955 of the
Public Health Service Act (42 U.S.C. 300x-65) relating
to a grant award to nongovernmental entities.
``(G) An elementary or secondary school.
``(2) Federal health safety net organization.--The term
`Federal health safety net organization' means--
``(A) a Federally-qualified health center (as
defined in section 1905(l)(2)(B));
``(B) a hospital defined as a disproportionate
share hospital for purposes of section 1923;
``(C) a covered entity described in section
340B(a)(4) of the Public Health Service Act (42 U.S.C.
256b(a)(4)); and
``(D) any other entity or consortium that serves
children under a federally funded program, including
the special supplemental nutrition program for women,
infants, and children (WIC) established under section
17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786),
the Head Start and Early Head Start programs under the
Head Start Act (42 U.S.C. 9801 et seq.), the school
lunch program established under the Richard B. Russell
National School Lunch Act, and an elementary or
secondary school.
``(3) Indians; indian tribe; tribal organization; urban
indian organization.--The terms `Indian', `Indian tribe',
`tribal organization', and `urban Indian organization' have the
meanings given such terms in section 4 of the Indian Health
Care Improvement Act (25 U.S.C. 1603).
``(4) Community health worker.--The term `community health
worker' means an individual who promotes health or nutrition
within the community in which the individual resides--
``(A) by serving as a liaison between communities
and health care agencies;
``(B) by providing guidance and social assistance
to community residents;
``(C) by enhancing community residents' ability to
effectively communicate with health care providers;
``(D) by providing culturally and linguistically
appropriate health or nutrition education;
``(E) by advocating for individual and community
health or nutrition needs; and
``(F) by providing referral and followup services.
``(g) Appropriation.--There is appropriated, out of any money in
the Treasury not otherwise appropriated, $100,000,000 for the period of
fiscal years 2009 through 2013, for the purpose of awarding grants
under this section. Amounts appropriated and paid under the authority
of this section shall be in addition to amounts appropriated under
section 2104 and paid to States in accordance with section 2105,
including with respect to expenditures for outreach activities in
accordance with subsections (a)(1)(D)(iii) and (c)(2)(C) of that
section.
``(h) National Enrollment Campaign.--From the amounts made
available under subsection (a)(2), the Secretary shall develop and
implement a national enrollment campaign to improve the enrollment of
underserved child populations in the programs established under this
title and title XIX. Such campaign may include--
``(1) the establishment of partnerships with the Secretary
of Education and the Secretary of Agriculture to develop
national campaigns to link the eligibility and enrollment
systems for the assistance programs each Secretary administers
that often serve the same children;
``(2) the integration of information about the programs
established under this title and title XIX in public health
awareness campaigns administered by the Secretary;
``(3) increased financial and technical support for
enrollment hotlines maintained by the Secretary to ensure that
all States participate in such hotlines;
``(4) the establishment of joint public awareness outreach
initiatives with the Secretary of Education and the Secretary
of Labor regarding the importance of health insurance to
building strong communities and the economy;
``(5) the development of special outreach materials for
Native Americans or for individuals with limited English
proficiency; and
``(6) such other outreach initiatives as the Secretary
determines would increase public awareness of the programs
under this title and title XIX.''.
(b) Enhanced Administrative Funding for Translation or
Interpretation Services Under CHIP and Medicaid.--
(1) CHIP.--Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as
amended by section 113, is amended--
(A) in the matter preceding subparagraph (A), by
inserting ``(or, in the case of expenditures described
in subparagraph (D)(iv), the higher of 75 percent or
the sum of the enhanced FMAP plus 5 percentage
points)'' after ``enhanced FMAP''; and
(B) in subparagraph (D)--
(i) in clause (iii), by striking ``and'' at
the end;
(ii) by redesignating clause (iv) as clause
(v); and
(iii) by inserting after clause (iii) the
following new clause:
``(iv) for translation or interpretation
services in connection with the enrollment of,
retention of, and use of services under this
title by, individuals for whom English is not
their primary language (as found necessary by
the Secretary for the proper and efficient
administration of the State plan); and''.
(2) Medicaid.--
(A) Use of medicaid funds.--Section 1903(a)(2) (42
U.S.C. 1396b(a)(2)) is amended by adding at the end the
following new subparagraph:
``(E) an amount equal to 75 percent of so much of the sums
expended during such quarter (as found necessary by the
Secretary for the proper and efficient administration of the
State plan) as are attributable to translation or
interpretation services in connection with the enrollment of,
retention of, and use of services under this title by, children
of families for whom English is not the primary language;
plus''.
(B) Use of community health workers for outreach
activities.--
(i) In general.--Section 2102(c)(1) of such
Act (42 U.S.C. 1397bb(c)(1)) is amended by
inserting ``(through community health workers
and others)'' after ``Outreach''.
(ii) In federal evaluation.--Section
2108(c)(3)(B) of such Act (42 U.S.C.
1397hh(c)(3)(B)) is amended by inserting
``(such as through community health workers and
others)'' after ``including practices''.
SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS.
(a) In General.--Section 1139 (42 U.S.C. 1320b-9) is amended to
read as follows:
``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE FOR
INDIANS UNDER TITLES XIX AND XXI.
``(a) Agreements With States for Medicaid and CHIP Outreach On or
Near Reservations To Increase the Enrollment of Indians in Those
Programs.--
``(1) In general.--In order to improve the access of
Indians residing on or near a reservation to obtain benefits
under the Medicaid and State children's health insurance
programs established under titles XIX and XXI, the Secretary
shall encourage the State to take steps to provide for
enrollment on or near the reservation. Such steps may include
outreach efforts such as the outstationing of eligibility
workers, entering into agreements with the Indian Health
Service, Indian Tribes, Tribal Organizations, and Urban Indian
Organizations to provide outreach, education regarding
eligibility and benefits, enrollment, and translation services
when such services are appropriate.
``(2) Construction.--Nothing in paragraph (1) shall be
construed as affecting arrangements entered into between States
and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations for such Service,
Tribes, or Organizations to conduct administrative activities
under such titles.
``(b) Requirement To Facilitate Cooperation.--The Secretary, acting
through the Centers for Medicare & Medicaid Services, shall take such
steps as are necessary to facilitate cooperation with, and agreements
between, States and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations with respect to the
provision of health care items and services to Indians under the
programs established under title XIX or XXI.
``(c) Definition of Indian; Indian Tribe; Indian Health Program;
Tribal Organization; Urban Indian Organization.--In this section, the
terms `Indian', `Indian Tribe', `Indian Health Program', `Tribal
Organization', and `Urban Indian Organization' have the meanings given
those terms in section 4 of the Indian Health Care Improvement Act.''.
(b) Nonapplication of 10 Percent Limit on Outreach and Certain
Other Expenditures.--Section 2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is
amended by adding at the end the following:
``(C) Nonapplication to certain expenditures.--The
limitation under subparagraph (A) shall not apply with
respect to the following expenditures:
``(i) Expenditures to increase outreach to,
and the enrollment of, indian children under
this title and title xix.--Expenditures for
outreach activities to families of Indian
children likely to be eligible for child health
assistance under the plan or medical assistance
under the State plan under title XIX (or under
a waiver of such plan), to inform such families
of the availability of, and to assist them in
enrolling their children in, such plans,
including such activities conducted under
grants, contracts, or agreements entered into
under section 1139(a).''.
SEC. 203. STATE OPTION TO RELY ON FINDINGS FROM AN EXPRESS LANE AGENCY
TO CONDUCT SIMPLIFIED ELIGIBILITY DETERMINATIONS.
(a) Application Under Medicaid and CHIP Programs.--
(1) Medicaid.--Section 1902(e) (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 (G)), 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 (F)) 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) and 1137(d) or 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 subparagraphs (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.
``(IV) Verification of citizenship or
nationality status.--The State shall satisfy
the requirements of section 1902(a)(46)(B) or
2105(c)(9), as applicable for verifications of
citizenship or nationality status.
``(V) Coding.--The State meets the
requirements of subparagraph (E).
``(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 CHIP 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 chip 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 chip 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.--The State may initiate and
determine eligibility for medical assistance under the
State Medicaid plan or for child health assistance
under the State CHIP plan without a program application
from, or on behalf of, the child based on data obtained
from sources other than the child (or the child's
family), but a child can only be automatically enrolled
in the State Medicaid plan or the State CHIP plan if
the child or the family affirmatively consents to being
enrolled through affirmation in writing, by telephone,
orally, through electronic signature, or through any
other means specified by the Secretary or by signature
on an Express Lane agency application, if the
requirement of clause (ii) is met.
``(ii) 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) Coding; application to enrollment error rates.--
``(i) In general.--For purposes of subparagraph
(A)(iv), the requirement of this subparagraph for a
State is that the State agrees to--
``(I) assign such codes as the Secretary
shall require to the children who are enrolled
in the State Medicaid plan or the State CHIP
plan through reliance on a finding made by an
Express Lane agency for the duration of the
State's election under this paragraph;
``(II) annually provide the Secretary with
a statistically valid sample (that is approved
by Secretary) of the children enrolled in such
plans through reliance on such a finding by
conducting a full Medicaid eligibility review
of the children identified for such sample for
purposes of determining an eligibility error
rate (as described in clause (iv)) with respect
to the enrollment of such children (and shall
not include such children in any data or
samples used for purposes of complying with a
Medicaid Eligibility Quality Control (MEQC)
review or a payment error rate measurement
(PERM) requirement);
``(III) submit the error rate determined
under subclause (II) to the Secretary;
``(IV) if such error rate exceeds 3 percent
for either of the first 2 fiscal years in which
the State elects to apply this paragraph,
demonstrate to the satisfaction of the
Secretary the specific corrective actions
implemented by the State to improve upon such
error rate; and
``(V) if such error rate exceeds 3 percent
for any fiscal year in which the State elects
to apply this paragraph, a reduction in the
amount otherwise payable to the State under
section 1903(a) for quarters for that fiscal
year, equal to the total amount of erroneous
excess payments determined for the fiscal year
only with respect to the children included in
the sample for the fiscal year that are in
excess of a 3 percent error rate with respect
to such children.
``(ii) No punitive action based on error rate.--The
Secretary shall not apply the error rate derived from
the sample under clause (i) to the entire population of
children enrolled in the State Medicaid plan or the
State CHIP plan through reliance on a finding made by
an Express Lane agency, or to the population of
children enrolled in such plans on the basis of the
State's regular procedures for determining eligibility,
or penalize the State on the basis of such error rate
in any manner other than the reduction of payments
provided for under clause (i)(V).
``(iii) Rule of construction.--Nothing in this
paragraph shall be construed as relieving a State that
elects to apply this paragraph from being subject to a
penalty under section 1903(u), for payments made under
the State Medicaid plan with respect to ineligible
individuals and families that are determined to exceed
the error rate permitted under that section (as
determined without regard to the error rate determined
under clause (i)(II)).
``(iv) Error rate defined.--In this subparagraph,
the term `error rate' means the rate of erroneous
excess payments for medical assistance (as defined in
section 1903(u)(1)(D)) for the period involved, except
that such payments shall be limited to individuals for
which eligibility determinations are made under this
paragraph and except that in applying this paragraph
under title XXI, there shall be substituted for
references to provisions of this title corresponding
provisions within title XXI.
``(F) Express lane agency.--
``(i) In general.--In this paragraph, the term
`Express Lane agency' means a public agency that--
``(I) is determined by the State Medicaid
agency or the State CHIP agency (as applicable)
to be capable of making the determinations of
one or more eligibility requirements described
in subparagraph (A)(i);
``(II) is identified in the State Medicaid
plan or the State CHIP plan; and
``(III) notifies the child's family--
``(aa) of the information which
shall be disclosed in accordance with
this paragraph;
``(bb) that the information
disclosed will be used solely for
purposes of determining eligibility for
medical assistance under the State
Medicaid plan or for child health
assistance under the State CHIP plan;
and
``(cc) that the family may elect to
not have the information disclosed for
such purposes; and
``(IV) enters into, or is subject to, an
interagency agreement to limit the disclosure
and use of the information disclosed.
``(ii) Inclusion of specific public agencies.--Such
term includes the following:
``(I) A public agency that determines
eligibility for assistance under any of the
following:
``(aa) The temporary assistance for
needy families program funded under
part A of title IV.
``(bb) A State program funded under
part D of title IV.
``(cc) The State Medicaid plan.
``(dd) The State CHIP plan.
``(ee) The Food and Nutrition Act
of 2008 (7 U.S.C. 2011 et seq.).
``(ff) The Head Start Act (42
U.S.C. 9801 et seq.).
``(gg) The Richard B. Russell
National School Lunch Act (42 U.S.C.
1751 et seq.).
``(hh) The Child Nutrition Act of
1966 (42 U.S.C. 1771 et seq.).
``(ii) The Child Care and
Development Block Grant Act of 1990 (42
U.S.C. 9858 et seq.).
``(jj) The Stewart B. McKinney
Homeless Assistance Act (42 U.S.C.
11301 et seq.).
``(kk) The United States Housing
Act of 1937 (42 U.S.C. 1437 et seq.).
``(ll) The Native American Housing
Assistance and Self-Determination Act
of 1996 (25 U.S.C. 4101 et seq.).
``(II) A State-specified governmental
agency that has fiscal liability or legal
responsibility for the accuracy of the
eligibility determination findings relied on by
the State.
``(III) A public agency that is subject to
an interagency agreement limiting the
disclosure and use of the information disclosed
for purposes of determining eligibility under
the State Medicaid plan or the State CHIP plan.
``(iii) Exclusions.--Such term does not include an
agency that determines eligibility for a program
established under the Social Services Block Grant
established under title XX or a private, for-profit
organization.
``(iv) Rules of construction.--Nothing in this
paragraph shall be construed as--
``(I) exempting a State Medicaid agency
from complying with the requirements of section
1902(a)(4) relating to merit-based personnel
standards for employees of the State Medicaid
agency and safeguards against conflicts of
interest); or
``(II) authorizing a State Medicaid agency
that elects to use Express Lane agencies under
this subparagraph to use the Express Lane
option to avoid complying with such
requirements for purposes of making eligibility
determinations under the State Medicaid plan.
``(v) Additional definitions.--In this paragraph:
``(I) State.--The term `State' means 1 of
the 50 States or the District of Columbia.
``(II) State chip agency.--The term `State
CHIP agency' means the State agency responsible
for administering the State CHIP plan.
``(III) State chip plan.--The term `State
CHIP plan' means the State child health plan
established under title XXI and includes any
waiver of such plan.
``(IV) State medicaid agency.--The term
`State Medicaid agency' means the State agency
responsible for administering the State
Medicaid plan.
``(V) State medicaid plan.--The term `State
Medicaid plan' means the State plan established
under title XIX and includes any waiver of such
plan.
``(G) 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.
``(H) State option to rely on state income tax data or
return.--At the option of the State, a finding from an Express
Lane agency may include gross income or adjusted gross income
shown by State income tax records or returns.
``(I) Application.--This paragraph shall not apply with
respect to eligibility determinations made after September 30,
2013.''.
(2) CHIP.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is
amended by redesignating subparagraphs (B), (C), and (D) as
subparagraphs (C), (D), and (E), respectively, 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).''.
(b) Evaluation and Report.--
(1) Evaluation.--The Secretary shall conduct, by grant,
contract, or interagency agreement, a comprehensive,
independent evaluation of the option provided under the
amendments made by subsection (a). Such evaluation shall
include an analysis of the effectiveness of the option, and
shall include--
(A) obtaining a statistically valid sample of the
children who were enrolled in the State Medicaid plan
or the State CHIP plan through reliance on a finding
made by an Express Lane agency and determining the
percentage of children who were erroneously enrolled in
such plans;
(B) determining whether enrolling children in such
plans through reliance on a finding made by an Express
Lane agency improves the ability of a State to identify
and enroll low-income, uninsured children who are
eligible but not enrolled in such plans;
(C) evaluating the administrative costs or savings
related to identifying and enrolling children in such
plans through reliance on such findings, and the extent
to which such costs differ from the costs that the
State otherwise would have incurred to identify and
enroll low-income, uninsured children who are eligible
but not enrolled in such plans; and
(D) any recommendations for legislative or
administrative changes that would improve the
effectiveness of enrolling children in such plans
through reliance on such findings.
(2) Report to congress.--Not later than September 30, 2012,
the Secretary shall submit a report to Congress on the results
of the evaluation under paragraph (1).
(3) Funding.--
(A) In general.--Out of any funds in the Treasury
not otherwise appropriated, there is appropriated to
the Secretary to carry out the evaluation under this
subsection $5,000,000 for the period of fiscal years
2009 through 2012.
(B) Budget authority.--Subparagraph (A) constitutes
budget authority in advance of appropriations Act and
represents the obligation of the Federal Government to
provide for the payment of such amount to conduct the
evaluation under this subsection.
(c) Electronic Transmission of Information.--Section 1902 (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 is amended by adding at the end
the following new section:
``SEC. 1942. AUTHORIZATION TO RECEIVE RELEVANT 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 directly relevant 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) Penalties for Improper Disclosure.--
``(1) Civil money 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 is subject to a civil
money penalty in an amount equal to $10,000 for each such
unauthorized publication or disclosure. The provisions of
section 1128A (other than subsections (a) and (b) and the
second sentence of subsection (f)) shall apply to a civil money
penalty under this paragraph in the same manner as such
provisions apply to a penalty or proceeding under section
1128A(a).
``(2) Criminal penalty.--A private entity described in the
subsection (a) that willfully 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 $10,000 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)
(42 U.S.C. 1397gg(e)(1)), as amended by subsection (a)(2), is
amended by adding at the end the following new subparagraph:
``(F) Section 1942 (relating to authorization to
receive data directly relevant to eligibility
determinations).''.
(3) Conforming amendment to provide access to data about
enrollment in insurance for purposes of evaluating applications
and for chip.--Section 1902(a)(25)(I)(i) (42 U.S.C.
1396a(a)(25)(I)(i)) is amended--
(A) by inserting ``(and, at State option,
individuals who apply or whose eligibility for medical
assistance is being evaluated in accordance with
section 1902(e)(13)(D))'' 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) Authorization for States Electing Express Lane Option To
Receive Certain Data Directly Relevant To Determining Eligibility and
Correct Amount of Assistance.--The Secretary shall enter into such
agreements as are necessary to permit a State that elects the Express
Lane option under section 1902(e)(13) of the Social Security Act to
receive data directly relevant to eligibility determinations and
determining the correct amount of benefits under a State child health
plan under CHIP or a State plan under Medicaid from the following:
(1) The National Directory of New Hires established under
section 453(i) of the Social Security Act (42 U.S.C. 653(i)).
(2) Data regarding enrollment in insurance that may help to
facilitate outreach and enrollment under the State Medicaid
plan, the State CHIP plan, and such other programs as the
Secretary may specify.
(f) Effective Date.--The amendments made by this section are
effective on the date of the enactment of this Act.
Subtitle B--Reducing Barriers to Enrollment
SEC. 211. VERIFICATION OF DECLARATION OF CITIZENSHIP OR NATIONALITY FOR
PURPOSES OF ELIGIBILITY FOR MEDICAID AND CHIP.
(a) Alternative State Process for Verification of Declaration of
Citizenship or Nationality for Purposes of Eligibility for Medicaid.--
(1) Alternative to documentation requirement.--
(A) In general.--Section 1902 (42 U.S.C. 1396a), as
amended by section 203(c), is amended--
(i) in subsection (a)(46)--
(I) by inserting ``(A)'' after
``(46)'';
(II) by adding ``and'' after the
semicolon; and
(III) by adding at the end the
following new subparagraph:
``(B) provide, with respect to an individual declaring to
be a citizen or national of the United States for purposes of
establishing eligibility under this title, that the State shall
satisfy the requirements of--
``(i) section 1903(x); or
``(ii) subsection (ee);''; and
(ii) by adding at the end the following new
subsection:
``(ee)(1) For purposes of subsection (a)(46)(B)(ii), the
requirements of this subsection with respect to an individual declaring
to be a citizen or national of the United States for purposes of
establishing eligibility under this title, are, in lieu of requiring
the individual to present satisfactory documentary evidence of
citizenship or nationality under section 1903(x) (if the individual is
not described in paragraph (2) of that section), as follows:
``(A) The State submits the name and social security number
of the individual to the Commissioner of Social Security as
part of the program established under paragraph (2).
``(B) If the State receives notice from the Commissioner of
Social Security that the name or social security number, or the
declaration of citizenship or nationality, of the individual is
inconsistent with information in the records maintained by the
Commissioner--
``(i) the State makes a reasonable effort to
identify and address the causes of such inconsistency,
including through typographical or other clerical
errors, by contacting the individual to confirm the
accuracy of the name or social security number
submitted or declaration of citizenship or nationality
and by taking such additional actions as the Secretary,
through regulation or other guidance, or the State may
identify, and continues to provide the individual with
medical assistance while making such effort; and
``(ii) in the case such inconsistency is not
resolved under clause (i), the State--
``(I) notifies the individual of such fact;
``(II) provides the individual with a
period of 90 days from the date on which the
notice required under subclause (I) is received
by the individual to either present
satisfactory documentary evidence of
citizenship or nationality (as defined in
section 1903(x)(3)) or resolve the
inconsistency with the Commissioner of Social
Security (and continues to provide the
individual with medical assistance during such
90-day period); and
``(III) disenrolls the individual from the
State plan under this title within 30 days
after the end of such 90-day period if no such
documentary evidence is presented or if such
inconsistency is not resolved.
``(2)(A) Each State electing to satisfy the requirements of this
subsection for purposes of section 1902(a)(46)(B) shall establish a
program under which the State submits at least monthly to the
Commissioner of Social Security for comparison of the name and social
security number, of each individual newly enrolled in the State plan
under this title that month who is not described in section 1903(x)(2)
and who declares to be a United States citizen or national, with
information in records maintained by the Commissioner.
``(B) In establishing the State program under this paragraph, the
State may enter into an agreement with the Commissioner of Social
Security--
``(i) to provide, through an on-line system or otherwise,
for the electronic submission of, and response to, the
information submitted under subparagraph (A) for an individual
enrolled in the State plan under this title who declares to be
citizen or national on at least a monthly basis; or
``(ii) to provide for a determination of the consistency of
the information submitted with the information maintained in
the records of the Commissioner through such other method as
agreed to by the State and the Commissioner and approved by the
Secretary, provided that such method is no more burdensome for
individuals to comply with than any burdens that may apply
under a method described in clause (i).
``(C) The program established under this paragraph shall provide
that, in the case of any individual who is required to submit a social
security number to the State under subparagraph (A) and who is unable
to provide the State with such number, shall be provided with at least
the reasonable opportunity to present satisfactory documentary evidence
of citizenship or nationality (as defined in section 1903(x)(3)) as is
provided under clauses (i) and (ii) of section 1137(d)(4)(A) to an
individual for the submittal to the State of evidence indicating a
satisfactory immigration status.
``(3)(A) The State agency implementing the plan approved under this
title shall, at such times and in such form as the Secretary may
specify, provide information on the percentage each month that the
inconsistent submissions bears to the total submissions made for
comparison for such month. For purposes of this subparagraph, a name,
social security number, or declaration of citizenship or nationality of
an individual shall be treated as inconsistent and included in the
determination of such percentage only if--
``(i) the information submitted by the individual is not
consistent with information in records maintained by the
Commissioner of Social Security;
``(ii) the inconsistency is not resolved by the State;
``(iii) the individual was provided with a reasonable
period of time to resolve the inconsistency with the
Commissioner of Social Security or provide satisfactory
documentation of citizenship status and did not successfully
resolve such inconsistency; and
``(iv) payment has been made for an item or service
furnished to the individual under this title.
``(B) If, for any fiscal year, the average monthly percentage
determined under subparagraph (A) is greater than 3 percent--
``(i) the State shall develop and adopt a corrective plan
to review its procedures for verifying the identities of
individuals seeking to enroll in the State plan under this
title and to identify and implement changes in such procedures
to improve their accuracy; and
``(ii) pay to the Secretary an amount equal to the amount
which bears the same ratio to the total payments under the
State plan for the fiscal year for providing medical assistance
to individuals who provided inconsistent information as the
number of individuals with inconsistent information in excess
of 3 percent of such total submitted bears to the total number
of individuals with inconsistent information.
``(C) The Secretary may waive, in certain limited cases, all or
part of the payment under subparagraph (B)(ii) if the State is unable
to reach the allowable error rate despite a good faith effort by such
State.
``(D) Subparagraphs (A) and (B) shall not apply to a State for a
fiscal year if there is an agreement described in paragraph (2)(B) in
effect as of the close of the fiscal year that provides for the
submission on a real-time basis of the information described in such
paragraph.
``(4) Nothing in this subsection shall affect the rights of any
individual under this title to appeal any disenrollment from a State
plan.''.
(B) Costs of implementing and maintaining system.--
Section 1903(a)(3) (42 U.S.C. 1396b(a)(3)) is amended--
(i) by striking ``plus'' at the end of
subparagraph (E) and inserting ``and'', and
(ii) by adding at the end the following new
subparagraph:
``(F)(i) 90 percent of the sums expended during the
quarter as are attributable to the design, development,
or installation of such mechanized verification and
information retrieval systems as the Secretary
determines are necessary to implement section 1902(ee)
(including a system described in paragraph (2)(B)
thereof), and
``(ii) 75 percent of the sums expended during the
quarter as are attributable to the operation of systems
to which clause (i) applies, plus''.
(2) Limitation on waiver authority.--Notwithstanding any
provision of section 1115 of the Social Security Act (42 U.S.C.
1315), or any other provision of law, the Secretary may not
waive the requirements of section 1902(a)(46)(B) of such Act
(42 U.S.C. 1396a(a)(46)(B)) with respect to a State.
(3) Conforming amendments.--Section 1903 (42 U.S.C. 1396b)
is amended--
(A) in subsection (i)(22), by striking ``subsection
(x)'' and inserting ``section 1902(a)(46)(B)''; and
(B) in subsection (x)(1), by striking ``subsection
(i)(22)'' and inserting ``section 1902(a)(46)(B)(i)''.
(4) Appropriation.--Out of any money in the Treasury of the
United States not otherwise appropriated, there are
appropriated to the Commissioner of Social Security $5,000,000
to remain available until expended to carry out the
Commissioner's responsibilities under section 1902(ee) of the
Social Security Act, as added by subsection (a).
(b) Clarification of Requirements Relating to Presentation of
Satisfactory Documentary Evidence of Citizenship or Nationality.--
(1) Acceptance of documentary evidence issued by a
federally recognized indian tribe.--Section 1903(x)(3)(B) (42
U.S.C. 1396b(x)(3)(B)) is amended--
(A) by redesignating clause (v) as clause (vi); and
(B) by inserting after clause (iv), the following
new clause:
``(v)(I) Except as provided in subclause (II), a document
issued by a federally recognized Indian tribe evidencing
membership or enrollment in, or affiliation with, such tribe
(such as a tribal enrollment card or certificate of degree of
Indian blood).
``(II) With respect to those federally recognized Indian
tribes located within States having an international border
whose membership includes individuals who are not citizens of
the United States, the Secretary shall, after consulting with
such tribes, issue regulations authorizing the presentation of
such other forms of documentation (including tribal
documentation, if appropriate) that the Secretary determines to
be satisfactory documentary evidence of citizenship or
nationality for purposes of satisfying the requirement of this
subsection.''.
(2) Requirement to provide reasonable opportunity to
present satisfactory documentary evidence.--Section 1903(x) (42
U.S.C. 1396b(x)) is amended by adding at the end the following
new paragraph:
``(4) In the case of an individual declaring to be a citizen or
national of the United States with respect to whom a State requires the
presentation of satisfactory documentary evidence of citizenship or
nationality under section 1902(a)(46)(B)(i), the individual shall be
provided at least the reasonable opportunity to present satisfactory
documentary evidence of citizenship or nationality under this
subsection as is provided under clauses (i) and (ii) of section
1137(d)(4)(A) to an individual for the submittal to the State of
evidence indicating a satisfactory immigration status.''.
(3) Children born in the united states to mothers eligible
for medicaid.--
(A) Clarification of rules.--Section 1903(x) (42
U.S.C. 1396b(x)), as amended by paragraph (2), is
amended--
(i) in paragraph (2)--
(I) in subparagraph (C), by
striking ``or'' at the end;
(II) by redesignating subparagraph
(D) as subparagraph (E); and
(III) by inserting after
subparagraph (C) the following new
subparagraph:
``(D) pursuant to the application of section 1902(e)(4)
(and, in the case of an individual who is eligible for medical
assistance on such basis, the individual shall be deemed to
have provided satisfactory documentary evidence of citizenship
or nationality and shall not be required to provide further
documentary evidence on any date that occurs during or after
the period in which the individual is eligible for medical
assistance on such basis); or''; and
(ii) by adding at the end the following new
paragraph:
``(5) Nothing in subparagraph (A) or (B) of section 1902(a)(46),
the preceding paragraphs of this subsection, or the Deficit Reduction
Act of 2005, including section 6036 of such Act, shall be construed as
changing the requirement of section 1902(e)(4) that a child born in the
United States to an alien mother for whom medical assistance for the
delivery of such child is available as treatment of an emergency
medical condition pursuant to subsection (v) shall be deemed eligible
for medical assistance during the first year of such child's life.''.
(B) State requirement to issue separate
identification number.--Section 1902(e)(4) (42 U.S.C.
1396a(e)(4)) is amended by adding at the end the
following new sentence: ``Notwithstanding the preceding
sentence, in the case of a child who is born in the
United States to an alien mother for whom medical
assistance for the delivery of the child is made
available pursuant to section 1903(v), the State
immediately shall issue a separate identification
number for the child upon notification by the facility
at which such delivery occurred of the child's
birth.''.
(4) Technical amendments.--Section 1903(x)(2) (42 U.S.C.
1396b(x)) is amended--
(A) in subparagraph (B)--
(i) by realigning the left margin of the
matter preceding clause (i) 2 ems to the left;
and
(ii) by realigning the left margins of
clauses (i) and (ii), respectively, 2 ems to
the left; and
(B) in subparagraph (C)--
(i) by realigning the left margin of the
matter preceding clause (i) 2 ems to the left;
and
(ii) by realigning the left margins of
clauses (i) and (ii), respectively, 2 ems to
the left.
(c) Application of Documentation System to CHIP.--
(1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by section 114(a), is amended by adding at the end the
following new paragraph:
``(9) Citizenship documentation requirements.--
``(A) In general.--No payment may be made under
this section with respect to an individual who has, or
is, declared to be a citizen or national of the United
States for purposes of establishing eligibility under
this title unless the State meets the requirements of
section 1902(a)(46)(B) with respect to the individual.
``(B) Enhanced payments.--Notwithstanding
subsection (b), the enhanced FMAP with respect to
payments under subsection (a) for expenditures
described in clause (i) or (ii) of section
1903(a)(3)(F) necessary to comply with subparagraph (A)
shall in no event be less than 90 percent and 75
percent, respectively.''.
(2) Nonapplication of administrative expenditures cap.--
Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended
by section 202(b), is amended by adding at the end the
following:
``(ii) Expenditures to comply with
citizenship or nationality verification
requirements.--Expenditures necessary for the
State to comply with paragraph (9)(A).''.
(d) Effective Date.--
(1) In general.--
(A) In general.--Except as provided in subparagraph
(B), the amendments made by this section shall take
effect on January 1, 2010.
(B) Technical amendments.--The amendments made by--
(i) paragraphs (1), (2), and (3) of
subsection (b) shall take effect as if included
in the enactment of section 6036 of the Deficit
Reduction Act of 2005 (Public Law 109-171; 120
Stat. 80); and
(ii) paragraph (4) of subsection (b) shall
take effect as if included in the enactment of
section 405 of division B of the Tax Relief and
Health Care Act of 2006 (Public Law 109-432;
120 Stat. 2996).
(2) Restoration of eligibility.--In the case of an
individual who, during the period that began on July 1, 2006,
and ends on October 1, 2009, was determined to be ineligible
for medical assistance under a State Medicaid plan, including
any waiver of such plan, solely as a result of the application
of subsections (i)(22) and (x) of section 1903 of the Social
Security Act (as in effect during such period), but who would
have been determined eligible for such assistance if such
subsections, as amended by subsection (b), had applied to the
individual, a State may deem the individual to be eligible for
such assistance as of the date that the individual was
determined to be ineligible for such medical assistance on such
basis.
(3) Special transition rule for indians.--During the period
that begins on July 1, 2006, and ends on the effective date of
final regulations issued under subclause (II) of section
1903(x)(3)(B)(v) of the Social Security Act (42 U.S.C.
1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an
individual who is a member of a federally-recognized Indian
tribe described in subclause (II) of that section who presents
a document described in subclause (I) of such section that is
issued by such Indian tribe, shall be deemed to have presented
satisfactory evidence of citizenship or nationality for
purposes of satisfying the requirement of subsection (x) of
section 1903 of such Act.
SEC. 212. REDUCING ADMINISTRATIVE BARRIERS TO ENROLLMENT.
Section 2102(b) (42 U.S.C. 1397bb(b)) is amended--
(1) by redesignating paragraph (4) as paragraph (5); and
(2) by inserting after paragraph (3) the following new
paragraph:
``(4) Reduction of administrative barriers to enrollment.--
``(A) In general.--Subject to subparagraph (B), the
plan shall include a description of the procedures used
to reduce administrative barriers to the enrollment of
children and pregnant women who are eligible for
medical assistance under title XIX or for child health
assistance or health benefits coverage under this
title. Such procedures shall be established and revised
as often as the State determines appropriate to take
into account the most recent information available to
the State identifying such barriers.
``(B) Deemed compliance if joint application and
renewal process that permits application other than in
person.--A State shall be deemed to comply with
subparagraph (A) if the State's application and renewal
forms and supplemental forms (if any) and information
verification process is the same for purposes of
establishing and renewing eligibility for children and
pregnant women for medical assistance under title XIX
and child health assistance under this title, and such
process does not require an application to be made in
person or a face-to-face interview.''.
SEC. 213. MODEL OF INTERSTATE COORDINATED ENROLLMENT AND COVERAGE
PROCESS.
(a) In General.--In order to assure continuity of coverage of low-
income children under the Medicaid program and the State Children's
Health Insurance Program (CHIP), not later than 18 months after the
date of the enactment of this Act, the Secretary of Health and Human
Services, in consultation with State Medicaid and CHIP directors and
organizations representing program beneficiaries, shall develop a model
process for the coordination of the enrollment, retention, and coverage
under such programs of children who, because of migration of families,
emergency evacuations, natural or other disasters, public health
emergencies, educational needs, or otherwise, frequently change their
State of residency or otherwise are temporarily located outside of the
State of their residency.
(b) Report to Congress.--After development of such model process,
the Secretary of Health and Human Services shall submit to Congress a
report describing additional steps or authority needed to make further
improvements to coordinate the enrollment, retention, and coverage
under CHIP and Medicaid of children described in subsection (a).
SEC. 214. PERMITTING STATES TO ENSURE COVERAGE WITHOUT A 5-YEAR DELAY
OF CERTAIN CHILDREN AND PREGNANT WOMEN UNDER THE MEDICAID
PROGRAM AND CHIP.
(a) Medicaid Program.--Section 1903(v) (42 U.S.C. 1396b(v)) is
amended--
(1) in paragraph (1), by striking ``paragraph (2)'' and
inserting ``paragraphs (2) and (4)''; and
(2) by adding at the end the following new paragraph:
``(4)(A) A State may elect (in a plan amendment under this title)
to provide medical assistance under this title, notwithstanding
sections 401(a), 402(b), 403, and 421 of the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996, to children and
pregnant women who are lawfully residing in the United States
(including battered individuals described in section 431(c) of such
Act) and who are otherwise eligible for such assistance, within either
or both of the following eligibility categories:
``(i) Pregnant women.--Women during pregnancy (and during
the 60-day period beginning on the last day of the pregnancy).
``(ii) Children.--Individuals under 21 years of age,
including optional targeted low-income children described in
section 1905(u)(2)(B).
``(B) In the case of a State that has elected to provide medical
assistance to a category of aliens under subparagraph (A), no debt
shall accrue under an affidavit of support against any sponsor of such
an alien on the basis of provision of assistance to such category and
the cost of such assistance shall not be considered as an unreimbursed
cost.
``(C) As part of the State's ongoing eligibility redetermination
requirements and procedures for an individual provided medical
assistance as a result of an election by the State under subparagraph
(A), a State shall verify that the individual continues to lawfully
reside in the United States using the documentation presented to the
State by the individual on initial enrollment. If the State cannot
successfully verify that the individual is lawfully residing in the
United States in this manner, it shall require that the individual
provide the State with further documentation or other evidence to
verify that the individual is lawfully residing in the United
States.''.
(b) CHIP.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as amended
by sections 203(a)(2) and 203(d)(2), is amended by redesignating
subparagraphs (E) and (F) as subparagraphs (F) and (G), respectively
and by inserting after subparagraph (D) the following new subparagraph:
``(E) Paragraph (4) of section 1903(v) (relating to
optional coverage of categories of lawfully residing
immigrant children or pregnant women), but only if the
State has elected to apply such paragraph with respect
to such category of children or pregnant women under
title XIX.''.
TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE
Subtitle A--Additional State Option for Providing Premium Assistance
SEC. 301. ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM ASSISTANCE.
(a) CHIP.--
(1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by sections 114(a) and 211(c), is amended by adding at
the end the following:
``(10) State option to offer premium assistance.--
``(A) In general.--A State may elect to offer a
premium assistance subsidy (as defined in subparagraph
(C)) for qualified employer-sponsored coverage (as
defined in subparagraph (B)) to all targeted low-income
children who are eligible for child health assistance
under the plan and have access to such coverage in
accordance with the requirements of this paragraph. No
subsidy shall be provided to a targeted low-income
child under this paragraph unless the child (or the
child's parent) voluntarily elects to receive such a
subsidy. A State may not require such an election as a
condition of receipt of child health assistance.
``(B) Qualified employer-sponsored coverage.--
``(i) In general.--Subject to clause (ii),
in this paragraph, the term `qualified
employer-sponsored coverage' means a group
health plan or health insurance coverage
offered through an employer--
``(I) that qualifies as creditable
coverage as a group health plan under
section 2701(c)(1) of the Public Health
Service Act;
``(II) for which the employer
contribution toward any premium for
such coverage is at least 40 percent;
and
``(III) that is offered to all
individuals in a manner that would be
considered a nondiscriminatory
eligibility classification for purposes
of paragraph (3)(A)(ii) of section
105(h) of the Internal Revenue Code of
1986 (but determined without regard to
clause (i) of subparagraph (B) of such
paragraph).
``(ii) Exception.--Such term does not
include coverage consisting of--
``(I) benefits provided under a
health flexible spending arrangement
(as defined in section 106(c)(2) of the
Internal Revenue Code of 1986); or
``(II) a high deductible health
plan (as defined in section 223(c)(2)
of such Code), without regard to
whether the plan is purchased in
conjunction with a health savings
account (as defined under section
223(d) of such Code).
``(C) Premium assistance subsidy.--
``(i) In general.--In this paragraph, the
term `premium assistance subsidy' means, with
respect to a targeted low-income child, the
amount equal to the difference between the
employee contribution required for enrollment
only of the employee under qualified employer-
sponsored coverage and the employee
contribution required for enrollment of the
employee and the child in such coverage, less
any applicable premium cost-sharing applied
under the State child health plan (subject to
the limitations imposed under section 2103(e),
including the requirement to count the total
amount of the employee contribution required
for enrollment of the employee and the child in
such coverage toward the annual aggregate cost-
sharing limit applied under paragraph (3)(B) of
such section).
``(ii) State payment option.--A State may
provide a premium assistance subsidy either as
reimbursement to an employee for out-of-pocket
expenditures or, subject to clause (iii),
directly to the employee's employer.
``(iii) Employer opt-out.--An employer may
notify a State that it elects to opt-out of
being directly paid a premium assistance
subsidy on behalf of an employee. In the event
of such a notification, an employer shall
withhold the total amount of the employee
contribution required for enrollment of the
employee and the child in the qualified
employer-sponsored coverage and the State shall
pay the premium assistance subsidy directly to
the employee.
``(iv) Treatment as child health
assistance.--Expenditures for the provision of
premium assistance subsidies shall be
considered child health assistance described in
paragraph (1)(C) of subsection (a) for purposes
of making payments under that subsection.
``(D) Application of secondary payor rules.--The
State shall be a secondary payor for any items or
services provided under the qualified employer-
sponsored coverage for which the State provides child
health assistance under the State child health plan.
``(E) Requirement to provide supplemental coverage
for benefits and cost-sharing protection provided under
the state child health plan.--
``(i) In general.--Notwithstanding section
2110(b)(1)(C), the State shall provide for each
targeted low-income child enrolled in qualified
employer-sponsored coverage, supplemental
coverage consisting of--
``(I) items or services that are
not covered, or are only partially
covered, under the qualified employer-
sponsored coverage; and
``(II) cost-sharing protection
consistent with section 2103(e).
``(ii) Record keeping requirements.--For
purposes of carrying out clause (i), a State
may elect to directly pay out-of-pocket
expenditures for cost-sharing imposed under the
qualified employer-sponsored coverage and
collect or not collect all or any portion of
such expenditures from the parent of the child.
``(F) Application of waiting period imposed under
the state.--Any waiting period imposed under the State
child health plan prior to the provision of child
health assistance to a targeted low-income child under
the State plan shall apply to the same extent to the
provision of a premium assistance subsidy for the child
under this paragraph.
``(G) Opt-out permitted for any month.--A State
shall establish a process for permitting the parent of
a targeted low-income child receiving a premium
assistance subsidy to disenroll the child from the
qualified employer-sponsored coverage and enroll the
child in, and receive child health assistance under,
the State child health plan, effective on the first day
of any month for which the child is eligible for such
assistance and in a manner that ensures continuity of
coverage for the child.
``(H) Application to parents.--If a State provides
child health assistance or health benefits coverage to
parents of a targeted low-income child in accordance
with section 2111(b), the State may elect to offer a
premium assistance subsidy to a parent of a targeted
low-income child who is eligible for such a subsidy
under this paragraph in the same manner as the State
offers such a subsidy for the enrollment of the child
in qualified employer-sponsored coverage, except that--
``(i) the amount of the premium assistance
subsidy shall be increased to take into account
the cost of the enrollment of the parent in the
qualified employer-sponsored coverage or, at
the option of the State if the State determines
it cost-effective, the cost of the enrollment
of the child's family in such coverage; and
``(ii) any reference in this paragraph to a
child is deemed to include a reference to the
parent or, if applicable under clause (i), the
family of the child.
``(I) Additional state option for providing premium
assistance.--
``(i) In general.--A State may establish an
employer-family premium assistance purchasing
pool for employers with less than 250 employees
who have at least 1 employee who is a pregnant
woman eligible for assistance under the State
child health plan (including through the
application of an option described in section
2112(f)) or a member of a family with at least
1 targeted low-income child and to provide a
premium assistance subsidy under this paragraph
for enrollment in coverage made available
through such pool.
``(ii) Access to choice of coverage.--A
State that elects the option under clause (i)
shall identify and offer access to not less
than 2 private health plans that are health
benefits coverage that is equivalent to the
benefits coverage in a benchmark benefit
package described in section 2103(b) or
benchmark-equivalent coverage that meets the
requirements of section 2103(a)(2) for
employees described in clause (i).
``(iii) Clarification of payment for
administrative expenditures.--Nothing in this
subparagraph shall be construed as permitting
payment under this section for administrative
expenditures attributable to the establishment
or operation of such pool, except to the extent
that such payment would otherwise be permitted
under this title.
``(J) No effect on premium assistance waiver
programs.--Nothing in this paragraph shall be construed
as limiting the authority of a State to offer premium
assistance under section 1906 or 1906A, a waiver
described in paragraph (2)(B) or (3), a waiver approved
under section 1115, or other authority in effect prior
to the date of enactment of the Children's Health
Insurance Program Reauthorization Act of 2009.
``(K) Notice of availability.--If a State elects to
provide premium assistance subsidies in accordance with
this paragraph, the State shall--
``(i) include on any application or
enrollment form for child health assistance a
notice of the availability of premium
assistance subsidies for the enrollment of
targeted low-income children in qualified
employer-sponsored coverage;
``(ii) provide, as part of the application
and enrollment process under the State child
health plan, information describing the
availability of such subsidies and how to elect
to obtain such a subsidy; and
``(iii) establish such other procedures as
the State determines necessary to ensure that
parents are fully informed of the choices for
receiving child health assistance under the
State child health plan or through the receipt
of premium assistance subsidies.
``(L) Application to qualified employer-sponsored
benchmark coverage.--If a group health plan or health
insurance coverage offered through an employer is
certified by an actuary as health benefits coverage
that is equivalent to the benefits coverage in a
benchmark benefit package described in section 2103(b)
or benchmark-equivalent coverage that meets the
requirements of section 2103(a)(2), the State may
provide premium assistance subsidies for enrollment of
targeted low-income children in such group health plan
or health insurance coverage in the same manner as such
subsidies are provided under this paragraph for
enrollment in qualified employer-sponsored coverage,
but without regard to the requirement to provide
supplemental coverage for benefits and cost-sharing
protection provided under the State child health plan
under subparagraph (E).
``(M) Satisfaction of cost-effectiveness test.--
Premium assistance subsidies for qualified employer-
sponsored coverage offered under this paragraph shall
be deemed to meet the requirement of subparagraph (A)
of paragraph (3).
``(N) Coordination with medicaid.--In the case of a
targeted low-income child who receives child health
assistance through a State plan under title XIX and who
voluntarily elects to receive a premium assistance
subsidy under this section, the provisions of section
1906A shall apply and shall supersede any other
provisions of this paragraph that are inconsistent with
such section.''.
(2) Determination of cost-effectiveness for premium
assistance or purchase of family coverage.--
(A) In general.--Section 2105(c)(3)(A) (42 U.S.C.
1397ee(c)(3)(A)) is amended by striking ``relative to''
and all that follows through the comma and inserting
``relative to
``(i) the amount of expenditures under the
State child health plan, including
administrative expenditures, that the State
would have made to provide comparable coverage
of the targeted low-income child involved or
the family involved (as applicable); or
``(ii) the aggregate amount of expenditures
that the State would have made under the State
child health plan, including administrative
expenditures, for providing coverage under such
plan for all such children or families.''.
(B) Nonapplication to previously approved
coverage.--The amendment made by subparagraph (A) shall
not apply to coverage the purchase of which has been
approved by the Secretary under section 2105(c)(3) of
the Social Security Act prior to the date of enactment
of this Act.
(b) Medicaid.--Title XIX is amended by inserting after section 1906
the following new section:
``premium assistance option for children
``Sec. 1906A. (a) In General.--A State may elect to offer a
premium assistance subsidy (as defined in subsection (c)) for qualified
employer-sponsored coverage (as defined in subsection (b)) to all
individuals under age 19 who are entitled to medical assistance under
this title (and to the parent of such an individual) who have access to
such coverage if the State meets the requirements of this section.
``(b) Qualified Employer-Sponsored Coverage.--
``(1) In general.--Subject to paragraph (2)), in this
paragraph, the term `qualified employer-sponsored coverage'
means a group health plan or health insurance coverage offered
through an employer--
``(A) that qualifies as creditable coverage as a
group health plan under section 2701(c)(1) of the
Public Health Service Act;
``(B) for which the employer contribution toward
any premium for such coverage is at least 40 percent;
and
``(C) that is offered to all individuals in a
manner that would be considered a nondiscriminatory
eligibility classification for purposes of paragraph
(3)(A)(ii) of section 105(h) of the Internal Revenue
Code of 1986 (but determined without regard to clause
(i) of subparagraph (B) of such paragraph).
``(2) Exception.--Such term does not include coverage
consisting of--
``(A) benefits provided under a health flexible
spending arrangement (as defined in section 106(c)(2)
of the Internal Revenue Code of 1986); or
``(B) a high deductible health plan (as defined in
section 223(c)(2) of such Code), without regard to
whether the plan is purchased in conjunction with a
health savings account (as defined under section 223(d)
of such Code).
``(3) Treatment as third party liability.--The State shall
treat the coverage provided under qualified employer-sponsored
coverage as a third party liability under section 1902(a)(25).
``(c) Premium Assistance Subsidy.--In this section, the term
`premium assistance subsidy' means the amount of the employee
contribution for enrollment in the qualified employer-sponsored
coverage by the individual under age 19 or by the individual's family.
Premium assistance subsidies under this section shall be considered,
for purposes of section 1903(a), to be a payment for medical
assistance.
``(d) Voluntary Participation.--
``(1) Employers.--Participation by an employer in a premium
assistance subsidy offered by a State under this section shall
be voluntary. An employer may notify a State that it elects to
opt-out of being directly paid a premium assistance subsidy on
behalf of an employee.
``(2) Beneficiaries.--No subsidy shall be provided to an
individual under age 19 under this section unless the
individual (or the individual's parent) voluntarily elects to
receive such a subsidy. A State may not require such an
election as a condition of receipt of medical assistance. State
may not require, as a condition of an individual under age 19
(or the individual's parent) being or remaining eligible for
medical assistance under this title, apply for enrollment in
qualified employer-sponsored coverage under this section.
``(3) Opt-out permitted for any month.--A State shall
establish a process for permitting the parent of an individual
under age 19 receiving a premium assistance subsidy to
disenroll the individual from the qualified employer-sponsored
coverage.
``(e) Requirement To Pay Premiums and Cost-Sharing and Provide
Supplemental Coverage.--In the case of the participation of an
individual under age 19 (or the individual's parent) in a premium
assistance subsidy under this section for qualified employer-sponsored
coverage, the State shall provide for payment of all enrollee premiums
for enrollment in such coverage and all deductibles, coinsurance, and
other cost-sharing obligations for items and services otherwise covered
under the State plan under this title (exceeding the amount otherwise
permitted under section 1916 or, if applicable, section 1916A). The
fact that an individual under age 19 (or a parent) elects to enroll in
qualified employer-sponsored coverage under this section shall not
change the individual's (or parent's) eligibility for medical
assistance under the State plan, except insofar as section 1902(a)(25)
provides that payments for such assistance shall first be made under
such coverage.''.
(c) GAO Study and Report.--Not later than January 1, 2010, the
Comptroller General of the United States shall study cost and coverage
issues relating to any State premium assistance programs for which
Federal matching payments are made under title XIX or XXI of the Social
Security Act, including under waiver authority, and shall submit a
report to the Committee on Finance of the Senate and the Committee on
Energy and Commerce of the House of Representatives on the results of
such study.
SEC. 302. OUTREACH, EDUCATION, AND ENROLLMENT ASSISTANCE.
(a) Requirement To Include Description of Outreach, Education, and
Enrollment Efforts Related to Premium Assistance Subsidies in State
Child Health Plan.--Section 2102(c) (42 U.S.C. 1397bb(c)) is amended by
adding at the end the following new paragraph:
``(3) Premium assistance subsidies.--In the case of a State
that provides for premium assistance subsidies under the State
child health plan in accordance with paragraph (2)(B), (3), or
(10) of section 2105(c), or a waiver approved under section
1115, outreach, education, and enrollment assistance for
families of children likely to be eligible for such subsidies,
to inform such families of the availability of, and to assist
them in enrolling their children in, such subsidies, and for
employers likely to provide coverage that is eligible for such
subsidies, including the specific, significant resources the
State intends to apply to educate employers about the
availability of premium assistance subsidies under the State
child health plan.''.
(b) Nonapplication of 10 Percent Limit on Outreach and Certain
Other Expenditures.--Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)),
as amended by section 211(c)(2), is amended by adding at the end the
following new clause:
``(iii) Expenditures for outreach to
increase the enrollment of children under this
title and title xix through premium assistance
subsidies.--Expenditures for outreach
activities to families of children likely to be
eligible for premium assistance subsidies in
accordance with paragraph (2)(B), (3), or (10),
or a waiver approved under section 1115, to
inform such families of the availability of,
and to assist them in enrolling their children
in, such subsidies, and to employers likely to
provide qualified employer-sponsored coverage
(as defined in subparagraph (B) of such
paragraph), but not to exceed an amount equal
to 1.25 percent of the maximum amount permitted
to be expended under subparagraph (A) for items
described in subsection (a)(1)(D).''.
Subtitle B--Coordinating Premium Assistance With Private Coverage
SEC. 311. SPECIAL ENROLLMENT PERIOD UNDER GROUP HEALTH PLANS IN CASE OF
TERMINATION OF MEDICAID OR CHIP COVERAGE OR ELIGIBILITY
FOR ASSISTANCE IN PURCHASE OF EMPLOYMENT-BASED COVERAGE;
COORDINATION OF COVERAGE.
(a) Amendments to Internal Revenue Code of 1986.--Section 9801(f)
of the Internal Revenue Code of 1986 (relating to special enrollment
periods) is amended by adding at the end the following new paragraph:
``(3) Special rules relating to medicaid and chip.--
``(A) In general.--A group health plan shall permit
an employee who is eligible, but not enrolled, for
coverage under the terms of the plan (or a dependent of
such an employee if the dependent is eligible, but not
enrolled, for coverage under such terms) to enroll for
coverage under the terms of the plan if either of the
following conditions is met:
``(i) Termination of medicaid or chip
coverage.--The employee or dependent is covered
under a Medicaid plan under title XIX of the
Social Security Act or under a State child
health plan under title XXI of such Act and
coverage of the employee or dependent under
such a plan is terminated as a result of loss
of eligibility for such coverage and the
employee requests coverage under the group
health plan not later than 60 days after the
date of termination of such coverage.
``(ii) Eligibility for employment
assistance under medicaid or chip.--The
employee or dependent becomes eligible for
assistance, with respect to coverage under the
group health plan under such Medicaid plan or
State child health plan (including under any
waiver or demonstration project conducted under
or in relation to such a plan), if the employee
requests coverage under the group health plan
not later than 60 days after the date the
employee or dependent is determined to be
eligible for such assistance.
``(B) Employee outreach and disclosure.--
``(i) Outreach to employees regarding
availability of medicaid and chip coverage.--
``(I) In general.--Each employer
that maintains a group health plan in a
State that provides medical assistance
under a State Medicaid plan under title
XIX of the Social Security Act, or
child health assistance under a State
child health plan under title XXI of
such Act, in the form of premium
assistance for the purchase of coverage
under a group health plan, shall
provide to each employee a written
notice informing the employee of
potential opportunities then currently
available in the State in which the
employee resides for premium assistance
under such plans for health coverage of
the employee or the employee's
dependents. For purposes of compliance
with this clause, the employer may use
any State-specific model notice
developed in accordance with section
701(f)(3)(B)(i)(II) of the Employee
Retirement Income Security Act of 1974
(29 U.S.C. 1181(f)(3)(B)(i)(II)).
``(II) Option to provide concurrent
with provision of plan materials to
employee.--An employer may provide the
model notice applicable to the State in
which an employee resides concurrent
with the furnishing of materials
notifying the employee of health plan
eligibility, concurrent with materials
provided to the employee in connection
with an open season or election process
conducted under the plan, or concurrent
with the furnishing of the summary plan
description as provided in section
104(b) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C.
1024).
``(ii) Disclosure about group health plan
benefits to states for medicaid and chip
eligible individuals.--In the case of a
participant or beneficiary of a group health
plan who is covered under a Medicaid plan of a
State under title XIX of the Social Security
Act or under a State child health plan under
title XXI of such Act, the plan administrator
of the group health plan shall disclose to the
State, upon request, information about the
benefits available under the group health plan
in sufficient specificity, as determined under
regulations of the Secretary of Health and
Human Services in consultation with the
Secretary that require use of the model
coverage coordination disclosure form developed
under section 311(b)(1)(C) of the Children's
Health Insurance Program Reauthorization Act of
2009, so as to permit the State to make a
determination (under paragraph (2)(B), (3), or
(10) of section 2105(c) of the Social Security
Act or otherwise) concerning the cost-
effectiveness of the State providing medical or
child health assistance through premium
assistance for the purchase of coverage under
such group health plan and in order for the
State to provide supplemental benefits required
under paragraph (10)(E) of such section or
other authority.''.
(b) Conforming Amendments.--
(1) Amendments to employee retirement income security
act.--
(A) In general.--Section 701(f) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C.
1181(f)) is amended by adding at the end the following
new paragraph:
``(3) Special rules for application in case of medicaid and
chip.--
``(A) In general.--A group health plan, and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan, shall
permit an employee who is eligible, but not enrolled,
for coverage under the terms of the plan (or a
dependent of such an employee if the dependent is
eligible, but not enrolled, for coverage under such
terms) to enroll for coverage under the terms of the
plan if either of the following conditions is met:
``(i) Termination of medicaid or chip
coverage.--The employee or dependent is covered
under a Medicaid plan under title XIX of the
Social Security Act or under a State child
health plan under title XXI of such Act and
coverage of the employee or dependent under
such a plan is terminated as a result of loss
of eligibility for such coverage and the
employee requests coverage under the group
health plan (or health insurance coverage) not
later than 60 days after the date of
termination of such coverage.
``(ii) Eligibility for employment
assistance under medicaid or chip.--The
employee or dependent becomes eligible for
assistance, with respect to coverage under the
group health plan or health insurance coverage,
under such Medicaid plan or State child health
plan (including under any waiver or
demonstration project conducted under or in
relation to such a plan), if the employee
requests coverage under the group health plan
or health insurance coverage not later than 60
days after the date the employee or dependent
is determined to be eligible for such
assistance.
``(B) Coordination with medicaid and chip.--
``(i) Outreach to employees regarding
availability of medicaid and chip coverage.--
``(I) In general.--Each employer
that maintains a group health plan in a
State that provides medical assistance
under a State Medicaid plan under title
XIX of the Social Security Act, or
child health assistance under a State
child health plan under title XXI of
such Act, in the form of premium
assistance for the purchase of coverage
under a group health plan, shall
provide to each employee a written
notice informing the employee of
potential opportunities then currently
available in the State in which the
employee resides for premium assistance
under such plans for health coverage of
the employee or the employee's
dependents.
``(II) Model notice.--Not later
than 1 year after the date of enactment
of the Children's Health Insurance
Program Reauthorization Act of 2009,
the Secretary and the Secretary of
Health and Human Services, in
consultation with Directors of State
Medicaid agencies under title XIX of
the Social Security Act and Directors
of State CHIP agencies under title XXI
of such Act, shall jointly develop
national and State-specific model
notices for purposes of subparagraph
(A). The Secretary shall provide
employers with such model notices so as
to enable employers to timely comply
with the requirements of subparagraph
(A). Such model notices shall include
information regarding how an employee
may contact the State in which the
employee resides for additional
information regarding potential
opportunities for such premium
assistance, including how to apply for
such assistance.
``(III) Option to provide
concurrent with provision of plan
materials to employee.--An employer may
provide the model notice applicable to
the State in which an employee resides
concurrent with the furnishing of
materials notifying the employee of
health plan eligibility, concurrent
with materials provided to the employee
in connection with an open season or
election process conducted under the
plan, or concurrent with the furnishing
of the summary plan description as
provided in section 104(b).
``(ii) Disclosure about group health plan
benefits to states for medicaid and chip
eligible individuals.--In the case of a
participant or beneficiary of a group health
plan who is covered under a Medicaid plan of a
State under title XIX of the Social Security
Act or under a State child health plan under
title XXI of such Act, the plan administrator
of the group health plan shall disclose to the
State, upon request, information about the
benefits available under the group health plan
in sufficient specificity, as determined under
regulations of the Secretary of Health and
Human Services in consultation with the
Secretary that require use of the model
coverage coordination disclosure form developed
under section 311(b)(1)(C) of the Children's
Health Insurance Program Reauthorization Act of
2009, so as to permit the State to make a
determination (under paragraph (2)(B), (3), or
(10) of section 2105(c) of the Social Security
Act or otherwise) concerning the cost-
effectiveness of the State providing medical or
child health assistance through premium
assistance for the purchase of coverage under
such group health plan and in order for the
State to provide supplemental benefits required
under paragraph (10)(E) of such section or
other authority.''.
(B) Conforming amendment.--Section 102(b) of the
Employee Retirement Income Security Act of 1974 (29
U.S.C. 1022(b)) is amended--
(i) by striking ``and the remedies'' and
inserting ``, the remedies''; and
(ii) by inserting before the period the
following: ``, and if the employer so elects
for purposes of complying with section
701(f)(3)(B)(i), the model notice applicable to
the State in which the participants and
beneficiaries reside''.
(C) Working group to develop model coverage
coordination disclosure form.--
(i) Medicaid, chip, and employer-sponsored
coverage coordination working group.--
(I) In general.--Not later than 60
days after the date of enactment of
this Act, the Secretary of Health and
Human Services and the Secretary of
Labor shall jointly establish a
Medicaid, CHIP, and Employer-Sponsored
Coverage Coordination Working Group (in
this subparagraph referred to as the
``Working Group''). The purpose of the
Working Group shall be to develop the
model coverage coordination disclosure
form described in subclause (II) and to
identify the impediments to the
effective coordination of coverage
available to families that include
employees of employers that maintain
group health plans and members who are
eligible for medical assistance under
title XIX of the Social Security Act or
child health assistance or other health
benefits coverage under title XXI of
such Act.
(II) Model coverage coordination
disclosure form described.--The model
form described in this subclause is a
form for plan administrators of group
health plans to complete for purposes
of permitting a State to determine the
availability and cost-effectiveness of
the coverage available under such plans
to employees who have family members
who are eligible for premium assistance
offered under a State plan under title
XIX or XXI of such Act and to allow for
coordination of coverage for enrollees
of such plans. Such form shall provide
the following information in addition
to such other information as the
Working Group determines appropriate:
(aa) A determination of
whether the employee is
eligible for coverage under the
group health plan.
(bb) The name and contract
information of the plan
administrator of the group
health plan.
(cc) The benefits offered
under the plan.
(dd) The premiums and cost-
sharing required under the
plan.
(ee) Any other information
relevant to coverage under the
plan.
(ii) Membership.--The Working Group shall
consist of not more than 30 members and shall
be composed of representatives of--
(I) the Department of Labor;
(II) the Department of Health and
Human Services;
(III) State directors of the
Medicaid program under title XIX of the
Social Security Act;
(IV) State directors of the State
Children's Health Insurance Program
under title XXI of the Social Security
Act;
(V) employers, including owners of
small businesses and their trade or
industry representatives and certified
human resource and payroll
professionals;
(VI) plan administrators and plan
sponsors of group health plans (as
defined in section 607(1) of the
Employee Retirement Income Security Act
of 1974);
(VII) health insurance issuers; and
(VIII) children and other
beneficiaries of medical assistance
under title XIX of the Social Security
Act or child health assistance or other
health benefits coverage under title
XXI of such Act.
(iii) Compensation.--The members of the
Working Group shall serve without compensation.
(iv) Administrative support.--The
Department of Health and Human Services and the
Department of Labor shall jointly provide
appropriate administrative support to the
Working Group, including technical assistance.
The Working Group may use the services and
facilities of either such Department, with or
without reimbursement, as jointly determined by
such Departments.
(v) Report.--
(I) Report by working group to the
secretaries.--Not later than 18 months
after the date of the enactment of this
Act, the Working Group shall submit to
the Secretary of Labor and the
Secretary of Health and Human Services
the model form described in clause
(i)(II) along with a report containing
recommendations for appropriate
measures to address the impediments to
the effective coordination of coverage
between group health plans and the
State plans under titles XIX and XXI of
the Social Security Act.
(II) Report by secretaries to the
congress.--Not later than 2 months
after receipt of the report pursuant to
subclause (I), the Secretaries shall
jointly submit a report to each House
of the Congress regarding the
recommendations contained in the report
under such subclause.
(vi) Termination.--The Working Group shall
terminate 30 days after the date of the
issuance of its report under clause (v).
(D) Effective dates.--The Secretary of Labor and
the Secretary of Health and Human Services shall
develop the initial model notices under section
701(f)(3)(B)(i)(II) of the Employee Retirement Income
Security Act of 1974, and the Secretary of Labor shall
provide such notices to employers, not later than the
date that is 1 year after the date of enactment of this
Act, and each employer shall provide the initial annual
notices to such employer's employees beginning with the
first plan year that begins after the date on which
such initial model notices are first issued. The model
coverage coordination disclosure form developed under
subparagraph (C) shall apply with respect to requests
made by States beginning with the first plan year that
begins after the date on which such model coverage
coordination disclosure form is first issued.
(E) Enforcement.--Section 502 of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1132)
is amended--
(i) in subsection (a)(6), by striking ``or
(8)'' and inserting ``(8), or (9)''; and
(ii) in subsection (c), by redesignating
paragraph (9) as paragraph (10), and by
inserting after paragraph (8) the following:
``(9)(A) The Secretary may assess a civil penalty against any
employer of up to $100 a day from the date of the employer's failure to
meet the notice requirement of section 701(f)(3)(B)(i)(I). For purposes
of this subparagraph, each violation with respect to any single
employee shall be treated as a separate violation.
``(B) The Secretary may assess a civil penalty against any plan
administrator of up to $100 a day from the date of the plan
administrator's failure to timely provide to any State the information
required to be disclosed under section 701(f)(3)(B)(ii). For purposes
of this subparagraph, each violation with respect to any single
participant or beneficiary shall be treated as a separate violation.''.
(2) Amendments to public health service act.--Section
2701(f) of the Public Health Service Act (42 U.S.C. 300gg(f))
is amended by adding at the end the following new paragraph:
``(3) Special rules for application in case of medicaid and
chip.--
``(A) In general.--A group health plan, and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan, shall
permit an employee who is eligible, but not enrolled,
for coverage under the terms of the plan (or a
dependent of such an employee if the dependent is
eligible, but not enrolled, for coverage under such
terms) to enroll for coverage under the terms of the
plan if either of the following conditions is met:
``(i) Termination of medicaid or chip
coverage.--The employee or dependent is covered
under a Medicaid plan under title XIX of the
Social Security Act or under a State child
health plan under title XXI of such Act and
coverage of the employee or dependent under
such a plan is terminated as a result of loss
of eligibility for such coverage and the
employee requests coverage under the group
health plan (or health insurance coverage) not
later than 60 days after the date of
termination of such coverage.
``(ii) Eligibility for employment
assistance under medicaid or chip.--The
employee or dependent becomes eligible for
assistance, with respect to coverage under the
group health plan or health insurance coverage,
under such Medicaid plan or State child health
plan (including under any waiver or
demonstration project conducted under or in
relation to such a plan), if the employee
requests coverage under the group health plan
or health insurance coverage not later than 60
days after the date the employee or dependent
is determined to be eligible for such
assistance.
``(B) Coordination with medicaid and chip.--
``(i) Outreach to employees regarding
availability of medicaid and chip coverage.--
``(I) In general.--Each employer
that maintains a group health plan in a
State that provides medical assistance
under a State Medicaid plan under title
XIX of the Social Security Act, or
child health assistance under a State
child health plan under title XXI of
such Act, in the form of premium
assistance for the purchase of coverage
under a group health plan, shall
provide to each employee a written
notice informing the employee of
potential opportunities then currently
available in the State in which the
employee resides for premium assistance
under such plans for health coverage of
the employee or the employee's
dependents. For purposes of compliance
with this subclause, the employer may
use any State-specific model notice
developed in accordance with section
701(f)(3)(B)(i)(II) of the Employee
Retirement Income Security Act of 1974
(29 U.S.C. 1181(f)(3)(B)(i)(II)).
``(II) Option to provide concurrent
with provision of plan materials to
employee.--An employer may provide the
model notice applicable to the State in
which an employee resides concurrent
with the furnishing of materials
notifying the employee of health plan
eligibility, concurrent with materials
provided to the employee in connection
with an open season or election process
conducted under the plan, or concurrent
with the furnishing of the summary plan
description as provided in section
104(b) of the Employee Retirement
Income Security Act of 1974.
``(ii) Disclosure about group health plan
benefits to states for medicaid and chip
eligible individuals.--In the case of an
enrollee in a group health plan who is covered
under a Medicaid plan of a State under title
XIX of the Social Security Act or under a State
child health plan under title XXI of such Act,
the plan administrator of the group health plan
shall disclose to the State, upon request,
information about the benefits available under
the group health plan in sufficient
specificity, as determined under regulations of
the Secretary of Health and Human Services in
consultation with the Secretary that require
use of the model coverage coordination
disclosure form developed under section
311(b)(1)(C) of the Children's Health Insurance
Reauthorization Act of 2009, so as to permit
the State to make a determination (under
paragraph (2)(B), (3), or (10) of section
2105(c) of the Social Security Act or
otherwise) concerning the cost-effectiveness of
the State providing medical or child health
assistance through premium assistance for the
purchase of coverage under such group health
plan and in order for the State to provide
supplemental benefits required under paragraph
(10)(E) of such section or other authority.''.
TITLE IV--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES
SEC. 401. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR CHILDREN
ENROLLED IN MEDICAID OR CHIP.
(a) Development of Child Health Quality Measures for Children
Enrolled in Medicaid or Chip.--Title XI (42 U.S.C. 1301 et seq.) is
amended by inserting after section 1139 the following new section:
``SEC. 1139A. CHILD HEALTH QUALITY MEASURES.
``(a) Development of an Initial Core Set of Health Care Quality
Measures for Children Enrolled in Medicaid or Chip.--
``(1) In general.--Not later than January 1, 2010, the
Secretary shall identify and publish for general comment an
initial, recommended core set of child health quality measures
for use by State programs administered under titles XIX and
XXI, health insurance issuers and managed care entities that
enter into contracts with such programs, and providers of items
and services under such programs.
``(2) Identification of initial core measures.--In
consultation with the individuals and entities described in
subsection (b)(3), the Secretary shall identify existing
quality of care measures for children that are in use under
public and privately sponsored health care coverage
arrangements, or that are part of reporting systems that
measure both the presence and duration of health insurance
coverage over time.
``(3) Recommendations and dissemination.--Based on such
existing and identified measures, the Secretary shall publish
an initial core set of child health quality measures that
includes (but is not limited to) the following:
``(A) The duration of children's health insurance
coverage over a 12-month time period.
``(B) The availability and effectiveness of a full
range of--
``(i) preventive services, treatments, and
services for acute conditions, including
services to promote healthy birth, prevent and
treat premature birth, and detect the presence
or risk of physical or mental conditions that
could adversely affect growth and development;
and
``(ii) treatments to correct or ameliorate
the effects of physical and mental conditions,
including chronic conditions, in infants, young
children, school-age children, and adolescents.
``(C) The availability of care in a range of
ambulatory and inpatient health care settings in which
such care is furnished.
``(D) The types of measures that, taken together,
can be used to estimate the overall national quality of
health care for children, including children with
special needs, and to perform comparative analyses of
pediatric health care quality and racial, ethnic, and
socioeconomic disparities in child health and health
care for children.
``(4) Encourage voluntary and standardized reporting.--Not
later than 2 years after the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2009, the Secretary, in consultation with States, shall develop
a standardized format for reporting information and procedures
and approaches that encourage States to use the initial core
measurement set to voluntarily report information regarding the
quality of pediatric health care under titles XIX and XXI.
``(5) Adoption of best practices in implementing quality
programs.--The Secretary shall disseminate information to
States regarding best practices among States with respect to
measuring and reporting on the quality of health care for
children, and shall facilitate the adoption of such best
practices. In developing best practices approaches, the
Secretary shall give particular attention to State measurement
techniques that ensure the timeliness and accuracy of provider
reporting, encourage provider reporting compliance, encourage
successful quality improvement strategies, and improve
efficiency in data collection using health information
technology.
``(6) Reports to congress.--Not later than January 1, 2011,
and every 3 years thereafter, the Secretary shall report to
Congress on--
``(A) the status of the Secretary's efforts to
improve--
``(i) quality related to the duration and
stability of health insurance coverage for
children under titles XIX and XXI;
``(ii) the quality of children's health
care under such titles, including preventive
health services, health care for acute
conditions, chronic health care, and health
services to ameliorate the effects of physical
and mental conditions and to aid in growth and
development of infants, young children, school-
age children, and adolescents with special
health care needs; and
``(iii) the quality of children's health
care under such titles across the domains of
quality, including clinical quality, health
care safety, family experience with health
care, health care in the most integrated
setting, and elimination of racial, ethnic, and
socioeconomic disparities in health and health
care;
``(B) the status of voluntary reporting by States
under titles XIX and XXI, utilizing the initial core
quality measurement set; and
``(C) any recommendations for legislative changes
needed to improve the quality of care provided to
children under titles XIX and XXI, including
recommendations for quality reporting by States.
``(7) Technical assistance.--The Secretary shall provide
technical assistance to States to assist them in adopting and
utilizing core child health quality measures in administering
the State plans under titles XIX and XXI.
``(8) Definition of core set.--In this section, the term
`core set' means a group of valid, reliable, and evidence-based
quality measures that, taken together--
``(A) provide information regarding the quality of
health coverage and health care for children;
``(B) address the needs of children throughout the
developmental age span; and
``(C) allow purchasers, families, and health care
providers to understand the quality of care in relation
to the preventive needs of children, treatments aimed
at managing and resolving acute conditions, and
diagnostic and treatment services whose purpose is to
correct or ameliorate physical, mental, or
developmental conditions that could, if untreated or
poorly treated, become chronic.
``(b) Advancing and Improving Pediatric Quality Measures.--
``(1) Establishment of pediatric quality measures
program.--Not later than January 1, 2011, the Secretary shall
establish a pediatric quality measures program to--
``(A) improve and strengthen the initial core child
health care quality measures established by the
Secretary under subsection (a);
``(B) expand on existing pediatric quality measures
used by public and private health care purchasers and
advance the development of such new and emerging
quality measures; and
``(C) increase the portfolio of evidence-based,
consensus pediatric quality measures available to
public and private purchasers of children's health care
services, providers, and consumers.
``(2) Evidence-based measures.--The measures developed
under the pediatric quality measures program shall, at a
minimum, be--
``(A) evidence-based and, where appropriate, risk
adjusted;
``(B) designed to identify and eliminate racial and
ethnic disparities in child health and the provision of
health care;
``(C) designed to ensure that the data required for
such measures is collected and reported in a standard
format that permits comparison of quality and data at a
State, plan, and provider level;
``(D) periodically updated; and
``(E) responsive to the child health needs,
services, and domains of health care quality described
in clauses (i), (ii), and (iii) of subsection
(a)(6)(A).
``(3) Process for pediatric quality measures program.--In
identifying gaps in existing pediatric quality measures and
establishing priorities for development and advancement of such
measures, the Secretary shall consult with--
``(A) States;
``(B) pediatricians, children's hospitals, and
other primary and specialized pediatric health care
professionals (including members of the allied health
professions) who specialize in the care and treatment
of children, particularly children with special
physical, mental, and developmental health care needs;
``(C) dental professionals, including pediatric
dental professionals;
``(D) health care providers that furnish primary
health care to children and families who live in urban
and rural medically underserved communities or who are
members of distinct population sub-groups at heightened
risk for poor health outcomes;
``(E) national organizations representing children,
including children with disabilities and children with
chronic conditions;
``(F) national organizations representing consumers
and purchasers of children's health care;
``(G) national organizations and individuals with
expertise in pediatric health quality measurement; and
``(H) voluntary consensus standards setting
organizations and other organizations involved in the
advancement of evidence-based measures of health care.
``(4) Developing, validating, and testing a portfolio of
pediatric quality measures.--As part of the program to advance
pediatric quality measures, the Secretary shall--
``(A) award grants and contracts for the
development, testing, and validation of new, emerging,
and innovative evidence-based measures for children's
health care services across the domains of quality
described in clauses (i), (ii), and (iii) of subsection
(a)(6)(A); and
``(B) award grants and contracts for--
``(i) the development of consensus on
evidence-based measures for children's health
care services;
``(ii) the dissemination of such measures
to public and private purchasers of health care
for children; and
``(iii) the updating of such measures as
necessary.
``(5) Revising, strengthening, and improving initial core
measures.--Beginning no later than January 1, 2013, and
annually thereafter, the Secretary shall publish recommended
changes to the core measures described in subsection (a) that
shall reflect the testing, validation, and consensus process
for the development of pediatric quality measures described in
subsection paragraphs (1) through (4).
``(6) Definition of pediatric quality measure.--In this
subsection, the term `pediatric quality measure' means a
measurement of clinical care that is capable of being examined
through the collection and analysis of relevant information,
that is developed in order to assess 1 or more aspects of
pediatric health care quality in various institutional and
ambulatory health care settings, including the structure of the
clinical care system, the process of care, the outcome of care,
or patient experiences in care.
``(7) Construction.--Nothing in this section shall be
construed as supporting the restriction of coverage, under
title XIX or XXI or otherwise, to only those services that are
evidence-based.
``(c) Annual State Reports Regarding State-Specific Quality of Care
Measures Applied Under Medicaid or Chip.--
``(1) Annual state reports.--Each State with a State plan
approved under title XIX or a State child health plan approved
under title XXI shall annually report to the Secretary on the--
``(A) State-specific child health quality measures
applied by the States under such plans, including
measures described in subparagraphs (A) and (B) of
subsection (a)(6); and
``(B) State-specific information on the quality of
health care furnished to children under such plans,
including information collected through external
quality reviews of managed care organizations under
section 1932 of the Social Security Act (42 U.S.C.
1396u-4) and benchmark plans under sections 1937 and
2103 of such Act (42 U.S.C. 1396u-7, 1397cc).
``(2) Publication.--Not later than September 30, 2010, and
annually thereafter, the Secretary shall collect, analyze, and
make publicly available the information reported by States
under paragraph (1).
``(d) Demonstration Projects for Improving the Quality of
Children's Health Care and the Use of Health Information Technology.--
``(1) In general.--During the period of fiscal years 2009
through 2013, the Secretary shall award not more than 10 grants
to States and child health providers to conduct demonstration
projects to evaluate promising ideas for improving the quality
of children's health care provided under title XIX or XXI,
including projects to--
``(A) experiment with, and evaluate the use of, new
measures of the quality of children's health care under
such titles (including testing the validity and
suitability for reporting of such measures);
``(B) promote the use of health information
technology in care delivery for children under such
titles;
``(C) evaluate provider-based models which improve
the delivery of children's health care services under
such titles, including care management for children
with chronic conditions and the use of evidence-based
approaches to improve the effectiveness, safety, and
efficiency of health care services for children; or
``(D) demonstrate the impact of the model
electronic health record format for children developed
and disseminated under subsection (f) on improving
pediatric health, including the effects of chronic
childhood health conditions, and pediatric health care
quality as well as reducing health care costs.
``(2) Requirements.--In awarding grants under this
subsection, the Secretary shall ensure that--
``(A) only 1 demonstration project funded under a
grant awarded under this subsection shall be conducted
in a State; and
``(B) demonstration projects funded under grants
awarded under this subsection shall be conducted evenly
between States with large urban areas and States with
large rural areas.
``(3) Authority for multistate projects.--A demonstration
project conducted with a grant awarded under this subsection
may be conducted on a multistate basis, as needed.
``(4) Funding.--$20,000,000 of the amount appropriated
under subsection (i) for a fiscal year shall be used to carry
out this subsection.
``(e) Childhood Obesity Demonstration Project.--
``(1) Authority to conduct demonstration.--The Secretary,
in consultation with the Administrator of the Centers for
Medicare & Medicaid Services, shall conduct a demonstration
project to develop a comprehensive and systematic model for
reducing childhood obesity by awarding grants to eligible
entities to carry out such project. Such model shall--
``(A) identify, through self-assessment, behavioral
risk factors for obesity among children;
``(B) identify, through self-assessment, needed
clinical preventive and screening benefits among those
children identified as target individuals on the basis
of such risk factors;
``(C) provide ongoing support to such target
individuals and their families to reduce risk factors
and promote the appropriate use of preventive and
screening benefits; and
``(D) be designed to improve health outcomes,
satisfaction, quality of life, and appropriate use of
items and services for which medical assistance is
available under title XIX or child health assistance is
available under title XXI among such target
individuals.
``(2) Eligibility entities.--For purposes of this
subsection, an eligible entity is any of the following:
``(A) A city, county, or Indian tribe.
``(B) A local or tribal educational agency.
``(C) An accredited university, college, or
community college.
``(D) A Federally-qualified health center.
``(E) A local health department.
``(F) A health care provider.
``(G) A community-based organization.
``(H) Any other entity determined appropriate by
the Secretary, including a consortia or partnership of
entities described in any of subparagraphs (A) through
(G).
``(3) Use of funds.--An eligible entity awarded a grant
under this subsection shall use the funds made available under
the grant to--
``(A) carry out community-based activities related
to reducing childhood obesity, including by--
``(i) forming partnerships with entities,
including schools and other facilities
providing recreational services, to establish
programs for after school and weekend community
activities that are designed to reduce
childhood obesity;
``(ii) forming partnerships with daycare
facilities to establish programs that promote
healthy eating behaviors and physical activity;
and
``(iii) developing and evaluating community
educational activities targeting good nutrition
and promoting healthy eating behaviors;
``(B) carry out age-appropriate school-based
activities that are designed to reduce childhood
obesity, including by--
``(i) developing and testing educational
curricula and intervention programs designed to
promote healthy eating behaviors and habits in
youth, which may include--
``(I) after hours physical activity
programs; and
``(II) science-based interventions
with multiple components to prevent
eating disorders including nutritional
content, understanding and responding
to hunger and satiety, positive body
image development, positive self-esteem
development, and learning life skills
(such as stress management,
communication skills, problemsolving
and decisionmaking skills), as well as
consideration of cultural and
developmental issues, and the role of
family, school, and community;
``(ii) providing education and training to
educational professionals regarding how to
promote a healthy lifestyle and a healthy
school environment for children;
``(iii) planning and implementing a healthy
lifestyle curriculum or program with an
emphasis on healthy eating behaviors and
physical activity; and
``(iv) planning and implementing healthy
lifestyle classes or programs for parents or
guardians, with an emphasis on healthy eating
behaviors and physical activity for children;
``(C) carry out educational, counseling,
promotional, and training activities through the local
health care delivery systems including by--
``(i) promoting healthy eating behaviors
and physical activity services to treat or
prevent eating disorders, being overweight, and
obesity;
``(ii) providing patient education and
counseling to increase physical activity and
promote healthy eating behaviors;
``(iii) training health professionals on
how to identify and treat obese and overweight
individuals which may include nutrition and
physical activity counseling; and
``(iv) providing community education by a
health professional on good nutrition and
physical activity to develop a better
understanding of the relationship between diet,
physical activity, and eating disorders,
obesity, or being overweight; and
``(D) provide, through qualified health
professionals, training and supervision for community
health workers to--
``(i) educate families regarding the
relationship between nutrition, eating habits,
physical activity, and obesity;
``(ii) educate families about effective
strategies to improve nutrition, establish
healthy eating patterns, and establish
appropriate levels of physical activity; and
``(iii) educate and guide parents regarding
the ability to model and communicate positive
health behaviors.
``(4) Priority.--In awarding grants under paragraph (1),
the Secretary shall give priority to awarding grants to
eligible entities--
``(A) that demonstrate that they have previously
applied successfully for funds to carry out activities
that seek to promote individual and community health
and to prevent the incidence of chronic disease and
that can cite published and peer-reviewed research
demonstrating that the activities that the entities
propose to carry out with funds made available under
the grant are effective;
``(B) that will carry out programs or activities
that seek to accomplish a goal or goals set by the
State in the Healthy People 2010 plan of the State;
``(C) that provide non-Federal contributions,
either in cash or in-kind, to the costs of funding
activities under the grants;
``(D) that develop comprehensive plans that include
a strategy for extending program activities developed
under grants in the years following the fiscal years
for which they receive grants under this subsection;
``(E) located in communities that are medically
underserved, as determined by the Secretary;
``(F) located in areas in which the average poverty
rate is at least 150 percent or higher of the average
poverty rate in the State involved, as determined by
the Secretary; and
``(G) that submit plans that exhibit multisectoral,
cooperative conduct that includes the involvement of a
broad range of stakeholders, including--
``(i) community-based organizations;
``(ii) local governments;
``(iii) local educational agencies;
``(iv) the private sector;
``(v) State or local departments of health;
``(vi) accredited colleges, universities,
and community colleges;
``(vii) health care providers;
``(viii) State and local departments of
transportation and city planning; and
``(ix) other entities determined
appropriate by the Secretary.
``(5) Program design.--
``(A) Initial design.--Not later than 1 year after
the date of enactment of the Children's Health
Insurance Program Reauthorization Act of 2009, the
Secretary shall design the demonstration project. The
demonstration should draw upon promising, innovative
models and incentives to reduce behavioral risk
factors. The Administrator of the Centers for Medicare
& Medicaid Services shall consult with the Director of
the Centers for Disease Control and Prevention, the
Director of the Office of Minority Health, the heads of
other agencies in the Department of Health and Human
Services, and such professional organizations, as the
Secretary determines to be appropriate, on the design,
conduct, and evaluation of the demonstration.
``(B) Number and project areas.--Not later than 2
years after the date of enactment of the Children's
Health Insurance Program Reauthorization Act of 2009,
the Secretary shall award 1 grant that is specifically
designed to determine whether programs similar to
programs to be conducted by other grantees under this
subsection should be implemented with respect to the
general population of children who are eligible for
child health assistance under State child health plans
under title XXI in order to reduce the incidence of
childhood obesity among such population.
``(6) Report to congress.--Not later than 3 years after the
date the Secretary implements the demonstration project under
this subsection, the Secretary shall submit to Congress a
report that describes the project, evaluates the effectiveness
and cost effectiveness of the project, evaluates the
beneficiary satisfaction under the project, and includes any
such other information as the Secretary determines to be
appropriate.
``(7) Definitions.--In this subsection:
``(A) Federally-qualified health center.--The term
`Federally-qualified health center' has the meaning
given that term in section 1905(l)(2)(B).
``(B) Indian tribe.--The term `Indian tribe' has
the meaning given that term in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603).
``(C) Self-assessment.--The term `self-assessment'
means a form that--
``(i) includes questions regarding--
``(I) behavioral risk factors;
``(II) needed preventive and
screening services; and
``(III) target individuals'
preferences for receiving follow-up
information;
``(ii) is assessed using such computer
generated assessment programs; and
``(iii) allows for the provision of such
ongoing support to the individual as the
Secretary determines appropriate.
``(D) Ongoing support.--The term `ongoing support'
means--
``(i) to provide any target individual with
information, feedback, health coaching, and
recommendations regarding--
``(I) the results of a self-
assessment given to the individual;
``(II) behavior modification based
on the self-assessment; and
``(III) any need for clinical
preventive and screening services or
treatment including medical nutrition
therapy;
``(ii) to provide any target individual
with referrals to community resources and
programs available to assist the target
individual in reducing health risks; and
``(iii) to provide the information
described in clause (i) to a health care
provider, if designated by the target
individual to receive such information.
``(8) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection, $25,000,000
for the period of fiscal years 2009 through 2013.
``(f) Development of Model Electronic Health Record Format for
Children Enrolled in Medicaid or CHIP.--
``(1) In general.--Not later than January 1, 2010, the
Secretary shall establish a program to encourage the
development and dissemination of a model electronic health
record format for children enrolled in the State plan under
title XIX or the State child health plan under title XXI that
is--
``(A) subject to State laws, accessible to parents,
caregivers, and other consumers for the sole purpose of
demonstrating compliance with school or leisure
activity requirements, such as appropriate
immunizations or physicals;
``(B) designed to allow interoperable exchanges
that conform with Federal and State privacy and
security requirements;
``(C) structured in a manner that permits parents
and caregivers to view and understand the extent to
which the care their children receive is clinically
appropriate and of high quality; and
``(D) capable of being incorporated into, and
otherwise compatible with, other standards developed
for electronic health records.
``(2) Funding.--$5,000,000 of the amount appropriated under
subsection (i) for a fiscal year shall be used to carry out
this subsection.
``(g) Study of Pediatric Health and Health Care Quality Measures.--
``(1) In general.--Not later than July 1, 2010, the
Institute of Medicine shall study and report to Congress on the
extent and quality of efforts to measure child health status
and the quality of health care for children across the age span
and in relation to preventive care, treatments for acute
conditions, and treatments aimed at ameliorating or correcting
physical, mental, and developmental conditions in children. In
conducting such study and preparing such report, the Institute
of Medicine shall--
``(A) consider all of the major national
population-based reporting systems sponsored by the
Federal Government that are currently in place,
including reporting requirements under Federal grant
programs and national population surveys and estimates
conducted directly by the Federal Government;
``(B) identify the information regarding child
health and health care quality that each system is
designed to capture and generate, the study and
reporting periods covered by each system, and the
extent to which the information so generated is made
widely available through publication;
``(C) identify gaps in knowledge related to
children's health status, health disparities among
subgroups of children, the effects of social conditions
on children's health status and use and effectiveness
of health care, and the relationship between child
health status and family income, family stability and
preservation, and children's school readiness and
educational achievement and attainment; and
``(D) make recommendations regarding improving and
strengthening the timeliness, quality, and public
transparency and accessibility of information about
child health and health care quality.
``(2) Funding.--Up to $1,000,000 of the amount appropriated
under subsection (i) for a fiscal year shall be used to carry
out this subsection.
``(h) Rule of Construction.--Notwithstanding any other provision in
this section, no evidence based quality measure developed, published,
or used as a basis of measurement or reporting under this section may
be used to establish an irrebuttable presumption regarding either the
medical necessity of care or the maximum permissible coverage for any
individual child who is eligible for and receiving medical assistance
under title XIX or child health assistance under title XXI.
``(i) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated for each of fiscal years
2009 through 2013, $45,000,000 for the purpose of carrying out this
section (other than subsection (e)). Funds appropriated under this
subsection shall remain available until expended.''.
(b) Increased Matching Rate for Collecting and Reporting on Child
Health Measures.--Section 1903(a)(3)(A) (42 U.S.C. 1396b(a)(3)(A)), is
amended--
(1) by striking ``and'' at the end of clause (i); and
(2) by adding at the end the following new clause:
``(iii) an amount equal to the Federal medical
assistance percentage (as defined in section 1905(b))
of so much of the sums expended during such quarter (as
found necessary by the Secretary for the proper and
efficient administration of the State plan) as are
attributable to such developments or modifications of
systems of the type described in clause (i) as are
necessary for the efficient collection and reporting on
child health measures; and''.
SEC. 402. IMPROVED AVAILABILITY OF PUBLIC INFORMATION REGARDING
ENROLLMENT OF CHILDREN IN CHIP AND MEDICAID.
(a) Inclusion of Process and Access Measures in Annual State
Reports.--Section 2108 (42 U.S.C. 1397hh) is amended--
(1) in subsection (a), in the matter preceding paragraph
(1), by striking ``The State'' and inserting ``Subject to
subsection (e), the State''; and
(2) by adding at the end the following new subsection:
``(e) Information Required for Inclusion in State Annual Report.--
The State shall include the following information in the annual report
required under subsection (a):
``(1) Eligibility criteria, enrollment, and retention data
(including data with respect to continuity of coverage or
duration of benefits).
``(2) Data regarding the extent to which the State uses
process measures with respect to determining the eligibility of
children under the State child health plan, including measures
such as 12-month continuous eligibility, self-declaration of
income for applications or renewals, or presumptive
eligibility.
``(3) Data regarding denials of eligibility and
redeterminations of eligibility.
``(4) Data regarding access to primary and specialty
services, access to networks of care, and care coordination
provided under the State child health plan, using quality care
and consumer satisfaction measures included in the Consumer
Assessment of Healthcare Providers and Systems (CAHPS) survey.
``(5) If the State provides child health assistance in the
form of premium assistance for the purchase of coverage under a
group health plan, data regarding the provision of such
assistance, including the extent to which employer-sponsored
health insurance coverage is available for children eligible
for child health assistance under the State child health plan,
the range of the monthly amount of such assistance provided on
behalf of a child or family, the number of children or families
provided such assistance on a monthly basis, the income of the
children or families provided such assistance, the benefits and
cost-sharing protection provided under the State child health
plan to supplement the coverage purchased with such premium
assistance, the effective strategies the State engages in to
reduce any administrative barriers to the provision of such
assistance, and, the effects, if any, of the provision of such
assistance on preventing the coverage provided under the State
child health plan from substituting for coverage provided under
employer-sponsored health insurance offered in the State.
``(6) To the extent applicable, a description of any State
activities that are designed to reduce the number of uncovered
children in the State, including through a State health
insurance connector program or support for innovative private
health coverage initiatives.''.
(b) Standardized Reporting Format.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, the Secretary shall specify a
standardized format for States to use for reporting the
information required under section 2108(e) of the Social
Security Act, as added by subsection (a)(2).
(2) Transition period for states.--Each State that is
required to submit a report under subsection (a) of section
2108 of the Social Security Act that includes the information
required under subsection (e) of such section may use up to 3
reporting periods to transition to the reporting of such
information in accordance with the standardized format
specified by the Secretary under paragraph (1).
(c) Additional Funding for the Secretary To Improve Timeliness of
Data Reporting and Analysis for Purposes of Determining Enrollment
Increases Under Medicaid and CHIP.--
(1) Appropriation.--There is appropriated, out of any money
in the Treasury not otherwise appropriated, $5,000,000 to the
Secretary for fiscal year 2009 for the purpose of improving the
timeliness of the data reported and analyzed from the Medicaid
Statistical Information System (MSIS) for purposes of providing
more timely data on enrollment and eligibility of children
under Medicaid and CHIP and to provide guidance to States with
respect to any new reporting requirements related to such
improvements. Amounts appropriated under this paragraph shall
remain available until expended.
(2) Requirements.--The improvements made by the Secretary
under paragraph (1) shall be designed and implemented
(including with respect to any necessary guidance for States to
report such information in a complete and expeditious manner)
so that, beginning no later than October 1, 2009, data
regarding the enrollment of low-income children (as defined in
section 2110(c)(4) of the Social Security Act (42 U.S.C.
1397jj(c)(4)) of a State enrolled in the State plan under
Medicaid or the State child health plan under CHIP with respect
to a fiscal year shall be collected and analyzed by the
Secretary within 6 months of submission.
(d) GAO Study and Report on Access to Primary and Speciality
Services.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of children's access to primary
and specialty services under Medicaid and CHIP, including--
(A) the extent to which providers are willing to
treat children eligible for such programs;
(B) information on such children's access to
networks of care;
(C) geographic availability of primary and
specialty services under such programs;
(D) the extent to which care coordination is
provided for children's care under Medicaid and CHIP;
and
(E) as appropriate, information on the degree of
availability of services for children under such
programs.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Comptroller General shall submit a
report to the Committee on Finance of the Senate and the
Committee on Energy and Commerce of the House of
Representatives on the study conducted under paragraph (1) that
includes recommendations for such Federal and State legislative
and administrative changes as the Comptroller General
determines are necessary to address any barriers to access to
children's care under Medicaid and CHIP that may exist.
SEC. 403. APPLICATION OF CERTAIN MANAGED CARE QUALITY SAFEGUARDS TO
CHIP.
(a) In General.--Section 2103(f) of Social Security Act (42 U.S.C.
1397bb(f)) is amended by adding at the end the following new paragraph:
``(3) Compliance with managed care requirements.--The State
child health plan shall provide for the application of
subsections (a)(4), (a)(5), (b), (c), (d), and (e) of section
1932 (relating to requirements for managed care) to coverage,
State agencies, enrollment brokers, managed care entities, and
managed care organizations under this title in the same manner
as such subsections apply to coverage and such entities and
organizations under title XIX.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to contract years for health plans beginning on or after July 1,
2009.
TITLE V--IMPROVING ACCESS TO BENEFITS
SEC. 501. DENTAL BENEFITS.
(a) Coverage.--
(1) In general.--Section 2103 (42 U.S.C. 1397cc) is
amended--
(A) in subsection (a)--
(i) in the matter before paragraph (1), by
striking ``subsection (c)(5)'' and inserting
``paragraphs (5) and (7) of subsection (c)'';
and
(ii) in paragraph (1), by inserting ``at
least'' after ``that is''; and
(B) in subsection (c)--
(i) by redesignating paragraph (5) as
paragraph (7); and
(ii) by inserting after paragraph (4), the
following:
``(5) Dental benefits.--
``(A) In general.--The child health assistance
provided to a targeted low-income child shall include
coverage of dental services necessary to prevent
disease and promote oral health, restore oral
structures to health and function, and treat emergency
conditions.
``(B) Permitting use of dental benchmark plans by
certain states.--A State may elect to meet the
requirement of subparagraph (A) through dental coverage
that is equivalent to a benchmark dental benefit
package described in subparagraph (C).
``(C) Benchmark dental benefit packages.--The
benchmark dental benefit packages are as follows:
``(i) FEHBP children's dental coverage.--A
dental benefits plan under chapter 89A of title
5, United States Code, that has been selected
most frequently by employees seeking dependent
coverage, among such plans that provide such
dependent coverage, in either of the previous 2
plan years.
``(ii) State employee dependent dental
coverage.--A dental benefits plan that is
offered and generally available to State
employees in the State involved and that has
been selected most frequently by employees
seeking dependent coverage, among such plans
that provide such dependent coverage, in either
of the previous 2 plan years.
``(iii) Coverage offered through commercial
dental plan.--A dental benefits plan that has
the largest insured commercial, non-medicaid
enrollment of dependent covered lives of such
plans that is offered in the State involved.''.
(2) Assuring access to care.--Section 2102(a)(7)(B) (42
U.S.C. 1397bb(c)(2)) is amended by inserting ``and services
described in section 2103(c)(5)'' after ``emergency services''.
(3) Effective date.--The amendments made by paragraphs (1)
and (2) shall apply to coverage of items and services furnished
on or after October 1, 2009.
(b) State Option To Provide Dental-Only Supplemental Coverage.--
(1) In general.--Section 2110(b) (42 U.S.C. 1397jj(b)) is
amended--
(A) in paragraph (1)(C), by inserting ``, subject
to paragraph (5),'' after ``under title XIX or''; and
(B) by adding at the end the following new
paragraph:
``(5) Option for states with a separate chip program to
provide dental-only supplemental coverage.--
``(A) In general.--Subject to subparagraphs (B) and
(C), in the case of any child who is enrolled in a
group health plan or health insurance coverage offered
through an employer who would, but for the application
of paragraph (1)(C), satisfy the requirements for being
a targeted low-income child under a State child health
plan that is implemented under this title, a State may
waive the application of such paragraph to the child in
order to provide--
``(i) dental coverage consistent with the
requirements of subsection (c)(5) of section
2103; or
``(ii) cost-sharing protection for dental
coverage consistent with such requirements and
the requirements of subsection (e)(3)(B) of
such section.
``(B) Limitation.--A State may limit the
application of a waiver of paragraph (1)(C) to children
whose family income does not exceed a level specified
by the State, so long as the level so specified does
not exceed the maximum income level otherwise
established for other children under the State child
health plan.
``(C) Conditions.--A State may not offer dental-
only supplemental coverage under this paragraph unless
the State satisfies the following conditions:
``(i) Income eligibility.--The State child
health plan under this title--
``(I) has the highest income
eligibility standard permitted under
this title (or a waiver) as of January
1, 2009;
``(II) does not limit the
acceptance of applications for children
or impose any numerical limitation,
waiting list, or similar limitation on
the eligibility of such children for
child health assistance under such
State plan; and
``(III) provides benefits to all
children in the State who apply for and
meet eligibility standards.
``(ii) No more favorable treatment.--The
State child health plan may not provide more
favorable dental coverage or cost-sharing
protection for dental coverage to children
provided dental-only supplemental coverage
under this paragraph than the dental coverage
and cost-sharing protection for dental coverage
provided to targeted low-income children who
are eligible for the full range of child health
assistance provided under the State child
health plan.''.
(2) State option to waive waiting period.--Section
2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)), as amended by
section 111(b)(2), is amended--
(A) in clause (ii), by striking ``and'' at the end;
(B) in clause (iii), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iv) at State option, may not apply a
waiting period in the case of a child provided
dental-only supplemental coverage under section
2110(b)(5).''.
(c) Dental Education for Parents of Newborns.--The Secretary shall
develop and implement, through entities that fund or provide perinatal
care services to targeted low-income children under a State child
health plan under title XXI of the Social Security Act, a program to
deliver oral health educational materials that inform new parents about
risks for, and prevention of, early childhood caries and the need for a
dental visit within their newborn's first year of life.
(d) Provision of Dental Services Through FQHCs.--
(1) Medicaid.--Section 1902(a) (42 U.S.C. 1396a(a)) is
amended--
(A) by striking ``and'' at the end of paragraph
(70);
(B) by striking the period at the end of paragraph
(71) and inserting ``; and''; and
(C) by inserting after paragraph (71) the following
new paragraph:
``(72) provide that the State will not prevent a Federally-
qualified health center from entering into contractual
relationships with private practice dental providers in the
provision of Federally-qualified health center services.''.
(2) CHIP.--Section 2107(e)(1) (42 U.S.C. 1397g(e)(1)), as
amended by subsections (a)(2) and (d)(2) of section 203, is
amended by inserting after subparagraph (B) the following new
subparagraph (and redesignating the succeeding subparagraphs
accordingly):
``(C) Section 1902(a)(72) (relating to limiting
FQHC contracting for provision of dental services).''.
(3) Effective date.--The amendments made by this subsection
shall take effect on January 1, 2009.
(e) Reporting Information on Dental Health.--
(1) Medicaid.--Section 1902(a)(43)(D)(iii) (42 U.S.C.
1396a(a)(43)(D)(iii)) is amended by inserting ``and other
information relating to the provision of dental services to
such children described in section 2108(e)'' after ``receiving
dental services,''.
(2) CHIP.--Section 2108 (42 U.S.C. 1397hh) is amended by
adding at the end the following new subsection:
``(e) Information on Dental Care for Children.--
``(1) In general.--Each annual report under subsection (a)
shall include the following information with respect to care
and services described in section 1905(r)(3) provided to
targeted low-income children enrolled in the State child health
plan under this title at any time during the year involved:
``(A) The number of enrolled children by age
grouping used for reporting purposes under section
1902(a)(43).
``(B) For children within each such age grouping,
information of the type contained in questions 12(a)-
(c) of CMS Form 416 (that consists of the number of
enrolled targeted low income children who receive any,
preventive, or restorative dental care under the State
plan).
``(C) For the age grouping that includes children 8
years of age, the number of such children who have
received a protective sealant on at least one permanent
molar tooth.
``(2) Inclusion of information on enrollees in managed care
plans.--The information under paragraph (1) shall include
information on children who are enrolled in managed care plans
and other private health plans and contracts with such plans
under this title shall provide for the reporting of such
information by such plans to the State.''.
(3) Effective date.--The amendments made by this subsection
shall be effective for annual reports submitted for years
beginning after date of enactment.
(f) Improved Accessibility of Dental Provider Information to
Enrollees Under Medicaid and CHIP.--The Secretary shall--
(1) work with States, pediatric dentists, and other dental
providers (including providers that are, or are affiliated
with, a school of dentistry) to include, not later than 6
months after the date of the enactment of this Act, on the
Insure Kids Now website (http://www.insurekidsnow.gov/) and
hotline (1-877-KIDS-NOW) (or on any successor websites or
hotlines) a current and accurate list of all such dentists and
providers within each State that provide dental services to
children enrolled in the State plan (or waiver) under Medicaid
or the State child health plan (or waiver) under CHIP, and
shall ensure that such list is updated at least quarterly; and
(2) work with States to include, not later than 6 months
after the date of the enactment of this Act, a description of
the dental services provided under each State plan (or waiver)
under Medicaid and each State child health plan (or waiver)
under CHIP on such Insure Kids Now website, and shall ensure
that such list is updated at least annually.
(g) Inclusion of Status of Efforts To Improve Dental Care in
Reports on the Quality of Children's Health Care Under Medicaid and
CHIP.--Section 1139A(a), as added by section 401(a), is amended--
(1) in paragraph (3)(B)(ii), by inserting ``and, with
respect to dental care, conditions requiring the restoration of
teeth, relief of pain and infection, and maintenance of dental
health'' after ``chronic conditions''; and
(2) in paragraph (6)(A)(ii), by inserting ``dental care,''
after ``preventive health services,''.
(h) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
shall provide for a study that examines--
(A) access to dental services by children in
underserved areas;
(B) children's access to oral health care,
including preventive and restorative services, under
Medicaid and CHIP, including--
(i) the extent to which dental providers
are willing to treat children eligible for such
programs;
(ii) information on such children's access
to networks of care, including such networks
that serve special needs children; and
(iii) geographic availability of oral
health care, including preventive and
restorative services, under such programs; and
(C) the feasibility and appropriateness of using
qualified mid-level dental health providers, in
coordination with dentists, to improve access for
children to oral health services and public health
overall.
(2) Report.--Not later than 18 months year after the date
of the enactment of this Act, the Comptroller General shall
submit to Congress a report on the study conducted under
paragraph (1). The report shall include recommendations for
such Federal and State legislative and administrative changes
as the Comptroller General determines are necessary to address
any barriers to access to oral health care, including
preventive and restorative services, under Medicaid and CHIP
that may exist.
SEC. 502. MENTAL HEALTH PARITY IN CHIP PLANS.
(a) Assurance of Parity.--Section 2103(c) (42 U.S.C. 1397cc(c)), as
amended by section 501(a)(1)(B), is amended by inserting after
paragraph (5), the following:
``(6) Mental health services parity.--
``(A) In general.--In the case of a State child
health plan that provides both medical and surgical
benefits and mental health or substance use disorder
benefits, such plan shall ensure that the financial
requirements and treatment limitations applicable to
such mental health or substance use disorder benefits
comply with the requirements of section 2705(a) of the
Public Health Service Act in the same manner as such
requirements apply to a group health plan.
``(B) Deemed compliance.--To the extent that a
State child health plan includes coverage with respect
to an individual described in section 1905(a)(4)(B) and
covered under the State plan under section
1902(a)(10)(A) of the services described in section
1905(a)(4)(B) (relating to early and periodic
screening, diagnostic, and treatment services defined
in section 1905(r)) and provided in accordance with
section 1902(a)(43), such plan shall be deemed to
satisfy the requirements of subparagraph (A).''.
(b) Conforming Amendments.--Section 2103 (42 U.S.C. 1397cc) is
amended--
(1) in subsection (a), as amended by section
501(a)(1)(A)(i), in the matter preceding paragraph (1), by
inserting ``, (6),'' after ``(5)''; and
(2) in subsection (c)(2), by striking subparagraph (B) and
redesignating subparagraphs (C) and (D) as subparagraphs (B)
and (C), respectively.
SEC. 503. APPLICATION OF PROSPECTIVE PAYMENT SYSTEM FOR SERVICES
PROVIDED BY FEDERALLY-QUALIFIED HEALTH CENTERS AND RURAL
HEALTH CLINICS.
(a) Application of Prospective Payment System.--
(1) In general.--Section 2107(e)(1) (42 U.S.C.
1397gg(e)(1)), as amended by section 501(c)(2) is amended by
inserting after subparagraph (C) the following new subparagraph
(and redesignating the succeeding subparagraphs accordingly):
``(D) Section 1902(bb) (relating to payment for
services provided by Federally-qualified health centers
and rural health clinics).''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to services provided on or after October 1, 2009.
(b) Transition Grants.--
(1) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to the Secretary
for fiscal year 2009, $5,000,000, to remain available until
expended, for the purpose of awarding grants to States with
State child health plans under CHIP that are operated
separately from the State Medicaid plan under title XIX of the
Social Security Act (including any waiver of such plan), or in
combination with the State Medicaid plan, for expenditures
related to transitioning to compliance with the requirement of
section 2107(e)(1)(D) of the Social Security Act (as added by
subsection (a)) to apply the prospective payment system
established under section 1902(bb) of the such Act (42 U.S.C.
1396a(bb)) to services provided by Federally-qualified health
centers and rural health clinics.
(2) Monitoring and report.--The Secretary shall monitor the
impact of the application of such prospective payment system on
the States described in paragraph (1) and, not later than
October 1, 2011, shall report to Congress on any effect on
access to benefits, provider payment rates, or scope of
benefits offered by such States as a result of the application
of such payment system.
SEC. 504. PREMIUM GRACE PERIOD.
(a) In General.--Section 2103(e)(3) (42 U.S.C. 1397cc(e)(3)) is
amended by adding at the end the following new subparagraph:
``(C) Premium grace period.--The State child health
plan--
``(i) shall afford individuals enrolled
under the plan a grace period of at least 30
days from the beginning of a new coverage
period to make premium payments before the
individual's coverage under the plan may be
terminated; and
``(ii) shall provide to such an individual,
not later than 7 days after the first day of
such grace period, notice--
``(I) that failure to make a
premium payment within the grace period
will result in termination of coverage
under the State child health plan; and
``(II) of the individual's right to
challenge the proposed termination
pursuant to the applicable Federal
regulations.
For purposes of clause (i), the term `new coverage
period' means the month immediately following the last
month for which the premium has been paid.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to new coverage periods beginning on or after the date of the
enactment of this Act.
SEC. 505. CLARIFICATION OF COVERAGE OF SERVICES PROVIDED THROUGH
SCHOOL-BASED HEALTH CENTERS.
(a) In General.--Section 2103(c) (42 U.S.C. 1397cc(c)), as amended
by section 501(a)(1)(B), is amended by adding at the end the following
new paragraph:
``(8) Availability of coverage for items and services
furnished through school-based health centers.--Nothing in this
title shall be construed as limiting a State's ability to
provide child health assistance for covered items and services
that are furnished through school-based health centers (as
defined in section 2110(c)(9)).''.
(b) Definition.--Section 2110(c) (42 U.S.C. 1397jj) is amended by
adding at the end the following:
``(9) School-based health center.--
``(A) In general.--The term `school-based health
center' means a health clinic that--
``(i) is located in or near a school
facility of a school district or board or of an
Indian tribe or tribal organization;
``(ii) is organized through school,
community, and health provider relationships;
``(iii) is administered by a sponsoring
facility;
``(iv) provides through health
professionals primary health services to
children in accordance with State and local
law, including laws relating to licensure and
certification; and
``(v) satisfies such other requirements as
a State may establish for the operation of such
a clinic.
``(B) Sponsoring facility.--For purposes of
subparagraph (A)(iii), the term `sponsoring facility'
includes any of the following:
``(i) A hospital.
``(ii) A public health department.
``(iii) A community health center.
``(iv) A nonprofit health care agency.
``(v) A school or school system.
``(vi) A program administered by the Indian
Health Service or the Bureau of Indian Affairs
or operated by an Indian tribe or a tribal
organization.''.
SEC. 506. MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION.
(a) In General.--Title XIX (42 U.S.C. 1396 et seq.) is amended by
inserting before section 1901 the following new section:
``medicaid and chip payment and access commission
``Sec. 1900. (a) Establishment.--There is hereby established the
Medicaid and CHIP Payment and Access Commission (in this section
referred to as `MACPAC').
``(b) Duties.--
``(1) Review of access policies and annual reports.--MACPAC
shall--
``(A) review policies of the Medicaid program
established under this title (in this section referred
to as `Medicaid') and the State Children's Health
Insurance Program established under title XXI (in this
section referred to as `CHIP') affecting children's
access to covered items and services, including topics
described in paragraph (2);
``(B) make recommendations to Congress concerning
such access policies;
``(C) by not later than March 1 of each year
(beginning with 2010), submit a report to Congress
containing the results of such reviews and MACPAC's
recommendations concerning such policies; and
``(D) by not later than June 1 of each year
(beginning with 2010), submit a report to Congress
containing an examination of issues affecting Medicaid
and CHIP, including the implications of changes in
health care delivery in the United States and in the
market for health care services on such programs.
``(2) Specific topics to be reviewed.--Specifically, MACPAC
shall review and assess the following:
``(A) Medicaid and chip payment policies.--Payment
policies under Medicaid and CHIP, including--
``(i) the factors affecting expenditures
for items and services in different sectors,
including the process for updating hospital,
skilled nursing facility, physician, Federally-
qualified health center, rural health center,
and other fees;
``(ii) payment methodologies; and
``(iii) the relationship of such factors
and methodologies to access and quality of care
for Medicaid and CHIP beneficiaries.
``(B) Interaction of medicaid and chip payment
policies with health care delivery generally.--The
effect of Medicaid and CHIP payment policies on access
to items and services for children and other Medicaid
and CHIP populations other than under this title or
title XXI and the implications of changes in health
care delivery in the United States and in the general
market for health care items and services on Medicaid
and CHIP.
``(C) Other access policies.--The effect of other
Medicaid and CHIP policies on access to covered items
and services, including policies relating to
transportation and language barriers.
``(3) Creation of early-warning system.--MACPAC shall
create an early-warning system to identify provider shortage
areas or any other problems that threaten access to care or the
health care status of Medicaid and CHIP beneficiaries.
``(4) Comments on certain secretarial reports.--If the
Secretary submits to Congress (or a committee of Congress) a
report that is required by law and that relates to access
policies, including with respect to payment policies, under
Medicaid or CHIP, the Secretary shall transmit a copy of the
report to MACPAC. MACPAC shall review the report and, not later
than 6 months after the date of submittal of the Secretary's
report to Congress, shall submit to the appropriate committees
of Congress written comments on such report. Such comments may
include such recommendations as MACPAC deems appropriate.
``(5) Agenda and additional reviews.--MACPAC shall consult
periodically with the chairmen and ranking minority members of
the appropriate committees of Congress regarding MACPAC's
agenda and progress towards achieving the agenda. MACPAC may
conduct additional reviews, and submit additional reports to
the appropriate committees of Congress, from time to time on
such topics relating to the program under this title or title
XXI as may be requested by such chairmen and members and as
MACPAC deems appropriate.
``(6) Availability of reports.--MACPAC shall transmit to
the Secretary a copy of each report submitted under this
subsection and shall make such reports available to the public.
``(7) Appropriate committee of congress.--For purposes of
this section, the term `appropriate committees of Congress'
means the Committee on Energy and Commerce of the House of
Representatives and the Committee on Finance of the Senate.
``(8) Voting and reporting requirements.--With respect to
each recommendation contained in a report submitted under
paragraph (1), each member of MACPAC shall vote on the
recommendation, and MACPAC shall include, by member, the
results of that vote in the report containing the
recommendation.
``(9) Examination of budget consequences.--Before making
any recommendations, MACPAC shall examine the budget
consequences of such recommendations, directly or through
consultation with appropriate expert entities.
``(c) Membership.--
``(1) Number and appointment.--MACPAC shall be composed of
17 members appointed by the Comptroller General of the United
States.
``(2) Qualifications.--
``(A) In general.--The membership of MACPAC shall
include individuals who have had direct experience as
enrollees or parents of enrollees in Medicaid or CHIP
and individuals with national recognition for their
expertise in Federal safety net health programs, health
finance and economics, actuarial science, health
facility management, health plans and integrated
delivery systems, reimbursement of health facilities,
health information technology, pediatric physicians,
dentists, and other providers of health services, and
other related fields, who provide a mix of different
professionals, broad geographic representation, and a
balance between urban and rural representatives.
``(B) Inclusion.--The membership of MACPAC shall
include (but not be limited to) physicians and other
health professionals, employers, third-party payers,
and individuals with expertise in the delivery of
health services. Such membership shall also include
consumers representing children, pregnant women, the
elderly, and individuals with disabilities, current or
former representatives of State agencies responsible
for administering Medicaid, and current or former
representatives of State agencies responsible for
administering CHIP.
``(C) Majority nonproviders.--Individuals who are
directly involved in the provision, or management of
the delivery, of items and services covered under
Medicaid or CHIP shall not constitute a majority of the
membership of MACPAC.
``(D) Ethical disclosure.--The Comptroller General
of the United States shall establish a system for
public disclosure by members of MACPAC of financial and
other potential conflicts of interest relating to such
members. Members of MACPAC shall be treated as
employees of Congress for purposes of applying title I
of the Ethics in Government Act of 1978 (Public Law 95-
521).
``(3) Terms.--
``(A) In general.--The terms of members of MACPAC
shall be for 3 years except that the Comptroller
General of the United States shall designate staggered
terms for the members first appointed.
``(B) Vacancies.--Any member appointed to fill a
vacancy occurring before the expiration of the term for
which the member's predecessor was appointed shall be
appointed only for the remainder of that term. A member
may serve after the expiration of that member's term
until a successor has taken office. A vacancy in MACPAC
shall be filled in the manner in which the original
appointment was made.
``(4) Compensation.--While serving on the business of
MACPAC (including travel time), a member of MACPAC shall be
entitled to compensation at the per diem equivalent of the rate
provided for level IV of the Executive Schedule under section
5315 of title 5, United States Code; and while so serving away
from home and the member's regular place of business, a member
may be allowed travel expenses, as authorized by the Chairman
of MACPAC. Physicians serving as personnel of MACPAC may be
provided a physician comparability allowance by MACPAC in the
same manner as Government physicians may be provided such an
allowance by an agency under section 5948 of title 5, United
States Code, and for such purpose subsection (i) of such
section shall apply to MACPAC in the same manner as it applies
to the Tennessee Valley Authority. For purposes of pay (other
than pay of members of MACPAC) and employment benefits, rights,
and privileges, all personnel of MACPAC shall be treated as if
they were employees of the United States Senate.
``(5) Chairman; vice chairman.--The Comptroller General of
the United States shall designate a member of MACPAC, at the
time of appointment of the member as Chairman and a member as
Vice Chairman for that term of appointment, except that in the
case of vacancy of the Chairmanship or Vice Chairmanship, the
Comptroller General of the United States may designate another
member for the remainder of that member's term.
``(6) Meetings.--MACPAC shall meet at the call of the
Chairman.
``(d) Director and Staff; Experts and Consultants.--Subject to such
review as the Comptroller General of the United States deems necessary
to assure the efficient administration of MACPAC, MACPAC may--
``(1) employ and fix the compensation of an Executive
Director (subject to the approval of the Comptroller General of
the United States) and such other personnel as may be necessary
to carry out its duties (without regard to the provisions of
title 5, United States Code, governing appointments in the
competitive service);
``(2) seek such assistance and support as may be required
in the performance of its duties from appropriate Federal
departments and agencies;
``(3) enter into contracts or make other arrangements, as
may be necessary for the conduct of the work of MACPAC (without
regard to section 3709 of the Revised Statutes (41 U.S.C. 5));
``(4) make advance, progress, and other payments which
relate to the work of MACPAC;
``(5) provide transportation and subsistence for persons
serving without compensation; and
``(6) prescribe such rules and regulations as it deems
necessary with respect to the internal organization and
operation of MACPAC.
``(e) Powers.--
``(1) Obtaining official data.--MACPAC may secure directly
from any department or agency of the United States information
necessary to enable it to carry out this section. Upon request
of the Chairman, the head of that department or agency shall
furnish that information to MACPAC on an agreed upon schedule.
``(2) Data collection.--In order to carry out its
functions, MACPAC shall--
``(A) utilize existing information, both published
and unpublished, where possible, collected and assessed
either by its own staff or under other arrangements
made in accordance with this section;
``(B) carry out, or award grants or contracts for,
original research and experimentation, where existing
information is inadequate; and
``(C) adopt procedures allowing any interested
party to submit information for MACPAC's use in making
reports and recommendations.
``(3) Access of gao to information.--The Comptroller
General of the United States shall have unrestricted access to
all deliberations, records, and nonproprietary data of MACPAC,
immediately upon request.
``(4) Periodic audit.--MACPAC shall be subject to periodic
audit by the Comptroller General of the United States.
``(f) Authorization of Appropriations.--
``(1) Request for appropriations.--MACPAC shall submit
requests for appropriations in the same manner as the
Comptroller General of the United States submits requests for
appropriations, but amounts appropriated for MACPAC shall be
separate from amounts appropriated for the Comptroller General
of the United States.
``(2) Authorization.--There are authorized to be
appropriated such sums as may be necessary to carry out the
provisions of this section.''.
(b) Deadline for Initial Appointments.--Not later than January 1,
2010, the Comptroller General of the United States shall appoint the
initial members of the Medicaid and CHIP Payment and Access Commission
established under section 1900 of the Social Security Act (as added by
subsection (a)).
(c) Annual Report on Medicaid.--Not later than January 1, 2010, and
annually thereafter, the Secretary, in consultation with the Secretary
of the Treasury, the Secretary of Labor, and the States (as defined for
purposes of Medicaid), shall submit an annual report to Congress on the
financial status of, enrollment in, and spending trends for, Medicaid
for the fiscal year ending on September 30 of the preceding year.
TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS
Subtitle A--Program Integrity and Data Collection
SEC. 601. PAYMENT ERROR RATE MEASUREMENT (``PERM'').
(a) Expenditures Related to Compliance With Requirements.--
(1) Enhanced payments.--Section 2105(c) (42 U.S.C.
1397ee(c)), as amended by section 301(a), is amended by adding
at the end the following new paragraph:
``(11) Enhanced payments.--Notwithstanding subsection (b),
the enhanced FMAP with respect to payments under subsection (a)
for expenditures related to the administration of the payment
error rate measurement (PERM) requirements applicable to the
State child health plan in accordance with the Improper
Payments Information Act of 2002 and parts 431 and 457 of title
42, Code of Federal Regulations (or any related or successor
guidance or regulations) shall in no event be less than 90
percent.''.
(2) Exclusion of from cap on administrative expenditures.--
Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)C)), as amended by
section 302(b)), is amended by adding at the end the following:
``(iv) Payment error rate measurement
(perm) expenditures.--Expenditures related to
the administration of the payment error rate
measurement (PERM) requirements applicable to
the State child health plan in accordance with
the Improper Payments Information Act of 2002
and parts 431 and 457 of title 42, Code of
Federal Regulations (or any related or
successor guidance or regulations).''.
(b) Final Rule Required To Be in Effect for All States.--
Notwithstanding parts 431 and 457 of title 42, Code of Federal
Regulations (as in effect on the date of enactment of this Act), the
Secretary shall not calculate or publish any national or State-specific
error rate based on the application of the payment error rate
measurement (in this section referred to as ``PERM'') requirements to
CHIP until after the date that is 6 months after the date on which a
new final rule (in this section referred to as the ``new final rule'')
promulgated after the date of the enactment of this Act and
implementing such requirements in accordance with the requirements of
subsection (c) is in effect for all States. Any calculation of a
national error rate or a State specific error rate after such new final
rule in effect for all States may only be inclusive of errors, as
defined in such new final rule or in guidance issued within a
reasonable time frame after the effective date for such new final rule
that includes detailed guidance for the specific methodology for error
determinations.
(c) Requirements for New Final Rule.--For purposes of subsection
(b), the requirements of this subsection are that the new final rule
implementing the PERM requirements shall--
(1) include--
(A) clearly defined criteria for errors for both
States and providers;
(B) a clearly defined process for appealing error
determinations by--
(i) review contractors; or
(ii) the agency and personnel described in
section 431.974(a)(2) of title 42, Code of
Federal Regulations, as in effect on September
1, 2007, responsible for the development,
direction, implementation, and evaluation of
eligibility reviews and associated activities;
and
(C) clearly defined responsibilities and deadlines
for States in implementing any corrective action plans;
and
(2) provide that the payment error rate determined for a
State shall not take into account payment errors resulting from
the State's verification of an applicant's self-declaration or
self-certification of eligibility for, and the correct amount
of, medical assistance or child health assistance, if the State
process for verifying an applicant's self-declaration or self-
certification satisfies the requirements for such process
applicable under regulations promulgated by the Secretary or
otherwise approved by the Secretary.
(d) Option for Application of Data for States in First Application
Cycle Under the Interim Final Rule.--After the new final rule
implementing the PERM requirements in accordance with the requirements
of subsection (c) is in effect for all States, a State for which the
PERM requirements were first in effect under an interim final rule for
fiscal year 2007 or under a final rule for fiscal year 2008 may elect
to accept any payment error rate determined in whole or in part for the
State on the basis of data for that fiscal year or may elect to not
have any payment error rate determined on the basis of such data and,
instead, shall be treated as if fiscal year 2010 or fiscal year 2011
were the first fiscal year for which the PERM requirements apply to the
State.
(e) Harmonization of MEQC and PERM.--
(1) Reduction of redundancies.--The Secretary shall review
the Medicaid Eligibility Quality Control (in this subsection
referred to as the ``MEQC'') requirements with the PERM
requirements and coordinate consistent implementation of both
sets of requirements, while reducing redundancies.
(2) State option to apply perm data.--A State may elect,
for purposes of determining the erroneous excess payments for
medical assistance ratio applicable to the State for a fiscal
year under section 1903(u) of the Social Security Act (42
U.S.C. 1396b(u)) to substitute data resulting from the
application of the PERM requirements to the State after the new
final rule implementing such requirements is in effect for all
States for data obtained from the application of the MEQC
requirements to the State with respect to a fiscal year.
(3) State option to apply meqc data.--For purposes of
satisfying the requirements of subpart Q of part 431 of title
42, Code of Federal Regulations, relating to Medicaid
eligibility reviews, a State may elect to substitute data
obtained through MEQC reviews conducted in accordance with
section 1903(u) of the Social Security Act (42 U.S.C. 1396b(u))
for data required for purposes of PERM requirements, but only
if the State MEQC reviews are based on a broad, representative
sample of Medicaid applicants or enrollees in the States.
(f) Identification of Improved State-Specific Sample Sizes.--The
Secretary shall establish State-specific sample sizes for application
of the PERM requirements with respect to State child health plans for
fiscal years beginning with the first fiscal year that begins on or
after the date on which the new final rule is in effect for all States,
on the basis of such information as the Secretary determines
appropriate. In establishing such sample sizes, the Secretary shall, to
the greatest extent practicable--
(1) minimize the administrative cost burden on States under
Medicaid and CHIP; and
(2) maintain State flexibility to manage such programs.
(g) Time for Promulgation of Final Rule.--The final rule
implementing the PERM requirements under subsection (b) shall be
promulgated not later than 6 months after the date of enactment of this
Act.
SEC. 602. IMPROVING DATA COLLECTION.
(a) Increased Appropriation.--Section 2109(b)(2) (42 U.S.C.
1397ii(b)(2)) is amended by striking ``$10,000,000 for fiscal year
2000'' and inserting ``$20,000,000 for fiscal year 2009''.
(b) Use of Additional Funds.--Section 2109(b) (42 U.S.C.
1397ii(b)), as amended by subsection (a), is amended--
(1) by redesignating paragraph (2) as paragraph (4); and
(2) by inserting after paragraph (1), the following new
paragraphs:
``(2) Additional requirements.--In addition to making the
adjustments required to produce the data described in paragraph
(1), with respect to data collection occurring for fiscal years
beginning with fiscal year 2009, in appropriate consultation
with the Secretary of Health and Human Services, the Secretary
of Commerce shall do the following:
``(A) Make appropriate adjustments to the Current
Population Survey to develop more accurate State-
specific estimates of the number of children enrolled
in health coverage under title XIX or this title.
``(B) Make appropriate adjustments to the Current
Population Survey to improve the survey estimates used
to determine the child population growth factor under
section 2104(m)(5)(B) and any other data necessary for
carrying out this title.
``(C) Include health insurance survey information
in the American Community Survey related to children.
``(D) Assess whether American Community Survey
estimates, once such survey data are first available,
produce more reliable estimates than the Current
Population Survey with respect to the purposes
described in subparagraph (B).
``(E) On the basis of the assessment required under
subparagraph (D), recommend to the Secretary of Health
and Human Services whether American Community Survey
estimates should be used in lieu of, or in some
combination with, Current Population Survey estimates
for the purposes described in subparagraph (B).
``(F) Continue making the adjustments described in
the last sentence of paragraph (1) with respect to
expansion of the sample size used in State sampling
units, the number of sampling units in a State, and
using an appropriate verification element.
``(3) Authority for the secretary of health and human
services to transition to the use of all, or some combination
of, acs estimates upon recommendation of the secretary of
commerce.--If, on the basis of the assessment required under
paragraph (2)(D), the Secretary of Commerce recommends to the
Secretary of Health and Human Services that American Community
Survey estimates should be used in lieu of, or in some
combination with, Current Population Survey estimates for the
purposes described in paragraph (2)(B), the Secretary of Health
and Human Services, in consultation with the States, may
provide for a period during which the Secretary may transition
from carrying out such purposes through the use of Current
Population Survey estimates to the use of American Community
Survey estimates (in lieu of, or in combination with the
Current Population Survey estimates, as recommended), provided
that any such transition is implemented in a manner that is
designed to avoid adverse impacts upon States with approved
State child health plans under this title.''.
SEC. 603. UPDATED FEDERAL EVALUATION OF CHIP.
Section 2108(c) (42 U.S.C. 1397hh(c)) is amended by striking
paragraph (5) and inserting the following:
``(5) Subsequent evaluation using updated information.--
``(A) In general.--The Secretary, directly or
through contracts or interagency agreements, shall
conduct an independent subsequent evaluation of 10
States with approved child health plans.
``(B) Selection of states and matters included.--
Paragraphs (2) and (3) shall apply to such subsequent
evaluation in the same manner as such provisions apply
to the evaluation conducted under paragraph (1).
``(C) Submission to congress.--Not later than
December 31, 2011, the Secretary shall submit to
Congress the results of the evaluation conducted under
this paragraph.
``(D) Funding.--Out of any money in the Treasury of
the United States not otherwise appropriated, there are
appropriated $10,000,000 for fiscal year 2010 for the
purpose of conducting the evaluation authorized under
this paragraph. Amounts appropriated under this
subparagraph shall remain available for expenditure
through fiscal year 2012.''.
SEC. 604. ACCESS TO RECORDS FOR IG AND GAO AUDITS AND EVALUATIONS.
Section 2108(d) (42 U.S.C. 1397hh(d)) is amended to read as
follows:
``(d) Access to Records for IG and GAO Audits and Evaluations.--For
the purpose of evaluating and auditing the program established under
this title, or title XIX, the Secretary, the Office of Inspector
General, and the Comptroller General shall have access to any books,
accounts, records, correspondence, and other documents that are related
to the expenditure of Federal funds under this title and that are in
the possession, custody, or control of States receiving Federal funds
under this title or political subdivisions thereof, or any grantee or
contractor of such States or political subdivisions.''.
SEC. 605. NO FEDERAL FUNDING FOR ILLEGAL ALIENS; DISALLOWANCE FOR
UNAUTHORIZED EXPENDITURES.
Nothing in this Act allows Federal payment for individuals who are
not legal residents. Titles XI, XIX, and XXI of the Social Security Act
provide for the disallowance of Federal financial participation for
erroneous expenditures under Medicaid and under CHIP, respectively.
Subtitle B--Miscellaneous Health Provisions
SEC. 611. DEFICIT REDUCTION ACT TECHNICAL CORRECTIONS.
(a) Clarification of Requirement To Provide EPSDT Services for All
Children in Benchmark Benefit Packages Under Medicaid.--Section
1937(a)(1) (42 U.S.C. 1396u-7(a)(1)), as inserted by section 6044(a) of
the Deficit Reduction Act of 2005 (Public Law 109-171, 120 Stat. 88),
is amended--
(1) in subparagraph (A)--
(A) in the matter before clause (i)--
(i) by striking ``Notwithstanding any other
provision of this title'' and inserting
``Notwithstanding section 1902(a)(1) (relating
to statewideness), section 1902(a)(10)(B)
(relating to comparability) and any other
provision of this title which would be directly
contrary to the authority under this section
and subject to subsection (E)''; and
(ii) by striking ``enrollment in coverage
that provides'' and inserting ``coverage
that'';
(B) in clause (i), by inserting ``provides'' after
``(i)''; and
(C) by striking clause (ii) and inserting the
following:
``(ii) for any individual described in
section 1905(a)(4)(B) who is eligible under the
State plan in accordance with paragraphs (10)
and (17) of section 1902(a), consists of the
items and services described in section
1905(a)(4)(B) (relating to early and periodic
screening, diagnostic, and treatment services
defined in section 1905(r)) and provided in
accordance with the requirements of section
1902(a)(43).'';
(2) in subparagraph (C)--
(A) in the heading, by striking ``wrap-around'' and
inserting ``additional''; and
(B) by striking ``wrap-around or''; and
(3) by adding at the end the following new subparagraph:
``(E) Rule of construction.--Nothing in this
paragraph shall be construed as--
``(i) requiring a State to offer all or any
of the items and services required by
subparagraph (A)(ii) through an issuer of
benchmark coverage described in subsection
(b)(1) or benchmark equivalent coverage
described in subsection (b)(2);
``(ii) preventing a State from offering all
or any of the items and services required by
subparagraph (A)(ii) through an issuer of
benchmark coverage described in subsection
(b)(1) or benchmark equivalent coverage
described in subsection (b)(2); or
``(iii) affecting a child's entitlement to
care and services described in subsections
(a)(4)(B) and (r) of section 1905 and provided
in accordance with section 1902(a)(43) whether
provided through benchmark coverage, benchmark
equivalent coverage, or otherwise.''.
(b) Correction of Reference to Children in Foster Care Receiving
Child Welfare Services.--Section 1937(a)(2)(B)(viii) (42 U.S.C. 1396u-
7(a)(2)(B)(viii)), as inserted by section 6044(a) of the Deficit
Reduction Act of 2005, is amended by striking ``aid or assistance is
made available under part B of title IV to children in foster care and
individuals'' and inserting ``child welfare services are made available
under part B of title IV on the basis of being a child in foster care
or''.
(c) Transparency.--Section 1937 (42 U.S.C. 1396u-7), as inserted by
section 6044(a) of the Deficit Reduction Act of 2005, is amended by
adding at the end the following:
``(c) Publication of Provisions Affected.--With respect to a State
plan amendment to provide benchmark benefits in accordance with
subsections (a) and (b) that is approved by the Secretary, the
Secretary shall publish on the Internet website of the Centers for
Medicare & Medicaid Services, a list of the provisions of this title
that the Secretary has determined do not apply in order to enable the
State to carry out the plan amendment and the reason for each such
determination on the date such approval is made, and shall publish such
list in the Federal Register and not later than 30 days after such date
of approval.''.
(d) Effective Date.--The amendments made by subsections (a), (b),
and (c) of this section shall take effect as if included in the
amendment made by section 6044(a) of the Deficit Reduction Act of 2005.
SEC. 612. REFERENCES TO TITLE XXI.
Section 704 of the Medicare, Medicaid, and SCHIP Balanced Budget
Refinement Act of 1999, as enacted into law by division B of Public Law
106-113 (113 Stat. 1501A-402) is repealed.
SEC. 613. PROHIBITING INITIATION OF NEW HEALTH OPPORTUNITY ACCOUNT
DEMONSTRATION PROGRAMS.
After the date of the enactment of this Act, the Secretary of
Health and Human Services may not approve any new demonstration
programs under section 1938 of the Social Security Act (42 U.S.C.
1396u-8).
SEC. 614. ADJUSTMENT IN COMPUTATION OF MEDICAID FMAP TO DISREGARD AN
EXTRAORDINARY EMPLOYER PENSION CONTRIBUTION.
(a) In General.--Only for purposes of computing the FMAP (as
defined in subsection (e)) for a State for a fiscal year (beginning
with fiscal year 2006) and applying the FMAP under title XIX of the
Social Security Act, any significantly disproportionate employer
pension or insurance fund contribution described in subsection (b)
shall be disregarded in computing the per capita income of such State,
but shall not be disregarded in computing the per capita income for the
continental United States (and Alaska) and Hawaii.
(b) Significantly Disproportionate Employer Pension and Insurance
Fund Contribution.--
(1) In general.--For purposes of this section, a
significantly disproportionate employer pension and insurance
fund contribution described in this subsection with respect to
a State is any identifiable employer contribution towards
pension or other employee insurance funds that is estimated to
accrue to residents of such State for a calendar year
(beginning with calendar year 2003) if the increase in the
amount so estimated exceeds 25 percent of the total increase in
personal income in that State for the year involved.
(2) Data to be used.--For estimating and adjustment a FMAP
already calculated as of the date of the enactment of this Act
for a State with a significantly disproportionate employer
pension and insurance fund contribution, the Secretary shall
use the personal income data set originally used in calculating
such FMAP.
(3) Special adjustment for negative growth.--If in any
calendar year the total personal income growth in a State is
negative, an employer pension and insurance fund contribution
for the purposes of calculating the State's FMAP for a calendar
year shall not exceed 125 percent of the amount of such
contribution for the previous calendar year for the State.
(c) Hold Harmless.--No State shall have its FMAP for a fiscal year
reduced as a result of the application of this section.
(d) Report.--Not later than May 15, 2009, the Secretary shall
submit to the Congress a report on the problems presented by the
current treatment of pension and insurance fund contributions in the
use of Bureau of Economic Affairs calculations for the FMAP and for
Medicaid and on possible alternative methodologies to mitigate such
problems.
(e) FMAP Defined.--For purposes of this section, the term ``FMAP''
means the Federal medical assistance percentage, as defined in section
1905(b) of the Social Security Act (42 U.S.C. 1396(d)).
SEC. 615. CLARIFICATION TREATMENT OF REGIONAL MEDICAL CENTER.
(a) In General.--Nothing in section 1903(w) of the Social Security
Act (42 U.S.C. 1396b(w)) shall be construed by the Secretary of Health
and Human Services as prohibiting a State's use of funds as the non-
Federal share of expenditures under title XIX of such Act where such
funds are transferred from or certified by a publicly-owned regional
medical center located in another State and described in subsection
(b), so long as the Secretary determines that such use of funds is
proper and in the interest of the program under title XIX.
(b) Center Described.--A center described in this subsection is a
publicly-owned regional medical center that--
(1) provides level 1 trauma and burn care services;
(2) provides level 3 neonatal care services;
(3) is obligated to serve all patients, regardless of
ability to pay;
(4) is located within a Standard Metropolitan Statistical
Area (SMSA) that includes at least 3 States;
(5) provides services as a tertiary care provider for
patients residing within a 125-mile radius; and
(6) meets the criteria for a disproportionate share
hospital under section 1923 of such Act (42 U.S.C. 1396r-4) in
at least one State other than the State in which the center is
located.
SEC. 616. EXTENSION OF MEDICAID DSH ALLOTMENTS FOR TENNESSEE AND
HAWAII.
Section 1923(f)(6) (42 U.S.C. 1396r-4(f)(6)), as amended by section
202 of the Medicare Improvements for Patients and Providers Act of 2008
(Public Law 110-275) is amended--
(1) in the paragraph heading, by striking ``2009 and the
first calendar quarter of fiscal year 2010'' and inserting
``2011 and the first calendar quarter of fiscal year 2012'';
(2) in subparagraph (A)--
(A) in clause (i)--
(i) in the second sentence--
(I) by striking ``and 2009'' and
inserting ``, 2009, 2010, and 2011'';
and
(II) by striking ``such portion
of''; and
(ii) in the third sentence, by striking
``2010 for the period ending on December 31,
2009'' and inserting ``2012 for the period
ending on December 31, 2011'';
(B) in clause (ii), by striking ``or for a period
in fiscal year 2010'' and inserting ``2010, 2011, or
for period in fiscal year 2012''; and
(C) in clause (iv)--
(i) in the clause heading, by striking
``2009 and the first calendar quarter of fiscal
year 2010'' and inserting ``2011 and the first
calendar quarter of fiscal year 2012''; and
(ii) in each of subclauses (I) and (II), by
striking `` or for a period in fiscal year
2010'' and inserting ``2010, 2011, or for a
period in fiscal year 2012''; and
(3) in subparagraph (B)--
(A) in clause (i)--
(i) in the first sentence, by striking
``2009'' and inserting ``2011''; and
(ii) in the second sentence, by striking
``2010 for the period ending on December 31,
2009'' and inserting ``2012 for the period
ending on December 31, 2011''.
SEC. 617. GAO REPORT ON MEDICAID MANAGED CARE PAYMENT RATES.
Not later than 18 months after the date of the enactment of this
Act, the Comptroller General of the United States shall submit a report
to the Committee on Finance of the Senate and the Committee on Energy
and Commerce of the House of Representatives analyzing the extent to
which State payment rates for medicaid managed care organizations under
Medicaid are actuarially sound.
Subtitle C--Other Provisions
SEC. 621. OUTREACH REGARDING HEALTH INSURANCE OPTIONS AVAILABLE TO
CHILDREN.
(a) Definitions.--In this section--
(1) the terms ``Administration'' and ``Administrator''
means the Small Business Administration and the Administrator
thereof, respectively;
(2) the term ``certified development company'' means a
development company participating in the program under title V
of the Small Business Investment Act of 1958 (15 U.S.C. 695 et
seq.);
(3) the term ``Medicaid program'' means the program
established under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.);
(4) the term ``Service Corps of Retired Executives'' means
the Service Corps of Retired Executives authorized by section
8(b)(1) of the Small Business Act (15 U.S.C. 637(b)(1));
(5) the term ``small business concern'' has the meaning
given that term in section 3 of the Small Business Act (15
U.S.C. 632);
(6) the term ``small business development center'' means a
small business development center described in section 21 of
the Small Business Act (15 U.S.C. 648);
(7) the term ``State'' has the meaning given that term for
purposes of title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.);
(8) the term ``State Children's Health Insurance Program''
means the State Children's Health Insurance Program established
under title XXI of the Social Security Act (42 U.S.C. 1397aa et
seq.);
(9) the term ``task force'' means the task force
established under subsection (b)(1); and
(10) the term ``women's business center'' means a women's
business center described in section 29 of the Small Business
Act (15 U.S.C. 656).
(b) Establishment of Task Force.--
(1) Establishment.--There is established a task force to
conduct a nationwide campaign of education and outreach for
small business concerns regarding the availability of coverage
for children through private insurance options, the Medicaid
program, and the State Children's Health Insurance Program.
(2) Membership.--The task force shall consist of the
Administrator, the Secretary of Health and Human Services, the
Secretary of Labor, and the Secretary of the Treasury.
(3) Responsibilities.--The campaign conducted under this
subsection shall include--
(A) efforts to educate the owners of small business
concerns about the value of health coverage for
children;
(B) information regarding options available to the
owners and employees of small business concerns to make
insurance more affordable, including Federal and State
tax deductions and credits for health care-related
expenses and health insurance expenses and Federal tax
exclusion for health insurance options available under
employer-sponsored cafeteria plans under section 125 of
the Internal Revenue Code of 1986;
(C) efforts to educate the owners of small business
concerns about assistance available through public
programs; and
(D) efforts to educate the owners and employees of
small business concerns regarding the availability of
the hotline operated as part of the Insure Kids Now
program of the Department of Health and Human Services.
(4) Implementation.--In carrying out this subsection, the
task force may--
(A) use any business partner of the Administration,
including--
(i) a small business development center;
(ii) a certified development company;
(iii) a women's business center; and
(iv) the Service Corps of Retired
Executives;
(B) enter into--
(i) a memorandum of understanding with a
chamber of commerce; and
(ii) a partnership with any appropriate
small business concern or health advocacy
group; and
(C) designate outreach programs at regional offices
of the Department of Health and Human Services to work
with district offices of the Administration.
(5) Website.--The Administrator shall ensure that links to
information on the eligibility and enrollment requirements for
the Medicaid program and State Children's Health Insurance
Program of each State are prominently displayed on the website
of the Administration.
(6) Report.--
(A) In general.--Not later than 2 years after the
date of enactment of this Act, and every 2 years
thereafter, the Administrator shall submit to the
Committee on Small Business and Entrepreneurship of the
Senate and the Committee on Small Business of the House
of Representatives a report on the status of the
nationwide campaign conducted under paragraph (1).
(B) Contents.--Each report submitted under
subparagraph (A) shall include a status update on all
efforts made to educate owners and employees of small
business concerns on options for providing health
insurance for children through public and private
alternatives.
SEC. 622. SENSE OF THE SENATE REGARDING ACCESS TO AFFORDABLE AND
MEANINGFUL HEALTH INSURANCE COVERAGE.
(a) Findings.--The Senate finds the following:
(1) There are approximately 45 million Americans currently
without health insurance.
(2) More than half of uninsured workers are employed by
businesses with less than 25 employees or are self-employed.
(3) Health insurance premiums continue to rise at more than
twice the rate of inflation for all consumer goods.
(4) Individuals in the small group and individual health
insurance markets usually pay more for similar coverage than
those in the large group market.
(5) The rapid growth in health insurance costs over the
last few years has forced many employers, particularly small
employers, to increase deductibles and co-pays or to drop
coverage completely.
(b) Sense of the Senate.--The Senate--
(1) recognizes the necessity to improve affordability and
access to health insurance for all Americans;
(2) acknowledges the value of building upon the existing
private health insurance market; and
(3) affirms its intent to enact legislation this year that,
with appropriate protection for consumers, improves access to
affordable and meaningful health insurance coverage for
employees of small businesses and individuals by--
(A) facilitating pooling mechanisms, including
pooling across State lines, and
(B) providing assistance to small businesses and
individuals, including financial assistance and tax
incentives, for the purchase of private insurance
coverage.
TITLE VII--REVENUE PROVISIONS
SEC. 701. INCREASE IN EXCISE TAX RATE ON TOBACCO PRODUCTS.
(a) Cigars.--Section 5701(a) of the Internal Revenue Code of 1986
is amended--
(1) by striking ``$1.828 cents per thousand ($1.594 cents
per thousand on cigars removed during 2000 or 2001)'' in
paragraph (1) and inserting ``$50.33 per thousand'',
(2) by striking ``20.719 percent (18.063 percent on cigars
removed during 2000 or 2001)'' in paragraph (2) and inserting
``52.75 percent'', and
(3) by striking ``$48.75 per thousand ($42.50 per thousand
on cigars removed during 2000 or 2001)'' in paragraph (2) and
inserting ``40.26 cents per cigar''.
(b) Cigarettes.--Section 5701(b) of such Code is amended--
(1) by striking ``$19.50 per thousand ($17 per thousand on
cigarettes removed during 2000 or 2001)'' in paragraph (1) and
inserting ``$50.33 per thousand'', and
(2) by striking ``$40.95 per thousand ($35.70 per thousand
on cigarettes removed during 2000 or 2001)'' in paragraph (2)
and inserting ``$105.69 per thousand''.
(c) Cigarette Papers.--Section 5701(c) of such Code is amended by
striking ``1.22 cents (1.06 cents on cigarette papers removed during
2000 or 2001)'' and inserting ``3.15 cents''.
(d) Cigarette Tubes.--Section 5701(d) of such Code is amended by
striking ``2.44 cents (2.13 cents on cigarette tubes removed during
2000 or 2001)'' and inserting ``6.30 cents''.
(e) Smokeless Tobacco.--Section 5701(e) of such Code is amended--
(1) by striking ``58.5 cents (51 cents on snuff removed
during 2000 or 2001)'' in paragraph (1) and inserting
``$1.51'', and
(2) by striking ``19.5 cents (17 cents on chewing tobacco
removed during 2000 or 2001)'' in paragraph (2) and inserting
``50.33 cents''.
(f) Pipe Tobacco.--Section 5701(f) of such Code is amended by
striking ``$1.0969 cents (95.67 cents on pipe tobacco removed during
2000 or 2001)'' and inserting ``$2.8311 cents''.
(g) Roll-Your-Own Tobacco.--Section 5701(g) of such Code is amended
by striking ``$1.0969 cents (95.67 cents on roll-your-own tobacco
removed during 2000 or 2001)'' and inserting ``$24.78''.
(h) Floor Stocks Taxes.--
(1) Imposition of tax.--On tobacco products (other than
cigars described in section 5701(a)(2) of the Internal Revenue
Code of 1986) and cigarette papers and tubes manufactured in or
imported into the United States which are removed before April
1, 2009, and held on such date for sale by any person, there is
hereby imposed a tax in an amount equal to the excess of--
(A) the tax which would be imposed under section
5701 of such Code on the article if the article had
been removed on such date, over
(B) the prior tax (if any) imposed under section
5701 of such Code on such article.
(2) Credit against tax.--Each person shall be allowed as a
credit against the taxes imposed by paragraph (1) an amount
equal to $500. Such credit shall not exceed the amount of taxes
imposed by paragraph (1) on April 1, 2009, for which such
person is liable.
(3) Liability for tax and method of payment.--
(A) Liability for tax.--A person holding tobacco
products, cigarette papers, or cigarette tubes on April
1, 2009, to which any tax imposed by paragraph (1)
applies shall be liable for such tax.
(B) Method of payment.--The tax imposed by
paragraph (1) shall be paid in such manner as the
Secretary shall prescribe by regulations.
(C) Time for payment.--The tax imposed by paragraph
(1) shall be paid on or before August 1, 2009.
(4) Articles in foreign trade zones.--Notwithstanding the
Act of June 18, 1934 (commonly known as the Foreign Trade Zone
Act, 48 Stat. 998, 19 U.S.C. 81a et seq.) or any other
provision of law, any article which is located in a foreign
trade zone on April 1, 2009, shall be subject to the tax
imposed by paragraph (1) if--
(A) internal revenue taxes have been determined, or
customs duties liquidated, with respect to such article
before such date pursuant to a request made under the
1st proviso of section 3(a) of such Act, or
(B) such article is held on such date under the
supervision of an officer of the United States Customs
and Border Protection of the Department of Homeland
Security pursuant to the 2d proviso of such section
3(a).
(5) Definitions.--For purposes of this subsection--
(A) In general.--Any term used in this subsection
which is also used in section 5702 of the Internal
Revenue Code of 1986 shall have the same meaning as
such term has in such section.
(B) Secretary.--The term ``Secretary'' means the
Secretary of the Treasury or the Secretary's delegate.
(6) Controlled groups.--Rules similar to the rules of
section 5061(e)(3) of such Code shall apply for purposes of
this subsection.
(7) Other laws applicable.--All provisions of law,
including penalties, applicable with respect to the taxes
imposed by section 5701 of such Code shall, insofar as
applicable and not inconsistent with the provisions of this
subsection, apply to the floor stocks taxes imposed by
paragraph (1), to the same extent as if such taxes were imposed
by such section 5701. The Secretary may treat any person who
bore the ultimate burden of the tax imposed by paragraph (1) as
the person to whom a credit or refund under such provisions may
be allowed or made.
(i) Effective Date.--The amendments made by this section shall
apply to articles removed (as defined in section 5702(j) of the
Internal Revenue Code of 1986) after March 31, 2009.
SEC. 702. ADMINISTRATIVE IMPROVEMENTS.
(a) Permit, Inventories, Reports, and Records Requirements for
Manufacturers and Importers of Processed Tobacco.--
(1) Permit.--
(A) Application.--Section 5712 of the Internal
Revenue Code of 1986 is amended by inserting ``or
processed tobacco'' after ``tobacco products''.
(B) Issuance.--Section 5713(a) of such Code is
amended by inserting ``or processed tobacco'' after
``tobacco products''.
(2) Inventories, reports, and packages.--
(A) Inventories.--Section 5721 of such Code is
amended by inserting ``, processed tobacco,'' after
``tobacco products''.
(B) Reports.--Section 5722 of such Code is amended
by inserting ``, processed tobacco,'' after ``tobacco
products''.
(C) Packages, marks, labels, and notices.--Section
5723 of such Code is amended by inserting ``, processed
tobacco,'' after ``tobacco products'' each place it
appears.
(3) Records.--Section 5741 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco products''.
(4) Manufacturer of processed tobacco.--Section 5702 of
such Code is amended by adding at the end the following new
subsection:
``(p) Manufacturer of Processed Tobacco.--
``(1) In general.--The term `manufacturer of processed
tobacco' means any person who processes any tobacco other than
tobacco products.
``(2) Processed tobacco.--The processing of tobacco shall
not include the farming or growing of tobacco or the handling
of tobacco solely for sale, shipment, or delivery to a
manufacturer of tobacco products or processed tobacco.''.
(5) Conforming amendments.--
(A) Section 5702(h) of such Code is amended by
striking ``tobacco products and cigarette papers and
tubes'' and inserting ``tobacco products or cigarette
papers or tubes or any processed tobacco''.
(B) Sections 5702(j) and 5702(k) of such Code are
each amended by inserting ``, or any processed
tobacco,'' after ``tobacco products or cigarette papers
or tubes''.
(6) Effective date.--The amendments made by this subsection
shall take effect on April 1, 2009.
(b) Basis for Denial, Suspension, or Revocation of Permits.--
(1) Denial.--Paragraph (3) of section 5712 of such Code is
amended to read as follows:
``(3) such person (including, in the case of a corporation,
any officer, director, or principal stockholder and, in the
case of a partnership, a partner)--
``(A) is, by reason of his business experience,
financial standing, or trade connections or by reason
of previous or current legal proceedings involving a
felony violation of any other provision of Federal
criminal law relating to tobacco products, processed
tobacco, cigarette paper, or cigarette tubes, not
likely to maintain operations in compliance with this
chapter,
``(B) has been convicted of a felony violation of
any provision of Federal or State criminal law relating
to tobacco products, processed tobacco, cigarette
paper, or cigarette tubes, or
``(C) has failed to disclose any material
information required or made any material false
statement in the application therefor.''.
(2) Suspension or revocation.--Subsection (b) of section
5713 of such Code is amended to read as follows:
``(b) Suspension or Revocation.--
``(1) Show cause hearing.--If the Secretary has reason to
believe that any person holding a permit--
``(A) has not in good faith complied with this
chapter, or with any other provision of this title
involving intent to defraud,
``(B) has violated the conditions of such permit,
``(C) has failed to disclose any material
information required or made any material false
statement in the application for such permit,
``(D) has failed to maintain his premises in such
manner as to protect the revenue,
``(E) is, by reason of previous or current legal
proceedings involving a felony violation of any other
provision of Federal criminal law relating to tobacco
products, processed tobacco, cigarette paper, or
cigarette tubes, not likely to maintain operations in
compliance with this chapter, or
``(F) has been convicted of a felony violation of
any provision of Federal or State criminal law relating
to tobacco products, processed tobacco, cigarette
paper, or cigarette tubes,
the Secretary shall issue an order, stating the facts charged,
citing such person to show cause why his permit should not be
suspended or revoked.
``(2) Action following hearing.--If, after hearing, the
Secretary finds that such person has not shown cause why his
permit should not be suspended or revoked, such permit shall be
suspended for such period as the Secretary deems proper or
shall be revoked.''.
(3) Effective date.--The amendments made by this subsection
shall take effect on the date of the enactment of this Act.
(c) Application of Internal Revenue Code Statute of Limitations for
Alcohol and Tobacco Excise Taxes.--
(1) In general.--Section 514(a) of the Tariff Act of 1930
(19 U.S.C. 1514(a)) is amended by striking ``and section 520
(relating to refunds)'' and inserting ``section 520 (relating
to refunds), and section 6501 of the Internal Revenue Code of
1986 (but only with respect to taxes imposed under chapters 51
and 52 of such Code)''.
(2) Effective date.--The amendment made by this subsection
shall apply to articles imported after the date of the
enactment of this Act.
(d) Expansion of Definition of Roll-Your-Own Tobacco.--
(1) In general.--Section 5702(o) of the Internal Revenue
Code of 1986 is amended by inserting ``or cigars, or for use as
wrappers thereof'' before the period at the end.
(2) Effective date.--The amendment made by this subsection
shall apply to articles removed (as defined in section 5702(j)
of the Internal Revenue Code of 1986) after March 31, 2009.
(e) Time of Tax for Unlawfully Manufactured Tobacco Products.--
(1) In general.--Section 5703(b)(2) of such Code is amended
by adding at the end the following new subparagraph:
``(F) Special rule for unlawfully manufactured
tobacco products.--In the case of any tobacco products,
cigarette paper, or cigarette tubes manufactured in the
United States at any place other than the premises of a
manufacturer of tobacco products, cigarette paper, or
cigarette tubes that has filed the bond and obtained
the permit required under this chapter, tax shall be
due and payable immediately upon manufacture.''.
(2) Effective date.--The amendment made by this subsection
shall take effect on the date of the enactment of this Act.
(f) Disclosure.--
(1) In general.--Paragraph (1) of section 6103(o) of such
Code is amended by designating the text as subparagraph (A),
moving such text 2 ems to the right, striking ``Returns'' and
inserting ``(a) in general.--Returns'', and by inserting after
subparagraph (A) (as so redesignated) the following new
subparagraph:
``(B) Use in certain proceedings.--Returns and
return information disclosed to a Federal agency under
subparagraph (A) may be used in an action or proceeding
(or in preparation for such action or proceeding)
brought under section 625 of the American Jobs Creation
Act of 2004 for the collection of any unpaid assessment
or penalty arising under such Act.''.
(2) Conforming amendment.--Section 6103(p)(4) of such Code
is amended by striking ``(o)(1)'' both places it appears and
inserting ``(o)(1)(A)''.
(3) Effective date.--The amendments made by this subsection
shall apply on or after the date of the enactment of this Act.
(g) Transitional Rule.--Any person who--
(1) on April 1, 2009 is engaged in business as a
manufacturer of processed tobacco or as an importer of
processed tobacco, and
(2) before the end of the 90-day period beginning on such
date, submits an application under subchapter B of chapter 52
of such Code to engage in such business, may, notwithstanding
such subchapter B, continue to engage in such business pending
final action on such application. Pending such final action,
all provisions of such chapter 52 shall apply to such applicant
in the same manner and to the same extent as if such applicant
were a holder of a permit under such chapter 52 to engage in
such business.
SEC. 703. TREASURY STUDY CONCERNING MAGNITUDE OF TOBACCO SMUGGLING IN
THE UNITED STATES.
Not later than one year after the date of the enactment of this
Act, the Secretary of the Treasury shall conduct a study concerning the
magnitude of tobacco smuggling in the United States and submit to
Congress recommendations for the most effective steps to reduce tobacco
smuggling. Such study shall also include a review of the loss of
Federal tax receipts due to illicit tobacco trade in the United States
and the role of imported tobacco products in the illicit tobacco trade
in the United States.
SEC. 704. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.
The percentage under subparagraph (C) of section 401(1) of the Tax
Increase Prevention and Reconciliation Act of 2005 in effect on the
date of the enactment of this Act is increased by 0.5 percentage point.
Attest:
Secretary.
111th CONGRESS
1st Session
H.R. 2
_______________________________________________________________________
AMENDMENT