[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 321 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 321

   To amend title XXI of the Social Security Act to expand coverage 
  options under the State Children's Health Insurance Program (SCHIP) 
                      through premium assistance.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 8, 2009

Mr. Fortenberry (for himself, Mr. Burgess, Mr. Sessions, Mr. Terry, Mr. 
Price of Georgia, and Mr. Shadegg) introduced the following bill; which 
 was referred to the Committee on Energy and Commerce, and in addition 
  to the Committees on Ways and Means and Education and Labor, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
   To amend title XXI of the Social Security Act to expand coverage 
  options under the State Children's Health Insurance Program (SCHIP) 
                      through premium assistance.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``SCHIP Plus Act of 2009''.

SEC. 2. EXPANDING COVERAGE OPTIONS IN SCHIP THROUGH PREMIUM ASSISTANCE.

    (a) Requiring Offering of Alternative Coverage Options.--Section 
2102 of the Social Security Act (42 U.S.C. 1397b) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (6), by striking ``and'' at the 
                end;
                    (B) in paragraph (7), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(8) effective for plan years beginning on or after 
        October 1, 2010, how the plan will provide for child health 
        assistance with respect to applicable targeted low-income 
        children through alternative coverage options in accordance 
        with subsection (d).''; and
            (2) by adding at the end the following new subsection:
    ``(d) Alternative Coverage Options.--
            ``(1) In general.--Effective October 1, 2010, a State child 
        health plan shall provide for the offering of any qualified 
        alternative coverage that a qualified entity seeks to offer to 
        applicable targeted low-income children through the plan in the 
        State.
            ``(2) Application of uniform financial limitation for all 
        alternative coverage options.--With respect to all qualified 
        alternative coverage offered in a State, the State child health 
        plan shall establish a uniform dollar limitation on the per 
        capita monthly amount that will be paid by the State to the 
        qualified entity with respect to such coverage provided to a 
        targeted low-income child. Such limitation may not be less than 
        90 percent of the per capita monthly payment made for coverage 
        offered under the State child health plan that is not in the 
        form of an alternative coverage option. Nothing in this 
        paragraph shall be construed--
                    ``(A) as requiring a State to provide for the full 
                payment of premiums for qualified alternative coverage;
                    ``(B) as preventing a State from charging 
                additional premiums to cover the difference between the 
                cost of qualified alternative coverage and the amount 
                of such payment limitation;
                    ``(C) as preventing a State from using its own 
                funds to provide a dollar limitation that exceeds the 
                Federal financial participation as limited under 
                section 2105(c)(8).
            ``(3) Qualified alternative coverage defined.--In this 
        section, the term `qualified alternative coverage' means health 
        insurance coverage that--
                    ``(A) meets the coverage requirements of section 
                2103 (other than cost-sharing requirements of such 
                section); and
                    ``(B) is offered by a qualified insurer, and not 
                directly by the State.
            ``(4) Qualified insurer defined.--In this section, the term 
        `qualified insurer' means, with respect to a State, an entity 
        that is licensed to offer health insurance coverage in the 
        State.
            ``(5) Applicable targeted low-income children defined.--In 
        this title, the term `applicable targeted low-income children' 
        means targeted low-income children with family income that does 
        not exceed 200 percent of the poverty line applicable to family 
        of the size involved.''.
    (b) Federal Financial Participation for Qualified Alternative 
Coverage.--Section 2105 of such Act (42 U.S.C. 1397d) is amended--
            (1) in subsection (a)(1)(C), by inserting before the 
        semicolon at the end the following: ``and, subject to paragraph 
        (8)(C), in the form of payment of the premiums for coverage for 
        qualified alternative coverage''; and
            (2) by adding at the end of subsection (c) the following 
        new paragraph:
            ``(8) Purchase of qualified alternative coverage.--
                    ``(A) In general.--Payment may be made to a State 
                under subsection (a)(1)(C), subject to the provisions 
                of this paragraph, for the purchase of qualified 
                alternative coverage for applicable targeted low-income 
                children.
                    ``(B) Waiver of certain provisions.--With respect 
                to coverage described in subparagraph (A), no 
                limitation on beneficiary cost-sharing otherwise 
                applicable under this title or title XIX shall apply.
                    ``(C) Limitation on ffp.--The amount of the payment 
                under paragraph (1)(C) for coverage described in 
                subparagraph (A) during a fiscal year in the aggregate 
                for all such coverage in the State may not exceed the 
                product of--
                            ``(i) the national per capita expenditure 
                        under this title (taking into account both 
                        Federal and State expenditures) for the 
                        previous fiscal year (as determined by the 
                        Secretary using the best available data);
                            ``(ii) the enhanced FMAP for the State and 
                        fiscal year involved; and
                            ``(iii) the number of targeted low-income 
                        children for whom such coverage is provided.
                    ``(D) Voluntary enrollment.--A State child health 
                plan--
                            ``(i) may not require a targeted low-income 
                        child to enroll in coverage described in 
                        subparagraph (A) in order to obtain child 
                        health assistance under this title;
                            ``(ii) before providing such child health 
                        assistance for such coverage of a child, shall 
                        make available (which may be through an 
                        Internet website or other means) to the parent 
                        or guardian of the child information on the 
                        coverage available under this title, including 
                        benefits and cost-sharing; and
                            ``(iii) shall--
                                    ``(I) provide at least one 
                                opportunity per fiscal year for 
                                beneficiaries to switch coverage under 
                                this title from coverage described in 
                                subparagraph (A) to the coverage that 
                                is otherwise made available under this 
                                title; and
                                    ``(II) permit beneficiaries to 
                                switch such coverage under such other 
                                circumstances, such as the change in 
                                employment, birth of a child, or change 
                                in households, as the Secretary 
                                specifies.
                    ``(E) Information on coverage options.--A State 
                child health plan shall--
                            ``(i) describe how the State will notify 
                        potential beneficiaries of coverage described 
                        in subparagraph (A);
                            ``(ii) provide such notification in writing 
                        at least during the initial application for 
                        enrollment under this title and during 
                        redeterminations of eligibility if the 
                        individual was enrolled before October 1, 2010; 
                        and
                            ``(iii) post a description of these 
                        coverage options on any official website that 
                        may be established by the State in connection 
                        with the plan.
                    ``(F) Rule of construction.--Nothing in this 
                section is to be construed to prohibit a State from--
                            ``(i) establishing limits on beneficiary 
                        cost-sharing under such alternative coverage;
                            ``(ii) paying all or part of a 
                        beneficiary's cost-sharing requirements under 
                        such coverage;
                            ``(iii) paying less than the full cost of a 
                        child's share of the premium under such 
                        coverage, insofar as the premium for such 
                        coverage exceeds the limitation established by 
                        the State under subparagraph (C);
                            ``(iv) using State funds to pay for 
                        benefits above the Federal upper limit 
                        established under subparagraph (C); or
                            ``(v) providing any guidance or information 
                        it deems appropriate in order to help 
                        beneficiaries make an informed decision 
                        regarding the option to enroll in coverage 
                        described in subparagraph (A).''.

SEC. 3. EASING ADMINISTRATIVE BARRIERS TO STATE COOPERATION WITH 
              EMPLOYER-SPONSORED INSURANCE COVERAGE.

    (a) Requiring Some Coverage for Employer-Sponsored Insurance.--
            (1) In general.--Section 2102(a) of the Social Security Act 
        (42 U.S.C. 1397b(a)), as amended by section 2(a), is amended--
                    (A) in paragraph (7), by striking ``and'' at the 
                end;
                    (B) in paragraph (8), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(9) effective for plan years beginning on or after 
        October 1, 2010, how the plan will provide for child health 
        assistance with respect to targeted low-income children covered 
        under a group health plan.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply beginning with fiscal year 2011.
    (b) Federal Financial Participation for Employer-Sponsored 
Insurance.--Section 2105 of such Act (42 U.S.C. 1397d) is amended--
            (1) in subsection (a)(1)(C), as amended by section 3(b), by 
        inserting before the semicolon at the end the following: ``and, 
        subject to paragraph (3)(C), in the form of payment of the 
        premiums for coverage under a group health plan that includes 
        coverage of targeted low-income children and benefits 
        supplemental to such coverage''; and
            (2) paragraph (3) of subsection (c) is amended to read as 
        follows:
            ``(3) Purchase of employer-sponsored insurance.--
                    ``(A) In general.--Payment may be made to a State 
                under subsection (a)(1)(C), subject to the provisions 
                of this paragraph, for the purchase of family coverage 
                under a group health plan that includes coverage of 
                targeted low-income children unless such coverage would 
                otherwise substitute for coverage that would be 
                provided to such children but for the purchase of 
                family coverage.
                    ``(B) Waiver of certain provisions.--With respect 
                to coverage described in subparagraph (A)--
                            ``(i) notwithstanding section 2102, no 
                        minimum benefits requirement (other than those 
                        otherwise applicable with respect to services 
                        referred to in section 2102(a)(7)) under this 
                        title shall apply; and
                            ``(ii) no limitation on beneficiary cost-
                        sharing otherwise applicable under this title 
                        or title XIX shall apply.
                    ``(C) Required provision of supplemental 
                benefits.--If the coverage described in subparagraph 
                (A) does not provide coverage for the services referred 
                to in section 2102(a)(7), the State child health plan 
                shall provide coverage of such services as supplemental 
                benefits.
                    ``(D) Limitation on ffp.--The amount of the payment 
                under paragraph (1)(C) for coverage described in 
                subparagraph (A) (and supplemental benefits under 
                subparagraph (C) for individuals so covered) during a 
                fiscal year may not exceed the product of--
                            ``(i) the national per capita expenditure 
                        under this title (taking into account both 
                        Federal and State expenditures) for the 
                        previous fiscal year (as determined by the 
                        Secretary using the best available data);
                            ``(ii) the enhanced FMAP for the State and 
                        fiscal year involved; and
                            ``(iii) the number of targeted low-income 
                        children for whom such coverage is provided.
                    ``(E) Voluntary enrollment.--A State child health 
                plan--
                            ``(i) may not require a targeted low-income 
                        child to enroll in coverage described in 
                        subparagraph (A) in order to obtain child 
                        health assistance under this title;
                            ``(ii) before providing such child health 
                        assistance for such coverage of a child, shall 
                        make available (which may be through an 
                        Internet website or other means) to the parent 
                        or guardian of the child information on the 
                        coverage available under this title, including 
                        benefits and cost-sharing; and
                            ``(iii) shall--
                                    ``(I) provide at least one 
                                opportunity per fiscal year for 
                                beneficiaries to switch coverage under 
                                this title from coverage described in 
                                subparagraph (A) to the coverage that 
                                is otherwise made available under this 
                                title; and
                                    ``(II) permit beneficiaries to 
                                switch such coverage under such other 
                                circumstances, such as the change in 
                                employment, birth of a child, or change 
                                in households, as the Secretary 
                                specifies.
                    ``(F) Information on coverage options.--A State 
                child health plan shall--
                            ``(i) describe how the State will notify 
                        potential beneficiaries of coverage described 
                        in subparagraph (A);
                            ``(ii) provide such notification in writing 
                        at least during the initial application for 
                        enrollment under this title and during 
                        redeterminations of eligibility if the 
                        individual was enrolled before October 1, 2010; 
                        and
                            ``(iii) post a description of these 
                        coverage options on any official website that 
                        may be established by the State in connection 
                        with the plan.
                    ``(G) Semiannual verification of coverage.--If 
                coverage described in subparagraph (A) is provided 
                under a group health plan with respect to a targeted 
                low-income child, the State child health plan shall 
                provide for the collection, at least once every six 
                months, of proof from the plan that the child is 
                enrolled in such coverage.
                    ``(H) Rule of construction.--Nothing in this 
                section is to be construed to prohibit a State from--
                            ``(i) offering wrap around benefits in 
                        order for a group health plan to meet any 
                        State-established minimum benefit requirements;
                            ``(ii) establishing a cost-effectiveness 
                        test to qualify for coverage under such a plan;
                            ``(iii) establishing limits on beneficiary 
                        cost-sharing under such a plan;
                            ``(iv) paying all or part of a 
                        beneficiary's cost-sharing requirements under 
                        such a plan;
                            ``(v) paying less than the full cost of the 
                        employee's share of the premium under such a 
                        plan, including prorating the cost of the 
                        premium to pay for only what the State 
                        determines is the portion of the premium that 
                        covers targeted low-income children;
                            ``(vi) using State funds to pay for 
                        benefits above the Federal upper limit 
                        established under subparagraph (C);
                            ``(vii) allowing beneficiaries enrolled in 
                        group health plans from changing plans to 
                        another coverage option available under this 
                        title at any time; or
                            ``(viii) providing any guidance or 
                        information it deems appropriate in order to 
                        help beneficiaries make an informed decision 
                        regarding the option to enroll in coverage 
                        described in subparagraph (A).
                    ``(I) Group health plan defined.--In this 
                paragraph, the term `group health plan' has the meaning 
                given such term in section 2791(a)(1) of the Public 
                Health Service Act (42 U.S.C. 300gg-91(a)(1)).''.

SEC. 4. EMPLOYEE NOTIFICATION OF PREMIUM ASSISTANCE OPPORTUNITIES.

    (a) Amendment 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) Outreach to employees regarding availability of schip 
        coverage.--
                    ``(A) In general.--Each employer that maintains a 
                group health plan in a State that provides child health 
                assistance under a State child health plan under title 
                XXI of the Social Security 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'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) of the Employee Retirement Income Security 
                Act of 1974 (29 U.S.C. 1181(f)(3)(B)).
                    ``(B) 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).''.
    (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) Outreach to employees regarding availability of schip 
        coverage.--
                    ``(A) In general.--Each employer that maintains a 
                group health plan in a State that provides 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.
                    ``(B) Model notice.--Not later than 1 year after 
                the date of enactment of this paragraph, the Secretary 
                and the Secretary of Health and Human Services, in 
                consultation with Directors of State SCHIP 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.
                    ``(C) 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).''.
                    (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) 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) 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.
            (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) Outreach to employees regarding availability of schip 
        coverage.--
                    ``(A) In general.--Each employer that maintains a 
                group health plan in a State that provides 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) of the Employee Retirement Income Security 
                Act of 1974 (29 U.S.C. 1181(f)(3)(B)).
                    ``(B) 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.''.
                                 <all>