[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 464 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 464
To provide for a 5-year SCHIP reauthorization for coverage of low-
income children, an expansion of child health care insurance coverage
through tax fairness, and a health care Federalism initiative, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 13, 2009
Mr. Price of Georgia (for himself, Mr. Blunt, Mr. Bishop of Utah, Mr.
Bartlett, Mr. Sessions, Mr. Gohmert, Mrs. Blackburn, Mr. Brown of South
Carolina, Mr. Crenshaw, Mr. Kline of Minnesota, Mr. Franks of Arizona,
Mr. Burton of Indiana, Mr. Souder, Mr. Cassidy, Mr. Shuster, Mrs.
Bachmann, Mr. Gingrey of Georgia, Mr. Coble, Mr. Smith of Texas, Mr.
Thornberry, Mr. Roskam, and Mr. Fleming) 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 Rules, 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 provide for a 5-year SCHIP reauthorization for coverage of low-
income children, an expansion of child health care insurance coverage
through tax fairness, and a health care Federalism initiative, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``More Children,
More Choices Act of 2009''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--SCHIP REAUTHORIZATION
Sec. 101. Requiring outreach and coverage before expansion of
eligibility.
Sec. 102. Application of citizenship documentation requirements;
increased Federal matching rate for
citizenship documentation enforcement under
Medicaid and SCHIP.
Sec. 103. Limitations on eligibility based on substantial net assets.
Sec. 104. Clarification of State authorities.
Sec. 105. Easing administrative barriers to State cooperation with
employer-sponsored insurance coverage.
Sec. 106. Improving beneficiary choice in SCHIP.
Sec. 107. Allotment distribution formula.
Sec. 108. Five-year reauthorization.
Sec. 109. Enhancing the programmatic focus on children and pregnant
women.
Sec. 110. Grants for outreach and enrollment.
TITLE II--CHILD HEALTH INSURANCE COVERAGE THROUGH TAX FAIRNESS
Sec. 201. Expansion of child health care insurance coverage through tax
fairness.
TITLE III--STATE HEALTH REFORM PROJECTS
Sec. 301. State health reform projects.
TITLE IV--SENSE OF THE HOUSE OF REPRESENTATIVES
Sec. 401. Medicare and Medicaid reform and savings.
TITLE I--SCHIP REAUTHORIZATION
SEC. 101. REQUIRING OUTREACH AND COVERAGE BEFORE EXPANSION OF
ELIGIBILITY.
(a) State Plan Required To Specify How It Will Achieve Coverage for
90 Percent of Targeted Low-Income Children.--
(1) In general.--Section 2102(a) of the Social Security Act
(42 U.S.C. 1397bb(a)) is amended--
(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) how the eligibility and benefits provided for under
the plan for each fiscal year (beginning with fiscal year 2010)
will allow for the State's annual funding allotment to cover at
least 90 percent of the eligible targeted low-income children
in the State.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to State child health plans for fiscal years
beginning with fiscal year 2010.
(b) Limitation on Program Expansions Until Lowest Income Eligible
Individuals Enrolled.--Section 2105(c) of such Act (42 U.S.C.
1397dd(c)) is amended by adding at the end the following new paragraph:
``(8) Limitation on increased coverage of higher income
children.--For child health assistance furnished in a fiscal
year beginning with fiscal year 2010:
``(A) No payment for children with family income
above 250 percent of poverty line.--Payment shall not
be made under this section for child health assistance
for a targeted low-income child in a family the income
of which exceeds 250 percent of the poverty line
applicable to a family of the size involved.
``(B) Special rules for payment for children with
family income above 200 percent of poverty line.--In
the case of child health assistance for a targeted low-
income child in a family the income of which exceeds
200 percent (but does not exceed 250 percent) of the
poverty line applicable to a family of the size
involved no payment shall be made under this section
for such assistance unless the State demonstrates to
the satisfaction of the Secretary that--
``(i) the State has met the 90 percent
retrospective coverage test specified in
subparagraph (C)(i) for the previous fiscal
year; and
``(ii) the State will meet the 90 percent
prospective coverage test specified in
subparagraph (C)(ii) for the fiscal year.
``(C) 90 percent coverage tests.--
``(i) Retrospective test.--The 90 percent
retrospective coverage test specified in this
clause is, for a State for a fiscal year, that
on average during the fiscal year, the State
has enrolled under this title or title XIX at
least 90 percent of the individuals residing in
the State who--
``(I) are children under 19 years
of age (or are pregnant women) and are
eligible for medical assistance under
title XIX; or
``(II) are targeted low-income
children whose family income does not
exceed 200 percent of the poverty line
and who are eligible for child health
assistance under this title.
``(ii) Prospective test.--The 90 percent
prospective test specified in this clause is,
for a State for a fiscal year, that on average
during the fiscal year, the State will enroll
under this title or title XIX at least 90
percent of the individuals residing in the
State who--
``(I) are children under 19 years
of age (or are pregnant women) and are
eligible for medical assistance under
title XIX; or
``(II) are targeted low-income
children whose family income does not
exceed such percent of the poverty line
(in excess of 200 percent) as the State
elects consistent with this paragraph
and who are eligible for child health
assistance under this title.
``(D) Grandfather.--Subparagraphs (A) and (B) shall
not apply to the provision of child health assistance--
``(i) to a targeted low-income child who is
enrolled for child health assistance under this
title as of September 30, 2007;
``(ii) to a pregnant woman who is enrolled
for assistance under this title as of September
30, 2008, through the completion of the post-
partum period following completion of her
pregnancy; and
``(iii) for items and services furnished
before October 1, 2009, to an individual who is
not a targeted low-income child and who is
enrolled for assistance under this title as of
September 30, 2008.
``(E) Treatment of pregnant women.--In this
paragraph and sections 2102(a)(8) and 2104(a)(2), the
term `targeted low-income child' includes an individual
under age 19, including the period from conception to
birth, who is eligible for child health assistance
under this title by virtue of the definition of the
term `child' under section 457.10 of title 42, Code of
Federal Regulations.''.
(c) Standardization of Income Determinations.--
(1) In general.--Section 2110(d) of such Act (42 U.S.C.
1397jj) is amended by adding at the end the following new
subsection:
``(d) Standardization of Income Determinations.--In determining
family income under this title (including in the case of a State child
health plan that provides health benefits coverage in the manner
described in section 2101(a)(2)), a State shall base such determination
on gross income (including amounts that would be included in gross
income if they were not exempt from income taxation) and may only take
into consideration such income disregards as the Secretary shall
develop.''.
(2) Effective date.--(A) Subject to subparagraph (B), the
amendment made by paragraph (1) shall apply to determinations
(and redeterminations) of income made on or after April 1,
2009.
(B) In the case of a State child health plan under title
XXI of the Social Security Act which the Secretary of Health
and Human Services determines requires State legislation (other
than legislation appropriating funds) in order for the plan to
meet the additional requirement imposed by the amendment made
by paragraph (1), the State child health plan shall not be
regarded as failing to comply with the requirements of such
title solely on the basis of its failure to meet this
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
the 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 such session shall be deemed to be a
separate regular session of the State legislature.
SEC. 102. APPLICATION OF CITIZENSHIP DOCUMENTATION REQUIREMENTS;
INCREASED FEDERAL MATCHING RATE FOR CITIZENSHIP
DOCUMENTATION ENFORCEMENT UNDER MEDICAID AND SCHIP.
(a) Application of Requirements.--
(1) In general.--Section 2105(c) of the Social Security Act
(42 U.S.C. 1397dd(c)), as amended by section 101(b), is amended
by adding at the end the following new paragraph:
``(9) Application of citizenship documentation
requirements.--
``(A) In general.--Subject to subparagraph (B), no
payment may be made under this section to a State with
respect to amounts expended for child health assistance
for an individual who declares under section
1137(d)(1)(A) to be a citizen or national of the United
States for purposes of establishing eligibility for
benefits under this title, unless the requirement of
section 1903(x) is met.
``(B) Treatment of pregnant women.--For purposes of
applying subparagraph (A) in the case of a pregnant
woman who qualifies for child health assistance by
virtue of the application of section 457.10 of title
42, Code of Federal Regulations, the requirement of
such section shall be deemed to be satisfied by the
presentation of documentation of personal identity
described in section 274A(b)(1)(D) of the Immigration
and Nationality Act or any other documentation of
personal identity of such other type as the Secretary
finds, by regulation, provides a reliable means of
identification.''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to eligibility determinations and redeterminations
made on or after April 1, 2009.
(b) Temporary Increase in Federal Matching Rate for Administrative
Costs Under Medicaid and SCHIP.----
(1) Medicaid.--
(A) In general.--With respect to administrative
costs incurred on or after July 1, 2006, and before
October 1, 2009, in implementing the amendments made by
section 6036 of the Deficit Reduction Act of 2005
(Public Law 109-171), 75 percent shall be substituted
for 50 per centum in section 1903(a)(7) of the Social
Security Act (42 U.S.C. 1396b(a)(7)).
(B) Retroactive adjustment.--The Secretary of
Health and Human Services shall take such steps as may
be necessary to provide for the adjustment of payments
under section 1903(a) of the Social Security Act (42
U.S.C. 1396b(a)) to take into account the application
of subparagraph (A) for periods before the date of the
enactment of this Act.
(2) SCHIP.--With respect to administrative costs incurred
on or after April 1, 2009, and before October 1, 2009, in
implementing the amendment made by subsection (a)(1), the
enhanced FMAP applied under section 2105(a)(1)(D)(iv) of the
Social Security Act (42 U.S.C. 1397d(a)(1)(D)(iv)) shall not be
less than 75 percent.
SEC. 103. LIMITATIONS ON ELIGIBILITY BASED ON SUBSTANTIAL NET ASSETS.
(a) In General.--Section 2110(b) of the Social Security Act (42
U.S.C. 1397jj(b)) is amended--
(1) in paragraph (1), by striking ``paragraph (2)'' and
inserting ``paragraphs (2) and (5)''; and
(2) by adding at the end the following new paragraph:
``(5) Disqualification for individuals in families with
substantial net assets.--An individual in a family is not
eligible for child health assistance under this title if the
individual's family has net assets (including the equity
interest in any home) that exceeds $500,000 or unless there is
provided a document (in such a form and manner as the Secretary
shall specify) signed under penalty of perjury by an applicant
for child health assistance on behalf of the individual that
the net assets of the individual's family (including the equity
interest in the any home) does not exceed $500,000. The
Secretary may increase the dollar amount specified in the
previous sentence from year to year beginning with 2014 based
on the percentage increase in the consumer price index for all
urban consumers (all items; United States city average),
rounded to the nearest $1,000.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to eligibility determinations and redeterminations made on or
after April 1, 2009.
SEC. 104. CLARIFICATION OF STATE AUTHORITIES.
Section 2102 of the Social Security Act (42 U.S.C. 1397bb) is
amended by adding at the end the following new subsection:
``(d) Clarification of State Authorities.--Nothing in this title
shall be construed as preventing a State, under its child health plan,
from doing any of the following:
``(1) Use of waiting periods to prevent crowd out.--From
using waiting periods and other tools to prevent crowding out
private sector insurance coverage.
``(2) Use of private providers and plans.--From cooperating
or contracting with private sector providers and plans in order
to provide care to targeted low-income children.
``(3) Use of state funds for ineligible individuals.--From
providing medical benefits for individuals who are not targeted
low-income children with State funds.''.
SEC. 105. 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 101(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, 2009, 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 2010.
(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), 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 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.
``(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, 2009;
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. 106. IMPROVING BENEFICIARY CHOICE IN SCHIP.
(a) Requiring Offering of Alternative Coverage Options.--Section
2102 of the Social Security Act (42 U.S.C. 1397b), as amended by
sections 101(a), 104, and 105(a), is amended--
(1) in subsection (a)--
(A) in paragraph (8), by striking ``and'' at the
end;
(B) in paragraph (9), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new
paragraph:
``(10) effective for plan years beginning on or after
October 1, 2009, how the plan will provide for child health
assistance with respect to targeted low-income children through
alternative coverage options in accordance with subsection
(e).''; and
(2) by adding at the end the following new subsection:
``(e) Alternative Coverage Options.--
``(1) In general.--Effective October 1, 2009, a State child
health plan shall provide for the offering of any qualified
alternative coverage that a qualified entity seeks to offer to
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)(10).
``(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.''.
(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), as amended by section 105(b),
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) in subsection (c), as amended by sections 101(b) and
102(a)(1), by adding at the end the following new paragraph:
``(10) 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.
``(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 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.
``(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, 2009;
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. 107. ALLOTMENT DISTRIBUTION FORMULA.
(a) Allotments to 50 States and the District of Columbia.--
(1) In general.--Section 2104(b) of the Social Security Act
(42 U.S.C. 1397dd(b)) is amended--
(A) in paragraph (1), by striking ``the same
proportion'' and all that follows and inserting ``the
product of the number of SCHIP targeted children, as
determined under paragraph (2) for the second preceding
fiscal year, the State and Federal per capita SCHIP
expenditures for the second preceding fiscal year, as
determined under such paragraph, and the enhanced FMAP
for the State for the second preceding fiscal year.'';
(B) by amending paragraph (2) to read as follows:
``(2) Number of schip targeted children and pregnant women
and national per capita schip expenditures.--
``(A) In general.--By not later than September 30
of each year (beginning with 2009), the Secretary (in
consultation with the Director of the Bureau of the
Census and using the best available data for the fiscal
year ending in the previous year) shall determine and
publish in the Federal Register--
``(i) the average number of low-income
targeted children (described in subparagraph
(B)) for any month during such preceding fiscal
year; and
``(ii) the combined State and Federal per
capita SCHIP expenditures (described in
subparagraph (C)) for such preceding fiscal
year.
``(B) Low-income schip targeted children.--Low-
income targeted children described in this subparagraph
with respect to a subsection (b) State are children
(including pregnant women described in section
2105(c)(8)(E)) residing in the State who are not
covered under a group health plan or health insurance
coverage (as defined for purposes of section
2110(b)(1)(C)) and whose family income--
``(i) exceeds the lesser of--
``(I) the Medicaid applicable
income level (as defined in section
2110(b)(4)); or
``(II) 150 percent of the poverty
line; but
``(ii) does not exceed 200 percent of the
poverty line.
``(C) State and federal per capita schip
expenditures.--The State and Federal per capita SCHIP
expenditures for a fiscal year is equal to--
``(i) the aggregate Federal and State
expenditures made that are attributable to
allotments under this title for subsection (b)
States for the fiscal year; divided by
``(ii) the average total number of targeted
low-income children (including pregnant women
described in section 2105(c)(8)(E)) for whom
health assistance was made available from such
allotments for such fiscal year.''; and
(C) by striking paragraphs (3) and (4) and
inserting the following:
``(3) Subsection (b) state defined.--In this subsection,
the term `subsection (b) State' means one of the 50 States or
the District of Columbia.
``(4) Proportional reduction if total allotments exceed
amount available.--If the Secretary estimates that the total of
the allotments under this subsection for a fiscal year (in
combination with allotments made under subsection (c)) will
exceed the aggregate amount available for allotments for such
fiscal year under subsection (a), the Secretary shall reduce
the amount of each allotment under this subsection in a pro-
rata manner so that such total does not exceed the aggregate
amount available for allotments.''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to allotments for fiscal years beginning with
fiscal year 2010.
(b) No Redistribution of Unused Allotments.--
(1) In general.--Section 2104(f) of such Act (42 U.S.C.
1397dd) is amended to read as follows:
``(f) No Redistribution of Unused Allotments.--There shall be no
redistribution of allotments from States that are not expended within
the period of availability under subsection (e).''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to allotments for fiscal years beginning with
fiscal year 2007.
SEC. 108. FIVE-YEAR REAUTHORIZATION.
(a) In General.--Section 2104(a) of the Social Security Act (42
U.S.C. 1397dd(a)) is amended--
(1) by striking ``and'' at the end of paragraph (10);
(2) by striking the period at the end of paragraph (11) and
inserting a semicolon; and
(3) by adding at the end the following new paragraphs:
``(12) for fiscal year 2010, $7,000,000,000;
``(13) for fiscal year 2011, $7,000,000,000;
``(14) for fiscal year 2012, $7,000,000,000;
``(15) for fiscal year 2013, $7,500,000,000; and
``(16) for fiscal year 2014, $8,000,000,000.''.
(b) Continuation of Additional Allotments to Territories.--Section
2104(c)(4)(B) of the Social Security Act (42 U.S.C. 1397dd(c)(4)(B)) is
amended by striking ``2009'' and inserting ``2014''.
(c) Application to Other SCHIP Funding for Fiscal Year 2010.--
Notwithstanding any other provision of law, if funds are appropriated
under any law (other than this Act) to provide allotments to States
under title XXI of the Social Security Act for all (or any portion) of
fiscal year 2010--
(1) any amounts that are so appropriated that are not so
allotted and obligated before the date of the enactment of this
Act are rescinded; and
(2) any amount provided for such title XXI 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.
SEC. 109. ENHANCING THE PROGRAMMATIC FOCUS ON CHILDREN AND PREGNANT
WOMEN.
(a) In General.--Section 2107(f) of the Social Security Act (42
U.S.C. 1397gg(f)) is amended by striking ``childless''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of the enactment of this Act but shall not
apply to projects, including extensions, amendments, or renewals to
such projects, that are in effect or have been approved on the date of
the enactment of this Act.
SEC. 110. GRANTS FOR OUTREACH AND ENROLLMENT.
(a) Grants.--Title XXI of the Social Security Act (42 U.S.C. 1397aa
et seq.) is amended by adding at the end the following:
``SEC. 2111. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT.
``(a) Outreach and Enrollment Grants; National Campaign.--
``(1) In general.--From the amounts appropriated for a
fiscal year under subsection (f), subject to paragraph (2), the
Secretary shall award grants to eligible entities 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) 10 percent set aside for national enrollment
campaign.--An amount equal to 10 percent of such amounts for
the fiscal year shall be used by the Secretary for expenditures
during the fiscal year to carry out a national enrollment
campaign in accordance with subsection (g).
``(b) Award of Grants.--
``(1) Priority for awarding.--
``(A) In general.--In awarding grants under
subsection (a), the Secretary shall give priority to
eligible entities that--
``(i) 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
``(ii) submit the most demonstrable
evidence required under paragraphs (1) and (2)
of subsection (c).
``(B) 10 percent set aside for outreach to indian
children.--An amount equal to 10 percent of the funds
appropriated under subsection (f) for a fiscal year
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.
``(2) 2-year availability.--A grant awarded under this
section for a fiscal year shall remain available for
expenditure through the end of the succeeding fiscal year.
``(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) Supplement, Not Supplant.--Federal funds awarded under this
section shall be used to supplement, not supplant, non-Federal funds
that are otherwise available for activities funded under this section.
``(e) 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 State, national, local, or community-based
public or nonprofit private organization.
``(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 non-governmental entities.
``(G) An elementary or secondary school.
``(H) A national, local, or community-based public
or nonprofit private organization, including
organizations that use community health workers or
community-based doula programs.
``(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.
``(f) Appropriation.--
``(1) In general.--There is appropriated, out of any money
in the Treasury not otherwise appropriated, for the purpose of
awarding grants under this section $100,000,000 for each of
fiscal years 2010 through 2014.
``(2) Grants in addition to other amounts paid.--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.
``(g) National Enrollment Campaign.--From the amounts made
available under subsection (a)(2) for a fiscal year, 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) Nonapplication of Administrative Expenditures Cap.--Section
2105(c)(2) of the Social Security Act (42 U.S.C. 1397ee(c)(2)) is
amended by adding at the end the following:
``(C) Nonapplication to expenditures for outreach
and enrollment.--The limitation under subparagraph (A)
shall not apply with respect to expenditures for
outreach activities under section 2102(c)(1), or for
enrollment activities, for children eligible for child
health assistance under the State child health plan or
medical assistance under the State plan under title
XIX.''.
TITLE II--CHILD HEALTH INSURANCE COVERAGE THROUGH TAX FAIRNESS
SEC. 201. EXPANSION OF CHILD HEALTH CARE INSURANCE COVERAGE THROUGH TAX
FAIRNESS.
(a) In General.--Subpart C of part IV of subchapter A of chapter 1
of the Internal Revenue Code of 1986 (relating to refundable credits)
is amended by redesignating section 37 as section 38 and by inserting
after section 36 the following new section:
``SEC. 37. CHILD HEALTH INSURANCE COSTS.
``(a) In General.--In the case of an eligible taxpayer, there shall
be allowed as a credit against the tax imposed by this subtitle an
amount equal to the amount paid by the taxpayer during the taxable year
for qualified health insurance for any dependent child of such
taxpayer.
``(b) Limitations.--
``(1) In general.--The amount allowed as a credit under
subsection (a) to an eligible taxpayer for the taxable year
shall not exceed the sum of the monthly limitations for
coverage months during such taxable year for the individual
referred to in subsection (a) for whom such taxpayer paid
during the taxable year any amount for coverage under qualified
health insurance.
``(2) Monthly limitation.--The monthly limitation for an
individual for each coverage month of such individual during
the taxable year is the amount equal to \1/12\ of $1,400.
``(3) Coverage month.--For purposes of this subsection--
``(A) In general.--The term `coverage month' means,
with respect to an individual, any month if--
``(i) as of the first day of such month
such individual is covered by qualified health
insurance, and
``(ii) the premium for coverage under such
insurance for such month is paid by an eligible
taxpayer.
``(B) Medicare and medicaid.--Such term shall not
include any month with respect to an individual if, as
of the first day of such month, such individual--
``(i) is entitled to any benefits under
title XVIII of the Social Security Act, or
``(ii) is a participant in the program
under title XIX or XXI of such Act.
``(C) Certain other coverage.--Such term shall not
include any month during a taxable year with respect to
an individual if, at any time during such year, any
benefit is provided to such individual under chapter 89
of title 5, United States Code.
``(D) Insufficient presence in united states.--Such
term shall not include any month during a taxable year
with respect to an individual if such individual is
present in the United States on fewer than 183 days
during such year (determined in accordance with section
7701(b)(7)).
``(4) Indexing.--For each taxable year beginning after
December 31, 2009, the dollar amount in paragraph (2) (as
adjusted for the preceding taxable year by reason of this
paragraph) shall be increased or decreased by the percentage
change in the average cost of private health insurance for
family coverage for such taxable year as compared to such
preceding taxable year as computed by the Office of the Actuary
of the Centers for Medicare and Medicaid Services, rounded to
the nearest whole dollar amount.
``(c) Qualified Health Insurance.--For purposes of this section--
``(1) In general.--The term `qualified health insurance'
means insurance which constitutes medical care as defined in
section 213(d) without regard to--
``(A) paragraph (1)(C) thereof, and
``(B) so much of paragraph (1)(D) thereof as
relates to qualified long-term care insurance
contracts.
``(2) Exclusion of certain other contracts.--Such term
shall not include insurance if a substantial portion of its
benefits are excepted benefits (as defined in section 9832(c)).
``(d) Eligible Taxpayer; Dependent; Child.--For purposes of this
section--
``(1) Eligible taxpayer.--The term `eligible taxpayer'
means any taxpayer whose income exceeds 200 percent but not 300
percent of the poverty level applicable to a family of the size
involved, as determined in accordance with criteria established
by the Director of the Office of Management and Budget.
``(2) Dependent.--The term `dependent' has the meaning
given such term by section 152. An individual to whom section
152(e) applies shall be treated as a dependent of the custodial
parent for a coverage month unless the custodial and
noncustodial parent provide otherwise.
``(3) Child.--The term `child' means a qualifying child (as
defined in section 152(c).
``(e) Special Rules.--
``(1) Coordination with medical deduction, etc.--Any amount
paid by an eligible taxpayer for insurance to which subsection
(a) applies shall not be taken into account in computing the
amount allowable to such taxpayer as a credit under section 35,
as a deduction under section 213(a) or 162(l), or as an
exclusion from gross income under section 106 or 125.
``(2) Denial of credit to dependents.--No credit shall be
allowed under this section to any individual with respect to
whom a deduction under section 151 is allowable to another
taxpayer for a taxable year beginning in the calendar year in
which such individual's taxable year begins.
``(3) Married couples must file joint return.--
``(A) In general.--If an eligible taxpayer is
married at the close of the taxable year, the credit
shall be allowed under subsection (a) only if the
taxpayer and his spouse file a joint return for the
taxable year.
``(B) Marital status; certain married individuals
living apart.--Rules similar to the rules of paragraphs
(3) and (4) of section 21(e) shall apply for purposes
of this paragraph.
``(4) Verification of coverage, etc.--No credit shall be
allowed under this section with respect to any individual
unless such individual's coverage (and such related information
as the Secretary may require) is verified in such manner as the
Secretary may prescribe.
``(5) Insurance which covers other individuals; treatment
of payments.--Rules similar to the rules of paragraphs (7) and
(8) of section 35(g) shall apply for purposes of this section.
``(6) Election not to claim credit.--This section shall not
apply to an eligible taxpayer for any taxable year if such
taxpayer elects to have this section not apply for such taxable
year.
``(f) Coordination With Advance Payments.--With respect to any
taxable year, the amount which would (but for this subsection) be
allowed as a credit to an eligible taxpayer under subsection (a) shall
be reduced (but not below zero) by the aggregate amount paid on behalf
of such taxpayer under section 7527A for months beginning in such
taxable year.''.
(b) Information Reporting.--
(1) In general.--Subpart B of part III of subchapter A of
chapter 61 of the Internal Revenue Code of 1986 (relating to
information concerning transactions with other persons) is
amended by inserting after section 6050W the following new
section:
``SEC. 6050X. RETURNS RELATING TO PAYMENTS FOR QUALIFIED HEALTH
INSURANCE.
``(a) In General.--Any person who, in connection with a trade or
business conducted by such person, receives payments during any
calendar year from any individual for coverage of such individual or
any other individual under qualified health insurance (as defined in
section 37(c)), shall make the return described in subsection (b) (at
such time as the Secretary may by regulations prescribe) with respect
to each individual from whom such payments were received.
``(b) Form and Manner of Returns.--A return is described in this
subsection if such return--
``(1) is in such form as the Secretary may prescribe, and
``(2) contains--
``(A) the name, address, and TIN of the individual
from whom payments described in subsection (a) were
received,
``(B) the name, address, and TIN of each individual
who was provided by such person with coverage under
qualified health insurance (as so defined) by reason of
such payments and the period of such coverage, and
``(C) such other information as the Secretary may
reasonably prescribe.
``(c) Statements To Be Furnished to Individuals With Respect to
Whom Information Is Required.--Every person required to make a return
under subsection (a) shall furnish to each individual whose name is
required under subsection (b)(2)(A) to be set forth in such return a
written statement showing--
``(1) the name and address of the person required to make
such return and the phone number of the information contact for
such person,
``(2) the aggregate amount of payments described in
subsection (a) received by the person required to make such
return from the individual to whom the statement is required to
be furnished, and
``(3) the information required under subsection (b)(2)(B)
with respect to such payments.
The written statement required under the preceding sentence shall be
furnished on or before January 31 of the year following the calendar
year for which the return under subsection (a) is required to be made.
``(d) Returns Which Would Be Required To Be Made by 2 or More
Persons.--Except to the extent provided in regulations prescribed by
the Secretary, in the case of any amount received by any person on
behalf of another person, only the person first receiving such amount
shall be required to make the return under subsection (a).''.
(2) Assessable penalties.--
(A) Subparagraph (B) of section 6724(d)(1) of such
Code (relating to definitions) is amended by
redesignating clauses (xxi) through (xxii) as clauses
(xxii) through (xxv), respectively, and by inserting
after clause (xxi) the following new clause:
``(xxii) section 6050X (relating to returns
relating to payments for qualified health
insurance),''.
(B) Paragraph (2) of section 6724(d) of such Code
is amended by redesignating subparagraphs (EE) and (FF)
as subparagraphs (FF) and (GG), respectively, and by
inserting after subparagraph (DD) the following new
subparagraph:
``(EE) section 6050X(c) (relating to returns
relating to payments for qualified health
insurance).''.
(3) Clerical amendment.--The table of sections for subpart
B of part III of subchapter A of chapter 61 of such Code is
amended by inserting after the item relating to section 6050W
the following new item:
``Sec. 6050X. Returns relating to payments for qualified health
insurance.''.
(c) Advance Payment of Credit for Purchasers of Qualified Health
Insurance.--
(1) In general.--Chapter 77 of the Internal Revenue Code of
1986 (relating to miscellaneous provisions) is amended by
adding at the end the following new section:
``SEC. 7529. ADVANCE PAYMENT OF HEALTH INSURANCE CREDIT FOR PURCHASERS
OF QUALIFIED HEALTH INSURANCE.
``(a) General Rule.--In the case of an eligible individual, the
Secretary shall make payments to the provider of such individual's
qualified health insurance equal to such individual's qualified health
insurance credit advance amount with respect to such provider.
``(b) Eligible Individual.--For purposes of this section, the term
`eligible individual' means any individual--
``(1) who purchases qualified health insurance (as defined
in section 37(c)), and
``(2) for whom a qualified health insurance credit
eligibility certificate is in effect.
``(c) Qualified Health Insurance Credit Eligibility Certificate.--
For purposes of this section, a qualified health insurance credit
eligibility certificate is a statement furnished by an individual to
the Secretary which--
``(1) certifies that the individual will be eligible to
receive the credit provided by section 37 for the taxable year,
``(2) estimates the amount of such credit for such taxable
year, and
``(3) provides such other information as the Secretary may
require for purposes of this section.
``(d) Qualified Health Insurance Credit Advance Amount.--For
purposes of this section, the term `qualified health insurance credit
advance amount' means, with respect to any provider of qualified health
insurance, the Secretary's estimate of the amount of credit allowable
under section 37 to the individual for the taxable year which is
attributable to the insurance provided to the individual by such
provider.
``(e) Regulations.--The Secretary shall prescribe such regulations
as may be necessary to carry out the purposes of this section.''.
(2) Clerical amendment.--The table of sections for chapter
77 of such Code is amended by adding at the end the following
new item:
``Sec. 7529. Advance payment of health insurance credit for purchasers
of qualified health insurance.''.
(d) Conforming Amendments.--
(1) Paragraph (2) of section 1324(b) of title 31, United
States Code, is amended by inserting before the period ``, or
from section 37 of such Code''.
(2) The table of sections for subpart C of part IV of
subchapter A of chapter 1 of the Internal Revenue Code of 1986
is amended by striking the last item and inserting the
following new items:
``Sec. 37. Health insurance costs.
``Sec. 38. Overpayments of tax.''.
(e) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2008.
TITLE III--STATE HEALTH REFORM PROJECTS
SEC. 301. STATE HEALTH REFORM PROJECTS.
(a) Purposes; Establishment of State Health Care Expansion and
Improvement Program.--
(1) Purposes.--The purposes of the programs approved under
this section shall include, but not be limited to--
(A) achieving the goals of increased health
coverage and access; and
(B) testing alternative reforms, such as building
on the public or private health systems, or creating
new systems, to achieve the objectives of this Act.
(2) Intent of congress.--It is the intent of Congress
that--
(A) the programs approved under this section each
comprise significant coverage expansions;
(B) taken as a whole, such programs should be
diverse and balanced in their approaches to covering
the uninsured; and
(C) each such program should be rigorously and
objectively evaluated, so that the State programs
developed pursuant to this section may guide the
development of future State and national policy.
(b) Applications by States and Local Governments.--
(1) Entities that may apply.--
(A) In general.--A State may apply for a State
health care expansion and improvement program for the
entire State (or for regions of the State) under
paragraph (2).
(B) Regional and sub-state groups.--A regional
entity consisting of more than one State or one or more
local governments within a State may apply for a multi-
State or a sub-State health care expansion and
improvement program for the region or area involved.
(C) Definition.--In this section, the term
``State'' means the 50 States, the District of
Columbia, and the Commonwealth of Puerto Rico. Such
term shall include a regional entity described in
subparagraph (B).
(2) Submission of application.--In accordance with this
section, each State or regional entity desiring to implement a
State health care expansion and improvement program may submit
an application to the State Health Coverage Innovation
Commission under subsection (c) (referred to in this section as
the ``Commission'') for approval.
(3) Local government applications.--Where a State fails to
submit an application under this section, a unit of local
government of such State, or a consortium of such units of
local governments, may submit an application directly to the
Commission for programs or projects under this subsection. Such
an application shall be subject to the requirements of this
section.
(c) State Health Coverage Innovation Commission.--
(1) In general.--Within 90 days after the date of the
enactment of this Act, the Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
shall establish a State Health Coverage Innovation Commission
that--
(A) shall be comprised of--
(i) the Secretary;
(ii) four State governors to be appointed
by the National Governors Association on a
bipartisan basis;
(iii) two members of a State legislature to
be appointed, on a joint and bipartisan basis,
by the National Conference of State Legislators
and the American Legislative Exchange Council;
(iv) two county officials to be appointed
by the National Association of Counties on a
bipartisan basis;
(v) two mayors to be appointed, on a joint
and bipartisan basis, by the National League of
Cities and by the United States Conference of
Mayors;
(vi) two individuals to be appointed by the
Speaker of the House of Representatives;
(vii) two individuals to be appointed by
the minority leader of the House of
Representatives;
(viii) two individuals to be appointed by
the majority leader of the Senate; and
(ix) two individuals to be appointed by the
minority leader of the Senate;
(B) shall request States to submit proposals, which
may include a variety of reform options such as tax
credit approaches, expansions of public programs such
as Medicaid and the State Children's Health Insurance
Program, the creation of purchasing pooling
arrangements similar to the Federal Employees Health
Benefits Program, individual market purchasing options,
single risk pool or single payer systems, health
savings accounts, a combination of the options
described in this subparagraph, or other alternatives
determined appropriate by the Commission, including
options suggested by States or the public, and nothing
in this subparagraph shall be construed to prevent the
Commission from approving a reform proposal not
included in this subparagraph;
(C) shall conduct a thorough review of the grant
application from a State and carry on a dialogue with
all State applicants concerning possible modifications
and adjustments;
(D) shall submit the recommendations and
legislative proposal described in subsection (d)(4)(C);
(E) shall be responsible for receiving information
to determine the status and progress achieved under
program or projects granted under this section;
(F) shall report to the public concerning progress
made by States with respect to the performance measures
and goals established under this section, the periodic
progress of the State relative to its State performance
measures and goals, and the State program application
procedures, by region and State jurisdiction;
(G) shall promote information exchange between
States and the Federal Government;
(H) shall be responsible for making recommendations
to the Secretary and the Congress, using equivalency or
minimum standards, for minimizing the negative effect
of State program on national employer groups, provider
organizations, and insurers because of differing State
requirements under the programs; and
(I) may require States to submit additional
information or reports concerning the status and
progress achieved under health care expansion and
improvement programs granted under this section, as
needed.
(2) Period of appointment; representation requirements;
vacancies.--Members shall be appointed for a term of 5 years.
In appointing such members under paragraph (1)(A), the
designated appointing individuals shall ensure the
representation of urban and rural areas and an appropriate
geographic distribution of such members. Any vacancy in the
Commission shall not affect its powers, but shall be filled in
the same manner as the original appointment.
(3) Chairperson, meetings.--
(A) Chairperson.--The Commission shall select a
Chairperson from among its members.
(B) Quorum.--Two-thirds of the members of the
Commission shall constitute a quorum, but a lesser
number of members may hold hearings.
(C) Meetings.--Not later than 30 days after the
date on which all members of the Commission have been
appointed, the Commission shall hold its first meeting.
The Commission shall meet at the call of the
Chairperson.
(4) Powers of the commission.--
(A) Negotiations with states.--The Commission may
conduct detailed discussions and negotiations with
States submitting applications under this section,
either individually or in groups, to facilitate a final
set of recommendations for purposes of subsection
(d)(4)(C).
(B) Hearings.--The Commission may hold such
hearings, sit and act at such times and places, take
such testimony, and receive such evidence as the
Commission considers advisable to carry out the
purposes of this subsection.
(C) Meetings.--In addition to other meetings the
Commission may hold, the Commission shall hold an
annual meeting with the participating States under this
section for the purpose of having States report
progress toward the purposes in subsection (a) and for
an exchange of information.
(D) Information.--The Commission may secure
directly from any Federal department or agency such
information as the Commission considers necessary to
carry out the provisions of this subsection. Upon
request of the Chairperson of the Commission, the head
of such department or agency shall furnish such
information to the Commission if the head of the
department or agency involved determines it
appropriate.
(E) Postal services.--The Commission may use the
United States mails in the same manner and under the
same conditions as other departments and agencies of
the Federal Government.
(5) Personnel matters.--
(A) Compensation.--Each member of the Commission
who is not an officer or employee of the Federal
Government or of a State or local government shall be
compensated at a rate equal to the daily equivalent of
the annual rate of basic pay prescribed for level IV of
the Executive Schedule under section 5315 of title 5,
United States Code, for each day (including travel
time) during which such member is engaged in the
performance of the duties of the Commission. All
members of the Commission who are officers or employees
of the United States shall serve without compensation
in addition to that received for their services as
officers or employees of the United States.
(B) Travel expenses.--The members of the Commission
shall be allowed travel expenses, including per diem in
lieu of subsistence, at rates authorized for employees
of agencies under subchapter I of chapter 57 of title
5, United States Code, while away from their homes or
regular places of business in the performance of
services for the Commission.
(C) Staff.--The Chairperson of the Commission may,
without regard to the civil service laws and
regulations, appoint and terminate an executive
director and such other additional personnel as may be
necessary to enable the Commission to perform its
duties. The employment of an executive director shall
be subject to confirmation by the Commission.
(D) Detail of government employees.--Any Federal
Government employee may be detailed to the Commission
without reimbursement, and such detail shall be without
interruption or loss of civil service status or
privilege.
(E) Temporary and intermittent services.--The
Chairperson of the Commission may procure temporary and
intermittent services under section 3109(b) of title 5,
United States Code, at rates for individuals which do
not exceed the daily equivalent of the annual rate of
basic pay prescribed for level V of the Executive
Schedule under section 5316 of such title.
(6) Funding.--For the purpose of carrying out this
subsection, there are authorized to be appropriated $3,000,000
for fiscal year 2008 and each fiscal year thereafter.
(d) Requirements for Programs.--
(1) State plan.--A State that seeks to operate a program
under this section shall prepare and submit to the Commission,
as part of the application under subsection (b), a State health
care plan that shall have as its goal increased coverage, and
in service of that goal such additional goals as improvements
in quality, efficiency, cost-effectiveness, and the appropriate
use of information technology. To achieve such goal, the State
plan shall comply with the following:
(A) Coverage.--
(i) In general.--With respect to coverage,
the State plan shall--
(I) provide and describe the manner
in which the State will ensure that an
increased number of individuals
residing within the State will have
expanded access to health care coverage
with a specific 5-year target for
reduction in the number or proportion
of uninsured individuals through either
private or public program expansion, or
both, in accordance with or in addition
to the options established by the
Commission;
(II) describe the number and
percentage of current uninsured
individuals who will achieve coverage
under a State health program;
(III) describe the coverage that
will be provided to beneficiaries under
a State health program;
(IV) identify Federal, State, or
local and private programs that
currently provide health care services
in the State and describe how such
programs could be coordinated with a
State health program, to the extent
practicable; and
(V) provide for improvements in the
availability of appropriate health care
coverage that will increase access to
care in urban, suburban, rural, and
frontier areas of the State with
medically underserved populations or
where there may be an inadequate supply
of health care providers.
(ii) Coverage options.--The coverage under
the State plan may be--
(I) health insurance coverage that
meets the aggregate actuarial value
requirement of section 2103(a)(2)(B) of
the Social Security Act (42 U.S.C.
1397cc(a)(2)(B));
(II) a combination of health
insurance coverage and a consumer-
directed health care spending account,
if the actuarial value of such coverage
plus the amount of annual deposits into
such account from sources other than
the beneficiary is not less than the
actuarial value amount described in
subclause (I); or
(III) health care access not less
on average than that provided through
coverage described in subclause (I).
(iii) Construction.--Nothing in this clause
shall be construed to limit in any way the
authority of the Secretary of Health and Human
Services to issue waivers under section 1115 of
the Social Security Act.
(B) Quality.--With respect to quality, the State
plan may describe efforts to improve health care
quality in the State, including an explanation of how
such efforts would change (if at all) under the State
plan.
(C) Costs.--With respect to costs, the State plan
shall--
(i) describe such steps as the State may
undertake to improve the efficiency of health
care;
(ii) describe the public and private sector
financing to be provided for the State health
program;
(iii) estimate the amount of Federal,
State, and local expenditures, as well as, the
costs to business and individuals under the
State health program; and
(iv) describe how the State plan will
ensure the financial solvency of the State
health program.
(D) Health information technology.--With respect to
health information technology, the State plan may
describe efforts to improve the appropriate use of
health information technology, including an explanation
of how such efforts would change (if at all) under the
State plan.
(E) Exceptions to federal policies.--The State plan
shall describe the exceptions to otherwise applicable
Federal statutes, regulations, and policies that would
apply within the geographic area and time period
governed by the plan.
(2) Technical assistance.--The Secretary shall, if
requested, provide technical assistance to States to assist
such States in developing applications and plans under this
section, including technical assistance by private sector
entities if determined appropriate by the Commission.
(3) Initial review.--With respect to a State application
under subsection (b), the Secretary and the Commission shall
complete an initial review of such State application within 60
days of the receipt of such application, analyze the scope of
the proposal, and determine whether additional information is
needed from the State. The Commission shall advise the State
within such period of the need to submit additional
information.
(4) Final determination.--
(A) In general.--In a timely manner consistent with
subparagraph (C), the Commission shall determine
whether to submit a State proposal to Congress for
approval.
(B) Voting.--
(i) In general.--The determination to
submit a State proposal to Congress under
subparagraph (A) shall be approved by \2/3\ of
the members of the Commission who are present
and eligible to vote and a majority of the
entire Commission.
(ii) Eligibility.--A member of the
Commission shall not participate in a
determination under subparagraph (A) if--
(I) in the case of a member who is
a Governor, such determination relates
to the State of which the member is the
Governor; or
(II) in the case of member not
described in subclause (I), such
determination relates to the geographic
area of a State of which such member
serves as a State or local official or
as a Member of Congress.
(C) Submission.--Not later than 90 days prior to
October 1 of each fiscal year, the Commission may
submit to Congress a list, in the form of a legislative
proposal, of the State applications that the Commission
recommends for approval under this section.
(5) Program or project period.--A State program or project
may be approved for a period of 5 years and may be extended for
a subsequent period of time upon approval by the Commission,
based upon achievement of targets.
(e) Expedited Congressional Consideration.--
(1) Introduction and expedited consideration in the house
of representatives.--
(A) Introduction in house of representatives.--The
legislative proposal submitted pursuant to subsection
(d)(4)(C) shall be in the form of a joint resolution
(in this subsection referred to as the ``resolution'').
Such resolution shall be introduced in the House of
Representatives by the Speaker immediately upon receipt
of the language and shall be referred non-sequentially
to the appropriate committee (or committees) of House
of Representatives. If the resolution is not introduced
in accordance with the preceding sentence, the
resolution may be introduced by any member of the House
of Representatives.
(B) Committee consideration.--Not later than 15
calendar days after the introduction of the resolution
described in subparagraph (A), each committee of House
of Representatives to which the resolution was referred
shall report the resolution. The report may include, at
the committee's discretion, a recommendation for action
by the House. If a committee has not reported such
resolution (or an identical resolution) at the end of
15 calendar days after its introduction or at the end
of the first day after there has been reported to the
House a resolution, whichever is earlier, such
committee shall be deemed to be discharged from further
consideration of such resolution and such resolution
shall be placed on the appropriate calendar of the
House of Representatives.
(C) Expedited procedure in house.--Not later than 5
legislative days after the date on which all committees
have been discharged from consideration of a
resolution, the Speaker of the House of
Representatives, or the Speaker's designee, shall move
to proceed to the consideration of the resolution. It
shall also be in order for any member of the House of
Representatives to move to proceed to the consideration
of the resolution at any time after the conclusion of
such 5-day period. All points of order against the
resolution (and against consideration of the
resolution) are waived. A motion to proceed to the
consideration of the resolution is highly privileged in
the House of Representatives and is not debatable. The
motion is not subject to amendment, to a motion to
postpone consideration of the resolution, or to a
motion to proceed to the consideration of other
business. A motion to reconsider the vote by which the
motion to proceed is agreed to or not agreed to shall
not be in order. If the motion to proceed is agreed to,
the House of Representatives shall immediately proceed
to consideration of the resolution without intervening
motion, order, or other business, and the resolution
shall remain the unfinished business of the House of
Representatives until disposed of. A motion to recommit
the resolution shall not be in order. Upon its passage
in the House, the clerk of the House shall provide for
its immediate transmittal to the Senate.
(2) Expedited consideration in the senate.--
(A) Referral to committee.--If the resolution is
agreed to by the House of Representatives, upon its
receipt in the Senate the majority leader of the
Senate, or the leader's designee, the resolution shall
be referred to the appropriate committee of Senate.
(B) Committee consideration.--Not later than 15
calendar days after the referral of the resolution
under subparagraph (A), the committee of the Senate to
which the resolution was referred shall report the
resolution. The report may include, at the committee's
discretion, a recommendation for action by the Senate.
If a committee has not reported such resolution (or an
identical resolution) at the end of 15 calendar days
after its referral or at the end of the first day after
there has been reported to the Senate a resolution,
whichever is earlier, such committee shall be deemed to
be discharged from further consideration of such
resolution and such resolution shall be placed on the
appropriate calendar of the Senate.
(C) Expedited floor consideration.--Not later than
5 legislative days after the date on which all
committees have been discharged from consideration of a
resolution, the majority leader of the Senate, or the
majority leader's designee, shall move to proceed to
the consideration of the resolution. It shall also be
in order for any member of the Senate to move to
proceed to the consideration of the resolution at any
time after the conclusion of such 5-day period. All
points of order against the resolution (and against
consideration of the resolution) are waived. A motion
to proceed to the consideration of the resolution in
the Senate is privileged and is not debatable. The
motion is not subject to amendment, to a motion to
postpone consideration of the resolution, or to a
motion to proceed to the consideration of other
business. A motion to reconsider the vote by which the
motion to proceed is agreed to or not agreed to shall
not be in order. If the motion to proceed is agreed to,
the Senate shall immediately proceed to consideration
of the resolution without intervening motion, order, or
other business, and the resolution shall remain the
unfinished business of the Senate until disposed of.
(3) Rules of the senate and house of representatives.--This
subsection is enacted by Congress--
(A) as an exercise of the rulemaking power of the
Senate and House of Representatives, respectively, and
is deemed to be part of the rules of each House,
respectively, but applicable only with respect to the
procedure to be followed in that House in the case of a
resolution under this subsection, and it supersedes
other rules only to the extent that it is inconsistent
with such rules; and
(B) with full recognition of the constitutional
right of either House to change the rules (so far as
they relate to the procedure of that House) at any
time, in the same manner, and to the same extent as in
the case of any other rule of that House.
(4) Federal budget neutrality.--Except insofar as it allots
appropriations made pursuant to subsection (k), the legislative
proposal submitted pursuant to subsection (d)(4)(C) may not
increase the cumulative, net Federal budget deficit during the
multi-year operation of all the State applications contained
therein, taking into account such applications' impact on
Federal mandatory and discretionary spending, Federal revenue,
and Federal tax expenditures.
(f) Funding.--
(1) In general.--The Secretary shall provide a grant to a
State that has an application approved under subsection (e) to
enable such State to carry out an innovative State health
program in the State, to the extent that such a grant is
included in the recommendation of the Commission.
(2) Amount of grant.--The amount of a grant provided to a
State under paragraph (1) shall be determined based upon the
recommendations of the Commission, subject to the amount
appropriated under subsection (k).
(3) Performance-based funding allocation.--In awarding
grants under paragraph (1), the Commission shall direct the
Secretary to--
(A) fund a balanced diversity of approaches as
provided for by the Commission in subsection (c)(1)(B);
and
(B) link allocations to the State to the meeting of
the goals and performance measures relating to health
care coverage and health care costs established under
this section through the State project application
process.
(4) Report.--One year prior to the end of the 5-year period
beginning on the date on which the first State begins to
implement a plan approved under subsection (e), the Commission
shall prepare and submit to the appropriate committees of
Congress, a report on the progress made by States in meeting
the goals of expanded coverage and cost containment through
performance measures established during the 5-year period of
the State plan. Such report may contain the recommendation of
the Commission concerning any future action that Congress
should take concerning health care reform, including whether or
not to extend the program established under this subsection.
(g) Monitoring and Evaluation.--
(1) Annual reports and participation by states.--Each State
that has received a program approval shall--
(A) submit to the Commission an annual report based
on the period representing the respective State's
fiscal year, detailing compliance with the requirements
established by the Commission and the Secretary in the
approval and in this section; and
(B) participate in the annual meeting under
subsection (c)(4)(C).
(2) Evaluations by commission.--The Commission shall
prepare and submit to the Congress annual reports that shall
contain--
(A) a description of the effects of the reforms
undertaken in States receiving approvals under this
section;
(B) a description of the recommendations of the
Commission and actions taken based on these
recommendations;
(C) an independent evaluation of the effectiveness
of such reforms in--
(i) expanding health care coverage for
State residents; and
(ii) reducing or containing health care
costs in the States,
as well as other relevant or significant findings;
(D) recommendations regarding the advisability of
increasing Federal financial assistance for State
ongoing or future health program initiatives, including
the amount and source of such assistance; and
(E) as required by the Commission or the Secretary
under this section, a periodic, independent evaluation
of the program.
(h) Noncompliance.--
(1) Corrective action plans.--If a State is not in
compliance with a requirement of this section, the Commission,
on recommendation of the Secretary, shall develop a corrective
action plan for such State.
(2) Termination.--The Commission, on recommendation of the
Secretary, may revoke any program granted under this section.
Such decisions shall be subject to a petition for
reconsideration and appeal pursuant to regulations established
by the Secretary.
(i) Relationship to Federal Programs.--
(1) In general.--Nothing in this section, or in section
1115 of the Social Security Act (42 U.S.C. 1315) shall be
construed as authorizing the Secretary, the Commission, a
State, or any other person or entity to alter or affect in any
way the provisions of title XIX of such Act (42 U.S.C. 1396 et
seq.) or the regulations implementing such title.
(2) Maintenance of effort.--No payment may be made under
subsection (f)(1) if the State adopts criteria for benefits or
criteria for standards and methodologies for purposes of
determining an individual's eligibility for medical assistance
under the State plan under title XIX that are more restrictive
than those required under Federal law and applied as of the
date of enactment of this Act.
(j) Miscellaneous Provisions.--
(1) Application of certain requirements.--
(A) Restriction on application of preexisting
condition exclusions.--
(i) In general.--Subject to subparagraph
(B), a State shall not permit the imposition of
any preexisting condition exclusion for covered
benefits under a program or project under this
section.
(ii) Group health plans and group health
insurance coverage.--If the State program or
project provides for benefits through payment
for, or a contract with, a group health plan or
group health insurance coverage, the program or
project may permit the imposition of a
preexisting condition exclusion but only
insofar and to the extent that such exclusion
is permitted under the applicable provisions of
part 7 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 and
title XXVII of the Public Health Service Act.
(B) Compliance with other requirements.--Coverage
offered under the program or project shall comply with
the requirements of subpart 2 of part A of title XXVII
of the Public Health Service Act insofar as such
requirements apply with respect to a health insurance
issuer that offers group health insurance coverage.
(2) Prevention of duplicative payments.--
(A) Other health plans.--No payment shall be made
to a State under subsection (f)(1) for expenditures for
health assistance provided for an individual to the
extent that a private insurer (as defined by the
Secretary by regulation and including a group health
plan (as defined in section 607(1) of the Employee
Retirement Income Security Act of 1974), a service
benefit plan, and a health maintenance organization)
would have been obligated to provide such assistance
but for a provision of its insurance contract which has
the effect of limiting or excluding such obligation
because the individual is eligible for or is provided
health assistance under the plan.
(B) Other federal governmental programs.--Except as
provided in any other provision of law, no payment
shall be made to a State under subsection (f)(1) for
expenditures for health assistance provided for an
individual to the extent that payment has been made or
can reasonably be expected to be made promptly (as
determined in accordance with regulations) under any
other federally operated or financed health care
insurance program. For purposes of this paragraph,
rules similar to the rules for overpayments under
section 1903(d)(2) of the Social Security Act shall
apply.
(3) Application of certain general provisions.--The
following provisions of the Social Security Act shall apply to
States under subsection (f)(1) in the same manner as they apply
to a State under such title XIX:
(A) Title xix provisions.--
(i) Section 1902(a)(4)(C) (relating to
conflict of interest standards).
(ii) Paragraphs (2), (16), and (17) of
section 1903(i) (relating to limitations on
payment).
(iii) Section 1903(w) (relating to
limitations on provider taxes and donations).
(iv) Section 1920A (relating to presumptive
eligibility for children).
(B) Title xi provisions.--
(i) Section 1116 (relating to
administrative and judicial review), but only
insofar as consistent with this title.
(ii) Section 1124 (relating to disclosure
of ownership and related information).
(iii) Section 1126 (relating to disclosure
of information about certain convicted
individuals).
(iv) Section 1128A (relating to civil
monetary penalties).
(v) Section 1128B(d) (relating to criminal
penalties for certain additional charges).
(vi) Section 1132 (relating to periods
within which claims must be filed).
(4) Relation to hipaa.--Health benefits coverage provided
under a State program or project under this section shall be
treated as creditable coverage for purposes of part 7 of
subtitle B of title I of the Employee Retirement Income
Security Act of 1974, title XXVII of the Public Health Service
Act, and subtitle K of the Internal Revenue Code of 1986.
(k) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
in each fiscal year. Amounts appropriated for a fiscal year under this
subsection and not expended may be used in subsequent fiscal years to
carry out this section.
TITLE IV--SENSE OF THE HOUSE OF REPRESENTATIVES
SEC. 401. MEDICARE AND MEDICAID REFORM AND SAVINGS.
(a) In General.--The Secretary of Health and Human Services shall
implement administrative reforms with respect to--
(1) the Medicare program under title XVIII of the Social
Security Act in--
(A) the reduction of fraud and abuse in the
program,
(B) health information technology,
(C) comparative effectiveness, and
(D) chronic disease management; and
(2) the Medicaid program under title XIX of the Social
Security Act, including changes in the Medicaid matching rate
and changes in the payments for Medicaid administrative costs
to prevent duplication of such payments under the temporary
assistance for needy families program under title IV of the
Social Security Act;
that are sufficient to result in projected reductions in the Medicare
and Medicaid Federal budget baselines for fiscal years 2010 through
2015 that exceed the projected revenue loss for the same period
attributable to the refundable portion of the tax credit under section
37 of the Internal Revenue Code of 1986 (as added by title II of this
Act) and the increase in the Federal budget baseline for the State
children's health insurance program under title XXI of the Social
Security Act from the provisions of and amendments made by title I of
this Act.
(b) Consultation and Consideration.--In developing the necessary
program changes under subsection (a), the Secretary of Health and Human
Services shall consult with the Government Accountability Office and
the Medicare Payment Advisory Commission and shall also consider any
significant proposals for program changes in the specified areas that
have been issued by private organizations within the last 3 years.
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