[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 747 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 747

 To amend the Social Security Act to provide health insurance coverage 
    for children and pregnant women throughout the United States by 
    combining the children and pregnant woman health coverage under 
  Medicaid and SCHIP into a new All Healthy Children Program, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 28, 2009

     Mr. Scott of Virginia (for himself, Mr. Watt, Mr. Thompson of 
    Mississippi, Mr. Bishop of Georgia, Mr. Johnson of Georgia, Mr. 
 Sarbanes, Mr. Rothman of New Jersey, Mr. Grijalva, and Ms. McCollum) 
 introduced the following bill; which was referred to the Committee on 
                          Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend the Social Security Act to provide health insurance coverage 
    for children and pregnant women throughout the United States by 
    combining the children and pregnant woman health coverage under 
  Medicaid and SCHIP into a new All Healthy Children Program, 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; FINDINGS; PURPOSE.

    (a) Short Title.--This Act may be cited as the ``All Healthy 
Children Act of 2009''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents; findings; purpose.
Sec. 2. Creation of new title XXII of the Social Security Act.
               ``TITLE XXII--ALL HEALTHY CHILDREN PROGRAM

        ``Sec. 2201. All Healthy Children Program.
        ``Sec. 2202. General contents of State All Healthy Children 
                            Plan; eligibility; enrollment.
        ``Sec. 2203. Benefits; premiums; cost-sharing; provider payment 
                            rates.
        ``Sec. 2204. Payments to States.
        ``Sec. 2205. Application of SCHIP, medicaid and related SSA 
                            provisions; waivers; administration.
        ``Sec. 2206. Definitions.
        ``Sec. 2207. Effective dates; transition.
Sec. 3. Commission on Children's Health Coverage.
    (c) Findings.--Congress finds the following:
            (1) More than nine million children in the United States, 
        one in nine, have no health insurance coverage.
            (2) Every 39 seconds, another baby is born uninsured in the 
        United States.
            (3) Existing health care programs for low-income children 
        vary widely, with different standards for eligibility, cost-
        sharing, and benefits in each of the 50 States and the District 
        of Columbia.
            (4) More than six million uninsured children are eligible 
        for coverage under Medicaid or the State Children's Health 
        Insurance Program (SCHIP), but are not enrolled in existing 
        programs because of different eligibility and enrollment 
        barriers that make it difficult to obtain or keep coverage.
            (5) Millions more children are underinsured or at risk of 
        losing coverage if their parents change jobs or more employers 
        drop family coverage.
            (6) Uninsured children are almost 12 times as likely as 
        insured children to have an untreated medical need and are four 
        times as likely as insured children to have an unmet dental 
        need.
            (7) Uninsured children are more than five times as likely 
        as insured children to have gone more than two years without a 
        doctor visit.
            (8) The majority of uninsured children live in two-parent 
        households and almost 90 percent of such children live in 
        families where at least one parent works.
            (9) An estimated two-thirds of children and adolescents 
        with mental health needs are not getting the care they need and 
        only one in five children with serious emotional disturbances 
        receives specialized treatment.
            (10) It costs less to provide health insurance coverage to 
        children than to any other group of people.
            (11) Increases in private health insurance costs are 
        dramatically outpacing increases in wages.
            (12) The United States spending on health care per person 
        is more than twice the average spent in industrialized 
        countries, yet the United States ranks near the bottom among 
        those countries in infant mortality rates.
            (13) Children enrolled in a health coverage program 
        experienced significant improvements in health after just one 
        year and significant decreases of limitations in their daily 
        activities.
            (14) Enrollment in health insurance has been associated 
        with improvements in school.
            (15) When juvenile offenders arrested for minor offenses 
        had access to intensive and coordinated mental health services, 
        more than a third fewer were re-arrested the following year, 
        compared to those who only had access to basic mental health 
        services.
    (d) Purpose.--It is the purpose of this Act to simplify and 
consolidate children's health coverage under Medicaid and SCHIP into a 
single program that guarantees children in all States, territories, and 
the District of Columbia all medically necessary services.

SEC. 2. CREATION OF NEW TITLE XXII OF THE SOCIAL SECURITY ACT.

    The Social Security Act is amended by adding at the end the 
following new title:

               ``TITLE XXII--ALL HEALTHY CHILDREN PROGRAM

``SEC. 2201. ALL HEALTHY CHILDREN PROGRAM.

    ``(a) In General.--There is established under this title a State-
operated program receiving Federal financial assistance to provide 
comprehensive health coverage for children, pregnant women, and post-
partum women in place of benefits previously provided for children, 
pregnant women, and post-partum women under the Medicaid program under 
title XIX and the State Children's Health Insurance Program under title 
XXI.
    ``(b) State All Healthy Children Plan Required.--A State is not 
eligible for payment under section 2204 unless the State has submitted 
to the Secretary under section 2202 a plan that--
            ``(1) sets forth how the State intends to use the funds 
        provided under this title to provide all healthy children 
        assistance to uninsured children and pregnant women consistent 
        with the provisions of this title; and
            ``(2) has been approved under section 2202.
    ``(c) State and Individual Entitlement.--This title constitutes 
budget authority in advance of appropriations Acts and represents the 
obligation of the Federal Government to provide for the payment to 
States of amounts provided under section 2204. Each individual who is 
an all healthy children eligible individual and who qualifies for 
benefits under this title has an entitlement to such benefits in 
accordance with this title.
    ``(d) Private Right of Action.--
            ``(1) In general.--Any person aggrieved by a violation of 
        this title or a failure of an individual or entity, including a 
        State or Federal agency, to comply with the provisions of this 
        title, including any regulation promulgated pursuant to this 
        title, may bring a civil action in any Federal district court, 
        regardless of amount in controversy, or State court of 
        competent jurisdiction to enforce such person's rights.
            ``(2) No exclusion of other remedies.--The availability of 
        a private right of action under this subsection shall not be 
        construed to preclude the ability of any person aggrieved to 
        obtain relief for a violation of this title or a failure of an 
        individual or entity to comply with the provision of this 
        title, or any regulations promulgated pursuant to this title, 
        under any other applicable statute or other basis for relief.
            ``(3) Relief.--In an action under this subsection, the 
        court may award all relief allowed by law, including but not 
        limited to compensatory and exemplary damages and injunctive 
        relief, and attorneys' fees and court costs.
            ``(4) Person aggrieved defined.--In this subsection, the 
        term `person aggrieved' includes a child or individual entitled 
        to benefits under this title, the parent or guardian of such 
        child, a provider of services to children or other individuals 
        entitled to such benefits, or an association or other entity 
        whose mission is to ensure that children, pregnant women, or 
        post-partum women receive adequate health care services.
    ``(e) Effective Date.--No State is eligible for payments under 
section 2204 for all healthy children assistance for coverage provided 
for periods beginning before October 1, 2010.

``SEC. 2202. GENERAL CONTENTS OF STATE ALL HEALTHY CHILDREN PLAN; 
              ELIGIBILITY; ENROLLMENT.

    ``(a) General Contents.--A State all healthy children plan shall 
include a description, consistent with the requirements of this title, 
of--
            ``(1) the all healthy children assistance provided under 
        the plan for all healthy children eligible individuals, 
        including the proposed methods of delivery and utilization 
        control systems;
            ``(2) eligibility standards consistent with subsection (b);
            ``(3) enrollment and outreach activities consistent with 
        subsection (c); and
            ``(4) methods (including monitoring) used--
                    ``(A) to assure the quality and appropriateness of 
                care, particularly with respect to pre-natal care, 
                well-baby care, well-child care, and immunizations 
                provided under the plan, and
                    ``(B) to assure access to all medically necessary 
                health care services, including emergency services.
    ``(b) Eligibility Standards and Methodology.--
            ``(1) In general.--The all healthy children plan for a 
        State shall provide that all of the following are all healthy 
        children eligible individuals if they are residents:
                    ``(A) Full subsidy individuals.--
                            ``(i) All children under age 19 whose 
                        family income does not exceed 300 percent of 
                        the poverty line (as defined in section 
                        2110(c)(5)).
                            ``(ii) All pregnant women and post-partum 
                        women whose family income does not exceed 300 
                        percent of the poverty line.
                            ``(iii) All children under age 19, pregnant 
                        women, and post-partum women who would have 
                        qualified for medical assistance under title 
                        XIX (as applied in the State as of October 1, 
                        2005).
                            ``(iv) All children under age 19 who meet 
                        the requirements of subparagraphs (A) and (B) 
                        of section 1905(w)(1) (relating to independent 
                        foster care adolescents).
                    ``(B) Transitional assistance.--An individual who 
                loses eligibility as an individual described in 
                subparagraph (A) because of an increase in family 
                income, but only during the 3-month period beginning 
                with the first month in which such eligibility is lost.
                    ``(C) Buy-in eligible individuals.--Individuals 
                who, but for the amount of family income, would be an 
                individual described in subparagraph (A) and who are 
                not described in subparagraph (B) if they meet such 
                terms and conditions as the Secretary determines 
                appropriate.
            ``(2) Residency requirement.--For purposes of this title, 
        an individual is a resident of a State if the individual is 
        present in the State with intent to remain, and includes any 
        individual who would be treated as such a resident under title 
        XIX (as in effect as of January 1, 2007).
            ``(3) Post-partum woman defined.--In this title, the term 
        `post-partum woman' means a woman during the period beginning 
        on the date of completion of pregnancy and ending on the last 
        day of the first month that ends at least 60 days after such 
        date.
            ``(4) Income methodology.--The methodology for determining 
        income under a State all healthy children plan shall not be 
        more restrictive than the income methodology described in 
        section 1931(b)(1)(B), to the extent such methodology is 
        consistent with the requirements of section 1902(a)(17).
            ``(5) Cost-sharing.--Any cost-sharing required by the State 
        to be paid by an individual under paragraph (1)(B) during the 
        period described in that paragraph may not exceed the amount 
        the State plan charged for such individual prior to such 
        period.
            ``(6) No asset test.--The State plan may not impose any 
        asset or resource test for eligibility.
            ``(7) Construction.--Nothing in this title shall be 
        construed as preventing a State from covering individuals under 
        Title XIX (such as individuals who are 19 or 20 years of age) 
        who are not all healthy children eligible individuals.
            ``(8) Exclusion of public benefit definition.--The benefits 
        provided under this title shall not be deemed to constitute a 
        Federal or State public benefit within the meaning of title IV 
        of the Personal Responsibility and Work Opportunity 
        Reconciliation Act of 1996 (Public Law 104-193) nor shall any 
        documentation of citizenship be required for the purpose of 
        securing benefits under this title.
            ``(9) Special rules for territories.--In the case of any 
        State that is not one of the 50 States or the District of 
        Columbia, the Secretary may, by regulation, adjust the income 
        eligibility levels set forth in this title, taking into account 
        factors such as average income, cost of living, and 
        availability of health care coverage in a manner that assures 
        the level of access to health coverage for children, pregnant 
        women, and post-partum women residing in such a State is 
        comparable to the level of access for children, pregnant women, 
        and post-partum women residing in the 50 States or the District 
        of Columbia.
    ``(c) Enrollment.--
            ``(1) Streamlined enrollment system.--Each State plan shall 
        provide for a system of streamlined enrollment that includes 
        the following (as specified by the Secretary):
                    ``(A) A simple, short application form translated 
                into multiple languages.
                    ``(B) Applicant self-attestation of eligibility, 
                subject to verification, random audits, or both.
                    ``(C) The option for applications to be submitted 
                in-person, on-line, by mail, or as part of applications 
                for other programs.
                    ``(D) Automatic enrollment, as provided under 
                paragraph (2).
                    ``(E) 12-month continuous eligibility for children.
                    ``(F) Presumptive eligibility during an interim 
                period of coverage for individuals who appear to 
                qualify for assistance under this title, on the basis 
                of preliminary information.
                    ``(G) A determination of continued eligibility at 
                the end of an individual's eligibility period, based on 
                all data available to the State. If such determination 
                cannot be made, the individual or family shall be 
                contacted for additional information, but only to the 
                extent such information is not available to State 
                officials from other sources. The family shall be 
                notified of all determinations and findings and given 
                an opportunity to contest and appeal them. An 
                individual's eligibility shall continue until the 
                redetermination process is complete.
            ``(2) Automatic enrollment procedures.--
                    ``(A) In general.--The automatic enrollment 
                procedures under this paragraph shall include 
                enrollment of any all healthy children eligible 
                individual at the following points, unless the 
                individual (or parent or guardian on the individual's 
                behalf) affirmatively declines such enrollment:
                            ``(i) Unless the individual otherwise 
                        establishes enrollment in a health benefits 
                        plan or coverage, at the point of a final 
                        determination--
                                    ``(I) of individual's eligibility 
                                to participate in any federally-funded, 
                                means-tested program, regardless of any 
                                differences between the program's 
                                eligibility or income methodology and 
                                those otherwise used under this title, 
                                or
                                    ``(II) that, based on the income 
                                determinations made as part of such 
                                eligibility determination, the 
                                individual is eligible to participate 
                                under this title.
                            ``(ii) Birth of a child in the United 
                        States.
                            ``(iii) Assignment of a social security 
                        account number for a child.
                            ``(iv) A visit with any health care 
                        provider eligible to participate in the program 
                        established under this title.
                            ``(v) Enrollment in any public elementary 
                        or secondary school within the State or any 
                        other elementary or secondary school subject to 
                        mandatory immunization requirements.
                            ``(vi) Enrollment in a publicly subsidized 
                        child care program.
                            ``(vii) Upon discharge of a child from a 
                        public institution or other institution where 
                        the child has been confined.
                            ``(viii) Such other points of enrollment as 
                        the State or Secretary may establish.
                For purposes of this subparagraph, the term `federally-
                funded, means-tested program' includes the National 
                School Lunch Program under the Richard B. Russell 
                National School Lunch Act (42 U.S.C. 1751 et seq.), the 
                Food Stamp Program under the Food and Nutrition Act of 
                2008 (7 U.S.C. 2011), the special supplemental 
                nutrition program for women, infants, and children 
                (WIC) under section 17 of the Child Nutrition Act of 
                1966 (42 U.S.C. 1786), subsidized child care under the 
                Child Care Development Block Grant Act of 1990 (42 
                U.S.C. 9858 et seq.), programs carried out under the 
                Head Start Act (42 U.S.C. 9831 et seq.), and other 
                means-tested programs designated by the Secretary.
                    ``(B) Operation of automatic enrollment.--
                            ``(i) In general.--In the case of an 
                        individual who is automatically enrolled under 
                        subparagraph (A) who does not pay any 
                        applicable initial premiums, such individual 
                        shall be deemed to have affirmatively declined 
                        such enrollment and such individual shall be 
                        disenrolled from coverage under the all healthy 
                        children program under section 2201.
                            ``(ii) Notice at time of enrollment.--The 
                        State plan shall implement effective 
                        procedures, consistent with the Secretary's 
                        guidelines, for ensuring that, at the time of 
                        enrollment, each auto-enrolled individual (or 
                        parent or guardian of such individual) is 
                        advised of--
                                    ``(I) the level of premiums and 
                                cost-sharing applicable, consistent 
                                with section 2203;
                                    ``(II) the fact that enrollment is 
                                conditioned upon payment of any 
                                applicable premiums; and
                                    ``(III) such individual's right to 
                                decline the coverage made available 
                                through auto-enrollment.
                            ``(iii) Notice after enrollment.--The State 
                        plan shall implement effective procedures, 
                        consistent with the Secretary's guidelines, for 
                        ensuring that, after enrollment, each auto-
                        enrolled individual (or parent or guardian of 
                        such individual) receives confirmation of 
                        coverage and information on benefits under the 
                        title.
                            ``(iv) Equal treatment.--A State plan shall 
                        implement effective procedures to ensure that 
                        individuals covered through auto-enrollment do 
                        not receive fewer services, on average, than do 
                        similar individuals enrolled through other 
                        means.
                            ``(v) Information sharing.--Each State 
                        shall develop the information technology 
                        infrastructure needed for automated 
                        transmission and analysis of data involving 
                        means-tested programs referred to in 
                        subparagraph (A) and other sources of data 
                        pertinent to eligibility under this title, 
                        including State and Federal income tax records 
                        and information contained in the National 
                        Directory of New Hires. Consistent with 
                        standards developed by the Secretary, the State 
                        shall implement effective safeguards that 
                        protect the confidentiality of such data and 
                        limit its use to the effective administration 
                        of this title, including an identification of 
                        potentially eligible individuals not enrolled 
                        in the State plan as well as eligibility 
                        verification.
            ``(3) Outreach.--Each State plan shall provide for a system 
        for culturally and linguistically competent outreach to 
        families of potentially eligible individuals, which shall--
                    ``(A) be fully accessible to those whose ability to 
                communicate is affected by disability; and
                    ``(B) incorporate proactive communication (via 
                telephone or in-person visits) to such families, 
                consumer education, a preliminary or final eligibility 
                determination, and enrollment completed within a single 
                encounter, whenever possible, and proactive follow-up, 
                when necessary.
    ``(d) Avoiding Crowd-Out and Coordination With Other Health 
Coverage Programs.--
            ``(1) In general.--The State plan shall include a 
        description of procedures, consistent with this subsection, to 
        be used to ensure--
                    ``(A) that benefits provided under the State all 
                healthy children plan do not substitute for coverage 
                under group health plans;
                    ``(B) the provision of all healthy children 
                assistance to all healthy children eligible individuals 
                in the State who are Indians (as defined in section 
                4(c) of the Indian Health Care Improvement Act, 25 
                U.S.C. 1603(c)); and
                    ``(C) coordination with other public and private 
                programs providing creditable coverage for low-income 
                children and pregnant women.
            ``(2) Group health plan coverage permitted.--
        Notwithstanding paragraph (1)(A), a State plan may not deny 
        enrollment under this title in the case of any of the following 
        individuals or circumstances:
                    ``(A) The individual would have qualified for 
                medical assistance under title XIX under State law as 
                in effect on October 1, 2005.
                    ``(B) The individual has family income that does 
                not exceed 150 percent of the poverty line.
                    ``(C) The individual's enrollment under a group 
                health plan--
                            ``(i) ended more than four months before 
                        applying for enrollment under this title; or
                            ``(ii) was involuntarily terminated because 
                        of the death of a parent, job loss, or other 
                        circumstance.
                    ``(D) Other than for the subsidies described in 
                section 2203(b)(2)(B) (in the case of all healthy 
                children eligible individuals with family income that 
                exceeds 300 percent of the poverty line), the failure 
                of a parent or other individual (other than the 
                enrollee) to enroll the all healthy children eligible 
                individual in an available group health plan.
            ``(3) Supplemental coverage.--
                    ``(A) In general.--In the case of an all healthy 
                children eligible individual who is enrolled in a group 
                health plan, the State plan--
                            ``(i) must provide full supplemental 
                        coverage (described in subparagraph (B)) if--
                                    ``(I) the individual would have 
                                qualified for supplemental coverage 
                                under title XIX under State law as in 
                                effect on October 1, 2005; or
                                    ``(II) the individual is disabled 
                                (as defined for purposes of the 
                                supplemental security income program 
                                under title XVI); and
                            ``(ii) may provide some or all of such 
                        coverage to other healthy children eligible 
                        individuals (or to reasonable classifications 
                        of such individuals, as specified under the 
                        State plan).
                    ``(B) Full supplemental coverage described.--Full 
                supplemental coverage described in this subparagraph 
                includes the following:
                            ``(i) Benefits covered by the State plan 
                        that are outside the scope of benefits offered 
                        under the group health plan.
                            ``(ii) Reimbursement of families' premium 
                        payments under the group health plan for all 
                        healthy children eligible individuals so that 
                        costs do not exceed levels otherwise permitted 
                        by the State plan.
                            ``(iii) Coverage of out-of-pocket costs 
                        incurred under the group health plan where such 
                        coverage prevents those costs from exceeding 
                        the levels otherwise permitted under the State 
                        plan.
    ``(e) Assistance for Children Who Age Out of Assistance.--The State 
plan shall provide assistance in obtaining health benefits to 
individuals who lose eligibility under this title because of age.
    ``(f) Emergency Coverage.--When an all healthy children eligible 
individual enrolled in a State plan in one State moves to another State 
because of natural disaster or other reasons, the individual shall 
receive immediate and automatic presumptive eligibility under this 
title in the State to which the individual moves.

``SEC. 2203. BENEFITS; PREMIUMS; COST-SHARING; PROVIDER PAYMENT RATES.

    ``(a) Benefits.--
            ``(1) In general.--The all healthy children assistance 
        under this title shall include benefits for all medically 
        necessary health care, including early and periodic screening, 
        diagnostic, and treatment services (as defined in section 
        1905(r)) consistent with the requirements of section 
        1902(a)(43).
            ``(2) Benefit protections.--The State plan shall provide 
        for all benefit protections for all healthy children eligible 
        individuals that would otherwise have applied under title XIX 
        if such individuals were entitled to medical assistance under 
        such title, including the application of no preexisting 
        condition exclusion as defined in section 2701(b)(1)(A) of the 
        Public Health Service Act and section 701(b)(1)(A) of the 
        Employee Retirement Income Security Act of 1974.
    ``(b) Premiums.--Subject to subsection (d)--
            ``(1) No premium for lower-income individuals.--For all 
        healthy children eligible individuals described in subparagraph 
        (A) or (B) of section 2202(b)(1), there shall be no premium 
        imposed for coverage under this title.
            ``(2) Required premiums for buy-in eligible individuals.--
                    ``(A) In general.--Except as provided in this 
                paragraph, in the case of all healthy children eligible 
                individuals described in section 2202(b)(1)(C), the 
                premium charged to an individual for coverage under 
                this title shall be the applicable percentage specified 
                in subparagraph (D) of the total premium. The total 
                premium (as estimated under a methodology specified by 
                the Secretary) shall be equal to the full average per 
                capita cost of benefits for all healthy children 
                eligible individuals under the State all healthy 
                children plan.
                    ``(B) Provision of premium subsidy.--
                            ``(i) In general.--Subject to clause (ii), 
                        in no case shall the premium charged to an 
                        individual for coverage under this title exceed 
                        (taking into account any private coverage in 
                        which the individual is enrolled as well as 
                        supplemental coverage purchased under this 
                        title)--
                                    ``(I) 7.5 percent of the family 
                                income; or
                                    ``(II) in the case of multiple 
                                eligible individuals within the same 
                                family, 15 percent of family income.
                            ``(ii) Limitation.--Clause (i) shall not 
                        apply for a healthy child eligible individual 
                        in a family if--
                                    ``(I) the individual could be 
                                covered under a group health plan for 
                                which the employer (or other plan 
                                sponsor) provides for payment of at 
                                least 50 percent of the premium for 
                                coverage of such individual; and
                                    ``(II) the individual is not so 
                                covered because of a rejection of such 
                                coverage option by the individual.
                    ``(C) Optional subsidies.--A State plan may reduce 
                premiums otherwise imposed for reasonable 
                classifications of all healthy children eligible 
                individuals described in section 2202(b)(1)(C). Such 
                classifications may include--
                            ``(i) individuals with family income within 
                        specific income ranges;
                            ``(ii) individuals with special health care 
                        needs; and
                            ``(iii) individuals who could have 
                        qualified for medical assistance under an 
                        optional eligibility category under title XIX 
                        (as in effect as of January 1, 2007).
                    ``(D) Applicable percentage specified.--For 
                purposes of subparagraph (A), with respect to all 
                healthy children eligible individuals described in 
                section 2202(b)(1)(C), the applicable percentage 
                specified in this subparagraph is as follows:
                            ``(i) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 300, but does not exceed 320 percent of 
                        the poverty line, 25 percent.
                            ``(ii) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 320, but does not exceed 340 per cent 
                        of the poverty line, 35 percent.
                            ``(iii) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 340, but does not exceed 360 percent of 
                        the poverty line, 45 percent.
                            ``(iv) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 360, but does not exceed 380 percent of 
                        the poverty line, 55 percent.
                            ``(v) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 380, but does not exceed 400 percent of 
                        the poverty line, 65 percent.
                            ``(vi) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 400, but does not exceed 425 percent of 
                        the poverty line, 80 percent.
                            ``(vii) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 425, but does not exceed 450 percent of 
                        the poverty line, 90 percent.
                            ``(viii) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 450 percent of the poverty line, 100 
                        percent.
            ``(3) Premium payments.--
                    ``(A) In general.--The State all healthy children 
                plan shall provide effective measures, consistent with 
                standards established by the Secretary, to make premium 
                payment simple and convenient to parents (or other 
                payers) and to preserve continuity of coverage. Such 
                measures shall include--
                            ``(i) discounts to encourage the payment of 
                        quarterly or annual premiums in advance;
                            ``(ii) options to make premium payments 
                        automatically by credit card, debit account 
                        payments, electronic fund transfers, payroll 
                        withholding, or otherwise; and
                            ``(iii) payment opportunities at multiple, 
                        convenient community locations.
                    ``(B) Promoting continuity of coverage.--In the 
                case of all healthy children eligible individuals for 
                whom premium payments are required under the State 
                plan, the plan shall have effective procedures to 
                prevent premium non-payment from interrupting 
                continuity of coverage. If there is a default on 
                premium payments, not including the initial premium 
                payment, the State plan shall provide reasonable 
                opportunities to cure such default, including at least 
                a 60-day period, following notice of default, during 
                which overdue premium payments may be made without 
                interrupting coverage or incurring interest charges, 
                late fees, or other costs.
    ``(c) Cost-Sharing.--
            ``(1) Limitations.--Subject to subsection (d), for all 
        healthy children eligible individuals with a family income 
        that--
                    ``(A) does not exceed 200 percent of the poverty 
                line, there shall be no out-of-pocket cost-sharing 
                imposed;
                    ``(B) does exceed 200 percent, but does not exceed 
                300 percent, of the poverty line, only nominal out-of-
                pocket cost-sharing may be imposed; or
                    ``(C) exceeds 300 percent of the poverty line, out-
                of-pocket cost-sharing charged may not exceed levels 
                the Secretary finds to be consistent with charges under 
                employer-based health insurance for the majority of 
                employees enrolled in such coverage nationally.
        In no case shall a child described in subparagraph (A) or (B) 
        of section 2202(b)(1) be denied services under this title 
        because of failure to pay out-of-pocket cost-sharing.
            ``(2) Waiver.--A state may elect to waive or reduce out-of-
        pocket cost-sharing otherwise authorized under this subsection.
    ``(d) Limitations on Out-of-Pocket Costs.--
            ``(1) Current medicaid.--For each all healthy children 
        eligible individual, premiums and out-of-pocket cost-sharing 
        may not exceed the levels that would have been charged for that 
        individual under State Medicaid and SCHIP law as of October 1, 
        2005, updated in a manner specified by the Secretary based on 
        changes, after that date, to average earnings among families 
        with incomes that do not exceed 200 percent of the poverty 
        line.
            ``(2) Affordability.--The State plan shall provide 
        effective measures, consistent with standards established by 
        the Secretary, to further limit out-of-pocket cost-sharing 
        (taking into account both premiums and cost-sharing) of all 
        healthy children eligible individuals to affordable levels, for 
        both individual health care services and total family costs. 
        Such measures may include coding of each individual's 
        enrollment card. Such measures may not include a requirement 
        that households track incurred costs.
    ``(e) Choice of Plans.--To the extent feasible, a State plan must 
provide, insofar as the plan provides for benefits through enrollment 
in a health benefits plan, for each enrollee to have a choice of at 
least two health plan options, consistent with the requirements of 
section 1932.
    ``(f) Reimbursement Rates.--The State shall establish under the 
State plan, in consultation with appropriate child health providers and 
experts--
            ``(1) payment rates for providers that are--
                    ``(A) not less than 80 percent of the average of 
                payment rates for similar services for providers under 
                private health insurance plans within that State; and
                    ``(B) sufficient in amount to ensure that enrolled 
                all healthy children eligible individuals have adequate 
                access to all services covered under this title; and
            ``(2) payments rates to capitated plans that are 
        actuarially sound, based on comprehensive encounter data.

``SEC. 2204. PAYMENTS TO STATES.

    ``(a) Payment.--Subject to the succeeding provisions of this 
section, the Secretary shall pay to each State with a plan approved 
under this title, an amount for each quarter equal to the Federal all 
healthy children matching rate for the State (as determined under 
subsection (b)) of the total expenditures under the plan for the 
quarter, except that the matching rate for the development and 
operation of information technology shall be the same as the Federal 
matching percentage in effect for such technology under subparagraphs 
(A) and (B) of section 1903(a)(3).
    ``(b) Computation of Federal All Healthy Children Matching Rate.--
            ``(1) In general.--Subject to paragraph (3), the Federal 
        all healthy children matching rate under this subsection for a 
        State for a calendar quarter in a fiscal year is equal to the 
        ratio of--
                    ``(A) the total expenditures under the State plan 
                under this title for the quarter that are attributable 
                to required populations and services, less the State 
                share of basic expenditures described in paragraph (2), 
                to
                    ``(B) the total expenditures referred to in 
                subparagraph (A).
            ``(2) State share for basic expenditures.--
                    ``(A) In general.--The State share of expenditures 
                attributable to required populations and services under 
                this title for a quarter in a fiscal year is equal to 
                \1/4\ of the product of the following:
                            ``(i) Base amount.--The base FY 2010 amount 
                        (specified in subparagraph (B) for the State).
                            ``(ii) Child increase factor.--One plus the 
                        percentage increase in the number of children 
                        residing in the State, as estimated by the 
                        Secretary, from fiscal year 2010 to the fiscal 
                        year involved.
                            ``(iii) Cost increase factor.--One plus the 
                        percentage increase in the medical care 
                        component of the consumer price index for all 
                        urban consumers (U.S. city average), as 
                        estimated by the Secretary, from fiscal year 
                        2010 to the fiscal year involved.
                    ``(B) Base fy 2010 amount.--For purposes of this 
                paragraph, the `base FY 2010 amount' for a State is 
                equal to the sum of--
                            ``(i) the total amount of expenditures made 
                        by the State during calendar quarters in fiscal 
                        year 2010 under title XIX (including under any 
                        waiver under section 1115) that are 
                        attributable to coverage of individuals who 
                        meet the requirement to be all healthy children 
                        eligible individuals, including an appropriate 
                        portion of administrative expenses, reduced by 
                        the amount of Federal financial participation 
                        provided with respect to such expenditures; and
                            ``(ii) the total amount of expenditures 
                        made by the State during calendar quarters in 
                        fiscal year 2010 under title XXI (including 
                        under any waiver under section 1115), reduced 
                        by the amount of payment received by the State 
                        under such title for such quarters.
            ``(3) Counter-cyclical reduction.--The Secretary shall 
        establish a formula for providing, in addition to the base 
        Federal matching amounts, automatic supplemental assistance to 
        States that experience a sustained economic downturn, based 
        upon State's quarterly unemployment rate exceeding the State's 
        average of such rates during a period of previous calendar 
        quarters (in such number as the Secretary shall specify) and by 
        a percentage to be determined by the Secretary and in an amount 
        calculated on the basis of the relationship between changes in 
        unemployment and anticipated increases in providing services 
        under this title. The supplemental assistance shall be 
        distributed quarterly through a supplement to the State's 
        Federal payment and shall be for such duration as the Secretary 
        determines appropriate.
    ``(c) Bonus for Meeting Enrollment Targets.--The Secretary is 
authorized to establish a system for providing additional bonus 
payments for States that meet or exceed enrollment targets established 
for each State by the Secretary, taking into account the circumstances 
in each State.
    ``(d) Advance Payment; Retrospective Adjustment.--The Secretary may 
make payments under this section for each quarter on the basis of 
advance estimates of expenditures submitted by the State and such other 
investigation as the Secretary may find necessary, and may reduce or 
increase the payments as necessary to adjust for any overpayment or 
underpayment for prior quarters.
    ``(e) Treatment of Territories.--In the case of any State that is 
not one of the 50 States or the District of Columbia, the Secretary 
shall, by regulation, establish a formula for allocating funds to 
provide all healthy children assistance in such a State. Such formula 
shall produce a funding level for such a State that comparable to the 
level of funding for the provision of all healthy children assistance 
in the 50 States or the District of Columbia.

``SEC. 2205. APPLICATION OF SCHIP, MEDICAID AND RELATED SSA PROVISIONS; 
              WAIVERS; ADMINISTRATION.

    ``(a) SCHIP Provisions Relating to Plan Submission, Strategic 
Objectives and Performance Goals, and Audits.--Except to the extent 
inconsistent with the provisions of this title, sections 2106, 2107, 
and 2108(d) shall apply with respect to State plans under this title in 
the same manner as they applied with respect to State plans under title 
XXI.
    ``(b) Medicaid Provisions.--Except to the extent inconsistent with 
the provisions of this title, the provisions of title XIX (and the 
provisions of title XI, including section 1115, insofar as they are 
applicable to title XIX) shall apply to activities under this title.
    ``(c) Limitation on Waivers.--No waiver shall be granted under 
section 1115 with respect to this title if it is likely to result in--
            ``(1) an increase in health care or health premium costs 
        for all healthy children eligible individuals under this title; 
        or
            ``(2) a reduction in benefits, eligibility, guaranteed 
        eligibility, health care access, or health care quality for 
        such individuals under this title.
    ``(d) Annual Reports.--The Secretary shall present annual reports 
to Congress describing implementation of this title. Such reports shall 
include a description of--
            ``(1) optional coverage chosen by States; and
            ``(2) for each category of coverage and method of 
        enrollment, nationwide and State-specific data showing the 
        number and characteristics of all healthy children eligible 
        individuals receiving coverage, services provided, categories 
        and amounts of expenditures.

``SEC. 2206. DEFINITIONS.

    ``(a) In General.--For purposes of this title:
            ``(1) All healthy children eligible individual.--The term 
        `all healthy children eligible individual' means individuals 
        described in section 2202(b)(1).
            ``(2) All healthy children assistance.--The term `all 
        healthy children assistance' means payment under this title for 
        part or all of the cost of health benefits coverage for all 
        healthy children eligible individual.
            ``(3) Child, group health plan, and poverty line.--The 
        terms `child', `group health plan', and `poverty line' have the 
        meanings given such terms in section 2110(c).
            ``(4) State all healthy children plan; state plan.--The 
        terms `State all healthy children plan' and `State plan' mean 
        such a plan as approved under this title.
            ``(5) State.--The term `State' has the meaning given such 
        term for purposes of titles XIX and XXI.

``SEC. 2207. EFFECTIVE DATES; TRANSITION.

    ``(a) Effective Date.--Benefits and payments to States shall first 
be available under this title for items and services furnished on or 
after October 1, 2010 (in this section referred to as the `All Healthy 
Children Program effective date').
    ``(b) Transition Provisions.--
            ``(1) In general.--Any child under 19 years of age, any 
        pregnant woman, or any independent foster care adolescent (as 
        defined in section 1905(w)(1)) who, as of the day before the 
        All Healthy Children Program effective date, is enrolled under 
        title XIX or XXI shall, as of such effective date, 
        automatically qualify for and be enrolled in the State plan 
        under this title, with the benefits based on the family income 
        of the individual as most recently determined for purposes of 
        the title under which the individual was enrolled.
            ``(2) Treatment of schip adults.--In the case of an 
        individual not described in paragraph (1) who, as of the day 
        before the All Healthy Children Program effective date, was 
        enrolled under title XXI through a program waiver, during the 
        remainder of such program waiver period, so long as the 
        individual continues to meet the conditions for eligibility 
        under such program waiver, shall be eligible for medical 
        assistance under the State plan under title XIX and, with 
        respect to medical assistance to such individuals, the enhanced 
        FMAP under title XXI shall be substituted for the Federal 
        medical assistance percentage (FMAP) for purposes of section 
        1903(a)(1).
            ``(3) Guidance.--The Secretary shall provide guidance and 
        assistance to the States in carrying out this section.
    ``(c) Medicaid; SCHIP Transition.--Notwithstanding any other 
provision of law, as of the All Healthy Children Program effective 
date, any all healthy children eligible individual shall not be 
eligible for medical assistance under title XIX or child health 
assistance under title XXI and no Federal financial participation shall 
be available under either such title with respect to such 
individuals.''.

SEC. 3. COMMISSION ON CHILDREN'S HEALTH COVERAGE.

    (a) Establishment.--There is hereby established a Commission on 
Children's Health Coverage (in this section referred to as the 
``Commission'').
    (b) Composition.--
            (1) In general.--The Commission shall be composed of the 
        following:
                    (A) Four members, one each appointed by the 
                majority and minority leaders of the House of 
                Representatives and the majority and minority leaders 
                of the Senate.
                    (B) One member appointed by the Secretary of Health 
                and Human Services.
                    (C) Two members, one each appointed by the American 
                Academy of Pediatrics and by the Institute of Medicine 
                of the National Academies of Science.
                    (D) One member appointed by the Secretary of Health 
                and Human Services who is a representative of parents 
                of children with special health care needs.
                    (E) One member appointed by the Secretary of Health 
                and Human Services who is a representative of a 
                children's advocacy group.
                    (F) Two non-voting advisory members appointed by 
                the National Governors Association.
        Appointment of members of the Commission shall first be made 
        not later than 60 days after the date of the enactment of this 
        Act.
            (2) Terms.--The term of each member of the Commission shall 
        be for 2 years. A vacancy shall be filled in the same manner as 
        the original appointment but the member so appointed shall 
        serve for the remainder of the term of the vacating member.
            (3) Compensation.--Members of the Commission who are not 
        Federal officers or employees shall be entitled to 
        compensation, including travel time, at a per diem rate 
        equivalent of rate for level IV of Executive Schedule under 
        section 5315 of title 5, United States Code, and for travel 
        expense reimbursement, at rates authorized for employees of 
        agencies under such title.
            (4) Chair.--The Secretary shall designate a member to serve 
        as Chair of the Commission.
            (5) Meetings.--The Commission shall meet at the call of the 
        Chair.
            (6) Use of committees.--The Commission may establish 
        committees if necessary to carry out its duties.
    (c) Supermajority Requirement for Actions.--Commission actions must 
be approved by at least six of the members described in subparagraphs 
(A) through (E) of subsection (b)(1).
    (d) Administration.--
            (1) Powers.--
                    (A) 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 this 
                section.
                    (B) Information from federal agencies.--The 
                Commission may secure directly from any Federal 
                department or agency such information as the Commission 
                considers necessary to carry out this section. Upon 
                request of the Chairperson of the Commission, the head 
                of such department or agency shall furnish such 
                information to the Commission.
                    (C) 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.
                    (D) Gifts.--The Commission may accept, use, and 
                dispose of gifts or donations of services or property.
            (2) Compensation.--While serving on the business of the 
        Commission (including travel time), a member of the Commission 
        who is not a Federal officer or employee shall be entitled to 
        compensation at the per diem equivalent of the rate provided 
        for level IV of the Executive Schedule under section 5315 of 
        title 5, United States Code, and while so serving away from 
        home and the member's regular place of business, any member may 
        be allowed travel expenses, as authorized by the chairperson 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.
            (3) Staff.--
                    (A) In general.--The Chair of the Commission may, 
                without regard to the civil service laws and 
                regulations, appoint and terminate--
                            (i) subject to the approval of a majority 
                        of the Commission, an executive director; and
                            (ii) such other additional personnel as may 
                        be necessary to enable the Commission to 
                        perform its duties.
                    (B) Staff compensation.--The Chair of the 
                Commission may fix the compensation of the executive 
                director and other personnel without regard to chapter 
                51 and subchapter III of chapter 53 of title 5, United 
                States Code, relating to classification of positions 
                and General Schedule pay rates, except that the rate of 
                pay for the executive director and other personnel may 
                not exceed the rate payable for level V of the 
                Executive Schedule under section 5316 of such title.
                    (C) 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.
                    (D) Procurement of temporary and intermittent 
                services.--The Chair 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.
    (e) Reimbursement of Costs.--The Secretary shall provide, from 
general operating funds of the Department of Health and Human Services, 
the Commission with such funds and support as may be necessary to 
support its activities.
    (f) Annual Reports.--Beginning one year after the All Healthy 
Children Program effective date under section 2207(a) of the Social 
Security Act, the Commission shall transmit to Congress an annual 
report that evaluates the status of children's health coverage in the 
United States, including an evaluation of the implementation of title 
XXII of the such Act and recommendations for policy improvements at the 
State and national levels and in the private sector to improve such 
coverage.
    (g) Submission of Legislative Proposal for Universal Coverage of 
Children.--Not later than three years after the date of the enactment 
of this Act, the Commission shall submit to Congress a report that 
contains a legislative proposal that would assure health benefits 
coverage for all children in the United States. Such proposal may 
include a requirement that parents obtain coverage for their children 
or that employers fund coverage for children of their workers. The 
proposal shall provide for the following:
            (1) Coverage shall include all medically necessary care for 
        all children.
            (2) Enrollment shall be simple and seamless.
            (3) Unnecessary costs shall be avoided.
            (4) Quality, access, and continuity of care shall be 
        promoted.
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