I 111th CONGRESS 1st Session H. R. 747 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.
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.
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: <enum>XXII</enum><header>All Healthy Children Program</header> <section id="HD271ED7D93CA4ABE8DF0865E1D546ECF"><enum>2201.</enum><header>All Healthy Children Program</header> <subsection id="HB1AB45D905224073A886107D2D8400B6"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text> </subsection><subsection id="HCE3B1F5400F44EF4BBBD30E402CEAE2C"><enum>(b)</enum><header>State All Healthy Children Plan Required</header><text display-inline="yes-display-inline">A State is not eligible for payment under section 2204 unless the State has submitted to the Secretary under section 2202 a plan that—</text> <paragraph id="HBF225C990DD14349AF457688CB426066"><enum>(1)</enum><text display-inline="yes-display-inline">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</text> </paragraph><paragraph id="H5E21BB0967C1481C8B5BFD2200907848"><enum>(2)</enum><text display-inline="yes-display-inline">has been approved under section 2202.</text> </paragraph></subsection><subsection id="H55148279250B4B79886C9B15E799BE37"><enum>(c)</enum><header>State and individual entitlement</header><text display-inline="yes-display-inline">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.</text> </subsection><subsection id="HA16F555C1DB14715B882333BF7A7DE4"><enum>(d)</enum><header>Private right of action</header> <paragraph id="HD4166E9723714C7897B301A41814FC4C"><enum>(1)</enum><header>In general</header><text>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.</text> </paragraph><paragraph id="HBA40118AC6D04636B2D9DC30DF25DBDA"><enum>(2)</enum><header>No exclusion of other remedies</header><text>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.</text> </paragraph><paragraph id="HA0E937D3AE9C4F88A438F75F00A3B24B"><enum>(3)</enum><header>Relief</header><text>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.</text> </paragraph><paragraph id="H8BEBD803FABE4162968E5DDCE374D00"><enum>(4)</enum><header>Person aggrieved defined</header><text>In this subsection, the term <term>person aggrieved</term> 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.</text> </paragraph></subsection><subsection id="H8633EADD81244A0BB9F6DF1F7F997C2"><enum>(e)</enum><header>Effective date</header><text display-inline="yes-display-inline">No State is eligible for payments under section 2204 for all healthy children assistance for coverage provided for periods beginning before October 1, 2010.</text> </subsection></section><section id="HA6A0838872A64DF9A0AB8EA178DE8026"><enum>2202.</enum><header>General contents of State All Healthy Children Plan; eligibility; enrollment</header> <subsection id="HF7DDAB89DAC148179F83E367B5D251AE"><enum>(a)</enum><header>General contents</header><text display-inline="yes-display-inline">A State all healthy children plan shall include a description, consistent with the requirements of this title, of—</text> <paragraph id="H73ACBFE91E9A49EF84BA1BC8DE6FABD"><enum>(1)</enum><text display-inline="yes-display-inline">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;</text> </paragraph><paragraph id="HAF5AD4FAD6F8433AB492C66CA2A3709D"><enum>(2)</enum><text>eligibility standards consistent with subsection (b);</text> </paragraph><paragraph id="H9E36528F0F124D8FB1FC73DFBD449CD"><enum>(3)</enum><text>enrollment and outreach activities consistent with subsection (c); and</text> </paragraph><paragraph id="H4E3AED7C295E4BD6A63897593E4F88C4"><enum>(4)</enum><text>methods (including monitoring) used—</text> <subparagraph id="H60B08037118C4F24AB1C0000C42540D3"><enum>(A)</enum><text>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</text> </subparagraph><subparagraph id="H886BBE73A7A14B0E8DA28077F332C067"><enum>(B)</enum><text>to assure access to all medically necessary health care services, including emergency services.</text> </subparagraph></paragraph></subsection><subsection id="H26867B655082433AA16BF93D00A7C365"><enum>(b)</enum><header>Eligibility standards and methodology</header> <paragraph id="HE49956F5EC8740039948DDCD9B6F044"><enum>(1)</enum><header>In general</header><text>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:</text> <subparagraph id="HF9482DF94ED7425587CDB92FCC5878E7"><enum>(A)</enum><header>Full subsidy individuals</header> <clause id="HECEF66E610BC42EC944FA5AD18EFED62"><enum>(i)</enum><text>All children under age 19 whose family income does not exceed 300 percent of the poverty line (as defined in section 2110(c)(5)).</text> </clause><clause id="H8191D8FAC62E41FD81FDC6BA6D9BB7D3"><enum>(ii)</enum><text>All pregnant women and post-partum women whose family income does not exceed 300 percent of the poverty line.</text> </clause><clause id="HD003D14A3653438EA854B2C97659E59"><enum>(iii)</enum><text display-inline="yes-display-inline">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).</text> </clause><clause id="HCD65F53A7F8D492A914311CAA4459100"><enum>(iv)</enum><text>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).</text> </clause></subparagraph><subparagraph id="H488C3C0776CD472EB7C4FE9EF0027CDD"><enum>(B)</enum><header>Transitional assistance</header><text>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.</text> </subparagraph><subparagraph id="HC566B4DB09984BF6A2B5FAF03CDB2423"><enum>(C)</enum><header>Buy-in eligible individuals</header><text>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.</text> </subparagraph></paragraph><paragraph id="HE6E68BD359C840F58C076E58BE0022C6"><enum>(2)</enum><header>Residency requirement</header><text>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).</text> </paragraph><paragraph id="H9395106454C944DAA5E5D50FC756BA"><enum>(3)</enum><header>Post-partum woman defined</header><text>In this title, the term <term>post-partum woman</term> 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.</text> </paragraph><paragraph display-inline="no-display-inline" id="HA4A13FE73FA6437E95DF3C1B7101A883"><enum>(4)</enum><header>Income methodology</header><text display-inline="yes-display-inline">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).</text> </paragraph><paragraph id="H9F62E05844334B1C98B4874BF08BDB1C"><enum>(5)</enum><header>Cost-sharing</header><text>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.</text> </paragraph><paragraph id="HDA55EC430AE4422A0024B6CDEF605CD2"><enum>(6)</enum><header>No asset test</header><text>The State plan may not impose any asset or resource test for eligibility.</text> </paragraph><paragraph id="H9C4EF797382E44C0A0F821CD002C21F9"><enum>(7)</enum><header>Construction</header><text>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.</text> </paragraph><paragraph id="H7351BF0E8300436EB0776CA378827193"><enum>(8)</enum><header>Exclusion of public benefit definition</header><text display-inline="yes-display-inline">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.</text> </paragraph><paragraph commented="no" id="HBFD6937E2D9441DD8EB649FFD307C2E4"><enum>(9)</enum><header>Special rules for territories</header><text display-inline="yes-display-inline">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.</text> </paragraph></subsection><subsection id="H025E113491AE455BBAD0D17327FC00E2"><enum>(c)</enum><header>Enrollment</header> <paragraph id="H91FB3E3ECDE7404D90FAA1A60007008F"><enum>(1)</enum><header>Streamlined enrollment system</header><text display-inline="yes-display-inline">Each State plan shall provide for a system of streamlined enrollment that includes the following (as specified by the Secretary):</text> <subparagraph id="H3899D10F9C1C4D2E8354AA77306C393F"><enum>(A)</enum><text display-inline="yes-display-inline">A simple, short application form translated into multiple languages.</text> </subparagraph><subparagraph id="H9F440FF9E5D84432B26685E97B0356B5"><enum>(B)</enum><text display-inline="yes-display-inline">Applicant self-attestation of eligibility, subject to verification, random audits, or both.</text> </subparagraph><subparagraph id="HC674DAB1D8CC445B9B00428C47457173"><enum>(C)</enum><text display-inline="yes-display-inline">The option for applications to be submitted in-person, on-line, by mail, or as part of applications for other programs.</text> </subparagraph><subparagraph id="HCCF902984C55445FADA4DE66A90656A2"><enum>(D)</enum><text>Automatic enrollment, as provided under paragraph (2).</text> </subparagraph><subparagraph id="HE79566D23B8A4AD3B35F98AA08279D89"><enum>(E)</enum><text display-inline="yes-display-inline">12-month continuous eligibility for children.</text> </subparagraph><subparagraph id="H4211E26AFC514A7B802BE1D9FDC742DF"><enum>(F)</enum><text display-inline="yes-display-inline">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.</text> </subparagraph><subparagraph id="HFD33149F790449609FC03320C23EA496"><enum>(G)</enum><text display-inline="yes-display-inline">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.</text> </subparagraph></paragraph><paragraph id="HFF319E4D7C5F4CA7A646A085D6E6A446"><enum>(2)</enum><header>Automatic enrollment procedures</header> <subparagraph id="HF95683987D8C4B75AC8E592B5D00D080"><enum>(A)</enum><header>In general</header><text>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:</text> <clause id="H5A0A4E37E73D488491C3C5AC22D2DF5C"><enum>(i)</enum><text display-inline="yes-display-inline">Unless the individual otherwise establishes enrollment in a health benefits plan or coverage, at the point of a final determination—</text> <subclause id="H9341F07C5F404447ACE3DBD6F400D43D"><enum>(I)</enum><text>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</text> </subclause><subclause id="HDDDB7F1853954F7C96A853F73D9C0070"><enum>(II)</enum><text>that, based on the income determinations made as part of such eligibility determination, the individual is eligible to participate under this title.</text> </subclause></clause><clause id="H4134A0C942A14AF800993EADF807AAED"><enum>(ii)</enum><text>Birth of a child in the United States.</text> </clause><clause id="H5FFE309BFCFE4BF990BF38FF3579ECEC"><enum>(iii)</enum><text>Assignment of a social security account number for a child.</text> </clause><clause id="H1CA227482C3A44BF9FF559F4852C7B23"><enum>(iv)</enum><text display-inline="yes-display-inline">A visit with any health care provider eligible to participate in the program established under this title.</text> </clause><clause id="H4437B0375A754F0491D01CDB3331BC28"><enum>(v)</enum><text>Enrollment in any public elementary or secondary school within the State or any other elementary or secondary school subject to mandatory immunization requirements.</text> </clause><clause id="H24150466513442A9845897E554392DF2"><enum>(vi)</enum><text>Enrollment in a publicly subsidized child care program.</text> </clause><clause id="H90298E7FA93B41B88674E29495F482F2"><enum>(vii)</enum><text>Upon discharge of a child from a public institution or other institution where the child has been confined.</text> </clause><clause id="HE7FE1D4F003F45D0ACD1EC92C8C90991"><enum>(viii)</enum><text>Such other points of enrollment as the State or Secretary may establish.</text> </clause><continuation-text continuation-text-level="subparagraph">For purposes of this subparagraph, the term <term>federally-funded, means-tested program</term> 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.</continuation-text></subparagraph><subparagraph id="HCB85BE462DC14E1CB1359CC6A3BCFB79"><enum>(B)</enum><header>Operation of automatic enrollment</header> <clause id="H72270C1B5033421195BEAEAEB4AC6D3C"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text> </clause><clause id="HB58F47F75B614A25A837B135D94602DC"><enum>(ii)</enum><header>Notice at time of enrollment</header><text display-inline="yes-display-inline">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—</text> <subclause id="H42F007460D7B4E099409C8E2DEFDFFAF"><enum>(I)</enum><text display-inline="yes-display-inline">the level of premiums and cost-sharing applicable, consistent with section 2203;</text> </subclause><subclause id="H5EC3D7F275DB43B58578C0A5B3CD23DA"><enum>(II)</enum><text>the fact that enrollment is conditioned upon payment of any applicable premiums; and</text> </subclause><subclause id="H9762926FD5324314B2E92BA82C31AE1C"><enum>(III)</enum><text>such individual’s right to decline the coverage made available through auto-enrollment.</text> </subclause></clause><clause id="H5C96E5ABEFB0442881010384512E5C5D"><enum>(iii) </enum><header>Notice after enrollment</header><text display-inline="yes-display-inline">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.</text> </clause><clause id="HC0932347BDD04C078F66C3E3AC745728"><enum>(iv)</enum><header>Equal treatment</header><text>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.</text> </clause><clause id="H189109AC4AB648AEA867C71B15A992D6"><enum>(v)</enum><header>Information sharing</header><text display-inline="yes-display-inline">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.</text> </clause></subparagraph></paragraph><paragraph id="H1AE294A66A6047CA842553D2E3667306"><enum>(3)</enum><header>Outreach</header><text display-inline="yes-display-inline">Each State plan shall provide for a system for culturally and linguistically competent outreach to families of potentially eligible individuals, which shall—</text> <subparagraph id="H7CD19A1D6AB64CA0B5A42C2BFD378A3"><enum>(A)</enum><text>be fully accessible to those whose ability to communicate is affected by disability; and</text> </subparagraph><subparagraph id="H95667207DE9F4EA9BCB436D017CD41B4"><enum>(B)</enum><text>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.</text> </subparagraph></paragraph></subsection><subsection id="HE671423E983C4705A8CB86BFC30211F"><enum>(d)</enum><header>Avoiding crowd-out and coordination with other health coverage programs</header> <paragraph id="H444BE112DC7E4390B466E2C2A3CAA00"><enum>(1)</enum><header>In general</header><text>The State plan shall include a description of procedures, consistent with this subsection, to be used to ensure—</text> <subparagraph id="H391D97DA840E42AC8EBB7DE990884B32"><enum>(A)</enum><text>that benefits provided under the State all healthy children plan do not substitute for coverage under group health plans;</text> </subparagraph><subparagraph id="H92E58FAB8AFB4AE1BD8135EA6E5600E5"><enum>(B)</enum><text>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</text> </subparagraph><subparagraph id="H38CF1C4BAFDB49CA9900A2F2E2649000"><enum>(C)</enum><text>coordination with other public and private programs providing creditable coverage for low-income children and pregnant women.</text> </subparagraph></paragraph><paragraph id="H1E55C43A4CA04092A8C7C1F735564D40"><enum>(2)</enum><header>Group health plan coverage permitted</header><text>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:</text> <subparagraph id="HBA34ACF5AEE242DEBA00742F8306DF7B"><enum>(A)</enum><text>The individual would have qualified for medical assistance under title XIX under State law as in effect on October 1, 2005.</text> </subparagraph><subparagraph id="H3EA024E4752346AD8F876F56C9AA8B28"><enum>(B)</enum><text>The individual has family income that does not exceed 150 percent of the poverty line.</text> </subparagraph><subparagraph id="HAC9CEA3BBBD243A2928C1B85C908F5D4"><enum>(C)</enum><text>The individual’s enrollment under a group health plan—</text> <clause id="H0E5072221642499C9D00D057E815CF6C"><enum>(i)</enum><text>ended more than four months before applying for enrollment under this title; or</text> </clause><clause id="HE4D92D1E61A8436CB7A70B6E6F22E23"><enum>(ii)</enum><text display-inline="yes-display-inline">was involuntarily terminated because of the death of a parent, job loss, or other circumstance.</text> </clause></subparagraph><subparagraph id="HCA09D778447141D7B2AB57AACE9C0787"><enum>(D)</enum><text display-inline="yes-display-inline">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.</text> </subparagraph></paragraph><paragraph id="HEF11EF16A3AF4C1D91044985EF8968B8"><enum>(3)</enum><header>Supplemental coverage</header> <subparagraph id="HE3367C3AEEC849729FC5FE35F1C7DBFB"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">In the case of an all healthy children eligible individual who is enrolled in a group health plan, the State plan—</text> <clause id="HB67B041EAD1141F1B268D6018398304D"><enum>(i)</enum><text>must provide full supplemental coverage (described in subparagraph (B)) if—</text> <subclause id="H25560B1C403141808EC6940125B6EC00"><enum>(I)</enum><text display-inline="yes-display-inline">the individual would have qualified for supplemental coverage under title XIX under State law as in effect on October 1, 2005; or</text> </subclause><subclause id="H6D494B6FBC344164A0CC6005C007CA5"><enum>(II)</enum><text display-inline="yes-display-inline">the individual is disabled (as defined for purposes of the supplemental security income program under title XVI); and</text> </subclause></clause><clause id="HF637AD822C554B6DB060D98D928E2EC8"><enum>(ii)</enum><text>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).</text> </clause></subparagraph><subparagraph id="HDF7C7F75677B490F8266AE9456A4EEC"><enum>(B)</enum><header>Full supplemental coverage described</header><text display-inline="yes-display-inline">Full supplemental coverage described in this subparagraph includes the following:</text> <clause id="HD67675332787485E000500AA33E368E7"><enum>(i)</enum><text display-inline="yes-display-inline">Benefits covered by the State plan that are outside the scope of benefits offered under the group health plan.</text> </clause><clause id="H55A60B817D3F4B0FA3A56713374BEE8F"><enum>(ii)</enum><text display-inline="yes-display-inline">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.</text> </clause><clause id="HA835104119A247ECB106625308B70023"><enum>(iii)</enum><text display-inline="yes-display-inline">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.</text> </clause></subparagraph></paragraph></subsection><subsection id="H183722D1AF354BD9946F9C2C354F8351"><enum>(e)</enum><header>Assistance for children who age out of assistance</header><text display-inline="yes-display-inline">The State plan shall provide assistance in obtaining health benefits to individuals who lose eligibility under this title because of age.</text> </subsection><subsection id="H9F9898DF6C6D42FC00E2AAAD51AAEC7C"><enum>(f)</enum><header>Emergency coverage</header><text>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.</text> </subsection></section><section id="H86AD036E694F46B697083D992492A1F0"><enum>2203.</enum><header>Benefits; premiums; cost-sharing; provider payment rates</header> <subsection id="H375BDBA5A9A2454896F93926DD21F11F"><enum>(a)</enum><header>Benefits</header> <paragraph id="HBF7079E8EA0D4FC2AF48CE1B123132AE"><enum>(1)</enum><header>In general</header><text>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).</text> </paragraph><paragraph id="H0640A67399AC4CA28135BC39F8B63408"><enum>(2)</enum><header>Benefit protections</header><text>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.</text> </paragraph></subsection><subsection id="H4766E9E41B1043B8BFD22B73002E4E00"><enum>(b)</enum><header>Premiums</header><text>Subject to subsection (d)—</text> <paragraph id="HDA8505816B074354AED31617C3944CD7"><enum>(1)</enum><header>No premium for lower-income individuals</header><text display-inline="yes-display-inline">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.</text> </paragraph><paragraph id="H28EDB848D6D640A39696F15E184FC92B"><enum>(2)</enum><header>Required premiums for buy-in eligible individuals</header> <subparagraph id="H632754BE6492486588290962BAC4724F"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text> </subparagraph><subparagraph id="H18A7220DBC7643738B17D8B7EC2CF17"><enum>(B)</enum><header>Provision of premium subsidy</header> <clause id="HEB84D36324D54838A4520000BF67C7A5"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">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)—</text> <subclause id="H8AA6DC42D2534D0CA2495EE2A07700D8"><enum>(I)</enum><text>7.5 percent of the family income; or</text> </subclause><subclause id="HD2C2033AC33141B3BA3F370043015D87"><enum>(II)</enum><text>in the case of multiple eligible individuals within the same family, 15 percent of family income.</text> </subclause></clause><clause id="H21D8CE5CE32D4696A330537210F1B1CB"><enum>(ii)</enum><header>Limitation</header><text>Clause (i) shall not apply for a healthy child eligible individual in a family if—</text> <subclause id="HB7F0F778E39945D1A001ED00C27CB050"><enum>(I)</enum><text>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</text> </subclause><subclause id="H77075F87F872401594000800191E1B69"><enum>(II)</enum><text>the individual is not so covered because of a rejection of such coverage option by the individual.</text> </subclause></clause></subparagraph><subparagraph id="H9A4B4389204F428592133BD8CE96AA08"><enum>(C)</enum><header>Optional subsidies</header><text display-inline="yes-display-inline">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—</text> <clause id="H8D469F07C6444B5589AC2899E8447EB9"><enum>(i)</enum><text>individuals with family income within specific income ranges;</text> </clause><clause id="H7A192C4A99324FE5BCF1E5F0D65497E4"><enum>(ii)</enum><text>individuals with special health care needs; and</text> </clause><clause id="H76D5E3E7477447BCADDDACCC64ECF67"><enum>(iii)</enum><text>individuals who could have qualified for medical assistance under an optional eligibility category under title XIX (as in effect as of January 1, 2007).</text> </clause></subparagraph><subparagraph id="H1A321A6F640B466FA9376C84B550C8DB"><enum>(D)</enum><header>Applicable percentage specified</header><text display-inline="yes-display-inline">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:</text> <clause id="HC8FD02FB04B64ABA8912AEAE538C9E00"><enum>(i)</enum><text>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.</text> </clause><clause id="H60E388E5994D41D898D1175F21BA3464"><enum>(ii)</enum><text>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.</text> </clause><clause id="H8A0AE4C601D648CFBDDD7FD0DA6603B9"><enum>(iii)</enum><text>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.</text> </clause><clause id="H3B15BF44CA794B7B875C851349660006"><enum>(iv)</enum><text>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.</text> </clause><clause id="HD37B7DC2E3694953B1C57FE740009EF9"><enum>(v)</enum><text>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.</text> </clause><clause id="HC1B6181EE6804FCE96B0A5CE68AEFE1"><enum>(vi)</enum><text>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.</text> </clause><clause id="HED0802ACD15B4094BE0777FE84BA8E1E"><enum>(vii)</enum><text>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.</text> </clause><clause id="HE37ED23BB2EA4F50AD0080A75DD35778"><enum>(viii)</enum><text>In the case of such all healthy children eligible individuals whose income exceeds 450 percent of the poverty line, 100 percent.</text> </clause></subparagraph></paragraph><paragraph id="HEA3808CCA2FA42EF9974C81A2EEE5C6"><enum>(3)</enum><header>Premium payments</header> <subparagraph id="H27D800E0E5EB46C38B2DE37163DFE06"><enum>(A)</enum><header>In general</header><text>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—</text> <clause id="HFC07F0F6A3924DEE89101211558700E8"><enum>(i)</enum><text>discounts to encourage the payment of quarterly or annual premiums in advance;</text> </clause><clause id="H475152C675764F05948D0448BE00CBB3"><enum>(ii)</enum><text>options to make premium payments automatically by credit card, debit account payments, electronic fund transfers, payroll withholding, or otherwise; and</text> </clause><clause id="H733DB6303BD24B359409DB14FFE71F3B"><enum>(iii)</enum><text>payment opportunities at multiple, convenient community locations.</text> </clause></subparagraph><subparagraph id="H861D99B59E3F423C955BD8C9F9632D3"><enum>(B)</enum><header>Promoting continuity of coverage</header><text>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.</text> </subparagraph></paragraph></subsection><subsection id="HE2308AACF078446B911C87B9DBF91E9E"><enum>(c)</enum><header>Cost-sharing</header> <paragraph id="H9DE14CDAECFD47448209473E779C22C6"><enum>(1)</enum><header>Limitations</header><text>Subject to subsection (d), for all healthy children eligible individuals with a family income that—</text> <subparagraph id="H18B7636805854692A7B99DD619A64400"><enum>(A)</enum><text>does not exceed 200 percent of the poverty line, there shall be no out-of-pocket cost-sharing imposed;</text> </subparagraph><subparagraph id="H7C4E35750E614B6A89787F18CC1C7D6"><enum>(B)</enum><text>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</text> </subparagraph><subparagraph id="H6235B3CAA66047DCB53BB3E79BC6EB5B"><enum>(C)</enum><text display-inline="yes-display-inline">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.</text> </subparagraph><continuation-text continuation-text-level="paragraph">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.</continuation-text></paragraph><paragraph id="H8D46B3F232194A7F93D4B18CEDB1AE15"><enum>(2)</enum><header>Waiver</header><text display-inline="yes-display-inline">A state may elect to waive or reduce out-of-pocket cost-sharing otherwise authorized under this subsection.</text> </paragraph></subsection><subsection id="H94D60013D5534CE79EFA609F2EC7BAFE"><enum>(d)</enum><header>Limitations on out-of-pocket costs</header> <paragraph id="H821430D1BA424DBFBCCE818FA483F098"><enum>(1)</enum><header>Current medicaid</header><text display-inline="yes-display-inline">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.</text> </paragraph><paragraph id="H3708AC4108CC4A2FA3569F12AB1500CC"><enum>(2)</enum><header>Affordability</header><text display-inline="yes-display-inline">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.</text> </paragraph></subsection><subsection id="HC4A60E505AFA445383F0DD59AD39861B"><enum>(e)</enum><header>Choice of plans</header><text>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.</text> </subsection><subsection id="H54C13A07F3CD4BBB9DB85C005E250041"><enum>(f)</enum><header>Reimbursement rates</header><text>The State shall establish under the State plan, in consultation with appropriate child health providers and experts—</text> <paragraph id="H351882310B034B6900D95623D8B74815"><enum>(1)</enum><text>payment rates for providers that are—</text> <subparagraph id="HF9F40DFECC234DBBB85800D8AFB16DFA"><enum>(A)</enum><text>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</text> </subparagraph><subparagraph id="HFD05060144B645219B0482DBCCF0C31B"><enum>(B)</enum><text>sufficient in amount to ensure that enrolled all healthy children eligible individuals have adequate access to all services covered under this title; and</text> </subparagraph></paragraph><paragraph id="HEBA0161B7C11420A82F5044B00E8CAFD"><enum>(2)</enum><text>payments rates to capitated plans that are actuarially sound, based on comprehensive encounter data.</text> </paragraph></subsection></section><section id="H113CEB715EEB4F2A8EDF8DA04F46B6BA"><enum>2204.</enum><header>Payments to States</header> <subsection id="H64E15841175348F5B927589980B94808"><enum>(a)</enum><header>Payment</header><text>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).</text> </subsection><subsection id="HFAEDEAB2D2DE4CD7996526A98DECFC6"><enum>(b)</enum><header>Computation of Federal all healthy children matching rate</header> <paragraph id="HA31D258A3B2E4EA5837423208900526F"><enum>(1)</enum><header>In general</header><text>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—</text> <subparagraph id="H4D27F7F5244A41118FE15D3C9DBD6152"><enum>(A)</enum><text>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</text> </subparagraph><subparagraph id="H6B93AEB6EDD14B2D884B6D800874F566"><enum>(B)</enum><text>the total expenditures referred to in subparagraph (A).</text> </subparagraph></paragraph><paragraph id="HD0B9A831438248E38010672478D56ECF"><enum>(2)</enum><header>State share for basic expenditures</header> <subparagraph id="HBCD1003DABAB4A30B6DBB8A6EEAC0082"><enum>(A)</enum><header>In general</header><text>The State share of expenditures attributable to required populations and services under this title for a quarter in a fiscal year is equal to ¼ of the product of the following:</text> <clause id="H1C7C2A51CAD2442FB8FBE991AAD02556"><enum>(i)</enum><header>Base amount</header><text>The base FY 2010 amount (specified in subparagraph (B) for the State).</text> </clause><clause id="HB650F212539E4D34B6A818FDE2D0F131"><enum>(ii)</enum><header>Child increase factor</header><text>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.</text> </clause><clause id="HDDF622A56ABE4ED6927342D7EA99DF54"><enum>(iii)</enum><header>Cost increase factor</header><text>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.</text> </clause></subparagraph><subparagraph id="H354E24DBE5F94012B7EF48DF1257363B"><enum>(B)</enum><header>Base FY 2010 amount</header><text>For purposes of this paragraph, the <quote>base FY 2010 amount</quote> for a State is equal to the sum of—</text> <clause id="H650003437D284271A532FC18459DE566"><enum>(i)</enum><text>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</text> </clause><clause id="HCCCB1D6DA4014C88B27C8F14EAD65C8D"><enum>(ii)</enum><text display-inline="yes-display-inline">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.</text> </clause></subparagraph></paragraph><paragraph id="HE76CC2F6A1AB445FBC388F094B5400C1"><enum>(3)</enum><header>Counter-cyclical reduction</header><text display-inline="yes-display-inline">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.</text> </paragraph></subsection><subsection id="H3447E28A3AAE44858E11E157620671AE"><enum>(c)</enum><header>Bonus for meeting enrollment targets</header><text display-inline="yes-display-inline">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.</text> </subsection><subsection id="H8243173AF3E04E39BFC9800312D7C12"><enum>(d)</enum><header>Advance Payment; Retrospective Adjustment</header><text display-inline="yes-display-inline">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.</text> </subsection><subsection commented="no" id="HB5E893E73E154A9A9B5852BD0056F2D5"><enum>(e)</enum><header>Treatment of territories</header><text display-inline="yes-display-inline">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.</text> </subsection></section><section id="HABE0E6C8B3C840100065EBE00320F8C9"><enum>2205.</enum><header>Application of SCHIP, medicaid and related SSA provisions; waivers; administration</header> <subsection id="HB7A73EBDD2DB4D38A734ED3ED83CF6A3"><enum>(a)</enum><header>SCHIP provisions relating to plan submission, strategic objectives and performance goals, and audits</header><text>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.</text> </subsection><subsection id="HBA629E33B1AF4FB1BE7B4FFDDD1987DE"><enum>(b)</enum><header>Medicaid provisions</header><text display-inline="yes-display-inline">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.</text> </subsection><subsection id="H84D4F832309844D38B0184763CAFB356"><enum>(c)</enum><header>Limitation on waivers</header><text>No waiver shall be granted under section 1115 with respect to this title if it is likely to result in—</text> <paragraph id="HD8A428C64B734CCD8E42DBDF3F00FBA4"><enum>(1)</enum><text>an increase in health care or health premium costs for all healthy children eligible individuals under this title; or</text> </paragraph><paragraph id="H0247C9BFF1584A45812EC824EEC94956"><enum>(2)</enum><text>a reduction in benefits, eligibility, guaranteed eligibility, health care access, or health care quality for such individuals under this title.</text> </paragraph></subsection><subsection id="HFBB3F507F1EC489AA3009FFEAD23F2FC"><enum>(d)</enum><header>Annual reports</header><text>The Secretary shall present annual reports to Congress describing implementation of this title. Such reports shall include a description of—</text> <paragraph id="HF0DDC3FDAFEB4A278200AD17BCE084F8"><enum>(1)</enum><text>optional coverage chosen by States; and</text> </paragraph><paragraph id="HFCCDF3D7AC0148CFA247143C11E4F000"><enum>(2)</enum><text>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.</text> </paragraph></subsection></section><section id="H3D0C762603BC4CEFBFD83472655B7423"><enum>2206.</enum><header>Definitions</header> <subsection id="H1CA75193153A4BB0A8787DC0008E8E65"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">For purposes of this title:</text> <paragraph id="H2B3D42F828ED4BFBB4DD0071B54062E"><enum>(1)</enum><header>All healthy children eligible individual</header><text>The term <term>all healthy children eligible individual</term> means individuals described in section 2202(b)(1).</text> </paragraph><paragraph id="H9EBBEF8CD6EC4FA68CF3FBF3DCD6CB96"><enum>(2)</enum><header>All healthy children assistance</header><text display-inline="yes-display-inline">The term <term>all healthy children assistance</term> means payment under this title for part or all of the cost of health benefits coverage for all healthy children eligible individual.</text> </paragraph><paragraph id="HD8751535946E4621B284111FF3AD49A1"><enum>(3)</enum><header>Child, group health plan, and poverty line</header><text>The terms <term>child</term>, <term>group health plan</term>, and <term>poverty line</term> have the meanings given such terms in section 2110(c).</text> </paragraph><paragraph id="H0D4A3D0C7A564C239C1D70C694A5B785"><enum>(4)</enum><header>State all healthy children plan; State plan</header><text>The terms <term>State all healthy children plan</term> and <term>State plan</term> mean such a plan as approved under this title.</text> </paragraph><paragraph id="HFE9353AC78164FE8B133E8B2D73B5300"><enum>(5)</enum><header>State</header><text>The term <term>State</term> has the meaning given such term for purposes of titles XIX and XXI.</text> </paragraph></subsection></section><section id="H69DBE95DE40E441AA31C63AF8E83BEEA"><enum>2207.</enum><header>Effective dates; transition</header> <subsection id="H090D04D690D249D58B1F402DBEEB3F88"><enum>(a)</enum><header>Effective date</header><text display-inline="yes-display-inline">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 <quote>All Healthy Children Program effective date</quote>).</text> </subsection><subsection id="H5ED943ECA4894298AC37C4DF371C0748"><enum>(b)</enum><header>Transition provisions</header> <paragraph id="H5E531A9FBDA9415382C7CEC704DAE72"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text> </paragraph><paragraph id="HAEC5F15B6BB248D89BB4A423921265CE"><enum>(2)</enum><header>Treatment of SCHIP adults</header><text display-inline="yes-display-inline">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).</text> </paragraph><paragraph id="HE18CE05AB6CA40978FE79662C45D2AA"><enum>(3)</enum><header>Guidance</header><text display-inline="yes-display-inline">The Secretary shall provide guidance and assistance to the States in carrying out this section.</text> </paragraph></subsection><subsection id="HCB1BE8B7A4DD4D51AA10E9CC92B3B278"><enum>(c)</enum><header>Medicaid; SCHIP transition</header><text>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.</text> </subsection></section>.
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.