1.Short
title; amendments to Social Security Act; references; table of
contents
(a)This Act may be cited
as the Children’s Health Insurance
Program Reauthorization Act of 2009
.
(b)Amendments to
Social Security ActExcept as
otherwise specifically provided, whenever in this Act an amendment is expressed
in terms of an amendment to or repeal of a section or other provision, the
reference shall be considered to be made to that section or other provision of
the Social Security Act.
(c)References to
CHIP; Medicaid; SecretaryIn this Act:
(1)The
term CHIP means the State Children’s Health Insurance Program
established under title XXI of the Social Security Act (42 U.S.C. 1397aa et
seq.).
(2)The
term Medicaid means the program for medical assistance established
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
(3)The
term Secretary means the Secretary of Health and Human
Services.
(d)The table of contents of this Act is as follows:
Sec. 1. Short title; amendments
to Social Security Act; references; table of contents.
Sec. 2. Purpose.
Sec. 3. General effective date; exception for State
legislation; contingent effective date; reliance on law.
TITLE I—Financing
Subtitle A—Funding
Sec. 101. Extension of CHIP.
Sec. 102. Allotments for States and territories for fiscal
years 2009 through 2013.
Sec. 103. Child Enrollment Contingency Fund.
Sec. 104. CHIP performance bonus payment
to offset additional enrollment costs resulting from enrollment and retention
efforts.
Sec. 105. Two-year initial availability of CHIP
allotments.
Sec. 106. Redistribution of unused allotments.
Sec. 107. Option for qualifying States to receive the enhanced
portion of the CHIP matching rate for Medicaid coverage of certain
children.
Sec. 108. One-time
appropriation.
Sec. 109. Improving funding for the territories under CHIP and
Medicaid.
Subtitle B—Focus on Low-Income Children
and Pregnant Women
Sec. 111. State option to cover low-income pregnant women under
CHIP through a State plan amendment.
Sec. 112. Phase-out of coverage for nonpregnant childless
adults under CHIP; conditions for coverage of parents.
Sec. 113. Elimination of counting Medicaid child presumptive
eligibility costs against title XXI
allotment.
Sec. 114. Limitation on matching rate for
States that propose to cover children with effective family income that exceeds
300 percent of the poverty line.
Sec. 115. State authority under Medicaid.
TITLE II—Outreach and Enrollment
Subtitle A—Outreach and Enrollment Activities
Sec. 201. Grants and enhanced administrative funding for
outreach and enrollment.
Sec. 202. Increased outreach and enrollment of
Indians.
Sec. 203. State option to rely on findings from an Express Lane
agency to conduct simplified eligibility determinations.
Subtitle B—Reducing Barriers to Enrollment
Sec. 211. Verification of declaration of citizenship or
nationality for purposes of eligibility for Medicaid and CHIP.
Sec. 212. Reducing administrative barriers to
enrollment.
Sec. 213. Model of Interstate coordinated enrollment and
coverage process.
Sec. 214. Permitting States to ensure
coverage without a 5-year delay of certain children and pregnant women under
the Medicaid program and CHIP.
TITLE III—Reducing Barriers to Providing Premium
Assistance
Subtitle A—Additional State Option for Providing Premium
Assistance
Sec. 301. Additional State option for providing premium
assistance.
Sec. 302. Outreach, education, and enrollment
assistance.
Subtitle B—Coordinating Premium Assistance with Private
Coverage
Sec. 311. Special enrollment period under group health plans in
case of termination of Medicaid or CHIP coverage or eligibility for assistance
in purchase of employment-based coverage; coordination of coverage.
TITLE IV—Strengthening Quality of Care and Health
Outcomes
Sec. 401. Child health quality improvement activities for
children enrolled in Medicaid or CHIP.
Sec. 402. Improved availability of public information regarding
enrollment of children in CHIP and Medicaid.
Sec. 403. Application of certain managed care quality
safeguards to CHIP.
TITLE V—Improving Access to Benefits
Sec. 501. Dental benefits.
Sec. 502. Mental health parity in CHIP plans.
Sec. 503. Application of prospective payment system for
services provided by Federally-qualified health centers and rural health
clinics.
Sec. 504. Premium grace period.
Sec. 505. Clarification of coverage of services provided
through school-based health centers.
Sec. 506. Medicaid and CHIP Payment and Access
Commission.
TITLE VI—Program Integrity and Other Miscellaneous
Provisions
Subtitle A—Program Integrity and Data Collection
Sec. 601. Payment error rate measurement
(PERM
).
Sec. 602. Improving data collection.
Sec. 603. Updated Federal evaluation of CHIP.
Sec. 604. Access to records for IG and GAO audits and
evaluations.
Sec. 605. No Federal funding for illegal aliens; disallowance
for unauthorized expenditures.
Subtitle B—Miscellaneous Health Provisions
Sec. 611. Deficit Reduction Act technical
corrections.
Sec. 612. References to title XXI.
Sec. 613. Prohibiting initiation of new health opportunity
account demonstration programs.
Sec. 614. Adjustment in computation of Medicaid FMAP to
disregard an extraordinary employer pension contribution.
Sec. 615. Clarification treatment of regional medical
center.
Sec. 616. Extension of Medicaid DSH allotments for Tennessee
and Hawaii.
Sec. 617. GAO report on Medicaid managed care payment
rates.
Subtitle C—Other Provisions
Sec. 621. Outreach regarding health insurance options available
to children.
Sec. 622. Sense of the Senate regarding access to affordable
and meaningful health insurance coverage.
TITLE VII—Revenue Provisions
Sec. 701. Increase in excise tax rate on tobacco
products.
Sec. 702. Administrative
improvements.
Sec. 703. Treasury study concerning
magnitude of tobacco smuggling in the United States.
Sec. 704. Time for payment of corporate
estimated taxes.
2.It is the purpose of this Act to provide
dependable and stable funding for children’s health insurance under titles XXI
and XIX of the Social Security Act in order to enroll all six million uninsured
children who are eligible, but not enrolled, for coverage today through such
titles.
3.General effective
date; exception for State legislation; contingent effective date; reliance on
law
(a)Unless otherwise provided in this Act, subject to
subsections (b) through (d), this Act (and the amendments made by this Act)
shall take effect on April 1, 2009, and shall apply to child health assistance
and medical assistance provided on or after that date.
(b)Exception for
State legislationIn the case of a State plan under title XIX or
State child health plan under XXI of the Social Security Act, which the
Secretary of Health and Human Services determines requires State legislation in
order for the respective plan to meet one or more additional requirements
imposed by amendments made by this Act, the respective plan shall not be
regarded as failing to comply with the requirements of such title solely on the
basis of its failure to meet such an additional requirement before the first
day of the first calendar quarter beginning after the close of the first
regular session of the State legislature that begins after the date of
enactment of this Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of the session shall be
considered to be a separate regular session of the State legislature.
(c)Coordination of
CHIP funding for fiscal year 2009Notwithstanding any other
provision of law, insofar as funds have been appropriated under section
2104(a)(11), 2104(k), or 2104(l) of the Social Security Act, as amended by
section 201 of Public Law 110–173, to provide allotments to States under CHIP
for fiscal year 2009—
(1)any amounts that
are so appropriated that are not so allotted and obligated before April 1, 2009
are rescinded; and
(2)any amount
provided for CHIP allotments to a State under this Act (and the amendments made
by this Act) for such fiscal year shall be reduced by the amount of such
appropriations so allotted and obligated before such date.
(d)With respect to
amendments made by this Act (other than title VII) that become effective as of
a date—
(1)such amendments are
effective as of such date whether or not regulations implementing such
amendments have been issued; and
(2)Federal financial
participation for medical assistance or child health assistance furnished under
title XIX or XXI, respectively, of the Social Security Act on or after such
date by a State in good faith reliance on such amendments before the date of
promulgation of final regulations, if any, to carry out such amendments (or
before the date of guidance, if any, regarding the implementation of such
amendments) shall not be denied on the basis of the State’s failure to comply
with such regulations or guidance.
<enum>I</enum><header>Financing</header>
<subtitle id="H60049B9D00B447F39149A803CFDA5D83"><enum>A</enum><header>Funding</header>
<section id="H28A163590EC0477680CB9200C74D8FE0"><enum>101.</enum><header>Extension of
CHIP</header><text display-inline="no-display-inline">Section 2104(a) (42
U.S.C. 1397dd(a)) is amended—</text>
<paragraph id="H33BDC801CAF747309E9BE9CAF9DEA2B"><enum>(1)</enum><text>in
paragraph (10), by striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="HBF4B2616655140E2000368C9C14F836D"><enum>(2)</enum><text>by amending
paragraph (11), by striking <quote>each of fiscal years 2008 and 2009</quote>
and inserting <quote>fiscal year 2008</quote>; and</text>
</paragraph><paragraph id="HAEEE0B10D2614F28B532C496B15BB9D3"><enum>(3)</enum><text>by adding at the
end the following new paragraphs:</text>
<quoted-block display-inline="no-display-inline" id="HE0808CD74D4D42AC8E4FA048F117C196" style="OLC">
<paragraph id="H03C266E21AC2431F86906BFB9F21E800"><enum>(12)</enum><text>for fiscal year
2009, $10,562,000,000;</text>
</paragraph><paragraph id="HF0C37DCA2D5C4022B3434F1790F09021"><enum>(13)</enum><text>for fiscal year
2010, $12,520,000,000;</text>
</paragraph><paragraph id="H9E815288E6194ACBB36FFE7E45157438"><enum>(14)</enum><text>for fiscal year
2011, $13,459,000,000;</text>
</paragraph><paragraph id="H95695F2C5E80432BAEA90E5DB4CD794"><enum>(15)</enum><text>for fiscal year
2012, $14,982,000,000; and</text>
</paragraph><paragraph id="H52033D26D9954B60A39CA4F98143E00"><enum>(16)</enum><text>for fiscal year
2013, for purposes of making 2 semi-annual allotments—</text>
<subparagraph commented="no" id="H055173BB217242ED9D43B28111B4D15"><enum>(A)</enum><text display-inline="yes-display-inline">$2,850,000,000 for the period beginning on
October 1, 2012, and ending on March 31, 2013, and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H0E0652852096405B984B00CE4294EF2E"><enum>(B)</enum><text display-inline="yes-display-inline">$2,850,000,000 for the period beginning on
April 1, 2013, and ending on September 30,
2013.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section display-inline="no-display-inline" id="H23D7153F349E4EA9BECEF192CC1010AC"><enum>102.</enum><header>Allotments for
States and territories for fiscal years 2009 through 2013</header><text display-inline="no-display-inline">Section 2104 (42 U.S.C. 1397dd) is
amended—</text>
<paragraph display-inline="no-display-inline" id="H09981CB94E864A4DA5ADA742F7CF4CCE"><enum>(1)</enum><text>in subsection
(b)(1), by striking <quote>subsection (d)</quote> and inserting
<quote>subsections (d) and (m)</quote>;</text>
</paragraph><paragraph id="H81ADCBF3D87D4494BBAD51DA23D0A23C"><enum>(2)</enum><text display-inline="yes-display-inline">in subsection (c)(1), by striking
<quote>subsection (d)</quote> and inserting <quote>subsections (d) and
(m)(4)</quote>; and</text>
</paragraph><paragraph id="H9E7FB8663A2A4128BBE4354900EC316B"><enum>(3)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H81F3FD4E63C147FC9B758D779EC9E4A2" style="OLC">
<subsection id="H89B3D62C6AB64810B8E03CF83D00D82F"><enum>(m)</enum><header>Allotments for
fiscal years 2009 through 2013</header>
<paragraph display-inline="no-display-inline" id="HF26F5202D9DC42C4A58CAEF8F4F9AC46"><enum>(1)</enum><header>For fiscal year
2009</header>
<subparagraph id="H4607329F2B984EAC912FBCC61FA6AAC"><enum>(A)</enum><header>For the 50 States
and the District of Columbia</header><text display-inline="yes-display-inline">Subject to the succeeding provisions of
this paragraph and paragraph (4), the Secretary shall allot for fiscal year
2009 from the amount made available under subsection (a)(12), to each of the 50
States and the District of Columbia 110 percent of the highest of the following
amounts for such State or District:</text>
<clause id="HDCD3C843EA6946D80018DA41DC030082"><enum>(i)</enum><text>The total Federal
payments to the State under this title for fiscal year 2008, multiplied by the
allotment increase factor determined under paragraph (5) for fiscal year
2009.</text>
</clause><clause id="H2805C046F32848EE8F005002DB41AC86"><enum>(ii)</enum><text display-inline="yes-display-inline">The amount allotted to the State for fiscal
year 2008 under subsection (b), multiplied by the allotment increase factor
determined under paragraph (5) for fiscal year 2009.</text>
</clause><clause id="H9C8EAD86297D43D8A358144933CCC782"><enum>(iii)</enum><text>The projected
total Federal payments to the State under this title for fiscal year 2009, as
determined on the basis of the February 2009 projections certified by the State
to the Secretary by not later than March 31, 2009.</text>
</clause></subparagraph><subparagraph display-inline="no-display-inline" id="H72CA3DAE8C2C4F65B8713D918FB2A000"><enum>(B)</enum><header>For the
commonwealths and territories</header><text display-inline="yes-display-inline">Subject to the succeeding provisions of
this paragraph and paragraph (4), the Secretary shall allot for fiscal year
2009 from the amount made available under subsection (a)(12) to each of the
commonwealths and territories described in subsection (c)(3) an amount equal to
the highest amount of Federal payments to the commonwealth or territory under
this title for any fiscal year occurring during the period of fiscal years 1999
through 2008, multiplied by the allotment increase factor determined under
paragraph (5) for fiscal year 2009, except that subparagraph (B) thereof shall
be applied by substituting <quote>the United States</quote> for <quote>the
State</quote>.</text>
</subparagraph><subparagraph commented="no" id="HF9CEF6F89196492884BD00D6D61CBF87"><enum>(C)</enum><header>Adjustment for
qualifying states</header><text display-inline="yes-display-inline">In the case
of a qualifying State described in paragraph (2) of section 2105(g), the
Secretary shall permit the State to submit a revised projection described in
subparagraph (A)(iii) in order to take into account changes in such projections
attributable to the application of paragraph (4) of such section.</text>
</subparagraph></paragraph><paragraph id="HFA58BC11288247A6AEAB8005B02F8B3"><enum>(2)</enum><header>For fiscal years
2010 through 2012</header>
<subparagraph id="H847105A913C0458FB298BDEDCB4C445F"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">Subject to paragraphs
(4) and (6), from the amount made available under paragraphs (13) through (15)
of subsection (a) for each of fiscal years 2010 through 2012, respectively, the
Secretary shall compute a State allotment for each State (including the
District of Columbia and each commonwealth and territory) for each such fiscal
year as follows:</text>
<clause id="HF4DE1C915FB243E1B033C2B37F002087"><enum>(i)</enum><header>Growth factor
update for fiscal year 2010</header><text>For fiscal year 2010, the allotment
of the State is equal to the sum of—</text>
<subclause id="H5D4630CAA72F46A491DD996B5BF21371"><enum>(I)</enum><text>the amount of the
State allotment under paragraph (1) for fiscal year 2009; and</text>
</subclause><subclause id="H85719E09283B4DCDA7AEBF90CE33469F"><enum>(II)</enum><text>the amount of any
payments made to the State under subsection (k), (l), or (n) for fiscal year
2009,</text>
</subclause><continuation-text continuation-text-level="clause">multiplied by
the allotment increase factor under paragraph (5) for fiscal year 2010.</continuation-text></clause><clause id="HFAAF86930A354B6EAFB2B7CF91EFE4E3"><enum>(ii)</enum><header>Rebasing in
fiscal year 2011</header><text display-inline="yes-display-inline">For fiscal
year 2011, the allotment of the State is equal to the Federal payments to the
State that are attributable to (and countable towards) the total amount of
allotments available under this section to the State in fiscal year 2010
(including payments made to the State under subsection (n) for fiscal year 2010
as well as amounts redistributed to the State in fiscal year 2010), multiplied
by the allotment increase factor under paragraph (5) for fiscal year
2011.</text>
</clause><clause display-inline="no-display-inline" id="HAFFC0D710D914AE7877419789F974CD5"><enum>(iii)</enum><header>Growth factor
update for fiscal year 2012</header><text display-inline="yes-display-inline">For fiscal year 2012, the allotment of the
State is equal to the sum of—</text>
<subclause id="H9DAB840B02814D17B78F6673A3055E56"><enum>(I)</enum><text>the amount of the
State allotment under clause (ii) for fiscal year 2011; and</text>
</subclause><subclause id="H6C2B458DC2DD4D74BC718D5E4C8913B3"><enum>(II)</enum><text>the amount of any
payments made to the State under subsection (n) for fiscal year 2011,</text>
</subclause><continuation-text continuation-text-level="clause">multiplied by
the allotment increase factor under paragraph (5) for fiscal year 2012.</continuation-text></clause></subparagraph></paragraph><paragraph display-inline="no-display-inline" id="H7172FC4AAA0B46B680E9B38D117B2694"><enum>(3)</enum><header>For fiscal year
2013</header>
<subparagraph id="HEDDB82BCCE114ED6003F71D6838F74D8"><enum>(A)</enum><header>First
half</header><text>Subject to paragraphs (4) and (6), from the amount made
available under subparagraph (A) of paragraph (16) of subsection (a) for the
semi-annual period described in such paragraph, increased by the amount of the
appropriation for such period under section 108 of the Children’s Health
Insurance Program Reauthorization Act of 2009, the Secretary shall compute a
State allotment for each State (including the District of Columbia and each
commonwealth and territory) for such semi-annual period in an amount equal to
the first half ratio (described in subparagraph (D)) of the amount described in
subparagraph (C).</text>
</subparagraph><subparagraph display-inline="no-display-inline" id="H489049CFE8FC4910A1D196ED3D1D97CA"><enum>(B)</enum><header>Second
half</header><text>Subject to paragraphs (4) and (6), from the amount made
available under subparagraph (B) of paragraph (16) of subsection (a) for the
semi-annual period described in such paragraph, the Secretary shall compute a
State allotment for each State (including the District of Columbia and each
commonwealth and territory) for such semi-annual period in an amount equal to
the amount made available under such subparagraph, multiplied by the ratio
of—</text>
<clause id="HF2976B23AB9A4078B82B573DD2F74F5E"><enum>(i)</enum><text>the amount of the
allotment to such State under subparagraph (A); to</text>
</clause><clause id="HBAE4D12437C34DF9845524A2DFCF9328"><enum>(ii)</enum><text>the total of the
amount of all of the allotments made available under such subparagraph.</text>
</clause></subparagraph><subparagraph id="H56A10199767847F19C76F7B9D6086BF3"><enum>(C)</enum><header>Full year amount
based on rebased amount</header><text display-inline="yes-display-inline">The
amount described in this subparagraph for a State is equal to the Federal
payments to the State that are attributable to (and countable towards) the
total amount of allotments available under this section to the State in fiscal
year 2012 (including payments made to the State under subsection (n) for fiscal
year 2012 as well as amounts redistributed to the State in fiscal year 2012),
multiplied by the allotment increase factor under paragraph (5) for fiscal year
2013.</text>
</subparagraph><subparagraph id="H69FB06B1C6BF4AC48E2673008C8F03C9"><enum>(D)</enum><header>First half
ratio</header><text>The first half ratio described in this subparagraph is the
ratio of—</text>
<clause id="HC1412D4D52FB4AB294104BA43FADA22F"><enum>(i)</enum><text display-inline="yes-display-inline">the sum of—</text>
<subclause id="HB7D5A89AC5314F73AD6821DBE0303BC4"><enum>(I)</enum><text>the amount made
available under subsection (a)(16)(A); and</text>
</subclause><subclause id="H766F4AEAA22744A396E859705D8ED641"><enum>(II)</enum><text>the amount of the
appropriation for such period under section 108 of the Children’s Health
Insurance Program Reauthorization Act of 2009; to</text>
</subclause></clause><clause id="H217F330E2AE54032B01E007EF0B40042"><enum>(ii)</enum><text display-inline="yes-display-inline">the sum of the—</text>
<subclause id="H568CC47D287D4D46A31EF0006CE0E3C"><enum>(I)</enum><text>amount described in
clause (i); and</text>
</subclause><subclause id="H719E70E52CBA4DF4B60080E8AE68724F"><enum>(II)</enum><text>the amount made
available under subsection (a)(16)(B).</text>
</subclause></clause></subparagraph></paragraph><paragraph id="HF5D97C574251438BAC932397331514FA"><enum>(4)</enum><header>Proration
rule</header><text>If, after the application of this subsection without regard
to this paragraph, the sum of the allotments determined under paragraph (1),
(2), or (3) for a fiscal year (or, in the case of fiscal year 2013, for a
semi-annual period in such fiscal year) exceeds the amount available under
subsection (a) for such fiscal year or period, the Secretary shall reduce each
allotment for any State under such paragraph for such fiscal year or period on
a proportional basis.</text>
</paragraph><paragraph display-inline="no-display-inline" id="H0AE7F2A9CFDA497DA0A17E261F941F21"><enum>(5)</enum><header>Allotment
increase factor</header><text display-inline="yes-display-inline">The allotment
increase factor under this paragraph for a fiscal year is equal to the product
of the following:</text>
<subparagraph id="H3735809D3FD54589BAD5DD5D248F6C31"><enum>(A)</enum><header>Per capita
health care growth factor</header><text>1 plus the percentage increase in the
projected per capita amount of National Health Expenditures from the calendar
year in which the previous fiscal year ends to the calendar year in which the
fiscal year involved ends, as most recently published by the Secretary before
the beginning of the fiscal year.</text>
</subparagraph><subparagraph id="H8AC08EC0521F403DA7BB8BB217434303"><enum>(B)</enum><header>Child population
growth factor</header><text display-inline="yes-display-inline">1 plus the
percentage increase (if any) in the population of children in the State from
July 1 in the previous fiscal year to July 1 in the fiscal year involved, as
determined by the Secretary based on the most recent published estimates of the
Bureau of the Census before the beginning of the fiscal year involved, plus 1
percentage point.</text>
</subparagraph></paragraph><paragraph id="HFDD4184A9ACF4F14B931AACDDA9ABFD"><enum>(6)</enum><header>Increase in
allotment to account for approved program expansions</header><text>In the case
of one of the 50 States or the District of Columbia that—</text>
<subparagraph id="HAF180E15E4494FBE99287F7D567E7410"><enum>(A)</enum><text>has submitted to
the Secretary, and has approved by the Secretary, a State plan amendment or
waiver request relating to an expansion of eligibility for children or benefits
under this title that becomes effective for a fiscal year (beginning with
fiscal year 2010 and ending with fiscal year 2013); and</text>
</subparagraph><subparagraph id="H29964BC9545E4A53941ECA12A3FD168"><enum>(B)</enum><text>has submitted to
the Secretary, before the August 31 preceding the beginning of the fiscal year,
a request for an expansion allotment adjustment under this paragraph for such
fiscal year that specifies—</text>
<clause id="HB53BEE4C9CEB462585831F98D9007C9F"><enum>(i)</enum><text display-inline="yes-display-inline">the additional expenditures that are
attributable to the eligibility or benefit expansion provided under the
amendment or waiver described in subparagraph (A), as certified by the State
and submitted to the Secretary by not later than August 31 preceding the
beginning of the fiscal year; and</text>
</clause><clause id="H4AE3623C129C448482055445FCBCFA5B"><enum>(ii)</enum><text>the extent to
which such additional expenditures are projected to exceed the allotment of the
State or District for the year,</text>
</clause></subparagraph><continuation-text continuation-text-level="paragraph">subject to
paragraph (4), the amount of the allotment of the State or District under this
subsection for such fiscal year shall be increased by the excess amount
described in subparagraph (B)(i). A State or District may only obtain an
increase under this paragraph for an allotment for fiscal year 2010 or fiscal
year 2012.</continuation-text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HA6701F9B17954906AB00C29633CA21FD"><enum>(7)</enum><header>Availability of
amounts for semi-annual periods in fiscal year 2013</header><text>Each
semi-annual allotment made under paragraph (3) for a period in fiscal year 2013
shall remain available for expenditure under this title for periods after the
end of such fiscal year in the same manner as if the allotment had been made
available for the entire fiscal
year.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section display-inline="no-display-inline" id="H99FED617DB0F48C1A66B8D36A692A525"><enum>103.</enum><header>Child
Enrollment Contingency Fund</header><text display-inline="no-display-inline">Section 2104 (42 U.S.C. 1397dd), as amended
by section 102, is amended by adding at the end the following new
subsection:</text>
<quoted-block display-inline="no-display-inline" id="H5BFDC31E0C644F358837768F54F866A5" style="OLC">
<subsection id="HE6277D74BC8B45FEB2ED5244CC63CCFD"><enum>(n)</enum><header>Child Enrollment
Contingency Fund</header>
<paragraph id="H15B2CA3CBC87412EADE228E6947C8C50"><enum>(1)</enum><header>Establishment</header><text>There
is hereby established in the Treasury of the United States a fund which shall
be known as the <quote>Child Enrollment Contingency Fund</quote> (in this
subsection referred to as the <quote>Fund</quote>). Amounts in the Fund shall
be available without further appropriations for payments under this
subsection.</text>
</paragraph><paragraph id="HFA2F79D90F1E411EB00029B72BBA36EC"><enum>(2)</enum><header>Deposits into
fund</header>
<subparagraph id="H2258570E8E7F46CDA000C579ABEDD25"><enum>(A)</enum><header>Initial and
subsequent appropriations</header><text>Subject to subparagraphs (B) and (D),
out of any money in the Treasury of the United States not otherwise
appropriated, there are appropriated to the Fund—<inline-comment display="no">updated:</inline-comment></text>
<clause id="HD932064946B341ACB9288657DE9FB0F6"><enum>(i)</enum><text display-inline="yes-display-inline">for fiscal year 2009, an amount equal to 20
percent of the amount made available under paragraph (12) of subsection (a) for
the fiscal year; and</text>
</clause><clause id="H197A0B09AF254928AD4698FBE883ED1"><enum>(ii)</enum><text>for each of fiscal
years 2010 through 2012 (and for each of the semi-annual allotment periods for
fiscal year 2013), such sums as are necessary for making payments to eligible
States for such fiscal year or period, but not in excess of the aggregate cap
described in subparagraph (B).</text>
</clause></subparagraph><subparagraph id="H7C3EB39D7DD545CEA376F2969871EF79"><enum>(B)</enum><header>Aggregate
cap</header><text display-inline="yes-display-inline">The total amount
available for payment from the Fund for each of fiscal years 2010 through 2012
(and for each of the semi-annual allotment periods for fiscal year 2013),
taking into account deposits made under subparagraph (C), shall not exceed 20
percent of the amount made available under subsection (a) for the fiscal year
or period.</text>
</subparagraph><subparagraph id="H64D3778ECCE04D18BE704800FC734635"><enum>(C)</enum><header>Investment of
fund</header><text>The Secretary of the Treasury shall invest, in interest
bearing securities of the United States, such currently available portions of
the Fund as are not immediately required for payments from the Fund. The income
derived from these investments constitutes a part of the Fund.</text>
</subparagraph><subparagraph id="H3A3730866B6E4119BB01BCE84C48B9FF"><enum>(D)</enum><header>Availability of
excess funds for performance bonuses</header><text display-inline="yes-display-inline">Any amounts in excess of the aggregate cap
described in subparagraph (B) for a fiscal year or period shall be made
available for purposes of carrying out section 2105(a)(3) for any succeeding
fiscal year and the Secretary of the Treasury shall reduce the amount in the
Fund by the amount so made available.</text>
</subparagraph></paragraph><paragraph display-inline="no-display-inline" id="H0DC897BA8C0E4F91BFA78CC4AF7D44B5"><enum>(3)</enum><header>Child Enrollment
Contingency Fund payments</header>
<subparagraph id="HF66D1EEFA7714A3DA2057B0066AA538E"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">If a State’s
expenditures under this title in fiscal year 2009, fiscal year 2010, fiscal
year 2011, fiscal year 2012, or a semi-annual allotment period for fiscal year
2013, exceed the total amount of allotments available under this section to the
State in the fiscal year or period (determined without regard to any
redistribution it receives under subsection (f) that is available for
expenditure during such fiscal year or period, but including any carryover from
a previous fiscal year) and if the average monthly unduplicated number of
children enrolled under the State plan under this title (including children
receiving health care coverage through funds under this title pursuant to a
waiver under section 1115) during such fiscal year or period exceeds its target
average number of such enrollees (as determined under subparagraph (B)) for
that fiscal year or period, subject to subparagraph (D), the Secretary shall
pay to the State from the Fund an amount equal to the product of—</text>
<clause id="HA1457A1C693B4C78B8FD9B3956940929"><enum>(i)</enum><text>the amount by
which such average monthly caseload exceeds such target number of enrollees;
and</text>
</clause><clause id="H90291123F4E64C02839FA65B24F2011D"><enum>(ii)</enum><text>the projected per
capita expenditures under the State child health plan (as determined under
subparagraph (C) for the fiscal year), multiplied by the enhanced FMAP (as
defined in section 2105(b)) for the State and fiscal year involved (or in which
the period occurs).</text>
</clause></subparagraph><subparagraph id="H710EAA8D32D04B4CB8C99B23CC2BCF10"><enum>(B)</enum><header>Target average
number of child enrollees</header><text display-inline="yes-display-inline">In
this paragraph, the target average number of child enrollees for a
State—</text>
<clause id="H0D0AA95C8F88406C00B1B73BFAC2D4E8"><enum>(i)</enum><text>for fiscal year
2009 is equal to the monthly average unduplicated number of children enrolled
in the State child health plan under this title (including such children
receiving health care coverage through funds under this title pursuant to a
waiver under section 1115) during fiscal year 2008 increased by the population
growth for children in that State for the year ending on June 30, 2007 (as
estimated by the Bureau of the Census) plus 1 percentage point; or</text>
</clause><clause id="HDF4CB40E546B4AC4B1CF61C1113400FB"><enum>(ii)</enum><text display-inline="yes-display-inline">for a subsequent fiscal year (or
semi-annual period occurring in a fiscal year) is equal to the target average
number of child enrollees for the State for the previous fiscal year increased
by the child population growth factor described in subsection (m)(5)(B) for the
State for the prior fiscal year.</text>
</clause></subparagraph><subparagraph id="H076A805B049E424AA197FBD411E3C4D2"><enum>(C)</enum><header>Projected per
capita expenditures</header><text>For purposes of subparagraph (A)(ii), the
projected per capita expenditures under a State child health plan—</text>
<clause id="H4206B5F4CA7143E399858DC0A3797144"><enum>(i)</enum><text display-inline="yes-display-inline">for fiscal year 2009 is equal to the
average per capita expenditures (including both State and Federal financial
participation) under such plan for the targeted low-income children counted in
the average monthly caseload for purposes of this paragraph during fiscal year
2008, increased by the annual percentage increase in the projected per capita
amount of National Health Expenditures (as estimated by the Secretary) for
2009; or</text>
</clause><clause id="HEE6B59E768F340CEB114665FF845491D"><enum>(ii)</enum><text display-inline="yes-display-inline">for a subsequent fiscal year (or
semi-annual period occurring in a fiscal year) is equal to the projected per
capita expenditures under such plan for the previous fiscal year (as determined
under clause (i) or this clause) increased by the annual percentage increase in
the projected per capita amount of National Health Expenditures (as estimated
by the Secretary) for the year in which such subsequent fiscal year
ends.</text>
</clause></subparagraph><subparagraph display-inline="no-display-inline" id="HF0C856B581E64C43AACF437C97DBDEEC"><enum>(D)</enum><header>Proration
rule</header><text>If the amounts available for payment from the Fund for a
fiscal year or period are less than the total amount of payments determined
under subparagraph (A) for the fiscal year or period, the amount to be paid
under such subparagraph to each eligible State shall be reduced
proportionally.</text>
</subparagraph><subparagraph id="H26B7370E240940F9B2FFC83BA77FC800"><enum>(E)</enum><header>Timely payment;
reconciliation</header><text display-inline="yes-display-inline">Payment under
this paragraph for a fiscal year or period shall be made before the end of the
fiscal year or period based upon the most recent data for expenditures and
enrollment and the provisions of subsection (e) of section 2105 shall apply to
payments under this subsection in the same manner as they apply to payments
under such section.</text>
</subparagraph><subparagraph id="H4B818AA3571346A48E50A665F719A38B"><enum>(F)</enum><header>Continued
reporting</header><text display-inline="yes-display-inline">For purposes of
this paragraph and subsection (f), the State shall submit to the Secretary the
State’s projected Federal expenditures, even if the amount of such expenditures
exceeds the total amount of allotments available to the State in such fiscal
year or period.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H0BC6AE47B1C1421384BB4FBFF9D466FE"><enum>(G)</enum><header>Application to
commonwealths and territories</header><text>No payment shall be made under this
paragraph to a commonwealth or territory described in subsection (c)(3) until
such time as the Secretary determines that there are in effect methods,
satisfactory to the Secretary, for the collection and reporting of reliable
data regarding the enrollment of children described in subparagraphs (A) and
(B) in order to accurately determine the commonwealth’s or territory’s
eligibility for, and amount of payment, under this
paragraph.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section commented="no" display-inline="no-display-inline" id="H8D656EAD12F44FA786996F1C00727207" section-type="subsequent-section"><enum>104.</enum><header>CHIP performance
bonus payment to offset additional enrollment costs resulting from enrollment
and retention efforts</header><text display-inline="no-display-inline">Section
2105(a) (42 U.S.C. 1397ee(a)) is amended by adding at the end the following new
paragraphs:</text>
<quoted-block display-inline="no-display-inline" id="HFDB56BA535804B829B294D14399D7DEF" style="OLC">
<paragraph commented="no" id="HCEB1AA1236964722A4D472947B2FF54"><enum>(3)</enum><header>Performance bonus
payment to offset additional medicaid and CHIP child enrollment costs resulting
from enrollment and retention efforts</header>
<subparagraph commented="no" id="HAA44D5255A2C43BBB6B6E2CC74D099AE"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">In addition to the
payments made under paragraph (1), for each fiscal year (beginning with fiscal
year 2009 and ending with fiscal year 2013), the Secretary shall pay from
amounts made available under subparagraph (E), to each State that meets the
condition under paragraph (4) for the fiscal year, an amount equal to the
amount described in subparagraph (B) for the State and fiscal year. The payment
under this paragraph shall be made, to a State for a fiscal year, as a single
payment not later than the last day of the first calendar quarter of the
following fiscal year.</text>
</subparagraph><subparagraph commented="no" id="H5B3FFD0967414AEDBD6FC3C05C59E1E1"><enum>(B)</enum><header>Amount for above
baseline Medicaid child enrollment costs</header><text>Subject to subparagraph
(E), the amount described in this subparagraph for a State for a fiscal year is
equal to the sum of the following amounts:</text>
<clause commented="no" id="HD25EE9E538D34B2AB3A30009304BD089"><enum>(i)</enum><header>First tier above
baseline Medicaid enrollees</header><text display-inline="yes-display-inline">An amount equal to the number of first tier
above baseline child enrollees (as determined under subparagraph (C)(i)) under
title XIX for the State and fiscal year, multiplied by 15 percent of the
projected per capita State Medicaid expenditures (as determined under
subparagraph (D)) for the State and fiscal year under title XIX.</text>
</clause><clause commented="no" id="H84C1015AADB84AD881CF2B727E51BBC8"><enum>(ii)</enum><header>Second tier
above baseline Medicaid enrollees</header><text display-inline="yes-display-inline">An amount equal to the number of second
tier above baseline child enrollees (as determined under subparagraph (C)(ii))
under title XIX for the State and fiscal year, multiplied by 62.5 percent of
the projected per capita State Medicaid expenditures (as determined under
subparagraph (D)) for the State and fiscal year under title XIX.</text>
</clause></subparagraph><subparagraph commented="no" id="H844FA3C4B34846B2ADF8FE515433BF3"><enum>(C)</enum><header>Number of first
and second tier above baseline child enrollees; baseline number of child
enrollees</header><text>For purposes of this paragraph:</text>
<clause commented="no" id="HD9F4BD5F664C432CA0197F4972FD0087"><enum>(i)</enum><header>First tier above
baseline child enrollees</header><text>The number of first tier above baseline
child enrollees for a State for a fiscal year under title XIX is equal to the
number (if any, as determined by the Secretary) by which—</text>
<subclause commented="no" id="H2051B18F332D4A1D9D81DFDB3A5586E"><enum>(I)</enum><text>the monthly average
unduplicated number of qualifying children (as defined in subparagraph (F))
enrolled during the fiscal year under the State plan under title XIX,
respectively; exceeds</text>
</subclause><subclause commented="no" id="H6811F5420ED040019C47998BD1000093"><enum>(II)</enum><text>the baseline
number of enrollees described in clause (iii) for the State and fiscal year
under title XIX, respectively;</text>
</subclause><continuation-text commented="no" continuation-text-level="clause">but not to exceed 10 percent of the
baseline number of enrollees described in subclause (II).</continuation-text></clause><clause commented="no" id="HC9496B25E5634735899B22EE08B489E5"><enum>(ii)</enum><header>Second tier
above baseline child enrollees</header><text display-inline="yes-display-inline">The number of second tier above baseline
child enrollees for a State for a fiscal year under title XIX is equal to the
number (if any, as determined by the Secretary) by which—</text>
<subclause commented="no" id="HD0D858AC0B1346BB92A6FEB2D921FDE"><enum>(I)</enum><text display-inline="yes-display-inline">the monthly average unduplicated number of
qualifying children (as defined in subparagraph (F)) enrolled during the fiscal
year under title XIX as described in clause (i)(I); exceeds</text>
</subclause><subclause commented="no" id="H1510EBF37AE84CE39C406072B57E30E7"><enum>(II)</enum><text>the sum of the
baseline number of child enrollees described in clause (iii) for the State and
fiscal year under title XIX, as described in clause (i)(II), and the maximum
number of first tier above baseline child enrollees for the State and fiscal
year under title XIX, as determined under clause (i).</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="H9AD18870D6C24A718C00B343A8C9004D"><enum>(iii)</enum><header>Baseline
number of child enrollees</header><text display-inline="yes-display-inline">Subject to subparagraph (H), the baseline
number of child enrollees for a State under title XIX—</text>
<subclause commented="no" id="HD6E97E90184F4E4FBB2790D6BE216373"><enum>(I)</enum><text display-inline="yes-display-inline">for fiscal year 2009 is equal to the
monthly average unduplicated number of qualifying children enrolled in the
State plan under title XIX during fiscal year 2007 increased by the population
growth for children in that State from 2007 to 2008 (as estimated by the Bureau
of the Census) plus 4 percentage points, and further increased by the
population growth for children in that State from 2008 to 2009 (as estimated by
the Bureau of the Census) plus 4 percentage points;</text>
</subclause><subclause id="HE33BD2EA3F4D483B90F321C99344C47"><enum>(II)</enum><text display-inline="yes-display-inline">for each of fiscal years 2010, 2011, and
2012, is equal to the baseline number of child enrollees for the State for the
previous fiscal year under title XIX, increased by the population growth for
children in that State from the calendar year in which the respective fiscal
year begins to the succeeding calendar year (as estimated by the Bureau of the
Census) plus 3.5 percentage points;</text>
</subclause><subclause display-inline="no-display-inline" id="H0E097327C5B74C1DBB897BDB546C717C"><enum>(III)</enum><text display-inline="yes-display-inline">for each of fiscal years 2013, 2014, and
2015, is equal to the baseline number of child enrollees for the State for the
previous fiscal year under title XIX, increased by the population growth for
children in that State from the calendar year in which the respective fiscal
year begins to the succeeding calendar year (as estimated by the Bureau of the
Census) plus 3 percentage points; and</text>
</subclause><subclause commented="no" id="H6A510CCC45584769A3CB411F4F40BFB8"><enum>(IV)</enum><text display-inline="yes-display-inline">for a subsequent fiscal year is equal to
the baseline number of child enrollees for the State for the previous fiscal
year under title XIX, increased by the population growth for children in that
State from the calendar year in which the fiscal year involved begins to the
succeeding calendar year (as estimated by the Bureau of the Census) plus 2
percentage points.</text>
</subclause></clause></subparagraph><subparagraph commented="no" id="H6752FC8C012C4137A5BE066B1FAB4FDE"><enum>(D)</enum><header>Projected per
capita State Medicaid expenditures</header><text display-inline="yes-display-inline">For purposes of subparagraph (B), the
projected per capita State Medicaid expenditures for a State and fiscal year
under title XIX is equal to the average per capita expenditures (including both
State and Federal financial participation) for children under the State plan
under such title, including under waivers but not including such children
eligible for assistance by virtue of the receipt of benefits under title XVI,
for the most recent fiscal year for which actual data are available (as
determined by the Secretary), increased (for each subsequent fiscal year up to
and including the fiscal year involved) by the annual percentage increase in
per capita amount of National Health Expenditures (as estimated by the
Secretary) for the calendar year in which the respective subsequent fiscal year
ends and multiplied by a State matching percentage equal to 100 percent minus
the Federal medical assistance percentage (as defined in section 1905(b)) for
the fiscal year involved.</text>
</subparagraph><subparagraph id="HBB3807BF28E94520B3A401DD313D7FEE"><enum>(E)</enum><header>Amounts
available for payments</header>
<clause id="HD6655FD70D254B29811392D5EE1F86AA"><enum>(i)</enum><header>Initial
appropriation</header><text display-inline="yes-display-inline">Out of any
money in the Treasury not otherwise appropriated, there are appropriated
$3,225,000,000 for fiscal year 2009 for making payments under this paragraph,
to be available until expended.</text>
</clause><clause id="H1B5D589956DE413A8470C91581C8D74C"><enum>(ii)</enum><header>Transfers</header><text>Notwithstanding
any other provision of this title, the following amounts shall also be
available, without fiscal year limitation, for making payments under this
paragraph:</text>
<subclause display-inline="no-display-inline" id="H233C2485721D4A56BB3F46B4EAAFF32"><enum>(I)</enum><header>Unobligated
national allotment</header>
<item id="HA9ADB38017E24F56A5ADF7C1A1F471E"><enum>(aa)</enum><header>Fiscal years
2009 through 2012</header><text>As of December 31 of fiscal year 2009, and as
of December 31 of each succeeding fiscal year through fiscal year 2012, the
portion, if any, of the amount appropriated under subsection (a) for such
fiscal year that is unobligated for allotment to a State under subsection (m)
for such fiscal year or set aside under subsection (a)(3) or (b)(2) of section
2111 for such fiscal year.</text>
</item><item id="H6898493B8C6C461F87BE0080E2A29611"><enum>(bb)</enum><header>First half of
fiscal year 2013</header><text>As of December 31 of fiscal year 2013, the
portion, if any, of the sum of the amounts appropriated under subsection
(a)(16)(A) and under section 108 of the Children’s Health Insurance
Reauthorization Act of 2009 for the period beginning on October 1, 2012, and
ending on March 31, 2013, that is unobligated for allotment to a State under
subsection (m) for such fiscal year or set aside under subsection (b)(2) of
section 2111 for such fiscal year.</text>
</item><item commented="no" id="HCF5686B5652F485F8E2947F0FD73E1A2"><enum>(cc)</enum><header>Second half of
fiscal year 2013</header><text>As of June 30 of fiscal year 2013, the portion,
if any, of the amount appropriated under subsection (a)(16)(B) for the period
beginning on April 1, 2013, and ending on September 30, 2013, that is
unobligated for allotment to a State under subsection (m) for such fiscal year
or set aside under subsection (b)(2) of section 2111 for such fiscal
year.</text>
</item></subclause><subclause id="H56A314751290486BA794B83FBFEDF7E"><enum>(II)</enum><header>Unexpended
allotments not used for redistribution</header><text>As of November 15 of each
of fiscal years 2010 through 2013, the total amount of allotments made to
States under section 2104 for the second preceding fiscal year (third preceding
fiscal year in the case of the fiscal year 2006, 2007, and 2008 allotments)
that is not expended or redistributed under section 2104(f) during the period
in which such allotments are available for obligation.</text>
</subclause><subclause id="HC5752CBE83904B4385FA9BE421F3FED"><enum>(III)</enum><header>Excess child
enrollment contingency funds</header><text>As of October 1 of each of fiscal
years 2010 through 2013, any amount in excess of the aggregate cap applicable
to the Child Enrollment Contingency Fund for the fiscal year under section
2104(n).</text>
</subclause><subclause commented="no" id="H6051A9BEEAFF4FF090044B2DBCA2F6E7"><enum>(IV)</enum><header>Unexpended
transitional coverage block grant for nonpregnant childless
adults</header><text>As of October 1, 2011, any amounts set aside under section
2111(a)(3) that are not expended by September 30, 2011.</text>
</subclause></clause><clause id="H7A73608A66A746F69F5DD24C33CD358"><enum>(iii)</enum><header>Proportional
reduction</header><text>If the sum of the amounts otherwise payable under this
paragraph for a fiscal year exceeds the amount available for the fiscal year
under this subparagraph, the amount to be paid under this paragraph to each
State shall be reduced proportionally.</text>
</clause></subparagraph><subparagraph commented="no" id="H42C44D09D4E844F2B33340088DC68003"><enum>(F)</enum><header>Qualifying
children defined</header>
<clause commented="no" id="idF15DD9B29A334260A81E6B8A597B7AFF"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">For purposes of this
subsection, subject to clauses (ii) and (iii), the term <term>qualifying
children</term> means children who meet the eligibility criteria (including
income, categorical eligibility, age, and immigration status criteria) in
effect as of July 1, 2008, for enrollment under title XIX, taking into account
criteria applied as of such date under title XIX pursuant to a waiver under
section 1115.</text>
</clause><clause commented="no" id="id682D2C21440B46E39A814531D9550C71"><enum>(ii)</enum><header>Limitation</header><text>A
child described in clause (i) who is provided medical assistance during a
presumptive eligibility period under section 1920A shall be considered to be a
<term>qualifying child</term> only if the child is determined to be eligible
for medical assistance under title XIX.</text>
</clause><clause commented="no" id="idECA4DA52B3804AE2938A9E21029FC443"><enum>(iii)</enum><header>Exclusion</header><text display-inline="yes-display-inline">Such term does not include any children for
whom the State has made an election to provide medical assistance under
paragraph (4) of section 1903(v).</text>
</clause></subparagraph><subparagraph id="H34DEBEDC9BC44C4B90980711D6EF13D0"><enum>(G)</enum><header>Application to
commonwealths and territories</header><text>The provisions of subparagraph (G)
of section 2104(n)(3) shall apply with respect to payment under this paragraph
in the same manner as such provisions apply to payment under such
section.</text>
</subparagraph><subparagraph commented="no" id="HA00940FF157F4DEB92FB9D4161ED3F5B"><enum>(H)</enum><header> Application to
states that implement a Medicaid expansion for children after fiscal year
2008</header><text>In the case of a State that provides coverage under section
115 of the Children’s Health Insurance Program Reauthorization Act of 2009 for
any fiscal year after fiscal year 2008—</text>
<clause commented="no" id="H3899021BB4EB40DDB0931E8827B5D456"><enum>(i)</enum><text>any child enrolled
in the State plan under title XIX through the application of such an election
shall be disregarded from the determination for the State of the monthly
average unduplicated number of qualifying children enrolled in such plan during
the first 3 fiscal years in which such an election is in effect; and</text>
</clause><clause commented="no" id="H67CA348FC8114025A2C40084CF6CA892"><enum>(ii)</enum><text>in determining
the baseline number of child enrollees for the State for any fiscal year
subsequent to such first 3 fiscal years, the baseline number of child enrollees
for the State under title XIX for the third of such fiscal years shall be the
monthly average unduplicated number of qualifying children enrolled in the
State plan under title XIX for such third fiscal year.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="H0B4AFEC0DA40426D8C2049BBD7CB7F86"><enum>(4)</enum><header>Enrollment and
retention provisions for children</header><text display-inline="yes-display-inline">For purposes of paragraph (3)(A), a State
meets the condition of this paragraph for a fiscal year if it is implementing
at least 5 of the following enrollment and retention provisions (treating each
subparagraph as a separate enrollment and retention provision) throughout the
entire fiscal year:</text>
<subparagraph commented="no" id="H5727B0541BF04CF780131D5B8D3E1432"><enum>(A)</enum><header>Continuous
eligibility</header><text display-inline="yes-display-inline">The State has
elected the option of continuous eligibility for a full 12 months for all
children described in section 1902(e)(12) under title XIX under 19 years of
age, as well as applying such policy under its State child health plan under
this title.</text>
</subparagraph><subparagraph commented="no" id="H47A2EBEFB0754E0A8F57FF8365A59493"><enum>(B)</enum><header>Liberalization
of asset requirements</header><text>The State meets the requirement specified
in either of the following clauses:</text>
<clause commented="no" id="HFC2FCE94BBEE41F9A7006065269100E7"><enum>(i)</enum><header>Elimination of
asset test</header><text display-inline="yes-display-inline">The State does not
apply any asset or resource test for eligibility for children under title XIX
or this title.</text>
</clause><clause commented="no" id="HB3DC7026576244B8A16DA339BEEF9570"><enum>(ii)</enum><header>Administrative
verification of assets</header><text>The State—</text>
<subclause commented="no" id="HFCE07D5874A34FC2B87D0000C6F99111"><enum>(I)</enum><text display-inline="yes-display-inline">permits a parent or caretaker relative who
is applying on behalf of a child for medical assistance under title XIX or
child health assistance under this title to declare and certify by signature
under penalty of perjury information relating to family assets for purposes of
determining and redetermining financial eligibility; and</text>
</subclause><subclause commented="no" id="HB601AC5741294D7196C923AA9C7E377E"><enum>(II)</enum><text>takes steps to
verify assets through means other than by requiring documentation from parents
and applicants except in individual cases of discrepancies or where otherwise
justified.</text>
</subclause></clause></subparagraph><subparagraph commented="no" id="H14FFA8A68EF24F13B28FDEA119E5D615"><enum>(C)</enum><header>Elimination of
in-person interview requirement</header><text display-inline="yes-display-inline">The State does not require an application
of a child for medical assistance under title XIX (or for child health
assistance under this title), including an application for renewal of such
assistance, to be made in person nor does the State require a face-to-face
interview, unless there are discrepancies or individual circumstances
justifying an in-person application or face-to-face interview.</text>
</subparagraph><subparagraph commented="no" id="H53725A0327C544FFBED7F2B79121F4C2"><enum>(D)</enum><header>Use of joint
application for medicaid and CHIP</header><text display-inline="yes-display-inline">The application form and supplemental forms
(if any) and information verification process is the same for purposes of
establishing and renewing eligibility for children for medical assistance under
title XIX and child health assistance under this title.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H0DBF97DF493B4BDB89B5CE571964C11"><enum>(E)</enum><header display-inline="yes-display-inline">Automatic renewal (use of administrative
renewal)</header>
<clause commented="no" id="H28C04CEBACD2441092AD6DC6BE270010"><enum>(i)</enum><header>In
general</header><text>The State provides, in the case of renewal of a child’s
eligibility for medical assistance under title XIX or child health assistance
under this title, a pre-printed form completed by the State based on the
information available to the State and notice to the parent or caretaker
relative of the child that eligibility of the child will be renewed and
continued based on such information unless the State is provided other
information. Nothing in this clause shall be construed as preventing a State
from verifying, through electronic and other means, the information so
provided.</text>
</clause><clause commented="no" id="H02140983E36E490E933263D6423FB6D3"><enum>(ii)</enum><header>Satisfaction
through demonstrated use of ex parte process</header><text>A State shall be
treated as satisfying the requirement of clause (i) if renewal of eligibility
of children under title XIX or this title is determined without any requirement
for an in-person interview, unless sufficient information is not in the State’s
possession and cannot be acquired from other sources (including other State
agencies) without the participation of the applicant or the applicant’s parent
or caretaker relative.</text>
</clause></subparagraph><subparagraph commented="no" id="HE55162B7EE0E46C8B5A3A32EDBFE85BE"><enum>(F)</enum><header>Presumptive
eligibility for children</header><text>The State is implementing section 1920A
under title XIX as well as, pursuant to section 2107(e)(1), under this
title.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H8F0BF12F71044E9D902DEBC0D4F9DAA1"><enum>(G)</enum><header>Express
lane</header><text>The State is implementing the option described in section
1902(e)(13) under title XIX as well as, pursuant to section 2107(e)(1), under
this title.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HC5A311768A0049249C9C956CB19F5362"><enum>(H)</enum><header display-inline="yes-display-inline">Premium assistance subsidies</header><text display-inline="yes-display-inline">The State is implementing the option of
providing premium assistance subsidies under section 2105(c)(10) or section
1906A.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section display-inline="no-display-inline" id="H70C5317F5D9B4CB598B6F77BD13505A0" section-type="subsequent-section"><enum>105.</enum><header>Two-year initial
availability of CHIP allotments</header><text display-inline="no-display-inline">Section 2104(e) (42 U.S.C. 1397dd(e)) is
amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="HD400ED3CE45D4A7E81768E6576B522C9" style="OLC">
<subsection id="HE6A1C8F141F349B983FD4E6E5FC6E07C"><enum>(e)</enum><header>Availability of
amounts allotted</header>
<paragraph id="H0FD0BA6DCEA64409A1E7CA87E6465974"><enum>(1)</enum><header>In
general</header><text>Except as provided in paragraph (2), amounts allotted to
a State pursuant to this section—</text>
<subparagraph id="HD3D3A02EF4CB4630AF2396003CA20584"><enum>(A)</enum><text>for each of fiscal
years 1998 through 2008, shall remain available for expenditure by the State
through the end of the second succeeding fiscal year; and</text>
</subparagraph><subparagraph id="H75AAD5FFB482456BA99285EC08E97813"><enum>(B)</enum><text>for fiscal year
2009 and each fiscal year thereafter, shall remain available for expenditure by
the State through the end of the succeeding fiscal year.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H62CB165D4C3140D4A97C2E3B3C0582FF"><enum>(2)</enum><header>Availability of
amounts redistributed</header><text>Amounts redistributed to a State under
subsection (f) shall be available for expenditure by the State through the end
of the fiscal year in which they are
redistributed.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="HF8594B687E974CFF94AD698BCB155B36"><enum>106.</enum><header>Redistribution
of unused allotments</header>
<subsection id="H3D33D450D8B846099E1D5209093B1833"><enum>(a)</enum><header>Beginning with
fiscal year 2007</header>
<paragraph id="H01A33F3EA449445B9B798220F2F6B99E"><enum>(1)</enum><header>In
general</header><text>Section 2104(f) (42 U.S.C. 1397dd(f)) is amended—</text>
<subparagraph id="H27A28B54488A4F4DB619CF1307F70086"><enum>(A)</enum><text>by striking
<quote>The Secretary</quote> and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="H2A4A84E8C9284D6CBA1E309CBA6E4E00" style="OLC">
<paragraph id="H12491204A99641CD98E2802F30145E9"><enum>(1)</enum><header>In
general</header><text>The
Secretary</text>
</paragraph><after-quoted-block>;</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="HE5DA987F3BF04520A1C8B300C58C32E7"><enum>(B)</enum><text>by striking
<quote>States that have fully expended the amount of their allotments under
this section.</quote> and inserting <quote>States that the Secretary determines
with respect to the fiscal year for which unused allotments are available for
redistribution under this subsection, are shortfall States described in
paragraph (2) for such fiscal year, but not to exceed the amount of the
shortfall described in paragraph (2)(A) for each such State (as may be adjusted
under paragraph (2)(C)).</quote>; and</text>
</subparagraph><subparagraph id="HE2C364880CDE4A18BF6F7FF828C11C4C"><enum>(C)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HF9867AE35B7E400EBDE36173F0A59577" style="OLC">
<paragraph id="H46F5218DFC6A4DC8AFE5D0325C9C923"><enum>(2)</enum><header>Shortfall states
described</header>
<subparagraph id="H414E77CB3571451E9BBC5B35A98B9C89"><enum>(A)</enum><header>In
general</header><text>For purposes of paragraph (1), with respect to a fiscal
year, a shortfall State described in this subparagraph is a State with a State
child health plan approved under this title for which the Secretary estimates
on the basis of the most recent data available to the Secretary, that the
projected expenditures under such plan for the State for the fiscal year will
exceed the sum of—</text>
<clause id="H6493E8D781F242859C6DABD121F4DBE4"><enum>(i)</enum><text>the amount of the
State’s allotments for any preceding fiscal years that remains available for
expenditure and that will not be expended by the end of the immediately
preceding fiscal year;</text>
</clause><clause id="H113539484ACA4C21A681C544B55FF728"><enum>(ii)</enum><text display-inline="yes-display-inline">the amount (if any) of the child enrollment
contingency fund payment under subsection (n); and</text>
</clause><clause id="H4D42E459A0244A509F687842DFAD34C5"><enum>(iii)</enum><text>the amount of
the State’s allotment for the fiscal year.</text>
</clause></subparagraph><subparagraph id="H89C5B3A11FB148A185D977D9ABA66EFA"><enum>(B)</enum><header>Proration
rule</header><text>If the amounts available for redistribution under paragraph
(1) for a fiscal year are less than the total amounts of the estimated
shortfalls determined for the year under subparagraph (A), the amount to be
redistributed under such paragraph for each shortfall State shall be reduced
proportionally.</text>
</subparagraph><subparagraph id="H36ADEBFA6D834273A5E6004BBC1796E2"><enum>(C)</enum><header>Retrospective
adjustment</header><text>The Secretary may adjust the estimates and
determinations made under paragraph (1) and this paragraph with respect to a
fiscal year as necessary on the basis of the amounts reported by States not
later than November 30 of the succeeding fiscal year, as approved by the
Secretary.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HF3CA32A9648948BCB53084EE0C15803"><enum>(2)</enum><header>Effective
date</header><text>The amendments made by paragraph (1) shall apply to
redistribution of allotments made for fiscal year 2007 and subsequent fiscal
years.</text>
</paragraph></subsection><subsection id="HD7640F1F678049DFB63D3F0091BA595C"><enum>(b)</enum><header>Redistribution
of unused allotments for fiscal year 2006</header><text display-inline="yes-display-inline">Section 2104(k) (42 U.S.C. 1397dd(k)) is
amended—</text>
<paragraph id="HDAE530AEE3B542D4AD7CC887D6F3232"><enum>(1)</enum><text>in
the subsection heading, by striking “<header-in-text level="subsection" style="OLC">the First 2 Quarters of</header-in-text>”;</text>
</paragraph><paragraph id="H8199577D22C44655B73700EF1DA50092"><enum>(2)</enum><text>in paragraph (1),
by striking “the first 2 quarters of”; and</text>
</paragraph><paragraph id="HC0CC8111EA76462C9029C89D634DB8F"><enum>(3)</enum><text>in
paragraph (6)—</text>
<subparagraph id="HB98F21B4DD84416DA635A1291FD89670"><enum>(A)</enum><text>by striking “the
first 2 quarters of”; and</text>
</subparagraph><subparagraph id="H951D3E6E47A04833A1ACDE6D4B613ED6"><enum>(B)</enum><text>by striking “March
31” and inserting “September 30”.</text>
</subparagraph></paragraph></subsection></section><section display-inline="no-display-inline" id="H6B0A7B0A57E645A1B9CDF2EADC6480" section-type="subsequent-section"><enum>107.</enum><header>Option for
qualifying States to receive the enhanced portion of the CHIP matching rate for
Medicaid coverage of certain children</header>
<subsection id="H4D58DC791BA3438F83CF88C8C000F924"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 2105(g) (42
U.S.C. 1397ee(g)) is amended—</text>
<paragraph id="HC004DE3C7DC448008E19805D988CB174"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (1)(A), as amended by section
201(b)(1) of Public Law 110–173—</text>
<subparagraph id="H8DCAD25962084C3D9102D815F5C1C793"><enum>(A)</enum><text display-inline="yes-display-inline">by inserting <quote>subject to paragraph
(4),</quote> after <quote>Notwithstanding any other provision of law,</quote>;
and</text>
</subparagraph><subparagraph id="HEC52DF696F3446E499C1B3C6CDAD91EF"><enum>(B)</enum><text>by striking
<quote>2008, or 2009</quote> and inserting <quote>or 2008</quote>; and</text>
</subparagraph></paragraph><paragraph id="HDAC3FD36BF7649CDAA58EB36DDE6F099"><enum>(2)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block id="H9A9F6E916F1C404598BCCC058E03EC38" style="OLC">
<paragraph id="HCDDD4CDDB2544AC1BA562709D0F33460"><enum>(4)</enum><header>Option for
allotments for fiscal years 2009 through 2013</header>
<subparagraph id="H42577AC6787D42C999B4F5001FABFB5F"><enum>(A)</enum><header>Payment of
enhanced portion of matching rate for certain expenditures</header><text>In the
case of expenditures described in subparagraph (B), a qualifying State (as
defined in paragraph (2)) may elect to be paid from the State’s allotment made
under section 2104 for any of fiscal years 2009 through 2013 (insofar as the
allotment is available to the State under subsections (e) and (m) of such
section) an amount each quarter equal to the additional amount that would have
been paid to the State under title XIX with respect to such expenditures if the
enhanced FMAP (as determined under subsection (b)) had been substituted for the
Federal medical assistance percentage (as defined in section 1905(b)).</text>
</subparagraph><subparagraph id="H042BCB7FDCC14013BAC45E34F7822D92"><enum>(B)</enum><header>Expenditures
described</header><text>For purposes of subparagraph (A), the expenditures
described in this subparagraph are expenditures made after the date of the
enactment of this paragraph and during the period in which funds are available
to the qualifying State for use under subparagraph (A), for the provision of
medical assistance to individuals residing in the State who are eligible for
medical assistance under the State plan under title XIX or under a waiver of
such plan and who have not attained age 19 (or, if a State has so elected under
the State plan under title XIX, age 20 or 21), and whose family income equals
or exceeds 133 percent of the poverty line but does not exceed the Medicaid
applicable income
level.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H8C85424D563148B40000BD34D631CD92"><enum>(b)</enum><header>Repeal of
limitation on availability of fiscal year 2009 allotments</header><text display-inline="yes-display-inline">Paragraph (2) of section 201(b) of the
Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) is
repealed.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="HF30659BC9C964C6EBBEF2219E628EDF9" section-type="subsequent-section"><enum>108.</enum><header>One-time
appropriation</header><text display-inline="no-display-inline">There is
appropriated to the Secretary, out of any money in the Treasury not otherwise
appropriated, $11,706,000,000 to accompany the allotment made for the period
beginning on October 1, 2012, and ending on March 31, 2013, under section
2104(a)(16)(A) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (42 U.S.C. 1397dd(a)(16)(A)) (as added by section 101), to
remain available until expended. Such amount shall be used to provide
allotments to States under paragraph (3) of section 2104(m) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1397dd(i)), as added by section 102, for the first 6 months of fiscal year 2013
in the same manner as allotments are provided under subsection (a)(16)(A) of
such section 2104 and subject to the same terms and conditions as apply to the
allotments provided from such subsection (a)(16)(A).</text>
</section><section commented="no" id="H6C95144194264024848BB34CBBA757D3"><enum>109.</enum><header>Improving
funding for the territories under CHIP and Medicaid</header><text display-inline="no-display-inline">Section 1108(g) (42 U.S.C. 1308(g)) is
amended by adding at the end the following new paragraph:</text>
<quoted-block id="HE77291E5E9D0423D93BF7896FA3F2167" style="OLC">
<paragraph commented="no" id="H4C0E75CD285348E0BEFD8D443ED91742"><enum>(4)</enum><header>Exclusion of
certain expenditures from payment limits</header><text>With respect to fiscal
years beginning with fiscal year 2009, if Puerto Rico, the Virgin Islands,
Guam, the Northern Mariana Islands, or American Samoa qualify for a payment
under subparagraph (A)(i), (B), or (F) of section 1903(a)(3) for a calendar
quarter of such fiscal year, the payment shall not be taken into account in
applying subsection (f) (as increased in accordance with paragraphs (1), (2),
and (3) of this subsection) to such commonwealth or territory for such fiscal
year.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section></subtitle><subtitle id="idB5285D1BEE614265BFBE95A0668E14F2"><enum>B</enum><header>Focus on
Low-Income Children and Pregnant Women</header>
<section id="H2840FF0091FB423095EB454ED3CDC586"><enum>111.</enum><header>State option to
cover low-income pregnant women under CHIP through a State plan
amendment</header>
<subsection id="HED2606D4FAF0497100D400EA9BD3E692"><enum>(a)</enum><header>In
General</header><text>Title XXI (42 U.S.C. 1397aa et seq.), as amended by
section 112(a), is amended by adding at the end the following new
section:</text>
<quoted-block display-inline="no-display-inline" id="H3B6407D4407646DC8E76924E3B05B9EC" style="OLC">
<section id="HFFD2FDDB4F184DE5944231CE4E2B89B9"><enum>2112.</enum><header>Optional
coverage of targeted low-income pregnant women through a State plan
amendment</header>
<subsection id="HF1A8732C79934062A0BCA22E64D0043"><enum>(a)</enum><header>In
General</header><text>Subject to the succeeding provisions of this section, a
State may elect through an amendment to its State child health plan under
section 2102 to provide pregnancy-related assistance under such plan for
targeted low-income pregnant women.</text>
</subsection><subsection id="H5334ED3885454C4B8BB844572CBF19F9"><enum>(b)</enum><header>Conditions</header><text>A
State may only elect the option under subsection (a) if the following
conditions are satisfied:</text>
<paragraph id="H3CFD548B11B14C9A973C90904614B48D"><enum>(1)</enum><header>Minimum income
eligibility levels for pregnant women and children</header><text>The State has
established an income eligibility level—</text>
<subparagraph id="HC8B8F588E3114E7400F84FD08ED1FCEE"><enum>(A)</enum><text>for pregnant women
under subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of section
1902 that is at least 185 percent (or such higher percent as the State has in
effect with regard to pregnant women under this title) of the poverty line
applicable to a family of the size involved, but in no case lower than the
percent in effect under any such subsection as of July 1, 2008; and</text>
</subparagraph><subparagraph id="H64F159C3492B4D198872426EA692001D"><enum>(B)</enum><text display-inline="yes-display-inline">for children under 19 years of age under
this title (or title XIX) that is at least 200 percent of the poverty line
applicable to a family of the size involved.</text>
</subparagraph></paragraph><paragraph id="H7D24F1D3307F4E9E8F3D00E6457BECAE"><enum>(2)</enum><header>No chip income
eligibility level for pregnant women lower than the state’s medicaid
level</header><text>The State does not apply an effective income level for
pregnant women under the State plan amendment that is lower than the effective
income level (expressed as a percent of the poverty line and considering
applicable income disregards) specified under subsection (a)(10)(A)(i)(III),
(a)(10)(A)(i)(IV), or (l)(1)(A) of section 1902, on the date of enactment of
this paragraph to be eligible for medical assistance as a pregnant
woman.</text>
</paragraph><paragraph id="H8B484F311A92435E90F4C045C22EEED"><enum>(3)</enum><header>No coverage for
higher income pregnant women without covering lower income pregnant
women</header><text>The State does not provide coverage for pregnant women with
higher family income without covering pregnant women with a lower family
income.</text>
</paragraph><paragraph id="HF6A8F87707CF481B005874FE6C00BF7E"><enum>(4)</enum><header>Application of
requirements for coverage of targeted low-income children</header><text>The
State provides pregnancy-related assistance for targeted low-income pregnant
women in the same manner, and subject to the same requirements, as the State
provides child health assistance for targeted low-income children under the
State child health plan, and in addition to providing child health assistance
for such women.</text>
</paragraph><paragraph id="H2C672566BD6D41C2BBAA9E4943A6886D"><enum>(5)</enum><header>No preexisting
condition exclusion or waiting period</header><text>The State does not apply
any exclusion of benefits for pregnancy-related assistance based on any
preexisting condition or any waiting period (including any waiting period
imposed to carry out section 2102(b)(3)(C)) for receipt of such
assistance.</text>
</paragraph><paragraph id="H15769C1CEB07423083A6D5D29F180000"><enum>(6)</enum><header>Application of
cost-sharing protection</header><text>The State provides pregnancy-related
assistance to a targeted low-income woman consistent with the cost-sharing
protections under section 2103(e) and applies the limitation on total annual
aggregate cost sharing imposed under paragraph (3)(B) of such section to the
family of such a woman.</text>
</paragraph><paragraph commented="no" id="HD5B5A24ECD324B0C8583126291E1307"><enum>(7)</enum><header>No waiting list
for children</header><text display-inline="yes-display-inline">The State does
not impose, with respect to the enrollment under the State child health plan of
targeted low-income children during the quarter, any enrollment cap or other
numerical limitation on enrollment, any waiting list, any procedures designed
to delay the consideration of applications for enrollment, or similar
limitation with respect to enrollment.</text>
</paragraph></subsection><subsection id="HBD8B83EF32EA4523A310A95F974BBC82"><enum>(c)</enum><header>Option To
Provide Presumptive Eligibility</header><text>A State that elects the option
under subsection (a) and satisfies the conditions described in subsection (b)
may elect to apply section 1920 (relating to presumptive eligibility for
pregnant women) to the State child health plan in the same manner as such
section applies to the State plan under title XIX.</text>
</subsection><subsection id="H45C8E911F24847D6B69DB100F2217C8D"><enum>(d)</enum><header>Definitions</header><text>For
purposes of this section:</text>
<paragraph id="H3ADA2ACE09A04611B3265C24BCEB2DCB"><enum>(1)</enum><header>Pregnancy-related
assistance</header><text>The term <term>pregnancy-related assistance</term> has
the meaning given the term <term>child health assistance</term> in section
2110(a) with respect to an individual during the period described in paragraph
(2)(A).</text>
</paragraph><paragraph id="H0FE39E99B11C49DA82302198E7C1933D"><enum>(2)</enum><header>Targeted
low-income pregnant woman</header><text>The term <term>targeted low-income
pregnant woman</term> means an individual—</text>
<subparagraph id="H34CF3B08F6C34687BB97BD9D54BAC0DD"><enum>(A)</enum><text>during pregnancy
and through the end of the month in which the 60-day period (beginning on the
last day of her pregnancy) ends;</text>
</subparagraph><subparagraph id="HD991AD4E5BFA43F4885018A23C03FE95"><enum>(B)</enum><text>whose family
income exceeds 185 percent (or, if higher, the percent applied under subsection
(b)(1)(A)) of the poverty line applicable to a family of the size involved, but
does not exceed the income eligibility level established under the State child
health plan under this title for a targeted low-income child; and</text>
</subparagraph><subparagraph id="H3575985FD7034C5F8F3E63AE4D83ABDD"><enum>(C)</enum><text>who satisfies the
requirements of paragraphs (1)(A), (1)(C), (2), and (3) of section 2110(b) in
the same manner as a child applying for child health assistance would have to
satisfy such requirements.</text>
</subparagraph></paragraph></subsection><subsection id="H15A7A18A4262423D9B9E1E01F800656B"><enum>(e)</enum><header>Automatic
Enrollment for Children Born to Women Receiving Pregnancy-Related
Assistance</header><text>If a child is born to a targeted low-income pregnant
woman who was receiving pregnancy-related assistance under this section on the
date of the child’s birth, the child shall be deemed to have applied for child
health assistance under the State child health plan and to have been found
eligible for such assistance under such plan or to have applied for medical
assistance under title XIX and to have been found eligible for such assistance
under such title, as appropriate, on the date of such birth and to remain
eligible for such assistance until the child attains 1 year of age. During the
period in which a child is deemed under the preceding sentence to be eligible
for child health or medical assistance, the child health or medical assistance
eligibility identification number of the mother shall also serve as the
identification number of the child, and all claims shall be submitted and paid
under such number (unless the State issues a separate identification number for
the child before such period expires).</text>
</subsection><subsection id="H95FB0D38B28A4444B4D006F7BE2160DC"><enum>(f)</enum><header>States Providing
Assistance Through Other Options</header>
<paragraph id="HCE78696DAB0C478EBD11FB9BBB74743"><enum>(1)</enum><header>Continuation of
other options for providing assistance</header><text>The option to provide
assistance in accordance with the preceding subsections of this section shall
not limit any other option for a State to provide—</text>
<subparagraph id="H05F23D7BAA0C484EBF002C00C3D18E3"><enum>(A)</enum><text>child health
assistance through the application of sections 457.10, 457.350(b)(2),
457.622(c)(5), and 457.626(a)(3) of title 42, Code of Federal Regulations (as
in effect after the final rule adopted by the Secretary and set forth at 67
Fed. Reg. 61956–61974 (October 2, 2002)), or</text>
</subparagraph><subparagraph id="H6EC733258A194DFB9370405044C64696"><enum>(B)</enum><text>pregnancy-related
services through the application of any waiver authority (as in effect on June
1, 2008).</text>
</subparagraph></paragraph><paragraph id="H8CACE66A470D4EC1AB89007B00F28C32"><enum>(2)</enum><header>Clarification of
authority to provide postpartum services</header><text>Any State that provides
child health assistance under any authority described in paragraph (1) may
continue to provide such assistance, as well as postpartum services, through
the end of the month in which the 60-day period (beginning on the last day of
the pregnancy) ends, in the same manner as such assistance and postpartum
services would be provided if provided under the State plan under title XIX,
but only if the mother would otherwise satisfy the eligibility requirements
that apply under the State child health plan (other than with respect to age)
during such period.</text>
</paragraph><paragraph id="HFB9D8955C7C4453CB827F683A9449549"><enum>(3)</enum><header>No
inference</header><text>Nothing in this subsection shall be construed—</text>
<subparagraph id="HCDDBA65863DB4CC1A854149CC88C5632"><enum>(A)</enum><text>to infer
congressional intent regarding the legality or illegality of the content of the
sections specified in paragraph (1)(A); or</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H7A33647634D2458FBEF822094D32C0B8"><enum>(B)</enum><text>to modify the
authority to provide pregnancy-related services under a waiver specified in
paragraph
(1)(B).</text>
</subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HF01444162D2B413081DFF18C25410000"><enum>(b)</enum><header>Additional
Conforming Amendments</header>
<paragraph id="H51E923AAE21C4575A236A517D13C0864"><enum>(1)</enum><header>No cost sharing
for pregnancy-related benefits</header><text>Section 2103(e)(2) (42 U.S.C.
1397cc(e)(2)) is amended—</text>
<subparagraph id="H9AB1CD061B6C4900883D614D266E2F00"><enum>(A)</enum><text>in the heading, by
inserting <quote><header-in-text>or pregnancy-related
assistance</header-in-text></quote> after <quote><header-in-text>preventive
services</header-in-text></quote>; and</text>
</subparagraph><subparagraph id="H7E6E828A80DE462CA8F24703F3386CB4"><enum>(B)</enum><text>by inserting
before the period at the end the following: <quote>or for pregnancy-related
assistance</quote>.</text>
</subparagraph></paragraph><paragraph id="H926ABC06A79343149E3F0198AC245014"><enum>(2)</enum><header>No waiting
period</header><text>Section 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is
amended—</text>
<subparagraph id="H02B62100CCD64B6CB3E868326953A66"><enum>(A)</enum><text>in clause (i), by
striking <quote>, and</quote> at the end and inserting a semicolon;</text>
</subparagraph><subparagraph id="H6621CA36F15B4FBDA80000693B221BE8"><enum>(B)</enum><text>in clause (ii), by
striking the period at the end and inserting <quote>; and</quote>; and</text>
</subparagraph><subparagraph id="H50CB9D37B40441AB8430F506C24EAA57"><enum>(C)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block id="H5FFC27EAC1354B7D8F491EAAF528CB4C" style="OLC">
<clause id="H9E647480ECB142DFAA574EE8012692D1"><enum>(iii)</enum><text>may not apply a
waiting period (including a waiting period to carry out paragraph (3)(C)) in
the case of a targeted low-income pregnant woman provided pregnancy-related
assistance under section
2112.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection></section><section display-inline="no-display-inline" id="HD8A68D128EC34D60888257DB5C10742C" section-type="subsequent-section"><enum>112.</enum><header>Phase-out of
coverage for nonpregnant childless adults under CHIP; conditions for coverage
of parents</header>
<subsection id="HD04B98ECDC0444CD89CDD0ECAE8F00EB"><enum>(a)</enum><header>Phase-Out
Rules</header>
<paragraph id="H0346A5DB3EF7484C8041AAD9409D6F50"><enum>(1)</enum><header>In
general</header><text>Title XXI (42 U.S.C. 1397aa et seq.) is amended by adding
at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="HD874DBD307064599AE2E17B3EAA3EBF6" style="OLC">
<section id="H899E40DE58CE4CAD973F00FF9118DBD1"><enum>2111.</enum><header>Phase-Out of
coverage for nonpregnant childless adults; conditions for coverage of
parents</header>
<subsection id="HB3A2CB41C9E84D669C08117B00D95F5E"><enum>(a)</enum><header>Termination of
Coverage for Nonpregnant Childless Adults</header>
<paragraph id="H412479FDE12842988FC8C4C968C69ED7"><enum>(1)</enum><header>No new chip
waivers; automatic extensions at state option through
2009</header><text>Notwithstanding section 1115 or any other provision of this
title, except as provided in this subsection—</text>
<subparagraph id="H7DC220E514B74DD3AB00C6E145AF38A"><enum>(A)</enum><text>the Secretary shall
not on or after the date of the enactment of the Children’s Health Insurance
Program Reauthorization Act of 2009, approve or renew a waiver, experimental,
pilot, or demonstration project that would allow funds made available under
this title to be used to provide child health assistance or other health
benefits coverage to a nonpregnant childless adult; and</text>
</subparagraph><subparagraph id="H56A42DB24E794D8F9315E795C0431F46"><enum>(B)</enum><text>notwithstanding
the terms and conditions of an applicable existing waiver, the provisions of
paragraph (2) shall apply for purposes of any period beginning on or after
January 1, 2010, in determining the period to which the waiver applies, the
individuals eligible to be covered by the waiver, and the amount of the Federal
payment under this title.</text>
</subparagraph></paragraph><paragraph id="HEFF3C6019C2442C0B8339C06985F9802"><enum>(2)</enum><header>Termination of
chip coverage under applicable existing waivers at the end of 2009</header>
<subparagraph id="HF5E91ABA5B7E40A4ADF51179ED49469F"><enum>(A)</enum><header>In
general</header><text>No funds shall be available under this title for child
health assistance or other health benefits coverage that is provided to a
nonpregnant childless adult under an applicable existing waiver after December
31, 2009.</text>
</subparagraph><subparagraph id="H9DAF8056CA8748A1BAC9ABDB6FA31363"><enum>(B)</enum><header>Extension upon
state request</header><text>If an applicable existing waiver described in
subparagraph (A) would otherwise expire before January 1, 2010, notwithstanding
the requirements of subsections (e) and (f) of section 1115, a State may
submit, not later than September 30, 2009, a request to the Secretary for an
extension of the waiver. The Secretary shall approve a request for an extension
of an applicable existing waiver submitted pursuant to this subparagraph, but
only through December 31, 2009.</text>
</subparagraph><subparagraph id="HC75D761CB50B486E83BD2C0900B9D46"><enum>(C)</enum><header>Application of
enhanced fmap</header><text>The enhanced FMAP determined under section 2105(b)
shall apply to expenditures under an applicable existing waiver for the
provision of child health assistance or other health benefits coverage to a
nonpregnant childless adult during the period beginning on the date of the
enactment of this subsection and ending on December 31, 2009.</text>
</subparagraph></paragraph><paragraph id="HAB2F115D62844AF999A7008C44D578B3"><enum>(3)</enum><header>State option to
apply for medicaid waiver to continue coverage for nonpregnant childless
adults</header>
<subparagraph id="HB6D58C94E1414941A78D16C55258C900"><enum>(A)</enum><header>In
general</header><text>Each State for which coverage under an applicable
existing waiver is terminated under paragraph (2)(A) may submit, not later than
September 30, 2009, an application to the Secretary for a waiver under section
1115 of the State plan under title XIX to provide medical assistance to a
nonpregnant childless adult whose coverage is so terminated (in this subsection
referred to as a <quote>Medicaid nonpregnant childless adults
waiver</quote>).</text>
</subparagraph><subparagraph id="HE8DEBB73DD0C4D0B8F704891E6C169DC"><enum>(B)</enum><header>Deadline for
approval</header><text>The Secretary shall make a decision to approve or deny
an application for a Medicaid nonpregnant childless adults waiver submitted
under subparagraph (A) within 90 days of the date of the submission of the
application. If no decision has been made by the Secretary as of December 31,
2009, on the application of a State for a Medicaid nonpregnant childless adults
waiver that was submitted to the Secretary by September 30, 2009, the
application shall be deemed approved.</text>
</subparagraph><subparagraph id="H2106155A831C4F5694A1735A585F7DF"><enum>(C)</enum><header>Standard for
budget neutrality</header><text>The budget neutrality requirement applicable
with respect to expenditures for medical assistance under a Medicaid
nonpregnant childless adults waiver shall—</text>
<clause id="H9FDA2F70B10B4B4EA6B4D53494B4FB3"><enum>(i)</enum><text>in
the case of fiscal year 2010, allow expenditures for medical assistance under
title XIX for all such adults to not exceed the total amount of payments made
to the State under paragraph (2)(B) for fiscal year 2009, increased by the
percentage increase (if any) in the projected nominal per capita amount of
National Health Expenditures for 2010 over 2009, as most recently published by
the Secretary; and</text>
</clause><clause id="H7C5E5A8CB92746D5A6E7B10A13DFA92"><enum>(ii)</enum><text>in
the case of any succeeding fiscal year, allow such expenditures to not exceed
the amount in effect under this subparagraph for the preceding fiscal year,
increased by the percentage increase (if any) in the projected nominal per
capita amount of National Health Expenditures for the calendar year that begins
during the year involved over the preceding calendar year, as most recently
published by the Secretary.</text>
</clause></subparagraph></paragraph></subsection><subsection id="H33071F7C13864EC481E608A4E05222A4"><enum>(b)</enum><header>Rules and
Conditions for Coverage of Parents of Targeted Low-Income Children</header>
<paragraph id="H7B163B4A3D3946A2A100F8D41F8F9CDA"><enum>(1)</enum><header>Two-year period;
automatic extension at state option through fiscal year 2011</header>
<subparagraph id="HF83C12852BEC4003812FBAAE20159BA"><enum>(A)</enum><header>No new chip
waivers</header><text>Notwithstanding section 1115 or any other provision of
this title, except as provided in this subsection—</text>
<clause id="H4165A3A3DFDA4C4682FCD81568C0C459"><enum>(i)</enum><text>the Secretary
shall not on or after the date of the enactment of the Children’s Health
Insurance Program Reauthorization Act of 2009 approve or renew a waiver,
experimental, pilot, or demonstration project that would allow funds made
available under this title to be used to provide child health assistance or
other health benefits coverage to a parent of a targeted low-income child;
and</text>
</clause><clause id="HD52A85EB70324897BAC0A26E1757DB8"><enum>(ii)</enum><text>notwithstanding
the terms and conditions of an applicable existing waiver, the provisions of
paragraphs (2) and (3) shall apply for purposes of any fiscal year beginning on
or after October 1, 2011, in determining the period to which the waiver
applies, the individuals eligible to be covered by the waiver, and the amount
of the Federal payment under this title.</text>
</clause></subparagraph><subparagraph id="HB3ACA5CC1C614BBA813D4399AA00F156"><enum>(B)</enum><header>Extension upon
state request</header><text>If an applicable existing waiver described in
subparagraph (A) would otherwise expire before October 1, 2011, and the State
requests an extension of such waiver, the Secretary shall grant such an
extension, but only, subject to paragraph (2)(A), through September 30,
2011.</text>
</subparagraph><subparagraph id="H7E562AC350554857BE731464BAE2F129"><enum>(C)</enum><header>Application of
enhanced fmap</header><text>The enhanced FMAP determined under section 2105(b)
shall apply to expenditures under an applicable existing waiver for the
provision of child health assistance or other health benefits coverage to a
parent of a targeted low-income child during the third and fourth quarters of
fiscal year 2009 and during fiscal years 2010 and 2011.</text>
</subparagraph></paragraph><paragraph id="H1CE910A082564C8899CEDE415C0994AE"><enum>(2)</enum><header>Rules for fiscal
years 2012 through 2013</header>
<subparagraph id="HB9E73B36918C4972A2700012C7B2F79"><enum>(A)</enum><header>Payments for
coverage limited to block grant funded from state allotment</header><text>Any
State that provides child health assistance or health benefits coverage under
an applicable existing waiver for a parent of a targeted low-income child may
elect to continue to provide such assistance or coverage through fiscal year
2012 or 2013, subject to the same terms and conditions that applied under the
applicable existing waiver, unless otherwise modified in subparagraph
(B).</text>
</subparagraph><subparagraph id="H83F2504393B54008AF4EC943EDACC85D"><enum>(B)</enum><header>Terms and
conditions</header>
<clause id="HD97B8EE00143478B918CFE4B2FB1D1D9"><enum>(i)</enum><header>Block grant set
aside from state allotment</header><text>If the State makes an election under
subparagraph (A), the Secretary shall set aside for the State for each such
fiscal year an amount equal to the Federal share of 110 percent of the State’s
projected expenditures under the applicable existing waiver for providing child
health assistance or health benefits coverage to all parents of targeted
low-income children enrolled under such waiver for the fiscal year (as
certified by the State and submitted to the Secretary by not later than August
31 of the preceding fiscal year). In the case of fiscal year 2013, the set
aside for any State shall be computed separately for each period described in
subparagraphs (A) and (B) of section 2104(a)(16) and any reduction in the
allotment for either such period under section 2104(m)(4) shall be allocated on
a pro rata basis to such set aside.</text>
</clause><clause id="HA3085D8574BB4078A5531E3E5648C688"><enum>(ii)</enum><header>Payments from
block grant</header><text>The Secretary shall pay the State from the amount set
aside under clause (i) for the fiscal year, an amount for each quarter of such
fiscal year equal to the applicable percentage determined under clause (iii) or
(iv) for expenditures in the quarter for providing child health assistance or
other health benefits coverage to a parent of a targeted low-income
child.</text>
</clause><clause id="H0B5D19F7D1414B67B213747BEA4CCADE"><enum>(iii)</enum><header>Enhanced fmap
only in fiscal year 2012 for states with significant child outreach or that
achieve child coverage benchmarks; fmap for any other states</header><text>For
purposes of clause (ii), the applicable percentage for any quarter of fiscal
year 2012 is equal to—</text>
<subclause id="H4190EFB02E934F11ADF3D1BC9DCE36E2"><enum>(I)</enum><text>the enhanced FMAP
determined under section 2105(b) in the case of a State that meets the outreach
or coverage benchmarks described in any of subparagraph (A), (B), or (C) of
paragraph (3) for fiscal year 2011; or</text>
</subclause><subclause id="H1F94CE663AB54B6FAB9FE1F3BCAA977"><enum>(II)</enum><text>the Federal
medical assistance percentage (as determined under section 1905(b) without
regard to clause (4) of such section) in the case of any other State.</text>
</subclause></clause><clause id="H0DD4E68FEC694D55AE6D5DCDC1352E73"><enum>(iv)</enum><header>Amount of
federal matching payment in 2013</header><text>For purposes of clause (ii), the
applicable percentage for any quarter of fiscal year 2013 is equal to—</text>
<subclause id="H074FB2B8C53149BEA086377E962F9881"><enum>(I)</enum><text>the REMAP
percentage if—</text>
<item id="HC26C542BA2864C72BBB654ECDB76799F"><enum>(aa)</enum><text>the
applicable percentage for the State under clause (iii) was the enhanced FMAP
for fiscal year 2012; and</text>
</item><item id="H42E9ED82C24A42F8AEA3F1688DC930BD"><enum>(bb)</enum><text>the
State met either of the coverage benchmarks described in subparagraph (B) or
(C) of paragraph (3) for fiscal year 2012; or</text>
</item></subclause><subclause id="H4F2D812F918C4931AD86EBEA4EDF3FA8"><enum>(II)</enum><text>the Federal
medical assistance percentage (as so determined) in the case of any State to
which subclause (I) does not apply.</text>
</subclause><continuation-text continuation-text-level="clause">For purposes
of subclause (I), the REMAP percentage is the percentage which is the sum of
such Federal medical assistance percentage and a number of percentage points
equal to one-half of the difference between such Federal medical assistance
percentage and such enhanced FMAP.</continuation-text></clause><clause id="H1ABCCDEA3FCE4A4480006B818EB9A9BE"><enum>(v)</enum><header>No federal
payments other than from block grant set aside</header><text>No payments shall
be made to a State for expenditures described in clause (ii) after the total
amount set aside under clause (i) for a fiscal year has been paid to the
State.</text>
</clause><clause id="H9E777C37FDD046A1AEBF51F431AA48FD"><enum>(vi)</enum><header>No increase in
income eligibility level for parents</header><text>No payments shall be made to
a State from the amount set aside under clause (i) for a fiscal year for
expenditures for providing child health assistance or health benefits coverage
to a parent of a targeted low-income child whose family income exceeds the
income eligibility level applied under the applicable existing waiver to
parents of targeted low-income children on the date of enactment of the
Children’s Health Insurance Program Reauthorization Act of 2009.</text>
</clause></subparagraph></paragraph><paragraph id="H657AC40D9CF24C84B6ACB17B3DD6F501"><enum>(3)</enum><header>Outreach or
coverage benchmarks</header><text>For purposes of paragraph (2), the outreach
or coverage benchmarks described in this paragraph are as follows:</text>
<subparagraph id="HF85A96DFB884417C9CFAA7DE87412EC5"><enum>(A)</enum><header>Significant
child outreach campaign</header><text>The State—</text>
<clause id="H325AB640314F4FB5BD5CEE1861FF3E70"><enum>(i)</enum><text>was awarded a
grant under section 2113 for fiscal year 2011;</text>
</clause><clause id="H29366370411C415AA0583FC89EEC7BE0"><enum>(ii)</enum><text>implemented 1 or
more of the enrollment and retention provisions described in section 2105(a)(4)
for such fiscal year; or</text>
</clause><clause id="H108F3DD615E84BABBE4442088BBE00CB"><enum>(iii)</enum><text>has submitted a
specific plan for outreach for such fiscal year.</text>
</clause></subparagraph><subparagraph id="HB641714C58CB4827862F17EA612EC8DF"><enum>(B)</enum><header>High-performing
state</header><text>The State, on the basis of the most timely and accurate
published estimates of the Bureau of the Census, ranks in the lowest
<fraction>1/3</fraction> of States in terms of the State’s percentage of
low-income children without health insurance.</text>
</subparagraph><subparagraph id="H14A5C24B0BA34DE88C6426353B81D551"><enum>(C)</enum><header>State increasing
enrollment of low-income children</header><text>The State qualified for a
performance bonus payment under section 2105(a)(3)(B) for the most recent
fiscal year applicable under such section.</text>
</subparagraph></paragraph><paragraph id="H06BBDAB2BC3E43CD88A4BAD103B21E4E"><enum>(4)</enum><header>Rules of
construction</header><text>Nothing in this subsection shall be construed as
prohibiting a State from submitting an application to the Secretary for a
waiver under section 1115 of the State plan under title XIX to provide medical
assistance to a parent of a targeted low-income child that was provided child
health assistance or health benefits coverage under an applicable existing
waiver.</text>
</paragraph></subsection><subsection id="H1DACCDF0CBB8459D98ABB04EDA06EC64"><enum>(c)</enum><header>Applicable
Existing Waiver</header><text>For purposes of this section—</text>
<paragraph id="HBB60983BD0D84400B13400007E00EC1F"><enum>(1)</enum><header>In
general</header><text>The term <term>applicable existing waiver</term> means a
waiver, experimental, pilot, or demonstration project under section 1115,
grandfathered under section 6102(c)(3) of the Deficit Reduction Act of 2005, or
otherwise conducted under authority that—</text>
<subparagraph id="HC84AE6866C044A76B3B6B44DBCE2E09E"><enum>(A)</enum><text>would allow funds
made available under this title to be used to provide child health assistance
or other health benefits coverage to—</text>
<clause id="HA2D2B02F98BC4C87B5D75C87D9F1C452"><enum>(i)</enum><text>a
parent of a targeted low-income child;</text>
</clause><clause id="H26967B622AA441B1A92DB08890678531"><enum>(ii)</enum><text>a
nonpregnant childless adult; or</text>
</clause><clause id="HD18153C71FB74375BE5244FB91112336"><enum>(iii)</enum><text>individuals
described in both clauses (i) and (ii); and</text>
</clause></subparagraph><subparagraph id="H5C4E7C450B734D0798769604E32C2DDC"><enum>(B)</enum><text>was in effect
during fiscal year 2009.</text>
</subparagraph></paragraph><paragraph id="H6F15932D05A74A6EBBCC13F758BAEF62"><enum>(2)</enum><header>Definitions</header>
<subparagraph id="HDA974524CA3E42629E2EAC3D1CA6FE99"><enum>(A)</enum><header>Parent</header><text>The
term <term>parent</term> includes a caretaker relative (as such term is used in
carrying out section 1931) and a legal guardian.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HCE26AFE69DF248E9BFB47492FE43B5D1"><enum>(B)</enum><header>Nonpregnant
childless adult</header><text>The term <term>nonpregnant childless adult</term>
has the meaning given such term by section
2107(f).</text>
</subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H2E6EB2FC0E494FA397F86FA2EEAAD356"><enum>(2)</enum><header>Conforming
amendments</header>
<subparagraph id="H5475849ABEA147F29955A1C27F3332BA"><enum>(A)</enum><text>Section 2107(f)
(42 U.S.C. 1397gg(f)) is amended—</text>
<clause id="H8D76911AD45E494FA1529224905BA100"><enum>(i)</enum><text>by
striking “, the Secretary” and inserting “:</text>
<quoted-block id="H88FC1CC6E9B3459AA0D2332DE2E35E82" style="OLC">
<paragraph id="HA557C3FD981042F8AEF8FDE25616F9B2"><enum>(1)</enum><text>The
Secretary</text>
</paragraph><after-quoted-block>;</after-quoted-block></quoted-block>
</clause><clause id="H65AEBEED1E5E4054BE803800C8EBA3A8"><enum>(ii)</enum><text>in
the first sentence, by inserting <quote>or a parent (as defined in section
2111(c)(2)(A)), who is not pregnant, of a targeted low-income child</quote>
before the period;</text>
</clause><clause id="H8D3BCAA4462540E9B526B020543DA2F"><enum>(iii)</enum><text>by
striking the second sentence; and</text>
</clause><clause id="HCFBD8C8B7CCA43D78EC894052875EDA2"><enum>(iv)</enum><text>by
adding at the end the following new paragraph:</text>
<quoted-block id="H89B25D7B2EEA49EABF01AFFA9348009" style="OLC">
<paragraph id="H74D24F5662DE46B881F3166791CFB48D"><enum>(2)</enum><text>The Secretary may
not approve, extend, renew, or amend a waiver, experimental, pilot, or
demonstration project with respect to a State after the date of enactment of
the Children’s Health Insurance Program Reauthorization Act of 2009 that would
waive or modify the requirements of section
2111.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="H9075C4A0E4E84236BD9B435465815759"><enum>(B)</enum><text>Section 6102(c) of
the Deficit Reduction Act of 2005 (Public Law 109–171; 120 Stat. 131) is
amended by striking <quote>Nothing</quote> and inserting <quote>Subject to
section 2111 of the <act-name parsable-cite="SSA">Social Security
Act</act-name>, as added by section 112 of the Children’s Health Insurance
Program Reauthorization Act of 2009, nothing</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="HD0FB775F6A8845E4A76804150282661B"><enum>(b)</enum><header>GAO Study and
Report</header>
<paragraph id="HC1F30DBC84124EBEB41358A749376891"><enum>(1)</enum><header>In
general</header><text>The Comptroller General of the United States shall
conduct a study of whether—</text>
<subparagraph id="H3DE569DF91C5470F93EBF09CC9271C7B"><enum>(A)</enum><text>the coverage of a
parent, a caretaker relative (as such term is used in carrying out section
1931), or a legal guardian of a targeted low-income child under a State health
plan under title XXI of the <act-name parsable-cite="SSA">Social Security
Act</act-name> increases the enrollment of, or the quality of care for,
children, and</text>
</subparagraph><subparagraph id="HC6557695E2604D55AAABA35EB1F18817"><enum>(B)</enum><text>such parents,
relatives, and legal guardians who enroll in such a plan are more likely to
enroll their children in such a plan or in a State plan under title XIX of such
Act.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H43B1DDE1772F4998A3E79587E50D7B5"><enum>(2)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 2 years after the date of
the enactment of this Act, the Comptroller General shall report the results of
the study to the Committee on Finance of the Senate and the Committee on Energy
and Commerce of the House of Representatives, including recommendations (if
any) for changes in legislation.</text>
</paragraph></subsection></section><section display-inline="no-display-inline" id="HBD5690B3629B4F71931BEEC2EDA9CAD" section-type="subsequent-section"><enum>113.</enum><header>Elimination of
counting Medicaid child presumptive eligibility costs against title
<enum-in-header>XXI</enum-in-header> allotment</header>
<subsection id="HE53503C2106F43F2B24B45BB8B26B4D"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 2105(a)(1)
(42 U.S.C. 1397ee(a)(1)) is amended—</text>
<paragraph id="H835CCA5C93AA424DAE3C420089CD15E4"><enum>(1)</enum><text>in the matter
preceding subparagraph (A), by striking <quote>(or, in the case of expenditures
described in subparagraph (B), the Federal medical assistance percentage (as
defined in the first sentence of section 1905(b)))</quote>; and</text>
</paragraph><paragraph id="H5D88F827790A4273A5615BF31E5C00DA"><enum>(2)</enum><text>by striking
subparagraph (B) and inserting the following new subparagraph:</text>
<quoted-block id="H506DBFDDED6B448396A1AB5F98B96957" style="OLC">
<subparagraph id="H008DA5CFEA2846EAA3423EA1BEFCA1B9"><enum>(B)</enum><text>[reserved]</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H1AB864C761B24B24B41997E1582F611E"><enum>(b)</enum><header>Amendments to
medicaid</header>
<paragraph id="H96E67CBC88594A388EC24BDE6CFB6799"><enum>(1)</enum><header>Eligibility of a
newborn</header><text>Section 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended in
the first sentence by striking <quote>so long as the child is a member of the
woman’s household and the woman remains (or would remain if pregnant) eligible
for such assistance</quote>.</text>
</paragraph><paragraph id="HDF9C8C7757064D1CA80638F2F380A5C7"><enum>(2)</enum><header>Application of
qualified entities to presumptive eligibility for pregnant women under
medicaid</header><text>Section 1920(b) (42 U.S.C. 1396r–1(b)) is amended by
adding after paragraph (2) the following flush sentence:</text>
<quoted-block display-inline="no-display-inline" id="H1677BD08A5DB445F00D3A4173B62FDD" style="OLC">
<quoted-block-continuation-text quoted-block-continuation-text-level="subsection">The term
<term>qualified provider</term> also includes a qualified entity, as defined in
section
1920A(b)(3).</quoted-block-continuation-text><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="HBAC3F08D22144C2DA45DCC9DDED6C14" section-type="subsequent-section"><enum>114.</enum><header>Limitation on
matching rate for States that propose to cover children with effective family
income that exceeds 300 percent of the poverty line</header>
<subsection commented="no" id="HA81B68427D57469AA86CD07B07ED8F2F"><enum>(a)</enum><header>FMAP Applied to
Expenditures</header><text>Section 2105(c) (<external-xref legal-doc="usc" parsable-cite="usc/42/1397ee">42 U.S.C. 1397ee(c)</external-xref>) is amended
by adding at the end the following new paragraph:</text>
<quoted-block id="H6957FBEB245E418FAB6656050118F500" style="OLC">
<paragraph commented="no" id="H2F3EB06E583E488A9DFA71A936A547F1"><enum>(8)</enum><header>Limitation on
matching rate for expenditures for child health assistance provided to children
whose effective family income exceeds 300 percent of the poverty line</header>
<subparagraph commented="no" id="H5CBE4FC26B964BB080FC37A27B8B8DD9"><enum>(A)</enum><header>FMAP applied to
expenditures</header><text>Except as provided in subparagraph (B), for fiscal
years beginning with fiscal year 2009, the Federal medical assistance
percentage (as determined under section 1905(b) without regard to clause (4) of
such section) shall be substituted for the enhanced FMAP under subsection
(a)(1) with respect to any expenditures for providing child health assistance
or health benefits coverage for a targeted low-income child whose effective
family income would exceed 300 percent of the poverty line but for the
application of a general exclusion of a block of income that is not determined
by type of expense or type of income.</text>
</subparagraph><subparagraph commented="no" id="H63C5072E95004A19A81075937E4B9CE6"><enum>(B)</enum><header>Exception</header><text>Subparagraph
(A) shall not apply to any State that, on the date of enactment of the
Children’s Health Insurance Program Reauthorization Act of 2009, has an
approved State plan amendment or waiver to provide, or has enacted a State law
to submit a State plan amendment to provide, expenditures described in such
subparagraph under the State child health
plan.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="HC501F1B50B4A48B1B99E003D99A1AAF6"><enum>(b)</enum><header>Rule of
construction</header><text>Nothing in the amendments made by this section shall
be construed as—</text>
<paragraph commented="no" id="H428DFE79DD97418D84489CB0682EC900"><enum>(1)</enum><text>changing any
income eligibility level for children under title XXI of the Social Security
Act; or</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HC571A52CFB4B4416A10041A696A244FB"><enum>(2)</enum><text>changing the
flexibility provided States under such title to establish the income
eligibility level for targeted low-income children under a State child health
plan and the methodologies used by the State to determine income or assets
under such plan.</text>
</paragraph></subsection></section><section commented="no" id="H512BE79A39544A3E0000875FE537CDC"><enum>115.</enum><header>State authority
under Medicaid</header><text display-inline="no-display-inline">Notwithstanding
any other provision of law, including the fourth sentence of subsection (b) of
section 1905 of the Social Security Act (42 U.S.C. 1396d) or subsection (u) of
such section, at State option, the Secretary shall provide the State with the
Federal medical assistance percentage determined for the State for Medicaid
with respect to expenditures described in section 1905(u)(2)(A) of such Act or
otherwise made to provide medical assistance under Medicaid to a child who
could be covered by the State under CHIP.</text>
</section></subtitle><enum>II</enum><header>Outreach and
Enrollment</header>
<subtitle id="H585EE1DEF0474B3580CB874B213C815F"><enum>A</enum><header>Outreach and
Enrollment Activities</header>
<section id="H354255B664914395B12647A6CD6FBDF"><enum>201.</enum><header>Grants and
enhanced administrative funding for outreach and enrollment</header>
<subsection id="HA9F51EA0EE2A4359B4FA2C69EF098743"><enum>(a)</enum><header>Grants</header><text>Title
XXI (42 U.S.C. 1397aa et seq.), as amended by section 111, is amended by adding
at the end the following:</text>
<quoted-block id="H641AECFD1EC04E7A9536E2387E31BD61" style="OLC">
<section id="H2C0E50379FE643AC82CBF894E14870F"><enum>2113.</enum><header>Grants to
improve outreach and enrollment</header>
<subsection id="HB84F256A93F7449F9777E99253B7BEC"><enum>(a)</enum><header>Outreach and
Enrollment Grants; National Campaign</header>
<paragraph id="H00BDACE06C3A4A20B008D5DC7E82934F"><enum>(1)</enum><header>In
general</header><text>From the amounts appropriated under subsection (g),
subject to paragraph (2), the Secretary shall award grants to eligible entities
during the period of fiscal years 2009 through 2013 to conduct outreach and
enrollment efforts that are designed to increase the enrollment and
participation of eligible children under this title and title XIX.</text>
</paragraph><paragraph id="HC9B67D4A9FEA4B3BAF00F8EC561655AA"><enum>(2)</enum><header>Ten percent set
aside for national enrollment campaign</header><text>An amount equal to 10
percent of such amounts shall be used by the Secretary for expenditures during
such period to carry out a national enrollment campaign in accordance with
subsection (h).</text>
</paragraph></subsection><subsection id="HA7E01390EA6042309E4915845361DA7B"><enum>(b)</enum><header>Priority for
Award of Grants</header>
<paragraph id="HE4918FDC0EF547139EF49BB0311F8666"><enum>(1)</enum><header>In
general</header><text>In awarding grants under subsection (a), the Secretary
shall give priority to eligible entities that—</text>
<subparagraph id="H84B664DCC27D47CF8FC572A7F9C03BB9"><enum>(A)</enum><text>propose to target
geographic areas with high rates of—</text>
<clause id="HACD3838C588E4EA48BDA1CADC5953893"><enum>(i)</enum><text>eligible but
unenrolled children, including such children who reside in rural areas;
or</text>
</clause><clause id="H0E9C4E7C85B844D8B79898E816604C8F"><enum>(ii)</enum><text>racial and ethnic
minorities and health disparity populations, including those proposals that
address cultural and linguistic barriers to enrollment; and</text>
</clause></subparagraph><subparagraph id="HFF971A79B52642E89CE7AD007EAA1D00"><enum>(B)</enum><text>submit the most
demonstrable evidence required under paragraphs (1) and (2) of subsection
(c).</text>
</subparagraph></paragraph><paragraph id="HF5CC7A08CA074314AC172FFE28EA3421"><enum>(2)</enum><header>Ten percent set
aside for outreach to indian children</header><text>An amount equal to 10
percent of the funds appropriated under subsection (g) shall be used by the
Secretary to award grants to Indian Health Service providers and urban Indian
organizations receiving funds under title V of the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>
(25 U.S.C. 1651 et seq.) for outreach to, and enrollment of, children who are
Indians.</text>
</paragraph></subsection><subsection id="H9263EF082D7D4E3289B46FAD28BE6098"><enum>(c)</enum><header>Application</header><text>An
eligible entity that desires to receive a grant under subsection (a) shall
submit an application to the Secretary in such form and manner, and containing
such information, as the Secretary may decide. Such application shall
include—</text>
<paragraph id="H8C1E0548B386467C92470049E8F1BE57"><enum>(1)</enum><text>evidence
demonstrating that the entity includes members who have access to, and
credibility with, ethnic or low-income populations in the communities in which
activities funded under the grant are to be conducted;</text>
</paragraph><paragraph id="HED876BA33DF74D51AE28470083F1B8F"><enum>(2)</enum><text>evidence
demonstrating that the entity has the ability to address barriers to
enrollment, such as lack of awareness of eligibility, stigma concerns and
punitive fears associated with receipt of benefits, and other cultural barriers
to applying for and receiving child health assistance or medical
assistance;</text>
</paragraph><paragraph id="HE2BF4E772A3E4356804FD9FD14ADC19B"><enum>(3)</enum><text>specific quality
or outcomes performance measures to evaluate the effectiveness of activities
funded by a grant awarded under this section; and</text>
</paragraph><paragraph id="H69BBD9146EB9443A84FC482BC5E40780"><enum>(4)</enum><text>an assurance that
the eligible entity shall—</text>
<subparagraph id="HC62101F94828476ABB59C12FC1B27492"><enum>(A)</enum><text>conduct an
assessment of the effectiveness of such activities against the performance
measures;</text>
</subparagraph><subparagraph id="HF5FDED8A4BFF4D3EB5A54B45B7A2AEDB"><enum>(B)</enum><text>cooperate with the
collection and reporting of enrollment data and other information in order for
the Secretary to conduct such assessments; and</text>
</subparagraph><subparagraph id="H3CB1CD82B3AA406A9B39ADEAA18CDBE1"><enum>(C)</enum><text>in the case of an
eligible entity that is not the State, provide the State with enrollment data
and other information as necessary for the State to make necessary projections
of eligible children and pregnant women.</text>
</subparagraph></paragraph></subsection><subsection id="H3353AD7F0AAE4079A3FCF488F64CD6CB"><enum>(d)</enum><header>Dissemination of
Enrollment Data and Information Determined From Effectiveness Assessments;
Annual Report</header><text>The Secretary shall—</text>
<paragraph id="H8943E7235BC64DACA3725FCE23CA07A4"><enum>(1)</enum><text>make publicly
available the enrollment data and information collected and reported in
accordance with subsection (c)(4)(B); and</text>
</paragraph><paragraph id="HFAB108C4FFB54BB4AB75EA83C6DE04F0"><enum>(2)</enum><text>submit an annual
report to Congress on the outreach and enrollment activities conducted with
funds appropriated under this section.</text>
</paragraph></subsection><subsection id="HB8709E0FB5584CB080F970E86F1014D2"><enum>(e)</enum><header>Maintenance of
Effort for States Awarded Grants; No State Match Required</header><text>In the
case of a State that is awarded a grant under this section—</text>
<paragraph id="H73D121D42D0342BB86047DA32D7EB29E"><enum>(1)</enum><text>the State share of
funds expended for outreach and enrollment activities under the State child
health plan shall not be less than the State share of such funds expended in
the fiscal year preceding the first fiscal year for which the grant is awarded;
and</text>
</paragraph><paragraph id="H84A2E685C4254EC1B0ADC2E792A91431"><enum>(2)</enum><text>no State matching
funds shall be required for the State to receive a grant under this
section.</text>
</paragraph></subsection><subsection id="H5E20A71A818C41E8B628D4784644B121"><enum>(f)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="H7A70190505F446E5A279C793EB65ADD6"><enum>(1)</enum><header>Eligible
entity</header><text>The term <term>eligible entity</term> means any of the
following:</text>
<subparagraph id="H72BA8B312DD24B4095E039E71C5F07B8"><enum>(A)</enum><text>A State with an
approved child health plan under this title.</text>
</subparagraph><subparagraph id="HCC7A418A1BB34C7BB817E2CECA78EB5"><enum>(B)</enum><text>A local
government.</text>
</subparagraph><subparagraph id="HF6F42020D89947F99C4205F6E2C0233B"><enum>(C)</enum><text>An Indian tribe or
tribal consortium, a tribal organization, an urban Indian organization
receiving funds under title V of the <act-name parsable-cite="IHCIA">Indian
Health Care Improvement Act</act-name> (25 U.S.C. 1651 et seq.), or an Indian
Health Service provider.</text>
</subparagraph><subparagraph id="H394E8F03BBDB4A72B41D762C201BBA2D"><enum>(D)</enum><text>A Federal health
safety net organization.</text>
</subparagraph><subparagraph id="H1244D46F10634A2ABDDCB122C6345538"><enum>(E)</enum><text>A national, State,
local, or community-based public or nonprofit private organization, including
organizations that use community health workers or community-based doula
programs.</text>
</subparagraph><subparagraph id="H613617AD297940D1810047BFBBD7497"><enum>(F)</enum><text>A faith-based
organization or consortia, to the extent that a grant awarded to such an entity
is consistent with the requirements of section 1955 of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C.
300x–65) relating to a grant award to nongovernmental entities.</text>
</subparagraph><subparagraph id="H384B3904BDCE4415BC56AE7ED3AED2E5"><enum>(G)</enum><text>An elementary or
secondary school.</text>
</subparagraph></paragraph><paragraph id="H7B95CB6592DA463ABA5CF085F49F00D4"><enum>(2)</enum><header>Federal health
safety net organization</header><text>The term <term>Federal health safety net
organization</term> means—</text>
<subparagraph id="H7AD72349824A42CFB98388718700E5BA"><enum>(A)</enum><text>a
Federally-qualified health center (as defined in section 1905(l)(2)(B));</text>
</subparagraph><subparagraph id="H4E7C9805D87845F3883718620000431C"><enum>(B)</enum><text>a hospital defined
as a disproportionate share hospital for purposes of section 1923;</text>
</subparagraph><subparagraph id="HB4FA74D3127F4BF9895562D50098003E"><enum>(C)</enum><text>a covered entity
described in section 340B(a)(4) of the <act-name parsable-cite="PHSA">Public
Health Service Act</act-name> (42 U.S.C. 256b(a)(4)); and</text>
</subparagraph><subparagraph id="HD0E93F7A658A46C89F2356C768FA588E"><enum>(D)</enum><text>any other entity
or consortium that serves children under a federally funded program, including
the special supplemental nutrition program for women, infants, and children
(WIC) established under section 17 of the <act-name parsable-cite="CNA66">Child
Nutrition Act of 1966</act-name> (42 U.S.C. 1786), the Head Start and Early
Head Start programs under the <act-name parsable-cite="HSA">Head Start
Act</act-name> (42 U.S.C. 9801 et seq.), the school lunch program established
under the Richard B. Russell <act-name parsable-cite="NSLA">National School
Lunch Act</act-name>, and an elementary or secondary school.</text>
</subparagraph></paragraph><paragraph id="HB2B5F992C6F2430AA1CE9F9939A32676"><enum>(3)</enum><header>Indians; indian
tribe; tribal organization; urban indian organization</header><text>The terms
<term>Indian</term>, <term>Indian tribe</term>, <term>tribal
organization</term>, and <term>urban Indian organization</term> have the
meanings given such terms in section 4 of the <act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name> (25 U.S.C.
1603).</text>
</paragraph><paragraph id="H222D767A62564654BEF857031B2F1907"><enum>(4)</enum><header>Community health
worker</header><text>The term <term>community health worker</term> means an
individual who promotes health or nutrition within the community in which the
individual resides—</text>
<subparagraph id="H9FDBC9EA20E74FC589A8D56E6F8CEE9C"><enum>(A)</enum><text>by serving as a
liaison between communities and health care agencies;</text>
</subparagraph><subparagraph id="H97933411A79141F69DFB644F39D14E2D"><enum>(B)</enum><text>by providing
guidance and social assistance to community residents;</text>
</subparagraph><subparagraph id="H0AC532DD4B8D4542B4539743815D6CEE"><enum>(C)</enum><text>by enhancing
community residents’ ability to effectively communicate with health care
providers;</text>
</subparagraph><subparagraph id="H96CD4701F7EE467EAEB2C88498D30553"><enum>(D)</enum><text>by providing
culturally and linguistically appropriate health or nutrition education;</text>
</subparagraph><subparagraph id="H52CFFDBFF0A243F39F21525B160565B5"><enum>(E)</enum><text>by advocating for
individual and community health or nutrition needs; and</text>
</subparagraph><subparagraph id="H75DA10C4674449C0BFD8E9A49D03C25F"><enum>(F)</enum><text>by providing
referral and followup services.</text>
</subparagraph></paragraph></subsection><subsection id="HB2939FD9D12748D6BFC2F60600F3D6DC"><enum>(g)</enum><header>Appropriation</header><text>There
is appropriated, out of any money in the Treasury not otherwise appropriated,
$100,000,000 for the period of fiscal years 2009 through 2013, for the purpose
of awarding grants under this section. Amounts appropriated and paid under the
authority of this section shall be in addition to amounts appropriated under
section 2104 and paid to States in accordance with section 2105, including with
respect to expenditures for outreach activities in accordance with subsections
(a)(1)(D)(iii) and (c)(2)(C) of that section.</text>
</subsection><subsection id="H7C99BA931BAF442D9D12D08819BA8EFA"><enum>(h)</enum><header>National
Enrollment Campaign</header><text>From the amounts made available under
subsection (a)(2), the Secretary shall develop and implement a national
enrollment campaign to improve the enrollment of underserved child populations
in the programs established under this title and title XIX. Such campaign may
include—</text>
<paragraph id="HD6ED326722EF4296B14975761100F501"><enum>(1)</enum><text>the establishment
of partnerships with the Secretary of Education and the Secretary of
Agriculture to develop national campaigns to link the eligibility and
enrollment systems for the assistance programs each Secretary administers that
often serve the same children;</text>
</paragraph><paragraph id="H4F13D656B37B4200A4F34631796D88E"><enum>(2)</enum><text>the integration of
information about the programs established under this title and title XIX in
public health awareness campaigns administered by the Secretary;</text>
</paragraph><paragraph id="H42B91B5C175F4A0DA65CB59FB000088"><enum>(3)</enum><text>increased financial
and technical support for enrollment hotlines maintained by the Secretary to
ensure that all States participate in such hotlines;</text>
</paragraph><paragraph id="H37D20AD650884E0AA54C4C65DCF80670"><enum>(4)</enum><text>the establishment
of joint public awareness outreach initiatives with the Secretary of Education
and the Secretary of Labor regarding the importance of health insurance to
building strong communities and the economy;</text>
</paragraph><paragraph id="HF6D438D2B32142EC9E95F670F6F00096"><enum>(5)</enum><text>the development of
special outreach materials for Native Americans or for individuals with limited
English proficiency; and</text>
</paragraph><paragraph id="HBD09416254924368915103B6FB882396"><enum>(6)</enum><text>such other
outreach initiatives as the Secretary determines would increase public
awareness of the programs under this title and title
XIX.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HAAFE68BB987A4A77A80023A2AE3C7902"><enum>(b)</enum><header>Enhanced
Administrative Funding for Translation or Interpretation Services Under CHIP
and Medicaid</header>
<paragraph id="H9AA8DC901F1E41C5A40769EAE4E0605F"><enum>(1)</enum><header>CHIP</header><text>Section
2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as amended by section 113, is
amended—</text>
<subparagraph id="H617B88999436436B8E560087F7B50B1"><enum>(A)</enum><text>in the matter
preceding subparagraph (A), by inserting <quote>(or, in the case of
expenditures described in subparagraph (D)(iv), the higher of 75 percent or the
sum of the enhanced FMAP plus 5 percentage points)</quote> after
<quote>enhanced FMAP</quote>; and</text>
</subparagraph><subparagraph id="H85426ADD6F8A4CAFB05554A79672A6ED"><enum>(B)</enum><text>in subparagraph
(D)—</text>
<clause id="HA6F49D06681A41208C144014C19556A1"><enum>(i)</enum><text>in
clause (iii), by striking <quote>and</quote> at the end;</text>
</clause><clause id="H44A20AEBD3DB4876AF209B6657BDCEF"><enum>(ii)</enum><text>by
redesignating clause (iv) as clause (v); and</text>
</clause><clause id="HD3BC0A68824342E98B543DB7BDEE897D"><enum>(iii)</enum><text>by
inserting after clause (iii) the following new clause:</text>
<quoted-block id="H64864989941F47F5AABFB9B781632EF" style="OLC">
<clause id="H6DF997D56F1E4B3A83011EBAF63CD029"><enum>(iv)</enum><text>for translation
or interpretation services in connection with the enrollment of, retention of,
and use of services under this title by, individuals for whom English is not
their primary language (as found necessary by the Secretary for the proper and
efficient administration of the State plan);
and</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph><paragraph display-inline="no-display-inline" id="HBB271FEDA82349CB8D596C203F00AD89"><enum>(2)</enum><header>Medicaid</header>
<subparagraph id="H0F87D1C98DF3489AB000B6001FD85B74"><enum>(A)</enum><header>Use of medicaid
funds</header><text display-inline="yes-display-inline">Section 1903(a)(2) (42
U.S.C. 1396b(a)(2)) is amended by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HBC33015610544103B359433991544F69" style="OLC">
<subparagraph id="H4EF3301E85674567B4CDF74445C1BC21" indent="up1"><enum>(E)</enum><text display-inline="yes-display-inline">an
amount equal to 75 percent of so much of the sums expended during such quarter
(as found necessary by the Secretary for the proper and efficient
administration of the State plan) as are attributable to translation or
interpretation services in connection with the enrollment of, retention of, and
use of services under this title by, children of families for whom English is
not the primary language;
plus</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph commented="no" id="H80D2A00431EB472C83FBBE7D7DE7B2E0"><enum>(B)</enum><header>Use of community
health workers for outreach activities</header>
<clause commented="no" id="HE83009616891427BA909DEB6CE301EF3"><enum>(i)</enum><header>In
general</header><text>Section 2102(c)(1) of such Act (42 U.S.C. 1397bb(c)(1))
is amended by inserting <quote>(through community health workers and
others)</quote> after <quote>Outreach</quote>.</text>
</clause><clause commented="no" id="H717318F3B5A54F420050447026C2ED2D"><enum>(ii)</enum><header>In Federal
evaluation</header><text>Section 2108(c)(3)(B) of such Act (42 U.S.C.
1397hh(c)(3)(B)) is amended by inserting <quote>(such as through community
health workers and others)</quote> after <quote>including
practices</quote>.</text>
</clause></subparagraph></paragraph></subsection></section><section display-inline="no-display-inline" id="H344CA9ADF078411D904D6BD583BE509B" section-type="subsequent-section"><enum>202.</enum><header>Increased outreach
and enrollment of Indians</header>
<subsection id="HCFB0DE5C695A404D9886A9F5A29BE5C4"><enum>(a)</enum><header>In
General</header><text>Section 1139 (42 U.S.C. 1320b–9) is amended to read as
follows:</text>
<quoted-block id="HF317D7FBC4AA40DE98ACFE0491C61B24" style="OLC">
<section id="H136BA0E4BAF54F2BB8A9947EA7A8D823"><enum>1139.</enum><header>Improved
access to, and delivery of, health care for Indians under titles XIX and
XXI</header>
<subsection id="H4651AA4BF84B43EC9C6678B9D53423C"><enum>(a)</enum><header>Agreements With
States for Medicaid and CHIP Outreach On or Near Reservations To Increase the
Enrollment of Indians in Those Programs</header>
<paragraph id="H8295DA7288AE4D24B7BE299321EC594"><enum>(1)</enum><header>In
general</header><text>In order to improve the access of Indians residing on or
near a reservation to obtain benefits under the Medicaid and State children’s
health insurance programs established under titles XIX and XXI, the Secretary
shall encourage the State to take steps to provide for enrollment on or near
the reservation. Such steps may include outreach efforts such as the
outstationing of eligibility workers, entering into agreements with the Indian
Health Service, Indian Tribes, Tribal Organizations, and Urban Indian
Organizations to provide outreach, education regarding eligibility and
benefits, enrollment, and translation services when such services are
appropriate.</text>
</paragraph><paragraph id="HA5014408E7714DC7860293DF94AA1F6D"><enum>(2)</enum><header>Construction</header><text>Nothing
in paragraph (1) shall be construed as affecting arrangements entered into
between States and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations for such Service, Tribes, or
Organizations to conduct administrative activities under such titles.</text>
</paragraph></subsection><subsection id="H41325CA0DFF74848B6F21DBAF8AA59AA"><enum>(b)</enum><header>Requirement To
Facilitate Cooperation</header><text>The Secretary, acting through the Centers
for Medicare & Medicaid Services, shall take such steps as are necessary to
facilitate cooperation with, and agreements between, States and the Indian
Health Service, Indian Tribes, Tribal Organizations, or Urban Indian
Organizations with respect to the provision of health care items and services
to Indians under the programs established under title XIX or XXI.</text>
</subsection><subsection id="HAE19AE512D9F435A9277F5F3BC641034"><enum>(c)</enum><header>Definition of
Indian; Indian Tribe; Indian Health Program; Tribal Organization; Urban Indian
Organization</header><text>In this section, the terms <term>Indian</term>,
<term>Indian Tribe</term>, <term>Indian Health Program</term>, <term>Tribal
Organization</term>, and <term>Urban Indian Organization</term> have the
meanings given those terms in section 4 of the <act-name parsable-cite="IHCIA">Indian Health Care Improvement
Act</act-name>.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H3CC76FF678E04CC789D59298A63031B3"><enum>(b)</enum><header>Nonapplication
of 10 Percent Limit on Outreach and Certain Other
Expenditures</header><text>Section 2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is
amended by adding at the end the following:</text>
<quoted-block id="HD863FDD9D3E14FC9B181CFA1ECF4C3E0" style="OLC">
<subparagraph id="HCAA868A2D8BC45889E1661B3833C00E9"><enum>(C)</enum><header>Nonapplication
to certain expenditures</header><text>The limitation under subparagraph (A)
shall not apply with respect to the following expenditures:</text>
<clause id="HDBA3D36EBF3C4185B66FA5EC00750687"><enum>(i)</enum><header>Expenditures to
increase outreach to, and the enrollment of, indian children under this title
and title <enum-in-header>XIX</enum-in-header></header><text>Expenditures for
outreach activities to families of Indian children likely to be eligible for
child health assistance under the plan or medical assistance under the State
plan under title XIX (or under a waiver of such plan), to inform such families
of the availability of, and to assist them in enrolling their children in, such
plans, including such activities conducted under grants, contracts, or
agreements entered into under section
1139(a).</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section display-inline="no-display-inline" id="H74E8545542ED431FBAE5969C77E87FED" section-type="subsequent-section"><enum>203.</enum><header>State option to rely
on findings from an Express Lane agency to conduct simplified eligibility
determinations</header>
<subsection id="H5DACD8C8FC7F4FA6AD008FB3DFB80690"><enum>(a)</enum><header>Application
under Medicaid and CHIP programs</header>
<paragraph id="H05E93385CE8347DF99B6147002D8F57C"><enum>(1)</enum><header>Medicaid</header><text>Section
1902(e) (42 U.S.C. 1396a(e)) is amended by adding at the end the
following:</text>
<quoted-block act-name="Social" id="H724961608E354D019B6818A0135C3579" style="traditional">
<paragraph id="HFCBF00028E31413E99BD0A983A70163" indent="up1"><enum>(13)</enum><header>Express lane option</header>
<subparagraph id="H7EC9234EED7446DE008282C700F17B14"><enum>(A)</enum><header>In general</header>
<clause id="H5BEBDF84277D455B92D898768D5279D9"><enum>(i)</enum><header>Option to use a finding from an
express lane agency</header><text display-inline="yes-display-inline">At the
option of the State, the State plan may provide that in determining eligibility
under this title for a child (as defined in subparagraph (G)), the State may
rely on a finding made within a reasonable period (as determined by the State)
from an Express Lane agency (as defined in subparagraph (F)) when it determines
whether a child satisfies one or more components of eligibility for medical
assistance under this title. The State may rely on a finding from an Express
Lane agency notwithstanding sections 1902(a)(46)(B) and 1137(d) or any
differences in budget unit, disregard, deeming or other methodology, if the
following requirements are met:</text>
<subclause id="H50ACB106BF92469BAAF249850027DA90"><enum>(I)</enum><header>Prohibition on determining children
ineligible for coverage</header><text display-inline="yes-display-inline">If a
finding from an Express Lane agency would result in a determination that a
child does not satisfy an eligibility requirement for medical assistance under
this title and for child health assistance under title XXI, the State shall
determine eligibility for assistance using its regular procedures.</text>
</subclause><subclause id="H6CE5A7D79E214B81BA005823AB26B823"><enum>(II)</enum><header>Notice requirement</header><text display-inline="yes-display-inline">For any child who is found eligible for
medical assistance under the State plan under this title or child health
assistance under title XXI and who is subject to premiums based on an Express
Lane agency’s finding of such child’s income level, the State shall provide
notice that the child may qualify for lower premium payments if evaluated by
the State using its regular policies and of the procedures for requesting such
an evaluation.</text>
</subclause><subclause id="HCFEE173DD15C493A9ED4333773D12324"><enum>(III)</enum><header>Compliance with screen and enroll
requirement</header><text display-inline="yes-display-inline">The State shall
satisfy the requirements under subparagraphs (A) and (B) of section 2102(b)(3)
(relating to screen and enroll) before enrolling a child in child health
assistance under title XXI. At its option, the State may fulfill such
requirements in accordance with either option provided under subparagraph (C)
of this paragraph.</text>
</subclause><subclause display-inline="no-display-inline" id="H73E0FA79CE384BFAA068E09CC61EAA66"><enum>(IV)</enum><header>Verification of citizenship or
nationality status</header><text>The State shall satisfy the requirements of
section 1902(a)(46)(B) or 2105(c)(9), as applicable for verifications of
citizenship or nationality status.</text>
</subclause><subclause id="HB58A1B264497475689CB49F3DCB2793"><enum>(V)</enum><header>Coding</header><text>The State meets
the requirements of subparagraph (E).</text>
</subclause></clause><clause id="H7B0088C5265844BB9EBA047AC02F94"><enum>(ii)</enum><header>Option to apply to renewals and
redeterminations</header><text display-inline="yes-display-inline">The State
may apply the provisions of this paragraph when conducting initial
determinations of eligibility, redeterminations of eligibility, or both, as
described in the State plan.</text>
</clause></subparagraph><subparagraph id="HCD07F83448A14F82A38E366E5C8C3897"><enum>(B)</enum><header>Rules of
construction</header><text>Nothing in this paragraph shall be construed—</text>
<clause id="HB84549778C604F7FAE66110017CAE45B"><enum>(i)</enum><text display-inline="yes-display-inline">to limit or prohibit a State from taking
any actions otherwise permitted under this title or title XXI in determining
eligibility for or enrolling children into medical assistance under this title
or child health assistance under title XXI; or</text>
</clause><clause id="H07F1299B9BFE41AB903DFA94B88F10ED"><enum>(ii)</enum><text display-inline="yes-display-inline">to modify the limitations in section
1902(a)(5) concerning the agencies that may make a determination of eligibility
for medical assistance under this title.</text>
</clause></subparagraph><subparagraph id="H6C26E000DBAE4CB0B02F85153EB5BF43"><enum>(C)</enum><header>Options for satisfying the screen
and enroll requirement</header>
<clause id="H2DD0F5206C584467823970682DE465F0"><enum>(i)</enum><header>In general</header><text>With
respect to a child whose eligibility for medical assistance under this title or
for child health assistance under title XXI has been evaluated by a State
agency using an income finding from an Express Lane agency, a State may carry
out its duties under subparagraphs (A) and (B) of section 2102(b)(3) (relating
to screen and enroll) in accordance with either clause (ii) or clause
(iii).</text>
</clause><clause id="H04CF12BFF1ED4263810000A2141E8B80"><enum>(ii)</enum><header>Establishing a screening
threshold</header>
<subclause id="H0EC70FC86DF24E1B95622FE8C8123FA6"><enum>(I)</enum><header>In general</header><text>Under this
clause, the State establishes a screening threshold set as a percentage of the
Federal poverty level that exceeds the highest income threshold applicable
under this title to the child by a minimum of 30 percentage points or, at State
option, a higher number of percentage points that reflects the value (as
determined by the State and described in the State plan) of any differences
between income methodologies used by the program administered by the Express
Lane agency and the methodologies used by the State in determining eligibility
for medical assistance under this title.</text>
</subclause><subclause id="H81B9A3E86A8E4462BB05266320007FE6"><enum>(II)</enum><header>Children with income not above
threshold</header><text display-inline="yes-display-inline">If the income of a
child does not exceed the screening threshold, the child is deemed to satisfy
the income eligibility criteria for medical assistance under this title
regardless of whether such child would otherwise satisfy such criteria.</text>
</subclause><subclause id="H8EF893C16D564BB9A50555459C558E2B"><enum>(III)</enum><header>Children with income above
threshold</header><text display-inline="yes-display-inline">If the income of a
child exceeds the screening threshold, the child shall be considered to have an
income above the Medicaid applicable income level described in section
2110(b)(4) and to satisfy the requirement under section 2110(b)(1)(C) (relating
to the requirement that CHIP matching funds be used only for children not
eligible for Medicaid). If such a child is enrolled in child health assistance
under title XXI, the State shall provide the parent, guardian, or custodial
relative with the following:</text>
<item id="HEEB80C51D945403F99619718E0B0DF08"><enum>(aa)</enum><text display-inline="yes-display-inline">Notice that the child may be eligible to
receive medical assistance under the State plan under this title if evaluated
for such assistance under the State’s regular procedures and notice of the
process through which a parent, guardian, or custodial relative can request
that the State evaluate the child’s eligibility for medical assistance under
this title using such regular procedures.</text>
</item><item id="HEF330D53E4F743A79CDE48B9EEDA8DAF"><enum>(bb)</enum><text display-inline="yes-display-inline">A
description of differences between the medical assistance provided under this
title and child health assistance under title XXI, including differences in
cost-sharing requirements and covered benefits.</text>
</item></subclause></clause><clause id="H8FE2706AA2124FAE9F9BFD20150092F1"><enum>(iii)</enum><header>Temporary enrollment in CHIP
pending screen and enroll</header>
<subclause id="HC838B23E010448B9948FB72C74CE6EC"><enum>(I)</enum><header>In
general</header><text display-inline="yes-display-inline">Under this clause, a
State enrolls a child in child health assistance under title XXI for a
temporary period if the child appears eligible for such assistance based on an
income finding by an Express Lane agency.</text>
</subclause><subclause id="HC40E24CB7E334EE4B54416EE4745CA86"><enum>(II)</enum><header>Determination of
eligibility</header><text display-inline="yes-display-inline">During such
temporary enrollment period, the State shall determine the child’s eligibility
for child health assistance under title XXI or for medical assistance under
this title in accordance with this clause.</text>
</subclause><subclause id="H7DE743A63ECC4A11B910D972ED8F3537"><enum>(III)</enum><header>Prompt follow up</header><text display-inline="yes-display-inline">In making such a determination, the State
shall take prompt action to determine whether the child should be enrolled in
medical assistance under this title or child health assistance under title XXI
pursuant to subparagraphs (A) and (B) of section 2102(b)(3) (relating to screen
and enroll).</text>
</subclause><subclause id="H48B0680A9F89430EB469EB31655F8900"><enum>(IV)</enum><header>Requirement for simplified
determination</header><text display-inline="yes-display-inline">In making such
a determination, the State shall use procedures that, to the maximum feasible
extent, reduce the burden imposed on the individual of such determination. Such
procedures may not require the child’s parent, guardian, or custodial relative
to provide or verify information that already has been provided to the State
agency by an Express Lane agency or another source of information unless the
State agency has reason to believe the information is erroneous.</text>
</subclause><subclause id="HB7A4F4713BBA46ABA4541573940058F"><enum>(V)</enum><header>Availability of CHIP matching funds
during temporary enrollment period</header><text display-inline="yes-display-inline">Medical assistance for items and services
that are provided to a child enrolled in title XXI during a temporary
enrollment period under this clause shall be treated as child health assistance
under such title.</text>
</subclause></clause></subparagraph><subparagraph id="H8218BF699C2C475EBC674619FDAA5B35"><enum>(D)</enum><header>Option for automatic
enrollment</header>
<clause commented="no" id="H8AEBBCC485904DEBAC2E0002001F76FE"><enum>(i)</enum><header>In general</header><text>The
State may initiate and determine eligibility for medical assistance under the
State Medicaid plan or for child health assistance under the State CHIP plan
without a program application from, or on behalf of, the child based on data
obtained from sources other than the child (or the child’s family), but a child
can only be automatically enrolled in the State Medicaid plan or the State CHIP
plan if the child or the family affirmatively consents to being enrolled
through affirmation and signature on an Express Lane agency application, if the
requirement of clause (ii) is met.</text>
</clause><clause id="H0FDF6A93C66445319EB82997A1CE6ED1"><enum>(ii)</enum><header>Information
requirement</header><text display-inline="yes-display-inline">The requirement
of this clause is that the State informs the parent, guardian, or custodial
relative of the child of the services that will be covered, appropriate methods
for using such services, premium or other cost sharing charges (if any) that
apply, medical support obligations (under section 1912(a)) created by
enrollment (if applicable), and the actions the parent, guardian, or relative
must take to maintain enrollment and renew coverage.</text>
</clause></subparagraph><subparagraph display-inline="no-display-inline" id="H5DD1F16BC3AB40A6B3FB287D603400FF"><enum>(E)</enum><header>Coding; application to enrollment
error rates</header>
<clause id="HA730742CB735401991DD909BF52CE5D7"><enum>(i)</enum><header>In general</header><text>For
purposes of subparagraph (A)(iv), the requirement of this subparagraph for a
State is that the State agrees to—</text>
<subclause id="HA55DFF7FAC7D46AC917610FE7B19854E"><enum>(I)</enum><text>assign such codes as the Secretary shall
require to the children who are enrolled in the State Medicaid plan or the
State CHIP plan through reliance on a finding made by an Express Lane agency
for the duration of the State’s election under this paragraph;</text>
</subclause><subclause id="H11ADA51D1D9449A099925DC55E7830C5"><enum>(II)</enum><text>annually provide the Secretary with a
statistically valid sample (that is approved by Secretary) of the children
enrolled in such plans through reliance on such a finding by conducting a full
Medicaid eligibility review of the children identified for such sample for
purposes of determining an eligibility error rate (as described in clause (iv))
with respect to the enrollment of such children (and shall not include such
children in any data or samples used for purposes of complying with a Medicaid
Eligibility Quality Control (MEQC) review or a payment error rate measurement
(PERM) requirement);</text>
</subclause><subclause id="HB1D1B0E3840D4AE0ADB3584FDFEF6153"><enum>(III)</enum><text>submit the error rate determined under
subclause (II) to the Secretary;</text>
</subclause><subclause id="HE840011679644DCA00AB9494FA99F3CF"><enum>(IV)</enum><text>if such error rate exceeds 3 percent for
either of the first 2 fiscal years in which the State elects to apply this
paragraph, demonstrate to the satisfaction of the Secretary the specific
corrective actions implemented by the State to improve upon such error rate;
and</text>
</subclause><subclause id="H73F794A25248423F89DCDE0064991F"><enum>(V)</enum><text>if such error rate exceeds 3 percent for
any fiscal year in which the State elects to apply this paragraph, a reduction
in the amount otherwise payable to the State under section 1903(a) for quarters
for that fiscal year, equal to the total amount of erroneous excess payments
determined for the fiscal year only with respect to the children included in
the sample for the fiscal year that are in excess of a 3 percent error rate
with respect to such children.</text>
</subclause></clause><clause id="H8F38BA8BBF6F486B93D00E0FF80E69F"><enum>(ii)</enum><header>No punitive action based on
error rate</header><text>The Secretary shall not apply the error rate derived
from the sample under clause (i) to the entire population of children enrolled
in the State Medicaid plan or the State CHIP plan through reliance on a finding
made by an Express Lane agency, or to the population of children enrolled in
such plans on the basis of the State’s regular procedures for determining
eligibility, or penalize the State on the basis of such error rate in any
manner other than the reduction of payments provided for under clause
(i)(V).</text>
</clause><clause id="H18E1B7DCC3B84E5DBA002985BEEB29A2"><enum>(iii)</enum><header>Rule of
construction</header><text>Nothing in this paragraph shall be construed as
relieving a State that elects to apply this paragraph from being subject to a
penalty under section 1903(u), for payments made under the State Medicaid plan
with respect to ineligible individuals and families that are determined to
exceed the error rate permitted under that section (as determined without
regard to the error rate determined under clause (i)(II)).</text>
</clause><clause id="H92BEAC76379D45CFB4BECD6B61F90078"><enum>(iv)</enum><header>Error rate
defined</header><text>In this subparagraph, the term <term>error rate</term>
means the rate of erroneous excess payments for medical assistance (as defined
in section 1903(u)(1)(D)) for the period involved, except that such payments
shall be limited to individuals for which eligibility determinations are made
under this paragraph and except that in applying this paragraph under title
XXI, there shall be substituted for references to provisions of this title
corresponding provisions within title XXI.</text>
</clause></subparagraph><subparagraph id="H2BFC7FA6176A4CA185A94D55699FD7C"><enum>(F)</enum><header>Express lane agency</header>
<clause id="H48B03A065E4A449D89AAF11483EC2EF"><enum>(i)</enum><header>In general</header><text>In this
paragraph, the term <quote>Express Lane agency</quote> means a public agency
that—</text>
<subclause id="H6A67659F1BD749DAA5A40600D549C0C0"><enum>(I)</enum><text>is determined by the State Medicaid
agency or the State CHIP agency (as applicable) to be capable of making the
determinations of one or more eligibility requirements described in
subparagraph (A)(i);</text>
</subclause><subclause id="HA5DEBAD21AAC45DFA859842FF2E4C2BE"><enum>(II)</enum><text>is identified in the State Medicaid plan
or the State CHIP plan; and</text>
</subclause><subclause id="H07CEFD414489475E8D7BF100F61CF82F"><enum>(III)</enum><text>notifies the child’s family—</text>
<item id="HABFD0A4C122D45BABFEEF7ABA75F20D3"><enum>(aa)</enum><text>of the information which shall be
disclosed in accordance with this paragraph;</text>
</item><item id="H725AEE507E7E48B2A961A022DC5E5156"><enum>(bb)</enum><text>that the information disclosed will
be used solely for purposes of determining eligibility for medical assistance
under the State Medicaid plan or for child health assistance under the State
CHIP plan; and</text>
</item><item id="H02011781EA8A47DABAAAC3AF49BB5759"><enum>(cc)</enum><text>that the family may elect to not have
the information disclosed for such purposes; and</text>
</item></subclause><subclause id="H5E2FC9B75D8F4F698C8206545DB208EC"><enum>(IV)</enum><text>enters into, or is subject to, an
interagency agreement to limit the disclosure and use of the information
disclosed.</text>
</subclause></clause><clause id="H6E0DDCC66FBF407097CAF8EC8D136E9C"><enum>(ii)</enum><header>Inclusion of specific public
agencies</header><text>Such term includes the following:</text>
<subclause id="HE750D3602A7F41E89729AC3211047682"><enum>(I)</enum><text>A public agency that determines
eligibility for assistance under any of the following:</text>
<item id="H679B191EC3FD4DCDAB01139900FAEDC6"><enum>(aa)</enum><text>The temporary assistance for needy
families program funded under part A of title IV.</text>
</item><item id="HA60F6805D97E4CFEBDCCB8092223BBA"><enum>(bb)</enum><text>A State program funded under part D
of title IV.</text>
</item><item id="H71832A3347B54B0EB4BD99A9009BA1ED"><enum>(cc)</enum><text>The State Medicaid plan.</text>
</item><item id="H712ECEC4751F474BBD9485D88922D022"><enum>(dd)</enum><text>The State CHIP plan.</text>
</item><item id="HC371F89F54A949A2B9005F441CD4835C"><enum>(ee)</enum><text>The Food and Nutrition Act of 2008 (7
U.S.C. 2011 et seq.).</text>
</item><item id="HF1CADFF31D274B43AC004F5ECA8FADBC"><enum>(ff)</enum><text>The Head Start Act (42 U.S.C. 9801 et
seq.).</text>
</item><item id="HB47AD2B1889F49139E94367270E28FA2"><enum>(gg)</enum><text>The Richard B. Russell National
School Lunch Act (42 U.S.C. 1751 et seq.).</text>
</item><item id="H9E940B33CC064303A9007F577C4358C7"><enum>(hh)</enum><text>The Child Nutrition Act of 1966 (42
U.S.C. 1771 et seq.).</text>
</item><item id="HA431A8055C324D1C00A6F98511F23562"><enum>(ii)</enum><text>The Child Care and Development Block
Grant Act of 1990 (42 U.S.C. 9858 et seq.).</text>
</item><item id="H9A1E69DFFDAA4050B4002F7B8E58B29F"><enum>(jj)</enum><text>The Stewart B. McKinney Homeless
Assistance Act (42 U.S.C. 11301 et seq.).</text>
</item><item id="H5F8B8C3933564ED2ADC5D299D9611F90"><enum>(kk)</enum><text>The United States Housing Act of 1937
(42 U.S.C. 1437 et seq.).</text>
</item><item id="H30E5758E50414E1B8F4C00713EC183A2"><enum>(ll)</enum><text>The Native American Housing
Assistance and Self-Determination Act of 1996 (25 U.S.C. 4101 et seq.).</text>
</item></subclause><subclause id="H50416E7FCDE14BC0855BA81EF4323E2D"><enum>(II)</enum><text>A State-specified governmental agency
that has fiscal liability or legal responsibility for the accuracy of the
eligibility determination findings relied on by the State.</text>
</subclause><subclause id="HD7EF6F7FC858430CB03606E7D6CD2FA7"><enum>(III)</enum><text>A public agency that is subject to an
interagency agreement limiting the disclosure and use of the information
disclosed for purposes of determining eligibility under the State Medicaid plan
or the State CHIP plan.</text>
</subclause></clause><clause id="HAC311E340ACF42C0BB35367E9C99C5BA"><enum>(iii)</enum><header>Exclusions</header><text>Such
term does not include an agency that determines eligibility for a program
established under the Social Services Block Grant established under title XX or
a private, for-profit organization.</text>
</clause><clause id="HD4325A82830E45F3A92D1FB6B8BDF5D0"><enum>(iv)</enum><header>Rules of
construction</header><text>Nothing in this paragraph shall be construed
as—</text>
<subclause id="H5EB7F97763D64BB4A2A94E90BE08E81"><enum>(I)</enum><text>exempting a State Medicaid agency from
complying with the requirements of section 1902(a)(4) relating to merit-based
personnel standards for employees of the State Medicaid agency and safeguards
against conflicts of interest); or</text>
</subclause><subclause id="H5D07B25D91C74117B2D9418224DBFBFD"><enum>(II)</enum><text>authorizing a State Medicaid agency that
elects to use Express Lane agencies under this subparagraph to use the Express
Lane option to avoid complying with such requirements for purposes of making
eligibility determinations under the State Medicaid plan.</text>
</subclause></clause><clause id="H36AB88A7EDDA441FB2F1D203A6182F40"><enum>(v)</enum><header>Additional
definitions</header><text>In this paragraph:</text>
<subclause id="HD9F56F63B9D8447380601438493078DF"><enum>(I)</enum><header>State</header><text>The term
<term>State</term> means 1 of the 50 States or the District of Columbia.</text>
</subclause><subclause id="HFF835EDAEA244F560066500564F9E737"><enum>(II)</enum><header>State chip agency</header><text>The
term <term>State CHIP agency</term> means the State agency responsible for
administering the State CHIP plan.</text>
</subclause><subclause id="H9F10DD0A59B24DC6BE4CB6A26671E9A6"><enum>(III)</enum><header>State chip plan</header><text>The
term <term>State CHIP plan</term> means the State child health plan established
under title XXI and includes any waiver of such plan.</text>
</subclause><subclause id="H730D4DFF1D0E4AC6BAB8E8D2463F5131"><enum>(IV)</enum><header>State medicaid
agency</header><text>The term <term>State Medicaid agency</term> means the
State agency responsible for administering the State Medicaid plan.</text>
</subclause><subclause id="HC62CC2827CD343F88300977E07D4285E"><enum>(V)</enum><header>State medicaid plan</header><text>The
term <term>State Medicaid plan</term> means the State plan established under
title XIX and includes any waiver of such plan.</text>
</subclause></clause></subparagraph><subparagraph id="H7F1C6DCA37FF4221A34118E0A5A7F551"><enum>(G)</enum><header>Child defined</header><text display-inline="yes-display-inline">For purposes of this paragraph, the term
<term>child</term> means an individual under 19 years of age, or, at the option
of a State, such higher age, not to exceed 21 years of age, as the State may
elect.</text>
</subparagraph><subparagraph id="H09642E6F51854EF68B09D9457FF0FAC"><enum>(H)</enum><header>Application</header><text>This
paragraph shall not apply with respect to eligibility determinations made after
September 30,
2013.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H297960612C3A41E5A3BDCFCEC66BA6D2"><enum>(2)</enum><header>CHIP</header><text display-inline="yes-display-inline">Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1))
is amended by redesignating subparagraphs (B), (C), and (D) as subparagraphs
(C), (D), and (E), respectively, and by inserting after subparagraph (A) the
following new subparagraph:</text>
<quoted-block act-name="Social" id="HC5FC12C7EF6447B600BD15CDD77C1F80">
<subparagraph id="HD814F336C1ED44B4AAC2C435745E3DB"><enum>(B)</enum><text display-inline="yes-display-inline">Section 1902(e)(13) (relating to the State
option to rely on findings from an Express Lane agency to help evaluate a
child’s eligibility for medical
assistance).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection display-inline="no-display-inline" id="HCC8CEA592EFA4CF58D1DADF68FEDCBD4"><enum>(b)</enum><header>Evaluation and
Report</header>
<paragraph id="H95D98972DB844DED973EA318E7E1B6E"><enum>(1)</enum><header>Evaluation</header><text>The
Secretary shall conduct, by grant, contract, or interagency agreement, a
comprehensive, independent evaluation of the option provided under the
amendments made by subsection (a). Such evaluation shall include an analysis of
the effectiveness of the option, and shall include—</text>
<subparagraph id="HD96C3D232F4E4930A01DB4B28B77EF67"><enum>(A)</enum><text>obtaining a
statistically valid sample of the children who were enrolled in the State
Medicaid plan or the State CHIP plan through reliance on a finding made by an
Express Lane agency and determining the percentage of children who were
erroneously enrolled in such plans;</text>
</subparagraph><subparagraph id="HCB339D7FD0BF4E4BBF99AAA3826DC863"><enum>(B)</enum><text>determining
whether enrolling children in such plans through reliance on a finding made by
an Express Lane agency improves the ability of a State to identify and enroll
low-income, uninsured children who are eligible but not enrolled in such
plans;</text>
</subparagraph><subparagraph id="H013EF6E029364EEF9B53A65E92BDCDB2"><enum>(C)</enum><text>evaluating the
administrative costs or savings related to identifying and enrolling children
in such plans through reliance on such findings, and the extent to which such
costs differ from the costs that the State otherwise would have incurred to
identify and enroll low-income, uninsured children who are eligible but not
enrolled in such plans; and</text>
</subparagraph><subparagraph id="H6F1D21CB3A8B4F278357D8543C3A83B"><enum>(D)</enum><text>any recommendations
for legislative or administrative changes that would improve the effectiveness
of enrolling children in such plans through reliance on such findings.</text>
</subparagraph></paragraph><paragraph id="HDEC7EB4BF4F34097894C00236796ABE1"><enum>(2)</enum><header>Report to
Congress</header><text>Not later than September 30, 2012, the Secretary shall
submit a report to Congress on the results of the evaluation under paragraph
(1).</text>
</paragraph><paragraph id="H90D60E60448B4806953F4B5E36D45048"><enum>(3)</enum><header>Funding</header>
<subparagraph id="H450966DCB676436DB2CAF6FCF12667C5"><enum>(A)</enum><header>In
general</header><text>Out of any funds in the Treasury not otherwise
appropriated, there is appropriated to the Secretary to carry out the
evaluation under this subsection $5,000,000 for the period of fiscal years 2009
through 2012.</text>
</subparagraph><subparagraph id="H45F7A14C65EA404CA6E119DCE9A70014"><enum>(B)</enum><header>Budget
authority</header><text>Subparagraph (A) constitutes budget authority in
advance of appropriations Act and represents the obligation of the Federal
Government to provide for the payment of such amount to conduct the evaluation
under this subsection.</text>
</subparagraph></paragraph></subsection><subsection id="HFC503DE4EE4D4798A2E8FE3256EB407C"><enum>(c)</enum><header>Electronic
transmission of information</header><text display-inline="yes-display-inline">Section 1902 (42 U.S.C. 1396a) is amended
by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HA4BA610CA9934774BA722915AEAF8D" style="OLC">
<subsection id="HD13816947FE941A8A0C1C7B663E9CB3"><enum>(dd)</enum><header>Electronic
transmission of information</header><text>If the State agency determining
eligibility for medical assistance under this title or child health assistance
under title XXI verifies an element of eligibility based on information from an
Express Lane Agency (as defined in subsection (e)(13)(F)), or from another
public agency, then the applicant’s signature under penalty of perjury shall
not be required as to such element. Any signature requirement for an
application for medical assistance may be satisfied through an electronic
signature, as defined in section 1710(1) of the Government Paperwork
Elimination Act (44 U.S.C. 3504 note). The requirements of subparagraphs (A)
and (B) of section 1137(d)(2) may be met through evidence in digital or
electronic
form.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection display-inline="no-display-inline" id="H38D88A71CBBB44888F9F21004CB2F6B"><enum>(d)</enum><header>Authorization of
information disclosure</header>
<paragraph id="H02D1EACC064E4FEAB0A4277B142D56EC"><enum>(1)</enum><header>In
general</header><text>Title XIX is amended by adding at the end the following
new section:</text>
<quoted-block id="H7B4B88896D7A45610053B5CCDEB38CC5" style="OLC">
<section id="H17E5C56F13DF400199AC0004E5439B86"><enum>1942.</enum><header>Authorization
to receive relevant information</header>
<subsection id="HCACE5D15AFCE4816BB9E228013734BE4"><enum>(a)</enum><header>In
general</header><text>Notwithstanding any other provision of law, a Federal or
State agency or private entity in possession of the sources of data directly
relevant to eligibility determinations under this title (including eligibility
files maintained by Express Lane agencies described in section 1902(e)(13)(F),
information described in paragraph (2) or (3) of section 1137(a), vital records
information about births in any State, and information described in sections
453(i) and 1902(a)(25)(I)) is authorized to convey such data or information to
the State agency administering the State plan under this title, to the extent
such conveyance meets the requirements of subsection (b).</text>
</subsection><subsection id="HF44C80D010BE4D1280BD3C795F31A714"><enum>(b)</enum><header>Requirements for
conveyance</header><text>Data or information may be conveyed pursuant to
subsection (a) only if the following requirements are met:</text>
<paragraph id="H20DD8FD07DBD4818976B2170B4CD6370"><enum>(1)</enum><text>The individual
whose circumstances are described in the data or information (or such
individual’s parent, guardian, caretaker relative, or authorized
representative) has either provided advance consent to disclosure or has not
objected to disclosure after receiving advance notice of disclosure and a
reasonable opportunity to object.</text>
</paragraph><paragraph id="H34F91883035E4BBEAB950989FDAC9225"><enum>(2)</enum><text>Such data or
information are used solely for the purposes of—</text>
<subparagraph id="HC5B1305B0D954112ADD79991043700C5"><enum>(A)</enum><text>identifying
individuals who are eligible or potentially eligible for medical assistance
under this title and enrolling or attempting to enroll such individuals in the
State plan; and</text>
</subparagraph><subparagraph id="H8E0A6B3AF7B244D09E3B63DC195615BD"><enum>(B)</enum><text>verifying the
eligibility of individuals for medical assistance under the State plan.</text>
</subparagraph></paragraph><paragraph id="HA2919BA07EFB453493483133E00004DF"><enum>(3)</enum><text>An interagency or
other agreement, consistent with standards developed by the Secretary—</text>
<subparagraph id="H27F5EB4B501640D2AEC94BB2963928D4"><enum>(A)</enum><text>prevents the
unauthorized use, disclosure, or modification of such data and otherwise meets
applicable Federal requirements safeguarding privacy and data security;
and</text>
</subparagraph><subparagraph id="H22B9B12CCEF641CD9CDCEB99FD4FEDE1"><enum>(B)</enum><text>requires the State
agency administering the State plan to use the data and information obtained
under this section to seek to enroll individuals in the plan.</text>
</subparagraph></paragraph></subsection><subsection id="H0FC251CCF7DA4EDCB9BF004257DC4926"><enum>(c)</enum><header>Penalties for
improper disclosure</header>
<paragraph id="H0530B106A95A4C8681366942FF31D0EE"><enum>(1)</enum><header>Civil money
penalty</header><text display-inline="yes-display-inline">A private entity
described in the subsection (a) that publishes, discloses, or makes known in
any manner, or to any extent not authorized by Federal law, any information
obtained under this section is subject to a civil money penalty in an amount
equal to $10,000 for each such unauthorized publication or disclosure. The
provisions of section 1128A (other than subsections (a) and (b) and the second
sentence of subsection (f)) shall apply to a civil money penalty under this
paragraph in the same manner as such provisions apply to a penalty or
proceeding under section 1128A(a).</text>
</paragraph><paragraph id="HB1D8B8B9F3D745CA87905032D00016F9"><enum>(2)</enum><header>Criminal
penalty</header><text display-inline="yes-display-inline">A private entity
described in the subsection (a) that willfully publishes, discloses, or makes
known in any manner, or to any extent not authorized by Federal law, any
information obtained under this section shall be fined not more than $10,000 or
imprisoned not more than 1 year, or both, for each such unauthorized
publication or disclosure.</text>
</paragraph></subsection><subsection id="H021D9B8166E149FF98DFACA605D23495"><enum>(d)</enum><header>Rule of
construction</header><text>The limitations and requirements that apply to
disclosure pursuant to this section shall not be construed to prohibit the
conveyance or disclosure of data or information otherwise permitted under
Federal law (without regard to this
section).</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H9636F85FE3314F87A108FC7EF2E0183C"><enum>(2)</enum><header>Conforming
amendment to title XXI</header><text>Section 2107(e)(1) (42 U.S.C.
1397gg(e)(1)), as amended by subsection (a)(2), is amended by adding at the end
the following new subparagraph:</text>
<quoted-block id="H4A4029B102064E3B8C140730BE4CDAAF" style="OLC">
<subparagraph id="H3EAE128DB17443C4B27C35CF343D4BE0"><enum>(F)</enum><text>Section 1942
(relating to authorization to receive data directly relevant to eligibility
determinations).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H2BB1A494AEA746EFBCD48852E25B4F4D"><enum>(3)</enum><header>Conforming
amendment to provide access to data about enrollment in insurance for purposes
of evaluating applications and for CHIP</header><text>Section 1902(a)(25)(I)(i)
(42 U.S.C. 1396a(a)(25)(I)(i)) is amended—</text>
<subparagraph id="H3F629A6E77CF4CBEB4B5AF7DD58C009B"><enum>(A)</enum><text>by inserting
<quote>(and, at State option, individuals who apply or whose eligibility for
medical assistance is being evaluated in accordance with section
1902(e)(13)(D))</quote> after <quote>with respect to individuals who are
eligible</quote>; and</text>
</subparagraph><subparagraph id="H1827F35EFBB941CB9F40F967F7DF68BE"><enum>(B)</enum><text>by inserting
<quote>under this title (and, at State option, child health assistance under
title XXI)</quote> after <quote>the State plan</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="H8D86FCD971F84BE099167B8475F493BA"><enum>(e)</enum><header>Authorization
for States Electing Express Lane Option To Receive Certain Data Directly
Relevant To Determining Eligibility and Correct Amount of
Assistance</header><text>The Secretary shall enter into such agreements as are
necessary to permit a State that elects the Express Lane option under section
1902(e)(13) of the Social Security Act to receive data directly relevant to
eligibility determinations and determining the correct amount of benefits under
a State child health plan under CHIP or a State plan under Medicaid from the
following:</text>
<paragraph id="HFDDA17CC415E476585A024FF63669111"><enum>(1)</enum><text>The National
Directory of New Hires established under section 453(i) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
653(i)).</text>
</paragraph><paragraph id="H1212FAC2331049508CC2DB555E2C224F"><enum>(2)</enum><text>Data regarding
enrollment in insurance that may help to facilitate outreach and enrollment
under the State Medicaid plan, the State CHIP plan, and such other programs as
the Secretary may specify.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HD82FFBAA53B6438B94F0D38D5F1FED48"><enum>(f)</enum><header>Effective
date</header><text>The amendments made by this section are effective on the
date of the enactment of this Act.</text>
</subsection></section></subtitle><subtitle id="H7A485072D1E6467D9F9279018D1100A0"><enum>B</enum><header>Reducing Barriers
to Enrollment</header>
<section display-inline="no-display-inline" id="HFB801CC34CEE40FDB4EDA673A65F3C20"><enum>211.</enum><header>Verification of
declaration of citizenship or nationality for purposes of eligibility for
Medicaid and CHIP</header>
<subsection id="HD34EE0A150234200994154006C01C545"><enum>(a)</enum><header>Alternative
State Process for Verification of Declaration of Citizenship or Nationality for
Purposes of Eligibility for Medicaid</header>
<paragraph id="HC52E800F9B6D49318503753F526076CE"><enum>(1)</enum><header>Alternative to
documentation requirement</header>
<subparagraph id="HE0C2E125E0DD4CA4A0B7CE3EC6BC87CB"><enum>(A)</enum><header>In
general</header><text>Section 1902 (42 U.S.C. 1396a), as amended by section
203(c), is amended—</text>
<clause id="H06B8E7EBF3114D2BBC857E9293AC98AA"><enum>(i)</enum><text>in
subsection (a)(46)—</text>
<subclause id="HF1B10DF241564F8B9000ECD4223C3360"><enum>(I)</enum><text>by inserting
<quote>(A)</quote> after <quote>(46)</quote>;</text>
</subclause><subclause id="H31EBB984772A4E6AB9005BCBCD556BCE"><enum>(II)</enum><text>by adding
<quote>and</quote> after the semicolon; and</text>
</subclause><subclause id="H9DA1B060EB4B493CBD004E3B21E7D3DB"><enum>(III)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block id="H29BF2DE1FE3D4EAF9FAD1090C7D99B5E" style="OLC">
<subparagraph id="HB8845EF6EEC548538DB3D00BA897F45" indent="up1"><enum>(B)</enum><text>provide, with respect to an individual
declaring to be a citizen or national of the United States for purposes of
establishing eligibility under this title, that the State shall satisfy the
requirements of—</text>
<clause id="HB73F0E41EB1A40998C38303B12E83FB4"><enum>(i)</enum><text>section 1903(x); or</text>
</clause><clause id="H07B28D1EA62E4BE1B9E31E392E3776CB"><enum>(ii)</enum><text>subsection
(ee);</text>
</clause></subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subclause></clause><clause id="H6FFD80AE78ED46CBB5B063A554F92B5C"><enum>(ii)</enum><text>by
adding at the end the following new subsection:</text>
<quoted-block id="H65A6801A392D4176B6942E811209FD2D" style="OLC">
<subsection id="H2389B07C015E41C60003D069A38D95C4"><enum>(ee)</enum><paragraph commented="no" display-inline="yes-display-inline" id="H63A4DE1452D94234B5BEFBEE91A0E65D"><enum>(1)</enum><text>For purposes of
subsection (a)(46)(B)(ii), the requirements of this subsection with respect to
an individual declaring to be a citizen or national of the United States for
purposes of establishing eligibility under this title, are, in lieu of
requiring the individual to present satisfactory documentary evidence of
citizenship or nationality under section 1903(x) (if the individual is not
described in paragraph (2) of that section), as follows:</text>
<subparagraph id="HAB55E7D24A2F4C57B2BCF1CABAD6D079" indent="up1"><enum>(A)</enum><text>The State submits the name and social
security number of the individual to the Commissioner of Social Security as
part of the program established under paragraph (2).</text>
</subparagraph><subparagraph id="HD886192C063C4F5B94CEA53E04294769" indent="up1"><enum>(B)</enum><text>If the State receives notice from the
Commissioner of Social Security that the name or social security number, or the
declaration of citizenship or nationality, of the individual is inconsistent
with information in the records maintained by the Commissioner—</text>
<clause id="H29B5496674CF4AB9AAAF35823E32B5B"><enum>(i)</enum><text>the State makes a reasonable effort
to identify and address the causes of such inconsistency, including through
typographical or other clerical errors, by contacting the individual to confirm
the accuracy of the name or social security number submitted or declaration of
citizenship or nationality and by taking such additional actions as the
Secretary, through regulation or other guidance, or the State may identify, and
continues to provide the individual with medical assistance while making such
effort; and</text>
</clause><clause id="HEF3F786C9E9D4041A3715F67FE3A560"><enum>(ii)</enum><text display-inline="yes-display-inline">in the case such inconsistency is not
resolved under clause (i), the State—</text>
<subclause id="HA2083F0005774048908493186F3BD04F"><enum>(I)</enum><text>notifies the individual of such
fact;</text>
</subclause><subclause id="H98BA30E74376471AA3AD8FCCD64CF317"><enum>(II)</enum><text>provides the individual with a period of
90 days from the date on which the notice required under subclause (I) is
received by the individual to either present satisfactory documentary evidence
of citizenship or nationality (as defined in section 1903(x)(3)) or resolve the
inconsistency with the Commissioner of Social Security (and continues to
provide the individual with medical assistance during such 90-day period);
and</text>
</subclause><subclause id="HA5DE071919004D5E940624E900C900B4"><enum>(III)</enum><text>disenrolls the individual from the
State plan under this title within 30 days after the end of such 90-day period
if no such documentary evidence is presented or if such inconsistency is not
resolved.</text>
</subclause></clause></subparagraph></paragraph><paragraph id="H247BC95124D14477B6B888A3C5ACE05" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H61B6F75C8F0246ADA8A5C61D00E960DA"><enum>(A)</enum><text>Each State electing to
satisfy the requirements of this subsection for purposes of section
1902(a)(46)(B) shall establish a program under which the State submits at least
monthly to the Commissioner of Social Security for comparison of the name and
social security number, of each individual newly enrolled in the State plan
under this title that month who is not described in section 1903(x)(2) and who
declares to be a United States citizen or national, with information in records
maintained by the Commissioner.</text>
</subparagraph><subparagraph id="H44C7CDDF409E497BB1B7A400D3F03BD5" indent="up1"><enum>(B)</enum><text>In establishing the State program
under this paragraph, the State may enter into an agreement with the
Commissioner of Social Security—</text>
<clause id="HD16A7E85B8A6406E972200EA7D16DC3B"><enum>(i)</enum><text display-inline="yes-display-inline">to
provide, through an on-line system or otherwise, for the electronic submission
of, and response to, the information submitted under subparagraph (A) for an
individual enrolled in the State plan under this title who declares to be
citizen or national on at least a monthly basis; or</text>
</clause><clause id="HE01D2157224949CCB92EE6006121ACD9"><enum>(ii)</enum><text display-inline="yes-display-inline">to provide for a determination of the
consistency of the information submitted with the information maintained in the
records of the Commissioner through such other method as agreed to by the State
and the Commissioner and approved by the Secretary, provided that such method
is no more burdensome for individuals to comply with than any burdens that may
apply under a method described in clause (i).</text>
</clause></subparagraph><subparagraph id="HAAB49ED74605471195CE1028BB83F319" indent="up1"><enum>(C)</enum><text>The program established under this
paragraph shall provide that, in the case of any individual who is required to
submit a social security number to the State under subparagraph (A) and who is
unable to provide the State with such number, shall be provided with at least
the reasonable opportunity to present satisfactory documentary evidence of
citizenship or nationality (as defined in section 1903(x)(3)) as is provided
under clauses (i) and (ii) of section 1137(d)(4)(A) to an individual for the
submittal to the State of evidence indicating a satisfactory immigration
status.</text>
</subparagraph></paragraph><paragraph id="HE96D8377C6304C01BE3DF7015C1CE600" indent="up1"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H8FF96F4202FD415886EA01E167014B00"><enum>(A)</enum><text display-inline="yes-display-inline">The State agency implementing the plan
approved under this title shall, at such times and in such form as the
Secretary may specify, provide information on the percentage each month that
the inconsistent submissions bears to the total submissions made for comparison
for such month. For purposes of this subparagraph, a name, social security
number, or declaration of citizenship or nationality of an individual shall be
treated as inconsistent and included in the determination of such percentage
only if—</text>
<clause id="HD4178A86609147298965C06725B872F3" indent="up1"><enum>(i)</enum><text display-inline="yes-display-inline">the information submitted by the individual
is not consistent with information in records maintained by the Commissioner of
Social Security;</text>
</clause><clause id="H3767562B5628474BBEDC36009DF58FFC" indent="up1"><enum>(ii)</enum><text>the inconsistency is not resolved by
the State;</text>
</clause><clause id="H448BC5F0633F49CC8D81AF281BC600B3" indent="up1"><enum>(iii)</enum><text>the individual was provided with a
reasonable period of time to resolve the inconsistency with the Commissioner of
Social Security or provide satisfactory documentation of citizenship status and
did not successfully resolve such inconsistency; and</text>
</clause><clause id="H9A7195D4A1ED43EF9130DDA2E58700D" indent="up1"><enum>(iv)</enum><text>payment has been made for an item or
service furnished to the individual under this title.</text>
</clause></subparagraph><subparagraph id="H91B0183603B641F7A85551B3599D9EB5" indent="up1"><enum>(B)</enum><text>If, for any fiscal year, the average
monthly percentage determined under subparagraph (A) is greater than 3
percent—</text>
<clause id="H8F2052FBCD65444BA3FB80D6A94239D9"><enum>(i)</enum><text>the State shall develop and adopt a
corrective plan to review its procedures for verifying the identities of
individuals seeking to enroll in the State plan under this title and to
identify and implement changes in such procedures to improve their accuracy;
and</text>
</clause><clause id="HE3E9495D9AAE433697FA6B9829955706"><enum>(ii)</enum><text>pay to the Secretary an amount equal
to the amount which bears the same ratio to the total payments under the State
plan for the fiscal year for providing medical assistance to individuals who
provided inconsistent information as the number of individuals with
inconsistent information in excess of 3 percent of such total submitted bears
to the total number of individuals with inconsistent information.</text>
</clause></subparagraph><subparagraph id="H847E25BA1DCF445EB61D51D9999FD0D9" indent="up1"><enum>(C)</enum><text>The Secretary may waive, in certain
limited cases, all or part of the payment under subparagraph (B)(ii) if the
State is unable to reach the allowable error rate despite a good faith effort
by such State.</text>
</subparagraph><subparagraph id="HAB48BFB99D1B4688A799AF4312D9500" indent="up1"><enum>(D)</enum><text>Subparagraphs (A) and (B) shall not
apply to a State for a fiscal year if there is an agreement described in
paragraph (2)(B) in effect as of the close of the fiscal year that provides for
the submission on a real-time basis of the information described in such
paragraph.</text>
</subparagraph></paragraph><paragraph id="H1237111CD8C24A108E3207B237CEDF46" indent="up1"><enum>(4)</enum><text>Nothing in this subsection shall
affect the rights of any individual under this title to appeal any
disenrollment from a State
plan.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="H8C0694DF9B7D4E3DA317E00C648F4EF"><enum>(B)</enum><header>Costs of
implementing and maintaining system</header><text>Section 1903(a)(3) (42 U.S.C.
1396b(a)(3)) is amended—</text>
<clause id="HFBFE62A2DAB64C9CBAD419FD2FC8D1D4"><enum>(i)</enum><text>by
striking <quote>plus</quote> at the end of subparagraph (E) and inserting
<quote>and</quote>, and</text>
</clause><clause id="HB28880FB06934E618408F0629700A138"><enum>(ii)</enum><text>by
adding at the end the following new subparagraph:</text>
<quoted-block id="H296450D3EDB743D8A8DFE48750F7379F" style="OLC">
<subparagraph id="HECCEE2A3BD06473AB453AD4900F95CEA"><enum>(F)</enum><clause commented="no" display-inline="yes-display-inline" id="H5F07278901974852A6795E8E550179A0"><enum>(i)</enum><text>90 percent of the sums
expended during the quarter as are attributable to the design, development, or
installation of such mechanized verification and information retrieval systems
as the Secretary determines are necessary to implement section 1902(ee)
(including a system described in paragraph (2)(B) thereof), and</text>
</clause><clause id="H3C156A31788B41CE970028A81374071" indent="up1"><enum>(ii)</enum><text>75 percent of the sums expended
during the quarter as are attributable to the operation of systems to which
clause (i) applies,
plus</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph><paragraph id="H1949A85284124820BAE8DD1DC9AEB455"><enum>(2)</enum><header>Limitation on
waiver authority</header><text>Notwithstanding any provision of section 1115 of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1315), or any other provision of law, the Secretary may not waive the
requirements of section 1902(a)(46)(B) of such Act (42 U.S.C. 1396a(a)(46)(B))
with respect to a State.</text>
</paragraph><paragraph id="H082B4D6DB49D44689900129E00833467"><enum>(3)</enum><header>Conforming
amendments</header><text>Section 1903 (42 U.S.C. 1396b) is amended—</text>
<subparagraph id="H30EAC0F8EE3F4B078C9FF9F9BB42DD63"><enum>(A)</enum><text>in subsection
(i)(22), by striking <quote>subsection (x)</quote> and inserting <quote>section
1902(a)(46)(B)</quote>; and</text>
</subparagraph><subparagraph id="H9F75DAA2C5D046DBA777366135EF2B6D"><enum>(B)</enum><text>in subsection
(x)(1), by striking <quote>subsection (i)(22)</quote> and inserting
<quote>section 1902(a)(46)(B)(i)</quote>.</text>
</subparagraph></paragraph><paragraph id="HD831546B0AFF4EF3A210C42CEF502F00"><enum>(4)</enum><header>Appropriation</header><text display-inline="yes-display-inline">Out of any money in the Treasury of the
United States not otherwise appropriated, there are appropriated to the
Commissioner of Social Security $5,000,000 to remain available until expended
to carry out the Commissioner’s responsibilities under section 1902(ee) of the
Social Security Act, as added by subsection (a).</text>
</paragraph></subsection><subsection id="HE56655D796334D41A44F071D7BBD9CDA"><enum>(b)</enum><header>Clarification of
Requirements Relating to Presentation of Satisfactory Documentary Evidence of
Citizenship or Nationality</header>
<paragraph id="H486589D6F5A7487BA7FC8CB956008CC4"><enum>(1)</enum><header>Acceptance of
documentary evidence issued by a federally recognized indian
tribe</header><text>Section 1903(x)(3)(B) (42 U.S.C. 1396b(x)(3)(B)) is
amended—</text>
<subparagraph id="H94944C17CE7F44B5B89E9E227FEFD087"><enum>(A)</enum><text>by redesignating
clause (v) as clause (vi); and</text>
</subparagraph><subparagraph id="HD9D39A818B7D46DA88777FF5CA0483E7"><enum>(B)</enum><text>by inserting after
clause (iv), the following new clause:</text>
<quoted-block id="HC5A39D0AD7A24F8BA953FAAB304C27A9" style="OLC">
<clause id="HF4B041EFBF0D4F5FBC7FAE7DAFD2BE37" indent="up2"><enum>(v)</enum><subclause commented="no" display-inline="yes-display-inline" id="HD97E37C5BA444E88A3E2B07F04DDDEB"><enum>(I)</enum><text>Except as provided in
subclause (II), a document issued by a federally recognized Indian tribe
evidencing membership or enrollment in, or affiliation with, such tribe (such
as a tribal enrollment card or certificate of degree of Indian blood).</text>
</subclause><subclause id="H49C6CBC33D484A17ADFFAA4286BEA42F" indent="up1"><enum>(II)</enum><text>With respect to those federally
recognized Indian tribes located within States having an international border
whose membership includes individuals who are not citizens of the United
States, the Secretary shall, after consulting with such tribes, issue
regulations authorizing the presentation of such other forms of documentation
(including tribal documentation, if appropriate) that the Secretary determines
to be satisfactory documentary evidence of citizenship or nationality for
purposes of satisfying the requirement of this
subsection.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HDB895B1481B64CAAB5EF14F0D67159E7"><enum>(2)</enum><header>Requirement to
provide reasonable opportunity to present satisfactory documentary
evidence</header><text>Section 1903(x) (42 U.S.C. 1396b(x)) is amended by
adding at the end the following new paragraph:</text>
<quoted-block id="HFFCFC4793AFA4688BBB26035B895E4F2" style="OLC">
<paragraph id="HB2BD7932BAF842ED851C45952FFF33F1" indent="up1"><enum>(4)</enum><text>In the case of an individual
declaring to be a citizen or national of the United States with respect to whom
a State requires the presentation of satisfactory documentary evidence of
citizenship or nationality under section 1902(a)(46)(B)(i), the individual
shall be provided at least the reasonable opportunity to present satisfactory
documentary evidence of citizenship or nationality under this subsection as is
provided under clauses (i) and (ii) of section 1137(d)(4)(A) to an individual
for the submittal to the State of evidence indicating a satisfactory
immigration
status.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H6028E4A3C6E94C4A8581530046103720"><enum>(3)</enum><header>Children born in
the united states to mothers eligible for medicaid</header>
<subparagraph id="HFF9B5B243E0E44ABA629C5F746BA0EB"><enum>(A)</enum><header>Clarification of
rules</header><text>Section 1903(x) (42 U.S.C. 1396b(x)), as amended by
paragraph (2), is amended—</text>
<clause id="HC2F21CFD7DEF45E5B5DAB6F5F95974D5"><enum>(i)</enum><text>in
paragraph (2)—</text>
<subclause id="HCC49A6F959924A39BE2EA023A1D172AB"><enum>(I)</enum><text>in subparagraph
(C), by striking <quote>or</quote> at the end;</text>
</subclause><subclause id="H5211928C014B4ED590EC4C156B006725"><enum>(II)</enum><text>by redesignating
subparagraph (D) as subparagraph (E); and</text>
</subclause><subclause id="H3D2CC2D968BC48B8942CD604B8005F84"><enum>(III)</enum><text>by inserting
after subparagraph (C) the following new subparagraph:</text>
<quoted-block id="H41FC0BA28A684383924508F630C3071C" style="OLC">
<subparagraph id="H956A2C003281411E9BDE00E630F68E10" indent="up1"><enum>(D)</enum><text>pursuant to the application of section
1902(e)(4) (and, in the case of an individual who is eligible for medical
assistance on such basis, the individual shall be deemed to have provided
satisfactory documentary evidence of citizenship or nationality and shall not
be required to provide further documentary evidence on any date that occurs
during or after the period in which the individual is eligible for medical
assistance on such basis); or</text>
</subparagraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subclause></clause><clause id="H472EFCCBB4C444E9BF84CEE388B9E813"><enum>(ii)</enum><text>by
adding at the end the following new paragraph:</text>
<quoted-block id="H9F880D861CA343B6A0133FE3F78905C6" style="OLC">
<paragraph id="HA83BBC93C96049DE82B7ACC12E0000EF" indent="up1"><enum>(5)</enum><text>Nothing in subparagraph (A) or (B) of
section 1902(a)(46), the preceding paragraphs of this subsection, or the
Deficit Reduction Act of 2005, including section 6036 of such Act, shall be
construed as changing the requirement of section 1902(e)(4) that a child born
in the United States to an alien mother for whom medical assistance for the
delivery of such child is available as treatment of an emergency medical
condition pursuant to subsection (v) shall be deemed eligible for medical
assistance during the first year of such child’s
life.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="HF2E3BAC4B13E4EDE8DEBA306E7DB6442"><enum>(B)</enum><header>State
requirement to issue separate identification number</header><text>Section
1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended by adding at the end the
following new sentence: <quote>Notwithstanding the preceding sentence, in the
case of a child who is born in the United States to an alien mother for whom
medical assistance for the delivery of the child is made available pursuant to
section 1903(v), the State immediately shall issue a separate identification
number for the child upon notification by the facility at which such delivery
occurred of the child’s birth.</quote>.</text>
</subparagraph></paragraph><paragraph id="HC181E330B1E04F4E9ED1A369EDD7F900"><enum>(4)</enum><header>Technical
amendments</header><text>Section 1903(x)(2) (42 U.S.C. 1396b(x)) is
amended—</text>
<subparagraph id="H7DEA733A60A643CCB335E5B2A913ED29"><enum>(A)</enum><text>in subparagraph
(B)—</text>
<clause id="HBEF5949F276D4330B7CDD1BEB4D8DE4C"><enum>(i)</enum><text>by
realigning the left margin of the matter preceding clause (i) 2 ems to the
left; and</text>
</clause><clause id="H5F8B12E652964DE696627F6B52BCF000"><enum>(ii)</enum><text>by
realigning the left margins of clauses (i) and (ii), respectively, 2 ems to the
left; and</text>
</clause></subparagraph><subparagraph id="HA4FB492F89C44F6CB1EDF2992666A3A4"><enum>(B)</enum><text>in subparagraph
(C)—</text>
<clause id="H9EE8348B347F49DEABAC688506DAB0F6"><enum>(i)</enum><text>by
realigning the left margin of the matter preceding clause (i) 2 ems to the
left; and</text>
</clause><clause id="H5D7D49D5908B41CF82A5BCB106B25178"><enum>(ii)</enum><text>by
realigning the left margins of clauses (i) and (ii), respectively, 2 ems to the
left.</text>
</clause></subparagraph></paragraph></subsection><subsection id="H7F1F242115E44019932F830208A6CFA7"><enum>(c)</enum><header>Application of
Documentation System to CHIP</header>
<paragraph id="H4ACBD94B6E964C16B0DF30FA001158BB"><enum>(1)</enum><header>In
general</header><text>Section 2105(c) (42 U.S.C. 1397ee(c)), as amended by
section 114(a), is amended by adding at the end the following new
paragraph:</text>
<quoted-block id="H480044234F254303BD16B4FA3994C1A7" style="OLC">
<paragraph id="HAC8C42A5D7F34809B5FABB00DF001FBB"><enum>(9)</enum><header>Citizenship
documentation requirements</header>
<subparagraph id="H29B52A9AB1B542098CDD348FF02BED6C"><enum>(A)</enum><header>In
general</header><text>No payment may be made under this section with respect to
an individual who has, or is, declared to be a citizen or national of the
United States for purposes of establishing eligibility under this title unless
the State meets the requirements of section 1902(a)(46)(B) with respect to the
individual.</text>
</subparagraph><subparagraph id="HCD840166FCE24F54BC494BD317A13586"><enum>(B)</enum><header>Enhanced
payments</header><text>Notwithstanding subsection (b), the enhanced FMAP with
respect to payments under subsection (a) for expenditures described in clause
(i) or (ii) of section 1903(a)(3)(F) necessary to comply with subparagraph (A)
shall in no event be less than 90 percent and 75 percent,
respectively.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HFC073ECE20064EC5B769F247E6E9212E"><enum>(2)</enum><header>Nonapplication
of administrative expenditures cap</header><text>Section 2105(c)(2)(C) (42
U.S.C. 1397ee(c)(2)(C)), as amended by section 202(b), is amended by adding at
the end the following:</text>
<quoted-block id="H09C28B66474E4CC1B3BE83957F9CAFFD" style="OLC">
<clause id="H185DA8AF9AA740859F00189300712B84"><enum>(ii)</enum><header>Expenditures to
comply with citizenship or nationality verification
requirements</header><text>Expenditures necessary for the State to comply with
paragraph
(9)(A).</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HCEE1CD2C056A4DFB0074546D413174A9"><enum>(d)</enum><header>Effective
Date</header>
<paragraph id="H3FC5DD11F4504440AFC0009800A585D"><enum>(1)</enum><header>In
general</header>
<subparagraph id="HE881FCF20EF34476AC38EF1B66DE051C"><enum>(A)</enum><header>In
general</header><text>Except as provided in subparagraph (B), the amendments
made by this section shall take effect on January 1, 2010.</text>
</subparagraph><subparagraph id="HB08681DC657B416F93F935A200B94255"><enum>(B)</enum><header>Technical
amendments</header><text>The amendments made by—</text>
<clause id="H486EAB5B73304E61A600EB678FC18194"><enum>(i)</enum><text>paragraphs (1),
(2), and (3) of subsection (b) shall take effect as if included in the
enactment of section 6036 of the Deficit Reduction Act of 2005 (Public Law
109–171; 120 Stat. 80); and</text>
</clause><clause id="HDA29E2C408F141A58415CB64A7A05073"><enum>(ii)</enum><text>paragraph (4) of
subsection (b) shall take effect as if included in the enactment of section 405
of division B of the Tax Relief and Health Care Act of 2006 (Public Law
109–432; 120 Stat. 2996).</text>
</clause></subparagraph></paragraph><paragraph id="H335A56287E5B4F9BB42D457239D0224"><enum>(2)</enum><header>Restoration of
eligibility</header><text>In the case of an individual who, during the period
that began on July 1, 2006, and ends on October 1, 2009, was determined to be
ineligible for medical assistance under a State Medicaid plan, including any
waiver of such plan, solely as a result of the application of subsections
(i)(22) and (x) of section 1903 of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (as in effect during such period), but who would have
been determined eligible for such assistance if such subsections, as amended by
subsection (b), had applied to the individual, a State may deem the individual
to be eligible for such assistance as of the date that the individual was
determined to be ineligible for such medical assistance on such basis.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H982667CADBE14DB790D98F3E596CC062"><enum>(3)</enum><header>Special
transition rule for indians</header><text>During the period that begins on July
1, 2006, and ends on the effective date of final regulations issued under
subclause (II) of section 1903(x)(3)(B)(v) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an individual who is a
member of a federally-recognized Indian tribe described in subclause (II) of
that section who presents a document described in subclause (I) of such section
that is issued by such Indian tribe, shall be deemed to have presented
satisfactory evidence of citizenship or nationality for purposes of satisfying
the requirement of subsection (x) of section 1903 of such Act.</text>
</paragraph></subsection></section><section display-inline="no-display-inline" id="HE8EB950EF27948FA963623D0651000A4" section-type="subsequent-section"><enum>212.</enum><header>Reducing
administrative barriers to enrollment</header><text display-inline="no-display-inline">Section 2102(b) (42 U.S.C. 1397bb(b)) is
amended—</text>
<paragraph id="HEE65C2EA0ADB4D8F82D7A27431FB5ED4"><enum>(1)</enum><text>by redesignating
paragraph (4) as paragraph (5); and</text>
</paragraph><paragraph id="H655B233711F84024B05C4BD8B0ECFE20"><enum>(2)</enum><text>by inserting after
paragraph (3) the following new paragraph:</text>
<quoted-block id="HACA12834822E4A09978BD6B14FDB956C" style="OLC">
<paragraph id="H23A1643C816B43DDA7FBF8DE9E2335FF"><enum>(4)</enum><header>Reduction of
administrative barriers to enrollment</header>
<subparagraph id="H23A5A54D19664E10B8DD362010A4C676"><enum>(A)</enum><header>In
general</header><text>Subject to subparagraph (B), the plan shall include a
description of the procedures used to reduce administrative barriers to the
enrollment of children and pregnant women who are eligible for medical
assistance under title XIX or for child health assistance or health benefits
coverage under this title. Such procedures shall be established and revised as
often as the State determines appropriate to take into account the most recent
information available to the State identifying such barriers.</text>
</subparagraph><subparagraph id="H97D9DC2BBE5F419DBBEB30AE19DC3794"><enum>(B)</enum><header>Deemed
compliance if joint application and renewal process that permits application
other than in person</header><text>A State shall be deemed to comply with
subparagraph (A) if the State’s application and renewal forms and supplemental
forms (if any) and information verification process is the same for purposes of
establishing and renewing eligibility for children and pregnant women for
medical assistance under title XIX and child health assistance under this
title, and such process does not require an application to be made in person or
a face-to-face
interview.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section display-inline="no-display-inline" id="H1C1ED0104ACD4929AEFE292703CB77ED" section-type="subsequent-section"><enum>213.</enum><header>Model of Interstate
coordinated enrollment and coverage process</header>
<subsection id="HEA92961B8EF1420DB5FEA889DD2374E7"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">In order to assure
continuity of coverage of low-income children under the Medicaid program and
the State Children’s Health Insurance Program (CHIP), not later than 18 months
after the date of the enactment of this Act, the Secretary of Health and Human
Services, in consultation with State Medicaid and CHIP directors and
organizations representing program beneficiaries, shall develop a model process
for the coordination of the enrollment, retention, and coverage under such
programs of children who, because of migration of families, emergency
evacuations, natural or other disasters, public health emergencies, educational
needs, or otherwise, frequently change their State of residency or otherwise
are temporarily located outside of the State of their residency.</text>
</subsection><subsection id="H5971EE1222D24F2DA95F2DC21ECD39E"><enum>(b)</enum><header>Report to
Congress</header><text>After development of such model process, the Secretary
of Health and Human Services shall submit to Congress a report describing
additional steps or authority needed to make further improvements to coordinate
the enrollment, retention, and coverage under CHIP and Medicaid of children
described in subsection (a).</text>
</subsection></section><section id="H8DD8250B18524DDA955362E9A5BCF1F5"><enum>214.</enum><header>Permitting
States to ensure coverage without a 5-year delay of certain children and
pregnant women under the Medicaid program and CHIP</header>
<subsection id="HFB747605E1764431B4DCDC9C51EF7358"><enum>(a)</enum><header>Medicaid
program</header><text>Section 1903(v) (42 U.S.C. 1396b(v)) is amended—</text>
<paragraph id="H049CEC6105224FAD90B8E5D742152FDD"><enum>(1)</enum><text>in paragraph (1),
by striking <quote>paragraph (2)</quote> and inserting <quote>paragraphs (2)
and (4)</quote>; and</text>
</paragraph><paragraph id="H5ABAB4DF05BD4CC68DA0017B2CAB5D0"><enum>(2)</enum><text>by
adding at the end the following new paragraph:</text>
<quoted-block id="H4F4AC6FF7EB34C6DAD4CD06C6B96DEF9">
<paragraph id="H4E0702006DAA4D6192006C3D4B319C72" indent="up1"><enum>(4)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="HB70CDB32D4D14F528B10DC2832381761"><enum>(A)</enum><text>A State may elect (in a
plan amendment under this title) to provide medical assistance under this
title, notwithstanding sections 401(a), 402(b), 403, and 421 of the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996, to children and
pregnant women who are lawfully residing in the United States (including
battered individuals described in section 431(c) of such Act) and who are
otherwise eligible for such assistance, within either or both of the following
eligibility categories:</text>
<clause id="HA8A2E18A04654CFC91E19706388EBE2D" indent="up1"><enum>(i)</enum><header>Pregnant women</header><text>Women
during pregnancy (and during the 60-day period beginning on the last day of the
pregnancy).</text>
</clause><clause id="HE61A92DDBF704435AC502B6C28F57831" indent="up1"><enum>(ii)</enum><header>Children</header><text display-inline="yes-display-inline">Individuals under 21 years of age,
including optional targeted low-income children described in section
1905(u)(2)(B).</text>
</clause></subparagraph><subparagraph id="H44D5438F380941898200EBB608DAEB4D" indent="up1"><enum>(B)</enum><text>In the case of a State that has
elected to provide medical assistance to a category of aliens under
subparagraph (A), no debt shall accrue under an affidavit of support against
any sponsor of such an alien on the basis of provision of assistance to such
category and the cost of such assistance shall not be considered as an
unreimbursed cost.</text>
</subparagraph><subparagraph commented="no" id="H96627F4DD4014FCCB23F94AB34579C25" indent="up1"><enum>(C)</enum><text>A State shall demonstrate that the
State requires an individual provided medical assistance as a result of an
election by the State under subparagraph (A), to provide the State, as part of
the State's ongoing eligibility redetermination requirements and procedures,
with documentation or other evidence that the individual is lawfully residing
in the United
States.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HA5CAC19C3FEA497A80D080F80052CBE1"><enum>(b)</enum><header>CHIP</header><text>Section
2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as amended by sections 203(a)(2) and
203(d)(2), is amended by redesignating subparagraphs (E) and (F) as
subparagraphs (F) and (G), respectively and by inserting after subparagraph (D)
the following new subparagraph:</text>
<quoted-block id="H7A64E40B1F9E4B22B106A092C87600D1">
<subparagraph id="HB1BAFFE0C6E24A0EBD1006F837211315"><enum>(E)</enum><text>Paragraph (4) of
section 1903(v) (relating to optional coverage of categories of lawfully
residing immigrant children or pregnant women), but only if the State has
elected to apply such paragraph with respect to such category of children or
pregnant women under title
XIX.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section></subtitle><enum>III</enum><header>Reducing
Barriers to Providing Premium Assistance</header>
<subtitle id="H03B4E8F5E78B4088BC0074104BDF091F"><enum>A</enum><header>Additional State
Option for Providing Premium Assistance</header>
<section id="H4BDAF9E6BB7A45048880889EC9DCA614"><enum>301.</enum><header>Additional
State option for providing premium assistance</header>
<subsection id="H5A00AC7A2A68465E80BDD97B13BD2729"><enum>(a)</enum><header>CHIP</header>
<paragraph id="H664D74AC320E47D1980091C611408173"><enum>(1)</enum><header>In
general</header><text>Section 2105(c) (42 U.S.C. 1397ee(c)), as amended by
sections 114(a) and 211(c), is amended by adding at the end the
following:</text>
<quoted-block id="H8D56A80CD86C4DD28068BF1700A1F1E8" style="OLC">
<paragraph display-inline="no-display-inline" id="H41240905C88A473A8C4D459DCA525FDD"><enum>(10)</enum><header>State option to
offer premium assistance</header>
<subparagraph id="HFAE88E6FF1104A92AA7D19EF8C3814D9"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">A State may elect to
offer a premium assistance subsidy (as defined in subparagraph (C)) for
qualified employer-sponsored coverage (as defined in subparagraph (B)) to all
targeted low-income children who are eligible for child health assistance under
the plan and have access to such coverage in accordance with the requirements
of this paragraph. No subsidy shall be provided to a targeted low-income child
under this paragraph unless the child (or the child’s parent) voluntarily
elects to receive such a subsidy. A State may not require such an election as a
condition of receipt of child health assistance.</text>
</subparagraph><subparagraph id="H57C54E0CDD2D4A3688C040C0EDAEBC71"><enum>(B)</enum><header>Qualified
employer-sponsored coverage</header>
<clause id="HE9AD4DB32D59452582151986ACCA8D79"><enum>(i)</enum><header>In
general</header><text>Subject to clause (ii), in this paragraph, the term
<term>qualified employer-sponsored coverage</term> means a group health plan or
health insurance coverage offered through an employer—</text>
<subclause id="H7CAD558E10544C1594B7BAD864C39854"><enum>(I)</enum><text>that qualifies as
creditable coverage as a group health plan under section 2701(c)(1) of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name>;</text>
</subclause><subclause id="H8B5BEB7EA8BC4E87BE50E5F71D28E151"><enum>(II)</enum><text>for which the
employer contribution toward any premium for such coverage is at least 40
percent; and</text>
</subclause><subclause id="H0DC75697F3FD40A1BAC5DF01004CCDEA"><enum>(III)</enum><text>that is offered
to all individuals in a manner that would be considered a nondiscriminatory
eligibility classification for purposes of paragraph (3)(A)(ii) of section
105(h) of the Internal Revenue Code of 1986 (but determined without regard to
clause (i) of subparagraph (B) of such paragraph).</text>
</subclause></clause><clause id="HFB1CD3A472D24396809CF669E39F47D"><enum>(ii)</enum><header>Exception</header><text>Such
term does not include coverage consisting of—</text>
<subclause id="H933D4028001546A7002FE8FAABFFB439"><enum>(I)</enum><text>benefits provided
under a health flexible spending arrangement (as defined in section 106(c)(2)
of the Internal Revenue Code of 1986); or</text>
</subclause><subclause id="H17457D9503564D9386BF9BA737862949"><enum>(II)</enum><text>a high deductible
health plan (as defined in section 223(c)(2) of such Code), without regard to
whether the plan is purchased in conjunction with a health savings account (as
defined under section 223(d) of such Code).</text>
</subclause></clause></subparagraph><subparagraph id="H756D13F9AC9B48879EDAF73984D59BA8"><enum>(C)</enum><header>Premium
assistance subsidy</header>
<clause id="HE196289033E94B35B9E8A48338513478"><enum>(i)</enum><header>In
general</header><text>In this paragraph, the term <term>premium assistance
subsidy</term> means, with respect to a targeted low-income child, the amount
equal to the difference between the employee contribution required for
enrollment only of the employee under qualified employer-sponsored coverage and
the employee contribution required for enrollment of the employee and the child
in such coverage, less any applicable premium cost-sharing applied under the
State child health plan (subject to the limitations imposed under section
2103(e), including the requirement to count the total amount of the employee
contribution required for enrollment of the employee and the child in such
coverage toward the annual aggregate cost-sharing limit applied under paragraph
(3)(B) of such section).</text>
</clause><clause id="HEF7D15DEA65640D89196A6F7F2C8AA7"><enum>(ii)</enum><header>State payment
option</header><text>A State may provide a premium assistance subsidy either as
reimbursement to an employee for out-of-pocket expenditures or, subject to
clause (iii), directly to the employee’s employer.</text>
</clause><clause id="H1F97C8772A654CD585792CA79B13DC2D"><enum>(iii)</enum><header>Employer
opt-out</header><text>An employer may notify a State that it elects to opt-out
of being directly paid a premium assistance subsidy on behalf of an employee.
In the event of such a notification, an employer shall withhold the total
amount of the employee contribution required for enrollment of the employee and
the child in the qualified employer-sponsored coverage and the State shall pay
the premium assistance subsidy directly to the employee.</text>
</clause><clause id="H5EF2AEED189344AD8690D4B9C68E19"><enum>(iv)</enum><header>Treatment as
child health assistance</header><text>Expenditures for the provision of premium
assistance subsidies shall be considered child health assistance described in
paragraph (1)(C) of subsection (a) for purposes of making payments under that
subsection.</text>
</clause></subparagraph><subparagraph id="H56DF8881F183499C907F0996718E0097"><enum>(D)</enum><header>Application of
secondary payor rules</header><text>The State shall be a secondary payor for
any items or services provided under the qualified employer-sponsored coverage
for which the State provides child health assistance under the State child
health plan.</text>
</subparagraph><subparagraph id="HDC3C0D3644404A39A96868EC9BE9FA5"><enum>(E)</enum><header>Requirement to
provide supplemental coverage for benefits and cost-sharing protection provided
under the state child health plan</header>
<clause id="HF163E4AFCEBE4C75B3AD5F655DFFA765"><enum>(i)</enum><header>In
general</header><text>Notwithstanding section 2110(b)(1)(C), the State shall
provide for each targeted low-income child enrolled in qualified
employer-sponsored coverage, supplemental coverage consisting of—</text>
<subclause id="HD7824D365CA04552AF4566CB44682FB0"><enum>(I)</enum><text>items or services
that are not covered, or are only partially covered, under the qualified
employer-sponsored coverage; and</text>
</subclause><subclause id="H382A461E3FD843B0B164C4A97CC8CF52"><enum>(II)</enum><text>cost-sharing
protection consistent with section 2103(e).</text>
</subclause></clause><clause id="HCEF579AA03AE433BBD5E6F296356AEDE"><enum>(ii)</enum><header>Record keeping
requirements</header><text>For purposes of carrying out clause (i), a State may
elect to directly pay out-of-pocket expenditures for cost-sharing imposed under
the qualified employer-sponsored coverage and collect or not collect all or any
portion of such expenditures from the parent of the child.</text>
</clause></subparagraph><subparagraph id="H2743EDC1D4BC41048F1EEAAB8D8795"><enum>(F)</enum><header>Application of
waiting period imposed under the state</header><text>Any waiting period imposed
under the State child health plan prior to the provision of child health
assistance to a targeted low-income child under the State plan shall apply to
the same extent to the provision of a premium assistance subsidy for the child
under this paragraph.</text>
</subparagraph><subparagraph id="H83420B63AB7842B182074C5268947699"><enum>(G)</enum><header>Opt-out
permitted for any month</header><text>A State shall establish a process for
permitting the parent of a targeted low-income child receiving a premium
assistance subsidy to disenroll the child from the qualified employer-sponsored
coverage and enroll the child in, and receive child health assistance under,
the State child health plan, effective on the first day of any month for which
the child is eligible for such assistance and in a manner that ensures
continuity of coverage for the child.</text>
</subparagraph><subparagraph id="H366AC5A8824B4D8F8BEC859C49E02EC0"><enum>(H)</enum><header>Application to
parents</header><text>If a State provides child health assistance or health
benefits coverage to parents of a targeted low-income child in accordance with
section 2111(b), the State may elect to offer a premium assistance subsidy to a
parent of a targeted low-income child who is eligible for such a subsidy under
this paragraph in the same manner as the State offers such a subsidy for the
enrollment of the child in qualified employer-sponsored coverage, except
that—</text>
<clause id="HEC5229EF7C564E61B743B4A5A5002F20"><enum>(i)</enum><text>the amount of the
premium assistance subsidy shall be increased to take into account the cost of
the enrollment of the parent in the qualified employer-sponsored coverage or,
at the option of the State if the State determines it cost-effective, the cost
of the enrollment of the child’s family in such coverage; and</text>
</clause><clause id="HF0F5765751C94996B7F944200985B3F0"><enum>(ii)</enum><text>any reference in
this paragraph to a child is deemed to include a reference to the parent or, if
applicable under clause (i), the family of the child.</text>
</clause></subparagraph><subparagraph id="HBB8FBC0082F74C869BB7FC3448B62891"><enum>(I)</enum><header>Additional state
option for providing premium assistance</header>
<clause id="H8DF67BA8A3C64F2093699D0970B2DBB0"><enum>(i)</enum><header>In
general</header><text>A State may establish an employer-family premium
assistance purchasing pool for employers with less than 250 employees who have
at least 1 employee who is a pregnant woman eligible for assistance under the
State child health plan (including through the application of an option
described in section 2112(f)) or a member of a family with at least 1 targeted
low-income child and to provide a premium assistance subsidy under this
paragraph for enrollment in coverage made available through such pool.</text>
</clause><clause id="H69AA67D9D5344BB5AFB145469D432BAB"><enum>(ii)</enum><header>Access to
choice of coverage</header><text>A State that elects the option under clause
(i) shall identify and offer access to not less than 2 private health plans
that are health benefits coverage that is equivalent to the benefits coverage
in a benchmark benefit package described in section 2103(b) or
benchmark-equivalent coverage that meets the requirements of section 2103(a)(2)
for employees described in clause (i).</text>
</clause><clause id="H79AA7EF9BB3C42BC85D113EC9F115632"><enum>(iii)</enum><header>Clarification
of payment for administrative expenditures</header><text>Nothing in this
subparagraph shall be construed as permitting payment under this section for
administrative expenditures attributable to the establishment or operation of
such pool, except to the extent that such payment would otherwise be permitted
under this title.</text>
</clause></subparagraph><subparagraph id="H1E271EB189D74966B95D9D97C5854579"><enum>(J)</enum><header>No effect on
premium assistance waiver programs</header><text>Nothing in this paragraph
shall be construed as limiting the authority of a State to offer premium
assistance under section 1906 or 1906A, a waiver described in paragraph (2)(B)
or (3), a waiver approved under section 1115, or other authority in effect
prior to the date of enactment of the Children’s Health Insurance Program
Reauthorization Act of 2009.</text>
</subparagraph><subparagraph id="H1CB79A6CF3AA4CA495426013C9D670EC"><enum>(K)</enum><header>Notice of
availability</header><text>If a State elects to provide premium assistance
subsidies in accordance with this paragraph, the State shall—</text>
<clause id="H821C6850E93F4DE7AC6434B928AE7800"><enum>(i)</enum><text>include on any
application or enrollment form for child health assistance a notice of the
availability of premium assistance subsidies for the enrollment of targeted
low-income children in qualified employer-sponsored coverage;</text>
</clause><clause id="H62DC67CAF9BC4972ACB782A8A82DC3F"><enum>(ii)</enum><text>provide, as part
of the application and enrollment process under the State child health plan,
information describing the availability of such subsidies and how to elect to
obtain such a subsidy; and</text>
</clause><clause id="H929D1ADC147444A08DA13EC00C28879"><enum>(iii)</enum><text>establish such
other procedures as the State determines necessary to ensure that parents are
fully informed of the choices for receiving child health assistance under the
State child health plan or through the receipt of premium assistance
subsidies.</text>
</clause></subparagraph><subparagraph id="H8EDAF9C9F73740E8B3C35D595DF8592"><enum>(L)</enum><header>Application to
qualified employer-sponsored benchmark coverage</header><text>If a group health
plan or health insurance coverage offered through an employer is certified by
an actuary as health benefits coverage that is equivalent to the benefits
coverage in a benchmark benefit package described in section 2103(b) or
benchmark-equivalent coverage that meets the requirements of section
2103(a)(2), the State may provide premium assistance subsidies for enrollment
of targeted low-income children in such group health plan or health insurance
coverage in the same manner as such subsidies are provided under this paragraph
for enrollment in qualified employer-sponsored coverage, but without regard to
the requirement to provide supplemental coverage for benefits and cost-sharing
protection provided under the State child health plan under subparagraph
(E).</text>
</subparagraph><subparagraph id="H4AF370231E6340C4A590CBAEE41DD754"><enum>(M)</enum><header>Satisfaction of
cost-effectiveness test</header><text display-inline="yes-display-inline">Premium assistance subsidies for qualified
employer-sponsored coverage offered under this paragraph shall be deemed to
meet the requirement of subparagraph (A) of paragraph (3).</text>
</subparagraph><subparagraph id="HBE189CE7615541228FA53F6B9EFDF4D"><enum>(N)</enum><header>Coordination with
medicaid</header><text display-inline="yes-display-inline">In the case of a
targeted low-income child who receives child health assistance through a State
plan under title XIX and who voluntarily elects to receive a premium assistance
subsidy under this section, the provisions of section 1906A shall apply and
shall supersede any other provisions of this paragraph that are inconsistent
with such
section.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HCB0804EC83124130A1254E7080627EA9"><enum>(2)</enum><header>Determination of
cost-effectiveness for premium assistance or purchase of family
coverage</header>
<subparagraph id="H8CC13BAE56574E50945476A4A3DA72C3"><enum>(A)</enum><header>In
general</header><text>Section 2105(c)(3)(A) (42 U.S.C. 1397ee(c)(3)(A)) is
amended by striking <quote>relative to</quote> and all that follows through the
comma and inserting “relative to</text>
<quoted-block display-inline="no-display-inline" id="HBD86C960347C4F33815CBB007411E520" style="OLC">
<clause id="H5C57F1AF60F34D7E88B36DE4C0F19479"><enum>(i)</enum><text>the amount of
expenditures under the State child health plan, including administrative
expenditures, that the State would have made to provide comparable coverage of
the targeted low-income child involved or the family involved (as applicable);
or</text>
</clause><clause id="HD1F480D0E6AA48D09E19773976CDACBF"><enum>(ii)</enum><text>the aggregate
amount of expenditures that the State would have made under the State child
health plan, including administrative expenditures, for providing coverage
under such plan for all such children or
families.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H2D04D129691F4AB7AD7F91572BD85EE1"><enum>(B)</enum><header>Nonapplication
to previously approved coverage</header><text>The amendment made by
subparagraph (A) shall not apply to coverage the purchase of which has been
approved by the Secretary under section 2105(c)(3) of the Social Security Act
prior to the date of enactment of this Act.</text>
</subparagraph></paragraph></subsection><subsection id="H74AF8D5ED51149F1B046A9CCB221DC13"><enum>(b)</enum><header>Medicaid</header><text display-inline="yes-display-inline">Title XIX is amended by inserting after
section 1906 the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H90A881B0A799443395B7D5003B52006D" style="traditional">
<section id="HA9B5C1A432ED4EC495464741E1F9AC00"><enum>1906A.</enum><header>Premium Assistance Option for Children</header><subsection commented="no" display-inline="yes-display-inline" id="HB8B0EE841DCC463DBE4900EE8054006D"><enum>(a)</enum><header>In
general</header><text>A State may elect to offer a premium assistance subsidy
(as defined in subsection (c)) for qualified employer-sponsored coverage (as
defined in subsection (b)) to all individuals under age 19 who are entitled to
medical assistance under this title (and to the parent of such an individual)
who have access to such coverage if the State meets the requirements of this
section.</text>
</subsection><subsection id="H89FB93AF44A7412BB01BA4AABE889DA5"><enum>(b)</enum><header>Qualified
employer-sponsored coverage</header>
<paragraph display-inline="no-display-inline" id="H1EB0BE21B5DF4F178960862ED3ED27A3"><enum>(1)</enum><header>In
general</header><text>Subject to paragraph (2)), in this paragraph, the term
<term>qualified employer-sponsored coverage</term> means a group health plan or
health insurance coverage offered through an employer—</text>
<subparagraph id="HC17DC1AF260D49AB93EAB06CED639E8"><enum>(A)</enum><text>that qualifies as
creditable coverage as a group health plan under section 2701(c)(1) of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name>;</text>
</subparagraph><subparagraph id="HF34260558ACC45C9BBDEC66F08C9A009"><enum>(B)</enum><text>for which the
employer contribution toward any premium for such coverage is at least 40
percent; and</text>
</subparagraph><subparagraph id="H3DFC5A54C7F04A1E8C9E7144CA29699B"><enum>(C)</enum><text>that is offered to
all individuals in a manner that would be considered a nondiscriminatory
eligibility classification for purposes of paragraph (3)(A)(ii) of section
105(h) of the Internal Revenue Code of 1986 (but determined without regard to
clause (i) of subparagraph (B) of such paragraph).</text>
</subparagraph></paragraph><paragraph id="H57454B4B4A5C458DA1C5128EF9710000"><enum>(2)</enum><header>Exception</header><text>Such
term does not include coverage consisting of—</text>
<subparagraph id="HA069E403134E435E00004521769E90E2"><enum>(A)</enum><text>benefits provided
under a health flexible spending arrangement (as defined in section 106(c)(2)
of the Internal Revenue Code of 1986); or</text>
</subparagraph><subparagraph id="H226CF38F3E0C4A94901D7F14A97F8400"><enum>(B)</enum><text>a high deductible
health plan (as defined in section 223(c)(2) of such Code), without regard to
whether the plan is purchased in conjunction with a health savings account (as
defined under section 223(d) of such Code).</text>
</subparagraph></paragraph><paragraph id="HD96C6C7D17ED48389630D0D487FAC9C1"><enum>(3)</enum><header>Treatment as
third party liability</header><text>The State shall treat the coverage provided
under qualified employer-sponsored coverage as a third party liability under
section 1902(a)(25).</text>
</paragraph></subsection><subsection id="H06BE3759C64345ADB39DEC34C4ED99B8"><enum>(c)</enum><header>Premium
assistance subsidy</header><text>In this section, the term <term>premium
assistance subsidy</term> means the amount of the employee contribution for
enrollment in the qualified employer-sponsored coverage by the individual under
age 19 or by the individual’s family. Premium assistance subsidies under this
section shall be considered, for purposes of section 1903(a), to be a payment
for medical assistance.</text>
</subsection><subsection id="H3B72D73CB73647A99B091FEC9BF198D"><enum>(d)</enum><header>Voluntary
participation</header>
<paragraph id="HB2B368958D60481592CDB0309638AD9F"><enum>(1)</enum><header>Employers</header><text>Participation
by an employer in a premium assistance subsidy offered by a State under this
section shall be voluntary. An employer may notify a State that it elects to
opt-out of being directly paid a premium assistance subsidy on behalf of an
employee.</text>
</paragraph><paragraph id="H056EE4607A5946C6A464BFA37DE3C786"><enum>(2)</enum><header>Beneficiaries</header><text display-inline="yes-display-inline">No subsidy shall be provided to an
individual under age 19 under this section unless the individual (or the
individual’s parent) voluntarily elects to receive such a subsidy. A State may
not require such an election as a condition of receipt of medical assistance.
State may not require, as a condition of an individual under age 19 (or the
individual’s parent) being or remaining eligible for medical assistance under
this title, apply for enrollment in qualified employer-sponsored coverage under
this section.</text>
</paragraph><paragraph id="H36B8D4AF17F64008ADC01BD9FB708C80"><enum>(3)</enum><header>Opt-out
permitted for any month</header><text>A State shall establish a process for
permitting the parent of an individual under age 19 receiving a premium
assistance subsidy to disenroll the individual from the qualified
employer-sponsored coverage.</text>
</paragraph></subsection><subsection id="H3ADEC043E297470F86B64214AD342E14"><enum>(e)</enum><header>Requirement To
pay premiums and cost-sharing and provide supplemental
coverage</header><text>In the case of the participation of an individual under
age 19 (or the individual’s parent) in a premium assistance subsidy under this
section for qualified employer-sponsored coverage, the State shall provide for
payment of all enrollee premiums for enrollment in such coverage and all
deductibles, coinsurance, and other cost-sharing obligations for items and
services otherwise covered under the State plan under this title (exceeding the
amount otherwise permitted under section 1916 or, if applicable, section
1916A). The fact that an individual under age 19 (or a parent) elects to enroll
in qualified employer-sponsored coverage under this section shall not change
the individual’s (or parent’s) eligibility for medical assistance under the
State plan, except insofar as section 1902(a)(25) provides that payments for
such assistance shall first be made under such
coverage.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H794AC52AD2344CA70057C4649389D034"><enum>(c)</enum><header>GAO Study and
Report</header><text>Not later than January 1, 2010, the Comptroller General of
the United States shall study cost and coverage issues relating to any State
premium assistance programs for which Federal matching payments are made under
title XIX or XXI of the <act-name parsable-cite="SSA">Social Security
Act</act-name>, including under waiver authority, and shall submit a report to
the Committee on Finance of the Senate and the Committee on Energy and Commerce
of the House of Representatives on the results of such study.</text>
</subsection></section><section display-inline="no-display-inline" id="HB42CC0C998FF4068A2E7EA3A4AD949" section-type="subsequent-section"><enum>302.</enum><header>Outreach, education,
and enrollment assistance</header>
<subsection id="H403F5F4F4C16471DAA879784552CB3D3"><enum>(a)</enum><header>Requirement To
Include Description of Outreach, Education, and Enrollment Efforts Related to
Premium Assistance Subsidies in State Child Health Plan</header><text>Section
2102(c) (42 U.S.C. 1397bb(c)) is amended by adding at the end the following new
paragraph:</text>
<quoted-block id="HD90768A952B14DD2A4DD390377A92695" style="OLC">
<paragraph id="HEAB2FE8107344C5FB3F5BEAC555500AB"><enum>(3)</enum><header>Premium
assistance subsidies</header><text display-inline="yes-display-inline">In the
case of a State that provides for premium assistance subsidies under the State
child health plan in accordance with paragraph (2)(B), (3), or (10) of section
2105(c), or a waiver approved under section 1115, outreach, education, and
enrollment assistance for families of children likely to be eligible for such
subsidies, to inform such families of the availability of, and to assist them
in enrolling their children in, such subsidies, and for employers likely to
provide coverage that is eligible for such subsidies, including the specific,
significant resources the State intends to apply to educate employers about the
availability of premium assistance subsidies under the State child health
plan.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HC1F5A2750E11448B86F1DD4B50F8238F"><enum>(b)</enum><header>Nonapplication
of 10 Percent Limit on Outreach and Certain Other
Expenditures</header><text>Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)),
as amended by section 211(c)(2), is amended by adding at the end the following
new clause:</text>
<quoted-block id="HD8267F459A6843888DCCF51509A25DD9" style="OLC">
<clause id="H69C555D1016349E49700CF60AE5DC733"><enum>(iii)</enum><header>Expenditures
for outreach to increase the enrollment of children under this title and title
<enum-in-header>XIX</enum-in-header> through premium assistance
subsidies</header><text>Expenditures for outreach activities to families of
children likely to be eligible for premium assistance subsidies in accordance
with paragraph (2)(B), (3), or (10), or a waiver approved under section 1115,
to inform such families of the availability of, and to assist them in enrolling
their children in, such subsidies, and to employers likely to provide qualified
employer-sponsored coverage (as defined in subparagraph (B) of such paragraph),
but not to exceed an amount equal to 1.25 percent of the maximum amount
permitted to be expended under subparagraph (A) for items described in
subsection
(a)(1)(D).</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section></subtitle><subtitle id="H5F0896894BC942869F44EB1EED69633C"><enum>B</enum><header>Coordinating
Premium Assistance with Private Coverage</header>
<section id="HB01F2916E7B74A4A84DF00197EDFA35F"><enum>311.</enum><header>Special
enrollment period under group health plans in case of termination of Medicaid
or CHIP coverage or eligibility for assistance in purchase of employment-based
coverage; coordination of coverage</header>
<subsection id="H6E89D64C991445B0A7D8902ED3970060"><enum>(a)</enum><header>Amendments to
Internal Revenue Code of 1986</header><text>Section 9801(f) of the Internal
Revenue Code of 1986 (relating to special enrollment periods) is amended by
adding at the end the following new paragraph:</text>
<quoted-block id="H9634A4FFD1F4485795001C16C2FBEF7B" style="OLC">
<paragraph id="H4A536D966E384D0EABAE2900F6C54F20"><enum>(3)</enum><header>Special rules
relating to medicaid and chip</header>
<subparagraph id="H0FB08CA4CD47460700F23E205ECE531C"><enum>(A)</enum><header>In
general</header><text>A group health plan shall permit an employee who is
eligible, but not enrolled, for coverage under the terms of the plan (or a
dependent of such an employee if the dependent is eligible, but not enrolled,
for coverage under such terms) to enroll for coverage under the terms of the
plan if either of the following conditions is met:</text>
<clause id="HDAA453DCAE0B460394108182A33C7746"><enum>(i)</enum><header>Termination of
medicaid or chip coverage</header><text>The employee or dependent is covered
under a Medicaid plan under title XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name> or under a State child
health plan under title XXI of such Act and coverage of the employee or
dependent under such a plan is terminated as a result of loss of eligibility
for such coverage and the employee requests coverage under the group health
plan not later than 60 days after the date of termination of such
coverage.</text>
</clause><clause id="H026C96044D3340030068A0C5EBA7DF8D"><enum>(ii)</enum><header>Eligibility for
employment assistance under medicaid or chip</header><text>The employee or
dependent becomes eligible for assistance, with respect to coverage under the
group health plan under such Medicaid plan or State child health plan
(including under any waiver or demonstration project conducted under or in
relation to such a plan), if the employee requests coverage under the group
health plan not later than 60 days after the date the employee or dependent is
determined to be eligible for such assistance.</text>
</clause></subparagraph><subparagraph id="H47B84FD43D094C03877510DCDAB9C0B3"><enum>(B)</enum><header>Employee
outreach and disclosure</header>
<clause id="H851F5ADD94234F1F973B6F97A63BE1E"><enum>(i)</enum><header>Outreach to
employees regarding availability of medicaid and chip coverage</header>
<subclause id="HB42341A2F63C4A86B41E3DF705F912FA"><enum>(I)</enum><header>In
general</header><text>Each employer that maintains a group health plan in a
State that provides medical assistance under a State Medicaid plan under title
XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name>, or
child health assistance under a State child health plan under title XXI of such
Act, in the form of premium assistance for the purchase of coverage under a
group health plan, shall provide to each employee a written notice informing
the employee of potential opportunities then currently available in the State
in which the employee resides for premium assistance under such plans for
health coverage of the employee or the employee’s dependents. For purposes of
compliance with this clause, the employer may use any State-specific model
notice developed in accordance with section 701(f)(3)(B)(i)(II) of the
<act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
1974</act-name> (29 U.S.C. 1181(f)(3)(B)(i)(II)).</text>
</subclause><subclause id="H46C5C26199DD4A2D83DDEFCBB2331627"><enum>(II)</enum><header>Option to
provide concurrent with provision of plan materials to employee</header><text display-inline="yes-display-inline">An employer may provide the model notice
applicable to the State in which an employee resides concurrent with the
furnishing of materials notifying the employee of health plan eligibility,
concurrent with materials provided to the employee in connection with an open
season or election process conducted under the plan, or concurrent with the
furnishing of the summary plan description as provided in section 104(b) of the
<act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
1974</act-name> (29 U.S.C. 1024).</text>
</subclause></clause><clause id="HF0B3AB7BC25143988CDAA1AE755B2744"><enum>(ii)</enum><header>Disclosure
about group health plan benefits to states for medicaid and chip eligible
individuals</header><text>In the case of a participant or beneficiary of a
group health plan who is covered under a Medicaid plan of a State under title
XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name> or
under a State child health plan under title XXI of such Act, the plan
administrator of the group health plan shall disclose to the State, upon
request, information about the benefits available under the group health plan
in sufficient specificity, as determined under regulations of the Secretary of
Health and Human Services in consultation with the Secretary that require use
of the model coverage coordination disclosure form developed under section
311(b)(1)(C) of the Children’s Health Insurance Program Reauthorization Act of
2009, so as to permit the State to make a determination (under paragraph
(2)(B), (3), or (10) of section 2105(c) of the <act-name parsable-cite="SSA">Social Security Act</act-name> or otherwise) concerning the
cost-effectiveness of the State providing medical or child health assistance
through premium assistance for the purchase of coverage under such group health
plan and in order for the State to provide supplemental benefits required under
paragraph (10)(E) of such section or other
authority.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H9631692DE6D54860BFB7FE639F26CB02"><enum>(b)</enum><header>Conforming
Amendments</header>
<paragraph id="HF11EDEC40193403B9C3F9F815100005C"><enum>(1)</enum><header>Amendments to
employee retirement income security act</header>
<subparagraph id="H868F2200BFE64210A1FC28C1F2226828"><enum>(A)</enum><header>In
general</header><text>Section 701(f) of the <act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
1974</act-name> (29 U.S.C. 1181(f)) is amended by adding at the end the
following new paragraph:</text>
<quoted-block act-name="Employee" id="HAD4A80278C2D4526877E73939F8B45E0" style="OLC">
<paragraph id="HE8C99A6FD3824882AF19987B5CB8DA20"><enum>(3)</enum><header>Special rules
for application in case of medicaid and chip</header>
<subparagraph id="H25BF5E73EF4D42D095BB25FD26020211"><enum>(A)</enum><header>In
general</header><text>A group health plan, and a health insurance issuer
offering group health insurance coverage in connection with a group health
plan, shall permit an employee who is eligible, but not enrolled, for coverage
under the terms of the plan (or a dependent of such an employee if the
dependent is eligible, but not enrolled, for coverage under such terms) to
enroll for coverage under the terms of the plan if either of the following
conditions is met:</text>
<clause id="HC7690F0CB9AF499800D82C50C1E490AC"><enum>(i)</enum><header>Termination of
medicaid or chip coverage</header><text>The employee or dependent is covered
under a Medicaid plan under title XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name> or under a State child
health plan under title XXI of such Act and coverage of the employee or
dependent under such a plan is terminated as a result of loss of eligibility
for such coverage and the employee requests coverage under the group health
plan (or health insurance coverage) not later than 60 days after the date of
termination of such coverage.</text>
</clause><clause id="H3357536E2DAD48FBA2977EABB84CA84"><enum>(ii)</enum><header>Eligibility for
employment assistance under medicaid or chip</header><text>The employee or
dependent becomes eligible for assistance, with respect to coverage under the
group health plan or health insurance coverage, under such Medicaid plan or
State child health plan (including under any waiver or demonstration project
conducted under or in relation to such a plan), if the employee requests
coverage under the group health plan or health insurance coverage not later
than 60 days after the date the employee or dependent is determined to be
eligible for such assistance.</text>
</clause></subparagraph><subparagraph id="H4C2B60543DF346EDA729AEB800C068D8"><enum>(B)</enum><header>Coordination
with medicaid and chip</header>
<clause id="HCD2EB7F8387F422CA27F90DD94280F6"><enum>(i)</enum><header>Outreach to
employees regarding availability of medicaid and chip coverage</header>
<subclause id="H3B9A66BFC3D540118900DED28BA3C9E8"><enum>(I)</enum><header>In
general</header><text>Each employer that maintains a group health plan in a
State that provides medical assistance under a State Medicaid plan under title
XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name>, or
child health assistance under a State child health plan under title XXI of such
Act, in the form of premium assistance for the purchase of coverage under a
group health plan, shall provide to each employee a written notice informing
the employee of potential opportunities then currently available in the State
in which the employee resides for premium assistance under such plans for
health coverage of the employee or the employee’s dependents.</text>
</subclause><subclause id="H7F31EC0E0A7F4D2DB9B0CE26943DDA24"><enum>(II)</enum><header>Model
notice</header><text>Not later than 1 year after the date of enactment of the
Children’s Health Insurance Program Reauthorization Act of 2009, the Secretary
and the Secretary of Health and Human Services, in consultation with Directors
of State Medicaid agencies under title XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name> and Directors of State CHIP
agencies under title XXI of such Act, shall jointly develop national and
State-specific model notices for purposes of subparagraph (A). The Secretary
shall provide employers with such model notices so as to enable employers to
timely comply with the requirements of subparagraph (A). Such model notices
shall include information regarding how an employee may contact the State in
which the employee resides for additional information regarding potential
opportunities for such premium assistance, including how to apply for such
assistance.</text>
</subclause><subclause display-inline="no-display-inline" id="H9C3B5BAFF51B4A35BEAEE100BE4D9297"><enum>(III)</enum><header>Option to
provide concurrent with provision of plan materials to employee</header><text display-inline="yes-display-inline">An employer may provide the model notice
applicable to the State in which an employee resides concurrent with the
furnishing of materials notifying the employee of health plan eligibility,
concurrent with materials provided to the employee in connection with an open
season or election process conducted under the plan, or concurrent with the
furnishing of the summary plan description as provided in section
104(b).</text>
</subclause></clause><clause id="HD9C9DD5820B4483AB7D6DE03FEAAB97"><enum>(ii)</enum><header>Disclosure about
group health plan benefits to states for medicaid and chip eligible
individuals</header><text>In the case of a participant or beneficiary of a
group health plan who is covered under a Medicaid plan of a State under title
XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name> or
under a State child health plan under title XXI of such Act, the plan
administrator of the group health plan shall disclose to the State, upon
request, information about the benefits available under the group health plan
in sufficient specificity, as determined under regulations of the Secretary of
Health and Human Services in consultation with the Secretary that require use
of the model coverage coordination disclosure form developed under section
311(b)(1)(C) of the Children’s Health Insurance Program Reauthorization Act of
2009, so as to permit the State to make a determination (under paragraph
(2)(B), (3), or (10) of section 2105(c) of the <act-name parsable-cite="SSA">Social Security Act</act-name> or otherwise) concerning the
cost-effectiveness of the State providing medical or child health assistance
through premium assistance for the purchase of coverage under such group health
plan and in order for the State to provide supplemental benefits required under
paragraph (10)(E) of such section or other
authority.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="HA79BC3403D80462AAC8C350660F69773"><enum>(B)</enum><header>Conforming
amendment</header><text>Section 102(b) of the <act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
1974</act-name> (29 U.S.C. 1022(b)) is amended—</text>
<clause id="H786762D00B804D9E8EEA5EF4DE7FF301"><enum>(i)</enum><text>by
striking <quote>and the remedies</quote> and inserting <quote>, the
remedies</quote>; and</text>
</clause><clause id="HC23C4B2BD858456A961142BE58E9321"><enum>(ii)</enum><text>by
inserting before the period the following: <quote>, and if the employer so
elects for purposes of complying with section 701(f)(3)(B)(i), the model notice
applicable to the State in which the participants and beneficiaries
reside</quote>.</text>
</clause></subparagraph><subparagraph id="H7215CF25DBDC461480FBB60301C66494"><enum>(C)</enum><header>Working group to
develop model coverage coordination disclosure form</header>
<clause id="H8B8BB8118F91487FB9B49F7334276061"><enum>(i)</enum><header>Medicaid, chip,
and employer-sponsored coverage coordination working group</header>
<subclause id="HCAC69DE0E45742F2853261DA48ED647"><enum>(I)</enum><header>In
general</header><text>Not later than 60 days after the date of enactment of
this Act, the Secretary of Health and Human Services and the Secretary of Labor
shall jointly establish a Medicaid, CHIP, and Employer-Sponsored Coverage
Coordination Working Group (in this subparagraph referred to as the
<quote>Working Group</quote>). The purpose of the Working Group shall be to
develop the model coverage coordination disclosure form described in subclause
(II) and to identify the impediments to the effective coordination of coverage
available to families that include employees of employers that maintain group
health plans and members who are eligible for medical assistance under title
XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name> or
child health assistance or other health benefits coverage under title XXI of
such Act.</text>
</subclause><subclause id="H09D37FB8C4A44ECE8FAD744DACCDF294"><enum>(II)</enum><header>Model coverage
coordination disclosure form described</header><text>The model form described
in this subclause is a form for plan administrators of group health plans to
complete for purposes of permitting a State to determine the availability and
cost-effectiveness of the coverage available under such plans to employees who
have family members who are eligible for premium assistance offered under a
State plan under title XIX or XXI of such Act and to allow for coordination of
coverage for enrollees of such plans. Such form shall provide the following
information in addition to such other information as the Working Group
determines appropriate:</text>
<item id="H4DC2343EEEF44FC0BBF65E9349111E12"><enum>(aa)</enum><text>A
determination of whether the employee is eligible for coverage under the group
health plan.</text>
</item><item id="HF1961E76DB0A4C958993A46F1CD9D10"><enum>(bb)</enum><text>The
name and contract information of the plan administrator of the group health
plan.</text>
</item><item id="H1B055F3C4E4C4C00A8FDE9E4148B6E2"><enum>(cc)</enum><text>The
benefits offered under the plan.</text>
</item><item id="H4150EC40CE2A4A3EA69B1674E1B845C6"><enum>(dd)</enum><text>The
premiums and cost-sharing required under the plan.</text>
</item><item id="HF285BF5968624B378B80E49F47886D76"><enum>(ee)</enum><text>Any
other information relevant to coverage under the plan.</text>
</item></subclause></clause><clause id="H54404F257C6A47790058BD3BF7764278"><enum>(ii)</enum><header>Membership</header><text>The
Working Group shall consist of not more than 30 members and shall be composed
of representatives of—</text>
<subclause id="H64C3AD11C79145398E00BC5CF0D578C"><enum>(I)</enum><text>the Department of
Labor;</text>
</subclause><subclause id="H893DE2A96AEA40A6A7B3E21C3565E7F"><enum>(II)</enum><text>the Department of
Health and Human Services;</text>
</subclause><subclause id="HB3D680C953BE414BA2D5370855E90050"><enum>(III)</enum><text>State directors
of the Medicaid program under title XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name>;</text>
</subclause><subclause id="H195202BA8E354080A6ADBEDDA5C1D7C6"><enum>(IV)</enum><text>State directors
of the State Children’s Health Insurance Program under title XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name>;</text>
</subclause><subclause id="HA10CC9E9025E4BE4BC3DD95374B95207"><enum>(V)</enum><text>employers,
including owners of small businesses and their trade or industry
representatives and certified human resource and payroll professionals;</text>
</subclause><subclause id="H1A6A75C5F29A46FF96124CC86EF178FD"><enum>(VI)</enum><text>plan
administrators and plan sponsors of group health plans (as defined in section
607(1) of the <act-name parsable-cite="ERISA">Employee Retirement Income
Security Act of 1974</act-name>);</text>
</subclause><subclause id="H406969EA67FD495BA4A4704C168073C"><enum>(VII)</enum><text>health insurance
issuers; and</text>
</subclause><subclause id="H6A539DDD181A40B9B110CA99FCD5886"><enum>(VIII)</enum><text>children and
other beneficiaries of medical assistance under title XIX of the
<act-name parsable-cite="SSA">Social Security Act</act-name> or child health
assistance or other health benefits coverage under title XXI of such
Act.</text>
</subclause></clause><clause id="H9884230CA7D948BE9950F2DB0006004E"><enum>(iii)</enum><header>Compensation</header><text>The
members of the Working Group shall serve without compensation.</text>
</clause><clause id="HF3EA07A731CC42889FD933000267CE00"><enum>(iv)</enum><header>Administrative
support</header><text>The Department of Health and Human Services and the
Department of Labor shall jointly provide appropriate administrative support to
the Working Group, including technical assistance. The Working Group may use
the services and facilities of either such Department, with or without
reimbursement, as jointly determined by such Departments.</text>
</clause><clause id="HDD4B8C9F24EB4E65B0D1C20A06345B3"><enum>(v)</enum><header>Report</header>
<subclause id="H0F35020EEE824F9987009188AD24400"><enum>(I)</enum><header>Report by working
group to the secretaries</header><text>Not later than 18 months after the date
of the enactment of this Act, the Working Group shall submit to the Secretary
of Labor and the Secretary of Health and Human Services the model form
described in clause (i)(II) along with a report containing recommendations for
appropriate measures to address the impediments to the effective coordination
of coverage between group health plans and the State plans under titles XIX and
XXI of the <act-name parsable-cite="SSA">Social Security Act</act-name>.</text>
</subclause><subclause id="HC14931046FC8422FA79FDB91C0981E3B"><enum>(II)</enum><header>Report by
secretaries to the congress</header><text>Not later than 2 months after receipt
of the report pursuant to subclause (I), the Secretaries shall jointly submit a
report to each House of the Congress regarding the recommendations contained in
the report under such subclause.</text>
</subclause></clause><clause id="H7D8CCD482CBF4F32BDF7B89102AED845"><enum>(vi)</enum><header>Termination</header><text>The
Working Group shall terminate 30 days after the date of the issuance of its
report under clause (v).</text>
</clause></subparagraph><subparagraph id="HBAFCCFD85E194662AE3803776261D39C"><enum>(D)</enum><header>Effective
dates</header><text>The Secretary of Labor and the Secretary of Health and
Human Services shall develop the initial model notices under section
701(f)(3)(B)(i)(II) of the <act-name parsable-cite="ERISA">Employee Retirement
Income Security Act of 1974</act-name>, and the Secretary of Labor shall
provide such notices to employers, not later than the date that is 1 year after
the date of enactment of this Act, and each employer shall provide the initial
annual notices to such employer’s employees beginning with the first plan year
that begins after the date on which such initial model notices are first
issued. The model coverage coordination disclosure form developed under
subparagraph (C) shall apply with respect to requests made by States beginning
with the first plan year that begins after the date on which such model
coverage coordination disclosure form is first issued.</text>
</subparagraph><subparagraph id="H5FD19988B0004DA79B19295187714505"><enum>(E)</enum><header>Enforcement</header><text>Section
502 of the <act-name parsable-cite="ERISA">Employee Retirement Income Security
Act of 1974</act-name> (29 U.S.C. 1132) is amended—</text>
<clause id="H3E990DE885044797A012EE2BED2B021"><enum>(i)</enum><text>in
subsection (a)(6), by striking <quote>or (8)</quote> and inserting <quote>(8),
or (9)</quote>; and</text>
</clause><clause id="HB2C33CA99EAB46AC92C4B4E5A9CBC169"><enum>(ii)</enum><text>in
subsection (c), by redesignating paragraph (9) as paragraph (10), and by
inserting after paragraph (8) the following:</text>
<quoted-block id="H854A3CB09A9E4295ACBEE1CB45E43B98" style="OLC">
<paragraph id="H6DBBFD99B2FD4BFAA76C6C5389728551" indent="up1"><enum>(9)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H827C3929E2C0437891B7FD8D2D1DE04C"><enum>(A)</enum><text>The Secretary may assess
a civil penalty against any employer of up to $100 a day from the date of the
employer’s failure to meet the notice requirement of section
701(f)(3)(B)(i)(I). For purposes of this subparagraph, each violation with
respect to any single employee shall be treated as a separate violation.</text>
</subparagraph><subparagraph id="H7167A67F0EA24A759BB6D600D3FBEC69" indent="up1"><enum>(B)</enum><text>The Secretary may assess a civil
penalty against any plan administrator of up to $100 a day from the date of the
plan administrator’s failure to timely provide to any State the information
required to be disclosed under section 701(f)(3)(B)(ii). For purposes of this
subparagraph, each violation with respect to any single participant or
beneficiary shall be treated as a separate
violation.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph><paragraph id="HB45AD60E75BF48ECADB4DBE5BD671403"><enum>(2)</enum><header>Amendments to
public health service act</header><text>Section 2701(f) of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C.
300gg(f)) is amended by adding at the end the following new paragraph:</text>
<quoted-block act-name="Public" display-inline="no-display-inline" id="H98133068592D4146914CF268FFFDF500" style="OLC">
<paragraph id="H04B12C26F5BF4953A02FB396A6B51F00"><enum>(3)</enum><header>Special rules
for application in case of medicaid and chip</header>
<subparagraph id="H0E1D5C9835AA4EBAA4A9E48CC3D385C8"><enum>(A)</enum><header>In
general</header><text>A group health plan, and a health insurance issuer
offering group health insurance coverage in connection with a group health
plan, shall permit an employee who is eligible, but not enrolled, for coverage
under the terms of the plan (or a dependent of such an employee if the
dependent is eligible, but not enrolled, for coverage under such terms) to
enroll for coverage under the terms of the plan if either of the following
conditions is met:</text>
<clause id="H14A4133AE92141CFA522A523D7C93D0"><enum>(i)</enum><header>Termination of
medicaid or chip coverage</header><text>The employee or dependent is covered
under a Medicaid plan under title XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name> or under a State child
health plan under title XXI of such Act and coverage of the employee or
dependent under such a plan is terminated as a result of loss of eligibility
for such coverage and the employee requests coverage under the group health
plan (or health insurance coverage) not later than 60 days after the date of
termination of such coverage.</text>
</clause><clause id="H27AE454C2C0840C694275E6ECC7E9816"><enum>(ii)</enum><header>Eligibility for
employment assistance under medicaid or chip</header><text>The employee or
dependent becomes eligible for assistance, with respect to coverage under the
group health plan or health insurance coverage, under such Medicaid plan or
State child health plan (including under any waiver or demonstration project
conducted under or in relation to such a plan), if the employee requests
coverage under the group health plan or health insurance coverage not later
than 60 days after the date the employee or dependent is determined to be
eligible for such assistance.</text>
</clause></subparagraph><subparagraph id="HE8553975E71744FBB27639832EDC7846"><enum>(B)</enum><header>Coordination
with medicaid and chip</header>
<clause id="HDCD4D11E6DC7446AA84C12BC451EFFE"><enum>(i)</enum><header>Outreach to
employees regarding availability of medicaid and chip coverage</header>
<subclause id="HCEC6E938A24645F38931933B98C300CE"><enum>(I)</enum><header>In
general</header><text>Each employer that maintains a group health plan in a
State that provides medical assistance under a State Medicaid plan under title
XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name>, or
child health assistance under a State child health plan under title XXI of such
Act, in the form of premium assistance for the purchase of coverage under a
group health plan, shall provide to each employee a written notice informing
the employee of potential opportunities then currently available in the State
in which the employee resides for premium assistance under such plans for
health coverage of the employee or the employee’s dependents. For purposes of
compliance with this subclause, the employer may use any State-specific model
notice developed in accordance with section 701(f)(3)(B)(i)(II) of the
<act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
1974</act-name> (29 U.S.C. 1181(f)(3)(B)(i)(II)).</text>
</subclause><subclause id="H32F1B590897340AC821682FD4817DF5"><enum>(II)</enum><header>Option to
provide concurrent with provision of plan materials to employee</header><text display-inline="yes-display-inline">An employer may provide the model notice
applicable to the State in which an employee resides concurrent with the
furnishing of materials notifying the employee of health plan eligibility,
concurrent with materials provided to the employee in connection with an open
season or election process conducted under the plan, or concurrent with the
furnishing of the summary plan description as provided in section 104(b) of the
<act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
1974</act-name>.</text>
</subclause></clause><clause commented="no" display-inline="no-display-inline" id="H41204F124E184D6594835E10328CD0DB"><enum>(ii)</enum><header>Disclosure
about group health plan benefits to states for medicaid and chip eligible
individuals</header><text>In the case of an enrollee in a group health plan who
is covered under a Medicaid plan of a State under title XIX of the
<act-name parsable-cite="SSA">Social Security Act</act-name> or under a State
child health plan under title XXI of such Act, the plan administrator of the
group health plan shall disclose to the State, upon request, information about
the benefits available under the group health plan in sufficient specificity,
as determined under regulations of the Secretary of Health and Human Services
in consultation with the Secretary that require use of the model coverage
coordination disclosure form developed under section 311(b)(1)(C) of the
Children’s Health Insurance Reauthorization Act of 2009, so as to permit the
State to make a determination (under paragraph (2)(B), (3), or (10) of section
2105(c) of the <act-name parsable-cite="SSA">Social Security Act</act-name> or
otherwise) concerning the cost-effectiveness of the State providing medical or
child health assistance through premium assistance for the purchase of coverage
under such group health plan and in order for the State to provide supplemental
benefits required under paragraph (10)(E) of such section or other
authority.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section></subtitle><enum>IV</enum><header>Strengthening
Quality of Care and Health Outcomes</header>
<section id="H46D292DCB5344D3A8CB1DD40E48F00BA"><enum>401.</enum><header>Child health
quality improvement activities for children enrolled in Medicaid or
CHIP</header>
<subsection id="HBCEE84455E52425E0085238CCB69DEDB"><enum>(a)</enum><header>Development of
Child Health Quality Measures for Children Enrolled in Medicaid or
Chip</header><text>Title XI (42 U.S.C. 1301 et seq.) is amended by inserting
after section 1139 the following new section:</text>
<quoted-block id="HF0D09DE1645847C1916648F5F1ADFC4" style="OLC">
<section id="H216EA4BB37E6474C8627D2A6FED80400"><enum>1139A.</enum><header>Child health
quality measures</header>
<subsection id="H70D86683FABF4D459637F174FBF0DCEB"><enum>(a)</enum><header>Development of
an Initial Core Set of Health Care Quality Measures for Children Enrolled in
Medicaid or Chip</header>
<paragraph id="H8CC933E5FA2D4616A137AAFEAF23575"><enum>(1)</enum><header>In
general</header><text>Not later than January 1, 2010, the Secretary shall
identify and publish for general comment an initial, recommended core set of
child health quality measures for use by State programs administered under
titles XIX and XXI, health insurance issuers and managed care entities that
enter into contracts with such programs, and providers of items and services
under such programs.</text>
</paragraph><paragraph id="HFF8ABD1F884A4FD5A2BA2D8183131C4E"><enum>(2)</enum><header>Identification
of initial core measures</header><text>In consultation with the individuals and
entities described in subsection (b)(3), the Secretary shall identify existing
quality of care measures for children that are in use under public and
privately sponsored health care coverage arrangements, or that are part of
reporting systems that measure both the presence and duration of health
insurance coverage over time.</text>
</paragraph><paragraph id="HC34D5EA1472742BFBC09992DA287699E"><enum>(3)</enum><header>Recommendations
and dissemination</header><text>Based on such existing and identified measures,
the Secretary shall publish an initial core set of child health quality
measures that includes (but is not limited to) the following:</text>
<subparagraph id="H4BAA062F832E48F4B8E7D08B755F00C5"><enum>(A)</enum><text>The duration of
children’s health insurance coverage over a 12-month time period.</text>
</subparagraph><subparagraph id="H347981E06E794B41A345197EA4F5E193"><enum>(B)</enum><text>The availability
and effectiveness of a full range of—</text>
<clause id="H1D23DBFB8CBE46FE9ED397A27BBAB020"><enum>(i)</enum><text>preventive
services, treatments, and services for acute conditions, including services to
promote healthy birth, prevent and treat premature birth, and detect the
presence or risk of physical or mental conditions that could adversely affect
growth and development; and</text>
</clause><clause id="HDA6D5E1511574874B22C9B4196808B3D"><enum>(ii)</enum><text>treatments to
correct or ameliorate the effects of physical and mental conditions, including
chronic conditions, in infants, young children, school-age children, and
adolescents.</text>
</clause></subparagraph><subparagraph id="H79B9351E2E0A441A999E53356C449904"><enum>(C)</enum><text>The availability
of care in a range of ambulatory and inpatient health care settings in which
such care is furnished.</text>
</subparagraph><subparagraph id="H0C16DDF6994046009BB3C9AEC3135D"><enum>(D)</enum><text>The types of
measures that, taken together, can be used to estimate the overall national
quality of health care for children, including children with special needs, and
to perform comparative analyses of pediatric health care quality and racial,
ethnic, and socioeconomic disparities in child health and health care for
children.</text>
</subparagraph></paragraph><paragraph id="H3322DF203ECC4FCAB4E32C4D88AB9257"><enum>(4)</enum><header>Encourage
voluntary and standardized reporting</header><text>Not later than 2 years after
the date of enactment of the Children’s Health Insurance Program
Reauthorization Act of 2009, the Secretary, in consultation with States, shall
develop a standardized format for reporting information and procedures and
approaches that encourage States to use the initial core measurement set to
voluntarily report information regarding the quality of pediatric health care
under titles XIX and XXI.</text>
</paragraph><paragraph id="H752A6A9767E64F11AC1B1FC800D981D0"><enum>(5)</enum><header>Adoption of best
practices in implementing quality programs</header><text>The Secretary shall
disseminate information to States regarding best practices among States with
respect to measuring and reporting on the quality of health care for children,
and shall facilitate the adoption of such best practices. In developing best
practices approaches, the Secretary shall give particular attention to State
measurement techniques that ensure the timeliness and accuracy of provider
reporting, encourage provider reporting compliance, encourage successful
quality improvement strategies, and improve efficiency in data collection using
health information technology.</text>
</paragraph><paragraph id="HF4CBF8C57480415BA83F74E800212470"><enum>(6)</enum><header>Reports to
congress</header><text>Not later than January 1, 2011, and every 3 years
thereafter, the Secretary shall report to Congress on—</text>
<subparagraph id="H65F33C55EBF642F3AEF77601191721FF"><enum>(A)</enum><text>the status of the
Secretary’s efforts to improve—</text>
<clause id="H64512676AB364C67B427EC21C7D800AA"><enum>(i)</enum><text>quality related to
the duration and stability of health insurance coverage for children under
titles XIX and XXI;</text>
</clause><clause id="H34B2B89FBB6E45AFBA11230024606267"><enum>(ii)</enum><text>the quality of
children’s health care under such titles, including preventive health services,
health care for acute conditions, chronic health care, and health services to
ameliorate the effects of physical and mental conditions and to aid in growth
and development of infants, young children, school-age children, and
adolescents with special health care needs; and</text>
</clause><clause id="H85DC9F76C8CC4FAAB3FB8B8F5ECCA06E"><enum>(iii)</enum><text>the quality of
children’s health care under such titles across the domains of quality,
including clinical quality, health care safety, family experience with health
care, health care in the most integrated setting, and elimination of racial,
ethnic, and socioeconomic disparities in health and health care;</text>
</clause></subparagraph><subparagraph id="HB9F2678733B74F259FB6EEA9FBBA86DF"><enum>(B)</enum><text>the status of
voluntary reporting by States under titles XIX and XXI, utilizing the initial
core quality measurement set; and</text>
</subparagraph><subparagraph id="HA591EB4D5F4D4BBBB5A6FC0889FB97F5"><enum>(C)</enum><text>any
recommendations for legislative changes needed to improve the quality of care
provided to children under titles XIX and XXI, including recommendations for
quality reporting by States.</text>
</subparagraph></paragraph><paragraph id="H480CB3C8BF1447E097BD67A3831DEB6B"><enum>(7)</enum><header>Technical
assistance</header><text>The Secretary shall provide technical assistance to
States to assist them in adopting and utilizing core child health quality
measures in administering the State plans under titles XIX and XXI.</text>
</paragraph><paragraph id="H6EA7789539C04E7EB3639885396F6CD"><enum>(8)</enum><header>Definition of
core set</header><text>In this section, the term <term>core set</term> means a
group of valid, reliable, and evidence-based quality measures that, taken
together—</text>
<subparagraph id="H435F5A55B65C4048B70000579000BE3F"><enum>(A)</enum><text>provide
information regarding the quality of health coverage and health care for
children;</text>
</subparagraph><subparagraph id="H8D6E58EB0A45443D951F9E7C2D68A7F6"><enum>(B)</enum><text>address the needs
of children throughout the developmental age span; and</text>
</subparagraph><subparagraph id="HCE9A0348A3634543B8A6E68FAA573348"><enum>(C)</enum><text>allow purchasers,
families, and health care providers to understand the quality of care in
relation to the preventive needs of children, treatments aimed at managing and
resolving acute conditions, and diagnostic and treatment services whose purpose
is to correct or ameliorate physical, mental, or developmental conditions that
could, if untreated or poorly treated, become chronic.</text>
</subparagraph></paragraph></subsection><subsection id="H252E19907D3744ADB98C7BE3F64F5B60"><enum>(b)</enum><header>Advancing and
Improving Pediatric Quality Measures</header>
<paragraph id="HFD3DCF12BCBB4B28AB43B4D3ED0000EC"><enum>(1)</enum><header>Establishment of
pediatric quality measures program</header><text>Not later than January 1,
2011, the Secretary shall establish a pediatric quality measures program
to—</text>
<subparagraph id="H50117A46A2084503A996A47E36A5F19"><enum>(A)</enum><text>improve and
strengthen the initial core child health care quality measures established by
the Secretary under subsection (a);</text>
</subparagraph><subparagraph id="H4DA2103915754F0B9CAF4154F86A8E5"><enum>(B)</enum><text>expand on existing
pediatric quality measures used by public and private health care purchasers
and advance the development of such new and emerging quality measures;
and</text>
</subparagraph><subparagraph id="H788AD936E481442E9E23006048B058F9"><enum>(C)</enum><text>increase the
portfolio of evidence-based, consensus pediatric quality measures available to
public and private purchasers of children’s health care services, providers,
and consumers.</text>
</subparagraph></paragraph><paragraph id="HEA60E20514224956AF7061D300C9AA10"><enum>(2)</enum><header>Evidence-based
measures</header><text>The measures developed under the pediatric quality
measures program shall, at a minimum, be—</text>
<subparagraph id="H303FFECE6EB04ECC9998A6D2A1DA1DD7"><enum>(A)</enum><text>evidence-based
and, where appropriate, risk adjusted;</text>
</subparagraph><subparagraph id="H8629FF369DDA4B798B52C4E73DCD8C8"><enum>(B)</enum><text>designed to
identify and eliminate racial and ethnic disparities in child health and the
provision of health care;</text>
</subparagraph><subparagraph id="H8B79DBEE84E24F5EA045A3E9B6C9F730"><enum>(C)</enum><text>designed to ensure
that the data required for such measures is collected and reported in a
standard format that permits comparison of quality and data at a State, plan,
and provider level;</text>
</subparagraph><subparagraph id="H722A4677B7A448E5B6BD6D7FBAF2F905"><enum>(D)</enum><text>periodically
updated; and</text>
</subparagraph><subparagraph id="HA9279EFA1E2F4E9F8B27009CAD7379C"><enum>(E)</enum><text>responsive to the
child health needs, services, and domains of health care quality described in
clauses (i), (ii), and (iii) of subsection (a)(6)(A).</text>
</subparagraph></paragraph><paragraph id="HD38F7BB913694F85B022CFBFEE26E67E"><enum>(3)</enum><header>Process for
pediatric quality measures program</header><text>In identifying gaps in
existing pediatric quality measures and establishing priorities for development
and advancement of such measures, the Secretary shall consult with—</text>
<subparagraph id="HB85983B63A1C4ED200F9006777D50900"><enum>(A)</enum><text>States;</text>
</subparagraph><subparagraph id="HB4E0ECEBBDDE4DB381ABB52DA2A2F547"><enum>(B)</enum><text>pediatricians,
children’s hospitals, and other primary and specialized pediatric health care
professionals (including members of the allied health professions) who
specialize in the care and treatment of children, particularly children with
special physical, mental, and developmental health care needs;</text>
</subparagraph><subparagraph id="HD047F8AB2FB24AF6A190B9D7A5FAB76"><enum>(C)</enum><text>dental
professionals, including pediatric dental professionals;</text>
</subparagraph><subparagraph id="HE778EF8DAC084F66BEEEECC74D0718F6"><enum>(D)</enum><text>health care
providers that furnish primary health care to children and families who live in
urban and rural medically underserved communities or who are members of
distinct population sub-groups at heightened risk for poor health
outcomes;</text>
</subparagraph><subparagraph id="HB37DA33760BB435BB43E1CE2DECC6CAB"><enum>(E)</enum><text>national
organizations representing children, including children with disabilities and
children with chronic conditions;</text>
</subparagraph><subparagraph id="H06E8A77905274439B07EAA66598BAC3E"><enum>(F)</enum><text>national
organizations representing consumers and purchasers of children’s health
care;</text>
</subparagraph><subparagraph id="HF066E9F527A84359A1005F1771B7439E"><enum>(G)</enum><text>national
organizations and individuals with expertise in pediatric health quality
measurement; and</text>
</subparagraph><subparagraph id="H26D143405E394D398F6CA41D249C46D"><enum>(H)</enum><text>voluntary consensus
standards setting organizations and other organizations involved in the
advancement of evidence-based measures of health care.</text>
</subparagraph></paragraph><paragraph id="H1E2F0FE0775B495C87CA27ACB0D9F59F"><enum>(4)</enum><header>Developing,
validating, and testing a portfolio of pediatric quality
measures</header><text>As part of the program to advance pediatric quality
measures, the Secretary shall—</text>
<subparagraph id="H113B18FF3D05422689DE82E6DDCAFE91"><enum>(A)</enum><text>award grants and
contracts for the development, testing, and validation of new, emerging, and
innovative evidence-based measures for children’s health care services across
the domains of quality described in clauses (i), (ii), and (iii) of subsection
(a)(6)(A); and</text>
</subparagraph><subparagraph id="H259E9DC3FE164EECB474C1D18DEB2585"><enum>(B)</enum><text>award grants and
contracts for—</text>
<clause id="HCD4975E2E98F4B03B2EAF19B04CDDC96"><enum>(i)</enum><text>the development of
consensus on evidence-based measures for children’s health care
services;</text>
</clause><clause id="H56440AED730E439D959F06779F9FB897"><enum>(ii)</enum><text>the dissemination
of such measures to public and private purchasers of health care for children;
and</text>
</clause><clause id="H888F1DA1FDA3476FBFF7D2A25200B705"><enum>(iii)</enum><text>the updating of
such measures as necessary.</text>
</clause></subparagraph></paragraph><paragraph id="HA7C9FC5089FE42A9894F965051114462"><enum>(5)</enum><header>Revising,
strengthening, and improving initial core measures</header><text>Beginning no
later than January 1, 2013, and annually thereafter, the Secretary shall
publish recommended changes to the core measures described in subsection (a)
that shall reflect the testing, validation, and consensus process for the
development of pediatric quality measures described in subsection paragraphs
(1) through (4).</text>
</paragraph><paragraph id="H50F8082019AF4C0700C20290D7AC5EA3"><enum>(6)</enum><header>Definition of
pediatric quality measure</header><text>In this subsection, the term
<term>pediatric quality measure</term> means a measurement of clinical care
that is capable of being examined through the collection and analysis of
relevant information, that is developed in order to assess 1 or more aspects of
pediatric health care quality in various institutional and ambulatory health
care settings, including the structure of the clinical care system, the process
of care, the outcome of care, or patient experiences in care.</text>
</paragraph><paragraph id="HAC89D5BA97614A5ABFF532BF703FAA1D"><enum>(7)</enum><header>Construction</header><text>Nothing
in this section shall be construed as supporting the restriction of coverage,
under title XIX or XXI or otherwise, to only those services that are
evidence-based.</text>
</paragraph></subsection><subsection id="H480CE5B472C2416AB075B68220267E68"><enum>(c)</enum><header>Annual State
Reports Regarding State-Specific Quality of Care Measures Applied Under
Medicaid or Chip</header>
<paragraph id="HB99D05CC43084873B237CD2299AC53C9"><enum>(1)</enum><header>Annual state
reports</header><text>Each State with a State plan approved under title XIX or
a State child health plan approved under title XXI shall annually report to the
Secretary on the—</text>
<subparagraph id="HE67B1BCA46794CB3982E73FB1413B71B"><enum>(A)</enum><text>State-specific
child health quality measures applied by the States under such plans, including
measures described in subparagraphs (A) and (B) of subsection (a)(6);
and</text>
</subparagraph><subparagraph id="H30F6174EB1E34FCA94DB90F2A4F41479"><enum>(B)</enum><text>State-specific
information on the quality of health care furnished to children under such
plans, including information collected through external quality reviews of
managed care organizations under section 1932 of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1396u–4) and benchmark plans under sections 1937 and 2103 of such Act (42
U.S.C. 1396u–7, 1397cc).</text>
</subparagraph></paragraph><paragraph id="H49AC9020FF1443B5B7B899414B15E9E6"><enum>(2)</enum><header>Publication</header><text>Not
later than September 30, 2010, and annually thereafter, the Secretary shall
collect, analyze, and make publicly available the information reported by
States under paragraph (1).</text>
</paragraph></subsection><subsection id="H8E2093AB3DB045C1A122E14DF6013BD"><enum>(d)</enum><header>Demonstration
Projects for Improving the Quality of Children’s Health Care and the Use of
Health Information Technology</header>
<paragraph id="H4CCEC9525D04427AB57253D606353E42"><enum>(1)</enum><header>In
general</header><text>During the period of fiscal years 2009 through 2013, the
Secretary shall award not more than 10 grants to States and child health
providers to conduct demonstration projects to evaluate promising ideas for
improving the quality of children’s health care provided under title XIX or
XXI, including projects to—</text>
<subparagraph id="HFFCDF35CB7114BC2AAECAF5581B05C84"><enum>(A)</enum><text>experiment with,
and evaluate the use of, new measures of the quality of children’s health care
under such titles (including testing the validity and suitability for reporting
of such measures);</text>
</subparagraph><subparagraph id="H9F1785630D4D411C95A6CC5503F28900"><enum>(B)</enum><text>promote the use of
health information technology in care delivery for children under such
titles;</text>
</subparagraph><subparagraph id="H8FDA2DEE482D4F4D8B414D3081D23DA9"><enum>(C)</enum><text>evaluate
provider-based models which improve the delivery of children’s health care
services under such titles, including care management for children with chronic
conditions and the use of evidence-based approaches to improve the
effectiveness, safety, and efficiency of health care services for children;
or</text>
</subparagraph><subparagraph id="H8C01CA80F5AB484C92CE7DF89398A341"><enum>(D)</enum><text>demonstrate the
impact of the model electronic health record format for children developed and
disseminated under subsection (f) on improving pediatric health, including the
effects of chronic childhood health conditions, and pediatric health care
quality as well as reducing health care costs.</text>
</subparagraph></paragraph><paragraph id="H99FB45D59A214A53957388FB611FA1C0"><enum>(2)</enum><header>Requirements</header><text>In
awarding grants under this subsection, the Secretary shall ensure that—</text>
<subparagraph id="H2A48A132971C460D9447A748F7E31FD9"><enum>(A)</enum><text>only 1
demonstration project funded under a grant awarded under this subsection shall
be conducted in a State; and</text>
</subparagraph><subparagraph id="H43701654A1AC4FC0A31DC4CAD46E05BD"><enum>(B)</enum><text>demonstration
projects funded under grants awarded under this subsection shall be conducted
evenly between States with large urban areas and States with large rural
areas.</text>
</subparagraph></paragraph><paragraph id="H1B18F6DD01EF47E2A0E1C2D8DA541707"><enum>(3)</enum><header>Authority for
multistate projects</header><text>A demonstration project conducted with a
grant awarded under this subsection may be conducted on a multistate basis, as
needed.</text>
</paragraph><paragraph id="H2A240ADC8EFE4678831CDAD5CE3D64E"><enum>(4)</enum><header>Funding</header><text>$20,000,000
of the amount appropriated under subsection (i) for a fiscal year shall be used
to carry out this subsection.</text>
</paragraph></subsection><subsection id="HDD94143C26464D169843DA5924A3522"><enum>(e)</enum><header>Childhood Obesity
Demonstration Project</header>
<paragraph id="H8E4A92DE943848DA843E82A500D68452"><enum>(1)</enum><header>Authority to
conduct demonstration</header><text>The Secretary, in consultation with the
Administrator of the Centers for Medicare & Medicaid Services, shall
conduct a demonstration project to develop a comprehensive and systematic model
for reducing childhood obesity by awarding grants to eligible entities to carry
out such project. Such model shall—</text>
<subparagraph id="HF07F95FE95F3432AB59586A8EEE67D2F"><enum>(A)</enum><text>identify, through
self-assessment, behavioral risk factors for obesity among children;</text>
</subparagraph><subparagraph id="H3D9DD798971A4311A28C5497A7E5BC9C"><enum>(B)</enum><text>identify, through
self-assessment, needed clinical preventive and screening benefits among those
children identified as target individuals on the basis of such risk
factors;</text>
</subparagraph><subparagraph id="H8C8A2B709BD54BF0BC997CC67D834900"><enum>(C)</enum><text>provide ongoing
support to such target individuals and their families to reduce risk factors
and promote the appropriate use of preventive and screening benefits;
and</text>
</subparagraph><subparagraph id="H47CF4EF6A9434452852436BEF9CBF00"><enum>(D)</enum><text>be designed to
improve health outcomes, satisfaction, quality of life, and appropriate use of
items and services for which medical assistance is available under title XIX or
child health assistance is available under title XXI among such target
individuals.</text>
</subparagraph></paragraph><paragraph id="HB002689D4FD34E589DC3B33F00CBDA4C"><enum>(2)</enum><header>Eligibility
entities</header><text>For purposes of this subsection, an eligible entity is
any of the following:</text>
<subparagraph id="H8F6A5F79595F4D328B7E7DD9D4F0AA71"><enum>(A)</enum><text>A city, county, or
Indian tribe.</text>
</subparagraph><subparagraph id="H6B213BD0608E42A78F3CD4895E0000D7"><enum>(B)</enum><text>A local or tribal
educational agency.</text>
</subparagraph><subparagraph id="H7325F563CDC5481E00E6233B01A3D2DB"><enum>(C)</enum><text>An accredited
university, college, or community college.</text>
</subparagraph><subparagraph id="HC590D4CBA7E94BC48E703DC5B7908BA0"><enum>(D)</enum><text>A
Federally-qualified health center.</text>
</subparagraph><subparagraph id="H0485AF79F8644AEF8385BFB1BF9CADDD"><enum>(E)</enum><text>A local health
department.</text>
</subparagraph><subparagraph id="HF81E0C7893204CCE9EE8B682B870DDE5"><enum>(F)</enum><text>A health care
provider.</text>
</subparagraph><subparagraph id="HB91EEAFE806A4FB38B8003DC8ED47368"><enum>(G)</enum><text>A community-based
organization.</text>
</subparagraph><subparagraph id="HC72F9B6C15CA48FBB2D88C287E1DAC05"><enum>(H)</enum><text>Any other entity
determined appropriate by the Secretary, including a consortia or partnership
of entities described in any of subparagraphs (A) through (G).</text>
</subparagraph></paragraph><paragraph id="H495FC7DC19874FB69C96007D0087DD00"><enum>(3)</enum><header>Use of
funds</header><text>An eligible entity awarded a grant under this subsection
shall use the funds made available under the grant to—</text>
<subparagraph id="HD93F278F5C91445CB4025402534F871F"><enum>(A)</enum><text>carry out
community-based activities related to reducing childhood obesity, including
by—</text>
<clause id="H81A46771721147099F694BE100A8A750"><enum>(i)</enum><text>forming
partnerships with entities, including schools and other facilities providing
recreational services, to establish programs for after school and weekend
community activities that are designed to reduce childhood obesity;</text>
</clause><clause id="H06440381DB14463AB019C0582EE0280"><enum>(ii)</enum><text>forming
partnerships with daycare facilities to establish programs that promote healthy
eating behaviors and physical activity; and</text>
</clause><clause id="HF4CD03AD10E743F7BC296D7B4958BDE"><enum>(iii)</enum><text>developing and
evaluating community educational activities targeting good nutrition and
promoting healthy eating behaviors;</text>
</clause></subparagraph><subparagraph id="H6BA735F9AD0F4E0399C5BE0067CFEE30"><enum>(B)</enum><text>carry out
age-appropriate school-based activities that are designed to reduce childhood
obesity, including by—</text>
<clause id="H13C304BF98444906832C71A674165974"><enum>(i)</enum><text>developing and
testing educational curricula and intervention programs designed to promote
healthy eating behaviors and habits in youth, which may include—</text>
<subclause id="H8E72F6FE13704D6D954F87A0753E5656"><enum>(I)</enum><text>after hours
physical activity programs; and</text>
</subclause><subclause id="H87C3C014B1AD481B80C8A9871C00BF61"><enum>(II)</enum><text>science-based
interventions with multiple components to prevent eating disorders including
nutritional content, understanding and responding to hunger and satiety,
positive body image development, positive self-esteem development, and learning
life skills (such as stress management, communication skills, problemsolving
and decisionmaking skills), as well as consideration of cultural and
developmental issues, and the role of family, school, and community;</text>
</subclause></clause><clause id="H4E5DDF66E665411388DD96052EABF639"><enum>(ii)</enum><text>providing
education and training to educational professionals regarding how to promote a
healthy lifestyle and a healthy school environment for children;</text>
</clause><clause id="H7841FF227BB145B70043CAD69EDBA79E"><enum>(iii)</enum><text>planning and
implementing a healthy lifestyle curriculum or program with an emphasis on
healthy eating behaviors and physical activity; and</text>
</clause><clause id="H62F0129AC47E4C4F8E876479284614F"><enum>(iv)</enum><text>planning and
implementing healthy lifestyle classes or programs for parents or guardians,
with an emphasis on healthy eating behaviors and physical activity for
children;</text>
</clause></subparagraph><subparagraph id="H71895573CCEF47EAB7761D98CD1039A3"><enum>(C)</enum><text>carry out
educational, counseling, promotional, and training activities through the local
health care delivery systems including by—</text>
<clause id="HB90E8D698C59467FAA75019CB098AC3E"><enum>(i)</enum><text>promoting healthy
eating behaviors and physical activity services to treat or prevent eating
disorders, being overweight, and obesity;</text>
</clause><clause id="H566739533E5B40B985F0BA00DBBC1BAF"><enum>(ii)</enum><text>providing patient
education and counseling to increase physical activity and promote healthy
eating behaviors;</text>
</clause><clause id="H64A18B7D32A14652A7BB02707DAE909B"><enum>(iii)</enum><text>training health
professionals on how to identify and treat obese and overweight individuals
which may include nutrition and physical activity counseling; and</text>
</clause><clause id="H710A4958D5ED41A3B6D2A422B21C7897"><enum>(iv)</enum><text>providing
community education by a health professional on good nutrition and physical
activity to develop a better understanding of the relationship between diet,
physical activity, and eating disorders, obesity, or being overweight;
and</text>
</clause></subparagraph><subparagraph id="HB6FC2627C141424DB2F57CDCC520169"><enum>(D)</enum><text>provide, through
qualified health professionals, training and supervision for community health
workers to—</text>
<clause id="H10A8D0C7240B4033B753E77C22074181"><enum>(i)</enum><text>educate families
regarding the relationship between nutrition, eating habits, physical activity,
and obesity;</text>
</clause><clause id="H90EE8156119E4C9382E458BFB83A2C"><enum>(ii)</enum><text>educate families
about effective strategies to improve nutrition, establish healthy eating
patterns, and establish appropriate levels of physical activity; and</text>
</clause><clause id="H9FC45BEBE8D64294B6D1FDE9B7C54B15"><enum>(iii)</enum><text>educate and
guide parents regarding the ability to model and communicate positive health
behaviors.</text>
</clause></subparagraph></paragraph><paragraph id="H9144A86D6DEC4B098F9BBD184789057E"><enum>(4)</enum><header>Priority</header><text>In
awarding grants under paragraph (1), the Secretary shall give priority to
awarding grants to eligible entities—</text>
<subparagraph id="HEA5CAF0E7C2042BF001C5412BEA9F9F4"><enum>(A)</enum><text>that demonstrate
that they have previously applied successfully for funds to carry out
activities that seek to promote individual and community health and to prevent
the incidence of chronic disease and that can cite published and peer-reviewed
research demonstrating that the activities that the entities propose to carry
out with funds made available under the grant are effective;</text>
</subparagraph><subparagraph id="H9675AD3A6119449C924859C4EBC9E7DA"><enum>(B)</enum><text>that will carry
out programs or activities that seek to accomplish a goal or goals set by the
State in the Healthy People 2010 plan of the State;</text>
</subparagraph><subparagraph id="H5F4E8AF7EFE043C18BE960861DC7C67E"><enum>(C)</enum><text>that provide
non-Federal contributions, either in cash or in-kind, to the costs of funding
activities under the grants;</text>
</subparagraph><subparagraph id="H32FF90FA44934D4BB03C3DCAFC9C14C7"><enum>(D)</enum><text>that develop
comprehensive plans that include a strategy for extending program activities
developed under grants in the years following the fiscal years for which they
receive grants under this subsection;</text>
</subparagraph><subparagraph id="H70597CAAE5FC4B10A700F1CC7CD2646B"><enum>(E)</enum><text>located in
communities that are medically underserved, as determined by the
Secretary;</text>
</subparagraph><subparagraph id="HAEF7A5B9D14C4B8A89C5B4CE16C5B75D"><enum>(F)</enum><text>located in areas
in which the average poverty rate is at least 150 percent or higher of the
average poverty rate in the State involved, as determined by the Secretary;
and</text>
</subparagraph><subparagraph id="HA1915C8BD779417580B8298DA04126FD"><enum>(G)</enum><text>that submit plans
that exhibit multisectoral, cooperative conduct that includes the involvement
of a broad range of stakeholders, including—</text>
<clause id="H00D59A0124114D029DD449E5C9B891E9"><enum>(i)</enum><text>community-based
organizations;</text>
</clause><clause id="H9086F94BEAF640BD87AD110744DC7442"><enum>(ii)</enum><text>local
governments;</text>
</clause><clause id="H23C15FC807B64C0684CD28B2AAB4AA71"><enum>(iii)</enum><text>local
educational agencies;</text>
</clause><clause id="H1F9C6ED8E97F47E18631CFA092A684D9"><enum>(iv)</enum><text>the private
sector;</text>
</clause><clause id="H856261134C3A4806B3A19173D1253719"><enum>(v)</enum><text>State or local
departments of health;</text>
</clause><clause id="H25A34EAB648B45F48DF3772284D81BA5"><enum>(vi)</enum><text>accredited
colleges, universities, and community colleges;</text>
</clause><clause id="H97F7FAAA9BAB4BD596D67DD0764794FB"><enum>(vii)</enum><text>health care
providers;</text>
</clause><clause id="H5F03DD6279D14FD19C9D677BCBCA4BD4"><enum>(viii)</enum><text>State and local
departments of transportation and city planning; and</text>
</clause><clause id="H83BFDB66809642C7B656109212007D65"><enum>(ix)</enum><text>other entities
determined appropriate by the Secretary.</text>
</clause></subparagraph></paragraph><paragraph id="HEFF1DDBDC93C4DF19E83152F178ECB98"><enum>(5)</enum><header>Program
design</header>
<subparagraph id="H00F3EB716B1E423389B67ED6AF91F01C"><enum>(A)</enum><header>Initial
design</header><text>Not later than 1 year after the date of enactment of the
Children’s Health Insurance Program Reauthorization Act of 2009, the Secretary
shall design the demonstration project. The demonstration should draw upon
promising, innovative models and incentives to reduce behavioral risk factors.
The Administrator of the Centers for Medicare & Medicaid Services shall
consult with the Director of the Centers for Disease Control and Prevention,
the Director of the Office of Minority Health, the heads of other agencies in
the Department of Health and Human Services, and such professional
organizations, as the Secretary determines to be appropriate, on the design,
conduct, and evaluation of the demonstration.</text>
</subparagraph><subparagraph id="HF079A07DBACD4E7E8FFB009C483ED48E"><enum>(B)</enum><header>Number and
project areas</header><text>Not later than 2 years after the date of enactment
of the Children’s Health Insurance Program Reauthorization Act of 2009, the
Secretary shall award 1 grant that is specifically designed to determine
whether programs similar to programs to be conducted by other grantees under
this subsection should be implemented with respect to the general population of
children who are eligible for child health assistance under State child health
plans under title XXI in order to reduce the incidence of childhood obesity
among such population.</text>
</subparagraph></paragraph><paragraph id="HADF5A25086F44738BF17881700CB02D"><enum>(6)</enum><header>Report to
congress</header><text>Not later than 3 years after the date the Secretary
implements the demonstration project under this subsection, the Secretary shall
submit to Congress a report that describes the project, evaluates the
effectiveness and cost effectiveness of the project, evaluates the beneficiary
satisfaction under the project, and includes any such other information as the
Secretary determines to be appropriate.</text>
</paragraph><paragraph id="HE1743DA7D0A24FB4B59FF998C99BD77"><enum>(7)</enum><header>Definitions</header><text>In
this subsection:</text>
<subparagraph id="H7917556C115D48459FB0A29D672EAF23"><enum>(A)</enum><header>Federally-qualified
health center</header><text>The term <term>Federally-qualified health
center</term> has the meaning given that term in section 1905(l)(2)(B).</text>
</subparagraph><subparagraph id="H6718C21258F3471286EE0193ABD0DADF"><enum>(B)</enum><header>Indian
tribe</header><text>The term <term>Indian tribe</term> has the meaning given
that term in section 4 of the <act-name parsable-cite="IHCIA">Indian Health
Care Improvement Act</act-name> (25 U.S.C. 1603).</text>
</subparagraph><subparagraph id="H86FD73B534D048E3BDBD5EAE90331FF0"><enum>(C)</enum><header>Self-assessment</header><text>The
term <term>self-assessment</term> means a form that—</text>
<clause id="HD07765FBC0524BC4844E269ED70041C7"><enum>(i)</enum><text>includes questions
regarding—</text>
<subclause id="H35399DFA076043E39C8296618DFBC212"><enum>(I)</enum><text>behavioral risk
factors;</text>
</subclause><subclause id="HF493BAD4DB7149B9A9D791399FCE25D9"><enum>(II)</enum><text>needed preventive
and screening services; and</text>
</subclause><subclause id="HE3822BF800184E1087C9CD028B6FE725"><enum>(III)</enum><text>target
individuals’ preferences for receiving follow-up information;</text>
</subclause></clause><clause id="H93D7505C823B4CEAAD15FC9415C825F5"><enum>(ii)</enum><text>is assessed using
such computer generated assessment programs; and</text>
</clause><clause id="HA4AB17B4480F4221AA81E375C475551B"><enum>(iii)</enum><text>allows for the
provision of such ongoing support to the individual as the Secretary determines
appropriate.</text>
</clause></subparagraph><subparagraph id="HCC6A447FD12843E99CC084A1FB646ED9"><enum>(D)</enum><header>Ongoing
support</header><text>The term <term>ongoing support</term> means—</text>
<clause id="H7C8011476CA746D68DABDD03F27D2FB4"><enum>(i)</enum><text>to
provide any target individual with information, feedback, health coaching, and
recommendations regarding—</text>
<subclause id="H41E989DC5E024730B907C1D5643B366B"><enum>(I)</enum><text>the results of a
self-assessment given to the individual;</text>
</subclause><subclause id="H50459D4927054E5D9597213D2407B113"><enum>(II)</enum><text>behavior
modification based on the self-assessment; and</text>
</subclause><subclause id="HA8B42EEC565847D0AD03B0B41786D2D5"><enum>(III)</enum><text>any need for
clinical preventive and screening services or treatment including medical
nutrition therapy;</text>
</subclause></clause><clause id="H9A7298A2D9B84278B5F4F1651907565"><enum>(ii)</enum><text>to
provide any target individual with referrals to community resources and
programs available to assist the target individual in reducing health risks;
and</text>
</clause><clause id="H5F69DBDEF45348CF930213399D84349F"><enum>(iii)</enum><text>to provide the
information described in clause (i) to a health care provider, if designated by
the target individual to receive such information.</text>
</clause></subparagraph></paragraph><paragraph id="H2E5890FA5711452698CCD67F1BCE909F"><enum>(8)</enum><header>Authorization of
appropriations</header><text>There is authorized to be appropriated to carry
out this subsection, $25,000,000 for the period of fiscal years 2009 through
2013.</text>
</paragraph></subsection><subsection id="HBB84976B79A24432B06D7B5B86DE949C"><enum>(f)</enum><header>Development of
Model Electronic Health Record Format for Children Enrolled in Medicaid or
CHIP</header>
<paragraph id="HE733202E6BE74A48BBEEC944993E5000"><enum>(1)</enum><header>In
general</header><text>Not later than January 1, 2010, the Secretary shall
establish a program to encourage the development and dissemination of a model
electronic health record format for children enrolled in the State plan under
title XIX or the State child health plan under title XXI that is—</text>
<subparagraph id="HF1C8EA52795B4C65005FCED34E65FC93"><enum>(A)</enum><text>subject to State
laws, accessible to parents, caregivers, and other consumers for the sole
purpose of demonstrating compliance with school or leisure activity
requirements, such as appropriate immunizations or physicals;</text>
</subparagraph><subparagraph id="HCAD8F0A6E6C3424789A4E146A82BBD9C"><enum>(B)</enum><text>designed to allow
interoperable exchanges that conform with Federal and State privacy and
security requirements;</text>
</subparagraph><subparagraph id="H0D15679C28A9498BB7D20098FD3F13B7"><enum>(C)</enum><text>structured in a
manner that permits parents and caregivers to view and understand the extent to
which the care their children receive is clinically appropriate and of high
quality; and</text>
</subparagraph><subparagraph id="H1DF1655BE3B04704B5994FCE40C3D19"><enum>(D)</enum><text>capable of being
incorporated into, and otherwise compatible with, other standards developed for
electronic health records.</text>
</subparagraph></paragraph><paragraph id="HFF66F7997E43448D8ED600DEE2535053"><enum>(2)</enum><header>Funding</header><text>$5,000,000
of the amount appropriated under subsection (i) for a fiscal year shall be used
to carry out this subsection.</text>
</paragraph></subsection><subsection id="H475A4DC4DC924EFFB7DF7EB4C8DCDA98"><enum>(g)</enum><header>Study of
Pediatric Health and Health Care Quality Measures</header>
<paragraph id="H3F55471E8F3E46BC948F7CEEA6FC005D"><enum>(1)</enum><header>In
general</header><text>Not later than July 1, 2010, the Institute of Medicine
shall study and report to Congress on the extent and quality of efforts to
measure child health status and the quality of health care for children across
the age span and in relation to preventive care, treatments for acute
conditions, and treatments aimed at ameliorating or correcting physical,
mental, and developmental conditions in children. In conducting such study and
preparing such report, the Institute of Medicine shall—</text>
<subparagraph id="H465D27A769F140298DA249FEDBDD40C9"><enum>(A)</enum><text>consider all of
the major national population-based reporting systems sponsored by the Federal
Government that are currently in place, including reporting requirements under
Federal grant programs and national population surveys and estimates conducted
directly by the Federal Government;</text>
</subparagraph><subparagraph id="HF16057159D1640FB9673408748D97961"><enum>(B)</enum><text>identify the
information regarding child health and health care quality that each system is
designed to capture and generate, the study and reporting periods covered by
each system, and the extent to which the information so generated is made
widely available through publication;</text>
</subparagraph><subparagraph id="H0E17A797A70E42B8971FA1D562C4CEE"><enum>(C)</enum><text>identify gaps in
knowledge related to children’s health status, health disparities among
subgroups of children, the effects of social conditions on children’s health
status and use and effectiveness of health care, and the relationship between
child health status and family income, family stability and preservation, and
children’s school readiness and educational achievement and attainment;
and</text>
</subparagraph><subparagraph id="H2E1BA55FDA4243BB85D83FF1230525DD"><enum>(D)</enum><text>make
recommendations regarding improving and strengthening the timeliness, quality,
and public transparency and accessibility of information about child health and
health care quality.</text>
</subparagraph></paragraph><paragraph id="H2345DC3D5FA64972A7AE4179467737FC"><enum>(2)</enum><header>Funding</header><text>Up
to $1,000,000 of the amount appropriated under subsection (i) for a fiscal year
shall be used to carry out this subsection.</text>
</paragraph></subsection><subsection id="H46DE794C03E1488687EF9453AE6DAAD"><enum>(h)</enum><header>Rule of
Construction</header><text>Notwithstanding any other provision in this section,
no evidence based quality measure developed, published, or used as a basis of
measurement or reporting under this section may be used to establish an
irrebuttable presumption regarding either the medical necessity of care or the
maximum permissible coverage for any individual child who is eligible for and
receiving medical assistance under title XIX or child health assistance under
title XXI.</text>
</subsection><subsection id="HF0E300779CE941D000C7C8B7FD17DB72"><enum>(i)</enum><header>Appropriation</header><text>Out
of any funds in the Treasury not otherwise appropriated, there is appropriated
for each of fiscal years 2009 through 2013, $45,000,000 for the purpose of
carrying out this section (other than subsection (e)). Funds appropriated under
this subsection shall remain available until
expended.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H480D2001668D48C2AAF9756C0754B7DB"><enum>(b)</enum><header>Increased
Matching Rate for Collecting and Reporting on Child Health
Measures</header><text>Section 1903(a)(3)(A) (42 U.S.C. 1396b(a)(3)(A)), is
amended—</text>
<paragraph id="H5F7F60C8B61B49CAA313E625582B1FD3"><enum>(1)</enum><text>by striking
<quote>and</quote> at the end of clause (i); and</text>
</paragraph><paragraph id="H8F467F212D5F4FEF91E944392F4D4508"><enum>(2)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block id="H8FAC8C76FF3A4EF6BCE6EFA1311E9F57" style="OLC">
<clause id="H9AB2E053F5924D659CAA2BFB54D6693C" indent="up1"><enum>(iii)</enum><text>an amount equal to the Federal
medical assistance percentage (as defined in section 1905(b)) of so much of the
sums expended during such quarter (as found necessary by the Secretary for the
proper and efficient administration of the State plan) as are attributable to
such developments or modifications of systems of the type described in clause
(i) as are necessary for the efficient collection and reporting on child health
measures;
and</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section display-inline="no-display-inline" id="HDBA281D71DE84EE300D8001CDEDE7166" section-type="subsequent-section"><enum>402.</enum><header>Improved
availability of public information regarding enrollment of children in CHIP and
Medicaid</header>
<subsection id="HEB08ADD19DA4461E8EA32242083F6EA1"><enum>(a)</enum><header>Inclusion of
Process and Access Measures in Annual State Reports</header><text>Section 2108
(42 U.S.C. 1397hh) is amended—</text>
<paragraph id="H5DC077ACEECD4173BEAC009D46C3DDA4"><enum>(1)</enum><text>in subsection (a),
in the matter preceding paragraph (1), by striking <quote>The State</quote> and
inserting <quote>Subject to subsection (e), the State</quote>; and</text>
</paragraph><paragraph id="HAE91E9AB03CE465A9B39A1B3D9EC186F"><enum>(2)</enum><text>by adding at the
end the following new subsection:</text>
<quoted-block id="H537BB91CE8E3413FB8B78B3563E88600" style="OLC">
<subsection id="H09EEACD07F1A4791A0E7A94362EA70B8"><enum>(e)</enum><header>Information
Required for Inclusion in State Annual Report</header><text>The State shall
include the following information in the annual report required under
subsection (a):</text>
<paragraph id="H410257D00A9A4EC68D255DA464F3C2C1"><enum>(1)</enum><text>Eligibility
criteria, enrollment, and retention data (including data with respect to
continuity of coverage or duration of benefits).</text>
</paragraph><paragraph id="H292F4ADD2C744494AA9CBFD4A7E7C362"><enum>(2)</enum><text>Data regarding the
extent to which the State uses process measures with respect to determining the
eligibility of children under the State child health plan, including measures
such as 12-month continuous eligibility, self-declaration of income for
applications or renewals, or presumptive eligibility.</text>
</paragraph><paragraph id="HF111F0EDBD7541B6A1D5B0F7CDEF43"><enum>(3)</enum><text>Data regarding
denials of eligibility and redeterminations of eligibility.</text>
</paragraph><paragraph id="HBC86FDF52B3440E48BE65037498E2387"><enum>(4)</enum><text>Data regarding
access to primary and specialty services, access to networks of care, and care
coordination provided under the State child health plan, using quality care and
consumer satisfaction measures included in the Consumer Assessment of
Healthcare Providers and Systems (CAHPS) survey.</text>
</paragraph><paragraph id="HC9C835128D4F4501B49BD4C5832566E0"><enum>(5)</enum><text>If the State
provides child health assistance in the form of premium assistance for the
purchase of coverage under a group health plan, data regarding the provision of
such assistance, including the extent to which employer-sponsored health
insurance coverage is available for children eligible for child health
assistance under the State child health plan, the range of the monthly amount
of such assistance provided on behalf of a child or family, the number of
children or families provided such assistance on a monthly basis, the income of
the children or families provided such assistance, the benefits and
cost-sharing protection provided under the State child health plan to
supplement the coverage purchased with such premium assistance, the effective
strategies the State engages in to reduce any administrative barriers to the
provision of such assistance, and, the effects, if any, of the provision of
such assistance on preventing the coverage provided under the State child
health plan from substituting for coverage provided under employer-sponsored
health insurance offered in the State.</text>
</paragraph><paragraph id="H4D283FD4E9044F2DB900661D2C6FC9F6"><enum>(6)</enum><text>To the extent
applicable, a description of any State activities that are designed to reduce
the number of uncovered children in the State, including through a State health
insurance connector program or support for innovative private health coverage
initiatives.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H72F1A7A73B5C49580009FB416CF4187C"><enum>(b)</enum><header>Standardized
reporting format</header>
<paragraph id="HD2365D9C608E45739F4F6917F22D966E"><enum>(1)</enum><header>In
general</header><text>Not later than 1 year after the date of enactment of this
Act, the Secretary shall specify a standardized format for States to use for
reporting the information required under section 2108(e) of the Social Security
Act, as added by subsection (a)(2).</text>
</paragraph><paragraph id="H3DAC8EDAB972440AA2CF46EBD16B105B"><enum>(2)</enum><header>Transition
period for states</header><text>Each State that is required to submit a report
under subsection (a) of section 2108 of the Social Security Act that includes
the information required under subsection (e) of such section may use up to 3
reporting periods to transition to the reporting of such information in
accordance with the standardized format specified by the Secretary under
paragraph (1).</text>
</paragraph></subsection><subsection display-inline="no-display-inline" id="HB9F10759A45240869D03C226C3653B9F"><enum>(c)</enum><header>Additional
Funding for the Secretary To Improve Timeliness of Data Reporting and Analysis
for Purposes of Determining Enrollment Increases Under Medicaid and
CHIP</header>
<paragraph id="H9779D13A6D934391818D33F0E7D1777"><enum>(1)</enum><header>Appropriation</header><text>There
is appropriated, out of any money in the Treasury not otherwise appropriated,
$5,000,000 to the Secretary for fiscal year 2009 for the purpose of improving
the timeliness of the data reported and analyzed from the Medicaid Statistical
Information System (MSIS) for purposes of providing more timely data on
enrollment and eligibility of children under Medicaid and CHIP and to provide
guidance to States with respect to any new reporting requirements related to
such improvements. Amounts appropriated under this paragraph shall remain
available until expended.</text>
</paragraph><paragraph id="HAA030E29204D4F8FBAD5DD2ECCE299FB"><enum>(2)</enum><header>Requirements</header><text>The
improvements made by the Secretary under paragraph (1) shall be designed and
implemented (including with respect to any necessary guidance for States to
report such information in a complete and expeditious manner) so that,
beginning no later than October 1, 2009, data regarding the enrollment of
low-income children (as defined in section 2110(c)(4) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1397jj(c)(4)) of a State enrolled in the State plan under Medicaid or the State
child health plan under CHIP with respect to a fiscal year shall be collected
and analyzed by the Secretary within 6 months of submission.</text>
</paragraph></subsection><subsection id="HF2924031AEDE4DFFA07098EED2B54953"><enum>(d)</enum><header>GAO Study and
Report on Access to Primary and Speciality Services</header>
<paragraph id="H4B315D51D6EA4CB1B9BF23B000376FB5"><enum>(1)</enum><header>In
general</header><text>The Comptroller General of the United States shall
conduct a study of children’s access to primary and specialty services under
Medicaid and CHIP, including—</text>
<subparagraph id="HA2641744741E4546BF06ACF03028F189"><enum>(A)</enum><text>the extent to
which providers are willing to treat children eligible for such
programs;</text>
</subparagraph><subparagraph id="H02A36DB3C6CB4F91A4009449E1D262F5"><enum>(B)</enum><text>information on
such children’s access to networks of care;</text>
</subparagraph><subparagraph id="H16362D4B862E4222ACAD1EC1786331D7"><enum>(C)</enum><text>geographic
availability of primary and specialty services under such programs;</text>
</subparagraph><subparagraph id="H99256791944C4498B3D3BFA1F50C9"><enum>(D)</enum><text>the extent to which
care coordination is provided for children’s care under Medicaid and CHIP;
and</text>
</subparagraph><subparagraph id="HBC3816A74C974B9BB9A9EB8D8E4467DE"><enum>(E)</enum><text>as appropriate,
information on the degree of availability of services for children under such
programs.</text>
</subparagraph></paragraph><paragraph id="HE375A65506BA44D800FBC6EB00000148"><enum>(2)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 2 years after the date of
enactment of this Act, the Comptroller General shall submit a report to the
Committee on Finance of the Senate and the Committee on Energy and Commerce of
the House of Representatives on the study conducted under paragraph (1) that
includes recommendations for such Federal and State legislative and
administrative changes as the Comptroller General determines are necessary to
address any barriers to access to children’s care under Medicaid and CHIP that
may exist.</text>
</paragraph></subsection></section><section display-inline="no-display-inline" id="HFA790A340B0743B28D053C7CDDEB3EEB" section-type="subsequent-section"><enum>403.</enum><header>Application of
certain managed care quality safeguards to CHIP</header>
<subsection id="H74A43BEBD80342DF9FA3C1D922BD9619"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 2103(f) of
Social Security Act (42 U.S.C. 1397bb(f)) is amended by adding at the end the
following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H10895B47162C4395004842CDDE21B294" style="OLC">
<paragraph id="HCA409B9795554A9F828E80362058BC23"><enum>(3)</enum><header>Compliance with
managed care requirements</header><text display-inline="yes-display-inline">The
State child health plan shall provide for the application of subsections
(a)(4), (a)(5), (b), (c), (d), and (e) of section 1932 (relating to
requirements for managed care) to coverage, State agencies, enrollment brokers,
managed care entities, and managed care organizations under this title in the
same manner as such subsections apply to coverage and such entities and
organizations under title XIX.</text>
</paragraph><after-quoted-block>.
</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H9E69E78387DC4BD8B1DAB7787C7800CD"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to contract
years for health plans beginning on or after July 1, 2009.</text>
</subsection></section><enum>V</enum><header>Improving Access
to Benefits</header>
<section id="H52E2210F174D49318379E4CA8E02BB17"><enum>501.</enum><header>Dental
benefits</header>
<subsection id="H0B3119323D2A45548D6F61A7E200679E"><enum>(a)</enum><header>Coverage</header>
<paragraph id="H22DDD4F11A774DA4A34B748FB6509D4E"><enum>(1)</enum><header>In
general</header><text>Section 2103 (42 U.S.C. 1397cc) is amended—</text>
<subparagraph id="H1D886B09FE1046BE8768AC32E36417D9"><enum>(A)</enum><text>in subsection
(a)—</text>
<clause id="H45739DCBF833464C80EE1B3EAEBD5441"><enum>(i)</enum><text>in
the matter before paragraph (1), by striking <quote>subsection (c)(5)</quote>
and inserting <quote>paragraphs (5) and (7) of subsection (c)</quote>;
and</text>
</clause><clause id="HBF721991573C4F578959CFC3FBDFD8FF"><enum>(ii)</enum><text>in
paragraph (1), by inserting <quote>at least</quote> after <quote>that
is</quote>; and</text>
</clause></subparagraph><subparagraph id="HD182D19D4DAA43C08497B892C790C917"><enum>(B)</enum><text>in subsection
(c)—</text>
<clause id="HDBFA0EC6258D4F6EBC053E006CB64FB9"><enum>(i)</enum><text>by
redesignating paragraph (5) as paragraph (7); and</text>
</clause><clause id="H4A665E19E6B24959A3240700BDB3A593"><enum>(ii)</enum><text>by
inserting after paragraph (4), the following:</text>
<quoted-block display-inline="no-display-inline" id="H48A33FA221F54AB99CBB8774DA72C11" style="OLC">
<paragraph commented="no" id="HDC48FE8984CD4D2EB6AA68D41C2975ED"><enum>(5)</enum><header>Dental
benefits</header>
<subparagraph id="H9F12B21C2CBC4310AD4C458E4EE135F3"><enum>(A)</enum><header>In
general</header><text>The child health assistance provided to a targeted
low-income child shall include coverage of dental services necessary to prevent
disease and promote oral health, restore oral structures to health and
function, and treat emergency conditions.</text>
</subparagraph><subparagraph id="HA66D646401944BF8986BEE903C61F2FB"><enum>(B)</enum><header>Permitting use
of dental benchmark plans by certain States</header><text display-inline="yes-display-inline">A State may elect to meet the requirement
of subparagraph (A) through dental coverage that is equivalent to a benchmark
dental benefit package described in subparagraph (C).</text>
</subparagraph><subparagraph id="H3FE59C25331D463984157E80EF371DF"><enum>(C)</enum><header>Benchmark Dental
Benefit Packages</header><text display-inline="yes-display-inline">The
benchmark dental benefit packages are as follows:</text>
<clause id="H040D3E5BEC964CD3A800E83E8945F465"><enum>(i)</enum><header>FEHBP children’s
dental coverage</header><text display-inline="yes-display-inline">A dental
benefits plan under chapter 89A of title 5, United States Code, that has been
selected most frequently by employees seeking dependent coverage, among such
plans that provide such dependent coverage, in either of the previous 2 plan
years.</text>
</clause><clause id="HD352F3CDAE2E4DDFBA0065423078DCFF"><enum>(ii)</enum><header>State employee
dependent dental coverage</header><text display-inline="yes-display-inline">A
dental benefits plan that is offered and generally available to State employees
in the State involved and that has been selected most frequently by employees
seeking dependent coverage, among such plans that provide such dependent
coverage, in either of the previous 2 plan years.</text>
</clause><clause id="HEED4DD869AAE4838A1F5626B2394D995"><enum>(iii)</enum><header>Coverage
offered through commercial dental plan</header><text>A dental benefits plan
that has the largest insured commercial, non-medicaid enrollment of dependent
covered lives of such plans that is offered in the State
involved.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph><paragraph id="H84A09F2A4B794F829CDACFCA742C93D"><enum>(2)</enum><header>Assuring access
to care</header><text>Section 2102(a)(7)(B) (42 U.S.C. 1397bb(c)(2)) is amended
by inserting <quote>and services described in section 2103(c)(5)</quote> after
<quote>emergency services</quote>.</text>
</paragraph><paragraph id="H1AFC0534271340428C662D03D2A34559"><enum>(3)</enum><header>Effective
date</header><text>The amendments made by paragraphs (1) and (2) shall apply to
coverage of items and services furnished on or after October 1, 2009.</text>
</paragraph></subsection><subsection id="ID28367cc4b8634a3c9617568b0f458ffa"><enum>(b)</enum><header>State option to
provide dental-only supplemental coverage</header>
<paragraph id="ID130f5490ecaa41d08051048a54095871"><enum>(1)</enum><header>In
general</header><text>—Section 2110(b) (42 U.S.C. 1397jj(b)) is amended—</text>
<subparagraph id="ID25c97409b8584a08af90fc424a58b49e"><enum>(A)</enum><text>in paragraph
(1)(C), by inserting <quote>, subject to paragraph (5),</quote> after
<quote>under title XIX or</quote>; and</text>
</subparagraph><subparagraph id="IDaf5e77890b5042b19035bf1cedbb6331"><enum>(B)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id7203750447364BF5BE5CD1EBAB3DC4A1" style="OLC">
<paragraph id="ID27264b30579441caaef0a95f6b4549c3"><enum>(5)</enum><header>State option to
provide dental-only supplemental coverage</header>
<subparagraph id="idBFF8522CE9084841B5C5305349D494A2"><enum>(A)</enum><header>In
general</header><text>Subject to subparagraphs (B) and (C), in the case of any
child who is enrolled in a group health plan or health insurance coverage
offered through an employer who would, but for the application of paragraph
(1)(C), satisfy the requirements for being a targeted low-income child under
the State child health plan, a State may waive the application of such
paragraph to the child in order to provide—</text>
<clause id="IDaa9ee43af6844fb0a4b8b6e76bfc0d7f"><enum>(i)</enum><text>dental coverage
consistent with the requirements of subsection (c)(5) of section 2103;
or</text>
</clause><clause id="ID6ae785bd416e4338b143e5a362d43a68"><enum>(ii)</enum><text>cost-sharing
protection for dental coverage consistent with such requirements and the
requirements of subsection (e)(3)(B) of such section.</text>
</clause></subparagraph><subparagraph commented="no" id="id5B1DE163C57B42EBA5B178580EB02E78"><enum>(B)</enum><header>Limitation</header><text>A
State may limit the application of a waiver of paragraph (1)(C) to children
whose family income does not exceed a level specified by the State, so long as
the level so specified does not exceed the maximum income level otherwise
established for other children under the State child health plan.</text>
</subparagraph><subparagraph id="idDE1E04E07A464F12BE6548A19C7F270E"><enum>(C)</enum><header>Conditions</header><text>A
State may not offer dental-only supplemental coverage under this paragraph
unless the State satisfies the following conditions:</text>
<clause id="IDcc6a608d03364e73852279c7f74ea7df"><enum>(i)</enum><header>Income
eligibility</header><text>The State child health plan (whether implemented
under title XIX or this title)—</text>
<subclause id="IDcd76873d19ba40cc987776029c3d53b1"><enum>(I)</enum><text>has the highest
income eligibility standard permitted under this title (or a waiver) as of
January 1, 2009;</text>
</subclause><subclause id="IDf04919aa861849f796a1c7fe7001a4d7"><enum>(II)</enum><text>does not limit
the acceptance of applications for children or impose any numerical limitation,
waiting list, or similar limitation on the eligibility of such children for
child health assistance under such State plan; and</text>
</subclause><subclause id="ID408934b20a9c40909e891775f85e48f4"><enum>(III)</enum><text>provides
benefits to all children in the State who apply for and meet eligibility
standards.</text>
</subclause></clause><clause id="idCD4A080417C443CF90E35EA7D900D1F4"><enum>(ii)</enum><header>No more
favorable treatment</header><text>The State child health plan may not provide
more favorable dental coverage or cost-sharing protection for dental coverage
to children provided dental-only supplemental coverage under this paragraph
than the dental coverage and cost-sharing protection for dental coverage
provided to targeted low-income children who are eligible for the full range of
child health assistance provided under the State child health
plan.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="IDeb42a30707f844d9988475fb88535ece"><enum>(2)</enum><header>State option to
waive waiting period</header><text>Section 2102(b)(1)(B) (42 U.S.C.
1397bb(b)(1)(B)), as amended by section 111(b)(2), is amended—</text>
<subparagraph id="IDa03db0b358a0481abe8ad6fe78d13c87"><enum>(A)</enum><text>in clause (ii),
by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph id="IDfd8afe5348784a839b791d222423ba1d"><enum>(B)</enum><text>in clause (iii),
by striking the period and inserting <quote>; and</quote>; and</text>
</subparagraph><subparagraph id="IDd5747f659284477a9f108beaa26d175c"><enum>(C)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="id76112C33ACCF4F67BC1C140111232021" style="OLC">
<clause id="ID4717ea56fc3d495892e1dbdd379cf8d9"><enum>(iv)</enum><text>at State option,
may not apply a waiting period in the case of a child provided dental-only
supplemental coverage under section
2110(b)(5).</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="ID691c9e01e6ff4122b57a73484c601f3a"><enum>(3)</enum><header>Application of
enhanced match under medicaid</header><text>Section 1905 (42 U.S.C. 1396d) is
amended—</text>
<subparagraph id="ID6931ae48850c4eff93f101246b4962b2"><enum>(A)</enum><text>in subsection
(b), in the fourth sentence, by striking <quote>or subsection (u)(3)</quote>
and inserting <quote>, (u)(3), or (u)(4)</quote>; and</text>
</subparagraph><subparagraph id="IDdb3019e360ad45dc8e5e2287c7f58a9f"><enum>(B)</enum><text>in subsection
(u)—</text>
<clause id="ID575a6e0211494a3aaa9422892741d915"><enum>(i)</enum><text>by
redesignating paragraph (4) as paragraph (5); and</text>
</clause><clause id="ID640d82d12d86497c9cdd999f4266c6f2"><enum>(ii)</enum><text>by
inserting after paragraph (3) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id65372F620A104046AB452BD4135850EA" style="OLC">
<paragraph id="ID624544e9673d4ffaa60be7010aac3f6b"><enum>(4)</enum><text>For purposes of
subsection (b), the expenditures described in this paragraph are expenditures
for dental-only supplemental coverage for children described in section
2110(b)(5).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph></subsection><subsection id="H5A352548D7134A91A630B17758EB8562"><enum>(c)</enum><header>Dental education
for parents of newborns</header><text display-inline="yes-display-inline">The
Secretary shall develop and implement, through entities that fund or provide
perinatal care services to targeted low-income children under a State child
health plan under title XXI of the Social Security Act, a program to deliver
oral health educational materials that inform new parents about risks for, and
prevention of, early childhood caries and the need for a dental visit within
their newborn’s first year of life.</text>
</subsection><subsection id="H0D3774EE38224994B2EAA11BA450F56"><enum>(d)</enum><header>Provision of
dental services through FQHCs</header>
<paragraph id="H84E5837E83BD45ACABF3AF9DEFDE9C04"><enum>(1)</enum><header>Medicaid</header><text>Section
1902(a) (42 U.S.C. 1396a(a)) is amended—</text>
<subparagraph id="H63EFB742326B4134AE007870F0B100EF"><enum>(A)</enum><text>by striking
<quote>and</quote> at the end of paragraph (70);</text>
</subparagraph><subparagraph id="HB2A0CFCCF6B74A49A50082D6EBE8E6D1"><enum>(B)</enum><text>by striking the
period at the end of paragraph (71) and inserting <quote>; and</quote>;
and</text>
</subparagraph><subparagraph id="HEFB89ABB564C47D8B43C8D8BC5980013"><enum>(C)</enum><text>by inserting after
paragraph (71) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H18146575886A41229065A37DC5B193A4" style="OLC">
<paragraph id="HE9479680046D4E6D9EDF2F264135906B"><enum>(72)</enum><text display-inline="yes-display-inline">provide that the State will not prevent a
Federally-qualified health center from entering into contractual relationships
with private practice dental providers in the provision of Federally-qualified
health center
services.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H8621EDF4B33C40158D871DD737A7ECE9"><enum>(2)</enum><header>CHIP</header><text>Section
2107(e)(1) (42 U.S.C. 1397g(e)(1)), as amended by subsections (a)(2) and (d)(2)
of section 203, is amended by inserting after subparagraph (B) the following
new subparagraph (and redesignating the succeeding subparagraphs
accordingly):</text>
<quoted-block display-inline="no-display-inline" id="H592486A89C9E43EBBBF4F7B2394C04C" style="OLC">
<subparagraph id="H44B856170E3B491484C8A1B37513ADD"><enum>(C)</enum><text>Section 1902(a)(72)
(relating to limiting FQHC contracting for provision of dental
services).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H13EF698678BB4E369F28CADDCA9CBD26"><enum>(3)</enum><header>Effective
date</header><text>The amendments made by this subsection shall take effect on
January 1, 2009.</text>
</paragraph></subsection><subsection id="H8D78F5CFBC1541E2B56B120068F42F43"><enum>(e)</enum><header>Reporting
information on dental health</header>
<paragraph id="H78B0ED9FFC8B4E0D8BDA75002122B4F5"><enum>(1)</enum><header>Medicaid</header><text>Section
1902(a)(43)(D)(iii) (42 U.S.C. 1396a(a)(43)(D)(iii)) is amended by inserting
<quote>and other information relating to the provision of dental services to
such children described in section 2108(e)</quote> after <quote>receiving
dental services,</quote>.</text>
</paragraph><paragraph id="H3F7E1E8EB9CB4E91ACDA5CD7AD9119B6"><enum>(2)</enum><header>CHIP</header><text display-inline="yes-display-inline">Section 2108 (42 U.S.C. 1397hh) is amended
by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H3B1C9EF255104E11ACC29F678F87D32B" style="OLC">
<subsection id="H27082E697A304855A6CB477969421658"><enum>(e)</enum><header>Information on
dental care for children</header>
<paragraph id="H865526971F194DF6BBDF9CCC5C82DFE4"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Each annual report
under subsection (a) shall include the following information with respect to
care and services described in section 1905(r)(3) provided to targeted
low-income children enrolled in the State child health plan under this title at
any time during the year involved:</text>
<subparagraph id="HC8105F1EA32845FAA3887852E0F3219E"><enum>(A)</enum><text display-inline="yes-display-inline">The number of enrolled children by age
grouping used for reporting purposes under section 1902(a)(43).</text>
</subparagraph><subparagraph id="H955658AC736D4BB4936CD699B45EF24E"><enum>(B)</enum><text>For children
within each such age grouping, information of the type contained in questions
12(a)–(c) of CMS Form 416 (that consists of the number of enrolled targeted low
income children who receive any, preventive, or restorative dental care under
the State plan).</text>
</subparagraph><subparagraph id="HF10669C75CD24E5DB07F26D5994E5686"><enum>(C)</enum><text>For the age
grouping that includes children 8 years of age, the number of such children who
have received a protective sealant on at least one permanent molar
tooth.</text>
</subparagraph></paragraph><paragraph id="HDFE66ED6812840CEBB14626E1EDDCE9D"><enum>(2)</enum><header>Inclusion of
information on enrollees in managed care plans</header><text>The information
under paragraph (1) shall include information on children who are enrolled in
managed care plans and other private health plans and contracts with such plans
under this title shall provide for the reporting of such information by such
plans to the
State.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HDAA2EA24636E4B34810015A86FA3B98E"><enum>(3)</enum><header>Effective
date</header><text display-inline="yes-display-inline">The amendments made by
this subsection shall be effective for annual reports submitted for years
beginning after date of enactment.</text>
</paragraph></subsection><subsection display-inline="no-display-inline" id="H46DAC990A47A4B0EBDC62993E256E8EE"><enum>(f)</enum><header>Improved
Accessibility of Dental Provider Information to Enrollees Under Medicaid and
CHIP</header><text>The Secretary shall—</text>
<paragraph id="H4E13B2FD38C34F11AEDF254C5CD7BC17"><enum>(1)</enum><text display-inline="yes-display-inline">work with States, pediatric dentists, and
other dental providers (including providers that are, or are affiliated with, a
school of dentistry) to include, not later than 6 months after the date of the
enactment of this Act, on the Insure Kids Now website
(http://www.insurekidsnow.gov/) and hotline (1–877–KIDS–NOW) (or on any
successor websites or hotlines) a current and accurate list of all such
dentists and providers within each State that provide dental services to
children enrolled in the State plan (or waiver) under Medicaid or the State
child health plan (or waiver) under CHIP, and shall ensure that such list is
updated at least quarterly; and</text>
</paragraph><paragraph id="H5E81AE22CDF94331984D0039D08A2BF"><enum>(2)</enum><text>work with States to
include, not later than 6 months after the date of the enactment of this Act, a
description of the dental services provided under each State plan (or waiver)
under Medicaid and each State child health plan (or waiver) under CHIP on such
Insure Kids Now website, and shall ensure that such list is updated at least
annually.</text>
</paragraph></subsection><subsection id="H126BD6F1EDE14B6FA6E5864BD4ABD58"><enum>(g)</enum><header>Inclusion of
Status of Efforts To Improve Dental Care in Reports on the Quality of
Children’s Health Care Under Medicaid and CHIP</header><text>Section 1139A(a),
as added by section 401(a), is amended—</text>
<paragraph id="HD34781C00940428D98E851E846207B89"><enum>(1)</enum><text>in paragraph
(3)(B)(ii), by inserting <quote>and, with respect to dental care, conditions
requiring the restoration of teeth, relief of pain and infection, and
maintenance of dental health</quote> after <quote>chronic conditions</quote>;
and</text>
</paragraph><paragraph id="H6CBF99AEBEDE434C934BA9A728E6FE09"><enum>(2)</enum><text>in paragraph
(6)(A)(ii), by inserting <quote>dental care,</quote> after <quote>preventive
health services,</quote>.</text>
</paragraph></subsection><subsection id="H08A21188CF8949BA861E29A5A691F000"><enum>(h)</enum><header>GAO study and
report</header>
<paragraph id="HC3744CD785F4428498AA2043E62B9917"><enum>(1)</enum><header>Study</header><text>The
Comptroller General of the United States shall provide for a study that
examines—</text>
<subparagraph id="H3ACBB33F811E4BE6ADBACA695C27157C"><enum>(A)</enum><text>access to dental
services by children in underserved areas;</text>
</subparagraph><subparagraph id="H9A6A8EA8EFEE457FA2E6085FE725CD27"><enum>(B)</enum><text display-inline="yes-display-inline">children’s access to oral health care,
including preventive and restorative services, under Medicaid and CHIP,
including—</text>
<clause display-inline="no-display-inline" id="HFF5B1848AF8D4FD3B069C4E9DB558812"><enum>(i)</enum><text>the extent to
which dental providers are willing to treat children eligible for such
programs;</text>
</clause><clause id="H883094534805416FB15BB9EE70FD1B25"><enum>(ii)</enum><text>information on
such children’s access to networks of care, including such networks that serve
special needs children; and</text>
</clause><clause id="H42800BAE959E4286A3E4EA86F6B3356"><enum>(iii)</enum><text>geographic
availability of oral health care, including preventive and restorative
services, under such programs; and</text>
</clause></subparagraph><subparagraph id="H341E5724159B424E9EC966DCE631A7F3"><enum>(C)</enum><text>the feasibility
and appropriateness of using qualified mid-level dental health providers, in
coordination with dentists, to improve access for children to oral health
services and public health overall.</text>
</subparagraph></paragraph><paragraph id="HF0208977ACC24E8C8EF5BD5741BEF024"><enum>(2)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 18 months year after the
date of the enactment of this Act, the Comptroller General shall submit to
Congress a report on the study conducted under paragraph (1). The report shall
include recommendations for such Federal and State legislative and
administrative changes as the Comptroller General determines are necessary to
address any barriers to access to oral health care, including preventive and
restorative services, under Medicaid and CHIP that may exist.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="HC750DCA872B74FEFA9C6F6588B5376D" section-type="subsequent-section"><enum>502.</enum><header>Mental health parity
in CHIP plans</header>
<subsection commented="no" id="H84BEE5ECF6E440D48D00A745FE862DED"><enum>(a)</enum><header>Assurance of
Parity</header><text display-inline="yes-display-inline">Section 2103(c) (42
U.S.C. 1397cc(c)), as amended by section 501(a)(1)(B), is amended by inserting
after paragraph (5), the following:</text>
<quoted-block id="H9F95335E0CD7454CA79D12A14D00BE8C" style="OLC">
<paragraph commented="no" id="H8F3AEFA319D1464980978FEB3E07F2FA"><enum>(6)</enum><header>Mental health
services parity</header>
<subparagraph id="idFDC8519042F045A782CF2DE2A110B030"><enum>(A)</enum><header>In
general</header><text>In the case of a State child health plan that provides
both medical and surgical benefits and mental health or substance use disorder
benefits, such plan shall ensure that the financial requirements and treatment
limitations applicable to such mental health or substance use disorder benefits
comply with the requirements of section 2705(a) of the Public Health Service
Act in the same manner as such requirements apply to a group health
plan.</text>
</subparagraph><subparagraph commented="no" id="H836A865674A54158964787DE00336745"><enum>(B)</enum><header>Deemed
compliance</header><text>To the extent that a State child health plan includes
coverage with respect to an individual described in section 1905(a)(4)(B) and
covered under the State plan under section 1902(a)(10)(A) of the services
described in section 1905(a)(4)(B) (relating to early and periodic screening,
diagnostic, and treatment services defined in section 1905(r)) and provided in
accordance with section 1902(a)(43), such plan shall be deemed to satisfy the
requirements of subparagraph
(A).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="H10FEACED30894405A69EB0F5906CDD6"><enum>(b)</enum><header>Conforming
Amendments</header><text>Section 2103 (42 U.S.C. 1397cc) is amended—</text>
<paragraph commented="no" id="HF00EC3B86F12476181AAD777A2D088B0"><enum>(1)</enum><text>in subsection (a),
as amended by section 501(a)(1)(A)(i), in the matter preceding paragraph (1),
by inserting <quote>, (6),</quote> after <quote>(5)</quote>; and</text>
</paragraph><paragraph commented="no" id="H095A3F0D5CAB4B0BB4DD8B15B57B007E"><enum>(2)</enum><text>in subsection
(c)(2), by striking subparagraph (B) and redesignating subparagraphs (C) and
(D) as subparagraphs (B) and (C), respectively.</text>
</paragraph></subsection></section><section display-inline="no-display-inline" id="HF897C466F3AF443E9213EDE6DBC67EE6" section-type="subsequent-section"><enum>503.</enum><header>Application of
prospective payment system for services provided by Federally-qualified health
centers and rural health clinics</header>
<subsection id="H28F20B0357CA4776A6558512117524DA"><enum>(a)</enum><header>Application of
Prospective Payment System</header>
<paragraph id="H9D53B6C3B43F4744A5422F82E7DBC800"><enum>(1)</enum><header>In
general</header><text>Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as amended
by section 501(c)(2) is amended by inserting after subparagraph (C) the
following new subparagraph (and redesignating the succeeding subparagraphs
accordingly):</text>
<quoted-block id="HB72E364751244C608D8D28B005834194" style="OLC">
<subparagraph id="H6ED609AD821D4621A49506547C182C8D"><enum>(D)</enum><text>Section 1902(bb)
(relating to payment for services provided by Federally-qualified health
centers and rural health
clinics).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HB410893B2FDA4D86BD225184A27D4ED"><enum>(2)</enum><header>Effective
date</header><text>The amendment made by paragraph (1) shall apply to services
provided on or after October 1, 2009.</text>
</paragraph></subsection><subsection id="HB18BCFCA875D43488297A632CF7FCDD0"><enum>(b)</enum><header>Transition
Grants</header>
<paragraph commented="no" id="H61382609ACD34A7FB730C47C9E006123"><enum>(1)</enum><header>Appropriation</header><text>Out
of any funds in the Treasury not otherwise appropriated, there is appropriated
to the Secretary for fiscal year 2009, $5,000,000, to remain available until
expended, for the purpose of awarding grants to States with State child health
plans under CHIP that are operated separately from the State Medicaid plan
under title XIX of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (including any waiver of such plan), or in combination with the
State Medicaid plan, for expenditures related to transitioning to compliance
with the requirement of section 2107(e)(1)(D) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (as added by
subsection (a)) to apply the prospective payment system established under
section 1902(bb) of the such Act (42 U.S.C. 1396a(bb)) to services provided by
Federally-qualified health centers and rural health clinics.</text>
</paragraph><paragraph id="H56EF7590D0B6427BA001B6E200D560F6"><enum>(2)</enum><header>Monitoring and
report</header><text>The Secretary shall monitor the impact of the application
of such prospective payment system on the States described in paragraph (1)
and, not later than October 1, 2011, shall report to Congress on any effect on
access to benefits, provider payment rates, or scope of benefits offered by
such States as a result of the application of such payment system.</text>
</paragraph></subsection></section><section display-inline="no-display-inline" id="HC13797ACCC6047C1AE9919233358B0FE" section-type="subsequent-section"><enum>504.</enum><header>Premium grace
period</header>
<subsection id="H5A55267EDAC144279D80A5C5D6D962D9"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 2103(e)(3)
(42 U.S.C. 1397cc(e)(3)) is amended by adding at the end the following new
subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H134CE0586D814007A751B7FB168700F8" style="OLC">
<subparagraph id="H541783F2F4FB46BFBFCF1BED504BB6E7"><enum>(C)</enum><header>Premium grace
period</header><text display-inline="yes-display-inline">The State child health
plan—</text>
<clause id="H57F44290FE8F4AFCA1A2634E136005E"><enum>(i)</enum><text display-inline="yes-display-inline">shall afford individuals enrolled under the
plan a grace period of at least 30 days from the beginning of a new coverage
period to make premium payments before the individual’s coverage under the plan
may be terminated; and</text>
</clause><clause id="H5CAE71ABBCF34E7D93D1D65EE6196838"><enum>(ii)</enum><text display-inline="yes-display-inline">shall provide to such an individual, not
later than 7 days after the first day of such grace period, notice—</text>
<subclause id="HC856E296945445D48E00463EA593A2DE"><enum>(I)</enum><text display-inline="yes-display-inline">that failure to make a premium payment
within the grace period will result in termination of coverage under the State
child health plan; and</text>
</subclause><subclause id="HA05DC65FAECB4D9791BAA7D9C6C96B20"><enum>(II)</enum><text display-inline="yes-display-inline">of the individual’s right to challenge the
proposed termination pursuant to the applicable Federal regulations.</text>
</subclause></clause><continuation-text continuation-text-level="subparagraph">For
purposes of clause (i), the term <term>new coverage period</term> means the
month immediately following the last month for which the premium has been
paid.</continuation-text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HF586202C7C5A4AC6B4E1FC7E8475429E"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to new
coverage periods beginning on or after the date of the enactment of this
Act.</text>
</subsection></section><section display-inline="no-display-inline" id="H31C0312C1EC84AB800C5967B5403C686" section-type="subsequent-section"><enum>505.</enum><header>Clarification of
coverage of services provided through school-based health centers</header>
<subsection display-inline="no-display-inline" id="idF1423E211E324893A355E15A4D0C57B1"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 2103(c) (42
U.S.C. 1397cc(c)), as amended by section 501(a)(1)(B), is amended by adding at
the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HE88EEB4820AD45B200B0D47541E8D0ED" style="OLC">
<paragraph id="H9B0F80A5113341BD8001D1DC72ED5024"><enum>(8)</enum><header>Availability of
coverage for items and services furnished through school-based health
centers</header><text>Nothing in this title shall be construed as limiting a
State’s ability to provide child health assistance for covered items and
services that are furnished through school-based health centers (as defined in
section
2110(c)(9)).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection display-inline="no-display-inline" id="idE0BC4796B5F040A28FFF16667B727EC1"><enum>(b)</enum><header>Definition</header><text>Section
2110(c) (42 U.S.C. 1397jj) is amended by adding at the end the
following:</text>
<quoted-block display-inline="no-display-inline" id="id8E5832C734234511AF74D69B03A2BC2C" style="OLC">
<paragraph display-inline="no-display-inline" id="id258687196BA643BA8C7BC481364127A0"><enum>(9)</enum><header>School-based
health center</header>
<subparagraph display-inline="no-display-inline" id="id08A0B811D4814647BC10B846A12A6E79"><enum>(A)</enum><header>In
general</header><text>The term <term>school-based health center</term> means a
health clinic that—</text>
<clause display-inline="no-display-inline" id="id8F481128B1414C4A921C68E90BB42F7D"><enum>(i)</enum><text>is located in or
near a school facility of a school district or board or of an Indian tribe or
tribal organization;</text>
</clause><clause display-inline="no-display-inline" id="id05B57CD361A0460FAB71A941596B5304"><enum>(ii)</enum><text>is organized
through school, community, and health provider relationships;</text>
</clause><clause display-inline="no-display-inline" id="idC2BC0B2CA8F74366A298206B5986348D"><enum>(iii)</enum><text>is administered
by a sponsoring facility;</text>
</clause><clause display-inline="no-display-inline" id="id530FCCC1E2684D2D930A07737AB5663C"><enum>(iv)</enum><text>provides through
health professionals primary health services to children in accordance with
State and local law, including laws relating to licensure and certification;
and</text>
</clause><clause display-inline="no-display-inline" id="idD51ECA6BD7284E848E905FBD380585C4"><enum>(v)</enum><text>satisfies such
other requirements as a State may establish for the operation of such a
clinic.</text>
</clause></subparagraph><subparagraph display-inline="no-display-inline" id="idE97504EF41434F079EE93962682A2C54"><enum>(B)</enum><header>Sponsoring
facility</header><text>For purposes of subparagraph (A)(iii), the term
<term>sponsoring facility</term> includes any of the following:</text>
<clause display-inline="no-display-inline" id="idB616DC01A9874D1F874A6BFB8262295C"><enum>(i)</enum><text>A
hospital.</text>
</clause><clause display-inline="no-display-inline" id="id58401640FD54450187FE42F6803FB9B9"><enum>(ii)</enum><text>A public health
department.</text>
</clause><clause display-inline="no-display-inline" id="idFB6F570DA4B9471DB7603B54BFBA7E92"><enum>(iii)</enum><text>A community
health center.</text>
</clause><clause display-inline="no-display-inline" id="id62A6A95D5F234C83954FE4FDC88A2687"><enum>(iv)</enum><text>A nonprofit
health care agency.</text>
</clause><clause display-inline="no-display-inline" id="idF2D7B94709714BC1830357637FEC87C6"><enum>(v)</enum><text>A school or
school system.</text>
</clause><clause display-inline="no-display-inline" id="idE9F4911B8292471B884010D25EDFE1AC"><enum>(vi)</enum><text>A program
administered by the Indian Health Service or the Bureau of Indian Affairs or
operated by an Indian tribe or a tribal
organization.</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="id33522E7637224DCD97648B46B9B20081"><enum>506.</enum><header>Medicaid and
CHIP Payment and Access Commission</header>
<subsection id="idC87CD4792B10479192B4B4AFA2155529"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Title XIX (42 U.S.C.
1396 et seq.) is amended by inserting before section 1901 the following new
section:</text>
<quoted-block display-inline="no-display-inline" id="id05E9CBFF31FD4A1BAB9251DA49F90022" style="traditional">
<section commented="no" display-inline="no-display-inline" id="id451C3E6ACBE447E8AEDA88EF5EDEABFA"><enum>1900.</enum><header>Medicaid and CHIP Payment and Access
Commission</header><subsection commented="no" display-inline="yes-display-inline" id="idEC6EEB44CDC741BB87A500529D7E1895"><enum>(a)</enum><header>Establishment</header><text>There
is hereby established the Medicaid and CHIP Payment and Access Commission (in
this section referred to as <quote>MACPAC</quote>).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id452D98F892CB4D8F9AC0B5F3A979897F"><enum>(b)</enum><header>Duties</header>
<paragraph commented="no" display-inline="no-display-inline" id="id1CB246AE656043C19BBB64EA95EEE9EB"><enum>(1)</enum><header>Review of
access policies and annual reports</header><text>MACPAC shall—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="idD7C3FFBB1A3A4AF381F0C0238FA15345"><enum>(A)</enum><text>review policies
of the Medicaid program established under this title (in this section referred
to as <quote>Medicaid</quote>) and the State Children's Health Insurance
Program established under title XXI (in this section referred to as
<quote>CHIP</quote>) affecting children's access to covered items and services,
including topics described in paragraph (2);</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id000AE41963564A0DA18C31AAB4099515"><enum>(B)</enum><text>make
recommendations to Congress concerning such access policies;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id0B5ED384880742EF952ABB6AB7F802CC"><enum>(C)</enum><text>by not later than
March 1 of each year (beginning with 2010), submit a report to Congress
containing the results of such reviews and MACPAC's recommendations concerning
such policies; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id64412BDA08AB4FE1AAFD2338F50990CB"><enum>(D)</enum><text>by not later than
June 1 of each year (beginning with 2010), submit a report to Congress
containing an examination of issues affecting Medicaid and CHIP, including the
implications of changes in health care delivery in the United States and in the
market for health care services on such programs.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id2F520C6A0BF54BB5B402B6355EED611F"><enum>(2)</enum><header>Specific topics
to be reviewed</header><text>Specifically, MACPAC shall review and assess the
following:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="idEB3EAD111F264D1D8AAA7D74557D163C"><enum>(A)</enum><header>Medicaid and
CHIP payment policies</header><text>Payment policies under Medicaid and CHIP,
including—</text>
<clause commented="no" display-inline="no-display-inline" id="id72C90754DA6245BBB599ECE7975E1D09"><enum>(i)</enum><text>the factors
affecting expenditures for items and services in different sectors, including
the process for updating hospital, skilled nursing facility, physician,
Federally-qualified health center, rural health center, and other fees;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idB26C24AFC645441AA19464AC9191D354"><enum>(ii)</enum><text>payment
methodologies; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idC538686E146E401F904CD3AC598754AB"><enum>(iii)</enum><text>the
relationship of such factors and methodologies to access and quality of care
for Medicaid and CHIP beneficiaries.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id3BBAF22909BF4B9B9F697EF966F9B847"><enum>(B)</enum><header>Interaction of
medicaid and chip payment policies with health care delivery
generally</header><text>The effect of Medicaid and CHIP payment policies on
access to items and services for children and other Medicaid and CHIP
populations other than under this title or title XXI and the implications of
changes in health care delivery in the United States and in the general market
for health care items and services on Medicaid and CHIP.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id23EA66A06DDB42FE90C0FDBAFB9C836A"><enum>(C)</enum><header>Other access
policies</header><text>The effect of other Medicaid and CHIP policies on access
to covered items and services, including policies relating to transportation
and language barriers.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id19B933E78AF04307B7B20DA52AE44832"><enum>(3)</enum><header>Creation of
early-warning system</header><text>MACPAC shall create an early-warning system
to identify provider shortage areas or any other problems that threaten access
to care or the health care status of Medicaid and CHIP beneficiaries.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idBF6DFB858A0248019C7D23811345A2B2"><enum>(4)</enum><header>Comments on
certain secretarial reports</header><text>If the Secretary submits to Congress
(or a committee of Congress) a report that is required by law and that relates
to access policies, including with respect to payment policies, under Medicaid
or CHIP, the Secretary shall transmit a copy of the report to MACPAC. MACPAC
shall review the report and, not later than 6 months after the date of
submittal of the Secretary's report to Congress, shall submit to the
appropriate committees of Congress written comments on such report. Such
comments may include such recommendations as MACPAC deems appropriate.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id1F9205E66A5A473BA6F83DEBFAF0D53C"><enum>(5)</enum><header>Agenda and
additional reviews</header><text>MACPAC shall consult periodically with the
chairmen and ranking minority members of the appropriate committees of Congress
regarding MACPAC's agenda and progress towards achieving the agenda. MACPAC may
conduct additional reviews, and submit additional reports to the appropriate
committees of Congress, from time to time on such topics relating to the
program under this title or title XXI as may be requested by such chairmen and
members and as MACPAC deems appropriate.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idA5EB3B9D1674405CB9C86519AFD9D61E"><enum>(6)</enum><header>Availability of
reports</header><text>MACPAC shall transmit to the Secretary a copy of each
report submitted under this subsection and shall make such reports available to
the public.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idBA485FFB0B584A7B9F3690DA23B3F3B7"><enum>(7)</enum><header>Appropriate
committee of congress</header><text>For purposes of this section, the term
<quote>appropriate committees of Congress</quote> means the Committee on Energy
and Commerce of the House of Representatives and the Committee on Finance of
the Senate.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idA9FB6A585D6046888A9A8873C025976E"><enum>(8)</enum><header>Voting and
reporting requirements</header><text>With respect to each recommendation
contained in a report submitted under paragraph (1), each member of MACPAC
shall vote on the recommendation, and MACPAC shall include, by member, the
results of that vote in the report containing the recommendation.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idEC0CAB6ABDD74EA7BFD9A3FD28BDAC96"><enum>(9)</enum><header>Examination of
budget consequences</header><text>Before making any recommendations, MACPAC
shall examine the budget consequences of such recommendations, directly or
through consultation with appropriate expert entities.</text>
</paragraph></subsection><subsection id="ID095C209922D7424087AA5109BCABAF92"><enum>(c)</enum><header>Membership</header>
<paragraph id="IDCBAA8ED78705489EBAFC46B524402A2E"><enum>(1)</enum><header>Number and
appointment</header><text>MACPAC shall be composed of 17 members appointed by
the Comptroller General of the United States.</text>
</paragraph><paragraph id="IDBDF26BC9B002421CA566001D62F9903C"><enum>(2)</enum><header>Qualifications</header>
<subparagraph id="ID9FCD95266D244FE1B5C061C90BC23276"><enum>(A)</enum><header>In
general</header><text>The membership of MACPAC shall include individuals who
have had direct experience as enrollees or parents of enrollees in Medicaid or
CHIP and individuals with national recognition for their expertise in Federal
safety net health programs, health finance and economics, actuarial science,
health facility management, health plans and integrated delivery systems,
reimbursement of health facilities, health information technology, pediatric
physicians, dentists, and other providers of health services, and other related
fields, who provide a mix of different professionals, broad geographic
representation, and a balance between urban and rural representatives.</text>
</subparagraph><subparagraph id="IDC791764D1B6048DD9C0E7B509573BE93"><enum>(B)</enum><header>Inclusion</header><text>The
membership of MACPAC shall include (but not be limited to) physicians and other
health professionals, employers, third-party payers, and individuals with
expertise in the delivery of health services. Such membership shall also
include consumers representing children, pregnant women, the elderly, and
individuals with disabilities, current or former representatives of State
agencies responsible for administering Medicaid, and current or former
representatives of State agencies responsible for administering CHIP.</text>
</subparagraph><subparagraph id="ID08148C0C33BF4F229F420BFC166B246A"><enum>(C)</enum><header>Majority
nonproviders</header><text>Individuals who are directly involved in the
provision, or management of the delivery, of items and services covered under
Medicaid or CHIP shall not constitute a majority of the membership of
MACPAC.</text>
</subparagraph><subparagraph id="ID962C04F2B667457ABC31EBEAB5AA8E94"><enum>(D)</enum><header>Ethical
disclosure</header><text>The Comptroller General of the United States shall
establish a system for public disclosure by members of MACPAC of financial and
other potential conflicts of interest relating to such members. Members of
MACPAC shall be treated as employees of Congress for purposes of applying title
I of the Ethics in Government Act of 1978 (Public Law 95–521).</text>
</subparagraph></paragraph><paragraph id="IDDD1DF10796D3450A943D06A36B95AEAF"><enum>(3)</enum><header>Terms</header>
<subparagraph id="ID217C888383204355855401725F525AB6"><enum>(A)</enum><header>In
general</header><text>The terms of members of MACPAC shall be for 3 years
except that the Comptroller General of the United States shall designate
staggered terms for the members first appointed.</text>
</subparagraph><subparagraph id="IDCCDE236CDD154868BC6772EA8299E366"><enum>(B)</enum><header>Vacancies</header><text>Any
member appointed to fill a vacancy occurring before the expiration of the term
for which the member's predecessor was appointed shall be appointed only for
the remainder of that term. A member may serve after the expiration of that
member's term until a successor has taken office. A vacancy in MACPAC shall be
filled in the manner in which the original appointment was made.</text>
</subparagraph></paragraph><paragraph id="IDFBDF074AA0F742CD930D963FF700A13A"><enum>(4)</enum><header>Compensation</header><text>While
serving on the business of MACPAC (including travel time), a member of MACPAC
shall be entitled to compensation at the per diem equivalent of the rate
provided for level IV of the Executive Schedule under section 5315 of title 5,
United States Code; and while so serving away from home and the member's
regular place of business, a member may be allowed travel expenses, as
authorized by the Chairman of MACPAC. Physicians serving as personnel of MACPAC
may be provided a physician comparability allowance by MACPAC in the same
manner as Government physicians may be provided such an allowance by an agency
under section 5948 of title 5, United States Code, and for such purpose
subsection (i) of such section shall apply to MACPAC in the same manner as it
applies to the Tennessee Valley Authority. For purposes of pay (other than pay
of members of MACPAC) and employment benefits, rights, and privileges, all
personnel of MACPAC shall be treated as if they were employees of the United
States Senate.</text>
</paragraph><paragraph id="IDEBD4788038C54397A3C76D97C5848E6B"><enum>(5)</enum><header>Chairman; vice
chairman</header><text>The Comptroller General of the United States shall
designate a member of MACPAC, at the time of appointment of the member as
Chairman and a member as Vice Chairman for that term of appointment, except
that in the case of vacancy of the Chairmanship or Vice Chairmanship, the
Comptroller General of the United States may designate another member for the
remainder of that member's term.</text>
</paragraph><paragraph id="ID96DD88FDB3864EE88A8A8C1DCDEBCB79"><enum>(6)</enum><header>Meetings</header><text>MACPAC
shall meet at the call of the Chairman.</text>
</paragraph></subsection><subsection id="ID2A1F246254444B8A89576844624BCA59"><enum>(d)</enum><header>Director and
staff; experts and consultants</header><text>Subject to such review as the
Comptroller General of the United States deems necessary to assure the
efficient administration of MACPAC, MACPAC may—</text>
<paragraph id="ID65ADFBC96C1D4729AA7FAE95F6D1A2B3"><enum>(1)</enum><text>employ and fix
the compensation of an Executive Director (subject to the approval of the
Comptroller General of the United States) and such other personnel as may be
necessary to carry out its duties (without regard to the provisions of title 5,
United States Code, governing appointments in the competitive service);</text>
</paragraph><paragraph id="ID088440CE7920453A9242951021F46822"><enum>(2)</enum><text>seek such
assistance and support as may be required in the performance of its duties from
appropriate Federal departments and agencies;</text>
</paragraph><paragraph id="IDE33E7A6EBC954C22BA80451ED57BB3FE"><enum>(3)</enum><text>enter into
contracts or make other arrangements, as may be necessary for the conduct of
the work of MACPAC (without regard to section 3709 of the Revised Statutes (41
U.S.C. 5));</text>
</paragraph><paragraph id="IDA84DAF2D8A5945F09B939982088F9CBF"><enum>(4)</enum><text>make advance,
progress, and other payments which relate to the work of MACPAC;</text>
</paragraph><paragraph id="ID90DC99F2834744F9845A033ADCE8FA64"><enum>(5)</enum><text>provide
transportation and subsistence for persons serving without compensation;
and</text>
</paragraph><paragraph id="IDFACAAE2E8DC847408BB5CEA48177EE62"><enum>(6)</enum><text>prescribe such
rules and regulations as it deems necessary with respect to the internal
organization and operation of MACPAC.</text>
</paragraph></subsection><subsection id="ID1D73D1FB47FF4A5A82E48ACAB86432E0"><enum>(e)</enum><header>Powers</header>
<paragraph id="ID5887F3E4CF5D41D3B6386E2ACCD64BAA"><enum>(1)</enum><header>Obtaining
official data</header><text>MACPAC may secure directly from any department or
agency of the United States information necessary to enable it to carry out
this section. Upon request of the Chairman, the head of that department or
agency shall furnish that information to MACPAC on an agreed upon
schedule.</text>
</paragraph><paragraph id="IDDAA7D26BE7EA4885AF5CC81821CD445A"><enum>(2)</enum><header>Data
collection</header><text>In order to carry out its functions, MACPAC
shall—</text>
<subparagraph id="ID4DA71D1D380B45088BC3FFB20F140ED6"><enum>(A)</enum><text>utilize existing
information, both published and unpublished, where possible, collected and
assessed either by its own staff or under other arrangements made in accordance
with this section;</text>
</subparagraph><subparagraph id="IDEA5577DA09EC4EF9A1669E1D8153FA78"><enum>(B)</enum><text>carry out, or
award grants or contracts for, original research and experimentation, where
existing information is inadequate; and</text>
</subparagraph><subparagraph id="IDACD711BC6FF646FABEDD261DDD4BE45A"><enum>(C)</enum><text>adopt procedures
allowing any interested party to submit information for MACPAC's use in making
reports and recommendations.</text>
</subparagraph></paragraph><paragraph id="ID8C9ABD05B5BB4BD08A6C1FFBAF09B7A1"><enum>(3)</enum><header>Access of gao
to information</header><text>The Comptroller General of the United States shall
have unrestricted access to all deliberations, records, and nonproprietary data
of MACPAC, immediately upon request.</text>
</paragraph><paragraph id="ID14122D88DDEB4BEDAF330E0D05E44058"><enum>(4)</enum><header>Periodic
audit</header><text>MACPAC shall be subject to periodic audit by the
Comptroller General of the United States.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idCD195AC4C7B8457985E58E1DBD96005B"><enum>(f)</enum><header>Authorization
of appropriations</header>
<paragraph commented="no" display-inline="no-display-inline" id="id55295A0D1595400297ECC9EA91B2293D"><enum>(1)</enum><header>Request for
appropriations</header><text>MACPAC shall submit requests for appropriations in
the same manner as the Comptroller General of the United States submits
requests for appropriations, but amounts appropriated for MACPAC shall be
separate from amounts appropriated for the Comptroller General of the United
States.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id153531C157DB49AC81DCFC58B46336D6"><enum>(2)</enum><header>Authorization</header><text>There
are authorized to be appropriated such sums as may be necessary to carry out
the provisions of this
section.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idC0689335DE974156B2D6F28916B1E431"><enum>(b)</enum><header>Deadline for
initial appointments</header><text>Not later than January 1, 2010, the
Comptroller General of the United States shall appoint the initial members of
the Medicaid and CHIP Payment and Access Commission established under section
1900 of the Social Security Act (as added by subsection (a)).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id32496623D4144D78A054281B7BA3D7F5"><enum>(c)</enum><header>Annual report
on Medicaid</header><text>Not later than January 1, 2010, and annually
thereafter, the Secretary, in consultation with the Secretary of the Treasury,
the Secretary of Labor, and the States (as defined for purposes of Medicaid),
shall submit an annual report to Congress on the financial status of,
enrollment in, and spending trends for, Medicaid for the fiscal year ending on
September 30 of the preceding year.</text>
</subsection></section><enum>VI</enum><header>Program Integrity
and Other Miscellaneous Provisions</header>
<subtitle id="H7580488BE06D4FC4A0FE4EC04F8541C0"><enum>A</enum><header>Program Integrity
and Data Collection</header>
<section display-inline="no-display-inline" id="H8B2C7AAEB9334FF9B084BEC950305F37"><enum>601.</enum><header>Payment error
rate measurement (<quote>PERM</quote>)</header>
<subsection id="HFBF34BD22D26414392FAA5FA75D53E4D"><enum>(a)</enum><header>Expenditures
Related to Compliance With Requirements</header>
<paragraph id="H86EE1983A7724AC7855641F8F5FBD8D7"><enum>(1)</enum><header>Enhanced
payments</header><text>Section 2105(c) (42 U.S.C. 1397ee(c)), as amended by
section 301(a), is amended by adding at the end the following new
paragraph:</text>
<quoted-block id="H01D3E29F88B5481793D91F6C21F21234" style="OLC">
<paragraph id="HEF5AB03FC8D54AC08191757500474E41"><enum>(11)</enum><header>Enhanced
payments</header><text>Notwithstanding subsection (b), the enhanced FMAP with
respect to payments under subsection (a) for expenditures related to the
administration of the payment error rate measurement (PERM) requirements
applicable to the State child health plan in accordance with the Improper
Payments Information Act of 2002 and parts 431 and 457 of title 42, Code of
Federal Regulations (or any related or successor guidance or regulations) shall
in no event be less than 90
percent.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HD3C9396A1FA145E7A63B03A0D446555B"><enum>(2)</enum><header>Exclusion of
from cap on administrative expenditures</header><text>Section 2105(c)(2)(C) (42
U.S.C. 1397ee(c)(2)C)), as amended by section 302(b)), is amended by adding at
the end the following:</text>
<quoted-block id="HD17A3FA1B5E34DA5AB2F8794BD111F5C" style="OLC">
<clause id="H2C3F2F9CAA8A494D94E4BB247ED00100"><enum>(iv)</enum><header>Payment error
rate measurement (perm) expenditures</header><text>Expenditures related to the
administration of the payment error rate measurement (PERM) requirements
applicable to the State child health plan in accordance with the Improper
Payments Information Act of 2002 and parts 431 and 457 of title 42, Code of
Federal Regulations (or any related or successor guidance or
regulations).</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H9BC21EAF48F547A7893D5DF4A8B06CA6"><enum>(b)</enum><header>Final Rule
Required To Be in Effect for All States</header><text>Notwithstanding parts 431
and 457 of title 42, Code of Federal Regulations (as in effect on the date of
enactment of this Act), the Secretary shall not calculate or publish any
national or State-specific error rate based on the application of the payment
error rate measurement (in this section referred to as <quote>PERM</quote>)
requirements to CHIP until after the date that is 6 months after the date on
which a new final rule (in this section referred to as the <quote>new final
rule</quote>) promulgated after the date of the enactment of this Act and
implementing such requirements in accordance with the requirements of
subsection (c) is in effect for all States. Any calculation of a national error
rate or a State specific error rate after such new final rule in effect for all
States may only be inclusive of errors, as defined in such new final rule or in
guidance issued within a reasonable time frame after the effective date for
such new final rule that includes detailed guidance for the specific
methodology for error determinations.</text>
</subsection><subsection id="H083EFEB7DC84432D942585BC508D7287"><enum>(c)</enum><header>Requirements for
New Final Rule</header><text>For purposes of subsection (b), the requirements
of this subsection are that the new final rule implementing the PERM
requirements shall—</text>
<paragraph id="H0B78123645104CF0AAB51654114F9344"><enum>(1)</enum><text>include—</text>
<subparagraph id="H8097F1D4916246569FB7B9E8269BEF9"><enum>(A)</enum><text>clearly defined
criteria for errors for both States and providers;</text>
</subparagraph><subparagraph id="HCB44236921614E4283684DA7D5428C14"><enum>(B)</enum><text>a clearly defined
process for appealing error determinations by—</text>
<clause id="H8587E45ABBCC436A9732FD3772A6F5DA"><enum>(i)</enum><text>review
contractors; or</text>
</clause><clause id="H6CFE715E14B64EF4BD98DE3B288E008F"><enum>(ii)</enum><text>the
agency and personnel described in section 431.974(a)(2) of title 42, Code of
Federal Regulations, as in effect on September 1, 2007, responsible for the
development, direction, implementation, and evaluation of eligibility reviews
and associated activities; and</text>
</clause></subparagraph><subparagraph id="H21F7CB2BD86F48ED9DFF21700099824C"><enum>(C)</enum><text>clearly defined
responsibilities and deadlines for States in implementing any corrective action
plans; and</text>
</subparagraph></paragraph><paragraph id="HD8B5760068D44F16B3A4EB4DCB6DAAC0"><enum>(2)</enum><text>provide that the
payment error rate determined for a State shall not take into account payment
errors resulting from the State’s verification of an applicant’s
self-declaration or self-certification of eligibility for, and the correct
amount of, medical assistance or child health assistance, if the State process
for verifying an applicant’s self-declaration or self-certification satisfies
the requirements for such process applicable under regulations promulgated by
the Secretary or otherwise approved by the Secretary.</text>
</paragraph></subsection><subsection id="HB3E948AB52814D39B694B3E6028300C6"><enum>(d)</enum><header>Option for
Application of Data for States in first application cycle Under the Interim
Final Rule</header><text display-inline="yes-display-inline">After the new
final rule implementing the PERM requirements in accordance with the
requirements of subsection (c) is in effect for all States, a State for which
the PERM requirements were first in effect under an interim final rule for
fiscal year 2007 or under a final rule for fiscal year 2008 may elect to accept
any payment error rate determined in whole or in part for the State on the
basis of data for that fiscal year or may elect to not have any payment error
rate determined on the basis of such data and, instead, shall be treated as if
fiscal year 2010 or fiscal year 2011 were the first fiscal year for which the
PERM requirements apply to the State.</text>
</subsection><subsection id="H33A4A911D4F7412E8F07E9632400FA96"><enum>(e)</enum><header>Harmonization of
MEQC and PERM</header>
<paragraph id="H2AD7597CE0294426BB6F003EDD609200"><enum>(1)</enum><header>Reduction of
redundancies</header><text>The Secretary shall review the Medicaid Eligibility
Quality Control (in this subsection referred to as the <quote>MEQC</quote>)
requirements with the PERM requirements and coordinate consistent
implementation of both sets of requirements, while reducing
redundancies.</text>
</paragraph><paragraph id="HEA5F84C5B5FE499993830049BCA65045"><enum>(2)</enum><header>State option to
apply PERM data</header><text>A State may elect, for purposes of determining
the erroneous excess payments for medical assistance ratio applicable to the
State for a fiscal year under section 1903(u) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1396b(u)) to substitute data resulting from the application of the PERM
requirements to the State after the new final rule implementing such
requirements is in effect for all States for data obtained from the application
of the MEQC requirements to the State with respect to a fiscal year.</text>
</paragraph><paragraph id="HDD4AAC1668914F67B825D1A52324A353"><enum>(3)</enum><header>State option to
apply MEQC data</header><text>For purposes of satisfying the requirements of
subpart Q of part 431 of title 42, Code of Federal Regulations, relating to
Medicaid eligibility reviews, a State may elect to substitute data obtained
through MEQC reviews conducted in accordance with section 1903(u) of the Social
Security Act (42 U.S.C. 1396b(u)) for data required for purposes of PERM
requirements, but only if the State MEQC reviews are based on a broad,
representative sample of Medicaid applicants or enrollees in the States.</text>
</paragraph></subsection><subsection id="H7AC5B2EF40D349F293745CE8E8C408E0"><enum>(f)</enum><header>Identification
of Improved State-Specific Sample Sizes</header><text>The Secretary shall
establish State-specific sample sizes for application of the PERM requirements
with respect to State child health plans for fiscal years beginning with the
first fiscal year that begins on or after the date on which the new final rule
is in effect for all States, on the basis of such information as the Secretary
determines appropriate. In establishing such sample sizes, the Secretary shall,
to the greatest extent practicable—</text>
<paragraph id="H1C90B125043149FB8DB669441125033F"><enum>(1)</enum><text>minimize the
administrative cost burden on States under Medicaid and CHIP; and</text>
</paragraph><paragraph id="HD29E672618274254AD58D2F85107C5E7"><enum>(2)</enum><text>maintain State
flexibility to manage such programs.</text>
</paragraph></subsection></section><section display-inline="no-display-inline" id="H11659357FE93430D89E1F524943937A6" section-type="subsequent-section"><enum>602.</enum><header>Improving data
collection</header>
<subsection id="H450D441F37DF413CAA3ED9E0935D5049"><enum>(a)</enum><header>Increased
Appropriation</header><text>Section 2109(b)(2) (42 U.S.C. 1397ii(b)(2)) is
amended by striking <quote>$10,000,000 for fiscal year 2000</quote> and
inserting <quote>$20,000,000 for fiscal year 2009</quote>.</text>
</subsection><subsection id="HACDB103AC61F4B7EBFC93B81B12FBD7C"><enum>(b)</enum><header>Use of
Additional Funds</header><text>Section 2109(b) (42 U.S.C. 1397ii(b)), as
amended by subsection (a), is amended—</text>
<paragraph id="H5B1C1D2FF5614F44A4D68662924D2839"><enum>(1)</enum><text>by redesignating
paragraph (2) as paragraph (4); and</text>
</paragraph><paragraph id="HAE326BE41E6842F49722AF4E50C6A974"><enum>(2)</enum><text>by inserting after
paragraph (1), the following new paragraphs:</text>
<quoted-block id="H2865876A71044FA79DD9D6B8C63340F" style="OLC">
<paragraph id="H1ADA7A81BE7B414282C5F9D45C84CCD"><enum>(2)</enum><header>Additional
requirements</header><text>In addition to making the adjustments required to
produce the data described in paragraph (1), with respect to data collection
occurring for fiscal years beginning with fiscal year 2009, in appropriate
consultation with the Secretary of Health and Human Services, the Secretary of
Commerce shall do the following:</text>
<subparagraph id="H3CECB25EB5254FC0B21ECDFC6EB6E9E"><enum>(A)</enum><text>Make appropriate
adjustments to the Current Population Survey to develop more accurate
State-specific estimates of the number of children enrolled in health coverage
under title XIX or this title.</text>
</subparagraph><subparagraph commented="no" id="HF1824EE2E06C4AB3821EABF3FCF91100"><enum>(B)</enum><text>Make appropriate
adjustments to the Current Population Survey to improve the survey estimates
used to determine the child population growth factor under section
2104(m)(5)(B) and any other data necessary for carrying out this title.</text>
</subparagraph><subparagraph id="HD742166185ED4B329600964B7E036B1C"><enum>(C)</enum><text>Include health
insurance survey information in the American Community Survey related to
children.</text>
</subparagraph><subparagraph commented="no" id="HA8CE12FEE1204E808223824DC6F40000"><enum>(D)</enum><text>Assess whether
American Community Survey estimates, once such survey data are first available,
produce more reliable estimates than the Current Population Survey with respect
to the purposes described in subparagraph (B).</text>
</subparagraph><subparagraph commented="no" id="HBDD5A293C80E4BB9B250768376E0DC53"><enum>(E)</enum><text>On the basis of
the assessment required under subparagraph (D), recommend to the Secretary of
Health and Human Services whether American Community Survey estimates should be
used in lieu of, or in some combination with, Current Population Survey
estimates for the purposes described in subparagraph (B).</text>
</subparagraph><subparagraph id="H71A76CD5665240FBB02D1762A2EC68A0"><enum>(F)</enum><text>Continue making
the adjustments described in the last sentence of paragraph (1) with respect to
expansion of the sample size used in State sampling units, the number of
sampling units in a State, and using an appropriate verification
element.</text>
</subparagraph></paragraph><paragraph id="H0EEA84DA392C4CF8B7F2BE4B00BCF8C"><enum>(3)</enum><header>Authority for the
secretary of health and human services to transition to the use of all, or some
combination of, acs estimates upon recommendation of the secretary of
commerce</header><text>If, on the basis of the assessment required under
paragraph (2)(D), the Secretary of Commerce recommends to the Secretary of
Health and Human Services that American Community Survey estimates should be
used in lieu of, or in some combination with, Current Population Survey
estimates for the purposes described in paragraph (2)(B), the Secretary of
Health and Human Services, in consultation with the States, may provide for a
period during which the Secretary may transition from carrying out such
purposes through the use of Current Population Survey estimates to the use of
American Community Survey estimates (in lieu of, or in combination with the
Current Population Survey estimates, as recommended), provided that any such
transition is implemented in a manner that is designed to avoid adverse impacts
upon States with approved State child health plans under this
title.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section display-inline="no-display-inline" id="HD0DFC972D8144AF29E7CED93E83276F" section-type="subsequent-section"><enum>603.</enum><header>Updated Federal
evaluation of CHIP</header><text display-inline="no-display-inline">Section
2108(c) (42 U.S.C. 1397hh(c)) is amended by striking paragraph (5) and
inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="H4FFC08F0F68C45EBB10097B92FB08815" style="OLC">
<paragraph id="H3156B4F2E54B4BDABBCF1843F817B5E"><enum>(5)</enum><header>Subsequent
evaluation using updated information</header>
<subparagraph id="H535C9CBF556E4A9AB29BFD003075C44"><enum>(A)</enum><header>In
general</header><text>The Secretary, directly or through contracts or
interagency agreements, shall conduct an independent subsequent evaluation of
10 States with approved child health plans.</text>
</subparagraph><subparagraph id="HBCEB4F4291E24F7D9519E3B27663D5C"><enum>(B)</enum><header>Selection of
States and matters included</header><text>Paragraphs (2) and (3) shall apply to
such subsequent evaluation in the same manner as such provisions apply to the
evaluation conducted under paragraph (1).</text>
</subparagraph><subparagraph id="H1D0ED7ECF3974F9C9140932674EDE1AC"><enum>(C)</enum><header>Submission to
Congress</header><text display-inline="yes-display-inline">Not later than
December 31, 2011, the Secretary shall submit to Congress the results of the
evaluation conducted under this paragraph.</text>
</subparagraph><subparagraph id="H882C87EBC9D042FEB56340996EEFCB40"><enum>(D)</enum><header>Funding</header><text>Out
of any money in the Treasury of the United States not otherwise appropriated,
there are appropriated $10,000,000 for fiscal year 2010 for the purpose of
conducting the evaluation authorized under this paragraph. Amounts appropriated
under this subparagraph shall remain available for expenditure through fiscal
year
2012.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section commented="no" id="H514DC415B6AB41058CD8124351B315DA"><enum>604.</enum><header>Access to
records for IG and GAO audits and evaluations</header><text display-inline="no-display-inline">Section 2108(d) (42 U.S.C. 1397hh(d)) is
amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="HD8B1CC601D094F758B944FD497452DFE" style="OLC">
<subsection commented="no" id="H6939A847BAD248D4BFF8D7FDBC98CDA3"><enum>(d)</enum><header>Access to
records for IG and GAO audits and evaluations</header><text display-inline="yes-display-inline">For the purpose of evaluating and auditing
the program established under this title, or title XIX, the Secretary, the
Office of Inspector General, and the Comptroller General shall have access to
any books, accounts, records, correspondence, and other documents that are
related to the expenditure of Federal funds under this title and that are in
the possession, custody, or control of States receiving Federal funds under
this title or political subdivisions thereof, or any grantee or contractor of
such States or political
subdivisions.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section display-inline="no-display-inline" id="HFC94171DBA554E89BD2BE9EBEC88B0C6" section-type="subsequent-section"><enum>605.</enum><header>No Federal funding
for illegal aliens; disallowance for unauthorized expenditures</header><text display-inline="no-display-inline">Nothing in this Act allows Federal payment
for individuals who are not legal residents. Titles XI, XIX, and XXI of the
Social Security Act provide for the disallowance of Federal financial
participation for erroneous expenditures under Medicaid and under CHIP,
respectively.</text>
</section></subtitle><subtitle id="HE6C209F0C96B4A3D9503F41460F82B3D"><enum>B</enum><header>Miscellaneous
Health Provisions</header>
<section display-inline="no-display-inline" id="H22A61575C3A74329B580AEE4A8364BC2" section-type="subsequent-section"><enum>611.</enum><header>Deficit Reduction
Act technical corrections</header>
<subsection display-inline="no-display-inline" id="H4E58C6FD39354093B6567B8432AA19C0"><enum>(a)</enum><header>Clarification of
requirement To provide EPSDT services for all children in benchmark benefit
packages under Medicaid</header><text>Section 1937(a)(1) (42 U.S.C.
1396u–7(a)(1)), as inserted by section 6044(a) of the Deficit Reduction Act of
2005 (Public Law 109–171, 120 Stat. 88), is amended—</text>
<paragraph id="HE20E3F5BBEA244EC86AEEE1DB5EA02FC"><enum>(1)</enum><text>in subparagraph
(A)—</text>
<subparagraph display-inline="no-display-inline" id="HCD00E89F445D4F3D9FDC6D7E2DA89188"><enum>(A)</enum><text display-inline="yes-display-inline">in the matter before clause (i)—</text>
<clause id="H5A21402BC15E4F7200C1B305EB54B77"><enum>(i)</enum><text display-inline="yes-display-inline">by striking <quote>Notwithstanding any
other provision of this title</quote> and inserting <quote>Notwithstanding
section 1902(a)(1) (relating to statewideness), section 1902(a)(10)(B)
(relating to comparability) and any other provision of this title which would
be directly contrary to the authority under this section and subject to
subsection (E)</quote>; and</text>
</clause><clause id="H040B8D0C236C454EB413006310A52395"><enum>(ii)</enum><text>by
striking <quote>enrollment in coverage that provides</quote> and inserting
<quote>coverage that</quote>;</text>
</clause></subparagraph><subparagraph id="H0A031F45028744F8A571CA255B4EBD2"><enum>(B)</enum><text>in clause (i), by
inserting <quote>provides</quote> after <quote>(i)</quote>; and</text>
</subparagraph><subparagraph id="H56C7698E65B34651B076E2F4CC97060"><enum>(C)</enum><text>by striking clause
(ii) and inserting the following:</text>
<quoted-block id="HA0FA171B3FD746C18E45B5D4E400533F" style="OLC">
<clause id="H0B239EF8232645A88F02003E1BE8A88"><enum>(ii)</enum><text>for any individual
described in section 1905(a)(4)(B) who is eligible under the State plan in
accordance with paragraphs (10) and (17) of section 1902(a), consists of the
items and services described in section 1905(a)(4)(B) (relating to early and
periodic screening, diagnostic, and treatment services defined in section
1905(r)) and provided in accordance with the requirements of section
1902(a)(43).</text>
</clause><after-quoted-block>;</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H98AAE1BB8B634FBDA0E2440049C79FA5"><enum>(2)</enum><text>in subparagraph
(C)—</text>
<subparagraph id="H501A930919794CEDB9F0B204C0C4E9B5"><enum>(A)</enum><text>in the heading, by
striking <quote><header-in-text>wrap-around</header-in-text></quote> and
inserting <quote><header-in-text>additional</header-in-text></quote>;
and</text>
</subparagraph><subparagraph id="H70CEC74D12EA4D14B1C804CB4E8E2196"><enum>(B)</enum><text>by striking
<quote>wrap-around or</quote>; and</text>
</subparagraph></paragraph><paragraph id="H915AA58E471949E7B55EAC1E6CF17E13"><enum>(3)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block id="H7EDBA56817FA432F81E81324E1C6D3A5" style="OLC">
<subparagraph id="H32D3230E334245258FA80048DF24D185"><enum>(E)</enum><header>Rule of
construction</header><text>Nothing in this paragraph shall be construed
as—</text>
<clause id="HB39A552432744BAD8737DF27F28FFED3"><enum>(i)</enum><text>requiring a State
to offer all or any of the items and services required by subparagraph (A)(ii)
through an issuer of benchmark coverage described in subsection (b)(1) or
benchmark equivalent coverage described in subsection (b)(2);</text>
</clause><clause id="HCAD6C1742093428586A0F90512D652B7"><enum>(ii)</enum><text>preventing a
State from offering all or any of the items and services required by
subparagraph (A)(ii) through an issuer of benchmark coverage described in
subsection (b)(1) or benchmark equivalent coverage described in subsection
(b)(2); or</text>
</clause><clause id="H33517C79D57948E08B53628944003FC2"><enum>(iii)</enum><text display-inline="yes-display-inline">affecting a child’s entitlement to care and
services described in subsections (a)(4)(B) and (r) of section 1905 and
provided in accordance with section 1902(a)(43) whether provided through
benchmark coverage, benchmark equivalent coverage, or
otherwise.</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HBD1FDDC360A34879A7CA7C13C4BCCB9"><enum>(b)</enum><header>Correction of
reference to children in foster care receiving child welfare
services</header><text>Section 1937(a)(2)(B)(viii) (42 U.S.C.
1396u–7(a)(2)(B)(viii)), as inserted by section 6044(a) of the Deficit
Reduction Act of 2005, is amended by striking <quote>aid or assistance is made
available under part B of title IV to children in foster care and
individuals</quote> and inserting <quote>child welfare services are made
available under part B of title IV on the basis of being a child in foster care
or</quote>.</text>
</subsection><subsection id="H58F1CF0F5B3C468D873B002D48AF0167"><enum>(c)</enum><header>Transparency</header><text>Section
1937 (42 U.S.C. 1396u–7), as inserted by section 6044(a) of the Deficit
Reduction Act of 2005, is amended by adding at the end the following:</text>
<quoted-block id="HDEEE42D3405F4AB5B8C335B855F32F5" style="OLC">
<subsection id="H9D263B794146439AACBC0000833F4C62"><enum>(c)</enum><header>Publication of
Provisions Affected</header><text>With respect to a State plan amendment to
provide benchmark benefits in accordance with subsections (a) and (b) that is
approved by the Secretary, the Secretary shall publish on the Internet website
of the Centers for Medicare & Medicaid Services, a list of the provisions
of this title that the Secretary has determined do not apply in order to enable
the State to carry out the plan amendment and the reason for each such
determination on the date such approval is made, and shall publish such list in
the Federal Register and not later than 30 days after such date of
approval.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H73A6C8F8B8FD4DB3B142314E1FA7C727"><enum>(d)</enum><header>Effective
date</header><text>The amendments made by subsections (a), (b), and (c) of this
section shall take effect as if included in the amendment made by section
6044(a) of the Deficit Reduction Act of 2005.</text>
</subsection></section><section display-inline="no-display-inline" id="H3814DF54992E412F963952D667EC2077" section-type="subsequent-section"><enum>612.</enum><header>References to title
XXI</header><text display-inline="no-display-inline">Section 704 of the
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, as
enacted into law by division B of Public Law 106–113 (113 Stat. 1501A–402) is
repealed.</text>
</section><section display-inline="no-display-inline" id="H47FF873FFD60490B840055F3434E299E" section-type="subsequent-section"><enum>613.</enum><header>Prohibiting
initiation of new health opportunity account demonstration
programs</header><text display-inline="no-display-inline">After the date of the
enactment of this Act, the Secretary of Health and Human Services may not
approve any new demonstration programs under section 1938 of the Social
Security Act (42 U.S.C. 1396u–8).</text>
</section><section display-inline="no-display-inline" id="H18EAA5AC0B294AC388EDECA45BA3ED3E" section-type="subsequent-section"><enum>614.</enum><header>Adjustment in
computation of Medicaid FMAP to disregard an extraordinary employer pension
contribution</header>
<subsection id="HED689AE0F4664A7BA2E2C9E9FB602E96"><enum>(a)</enum><header>In
general</header><text>Only for purposes of computing the FMAP (as defined in
subsection (e)) for a State for a fiscal year (beginning with fiscal year 2006)
and applying the FMAP under title XIX of the Social Security Act, any
significantly disproportionate employer pension or insurance fund contribution
described in subsection (b) shall be disregarded in computing the per capita
income of such State, but shall not be disregarded in computing the per capita
income for the continental United States (and Alaska) and Hawaii.</text>
</subsection><subsection id="H129320D2952142939601D27D94D71E0"><enum>(b)</enum><header>Significantly
disproportionate employer pension and insurance fund contribution</header>
<paragraph id="H1158545CAF7E415C8899ACECADB77300"><enum>(1)</enum><header>In
general</header><text>For purposes of this section, a significantly
disproportionate employer pension and insurance fund contribution described in
this subsection with respect to a State is any identifiable employer
contribution towards pension or other employee insurance funds that is
estimated to accrue to residents of such State for a calendar year (beginning
with calendar year 2003) if the increase in the amount so estimated exceeds 25
percent of the total increase in personal income in that State for the year
involved.</text>
</paragraph><paragraph id="H3F4B28689A02471EABF462005F7564BF"><enum>(2)</enum><header>Data to be
used</header><text>For estimating and adjustment a FMAP already calculated as
of the date of the enactment of this Act for a State with a significantly
disproportionate employer pension and insurance fund contribution, the
Secretary shall use the personal income data set originally used in calculating
such FMAP.</text>
</paragraph><paragraph id="H5E3AF7F9BF394D6E8B65873283C4D3AD"><enum>(3)</enum><header>Special
adjustment for negative growth</header><text>If in any calendar year the total
personal income growth in a State is negative, an employer pension and
insurance fund contribution for the purposes of calculating the State’s FMAP
for a calendar year shall not exceed 125 percent of the amount of such
contribution for the previous calendar year for the State.</text>
</paragraph></subsection><subsection id="H44A56AA9F6834CE88393AF52FE117B8F"><enum>(c)</enum><header>Hold
harmless</header><text>No State shall have its FMAP for a fiscal year reduced
as a result of the application of this section.</text>
</subsection><subsection id="HA7FC31AE2D3B4AC000ECCA6135E7C818"><enum>(d)</enum><header>Report</header><text>Not
later than May 15, 2009, the Secretary shall submit to the Congress a report on
the problems presented by the current treatment of pension and insurance fund
contributions in the use of Bureau of Economic Affairs calculations for the
FMAP and for Medicaid and on possible alternative methodologies to mitigate
such problems.</text>
</subsection><subsection id="HD273486FA3084543B60388E848BC55E1"><enum>(e)</enum><header>FMAP
defined</header><text>For purposes of this section, the term <term>FMAP</term>
means the Federal medical assistance percentage, as defined in section 1905(b)
of the Social Security Act (42 U.S.C. 1396(d)).</text>
</subsection></section><section commented="no" id="H2B0549E071CA4820ABF775277C76A619"><enum>615.</enum><header>Clarification
treatment of regional medical center</header>
<subsection commented="no" id="H8F5296CBBFEC43A7BFA21B00E04F4CD9"><enum>(a)</enum><header>In
general</header><text>Nothing in section 1903(w) of the Social Security Act (42
U.S.C. 1396b(w)) shall be construed by the Secretary of Health and Human
Services as prohibiting a State’s use of funds as the non-Federal share of
expenditures under title XIX of such Act where such funds are transferred from
or certified by a publicly-owned regional medical center located in another
State and described in subsection (b), so long as the Secretary determines that
such use of funds is proper and in the interest of the program under title
XIX.</text>
</subsection><subsection commented="no" id="HDCF73405E21A401DA447D3CCF2528566"><enum>(b)</enum><header>Center
described</header><text>A center described in this subsection is a
publicly-owned regional medical center that—</text>
<paragraph commented="no" id="HF5B6E377A31A444990BB2FE6B4EAF01D"><enum>(1)</enum><text>provides level 1
trauma and burn care services;</text>
</paragraph><paragraph commented="no" id="HAA20D04DA7CE4F0991B4E1D56575D8D1"><enum>(2)</enum><text>provides level 3
neonatal care services;</text>
</paragraph><paragraph commented="no" id="H159B3C8E2BD244B7B63D726E653CC84"><enum>(3)</enum><text>is obligated to
serve all patients, regardless of ability to pay;</text>
</paragraph><paragraph commented="no" id="H9AC2E90AB1BD40D18637DC17A39411D3"><enum>(4)</enum><text>is located within
a Standard Metropolitan Statistical Area (SMSA) that includes at least 3
States;</text>
</paragraph><paragraph commented="no" id="HBA3972E2B30C4DD09CE2552F006C3C54"><enum>(5)</enum><text>provides services
as a tertiary care provider for patients residing within a 125-mile radius;
and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HFDABCDA1AEFD47AAB198460643A91751"><enum>(6)</enum><text>meets the criteria
for a disproportionate share hospital under section 1923 of such Act (42 U.S.C.
1396r–4) in at least one State other than the State in which the center is
located.</text>
</paragraph></subsection></section><section id="id4DFD77ABB8B24877BAFDD3EC0625AF4C"><enum>616.</enum><header>Extension of
Medicaid DSH allotments for Tennessee and Hawaii</header><text display-inline="no-display-inline">Section 1923(f)(6) (42 U.S.C.
1396r–4(f)(6)), as amended by section 202 of the Medicare Improvements for
Patients and Providers Act of 2008 (Public Law 110–275) is amended—</text>
<paragraph id="idB9EF812BED484CF4BBF9B22A134CD5D5"><enum>(1)</enum><text>in the paragraph
heading, by striking <quote><header-in-text level="paragraph" style="OLC">2009
and the first calendar quarter of fiscal year 2010</header-in-text></quote> and
inserting <quote><header-in-text level="paragraph" style="OLC">2011 and the
first calendar quarter of fiscal year 2012</header-in-text></quote>;</text>
</paragraph><paragraph id="idB08D32D9984A4857AE2F596BA87A9940"><enum>(2)</enum><text>in subparagraph
(A)—</text>
<subparagraph id="idB450D7BE49884CA98B5F4678B8584D37"><enum>(A)</enum><text>in clause
(i)—</text>
<clause id="idA1C40A6AF44F466198D5A397FA287DB7"><enum>(i)</enum><text>in
the second sentence—</text>
<subclause id="id80AC9766E1944A82A80E9ABDB65BA637"><enum>(I)</enum><text>by striking
<quote>and 2009</quote> and inserting <quote>, 2009, 2010, and 2011</quote>;
and</text>
</subclause><subclause id="id4647A4F6B72F433FAFBF153524BAD9E4"><enum>(II)</enum><text>by striking
<quote>such portion of</quote>; and</text>
</subclause></clause><clause id="id924326BBA5544B4C91B02ECDEC7ACD08"><enum>(ii)</enum><text>in
the third sentence, by striking <quote>2010 for the period ending on December
31, 2009</quote> and inserting <quote>2012 for the period ending on December
31, 2011</quote>;</text>
</clause></subparagraph><subparagraph id="idB025D23476C04DEDA15505FC75138ABE"><enum>(B)</enum><text>in clause (ii),
by striking <quote>or for a period in fiscal year 2010</quote> and inserting
<quote>2010, 2011, or for period in fiscal year 2012</quote>; and</text>
</subparagraph><subparagraph id="id6F1A310E133C403CA5497140BCEF208F"><enum>(C)</enum><text>in clause
(iv)—</text>
<clause id="idBBA3DD15E03F4C7C9B51046F9C0B41D1"><enum>(i)</enum><text>in
the clause heading, by striking <quote><header-in-text level="clause" style="OLC">2009 and the first calendar quarter of fiscal year
2010</header-in-text></quote> and inserting <quote><header-in-text level="clause" style="OLC">2011 and the first calendar quarter of fiscal year
2012</header-in-text></quote>; and</text>
</clause><clause id="id5C3833F58C1C4F2388DE42D4F933A2CF"><enum>(ii)</enum><text>in
each of subclauses (I) and (II), by striking <quote> or for a period in fiscal
year 2010</quote> and inserting <quote>2010, 2011, or for a period in fiscal
year 2012</quote>; and</text>
</clause></subparagraph></paragraph><paragraph id="id063A59B34E3D4E239A0810A4EC226601"><enum>(3)</enum><text>in subparagraph
(B)—</text>
<subparagraph id="id49061A3AFEF64F56B97764D4D42D3845"><enum>(A)</enum><text>in clause
(i)—</text>
<clause id="idD3474BCB9ED0434B845D73A9D10820DD"><enum>(i)</enum><text>in
the first sentence, by striking <quote>2009</quote> and inserting
<quote>2011</quote>; and</text>
</clause><clause id="id889774FE513E4D6182D7F72FCD1EC568"><enum>(ii)</enum><text>in
the second sentence, by striking <quote>2010 for the period ending on December
31, 2009</quote> and inserting <quote>2012 for the period ending on December
31, 2011</quote>.</text>
</clause></subparagraph></paragraph></section><section commented="no" display-inline="no-display-inline" id="HDD3D2108D9244D149C3B3EF36397FD9D" section-type="subsequent-section"><enum>617.</enum><header>GAO report on
Medicaid managed care payment rates</header><text display-inline="no-display-inline">Not later than 18 months after the date of
the enactment of this Act, the Comptroller General of the United States shall
submit a report to the Committee on Finance of the Senate and the Committee on
Energy and Commerce of the House of Representatives analyzing the extent to
which State payment rates for medicaid managed care organizations under
Medicaid are actuarially sound.</text>
</section></subtitle><subtitle id="HCB29A76A8358488790EFC7056B01A196"><enum>C</enum><header>Other
Provisions</header>
<section commented="no" display-inline="no-display-inline" id="H3188275CE8184E6195FAD19F41D8A5A2" section-type="subsequent-section"><enum>621.</enum><header>Outreach regarding
health insurance options available to children</header>
<subsection commented="no" id="HBD66998A46E34CC293C05663569800F1"><enum>(a)</enum><header>Definitions</header><text>In
this section—</text>
<paragraph commented="no" id="HFCF0885680AE4AA38EA3D47059F232F8"><enum>(1)</enum><text>the terms
<term>Administration</term> and <term>Administrator</term> means the Small
Business Administration and the Administrator thereof, respectively;</text>
</paragraph><paragraph commented="no" id="HDD9A0A5975AB4052B8D9442D5C78AB76"><enum>(2)</enum><text>the term
<term>certified development company</term> means a development company
participating in the program under title V of the
<act-name parsable-cite="SBIA">Small Business Investment Act of 1958</act-name>
(15 U.S.C. 695 et seq.);</text>
</paragraph><paragraph commented="no" id="H46F11EE083BB4AF895239815D871DC1F"><enum>(3)</enum><text>the term
<term>Medicaid program</term> means the program established under title XIX of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1396 et seq.);</text>
</paragraph><paragraph commented="no" id="H49D3C13E4F9045CDAE6E22E4213E3DF5"><enum>(4)</enum><text>the term
<term>Service Corps of Retired Executives</term> means the Service Corps of
Retired Executives authorized by section 8(b)(1) of the
<act-name parsable-cite="SBA">Small Business Act</act-name> (15 U.S.C.
637(b)(1));</text>
</paragraph><paragraph commented="no" id="HF7F6B886C9984540A6231C36C9AB6898"><enum>(5)</enum><text>the term
<term>small business concern</term> has the meaning given that term in section
3 of the <act-name parsable-cite="SBA">Small Business Act</act-name> (15 U.S.C.
632);</text>
</paragraph><paragraph commented="no" id="H09AC03E8782346E79E7BFA345D6C4596"><enum>(6)</enum><text>the term
<term>small business development center</term> means a small business
development center described in section 21 of the <act-name parsable-cite="SBA">Small Business Act</act-name> (15 U.S.C. 648);</text>
</paragraph><paragraph commented="no" id="H86F53DAD2CC342F2A5D8485E2083B172"><enum>(7)</enum><text>the term
<term>State</term> has the meaning given that term for purposes of title XXI of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1397aa et seq.);</text>
</paragraph><paragraph commented="no" id="H47682508D7064DFA8876C91F00A57A7"><enum>(8)</enum><text>the term
<term>State Children’s Health Insurance Program</term> means the State
Children’s Health Insurance Program established under title XXI of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1397aa
et seq.);</text>
</paragraph><paragraph commented="no" id="H9FAA50657B304457B2984959795D4C3F"><enum>(9)</enum><text>the term
<term>task force</term> means the task force established under subsection
(b)(1); and</text>
</paragraph><paragraph commented="no" id="H251FEF4CF9EC4812A138C4ABF2AEF4ED"><enum>(10)</enum><text>the term
<term>women’s business center</term> means a women’s business center described
in section 29 of the <act-name parsable-cite="SBA">Small Business
Act</act-name> (15 U.S.C. 656).</text>
</paragraph></subsection><subsection commented="no" id="H9A3B3BEF1C424195A2A9D0005BCD71A3"><enum>(b)</enum><header>Establishment of
Task Force</header>
<paragraph commented="no" id="H8D8D4C087FFD499D8D7817B19BE78BCA"><enum>(1)</enum><header>Establishment</header><text>There
is established a task force to conduct a nationwide campaign of education and
outreach for small business concerns regarding the availability of coverage for
children through private insurance options, the Medicaid program, and the State
Children’s Health Insurance Program.</text>
</paragraph><paragraph commented="no" id="H5B317148718249BEA1EE00E1CAF0AD79"><enum>(2)</enum><header>Membership</header><text>The
task force shall consist of the Administrator, the Secretary of Health and
Human Services, the Secretary of Labor, and the Secretary of the
Treasury.</text>
</paragraph><paragraph commented="no" id="H6C654427607F4D46B299D9C8F700C345"><enum>(3)</enum><header>Responsibilities</header><text>The
campaign conducted under this subsection shall include—</text>
<subparagraph commented="no" id="HA1D1F89FD92844C7AC48F98586A64DF9"><enum>(A)</enum><text>efforts to educate
the owners of small business concerns about the value of health coverage for
children;</text>
</subparagraph><subparagraph commented="no" id="H7F85844D3A1B4B97AC002975C354AEDA"><enum>(B)</enum><text>information
regarding options available to the owners and employees of small business
concerns to make insurance more affordable, including Federal and State tax
deductions and credits for health care-related expenses and health insurance
expenses and Federal tax exclusion for health insurance options available under
employer-sponsored cafeteria plans under section 125 of the Internal Revenue
Code of 1986;</text>
</subparagraph><subparagraph commented="no" id="H1E371E5AF0674726A6A28C60D4F462D6"><enum>(C)</enum><text>efforts to educate
the owners of small business concerns about assistance available through public
programs; and</text>
</subparagraph><subparagraph commented="no" id="H8F3745CB07654CA0AD133BA4BF75637C"><enum>(D)</enum><text>efforts to educate
the owners and employees of small business concerns regarding the availability
of the hotline operated as part of the Insure Kids Now program of the
Department of Health and Human Services.</text>
</subparagraph></paragraph><paragraph commented="no" id="H0100DAB935C94BE2B0A7BA5470427303"><enum>(4)</enum><header>Implementation</header><text>In
carrying out this subsection, the task force may—</text>
<subparagraph commented="no" id="H7CD0D2502FD544D8B856DB00F55D4376"><enum>(A)</enum><text>use any business
partner of the Administration, including—</text>
<clause commented="no" id="HBE1947340B7B4C1EBCE0D0DBF1E00F3"><enum>(i)</enum><text>a small business
development center;</text>
</clause><clause commented="no" id="H53A04788CC4442148900914F985C86C5"><enum>(ii)</enum><text>a certified
development company;</text>
</clause><clause commented="no" id="HD0997D0A68FB423EB9A4CB2C455F4B00"><enum>(iii)</enum><text>a women’s
business center; and</text>
</clause><clause commented="no" id="HBC0B10CF3286452FB71267323304DCE2"><enum>(iv)</enum><text>the Service Corps
of Retired Executives;</text>
</clause></subparagraph><subparagraph commented="no" id="H85DE38B1C91547AA8587C66309552CDB"><enum>(B)</enum><text>enter into—</text>
<clause commented="no" id="H17A7A2B92A634B6C8133D9D77756C244"><enum>(i)</enum><text>a memorandum of
understanding with a chamber of commerce; and</text>
</clause><clause commented="no" id="HA94596EDAC444C25A58611943C7806AA"><enum>(ii)</enum><text>a partnership
with any appropriate small business concern or health advocacy group;
and</text>
</clause></subparagraph><subparagraph commented="no" id="HE066BFED019142DE8774DB0008EC21C5"><enum>(C)</enum><text>designate outreach
programs at regional offices of the Department of Health and Human Services to
work with district offices of the Administration.</text>
</subparagraph></paragraph><paragraph commented="no" id="H3D1F27058D9A40D8A55E102CFEBEA7DE"><enum>(5)</enum><header>Website</header><text>The
Administrator shall ensure that links to information on the eligibility and
enrollment requirements for the Medicaid program and State Children’s Health
Insurance Program of each State are prominently displayed on the website of the
Administration.</text>
</paragraph><paragraph commented="no" id="H7B94FF28B45F4E2789E02C9166C5AFD8"><enum>(6)</enum><header>Report</header>
<subparagraph commented="no" id="H55536A290665401DA26CEBD2B684A61E"><enum>(A)</enum><header>In
general</header><text>Not later than 2 years after the date of enactment of
this Act, and every 2 years thereafter, the Administrator shall submit to the
Committee on Small Business and Entrepreneurship of the Senate and the
Committee on Small Business of the House of Representatives a report on the
status of the nationwide campaign conducted under paragraph (1).</text>
</subparagraph><subparagraph commented="no" id="H4D50954F400A4F2CBF5B857C97F69BA9"><enum>(B)</enum><header>Contents</header><text>Each
report submitted under subparagraph (A) shall include a status update on all
efforts made to educate owners and employees of small business concerns on
options for providing health insurance for children through public and private
alternatives.</text>
</subparagraph></paragraph></subsection></section><section commented="no" id="H4F2CBABFA6F148EA841BCEC1FB1DCF20"><enum>622.</enum><header>Sense of the
Senate regarding access to affordable and meaningful health insurance
coverage</header>
<subsection commented="no" id="HFD56D74C9A244BA6808C13F632089DD1"><enum>(a)</enum><header>Findings</header><text>The
Senate finds the following:</text>
<paragraph commented="no" id="HA31B2F15C08741C6B14788F056E85C00"><enum>(1)</enum><text>There are
approximately 45 million Americans currently without health insurance.</text>
</paragraph><paragraph commented="no" id="H8D675F2539174364811D6159BA885779"><enum>(2)</enum><text>More than half of
uninsured workers are employed by businesses with less than 25 employees or are
self-employed.</text>
</paragraph><paragraph commented="no" id="H96474D54385140DA97D88F7564421500"><enum>(3)</enum><text>Health insurance
premiums continue to rise at more than twice the rate of inflation for all
consumer goods.</text>
</paragraph><paragraph commented="no" id="H7774305934F94290B7AF245B22BB61E"><enum>(4)</enum><text>Individuals in the
small group and individual health insurance markets usually pay more for
similar coverage than those in the large group market.</text>
</paragraph><paragraph commented="no" id="HC757FE417210484B9BB3FA9FF78540F"><enum>(5)</enum><text>The rapid growth in
health insurance costs over the last few years has forced many employers,
particularly small employers, to increase deductibles and co-pays or to drop
coverage completely.</text>
</paragraph></subsection><subsection commented="no" id="H6F6753F18A6A4228BBAB95D544F7DE4"><enum>(b)</enum><header>Sense of the
Senate</header><text>The Senate—</text>
<paragraph commented="no" id="HF7E5A05EFA66453990FA7BDB89349BD6"><enum>(1)</enum><text>recognizes the
necessity to improve affordability and access to health insurance for all
Americans;</text>
</paragraph><paragraph commented="no" id="HC90017ACF0BF4B4CB4F64D77D223885E"><enum>(2)</enum><text>acknowledges the
value of building upon the existing private health insurance market; and</text>
</paragraph><paragraph commented="no" id="H5845486041FA4F0EA59BD20010853E83"><enum>(3)</enum><text>affirms its intent
to enact legislation this year that, with appropriate protection for consumers,
improves access to affordable and meaningful health insurance coverage for
employees of small businesses and individuals by—</text>
<subparagraph commented="no" id="HF3DBA4B623EF4C27A3C44F39AE739512"><enum>(A)</enum><text>facilitating
pooling mechanisms, including pooling across State lines, and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H47007409386F4B8484A57534B3ACAFF6"><enum>(B)</enum><text>providing
assistance to small businesses and individuals, including financial assistance
and tax incentives, for the purchase of private insurance coverage.</text>
</subparagraph></paragraph></subsection></section></subtitle><enum>VII</enum><header>Revenue
Provisions </header>
<section id="H62CB84557780475A86931E9D8B16714B"><enum>701.</enum><header>Increase in
excise tax rate on tobacco products</header>
<subsection id="H32DC68AEEB5D43619E20BFBA09FBB6C"><enum>(a)</enum><header>Cigars</header><text display-inline="yes-display-inline">Section 5701(a) of the Internal Revenue
Code of 1986 is amended—</text>
<paragraph id="H7417B11AF79244FAA7DF1B56CEC7D6D9"><enum>(1)</enum><text>by striking
<quote>$1.828 cents per thousand ($1.594 cents per thousand on cigars removed
during 2000 or 2001)</quote> in paragraph (1) and inserting <quote>$50.33 per
thousand</quote>,</text>
</paragraph><paragraph id="H988487268F9245FFB3C4D0DBC9F5CD00"><enum>(2)</enum><text>by striking
<quote>20.719 percent (18.063 percent on cigars removed during 2000 or
2001)</quote> in paragraph (2) and inserting <quote>52.75 percent</quote>,
and</text>
</paragraph><paragraph id="H276B70DF24D04A1F819CF4FDDE70456F"><enum>(3)</enum><text>by striking
<quote>$48.75 per thousand ($42.50 per thousand on cigars removed during 2000
or 2001)</quote> in paragraph (2) and inserting <quote>40.26 cents per
cigar</quote>.</text>
</paragraph></subsection><subsection id="H4F5C75C4EC25499BA2004577F7692F3B"><enum>(b)</enum><header>Cigarettes</header><text>Section
5701(b) of such Code is amended—</text>
<paragraph id="HF776C5E98A0A4E5F9005C7B30224CED4"><enum>(1)</enum><text>by striking
<quote>$19.50 per thousand ($17 per thousand on cigarettes removed during 2000
or 2001)</quote> in paragraph (1) and inserting <quote>$50.33 per
thousand</quote>, and</text>
</paragraph><paragraph id="HD0B1BE8DF92F4CCBA5B3E8A0D6EBC000"><enum>(2)</enum><text>by striking
<quote>$40.95 per thousand ($35.70 per thousand on cigarettes removed during
2000 or 2001)</quote> in paragraph (2) and inserting <quote>$105.69 per
thousand</quote>.</text>
</paragraph></subsection><subsection id="H6DEA149C1CB74BE3B18F446BD84BC82"><enum>(c)</enum><header>Cigarette
Papers</header><text>Section 5701(c) of such Code is amended by striking
<quote>1.22 cents (1.06 cents on cigarette papers removed during 2000 or
2001)</quote> and inserting <quote>3.15 cents</quote>.</text>
</subsection><subsection id="HA6BA161E706048BAA380F58E58E657DD"><enum>(d)</enum><header>Cigarette
Tubes</header><text>Section 5701(d) of such Code is amended by striking
<quote>2.44 cents (2.13 cents on cigarette tubes removed during 2000 or
2001)</quote> and inserting <quote>6.30 cents</quote>.</text>
</subsection><subsection id="H4B2D6DEEE82345878C7253C441DD986F"><enum>(e)</enum><header>Smokeless
Tobacco</header><text>Section 5701(e) of such Code is amended—</text>
<paragraph id="H5BD0D994AF9747F8AD6EDD7924442659"><enum>(1)</enum><text>by striking
<quote>58.5 cents (51 cents on snuff removed during 2000 or 2001)</quote> in
paragraph (1) and inserting <quote>$1.51</quote>, and</text>
</paragraph><paragraph id="HC19BE5407AAA478CA4AC269C27D6DFC4"><enum>(2)</enum><text>by striking
<quote>19.5 cents (17 cents on chewing tobacco removed during 2000 or
2001)</quote> in paragraph (2) and inserting <quote>50.33 cents</quote>.</text>
</paragraph></subsection><subsection id="H8EBD26EA4D0F40BEBD32DC8D2D770163"><enum>(f)</enum><header>Pipe
Tobacco</header><text>Section 5701(f) of such Code is amended by striking
<quote>$1.0969 cents (95.67 cents on pipe tobacco removed during 2000 or
2001)</quote> and inserting <quote>$2.8311 cents</quote>.</text>
</subsection><subsection id="HDA66C21B7D7645B59F32D0CE49F9D4B"><enum>(g)</enum><header>Roll-Your-Own
Tobacco</header><text>Section 5701(g) of such Code is amended by striking
<quote>$1.0969 cents (95.67 cents on roll-your-own tobacco removed during 2000
or 2001)</quote> and inserting <quote>$24.78</quote>.</text>
</subsection><subsection id="HE5E187B291AA4C788536EDAA08003B45"><enum>(h)</enum><header>Floor Stocks
Taxes</header>
<paragraph id="HD54D5DD8C6814078A1AA8002738CCF08"><enum>(1)</enum><header>Imposition of
tax</header><text>On tobacco products (other than cigars described in section
5701(a)(2) of the Internal Revenue Code of 1986) and cigarette papers and tubes
manufactured in or imported into the United States which are removed before
April 1, 2009, and held on such date for sale by any person, there is hereby
imposed a tax in an amount equal to the excess of—</text>
<subparagraph id="H2AC29275E63B4083A5B69ED4D582BC29"><enum>(A)</enum><text>the tax which
would be imposed under section 5701 of such Code on the article if the article
had been removed on such date, over</text>
</subparagraph><subparagraph id="HF591DDFF1F9D4729B6EC764938FBC408"><enum>(B)</enum><text>the prior tax (if
any) imposed under section 5701 of such Code on such article.</text>
</subparagraph></paragraph><paragraph id="H79B3AC97DE01466DB5C7551520F5C986"><enum>(2)</enum><header>Credit against
tax</header><text>Each person shall be allowed as a credit against the taxes
imposed by paragraph (1) an amount equal to $500. Such credit shall not exceed
the amount of taxes imposed by paragraph (1) on April 1, 2009, for which such
person is liable.</text>
</paragraph><paragraph id="H14590812F233493F97E4BA557B3B3682"><enum>(3)</enum><header>Liability for
tax and method of payment</header>
<subparagraph id="H00431CE116454156B222AD9833239E7B"><enum>(A)</enum><header>Liability for
tax</header><text>A person holding tobacco products, cigarette papers, or
cigarette tubes on April 1, 2009, to which any tax imposed by paragraph (1)
applies shall be liable for such tax.</text>
</subparagraph><subparagraph id="H6DDF4655374947A1B90045C09C7F9D27"><enum>(B)</enum><header>Method of
payment</header><text>The tax imposed by paragraph (1) shall be paid in such
manner as the Secretary shall prescribe by regulations.</text>
</subparagraph><subparagraph id="H8A382F3E97604854A22CED350793304E"><enum>(C)</enum><header>Time for
payment</header><text>The tax imposed by paragraph (1) shall be paid on or
before August 1, 2009.</text>
</subparagraph></paragraph><paragraph id="HCF2468A171C0404D97168CDF44D9D34B"><enum>(4)</enum><header>Articles in
foreign trade zones</header><text>Notwithstanding the Act of June 18, 1934
(commonly known as the Foreign Trade Zone Act, 48 Stat. 998, 19 U.S.C. 81a et
seq.) or any other provision of law, any article which is located in a foreign
trade zone on April 1, 2009, shall be subject to the tax imposed by paragraph
(1) if—</text>
<subparagraph id="HF290BFDD70954B43A8F1ABE6EC1B567C"><enum>(A)</enum><text>internal revenue
taxes have been determined, or customs duties liquidated, with respect to such
article before such date pursuant to a request made under the 1st proviso of
section 3(a) of such Act, or</text>
</subparagraph><subparagraph id="HD6C2F3E745C04D9283DC557433B84B20"><enum>(B)</enum><text>such article is
held on such date under the supervision of an officer of the United States
Customs and Border Protection of the Department of Homeland Security pursuant
to the 2d proviso of such section 3(a).</text>
</subparagraph></paragraph><paragraph id="H487EB1823E194F1B91D2CCF1130E768"><enum>(5)</enum><header>Definitions</header><text>For
purposes of this subsection—</text>
<subparagraph id="H3D5266EB7DAE4E0E824DB128093869FE"><enum>(A)</enum><header>In
general</header><text>Any term used in this subsection which is also used in
section 5702 of the Internal Revenue Code of 1986 shall have the same meaning
as such term has in such section.</text>
</subparagraph><subparagraph id="H7A8F954F0C174658A22E1B87F7CC8B78"><enum>(B)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of the Treasury or the
Secretary’s delegate.</text>
</subparagraph></paragraph><paragraph id="HA044B7FC65334928B39072604C7615FA"><enum>(6)</enum><header>Controlled
groups</header><text>Rules similar to the rules of section 5061(e)(3) of such
Code shall apply for purposes of this subsection.</text>
</paragraph><paragraph id="H40425362B8254E0C962B3FC3FA6F415E"><enum>(7)</enum><header>Other laws
applicable</header><text>All provisions of law, including penalties, applicable
with respect to the taxes imposed by section 5701 of such Code shall, insofar
as applicable and not inconsistent with the provisions of this subsection,
apply to the floor stocks taxes imposed by paragraph (1), to the same extent as
if such taxes were imposed by such section 5701. The Secretary may treat any
person who bore the ultimate burden of the tax imposed by paragraph (1) as the
person to whom a credit or refund under such provisions may be allowed or
made.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H3457C61F344A4BD587E523192739A13D"><enum>(i)</enum><header>Effective
Date</header><text>The amendments made by this section shall apply to articles
removed (as defined in section 5702(j) of the Internal Revenue Code of 1986)
after March 31, 2009.</text>
</subsection></section><section commented="no" id="H4932E623557B4D40994D45A0F24923FE"><enum>702.</enum><header>Administrative
improvements</header>
<subsection commented="no" id="H977CBEF018A54F26A81C1E15495E90CE"><enum>(a)</enum><header>Permit,
Inventories, Reports, and Records Requirements for Manufacturers and Importers
of Processed Tobacco</header>
<paragraph commented="no" id="H3AF480B3575247D1B1135E743CC8AB2C"><enum>(1)</enum><header>Permit</header>
<subparagraph commented="no" id="HCA66689431C444A0B9FDB829CFBDDB6E"><enum>(A)</enum><header>Application</header><text>Section
5712 of the Internal Revenue Code of 1986 is amended by inserting <quote>or
processed tobacco</quote> after <quote>tobacco products</quote>.</text>
</subparagraph><subparagraph commented="no" id="H9959952AD8A8413EB58154A55FD96BB3"><enum>(B)</enum><header>Issuance</header><text>Section
5713(a) of such Code is amended by inserting <quote>or processed
tobacco</quote> after <quote>tobacco products</quote>.</text>
</subparagraph></paragraph><paragraph commented="no" id="HC87830F1B0624F108008ACF0BCDF00DC"><enum>(2)</enum><header>Inventories,
reports, and packages</header>
<subparagraph commented="no" id="H26CFCA3313D3429185B7D0F692ED883E"><enum>(A)</enum><header>Inventories</header><text>Section
5721 of such Code is amended by inserting <quote>, processed tobacco,</quote>
after <quote>tobacco products</quote>.</text>
</subparagraph><subparagraph commented="no" id="HA2F22BDFE3094D26B685F41DCC54954"><enum>(B)</enum><header>Reports</header><text>Section
5722 of such Code is amended by inserting <quote>, processed tobacco,</quote>
after <quote>tobacco products</quote>.</text>
</subparagraph><subparagraph id="H7CE56CE412764B3A93A08900199B97BA"><enum>(C)</enum><header>Packages, marks,
labels, and notices</header><text display-inline="yes-display-inline">Section
5723 of such Code is amended by inserting “, processed tobacco,” after “tobacco
products” each place it appears.</text>
</subparagraph></paragraph><paragraph commented="no" id="HF20388C8918A4F1EB41720A45CDB95F8"><enum>(3)</enum><header>Records</header><text>Section
5741 of such Code is amended by inserting <quote>, processed tobacco,</quote>
after <quote>tobacco products</quote>.</text>
</paragraph><paragraph commented="no" id="H7A86047D547E4F42BAC9086FC956658"><enum>(4)</enum><header>Manufacturer of
processed tobacco</header><text>Section 5702 of such Code is amended by adding
at the end the following new subsection:</text>
<quoted-block id="H290AE48959C24B70812495EEB300A100" style="OLC">
<subsection commented="no" id="HA5F6FD2B744A41F3A3150067596D70B3"><enum>(p)</enum><header>Manufacturer of
Processed Tobacco</header>
<paragraph commented="no" id="HB926AAC2E2304470AC7E5C0430B4E5B2"><enum>(1)</enum><header>In
general</header><text>The term <term>manufacturer of processed tobacco</term>
means any person who processes any tobacco other than tobacco products.</text>
</paragraph><paragraph commented="no" id="HCF928BD0542A4CE4BFF7985B98E8C85E"><enum>(2)</enum><header>Processed
tobacco</header><text>The processing of tobacco shall not include the farming
or growing of tobacco or the handling of tobacco solely for sale, shipment, or
delivery to a manufacturer of tobacco products or processed
tobacco.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" id="HCDD1849535CE4BFB86E21693DF54D378"><enum>(5)</enum><header>Conforming
amendments</header>
<subparagraph commented="no" id="id10B99C2075AF45B78A31DB54ED116F59"><enum>(A)</enum><text>Section 5702(h)
of such Code is amended by striking <quote>tobacco products and cigarette
papers and tubes</quote> and inserting <quote>tobacco products or cigarette
papers or tubes or any processed tobacco</quote>.</text>
</subparagraph><subparagraph commented="no" id="id98C0535A68B14F3783F7AD009F3C4532"><enum>(B)</enum><text>Sections 5702(j)
and 5702(k) of such Code are each amended by inserting <quote>, or any
processed tobacco,</quote> after <quote>tobacco products or cigarette papers or
tubes</quote>.</text>
</subparagraph></paragraph><paragraph commented="no" id="H512DB970DEA64441B4CFECB014BFCF3"><enum>(6)</enum><header>Effective
date</header><text>The amendments made by this subsection shall take effect on
April 1, 2009.</text>
</paragraph></subsection><subsection commented="no" id="H516EBCED38384981A4FEF6F25DBED5BA"><enum>(b)</enum><header>Basis for
Denial, Suspension, or Revocation of Permits</header>
<paragraph commented="no" id="HEEC7EAA052FE4D7A007E95D0A08CC626"><enum>(1)</enum><header>Denial</header><text>Paragraph
(3) of section 5712 of such Code is amended to read as follows:</text>
<quoted-block id="HEB93C7F6DC5A4762BD054B27BC71237C" style="OLC">
<paragraph commented="no" id="HD50B8844BD4C4BC7BDB9B1B66F524FC"><enum>(3)</enum><text>such person
(including, in the case of a corporation, any officer, director, or principal
stockholder and, in the case of a partnership, a partner)—</text>
<subparagraph commented="no" id="H86324569792D4458B2C7E855D14315C4"><enum>(A)</enum><text>is, by reason of
his business experience, financial standing, or trade connections or by reason
of previous or current legal proceedings involving a felony violation of any
other provision of Federal criminal law relating to tobacco products, processed
tobacco, cigarette paper, or cigarette tubes, not likely to maintain operations
in compliance with this chapter,</text>
</subparagraph><subparagraph commented="no" id="HD4DC859F4C77441B971F30B2D337CD78"><enum>(B)</enum><text display-inline="yes-display-inline">has been convicted of a felony violation of
any provision of Federal or State criminal law relating to tobacco products,
processed tobacco, cigarette paper, or cigarette tubes, or</text>
</subparagraph><subparagraph commented="no" id="H0D7028A101BE440598EF9F87232F39EF"><enum>(C)</enum><text>has failed to
disclose any material information required or made any material false statement
in the application
therefor.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" id="H9B0E309849D84C2F98FF8DA73CC22906"><enum>(2)</enum><header>Suspension or
revocation</header><text>Subsection (b) of section 5713 of such Code is amended
to read as follows:</text>
<quoted-block id="H650BF1478EDB4CB7AF48BF94AB94E244" style="OLC">
<subsection commented="no" id="H38C91DCD56BE43E5A7C5BA4D00083EFD"><enum>(b)</enum><header>Suspension or
Revocation</header>
<paragraph commented="no" id="H5D13E9C6D3BA4B2991941F39F03CE3AE"><enum>(1)</enum><header>Show cause
hearing</header><text>If the Secretary has reason to believe that any person
holding a permit—</text>
<subparagraph commented="no" id="H2061135ED77447F3B5C396D5847100F9"><enum>(A)</enum><text>has not in good
faith complied with this chapter, or with any other provision of this title
involving intent to defraud,</text>
</subparagraph><subparagraph commented="no" id="H7124B0F4EA31432C8F469B7E3EA20736"><enum>(B)</enum><text>has violated the
conditions of such permit,</text>
</subparagraph><subparagraph commented="no" id="H440FC9C8C07548129F2D473141399E2D"><enum>(C)</enum><text>has failed to
disclose any material information required or made any material false statement
in the application for such permit,</text>
</subparagraph><subparagraph commented="no" id="H9B265E6B50A645798FE11006B1B3D30"><enum>(D)</enum><text>has failed to
maintain his premises in such manner as to protect the revenue,</text>
</subparagraph><subparagraph commented="no" id="H842BC021BA714917898E793454FED304"><enum>(E)</enum><text display-inline="yes-display-inline">is, by reason of previous or current legal
proceedings involving a felony violation of any other provision of Federal
criminal law relating to tobacco products, processed tobacco, cigarette paper,
or cigarette tubes, not likely to maintain operations in compliance with this
chapter, or</text>
</subparagraph><subparagraph commented="no" id="H6C60200D8A4D40E3B560E919001EE9E1"><enum>(F)</enum><text display-inline="yes-display-inline">has been convicted of a felony violation of
any provision of Federal or State criminal law relating to tobacco products,
processed tobacco, cigarette paper, or cigarette tubes,</text>
</subparagraph><continuation-text commented="no" continuation-text-level="paragraph">the Secretary shall issue an order,
stating the facts charged, citing such person to show cause why his permit
should not be suspended or revoked.</continuation-text></paragraph><paragraph commented="no" id="HE8233131909144DCBA23510090C58C09"><enum>(2)</enum><header>Action following
hearing</header><text>If, after hearing, the Secretary finds that such person
has not shown cause why his permit should not be suspended or revoked, such
permit shall be suspended for such period as the Secretary deems proper or
shall be
revoked.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H9A501BC0EB8C4F909E9EF9991800005E"><enum>(3)</enum><header>Effective
date</header><text>The amendments made by this subsection shall take effect on
the date of the enactment of this Act.</text>
</paragraph></subsection><subsection commented="no" id="H8DF97F1D4CDA401989B258E4EE708F68"><enum>(c)</enum><header>Application of
Internal Revenue Code Statute of Limitations for Alcohol and Tobacco Excise
Taxes</header>
<paragraph id="H3D045C134BEC46698E4989545245C38D"><enum>(1)</enum><header>In
general</header><text>Section 514(a) of the <act-name parsable-cite="TA30">Tariff Act of 1930</act-name> (19 U.S.C. 1514(a)) is
amended by striking <quote>and section 520 (relating to refunds)</quote> and
inserting <quote>section 520 (relating to refunds), and section 6501 of the
Internal Revenue Code of 1986 (but only with respect to taxes imposed under
chapters 51 and 52 of such Code)</quote>.</text>
</paragraph><paragraph commented="no" id="HA6752D7C78FC4CFD9EF937AF418EC723"><enum>(2)</enum><header>Effective
date</header><text>The amendment made by this subsection shall apply to
articles imported after the date of the enactment of this Act.</text>
</paragraph></subsection><subsection commented="no" id="H5E4368FBCFC04D61B33E4889299D4C6B"><enum>(d)</enum><header>Expansion of
Definition of Roll-Your-Own Tobacco</header>
<paragraph commented="no" id="HFBC3A636679545B2B2009BF56EA0B6A"><enum>(1)</enum><header>In
general</header><text>Section 5702(o) of the Internal Revenue Code of 1986 is
amended by inserting <quote>or cigars, or for use as wrappers thereof</quote>
before the period at the end.</text>
</paragraph><paragraph commented="no" id="H1F013CACD8394E649E00B5956B8DA100"><enum>(2)</enum><header>Effective
date</header><text>The amendment made by this subsection shall apply to
articles removed (as defined in section 5702(j) of the Internal Revenue Code of
1986) after March 31, 2009.</text>
</paragraph></subsection><subsection commented="no" id="H43131561212B4DE4AB06929CD1A59325"><enum>(e)</enum><header>Time of Tax for
Unlawfully Manufactured Tobacco Products</header>
<paragraph id="H023F77B7BC3C4C78B83FBA58BDAF59A5"><enum>(1)</enum><header>In
general</header><text>Section 5703(b)(2) of such Code is amended by adding at
the end the following new subparagraph:</text>
<quoted-block id="H16D4C1DC3C5345D5B89600269CEFE5AA" style="OLC">
<subparagraph commented="no" id="H29E0DE12895A4BA29D2EBC074BD7B2F6"><enum>(F)</enum><header>Special rule for
unlawfully manufactured tobacco products</header><text display-inline="yes-display-inline">In the case of any tobacco products,
cigarette paper, or cigarette tubes manufactured in the United States at any
place other than the premises of a manufacturer of tobacco products, cigarette
paper, or cigarette tubes that has filed the bond and obtained the permit
required under this chapter, tax shall be due and payable immediately upon
manufacture.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HE261B18A60454E01976CC59CCFBCACF4"><enum>(2)</enum><header>Effective
date</header><text>The amendment made by this subsection shall take effect on
the date of the enactment of this Act.</text>
</paragraph></subsection><subsection display-inline="no-display-inline" id="H2823EE8FE0964DD6A6FB60F957EB8C04"><enum>(f)</enum><header>Disclosure</header>
<paragraph id="H6F9B6B3BF4F845DB9950B36EDDEDBD6"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Paragraph (1) of
section 6103(o) of such Code is amended by designating the text as subparagraph
(A), moving such text 2 ems to the right, striking <quote>Returns</quote> and
inserting <quote><header-in-text level="subparagraph" style="OLC">(A) In
general.—</header-in-text>Returns</quote>, and by inserting after subparagraph
(A) (as so redesignated) the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HD4CF5618706347AC9B58CD8201A6DF85" style="OLC">
<subparagraph id="H9AA013DFEDA1427EAD04C4D79E6D1548"><enum>(B)</enum><header>Use in certain
proceedings</header><text display-inline="yes-display-inline">Returns and
return information disclosed to a Federal agency under subparagraph (A) may be
used in an action or proceeding (or in preparation for such action or
proceeding) brought under section 625 of the American Jobs Creation Act of 2004
for the collection of any unpaid assessment or penalty arising under such
Act.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H26848CB961BB48D9A5A29E8C5BBD344E"><enum>(2)</enum><header>Conforming
amendment</header><text>Section 6103(p)(4) of such Code is amended by striking
<quote>(o)(1)</quote> both places it appears and inserting
<quote>(o)(1)(A)</quote>.</text>
</paragraph><paragraph id="H3EB8A36FAAEB4EEE8DA16371A41B29F1"><enum>(3)</enum><header>Effective
date</header><text>The amendments made by this subsection shall apply on or
after the date of the enactment of this Act.</text>
</paragraph></subsection><subsection id="H764666046E594FF2BD20B4CE5D5F3F84"><enum>(g)</enum><header>Transitional
rule</header><text>Any person who—</text>
<paragraph id="H069AB8DBE9974BF492F54FCE92914EBB"><enum>(1)</enum><text>on April 1 is
engaged in business as a manufacturer of processed tobacco or as an importer of
processed tobacco, and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HFC76D812AB5D47979000231C5C2F12C8"><enum>(2)</enum><text>before the end of
the 90-day period beginning on such date, submits an application under
subchapter B of chapter 52 of such Code to engage in such business, may,
notwithstanding such subchapter B, continue to engage in such business pending
final action on such application. Pending such final action, all provisions of
such chapter 52 shall apply to such applicant in the same manner and to the
same extent as if such applicant were a holder of a permit under such chapter
52 to engage in such business.</text>
</paragraph></subsection></section><section id="id4710D6B9AA654F2BB24A5F83728A8F91"><enum>703.</enum><header>Treasury study
concerning magnitude of tobacco smuggling in the United States</header><text display-inline="no-display-inline">Not later than one year after the date of
the enactment of this Act, the Secretary of the Treasury shall conduct a study
concerning the magnitude of tobacco smuggling in the United States and submit
to Congress recommendations for the most effective steps to reduce tobacco
smuggling. Such study shall also include a review of the loss of Federal tax
receipts due to illicit tobacco trade in the United States and the role of
imported tobacco products in the illicit tobacco trade in the United
States.</text>
</section><section commented="no" display-inline="no-display-inline" id="H34CF6F185347497BA3F5FB2E303BB900" section-type="subsequent-section"><enum>704.</enum><header>Time for payment of
corporate estimated taxes</header><text display-inline="no-display-inline">The
percentage under subparagraph (C) of section 401(1) of the Tax Increase
Prevention and Reconciliation Act of 2005 in effect on the date of the
enactment of this Act is increased by 0.5 percentage point.</text>
</section>
January 16, 2009
Read twice and placed on the calendar