1.Short
title; table of contents
(a)This Act may be cited
as the States' Right To Innovate in
Health Care Act of 2009
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of
contents.
Sec. 2. Findings and purposes.
Sec. 3. Amendment to Social Security
Act.
TITLE XXII—State comprehensive health care and cost containment
demonstration projects
Sec. 2201. State-based Universal Health Care Coverage
Commission.
Sec. 2202. Planning
grants.
Sec. 2203. Demonstration
grants.
Sec. 2204. State plan
requirements.
Sec. 2205. Interstate
arrangements.
Sec. 2206. Definitions.
2.
(a)Congress
finds the following:
(1)In 2006, annual
health care expenditures in the United States totaled $2.1 trillion, or $6,800
per person.
(2)In 2006, health
care expenditures represented 16 percent of the gross domestic product
(GDP
) in the United States and grew at the rate of 6.7
percent.
(3)Health care
spending in the United States is expected to increase at similar levels for the
next decade, reaching $4 trillion in 2015, or 20 percent of GDP.
(4)Yet, access to
health care is a problem for many citizens of the United States. According to
the Census Bureau, there are now over 46,000,000 citizens who lack health
insurance and each year this figure grows. This figure does not include the
millions of citizens who are under-insured and millions of others who may not
have insurance coverage at some point during a year.
(5)There is enough
money in the health care system to ensure that the rationing of health care
services does not need to occur, either explicitly by design or, as happens
currently, implicitly due to an individual’s or family’s economic status.
Health care reform is needed to assure that there is universal health coverage
for all citizens of the United States.
(6)States are the
natural vehicles to test methods and forms of achieving universal health
coverage. There is a well-established tradition for this. In the past, States
have led the way in testing ideas for national application, involving such
areas as child labor, social security, welfare reform, and environmental
protection. Several States are embarking on major health care initiatives to
cover residents of the State who are uninsured. Given past successes in
individual State action that have resulted in national changes, the Federal
Government should invest in a broad range of efforts in a variety of
geographically dispersed States prior to attempting a national system of health
care reform.
(7)In 2002, in
response to a request from the Secretary of Health and Human Services, the
Institute of Medicine of the National Academy of Sciences established a
committee, officially known as the Committee on Rapid Advance
Demonstration Projects: Health Care Finance and Delivery Systems
, with
the goal of formulating models for broader health care reform. The committee
recommended a 10-year commitment to State demonstration projects as a means to
encourage States to develop their own systems of universal health care and to
facilitate innovation.
(b)The
purpose of this Act is to encourage States—
(1)to develop plans
for universal, comprehensive, cost-effective systems of health care with
simplified administration to individuals residing in such States; and
(2)to implement such
plans by offering transitional grants and by removing Federal statutory and
administrative barriers that may inhibit or discourage efforts by States to
provide such health care while maintaining Federal payments for health care
under Federal health care programs.
3.Amendment to
Social Security ActThe Social
Security Act (42 U.S.C. 301 et seq.) is amended by adding at the end the
following new title:
<enum>XXII</enum><header>State
comprehensive health care and cost containment demonstration projects</header>
<section id="ID155a534f7a5e4ce7bfb4a0a3aa0a9ff6"><enum>2201.</enum><header>State-based
universal health care coverage commission</header>
<subsection id="ID627cb780afe7404499001f052602eb02"><enum>(a)</enum><header>Establishment</header>
<paragraph id="id288A6017EFEB4F1BAC8D59EC3ED4F482"><enum>(1)</enum><header>In
general</header><text>Not later than 90 days after the date of the enactment of
this title, the Secretary shall establish a State-based Universal Health Care
Coverage Commission (in this section referred to as the
<term>Commission</term>).</text>
</paragraph><paragraph id="id91E1FB320BFE427D8724BA2B529E7B16"><enum>(2)</enum><header>Membership</header><text>The
Commission shall be composed of 17 members—</text>
<subparagraph id="IDc63c45401e954eb4825685290f2114dc"><enum>(A)</enum><text>1 of whom shall
be the Secretary;</text>
</subparagraph><subparagraph id="ID04298cad1e1d4b14949d18da7847788a"><enum>(B)</enum><text>4 of whom shall
be governors of a State who are appointed by the National Governors Association
on a bipartisan basis;</text>
</subparagraph><subparagraph id="ID616c0ab23852456aad6c02647aa89822"><enum>(C)</enum><text>4 of whom shall
be State legislators who are appointed, on a joint and bipartisan basis, by the
National Conference of State Legislators and the American Legislative Exchange
Council;</text>
</subparagraph><subparagraph id="IDc04331b56675489e98e88a967f1f5eae"><enum>(D)</enum><text>2 of whom shall
be appointed by the majority leader of the Senate;</text>
</subparagraph><subparagraph id="IDb673309146c7415d851213deb1193f0c"><enum>(E)</enum><text>2 of whom shall
be appointed by the minority leader of the Senate;</text>
</subparagraph><subparagraph id="IDea825b52b9f94b25a05e4c285d4b8778"><enum>(F)</enum><text>2 of whom shall
be appointed by the Speaker of the House of Representatives; and</text>
</subparagraph><subparagraph id="ID2fd6f6db91044b599264025fd70ed3e1"><enum>(G)</enum><text>2 of whom shall
be appointed by the minority leader of the House of Representatives.</text>
</subparagraph></paragraph></subsection><subsection id="IDb3852ce1d3a04cfaba0083a8011098d9"><enum>(b)</enum><header>Duties of the
commission</header>
<paragraph id="ID5e25b6813c684cc7b3d83dfadb4d5b40"><enum>(1)</enum><header>Guidance and
information</header><text>The Commission shall—</text>
<subparagraph id="ID88612f73645047b3b6fe45a728b5525a"><enum>(A)</enum><text>provide guidance
to State health care officials regarding applications for grants under this
title and exchange information with, and otherwise assist, such officials upon
the request of the officials;</text>
</subparagraph><subparagraph id="ID0759565b0e624a7f98717685e8247afb"><enum>(B)</enum><text>submit proposed
procedures with respect to applications for grants under this title;</text>
</subparagraph><subparagraph id="ID7507b59e15fd4c4580ec1a3a22aabaf7"><enum>(C)</enum><text>review and
recommend the approval of applications for demonstration grants under section
2203, including providing guidance on the issuance of appropriate waivers
described in section 2203(f);</text>
</subparagraph><subparagraph id="IDe8fa81284f934fc4b0755fefa4eb97db"><enum>(D)</enum><text>suggest
appropriate levels of funding for applications for planning grants approved
under section 2202 consistent with such section;</text>
</subparagraph><subparagraph id="IDe03b3c1cadcd4ea99002684edd4be370"><enum>(E)</enum><text>provide guidance
with respect to such evaluation, monitoring, compliance, and other review
functions with respect to grants under this title as may be appropriate;</text>
</subparagraph><subparagraph id="ID2b94b7666d744be4bca267556538de7d"><enum>(F)</enum><text>develop proposed
guidelines, standards, and formats for the evaluation, reporting, and
collection of data by States in order to enable the Secretary to monitor State
plan administration and compliance, and to evaluate and compare the
effectiveness of State plans; and</text>
</subparagraph><subparagraph id="IDc1a890efbd424279a7f64486c4418ead"><enum>(G)</enum><text>provide guidance
on the implementation of any other requirements or activities necessary and
appropriate under this title.</text>
</subparagraph></paragraph><paragraph id="ID45e266f365984c9ea898eff21f5aedb9"><enum>(2)</enum><header>Annual
report</header><text>The Commission shall prepare and submit to the President
and to Congress an annual report. Such report shall be submitted not later than
March 30 of each year and shall include information concerning States that
receive grants under this title and the effectiveness of any health care
programs assisted by such grants during the previous year.</text>
</paragraph><paragraph id="IDd50795570d5044e88351d4ec97569f84"><enum>(3)</enum><header>Approval
process</header><text>The provisions of section 2106(c) shall apply to State
plans and the Secretary under this title in the same manner as they apply to
State plans and the Secretary under such section.</text>
</paragraph><paragraph id="idCAFE1E98E0B545148185C83D7F6E079C"><enum>(4)</enum><header>Consultation</header><text>To
the extent feasible, the Secretary shall carry out the State Comprehensive
Health Care and Cost Containment demonstration projects under this title based
on, and in accordance with, the advice and recommendations of the
Commission.</text>
</paragraph></subsection><subsection id="IDd1e56efe4b38427c9389fe99e9fce9e4"><enum>(c)</enum><header>Period of
appointment; representation requirements; vacancies</header><text>Members shall
be appointed for a term of such time as is needed to complete the requirements
of this section and to carry out the requirements of this section. In
appointing members under subsection (a)(2), the designated appointing
individuals shall ensure the representation of urban and rural areas and an
appropriate geographic distribution of such members. Any vacancy in the
Commission shall not affect its powers, but shall be filled in the same manner
as the original appointment.</text>
</subsection><subsection id="ID187e7050017d4395a7d8ef8202666635"><enum>(d)</enum><header>Chairperson,
meetings</header>
<paragraph id="IDd2db61d2e8d44f7d844785de290f4d6d"><enum>(1)</enum><header>Chairperson</header><text>The
Commission shall select a Chairperson from among its members.</text>
</paragraph><paragraph id="IDe2d01b7930c8471bab46ed9c726782e0"><enum>(2)</enum><header>Quorum</header><text>Two-thirds
of the members of the Commission shall constitute a quorum, but a lesser number
of members may hold hearings.</text>
</paragraph><paragraph id="IDb3463f87893b4cf4bb6765d068389911"><enum>(3)</enum><header>Meetings</header><text>Not
later than 30 days after the date on which all members of the Commission have
been appointed, the Commission shall hold its first meeting. The Commission
shall meet at the call of the Chairperson.</text>
</paragraph></subsection><subsection id="ID666bbc660e3347e381d24760574070bc"><enum>(e)</enum><header>Personnel
matters</header>
<paragraph id="ID52641203b64748a19127c9dfb3c5b9e3"><enum>(1)</enum><header>Compensation</header><text>Each
member of the Commission who is not an officer or employee of the Federal
Government or of a State or local government shall be compensated at a rate
equal to the daily equivalent of the annual rate of basic pay prescribed for
level IV of the Executive Schedule under section 5315 of title 5, United States
Code, for each day (including travel time) during which such member is engaged
in the performance of the duties of the Commission. All members of the
Commission who are officers or employees of the United States shall serve
without compensation in addition to that received for their services as
officers or employees of the United States.</text>
</paragraph><paragraph id="ID64881006ad2748b9bb8ee0eebd6803df"><enum>(2)</enum><header>Travel
expenses</header><text>The members of the Commission shall be allowed travel
expenses, including per diem in lieu of subsistence, at rates authorized for
employees of agencies under subchapter I of chapter 57 of title 5, United
States Code, while away from their homes or regular places of business in the
performance of services for the Commission.</text>
</paragraph><paragraph id="IDeb0e9958d10448f49e114940bdc0fa4d"><enum>(3)</enum><header>Staff</header><text>The
Chairperson of the Commission may, without regard to the civil service laws and
regulations, appoint and terminate an executive director and such other
additional personnel as may be necessary to enable the Commission to perform
its duties. The employment of an executive director shall be subject to
confirmation by the Commission.</text>
</paragraph><paragraph id="IDc743a3d53bbf442881ae27e377ffe1bf"><enum>(4)</enum><header>Detail of
government employees</header><text>Any Federal Government employee may be
detailed to the Commission without reimbursement, and such detail shall be
without interruption or loss of civil service status or privilege.</text>
</paragraph><paragraph id="IDe6dfb970aaf04940a837b5bf109417ae"><enum>(5)</enum><header>Temporary and
intermittent services</header><text>The Chairperson of the Commission may
procure temporary and intermittent services under section 3109(b) of title 5,
United States Code, at rates for individuals which do not exceed the daily
equivalent of the annual rate of basic pay prescribed for level V of the
Executive Schedule under section 5316 of such title.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID80690573bd554bf681ab8291aea4f5de"><enum>(f)</enum><header>Funding</header><text>There
are authorized to be appropriated such funds as necessary for the purposes of
carrying out this section.</text>
</subsection></section><section id="idFBDEE4A633BC4E7A8350060954FD388D"><enum>2202.</enum><header>Planning
grants</header>
<subsection id="ID2e7ddac3ef0b4613bd0baf54e4a84955"><enum>(a)</enum><header>Application</header><text>A
State may apply to the Secretary for a State planning grant under this section
to develop a State plan to offer universal comprehensive health care, with
simplified administration, and to improve the cost-effectiveness of the health
care delivery system.</text>
</subsection><subsection id="IDad962b6a7272406eb3bc3aafe4874089"><enum>(b)</enum><header>Contents</header><text>The
Secretary may not approve such a State planning grant for a State unless the
application for the grant includes or provides for the following:</text>
<paragraph id="ID71f7ab5819b24dbaa360c326a546bc3c"><enum>(1)</enum><header>Budget</header><text>A
budget and a budget justification.</text>
</paragraph><paragraph id="ID117703833c624e208fd7132fead848eb"><enum>(2)</enum><header>Planning
process</header><text>A description of how under the grant the State
shall—</text>
<subparagraph id="ID82e9a74b61124c209f259ac7382c573e"><enum>(A)</enum><text>identify options
to provide a universal, comprehensive, and cost-effective system of health
care, with simplified administration, that is affordable and accessible to all
eligible beneficiaries in the State; and</text>
</subparagraph><subparagraph id="IDe57a194d526041698ef1c933fdfe1ca3"><enum>(B)</enum><text>conduct an
analysis that compares projected overall health expenditures over a 5-year
period under the proposed system with the projected overall health expenditures
that would otherwise occur during such period.</text>
</subparagraph></paragraph><paragraph id="ID59689ecddf4d476ea93d3d91b8b2043d"><enum>(3)</enum><header>Opportunity for
public participation</header><text>Assurances that the State will include a
process for public contribution and participation in the planning
process.</text>
</paragraph></subsection><subsection id="ID175fcd95bdda4539aa5edf80d3345ba0"><enum>(c)</enum><header>Number of
States; period of grant</header><text>The Secretary may not award State
planning grants under this section to more than 10 States. A State planning
grant under this section shall be effective for a period of up to 30 months. In
awarding State planning grants under this section the Secretary shall give
preference to States from a variety of geographic areas in the United
States.</text>
</subsection><subsection id="ID6300e5ff718e482d829be18835aa11ae"><enum>(d)</enum><header>Amount</header><text>The
amount of a State planning grant under this section to a State may not exceed
$4,500,000.</text>
</subsection><subsection id="IDa9811458e0224e6e9e9de2ec6ffed89c"><enum>(e)</enum><header>Technical
assistance</header><text>The Secretary shall provide States with technical
assistance in applying for and implementing State planning grants under this
section. At the request of the Secretary, other Departments and Offices of the
Federal Government shall provide States with such technical assistance.</text>
</subsection></section><section id="IDa95f23d119624efc90946d88a7f399ed"><enum>2203.</enum><header>Demonstration
grants</header>
<subsection id="IDc1e4aaf9f64d44d5b0fb84af9c2d53da"><enum>(a)</enum><header>Application</header><text>A
State that has developed a State plan may apply to the Secretary for approval
of a demonstration grant under this section to achieve a cost-effective
delivery system of universal, comprehensive health care with simplified
administration. The Secretary shall reach out to States in order to ensure that
at least 1 application is for approval of a demonstration grant to provide a
single payer system of health care coverage. The Secretary shall notify the
chief executive officer of all States of the availability of demonstration
grants under this section.</text>
</subsection><subsection id="ID14f7878ee4cc41e594284a2eab00969d"><enum>(b)</enum><header>Approval</header><text>The
Secretary shall approve the applications of not more than 5 States under this
section. In approving grants under this section the Secretary shall give
preference to States from a variety of geographic areas in the United States
and for a variety of policy options, at least 1 of which shall be a
single-payer system of health care coverage. If the Secretary determines that a
State no longer meets the conditions for approval of the grant, the Secretary
shall notify the State of such determination and provide the State with an
opportunity to correct deficiencies in a timely manner. If the Secretary
further determines that a State has not corrected such deficiencies in a timely
manner, the Secretary shall terminate the grant (including waivers authorized
under the grant).</text>
</subsection><subsection id="IDedf0040a22824429a51db7ba49a4a902"><enum>(c)</enum><header>Period</header><text>A
demonstration grant approved under this section shall be effective for up to 5
years from the date of final approval of the demonstration grant application
under subsection (b).</text>
</subsection><subsection id="IDf603661a48fd4ab5aa07c7319be890cd"><enum>(d)</enum><header>State plan
required</header><text>The Secretary may not approve a demonstration grant
under this section unless the State has a State plan to carry out the grant
consistent with the requirements of section 2204.</text>
</subsection><subsection id="IDe54c111f705441308fb9ae5b4553e4db"><enum>(e)</enum><header>Funding</header>
<paragraph id="ID9ae8b2fbf504476787a12c7d56e841c6"><enum>(1)</enum><header>Transitional
grant amount</header><text>The amount awarded under this section to a State
with a demonstration grant approved under this section may not exceed an
aggregate amount of $13,000,000 plus $4 multiplied by the number of eligible
State residents of the State to assist the State in the transition of the
health care delivery and financing infrastructure. Such amount shall be made
available to a State during the period of transition, as provided in the State
plan. The number of eligible State residents of a State shall be determined
based on the best available Census Bureau data as of the July 1 before the date
the grant under this section is approved.</text>
</paragraph><paragraph id="IDd7ee5a0483244c6bb521a09ed712fd0c"><enum>(2)</enum><header>Maintenance of
Federal funds under waivers</header><text>Pursuant to the waivers under
subsection (f), the Federal Government shall pay to a State amounts for health
care under Federal health care programs that would otherwise have been payable
by the Federal Government but for the State’s universal, comprehensive health
care system under this section.</text>
</paragraph><paragraph id="IDe46b681af39047fa8231566bfc1a41b6"><enum>(3)</enum><header>General 3
percentage points increase in FMAP for calendar quarters occurring during the
period of the demonstration grant</header>
<subparagraph id="ID63370abe61894ec58aedc3328e0a9e01"><enum>(A)</enum><header>In
general</header><text>Notwithstanding any other provision of law, for each
State for which a demonstration grant is approved under this section, the FMAP
of the State shall be increased by 3 percentage points for each calendar
quarter occurring during the period referred to in subsection (c).</text>
</subparagraph><subparagraph id="ID25ee39a8abe547ef82d70782b083e5ee"><enum>(B)</enum><header>FMAP</header><text>In
this paragraph, the term <term>FMAP</term> means the Federal medical assistance
percentage, as defined in section 1905(b).</text>
</subparagraph></paragraph></subsection><subsection id="ID7c4aaf266e44472f8e30e83f8319f3ac"><enum>(f)</enum><header>Waiver of ERISA
preemption and waivers To pool funds</header><text>As part of a demonstration
grant under this section and subject to the benefit maintenance requirements
applicable under section 2204(b), a State may request (and the Secretary may
grant) the following waivers of requirements and provisions to the extent
necessary to carry out the State plan under section 2204:</text>
<paragraph id="ID3464530293034de29c60117aa76e5d21"><enum>(1)</enum><header>ERISA</header><text>Waiving
application of section 514 of the Employee Retirement Income Security Act of
1974.</text>
</paragraph><paragraph id="ID66c1d6b2c01246418f1e97c3e6ff86ee"><enum>(2)</enum><header>Medicare</header><text>Waiving
provisions necessary to permit the State—</text>
<subparagraph id="IDb82af90b1b9e41c7b05a0856e7d3343c"><enum>(A)</enum><text>to use funds
otherwise paid under title XVIII for beneficiaries residing in the State;
and</text>
</subparagraph><subparagraph id="IDb0a397ccd3af41da8cba5c291759dfec"><enum>(B)</enum><text>to permit the
State to enter into an arrangement with the Secretary under which eligible
State residents who are not otherwise enrolled for benefits under parts A and B
of such title are enrolled for such benefits under such title and the State
provides for such actuarially appropriate reimbursement to the Secretary with
respect to coverage of such benefits for such residents as is necessary to
assure that the Federal Hospital Insurance Trust Fund and the Federal
Supplementary Medical Insurance Trust Fund under such title are not adversely
affected by virtue of such waiver, such reimbursement subject to—</text>
<clause id="ID0434ba03c8d0454badfac6ae9802e418"><enum>(i)</enum><text>an independent
audit, to be reviewed by the Comptroller General of the United States, assuring
that such reimbursement does not adversely affect in any way such Trust Funds;
and</text>
</clause><clause id="ID6ecb06078bff4ebcb415c4327dd1d4ab"><enum>(ii)</enum><text>in the case that
the audit determines that additional reimbursement to the Secretary is
required, such additional reimbursement, with appropriate adjustments for
interest attributable to the late reimbursement.</text>
</clause></subparagraph></paragraph><paragraph id="ID5868b01abd754169b2d125a125217375"><enum>(3)</enum><header>Medicaid</header><text>Waiving
provisions necessary to permit the State to use funds otherwise paid to the
State under title XIX.</text>
</paragraph><paragraph id="ID4691c0128b3249e0a8a97a7185973c71"><enum>(4)</enum><header>CHIP</header><text>Waiving
provisions necessary to permit the State to use funds otherwise paid to the
State under title XXI.</text>
</paragraph><paragraph id="ID8302bda38a87475d8924313680291eab"><enum>(5)</enum><header>FEHBP</header><text>Waiving
provisions necessary to permit the State to use funds otherwise paid under
chapter 89 of title 5, United States Code, or allowing the Office of Personnel
Management to purchase health care coverage for Federal employees and retirees
in the State under the State plan.</text>
</paragraph><paragraph id="ID93fcf846b0b34fffb9cf5fe7d303843a"><enum>(6)</enum><header>Use of other
funds</header><text>Waiving provisions necessary to permit the State to use
funds otherwise provided under other Federal programs for the provision of
health care coverage or services, as identified by the State.</text>
</paragraph><paragraph id="IDd12fcbafe79245eda32595b0525b6849"><enum>(7)</enum><header>Other
laws</header><text>Waiving of other provisions of Federal law identified by the
State under section 2204(f)(3) only if the Secretary determines such a waiver
to be appropriate after consultation with the head of the Federal agency or
department concerned.</text>
</paragraph><continuation-text continuation-text-level="subsection">The
Secretary may grant a waiver under this subsection only if the State provides
the Secretary with satisfactory assurances that necessary safeguards have been
taken to protect the health and welfare of individuals provided services under
the waiver and that financial accountability is maintained for any funds
expended under the waiver. The Secretary may grant a waiver under paragraph (1)
only with the concurrence of the Secretary of Labor.</continuation-text></subsection><subsection id="ID8b00c8ccea234ea088ba48a4c21d911c"><enum>(g)</enum><header>Reenrollment of
eligible State residents who move from a participating state</header><text>In
the case of an eligible State resident who is covered under a State plan under
section 2204, who (but for such coverage) is eligible to be enrolled in a
program described in subsection (f) (including the Medicare and Medicaid
programs), and who is not enrolled in such a program because of such coverage,
if the resident leaves the State to reside in a State that does not have such a
State plan in effect, the resident shall be permitted, notwithstanding any
other provision of law, to enroll immediately in such a program if the resident
is still otherwise eligible to be so enrolled. In the case of such enrollment
in the Medicare program, the resident shall be treated for purposes of section
1882(s)(2) (relating to availability of medicare supplemental policies without
underwriting) as if the resident had turned 65 years of age on the date the
resident enrolls in the Medicare program.</text>
</subsection></section><section id="ID54a48de5c6f2430b811ca74d1c7e074b"><enum>2204.</enum><header>State plan
requirements</header>
<subsection id="ID4e4593215bd54aee8a7afcb23926945f"><enum>(a)</enum><header>Coverage</header>
<paragraph id="IDf564363a656b4336aec6956f7dc40745"><enum>(1)</enum><header>In
general</header><text>A State plan shall provide a process and a timeline for
achieving coverage of all eligible State residents statewide, without regard to
employment status, income, health status or preexisting condition, or location
of residency within the State.</text>
</paragraph><paragraph id="ID17d5919926c74d66af45284e270a908b"><enum>(2)</enum><header>Outreach
mechanisms</header><text>A State plan shall describe the outreach mechanisms to
be used to assure coverage of all eligible individuals, including measures to
assure coverage of individuals in hard-to-reach populations and to assure
benefits are provided to eligible individuals located in underserved
areas.</text>
</paragraph></subsection><subsection id="ID253d32e1c5734e2a8fbe7ce5482a0d0b"><enum>(b)</enum><header>Benefits</header>
<paragraph id="IDcac700a7d3654148a0dfa3f7c3d3b511"><enum>(1)</enum><header>In
general</header>
<subparagraph id="id7D97237214884B88BC03B041A990E600"><enum>(A)</enum><header>Basic
benefits</header><text>A State plan shall provide for health benefits that are
at least actuarially equivalent to the standard Blue Cross/Blue Shield
preferred provider option service benefit plan, described in and offered under
section 8903(1) of title 5, United States Code.</text>
</subparagraph><subparagraph id="IDc5bdd203126f49c2aeb1575b99a1937f"><enum>(B)</enum><header>Items and
services</header><text>A State plan shall include benefits for at least the
following items and services:</text>
<clause id="ID962a69917dca4f2099b5f9df683772cb"><enum>(i)</enum><text>Inpatient and
outpatient hospital services, including emergency services available 24 hours a
day.</text>
</clause><clause id="ID1aae012acae4472a8a73494ffb9f6083"><enum>(ii)</enum><text>Long-term,
acute, and chronic care services, including skilled nursing facility services,
intermediate care facility services, home health services, home and
community-based long-term care services, hospice care, and services in
intermediate care facilities for individuals diagnosed with mental
retardation.</text>
</clause><clause id="ID256a74fbb3b949fd981d5cb16d3bdc52"><enum>(iii)</enum><text>Professional
services of health care practitioners authorized to provide health care
services under State law.</text>
</clause><clause id="ID19d8234240c244609d78d2ba67119ad8"><enum>(iv)</enum><text>Community-based
primary health care services, including rural health clinic services and
federally qualified health center services.</text>
</clause><clause id="ID9832961dbc774208ab80fa0d61d89032"><enum>(v)</enum><text>Laboratory, x-ray
services, and diagnostic tests.</text>
</clause><clause id="ID1263f467f41d465386736d8b65c591de"><enum>(vi)</enum><text>Preventive care,
including prenatal, well-baby, and well-child care, appropriate immunizations,
pap smears, screening mammography, colorectal cancer screening, physical
examinations, and family planning.</text>
</clause><clause id="IDf41368e1324f47eeb58718d1b159d1ad"><enum>(vii)</enum><text>Prescription
drugs and biologicals, including insulin and medical foods.</text>
</clause><clause id="IDf12043ec96f942b58bb099a455c633f0"><enum>(viii)</enum><text>Mental health
services.</text>
</clause><clause id="ID4a78c9c46b0f4318bad9041bc5bf66bf"><enum>(ix)</enum><text>Substance use
disorder services.</text>
</clause><clause id="IDe633d51120014a7d848baa7ae014db86"><enum>(x)</enum><text>Vision services,
including routine eye examinations, eyeglasses, and contact lenses.</text>
</clause><clause id="IDc68e59a2c0754e5bb29551ceba5ec3ea"><enum>(xi)</enum><text>Hearing
services, including hearing aids.</text>
</clause><clause id="ID6884c5fab99a443c9b4198637ccd6c7f"><enum>(xii)</enum><text>Dental
services, including routine check ups.</text>
</clause><clause id="ID1edcbf1e73984f03a1d8537b774388ff"><enum>(xiii)</enum><text>Durable
medical equipment, including home dialysis supplies and equipment.</text>
</clause><clause id="IDf7ea48ea7d8647c998f51439c7dec52c"><enum>(xiv)</enum><text>Emergency
ambulance services.</text>
</clause><clause id="ID0600f1104e2647c986639f8c24104773"><enum>(xv)</enum><text>Prosthetics.</text>
</clause><clause id="ID58f4449e983d40129022c114eb967ea8"><enum>(xvi)</enum><text>Outpatient
therapy, including physical therapy, occupational therapy, and speech language
pathology services and related services.</text>
</clause></subparagraph></paragraph><paragraph id="ID8aca8d7f185b44b1bc64075225e75dba"><enum>(2)</enum><header>Assurance that
benefits are not reduced for individuals covered under Federal
programs</header><text>Insofar as the State under the plan incorporates funding
provided by Federal programs described in section 2203(f), the State plan may
not provide for a reduction in benefits (including coverage, access,
availability, duration, and beneficiary rights, and, if applicable, vaccine
benefits under section 1928) otherwise provided for under such programs or an
increase in cost-sharing and premiums otherwise provided for under such
programs.</text>
</paragraph></subsection><subsection id="IDd7d0cba584eb497893f5b48f517b9d5b"><enum>(c)</enum><header>Quality
assurance</header>
<paragraph id="IDe9d35a423bdf43918f1a1dfc3bfac14c"><enum>(1)</enum><header>In
general</header><text>A State plan shall provide, and describe, mechanisms to
be used to assure, monitor, and maintain the quality of items and services
furnished under the plan.</text>
</paragraph><paragraph id="ID42cccf6c14654a7b90ffaab2819a6e7a"><enum>(2)</enum><header>Health
outcomes</header><text>A State plan shall describe the plan's projected effect
on health outcomes in the State, including estimates of health benefits,
decreased morbidity and mortality, and improved productivity resulting from
reduction in the number of individuals without health benefits.</text>
</paragraph></subsection><subsection id="H5A59572EB9C047288C702B455C662D6E"><enum>(d)</enum><header>Programs for
medical education</header><text>A State plan shall describe health professions
training and graduate medical education activities applicable under the plan,
and shall provide, under the State plan, for payment from Federal, State, and
local governments for such training and education activities in the amounts
that would otherwise be payable by such governments but for the State’s
universal, comprehensive health care system under the State plan.</text>
</subsection><subsection id="ID9cdaec139d28485da47c448afa5d61a7"><enum>(e)</enum><header>Financing</header>
<paragraph id="ID0ccc9f8fdf9741779d068f62340fe10c"><enum>(1)</enum><header>Budget</header><text>A
State plan shall incorporate a budget which contains—</text>
<subparagraph id="IDe90531f4b1f84708b5c6daed8b640408"><enum>(A)</enum><text>detailed
projections of health care expenditures prior to and under the proposed system,
including an identification and calculation of the amount of funding to be
provided by Federal, State, and local governments under the plan and an
assurance that the amount of expenditures made by the State and local
governments will not be reduced as a result of the implementation of the plan;
and</text>
</subparagraph><subparagraph id="IDce52345295214258b2edc23da35fa1c2"><enum>(B)</enum><text>a description
(and an estimate of the costs) of transitional activities to be undertaken in
implementing the proposed system.</text>
</subparagraph></paragraph><paragraph id="ID3c54b1c4f70b4f548fd4e0f19119d646"><enum>(2)</enum><header>Cost
containment</header><text>A State plan shall describe the means to be used to
contain costs under the plan, including when and how the plan will increase
efficiencies.</text>
</paragraph><paragraph id="H0926A999AEEB4812A503A6195644C5AA"><enum>(3)</enum><header>Federal
expenditure limit</header><text>A State plan shall contain assurances that
aggregate Federal expenditures on health care (including Federal expenditures
under titles 5, 10, and 38 of the United States Code, and under this Act) under
the plan will not exceed aggregate Federal expenditures that would have been
incurred in the absence of such plan.</text>
</paragraph></subsection><subsection id="ID0bd5b918f95e43a4b85c768d810b1c0b"><enum>(f)</enum><header>Implementation</header>
<paragraph id="IDe48133561bfd48a4ae5ab786d49bcb50"><enum>(1)</enum><header>In
general</header><text>A State plan shall describe the method (including a
timetable and period of transition) for implementing the plan.</text>
</paragraph><paragraph id="ID6562a7b96bf04b998c573aa55fbcef6d"><enum>(2)</enum><header>Coordination</header><text>A
State plan shall identify all Federal, State, and local programs that provide
health care services in the State and describe how such programs would be
incorporated in, or coordinated with, the health coverage system under the
plan.</text>
</paragraph><paragraph id="ID70811b47e9b5496b94fd6a4de0016e98"><enum>(3)</enum><header>Federal waivers
required</header><text>A State plan shall identify any waivers of Federal law
required to implement the plan, including the use of any pooled Federal funds
and other waivers described in section 2203(f).</text>
</paragraph><paragraph id="ID7f8c8cab322d4037a03a2bfd7a4749d9"><enum>(4)</enum><header>Approval of
State legislature</header><text>A State plan shall provide that State approvals
and commitments (including approval of the State legislature) necessary for the
implementation of the plan will be obtained by not later than 1 year after the
date of the Secretary's approval of the plan. Any approval of a grant is
conditioned upon the timely completion of such approvals and
commitments.</text>
</paragraph></subsection><subsection id="IDf76b27b59fbb40349337f993578f5b0b"><enum>(g)</enum><header>Evaluation</header><text>A
State plan shall provide for a process for its evaluation, and shall comply
with any evaluation, reporting, or data collection requirements imposed by the
Secretary.</text>
</subsection><subsection id="ID7f02f0eebb9c41f48c562047e34a91d9"><enum>(h)</enum><header>Construction</header><text>Nothing
in this title shall be construed as preempting State laws that provide greater
protections or benefits than the protections or benefits required under this
title.</text>
</subsection></section><section id="ID5d89228cc26749e3b8ae299f12d0c7de"><enum>2205.</enum><header>Interstate
arrangements</header>
<subsection id="ID0eaed5f050e1492992b597d92fd15113"><enum>(a)</enum><header>In
general</header><text>One or more contiguous States in a geographic region may
file a joint application for planning and demonstration grants under this
title.</text>
</subsection><subsection id="IDcfeed531dc2343d1814cf3f5e690f63b"><enum>(b)</enum><header>Congressional
approval</header><text>Congress hereby authorizes and approves States entering
into Interstate Compacts in order to conduct joint health care programs under
such a grant.</text>
</subsection><subsection id="IDe1ec3eb1d25f45a7bb8869e209b90e6e"><enum>(c)</enum><header>References to
State</header><text>In the case of a joint application described in subsection
(a), any reference in this title to a State is deemed to refer to all of the
States that have filed the application, and the approval of a grant with
respect to such a joint application shall be counted as 1 State for purposes of
applying sections 2202(c) and 2203(b).</text>
</subsection></section><section id="IDa1f0106c7d744fc694c4094eb95a33bf"><enum>2206.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph id="HB9254FE8D93145D79E2D333E52E46030"><enum>(1)</enum><header>Eligible State
resident</header><text>The term <term>eligible State resident</term> means any
resident of the United States who is a citizen or national of the United
States, or lawful resident alien, and who resides in any particular State. Such
term may include, at the option of a State, the following:</text>
<subparagraph id="H1FDCBFDDED124FFC94E02165EEB2FFF"><enum>(A)</enum><text>State employees and
dependents of such employees.</text>
</subparagraph><subparagraph id="H0CC48242435F49DEA8A359B6ABAE5716"><enum>(B)</enum><text>Employees, and
dependents of such employees, working in a work site of a business located in
the State.</text>
</subparagraph><subparagraph id="HBD15D02A41E447AFB69374CC8089349F"><enum>(C)</enum><text>One or more
classes of nonimmigrants (as defined in section 101(a)(15) of the
<act-name parsable-cite="INA">Immigration and Nationality Act</act-name>)
specified in the State plan.</text>
</subparagraph></paragraph><paragraph id="H39458FD50E264DBE94AD07C3DF9E6CA"><enum>(2)</enum><header>Lawful resident
alien</header><text>The term <term>lawful resident alien</term> means an alien
lawfully admitted for permanent residence and any other alien lawfully residing
permanently in the United States under color of law, including an alien granted
asylum or with lawful temporary resident status under section 210, 210A, or
245A of the <act-name parsable-cite="INA">Immigration and Nationality
Act</act-name>.</text>
</paragraph><paragraph id="HC2C9306F661549FA9DC3632474986FEA"><enum>(3)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID39240415f00a4588ae4bcd90c163ec8a"><enum>(4)</enum><header display-inline="yes-display-inline">Single payer system</header><text display-inline="yes-display-inline">The term <term>single payer system</term>
means an approach to health care financing with only 1 source of money for
paying health care providers. The payer may be either a governmental unit or
other entity (such as an insurance company). The elements of a single payer
system offer administrative simplicity for patients and providers, and savings
in overhead costs.</text>
</paragraph><paragraph id="H77CCB101FA984CE2AA6476DCFC5ED51C"><enum>(5)</enum><header>State</header><text>Subject
to section 2205(c), the term <term>State</term> means a State, the District of
Columbia, the Commonwealth of Puerto Rico, the United States Virgin Islands,
Guam, American Samoa, and the Commonwealth of the Northern Mariana
Islands.</text>
</paragraph><paragraph id="H885B83BAC6C9430BBAF6274E5637EA4C"><enum>(6)</enum><header>State
plan</header><text>The term <term>State plan</term> means a comprehensive
health care plan of a State participating in a State Comprehensive Health Care
and Cost Containment demonstration project under this title that meets the
requirements of section
2204.</text>
</paragraph></section>.